|
MISOPROSTOL 200 MCG ORAL TAB
|
Facility
|
OP
|
$16.23
|
|
|
Service Code
|
NDC 60687074611
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$15.10 |
| Rate for Payer: Aetna Commercial |
$13.70
|
| Rate for Payer: Aetna Medicare |
$5.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.71
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Centivo All Commercial |
$8.83
|
| Rate for Payer: Cigna All Commercial |
$14.01
|
| Rate for Payer: CORVEL All Commercial |
$15.10
|
| Rate for Payer: Coventry All Commercial |
$14.29
|
| Rate for Payer: Encore All Commercial |
$14.94
|
| Rate for Payer: Frontpath All Commercial |
$14.93
|
| Rate for Payer: Humana ChoiceCare |
$14.02
|
| Rate for Payer: Humana Medicare |
$5.19
|
| Rate for Payer: Lucent All Commercial |
$8.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.61
|
| Rate for Payer: PHCS All Commercial |
$12.17
|
| Rate for Payer: PHP All Commercial |
$12.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.33
|
| Rate for Payer: Sagamore Health Network All Products |
$12.53
|
| Rate for Payer: Signature Care EPO |
$13.47
|
| Rate for Payer: Signature Care PPO |
$14.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.80
|
| Rate for Payer: United Healthcare Commercial |
$12.79
|
| Rate for Payer: United Healthcare Medicare |
$5.19
|
|
|
MISOPROSTOL 200 MCG ORAL TAB
|
Facility
|
OP
|
$16.23
|
|
|
Service Code
|
NDC 60687074601
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$15.10 |
| Rate for Payer: Aetna Commercial |
$13.70
|
| Rate for Payer: Aetna Medicare |
$5.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.71
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Centivo All Commercial |
$8.83
|
| Rate for Payer: Cigna All Commercial |
$14.01
|
| Rate for Payer: CORVEL All Commercial |
$15.10
|
| Rate for Payer: Coventry All Commercial |
$14.29
|
| Rate for Payer: Encore All Commercial |
$14.94
|
| Rate for Payer: Frontpath All Commercial |
$14.93
|
| Rate for Payer: Humana ChoiceCare |
$14.02
|
| Rate for Payer: Humana Medicare |
$5.19
|
| Rate for Payer: Lucent All Commercial |
$8.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.61
|
| Rate for Payer: PHCS All Commercial |
$12.17
|
| Rate for Payer: PHP All Commercial |
$12.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.33
|
| Rate for Payer: Sagamore Health Network All Products |
$12.53
|
| Rate for Payer: Signature Care EPO |
$13.47
|
| Rate for Payer: Signature Care PPO |
$14.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.80
|
| Rate for Payer: United Healthcare Commercial |
$12.79
|
| Rate for Payer: United Healthcare Medicare |
$5.19
|
|
|
MISOPROSTOL 200 MCG ORAL TAB
|
Facility
|
IP
|
$16.23
|
|
|
Service Code
|
NDC 60687074601
|
| Hospital Charge Code |
10629
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.17 |
| Max. Negotiated Rate |
$15.10 |
| Rate for Payer: Aetna Commercial |
$14.03
|
| Rate for Payer: Cash Price |
$9.74
|
| Rate for Payer: Cigna All Commercial |
$14.01
|
| Rate for Payer: CORVEL All Commercial |
$15.10
|
| Rate for Payer: Coventry All Commercial |
$14.29
|
| Rate for Payer: Encore All Commercial |
$14.94
|
| Rate for Payer: Frontpath All Commercial |
$14.93
|
| Rate for Payer: Humana ChoiceCare |
$14.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.61
|
| Rate for Payer: PHCS All Commercial |
$12.17
|
| Rate for Payer: PHP All Commercial |
$12.31
|
| Rate for Payer: Sagamore Health Network All Products |
$12.53
|
| Rate for Payer: Signature Care EPO |
$13.47
|
| Rate for Payer: Signature Care PPO |
$14.29
|
| Rate for Payer: United Healthcare Commercial |
$12.79
|
|
|
MISOPROSTOL 25 MCG TABLET (QUARTER TAB)
|
Facility
|
OP
|
$1.05
|
|
|
Service Code
|
NDC 579625007
|
| Hospital Charge Code |
800064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna Commercial |
$0.89
|
| Rate for Payer: Aetna Medicare |
$0.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.37
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Centivo All Commercial |
$0.57
|
| Rate for Payer: Cigna All Commercial |
$0.91
|
| Rate for Payer: CORVEL All Commercial |
$0.98
|
| Rate for Payer: Coventry All Commercial |
$0.92
|
| Rate for Payer: Encore All Commercial |
$0.97
|
| Rate for Payer: Frontpath All Commercial |
$0.97
|
| Rate for Payer: Humana ChoiceCare |
$0.91
|
| Rate for Payer: Humana Medicare |
$0.34
|
| Rate for Payer: Lucent All Commercial |
$0.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.95
|
| Rate for Payer: PHCS All Commercial |
$0.79
|
| Rate for Payer: PHP All Commercial |
$0.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.41
|
| Rate for Payer: Sagamore Health Network All Products |
$0.81
|
| Rate for Payer: Signature Care EPO |
$0.87
|
| Rate for Payer: Signature Care PPO |
$0.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.89
|
| Rate for Payer: United Healthcare Commercial |
$0.83
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
|
|
MISOPROSTOL 25 MCG TABLET (QUARTER TAB)
|
Facility
|
IP
|
$1.05
|
|
|
Service Code
|
NDC 579625007
|
| Hospital Charge Code |
800064
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.79 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna Commercial |
$0.91
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna All Commercial |
$0.91
|
| Rate for Payer: CORVEL All Commercial |
$0.98
|
| Rate for Payer: Coventry All Commercial |
$0.92
|
| Rate for Payer: Encore All Commercial |
$0.97
|
| Rate for Payer: Frontpath All Commercial |
$0.97
|
| Rate for Payer: Humana ChoiceCare |
$0.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.95
|
| Rate for Payer: PHCS All Commercial |
$0.79
|
| Rate for Payer: PHP All Commercial |
$0.80
|
| Rate for Payer: Sagamore Health Network All Products |
$0.81
|
| Rate for Payer: Signature Care EPO |
$0.87
|
| Rate for Payer: Signature Care PPO |
$0.92
|
| Rate for Payer: United Healthcare Commercial |
$0.83
|
|
|
MODIFIED LANOLIN 100 % TOP CREA
|
Facility
|
IP
|
$61.04
|
|
|
Service Code
|
NDC 44677010020
|
| Hospital Charge Code |
188599
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.78 |
| Max. Negotiated Rate |
$56.77 |
| Rate for Payer: Aetna Commercial |
$52.74
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Cigna All Commercial |
$52.68
|
| Rate for Payer: CORVEL All Commercial |
$56.77
|
| Rate for Payer: Coventry All Commercial |
$53.72
|
| Rate for Payer: Encore All Commercial |
$56.19
|
| Rate for Payer: Frontpath All Commercial |
$56.16
|
| Rate for Payer: Humana ChoiceCare |
$52.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.94
|
| Rate for Payer: PHCS All Commercial |
$45.78
|
| Rate for Payer: PHP All Commercial |
$46.29
|
| Rate for Payer: Sagamore Health Network All Products |
$47.12
|
| Rate for Payer: Signature Care EPO |
$50.66
|
| Rate for Payer: Signature Care PPO |
$53.72
|
| Rate for Payer: United Healthcare Commercial |
$48.10
|
|
|
MODIFIED LANOLIN 100 % TOP CREA
|
Facility
|
OP
|
$61.04
|
|
|
Service Code
|
NDC 44677010020
|
| Hospital Charge Code |
188599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$18.92 |
| Max. Negotiated Rate |
$56.77 |
| Rate for Payer: Aetna Commercial |
$51.52
|
| Rate for Payer: Aetna Medicare |
$19.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$35.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.49
|
| Rate for Payer: Cash Price |
$36.62
|
| Rate for Payer: Centivo All Commercial |
$33.21
|
| Rate for Payer: Cigna All Commercial |
$52.68
|
| Rate for Payer: CORVEL All Commercial |
$56.77
|
| Rate for Payer: Coventry All Commercial |
$53.72
|
| Rate for Payer: Encore All Commercial |
$56.19
|
| Rate for Payer: Frontpath All Commercial |
$56.16
|
| Rate for Payer: Humana ChoiceCare |
$52.72
|
| Rate for Payer: Humana Medicare |
$19.53
|
| Rate for Payer: Lucent All Commercial |
$33.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.94
|
| Rate for Payer: PHCS All Commercial |
$45.78
|
| Rate for Payer: PHP All Commercial |
$46.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.81
|
| Rate for Payer: Sagamore Health Network All Products |
$47.12
|
| Rate for Payer: Signature Care EPO |
$50.66
|
| Rate for Payer: Signature Care PPO |
$53.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.88
|
| Rate for Payer: United Healthcare Commercial |
$48.10
|
| Rate for Payer: United Healthcare Medicare |
$19.53
|
|
|
MONTELUKAST 10 MG ORAL TAB
|
Facility
|
OP
|
$1.42
|
|
|
Service Code
|
NDC 00904680861
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Aetna Commercial |
$1.20
|
| Rate for Payer: Aetna Medicare |
$0.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.50
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Centivo All Commercial |
$0.77
|
| Rate for Payer: Cigna All Commercial |
$1.23
|
| Rate for Payer: CORVEL All Commercial |
$1.32
|
| Rate for Payer: Coventry All Commercial |
$1.25
|
| Rate for Payer: Encore All Commercial |
$1.31
|
| Rate for Payer: Frontpath All Commercial |
$1.31
|
| Rate for Payer: Humana ChoiceCare |
$1.23
|
| Rate for Payer: Humana Medicare |
$0.45
|
| Rate for Payer: Lucent All Commercial |
$0.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.28
|
| Rate for Payer: PHCS All Commercial |
$1.07
|
| Rate for Payer: PHP All Commercial |
$1.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.55
|
| Rate for Payer: Sagamore Health Network All Products |
$1.10
|
| Rate for Payer: Signature Care EPO |
$1.18
|
| Rate for Payer: Signature Care PPO |
$1.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.21
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
| Rate for Payer: United Healthcare Medicare |
$0.45
|
|
|
MONTELUKAST 10 MG ORAL TAB
|
Facility
|
IP
|
$1.42
|
|
|
Service Code
|
NDC 00904680861
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$1.32 |
| Rate for Payer: Aetna Commercial |
$1.23
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cigna All Commercial |
$1.23
|
| Rate for Payer: CORVEL All Commercial |
$1.32
|
| Rate for Payer: Coventry All Commercial |
$1.25
|
| Rate for Payer: Encore All Commercial |
$1.31
|
| Rate for Payer: Frontpath All Commercial |
$1.31
|
| Rate for Payer: Humana ChoiceCare |
$1.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.28
|
| Rate for Payer: PHCS All Commercial |
$1.07
|
| Rate for Payer: PHP All Commercial |
$1.08
|
| Rate for Payer: Sagamore Health Network All Products |
$1.10
|
| Rate for Payer: Signature Care EPO |
$1.18
|
| Rate for Payer: Signature Care PPO |
$1.25
|
| Rate for Payer: United Healthcare Commercial |
$1.12
|
|
|
MORPHINE 10 MG/ML INJECTION S.O.
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
420602
|
|
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
|
|
|
MORPHINE 10 MG/ML INJECTION S.O.
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
420602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$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
|
|
|
MORPHINE 10 MG/ML IV SYRG
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
170438
|
|
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
|
|
|
MORPHINE 10 MG/ML IV SYRG
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
170438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$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
|
|
|
MORPHINE 15 MG ORAL TAB
|
Facility
|
OP
|
$4.97
|
|
|
Service Code
|
NDC 00406511862
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$4.19
|
| Rate for Payer: Aetna Medicare |
$1.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.75
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Centivo All Commercial |
$2.70
|
| Rate for Payer: Cigna All Commercial |
$4.29
|
| Rate for Payer: CORVEL All Commercial |
$4.62
|
| Rate for Payer: Coventry All Commercial |
$4.37
|
| Rate for Payer: Encore All Commercial |
$4.57
|
| Rate for Payer: Frontpath All Commercial |
$4.57
|
| Rate for Payer: Humana ChoiceCare |
$4.29
|
| Rate for Payer: Humana Medicare |
$1.59
|
| Rate for Payer: Lucent All Commercial |
$2.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.47
|
| Rate for Payer: PHCS All Commercial |
$3.73
|
| Rate for Payer: PHP All Commercial |
$3.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.94
|
| Rate for Payer: Sagamore Health Network All Products |
$3.84
|
| Rate for Payer: Signature Care EPO |
$4.13
|
| Rate for Payer: Signature Care PPO |
$4.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.22
|
| Rate for Payer: United Healthcare Commercial |
$3.92
|
| Rate for Payer: United Healthcare Medicare |
$1.59
|
|
|
MORPHINE 15 MG ORAL TAB
|
Facility
|
IP
|
$4.97
|
|
|
Service Code
|
NDC 00406511862
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$4.62 |
| Rate for Payer: Aetna Commercial |
$4.29
|
| Rate for Payer: Cash Price |
$2.98
|
| Rate for Payer: Cigna All Commercial |
$4.29
|
| Rate for Payer: CORVEL All Commercial |
$4.62
|
| Rate for Payer: Coventry All Commercial |
$4.37
|
| Rate for Payer: Encore All Commercial |
$4.57
|
| Rate for Payer: Frontpath All Commercial |
$4.57
|
| Rate for Payer: Humana ChoiceCare |
$4.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.47
|
| Rate for Payer: PHCS All Commercial |
$3.73
|
| Rate for Payer: PHP All Commercial |
$3.77
|
| Rate for Payer: Sagamore Health Network All Products |
$3.84
|
| Rate for Payer: Signature Care EPO |
$4.13
|
| Rate for Payer: Signature Care PPO |
$4.37
|
| Rate for Payer: United Healthcare Commercial |
$3.92
|
|
|
MORPHINE 15 MG ORAL TBER
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 42858080101
|
| Hospital Charge Code |
20920
|
|
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
|
|
|
MORPHINE 15 MG ORAL TBER
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 42858080101
|
| Hospital Charge Code |
20920
|
|
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
|
|
|
MORPHINE 2 MG/ML INJECTION S.O.
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
420600
|
|
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
|
|
|
MORPHINE 2 MG/ML INJECTION S.O.
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
420600
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$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
|
|
|
MORPHINE 2 MG/ML IV SYRG
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
167699
|
|
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
|
|
|
MORPHINE 2 MG/ML IV SYRG
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
167699
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$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
|
|
|
MORPHINE 30 MG/30 ML PCA (CAMERON)
|
Facility
|
IP
|
$65.73
|
|
|
Service Code
|
NDC 76329191201
|
| Hospital Charge Code |
1.401E+12
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.30 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna Commercial |
$56.79
|
| Rate for Payer: Cash Price |
$39.44
|
| Rate for Payer: Cigna All Commercial |
$56.72
|
| Rate for Payer: CORVEL All Commercial |
$61.13
|
| Rate for Payer: Coventry All Commercial |
$57.84
|
| Rate for Payer: Encore All Commercial |
$60.50
|
| Rate for Payer: Frontpath All Commercial |
$60.47
|
| Rate for Payer: Humana ChoiceCare |
$56.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.16
|
| Rate for Payer: PHCS All Commercial |
$49.30
|
| Rate for Payer: PHP All Commercial |
$49.85
|
| Rate for Payer: Sagamore Health Network All Products |
$50.74
|
| Rate for Payer: Signature Care EPO |
$54.56
|
| Rate for Payer: Signature Care PPO |
$57.84
|
| Rate for Payer: United Healthcare Commercial |
$51.80
|
|
|
MORPHINE 30 MG/30 ML PCA (CAMERON)
|
Facility
|
OP
|
$65.73
|
|
|
Service Code
|
NDC 76329191201
|
| Hospital Charge Code |
1.401E+12
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna Commercial |
$55.48
|
| Rate for Payer: Aetna Medicare |
$21.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$37.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.14
|
| Rate for Payer: Cash Price |
$39.44
|
| Rate for Payer: Centivo All Commercial |
$35.76
|
| Rate for Payer: Cigna All Commercial |
$56.72
|
| Rate for Payer: CORVEL All Commercial |
$61.13
|
| Rate for Payer: Coventry All Commercial |
$57.84
|
| Rate for Payer: Encore All Commercial |
$60.50
|
| Rate for Payer: Frontpath All Commercial |
$60.47
|
| Rate for Payer: Humana ChoiceCare |
$56.77
|
| Rate for Payer: Humana Medicare |
$21.03
|
| Rate for Payer: Lucent All Commercial |
$35.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.16
|
| Rate for Payer: PHCS All Commercial |
$49.30
|
| Rate for Payer: PHP All Commercial |
$49.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.63
|
| Rate for Payer: Sagamore Health Network All Products |
$50.74
|
| Rate for Payer: Signature Care EPO |
$54.56
|
| Rate for Payer: Signature Care PPO |
$57.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.87
|
| Rate for Payer: United Healthcare Commercial |
$51.80
|
| Rate for Payer: United Healthcare Medicare |
$21.03
|
|
|
MORPHINE 30 MG ORAL TBER
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 42858080201
|
| Hospital Charge Code |
20921
|
|
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
|
|
|
MORPHINE 30 MG ORAL TBER
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 42858080201
|
| Hospital Charge Code |
20921
|
|
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
|
|
