|
CEFTAROLINE FOSAMIL 600 MG IV SOLR
|
Facility
|
OP
|
$930.29
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
107671
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$865.17 |
| Rate for Payer: Aetna Commercial |
$785.16
|
| Rate for Payer: Aetna Medicare |
$307.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$307.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$534.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$581.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$353.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$337.70
|
| Rate for Payer: Cash Price |
$576.78
|
| Rate for Payer: Cash Price |
$576.78
|
| Rate for Payer: Centivo All Commercial |
$474.45
|
| Rate for Payer: Cigna All Commercial |
$802.84
|
| Rate for Payer: CORVEL All Commercial |
$865.17
|
| Rate for Payer: Coventry All Commercial |
$818.66
|
| Rate for Payer: Encore All Commercial |
$856.33
|
| Rate for Payer: Frontpath All Commercial |
$855.87
|
| Rate for Payer: Humana ChoiceCare |
$803.49
|
| Rate for Payer: Humana Medicare |
$474.45
|
| Rate for Payer: Lucent All Commercial |
$474.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.26
|
| Rate for Payer: Managed Health Services Medicaid |
$4.09
|
| Rate for Payer: MDWise Medicaid |
$4.09
|
| Rate for Payer: PHCS All Commercial |
$697.72
|
| Rate for Payer: PHP All Commercial |
$705.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$362.81
|
| Rate for Payer: Sagamore Health Network All Products |
$718.18
|
| Rate for Payer: Signature Care EPO |
$772.14
|
| Rate for Payer: Signature Care PPO |
$818.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$790.75
|
| Rate for Payer: United Healthcare Commercial |
$733.07
|
| Rate for Payer: United Healthcare Medicare |
$307.00
|
|
|
CEFTAROLINE FOSAMIL 600 MG IV SOLR
|
Facility
|
IP
|
$930.29
|
|
|
Service Code
|
HCPCS J0712
|
| Hospital Charge Code |
107671
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$697.72 |
| Max. Negotiated Rate |
$865.17 |
| Rate for Payer: Aetna Commercial |
$803.77
|
| Rate for Payer: Cash Price |
$576.78
|
| Rate for Payer: Cigna All Commercial |
$802.84
|
| Rate for Payer: CORVEL All Commercial |
$865.17
|
| Rate for Payer: Coventry All Commercial |
$818.66
|
| Rate for Payer: Encore All Commercial |
$856.33
|
| Rate for Payer: Frontpath All Commercial |
$855.87
|
| Rate for Payer: Humana ChoiceCare |
$803.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$837.26
|
| Rate for Payer: PHCS All Commercial |
$697.72
|
| Rate for Payer: PHP All Commercial |
$705.53
|
| Rate for Payer: Sagamore Health Network All Products |
$718.18
|
| Rate for Payer: Signature Care EPO |
$772.14
|
| Rate for Payer: Signature Care PPO |
$818.66
|
| Rate for Payer: United Healthcare Commercial |
$733.07
|
|
|
CEFTAZIDIME 1 G INJ SOLR
|
Facility
|
IP
|
$21.51
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
9474
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$20.01 |
| Rate for Payer: Aetna Commercial |
$18.59
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Cigna All Commercial |
$18.56
|
| Rate for Payer: CORVEL All Commercial |
$20.01
|
| Rate for Payer: Coventry All Commercial |
$18.93
|
| Rate for Payer: Encore All Commercial |
$19.80
|
| Rate for Payer: Frontpath All Commercial |
$19.79
|
| Rate for Payer: Humana ChoiceCare |
$18.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.36
|
| Rate for Payer: PHCS All Commercial |
$16.13
|
| Rate for Payer: PHP All Commercial |
$16.31
|
| Rate for Payer: Sagamore Health Network All Products |
$16.61
|
| Rate for Payer: Signature Care EPO |
$17.85
|
| Rate for Payer: Signature Care PPO |
$18.93
|
| Rate for Payer: United Healthcare Commercial |
$16.95
|
|
|
CEFTAZIDIME 1 G INJ SOLR
|
Facility
|
OP
|
$21.51
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
9474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$20.01 |
| Rate for Payer: Aetna Commercial |
$18.16
|
| Rate for Payer: Aetna Medicare |
$7.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.81
|
| Rate for Payer: Cash Price |
$13.34
|
| Rate for Payer: Centivo All Commercial |
$10.97
|
| Rate for Payer: Cigna All Commercial |
$18.56
|
| Rate for Payer: CORVEL All Commercial |
$20.01
|
| Rate for Payer: Coventry All Commercial |
$18.93
|
| Rate for Payer: Encore All Commercial |
$19.80
|
| Rate for Payer: Frontpath All Commercial |
$19.79
|
| Rate for Payer: Humana ChoiceCare |
$18.58
|
| Rate for Payer: Humana Medicare |
$10.97
|
| Rate for Payer: Lucent All Commercial |
$10.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.36
|
| Rate for Payer: PHCS All Commercial |
$16.13
|
| Rate for Payer: PHP All Commercial |
$16.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.39
|
| Rate for Payer: Sagamore Health Network All Products |
$16.61
|
| Rate for Payer: Signature Care EPO |
$17.85
|
| Rate for Payer: Signature Care PPO |
$18.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.28
|
| Rate for Payer: United Healthcare Commercial |
$16.95
|
| Rate for Payer: United Healthcare Medicare |
$7.10
|
|
|
CEFTAZIDIME 2 G INJ SOLR
|
Facility
|
OP
|
$60.27
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
9476
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.89 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Aetna Commercial |
$50.87
|
| Rate for Payer: Aetna Medicare |
$19.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$34.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.88
|
| Rate for Payer: Cash Price |
$37.37
|
| Rate for Payer: Centivo All Commercial |
$30.74
|
| Rate for Payer: Cigna All Commercial |
$52.01
|
| Rate for Payer: CORVEL All Commercial |
$56.05
|
| Rate for Payer: Coventry All Commercial |
$53.04
|
| Rate for Payer: Encore All Commercial |
$55.48
|
| Rate for Payer: Frontpath All Commercial |
$55.45
|
| Rate for Payer: Humana ChoiceCare |
$52.06
|
| Rate for Payer: Humana Medicare |
$30.74
|
| Rate for Payer: Lucent All Commercial |
$30.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.24
|
| Rate for Payer: PHCS All Commercial |
$45.20
|
| Rate for Payer: PHP All Commercial |
$45.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.51
|
| Rate for Payer: Sagamore Health Network All Products |
$46.53
|
| Rate for Payer: Signature Care EPO |
$50.02
|
| Rate for Payer: Signature Care PPO |
$53.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.23
|
| Rate for Payer: United Healthcare Commercial |
$47.49
|
| Rate for Payer: United Healthcare Medicare |
$19.89
|
|
|
CEFTAZIDIME 2 G INJ SOLR
|
Facility
|
IP
|
$60.27
|
|
|
Service Code
|
HCPCS J0713
|
| Hospital Charge Code |
9476
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Aetna Commercial |
$52.07
|
| Rate for Payer: Cash Price |
$37.37
|
| Rate for Payer: Cigna All Commercial |
$52.01
|
| Rate for Payer: CORVEL All Commercial |
$56.05
|
| Rate for Payer: Coventry All Commercial |
$53.04
|
| Rate for Payer: Encore All Commercial |
$55.48
|
| Rate for Payer: Frontpath All Commercial |
$55.45
|
| Rate for Payer: Humana ChoiceCare |
$52.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.24
|
| Rate for Payer: PHCS All Commercial |
$45.20
|
| Rate for Payer: PHP All Commercial |
$45.71
|
| Rate for Payer: Sagamore Health Network All Products |
$46.53
|
| Rate for Payer: Signature Care EPO |
$50.02
|
| Rate for Payer: Signature Care PPO |
$53.04
|
| Rate for Payer: United Healthcare Commercial |
$47.49
|
|
|
CEFTRIAXONE 1 G INJ SOLR
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9487
|
|
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
|
|
|
CEFTRIAXONE 1 G INJ SOLR
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9487
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| 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 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: 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: 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
|
|
|
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 |
$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
|
|
|
CEFTRIAXONE 250 MG INJ SOLR
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9489
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| 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 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: 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: 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
|
|
|
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 |
$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
|
|
|
CEFTRIAXONE 2 G INJ SOLR
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9488
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| 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 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: 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: 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
|
|
|
CEFTRIAXONE 500 MG INJ SOLR
|
Facility
|
OP
|
$5.91
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$5.49 |
| Rate for Payer: Aetna Commercial |
$4.99
|
| Rate for Payer: Aetna Medicare |
$1.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.14
|
| Rate for Payer: Cash Price |
$3.66
|
| Rate for Payer: Centivo All Commercial |
$3.01
|
| Rate for Payer: Cigna All Commercial |
$5.10
|
| Rate for Payer: CORVEL All Commercial |
$5.49
|
| Rate for Payer: Coventry All Commercial |
$5.20
|
| Rate for Payer: Encore All Commercial |
$5.44
|
| Rate for Payer: Frontpath All Commercial |
$5.44
|
| Rate for Payer: Humana ChoiceCare |
$5.10
|
| Rate for Payer: Humana Medicare |
$3.01
|
| Rate for Payer: Lucent All Commercial |
$3.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.32
|
| Rate for Payer: PHCS All Commercial |
$4.43
|
| Rate for Payer: PHP All Commercial |
$4.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.30
|
| Rate for Payer: Sagamore Health Network All Products |
$4.56
|
| Rate for Payer: Signature Care EPO |
$4.90
|
| Rate for Payer: Signature Care PPO |
$5.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.02
|
| Rate for Payer: United Healthcare Commercial |
$4.66
|
| Rate for Payer: United Healthcare Medicare |
$1.95
|
|
|
CEFTRIAXONE 500 MG INJ SOLR
|
Facility
|
IP
|
$5.91
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9490
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.43 |
| Max. Negotiated Rate |
$5.49 |
| Rate for Payer: Aetna Commercial |
$5.10
|
| Rate for Payer: Cash Price |
$3.66
|
| Rate for Payer: Cigna All Commercial |
$5.10
|
| Rate for Payer: CORVEL All Commercial |
$5.49
|
| Rate for Payer: Coventry All Commercial |
$5.20
|
| Rate for Payer: Encore All Commercial |
$5.44
|
| Rate for Payer: Frontpath All Commercial |
$5.44
|
| Rate for Payer: Humana ChoiceCare |
$5.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.32
|
| Rate for Payer: PHCS All Commercial |
$4.43
|
| Rate for Payer: PHP All Commercial |
$4.48
|
| Rate for Payer: Sagamore Health Network All Products |
$4.56
|
| Rate for Payer: Signature Care EPO |
$4.90
|
| Rate for Payer: Signature Care PPO |
$5.20
|
| Rate for Payer: United Healthcare Commercial |
$4.66
|
|
|
CEFTRIAXONE IN DEXTROSE,ISO-OS 1 GRAM/50 ML IV PGBK
|
Facility
|
IP
|
$123.53
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9492
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$92.65 |
| Max. Negotiated Rate |
$114.88 |
| Rate for Payer: Aetna Commercial |
$106.73
|
| Rate for Payer: Cash Price |
$76.59
|
| Rate for Payer: Cigna All Commercial |
$106.61
|
| Rate for Payer: CORVEL All Commercial |
$114.88
|
| Rate for Payer: Coventry All Commercial |
$108.71
|
| Rate for Payer: Encore All Commercial |
$113.71
|
| Rate for Payer: Frontpath All Commercial |
$113.65
|
| Rate for Payer: Humana ChoiceCare |
$106.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.18
|
| Rate for Payer: PHCS All Commercial |
$92.65
|
| Rate for Payer: PHP All Commercial |
$93.68
|
| Rate for Payer: Sagamore Health Network All Products |
$95.36
|
| Rate for Payer: Signature Care EPO |
$102.53
|
| Rate for Payer: Signature Care PPO |
$108.71
|
| Rate for Payer: United Healthcare Commercial |
$97.34
|
|
|
CEFTRIAXONE IN DEXTROSE,ISO-OS 1 GRAM/50 ML IV PGBK
|
Facility
|
OP
|
$123.53
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
9492
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.76 |
| Max. Negotiated Rate |
$114.88 |
| Rate for Payer: Aetna Commercial |
$104.26
|
| Rate for Payer: Aetna Medicare |
$40.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$40.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$70.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$77.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.84
|
| Rate for Payer: Cash Price |
$76.59
|
| Rate for Payer: Centivo All Commercial |
$63.00
|
| Rate for Payer: Cigna All Commercial |
$106.61
|
| Rate for Payer: CORVEL All Commercial |
$114.88
|
| Rate for Payer: Coventry All Commercial |
$108.71
|
| Rate for Payer: Encore All Commercial |
$113.71
|
| Rate for Payer: Frontpath All Commercial |
$113.65
|
| Rate for Payer: Humana ChoiceCare |
$106.69
|
| Rate for Payer: Humana Medicare |
$63.00
|
| Rate for Payer: Lucent All Commercial |
$63.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.18
|
| Rate for Payer: PHCS All Commercial |
$92.65
|
| Rate for Payer: PHP All Commercial |
$93.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.18
|
| Rate for Payer: Sagamore Health Network All Products |
$95.36
|
| Rate for Payer: Signature Care EPO |
$102.53
|
| Rate for Payer: Signature Care PPO |
$108.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$105.00
|
| Rate for Payer: United Healthcare Commercial |
$97.34
|
| Rate for Payer: United Healthcare Medicare |
$40.76
|
|
|
CEFUROXIME SODIUM 1.5 G IV SOLR
|
Facility
|
IP
|
$38.75
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
111827
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$36.03 |
| Rate for Payer: Aetna Commercial |
$33.48
|
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Cigna All Commercial |
$33.44
|
| Rate for Payer: CORVEL All Commercial |
$36.03
|
| Rate for Payer: Coventry All Commercial |
$34.10
|
| Rate for Payer: Encore All Commercial |
$35.66
|
| Rate for Payer: Frontpath All Commercial |
$35.65
|
| Rate for Payer: Humana ChoiceCare |
$33.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.87
|
| Rate for Payer: PHCS All Commercial |
$29.06
|
| Rate for Payer: PHP All Commercial |
$29.38
|
| Rate for Payer: Sagamore Health Network All Products |
$29.91
|
| Rate for Payer: Signature Care EPO |
$32.16
|
| Rate for Payer: Signature Care PPO |
$34.10
|
| Rate for Payer: United Healthcare Commercial |
$30.53
|
|
|
CEFUROXIME SODIUM 1.5 G IV SOLR
|
Facility
|
OP
|
$38.75
|
|
|
Service Code
|
HCPCS J0697
|
| Hospital Charge Code |
111827
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$36.03 |
| Rate for Payer: Aetna Commercial |
$32.70
|
| Rate for Payer: Aetna Medicare |
$12.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.06
|
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Centivo All Commercial |
$19.76
|
| Rate for Payer: Cigna All Commercial |
$33.44
|
| Rate for Payer: CORVEL All Commercial |
$36.03
|
| Rate for Payer: Coventry All Commercial |
$34.10
|
| Rate for Payer: Encore All Commercial |
$35.66
|
| Rate for Payer: Frontpath All Commercial |
$35.65
|
| Rate for Payer: Humana ChoiceCare |
$33.46
|
| Rate for Payer: Humana Medicare |
$19.76
|
| Rate for Payer: Lucent All Commercial |
$19.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.87
|
| Rate for Payer: PHCS All Commercial |
$29.06
|
| Rate for Payer: PHP All Commercial |
$29.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.11
|
| Rate for Payer: Sagamore Health Network All Products |
$29.91
|
| Rate for Payer: Signature Care EPO |
$32.16
|
| Rate for Payer: Signature Care PPO |
$34.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.93
|
| Rate for Payer: United Healthcare Commercial |
$30.53
|
| Rate for Payer: United Healthcare Medicare |
$12.79
|
|
|
CELECOXIB 100 MG ORAL CAP
|
Facility
|
IP
|
$4.40
|
|
|
Service Code
|
NDC 00904650261
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cigna All Commercial |
$3.79
|
| Rate for Payer: CORVEL All Commercial |
$4.09
|
| Rate for Payer: Coventry All Commercial |
$3.87
|
| Rate for Payer: Encore All Commercial |
$4.05
|
| Rate for Payer: Frontpath All Commercial |
$4.04
|
| Rate for Payer: Humana ChoiceCare |
$3.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.96
|
| Rate for Payer: PHCS All Commercial |
$3.30
|
| Rate for Payer: PHP All Commercial |
$3.33
|
| Rate for Payer: Sagamore Health Network All Products |
$3.39
|
| Rate for Payer: Signature Care EPO |
$3.65
|
| Rate for Payer: Signature Care PPO |
$3.87
|
| Rate for Payer: United Healthcare Commercial |
$3.46
|
|
|
CELECOXIB 100 MG ORAL CAP
|
Facility
|
OP
|
$4.40
|
|
|
Service Code
|
NDC 00904650261
|
| Hospital Charge Code |
24500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.45 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna Medicare |
$1.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.60
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Centivo All Commercial |
$2.24
|
| Rate for Payer: Cigna All Commercial |
$3.79
|
| Rate for Payer: CORVEL All Commercial |
$4.09
|
| Rate for Payer: Coventry All Commercial |
$3.87
|
| Rate for Payer: Encore All Commercial |
$4.05
|
| Rate for Payer: Frontpath All Commercial |
$4.04
|
| Rate for Payer: Humana ChoiceCare |
$3.80
|
| Rate for Payer: Humana Medicare |
$2.24
|
| Rate for Payer: Lucent All Commercial |
$2.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.96
|
| Rate for Payer: PHCS All Commercial |
$3.30
|
| Rate for Payer: PHP All Commercial |
$3.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.71
|
| Rate for Payer: Sagamore Health Network All Products |
$3.39
|
| Rate for Payer: Signature Care EPO |
$3.65
|
| Rate for Payer: Signature Care PPO |
$3.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.74
|
| Rate for Payer: United Healthcare Commercial |
$3.46
|
| Rate for Payer: United Healthcare Medicare |
$1.45
|
|
|
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 |
$92.01
|
| 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/5 ML ORAL SUSR
|
Facility
|
OP
|
$148.40
|
|
|
Service Code
|
NDC 68180044101
|
| Hospital Charge Code |
9502
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.97 |
| Max. Negotiated Rate |
$138.01 |
| Rate for Payer: Aetna Commercial |
$125.25
|
| Rate for Payer: Aetna Medicare |
$48.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.87
|
| Rate for Payer: Cash Price |
$92.01
|
| Rate for Payer: Centivo All Commercial |
$75.68
|
| 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 |
$75.68
|
| Rate for Payer: Lucent All Commercial |
$75.68
|
| 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 |
$48.97
|
|
|
CEPHALEXIN 250 MG/5 ML ORAL SUSR ED PACK (CAMERON)
|
Facility
|
IP
|
$148.40
|
|
|
Service Code
|
NDC 67877545
|
| Hospital Charge Code |
1401000800670
|
|
Hospital Revenue Code
|
253
|
| Min. Negotiated Rate |
$111.30 |
| Max. Negotiated Rate |
$138.01 |
| Rate for Payer: Aetna Commercial |
$128.22
|
| Rate for Payer: Cash Price |
$92.01
|
| 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/5 ML ORAL SUSR ED PACK (CAMERON)
|
Facility
|
OP
|
$148.40
|
|
|
Service Code
|
NDC 67877545
|
| Hospital Charge Code |
1401000800670
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.97 |
| Max. Negotiated Rate |
$138.01 |
| Rate for Payer: Aetna Commercial |
$125.25
|
| Rate for Payer: Aetna Medicare |
$48.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.87
|
| Rate for Payer: Cash Price |
$92.01
|
| Rate for Payer: Centivo All Commercial |
$75.68
|
| 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 |
$75.68
|
| Rate for Payer: Lucent All Commercial |
$75.68
|
| 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 |
$48.97
|
|
|
CEPHALEXIN 250 MG ORAL CAP
|
Facility
|
OP
|
$1.98
|
|
|
Service Code
|
NDC 60687015201
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.65 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.67
|
| Rate for Payer: Aetna Medicare |
$0.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.72
|
| Rate for Payer: Cash Price |
$1.23
|
| Rate for Payer: Centivo All Commercial |
$1.01
|
| Rate for Payer: Cigna All Commercial |
$1.71
|
| Rate for Payer: CORVEL All Commercial |
$1.84
|
| Rate for Payer: Coventry All Commercial |
$1.74
|
| Rate for Payer: Encore All Commercial |
$1.82
|
| Rate for Payer: Frontpath All Commercial |
$1.82
|
| Rate for Payer: Humana ChoiceCare |
$1.71
|
| Rate for Payer: Humana Medicare |
$1.01
|
| Rate for Payer: Lucent All Commercial |
$1.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.78
|
| Rate for Payer: PHCS All Commercial |
$1.49
|
| Rate for Payer: PHP All Commercial |
$1.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.77
|
| Rate for Payer: Sagamore Health Network All Products |
$1.53
|
| Rate for Payer: Signature Care EPO |
$1.64
|
| Rate for Payer: Signature Care PPO |
$1.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.68
|
| Rate for Payer: United Healthcare Commercial |
$1.56
|
| Rate for Payer: United Healthcare Medicare |
$0.65
|
|
