|
PR ECHO TRANSESOPHAG IMAGE ACQUISJ INTERP&REPORT
|
Professional
|
Both
|
$163.36
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
z93317
|
| Min. Negotiated Rate |
$138.86 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$301.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$301.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$301.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$301.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$247.91
|
| Rate for Payer: Cash Price |
$101.28
|
| Rate for Payer: Cash Price |
$101.28
|
| Rate for Payer: Frontpath All Commercial |
$182.87
|
| Rate for Payer: Humana ChoiceCare |
$305.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$138.86
|
| Rate for Payer: Managed Health Services Medicaid |
$247.91
|
| Rate for Payer: MDWise Medicaid |
$247.91
|
| Rate for Payer: Signature Care EPO |
$171.60
|
| Rate for Payer: Signature Care PPO |
$171.60
|
| Rate for Payer: United Healthcare Commercial |
$317.40
|
|
|
PR ECHO TRANSESOPHAG R-T 2D W/PRB IMG ACQUISJ I&R
|
Professional
|
Both
|
$221.05
|
|
|
Service Code
|
CPT 93312
|
| Hospital Charge Code |
z93312
|
| Min. Negotiated Rate |
$217.44 |
| Max. Negotiated Rate |
$33,500.00 |
| Rate for Payer: Aetna Commercial |
$228.68
|
| Rate for Payer: Aetna Commercial |
$228.68
|
| Rate for Payer: Aetna Commercial |
$228.68
|
| Rate for Payer: Aetna Medicare |
$228.68
|
| Rate for Payer: Aetna Medicare |
$228.68
|
| Rate for Payer: Aetna Medicare |
$228.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$338.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$338.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$338.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$338.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$338.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$338.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$338.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$338.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$338.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$338.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$217.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$217.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$217.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$262.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$262.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$262.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$251.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$251.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$251.55
|
| Rate for Payer: Cash Price |
$137.05
|
| Rate for Payer: Cash Price |
$146.79
|
| Rate for Payer: Cash Price |
$123.48
|
| Rate for Payer: Centivo All Commercial |
$354.45
|
| Rate for Payer: Centivo All Commercial |
$354.45
|
| Rate for Payer: Centivo All Commercial |
$354.45
|
| Rate for Payer: Cigna All Commercial |
$228.68
|
| Rate for Payer: Cigna All Commercial |
$228.68
|
| Rate for Payer: Cigna All Commercial |
$228.68
|
| Rate for Payer: CORVEL All Commercial |
$228.68
|
| Rate for Payer: CORVEL All Commercial |
$228.68
|
| Rate for Payer: CORVEL All Commercial |
$228.68
|
| Rate for Payer: Coventry All Commercial |
$274.42
|
| Rate for Payer: Coventry All Commercial |
$274.42
|
| Rate for Payer: Coventry All Commercial |
$274.42
|
| Rate for Payer: Encore All Commercial |
$228.68
|
| Rate for Payer: Encore All Commercial |
$228.68
|
| Rate for Payer: Encore All Commercial |
$228.68
|
| Rate for Payer: Frontpath All Commercial |
$256.53
|
| Rate for Payer: Frontpath All Commercial |
$256.53
|
| Rate for Payer: Frontpath All Commercial |
$256.53
|
| Rate for Payer: Humana ChoiceCare |
$259.85
|
| Rate for Payer: Humana ChoiceCare |
$259.85
|
| Rate for Payer: Humana ChoiceCare |
$259.85
|
| Rate for Payer: Humana Medicare |
$228.68
|
| Rate for Payer: Humana Medicare |
$228.68
|
| Rate for Payer: Humana Medicare |
$228.68
|
| Rate for Payer: Lucent All Commercial |
$320.15
|
| Rate for Payer: Lucent All Commercial |
$320.15
|
| Rate for Payer: Lucent All Commercial |
$320.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$357.00
|
| Rate for Payer: Managed Health Services Medicaid |
$217.44
|
| Rate for Payer: Managed Health Services Medicaid |
$217.44
|
| Rate for Payer: Managed Health Services Medicaid |
$217.44
|
| Rate for Payer: MDWise Medicaid |
$217.44
|
| Rate for Payer: MDWise Medicaid |
$217.44
|
| Rate for Payer: MDWise Medicaid |
$217.44
|
| Rate for Payer: PHCS All Commercial |
$228.68
|
| Rate for Payer: PHCS All Commercial |
$228.68
|
| Rate for Payer: PHCS All Commercial |
$228.68
|
| Rate for Payer: PHP All Commercial |
$320.40
|
| Rate for Payer: PHP All Commercial |
$320.40
|
| Rate for Payer: PHP All Commercial |
$320.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$228.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$228.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$228.68
|
| Rate for Payer: Sagamore Health Network All Products |
$228.68
|
| Rate for Payer: Sagamore Health Network All Products |
$228.68
|
| Rate for Payer: Sagamore Health Network All Products |
$228.68
|
| Rate for Payer: Signature Care EPO |
$248.56
|
| Rate for Payer: Signature Care EPO |
$248.56
|
| Rate for Payer: Signature Care EPO |
$248.56
|
| Rate for Payer: Signature Care PPO |
$248.56
|
| Rate for Payer: Signature Care PPO |
$248.56
|
| Rate for Payer: Signature Care PPO |
$248.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$33,500.00
|
| Rate for Payer: United Healthcare Commercial |
$376.53
|
| Rate for Payer: United Healthcare Commercial |
$376.53
|
| Rate for Payer: United Healthcare Commercial |
$376.53
|
|
|
PR ECHO TTHRC R-T 2D W/WO M-MODE REST&STRS CONT ECG
|
Professional
|
Both
|
$216.70
|
|
|
Service Code
|
CPT 93351
|
| Hospital Charge Code |
z93351
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$32,700.00 |
| Rate for Payer: Aetna Commercial |
$221.80
|
| Rate for Payer: Aetna Commercial |
$221.80
|
| Rate for Payer: Aetna Medicare |
$221.80
|
| Rate for Payer: Aetna Medicare |
$221.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$380.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$380.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$380.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$380.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$380.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$380.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$380.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$380.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$213.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$213.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$255.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$255.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$243.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$243.98
|
| Rate for Payer: Cash Price |
$95.69
|
| Rate for Payer: Cash Price |
$134.35
|
| Rate for Payer: Centivo All Commercial |
$343.79
|
| Rate for Payer: Centivo All Commercial |
$343.79
|
| Rate for Payer: Cigna All Commercial |
$221.80
|
| Rate for Payer: Cigna All Commercial |
$221.80
|
| Rate for Payer: CORVEL All Commercial |
$221.80
|
| Rate for Payer: CORVEL All Commercial |
$221.80
|
| Rate for Payer: Coventry All Commercial |
$266.16
|
| Rate for Payer: Coventry All Commercial |
$266.16
|
| Rate for Payer: Encore All Commercial |
$221.80
|
| Rate for Payer: Encore All Commercial |
$221.80
|
| Rate for Payer: Frontpath All Commercial |
$249.14
|
| Rate for Payer: Frontpath All Commercial |
$249.14
|
| Rate for Payer: Humana ChoiceCare |
$250.50
|
| Rate for Payer: Humana ChoiceCare |
$250.50
|
| Rate for Payer: Humana Medicare |
$221.80
|
| Rate for Payer: Humana Medicare |
$221.80
|
| Rate for Payer: Lucent All Commercial |
$310.52
|
| Rate for Payer: Lucent All Commercial |
$310.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$348.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$348.00
|
| Rate for Payer: Managed Health Services Medicaid |
$213.16
|
| Rate for Payer: Managed Health Services Medicaid |
$213.16
|
| Rate for Payer: MDWise Medicaid |
$213.16
|
| Rate for Payer: MDWise Medicaid |
$213.16
|
| Rate for Payer: PHCS All Commercial |
$221.80
|
| Rate for Payer: PHCS All Commercial |
$221.80
|
| Rate for Payer: PHP All Commercial |
$312.27
|
| Rate for Payer: PHP All Commercial |
$312.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$221.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$221.80
|
| Rate for Payer: Sagamore Health Network All Products |
$221.80
|
| Rate for Payer: Sagamore Health Network All Products |
$221.80
|
| Rate for Payer: Signature Care EPO |
$162.00
|
| Rate for Payer: Signature Care EPO |
$162.00
|
| Rate for Payer: Signature Care PPO |
$162.00
|
| Rate for Payer: Signature Care PPO |
$162.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32,700.00
|
| Rate for Payer: United Healthcare Commercial |
$294.66
|
| Rate for Payer: United Healthcare Commercial |
$294.66
|
|
|
PR ECHO XTHORACIC,CONG ANOM,COMPLETE
|
Professional
|
Both
|
$204.30
|
|
|
Service Code
|
CPT 93303
|
| Hospital Charge Code |
z93303
|
| Min. Negotiated Rate |
$120.54 |
| Max. Negotiated Rate |
$30,900.00 |
| Rate for Payer: Aetna Commercial |
$211.65
|
| Rate for Payer: Aetna Commercial |
$211.65
|
| Rate for Payer: Aetna Medicare |
$211.65
|
| Rate for Payer: Aetna Medicare |
$211.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$279.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$279.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$279.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$279.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$279.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$279.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$279.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$279.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$200.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$200.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$243.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$243.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$232.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$232.81
|
| Rate for Payer: Cash Price |
$71.25
|
| Rate for Payer: Cash Price |
$126.67
|
| Rate for Payer: Centivo All Commercial |
$328.06
|
| Rate for Payer: Centivo All Commercial |
$328.06
|
| Rate for Payer: Cigna All Commercial |
$211.65
|
| Rate for Payer: Cigna All Commercial |
$211.65
|
| Rate for Payer: CORVEL All Commercial |
$211.65
|
| Rate for Payer: CORVEL All Commercial |
$211.65
|
| Rate for Payer: Coventry All Commercial |
$253.98
|
| Rate for Payer: Coventry All Commercial |
$253.98
|
| Rate for Payer: Encore All Commercial |
$211.65
|
| Rate for Payer: Encore All Commercial |
$211.65
|
| Rate for Payer: Frontpath All Commercial |
$236.89
|
| Rate for Payer: Frontpath All Commercial |
$236.89
|
| Rate for Payer: Humana ChoiceCare |
$245.11
|
| Rate for Payer: Humana ChoiceCare |
$245.11
|
| Rate for Payer: Humana Medicare |
$211.65
|
| Rate for Payer: Humana Medicare |
$211.65
|
| Rate for Payer: Lucent All Commercial |
$296.31
|
| Rate for Payer: Lucent All Commercial |
$296.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$330.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$330.00
|
| Rate for Payer: Managed Health Services Medicaid |
$200.97
|
| Rate for Payer: Managed Health Services Medicaid |
$200.97
|
| Rate for Payer: MDWise Medicaid |
$200.97
|
| Rate for Payer: MDWise Medicaid |
$200.97
|
| Rate for Payer: PHCS All Commercial |
$211.65
|
| Rate for Payer: PHCS All Commercial |
$211.65
|
| Rate for Payer: PHP All Commercial |
$295.69
|
| Rate for Payer: PHP All Commercial |
$295.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$211.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$211.65
|
| Rate for Payer: Sagamore Health Network All Products |
$211.65
|
| Rate for Payer: Sagamore Health Network All Products |
$211.65
|
| Rate for Payer: Signature Care EPO |
$120.54
|
| Rate for Payer: Signature Care EPO |
$120.54
|
| Rate for Payer: Signature Care PPO |
$120.54
|
| Rate for Payer: Signature Care PPO |
$120.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30,900.00
|
| Rate for Payer: United Healthcare Commercial |
$251.31
|
| Rate for Payer: United Healthcare Commercial |
$251.31
|
|
|
PR ECHO XTHORACIC,CONG ANOM,LIMITED
|
Professional
|
Both
|
$67.12
|
|
|
Service Code
|
CPT 93304
|
| Hospital Charge Code |
z93304
|
| Min. Negotiated Rate |
$70.02 |
| Max. Negotiated Rate |
$21,700.00 |
| Rate for Payer: Aetna Commercial |
$148.39
|
| Rate for Payer: Aetna Commercial |
$148.39
|
| Rate for Payer: Aetna Medicare |
$148.39
|
| Rate for Payer: Aetna Medicare |
$148.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$151.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$151.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$151.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$151.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$151.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$151.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$151.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$151.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$141.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$141.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$170.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$170.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$163.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$163.23
|
| Rate for Payer: Cash Price |
$89.43
|
| Rate for Payer: Cash Price |
$41.61
|
| Rate for Payer: Centivo All Commercial |
$230.00
|
| Rate for Payer: Centivo All Commercial |
$230.00
|
| Rate for Payer: Cigna All Commercial |
$148.39
|
| Rate for Payer: Cigna All Commercial |
$148.39
|
| Rate for Payer: CORVEL All Commercial |
$148.39
|
| Rate for Payer: CORVEL All Commercial |
$148.39
|
| Rate for Payer: Coventry All Commercial |
$178.07
|
| Rate for Payer: Coventry All Commercial |
$178.07
|
| Rate for Payer: Encore All Commercial |
$148.39
|
| Rate for Payer: Encore All Commercial |
$148.39
|
| Rate for Payer: Frontpath All Commercial |
$166.60
|
| Rate for Payer: Frontpath All Commercial |
$166.60
|
| Rate for Payer: Humana ChoiceCare |
$171.79
|
| Rate for Payer: Humana ChoiceCare |
$171.79
|
| Rate for Payer: Humana Medicare |
$148.39
|
| Rate for Payer: Humana Medicare |
$148.39
|
| Rate for Payer: Lucent All Commercial |
$207.75
|
| Rate for Payer: Lucent All Commercial |
$207.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$232.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$232.00
|
| Rate for Payer: Managed Health Services Medicaid |
$141.89
|
| Rate for Payer: Managed Health Services Medicaid |
$141.89
|
| Rate for Payer: MDWise Medicaid |
$141.89
|
| Rate for Payer: MDWise Medicaid |
$141.89
|
| Rate for Payer: PHCS All Commercial |
$148.39
|
| Rate for Payer: PHCS All Commercial |
$148.39
|
| Rate for Payer: PHP All Commercial |
$207.85
|
| Rate for Payer: PHP All Commercial |
$207.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$148.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$148.39
|
| Rate for Payer: Sagamore Health Network All Products |
$148.39
|
| Rate for Payer: Sagamore Health Network All Products |
$148.39
|
| Rate for Payer: Signature Care EPO |
$70.02
|
| Rate for Payer: Signature Care EPO |
$70.02
|
| Rate for Payer: Signature Care PPO |
$70.02
|
| Rate for Payer: Signature Care PPO |
$70.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21,700.00
|
| Rate for Payer: United Healthcare Commercial |
$155.40
|
| Rate for Payer: United Healthcare Commercial |
$155.40
|
|
|
PREDNISOLONE ACETATE 1 % OPHT DRPS
|
Facility
|
OP
|
$213.99
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$199.01 |
| Rate for Payer: Aetna Commercial |
$180.61
|
| Rate for Payer: Aetna Medicare |
$68.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$66.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$122.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$133.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.32
|
| Rate for Payer: Cash Price |
$132.67
|
| Rate for Payer: Cash Price |
$132.67
|
| Rate for Payer: Centivo All Commercial |
$116.41
|
| Rate for Payer: Cigna All Commercial |
$184.67
|
| Rate for Payer: CORVEL All Commercial |
$199.01
|
| Rate for Payer: Coventry All Commercial |
$188.31
|
| Rate for Payer: Encore All Commercial |
$196.98
|
| Rate for Payer: Frontpath All Commercial |
$196.87
|
| Rate for Payer: Humana ChoiceCare |
$184.82
|
| Rate for Payer: Humana Medicare |
$68.48
|
| Rate for Payer: Lucent All Commercial |
$116.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.59
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$160.49
|
| Rate for Payer: PHP All Commercial |
$162.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$83.46
|
| Rate for Payer: Sagamore Health Network All Products |
$165.20
|
| Rate for Payer: Signature Care EPO |
$177.61
|
| Rate for Payer: Signature Care PPO |
$188.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$181.89
|
| Rate for Payer: United Healthcare Commercial |
$168.62
|
| Rate for Payer: United Healthcare Medicare |
$68.48
|
|
|
PREDNISOLONE ACETATE 1 % OPHT DRPS
|
Facility
|
IP
|
$213.99
|
|
|
Service Code
|
NDC 61314063705
|
| Hospital Charge Code |
6487
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$160.49 |
| Max. Negotiated Rate |
$199.01 |
| Rate for Payer: Aetna Commercial |
$184.89
|
| Rate for Payer: Cash Price |
$132.67
|
| Rate for Payer: Cigna All Commercial |
$184.67
|
| Rate for Payer: CORVEL All Commercial |
$199.01
|
| Rate for Payer: Coventry All Commercial |
$188.31
|
| Rate for Payer: Encore All Commercial |
$196.98
|
| Rate for Payer: Frontpath All Commercial |
$196.87
|
| Rate for Payer: Humana ChoiceCare |
$184.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$192.59
|
| Rate for Payer: PHCS All Commercial |
$160.49
|
| Rate for Payer: PHP All Commercial |
$162.29
|
| Rate for Payer: Sagamore Health Network All Products |
$165.20
|
| Rate for Payer: Signature Care EPO |
$177.61
|
| Rate for Payer: Signature Care PPO |
$188.31
|
| Rate for Payer: United Healthcare Commercial |
$168.62
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN
|
Facility
|
IP
|
$4.17
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
29302
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Commercial |
$170.57
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cigna All Commercial |
$170.37
|
| Rate for Payer: Cigna All Commercial |
$3.59
|
| Rate for Payer: CORVEL All Commercial |
$183.60
|
| Rate for Payer: CORVEL All Commercial |
$3.87
|
| Rate for Payer: Coventry All Commercial |
$3.67
|
| Rate for Payer: Coventry All Commercial |
$173.73
|
| Rate for Payer: Encore All Commercial |
$3.83
|
| Rate for Payer: Encore All Commercial |
$181.73
|
| Rate for Payer: Frontpath All Commercial |
$181.63
|
| Rate for Payer: Frontpath All Commercial |
$3.83
|
| Rate for Payer: Humana ChoiceCare |
$170.51
|
| Rate for Payer: Humana ChoiceCare |
$3.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.75
|
| Rate for Payer: PHCS All Commercial |
$3.12
|
| Rate for Payer: PHCS All Commercial |
$148.07
|
| Rate for Payer: PHP All Commercial |
$149.72
|
| Rate for Payer: PHP All Commercial |
$3.16
|
| Rate for Payer: Sagamore Health Network All Products |
$3.22
|
| Rate for Payer: Sagamore Health Network All Products |
$152.41
|
| Rate for Payer: Signature Care EPO |
$3.46
|
| Rate for Payer: Signature Care EPO |
$163.86
|
| Rate for Payer: Signature Care PPO |
$173.73
|
| Rate for Payer: Signature Care PPO |
$3.67
|
| Rate for Payer: United Healthcare Commercial |
$155.57
|
| Rate for Payer: United Healthcare Commercial |
$3.28
|
|
|
PREDNISOLONE SODIUM PHOSPHATE 15 MG/5 ML (3 MG/ML) ORAL SOLN
|
Facility
|
OP
|
$4.17
|
|
|
Service Code
|
HCPCS J7510
|
| Hospital Charge Code |
29302
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.29 |
| Max. Negotiated Rate |
$3.87 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Aetna Commercial |
$166.62
|
| Rate for Payer: Aetna Medicare |
$63.17
|
| Rate for Payer: Aetna Medicare |
$1.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$113.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$123.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$72.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$69.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.47
|
| Rate for Payer: Cash Price |
$2.58
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Centivo All Commercial |
$2.27
|
| Rate for Payer: Centivo All Commercial |
$107.40
|
| Rate for Payer: Cigna All Commercial |
$170.37
|
| Rate for Payer: Cigna All Commercial |
$3.59
|
| Rate for Payer: CORVEL All Commercial |
$183.60
|
| Rate for Payer: CORVEL All Commercial |
$3.87
|
| Rate for Payer: Coventry All Commercial |
$173.73
|
| Rate for Payer: Coventry All Commercial |
$3.67
|
| Rate for Payer: Encore All Commercial |
$181.73
|
| Rate for Payer: Encore All Commercial |
$3.83
|
| Rate for Payer: Frontpath All Commercial |
$3.83
|
| Rate for Payer: Frontpath All Commercial |
$181.63
|
| Rate for Payer: Humana ChoiceCare |
$3.60
|
| Rate for Payer: Humana ChoiceCare |
$170.51
|
| Rate for Payer: Humana Medicare |
$1.33
|
| Rate for Payer: Humana Medicare |
$63.17
|
| Rate for Payer: Lucent All Commercial |
$107.40
|
| Rate for Payer: Lucent All Commercial |
$2.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$177.68
|
| Rate for Payer: PHCS All Commercial |
$3.12
|
| Rate for Payer: PHCS All Commercial |
$148.07
|
| Rate for Payer: PHP All Commercial |
$149.72
|
| Rate for Payer: PHP All Commercial |
$3.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.62
|
| Rate for Payer: Sagamore Health Network All Products |
$152.41
|
| Rate for Payer: Sagamore Health Network All Products |
$3.22
|
| Rate for Payer: Signature Care EPO |
$3.46
|
| Rate for Payer: Signature Care EPO |
$163.86
|
| Rate for Payer: Signature Care PPO |
$173.73
|
| Rate for Payer: Signature Care PPO |
$3.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$167.81
|
| Rate for Payer: United Healthcare Commercial |
$155.57
|
| Rate for Payer: United Healthcare Commercial |
$3.28
|
| Rate for Payer: United Healthcare Medicare |
$63.17
|
| Rate for Payer: United Healthcare Medicare |
$1.33
|
|
|
PREDNISONE 10 MG ORAL TAB
|
Facility
|
OP
|
$2.23
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6494
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna Commercial |
$1.88
|
| Rate for Payer: Aetna Medicare |
$0.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.78
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Centivo All Commercial |
$1.21
|
| Rate for Payer: Cigna All Commercial |
$1.92
|
| Rate for Payer: CORVEL All Commercial |
$2.07
|
| Rate for Payer: Coventry All Commercial |
$1.96
|
| Rate for Payer: Encore All Commercial |
$2.05
|
| Rate for Payer: Frontpath All Commercial |
$2.05
|
| Rate for Payer: Humana ChoiceCare |
$1.92
|
| Rate for Payer: Humana Medicare |
$0.71
|
| Rate for Payer: Lucent All Commercial |
$1.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.00
|
| Rate for Payer: PHCS All Commercial |
$1.67
|
| Rate for Payer: PHP All Commercial |
$1.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1.72
|
| Rate for Payer: Signature Care EPO |
$1.85
|
| Rate for Payer: Signature Care PPO |
$1.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.89
|
| Rate for Payer: United Healthcare Commercial |
$1.75
|
| Rate for Payer: United Healthcare Medicare |
$0.71
|
|
|
PREDNISONE 10 MG ORAL TAB
|
Facility
|
IP
|
$2.23
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6494
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.07 |
| Rate for Payer: Aetna Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$1.38
|
| Rate for Payer: Cigna All Commercial |
$1.92
|
| Rate for Payer: CORVEL All Commercial |
$2.07
|
| Rate for Payer: Coventry All Commercial |
$1.96
|
| Rate for Payer: Encore All Commercial |
$2.05
|
| Rate for Payer: Frontpath All Commercial |
$2.05
|
| Rate for Payer: Humana ChoiceCare |
$1.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.00
|
| Rate for Payer: PHCS All Commercial |
$1.67
|
| Rate for Payer: PHP All Commercial |
$1.69
|
| Rate for Payer: Sagamore Health Network All Products |
$1.72
|
| Rate for Payer: Signature Care EPO |
$1.85
|
| Rate for Payer: Signature Care PPO |
$1.96
|
| Rate for Payer: United Healthcare Commercial |
$1.75
|
|
|
PREDNISONE 1 MG ORAL TAB
|
Facility
|
OP
|
$1.95
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6493
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna Commercial |
$1.64
|
| Rate for Payer: Aetna Medicare |
$0.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.68
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Centivo All Commercial |
$1.06
|
| Rate for Payer: Cigna All Commercial |
$1.68
|
| Rate for Payer: CORVEL All Commercial |
$1.81
|
| Rate for Payer: Coventry All Commercial |
$1.71
|
| Rate for Payer: Encore All Commercial |
$1.79
|
| Rate for Payer: Frontpath All Commercial |
$1.79
|
| Rate for Payer: Humana ChoiceCare |
$1.68
|
| Rate for Payer: Humana Medicare |
$0.62
|
| Rate for Payer: Lucent All Commercial |
$1.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.75
|
| Rate for Payer: PHCS All Commercial |
$1.46
|
| Rate for Payer: PHP All Commercial |
$1.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.76
|
| Rate for Payer: Sagamore Health Network All Products |
$1.50
|
| Rate for Payer: Signature Care EPO |
$1.62
|
| Rate for Payer: Signature Care PPO |
$1.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.65
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
| Rate for Payer: United Healthcare Medicare |
$0.62
|
|
|
PREDNISONE 1 MG ORAL TAB
|
Facility
|
IP
|
$1.95
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6493
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Aetna Commercial |
$1.68
|
| Rate for Payer: Cash Price |
$1.21
|
| Rate for Payer: Cigna All Commercial |
$1.68
|
| Rate for Payer: CORVEL All Commercial |
$1.81
|
| Rate for Payer: Coventry All Commercial |
$1.71
|
| Rate for Payer: Encore All Commercial |
$1.79
|
| Rate for Payer: Frontpath All Commercial |
$1.79
|
| Rate for Payer: Humana ChoiceCare |
$1.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.75
|
| Rate for Payer: PHCS All Commercial |
$1.46
|
| Rate for Payer: PHP All Commercial |
$1.48
|
| Rate for Payer: Sagamore Health Network All Products |
$1.50
|
| Rate for Payer: Signature Care EPO |
$1.62
|
| Rate for Payer: Signature Care PPO |
$1.71
|
| Rate for Payer: United Healthcare Commercial |
$1.53
|
|
|
PREDNISONE 20 MG ORAL TAB
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6496
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.31 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.35
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Centivo All Commercial |
$0.54
|
| 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 |
$0.32
|
| Rate for Payer: Lucent All Commercial |
$0.54
|
| 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 |
$0.32
|
|
|
PREDNISONE 20 MG ORAL TAB
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6496
|
|
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
|
|
|
PREDNISONE 5 MG ORAL TAB
|
Facility
|
OP
|
$1.74
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6497
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna Commercial |
$1.47
|
| Rate for Payer: Aetna Medicare |
$0.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.61
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Centivo All Commercial |
$0.95
|
| Rate for Payer: Cigna All Commercial |
$1.50
|
| Rate for Payer: CORVEL All Commercial |
$1.62
|
| Rate for Payer: Coventry All Commercial |
$1.53
|
| Rate for Payer: Encore All Commercial |
$1.60
|
| Rate for Payer: Frontpath All Commercial |
$1.60
|
| Rate for Payer: Humana ChoiceCare |
$1.51
|
| Rate for Payer: Humana Medicare |
$0.56
|
| Rate for Payer: Lucent All Commercial |
$0.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.57
|
| Rate for Payer: PHCS All Commercial |
$1.31
|
| Rate for Payer: PHP All Commercial |
$1.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.68
|
| Rate for Payer: Sagamore Health Network All Products |
$1.35
|
| Rate for Payer: Signature Care EPO |
$1.45
|
| Rate for Payer: Signature Care PPO |
$1.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.48
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
| Rate for Payer: United Healthcare Medicare |
$0.56
|
|
|
PREDNISONE 5 MG ORAL TAB
|
Facility
|
IP
|
$1.74
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
6497
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.31 |
| Max. Negotiated Rate |
$1.62 |
| Rate for Payer: Aetna Commercial |
$1.51
|
| Rate for Payer: Cash Price |
$1.08
|
| Rate for Payer: Cigna All Commercial |
$1.50
|
| Rate for Payer: CORVEL All Commercial |
$1.62
|
| Rate for Payer: Coventry All Commercial |
$1.53
|
| Rate for Payer: Encore All Commercial |
$1.60
|
| Rate for Payer: Frontpath All Commercial |
$1.60
|
| Rate for Payer: Humana ChoiceCare |
$1.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.57
|
| Rate for Payer: PHCS All Commercial |
$1.31
|
| Rate for Payer: PHP All Commercial |
$1.32
|
| Rate for Payer: Sagamore Health Network All Products |
$1.35
|
| Rate for Payer: Signature Care EPO |
$1.45
|
| Rate for Payer: Signature Care PPO |
$1.53
|
| Rate for Payer: United Healthcare Commercial |
$1.37
|
|
|
PREGABALIN 25 MG ORAL CAP
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904699161
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.41
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Centivo All Commercial |
$2.18
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Humana Medicare |
$1.28
|
| Rate for Payer: Lucent All Commercial |
$2.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.40
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$1.28
|
|
|
PREGABALIN 25 MG ORAL CAP
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904699161
|
| Hospital Charge Code |
42162
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
|
|
PREGABALIN 75 MG ORAL CAP
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
|
|
PREGABALIN 75 MG ORAL CAP
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00904700061
|
| Hospital Charge Code |
42164
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.41
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Centivo All Commercial |
$2.18
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Humana Medicare |
$1.28
|
| Rate for Payer: Lucent All Commercial |
$2.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.40
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$1.28
|
|
|
PR EGD BALLOON DILATION ESOPHAGUS <30 MM DIAM
|
Professional
|
Both
|
$1,975.64
|
|
|
Service Code
|
CPT 43249
|
| Hospital Charge Code |
z43249
|
| Min. Negotiated Rate |
$144.27 |
| Max. Negotiated Rate |
$19,900.00 |
| Rate for Payer: Aetna Commercial |
$144.27
|
| Rate for Payer: Aetna Commercial |
$144.27
|
| Rate for Payer: Aetna Medicare |
$144.27
|
| Rate for Payer: Aetna Medicare |
$144.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$249.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$249.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$249.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$249.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$249.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$249.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$249.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$249.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$145.61
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$145.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$969.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$969.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$165.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$165.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$158.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$158.70
|
| Rate for Payer: Cash Price |
$1,221.81
|
| Rate for Payer: Cash Price |
$1,224.90
|
| Rate for Payer: Centivo All Commercial |
$223.62
|
| Rate for Payer: Centivo All Commercial |
$223.62
|
| Rate for Payer: Cigna All Commercial |
$144.27
|
| Rate for Payer: Cigna All Commercial |
$144.27
|
| Rate for Payer: CORVEL All Commercial |
$144.27
|
| Rate for Payer: CORVEL All Commercial |
$144.27
|
| Rate for Payer: Coventry All Commercial |
$173.12
|
| Rate for Payer: Coventry All Commercial |
$173.12
|
| Rate for Payer: Encore All Commercial |
$144.27
|
| Rate for Payer: Encore All Commercial |
$144.27
|
| Rate for Payer: Frontpath All Commercial |
$197.48
|
| Rate for Payer: Frontpath All Commercial |
$197.48
|
| Rate for Payer: Humana ChoiceCare |
$185.63
|
| Rate for Payer: Humana ChoiceCare |
$185.63
|
| Rate for Payer: Humana Medicare |
$144.27
|
| Rate for Payer: Humana Medicare |
$144.27
|
| Rate for Payer: Lucent All Commercial |
$201.98
|
| Rate for Payer: Lucent All Commercial |
$201.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.00
|
| Rate for Payer: Managed Health Services Medicaid |
$969.25
|
| Rate for Payer: Managed Health Services Medicaid |
$969.25
|
| Rate for Payer: MDWise Medicaid |
$969.25
|
| Rate for Payer: MDWise Medicaid |
$969.25
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$145.61
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$145.61
|
| Rate for Payer: PHCS All Commercial |
$144.27
|
| Rate for Payer: PHCS All Commercial |
$144.27
|
| Rate for Payer: PHP All Commercial |
$242.88
|
| Rate for Payer: PHP All Commercial |
$242.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.27
|
| Rate for Payer: Sagamore Health Network All Products |
$144.27
|
| Rate for Payer: Sagamore Health Network All Products |
$144.27
|
| Rate for Payer: Signature Care EPO |
$906.78
|
| Rate for Payer: Signature Care EPO |
$906.78
|
| Rate for Payer: Signature Care PPO |
$906.78
|
| Rate for Payer: Signature Care PPO |
$906.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19,900.00
|
| Rate for Payer: United Healthcare Commercial |
$200.84
|
| Rate for Payer: United Healthcare Commercial |
$200.84
|
| Rate for Payer: United Healthcare Medicare |
$987.82
|
| Rate for Payer: United Healthcare Medicare |
$987.82
|
|
|
PR EGD DILATION GASTRIC/DUODENAL STRICTURE
|
Professional
|
Both
|
$1,030.56
|
|
|
Service Code
|
CPT 43245
|
| Hospital Charge Code |
z43245
|
| Min. Negotiated Rate |
$138.87 |
| Max. Negotiated Rate |
$543.19 |
| Rate for Payer: Aetna Commercial |
$164.57
|
| Rate for Payer: Aetna Medicare |
$164.57
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$138.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$536.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$189.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$181.03
|
| Rate for Payer: Cash Price |
$638.95
|
| Rate for Payer: Centivo All Commercial |
$255.08
|
| Rate for Payer: Cigna All Commercial |
$164.57
|
| Rate for Payer: CORVEL All Commercial |
$164.57
|
| Rate for Payer: Coventry All Commercial |
$197.48
|
| Rate for Payer: Encore All Commercial |
$164.57
|
| Rate for Payer: Frontpath All Commercial |
$226.51
|
| Rate for Payer: Humana ChoiceCare |
$202.83
|
| Rate for Payer: Humana Medicare |
$164.57
|
| Rate for Payer: Lucent All Commercial |
$230.40
|
| Rate for Payer: Managed Health Services Medicaid |
$536.54
|
| Rate for Payer: MDWise Medicaid |
$536.54
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$138.87
|
| Rate for Payer: PHCS All Commercial |
$164.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$164.57
|
| Rate for Payer: Sagamore Health Network All Products |
$164.57
|
| Rate for Payer: United Healthcare Commercial |
$215.78
|
| Rate for Payer: United Healthcare Medicare |
$543.19
|
|
|
PR EGD FLEXIBLE FOREIGN BODY REMOVAL
|
Professional
|
Both
|
$709.80
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
z43247
|
| Min. Negotiated Rate |
$166.23 |
| Max. Negotiated Rate |
$22,900.00 |
| Rate for Payer: Aetna Commercial |
$166.23
|
| Rate for Payer: Aetna Commercial |
$166.23
|
| Rate for Payer: Aetna Medicare |
$166.23
|
| Rate for Payer: Aetna Medicare |
$166.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$292.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$292.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$292.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$292.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$292.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$292.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$292.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$292.20
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$172.27
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$172.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$349.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$349.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$182.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$182.85
|
| Rate for Payer: Cash Price |
$434.81
|
| Rate for Payer: Cash Price |
$440.08
|
| Rate for Payer: Centivo All Commercial |
$257.66
|
| Rate for Payer: Centivo All Commercial |
$257.66
|
| Rate for Payer: Cigna All Commercial |
$166.23
|
| Rate for Payer: Cigna All Commercial |
$166.23
|
| Rate for Payer: CORVEL All Commercial |
$166.23
|
| Rate for Payer: CORVEL All Commercial |
$166.23
|
| Rate for Payer: Coventry All Commercial |
$199.48
|
| Rate for Payer: Coventry All Commercial |
$199.48
|
| Rate for Payer: Encore All Commercial |
$166.23
|
| Rate for Payer: Encore All Commercial |
$166.23
|
| Rate for Payer: Frontpath All Commercial |
$228.11
|
| Rate for Payer: Frontpath All Commercial |
$228.11
|
| Rate for Payer: Humana ChoiceCare |
$214.97
|
| Rate for Payer: Humana ChoiceCare |
$214.97
|
| Rate for Payer: Humana Medicare |
$166.23
|
| Rate for Payer: Humana Medicare |
$166.23
|
| Rate for Payer: Lucent All Commercial |
$232.72
|
| Rate for Payer: Lucent All Commercial |
$232.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$246.00
|
| Rate for Payer: Managed Health Services Medicaid |
$349.10
|
| Rate for Payer: Managed Health Services Medicaid |
$349.10
|
| Rate for Payer: MDWise Medicaid |
$349.10
|
| Rate for Payer: MDWise Medicaid |
$349.10
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$172.27
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$172.27
|
| Rate for Payer: PHCS All Commercial |
$166.23
|
| Rate for Payer: PHCS All Commercial |
$166.23
|
| Rate for Payer: PHP All Commercial |
$279.47
|
| Rate for Payer: PHP All Commercial |
$279.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.23
|
| Rate for Payer: Sagamore Health Network All Products |
$166.23
|
| Rate for Payer: Sagamore Health Network All Products |
$166.23
|
| Rate for Payer: Signature Care EPO |
$330.95
|
| Rate for Payer: Signature Care EPO |
$330.95
|
| Rate for Payer: Signature Care PPO |
$330.95
|
| Rate for Payer: Signature Care PPO |
$330.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,900.00
|
| Rate for Payer: United Healthcare Commercial |
$230.86
|
| Rate for Payer: United Healthcare Commercial |
$230.86
|
| Rate for Payer: United Healthcare Medicare |
$350.65
|
| Rate for Payer: United Healthcare Medicare |
$350.65
|
|
|
PR EGD FLEX REMOVAL LESION(S) BY HOT BIOPSY FORCEPS
|
Professional
|
Both
|
$828.50
|
|
|
Service Code
|
CPT 43250
|
| Hospital Charge Code |
z43250
|
| Min. Negotiated Rate |
$159.06 |
| Max. Negotiated Rate |
$22,000.00 |
| Rate for Payer: Aetna Commercial |
$159.06
|
| Rate for Payer: Aetna Commercial |
$159.06
|
| Rate for Payer: Aetna Medicare |
$159.06
|
| Rate for Payer: Aetna Medicare |
$159.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$275.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$275.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$275.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$275.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$275.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$275.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$275.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$275.80
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$161.21
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$161.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$407.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$407.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$182.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$182.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.97
|
| Rate for Payer: Cash Price |
$510.69
|
| Rate for Payer: Cash Price |
$513.67
|
| Rate for Payer: Centivo All Commercial |
$246.54
|
| Rate for Payer: Centivo All Commercial |
$246.54
|
| Rate for Payer: Cigna All Commercial |
$159.06
|
| Rate for Payer: Cigna All Commercial |
$159.06
|
| Rate for Payer: CORVEL All Commercial |
$159.06
|
| Rate for Payer: CORVEL All Commercial |
$159.06
|
| Rate for Payer: Coventry All Commercial |
$190.87
|
| Rate for Payer: Coventry All Commercial |
$190.87
|
| Rate for Payer: Encore All Commercial |
$159.06
|
| Rate for Payer: Encore All Commercial |
$159.06
|
| Rate for Payer: Frontpath All Commercial |
$219.60
|
| Rate for Payer: Frontpath All Commercial |
$219.60
|
| Rate for Payer: Humana ChoiceCare |
$204.15
|
| Rate for Payer: Humana ChoiceCare |
$204.15
|
| Rate for Payer: Humana Medicare |
$159.06
|
| Rate for Payer: Humana Medicare |
$159.06
|
| Rate for Payer: Lucent All Commercial |
$222.68
|
| Rate for Payer: Lucent All Commercial |
$222.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$235.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$235.00
|
| Rate for Payer: Managed Health Services Medicaid |
$407.49
|
| Rate for Payer: Managed Health Services Medicaid |
$407.49
|
| Rate for Payer: MDWise Medicaid |
$407.49
|
| Rate for Payer: MDWise Medicaid |
$407.49
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$161.21
|
| Rate for Payer: Molina Healthcare of OH Medicare |
$161.21
|
| Rate for Payer: PHCS All Commercial |
$159.06
|
| Rate for Payer: PHCS All Commercial |
$159.06
|
| Rate for Payer: PHP All Commercial |
$267.98
|
| Rate for Payer: PHP All Commercial |
$267.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$159.06
|
| Rate for Payer: Sagamore Health Network All Products |
$159.06
|
| Rate for Payer: Sagamore Health Network All Products |
$159.06
|
| Rate for Payer: Signature Care EPO |
$373.20
|
| Rate for Payer: Signature Care EPO |
$373.20
|
| Rate for Payer: Signature Care PPO |
$373.20
|
| Rate for Payer: Signature Care PPO |
$373.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22,000.00
|
| Rate for Payer: United Healthcare Commercial |
$215.85
|
| Rate for Payer: United Healthcare Commercial |
$215.85
|
| Rate for Payer: United Healthcare Medicare |
$411.85
|
| Rate for Payer: United Healthcare Medicare |
$411.85
|
|
