|
OCRELIZUMAB 30 MG/ML IV SOLN
|
Facility
IP
|
$69,000.33
|
|
|
Service Code
|
HCPCS J2350
|
| Hospital Charge Code |
180498
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$51,750.25 |
| Max. Negotiated Rate |
$64,170.31 |
| Rate for Payer: Aetna Commercial |
$59,616.29
|
| Rate for Payer: Cash Price |
$42,780.20
|
| Rate for Payer: Cigna All Commercial |
$59,547.28
|
| Rate for Payer: CORVEL All Commercial |
$64,170.31
|
| Rate for Payer: Coventry All Commercial |
$60,720.29
|
| Rate for Payer: Encore All Commercial |
$63,514.80
|
| Rate for Payer: Frontpath All Commercial |
$63,480.30
|
| Rate for Payer: Humana ChoiceCare |
$59,595.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62,100.30
|
| Rate for Payer: PHCS All Commercial |
$51,750.25
|
| Rate for Payer: PHP All Commercial |
$52,329.85
|
| Rate for Payer: Sagamore Health Network All Products |
$53,268.25
|
| Rate for Payer: Signature Care EPO |
$57,270.27
|
| Rate for Payer: Signature Care PPO |
$60,720.29
|
| Rate for Payer: United Healthcare Commercial |
$54,372.26
|
|
|
OCRELIZUMAB 30 MG/ML IV SOLN
|
Facility
OP
|
$69,000.33
|
|
|
Service Code
|
HCPCS J2350
|
| Hospital Charge Code |
180498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.71 |
| Max. Negotiated Rate |
$64,170.31 |
| Rate for Payer: Aetna Commercial |
$58,236.28
|
| Rate for Payer: Aetna Medicare |
$22,770.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$22,770.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39,626.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$43,132.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$65.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26,185.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25,047.12
|
| Rate for Payer: Cash Price |
$42,780.20
|
| Rate for Payer: Cash Price |
$42,780.20
|
| Rate for Payer: Centivo All Commercial |
$35,190.17
|
| Rate for Payer: Cigna All Commercial |
$59,547.28
|
| Rate for Payer: CORVEL All Commercial |
$64,170.31
|
| Rate for Payer: Coventry All Commercial |
$60,720.29
|
| Rate for Payer: Encore All Commercial |
$63,514.80
|
| Rate for Payer: Frontpath All Commercial |
$63,480.30
|
| Rate for Payer: Humana ChoiceCare |
$59,595.59
|
| Rate for Payer: Humana Medicare |
$35,190.17
|
| Rate for Payer: Lucent All Commercial |
$35,190.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62,100.30
|
| Rate for Payer: Managed Health Services Medicaid |
$65.71
|
| Rate for Payer: MDWise Medicaid |
$65.71
|
| Rate for Payer: PHCS All Commercial |
$51,750.25
|
| Rate for Payer: PHP All Commercial |
$52,329.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26,910.13
|
| Rate for Payer: Sagamore Health Network All Products |
$53,268.25
|
| Rate for Payer: Signature Care EPO |
$57,270.27
|
| Rate for Payer: Signature Care PPO |
$60,720.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58,650.28
|
| Rate for Payer: United Healthcare Commercial |
$54,372.26
|
| Rate for Payer: United Healthcare Medicare |
$22,770.11
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJ SOLN
|
Facility
OP
|
$181.80
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91279
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$169.08 |
| Rate for Payer: Aetna Commercial |
$153.44
|
| Rate for Payer: Aetna Medicare |
$60.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$104.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$113.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$68.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$65.99
|
| Rate for Payer: Cash Price |
$112.72
|
| Rate for Payer: Centivo All Commercial |
$92.72
|
| Rate for Payer: Cigna All Commercial |
$156.90
|
| Rate for Payer: CORVEL All Commercial |
$169.08
|
| Rate for Payer: Coventry All Commercial |
$159.99
|
| Rate for Payer: Encore All Commercial |
$167.35
|
| Rate for Payer: Frontpath All Commercial |
$167.26
|
| Rate for Payer: Humana ChoiceCare |
$157.02
|
| Rate for Payer: Humana Medicare |
$92.72
|
| Rate for Payer: Lucent All Commercial |
$92.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$163.62
|
| Rate for Payer: PHCS All Commercial |
$136.35
|
| Rate for Payer: PHP All Commercial |
$137.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$70.90
|
| Rate for Payer: Sagamore Health Network All Products |
$140.35
|
| Rate for Payer: Signature Care EPO |
$150.90
|
| Rate for Payer: Signature Care PPO |
$159.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$154.53
|
| Rate for Payer: United Healthcare Commercial |
$143.26
|
| Rate for Payer: United Healthcare Medicare |
$60.00
|
|
|
OCTREOTIDE ACETATE 100 MCG/ML INJ SOLN
|
Facility
IP
|
$181.80
|
|
|
Service Code
|
HCPCS J2354
|
| Hospital Charge Code |
91279
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$136.35 |
| Max. Negotiated Rate |
$169.08 |
| Rate for Payer: Aetna Commercial |
$157.08
|
| Rate for Payer: Cash Price |
$112.72
|
| Rate for Payer: Cigna All Commercial |
$156.90
|
| Rate for Payer: CORVEL All Commercial |
$169.08
|
| Rate for Payer: Coventry All Commercial |
$159.99
|
| Rate for Payer: Encore All Commercial |
$167.35
|
| Rate for Payer: Frontpath All Commercial |
$167.26
|
| Rate for Payer: Humana ChoiceCare |
$157.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$163.62
|
| Rate for Payer: PHCS All Commercial |
$136.35
|
| Rate for Payer: PHP All Commercial |
$137.88
|
| Rate for Payer: Sagamore Health Network All Products |
$140.35
|
| Rate for Payer: Signature Care EPO |
$150.90
|
| Rate for Payer: Signature Care PPO |
$159.99
|
| Rate for Payer: United Healthcare Commercial |
$143.26
|
|
|
OCTREOTIDE,MICROSPHERES 20 MG IM SERR
|
Facility
IP
|
$15,324.96
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
172236
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11,493.72 |
| Max. Negotiated Rate |
$14,252.21 |
| Rate for Payer: Aetna Commercial |
$13,240.77
|
| Rate for Payer: Cash Price |
$9,501.48
|
| Rate for Payer: Cigna All Commercial |
$13,225.44
|
| Rate for Payer: CORVEL All Commercial |
$14,252.21
|
| Rate for Payer: Coventry All Commercial |
$13,485.96
|
| Rate for Payer: Encore All Commercial |
$14,106.63
|
| Rate for Payer: Frontpath All Commercial |
$14,098.96
|
| Rate for Payer: Humana ChoiceCare |
$13,236.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13,792.46
|
| Rate for Payer: PHCS All Commercial |
$11,493.72
|
| Rate for Payer: PHP All Commercial |
$11,622.45
|
| Rate for Payer: Sagamore Health Network All Products |
$11,830.87
|
| Rate for Payer: Signature Care EPO |
$12,719.72
|
| Rate for Payer: Signature Care PPO |
$13,485.96
|
| Rate for Payer: United Healthcare Commercial |
$12,076.07
|
|
|
OCTREOTIDE,MICROSPHERES 20 MG IM SERR
|
Facility
OP
|
$15,324.96
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
172236
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.54 |
| Max. Negotiated Rate |
$14,252.21 |
| Rate for Payer: Aetna Commercial |
$12,934.27
|
| Rate for Payer: Aetna Medicare |
$5,057.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5,057.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8,801.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,579.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$232.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5,815.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5,562.96
|
| Rate for Payer: Cash Price |
$9,501.48
|
| Rate for Payer: Cash Price |
$9,501.48
|
| Rate for Payer: Centivo All Commercial |
$7,815.73
|
| Rate for Payer: Cigna All Commercial |
$13,225.44
|
| Rate for Payer: CORVEL All Commercial |
$14,252.21
|
| Rate for Payer: Coventry All Commercial |
$13,485.96
|
| Rate for Payer: Encore All Commercial |
$14,106.63
|
| Rate for Payer: Frontpath All Commercial |
$14,098.96
|
| Rate for Payer: Humana ChoiceCare |
$13,236.17
|
| Rate for Payer: Humana Medicare |
$7,815.73
|
| Rate for Payer: Lucent All Commercial |
$7,815.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13,792.46
|
| Rate for Payer: Managed Health Services Medicaid |
$232.54
|
| Rate for Payer: MDWise Medicaid |
$232.54
|
| Rate for Payer: PHCS All Commercial |
$11,493.72
|
| Rate for Payer: PHP All Commercial |
$11,622.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,976.73
|
| Rate for Payer: Sagamore Health Network All Products |
$11,830.87
|
| Rate for Payer: Signature Care EPO |
$12,719.72
|
| Rate for Payer: Signature Care PPO |
$13,485.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13,026.22
|
| Rate for Payer: United Healthcare Commercial |
$12,076.07
|
| Rate for Payer: United Healthcare Medicare |
$5,057.24
|
|
|
OCTREOTIDE,MICROSPHERES 30 MG IM SERR
|
Facility
OP
|
$22,947.96
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
172237
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.54 |
| Max. Negotiated Rate |
$21,341.60 |
| Rate for Payer: Aetna Commercial |
$19,368.08
|
| Rate for Payer: Aetna Medicare |
$7,572.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7,572.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13,179.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14,344.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$232.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8,708.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8,330.11
|
| Rate for Payer: Cash Price |
$14,227.74
|
| Rate for Payer: Cash Price |
$14,227.74
|
| Rate for Payer: Centivo All Commercial |
$11,703.46
|
| Rate for Payer: Cigna All Commercial |
$19,804.09
|
| Rate for Payer: CORVEL All Commercial |
$21,341.60
|
| Rate for Payer: Coventry All Commercial |
$20,194.20
|
| Rate for Payer: Encore All Commercial |
$21,123.60
|
| Rate for Payer: Frontpath All Commercial |
$21,112.12
|
| Rate for Payer: Humana ChoiceCare |
$19,820.15
|
| Rate for Payer: Humana Medicare |
$11,703.46
|
| Rate for Payer: Lucent All Commercial |
$11,703.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20,653.16
|
| Rate for Payer: Managed Health Services Medicaid |
$232.54
|
| Rate for Payer: MDWise Medicaid |
$232.54
|
| Rate for Payer: PHCS All Commercial |
$17,210.97
|
| Rate for Payer: PHP All Commercial |
$17,403.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8,949.70
|
| Rate for Payer: Sagamore Health Network All Products |
$17,715.83
|
| Rate for Payer: Signature Care EPO |
$19,046.81
|
| Rate for Payer: Signature Care PPO |
$20,194.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19,505.77
|
| Rate for Payer: United Healthcare Commercial |
$18,082.99
|
| Rate for Payer: United Healthcare Medicare |
$7,572.83
|
|
|
OCTREOTIDE,MICROSPHERES 30 MG IM SERR
|
Facility
IP
|
$22,947.96
|
|
|
Service Code
|
HCPCS J2353
|
| Hospital Charge Code |
172237
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17,210.97 |
| Max. Negotiated Rate |
$21,341.60 |
| Rate for Payer: Aetna Commercial |
$19,827.04
|
| Rate for Payer: Cash Price |
$14,227.74
|
| Rate for Payer: Cigna All Commercial |
$19,804.09
|
| Rate for Payer: CORVEL All Commercial |
$21,341.60
|
| Rate for Payer: Coventry All Commercial |
$20,194.20
|
| Rate for Payer: Encore All Commercial |
$21,123.60
|
| Rate for Payer: Frontpath All Commercial |
$21,112.12
|
| Rate for Payer: Humana ChoiceCare |
$19,820.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20,653.16
|
| Rate for Payer: PHCS All Commercial |
$17,210.97
|
| Rate for Payer: PHP All Commercial |
$17,403.73
|
| Rate for Payer: Sagamore Health Network All Products |
$17,715.83
|
| Rate for Payer: Signature Care EPO |
$19,046.81
|
| Rate for Payer: Signature Care PPO |
$20,194.20
|
| Rate for Payer: United Healthcare Commercial |
$18,082.99
|
|
|
OFLOXACIN 0.3 % OPHT DROP
|
Facility
IP
|
$47.04
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$43.75 |
| Rate for Payer: Aetna Commercial |
$40.64
|
| Rate for Payer: Cash Price |
$29.16
|
| Rate for Payer: Cigna All Commercial |
$40.60
|
| Rate for Payer: CORVEL All Commercial |
$43.75
|
| Rate for Payer: Coventry All Commercial |
$41.40
|
| Rate for Payer: Encore All Commercial |
$43.30
|
| Rate for Payer: Frontpath All Commercial |
$43.28
|
| Rate for Payer: Humana ChoiceCare |
$40.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.34
|
| Rate for Payer: PHCS All Commercial |
$35.28
|
| Rate for Payer: PHP All Commercial |
$35.68
|
| Rate for Payer: Sagamore Health Network All Products |
$36.31
|
| Rate for Payer: Signature Care EPO |
$39.04
|
| Rate for Payer: Signature Care PPO |
$41.40
|
| Rate for Payer: United Healthcare Commercial |
$37.07
|
|
|
OFLOXACIN 0.3 % OPHT DROP
|
Facility
OP
|
$47.04
|
|
|
Service Code
|
NDC 64980051505
|
| Hospital Charge Code |
19746
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.52 |
| Max. Negotiated Rate |
$43.75 |
| Rate for Payer: Aetna Commercial |
$39.70
|
| Rate for Payer: Aetna Medicare |
$15.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.08
|
| Rate for Payer: Cash Price |
$29.16
|
| Rate for Payer: Cash Price |
$29.16
|
| Rate for Payer: Centivo All Commercial |
$23.99
|
| Rate for Payer: Cigna All Commercial |
$40.60
|
| Rate for Payer: CORVEL All Commercial |
$43.75
|
| Rate for Payer: Coventry All Commercial |
$41.40
|
| Rate for Payer: Encore All Commercial |
$43.30
|
| Rate for Payer: Frontpath All Commercial |
$43.28
|
| Rate for Payer: Humana ChoiceCare |
$40.63
|
| Rate for Payer: Humana Medicare |
$23.99
|
| Rate for Payer: Lucent All Commercial |
$23.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.34
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$35.28
|
| Rate for Payer: PHP All Commercial |
$35.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.35
|
| Rate for Payer: Sagamore Health Network All Products |
$36.31
|
| Rate for Payer: Signature Care EPO |
$39.04
|
| Rate for Payer: Signature Care PPO |
$41.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.98
|
| Rate for Payer: United Healthcare Commercial |
$37.07
|
| Rate for Payer: United Healthcare Medicare |
$15.52
|
|
|
OLANZAPINE 10 MG IM SOLR
|
Facility
IP
|
$167.86
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
38263
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$125.90 |
| Max. Negotiated Rate |
$156.11 |
| Rate for Payer: Aetna Commercial |
$145.03
|
| Rate for Payer: Cash Price |
$104.07
|
| Rate for Payer: Cigna All Commercial |
$144.86
|
| Rate for Payer: CORVEL All Commercial |
$156.11
|
| Rate for Payer: Coventry All Commercial |
$147.72
|
| Rate for Payer: Encore All Commercial |
$154.52
|
| Rate for Payer: Frontpath All Commercial |
$154.43
|
| Rate for Payer: Humana ChoiceCare |
$144.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.07
|
| Rate for Payer: PHCS All Commercial |
$125.90
|
| Rate for Payer: PHP All Commercial |
$127.31
|
| Rate for Payer: Sagamore Health Network All Products |
$129.59
|
| Rate for Payer: Signature Care EPO |
$139.32
|
| Rate for Payer: Signature Care PPO |
$147.72
|
| Rate for Payer: United Healthcare Commercial |
$132.27
|
|
|
OLANZAPINE 10 MG IM SOLR
|
Facility
OP
|
$167.86
|
|
|
Service Code
|
HCPCS J2359
|
| Hospital Charge Code |
38263
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$156.11 |
| Rate for Payer: Aetna Commercial |
$141.67
|
| Rate for Payer: Aetna Medicare |
$55.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$104.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.93
|
| Rate for Payer: Cash Price |
$104.07
|
| Rate for Payer: Centivo All Commercial |
$85.61
|
| Rate for Payer: Cigna All Commercial |
$144.86
|
| Rate for Payer: CORVEL All Commercial |
$156.11
|
| Rate for Payer: Coventry All Commercial |
$147.72
|
| Rate for Payer: Encore All Commercial |
$154.52
|
| Rate for Payer: Frontpath All Commercial |
$154.43
|
| Rate for Payer: Humana ChoiceCare |
$144.98
|
| Rate for Payer: Humana Medicare |
$85.61
|
| Rate for Payer: Lucent All Commercial |
$85.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$151.07
|
| Rate for Payer: PHCS All Commercial |
$125.90
|
| Rate for Payer: PHP All Commercial |
$127.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$65.47
|
| Rate for Payer: Sagamore Health Network All Products |
$129.59
|
| Rate for Payer: Signature Care EPO |
$139.32
|
| Rate for Payer: Signature Care PPO |
$147.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$142.68
|
| Rate for Payer: United Healthcare Commercial |
$132.27
|
| Rate for Payer: United Healthcare Medicare |
$55.39
|
|
|
OLANZAPINE 5 MG ORAL TAB
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 00904637761
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.36
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Centivo All Commercial |
$0.51
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Humana Medicare |
$0.51
|
| Rate for Payer: Lucent All Commercial |
$0.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.39
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
| Rate for Payer: United Healthcare Medicare |
$0.33
|
|
|
OLANZAPINE 5 MG ORAL TAB
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 00904637761
|
| Hospital Charge Code |
17936
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
|
|
OLOPATADINE 0.1 % OPHT DROP
|
Facility
OP
|
$87.01
|
|
|
Service Code
|
NDC 70069000701
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$28.71 |
| Max. Negotiated Rate |
$80.92 |
| Rate for Payer: Aetna Commercial |
$73.44
|
| Rate for Payer: Aetna Medicare |
$28.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.58
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Centivo All Commercial |
$44.38
|
| Rate for Payer: Cigna All Commercial |
$75.09
|
| Rate for Payer: CORVEL All Commercial |
$80.92
|
| Rate for Payer: Coventry All Commercial |
$76.57
|
| Rate for Payer: Encore All Commercial |
$80.09
|
| Rate for Payer: Frontpath All Commercial |
$80.05
|
| Rate for Payer: Humana ChoiceCare |
$75.15
|
| Rate for Payer: Humana Medicare |
$44.38
|
| Rate for Payer: Lucent All Commercial |
$44.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.31
|
| Rate for Payer: PHCS All Commercial |
$65.26
|
| Rate for Payer: PHP All Commercial |
$65.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.93
|
| Rate for Payer: Sagamore Health Network All Products |
$67.17
|
| Rate for Payer: Signature Care EPO |
$72.22
|
| Rate for Payer: Signature Care PPO |
$76.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$73.96
|
| Rate for Payer: United Healthcare Commercial |
$68.56
|
| Rate for Payer: United Healthcare Medicare |
$28.71
|
|
|
OLOPATADINE 0.1 % OPHT DROP
|
Facility
IP
|
$87.01
|
|
|
Service Code
|
NDC 70069000701
|
| Hospital Charge Code |
19452
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$65.26 |
| Max. Negotiated Rate |
$80.92 |
| Rate for Payer: Aetna Commercial |
$75.18
|
| Rate for Payer: Cash Price |
$53.95
|
| Rate for Payer: Cigna All Commercial |
$75.09
|
| Rate for Payer: CORVEL All Commercial |
$80.92
|
| Rate for Payer: Coventry All Commercial |
$76.57
|
| Rate for Payer: Encore All Commercial |
$80.09
|
| Rate for Payer: Frontpath All Commercial |
$80.05
|
| Rate for Payer: Humana ChoiceCare |
$75.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$78.31
|
| Rate for Payer: PHCS All Commercial |
$65.26
|
| Rate for Payer: PHP All Commercial |
$65.99
|
| Rate for Payer: Sagamore Health Network All Products |
$67.17
|
| Rate for Payer: Signature Care EPO |
$72.22
|
| Rate for Payer: Signature Care PPO |
$76.57
|
| Rate for Payer: United Healthcare Commercial |
$68.56
|
|
|
OMALIZUMAB 150 MG/ML SUBQ SYRG
|
Facility
OP
|
$4,857.06
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
186619
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.73 |
| Max. Negotiated Rate |
$4,517.06 |
| Rate for Payer: Aetna Commercial |
$4,099.35
|
| Rate for Payer: Aetna Medicare |
$1,602.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,602.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,789.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,036.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$45.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,843.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,763.11
|
| Rate for Payer: Cash Price |
$3,011.37
|
| Rate for Payer: Cash Price |
$3,011.37
|
| Rate for Payer: Centivo All Commercial |
$2,477.10
|
| Rate for Payer: Cigna All Commercial |
$4,191.64
|
| Rate for Payer: CORVEL All Commercial |
$4,517.06
|
| Rate for Payer: Coventry All Commercial |
$4,274.21
|
| Rate for Payer: Encore All Commercial |
$4,470.92
|
| Rate for Payer: Frontpath All Commercial |
$4,468.49
|
| Rate for Payer: Humana ChoiceCare |
$4,195.04
|
| Rate for Payer: Humana Medicare |
$2,477.10
|
| Rate for Payer: Lucent All Commercial |
$2,477.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,371.35
|
| Rate for Payer: Managed Health Services Medicaid |
$45.73
|
| Rate for Payer: MDWise Medicaid |
$45.73
|
| Rate for Payer: PHCS All Commercial |
$3,642.79
|
| Rate for Payer: PHP All Commercial |
$3,683.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,894.25
|
| Rate for Payer: Sagamore Health Network All Products |
$3,749.65
|
| Rate for Payer: Signature Care EPO |
$4,031.36
|
| Rate for Payer: Signature Care PPO |
$4,274.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,128.50
|
| Rate for Payer: United Healthcare Commercial |
$3,827.36
|
| Rate for Payer: United Healthcare Medicare |
$1,602.83
|
|
|
OMALIZUMAB 150 MG/ML SUBQ SYRG
|
Facility
IP
|
$4,857.06
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
186619
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,642.79 |
| Max. Negotiated Rate |
$4,517.06 |
| Rate for Payer: Aetna Commercial |
$4,196.50
|
| Rate for Payer: Cash Price |
$3,011.37
|
| Rate for Payer: Cigna All Commercial |
$4,191.64
|
| Rate for Payer: CORVEL All Commercial |
$4,517.06
|
| Rate for Payer: Coventry All Commercial |
$4,274.21
|
| Rate for Payer: Encore All Commercial |
$4,470.92
|
| Rate for Payer: Frontpath All Commercial |
$4,468.49
|
| Rate for Payer: Humana ChoiceCare |
$4,195.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,371.35
|
| Rate for Payer: PHCS All Commercial |
$3,642.79
|
| Rate for Payer: PHP All Commercial |
$3,683.59
|
| Rate for Payer: Sagamore Health Network All Products |
$3,749.65
|
| Rate for Payer: Signature Care EPO |
$4,031.36
|
| Rate for Payer: Signature Care PPO |
$4,274.21
|
| Rate for Payer: United Healthcare Commercial |
$3,827.36
|
|
|
OMALIZUMAB 150 MG SUBQ SOLR
|
Facility
OP
|
$4,847.33
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
36151
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.73 |
| Max. Negotiated Rate |
$4,508.01 |
| Rate for Payer: Aetna Commercial |
$4,091.14
|
| Rate for Payer: Aetna Medicare |
$1,599.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,599.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,783.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,030.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$45.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,839.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,759.58
|
| Rate for Payer: Cash Price |
$3,005.34
|
| Rate for Payer: Cash Price |
$3,005.34
|
| Rate for Payer: Centivo All Commercial |
$2,472.14
|
| Rate for Payer: Cigna All Commercial |
$4,183.24
|
| Rate for Payer: CORVEL All Commercial |
$4,508.01
|
| Rate for Payer: Coventry All Commercial |
$4,265.65
|
| Rate for Payer: Encore All Commercial |
$4,461.96
|
| Rate for Payer: Frontpath All Commercial |
$4,459.54
|
| Rate for Payer: Humana ChoiceCare |
$4,186.63
|
| Rate for Payer: Humana Medicare |
$2,472.14
|
| Rate for Payer: Lucent All Commercial |
$2,472.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,362.59
|
| Rate for Payer: Managed Health Services Medicaid |
$45.73
|
| Rate for Payer: MDWise Medicaid |
$45.73
|
| Rate for Payer: PHCS All Commercial |
$3,635.49
|
| Rate for Payer: PHP All Commercial |
$3,676.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,890.46
|
| Rate for Payer: Sagamore Health Network All Products |
$3,742.13
|
| Rate for Payer: Signature Care EPO |
$4,023.28
|
| Rate for Payer: Signature Care PPO |
$4,265.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,120.23
|
| Rate for Payer: United Healthcare Commercial |
$3,819.69
|
| Rate for Payer: United Healthcare Medicare |
$1,599.62
|
|
|
OMALIZUMAB 150 MG SUBQ SOLR
|
Facility
IP
|
$4,847.33
|
|
|
Service Code
|
HCPCS J2357
|
| Hospital Charge Code |
36151
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,635.49 |
| Max. Negotiated Rate |
$4,508.01 |
| Rate for Payer: Aetna Commercial |
$4,188.09
|
| Rate for Payer: Cash Price |
$3,005.34
|
| Rate for Payer: Cigna All Commercial |
$4,183.24
|
| Rate for Payer: CORVEL All Commercial |
$4,508.01
|
| Rate for Payer: Coventry All Commercial |
$4,265.65
|
| Rate for Payer: Encore All Commercial |
$4,461.96
|
| Rate for Payer: Frontpath All Commercial |
$4,459.54
|
| Rate for Payer: Humana ChoiceCare |
$4,186.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,362.59
|
| Rate for Payer: PHCS All Commercial |
$3,635.49
|
| Rate for Payer: PHP All Commercial |
$3,676.21
|
| Rate for Payer: Sagamore Health Network All Products |
$3,742.13
|
| Rate for Payer: Signature Care EPO |
$4,023.28
|
| Rate for Payer: Signature Care PPO |
$4,265.65
|
| Rate for Payer: United Healthcare Commercial |
$3,819.69
|
|
|
OMEGA 3-DHA-EPA-FISH OIL 60-90-500 MG ORAL CPDR
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 11845014479
|
| Hospital Charge Code |
119301
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.36
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Centivo All Commercial |
$0.51
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Humana Medicare |
$0.51
|
| Rate for Payer: Lucent All Commercial |
$0.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.39
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
| Rate for Payer: United Healthcare Medicare |
$0.33
|
|
|
OMEGA 3-DHA-EPA-FISH OIL 60-90-500 MG ORAL CPDR
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 11845014479
|
| Hospital Charge Code |
119301
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
|
|
OMEPRAZOLE 20 MG ORAL TBLD
|
Facility
OP
|
$2.51
|
|
|
Service Code
|
NDC 70000038102
|
| Hospital Charge Code |
184898
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.83 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.12
|
| Rate for Payer: Aetna Medicare |
$0.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.91
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Centivo All Commercial |
$1.28
|
| Rate for Payer: Cigna All Commercial |
$2.16
|
| Rate for Payer: CORVEL All Commercial |
$2.33
|
| Rate for Payer: Coventry All Commercial |
$2.21
|
| Rate for Payer: Encore All Commercial |
$2.31
|
| Rate for Payer: Frontpath All Commercial |
$2.31
|
| Rate for Payer: Humana ChoiceCare |
$2.16
|
| Rate for Payer: Humana Medicare |
$1.28
|
| Rate for Payer: Lucent All Commercial |
$1.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.26
|
| Rate for Payer: PHCS All Commercial |
$1.88
|
| Rate for Payer: PHP All Commercial |
$1.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.98
|
| Rate for Payer: Sagamore Health Network All Products |
$1.93
|
| Rate for Payer: Signature Care EPO |
$2.08
|
| Rate for Payer: Signature Care PPO |
$2.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.13
|
| Rate for Payer: United Healthcare Commercial |
$1.97
|
| Rate for Payer: United Healthcare Medicare |
$0.83
|
|
|
OMEPRAZOLE 20 MG ORAL TBLD
|
Facility
IP
|
$2.51
|
|
|
Service Code
|
NDC 70000038102
|
| Hospital Charge Code |
184898
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.88 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cigna All Commercial |
$2.16
|
| Rate for Payer: CORVEL All Commercial |
$2.33
|
| Rate for Payer: Coventry All Commercial |
$2.21
|
| Rate for Payer: Encore All Commercial |
$2.31
|
| Rate for Payer: Frontpath All Commercial |
$2.31
|
| Rate for Payer: Humana ChoiceCare |
$2.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.26
|
| Rate for Payer: PHCS All Commercial |
$1.88
|
| Rate for Payer: PHP All Commercial |
$1.90
|
| Rate for Payer: Sagamore Health Network All Products |
$1.93
|
| Rate for Payer: Signature Care EPO |
$2.08
|
| Rate for Payer: Signature Care PPO |
$2.21
|
| Rate for Payer: United Healthcare Commercial |
$1.97
|
|
|
ONABOTULINUMTOXINA 100 UNITS INJ SOLR
|
Facility
OP
|
$2,584.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
32700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.66 |
| Max. Negotiated Rate |
$2,403.12 |
| Rate for Payer: Aetna Commercial |
$2,180.90
|
| Rate for Payer: Aetna Medicare |
$852.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$852.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,483.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,615.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$6.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$980.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$937.99
|
| Rate for Payer: Cash Price |
$1,602.08
|
| Rate for Payer: Cash Price |
$1,602.08
|
| Rate for Payer: Centivo All Commercial |
$1,317.84
|
| Rate for Payer: Cigna All Commercial |
$2,229.99
|
| Rate for Payer: CORVEL All Commercial |
$2,403.12
|
| Rate for Payer: Coventry All Commercial |
$2,273.92
|
| Rate for Payer: Encore All Commercial |
$2,378.57
|
| Rate for Payer: Frontpath All Commercial |
$2,377.28
|
| Rate for Payer: Humana ChoiceCare |
$2,231.80
|
| Rate for Payer: Humana Medicare |
$1,317.84
|
| Rate for Payer: Lucent All Commercial |
$1,317.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,325.60
|
| Rate for Payer: Managed Health Services Medicaid |
$6.66
|
| Rate for Payer: MDWise Medicaid |
$6.66
|
| Rate for Payer: PHCS All Commercial |
$1,938.00
|
| Rate for Payer: PHP All Commercial |
$1,959.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,007.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1,994.85
|
| Rate for Payer: Signature Care EPO |
$2,144.72
|
| Rate for Payer: Signature Care PPO |
$2,273.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,196.40
|
| Rate for Payer: United Healthcare Commercial |
$2,036.19
|
| Rate for Payer: United Healthcare Medicare |
$852.72
|
|
