|
CEFDINIR 125 MG/5 ML ORAL SUSR
|
Facility
|
OP
|
$130.20
|
|
|
Service Code
|
NDC 65862021860
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$40.36 |
| Max. Negotiated Rate |
$121.09 |
| Rate for Payer: Aetna Commercial |
$109.89
|
| Rate for Payer: Aetna Medicare |
$41.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$74.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.83
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Centivo All Commercial |
$70.83
|
| Rate for Payer: Cigna All Commercial |
$112.36
|
| Rate for Payer: CORVEL All Commercial |
$121.09
|
| Rate for Payer: Coventry All Commercial |
$114.58
|
| Rate for Payer: Encore All Commercial |
$119.85
|
| Rate for Payer: Frontpath All Commercial |
$119.78
|
| Rate for Payer: Humana ChoiceCare |
$112.45
|
| Rate for Payer: Humana Medicare |
$41.66
|
| Rate for Payer: Lucent All Commercial |
$70.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.18
|
| Rate for Payer: PHCS All Commercial |
$97.65
|
| Rate for Payer: PHP All Commercial |
$98.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.78
|
| Rate for Payer: Sagamore Health Network All Products |
$100.51
|
| Rate for Payer: Signature Care EPO |
$108.07
|
| Rate for Payer: Signature Care PPO |
$114.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$110.67
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
| Rate for Payer: United Healthcare Medicare |
$41.66
|
|
|
CEFDINIR 125 MG/5 ML ORAL SUSR
|
Facility
|
IP
|
$130.20
|
|
|
Service Code
|
NDC 65862021860
|
| Hospital Charge Code |
22290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.65 |
| Max. Negotiated Rate |
$121.09 |
| Rate for Payer: Aetna Commercial |
$112.49
|
| Rate for Payer: Cash Price |
$78.12
|
| Rate for Payer: Cigna All Commercial |
$112.36
|
| Rate for Payer: CORVEL All Commercial |
$121.09
|
| Rate for Payer: Coventry All Commercial |
$114.58
|
| Rate for Payer: Encore All Commercial |
$119.85
|
| Rate for Payer: Frontpath All Commercial |
$119.78
|
| Rate for Payer: Humana ChoiceCare |
$112.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$117.18
|
| Rate for Payer: PHCS All Commercial |
$97.65
|
| Rate for Payer: PHP All Commercial |
$98.74
|
| Rate for Payer: Sagamore Health Network All Products |
$100.51
|
| Rate for Payer: Signature Care EPO |
$108.07
|
| Rate for Payer: Signature Care PPO |
$114.58
|
| Rate for Payer: United Healthcare Commercial |
$102.60
|
|
|
CEFDINIR 300 MG ORAL CAP
|
Facility
|
IP
|
$19.50
|
|
|
Service Code
|
NDC 60687069921
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$18.13 |
| Rate for Payer: Aetna Commercial |
$16.84
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna All Commercial |
$16.82
|
| Rate for Payer: CORVEL All Commercial |
$18.13
|
| Rate for Payer: Coventry All Commercial |
$17.16
|
| Rate for Payer: Encore All Commercial |
$17.95
|
| Rate for Payer: Frontpath All Commercial |
$17.94
|
| Rate for Payer: Humana ChoiceCare |
$16.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.55
|
| Rate for Payer: PHCS All Commercial |
$14.62
|
| Rate for Payer: PHP All Commercial |
$14.79
|
| Rate for Payer: Sagamore Health Network All Products |
$15.05
|
| Rate for Payer: Signature Care EPO |
$16.18
|
| Rate for Payer: Signature Care PPO |
$17.16
|
| Rate for Payer: United Healthcare Commercial |
$15.36
|
|
|
CEFDINIR 300 MG ORAL CAP
|
Facility
|
OP
|
$19.50
|
|
|
Service Code
|
NDC 60687069921
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$18.13 |
| Rate for Payer: Aetna Commercial |
$16.45
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.86
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Centivo All Commercial |
$10.61
|
| Rate for Payer: Cigna All Commercial |
$16.82
|
| Rate for Payer: CORVEL All Commercial |
$18.13
|
| Rate for Payer: Coventry All Commercial |
$17.16
|
| Rate for Payer: Encore All Commercial |
$17.95
|
| Rate for Payer: Frontpath All Commercial |
$17.94
|
| Rate for Payer: Humana ChoiceCare |
$16.84
|
| Rate for Payer: Humana Medicare |
$6.24
|
| Rate for Payer: Lucent All Commercial |
$10.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.55
|
| Rate for Payer: PHCS All Commercial |
$14.62
|
| Rate for Payer: PHP All Commercial |
$14.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.60
|
| Rate for Payer: Sagamore Health Network All Products |
$15.05
|
| Rate for Payer: Signature Care EPO |
$16.18
|
| Rate for Payer: Signature Care PPO |
$17.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.57
|
| Rate for Payer: United Healthcare Commercial |
$15.36
|
| Rate for Payer: United Healthcare Medicare |
$6.24
|
|
|
CEFDINIR 300 MG ORAL CAP
|
Facility
|
OP
|
$19.50
|
|
|
Service Code
|
NDC 60687069911
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.04 |
| Max. Negotiated Rate |
$18.13 |
| Rate for Payer: Aetna Commercial |
$16.45
|
| Rate for Payer: Aetna Medicare |
$6.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.86
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Centivo All Commercial |
$10.61
|
| Rate for Payer: Cigna All Commercial |
$16.82
|
| Rate for Payer: CORVEL All Commercial |
$18.13
|
| Rate for Payer: Coventry All Commercial |
$17.16
|
| Rate for Payer: Encore All Commercial |
$17.95
|
| Rate for Payer: Frontpath All Commercial |
$17.94
|
| Rate for Payer: Humana ChoiceCare |
$16.84
|
| Rate for Payer: Humana Medicare |
$6.24
|
| Rate for Payer: Lucent All Commercial |
$10.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.55
|
| Rate for Payer: PHCS All Commercial |
$14.62
|
| Rate for Payer: PHP All Commercial |
$14.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.60
|
| Rate for Payer: Sagamore Health Network All Products |
$15.05
|
| Rate for Payer: Signature Care EPO |
$16.18
|
| Rate for Payer: Signature Care PPO |
$17.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.57
|
| Rate for Payer: United Healthcare Commercial |
$15.36
|
| Rate for Payer: United Healthcare Medicare |
$6.24
|
|
|
CEFDINIR 300 MG ORAL CAP
|
Facility
|
IP
|
$19.50
|
|
|
Service Code
|
NDC 60687069911
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$18.13 |
| Rate for Payer: Aetna Commercial |
$16.84
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna All Commercial |
$16.82
|
| Rate for Payer: CORVEL All Commercial |
$18.13
|
| Rate for Payer: Coventry All Commercial |
$17.16
|
| Rate for Payer: Encore All Commercial |
$17.95
|
| Rate for Payer: Frontpath All Commercial |
$17.94
|
| Rate for Payer: Humana ChoiceCare |
$16.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.55
|
| Rate for Payer: PHCS All Commercial |
$14.62
|
| Rate for Payer: PHP All Commercial |
$14.79
|
| Rate for Payer: Sagamore Health Network All Products |
$15.05
|
| Rate for Payer: Signature Care EPO |
$16.18
|
| Rate for Payer: Signature Care PPO |
$17.16
|
| Rate for Payer: United Healthcare Commercial |
$15.36
|
|
|
CEFEPIME 1 G INJ SOLR
|
Facility
|
OP
|
$28.67
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.89 |
| Max. Negotiated Rate |
$26.66 |
| Rate for Payer: Aetna Commercial |
$24.19
|
| Rate for Payer: Aetna Medicare |
$9.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$16.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.09
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Centivo All Commercial |
$15.59
|
| Rate for Payer: Cigna All Commercial |
$24.74
|
| Rate for Payer: CORVEL All Commercial |
$26.66
|
| Rate for Payer: Coventry All Commercial |
$25.23
|
| Rate for Payer: Encore All Commercial |
$26.39
|
| Rate for Payer: Frontpath All Commercial |
$26.37
|
| Rate for Payer: Humana ChoiceCare |
$24.76
|
| Rate for Payer: Humana Medicare |
$9.17
|
| Rate for Payer: Lucent All Commercial |
$15.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.80
|
| Rate for Payer: PHCS All Commercial |
$21.50
|
| Rate for Payer: PHP All Commercial |
$21.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.18
|
| Rate for Payer: Sagamore Health Network All Products |
$22.13
|
| Rate for Payer: Signature Care EPO |
$23.79
|
| Rate for Payer: Signature Care PPO |
$25.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.37
|
| Rate for Payer: United Healthcare Commercial |
$22.59
|
| Rate for Payer: United Healthcare Medicare |
$9.17
|
|
|
CEFEPIME 1 G INJ SOLR
|
Facility
|
IP
|
$28.67
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.50 |
| Max. Negotiated Rate |
$26.66 |
| Rate for Payer: Aetna Commercial |
$24.77
|
| Rate for Payer: Cash Price |
$17.20
|
| Rate for Payer: Cigna All Commercial |
$24.74
|
| Rate for Payer: CORVEL All Commercial |
$26.66
|
| Rate for Payer: Coventry All Commercial |
$25.23
|
| Rate for Payer: Encore All Commercial |
$26.39
|
| Rate for Payer: Frontpath All Commercial |
$26.37
|
| Rate for Payer: Humana ChoiceCare |
$24.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.80
|
| Rate for Payer: PHCS All Commercial |
$21.50
|
| Rate for Payer: PHP All Commercial |
$21.74
|
| Rate for Payer: Sagamore Health Network All Products |
$22.13
|
| Rate for Payer: Signature Care EPO |
$23.79
|
| Rate for Payer: Signature Care PPO |
$25.23
|
| Rate for Payer: United Healthcare Commercial |
$22.59
|
|
|
CEFEPIME 2 G INJ SOLR
|
Facility
|
OP
|
$51.41
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.94 |
| Max. Negotiated Rate |
$47.81 |
| Rate for Payer: Aetna Commercial |
$43.39
|
| Rate for Payer: Aetna Medicare |
$16.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$29.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$32.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.10
|
| Rate for Payer: Cash Price |
$30.84
|
| Rate for Payer: Centivo All Commercial |
$27.97
|
| Rate for Payer: Cigna All Commercial |
$44.37
|
| Rate for Payer: CORVEL All Commercial |
$47.81
|
| Rate for Payer: Coventry All Commercial |
$45.24
|
| Rate for Payer: Encore All Commercial |
$47.32
|
| Rate for Payer: Frontpath All Commercial |
$47.30
|
| Rate for Payer: Humana ChoiceCare |
$44.40
|
| Rate for Payer: Humana Medicare |
$16.45
|
| Rate for Payer: Lucent All Commercial |
$27.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.27
|
| Rate for Payer: PHCS All Commercial |
$38.56
|
| Rate for Payer: PHP All Commercial |
$38.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.05
|
| Rate for Payer: Sagamore Health Network All Products |
$39.69
|
| Rate for Payer: Signature Care EPO |
$42.67
|
| Rate for Payer: Signature Care PPO |
$45.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.70
|
| Rate for Payer: United Healthcare Commercial |
$40.51
|
| Rate for Payer: United Healthcare Medicare |
$16.45
|
|
|
CEFEPIME 2 G INJ SOLR
|
Facility
|
IP
|
$51.41
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.56 |
| Max. Negotiated Rate |
$47.81 |
| Rate for Payer: Aetna Commercial |
$44.42
|
| Rate for Payer: Cash Price |
$30.84
|
| Rate for Payer: Cigna All Commercial |
$44.37
|
| Rate for Payer: CORVEL All Commercial |
$47.81
|
| Rate for Payer: Coventry All Commercial |
$45.24
|
| Rate for Payer: Encore All Commercial |
$47.32
|
| Rate for Payer: Frontpath All Commercial |
$47.30
|
| Rate for Payer: Humana ChoiceCare |
$44.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.27
|
| Rate for Payer: PHCS All Commercial |
$38.56
|
| Rate for Payer: PHP All Commercial |
$38.99
|
| Rate for Payer: Sagamore Health Network All Products |
$39.69
|
| Rate for Payer: Signature Care EPO |
$42.67
|
| Rate for Payer: Signature Care PPO |
$45.24
|
| Rate for Payer: United Healthcare Commercial |
$40.51
|
|
|
CEFOXITIN 2 G IV SOLR
|
Facility
|
OP
|
$44.63
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$41.50 |
| Rate for Payer: Aetna Commercial |
$37.66
|
| Rate for Payer: Aetna Medicare |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.71
|
| Rate for Payer: Cash Price |
$26.78
|
| Rate for Payer: Centivo All Commercial |
$24.28
|
| Rate for Payer: Cigna All Commercial |
$38.51
|
| Rate for Payer: CORVEL All Commercial |
$41.50
|
| Rate for Payer: Coventry All Commercial |
$39.27
|
| Rate for Payer: Encore All Commercial |
$41.08
|
| Rate for Payer: Frontpath All Commercial |
$41.05
|
| Rate for Payer: Humana ChoiceCare |
$38.54
|
| Rate for Payer: Humana Medicare |
$14.28
|
| Rate for Payer: Lucent All Commercial |
$24.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.16
|
| Rate for Payer: PHCS All Commercial |
$33.47
|
| Rate for Payer: PHP All Commercial |
$33.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.40
|
| Rate for Payer: Sagamore Health Network All Products |
$34.45
|
| Rate for Payer: Signature Care EPO |
$37.04
|
| Rate for Payer: Signature Care PPO |
$39.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$37.93
|
| Rate for Payer: United Healthcare Commercial |
$35.16
|
| Rate for Payer: United Healthcare Medicare |
$14.28
|
|
|
CEFOXITIN 2 G IV SOLR
|
Facility
|
IP
|
$44.63
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.47 |
| Max. Negotiated Rate |
$41.50 |
| Rate for Payer: Aetna Commercial |
$38.56
|
| Rate for Payer: Cash Price |
$26.78
|
| Rate for Payer: Cigna All Commercial |
$38.51
|
| Rate for Payer: CORVEL All Commercial |
$41.50
|
| Rate for Payer: Coventry All Commercial |
$39.27
|
| Rate for Payer: Encore All Commercial |
$41.08
|
| Rate for Payer: Frontpath All Commercial |
$41.05
|
| Rate for Payer: Humana ChoiceCare |
$38.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.16
|
| Rate for Payer: PHCS All Commercial |
$33.47
|
| Rate for Payer: PHP All Commercial |
$33.84
|
| Rate for Payer: Sagamore Health Network All Products |
$34.45
|
| Rate for Payer: Signature Care EPO |
$37.04
|
| Rate for Payer: Signature Care PPO |
$39.27
|
| Rate for Payer: United Healthcare Commercial |
$35.16
|
|
|
CEFPROZIL 250 MG/5 ML ORAL SUSR
|
Facility
|
IP
|
$273.70
|
|
|
Service Code
|
NDC 68180040201
|
| Hospital Charge Code |
9471
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$205.28 |
| Max. Negotiated Rate |
$254.54 |
| Rate for Payer: Aetna Commercial |
$236.48
|
| Rate for Payer: Cash Price |
$164.22
|
| Rate for Payer: Cigna All Commercial |
$236.20
|
| Rate for Payer: CORVEL All Commercial |
$254.54
|
| Rate for Payer: Coventry All Commercial |
$240.86
|
| Rate for Payer: Encore All Commercial |
$251.94
|
| Rate for Payer: Frontpath All Commercial |
$251.80
|
| Rate for Payer: Humana ChoiceCare |
$236.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.33
|
| Rate for Payer: PHCS All Commercial |
$205.28
|
| Rate for Payer: PHP All Commercial |
$207.57
|
| Rate for Payer: Sagamore Health Network All Products |
$211.30
|
| Rate for Payer: Signature Care EPO |
$227.17
|
| Rate for Payer: Signature Care PPO |
$240.86
|
| Rate for Payer: United Healthcare Commercial |
$215.68
|
|
|
CEFPROZIL 250 MG/5 ML ORAL SUSR
|
Facility
|
OP
|
$273.70
|
|
|
Service Code
|
NDC 68180040201
|
| Hospital Charge Code |
9471
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.85 |
| Max. Negotiated Rate |
$254.54 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Aetna Medicare |
$87.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$157.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.34
|
| Rate for Payer: Cash Price |
$164.22
|
| Rate for Payer: Centivo All Commercial |
$148.89
|
| Rate for Payer: Cigna All Commercial |
$236.20
|
| Rate for Payer: CORVEL All Commercial |
$254.54
|
| Rate for Payer: Coventry All Commercial |
$240.86
|
| Rate for Payer: Encore All Commercial |
$251.94
|
| Rate for Payer: Frontpath All Commercial |
$251.80
|
| Rate for Payer: Humana ChoiceCare |
$236.39
|
| Rate for Payer: Humana Medicare |
$87.58
|
| Rate for Payer: Lucent All Commercial |
$148.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.33
|
| Rate for Payer: PHCS All Commercial |
$205.28
|
| Rate for Payer: PHP All Commercial |
$207.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.74
|
| Rate for Payer: Sagamore Health Network All Products |
$211.30
|
| Rate for Payer: Signature Care EPO |
$227.17
|
| Rate for Payer: Signature Care PPO |
$240.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.65
|
| Rate for Payer: United Healthcare Commercial |
$215.68
|
| Rate for Payer: United Healthcare Medicare |
$87.58
|
|
|
CEFPROZIL 250 MG/5 ML ORAL SUSR 50 ML ED PACK (CAMERON)
|
Facility
|
OP
|
$273.70
|
|
|
Service Code
|
NDC 681800402
|
| Hospital Charge Code |
1.401E+12
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$84.85 |
| Max. Negotiated Rate |
$254.54 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Aetna Medicare |
$87.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$157.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.34
|
| Rate for Payer: Cash Price |
$164.22
|
| Rate for Payer: Centivo All Commercial |
$148.89
|
| Rate for Payer: Cigna All Commercial |
$236.20
|
| Rate for Payer: CORVEL All Commercial |
$254.54
|
| Rate for Payer: Coventry All Commercial |
$240.86
|
| Rate for Payer: Encore All Commercial |
$251.94
|
| Rate for Payer: Frontpath All Commercial |
$251.80
|
| Rate for Payer: Humana ChoiceCare |
$236.39
|
| Rate for Payer: Humana Medicare |
$87.58
|
| Rate for Payer: Lucent All Commercial |
$148.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.33
|
| Rate for Payer: PHCS All Commercial |
$205.28
|
| Rate for Payer: PHP All Commercial |
$207.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$106.74
|
| Rate for Payer: Sagamore Health Network All Products |
$211.30
|
| Rate for Payer: Signature Care EPO |
$227.17
|
| Rate for Payer: Signature Care PPO |
$240.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$232.65
|
| Rate for Payer: United Healthcare Commercial |
$215.68
|
| Rate for Payer: United Healthcare Medicare |
$87.58
|
|
|
CEFPROZIL 250 MG/5 ML ORAL SUSR 50 ML ED PACK (CAMERON)
|
Facility
|
IP
|
$273.70
|
|
|
Service Code
|
NDC 681800402
|
| Hospital Charge Code |
1.401E+12
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$205.28 |
| Max. Negotiated Rate |
$254.54 |
| Rate for Payer: Aetna Commercial |
$236.48
|
| Rate for Payer: Cash Price |
$164.22
|
| Rate for Payer: Cigna All Commercial |
$236.20
|
| Rate for Payer: CORVEL All Commercial |
$254.54
|
| Rate for Payer: Coventry All Commercial |
$240.86
|
| Rate for Payer: Encore All Commercial |
$251.94
|
| Rate for Payer: Frontpath All Commercial |
$251.80
|
| Rate for Payer: Humana ChoiceCare |
$236.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.33
|
| Rate for Payer: PHCS All Commercial |
$205.28
|
| Rate for Payer: PHP All Commercial |
$207.57
|
| Rate for Payer: Sagamore Health Network All Products |
$211.30
|
| Rate for Payer: Signature Care EPO |
$227.17
|
| Rate for Payer: Signature Care PPO |
$240.86
|
| Rate for Payer: United Healthcare Commercial |
$215.68
|
|
|
CEFPROZIL 500 MG ORAL TAB
|
Facility
|
IP
|
$7.06
|
|
|
Service Code
|
NDC 57237003750
|
| Hospital Charge Code |
9473
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$6.57 |
| Rate for Payer: Aetna Commercial |
$6.10
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cigna All Commercial |
$6.10
|
| Rate for Payer: CORVEL All Commercial |
$6.57
|
| Rate for Payer: Coventry All Commercial |
$6.22
|
| Rate for Payer: Encore All Commercial |
$6.50
|
| Rate for Payer: Frontpath All Commercial |
$6.50
|
| Rate for Payer: Humana ChoiceCare |
$6.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.36
|
| Rate for Payer: PHCS All Commercial |
$5.30
|
| Rate for Payer: PHP All Commercial |
$5.36
|
| Rate for Payer: Sagamore Health Network All Products |
$5.45
|
| Rate for Payer: Signature Care EPO |
$5.86
|
| Rate for Payer: Signature Care PPO |
$6.22
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
|
|
CEFPROZIL 500 MG ORAL TAB
|
Facility
|
OP
|
$7.06
|
|
|
Service Code
|
NDC 57237003750
|
| Hospital Charge Code |
9473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$6.57 |
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.49
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Centivo All Commercial |
$3.84
|
| Rate for Payer: Cigna All Commercial |
$6.10
|
| Rate for Payer: CORVEL All Commercial |
$6.57
|
| Rate for Payer: Coventry All Commercial |
$6.22
|
| Rate for Payer: Encore All Commercial |
$6.50
|
| Rate for Payer: Frontpath All Commercial |
$6.50
|
| Rate for Payer: Humana ChoiceCare |
$6.10
|
| Rate for Payer: Humana Medicare |
$2.26
|
| Rate for Payer: Lucent All Commercial |
$3.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.36
|
| Rate for Payer: PHCS All Commercial |
$5.30
|
| Rate for Payer: PHP All Commercial |
$5.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.75
|
| Rate for Payer: Sagamore Health Network All Products |
$5.45
|
| Rate for Payer: Signature Care EPO |
$5.86
|
| Rate for Payer: Signature Care PPO |
$6.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.00
|
| Rate for Payer: United Healthcare Commercial |
$5.57
|
| Rate for Payer: United Healthcare Medicare |
$2.26
|
|
|
CEFTAROLINE FOSAMIL 600 MG IV SOLR
|
Facility
|
OP
|
$965.48
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
107671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$897.89 |
| Rate for Payer: Aetna Commercial |
$814.86
|
| Rate for Payer: Aetna Medicare |
$308.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$299.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$554.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$603.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$4.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$355.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$339.85
|
| Rate for Payer: Cash Price |
$579.29
|
| Rate for Payer: Cash Price |
$579.29
|
| Rate for Payer: Centivo All Commercial |
$525.22
|
| Rate for Payer: Cigna All Commercial |
$833.20
|
| Rate for Payer: CORVEL All Commercial |
$897.89
|
| Rate for Payer: Coventry All Commercial |
$849.62
|
| Rate for Payer: Encore All Commercial |
$888.72
|
| Rate for Payer: Frontpath All Commercial |
$888.24
|
| Rate for Payer: Humana ChoiceCare |
$833.88
|
| Rate for Payer: Humana Medicare |
$308.95
|
| Rate for Payer: Lucent All Commercial |
$525.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.93
|
| Rate for Payer: Managed Health Services Medicaid |
$4.09
|
| Rate for Payer: MDWise Medicaid |
$4.09
|
| Rate for Payer: PHCS All Commercial |
$724.11
|
| Rate for Payer: PHP All Commercial |
$732.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$376.54
|
| Rate for Payer: Sagamore Health Network All Products |
$745.35
|
| Rate for Payer: Signature Care EPO |
$801.34
|
| Rate for Payer: Signature Care PPO |
$849.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$820.65
|
| Rate for Payer: United Healthcare Commercial |
$760.79
|
| Rate for Payer: United Healthcare Medicare |
$308.95
|
|
|
CEFTAROLINE FOSAMIL 600 MG IV SOLR
|
Facility
|
IP
|
$965.48
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
107671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$724.11 |
| Max. Negotiated Rate |
$897.89 |
| Rate for Payer: Aetna Commercial |
$834.17
|
| Rate for Payer: Cash Price |
$579.29
|
| Rate for Payer: Cigna All Commercial |
$833.20
|
| Rate for Payer: CORVEL All Commercial |
$897.89
|
| Rate for Payer: Coventry All Commercial |
$849.62
|
| Rate for Payer: Encore All Commercial |
$888.72
|
| Rate for Payer: Frontpath All Commercial |
$888.24
|
| Rate for Payer: Humana ChoiceCare |
$833.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$868.93
|
| Rate for Payer: PHCS All Commercial |
$724.11
|
| Rate for Payer: PHP All Commercial |
$732.22
|
| Rate for Payer: Sagamore Health Network All Products |
$745.35
|
| Rate for Payer: Signature Care EPO |
$801.34
|
| Rate for Payer: Signature Care PPO |
$849.62
|
| Rate for Payer: United Healthcare Commercial |
$760.79
|
|
|
CEFTAZIDIME 1 G INJ SOLR
|
Facility
|
OP
|
$21.27
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
9474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.59 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Aetna Commercial |
$17.95
|
| Rate for Payer: Aetna Medicare |
$6.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.49
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Centivo All Commercial |
$11.57
|
| Rate for Payer: Cigna All Commercial |
$18.35
|
| Rate for Payer: CORVEL All Commercial |
$19.78
|
| Rate for Payer: Coventry All Commercial |
$18.71
|
| Rate for Payer: Encore All Commercial |
$19.58
|
| Rate for Payer: Frontpath All Commercial |
$19.56
|
| Rate for Payer: Humana ChoiceCare |
$18.37
|
| Rate for Payer: Humana Medicare |
$6.81
|
| Rate for Payer: Lucent All Commercial |
$11.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.14
|
| Rate for Payer: PHCS All Commercial |
$15.95
|
| Rate for Payer: PHP All Commercial |
$16.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.29
|
| Rate for Payer: Sagamore Health Network All Products |
$16.42
|
| Rate for Payer: Signature Care EPO |
$17.65
|
| Rate for Payer: Signature Care PPO |
$18.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.08
|
| Rate for Payer: United Healthcare Commercial |
$16.76
|
| Rate for Payer: United Healthcare Medicare |
$6.81
|
|
|
CEFTAZIDIME 1 G INJ SOLR
|
Facility
|
IP
|
$21.27
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
9474
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.95 |
| Max. Negotiated Rate |
$19.78 |
| Rate for Payer: Aetna Commercial |
$18.37
|
| Rate for Payer: Cash Price |
$12.76
|
| Rate for Payer: Cigna All Commercial |
$18.35
|
| Rate for Payer: CORVEL All Commercial |
$19.78
|
| Rate for Payer: Coventry All Commercial |
$18.71
|
| Rate for Payer: Encore All Commercial |
$19.58
|
| Rate for Payer: Frontpath All Commercial |
$19.56
|
| Rate for Payer: Humana ChoiceCare |
$18.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.14
|
| Rate for Payer: PHCS All Commercial |
$15.95
|
| Rate for Payer: PHP All Commercial |
$16.13
|
| Rate for Payer: Sagamore Health Network All Products |
$16.42
|
| Rate for Payer: Signature Care EPO |
$17.65
|
| Rate for Payer: Signature Care PPO |
$18.71
|
| Rate for Payer: United Healthcare Commercial |
$16.76
|
|
|
CEFTAZIDIME 2 G INJ SOLR
|
Facility
|
IP
|
$60.27
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
9476
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Aetna Commercial |
$52.07
|
| Rate for Payer: Cash Price |
$36.16
|
| Rate for Payer: Cigna All Commercial |
$52.01
|
| Rate for Payer: CORVEL All Commercial |
$56.05
|
| Rate for Payer: Coventry All Commercial |
$53.04
|
| Rate for Payer: Encore All Commercial |
$55.48
|
| Rate for Payer: Frontpath All Commercial |
$55.45
|
| Rate for Payer: Humana ChoiceCare |
$52.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.24
|
| Rate for Payer: PHCS All Commercial |
$45.20
|
| Rate for Payer: PHP All Commercial |
$45.71
|
| Rate for Payer: Sagamore Health Network All Products |
$46.53
|
| Rate for Payer: Signature Care EPO |
$50.02
|
| Rate for Payer: Signature Care PPO |
$53.04
|
| Rate for Payer: United Healthcare Commercial |
$47.49
|
|
|
CEFTAZIDIME 2 G INJ SOLR
|
Facility
|
OP
|
$60.27
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
9476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.68 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Aetna Commercial |
$50.87
|
| Rate for Payer: Aetna Medicare |
$19.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$34.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.22
|
| Rate for Payer: Cash Price |
$36.16
|
| Rate for Payer: Centivo All Commercial |
$32.79
|
| Rate for Payer: Cigna All Commercial |
$52.01
|
| Rate for Payer: CORVEL All Commercial |
$56.05
|
| Rate for Payer: Coventry All Commercial |
$53.04
|
| Rate for Payer: Encore All Commercial |
$55.48
|
| Rate for Payer: Frontpath All Commercial |
$55.45
|
| Rate for Payer: Humana ChoiceCare |
$52.06
|
| Rate for Payer: Humana Medicare |
$19.29
|
| Rate for Payer: Lucent All Commercial |
$32.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.24
|
| Rate for Payer: PHCS All Commercial |
$45.20
|
| Rate for Payer: PHP All Commercial |
$45.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.51
|
| Rate for Payer: Sagamore Health Network All Products |
$46.53
|
| Rate for Payer: Signature Care EPO |
$50.02
|
| Rate for Payer: Signature Care PPO |
$53.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.23
|
| Rate for Payer: United Healthcare Commercial |
$47.49
|
| Rate for Payer: United Healthcare Medicare |
$19.29
|
|
|
CEFTRIAXONE 1 G INJ SOLR
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Centivo All Commercial |
$9.79
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$5.76
|
| Rate for Payer: Lucent All Commercial |
$9.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.76
|
|
