|
EPINEPHRINE HCL 1 MG/ML NASL SOLN
|
Facility
IP
|
$335.64
|
|
|
Service Code
|
NDC 54288012301
|
| Hospital Charge Code |
19604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$251.73 |
| Max. Negotiated Rate |
$312.15 |
| Rate for Payer: Aetna Commercial |
$289.99
|
| Rate for Payer: Cash Price |
$208.10
|
| Rate for Payer: Cigna All Commercial |
$289.66
|
| Rate for Payer: CORVEL All Commercial |
$312.15
|
| Rate for Payer: Coventry All Commercial |
$295.36
|
| Rate for Payer: Encore All Commercial |
$308.96
|
| Rate for Payer: Frontpath All Commercial |
$308.79
|
| Rate for Payer: Humana ChoiceCare |
$289.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$302.08
|
| Rate for Payer: PHCS All Commercial |
$251.73
|
| Rate for Payer: PHP All Commercial |
$254.55
|
| Rate for Payer: Sagamore Health Network All Products |
$259.11
|
| Rate for Payer: Signature Care EPO |
$278.58
|
| Rate for Payer: Signature Care PPO |
$295.36
|
| Rate for Payer: United Healthcare Commercial |
$264.48
|
|
|
EPINEPHRINE HCL 1 MG/ML NASL SOLN
|
Facility
OP
|
$335.64
|
|
|
Service Code
|
NDC 54288012301
|
| Hospital Charge Code |
19604
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$312.15 |
| Rate for Payer: Aetna Commercial |
$283.28
|
| Rate for Payer: Aetna Medicare |
$110.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$192.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$209.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$127.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.84
|
| Rate for Payer: Cash Price |
$208.10
|
| Rate for Payer: Cash Price |
$208.10
|
| Rate for Payer: Centivo All Commercial |
$171.18
|
| Rate for Payer: Cigna All Commercial |
$289.66
|
| Rate for Payer: CORVEL All Commercial |
$312.15
|
| Rate for Payer: Coventry All Commercial |
$295.36
|
| Rate for Payer: Encore All Commercial |
$308.96
|
| Rate for Payer: Frontpath All Commercial |
$308.79
|
| Rate for Payer: Humana ChoiceCare |
$289.89
|
| Rate for Payer: Humana Medicare |
$171.18
|
| Rate for Payer: Lucent All Commercial |
$171.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$302.08
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$251.73
|
| Rate for Payer: PHP All Commercial |
$254.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$130.90
|
| Rate for Payer: Sagamore Health Network All Products |
$259.11
|
| Rate for Payer: Signature Care EPO |
$278.58
|
| Rate for Payer: Signature Care PPO |
$295.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$285.29
|
| Rate for Payer: United Healthcare Commercial |
$264.48
|
| Rate for Payer: United Healthcare Medicare |
$110.76
|
|
|
EPINEPHRINE HCL IN 0.9 % NACL 100 MCG/10 ML (10 MCG/ML) IV SYRG
|
Facility
IP
|
$31.50
|
|
|
Service Code
|
NDC 69374054410
|
| Hospital Charge Code |
176715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$23.62 |
| Max. Negotiated Rate |
$29.30 |
| Rate for Payer: Aetna Commercial |
$27.22
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Cigna All Commercial |
$27.18
|
| Rate for Payer: CORVEL All Commercial |
$29.30
|
| Rate for Payer: Coventry All Commercial |
$27.72
|
| Rate for Payer: Encore All Commercial |
$29.00
|
| Rate for Payer: Frontpath All Commercial |
$28.98
|
| Rate for Payer: Humana ChoiceCare |
$27.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.35
|
| Rate for Payer: PHCS All Commercial |
$23.62
|
| Rate for Payer: PHP All Commercial |
$23.89
|
| Rate for Payer: Sagamore Health Network All Products |
$24.32
|
| Rate for Payer: Signature Care EPO |
$26.14
|
| Rate for Payer: Signature Care PPO |
$27.72
|
| Rate for Payer: United Healthcare Commercial |
$24.82
|
|
|
EPINEPHRINE HCL IN 0.9 % NACL 100 MCG/10 ML (10 MCG/ML) IV SYRG
|
Facility
OP
|
$31.50
|
|
|
Service Code
|
NDC 69374054410
|
| Hospital Charge Code |
176715
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Aetna Commercial |
$26.59
|
| Rate for Payer: Aetna Medicare |
$10.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$18.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$19.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.43
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Cash Price |
$19.53
|
| Rate for Payer: Centivo All Commercial |
$16.06
|
| Rate for Payer: Cigna All Commercial |
$27.18
|
| Rate for Payer: CORVEL All Commercial |
$29.30
|
| Rate for Payer: Coventry All Commercial |
$27.72
|
| Rate for Payer: Encore All Commercial |
$29.00
|
| Rate for Payer: Frontpath All Commercial |
$28.98
|
| Rate for Payer: Humana ChoiceCare |
$27.21
|
| Rate for Payer: Humana Medicare |
$16.06
|
| Rate for Payer: Lucent All Commercial |
$16.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$28.35
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$23.62
|
| Rate for Payer: PHP All Commercial |
$23.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.28
|
| Rate for Payer: Sagamore Health Network All Products |
$24.32
|
| Rate for Payer: Signature Care EPO |
$26.14
|
| Rate for Payer: Signature Care PPO |
$27.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26.78
|
| Rate for Payer: United Healthcare Commercial |
$24.82
|
| Rate for Payer: United Healthcare Medicare |
$10.40
|
|
|
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN
|
Facility
IP
|
$66.40
|
|
|
Service Code
|
HCPCS J0173
|
| Hospital Charge Code |
118405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Aetna Commercial |
$57.37
|
| Rate for Payer: Cash Price |
$41.16
|
| Rate for Payer: Cigna All Commercial |
$57.30
|
| Rate for Payer: CORVEL All Commercial |
$61.75
|
| Rate for Payer: Coventry All Commercial |
$58.43
|
| Rate for Payer: Encore All Commercial |
$61.12
|
| Rate for Payer: Frontpath All Commercial |
$61.08
|
| Rate for Payer: Humana ChoiceCare |
$57.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.76
|
| Rate for Payer: PHCS All Commercial |
$49.80
|
| Rate for Payer: PHP All Commercial |
$50.35
|
| Rate for Payer: Sagamore Health Network All Products |
$51.26
|
| Rate for Payer: Signature Care EPO |
$55.11
|
| Rate for Payer: Signature Care PPO |
$58.43
|
| Rate for Payer: United Healthcare Commercial |
$52.32
|
|
|
EPINEPHRINE HCL (PF) 1 MG/ML (1 ML) INJ SOLN
|
Facility
OP
|
$66.40
|
|
|
Service Code
|
HCPCS J0173
|
| Hospital Charge Code |
118405
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.91 |
| Max. Negotiated Rate |
$61.75 |
| Rate for Payer: Aetna Commercial |
$56.04
|
| Rate for Payer: Aetna Medicare |
$21.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$38.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.10
|
| Rate for Payer: Cash Price |
$41.16
|
| Rate for Payer: Centivo All Commercial |
$33.86
|
| Rate for Payer: Cigna All Commercial |
$57.30
|
| Rate for Payer: CORVEL All Commercial |
$61.75
|
| Rate for Payer: Coventry All Commercial |
$58.43
|
| Rate for Payer: Encore All Commercial |
$61.12
|
| Rate for Payer: Frontpath All Commercial |
$61.08
|
| Rate for Payer: Humana ChoiceCare |
$57.35
|
| Rate for Payer: Humana Medicare |
$33.86
|
| Rate for Payer: Lucent All Commercial |
$33.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.76
|
| Rate for Payer: PHCS All Commercial |
$49.80
|
| Rate for Payer: PHP All Commercial |
$50.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.89
|
| Rate for Payer: Sagamore Health Network All Products |
$51.26
|
| Rate for Payer: Signature Care EPO |
$55.11
|
| Rate for Payer: Signature Care PPO |
$58.43
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$56.44
|
| Rate for Payer: United Healthcare Commercial |
$52.32
|
| Rate for Payer: United Healthcare Medicare |
$21.91
|
|
|
EPOETIN ALFA 10000 UNITS INJ SOLN
|
Facility
IP
|
$696.30
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9938
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$522.22 |
| Max. Negotiated Rate |
$647.55 |
| Rate for Payer: Aetna Commercial |
$601.60
|
| Rate for Payer: Aetna Commercial |
$607.85
|
| Rate for Payer: Cash Price |
$436.19
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cigna All Commercial |
$607.15
|
| Rate for Payer: Cigna All Commercial |
$600.90
|
| Rate for Payer: CORVEL All Commercial |
$647.55
|
| Rate for Payer: CORVEL All Commercial |
$654.29
|
| Rate for Payer: Coventry All Commercial |
$612.74
|
| Rate for Payer: Coventry All Commercial |
$619.11
|
| Rate for Payer: Encore All Commercial |
$647.60
|
| Rate for Payer: Encore All Commercial |
$640.94
|
| Rate for Payer: Frontpath All Commercial |
$647.25
|
| Rate for Payer: Frontpath All Commercial |
$640.59
|
| Rate for Payer: Humana ChoiceCare |
$607.64
|
| Rate for Payer: Humana ChoiceCare |
$601.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$633.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$626.67
|
| Rate for Payer: PHCS All Commercial |
$527.65
|
| Rate for Payer: PHCS All Commercial |
$522.22
|
| Rate for Payer: PHP All Commercial |
$533.56
|
| Rate for Payer: PHP All Commercial |
$528.07
|
| Rate for Payer: Sagamore Health Network All Products |
$543.13
|
| Rate for Payer: Sagamore Health Network All Products |
$537.54
|
| Rate for Payer: Signature Care EPO |
$583.93
|
| Rate for Payer: Signature Care EPO |
$577.92
|
| Rate for Payer: Signature Care PPO |
$612.74
|
| Rate for Payer: Signature Care PPO |
$619.11
|
| Rate for Payer: United Healthcare Commercial |
$554.39
|
| Rate for Payer: United Healthcare Commercial |
$548.68
|
|
|
EPOETIN ALFA 10000 UNITS INJ SOLN
|
Facility
OP
|
$696.30
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
9938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.41 |
| Max. Negotiated Rate |
$647.55 |
| Rate for Payer: Aetna Commercial |
$587.67
|
| Rate for Payer: Aetna Commercial |
$593.78
|
| Rate for Payer: Aetna Medicare |
$229.78
|
| Rate for Payer: Aetna Medicare |
$232.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$232.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$229.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$404.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$399.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$435.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$439.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$264.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$252.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$255.38
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cash Price |
$436.19
|
| Rate for Payer: Cash Price |
$436.19
|
| Rate for Payer: Centivo All Commercial |
$355.11
|
| Rate for Payer: Centivo All Commercial |
$358.80
|
| Rate for Payer: Cigna All Commercial |
$600.90
|
| Rate for Payer: Cigna All Commercial |
$607.15
|
| Rate for Payer: CORVEL All Commercial |
$647.55
|
| Rate for Payer: CORVEL All Commercial |
$654.29
|
| Rate for Payer: Coventry All Commercial |
$612.74
|
| Rate for Payer: Coventry All Commercial |
$619.11
|
| Rate for Payer: Encore All Commercial |
$647.60
|
| Rate for Payer: Encore All Commercial |
$640.94
|
| Rate for Payer: Frontpath All Commercial |
$640.59
|
| Rate for Payer: Frontpath All Commercial |
$647.25
|
| Rate for Payer: Humana ChoiceCare |
$601.39
|
| Rate for Payer: Humana ChoiceCare |
$607.64
|
| Rate for Payer: Humana Medicare |
$358.80
|
| Rate for Payer: Humana Medicare |
$355.11
|
| Rate for Payer: Lucent All Commercial |
$355.11
|
| Rate for Payer: Lucent All Commercial |
$358.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$626.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$633.18
|
| Rate for Payer: Managed Health Services Medicaid |
$17.41
|
| Rate for Payer: Managed Health Services Medicaid |
$17.41
|
| Rate for Payer: MDWise Medicaid |
$17.41
|
| Rate for Payer: MDWise Medicaid |
$17.41
|
| Rate for Payer: PHCS All Commercial |
$522.22
|
| Rate for Payer: PHCS All Commercial |
$527.65
|
| Rate for Payer: PHP All Commercial |
$528.07
|
| Rate for Payer: PHP All Commercial |
$533.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$271.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.38
|
| Rate for Payer: Sagamore Health Network All Products |
$537.54
|
| Rate for Payer: Sagamore Health Network All Products |
$543.13
|
| Rate for Payer: Signature Care EPO |
$577.92
|
| Rate for Payer: Signature Care EPO |
$583.93
|
| Rate for Payer: Signature Care PPO |
$612.74
|
| Rate for Payer: Signature Care PPO |
$619.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$591.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$598.00
|
| Rate for Payer: United Healthcare Commercial |
$554.39
|
| Rate for Payer: United Healthcare Commercial |
$548.68
|
| Rate for Payer: United Healthcare Medicare |
$229.78
|
| Rate for Payer: United Healthcare Medicare |
$232.17
|
|
|
EPOETIN ALFA 40000 UNITS INJ SOLN
|
Facility
OP
|
$2,228.23
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
24513
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.41 |
| Max. Negotiated Rate |
$2,072.26 |
| Rate for Payer: Aetna Commercial |
$1,880.63
|
| Rate for Payer: Aetna Medicare |
$735.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$735.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,279.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,392.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$845.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$808.85
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Centivo All Commercial |
$1,136.40
|
| Rate for Payer: Cigna All Commercial |
$1,922.96
|
| Rate for Payer: CORVEL All Commercial |
$2,072.26
|
| Rate for Payer: Coventry All Commercial |
$1,960.84
|
| Rate for Payer: Encore All Commercial |
$2,051.09
|
| Rate for Payer: Frontpath All Commercial |
$2,049.97
|
| Rate for Payer: Humana ChoiceCare |
$1,924.52
|
| Rate for Payer: Humana Medicare |
$1,136.40
|
| Rate for Payer: Lucent All Commercial |
$1,136.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,005.41
|
| Rate for Payer: Managed Health Services Medicaid |
$17.41
|
| Rate for Payer: MDWise Medicaid |
$17.41
|
| Rate for Payer: PHCS All Commercial |
$1,671.17
|
| Rate for Payer: PHP All Commercial |
$1,689.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$869.01
|
| Rate for Payer: Sagamore Health Network All Products |
$1,720.20
|
| Rate for Payer: Signature Care EPO |
$1,849.43
|
| Rate for Payer: Signature Care PPO |
$1,960.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,894.00
|
| Rate for Payer: United Healthcare Commercial |
$1,755.85
|
| Rate for Payer: United Healthcare Medicare |
$735.32
|
|
|
EPOETIN ALFA 40000 UNITS INJ SOLN
|
Facility
IP
|
$2,228.23
|
|
|
Service Code
|
HCPCS J0885
|
| Hospital Charge Code |
24513
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,671.17 |
| Max. Negotiated Rate |
$2,072.26 |
| Rate for Payer: Aetna Commercial |
$1,925.19
|
| Rate for Payer: Cash Price |
$1,381.50
|
| Rate for Payer: Cigna All Commercial |
$1,922.96
|
| Rate for Payer: CORVEL All Commercial |
$2,072.26
|
| Rate for Payer: Coventry All Commercial |
$1,960.84
|
| Rate for Payer: Encore All Commercial |
$2,051.09
|
| Rate for Payer: Frontpath All Commercial |
$2,049.97
|
| Rate for Payer: Humana ChoiceCare |
$1,924.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,005.41
|
| Rate for Payer: PHCS All Commercial |
$1,671.17
|
| Rate for Payer: PHP All Commercial |
$1,689.89
|
| Rate for Payer: Sagamore Health Network All Products |
$1,720.20
|
| Rate for Payer: Signature Care EPO |
$1,849.43
|
| Rate for Payer: Signature Care PPO |
$1,960.84
|
| Rate for Payer: United Healthcare Commercial |
$1,755.85
|
|
|
EPOETIN ALFA-EPBX 2000 UNITS/ML INJ SOLN
|
Facility
OP
|
$128.28
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
184848
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.33 |
| Max. Negotiated Rate |
$119.30 |
| Rate for Payer: Aetna Commercial |
$108.26
|
| Rate for Payer: Aetna Medicare |
$42.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$73.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$80.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.56
|
| Rate for Payer: Cash Price |
$79.53
|
| Rate for Payer: Centivo All Commercial |
$65.42
|
| Rate for Payer: Cigna All Commercial |
$110.70
|
| Rate for Payer: CORVEL All Commercial |
$119.30
|
| Rate for Payer: Coventry All Commercial |
$112.88
|
| Rate for Payer: Encore All Commercial |
$118.08
|
| Rate for Payer: Frontpath All Commercial |
$118.01
|
| Rate for Payer: Humana ChoiceCare |
$110.79
|
| Rate for Payer: Humana Medicare |
$65.42
|
| Rate for Payer: Lucent All Commercial |
$65.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.45
|
| Rate for Payer: PHCS All Commercial |
$96.21
|
| Rate for Payer: PHP All Commercial |
$97.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.03
|
| Rate for Payer: Sagamore Health Network All Products |
$99.03
|
| Rate for Payer: Signature Care EPO |
$106.47
|
| Rate for Payer: Signature Care PPO |
$112.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$109.03
|
| Rate for Payer: United Healthcare Commercial |
$101.08
|
| Rate for Payer: United Healthcare Medicare |
$42.33
|
|
|
EPOETIN ALFA-EPBX 2000 UNITS/ML INJ SOLN
|
Facility
IP
|
$128.28
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
184848
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$96.21 |
| Max. Negotiated Rate |
$119.30 |
| Rate for Payer: Aetna Commercial |
$110.83
|
| Rate for Payer: Cash Price |
$79.53
|
| Rate for Payer: Cigna All Commercial |
$110.70
|
| Rate for Payer: CORVEL All Commercial |
$119.30
|
| Rate for Payer: Coventry All Commercial |
$112.88
|
| Rate for Payer: Encore All Commercial |
$118.08
|
| Rate for Payer: Frontpath All Commercial |
$118.01
|
| Rate for Payer: Humana ChoiceCare |
$110.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$115.45
|
| Rate for Payer: PHCS All Commercial |
$96.21
|
| Rate for Payer: PHP All Commercial |
$97.28
|
| Rate for Payer: Sagamore Health Network All Products |
$99.03
|
| Rate for Payer: Signature Care EPO |
$106.47
|
| Rate for Payer: Signature Care PPO |
$112.88
|
| Rate for Payer: United Healthcare Commercial |
$101.08
|
|
|
EPOETIN ALFA-EPBX 3000 UNITS/ML INJ SOLN
|
Facility
IP
|
$256.30
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
184849
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$192.22 |
| Max. Negotiated Rate |
$238.36 |
| Rate for Payer: Aetna Commercial |
$221.44
|
| Rate for Payer: Cash Price |
$158.91
|
| Rate for Payer: Cigna All Commercial |
$221.19
|
| Rate for Payer: CORVEL All Commercial |
$238.36
|
| Rate for Payer: Coventry All Commercial |
$225.54
|
| Rate for Payer: Encore All Commercial |
$235.92
|
| Rate for Payer: Frontpath All Commercial |
$235.80
|
| Rate for Payer: Humana ChoiceCare |
$221.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$230.67
|
| Rate for Payer: PHCS All Commercial |
$192.22
|
| Rate for Payer: PHP All Commercial |
$194.38
|
| Rate for Payer: Sagamore Health Network All Products |
$197.86
|
| Rate for Payer: Signature Care EPO |
$212.73
|
| Rate for Payer: Signature Care PPO |
$225.54
|
| Rate for Payer: United Healthcare Commercial |
$201.96
|
|
|
EPOETIN ALFA-EPBX 3000 UNITS/ML INJ SOLN
|
Facility
OP
|
$256.30
|
|
|
Service Code
|
HCPCS Q5106
|
| Hospital Charge Code |
184849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.58 |
| Max. Negotiated Rate |
$238.36 |
| Rate for Payer: Aetna Commercial |
$216.32
|
| Rate for Payer: Aetna Medicare |
$84.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$84.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$147.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$160.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$97.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.04
|
| Rate for Payer: Cash Price |
$158.91
|
| Rate for Payer: Centivo All Commercial |
$130.71
|
| Rate for Payer: Cigna All Commercial |
$221.19
|
| Rate for Payer: CORVEL All Commercial |
$238.36
|
| Rate for Payer: Coventry All Commercial |
$225.54
|
| Rate for Payer: Encore All Commercial |
$235.92
|
| Rate for Payer: Frontpath All Commercial |
$235.80
|
| Rate for Payer: Humana ChoiceCare |
$221.37
|
| Rate for Payer: Humana Medicare |
$130.71
|
| Rate for Payer: Lucent All Commercial |
$130.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$230.67
|
| Rate for Payer: PHCS All Commercial |
$192.22
|
| Rate for Payer: PHP All Commercial |
$194.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$99.96
|
| Rate for Payer: Sagamore Health Network All Products |
$197.86
|
| Rate for Payer: Signature Care EPO |
$212.73
|
| Rate for Payer: Signature Care PPO |
$225.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$217.85
|
| Rate for Payer: United Healthcare Commercial |
$201.96
|
| Rate for Payer: United Healthcare Medicare |
$84.58
|
|
|
ERTAPENEM 1 G INJ SOLR
|
Facility
IP
|
$203.65
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$152.74 |
| Max. Negotiated Rate |
$189.40 |
| Rate for Payer: Aetna Commercial |
$175.95
|
| Rate for Payer: Aetna Commercial |
$187.65
|
| Rate for Payer: Cash Price |
$134.66
|
| Rate for Payer: Cash Price |
$126.26
|
| Rate for Payer: Cigna All Commercial |
$187.43
|
| Rate for Payer: Cigna All Commercial |
$175.75
|
| Rate for Payer: CORVEL All Commercial |
$201.99
|
| Rate for Payer: CORVEL All Commercial |
$189.40
|
| Rate for Payer: Coventry All Commercial |
$179.21
|
| Rate for Payer: Coventry All Commercial |
$191.13
|
| Rate for Payer: Encore All Commercial |
$187.46
|
| Rate for Payer: Encore All Commercial |
$199.92
|
| Rate for Payer: Frontpath All Commercial |
$199.81
|
| Rate for Payer: Frontpath All Commercial |
$187.36
|
| Rate for Payer: Humana ChoiceCare |
$175.89
|
| Rate for Payer: Humana ChoiceCare |
$187.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$195.47
|
| Rate for Payer: PHCS All Commercial |
$162.89
|
| Rate for Payer: PHCS All Commercial |
$152.74
|
| Rate for Payer: PHP All Commercial |
$154.45
|
| Rate for Payer: PHP All Commercial |
$164.72
|
| Rate for Payer: Sagamore Health Network All Products |
$167.67
|
| Rate for Payer: Sagamore Health Network All Products |
$157.22
|
| Rate for Payer: Signature Care EPO |
$180.27
|
| Rate for Payer: Signature Care EPO |
$169.03
|
| Rate for Payer: Signature Care PPO |
$179.21
|
| Rate for Payer: Signature Care PPO |
$191.13
|
| Rate for Payer: United Healthcare Commercial |
$160.48
|
| Rate for Payer: United Healthcare Commercial |
$171.14
|
|
|
ERTAPENEM 1 G INJ SOLR
|
Facility
OP
|
$217.19
|
|
|
Service Code
|
HCPCS J1335
|
| Hospital Charge Code |
31922
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$201.99 |
| Rate for Payer: Aetna Commercial |
$183.31
|
| Rate for Payer: Aetna Commercial |
$171.88
|
| Rate for Payer: Aetna Medicare |
$71.67
|
| Rate for Payer: Aetna Medicare |
$67.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$124.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$116.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$135.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$127.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$21.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$21.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$73.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$78.84
|
| Rate for Payer: Cash Price |
$134.66
|
| Rate for Payer: Cash Price |
$126.26
|
| Rate for Payer: Cash Price |
$126.26
|
| Rate for Payer: Cash Price |
$134.66
|
| Rate for Payer: Centivo All Commercial |
$110.77
|
| Rate for Payer: Centivo All Commercial |
$103.86
|
| Rate for Payer: Cigna All Commercial |
$175.75
|
| Rate for Payer: Cigna All Commercial |
$187.43
|
| Rate for Payer: CORVEL All Commercial |
$201.99
|
| Rate for Payer: CORVEL All Commercial |
$189.40
|
| Rate for Payer: Coventry All Commercial |
$191.13
|
| Rate for Payer: Coventry All Commercial |
$179.21
|
| Rate for Payer: Encore All Commercial |
$199.92
|
| Rate for Payer: Encore All Commercial |
$187.46
|
| Rate for Payer: Frontpath All Commercial |
$199.81
|
| Rate for Payer: Frontpath All Commercial |
$187.36
|
| Rate for Payer: Humana ChoiceCare |
$187.59
|
| Rate for Payer: Humana ChoiceCare |
$175.89
|
| Rate for Payer: Humana Medicare |
$110.77
|
| Rate for Payer: Humana Medicare |
$103.86
|
| Rate for Payer: Lucent All Commercial |
$103.86
|
| Rate for Payer: Lucent All Commercial |
$110.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$195.47
|
| Rate for Payer: Managed Health Services Medicaid |
$21.00
|
| Rate for Payer: Managed Health Services Medicaid |
$21.00
|
| Rate for Payer: MDWise Medicaid |
$21.00
|
| Rate for Payer: MDWise Medicaid |
$21.00
|
| Rate for Payer: PHCS All Commercial |
$152.74
|
| Rate for Payer: PHCS All Commercial |
$162.89
|
| Rate for Payer: PHP All Commercial |
$154.45
|
| Rate for Payer: PHP All Commercial |
$164.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.42
|
| Rate for Payer: Sagamore Health Network All Products |
$157.22
|
| Rate for Payer: Sagamore Health Network All Products |
$167.67
|
| Rate for Payer: Signature Care EPO |
$169.03
|
| Rate for Payer: Signature Care EPO |
$180.27
|
| Rate for Payer: Signature Care PPO |
$179.21
|
| Rate for Payer: Signature Care PPO |
$191.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$184.61
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$173.10
|
| Rate for Payer: United Healthcare Commercial |
$160.48
|
| Rate for Payer: United Healthcare Commercial |
$171.14
|
| Rate for Payer: United Healthcare Medicare |
$67.20
|
| Rate for Payer: United Healthcare Medicare |
$71.67
|
|
|
ERYTHROMYCIN 250 MG ORAL TBEC
|
Facility
IP
|
$36.10
|
|
|
Service Code
|
NDC 69238147103
|
| Hospital Charge Code |
110820
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$33.57 |
| Rate for Payer: Aetna Commercial |
$31.19
|
| Rate for Payer: Cash Price |
$22.38
|
| Rate for Payer: Cigna All Commercial |
$31.15
|
| Rate for Payer: CORVEL All Commercial |
$33.57
|
| Rate for Payer: Coventry All Commercial |
$31.77
|
| Rate for Payer: Encore All Commercial |
$33.23
|
| Rate for Payer: Frontpath All Commercial |
$33.21
|
| Rate for Payer: Humana ChoiceCare |
$31.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.49
|
| Rate for Payer: PHCS All Commercial |
$27.07
|
| Rate for Payer: PHP All Commercial |
$27.38
|
| Rate for Payer: Sagamore Health Network All Products |
$27.87
|
| Rate for Payer: Signature Care EPO |
$29.96
|
| Rate for Payer: Signature Care PPO |
$31.77
|
| Rate for Payer: United Healthcare Commercial |
$28.45
|
|
|
ERYTHROMYCIN 250 MG ORAL TBEC
|
Facility
OP
|
$36.10
|
|
|
Service Code
|
NDC 69238147103
|
| Hospital Charge Code |
110820
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$33.57 |
| Rate for Payer: Aetna Commercial |
$30.47
|
| Rate for Payer: Aetna Medicare |
$11.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.10
|
| Rate for Payer: Cash Price |
$22.38
|
| Rate for Payer: Centivo All Commercial |
$18.41
|
| Rate for Payer: Cigna All Commercial |
$31.15
|
| Rate for Payer: CORVEL All Commercial |
$33.57
|
| Rate for Payer: Coventry All Commercial |
$31.77
|
| Rate for Payer: Encore All Commercial |
$33.23
|
| Rate for Payer: Frontpath All Commercial |
$33.21
|
| Rate for Payer: Humana ChoiceCare |
$31.18
|
| Rate for Payer: Humana Medicare |
$18.41
|
| Rate for Payer: Lucent All Commercial |
$18.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$32.49
|
| Rate for Payer: PHCS All Commercial |
$27.07
|
| Rate for Payer: PHP All Commercial |
$27.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.08
|
| Rate for Payer: Sagamore Health Network All Products |
$27.87
|
| Rate for Payer: Signature Care EPO |
$29.96
|
| Rate for Payer: Signature Care PPO |
$31.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.68
|
| Rate for Payer: United Healthcare Commercial |
$28.45
|
| Rate for Payer: United Healthcare Medicare |
$11.91
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT
|
Facility
IP
|
$47.14
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$35.35 |
| Max. Negotiated Rate |
$43.84 |
| Rate for Payer: Aetna Commercial |
$40.73
|
| Rate for Payer: Cash Price |
$29.23
|
| Rate for Payer: Cigna All Commercial |
$40.68
|
| Rate for Payer: CORVEL All Commercial |
$43.84
|
| Rate for Payer: Coventry All Commercial |
$41.48
|
| Rate for Payer: Encore All Commercial |
$43.39
|
| Rate for Payer: Frontpath All Commercial |
$43.37
|
| Rate for Payer: Humana ChoiceCare |
$40.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.42
|
| Rate for Payer: PHCS All Commercial |
$35.35
|
| Rate for Payer: PHP All Commercial |
$35.75
|
| Rate for Payer: Sagamore Health Network All Products |
$36.39
|
| Rate for Payer: Signature Care EPO |
$39.12
|
| Rate for Payer: Signature Care PPO |
$41.48
|
| Rate for Payer: United Healthcare Commercial |
$37.14
|
|
|
ERYTHROMYCIN 5 MG/GRAM (0.5 %) OPHT OINT
|
Facility
OP
|
$47.14
|
|
|
Service Code
|
NDC 24208091019
|
| Hospital Charge Code |
2888
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$43.84 |
| Rate for Payer: Aetna Commercial |
$39.78
|
| Rate for Payer: Aetna Medicare |
$15.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$17.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.11
|
| Rate for Payer: Cash Price |
$29.23
|
| Rate for Payer: Centivo All Commercial |
$24.04
|
| Rate for Payer: Cigna All Commercial |
$40.68
|
| Rate for Payer: CORVEL All Commercial |
$43.84
|
| Rate for Payer: Coventry All Commercial |
$41.48
|
| Rate for Payer: Encore All Commercial |
$43.39
|
| Rate for Payer: Frontpath All Commercial |
$43.37
|
| Rate for Payer: Humana ChoiceCare |
$40.71
|
| Rate for Payer: Humana Medicare |
$24.04
|
| Rate for Payer: Lucent All Commercial |
$24.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.42
|
| Rate for Payer: PHCS All Commercial |
$35.35
|
| Rate for Payer: PHP All Commercial |
$35.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18.38
|
| Rate for Payer: Sagamore Health Network All Products |
$36.39
|
| Rate for Payer: Signature Care EPO |
$39.12
|
| Rate for Payer: Signature Care PPO |
$41.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.07
|
| Rate for Payer: United Healthcare Commercial |
$37.14
|
| Rate for Payer: United Healthcare Medicare |
$15.56
|
|
|
ESMOLOL 100 MG/10 ML (10 MG/ML) IV SOLN
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
9957
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.55
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
|
|
ESMOLOL 100 MG/10 ML (10 MG/ML) IV SOLN
|
Facility
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J1805
|
| Hospital Charge Code |
9957
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.53
|
| Rate for Payer: Cash Price |
$11.16
|
| Rate for Payer: Centivo All Commercial |
$9.18
|
| Rate for Payer: Cigna All Commercial |
$15.53
|
| Rate for Payer: CORVEL All Commercial |
$16.74
|
| Rate for Payer: Coventry All Commercial |
$15.84
|
| Rate for Payer: Encore All Commercial |
$16.57
|
| Rate for Payer: Frontpath All Commercial |
$16.56
|
| Rate for Payer: Humana ChoiceCare |
$15.55
|
| Rate for Payer: Humana Medicare |
$9.18
|
| Rate for Payer: Lucent All Commercial |
$9.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.20
|
| Rate for Payer: PHCS All Commercial |
$13.50
|
| Rate for Payer: PHP All Commercial |
$13.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.02
|
| Rate for Payer: Sagamore Health Network All Products |
$13.90
|
| Rate for Payer: Signature Care EPO |
$14.94
|
| Rate for Payer: Signature Care PPO |
$15.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$14.18
|
| Rate for Payer: United Healthcare Medicare |
$5.94
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)
|
Facility
OP
|
$2,273.62
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
CPT-43235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,273.62 |
| Max. Negotiated Rate |
$2,273.62 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,273.62
|
| Rate for Payer: Managed Health Services Medicaid |
$2,273.62
|
| Rate for Payer: MDWise Medicaid |
$2,273.62
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple
|
Facility
OP
|
$2,273.62
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
CPT-43239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,273.62 |
| Max. Negotiated Rate |
$2,273.62 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2,273.62
|
| Rate for Payer: Managed Health Services Medicaid |
$2,273.62
|
| Rate for Payer: MDWise Medicaid |
$2,273.62
|
|
|
Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube
|
Facility
OP
|
$4,315.74
|
|
|
Service Code
|
CPT 43246
|
| Hospital Charge Code |
CPT-43246
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,315.74 |
| Max. Negotiated Rate |
$4,315.74 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4,315.74
|
| Rate for Payer: Managed Health Services Medicaid |
$4,315.74
|
| Rate for Payer: MDWise Medicaid |
$4,315.74
|
|
