|
MISOPROSTOL 25 MCG TABLET (QUARTER TAB)
|
Facility
OP
|
$1.05
|
|
|
Service Code
|
NDC 579625007
|
| Hospital Charge Code |
800064
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.35 |
| Max. Negotiated Rate |
$0.98 |
| Rate for Payer: Aetna Commercial |
$0.89
|
| Rate for Payer: Aetna Medicare |
$0.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.38
|
| Rate for Payer: Cash Price |
$0.65
|
| Rate for Payer: Centivo All Commercial |
$0.54
|
| Rate for Payer: Cigna All Commercial |
$0.91
|
| Rate for Payer: CORVEL All Commercial |
$0.98
|
| Rate for Payer: Coventry All Commercial |
$0.92
|
| Rate for Payer: Encore All Commercial |
$0.97
|
| Rate for Payer: Frontpath All Commercial |
$0.97
|
| Rate for Payer: Humana ChoiceCare |
$0.91
|
| Rate for Payer: Humana Medicare |
$0.54
|
| Rate for Payer: Lucent All Commercial |
$0.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.95
|
| Rate for Payer: PHCS All Commercial |
$0.79
|
| Rate for Payer: PHP All Commercial |
$0.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.41
|
| Rate for Payer: Sagamore Health Network All Products |
$0.81
|
| Rate for Payer: Signature Care EPO |
$0.87
|
| Rate for Payer: Signature Care PPO |
$0.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.89
|
| Rate for Payer: United Healthcare Commercial |
$0.83
|
| Rate for Payer: United Healthcare Medicare |
$0.35
|
|
|
MODIFIED LANOLIN 100 % TOP CREA
|
Facility
OP
|
$51.80
|
|
|
Service Code
|
NDC 44677010020
|
| Hospital Charge Code |
188599
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$17.09 |
| Max. Negotiated Rate |
$48.17 |
| Rate for Payer: Aetna Commercial |
$43.72
|
| Rate for Payer: Aetna Medicare |
$17.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$32.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$19.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.80
|
| Rate for Payer: Cash Price |
$32.12
|
| Rate for Payer: Centivo All Commercial |
$26.42
|
| Rate for Payer: Cigna All Commercial |
$44.70
|
| Rate for Payer: CORVEL All Commercial |
$48.17
|
| Rate for Payer: Coventry All Commercial |
$45.58
|
| Rate for Payer: Encore All Commercial |
$47.68
|
| Rate for Payer: Frontpath All Commercial |
$47.66
|
| Rate for Payer: Humana ChoiceCare |
$44.74
|
| Rate for Payer: Humana Medicare |
$26.42
|
| Rate for Payer: Lucent All Commercial |
$26.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.62
|
| Rate for Payer: PHCS All Commercial |
$38.85
|
| Rate for Payer: PHP All Commercial |
$39.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$20.20
|
| Rate for Payer: Sagamore Health Network All Products |
$39.99
|
| Rate for Payer: Signature Care EPO |
$42.99
|
| Rate for Payer: Signature Care PPO |
$45.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44.03
|
| Rate for Payer: United Healthcare Commercial |
$40.82
|
| Rate for Payer: United Healthcare Medicare |
$17.09
|
|
|
MODIFIED LANOLIN 100 % TOP CREA
|
Facility
IP
|
$51.80
|
|
|
Service Code
|
NDC 44677010020
|
| Hospital Charge Code |
188599
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$38.85 |
| Max. Negotiated Rate |
$48.17 |
| Rate for Payer: Aetna Commercial |
$44.76
|
| Rate for Payer: Cash Price |
$32.12
|
| Rate for Payer: Cigna All Commercial |
$44.70
|
| Rate for Payer: CORVEL All Commercial |
$48.17
|
| Rate for Payer: Coventry All Commercial |
$45.58
|
| Rate for Payer: Encore All Commercial |
$47.68
|
| Rate for Payer: Frontpath All Commercial |
$47.66
|
| Rate for Payer: Humana ChoiceCare |
$44.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.62
|
| Rate for Payer: PHCS All Commercial |
$38.85
|
| Rate for Payer: PHP All Commercial |
$39.29
|
| Rate for Payer: Sagamore Health Network All Products |
$39.99
|
| Rate for Payer: Signature Care EPO |
$42.99
|
| Rate for Payer: Signature Care PPO |
$45.58
|
| Rate for Payer: United Healthcare Commercial |
$40.82
|
|
|
MONTELUKAST 10 MG ORAL TAB
|
Facility
OP
|
$1.56
|
|
|
Service Code
|
NDC 00904680861
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Aetna Commercial |
$1.32
|
| Rate for Payer: Aetna Medicare |
$0.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.57
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Centivo All Commercial |
$0.80
|
| Rate for Payer: Cigna All Commercial |
$1.35
|
| Rate for Payer: CORVEL All Commercial |
$1.45
|
| Rate for Payer: Coventry All Commercial |
$1.37
|
| Rate for Payer: Encore All Commercial |
$1.44
|
| Rate for Payer: Frontpath All Commercial |
$1.44
|
| Rate for Payer: Humana ChoiceCare |
$1.35
|
| Rate for Payer: Humana Medicare |
$0.80
|
| Rate for Payer: Lucent All Commercial |
$0.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.40
|
| Rate for Payer: PHCS All Commercial |
$1.17
|
| Rate for Payer: PHP All Commercial |
$1.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.61
|
| Rate for Payer: Sagamore Health Network All Products |
$1.21
|
| Rate for Payer: Signature Care EPO |
$1.30
|
| Rate for Payer: Signature Care PPO |
$1.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.33
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
| Rate for Payer: United Healthcare Medicare |
$0.52
|
|
|
MONTELUKAST 10 MG ORAL TAB
|
Facility
IP
|
$1.56
|
|
|
Service Code
|
NDC 00904680861
|
| Hospital Charge Code |
22509
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.17 |
| Max. Negotiated Rate |
$1.45 |
| Rate for Payer: Aetna Commercial |
$1.35
|
| Rate for Payer: Cash Price |
$0.97
|
| Rate for Payer: Cigna All Commercial |
$1.35
|
| Rate for Payer: CORVEL All Commercial |
$1.45
|
| Rate for Payer: Coventry All Commercial |
$1.37
|
| Rate for Payer: Encore All Commercial |
$1.44
|
| Rate for Payer: Frontpath All Commercial |
$1.44
|
| Rate for Payer: Humana ChoiceCare |
$1.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.40
|
| Rate for Payer: PHCS All Commercial |
$1.17
|
| Rate for Payer: PHP All Commercial |
$1.18
|
| Rate for Payer: Sagamore Health Network All Products |
$1.21
|
| Rate for Payer: Signature Care EPO |
$1.30
|
| Rate for Payer: Signature Care PPO |
$1.37
|
| Rate for Payer: United Healthcare Commercial |
$1.23
|
|
|
MORPHINE 10 MG/ML INJECTION S.O.
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
420602
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
MORPHINE 10 MG/ML INJECTION S.O.
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
420602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
|
|
MORPHINE 10 MG/ML IV SYRG
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
170438
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
|
|
MORPHINE 10 MG/ML IV SYRG
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
170438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
MORPHINE 15 MG ORAL TAB
|
Facility
OP
|
$6.01
|
|
|
Service Code
|
NDC 00406511862
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$5.59 |
| Rate for Payer: Aetna Commercial |
$5.07
|
| Rate for Payer: Aetna Medicare |
$1.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.18
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Centivo All Commercial |
$3.06
|
| Rate for Payer: Cigna All Commercial |
$5.18
|
| Rate for Payer: CORVEL All Commercial |
$5.59
|
| Rate for Payer: Coventry All Commercial |
$5.29
|
| Rate for Payer: Encore All Commercial |
$5.53
|
| Rate for Payer: Frontpath All Commercial |
$5.53
|
| Rate for Payer: Humana ChoiceCare |
$5.19
|
| Rate for Payer: Humana Medicare |
$3.06
|
| Rate for Payer: Lucent All Commercial |
$3.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.41
|
| Rate for Payer: PHCS All Commercial |
$4.50
|
| Rate for Payer: PHP All Commercial |
$4.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.34
|
| Rate for Payer: Sagamore Health Network All Products |
$4.64
|
| Rate for Payer: Signature Care EPO |
$4.98
|
| Rate for Payer: Signature Care PPO |
$5.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.11
|
| Rate for Payer: United Healthcare Commercial |
$4.73
|
| Rate for Payer: United Healthcare Medicare |
$1.98
|
|
|
MORPHINE 15 MG ORAL TAB
|
Facility
IP
|
$6.01
|
|
|
Service Code
|
NDC 00406511862
|
| Hospital Charge Code |
5178
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$5.59 |
| Rate for Payer: Aetna Commercial |
$5.19
|
| Rate for Payer: Cash Price |
$3.72
|
| Rate for Payer: Cigna All Commercial |
$5.18
|
| Rate for Payer: CORVEL All Commercial |
$5.59
|
| Rate for Payer: Coventry All Commercial |
$5.29
|
| Rate for Payer: Encore All Commercial |
$5.53
|
| Rate for Payer: Frontpath All Commercial |
$5.53
|
| Rate for Payer: Humana ChoiceCare |
$5.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.41
|
| Rate for Payer: PHCS All Commercial |
$4.50
|
| Rate for Payer: PHP All Commercial |
$4.55
|
| Rate for Payer: Sagamore Health Network All Products |
$4.64
|
| Rate for Payer: Signature Care EPO |
$4.98
|
| Rate for Payer: Signature Care PPO |
$5.29
|
| Rate for Payer: United Healthcare Commercial |
$4.73
|
|
|
MORPHINE 15 MG ORAL TBER
|
Facility
IP
|
$4.00
|
|
|
Service Code
|
NDC 42858080101
|
| Hospital Charge Code |
20920
|
|
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
|
|
|
MORPHINE 15 MG ORAL TBER
|
Facility
OP
|
$4.00
|
|
|
Service Code
|
NDC 42858080101
|
| Hospital Charge Code |
20920
|
|
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
|
|
|
MORPHINE 2 MG/ML INJECTION S.O.
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
420600
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
MORPHINE 2 MG/ML INJECTION S.O.
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
420600
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
|
|
MORPHINE 2 MG/ML IV SYRG
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
167699
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
|
|
MORPHINE 2 MG/ML IV SYRG
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
167699
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
MORPHINE 30 MG/30 ML PCA (CAMERON)
|
Facility
IP
|
$66.36
|
|
|
Service Code
|
NDC 76329191201
|
| Hospital Charge Code |
1401000121126
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.77 |
| Max. Negotiated Rate |
$61.71 |
| Rate for Payer: Aetna Commercial |
$57.34
|
| Rate for Payer: Cash Price |
$41.14
|
| Rate for Payer: Cigna All Commercial |
$57.27
|
| Rate for Payer: CORVEL All Commercial |
$61.71
|
| Rate for Payer: Coventry All Commercial |
$58.40
|
| Rate for Payer: Encore All Commercial |
$61.08
|
| Rate for Payer: Frontpath All Commercial |
$61.05
|
| Rate for Payer: Humana ChoiceCare |
$57.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.72
|
| Rate for Payer: PHCS All Commercial |
$49.77
|
| Rate for Payer: PHP All Commercial |
$50.33
|
| Rate for Payer: Sagamore Health Network All Products |
$51.23
|
| Rate for Payer: Signature Care EPO |
$55.08
|
| Rate for Payer: Signature Care PPO |
$58.40
|
| Rate for Payer: United Healthcare Commercial |
$52.29
|
|
|
MORPHINE 30 MG/30 ML PCA (CAMERON)
|
Facility
OP
|
$66.36
|
|
|
Service Code
|
NDC 76329191201
|
| Hospital Charge Code |
1401000121126
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.90 |
| Max. Negotiated Rate |
$61.71 |
| Rate for Payer: Aetna Commercial |
$56.01
|
| Rate for Payer: Aetna Medicare |
$21.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.09
|
| Rate for Payer: Cash Price |
$41.14
|
| Rate for Payer: Centivo All Commercial |
$33.84
|
| Rate for Payer: Cigna All Commercial |
$57.27
|
| Rate for Payer: CORVEL All Commercial |
$61.71
|
| Rate for Payer: Coventry All Commercial |
$58.40
|
| Rate for Payer: Encore All Commercial |
$61.08
|
| Rate for Payer: Frontpath All Commercial |
$61.05
|
| Rate for Payer: Humana ChoiceCare |
$57.32
|
| Rate for Payer: Humana Medicare |
$33.84
|
| Rate for Payer: Lucent All Commercial |
$33.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.72
|
| Rate for Payer: PHCS All Commercial |
$49.77
|
| Rate for Payer: PHP All Commercial |
$50.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.88
|
| Rate for Payer: Sagamore Health Network All Products |
$51.23
|
| Rate for Payer: Signature Care EPO |
$55.08
|
| Rate for Payer: Signature Care PPO |
$58.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.41
|
| Rate for Payer: United Healthcare Commercial |
$52.29
|
| Rate for Payer: United Healthcare Medicare |
$21.90
|
|
|
MORPHINE 30 MG ORAL TBER
|
Facility
OP
|
$4.00
|
|
|
Service Code
|
NDC 42858080201
|
| Hospital Charge Code |
20921
|
|
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
|
|
|
MORPHINE 30 MG ORAL TBER
|
Facility
IP
|
$4.00
|
|
|
Service Code
|
NDC 42858080201
|
| Hospital Charge Code |
20921
|
|
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
|
|
|
MORPHINE 4 MG/ML INJECTION S.O.
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
420601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
|
|
MORPHINE 4 MG/ML INJECTION S.O.
|
Facility
IP
|
$19.05
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
420601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.29 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna Commercial |
$16.46
|
| Rate for Payer: Cash Price |
$11.81
|
| Rate for Payer: Cigna All Commercial |
$16.44
|
| Rate for Payer: CORVEL All Commercial |
$17.72
|
| Rate for Payer: Coventry All Commercial |
$16.77
|
| Rate for Payer: Encore All Commercial |
$17.54
|
| Rate for Payer: Frontpath All Commercial |
$17.53
|
| Rate for Payer: Humana ChoiceCare |
$16.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.15
|
| Rate for Payer: PHCS All Commercial |
$14.29
|
| Rate for Payer: PHP All Commercial |
$14.45
|
| Rate for Payer: Sagamore Health Network All Products |
$14.71
|
| Rate for Payer: Signature Care EPO |
$15.81
|
| Rate for Payer: Signature Care PPO |
$16.77
|
| Rate for Payer: United Healthcare Commercial |
$15.01
|
|
|
MORPHINE 4 MG/ML INJECTION S.O.
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
420601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
MORPHINE 4 MG/ML INJECTION S.O.
|
Facility
OP
|
$19.05
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
420601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.29 |
| Max. Negotiated Rate |
$17.72 |
| Rate for Payer: Aetna Commercial |
$16.08
|
| Rate for Payer: Aetna Medicare |
$6.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.92
|
| Rate for Payer: Cash Price |
$11.81
|
| Rate for Payer: Centivo All Commercial |
$9.72
|
| Rate for Payer: Cigna All Commercial |
$16.44
|
| Rate for Payer: CORVEL All Commercial |
$17.72
|
| Rate for Payer: Coventry All Commercial |
$16.77
|
| Rate for Payer: Encore All Commercial |
$17.54
|
| Rate for Payer: Frontpath All Commercial |
$17.53
|
| Rate for Payer: Humana ChoiceCare |
$16.46
|
| Rate for Payer: Humana Medicare |
$9.72
|
| Rate for Payer: Lucent All Commercial |
$9.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.15
|
| Rate for Payer: PHCS All Commercial |
$14.29
|
| Rate for Payer: PHP All Commercial |
$14.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.43
|
| Rate for Payer: Sagamore Health Network All Products |
$14.71
|
| Rate for Payer: Signature Care EPO |
$15.81
|
| Rate for Payer: Signature Care PPO |
$16.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.20
|
| Rate for Payer: United Healthcare Commercial |
$15.01
|
| Rate for Payer: United Healthcare Medicare |
$6.29
|
|
