|
METFORMIN 500 MG ORAL TB24
|
Facility
OP
|
$2.74
|
|
|
Service Code
|
NDC 60687064001
|
| 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
|
|
|
METFORMIN 850 MG ORAL TAB
|
Facility
OP
|
$1.30
|
|
|
Service Code
|
NDC 60687014301
|
| Hospital Charge Code |
14719
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Aetna Commercial |
$1.09
|
| Rate for Payer: Aetna Medicare |
$0.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.47
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Centivo All Commercial |
$0.66
|
| Rate for Payer: Cigna All Commercial |
$1.12
|
| Rate for Payer: CORVEL All Commercial |
$1.20
|
| Rate for Payer: Coventry All Commercial |
$1.14
|
| Rate for Payer: Encore All Commercial |
$1.19
|
| Rate for Payer: Frontpath All Commercial |
$1.19
|
| Rate for Payer: Humana ChoiceCare |
$1.12
|
| Rate for Payer: Humana Medicare |
$0.66
|
| Rate for Payer: Lucent All Commercial |
$0.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.17
|
| Rate for Payer: PHCS All Commercial |
$0.97
|
| Rate for Payer: PHP All Commercial |
$0.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.51
|
| Rate for Payer: Sagamore Health Network All Products |
$1.00
|
| Rate for Payer: Signature Care EPO |
$1.07
|
| Rate for Payer: Signature Care PPO |
$1.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.10
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
| Rate for Payer: United Healthcare Medicare |
$0.43
|
|
|
METFORMIN 850 MG ORAL TAB
|
Facility
IP
|
$1.30
|
|
|
Service Code
|
NDC 60687014301
|
| Hospital Charge Code |
14719
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$1.20 |
| Rate for Payer: Aetna Commercial |
$1.12
|
| Rate for Payer: Cash Price |
$0.80
|
| Rate for Payer: Cigna All Commercial |
$1.12
|
| Rate for Payer: CORVEL All Commercial |
$1.20
|
| Rate for Payer: Coventry All Commercial |
$1.14
|
| Rate for Payer: Encore All Commercial |
$1.19
|
| Rate for Payer: Frontpath All Commercial |
$1.19
|
| Rate for Payer: Humana ChoiceCare |
$1.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.17
|
| Rate for Payer: PHCS All Commercial |
$0.97
|
| Rate for Payer: PHP All Commercial |
$0.98
|
| Rate for Payer: Sagamore Health Network All Products |
$1.00
|
| Rate for Payer: Signature Care EPO |
$1.07
|
| Rate for Payer: Signature Care PPO |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$1.02
|
|
|
METHACHOLINE CHLORIDE 100 MG INHL SOLR
|
Facility
OP
|
$472.35
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
27032
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.88 |
| Max. Negotiated Rate |
$439.29 |
| Rate for Payer: Aetna Commercial |
$398.66
|
| Rate for Payer: Aetna Medicare |
$155.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$155.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$271.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$295.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$179.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$171.46
|
| Rate for Payer: Cash Price |
$292.86
|
| Rate for Payer: Centivo All Commercial |
$240.90
|
| Rate for Payer: Cigna All Commercial |
$407.64
|
| Rate for Payer: CORVEL All Commercial |
$439.29
|
| Rate for Payer: Coventry All Commercial |
$415.67
|
| Rate for Payer: Encore All Commercial |
$434.80
|
| Rate for Payer: Frontpath All Commercial |
$434.56
|
| Rate for Payer: Humana ChoiceCare |
$407.97
|
| Rate for Payer: Humana Medicare |
$240.90
|
| Rate for Payer: Lucent All Commercial |
$240.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$425.12
|
| Rate for Payer: PHCS All Commercial |
$354.26
|
| Rate for Payer: PHP All Commercial |
$358.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$184.22
|
| Rate for Payer: Sagamore Health Network All Products |
$364.65
|
| Rate for Payer: Signature Care EPO |
$392.05
|
| Rate for Payer: Signature Care PPO |
$415.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$401.50
|
| Rate for Payer: United Healthcare Commercial |
$372.21
|
| Rate for Payer: United Healthcare Medicare |
$155.88
|
|
|
METHACHOLINE CHLORIDE 100 MG INHL SOLR
|
Facility
IP
|
$472.35
|
|
|
Service Code
|
HCPCS J7674
|
| Hospital Charge Code |
27032
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$354.26 |
| Max. Negotiated Rate |
$439.29 |
| Rate for Payer: Aetna Commercial |
$408.11
|
| Rate for Payer: Cash Price |
$292.86
|
| Rate for Payer: Cigna All Commercial |
$407.64
|
| Rate for Payer: CORVEL All Commercial |
$439.29
|
| Rate for Payer: Coventry All Commercial |
$415.67
|
| Rate for Payer: Encore All Commercial |
$434.80
|
| Rate for Payer: Frontpath All Commercial |
$434.56
|
| Rate for Payer: Humana ChoiceCare |
$407.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$425.12
|
| Rate for Payer: PHCS All Commercial |
$354.26
|
| Rate for Payer: PHP All Commercial |
$358.23
|
| Rate for Payer: Sagamore Health Network All Products |
$364.65
|
| Rate for Payer: Signature Care EPO |
$392.05
|
| Rate for Payer: Signature Care PPO |
$415.67
|
| Rate for Payer: United Healthcare Commercial |
$372.21
|
|
|
METHADONE 5 MG ORAL TAB
|
Facility
IP
|
$4.00
|
|
|
Service Code
|
NDC 00406575562
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
|
|
METHADONE 5 MG ORAL TAB
|
Facility
OP
|
$4.00
|
|
|
Service Code
|
NDC 00406575562
|
| Hospital Charge Code |
4954
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.45
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Centivo All Commercial |
$2.04
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Humana Medicare |
$2.04
|
| Rate for Payer: Lucent All Commercial |
$2.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.40
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$1.32
|
|
|
METHIMAZOLE 5 MG ORAL TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 60687035701
|
| Hospital Charge Code |
10553
|
|
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
|
|
|
METHIMAZOLE 5 MG ORAL TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 60687035701
|
| Hospital Charge Code |
10553
|
|
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
|
|
|
METHOCARBAMOL 500 MG ORAL TAB
|
Facility
IP
|
$1.66
|
|
|
Service Code
|
NDC 50268052015
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna Commercial |
$1.43
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cigna All Commercial |
$1.43
|
| Rate for Payer: CORVEL All Commercial |
$1.54
|
| Rate for Payer: Coventry All Commercial |
$1.46
|
| Rate for Payer: Encore All Commercial |
$1.53
|
| Rate for Payer: Frontpath All Commercial |
$1.53
|
| Rate for Payer: Humana ChoiceCare |
$1.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.49
|
| Rate for Payer: PHCS All Commercial |
$1.24
|
| Rate for Payer: PHP All Commercial |
$1.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1.28
|
| Rate for Payer: Signature Care EPO |
$1.38
|
| Rate for Payer: Signature Care PPO |
$1.46
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
|
|
METHOCARBAMOL 500 MG ORAL TAB
|
Facility
IP
|
$1.66
|
|
|
Service Code
|
NDC 50268052011
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna Commercial |
$1.43
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Cigna All Commercial |
$1.43
|
| Rate for Payer: CORVEL All Commercial |
$1.54
|
| Rate for Payer: Coventry All Commercial |
$1.46
|
| Rate for Payer: Encore All Commercial |
$1.53
|
| Rate for Payer: Frontpath All Commercial |
$1.53
|
| Rate for Payer: Humana ChoiceCare |
$1.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.49
|
| Rate for Payer: PHCS All Commercial |
$1.24
|
| Rate for Payer: PHP All Commercial |
$1.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1.28
|
| Rate for Payer: Signature Care EPO |
$1.38
|
| Rate for Payer: Signature Care PPO |
$1.46
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
|
|
METHOCARBAMOL 500 MG ORAL TAB
|
Facility
OP
|
$1.66
|
|
|
Service Code
|
NDC 50268052011
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: Aetna Medicare |
$0.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.60
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Centivo All Commercial |
$0.85
|
| Rate for Payer: Cigna All Commercial |
$1.43
|
| Rate for Payer: CORVEL All Commercial |
$1.54
|
| Rate for Payer: Coventry All Commercial |
$1.46
|
| Rate for Payer: Encore All Commercial |
$1.53
|
| Rate for Payer: Frontpath All Commercial |
$1.53
|
| Rate for Payer: Humana ChoiceCare |
$1.43
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: Lucent All Commercial |
$0.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.49
|
| Rate for Payer: PHCS All Commercial |
$1.24
|
| Rate for Payer: PHP All Commercial |
$1.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1.28
|
| Rate for Payer: Signature Care EPO |
$1.38
|
| Rate for Payer: Signature Care PPO |
$1.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.41
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
| Rate for Payer: United Healthcare Medicare |
$0.55
|
|
|
METHOCARBAMOL 500 MG ORAL TAB
|
Facility
OP
|
$1.66
|
|
|
Service Code
|
NDC 50268052015
|
| Hospital Charge Code |
4971
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.55 |
| Max. Negotiated Rate |
$1.54 |
| Rate for Payer: Aetna Commercial |
$1.40
|
| Rate for Payer: Aetna Medicare |
$0.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.60
|
| Rate for Payer: Cash Price |
$1.03
|
| Rate for Payer: Centivo All Commercial |
$0.85
|
| Rate for Payer: Cigna All Commercial |
$1.43
|
| Rate for Payer: CORVEL All Commercial |
$1.54
|
| Rate for Payer: Coventry All Commercial |
$1.46
|
| Rate for Payer: Encore All Commercial |
$1.53
|
| Rate for Payer: Frontpath All Commercial |
$1.53
|
| Rate for Payer: Humana ChoiceCare |
$1.43
|
| Rate for Payer: Humana Medicare |
$0.85
|
| Rate for Payer: Lucent All Commercial |
$0.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.49
|
| Rate for Payer: PHCS All Commercial |
$1.24
|
| Rate for Payer: PHP All Commercial |
$1.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1.28
|
| Rate for Payer: Signature Care EPO |
$1.38
|
| Rate for Payer: Signature Care PPO |
$1.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.41
|
| Rate for Payer: United Healthcare Commercial |
$1.31
|
| Rate for Payer: United Healthcare Medicare |
$0.55
|
|
|
METHOHEXITAL 500 MG INJ SOLR
|
Facility
IP
|
$531.12
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
70545
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$398.34 |
| Max. Negotiated Rate |
$493.94 |
| Rate for Payer: Aetna Commercial |
$458.89
|
| Rate for Payer: Cash Price |
$329.29
|
| Rate for Payer: Cigna All Commercial |
$458.36
|
| Rate for Payer: CORVEL All Commercial |
$493.94
|
| Rate for Payer: Coventry All Commercial |
$467.39
|
| Rate for Payer: Encore All Commercial |
$488.90
|
| Rate for Payer: Frontpath All Commercial |
$488.63
|
| Rate for Payer: Humana ChoiceCare |
$458.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$478.01
|
| Rate for Payer: PHCS All Commercial |
$398.34
|
| Rate for Payer: PHP All Commercial |
$402.80
|
| Rate for Payer: Sagamore Health Network All Products |
$410.02
|
| Rate for Payer: Signature Care EPO |
$440.83
|
| Rate for Payer: Signature Care PPO |
$467.39
|
| Rate for Payer: United Healthcare Commercial |
$418.52
|
|
|
METHOHEXITAL 500 MG INJ SOLR
|
Facility
OP
|
$531.12
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
70545
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.27 |
| Max. Negotiated Rate |
$493.94 |
| Rate for Payer: Aetna Commercial |
$448.27
|
| Rate for Payer: Aetna Medicare |
$175.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$175.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$305.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$332.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$201.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$192.80
|
| Rate for Payer: Cash Price |
$329.29
|
| Rate for Payer: Centivo All Commercial |
$270.87
|
| Rate for Payer: Cigna All Commercial |
$458.36
|
| Rate for Payer: CORVEL All Commercial |
$493.94
|
| Rate for Payer: Coventry All Commercial |
$467.39
|
| Rate for Payer: Encore All Commercial |
$488.90
|
| Rate for Payer: Frontpath All Commercial |
$488.63
|
| Rate for Payer: Humana ChoiceCare |
$458.73
|
| Rate for Payer: Humana Medicare |
$270.87
|
| Rate for Payer: Lucent All Commercial |
$270.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$478.01
|
| Rate for Payer: PHCS All Commercial |
$398.34
|
| Rate for Payer: PHP All Commercial |
$402.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$207.14
|
| Rate for Payer: Sagamore Health Network All Products |
$410.02
|
| Rate for Payer: Signature Care EPO |
$440.83
|
| Rate for Payer: Signature Care PPO |
$467.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$451.45
|
| Rate for Payer: United Healthcare Commercial |
$418.52
|
| Rate for Payer: United Healthcare Medicare |
$175.27
|
|
|
METHOTREXATE SODIUM 2.5 MG ORAL TAB
|
Facility
OP
|
$18.44
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
4973
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$17.15 |
| Rate for Payer: Aetna Commercial |
$15.56
|
| Rate for Payer: Aetna Medicare |
$6.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.69
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Centivo All Commercial |
$9.40
|
| Rate for Payer: Cigna All Commercial |
$15.91
|
| Rate for Payer: CORVEL All Commercial |
$17.15
|
| Rate for Payer: Coventry All Commercial |
$16.23
|
| Rate for Payer: Encore All Commercial |
$16.97
|
| Rate for Payer: Frontpath All Commercial |
$16.96
|
| Rate for Payer: Humana ChoiceCare |
$15.92
|
| Rate for Payer: Humana Medicare |
$9.40
|
| Rate for Payer: Lucent All Commercial |
$9.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.59
|
| Rate for Payer: PHCS All Commercial |
$13.83
|
| Rate for Payer: PHP All Commercial |
$13.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.19
|
| Rate for Payer: Sagamore Health Network All Products |
$14.23
|
| Rate for Payer: Signature Care EPO |
$15.30
|
| Rate for Payer: Signature Care PPO |
$16.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.67
|
| Rate for Payer: United Healthcare Commercial |
$14.53
|
| Rate for Payer: United Healthcare Medicare |
$6.08
|
|
|
METHOTREXATE SODIUM 2.5 MG ORAL TAB
|
Facility
IP
|
$18.44
|
|
|
Service Code
|
HCPCS J8610
|
| Hospital Charge Code |
4973
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$17.15 |
| Rate for Payer: Aetna Commercial |
$15.93
|
| Rate for Payer: Cash Price |
$11.43
|
| Rate for Payer: Cigna All Commercial |
$15.91
|
| Rate for Payer: CORVEL All Commercial |
$17.15
|
| Rate for Payer: Coventry All Commercial |
$16.23
|
| Rate for Payer: Encore All Commercial |
$16.97
|
| Rate for Payer: Frontpath All Commercial |
$16.96
|
| Rate for Payer: Humana ChoiceCare |
$15.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.59
|
| Rate for Payer: PHCS All Commercial |
$13.83
|
| Rate for Payer: PHP All Commercial |
$13.98
|
| Rate for Payer: Sagamore Health Network All Products |
$14.23
|
| Rate for Payer: Signature Care EPO |
$15.30
|
| Rate for Payer: Signature Care PPO |
$16.23
|
| Rate for Payer: United Healthcare Commercial |
$14.53
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN
|
Facility
IP
|
$126.54
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
4985
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$94.90 |
| Max. Negotiated Rate |
$117.68 |
| Rate for Payer: Aetna Commercial |
$109.33
|
| Rate for Payer: Cash Price |
$78.45
|
| Rate for Payer: Cigna All Commercial |
$109.20
|
| Rate for Payer: CORVEL All Commercial |
$117.68
|
| Rate for Payer: Coventry All Commercial |
$111.35
|
| Rate for Payer: Encore All Commercial |
$116.48
|
| Rate for Payer: Frontpath All Commercial |
$116.42
|
| Rate for Payer: Humana ChoiceCare |
$109.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$113.89
|
| Rate for Payer: PHCS All Commercial |
$94.90
|
| Rate for Payer: PHP All Commercial |
$95.97
|
| Rate for Payer: Sagamore Health Network All Products |
$97.69
|
| Rate for Payer: Signature Care EPO |
$105.03
|
| Rate for Payer: Signature Care PPO |
$111.35
|
| Rate for Payer: United Healthcare Commercial |
$99.71
|
|
|
METHYLENE BLUE (ANTIDOTE) 1 % (10 MG/ML) IV SOLN
|
Facility
OP
|
$126.54
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
4985
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$117.68 |
| Rate for Payer: Aetna Commercial |
$106.80
|
| Rate for Payer: Aetna Medicare |
$41.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$72.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.93
|
| Rate for Payer: Cash Price |
$78.45
|
| Rate for Payer: Centivo All Commercial |
$64.53
|
| Rate for Payer: Cigna All Commercial |
$109.20
|
| Rate for Payer: CORVEL All Commercial |
$117.68
|
| Rate for Payer: Coventry All Commercial |
$111.35
|
| Rate for Payer: Encore All Commercial |
$116.48
|
| Rate for Payer: Frontpath All Commercial |
$116.42
|
| Rate for Payer: Humana ChoiceCare |
$109.29
|
| Rate for Payer: Humana Medicare |
$64.53
|
| Rate for Payer: Lucent All Commercial |
$64.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$113.89
|
| Rate for Payer: PHCS All Commercial |
$94.90
|
| Rate for Payer: PHP All Commercial |
$95.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.35
|
| Rate for Payer: Sagamore Health Network All Products |
$97.69
|
| Rate for Payer: Signature Care EPO |
$105.03
|
| Rate for Payer: Signature Care PPO |
$111.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$107.56
|
| Rate for Payer: United Healthcare Commercial |
$99.71
|
| Rate for Payer: United Healthcare Medicare |
$41.76
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN
|
Facility
OP
|
$569.10
|
|
|
Service Code
|
NDC 00517037405
|
| Hospital Charge Code |
178916
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$529.26 |
| Rate for Payer: Aetna Commercial |
$480.32
|
| Rate for Payer: Aetna Medicare |
$187.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$187.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$326.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$355.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$215.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$206.58
|
| Rate for Payer: Cash Price |
$352.84
|
| Rate for Payer: Cash Price |
$352.84
|
| Rate for Payer: Centivo All Commercial |
$290.24
|
| Rate for Payer: Cigna All Commercial |
$491.13
|
| Rate for Payer: CORVEL All Commercial |
$529.26
|
| Rate for Payer: Coventry All Commercial |
$500.81
|
| Rate for Payer: Encore All Commercial |
$523.86
|
| Rate for Payer: Frontpath All Commercial |
$523.57
|
| Rate for Payer: Humana ChoiceCare |
$491.53
|
| Rate for Payer: Humana Medicare |
$290.24
|
| Rate for Payer: Lucent All Commercial |
$290.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$512.19
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$426.82
|
| Rate for Payer: PHP All Commercial |
$431.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$221.95
|
| Rate for Payer: Sagamore Health Network All Products |
$439.35
|
| Rate for Payer: Signature Care EPO |
$472.35
|
| Rate for Payer: Signature Care PPO |
$500.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$483.74
|
| Rate for Payer: United Healthcare Commercial |
$448.45
|
| Rate for Payer: United Healthcare Medicare |
$187.80
|
|
|
METHYLENE BLUE (ANTIDOTE) 5 MG/ML IV SOLN
|
Facility
IP
|
$569.10
|
|
|
Service Code
|
NDC 00517037405
|
| Hospital Charge Code |
178916
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$426.82 |
| Max. Negotiated Rate |
$529.26 |
| Rate for Payer: Aetna Commercial |
$491.70
|
| Rate for Payer: Cash Price |
$352.84
|
| Rate for Payer: Cigna All Commercial |
$491.13
|
| Rate for Payer: CORVEL All Commercial |
$529.26
|
| Rate for Payer: Coventry All Commercial |
$500.81
|
| Rate for Payer: Encore All Commercial |
$523.86
|
| Rate for Payer: Frontpath All Commercial |
$523.57
|
| Rate for Payer: Humana ChoiceCare |
$491.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$512.19
|
| Rate for Payer: PHCS All Commercial |
$426.82
|
| Rate for Payer: PHP All Commercial |
$431.61
|
| Rate for Payer: Sagamore Health Network All Products |
$439.35
|
| Rate for Payer: Signature Care EPO |
$472.35
|
| Rate for Payer: Signature Care PPO |
$500.81
|
| Rate for Payer: United Healthcare Commercial |
$448.45
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN
|
Facility
IP
|
$148.33
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10571
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$111.25 |
| Max. Negotiated Rate |
$137.95 |
| Rate for Payer: Aetna Commercial |
$128.16
|
| Rate for Payer: Cash Price |
$91.96
|
| Rate for Payer: Cigna All Commercial |
$128.01
|
| Rate for Payer: CORVEL All Commercial |
$137.95
|
| Rate for Payer: Coventry All Commercial |
$130.53
|
| Rate for Payer: Encore All Commercial |
$136.54
|
| Rate for Payer: Frontpath All Commercial |
$136.46
|
| Rate for Payer: Humana ChoiceCare |
$128.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.50
|
| Rate for Payer: PHCS All Commercial |
$111.25
|
| Rate for Payer: PHP All Commercial |
$112.49
|
| Rate for Payer: Sagamore Health Network All Products |
$114.51
|
| Rate for Payer: Signature Care EPO |
$123.11
|
| Rate for Payer: Signature Care PPO |
$130.53
|
| Rate for Payer: United Healthcare Commercial |
$116.88
|
|
|
METHYLERGONOVINE 0.2 MG/ML (1 ML) INJ SOLN
|
Facility
OP
|
$148.33
|
|
|
Service Code
|
HCPCS J2210
|
| Hospital Charge Code |
10571
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.95 |
| Max. Negotiated Rate |
$137.95 |
| Rate for Payer: Aetna Commercial |
$125.19
|
| Rate for Payer: Aetna Medicare |
$48.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$92.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.84
|
| Rate for Payer: Cash Price |
$91.96
|
| Rate for Payer: Centivo All Commercial |
$75.65
|
| Rate for Payer: Cigna All Commercial |
$128.01
|
| Rate for Payer: CORVEL All Commercial |
$137.95
|
| Rate for Payer: Coventry All Commercial |
$130.53
|
| Rate for Payer: Encore All Commercial |
$136.54
|
| Rate for Payer: Frontpath All Commercial |
$136.46
|
| Rate for Payer: Humana ChoiceCare |
$128.11
|
| Rate for Payer: Humana Medicare |
$75.65
|
| Rate for Payer: Lucent All Commercial |
$75.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$133.50
|
| Rate for Payer: PHCS All Commercial |
$111.25
|
| Rate for Payer: PHP All Commercial |
$112.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.85
|
| Rate for Payer: Sagamore Health Network All Products |
$114.51
|
| Rate for Payer: Signature Care EPO |
$123.11
|
| Rate for Payer: Signature Care PPO |
$130.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$126.08
|
| Rate for Payer: United Healthcare Commercial |
$116.88
|
| Rate for Payer: United Healthcare Medicare |
$48.95
|
|
|
METHYLPREDNISOLONE 4 MG ORAL TAB (IP DOSEPAK)
|
Facility
OP
|
$1.87
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
163342
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Aetna Commercial |
$1.58
|
| Rate for Payer: Aetna Medicare |
$0.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.68
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Centivo All Commercial |
$0.95
|
| Rate for Payer: Cigna All Commercial |
$1.61
|
| Rate for Payer: CORVEL All Commercial |
$1.74
|
| Rate for Payer: Coventry All Commercial |
$1.64
|
| Rate for Payer: Encore All Commercial |
$1.72
|
| Rate for Payer: Frontpath All Commercial |
$1.72
|
| Rate for Payer: Humana ChoiceCare |
$1.61
|
| Rate for Payer: Humana Medicare |
$0.95
|
| Rate for Payer: Lucent All Commercial |
$0.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.68
|
| Rate for Payer: PHCS All Commercial |
$1.40
|
| Rate for Payer: PHP All Commercial |
$1.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.73
|
| Rate for Payer: Sagamore Health Network All Products |
$1.44
|
| Rate for Payer: Signature Care EPO |
$1.55
|
| Rate for Payer: Signature Care PPO |
$1.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.59
|
| Rate for Payer: United Healthcare Commercial |
$1.47
|
| Rate for Payer: United Healthcare Medicare |
$0.62
|
|
|
METHYLPREDNISOLONE 4 MG ORAL TAB (IP DOSEPAK)
|
Facility
IP
|
$1.87
|
|
|
Service Code
|
HCPCS J7509
|
| Hospital Charge Code |
163342
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Aetna Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$1.16
|
| Rate for Payer: Cigna All Commercial |
$1.61
|
| Rate for Payer: CORVEL All Commercial |
$1.74
|
| Rate for Payer: Coventry All Commercial |
$1.64
|
| Rate for Payer: Encore All Commercial |
$1.72
|
| Rate for Payer: Frontpath All Commercial |
$1.72
|
| Rate for Payer: Humana ChoiceCare |
$1.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.68
|
| Rate for Payer: PHCS All Commercial |
$1.40
|
| Rate for Payer: PHP All Commercial |
$1.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1.44
|
| Rate for Payer: Signature Care EPO |
$1.55
|
| Rate for Payer: Signature Care PPO |
$1.64
|
| Rate for Payer: United Healthcare Commercial |
$1.47
|
|
