|
METHYLPREDNISOLONE 4 MG ORAL TAB (IP DOSEPAK)
|
Facility
|
OP
|
$2.25
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
163342
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.70 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Aetna Commercial |
$1.90
|
| Rate for Payer: Aetna Medicare |
$0.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.79
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Centivo All Commercial |
$1.22
|
| Rate for Payer: Cigna All Commercial |
$1.94
|
| Rate for Payer: CORVEL All Commercial |
$2.09
|
| Rate for Payer: Coventry All Commercial |
$1.98
|
| Rate for Payer: Encore All Commercial |
$2.07
|
| Rate for Payer: Frontpath All Commercial |
$2.07
|
| Rate for Payer: Humana ChoiceCare |
$1.94
|
| Rate for Payer: Humana Medicare |
$0.72
|
| Rate for Payer: Lucent All Commercial |
$1.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.02
|
| Rate for Payer: PHCS All Commercial |
$1.69
|
| Rate for Payer: PHP All Commercial |
$1.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.88
|
| Rate for Payer: Sagamore Health Network All Products |
$1.73
|
| Rate for Payer: Signature Care EPO |
$1.87
|
| Rate for Payer: Signature Care PPO |
$1.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.91
|
| Rate for Payer: United Healthcare Commercial |
$1.77
|
| Rate for Payer: United Healthcare Medicare |
$0.72
|
|
|
METHYLPREDNISOLONE 4 MG ORAL TAB (IP DOSEPAK)
|
Facility
|
IP
|
$2.25
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
163342
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$2.09 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Cash Price |
$1.35
|
| Rate for Payer: Cigna All Commercial |
$1.94
|
| Rate for Payer: CORVEL All Commercial |
$2.09
|
| Rate for Payer: Coventry All Commercial |
$1.98
|
| Rate for Payer: Encore All Commercial |
$2.07
|
| Rate for Payer: Frontpath All Commercial |
$2.07
|
| Rate for Payer: Humana ChoiceCare |
$1.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.02
|
| Rate for Payer: PHCS All Commercial |
$1.69
|
| Rate for Payer: PHP All Commercial |
$1.70
|
| Rate for Payer: Sagamore Health Network All Products |
$1.73
|
| Rate for Payer: Signature Care EPO |
$1.87
|
| Rate for Payer: Signature Care PPO |
$1.98
|
| Rate for Payer: United Healthcare Commercial |
$1.77
|
|
|
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP
|
Facility
|
OP
|
$79.58
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
4995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.67 |
| Max. Negotiated Rate |
$74.01 |
| Rate for Payer: Aetna Commercial |
$67.16
|
| Rate for Payer: Aetna Medicare |
$25.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$45.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.01
|
| Rate for Payer: Cash Price |
$47.75
|
| Rate for Payer: Centivo All Commercial |
$43.29
|
| Rate for Payer: Cigna All Commercial |
$68.67
|
| Rate for Payer: CORVEL All Commercial |
$74.01
|
| Rate for Payer: Coventry All Commercial |
$70.03
|
| Rate for Payer: Encore All Commercial |
$73.25
|
| Rate for Payer: Frontpath All Commercial |
$73.21
|
| Rate for Payer: Humana ChoiceCare |
$68.73
|
| Rate for Payer: Humana Medicare |
$25.46
|
| Rate for Payer: Lucent All Commercial |
$43.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.62
|
| Rate for Payer: PHCS All Commercial |
$59.68
|
| Rate for Payer: PHP All Commercial |
$60.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.03
|
| Rate for Payer: Sagamore Health Network All Products |
$61.43
|
| Rate for Payer: Signature Care EPO |
$66.05
|
| Rate for Payer: Signature Care PPO |
$70.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$67.64
|
| Rate for Payer: United Healthcare Commercial |
$62.71
|
| Rate for Payer: United Healthcare Medicare |
$25.46
|
|
|
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP
|
Facility
|
IP
|
$79.58
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
4995
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$59.68 |
| Max. Negotiated Rate |
$74.01 |
| Rate for Payer: Aetna Commercial |
$68.75
|
| Rate for Payer: Cash Price |
$47.75
|
| Rate for Payer: Cigna All Commercial |
$68.67
|
| Rate for Payer: CORVEL All Commercial |
$74.01
|
| Rate for Payer: Coventry All Commercial |
$70.03
|
| Rate for Payer: Encore All Commercial |
$73.25
|
| Rate for Payer: Frontpath All Commercial |
$73.21
|
| Rate for Payer: Humana ChoiceCare |
$68.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.62
|
| Rate for Payer: PHCS All Commercial |
$59.68
|
| Rate for Payer: PHP All Commercial |
$60.35
|
| Rate for Payer: Sagamore Health Network All Products |
$61.43
|
| Rate for Payer: Signature Care EPO |
$66.05
|
| Rate for Payer: Signature Care PPO |
$70.03
|
| Rate for Payer: United Healthcare Commercial |
$62.71
|
|
|
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP
|
Facility
|
IP
|
$138.07
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
4996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$103.55 |
| Max. Negotiated Rate |
$128.40 |
| Rate for Payer: Aetna Commercial |
$119.29
|
| Rate for Payer: Cash Price |
$82.84
|
| Rate for Payer: Cigna All Commercial |
$119.15
|
| Rate for Payer: CORVEL All Commercial |
$128.40
|
| Rate for Payer: Coventry All Commercial |
$121.50
|
| Rate for Payer: Encore All Commercial |
$127.09
|
| Rate for Payer: Frontpath All Commercial |
$127.02
|
| Rate for Payer: Humana ChoiceCare |
$119.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.26
|
| Rate for Payer: PHCS All Commercial |
$103.55
|
| Rate for Payer: PHP All Commercial |
$104.71
|
| Rate for Payer: Sagamore Health Network All Products |
$106.59
|
| Rate for Payer: Signature Care EPO |
$114.60
|
| Rate for Payer: Signature Care PPO |
$121.50
|
| Rate for Payer: United Healthcare Commercial |
$108.80
|
|
|
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP
|
Facility
|
OP
|
$138.07
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
4996
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$128.40 |
| Rate for Payer: Aetna Commercial |
$116.53
|
| Rate for Payer: Aetna Medicare |
$44.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.60
|
| Rate for Payer: Cash Price |
$82.84
|
| Rate for Payer: Centivo All Commercial |
$75.11
|
| Rate for Payer: Cigna All Commercial |
$119.15
|
| Rate for Payer: CORVEL All Commercial |
$128.40
|
| Rate for Payer: Coventry All Commercial |
$121.50
|
| Rate for Payer: Encore All Commercial |
$127.09
|
| Rate for Payer: Frontpath All Commercial |
$127.02
|
| Rate for Payer: Humana ChoiceCare |
$119.25
|
| Rate for Payer: Humana Medicare |
$44.18
|
| Rate for Payer: Lucent All Commercial |
$75.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.26
|
| Rate for Payer: PHCS All Commercial |
$103.55
|
| Rate for Payer: PHP All Commercial |
$104.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.85
|
| Rate for Payer: Sagamore Health Network All Products |
$106.59
|
| Rate for Payer: Signature Care EPO |
$114.60
|
| Rate for Payer: Signature Care PPO |
$121.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.36
|
| Rate for Payer: United Healthcare Commercial |
$108.80
|
| Rate for Payer: United Healthcare Medicare |
$44.18
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 1000 MG IV SOLR
|
Facility
|
OP
|
$154.98
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.04 |
| Max. Negotiated Rate |
$144.13 |
| Rate for Payer: Aetna Commercial |
$130.80
|
| Rate for Payer: Aetna Medicare |
$49.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$89.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$96.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.55
|
| Rate for Payer: Cash Price |
$92.99
|
| Rate for Payer: Centivo All Commercial |
$84.31
|
| Rate for Payer: Cigna All Commercial |
$133.75
|
| Rate for Payer: CORVEL All Commercial |
$144.13
|
| Rate for Payer: Coventry All Commercial |
$136.38
|
| Rate for Payer: Encore All Commercial |
$142.66
|
| Rate for Payer: Frontpath All Commercial |
$142.58
|
| Rate for Payer: Humana ChoiceCare |
$133.86
|
| Rate for Payer: Humana Medicare |
$49.59
|
| Rate for Payer: Lucent All Commercial |
$84.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.48
|
| Rate for Payer: PHCS All Commercial |
$116.23
|
| Rate for Payer: PHP All Commercial |
$117.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.44
|
| Rate for Payer: Sagamore Health Network All Products |
$119.64
|
| Rate for Payer: Signature Care EPO |
$128.63
|
| Rate for Payer: Signature Care PPO |
$136.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$131.73
|
| Rate for Payer: United Healthcare Commercial |
$122.12
|
| Rate for Payer: United Healthcare Medicare |
$49.59
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 1000 MG IV SOLR
|
Facility
|
IP
|
$154.98
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$116.23 |
| Max. Negotiated Rate |
$144.13 |
| Rate for Payer: Aetna Commercial |
$133.90
|
| Rate for Payer: Cash Price |
$92.99
|
| Rate for Payer: Cigna All Commercial |
$133.75
|
| Rate for Payer: CORVEL All Commercial |
$144.13
|
| Rate for Payer: Coventry All Commercial |
$136.38
|
| Rate for Payer: Encore All Commercial |
$142.66
|
| Rate for Payer: Frontpath All Commercial |
$142.58
|
| Rate for Payer: Humana ChoiceCare |
$133.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.48
|
| Rate for Payer: PHCS All Commercial |
$116.23
|
| Rate for Payer: PHP All Commercial |
$117.54
|
| Rate for Payer: Sagamore Health Network All Products |
$119.64
|
| Rate for Payer: Signature Care EPO |
$128.63
|
| Rate for Payer: Signature Care PPO |
$136.38
|
| Rate for Payer: United Healthcare Commercial |
$122.12
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 125 MG INJ SOLR
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Centivo All Commercial |
$9.79
|
| 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 |
$5.76
|
| Rate for Payer: Lucent All Commercial |
$9.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.76
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 125 MG INJ SOLR
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10578
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$10.80
|
| 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
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 2 G IV SOLR
|
Facility
|
IP
|
$572.58
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10579
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$429.44 |
| Max. Negotiated Rate |
$532.50 |
| Rate for Payer: Aetna Commercial |
$494.71
|
| Rate for Payer: Cash Price |
$343.55
|
| Rate for Payer: Cigna All Commercial |
$494.14
|
| Rate for Payer: CORVEL All Commercial |
$532.50
|
| Rate for Payer: Coventry All Commercial |
$503.87
|
| Rate for Payer: Encore All Commercial |
$527.06
|
| Rate for Payer: Frontpath All Commercial |
$526.77
|
| Rate for Payer: Humana ChoiceCare |
$494.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$515.32
|
| Rate for Payer: PHCS All Commercial |
$429.44
|
| Rate for Payer: PHP All Commercial |
$434.24
|
| Rate for Payer: Sagamore Health Network All Products |
$442.03
|
| Rate for Payer: Signature Care EPO |
$475.24
|
| Rate for Payer: Signature Care PPO |
$503.87
|
| Rate for Payer: United Healthcare Commercial |
$451.19
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 2 G IV SOLR
|
Facility
|
OP
|
$572.58
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10579
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.50 |
| Max. Negotiated Rate |
$532.50 |
| Rate for Payer: Aetna Commercial |
$483.26
|
| Rate for Payer: Aetna Medicare |
$183.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$177.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$328.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$357.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$210.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$201.55
|
| Rate for Payer: Cash Price |
$343.55
|
| Rate for Payer: Centivo All Commercial |
$311.48
|
| Rate for Payer: Cigna All Commercial |
$494.14
|
| Rate for Payer: CORVEL All Commercial |
$532.50
|
| Rate for Payer: Coventry All Commercial |
$503.87
|
| Rate for Payer: Encore All Commercial |
$527.06
|
| Rate for Payer: Frontpath All Commercial |
$526.77
|
| Rate for Payer: Humana ChoiceCare |
$494.54
|
| Rate for Payer: Humana Medicare |
$183.23
|
| Rate for Payer: Lucent All Commercial |
$311.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$515.32
|
| Rate for Payer: PHCS All Commercial |
$429.44
|
| Rate for Payer: PHP All Commercial |
$434.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$223.31
|
| Rate for Payer: Sagamore Health Network All Products |
$442.03
|
| Rate for Payer: Signature Care EPO |
$475.24
|
| Rate for Payer: Signature Care PPO |
$503.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$486.69
|
| Rate for Payer: United Healthcare Commercial |
$451.19
|
| Rate for Payer: United Healthcare Medicare |
$183.23
|
|
|
METHYLPREDNISOLONE SOD SUC(PF) 1000 MG/8 ML IV SOLR
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
120963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$254.25 |
| Max. Negotiated Rate |
$315.27 |
| Rate for Payer: Aetna Commercial |
$292.90
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna All Commercial |
$292.56
|
| Rate for Payer: CORVEL All Commercial |
$315.27
|
| Rate for Payer: Coventry All Commercial |
$298.32
|
| Rate for Payer: Encore All Commercial |
$312.05
|
| Rate for Payer: Frontpath All Commercial |
$311.88
|
| Rate for Payer: Humana ChoiceCare |
$292.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$305.10
|
| Rate for Payer: PHCS All Commercial |
$254.25
|
| Rate for Payer: PHP All Commercial |
$257.10
|
| Rate for Payer: Sagamore Health Network All Products |
$261.71
|
| Rate for Payer: Signature Care EPO |
$281.37
|
| Rate for Payer: Signature Care PPO |
$298.32
|
| Rate for Payer: United Healthcare Commercial |
$267.13
|
|
|
METHYLPREDNISOLONE SOD SUC(PF) 1000 MG/8 ML IV SOLR
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
120963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$315.27 |
| Rate for Payer: Aetna Commercial |
$286.12
|
| Rate for Payer: Aetna Medicare |
$108.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$194.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$211.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$119.33
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Centivo All Commercial |
$184.42
|
| Rate for Payer: Cigna All Commercial |
$292.56
|
| Rate for Payer: CORVEL All Commercial |
$315.27
|
| Rate for Payer: Coventry All Commercial |
$298.32
|
| Rate for Payer: Encore All Commercial |
$312.05
|
| Rate for Payer: Frontpath All Commercial |
$311.88
|
| Rate for Payer: Humana ChoiceCare |
$292.79
|
| Rate for Payer: Humana Medicare |
$108.48
|
| Rate for Payer: Lucent All Commercial |
$184.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$305.10
|
| Rate for Payer: PHCS All Commercial |
$254.25
|
| Rate for Payer: PHP All Commercial |
$257.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$132.21
|
| Rate for Payer: Sagamore Health Network All Products |
$261.71
|
| Rate for Payer: Signature Care EPO |
$281.37
|
| Rate for Payer: Signature Care PPO |
$298.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$288.15
|
| Rate for Payer: United Healthcare Commercial |
$267.13
|
| Rate for Payer: United Healthcare Medicare |
$108.48
|
|
|
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR
|
Facility
|
IP
|
$54.10
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
120961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$40.57 |
| Max. Negotiated Rate |
$50.31 |
| Rate for Payer: Aetna Commercial |
$46.74
|
| Rate for Payer: Cash Price |
$32.46
|
| Rate for Payer: Cigna All Commercial |
$46.68
|
| Rate for Payer: CORVEL All Commercial |
$50.31
|
| Rate for Payer: Coventry All Commercial |
$47.60
|
| Rate for Payer: Encore All Commercial |
$49.80
|
| Rate for Payer: Frontpath All Commercial |
$49.77
|
| Rate for Payer: Humana ChoiceCare |
$46.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.69
|
| Rate for Payer: PHCS All Commercial |
$40.57
|
| Rate for Payer: PHP All Commercial |
$41.03
|
| Rate for Payer: Sagamore Health Network All Products |
$41.76
|
| Rate for Payer: Signature Care EPO |
$44.90
|
| Rate for Payer: Signature Care PPO |
$47.60
|
| Rate for Payer: United Healthcare Commercial |
$42.63
|
|
|
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR
|
Facility
|
OP
|
$54.10
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
120961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$50.31 |
| Rate for Payer: Aetna Commercial |
$45.66
|
| Rate for Payer: Aetna Medicare |
$17.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$31.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.04
|
| Rate for Payer: Cash Price |
$32.46
|
| Rate for Payer: Centivo All Commercial |
$29.43
|
| Rate for Payer: Cigna All Commercial |
$46.68
|
| Rate for Payer: CORVEL All Commercial |
$50.31
|
| Rate for Payer: Coventry All Commercial |
$47.60
|
| Rate for Payer: Encore All Commercial |
$49.80
|
| Rate for Payer: Frontpath All Commercial |
$49.77
|
| Rate for Payer: Humana ChoiceCare |
$46.72
|
| Rate for Payer: Humana Medicare |
$17.31
|
| Rate for Payer: Lucent All Commercial |
$29.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.69
|
| Rate for Payer: PHCS All Commercial |
$40.57
|
| Rate for Payer: PHP All Commercial |
$41.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.10
|
| Rate for Payer: Sagamore Health Network All Products |
$41.76
|
| Rate for Payer: Signature Care EPO |
$44.90
|
| Rate for Payer: Signature Care PPO |
$47.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.98
|
| Rate for Payer: United Healthcare Commercial |
$42.63
|
| Rate for Payer: United Healthcare Medicare |
$17.31
|
|
|
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR
|
Facility
|
IP
|
$33.97
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
120960
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$31.59 |
| Rate for Payer: Aetna Commercial |
$29.35
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Cigna All Commercial |
$29.32
|
| Rate for Payer: CORVEL All Commercial |
$31.59
|
| Rate for Payer: Coventry All Commercial |
$29.89
|
| Rate for Payer: Encore All Commercial |
$31.27
|
| Rate for Payer: Frontpath All Commercial |
$31.25
|
| Rate for Payer: Humana ChoiceCare |
$29.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.57
|
| Rate for Payer: PHCS All Commercial |
$25.48
|
| Rate for Payer: PHP All Commercial |
$25.76
|
| Rate for Payer: Sagamore Health Network All Products |
$26.23
|
| Rate for Payer: Signature Care EPO |
$28.20
|
| Rate for Payer: Signature Care PPO |
$29.89
|
| Rate for Payer: United Healthcare Commercial |
$26.77
|
|
|
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR
|
Facility
|
OP
|
$33.97
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
120960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$31.59 |
| Rate for Payer: Aetna Commercial |
$28.67
|
| Rate for Payer: Aetna Medicare |
$10.87
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$19.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.96
|
| Rate for Payer: Cash Price |
$20.38
|
| Rate for Payer: Centivo All Commercial |
$18.48
|
| Rate for Payer: Cigna All Commercial |
$29.32
|
| Rate for Payer: CORVEL All Commercial |
$31.59
|
| Rate for Payer: Coventry All Commercial |
$29.89
|
| Rate for Payer: Encore All Commercial |
$31.27
|
| Rate for Payer: Frontpath All Commercial |
$31.25
|
| Rate for Payer: Humana ChoiceCare |
$29.34
|
| Rate for Payer: Humana Medicare |
$10.87
|
| Rate for Payer: Lucent All Commercial |
$18.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.57
|
| Rate for Payer: PHCS All Commercial |
$25.48
|
| Rate for Payer: PHP All Commercial |
$25.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.25
|
| Rate for Payer: Sagamore Health Network All Products |
$26.23
|
| Rate for Payer: Signature Care EPO |
$28.20
|
| Rate for Payer: Signature Care PPO |
$29.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28.88
|
| Rate for Payer: United Healthcare Commercial |
$26.77
|
| Rate for Payer: United Healthcare Medicare |
$10.87
|
|
|
METOCLOPRAMIDE HCL 10 MG ORAL TAB
|
Facility
|
IP
|
$3.95
|
|
|
Service Code
|
NDC 60687063101
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.96 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$3.41
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cigna All Commercial |
$3.41
|
| Rate for Payer: CORVEL All Commercial |
$3.67
|
| Rate for Payer: Coventry All Commercial |
$3.47
|
| Rate for Payer: Encore All Commercial |
$3.63
|
| Rate for Payer: Frontpath All Commercial |
$3.63
|
| Rate for Payer: Humana ChoiceCare |
$3.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.55
|
| Rate for Payer: PHCS All Commercial |
$2.96
|
| Rate for Payer: PHP All Commercial |
$2.99
|
| Rate for Payer: Sagamore Health Network All Products |
$3.05
|
| Rate for Payer: Signature Care EPO |
$3.28
|
| Rate for Payer: Signature Care PPO |
$3.47
|
| Rate for Payer: United Healthcare Commercial |
$3.11
|
|
|
METOCLOPRAMIDE HCL 10 MG ORAL TAB
|
Facility
|
OP
|
$3.95
|
|
|
Service Code
|
NDC 60687063101
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$3.67 |
| Rate for Payer: Aetna Commercial |
$3.33
|
| Rate for Payer: Aetna Medicare |
$1.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.39
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Centivo All Commercial |
$2.15
|
| Rate for Payer: Cigna All Commercial |
$3.41
|
| Rate for Payer: CORVEL All Commercial |
$3.67
|
| Rate for Payer: Coventry All Commercial |
$3.47
|
| Rate for Payer: Encore All Commercial |
$3.63
|
| Rate for Payer: Frontpath All Commercial |
$3.63
|
| Rate for Payer: Humana ChoiceCare |
$3.41
|
| Rate for Payer: Humana Medicare |
$1.26
|
| Rate for Payer: Lucent All Commercial |
$2.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.55
|
| Rate for Payer: PHCS All Commercial |
$2.96
|
| Rate for Payer: PHP All Commercial |
$2.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.54
|
| Rate for Payer: Sagamore Health Network All Products |
$3.05
|
| Rate for Payer: Signature Care EPO |
$3.28
|
| Rate for Payer: Signature Care PPO |
$3.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.36
|
| Rate for Payer: United Healthcare Commercial |
$3.11
|
| Rate for Payer: United Healthcare Medicare |
$1.26
|
|
|
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN
|
Facility
|
IP
|
$21.42
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.07 |
| Max. Negotiated Rate |
$19.92 |
| Rate for Payer: Aetna Commercial |
$18.51
|
| Rate for Payer: Cash Price |
$12.85
|
| Rate for Payer: Cigna All Commercial |
$18.49
|
| Rate for Payer: CORVEL All Commercial |
$19.92
|
| Rate for Payer: Coventry All Commercial |
$18.85
|
| Rate for Payer: Encore All Commercial |
$19.72
|
| Rate for Payer: Frontpath All Commercial |
$19.71
|
| Rate for Payer: Humana ChoiceCare |
$18.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.28
|
| Rate for Payer: PHCS All Commercial |
$16.07
|
| Rate for Payer: PHP All Commercial |
$16.24
|
| Rate for Payer: Sagamore Health Network All Products |
$16.54
|
| Rate for Payer: Signature Care EPO |
$17.78
|
| Rate for Payer: Signature Care PPO |
$18.85
|
| Rate for Payer: United Healthcare Commercial |
$16.88
|
|
|
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN
|
Facility
|
OP
|
$21.42
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.64 |
| Max. Negotiated Rate |
$19.92 |
| Rate for Payer: Aetna Commercial |
$18.08
|
| Rate for Payer: Aetna Medicare |
$6.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.54
|
| Rate for Payer: Cash Price |
$12.85
|
| Rate for Payer: Centivo All Commercial |
$11.65
|
| Rate for Payer: Cigna All Commercial |
$18.49
|
| Rate for Payer: CORVEL All Commercial |
$19.92
|
| Rate for Payer: Coventry All Commercial |
$18.85
|
| Rate for Payer: Encore All Commercial |
$19.72
|
| Rate for Payer: Frontpath All Commercial |
$19.71
|
| Rate for Payer: Humana ChoiceCare |
$18.50
|
| Rate for Payer: Humana Medicare |
$6.85
|
| Rate for Payer: Lucent All Commercial |
$11.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$19.28
|
| Rate for Payer: PHCS All Commercial |
$16.07
|
| Rate for Payer: PHP All Commercial |
$16.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.35
|
| Rate for Payer: Sagamore Health Network All Products |
$16.54
|
| Rate for Payer: Signature Care EPO |
$17.78
|
| Rate for Payer: Signature Care PPO |
$18.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.21
|
| Rate for Payer: United Healthcare Commercial |
$16.88
|
| Rate for Payer: United Healthcare Medicare |
$6.85
|
|
|
METOCLOPRAMIDE HCL 5 MG ORAL TAB
|
Facility
|
IP
|
$3.89
|
|
|
Service Code
|
NDC 60687062001
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Aetna Commercial |
$3.36
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cigna All Commercial |
$3.36
|
| Rate for Payer: CORVEL All Commercial |
$3.62
|
| Rate for Payer: Coventry All Commercial |
$3.42
|
| Rate for Payer: Encore All Commercial |
$3.58
|
| Rate for Payer: Frontpath All Commercial |
$3.58
|
| Rate for Payer: Humana ChoiceCare |
$3.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.50
|
| Rate for Payer: PHCS All Commercial |
$2.92
|
| Rate for Payer: PHP All Commercial |
$2.95
|
| Rate for Payer: Sagamore Health Network All Products |
$3.00
|
| Rate for Payer: Signature Care EPO |
$3.23
|
| Rate for Payer: Signature Care PPO |
$3.42
|
| Rate for Payer: United Healthcare Commercial |
$3.07
|
|
|
METOCLOPRAMIDE HCL 5 MG ORAL TAB
|
Facility
|
OP
|
$3.89
|
|
|
Service Code
|
NDC 60687062001
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$9.56 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Aetna Medicare |
$1.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.37
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Cash Price |
$2.34
|
| Rate for Payer: Centivo All Commercial |
$2.12
|
| Rate for Payer: Cigna All Commercial |
$3.36
|
| Rate for Payer: CORVEL All Commercial |
$3.62
|
| Rate for Payer: Coventry All Commercial |
$3.42
|
| Rate for Payer: Encore All Commercial |
$3.58
|
| Rate for Payer: Frontpath All Commercial |
$3.58
|
| Rate for Payer: Humana ChoiceCare |
$3.36
|
| Rate for Payer: Humana Medicare |
$1.25
|
| Rate for Payer: Lucent All Commercial |
$2.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.50
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$2.92
|
| Rate for Payer: PHP All Commercial |
$2.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.52
|
| Rate for Payer: Sagamore Health Network All Products |
$3.00
|
| Rate for Payer: Signature Care EPO |
$3.23
|
| Rate for Payer: Signature Care PPO |
$3.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.31
|
| Rate for Payer: United Healthcare Commercial |
$3.07
|
| Rate for Payer: United Healthcare Medicare |
$1.25
|
|
|
METOLAZONE 2.5 MG ORAL TAB
|
Facility
|
OP
|
$19.59
|
|
|
Service Code
|
NDC 51079002320
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$18.21 |
| Rate for Payer: Aetna Commercial |
$16.53
|
| Rate for Payer: Aetna Medicare |
$6.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.89
|
| Rate for Payer: Cash Price |
$11.75
|
| Rate for Payer: Centivo All Commercial |
$10.65
|
| Rate for Payer: Cigna All Commercial |
$16.90
|
| Rate for Payer: CORVEL All Commercial |
$18.21
|
| Rate for Payer: Coventry All Commercial |
$17.24
|
| Rate for Payer: Encore All Commercial |
$18.03
|
| Rate for Payer: Frontpath All Commercial |
$18.02
|
| Rate for Payer: Humana ChoiceCare |
$16.92
|
| Rate for Payer: Humana Medicare |
$6.27
|
| Rate for Payer: Lucent All Commercial |
$10.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.63
|
| Rate for Payer: PHCS All Commercial |
$14.69
|
| Rate for Payer: PHP All Commercial |
$14.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.64
|
| Rate for Payer: Sagamore Health Network All Products |
$15.12
|
| Rate for Payer: Signature Care EPO |
$16.26
|
| Rate for Payer: Signature Care PPO |
$17.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.65
|
| Rate for Payer: United Healthcare Commercial |
$15.43
|
| Rate for Payer: United Healthcare Medicare |
$6.27
|
|
