|
RIMANTADINE 100 MG ORAL TAB
|
Facility
|
OP
|
$19.26
|
|
|
Service Code
|
NDC 00115191101
|
| Hospital Charge Code |
15440
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$16.26
|
| Rate for Payer: Aetna Medicare |
$6.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.78
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: Centivo All Commercial |
$10.48
|
| Rate for Payer: Cigna All Commercial |
$16.62
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.95
|
| Rate for Payer: Encore All Commercial |
$17.73
|
| Rate for Payer: Frontpath All Commercial |
$17.72
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Humana Medicare |
$6.16
|
| Rate for Payer: Lucent All Commercial |
$10.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.51
|
| Rate for Payer: Sagamore Health Network All Products |
$14.87
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.37
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
| Rate for Payer: United Healthcare Medicare |
$6.16
|
|
|
RIMANTADINE 100 MG ORAL TAB
|
Facility
|
IP
|
$19.26
|
|
|
Service Code
|
NDC 00115191101
|
| Hospital Charge Code |
15440
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$16.64
|
| Rate for Payer: Cash Price |
$11.94
|
| Rate for Payer: Cigna All Commercial |
$16.62
|
| Rate for Payer: CORVEL All Commercial |
$17.92
|
| Rate for Payer: Coventry All Commercial |
$16.95
|
| Rate for Payer: Encore All Commercial |
$17.73
|
| Rate for Payer: Frontpath All Commercial |
$17.72
|
| Rate for Payer: Humana ChoiceCare |
$16.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.34
|
| Rate for Payer: PHCS All Commercial |
$14.45
|
| Rate for Payer: PHP All Commercial |
$14.61
|
| Rate for Payer: Sagamore Health Network All Products |
$14.87
|
| Rate for Payer: Signature Care EPO |
$15.99
|
| Rate for Payer: Signature Care PPO |
$16.95
|
| Rate for Payer: United Healthcare Commercial |
$15.18
|
|
|
RISANKIZUMAB-RZAA 60 MG/ML IV SOLN
|
Facility
|
OP
|
$36,304.45
|
|
|
Service Code
|
HCPCS J2327
|
| Hospital Charge Code |
198293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$33,763.14 |
| Rate for Payer: Aetna Commercial |
$30,640.96
|
| Rate for Payer: Aetna Medicare |
$11,617.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11,254.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20,849.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22,693.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13,360.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12,779.17
|
| Rate for Payer: Cash Price |
$22,508.76
|
| Rate for Payer: Cash Price |
$22,508.76
|
| Rate for Payer: Centivo All Commercial |
$19,749.62
|
| Rate for Payer: Cigna All Commercial |
$31,330.74
|
| Rate for Payer: CORVEL All Commercial |
$33,763.14
|
| Rate for Payer: Coventry All Commercial |
$31,947.92
|
| Rate for Payer: Encore All Commercial |
$33,418.25
|
| Rate for Payer: Frontpath All Commercial |
$33,400.09
|
| Rate for Payer: Humana ChoiceCare |
$31,356.15
|
| Rate for Payer: Humana Medicare |
$11,617.42
|
| Rate for Payer: Lucent All Commercial |
$19,749.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32,674.01
|
| Rate for Payer: Managed Health Services Medicaid |
$18.15
|
| Rate for Payer: MDWise Medicaid |
$18.15
|
| Rate for Payer: PHCS All Commercial |
$27,228.34
|
| Rate for Payer: PHP All Commercial |
$27,533.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14,158.74
|
| Rate for Payer: Sagamore Health Network All Products |
$28,027.04
|
| Rate for Payer: Signature Care EPO |
$30,132.69
|
| Rate for Payer: Signature Care PPO |
$31,947.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30,858.78
|
| Rate for Payer: United Healthcare Commercial |
$28,607.91
|
| Rate for Payer: United Healthcare Medicare |
$11,617.42
|
|
|
RISANKIZUMAB-RZAA 60 MG/ML IV SOLN
|
Facility
|
IP
|
$36,304.45
|
|
|
Service Code
|
HCPCS J2327
|
| Hospital Charge Code |
198293
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27,228.34 |
| Max. Negotiated Rate |
$33,763.14 |
| Rate for Payer: Aetna Commercial |
$31,367.04
|
| Rate for Payer: Cash Price |
$22,508.76
|
| Rate for Payer: Cigna All Commercial |
$31,330.74
|
| Rate for Payer: CORVEL All Commercial |
$33,763.14
|
| Rate for Payer: Coventry All Commercial |
$31,947.92
|
| Rate for Payer: Encore All Commercial |
$33,418.25
|
| Rate for Payer: Frontpath All Commercial |
$33,400.09
|
| Rate for Payer: Humana ChoiceCare |
$31,356.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32,674.01
|
| Rate for Payer: PHCS All Commercial |
$27,228.34
|
| Rate for Payer: PHP All Commercial |
$27,533.29
|
| Rate for Payer: Sagamore Health Network All Products |
$28,027.04
|
| Rate for Payer: Signature Care EPO |
$30,132.69
|
| Rate for Payer: Signature Care PPO |
$31,947.92
|
| Rate for Payer: United Healthcare Commercial |
$28,607.91
|
|
|
RISPERIDONE 0.5 MG ORAL TAB
|
Facility
|
IP
|
$1.16
|
|
|
Service Code
|
NDC 00904736161
|
| Hospital Charge Code |
25520
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Cigna All Commercial |
$1.00
|
| Rate for Payer: CORVEL All Commercial |
$1.08
|
| Rate for Payer: Coventry All Commercial |
$1.02
|
| Rate for Payer: Encore All Commercial |
$1.07
|
| Rate for Payer: Frontpath All Commercial |
$1.07
|
| Rate for Payer: Humana ChoiceCare |
$1.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.05
|
| Rate for Payer: PHCS All Commercial |
$0.87
|
| Rate for Payer: PHP All Commercial |
$0.88
|
| Rate for Payer: Sagamore Health Network All Products |
$0.90
|
| Rate for Payer: Signature Care EPO |
$0.96
|
| Rate for Payer: Signature Care PPO |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$0.92
|
|
|
RISPERIDONE 0.5 MG ORAL TAB
|
Facility
|
OP
|
$1.16
|
|
|
Service Code
|
NDC 00904736161
|
| Hospital Charge Code |
25520
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna Commercial |
$0.98
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.41
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Centivo All Commercial |
$0.63
|
| Rate for Payer: Cigna All Commercial |
$1.00
|
| Rate for Payer: CORVEL All Commercial |
$1.08
|
| Rate for Payer: Coventry All Commercial |
$1.02
|
| Rate for Payer: Encore All Commercial |
$1.07
|
| Rate for Payer: Frontpath All Commercial |
$1.07
|
| Rate for Payer: Humana ChoiceCare |
$1.00
|
| Rate for Payer: Humana Medicare |
$0.37
|
| Rate for Payer: Lucent All Commercial |
$0.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.05
|
| Rate for Payer: PHCS All Commercial |
$0.87
|
| Rate for Payer: PHP All Commercial |
$0.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.45
|
| Rate for Payer: Sagamore Health Network All Products |
$0.90
|
| Rate for Payer: Signature Care EPO |
$0.96
|
| Rate for Payer: Signature Care PPO |
$1.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.99
|
| Rate for Payer: United Healthcare Commercial |
$0.92
|
| Rate for Payer: United Healthcare Medicare |
$0.37
|
|
|
RITUXIMAB 10 MG/ML IV CONC
|
Facility
|
IP
|
$16,441.60
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
22149
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12,331.20 |
| Max. Negotiated Rate |
$15,290.69 |
| Rate for Payer: Aetna Commercial |
$14,205.54
|
| Rate for Payer: Aetna Commercial |
$3,246.98
|
| Rate for Payer: Cash Price |
$10,193.79
|
| Rate for Payer: Cash Price |
$2,330.01
|
| Rate for Payer: Cigna All Commercial |
$14,189.10
|
| Rate for Payer: Cigna All Commercial |
$3,243.22
|
| Rate for Payer: CORVEL All Commercial |
$15,290.69
|
| Rate for Payer: CORVEL All Commercial |
$3,495.01
|
| Rate for Payer: Coventry All Commercial |
$3,307.11
|
| Rate for Payer: Coventry All Commercial |
$14,468.61
|
| Rate for Payer: Encore All Commercial |
$3,459.31
|
| Rate for Payer: Encore All Commercial |
$15,134.49
|
| Rate for Payer: Frontpath All Commercial |
$15,126.27
|
| Rate for Payer: Frontpath All Commercial |
$3,457.43
|
| Rate for Payer: Humana ChoiceCare |
$14,200.61
|
| Rate for Payer: Humana ChoiceCare |
$3,245.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,797.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,382.27
|
| Rate for Payer: PHCS All Commercial |
$2,818.56
|
| Rate for Payer: PHCS All Commercial |
$12,331.20
|
| Rate for Payer: PHP All Commercial |
$12,469.31
|
| Rate for Payer: PHP All Commercial |
$2,850.13
|
| Rate for Payer: Sagamore Health Network All Products |
$2,901.24
|
| Rate for Payer: Sagamore Health Network All Products |
$12,692.92
|
| Rate for Payer: Signature Care EPO |
$3,119.21
|
| Rate for Payer: Signature Care EPO |
$13,646.53
|
| Rate for Payer: Signature Care PPO |
$14,468.61
|
| Rate for Payer: Signature Care PPO |
$3,307.11
|
| Rate for Payer: United Healthcare Commercial |
$12,955.98
|
| Rate for Payer: United Healthcare Commercial |
$2,961.37
|
|
|
RITUXIMAB 10 MG/ML IV CONC
|
Facility
|
OP
|
$16,441.60
|
|
|
Service Code
|
HCPCS J9312
|
| Hospital Charge Code |
22149
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.65 |
| Max. Negotiated Rate |
$15,290.69 |
| Rate for Payer: Aetna Commercial |
$13,876.71
|
| Rate for Payer: Aetna Commercial |
$3,171.82
|
| Rate for Payer: Aetna Medicare |
$5,261.31
|
| Rate for Payer: Aetna Medicare |
$1,202.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$98.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$98.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,165.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,096.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,442.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,158.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,349.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,277.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$98.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$98.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6,050.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,382.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,322.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,787.44
|
| Rate for Payer: Cash Price |
$2,330.01
|
| Rate for Payer: Cash Price |
$10,193.79
|
| Rate for Payer: Cash Price |
$10,193.79
|
| Rate for Payer: Cash Price |
$2,330.01
|
| Rate for Payer: Centivo All Commercial |
$2,044.40
|
| Rate for Payer: Centivo All Commercial |
$8,944.23
|
| Rate for Payer: Cigna All Commercial |
$14,189.10
|
| Rate for Payer: Cigna All Commercial |
$3,243.22
|
| Rate for Payer: CORVEL All Commercial |
$15,290.69
|
| Rate for Payer: CORVEL All Commercial |
$3,495.01
|
| Rate for Payer: Coventry All Commercial |
$3,307.11
|
| Rate for Payer: Coventry All Commercial |
$14,468.61
|
| Rate for Payer: Encore All Commercial |
$3,459.31
|
| Rate for Payer: Encore All Commercial |
$15,134.49
|
| Rate for Payer: Frontpath All Commercial |
$15,126.27
|
| Rate for Payer: Frontpath All Commercial |
$3,457.43
|
| Rate for Payer: Humana ChoiceCare |
$3,245.85
|
| Rate for Payer: Humana ChoiceCare |
$14,200.61
|
| Rate for Payer: Humana Medicare |
$5,261.31
|
| Rate for Payer: Humana Medicare |
$1,202.59
|
| Rate for Payer: Lucent All Commercial |
$8,944.23
|
| Rate for Payer: Lucent All Commercial |
$2,044.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14,797.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,382.27
|
| Rate for Payer: Managed Health Services Medicaid |
$98.65
|
| Rate for Payer: Managed Health Services Medicaid |
$98.65
|
| Rate for Payer: MDWise Medicaid |
$98.65
|
| Rate for Payer: MDWise Medicaid |
$98.65
|
| Rate for Payer: PHCS All Commercial |
$2,818.56
|
| Rate for Payer: PHCS All Commercial |
$12,331.20
|
| Rate for Payer: PHP All Commercial |
$12,469.31
|
| Rate for Payer: PHP All Commercial |
$2,850.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,412.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,465.65
|
| Rate for Payer: Sagamore Health Network All Products |
$12,692.92
|
| Rate for Payer: Sagamore Health Network All Products |
$2,901.24
|
| Rate for Payer: Signature Care EPO |
$13,646.53
|
| Rate for Payer: Signature Care EPO |
$3,119.21
|
| Rate for Payer: Signature Care PPO |
$3,307.11
|
| Rate for Payer: Signature Care PPO |
$14,468.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,194.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,975.36
|
| Rate for Payer: United Healthcare Commercial |
$12,955.98
|
| Rate for Payer: United Healthcare Commercial |
$2,961.37
|
| Rate for Payer: United Healthcare Medicare |
$5,261.31
|
| Rate for Payer: United Healthcare Medicare |
$1,202.59
|
|
|
RITUXIMAB-PVVR 10 MG/ML IV SOLN
|
Facility
|
IP
|
$10,616.03
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
190336
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7,962.02 |
| Max. Negotiated Rate |
$9,872.90 |
| Rate for Payer: Aetna Commercial |
$9,172.25
|
| Rate for Payer: Cash Price |
$6,581.94
|
| Rate for Payer: Cigna All Commercial |
$9,161.63
|
| Rate for Payer: CORVEL All Commercial |
$9,872.90
|
| Rate for Payer: Coventry All Commercial |
$9,342.10
|
| Rate for Payer: Encore All Commercial |
$9,772.05
|
| Rate for Payer: Frontpath All Commercial |
$9,766.74
|
| Rate for Payer: Humana ChoiceCare |
$9,169.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,554.42
|
| Rate for Payer: PHCS All Commercial |
$7,962.02
|
| Rate for Payer: PHP All Commercial |
$8,051.19
|
| Rate for Payer: Sagamore Health Network All Products |
$8,195.57
|
| Rate for Payer: Signature Care EPO |
$8,811.30
|
| Rate for Payer: Signature Care PPO |
$9,342.10
|
| Rate for Payer: United Healthcare Commercial |
$8,365.43
|
|
|
RITUXIMAB-PVVR 10 MG/ML IV SOLN
|
Facility
|
OP
|
$10,616.03
|
|
|
Service Code
|
HCPCS Q5119
|
| Hospital Charge Code |
190336
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$75.26 |
| Max. Negotiated Rate |
$9,872.90 |
| Rate for Payer: Aetna Commercial |
$8,959.93
|
| Rate for Payer: Aetna Medicare |
$3,397.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$75.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,290.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,096.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,636.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,906.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,736.84
|
| Rate for Payer: Cash Price |
$6,581.94
|
| Rate for Payer: Cash Price |
$6,581.94
|
| Rate for Payer: Centivo All Commercial |
$5,775.12
|
| Rate for Payer: Cigna All Commercial |
$9,161.63
|
| Rate for Payer: CORVEL All Commercial |
$9,872.90
|
| Rate for Payer: Coventry All Commercial |
$9,342.10
|
| Rate for Payer: Encore All Commercial |
$9,772.05
|
| Rate for Payer: Frontpath All Commercial |
$9,766.74
|
| Rate for Payer: Humana ChoiceCare |
$9,169.06
|
| Rate for Payer: Humana Medicare |
$3,397.13
|
| Rate for Payer: Lucent All Commercial |
$5,775.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,554.42
|
| Rate for Payer: Managed Health Services Medicaid |
$75.26
|
| Rate for Payer: MDWise Medicaid |
$75.26
|
| Rate for Payer: PHCS All Commercial |
$7,962.02
|
| Rate for Payer: PHP All Commercial |
$8,051.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,140.25
|
| Rate for Payer: Sagamore Health Network All Products |
$8,195.57
|
| Rate for Payer: Signature Care EPO |
$8,811.30
|
| Rate for Payer: Signature Care PPO |
$9,342.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,023.62
|
| Rate for Payer: United Healthcare Commercial |
$8,365.43
|
| Rate for Payer: United Healthcare Medicare |
$3,397.13
|
|
|
RIVAROXABAN 10 MG ORAL TAB
|
Facility
|
OP
|
$98.12
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
152539
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$91.25 |
| Rate for Payer: Aetna Commercial |
$82.81
|
| Rate for Payer: Aetna Medicare |
$31.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.54
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Centivo All Commercial |
$53.38
|
| Rate for Payer: Cigna All Commercial |
$84.68
|
| Rate for Payer: CORVEL All Commercial |
$91.25
|
| Rate for Payer: Coventry All Commercial |
$86.34
|
| Rate for Payer: Encore All Commercial |
$90.32
|
| Rate for Payer: Frontpath All Commercial |
$90.27
|
| Rate for Payer: Humana ChoiceCare |
$84.75
|
| Rate for Payer: Humana Medicare |
$31.40
|
| Rate for Payer: Lucent All Commercial |
$53.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.31
|
| Rate for Payer: PHCS All Commercial |
$73.59
|
| Rate for Payer: PHP All Commercial |
$74.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.27
|
| Rate for Payer: Sagamore Health Network All Products |
$75.75
|
| Rate for Payer: Signature Care EPO |
$81.44
|
| Rate for Payer: Signature Care PPO |
$86.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.40
|
| Rate for Payer: United Healthcare Commercial |
$77.32
|
| Rate for Payer: United Healthcare Medicare |
$31.40
|
|
|
RIVAROXABAN 10 MG ORAL TAB
|
Facility
|
IP
|
$98.12
|
|
|
Service Code
|
NDC 50458058030
|
| Hospital Charge Code |
152539
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.59 |
| Max. Negotiated Rate |
$91.25 |
| Rate for Payer: Aetna Commercial |
$84.77
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cigna All Commercial |
$84.68
|
| Rate for Payer: CORVEL All Commercial |
$91.25
|
| Rate for Payer: Coventry All Commercial |
$86.34
|
| Rate for Payer: Encore All Commercial |
$90.32
|
| Rate for Payer: Frontpath All Commercial |
$90.27
|
| Rate for Payer: Humana ChoiceCare |
$84.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.31
|
| Rate for Payer: PHCS All Commercial |
$73.59
|
| Rate for Payer: PHP All Commercial |
$74.41
|
| Rate for Payer: Sagamore Health Network All Products |
$75.75
|
| Rate for Payer: Signature Care EPO |
$81.44
|
| Rate for Payer: Signature Care PPO |
$86.34
|
| Rate for Payer: United Healthcare Commercial |
$77.32
|
|
|
RIVAROXABAN 15 MG ORAL TAB
|
Facility
|
IP
|
$98.12
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
153451
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$73.59 |
| Max. Negotiated Rate |
$91.25 |
| Rate for Payer: Aetna Commercial |
$84.77
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cigna All Commercial |
$84.68
|
| Rate for Payer: CORVEL All Commercial |
$91.25
|
| Rate for Payer: Coventry All Commercial |
$86.34
|
| Rate for Payer: Encore All Commercial |
$90.32
|
| Rate for Payer: Frontpath All Commercial |
$90.27
|
| Rate for Payer: Humana ChoiceCare |
$84.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.31
|
| Rate for Payer: PHCS All Commercial |
$73.59
|
| Rate for Payer: PHP All Commercial |
$74.41
|
| Rate for Payer: Sagamore Health Network All Products |
$75.75
|
| Rate for Payer: Signature Care EPO |
$81.44
|
| Rate for Payer: Signature Care PPO |
$86.34
|
| Rate for Payer: United Healthcare Commercial |
$77.32
|
|
|
RIVAROXABAN 15 MG ORAL TAB
|
Facility
|
OP
|
$98.12
|
|
|
Service Code
|
NDC 50458057830
|
| Hospital Charge Code |
153451
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.42 |
| Max. Negotiated Rate |
$91.25 |
| Rate for Payer: Aetna Commercial |
$82.81
|
| Rate for Payer: Aetna Medicare |
$31.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$56.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$61.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.54
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Centivo All Commercial |
$53.38
|
| Rate for Payer: Cigna All Commercial |
$84.68
|
| Rate for Payer: CORVEL All Commercial |
$91.25
|
| Rate for Payer: Coventry All Commercial |
$86.34
|
| Rate for Payer: Encore All Commercial |
$90.32
|
| Rate for Payer: Frontpath All Commercial |
$90.27
|
| Rate for Payer: Humana ChoiceCare |
$84.75
|
| Rate for Payer: Humana Medicare |
$31.40
|
| Rate for Payer: Lucent All Commercial |
$53.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$88.31
|
| Rate for Payer: PHCS All Commercial |
$73.59
|
| Rate for Payer: PHP All Commercial |
$74.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.27
|
| Rate for Payer: Sagamore Health Network All Products |
$75.75
|
| Rate for Payer: Signature Care EPO |
$81.44
|
| Rate for Payer: Signature Care PPO |
$86.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$83.40
|
| Rate for Payer: United Healthcare Commercial |
$77.32
|
| Rate for Payer: United Healthcare Medicare |
$31.40
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24
|
Facility
|
IP
|
$15.62
|
|
|
Service Code
|
NDC 65162082534
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.71 |
| Max. Negotiated Rate |
$14.52 |
| Rate for Payer: Aetna Commercial |
$13.49
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Cigna All Commercial |
$13.48
|
| Rate for Payer: CORVEL All Commercial |
$14.52
|
| Rate for Payer: Coventry All Commercial |
$13.74
|
| Rate for Payer: Encore All Commercial |
$14.38
|
| Rate for Payer: Frontpath All Commercial |
$14.37
|
| Rate for Payer: Humana ChoiceCare |
$13.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.06
|
| Rate for Payer: PHCS All Commercial |
$11.71
|
| Rate for Payer: PHP All Commercial |
$11.84
|
| Rate for Payer: Sagamore Health Network All Products |
$12.06
|
| Rate for Payer: Signature Care EPO |
$12.96
|
| Rate for Payer: Signature Care PPO |
$13.74
|
| Rate for Payer: United Healthcare Commercial |
$12.31
|
|
|
RIVASTIGMINE 4.6 MG/24 HOUR TD PT24
|
Facility
|
OP
|
$15.62
|
|
|
Service Code
|
NDC 65162082534
|
| Hospital Charge Code |
82504
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$14.52 |
| Rate for Payer: Aetna Commercial |
$13.18
|
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.50
|
| Rate for Payer: Cash Price |
$9.68
|
| Rate for Payer: Centivo All Commercial |
$8.50
|
| Rate for Payer: Cigna All Commercial |
$13.48
|
| Rate for Payer: CORVEL All Commercial |
$14.52
|
| Rate for Payer: Coventry All Commercial |
$13.74
|
| Rate for Payer: Encore All Commercial |
$14.38
|
| Rate for Payer: Frontpath All Commercial |
$14.37
|
| Rate for Payer: Humana ChoiceCare |
$13.49
|
| Rate for Payer: Humana Medicare |
$5.00
|
| Rate for Payer: Lucent All Commercial |
$8.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.06
|
| Rate for Payer: PHCS All Commercial |
$11.71
|
| Rate for Payer: PHP All Commercial |
$11.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.09
|
| Rate for Payer: Sagamore Health Network All Products |
$12.06
|
| Rate for Payer: Signature Care EPO |
$12.96
|
| Rate for Payer: Signature Care PPO |
$13.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.27
|
| Rate for Payer: United Healthcare Commercial |
$12.31
|
| Rate for Payer: United Healthcare Medicare |
$5.00
|
|
|
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP
|
Facility
|
IP
|
$3.80
|
|
|
Service Code
|
NDC 62756014586
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.85 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Cigna All Commercial |
$3.28
|
| Rate for Payer: CORVEL All Commercial |
$3.53
|
| Rate for Payer: Coventry All Commercial |
$3.34
|
| Rate for Payer: Encore All Commercial |
$3.50
|
| Rate for Payer: Frontpath All Commercial |
$3.50
|
| Rate for Payer: Humana ChoiceCare |
$3.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.42
|
| Rate for Payer: PHCS All Commercial |
$2.85
|
| Rate for Payer: PHP All Commercial |
$2.88
|
| Rate for Payer: Sagamore Health Network All Products |
$2.93
|
| Rate for Payer: Signature Care EPO |
$3.15
|
| Rate for Payer: Signature Care PPO |
$3.34
|
| Rate for Payer: United Healthcare Commercial |
$3.00
|
|
|
RIVASTIGMINE TARTRATE 1.5 MG ORAL CAP
|
Facility
|
OP
|
$3.80
|
|
|
Service Code
|
NDC 62756014586
|
| Hospital Charge Code |
28278
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$3.53 |
| Rate for Payer: Aetna Commercial |
$3.21
|
| Rate for Payer: Aetna Medicare |
$1.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.34
|
| Rate for Payer: Cash Price |
$2.36
|
| Rate for Payer: Centivo All Commercial |
$2.07
|
| Rate for Payer: Cigna All Commercial |
$3.28
|
| Rate for Payer: CORVEL All Commercial |
$3.53
|
| Rate for Payer: Coventry All Commercial |
$3.34
|
| Rate for Payer: Encore All Commercial |
$3.50
|
| Rate for Payer: Frontpath All Commercial |
$3.50
|
| Rate for Payer: Humana ChoiceCare |
$3.28
|
| Rate for Payer: Humana Medicare |
$1.22
|
| Rate for Payer: Lucent All Commercial |
$2.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.42
|
| Rate for Payer: PHCS All Commercial |
$2.85
|
| Rate for Payer: PHP All Commercial |
$2.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.48
|
| Rate for Payer: Sagamore Health Network All Products |
$2.93
|
| Rate for Payer: Signature Care EPO |
$3.15
|
| Rate for Payer: Signature Care PPO |
$3.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.23
|
| Rate for Payer: United Healthcare Commercial |
$3.00
|
| Rate for Payer: United Healthcare Medicare |
$1.22
|
|
|
RIZATRIPTAN 5 MG ORAL TAB
|
Facility
|
OP
|
$9.74
|
|
|
Service Code
|
NDC 00093747143
|
| Hospital Charge Code |
23376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna Commercial |
$8.22
|
| Rate for Payer: Aetna Medicare |
$3.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.43
|
| Rate for Payer: Cash Price |
$6.04
|
| Rate for Payer: Centivo All Commercial |
$5.30
|
| Rate for Payer: Cigna All Commercial |
$8.40
|
| Rate for Payer: CORVEL All Commercial |
$9.06
|
| Rate for Payer: Coventry All Commercial |
$8.57
|
| Rate for Payer: Encore All Commercial |
$8.96
|
| Rate for Payer: Frontpath All Commercial |
$8.96
|
| Rate for Payer: Humana ChoiceCare |
$8.41
|
| Rate for Payer: Humana Medicare |
$3.12
|
| Rate for Payer: Lucent All Commercial |
$5.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.76
|
| Rate for Payer: PHCS All Commercial |
$7.30
|
| Rate for Payer: PHP All Commercial |
$7.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.80
|
| Rate for Payer: Sagamore Health Network All Products |
$7.52
|
| Rate for Payer: Signature Care EPO |
$8.08
|
| Rate for Payer: Signature Care PPO |
$8.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.28
|
| Rate for Payer: United Healthcare Commercial |
$7.67
|
| Rate for Payer: United Healthcare Medicare |
$3.12
|
|
|
RIZATRIPTAN 5 MG ORAL TAB
|
Facility
|
OP
|
$9.74
|
|
|
Service Code
|
NDC 00093747119
|
| Hospital Charge Code |
23376
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna Commercial |
$8.22
|
| Rate for Payer: Aetna Medicare |
$3.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.43
|
| Rate for Payer: Cash Price |
$6.04
|
| Rate for Payer: Centivo All Commercial |
$5.30
|
| Rate for Payer: Cigna All Commercial |
$8.40
|
| Rate for Payer: CORVEL All Commercial |
$9.06
|
| Rate for Payer: Coventry All Commercial |
$8.57
|
| Rate for Payer: Encore All Commercial |
$8.96
|
| Rate for Payer: Frontpath All Commercial |
$8.96
|
| Rate for Payer: Humana ChoiceCare |
$8.41
|
| Rate for Payer: Humana Medicare |
$3.12
|
| Rate for Payer: Lucent All Commercial |
$5.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.76
|
| Rate for Payer: PHCS All Commercial |
$7.30
|
| Rate for Payer: PHP All Commercial |
$7.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.80
|
| Rate for Payer: Sagamore Health Network All Products |
$7.52
|
| Rate for Payer: Signature Care EPO |
$8.08
|
| Rate for Payer: Signature Care PPO |
$8.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.28
|
| Rate for Payer: United Healthcare Commercial |
$7.67
|
| Rate for Payer: United Healthcare Medicare |
$3.12
|
|
|
RIZATRIPTAN 5 MG ORAL TAB
|
Facility
|
IP
|
$9.74
|
|
|
Service Code
|
NDC 00093747143
|
| Hospital Charge Code |
23376
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna Commercial |
$8.41
|
| Rate for Payer: Cash Price |
$6.04
|
| Rate for Payer: Cigna All Commercial |
$8.40
|
| Rate for Payer: CORVEL All Commercial |
$9.06
|
| Rate for Payer: Coventry All Commercial |
$8.57
|
| Rate for Payer: Encore All Commercial |
$8.96
|
| Rate for Payer: Frontpath All Commercial |
$8.96
|
| Rate for Payer: Humana ChoiceCare |
$8.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.76
|
| Rate for Payer: PHCS All Commercial |
$7.30
|
| Rate for Payer: PHP All Commercial |
$7.38
|
| Rate for Payer: Sagamore Health Network All Products |
$7.52
|
| Rate for Payer: Signature Care EPO |
$8.08
|
| Rate for Payer: Signature Care PPO |
$8.57
|
| Rate for Payer: United Healthcare Commercial |
$7.67
|
|
|
RIZATRIPTAN 5 MG ORAL TAB
|
Facility
|
IP
|
$9.74
|
|
|
Service Code
|
NDC 00093747119
|
| Hospital Charge Code |
23376
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Aetna Commercial |
$8.41
|
| Rate for Payer: Cash Price |
$6.04
|
| Rate for Payer: Cigna All Commercial |
$8.40
|
| Rate for Payer: CORVEL All Commercial |
$9.06
|
| Rate for Payer: Coventry All Commercial |
$8.57
|
| Rate for Payer: Encore All Commercial |
$8.96
|
| Rate for Payer: Frontpath All Commercial |
$8.96
|
| Rate for Payer: Humana ChoiceCare |
$8.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.76
|
| Rate for Payer: PHCS All Commercial |
$7.30
|
| Rate for Payer: PHP All Commercial |
$7.38
|
| Rate for Payer: Sagamore Health Network All Products |
$7.52
|
| Rate for Payer: Signature Care EPO |
$8.08
|
| Rate for Payer: Signature Care PPO |
$8.57
|
| Rate for Payer: United Healthcare Commercial |
$7.67
|
|
|
ROCURONIUM 10 MG/ML IV S.O.
|
Facility
|
IP
|
$26.01
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
42095812
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$19.50 |
| Max. Negotiated Rate |
$24.18 |
| Rate for Payer: Aetna Commercial |
$22.47
|
| Rate for Payer: Aetna Commercial |
$66.59
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Cash Price |
$47.78
|
| Rate for Payer: Cigna All Commercial |
$22.44
|
| Rate for Payer: Cigna All Commercial |
$66.51
|
| Rate for Payer: CORVEL All Commercial |
$24.18
|
| Rate for Payer: CORVEL All Commercial |
$71.68
|
| Rate for Payer: Coventry All Commercial |
$67.82
|
| Rate for Payer: Coventry All Commercial |
$22.88
|
| Rate for Payer: Encore All Commercial |
$70.94
|
| Rate for Payer: Encore All Commercial |
$23.94
|
| Rate for Payer: Frontpath All Commercial |
$23.92
|
| Rate for Payer: Frontpath All Commercial |
$70.90
|
| Rate for Payer: Humana ChoiceCare |
$22.46
|
| Rate for Payer: Humana ChoiceCare |
$66.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.36
|
| Rate for Payer: PHCS All Commercial |
$57.80
|
| Rate for Payer: PHCS All Commercial |
$19.50
|
| Rate for Payer: PHP All Commercial |
$19.72
|
| Rate for Payer: PHP All Commercial |
$58.45
|
| Rate for Payer: Sagamore Health Network All Products |
$59.50
|
| Rate for Payer: Sagamore Health Network All Products |
$20.08
|
| Rate for Payer: Signature Care EPO |
$63.97
|
| Rate for Payer: Signature Care EPO |
$21.58
|
| Rate for Payer: Signature Care PPO |
$22.88
|
| Rate for Payer: Signature Care PPO |
$67.82
|
| Rate for Payer: United Healthcare Commercial |
$20.49
|
| Rate for Payer: United Healthcare Commercial |
$60.73
|
|
|
ROCURONIUM 10 MG/ML IV S.O.
|
Facility
|
OP
|
$77.07
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
42095812
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.89 |
| Max. Negotiated Rate |
$71.68 |
| Rate for Payer: Aetna Commercial |
$65.05
|
| Rate for Payer: Aetna Commercial |
$21.95
|
| Rate for Payer: Aetna Medicare |
$24.66
|
| Rate for Payer: Aetna Medicare |
$8.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$44.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$14.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$48.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$27.13
|
| Rate for Payer: Cash Price |
$47.78
|
| Rate for Payer: Cash Price |
$16.12
|
| Rate for Payer: Centivo All Commercial |
$14.15
|
| Rate for Payer: Centivo All Commercial |
$41.93
|
| Rate for Payer: Cigna All Commercial |
$66.51
|
| Rate for Payer: Cigna All Commercial |
$22.44
|
| Rate for Payer: CORVEL All Commercial |
$24.18
|
| Rate for Payer: CORVEL All Commercial |
$71.68
|
| Rate for Payer: Coventry All Commercial |
$22.88
|
| Rate for Payer: Coventry All Commercial |
$67.82
|
| Rate for Payer: Encore All Commercial |
$70.94
|
| Rate for Payer: Encore All Commercial |
$23.94
|
| Rate for Payer: Frontpath All Commercial |
$23.92
|
| Rate for Payer: Frontpath All Commercial |
$70.90
|
| Rate for Payer: Humana ChoiceCare |
$66.57
|
| Rate for Payer: Humana ChoiceCare |
$22.46
|
| Rate for Payer: Humana Medicare |
$24.66
|
| Rate for Payer: Humana Medicare |
$8.32
|
| Rate for Payer: Lucent All Commercial |
$14.15
|
| Rate for Payer: Lucent All Commercial |
$41.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$69.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.40
|
| Rate for Payer: PHCS All Commercial |
$19.50
|
| Rate for Payer: PHCS All Commercial |
$57.80
|
| Rate for Payer: PHP All Commercial |
$19.72
|
| Rate for Payer: PHP All Commercial |
$58.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.14
|
| Rate for Payer: Sagamore Health Network All Products |
$20.08
|
| Rate for Payer: Sagamore Health Network All Products |
$59.50
|
| Rate for Payer: Signature Care EPO |
$63.97
|
| Rate for Payer: Signature Care EPO |
$21.58
|
| Rate for Payer: Signature Care PPO |
$22.88
|
| Rate for Payer: Signature Care PPO |
$67.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.10
|
| Rate for Payer: United Healthcare Commercial |
$20.49
|
| Rate for Payer: United Healthcare Commercial |
$60.73
|
| Rate for Payer: United Healthcare Medicare |
$8.32
|
| Rate for Payer: United Healthcare Medicare |
$24.66
|
|
|
ROCURONIUM 10 MG/ML IV SOLN
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
95812
|
|
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 |
$11.16
|
| 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
|
|
