|
HONEY 80 % TOP GEL
|
Facility
OP
|
$95.79
|
|
|
Service Code
|
NDC 09958003471
|
| Hospital Charge Code |
162300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.61 |
| Max. Negotiated Rate |
$89.08 |
| Rate for Payer: Aetna Commercial |
$80.85
|
| Rate for Payer: Aetna Medicare |
$31.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$55.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.77
|
| Rate for Payer: Cash Price |
$59.39
|
| Rate for Payer: Cash Price |
$59.39
|
| Rate for Payer: Centivo All Commercial |
$48.85
|
| Rate for Payer: Cigna All Commercial |
$82.67
|
| Rate for Payer: CORVEL All Commercial |
$89.08
|
| Rate for Payer: Coventry All Commercial |
$84.29
|
| Rate for Payer: Encore All Commercial |
$88.17
|
| Rate for Payer: Frontpath All Commercial |
$88.12
|
| Rate for Payer: Humana ChoiceCare |
$82.73
|
| Rate for Payer: Humana Medicare |
$48.85
|
| Rate for Payer: Lucent All Commercial |
$48.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.21
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$71.84
|
| Rate for Payer: PHP All Commercial |
$72.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.36
|
| Rate for Payer: Sagamore Health Network All Products |
$73.95
|
| Rate for Payer: Signature Care EPO |
$79.50
|
| Rate for Payer: Signature Care PPO |
$84.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$81.42
|
| Rate for Payer: United Healthcare Commercial |
$75.48
|
| Rate for Payer: United Healthcare Medicare |
$31.61
|
|
|
HONEY 80 % TOP GEL
|
Facility
IP
|
$95.79
|
|
|
Service Code
|
NDC 09958003471
|
| Hospital Charge Code |
162300
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$71.84 |
| Max. Negotiated Rate |
$89.08 |
| Rate for Payer: Aetna Commercial |
$82.76
|
| Rate for Payer: Cash Price |
$59.39
|
| Rate for Payer: Cigna All Commercial |
$82.67
|
| Rate for Payer: CORVEL All Commercial |
$89.08
|
| Rate for Payer: Coventry All Commercial |
$84.29
|
| Rate for Payer: Encore All Commercial |
$88.17
|
| Rate for Payer: Frontpath All Commercial |
$88.12
|
| Rate for Payer: Humana ChoiceCare |
$82.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$86.21
|
| Rate for Payer: PHCS All Commercial |
$71.84
|
| Rate for Payer: PHP All Commercial |
$72.65
|
| Rate for Payer: Sagamore Health Network All Products |
$73.95
|
| Rate for Payer: Signature Care EPO |
$79.50
|
| Rate for Payer: Signature Care PPO |
$84.29
|
| Rate for Payer: United Healthcare Commercial |
$75.48
|
|
|
HUMAN PAPILLOMAV VAC,9-VAL(PF) 0.5 ML IM SUSP
|
Facility
OP
|
$560.92
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
170975
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$185.10 |
| Max. Negotiated Rate |
$521.66 |
| Rate for Payer: Aetna Commercial |
$473.42
|
| Rate for Payer: Aetna Medicare |
$185.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$185.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$322.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$350.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$301.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.62
|
| Rate for Payer: Cash Price |
$347.77
|
| Rate for Payer: Cash Price |
$347.77
|
| Rate for Payer: Centivo All Commercial |
$286.07
|
| Rate for Payer: Cigna All Commercial |
$484.08
|
| Rate for Payer: CORVEL All Commercial |
$521.66
|
| Rate for Payer: Coventry All Commercial |
$493.61
|
| Rate for Payer: Encore All Commercial |
$516.33
|
| Rate for Payer: Frontpath All Commercial |
$516.05
|
| Rate for Payer: Humana ChoiceCare |
$484.47
|
| Rate for Payer: Humana Medicare |
$286.07
|
| Rate for Payer: Lucent All Commercial |
$286.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$504.83
|
| Rate for Payer: Managed Health Services Medicaid |
$301.12
|
| Rate for Payer: MDWise Medicaid |
$301.12
|
| Rate for Payer: PHCS All Commercial |
$420.69
|
| Rate for Payer: PHP All Commercial |
$425.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$218.76
|
| Rate for Payer: Sagamore Health Network All Products |
$433.03
|
| Rate for Payer: Signature Care EPO |
$465.57
|
| Rate for Payer: Signature Care PPO |
$493.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$476.78
|
| Rate for Payer: United Healthcare Commercial |
$442.01
|
| Rate for Payer: United Healthcare Medicare |
$185.10
|
|
|
HUMAN PAPILLOMAV VAC,9-VAL(PF) 0.5 ML IM SUSP
|
Facility
IP
|
$560.92
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
170975
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$420.69 |
| Max. Negotiated Rate |
$521.66 |
| Rate for Payer: Aetna Commercial |
$484.64
|
| Rate for Payer: Cash Price |
$347.77
|
| Rate for Payer: Cigna All Commercial |
$484.08
|
| Rate for Payer: CORVEL All Commercial |
$521.66
|
| Rate for Payer: Coventry All Commercial |
$493.61
|
| Rate for Payer: Encore All Commercial |
$516.33
|
| Rate for Payer: Frontpath All Commercial |
$516.05
|
| Rate for Payer: Humana ChoiceCare |
$484.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$504.83
|
| Rate for Payer: PHCS All Commercial |
$420.69
|
| Rate for Payer: PHP All Commercial |
$425.40
|
| Rate for Payer: Sagamore Health Network All Products |
$433.03
|
| Rate for Payer: Signature Care EPO |
$465.57
|
| Rate for Payer: Signature Care PPO |
$493.61
|
| Rate for Payer: United Healthcare Commercial |
$442.01
|
|
|
HUMAN PAPILLOMAV VAC,9-VAL(PF) 0.5 ML IM SYRG
|
Facility
IP
|
$600.08
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
170976
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$450.06 |
| Max. Negotiated Rate |
$558.07 |
| Rate for Payer: Aetna Commercial |
$518.46
|
| Rate for Payer: Cash Price |
$372.05
|
| Rate for Payer: Cigna All Commercial |
$517.86
|
| Rate for Payer: CORVEL All Commercial |
$558.07
|
| Rate for Payer: Coventry All Commercial |
$528.07
|
| Rate for Payer: Encore All Commercial |
$552.37
|
| Rate for Payer: Frontpath All Commercial |
$552.07
|
| Rate for Payer: Humana ChoiceCare |
$518.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$540.07
|
| Rate for Payer: PHCS All Commercial |
$450.06
|
| Rate for Payer: PHP All Commercial |
$455.10
|
| Rate for Payer: Sagamore Health Network All Products |
$463.26
|
| Rate for Payer: Signature Care EPO |
$498.06
|
| Rate for Payer: Signature Care PPO |
$528.07
|
| Rate for Payer: United Healthcare Commercial |
$472.86
|
|
|
HUMAN PAPILLOMAV VAC,9-VAL(PF) 0.5 ML IM SYRG
|
Facility
OP
|
$600.08
|
|
|
Service Code
|
HCPCS 90651
|
| Hospital Charge Code |
170976
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$198.02 |
| Max. Negotiated Rate |
$558.07 |
| Rate for Payer: Aetna Commercial |
$506.46
|
| Rate for Payer: Aetna Medicare |
$198.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$198.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$344.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$375.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$301.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$227.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$217.83
|
| Rate for Payer: Cash Price |
$372.05
|
| Rate for Payer: Cash Price |
$372.05
|
| Rate for Payer: Centivo All Commercial |
$306.04
|
| Rate for Payer: Cigna All Commercial |
$517.86
|
| Rate for Payer: CORVEL All Commercial |
$558.07
|
| Rate for Payer: Coventry All Commercial |
$528.07
|
| Rate for Payer: Encore All Commercial |
$552.37
|
| Rate for Payer: Frontpath All Commercial |
$552.07
|
| Rate for Payer: Humana ChoiceCare |
$518.28
|
| Rate for Payer: Humana Medicare |
$306.04
|
| Rate for Payer: Lucent All Commercial |
$306.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$540.07
|
| Rate for Payer: Managed Health Services Medicaid |
$301.12
|
| Rate for Payer: MDWise Medicaid |
$301.12
|
| Rate for Payer: PHCS All Commercial |
$450.06
|
| Rate for Payer: PHP All Commercial |
$455.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$234.03
|
| Rate for Payer: Sagamore Health Network All Products |
$463.26
|
| Rate for Payer: Signature Care EPO |
$498.06
|
| Rate for Payer: Signature Care PPO |
$528.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$510.06
|
| Rate for Payer: United Healthcare Commercial |
$472.86
|
| Rate for Payer: United Healthcare Medicare |
$198.02
|
|
|
HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR
|
Facility
OP
|
$8,407.00
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
168886
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,774.31 |
| Max. Negotiated Rate |
$7,818.51 |
| Rate for Payer: Aetna Commercial |
$7,095.51
|
| Rate for Payer: Aetna Medicare |
$2,774.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,774.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,828.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,255.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,190.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,051.74
|
| Rate for Payer: Cash Price |
$5,212.34
|
| Rate for Payer: Centivo All Commercial |
$4,287.57
|
| Rate for Payer: Cigna All Commercial |
$7,255.24
|
| Rate for Payer: CORVEL All Commercial |
$7,818.51
|
| Rate for Payer: Coventry All Commercial |
$7,398.16
|
| Rate for Payer: Encore All Commercial |
$7,738.64
|
| Rate for Payer: Frontpath All Commercial |
$7,734.44
|
| Rate for Payer: Humana ChoiceCare |
$7,261.13
|
| Rate for Payer: Humana Medicare |
$4,287.57
|
| Rate for Payer: Lucent All Commercial |
$4,287.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,566.30
|
| Rate for Payer: PHCS All Commercial |
$6,305.25
|
| Rate for Payer: PHP All Commercial |
$6,375.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,278.73
|
| Rate for Payer: Sagamore Health Network All Products |
$6,490.20
|
| Rate for Payer: Signature Care EPO |
$6,977.81
|
| Rate for Payer: Signature Care PPO |
$7,398.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,145.95
|
| Rate for Payer: United Healthcare Commercial |
$6,624.72
|
| Rate for Payer: United Healthcare Medicare |
$2,774.31
|
|
|
HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR
|
Facility
IP
|
$8,407.00
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
168886
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6,305.25 |
| Max. Negotiated Rate |
$7,818.51 |
| Rate for Payer: Aetna Commercial |
$7,263.65
|
| Rate for Payer: Cash Price |
$5,212.34
|
| Rate for Payer: Cigna All Commercial |
$7,255.24
|
| Rate for Payer: CORVEL All Commercial |
$7,818.51
|
| Rate for Payer: Coventry All Commercial |
$7,398.16
|
| Rate for Payer: Encore All Commercial |
$7,738.64
|
| Rate for Payer: Frontpath All Commercial |
$7,734.44
|
| Rate for Payer: Humana ChoiceCare |
$7,261.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,566.30
|
| Rate for Payer: PHCS All Commercial |
$6,305.25
|
| Rate for Payer: PHP All Commercial |
$6,375.87
|
| Rate for Payer: Sagamore Health Network All Products |
$6,490.20
|
| Rate for Payer: Signature Care EPO |
$6,977.81
|
| Rate for Payer: Signature Care PPO |
$7,398.16
|
| Rate for Payer: United Healthcare Commercial |
$6,624.72
|
|
|
HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR (CAMERON)
|
Facility
OP
|
$8,407.00
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
14010016888601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,774.31 |
| Max. Negotiated Rate |
$7,818.51 |
| Rate for Payer: Aetna Commercial |
$7,095.51
|
| Rate for Payer: Aetna Medicare |
$2,774.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,774.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4,828.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,255.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,190.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,051.74
|
| Rate for Payer: Cash Price |
$5,212.34
|
| Rate for Payer: Centivo All Commercial |
$4,287.57
|
| Rate for Payer: Cigna All Commercial |
$7,255.24
|
| Rate for Payer: CORVEL All Commercial |
$7,818.51
|
| Rate for Payer: Coventry All Commercial |
$7,398.16
|
| Rate for Payer: Encore All Commercial |
$7,738.64
|
| Rate for Payer: Frontpath All Commercial |
$7,734.44
|
| Rate for Payer: Humana ChoiceCare |
$7,261.13
|
| Rate for Payer: Humana Medicare |
$4,287.57
|
| Rate for Payer: Lucent All Commercial |
$4,287.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,566.30
|
| Rate for Payer: PHCS All Commercial |
$6,305.25
|
| Rate for Payer: PHP All Commercial |
$6,375.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,278.73
|
| Rate for Payer: Sagamore Health Network All Products |
$6,490.20
|
| Rate for Payer: Signature Care EPO |
$6,977.81
|
| Rate for Payer: Signature Care PPO |
$7,398.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,145.95
|
| Rate for Payer: United Healthcare Commercial |
$6,624.72
|
| Rate for Payer: United Healthcare Medicare |
$2,774.31
|
|
|
HUM PROTHROMBIN CPLX(PCC)4FACT 1,000 UNIT (800-1240 UNIT) IV SOLR (CAMERON)
|
Facility
IP
|
$8,407.00
|
|
|
Service Code
|
HCPCS J7168
|
| Hospital Charge Code |
14010016888601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$6,305.25 |
| Max. Negotiated Rate |
$7,818.51 |
| Rate for Payer: Aetna Commercial |
$7,263.65
|
| Rate for Payer: Cash Price |
$5,212.34
|
| Rate for Payer: Cigna All Commercial |
$7,255.24
|
| Rate for Payer: CORVEL All Commercial |
$7,818.51
|
| Rate for Payer: Coventry All Commercial |
$7,398.16
|
| Rate for Payer: Encore All Commercial |
$7,738.64
|
| Rate for Payer: Frontpath All Commercial |
$7,734.44
|
| Rate for Payer: Humana ChoiceCare |
$7,261.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7,566.30
|
| Rate for Payer: PHCS All Commercial |
$6,305.25
|
| Rate for Payer: PHP All Commercial |
$6,375.87
|
| Rate for Payer: Sagamore Health Network All Products |
$6,490.20
|
| Rate for Payer: Signature Care EPO |
$6,977.81
|
| Rate for Payer: Signature Care PPO |
$7,398.16
|
| Rate for Payer: United Healthcare Commercial |
$6,624.72
|
|
|
HYALURONATE SOD, CROSS-LINKED 30 MG/3 ML IATC SYRG
|
Facility
OP
|
$4,025.00
|
|
|
Service Code
|
HCPCS J7326
|
| Hospital Charge Code |
163847
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,207.50 |
| Max. Negotiated Rate |
$3,743.25 |
| Rate for Payer: Aetna Commercial |
$3,397.10
|
| Rate for Payer: Aetna Medicare |
$1,328.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,328.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,311.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,516.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,207.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,527.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,461.07
|
| Rate for Payer: Cash Price |
$2,495.50
|
| Rate for Payer: Cash Price |
$2,495.50
|
| Rate for Payer: Centivo All Commercial |
$2,052.75
|
| Rate for Payer: Cigna All Commercial |
$3,473.57
|
| Rate for Payer: CORVEL All Commercial |
$3,743.25
|
| Rate for Payer: Coventry All Commercial |
$3,542.00
|
| Rate for Payer: Encore All Commercial |
$3,705.01
|
| Rate for Payer: Frontpath All Commercial |
$3,703.00
|
| Rate for Payer: Humana ChoiceCare |
$3,476.39
|
| Rate for Payer: Humana Medicare |
$2,052.75
|
| Rate for Payer: Lucent All Commercial |
$2,052.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,622.50
|
| Rate for Payer: Managed Health Services Medicaid |
$1,207.50
|
| Rate for Payer: MDWise Medicaid |
$1,207.50
|
| Rate for Payer: PHCS All Commercial |
$3,018.75
|
| Rate for Payer: PHP All Commercial |
$3,052.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,569.75
|
| Rate for Payer: Sagamore Health Network All Products |
$3,107.30
|
| Rate for Payer: Signature Care EPO |
$3,340.75
|
| Rate for Payer: Signature Care PPO |
$3,542.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,421.25
|
| Rate for Payer: United Healthcare Commercial |
$3,171.70
|
| Rate for Payer: United Healthcare Medicare |
$1,328.25
|
|
|
HYALURONATE SOD, CROSS-LINKED 30 MG/3 ML IATC SYRG
|
Facility
IP
|
$4,025.00
|
|
|
Service Code
|
HCPCS J7326
|
| Hospital Charge Code |
163847
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,018.75 |
| Max. Negotiated Rate |
$3,743.25 |
| Rate for Payer: Aetna Commercial |
$3,477.60
|
| Rate for Payer: Cash Price |
$2,495.50
|
| Rate for Payer: Cigna All Commercial |
$3,473.57
|
| Rate for Payer: CORVEL All Commercial |
$3,743.25
|
| Rate for Payer: Coventry All Commercial |
$3,542.00
|
| Rate for Payer: Encore All Commercial |
$3,705.01
|
| Rate for Payer: Frontpath All Commercial |
$3,703.00
|
| Rate for Payer: Humana ChoiceCare |
$3,476.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,622.50
|
| Rate for Payer: PHCS All Commercial |
$3,018.75
|
| Rate for Payer: PHP All Commercial |
$3,052.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3,107.30
|
| Rate for Payer: Signature Care EPO |
$3,340.75
|
| Rate for Payer: Signature Care PPO |
$3,542.00
|
| Rate for Payer: United Healthcare Commercial |
$3,171.70
|
|
|
HYALURONATE SODIUM, STABILIZED 60 MG/3 ML IATC SYRG
|
Facility
IP
|
$3,568.74
|
|
|
Service Code
|
HCPCS J7318
|
| Hospital Charge Code |
182898
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,676.56 |
| Max. Negotiated Rate |
$3,318.93 |
| Rate for Payer: Aetna Commercial |
$3,083.39
|
| Rate for Payer: Cash Price |
$2,212.62
|
| Rate for Payer: Cigna All Commercial |
$3,079.82
|
| Rate for Payer: CORVEL All Commercial |
$3,318.93
|
| Rate for Payer: Coventry All Commercial |
$3,140.49
|
| Rate for Payer: Encore All Commercial |
$3,285.03
|
| Rate for Payer: Frontpath All Commercial |
$3,283.24
|
| Rate for Payer: Humana ChoiceCare |
$3,082.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,211.87
|
| Rate for Payer: PHCS All Commercial |
$2,676.56
|
| Rate for Payer: PHP All Commercial |
$2,706.53
|
| Rate for Payer: Sagamore Health Network All Products |
$2,755.07
|
| Rate for Payer: Signature Care EPO |
$2,962.05
|
| Rate for Payer: Signature Care PPO |
$3,140.49
|
| Rate for Payer: United Healthcare Commercial |
$2,812.17
|
|
|
HYALURONATE SODIUM, STABILIZED 60 MG/3 ML IATC SYRG
|
Facility
OP
|
$3,568.74
|
|
|
Service Code
|
HCPCS J7318
|
| Hospital Charge Code |
182898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$3,318.93 |
| Rate for Payer: Aetna Commercial |
$3,012.02
|
| Rate for Payer: Aetna Medicare |
$1,177.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,177.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,049.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,230.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$71.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,354.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,295.45
|
| Rate for Payer: Cash Price |
$2,212.62
|
| Rate for Payer: Cash Price |
$2,212.62
|
| Rate for Payer: Centivo All Commercial |
$1,820.06
|
| Rate for Payer: Cigna All Commercial |
$3,079.82
|
| Rate for Payer: CORVEL All Commercial |
$3,318.93
|
| Rate for Payer: Coventry All Commercial |
$3,140.49
|
| Rate for Payer: Encore All Commercial |
$3,285.03
|
| Rate for Payer: Frontpath All Commercial |
$3,283.24
|
| Rate for Payer: Humana ChoiceCare |
$3,082.32
|
| Rate for Payer: Humana Medicare |
$1,820.06
|
| Rate for Payer: Lucent All Commercial |
$1,820.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,211.87
|
| Rate for Payer: Managed Health Services Medicaid |
$71.68
|
| Rate for Payer: MDWise Medicaid |
$71.68
|
| Rate for Payer: PHCS All Commercial |
$2,676.56
|
| Rate for Payer: PHP All Commercial |
$2,706.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,391.81
|
| Rate for Payer: Sagamore Health Network All Products |
$2,755.07
|
| Rate for Payer: Signature Care EPO |
$2,962.05
|
| Rate for Payer: Signature Care PPO |
$3,140.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,033.43
|
| Rate for Payer: United Healthcare Commercial |
$2,812.17
|
| Rate for Payer: United Healthcare Medicare |
$1,177.68
|
|
|
HYALURONIDASE 150 UNITS/ML INJ SOLN
|
Facility
OP
|
$223.29
|
|
|
Service Code
|
HCPCS J3470
|
| Hospital Charge Code |
10201
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.68 |
| Max. Negotiated Rate |
$207.66 |
| Rate for Payer: Aetna Commercial |
$188.45
|
| Rate for Payer: Aetna Medicare |
$73.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$128.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$139.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.05
|
| Rate for Payer: Cash Price |
$138.44
|
| Rate for Payer: Centivo All Commercial |
$113.88
|
| Rate for Payer: Cigna All Commercial |
$192.70
|
| Rate for Payer: CORVEL All Commercial |
$207.66
|
| Rate for Payer: Coventry All Commercial |
$196.49
|
| Rate for Payer: Encore All Commercial |
$205.53
|
| Rate for Payer: Frontpath All Commercial |
$205.42
|
| Rate for Payer: Humana ChoiceCare |
$192.85
|
| Rate for Payer: Humana Medicare |
$113.88
|
| Rate for Payer: Lucent All Commercial |
$113.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$200.96
|
| Rate for Payer: PHCS All Commercial |
$167.46
|
| Rate for Payer: PHP All Commercial |
$169.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.08
|
| Rate for Payer: Sagamore Health Network All Products |
$172.38
|
| Rate for Payer: Signature Care EPO |
$185.33
|
| Rate for Payer: Signature Care PPO |
$196.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$189.79
|
| Rate for Payer: United Healthcare Commercial |
$175.95
|
| Rate for Payer: United Healthcare Medicare |
$73.68
|
|
|
HYALURONIDASE 150 UNITS/ML INJ SOLN
|
Facility
IP
|
$223.29
|
|
|
Service Code
|
HCPCS J3470
|
| Hospital Charge Code |
10201
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$167.46 |
| Max. Negotiated Rate |
$207.66 |
| Rate for Payer: Aetna Commercial |
$192.92
|
| Rate for Payer: Cash Price |
$138.44
|
| Rate for Payer: Cigna All Commercial |
$192.70
|
| Rate for Payer: CORVEL All Commercial |
$207.66
|
| Rate for Payer: Coventry All Commercial |
$196.49
|
| Rate for Payer: Encore All Commercial |
$205.53
|
| Rate for Payer: Frontpath All Commercial |
$205.42
|
| Rate for Payer: Humana ChoiceCare |
$192.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$200.96
|
| Rate for Payer: PHCS All Commercial |
$167.46
|
| Rate for Payer: PHP All Commercial |
$169.34
|
| Rate for Payer: Sagamore Health Network All Products |
$172.38
|
| Rate for Payer: Signature Care EPO |
$185.33
|
| Rate for Payer: Signature Care PPO |
$196.49
|
| Rate for Payer: United Healthcare Commercial |
$175.95
|
|
|
HYDRALAZINE 10 MG ORAL TAB
|
Facility
IP
|
$1.18
|
|
|
Service Code
|
NDC 50111039801
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.88 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna Commercial |
$1.02
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Cigna All Commercial |
$1.01
|
| Rate for Payer: CORVEL All Commercial |
$1.09
|
| Rate for Payer: Coventry All Commercial |
$1.03
|
| Rate for Payer: Encore All Commercial |
$1.08
|
| Rate for Payer: Frontpath All Commercial |
$1.08
|
| Rate for Payer: Humana ChoiceCare |
$1.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.06
|
| Rate for Payer: PHCS All Commercial |
$0.88
|
| Rate for Payer: PHP All Commercial |
$0.89
|
| Rate for Payer: Sagamore Health Network All Products |
$0.91
|
| Rate for Payer: Signature Care EPO |
$0.98
|
| Rate for Payer: Signature Care PPO |
$1.03
|
| Rate for Payer: United Healthcare Commercial |
$0.93
|
|
|
HYDRALAZINE 10 MG ORAL TAB
|
Facility
OP
|
$1.18
|
|
|
Service Code
|
NDC 50111039801
|
| Hospital Charge Code |
3698
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.39 |
| Max. Negotiated Rate |
$1.09 |
| Rate for Payer: Aetna Commercial |
$0.99
|
| Rate for Payer: Aetna Medicare |
$0.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.43
|
| Rate for Payer: Cash Price |
$0.73
|
| Rate for Payer: Centivo All Commercial |
$0.60
|
| Rate for Payer: Cigna All Commercial |
$1.01
|
| Rate for Payer: CORVEL All Commercial |
$1.09
|
| Rate for Payer: Coventry All Commercial |
$1.03
|
| Rate for Payer: Encore All Commercial |
$1.08
|
| Rate for Payer: Frontpath All Commercial |
$1.08
|
| Rate for Payer: Humana ChoiceCare |
$1.02
|
| Rate for Payer: Humana Medicare |
$0.60
|
| Rate for Payer: Lucent All Commercial |
$0.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.06
|
| Rate for Payer: PHCS All Commercial |
$0.88
|
| Rate for Payer: PHP All Commercial |
$0.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.46
|
| Rate for Payer: Sagamore Health Network All Products |
$0.91
|
| Rate for Payer: Signature Care EPO |
$0.98
|
| Rate for Payer: Signature Care PPO |
$1.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$0.39
|
|
|
HYDRALAZINE 20 MG/ML INJ SOLN
|
Facility
IP
|
$100.24
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
3697
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$75.18 |
| Max. Negotiated Rate |
$93.22 |
| Rate for Payer: Aetna Commercial |
$86.61
|
| Rate for Payer: Cash Price |
$62.15
|
| Rate for Payer: Cigna All Commercial |
$86.51
|
| Rate for Payer: CORVEL All Commercial |
$93.22
|
| Rate for Payer: Coventry All Commercial |
$88.21
|
| Rate for Payer: Encore All Commercial |
$92.27
|
| Rate for Payer: Frontpath All Commercial |
$92.22
|
| Rate for Payer: Humana ChoiceCare |
$86.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$90.22
|
| Rate for Payer: PHCS All Commercial |
$75.18
|
| Rate for Payer: PHP All Commercial |
$76.02
|
| Rate for Payer: Sagamore Health Network All Products |
$77.39
|
| Rate for Payer: Signature Care EPO |
$83.20
|
| Rate for Payer: Signature Care PPO |
$88.21
|
| Rate for Payer: United Healthcare Commercial |
$78.99
|
|
|
HYDRALAZINE 20 MG/ML INJ SOLN
|
Facility
OP
|
$100.24
|
|
|
Service Code
|
HCPCS J0360
|
| Hospital Charge Code |
3697
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.08 |
| Max. Negotiated Rate |
$93.22 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Medicare |
$33.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$57.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.39
|
| Rate for Payer: Cash Price |
$62.15
|
| Rate for Payer: Centivo All Commercial |
$51.12
|
| Rate for Payer: Cigna All Commercial |
$86.51
|
| Rate for Payer: CORVEL All Commercial |
$93.22
|
| Rate for Payer: Coventry All Commercial |
$88.21
|
| Rate for Payer: Encore All Commercial |
$92.27
|
| Rate for Payer: Frontpath All Commercial |
$92.22
|
| Rate for Payer: Humana ChoiceCare |
$86.58
|
| Rate for Payer: Humana Medicare |
$51.12
|
| Rate for Payer: Lucent All Commercial |
$51.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$90.22
|
| Rate for Payer: PHCS All Commercial |
$75.18
|
| Rate for Payer: PHP All Commercial |
$76.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.09
|
| Rate for Payer: Sagamore Health Network All Products |
$77.39
|
| Rate for Payer: Signature Care EPO |
$83.20
|
| Rate for Payer: Signature Care PPO |
$88.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$85.20
|
| Rate for Payer: United Healthcare Commercial |
$78.99
|
| Rate for Payer: United Healthcare Medicare |
$33.08
|
|
|
HYDRALAZINE 25 MG ORAL TAB
|
Facility
OP
|
$1.13
|
|
|
Service Code
|
NDC 62584073301
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna Commercial |
$0.96
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.71
|
| 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 |
$0.70
|
| Rate for Payer: Centivo All Commercial |
$0.58
|
| Rate for Payer: Cigna All Commercial |
$0.98
|
| Rate for Payer: CORVEL All Commercial |
$1.05
|
| Rate for Payer: Coventry All Commercial |
$1.00
|
| Rate for Payer: Encore All Commercial |
$1.04
|
| Rate for Payer: Frontpath All Commercial |
$1.04
|
| Rate for Payer: Humana ChoiceCare |
$0.98
|
| Rate for Payer: Humana Medicare |
$0.58
|
| Rate for Payer: Lucent All Commercial |
$0.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.02
|
| Rate for Payer: PHCS All Commercial |
$0.85
|
| Rate for Payer: PHP All Commercial |
$0.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.44
|
| Rate for Payer: Sagamore Health Network All Products |
$0.88
|
| Rate for Payer: Signature Care EPO |
$0.94
|
| Rate for Payer: Signature Care PPO |
$1.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$0.89
|
| Rate for Payer: United Healthcare Medicare |
$0.37
|
|
|
HYDRALAZINE 25 MG ORAL TAB
|
Facility
OP
|
$1.13
|
|
|
Service Code
|
NDC 62584073311
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna Commercial |
$0.96
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.71
|
| 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 |
$0.70
|
| Rate for Payer: Centivo All Commercial |
$0.58
|
| Rate for Payer: Cigna All Commercial |
$0.98
|
| Rate for Payer: CORVEL All Commercial |
$1.05
|
| Rate for Payer: Coventry All Commercial |
$1.00
|
| Rate for Payer: Encore All Commercial |
$1.04
|
| Rate for Payer: Frontpath All Commercial |
$1.04
|
| Rate for Payer: Humana ChoiceCare |
$0.98
|
| Rate for Payer: Humana Medicare |
$0.58
|
| Rate for Payer: Lucent All Commercial |
$0.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.02
|
| Rate for Payer: PHCS All Commercial |
$0.85
|
| Rate for Payer: PHP All Commercial |
$0.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.44
|
| Rate for Payer: Sagamore Health Network All Products |
$0.88
|
| Rate for Payer: Signature Care EPO |
$0.94
|
| Rate for Payer: Signature Care PPO |
$1.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$0.89
|
| Rate for Payer: United Healthcare Medicare |
$0.37
|
|
|
HYDRALAZINE 25 MG ORAL TAB
|
Facility
IP
|
$1.13
|
|
|
Service Code
|
NDC 62584073301
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna All Commercial |
$0.98
|
| Rate for Payer: CORVEL All Commercial |
$1.05
|
| Rate for Payer: Coventry All Commercial |
$1.00
|
| Rate for Payer: Encore All Commercial |
$1.04
|
| Rate for Payer: Frontpath All Commercial |
$1.04
|
| Rate for Payer: Humana ChoiceCare |
$0.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.02
|
| Rate for Payer: PHCS All Commercial |
$0.85
|
| Rate for Payer: PHP All Commercial |
$0.86
|
| Rate for Payer: Sagamore Health Network All Products |
$0.88
|
| Rate for Payer: Signature Care EPO |
$0.94
|
| Rate for Payer: Signature Care PPO |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$0.89
|
|
|
HYDRALAZINE 25 MG ORAL TAB
|
Facility
IP
|
$1.13
|
|
|
Service Code
|
NDC 62584073311
|
| Hospital Charge Code |
3700
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna All Commercial |
$0.98
|
| Rate for Payer: CORVEL All Commercial |
$1.05
|
| Rate for Payer: Coventry All Commercial |
$1.00
|
| Rate for Payer: Encore All Commercial |
$1.04
|
| Rate for Payer: Frontpath All Commercial |
$1.04
|
| Rate for Payer: Humana ChoiceCare |
$0.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.02
|
| Rate for Payer: PHCS All Commercial |
$0.85
|
| Rate for Payer: PHP All Commercial |
$0.86
|
| Rate for Payer: Sagamore Health Network All Products |
$0.88
|
| Rate for Payer: Signature Care EPO |
$0.94
|
| Rate for Payer: Signature Care PPO |
$1.00
|
| Rate for Payer: United Healthcare Commercial |
$0.89
|
|
|
HYDROCHLOROTHIAZIDE 12.5 MG ORAL TAB
|
Facility
OP
|
$1.20
|
|
|
Service Code
|
NDC 69315015501
|
| Hospital Charge Code |
76988
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.11 |
| Rate for Payer: Aetna Commercial |
$1.01
|
| Rate for Payer: Aetna Medicare |
$0.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.69
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.43
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Centivo All Commercial |
$0.61
|
| Rate for Payer: Cigna All Commercial |
$1.03
|
| Rate for Payer: CORVEL All Commercial |
$1.11
|
| Rate for Payer: Coventry All Commercial |
$1.05
|
| Rate for Payer: Encore All Commercial |
$1.10
|
| Rate for Payer: Frontpath All Commercial |
$1.10
|
| Rate for Payer: Humana ChoiceCare |
$1.03
|
| Rate for Payer: Humana Medicare |
$0.61
|
| Rate for Payer: Lucent All Commercial |
$0.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.08
|
| Rate for Payer: PHCS All Commercial |
$0.90
|
| Rate for Payer: PHP All Commercial |
$0.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.47
|
| Rate for Payer: Sagamore Health Network All Products |
$0.92
|
| Rate for Payer: Signature Care EPO |
$0.99
|
| Rate for Payer: Signature Care PPO |
$1.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.02
|
| Rate for Payer: United Healthcare Commercial |
$0.94
|
| Rate for Payer: United Healthcare Medicare |
$0.40
|
|
