|
ROMIPLOSTIM 125 MCG SUBQ SOLR
|
Facility
IP
|
$4,588.06
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
189827
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,441.05 |
| Max. Negotiated Rate |
$4,266.90 |
| Rate for Payer: Aetna Commercial |
$3,964.09
|
| Rate for Payer: Cash Price |
$2,844.60
|
| 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: Lutheran Preferred All Commercial |
$4,129.26
|
| Rate for Payer: PHCS All Commercial |
$3,441.05
|
| Rate for Payer: PHP All Commercial |
$3,479.59
|
| 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: United Healthcare Commercial |
$3,615.39
|
|
|
ROMIPLOSTIM 125 MCG SUBQ SOLR (CAMERON)
|
Facility
IP
|
$4,588.06
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
14010189827
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,441.05 |
| Max. Negotiated Rate |
$4,266.90 |
| Rate for Payer: Aetna Commercial |
$3,964.09
|
| Rate for Payer: Cash Price |
$2,844.60
|
| 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: Lutheran Preferred All Commercial |
$4,129.26
|
| Rate for Payer: PHCS All Commercial |
$3,441.05
|
| Rate for Payer: PHP All Commercial |
$3,479.59
|
| 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: United Healthcare Commercial |
$3,615.39
|
|
|
ROMIPLOSTIM 125 MCG SUBQ SOLR (CAMERON)
|
Facility
OP
|
$4,588.06
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
14010189827
|
|
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
|
|
|
ROMIPLOSTIM 250 MCG SUBQ SOLR
|
Facility
IP
|
$9,176.13
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6,882.09 |
| Max. Negotiated Rate |
$8,533.80 |
| Rate for Payer: Aetna Commercial |
$7,928.17
|
| Rate for Payer: Cash Price |
$5,689.20
|
| Rate for Payer: Cigna All Commercial |
$7,919.00
|
| Rate for Payer: CORVEL All Commercial |
$8,533.80
|
| Rate for Payer: Coventry All Commercial |
$8,074.99
|
| Rate for Payer: Encore All Commercial |
$8,446.62
|
| Rate for Payer: Frontpath All Commercial |
$8,442.04
|
| Rate for Payer: Humana ChoiceCare |
$7,925.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,258.51
|
| Rate for Payer: PHCS All Commercial |
$6,882.09
|
| Rate for Payer: PHP All Commercial |
$6,959.17
|
| Rate for Payer: Sagamore Health Network All Products |
$7,083.97
|
| Rate for Payer: Signature Care EPO |
$7,616.18
|
| Rate for Payer: Signature Care PPO |
$8,074.99
|
| Rate for Payer: United Healthcare Commercial |
$7,230.79
|
|
|
ROMIPLOSTIM 250 MCG SUBQ SOLR
|
Facility
OP
|
$9,176.13
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
93566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.17 |
| Max. Negotiated Rate |
$8,533.80 |
| Rate for Payer: Aetna Commercial |
$7,744.65
|
| Rate for Payer: Aetna Medicare |
$3,028.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,028.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,269.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,736.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$100.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,482.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,330.93
|
| Rate for Payer: Cash Price |
$5,689.20
|
| Rate for Payer: Cash Price |
$5,689.20
|
| Rate for Payer: Centivo All Commercial |
$4,679.82
|
| Rate for Payer: Cigna All Commercial |
$7,919.00
|
| Rate for Payer: CORVEL All Commercial |
$8,533.80
|
| Rate for Payer: Coventry All Commercial |
$8,074.99
|
| Rate for Payer: Encore All Commercial |
$8,446.62
|
| Rate for Payer: Frontpath All Commercial |
$8,442.04
|
| Rate for Payer: Humana ChoiceCare |
$7,925.42
|
| Rate for Payer: Humana Medicare |
$4,679.82
|
| Rate for Payer: Lucent All Commercial |
$4,679.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,258.51
|
| Rate for Payer: Managed Health Services Medicaid |
$100.17
|
| Rate for Payer: MDWise Medicaid |
$100.17
|
| Rate for Payer: PHCS All Commercial |
$6,882.09
|
| Rate for Payer: PHP All Commercial |
$6,959.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,578.69
|
| Rate for Payer: Sagamore Health Network All Products |
$7,083.97
|
| Rate for Payer: Signature Care EPO |
$7,616.18
|
| Rate for Payer: Signature Care PPO |
$8,074.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,799.71
|
| Rate for Payer: United Healthcare Commercial |
$7,230.79
|
| Rate for Payer: United Healthcare Medicare |
$3,028.12
|
|
|
ROMIPLOSTIM 250 MCG SUBQ SOLR (CAMERON)
|
Facility
IP
|
$9,176.13
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
140109366
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6,882.09 |
| Max. Negotiated Rate |
$8,533.80 |
| Rate for Payer: Aetna Commercial |
$7,928.17
|
| Rate for Payer: Cash Price |
$5,689.20
|
| Rate for Payer: Cigna All Commercial |
$7,919.00
|
| Rate for Payer: CORVEL All Commercial |
$8,533.80
|
| Rate for Payer: Coventry All Commercial |
$8,074.99
|
| Rate for Payer: Encore All Commercial |
$8,446.62
|
| Rate for Payer: Frontpath All Commercial |
$8,442.04
|
| Rate for Payer: Humana ChoiceCare |
$7,925.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,258.51
|
| Rate for Payer: PHCS All Commercial |
$6,882.09
|
| Rate for Payer: PHP All Commercial |
$6,959.17
|
| Rate for Payer: Sagamore Health Network All Products |
$7,083.97
|
| Rate for Payer: Signature Care EPO |
$7,616.18
|
| Rate for Payer: Signature Care PPO |
$8,074.99
|
| Rate for Payer: United Healthcare Commercial |
$7,230.79
|
|
|
ROMIPLOSTIM 250 MCG SUBQ SOLR (CAMERON)
|
Facility
OP
|
$9,176.13
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
140109366
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.17 |
| Max. Negotiated Rate |
$8,533.80 |
| Rate for Payer: Aetna Commercial |
$7,744.65
|
| Rate for Payer: Aetna Medicare |
$3,028.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,028.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,269.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,736.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$100.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,482.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,330.93
|
| Rate for Payer: Cash Price |
$5,689.20
|
| Rate for Payer: Cash Price |
$5,689.20
|
| Rate for Payer: Centivo All Commercial |
$4,679.82
|
| Rate for Payer: Cigna All Commercial |
$7,919.00
|
| Rate for Payer: CORVEL All Commercial |
$8,533.80
|
| Rate for Payer: Coventry All Commercial |
$8,074.99
|
| Rate for Payer: Encore All Commercial |
$8,446.62
|
| Rate for Payer: Frontpath All Commercial |
$8,442.04
|
| Rate for Payer: Humana ChoiceCare |
$7,925.42
|
| Rate for Payer: Humana Medicare |
$4,679.82
|
| Rate for Payer: Lucent All Commercial |
$4,679.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,258.51
|
| Rate for Payer: Managed Health Services Medicaid |
$100.17
|
| Rate for Payer: MDWise Medicaid |
$100.17
|
| Rate for Payer: PHCS All Commercial |
$6,882.09
|
| Rate for Payer: PHP All Commercial |
$6,959.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,578.69
|
| Rate for Payer: Sagamore Health Network All Products |
$7,083.97
|
| Rate for Payer: Signature Care EPO |
$7,616.18
|
| Rate for Payer: Signature Care PPO |
$8,074.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,799.71
|
| Rate for Payer: United Healthcare Commercial |
$7,230.79
|
| Rate for Payer: United Healthcare Medicare |
$3,028.12
|
|
|
ROMIPLOSTIM 500 MCG SUBQ SOLR
|
Facility
IP
|
$18,352.25
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
93567
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13,764.19 |
| Max. Negotiated Rate |
$17,067.59 |
| Rate for Payer: Aetna Commercial |
$15,856.34
|
| Rate for Payer: Cash Price |
$11,378.40
|
| Rate for Payer: Cigna All Commercial |
$15,837.99
|
| Rate for Payer: CORVEL All Commercial |
$17,067.59
|
| Rate for Payer: Coventry All Commercial |
$16,149.98
|
| Rate for Payer: Encore All Commercial |
$16,893.25
|
| Rate for Payer: Frontpath All Commercial |
$16,884.07
|
| Rate for Payer: Humana ChoiceCare |
$15,850.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16,517.02
|
| Rate for Payer: PHCS All Commercial |
$13,764.19
|
| Rate for Payer: PHP All Commercial |
$13,918.35
|
| Rate for Payer: Sagamore Health Network All Products |
$14,167.94
|
| Rate for Payer: Signature Care EPO |
$15,232.37
|
| Rate for Payer: Signature Care PPO |
$16,149.98
|
| Rate for Payer: United Healthcare Commercial |
$14,461.57
|
|
|
ROMIPLOSTIM 500 MCG SUBQ SOLR
|
Facility
OP
|
$18,352.25
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
93567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.17 |
| Max. Negotiated Rate |
$17,067.59 |
| Rate for Payer: Aetna Commercial |
$15,489.30
|
| Rate for Payer: Aetna Medicare |
$6,056.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6,056.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10,539.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11,471.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$100.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,964.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6,661.87
|
| Rate for Payer: Cash Price |
$11,378.40
|
| Rate for Payer: Cash Price |
$11,378.40
|
| Rate for Payer: Centivo All Commercial |
$9,359.65
|
| Rate for Payer: Cigna All Commercial |
$15,837.99
|
| Rate for Payer: CORVEL All Commercial |
$17,067.59
|
| Rate for Payer: Coventry All Commercial |
$16,149.98
|
| Rate for Payer: Encore All Commercial |
$16,893.25
|
| Rate for Payer: Frontpath All Commercial |
$16,884.07
|
| Rate for Payer: Humana ChoiceCare |
$15,850.84
|
| Rate for Payer: Humana Medicare |
$9,359.65
|
| Rate for Payer: Lucent All Commercial |
$9,359.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16,517.02
|
| Rate for Payer: Managed Health Services Medicaid |
$100.17
|
| Rate for Payer: MDWise Medicaid |
$100.17
|
| Rate for Payer: PHCS All Commercial |
$13,764.19
|
| Rate for Payer: PHP All Commercial |
$13,918.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7,157.38
|
| Rate for Payer: Sagamore Health Network All Products |
$14,167.94
|
| Rate for Payer: Signature Care EPO |
$15,232.37
|
| Rate for Payer: Signature Care PPO |
$16,149.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,599.41
|
| Rate for Payer: United Healthcare Commercial |
$14,461.57
|
| Rate for Payer: United Healthcare Medicare |
$6,056.24
|
|
|
ROMIPLOSTIM 500 MCG SUBQ SOLR (CAMERON)
|
Facility
OP
|
$18,352.25
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
14093567
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$17,067.59 |
| Rate for Payer: Aetna Commercial |
$15,489.30
|
| Rate for Payer: Aetna Medicare |
$6,056.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6,056.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10,539.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11,471.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,964.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6,661.87
|
| Rate for Payer: Cash Price |
$11,378.40
|
| Rate for Payer: Cash Price |
$11,378.40
|
| Rate for Payer: Centivo All Commercial |
$9,359.65
|
| Rate for Payer: Cigna All Commercial |
$15,837.99
|
| Rate for Payer: CORVEL All Commercial |
$17,067.59
|
| Rate for Payer: Coventry All Commercial |
$16,149.98
|
| Rate for Payer: Encore All Commercial |
$16,893.25
|
| Rate for Payer: Frontpath All Commercial |
$16,884.07
|
| Rate for Payer: Humana ChoiceCare |
$15,850.84
|
| Rate for Payer: Humana Medicare |
$9,359.65
|
| Rate for Payer: Lucent All Commercial |
$9,359.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16,517.02
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$13,764.19
|
| Rate for Payer: PHP All Commercial |
$13,918.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7,157.38
|
| Rate for Payer: Sagamore Health Network All Products |
$14,167.94
|
| Rate for Payer: Signature Care EPO |
$15,232.37
|
| Rate for Payer: Signature Care PPO |
$16,149.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,599.41
|
| Rate for Payer: United Healthcare Commercial |
$14,461.57
|
| Rate for Payer: United Healthcare Medicare |
$6,056.24
|
|
|
ROMIPLOSTIM 500 MCG SUBQ SOLR (CAMERON)
|
Facility
IP
|
$18,352.25
|
|
|
Service Code
|
HCPCS J2796
|
| Hospital Charge Code |
14093567
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13,764.19 |
| Max. Negotiated Rate |
$17,067.59 |
| Rate for Payer: Aetna Commercial |
$15,856.34
|
| Rate for Payer: Cash Price |
$11,378.40
|
| Rate for Payer: Cigna All Commercial |
$15,837.99
|
| Rate for Payer: CORVEL All Commercial |
$17,067.59
|
| Rate for Payer: Coventry All Commercial |
$16,149.98
|
| Rate for Payer: Encore All Commercial |
$16,893.25
|
| Rate for Payer: Frontpath All Commercial |
$16,884.07
|
| Rate for Payer: Humana ChoiceCare |
$15,850.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16,517.02
|
| Rate for Payer: PHCS All Commercial |
$13,764.19
|
| Rate for Payer: PHP All Commercial |
$13,918.35
|
| Rate for Payer: Sagamore Health Network All Products |
$14,167.94
|
| Rate for Payer: Signature Care EPO |
$15,232.37
|
| Rate for Payer: Signature Care PPO |
$16,149.98
|
| Rate for Payer: United Healthcare Commercial |
$14,461.57
|
|
|
ROMOSOZUMAB-AQQG 210MG/2.34ML ( 105MG/1.17MLX2) SUBQ SYRG
|
Facility
OP
|
$4,381.54
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
187929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.59 |
| Max. Negotiated Rate |
$4,074.84 |
| Rate for Payer: Aetna Commercial |
$3,698.02
|
| Rate for Payer: Aetna Medicare |
$1,445.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,445.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,516.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,738.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$11.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,662.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,590.50
|
| Rate for Payer: Cash Price |
$2,716.56
|
| Rate for Payer: Cash Price |
$2,716.56
|
| Rate for Payer: Centivo All Commercial |
$2,234.59
|
| Rate for Payer: Cigna All Commercial |
$3,781.27
|
| Rate for Payer: CORVEL All Commercial |
$4,074.84
|
| Rate for Payer: Coventry All Commercial |
$3,855.76
|
| Rate for Payer: Encore All Commercial |
$4,033.21
|
| Rate for Payer: Frontpath All Commercial |
$4,031.02
|
| Rate for Payer: Humana ChoiceCare |
$3,784.34
|
| Rate for Payer: Humana Medicare |
$2,234.59
|
| Rate for Payer: Lucent All Commercial |
$2,234.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,943.39
|
| Rate for Payer: Managed Health Services Medicaid |
$11.59
|
| Rate for Payer: MDWise Medicaid |
$11.59
|
| Rate for Payer: PHCS All Commercial |
$3,286.16
|
| Rate for Payer: PHP All Commercial |
$3,322.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,708.80
|
| Rate for Payer: Sagamore Health Network All Products |
$3,382.55
|
| Rate for Payer: Signature Care EPO |
$3,636.68
|
| Rate for Payer: Signature Care PPO |
$3,855.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,724.31
|
| Rate for Payer: United Healthcare Commercial |
$3,452.66
|
| Rate for Payer: United Healthcare Medicare |
$1,445.91
|
|
|
ROMOSOZUMAB-AQQG 210MG/2.34ML ( 105MG/1.17MLX2) SUBQ SYRG
|
Facility
IP
|
$4,381.54
|
|
|
Service Code
|
HCPCS J3111
|
| Hospital Charge Code |
187929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,286.16 |
| Max. Negotiated Rate |
$4,074.84 |
| Rate for Payer: Aetna Commercial |
$3,785.65
|
| Rate for Payer: Cash Price |
$2,716.56
|
| Rate for Payer: Cigna All Commercial |
$3,781.27
|
| Rate for Payer: CORVEL All Commercial |
$4,074.84
|
| Rate for Payer: Coventry All Commercial |
$3,855.76
|
| Rate for Payer: Encore All Commercial |
$4,033.21
|
| Rate for Payer: Frontpath All Commercial |
$4,031.02
|
| Rate for Payer: Humana ChoiceCare |
$3,784.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,943.39
|
| Rate for Payer: PHCS All Commercial |
$3,286.16
|
| Rate for Payer: PHP All Commercial |
$3,322.96
|
| Rate for Payer: Sagamore Health Network All Products |
$3,382.55
|
| Rate for Payer: Signature Care EPO |
$3,636.68
|
| Rate for Payer: Signature Care PPO |
$3,855.76
|
| Rate for Payer: United Healthcare Commercial |
$3,452.66
|
|
|
ROPINIROLE 0.25 MG ORAL TAB
|
Facility
OP
|
$2.05
|
|
|
Service Code
|
NDC 00904637361
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.73
|
| Rate for Payer: Aetna Medicare |
$0.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.74
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Centivo All Commercial |
$1.05
|
| Rate for Payer: Cigna All Commercial |
$1.77
|
| Rate for Payer: CORVEL All Commercial |
$1.91
|
| Rate for Payer: Coventry All Commercial |
$1.80
|
| Rate for Payer: Encore All Commercial |
$1.89
|
| Rate for Payer: Frontpath All Commercial |
$1.89
|
| Rate for Payer: Humana ChoiceCare |
$1.77
|
| Rate for Payer: Humana Medicare |
$1.05
|
| Rate for Payer: Lucent All Commercial |
$1.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.85
|
| Rate for Payer: PHCS All Commercial |
$1.54
|
| Rate for Payer: PHP All Commercial |
$1.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1.58
|
| Rate for Payer: Signature Care EPO |
$1.70
|
| Rate for Payer: Signature Care PPO |
$1.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.74
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
| Rate for Payer: United Healthcare Medicare |
$0.68
|
|
|
ROPINIROLE 0.25 MG ORAL TAB
|
Facility
IP
|
$2.05
|
|
|
Service Code
|
NDC 00904637361
|
| Hospital Charge Code |
21688
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.77
|
| Rate for Payer: Cash Price |
$1.27
|
| Rate for Payer: Cigna All Commercial |
$1.77
|
| Rate for Payer: CORVEL All Commercial |
$1.91
|
| Rate for Payer: Coventry All Commercial |
$1.80
|
| Rate for Payer: Encore All Commercial |
$1.89
|
| Rate for Payer: Frontpath All Commercial |
$1.89
|
| Rate for Payer: Humana ChoiceCare |
$1.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.85
|
| Rate for Payer: PHCS All Commercial |
$1.54
|
| Rate for Payer: PHP All Commercial |
$1.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1.58
|
| Rate for Payer: Signature Care EPO |
$1.70
|
| Rate for Payer: Signature Care PPO |
$1.80
|
| Rate for Payer: United Healthcare Commercial |
$1.62
|
|
|
ROPINIROLE 1 MG ORAL TAB
|
Facility
IP
|
$2.21
|
|
|
Service Code
|
NDC 00904637461
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Aetna Commercial |
$1.91
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Cigna All Commercial |
$1.91
|
| Rate for Payer: CORVEL All Commercial |
$2.06
|
| Rate for Payer: Coventry All Commercial |
$1.95
|
| Rate for Payer: Encore All Commercial |
$2.04
|
| Rate for Payer: Frontpath All Commercial |
$2.04
|
| Rate for Payer: Humana ChoiceCare |
$1.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.99
|
| Rate for Payer: PHCS All Commercial |
$1.66
|
| Rate for Payer: PHP All Commercial |
$1.68
|
| Rate for Payer: Sagamore Health Network All Products |
$1.71
|
| Rate for Payer: Signature Care EPO |
$1.84
|
| Rate for Payer: Signature Care PPO |
$1.95
|
| Rate for Payer: United Healthcare Commercial |
$1.74
|
|
|
ROPINIROLE 1 MG ORAL TAB
|
Facility
OP
|
$2.21
|
|
|
Service Code
|
NDC 00904637461
|
| Hospital Charge Code |
21689
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.73 |
| Max. Negotiated Rate |
$2.06 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| 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 |
$1.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.80
|
| Rate for Payer: Cash Price |
$1.37
|
| Rate for Payer: Centivo All Commercial |
$1.13
|
| Rate for Payer: Cigna All Commercial |
$1.91
|
| Rate for Payer: CORVEL All Commercial |
$2.06
|
| Rate for Payer: Coventry All Commercial |
$1.95
|
| Rate for Payer: Encore All Commercial |
$2.04
|
| Rate for Payer: Frontpath All Commercial |
$2.04
|
| Rate for Payer: Humana ChoiceCare |
$1.91
|
| Rate for Payer: Humana Medicare |
$1.13
|
| Rate for Payer: Lucent All Commercial |
$1.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.99
|
| Rate for Payer: PHCS All Commercial |
$1.66
|
| Rate for Payer: PHP All Commercial |
$1.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.86
|
| Rate for Payer: Sagamore Health Network All Products |
$1.71
|
| Rate for Payer: Signature Care EPO |
$1.84
|
| Rate for Payer: Signature Care PPO |
$1.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.88
|
| Rate for Payer: United Healthcare Commercial |
$1.74
|
| Rate for Payer: United Healthcare Medicare |
$0.73
|
|
|
ROPIVACAINE-EPI-CLONID-KETOROL 2.46-0.005- 0.0008-0.3MG/ML PATC SYRG
|
Facility
IP
|
$324.90
|
|
|
Service Code
|
NDC 70092143350
|
| Hospital Charge Code |
183693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$243.68 |
| Max. Negotiated Rate |
$302.16 |
| Rate for Payer: Aetna Commercial |
$280.71
|
| Rate for Payer: Cash Price |
$201.44
|
| Rate for Payer: Cigna All Commercial |
$280.39
|
| Rate for Payer: CORVEL All Commercial |
$302.16
|
| Rate for Payer: Coventry All Commercial |
$285.91
|
| Rate for Payer: Encore All Commercial |
$299.07
|
| Rate for Payer: Frontpath All Commercial |
$298.91
|
| Rate for Payer: Humana ChoiceCare |
$280.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$292.41
|
| Rate for Payer: PHCS All Commercial |
$243.68
|
| Rate for Payer: PHP All Commercial |
$246.40
|
| Rate for Payer: Sagamore Health Network All Products |
$250.82
|
| Rate for Payer: Signature Care EPO |
$269.67
|
| Rate for Payer: Signature Care PPO |
$285.91
|
| Rate for Payer: United Healthcare Commercial |
$256.02
|
|
|
ROPIVACAINE-EPI-CLONID-KETOROL 2.46-0.005- 0.0008-0.3MG/ML PATC SYRG
|
Facility
OP
|
$324.90
|
|
|
Service Code
|
NDC 70092143350
|
| Hospital Charge Code |
183693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$302.16 |
| Rate for Payer: Aetna Commercial |
$274.22
|
| Rate for Payer: Aetna Medicare |
$107.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$186.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$203.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$123.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$117.94
|
| Rate for Payer: Cash Price |
$201.44
|
| Rate for Payer: Cash Price |
$201.44
|
| Rate for Payer: Centivo All Commercial |
$165.70
|
| Rate for Payer: Cigna All Commercial |
$280.39
|
| Rate for Payer: CORVEL All Commercial |
$302.16
|
| Rate for Payer: Coventry All Commercial |
$285.91
|
| Rate for Payer: Encore All Commercial |
$299.07
|
| Rate for Payer: Frontpath All Commercial |
$298.91
|
| Rate for Payer: Humana ChoiceCare |
$280.62
|
| Rate for Payer: Humana Medicare |
$165.70
|
| Rate for Payer: Lucent All Commercial |
$165.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$292.41
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$243.68
|
| Rate for Payer: PHP All Commercial |
$246.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$126.71
|
| Rate for Payer: Sagamore Health Network All Products |
$250.82
|
| Rate for Payer: Signature Care EPO |
$269.67
|
| Rate for Payer: Signature Care PPO |
$285.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$276.16
|
| Rate for Payer: United Healthcare Commercial |
$256.02
|
| Rate for Payer: United Healthcare Medicare |
$107.22
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN
|
Facility
IP
|
$28.35
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
152796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$26.37 |
| Rate for Payer: Aetna Commercial |
$24.49
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Cigna All Commercial |
$24.47
|
| Rate for Payer: CORVEL All Commercial |
$26.37
|
| Rate for Payer: Coventry All Commercial |
$24.95
|
| Rate for Payer: Encore All Commercial |
$26.10
|
| Rate for Payer: Frontpath All Commercial |
$26.08
|
| Rate for Payer: Humana ChoiceCare |
$24.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.52
|
| Rate for Payer: PHCS All Commercial |
$21.26
|
| Rate for Payer: PHP All Commercial |
$21.50
|
| Rate for Payer: Sagamore Health Network All Products |
$21.89
|
| Rate for Payer: Signature Care EPO |
$23.53
|
| Rate for Payer: Signature Care PPO |
$24.95
|
| Rate for Payer: United Healthcare Commercial |
$22.34
|
|
|
ROPIVACAINE (PF) 5 MG/ML (0.5 %) INJ SOLN
|
Facility
OP
|
$28.35
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
152796
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$26.37 |
| Rate for Payer: Aetna Commercial |
$23.93
|
| Rate for Payer: Aetna Medicare |
$9.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$0.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.29
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Cash Price |
$17.58
|
| Rate for Payer: Centivo All Commercial |
$14.46
|
| Rate for Payer: Cigna All Commercial |
$24.47
|
| Rate for Payer: CORVEL All Commercial |
$26.37
|
| Rate for Payer: Coventry All Commercial |
$24.95
|
| Rate for Payer: Encore All Commercial |
$26.10
|
| Rate for Payer: Frontpath All Commercial |
$26.08
|
| Rate for Payer: Humana ChoiceCare |
$24.49
|
| Rate for Payer: Humana Medicare |
$14.46
|
| Rate for Payer: Lucent All Commercial |
$14.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.52
|
| Rate for Payer: Managed Health Services Medicaid |
$0.04
|
| Rate for Payer: MDWise Medicaid |
$0.04
|
| Rate for Payer: PHCS All Commercial |
$21.26
|
| Rate for Payer: PHP All Commercial |
$21.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.06
|
| Rate for Payer: Sagamore Health Network All Products |
$21.89
|
| Rate for Payer: Signature Care EPO |
$23.53
|
| Rate for Payer: Signature Care PPO |
$24.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.10
|
| Rate for Payer: United Healthcare Commercial |
$22.34
|
| Rate for Payer: United Healthcare Medicare |
$9.36
|
|
|
ROSUVASTATIN 10 MG ORAL TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 13668018030
|
| Hospital Charge Code |
35134
|
|
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
|
|
|
ROSUVASTATIN 10 MG ORAL TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 13668018030
|
| Hospital Charge Code |
35134
|
|
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
|
|
|
ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN
|
Facility
IP
|
$486.74
|
|
|
Service Code
|
HCPCS 90680
|
| Hospital Charge Code |
70476
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$365.06 |
| Max. Negotiated Rate |
$452.67 |
| Rate for Payer: Aetna Commercial |
$420.55
|
| Rate for Payer: Cash Price |
$301.78
|
| Rate for Payer: Cigna All Commercial |
$420.06
|
| Rate for Payer: CORVEL All Commercial |
$452.67
|
| Rate for Payer: Coventry All Commercial |
$428.33
|
| Rate for Payer: Encore All Commercial |
$448.05
|
| Rate for Payer: Frontpath All Commercial |
$447.80
|
| Rate for Payer: Humana ChoiceCare |
$420.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$438.07
|
| Rate for Payer: PHCS All Commercial |
$365.06
|
| Rate for Payer: PHP All Commercial |
$369.15
|
| Rate for Payer: Sagamore Health Network All Products |
$375.77
|
| Rate for Payer: Signature Care EPO |
$404.00
|
| Rate for Payer: Signature Care PPO |
$428.33
|
| Rate for Payer: United Healthcare Commercial |
$383.55
|
|
|
ROTAVIRUS VACCINE LIVE, PENTA 2 ML ORAL SOLN
|
Facility
OP
|
$486.74
|
|
|
Service Code
|
HCPCS 90680
|
| Hospital Charge Code |
70476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.97 |
| Max. Negotiated Rate |
$452.67 |
| Rate for Payer: Aetna Commercial |
$410.81
|
| Rate for Payer: Aetna Medicare |
$160.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$160.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$279.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$304.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$99.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$184.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$176.69
|
| Rate for Payer: Cash Price |
$301.78
|
| Rate for Payer: Cash Price |
$301.78
|
| Rate for Payer: Centivo All Commercial |
$248.24
|
| Rate for Payer: Cigna All Commercial |
$420.06
|
| Rate for Payer: CORVEL All Commercial |
$452.67
|
| Rate for Payer: Coventry All Commercial |
$428.33
|
| Rate for Payer: Encore All Commercial |
$448.05
|
| Rate for Payer: Frontpath All Commercial |
$447.80
|
| Rate for Payer: Humana ChoiceCare |
$420.40
|
| Rate for Payer: Humana Medicare |
$248.24
|
| Rate for Payer: Lucent All Commercial |
$248.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$438.07
|
| Rate for Payer: Managed Health Services Medicaid |
$99.97
|
| Rate for Payer: MDWise Medicaid |
$99.97
|
| Rate for Payer: PHCS All Commercial |
$365.06
|
| Rate for Payer: PHP All Commercial |
$369.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$189.83
|
| Rate for Payer: Sagamore Health Network All Products |
$375.77
|
| Rate for Payer: Signature Care EPO |
$404.00
|
| Rate for Payer: Signature Care PPO |
$428.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$413.73
|
| Rate for Payer: United Healthcare Commercial |
$383.55
|
| Rate for Payer: United Healthcare Medicare |
$160.63
|
|
