|
HC IV INF THER EA ADD 31-60 MN
|
Facility
OP
|
$183.60
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
01689105
|
|
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 Hoosier Healthwise |
$73.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.65
|
| Rate for Payer: Cash Price |
$113.83
|
| Rate for Payer: Cash Price |
$113.83
|
| Rate for Payer: Centivo All Commercial |
$93.64
|
| Rate for Payer: Cigna All Commercial |
$158.45
|
| Rate for Payer: CORVEL All Commercial |
$170.75
|
| Rate for Payer: Coventry All Commercial |
$161.57
|
| Rate for Payer: Encore All Commercial |
$169.00
|
| Rate for Payer: Frontpath All Commercial |
$168.91
|
| Rate for Payer: Humana ChoiceCare |
$158.58
|
| Rate for Payer: Humana Medicare |
$93.64
|
| Rate for Payer: Lucent All Commercial |
$93.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.24
|
| Rate for Payer: Managed Health Services Medicaid |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| 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 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
|
|
|
HC IV INF THER EA ADD 31-60 MN
|
Facility
OP
|
$183.60
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
00520766
|
|
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 Hoosier Healthwise |
$73.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$69.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$66.65
|
| Rate for Payer: Cash Price |
$113.83
|
| Rate for Payer: Cash Price |
$113.83
|
| Rate for Payer: Centivo All Commercial |
$93.64
|
| Rate for Payer: Cigna All Commercial |
$158.45
|
| Rate for Payer: CORVEL All Commercial |
$170.75
|
| Rate for Payer: Coventry All Commercial |
$161.57
|
| Rate for Payer: Encore All Commercial |
$169.00
|
| Rate for Payer: Frontpath All Commercial |
$168.91
|
| Rate for Payer: Humana ChoiceCare |
$158.58
|
| Rate for Payer: Humana Medicare |
$93.64
|
| Rate for Payer: Lucent All Commercial |
$93.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$165.24
|
| Rate for Payer: Managed Health Services Medicaid |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| 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 THER INIT 16-60 MINS
|
Facility
IP
|
$450.84
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
00520765
|
|
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 THER INIT 16-60 MINS
|
Facility
IP
|
$450.84
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
01689106
|
|
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 THER INIT 16-60 MINS
|
Facility
OP
|
$450.84
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
01689106
|
|
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 THER INIT 16-60 MINS
|
Facility
OP
|
$450.84
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
00520765
|
|
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 INFUSION CONCURRENT
|
Facility
IP
|
$251.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
01689100
|
|
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 INFUSION CONCURRENT
|
Facility
OP
|
$251.67
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
01689100
|
|
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 INFUSION INSULIN CONCURRENT
|
Facility
IP
|
$251.67
|
|
|
Service Code
|
CPT 96368 GZ
|
| Hospital Charge Code |
21689100
|
|
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 INFUSION INSULIN CONCURRENT
|
Facility
OP
|
$251.67
|
|
|
Service Code
|
CPT 96368 GZ
|
| Hospital Charge Code |
21689100
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$83.05 |
| 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 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: 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: 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 PUSH EA ADDITIONAL DRUG
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
01689109
|
|
Hospital Revenue Code
|
260
|
| 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 IV PUSH EA ADDITIONAL DRUG
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
00521786
|
|
Hospital Revenue Code
|
260
|
| 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 IV PUSH EA ADDITIONAL DRUG
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
01689109
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$50.49 |
| Max. Negotiated Rate |
$142.29 |
| 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 |
$73.71
|
| 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 |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| 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 IV PUSH EA ADDITIONAL DRUG
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
CPT 96375
|
| Hospital Charge Code |
00521786
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$50.49 |
| Max. Negotiated Rate |
$142.29 |
| 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 |
$73.71
|
| 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 |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| 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 IV PUSH EA ADD SAME DRUG
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
00520776
|
|
Hospital Revenue Code
|
260
|
| 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 IV PUSH EA ADD SAME DRUG
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
01689108
|
|
Hospital Revenue Code
|
260
|
| 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 IV PUSH EA ADD SAME DRUG
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
01689108
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$50.49 |
| Max. Negotiated Rate |
$142.29 |
| 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 |
$73.71
|
| 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 |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| 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 IV PUSH EA ADD SAME DRUG
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
CPT 96376
|
| Hospital Charge Code |
00520776
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$50.49 |
| Max. Negotiated Rate |
$142.29 |
| 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 |
$73.71
|
| 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 |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| 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 IV PUSH INITIAL
|
Facility
OP
|
$164.42
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
00521784
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$54.26 |
| Max. Negotiated Rate |
$152.91 |
| 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 |
$73.71
|
| 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 |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| 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 IV PUSH INITIAL
|
Facility
OP
|
$164.42
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
01689107
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$54.26 |
| Max. Negotiated Rate |
$152.91 |
| 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 |
$73.71
|
| 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 |
$73.71
|
| Rate for Payer: MDWise Medicaid |
$73.71
|
| 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 IV PUSH INITIAL
|
Facility
IP
|
$164.42
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
00521784
|
|
Hospital Revenue Code
|
260
|
| 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 IV PUSH INITIAL
|
Facility
IP
|
$164.42
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
01689107
|
|
Hospital Revenue Code
|
260
|
| 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 IV PUSH INSULIN EA ADDITIONAL DRUG
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
CPT 96375 GZ
|
| Hospital Charge Code |
21689109
|
|
Hospital Revenue Code
|
260
|
| 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 IV PUSH INSULIN EA ADDITIONAL DRUG
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
CPT 96375 GZ
|
| Hospital Charge Code |
21689109
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$50.49 |
| Max. Negotiated Rate |
$142.29 |
| 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 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: 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: 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
|
|
