|
HC ISTENT INJECT
|
Facility
OP
|
$10,260.00
|
|
|
Service Code
|
CPT C1783
|
| Hospital Charge Code |
41606635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$9,541.80 |
| Rate for Payer: Aetna Commercial |
$8,659.44
|
| Rate for Payer: Aetna Medicare |
$3,385.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,385.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,892.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,413.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,893.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,724.38
|
| Rate for Payer: Cash Price |
$6,361.20
|
| Rate for Payer: Cash Price |
$6,361.20
|
| Rate for Payer: Centivo All Commercial |
$5,232.60
|
| Rate for Payer: Cigna All Commercial |
$8,854.38
|
| Rate for Payer: CORVEL All Commercial |
$9,541.80
|
| Rate for Payer: Coventry All Commercial |
$9,028.80
|
| Rate for Payer: Encore All Commercial |
$9,444.33
|
| Rate for Payer: Frontpath All Commercial |
$9,439.20
|
| Rate for Payer: Humana ChoiceCare |
$8,861.56
|
| Rate for Payer: Humana Medicare |
$5,232.60
|
| Rate for Payer: Lucent All Commercial |
$5,232.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,234.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,695.00
|
| Rate for Payer: PHP All Commercial |
$7,781.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,001.40
|
| Rate for Payer: Sagamore Health Network All Products |
$7,920.72
|
| Rate for Payer: Signature Care EPO |
$8,515.80
|
| Rate for Payer: Signature Care PPO |
$9,028.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,721.00
|
| Rate for Payer: United Healthcare Commercial |
$8,084.88
|
| Rate for Payer: United Healthcare Medicare |
$3,385.80
|
|
|
HC ISTENT INJECT
|
Facility
IP
|
$10,260.00
|
|
|
Service Code
|
CPT C1783
|
| Hospital Charge Code |
41606635
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,695.00 |
| Max. Negotiated Rate |
$9,541.80 |
| Rate for Payer: Aetna Commercial |
$8,864.64
|
| Rate for Payer: Cash Price |
$6,361.20
|
| Rate for Payer: Cigna All Commercial |
$8,854.38
|
| Rate for Payer: CORVEL All Commercial |
$9,541.80
|
| Rate for Payer: Coventry All Commercial |
$9,028.80
|
| Rate for Payer: Encore All Commercial |
$9,444.33
|
| Rate for Payer: Frontpath All Commercial |
$9,439.20
|
| Rate for Payer: Humana ChoiceCare |
$8,861.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,234.00
|
| Rate for Payer: PHCS All Commercial |
$7,695.00
|
| Rate for Payer: PHP All Commercial |
$7,781.18
|
| Rate for Payer: Sagamore Health Network All Products |
$7,920.72
|
| Rate for Payer: Signature Care EPO |
$8,515.80
|
| Rate for Payer: Signature Care PPO |
$9,028.80
|
| Rate for Payer: United Healthcare Commercial |
$8,084.88
|
|
|
HC I STENT LEFT
|
Facility
IP
|
$10,260.00
|
|
|
Service Code
|
CPT C1783
|
| Hospital Charge Code |
41602463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,695.00 |
| Max. Negotiated Rate |
$9,541.80 |
| Rate for Payer: Aetna Commercial |
$8,864.64
|
| Rate for Payer: Cash Price |
$6,361.20
|
| Rate for Payer: Cigna All Commercial |
$8,854.38
|
| Rate for Payer: CORVEL All Commercial |
$9,541.80
|
| Rate for Payer: Coventry All Commercial |
$9,028.80
|
| Rate for Payer: Encore All Commercial |
$9,444.33
|
| Rate for Payer: Frontpath All Commercial |
$9,439.20
|
| Rate for Payer: Humana ChoiceCare |
$8,861.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,234.00
|
| Rate for Payer: PHCS All Commercial |
$7,695.00
|
| Rate for Payer: PHP All Commercial |
$7,781.18
|
| Rate for Payer: Sagamore Health Network All Products |
$7,920.72
|
| Rate for Payer: Signature Care EPO |
$8,515.80
|
| Rate for Payer: Signature Care PPO |
$9,028.80
|
| Rate for Payer: United Healthcare Commercial |
$8,084.88
|
|
|
HC I STENT LEFT
|
Facility
OP
|
$10,260.00
|
|
|
Service Code
|
CPT C1783
|
| Hospital Charge Code |
41602463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$9,541.80 |
| Rate for Payer: Aetna Commercial |
$8,659.44
|
| Rate for Payer: Aetna Medicare |
$3,385.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,385.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,892.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,413.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,893.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,724.38
|
| Rate for Payer: Cash Price |
$6,361.20
|
| Rate for Payer: Cash Price |
$6,361.20
|
| Rate for Payer: Centivo All Commercial |
$5,232.60
|
| Rate for Payer: Cigna All Commercial |
$8,854.38
|
| Rate for Payer: CORVEL All Commercial |
$9,541.80
|
| Rate for Payer: Coventry All Commercial |
$9,028.80
|
| Rate for Payer: Encore All Commercial |
$9,444.33
|
| Rate for Payer: Frontpath All Commercial |
$9,439.20
|
| Rate for Payer: Humana ChoiceCare |
$8,861.56
|
| Rate for Payer: Humana Medicare |
$5,232.60
|
| Rate for Payer: Lucent All Commercial |
$5,232.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,234.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,695.00
|
| Rate for Payer: PHP All Commercial |
$7,781.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,001.40
|
| Rate for Payer: Sagamore Health Network All Products |
$7,920.72
|
| Rate for Payer: Signature Care EPO |
$8,515.80
|
| Rate for Payer: Signature Care PPO |
$9,028.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,721.00
|
| Rate for Payer: United Healthcare Commercial |
$8,084.88
|
| Rate for Payer: United Healthcare Medicare |
$3,385.80
|
|
|
HC I STENT RIGHT
|
Facility
IP
|
$10,260.00
|
|
|
Service Code
|
CPT C1783
|
| Hospital Charge Code |
41602464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,695.00 |
| Max. Negotiated Rate |
$9,541.80 |
| Rate for Payer: Aetna Commercial |
$8,864.64
|
| Rate for Payer: Cash Price |
$6,361.20
|
| Rate for Payer: Cigna All Commercial |
$8,854.38
|
| Rate for Payer: CORVEL All Commercial |
$9,541.80
|
| Rate for Payer: Coventry All Commercial |
$9,028.80
|
| Rate for Payer: Encore All Commercial |
$9,444.33
|
| Rate for Payer: Frontpath All Commercial |
$9,439.20
|
| Rate for Payer: Humana ChoiceCare |
$8,861.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,234.00
|
| Rate for Payer: PHCS All Commercial |
$7,695.00
|
| Rate for Payer: PHP All Commercial |
$7,781.18
|
| Rate for Payer: Sagamore Health Network All Products |
$7,920.72
|
| Rate for Payer: Signature Care EPO |
$8,515.80
|
| Rate for Payer: Signature Care PPO |
$9,028.80
|
| Rate for Payer: United Healthcare Commercial |
$8,084.88
|
|
|
HC I STENT RIGHT
|
Facility
OP
|
$10,260.00
|
|
|
Service Code
|
CPT C1783
|
| Hospital Charge Code |
41602464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$9,541.80 |
| Rate for Payer: Aetna Commercial |
$8,659.44
|
| Rate for Payer: Aetna Medicare |
$3,385.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3,385.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,892.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6,413.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,893.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,724.38
|
| Rate for Payer: Cash Price |
$6,361.20
|
| Rate for Payer: Cash Price |
$6,361.20
|
| Rate for Payer: Centivo All Commercial |
$5,232.60
|
| Rate for Payer: Cigna All Commercial |
$8,854.38
|
| Rate for Payer: CORVEL All Commercial |
$9,541.80
|
| Rate for Payer: Coventry All Commercial |
$9,028.80
|
| Rate for Payer: Encore All Commercial |
$9,444.33
|
| Rate for Payer: Frontpath All Commercial |
$9,439.20
|
| Rate for Payer: Humana ChoiceCare |
$8,861.56
|
| Rate for Payer: Humana Medicare |
$5,232.60
|
| Rate for Payer: Lucent All Commercial |
$5,232.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9,234.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$7,695.00
|
| Rate for Payer: PHP All Commercial |
$7,781.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4,001.40
|
| Rate for Payer: Sagamore Health Network All Products |
$7,920.72
|
| Rate for Payer: Signature Care EPO |
$8,515.80
|
| Rate for Payer: Signature Care PPO |
$9,028.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,721.00
|
| Rate for Payer: United Healthcare Commercial |
$8,084.88
|
| Rate for Payer: United Healthcare Medicare |
$3,385.80
|
|
|
HC IV INF CONCURRENT 16+ MIN
|
Facility
IP
|
$251.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
00520768
|
|
Hospital Revenue Code
|
260
|
| 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 IV INF CONCURRENT 16+ MIN
|
Facility
OP
|
$251.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
00520768
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$73.71 |
| Max. Negotiated Rate |
$234.06 |
| 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 |
$73.71
|
| 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 |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| 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 IV INF HYD EA ADD 31-60 MIN
|
Facility
OP
|
$178.50
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
01689102
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$58.90 |
| Max. Negotiated Rate |
$166.00 |
| 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 |
$73.71
|
| 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 |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| 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 IV INF HYD EA ADD 31-60 MIN
|
Facility
IP
|
$178.50
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
01689102
|
|
Hospital Revenue Code
|
260
|
| 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 IV INF HYD EA ADD 31-60 MNS
|
Facility
IP
|
$178.50
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
00520761
|
|
Hospital Revenue Code
|
260
|
| 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 IV INF HYD EA ADD 31-60 MNS
|
Facility
OP
|
$178.50
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
00520761
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$58.90 |
| Max. Negotiated Rate |
$166.00 |
| 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 |
$73.71
|
| 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 |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| 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 IV INF HYD INIT 31-60 MINS
|
Facility
IP
|
$450.84
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
00520760
|
|
Hospital Revenue Code
|
260
|
| 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 IV INF HYD INIT 31-60 MINS
|
Facility
OP
|
$450.84
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
00520760
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$73.71 |
| 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 |
$73.71
|
| 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 |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| 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 IV INF HYD INIT 31-60 MINS
|
Facility
IP
|
$450.84
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
01689103
|
|
Hospital Revenue Code
|
260
|
| 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 IV INF HYD INIT 31-60 MINS
|
Facility
OP
|
$450.84
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
01689103
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$73.71 |
| 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 |
$73.71
|
| 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 |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| 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 IV INF INSULIN THER EA ADD 31-60 MN
|
Facility
OP
|
$183.60
|
|
|
Service Code
|
CPT 96366 GZ
|
| Hospital Charge Code |
21689105
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$60.59 |
| Max. Negotiated Rate |
$170.75 |
| 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 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: 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: 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 IV INF INSULIN THER EA ADD 31-60 MN
|
Facility
IP
|
$183.60
|
|
|
Service Code
|
CPT 96366 GZ
|
| Hospital Charge Code |
21689105
|
|
Hospital Revenue Code
|
260
|
| 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 IV INF INSULIN THER INIT 16-60 MINS
|
Facility
OP
|
$450.84
|
|
|
Service Code
|
CPT 96365 GZ
|
| Hospital Charge Code |
21689106
|
|
Hospital Revenue Code
|
260
|
| 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 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: 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: 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 IV INF INSULIN THER INIT 16-60 MINS
|
Facility
IP
|
$450.84
|
|
|
Service Code
|
CPT 96365 GZ
|
| Hospital Charge Code |
21689106
|
|
Hospital Revenue Code
|
260
|
| 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 IV INF SEQUENTIAL 16-60 MIN
|
Facility
IP
|
$381.31
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
00520767
|
|
Hospital Revenue Code
|
260
|
| 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 IV INF SEQUENTIAL 16-60 MIN
|
Facility
OP
|
$381.31
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
00520767
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$73.71 |
| 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 |
$73.71
|
| 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 |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| 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 IV INF SEQUENTIAL 16-60 MINS
|
Facility
IP
|
$381.31
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
01689104
|
|
Hospital Revenue Code
|
260
|
| 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 IV INF SEQUENTIAL 16-60 MINS
|
Facility
OP
|
$381.31
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
01689104
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$73.71 |
| 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 |
$73.71
|
| 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 |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| 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 IV INF THER EA ADD 31-60 MN
|
Facility
IP
|
$183.60
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
00520766
|
|
Hospital Revenue Code
|
260
|
| 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
|
|
