|
CHORIONIC GONADOTROPIN, HUMAN 5000 UNITS IM SOLR
|
Facility
|
IP
|
$338.67
|
|
|
Service Code
|
HCPCS J0725
|
| Hospital Charge Code |
1677
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$254.00 |
| Max. Negotiated Rate |
$314.96 |
| Rate for Payer: Aetna Commercial |
$292.61
|
| Rate for Payer: Cash Price |
$209.97
|
| Rate for Payer: Cigna All Commercial |
$292.27
|
| Rate for Payer: CORVEL All Commercial |
$314.96
|
| Rate for Payer: Coventry All Commercial |
$298.03
|
| Rate for Payer: Encore All Commercial |
$311.74
|
| Rate for Payer: Frontpath All Commercial |
$311.57
|
| Rate for Payer: Humana ChoiceCare |
$292.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$304.80
|
| Rate for Payer: PHCS All Commercial |
$254.00
|
| Rate for Payer: PHP All Commercial |
$256.85
|
| Rate for Payer: Sagamore Health Network All Products |
$261.45
|
| Rate for Payer: Signature Care EPO |
$281.09
|
| Rate for Payer: Signature Care PPO |
$298.03
|
| Rate for Payer: United Healthcare Commercial |
$266.87
|
|
|
CILOSTAZOL 100 MG ORAL TAB
|
Facility
|
IP
|
$4.80
|
|
|
Service Code
|
NDC 50268017715
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.14
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Cigna All Commercial |
$4.14
|
| Rate for Payer: CORVEL All Commercial |
$4.46
|
| Rate for Payer: Coventry All Commercial |
$4.22
|
| Rate for Payer: Encore All Commercial |
$4.41
|
| Rate for Payer: Frontpath All Commercial |
$4.41
|
| Rate for Payer: Humana ChoiceCare |
$4.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.32
|
| Rate for Payer: PHCS All Commercial |
$3.60
|
| Rate for Payer: PHP All Commercial |
$3.64
|
| Rate for Payer: Sagamore Health Network All Products |
$3.70
|
| Rate for Payer: Signature Care EPO |
$3.98
|
| Rate for Payer: Signature Care PPO |
$4.22
|
| Rate for Payer: United Healthcare Commercial |
$3.78
|
|
|
CILOSTAZOL 100 MG ORAL TAB
|
Facility
|
OP
|
$4.80
|
|
|
Service Code
|
NDC 50268017715
|
| Hospital Charge Code |
24474
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$4.46 |
| Rate for Payer: Aetna Commercial |
$4.05
|
| Rate for Payer: Aetna Medicare |
$1.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.74
|
| Rate for Payer: Cash Price |
$2.97
|
| Rate for Payer: Centivo All Commercial |
$2.45
|
| Rate for Payer: Cigna All Commercial |
$4.14
|
| Rate for Payer: CORVEL All Commercial |
$4.46
|
| Rate for Payer: Coventry All Commercial |
$4.22
|
| Rate for Payer: Encore All Commercial |
$4.41
|
| Rate for Payer: Frontpath All Commercial |
$4.41
|
| Rate for Payer: Humana ChoiceCare |
$4.14
|
| Rate for Payer: Humana Medicare |
$2.45
|
| Rate for Payer: Lucent All Commercial |
$2.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.32
|
| Rate for Payer: PHCS All Commercial |
$3.60
|
| Rate for Payer: PHP All Commercial |
$3.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.87
|
| Rate for Payer: Sagamore Health Network All Products |
$3.70
|
| Rate for Payer: Signature Care EPO |
$3.98
|
| Rate for Payer: Signature Care PPO |
$4.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.08
|
| Rate for Payer: United Healthcare Commercial |
$3.78
|
| Rate for Payer: United Healthcare Medicare |
$1.58
|
|
|
CINACALCET 30 MG ORAL TAB
|
Facility
|
OP
|
$1.91
|
|
|
Service Code
|
HCPCS J0604
|
| Hospital Charge Code |
38100
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$1.78 |
| Rate for Payer: Aetna Commercial |
$1.61
|
| Rate for Payer: Aetna Medicare |
$0.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.69
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Centivo All Commercial |
$0.97
|
| 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 |
$0.97
|
| Rate for Payer: Lucent All Commercial |
$0.97
|
| 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 |
$0.63
|
|
|
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 |
$1.18
|
| 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
|
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 |
$702.34
|
| 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 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 |
$373.82 |
| Max. Negotiated Rate |
$1,053.50 |
| Rate for Payer: Aetna Commercial |
$956.08
|
| Rate for Payer: Aetna Medicare |
$373.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$373.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$650.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$708.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$429.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$411.21
|
| Rate for Payer: Cash Price |
$702.34
|
| Rate for Payer: Centivo All Commercial |
$577.73
|
| 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 |
$577.73
|
| Rate for Payer: Lucent All Commercial |
$577.73
|
| 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 |
$373.82
|
|
|
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 |
$37.28 |
| Max. Negotiated Rate |
$969.49 |
| Rate for Payer: Aetna Commercial |
$879.84
|
| Rate for Payer: Aetna Medicare |
$344.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$344.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$598.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$651.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$395.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$378.41
|
| Rate for Payer: Cash Price |
$646.33
|
| Rate for Payer: Cash Price |
$646.33
|
| Rate for Payer: Centivo All Commercial |
$531.66
|
| 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 |
$531.66
|
| Rate for Payer: Lucent All Commercial |
$531.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$938.22
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| 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 |
$344.01
|
|
|
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 |
$646.33
|
| 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
|
$33.46
|
|
|
Service Code
|
NDC 69315030802
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.04 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Aetna Commercial |
$28.24
|
| Rate for Payer: Aetna Medicare |
$11.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.15
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Centivo All Commercial |
$17.06
|
| Rate for Payer: Cigna All Commercial |
$28.88
|
| Rate for Payer: CORVEL All Commercial |
$31.12
|
| Rate for Payer: Coventry All Commercial |
$29.44
|
| Rate for Payer: Encore All Commercial |
$30.80
|
| Rate for Payer: Frontpath All Commercial |
$30.78
|
| Rate for Payer: Humana ChoiceCare |
$28.90
|
| Rate for Payer: Humana Medicare |
$17.06
|
| Rate for Payer: Lucent All Commercial |
$17.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.11
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$25.10
|
| Rate for Payer: PHP All Commercial |
$25.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.05
|
| Rate for Payer: Sagamore Health Network All Products |
$25.83
|
| Rate for Payer: Signature Care EPO |
$27.77
|
| Rate for Payer: Signature Care PPO |
$29.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28.44
|
| Rate for Payer: United Healthcare Commercial |
$26.37
|
| Rate for Payer: United Healthcare Medicare |
$11.04
|
|
|
CIPROFLOXACIN HCL 0.3 % OPHT DROP
|
Facility
|
IP
|
$33.46
|
|
|
Service Code
|
NDC 69315030802
|
| Hospital Charge Code |
9610
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.10 |
| Max. Negotiated Rate |
$31.12 |
| Rate for Payer: Aetna Commercial |
$28.91
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cigna All Commercial |
$28.88
|
| Rate for Payer: CORVEL All Commercial |
$31.12
|
| Rate for Payer: Coventry All Commercial |
$29.44
|
| Rate for Payer: Encore All Commercial |
$30.80
|
| Rate for Payer: Frontpath All Commercial |
$30.78
|
| Rate for Payer: Humana ChoiceCare |
$28.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.11
|
| Rate for Payer: PHCS All Commercial |
$25.10
|
| Rate for Payer: PHP All Commercial |
$25.38
|
| Rate for Payer: Sagamore Health Network All Products |
$25.83
|
| Rate for Payer: Signature Care EPO |
$27.77
|
| Rate for Payer: Signature Care PPO |
$29.44
|
| Rate for Payer: United Healthcare Commercial |
$26.37
|
|
|
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 |
$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
|
|
|
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 |
$5.94 |
| 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
|
|
|
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 |
$0.62
|
| 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 |
$0.33 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.36
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Centivo All Commercial |
$0.51
|
| 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 |
$0.51
|
| Rate for Payer: Lucent All Commercial |
$0.51
|
| 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 |
$0.33
|
|
|
Claviculectomy; partial
|
Facility
|
OP
|
$3,121.64
|
|
|
Service Code
|
CPT 23120
|
| Hospital Charge Code |
CPT-23120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,121.64 |
| Max. Negotiated Rate |
$3,121.64 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3,121.64
|
| Rate for Payer: Managed Health Services Medicaid |
$3,121.64
|
| Rate for Payer: MDWise Medicaid |
$3,121.64
|
|
|
CLINDAMYCIN HCL 150 MG ORAL CAP
|
Facility
|
IP
|
$1.02
|
|
|
Service Code
|
NDC 00904595961
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna All Commercial |
$0.88
|
| Rate for Payer: CORVEL All Commercial |
$0.94
|
| Rate for Payer: Coventry All Commercial |
$0.89
|
| Rate for Payer: Encore All Commercial |
$0.93
|
| Rate for Payer: Frontpath All Commercial |
$0.93
|
| Rate for Payer: Humana ChoiceCare |
$0.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.91
|
| Rate for Payer: PHCS All Commercial |
$0.76
|
| Rate for Payer: PHP All Commercial |
$0.77
|
| Rate for Payer: Sagamore Health Network All Products |
$0.78
|
| Rate for Payer: Signature Care EPO |
$0.84
|
| Rate for Payer: Signature Care PPO |
$0.89
|
| Rate for Payer: United Healthcare Commercial |
$0.80
|
|
|
CLINDAMYCIN HCL 150 MG ORAL CAP
|
Facility
|
OP
|
$1.02
|
|
|
Service Code
|
NDC 00904595961
|
| Hospital Charge Code |
1740
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.94 |
| Rate for Payer: Aetna Commercial |
$0.86
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.37
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Centivo All Commercial |
$0.52
|
| Rate for Payer: Cigna All Commercial |
$0.88
|
| Rate for Payer: CORVEL All Commercial |
$0.94
|
| Rate for Payer: Coventry All Commercial |
$0.89
|
| Rate for Payer: Encore All Commercial |
$0.93
|
| Rate for Payer: Frontpath All Commercial |
$0.93
|
| Rate for Payer: Humana ChoiceCare |
$0.88
|
| Rate for Payer: Humana Medicare |
$0.52
|
| Rate for Payer: Lucent All Commercial |
$0.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.91
|
| Rate for Payer: PHCS All Commercial |
$0.76
|
| Rate for Payer: PHP All Commercial |
$0.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.40
|
| Rate for Payer: Sagamore Health Network All Products |
$0.78
|
| Rate for Payer: Signature Care EPO |
$0.84
|
| Rate for Payer: Signature Care PPO |
$0.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.86
|
| Rate for Payer: United Healthcare Commercial |
$0.80
|
| Rate for Payer: United Healthcare Medicare |
$0.33
|
|
|
CLINDAMYCIN IN 0.9 % SOD CHLOR 600 MG/50 ML IV PGBK
|
Facility
|
IP
|
$54.60
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
181019
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.95 |
| Max. Negotiated Rate |
$50.78 |
| Rate for Payer: Aetna Commercial |
$47.17
|
| Rate for Payer: Cash Price |
$33.85
|
| Rate for Payer: Cigna All Commercial |
$47.12
|
| Rate for Payer: CORVEL All Commercial |
$50.78
|
| Rate for Payer: Coventry All Commercial |
$48.05
|
| Rate for Payer: Encore All Commercial |
$50.26
|
| Rate for Payer: Frontpath All Commercial |
$50.23
|
| Rate for Payer: Humana ChoiceCare |
$47.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.14
|
| Rate for Payer: PHCS All Commercial |
$40.95
|
| Rate for Payer: PHP All Commercial |
$41.41
|
| Rate for Payer: Sagamore Health Network All Products |
$42.15
|
| Rate for Payer: Signature Care EPO |
$45.32
|
| Rate for Payer: Signature Care PPO |
$48.05
|
| Rate for Payer: United Healthcare Commercial |
$43.02
|
|
|
CLINDAMYCIN IN 0.9 % SOD CHLOR 600 MG/50 ML IV PGBK
|
Facility
|
OP
|
$54.60
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
181019
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.02 |
| Max. Negotiated Rate |
$50.78 |
| Rate for Payer: Aetna Commercial |
$46.08
|
| Rate for Payer: Aetna Medicare |
$18.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.82
|
| Rate for Payer: Cash Price |
$33.85
|
| Rate for Payer: Centivo All Commercial |
$27.85
|
| Rate for Payer: Cigna All Commercial |
$47.12
|
| Rate for Payer: CORVEL All Commercial |
$50.78
|
| Rate for Payer: Coventry All Commercial |
$48.05
|
| Rate for Payer: Encore All Commercial |
$50.26
|
| Rate for Payer: Frontpath All Commercial |
$50.23
|
| Rate for Payer: Humana ChoiceCare |
$47.16
|
| Rate for Payer: Humana Medicare |
$27.85
|
| Rate for Payer: Lucent All Commercial |
$27.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.14
|
| Rate for Payer: PHCS All Commercial |
$40.95
|
| Rate for Payer: PHP All Commercial |
$41.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.29
|
| Rate for Payer: Sagamore Health Network All Products |
$42.15
|
| Rate for Payer: Signature Care EPO |
$45.32
|
| Rate for Payer: Signature Care PPO |
$48.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.41
|
| Rate for Payer: United Healthcare Commercial |
$43.02
|
| Rate for Payer: United Healthcare Medicare |
$18.02
|
|
|
CLINDAMYCIN IN 0.9 % SOD CHLOR 900 MG/50 ML IV PGBK
|
Facility
|
OP
|
$65.10
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
181020
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$60.54 |
| Rate for Payer: Aetna Commercial |
$54.94
|
| Rate for Payer: Aetna Medicare |
$21.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.63
|
| Rate for Payer: Cash Price |
$40.36
|
| Rate for Payer: Centivo All Commercial |
$33.20
|
| Rate for Payer: Cigna All Commercial |
$56.18
|
| Rate for Payer: CORVEL All Commercial |
$60.54
|
| Rate for Payer: Coventry All Commercial |
$57.29
|
| Rate for Payer: Encore All Commercial |
$59.92
|
| Rate for Payer: Frontpath All Commercial |
$59.89
|
| Rate for Payer: Humana ChoiceCare |
$56.23
|
| Rate for Payer: Humana Medicare |
$33.20
|
| Rate for Payer: Lucent All Commercial |
$33.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.59
|
| Rate for Payer: PHCS All Commercial |
$48.82
|
| Rate for Payer: PHP All Commercial |
$49.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.39
|
| Rate for Payer: Sagamore Health Network All Products |
$50.26
|
| Rate for Payer: Signature Care EPO |
$54.03
|
| Rate for Payer: Signature Care PPO |
$57.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.34
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
| Rate for Payer: United Healthcare Medicare |
$21.48
|
|
|
CLINDAMYCIN IN 0.9 % SOD CHLOR 900 MG/50 ML IV PGBK
|
Facility
|
IP
|
$65.10
|
|
|
Service Code
|
HCPCS J0737
|
| Hospital Charge Code |
181020
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.82 |
| Max. Negotiated Rate |
$60.54 |
| Rate for Payer: Aetna Commercial |
$56.25
|
| Rate for Payer: Cash Price |
$40.36
|
| Rate for Payer: Cigna All Commercial |
$56.18
|
| Rate for Payer: CORVEL All Commercial |
$60.54
|
| Rate for Payer: Coventry All Commercial |
$57.29
|
| Rate for Payer: Encore All Commercial |
$59.92
|
| Rate for Payer: Frontpath All Commercial |
$59.89
|
| Rate for Payer: Humana ChoiceCare |
$56.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.59
|
| Rate for Payer: PHCS All Commercial |
$48.82
|
| Rate for Payer: PHP All Commercial |
$49.37
|
| Rate for Payer: Sagamore Health Network All Products |
$50.26
|
| Rate for Payer: Signature Care EPO |
$54.03
|
| Rate for Payer: Signature Care PPO |
$57.29
|
| Rate for Payer: United Healthcare Commercial |
$51.30
|
|
|
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK
|
Facility
|
IP
|
$35.70
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9625
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.78 |
| Max. Negotiated Rate |
$33.20 |
| Rate for Payer: Aetna Commercial |
$30.84
|
| Rate for Payer: Cash Price |
$22.13
|
| Rate for Payer: Cigna All Commercial |
$30.81
|
| Rate for Payer: CORVEL All Commercial |
$33.20
|
| Rate for Payer: Coventry All Commercial |
$31.42
|
| Rate for Payer: Encore All Commercial |
$32.86
|
| Rate for Payer: Frontpath All Commercial |
$32.84
|
| Rate for Payer: Humana ChoiceCare |
$30.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.13
|
| Rate for Payer: PHCS All Commercial |
$26.78
|
| Rate for Payer: PHP All Commercial |
$27.07
|
| Rate for Payer: Sagamore Health Network All Products |
$27.56
|
| Rate for Payer: Signature Care EPO |
$29.63
|
| Rate for Payer: Signature Care PPO |
$31.42
|
| Rate for Payer: United Healthcare Commercial |
$28.13
|
|
|
CLINDAMYCIN IN 5 % DEXTROSE 300 MG/50 ML IV PGBK
|
Facility
|
OP
|
$35.70
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9625
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.78 |
| Max. Negotiated Rate |
$33.20 |
| Rate for Payer: Aetna Commercial |
$30.13
|
| Rate for Payer: Aetna Medicare |
$11.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.96
|
| Rate for Payer: Cash Price |
$22.13
|
| Rate for Payer: Centivo All Commercial |
$18.21
|
| Rate for Payer: Cigna All Commercial |
$30.81
|
| Rate for Payer: CORVEL All Commercial |
$33.20
|
| Rate for Payer: Coventry All Commercial |
$31.42
|
| Rate for Payer: Encore All Commercial |
$32.86
|
| Rate for Payer: Frontpath All Commercial |
$32.84
|
| Rate for Payer: Humana ChoiceCare |
$30.83
|
| Rate for Payer: Humana Medicare |
$18.21
|
| Rate for Payer: Lucent All Commercial |
$18.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.13
|
| Rate for Payer: PHCS All Commercial |
$26.78
|
| Rate for Payer: PHP All Commercial |
$27.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.92
|
| Rate for Payer: Sagamore Health Network All Products |
$27.56
|
| Rate for Payer: Signature Care EPO |
$29.63
|
| Rate for Payer: Signature Care PPO |
$31.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.34
|
| Rate for Payer: United Healthcare Commercial |
$28.13
|
| Rate for Payer: United Healthcare Medicare |
$11.78
|
|
|
CLINDAMYCIN IN 5 % DEXTROSE 600 MG/50 ML IV PGBK
|
Facility
|
IP
|
$54.25
|
|
|
Service Code
|
HCPCS J0736
|
| Hospital Charge Code |
9626
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.69 |
| Max. Negotiated Rate |
$50.45 |
| Rate for Payer: Aetna Commercial |
$46.87
|
| Rate for Payer: Cash Price |
$33.64
|
| Rate for Payer: Cigna All Commercial |
$46.82
|
| Rate for Payer: CORVEL All Commercial |
$50.45
|
| Rate for Payer: Coventry All Commercial |
$47.74
|
| Rate for Payer: Encore All Commercial |
$49.94
|
| Rate for Payer: Frontpath All Commercial |
$49.91
|
| Rate for Payer: Humana ChoiceCare |
$46.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.82
|
| Rate for Payer: PHCS All Commercial |
$40.69
|
| Rate for Payer: PHP All Commercial |
$41.14
|
| Rate for Payer: Sagamore Health Network All Products |
$41.88
|
| Rate for Payer: Signature Care EPO |
$45.03
|
| Rate for Payer: Signature Care PPO |
$47.74
|
| Rate for Payer: United Healthcare Commercial |
$42.75
|
|
