|
HC E COLI 0157
|
Facility
OP
|
$31.70
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
63001078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.22 |
| Max. Negotiated Rate |
$29.48 |
| Rate for Payer: Aetna Commercial |
$26.76
|
| Rate for Payer: Aetna Medicare |
$10.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$3.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.51
|
| Rate for Payer: Cash Price |
$19.66
|
| Rate for Payer: Cash Price |
$19.66
|
| Rate for Payer: Centivo All Commercial |
$16.17
|
| Rate for Payer: Cigna All Commercial |
$27.36
|
| Rate for Payer: CORVEL All Commercial |
$29.48
|
| Rate for Payer: Coventry All Commercial |
$27.90
|
| Rate for Payer: Encore All Commercial |
$29.18
|
| Rate for Payer: Frontpath All Commercial |
$29.17
|
| Rate for Payer: Humana ChoiceCare |
$27.38
|
| Rate for Payer: Humana Medicare |
$16.17
|
| Rate for Payer: Lucent All Commercial |
$16.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.53
|
| Rate for Payer: Managed Health Services Medicaid |
$3.22
|
| Rate for Payer: MDWise Medicaid |
$3.22
|
| Rate for Payer: PHCS All Commercial |
$23.78
|
| Rate for Payer: PHP All Commercial |
$24.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.36
|
| Rate for Payer: Sagamore Health Network All Products |
$24.47
|
| Rate for Payer: Signature Care EPO |
$26.31
|
| Rate for Payer: Signature Care PPO |
$27.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.95
|
| Rate for Payer: United Healthcare Commercial |
$24.98
|
| Rate for Payer: United Healthcare Medicare |
$10.46
|
|
|
HC E COLI 0157
|
Facility
IP
|
$31.70
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
63001078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.78 |
| Max. Negotiated Rate |
$29.48 |
| Rate for Payer: Aetna Commercial |
$27.39
|
| Rate for Payer: Cash Price |
$19.66
|
| Rate for Payer: Cigna All Commercial |
$27.36
|
| Rate for Payer: CORVEL All Commercial |
$29.48
|
| Rate for Payer: Coventry All Commercial |
$27.90
|
| Rate for Payer: Encore All Commercial |
$29.18
|
| Rate for Payer: Frontpath All Commercial |
$29.17
|
| Rate for Payer: Humana ChoiceCare |
$27.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.53
|
| Rate for Payer: PHCS All Commercial |
$23.78
|
| Rate for Payer: PHP All Commercial |
$24.04
|
| Rate for Payer: Sagamore Health Network All Products |
$24.47
|
| Rate for Payer: Signature Care EPO |
$26.31
|
| Rate for Payer: Signature Care PPO |
$27.90
|
| Rate for Payer: United Healthcare Commercial |
$24.98
|
|
|
HC EDA PATCH WITH ACCESS SLOT
|
Facility
OP
|
$19.60
|
|
| Hospital Charge Code |
41601350
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.47 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$16.54
|
| Rate for Payer: Aetna Medicare |
$6.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.11
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Centivo All Commercial |
$10.00
|
| Rate for Payer: Cigna All Commercial |
$16.91
|
| Rate for Payer: CORVEL All Commercial |
$18.23
|
| Rate for Payer: Coventry All Commercial |
$17.25
|
| Rate for Payer: Encore All Commercial |
$18.04
|
| Rate for Payer: Frontpath All Commercial |
$18.03
|
| Rate for Payer: Humana ChoiceCare |
$16.93
|
| Rate for Payer: Humana Medicare |
$10.00
|
| Rate for Payer: Lucent All Commercial |
$10.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.64
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$14.70
|
| Rate for Payer: PHP All Commercial |
$14.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.64
|
| Rate for Payer: Sagamore Health Network All Products |
$15.13
|
| Rate for Payer: Signature Care EPO |
$16.27
|
| Rate for Payer: Signature Care PPO |
$17.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.66
|
| Rate for Payer: United Healthcare Commercial |
$15.44
|
| Rate for Payer: United Healthcare Medicare |
$6.47
|
|
|
HC EDA PATCH WITH ACCESS SLOT
|
Facility
IP
|
$19.60
|
|
| Hospital Charge Code |
41601350
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$18.23 |
| Rate for Payer: Aetna Commercial |
$16.93
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna All Commercial |
$16.91
|
| Rate for Payer: CORVEL All Commercial |
$18.23
|
| Rate for Payer: Coventry All Commercial |
$17.25
|
| Rate for Payer: Encore All Commercial |
$18.04
|
| Rate for Payer: Frontpath All Commercial |
$18.03
|
| Rate for Payer: Humana ChoiceCare |
$16.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$17.64
|
| Rate for Payer: PHCS All Commercial |
$14.70
|
| Rate for Payer: PHP All Commercial |
$14.86
|
| Rate for Payer: Sagamore Health Network All Products |
$15.13
|
| Rate for Payer: Signature Care EPO |
$16.27
|
| Rate for Payer: Signature Care PPO |
$17.25
|
| Rate for Payer: United Healthcare Commercial |
$15.44
|
|
|
HC ED CRITICAL CARE:INIT 30-74 MN
|
Facility
IP
|
$3,864.78
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
01297973
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,898.58 |
| Max. Negotiated Rate |
$3,594.25 |
| Rate for Payer: Aetna Commercial |
$3,339.17
|
| Rate for Payer: Cash Price |
$2,396.16
|
| Rate for Payer: Cigna All Commercial |
$3,335.31
|
| Rate for Payer: CORVEL All Commercial |
$3,594.25
|
| Rate for Payer: Coventry All Commercial |
$3,401.01
|
| Rate for Payer: Encore All Commercial |
$3,557.53
|
| Rate for Payer: Frontpath All Commercial |
$3,555.60
|
| Rate for Payer: Humana ChoiceCare |
$3,338.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,478.30
|
| Rate for Payer: PHCS All Commercial |
$2,898.58
|
| Rate for Payer: PHP All Commercial |
$2,931.05
|
| Rate for Payer: Sagamore Health Network All Products |
$2,983.61
|
| Rate for Payer: Signature Care EPO |
$3,207.77
|
| Rate for Payer: Signature Care PPO |
$3,401.01
|
| Rate for Payer: United Healthcare Commercial |
$3,045.45
|
|
|
HC ED CRITICAL CARE:INIT 30-74 MN
|
Facility
OP
|
$3,864.78
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
01297973
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.62 |
| Max. Negotiated Rate |
$3,594.25 |
| Rate for Payer: Aetna Commercial |
$3,261.87
|
| Rate for Payer: Aetna Medicare |
$1,275.38
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,275.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,219.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,415.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,466.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,402.92
|
| Rate for Payer: Cash Price |
$2,396.16
|
| Rate for Payer: Cash Price |
$2,396.16
|
| Rate for Payer: Centivo All Commercial |
$1,971.04
|
| Rate for Payer: Cigna All Commercial |
$3,335.31
|
| Rate for Payer: CORVEL All Commercial |
$3,594.25
|
| Rate for Payer: Coventry All Commercial |
$3,401.01
|
| Rate for Payer: Encore All Commercial |
$3,557.53
|
| Rate for Payer: Frontpath All Commercial |
$3,555.60
|
| Rate for Payer: Humana ChoiceCare |
$3,338.01
|
| Rate for Payer: Humana Medicare |
$1,971.04
|
| Rate for Payer: Lucent All Commercial |
$1,971.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,478.30
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$2,898.58
|
| Rate for Payer: PHP All Commercial |
$2,931.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,507.26
|
| Rate for Payer: Sagamore Health Network All Products |
$2,983.61
|
| Rate for Payer: Signature Care EPO |
$3,207.77
|
| Rate for Payer: Signature Care PPO |
$3,401.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,285.06
|
| Rate for Payer: United Healthcare Commercial |
$3,045.45
|
| Rate for Payer: United Healthcare Medicare |
$1,275.38
|
|
|
HC ED IMMUN ADMIN
|
Facility
IP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
01290471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$82.18
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Cigna All Commercial |
$82.08
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.70
|
| Rate for Payer: Encore All Commercial |
$87.55
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.60
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.70
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
|
|
HC ED IMMUN ADMIN
|
Facility
OP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
01290471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$31.39 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna Medicare |
$31.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$31.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.53
|
| Rate for Payer: Cash Price |
$58.97
|
| Rate for Payer: Centivo All Commercial |
$48.51
|
| Rate for Payer: Cigna All Commercial |
$82.08
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.70
|
| Rate for Payer: Encore All Commercial |
$87.55
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.15
|
| Rate for Payer: Humana Medicare |
$48.51
|
| Rate for Payer: Lucent All Commercial |
$48.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.60
|
| Rate for Payer: PHCS All Commercial |
$71.34
|
| Rate for Payer: PHP All Commercial |
$72.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.09
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
| Rate for Payer: United Healthcare Medicare |
$31.39
|
|
|
HC ED IMMUN ADMIN EA ADD
|
Facility
OP
|
$91.49
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
01290472
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$30.19 |
| Max. Negotiated Rate |
$85.09 |
| Rate for Payer: Aetna Commercial |
$77.22
|
| Rate for Payer: Aetna Medicare |
$30.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.21
|
| Rate for Payer: Cash Price |
$56.73
|
| Rate for Payer: Centivo All Commercial |
$46.66
|
| Rate for Payer: Cigna All Commercial |
$78.96
|
| Rate for Payer: CORVEL All Commercial |
$85.09
|
| Rate for Payer: Coventry All Commercial |
$80.51
|
| Rate for Payer: Encore All Commercial |
$84.22
|
| Rate for Payer: Frontpath All Commercial |
$84.17
|
| Rate for Payer: Humana ChoiceCare |
$79.02
|
| Rate for Payer: Humana Medicare |
$46.66
|
| Rate for Payer: Lucent All Commercial |
$46.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.34
|
| Rate for Payer: PHCS All Commercial |
$68.62
|
| Rate for Payer: PHP All Commercial |
$69.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.68
|
| Rate for Payer: Sagamore Health Network All Products |
$70.63
|
| Rate for Payer: Signature Care EPO |
$75.94
|
| Rate for Payer: Signature Care PPO |
$80.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$77.77
|
| Rate for Payer: United Healthcare Commercial |
$72.10
|
| Rate for Payer: United Healthcare Medicare |
$30.19
|
|
|
HC ED IMMUN ADMIN EA ADD
|
Facility
IP
|
$91.49
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
01290472
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$68.62 |
| Max. Negotiated Rate |
$85.09 |
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: Cash Price |
$56.73
|
| Rate for Payer: Cigna All Commercial |
$78.96
|
| Rate for Payer: CORVEL All Commercial |
$85.09
|
| Rate for Payer: Coventry All Commercial |
$80.51
|
| Rate for Payer: Encore All Commercial |
$84.22
|
| Rate for Payer: Frontpath All Commercial |
$84.17
|
| Rate for Payer: Humana ChoiceCare |
$79.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.34
|
| Rate for Payer: PHCS All Commercial |
$68.62
|
| Rate for Payer: PHP All Commercial |
$69.39
|
| Rate for Payer: Sagamore Health Network All Products |
$70.63
|
| Rate for Payer: Signature Care EPO |
$75.94
|
| Rate for Payer: Signature Care PPO |
$80.51
|
| Rate for Payer: United Healthcare Commercial |
$72.10
|
|
|
HC ED INTERM SURG PROC
|
Facility
IP
|
$309.22
|
|
| Hospital Charge Code |
01291502
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$231.92 |
| Max. Negotiated Rate |
$287.58 |
| Rate for Payer: Aetna Commercial |
$267.17
|
| Rate for Payer: Cash Price |
$191.72
|
| Rate for Payer: Cigna All Commercial |
$266.86
|
| Rate for Payer: CORVEL All Commercial |
$287.58
|
| Rate for Payer: Coventry All Commercial |
$272.12
|
| Rate for Payer: Encore All Commercial |
$284.64
|
| Rate for Payer: Frontpath All Commercial |
$284.49
|
| Rate for Payer: Humana ChoiceCare |
$267.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.30
|
| Rate for Payer: PHCS All Commercial |
$231.92
|
| Rate for Payer: PHP All Commercial |
$234.51
|
| Rate for Payer: Sagamore Health Network All Products |
$238.72
|
| Rate for Payer: Signature Care EPO |
$256.66
|
| Rate for Payer: Signature Care PPO |
$272.12
|
| Rate for Payer: United Healthcare Commercial |
$243.67
|
|
|
HC ED INTERM SURG PROC
|
Facility
OP
|
$309.22
|
|
| Hospital Charge Code |
01291502
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.04 |
| Max. Negotiated Rate |
$295.62 |
| Rate for Payer: Aetna Commercial |
$260.98
|
| Rate for Payer: Aetna Medicare |
$102.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$102.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$177.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$117.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$112.25
|
| Rate for Payer: Cash Price |
$191.72
|
| Rate for Payer: Cash Price |
$191.72
|
| Rate for Payer: Centivo All Commercial |
$157.70
|
| Rate for Payer: Cigna All Commercial |
$266.86
|
| Rate for Payer: CORVEL All Commercial |
$287.58
|
| Rate for Payer: Coventry All Commercial |
$272.12
|
| Rate for Payer: Encore All Commercial |
$284.64
|
| Rate for Payer: Frontpath All Commercial |
$284.49
|
| Rate for Payer: Humana ChoiceCare |
$267.08
|
| Rate for Payer: Humana Medicare |
$157.70
|
| Rate for Payer: Lucent All Commercial |
$157.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.30
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$231.92
|
| Rate for Payer: PHP All Commercial |
$234.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$120.60
|
| Rate for Payer: Sagamore Health Network All Products |
$238.72
|
| Rate for Payer: Signature Care EPO |
$256.66
|
| Rate for Payer: Signature Care PPO |
$272.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$262.84
|
| Rate for Payer: United Healthcare Commercial |
$243.67
|
| Rate for Payer: United Healthcare Medicare |
$102.04
|
|
|
HC ED IV INF CONCURRENT 16+ MIN
|
Facility
IP
|
$251.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
01290768
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$188.76 |
| Max. Negotiated Rate |
$234.06 |
| Rate for Payer: Aetna Commercial |
$217.45
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cigna All Commercial |
$217.20
|
| Rate for Payer: CORVEL All Commercial |
$234.06
|
| Rate for Payer: Coventry All Commercial |
$221.47
|
| Rate for Payer: Encore All Commercial |
$231.67
|
| Rate for Payer: Frontpath All Commercial |
$231.54
|
| Rate for Payer: Humana ChoiceCare |
$217.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$226.51
|
| Rate for Payer: PHCS All Commercial |
$188.76
|
| Rate for Payer: PHP All Commercial |
$190.87
|
| Rate for Payer: Sagamore Health Network All Products |
$194.29
|
| Rate for Payer: Signature Care EPO |
$208.89
|
| Rate for Payer: Signature Care PPO |
$221.47
|
| Rate for Payer: United Healthcare Commercial |
$198.32
|
|
|
HC ED IV INF CONCURRENT 16+ MIN
|
Facility
OP
|
$251.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
01290768
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.05 |
| Max. Negotiated Rate |
$295.62 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna Medicare |
$83.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$83.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$144.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$157.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$95.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.36
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Cash Price |
$156.04
|
| Rate for Payer: Centivo All Commercial |
$128.35
|
| Rate for Payer: Cigna All Commercial |
$217.20
|
| Rate for Payer: CORVEL All Commercial |
$234.06
|
| Rate for Payer: Coventry All Commercial |
$221.47
|
| Rate for Payer: Encore All Commercial |
$231.67
|
| Rate for Payer: Frontpath All Commercial |
$231.54
|
| Rate for Payer: Humana ChoiceCare |
$217.37
|
| Rate for Payer: Humana Medicare |
$128.35
|
| Rate for Payer: Lucent All Commercial |
$128.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$226.51
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$188.76
|
| Rate for Payer: PHP All Commercial |
$190.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$98.15
|
| Rate for Payer: Sagamore Health Network All Products |
$194.29
|
| Rate for Payer: Signature Care EPO |
$208.89
|
| Rate for Payer: Signature Care PPO |
$221.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$213.92
|
| Rate for Payer: United Healthcare Commercial |
$198.32
|
| Rate for Payer: United Healthcare Medicare |
$83.05
|
|
|
HC ED IV INF HYD EA ADD 31-60 MIN
|
Facility
IP
|
$178.50
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
01290761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.88 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$154.22
|
| Rate for Payer: Cash Price |
$110.67
|
| Rate for Payer: Cigna All Commercial |
$154.05
|
| Rate for Payer: CORVEL All Commercial |
$166.00
|
| Rate for Payer: Coventry All Commercial |
$157.08
|
| Rate for Payer: Encore All Commercial |
$164.31
|
| Rate for Payer: Frontpath All Commercial |
$164.22
|
| Rate for Payer: Humana ChoiceCare |
$154.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.65
|
| Rate for Payer: PHCS All Commercial |
$133.88
|
| Rate for Payer: PHP All Commercial |
$135.37
|
| Rate for Payer: Sagamore Health Network All Products |
$137.80
|
| Rate for Payer: Signature Care EPO |
$148.16
|
| Rate for Payer: Signature Care PPO |
$157.08
|
| Rate for Payer: United Healthcare Commercial |
$140.66
|
|
|
HC ED IV INF HYD EA ADD 31-60 MIN
|
Facility
OP
|
$178.50
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
01290761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.90 |
| Max. Negotiated Rate |
$295.62 |
| Rate for Payer: Aetna Commercial |
$150.65
|
| Rate for Payer: Aetna Medicare |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$102.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.80
|
| Rate for Payer: Cash Price |
$110.67
|
| Rate for Payer: Cash Price |
$110.67
|
| Rate for Payer: Centivo All Commercial |
$91.04
|
| Rate for Payer: Cigna All Commercial |
$154.05
|
| Rate for Payer: CORVEL All Commercial |
$166.00
|
| Rate for Payer: Coventry All Commercial |
$157.08
|
| Rate for Payer: Encore All Commercial |
$164.31
|
| Rate for Payer: Frontpath All Commercial |
$164.22
|
| Rate for Payer: Humana ChoiceCare |
$154.17
|
| Rate for Payer: Humana Medicare |
$91.04
|
| Rate for Payer: Lucent All Commercial |
$91.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.65
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$133.88
|
| Rate for Payer: PHP All Commercial |
$135.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.62
|
| Rate for Payer: Sagamore Health Network All Products |
$137.80
|
| Rate for Payer: Signature Care EPO |
$148.16
|
| Rate for Payer: Signature Care PPO |
$157.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$151.72
|
| Rate for Payer: United Healthcare Commercial |
$140.66
|
| Rate for Payer: United Healthcare Medicare |
$58.90
|
|
|
HC ED IV INF HYD INIT 31-60 MINS
|
Facility
OP
|
$450.84
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
01290760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.78 |
| Max. Negotiated Rate |
$419.28 |
| Rate for Payer: Aetna Commercial |
$380.51
|
| Rate for Payer: Aetna Medicare |
$148.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$148.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$258.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$281.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$171.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$163.65
|
| Rate for Payer: Cash Price |
$279.52
|
| Rate for Payer: Cash Price |
$279.52
|
| Rate for Payer: Centivo All Commercial |
$229.93
|
| Rate for Payer: Cigna All Commercial |
$389.07
|
| Rate for Payer: CORVEL All Commercial |
$419.28
|
| Rate for Payer: Coventry All Commercial |
$396.74
|
| Rate for Payer: Encore All Commercial |
$415.00
|
| Rate for Payer: Frontpath All Commercial |
$414.77
|
| Rate for Payer: Humana ChoiceCare |
$389.39
|
| Rate for Payer: Humana Medicare |
$229.93
|
| Rate for Payer: Lucent All Commercial |
$229.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$405.76
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$338.13
|
| Rate for Payer: PHP All Commercial |
$341.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$175.83
|
| Rate for Payer: Sagamore Health Network All Products |
$348.05
|
| Rate for Payer: Signature Care EPO |
$374.20
|
| Rate for Payer: Signature Care PPO |
$396.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$383.21
|
| Rate for Payer: United Healthcare Commercial |
$355.26
|
| Rate for Payer: United Healthcare Medicare |
$148.78
|
|
|
HC ED IV INF HYD INIT 31-60 MINS
|
Facility
IP
|
$450.84
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
01290760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$338.13 |
| Max. Negotiated Rate |
$419.28 |
| Rate for Payer: Aetna Commercial |
$389.53
|
| Rate for Payer: Cash Price |
$279.52
|
| Rate for Payer: Cigna All Commercial |
$389.07
|
| Rate for Payer: CORVEL All Commercial |
$419.28
|
| Rate for Payer: Coventry All Commercial |
$396.74
|
| Rate for Payer: Encore All Commercial |
$415.00
|
| Rate for Payer: Frontpath All Commercial |
$414.77
|
| Rate for Payer: Humana ChoiceCare |
$389.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$405.76
|
| Rate for Payer: PHCS All Commercial |
$338.13
|
| Rate for Payer: PHP All Commercial |
$341.92
|
| Rate for Payer: Sagamore Health Network All Products |
$348.05
|
| Rate for Payer: Signature Care EPO |
$374.20
|
| Rate for Payer: Signature Care PPO |
$396.74
|
| Rate for Payer: United Healthcare Commercial |
$355.26
|
|
|
HC ED IV INF SEQUENTIAL 16-60 MIN
|
Facility
OP
|
$381.31
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
01290767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.83 |
| Max. Negotiated Rate |
$354.62 |
| Rate for Payer: Aetna Commercial |
$321.82
|
| Rate for Payer: Aetna Medicare |
$125.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$125.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$218.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$238.35
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$144.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.41
|
| Rate for Payer: Cash Price |
$236.41
|
| Rate for Payer: Cash Price |
$236.41
|
| Rate for Payer: Centivo All Commercial |
$194.47
|
| Rate for Payer: Cigna All Commercial |
$329.07
|
| Rate for Payer: CORVEL All Commercial |
$354.62
|
| Rate for Payer: Coventry All Commercial |
$335.55
|
| Rate for Payer: Encore All Commercial |
$350.99
|
| Rate for Payer: Frontpath All Commercial |
$350.80
|
| Rate for Payer: Humana ChoiceCare |
$329.33
|
| Rate for Payer: Humana Medicare |
$194.47
|
| Rate for Payer: Lucent All Commercial |
$194.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.18
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$285.98
|
| Rate for Payer: PHP All Commercial |
$289.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$148.71
|
| Rate for Payer: Sagamore Health Network All Products |
$294.37
|
| Rate for Payer: Signature Care EPO |
$316.48
|
| Rate for Payer: Signature Care PPO |
$335.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$324.11
|
| Rate for Payer: United Healthcare Commercial |
$300.47
|
| Rate for Payer: United Healthcare Medicare |
$125.83
|
|
|
HC ED IV INF SEQUENTIAL 16-60 MIN
|
Facility
IP
|
$381.31
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
01290767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$285.98 |
| Max. Negotiated Rate |
$354.62 |
| Rate for Payer: Aetna Commercial |
$329.45
|
| Rate for Payer: Cash Price |
$236.41
|
| Rate for Payer: Cigna All Commercial |
$329.07
|
| Rate for Payer: CORVEL All Commercial |
$354.62
|
| Rate for Payer: Coventry All Commercial |
$335.55
|
| Rate for Payer: Encore All Commercial |
$350.99
|
| Rate for Payer: Frontpath All Commercial |
$350.80
|
| Rate for Payer: Humana ChoiceCare |
$329.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.18
|
| Rate for Payer: PHCS All Commercial |
$285.98
|
| Rate for Payer: PHP All Commercial |
$289.18
|
| Rate for Payer: Sagamore Health Network All Products |
$294.37
|
| Rate for Payer: Signature Care EPO |
$316.48
|
| Rate for Payer: Signature Care PPO |
$335.55
|
| Rate for Payer: United Healthcare Commercial |
$300.47
|
|
|
HC ED IV INF THER EA ADD 31-60 MN
|
Facility
IP
|
$183.60
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
01290766
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.70 |
| Max. Negotiated Rate |
$170.75 |
| Rate for Payer: Aetna Commercial |
$158.63
|
| Rate for Payer: Cash Price |
$113.83
|
| Rate for Payer: Cigna All Commercial |
$158.45
|
| Rate for Payer: CORVEL All Commercial |
$170.75
|
| Rate for Payer: Coventry All Commercial |
$161.57
|
| Rate for Payer: Encore All Commercial |
$169.00
|
| Rate for Payer: Frontpath All Commercial |
$168.91
|
| Rate for Payer: Humana ChoiceCare |
$158.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.24
|
| Rate for Payer: PHCS All Commercial |
$137.70
|
| Rate for Payer: PHP All Commercial |
$139.24
|
| Rate for Payer: Sagamore Health Network All Products |
$141.74
|
| Rate for Payer: Signature Care EPO |
$152.39
|
| Rate for Payer: Signature Care PPO |
$161.57
|
| Rate for Payer: United Healthcare Commercial |
$144.68
|
|
|
HC ED IV INF THER EA ADD 31-60 MN
|
Facility
OP
|
$183.60
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
01290766
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.59 |
| Max. Negotiated Rate |
$295.62 |
| Rate for Payer: Aetna Commercial |
$154.96
|
| Rate for Payer: Aetna Medicare |
$60.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$60.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$105.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$114.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.65
|
| Rate for Payer: Cash Price |
$113.83
|
| Rate for Payer: Cash Price |
$113.83
|
| Rate for Payer: Centivo All Commercial |
$93.64
|
| Rate for Payer: Cigna All Commercial |
$158.45
|
| Rate for Payer: CORVEL All Commercial |
$170.75
|
| Rate for Payer: Coventry All Commercial |
$161.57
|
| Rate for Payer: Encore All Commercial |
$169.00
|
| Rate for Payer: Frontpath All Commercial |
$168.91
|
| Rate for Payer: Humana ChoiceCare |
$158.58
|
| Rate for Payer: Humana Medicare |
$93.64
|
| Rate for Payer: Lucent All Commercial |
$93.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.24
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$137.70
|
| Rate for Payer: PHP All Commercial |
$139.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.60
|
| Rate for Payer: Sagamore Health Network All Products |
$141.74
|
| Rate for Payer: Signature Care EPO |
$152.39
|
| Rate for Payer: Signature Care PPO |
$161.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$156.06
|
| Rate for Payer: United Healthcare Commercial |
$144.68
|
| Rate for Payer: United Healthcare Medicare |
$60.59
|
|
|
HC ED IV INF THER INIT 16-60 MINS
|
Facility
IP
|
$450.84
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
01290765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$338.13 |
| Max. Negotiated Rate |
$419.28 |
| Rate for Payer: Aetna Commercial |
$389.53
|
| Rate for Payer: Cash Price |
$279.52
|
| Rate for Payer: Cigna All Commercial |
$389.07
|
| Rate for Payer: CORVEL All Commercial |
$419.28
|
| Rate for Payer: Coventry All Commercial |
$396.74
|
| Rate for Payer: Encore All Commercial |
$415.00
|
| Rate for Payer: Frontpath All Commercial |
$414.77
|
| Rate for Payer: Humana ChoiceCare |
$389.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$405.76
|
| Rate for Payer: PHCS All Commercial |
$338.13
|
| Rate for Payer: PHP All Commercial |
$341.92
|
| Rate for Payer: Sagamore Health Network All Products |
$348.05
|
| Rate for Payer: Signature Care EPO |
$374.20
|
| Rate for Payer: Signature Care PPO |
$396.74
|
| Rate for Payer: United Healthcare Commercial |
$355.26
|
|
|
HC ED IV INF THER INIT 16-60 MINS
|
Facility
OP
|
$450.84
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
01290765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.78 |
| Max. Negotiated Rate |
$419.28 |
| Rate for Payer: Aetna Commercial |
$380.51
|
| Rate for Payer: Aetna Medicare |
$148.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$148.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$258.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$281.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$171.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$163.65
|
| Rate for Payer: Cash Price |
$279.52
|
| Rate for Payer: Cash Price |
$279.52
|
| Rate for Payer: Centivo All Commercial |
$229.93
|
| Rate for Payer: Cigna All Commercial |
$389.07
|
| Rate for Payer: CORVEL All Commercial |
$419.28
|
| Rate for Payer: Coventry All Commercial |
$396.74
|
| Rate for Payer: Encore All Commercial |
$415.00
|
| Rate for Payer: Frontpath All Commercial |
$414.77
|
| Rate for Payer: Humana ChoiceCare |
$389.39
|
| Rate for Payer: Humana Medicare |
$229.93
|
| Rate for Payer: Lucent All Commercial |
$229.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$405.76
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$338.13
|
| Rate for Payer: PHP All Commercial |
$341.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$175.83
|
| Rate for Payer: Sagamore Health Network All Products |
$348.05
|
| Rate for Payer: Signature Care EPO |
$374.20
|
| Rate for Payer: Signature Care PPO |
$396.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$383.21
|
| Rate for Payer: United Healthcare Commercial |
$355.26
|
| Rate for Payer: United Healthcare Medicare |
$148.78
|
|
|
HC ED IV PUSH EA ADDITIONAL DRUG
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
01291784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.49 |
| Max. Negotiated Rate |
$295.62 |
| Rate for Payer: Aetna Commercial |
$129.13
|
| Rate for Payer: Aetna Medicare |
$50.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$87.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.54
|
| Rate for Payer: Cash Price |
$94.86
|
| Rate for Payer: Cash Price |
$94.86
|
| Rate for Payer: Centivo All Commercial |
$78.03
|
| Rate for Payer: Cigna All Commercial |
$132.04
|
| Rate for Payer: CORVEL All Commercial |
$142.29
|
| Rate for Payer: Coventry All Commercial |
$134.64
|
| Rate for Payer: Encore All Commercial |
$140.84
|
| Rate for Payer: Frontpath All Commercial |
$140.76
|
| Rate for Payer: Humana ChoiceCare |
$132.15
|
| Rate for Payer: Humana Medicare |
$78.03
|
| Rate for Payer: Lucent All Commercial |
$78.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.70
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$114.75
|
| Rate for Payer: PHP All Commercial |
$116.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.67
|
| Rate for Payer: Sagamore Health Network All Products |
$118.12
|
| Rate for Payer: Signature Care EPO |
$126.99
|
| Rate for Payer: Signature Care PPO |
$134.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$130.05
|
| Rate for Payer: United Healthcare Commercial |
$120.56
|
| Rate for Payer: United Healthcare Medicare |
$50.49
|
|
