|
PR OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW
|
Professional
|
$1,233.44
|
|
|
Service Code
|
CPT 24635
|
| Hospital Charge Code |
z24635
|
| Min. Negotiated Rate |
$632.14 |
| Max. Negotiated Rate |
$1,416.40 |
| Rate for Payer: Aetna Medicare |
$632.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,416.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,416.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$726.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$695.35
|
| Rate for Payer: Cash Price |
$764.73
|
| Rate for Payer: Cash Price |
$764.73
|
| Rate for Payer: Coventry All Commercial |
$758.57
|
| Rate for Payer: Frontpath All Commercial |
$874.12
|
| Rate for Payer: Humana ChoiceCare |
$1,175.70
|
| Rate for Payer: Humana Medicare |
$632.14
|
| Rate for Payer: Lucent All Commercial |
$1,074.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,011.00
|
| Rate for Payer: PHCS All Commercial |
$925.08
|
| Rate for Payer: PHP All Commercial |
$1,073.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$632.14
|
| Rate for Payer: Signature Care EPO |
$1,071.75
|
| Rate for Payer: Signature Care PPO |
$1,071.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$948.00
|
| Rate for Payer: United Healthcare Commercial |
$806.45
|
| Rate for Payer: United Healthcare Medicare |
$632.14
|
|
|
PR OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA
|
Professional
|
$1,088.74
|
|
|
Service Code
|
CPT 26735
|
| Hospital Charge Code |
z26735
|
| Min. Negotiated Rate |
$499.03 |
| Max. Negotiated Rate |
$948.57 |
| Rate for Payer: Aetna Medicare |
$557.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$575.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$575.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$641.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$613.78
|
| Rate for Payer: Cash Price |
$675.02
|
| Rate for Payer: Cash Price |
$675.02
|
| Rate for Payer: Coventry All Commercial |
$669.58
|
| Rate for Payer: Frontpath All Commercial |
$768.27
|
| Rate for Payer: Humana ChoiceCare |
$499.03
|
| Rate for Payer: Humana Medicare |
$557.98
|
| Rate for Payer: Lucent All Commercial |
$948.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$893.00
|
| Rate for Payer: PHCS All Commercial |
$816.56
|
| Rate for Payer: PHP All Commercial |
$947.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$557.98
|
| Rate for Payer: Signature Care EPO |
$685.10
|
| Rate for Payer: Signature Care PPO |
$685.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$837.00
|
| Rate for Payer: United Healthcare Commercial |
$605.41
|
| Rate for Payer: United Healthcare Medicare |
$557.98
|
|
|
PR OPEN TX RADIAL HEAD/NECK FRACTURE
|
Professional
|
$1,199.98
|
|
|
Service Code
|
CPT 24665
|
| Hospital Charge Code |
z24665
|
| Min. Negotiated Rate |
$614.99 |
| Max. Negotiated Rate |
$1,045.48 |
| Rate for Payer: Aetna Medicare |
$614.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$798.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$798.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$707.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$676.49
|
| Rate for Payer: Cash Price |
$743.99
|
| Rate for Payer: Cash Price |
$743.99
|
| Rate for Payer: Coventry All Commercial |
$737.99
|
| Rate for Payer: Frontpath All Commercial |
$851.54
|
| Rate for Payer: Humana ChoiceCare |
$679.62
|
| Rate for Payer: Humana Medicare |
$614.99
|
| Rate for Payer: Lucent All Commercial |
$1,045.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$984.00
|
| Rate for Payer: PHCS All Commercial |
$899.98
|
| Rate for Payer: PHP All Commercial |
$1,043.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$614.99
|
| Rate for Payer: Signature Care EPO |
$908.65
|
| Rate for Payer: Signature Care PPO |
$908.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$922.00
|
| Rate for Payer: United Healthcare Commercial |
$693.40
|
| Rate for Payer: United Healthcare Medicare |
$614.99
|
|
|
PR OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC
|
Professional
|
$1,334.50
|
|
|
Service Code
|
CPT 24666
|
| Hospital Charge Code |
z24666
|
| Min. Negotiated Rate |
$683.93 |
| Max. Negotiated Rate |
$1,162.68 |
| Rate for Payer: Aetna Medicare |
$683.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$964.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$964.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$786.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$752.32
|
| Rate for Payer: Cash Price |
$827.39
|
| Rate for Payer: Cash Price |
$827.39
|
| Rate for Payer: Coventry All Commercial |
$820.72
|
| Rate for Payer: Frontpath All Commercial |
$949.39
|
| Rate for Payer: Humana ChoiceCare |
$764.71
|
| Rate for Payer: Humana Medicare |
$683.93
|
| Rate for Payer: Lucent All Commercial |
$1,162.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,094.00
|
| Rate for Payer: PHCS All Commercial |
$1,000.88
|
| Rate for Payer: PHP All Commercial |
$1,161.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$683.93
|
| Rate for Payer: Signature Care EPO |
$1,024.25
|
| Rate for Payer: Signature Care PPO |
$1,024.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,026.00
|
| Rate for Payer: United Healthcare Commercial |
$789.11
|
| Rate for Payer: United Healthcare Medicare |
$683.93
|
|
|
PR OPEN TX RADIAL & ULNAR SHAFT FX FIX RADIUS AND ULNA
|
Professional
|
$1,643.40
|
|
|
Service Code
|
CPT 25575
|
| Hospital Charge Code |
z25575
|
| Min. Negotiated Rate |
$842.24 |
| Max. Negotiated Rate |
$1,431.81 |
| Rate for Payer: Aetna Medicare |
$842.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,037.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,037.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$968.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$926.46
|
| Rate for Payer: Cash Price |
$1,018.91
|
| Rate for Payer: Cash Price |
$1,018.91
|
| Rate for Payer: Coventry All Commercial |
$1,010.69
|
| Rate for Payer: Frontpath All Commercial |
$1,172.29
|
| Rate for Payer: Humana ChoiceCare |
$867.16
|
| Rate for Payer: Humana Medicare |
$842.24
|
| Rate for Payer: Lucent All Commercial |
$1,431.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,348.00
|
| Rate for Payer: PHCS All Commercial |
$1,232.55
|
| Rate for Payer: PHP All Commercial |
$1,429.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$842.24
|
| Rate for Payer: Signature Care EPO |
$1,155.15
|
| Rate for Payer: Signature Care PPO |
$1,155.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,263.00
|
| Rate for Payer: United Healthcare Commercial |
$961.34
|
| Rate for Payer: United Healthcare Medicare |
$842.24
|
|
|
PR OPEN TX RADIAL & ULNAR SHAFT FX FIX RADIUS OR ULNA
|
Professional
|
$1,233.72
|
|
|
Service Code
|
CPT 25574
|
| Hospital Charge Code |
z25574
|
| Min. Negotiated Rate |
$614.22 |
| Max. Negotiated Rate |
$1,074.88 |
| Rate for Payer: Aetna Medicare |
$632.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$727.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$695.51
|
| Rate for Payer: Cash Price |
$764.91
|
| Rate for Payer: Cash Price |
$764.91
|
| Rate for Payer: Coventry All Commercial |
$758.74
|
| Rate for Payer: Frontpath All Commercial |
$874.28
|
| Rate for Payer: Humana ChoiceCare |
$614.22
|
| Rate for Payer: Humana Medicare |
$632.28
|
| Rate for Payer: Lucent All Commercial |
$1,074.88
|
| Rate for Payer: PHCS All Commercial |
$925.29
|
| Rate for Payer: PHP All Commercial |
$1,073.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$632.28
|
| Rate for Payer: Signature Care EPO |
$819.40
|
| Rate for Payer: Signature Care PPO |
$819.40
|
| Rate for Payer: United Healthcare Commercial |
$705.69
|
| Rate for Payer: United Healthcare Medicare |
$632.28
|
|
|
PR OPEN TX TARSAL FRACTURE XCP TALUS &CALCANEUS EA
|
Professional
|
$1,165.30
|
|
|
Service Code
|
CPT 28465
|
| Hospital Charge Code |
z28465
|
| Min. Negotiated Rate |
$576.92 |
| Max. Negotiated Rate |
$1,015.27 |
| Rate for Payer: Aetna Medicare |
$597.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$584.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$584.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$686.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$656.94
|
| Rate for Payer: Cash Price |
$722.49
|
| Rate for Payer: Cash Price |
$722.49
|
| Rate for Payer: Coventry All Commercial |
$716.66
|
| Rate for Payer: Frontpath All Commercial |
$820.68
|
| Rate for Payer: Humana ChoiceCare |
$576.92
|
| Rate for Payer: Humana Medicare |
$597.22
|
| Rate for Payer: Lucent All Commercial |
$1,015.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$956.00
|
| Rate for Payer: PHCS All Commercial |
$873.98
|
| Rate for Payer: PHP All Commercial |
$1,013.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$597.22
|
| Rate for Payer: Signature Care EPO |
$776.05
|
| Rate for Payer: Signature Care PPO |
$776.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$896.00
|
| Rate for Payer: United Healthcare Commercial |
$671.26
|
| Rate for Payer: United Healthcare Medicare |
$597.22
|
|
|
PR OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR
|
Professional
|
$1,620.50
|
|
|
Service Code
|
CPT 27535
|
| Hospital Charge Code |
z27535
|
| Min. Negotiated Rate |
$830.51 |
| Max. Negotiated Rate |
$1,411.87 |
| Rate for Payer: Aetna Medicare |
$830.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,145.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,145.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$955.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$913.56
|
| Rate for Payer: Cash Price |
$1,004.71
|
| Rate for Payer: Cash Price |
$1,004.71
|
| Rate for Payer: Coventry All Commercial |
$996.61
|
| Rate for Payer: Frontpath All Commercial |
$1,168.44
|
| Rate for Payer: Humana ChoiceCare |
$940.34
|
| Rate for Payer: Humana Medicare |
$830.51
|
| Rate for Payer: Lucent All Commercial |
$1,411.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,329.00
|
| Rate for Payer: PHCS All Commercial |
$1,215.38
|
| Rate for Payer: PHP All Commercial |
$1,409.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$830.51
|
| Rate for Payer: Signature Care EPO |
$1,258.85
|
| Rate for Payer: Signature Care PPO |
$1,258.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,246.00
|
| Rate for Payer: United Healthcare Commercial |
$998.53
|
| Rate for Payer: United Healthcare Medicare |
$830.51
|
|
|
PR OPEN TX TRIMALLEOLAR ANKLE FX W FIX PST LIP
|
Professional
|
$1,790.44
|
|
|
Service Code
|
CPT 27823
|
| Hospital Charge Code |
z27823
|
| Min. Negotiated Rate |
$917.76 |
| Max. Negotiated Rate |
$1,766.30 |
| Rate for Payer: Aetna Medicare |
$917.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,766.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,766.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,055.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,009.54
|
| Rate for Payer: Cash Price |
$1,110.07
|
| Rate for Payer: Cash Price |
$1,110.07
|
| Rate for Payer: Coventry All Commercial |
$1,101.31
|
| Rate for Payer: Frontpath All Commercial |
$1,279.36
|
| Rate for Payer: Humana ChoiceCare |
$1,064.38
|
| Rate for Payer: Humana Medicare |
$917.76
|
| Rate for Payer: Lucent All Commercial |
$1,560.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,468.00
|
| Rate for Payer: PHCS All Commercial |
$1,342.83
|
| Rate for Payer: PHP All Commercial |
$1,557.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$917.76
|
| Rate for Payer: Signature Care EPO |
$1,422.05
|
| Rate for Payer: Signature Care PPO |
$1,422.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare Commercial |
$1,050.56
|
| Rate for Payer: United Healthcare Medicare |
$917.76
|
|
|
PR OPEN TX TRIMALLEOLAR ANKLE FX W/O FIX PST LIP
|
Professional
|
$1,592.64
|
|
|
Service Code
|
CPT 27822
|
| Hospital Charge Code |
z27822
|
| Min. Negotiated Rate |
$816.23 |
| Max. Negotiated Rate |
$1,551.90 |
| Rate for Payer: Aetna Medicare |
$816.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,551.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,551.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$938.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$897.85
|
| Rate for Payer: Cash Price |
$987.44
|
| Rate for Payer: Cash Price |
$987.44
|
| Rate for Payer: Coventry All Commercial |
$979.48
|
| Rate for Payer: Frontpath All Commercial |
$1,136.46
|
| Rate for Payer: Humana ChoiceCare |
$938.15
|
| Rate for Payer: Humana Medicare |
$816.23
|
| Rate for Payer: Lucent All Commercial |
$1,387.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,306.00
|
| Rate for Payer: PHCS All Commercial |
$1,194.48
|
| Rate for Payer: PHP All Commercial |
$1,385.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$816.23
|
| Rate for Payer: Signature Care EPO |
$1,248.65
|
| Rate for Payer: Signature Care PPO |
$1,248.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,224.00
|
| Rate for Payer: United Healthcare Commercial |
$920.76
|
| Rate for Payer: United Healthcare Medicare |
$816.23
|
|
|
PR OPEN TX ULNAR FRACTURE PROX END
|
Professional
|
$1,192.54
|
|
|
Service Code
|
CPT 24685
|
| Hospital Charge Code |
z24685
|
| Min. Negotiated Rate |
$611.18 |
| Max. Negotiated Rate |
$1,039.01 |
| Rate for Payer: Aetna Medicare |
$611.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$873.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$873.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$702.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$672.30
|
| Rate for Payer: Cash Price |
$739.37
|
| Rate for Payer: Cash Price |
$739.37
|
| Rate for Payer: Coventry All Commercial |
$733.42
|
| Rate for Payer: Frontpath All Commercial |
$846.40
|
| Rate for Payer: Humana ChoiceCare |
$710.92
|
| Rate for Payer: Humana Medicare |
$611.18
|
| Rate for Payer: Lucent All Commercial |
$1,039.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$978.00
|
| Rate for Payer: PHCS All Commercial |
$894.40
|
| Rate for Payer: PHP All Commercial |
$1,037.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$611.18
|
| Rate for Payer: Signature Care EPO |
$952.85
|
| Rate for Payer: Signature Care PPO |
$952.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$917.00
|
| Rate for Payer: United Healthcare Commercial |
$696.34
|
| Rate for Payer: United Healthcare Medicare |
$611.18
|
|
|
PROPOFOL 10 MG/ML IV EMUL
|
Facility
IP
|
$29.40
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$27.34 |
| Rate for Payer: Aetna Commercial |
$25.40
|
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Aetna Commercial |
$50.80
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: Cigna All Commercial |
$25.37
|
| Rate for Payer: Cigna All Commercial |
$50.74
|
| Rate for Payer: CORVEL All Commercial |
$27.34
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: CORVEL All Commercial |
$54.68
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Coventry All Commercial |
$51.74
|
| Rate for Payer: Coventry All Commercial |
$25.87
|
| Rate for Payer: Encore All Commercial |
$54.13
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Encore All Commercial |
$27.06
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Frontpath All Commercial |
$54.10
|
| Rate for Payer: Frontpath All Commercial |
$27.05
|
| Rate for Payer: Humana ChoiceCare |
$25.39
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana ChoiceCare |
$50.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.92
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHCS All Commercial |
$22.05
|
| Rate for Payer: PHCS All Commercial |
$44.10
|
| Rate for Payer: PHP All Commercial |
$22.30
|
| Rate for Payer: PHP All Commercial |
$44.59
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$45.39
|
| Rate for Payer: Sagamore Health Network All Products |
$22.70
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care EPO |
$48.80
|
| Rate for Payer: Signature Care EPO |
$24.40
|
| Rate for Payer: Signature Care PPO |
$25.87
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Signature Care PPO |
$51.74
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Commercial |
$46.33
|
| Rate for Payer: United Healthcare Commercial |
$23.17
|
|
|
PROPOFOL 10 MG/ML IV EMUL
|
Facility
OP
|
$58.80
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
11150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$54.68 |
| Rate for Payer: Aetna Commercial |
$49.63
|
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Commercial |
$24.81
|
| Rate for Payer: Aetna Medicare |
$9.70
|
| Rate for Payer: Aetna Medicare |
$19.40
|
| 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 Medicare |
$9.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Centivo All Commercial |
$29.99
|
| Rate for Payer: Centivo All Commercial |
$14.99
|
| Rate for Payer: Cigna All Commercial |
$25.37
|
| Rate for Payer: Cigna All Commercial |
$50.74
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$27.34
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: CORVEL All Commercial |
$54.68
|
| Rate for Payer: Coventry All Commercial |
$25.87
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Coventry All Commercial |
$51.74
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Encore All Commercial |
$54.13
|
| Rate for Payer: Encore All Commercial |
$27.06
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Frontpath All Commercial |
$27.05
|
| Rate for Payer: Frontpath All Commercial |
$54.10
|
| Rate for Payer: Humana ChoiceCare |
$50.79
|
| Rate for Payer: Humana ChoiceCare |
$25.39
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Humana Medicare |
$14.99
|
| Rate for Payer: Humana Medicare |
$29.99
|
| Rate for Payer: Lucent All Commercial |
$14.99
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$29.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHCS All Commercial |
$44.10
|
| Rate for Payer: PHCS All Commercial |
$22.05
|
| Rate for Payer: PHP All Commercial |
$44.59
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: PHP All Commercial |
$22.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.93
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Sagamore Health Network All Products |
$22.70
|
| Rate for Payer: Sagamore Health Network All Products |
$45.39
|
| Rate for Payer: Signature Care EPO |
$48.80
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care EPO |
$24.40
|
| Rate for Payer: Signature Care PPO |
$25.87
|
| Rate for Payer: Signature Care PPO |
$51.74
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.98
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Commercial |
$23.17
|
| Rate for Payer: United Healthcare Commercial |
$46.33
|
| Rate for Payer: United Healthcare Medicare |
$9.70
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
| Rate for Payer: United Healthcare Medicare |
$19.40
|
|
|
PROPOFOL 10 MG/ML IV INFUSION
|
Facility
IP
|
$58.80
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
408011150
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$54.68 |
| Rate for Payer: Aetna Commercial |
$50.80
|
| Rate for Payer: Aetna Commercial |
$25.40
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Cigna All Commercial |
$25.37
|
| Rate for Payer: Cigna All Commercial |
$50.74
|
| Rate for Payer: CORVEL All Commercial |
$54.68
|
| Rate for Payer: CORVEL All Commercial |
$27.34
|
| Rate for Payer: Coventry All Commercial |
$51.74
|
| Rate for Payer: Coventry All Commercial |
$25.87
|
| Rate for Payer: Encore All Commercial |
$27.06
|
| Rate for Payer: Encore All Commercial |
$54.13
|
| Rate for Payer: Frontpath All Commercial |
$27.05
|
| Rate for Payer: Frontpath All Commercial |
$54.10
|
| Rate for Payer: Humana ChoiceCare |
$50.79
|
| Rate for Payer: Humana ChoiceCare |
$25.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.92
|
| Rate for Payer: PHCS All Commercial |
$22.05
|
| Rate for Payer: PHCS All Commercial |
$44.10
|
| Rate for Payer: PHP All Commercial |
$44.59
|
| Rate for Payer: PHP All Commercial |
$22.30
|
| Rate for Payer: Sagamore Health Network All Products |
$22.70
|
| Rate for Payer: Sagamore Health Network All Products |
$45.39
|
| Rate for Payer: Signature Care EPO |
$24.40
|
| Rate for Payer: Signature Care EPO |
$48.80
|
| Rate for Payer: Signature Care PPO |
$25.87
|
| Rate for Payer: Signature Care PPO |
$51.74
|
| Rate for Payer: United Healthcare Commercial |
$23.17
|
| Rate for Payer: United Healthcare Commercial |
$46.33
|
|
|
PROPOFOL 10 MG/ML IV INFUSION
|
Facility
OP
|
$29.40
|
|
|
Service Code
|
HCPCS J2704
|
| Hospital Charge Code |
408011150
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$27.34 |
| Rate for Payer: Aetna Commercial |
$24.81
|
| Rate for Payer: Aetna Commercial |
$49.63
|
| Rate for Payer: Aetna Medicare |
$19.40
|
| Rate for Payer: Aetna Medicare |
$9.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$18.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.67
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Centivo All Commercial |
$29.99
|
| Rate for Payer: Centivo All Commercial |
$14.99
|
| Rate for Payer: Cigna All Commercial |
$25.37
|
| Rate for Payer: Cigna All Commercial |
$50.74
|
| Rate for Payer: CORVEL All Commercial |
$27.34
|
| Rate for Payer: CORVEL All Commercial |
$54.68
|
| Rate for Payer: Coventry All Commercial |
$25.87
|
| Rate for Payer: Coventry All Commercial |
$51.74
|
| Rate for Payer: Encore All Commercial |
$54.13
|
| Rate for Payer: Encore All Commercial |
$27.06
|
| Rate for Payer: Frontpath All Commercial |
$27.05
|
| Rate for Payer: Frontpath All Commercial |
$54.10
|
| Rate for Payer: Humana ChoiceCare |
$25.39
|
| Rate for Payer: Humana ChoiceCare |
$50.79
|
| Rate for Payer: Humana Medicare |
$29.99
|
| Rate for Payer: Humana Medicare |
$14.99
|
| Rate for Payer: Lucent All Commercial |
$14.99
|
| Rate for Payer: Lucent All Commercial |
$29.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$26.46
|
| Rate for Payer: PHCS All Commercial |
$22.05
|
| Rate for Payer: PHCS All Commercial |
$44.10
|
| Rate for Payer: PHP All Commercial |
$44.59
|
| Rate for Payer: PHP All Commercial |
$22.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.93
|
| Rate for Payer: Sagamore Health Network All Products |
$22.70
|
| Rate for Payer: Sagamore Health Network All Products |
$45.39
|
| Rate for Payer: Signature Care EPO |
$48.80
|
| Rate for Payer: Signature Care EPO |
$24.40
|
| Rate for Payer: Signature Care PPO |
$25.87
|
| Rate for Payer: Signature Care PPO |
$51.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.99
|
| Rate for Payer: United Healthcare Commercial |
$23.17
|
| Rate for Payer: United Healthcare Commercial |
$46.33
|
| Rate for Payer: United Healthcare Medicare |
$9.70
|
| Rate for Payer: United Healthcare Medicare |
$19.40
|
|
|
PROPRANOLOL 10 MG ORAL TAB
|
Facility
OP
|
$1.63
|
|
|
Service Code
|
NDC 60687058711
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna Commercial |
$1.38
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.59
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Centivo All Commercial |
$0.83
|
| Rate for Payer: Cigna All Commercial |
$1.41
|
| Rate for Payer: CORVEL All Commercial |
$1.52
|
| Rate for Payer: Coventry All Commercial |
$1.44
|
| Rate for Payer: Encore All Commercial |
$1.50
|
| Rate for Payer: Frontpath All Commercial |
$1.50
|
| Rate for Payer: Humana ChoiceCare |
$1.41
|
| Rate for Payer: Humana Medicare |
$0.83
|
| Rate for Payer: Lucent All Commercial |
$0.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.47
|
| Rate for Payer: PHCS All Commercial |
$1.22
|
| Rate for Payer: PHP All Commercial |
$1.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.64
|
| Rate for Payer: Sagamore Health Network All Products |
$1.26
|
| Rate for Payer: Signature Care EPO |
$1.35
|
| Rate for Payer: Signature Care PPO |
$1.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.39
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Medicare |
$0.54
|
|
|
PROPRANOLOL 10 MG ORAL TAB
|
Facility
IP
|
$1.63
|
|
|
Service Code
|
NDC 60687058701
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna Commercial |
$1.41
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna All Commercial |
$1.41
|
| Rate for Payer: CORVEL All Commercial |
$1.52
|
| Rate for Payer: Coventry All Commercial |
$1.44
|
| Rate for Payer: Encore All Commercial |
$1.50
|
| Rate for Payer: Frontpath All Commercial |
$1.50
|
| Rate for Payer: Humana ChoiceCare |
$1.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.47
|
| Rate for Payer: PHCS All Commercial |
$1.22
|
| Rate for Payer: PHP All Commercial |
$1.24
|
| Rate for Payer: Sagamore Health Network All Products |
$1.26
|
| Rate for Payer: Signature Care EPO |
$1.35
|
| Rate for Payer: Signature Care PPO |
$1.44
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
|
|
PROPRANOLOL 10 MG ORAL TAB
|
Facility
OP
|
$1.63
|
|
|
Service Code
|
NDC 60687058701
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna Commercial |
$1.38
|
| Rate for Payer: Aetna Medicare |
$0.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.59
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Centivo All Commercial |
$0.83
|
| Rate for Payer: Cigna All Commercial |
$1.41
|
| Rate for Payer: CORVEL All Commercial |
$1.52
|
| Rate for Payer: Coventry All Commercial |
$1.44
|
| Rate for Payer: Encore All Commercial |
$1.50
|
| Rate for Payer: Frontpath All Commercial |
$1.50
|
| Rate for Payer: Humana ChoiceCare |
$1.41
|
| Rate for Payer: Humana Medicare |
$0.83
|
| Rate for Payer: Lucent All Commercial |
$0.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.47
|
| Rate for Payer: PHCS All Commercial |
$1.22
|
| Rate for Payer: PHP All Commercial |
$1.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.64
|
| Rate for Payer: Sagamore Health Network All Products |
$1.26
|
| Rate for Payer: Signature Care EPO |
$1.35
|
| Rate for Payer: Signature Care PPO |
$1.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.39
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
| Rate for Payer: United Healthcare Medicare |
$0.54
|
|
|
PROPRANOLOL 10 MG ORAL TAB
|
Facility
IP
|
$1.63
|
|
|
Service Code
|
NDC 60687058711
|
| Hospital Charge Code |
6656
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.22 |
| Max. Negotiated Rate |
$1.52 |
| Rate for Payer: Aetna Commercial |
$1.41
|
| Rate for Payer: Cash Price |
$1.01
|
| Rate for Payer: Cigna All Commercial |
$1.41
|
| Rate for Payer: CORVEL All Commercial |
$1.52
|
| Rate for Payer: Coventry All Commercial |
$1.44
|
| Rate for Payer: Encore All Commercial |
$1.50
|
| Rate for Payer: Frontpath All Commercial |
$1.50
|
| Rate for Payer: Humana ChoiceCare |
$1.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.47
|
| Rate for Payer: PHCS All Commercial |
$1.22
|
| Rate for Payer: PHP All Commercial |
$1.24
|
| Rate for Payer: Sagamore Health Network All Products |
$1.26
|
| Rate for Payer: Signature Care EPO |
$1.35
|
| Rate for Payer: Signature Care PPO |
$1.44
|
| Rate for Payer: United Healthcare Commercial |
$1.29
|
|
|
PROPRANOLOL 80 MG ORAL CS24
|
Facility
OP
|
$5.45
|
|
|
Service Code
|
NDC 51991081801
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$5.07 |
| Rate for Payer: Aetna Commercial |
$4.60
|
| Rate for Payer: Aetna Medicare |
$1.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.98
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Centivo All Commercial |
$2.78
|
| Rate for Payer: Cigna All Commercial |
$4.71
|
| Rate for Payer: CORVEL All Commercial |
$5.07
|
| Rate for Payer: Coventry All Commercial |
$4.80
|
| Rate for Payer: Encore All Commercial |
$5.02
|
| Rate for Payer: Frontpath All Commercial |
$5.02
|
| Rate for Payer: Humana ChoiceCare |
$4.71
|
| Rate for Payer: Humana Medicare |
$2.78
|
| Rate for Payer: Lucent All Commercial |
$2.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.91
|
| Rate for Payer: PHCS All Commercial |
$4.09
|
| Rate for Payer: PHP All Commercial |
$4.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.13
|
| Rate for Payer: Sagamore Health Network All Products |
$4.21
|
| Rate for Payer: Signature Care EPO |
$4.53
|
| Rate for Payer: Signature Care PPO |
$4.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.64
|
| Rate for Payer: United Healthcare Commercial |
$4.30
|
| Rate for Payer: United Healthcare Medicare |
$1.80
|
|
|
PROPRANOLOL 80 MG ORAL CS24
|
Facility
IP
|
$5.45
|
|
|
Service Code
|
NDC 51991081801
|
| Hospital Charge Code |
38225
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$5.07 |
| Rate for Payer: Aetna Commercial |
$4.71
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Cigna All Commercial |
$4.71
|
| Rate for Payer: CORVEL All Commercial |
$5.07
|
| Rate for Payer: Coventry All Commercial |
$4.80
|
| Rate for Payer: Encore All Commercial |
$5.02
|
| Rate for Payer: Frontpath All Commercial |
$5.02
|
| Rate for Payer: Humana ChoiceCare |
$4.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4.91
|
| Rate for Payer: PHCS All Commercial |
$4.09
|
| Rate for Payer: PHP All Commercial |
$4.14
|
| Rate for Payer: Sagamore Health Network All Products |
$4.21
|
| Rate for Payer: Signature Care EPO |
$4.53
|
| Rate for Payer: Signature Care PPO |
$4.80
|
| Rate for Payer: United Healthcare Commercial |
$4.30
|
|
|
PROPYLENE GLYCOL-GLYCERIN 1-0.3 % OPHT DROP
|
Facility
OP
|
$33.92
|
|
|
Service Code
|
NDC 10119002003
|
| Hospital Charge Code |
34235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$11.19 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Aetna Commercial |
$28.62
|
| Rate for Payer: Aetna Medicare |
$11.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.31
|
| Rate for Payer: Cash Price |
$21.03
|
| Rate for Payer: Cash Price |
$21.03
|
| Rate for Payer: Centivo All Commercial |
$17.30
|
| Rate for Payer: Cigna All Commercial |
$29.27
|
| Rate for Payer: CORVEL All Commercial |
$31.54
|
| Rate for Payer: Coventry All Commercial |
$29.85
|
| Rate for Payer: Encore All Commercial |
$31.22
|
| Rate for Payer: Frontpath All Commercial |
$31.20
|
| Rate for Payer: Humana ChoiceCare |
$29.29
|
| Rate for Payer: Humana Medicare |
$17.30
|
| Rate for Payer: Lucent All Commercial |
$17.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.52
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$25.44
|
| Rate for Payer: PHP All Commercial |
$25.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.23
|
| Rate for Payer: Sagamore Health Network All Products |
$26.18
|
| Rate for Payer: Signature Care EPO |
$28.15
|
| Rate for Payer: Signature Care PPO |
$29.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28.83
|
| Rate for Payer: United Healthcare Commercial |
$26.73
|
| Rate for Payer: United Healthcare Medicare |
$11.19
|
|
|
PROPYLENE GLYCOL-GLYCERIN 1-0.3 % OPHT DROP
|
Facility
IP
|
$33.92
|
|
|
Service Code
|
NDC 10119002003
|
| Hospital Charge Code |
34235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$25.44 |
| Max. Negotiated Rate |
$31.54 |
| Rate for Payer: Aetna Commercial |
$29.30
|
| Rate for Payer: Cash Price |
$21.03
|
| Rate for Payer: Cigna All Commercial |
$29.27
|
| Rate for Payer: CORVEL All Commercial |
$31.54
|
| Rate for Payer: Coventry All Commercial |
$29.85
|
| Rate for Payer: Encore All Commercial |
$31.22
|
| Rate for Payer: Frontpath All Commercial |
$31.20
|
| Rate for Payer: Humana ChoiceCare |
$29.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.52
|
| Rate for Payer: PHCS All Commercial |
$25.44
|
| Rate for Payer: PHP All Commercial |
$25.72
|
| Rate for Payer: Sagamore Health Network All Products |
$26.18
|
| Rate for Payer: Signature Care EPO |
$28.15
|
| Rate for Payer: Signature Care PPO |
$29.85
|
| Rate for Payer: United Healthcare Commercial |
$26.73
|
|
|
PROPYLTHIOURACIL 50 MG ORAL TAB
|
Facility
OP
|
$15.75
|
|
|
Service Code
|
NDC 68084096495
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$14.65 |
| Rate for Payer: Aetna Commercial |
$13.29
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.72
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Centivo All Commercial |
$8.03
|
| Rate for Payer: Cigna All Commercial |
$13.59
|
| Rate for Payer: CORVEL All Commercial |
$14.65
|
| Rate for Payer: Coventry All Commercial |
$13.86
|
| Rate for Payer: Encore All Commercial |
$14.50
|
| Rate for Payer: Frontpath All Commercial |
$14.49
|
| Rate for Payer: Humana ChoiceCare |
$13.60
|
| Rate for Payer: Humana Medicare |
$8.03
|
| Rate for Payer: Lucent All Commercial |
$8.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.18
|
| Rate for Payer: PHCS All Commercial |
$11.81
|
| Rate for Payer: PHP All Commercial |
$11.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.14
|
| Rate for Payer: Sagamore Health Network All Products |
$12.16
|
| Rate for Payer: Signature Care EPO |
$13.07
|
| Rate for Payer: Signature Care PPO |
$13.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.39
|
| Rate for Payer: United Healthcare Commercial |
$12.41
|
| Rate for Payer: United Healthcare Medicare |
$5.20
|
|
|
PROPYLTHIOURACIL 50 MG ORAL TAB
|
Facility
OP
|
$15.75
|
|
|
Service Code
|
NDC 68084096425
|
| Hospital Charge Code |
6662
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$14.65 |
| Rate for Payer: Aetna Commercial |
$13.29
|
| Rate for Payer: Aetna Medicare |
$5.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.72
|
| Rate for Payer: Cash Price |
$9.77
|
| Rate for Payer: Centivo All Commercial |
$8.03
|
| Rate for Payer: Cigna All Commercial |
$13.59
|
| Rate for Payer: CORVEL All Commercial |
$14.65
|
| Rate for Payer: Coventry All Commercial |
$13.86
|
| Rate for Payer: Encore All Commercial |
$14.50
|
| Rate for Payer: Frontpath All Commercial |
$14.49
|
| Rate for Payer: Humana ChoiceCare |
$13.60
|
| Rate for Payer: Humana Medicare |
$8.03
|
| Rate for Payer: Lucent All Commercial |
$8.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.18
|
| Rate for Payer: PHCS All Commercial |
$11.81
|
| Rate for Payer: PHP All Commercial |
$11.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.14
|
| Rate for Payer: Sagamore Health Network All Products |
$12.16
|
| Rate for Payer: Signature Care EPO |
$13.07
|
| Rate for Payer: Signature Care PPO |
$13.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.39
|
| Rate for Payer: United Healthcare Commercial |
$12.41
|
| Rate for Payer: United Healthcare Medicare |
$5.20
|
|
