|
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT
|
Facility
|
OP
|
$34.79
|
|
|
Service Code
|
NDC 00799000102
|
| Hospital Charge Code |
91352
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$32.35 |
| Rate for Payer: Aetna Commercial |
$29.36
|
| Rate for Payer: Aetna Medicare |
$11.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$19.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.25
|
| Rate for Payer: Cash Price |
$20.87
|
| Rate for Payer: Centivo All Commercial |
$18.93
|
| Rate for Payer: Cigna All Commercial |
$30.02
|
| Rate for Payer: CORVEL All Commercial |
$32.35
|
| Rate for Payer: Coventry All Commercial |
$30.62
|
| Rate for Payer: Encore All Commercial |
$32.02
|
| Rate for Payer: Frontpath All Commercial |
$32.01
|
| Rate for Payer: Humana ChoiceCare |
$30.05
|
| Rate for Payer: Humana Medicare |
$11.13
|
| Rate for Payer: Lucent All Commercial |
$18.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.31
|
| Rate for Payer: PHCS All Commercial |
$26.09
|
| Rate for Payer: PHP All Commercial |
$26.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.57
|
| Rate for Payer: Sagamore Health Network All Products |
$26.86
|
| Rate for Payer: Signature Care EPO |
$28.88
|
| Rate for Payer: Signature Care PPO |
$30.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.57
|
| Rate for Payer: United Healthcare Commercial |
$27.41
|
| Rate for Payer: United Healthcare Medicare |
$11.13
|
|
|
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT
|
Facility
|
IP
|
$34.79
|
|
|
Service Code
|
NDC 00799000102
|
| Hospital Charge Code |
91352
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.09 |
| Max. Negotiated Rate |
$32.35 |
| Rate for Payer: Aetna Commercial |
$30.06
|
| Rate for Payer: Cash Price |
$20.87
|
| Rate for Payer: Cigna All Commercial |
$30.02
|
| Rate for Payer: CORVEL All Commercial |
$32.35
|
| Rate for Payer: Coventry All Commercial |
$30.62
|
| Rate for Payer: Encore All Commercial |
$32.02
|
| Rate for Payer: Frontpath All Commercial |
$32.01
|
| Rate for Payer: Humana ChoiceCare |
$30.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.31
|
| Rate for Payer: PHCS All Commercial |
$26.09
|
| Rate for Payer: PHP All Commercial |
$26.38
|
| Rate for Payer: Sagamore Health Network All Products |
$26.86
|
| Rate for Payer: Signature Care EPO |
$28.88
|
| Rate for Payer: Signature Care PPO |
$30.62
|
| Rate for Payer: United Healthcare Commercial |
$27.41
|
|
|
MEPERIDINE (PF) 25 MG/ML INJ SYRG
|
Facility
|
IP
|
$39.57
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
117788
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: Aetna Commercial |
$34.19
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Cigna All Commercial |
$34.15
|
| Rate for Payer: CORVEL All Commercial |
$36.80
|
| Rate for Payer: Coventry All Commercial |
$34.82
|
| Rate for Payer: Encore All Commercial |
$36.43
|
| Rate for Payer: Frontpath All Commercial |
$36.41
|
| Rate for Payer: Humana ChoiceCare |
$34.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.61
|
| Rate for Payer: PHCS All Commercial |
$29.68
|
| Rate for Payer: PHP All Commercial |
$30.01
|
| Rate for Payer: Sagamore Health Network All Products |
$30.55
|
| Rate for Payer: Signature Care EPO |
$32.84
|
| Rate for Payer: Signature Care PPO |
$34.82
|
| Rate for Payer: United Healthcare Commercial |
$31.18
|
|
|
MEPERIDINE (PF) 25 MG/ML INJ SYRG
|
Facility
|
OP
|
$39.57
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
117788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.27 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: Aetna Commercial |
$33.40
|
| Rate for Payer: Aetna Medicare |
$12.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$22.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.93
|
| Rate for Payer: Cash Price |
$23.74
|
| Rate for Payer: Centivo All Commercial |
$21.53
|
| Rate for Payer: Cigna All Commercial |
$34.15
|
| Rate for Payer: CORVEL All Commercial |
$36.80
|
| Rate for Payer: Coventry All Commercial |
$34.82
|
| Rate for Payer: Encore All Commercial |
$36.43
|
| Rate for Payer: Frontpath All Commercial |
$36.41
|
| Rate for Payer: Humana ChoiceCare |
$34.18
|
| Rate for Payer: Humana Medicare |
$12.66
|
| Rate for Payer: Lucent All Commercial |
$21.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$35.61
|
| Rate for Payer: PHCS All Commercial |
$29.68
|
| Rate for Payer: PHP All Commercial |
$30.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.43
|
| Rate for Payer: Sagamore Health Network All Products |
$30.55
|
| Rate for Payer: Signature Care EPO |
$32.84
|
| Rate for Payer: Signature Care PPO |
$34.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33.64
|
| Rate for Payer: United Healthcare Commercial |
$31.18
|
| Rate for Payer: United Healthcare Medicare |
$12.66
|
|
|
MEPERIDINE (PF) 50 MG/ML INJ S.O.
|
Facility
|
OP
|
$45.02
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
420793
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$41.87 |
| Rate for Payer: Aetna Commercial |
$37.99
|
| Rate for Payer: Aetna Medicare |
$14.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.85
|
| Rate for Payer: Cash Price |
$27.01
|
| Rate for Payer: Centivo All Commercial |
$24.49
|
| Rate for Payer: Cigna All Commercial |
$38.85
|
| Rate for Payer: CORVEL All Commercial |
$41.87
|
| Rate for Payer: Coventry All Commercial |
$39.61
|
| Rate for Payer: Encore All Commercial |
$41.44
|
| Rate for Payer: Frontpath All Commercial |
$41.42
|
| Rate for Payer: Humana ChoiceCare |
$38.88
|
| Rate for Payer: Humana Medicare |
$14.41
|
| Rate for Payer: Lucent All Commercial |
$24.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.52
|
| Rate for Payer: PHCS All Commercial |
$33.76
|
| Rate for Payer: PHP All Commercial |
$34.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.56
|
| Rate for Payer: Sagamore Health Network All Products |
$34.75
|
| Rate for Payer: Signature Care EPO |
$37.36
|
| Rate for Payer: Signature Care PPO |
$39.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38.26
|
| Rate for Payer: United Healthcare Commercial |
$35.47
|
| Rate for Payer: United Healthcare Medicare |
$14.41
|
|
|
MEPERIDINE (PF) 50 MG/ML INJ S.O.
|
Facility
|
IP
|
$45.02
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
420793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.76 |
| Max. Negotiated Rate |
$41.87 |
| Rate for Payer: Aetna Commercial |
$38.89
|
| Rate for Payer: Cash Price |
$27.01
|
| Rate for Payer: Cigna All Commercial |
$38.85
|
| Rate for Payer: CORVEL All Commercial |
$41.87
|
| Rate for Payer: Coventry All Commercial |
$39.61
|
| Rate for Payer: Encore All Commercial |
$41.44
|
| Rate for Payer: Frontpath All Commercial |
$41.42
|
| Rate for Payer: Humana ChoiceCare |
$38.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.52
|
| Rate for Payer: PHCS All Commercial |
$33.76
|
| Rate for Payer: PHP All Commercial |
$34.14
|
| Rate for Payer: Sagamore Health Network All Products |
$34.75
|
| Rate for Payer: Signature Care EPO |
$37.36
|
| Rate for Payer: Signature Care PPO |
$39.61
|
| Rate for Payer: United Healthcare Commercial |
$35.47
|
|
|
MEPERIDINE (PF) 50 MG/ML INJ SYRG
|
Facility
|
OP
|
$45.02
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
117789
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$41.87 |
| Rate for Payer: Aetna Commercial |
$37.99
|
| Rate for Payer: Aetna Medicare |
$14.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$16.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$15.85
|
| Rate for Payer: Cash Price |
$27.01
|
| Rate for Payer: Centivo All Commercial |
$24.49
|
| Rate for Payer: Cigna All Commercial |
$38.85
|
| Rate for Payer: CORVEL All Commercial |
$41.87
|
| Rate for Payer: Coventry All Commercial |
$39.61
|
| Rate for Payer: Encore All Commercial |
$41.44
|
| Rate for Payer: Frontpath All Commercial |
$41.42
|
| Rate for Payer: Humana ChoiceCare |
$38.88
|
| Rate for Payer: Humana Medicare |
$14.41
|
| Rate for Payer: Lucent All Commercial |
$24.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.52
|
| Rate for Payer: PHCS All Commercial |
$33.76
|
| Rate for Payer: PHP All Commercial |
$34.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.56
|
| Rate for Payer: Sagamore Health Network All Products |
$34.75
|
| Rate for Payer: Signature Care EPO |
$37.36
|
| Rate for Payer: Signature Care PPO |
$39.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38.26
|
| Rate for Payer: United Healthcare Commercial |
$35.47
|
| Rate for Payer: United Healthcare Medicare |
$14.41
|
|
|
MEPERIDINE (PF) 50 MG/ML INJ SYRG
|
Facility
|
IP
|
$45.02
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
117789
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$33.76 |
| Max. Negotiated Rate |
$41.87 |
| Rate for Payer: Aetna Commercial |
$38.89
|
| Rate for Payer: Cash Price |
$27.01
|
| Rate for Payer: Cigna All Commercial |
$38.85
|
| Rate for Payer: CORVEL All Commercial |
$41.87
|
| Rate for Payer: Coventry All Commercial |
$39.61
|
| Rate for Payer: Encore All Commercial |
$41.44
|
| Rate for Payer: Frontpath All Commercial |
$41.42
|
| Rate for Payer: Humana ChoiceCare |
$38.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.52
|
| Rate for Payer: PHCS All Commercial |
$33.76
|
| Rate for Payer: PHP All Commercial |
$34.14
|
| Rate for Payer: Sagamore Health Network All Products |
$34.75
|
| Rate for Payer: Signature Care EPO |
$37.36
|
| Rate for Payer: Signature Care PPO |
$39.61
|
| Rate for Payer: United Healthcare Commercial |
$35.47
|
|
|
MEPIVACAINE (PF) 15 MG/ML (1.5 %) INJ SOLN
|
Facility
|
IP
|
$60.48
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
10529
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.36 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna Commercial |
$52.25
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cigna All Commercial |
$52.19
|
| Rate for Payer: CORVEL All Commercial |
$56.25
|
| Rate for Payer: Coventry All Commercial |
$53.22
|
| Rate for Payer: Encore All Commercial |
$55.67
|
| Rate for Payer: Frontpath All Commercial |
$55.64
|
| Rate for Payer: Humana ChoiceCare |
$52.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.43
|
| Rate for Payer: PHCS All Commercial |
$45.36
|
| Rate for Payer: PHP All Commercial |
$45.87
|
| Rate for Payer: Sagamore Health Network All Products |
$46.69
|
| Rate for Payer: Signature Care EPO |
$50.20
|
| Rate for Payer: Signature Care PPO |
$53.22
|
| Rate for Payer: United Healthcare Commercial |
$47.66
|
|
|
MEPIVACAINE (PF) 15 MG/ML (1.5 %) INJ SOLN
|
Facility
|
OP
|
$60.48
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
10529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.75 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: Aetna Commercial |
$51.05
|
| Rate for Payer: Aetna Medicare |
$19.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$34.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.29
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Centivo All Commercial |
$32.90
|
| Rate for Payer: Cigna All Commercial |
$52.19
|
| Rate for Payer: CORVEL All Commercial |
$56.25
|
| Rate for Payer: Coventry All Commercial |
$53.22
|
| Rate for Payer: Encore All Commercial |
$55.67
|
| Rate for Payer: Frontpath All Commercial |
$55.64
|
| Rate for Payer: Humana ChoiceCare |
$52.24
|
| Rate for Payer: Humana Medicare |
$19.35
|
| Rate for Payer: Lucent All Commercial |
$32.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.43
|
| Rate for Payer: PHCS All Commercial |
$45.36
|
| Rate for Payer: PHP All Commercial |
$45.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.59
|
| Rate for Payer: Sagamore Health Network All Products |
$46.69
|
| Rate for Payer: Signature Care EPO |
$50.20
|
| Rate for Payer: Signature Care PPO |
$53.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.41
|
| Rate for Payer: United Healthcare Commercial |
$47.66
|
| Rate for Payer: United Healthcare Medicare |
$19.35
|
|
|
MEPOLIZUMAB 100 MG SUBQ SOLR
|
Facility
|
OP
|
$12,362.63
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
174918
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.09 |
| Max. Negotiated Rate |
$11,497.25 |
| Rate for Payer: Aetna Commercial |
$10,434.06
|
| Rate for Payer: Aetna Medicare |
$3,956.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$37.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,832.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7,099.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,727.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$37.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,549.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,351.65
|
| Rate for Payer: Cash Price |
$7,417.58
|
| Rate for Payer: Cash Price |
$7,417.58
|
| Rate for Payer: Centivo All Commercial |
$6,725.27
|
| Rate for Payer: Cigna All Commercial |
$10,668.95
|
| Rate for Payer: CORVEL All Commercial |
$11,497.25
|
| Rate for Payer: Coventry All Commercial |
$10,879.11
|
| Rate for Payer: Encore All Commercial |
$11,379.80
|
| Rate for Payer: Frontpath All Commercial |
$11,373.62
|
| Rate for Payer: Humana ChoiceCare |
$10,677.60
|
| Rate for Payer: Humana Medicare |
$3,956.04
|
| Rate for Payer: Lucent All Commercial |
$6,725.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,126.37
|
| Rate for Payer: Managed Health Services Medicaid |
$37.09
|
| Rate for Payer: MDWise Medicaid |
$37.09
|
| Rate for Payer: PHCS All Commercial |
$9,271.97
|
| Rate for Payer: PHP All Commercial |
$9,375.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,821.43
|
| Rate for Payer: Sagamore Health Network All Products |
$9,543.95
|
| Rate for Payer: Signature Care EPO |
$10,260.98
|
| Rate for Payer: Signature Care PPO |
$10,879.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,508.24
|
| Rate for Payer: United Healthcare Commercial |
$9,741.75
|
| Rate for Payer: United Healthcare Medicare |
$3,956.04
|
|
|
MEPOLIZUMAB 100 MG SUBQ SOLR
|
Facility
|
IP
|
$12,362.63
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
174918
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9,271.97 |
| Max. Negotiated Rate |
$11,497.25 |
| Rate for Payer: Aetna Commercial |
$10,681.31
|
| Rate for Payer: Cash Price |
$7,417.58
|
| Rate for Payer: Cigna All Commercial |
$10,668.95
|
| Rate for Payer: CORVEL All Commercial |
$11,497.25
|
| Rate for Payer: Coventry All Commercial |
$10,879.11
|
| Rate for Payer: Encore All Commercial |
$11,379.80
|
| Rate for Payer: Frontpath All Commercial |
$11,373.62
|
| Rate for Payer: Humana ChoiceCare |
$10,677.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11,126.37
|
| Rate for Payer: PHCS All Commercial |
$9,271.97
|
| Rate for Payer: PHP All Commercial |
$9,375.82
|
| Rate for Payer: Sagamore Health Network All Products |
$9,543.95
|
| Rate for Payer: Signature Care EPO |
$10,260.98
|
| Rate for Payer: Signature Care PPO |
$10,879.11
|
| Rate for Payer: United Healthcare Commercial |
$9,741.75
|
|
|
MEROPENEM 1 G IV SOLR
|
Facility
|
IP
|
$23.81
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17380
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.86 |
| Max. Negotiated Rate |
$22.14 |
| Rate for Payer: Aetna Commercial |
$20.57
|
| Rate for Payer: Cash Price |
$14.28
|
| Rate for Payer: Cigna All Commercial |
$20.55
|
| Rate for Payer: CORVEL All Commercial |
$22.14
|
| Rate for Payer: Coventry All Commercial |
$20.95
|
| Rate for Payer: Encore All Commercial |
$21.91
|
| Rate for Payer: Frontpath All Commercial |
$21.90
|
| Rate for Payer: Humana ChoiceCare |
$20.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.43
|
| Rate for Payer: PHCS All Commercial |
$17.86
|
| Rate for Payer: PHP All Commercial |
$18.06
|
| Rate for Payer: Sagamore Health Network All Products |
$18.38
|
| Rate for Payer: Signature Care EPO |
$19.76
|
| Rate for Payer: Signature Care PPO |
$20.95
|
| Rate for Payer: United Healthcare Commercial |
$18.76
|
|
|
MEROPENEM 1 G IV SOLR
|
Facility
|
OP
|
$23.81
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$22.14 |
| Rate for Payer: Aetna Commercial |
$20.09
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.38
|
| Rate for Payer: Cash Price |
$14.28
|
| Rate for Payer: Centivo All Commercial |
$12.95
|
| Rate for Payer: Cigna All Commercial |
$20.55
|
| Rate for Payer: CORVEL All Commercial |
$22.14
|
| Rate for Payer: Coventry All Commercial |
$20.95
|
| Rate for Payer: Encore All Commercial |
$21.91
|
| Rate for Payer: Frontpath All Commercial |
$21.90
|
| Rate for Payer: Humana ChoiceCare |
$20.56
|
| Rate for Payer: Humana Medicare |
$7.62
|
| Rate for Payer: Lucent All Commercial |
$12.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.43
|
| Rate for Payer: PHCS All Commercial |
$17.86
|
| Rate for Payer: PHP All Commercial |
$18.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.28
|
| Rate for Payer: Sagamore Health Network All Products |
$18.38
|
| Rate for Payer: Signature Care EPO |
$19.76
|
| Rate for Payer: Signature Care PPO |
$20.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.24
|
| Rate for Payer: United Healthcare Commercial |
$18.76
|
| Rate for Payer: United Healthcare Medicare |
$7.62
|
|
|
MEROPENEM 500 MG IV SOLR
|
Facility
|
IP
|
$18.47
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17379
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$15.96
|
| Rate for Payer: Cash Price |
$11.08
|
| Rate for Payer: Cigna All Commercial |
$15.94
|
| Rate for Payer: CORVEL All Commercial |
$17.18
|
| Rate for Payer: Coventry All Commercial |
$16.26
|
| Rate for Payer: Encore All Commercial |
$17.00
|
| Rate for Payer: Frontpath All Commercial |
$17.00
|
| Rate for Payer: Humana ChoiceCare |
$15.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.63
|
| Rate for Payer: PHCS All Commercial |
$13.85
|
| Rate for Payer: PHP All Commercial |
$14.01
|
| Rate for Payer: Sagamore Health Network All Products |
$14.26
|
| Rate for Payer: Signature Care EPO |
$15.33
|
| Rate for Payer: Signature Care PPO |
$16.26
|
| Rate for Payer: United Healthcare Commercial |
$14.56
|
|
|
MEROPENEM 500 MG IV SOLR
|
Facility
|
OP
|
$18.47
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17379
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna Commercial |
$15.59
|
| Rate for Payer: Aetna Medicare |
$5.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.50
|
| Rate for Payer: Cash Price |
$11.08
|
| Rate for Payer: Centivo All Commercial |
$10.05
|
| Rate for Payer: Cigna All Commercial |
$15.94
|
| Rate for Payer: CORVEL All Commercial |
$17.18
|
| Rate for Payer: Coventry All Commercial |
$16.26
|
| Rate for Payer: Encore All Commercial |
$17.00
|
| Rate for Payer: Frontpath All Commercial |
$17.00
|
| Rate for Payer: Humana ChoiceCare |
$15.96
|
| Rate for Payer: Humana Medicare |
$5.91
|
| Rate for Payer: Lucent All Commercial |
$10.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.63
|
| Rate for Payer: PHCS All Commercial |
$13.85
|
| Rate for Payer: PHP All Commercial |
$14.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.20
|
| Rate for Payer: Sagamore Health Network All Products |
$14.26
|
| Rate for Payer: Signature Care EPO |
$15.33
|
| Rate for Payer: Signature Care PPO |
$16.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.70
|
| Rate for Payer: United Healthcare Commercial |
$14.56
|
| Rate for Payer: United Healthcare Medicare |
$5.91
|
|
|
MESALAMINE 400 MG ORAL CDTI
|
Facility
|
IP
|
$40.52
|
|
|
Service Code
|
NDC 60687055633
|
| Hospital Charge Code |
177796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.39 |
| Max. Negotiated Rate |
$37.69 |
| Rate for Payer: Aetna Commercial |
$35.01
|
| Rate for Payer: Cash Price |
$24.31
|
| Rate for Payer: Cigna All Commercial |
$34.97
|
| Rate for Payer: CORVEL All Commercial |
$37.69
|
| Rate for Payer: Coventry All Commercial |
$35.66
|
| Rate for Payer: Encore All Commercial |
$37.30
|
| Rate for Payer: Frontpath All Commercial |
$37.28
|
| Rate for Payer: Humana ChoiceCare |
$35.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.47
|
| Rate for Payer: PHCS All Commercial |
$30.39
|
| Rate for Payer: PHP All Commercial |
$30.73
|
| Rate for Payer: Sagamore Health Network All Products |
$31.28
|
| Rate for Payer: Signature Care EPO |
$33.63
|
| Rate for Payer: Signature Care PPO |
$35.66
|
| Rate for Payer: United Healthcare Commercial |
$31.93
|
|
|
MESALAMINE 400 MG ORAL CDTI
|
Facility
|
OP
|
$40.52
|
|
|
Service Code
|
NDC 60687055633
|
| Hospital Charge Code |
177796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$37.69 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.26
|
| Rate for Payer: Cash Price |
$24.31
|
| Rate for Payer: Centivo All Commercial |
$22.04
|
| Rate for Payer: Cigna All Commercial |
$34.97
|
| Rate for Payer: CORVEL All Commercial |
$37.69
|
| Rate for Payer: Coventry All Commercial |
$35.66
|
| Rate for Payer: Encore All Commercial |
$37.30
|
| Rate for Payer: Frontpath All Commercial |
$37.28
|
| Rate for Payer: Humana ChoiceCare |
$35.00
|
| Rate for Payer: Humana Medicare |
$12.97
|
| Rate for Payer: Lucent All Commercial |
$22.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.47
|
| Rate for Payer: PHCS All Commercial |
$30.39
|
| Rate for Payer: PHP All Commercial |
$30.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.80
|
| Rate for Payer: Sagamore Health Network All Products |
$31.28
|
| Rate for Payer: Signature Care EPO |
$33.63
|
| Rate for Payer: Signature Care PPO |
$35.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.44
|
| Rate for Payer: United Healthcare Commercial |
$31.93
|
| Rate for Payer: United Healthcare Medicare |
$12.97
|
|
|
MESALAMINE 400 MG ORAL CDTI
|
Facility
|
IP
|
$40.52
|
|
|
Service Code
|
NDC 60687055632
|
| Hospital Charge Code |
177796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.39 |
| Max. Negotiated Rate |
$37.69 |
| Rate for Payer: Aetna Commercial |
$35.01
|
| Rate for Payer: Cash Price |
$24.31
|
| Rate for Payer: Cigna All Commercial |
$34.97
|
| Rate for Payer: CORVEL All Commercial |
$37.69
|
| Rate for Payer: Coventry All Commercial |
$35.66
|
| Rate for Payer: Encore All Commercial |
$37.30
|
| Rate for Payer: Frontpath All Commercial |
$37.28
|
| Rate for Payer: Humana ChoiceCare |
$35.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.47
|
| Rate for Payer: PHCS All Commercial |
$30.39
|
| Rate for Payer: PHP All Commercial |
$30.73
|
| Rate for Payer: Sagamore Health Network All Products |
$31.28
|
| Rate for Payer: Signature Care EPO |
$33.63
|
| Rate for Payer: Signature Care PPO |
$35.66
|
| Rate for Payer: United Healthcare Commercial |
$31.93
|
|
|
MESALAMINE 400 MG ORAL CDTI
|
Facility
|
OP
|
$40.52
|
|
|
Service Code
|
NDC 60687055632
|
| Hospital Charge Code |
177796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$37.69 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Medicare |
$12.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.26
|
| Rate for Payer: Cash Price |
$24.31
|
| Rate for Payer: Centivo All Commercial |
$22.04
|
| Rate for Payer: Cigna All Commercial |
$34.97
|
| Rate for Payer: CORVEL All Commercial |
$37.69
|
| Rate for Payer: Coventry All Commercial |
$35.66
|
| Rate for Payer: Encore All Commercial |
$37.30
|
| Rate for Payer: Frontpath All Commercial |
$37.28
|
| Rate for Payer: Humana ChoiceCare |
$35.00
|
| Rate for Payer: Humana Medicare |
$12.97
|
| Rate for Payer: Lucent All Commercial |
$22.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.47
|
| Rate for Payer: PHCS All Commercial |
$30.39
|
| Rate for Payer: PHP All Commercial |
$30.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.80
|
| Rate for Payer: Sagamore Health Network All Products |
$31.28
|
| Rate for Payer: Signature Care EPO |
$33.63
|
| Rate for Payer: Signature Care PPO |
$35.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.44
|
| Rate for Payer: United Healthcare Commercial |
$31.93
|
| Rate for Payer: United Healthcare Medicare |
$12.97
|
|
|
METFORMIN 500 MG ORAL TAB
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 00904716261
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
|
|
METFORMIN 500 MG ORAL TAB
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 00904716261
|
| Hospital Charge Code |
10544
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.35
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Centivo All Commercial |
$0.54
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Humana Medicare |
$0.32
|
| Rate for Payer: Lucent All Commercial |
$0.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.39
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
| Rate for Payer: United Healthcare Medicare |
$0.32
|
|
|
METFORMIN 500 MG ORAL TB24
|
Facility
|
IP
|
$2.72
|
|
|
Service Code
|
NDC 50268055015
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cigna All Commercial |
$2.34
|
| Rate for Payer: CORVEL All Commercial |
$2.53
|
| Rate for Payer: Coventry All Commercial |
$2.39
|
| Rate for Payer: Encore All Commercial |
$2.50
|
| Rate for Payer: Frontpath All Commercial |
$2.50
|
| Rate for Payer: Humana ChoiceCare |
$2.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.44
|
| Rate for Payer: PHCS All Commercial |
$2.04
|
| Rate for Payer: PHP All Commercial |
$2.06
|
| Rate for Payer: Sagamore Health Network All Products |
$2.10
|
| Rate for Payer: Signature Care EPO |
$2.25
|
| Rate for Payer: Signature Care PPO |
$2.39
|
| Rate for Payer: United Healthcare Commercial |
$2.14
|
|
|
METFORMIN 500 MG ORAL TB24
|
Facility
|
IP
|
$2.72
|
|
|
Service Code
|
NDC 50268055011
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna Commercial |
$2.35
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Cigna All Commercial |
$2.34
|
| Rate for Payer: CORVEL All Commercial |
$2.53
|
| Rate for Payer: Coventry All Commercial |
$2.39
|
| Rate for Payer: Encore All Commercial |
$2.50
|
| Rate for Payer: Frontpath All Commercial |
$2.50
|
| Rate for Payer: Humana ChoiceCare |
$2.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.44
|
| Rate for Payer: PHCS All Commercial |
$2.04
|
| Rate for Payer: PHP All Commercial |
$2.06
|
| Rate for Payer: Sagamore Health Network All Products |
$2.10
|
| Rate for Payer: Signature Care EPO |
$2.25
|
| Rate for Payer: Signature Care PPO |
$2.39
|
| Rate for Payer: United Healthcare Commercial |
$2.14
|
|
|
METFORMIN 500 MG ORAL TB24
|
Facility
|
OP
|
$2.72
|
|
|
Service Code
|
NDC 50268055015
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.53 |
| Rate for Payer: Aetna Commercial |
$2.29
|
| Rate for Payer: Aetna Medicare |
$0.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.96
|
| Rate for Payer: Cash Price |
$1.63
|
| Rate for Payer: Centivo All Commercial |
$1.48
|
| Rate for Payer: Cigna All Commercial |
$2.34
|
| Rate for Payer: CORVEL All Commercial |
$2.53
|
| Rate for Payer: Coventry All Commercial |
$2.39
|
| Rate for Payer: Encore All Commercial |
$2.50
|
| Rate for Payer: Frontpath All Commercial |
$2.50
|
| Rate for Payer: Humana ChoiceCare |
$2.35
|
| Rate for Payer: Humana Medicare |
$0.87
|
| Rate for Payer: Lucent All Commercial |
$1.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.44
|
| Rate for Payer: PHCS All Commercial |
$2.04
|
| Rate for Payer: PHP All Commercial |
$2.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.06
|
| Rate for Payer: Sagamore Health Network All Products |
$2.10
|
| Rate for Payer: Signature Care EPO |
$2.25
|
| Rate for Payer: Signature Care PPO |
$2.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.31
|
| Rate for Payer: United Healthcare Commercial |
$2.14
|
| Rate for Payer: United Healthcare Medicare |
$0.87
|
|
