|
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
|
|
|
HC ED IV PUSH EA ADD SAME DRUG
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
01290776
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$114.75 |
| Max. Negotiated Rate |
$142.29 |
| Rate for Payer: Aetna Commercial |
$132.19
|
| Rate for Payer: Cash Price |
$94.86
|
| 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: Lutheran Preferred All Commercial |
$137.70
|
| Rate for Payer: PHCS All Commercial |
$114.75
|
| Rate for Payer: PHP All Commercial |
$116.04
|
| 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: United Healthcare Commercial |
$120.56
|
|
|
HC ED IV PUSH EA ADD SAME DRUG
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
01290776
|
|
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
|
|
|
HC ED IV PUSH INITIAL
|
Facility
IP
|
$164.42
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
01290784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.32 |
| Max. Negotiated Rate |
$152.91 |
| Rate for Payer: Aetna Commercial |
$142.06
|
| Rate for Payer: Cash Price |
$101.94
|
| Rate for Payer: Cigna All Commercial |
$141.90
|
| Rate for Payer: CORVEL All Commercial |
$152.91
|
| Rate for Payer: Coventry All Commercial |
$144.69
|
| Rate for Payer: Encore All Commercial |
$151.35
|
| Rate for Payer: Frontpath All Commercial |
$151.27
|
| Rate for Payer: Humana ChoiceCare |
$142.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.98
|
| Rate for Payer: PHCS All Commercial |
$123.32
|
| Rate for Payer: PHP All Commercial |
$124.70
|
| Rate for Payer: Sagamore Health Network All Products |
$126.94
|
| Rate for Payer: Signature Care EPO |
$136.47
|
| Rate for Payer: Signature Care PPO |
$144.69
|
| Rate for Payer: United Healthcare Commercial |
$129.57
|
|
|
HC ED IV PUSH INITIAL
|
Facility
OP
|
$164.42
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
01290784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$54.26 |
| Max. Negotiated Rate |
$295.62 |
| Rate for Payer: Aetna Commercial |
$138.77
|
| Rate for Payer: Aetna Medicare |
$54.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.69
|
| Rate for Payer: Cash Price |
$101.94
|
| Rate for Payer: Cash Price |
$101.94
|
| Rate for Payer: Centivo All Commercial |
$83.86
|
| Rate for Payer: Cigna All Commercial |
$141.90
|
| Rate for Payer: CORVEL All Commercial |
$152.91
|
| Rate for Payer: Coventry All Commercial |
$144.69
|
| Rate for Payer: Encore All Commercial |
$151.35
|
| Rate for Payer: Frontpath All Commercial |
$151.27
|
| Rate for Payer: Humana ChoiceCare |
$142.01
|
| Rate for Payer: Humana Medicare |
$83.86
|
| Rate for Payer: Lucent All Commercial |
$83.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.98
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$123.32
|
| Rate for Payer: PHP All Commercial |
$124.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.13
|
| Rate for Payer: Sagamore Health Network All Products |
$126.94
|
| Rate for Payer: Signature Care EPO |
$136.47
|
| Rate for Payer: Signature Care PPO |
$144.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$139.76
|
| Rate for Payer: United Healthcare Commercial |
$129.57
|
| Rate for Payer: United Healthcare Medicare |
$54.26
|
|
|
HC ED LEVEL 1
|
Facility
OP
|
$423.47
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
01294941
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$139.75 |
| Max. Negotiated Rate |
$393.83 |
| Rate for Payer: Aetna Commercial |
$357.41
|
| Rate for Payer: Aetna Medicare |
$139.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$243.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$264.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$160.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$153.72
|
| Rate for Payer: Cash Price |
$262.55
|
| Rate for Payer: Cash Price |
$262.55
|
| Rate for Payer: Centivo All Commercial |
$215.97
|
| Rate for Payer: Cigna All Commercial |
$365.46
|
| Rate for Payer: CORVEL All Commercial |
$393.83
|
| Rate for Payer: Coventry All Commercial |
$372.66
|
| Rate for Payer: Encore All Commercial |
$389.81
|
| Rate for Payer: Frontpath All Commercial |
$389.60
|
| Rate for Payer: Humana ChoiceCare |
$365.75
|
| Rate for Payer: Humana Medicare |
$215.97
|
| Rate for Payer: Lucent All Commercial |
$215.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.13
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$317.61
|
| Rate for Payer: PHP All Commercial |
$321.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.15
|
| Rate for Payer: Sagamore Health Network All Products |
$326.92
|
| Rate for Payer: Signature Care EPO |
$351.48
|
| Rate for Payer: Signature Care PPO |
$372.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$359.95
|
| Rate for Payer: United Healthcare Commercial |
$333.70
|
| Rate for Payer: United Healthcare Medicare |
$139.75
|
|
|
HC ED LEVEL 1
|
Facility
IP
|
$423.47
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
01294941
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.61 |
| Max. Negotiated Rate |
$393.83 |
| Rate for Payer: Aetna Commercial |
$365.88
|
| Rate for Payer: Cash Price |
$262.55
|
| Rate for Payer: Cigna All Commercial |
$365.46
|
| Rate for Payer: CORVEL All Commercial |
$393.83
|
| Rate for Payer: Coventry All Commercial |
$372.66
|
| Rate for Payer: Encore All Commercial |
$389.81
|
| Rate for Payer: Frontpath All Commercial |
$389.60
|
| Rate for Payer: Humana ChoiceCare |
$365.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.13
|
| Rate for Payer: PHCS All Commercial |
$317.61
|
| Rate for Payer: PHP All Commercial |
$321.16
|
| Rate for Payer: Sagamore Health Network All Products |
$326.92
|
| Rate for Payer: Signature Care EPO |
$351.48
|
| Rate for Payer: Signature Care PPO |
$372.66
|
| Rate for Payer: United Healthcare Commercial |
$333.70
|
|
|
HC ED LEVEL 2
|
Facility
OP
|
$721.87
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
01294942
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.22 |
| Max. Negotiated Rate |
$671.34 |
| Rate for Payer: Aetna Commercial |
$609.26
|
| Rate for Payer: Aetna Medicare |
$238.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$238.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$414.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$451.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$273.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$262.04
|
| Rate for Payer: Cash Price |
$447.56
|
| Rate for Payer: Cash Price |
$447.56
|
| Rate for Payer: Centivo All Commercial |
$368.16
|
| Rate for Payer: Cigna All Commercial |
$622.98
|
| Rate for Payer: CORVEL All Commercial |
$671.34
|
| Rate for Payer: Coventry All Commercial |
$635.25
|
| Rate for Payer: Encore All Commercial |
$664.49
|
| Rate for Payer: Frontpath All Commercial |
$664.12
|
| Rate for Payer: Humana ChoiceCare |
$623.48
|
| Rate for Payer: Humana Medicare |
$368.16
|
| Rate for Payer: Lucent All Commercial |
$368.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$649.69
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$541.41
|
| Rate for Payer: PHP All Commercial |
$547.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$281.53
|
| Rate for Payer: Sagamore Health Network All Products |
$557.29
|
| Rate for Payer: Signature Care EPO |
$599.16
|
| Rate for Payer: Signature Care PPO |
$635.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$613.59
|
| Rate for Payer: United Healthcare Commercial |
$568.84
|
| Rate for Payer: United Healthcare Medicare |
$238.22
|
|
|
HC ED LEVEL 2
|
Facility
IP
|
$721.87
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
01294942
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$541.41 |
| Max. Negotiated Rate |
$671.34 |
| Rate for Payer: Aetna Commercial |
$623.70
|
| Rate for Payer: Cash Price |
$447.56
|
| Rate for Payer: Cigna All Commercial |
$622.98
|
| Rate for Payer: CORVEL All Commercial |
$671.34
|
| Rate for Payer: Coventry All Commercial |
$635.25
|
| Rate for Payer: Encore All Commercial |
$664.49
|
| Rate for Payer: Frontpath All Commercial |
$664.12
|
| Rate for Payer: Humana ChoiceCare |
$623.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$649.69
|
| Rate for Payer: PHCS All Commercial |
$541.41
|
| Rate for Payer: PHP All Commercial |
$547.47
|
| Rate for Payer: Sagamore Health Network All Products |
$557.29
|
| Rate for Payer: Signature Care EPO |
$599.16
|
| Rate for Payer: Signature Care PPO |
$635.25
|
| Rate for Payer: United Healthcare Commercial |
$568.84
|
|
|
HC ED LEVEL 3
|
Facility
OP
|
$1,468.69
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
01294943
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.62 |
| Max. Negotiated Rate |
$1,365.88 |
| Rate for Payer: Aetna Commercial |
$1,239.57
|
| Rate for Payer: Aetna Medicare |
$484.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$484.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$843.47
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$918.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$557.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$533.13
|
| Rate for Payer: Cash Price |
$910.59
|
| Rate for Payer: Cash Price |
$910.59
|
| Rate for Payer: Centivo All Commercial |
$749.03
|
| Rate for Payer: Cigna All Commercial |
$1,267.48
|
| Rate for Payer: CORVEL All Commercial |
$1,365.88
|
| Rate for Payer: Coventry All Commercial |
$1,292.45
|
| Rate for Payer: Encore All Commercial |
$1,351.93
|
| Rate for Payer: Frontpath All Commercial |
$1,351.19
|
| Rate for Payer: Humana ChoiceCare |
$1,268.51
|
| Rate for Payer: Humana Medicare |
$749.03
|
| Rate for Payer: Lucent All Commercial |
$749.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,321.82
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$1,101.52
|
| Rate for Payer: PHP All Commercial |
$1,113.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$572.79
|
| Rate for Payer: Sagamore Health Network All Products |
$1,133.83
|
| Rate for Payer: Signature Care EPO |
$1,219.01
|
| Rate for Payer: Signature Care PPO |
$1,292.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,248.38
|
| Rate for Payer: United Healthcare Commercial |
$1,157.33
|
| Rate for Payer: United Healthcare Medicare |
$484.67
|
|
|
HC ED LEVEL 3
|
Facility
IP
|
$1,468.69
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
01294943
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,101.52 |
| Max. Negotiated Rate |
$1,365.88 |
| Rate for Payer: Aetna Commercial |
$1,268.95
|
| Rate for Payer: Cash Price |
$910.59
|
| Rate for Payer: Cigna All Commercial |
$1,267.48
|
| Rate for Payer: CORVEL All Commercial |
$1,365.88
|
| Rate for Payer: Coventry All Commercial |
$1,292.45
|
| Rate for Payer: Encore All Commercial |
$1,351.93
|
| Rate for Payer: Frontpath All Commercial |
$1,351.19
|
| Rate for Payer: Humana ChoiceCare |
$1,268.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,321.82
|
| Rate for Payer: PHCS All Commercial |
$1,101.52
|
| Rate for Payer: PHP All Commercial |
$1,113.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1,133.83
|
| Rate for Payer: Signature Care EPO |
$1,219.01
|
| Rate for Payer: Signature Care PPO |
$1,292.45
|
| Rate for Payer: United Healthcare Commercial |
$1,157.33
|
|
|
HC ED LEVEL 4
|
Facility
IP
|
$2,234.36
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
01294944
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,675.77 |
| Max. Negotiated Rate |
$2,077.96 |
| Rate for Payer: Aetna Commercial |
$1,930.49
|
| Rate for Payer: Cash Price |
$1,385.30
|
| Rate for Payer: Cigna All Commercial |
$1,928.25
|
| Rate for Payer: CORVEL All Commercial |
$2,077.96
|
| Rate for Payer: Coventry All Commercial |
$1,966.24
|
| Rate for Payer: Encore All Commercial |
$2,056.73
|
| Rate for Payer: Frontpath All Commercial |
$2,055.61
|
| Rate for Payer: Humana ChoiceCare |
$1,929.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,010.92
|
| Rate for Payer: PHCS All Commercial |
$1,675.77
|
| Rate for Payer: PHP All Commercial |
$1,694.54
|
| Rate for Payer: Sagamore Health Network All Products |
$1,724.93
|
| Rate for Payer: Signature Care EPO |
$1,854.52
|
| Rate for Payer: Signature Care PPO |
$1,966.24
|
| Rate for Payer: United Healthcare Commercial |
$1,760.68
|
|
|
HC ED LEVEL 4
|
Facility
OP
|
$2,234.36
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
01294944
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.62 |
| Max. Negotiated Rate |
$2,077.96 |
| Rate for Payer: Aetna Commercial |
$1,885.80
|
| Rate for Payer: Aetna Medicare |
$737.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$737.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,283.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,396.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$847.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$811.07
|
| Rate for Payer: Cash Price |
$1,385.30
|
| Rate for Payer: Cash Price |
$1,385.30
|
| Rate for Payer: Centivo All Commercial |
$1,139.52
|
| Rate for Payer: Cigna All Commercial |
$1,928.25
|
| Rate for Payer: CORVEL All Commercial |
$2,077.96
|
| Rate for Payer: Coventry All Commercial |
$1,966.24
|
| Rate for Payer: Encore All Commercial |
$2,056.73
|
| Rate for Payer: Frontpath All Commercial |
$2,055.61
|
| Rate for Payer: Humana ChoiceCare |
$1,929.82
|
| Rate for Payer: Humana Medicare |
$1,139.52
|
| Rate for Payer: Lucent All Commercial |
$1,139.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,010.92
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$1,675.77
|
| Rate for Payer: PHP All Commercial |
$1,694.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$871.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,724.93
|
| Rate for Payer: Signature Care EPO |
$1,854.52
|
| Rate for Payer: Signature Care PPO |
$1,966.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,899.21
|
| Rate for Payer: United Healthcare Commercial |
$1,760.68
|
| Rate for Payer: United Healthcare Medicare |
$737.34
|
|
|
HC ED LEVEL 5
|
Facility
IP
|
$3,371.44
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
01299285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,528.58 |
| Max. Negotiated Rate |
$3,135.44 |
| Rate for Payer: Aetna Commercial |
$2,912.92
|
| Rate for Payer: Cash Price |
$2,090.29
|
| Rate for Payer: Cigna All Commercial |
$2,909.55
|
| Rate for Payer: CORVEL All Commercial |
$3,135.44
|
| Rate for Payer: Coventry All Commercial |
$2,966.86
|
| Rate for Payer: Encore All Commercial |
$3,103.41
|
| Rate for Payer: Frontpath All Commercial |
$3,101.72
|
| Rate for Payer: Humana ChoiceCare |
$2,911.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,034.29
|
| Rate for Payer: PHCS All Commercial |
$2,528.58
|
| Rate for Payer: PHP All Commercial |
$2,556.90
|
| Rate for Payer: Sagamore Health Network All Products |
$2,602.75
|
| Rate for Payer: Signature Care EPO |
$2,798.29
|
| Rate for Payer: Signature Care PPO |
$2,966.86
|
| Rate for Payer: United Healthcare Commercial |
$2,656.69
|
|
|
HC ED LEVEL 5
|
Facility
OP
|
$3,371.44
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
01299285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.62 |
| Max. Negotiated Rate |
$3,135.44 |
| Rate for Payer: Aetna Commercial |
$2,845.49
|
| Rate for Payer: Aetna Medicare |
$1,112.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,112.57
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,936.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,107.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,279.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,223.83
|
| Rate for Payer: Cash Price |
$2,090.29
|
| Rate for Payer: Cash Price |
$2,090.29
|
| Rate for Payer: Centivo All Commercial |
$1,719.43
|
| Rate for Payer: Cigna All Commercial |
$2,909.55
|
| Rate for Payer: CORVEL All Commercial |
$3,135.44
|
| Rate for Payer: Coventry All Commercial |
$2,966.86
|
| Rate for Payer: Encore All Commercial |
$3,103.41
|
| Rate for Payer: Frontpath All Commercial |
$3,101.72
|
| Rate for Payer: Humana ChoiceCare |
$2,911.91
|
| Rate for Payer: Humana Medicare |
$1,719.43
|
| Rate for Payer: Lucent All Commercial |
$1,719.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,034.29
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$2,528.58
|
| Rate for Payer: PHP All Commercial |
$2,556.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,314.86
|
| Rate for Payer: Sagamore Health Network All Products |
$2,602.75
|
| Rate for Payer: Signature Care EPO |
$2,798.29
|
| Rate for Payer: Signature Care PPO |
$2,966.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,865.72
|
| Rate for Payer: United Healthcare Commercial |
$2,656.69
|
| Rate for Payer: United Healthcare Medicare |
$1,112.57
|
|
|
HC ED LEVEL 6
|
Facility
OP
|
$3,447.60
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
01299985
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.62 |
| Max. Negotiated Rate |
$3,206.27 |
| Rate for Payer: Aetna Commercial |
$2,909.77
|
| Rate for Payer: Aetna Medicare |
$1,137.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,137.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,979.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,155.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,308.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,251.48
|
| Rate for Payer: Cash Price |
$2,137.51
|
| Rate for Payer: Cash Price |
$2,137.51
|
| Rate for Payer: Centivo All Commercial |
$1,758.28
|
| Rate for Payer: Cigna All Commercial |
$2,975.28
|
| Rate for Payer: CORVEL All Commercial |
$3,206.27
|
| Rate for Payer: Coventry All Commercial |
$3,033.89
|
| Rate for Payer: Encore All Commercial |
$3,173.52
|
| Rate for Payer: Frontpath All Commercial |
$3,171.79
|
| Rate for Payer: Humana ChoiceCare |
$2,977.69
|
| Rate for Payer: Humana Medicare |
$1,758.28
|
| Rate for Payer: Lucent All Commercial |
$1,758.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,102.84
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$2,585.70
|
| Rate for Payer: PHP All Commercial |
$2,614.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,344.56
|
| Rate for Payer: Sagamore Health Network All Products |
$2,661.55
|
| Rate for Payer: Signature Care EPO |
$2,861.51
|
| Rate for Payer: Signature Care PPO |
$3,033.89
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,930.46
|
| Rate for Payer: United Healthcare Commercial |
$2,716.71
|
| Rate for Payer: United Healthcare Medicare |
$1,137.71
|
|
|
HC ED LEVEL 6
|
Facility
IP
|
$3,447.60
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
01299985
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,585.70 |
| Max. Negotiated Rate |
$3,206.27 |
| Rate for Payer: Aetna Commercial |
$2,978.73
|
| Rate for Payer: Cash Price |
$2,137.51
|
| Rate for Payer: Cigna All Commercial |
$2,975.28
|
| Rate for Payer: CORVEL All Commercial |
$3,206.27
|
| Rate for Payer: Coventry All Commercial |
$3,033.89
|
| Rate for Payer: Encore All Commercial |
$3,173.52
|
| Rate for Payer: Frontpath All Commercial |
$3,171.79
|
| Rate for Payer: Humana ChoiceCare |
$2,977.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,102.84
|
| Rate for Payer: PHCS All Commercial |
$2,585.70
|
| Rate for Payer: PHP All Commercial |
$2,614.66
|
| Rate for Payer: Sagamore Health Network All Products |
$2,661.55
|
| Rate for Payer: Signature Care EPO |
$2,861.51
|
| Rate for Payer: Signature Care PPO |
$3,033.89
|
| Rate for Payer: United Healthcare Commercial |
$2,716.71
|
|
|
HC ED MAJOR SURG PROC
|
Facility
IP
|
$432.91
|
|
| Hospital Charge Code |
01291503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$324.68 |
| Max. Negotiated Rate |
$402.60 |
| Rate for Payer: Aetna Commercial |
$374.03
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cigna All Commercial |
$373.60
|
| Rate for Payer: CORVEL All Commercial |
$402.60
|
| Rate for Payer: Coventry All Commercial |
$380.96
|
| Rate for Payer: Encore All Commercial |
$398.49
|
| Rate for Payer: Frontpath All Commercial |
$398.28
|
| Rate for Payer: Humana ChoiceCare |
$373.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$389.62
|
| Rate for Payer: PHCS All Commercial |
$324.68
|
| Rate for Payer: PHP All Commercial |
$328.32
|
| Rate for Payer: Sagamore Health Network All Products |
$334.21
|
| Rate for Payer: Signature Care EPO |
$359.31
|
| Rate for Payer: Signature Care PPO |
$380.96
|
| Rate for Payer: United Healthcare Commercial |
$341.13
|
|
|
HC ED MAJOR SURG PROC
|
Facility
OP
|
$432.91
|
|
| Hospital Charge Code |
01291503
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.86 |
| Max. Negotiated Rate |
$402.60 |
| Rate for Payer: Aetna Commercial |
$365.37
|
| Rate for Payer: Aetna Medicare |
$142.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$142.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$248.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$270.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$164.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$157.15
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Cash Price |
$268.40
|
| Rate for Payer: Centivo All Commercial |
$220.78
|
| Rate for Payer: Cigna All Commercial |
$373.60
|
| Rate for Payer: CORVEL All Commercial |
$402.60
|
| Rate for Payer: Coventry All Commercial |
$380.96
|
| Rate for Payer: Encore All Commercial |
$398.49
|
| Rate for Payer: Frontpath All Commercial |
$398.28
|
| Rate for Payer: Humana ChoiceCare |
$373.90
|
| Rate for Payer: Humana Medicare |
$220.78
|
| Rate for Payer: Lucent All Commercial |
$220.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$389.62
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$324.68
|
| Rate for Payer: PHP All Commercial |
$328.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$168.83
|
| Rate for Payer: Sagamore Health Network All Products |
$334.21
|
| Rate for Payer: Signature Care EPO |
$359.31
|
| Rate for Payer: Signature Care PPO |
$380.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$367.97
|
| Rate for Payer: United Healthcare Commercial |
$341.13
|
| Rate for Payer: United Healthcare Medicare |
$142.86
|
|
|
HC ED MINOR SURG PROC
|
Facility
OP
|
$185.54
|
|
| Hospital Charge Code |
01291501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$61.23 |
| Max. Negotiated Rate |
$295.62 |
| Rate for Payer: Aetna Commercial |
$156.59
|
| Rate for Payer: Aetna Medicare |
$61.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$106.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$115.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$70.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$67.35
|
| Rate for Payer: Cash Price |
$115.03
|
| Rate for Payer: Cash Price |
$115.03
|
| Rate for Payer: Centivo All Commercial |
$94.62
|
| Rate for Payer: Cigna All Commercial |
$160.12
|
| Rate for Payer: CORVEL All Commercial |
$172.55
|
| Rate for Payer: Coventry All Commercial |
$163.27
|
| Rate for Payer: Encore All Commercial |
$170.79
|
| Rate for Payer: Frontpath All Commercial |
$170.69
|
| Rate for Payer: Humana ChoiceCare |
$160.25
|
| Rate for Payer: Humana Medicare |
$94.62
|
| Rate for Payer: Lucent All Commercial |
$94.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$166.98
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$139.15
|
| Rate for Payer: PHP All Commercial |
$140.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$72.36
|
| Rate for Payer: Sagamore Health Network All Products |
$143.24
|
| Rate for Payer: Signature Care EPO |
$154.00
|
| Rate for Payer: Signature Care PPO |
$163.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$157.71
|
| Rate for Payer: United Healthcare Commercial |
$146.20
|
| Rate for Payer: United Healthcare Medicare |
$61.23
|
|
|
HC ED MINOR SURG PROC
|
Facility
IP
|
$185.54
|
|
| Hospital Charge Code |
01291501
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$139.15 |
| Max. Negotiated Rate |
$172.55 |
| Rate for Payer: Aetna Commercial |
$160.30
|
| Rate for Payer: Cash Price |
$115.03
|
| Rate for Payer: Cigna All Commercial |
$160.12
|
| Rate for Payer: CORVEL All Commercial |
$172.55
|
| Rate for Payer: Coventry All Commercial |
$163.27
|
| Rate for Payer: Encore All Commercial |
$170.79
|
| Rate for Payer: Frontpath All Commercial |
$170.69
|
| Rate for Payer: Humana ChoiceCare |
$160.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$166.98
|
| Rate for Payer: PHCS All Commercial |
$139.15
|
| Rate for Payer: PHP All Commercial |
$140.71
|
| Rate for Payer: Sagamore Health Network All Products |
$143.24
|
| Rate for Payer: Signature Care EPO |
$154.00
|
| Rate for Payer: Signature Care PPO |
$163.27
|
| Rate for Payer: United Healthcare Commercial |
$146.20
|
|
|
HC ED NURSING ASSESSMENT
|
Facility
IP
|
$138.12
|
|
| Hospital Charge Code |
01290900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$103.59 |
| Max. Negotiated Rate |
$128.45 |
| Rate for Payer: Aetna Commercial |
$119.33
|
| Rate for Payer: Cash Price |
$85.63
|
| Rate for Payer: Cigna All Commercial |
$119.20
|
| Rate for Payer: CORVEL All Commercial |
$128.45
|
| Rate for Payer: Coventry All Commercial |
$121.54
|
| Rate for Payer: Encore All Commercial |
$127.14
|
| Rate for Payer: Frontpath All Commercial |
$127.07
|
| Rate for Payer: Humana ChoiceCare |
$119.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.31
|
| Rate for Payer: PHCS All Commercial |
$103.59
|
| Rate for Payer: PHP All Commercial |
$104.75
|
| Rate for Payer: Sagamore Health Network All Products |
$106.63
|
| Rate for Payer: Signature Care EPO |
$114.64
|
| Rate for Payer: Signature Care PPO |
$121.54
|
| Rate for Payer: United Healthcare Commercial |
$108.84
|
|
|
HC ED NURSING ASSESSMENT
|
Facility
OP
|
$138.12
|
|
| Hospital Charge Code |
01290900
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$295.62 |
| Rate for Payer: Aetna Commercial |
$116.57
|
| Rate for Payer: Aetna Medicare |
$45.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.14
|
| Rate for Payer: Cash Price |
$85.63
|
| Rate for Payer: Cash Price |
$85.63
|
| Rate for Payer: Centivo All Commercial |
$70.44
|
| Rate for Payer: Cigna All Commercial |
$119.20
|
| Rate for Payer: CORVEL All Commercial |
$128.45
|
| Rate for Payer: Coventry All Commercial |
$121.54
|
| Rate for Payer: Encore All Commercial |
$127.14
|
| Rate for Payer: Frontpath All Commercial |
$127.07
|
| Rate for Payer: Humana ChoiceCare |
$119.29
|
| Rate for Payer: Humana Medicare |
$70.44
|
| Rate for Payer: Lucent All Commercial |
$70.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.31
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$103.59
|
| Rate for Payer: PHP All Commercial |
$104.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.87
|
| Rate for Payer: Sagamore Health Network All Products |
$106.63
|
| Rate for Payer: Signature Care EPO |
$114.64
|
| Rate for Payer: Signature Care PPO |
$121.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$117.40
|
| Rate for Payer: United Healthcare Commercial |
$108.84
|
| Rate for Payer: United Healthcare Medicare |
$45.58
|
|
|
HC ED SQ/IM INJECTION
|
Facility
IP
|
$106.08
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
00520372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$79.56 |
| Max. Negotiated Rate |
$98.65 |
| Rate for Payer: Aetna Commercial |
$91.65
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Cigna All Commercial |
$91.55
|
| Rate for Payer: CORVEL All Commercial |
$98.65
|
| Rate for Payer: Coventry All Commercial |
$93.35
|
| Rate for Payer: Encore All Commercial |
$97.65
|
| Rate for Payer: Frontpath All Commercial |
$97.59
|
| Rate for Payer: Humana ChoiceCare |
$91.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.47
|
| Rate for Payer: PHCS All Commercial |
$79.56
|
| Rate for Payer: PHP All Commercial |
$80.45
|
| Rate for Payer: Sagamore Health Network All Products |
$81.89
|
| Rate for Payer: Signature Care EPO |
$88.05
|
| Rate for Payer: Signature Care PPO |
$93.35
|
| Rate for Payer: United Healthcare Commercial |
$83.59
|
|
|
HC ED SQ/IM INJECTION
|
Facility
OP
|
$106.08
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
00520372
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$35.01 |
| Max. Negotiated Rate |
$295.62 |
| Rate for Payer: Aetna Commercial |
$89.53
|
| Rate for Payer: Aetna Medicare |
$35.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$66.31
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$295.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.51
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Cash Price |
$65.77
|
| Rate for Payer: Centivo All Commercial |
$54.10
|
| Rate for Payer: Cigna All Commercial |
$91.55
|
| Rate for Payer: CORVEL All Commercial |
$98.65
|
| Rate for Payer: Coventry All Commercial |
$93.35
|
| Rate for Payer: Encore All Commercial |
$97.65
|
| Rate for Payer: Frontpath All Commercial |
$97.59
|
| Rate for Payer: Humana ChoiceCare |
$91.62
|
| Rate for Payer: Humana Medicare |
$54.10
|
| Rate for Payer: Lucent All Commercial |
$54.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$95.47
|
| Rate for Payer: Managed Health Services Medicaid |
$295.62
|
| Rate for Payer: MDWise Medicaid |
$295.62
|
| Rate for Payer: PHCS All Commercial |
$79.56
|
| Rate for Payer: PHP All Commercial |
$80.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.37
|
| Rate for Payer: Sagamore Health Network All Products |
$81.89
|
| Rate for Payer: Signature Care EPO |
$88.05
|
| Rate for Payer: Signature Care PPO |
$93.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$90.17
|
| Rate for Payer: United Healthcare Commercial |
$83.59
|
| Rate for Payer: United Healthcare Medicare |
$35.01
|
|
