|
MENING VAC A,C,Y,W135 DIP (PF) 10-5 MCG/0.5 ML IM SOLN
|
Facility
IP
|
$746.43
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
199622
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
|
MENING VAC A,C,Y,W135 DIP (PF) 10-5 MCG/0.5 ML IM SOLN
|
Facility
OP
|
$746.43
|
|
|
Service Code
|
HCPCS 90734
|
| Hospital Charge Code |
199622
|
|
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
|
|
|
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT
|
Facility
OP
|
$29.82
|
|
|
Service Code
|
NDC 00799000102
|
| Hospital Charge Code |
91352
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$27.73 |
| Rate for Payer: Aetna Commercial |
$25.17
|
| Rate for Payer: Aetna Medicare |
$9.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.82
|
| Rate for Payer: Cash Price |
$18.49
|
| Rate for Payer: Centivo All Commercial |
$15.21
|
| Rate for Payer: Cigna All Commercial |
$25.73
|
| Rate for Payer: CORVEL All Commercial |
$27.73
|
| Rate for Payer: Coventry All Commercial |
$26.24
|
| Rate for Payer: Encore All Commercial |
$27.45
|
| Rate for Payer: Frontpath All Commercial |
$27.43
|
| Rate for Payer: Humana ChoiceCare |
$25.76
|
| Rate for Payer: Humana Medicare |
$15.21
|
| Rate for Payer: Lucent All Commercial |
$15.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.84
|
| Rate for Payer: PHCS All Commercial |
$22.36
|
| Rate for Payer: PHP All Commercial |
$22.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.63
|
| Rate for Payer: Sagamore Health Network All Products |
$23.02
|
| Rate for Payer: Signature Care EPO |
$24.75
|
| Rate for Payer: Signature Care PPO |
$26.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25.35
|
| Rate for Payer: United Healthcare Commercial |
$23.50
|
| Rate for Payer: United Healthcare Medicare |
$9.84
|
|
|
MENTHOL-ZINC OXIDE 0.44-20.6 % TOP OINT
|
Facility
IP
|
$29.82
|
|
|
Service Code
|
NDC 00799000102
|
| Hospital Charge Code |
91352
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.36 |
| Max. Negotiated Rate |
$27.73 |
| Rate for Payer: Aetna Commercial |
$25.76
|
| Rate for Payer: Cash Price |
$18.49
|
| Rate for Payer: Cigna All Commercial |
$25.73
|
| Rate for Payer: CORVEL All Commercial |
$27.73
|
| Rate for Payer: Coventry All Commercial |
$26.24
|
| Rate for Payer: Encore All Commercial |
$27.45
|
| Rate for Payer: Frontpath All Commercial |
$27.43
|
| Rate for Payer: Humana ChoiceCare |
$25.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.84
|
| Rate for Payer: PHCS All Commercial |
$22.36
|
| Rate for Payer: PHP All Commercial |
$22.62
|
| Rate for Payer: Sagamore Health Network All Products |
$23.02
|
| Rate for Payer: Signature Care EPO |
$24.75
|
| Rate for Payer: Signature Care PPO |
$26.24
|
| Rate for Payer: United Healthcare Commercial |
$23.50
|
|
|
MEPERIDINE (PF) 25 MG/ML INJ SYRG
|
Facility
OP
|
$40.03
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
117788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.21 |
| Max. Negotiated Rate |
$37.23 |
| Rate for Payer: Aetna Commercial |
$33.79
|
| Rate for Payer: Aetna Medicare |
$13.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$13.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.53
|
| Rate for Payer: Cash Price |
$24.82
|
| Rate for Payer: Centivo All Commercial |
$20.42
|
| Rate for Payer: Cigna All Commercial |
$34.55
|
| Rate for Payer: CORVEL All Commercial |
$37.23
|
| Rate for Payer: Coventry All Commercial |
$35.23
|
| Rate for Payer: Encore All Commercial |
$36.85
|
| Rate for Payer: Frontpath All Commercial |
$36.83
|
| Rate for Payer: Humana ChoiceCare |
$34.58
|
| Rate for Payer: Humana Medicare |
$20.42
|
| Rate for Payer: Lucent All Commercial |
$20.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.03
|
| Rate for Payer: PHCS All Commercial |
$30.02
|
| Rate for Payer: PHP All Commercial |
$30.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.61
|
| Rate for Payer: Sagamore Health Network All Products |
$30.91
|
| Rate for Payer: Signature Care EPO |
$33.23
|
| Rate for Payer: Signature Care PPO |
$35.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$34.03
|
| Rate for Payer: United Healthcare Commercial |
$31.55
|
| Rate for Payer: United Healthcare Medicare |
$13.21
|
|
|
MEPERIDINE (PF) 25 MG/ML INJ SYRG
|
Facility
IP
|
$40.03
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
117788
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.02 |
| Max. Negotiated Rate |
$37.23 |
| Rate for Payer: Aetna Commercial |
$34.59
|
| Rate for Payer: Cash Price |
$24.82
|
| Rate for Payer: Cigna All Commercial |
$34.55
|
| Rate for Payer: CORVEL All Commercial |
$37.23
|
| Rate for Payer: Coventry All Commercial |
$35.23
|
| Rate for Payer: Encore All Commercial |
$36.85
|
| Rate for Payer: Frontpath All Commercial |
$36.83
|
| Rate for Payer: Humana ChoiceCare |
$34.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$36.03
|
| Rate for Payer: PHCS All Commercial |
$30.02
|
| Rate for Payer: PHP All Commercial |
$30.36
|
| Rate for Payer: Sagamore Health Network All Products |
$30.91
|
| Rate for Payer: Signature Care EPO |
$33.23
|
| Rate for Payer: Signature Care PPO |
$35.23
|
| Rate for Payer: United Healthcare Commercial |
$31.55
|
|
|
MEPERIDINE (PF) 50 MG/ML INJ S.O.
|
Facility
IP
|
$45.55
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
420793
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.16 |
| Max. Negotiated Rate |
$42.36 |
| Rate for Payer: Aetna Commercial |
$39.35
|
| Rate for Payer: Cash Price |
$28.24
|
| Rate for Payer: Cigna All Commercial |
$39.31
|
| Rate for Payer: CORVEL All Commercial |
$42.36
|
| Rate for Payer: Coventry All Commercial |
$40.08
|
| Rate for Payer: Encore All Commercial |
$41.93
|
| Rate for Payer: Frontpath All Commercial |
$41.91
|
| Rate for Payer: Humana ChoiceCare |
$39.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.99
|
| Rate for Payer: PHCS All Commercial |
$34.16
|
| Rate for Payer: PHP All Commercial |
$34.54
|
| Rate for Payer: Sagamore Health Network All Products |
$35.16
|
| Rate for Payer: Signature Care EPO |
$37.81
|
| Rate for Payer: Signature Care PPO |
$40.08
|
| Rate for Payer: United Healthcare Commercial |
$35.89
|
|
|
MEPERIDINE (PF) 50 MG/ML INJ S.O.
|
Facility
OP
|
$45.55
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
420793
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$42.36 |
| Rate for Payer: Aetna Commercial |
$38.44
|
| Rate for Payer: Aetna Medicare |
$15.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.53
|
| Rate for Payer: Cash Price |
$28.24
|
| Rate for Payer: Centivo All Commercial |
$23.23
|
| Rate for Payer: Cigna All Commercial |
$39.31
|
| Rate for Payer: CORVEL All Commercial |
$42.36
|
| Rate for Payer: Coventry All Commercial |
$40.08
|
| Rate for Payer: Encore All Commercial |
$41.93
|
| Rate for Payer: Frontpath All Commercial |
$41.91
|
| Rate for Payer: Humana ChoiceCare |
$39.34
|
| Rate for Payer: Humana Medicare |
$23.23
|
| Rate for Payer: Lucent All Commercial |
$23.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.99
|
| Rate for Payer: PHCS All Commercial |
$34.16
|
| Rate for Payer: PHP All Commercial |
$34.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.76
|
| Rate for Payer: Sagamore Health Network All Products |
$35.16
|
| Rate for Payer: Signature Care EPO |
$37.81
|
| Rate for Payer: Signature Care PPO |
$40.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38.72
|
| Rate for Payer: United Healthcare Commercial |
$35.89
|
| Rate for Payer: United Healthcare Medicare |
$15.03
|
|
|
MEPERIDINE (PF) 50 MG/ML INJ SYRG
|
Facility
IP
|
$45.55
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
117789
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.16 |
| Max. Negotiated Rate |
$42.36 |
| Rate for Payer: Aetna Commercial |
$39.35
|
| Rate for Payer: Cash Price |
$28.24
|
| Rate for Payer: Cigna All Commercial |
$39.31
|
| Rate for Payer: CORVEL All Commercial |
$42.36
|
| Rate for Payer: Coventry All Commercial |
$40.08
|
| Rate for Payer: Encore All Commercial |
$41.93
|
| Rate for Payer: Frontpath All Commercial |
$41.91
|
| Rate for Payer: Humana ChoiceCare |
$39.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.99
|
| Rate for Payer: PHCS All Commercial |
$34.16
|
| Rate for Payer: PHP All Commercial |
$34.54
|
| Rate for Payer: Sagamore Health Network All Products |
$35.16
|
| Rate for Payer: Signature Care EPO |
$37.81
|
| Rate for Payer: Signature Care PPO |
$40.08
|
| Rate for Payer: United Healthcare Commercial |
$35.89
|
|
|
MEPERIDINE (PF) 50 MG/ML INJ SYRG
|
Facility
OP
|
$45.55
|
|
|
Service Code
|
HCPCS J2175
|
| Hospital Charge Code |
117789
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$42.36 |
| Rate for Payer: Aetna Commercial |
$38.44
|
| Rate for Payer: Aetna Medicare |
$15.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$16.53
|
| Rate for Payer: Cash Price |
$28.24
|
| Rate for Payer: Centivo All Commercial |
$23.23
|
| Rate for Payer: Cigna All Commercial |
$39.31
|
| Rate for Payer: CORVEL All Commercial |
$42.36
|
| Rate for Payer: Coventry All Commercial |
$40.08
|
| Rate for Payer: Encore All Commercial |
$41.93
|
| Rate for Payer: Frontpath All Commercial |
$41.91
|
| Rate for Payer: Humana ChoiceCare |
$39.34
|
| Rate for Payer: Humana Medicare |
$23.23
|
| Rate for Payer: Lucent All Commercial |
$23.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$40.99
|
| Rate for Payer: PHCS All Commercial |
$34.16
|
| Rate for Payer: PHP All Commercial |
$34.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.76
|
| Rate for Payer: Sagamore Health Network All Products |
$35.16
|
| Rate for Payer: Signature Care EPO |
$37.81
|
| Rate for Payer: Signature Care PPO |
$40.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$38.72
|
| Rate for Payer: United Healthcare Commercial |
$35.89
|
| Rate for Payer: United Healthcare Medicare |
$15.03
|
|
|
MEPIVACAINE (PF) 15 MG/ML (1.5 %) INJ SOLN
|
Facility
IP
|
$61.11
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
10529
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.83 |
| Max. Negotiated Rate |
$56.83 |
| Rate for Payer: Aetna Commercial |
$52.80
|
| Rate for Payer: Cash Price |
$37.89
|
| Rate for Payer: Cigna All Commercial |
$52.74
|
| Rate for Payer: CORVEL All Commercial |
$56.83
|
| Rate for Payer: Coventry All Commercial |
$53.78
|
| Rate for Payer: Encore All Commercial |
$56.25
|
| Rate for Payer: Frontpath All Commercial |
$56.22
|
| Rate for Payer: Humana ChoiceCare |
$52.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.00
|
| Rate for Payer: PHCS All Commercial |
$45.83
|
| Rate for Payer: PHP All Commercial |
$46.35
|
| Rate for Payer: Sagamore Health Network All Products |
$47.18
|
| Rate for Payer: Signature Care EPO |
$50.72
|
| Rate for Payer: Signature Care PPO |
$53.78
|
| Rate for Payer: United Healthcare Commercial |
$48.15
|
|
|
MEPIVACAINE (PF) 15 MG/ML (1.5 %) INJ SOLN
|
Facility
OP
|
$61.11
|
|
|
Service Code
|
HCPCS J0670
|
| Hospital Charge Code |
10529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.17 |
| Max. Negotiated Rate |
$56.83 |
| Rate for Payer: Aetna Commercial |
$51.58
|
| Rate for Payer: Aetna Medicare |
$20.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$35.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$23.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$22.18
|
| Rate for Payer: Cash Price |
$37.89
|
| Rate for Payer: Centivo All Commercial |
$31.17
|
| Rate for Payer: Cigna All Commercial |
$52.74
|
| Rate for Payer: CORVEL All Commercial |
$56.83
|
| Rate for Payer: Coventry All Commercial |
$53.78
|
| Rate for Payer: Encore All Commercial |
$56.25
|
| Rate for Payer: Frontpath All Commercial |
$56.22
|
| Rate for Payer: Humana ChoiceCare |
$52.78
|
| Rate for Payer: Humana Medicare |
$31.17
|
| Rate for Payer: Lucent All Commercial |
$31.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.00
|
| Rate for Payer: PHCS All Commercial |
$45.83
|
| Rate for Payer: PHP All Commercial |
$46.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.83
|
| Rate for Payer: Sagamore Health Network All Products |
$47.18
|
| Rate for Payer: Signature Care EPO |
$50.72
|
| Rate for Payer: Signature Care PPO |
$53.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.94
|
| Rate for Payer: United Healthcare Commercial |
$48.15
|
| Rate for Payer: United Healthcare Medicare |
$20.17
|
|
|
MEPOLIZUMAB 100 MG SUBQ SOLR
|
Facility
IP
|
$12,120.22
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
174918
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9,090.16 |
| Max. Negotiated Rate |
$11,271.80 |
| Rate for Payer: Aetna Commercial |
$10,471.87
|
| Rate for Payer: Cash Price |
$7,514.54
|
| Rate for Payer: Cigna All Commercial |
$10,459.75
|
| Rate for Payer: CORVEL All Commercial |
$11,271.80
|
| Rate for Payer: Coventry All Commercial |
$10,665.79
|
| Rate for Payer: Encore All Commercial |
$11,156.66
|
| Rate for Payer: Frontpath All Commercial |
$11,150.60
|
| Rate for Payer: Humana ChoiceCare |
$10,468.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,908.20
|
| Rate for Payer: PHCS All Commercial |
$9,090.16
|
| Rate for Payer: PHP All Commercial |
$9,191.97
|
| Rate for Payer: Sagamore Health Network All Products |
$9,356.81
|
| Rate for Payer: Signature Care EPO |
$10,059.78
|
| Rate for Payer: Signature Care PPO |
$10,665.79
|
| Rate for Payer: United Healthcare Commercial |
$9,550.73
|
|
|
MEPOLIZUMAB 100 MG SUBQ SOLR
|
Facility
OP
|
$12,120.22
|
|
|
Service Code
|
HCPCS J2182
|
| Hospital Charge Code |
174918
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.29 |
| Max. Negotiated Rate |
$11,271.80 |
| Rate for Payer: Aetna Commercial |
$10,229.47
|
| Rate for Payer: Aetna Medicare |
$3,999.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,999.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6,960.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,576.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$35.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,599.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4,399.64
|
| Rate for Payer: Cash Price |
$7,514.54
|
| Rate for Payer: Cash Price |
$7,514.54
|
| Rate for Payer: Centivo All Commercial |
$6,181.31
|
| Rate for Payer: Cigna All Commercial |
$10,459.75
|
| Rate for Payer: CORVEL All Commercial |
$11,271.80
|
| Rate for Payer: Coventry All Commercial |
$10,665.79
|
| Rate for Payer: Encore All Commercial |
$11,156.66
|
| Rate for Payer: Frontpath All Commercial |
$11,150.60
|
| Rate for Payer: Humana ChoiceCare |
$10,468.23
|
| Rate for Payer: Humana Medicare |
$6,181.31
|
| Rate for Payer: Lucent All Commercial |
$6,181.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,908.20
|
| Rate for Payer: Managed Health Services Medicaid |
$35.29
|
| Rate for Payer: MDWise Medicaid |
$35.29
|
| Rate for Payer: PHCS All Commercial |
$9,090.16
|
| Rate for Payer: PHP All Commercial |
$9,191.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,726.89
|
| Rate for Payer: Sagamore Health Network All Products |
$9,356.81
|
| Rate for Payer: Signature Care EPO |
$10,059.78
|
| Rate for Payer: Signature Care PPO |
$10,665.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,302.19
|
| Rate for Payer: United Healthcare Commercial |
$9,550.73
|
| Rate for Payer: United Healthcare Medicare |
$3,999.67
|
|
|
MEROPENEM 1 G IV SOLR
|
Facility
OP
|
$24.09
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17380
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$20.33
|
| Rate for Payer: Aetna Medicare |
$7.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.74
|
| Rate for Payer: Cash Price |
$14.93
|
| Rate for Payer: Centivo All Commercial |
$12.28
|
| Rate for Payer: Cigna All Commercial |
$20.79
|
| Rate for Payer: CORVEL All Commercial |
$22.40
|
| Rate for Payer: Coventry All Commercial |
$21.20
|
| Rate for Payer: Encore All Commercial |
$22.17
|
| Rate for Payer: Frontpath All Commercial |
$22.16
|
| Rate for Payer: Humana ChoiceCare |
$20.80
|
| Rate for Payer: Humana Medicare |
$12.28
|
| Rate for Payer: Lucent All Commercial |
$12.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.68
|
| Rate for Payer: PHCS All Commercial |
$18.07
|
| Rate for Payer: PHP All Commercial |
$18.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.39
|
| Rate for Payer: Sagamore Health Network All Products |
$18.60
|
| Rate for Payer: Signature Care EPO |
$19.99
|
| Rate for Payer: Signature Care PPO |
$21.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.47
|
| Rate for Payer: United Healthcare Commercial |
$18.98
|
| Rate for Payer: United Healthcare Medicare |
$7.95
|
|
|
MEROPENEM 1 G IV SOLR
|
Facility
IP
|
$24.09
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17380
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.07 |
| Max. Negotiated Rate |
$22.40 |
| Rate for Payer: Aetna Commercial |
$20.81
|
| Rate for Payer: Cash Price |
$14.93
|
| Rate for Payer: Cigna All Commercial |
$20.79
|
| Rate for Payer: CORVEL All Commercial |
$22.40
|
| Rate for Payer: Coventry All Commercial |
$21.20
|
| Rate for Payer: Encore All Commercial |
$22.17
|
| Rate for Payer: Frontpath All Commercial |
$22.16
|
| Rate for Payer: Humana ChoiceCare |
$20.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$21.68
|
| Rate for Payer: PHCS All Commercial |
$18.07
|
| Rate for Payer: PHP All Commercial |
$18.27
|
| Rate for Payer: Sagamore Health Network All Products |
$18.60
|
| Rate for Payer: Signature Care EPO |
$19.99
|
| Rate for Payer: Signature Care PPO |
$21.20
|
| Rate for Payer: United Healthcare Commercial |
$18.98
|
|
|
MEROPENEM 500 MG IV SOLR
|
Facility
IP
|
$18.69
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17379
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.02 |
| Max. Negotiated Rate |
$17.38 |
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Cash Price |
$11.59
|
| Rate for Payer: Cigna All Commercial |
$16.13
|
| Rate for Payer: CORVEL All Commercial |
$17.38
|
| Rate for Payer: Coventry All Commercial |
$16.45
|
| Rate for Payer: Encore All Commercial |
$17.20
|
| Rate for Payer: Frontpath All Commercial |
$17.19
|
| Rate for Payer: Humana ChoiceCare |
$16.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.82
|
| Rate for Payer: PHCS All Commercial |
$14.02
|
| Rate for Payer: PHP All Commercial |
$14.17
|
| Rate for Payer: Sagamore Health Network All Products |
$14.43
|
| Rate for Payer: Signature Care EPO |
$15.51
|
| Rate for Payer: Signature Care PPO |
$16.45
|
| Rate for Payer: United Healthcare Commercial |
$14.73
|
|
|
MEROPENEM 500 MG IV SOLR
|
Facility
OP
|
$18.69
|
|
|
Service Code
|
HCPCS J2185
|
| Hospital Charge Code |
17379
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.17 |
| Max. Negotiated Rate |
$17.38 |
| Rate for Payer: Aetna Commercial |
$15.77
|
| Rate for Payer: Aetna Medicare |
$6.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.68
|
| 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 |
$11.59
|
| Rate for Payer: Centivo All Commercial |
$9.53
|
| Rate for Payer: Cigna All Commercial |
$16.13
|
| Rate for Payer: CORVEL All Commercial |
$17.38
|
| Rate for Payer: Coventry All Commercial |
$16.45
|
| Rate for Payer: Encore All Commercial |
$17.20
|
| Rate for Payer: Frontpath All Commercial |
$17.19
|
| Rate for Payer: Humana ChoiceCare |
$16.14
|
| Rate for Payer: Humana Medicare |
$9.53
|
| Rate for Payer: Lucent All Commercial |
$9.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.82
|
| Rate for Payer: PHCS All Commercial |
$14.02
|
| Rate for Payer: PHP All Commercial |
$14.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.29
|
| Rate for Payer: Sagamore Health Network All Products |
$14.43
|
| Rate for Payer: Signature Care EPO |
$15.51
|
| Rate for Payer: Signature Care PPO |
$16.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.89
|
| Rate for Payer: United Healthcare Commercial |
$14.73
|
| Rate for Payer: United Healthcare Medicare |
$6.17
|
|
|
MESALAMINE 400 MG ORAL CDTI
|
Facility
OP
|
$10.97
|
|
|
Service Code
|
NDC 00093590786
|
| Hospital Charge Code |
177796
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Aetna Commercial |
$9.26
|
| Rate for Payer: Aetna Medicare |
$3.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.98
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Centivo All Commercial |
$5.59
|
| Rate for Payer: Cigna All Commercial |
$9.47
|
| Rate for Payer: CORVEL All Commercial |
$10.20
|
| Rate for Payer: Coventry All Commercial |
$9.65
|
| Rate for Payer: Encore All Commercial |
$10.10
|
| Rate for Payer: Frontpath All Commercial |
$10.09
|
| Rate for Payer: Humana ChoiceCare |
$9.47
|
| Rate for Payer: Humana Medicare |
$5.59
|
| Rate for Payer: Lucent All Commercial |
$5.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.87
|
| Rate for Payer: PHCS All Commercial |
$8.23
|
| Rate for Payer: PHP All Commercial |
$8.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.28
|
| Rate for Payer: Sagamore Health Network All Products |
$8.47
|
| Rate for Payer: Signature Care EPO |
$9.10
|
| Rate for Payer: Signature Care PPO |
$9.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.32
|
| Rate for Payer: United Healthcare Commercial |
$8.64
|
| Rate for Payer: United Healthcare Medicare |
$3.62
|
|
|
MESALAMINE 400 MG ORAL CDTI
|
Facility
IP
|
$10.97
|
|
|
Service Code
|
NDC 00093590786
|
| Hospital Charge Code |
177796
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.23 |
| Max. Negotiated Rate |
$10.20 |
| Rate for Payer: Aetna Commercial |
$9.48
|
| Rate for Payer: Cash Price |
$6.80
|
| Rate for Payer: Cigna All Commercial |
$9.47
|
| Rate for Payer: CORVEL All Commercial |
$10.20
|
| Rate for Payer: Coventry All Commercial |
$9.65
|
| Rate for Payer: Encore All Commercial |
$10.10
|
| Rate for Payer: Frontpath All Commercial |
$10.09
|
| Rate for Payer: Humana ChoiceCare |
$9.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.87
|
| Rate for Payer: PHCS All Commercial |
$8.23
|
| Rate for Payer: PHP All Commercial |
$8.32
|
| Rate for Payer: Sagamore Health Network All Products |
$8.47
|
| Rate for Payer: Signature Care EPO |
$9.10
|
| Rate for Payer: Signature Care PPO |
$9.65
|
| Rate for Payer: United Healthcare Commercial |
$8.64
|
|
|
METFORMIN 500 MG ORAL TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 00904716261
|
| Hospital Charge Code |
10544
|
|
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
|
|
|
METFORMIN 500 MG ORAL TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 00904716261
|
| Hospital Charge Code |
10544
|
|
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
|
|
|
METFORMIN 500 MG ORAL TB24
|
Facility
IP
|
$2.74
|
|
|
Service Code
|
NDC 60687064001
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cigna All Commercial |
$2.37
|
| Rate for Payer: CORVEL All Commercial |
$2.55
|
| Rate for Payer: Coventry All Commercial |
$2.41
|
| Rate for Payer: Encore All Commercial |
$2.53
|
| Rate for Payer: Frontpath All Commercial |
$2.52
|
| Rate for Payer: Humana ChoiceCare |
$2.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.47
|
| Rate for Payer: PHCS All Commercial |
$2.06
|
| Rate for Payer: PHP All Commercial |
$2.08
|
| Rate for Payer: Sagamore Health Network All Products |
$2.12
|
| Rate for Payer: Signature Care EPO |
$2.28
|
| Rate for Payer: Signature Care PPO |
$2.41
|
| Rate for Payer: United Healthcare Commercial |
$2.16
|
|
|
METFORMIN 500 MG ORAL TB24
|
Facility
IP
|
$2.74
|
|
|
Service Code
|
NDC 60687064011
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Cigna All Commercial |
$2.37
|
| Rate for Payer: CORVEL All Commercial |
$2.55
|
| Rate for Payer: Coventry All Commercial |
$2.41
|
| Rate for Payer: Encore All Commercial |
$2.53
|
| Rate for Payer: Frontpath All Commercial |
$2.52
|
| Rate for Payer: Humana ChoiceCare |
$2.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.47
|
| Rate for Payer: PHCS All Commercial |
$2.06
|
| Rate for Payer: PHP All Commercial |
$2.08
|
| Rate for Payer: Sagamore Health Network All Products |
$2.12
|
| Rate for Payer: Signature Care EPO |
$2.28
|
| Rate for Payer: Signature Care PPO |
$2.41
|
| Rate for Payer: United Healthcare Commercial |
$2.16
|
|
|
METFORMIN 500 MG ORAL TB24
|
Facility
OP
|
$2.74
|
|
|
Service Code
|
NDC 60687064011
|
| Hospital Charge Code |
28995
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.91 |
| Max. Negotiated Rate |
$2.55 |
| Rate for Payer: Aetna Commercial |
$2.32
|
| 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 |
$1.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.00
|
| Rate for Payer: Cash Price |
$1.70
|
| Rate for Payer: Centivo All Commercial |
$1.40
|
| Rate for Payer: Cigna All Commercial |
$2.37
|
| Rate for Payer: CORVEL All Commercial |
$2.55
|
| Rate for Payer: Coventry All Commercial |
$2.41
|
| Rate for Payer: Encore All Commercial |
$2.53
|
| Rate for Payer: Frontpath All Commercial |
$2.52
|
| Rate for Payer: Humana ChoiceCare |
$2.37
|
| Rate for Payer: Humana Medicare |
$1.40
|
| Rate for Payer: Lucent All Commercial |
$1.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.47
|
| Rate for Payer: PHCS All Commercial |
$2.06
|
| Rate for Payer: PHP All Commercial |
$2.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.07
|
| Rate for Payer: Sagamore Health Network All Products |
$2.12
|
| Rate for Payer: Signature Care EPO |
$2.28
|
| Rate for Payer: Signature Care PPO |
$2.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.33
|
| Rate for Payer: United Healthcare Commercial |
$2.16
|
| Rate for Payer: United Healthcare Medicare |
$0.91
|
|
