|
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP
|
Facility
IP
|
$58.03
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
4995
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.52 |
| Max. Negotiated Rate |
$53.97 |
| Rate for Payer: Aetna Commercial |
$50.14
|
| Rate for Payer: Cash Price |
$35.98
|
| Rate for Payer: Cigna All Commercial |
$50.08
|
| Rate for Payer: CORVEL All Commercial |
$53.97
|
| Rate for Payer: Coventry All Commercial |
$51.07
|
| Rate for Payer: Encore All Commercial |
$53.42
|
| Rate for Payer: Frontpath All Commercial |
$53.39
|
| Rate for Payer: Humana ChoiceCare |
$50.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.23
|
| Rate for Payer: PHCS All Commercial |
$43.52
|
| Rate for Payer: PHP All Commercial |
$44.01
|
| Rate for Payer: Sagamore Health Network All Products |
$44.80
|
| Rate for Payer: Signature Care EPO |
$48.16
|
| Rate for Payer: Signature Care PPO |
$51.07
|
| Rate for Payer: United Healthcare Commercial |
$45.73
|
|
|
METHYLPREDNISOLONE ACETATE 40 MG/ML INJ SUSP
|
Facility
OP
|
$58.03
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
4995
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.15 |
| Max. Negotiated Rate |
$53.97 |
| Rate for Payer: Aetna Commercial |
$48.98
|
| Rate for Payer: Aetna Medicare |
$19.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.06
|
| Rate for Payer: Cash Price |
$35.98
|
| Rate for Payer: Centivo All Commercial |
$29.60
|
| Rate for Payer: Cigna All Commercial |
$50.08
|
| Rate for Payer: CORVEL All Commercial |
$53.97
|
| Rate for Payer: Coventry All Commercial |
$51.07
|
| Rate for Payer: Encore All Commercial |
$53.42
|
| Rate for Payer: Frontpath All Commercial |
$53.39
|
| Rate for Payer: Humana ChoiceCare |
$50.12
|
| Rate for Payer: Humana Medicare |
$29.60
|
| Rate for Payer: Lucent All Commercial |
$29.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.23
|
| Rate for Payer: PHCS All Commercial |
$43.52
|
| Rate for Payer: PHP All Commercial |
$44.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.63
|
| Rate for Payer: Sagamore Health Network All Products |
$44.80
|
| Rate for Payer: Signature Care EPO |
$48.16
|
| Rate for Payer: Signature Care PPO |
$51.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.33
|
| Rate for Payer: United Healthcare Commercial |
$45.73
|
| Rate for Payer: United Healthcare Medicare |
$19.15
|
|
|
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP
|
Facility
OP
|
$87.89
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
4996
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$81.73 |
| Rate for Payer: Aetna Commercial |
$74.17
|
| Rate for Payer: Aetna Medicare |
$29.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$50.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.94
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.90
|
| Rate for Payer: Cash Price |
$54.49
|
| Rate for Payer: Centivo All Commercial |
$44.82
|
| Rate for Payer: Cigna All Commercial |
$75.84
|
| Rate for Payer: CORVEL All Commercial |
$81.73
|
| Rate for Payer: Coventry All Commercial |
$77.34
|
| Rate for Payer: Encore All Commercial |
$80.90
|
| Rate for Payer: Frontpath All Commercial |
$80.85
|
| Rate for Payer: Humana ChoiceCare |
$75.91
|
| Rate for Payer: Humana Medicare |
$44.82
|
| Rate for Payer: Lucent All Commercial |
$44.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.10
|
| Rate for Payer: PHCS All Commercial |
$65.91
|
| Rate for Payer: PHP All Commercial |
$66.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.28
|
| Rate for Payer: Sagamore Health Network All Products |
$67.85
|
| Rate for Payer: Signature Care EPO |
$72.94
|
| Rate for Payer: Signature Care PPO |
$77.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74.70
|
| Rate for Payer: United Healthcare Commercial |
$69.25
|
| Rate for Payer: United Healthcare Medicare |
$29.00
|
|
|
METHYLPREDNISOLONE ACETATE 80 MG/ML INJ SUSP
|
Facility
IP
|
$87.89
|
|
|
Service Code
|
HCPCS J1010
|
| Hospital Charge Code |
4996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.91 |
| Max. Negotiated Rate |
$81.73 |
| Rate for Payer: Aetna Commercial |
$75.93
|
| Rate for Payer: Cash Price |
$54.49
|
| Rate for Payer: Cigna All Commercial |
$75.84
|
| Rate for Payer: CORVEL All Commercial |
$81.73
|
| Rate for Payer: Coventry All Commercial |
$77.34
|
| Rate for Payer: Encore All Commercial |
$80.90
|
| Rate for Payer: Frontpath All Commercial |
$80.85
|
| Rate for Payer: Humana ChoiceCare |
$75.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$79.10
|
| Rate for Payer: PHCS All Commercial |
$65.91
|
| Rate for Payer: PHP All Commercial |
$66.65
|
| Rate for Payer: Sagamore Health Network All Products |
$67.85
|
| Rate for Payer: Signature Care EPO |
$72.94
|
| Rate for Payer: Signature Care PPO |
$77.34
|
| Rate for Payer: United Healthcare Commercial |
$69.25
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 1000 MG IV SOLR
|
Facility
IP
|
$156.80
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$145.82 |
| Rate for Payer: Aetna Commercial |
$135.48
|
| Rate for Payer: Cash Price |
$97.22
|
| Rate for Payer: Cigna All Commercial |
$135.32
|
| Rate for Payer: CORVEL All Commercial |
$145.82
|
| Rate for Payer: Coventry All Commercial |
$137.98
|
| Rate for Payer: Encore All Commercial |
$144.33
|
| Rate for Payer: Frontpath All Commercial |
$144.26
|
| Rate for Payer: Humana ChoiceCare |
$135.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.12
|
| Rate for Payer: PHCS All Commercial |
$117.60
|
| Rate for Payer: PHP All Commercial |
$118.92
|
| Rate for Payer: Sagamore Health Network All Products |
$121.05
|
| Rate for Payer: Signature Care EPO |
$130.14
|
| Rate for Payer: Signature Care PPO |
$137.98
|
| Rate for Payer: United Healthcare Commercial |
$123.56
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 1000 MG IV SOLR
|
Facility
OP
|
$156.80
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10577
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$51.74 |
| Max. Negotiated Rate |
$145.82 |
| Rate for Payer: Aetna Commercial |
$132.34
|
| Rate for Payer: Aetna Medicare |
$51.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$90.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$98.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.92
|
| Rate for Payer: Cash Price |
$97.22
|
| Rate for Payer: Centivo All Commercial |
$79.97
|
| Rate for Payer: Cigna All Commercial |
$135.32
|
| Rate for Payer: CORVEL All Commercial |
$145.82
|
| Rate for Payer: Coventry All Commercial |
$137.98
|
| Rate for Payer: Encore All Commercial |
$144.33
|
| Rate for Payer: Frontpath All Commercial |
$144.26
|
| Rate for Payer: Humana ChoiceCare |
$135.43
|
| Rate for Payer: Humana Medicare |
$79.97
|
| Rate for Payer: Lucent All Commercial |
$79.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.12
|
| Rate for Payer: PHCS All Commercial |
$117.60
|
| Rate for Payer: PHP All Commercial |
$118.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$61.15
|
| Rate for Payer: Sagamore Health Network All Products |
$121.05
|
| Rate for Payer: Signature Care EPO |
$130.14
|
| Rate for Payer: Signature Care PPO |
$137.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$133.28
|
| Rate for Payer: United Healthcare Commercial |
$123.56
|
| Rate for Payer: United Healthcare Medicare |
$51.74
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 2 G IV SOLR
|
Facility
IP
|
$583.94
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10579
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$437.95 |
| Max. Negotiated Rate |
$543.06 |
| Rate for Payer: Aetna Commercial |
$504.52
|
| Rate for Payer: Cash Price |
$362.04
|
| Rate for Payer: Cigna All Commercial |
$503.94
|
| Rate for Payer: CORVEL All Commercial |
$543.06
|
| Rate for Payer: Coventry All Commercial |
$513.86
|
| Rate for Payer: Encore All Commercial |
$537.51
|
| Rate for Payer: Frontpath All Commercial |
$537.22
|
| Rate for Payer: Humana ChoiceCare |
$504.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$525.54
|
| Rate for Payer: PHCS All Commercial |
$437.95
|
| Rate for Payer: PHP All Commercial |
$442.86
|
| Rate for Payer: Sagamore Health Network All Products |
$450.80
|
| Rate for Payer: Signature Care EPO |
$484.67
|
| Rate for Payer: Signature Care PPO |
$513.86
|
| Rate for Payer: United Healthcare Commercial |
$460.14
|
|
|
METHYLPREDNISOLONE SODIUM SUCC 2 G IV SOLR
|
Facility
OP
|
$583.94
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
10579
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$192.70 |
| Max. Negotiated Rate |
$543.06 |
| Rate for Payer: Aetna Commercial |
$492.84
|
| Rate for Payer: Aetna Medicare |
$192.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$192.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$335.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$365.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$221.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$211.97
|
| Rate for Payer: Cash Price |
$362.04
|
| Rate for Payer: Centivo All Commercial |
$297.81
|
| Rate for Payer: Cigna All Commercial |
$503.94
|
| Rate for Payer: CORVEL All Commercial |
$543.06
|
| Rate for Payer: Coventry All Commercial |
$513.86
|
| Rate for Payer: Encore All Commercial |
$537.51
|
| Rate for Payer: Frontpath All Commercial |
$537.22
|
| Rate for Payer: Humana ChoiceCare |
$504.34
|
| Rate for Payer: Humana Medicare |
$297.81
|
| Rate for Payer: Lucent All Commercial |
$297.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$525.54
|
| Rate for Payer: PHCS All Commercial |
$437.95
|
| Rate for Payer: PHP All Commercial |
$442.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$227.73
|
| Rate for Payer: Sagamore Health Network All Products |
$450.80
|
| Rate for Payer: Signature Care EPO |
$484.67
|
| Rate for Payer: Signature Care PPO |
$513.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$496.34
|
| Rate for Payer: United Healthcare Commercial |
$460.14
|
| Rate for Payer: United Healthcare Medicare |
$192.70
|
|
|
METHYLPREDNISOLONE SOD SUC(PF) 1000 MG/8 ML IV SOLR
|
Facility
OP
|
$343.02
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
120963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.20 |
| Max. Negotiated Rate |
$319.01 |
| Rate for Payer: Aetna Commercial |
$289.51
|
| Rate for Payer: Aetna Medicare |
$113.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$113.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$197.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$214.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.52
|
| Rate for Payer: Cash Price |
$212.67
|
| Rate for Payer: Centivo All Commercial |
$174.94
|
| Rate for Payer: Cigna All Commercial |
$296.03
|
| Rate for Payer: CORVEL All Commercial |
$319.01
|
| Rate for Payer: Coventry All Commercial |
$301.86
|
| Rate for Payer: Encore All Commercial |
$315.75
|
| Rate for Payer: Frontpath All Commercial |
$315.58
|
| Rate for Payer: Humana ChoiceCare |
$296.27
|
| Rate for Payer: Humana Medicare |
$174.94
|
| Rate for Payer: Lucent All Commercial |
$174.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$308.72
|
| Rate for Payer: PHCS All Commercial |
$257.26
|
| Rate for Payer: PHP All Commercial |
$260.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$133.78
|
| Rate for Payer: Sagamore Health Network All Products |
$264.81
|
| Rate for Payer: Signature Care EPO |
$284.71
|
| Rate for Payer: Signature Care PPO |
$301.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$291.57
|
| Rate for Payer: United Healthcare Commercial |
$270.30
|
| Rate for Payer: United Healthcare Medicare |
$113.20
|
|
|
METHYLPREDNISOLONE SOD SUC(PF) 1000 MG/8 ML IV SOLR
|
Facility
IP
|
$343.02
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
120963
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$257.26 |
| Max. Negotiated Rate |
$319.01 |
| Rate for Payer: Aetna Commercial |
$296.37
|
| Rate for Payer: Cash Price |
$212.67
|
| Rate for Payer: Cigna All Commercial |
$296.03
|
| Rate for Payer: CORVEL All Commercial |
$319.01
|
| Rate for Payer: Coventry All Commercial |
$301.86
|
| Rate for Payer: Encore All Commercial |
$315.75
|
| Rate for Payer: Frontpath All Commercial |
$315.58
|
| Rate for Payer: Humana ChoiceCare |
$296.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$308.72
|
| Rate for Payer: PHCS All Commercial |
$257.26
|
| Rate for Payer: PHP All Commercial |
$260.15
|
| Rate for Payer: Sagamore Health Network All Products |
$264.81
|
| Rate for Payer: Signature Care EPO |
$284.71
|
| Rate for Payer: Signature Care PPO |
$301.86
|
| Rate for Payer: United Healthcare Commercial |
$270.30
|
|
|
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR
|
Facility
OP
|
$54.73
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
120961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$50.90 |
| Rate for Payer: Aetna Commercial |
$46.19
|
| Rate for Payer: Aetna Medicare |
$18.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.87
|
| Rate for Payer: Cash Price |
$33.93
|
| Rate for Payer: Centivo All Commercial |
$27.91
|
| Rate for Payer: Cigna All Commercial |
$47.23
|
| Rate for Payer: CORVEL All Commercial |
$50.90
|
| Rate for Payer: Coventry All Commercial |
$48.17
|
| Rate for Payer: Encore All Commercial |
$50.38
|
| Rate for Payer: Frontpath All Commercial |
$50.35
|
| Rate for Payer: Humana ChoiceCare |
$47.27
|
| Rate for Payer: Humana Medicare |
$27.91
|
| Rate for Payer: Lucent All Commercial |
$27.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.26
|
| Rate for Payer: PHCS All Commercial |
$41.05
|
| Rate for Payer: PHP All Commercial |
$41.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.35
|
| Rate for Payer: Sagamore Health Network All Products |
$42.25
|
| Rate for Payer: Signature Care EPO |
$45.43
|
| Rate for Payer: Signature Care PPO |
$48.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.52
|
| Rate for Payer: United Healthcare Commercial |
$43.13
|
| Rate for Payer: United Healthcare Medicare |
$18.06
|
|
|
METHYLPREDNISOLONE SOD SUC(PF) 125 MG/2 ML INJ SOLR
|
Facility
IP
|
$54.73
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
120961
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$41.05 |
| Max. Negotiated Rate |
$50.90 |
| Rate for Payer: Aetna Commercial |
$47.29
|
| Rate for Payer: Cash Price |
$33.93
|
| Rate for Payer: Cigna All Commercial |
$47.23
|
| Rate for Payer: CORVEL All Commercial |
$50.90
|
| Rate for Payer: Coventry All Commercial |
$48.17
|
| Rate for Payer: Encore All Commercial |
$50.38
|
| Rate for Payer: Frontpath All Commercial |
$50.35
|
| Rate for Payer: Humana ChoiceCare |
$47.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.26
|
| Rate for Payer: PHCS All Commercial |
$41.05
|
| Rate for Payer: PHP All Commercial |
$41.51
|
| Rate for Payer: Sagamore Health Network All Products |
$42.25
|
| Rate for Payer: Signature Care EPO |
$45.43
|
| Rate for Payer: Signature Care PPO |
$48.17
|
| Rate for Payer: United Healthcare Commercial |
$43.13
|
|
|
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR
|
Facility
IP
|
$34.37
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
120960
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.78 |
| Max. Negotiated Rate |
$31.96 |
| Rate for Payer: Aetna Commercial |
$29.70
|
| Rate for Payer: Cash Price |
$21.31
|
| Rate for Payer: Cigna All Commercial |
$29.66
|
| Rate for Payer: CORVEL All Commercial |
$31.96
|
| Rate for Payer: Coventry All Commercial |
$30.25
|
| Rate for Payer: Encore All Commercial |
$31.64
|
| Rate for Payer: Frontpath All Commercial |
$31.62
|
| Rate for Payer: Humana ChoiceCare |
$29.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.93
|
| Rate for Payer: PHCS All Commercial |
$25.78
|
| Rate for Payer: PHP All Commercial |
$26.07
|
| Rate for Payer: Sagamore Health Network All Products |
$26.53
|
| Rate for Payer: Signature Care EPO |
$28.53
|
| Rate for Payer: Signature Care PPO |
$30.25
|
| Rate for Payer: United Healthcare Commercial |
$27.08
|
|
|
METHYLPREDNISOLONE SOD SUC(PF) 40 MG/ML INJ SOLR
|
Facility
OP
|
$34.37
|
|
|
Service Code
|
HCPCS J2919
|
| Hospital Charge Code |
120960
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.34 |
| Max. Negotiated Rate |
$31.96 |
| Rate for Payer: Aetna Commercial |
$29.01
|
| Rate for Payer: Aetna Medicare |
$11.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.48
|
| Rate for Payer: Cash Price |
$21.31
|
| Rate for Payer: Centivo All Commercial |
$17.53
|
| Rate for Payer: Cigna All Commercial |
$29.66
|
| Rate for Payer: CORVEL All Commercial |
$31.96
|
| Rate for Payer: Coventry All Commercial |
$30.25
|
| Rate for Payer: Encore All Commercial |
$31.64
|
| Rate for Payer: Frontpath All Commercial |
$31.62
|
| Rate for Payer: Humana ChoiceCare |
$29.69
|
| Rate for Payer: Humana Medicare |
$17.53
|
| Rate for Payer: Lucent All Commercial |
$17.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.93
|
| Rate for Payer: PHCS All Commercial |
$25.78
|
| Rate for Payer: PHP All Commercial |
$26.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.40
|
| Rate for Payer: Sagamore Health Network All Products |
$26.53
|
| Rate for Payer: Signature Care EPO |
$28.53
|
| Rate for Payer: Signature Care PPO |
$30.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$29.21
|
| Rate for Payer: United Healthcare Commercial |
$27.08
|
| Rate for Payer: United Healthcare Medicare |
$11.34
|
|
|
METOCLOPRAMIDE HCL 10 MG ORAL TAB
|
Facility
OP
|
$3.93
|
|
|
Service Code
|
NDC 60687063101
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.30 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna Commercial |
$3.32
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.43
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Centivo All Commercial |
$2.01
|
| Rate for Payer: Cigna All Commercial |
$3.40
|
| Rate for Payer: CORVEL All Commercial |
$3.66
|
| Rate for Payer: Coventry All Commercial |
$3.46
|
| Rate for Payer: Encore All Commercial |
$3.62
|
| Rate for Payer: Frontpath All Commercial |
$3.62
|
| Rate for Payer: Humana ChoiceCare |
$3.40
|
| Rate for Payer: Humana Medicare |
$2.01
|
| Rate for Payer: Lucent All Commercial |
$2.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.54
|
| Rate for Payer: PHCS All Commercial |
$2.95
|
| Rate for Payer: PHP All Commercial |
$2.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.53
|
| Rate for Payer: Sagamore Health Network All Products |
$3.04
|
| Rate for Payer: Signature Care EPO |
$3.27
|
| Rate for Payer: Signature Care PPO |
$3.46
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.34
|
| Rate for Payer: United Healthcare Commercial |
$3.10
|
| Rate for Payer: United Healthcare Medicare |
$1.30
|
|
|
METOCLOPRAMIDE HCL 10 MG ORAL TAB
|
Facility
IP
|
$3.93
|
|
|
Service Code
|
NDC 60687063101
|
| Hospital Charge Code |
5005
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.95 |
| Max. Negotiated Rate |
$3.66 |
| Rate for Payer: Aetna Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna All Commercial |
$3.40
|
| Rate for Payer: CORVEL All Commercial |
$3.66
|
| Rate for Payer: Coventry All Commercial |
$3.46
|
| Rate for Payer: Encore All Commercial |
$3.62
|
| Rate for Payer: Frontpath All Commercial |
$3.62
|
| Rate for Payer: Humana ChoiceCare |
$3.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.54
|
| Rate for Payer: PHCS All Commercial |
$2.95
|
| Rate for Payer: PHP All Commercial |
$2.98
|
| Rate for Payer: Sagamore Health Network All Products |
$3.04
|
| Rate for Payer: Signature Care EPO |
$3.27
|
| Rate for Payer: Signature Care PPO |
$3.46
|
| Rate for Payer: United Healthcare Commercial |
$3.10
|
|
|
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN
|
Facility
IP
|
$20.76
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.57 |
| Max. Negotiated Rate |
$19.31 |
| Rate for Payer: Aetna Commercial |
$17.94
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Cigna All Commercial |
$17.92
|
| Rate for Payer: CORVEL All Commercial |
$19.31
|
| Rate for Payer: Coventry All Commercial |
$18.27
|
| Rate for Payer: Encore All Commercial |
$19.11
|
| Rate for Payer: Frontpath All Commercial |
$19.10
|
| Rate for Payer: Humana ChoiceCare |
$17.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.69
|
| Rate for Payer: PHCS All Commercial |
$15.57
|
| Rate for Payer: PHP All Commercial |
$15.75
|
| Rate for Payer: Sagamore Health Network All Products |
$16.03
|
| Rate for Payer: Signature Care EPO |
$17.23
|
| Rate for Payer: Signature Care PPO |
$18.27
|
| Rate for Payer: United Healthcare Commercial |
$16.36
|
|
|
METOCLOPRAMIDE HCL 5 MG/ML INJ SOLN
|
Facility
OP
|
$20.76
|
|
|
Service Code
|
HCPCS J2765
|
| Hospital Charge Code |
5002
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$19.31 |
| Rate for Payer: Aetna Commercial |
$17.52
|
| Rate for Payer: Aetna Medicare |
$6.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.54
|
| Rate for Payer: Cash Price |
$12.87
|
| Rate for Payer: Centivo All Commercial |
$10.59
|
| Rate for Payer: Cigna All Commercial |
$17.92
|
| Rate for Payer: CORVEL All Commercial |
$19.31
|
| Rate for Payer: Coventry All Commercial |
$18.27
|
| Rate for Payer: Encore All Commercial |
$19.11
|
| Rate for Payer: Frontpath All Commercial |
$19.10
|
| Rate for Payer: Humana ChoiceCare |
$17.93
|
| Rate for Payer: Humana Medicare |
$10.59
|
| Rate for Payer: Lucent All Commercial |
$10.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.69
|
| Rate for Payer: PHCS All Commercial |
$15.57
|
| Rate for Payer: PHP All Commercial |
$15.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.10
|
| Rate for Payer: Sagamore Health Network All Products |
$16.03
|
| Rate for Payer: Signature Care EPO |
$17.23
|
| Rate for Payer: Signature Care PPO |
$18.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.65
|
| Rate for Payer: United Healthcare Commercial |
$16.36
|
| Rate for Payer: United Healthcare Medicare |
$6.85
|
|
|
METOCLOPRAMIDE HCL 5 MG ORAL TAB
|
Facility
IP
|
$3.82
|
|
|
Service Code
|
NDC 60687062001
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.87 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Aetna Commercial |
$3.30
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Cigna All Commercial |
$3.30
|
| Rate for Payer: CORVEL All Commercial |
$3.55
|
| Rate for Payer: Coventry All Commercial |
$3.36
|
| Rate for Payer: Encore All Commercial |
$3.52
|
| Rate for Payer: Frontpath All Commercial |
$3.52
|
| Rate for Payer: Humana ChoiceCare |
$3.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.44
|
| Rate for Payer: PHCS All Commercial |
$2.87
|
| Rate for Payer: PHP All Commercial |
$2.90
|
| Rate for Payer: Sagamore Health Network All Products |
$2.95
|
| Rate for Payer: Signature Care EPO |
$3.17
|
| Rate for Payer: Signature Care PPO |
$3.36
|
| Rate for Payer: United Healthcare Commercial |
$3.01
|
|
|
METOCLOPRAMIDE HCL 5 MG ORAL TAB
|
Facility
OP
|
$3.82
|
|
|
Service Code
|
NDC 60687062001
|
| Hospital Charge Code |
5006
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Aetna Commercial |
$3.23
|
| Rate for Payer: Aetna Medicare |
$1.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.39
|
| Rate for Payer: Cash Price |
$2.37
|
| Rate for Payer: Centivo All Commercial |
$1.95
|
| Rate for Payer: Cigna All Commercial |
$3.30
|
| Rate for Payer: CORVEL All Commercial |
$3.55
|
| Rate for Payer: Coventry All Commercial |
$3.36
|
| Rate for Payer: Encore All Commercial |
$3.52
|
| Rate for Payer: Frontpath All Commercial |
$3.52
|
| Rate for Payer: Humana ChoiceCare |
$3.30
|
| Rate for Payer: Humana Medicare |
$1.95
|
| Rate for Payer: Lucent All Commercial |
$1.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.44
|
| Rate for Payer: PHCS All Commercial |
$2.87
|
| Rate for Payer: PHP All Commercial |
$2.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.49
|
| Rate for Payer: Sagamore Health Network All Products |
$2.95
|
| Rate for Payer: Signature Care EPO |
$3.17
|
| Rate for Payer: Signature Care PPO |
$3.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.25
|
| Rate for Payer: United Healthcare Commercial |
$3.01
|
| Rate for Payer: United Healthcare Medicare |
$1.26
|
|
|
METOLAZONE 2.5 MG ORAL TAB
|
Facility
IP
|
$18.49
|
|
|
Service Code
|
NDC 51079002320
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Aetna Commercial |
$15.98
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Cigna All Commercial |
$15.96
|
| Rate for Payer: CORVEL All Commercial |
$17.20
|
| Rate for Payer: Coventry All Commercial |
$16.27
|
| Rate for Payer: Encore All Commercial |
$17.02
|
| Rate for Payer: Frontpath All Commercial |
$17.01
|
| Rate for Payer: Humana ChoiceCare |
$15.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.64
|
| Rate for Payer: PHCS All Commercial |
$13.87
|
| Rate for Payer: PHP All Commercial |
$14.03
|
| Rate for Payer: Sagamore Health Network All Products |
$14.28
|
| Rate for Payer: Signature Care EPO |
$15.35
|
| Rate for Payer: Signature Care PPO |
$16.27
|
| Rate for Payer: United Healthcare Commercial |
$14.57
|
|
|
METOLAZONE 2.5 MG ORAL TAB
|
Facility
OP
|
$18.49
|
|
|
Service Code
|
NDC 51079002320
|
| Hospital Charge Code |
10587
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$17.20 |
| Rate for Payer: Aetna Commercial |
$15.61
|
| Rate for Payer: Aetna Medicare |
$6.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.71
|
| Rate for Payer: Cash Price |
$11.47
|
| Rate for Payer: Centivo All Commercial |
$9.43
|
| Rate for Payer: Cigna All Commercial |
$15.96
|
| Rate for Payer: CORVEL All Commercial |
$17.20
|
| Rate for Payer: Coventry All Commercial |
$16.27
|
| Rate for Payer: Encore All Commercial |
$17.02
|
| Rate for Payer: Frontpath All Commercial |
$17.01
|
| Rate for Payer: Humana ChoiceCare |
$15.97
|
| Rate for Payer: Humana Medicare |
$9.43
|
| Rate for Payer: Lucent All Commercial |
$9.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.64
|
| Rate for Payer: PHCS All Commercial |
$13.87
|
| Rate for Payer: PHP All Commercial |
$14.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.21
|
| Rate for Payer: Sagamore Health Network All Products |
$14.28
|
| Rate for Payer: Signature Care EPO |
$15.35
|
| Rate for Payer: Signature Care PPO |
$16.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.72
|
| Rate for Payer: United Healthcare Commercial |
$14.57
|
| Rate for Payer: United Healthcare Medicare |
$6.10
|
|
|
METOPROLOL SUCCINATE 25 MG ORAL TB24
|
Facility
IP
|
$2.81
|
|
|
Service Code
|
NDC 00904632261
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.11 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna Commercial |
$2.43
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: Cigna All Commercial |
$2.43
|
| Rate for Payer: CORVEL All Commercial |
$2.62
|
| Rate for Payer: Coventry All Commercial |
$2.48
|
| Rate for Payer: Encore All Commercial |
$2.59
|
| Rate for Payer: Frontpath All Commercial |
$2.59
|
| Rate for Payer: Humana ChoiceCare |
$2.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.53
|
| Rate for Payer: PHCS All Commercial |
$2.11
|
| Rate for Payer: PHP All Commercial |
$2.13
|
| Rate for Payer: Sagamore Health Network All Products |
$2.17
|
| Rate for Payer: Signature Care EPO |
$2.34
|
| Rate for Payer: Signature Care PPO |
$2.48
|
| Rate for Payer: United Healthcare Commercial |
$2.22
|
|
|
METOPROLOL SUCCINATE 25 MG ORAL TB24
|
Facility
OP
|
$2.81
|
|
|
Service Code
|
NDC 00904632261
|
| Hospital Charge Code |
29858
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.62 |
| Rate for Payer: Aetna Commercial |
$2.38
|
| Rate for Payer: Aetna Medicare |
$0.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.02
|
| Rate for Payer: Cash Price |
$1.74
|
| Rate for Payer: Centivo All Commercial |
$1.44
|
| Rate for Payer: Cigna All Commercial |
$2.43
|
| Rate for Payer: CORVEL All Commercial |
$2.62
|
| Rate for Payer: Coventry All Commercial |
$2.48
|
| Rate for Payer: Encore All Commercial |
$2.59
|
| Rate for Payer: Frontpath All Commercial |
$2.59
|
| Rate for Payer: Humana ChoiceCare |
$2.43
|
| Rate for Payer: Humana Medicare |
$1.44
|
| Rate for Payer: Lucent All Commercial |
$1.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.53
|
| Rate for Payer: PHCS All Commercial |
$2.11
|
| Rate for Payer: PHP All Commercial |
$2.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.10
|
| Rate for Payer: Sagamore Health Network All Products |
$2.17
|
| Rate for Payer: Signature Care EPO |
$2.34
|
| Rate for Payer: Signature Care PPO |
$2.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.39
|
| Rate for Payer: United Healthcare Commercial |
$2.22
|
| Rate for Payer: United Healthcare Medicare |
$0.93
|
|
|
METOPROLOL SUCCINATE 50 MG ORAL TB24
|
Facility
OP
|
$2.30
|
|
|
Service Code
|
NDC 00904632361
|
| Hospital Charge Code |
30070
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.76 |
| Max. Negotiated Rate |
$2.14 |
| Rate for Payer: Aetna Commercial |
$1.94
|
| Rate for Payer: Aetna Medicare |
$0.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.84
|
| Rate for Payer: Cash Price |
$1.43
|
| Rate for Payer: Centivo All Commercial |
$1.17
|
| Rate for Payer: Cigna All Commercial |
$1.99
|
| Rate for Payer: CORVEL All Commercial |
$2.14
|
| Rate for Payer: Coventry All Commercial |
$2.03
|
| Rate for Payer: Encore All Commercial |
$2.12
|
| Rate for Payer: Frontpath All Commercial |
$2.12
|
| Rate for Payer: Humana ChoiceCare |
$1.99
|
| Rate for Payer: Humana Medicare |
$1.17
|
| Rate for Payer: Lucent All Commercial |
$1.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.07
|
| Rate for Payer: PHCS All Commercial |
$1.73
|
| Rate for Payer: PHP All Commercial |
$1.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.90
|
| Rate for Payer: Sagamore Health Network All Products |
$1.78
|
| Rate for Payer: Signature Care EPO |
$1.91
|
| Rate for Payer: Signature Care PPO |
$2.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.96
|
| Rate for Payer: United Healthcare Commercial |
$1.81
|
| Rate for Payer: United Healthcare Medicare |
$0.76
|
|
