|
MEASLES,MUMPS,RUBELLA VACC(PF) 10EXP3.4-4.2- 3.3CCID50/0.5ML SUBQ SUSR
|
Facility
IP
|
$527.08
|
|
|
Service Code
|
HCPCS 90707
|
| Hospital Charge Code |
198256
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$395.31 |
| Max. Negotiated Rate |
$490.18 |
| Rate for Payer: Aetna Commercial |
$455.39
|
| Rate for Payer: Cash Price |
$326.79
|
| Rate for Payer: Cigna All Commercial |
$454.87
|
| Rate for Payer: CORVEL All Commercial |
$490.18
|
| Rate for Payer: Coventry All Commercial |
$463.83
|
| Rate for Payer: Encore All Commercial |
$485.17
|
| Rate for Payer: Frontpath All Commercial |
$484.91
|
| Rate for Payer: Humana ChoiceCare |
$455.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$474.37
|
| Rate for Payer: PHCS All Commercial |
$395.31
|
| Rate for Payer: PHP All Commercial |
$399.73
|
| Rate for Payer: Sagamore Health Network All Products |
$406.90
|
| Rate for Payer: Signature Care EPO |
$437.47
|
| Rate for Payer: Signature Care PPO |
$463.83
|
| Rate for Payer: United Healthcare Commercial |
$415.34
|
|
|
MEASLES,MUMPS,RUB,VARICEL(PF) 10EXP3-4.3-3- 3.99 TCID50/0.5 SUBQ SUSR
|
Facility
IP
|
$1,005.79
|
|
|
Service Code
|
HCPCS 90710
|
| Hospital Charge Code |
42622
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$754.34 |
| Max. Negotiated Rate |
$935.39 |
| Rate for Payer: Aetna Commercial |
$869.00
|
| Rate for Payer: Cash Price |
$623.59
|
| Rate for Payer: Cigna All Commercial |
$868.00
|
| Rate for Payer: CORVEL All Commercial |
$935.39
|
| Rate for Payer: Coventry All Commercial |
$885.10
|
| Rate for Payer: Encore All Commercial |
$925.83
|
| Rate for Payer: Frontpath All Commercial |
$925.33
|
| Rate for Payer: Humana ChoiceCare |
$868.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$905.21
|
| Rate for Payer: PHCS All Commercial |
$754.34
|
| Rate for Payer: PHP All Commercial |
$762.79
|
| Rate for Payer: Sagamore Health Network All Products |
$776.47
|
| Rate for Payer: Signature Care EPO |
$834.81
|
| Rate for Payer: Signature Care PPO |
$885.10
|
| Rate for Payer: United Healthcare Commercial |
$792.56
|
|
|
MEASLES,MUMPS,RUB,VARICEL(PF) 10EXP3-4.3-3- 3.99 TCID50/0.5 SUBQ SUSR
|
Facility
OP
|
$1,005.79
|
|
|
Service Code
|
HCPCS 90710
|
| Hospital Charge Code |
42622
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$280.51 |
| Max. Negotiated Rate |
$935.39 |
| Rate for Payer: Aetna Commercial |
$848.89
|
| Rate for Payer: Aetna Medicare |
$331.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$331.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$577.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$628.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$280.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$381.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$365.10
|
| Rate for Payer: Cash Price |
$623.59
|
| Rate for Payer: Cash Price |
$623.59
|
| Rate for Payer: Centivo All Commercial |
$512.95
|
| Rate for Payer: Cigna All Commercial |
$868.00
|
| Rate for Payer: CORVEL All Commercial |
$935.39
|
| Rate for Payer: Coventry All Commercial |
$885.10
|
| Rate for Payer: Encore All Commercial |
$925.83
|
| Rate for Payer: Frontpath All Commercial |
$925.33
|
| Rate for Payer: Humana ChoiceCare |
$868.70
|
| Rate for Payer: Humana Medicare |
$512.95
|
| Rate for Payer: Lucent All Commercial |
$512.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$905.21
|
| Rate for Payer: Managed Health Services Medicaid |
$280.51
|
| Rate for Payer: MDWise Medicaid |
$280.51
|
| Rate for Payer: PHCS All Commercial |
$754.34
|
| Rate for Payer: PHP All Commercial |
$762.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$392.26
|
| Rate for Payer: Sagamore Health Network All Products |
$776.47
|
| Rate for Payer: Signature Care EPO |
$834.81
|
| Rate for Payer: Signature Care PPO |
$885.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$854.92
|
| Rate for Payer: United Healthcare Commercial |
$792.56
|
| Rate for Payer: United Healthcare Medicare |
$331.91
|
|
|
MECLIZINE 12.5 MG ORAL TAB
|
Facility
OP
|
$2.76
|
|
|
Service Code
|
HCPCS J8597
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna Medicare |
$0.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.00
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Centivo All Commercial |
$1.41
|
| Rate for Payer: Cigna All Commercial |
$2.38
|
| Rate for Payer: CORVEL All Commercial |
$2.56
|
| Rate for Payer: Coventry All Commercial |
$2.43
|
| Rate for Payer: Encore All Commercial |
$2.54
|
| Rate for Payer: Frontpath All Commercial |
$2.54
|
| Rate for Payer: Humana ChoiceCare |
$2.38
|
| Rate for Payer: Humana Medicare |
$1.41
|
| Rate for Payer: Lucent All Commercial |
$1.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.48
|
| Rate for Payer: PHCS All Commercial |
$2.07
|
| Rate for Payer: PHP All Commercial |
$2.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.08
|
| Rate for Payer: Sagamore Health Network All Products |
$2.13
|
| Rate for Payer: Signature Care EPO |
$2.29
|
| Rate for Payer: Signature Care PPO |
$2.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.34
|
| Rate for Payer: United Healthcare Commercial |
$2.17
|
| Rate for Payer: United Healthcare Medicare |
$0.91
|
|
|
MECLIZINE 12.5 MG ORAL TAB
|
Facility
IP
|
$2.76
|
|
|
Service Code
|
HCPCS J8597
|
| Hospital Charge Code |
12024
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.07 |
| Max. Negotiated Rate |
$2.56 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: Cash Price |
$1.71
|
| Rate for Payer: Cigna All Commercial |
$2.38
|
| Rate for Payer: CORVEL All Commercial |
$2.56
|
| Rate for Payer: Coventry All Commercial |
$2.43
|
| Rate for Payer: Encore All Commercial |
$2.54
|
| Rate for Payer: Frontpath All Commercial |
$2.54
|
| Rate for Payer: Humana ChoiceCare |
$2.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.48
|
| Rate for Payer: PHCS All Commercial |
$2.07
|
| Rate for Payer: PHP All Commercial |
$2.09
|
| Rate for Payer: Sagamore Health Network All Products |
$2.13
|
| Rate for Payer: Signature Care EPO |
$2.29
|
| Rate for Payer: Signature Care PPO |
$2.43
|
| Rate for Payer: United Healthcare Commercial |
$2.17
|
|
|
MEDROXYPROGESTERONE 150 MG/ML IM S.O.
|
Facility
IP
|
$401.76
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
420792
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$301.32 |
| Max. Negotiated Rate |
$373.64 |
| Rate for Payer: Aetna Commercial |
$347.12
|
| Rate for Payer: Cash Price |
$249.09
|
| Rate for Payer: Cigna All Commercial |
$346.72
|
| Rate for Payer: CORVEL All Commercial |
$373.64
|
| Rate for Payer: Coventry All Commercial |
$353.55
|
| Rate for Payer: Encore All Commercial |
$369.82
|
| Rate for Payer: Frontpath All Commercial |
$369.62
|
| Rate for Payer: Humana ChoiceCare |
$347.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$361.58
|
| Rate for Payer: PHCS All Commercial |
$301.32
|
| Rate for Payer: PHP All Commercial |
$304.69
|
| Rate for Payer: Sagamore Health Network All Products |
$310.16
|
| Rate for Payer: Signature Care EPO |
$333.46
|
| Rate for Payer: Signature Care PPO |
$353.55
|
| Rate for Payer: United Healthcare Commercial |
$316.59
|
|
|
MEDROXYPROGESTERONE 150 MG/ML IM S.O.
|
Facility
OP
|
$401.76
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
420792
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.58 |
| Max. Negotiated Rate |
$373.64 |
| Rate for Payer: Aetna Commercial |
$339.09
|
| Rate for Payer: Aetna Medicare |
$132.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$132.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$230.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$251.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$152.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$145.84
|
| Rate for Payer: Cash Price |
$249.09
|
| Rate for Payer: Centivo All Commercial |
$204.90
|
| Rate for Payer: Cigna All Commercial |
$346.72
|
| Rate for Payer: CORVEL All Commercial |
$373.64
|
| Rate for Payer: Coventry All Commercial |
$353.55
|
| Rate for Payer: Encore All Commercial |
$369.82
|
| Rate for Payer: Frontpath All Commercial |
$369.62
|
| Rate for Payer: Humana ChoiceCare |
$347.00
|
| Rate for Payer: Humana Medicare |
$204.90
|
| Rate for Payer: Lucent All Commercial |
$204.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$361.58
|
| Rate for Payer: PHCS All Commercial |
$301.32
|
| Rate for Payer: PHP All Commercial |
$304.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$156.69
|
| Rate for Payer: Sagamore Health Network All Products |
$310.16
|
| Rate for Payer: Signature Care EPO |
$333.46
|
| Rate for Payer: Signature Care PPO |
$353.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$341.50
|
| Rate for Payer: United Healthcare Commercial |
$316.59
|
| Rate for Payer: United Healthcare Medicare |
$132.58
|
|
|
MEDROXYPROGESTERONE 150 MG/ML IM SYRG
|
Facility
IP
|
$401.76
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
114250
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$301.32 |
| Max. Negotiated Rate |
$373.64 |
| Rate for Payer: Aetna Commercial |
$347.12
|
| Rate for Payer: Cash Price |
$249.09
|
| Rate for Payer: Cigna All Commercial |
$346.72
|
| Rate for Payer: CORVEL All Commercial |
$373.64
|
| Rate for Payer: Coventry All Commercial |
$353.55
|
| Rate for Payer: Encore All Commercial |
$369.82
|
| Rate for Payer: Frontpath All Commercial |
$369.62
|
| Rate for Payer: Humana ChoiceCare |
$347.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$361.58
|
| Rate for Payer: PHCS All Commercial |
$301.32
|
| Rate for Payer: PHP All Commercial |
$304.69
|
| Rate for Payer: Sagamore Health Network All Products |
$310.16
|
| Rate for Payer: Signature Care EPO |
$333.46
|
| Rate for Payer: Signature Care PPO |
$353.55
|
| Rate for Payer: United Healthcare Commercial |
$316.59
|
|
|
MEDROXYPROGESTERONE 150 MG/ML IM SYRG
|
Facility
OP
|
$401.76
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
114250
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.58 |
| Max. Negotiated Rate |
$373.64 |
| Rate for Payer: Aetna Commercial |
$339.09
|
| Rate for Payer: Aetna Medicare |
$132.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$132.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$230.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$251.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$152.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$145.84
|
| Rate for Payer: Cash Price |
$249.09
|
| Rate for Payer: Centivo All Commercial |
$204.90
|
| Rate for Payer: Cigna All Commercial |
$346.72
|
| Rate for Payer: CORVEL All Commercial |
$373.64
|
| Rate for Payer: Coventry All Commercial |
$353.55
|
| Rate for Payer: Encore All Commercial |
$369.82
|
| Rate for Payer: Frontpath All Commercial |
$369.62
|
| Rate for Payer: Humana ChoiceCare |
$347.00
|
| Rate for Payer: Humana Medicare |
$204.90
|
| Rate for Payer: Lucent All Commercial |
$204.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$361.58
|
| Rate for Payer: PHCS All Commercial |
$301.32
|
| Rate for Payer: PHP All Commercial |
$304.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$156.69
|
| Rate for Payer: Sagamore Health Network All Products |
$310.16
|
| Rate for Payer: Signature Care EPO |
$333.46
|
| Rate for Payer: Signature Care PPO |
$353.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$341.50
|
| Rate for Payer: United Healthcare Commercial |
$316.59
|
| Rate for Payer: United Healthcare Medicare |
$132.58
|
|
|
MEGESTROL 20 MG ORAL TAB
|
Facility
OP
|
$1.16
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
4870
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.08 |
| Rate for Payer: Aetna Commercial |
$0.98
|
| Rate for Payer: Aetna Medicare |
$0.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.42
|
| Rate for Payer: Cash Price |
$0.72
|
| Rate for Payer: Centivo All Commercial |
$0.59
|
| 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 |
$0.59
|
| Rate for Payer: Lucent All Commercial |
$0.59
|
| 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 |
$0.38
|
|
|
MEGESTROL 20 MG ORAL TAB
|
Facility
IP
|
$1.16
|
|
|
Service Code
|
HCPCS J8999
|
| Hospital Charge Code |
4870
|
|
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
|
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP
|
Facility
IP
|
$31.92
|
|
|
Service Code
|
NDC 68094006359
|
| Hospital Charge Code |
159414
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.94 |
| Max. Negotiated Rate |
$29.69 |
| Rate for Payer: Aetna Commercial |
$27.58
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cigna All Commercial |
$27.55
|
| Rate for Payer: CORVEL All Commercial |
$29.69
|
| Rate for Payer: Coventry All Commercial |
$28.09
|
| Rate for Payer: Encore All Commercial |
$29.38
|
| Rate for Payer: Frontpath All Commercial |
$29.37
|
| Rate for Payer: Humana ChoiceCare |
$27.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.73
|
| Rate for Payer: PHCS All Commercial |
$23.94
|
| Rate for Payer: PHP All Commercial |
$24.21
|
| Rate for Payer: Sagamore Health Network All Products |
$24.64
|
| Rate for Payer: Signature Care EPO |
$26.49
|
| Rate for Payer: Signature Care PPO |
$28.09
|
| Rate for Payer: United Healthcare Commercial |
$25.15
|
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP
|
Facility
IP
|
$33.25
|
|
|
Service Code
|
NDC 68094006362
|
| Hospital Charge Code |
159414
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$24.94 |
| Max. Negotiated Rate |
$30.92 |
| Rate for Payer: Aetna Commercial |
$28.73
|
| Rate for Payer: Cash Price |
$20.62
|
| Rate for Payer: Cigna All Commercial |
$28.69
|
| Rate for Payer: CORVEL All Commercial |
$30.92
|
| Rate for Payer: Coventry All Commercial |
$29.26
|
| Rate for Payer: Encore All Commercial |
$30.61
|
| Rate for Payer: Frontpath All Commercial |
$30.59
|
| Rate for Payer: Humana ChoiceCare |
$28.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.92
|
| Rate for Payer: PHCS All Commercial |
$24.94
|
| Rate for Payer: PHP All Commercial |
$25.22
|
| Rate for Payer: Sagamore Health Network All Products |
$25.67
|
| Rate for Payer: Signature Care EPO |
$27.60
|
| Rate for Payer: Signature Care PPO |
$29.26
|
| Rate for Payer: United Healthcare Commercial |
$26.20
|
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP
|
Facility
OP
|
$31.92
|
|
|
Service Code
|
NDC 68094006359
|
| Hospital Charge Code |
159414
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$29.69 |
| Rate for Payer: Aetna Commercial |
$26.94
|
| Rate for Payer: Aetna Medicare |
$10.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.59
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Centivo All Commercial |
$16.28
|
| Rate for Payer: Cigna All Commercial |
$27.55
|
| Rate for Payer: CORVEL All Commercial |
$29.69
|
| Rate for Payer: Coventry All Commercial |
$28.09
|
| Rate for Payer: Encore All Commercial |
$29.38
|
| Rate for Payer: Frontpath All Commercial |
$29.37
|
| Rate for Payer: Humana ChoiceCare |
$27.57
|
| Rate for Payer: Humana Medicare |
$16.28
|
| Rate for Payer: Lucent All Commercial |
$16.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.73
|
| Rate for Payer: PHCS All Commercial |
$23.94
|
| Rate for Payer: PHP All Commercial |
$24.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.45
|
| Rate for Payer: Sagamore Health Network All Products |
$24.64
|
| Rate for Payer: Signature Care EPO |
$26.49
|
| Rate for Payer: Signature Care PPO |
$28.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27.13
|
| Rate for Payer: United Healthcare Commercial |
$25.15
|
| Rate for Payer: United Healthcare Medicare |
$10.53
|
|
|
MEGESTROL 400 MG/10 ML (10 ML) ORAL SUSP
|
Facility
OP
|
$33.25
|
|
|
Service Code
|
NDC 68094006362
|
| Hospital Charge Code |
159414
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$10.97 |
| Max. Negotiated Rate |
$30.92 |
| Rate for Payer: Aetna Commercial |
$28.06
|
| Rate for Payer: Aetna Medicare |
$10.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.07
|
| Rate for Payer: Cash Price |
$20.62
|
| Rate for Payer: Centivo All Commercial |
$16.96
|
| Rate for Payer: Cigna All Commercial |
$28.69
|
| Rate for Payer: CORVEL All Commercial |
$30.92
|
| Rate for Payer: Coventry All Commercial |
$29.26
|
| Rate for Payer: Encore All Commercial |
$30.61
|
| Rate for Payer: Frontpath All Commercial |
$30.59
|
| Rate for Payer: Humana ChoiceCare |
$28.72
|
| Rate for Payer: Humana Medicare |
$16.96
|
| Rate for Payer: Lucent All Commercial |
$16.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.92
|
| Rate for Payer: PHCS All Commercial |
$24.94
|
| Rate for Payer: PHP All Commercial |
$25.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.97
|
| Rate for Payer: Sagamore Health Network All Products |
$25.67
|
| Rate for Payer: Signature Care EPO |
$27.60
|
| Rate for Payer: Signature Care PPO |
$29.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28.26
|
| Rate for Payer: United Healthcare Commercial |
$26.20
|
| Rate for Payer: United Healthcare Medicare |
$10.97
|
|
|
MELATONIN 3 MG ORAL TAB
|
Facility
OP
|
$1.36
|
|
|
Service Code
|
NDC 77333051610
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna Commercial |
$1.15
|
| Rate for Payer: Aetna Medicare |
$0.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.49
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Centivo All Commercial |
$0.69
|
| Rate for Payer: Cigna All Commercial |
$1.17
|
| Rate for Payer: CORVEL All Commercial |
$1.26
|
| Rate for Payer: Coventry All Commercial |
$1.20
|
| Rate for Payer: Encore All Commercial |
$1.25
|
| Rate for Payer: Frontpath All Commercial |
$1.25
|
| Rate for Payer: Humana ChoiceCare |
$1.17
|
| Rate for Payer: Humana Medicare |
$0.69
|
| Rate for Payer: Lucent All Commercial |
$0.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.22
|
| Rate for Payer: PHCS All Commercial |
$1.02
|
| Rate for Payer: PHP All Commercial |
$1.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.53
|
| Rate for Payer: Sagamore Health Network All Products |
$1.05
|
| Rate for Payer: Signature Care EPO |
$1.13
|
| Rate for Payer: Signature Care PPO |
$1.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.15
|
| Rate for Payer: United Healthcare Commercial |
$1.07
|
| Rate for Payer: United Healthcare Medicare |
$0.45
|
|
|
MELATONIN 3 MG ORAL TAB
|
Facility
IP
|
$1.36
|
|
|
Service Code
|
NDC 77333051610
|
| Hospital Charge Code |
16830
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.26 |
| Rate for Payer: Aetna Commercial |
$1.17
|
| Rate for Payer: Cash Price |
$0.84
|
| Rate for Payer: Cigna All Commercial |
$1.17
|
| Rate for Payer: CORVEL All Commercial |
$1.26
|
| Rate for Payer: Coventry All Commercial |
$1.20
|
| Rate for Payer: Encore All Commercial |
$1.25
|
| Rate for Payer: Frontpath All Commercial |
$1.25
|
| Rate for Payer: Humana ChoiceCare |
$1.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.22
|
| Rate for Payer: PHCS All Commercial |
$1.02
|
| Rate for Payer: PHP All Commercial |
$1.03
|
| Rate for Payer: Sagamore Health Network All Products |
$1.05
|
| Rate for Payer: Signature Care EPO |
$1.13
|
| Rate for Payer: Signature Care PPO |
$1.20
|
| Rate for Payer: United Healthcare Commercial |
$1.07
|
|
|
MELOXICAM 7.5 MG ORAL TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 50268052515
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.36
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Centivo All Commercial |
$0.51
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Humana Medicare |
$0.51
|
| Rate for Payer: Lucent All Commercial |
$0.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.39
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
| Rate for Payer: United Healthcare Medicare |
$0.33
|
|
|
MELOXICAM 7.5 MG ORAL TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 50268052515
|
| Hospital Charge Code |
20566
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
|
|
MEMANTINE 5 MG ORAL TAB
|
Facility
IP
|
$2.02
|
|
|
Service Code
|
NDC 00591387044
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.51 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Cigna All Commercial |
$1.74
|
| Rate for Payer: CORVEL All Commercial |
$1.87
|
| Rate for Payer: Coventry All Commercial |
$1.77
|
| Rate for Payer: Encore All Commercial |
$1.86
|
| Rate for Payer: Frontpath All Commercial |
$1.85
|
| Rate for Payer: Humana ChoiceCare |
$1.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.81
|
| Rate for Payer: PHCS All Commercial |
$1.51
|
| Rate for Payer: PHP All Commercial |
$1.53
|
| Rate for Payer: Sagamore Health Network All Products |
$1.56
|
| Rate for Payer: Signature Care EPO |
$1.67
|
| Rate for Payer: Signature Care PPO |
$1.77
|
| Rate for Payer: United Healthcare Commercial |
$1.59
|
|
|
MEMANTINE 5 MG ORAL TAB
|
Facility
OP
|
$2.02
|
|
|
Service Code
|
NDC 00591387044
|
| Hospital Charge Code |
37170
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$1.87 |
| Rate for Payer: Aetna Commercial |
$1.70
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.73
|
| Rate for Payer: Cash Price |
$1.25
|
| Rate for Payer: Centivo All Commercial |
$1.03
|
| Rate for Payer: Cigna All Commercial |
$1.74
|
| Rate for Payer: CORVEL All Commercial |
$1.87
|
| Rate for Payer: Coventry All Commercial |
$1.77
|
| Rate for Payer: Encore All Commercial |
$1.86
|
| Rate for Payer: Frontpath All Commercial |
$1.85
|
| Rate for Payer: Humana ChoiceCare |
$1.74
|
| Rate for Payer: Humana Medicare |
$1.03
|
| Rate for Payer: Lucent All Commercial |
$1.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.81
|
| Rate for Payer: PHCS All Commercial |
$1.51
|
| Rate for Payer: PHP All Commercial |
$1.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.79
|
| Rate for Payer: Sagamore Health Network All Products |
$1.56
|
| Rate for Payer: Signature Care EPO |
$1.67
|
| Rate for Payer: Signature Care PPO |
$1.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.71
|
| Rate for Payer: United Healthcare Commercial |
$1.59
|
| Rate for Payer: United Healthcare Medicare |
$0.67
|
|
|
MENINGOCOCCAL B VACCINE,4-COMP 50-50-50-25 MCG/0.5 ML IM SYRG
|
Facility
OP
|
$1,061.31
|
|
|
Service Code
|
HCPCS 90620
|
| Hospital Charge Code |
171239
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$221.10 |
| Max. Negotiated Rate |
$987.02 |
| Rate for Payer: Aetna Commercial |
$895.75
|
| Rate for Payer: Aetna Medicare |
$350.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$350.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$609.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$663.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$221.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$402.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$385.26
|
| Rate for Payer: Cash Price |
$658.01
|
| Rate for Payer: Cash Price |
$658.01
|
| Rate for Payer: Centivo All Commercial |
$541.27
|
| Rate for Payer: Cigna All Commercial |
$915.91
|
| Rate for Payer: CORVEL All Commercial |
$987.02
|
| Rate for Payer: Coventry All Commercial |
$933.95
|
| Rate for Payer: Encore All Commercial |
$976.94
|
| Rate for Payer: Frontpath All Commercial |
$976.41
|
| Rate for Payer: Humana ChoiceCare |
$916.65
|
| Rate for Payer: Humana Medicare |
$541.27
|
| Rate for Payer: Lucent All Commercial |
$541.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$955.18
|
| Rate for Payer: Managed Health Services Medicaid |
$221.10
|
| Rate for Payer: MDWise Medicaid |
$221.10
|
| Rate for Payer: PHCS All Commercial |
$795.98
|
| Rate for Payer: PHP All Commercial |
$804.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$413.91
|
| Rate for Payer: Sagamore Health Network All Products |
$819.33
|
| Rate for Payer: Signature Care EPO |
$880.89
|
| Rate for Payer: Signature Care PPO |
$933.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$902.11
|
| Rate for Payer: United Healthcare Commercial |
$836.31
|
| Rate for Payer: United Healthcare Medicare |
$350.23
|
|
|
MENINGOCOCCAL B VACCINE,4-COMP 50-50-50-25 MCG/0.5 ML IM SYRG
|
Facility
IP
|
$1,061.31
|
|
|
Service Code
|
HCPCS 90620
|
| Hospital Charge Code |
171239
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$795.98 |
| Max. Negotiated Rate |
$987.02 |
| Rate for Payer: Aetna Commercial |
$916.97
|
| Rate for Payer: Cash Price |
$658.01
|
| Rate for Payer: Cigna All Commercial |
$915.91
|
| Rate for Payer: CORVEL All Commercial |
$987.02
|
| Rate for Payer: Coventry All Commercial |
$933.95
|
| Rate for Payer: Encore All Commercial |
$976.94
|
| Rate for Payer: Frontpath All Commercial |
$976.41
|
| Rate for Payer: Humana ChoiceCare |
$916.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$955.18
|
| Rate for Payer: PHCS All Commercial |
$795.98
|
| Rate for Payer: PHP All Commercial |
$804.90
|
| Rate for Payer: Sagamore Health Network All Products |
$819.33
|
| Rate for Payer: Signature Care EPO |
$880.89
|
| Rate for Payer: Signature Care PPO |
$933.95
|
| Rate for Payer: United Healthcare Commercial |
$836.31
|
|
|
MENING VAC A,C,Y,W135 DIP (PF) 10-5 MCG/0.5 ML IM KIT
|
Facility
OP
|
$746.43
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
101034
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.50 |
| Max. Negotiated Rate |
$694.18 |
| Rate for Payer: Aetna Commercial |
$629.99
|
| Rate for Payer: Aetna Medicare |
$246.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$246.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$428.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$466.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$102.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$283.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$270.95
|
| Rate for Payer: Cash Price |
$462.79
|
| Rate for Payer: Cash Price |
$462.79
|
| Rate for Payer: Centivo All Commercial |
$380.68
|
| Rate for Payer: Cigna All Commercial |
$644.17
|
| Rate for Payer: CORVEL All Commercial |
$694.18
|
| Rate for Payer: Coventry All Commercial |
$656.86
|
| Rate for Payer: Encore All Commercial |
$687.09
|
| Rate for Payer: Frontpath All Commercial |
$686.72
|
| Rate for Payer: Humana ChoiceCare |
$644.69
|
| Rate for Payer: Humana Medicare |
$380.68
|
| Rate for Payer: Lucent All Commercial |
$380.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$671.79
|
| Rate for Payer: Managed Health Services Medicaid |
$102.50
|
| Rate for Payer: MDWise Medicaid |
$102.50
|
| Rate for Payer: PHCS All Commercial |
$559.82
|
| Rate for Payer: PHP All Commercial |
$566.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$291.11
|
| Rate for Payer: Sagamore Health Network All Products |
$576.24
|
| Rate for Payer: Signature Care EPO |
$619.54
|
| Rate for Payer: Signature Care PPO |
$656.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$634.47
|
| Rate for Payer: United Healthcare Commercial |
$588.19
|
| Rate for Payer: United Healthcare Medicare |
$246.32
|
|
|
MENING VAC A,C,Y,W135 DIP (PF) 10-5 MCG/0.5 ML IM KIT
|
Facility
IP
|
$746.43
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
101034
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$559.82 |
| Max. Negotiated Rate |
$694.18 |
| Rate for Payer: Aetna Commercial |
$644.92
|
| Rate for Payer: Cash Price |
$462.79
|
| Rate for Payer: Cigna All Commercial |
$644.17
|
| Rate for Payer: CORVEL All Commercial |
$694.18
|
| Rate for Payer: Coventry All Commercial |
$656.86
|
| Rate for Payer: Encore All Commercial |
$687.09
|
| Rate for Payer: Frontpath All Commercial |
$686.72
|
| Rate for Payer: Humana ChoiceCare |
$644.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$671.79
|
| Rate for Payer: PHCS All Commercial |
$559.82
|
| Rate for Payer: PHP All Commercial |
$566.09
|
| Rate for Payer: Sagamore Health Network All Products |
$576.24
|
| Rate for Payer: Signature Care EPO |
$619.54
|
| Rate for Payer: Signature Care PPO |
$656.86
|
| Rate for Payer: United Healthcare Commercial |
$588.19
|
|
