|
MORPHINE 4 MG/ML INJECTION S.O.
|
Facility
|
OP
|
$18.84
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
420601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.84 |
| Max. Negotiated Rate |
$17.52 |
| Rate for Payer: Aetna Commercial |
$15.90
|
| Rate for Payer: Aetna Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.63
|
| Rate for Payer: Cash Price |
$11.30
|
| Rate for Payer: Centivo All Commercial |
$10.25
|
| Rate for Payer: Cigna All Commercial |
$16.26
|
| Rate for Payer: CORVEL All Commercial |
$17.52
|
| Rate for Payer: Coventry All Commercial |
$16.58
|
| Rate for Payer: Encore All Commercial |
$17.34
|
| Rate for Payer: Frontpath All Commercial |
$17.33
|
| Rate for Payer: Humana ChoiceCare |
$16.27
|
| Rate for Payer: Humana Medicare |
$6.03
|
| Rate for Payer: Lucent All Commercial |
$10.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.95
|
| Rate for Payer: PHCS All Commercial |
$14.13
|
| Rate for Payer: PHP All Commercial |
$14.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$7.35
|
| Rate for Payer: Sagamore Health Network All Products |
$14.54
|
| Rate for Payer: Signature Care EPO |
$15.63
|
| Rate for Payer: Signature Care PPO |
$16.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16.01
|
| Rate for Payer: United Healthcare Commercial |
$14.84
|
| Rate for Payer: United Healthcare Medicare |
$6.03
|
|
|
MORPHINE 4 MG/ML INJECTION S.O.
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
420601
|
|
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 |
$10.80
|
| 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
|
|
|
MORPHINE 4 MG/ML INJECTION S.O.
|
Facility
|
IP
|
$18.84
|
|
|
Service Code
|
HCPCS J2272
|
| Hospital Charge Code |
420601
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$17.52 |
| Rate for Payer: Aetna Commercial |
$16.28
|
| Rate for Payer: Cash Price |
$11.30
|
| Rate for Payer: Cigna All Commercial |
$16.26
|
| Rate for Payer: CORVEL All Commercial |
$17.52
|
| Rate for Payer: Coventry All Commercial |
$16.58
|
| Rate for Payer: Encore All Commercial |
$17.34
|
| Rate for Payer: Frontpath All Commercial |
$17.33
|
| Rate for Payer: Humana ChoiceCare |
$16.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$16.95
|
| Rate for Payer: PHCS All Commercial |
$14.13
|
| Rate for Payer: PHP All Commercial |
$14.29
|
| Rate for Payer: Sagamore Health Network All Products |
$14.54
|
| Rate for Payer: Signature Care EPO |
$15.63
|
| Rate for Payer: Signature Care PPO |
$16.58
|
| Rate for Payer: United Healthcare Commercial |
$14.84
|
|
|
MORPHINE 4 MG/ML INJECTION S.O.
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
420601
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Centivo All Commercial |
$9.79
|
| 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 |
$5.76
|
| Rate for Payer: Lucent All Commercial |
$9.79
|
| 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 |
$5.76
|
|
|
MORPHINE 4 MG/ML IV SOLN
|
Facility
|
IP
|
$16.32
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
174484
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$15.18 |
| Rate for Payer: Aetna Commercial |
$14.10
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Cigna All Commercial |
$14.09
|
| Rate for Payer: CORVEL All Commercial |
$15.18
|
| Rate for Payer: Coventry All Commercial |
$14.37
|
| Rate for Payer: Encore All Commercial |
$15.03
|
| Rate for Payer: Frontpath All Commercial |
$15.02
|
| Rate for Payer: Humana ChoiceCare |
$14.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.69
|
| Rate for Payer: PHCS All Commercial |
$12.24
|
| Rate for Payer: PHP All Commercial |
$12.38
|
| Rate for Payer: Sagamore Health Network All Products |
$12.60
|
| Rate for Payer: Signature Care EPO |
$13.55
|
| Rate for Payer: Signature Care PPO |
$14.37
|
| Rate for Payer: United Healthcare Commercial |
$12.86
|
|
|
MORPHINE 4 MG/ML IV SOLN
|
Facility
|
OP
|
$16.32
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
174484
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$15.18 |
| Rate for Payer: Aetna Commercial |
$13.78
|
| Rate for Payer: Aetna Medicare |
$5.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.75
|
| Rate for Payer: Cash Price |
$9.79
|
| Rate for Payer: Centivo All Commercial |
$8.88
|
| Rate for Payer: Cigna All Commercial |
$14.09
|
| Rate for Payer: CORVEL All Commercial |
$15.18
|
| Rate for Payer: Coventry All Commercial |
$14.37
|
| Rate for Payer: Encore All Commercial |
$15.03
|
| Rate for Payer: Frontpath All Commercial |
$15.02
|
| Rate for Payer: Humana ChoiceCare |
$14.10
|
| Rate for Payer: Humana Medicare |
$5.22
|
| Rate for Payer: Lucent All Commercial |
$8.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.69
|
| Rate for Payer: PHCS All Commercial |
$12.24
|
| Rate for Payer: PHP All Commercial |
$12.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.37
|
| Rate for Payer: Sagamore Health Network All Products |
$12.60
|
| Rate for Payer: Signature Care EPO |
$13.55
|
| Rate for Payer: Signature Care PPO |
$14.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.88
|
| Rate for Payer: United Healthcare Commercial |
$12.86
|
| Rate for Payer: United Healthcare Medicare |
$5.22
|
|
|
MORPHINE 4 MG/ML IV SYRG
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
167700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$16.74 |
| Rate for Payer: Aetna Commercial |
$15.19
|
| Rate for Payer: Aetna Medicare |
$5.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$10.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.34
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Centivo All Commercial |
$9.79
|
| 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 |
$5.76
|
| Rate for Payer: Lucent All Commercial |
$9.79
|
| 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 |
$5.76
|
|
|
MORPHINE 4 MG/ML IV SYRG
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
167700
|
|
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 |
$10.80
|
| 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
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRG
|
Facility
|
OP
|
$20.53
|
|
|
Service Code
|
NDC 68094004501
|
| Hospital Charge Code |
187373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$19.09 |
| Rate for Payer: Aetna Commercial |
$17.33
|
| Rate for Payer: Aetna Medicare |
$6.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.23
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Centivo All Commercial |
$11.17
|
| Rate for Payer: Cigna All Commercial |
$17.72
|
| Rate for Payer: CORVEL All Commercial |
$19.09
|
| Rate for Payer: Coventry All Commercial |
$18.07
|
| Rate for Payer: Encore All Commercial |
$18.90
|
| Rate for Payer: Frontpath All Commercial |
$18.89
|
| Rate for Payer: Humana ChoiceCare |
$17.73
|
| Rate for Payer: Humana Medicare |
$6.57
|
| Rate for Payer: Lucent All Commercial |
$11.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.48
|
| Rate for Payer: PHCS All Commercial |
$15.40
|
| Rate for Payer: PHP All Commercial |
$15.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.01
|
| Rate for Payer: Sagamore Health Network All Products |
$15.85
|
| Rate for Payer: Signature Care EPO |
$17.04
|
| Rate for Payer: Signature Care PPO |
$18.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.45
|
| Rate for Payer: United Healthcare Commercial |
$16.18
|
| Rate for Payer: United Healthcare Medicare |
$6.57
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRG
|
Facility
|
IP
|
$20.53
|
|
|
Service Code
|
NDC 68094004558
|
| Hospital Charge Code |
187373
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$19.09 |
| Rate for Payer: Aetna Commercial |
$17.74
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Cigna All Commercial |
$17.72
|
| Rate for Payer: CORVEL All Commercial |
$19.09
|
| Rate for Payer: Coventry All Commercial |
$18.07
|
| Rate for Payer: Encore All Commercial |
$18.90
|
| Rate for Payer: Frontpath All Commercial |
$18.89
|
| Rate for Payer: Humana ChoiceCare |
$17.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.48
|
| Rate for Payer: PHCS All Commercial |
$15.40
|
| Rate for Payer: PHP All Commercial |
$15.57
|
| Rate for Payer: Sagamore Health Network All Products |
$15.85
|
| Rate for Payer: Signature Care EPO |
$17.04
|
| Rate for Payer: Signature Care PPO |
$18.07
|
| Rate for Payer: United Healthcare Commercial |
$16.18
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRG
|
Facility
|
IP
|
$20.53
|
|
|
Service Code
|
NDC 68094004501
|
| Hospital Charge Code |
187373
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$19.09 |
| Rate for Payer: Aetna Commercial |
$17.74
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Cigna All Commercial |
$17.72
|
| Rate for Payer: CORVEL All Commercial |
$19.09
|
| Rate for Payer: Coventry All Commercial |
$18.07
|
| Rate for Payer: Encore All Commercial |
$18.90
|
| Rate for Payer: Frontpath All Commercial |
$18.89
|
| Rate for Payer: Humana ChoiceCare |
$17.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.48
|
| Rate for Payer: PHCS All Commercial |
$15.40
|
| Rate for Payer: PHP All Commercial |
$15.57
|
| Rate for Payer: Sagamore Health Network All Products |
$15.85
|
| Rate for Payer: Signature Care EPO |
$17.04
|
| Rate for Payer: Signature Care PPO |
$18.07
|
| Rate for Payer: United Healthcare Commercial |
$16.18
|
|
|
MORPHINE CONCENTRATE 10 MG/0.5 ML ORAL SYRG
|
Facility
|
OP
|
$20.53
|
|
|
Service Code
|
NDC 68094004558
|
| Hospital Charge Code |
187373
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.36 |
| Max. Negotiated Rate |
$19.09 |
| Rate for Payer: Aetna Commercial |
$17.33
|
| Rate for Payer: Aetna Medicare |
$6.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$11.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$12.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.23
|
| Rate for Payer: Cash Price |
$12.32
|
| Rate for Payer: Centivo All Commercial |
$11.17
|
| Rate for Payer: Cigna All Commercial |
$17.72
|
| Rate for Payer: CORVEL All Commercial |
$19.09
|
| Rate for Payer: Coventry All Commercial |
$18.07
|
| Rate for Payer: Encore All Commercial |
$18.90
|
| Rate for Payer: Frontpath All Commercial |
$18.89
|
| Rate for Payer: Humana ChoiceCare |
$17.73
|
| Rate for Payer: Humana Medicare |
$6.57
|
| Rate for Payer: Lucent All Commercial |
$11.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.48
|
| Rate for Payer: PHCS All Commercial |
$15.40
|
| Rate for Payer: PHP All Commercial |
$15.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.01
|
| Rate for Payer: Sagamore Health Network All Products |
$15.85
|
| Rate for Payer: Signature Care EPO |
$17.04
|
| Rate for Payer: Signature Care PPO |
$18.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.45
|
| Rate for Payer: United Healthcare Commercial |
$16.18
|
| Rate for Payer: United Healthcare Medicare |
$6.57
|
|
|
MORPHINE (PF) 1 MG/ML INJ SOLN
|
Facility
|
OP
|
$56.35
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
15852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Aetna Commercial |
$47.56
|
| Rate for Payer: Aetna Medicare |
$18.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$32.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$35.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$20.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$19.84
|
| Rate for Payer: Cash Price |
$33.81
|
| Rate for Payer: Centivo All Commercial |
$30.65
|
| Rate for Payer: Cigna All Commercial |
$48.63
|
| Rate for Payer: CORVEL All Commercial |
$52.41
|
| Rate for Payer: Coventry All Commercial |
$49.59
|
| Rate for Payer: Encore All Commercial |
$51.87
|
| Rate for Payer: Frontpath All Commercial |
$51.84
|
| Rate for Payer: Humana ChoiceCare |
$48.67
|
| Rate for Payer: Humana Medicare |
$18.03
|
| Rate for Payer: Lucent All Commercial |
$30.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.72
|
| Rate for Payer: PHCS All Commercial |
$42.26
|
| Rate for Payer: PHP All Commercial |
$42.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.98
|
| Rate for Payer: Sagamore Health Network All Products |
$43.50
|
| Rate for Payer: Signature Care EPO |
$46.77
|
| Rate for Payer: Signature Care PPO |
$49.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.90
|
| Rate for Payer: United Healthcare Commercial |
$44.40
|
| Rate for Payer: United Healthcare Medicare |
$18.03
|
|
|
MORPHINE (PF) 1 MG/ML INJ SOLN
|
Facility
|
IP
|
$56.35
|
|
|
Service Code
|
HCPCS J2274
|
| Hospital Charge Code |
15852
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$42.26 |
| Max. Negotiated Rate |
$52.41 |
| Rate for Payer: Aetna Commercial |
$48.69
|
| Rate for Payer: Cash Price |
$33.81
|
| Rate for Payer: Cigna All Commercial |
$48.63
|
| Rate for Payer: CORVEL All Commercial |
$52.41
|
| Rate for Payer: Coventry All Commercial |
$49.59
|
| Rate for Payer: Encore All Commercial |
$51.87
|
| Rate for Payer: Frontpath All Commercial |
$51.84
|
| Rate for Payer: Humana ChoiceCare |
$48.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.72
|
| Rate for Payer: PHCS All Commercial |
$42.26
|
| Rate for Payer: PHP All Commercial |
$42.74
|
| Rate for Payer: Sagamore Health Network All Products |
$43.50
|
| Rate for Payer: Signature Care EPO |
$46.77
|
| Rate for Payer: Signature Care PPO |
$49.59
|
| Rate for Payer: United Healthcare Commercial |
$44.40
|
|
|
MORPHINE (PF) 30 MG/30 ML (1 MG/ML) IV PCAS
|
Facility
|
OP
|
$65.73
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
119818
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna Commercial |
$55.48
|
| Rate for Payer: Aetna Medicare |
$21.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$37.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.14
|
| Rate for Payer: Cash Price |
$39.44
|
| Rate for Payer: Centivo All Commercial |
$35.76
|
| Rate for Payer: Cigna All Commercial |
$56.72
|
| Rate for Payer: CORVEL All Commercial |
$61.13
|
| Rate for Payer: Coventry All Commercial |
$57.84
|
| Rate for Payer: Encore All Commercial |
$60.50
|
| Rate for Payer: Frontpath All Commercial |
$60.47
|
| Rate for Payer: Humana ChoiceCare |
$56.77
|
| Rate for Payer: Humana Medicare |
$21.03
|
| Rate for Payer: Lucent All Commercial |
$35.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.16
|
| Rate for Payer: PHCS All Commercial |
$49.30
|
| Rate for Payer: PHP All Commercial |
$49.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$25.63
|
| Rate for Payer: Sagamore Health Network All Products |
$50.74
|
| Rate for Payer: Signature Care EPO |
$54.56
|
| Rate for Payer: Signature Care PPO |
$57.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.87
|
| Rate for Payer: United Healthcare Commercial |
$51.80
|
| Rate for Payer: United Healthcare Medicare |
$21.03
|
|
|
MORPHINE (PF) 30 MG/30 ML (1 MG/ML) IV PCAS
|
Facility
|
IP
|
$65.73
|
|
|
Service Code
|
HCPCS J2270
|
| Hospital Charge Code |
119818
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$49.30 |
| Max. Negotiated Rate |
$61.13 |
| Rate for Payer: Aetna Commercial |
$56.79
|
| Rate for Payer: Cash Price |
$39.44
|
| Rate for Payer: Cigna All Commercial |
$56.72
|
| Rate for Payer: CORVEL All Commercial |
$61.13
|
| Rate for Payer: Coventry All Commercial |
$57.84
|
| Rate for Payer: Encore All Commercial |
$60.50
|
| Rate for Payer: Frontpath All Commercial |
$60.47
|
| Rate for Payer: Humana ChoiceCare |
$56.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.16
|
| Rate for Payer: PHCS All Commercial |
$49.30
|
| Rate for Payer: PHP All Commercial |
$49.85
|
| Rate for Payer: Sagamore Health Network All Products |
$50.74
|
| Rate for Payer: Signature Care EPO |
$54.56
|
| Rate for Payer: Signature Care PPO |
$57.84
|
| Rate for Payer: United Healthcare Commercial |
$51.80
|
|
|
MOXIFLOXACIN 0.5 % OPHT DROP
|
Facility
|
OP
|
$61.17
|
|
|
Service Code
|
NDC 68180042201
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.56 |
| Max. Negotiated Rate |
$56.89 |
| Rate for Payer: Aetna Commercial |
$51.63
|
| Rate for Payer: Aetna Medicare |
$19.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$35.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$38.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.53
|
| Rate for Payer: Cash Price |
$36.70
|
| Rate for Payer: Cash Price |
$36.70
|
| Rate for Payer: Centivo All Commercial |
$33.28
|
| Rate for Payer: Cigna All Commercial |
$52.79
|
| Rate for Payer: CORVEL All Commercial |
$56.89
|
| Rate for Payer: Coventry All Commercial |
$53.83
|
| Rate for Payer: Encore All Commercial |
$56.31
|
| Rate for Payer: Frontpath All Commercial |
$56.28
|
| Rate for Payer: Humana ChoiceCare |
$52.84
|
| Rate for Payer: Humana Medicare |
$19.58
|
| Rate for Payer: Lucent All Commercial |
$33.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.06
|
| Rate for Payer: Managed Health Services Medicaid |
$9.56
|
| Rate for Payer: MDWise Medicaid |
$9.56
|
| Rate for Payer: PHCS All Commercial |
$45.88
|
| Rate for Payer: PHP All Commercial |
$46.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.86
|
| Rate for Payer: Sagamore Health Network All Products |
$47.23
|
| Rate for Payer: Signature Care EPO |
$50.77
|
| Rate for Payer: Signature Care PPO |
$53.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52.00
|
| Rate for Payer: United Healthcare Commercial |
$48.20
|
| Rate for Payer: United Healthcare Medicare |
$19.58
|
|
|
MOXIFLOXACIN 0.5 % OPHT DROP
|
Facility
|
IP
|
$61.17
|
|
|
Service Code
|
NDC 68180042201
|
| Hospital Charge Code |
35699
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$45.88 |
| Max. Negotiated Rate |
$56.89 |
| Rate for Payer: Aetna Commercial |
$52.85
|
| Rate for Payer: Cash Price |
$36.70
|
| Rate for Payer: Cigna All Commercial |
$52.79
|
| Rate for Payer: CORVEL All Commercial |
$56.89
|
| Rate for Payer: Coventry All Commercial |
$53.83
|
| Rate for Payer: Encore All Commercial |
$56.31
|
| Rate for Payer: Frontpath All Commercial |
$56.28
|
| Rate for Payer: Humana ChoiceCare |
$52.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.06
|
| Rate for Payer: PHCS All Commercial |
$45.88
|
| Rate for Payer: PHP All Commercial |
$46.39
|
| Rate for Payer: Sagamore Health Network All Products |
$47.23
|
| Rate for Payer: Signature Care EPO |
$50.77
|
| Rate for Payer: Signature Care PPO |
$53.83
|
| Rate for Payer: United Healthcare Commercial |
$48.20
|
|
|
MS-DRG 42.00: ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY
|
Facility
|
IP
|
$11,092.48
|
|
|
Service Code
|
MSDRG 770
|
| Min. Negotiated Rate |
$6,055.28 |
| Max. Negotiated Rate |
$11,092.48 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$9,404.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11,092.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,055.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,908.60
|
|
|
MS-DRG 42.00: ABORTION WITHOUT D&C
|
Facility
|
IP
|
$9,636.85
|
|
|
Service Code
|
MSDRG 779
|
| Min. Negotiated Rate |
$5,260.66 |
| Max. Negotiated Rate |
$9,636.85 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,170.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,636.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,260.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,870.78
|
|
|
MS-DRG 42.00: ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
|
IP
|
$9,882.21
|
|
|
Service Code
|
MSDRG 880
|
| Min. Negotiated Rate |
$5,394.60 |
| Max. Negotiated Rate |
$9,882.21 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,378.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9,882.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,394.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,045.71
|
|
|
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
|
IP
|
$16,254.20
|
|
|
Service Code
|
MSDRG 289
|
| Min. Negotiated Rate |
$8,873.01 |
| Max. Negotiated Rate |
$16,254.20 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13,780.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16,254.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8,873.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,588.75
|
|
|
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
|
IP
|
$28,159.03
|
|
|
Service Code
|
MSDRG 288
|
| Min. Negotiated Rate |
$15,371.73 |
| Max. Negotiated Rate |
$28,159.03 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23,873.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28,159.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15,371.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20,076.53
|
|
|
MS-DRG 42.00: ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$10,092.51
|
|
|
Service Code
|
MSDRG 290
|
| Min. Negotiated Rate |
$5,509.40 |
| Max. Negotiated Rate |
$10,092.51 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8,556.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,092.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5,509.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,195.65
|
|
|
MS-DRG 42.00: ACUTE LEUKEMIA WITH CC
|
Facility
|
IP
|
$22,018.99
|
|
|
Service Code
|
MSDRG 835
|
| Min. Negotiated Rate |
$12,019.95 |
| Max. Negotiated Rate |
$22,018.99 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$18,667.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22,018.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12,019.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,698.86
|
|
