|
OXYCODONE 40 MG ORAL TR12
|
Facility
|
OP
|
$102.27
|
|
|
Service Code
|
NDC 59011044020
|
| Hospital Charge Code |
171245
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$31.70 |
| Max. Negotiated Rate |
$95.11 |
| Rate for Payer: Aetna Commercial |
$86.32
|
| Rate for Payer: Aetna Medicare |
$32.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$58.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$63.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.00
|
| Rate for Payer: Cash Price |
$61.36
|
| Rate for Payer: Centivo All Commercial |
$55.63
|
| Rate for Payer: Cigna All Commercial |
$88.26
|
| Rate for Payer: CORVEL All Commercial |
$95.11
|
| Rate for Payer: Coventry All Commercial |
$90.00
|
| Rate for Payer: Encore All Commercial |
$94.14
|
| Rate for Payer: Frontpath All Commercial |
$94.09
|
| Rate for Payer: Humana ChoiceCare |
$88.33
|
| Rate for Payer: Humana Medicare |
$32.73
|
| Rate for Payer: Lucent All Commercial |
$55.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.04
|
| Rate for Payer: PHCS All Commercial |
$76.70
|
| Rate for Payer: PHP All Commercial |
$77.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.89
|
| Rate for Payer: Sagamore Health Network All Products |
$78.95
|
| Rate for Payer: Signature Care EPO |
$84.88
|
| Rate for Payer: Signature Care PPO |
$90.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$86.93
|
| Rate for Payer: United Healthcare Commercial |
$80.59
|
| Rate for Payer: United Healthcare Medicare |
$32.73
|
|
|
OXYCODONE 5 MG ORAL TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904696661
|
| Hospital Charge Code |
10814
|
|
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
|
|
|
OXYCODONE 5 MG ORAL TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904696661
|
| Hospital Charge Code |
10814
|
|
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
|
|
|
OXYCODONE 80 MG ORAL TR12
|
Facility
|
OP
|
$178.53
|
|
|
Service Code
|
NDC 59011048020
|
| Hospital Charge Code |
171247
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$55.34 |
| Max. Negotiated Rate |
$166.03 |
| Rate for Payer: Aetna Commercial |
$150.68
|
| Rate for Payer: Aetna Medicare |
$57.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$102.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.84
|
| Rate for Payer: Cash Price |
$107.12
|
| Rate for Payer: Centivo All Commercial |
$97.12
|
| Rate for Payer: Cigna All Commercial |
$154.07
|
| Rate for Payer: CORVEL All Commercial |
$166.03
|
| Rate for Payer: Coventry All Commercial |
$157.10
|
| Rate for Payer: Encore All Commercial |
$164.34
|
| Rate for Payer: Frontpath All Commercial |
$164.25
|
| Rate for Payer: Humana ChoiceCare |
$154.19
|
| Rate for Payer: Humana Medicare |
$57.13
|
| Rate for Payer: Lucent All Commercial |
$97.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.68
|
| Rate for Payer: PHCS All Commercial |
$133.90
|
| Rate for Payer: PHP All Commercial |
$135.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.63
|
| Rate for Payer: Sagamore Health Network All Products |
$137.82
|
| Rate for Payer: Signature Care EPO |
$148.18
|
| Rate for Payer: Signature Care PPO |
$157.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151.75
|
| Rate for Payer: United Healthcare Commercial |
$140.68
|
| Rate for Payer: United Healthcare Medicare |
$57.13
|
|
|
OXYCODONE 80 MG ORAL TR12
|
Facility
|
IP
|
$178.53
|
|
|
Service Code
|
NDC 59011048020
|
| Hospital Charge Code |
171247
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$133.90 |
| Max. Negotiated Rate |
$166.03 |
| Rate for Payer: Aetna Commercial |
$154.25
|
| Rate for Payer: Cash Price |
$107.12
|
| Rate for Payer: Cigna All Commercial |
$154.07
|
| Rate for Payer: CORVEL All Commercial |
$166.03
|
| Rate for Payer: Coventry All Commercial |
$157.10
|
| Rate for Payer: Encore All Commercial |
$164.34
|
| Rate for Payer: Frontpath All Commercial |
$164.25
|
| Rate for Payer: Humana ChoiceCare |
$154.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.68
|
| Rate for Payer: PHCS All Commercial |
$133.90
|
| Rate for Payer: PHP All Commercial |
$135.40
|
| Rate for Payer: Sagamore Health Network All Products |
$137.82
|
| Rate for Payer: Signature Care EPO |
$148.18
|
| Rate for Payer: Signature Care PPO |
$157.10
|
| Rate for Payer: United Healthcare Commercial |
$140.68
|
|
|
OXYCODONE-ACETAMINOPHEN 10-325 MG ORAL TAB
|
Facility
|
IP
|
$11.31
|
|
|
Service Code
|
NDC 00904709561
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$10.52 |
| Rate for Payer: Aetna Commercial |
$9.77
|
| Rate for Payer: Cash Price |
$6.79
|
| Rate for Payer: Cigna All Commercial |
$9.76
|
| Rate for Payer: CORVEL All Commercial |
$10.52
|
| Rate for Payer: Coventry All Commercial |
$9.95
|
| Rate for Payer: Encore All Commercial |
$10.41
|
| Rate for Payer: Frontpath All Commercial |
$10.41
|
| Rate for Payer: Humana ChoiceCare |
$9.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.18
|
| Rate for Payer: PHCS All Commercial |
$8.48
|
| Rate for Payer: PHP All Commercial |
$8.58
|
| Rate for Payer: Sagamore Health Network All Products |
$8.73
|
| Rate for Payer: Signature Care EPO |
$9.39
|
| Rate for Payer: Signature Care PPO |
$9.95
|
| Rate for Payer: United Healthcare Commercial |
$8.91
|
|
|
OXYCODONE-ACETAMINOPHEN 10-325 MG ORAL TAB
|
Facility
|
OP
|
$11.31
|
|
|
Service Code
|
NDC 00904709561
|
| Hospital Charge Code |
31864
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.51 |
| Max. Negotiated Rate |
$10.52 |
| Rate for Payer: Aetna Commercial |
$9.55
|
| Rate for Payer: Aetna Medicare |
$3.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.98
|
| Rate for Payer: Cash Price |
$6.79
|
| Rate for Payer: Centivo All Commercial |
$6.15
|
| Rate for Payer: Cigna All Commercial |
$9.76
|
| Rate for Payer: CORVEL All Commercial |
$10.52
|
| Rate for Payer: Coventry All Commercial |
$9.95
|
| Rate for Payer: Encore All Commercial |
$10.41
|
| Rate for Payer: Frontpath All Commercial |
$10.41
|
| Rate for Payer: Humana ChoiceCare |
$9.77
|
| Rate for Payer: Humana Medicare |
$3.62
|
| Rate for Payer: Lucent All Commercial |
$6.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.18
|
| Rate for Payer: PHCS All Commercial |
$8.48
|
| Rate for Payer: PHP All Commercial |
$8.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.41
|
| Rate for Payer: Sagamore Health Network All Products |
$8.73
|
| Rate for Payer: Signature Care EPO |
$9.39
|
| Rate for Payer: Signature Care PPO |
$9.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.62
|
| Rate for Payer: United Healthcare Commercial |
$8.91
|
| Rate for Payer: United Healthcare Medicare |
$3.62
|
|
|
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TAB
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00406051262
|
| Hospital Charge Code |
5940
|
|
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
|
|
|
OXYCODONE-ACETAMINOPHEN 5-325 MG ORAL TAB
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00406051262
|
| Hospital Charge Code |
5940
|
|
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
|
|
|
OXYMETAZOLINE 0.05 % NASL SPRY
|
Facility
|
OP
|
$16.70
|
|
|
Service Code
|
NDC 00904743535
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna Commercial |
$14.09
|
| Rate for Payer: Aetna Medicare |
$5.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.88
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Centivo All Commercial |
$9.08
|
| Rate for Payer: Cigna All Commercial |
$14.41
|
| Rate for Payer: CORVEL All Commercial |
$15.53
|
| Rate for Payer: Coventry All Commercial |
$14.69
|
| Rate for Payer: Encore All Commercial |
$15.37
|
| Rate for Payer: Frontpath All Commercial |
$15.36
|
| Rate for Payer: Humana ChoiceCare |
$14.42
|
| Rate for Payer: Humana Medicare |
$5.34
|
| Rate for Payer: Lucent All Commercial |
$9.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.03
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$12.52
|
| Rate for Payer: PHP All Commercial |
$12.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.51
|
| Rate for Payer: Sagamore Health Network All Products |
$12.89
|
| Rate for Payer: Signature Care EPO |
$13.86
|
| Rate for Payer: Signature Care PPO |
$14.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14.19
|
| Rate for Payer: United Healthcare Commercial |
$13.16
|
| Rate for Payer: United Healthcare Medicare |
$5.34
|
|
|
OXYMETAZOLINE 0.05 % NASL SPRY
|
Facility
|
IP
|
$16.70
|
|
|
Service Code
|
NDC 00904743535
|
| Hospital Charge Code |
5943
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.52 |
| Max. Negotiated Rate |
$15.53 |
| Rate for Payer: Aetna Commercial |
$14.42
|
| Rate for Payer: Cash Price |
$10.02
|
| Rate for Payer: Cigna All Commercial |
$14.41
|
| Rate for Payer: CORVEL All Commercial |
$15.53
|
| Rate for Payer: Coventry All Commercial |
$14.69
|
| Rate for Payer: Encore All Commercial |
$15.37
|
| Rate for Payer: Frontpath All Commercial |
$15.36
|
| Rate for Payer: Humana ChoiceCare |
$14.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15.03
|
| Rate for Payer: PHCS All Commercial |
$12.52
|
| Rate for Payer: PHP All Commercial |
$12.66
|
| Rate for Payer: Sagamore Health Network All Products |
$12.89
|
| Rate for Payer: Signature Care EPO |
$13.86
|
| Rate for Payer: Signature Care PPO |
$14.69
|
| Rate for Payer: United Healthcare Commercial |
$13.16
|
|
|
OXYTOCIN 10 UNITS/ML INJ SOLN
|
Facility
|
OP
|
$18.70
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$17.39 |
| Rate for Payer: Aetna Commercial |
$15.79
|
| Rate for Payer: Aetna Medicare |
$5.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.69
|
| 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 |
$11.22
|
| Rate for Payer: Centivo All Commercial |
$10.17
|
| Rate for Payer: Cigna All Commercial |
$16.14
|
| Rate for Payer: CORVEL All Commercial |
$17.39
|
| Rate for Payer: Coventry All Commercial |
$16.46
|
| Rate for Payer: Encore All Commercial |
$17.22
|
| Rate for Payer: Frontpath All Commercial |
$17.21
|
| Rate for Payer: Humana ChoiceCare |
$16.15
|
| Rate for Payer: Humana Medicare |
$5.99
|
| Rate for Payer: Lucent All Commercial |
$10.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.83
|
| Rate for Payer: PHCS All Commercial |
$14.03
|
| Rate for Payer: PHP All Commercial |
$14.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.29
|
| Rate for Payer: Sagamore Health Network All Products |
$14.44
|
| Rate for Payer: Signature Care EPO |
$15.52
|
| Rate for Payer: Signature Care PPO |
$16.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.90
|
| Rate for Payer: United Healthcare Commercial |
$14.74
|
| Rate for Payer: United Healthcare Medicare |
$5.99
|
|
|
OXYTOCIN 10 UNITS/ML INJ SOLN
|
Facility
|
IP
|
$18.70
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
5944
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.03 |
| Max. Negotiated Rate |
$17.39 |
| Rate for Payer: Aetna Commercial |
$16.16
|
| Rate for Payer: Cash Price |
$11.22
|
| Rate for Payer: Cigna All Commercial |
$16.14
|
| Rate for Payer: CORVEL All Commercial |
$17.39
|
| Rate for Payer: Coventry All Commercial |
$16.46
|
| Rate for Payer: Encore All Commercial |
$17.22
|
| Rate for Payer: Frontpath All Commercial |
$17.21
|
| Rate for Payer: Humana ChoiceCare |
$16.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.83
|
| Rate for Payer: PHCS All Commercial |
$14.03
|
| Rate for Payer: PHP All Commercial |
$14.19
|
| Rate for Payer: Sagamore Health Network All Products |
$14.44
|
| Rate for Payer: Signature Care EPO |
$15.52
|
| Rate for Payer: Signature Care PPO |
$16.46
|
| Rate for Payer: United Healthcare Commercial |
$14.74
|
|
|
OXYTOCIN IN 0.9 % SOD CHLORIDE 30 UNIT/500 ML IV SOLN
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
HCPCS J7999
|
| Hospital Charge Code |
117335
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.91 |
| Max. Negotiated Rate |
$149.73 |
| Rate for Payer: Aetna Commercial |
$135.88
|
| Rate for Payer: Aetna Medicare |
$51.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$92.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.67
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Centivo All Commercial |
$87.58
|
| Rate for Payer: Cigna All Commercial |
$138.94
|
| Rate for Payer: CORVEL All Commercial |
$149.73
|
| Rate for Payer: Coventry All Commercial |
$141.68
|
| Rate for Payer: Encore All Commercial |
$148.20
|
| Rate for Payer: Frontpath All Commercial |
$148.12
|
| Rate for Payer: Humana ChoiceCare |
$139.06
|
| Rate for Payer: Humana Medicare |
$51.52
|
| Rate for Payer: Lucent All Commercial |
$87.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.90
|
| Rate for Payer: PHCS All Commercial |
$120.75
|
| Rate for Payer: PHP All Commercial |
$122.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.79
|
| Rate for Payer: Sagamore Health Network All Products |
$124.29
|
| Rate for Payer: Signature Care EPO |
$133.63
|
| Rate for Payer: Signature Care PPO |
$141.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.85
|
| Rate for Payer: United Healthcare Commercial |
$126.87
|
| Rate for Payer: United Healthcare Medicare |
$51.52
|
|
|
OXYTOCIN IN 0.9 % SOD CHLORIDE 30 UNIT/500 ML IV SOLN
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
HCPCS J7999
|
| Hospital Charge Code |
117335
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$149.73 |
| Rate for Payer: Aetna Commercial |
$139.10
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna All Commercial |
$138.94
|
| Rate for Payer: CORVEL All Commercial |
$149.73
|
| Rate for Payer: Coventry All Commercial |
$141.68
|
| Rate for Payer: Encore All Commercial |
$148.20
|
| Rate for Payer: Frontpath All Commercial |
$148.12
|
| Rate for Payer: Humana ChoiceCare |
$139.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.90
|
| Rate for Payer: PHCS All Commercial |
$120.75
|
| Rate for Payer: PHP All Commercial |
$122.10
|
| Rate for Payer: Sagamore Health Network All Products |
$124.29
|
| Rate for Payer: Signature Care EPO |
$133.63
|
| Rate for Payer: Signature Care PPO |
$141.68
|
| Rate for Payer: United Healthcare Commercial |
$126.87
|
|
|
PALIPERIDONE PALM (3 MONTH) 273 MG/0.88 ML IM SYRG
|
Facility
|
IP
|
$11,476.71
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
172862
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8,607.53 |
| Max. Negotiated Rate |
$10,673.34 |
| Rate for Payer: Aetna Commercial |
$9,915.88
|
| Rate for Payer: Cash Price |
$6,886.03
|
| Rate for Payer: Cigna All Commercial |
$9,904.40
|
| Rate for Payer: CORVEL All Commercial |
$10,673.34
|
| Rate for Payer: Coventry All Commercial |
$10,099.51
|
| Rate for Payer: Encore All Commercial |
$10,564.31
|
| Rate for Payer: Frontpath All Commercial |
$10,558.58
|
| Rate for Payer: Humana ChoiceCare |
$9,912.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,329.04
|
| Rate for Payer: PHCS All Commercial |
$8,607.53
|
| Rate for Payer: PHP All Commercial |
$8,703.94
|
| Rate for Payer: Sagamore Health Network All Products |
$8,860.02
|
| Rate for Payer: Signature Care EPO |
$9,525.67
|
| Rate for Payer: Signature Care PPO |
$10,099.51
|
| Rate for Payer: United Healthcare Commercial |
$9,043.65
|
|
|
PALIPERIDONE PALM (3 MONTH) 273 MG/0.88 ML IM SYRG
|
Facility
|
OP
|
$11,476.71
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
172862
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$10,673.34 |
| Rate for Payer: Aetna Commercial |
$9,686.34
|
| Rate for Payer: Aetna Medicare |
$3,672.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,557.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,591.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,174.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,223.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,039.80
|
| Rate for Payer: Cash Price |
$6,886.03
|
| Rate for Payer: Cash Price |
$6,886.03
|
| Rate for Payer: Centivo All Commercial |
$6,243.33
|
| Rate for Payer: Cigna All Commercial |
$9,904.40
|
| Rate for Payer: CORVEL All Commercial |
$10,673.34
|
| Rate for Payer: Coventry All Commercial |
$10,099.51
|
| Rate for Payer: Encore All Commercial |
$10,564.31
|
| Rate for Payer: Frontpath All Commercial |
$10,558.58
|
| Rate for Payer: Humana ChoiceCare |
$9,912.44
|
| Rate for Payer: Humana Medicare |
$3,672.55
|
| Rate for Payer: Lucent All Commercial |
$6,243.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,329.04
|
| Rate for Payer: Managed Health Services Medicaid |
$13.71
|
| Rate for Payer: MDWise Medicaid |
$13.71
|
| Rate for Payer: PHCS All Commercial |
$8,607.53
|
| Rate for Payer: PHP All Commercial |
$8,703.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,475.92
|
| Rate for Payer: Sagamore Health Network All Products |
$8,860.02
|
| Rate for Payer: Signature Care EPO |
$9,525.67
|
| Rate for Payer: Signature Care PPO |
$10,099.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,755.21
|
| Rate for Payer: United Healthcare Commercial |
$9,043.65
|
| Rate for Payer: United Healthcare Medicare |
$3,672.55
|
|
|
PALIPERIDONE PALM (3 MONTH) 410 MG/1.32 ML IM SYRG
|
Facility
|
IP
|
$17,346.76
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
172863
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13,010.07 |
| Max. Negotiated Rate |
$16,132.49 |
| Rate for Payer: Aetna Commercial |
$14,987.60
|
| Rate for Payer: Cash Price |
$10,408.06
|
| Rate for Payer: Cigna All Commercial |
$14,970.25
|
| Rate for Payer: CORVEL All Commercial |
$16,132.49
|
| Rate for Payer: Coventry All Commercial |
$15,265.15
|
| Rate for Payer: Encore All Commercial |
$15,967.69
|
| Rate for Payer: Frontpath All Commercial |
$15,959.02
|
| Rate for Payer: Humana ChoiceCare |
$14,982.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15,612.08
|
| Rate for Payer: PHCS All Commercial |
$13,010.07
|
| Rate for Payer: PHP All Commercial |
$13,155.78
|
| Rate for Payer: Sagamore Health Network All Products |
$13,391.70
|
| Rate for Payer: Signature Care EPO |
$14,397.81
|
| Rate for Payer: Signature Care PPO |
$15,265.15
|
| Rate for Payer: United Healthcare Commercial |
$13,669.25
|
|
|
PALIPERIDONE PALM (3 MONTH) 410 MG/1.32 ML IM SYRG
|
Facility
|
OP
|
$17,346.76
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
172863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$16,132.49 |
| Rate for Payer: Aetna Commercial |
$14,640.67
|
| Rate for Payer: Aetna Medicare |
$5,550.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,377.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,962.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,843.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,383.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6,106.06
|
| Rate for Payer: Cash Price |
$10,408.06
|
| Rate for Payer: Cash Price |
$10,408.06
|
| Rate for Payer: Centivo All Commercial |
$9,436.64
|
| Rate for Payer: Cigna All Commercial |
$14,970.25
|
| Rate for Payer: CORVEL All Commercial |
$16,132.49
|
| Rate for Payer: Coventry All Commercial |
$15,265.15
|
| Rate for Payer: Encore All Commercial |
$15,967.69
|
| Rate for Payer: Frontpath All Commercial |
$15,959.02
|
| Rate for Payer: Humana ChoiceCare |
$14,982.40
|
| Rate for Payer: Humana Medicare |
$5,550.96
|
| Rate for Payer: Lucent All Commercial |
$9,436.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$15,612.08
|
| Rate for Payer: Managed Health Services Medicaid |
$13.71
|
| Rate for Payer: MDWise Medicaid |
$13.71
|
| Rate for Payer: PHCS All Commercial |
$13,010.07
|
| Rate for Payer: PHP All Commercial |
$13,155.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,765.24
|
| Rate for Payer: Sagamore Health Network All Products |
$13,391.70
|
| Rate for Payer: Signature Care EPO |
$14,397.81
|
| Rate for Payer: Signature Care PPO |
$15,265.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,744.75
|
| Rate for Payer: United Healthcare Commercial |
$13,669.25
|
| Rate for Payer: United Healthcare Medicare |
$5,550.96
|
|
|
PALIPERIDONE PALM (3 MONTH) 546 MG/1.75 ML IM SYRG
|
Facility
|
OP
|
$22,954.65
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
172864
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$21,347.82 |
| Rate for Payer: Aetna Commercial |
$19,373.72
|
| Rate for Payer: Aetna Medicare |
$7,345.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7,115.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13,182.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14,348.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8,447.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8,080.04
|
| Rate for Payer: Cash Price |
$13,772.79
|
| Rate for Payer: Cash Price |
$13,772.79
|
| Rate for Payer: Centivo All Commercial |
$12,487.33
|
| Rate for Payer: Cigna All Commercial |
$19,809.86
|
| Rate for Payer: CORVEL All Commercial |
$21,347.82
|
| Rate for Payer: Coventry All Commercial |
$20,200.09
|
| Rate for Payer: Encore All Commercial |
$21,129.75
|
| Rate for Payer: Frontpath All Commercial |
$21,118.27
|
| Rate for Payer: Humana ChoiceCare |
$19,825.93
|
| Rate for Payer: Humana Medicare |
$7,345.49
|
| Rate for Payer: Lucent All Commercial |
$12,487.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20,659.18
|
| Rate for Payer: Managed Health Services Medicaid |
$13.71
|
| Rate for Payer: MDWise Medicaid |
$13.71
|
| Rate for Payer: PHCS All Commercial |
$17,215.98
|
| Rate for Payer: PHP All Commercial |
$17,408.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8,952.31
|
| Rate for Payer: Sagamore Health Network All Products |
$17,720.99
|
| Rate for Payer: Signature Care EPO |
$19,052.36
|
| Rate for Payer: Signature Care PPO |
$20,200.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19,511.45
|
| Rate for Payer: United Healthcare Commercial |
$18,088.26
|
| Rate for Payer: United Healthcare Medicare |
$7,345.49
|
|
|
PALIPERIDONE PALM (3 MONTH) 546 MG/1.75 ML IM SYRG
|
Facility
|
IP
|
$22,954.65
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
172864
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17,215.98 |
| Max. Negotiated Rate |
$21,347.82 |
| Rate for Payer: Aetna Commercial |
$19,832.81
|
| Rate for Payer: Cash Price |
$13,772.79
|
| Rate for Payer: Cigna All Commercial |
$19,809.86
|
| Rate for Payer: CORVEL All Commercial |
$21,347.82
|
| Rate for Payer: Coventry All Commercial |
$20,200.09
|
| Rate for Payer: Encore All Commercial |
$21,129.75
|
| Rate for Payer: Frontpath All Commercial |
$21,118.27
|
| Rate for Payer: Humana ChoiceCare |
$19,825.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20,659.18
|
| Rate for Payer: PHCS All Commercial |
$17,215.98
|
| Rate for Payer: PHP All Commercial |
$17,408.80
|
| Rate for Payer: Sagamore Health Network All Products |
$17,720.99
|
| Rate for Payer: Signature Care EPO |
$19,052.36
|
| Rate for Payer: Signature Care PPO |
$20,200.09
|
| Rate for Payer: United Healthcare Commercial |
$18,088.26
|
|
|
PALIPERIDONE PALM (3 MONTH) 819 MG/2.63 ML IM SYRG
|
Facility
|
IP
|
$34,562.57
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
172865
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25,921.92 |
| Max. Negotiated Rate |
$32,143.19 |
| Rate for Payer: Aetna Commercial |
$29,862.06
|
| Rate for Payer: Cash Price |
$20,737.54
|
| Rate for Payer: Cigna All Commercial |
$29,827.49
|
| Rate for Payer: CORVEL All Commercial |
$32,143.19
|
| Rate for Payer: Coventry All Commercial |
$30,415.06
|
| Rate for Payer: Encore All Commercial |
$31,814.84
|
| Rate for Payer: Frontpath All Commercial |
$31,797.56
|
| Rate for Payer: Humana ChoiceCare |
$29,851.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31,106.31
|
| Rate for Payer: PHCS All Commercial |
$25,921.92
|
| Rate for Payer: PHP All Commercial |
$26,212.25
|
| Rate for Payer: Sagamore Health Network All Products |
$26,682.30
|
| Rate for Payer: Signature Care EPO |
$28,686.93
|
| Rate for Payer: Signature Care PPO |
$30,415.06
|
| Rate for Payer: United Healthcare Commercial |
$27,235.30
|
|
|
PALIPERIDONE PALM (3 MONTH) 819 MG/2.63 ML IM SYRG
|
Facility
|
OP
|
$34,562.57
|
|
|
Service Code
|
HCPCS J2427
|
| Hospital Charge Code |
172865
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.71 |
| Max. Negotiated Rate |
$32,143.19 |
| Rate for Payer: Aetna Commercial |
$29,170.81
|
| Rate for Payer: Aetna Medicare |
$11,060.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10,714.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$19,849.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21,605.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12,719.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12,166.02
|
| Rate for Payer: Cash Price |
$20,737.54
|
| Rate for Payer: Cash Price |
$20,737.54
|
| Rate for Payer: Centivo All Commercial |
$18,802.04
|
| Rate for Payer: Cigna All Commercial |
$29,827.49
|
| Rate for Payer: CORVEL All Commercial |
$32,143.19
|
| Rate for Payer: Coventry All Commercial |
$30,415.06
|
| Rate for Payer: Encore All Commercial |
$31,814.84
|
| Rate for Payer: Frontpath All Commercial |
$31,797.56
|
| Rate for Payer: Humana ChoiceCare |
$29,851.69
|
| Rate for Payer: Humana Medicare |
$11,060.02
|
| Rate for Payer: Lucent All Commercial |
$18,802.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31,106.31
|
| Rate for Payer: Managed Health Services Medicaid |
$13.71
|
| Rate for Payer: MDWise Medicaid |
$13.71
|
| Rate for Payer: PHCS All Commercial |
$25,921.92
|
| Rate for Payer: PHP All Commercial |
$26,212.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13,479.40
|
| Rate for Payer: Sagamore Health Network All Products |
$26,682.30
|
| Rate for Payer: Signature Care EPO |
$28,686.93
|
| Rate for Payer: Signature Care PPO |
$30,415.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29,378.18
|
| Rate for Payer: United Healthcare Commercial |
$27,235.30
|
| Rate for Payer: United Healthcare Medicare |
$11,060.02
|
|
|
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG
|
Facility
|
OP
|
$7,651.56
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
99702
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.01 |
| Max. Negotiated Rate |
$7,115.95 |
| Rate for Payer: Aetna Commercial |
$6,457.92
|
| Rate for Payer: Aetna Medicare |
$2,448.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,371.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4,394.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4,782.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,815.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,693.35
|
| Rate for Payer: Cash Price |
$4,590.94
|
| Rate for Payer: Cash Price |
$4,590.94
|
| Rate for Payer: Centivo All Commercial |
$4,162.45
|
| Rate for Payer: Cigna All Commercial |
$6,603.30
|
| Rate for Payer: CORVEL All Commercial |
$7,115.95
|
| Rate for Payer: Coventry All Commercial |
$6,733.37
|
| Rate for Payer: Encore All Commercial |
$7,043.26
|
| Rate for Payer: Frontpath All Commercial |
$7,039.44
|
| Rate for Payer: Humana ChoiceCare |
$6,608.65
|
| Rate for Payer: Humana Medicare |
$2,448.50
|
| Rate for Payer: Lucent All Commercial |
$4,162.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,886.40
|
| Rate for Payer: Managed Health Services Medicaid |
$16.01
|
| Rate for Payer: MDWise Medicaid |
$16.01
|
| Rate for Payer: PHCS All Commercial |
$5,738.67
|
| Rate for Payer: PHP All Commercial |
$5,802.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,984.11
|
| Rate for Payer: Sagamore Health Network All Products |
$5,907.00
|
| Rate for Payer: Signature Care EPO |
$6,350.79
|
| Rate for Payer: Signature Care PPO |
$6,733.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,503.83
|
| Rate for Payer: United Healthcare Commercial |
$6,029.43
|
| Rate for Payer: United Healthcare Medicare |
$2,448.50
|
|
|
PALIPERIDONE PALMITATE 156 MG/ML IM SYRG
|
Facility
|
IP
|
$7,651.56
|
|
|
Service Code
|
HCPCS J2426
|
| Hospital Charge Code |
99702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5,738.67 |
| Max. Negotiated Rate |
$7,115.95 |
| Rate for Payer: Aetna Commercial |
$6,610.95
|
| Rate for Payer: Cash Price |
$4,590.94
|
| Rate for Payer: Cigna All Commercial |
$6,603.30
|
| Rate for Payer: CORVEL All Commercial |
$7,115.95
|
| Rate for Payer: Coventry All Commercial |
$6,733.37
|
| Rate for Payer: Encore All Commercial |
$7,043.26
|
| Rate for Payer: Frontpath All Commercial |
$7,039.44
|
| Rate for Payer: Humana ChoiceCare |
$6,608.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,886.40
|
| Rate for Payer: PHCS All Commercial |
$5,738.67
|
| Rate for Payer: PHP All Commercial |
$5,802.94
|
| Rate for Payer: Sagamore Health Network All Products |
$5,907.00
|
| Rate for Payer: Signature Care EPO |
$6,350.79
|
| Rate for Payer: Signature Care PPO |
$6,733.37
|
| Rate for Payer: United Healthcare Commercial |
$6,029.43
|
|
