|
PR NEUROPLASTY OTHER ARM/LEG NERVE,OPEN
|
Professional
|
$914.64
|
|
|
Service Code
|
CPT 64708
|
| Hospital Charge Code |
z64708
|
| Min. Negotiated Rate |
$468.75 |
| Max. Negotiated Rate |
$800.30 |
| Rate for Payer: Aetna Medicare |
$468.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$599.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$599.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$539.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$515.62
|
| Rate for Payer: Cash Price |
$567.08
|
| Rate for Payer: Cash Price |
$567.08
|
| Rate for Payer: Coventry All Commercial |
$562.50
|
| Rate for Payer: Frontpath All Commercial |
$647.57
|
| Rate for Payer: Humana ChoiceCare |
$559.75
|
| Rate for Payer: Humana Medicare |
$468.75
|
| Rate for Payer: Lucent All Commercial |
$796.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$750.00
|
| Rate for Payer: PHCS All Commercial |
$685.98
|
| Rate for Payer: PHP All Commercial |
$800.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$468.75
|
| Rate for Payer: Signature Care EPO |
$640.05
|
| Rate for Payer: Signature Care PPO |
$640.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$703.00
|
| Rate for Payer: United Healthcare Commercial |
$513.28
|
| Rate for Payer: United Healthcare Medicare |
$468.75
|
|
|
PR NJX AA&/STRD PLANTAR COMMON DIGITAL NERVES
|
Professional
|
$91.84
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
z64455
|
| Min. Negotiated Rate |
$31.94 |
| Max. Negotiated Rate |
$78.25 |
| Rate for Payer: Aetna Medicare |
$31.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$68.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.13
|
| Rate for Payer: Cash Price |
$56.94
|
| Rate for Payer: Cash Price |
$56.94
|
| Rate for Payer: Coventry All Commercial |
$38.33
|
| Rate for Payer: Frontpath All Commercial |
$44.17
|
| Rate for Payer: Humana ChoiceCare |
$49.87
|
| Rate for Payer: Humana Medicare |
$31.94
|
| Rate for Payer: Lucent All Commercial |
$54.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.00
|
| Rate for Payer: PHCS All Commercial |
$68.88
|
| Rate for Payer: PHP All Commercial |
$49.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.94
|
| Rate for Payer: Signature Care EPO |
$78.25
|
| Rate for Payer: Signature Care PPO |
$78.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.00
|
| Rate for Payer: United Healthcare Commercial |
$46.18
|
| Rate for Payer: United Healthcare Medicare |
$31.94
|
|
|
PR NONINVASV OXYGEN SATUR;SINGLE
|
Professional
|
$3.92
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
z94760
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$4.09 |
| Rate for Payer: Aetna Medicare |
$2.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.21
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Coventry All Commercial |
$2.41
|
| Rate for Payer: Frontpath All Commercial |
$2.50
|
| Rate for Payer: Humana ChoiceCare |
$2.37
|
| Rate for Payer: Humana Medicare |
$2.01
|
| Rate for Payer: Lucent All Commercial |
$3.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.00
|
| Rate for Payer: PHCS All Commercial |
$2.94
|
| Rate for Payer: PHP All Commercial |
$2.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.01
|
| Rate for Payer: Signature Care EPO |
$2.55
|
| Rate for Payer: Signature Care PPO |
$2.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2.00
|
| Rate for Payer: United Healthcare Commercial |
$3.03
|
| Rate for Payer: United Healthcare Medicare |
$2.01
|
|
|
PR NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN
|
Professional
|
$45.14
|
|
|
Service Code
|
CPT 98967
|
| Hospital Charge Code |
z98967
|
| Min. Negotiated Rate |
$20.58 |
| Max. Negotiated Rate |
$36.18 |
| Rate for Payer: Aetna Medicare |
$21.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$31.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.41
|
| Rate for Payer: Cash Price |
$27.99
|
| Rate for Payer: Cash Price |
$27.99
|
| Rate for Payer: Coventry All Commercial |
$25.54
|
| Rate for Payer: Frontpath All Commercial |
$22.72
|
| Rate for Payer: Humana ChoiceCare |
$20.97
|
| Rate for Payer: Humana Medicare |
$21.28
|
| Rate for Payer: Lucent All Commercial |
$36.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.00
|
| Rate for Payer: PHCS All Commercial |
$33.86
|
| Rate for Payer: PHP All Commercial |
$24.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.28
|
| Rate for Payer: Signature Care EPO |
$20.58
|
| Rate for Payer: Signature Care PPO |
$20.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.00
|
| Rate for Payer: United Healthcare Commercial |
$30.11
|
| Rate for Payer: United Healthcare Medicare |
$21.28
|
|
|
PR NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN
|
Professional
|
$63.48
|
|
|
Service Code
|
CPT 98968
|
| Hospital Charge Code |
z98968
|
| Min. Negotiated Rate |
$30.37 |
| Max. Negotiated Rate |
$51.63 |
| Rate for Payer: Aetna Medicare |
$30.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$46.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.41
|
| Rate for Payer: Cash Price |
$39.36
|
| Rate for Payer: Cash Price |
$39.36
|
| Rate for Payer: Coventry All Commercial |
$36.44
|
| Rate for Payer: Frontpath All Commercial |
$33.17
|
| Rate for Payer: Humana ChoiceCare |
$31.63
|
| Rate for Payer: Humana Medicare |
$30.37
|
| Rate for Payer: Lucent All Commercial |
$51.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$39.00
|
| Rate for Payer: PHCS All Commercial |
$47.61
|
| Rate for Payer: PHP All Commercial |
$35.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.37
|
| Rate for Payer: Signature Care EPO |
$30.55
|
| Rate for Payer: Signature Care PPO |
$30.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$36.00
|
| Rate for Payer: United Healthcare Commercial |
$44.98
|
| Rate for Payer: United Healthcare Medicare |
$30.37
|
|
|
PR NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN
|
Professional
|
$24.68
|
|
|
Service Code
|
CPT 98966
|
| Hospital Charge Code |
z98966
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$18.51 |
| Rate for Payer: Aetna Medicare |
$10.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.87
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Coventry All Commercial |
$12.95
|
| Rate for Payer: Frontpath All Commercial |
$11.69
|
| Rate for Payer: Humana ChoiceCare |
$10.66
|
| Rate for Payer: Humana Medicare |
$10.79
|
| Rate for Payer: Lucent All Commercial |
$18.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.00
|
| Rate for Payer: PHCS All Commercial |
$18.51
|
| Rate for Payer: PHP All Commercial |
$12.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.79
|
| Rate for Payer: Signature Care EPO |
$10.94
|
| Rate for Payer: Signature Care PPO |
$10.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.00
|
| Rate for Payer: United Healthcare Commercial |
$14.85
|
| Rate for Payer: United Healthcare Medicare |
$10.79
|
|
|
PR NORMAL SALINE SOLUTION INFUS
|
Professional
|
$4.04
|
|
|
Service Code
|
CPT J7040
|
| Hospital Charge Code |
zJ7040
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$4.04 |
| Rate for Payer: Humana ChoiceCare |
$1.32
|
| Rate for Payer: PHP All Commercial |
$4.04
|
|
|
PR NORMAL SALINE SOLUTION INFUS
|
Professional
|
$5.01
|
|
|
Service Code
|
CPT J7030
|
| Hospital Charge Code |
zJ7030
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Humana ChoiceCare |
$2.64
|
| Rate for Payer: PHP All Commercial |
$5.01
|
|
|
PR NORMAL SALINE SOLUTION INFUS
|
Professional
|
$3.84
|
|
|
Service Code
|
CPT J7050
|
| Hospital Charge Code |
zJ7050
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$3.84 |
| Rate for Payer: Humana ChoiceCare |
$0.66
|
| Rate for Payer: PHP All Commercial |
$3.84
|
|
|
PR NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME
|
Professional
|
$151.12
|
|
|
Service Code
|
CPT 99315
|
| Hospital Charge Code |
z99315
|
| Min. Negotiated Rate |
$58.87 |
| Max. Negotiated Rate |
$131.66 |
| Rate for Payer: Aetna Medicare |
$77.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$72.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.20
|
| Rate for Payer: Cash Price |
$93.69
|
| Rate for Payer: Cash Price |
$93.69
|
| Rate for Payer: Coventry All Commercial |
$92.94
|
| Rate for Payer: Frontpath All Commercial |
$73.27
|
| Rate for Payer: Humana ChoiceCare |
$62.88
|
| Rate for Payer: Humana Medicare |
$77.45
|
| Rate for Payer: Lucent All Commercial |
$131.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$81.00
|
| Rate for Payer: PHCS All Commercial |
$113.34
|
| Rate for Payer: PHP All Commercial |
$77.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.45
|
| Rate for Payer: Signature Care EPO |
$61.20
|
| Rate for Payer: Signature Care PPO |
$61.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.00
|
| Rate for Payer: United Healthcare Commercial |
$58.87
|
| Rate for Payer: United Healthcare Medicare |
$77.45
|
|
|
Probing of nasolacrimal duct, with or without irrigation; requiring general anesthesia
|
Facility
OP
|
$1,728.79
|
|
|
Service Code
|
CPT 68811
|
| Hospital Charge Code |
CPT-68811
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,728.79 |
| Max. Negotiated Rate |
$1,728.79 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,728.79
|
| Rate for Payer: Managed Health Services Medicaid |
$1,728.79
|
| Rate for Payer: MDWise Medicaid |
$1,728.79
|
|
|
PR OBSTE CARE,VAG DELIV+POSTPARTUM
|
Professional
|
$1,877.74
|
|
|
Service Code
|
CPT 59410
|
| Hospital Charge Code |
z59410
|
| Min. Negotiated Rate |
$834.36 |
| Max. Negotiated Rate |
$1,635.71 |
| Rate for Payer: Aetna Medicare |
$962.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,089.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,089.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,106.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,058.40
|
| Rate for Payer: Cash Price |
$1,164.20
|
| Rate for Payer: Cash Price |
$1,164.20
|
| Rate for Payer: Coventry All Commercial |
$1,154.62
|
| Rate for Payer: Frontpath All Commercial |
$1,377.84
|
| Rate for Payer: Humana ChoiceCare |
$834.36
|
| Rate for Payer: Humana Medicare |
$962.18
|
| Rate for Payer: Lucent All Commercial |
$1,635.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,347.00
|
| Rate for Payer: PHCS All Commercial |
$1,408.30
|
| Rate for Payer: PHP All Commercial |
$1,239.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$962.18
|
| Rate for Payer: Signature Care EPO |
$1,071.00
|
| Rate for Payer: Signature Care PPO |
$1,071.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,251.00
|
| Rate for Payer: United Healthcare Commercial |
$1,011.59
|
| Rate for Payer: United Healthcare Medicare |
$962.18
|
|
|
PR OBSTETRICAL CARE,VAG DELIV ONLY
|
Professional
|
$1,417.42
|
|
|
Service Code
|
CPT 59409
|
| Hospital Charge Code |
z59409
|
| Min. Negotiated Rate |
$726.43 |
| Max. Negotiated Rate |
$1,234.93 |
| Rate for Payer: Aetna Medicare |
$726.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$987.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$987.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$835.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$799.07
|
| Rate for Payer: Cash Price |
$878.80
|
| Rate for Payer: Cash Price |
$878.80
|
| Rate for Payer: Coventry All Commercial |
$871.72
|
| Rate for Payer: Frontpath All Commercial |
$1,044.98
|
| Rate for Payer: Humana ChoiceCare |
$746.56
|
| Rate for Payer: Humana Medicare |
$726.43
|
| Rate for Payer: Lucent All Commercial |
$1,234.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,017.00
|
| Rate for Payer: PHCS All Commercial |
$1,063.06
|
| Rate for Payer: PHP All Commercial |
$935.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$726.43
|
| Rate for Payer: Signature Care EPO |
$957.95
|
| Rate for Payer: Signature Care PPO |
$957.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$944.00
|
| Rate for Payer: United Healthcare Commercial |
$872.23
|
| Rate for Payer: United Healthcare Medicare |
$726.43
|
|
|
PR OBTAINING SCREEN PAP SMEAR
|
Professional
|
$105.00
|
|
|
Service Code
|
CPT Q0091
|
| Hospital Charge Code |
zQ0091
|
| Min. Negotiated Rate |
$12.33 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Aetna Medicare |
$17.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.24
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Coventry All Commercial |
$20.99
|
| Rate for Payer: Humana Medicare |
$17.49
|
| Rate for Payer: Lucent All Commercial |
$29.73
|
| Rate for Payer: PHCS All Commercial |
$78.75
|
| Rate for Payer: PHP All Commercial |
$12.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$17.49
|
| Rate for Payer: Signature Care EPO |
$57.80
|
| Rate for Payer: Signature Care PPO |
$57.80
|
| Rate for Payer: United Healthcare Commercial |
$18.29
|
| Rate for Payer: United Healthcare Medicare |
$17.49
|
|
|
PROCAINAMIDE 500 MG/ML INJ SOLN
|
Facility
OP
|
$2,276.40
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
6563
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$751.21 |
| Max. Negotiated Rate |
$2,117.05 |
| Rate for Payer: Aetna Commercial |
$1,921.28
|
| Rate for Payer: Aetna Medicare |
$751.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$751.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,307.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,422.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$863.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$826.33
|
| Rate for Payer: Cash Price |
$1,411.37
|
| Rate for Payer: Centivo All Commercial |
$1,160.96
|
| Rate for Payer: Cigna All Commercial |
$1,964.53
|
| Rate for Payer: CORVEL All Commercial |
$2,117.05
|
| Rate for Payer: Coventry All Commercial |
$2,003.23
|
| Rate for Payer: Encore All Commercial |
$2,095.43
|
| Rate for Payer: Frontpath All Commercial |
$2,094.29
|
| Rate for Payer: Humana ChoiceCare |
$1,966.13
|
| Rate for Payer: Humana Medicare |
$1,160.96
|
| Rate for Payer: Lucent All Commercial |
$1,160.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,048.76
|
| Rate for Payer: PHCS All Commercial |
$1,707.30
|
| Rate for Payer: PHP All Commercial |
$1,726.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$887.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,757.38
|
| Rate for Payer: Signature Care EPO |
$1,889.41
|
| Rate for Payer: Signature Care PPO |
$2,003.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,934.94
|
| Rate for Payer: United Healthcare Commercial |
$1,793.80
|
| Rate for Payer: United Healthcare Medicare |
$751.21
|
|
|
PROCAINAMIDE 500 MG/ML INJ SOLN
|
Facility
IP
|
$2,276.40
|
|
|
Service Code
|
HCPCS J2690
|
| Hospital Charge Code |
6563
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,707.30 |
| Max. Negotiated Rate |
$2,117.05 |
| Rate for Payer: Aetna Commercial |
$1,966.81
|
| Rate for Payer: Cash Price |
$1,411.37
|
| Rate for Payer: Cigna All Commercial |
$1,964.53
|
| Rate for Payer: CORVEL All Commercial |
$2,117.05
|
| Rate for Payer: Coventry All Commercial |
$2,003.23
|
| Rate for Payer: Encore All Commercial |
$2,095.43
|
| Rate for Payer: Frontpath All Commercial |
$2,094.29
|
| Rate for Payer: Humana ChoiceCare |
$1,966.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,048.76
|
| Rate for Payer: PHCS All Commercial |
$1,707.30
|
| Rate for Payer: PHP All Commercial |
$1,726.42
|
| Rate for Payer: Sagamore Health Network All Products |
$1,757.38
|
| Rate for Payer: Signature Care EPO |
$1,889.41
|
| Rate for Payer: Signature Care PPO |
$2,003.23
|
| Rate for Payer: United Healthcare Commercial |
$1,793.80
|
|
|
PROCHLORPERAZINE 25 MG RECT SUPP
|
Facility
OP
|
$57.94
|
|
|
Service Code
|
HCPCS J8498
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.12 |
| Max. Negotiated Rate |
$53.88 |
| Rate for Payer: Aetna Commercial |
$48.90
|
| Rate for Payer: Aetna Medicare |
$19.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.03
|
| Rate for Payer: Cash Price |
$35.92
|
| Rate for Payer: Centivo All Commercial |
$29.55
|
| Rate for Payer: Cigna All Commercial |
$50.00
|
| Rate for Payer: CORVEL All Commercial |
$53.88
|
| Rate for Payer: Coventry All Commercial |
$50.99
|
| Rate for Payer: Encore All Commercial |
$53.33
|
| Rate for Payer: Frontpath All Commercial |
$53.30
|
| Rate for Payer: Humana ChoiceCare |
$50.04
|
| Rate for Payer: Humana Medicare |
$29.55
|
| Rate for Payer: Lucent All Commercial |
$29.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.15
|
| Rate for Payer: PHCS All Commercial |
$43.45
|
| Rate for Payer: PHP All Commercial |
$43.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.60
|
| Rate for Payer: Sagamore Health Network All Products |
$44.73
|
| Rate for Payer: Signature Care EPO |
$48.09
|
| Rate for Payer: Signature Care PPO |
$50.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.25
|
| Rate for Payer: United Healthcare Commercial |
$45.66
|
| Rate for Payer: United Healthcare Medicare |
$19.12
|
|
|
PROCHLORPERAZINE 25 MG RECT SUPP
|
Facility
IP
|
$57.94
|
|
|
Service Code
|
HCPCS J8498
|
| Hospital Charge Code |
11138
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.45 |
| Max. Negotiated Rate |
$53.88 |
| Rate for Payer: Aetna Commercial |
$50.06
|
| Rate for Payer: Cash Price |
$35.92
|
| Rate for Payer: Cigna All Commercial |
$50.00
|
| Rate for Payer: CORVEL All Commercial |
$53.88
|
| Rate for Payer: Coventry All Commercial |
$50.99
|
| Rate for Payer: Encore All Commercial |
$53.33
|
| Rate for Payer: Frontpath All Commercial |
$53.30
|
| Rate for Payer: Humana ChoiceCare |
$50.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.15
|
| Rate for Payer: PHCS All Commercial |
$43.45
|
| Rate for Payer: PHP All Commercial |
$43.94
|
| Rate for Payer: Sagamore Health Network All Products |
$44.73
|
| Rate for Payer: Signature Care EPO |
$48.09
|
| Rate for Payer: Signature Care PPO |
$50.99
|
| Rate for Payer: United Healthcare Commercial |
$45.66
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN
|
Facility
OP
|
$19.12
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
152840
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.31 |
| Max. Negotiated Rate |
$17.79 |
| Rate for Payer: Aetna Commercial |
$16.14
|
| Rate for Payer: Aetna Medicare |
$6.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.94
|
| Rate for Payer: Cash Price |
$11.86
|
| Rate for Payer: Centivo All Commercial |
$9.75
|
| Rate for Payer: Cigna All Commercial |
$16.50
|
| Rate for Payer: CORVEL All Commercial |
$17.79
|
| Rate for Payer: Coventry All Commercial |
$16.83
|
| Rate for Payer: Encore All Commercial |
$17.60
|
| Rate for Payer: Frontpath All Commercial |
$17.59
|
| Rate for Payer: Humana ChoiceCare |
$16.52
|
| Rate for Payer: Humana Medicare |
$9.75
|
| Rate for Payer: Lucent All Commercial |
$9.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.21
|
| Rate for Payer: PHCS All Commercial |
$14.34
|
| Rate for Payer: PHP All Commercial |
$14.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.46
|
| Rate for Payer: Sagamore Health Network All Products |
$14.76
|
| Rate for Payer: Signature Care EPO |
$15.87
|
| Rate for Payer: Signature Care PPO |
$16.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.26
|
| Rate for Payer: United Healthcare Commercial |
$15.07
|
| Rate for Payer: United Healthcare Medicare |
$6.31
|
|
|
PROCHLORPERAZINE EDISYLATE 10 MG/2 ML (5 MG/ML) INJ SOLN
|
Facility
IP
|
$19.12
|
|
|
Service Code
|
HCPCS J0780
|
| Hospital Charge Code |
152840
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$17.79 |
| Rate for Payer: Aetna Commercial |
$16.52
|
| Rate for Payer: Cash Price |
$11.86
|
| Rate for Payer: Cigna All Commercial |
$16.50
|
| Rate for Payer: CORVEL All Commercial |
$17.79
|
| Rate for Payer: Coventry All Commercial |
$16.83
|
| Rate for Payer: Encore All Commercial |
$17.60
|
| Rate for Payer: Frontpath All Commercial |
$17.59
|
| Rate for Payer: Humana ChoiceCare |
$16.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.21
|
| Rate for Payer: PHCS All Commercial |
$14.34
|
| Rate for Payer: PHP All Commercial |
$14.50
|
| Rate for Payer: Sagamore Health Network All Products |
$14.76
|
| Rate for Payer: Signature Care EPO |
$15.87
|
| Rate for Payer: Signature Care PPO |
$16.83
|
| Rate for Payer: United Healthcare Commercial |
$15.07
|
|
|
PROCHLORPERAZINE MALEATE 10 MG ORAL TAB
|
Facility
IP
|
$7.94
|
|
|
Service Code
|
HCPCS Q0164
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Aetna Commercial |
$6.86
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: Cigna All Commercial |
$6.85
|
| Rate for Payer: CORVEL All Commercial |
$7.38
|
| Rate for Payer: Coventry All Commercial |
$6.99
|
| Rate for Payer: Encore All Commercial |
$7.31
|
| Rate for Payer: Frontpath All Commercial |
$7.30
|
| Rate for Payer: Humana ChoiceCare |
$6.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.14
|
| Rate for Payer: PHCS All Commercial |
$5.95
|
| Rate for Payer: PHP All Commercial |
$6.02
|
| Rate for Payer: Sagamore Health Network All Products |
$6.13
|
| Rate for Payer: Signature Care EPO |
$6.59
|
| Rate for Payer: Signature Care PPO |
$6.99
|
| Rate for Payer: United Healthcare Commercial |
$6.26
|
|
|
PROCHLORPERAZINE MALEATE 10 MG ORAL TAB
|
Facility
OP
|
$7.94
|
|
|
Service Code
|
HCPCS Q0164
|
| Hospital Charge Code |
6582
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$7.38 |
| Rate for Payer: Aetna Commercial |
$6.70
|
| Rate for Payer: Aetna Medicare |
$2.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.88
|
| Rate for Payer: Cash Price |
$4.92
|
| Rate for Payer: Centivo All Commercial |
$4.05
|
| Rate for Payer: Cigna All Commercial |
$6.85
|
| Rate for Payer: CORVEL All Commercial |
$7.38
|
| Rate for Payer: Coventry All Commercial |
$6.99
|
| Rate for Payer: Encore All Commercial |
$7.31
|
| Rate for Payer: Frontpath All Commercial |
$7.30
|
| Rate for Payer: Humana ChoiceCare |
$6.86
|
| Rate for Payer: Humana Medicare |
$4.05
|
| Rate for Payer: Lucent All Commercial |
$4.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.14
|
| Rate for Payer: PHCS All Commercial |
$5.95
|
| Rate for Payer: PHP All Commercial |
$6.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.10
|
| Rate for Payer: Sagamore Health Network All Products |
$6.13
|
| Rate for Payer: Signature Care EPO |
$6.59
|
| Rate for Payer: Signature Care PPO |
$6.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6.75
|
| Rate for Payer: United Healthcare Commercial |
$6.26
|
| Rate for Payer: United Healthcare Medicare |
$2.62
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT HIGH MDM 55 MINUTES
|
Professional
|
$393.40
|
|
|
Service Code
|
CPT 99245
|
| Hospital Charge Code |
z99245
|
| Min. Negotiated Rate |
$174.07 |
| Max. Negotiated Rate |
$295.05 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$201.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$201.30
|
| Rate for Payer: Cash Price |
$243.91
|
| Rate for Payer: Cash Price |
$243.91
|
| Rate for Payer: Frontpath All Commercial |
$187.56
|
| Rate for Payer: Humana ChoiceCare |
$208.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$182.00
|
| Rate for Payer: PHCS All Commercial |
$295.05
|
| Rate for Payer: PHP All Commercial |
$174.07
|
| Rate for Payer: Signature Care EPO |
$232.05
|
| Rate for Payer: Signature Care PPO |
$232.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$178.00
|
| Rate for Payer: United Healthcare Commercial |
$194.47
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT LOW MDM 30 MINUTES
|
Professional
|
$210.42
|
|
|
Service Code
|
CPT 99243
|
| Hospital Charge Code |
z99243
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$157.82 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$106.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$106.19
|
| Rate for Payer: Cash Price |
$130.46
|
| Rate for Payer: Cash Price |
$130.46
|
| Rate for Payer: Frontpath All Commercial |
$94.82
|
| Rate for Payer: Humana ChoiceCare |
$105.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.00
|
| Rate for Payer: PHCS All Commercial |
$157.82
|
| Rate for Payer: PHP All Commercial |
$85.10
|
| Rate for Payer: Signature Care EPO |
$125.80
|
| Rate for Payer: Signature Care PPO |
$125.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.00
|
| Rate for Payer: United Healthcare Commercial |
$98.13
|
|
|
PR OFFICE/OP CONSLTJ NEW/EST PT MOD MDM 40 MINUTES
|
Professional
|
$301.26
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
z99244
|
| Min. Negotiated Rate |
$129.72 |
| Max. Negotiated Rate |
$225.94 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$162.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$162.17
|
| Rate for Payer: Cash Price |
$186.78
|
| Rate for Payer: Cash Price |
$186.78
|
| Rate for Payer: Frontpath All Commercial |
$151.41
|
| Rate for Payer: Humana ChoiceCare |
$156.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.00
|
| Rate for Payer: PHCS All Commercial |
$225.94
|
| Rate for Payer: PHP All Commercial |
$129.72
|
| Rate for Payer: Signature Care EPO |
$179.35
|
| Rate for Payer: Signature Care PPO |
$179.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$133.00
|
| Rate for Payer: United Healthcare Commercial |
$155.89
|
|
