|
PR WRIST ARTHROSCOP,RELEASE XVERS LIG
|
Professional
|
Both
|
$959.86
|
|
|
Service Code
|
CPT 29848
|
| Hospital Charge Code |
z29848
|
| Min. Negotiated Rate |
$467.88 |
| Max. Negotiated Rate |
$814.11 |
| Rate for Payer: Aetna Commercial |
$477.46
|
| Rate for Payer: Aetna Commercial |
$477.46
|
| Rate for Payer: Aetna Medicare |
$477.46
|
| Rate for Payer: Aetna Medicare |
$477.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$472.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$472.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$549.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$549.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$525.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$525.21
|
| Rate for Payer: Cash Price |
$575.92
|
| Rate for Payer: Cash Price |
$561.46
|
| Rate for Payer: Centivo All Commercial |
$740.06
|
| Rate for Payer: Centivo All Commercial |
$740.06
|
| Rate for Payer: Cigna All Commercial |
$477.46
|
| Rate for Payer: Cigna All Commercial |
$477.46
|
| Rate for Payer: CORVEL All Commercial |
$477.46
|
| Rate for Payer: CORVEL All Commercial |
$477.46
|
| Rate for Payer: Coventry All Commercial |
$572.95
|
| Rate for Payer: Coventry All Commercial |
$572.95
|
| Rate for Payer: Encore All Commercial |
$477.46
|
| Rate for Payer: Encore All Commercial |
$477.46
|
| Rate for Payer: Frontpath All Commercial |
$659.11
|
| Rate for Payer: Frontpath All Commercial |
$659.11
|
| Rate for Payer: Humana ChoiceCare |
$475.73
|
| Rate for Payer: Humana ChoiceCare |
$475.73
|
| Rate for Payer: Humana Medicare |
$477.46
|
| Rate for Payer: Humana Medicare |
$477.46
|
| Rate for Payer: Lucent All Commercial |
$668.44
|
| Rate for Payer: Lucent All Commercial |
$668.44
|
| Rate for Payer: Managed Health Services Medicaid |
$472.10
|
| Rate for Payer: Managed Health Services Medicaid |
$472.10
|
| Rate for Payer: MDWise Medicaid |
$472.10
|
| Rate for Payer: MDWise Medicaid |
$472.10
|
| Rate for Payer: PHCS All Commercial |
$477.46
|
| Rate for Payer: PHCS All Commercial |
$477.46
|
| Rate for Payer: PHP All Commercial |
$814.11
|
| Rate for Payer: PHP All Commercial |
$814.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$477.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$477.46
|
| Rate for Payer: Sagamore Health Network All Products |
$477.46
|
| Rate for Payer: Sagamore Health Network All Products |
$477.46
|
| Rate for Payer: Signature Care EPO |
$632.40
|
| Rate for Payer: Signature Care EPO |
$632.40
|
| Rate for Payer: Signature Care PPO |
$632.40
|
| Rate for Payer: Signature Care PPO |
$632.40
|
| Rate for Payer: United Healthcare Commercial |
$529.69
|
| Rate for Payer: United Healthcare Commercial |
$529.69
|
| Rate for Payer: United Healthcare Medicare |
$467.88
|
| Rate for Payer: United Healthcare Medicare |
$467.88
|
|
|
PR XFER SINGLE DEEP LOW LEG TENDON
|
Professional
|
Both
|
$1,385.88
|
|
|
Service Code
|
CPT 27691
|
| Hospital Charge Code |
z27691
|
| Min. Negotiated Rate |
$678.31 |
| Max. Negotiated Rate |
$104,300.00 |
| Rate for Payer: Aetna Commercial |
$697.20
|
| Rate for Payer: Aetna Commercial |
$697.20
|
| Rate for Payer: Aetna Medicare |
$697.20
|
| Rate for Payer: Aetna Medicare |
$697.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$947.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$947.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$947.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$947.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$947.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$947.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$947.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$947.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$681.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$681.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$801.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$801.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$766.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$766.92
|
| Rate for Payer: Cash Price |
$831.53
|
| Rate for Payer: Cash Price |
$813.97
|
| Rate for Payer: Centivo All Commercial |
$1,080.66
|
| Rate for Payer: Centivo All Commercial |
$1,080.66
|
| Rate for Payer: Cigna All Commercial |
$697.20
|
| Rate for Payer: Cigna All Commercial |
$697.20
|
| Rate for Payer: CORVEL All Commercial |
$697.20
|
| Rate for Payer: CORVEL All Commercial |
$697.20
|
| Rate for Payer: Coventry All Commercial |
$836.64
|
| Rate for Payer: Coventry All Commercial |
$836.64
|
| Rate for Payer: Encore All Commercial |
$697.20
|
| Rate for Payer: Encore All Commercial |
$697.20
|
| Rate for Payer: Frontpath All Commercial |
$962.47
|
| Rate for Payer: Frontpath All Commercial |
$962.47
|
| Rate for Payer: Humana ChoiceCare |
$773.35
|
| Rate for Payer: Humana ChoiceCare |
$773.35
|
| Rate for Payer: Humana Medicare |
$697.20
|
| Rate for Payer: Humana Medicare |
$697.20
|
| Rate for Payer: Lucent All Commercial |
$976.08
|
| Rate for Payer: Lucent All Commercial |
$976.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,112.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,112.00
|
| Rate for Payer: Managed Health Services Medicaid |
$681.63
|
| Rate for Payer: Managed Health Services Medicaid |
$681.63
|
| Rate for Payer: MDWise Medicaid |
$681.63
|
| Rate for Payer: MDWise Medicaid |
$681.63
|
| Rate for Payer: PHCS All Commercial |
$697.20
|
| Rate for Payer: PHCS All Commercial |
$697.20
|
| Rate for Payer: PHP All Commercial |
$1,180.27
|
| Rate for Payer: PHP All Commercial |
$1,180.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$697.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$697.20
|
| Rate for Payer: Sagamore Health Network All Products |
$697.20
|
| Rate for Payer: Sagamore Health Network All Products |
$697.20
|
| Rate for Payer: Signature Care EPO |
$1,041.25
|
| Rate for Payer: Signature Care EPO |
$1,041.25
|
| Rate for Payer: Signature Care PPO |
$1,041.25
|
| Rate for Payer: Signature Care PPO |
$1,041.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104,300.00
|
| Rate for Payer: United Healthcare Commercial |
$817.31
|
| Rate for Payer: United Healthcare Commercial |
$817.31
|
| Rate for Payer: United Healthcare Medicare |
$678.31
|
| Rate for Payer: United Healthcare Medicare |
$678.31
|
|
|
PR XTRNL ECG CONTINUOUS RHYTHM W/I&R UP TO 48 HRS
|
Professional
|
Both
|
$34.88
|
|
|
Service Code
|
CPT 93227
|
| Hospital Charge Code |
z93227
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$18.02
|
| Rate for Payer: Aetna Commercial |
$18.02
|
| Rate for Payer: Aetna Medicare |
$18.02
|
| Rate for Payer: Aetna Medicare |
$18.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.82
|
| Rate for Payer: Cash Price |
$20.93
|
| Rate for Payer: Cash Price |
$20.72
|
| Rate for Payer: Centivo All Commercial |
$27.93
|
| Rate for Payer: Centivo All Commercial |
$27.93
|
| Rate for Payer: Cigna All Commercial |
$18.02
|
| Rate for Payer: Cigna All Commercial |
$18.02
|
| Rate for Payer: CORVEL All Commercial |
$18.02
|
| Rate for Payer: CORVEL All Commercial |
$18.02
|
| Rate for Payer: Coventry All Commercial |
$21.62
|
| Rate for Payer: Coventry All Commercial |
$21.62
|
| Rate for Payer: Encore All Commercial |
$18.02
|
| Rate for Payer: Encore All Commercial |
$18.02
|
| Rate for Payer: Frontpath All Commercial |
$20.13
|
| Rate for Payer: Frontpath All Commercial |
$20.13
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$18.02
|
| Rate for Payer: Humana Medicare |
$18.02
|
| Rate for Payer: Lucent All Commercial |
$25.23
|
| Rate for Payer: Lucent All Commercial |
$25.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.00
|
| Rate for Payer: Managed Health Services Medicaid |
$17.16
|
| Rate for Payer: Managed Health Services Medicaid |
$17.16
|
| Rate for Payer: MDWise Medicaid |
$17.16
|
| Rate for Payer: MDWise Medicaid |
$17.16
|
| Rate for Payer: PHCS All Commercial |
$18.02
|
| Rate for Payer: PHCS All Commercial |
$18.02
|
| Rate for Payer: PHP All Commercial |
$25.38
|
| Rate for Payer: PHP All Commercial |
$25.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.02
|
| Rate for Payer: Sagamore Health Network All Products |
$18.02
|
| Rate for Payer: Sagamore Health Network All Products |
$18.02
|
| Rate for Payer: Signature Care EPO |
$30.63
|
| Rate for Payer: Signature Care EPO |
$30.63
|
| Rate for Payer: Signature Care PPO |
$30.63
|
| Rate for Payer: Signature Care PPO |
$30.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,700.00
|
| Rate for Payer: United Healthcare Commercial |
$34.33
|
| Rate for Payer: United Healthcare Commercial |
$34.33
|
| Rate for Payer: United Healthcare Medicare |
$17.27
|
| Rate for Payer: United Healthcare Medicare |
$17.27
|
|
|
PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS
|
Professional
|
Both
|
$47.04
|
|
|
Service Code
|
CPT 93228
|
| Hospital Charge Code |
z93228
|
| Min. Negotiated Rate |
$23.14 |
| Max. Negotiated Rate |
$3,600.00 |
| Rate for Payer: Aetna Commercial |
$24.42
|
| Rate for Payer: Aetna Commercial |
$24.42
|
| Rate for Payer: Aetna Medicare |
$24.42
|
| Rate for Payer: Aetna Medicare |
$24.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$24.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$24.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$23.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$23.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.86
|
| Rate for Payer: Cash Price |
$28.22
|
| Rate for Payer: Cash Price |
$28.10
|
| Rate for Payer: Centivo All Commercial |
$37.85
|
| Rate for Payer: Centivo All Commercial |
$37.85
|
| Rate for Payer: Cigna All Commercial |
$24.42
|
| Rate for Payer: Cigna All Commercial |
$24.42
|
| Rate for Payer: CORVEL All Commercial |
$24.42
|
| Rate for Payer: CORVEL All Commercial |
$24.42
|
| Rate for Payer: Coventry All Commercial |
$29.30
|
| Rate for Payer: Coventry All Commercial |
$29.30
|
| Rate for Payer: Encore All Commercial |
$24.42
|
| Rate for Payer: Encore All Commercial |
$24.42
|
| Rate for Payer: Frontpath All Commercial |
$27.93
|
| Rate for Payer: Frontpath All Commercial |
$27.93
|
| Rate for Payer: Humana ChoiceCare |
$33.73
|
| Rate for Payer: Humana ChoiceCare |
$33.73
|
| Rate for Payer: Humana Medicare |
$24.42
|
| Rate for Payer: Humana Medicare |
$24.42
|
| Rate for Payer: Lucent All Commercial |
$34.19
|
| Rate for Payer: Lucent All Commercial |
$34.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$38.00
|
| Rate for Payer: Managed Health Services Medicaid |
$23.14
|
| Rate for Payer: Managed Health Services Medicaid |
$23.14
|
| Rate for Payer: MDWise Medicaid |
$23.14
|
| Rate for Payer: MDWise Medicaid |
$23.14
|
| Rate for Payer: PHCS All Commercial |
$24.42
|
| Rate for Payer: PHCS All Commercial |
$24.42
|
| Rate for Payer: PHP All Commercial |
$34.43
|
| Rate for Payer: PHP All Commercial |
$34.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.42
|
| Rate for Payer: Sagamore Health Network All Products |
$24.42
|
| Rate for Payer: Sagamore Health Network All Products |
$24.42
|
| Rate for Payer: Signature Care EPO |
$37.97
|
| Rate for Payer: Signature Care EPO |
$37.97
|
| Rate for Payer: Signature Care PPO |
$37.97
|
| Rate for Payer: Signature Care PPO |
$37.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,600.00
|
| Rate for Payer: United Healthcare Commercial |
$31.03
|
| Rate for Payer: United Healthcare Commercial |
$31.03
|
| Rate for Payer: United Healthcare Medicare |
$23.42
|
| Rate for Payer: United Healthcare Medicare |
$23.42
|
|
|
PR XTRNL MOBILE CV TELEMETRY W/TECHNICAL SUPPORT
|
Professional
|
Both
|
$1,507.24
|
|
|
Service Code
|
CPT 93229
|
| Hospital Charge Code |
z93229
|
| Min. Negotiated Rate |
$381.10 |
| Max. Negotiated Rate |
$115,900.00 |
| Rate for Payer: Aetna Commercial |
$819.18
|
| Rate for Payer: Aetna Commercial |
$819.18
|
| Rate for Payer: Aetna Medicare |
$819.18
|
| Rate for Payer: Aetna Medicare |
$819.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$679.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$679.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$679.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$679.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$679.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$679.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$679.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$679.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$735.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$735.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$942.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$942.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$901.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$901.10
|
| Rate for Payer: Cash Price |
$904.34
|
| Rate for Payer: Cash Price |
$897.80
|
| Rate for Payer: Centivo All Commercial |
$1,269.73
|
| Rate for Payer: Centivo All Commercial |
$1,269.73
|
| Rate for Payer: Cigna All Commercial |
$819.18
|
| Rate for Payer: Cigna All Commercial |
$819.18
|
| Rate for Payer: CORVEL All Commercial |
$819.18
|
| Rate for Payer: CORVEL All Commercial |
$819.18
|
| Rate for Payer: Coventry All Commercial |
$983.02
|
| Rate for Payer: Coventry All Commercial |
$983.02
|
| Rate for Payer: Encore All Commercial |
$819.18
|
| Rate for Payer: Encore All Commercial |
$819.18
|
| Rate for Payer: Frontpath All Commercial |
$916.49
|
| Rate for Payer: Frontpath All Commercial |
$916.49
|
| Rate for Payer: Humana ChoiceCare |
$885.81
|
| Rate for Payer: Humana ChoiceCare |
$885.81
|
| Rate for Payer: Humana Medicare |
$819.18
|
| Rate for Payer: Humana Medicare |
$819.18
|
| Rate for Payer: Lucent All Commercial |
$1,146.85
|
| Rate for Payer: Lucent All Commercial |
$1,146.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,236.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,236.00
|
| Rate for Payer: Managed Health Services Medicaid |
$735.96
|
| Rate for Payer: Managed Health Services Medicaid |
$735.96
|
| Rate for Payer: MDWise Medicaid |
$735.96
|
| Rate for Payer: MDWise Medicaid |
$735.96
|
| Rate for Payer: PHCS All Commercial |
$819.18
|
| Rate for Payer: PHCS All Commercial |
$819.18
|
| Rate for Payer: PHP All Commercial |
$1,107.83
|
| Rate for Payer: PHP All Commercial |
$1,107.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$819.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$819.18
|
| Rate for Payer: Sagamore Health Network All Products |
$819.18
|
| Rate for Payer: Sagamore Health Network All Products |
$819.18
|
| Rate for Payer: Signature Care EPO |
$1,157.58
|
| Rate for Payer: Signature Care EPO |
$1,157.58
|
| Rate for Payer: Signature Care PPO |
$1,157.58
|
| Rate for Payer: Signature Care PPO |
$1,157.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$115,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$115,900.00
|
| Rate for Payer: United Healthcare Commercial |
$381.10
|
| Rate for Payer: United Healthcare Commercial |
$381.10
|
| Rate for Payer: United Healthcare Medicare |
$753.62
|
| Rate for Payer: United Healthcare Medicare |
$753.62
|
|
|
PR XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS
|
Professional
|
Both
|
$323.80
|
|
|
Service Code
|
CPT 93268
|
| Hospital Charge Code |
z93268
|
| Min. Negotiated Rate |
$159.25 |
| Max. Negotiated Rate |
$24,800.00 |
| Rate for Payer: Aetna Commercial |
$171.56
|
| Rate for Payer: Aetna Commercial |
$171.56
|
| Rate for Payer: Aetna Medicare |
$171.56
|
| Rate for Payer: Aetna Medicare |
$171.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$205.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$205.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$205.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$205.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$205.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$205.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$205.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$205.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$159.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$159.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$197.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$197.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$188.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$188.72
|
| Rate for Payer: Cash Price |
$194.28
|
| Rate for Payer: Cash Price |
$193.78
|
| Rate for Payer: Centivo All Commercial |
$265.92
|
| Rate for Payer: Centivo All Commercial |
$265.92
|
| Rate for Payer: Cigna All Commercial |
$171.56
|
| Rate for Payer: Cigna All Commercial |
$171.56
|
| Rate for Payer: CORVEL All Commercial |
$171.56
|
| Rate for Payer: CORVEL All Commercial |
$171.56
|
| Rate for Payer: Coventry All Commercial |
$205.87
|
| Rate for Payer: Coventry All Commercial |
$205.87
|
| Rate for Payer: Encore All Commercial |
$171.56
|
| Rate for Payer: Encore All Commercial |
$171.56
|
| Rate for Payer: Frontpath All Commercial |
$192.10
|
| Rate for Payer: Frontpath All Commercial |
$192.10
|
| Rate for Payer: Humana ChoiceCare |
$381.16
|
| Rate for Payer: Humana ChoiceCare |
$381.16
|
| Rate for Payer: Humana Medicare |
$171.56
|
| Rate for Payer: Humana Medicare |
$171.56
|
| Rate for Payer: Lucent All Commercial |
$240.18
|
| Rate for Payer: Lucent All Commercial |
$240.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$265.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$265.00
|
| Rate for Payer: Managed Health Services Medicaid |
$159.25
|
| Rate for Payer: Managed Health Services Medicaid |
$159.25
|
| Rate for Payer: MDWise Medicaid |
$159.25
|
| Rate for Payer: MDWise Medicaid |
$159.25
|
| Rate for Payer: PHCS All Commercial |
$171.56
|
| Rate for Payer: PHCS All Commercial |
$171.56
|
| Rate for Payer: PHP All Commercial |
$237.38
|
| Rate for Payer: PHP All Commercial |
$237.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$171.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$171.56
|
| Rate for Payer: Sagamore Health Network All Products |
$171.56
|
| Rate for Payer: Sagamore Health Network All Products |
$171.56
|
| Rate for Payer: Signature Care EPO |
$291.65
|
| Rate for Payer: Signature Care EPO |
$291.65
|
| Rate for Payer: Signature Care PPO |
$291.65
|
| Rate for Payer: Signature Care PPO |
$291.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24,800.00
|
| Rate for Payer: United Healthcare Commercial |
$302.50
|
| Rate for Payer: United Healthcare Commercial |
$302.50
|
| Rate for Payer: United Healthcare Medicare |
$161.48
|
| Rate for Payer: United Healthcare Medicare |
$161.48
|
|
|
PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS
|
Professional
|
Both
|
$45.70
|
|
|
Service Code
|
CPT 93272
|
| Hospital Charge Code |
z93272
|
| Min. Negotiated Rate |
$22.48 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$23.92
|
| Rate for Payer: Aetna Commercial |
$23.92
|
| Rate for Payer: Aetna Medicare |
$23.92
|
| Rate for Payer: Aetna Medicare |
$23.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$23.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$23.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$23.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$22.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$22.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.31
|
| Rate for Payer: Cash Price |
$27.42
|
| Rate for Payer: Cash Price |
$27.16
|
| Rate for Payer: Centivo All Commercial |
$37.08
|
| Rate for Payer: Centivo All Commercial |
$37.08
|
| Rate for Payer: Cigna All Commercial |
$23.92
|
| Rate for Payer: Cigna All Commercial |
$23.92
|
| Rate for Payer: CORVEL All Commercial |
$23.92
|
| Rate for Payer: CORVEL All Commercial |
$23.92
|
| Rate for Payer: Coventry All Commercial |
$28.70
|
| Rate for Payer: Coventry All Commercial |
$28.70
|
| Rate for Payer: Encore All Commercial |
$23.92
|
| Rate for Payer: Encore All Commercial |
$23.92
|
| Rate for Payer: Frontpath All Commercial |
$26.88
|
| Rate for Payer: Frontpath All Commercial |
$26.88
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana ChoiceCare |
$36.10
|
| Rate for Payer: Humana Medicare |
$23.92
|
| Rate for Payer: Humana Medicare |
$23.92
|
| Rate for Payer: Lucent All Commercial |
$33.49
|
| Rate for Payer: Lucent All Commercial |
$33.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.00
|
| Rate for Payer: Managed Health Services Medicaid |
$22.48
|
| Rate for Payer: Managed Health Services Medicaid |
$22.48
|
| Rate for Payer: MDWise Medicaid |
$22.48
|
| Rate for Payer: MDWise Medicaid |
$22.48
|
| Rate for Payer: PHCS All Commercial |
$23.92
|
| Rate for Payer: PHCS All Commercial |
$23.92
|
| Rate for Payer: PHP All Commercial |
$33.26
|
| Rate for Payer: PHP All Commercial |
$33.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.92
|
| Rate for Payer: Sagamore Health Network All Products |
$23.92
|
| Rate for Payer: Sagamore Health Network All Products |
$23.92
|
| Rate for Payer: Signature Care EPO |
$40.66
|
| Rate for Payer: Signature Care EPO |
$40.66
|
| Rate for Payer: Signature Care PPO |
$40.66
|
| Rate for Payer: Signature Care PPO |
$40.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,500.00
|
| Rate for Payer: United Healthcare Commercial |
$33.09
|
| Rate for Payer: United Healthcare Commercial |
$33.09
|
| Rate for Payer: United Healthcare Medicare |
$22.63
|
| Rate for Payer: United Healthcare Medicare |
$22.63
|
|
|
PSEUDOEPHEDRINE HCL 30 MG ORAL TAB
|
Facility
|
IP
|
$0.16
|
|
|
Service Code
|
NDC 00904505359
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Cigna All Commercial |
$0.14
|
| Rate for Payer: CORVEL All Commercial |
$0.15
|
| Rate for Payer: Coventry All Commercial |
$0.14
|
| Rate for Payer: Encore All Commercial |
$0.15
|
| Rate for Payer: Frontpath All Commercial |
$0.15
|
| Rate for Payer: Humana ChoiceCare |
$0.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.14
|
| Rate for Payer: PHCS All Commercial |
$0.12
|
| Rate for Payer: PHP All Commercial |
$0.12
|
| Rate for Payer: Sagamore Health Network All Products |
$0.12
|
| Rate for Payer: Signature Care EPO |
$0.13
|
| Rate for Payer: Signature Care PPO |
$0.14
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
|
|
PSEUDOEPHEDRINE HCL 30 MG ORAL TAB
|
Facility
|
OP
|
$0.16
|
|
|
Service Code
|
NDC 00904505359
|
| Hospital Charge Code |
6714
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.15 |
| Rate for Payer: Aetna Commercial |
$0.14
|
| Rate for Payer: Aetna Medicare |
$0.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.06
|
| Rate for Payer: Cash Price |
$0.10
|
| Rate for Payer: Centivo All Commercial |
$0.09
|
| Rate for Payer: Cigna All Commercial |
$0.14
|
| Rate for Payer: CORVEL All Commercial |
$0.15
|
| Rate for Payer: Coventry All Commercial |
$0.14
|
| Rate for Payer: Encore All Commercial |
$0.15
|
| Rate for Payer: Frontpath All Commercial |
$0.15
|
| Rate for Payer: Humana ChoiceCare |
$0.14
|
| Rate for Payer: Humana Medicare |
$0.05
|
| Rate for Payer: Lucent All Commercial |
$0.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.14
|
| Rate for Payer: PHCS All Commercial |
$0.12
|
| Rate for Payer: PHP All Commercial |
$0.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.06
|
| Rate for Payer: Sagamore Health Network All Products |
$0.12
|
| Rate for Payer: Signature Care EPO |
$0.13
|
| Rate for Payer: Signature Care PPO |
$0.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.14
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
| Rate for Payer: United Healthcare Medicare |
$0.05
|
|
|
PSYLLIUM HUSK 3.4 G ORAL PWPK
|
Facility
|
IP
|
$4.07
|
|
|
Service Code
|
NDC 37000002404
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Aetna Commercial |
$3.51
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna All Commercial |
$3.51
|
| Rate for Payer: CORVEL All Commercial |
$3.78
|
| Rate for Payer: Coventry All Commercial |
$3.58
|
| Rate for Payer: Encore All Commercial |
$3.74
|
| Rate for Payer: Frontpath All Commercial |
$3.74
|
| Rate for Payer: Humana ChoiceCare |
$3.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.66
|
| Rate for Payer: PHCS All Commercial |
$3.05
|
| Rate for Payer: PHP All Commercial |
$3.08
|
| Rate for Payer: Sagamore Health Network All Products |
$3.14
|
| Rate for Payer: Signature Care EPO |
$3.38
|
| Rate for Payer: Signature Care PPO |
$3.58
|
| Rate for Payer: United Healthcare Commercial |
$3.20
|
|
|
PSYLLIUM HUSK 3.4 G ORAL PWPK
|
Facility
|
OP
|
$4.07
|
|
|
Service Code
|
NDC 37000002404
|
| Hospital Charge Code |
11218
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$3.78 |
| Rate for Payer: Aetna Commercial |
$3.43
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.43
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Centivo All Commercial |
$2.21
|
| Rate for Payer: Cigna All Commercial |
$3.51
|
| Rate for Payer: CORVEL All Commercial |
$3.78
|
| Rate for Payer: Coventry All Commercial |
$3.58
|
| Rate for Payer: Encore All Commercial |
$3.74
|
| Rate for Payer: Frontpath All Commercial |
$3.74
|
| Rate for Payer: Humana ChoiceCare |
$3.51
|
| Rate for Payer: Humana Medicare |
$1.30
|
| Rate for Payer: Lucent All Commercial |
$2.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.66
|
| Rate for Payer: PHCS All Commercial |
$3.05
|
| Rate for Payer: PHP All Commercial |
$3.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.59
|
| Rate for Payer: Sagamore Health Network All Products |
$3.14
|
| Rate for Payer: Signature Care EPO |
$3.38
|
| Rate for Payer: Signature Care PPO |
$3.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.46
|
| Rate for Payer: United Healthcare Commercial |
$3.20
|
| Rate for Payer: United Healthcare Medicare |
$1.30
|
|
|
PSYLLIUM HUSK (WITH SUGAR) 3.4 G ORAL PWPK
|
Facility
|
IP
|
$4.07
|
|
|
Service Code
|
NDC 37000002304
|
| Hospital Charge Code |
168105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna All Commercial |
$3.52
|
| Rate for Payer: CORVEL All Commercial |
$3.79
|
| Rate for Payer: Coventry All Commercial |
$3.59
|
| Rate for Payer: Encore All Commercial |
$3.75
|
| Rate for Payer: Frontpath All Commercial |
$3.75
|
| Rate for Payer: Humana ChoiceCare |
$3.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$3.06
|
| Rate for Payer: PHP All Commercial |
$3.09
|
| Rate for Payer: Sagamore Health Network All Products |
$3.15
|
| Rate for Payer: Signature Care EPO |
$3.38
|
| Rate for Payer: Signature Care PPO |
$3.59
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
|
|
PSYLLIUM HUSK (WITH SUGAR) 3.4 G ORAL PWPK
|
Facility
|
OP
|
$4.07
|
|
|
Service Code
|
NDC 37000002310
|
| Hospital Charge Code |
168105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.43
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Centivo All Commercial |
$2.22
|
| Rate for Payer: Cigna All Commercial |
$3.52
|
| Rate for Payer: CORVEL All Commercial |
$3.79
|
| Rate for Payer: Coventry All Commercial |
$3.59
|
| Rate for Payer: Encore All Commercial |
$3.75
|
| Rate for Payer: Frontpath All Commercial |
$3.75
|
| Rate for Payer: Humana ChoiceCare |
$3.52
|
| Rate for Payer: Humana Medicare |
$1.30
|
| Rate for Payer: Lucent All Commercial |
$2.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$3.06
|
| Rate for Payer: PHP All Commercial |
$3.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.59
|
| Rate for Payer: Sagamore Health Network All Products |
$3.15
|
| Rate for Payer: Signature Care EPO |
$3.38
|
| Rate for Payer: Signature Care PPO |
$3.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.46
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
| Rate for Payer: United Healthcare Medicare |
$1.30
|
|
|
PSYLLIUM HUSK (WITH SUGAR) 3.4 G ORAL PWPK
|
Facility
|
OP
|
$4.07
|
|
|
Service Code
|
NDC 37000002304
|
| Hospital Charge Code |
168105
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna Commercial |
$3.44
|
| Rate for Payer: Aetna Medicare |
$1.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.43
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Centivo All Commercial |
$2.22
|
| Rate for Payer: Cigna All Commercial |
$3.52
|
| Rate for Payer: CORVEL All Commercial |
$3.79
|
| Rate for Payer: Coventry All Commercial |
$3.59
|
| Rate for Payer: Encore All Commercial |
$3.75
|
| Rate for Payer: Frontpath All Commercial |
$3.75
|
| Rate for Payer: Humana ChoiceCare |
$3.52
|
| Rate for Payer: Humana Medicare |
$1.30
|
| Rate for Payer: Lucent All Commercial |
$2.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$3.06
|
| Rate for Payer: PHP All Commercial |
$3.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.59
|
| Rate for Payer: Sagamore Health Network All Products |
$3.15
|
| Rate for Payer: Signature Care EPO |
$3.38
|
| Rate for Payer: Signature Care PPO |
$3.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.46
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
| Rate for Payer: United Healthcare Medicare |
$1.30
|
|
|
PSYLLIUM HUSK (WITH SUGAR) 3.4 G ORAL PWPK
|
Facility
|
IP
|
$4.07
|
|
|
Service Code
|
NDC 37000002310
|
| Hospital Charge Code |
168105
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$3.79 |
| Rate for Payer: Aetna Commercial |
$3.52
|
| Rate for Payer: Cash Price |
$2.44
|
| Rate for Payer: Cigna All Commercial |
$3.52
|
| Rate for Payer: CORVEL All Commercial |
$3.79
|
| Rate for Payer: Coventry All Commercial |
$3.59
|
| Rate for Payer: Encore All Commercial |
$3.75
|
| Rate for Payer: Frontpath All Commercial |
$3.75
|
| Rate for Payer: Humana ChoiceCare |
$3.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.67
|
| Rate for Payer: PHCS All Commercial |
$3.06
|
| Rate for Payer: PHP All Commercial |
$3.09
|
| Rate for Payer: Sagamore Health Network All Products |
$3.15
|
| Rate for Payer: Signature Care EPO |
$3.38
|
| Rate for Payer: Signature Care PPO |
$3.59
|
| Rate for Payer: United Healthcare Commercial |
$3.21
|
|
|
QUETIAPINE 100 MG ORAL TAB
|
Facility
|
IP
|
$1.18
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.89 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna Commercial |
$1.02
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Cigna All Commercial |
$1.02
|
| Rate for Payer: CORVEL All Commercial |
$1.10
|
| Rate for Payer: Coventry All Commercial |
$1.04
|
| Rate for Payer: Encore All Commercial |
$1.09
|
| Rate for Payer: Frontpath All Commercial |
$1.09
|
| Rate for Payer: Humana ChoiceCare |
$1.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.06
|
| Rate for Payer: PHCS All Commercial |
$0.89
|
| Rate for Payer: PHP All Commercial |
$0.90
|
| Rate for Payer: Sagamore Health Network All Products |
$0.91
|
| Rate for Payer: Signature Care EPO |
$0.98
|
| Rate for Payer: Signature Care PPO |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$0.93
|
|
|
QUETIAPINE 100 MG ORAL TAB
|
Facility
|
OP
|
$1.18
|
|
|
Service Code
|
NDC 00904664061
|
| Hospital Charge Code |
21824
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.10 |
| Rate for Payer: Aetna Commercial |
$1.00
|
| Rate for Payer: Aetna Medicare |
$0.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.42
|
| Rate for Payer: Cash Price |
$0.71
|
| Rate for Payer: Centivo All Commercial |
$0.64
|
| Rate for Payer: Cigna All Commercial |
$1.02
|
| Rate for Payer: CORVEL All Commercial |
$1.10
|
| Rate for Payer: Coventry All Commercial |
$1.04
|
| Rate for Payer: Encore All Commercial |
$1.09
|
| Rate for Payer: Frontpath All Commercial |
$1.09
|
| Rate for Payer: Humana ChoiceCare |
$1.02
|
| Rate for Payer: Humana Medicare |
$0.38
|
| Rate for Payer: Lucent All Commercial |
$0.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.06
|
| Rate for Payer: PHCS All Commercial |
$0.89
|
| Rate for Payer: PHP All Commercial |
$0.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.46
|
| Rate for Payer: Sagamore Health Network All Products |
$0.91
|
| Rate for Payer: Signature Care EPO |
$0.98
|
| Rate for Payer: Signature Care PPO |
$1.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.01
|
| Rate for Payer: United Healthcare Commercial |
$0.93
|
| Rate for Payer: United Healthcare Medicare |
$0.38
|
|
|
QUETIAPINE 25 MG ORAL TAB
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
21823
|
|
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 |
$0.60
|
| 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
|
|
|
QUETIAPINE 25 MG ORAL TAB
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
NDC 00904663861
|
| Hospital Charge Code |
21823
|
|
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 |
$0.60
|
| 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
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNITS/ML IM SOLN
|
Facility
|
OP
|
$2,585.24
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
184464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$714.52 |
| Max. Negotiated Rate |
$2,404.27 |
| Rate for Payer: Aetna Commercial |
$2,181.94
|
| Rate for Payer: Aetna Commercial |
$9,546.00
|
| Rate for Payer: Aetna Medicare |
$827.28
|
| Rate for Payer: Aetna Medicare |
$3,619.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$714.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$714.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$801.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,506.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6,495.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,484.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,616.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7,070.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$714.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$714.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$951.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4,162.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$910.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,981.27
|
| Rate for Payer: Cash Price |
$1,551.14
|
| Rate for Payer: Cash Price |
$6,786.26
|
| Rate for Payer: Cash Price |
$6,786.26
|
| Rate for Payer: Cash Price |
$1,551.14
|
| Rate for Payer: Centivo All Commercial |
$6,152.87
|
| Rate for Payer: Centivo All Commercial |
$1,406.37
|
| Rate for Payer: Cigna All Commercial |
$2,231.06
|
| Rate for Payer: Cigna All Commercial |
$9,760.90
|
| Rate for Payer: CORVEL All Commercial |
$2,404.27
|
| Rate for Payer: CORVEL All Commercial |
$10,518.70
|
| Rate for Payer: Coventry All Commercial |
$2,275.01
|
| Rate for Payer: Coventry All Commercial |
$9,953.17
|
| Rate for Payer: Encore All Commercial |
$2,379.71
|
| Rate for Payer: Encore All Commercial |
$10,411.25
|
| Rate for Payer: Frontpath All Commercial |
$10,405.59
|
| Rate for Payer: Frontpath All Commercial |
$2,378.42
|
| Rate for Payer: Humana ChoiceCare |
$2,232.87
|
| Rate for Payer: Humana ChoiceCare |
$9,768.81
|
| Rate for Payer: Humana Medicare |
$3,619.34
|
| Rate for Payer: Humana Medicare |
$827.28
|
| Rate for Payer: Lucent All Commercial |
$1,406.37
|
| Rate for Payer: Lucent All Commercial |
$6,152.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,326.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,179.38
|
| Rate for Payer: Managed Health Services Medicaid |
$714.52
|
| Rate for Payer: Managed Health Services Medicaid |
$714.52
|
| Rate for Payer: MDWise Medicaid |
$714.52
|
| Rate for Payer: MDWise Medicaid |
$714.52
|
| Rate for Payer: PHCS All Commercial |
$8,482.82
|
| Rate for Payer: PHCS All Commercial |
$1,938.93
|
| Rate for Payer: PHP All Commercial |
$1,960.65
|
| Rate for Payer: PHP All Commercial |
$8,577.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,411.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,008.24
|
| Rate for Payer: Sagamore Health Network All Products |
$8,731.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,995.81
|
| Rate for Payer: Signature Care EPO |
$2,145.75
|
| Rate for Payer: Signature Care EPO |
$9,387.65
|
| Rate for Payer: Signature Care PPO |
$9,953.17
|
| Rate for Payer: Signature Care PPO |
$2,275.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,197.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,613.86
|
| Rate for Payer: United Healthcare Commercial |
$8,912.61
|
| Rate for Payer: United Healthcare Commercial |
$2,037.17
|
| Rate for Payer: United Healthcare Medicare |
$3,619.34
|
| Rate for Payer: United Healthcare Medicare |
$827.28
|
|
|
RABIES IMMUNE GLOBULIN (PF) 300 UNITS/ML IM SOLN
|
Facility
|
IP
|
$2,585.24
|
|
|
Service Code
|
HCPCS 90375
|
| Hospital Charge Code |
184464
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,938.93 |
| Max. Negotiated Rate |
$2,404.27 |
| Rate for Payer: Aetna Commercial |
$2,233.65
|
| Rate for Payer: Aetna Commercial |
$9,772.21
|
| Rate for Payer: Cash Price |
$1,551.14
|
| Rate for Payer: Cash Price |
$6,786.26
|
| Rate for Payer: Cigna All Commercial |
$2,231.06
|
| Rate for Payer: Cigna All Commercial |
$9,760.90
|
| Rate for Payer: CORVEL All Commercial |
$10,518.70
|
| Rate for Payer: CORVEL All Commercial |
$2,404.27
|
| Rate for Payer: Coventry All Commercial |
$9,953.17
|
| Rate for Payer: Coventry All Commercial |
$2,275.01
|
| Rate for Payer: Encore All Commercial |
$2,379.71
|
| Rate for Payer: Encore All Commercial |
$10,411.25
|
| Rate for Payer: Frontpath All Commercial |
$10,405.59
|
| Rate for Payer: Frontpath All Commercial |
$2,378.42
|
| Rate for Payer: Humana ChoiceCare |
$2,232.87
|
| Rate for Payer: Humana ChoiceCare |
$9,768.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,326.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10,179.38
|
| Rate for Payer: PHCS All Commercial |
$8,482.82
|
| Rate for Payer: PHCS All Commercial |
$1,938.93
|
| Rate for Payer: PHP All Commercial |
$8,577.83
|
| Rate for Payer: PHP All Commercial |
$1,960.65
|
| Rate for Payer: Sagamore Health Network All Products |
$8,731.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,995.81
|
| Rate for Payer: Signature Care EPO |
$9,387.65
|
| Rate for Payer: Signature Care EPO |
$2,145.75
|
| Rate for Payer: Signature Care PPO |
$2,275.01
|
| Rate for Payer: Signature Care PPO |
$9,953.17
|
| Rate for Payer: United Healthcare Commercial |
$8,912.61
|
| Rate for Payer: United Healthcare Commercial |
$2,037.17
|
|
|
RABIES VACCINE, PCEC (PF) 2.5 UNITS IM SUSR
|
Facility
|
IP
|
$1,629.80
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,222.35 |
| Max. Negotiated Rate |
$1,515.71 |
| Rate for Payer: Aetna Commercial |
$1,408.15
|
| Rate for Payer: Cash Price |
$977.88
|
| Rate for Payer: Cigna All Commercial |
$1,406.52
|
| Rate for Payer: CORVEL All Commercial |
$1,515.71
|
| Rate for Payer: Coventry All Commercial |
$1,434.22
|
| Rate for Payer: Encore All Commercial |
$1,500.23
|
| Rate for Payer: Frontpath All Commercial |
$1,499.42
|
| Rate for Payer: Humana ChoiceCare |
$1,407.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,466.82
|
| Rate for Payer: PHCS All Commercial |
$1,222.35
|
| Rate for Payer: PHP All Commercial |
$1,236.04
|
| Rate for Payer: Sagamore Health Network All Products |
$1,258.21
|
| Rate for Payer: Signature Care EPO |
$1,352.73
|
| Rate for Payer: Signature Care PPO |
$1,434.22
|
| Rate for Payer: United Healthcare Commercial |
$1,284.28
|
|
|
RABIES VACCINE, PCEC (PF) 2.5 UNITS IM SUSR
|
Facility
|
OP
|
$1,629.80
|
|
|
Service Code
|
HCPCS 90675
|
| Hospital Charge Code |
22120
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$397.99 |
| Max. Negotiated Rate |
$1,515.71 |
| Rate for Payer: Aetna Commercial |
$1,375.55
|
| Rate for Payer: Aetna Medicare |
$521.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$397.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$505.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$935.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,018.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$397.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$599.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$573.69
|
| Rate for Payer: Cash Price |
$977.88
|
| Rate for Payer: Cash Price |
$977.88
|
| Rate for Payer: Centivo All Commercial |
$886.61
|
| Rate for Payer: Cigna All Commercial |
$1,406.52
|
| Rate for Payer: CORVEL All Commercial |
$1,515.71
|
| Rate for Payer: Coventry All Commercial |
$1,434.22
|
| Rate for Payer: Encore All Commercial |
$1,500.23
|
| Rate for Payer: Frontpath All Commercial |
$1,499.42
|
| Rate for Payer: Humana ChoiceCare |
$1,407.66
|
| Rate for Payer: Humana Medicare |
$521.54
|
| Rate for Payer: Lucent All Commercial |
$886.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,466.82
|
| Rate for Payer: Managed Health Services Medicaid |
$397.99
|
| Rate for Payer: MDWise Medicaid |
$397.99
|
| Rate for Payer: PHCS All Commercial |
$1,222.35
|
| Rate for Payer: PHP All Commercial |
$1,236.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$635.62
|
| Rate for Payer: Sagamore Health Network All Products |
$1,258.21
|
| Rate for Payer: Signature Care EPO |
$1,352.73
|
| Rate for Payer: Signature Care PPO |
$1,434.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,385.33
|
| Rate for Payer: United Healthcare Commercial |
$1,284.28
|
| Rate for Payer: United Healthcare Medicare |
$521.54
|
|
|
RACEPINEPHRINE 2.25 % INHL NEBU
|
Facility
|
OP
|
$11.17
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$10.38 |
| Rate for Payer: Aetna Commercial |
$9.42
|
| Rate for Payer: Aetna Medicare |
$3.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.93
|
| Rate for Payer: Cash Price |
$6.70
|
| Rate for Payer: Cash Price |
$6.70
|
| Rate for Payer: Centivo All Commercial |
$6.07
|
| Rate for Payer: Cigna All Commercial |
$9.64
|
| Rate for Payer: CORVEL All Commercial |
$10.38
|
| Rate for Payer: Coventry All Commercial |
$9.83
|
| Rate for Payer: Encore All Commercial |
$10.28
|
| Rate for Payer: Frontpath All Commercial |
$10.27
|
| Rate for Payer: Humana ChoiceCare |
$9.64
|
| Rate for Payer: Humana Medicare |
$3.57
|
| Rate for Payer: Lucent All Commercial |
$6.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.05
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$8.37
|
| Rate for Payer: PHP All Commercial |
$8.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.35
|
| Rate for Payer: Sagamore Health Network All Products |
$8.62
|
| Rate for Payer: Signature Care EPO |
$9.27
|
| Rate for Payer: Signature Care PPO |
$9.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.49
|
| Rate for Payer: United Healthcare Commercial |
$8.80
|
| Rate for Payer: United Healthcare Medicare |
$3.57
|
|
|
RACEPINEPHRINE 2.25 % INHL NEBU
|
Facility
|
IP
|
$11.17
|
|
|
Service Code
|
NDC 00487590199
|
| Hospital Charge Code |
2851
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$10.38 |
| Rate for Payer: Aetna Commercial |
$9.65
|
| Rate for Payer: Cash Price |
$6.70
|
| Rate for Payer: Cigna All Commercial |
$9.64
|
| Rate for Payer: CORVEL All Commercial |
$10.38
|
| Rate for Payer: Coventry All Commercial |
$9.83
|
| Rate for Payer: Encore All Commercial |
$10.28
|
| Rate for Payer: Frontpath All Commercial |
$10.27
|
| Rate for Payer: Humana ChoiceCare |
$9.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.05
|
| Rate for Payer: PHCS All Commercial |
$8.37
|
| Rate for Payer: PHP All Commercial |
$8.47
|
| Rate for Payer: Sagamore Health Network All Products |
$8.62
|
| Rate for Payer: Signature Care EPO |
$9.27
|
| Rate for Payer: Signature Care PPO |
$9.83
|
| Rate for Payer: United Healthcare Commercial |
$8.80
|
|
