|
PR ADALIMUMAB INJECTION
|
Professional
|
$2,472.35
|
|
|
Service Code
|
CPT J0135
|
| Hospital Charge Code |
zJ0135
|
| Min. Negotiated Rate |
$1,218.01 |
| Max. Negotiated Rate |
$2,472.35 |
| Rate for Payer: Humana ChoiceCare |
$1,218.01
|
| Rate for Payer: United Healthcare Commercial |
$2,472.35
|
|
|
PR ADJ TISS XFER ANY AREA,30.1-60 SQCM
|
Professional
|
$1,972.92
|
|
|
Service Code
|
CPT 14301
|
| Hospital Charge Code |
z14301
|
| Min. Negotiated Rate |
$807.07 |
| Max. Negotiated Rate |
$1,479.69 |
| Rate for Payer: Aetna Medicare |
$807.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,234.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,234.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$928.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$887.78
|
| Rate for Payer: Cash Price |
$1,223.21
|
| Rate for Payer: Cash Price |
$1,223.21
|
| Rate for Payer: Coventry All Commercial |
$968.48
|
| Rate for Payer: Frontpath All Commercial |
$1,111.46
|
| Rate for Payer: Humana ChoiceCare |
$812.65
|
| Rate for Payer: Humana Medicare |
$807.07
|
| Rate for Payer: Lucent All Commercial |
$1,372.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,049.00
|
| Rate for Payer: PHCS All Commercial |
$1,479.69
|
| Rate for Payer: PHP All Commercial |
$1,102.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$807.07
|
| Rate for Payer: Signature Care EPO |
$895.90
|
| Rate for Payer: Signature Care PPO |
$895.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$968.00
|
| Rate for Payer: United Healthcare Commercial |
$1,025.74
|
| Rate for Payer: United Healthcare Medicare |
$807.07
|
|
|
PR ADJ TISS XFER ANY AREA,EA ADD 30.0 SQCM
|
Professional
|
$388.44
|
|
|
Service Code
|
CPT 14302
|
| Hospital Charge Code |
z14302
|
| Min. Negotiated Rate |
$197.20 |
| Max. Negotiated Rate |
$338.42 |
| Rate for Payer: Aetna Medicare |
$199.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$270.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$270.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$228.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$218.98
|
| Rate for Payer: Cash Price |
$240.83
|
| Rate for Payer: Cash Price |
$240.83
|
| Rate for Payer: Coventry All Commercial |
$238.88
|
| Rate for Payer: Frontpath All Commercial |
$280.31
|
| Rate for Payer: Humana ChoiceCare |
$211.34
|
| Rate for Payer: Humana Medicare |
$199.07
|
| Rate for Payer: Lucent All Commercial |
$338.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$259.00
|
| Rate for Payer: PHCS All Commercial |
$291.33
|
| Rate for Payer: PHP All Commercial |
$271.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.07
|
| Rate for Payer: Signature Care EPO |
$197.20
|
| Rate for Payer: Signature Care PPO |
$197.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$239.00
|
| Rate for Payer: United Healthcare Commercial |
$267.08
|
| Rate for Payer: United Healthcare Medicare |
$199.07
|
|
|
PR ADJ TISS XFER HEAD,FAC,HAND 10.1-30 SQCM
|
Professional
|
$1,687.30
|
|
|
Service Code
|
CPT 14041
|
| Hospital Charge Code |
z14041
|
| Min. Negotiated Rate |
$711.92 |
| Max. Negotiated Rate |
$1,265.48 |
| Rate for Payer: Aetna Medicare |
$711.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$997.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$997.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$818.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$783.11
|
| Rate for Payer: Cash Price |
$1,046.13
|
| Rate for Payer: Cash Price |
$1,046.13
|
| Rate for Payer: Coventry All Commercial |
$854.30
|
| Rate for Payer: Frontpath All Commercial |
$965.07
|
| Rate for Payer: Humana ChoiceCare |
$745.46
|
| Rate for Payer: Humana Medicare |
$711.92
|
| Rate for Payer: Lucent All Commercial |
$1,210.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$926.00
|
| Rate for Payer: PHCS All Commercial |
$1,265.48
|
| Rate for Payer: PHP All Commercial |
$972.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$711.92
|
| Rate for Payer: Signature Care EPO |
$907.80
|
| Rate for Payer: Signature Care PPO |
$907.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$854.00
|
| Rate for Payer: United Healthcare Commercial |
$858.19
|
| Rate for Payer: United Healthcare Medicare |
$711.92
|
|
|
PR ADJ TISS XFER HEAD,FAC,HAND <10 SQCM
|
Professional
|
$1,388.08
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
z14040
|
| Min. Negotiated Rate |
$556.02 |
| Max. Negotiated Rate |
$1,041.06 |
| Rate for Payer: Aetna Medicare |
$582.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$775.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$775.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$669.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$640.24
|
| Rate for Payer: Cash Price |
$860.61
|
| Rate for Payer: Cash Price |
$860.61
|
| Rate for Payer: Coventry All Commercial |
$698.45
|
| Rate for Payer: Frontpath All Commercial |
$789.42
|
| Rate for Payer: Humana ChoiceCare |
$556.02
|
| Rate for Payer: Humana Medicare |
$582.04
|
| Rate for Payer: Lucent All Commercial |
$989.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$757.00
|
| Rate for Payer: PHCS All Commercial |
$1,041.06
|
| Rate for Payer: PHP All Commercial |
$794.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$582.04
|
| Rate for Payer: Signature Care EPO |
$660.45
|
| Rate for Payer: Signature Care PPO |
$660.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$698.00
|
| Rate for Payer: United Healthcare Commercial |
$694.40
|
| Rate for Payer: United Healthcare Medicare |
$582.04
|
|
|
PR ADJ TISS XFER LID,NOS,EAR 10.1-30 SQCM
|
Professional
|
$1,818.00
|
|
|
Service Code
|
CPT 14061
|
| Hospital Charge Code |
z14061
|
| Min. Negotiated Rate |
$764.10 |
| Max. Negotiated Rate |
$1,363.50 |
| Rate for Payer: Aetna Medicare |
$764.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,126.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,126.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$878.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$840.51
|
| Rate for Payer: Cash Price |
$1,127.16
|
| Rate for Payer: Cash Price |
$1,127.16
|
| Rate for Payer: Coventry All Commercial |
$916.92
|
| Rate for Payer: Frontpath All Commercial |
$1,035.05
|
| Rate for Payer: Humana ChoiceCare |
$804.77
|
| Rate for Payer: Humana Medicare |
$764.10
|
| Rate for Payer: Lucent All Commercial |
$1,298.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$993.00
|
| Rate for Payer: PHCS All Commercial |
$1,363.50
|
| Rate for Payer: PHP All Commercial |
$1,043.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$764.10
|
| Rate for Payer: Signature Care EPO |
$981.75
|
| Rate for Payer: Signature Care PPO |
$981.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$917.00
|
| Rate for Payer: United Healthcare Commercial |
$915.09
|
| Rate for Payer: United Healthcare Medicare |
$764.10
|
|
|
PR ADJ TISS XFER LID,NOS,EAR <10 SQCM
|
Professional
|
$1,405.66
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
z14060
|
| Min. Negotiated Rate |
$588.78 |
| Max. Negotiated Rate |
$1,056.74 |
| Rate for Payer: Aetna Medicare |
$621.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$816.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$816.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$714.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$683.77
|
| Rate for Payer: Cash Price |
$871.51
|
| Rate for Payer: Cash Price |
$871.51
|
| Rate for Payer: Coventry All Commercial |
$745.93
|
| Rate for Payer: Frontpath All Commercial |
$841.42
|
| Rate for Payer: Humana ChoiceCare |
$588.78
|
| Rate for Payer: Humana Medicare |
$621.61
|
| Rate for Payer: Lucent All Commercial |
$1,056.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$808.00
|
| Rate for Payer: PHCS All Commercial |
$1,054.24
|
| Rate for Payer: PHP All Commercial |
$849.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$621.61
|
| Rate for Payer: Signature Care EPO |
$719.95
|
| Rate for Payer: Signature Care PPO |
$719.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$746.00
|
| Rate for Payer: United Healthcare Commercial |
$733.53
|
| Rate for Payer: United Healthcare Medicare |
$621.61
|
|
|
PR ADJ TISS XFER SCALP,EXTREM <10 SQCM
|
Professional
|
$1,281.06
|
|
|
Service Code
|
CPT 14020
|
| Hospital Charge Code |
z14020
|
| Min. Negotiated Rate |
$484.84 |
| Max. Negotiated Rate |
$960.80 |
| Rate for Payer: Aetna Medicare |
$526.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$696.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$696.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$605.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$579.58
|
| Rate for Payer: Cash Price |
$794.26
|
| Rate for Payer: Cash Price |
$794.26
|
| Rate for Payer: Coventry All Commercial |
$632.27
|
| Rate for Payer: Frontpath All Commercial |
$715.44
|
| Rate for Payer: Humana ChoiceCare |
$484.84
|
| Rate for Payer: Humana Medicare |
$526.89
|
| Rate for Payer: Lucent All Commercial |
$895.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$685.00
|
| Rate for Payer: PHCS All Commercial |
$960.80
|
| Rate for Payer: PHP All Commercial |
$719.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$526.89
|
| Rate for Payer: Signature Care EPO |
$641.75
|
| Rate for Payer: Signature Care PPO |
$641.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$632.00
|
| Rate for Payer: United Healthcare Commercial |
$609.40
|
| Rate for Payer: United Healthcare Medicare |
$526.89
|
|
|
PR ADJ TISS XFER TRUNK 10.1-30 SQCM
|
Professional
|
$1,468.68
|
|
|
Service Code
|
CPT 14001
|
| Hospital Charge Code |
z14001
|
| Min. Negotiated Rate |
$577.60 |
| Max. Negotiated Rate |
$1,101.51 |
| Rate for Payer: Aetna Medicare |
$603.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$805.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$805.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$694.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$664.29
|
| Rate for Payer: Cash Price |
$910.58
|
| Rate for Payer: Cash Price |
$910.58
|
| Rate for Payer: Coventry All Commercial |
$724.68
|
| Rate for Payer: Frontpath All Commercial |
$834.95
|
| Rate for Payer: Humana ChoiceCare |
$577.60
|
| Rate for Payer: Humana Medicare |
$603.90
|
| Rate for Payer: Lucent All Commercial |
$1,026.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$785.00
|
| Rate for Payer: PHCS All Commercial |
$1,101.51
|
| Rate for Payer: PHP All Commercial |
$824.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$603.90
|
| Rate for Payer: Signature Care EPO |
$753.10
|
| Rate for Payer: Signature Care PPO |
$753.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$725.00
|
| Rate for Payer: United Healthcare Commercial |
$707.76
|
| Rate for Payer: United Healthcare Medicare |
$603.90
|
|
|
PR ADJ TISS XFER TRUNK <10 SQCM
|
Professional
|
$1,153.88
|
|
|
Service Code
|
CPT 14000
|
| Hospital Charge Code |
z14000
|
| Min. Negotiated Rate |
$420.74 |
| Max. Negotiated Rate |
$865.41 |
| Rate for Payer: Aetna Medicare |
$466.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$618.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$618.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$536.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$513.32
|
| Rate for Payer: Cash Price |
$715.41
|
| Rate for Payer: Cash Price |
$715.41
|
| Rate for Payer: Coventry All Commercial |
$559.98
|
| Rate for Payer: Frontpath All Commercial |
$640.06
|
| Rate for Payer: Humana ChoiceCare |
$420.74
|
| Rate for Payer: Humana Medicare |
$466.65
|
| Rate for Payer: Lucent All Commercial |
$793.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$607.00
|
| Rate for Payer: PHCS All Commercial |
$865.41
|
| Rate for Payer: PHP All Commercial |
$637.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$466.65
|
| Rate for Payer: Signature Care EPO |
$585.65
|
| Rate for Payer: Signature Care PPO |
$585.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$560.00
|
| Rate for Payer: United Healthcare Commercial |
$532.56
|
| Rate for Payer: United Healthcare Medicare |
$466.65
|
|
|
PR ADMIN INFLUENZA VIRUS VAC
|
Professional
|
$35.00
|
|
|
Service Code
|
CPT G0008
|
| Hospital Charge Code |
zG0008
|
| Min. Negotiated Rate |
$19.59 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.73
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Humana ChoiceCare |
$24.17
|
| Rate for Payer: PHCS All Commercial |
$26.25
|
| Rate for Payer: United Healthcare Commercial |
$19.59
|
|
|
PR ADMIN PNEUMOCOCCAL VACCINE
|
Professional
|
$35.00
|
|
|
Service Code
|
CPT G0009
|
| Hospital Charge Code |
zG0009
|
| Min. Negotiated Rate |
$19.59 |
| Max. Negotiated Rate |
$35.00 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.73
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Humana ChoiceCare |
$24.17
|
| Rate for Payer: PHCS All Commercial |
$26.25
|
| Rate for Payer: Signature Care EPO |
$35.00
|
| Rate for Payer: Signature Care PPO |
$35.00
|
| Rate for Payer: United Healthcare Commercial |
$19.59
|
|
|
PR ADMN RSV MONOC ANTB IM CNSL
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT 96380
|
| Hospital Charge Code |
z96380
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: PHCS All Commercial |
$60.00
|
|
|
PR ADMN RSV MONOC ANTB IM NJX
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT 96381
|
| Hospital Charge Code |
z96381
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: PHCS All Commercial |
$60.00
|
|
|
PR ADMN SARSCOV2 VACC 1 DOSE
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
z90480
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$60.00 |
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: PHCS All Commercial |
$60.00
|
|
|
PR ADM OF SOC DTR ASSESS 5-15 M
|
Professional
|
$37.32
|
|
|
Service Code
|
CPT G0136
|
| Hospital Charge Code |
zG0136
|
| Min. Negotiated Rate |
$27.99 |
| Max. Negotiated Rate |
$27.99 |
| Rate for Payer: Cash Price |
$23.14
|
| Rate for Payer: PHCS All Commercial |
$27.99
|
|
|
PR ADRENALIN EPINEPHRINE INJECT
|
Professional
|
$0.72
|
|
|
Service Code
|
CPT J0171
|
| Hospital Charge Code |
zJ0171
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$0.72 |
| Rate for Payer: Humana ChoiceCare |
$0.72
|
| Rate for Payer: PHP All Commercial |
$0.61
|
|
|
PR ADVANCE CARE PLANNING EA ADDL 30 MINS
|
Professional
|
$133.06
|
|
|
Service Code
|
CPT 99498
|
| Hospital Charge Code |
z99498
|
| Min. Negotiated Rate |
$33.27 |
| Max. Negotiated Rate |
$115.40 |
| Rate for Payer: Aetna Medicare |
$67.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.67
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Coventry All Commercial |
$81.46
|
| Rate for Payer: Frontpath All Commercial |
$74.63
|
| Rate for Payer: Humana ChoiceCare |
$76.03
|
| Rate for Payer: Humana Medicare |
$67.88
|
| Rate for Payer: Lucent All Commercial |
$115.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.00
|
| Rate for Payer: PHCS All Commercial |
$99.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.88
|
| Rate for Payer: Signature Care EPO |
$75.20
|
| Rate for Payer: Signature Care PPO |
$75.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$75.45
|
| Rate for Payer: United Healthcare Medicare |
$67.88
|
|
|
PR ADVANCE CARE PLANNING FIRST 30 MINS
|
Professional
|
$153.52
|
|
|
Service Code
|
CPT 99497
|
| Hospital Charge Code |
z99497
|
| Min. Negotiated Rate |
$66.54 |
| Max. Negotiated Rate |
$122.21 |
| Rate for Payer: Aetna Medicare |
$71.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.08
|
| Rate for Payer: Cash Price |
$95.18
|
| Rate for Payer: Cash Price |
$95.18
|
| Rate for Payer: Coventry All Commercial |
$86.27
|
| Rate for Payer: Frontpath All Commercial |
$79.28
|
| Rate for Payer: Humana ChoiceCare |
$81.25
|
| Rate for Payer: Humana Medicare |
$71.89
|
| Rate for Payer: Lucent All Commercial |
$122.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$75.00
|
| Rate for Payer: PHCS All Commercial |
$115.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.89
|
| Rate for Payer: Signature Care EPO |
$89.55
|
| Rate for Payer: Signature Care PPO |
$89.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$74.00
|
| Rate for Payer: United Healthcare Commercial |
$80.63
|
| Rate for Payer: United Healthcare Medicare |
$71.89
|
|
|
PR ALBUTEROL IPRATROP NON-COMP
|
Professional
|
$0.38
|
|
|
Service Code
|
CPT J7620
|
| Hospital Charge Code |
zJ7620
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.38 |
| Rate for Payer: Humana ChoiceCare |
$0.13
|
| Rate for Payer: PHP All Commercial |
$0.38
|
| Rate for Payer: United Healthcare Commercial |
$0.13
|
|
|
PR ALBUTEROL NON-COMP UNIT
|
Professional
|
$0.08
|
|
|
Service Code
|
CPT J7613
|
| Hospital Charge Code |
zJ7613
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$0.08 |
| Rate for Payer: Humana ChoiceCare |
$0.04
|
| Rate for Payer: PHP All Commercial |
$0.08
|
| Rate for Payer: United Healthcare Commercial |
$0.04
|
|
|
PR ALCOHOL/DRUG SERVICES C&T PER 15 MINS
|
Professional
|
$787.74
|
|
|
Service Code
|
CPT 27788
|
| Hospital Charge Code |
z27788
|
| Min. Negotiated Rate |
$364.82 |
| Max. Negotiated Rate |
$623.90 |
| Rate for Payer: Aetna Medicare |
$364.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$591.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$591.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$419.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$401.30
|
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Cash Price |
$488.40
|
| Rate for Payer: Coventry All Commercial |
$437.78
|
| Rate for Payer: Frontpath All Commercial |
$500.31
|
| Rate for Payer: Humana ChoiceCare |
$392.24
|
| Rate for Payer: Humana Medicare |
$364.82
|
| Rate for Payer: Lucent All Commercial |
$620.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$584.00
|
| Rate for Payer: PHCS All Commercial |
$590.80
|
| Rate for Payer: PHP All Commercial |
$619.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$364.82
|
| Rate for Payer: Signature Care EPO |
$623.90
|
| Rate for Payer: Signature Care PPO |
$623.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$547.00
|
| Rate for Payer: United Healthcare Commercial |
$404.20
|
| Rate for Payer: United Healthcare Medicare |
$364.82
|
|
|
PR ALD TRANSMITTER MICROPHONE
|
Professional
|
$700.00
|
|
|
Service Code
|
CPT V5290
|
| Hospital Charge Code |
zV5290
|
| Min. Negotiated Rate |
$525.00 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: Cash Price |
$434.00
|
| Rate for Payer: PHCS All Commercial |
$525.00
|
| Rate for Payer: Signature Care EPO |
$595.00
|
| Rate for Payer: Signature Care PPO |
$595.00
|
|
|
PR ALLG TEST PERQ & IC DRUG/BIOL IMMED REACT W/ I&R
|
Professional
|
$36.68
|
|
|
Service Code
|
CPT 95018
|
| Hospital Charge Code |
z95018
|
| Min. Negotiated Rate |
$6.76 |
| Max. Negotiated Rate |
$27.51 |
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$22.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.44
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Cash Price |
$22.74
|
| Rate for Payer: Coventry All Commercial |
$8.11
|
| Rate for Payer: Frontpath All Commercial |
$7.40
|
| Rate for Payer: Humana ChoiceCare |
$26.94
|
| Rate for Payer: Humana Medicare |
$6.76
|
| Rate for Payer: Lucent All Commercial |
$11.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.00
|
| Rate for Payer: PHCS All Commercial |
$27.51
|
| Rate for Payer: PHP All Commercial |
$7.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.76
|
| Rate for Payer: Signature Care EPO |
$23.37
|
| Rate for Payer: Signature Care PPO |
$23.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.00
|
| Rate for Payer: United Healthcare Commercial |
$9.06
|
| Rate for Payer: United Healthcare Medicare |
$6.76
|
|
|
PRAMIPEXOLE 0.25 MG ORAL TAB
|
Facility
OP
|
$1.34
|
|
|
Service Code
|
NDC 00904670461
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.44 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna Commercial |
$1.13
|
| Rate for Payer: Aetna Medicare |
$0.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.49
|
| Rate for Payer: Cash Price |
$0.83
|
| Rate for Payer: Centivo All Commercial |
$0.69
|
| Rate for Payer: Cigna All Commercial |
$1.16
|
| Rate for Payer: CORVEL All Commercial |
$1.25
|
| Rate for Payer: Coventry All Commercial |
$1.18
|
| Rate for Payer: Encore All Commercial |
$1.24
|
| Rate for Payer: Frontpath All Commercial |
$1.24
|
| Rate for Payer: Humana ChoiceCare |
$1.16
|
| Rate for Payer: Humana Medicare |
$0.69
|
| Rate for Payer: Lucent All Commercial |
$0.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.21
|
| Rate for Payer: PHCS All Commercial |
$1.01
|
| Rate for Payer: PHP All Commercial |
$1.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.52
|
| Rate for Payer: Sagamore Health Network All Products |
$1.04
|
| Rate for Payer: Signature Care EPO |
$1.12
|
| Rate for Payer: Signature Care PPO |
$1.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.14
|
| Rate for Payer: United Healthcare Commercial |
$1.06
|
| Rate for Payer: United Healthcare Medicare |
$0.44
|
|
