|
PR HYSTEROSCOPY,RMV MYOMA
|
Professional
|
$648.64
|
|
|
Service Code
|
CPT 58561
|
| Hospital Charge Code |
z58561
|
| Min. Negotiated Rate |
$332.43 |
| Max. Negotiated Rate |
$1,077.60 |
| Rate for Payer: Aetna Medicare |
$332.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,077.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,077.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$382.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$365.67
|
| Rate for Payer: Cash Price |
$402.16
|
| Rate for Payer: Cash Price |
$402.16
|
| Rate for Payer: Coventry All Commercial |
$398.92
|
| Rate for Payer: Frontpath All Commercial |
$467.88
|
| Rate for Payer: Humana ChoiceCare |
$638.69
|
| Rate for Payer: Humana Medicare |
$332.43
|
| Rate for Payer: Lucent All Commercial |
$565.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$465.00
|
| Rate for Payer: PHCS All Commercial |
$486.48
|
| Rate for Payer: PHP All Commercial |
$428.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$332.43
|
| Rate for Payer: Signature Care EPO |
$570.04
|
| Rate for Payer: Signature Care PPO |
$570.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$432.00
|
| Rate for Payer: United Healthcare Commercial |
$629.56
|
| Rate for Payer: United Healthcare Medicare |
$332.43
|
|
|
PR HYSTEROSCOPY, STERILIZE W IMPLANTS
|
Professional
|
$3,064.88
|
|
|
Service Code
|
CPT 58565
|
| Hospital Charge Code |
z58565
|
| Min. Negotiated Rate |
$429.45 |
| Max. Negotiated Rate |
$2,655.40 |
| Rate for Payer: Aetna Medicare |
$429.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$493.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$472.40
|
| Rate for Payer: Cash Price |
$1,900.23
|
| Rate for Payer: Cash Price |
$1,900.23
|
| Rate for Payer: Coventry All Commercial |
$515.34
|
| Rate for Payer: Frontpath All Commercial |
$598.87
|
| Rate for Payer: Humana ChoiceCare |
$491.34
|
| Rate for Payer: Humana Medicare |
$429.45
|
| Rate for Payer: Lucent All Commercial |
$730.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$601.00
|
| Rate for Payer: PHCS All Commercial |
$2,298.66
|
| Rate for Payer: PHP All Commercial |
$553.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$429.45
|
| Rate for Payer: Signature Care EPO |
$2,655.40
|
| Rate for Payer: Signature Care PPO |
$2,655.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$558.00
|
| Rate for Payer: United Healthcare Commercial |
$499.00
|
| Rate for Payer: United Healthcare Medicare |
$429.45
|
|
|
PR HYSTEROSCOPY,UTERUS,UNL PROC
|
Professional
|
$663.70
|
|
|
Service Code
|
CPT 58579
|
| Hospital Charge Code |
z58579
|
| Min. Negotiated Rate |
$497.78 |
| Max. Negotiated Rate |
$497.78 |
| Rate for Payer: Cash Price |
$411.49
|
| Rate for Payer: PHCS All Commercial |
$497.78
|
|
|
PR HYSTEROSCOPY,W/ENDO BX
|
Professional
|
$2,444.22
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
z58558
|
| Min. Negotiated Rate |
$215.08 |
| Max. Negotiated Rate |
$1,934.43 |
| Rate for Payer: Aetna Medicare |
$215.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,934.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,934.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$247.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$236.59
|
| Rate for Payer: Cash Price |
$1,515.42
|
| Rate for Payer: Cash Price |
$1,515.42
|
| Rate for Payer: Coventry All Commercial |
$258.10
|
| Rate for Payer: Frontpath All Commercial |
$301.08
|
| Rate for Payer: Humana ChoiceCare |
$308.76
|
| Rate for Payer: Humana Medicare |
$215.08
|
| Rate for Payer: Lucent All Commercial |
$365.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$301.00
|
| Rate for Payer: PHCS All Commercial |
$1,833.16
|
| Rate for Payer: PHP All Commercial |
$276.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$215.08
|
| Rate for Payer: Signature Care EPO |
$1,638.55
|
| Rate for Payer: Signature Care PPO |
$1,638.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$280.00
|
| Rate for Payer: United Healthcare Commercial |
$305.65
|
| Rate for Payer: United Healthcare Medicare |
$215.08
|
|
|
PR HYSTEROSCOPY,W/ENDOMETRIAL ABLATION
|
Professional
|
$3,887.22
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
z58563
|
| Min. Negotiated Rate |
$228.83 |
| Max. Negotiated Rate |
$3,197.32 |
| Rate for Payer: Aetna Medicare |
$228.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,197.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,197.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$263.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$251.71
|
| Rate for Payer: Cash Price |
$2,410.08
|
| Rate for Payer: Cash Price |
$2,410.08
|
| Rate for Payer: Coventry All Commercial |
$274.60
|
| Rate for Payer: Frontpath All Commercial |
$321.23
|
| Rate for Payer: Humana ChoiceCare |
$398.31
|
| Rate for Payer: Humana Medicare |
$228.83
|
| Rate for Payer: Lucent All Commercial |
$389.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$320.00
|
| Rate for Payer: PHCS All Commercial |
$2,915.42
|
| Rate for Payer: PHP All Commercial |
$294.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$228.83
|
| Rate for Payer: Signature Care EPO |
$2,404.65
|
| Rate for Payer: Signature Care PPO |
$2,404.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$297.00
|
| Rate for Payer: United Healthcare Commercial |
$393.30
|
| Rate for Payer: United Healthcare Medicare |
$228.83
|
|
|
PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM NJX
|
Professional
|
$220.09
|
|
|
Service Code
|
CPT 90750
|
| Hospital Charge Code |
z90750
|
| Min. Negotiated Rate |
$164.78 |
| Max. Negotiated Rate |
$220.09 |
| Rate for Payer: Frontpath All Commercial |
$164.78
|
| Rate for Payer: Humana ChoiceCare |
$175.86
|
| Rate for Payer: PHP All Commercial |
$188.72
|
| Rate for Payer: United Healthcare Commercial |
$220.09
|
|
|
PR I&D BARTHOLIN GLAND ABSCESS
|
Professional
|
$340.40
|
|
|
Service Code
|
CPT 56420
|
| Hospital Charge Code |
z56420
|
| Min. Negotiated Rate |
$103.06 |
| Max. Negotiated Rate |
$255.30 |
| Rate for Payer: Aetna Medicare |
$104.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$187.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$187.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.48
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Coventry All Commercial |
$124.88
|
| Rate for Payer: Frontpath All Commercial |
$144.44
|
| Rate for Payer: Humana ChoiceCare |
$106.51
|
| Rate for Payer: Humana Medicare |
$104.07
|
| Rate for Payer: Lucent All Commercial |
$176.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$146.00
|
| Rate for Payer: PHCS All Commercial |
$255.30
|
| Rate for Payer: PHP All Commercial |
$134.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.07
|
| Rate for Payer: Signature Care EPO |
$176.80
|
| Rate for Payer: Signature Care PPO |
$176.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$135.00
|
| Rate for Payer: United Healthcare Commercial |
$103.06
|
| Rate for Payer: United Healthcare Medicare |
$104.07
|
|
|
PR IDENTIFY SENTINEL NODE
|
Professional
|
$150.30
|
|
|
Service Code
|
CPT 38792
|
| Hospital Charge Code |
z38792
|
| Min. Negotiated Rate |
$30.41 |
| Max. Negotiated Rate |
$112.72 |
| Rate for Payer: Aetna Medicare |
$30.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$76.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$76.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.45
|
| Rate for Payer: Cash Price |
$93.19
|
| Rate for Payer: Cash Price |
$93.19
|
| Rate for Payer: Coventry All Commercial |
$36.49
|
| Rate for Payer: Frontpath All Commercial |
$43.12
|
| Rate for Payer: Humana ChoiceCare |
$46.73
|
| Rate for Payer: Humana Medicare |
$30.41
|
| Rate for Payer: Lucent All Commercial |
$51.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: PHCS All Commercial |
$112.72
|
| Rate for Payer: PHP All Commercial |
$41.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.41
|
| Rate for Payer: Signature Care EPO |
$65.88
|
| Rate for Payer: Signature Care PPO |
$65.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.00
|
| Rate for Payer: United Healthcare Commercial |
$44.93
|
| Rate for Payer: United Healthcare Medicare |
$30.41
|
|
|
PR I&D HEMATOMA SEROMA/FLUID COLLECTION
|
Professional
|
$308.94
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
z10140
|
| Min. Negotiated Rate |
$105.41 |
| Max. Negotiated Rate |
$231.70 |
| Rate for Payer: Aetna Medicare |
$110.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$120.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$120.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$126.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.19
|
| Rate for Payer: Cash Price |
$191.54
|
| Rate for Payer: Cash Price |
$191.54
|
| Rate for Payer: Coventry All Commercial |
$132.20
|
| Rate for Payer: Frontpath All Commercial |
$150.42
|
| Rate for Payer: Humana ChoiceCare |
$105.41
|
| Rate for Payer: Humana Medicare |
$110.17
|
| Rate for Payer: Lucent All Commercial |
$187.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$143.00
|
| Rate for Payer: PHCS All Commercial |
$231.70
|
| Rate for Payer: PHP All Commercial |
$150.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$110.17
|
| Rate for Payer: Signature Care EPO |
$136.18
|
| Rate for Payer: Signature Care PPO |
$136.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$132.00
|
| Rate for Payer: United Healthcare Commercial |
$127.99
|
| Rate for Payer: United Healthcare Medicare |
$110.17
|
|
|
PR I&D OF VULVA/PERINEUM ABSCESS
|
Professional
|
$270.22
|
|
|
Service Code
|
CPT 56405
|
| Hospital Charge Code |
z56405
|
| Min. Negotiated Rate |
$112.93 |
| Max. Negotiated Rate |
$202.66 |
| Rate for Payer: Aetna Medicare |
$119.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$143.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$136.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$130.94
|
| Rate for Payer: Cash Price |
$167.54
|
| Rate for Payer: Cash Price |
$167.54
|
| Rate for Payer: Coventry All Commercial |
$142.85
|
| Rate for Payer: Frontpath All Commercial |
$163.94
|
| Rate for Payer: Humana ChoiceCare |
$112.93
|
| Rate for Payer: Humana Medicare |
$119.04
|
| Rate for Payer: Lucent All Commercial |
$202.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$167.00
|
| Rate for Payer: PHCS All Commercial |
$202.66
|
| Rate for Payer: PHP All Commercial |
$153.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$119.04
|
| Rate for Payer: Signature Care EPO |
$136.00
|
| Rate for Payer: Signature Care PPO |
$136.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$155.00
|
| Rate for Payer: United Healthcare Commercial |
$118.43
|
| Rate for Payer: United Healthcare Medicare |
$119.04
|
|
|
PR I&D PERIANAL ABSCESS,SUPERFICIAL
|
Professional
|
$430.78
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
z46050
|
| Min. Negotiated Rate |
$91.27 |
| Max. Negotiated Rate |
$323.08 |
| Rate for Payer: Aetna Medicare |
$93.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$153.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$153.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$107.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$103.28
|
| Rate for Payer: Cash Price |
$267.08
|
| Rate for Payer: Cash Price |
$267.08
|
| Rate for Payer: Coventry All Commercial |
$112.67
|
| Rate for Payer: Frontpath All Commercial |
$129.21
|
| Rate for Payer: Humana ChoiceCare |
$91.27
|
| Rate for Payer: Humana Medicare |
$93.89
|
| Rate for Payer: Lucent All Commercial |
$159.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$141.00
|
| Rate for Payer: PHCS All Commercial |
$323.08
|
| Rate for Payer: PHP All Commercial |
$160.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$93.89
|
| Rate for Payer: Signature Care EPO |
$206.55
|
| Rate for Payer: Signature Care PPO |
$206.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$131.00
|
| Rate for Payer: United Healthcare Commercial |
$97.24
|
| Rate for Payer: United Healthcare Medicare |
$93.89
|
|
|
PR I&D PERIRECTAL ABSCESS
|
Professional
|
$1,005.58
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
z46040
|
| Min. Negotiated Rate |
$384.36 |
| Max. Negotiated Rate |
$754.18 |
| Rate for Payer: Aetna Medicare |
$394.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$419.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$419.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$453.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$433.43
|
| Rate for Payer: Cash Price |
$623.46
|
| Rate for Payer: Cash Price |
$623.46
|
| Rate for Payer: Coventry All Commercial |
$472.84
|
| Rate for Payer: Frontpath All Commercial |
$553.33
|
| Rate for Payer: Humana ChoiceCare |
$384.36
|
| Rate for Payer: Humana Medicare |
$394.03
|
| Rate for Payer: Lucent All Commercial |
$669.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$591.00
|
| Rate for Payer: PHCS All Commercial |
$754.18
|
| Rate for Payer: PHP All Commercial |
$672.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$394.03
|
| Rate for Payer: Signature Care EPO |
$577.15
|
| Rate for Payer: Signature Care PPO |
$577.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$552.00
|
| Rate for Payer: United Healthcare Commercial |
$415.70
|
| Rate for Payer: United Healthcare Medicare |
$394.03
|
|
|
PR IIV3 VACCINE SPLIT VIRUS 0.5 ML DOSAGE IM USE
|
Professional
|
$19.20
|
|
|
Service Code
|
CPT 90658
|
| Hospital Charge Code |
z90658
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$19.20 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.00
|
| Rate for Payer: Frontpath All Commercial |
$11.43
|
| Rate for Payer: Humana ChoiceCare |
$18.24
|
| Rate for Payer: United Healthcare Commercial |
$19.20
|
|
|
PR IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE
|
Professional
|
$27.66
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
z90686
|
| Min. Negotiated Rate |
$20.90 |
| Max. Negotiated Rate |
$27.66 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$21.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.00
|
| Rate for Payer: Frontpath All Commercial |
$22.58
|
| Rate for Payer: Humana ChoiceCare |
$21.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.66
|
| Rate for Payer: PHP All Commercial |
$20.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$27.66
|
| Rate for Payer: United Healthcare Commercial |
$23.06
|
|
|
PR IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE
|
Professional
|
$19.90
|
|
|
Service Code
|
CPT 90687
|
| Hospital Charge Code |
z90687
|
| Min. Negotiated Rate |
$10.24 |
| Max. Negotiated Rate |
$19.90 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.00
|
| Rate for Payer: Frontpath All Commercial |
$10.95
|
| Rate for Payer: Humana ChoiceCare |
$10.24
|
| Rate for Payer: PHP All Commercial |
$19.90
|
| Rate for Payer: United Healthcare Commercial |
$11.34
|
|
|
PR IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE
|
Professional
|
$22.68
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
z90688
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$22.68 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.00
|
| Rate for Payer: Frontpath All Commercial |
$21.90
|
| Rate for Payer: Humana ChoiceCare |
$20.48
|
| Rate for Payer: PHP All Commercial |
$21.32
|
| Rate for Payer: United Healthcare Commercial |
$22.68
|
|
|
PR IIV VACCINE PRESERV FREE INCREASED AG COUNT IM
|
Professional
|
$73.63
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
z90662
|
| Min. Negotiated Rate |
$21.32 |
| Max. Negotiated Rate |
$73.63 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.26
|
| Rate for Payer: Frontpath All Commercial |
$71.79
|
| Rate for Payer: Humana ChoiceCare |
$69.94
|
| Rate for Payer: PHP All Commercial |
$21.32
|
| Rate for Payer: United Healthcare Commercial |
$73.63
|
|
|
PR ILEOSCOPY STOMA W/BX SINGLE/MULTIPLE
|
Professional
|
$545.32
|
|
|
Service Code
|
CPT 44382
|
| Hospital Charge Code |
z44382
|
| Min. Negotiated Rate |
$68.62 |
| Max. Negotiated Rate |
$408.99 |
| Rate for Payer: Aetna Medicare |
$68.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$75.48
|
| Rate for Payer: Cash Price |
$338.10
|
| Rate for Payer: Cash Price |
$338.10
|
| Rate for Payer: Coventry All Commercial |
$82.34
|
| Rate for Payer: Frontpath All Commercial |
$93.04
|
| Rate for Payer: Humana ChoiceCare |
$85.87
|
| Rate for Payer: Humana Medicare |
$68.62
|
| Rate for Payer: Lucent All Commercial |
$116.65
|
| Rate for Payer: PHCS All Commercial |
$408.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$68.62
|
| Rate for Payer: United Healthcare Commercial |
$94.85
|
| Rate for Payer: United Healthcare Medicare |
$68.62
|
|
|
PRIMIDONE 50 MG ORAL TAB
|
Facility
OP
|
$2.44
|
|
|
Service Code
|
NDC 50268068615
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna Commercial |
$2.06
|
| Rate for Payer: Aetna Medicare |
$0.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.88
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Centivo All Commercial |
$1.24
|
| Rate for Payer: Cigna All Commercial |
$2.10
|
| Rate for Payer: CORVEL All Commercial |
$2.27
|
| Rate for Payer: Coventry All Commercial |
$2.14
|
| Rate for Payer: Encore All Commercial |
$2.24
|
| Rate for Payer: Frontpath All Commercial |
$2.24
|
| Rate for Payer: Humana ChoiceCare |
$2.10
|
| Rate for Payer: Humana Medicare |
$1.24
|
| Rate for Payer: Lucent All Commercial |
$1.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.19
|
| Rate for Payer: PHCS All Commercial |
$1.83
|
| Rate for Payer: PHP All Commercial |
$1.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.95
|
| Rate for Payer: Sagamore Health Network All Products |
$1.88
|
| Rate for Payer: Signature Care EPO |
$2.02
|
| Rate for Payer: Signature Care PPO |
$2.14
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.07
|
| Rate for Payer: United Healthcare Commercial |
$1.92
|
| Rate for Payer: United Healthcare Medicare |
$0.80
|
|
|
PRIMIDONE 50 MG ORAL TAB
|
Facility
IP
|
$2.44
|
|
|
Service Code
|
NDC 50268068615
|
| Hospital Charge Code |
11129
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$2.27 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Cash Price |
$1.51
|
| Rate for Payer: Cigna All Commercial |
$2.10
|
| Rate for Payer: CORVEL All Commercial |
$2.27
|
| Rate for Payer: Coventry All Commercial |
$2.14
|
| Rate for Payer: Encore All Commercial |
$2.24
|
| Rate for Payer: Frontpath All Commercial |
$2.24
|
| Rate for Payer: Humana ChoiceCare |
$2.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2.19
|
| Rate for Payer: PHCS All Commercial |
$1.83
|
| Rate for Payer: PHP All Commercial |
$1.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1.88
|
| Rate for Payer: Signature Care EPO |
$2.02
|
| Rate for Payer: Signature Care PPO |
$2.14
|
| Rate for Payer: United Healthcare Commercial |
$1.92
|
|
|
PR IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID
|
Professional
|
$36.86
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
z90471
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$32.11 |
| Rate for Payer: Aetna Medicare |
$18.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.78
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Cash Price |
$22.85
|
| Rate for Payer: Coventry All Commercial |
$22.67
|
| Rate for Payer: Frontpath All Commercial |
$17.67
|
| Rate for Payer: Humana ChoiceCare |
$14.44
|
| Rate for Payer: Humana Medicare |
$18.89
|
| Rate for Payer: Lucent All Commercial |
$32.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.00
|
| Rate for Payer: PHCS All Commercial |
$27.64
|
| Rate for Payer: PHP All Commercial |
$26.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.89
|
| Rate for Payer: Signature Care EPO |
$15.00
|
| Rate for Payer: Signature Care PPO |
$15.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.00
|
| Rate for Payer: United Healthcare Commercial |
$19.59
|
| Rate for Payer: United Healthcare Medicare |
$18.89
|
|
|
PR IMMUNIZ,ADMIN,EACH ADDL
|
Professional
|
$26.50
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
z90472
|
| Min. Negotiated Rate |
$7.50 |
| Max. Negotiated Rate |
$23.09 |
| Rate for Payer: Aetna Medicare |
$13.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.94
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Cash Price |
$16.43
|
| Rate for Payer: Coventry All Commercial |
$16.30
|
| Rate for Payer: Frontpath All Commercial |
$13.42
|
| Rate for Payer: Humana ChoiceCare |
$12.99
|
| Rate for Payer: Humana Medicare |
$13.58
|
| Rate for Payer: Lucent All Commercial |
$23.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.00
|
| Rate for Payer: PHCS All Commercial |
$19.88
|
| Rate for Payer: PHP All Commercial |
$19.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.58
|
| Rate for Payer: Signature Care EPO |
$7.50
|
| Rate for Payer: Signature Care PPO |
$7.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.00
|
| Rate for Payer: United Healthcare Commercial |
$7.61
|
| Rate for Payer: United Healthcare Medicare |
$13.58
|
|
|
PR IMMUNIZ ADMIN,INTRANASAL/ORAL,1 VAC/TOX
|
Professional
|
$30.22
|
|
|
Service Code
|
CPT 90473
|
| Hospital Charge Code |
z90473
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$26.33 |
| Rate for Payer: Aetna Medicare |
$15.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.04
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Cash Price |
$18.74
|
| Rate for Payer: Coventry All Commercial |
$18.59
|
| Rate for Payer: Frontpath All Commercial |
$17.67
|
| Rate for Payer: Humana ChoiceCare |
$14.44
|
| Rate for Payer: Humana Medicare |
$15.49
|
| Rate for Payer: Lucent All Commercial |
$26.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.00
|
| Rate for Payer: PHCS All Commercial |
$22.66
|
| Rate for Payer: PHP All Commercial |
$21.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.49
|
| Rate for Payer: Signature Care EPO |
$17.00
|
| Rate for Payer: Signature Care PPO |
$17.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.00
|
| Rate for Payer: United Healthcare Commercial |
$8.00
|
| Rate for Payer: United Healthcare Medicare |
$15.49
|
|
|
PR IMMUNIZ ADMIN,INTRANASAL/ORAL,EACH ADDL
|
Professional
|
$21.68
|
|
|
Service Code
|
CPT 90474
|
| Hospital Charge Code |
z90474
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$18.89 |
| Rate for Payer: Aetna Medicare |
$11.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.22
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Cash Price |
$13.44
|
| Rate for Payer: Coventry All Commercial |
$13.33
|
| Rate for Payer: Frontpath All Commercial |
$13.42
|
| Rate for Payer: Humana ChoiceCare |
$12.99
|
| Rate for Payer: Humana Medicare |
$11.11
|
| Rate for Payer: Lucent All Commercial |
$18.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.00
|
| Rate for Payer: PHCS All Commercial |
$16.26
|
| Rate for Payer: PHP All Commercial |
$15.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.11
|
| Rate for Payer: Signature Care EPO |
$17.00
|
| Rate for Payer: Signature Care PPO |
$17.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.00
|
| Rate for Payer: United Healthcare Commercial |
$7.28
|
| Rate for Payer: United Healthcare Medicare |
$11.11
|
|
|
PR IMMUNIZ ADMIN, THRU AGE 18, ANY ROUTE,W COUNSEL, 1ST VACCINE/TOXOID
|
Professional
|
$41.20
|
|
|
Service Code
|
CPT 90460
|
| Hospital Charge Code |
z90460
|
| Min. Negotiated Rate |
$14.44 |
| Max. Negotiated Rate |
$35.89 |
| Rate for Payer: Aetna Medicare |
$21.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.22
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Cash Price |
$25.54
|
| Rate for Payer: Coventry All Commercial |
$25.33
|
| Rate for Payer: Frontpath All Commercial |
$17.67
|
| Rate for Payer: Humana ChoiceCare |
$14.44
|
| Rate for Payer: Humana Medicare |
$21.11
|
| Rate for Payer: Lucent All Commercial |
$35.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$27.00
|
| Rate for Payer: PHCS All Commercial |
$30.90
|
| Rate for Payer: PHP All Commercial |
$29.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.11
|
| Rate for Payer: Signature Care EPO |
$23.75
|
| Rate for Payer: Signature Care PPO |
$23.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$25.00
|
| Rate for Payer: United Healthcare Commercial |
$22.90
|
| Rate for Payer: United Healthcare Medicare |
$21.11
|
|
