|
BUTORPHANOL 1 MG/ML INJ SOLN
|
Facility
|
IP
|
$45.35
|
|
|
Service Code
|
HCPCS J0595
|
| Hospital Charge Code |
9333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.01 |
| Max. Negotiated Rate |
$42.17 |
| Rate for Payer: Aetna Commercial |
$39.18
|
| Rate for Payer: Cash Price |
$27.21
|
| Rate for Payer: Cigna All Commercial |
$39.13
|
| Rate for Payer: CORVEL All Commercial |
$42.17
|
| Rate for Payer: Coventry All Commercial |
$39.90
|
| Rate for Payer: Encore All Commercial |
$41.74
|
| Rate for Payer: Frontpath All Commercial |
$41.72
|
| Rate for Payer: Humana ChoiceCare |
$39.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.81
|
| Rate for Payer: PHCS All Commercial |
$34.01
|
| Rate for Payer: PHP All Commercial |
$34.39
|
| Rate for Payer: Sagamore Health Network All Products |
$35.01
|
| Rate for Payer: Signature Care EPO |
$37.64
|
| Rate for Payer: Signature Care PPO |
$39.90
|
| Rate for Payer: United Healthcare Commercial |
$35.73
|
|
|
CAFFEINE 200 MG ORAL TAB
|
Facility
|
OP
|
$0.64
|
|
|
Service Code
|
NDC 70000040901
|
| Hospital Charge Code |
1259
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Aetna Commercial |
$0.54
|
| Rate for Payer: Aetna Medicare |
$0.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.23
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Centivo All Commercial |
$0.35
|
| Rate for Payer: Cigna All Commercial |
$0.56
|
| Rate for Payer: CORVEL All Commercial |
$0.60
|
| Rate for Payer: Coventry All Commercial |
$0.57
|
| Rate for Payer: Encore All Commercial |
$0.59
|
| Rate for Payer: Frontpath All Commercial |
$0.59
|
| Rate for Payer: Humana ChoiceCare |
$0.56
|
| Rate for Payer: Humana Medicare |
$0.21
|
| Rate for Payer: Lucent All Commercial |
$0.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.58
|
| Rate for Payer: PHCS All Commercial |
$0.48
|
| Rate for Payer: PHP All Commercial |
$0.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.25
|
| Rate for Payer: Sagamore Health Network All Products |
$0.50
|
| Rate for Payer: Signature Care EPO |
$0.53
|
| Rate for Payer: Signature Care PPO |
$0.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.55
|
| Rate for Payer: United Healthcare Commercial |
$0.51
|
| Rate for Payer: United Healthcare Medicare |
$0.21
|
|
|
CAFFEINE 200 MG ORAL TAB
|
Facility
|
IP
|
$0.64
|
|
|
Service Code
|
NDC 70000040901
|
| Hospital Charge Code |
1259
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.48 |
| Max. Negotiated Rate |
$0.60 |
| Rate for Payer: Aetna Commercial |
$0.56
|
| Rate for Payer: Cash Price |
$0.39
|
| Rate for Payer: Cigna All Commercial |
$0.56
|
| Rate for Payer: CORVEL All Commercial |
$0.60
|
| Rate for Payer: Coventry All Commercial |
$0.57
|
| Rate for Payer: Encore All Commercial |
$0.59
|
| Rate for Payer: Frontpath All Commercial |
$0.59
|
| Rate for Payer: Humana ChoiceCare |
$0.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.58
|
| Rate for Payer: PHCS All Commercial |
$0.48
|
| Rate for Payer: PHP All Commercial |
$0.49
|
| Rate for Payer: Sagamore Health Network All Products |
$0.50
|
| Rate for Payer: Signature Care EPO |
$0.53
|
| Rate for Payer: Signature Care PPO |
$0.57
|
| Rate for Payer: United Healthcare Commercial |
$0.51
|
|
|
CALCITONIN (SALMON) 200 UNITS/ML INJ SOLN
|
Facility
|
IP
|
$3,750.00
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,812.50 |
| Max. Negotiated Rate |
$3,487.50 |
| Rate for Payer: Aetna Commercial |
$3,240.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna All Commercial |
$3,236.25
|
| Rate for Payer: CORVEL All Commercial |
$3,487.50
|
| Rate for Payer: Coventry All Commercial |
$3,300.00
|
| Rate for Payer: Encore All Commercial |
$3,451.88
|
| Rate for Payer: Frontpath All Commercial |
$3,450.00
|
| Rate for Payer: Humana ChoiceCare |
$3,238.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,375.00
|
| Rate for Payer: PHCS All Commercial |
$2,812.50
|
| Rate for Payer: PHP All Commercial |
$2,844.00
|
| Rate for Payer: Sagamore Health Network All Products |
$2,895.00
|
| Rate for Payer: Signature Care EPO |
$3,112.50
|
| Rate for Payer: Signature Care PPO |
$3,300.00
|
| Rate for Payer: United Healthcare Commercial |
$2,955.00
|
|
|
CALCITONIN (SALMON) 200 UNITS/ML INJ SOLN
|
Facility
|
OP
|
$3,750.00
|
|
|
Service Code
|
HCPCS J0630
|
| Hospital Charge Code |
9347
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$840.00 |
| Max. Negotiated Rate |
$3,487.50 |
| Rate for Payer: Aetna Commercial |
$3,165.00
|
| Rate for Payer: Aetna Medicare |
$1,200.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$840.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,162.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,153.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,344.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$840.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,380.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,320.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Centivo All Commercial |
$2,040.00
|
| Rate for Payer: Cigna All Commercial |
$3,236.25
|
| Rate for Payer: CORVEL All Commercial |
$3,487.50
|
| Rate for Payer: Coventry All Commercial |
$3,300.00
|
| Rate for Payer: Encore All Commercial |
$3,451.88
|
| Rate for Payer: Frontpath All Commercial |
$3,450.00
|
| Rate for Payer: Humana ChoiceCare |
$3,238.88
|
| Rate for Payer: Humana Medicare |
$1,200.00
|
| Rate for Payer: Lucent All Commercial |
$2,040.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,375.00
|
| Rate for Payer: Managed Health Services Medicaid |
$840.00
|
| Rate for Payer: MDWise Medicaid |
$840.00
|
| Rate for Payer: PHCS All Commercial |
$2,812.50
|
| Rate for Payer: PHP All Commercial |
$2,844.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,462.50
|
| Rate for Payer: Sagamore Health Network All Products |
$2,895.00
|
| Rate for Payer: Signature Care EPO |
$3,112.50
|
| Rate for Payer: Signature Care PPO |
$3,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,187.50
|
| Rate for Payer: United Healthcare Commercial |
$2,955.00
|
| Rate for Payer: United Healthcare Medicare |
$1,200.00
|
|
|
CALCITRIOL 0.25 MCG ORAL CAP
|
Facility
|
OP
|
$1.58
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna Commercial |
$1.34
|
| Rate for Payer: Aetna Medicare |
$0.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.56
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Centivo All Commercial |
$0.86
|
| Rate for Payer: Cigna All Commercial |
$1.37
|
| Rate for Payer: CORVEL All Commercial |
$1.47
|
| Rate for Payer: Coventry All Commercial |
$1.39
|
| Rate for Payer: Encore All Commercial |
$1.46
|
| Rate for Payer: Frontpath All Commercial |
$1.46
|
| Rate for Payer: Humana ChoiceCare |
$1.37
|
| Rate for Payer: Humana Medicare |
$0.51
|
| Rate for Payer: Lucent All Commercial |
$0.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.42
|
| Rate for Payer: PHCS All Commercial |
$1.19
|
| Rate for Payer: PHP All Commercial |
$1.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.62
|
| Rate for Payer: Sagamore Health Network All Products |
$1.22
|
| Rate for Payer: Signature Care EPO |
$1.31
|
| Rate for Payer: Signature Care PPO |
$1.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.34
|
| Rate for Payer: United Healthcare Commercial |
$1.25
|
| Rate for Payer: United Healthcare Medicare |
$0.51
|
|
|
CALCITRIOL 0.25 MCG ORAL CAP
|
Facility
|
IP
|
$1.58
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
9350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$1.47 |
| Rate for Payer: Aetna Commercial |
$1.37
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cigna All Commercial |
$1.37
|
| Rate for Payer: CORVEL All Commercial |
$1.47
|
| Rate for Payer: Coventry All Commercial |
$1.39
|
| Rate for Payer: Encore All Commercial |
$1.46
|
| Rate for Payer: Frontpath All Commercial |
$1.46
|
| Rate for Payer: Humana ChoiceCare |
$1.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.42
|
| Rate for Payer: PHCS All Commercial |
$1.19
|
| Rate for Payer: PHP All Commercial |
$1.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1.22
|
| Rate for Payer: Signature Care EPO |
$1.31
|
| Rate for Payer: Signature Care PPO |
$1.39
|
| Rate for Payer: United Healthcare Commercial |
$1.25
|
|
|
CALCIUM CARBONATE 500 MG ORAL CHEW
|
Facility
|
OP
|
$1.41
|
|
|
Service Code
|
NDC 48433010601
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Aetna Commercial |
$1.19
|
| Rate for Payer: Aetna Medicare |
$0.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.50
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Centivo All Commercial |
$0.77
|
| Rate for Payer: Cigna All Commercial |
$1.21
|
| Rate for Payer: CORVEL All Commercial |
$1.31
|
| Rate for Payer: Coventry All Commercial |
$1.24
|
| Rate for Payer: Encore All Commercial |
$1.30
|
| Rate for Payer: Frontpath All Commercial |
$1.29
|
| Rate for Payer: Humana ChoiceCare |
$1.22
|
| Rate for Payer: Humana Medicare |
$0.45
|
| Rate for Payer: Lucent All Commercial |
$0.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.27
|
| Rate for Payer: PHCS All Commercial |
$1.06
|
| Rate for Payer: PHP All Commercial |
$1.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1.09
|
| Rate for Payer: Signature Care EPO |
$1.17
|
| Rate for Payer: Signature Care PPO |
$1.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.11
|
| Rate for Payer: United Healthcare Medicare |
$0.45
|
|
|
CALCIUM CARBONATE 500 MG ORAL CHEW
|
Facility
|
IP
|
$1.41
|
|
|
Service Code
|
NDC 48433010601
|
| Hospital Charge Code |
9385
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.06 |
| Max. Negotiated Rate |
$1.31 |
| Rate for Payer: Aetna Commercial |
$1.22
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna All Commercial |
$1.21
|
| Rate for Payer: CORVEL All Commercial |
$1.31
|
| Rate for Payer: Coventry All Commercial |
$1.24
|
| Rate for Payer: Encore All Commercial |
$1.30
|
| Rate for Payer: Frontpath All Commercial |
$1.29
|
| Rate for Payer: Humana ChoiceCare |
$1.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.27
|
| Rate for Payer: PHCS All Commercial |
$1.06
|
| Rate for Payer: PHP All Commercial |
$1.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1.09
|
| Rate for Payer: Signature Care EPO |
$1.17
|
| Rate for Payer: Signature Care PPO |
$1.24
|
| Rate for Payer: United Healthcare Commercial |
$1.11
|
|
|
CALCIUM CARBONATE-VITAMIN D3 600 MG-5 MCG (200 UNIT) ORAL TAB
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 80681013800
|
| Hospital Charge Code |
9378
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna All Commercial |
$0.14
|
| Rate for Payer: CORVEL All Commercial |
$0.15
|
| Rate for Payer: Coventry All Commercial |
$0.14
|
| Rate for Payer: Encore All Commercial |
$0.15
|
| Rate for Payer: Frontpath All Commercial |
$0.15
|
| Rate for Payer: Humana ChoiceCare |
$0.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.14
|
| Rate for Payer: PHCS All Commercial |
$0.12
|
| Rate for Payer: PHP All Commercial |
$0.12
|
| Rate for Payer: Sagamore Health Network All Products |
$0.12
|
| Rate for Payer: Signature Care EPO |
$0.13
|
| Rate for Payer: Signature Care PPO |
$0.14
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
|
|
CALCIUM CARBONATE-VITAMIN D3 600 MG-5 MCG (200 UNIT) ORAL TAB
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 80681013800
|
| Hospital Charge Code |
9378
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Aetna Medicare |
$0.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.06
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Centivo All Commercial |
$0.09
|
| Rate for Payer: Cigna All Commercial |
$0.14
|
| Rate for Payer: CORVEL All Commercial |
$0.15
|
| Rate for Payer: Coventry All Commercial |
$0.14
|
| Rate for Payer: Encore All Commercial |
$0.15
|
| Rate for Payer: Frontpath All Commercial |
$0.15
|
| Rate for Payer: Humana ChoiceCare |
$0.14
|
| Rate for Payer: Humana Medicare |
$0.05
|
| Rate for Payer: Lucent All Commercial |
$0.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.14
|
| Rate for Payer: PHCS All Commercial |
$0.12
|
| Rate for Payer: PHP All Commercial |
$0.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.06
|
| Rate for Payer: Sagamore Health Network All Products |
$0.12
|
| Rate for Payer: Signature Care EPO |
$0.13
|
| Rate for Payer: Signature Care PPO |
$0.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.14
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG
|
Facility
|
OP
|
$62.86
|
|
|
Service Code
|
HCPCS J0618
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$58.46 |
| Rate for Payer: Aetna Commercial |
$53.05
|
| Rate for Payer: Aetna Medicare |
$20.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.13
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Centivo All Commercial |
$34.20
|
| Rate for Payer: Cigna All Commercial |
$54.25
|
| Rate for Payer: CORVEL All Commercial |
$58.46
|
| Rate for Payer: Coventry All Commercial |
$55.32
|
| Rate for Payer: Encore All Commercial |
$57.86
|
| Rate for Payer: Frontpath All Commercial |
$57.83
|
| Rate for Payer: Humana ChoiceCare |
$54.29
|
| Rate for Payer: Humana Medicare |
$20.12
|
| Rate for Payer: Lucent All Commercial |
$34.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.57
|
| Rate for Payer: PHCS All Commercial |
$47.15
|
| Rate for Payer: PHP All Commercial |
$47.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.52
|
| Rate for Payer: Sagamore Health Network All Products |
$48.53
|
| Rate for Payer: Signature Care EPO |
$52.17
|
| Rate for Payer: Signature Care PPO |
$55.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.43
|
| Rate for Payer: United Healthcare Commercial |
$49.53
|
| Rate for Payer: United Healthcare Medicare |
$20.12
|
|
|
CALCIUM CHLORIDE 100 MG/ML (10 %) IV SYRG
|
Facility
|
IP
|
$62.86
|
|
|
Service Code
|
HCPCS J0618
|
| Hospital Charge Code |
1306
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.15 |
| Max. Negotiated Rate |
$58.46 |
| Rate for Payer: Aetna Commercial |
$54.31
|
| Rate for Payer: Cash Price |
$37.72
|
| Rate for Payer: Cigna All Commercial |
$54.25
|
| Rate for Payer: CORVEL All Commercial |
$58.46
|
| Rate for Payer: Coventry All Commercial |
$55.32
|
| Rate for Payer: Encore All Commercial |
$57.86
|
| Rate for Payer: Frontpath All Commercial |
$57.83
|
| Rate for Payer: Humana ChoiceCare |
$54.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$56.57
|
| Rate for Payer: PHCS All Commercial |
$47.15
|
| Rate for Payer: PHP All Commercial |
$47.67
|
| Rate for Payer: Sagamore Health Network All Products |
$48.53
|
| Rate for Payer: Signature Care EPO |
$52.17
|
| Rate for Payer: Signature Care PPO |
$55.32
|
| Rate for Payer: United Healthcare Commercial |
$49.53
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN
|
Facility
|
OP
|
$74.34
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.05 |
| Max. Negotiated Rate |
$69.14 |
| Rate for Payer: Aetna Commercial |
$62.74
|
| Rate for Payer: Aetna Medicare |
$23.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.17
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Centivo All Commercial |
$40.44
|
| Rate for Payer: Cigna All Commercial |
$64.16
|
| Rate for Payer: CORVEL All Commercial |
$69.14
|
| Rate for Payer: Coventry All Commercial |
$65.42
|
| Rate for Payer: Encore All Commercial |
$68.43
|
| Rate for Payer: Frontpath All Commercial |
$68.39
|
| Rate for Payer: Humana ChoiceCare |
$64.21
|
| Rate for Payer: Humana Medicare |
$23.79
|
| Rate for Payer: Lucent All Commercial |
$40.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.91
|
| Rate for Payer: PHCS All Commercial |
$55.76
|
| Rate for Payer: PHP All Commercial |
$56.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.99
|
| Rate for Payer: Sagamore Health Network All Products |
$57.39
|
| Rate for Payer: Signature Care EPO |
$61.70
|
| Rate for Payer: Signature Care PPO |
$65.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63.19
|
| Rate for Payer: United Healthcare Commercial |
$58.58
|
| Rate for Payer: United Healthcare Medicare |
$23.79
|
|
|
CALCIUM GLUCONATE 100 MG/ML (10%) IV SOLN
|
Facility
|
IP
|
$74.34
|
|
|
Service Code
|
HCPCS J0612
|
| Hospital Charge Code |
1312
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$55.76 |
| Max. Negotiated Rate |
$69.14 |
| Rate for Payer: Aetna Commercial |
$64.23
|
| Rate for Payer: Cash Price |
$44.60
|
| Rate for Payer: Cigna All Commercial |
$64.16
|
| Rate for Payer: CORVEL All Commercial |
$69.14
|
| Rate for Payer: Coventry All Commercial |
$65.42
|
| Rate for Payer: Encore All Commercial |
$68.43
|
| Rate for Payer: Frontpath All Commercial |
$68.39
|
| Rate for Payer: Humana ChoiceCare |
$64.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.91
|
| Rate for Payer: PHCS All Commercial |
$55.76
|
| Rate for Payer: PHP All Commercial |
$56.38
|
| Rate for Payer: Sagamore Health Network All Products |
$57.39
|
| Rate for Payer: Signature Care EPO |
$61.70
|
| Rate for Payer: Signature Care PPO |
$65.42
|
| Rate for Payer: United Healthcare Commercial |
$58.58
|
|
|
CALCIUM POLYCARBOPHIL 625 MG ORAL TAB
|
Facility
|
OP
|
$0.55
|
|
|
Service Code
|
NDC 00536430608
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.17 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Aetna Commercial |
$0.47
|
| Rate for Payer: Aetna Medicare |
$0.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.19
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Centivo All Commercial |
$0.30
|
| Rate for Payer: Cigna All Commercial |
$0.48
|
| Rate for Payer: CORVEL All Commercial |
$0.51
|
| Rate for Payer: Coventry All Commercial |
$0.49
|
| Rate for Payer: Encore All Commercial |
$0.51
|
| Rate for Payer: Frontpath All Commercial |
$0.51
|
| Rate for Payer: Humana ChoiceCare |
$0.48
|
| Rate for Payer: Humana Medicare |
$0.18
|
| Rate for Payer: Lucent All Commercial |
$0.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.50
|
| Rate for Payer: PHCS All Commercial |
$0.41
|
| Rate for Payer: PHP All Commercial |
$0.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.22
|
| Rate for Payer: Sagamore Health Network All Products |
$0.43
|
| Rate for Payer: Signature Care EPO |
$0.46
|
| Rate for Payer: Signature Care PPO |
$0.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.47
|
| Rate for Payer: United Healthcare Commercial |
$0.44
|
| Rate for Payer: United Healthcare Medicare |
$0.18
|
|
|
CALCIUM POLYCARBOPHIL 625 MG ORAL TAB
|
Facility
|
IP
|
$0.55
|
|
|
Service Code
|
NDC 00536430608
|
| Hospital Charge Code |
11046
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Aetna Commercial |
$0.48
|
| Rate for Payer: Cash Price |
$0.33
|
| Rate for Payer: Cigna All Commercial |
$0.48
|
| Rate for Payer: CORVEL All Commercial |
$0.51
|
| Rate for Payer: Coventry All Commercial |
$0.49
|
| Rate for Payer: Encore All Commercial |
$0.51
|
| Rate for Payer: Frontpath All Commercial |
$0.51
|
| Rate for Payer: Humana ChoiceCare |
$0.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.50
|
| Rate for Payer: PHCS All Commercial |
$0.41
|
| Rate for Payer: PHP All Commercial |
$0.42
|
| Rate for Payer: Sagamore Health Network All Products |
$0.43
|
| Rate for Payer: Signature Care EPO |
$0.46
|
| Rate for Payer: Signature Care PPO |
$0.49
|
| Rate for Payer: United Healthcare Commercial |
$0.44
|
|
|
CAMPHOR-METHYL SALICYL-MENTHOL 4-30-10 % TOP CREA
|
Facility
|
IP
|
$38.30
|
|
|
Service Code
|
NDC 74300008193
|
| Hospital Charge Code |
103884
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.73 |
| Max. Negotiated Rate |
$35.62 |
| Rate for Payer: Aetna Commercial |
$33.09
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Cigna All Commercial |
$33.06
|
| Rate for Payer: CORVEL All Commercial |
$35.62
|
| Rate for Payer: Coventry All Commercial |
$33.71
|
| Rate for Payer: Encore All Commercial |
$35.26
|
| Rate for Payer: Frontpath All Commercial |
$35.24
|
| Rate for Payer: Humana ChoiceCare |
$33.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.47
|
| Rate for Payer: PHCS All Commercial |
$28.73
|
| Rate for Payer: PHP All Commercial |
$29.05
|
| Rate for Payer: Sagamore Health Network All Products |
$29.57
|
| Rate for Payer: Signature Care EPO |
$31.79
|
| Rate for Payer: Signature Care PPO |
$33.71
|
| Rate for Payer: United Healthcare Commercial |
$30.18
|
|
|
CAMPHOR-METHYL SALICYL-MENTHOL 4-30-10 % TOP CREA
|
Facility
|
OP
|
$38.30
|
|
|
Service Code
|
NDC 74300008193
|
| Hospital Charge Code |
103884
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$35.62 |
| Rate for Payer: Aetna Commercial |
$32.33
|
| Rate for Payer: Aetna Medicare |
$12.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.48
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Centivo All Commercial |
$20.84
|
| Rate for Payer: Cigna All Commercial |
$33.06
|
| Rate for Payer: CORVEL All Commercial |
$35.62
|
| Rate for Payer: Coventry All Commercial |
$33.71
|
| Rate for Payer: Encore All Commercial |
$35.26
|
| Rate for Payer: Frontpath All Commercial |
$35.24
|
| Rate for Payer: Humana ChoiceCare |
$33.08
|
| Rate for Payer: Humana Medicare |
$12.26
|
| Rate for Payer: Lucent All Commercial |
$20.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.47
|
| Rate for Payer: PHCS All Commercial |
$28.73
|
| Rate for Payer: PHP All Commercial |
$29.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.94
|
| Rate for Payer: Sagamore Health Network All Products |
$29.57
|
| Rate for Payer: Signature Care EPO |
$31.79
|
| Rate for Payer: Signature Care PPO |
$33.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.56
|
| Rate for Payer: United Healthcare Commercial |
$30.18
|
| Rate for Payer: United Healthcare Medicare |
$12.26
|
|
|
CANTHARIDIN-PODOPHYLLIN-SALICYLIC ACID SOLUTION
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
NDC 05446097003
|
| Hospital Charge Code |
810084
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$232.50 |
| Max. Negotiated Rate |
$697.50 |
| Rate for Payer: Aetna Commercial |
$633.00
|
| Rate for Payer: Aetna Medicare |
$240.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$232.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$430.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$468.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$276.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$264.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Centivo All Commercial |
$408.00
|
| Rate for Payer: Cigna All Commercial |
$647.25
|
| Rate for Payer: CORVEL All Commercial |
$697.50
|
| Rate for Payer: Coventry All Commercial |
$660.00
|
| Rate for Payer: Encore All Commercial |
$690.38
|
| Rate for Payer: Frontpath All Commercial |
$690.00
|
| Rate for Payer: Humana ChoiceCare |
$647.77
|
| Rate for Payer: Humana Medicare |
$240.00
|
| Rate for Payer: Lucent All Commercial |
$408.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$675.00
|
| Rate for Payer: PHCS All Commercial |
$562.50
|
| Rate for Payer: PHP All Commercial |
$568.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$292.50
|
| Rate for Payer: Sagamore Health Network All Products |
$579.00
|
| Rate for Payer: Signature Care EPO |
$622.50
|
| Rate for Payer: Signature Care PPO |
$660.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$637.50
|
| Rate for Payer: United Healthcare Commercial |
$591.00
|
| Rate for Payer: United Healthcare Medicare |
$240.00
|
|
|
CANTHARIDIN-PODOPHYLLIN-SALICYLIC ACID SOLUTION
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
NDC 05446097003
|
| Hospital Charge Code |
810084
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$562.50 |
| Max. Negotiated Rate |
$697.50 |
| Rate for Payer: Aetna Commercial |
$648.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cigna All Commercial |
$647.25
|
| Rate for Payer: CORVEL All Commercial |
$697.50
|
| Rate for Payer: Coventry All Commercial |
$660.00
|
| Rate for Payer: Encore All Commercial |
$690.38
|
| Rate for Payer: Frontpath All Commercial |
$690.00
|
| Rate for Payer: Humana ChoiceCare |
$647.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$675.00
|
| Rate for Payer: PHCS All Commercial |
$562.50
|
| Rate for Payer: PHP All Commercial |
$568.80
|
| Rate for Payer: Sagamore Health Network All Products |
$579.00
|
| Rate for Payer: Signature Care EPO |
$622.50
|
| Rate for Payer: Signature Care PPO |
$660.00
|
| Rate for Payer: United Healthcare Commercial |
$591.00
|
|
|
CAPSAICIN 0.025 % TOP CREA
|
Facility
|
IP
|
$27.72
|
|
|
Service Code
|
NDC 00536252525
|
| Hospital Charge Code |
1350
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.79 |
| Max. Negotiated Rate |
$25.78 |
| Rate for Payer: Aetna Commercial |
$23.95
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Cigna All Commercial |
$23.92
|
| Rate for Payer: CORVEL All Commercial |
$25.78
|
| Rate for Payer: Coventry All Commercial |
$24.39
|
| Rate for Payer: Encore All Commercial |
$25.52
|
| Rate for Payer: Frontpath All Commercial |
$25.50
|
| Rate for Payer: Humana ChoiceCare |
$23.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.95
|
| Rate for Payer: PHCS All Commercial |
$20.79
|
| Rate for Payer: PHP All Commercial |
$21.02
|
| Rate for Payer: Sagamore Health Network All Products |
$21.40
|
| Rate for Payer: Signature Care EPO |
$23.01
|
| Rate for Payer: Signature Care PPO |
$24.39
|
| Rate for Payer: United Healthcare Commercial |
$21.84
|
|
|
CAPSAICIN 0.025 % TOP CREA
|
Facility
|
OP
|
$27.72
|
|
|
Service Code
|
NDC 00536252525
|
| Hospital Charge Code |
1350
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.59 |
| Max. Negotiated Rate |
$25.78 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Medicare |
$8.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.76
|
| Rate for Payer: Cash Price |
$16.63
|
| Rate for Payer: Centivo All Commercial |
$15.08
|
| Rate for Payer: Cigna All Commercial |
$23.92
|
| Rate for Payer: CORVEL All Commercial |
$25.78
|
| Rate for Payer: Coventry All Commercial |
$24.39
|
| Rate for Payer: Encore All Commercial |
$25.52
|
| Rate for Payer: Frontpath All Commercial |
$25.50
|
| Rate for Payer: Humana ChoiceCare |
$23.94
|
| Rate for Payer: Humana Medicare |
$8.87
|
| Rate for Payer: Lucent All Commercial |
$15.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.95
|
| Rate for Payer: PHCS All Commercial |
$20.79
|
| Rate for Payer: PHP All Commercial |
$21.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.81
|
| Rate for Payer: Sagamore Health Network All Products |
$21.40
|
| Rate for Payer: Signature Care EPO |
$23.01
|
| Rate for Payer: Signature Care PPO |
$24.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.56
|
| Rate for Payer: United Healthcare Commercial |
$21.84
|
| Rate for Payer: United Healthcare Medicare |
$8.87
|
|
|
CAPTOPRIL 12.5 MG ORAL TAB
|
Facility
|
IP
|
$6.59
|
|
|
Service Code
|
NDC 00904710561
|
| Hospital Charge Code |
9401
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: Aetna Commercial |
$5.69
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Cigna All Commercial |
$5.68
|
| Rate for Payer: CORVEL All Commercial |
$6.13
|
| Rate for Payer: Coventry All Commercial |
$5.80
|
| Rate for Payer: Encore All Commercial |
$6.06
|
| Rate for Payer: Frontpath All Commercial |
$6.06
|
| Rate for Payer: Humana ChoiceCare |
$5.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.93
|
| Rate for Payer: PHCS All Commercial |
$4.94
|
| Rate for Payer: PHP All Commercial |
$5.00
|
| Rate for Payer: Sagamore Health Network All Products |
$5.09
|
| Rate for Payer: Signature Care EPO |
$5.47
|
| Rate for Payer: Signature Care PPO |
$5.80
|
| Rate for Payer: United Healthcare Commercial |
$5.19
|
|
|
CAPTOPRIL 12.5 MG ORAL TAB
|
Facility
|
OP
|
$6.59
|
|
|
Service Code
|
NDC 00904710561
|
| Hospital Charge Code |
9401
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: Aetna Commercial |
$5.56
|
| Rate for Payer: Aetna Medicare |
$2.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.32
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Centivo All Commercial |
$3.58
|
| Rate for Payer: Cigna All Commercial |
$5.68
|
| Rate for Payer: CORVEL All Commercial |
$6.13
|
| Rate for Payer: Coventry All Commercial |
$5.80
|
| Rate for Payer: Encore All Commercial |
$6.06
|
| Rate for Payer: Frontpath All Commercial |
$6.06
|
| Rate for Payer: Humana ChoiceCare |
$5.69
|
| Rate for Payer: Humana Medicare |
$2.11
|
| Rate for Payer: Lucent All Commercial |
$3.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.93
|
| Rate for Payer: PHCS All Commercial |
$4.94
|
| Rate for Payer: PHP All Commercial |
$5.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.57
|
| Rate for Payer: Sagamore Health Network All Products |
$5.09
|
| Rate for Payer: Signature Care EPO |
$5.47
|
| Rate for Payer: Signature Care PPO |
$5.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.60
|
| Rate for Payer: United Healthcare Commercial |
$5.19
|
| Rate for Payer: United Healthcare Medicare |
$2.11
|
|
