|
CARBACHOL 0.01 % IO SOLN
|
Facility
|
OP
|
$304.96
|
|
|
Service Code
|
NDC 00065002315
|
| Hospital Charge Code |
19704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$283.61 |
| Rate for Payer: Aetna Commercial |
$257.39
|
| Rate for Payer: Aetna Medicare |
$97.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$94.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$175.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$190.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.35
|
| Rate for Payer: Cash Price |
$182.98
|
| Rate for Payer: Cash Price |
$182.98
|
| Rate for Payer: Centivo All Commercial |
$165.90
|
| Rate for Payer: Cigna All Commercial |
$263.18
|
| Rate for Payer: CORVEL All Commercial |
$283.61
|
| Rate for Payer: Coventry All Commercial |
$268.37
|
| Rate for Payer: Encore All Commercial |
$280.72
|
| Rate for Payer: Frontpath All Commercial |
$280.57
|
| Rate for Payer: Humana ChoiceCare |
$263.40
|
| Rate for Payer: Humana Medicare |
$97.59
|
| Rate for Payer: Lucent All Commercial |
$165.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$274.47
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$228.72
|
| Rate for Payer: PHP All Commercial |
$231.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$118.94
|
| Rate for Payer: Sagamore Health Network All Products |
$235.43
|
| Rate for Payer: Signature Care EPO |
$253.12
|
| Rate for Payer: Signature Care PPO |
$268.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$259.22
|
| Rate for Payer: United Healthcare Commercial |
$240.31
|
| Rate for Payer: United Healthcare Medicare |
$97.59
|
|
|
CARBACHOL 0.01 % IO SOLN
|
Facility
|
IP
|
$304.96
|
|
|
Service Code
|
NDC 00065002315
|
| Hospital Charge Code |
19704
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$228.72 |
| Max. Negotiated Rate |
$283.61 |
| Rate for Payer: Aetna Commercial |
$263.49
|
| Rate for Payer: Cash Price |
$182.98
|
| Rate for Payer: Cigna All Commercial |
$263.18
|
| Rate for Payer: CORVEL All Commercial |
$283.61
|
| Rate for Payer: Coventry All Commercial |
$268.37
|
| Rate for Payer: Encore All Commercial |
$280.72
|
| Rate for Payer: Frontpath All Commercial |
$280.57
|
| Rate for Payer: Humana ChoiceCare |
$263.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$274.47
|
| Rate for Payer: PHCS All Commercial |
$228.72
|
| Rate for Payer: PHP All Commercial |
$231.28
|
| Rate for Payer: Sagamore Health Network All Products |
$235.43
|
| Rate for Payer: Signature Care EPO |
$253.12
|
| Rate for Payer: Signature Care PPO |
$268.37
|
| Rate for Payer: United Healthcare Commercial |
$240.31
|
|
|
CARBAMAZEPINE 200 MG ORAL CM12
|
Facility
|
OP
|
$17.09
|
|
|
Service Code
|
NDC 50268017113
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$15.89 |
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: Aetna Medicare |
$5.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.01
|
| Rate for Payer: Cash Price |
$10.25
|
| Rate for Payer: Centivo All Commercial |
$9.30
|
| Rate for Payer: Cigna All Commercial |
$14.75
|
| Rate for Payer: CORVEL All Commercial |
$15.89
|
| Rate for Payer: Coventry All Commercial |
$15.04
|
| Rate for Payer: Encore All Commercial |
$15.73
|
| Rate for Payer: Frontpath All Commercial |
$15.72
|
| Rate for Payer: Humana ChoiceCare |
$14.76
|
| Rate for Payer: Humana Medicare |
$5.47
|
| Rate for Payer: Lucent All Commercial |
$9.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.38
|
| Rate for Payer: PHCS All Commercial |
$12.82
|
| Rate for Payer: PHP All Commercial |
$12.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.66
|
| Rate for Payer: Sagamore Health Network All Products |
$13.19
|
| Rate for Payer: Signature Care EPO |
$14.18
|
| Rate for Payer: Signature Care PPO |
$15.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.52
|
| Rate for Payer: United Healthcare Commercial |
$13.46
|
| Rate for Payer: United Healthcare Medicare |
$5.47
|
|
|
CARBAMAZEPINE 200 MG ORAL CM12
|
Facility
|
OP
|
$17.09
|
|
|
Service Code
|
NDC 50268017111
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$15.89 |
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: Aetna Medicare |
$5.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.01
|
| Rate for Payer: Cash Price |
$10.25
|
| Rate for Payer: Centivo All Commercial |
$9.30
|
| Rate for Payer: Cigna All Commercial |
$14.75
|
| Rate for Payer: CORVEL All Commercial |
$15.89
|
| Rate for Payer: Coventry All Commercial |
$15.04
|
| Rate for Payer: Encore All Commercial |
$15.73
|
| Rate for Payer: Frontpath All Commercial |
$15.72
|
| Rate for Payer: Humana ChoiceCare |
$14.76
|
| Rate for Payer: Humana Medicare |
$5.47
|
| Rate for Payer: Lucent All Commercial |
$9.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.38
|
| Rate for Payer: PHCS All Commercial |
$12.82
|
| Rate for Payer: PHP All Commercial |
$12.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.66
|
| Rate for Payer: Sagamore Health Network All Products |
$13.19
|
| Rate for Payer: Signature Care EPO |
$14.18
|
| Rate for Payer: Signature Care PPO |
$15.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.52
|
| Rate for Payer: United Healthcare Commercial |
$13.46
|
| Rate for Payer: United Healthcare Medicare |
$5.47
|
|
|
CARBAMAZEPINE 200 MG ORAL CM12
|
Facility
|
IP
|
$17.09
|
|
|
Service Code
|
NDC 50268017113
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$15.89 |
| Rate for Payer: Aetna Commercial |
$14.76
|
| Rate for Payer: Cash Price |
$10.25
|
| Rate for Payer: Cigna All Commercial |
$14.75
|
| Rate for Payer: CORVEL All Commercial |
$15.89
|
| Rate for Payer: Coventry All Commercial |
$15.04
|
| Rate for Payer: Encore All Commercial |
$15.73
|
| Rate for Payer: Frontpath All Commercial |
$15.72
|
| Rate for Payer: Humana ChoiceCare |
$14.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.38
|
| Rate for Payer: PHCS All Commercial |
$12.82
|
| Rate for Payer: PHP All Commercial |
$12.96
|
| Rate for Payer: Sagamore Health Network All Products |
$13.19
|
| Rate for Payer: Signature Care EPO |
$14.18
|
| Rate for Payer: Signature Care PPO |
$15.04
|
| Rate for Payer: United Healthcare Commercial |
$13.46
|
|
|
CARBAMAZEPINE 200 MG ORAL CM12
|
Facility
|
IP
|
$17.09
|
|
|
Service Code
|
NDC 50268017111
|
| Hospital Charge Code |
27632
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$15.89 |
| Rate for Payer: Aetna Commercial |
$14.76
|
| Rate for Payer: Cash Price |
$10.25
|
| Rate for Payer: Cigna All Commercial |
$14.75
|
| Rate for Payer: CORVEL All Commercial |
$15.89
|
| Rate for Payer: Coventry All Commercial |
$15.04
|
| Rate for Payer: Encore All Commercial |
$15.73
|
| Rate for Payer: Frontpath All Commercial |
$15.72
|
| Rate for Payer: Humana ChoiceCare |
$14.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.38
|
| Rate for Payer: PHCS All Commercial |
$12.82
|
| Rate for Payer: PHP All Commercial |
$12.96
|
| Rate for Payer: Sagamore Health Network All Products |
$13.19
|
| Rate for Payer: Signature Care EPO |
$14.18
|
| Rate for Payer: Signature Care PPO |
$15.04
|
| Rate for Payer: United Healthcare Commercial |
$13.46
|
|
|
CARBAMAZEPINE 200 MG ORAL TAB
|
Facility
|
OP
|
$2.97
|
|
|
Service Code
|
NDC 00904617261
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.50
|
| Rate for Payer: Aetna Medicare |
$0.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.04
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Centivo All Commercial |
$1.61
|
| Rate for Payer: Cigna All Commercial |
$2.56
|
| Rate for Payer: CORVEL All Commercial |
$2.76
|
| Rate for Payer: Coventry All Commercial |
$2.61
|
| Rate for Payer: Encore All Commercial |
$2.73
|
| Rate for Payer: Frontpath All Commercial |
$2.73
|
| Rate for Payer: Humana ChoiceCare |
$2.56
|
| Rate for Payer: Humana Medicare |
$0.95
|
| Rate for Payer: Lucent All Commercial |
$1.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.67
|
| Rate for Payer: PHCS All Commercial |
$2.23
|
| Rate for Payer: PHP All Commercial |
$2.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.16
|
| Rate for Payer: Sagamore Health Network All Products |
$2.29
|
| Rate for Payer: Signature Care EPO |
$2.46
|
| Rate for Payer: Signature Care PPO |
$2.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.52
|
| Rate for Payer: United Healthcare Commercial |
$2.34
|
| Rate for Payer: United Healthcare Medicare |
$0.95
|
|
|
CARBAMAZEPINE 200 MG ORAL TAB
|
Facility
|
IP
|
$2.97
|
|
|
Service Code
|
NDC 00904617261
|
| Hospital Charge Code |
1357
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.23 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$1.78
|
| Rate for Payer: Cigna All Commercial |
$2.56
|
| Rate for Payer: CORVEL All Commercial |
$2.76
|
| Rate for Payer: Coventry All Commercial |
$2.61
|
| Rate for Payer: Encore All Commercial |
$2.73
|
| Rate for Payer: Frontpath All Commercial |
$2.73
|
| Rate for Payer: Humana ChoiceCare |
$2.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.67
|
| Rate for Payer: PHCS All Commercial |
$2.23
|
| Rate for Payer: PHP All Commercial |
$2.25
|
| Rate for Payer: Sagamore Health Network All Products |
$2.29
|
| Rate for Payer: Signature Care EPO |
$2.46
|
| Rate for Payer: Signature Care PPO |
$2.61
|
| Rate for Payer: United Healthcare Commercial |
$2.34
|
|
|
CARBAMIDE PEROXIDE 6.5 % OTIC DROP
|
Facility
|
OP
|
$12.50
|
|
|
Service Code
|
NDC 00904662735
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna Commercial |
$10.55
|
| Rate for Payer: Aetna Medicare |
$4.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.40
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Centivo All Commercial |
$6.80
|
| Rate for Payer: Cigna All Commercial |
$10.78
|
| Rate for Payer: CORVEL All Commercial |
$11.62
|
| Rate for Payer: Coventry All Commercial |
$11.00
|
| Rate for Payer: Encore All Commercial |
$11.50
|
| Rate for Payer: Frontpath All Commercial |
$11.50
|
| Rate for Payer: Humana ChoiceCare |
$10.79
|
| Rate for Payer: Humana Medicare |
$4.00
|
| Rate for Payer: Lucent All Commercial |
$6.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.25
|
| Rate for Payer: PHCS All Commercial |
$9.37
|
| Rate for Payer: PHP All Commercial |
$9.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.87
|
| Rate for Payer: Sagamore Health Network All Products |
$9.65
|
| Rate for Payer: Signature Care EPO |
$10.37
|
| Rate for Payer: Signature Care PPO |
$11.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.62
|
| Rate for Payer: United Healthcare Commercial |
$9.85
|
| Rate for Payer: United Healthcare Medicare |
$4.00
|
|
|
CARBAMIDE PEROXIDE 6.5 % OTIC DROP
|
Facility
|
IP
|
$12.50
|
|
|
Service Code
|
NDC 00904662735
|
| Hospital Charge Code |
1359
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.37 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna All Commercial |
$10.78
|
| Rate for Payer: CORVEL All Commercial |
$11.62
|
| Rate for Payer: Coventry All Commercial |
$11.00
|
| Rate for Payer: Encore All Commercial |
$11.50
|
| Rate for Payer: Frontpath All Commercial |
$11.50
|
| Rate for Payer: Humana ChoiceCare |
$10.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.25
|
| Rate for Payer: PHCS All Commercial |
$9.37
|
| Rate for Payer: PHP All Commercial |
$9.48
|
| Rate for Payer: Sagamore Health Network All Products |
$9.65
|
| Rate for Payer: Signature Care EPO |
$10.37
|
| Rate for Payer: Signature Care PPO |
$11.00
|
| Rate for Payer: United Healthcare Commercial |
$9.85
|
|
|
CARBIDOPA-LEVODOPA 10-100 MG ORAL TAB
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 50228045701
|
| Hospital Charge Code |
9406
|
|
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 |
$0.60
|
| 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
|
|
|
CARBIDOPA-LEVODOPA 10-100 MG ORAL TAB
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 50228045701
|
| Hospital Charge Code |
9406
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.35
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Centivo All Commercial |
$0.54
|
| 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 |
$0.32
|
| Rate for Payer: Lucent All Commercial |
$0.54
|
| 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 |
$0.32
|
|
|
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB
|
Facility
|
OP
|
$1.11
|
|
|
Service Code
|
NDC 00904750161
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Aetna Commercial |
$0.93
|
| Rate for Payer: Aetna Medicare |
$0.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.39
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Centivo All Commercial |
$0.60
|
| Rate for Payer: Cigna All Commercial |
$0.95
|
| Rate for Payer: CORVEL All Commercial |
$1.03
|
| Rate for Payer: Coventry All Commercial |
$0.97
|
| Rate for Payer: Encore All Commercial |
$1.02
|
| Rate for Payer: Frontpath All Commercial |
$1.02
|
| Rate for Payer: Humana ChoiceCare |
$0.96
|
| Rate for Payer: Humana Medicare |
$0.35
|
| Rate for Payer: Lucent All Commercial |
$0.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.00
|
| Rate for Payer: PHCS All Commercial |
$0.83
|
| Rate for Payer: PHP All Commercial |
$0.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.43
|
| Rate for Payer: Sagamore Health Network All Products |
$0.85
|
| Rate for Payer: Signature Care EPO |
$0.92
|
| Rate for Payer: Signature Care PPO |
$0.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.94
|
| Rate for Payer: United Healthcare Commercial |
$0.87
|
| Rate for Payer: United Healthcare Medicare |
$0.35
|
|
|
CARBIDOPA-LEVODOPA 25-100 MG ORAL TAB
|
Facility
|
IP
|
$1.11
|
|
|
Service Code
|
NDC 00904750161
|
| Hospital Charge Code |
9407
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$1.03 |
| Rate for Payer: Aetna Commercial |
$0.96
|
| Rate for Payer: Cash Price |
$0.66
|
| Rate for Payer: Cigna All Commercial |
$0.95
|
| Rate for Payer: CORVEL All Commercial |
$1.03
|
| Rate for Payer: Coventry All Commercial |
$0.97
|
| Rate for Payer: Encore All Commercial |
$1.02
|
| Rate for Payer: Frontpath All Commercial |
$1.02
|
| Rate for Payer: Humana ChoiceCare |
$0.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.00
|
| Rate for Payer: PHCS All Commercial |
$0.83
|
| Rate for Payer: PHP All Commercial |
$0.84
|
| Rate for Payer: Sagamore Health Network All Products |
$0.85
|
| Rate for Payer: Signature Care EPO |
$0.92
|
| Rate for Payer: Signature Care PPO |
$0.97
|
| Rate for Payer: United Healthcare Commercial |
$0.87
|
|
|
CARBIDOPA-LEVODOPA 25-100 MG ORAL TBER
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 51079097820
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: Aetna Medicare |
$0.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.70
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Centivo All Commercial |
$1.09
|
| Rate for Payer: Cigna All Commercial |
$1.73
|
| Rate for Payer: CORVEL All Commercial |
$1.86
|
| Rate for Payer: Coventry All Commercial |
$1.76
|
| Rate for Payer: Encore All Commercial |
$1.84
|
| Rate for Payer: Frontpath All Commercial |
$1.84
|
| Rate for Payer: Humana ChoiceCare |
$1.73
|
| Rate for Payer: Humana Medicare |
$0.64
|
| Rate for Payer: Lucent All Commercial |
$1.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.80
|
| Rate for Payer: PHCS All Commercial |
$1.50
|
| Rate for Payer: PHP All Commercial |
$1.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1.55
|
| Rate for Payer: Signature Care EPO |
$1.66
|
| Rate for Payer: Signature Care PPO |
$1.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.70
|
| Rate for Payer: United Healthcare Commercial |
$1.58
|
| Rate for Payer: United Healthcare Medicare |
$0.64
|
|
|
CARBIDOPA-LEVODOPA 25-100 MG ORAL TBER
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 51079097820
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.73
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna All Commercial |
$1.73
|
| Rate for Payer: CORVEL All Commercial |
$1.86
|
| Rate for Payer: Coventry All Commercial |
$1.76
|
| Rate for Payer: Encore All Commercial |
$1.84
|
| Rate for Payer: Frontpath All Commercial |
$1.84
|
| Rate for Payer: Humana ChoiceCare |
$1.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.80
|
| Rate for Payer: PHCS All Commercial |
$1.50
|
| Rate for Payer: PHP All Commercial |
$1.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1.55
|
| Rate for Payer: Signature Care EPO |
$1.66
|
| Rate for Payer: Signature Care PPO |
$1.76
|
| Rate for Payer: United Healthcare Commercial |
$1.58
|
|
|
CARBIDOPA-LEVODOPA 25-100 MG ORAL TBER
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
NDC 51079097801
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.50 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.73
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna All Commercial |
$1.73
|
| Rate for Payer: CORVEL All Commercial |
$1.86
|
| Rate for Payer: Coventry All Commercial |
$1.76
|
| Rate for Payer: Encore All Commercial |
$1.84
|
| Rate for Payer: Frontpath All Commercial |
$1.84
|
| Rate for Payer: Humana ChoiceCare |
$1.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.80
|
| Rate for Payer: PHCS All Commercial |
$1.50
|
| Rate for Payer: PHP All Commercial |
$1.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1.55
|
| Rate for Payer: Signature Care EPO |
$1.66
|
| Rate for Payer: Signature Care PPO |
$1.76
|
| Rate for Payer: United Healthcare Commercial |
$1.58
|
|
|
CARBIDOPA-LEVODOPA 25-100 MG ORAL TBER
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
NDC 51079097801
|
| Hospital Charge Code |
12329
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.86 |
| Rate for Payer: Aetna Commercial |
$1.69
|
| Rate for Payer: Aetna Medicare |
$0.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.70
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Centivo All Commercial |
$1.09
|
| Rate for Payer: Cigna All Commercial |
$1.73
|
| Rate for Payer: CORVEL All Commercial |
$1.86
|
| Rate for Payer: Coventry All Commercial |
$1.76
|
| Rate for Payer: Encore All Commercial |
$1.84
|
| Rate for Payer: Frontpath All Commercial |
$1.84
|
| Rate for Payer: Humana ChoiceCare |
$1.73
|
| Rate for Payer: Humana Medicare |
$0.64
|
| Rate for Payer: Lucent All Commercial |
$1.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.80
|
| Rate for Payer: PHCS All Commercial |
$1.50
|
| Rate for Payer: PHP All Commercial |
$1.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1.55
|
| Rate for Payer: Signature Care EPO |
$1.66
|
| Rate for Payer: Signature Care PPO |
$1.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.70
|
| Rate for Payer: United Healthcare Commercial |
$1.58
|
| Rate for Payer: United Healthcare Medicare |
$0.64
|
|
|
CARBIDOPA-LEVODOPA 25-250 MG ORAL TAB
|
Facility
|
IP
|
$2.18
|
|
|
Service Code
|
NDC 60687083601
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Aetna Commercial |
$1.89
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna All Commercial |
$1.88
|
| Rate for Payer: CORVEL All Commercial |
$2.03
|
| Rate for Payer: Coventry All Commercial |
$1.92
|
| Rate for Payer: Encore All Commercial |
$2.01
|
| Rate for Payer: Frontpath All Commercial |
$2.01
|
| Rate for Payer: Humana ChoiceCare |
$1.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.97
|
| Rate for Payer: PHCS All Commercial |
$1.64
|
| Rate for Payer: PHP All Commercial |
$1.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1.69
|
| Rate for Payer: Signature Care EPO |
$1.81
|
| Rate for Payer: Signature Care PPO |
$1.92
|
| Rate for Payer: United Healthcare Commercial |
$1.72
|
|
|
CARBIDOPA-LEVODOPA 25-250 MG ORAL TAB
|
Facility
|
IP
|
$2.18
|
|
|
Service Code
|
NDC 60687083611
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Aetna Commercial |
$1.89
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Cigna All Commercial |
$1.88
|
| Rate for Payer: CORVEL All Commercial |
$2.03
|
| Rate for Payer: Coventry All Commercial |
$1.92
|
| Rate for Payer: Encore All Commercial |
$2.01
|
| Rate for Payer: Frontpath All Commercial |
$2.01
|
| Rate for Payer: Humana ChoiceCare |
$1.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.97
|
| Rate for Payer: PHCS All Commercial |
$1.64
|
| Rate for Payer: PHP All Commercial |
$1.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1.69
|
| Rate for Payer: Signature Care EPO |
$1.81
|
| Rate for Payer: Signature Care PPO |
$1.92
|
| Rate for Payer: United Healthcare Commercial |
$1.72
|
|
|
CARBIDOPA-LEVODOPA 25-250 MG ORAL TAB
|
Facility
|
OP
|
$2.18
|
|
|
Service Code
|
NDC 60687083601
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.77
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Centivo All Commercial |
$1.19
|
| Rate for Payer: Cigna All Commercial |
$1.88
|
| Rate for Payer: CORVEL All Commercial |
$2.03
|
| Rate for Payer: Coventry All Commercial |
$1.92
|
| Rate for Payer: Encore All Commercial |
$2.01
|
| Rate for Payer: Frontpath All Commercial |
$2.01
|
| Rate for Payer: Humana ChoiceCare |
$1.89
|
| Rate for Payer: Humana Medicare |
$0.70
|
| Rate for Payer: Lucent All Commercial |
$1.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.97
|
| Rate for Payer: PHCS All Commercial |
$1.64
|
| Rate for Payer: PHP All Commercial |
$1.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1.69
|
| Rate for Payer: Signature Care EPO |
$1.81
|
| Rate for Payer: Signature Care PPO |
$1.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.86
|
| Rate for Payer: United Healthcare Commercial |
$1.72
|
| Rate for Payer: United Healthcare Medicare |
$0.70
|
|
|
CARBIDOPA-LEVODOPA 25-250 MG ORAL TAB
|
Facility
|
OP
|
$2.18
|
|
|
Service Code
|
NDC 60687083611
|
| Hospital Charge Code |
9408
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$2.03 |
| Rate for Payer: Aetna Commercial |
$1.84
|
| Rate for Payer: Aetna Medicare |
$0.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.77
|
| Rate for Payer: Cash Price |
$1.31
|
| Rate for Payer: Centivo All Commercial |
$1.19
|
| Rate for Payer: Cigna All Commercial |
$1.88
|
| Rate for Payer: CORVEL All Commercial |
$2.03
|
| Rate for Payer: Coventry All Commercial |
$1.92
|
| Rate for Payer: Encore All Commercial |
$2.01
|
| Rate for Payer: Frontpath All Commercial |
$2.01
|
| Rate for Payer: Humana ChoiceCare |
$1.89
|
| Rate for Payer: Humana Medicare |
$0.70
|
| Rate for Payer: Lucent All Commercial |
$1.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.97
|
| Rate for Payer: PHCS All Commercial |
$1.64
|
| Rate for Payer: PHP All Commercial |
$1.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1.69
|
| Rate for Payer: Signature Care EPO |
$1.81
|
| Rate for Payer: Signature Care PPO |
$1.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.86
|
| Rate for Payer: United Healthcare Commercial |
$1.72
|
| Rate for Payer: United Healthcare Medicare |
$0.70
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN
|
Facility
|
IP
|
$262.17
|
|
|
Service Code
|
NDC 70594011202
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$196.63 |
| Max. Negotiated Rate |
$243.82 |
| Rate for Payer: Aetna Commercial |
$226.52
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Cigna All Commercial |
$226.25
|
| Rate for Payer: CORVEL All Commercial |
$243.82
|
| Rate for Payer: Coventry All Commercial |
$230.71
|
| Rate for Payer: Encore All Commercial |
$241.33
|
| Rate for Payer: Frontpath All Commercial |
$241.20
|
| Rate for Payer: Humana ChoiceCare |
$226.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$235.95
|
| Rate for Payer: PHCS All Commercial |
$196.63
|
| Rate for Payer: PHP All Commercial |
$198.83
|
| Rate for Payer: Sagamore Health Network All Products |
$202.40
|
| Rate for Payer: Signature Care EPO |
$217.60
|
| Rate for Payer: Signature Care PPO |
$230.71
|
| Rate for Payer: United Healthcare Commercial |
$206.59
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN
|
Facility
|
OP
|
$262.17
|
|
|
Service Code
|
NDC 70594011201
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$243.82 |
| Rate for Payer: Aetna Commercial |
$221.27
|
| Rate for Payer: Aetna Medicare |
$83.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$150.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$163.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.28
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Centivo All Commercial |
$142.62
|
| Rate for Payer: Cigna All Commercial |
$226.25
|
| Rate for Payer: CORVEL All Commercial |
$243.82
|
| Rate for Payer: Coventry All Commercial |
$230.71
|
| Rate for Payer: Encore All Commercial |
$241.33
|
| Rate for Payer: Frontpath All Commercial |
$241.20
|
| Rate for Payer: Humana ChoiceCare |
$226.44
|
| Rate for Payer: Humana Medicare |
$83.89
|
| Rate for Payer: Lucent All Commercial |
$142.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$235.95
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$196.63
|
| Rate for Payer: PHP All Commercial |
$198.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.25
|
| Rate for Payer: Sagamore Health Network All Products |
$202.40
|
| Rate for Payer: Signature Care EPO |
$217.60
|
| Rate for Payer: Signature Care PPO |
$230.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$222.85
|
| Rate for Payer: United Healthcare Commercial |
$206.59
|
| Rate for Payer: United Healthcare Medicare |
$83.89
|
|
|
CARBOPROST TROMETHAMINE 250 MCG/ML IM SOLN
|
Facility
|
IP
|
$262.17
|
|
|
Service Code
|
NDC 70594011201
|
| Hospital Charge Code |
9413
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$196.63 |
| Max. Negotiated Rate |
$243.82 |
| Rate for Payer: Aetna Commercial |
$226.52
|
| Rate for Payer: Cash Price |
$157.30
|
| Rate for Payer: Cigna All Commercial |
$226.25
|
| Rate for Payer: CORVEL All Commercial |
$243.82
|
| Rate for Payer: Coventry All Commercial |
$230.71
|
| Rate for Payer: Encore All Commercial |
$241.33
|
| Rate for Payer: Frontpath All Commercial |
$241.20
|
| Rate for Payer: Humana ChoiceCare |
$226.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$235.95
|
| Rate for Payer: PHCS All Commercial |
$196.63
|
| Rate for Payer: PHP All Commercial |
$198.83
|
| Rate for Payer: Sagamore Health Network All Products |
$202.40
|
| Rate for Payer: Signature Care EPO |
$217.60
|
| Rate for Payer: Signature Care PPO |
$230.71
|
| Rate for Payer: United Healthcare Commercial |
$206.59
|
|
