|
HYDROMORPHONE 6 MG/30 ML (0.2 MG/ML) PCA (CAMERON)
|
Facility
OP
|
$104.58
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
1401000152453
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$97.26 |
| Rate for Payer: Aetna Commercial |
$88.27
|
| Rate for Payer: Aetna Medicare |
$34.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.96
|
| Rate for Payer: Cash Price |
$64.84
|
| Rate for Payer: Centivo All Commercial |
$53.34
|
| Rate for Payer: Cigna All Commercial |
$90.25
|
| Rate for Payer: CORVEL All Commercial |
$97.26
|
| Rate for Payer: Coventry All Commercial |
$92.03
|
| Rate for Payer: Encore All Commercial |
$96.27
|
| Rate for Payer: Frontpath All Commercial |
$96.21
|
| Rate for Payer: Humana ChoiceCare |
$90.33
|
| Rate for Payer: Humana Medicare |
$53.34
|
| Rate for Payer: Lucent All Commercial |
$53.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.12
|
| Rate for Payer: PHCS All Commercial |
$78.44
|
| Rate for Payer: PHP All Commercial |
$79.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.79
|
| Rate for Payer: Sagamore Health Network All Products |
$80.74
|
| Rate for Payer: Signature Care EPO |
$86.80
|
| Rate for Payer: Signature Care PPO |
$92.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$88.89
|
| Rate for Payer: United Healthcare Commercial |
$82.41
|
| Rate for Payer: United Healthcare Medicare |
$34.51
|
|
|
HYDROMORPHONE (PF) 0.5 MG/0.5 ML INJ SYRG
|
Facility
OP
|
$27.60
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
180106
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.11 |
| Max. Negotiated Rate |
$25.67 |
| Rate for Payer: Aetna Commercial |
$23.30
|
| Rate for Payer: Aetna Medicare |
$9.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$15.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.02
|
| Rate for Payer: Cash Price |
$17.11
|
| Rate for Payer: Centivo All Commercial |
$14.08
|
| Rate for Payer: Cigna All Commercial |
$23.82
|
| Rate for Payer: CORVEL All Commercial |
$25.67
|
| Rate for Payer: Coventry All Commercial |
$24.29
|
| Rate for Payer: Encore All Commercial |
$25.41
|
| Rate for Payer: Frontpath All Commercial |
$25.39
|
| Rate for Payer: Humana ChoiceCare |
$23.84
|
| Rate for Payer: Humana Medicare |
$14.08
|
| Rate for Payer: Lucent All Commercial |
$14.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.84
|
| Rate for Payer: PHCS All Commercial |
$20.70
|
| Rate for Payer: PHP All Commercial |
$20.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$10.76
|
| Rate for Payer: Sagamore Health Network All Products |
$21.31
|
| Rate for Payer: Signature Care EPO |
$22.91
|
| Rate for Payer: Signature Care PPO |
$24.29
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$23.46
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
| Rate for Payer: United Healthcare Medicare |
$9.11
|
|
|
HYDROMORPHONE (PF) 0.5 MG/0.5 ML INJ SYRG
|
Facility
IP
|
$27.60
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
180106
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$20.70 |
| Max. Negotiated Rate |
$25.67 |
| Rate for Payer: Aetna Commercial |
$23.85
|
| Rate for Payer: Cash Price |
$17.11
|
| Rate for Payer: Cigna All Commercial |
$23.82
|
| Rate for Payer: CORVEL All Commercial |
$25.67
|
| Rate for Payer: Coventry All Commercial |
$24.29
|
| Rate for Payer: Encore All Commercial |
$25.41
|
| Rate for Payer: Frontpath All Commercial |
$25.39
|
| Rate for Payer: Humana ChoiceCare |
$23.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$24.84
|
| Rate for Payer: PHCS All Commercial |
$20.70
|
| Rate for Payer: PHP All Commercial |
$20.93
|
| Rate for Payer: Sagamore Health Network All Products |
$21.31
|
| Rate for Payer: Signature Care EPO |
$22.91
|
| Rate for Payer: Signature Care PPO |
$24.29
|
| Rate for Payer: United Healthcare Commercial |
$21.75
|
|
|
HYDROMORPHONE (PF)-0.9 % NACL 6 MG/30 ML (0.2 MG/ML) IV SPCA
|
Facility
OP
|
$104.58
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
157003
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$97.26 |
| Rate for Payer: Aetna Commercial |
$88.27
|
| Rate for Payer: Aetna Medicare |
$34.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$60.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.96
|
| Rate for Payer: Cash Price |
$64.84
|
| Rate for Payer: Centivo All Commercial |
$53.34
|
| Rate for Payer: Cigna All Commercial |
$90.25
|
| Rate for Payer: CORVEL All Commercial |
$97.26
|
| Rate for Payer: Coventry All Commercial |
$92.03
|
| Rate for Payer: Encore All Commercial |
$96.27
|
| Rate for Payer: Frontpath All Commercial |
$96.21
|
| Rate for Payer: Humana ChoiceCare |
$90.33
|
| Rate for Payer: Humana Medicare |
$53.34
|
| Rate for Payer: Lucent All Commercial |
$53.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.12
|
| Rate for Payer: PHCS All Commercial |
$78.44
|
| Rate for Payer: PHP All Commercial |
$79.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.79
|
| Rate for Payer: Sagamore Health Network All Products |
$80.74
|
| Rate for Payer: Signature Care EPO |
$86.80
|
| Rate for Payer: Signature Care PPO |
$92.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$88.89
|
| Rate for Payer: United Healthcare Commercial |
$82.41
|
| Rate for Payer: United Healthcare Medicare |
$34.51
|
|
|
HYDROMORPHONE (PF)-0.9 % NACL 6 MG/30 ML (0.2 MG/ML) IV SPCA
|
Facility
IP
|
$104.58
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
157003
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$78.44 |
| Max. Negotiated Rate |
$97.26 |
| Rate for Payer: Aetna Commercial |
$90.36
|
| Rate for Payer: Cash Price |
$64.84
|
| Rate for Payer: Cigna All Commercial |
$90.25
|
| Rate for Payer: CORVEL All Commercial |
$97.26
|
| Rate for Payer: Coventry All Commercial |
$92.03
|
| Rate for Payer: Encore All Commercial |
$96.27
|
| Rate for Payer: Frontpath All Commercial |
$96.21
|
| Rate for Payer: Humana ChoiceCare |
$90.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$94.12
|
| Rate for Payer: PHCS All Commercial |
$78.44
|
| Rate for Payer: PHP All Commercial |
$79.31
|
| Rate for Payer: Sagamore Health Network All Products |
$80.74
|
| Rate for Payer: Signature Care EPO |
$86.80
|
| Rate for Payer: Signature Care PPO |
$92.03
|
| Rate for Payer: United Healthcare Commercial |
$82.41
|
|
|
HYDROMORPHONE (PF) 1 MG/ML INJ SOLN
|
Facility
OP
|
$28.62
|
|
|
Service Code
|
NDC 63323085203
|
| Hospital Charge Code |
110971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$37.28 |
| Rate for Payer: Aetna Commercial |
$24.15
|
| Rate for Payer: Aetna Medicare |
$9.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$37.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.39
|
| Rate for Payer: Cash Price |
$17.74
|
| Rate for Payer: Cash Price |
$17.74
|
| Rate for Payer: Centivo All Commercial |
$14.59
|
| Rate for Payer: Cigna All Commercial |
$24.70
|
| Rate for Payer: CORVEL All Commercial |
$26.61
|
| Rate for Payer: Coventry All Commercial |
$25.18
|
| Rate for Payer: Encore All Commercial |
$26.34
|
| Rate for Payer: Frontpath All Commercial |
$26.33
|
| Rate for Payer: Humana ChoiceCare |
$24.72
|
| Rate for Payer: Humana Medicare |
$14.59
|
| Rate for Payer: Lucent All Commercial |
$14.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.75
|
| Rate for Payer: Managed Health Services Medicaid |
$37.28
|
| Rate for Payer: MDWise Medicaid |
$37.28
|
| Rate for Payer: PHCS All Commercial |
$21.46
|
| Rate for Payer: PHP All Commercial |
$21.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.16
|
| Rate for Payer: Sagamore Health Network All Products |
$22.09
|
| Rate for Payer: Signature Care EPO |
$23.75
|
| Rate for Payer: Signature Care PPO |
$25.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.32
|
| Rate for Payer: United Healthcare Commercial |
$22.55
|
| Rate for Payer: United Healthcare Medicare |
$9.44
|
|
|
HYDROMORPHONE (PF) 1 MG/ML INJ SOLN
|
Facility
IP
|
$28.62
|
|
|
Service Code
|
NDC 63323085203
|
| Hospital Charge Code |
110971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.46 |
| Max. Negotiated Rate |
$26.61 |
| Rate for Payer: Aetna Commercial |
$24.72
|
| Rate for Payer: Cash Price |
$17.74
|
| Rate for Payer: Cigna All Commercial |
$24.70
|
| Rate for Payer: CORVEL All Commercial |
$26.61
|
| Rate for Payer: Coventry All Commercial |
$25.18
|
| Rate for Payer: Encore All Commercial |
$26.34
|
| Rate for Payer: Frontpath All Commercial |
$26.33
|
| Rate for Payer: Humana ChoiceCare |
$24.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.75
|
| Rate for Payer: PHCS All Commercial |
$21.46
|
| Rate for Payer: PHP All Commercial |
$21.70
|
| Rate for Payer: Sagamore Health Network All Products |
$22.09
|
| Rate for Payer: Signature Care EPO |
$23.75
|
| Rate for Payer: Signature Care PPO |
$25.18
|
| Rate for Payer: United Healthcare Commercial |
$22.55
|
|
|
HYDROMORPHONE (PF) 1 MG/ML INJ SYRG
|
Facility
OP
|
$22.34
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
3757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.37 |
| Max. Negotiated Rate |
$20.78 |
| Rate for Payer: Aetna Commercial |
$18.86
|
| Rate for Payer: Aetna Medicare |
$7.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.11
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Centivo All Commercial |
$11.40
|
| Rate for Payer: Cigna All Commercial |
$19.28
|
| Rate for Payer: CORVEL All Commercial |
$20.78
|
| Rate for Payer: Coventry All Commercial |
$19.66
|
| Rate for Payer: Encore All Commercial |
$20.57
|
| Rate for Payer: Frontpath All Commercial |
$20.56
|
| Rate for Payer: Humana ChoiceCare |
$19.30
|
| Rate for Payer: Humana Medicare |
$11.40
|
| Rate for Payer: Lucent All Commercial |
$11.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.11
|
| Rate for Payer: PHCS All Commercial |
$16.76
|
| Rate for Payer: PHP All Commercial |
$16.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.71
|
| Rate for Payer: Sagamore Health Network All Products |
$17.25
|
| Rate for Payer: Signature Care EPO |
$18.55
|
| Rate for Payer: Signature Care PPO |
$19.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.99
|
| Rate for Payer: United Healthcare Commercial |
$17.61
|
| Rate for Payer: United Healthcare Medicare |
$7.37
|
|
|
HYDROMORPHONE (PF) 1 MG/ML INJ SYRG
|
Facility
IP
|
$22.34
|
|
|
Service Code
|
HCPCS J1170
|
| Hospital Charge Code |
3757
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$16.76 |
| Max. Negotiated Rate |
$20.78 |
| Rate for Payer: Aetna Commercial |
$19.31
|
| Rate for Payer: Cash Price |
$13.85
|
| Rate for Payer: Cigna All Commercial |
$19.28
|
| Rate for Payer: CORVEL All Commercial |
$20.78
|
| Rate for Payer: Coventry All Commercial |
$19.66
|
| Rate for Payer: Encore All Commercial |
$20.57
|
| Rate for Payer: Frontpath All Commercial |
$20.56
|
| Rate for Payer: Humana ChoiceCare |
$19.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.11
|
| Rate for Payer: PHCS All Commercial |
$16.76
|
| Rate for Payer: PHP All Commercial |
$16.95
|
| Rate for Payer: Sagamore Health Network All Products |
$17.25
|
| Rate for Payer: Signature Care EPO |
$18.55
|
| Rate for Payer: Signature Care PPO |
$19.66
|
| Rate for Payer: United Healthcare Commercial |
$17.61
|
|
|
HYDROXYCHLOROQUINE 200 MG ORAL TAB
|
Facility
OP
|
$5.89
|
|
|
Service Code
|
NDC 00904704606
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$5.48 |
| Rate for Payer: Aetna Commercial |
$4.97
|
| Rate for Payer: Aetna Medicare |
$1.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.14
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Centivo All Commercial |
$3.01
|
| Rate for Payer: Cigna All Commercial |
$5.09
|
| Rate for Payer: CORVEL All Commercial |
$5.48
|
| Rate for Payer: Coventry All Commercial |
$5.19
|
| Rate for Payer: Encore All Commercial |
$5.43
|
| Rate for Payer: Frontpath All Commercial |
$5.42
|
| Rate for Payer: Humana ChoiceCare |
$5.09
|
| Rate for Payer: Humana Medicare |
$3.01
|
| Rate for Payer: Lucent All Commercial |
$3.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.30
|
| Rate for Payer: PHCS All Commercial |
$4.42
|
| Rate for Payer: PHP All Commercial |
$4.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.30
|
| Rate for Payer: Sagamore Health Network All Products |
$4.55
|
| Rate for Payer: Signature Care EPO |
$4.89
|
| Rate for Payer: Signature Care PPO |
$5.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.01
|
| Rate for Payer: United Healthcare Commercial |
$4.64
|
| Rate for Payer: United Healthcare Medicare |
$1.95
|
|
|
HYDROXYCHLOROQUINE 200 MG ORAL TAB
|
Facility
IP
|
$5.89
|
|
|
Service Code
|
NDC 00904704606
|
| Hospital Charge Code |
10235
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$5.48 |
| Rate for Payer: Aetna Commercial |
$5.09
|
| Rate for Payer: Cash Price |
$3.65
|
| Rate for Payer: Cigna All Commercial |
$5.09
|
| Rate for Payer: CORVEL All Commercial |
$5.48
|
| Rate for Payer: Coventry All Commercial |
$5.19
|
| Rate for Payer: Encore All Commercial |
$5.43
|
| Rate for Payer: Frontpath All Commercial |
$5.42
|
| Rate for Payer: Humana ChoiceCare |
$5.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.30
|
| Rate for Payer: PHCS All Commercial |
$4.42
|
| Rate for Payer: PHP All Commercial |
$4.47
|
| Rate for Payer: Sagamore Health Network All Products |
$4.55
|
| Rate for Payer: Signature Care EPO |
$4.89
|
| Rate for Payer: Signature Care PPO |
$5.19
|
| Rate for Payer: United Healthcare Commercial |
$4.64
|
|
|
HYDROXYPROGEST(PF)(PREG PRESV) 275 MG/1.1 ML SUBQ ATIN
|
Facility
OP
|
$3,270.40
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
184036
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.66 |
| Max. Negotiated Rate |
$3,041.47 |
| Rate for Payer: Aetna Commercial |
$2,760.22
|
| Rate for Payer: Aetna Medicare |
$1,079.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,079.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,878.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,044.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$30.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,241.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,187.16
|
| Rate for Payer: Cash Price |
$2,027.65
|
| Rate for Payer: Cash Price |
$2,027.65
|
| Rate for Payer: Centivo All Commercial |
$1,667.90
|
| Rate for Payer: Cigna All Commercial |
$2,822.36
|
| Rate for Payer: CORVEL All Commercial |
$3,041.47
|
| Rate for Payer: Coventry All Commercial |
$2,877.95
|
| Rate for Payer: Encore All Commercial |
$3,010.40
|
| Rate for Payer: Frontpath All Commercial |
$3,008.77
|
| Rate for Payer: Humana ChoiceCare |
$2,824.64
|
| Rate for Payer: Humana Medicare |
$1,667.90
|
| Rate for Payer: Lucent All Commercial |
$1,667.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,943.36
|
| Rate for Payer: Managed Health Services Medicaid |
$30.66
|
| Rate for Payer: MDWise Medicaid |
$30.66
|
| Rate for Payer: PHCS All Commercial |
$2,452.80
|
| Rate for Payer: PHP All Commercial |
$2,480.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,275.46
|
| Rate for Payer: Sagamore Health Network All Products |
$2,524.75
|
| Rate for Payer: Signature Care EPO |
$2,714.43
|
| Rate for Payer: Signature Care PPO |
$2,877.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,779.84
|
| Rate for Payer: United Healthcare Commercial |
$2,577.08
|
| Rate for Payer: United Healthcare Medicare |
$1,079.23
|
|
|
HYDROXYPROGEST(PF)(PREG PRESV) 275 MG/1.1 ML SUBQ ATIN
|
Facility
IP
|
$3,270.40
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
184036
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2,452.80 |
| Max. Negotiated Rate |
$3,041.47 |
| Rate for Payer: Aetna Commercial |
$2,825.63
|
| Rate for Payer: Cash Price |
$2,027.65
|
| Rate for Payer: Cigna All Commercial |
$2,822.36
|
| Rate for Payer: CORVEL All Commercial |
$3,041.47
|
| Rate for Payer: Coventry All Commercial |
$2,877.95
|
| Rate for Payer: Encore All Commercial |
$3,010.40
|
| Rate for Payer: Frontpath All Commercial |
$3,008.77
|
| Rate for Payer: Humana ChoiceCare |
$2,824.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,943.36
|
| Rate for Payer: PHCS All Commercial |
$2,452.80
|
| Rate for Payer: PHP All Commercial |
$2,480.27
|
| Rate for Payer: Sagamore Health Network All Products |
$2,524.75
|
| Rate for Payer: Signature Care EPO |
$2,714.43
|
| Rate for Payer: Signature Care PPO |
$2,877.95
|
| Rate for Payer: United Healthcare Commercial |
$2,577.08
|
|
|
HYDROXYZINE HCL 10 MG ORAL TAB
|
Facility
IP
|
$1.13
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna Commercial |
$0.97
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Cigna All Commercial |
$0.97
|
| Rate for Payer: CORVEL All Commercial |
$1.05
|
| Rate for Payer: Coventry All Commercial |
$0.99
|
| Rate for Payer: Encore All Commercial |
$1.04
|
| Rate for Payer: Frontpath All Commercial |
$1.04
|
| Rate for Payer: Humana ChoiceCare |
$0.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.01
|
| Rate for Payer: PHCS All Commercial |
$0.85
|
| Rate for Payer: PHP All Commercial |
$0.85
|
| Rate for Payer: Sagamore Health Network All Products |
$0.87
|
| Rate for Payer: Signature Care EPO |
$0.94
|
| Rate for Payer: Signature Care PPO |
$0.99
|
| Rate for Payer: United Healthcare Commercial |
$0.89
|
|
|
HYDROXYZINE HCL 10 MG ORAL TAB
|
Facility
OP
|
$1.13
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
3772
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.37 |
| Max. Negotiated Rate |
$1.05 |
| Rate for Payer: Aetna Commercial |
$0.95
|
| Rate for Payer: Aetna Medicare |
$0.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.41
|
| Rate for Payer: Cash Price |
$0.70
|
| Rate for Payer: Centivo All Commercial |
$0.57
|
| Rate for Payer: Cigna All Commercial |
$0.97
|
| Rate for Payer: CORVEL All Commercial |
$1.05
|
| Rate for Payer: Coventry All Commercial |
$0.99
|
| Rate for Payer: Encore All Commercial |
$1.04
|
| Rate for Payer: Frontpath All Commercial |
$1.04
|
| Rate for Payer: Humana ChoiceCare |
$0.97
|
| Rate for Payer: Humana Medicare |
$0.57
|
| Rate for Payer: Lucent All Commercial |
$0.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.01
|
| Rate for Payer: PHCS All Commercial |
$0.85
|
| Rate for Payer: PHP All Commercial |
$0.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.44
|
| Rate for Payer: Sagamore Health Network All Products |
$0.87
|
| Rate for Payer: Signature Care EPO |
$0.94
|
| Rate for Payer: Signature Care PPO |
$0.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.96
|
| Rate for Payer: United Healthcare Commercial |
$0.89
|
| Rate for Payer: United Healthcare Medicare |
$0.37
|
|
|
HYDROXYZINE HCL 25 MG ORAL TAB
|
Facility
IP
|
$1.02
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna Commercial |
$0.88
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Cigna All Commercial |
$0.88
|
| Rate for Payer: CORVEL All Commercial |
$0.95
|
| Rate for Payer: Coventry All Commercial |
$0.90
|
| Rate for Payer: Encore All Commercial |
$0.94
|
| Rate for Payer: Frontpath All Commercial |
$0.94
|
| Rate for Payer: Humana ChoiceCare |
$0.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.92
|
| Rate for Payer: PHCS All Commercial |
$0.77
|
| Rate for Payer: PHP All Commercial |
$0.78
|
| Rate for Payer: Sagamore Health Network All Products |
$0.79
|
| Rate for Payer: Signature Care EPO |
$0.85
|
| Rate for Payer: Signature Care PPO |
$0.90
|
| Rate for Payer: United Healthcare Commercial |
$0.81
|
|
|
HYDROXYZINE HCL 25 MG ORAL TAB
|
Facility
OP
|
$1.02
|
|
|
Service Code
|
HCPCS J8499
|
| Hospital Charge Code |
3774
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$0.95 |
| Rate for Payer: Aetna Commercial |
$0.86
|
| Rate for Payer: Aetna Medicare |
$0.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.37
|
| Rate for Payer: Cash Price |
$0.63
|
| Rate for Payer: Centivo All Commercial |
$0.52
|
| Rate for Payer: Cigna All Commercial |
$0.88
|
| Rate for Payer: CORVEL All Commercial |
$0.95
|
| Rate for Payer: Coventry All Commercial |
$0.90
|
| Rate for Payer: Encore All Commercial |
$0.94
|
| Rate for Payer: Frontpath All Commercial |
$0.94
|
| Rate for Payer: Humana ChoiceCare |
$0.88
|
| Rate for Payer: Humana Medicare |
$0.52
|
| Rate for Payer: Lucent All Commercial |
$0.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.92
|
| Rate for Payer: PHCS All Commercial |
$0.77
|
| Rate for Payer: PHP All Commercial |
$0.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.40
|
| Rate for Payer: Sagamore Health Network All Products |
$0.79
|
| Rate for Payer: Signature Care EPO |
$0.85
|
| Rate for Payer: Signature Care PPO |
$0.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.87
|
| Rate for Payer: United Healthcare Commercial |
$0.81
|
| Rate for Payer: United Healthcare Medicare |
$0.34
|
|
|
HYDROXYZINE HCL 50 MG/ML IM SOLN
|
Facility
IP
|
$138.83
|
|
|
Service Code
|
HCPCS J3410
|
| Hospital Charge Code |
3770
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$104.12 |
| Max. Negotiated Rate |
$129.11 |
| Rate for Payer: Aetna Commercial |
$119.95
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Cigna All Commercial |
$119.81
|
| Rate for Payer: CORVEL All Commercial |
$129.11
|
| Rate for Payer: Coventry All Commercial |
$122.17
|
| Rate for Payer: Encore All Commercial |
$127.79
|
| Rate for Payer: Frontpath All Commercial |
$127.72
|
| Rate for Payer: Humana ChoiceCare |
$119.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.95
|
| Rate for Payer: PHCS All Commercial |
$104.12
|
| Rate for Payer: PHP All Commercial |
$105.29
|
| Rate for Payer: Sagamore Health Network All Products |
$107.18
|
| Rate for Payer: Signature Care EPO |
$115.23
|
| Rate for Payer: Signature Care PPO |
$122.17
|
| Rate for Payer: United Healthcare Commercial |
$109.40
|
|
|
HYDROXYZINE HCL 50 MG/ML IM SOLN
|
Facility
OP
|
$138.83
|
|
|
Service Code
|
HCPCS J3410
|
| Hospital Charge Code |
3770
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.81 |
| Max. Negotiated Rate |
$129.11 |
| Rate for Payer: Aetna Commercial |
$117.17
|
| Rate for Payer: Aetna Medicare |
$45.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$79.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$86.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.40
|
| Rate for Payer: Cash Price |
$86.08
|
| Rate for Payer: Centivo All Commercial |
$70.80
|
| Rate for Payer: Cigna All Commercial |
$119.81
|
| Rate for Payer: CORVEL All Commercial |
$129.11
|
| Rate for Payer: Coventry All Commercial |
$122.17
|
| Rate for Payer: Encore All Commercial |
$127.79
|
| Rate for Payer: Frontpath All Commercial |
$127.72
|
| Rate for Payer: Humana ChoiceCare |
$119.91
|
| Rate for Payer: Humana Medicare |
$70.80
|
| Rate for Payer: Lucent All Commercial |
$70.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$124.95
|
| Rate for Payer: PHCS All Commercial |
$104.12
|
| Rate for Payer: PHP All Commercial |
$105.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$54.14
|
| Rate for Payer: Sagamore Health Network All Products |
$107.18
|
| Rate for Payer: Signature Care EPO |
$115.23
|
| Rate for Payer: Signature Care PPO |
$122.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$118.01
|
| Rate for Payer: United Healthcare Commercial |
$109.40
|
| Rate for Payer: United Healthcare Medicare |
$45.81
|
|
|
HYLAN G-F 20 48 MG/6 ML IATC SYRG
|
Facility
OP
|
$4,546.77
|
|
|
Service Code
|
HCPCS j7325
|
| Hospital Charge Code |
120298
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,500.44 |
| Max. Negotiated Rate |
$4,228.50 |
| Rate for Payer: Aetna Commercial |
$3,837.48
|
| Rate for Payer: Aetna Medicare |
$1,500.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,500.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,611.21
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,842.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,725.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,650.48
|
| Rate for Payer: Cash Price |
$2,819.00
|
| Rate for Payer: Centivo All Commercial |
$2,318.85
|
| Rate for Payer: Cigna All Commercial |
$3,923.87
|
| Rate for Payer: CORVEL All Commercial |
$4,228.50
|
| Rate for Payer: Coventry All Commercial |
$4,001.16
|
| Rate for Payer: Encore All Commercial |
$4,185.30
|
| Rate for Payer: Frontpath All Commercial |
$4,183.03
|
| Rate for Payer: Humana ChoiceCare |
$3,927.05
|
| Rate for Payer: Humana Medicare |
$2,318.85
|
| Rate for Payer: Lucent All Commercial |
$2,318.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,092.10
|
| Rate for Payer: PHCS All Commercial |
$3,410.08
|
| Rate for Payer: PHP All Commercial |
$3,448.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,773.24
|
| Rate for Payer: Sagamore Health Network All Products |
$3,510.11
|
| Rate for Payer: Signature Care EPO |
$3,773.82
|
| Rate for Payer: Signature Care PPO |
$4,001.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,864.76
|
| Rate for Payer: United Healthcare Commercial |
$3,582.86
|
| Rate for Payer: United Healthcare Medicare |
$1,500.44
|
|
|
HYLAN G-F 20 48 MG/6 ML IATC SYRG
|
Facility
IP
|
$4,546.77
|
|
|
Service Code
|
HCPCS j7325
|
| Hospital Charge Code |
120298
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3,410.08 |
| Max. Negotiated Rate |
$4,228.50 |
| Rate for Payer: Aetna Commercial |
$3,928.41
|
| Rate for Payer: Cash Price |
$2,819.00
|
| Rate for Payer: Cigna All Commercial |
$3,923.87
|
| Rate for Payer: CORVEL All Commercial |
$4,228.50
|
| Rate for Payer: Coventry All Commercial |
$4,001.16
|
| Rate for Payer: Encore All Commercial |
$4,185.30
|
| Rate for Payer: Frontpath All Commercial |
$4,183.03
|
| Rate for Payer: Humana ChoiceCare |
$3,927.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,092.10
|
| Rate for Payer: PHCS All Commercial |
$3,410.08
|
| Rate for Payer: PHP All Commercial |
$3,448.27
|
| Rate for Payer: Sagamore Health Network All Products |
$3,510.11
|
| Rate for Payer: Signature Care EPO |
$3,773.82
|
| Rate for Payer: Signature Care PPO |
$4,001.16
|
| Rate for Payer: United Healthcare Commercial |
$3,582.86
|
|
|
Hymenotomy, simple incision
|
Facility
OP
|
$1,242.31
|
|
|
Service Code
|
CPT 56442
|
| Hospital Charge Code |
CPT-56442
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,242.31 |
| Max. Negotiated Rate |
$1,242.31 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,242.31
|
| Rate for Payer: Managed Health Services Medicaid |
$1,242.31
|
| Rate for Payer: MDWise Medicaid |
$1,242.31
|
|
|
HYOSCYAMINE SULFATE 0.125 MG SL SUBL
|
Facility
OP
|
$1.00
|
|
|
Service Code
|
NDC 47781001101
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.84
|
| Rate for Payer: Aetna Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$0.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.36
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Centivo All Commercial |
$0.51
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Humana Medicare |
$0.51
|
| Rate for Payer: Lucent All Commercial |
$0.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.39
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$0.85
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
| Rate for Payer: United Healthcare Medicare |
$0.33
|
|
|
HYOSCYAMINE SULFATE 0.125 MG SL SUBL
|
Facility
IP
|
$1.00
|
|
|
Service Code
|
NDC 47781001101
|
| Hospital Charge Code |
17023
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$0.93 |
| Rate for Payer: Aetna Commercial |
$0.86
|
| Rate for Payer: Cash Price |
$0.62
|
| Rate for Payer: Cigna All Commercial |
$0.86
|
| Rate for Payer: CORVEL All Commercial |
$0.93
|
| Rate for Payer: Coventry All Commercial |
$0.88
|
| Rate for Payer: Encore All Commercial |
$0.92
|
| Rate for Payer: Frontpath All Commercial |
$0.92
|
| Rate for Payer: Humana ChoiceCare |
$0.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.90
|
| Rate for Payer: PHCS All Commercial |
$0.75
|
| Rate for Payer: PHP All Commercial |
$0.76
|
| Rate for Payer: Sagamore Health Network All Products |
$0.77
|
| Rate for Payer: Signature Care EPO |
$0.83
|
| Rate for Payer: Signature Care PPO |
$0.88
|
| Rate for Payer: United Healthcare Commercial |
$0.79
|
|
|
Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation)
|
Facility
OP
|
$2,273.62
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
CPT-58563
|
|
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
|
|
