|
HC ECHO MYOCARDIAL STRAIN IMAGING
|
Facility
|
IP
|
$564.52
|
|
|
Service Code
|
CPT 93356
|
| Hospital Charge Code |
860399
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$423.39 |
| Max. Negotiated Rate |
$525.00 |
| Rate for Payer: Aetna Commercial |
$487.75
|
| Rate for Payer: Cash Price |
$338.71
|
| Rate for Payer: Cigna All Commercial |
$487.18
|
| Rate for Payer: CORVEL All Commercial |
$525.00
|
| Rate for Payer: Coventry All Commercial |
$496.78
|
| Rate for Payer: Encore All Commercial |
$519.64
|
| Rate for Payer: Frontpath All Commercial |
$519.36
|
| Rate for Payer: Humana ChoiceCare |
$487.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$508.07
|
| Rate for Payer: PHCS All Commercial |
$423.39
|
| Rate for Payer: PHP All Commercial |
$428.13
|
| Rate for Payer: Sagamore Health Network All Products |
$435.81
|
| Rate for Payer: Signature Care EPO |
$468.55
|
| Rate for Payer: Signature Care PPO |
$496.78
|
| Rate for Payer: United Healthcare Commercial |
$444.84
|
|
|
HC ED CRITICAL CARE:INIT 30-74 MN
|
Facility
|
IP
|
$3,864.78
|
|
|
Service Code
|
CPT 99291
|
| Hospital Charge Code |
1297973
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,898.59 |
| Max. Negotiated Rate |
$3,594.25 |
| Rate for Payer: Aetna Commercial |
$3,339.17
|
| Rate for Payer: Cash Price |
$2,318.87
|
| 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 |
$2,898.59
|
| 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 |
1297973
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$3,594.25 |
| Rate for Payer: Aetna Commercial |
$3,261.87
|
| Rate for Payer: Aetna Medicare |
$1,236.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$75.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,198.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,219.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,415.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,422.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,360.40
|
| Rate for Payer: Cash Price |
$2,318.87
|
| Rate for Payer: Cash Price |
$2,318.87
|
| Rate for Payer: Centivo All Commercial |
$2,102.44
|
| 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 |
$1,236.73
|
| Rate for Payer: Lucent All Commercial |
$2,102.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,478.30
|
| Rate for Payer: Managed Health Services Medicaid |
$75.80
|
| Rate for Payer: MDWise Medicaid |
$75.80
|
| Rate for Payer: PHCS All Commercial |
$2,898.59
|
| 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 |
$1,236.73
|
|
|
HC ED IMMUN ADMIN
|
Facility
|
OP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1290471
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$29.49 |
| Max. Negotiated Rate |
$88.46 |
| Rate for Payer: Aetna Commercial |
$80.28
|
| Rate for Payer: Aetna Medicare |
$30.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$54.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$59.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.48
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Centivo All Commercial |
$51.75
|
| Rate for Payer: Cigna All Commercial |
$82.09
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.71
|
| Rate for Payer: Encore All Commercial |
$87.56
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.16
|
| Rate for Payer: Humana Medicare |
$30.44
|
| Rate for Payer: Lucent All Commercial |
$51.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.61
|
| 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 |
$37.10
|
| Rate for Payer: Sagamore Health Network All Products |
$73.43
|
| Rate for Payer: Signature Care EPO |
$78.95
|
| Rate for Payer: Signature Care PPO |
$83.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$80.85
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
| Rate for Payer: United Healthcare Medicare |
$30.44
|
|
|
HC ED IMMUN ADMIN
|
Facility
|
IP
|
$95.12
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
1290471
|
|
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 |
$57.07
|
| Rate for Payer: Cigna All Commercial |
$82.09
|
| Rate for Payer: CORVEL All Commercial |
$88.46
|
| Rate for Payer: Coventry All Commercial |
$83.71
|
| Rate for Payer: Encore All Commercial |
$87.56
|
| Rate for Payer: Frontpath All Commercial |
$87.51
|
| Rate for Payer: Humana ChoiceCare |
$82.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$85.61
|
| 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 |
$83.71
|
| Rate for Payer: United Healthcare Commercial |
$74.95
|
|
|
HC ED INTERM SURG PROC
|
Facility
|
OP
|
$309.22
|
|
| Hospital Charge Code |
1291502
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$287.57 |
| Rate for Payer: Aetna Commercial |
$260.98
|
| Rate for Payer: Aetna Medicare |
$98.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$75.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$177.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.85
|
| Rate for Payer: Cash Price |
$185.53
|
| Rate for Payer: Cash Price |
$185.53
|
| Rate for Payer: Centivo All Commercial |
$168.22
|
| Rate for Payer: Cigna All Commercial |
$266.86
|
| Rate for Payer: CORVEL All Commercial |
$287.57
|
| Rate for Payer: Coventry All Commercial |
$272.11
|
| Rate for Payer: Encore All Commercial |
$284.64
|
| Rate for Payer: Frontpath All Commercial |
$284.48
|
| Rate for Payer: Humana ChoiceCare |
$267.07
|
| Rate for Payer: Humana Medicare |
$98.95
|
| Rate for Payer: Lucent All Commercial |
$168.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.30
|
| Rate for Payer: Managed Health Services Medicaid |
$75.80
|
| Rate for Payer: MDWise Medicaid |
$75.80
|
| Rate for Payer: PHCS All Commercial |
$231.91
|
| 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 |
$256.65
|
| Rate for Payer: Signature Care PPO |
$272.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$262.84
|
| Rate for Payer: United Healthcare Commercial |
$243.67
|
| Rate for Payer: United Healthcare Medicare |
$98.95
|
|
|
HC ED INTERM SURG PROC
|
Facility
|
IP
|
$309.22
|
|
| Hospital Charge Code |
1291502
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$231.91 |
| Max. Negotiated Rate |
$287.57 |
| Rate for Payer: Aetna Commercial |
$267.17
|
| Rate for Payer: Cash Price |
$185.53
|
| Rate for Payer: Cigna All Commercial |
$266.86
|
| Rate for Payer: CORVEL All Commercial |
$287.57
|
| Rate for Payer: Coventry All Commercial |
$272.11
|
| Rate for Payer: Encore All Commercial |
$284.64
|
| Rate for Payer: Frontpath All Commercial |
$284.48
|
| Rate for Payer: Humana ChoiceCare |
$267.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.30
|
| Rate for Payer: PHCS All Commercial |
$231.91
|
| Rate for Payer: PHP All Commercial |
$234.51
|
| Rate for Payer: Sagamore Health Network All Products |
$238.72
|
| Rate for Payer: Signature Care EPO |
$256.65
|
| Rate for Payer: Signature Care PPO |
$272.11
|
| Rate for Payer: United Healthcare Commercial |
$243.67
|
|
|
HC ED IV INF CONCURRENT 16+ MIN
|
Facility
|
OP
|
$251.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
1290768
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$234.05 |
| Rate for Payer: Aetna Commercial |
$212.41
|
| Rate for Payer: Aetna Medicare |
$80.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$75.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$144.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$157.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$92.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$88.59
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Centivo All Commercial |
$136.91
|
| Rate for Payer: Cigna All Commercial |
$217.19
|
| Rate for Payer: CORVEL All Commercial |
$234.05
|
| Rate for Payer: Coventry All Commercial |
$221.47
|
| Rate for Payer: Encore All Commercial |
$231.66
|
| Rate for Payer: Frontpath All Commercial |
$231.54
|
| Rate for Payer: Humana ChoiceCare |
$217.37
|
| Rate for Payer: Humana Medicare |
$80.53
|
| Rate for Payer: Lucent All Commercial |
$136.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$226.50
|
| Rate for Payer: Managed Health Services Medicaid |
$75.80
|
| Rate for Payer: MDWise Medicaid |
$75.80
|
| Rate for Payer: PHCS All Commercial |
$188.75
|
| 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 |
$80.53
|
|
|
HC ED IV INF CONCURRENT 16+ MIN
|
Facility
|
IP
|
$251.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
1290768
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$188.75 |
| Max. Negotiated Rate |
$234.05 |
| Rate for Payer: Aetna Commercial |
$217.44
|
| Rate for Payer: Cash Price |
$151.00
|
| Rate for Payer: Cigna All Commercial |
$217.19
|
| Rate for Payer: CORVEL All Commercial |
$234.05
|
| Rate for Payer: Coventry All Commercial |
$221.47
|
| Rate for Payer: Encore All Commercial |
$231.66
|
| Rate for Payer: Frontpath All Commercial |
$231.54
|
| Rate for Payer: Humana ChoiceCare |
$217.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$226.50
|
| Rate for Payer: PHCS All Commercial |
$188.75
|
| 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 HYD EA ADD 31-60 MIN
|
Facility
|
IP
|
$178.50
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
1290761
|
|
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 |
$107.10
|
| 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 |
1290761
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$55.34 |
| Max. Negotiated Rate |
$166.00 |
| Rate for Payer: Aetna Commercial |
$150.65
|
| Rate for Payer: Aetna Medicare |
$57.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$75.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$55.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$102.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$111.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.83
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Centivo All Commercial |
$97.10
|
| 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 |
$57.12
|
| Rate for Payer: Lucent All Commercial |
$97.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$160.65
|
| Rate for Payer: Managed Health Services Medicaid |
$75.80
|
| Rate for Payer: MDWise Medicaid |
$75.80
|
| 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 |
$69.61
|
| 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 |
$57.12
|
|
|
HC ED IV INF HYD INIT 31-60 MINS
|
Facility
|
IP
|
$450.84
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
1290760
|
|
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 |
$270.50
|
| 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 HYD INIT 31-60 MINS
|
Facility
|
OP
|
$450.84
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
1290760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$419.28 |
| Rate for Payer: Aetna Commercial |
$380.51
|
| Rate for Payer: Aetna Medicare |
$144.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$75.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$258.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$281.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$165.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$158.70
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Centivo All Commercial |
$245.26
|
| 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 |
$144.27
|
| Rate for Payer: Lucent All Commercial |
$245.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$405.76
|
| Rate for Payer: Managed Health Services Medicaid |
$75.80
|
| Rate for Payer: MDWise Medicaid |
$75.80
|
| 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 |
$144.27
|
|
|
HC ED IV INF SEQUENTIAL 16-60 MIN
|
Facility
|
IP
|
$381.31
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
1290767
|
|
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 |
$228.79
|
| 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 |
$351.00
|
| Rate for Payer: Frontpath All Commercial |
$350.81
|
| Rate for Payer: Humana ChoiceCare |
$329.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.18
|
| Rate for Payer: PHCS All Commercial |
$285.98
|
| Rate for Payer: PHP All Commercial |
$289.19
|
| Rate for Payer: Sagamore Health Network All Products |
$294.37
|
| Rate for Payer: Signature Care EPO |
$316.49
|
| Rate for Payer: Signature Care PPO |
$335.55
|
| Rate for Payer: United Healthcare Commercial |
$300.47
|
|
|
HC ED IV INF SEQUENTIAL 16-60 MIN
|
Facility
|
OP
|
$381.31
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
1290767
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$354.62 |
| Rate for Payer: Aetna Commercial |
$321.83
|
| Rate for Payer: Aetna Medicare |
$122.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$75.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$118.21
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$218.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$238.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.22
|
| Rate for Payer: Cash Price |
$228.79
|
| Rate for Payer: Cash Price |
$228.79
|
| Rate for Payer: Centivo All Commercial |
$207.43
|
| 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 |
$351.00
|
| Rate for Payer: Frontpath All Commercial |
$350.81
|
| Rate for Payer: Humana ChoiceCare |
$329.34
|
| Rate for Payer: Humana Medicare |
$122.02
|
| Rate for Payer: Lucent All Commercial |
$207.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$343.18
|
| Rate for Payer: Managed Health Services Medicaid |
$75.80
|
| Rate for Payer: MDWise Medicaid |
$75.80
|
| Rate for Payer: PHCS All Commercial |
$285.98
|
| Rate for Payer: PHP All Commercial |
$289.19
|
| 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 |
$316.49
|
| 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 |
$122.02
|
|
|
HC ED IV INF THER EA ADD 31-60 MN
|
Facility
|
OP
|
$183.60
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
1290766
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$56.92 |
| Max. Negotiated Rate |
$170.75 |
| Rate for Payer: Aetna Commercial |
$154.96
|
| Rate for Payer: Aetna Medicare |
$58.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$75.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$105.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$114.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.63
|
| Rate for Payer: Cash Price |
$110.16
|
| Rate for Payer: Cash Price |
$110.16
|
| Rate for Payer: Centivo All Commercial |
$99.88
|
| 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 |
$58.75
|
| Rate for Payer: Lucent All Commercial |
$99.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.24
|
| Rate for Payer: Managed Health Services Medicaid |
$75.80
|
| Rate for Payer: MDWise Medicaid |
$75.80
|
| 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 |
$58.75
|
|
|
HC ED IV INF THER EA ADD 31-60 MN
|
Facility
|
IP
|
$183.60
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
1290766
|
|
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 |
$110.16
|
| 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 INIT 16-60 MINS
|
Facility
|
IP
|
$450.84
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
1290765
|
|
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 |
$270.50
|
| 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 |
1290765
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$419.28 |
| Rate for Payer: Aetna Commercial |
$380.51
|
| Rate for Payer: Aetna Medicare |
$144.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$75.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$258.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$281.82
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$165.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$158.70
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Cash Price |
$270.50
|
| Rate for Payer: Centivo All Commercial |
$245.26
|
| 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 |
$144.27
|
| Rate for Payer: Lucent All Commercial |
$245.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$405.76
|
| Rate for Payer: Managed Health Services Medicaid |
$75.80
|
| Rate for Payer: MDWise Medicaid |
$75.80
|
| 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 |
$144.27
|
|
|
HC ED IV PUSH EA ADDITIONAL DRUG
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
1291784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.43 |
| Max. Negotiated Rate |
$142.29 |
| Rate for Payer: Aetna Commercial |
$129.13
|
| Rate for Payer: Aetna Medicare |
$48.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$75.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$87.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.86
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Centivo All Commercial |
$83.23
|
| 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 |
$48.96
|
| Rate for Payer: Lucent All Commercial |
$83.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.70
|
| Rate for Payer: Managed Health Services Medicaid |
$75.80
|
| Rate for Payer: MDWise Medicaid |
$75.80
|
| 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 |
$48.96
|
|
|
HC ED IV PUSH EA ADDITIONAL DRUG
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
1291784
|
|
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 |
$91.80
|
| 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 |
1290776
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$47.43 |
| Max. Negotiated Rate |
$142.29 |
| Rate for Payer: Aetna Commercial |
$129.13
|
| Rate for Payer: Aetna Medicare |
$48.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$75.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$87.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.86
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Centivo All Commercial |
$83.23
|
| 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 |
$48.96
|
| Rate for Payer: Lucent All Commercial |
$83.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.70
|
| Rate for Payer: Managed Health Services Medicaid |
$75.80
|
| Rate for Payer: MDWise Medicaid |
$75.80
|
| 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 |
$48.96
|
|
|
HC ED IV PUSH EA ADD SAME DRUG
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
1290776
|
|
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 |
$91.80
|
| 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 INITIAL
|
Facility
|
OP
|
$164.42
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
1290784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$50.97 |
| Max. Negotiated Rate |
$152.91 |
| Rate for Payer: Aetna Commercial |
$138.77
|
| Rate for Payer: Aetna Medicare |
$52.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$75.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$94.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$75.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$60.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$57.88
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Centivo All Commercial |
$89.44
|
| Rate for Payer: Cigna All Commercial |
$141.89
|
| 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 |
$52.61
|
| Rate for Payer: Lucent All Commercial |
$89.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.98
|
| Rate for Payer: Managed Health Services Medicaid |
$75.80
|
| Rate for Payer: MDWise Medicaid |
$75.80
|
| Rate for Payer: PHCS All Commercial |
$123.31
|
| Rate for Payer: PHP All Commercial |
$124.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.12
|
| Rate for Payer: Sagamore Health Network All Products |
$126.93
|
| 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 |
$129.56
|
| Rate for Payer: United Healthcare Medicare |
$52.61
|
|
|
HC ED IV PUSH INITIAL
|
Facility
|
IP
|
$164.42
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
1290784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.31 |
| Max. Negotiated Rate |
$152.91 |
| Rate for Payer: Aetna Commercial |
$142.06
|
| Rate for Payer: Cash Price |
$98.65
|
| Rate for Payer: Cigna All Commercial |
$141.89
|
| 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 |
$123.31
|
| Rate for Payer: PHP All Commercial |
$124.70
|
| Rate for Payer: Sagamore Health Network All Products |
$126.93
|
| Rate for Payer: Signature Care EPO |
$136.47
|
| Rate for Payer: Signature Care PPO |
$144.69
|
| Rate for Payer: United Healthcare Commercial |
$129.56
|
|
