|
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN
|
Facility
OP
|
$31.92
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
165302
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.53 |
| Max. Negotiated Rate |
$29.69 |
| Rate for Payer: Aetna Commercial |
$26.94
|
| Rate for Payer: Aetna Medicare |
$10.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.59
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Centivo All Commercial |
$16.28
|
| Rate for Payer: Cigna All Commercial |
$27.55
|
| Rate for Payer: CORVEL All Commercial |
$29.69
|
| Rate for Payer: Coventry All Commercial |
$28.09
|
| Rate for Payer: Encore All Commercial |
$29.38
|
| Rate for Payer: Frontpath All Commercial |
$29.37
|
| Rate for Payer: Humana ChoiceCare |
$27.57
|
| Rate for Payer: Humana Medicare |
$16.28
|
| Rate for Payer: Lucent All Commercial |
$16.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.73
|
| Rate for Payer: PHCS All Commercial |
$23.94
|
| Rate for Payer: PHP All Commercial |
$24.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.45
|
| Rate for Payer: Sagamore Health Network All Products |
$24.64
|
| Rate for Payer: Signature Care EPO |
$26.49
|
| Rate for Payer: Signature Care PPO |
$28.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27.13
|
| Rate for Payer: United Healthcare Commercial |
$25.15
|
| Rate for Payer: United Healthcare Medicare |
$10.53
|
|
|
NEOSTIGMINE METHYLSULFATE 1 MG/ML IV SOLN
|
Facility
IP
|
$31.92
|
|
|
Service Code
|
HCPCS J2710
|
| Hospital Charge Code |
165302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.94 |
| Max. Negotiated Rate |
$29.69 |
| Rate for Payer: Aetna Commercial |
$27.58
|
| Rate for Payer: Cash Price |
$19.79
|
| Rate for Payer: Cigna All Commercial |
$27.55
|
| Rate for Payer: CORVEL All Commercial |
$29.69
|
| Rate for Payer: Coventry All Commercial |
$28.09
|
| Rate for Payer: Encore All Commercial |
$29.38
|
| Rate for Payer: Frontpath All Commercial |
$29.37
|
| Rate for Payer: Humana ChoiceCare |
$27.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.73
|
| Rate for Payer: PHCS All Commercial |
$23.94
|
| Rate for Payer: PHP All Commercial |
$24.21
|
| Rate for Payer: Sagamore Health Network All Products |
$24.64
|
| Rate for Payer: Signature Care EPO |
$26.49
|
| Rate for Payer: Signature Care PPO |
$28.09
|
| Rate for Payer: United Healthcare Commercial |
$25.15
|
|
|
NETARSUDIL 0.02 % OPHT DROP
|
Facility
OP
|
$1,230.92
|
|
|
Service Code
|
NDC 70727049725
|
| Hospital Charge Code |
184178
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$406.20 |
| Max. Negotiated Rate |
$1,144.76 |
| Rate for Payer: Aetna Commercial |
$1,038.90
|
| Rate for Payer: Aetna Medicare |
$406.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$406.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$706.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$769.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$467.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$446.82
|
| Rate for Payer: Cash Price |
$763.17
|
| Rate for Payer: Centivo All Commercial |
$627.77
|
| Rate for Payer: Cigna All Commercial |
$1,062.28
|
| Rate for Payer: CORVEL All Commercial |
$1,144.76
|
| Rate for Payer: Coventry All Commercial |
$1,083.21
|
| Rate for Payer: Encore All Commercial |
$1,133.06
|
| Rate for Payer: Frontpath All Commercial |
$1,132.45
|
| Rate for Payer: Humana ChoiceCare |
$1,063.15
|
| Rate for Payer: Humana Medicare |
$627.77
|
| Rate for Payer: Lucent All Commercial |
$627.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,107.83
|
| Rate for Payer: PHCS All Commercial |
$923.19
|
| Rate for Payer: PHP All Commercial |
$933.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$480.06
|
| Rate for Payer: Sagamore Health Network All Products |
$950.27
|
| Rate for Payer: Signature Care EPO |
$1,021.66
|
| Rate for Payer: Signature Care PPO |
$1,083.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,046.28
|
| Rate for Payer: United Healthcare Commercial |
$969.96
|
| Rate for Payer: United Healthcare Medicare |
$406.20
|
|
|
NETARSUDIL 0.02 % OPHT DROP
|
Facility
IP
|
$1,230.92
|
|
|
Service Code
|
NDC 70727049725
|
| Hospital Charge Code |
184178
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$923.19 |
| Max. Negotiated Rate |
$1,144.76 |
| Rate for Payer: Aetna Commercial |
$1,063.51
|
| Rate for Payer: Cash Price |
$763.17
|
| Rate for Payer: Cigna All Commercial |
$1,062.28
|
| Rate for Payer: CORVEL All Commercial |
$1,144.76
|
| Rate for Payer: Coventry All Commercial |
$1,083.21
|
| Rate for Payer: Encore All Commercial |
$1,133.06
|
| Rate for Payer: Frontpath All Commercial |
$1,132.45
|
| Rate for Payer: Humana ChoiceCare |
$1,063.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,107.83
|
| Rate for Payer: PHCS All Commercial |
$923.19
|
| Rate for Payer: PHP All Commercial |
$933.53
|
| Rate for Payer: Sagamore Health Network All Products |
$950.27
|
| Rate for Payer: Signature Care EPO |
$1,021.66
|
| Rate for Payer: Signature Care PPO |
$1,083.21
|
| Rate for Payer: United Healthcare Commercial |
$969.96
|
|
|
Neuroplasty and/or transposition; median nerve at carpal tunnel
|
Facility
OP
|
$1,728.79
|
|
|
Service Code
|
CPT 64721
|
| Hospital Charge Code |
CPT-64721
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,728.79 |
| Max. Negotiated Rate |
$1,728.79 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,728.79
|
| Rate for Payer: Managed Health Services Medicaid |
$1,728.79
|
| Rate for Payer: MDWise Medicaid |
$1,728.79
|
|
|
Neuroplasty and/or transposition; ulnar nerve at elbow
|
Facility
OP
|
$1,728.79
|
|
|
Service Code
|
CPT 64718
|
| Hospital Charge Code |
CPT-64718
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,728.79 |
| Max. Negotiated Rate |
$1,728.79 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,728.79
|
| Rate for Payer: Managed Health Services Medicaid |
$1,728.79
|
| Rate for Payer: MDWise Medicaid |
$1,728.79
|
|
|
Neuroplasty and/or transposition; ulnar nerve at wrist
|
Facility
OP
|
$1,728.79
|
|
|
Service Code
|
CPT 64719
|
| Hospital Charge Code |
CPT-64719
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,728.79 |
| Max. Negotiated Rate |
$1,728.79 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,728.79
|
| Rate for Payer: Managed Health Services Medicaid |
$1,728.79
|
| Rate for Payer: MDWise Medicaid |
$1,728.79
|
|
|
NICARDIPINE 25 MG/10 ML IV SOLN
|
Facility
OP
|
$57.96
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
12370
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$53.90 |
| Rate for Payer: Aetna Commercial |
$48.92
|
| Rate for Payer: Aetna Medicare |
$19.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.04
|
| Rate for Payer: Cash Price |
$35.94
|
| Rate for Payer: Centivo All Commercial |
$29.56
|
| Rate for Payer: Cigna All Commercial |
$50.02
|
| Rate for Payer: CORVEL All Commercial |
$53.90
|
| Rate for Payer: Coventry All Commercial |
$51.00
|
| Rate for Payer: Encore All Commercial |
$53.35
|
| Rate for Payer: Frontpath All Commercial |
$53.32
|
| Rate for Payer: Humana ChoiceCare |
$50.06
|
| Rate for Payer: Humana Medicare |
$29.56
|
| Rate for Payer: Lucent All Commercial |
$29.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.16
|
| Rate for Payer: PHCS All Commercial |
$43.47
|
| Rate for Payer: PHP All Commercial |
$43.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.60
|
| Rate for Payer: Sagamore Health Network All Products |
$44.75
|
| Rate for Payer: Signature Care EPO |
$48.11
|
| Rate for Payer: Signature Care PPO |
$51.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.27
|
| Rate for Payer: United Healthcare Commercial |
$45.67
|
| Rate for Payer: United Healthcare Medicare |
$19.13
|
|
|
NICARDIPINE 25 MG/10 ML IV SOLN
|
Facility
IP
|
$57.96
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
12370
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.47 |
| Max. Negotiated Rate |
$53.90 |
| Rate for Payer: Aetna Commercial |
$50.08
|
| Rate for Payer: Cash Price |
$35.94
|
| Rate for Payer: Cigna All Commercial |
$50.02
|
| Rate for Payer: CORVEL All Commercial |
$53.90
|
| Rate for Payer: Coventry All Commercial |
$51.00
|
| Rate for Payer: Encore All Commercial |
$53.35
|
| Rate for Payer: Frontpath All Commercial |
$53.32
|
| Rate for Payer: Humana ChoiceCare |
$50.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.16
|
| Rate for Payer: PHCS All Commercial |
$43.47
|
| Rate for Payer: PHP All Commercial |
$43.96
|
| Rate for Payer: Sagamore Health Network All Products |
$44.75
|
| Rate for Payer: Signature Care EPO |
$48.11
|
| Rate for Payer: Signature Care PPO |
$51.00
|
| Rate for Payer: United Healthcare Commercial |
$45.67
|
|
|
NICARDIPINE 40 MG/200 ML (200 MCG/ML) INFUSION
|
Facility
OP
|
$346.80
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
94576
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.44 |
| Max. Negotiated Rate |
$322.52 |
| Rate for Payer: Aetna Commercial |
$292.70
|
| Rate for Payer: Aetna Medicare |
$114.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$114.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$199.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$216.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$131.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$125.89
|
| Rate for Payer: Cash Price |
$215.02
|
| Rate for Payer: Centivo All Commercial |
$176.87
|
| Rate for Payer: Cigna All Commercial |
$299.29
|
| Rate for Payer: CORVEL All Commercial |
$322.52
|
| Rate for Payer: Coventry All Commercial |
$305.18
|
| Rate for Payer: Encore All Commercial |
$319.23
|
| Rate for Payer: Frontpath All Commercial |
$319.06
|
| Rate for Payer: Humana ChoiceCare |
$299.53
|
| Rate for Payer: Humana Medicare |
$176.87
|
| Rate for Payer: Lucent All Commercial |
$176.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$312.12
|
| Rate for Payer: PHCS All Commercial |
$260.10
|
| Rate for Payer: PHP All Commercial |
$263.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.25
|
| Rate for Payer: Sagamore Health Network All Products |
$267.73
|
| Rate for Payer: Signature Care EPO |
$287.84
|
| Rate for Payer: Signature Care PPO |
$305.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$294.78
|
| Rate for Payer: United Healthcare Commercial |
$273.28
|
| Rate for Payer: United Healthcare Medicare |
$114.44
|
|
|
NICARDIPINE 40 MG/200 ML (200 MCG/ML) INFUSION
|
Facility
IP
|
$346.80
|
|
|
Service Code
|
HCPCS J2404
|
| Hospital Charge Code |
94576
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$260.10 |
| Max. Negotiated Rate |
$322.52 |
| Rate for Payer: Aetna Commercial |
$299.64
|
| Rate for Payer: Cash Price |
$215.02
|
| Rate for Payer: Cigna All Commercial |
$299.29
|
| Rate for Payer: CORVEL All Commercial |
$322.52
|
| Rate for Payer: Coventry All Commercial |
$305.18
|
| Rate for Payer: Encore All Commercial |
$319.23
|
| Rate for Payer: Frontpath All Commercial |
$319.06
|
| Rate for Payer: Humana ChoiceCare |
$299.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$312.12
|
| Rate for Payer: PHCS All Commercial |
$260.10
|
| Rate for Payer: PHP All Commercial |
$263.01
|
| Rate for Payer: Sagamore Health Network All Products |
$267.73
|
| Rate for Payer: Signature Care EPO |
$287.84
|
| Rate for Payer: Signature Care PPO |
$305.18
|
| Rate for Payer: United Healthcare Commercial |
$273.28
|
|
|
NICOTINE 14 MG/24 HR TD PT24
|
Facility
OP
|
$11.99
|
|
|
Service Code
|
NDC 00536110788
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.96 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: Aetna Commercial |
$10.12
|
| Rate for Payer: Aetna Medicare |
$3.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.35
|
| Rate for Payer: Cash Price |
$7.43
|
| Rate for Payer: Centivo All Commercial |
$6.12
|
| Rate for Payer: Cigna All Commercial |
$10.35
|
| Rate for Payer: CORVEL All Commercial |
$11.15
|
| Rate for Payer: Coventry All Commercial |
$10.55
|
| Rate for Payer: Encore All Commercial |
$11.04
|
| Rate for Payer: Frontpath All Commercial |
$11.03
|
| Rate for Payer: Humana ChoiceCare |
$10.36
|
| Rate for Payer: Humana Medicare |
$6.12
|
| Rate for Payer: Lucent All Commercial |
$6.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.79
|
| Rate for Payer: PHCS All Commercial |
$8.99
|
| Rate for Payer: PHP All Commercial |
$9.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.68
|
| Rate for Payer: Sagamore Health Network All Products |
$9.26
|
| Rate for Payer: Signature Care EPO |
$9.95
|
| Rate for Payer: Signature Care PPO |
$10.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.19
|
| Rate for Payer: United Healthcare Commercial |
$9.45
|
| Rate for Payer: United Healthcare Medicare |
$3.96
|
|
|
NICOTINE 14 MG/24 HR TD PT24
|
Facility
IP
|
$11.99
|
|
|
Service Code
|
NDC 00536110788
|
| Hospital Charge Code |
27862
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: Aetna Commercial |
$10.36
|
| Rate for Payer: Cash Price |
$7.43
|
| Rate for Payer: Cigna All Commercial |
$10.35
|
| Rate for Payer: CORVEL All Commercial |
$11.15
|
| Rate for Payer: Coventry All Commercial |
$10.55
|
| Rate for Payer: Encore All Commercial |
$11.04
|
| Rate for Payer: Frontpath All Commercial |
$11.03
|
| Rate for Payer: Humana ChoiceCare |
$10.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.79
|
| Rate for Payer: PHCS All Commercial |
$8.99
|
| Rate for Payer: PHP All Commercial |
$9.09
|
| Rate for Payer: Sagamore Health Network All Products |
$9.26
|
| Rate for Payer: Signature Care EPO |
$9.95
|
| Rate for Payer: Signature Care PPO |
$10.55
|
| Rate for Payer: United Healthcare Commercial |
$9.45
|
|
|
NICOTINE 21 MG/24 HR TD PT24
|
Facility
OP
|
$13.93
|
|
|
Service Code
|
NDC 00536589653
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$12.95 |
| Rate for Payer: Aetna Commercial |
$11.76
|
| Rate for Payer: Aetna Medicare |
$4.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$8.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.06
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Centivo All Commercial |
$7.10
|
| Rate for Payer: Cigna All Commercial |
$12.02
|
| Rate for Payer: CORVEL All Commercial |
$12.95
|
| Rate for Payer: Coventry All Commercial |
$12.26
|
| Rate for Payer: Encore All Commercial |
$12.82
|
| Rate for Payer: Frontpath All Commercial |
$12.82
|
| Rate for Payer: Humana ChoiceCare |
$12.03
|
| Rate for Payer: Humana Medicare |
$7.10
|
| Rate for Payer: Lucent All Commercial |
$7.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.54
|
| Rate for Payer: PHCS All Commercial |
$10.45
|
| Rate for Payer: PHP All Commercial |
$10.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.43
|
| Rate for Payer: Sagamore Health Network All Products |
$10.75
|
| Rate for Payer: Signature Care EPO |
$11.56
|
| Rate for Payer: Signature Care PPO |
$12.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.84
|
| Rate for Payer: United Healthcare Commercial |
$10.98
|
| Rate for Payer: United Healthcare Medicare |
$4.60
|
|
|
NICOTINE 21 MG/24 HR TD PT24
|
Facility
IP
|
$13.93
|
|
|
Service Code
|
NDC 00536589653
|
| Hospital Charge Code |
27863
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$12.95 |
| Rate for Payer: Aetna Commercial |
$12.04
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cigna All Commercial |
$12.02
|
| Rate for Payer: CORVEL All Commercial |
$12.95
|
| Rate for Payer: Coventry All Commercial |
$12.26
|
| Rate for Payer: Encore All Commercial |
$12.82
|
| Rate for Payer: Frontpath All Commercial |
$12.82
|
| Rate for Payer: Humana ChoiceCare |
$12.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.54
|
| Rate for Payer: PHCS All Commercial |
$10.45
|
| Rate for Payer: PHP All Commercial |
$10.56
|
| Rate for Payer: Sagamore Health Network All Products |
$10.75
|
| Rate for Payer: Signature Care EPO |
$11.56
|
| Rate for Payer: Signature Care PPO |
$12.26
|
| Rate for Payer: United Healthcare Commercial |
$10.98
|
|
|
NICOTINE 7 MG/24 HR TD PT24
|
Facility
OP
|
$14.61
|
|
|
Service Code
|
NDC 00536589453
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$13.59 |
| Rate for Payer: Aetna Commercial |
$12.33
|
| Rate for Payer: Aetna Medicare |
$4.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.30
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Centivo All Commercial |
$7.45
|
| Rate for Payer: Cigna All Commercial |
$12.61
|
| Rate for Payer: CORVEL All Commercial |
$13.59
|
| Rate for Payer: Coventry All Commercial |
$12.86
|
| Rate for Payer: Encore All Commercial |
$13.45
|
| Rate for Payer: Frontpath All Commercial |
$13.44
|
| Rate for Payer: Humana ChoiceCare |
$12.62
|
| Rate for Payer: Humana Medicare |
$7.45
|
| Rate for Payer: Lucent All Commercial |
$7.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.15
|
| Rate for Payer: PHCS All Commercial |
$10.96
|
| Rate for Payer: PHP All Commercial |
$11.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.70
|
| Rate for Payer: Sagamore Health Network All Products |
$11.28
|
| Rate for Payer: Signature Care EPO |
$12.13
|
| Rate for Payer: Signature Care PPO |
$12.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.42
|
| Rate for Payer: United Healthcare Commercial |
$11.51
|
| Rate for Payer: United Healthcare Medicare |
$4.82
|
|
|
NICOTINE 7 MG/24 HR TD PT24
|
Facility
IP
|
$14.61
|
|
|
Service Code
|
NDC 00536589453
|
| Hospital Charge Code |
27860
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$13.59 |
| Rate for Payer: Aetna Commercial |
$12.62
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cigna All Commercial |
$12.61
|
| Rate for Payer: CORVEL All Commercial |
$13.59
|
| Rate for Payer: Coventry All Commercial |
$12.86
|
| Rate for Payer: Encore All Commercial |
$13.45
|
| Rate for Payer: Frontpath All Commercial |
$13.44
|
| Rate for Payer: Humana ChoiceCare |
$12.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.15
|
| Rate for Payer: PHCS All Commercial |
$10.96
|
| Rate for Payer: PHP All Commercial |
$11.08
|
| Rate for Payer: Sagamore Health Network All Products |
$11.28
|
| Rate for Payer: Signature Care EPO |
$12.13
|
| Rate for Payer: Signature Care PPO |
$12.86
|
| Rate for Payer: United Healthcare Commercial |
$11.51
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCL GUM
|
Facility
IP
|
$2.99
|
|
|
Service Code
|
NDC 00536136234
|
| Hospital Charge Code |
10717
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: Aetna Commercial |
$2.58
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Cigna All Commercial |
$2.58
|
| Rate for Payer: CORVEL All Commercial |
$2.78
|
| Rate for Payer: Coventry All Commercial |
$2.63
|
| Rate for Payer: Encore All Commercial |
$2.75
|
| Rate for Payer: Frontpath All Commercial |
$2.75
|
| Rate for Payer: Humana ChoiceCare |
$2.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.69
|
| Rate for Payer: PHCS All Commercial |
$2.24
|
| Rate for Payer: PHP All Commercial |
$2.27
|
| Rate for Payer: Sagamore Health Network All Products |
$2.31
|
| Rate for Payer: Signature Care EPO |
$2.48
|
| Rate for Payer: Signature Care PPO |
$2.63
|
| Rate for Payer: United Healthcare Commercial |
$2.36
|
|
|
NICOTINE (POLACRILEX) 2 MG BUCL GUM
|
Facility
OP
|
$2.99
|
|
|
Service Code
|
NDC 00536136234
|
| Hospital Charge Code |
10717
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$2.78 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna Medicare |
$0.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.09
|
| Rate for Payer: Cash Price |
$1.85
|
| Rate for Payer: Centivo All Commercial |
$1.52
|
| Rate for Payer: Cigna All Commercial |
$2.58
|
| Rate for Payer: CORVEL All Commercial |
$2.78
|
| Rate for Payer: Coventry All Commercial |
$2.63
|
| Rate for Payer: Encore All Commercial |
$2.75
|
| Rate for Payer: Frontpath All Commercial |
$2.75
|
| Rate for Payer: Humana ChoiceCare |
$2.58
|
| Rate for Payer: Humana Medicare |
$1.52
|
| Rate for Payer: Lucent All Commercial |
$1.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.69
|
| Rate for Payer: PHCS All Commercial |
$2.24
|
| Rate for Payer: PHP All Commercial |
$2.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.17
|
| Rate for Payer: Sagamore Health Network All Products |
$2.31
|
| Rate for Payer: Signature Care EPO |
$2.48
|
| Rate for Payer: Signature Care PPO |
$2.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.54
|
| Rate for Payer: United Healthcare Commercial |
$2.36
|
| Rate for Payer: United Healthcare Medicare |
$0.99
|
|
|
NIFEDIPINE 10 MG ORAL CAP
|
Facility
IP
|
$4.82
|
|
|
Service Code
|
NDC 00904722961
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Aetna Commercial |
$4.17
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Cigna All Commercial |
$4.16
|
| Rate for Payer: CORVEL All Commercial |
$4.49
|
| Rate for Payer: Coventry All Commercial |
$4.24
|
| Rate for Payer: Encore All Commercial |
$4.44
|
| Rate for Payer: Frontpath All Commercial |
$4.44
|
| Rate for Payer: Humana ChoiceCare |
$4.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.34
|
| Rate for Payer: PHCS All Commercial |
$3.62
|
| Rate for Payer: PHP All Commercial |
$3.66
|
| Rate for Payer: Sagamore Health Network All Products |
$3.72
|
| Rate for Payer: Signature Care EPO |
$4.00
|
| Rate for Payer: Signature Care PPO |
$4.24
|
| Rate for Payer: United Healthcare Commercial |
$3.80
|
|
|
NIFEDIPINE 10 MG ORAL CAP
|
Facility
OP
|
$4.82
|
|
|
Service Code
|
NDC 00904722961
|
| Hospital Charge Code |
5558
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$4.49 |
| Rate for Payer: Aetna Commercial |
$4.07
|
| Rate for Payer: Aetna Medicare |
$1.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.75
|
| Rate for Payer: Cash Price |
$2.99
|
| Rate for Payer: Centivo All Commercial |
$2.46
|
| Rate for Payer: Cigna All Commercial |
$4.16
|
| Rate for Payer: CORVEL All Commercial |
$4.49
|
| Rate for Payer: Coventry All Commercial |
$4.24
|
| Rate for Payer: Encore All Commercial |
$4.44
|
| Rate for Payer: Frontpath All Commercial |
$4.44
|
| Rate for Payer: Humana ChoiceCare |
$4.17
|
| Rate for Payer: Humana Medicare |
$2.46
|
| Rate for Payer: Lucent All Commercial |
$2.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.34
|
| Rate for Payer: PHCS All Commercial |
$3.62
|
| Rate for Payer: PHP All Commercial |
$3.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.88
|
| Rate for Payer: Sagamore Health Network All Products |
$3.72
|
| Rate for Payer: Signature Care EPO |
$4.00
|
| Rate for Payer: Signature Care PPO |
$4.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.10
|
| Rate for Payer: United Healthcare Commercial |
$3.80
|
| Rate for Payer: United Healthcare Medicare |
$1.59
|
|
|
NIFEDIPINE 30 MG ORAL TR24
|
Facility
OP
|
$5.72
|
|
|
Service Code
|
NDC 68084059701
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna Commercial |
$4.83
|
| Rate for Payer: Aetna Medicare |
$1.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.08
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Centivo All Commercial |
$2.92
|
| Rate for Payer: Cigna All Commercial |
$4.94
|
| Rate for Payer: CORVEL All Commercial |
$5.32
|
| Rate for Payer: Coventry All Commercial |
$5.03
|
| Rate for Payer: Encore All Commercial |
$5.26
|
| Rate for Payer: Frontpath All Commercial |
$5.26
|
| Rate for Payer: Humana ChoiceCare |
$4.94
|
| Rate for Payer: Humana Medicare |
$2.92
|
| Rate for Payer: Lucent All Commercial |
$2.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.15
|
| Rate for Payer: PHCS All Commercial |
$4.29
|
| Rate for Payer: PHP All Commercial |
$4.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.23
|
| Rate for Payer: Sagamore Health Network All Products |
$4.42
|
| Rate for Payer: Signature Care EPO |
$4.75
|
| Rate for Payer: Signature Care PPO |
$5.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.86
|
| Rate for Payer: United Healthcare Commercial |
$4.51
|
| Rate for Payer: United Healthcare Medicare |
$1.89
|
|
|
NIFEDIPINE 30 MG ORAL TR24
|
Facility
IP
|
$5.72
|
|
|
Service Code
|
NDC 68084059701
|
| Hospital Charge Code |
27333
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$5.32 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Cash Price |
$3.55
|
| Rate for Payer: Cigna All Commercial |
$4.94
|
| Rate for Payer: CORVEL All Commercial |
$5.32
|
| Rate for Payer: Coventry All Commercial |
$5.03
|
| Rate for Payer: Encore All Commercial |
$5.26
|
| Rate for Payer: Frontpath All Commercial |
$5.26
|
| Rate for Payer: Humana ChoiceCare |
$4.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.15
|
| Rate for Payer: PHCS All Commercial |
$4.29
|
| Rate for Payer: PHP All Commercial |
$4.34
|
| Rate for Payer: Sagamore Health Network All Products |
$4.42
|
| Rate for Payer: Signature Care EPO |
$4.75
|
| Rate for Payer: Signature Care PPO |
$5.03
|
| Rate for Payer: United Healthcare Commercial |
$4.51
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML IM SYRG
|
Facility
IP
|
$1,932.50
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
202293
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,449.37 |
| Max. Negotiated Rate |
$1,797.22 |
| Rate for Payer: Aetna Commercial |
$1,669.68
|
| Rate for Payer: Cash Price |
$1,198.15
|
| Rate for Payer: Cigna All Commercial |
$1,667.74
|
| Rate for Payer: CORVEL All Commercial |
$1,797.22
|
| Rate for Payer: Coventry All Commercial |
$1,700.60
|
| Rate for Payer: Encore All Commercial |
$1,778.86
|
| Rate for Payer: Frontpath All Commercial |
$1,777.90
|
| Rate for Payer: Humana ChoiceCare |
$1,669.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,739.25
|
| Rate for Payer: PHCS All Commercial |
$1,449.37
|
| Rate for Payer: PHP All Commercial |
$1,465.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,491.89
|
| Rate for Payer: Signature Care EPO |
$1,603.97
|
| Rate for Payer: Signature Care PPO |
$1,700.60
|
| Rate for Payer: United Healthcare Commercial |
$1,522.81
|
|
|
NIRSEVIMAB-ALIP 100 MG/ML IM SYRG
|
Facility
OP
|
$1,932.50
|
|
|
Service Code
|
HCPCS 90381
|
| Hospital Charge Code |
202293
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$637.72 |
| Max. Negotiated Rate |
$1,797.22 |
| Rate for Payer: Aetna Commercial |
$1,631.03
|
| Rate for Payer: Aetna Medicare |
$637.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$637.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,109.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,208.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$733.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$701.50
|
| Rate for Payer: Cash Price |
$1,198.15
|
| Rate for Payer: Centivo All Commercial |
$985.57
|
| Rate for Payer: Cigna All Commercial |
$1,667.74
|
| Rate for Payer: CORVEL All Commercial |
$1,797.22
|
| Rate for Payer: Coventry All Commercial |
$1,700.60
|
| Rate for Payer: Encore All Commercial |
$1,778.86
|
| Rate for Payer: Frontpath All Commercial |
$1,777.90
|
| Rate for Payer: Humana ChoiceCare |
$1,669.10
|
| Rate for Payer: Humana Medicare |
$985.57
|
| Rate for Payer: Lucent All Commercial |
$985.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,739.25
|
| Rate for Payer: PHCS All Commercial |
$1,449.37
|
| Rate for Payer: PHP All Commercial |
$1,465.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$753.67
|
| Rate for Payer: Sagamore Health Network All Products |
$1,491.89
|
| Rate for Payer: Signature Care EPO |
$1,603.97
|
| Rate for Payer: Signature Care PPO |
$1,700.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,642.62
|
| Rate for Payer: United Healthcare Commercial |
$1,522.81
|
| Rate for Payer: United Healthcare Medicare |
$637.72
|
|
