|
CEFAZOLIN IN DEXTROSE (ISO-OS) 1 GRAM/50 ML IV PGBK
|
Facility
|
OP
|
$82.36
|
|
|
Service Code
|
HCPCS J0689
|
| Hospital Charge Code |
25365
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.18 |
| Max. Negotiated Rate |
$76.59 |
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: Aetna Medicare |
$27.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.89
|
| Rate for Payer: Cash Price |
$51.06
|
| Rate for Payer: Centivo All Commercial |
$42.00
|
| Rate for Payer: Cigna All Commercial |
$71.07
|
| Rate for Payer: CORVEL All Commercial |
$76.59
|
| Rate for Payer: Coventry All Commercial |
$72.47
|
| Rate for Payer: Encore All Commercial |
$75.81
|
| Rate for Payer: Frontpath All Commercial |
$75.77
|
| Rate for Payer: Humana ChoiceCare |
$71.13
|
| Rate for Payer: Humana Medicare |
$42.00
|
| Rate for Payer: Lucent All Commercial |
$42.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.12
|
| Rate for Payer: PHCS All Commercial |
$61.77
|
| Rate for Payer: PHP All Commercial |
$62.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.12
|
| Rate for Payer: Sagamore Health Network All Products |
$63.58
|
| Rate for Payer: Signature Care EPO |
$68.35
|
| Rate for Payer: Signature Care PPO |
$72.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$64.90
|
| Rate for Payer: United Healthcare Medicare |
$27.18
|
|
|
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 G/100 ML IV PGBK
|
Facility
|
IP
|
$98.70
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
174932
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$74.02 |
| Max. Negotiated Rate |
$91.79 |
| Rate for Payer: Aetna Commercial |
$85.28
|
| Rate for Payer: Cash Price |
$61.19
|
| Rate for Payer: Cigna All Commercial |
$85.18
|
| Rate for Payer: CORVEL All Commercial |
$91.79
|
| Rate for Payer: Coventry All Commercial |
$86.86
|
| Rate for Payer: Encore All Commercial |
$90.85
|
| Rate for Payer: Frontpath All Commercial |
$90.80
|
| Rate for Payer: Humana ChoiceCare |
$85.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.83
|
| Rate for Payer: PHCS All Commercial |
$74.02
|
| Rate for Payer: PHP All Commercial |
$74.85
|
| Rate for Payer: Sagamore Health Network All Products |
$76.20
|
| Rate for Payer: Signature Care EPO |
$81.92
|
| Rate for Payer: Signature Care PPO |
$86.86
|
| Rate for Payer: United Healthcare Commercial |
$77.78
|
|
|
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 G/100 ML IV PGBK
|
Facility
|
OP
|
$98.70
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
174932
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.57 |
| Max. Negotiated Rate |
$91.79 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Medicare |
$32.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$56.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.83
|
| Rate for Payer: Cash Price |
$61.19
|
| Rate for Payer: Centivo All Commercial |
$50.34
|
| Rate for Payer: Cigna All Commercial |
$85.18
|
| Rate for Payer: CORVEL All Commercial |
$91.79
|
| Rate for Payer: Coventry All Commercial |
$86.86
|
| Rate for Payer: Encore All Commercial |
$90.85
|
| Rate for Payer: Frontpath All Commercial |
$90.80
|
| Rate for Payer: Humana ChoiceCare |
$85.25
|
| Rate for Payer: Humana Medicare |
$50.34
|
| Rate for Payer: Lucent All Commercial |
$50.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.83
|
| Rate for Payer: PHCS All Commercial |
$74.02
|
| Rate for Payer: PHP All Commercial |
$74.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.49
|
| Rate for Payer: Sagamore Health Network All Products |
$76.20
|
| Rate for Payer: Signature Care EPO |
$81.92
|
| Rate for Payer: Signature Care PPO |
$86.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.90
|
| Rate for Payer: United Healthcare Commercial |
$77.78
|
| Rate for Payer: United Healthcare Medicare |
$32.57
|
|
|
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK
|
Facility
|
OP
|
$92.65
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
154207
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.57 |
| Max. Negotiated Rate |
$86.16 |
| Rate for Payer: Aetna Commercial |
$78.19
|
| Rate for Payer: Aetna Medicare |
$30.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$53.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.63
|
| Rate for Payer: Cash Price |
$57.44
|
| Rate for Payer: Centivo All Commercial |
$47.25
|
| Rate for Payer: Cigna All Commercial |
$79.95
|
| Rate for Payer: CORVEL All Commercial |
$86.16
|
| Rate for Payer: Coventry All Commercial |
$81.53
|
| Rate for Payer: Encore All Commercial |
$85.28
|
| Rate for Payer: Frontpath All Commercial |
$85.23
|
| Rate for Payer: Humana ChoiceCare |
$80.02
|
| Rate for Payer: Humana Medicare |
$47.25
|
| Rate for Payer: Lucent All Commercial |
$47.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.38
|
| Rate for Payer: PHCS All Commercial |
$69.48
|
| Rate for Payer: PHP All Commercial |
$70.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.13
|
| Rate for Payer: Sagamore Health Network All Products |
$71.52
|
| Rate for Payer: Signature Care EPO |
$76.90
|
| Rate for Payer: Signature Care PPO |
$81.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.75
|
| Rate for Payer: United Healthcare Commercial |
$73.00
|
| Rate for Payer: United Healthcare Medicare |
$30.57
|
|
|
CEFAZOLIN IN DEXTROSE (ISO-OS) 2 GRAM/50 ML IV PGBK
|
Facility
|
IP
|
$92.65
|
|
|
Service Code
|
HCPCS J0690
|
| Hospital Charge Code |
154207
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$69.48 |
| Max. Negotiated Rate |
$86.16 |
| Rate for Payer: Aetna Commercial |
$80.05
|
| Rate for Payer: Cash Price |
$57.44
|
| Rate for Payer: Cigna All Commercial |
$79.95
|
| Rate for Payer: CORVEL All Commercial |
$86.16
|
| Rate for Payer: Coventry All Commercial |
$81.53
|
| Rate for Payer: Encore All Commercial |
$85.28
|
| Rate for Payer: Frontpath All Commercial |
$85.23
|
| Rate for Payer: Humana ChoiceCare |
$80.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$83.38
|
| Rate for Payer: PHCS All Commercial |
$69.48
|
| Rate for Payer: PHP All Commercial |
$70.26
|
| Rate for Payer: Sagamore Health Network All Products |
$71.52
|
| Rate for Payer: Signature Care EPO |
$76.90
|
| Rate for Payer: Signature Care PPO |
$81.53
|
| Rate for Payer: United Healthcare Commercial |
$73.00
|
|
|
CEFAZOLIN SKIN TEST (CAMERON)
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
NDC 605050749
|
| Hospital Charge Code |
1401000700003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| 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 |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| 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 |
$5.94
|
|
|
CEFAZOLIN SKIN TEST (CAMERON)
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
NDC 605050749
|
| Hospital Charge Code |
1401000700003
|
|
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 |
$11.16
|
| 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
|
|
|
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 |
$42.97 |
| Max. Negotiated Rate |
$121.09 |
| Rate for Payer: Aetna Commercial |
$109.89
|
| Rate for Payer: Aetna Medicare |
$42.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$74.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.26
|
| Rate for Payer: Cash Price |
$80.72
|
| Rate for Payer: Centivo All Commercial |
$66.40
|
| 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 |
$66.40
|
| Rate for Payer: Lucent All Commercial |
$66.40
|
| 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 |
$42.97
|
|
|
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 |
$80.72
|
| 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
|
OP
|
$18.45
|
|
|
Service Code
|
NDC 60687069911
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$17.16 |
| Rate for Payer: Aetna Commercial |
$15.57
|
| Rate for Payer: Aetna Medicare |
$6.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.70
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Centivo All Commercial |
$9.41
|
| Rate for Payer: Cigna All Commercial |
$15.92
|
| Rate for Payer: CORVEL All Commercial |
$17.16
|
| Rate for Payer: Coventry All Commercial |
$16.24
|
| Rate for Payer: Encore All Commercial |
$16.99
|
| Rate for Payer: Frontpath All Commercial |
$16.98
|
| Rate for Payer: Humana ChoiceCare |
$15.94
|
| Rate for Payer: Humana Medicare |
$9.41
|
| Rate for Payer: Lucent All Commercial |
$9.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.61
|
| Rate for Payer: PHCS All Commercial |
$13.84
|
| Rate for Payer: PHP All Commercial |
$13.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.20
|
| Rate for Payer: Sagamore Health Network All Products |
$14.24
|
| Rate for Payer: Signature Care EPO |
$15.32
|
| Rate for Payer: Signature Care PPO |
$16.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.68
|
| Rate for Payer: United Healthcare Commercial |
$14.54
|
| Rate for Payer: United Healthcare Medicare |
$6.09
|
|
|
CEFDINIR 300 MG ORAL CAP
|
Facility
|
IP
|
$18.45
|
|
|
Service Code
|
NDC 60687069921
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$17.16 |
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cigna All Commercial |
$15.92
|
| Rate for Payer: CORVEL All Commercial |
$17.16
|
| Rate for Payer: Coventry All Commercial |
$16.24
|
| Rate for Payer: Encore All Commercial |
$16.99
|
| Rate for Payer: Frontpath All Commercial |
$16.98
|
| Rate for Payer: Humana ChoiceCare |
$15.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.61
|
| Rate for Payer: PHCS All Commercial |
$13.84
|
| Rate for Payer: PHP All Commercial |
$13.99
|
| Rate for Payer: Sagamore Health Network All Products |
$14.24
|
| Rate for Payer: Signature Care EPO |
$15.32
|
| Rate for Payer: Signature Care PPO |
$16.24
|
| Rate for Payer: United Healthcare Commercial |
$14.54
|
|
|
CEFDINIR 300 MG ORAL CAP
|
Facility
|
OP
|
$18.45
|
|
|
Service Code
|
NDC 60687069921
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.09 |
| Max. Negotiated Rate |
$17.16 |
| Rate for Payer: Aetna Commercial |
$15.57
|
| Rate for Payer: Aetna Medicare |
$6.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.70
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Centivo All Commercial |
$9.41
|
| Rate for Payer: Cigna All Commercial |
$15.92
|
| Rate for Payer: CORVEL All Commercial |
$17.16
|
| Rate for Payer: Coventry All Commercial |
$16.24
|
| Rate for Payer: Encore All Commercial |
$16.99
|
| Rate for Payer: Frontpath All Commercial |
$16.98
|
| Rate for Payer: Humana ChoiceCare |
$15.94
|
| Rate for Payer: Humana Medicare |
$9.41
|
| Rate for Payer: Lucent All Commercial |
$9.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.61
|
| Rate for Payer: PHCS All Commercial |
$13.84
|
| Rate for Payer: PHP All Commercial |
$13.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.20
|
| Rate for Payer: Sagamore Health Network All Products |
$14.24
|
| Rate for Payer: Signature Care EPO |
$15.32
|
| Rate for Payer: Signature Care PPO |
$16.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.68
|
| Rate for Payer: United Healthcare Commercial |
$14.54
|
| Rate for Payer: United Healthcare Medicare |
$6.09
|
|
|
CEFDINIR 300 MG ORAL CAP
|
Facility
|
IP
|
$18.45
|
|
|
Service Code
|
NDC 60687069911
|
| Hospital Charge Code |
22289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$17.16 |
| Rate for Payer: Aetna Commercial |
$15.94
|
| Rate for Payer: Cash Price |
$11.44
|
| Rate for Payer: Cigna All Commercial |
$15.92
|
| Rate for Payer: CORVEL All Commercial |
$17.16
|
| Rate for Payer: Coventry All Commercial |
$16.24
|
| Rate for Payer: Encore All Commercial |
$16.99
|
| Rate for Payer: Frontpath All Commercial |
$16.98
|
| Rate for Payer: Humana ChoiceCare |
$15.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.61
|
| Rate for Payer: PHCS All Commercial |
$13.84
|
| Rate for Payer: PHP All Commercial |
$13.99
|
| Rate for Payer: Sagamore Health Network All Products |
$14.24
|
| Rate for Payer: Signature Care EPO |
$15.32
|
| Rate for Payer: Signature Care PPO |
$16.24
|
| Rate for Payer: United Healthcare Commercial |
$14.54
|
|
|
CEFEPIME 1 G INJ SOLR
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.75 |
| Max. Negotiated Rate |
$26.97 |
| Rate for Payer: Aetna Commercial |
$25.06
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Cigna All Commercial |
$25.03
|
| Rate for Payer: CORVEL All Commercial |
$26.97
|
| Rate for Payer: Coventry All Commercial |
$25.52
|
| Rate for Payer: Encore All Commercial |
$26.70
|
| Rate for Payer: Frontpath All Commercial |
$26.68
|
| Rate for Payer: Humana ChoiceCare |
$25.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.10
|
| Rate for Payer: PHCS All Commercial |
$21.75
|
| Rate for Payer: PHP All Commercial |
$21.99
|
| Rate for Payer: Sagamore Health Network All Products |
$22.39
|
| Rate for Payer: Signature Care EPO |
$24.07
|
| Rate for Payer: Signature Care PPO |
$25.52
|
| Rate for Payer: United Healthcare Commercial |
$22.85
|
|
|
CEFEPIME 1 G INJ SOLR
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16369
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.57 |
| Max. Negotiated Rate |
$26.97 |
| Rate for Payer: Aetna Commercial |
$24.48
|
| Rate for Payer: Aetna Medicare |
$9.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.53
|
| Rate for Payer: Cash Price |
$17.98
|
| Rate for Payer: Centivo All Commercial |
$14.79
|
| Rate for Payer: Cigna All Commercial |
$25.03
|
| Rate for Payer: CORVEL All Commercial |
$26.97
|
| Rate for Payer: Coventry All Commercial |
$25.52
|
| Rate for Payer: Encore All Commercial |
$26.70
|
| Rate for Payer: Frontpath All Commercial |
$26.68
|
| Rate for Payer: Humana ChoiceCare |
$25.05
|
| Rate for Payer: Humana Medicare |
$14.79
|
| Rate for Payer: Lucent All Commercial |
$14.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.10
|
| Rate for Payer: PHCS All Commercial |
$21.75
|
| Rate for Payer: PHP All Commercial |
$21.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.31
|
| Rate for Payer: Sagamore Health Network All Products |
$22.39
|
| Rate for Payer: Signature Care EPO |
$24.07
|
| Rate for Payer: Signature Care PPO |
$25.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.65
|
| Rate for Payer: United Healthcare Commercial |
$22.85
|
| Rate for Payer: United Healthcare Medicare |
$9.57
|
|
|
CEFEPIME 2 G INJ SOLR
|
Facility
|
OP
|
$52.02
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.17 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna Commercial |
$43.90
|
| Rate for Payer: Aetna Medicare |
$17.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$32.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.88
|
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: Centivo All Commercial |
$26.53
|
| Rate for Payer: Cigna All Commercial |
$44.89
|
| Rate for Payer: CORVEL All Commercial |
$48.38
|
| Rate for Payer: Coventry All Commercial |
$45.77
|
| Rate for Payer: Encore All Commercial |
$47.88
|
| Rate for Payer: Frontpath All Commercial |
$47.86
|
| Rate for Payer: Humana ChoiceCare |
$44.93
|
| Rate for Payer: Humana Medicare |
$26.53
|
| Rate for Payer: Lucent All Commercial |
$26.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.82
|
| Rate for Payer: PHCS All Commercial |
$39.01
|
| Rate for Payer: PHP All Commercial |
$39.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.29
|
| Rate for Payer: Sagamore Health Network All Products |
$40.16
|
| Rate for Payer: Signature Care EPO |
$43.17
|
| Rate for Payer: Signature Care PPO |
$45.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44.21
|
| Rate for Payer: United Healthcare Commercial |
$40.99
|
| Rate for Payer: United Healthcare Medicare |
$17.17
|
|
|
CEFEPIME 2 G INJ SOLR
|
Facility
|
IP
|
$52.02
|
|
|
Service Code
|
HCPCS J0692
|
| Hospital Charge Code |
16371
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.01 |
| Max. Negotiated Rate |
$48.38 |
| Rate for Payer: Aetna Commercial |
$44.94
|
| Rate for Payer: Cash Price |
$32.25
|
| Rate for Payer: Cigna All Commercial |
$44.89
|
| Rate for Payer: CORVEL All Commercial |
$48.38
|
| Rate for Payer: Coventry All Commercial |
$45.77
|
| Rate for Payer: Encore All Commercial |
$47.88
|
| Rate for Payer: Frontpath All Commercial |
$47.86
|
| Rate for Payer: Humana ChoiceCare |
$44.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.82
|
| Rate for Payer: PHCS All Commercial |
$39.01
|
| Rate for Payer: PHP All Commercial |
$39.45
|
| Rate for Payer: Sagamore Health Network All Products |
$40.16
|
| Rate for Payer: Signature Care EPO |
$43.17
|
| Rate for Payer: Signature Care PPO |
$45.77
|
| Rate for Payer: United Healthcare Commercial |
$40.99
|
|
|
CEFOXITIN 2 G IV SOLR
|
Facility
|
OP
|
$45.15
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.90 |
| Max. Negotiated Rate |
$41.99 |
| Rate for Payer: Aetna Commercial |
$38.11
|
| Rate for Payer: Aetna Medicare |
$14.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$14.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.39
|
| Rate for Payer: Cash Price |
$27.99
|
| Rate for Payer: Centivo All Commercial |
$23.03
|
| Rate for Payer: Cigna All Commercial |
$38.96
|
| Rate for Payer: CORVEL All Commercial |
$41.99
|
| Rate for Payer: Coventry All Commercial |
$39.73
|
| Rate for Payer: Encore All Commercial |
$41.56
|
| Rate for Payer: Frontpath All Commercial |
$41.54
|
| Rate for Payer: Humana ChoiceCare |
$39.00
|
| Rate for Payer: Humana Medicare |
$23.03
|
| Rate for Payer: Lucent All Commercial |
$23.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.64
|
| Rate for Payer: PHCS All Commercial |
$33.86
|
| Rate for Payer: PHP All Commercial |
$34.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.61
|
| Rate for Payer: Sagamore Health Network All Products |
$34.86
|
| Rate for Payer: Signature Care EPO |
$37.47
|
| Rate for Payer: Signature Care PPO |
$39.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38.38
|
| Rate for Payer: United Healthcare Commercial |
$35.58
|
| Rate for Payer: United Healthcare Medicare |
$14.90
|
|
|
CEFOXITIN 2 G IV SOLR
|
Facility
|
IP
|
$45.15
|
|
|
Service Code
|
HCPCS J0694
|
| Hospital Charge Code |
9463
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.86 |
| Max. Negotiated Rate |
$41.99 |
| Rate for Payer: Aetna Commercial |
$39.01
|
| Rate for Payer: Cash Price |
$27.99
|
| Rate for Payer: Cigna All Commercial |
$38.96
|
| Rate for Payer: CORVEL All Commercial |
$41.99
|
| Rate for Payer: Coventry All Commercial |
$39.73
|
| Rate for Payer: Encore All Commercial |
$41.56
|
| Rate for Payer: Frontpath All Commercial |
$41.54
|
| Rate for Payer: Humana ChoiceCare |
$39.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.64
|
| Rate for Payer: PHCS All Commercial |
$33.86
|
| Rate for Payer: PHP All Commercial |
$34.24
|
| Rate for Payer: Sagamore Health Network All Products |
$34.86
|
| Rate for Payer: Signature Care EPO |
$37.47
|
| Rate for Payer: Signature Care PPO |
$39.73
|
| Rate for Payer: United Healthcare Commercial |
$35.58
|
|
|
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 |
$169.69
|
| 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 |
$90.32 |
| Max. Negotiated Rate |
$254.54 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Aetna Medicare |
$90.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$157.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.35
|
| Rate for Payer: Cash Price |
$169.69
|
| Rate for Payer: Centivo All Commercial |
$139.59
|
| 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 |
$139.59
|
| Rate for Payer: Lucent All Commercial |
$139.59
|
| 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 |
$232.64
|
| Rate for Payer: United Healthcare Commercial |
$215.68
|
| Rate for Payer: United Healthcare Medicare |
$90.32
|
|
|
CEFPROZIL 250 MG/5 ML ORAL SUSR 50 ML ED PACK (CAMERON)
|
Facility
|
OP
|
$273.70
|
|
|
Service Code
|
NDC 681800402
|
| Hospital Charge Code |
1401000800947
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$90.32 |
| Max. Negotiated Rate |
$254.54 |
| Rate for Payer: Aetna Commercial |
$231.00
|
| Rate for Payer: Aetna Medicare |
$90.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$157.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$171.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.35
|
| Rate for Payer: Cash Price |
$169.69
|
| Rate for Payer: Centivo All Commercial |
$139.59
|
| 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 |
$139.59
|
| Rate for Payer: Lucent All Commercial |
$139.59
|
| 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 |
$232.64
|
| Rate for Payer: United Healthcare Commercial |
$215.68
|
| Rate for Payer: United Healthcare Medicare |
$90.32
|
|
|
CEFPROZIL 250 MG/5 ML ORAL SUSR 50 ML ED PACK (CAMERON)
|
Facility
|
IP
|
$273.70
|
|
|
Service Code
|
NDC 681800402
|
| Hospital Charge Code |
1401000800947
|
|
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 |
$169.69
|
| 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
|
$7.05
|
|
|
Service Code
|
NDC 57237003750
|
| Hospital Charge Code |
9473
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$6.56 |
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cigna All Commercial |
$6.08
|
| Rate for Payer: CORVEL All Commercial |
$6.56
|
| Rate for Payer: Coventry All Commercial |
$6.20
|
| Rate for Payer: Encore All Commercial |
$6.49
|
| Rate for Payer: Frontpath All Commercial |
$6.49
|
| Rate for Payer: Humana ChoiceCare |
$6.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.34
|
| Rate for Payer: PHCS All Commercial |
$5.29
|
| Rate for Payer: PHP All Commercial |
$5.35
|
| Rate for Payer: Sagamore Health Network All Products |
$5.44
|
| Rate for Payer: Signature Care EPO |
$5.85
|
| Rate for Payer: Signature Care PPO |
$6.20
|
| Rate for Payer: United Healthcare Commercial |
$5.55
|
|
|
CEFPROZIL 500 MG ORAL TAB
|
Facility
|
OP
|
$7.05
|
|
|
Service Code
|
NDC 57237003750
|
| Hospital Charge Code |
9473
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$6.56 |
| Rate for Payer: Aetna Commercial |
$5.95
|
| Rate for Payer: Aetna Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.56
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Centivo All Commercial |
$3.59
|
| Rate for Payer: Cigna All Commercial |
$6.08
|
| Rate for Payer: CORVEL All Commercial |
$6.56
|
| Rate for Payer: Coventry All Commercial |
$6.20
|
| Rate for Payer: Encore All Commercial |
$6.49
|
| Rate for Payer: Frontpath All Commercial |
$6.49
|
| Rate for Payer: Humana ChoiceCare |
$6.09
|
| Rate for Payer: Humana Medicare |
$3.59
|
| Rate for Payer: Lucent All Commercial |
$3.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.34
|
| Rate for Payer: PHCS All Commercial |
$5.29
|
| Rate for Payer: PHP All Commercial |
$5.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.75
|
| Rate for Payer: Sagamore Health Network All Products |
$5.44
|
| Rate for Payer: Signature Care EPO |
$5.85
|
| Rate for Payer: Signature Care PPO |
$6.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.99
|
| Rate for Payer: United Healthcare Commercial |
$5.55
|
| Rate for Payer: United Healthcare Medicare |
$2.33
|
|
