|
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
|
|
|
CEFTRIAXONE 250 MG INJ SOLR
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9489
|
|
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
|
|
|
CEFTRIAXONE 250 MG INJ SOLR
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9489
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
CEFTRIAXONE 2 G INJ SOLR
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9488
|
|
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
|
|
|
CEFTRIAXONE 2 G INJ SOLR
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9488
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
CEFTRIAXONE 500 MG INJ SOLR
|
Facility
|
OP
|
$5.84
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.81 |
| Max. Negotiated Rate |
$5.43 |
| Rate for Payer: Aetna Commercial |
$4.93
|
| Rate for Payer: Aetna Medicare |
$1.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.05
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Centivo All Commercial |
$3.18
|
| Rate for Payer: Cigna All Commercial |
$5.04
|
| Rate for Payer: CORVEL All Commercial |
$5.43
|
| Rate for Payer: Coventry All Commercial |
$5.14
|
| Rate for Payer: Encore All Commercial |
$5.37
|
| Rate for Payer: Frontpath All Commercial |
$5.37
|
| Rate for Payer: Humana ChoiceCare |
$5.04
|
| Rate for Payer: Humana Medicare |
$1.87
|
| Rate for Payer: Lucent All Commercial |
$3.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.25
|
| Rate for Payer: PHCS All Commercial |
$4.38
|
| Rate for Payer: PHP All Commercial |
$4.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.28
|
| Rate for Payer: Sagamore Health Network All Products |
$4.51
|
| Rate for Payer: Signature Care EPO |
$4.85
|
| Rate for Payer: Signature Care PPO |
$5.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.96
|
| Rate for Payer: United Healthcare Commercial |
$4.60
|
| Rate for Payer: United Healthcare Medicare |
$1.87
|
|
|
CEFTRIAXONE 500 MG INJ SOLR
|
Facility
|
IP
|
$5.84
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.38 |
| Max. Negotiated Rate |
$5.43 |
| Rate for Payer: Aetna Commercial |
$5.04
|
| Rate for Payer: Cash Price |
$3.50
|
| Rate for Payer: Cigna All Commercial |
$5.04
|
| Rate for Payer: CORVEL All Commercial |
$5.43
|
| Rate for Payer: Coventry All Commercial |
$5.14
|
| Rate for Payer: Encore All Commercial |
$5.37
|
| Rate for Payer: Frontpath All Commercial |
$5.37
|
| Rate for Payer: Humana ChoiceCare |
$5.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.25
|
| Rate for Payer: PHCS All Commercial |
$4.38
|
| Rate for Payer: PHP All Commercial |
$4.43
|
| Rate for Payer: Sagamore Health Network All Products |
$4.51
|
| Rate for Payer: Signature Care EPO |
$4.85
|
| Rate for Payer: Signature Care PPO |
$5.14
|
| Rate for Payer: United Healthcare Commercial |
$4.60
|
|
|
CEFTRIAXONE IN DEXTROSE,ISO-OS 1 GRAM/50 ML IV PGBK
|
Facility
|
OP
|
$122.09
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9492
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.85 |
| Max. Negotiated Rate |
$113.55 |
| Rate for Payer: Aetna Commercial |
$103.05
|
| Rate for Payer: Aetna Medicare |
$39.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$70.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.98
|
| Rate for Payer: Cash Price |
$73.26
|
| Rate for Payer: Centivo All Commercial |
$66.42
|
| Rate for Payer: Cigna All Commercial |
$105.37
|
| Rate for Payer: CORVEL All Commercial |
$113.55
|
| Rate for Payer: Coventry All Commercial |
$107.44
|
| Rate for Payer: Encore All Commercial |
$112.39
|
| Rate for Payer: Frontpath All Commercial |
$112.33
|
| Rate for Payer: Humana ChoiceCare |
$105.45
|
| Rate for Payer: Humana Medicare |
$39.07
|
| Rate for Payer: Lucent All Commercial |
$66.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.88
|
| Rate for Payer: PHCS All Commercial |
$91.57
|
| Rate for Payer: PHP All Commercial |
$92.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$47.62
|
| Rate for Payer: Sagamore Health Network All Products |
$94.26
|
| Rate for Payer: Signature Care EPO |
$101.34
|
| Rate for Payer: Signature Care PPO |
$107.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$103.78
|
| Rate for Payer: United Healthcare Commercial |
$96.21
|
| Rate for Payer: United Healthcare Medicare |
$39.07
|
|
|
CEFTRIAXONE IN DEXTROSE,ISO-OS 1 GRAM/50 ML IV PGBK
|
Facility
|
IP
|
$122.09
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9492
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.57 |
| Max. Negotiated Rate |
$113.55 |
| Rate for Payer: Aetna Commercial |
$105.49
|
| Rate for Payer: Cash Price |
$73.26
|
| Rate for Payer: Cigna All Commercial |
$105.37
|
| Rate for Payer: CORVEL All Commercial |
$113.55
|
| Rate for Payer: Coventry All Commercial |
$107.44
|
| Rate for Payer: Encore All Commercial |
$112.39
|
| Rate for Payer: Frontpath All Commercial |
$112.33
|
| Rate for Payer: Humana ChoiceCare |
$105.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.88
|
| Rate for Payer: PHCS All Commercial |
$91.57
|
| Rate for Payer: PHP All Commercial |
$92.60
|
| Rate for Payer: Sagamore Health Network All Products |
$94.26
|
| Rate for Payer: Signature Care EPO |
$101.34
|
| Rate for Payer: Signature Care PPO |
$107.44
|
| Rate for Payer: United Healthcare Commercial |
$96.21
|
|
|
CEFUROXIME SODIUM 1.5 G IV SOLR
|
Facility
|
OP
|
$38.30
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
111827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.87 |
| Max. Negotiated Rate |
$35.62 |
| Rate for Payer: Aetna Commercial |
$32.32
|
| 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 |
$21.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.48
|
| Rate for Payer: Cash Price |
$22.98
|
| Rate for Payer: Centivo All Commercial |
$20.83
|
| Rate for Payer: Cigna All Commercial |
$33.05
|
| Rate for Payer: CORVEL All Commercial |
$35.62
|
| Rate for Payer: Coventry All Commercial |
$33.70
|
| Rate for Payer: Encore All Commercial |
$35.25
|
| Rate for Payer: Frontpath All Commercial |
$35.23
|
| Rate for Payer: Humana ChoiceCare |
$33.08
|
| Rate for Payer: Humana Medicare |
$12.26
|
| Rate for Payer: Lucent All Commercial |
$20.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.47
|
| Rate for Payer: PHCS All Commercial |
$28.72
|
| Rate for Payer: PHP All Commercial |
$29.04
|
| 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 |
$33.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.55
|
| Rate for Payer: United Healthcare Commercial |
$30.18
|
| Rate for Payer: United Healthcare Medicare |
$12.26
|
|
|
CEFUROXIME SODIUM 1.5 G IV SOLR
|
Facility
|
IP
|
$38.30
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
111827
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$28.72 |
| 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 |
$33.05
|
| Rate for Payer: CORVEL All Commercial |
$35.62
|
| Rate for Payer: Coventry All Commercial |
$33.70
|
| Rate for Payer: Encore All Commercial |
$35.25
|
| Rate for Payer: Frontpath All Commercial |
$35.23
|
| Rate for Payer: Humana ChoiceCare |
$33.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.47
|
| Rate for Payer: PHCS All Commercial |
$28.72
|
| Rate for Payer: PHP All Commercial |
$29.04
|
| Rate for Payer: Sagamore Health Network All Products |
$29.57
|
| Rate for Payer: Signature Care EPO |
$31.79
|
| Rate for Payer: Signature Care PPO |
$33.70
|
| Rate for Payer: United Healthcare Commercial |
$30.18
|
|
|
CELECOXIB 100 MG ORAL CAP
|
Facility
|
IP
|
$5.61
|
|
|
Service Code
|
NDC 60687043611
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna Commercial |
$4.85
|
| Rate for Payer: Cash Price |
$3.37
|
| Rate for Payer: Cigna All Commercial |
$4.84
|
| Rate for Payer: CORVEL All Commercial |
$5.22
|
| Rate for Payer: Coventry All Commercial |
$4.94
|
| Rate for Payer: Encore All Commercial |
$5.17
|
| Rate for Payer: Frontpath All Commercial |
$5.16
|
| Rate for Payer: Humana ChoiceCare |
$4.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.05
|
| Rate for Payer: PHCS All Commercial |
$4.21
|
| Rate for Payer: PHP All Commercial |
$4.26
|
| Rate for Payer: Sagamore Health Network All Products |
$4.33
|
| Rate for Payer: Signature Care EPO |
$4.66
|
| Rate for Payer: Signature Care PPO |
$4.94
|
| Rate for Payer: United Healthcare Commercial |
$4.42
|
|
|
CELECOXIB 100 MG ORAL CAP
|
Facility
|
OP
|
$5.61
|
|
|
Service Code
|
NDC 60687043611
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna Commercial |
$4.74
|
| Rate for Payer: Aetna Medicare |
$1.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.98
|
| Rate for Payer: Cash Price |
$3.37
|
| Rate for Payer: Centivo All Commercial |
$3.05
|
| Rate for Payer: Cigna All Commercial |
$4.84
|
| Rate for Payer: CORVEL All Commercial |
$5.22
|
| Rate for Payer: Coventry All Commercial |
$4.94
|
| Rate for Payer: Encore All Commercial |
$5.17
|
| Rate for Payer: Frontpath All Commercial |
$5.16
|
| Rate for Payer: Humana ChoiceCare |
$4.85
|
| Rate for Payer: Humana Medicare |
$1.80
|
| Rate for Payer: Lucent All Commercial |
$3.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.05
|
| Rate for Payer: PHCS All Commercial |
$4.21
|
| Rate for Payer: PHP All Commercial |
$4.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.19
|
| Rate for Payer: Sagamore Health Network All Products |
$4.33
|
| Rate for Payer: Signature Care EPO |
$4.66
|
| Rate for Payer: Signature Care PPO |
$4.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.77
|
| Rate for Payer: United Healthcare Commercial |
$4.42
|
| Rate for Payer: United Healthcare Medicare |
$1.80
|
|
|
CELECOXIB 100 MG ORAL CAP
|
Facility
|
OP
|
$5.61
|
|
|
Service Code
|
NDC 60687043601
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna Commercial |
$4.74
|
| Rate for Payer: Aetna Medicare |
$1.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.98
|
| Rate for Payer: Cash Price |
$3.37
|
| Rate for Payer: Centivo All Commercial |
$3.05
|
| Rate for Payer: Cigna All Commercial |
$4.84
|
| Rate for Payer: CORVEL All Commercial |
$5.22
|
| Rate for Payer: Coventry All Commercial |
$4.94
|
| Rate for Payer: Encore All Commercial |
$5.17
|
| Rate for Payer: Frontpath All Commercial |
$5.16
|
| Rate for Payer: Humana ChoiceCare |
$4.85
|
| Rate for Payer: Humana Medicare |
$1.80
|
| Rate for Payer: Lucent All Commercial |
$3.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.05
|
| Rate for Payer: PHCS All Commercial |
$4.21
|
| Rate for Payer: PHP All Commercial |
$4.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.19
|
| Rate for Payer: Sagamore Health Network All Products |
$4.33
|
| Rate for Payer: Signature Care EPO |
$4.66
|
| Rate for Payer: Signature Care PPO |
$4.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.77
|
| Rate for Payer: United Healthcare Commercial |
$4.42
|
| Rate for Payer: United Healthcare Medicare |
$1.80
|
|
|
CELECOXIB 100 MG ORAL CAP
|
Facility
|
IP
|
$5.61
|
|
|
Service Code
|
NDC 60687043601
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.21 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Aetna Commercial |
$4.85
|
| Rate for Payer: Cash Price |
$3.37
|
| Rate for Payer: Cigna All Commercial |
$4.84
|
| Rate for Payer: CORVEL All Commercial |
$5.22
|
| Rate for Payer: Coventry All Commercial |
$4.94
|
| Rate for Payer: Encore All Commercial |
$5.17
|
| Rate for Payer: Frontpath All Commercial |
$5.16
|
| Rate for Payer: Humana ChoiceCare |
$4.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.05
|
| Rate for Payer: PHCS All Commercial |
$4.21
|
| Rate for Payer: PHP All Commercial |
$4.26
|
| Rate for Payer: Sagamore Health Network All Products |
$4.33
|
| Rate for Payer: Signature Care EPO |
$4.66
|
| Rate for Payer: Signature Care PPO |
$4.94
|
| Rate for Payer: United Healthcare Commercial |
$4.42
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSR
|
Facility
|
OP
|
$148.40
|
|
|
Service Code
|
NDC 68180044101
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$138.01 |
| Rate for Payer: Aetna Commercial |
$125.25
|
| Rate for Payer: Aetna Medicare |
$47.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$85.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$54.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.24
|
| Rate for Payer: Cash Price |
$89.04
|
| Rate for Payer: Centivo All Commercial |
$80.73
|
| Rate for Payer: Cigna All Commercial |
$128.07
|
| Rate for Payer: CORVEL All Commercial |
$138.01
|
| Rate for Payer: Coventry All Commercial |
$130.59
|
| Rate for Payer: Encore All Commercial |
$136.60
|
| Rate for Payer: Frontpath All Commercial |
$136.53
|
| Rate for Payer: Humana ChoiceCare |
$128.17
|
| Rate for Payer: Humana Medicare |
$47.49
|
| Rate for Payer: Lucent All Commercial |
$80.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.56
|
| Rate for Payer: PHCS All Commercial |
$111.30
|
| Rate for Payer: PHP All Commercial |
$112.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.88
|
| Rate for Payer: Sagamore Health Network All Products |
$114.56
|
| Rate for Payer: Signature Care EPO |
$123.17
|
| Rate for Payer: Signature Care PPO |
$130.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.14
|
| Rate for Payer: United Healthcare Commercial |
$116.94
|
| Rate for Payer: United Healthcare Medicare |
$47.49
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSR
|
Facility
|
IP
|
$148.40
|
|
|
Service Code
|
NDC 68180044101
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$138.01 |
| Rate for Payer: Aetna Commercial |
$128.22
|
| Rate for Payer: Cash Price |
$89.04
|
| Rate for Payer: Cigna All Commercial |
$128.07
|
| Rate for Payer: CORVEL All Commercial |
$138.01
|
| Rate for Payer: Coventry All Commercial |
$130.59
|
| Rate for Payer: Encore All Commercial |
$136.60
|
| Rate for Payer: Frontpath All Commercial |
$136.53
|
| Rate for Payer: Humana ChoiceCare |
$128.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.56
|
| Rate for Payer: PHCS All Commercial |
$111.30
|
| Rate for Payer: PHP All Commercial |
$112.55
|
| Rate for Payer: Sagamore Health Network All Products |
$114.56
|
| Rate for Payer: Signature Care EPO |
$123.17
|
| Rate for Payer: Signature Care PPO |
$130.59
|
| Rate for Payer: United Healthcare Commercial |
$116.94
|
|
|
CEPHALEXIN 250 MG ORAL CAP
|
Facility
|
OP
|
$2.02
|
|
|
Service Code
|
NDC 60687015201
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna Commercial |
$1.71
|
| Rate for Payer: Aetna Medicare |
$0.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.71
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Centivo All Commercial |
$1.10
|
| Rate for Payer: Cigna All Commercial |
$1.75
|
| Rate for Payer: CORVEL All Commercial |
$1.88
|
| Rate for Payer: Coventry All Commercial |
$1.78
|
| Rate for Payer: Encore All Commercial |
$1.86
|
| Rate for Payer: Frontpath All Commercial |
$1.86
|
| Rate for Payer: Humana ChoiceCare |
$1.75
|
| Rate for Payer: Humana Medicare |
$0.65
|
| Rate for Payer: Lucent All Commercial |
$1.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.82
|
| Rate for Payer: PHCS All Commercial |
$1.52
|
| Rate for Payer: PHP All Commercial |
$1.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.79
|
| Rate for Payer: Sagamore Health Network All Products |
$1.56
|
| Rate for Payer: Signature Care EPO |
$1.68
|
| Rate for Payer: Signature Care PPO |
$1.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.72
|
| Rate for Payer: United Healthcare Commercial |
$1.59
|
| Rate for Payer: United Healthcare Medicare |
$0.65
|
|
|
CEPHALEXIN 250 MG ORAL CAP
|
Facility
|
IP
|
$2.02
|
|
|
Service Code
|
NDC 60687015201
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.52 |
| Max. Negotiated Rate |
$1.88 |
| Rate for Payer: Aetna Commercial |
$1.75
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Cigna All Commercial |
$1.75
|
| Rate for Payer: CORVEL All Commercial |
$1.88
|
| Rate for Payer: Coventry All Commercial |
$1.78
|
| Rate for Payer: Encore All Commercial |
$1.86
|
| Rate for Payer: Frontpath All Commercial |
$1.86
|
| Rate for Payer: Humana ChoiceCare |
$1.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.82
|
| Rate for Payer: PHCS All Commercial |
$1.52
|
| Rate for Payer: PHP All Commercial |
$1.53
|
| Rate for Payer: Sagamore Health Network All Products |
$1.56
|
| Rate for Payer: Signature Care EPO |
$1.68
|
| Rate for Payer: Signature Care PPO |
$1.78
|
| Rate for Payer: United Healthcare Commercial |
$1.59
|
|
|
CEPHALEXIN 500 MG ORAL CAP
|
Facility
|
OP
|
$2.74
|
|
|
Service Code
|
NDC 60687016301
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna Commercial |
$2.31
|
| Rate for Payer: Aetna Medicare |
$0.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.96
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Centivo All Commercial |
$1.49
|
| Rate for Payer: Cigna All Commercial |
$2.36
|
| Rate for Payer: CORVEL All Commercial |
$2.55
|
| Rate for Payer: Coventry All Commercial |
$2.41
|
| Rate for Payer: Encore All Commercial |
$2.52
|
| Rate for Payer: Frontpath All Commercial |
$2.52
|
| Rate for Payer: Humana ChoiceCare |
$2.36
|
| Rate for Payer: Humana Medicare |
$0.88
|
| Rate for Payer: Lucent All Commercial |
$1.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.46
|
| Rate for Payer: PHCS All Commercial |
$2.05
|
| Rate for Payer: PHP All Commercial |
$2.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.07
|
| Rate for Payer: Sagamore Health Network All Products |
$2.11
|
| Rate for Payer: Signature Care EPO |
$2.27
|
| Rate for Payer: Signature Care PPO |
$2.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.33
|
| Rate for Payer: United Healthcare Commercial |
$2.16
|
| Rate for Payer: United Healthcare Medicare |
$0.88
|
|
|
CEPHALEXIN 500 MG ORAL CAP
|
Facility
|
IP
|
$2.74
|
|
|
Service Code
|
NDC 60687016301
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$1.64
|
| Rate for Payer: Cigna All Commercial |
$2.36
|
| Rate for Payer: CORVEL All Commercial |
$2.55
|
| Rate for Payer: Coventry All Commercial |
$2.41
|
| Rate for Payer: Encore All Commercial |
$2.52
|
| Rate for Payer: Frontpath All Commercial |
$2.52
|
| Rate for Payer: Humana ChoiceCare |
$2.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.46
|
| Rate for Payer: PHCS All Commercial |
$2.05
|
| Rate for Payer: PHP All Commercial |
$2.08
|
| Rate for Payer: Sagamore Health Network All Products |
$2.11
|
| Rate for Payer: Signature Care EPO |
$2.27
|
| Rate for Payer: Signature Care PPO |
$2.41
|
| Rate for Payer: United Healthcare Commercial |
$2.16
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT
|
Facility
|
IP
|
$20,165.95
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
97853
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15,124.46 |
| Max. Negotiated Rate |
$18,754.33 |
| Rate for Payer: Aetna Commercial |
$17,423.38
|
| Rate for Payer: Cash Price |
$12,099.57
|
| Rate for Payer: Cigna All Commercial |
$17,403.21
|
| Rate for Payer: CORVEL All Commercial |
$18,754.33
|
| Rate for Payer: Coventry All Commercial |
$17,746.04
|
| Rate for Payer: Encore All Commercial |
$18,562.76
|
| Rate for Payer: Frontpath All Commercial |
$18,552.67
|
| Rate for Payer: Humana ChoiceCare |
$17,417.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18,149.35
|
| Rate for Payer: PHCS All Commercial |
$15,124.46
|
| Rate for Payer: PHP All Commercial |
$15,293.86
|
| Rate for Payer: Sagamore Health Network All Products |
$15,568.11
|
| Rate for Payer: Signature Care EPO |
$16,737.74
|
| Rate for Payer: Signature Care PPO |
$17,746.04
|
| Rate for Payer: United Healthcare Commercial |
$15,890.77
|
|
|
CERTOLIZUMAB PEGOL 400 MG/2 ML (200 MG/ML X 2) SUBQ SYKT
|
Facility
|
OP
|
$20,165.95
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
97853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$18,754.33 |
| Rate for Payer: Aetna Commercial |
$17,020.06
|
| Rate for Payer: Aetna Medicare |
$6,453.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6,251.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11,581.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12,605.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7,421.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7,098.41
|
| Rate for Payer: Cash Price |
$12,099.57
|
| Rate for Payer: Cash Price |
$12,099.57
|
| Rate for Payer: Centivo All Commercial |
$10,970.28
|
| Rate for Payer: Cigna All Commercial |
$17,403.21
|
| Rate for Payer: CORVEL All Commercial |
$18,754.33
|
| Rate for Payer: Coventry All Commercial |
$17,746.04
|
| Rate for Payer: Encore All Commercial |
$18,562.76
|
| Rate for Payer: Frontpath All Commercial |
$18,552.67
|
| Rate for Payer: Humana ChoiceCare |
$17,417.33
|
| Rate for Payer: Humana Medicare |
$6,453.10
|
| Rate for Payer: Lucent All Commercial |
$10,970.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18,149.35
|
| Rate for Payer: Managed Health Services Medicaid |
$15.75
|
| Rate for Payer: MDWise Medicaid |
$15.75
|
| Rate for Payer: PHCS All Commercial |
$15,124.46
|
| Rate for Payer: PHP All Commercial |
$15,293.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7,864.72
|
| Rate for Payer: Sagamore Health Network All Products |
$15,568.11
|
| Rate for Payer: Signature Care EPO |
$16,737.74
|
| Rate for Payer: Signature Care PPO |
$17,746.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17,141.06
|
| Rate for Payer: United Healthcare Commercial |
$15,890.77
|
| Rate for Payer: United Healthcare Medicare |
$6,453.10
|
|
|
CETIRIZINE 10 MG ORAL TAB
|
Facility
|
IP
|
$1.23
|
|
|
Service Code
|
NDC 51079059720
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna Commercial |
$1.06
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Cigna All Commercial |
$1.06
|
| Rate for Payer: CORVEL All Commercial |
$1.14
|
| Rate for Payer: Coventry All Commercial |
$1.08
|
| Rate for Payer: Encore All Commercial |
$1.13
|
| Rate for Payer: Frontpath All Commercial |
$1.13
|
| Rate for Payer: Humana ChoiceCare |
$1.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.10
|
| Rate for Payer: PHCS All Commercial |
$0.92
|
| Rate for Payer: PHP All Commercial |
$0.93
|
| Rate for Payer: Sagamore Health Network All Products |
$0.95
|
| Rate for Payer: Signature Care EPO |
$1.02
|
| Rate for Payer: Signature Care PPO |
$1.08
|
| Rate for Payer: United Healthcare Commercial |
$0.97
|
|
|
CETIRIZINE 10 MG ORAL TAB
|
Facility
|
OP
|
$0.85
|
|
|
Service Code
|
NDC 00904671761
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.26 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Aetna Commercial |
$0.72
|
| Rate for Payer: Aetna Medicare |
$0.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.30
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Centivo All Commercial |
$0.46
|
| Rate for Payer: Cigna All Commercial |
$0.74
|
| Rate for Payer: CORVEL All Commercial |
$0.79
|
| Rate for Payer: Coventry All Commercial |
$0.75
|
| Rate for Payer: Encore All Commercial |
$0.79
|
| Rate for Payer: Frontpath All Commercial |
$0.79
|
| Rate for Payer: Humana ChoiceCare |
$0.74
|
| Rate for Payer: Humana Medicare |
$0.27
|
| Rate for Payer: Lucent All Commercial |
$0.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.77
|
| Rate for Payer: PHCS All Commercial |
$0.64
|
| Rate for Payer: PHP All Commercial |
$0.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.33
|
| Rate for Payer: Sagamore Health Network All Products |
$0.66
|
| Rate for Payer: Signature Care EPO |
$0.71
|
| Rate for Payer: Signature Care PPO |
$0.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.73
|
| Rate for Payer: United Healthcare Commercial |
$0.67
|
| Rate for Payer: United Healthcare Medicare |
$0.27
|
|
