|
CHORIONIC GONADOTROPIN, HUMAN 5000 UNITS IM SOLR
|
Facility
|
OP
|
$348.13
|
|
|
Service Code
|
HCPCS J0725
|
| Hospital Charge Code |
1677
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$107.92 |
| Max. Negotiated Rate |
$323.76 |
| Rate for Payer: Aetna Commercial |
$293.82
|
| Rate for Payer: Aetna Medicare |
$111.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$199.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$217.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.54
|
| Rate for Payer: Cash Price |
$208.88
|
| Rate for Payer: Centivo All Commercial |
$189.38
|
| Rate for Payer: Cigna All Commercial |
$300.43
|
| Rate for Payer: CORVEL All Commercial |
$323.76
|
| Rate for Payer: Coventry All Commercial |
$306.35
|
| Rate for Payer: Encore All Commercial |
$320.45
|
| Rate for Payer: Frontpath All Commercial |
$320.28
|
| Rate for Payer: Humana ChoiceCare |
$300.68
|
| Rate for Payer: Humana Medicare |
$111.40
|
| Rate for Payer: Lucent All Commercial |
$189.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$313.32
|
| Rate for Payer: PHCS All Commercial |
$261.10
|
| Rate for Payer: PHP All Commercial |
$264.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.77
|
| Rate for Payer: Sagamore Health Network All Products |
$268.75
|
| Rate for Payer: Signature Care EPO |
$288.95
|
| Rate for Payer: Signature Care PPO |
$306.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$295.91
|
| Rate for Payer: United Healthcare Commercial |
$274.32
|
| Rate for Payer: United Healthcare Medicare |
$111.40
|
|
|
CHORIONIC GONADOTROPIN, HUMAN 5000 UNITS IM SOLR
|
Facility
|
IP
|
$348.13
|
|
|
Service Code
|
HCPCS J0725
|
| Hospital Charge Code |
1677
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$261.10 |
| Max. Negotiated Rate |
$323.76 |
| Rate for Payer: Aetna Commercial |
$300.78
|
| Rate for Payer: Cash Price |
$208.88
|
| Rate for Payer: Cigna All Commercial |
$300.43
|
| Rate for Payer: CORVEL All Commercial |
$323.76
|
| Rate for Payer: Coventry All Commercial |
$306.35
|
| Rate for Payer: Encore All Commercial |
$320.45
|
| Rate for Payer: Frontpath All Commercial |
$320.28
|
| Rate for Payer: Humana ChoiceCare |
$300.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$313.32
|
| Rate for Payer: PHCS All Commercial |
$261.10
|
| Rate for Payer: PHP All Commercial |
$264.02
|
| Rate for Payer: Sagamore Health Network All Products |
$268.75
|
| Rate for Payer: Signature Care EPO |
$288.95
|
| Rate for Payer: Signature Care PPO |
$306.35
|
| Rate for Payer: United Healthcare Commercial |
$274.32
|
|
|
CILOSTAZOL 100 MG ORAL TAB
|
Facility
|
OP
|
$4.81
|
|
|
Service Code
|
NDC 50268017715
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Aetna Commercial |
$4.06
|
| Rate for Payer: Aetna Medicare |
$1.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.69
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Centivo All Commercial |
$2.62
|
| Rate for Payer: Cigna All Commercial |
$4.15
|
| Rate for Payer: CORVEL All Commercial |
$4.47
|
| Rate for Payer: Coventry All Commercial |
$4.23
|
| Rate for Payer: Encore All Commercial |
$4.43
|
| Rate for Payer: Frontpath All Commercial |
$4.42
|
| Rate for Payer: Humana ChoiceCare |
$4.15
|
| Rate for Payer: Humana Medicare |
$1.54
|
| Rate for Payer: Lucent All Commercial |
$2.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.33
|
| Rate for Payer: PHCS All Commercial |
$3.61
|
| Rate for Payer: PHP All Commercial |
$3.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.88
|
| Rate for Payer: Sagamore Health Network All Products |
$3.71
|
| Rate for Payer: Signature Care EPO |
$3.99
|
| Rate for Payer: Signature Care PPO |
$4.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.09
|
| Rate for Payer: United Healthcare Commercial |
$3.79
|
| Rate for Payer: United Healthcare Medicare |
$1.54
|
|
|
CILOSTAZOL 100 MG ORAL TAB
|
Facility
|
IP
|
$4.81
|
|
|
Service Code
|
NDC 50268017715
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$4.47 |
| Rate for Payer: Aetna Commercial |
$4.15
|
| Rate for Payer: Cash Price |
$2.89
|
| Rate for Payer: Cigna All Commercial |
$4.15
|
| Rate for Payer: CORVEL All Commercial |
$4.47
|
| Rate for Payer: Coventry All Commercial |
$4.23
|
| Rate for Payer: Encore All Commercial |
$4.43
|
| Rate for Payer: Frontpath All Commercial |
$4.42
|
| Rate for Payer: Humana ChoiceCare |
$4.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.33
|
| Rate for Payer: PHCS All Commercial |
$3.61
|
| Rate for Payer: PHP All Commercial |
$3.65
|
| Rate for Payer: Sagamore Health Network All Products |
$3.71
|
| Rate for Payer: Signature Care EPO |
$3.99
|
| Rate for Payer: Signature Care PPO |
$4.23
|
| Rate for Payer: United Healthcare Commercial |
$3.79
|
|
|
CINACALCET 30 MG ORAL TAB
|
Facility
|
OP
|
$1.91
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
38100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna Commercial |
$1.61
|
| Rate for Payer: Aetna Medicare |
$0.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.67
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Centivo All Commercial |
$1.04
|
| Rate for Payer: Cigna All Commercial |
$1.65
|
| Rate for Payer: CORVEL All Commercial |
$1.78
|
| Rate for Payer: Coventry All Commercial |
$1.68
|
| Rate for Payer: Encore All Commercial |
$1.76
|
| Rate for Payer: Frontpath All Commercial |
$1.76
|
| Rate for Payer: Humana ChoiceCare |
$1.65
|
| Rate for Payer: Humana Medicare |
$0.61
|
| Rate for Payer: Lucent All Commercial |
$1.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.72
|
| Rate for Payer: PHCS All Commercial |
$1.43
|
| Rate for Payer: PHP All Commercial |
$1.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1.48
|
| Rate for Payer: Signature Care EPO |
$1.59
|
| Rate for Payer: Signature Care PPO |
$1.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.62
|
| Rate for Payer: United Healthcare Commercial |
$1.51
|
| Rate for Payer: United Healthcare Medicare |
$0.61
|
|
|
CINACALCET 30 MG ORAL TAB
|
Facility
|
IP
|
$1.91
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
38100
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna Commercial |
$1.65
|
| Rate for Payer: Cash Price |
$1.15
|
| Rate for Payer: Cigna All Commercial |
$1.65
|
| Rate for Payer: CORVEL All Commercial |
$1.78
|
| Rate for Payer: Coventry All Commercial |
$1.68
|
| Rate for Payer: Encore All Commercial |
$1.76
|
| Rate for Payer: Frontpath All Commercial |
$1.76
|
| Rate for Payer: Humana ChoiceCare |
$1.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.72
|
| Rate for Payer: PHCS All Commercial |
$1.43
|
| Rate for Payer: PHP All Commercial |
$1.45
|
| Rate for Payer: Sagamore Health Network All Products |
$1.48
|
| Rate for Payer: Signature Care EPO |
$1.59
|
| Rate for Payer: Signature Care PPO |
$1.68
|
| Rate for Payer: United Healthcare Commercial |
$1.51
|
|
|
CIPROFLOXACIN 6 % (6 MG/0.1 ML) ITYM SUSP
|
Facility
|
OP
|
$1,132.80
|
|
|
Service Code
|
HCPCS J7342
|
| Hospital Charge Code |
176190
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$351.17 |
| Max. Negotiated Rate |
$1,053.50 |
| Rate for Payer: Aetna Commercial |
$956.08
|
| Rate for Payer: Aetna Medicare |
$362.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$351.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$650.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$708.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$416.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$398.75
|
| Rate for Payer: Cash Price |
$679.68
|
| Rate for Payer: Centivo All Commercial |
$616.24
|
| Rate for Payer: Cigna All Commercial |
$977.61
|
| Rate for Payer: CORVEL All Commercial |
$1,053.50
|
| Rate for Payer: Coventry All Commercial |
$996.86
|
| Rate for Payer: Encore All Commercial |
$1,042.74
|
| Rate for Payer: Frontpath All Commercial |
$1,042.18
|
| Rate for Payer: Humana ChoiceCare |
$978.40
|
| Rate for Payer: Humana Medicare |
$362.50
|
| Rate for Payer: Lucent All Commercial |
$616.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,019.52
|
| Rate for Payer: PHCS All Commercial |
$849.60
|
| Rate for Payer: PHP All Commercial |
$859.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$441.79
|
| Rate for Payer: Sagamore Health Network All Products |
$874.52
|
| Rate for Payer: Signature Care EPO |
$940.22
|
| Rate for Payer: Signature Care PPO |
$996.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$962.88
|
| Rate for Payer: United Healthcare Commercial |
$892.65
|
| Rate for Payer: United Healthcare Medicare |
$362.50
|
|
|
CIPROFLOXACIN 6 % (6 MG/0.1 ML) ITYM SUSP
|
Facility
|
IP
|
$1,132.80
|
|
|
Service Code
|
HCPCS J7342
|
| Hospital Charge Code |
176190
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$849.60 |
| Max. Negotiated Rate |
$1,053.50 |
| Rate for Payer: Aetna Commercial |
$978.74
|
| Rate for Payer: Cash Price |
$679.68
|
| Rate for Payer: Cigna All Commercial |
$977.61
|
| Rate for Payer: CORVEL All Commercial |
$1,053.50
|
| Rate for Payer: Coventry All Commercial |
$996.86
|
| Rate for Payer: Encore All Commercial |
$1,042.74
|
| Rate for Payer: Frontpath All Commercial |
$1,042.18
|
| Rate for Payer: Humana ChoiceCare |
$978.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,019.52
|
| Rate for Payer: PHCS All Commercial |
$849.60
|
| Rate for Payer: PHP All Commercial |
$859.12
|
| Rate for Payer: Sagamore Health Network All Products |
$874.52
|
| Rate for Payer: Signature Care EPO |
$940.22
|
| Rate for Payer: Signature Care PPO |
$996.86
|
| Rate for Payer: United Healthcare Commercial |
$892.65
|
|
|
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS
|
Facility
|
OP
|
$1,042.46
|
|
|
Service Code
|
NDC 00781618667
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$969.49 |
| Rate for Payer: Aetna Commercial |
$879.84
|
| Rate for Payer: Aetna Medicare |
$333.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$323.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$598.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$651.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$383.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$366.95
|
| Rate for Payer: Cash Price |
$625.48
|
| Rate for Payer: Cash Price |
$625.48
|
| Rate for Payer: Centivo All Commercial |
$567.10
|
| Rate for Payer: Cigna All Commercial |
$899.65
|
| Rate for Payer: CORVEL All Commercial |
$969.49
|
| Rate for Payer: Coventry All Commercial |
$917.37
|
| Rate for Payer: Encore All Commercial |
$959.59
|
| Rate for Payer: Frontpath All Commercial |
$959.07
|
| Rate for Payer: Humana ChoiceCare |
$900.38
|
| Rate for Payer: Humana Medicare |
$333.59
|
| Rate for Payer: Lucent All Commercial |
$567.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$938.22
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$781.85
|
| Rate for Payer: PHP All Commercial |
$790.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$406.56
|
| Rate for Payer: Sagamore Health Network All Products |
$804.78
|
| Rate for Payer: Signature Care EPO |
$865.24
|
| Rate for Payer: Signature Care PPO |
$917.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$886.09
|
| Rate for Payer: United Healthcare Commercial |
$821.46
|
| Rate for Payer: United Healthcare Medicare |
$333.59
|
|
|
CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OTIC DRPS
|
Facility
|
IP
|
$1,042.46
|
|
|
Service Code
|
NDC 00781618667
|
| Hospital Charge Code |
36576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$781.85 |
| Max. Negotiated Rate |
$969.49 |
| Rate for Payer: Aetna Commercial |
$900.69
|
| Rate for Payer: Cash Price |
$625.48
|
| Rate for Payer: Cigna All Commercial |
$899.65
|
| Rate for Payer: CORVEL All Commercial |
$969.49
|
| Rate for Payer: Coventry All Commercial |
$917.37
|
| Rate for Payer: Encore All Commercial |
$959.59
|
| Rate for Payer: Frontpath All Commercial |
$959.07
|
| Rate for Payer: Humana ChoiceCare |
$900.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$938.22
|
| Rate for Payer: PHCS All Commercial |
$781.85
|
| Rate for Payer: PHP All Commercial |
$790.60
|
| Rate for Payer: Sagamore Health Network All Products |
$804.78
|
| Rate for Payer: Signature Care EPO |
$865.24
|
| Rate for Payer: Signature Care PPO |
$917.37
|
| Rate for Payer: United Healthcare Commercial |
$821.46
|
|
|
CIPROFLOXACIN HCL 0.3 % OPHT DROP
|
Facility
|
OP
|
$33.11
|
|
|
Service Code
|
NDC 69315030802
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$30.79 |
| Rate for Payer: Aetna Commercial |
$27.94
|
| Rate for Payer: Aetna Medicare |
$10.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$19.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.65
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Centivo All Commercial |
$18.01
|
| Rate for Payer: Cigna All Commercial |
$28.57
|
| Rate for Payer: CORVEL All Commercial |
$30.79
|
| Rate for Payer: Coventry All Commercial |
$29.14
|
| Rate for Payer: Encore All Commercial |
$30.48
|
| Rate for Payer: Frontpath All Commercial |
$30.46
|
| Rate for Payer: Humana ChoiceCare |
$28.60
|
| Rate for Payer: Humana Medicare |
$10.60
|
| Rate for Payer: Lucent All Commercial |
$18.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.80
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$24.83
|
| Rate for Payer: PHP All Commercial |
$25.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.91
|
| Rate for Payer: Sagamore Health Network All Products |
$25.56
|
| Rate for Payer: Signature Care EPO |
$27.48
|
| Rate for Payer: Signature Care PPO |
$29.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28.14
|
| Rate for Payer: United Healthcare Commercial |
$26.09
|
| Rate for Payer: United Healthcare Medicare |
$10.60
|
|
|
CIPROFLOXACIN HCL 0.3 % OPHT DROP
|
Facility
|
IP
|
$33.11
|
|
|
Service Code
|
NDC 69315030802
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$30.79 |
| Rate for Payer: Aetna Commercial |
$28.61
|
| Rate for Payer: Cash Price |
$19.87
|
| Rate for Payer: Cigna All Commercial |
$28.57
|
| Rate for Payer: CORVEL All Commercial |
$30.79
|
| Rate for Payer: Coventry All Commercial |
$29.14
|
| Rate for Payer: Encore All Commercial |
$30.48
|
| Rate for Payer: Frontpath All Commercial |
$30.46
|
| Rate for Payer: Humana ChoiceCare |
$28.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.80
|
| Rate for Payer: PHCS All Commercial |
$24.83
|
| Rate for Payer: PHP All Commercial |
$25.11
|
| Rate for Payer: Sagamore Health Network All Products |
$25.56
|
| Rate for Payer: Signature Care EPO |
$27.48
|
| Rate for Payer: Signature Care PPO |
$29.14
|
| Rate for Payer: United Healthcare Commercial |
$26.09
|
|
|
CISATRACURIUM 2 MG/ML IV SOLN
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
NDC 71288071206
|
| Hospital Charge Code |
16168
|
|
Hospital Revenue Code
|
250
|
| 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 Medicaid |
$9.56
|
| 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 Hoosier Healthwise/HIP |
$9.56
|
| 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: 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: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| 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
|
|
|
CISATRACURIUM 2 MG/ML IV SOLN
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
NDC 71288071206
|
| Hospital Charge Code |
16168
|
|
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
|
|
|
CITALOPRAM 20 MG ORAL TAB
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
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
|
|
|
CITALOPRAM 20 MG ORAL TAB
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 00904608561
|
| Hospital Charge Code |
21062
|
|
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
|
|
|
CLINDAMYCIN HCL 150 MG ORAL CAP
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 00904595961
|
| Hospital Charge Code |
1740
|
|
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
|
|
|
CLINDAMYCIN HCL 150 MG ORAL CAP
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 00904595961
|
| Hospital Charge Code |
1740
|
|
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
|
|
|
CLINDAMYCIN IN 0.9 % SOD CHLOR 600 MG/50 ML IV PGBK
|
Facility
|
IP
|
$55.30
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
181019
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$51.43 |
| Rate for Payer: Aetna Commercial |
$47.78
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cigna All Commercial |
$47.72
|
| Rate for Payer: CORVEL All Commercial |
$51.43
|
| Rate for Payer: Coventry All Commercial |
$48.66
|
| Rate for Payer: Encore All Commercial |
$50.90
|
| Rate for Payer: Frontpath All Commercial |
$50.88
|
| Rate for Payer: Humana ChoiceCare |
$47.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.77
|
| Rate for Payer: PHCS All Commercial |
$41.48
|
| Rate for Payer: PHP All Commercial |
$41.94
|
| Rate for Payer: Sagamore Health Network All Products |
$42.69
|
| Rate for Payer: Signature Care EPO |
$45.90
|
| Rate for Payer: Signature Care PPO |
$48.66
|
| Rate for Payer: United Healthcare Commercial |
$43.58
|
|
|
CLINDAMYCIN IN 0.9 % SOD CHLOR 600 MG/50 ML IV PGBK
|
Facility
|
OP
|
$55.30
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
181019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$51.43 |
| Rate for Payer: Aetna Commercial |
$46.67
|
| Rate for Payer: Aetna Medicare |
$17.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$31.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.47
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Centivo All Commercial |
$30.08
|
| Rate for Payer: Cigna All Commercial |
$47.72
|
| Rate for Payer: CORVEL All Commercial |
$51.43
|
| Rate for Payer: Coventry All Commercial |
$48.66
|
| Rate for Payer: Encore All Commercial |
$50.90
|
| Rate for Payer: Frontpath All Commercial |
$50.88
|
| Rate for Payer: Humana ChoiceCare |
$47.76
|
| Rate for Payer: Humana Medicare |
$17.70
|
| Rate for Payer: Lucent All Commercial |
$30.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.77
|
| Rate for Payer: PHCS All Commercial |
$41.48
|
| Rate for Payer: PHP All Commercial |
$41.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.57
|
| Rate for Payer: Sagamore Health Network All Products |
$42.69
|
| Rate for Payer: Signature Care EPO |
$45.90
|
| Rate for Payer: Signature Care PPO |
$48.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.01
|
| Rate for Payer: United Healthcare Commercial |
$43.58
|
| Rate for Payer: United Healthcare Medicare |
$17.70
|
|
|
CLINDAMYCIN IN 0.9 % SOD CHLOR 900 MG/50 ML IV PGBK
|
Facility
|
OP
|
$66.15
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
181020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.51 |
| Max. Negotiated Rate |
$61.52 |
| Rate for Payer: Aetna Commercial |
$55.83
|
| Rate for Payer: Aetna Medicare |
$21.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$37.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.28
|
| Rate for Payer: Cash Price |
$39.69
|
| Rate for Payer: Centivo All Commercial |
$35.99
|
| Rate for Payer: Cigna All Commercial |
$57.09
|
| Rate for Payer: CORVEL All Commercial |
$61.52
|
| Rate for Payer: Coventry All Commercial |
$58.21
|
| Rate for Payer: Encore All Commercial |
$60.89
|
| Rate for Payer: Frontpath All Commercial |
$60.86
|
| Rate for Payer: Humana ChoiceCare |
$57.13
|
| Rate for Payer: Humana Medicare |
$21.17
|
| Rate for Payer: Lucent All Commercial |
$35.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.53
|
| Rate for Payer: PHCS All Commercial |
$49.61
|
| Rate for Payer: PHP All Commercial |
$50.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.80
|
| Rate for Payer: Sagamore Health Network All Products |
$51.07
|
| Rate for Payer: Signature Care EPO |
$54.90
|
| Rate for Payer: Signature Care PPO |
$58.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.23
|
| Rate for Payer: United Healthcare Commercial |
$52.13
|
| Rate for Payer: United Healthcare Medicare |
$21.17
|
|
|
CLINDAMYCIN IN 0.9 % SOD CHLOR 900 MG/50 ML IV PGBK
|
Facility
|
IP
|
$66.15
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
181020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.61 |
| Max. Negotiated Rate |
$61.52 |
| Rate for Payer: Aetna Commercial |
$57.15
|
| Rate for Payer: Cash Price |
$39.69
|
| Rate for Payer: Cigna All Commercial |
$57.09
|
| Rate for Payer: CORVEL All Commercial |
$61.52
|
| Rate for Payer: Coventry All Commercial |
$58.21
|
| Rate for Payer: Encore All Commercial |
$60.89
|
| Rate for Payer: Frontpath All Commercial |
$60.86
|
| Rate for Payer: Humana ChoiceCare |
$57.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.53
|
| Rate for Payer: PHCS All Commercial |
$49.61
|
| Rate for Payer: PHP All Commercial |
$50.17
|
| Rate for Payer: Sagamore Health Network All Products |
$51.07
|
| Rate for Payer: Signature Care EPO |
$54.90
|
| Rate for Payer: Signature Care PPO |
$58.21
|
| Rate for Payer: United Healthcare Commercial |
$52.13
|
|
|
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK
|
Facility
|
IP
|
$36.75
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9625
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.56 |
| Max. Negotiated Rate |
$34.18 |
| Rate for Payer: Aetna Commercial |
$31.75
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna All Commercial |
$31.72
|
| Rate for Payer: CORVEL All Commercial |
$34.18
|
| Rate for Payer: Coventry All Commercial |
$32.34
|
| Rate for Payer: Encore All Commercial |
$33.83
|
| Rate for Payer: Frontpath All Commercial |
$33.81
|
| Rate for Payer: Humana ChoiceCare |
$31.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.08
|
| Rate for Payer: PHCS All Commercial |
$27.56
|
| Rate for Payer: PHP All Commercial |
$27.87
|
| Rate for Payer: Sagamore Health Network All Products |
$28.37
|
| Rate for Payer: Signature Care EPO |
$30.50
|
| Rate for Payer: Signature Care PPO |
$32.34
|
| Rate for Payer: United Healthcare Commercial |
$28.96
|
|
|
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK
|
Facility
|
OP
|
$36.75
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9625
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.39 |
| Max. Negotiated Rate |
$34.18 |
| Rate for Payer: Aetna Commercial |
$31.02
|
| Rate for Payer: Aetna Medicare |
$11.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$21.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.94
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Centivo All Commercial |
$19.99
|
| Rate for Payer: Cigna All Commercial |
$31.72
|
| Rate for Payer: CORVEL All Commercial |
$34.18
|
| Rate for Payer: Coventry All Commercial |
$32.34
|
| Rate for Payer: Encore All Commercial |
$33.83
|
| Rate for Payer: Frontpath All Commercial |
$33.81
|
| Rate for Payer: Humana ChoiceCare |
$31.74
|
| Rate for Payer: Humana Medicare |
$11.76
|
| Rate for Payer: Lucent All Commercial |
$19.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.08
|
| Rate for Payer: PHCS All Commercial |
$27.56
|
| Rate for Payer: PHP All Commercial |
$27.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.33
|
| Rate for Payer: Sagamore Health Network All Products |
$28.37
|
| Rate for Payer: Signature Care EPO |
$30.50
|
| Rate for Payer: Signature Care PPO |
$32.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$31.24
|
| Rate for Payer: United Healthcare Commercial |
$28.96
|
| Rate for Payer: United Healthcare Medicare |
$11.76
|
|
|
CLINDAMYCIN IN 5 % DEXTROSE 600 MG/50 ML IV PGBK
|
Facility
|
IP
|
$55.30
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.48 |
| Max. Negotiated Rate |
$51.43 |
| Rate for Payer: Aetna Commercial |
$47.78
|
| Rate for Payer: Cash Price |
$33.18
|
| Rate for Payer: Cigna All Commercial |
$47.72
|
| Rate for Payer: CORVEL All Commercial |
$51.43
|
| Rate for Payer: Coventry All Commercial |
$48.66
|
| Rate for Payer: Encore All Commercial |
$50.90
|
| Rate for Payer: Frontpath All Commercial |
$50.88
|
| Rate for Payer: Humana ChoiceCare |
$47.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.77
|
| Rate for Payer: PHCS All Commercial |
$41.48
|
| Rate for Payer: PHP All Commercial |
$41.94
|
| Rate for Payer: Sagamore Health Network All Products |
$42.69
|
| Rate for Payer: Signature Care EPO |
$45.90
|
| Rate for Payer: Signature Care PPO |
$48.66
|
| Rate for Payer: United Healthcare Commercial |
$43.58
|
|
