|
PRAMIPEXOLE 0.25 MG ORAL TAB
|
Facility
IP
|
$1.34
|
|
|
Service Code
|
NDC 00904670461
|
| Hospital Charge Code |
21290
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.01 |
| Max. Negotiated Rate |
$1.25 |
| Rate for Payer: Aetna Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$0.83
|
| 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: 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: 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: United Healthcare Commercial |
$1.06
|
|
|
PRAMIPEXOLE 1 MG ORAL TAB
|
Facility
OP
|
$7.05
|
|
|
Service Code
|
NDC 60687059221
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$6.56 |
| Rate for Payer: Aetna Commercial |
$5.95
|
| Rate for Payer: Aetna Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.56
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Centivo All Commercial |
$3.59
|
| Rate for Payer: Cigna All Commercial |
$6.08
|
| Rate for Payer: CORVEL All Commercial |
$6.56
|
| Rate for Payer: Coventry All Commercial |
$6.20
|
| Rate for Payer: Encore All Commercial |
$6.49
|
| Rate for Payer: Frontpath All Commercial |
$6.49
|
| Rate for Payer: Humana ChoiceCare |
$6.09
|
| Rate for Payer: Humana Medicare |
$3.59
|
| Rate for Payer: Lucent All Commercial |
$3.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.34
|
| Rate for Payer: PHCS All Commercial |
$5.29
|
| Rate for Payer: PHP All Commercial |
$5.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.75
|
| Rate for Payer: Sagamore Health Network All Products |
$5.44
|
| Rate for Payer: Signature Care EPO |
$5.85
|
| Rate for Payer: Signature Care PPO |
$6.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.99
|
| Rate for Payer: United Healthcare Commercial |
$5.55
|
| Rate for Payer: United Healthcare Medicare |
$2.33
|
|
|
PRAMIPEXOLE 1 MG ORAL TAB
|
Facility
IP
|
$7.05
|
|
|
Service Code
|
NDC 60687059221
|
| Hospital Charge Code |
21288
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.29 |
| Max. Negotiated Rate |
$6.56 |
| Rate for Payer: Aetna Commercial |
$6.09
|
| Rate for Payer: Cash Price |
$4.37
|
| Rate for Payer: Cigna All Commercial |
$6.08
|
| Rate for Payer: CORVEL All Commercial |
$6.56
|
| Rate for Payer: Coventry All Commercial |
$6.20
|
| Rate for Payer: Encore All Commercial |
$6.49
|
| Rate for Payer: Frontpath All Commercial |
$6.49
|
| Rate for Payer: Humana ChoiceCare |
$6.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6.34
|
| Rate for Payer: PHCS All Commercial |
$5.29
|
| Rate for Payer: PHP All Commercial |
$5.35
|
| Rate for Payer: Sagamore Health Network All Products |
$5.44
|
| Rate for Payer: Signature Care EPO |
$5.85
|
| Rate for Payer: Signature Care PPO |
$6.20
|
| Rate for Payer: United Healthcare Commercial |
$5.55
|
|
|
PR AMNIOCENTESIS,DIAGNOSTIC
|
Professional
|
$208.72
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
z59000
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$180.62 |
| Rate for Payer: Aetna Medicare |
$72.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$180.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$180.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$83.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.64
|
| Rate for Payer: Cash Price |
$129.41
|
| Rate for Payer: Cash Price |
$129.41
|
| Rate for Payer: Coventry All Commercial |
$86.88
|
| Rate for Payer: Frontpath All Commercial |
$103.42
|
| Rate for Payer: Humana ChoiceCare |
$77.39
|
| Rate for Payer: Humana Medicare |
$72.40
|
| Rate for Payer: Lucent All Commercial |
$123.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$101.00
|
| Rate for Payer: PHCS All Commercial |
$156.54
|
| Rate for Payer: PHP All Commercial |
$93.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.40
|
| Rate for Payer: Signature Care EPO |
$163.20
|
| Rate for Payer: Signature Care PPO |
$163.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.00
|
| Rate for Payer: United Healthcare Commercial |
$91.40
|
| Rate for Payer: United Healthcare Medicare |
$72.40
|
|
|
PR AMPUTATION FINGER/THUMB
|
Professional
|
$1,287.52
|
|
|
Service Code
|
CPT 26951
|
| Hospital Charge Code |
z26951
|
| Min. Negotiated Rate |
$616.12 |
| Max. Negotiated Rate |
$1,121.76 |
| Rate for Payer: Aetna Medicare |
$659.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$669.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$669.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$758.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$725.85
|
| Rate for Payer: Cash Price |
$798.26
|
| Rate for Payer: Cash Price |
$798.26
|
| Rate for Payer: Coventry All Commercial |
$791.83
|
| Rate for Payer: Frontpath All Commercial |
$902.71
|
| Rate for Payer: Humana ChoiceCare |
$616.12
|
| Rate for Payer: Humana Medicare |
$659.86
|
| Rate for Payer: Lucent All Commercial |
$1,121.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,056.00
|
| Rate for Payer: PHCS All Commercial |
$965.64
|
| Rate for Payer: PHP All Commercial |
$1,120.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$659.86
|
| Rate for Payer: Signature Care EPO |
$852.55
|
| Rate for Payer: Signature Care PPO |
$852.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$990.00
|
| Rate for Payer: United Healthcare Commercial |
$647.53
|
| Rate for Payer: United Healthcare Medicare |
$659.86
|
|
|
PR AMPUTATION FOOT,TRANSMETATARSAL
|
Professional
|
$1,294.84
|
|
|
Service Code
|
CPT 28805
|
| Hospital Charge Code |
z28805
|
| Min. Negotiated Rate |
$612.20 |
| Max. Negotiated Rate |
$1,128.14 |
| Rate for Payer: Aetna Medicare |
$663.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$763.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$729.97
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Cash Price |
$802.80
|
| Rate for Payer: Coventry All Commercial |
$796.33
|
| Rate for Payer: Frontpath All Commercial |
$923.92
|
| Rate for Payer: Humana ChoiceCare |
$612.20
|
| Rate for Payer: Humana Medicare |
$663.61
|
| Rate for Payer: Lucent All Commercial |
$1,128.14
|
| Rate for Payer: PHCS All Commercial |
$971.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$663.61
|
| Rate for Payer: United Healthcare Commercial |
$842.66
|
| Rate for Payer: United Healthcare Medicare |
$663.61
|
|
|
PR AMPUTATION METATARSAL+TOE,SINGLE
|
Professional
|
$769.20
|
|
|
Service Code
|
CPT 28810
|
| Hospital Charge Code |
z28810
|
| Min. Negotiated Rate |
$394.22 |
| Max. Negotiated Rate |
$670.17 |
| Rate for Payer: Aetna Medicare |
$394.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$483.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$483.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$453.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$433.64
|
| Rate for Payer: Cash Price |
$476.90
|
| Rate for Payer: Cash Price |
$476.90
|
| Rate for Payer: Coventry All Commercial |
$473.06
|
| Rate for Payer: Frontpath All Commercial |
$549.61
|
| Rate for Payer: Humana ChoiceCare |
$464.26
|
| Rate for Payer: Humana Medicare |
$394.22
|
| Rate for Payer: Lucent All Commercial |
$670.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$631.00
|
| Rate for Payer: PHCS All Commercial |
$576.90
|
| Rate for Payer: PHP All Commercial |
$669.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$394.22
|
| Rate for Payer: Signature Care EPO |
$637.50
|
| Rate for Payer: Signature Care PPO |
$637.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$591.00
|
| Rate for Payer: United Healthcare Commercial |
$490.16
|
| Rate for Payer: United Healthcare Medicare |
$394.22
|
|
|
PR AMPUTATION TOE,I-P JT
|
Professional
|
$533.18
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
z28825
|
| Min. Negotiated Rate |
$162.42 |
| Max. Negotiated Rate |
$473.11 |
| Rate for Payer: Aetna Medicare |
$162.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$429.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$429.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$186.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$178.66
|
| Rate for Payer: Cash Price |
$330.57
|
| Rate for Payer: Cash Price |
$330.57
|
| Rate for Payer: Coventry All Commercial |
$194.90
|
| Rate for Payer: Frontpath All Commercial |
$226.08
|
| Rate for Payer: Humana ChoiceCare |
$303.85
|
| Rate for Payer: Humana Medicare |
$162.42
|
| Rate for Payer: Lucent All Commercial |
$276.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$260.00
|
| Rate for Payer: PHCS All Commercial |
$399.88
|
| Rate for Payer: PHP All Commercial |
$275.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.42
|
| Rate for Payer: Signature Care EPO |
$473.11
|
| Rate for Payer: Signature Care PPO |
$473.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$244.00
|
| Rate for Payer: United Healthcare Commercial |
$440.71
|
| Rate for Payer: United Healthcare Medicare |
$162.42
|
|
|
PR AMPUTATION TOE,MT-P JT
|
Professional
|
$544.06
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
z28820
|
| Min. Negotiated Rate |
$167.38 |
| Max. Negotiated Rate |
$491.00 |
| Rate for Payer: Aetna Medicare |
$167.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$491.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$491.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$192.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$184.12
|
| Rate for Payer: Cash Price |
$337.32
|
| Rate for Payer: Cash Price |
$337.32
|
| Rate for Payer: Coventry All Commercial |
$200.86
|
| Rate for Payer: Frontpath All Commercial |
$232.79
|
| Rate for Payer: Humana ChoiceCare |
$353.62
|
| Rate for Payer: Humana Medicare |
$167.38
|
| Rate for Payer: Lucent All Commercial |
$284.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$268.00
|
| Rate for Payer: PHCS All Commercial |
$408.04
|
| Rate for Payer: PHP All Commercial |
$284.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$167.38
|
| Rate for Payer: Signature Care EPO |
$482.19
|
| Rate for Payer: Signature Care PPO |
$482.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$251.00
|
| Rate for Payer: United Healthcare Commercial |
$385.93
|
| Rate for Payer: United Healthcare Medicare |
$167.38
|
|
|
PR ANKLE SCOPE,EXTENS DEBRIDEMNT
|
Professional
|
$1,027.68
|
|
|
Service Code
|
CPT 29898
|
| Hospital Charge Code |
z29898
|
| Min. Negotiated Rate |
$526.85 |
| Max. Negotiated Rate |
$895.64 |
| Rate for Payer: Aetna Medicare |
$526.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$834.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$834.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$605.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$579.54
|
| Rate for Payer: Cash Price |
$637.16
|
| Rate for Payer: Cash Price |
$637.16
|
| Rate for Payer: Coventry All Commercial |
$632.22
|
| Rate for Payer: Frontpath All Commercial |
$726.56
|
| Rate for Payer: Humana ChoiceCare |
$632.79
|
| Rate for Payer: Humana Medicare |
$526.85
|
| Rate for Payer: Lucent All Commercial |
$895.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$843.00
|
| Rate for Payer: PHCS All Commercial |
$770.76
|
| Rate for Payer: PHP All Commercial |
$894.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$526.85
|
| Rate for Payer: Signature Care EPO |
$846.60
|
| Rate for Payer: Signature Care PPO |
$846.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$790.00
|
| Rate for Payer: United Healthcare Commercial |
$640.81
|
| Rate for Payer: United Healthcare Medicare |
$526.85
|
|
|
PR ANKLE SCOPE,PART SYNOVECTOMY
|
Professional
|
$851.60
|
|
|
Service Code
|
CPT 29895
|
| Hospital Charge Code |
z29895
|
| Min. Negotiated Rate |
$436.44 |
| Max. Negotiated Rate |
$741.95 |
| Rate for Payer: Aetna Medicare |
$436.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$723.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$723.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$501.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$480.08
|
| Rate for Payer: Cash Price |
$527.99
|
| Rate for Payer: Cash Price |
$527.99
|
| Rate for Payer: Coventry All Commercial |
$523.73
|
| Rate for Payer: Frontpath All Commercial |
$605.90
|
| Rate for Payer: Humana ChoiceCare |
$543.02
|
| Rate for Payer: Humana Medicare |
$436.44
|
| Rate for Payer: Lucent All Commercial |
$741.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$698.00
|
| Rate for Payer: PHCS All Commercial |
$638.70
|
| Rate for Payer: PHP All Commercial |
$740.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$436.44
|
| Rate for Payer: Signature Care EPO |
$725.05
|
| Rate for Payer: Signature Care PPO |
$725.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$655.00
|
| Rate for Payer: United Healthcare Commercial |
$546.85
|
| Rate for Payer: United Healthcare Medicare |
$436.44
|
|
|
PR ANNUAL WELLNESS VISIT; PERSONALIZ PPS INIT VISIT
|
Professional
|
$391.00
|
|
|
Service Code
|
CPT G0438
|
| Hospital Charge Code |
zG0438
|
| Min. Negotiated Rate |
$133.25 |
| Max. Negotiated Rate |
$293.25 |
| Rate for Payer: Aetna Medicare |
$156.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$173.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$173.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$180.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$172.44
|
| Rate for Payer: Cash Price |
$242.42
|
| Rate for Payer: Cash Price |
$242.42
|
| Rate for Payer: Coventry All Commercial |
$188.11
|
| Rate for Payer: Humana ChoiceCare |
$133.25
|
| Rate for Payer: Humana Medicare |
$156.76
|
| Rate for Payer: Lucent All Commercial |
$266.49
|
| Rate for Payer: PHCS All Commercial |
$293.25
|
| Rate for Payer: PHP All Commercial |
$157.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$156.76
|
| Rate for Payer: Signature Care EPO |
$135.19
|
| Rate for Payer: Signature Care PPO |
$135.19
|
| Rate for Payer: United Healthcare Commercial |
$170.88
|
| Rate for Payer: United Healthcare Medicare |
$156.76
|
|
|
PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD
|
Professional
|
$217.20
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
z46600
|
| Min. Negotiated Rate |
$37.65 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Aetna Medicare |
$38.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$124.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$124.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.96
|
| Rate for Payer: Cash Price |
$134.66
|
| Rate for Payer: Cash Price |
$134.66
|
| Rate for Payer: Coventry All Commercial |
$45.78
|
| Rate for Payer: Frontpath All Commercial |
$52.17
|
| Rate for Payer: Humana ChoiceCare |
$37.65
|
| Rate for Payer: Humana Medicare |
$38.15
|
| Rate for Payer: Lucent All Commercial |
$64.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.00
|
| Rate for Payer: PHCS All Commercial |
$162.90
|
| Rate for Payer: PHP All Commercial |
$65.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.15
|
| Rate for Payer: Signature Care EPO |
$113.05
|
| Rate for Payer: Signature Care PPO |
$113.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.00
|
| Rate for Payer: United Healthcare Commercial |
$41.46
|
| Rate for Payer: United Healthcare Medicare |
$38.15
|
|
|
PR ANTEPARTUM CARE, 1-6 VISITS
|
Professional
|
$1,001.56
|
|
|
Service Code
|
CPT 59425
|
| Hospital Charge Code |
z59425
|
| Min. Negotiated Rate |
$264.61 |
| Max. Negotiated Rate |
$751.17 |
| Rate for Payer: Aetna Medicare |
$393.21
|
| Rate for Payer: Aetna Medicare |
$393.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$388.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$388.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$388.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$388.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$452.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$452.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$432.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$432.53
|
| Rate for Payer: Cash Price |
$620.97
|
| Rate for Payer: Cash Price |
$620.97
|
| Rate for Payer: Cash Price |
$52.70
|
| Rate for Payer: Cash Price |
$52.70
|
| Rate for Payer: Coventry All Commercial |
$471.85
|
| Rate for Payer: Coventry All Commercial |
$471.85
|
| Rate for Payer: Frontpath All Commercial |
$565.04
|
| Rate for Payer: Frontpath All Commercial |
$565.04
|
| Rate for Payer: Humana ChoiceCare |
$264.61
|
| Rate for Payer: Humana ChoiceCare |
$264.61
|
| Rate for Payer: Humana Medicare |
$393.21
|
| Rate for Payer: Humana Medicare |
$393.21
|
| Rate for Payer: Lucent All Commercial |
$668.46
|
| Rate for Payer: Lucent All Commercial |
$668.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$550.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$550.00
|
| Rate for Payer: PHCS All Commercial |
$63.75
|
| Rate for Payer: PHCS All Commercial |
$751.17
|
| Rate for Payer: PHP All Commercial |
$506.37
|
| Rate for Payer: PHP All Commercial |
$506.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$393.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$393.21
|
| Rate for Payer: Signature Care EPO |
$447.10
|
| Rate for Payer: Signature Care EPO |
$447.10
|
| Rate for Payer: Signature Care PPO |
$447.10
|
| Rate for Payer: Signature Care PPO |
$447.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$511.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$511.00
|
| Rate for Payer: United Healthcare Commercial |
$386.53
|
| Rate for Payer: United Healthcare Commercial |
$386.53
|
| Rate for Payer: United Healthcare Medicare |
$393.21
|
| Rate for Payer: United Healthcare Medicare |
$393.21
|
|
|
PR ANTEPARTUM CARE, 7+ VISITS
|
Professional
|
$1,830.86
|
|
|
Service Code
|
CPT 59426
|
| Hospital Charge Code |
z59426
|
| Min. Negotiated Rate |
$456.87 |
| Max. Negotiated Rate |
$1,373.14 |
| Rate for Payer: Aetna Medicare |
$721.92
|
| Rate for Payer: Aetna Medicare |
$721.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$666.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$666.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$666.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$666.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$830.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$830.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$794.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$794.11
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$1,135.13
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$1,135.13
|
| Rate for Payer: Coventry All Commercial |
$866.30
|
| Rate for Payer: Coventry All Commercial |
$866.30
|
| Rate for Payer: Frontpath All Commercial |
$1,034.60
|
| Rate for Payer: Frontpath All Commercial |
$1,034.60
|
| Rate for Payer: Humana ChoiceCare |
$456.87
|
| Rate for Payer: Humana ChoiceCare |
$456.87
|
| Rate for Payer: Humana Medicare |
$721.92
|
| Rate for Payer: Humana Medicare |
$721.92
|
| Rate for Payer: Lucent All Commercial |
$1,227.26
|
| Rate for Payer: Lucent All Commercial |
$1,227.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,011.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,011.00
|
| Rate for Payer: PHCS All Commercial |
$1,373.14
|
| Rate for Payer: PHCS All Commercial |
$67.50
|
| Rate for Payer: PHP All Commercial |
$929.28
|
| Rate for Payer: PHP All Commercial |
$929.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$721.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$721.92
|
| Rate for Payer: Signature Care EPO |
$799.36
|
| Rate for Payer: Signature Care EPO |
$799.36
|
| Rate for Payer: Signature Care PPO |
$799.36
|
| Rate for Payer: Signature Care PPO |
$799.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$938.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$938.00
|
| Rate for Payer: United Healthcare Commercial |
$684.04
|
| Rate for Payer: United Healthcare Commercial |
$684.04
|
| Rate for Payer: United Healthcare Medicare |
$721.92
|
| Rate for Payer: United Healthcare Medicare |
$721.92
|
|
|
PR ANTEPARTUM HEAD MANIPULATION
|
Professional
|
$180.28
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
z59412
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$157.08 |
| Rate for Payer: Aetna Medicare |
$92.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$132.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$106.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$101.64
|
| Rate for Payer: Cash Price |
$111.77
|
| Rate for Payer: Cash Price |
$111.77
|
| Rate for Payer: Coventry All Commercial |
$110.88
|
| Rate for Payer: Frontpath All Commercial |
$133.13
|
| Rate for Payer: Humana ChoiceCare |
$99.23
|
| Rate for Payer: Humana Medicare |
$92.40
|
| Rate for Payer: Lucent All Commercial |
$157.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$129.00
|
| Rate for Payer: PHCS All Commercial |
$135.21
|
| Rate for Payer: PHP All Commercial |
$118.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.40
|
| Rate for Payer: Signature Care EPO |
$127.50
|
| Rate for Payer: Signature Care PPO |
$127.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$120.00
|
| Rate for Payer: United Healthcare Commercial |
$116.86
|
| Rate for Payer: United Healthcare Medicare |
$92.40
|
|
|
PR ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO
|
Professional
|
$1,123.88
|
|
|
Service Code
|
CPT 57240
|
| Hospital Charge Code |
z57240
|
| Min. Negotiated Rate |
$434.14 |
| Max. Negotiated Rate |
$979.18 |
| Rate for Payer: Aetna Medicare |
$575.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$513.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$513.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$662.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$633.59
|
| Rate for Payer: Cash Price |
$696.81
|
| Rate for Payer: Cash Price |
$696.81
|
| Rate for Payer: Coventry All Commercial |
$691.19
|
| Rate for Payer: Frontpath All Commercial |
$801.35
|
| Rate for Payer: Humana ChoiceCare |
$434.14
|
| Rate for Payer: Humana Medicare |
$575.99
|
| Rate for Payer: Lucent All Commercial |
$979.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$806.00
|
| Rate for Payer: PHCS All Commercial |
$842.91
|
| Rate for Payer: PHP All Commercial |
$741.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$575.99
|
| Rate for Payer: Signature Care EPO |
$549.11
|
| Rate for Payer: Signature Care PPO |
$549.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$749.00
|
| Rate for Payer: United Healthcare Commercial |
$748.88
|
| Rate for Payer: United Healthcare Medicare |
$575.99
|
|
|
PR APLIGRAF
|
Professional
|
$30.36
|
|
|
Service Code
|
CPT Q4101
|
| Hospital Charge Code |
zQ4101
|
| Min. Negotiated Rate |
$30.36 |
| Max. Negotiated Rate |
$30.36 |
| Rate for Payer: Humana ChoiceCare |
$30.36
|
|
|
PR APPENDECTOMY
|
Professional
|
$1,146.02
|
|
|
Service Code
|
CPT 44950
|
| Hospital Charge Code |
z44950
|
| Min. Negotiated Rate |
$587.33 |
| Max. Negotiated Rate |
$1,002.76 |
| Rate for Payer: Aetna Medicare |
$587.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$685.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$685.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$675.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$646.06
|
| Rate for Payer: Cash Price |
$710.53
|
| Rate for Payer: Cash Price |
$710.53
|
| Rate for Payer: Coventry All Commercial |
$704.80
|
| Rate for Payer: Frontpath All Commercial |
$850.21
|
| Rate for Payer: Humana ChoiceCare |
$656.64
|
| Rate for Payer: Humana Medicare |
$587.33
|
| Rate for Payer: Lucent All Commercial |
$998.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$881.00
|
| Rate for Payer: PHCS All Commercial |
$859.52
|
| Rate for Payer: PHP All Commercial |
$1,002.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$587.33
|
| Rate for Payer: Signature Care EPO |
$827.90
|
| Rate for Payer: Signature Care PPO |
$827.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$822.00
|
| Rate for Payer: United Healthcare Commercial |
$685.13
|
| Rate for Payer: United Healthcare Medicare |
$587.33
|
|
|
PR APPENDECTOMY,W OTHR PROC
|
Professional
|
$148.58
|
|
|
Service Code
|
CPT 44955
|
| Hospital Charge Code |
z44955
|
| Min. Negotiated Rate |
$76.15 |
| Max. Negotiated Rate |
$134.60 |
| Rate for Payer: Aetna Medicare |
$76.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$134.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$134.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.76
|
| Rate for Payer: Cash Price |
$92.12
|
| Rate for Payer: Cash Price |
$92.12
|
| Rate for Payer: Coventry All Commercial |
$91.38
|
| Rate for Payer: Frontpath All Commercial |
$109.72
|
| Rate for Payer: Humana ChoiceCare |
$95.56
|
| Rate for Payer: Humana Medicare |
$76.15
|
| Rate for Payer: Lucent All Commercial |
$129.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.00
|
| Rate for Payer: PHCS All Commercial |
$111.44
|
| Rate for Payer: PHP All Commercial |
$130.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.15
|
| Rate for Payer: Signature Care EPO |
$120.70
|
| Rate for Payer: Signature Care PPO |
$120.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$107.00
|
| Rate for Payer: United Healthcare Commercial |
$93.41
|
| Rate for Payer: United Healthcare Medicare |
$76.15
|
|
|
PR APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM
|
Professional
|
$2,040.20
|
|
|
Service Code
|
CPT 20692
|
| Hospital Charge Code |
z20692
|
| Min. Negotiated Rate |
$448.91 |
| Max. Negotiated Rate |
$1,777.52 |
| Rate for Payer: Aetna Medicare |
$1,045.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,264.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,264.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,202.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,150.16
|
| Rate for Payer: Cash Price |
$1,264.92
|
| Rate for Payer: Cash Price |
$1,264.92
|
| Rate for Payer: Coventry All Commercial |
$1,254.72
|
| Rate for Payer: Frontpath All Commercial |
$1,447.67
|
| Rate for Payer: Humana ChoiceCare |
$448.91
|
| Rate for Payer: Humana Medicare |
$1,045.60
|
| Rate for Payer: Lucent All Commercial |
$1,777.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,673.00
|
| Rate for Payer: PHCS All Commercial |
$1,530.15
|
| Rate for Payer: PHP All Commercial |
$1,774.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,045.60
|
| Rate for Payer: Signature Care EPO |
$913.47
|
| Rate for Payer: Signature Care PPO |
$913.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,568.00
|
| Rate for Payer: United Healthcare Commercial |
$1,107.26
|
| Rate for Payer: United Healthcare Medicare |
$1,045.60
|
|
|
PR APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP
|
Professional
|
$21.98
|
|
|
Service Code
|
CPT 99188
|
| Hospital Charge Code |
z99188
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$22.58 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.00
|
| Rate for Payer: Cash Price |
$13.63
|
| Rate for Payer: Cash Price |
$13.63
|
| Rate for Payer: Frontpath All Commercial |
$10.30
|
| Rate for Payer: Humana ChoiceCare |
$11.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.00
|
| Rate for Payer: PHCS All Commercial |
$16.48
|
| Rate for Payer: PHP All Commercial |
$7.80
|
| Rate for Payer: Signature Care EPO |
$22.58
|
| Rate for Payer: Signature Care PPO |
$22.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.00
|
| Rate for Payer: United Healthcare Commercial |
$12.60
|
|
|
PR APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE
|
Professional
|
$164.08
|
|
|
Service Code
|
CPT 29581
|
| Hospital Charge Code |
z29581
|
| Min. Negotiated Rate |
$26.05 |
| Max. Negotiated Rate |
$123.06 |
| Rate for Payer: Aetna Medicare |
$26.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.66
|
| Rate for Payer: Cash Price |
$101.73
|
| Rate for Payer: Cash Price |
$101.73
|
| Rate for Payer: Coventry All Commercial |
$31.26
|
| Rate for Payer: Frontpath All Commercial |
$35.37
|
| Rate for Payer: Humana ChoiceCare |
$34.86
|
| Rate for Payer: Humana Medicare |
$26.05
|
| Rate for Payer: Lucent All Commercial |
$44.28
|
| Rate for Payer: PHCS All Commercial |
$123.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.05
|
| Rate for Payer: United Healthcare Commercial |
$37.93
|
| Rate for Payer: United Healthcare Medicare |
$26.05
|
|
|
PR APPLY FINGER SPLINT,STATIC
|
Professional
|
$75.96
|
|
|
Service Code
|
CPT 29130
|
| Hospital Charge Code |
z29130
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$56.97 |
| Rate for Payer: Aetna Medicare |
$27.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.92
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Coventry All Commercial |
$32.64
|
| Rate for Payer: Frontpath All Commercial |
$38.01
|
| Rate for Payer: Humana ChoiceCare |
$29.70
|
| Rate for Payer: Humana Medicare |
$27.20
|
| Rate for Payer: Lucent All Commercial |
$46.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.00
|
| Rate for Payer: PHCS All Commercial |
$56.97
|
| Rate for Payer: PHP All Commercial |
$46.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.20
|
| Rate for Payer: Signature Care EPO |
$54.40
|
| Rate for Payer: Signature Care PPO |
$54.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41.00
|
| Rate for Payer: United Healthcare Commercial |
$32.03
|
| Rate for Payer: United Healthcare Medicare |
$27.20
|
|
|
PR APPLY FOREARM CAST
|
Professional
|
$159.26
|
|
|
Service Code
|
CPT 29075
|
| Hospital Charge Code |
z29075
|
| Min. Negotiated Rate |
$57.85 |
| Max. Negotiated Rate |
$119.44 |
| Rate for Payer: Aetna Medicare |
$57.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$106.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$66.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$63.64
|
| Rate for Payer: Cash Price |
$98.74
|
| Rate for Payer: Cash Price |
$98.74
|
| Rate for Payer: Coventry All Commercial |
$69.42
|
| Rate for Payer: Frontpath All Commercial |
$78.49
|
| Rate for Payer: Humana ChoiceCare |
$62.99
|
| Rate for Payer: Humana Medicare |
$57.85
|
| Rate for Payer: Lucent All Commercial |
$98.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.00
|
| Rate for Payer: PHCS All Commercial |
$119.44
|
| Rate for Payer: PHP All Commercial |
$98.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.85
|
| Rate for Payer: Signature Care EPO |
$112.20
|
| Rate for Payer: Signature Care PPO |
$112.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.00
|
| Rate for Payer: United Healthcare Commercial |
$65.95
|
| Rate for Payer: United Healthcare Medicare |
$57.85
|
|
