|
METFORMIN 500 MG ORAL TB24
|
Facility
|
OP
|
$2.72
|
|
|
Service Code
|
NDC 50268055011
|
| 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
|
|
|
METFORMIN 850 MG ORAL TAB
|
Facility
|
IP
|
$1.37
|
|
|
Service Code
|
NDC 60687014301
|
| Hospital Charge Code |
14719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna Commercial |
$1.19
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Cigna All Commercial |
$1.18
|
| Rate for Payer: CORVEL All Commercial |
$1.28
|
| Rate for Payer: Coventry All Commercial |
$1.21
|
| Rate for Payer: Encore All Commercial |
$1.26
|
| Rate for Payer: Frontpath All Commercial |
$1.26
|
| Rate for Payer: Humana ChoiceCare |
$1.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.23
|
| Rate for Payer: PHCS All Commercial |
$1.03
|
| Rate for Payer: PHP All Commercial |
$1.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1.06
|
| Rate for Payer: Signature Care EPO |
$1.14
|
| Rate for Payer: Signature Care PPO |
$1.21
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
|
|
METFORMIN 850 MG ORAL TAB
|
Facility
|
OP
|
$1.37
|
|
|
Service Code
|
NDC 60687014301
|
| Hospital Charge Code |
14719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.28 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: Aetna Medicare |
$0.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.48
|
| Rate for Payer: Cash Price |
$0.82
|
| Rate for Payer: Centivo All Commercial |
$0.75
|
| Rate for Payer: Cigna All Commercial |
$1.18
|
| Rate for Payer: CORVEL All Commercial |
$1.28
|
| Rate for Payer: Coventry All Commercial |
$1.21
|
| Rate for Payer: Encore All Commercial |
$1.26
|
| Rate for Payer: Frontpath All Commercial |
$1.26
|
| Rate for Payer: Humana ChoiceCare |
$1.18
|
| Rate for Payer: Humana Medicare |
$0.44
|
| Rate for Payer: Lucent All Commercial |
$0.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.23
|
| Rate for Payer: PHCS All Commercial |
$1.03
|
| Rate for Payer: PHP All Commercial |
$1.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.54
|
| Rate for Payer: Sagamore Health Network All Products |
$1.06
|
| Rate for Payer: Signature Care EPO |
$1.14
|
| Rate for Payer: Signature Care PPO |
$1.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.17
|
| Rate for Payer: United Healthcare Commercial |
$1.08
|
| Rate for Payer: United Healthcare Medicare |
$0.44
|
|
|
METHACHOLINE CHLORIDE 100 MG INHL SOLR
|
Facility
|
OP
|
$511.88
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
27032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$158.68 |
| Max. Negotiated Rate |
$476.05 |
| Rate for Payer: Aetna Commercial |
$432.03
|
| Rate for Payer: Aetna Medicare |
$163.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$158.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$293.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$319.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$188.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$180.18
|
| Rate for Payer: Cash Price |
$307.13
|
| Rate for Payer: Centivo All Commercial |
$278.46
|
| Rate for Payer: Cigna All Commercial |
$441.75
|
| Rate for Payer: CORVEL All Commercial |
$476.05
|
| Rate for Payer: Coventry All Commercial |
$450.45
|
| Rate for Payer: Encore All Commercial |
$471.18
|
| Rate for Payer: Frontpath All Commercial |
$470.93
|
| Rate for Payer: Humana ChoiceCare |
$442.11
|
| Rate for Payer: Humana Medicare |
$163.80
|
| Rate for Payer: Lucent All Commercial |
$278.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$460.69
|
| Rate for Payer: PHCS All Commercial |
$383.91
|
| Rate for Payer: PHP All Commercial |
$388.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.63
|
| Rate for Payer: Sagamore Health Network All Products |
$395.17
|
| Rate for Payer: Signature Care EPO |
$424.86
|
| Rate for Payer: Signature Care PPO |
$450.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$435.10
|
| Rate for Payer: United Healthcare Commercial |
$403.36
|
| Rate for Payer: United Healthcare Medicare |
$163.80
|
|
|
METHACHOLINE CHLORIDE 100 MG INHL SOLR
|
Facility
|
IP
|
$511.88
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
27032
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$383.91 |
| Max. Negotiated Rate |
$476.05 |
| Rate for Payer: Aetna Commercial |
$442.26
|
| Rate for Payer: Cash Price |
$307.13
|
| Rate for Payer: Cigna All Commercial |
$441.75
|
| Rate for Payer: CORVEL All Commercial |
$476.05
|
| Rate for Payer: Coventry All Commercial |
$450.45
|
| Rate for Payer: Encore All Commercial |
$471.18
|
| Rate for Payer: Frontpath All Commercial |
$470.93
|
| Rate for Payer: Humana ChoiceCare |
$442.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$460.69
|
| Rate for Payer: PHCS All Commercial |
$383.91
|
| Rate for Payer: PHP All Commercial |
$388.21
|
| Rate for Payer: Sagamore Health Network All Products |
$395.17
|
| Rate for Payer: Signature Care EPO |
$424.86
|
| Rate for Payer: Signature Care PPO |
$450.45
|
| Rate for Payer: United Healthcare Commercial |
$403.36
|
|
|
METHADONE 5 MG ORAL TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00406575562
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
|
|
METHADONE 5 MG ORAL TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00406575562
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Centivo All Commercial |
$2.18
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Humana Medicare |
$1.28
|
| Rate for Payer: Lucent All Commercial |
$2.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.40
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$1.28
|
|
|
METHIMAZOLE 5 MG ORAL TAB
|
Facility
|
IP
|
$3.62
|
|
|
Service Code
|
NDC 60687066901
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna All Commercial |
$3.12
|
| Rate for Payer: CORVEL All Commercial |
$3.37
|
| Rate for Payer: Coventry All Commercial |
$3.18
|
| Rate for Payer: Encore All Commercial |
$3.33
|
| Rate for Payer: Frontpath All Commercial |
$3.33
|
| Rate for Payer: Humana ChoiceCare |
$3.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.26
|
| Rate for Payer: PHCS All Commercial |
$2.71
|
| Rate for Payer: PHP All Commercial |
$2.74
|
| Rate for Payer: Sagamore Health Network All Products |
$2.79
|
| Rate for Payer: Signature Care EPO |
$3.00
|
| Rate for Payer: Signature Care PPO |
$3.18
|
| Rate for Payer: United Healthcare Commercial |
$2.85
|
|
|
METHIMAZOLE 5 MG ORAL TAB
|
Facility
|
OP
|
$3.62
|
|
|
Service Code
|
NDC 60687066911
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.05
|
| Rate for Payer: Aetna Medicare |
$1.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.27
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Centivo All Commercial |
$1.97
|
| Rate for Payer: Cigna All Commercial |
$3.12
|
| Rate for Payer: CORVEL All Commercial |
$3.37
|
| Rate for Payer: Coventry All Commercial |
$3.18
|
| Rate for Payer: Encore All Commercial |
$3.33
|
| Rate for Payer: Frontpath All Commercial |
$3.33
|
| Rate for Payer: Humana ChoiceCare |
$3.13
|
| Rate for Payer: Humana Medicare |
$1.16
|
| Rate for Payer: Lucent All Commercial |
$1.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.26
|
| Rate for Payer: PHCS All Commercial |
$2.71
|
| Rate for Payer: PHP All Commercial |
$2.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.41
|
| Rate for Payer: Sagamore Health Network All Products |
$2.79
|
| Rate for Payer: Signature Care EPO |
$3.00
|
| Rate for Payer: Signature Care PPO |
$3.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.08
|
| Rate for Payer: United Healthcare Commercial |
$2.85
|
| Rate for Payer: United Healthcare Medicare |
$1.16
|
|
|
METHIMAZOLE 5 MG ORAL TAB
|
Facility
|
IP
|
$3.62
|
|
|
Service Code
|
NDC 60687066911
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.71 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.13
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Cigna All Commercial |
$3.12
|
| Rate for Payer: CORVEL All Commercial |
$3.37
|
| Rate for Payer: Coventry All Commercial |
$3.18
|
| Rate for Payer: Encore All Commercial |
$3.33
|
| Rate for Payer: Frontpath All Commercial |
$3.33
|
| Rate for Payer: Humana ChoiceCare |
$3.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.26
|
| Rate for Payer: PHCS All Commercial |
$2.71
|
| Rate for Payer: PHP All Commercial |
$2.74
|
| Rate for Payer: Sagamore Health Network All Products |
$2.79
|
| Rate for Payer: Signature Care EPO |
$3.00
|
| Rate for Payer: Signature Care PPO |
$3.18
|
| Rate for Payer: United Healthcare Commercial |
$2.85
|
|
|
METHIMAZOLE 5 MG ORAL TAB
|
Facility
|
OP
|
$3.62
|
|
|
Service Code
|
NDC 60687066901
|
| Hospital Charge Code |
10553
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$3.37 |
| Rate for Payer: Aetna Commercial |
$3.05
|
| Rate for Payer: Aetna Medicare |
$1.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.27
|
| Rate for Payer: Cash Price |
$2.17
|
| Rate for Payer: Centivo All Commercial |
$1.97
|
| Rate for Payer: Cigna All Commercial |
$3.12
|
| Rate for Payer: CORVEL All Commercial |
$3.37
|
| Rate for Payer: Coventry All Commercial |
$3.18
|
| Rate for Payer: Encore All Commercial |
$3.33
|
| Rate for Payer: Frontpath All Commercial |
$3.33
|
| Rate for Payer: Humana ChoiceCare |
$3.13
|
| Rate for Payer: Humana Medicare |
$1.16
|
| Rate for Payer: Lucent All Commercial |
$1.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.26
|
| Rate for Payer: PHCS All Commercial |
$2.71
|
| Rate for Payer: PHP All Commercial |
$2.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.41
|
| Rate for Payer: Sagamore Health Network All Products |
$2.79
|
| Rate for Payer: Signature Care EPO |
$3.00
|
| Rate for Payer: Signature Care PPO |
$3.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.08
|
| Rate for Payer: United Healthcare Commercial |
$2.85
|
| Rate for Payer: United Healthcare Medicare |
$1.16
|
|
|
METHOCARBAMOL 500 MG ORAL TAB
|
Facility
|
OP
|
$1.69
|
|
|
Service Code
|
NDC 50268052015
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna Commercial |
$1.43
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.60
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Centivo All Commercial |
$0.92
|
| Rate for Payer: Cigna All Commercial |
$1.46
|
| Rate for Payer: CORVEL All Commercial |
$1.58
|
| Rate for Payer: Coventry All Commercial |
$1.49
|
| Rate for Payer: Encore All Commercial |
$1.56
|
| Rate for Payer: Frontpath All Commercial |
$1.56
|
| Rate for Payer: Humana ChoiceCare |
$1.46
|
| Rate for Payer: Humana Medicare |
$0.54
|
| Rate for Payer: Lucent All Commercial |
$0.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.52
|
| Rate for Payer: PHCS All Commercial |
$1.27
|
| Rate for Payer: PHP All Commercial |
$1.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1.31
|
| Rate for Payer: Signature Care EPO |
$1.41
|
| Rate for Payer: Signature Care PPO |
$1.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.44
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
| Rate for Payer: United Healthcare Medicare |
$0.54
|
|
|
METHOCARBAMOL 500 MG ORAL TAB
|
Facility
|
IP
|
$1.69
|
|
|
Service Code
|
NDC 50268052011
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna Commercial |
$1.46
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna All Commercial |
$1.46
|
| Rate for Payer: CORVEL All Commercial |
$1.58
|
| Rate for Payer: Coventry All Commercial |
$1.49
|
| Rate for Payer: Encore All Commercial |
$1.56
|
| Rate for Payer: Frontpath All Commercial |
$1.56
|
| Rate for Payer: Humana ChoiceCare |
$1.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.52
|
| Rate for Payer: PHCS All Commercial |
$1.27
|
| Rate for Payer: PHP All Commercial |
$1.28
|
| Rate for Payer: Sagamore Health Network All Products |
$1.31
|
| Rate for Payer: Signature Care EPO |
$1.41
|
| Rate for Payer: Signature Care PPO |
$1.49
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
|
|
METHOCARBAMOL 500 MG ORAL TAB
|
Facility
|
OP
|
$1.69
|
|
|
Service Code
|
NDC 50268052011
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.53 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna Commercial |
$1.43
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.60
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Centivo All Commercial |
$0.92
|
| Rate for Payer: Cigna All Commercial |
$1.46
|
| Rate for Payer: CORVEL All Commercial |
$1.58
|
| Rate for Payer: Coventry All Commercial |
$1.49
|
| Rate for Payer: Encore All Commercial |
$1.56
|
| Rate for Payer: Frontpath All Commercial |
$1.56
|
| Rate for Payer: Humana ChoiceCare |
$1.46
|
| Rate for Payer: Humana Medicare |
$0.54
|
| Rate for Payer: Lucent All Commercial |
$0.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.52
|
| Rate for Payer: PHCS All Commercial |
$1.27
|
| Rate for Payer: PHP All Commercial |
$1.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1.31
|
| Rate for Payer: Signature Care EPO |
$1.41
|
| Rate for Payer: Signature Care PPO |
$1.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.44
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
| Rate for Payer: United Healthcare Medicare |
$0.54
|
|
|
METHOCARBAMOL 500 MG ORAL TAB
|
Facility
|
IP
|
$1.69
|
|
|
Service Code
|
NDC 50268052015
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.27 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna Commercial |
$1.46
|
| Rate for Payer: Cash Price |
$1.02
|
| Rate for Payer: Cigna All Commercial |
$1.46
|
| Rate for Payer: CORVEL All Commercial |
$1.58
|
| Rate for Payer: Coventry All Commercial |
$1.49
|
| Rate for Payer: Encore All Commercial |
$1.56
|
| Rate for Payer: Frontpath All Commercial |
$1.56
|
| Rate for Payer: Humana ChoiceCare |
$1.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.52
|
| Rate for Payer: PHCS All Commercial |
$1.27
|
| Rate for Payer: PHP All Commercial |
$1.28
|
| Rate for Payer: Sagamore Health Network All Products |
$1.31
|
| Rate for Payer: Signature Care EPO |
$1.41
|
| Rate for Payer: Signature Care PPO |
$1.49
|
| Rate for Payer: United Healthcare Commercial |
$1.33
|
|
|
METHOHEXITAL 500 MG INJ SOLR
|
Facility
|
OP
|
$503.10
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
70545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.96 |
| Max. Negotiated Rate |
$467.88 |
| Rate for Payer: Aetna Commercial |
$424.62
|
| Rate for Payer: Aetna Medicare |
$160.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$155.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$288.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$314.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$185.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$177.09
|
| Rate for Payer: Cash Price |
$301.86
|
| Rate for Payer: Centivo All Commercial |
$273.69
|
| Rate for Payer: Cigna All Commercial |
$434.18
|
| Rate for Payer: CORVEL All Commercial |
$467.88
|
| Rate for Payer: Coventry All Commercial |
$442.73
|
| Rate for Payer: Encore All Commercial |
$463.10
|
| Rate for Payer: Frontpath All Commercial |
$462.85
|
| Rate for Payer: Humana ChoiceCare |
$434.53
|
| Rate for Payer: Humana Medicare |
$160.99
|
| Rate for Payer: Lucent All Commercial |
$273.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$452.79
|
| Rate for Payer: PHCS All Commercial |
$377.32
|
| Rate for Payer: PHP All Commercial |
$381.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$196.21
|
| Rate for Payer: Sagamore Health Network All Products |
$388.39
|
| Rate for Payer: Signature Care EPO |
$417.57
|
| Rate for Payer: Signature Care PPO |
$442.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$427.63
|
| Rate for Payer: United Healthcare Commercial |
$396.44
|
| Rate for Payer: United Healthcare Medicare |
$160.99
|
|
|
METHOHEXITAL 500 MG INJ SOLR
|
Facility
|
IP
|
$503.10
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
70545
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$377.32 |
| Max. Negotiated Rate |
$467.88 |
| Rate for Payer: Aetna Commercial |
$434.68
|
| Rate for Payer: Cash Price |
$301.86
|
| Rate for Payer: Cigna All Commercial |
$434.18
|
| Rate for Payer: CORVEL All Commercial |
$467.88
|
| Rate for Payer: Coventry All Commercial |
$442.73
|
| Rate for Payer: Encore All Commercial |
$463.10
|
| Rate for Payer: Frontpath All Commercial |
$462.85
|
| Rate for Payer: Humana ChoiceCare |
$434.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$452.79
|
| Rate for Payer: PHCS All Commercial |
$377.32
|
| Rate for Payer: PHP All Commercial |
$381.55
|
| Rate for Payer: Sagamore Health Network All Products |
$388.39
|
| Rate for Payer: Signature Care EPO |
$417.57
|
| Rate for Payer: Signature Care PPO |
$442.73
|
| Rate for Payer: United Healthcare Commercial |
$396.44
|
|
|
METHOTREXATE SODIUM 2.5 MG ORAL TAB
|
Facility
|
OP
|
$18.68
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
4973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.79 |
| Max. Negotiated Rate |
$17.38 |
| Rate for Payer: Aetna Commercial |
$15.77
|
| Rate for Payer: Aetna Medicare |
$5.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.58
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Centivo All Commercial |
$10.16
|
| Rate for Payer: Cigna All Commercial |
$16.12
|
| Rate for Payer: CORVEL All Commercial |
$17.38
|
| Rate for Payer: Coventry All Commercial |
$16.44
|
| Rate for Payer: Encore All Commercial |
$17.20
|
| Rate for Payer: Frontpath All Commercial |
$17.19
|
| Rate for Payer: Humana ChoiceCare |
$16.14
|
| Rate for Payer: Humana Medicare |
$5.98
|
| Rate for Payer: Lucent All Commercial |
$10.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.81
|
| Rate for Payer: PHCS All Commercial |
$14.01
|
| Rate for Payer: PHP All Commercial |
$14.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.29
|
| Rate for Payer: Sagamore Health Network All Products |
$14.42
|
| Rate for Payer: Signature Care EPO |
$15.51
|
| Rate for Payer: Signature Care PPO |
$16.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.88
|
| Rate for Payer: United Healthcare Commercial |
$14.72
|
| Rate for Payer: United Healthcare Medicare |
$5.98
|
|
|
METHOTREXATE SODIUM 2.5 MG ORAL TAB
|
Facility
|
IP
|
$18.68
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
4973
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$17.38 |
| Rate for Payer: Aetna Commercial |
$16.14
|
| Rate for Payer: Cash Price |
$11.21
|
| Rate for Payer: Cigna All Commercial |
$16.12
|
| Rate for Payer: CORVEL All Commercial |
$17.38
|
| Rate for Payer: Coventry All Commercial |
$16.44
|
| Rate for Payer: Encore All Commercial |
$17.20
|
| Rate for Payer: Frontpath All Commercial |
$17.19
|
| Rate for Payer: Humana ChoiceCare |
$16.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.81
|
| Rate for Payer: PHCS All Commercial |
$14.01
|
| Rate for Payer: PHP All Commercial |
$14.17
|
| Rate for Payer: Sagamore Health Network All Products |
$14.42
|
| Rate for Payer: Signature Care EPO |
$15.51
|
| Rate for Payer: Signature Care PPO |
$16.44
|
| Rate for Payer: United Healthcare Commercial |
$14.72
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN
|
Facility
|
IP
|
$126.54
|
|
|
Service Code
|
NDC 17478050401
|
| Hospital Charge Code |
4985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.90 |
| Max. Negotiated Rate |
$117.68 |
| Rate for Payer: Aetna Commercial |
$109.33
|
| Rate for Payer: Cash Price |
$75.92
|
| Rate for Payer: Cigna All Commercial |
$109.20
|
| Rate for Payer: CORVEL All Commercial |
$117.68
|
| Rate for Payer: Coventry All Commercial |
$111.35
|
| Rate for Payer: Encore All Commercial |
$116.48
|
| Rate for Payer: Frontpath All Commercial |
$116.42
|
| Rate for Payer: Humana ChoiceCare |
$109.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$113.89
|
| Rate for Payer: PHCS All Commercial |
$94.90
|
| Rate for Payer: PHP All Commercial |
$95.97
|
| Rate for Payer: Sagamore Health Network All Products |
$97.69
|
| Rate for Payer: Signature Care EPO |
$105.03
|
| Rate for Payer: Signature Care PPO |
$111.35
|
| Rate for Payer: United Healthcare Commercial |
$99.71
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN
|
Facility
|
OP
|
$126.54
|
|
|
Service Code
|
NDC 17478050401
|
| Hospital Charge Code |
4985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$117.68 |
| Rate for Payer: Aetna Commercial |
$106.80
|
| Rate for Payer: Aetna Medicare |
$40.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$72.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.54
|
| Rate for Payer: Cash Price |
$75.92
|
| Rate for Payer: Cash Price |
$75.92
|
| Rate for Payer: Centivo All Commercial |
$68.84
|
| Rate for Payer: Cigna All Commercial |
$109.20
|
| Rate for Payer: CORVEL All Commercial |
$117.68
|
| Rate for Payer: Coventry All Commercial |
$111.35
|
| Rate for Payer: Encore All Commercial |
$116.48
|
| Rate for Payer: Frontpath All Commercial |
$116.42
|
| Rate for Payer: Humana ChoiceCare |
$109.29
|
| Rate for Payer: Humana Medicare |
$40.49
|
| Rate for Payer: Lucent All Commercial |
$68.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$113.89
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$94.90
|
| Rate for Payer: PHP All Commercial |
$95.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.35
|
| Rate for Payer: Sagamore Health Network All Products |
$97.69
|
| Rate for Payer: Signature Care EPO |
$105.03
|
| Rate for Payer: Signature Care PPO |
$111.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$107.56
|
| Rate for Payer: United Healthcare Commercial |
$99.71
|
| Rate for Payer: United Healthcare Medicare |
$40.49
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN
|
Facility
|
OP
|
$562.50
|
|
|
Service Code
|
NDC 00517037405
|
| Hospital Charge Code |
178916
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$523.12 |
| Rate for Payer: Aetna Commercial |
$474.75
|
| Rate for Payer: Aetna Medicare |
$180.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$174.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$323.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$351.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$207.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$198.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Centivo All Commercial |
$306.00
|
| Rate for Payer: Cigna All Commercial |
$485.44
|
| Rate for Payer: CORVEL All Commercial |
$523.12
|
| Rate for Payer: Coventry All Commercial |
$495.00
|
| Rate for Payer: Encore All Commercial |
$517.78
|
| Rate for Payer: Frontpath All Commercial |
$517.50
|
| Rate for Payer: Humana ChoiceCare |
$485.83
|
| Rate for Payer: Humana Medicare |
$180.00
|
| Rate for Payer: Lucent All Commercial |
$306.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$506.25
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$421.88
|
| Rate for Payer: PHP All Commercial |
$426.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$219.38
|
| Rate for Payer: Sagamore Health Network All Products |
$434.25
|
| Rate for Payer: Signature Care EPO |
$466.88
|
| Rate for Payer: Signature Care PPO |
$495.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$478.12
|
| Rate for Payer: United Healthcare Commercial |
$443.25
|
| Rate for Payer: United Healthcare Medicare |
$180.00
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN
|
Facility
|
IP
|
$562.50
|
|
|
Service Code
|
NDC 00517037405
|
| Hospital Charge Code |
178916
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$421.88 |
| Max. Negotiated Rate |
$523.12 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna All Commercial |
$485.44
|
| Rate for Payer: CORVEL All Commercial |
$523.12
|
| Rate for Payer: Coventry All Commercial |
$495.00
|
| Rate for Payer: Encore All Commercial |
$517.78
|
| Rate for Payer: Frontpath All Commercial |
$517.50
|
| Rate for Payer: Humana ChoiceCare |
$485.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$506.25
|
| Rate for Payer: PHCS All Commercial |
$421.88
|
| Rate for Payer: PHP All Commercial |
$426.60
|
| Rate for Payer: Sagamore Health Network All Products |
$434.25
|
| Rate for Payer: Signature Care EPO |
$466.88
|
| Rate for Payer: Signature Care PPO |
$495.00
|
| Rate for Payer: United Healthcare Commercial |
$443.25
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10571
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.25 |
| Max. Negotiated Rate |
$140.43 |
| Rate for Payer: Aetna Commercial |
$130.47
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna All Commercial |
$130.32
|
| Rate for Payer: CORVEL All Commercial |
$140.43
|
| Rate for Payer: Coventry All Commercial |
$132.88
|
| Rate for Payer: Encore All Commercial |
$139.00
|
| Rate for Payer: Frontpath All Commercial |
$138.92
|
| Rate for Payer: Humana ChoiceCare |
$130.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.90
|
| Rate for Payer: PHCS All Commercial |
$113.25
|
| Rate for Payer: PHP All Commercial |
$114.52
|
| Rate for Payer: Sagamore Health Network All Products |
$116.58
|
| Rate for Payer: Signature Care EPO |
$125.33
|
| Rate for Payer: Signature Care PPO |
$132.88
|
| Rate for Payer: United Healthcare Commercial |
$118.99
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$140.43 |
| Rate for Payer: Aetna Commercial |
$127.45
|
| Rate for Payer: Aetna Medicare |
$48.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$46.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$86.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.15
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Centivo All Commercial |
$82.15
|
| Rate for Payer: Cigna All Commercial |
$130.32
|
| Rate for Payer: CORVEL All Commercial |
$140.43
|
| Rate for Payer: Coventry All Commercial |
$132.88
|
| Rate for Payer: Encore All Commercial |
$139.00
|
| Rate for Payer: Frontpath All Commercial |
$138.92
|
| Rate for Payer: Humana ChoiceCare |
$130.42
|
| Rate for Payer: Humana Medicare |
$48.32
|
| Rate for Payer: Lucent All Commercial |
$82.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$135.90
|
| Rate for Payer: PHCS All Commercial |
$113.25
|
| Rate for Payer: PHP All Commercial |
$114.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.89
|
| Rate for Payer: Sagamore Health Network All Products |
$116.58
|
| Rate for Payer: Signature Care EPO |
$125.33
|
| Rate for Payer: Signature Care PPO |
$132.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$128.35
|
| Rate for Payer: United Healthcare Commercial |
$118.99
|
| Rate for Payer: United Healthcare Medicare |
$48.32
|
|
