|
INPATIENT MSDRG 987: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
IP
|
$32,563.46
|
|
|
Service Code
|
MS-DRG 987
|
| Hospital Charge Code |
MSDRG 987
|
| Min. Negotiated Rate |
$18,674.56 |
| Max. Negotiated Rate |
$32,563.46 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27,605.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$32,563.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$18,674.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24,390.24
|
|
|
INPATIENT MSDRG 988: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
IP
|
$16,646.77
|
|
|
Service Code
|
MS-DRG 988
|
| Hospital Charge Code |
MSDRG 988
|
| Min. Negotiated Rate |
$9,546.63 |
| Max. Negotiated Rate |
$16,646.77 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14,112.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16,646.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9,546.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,468.54
|
|
|
INPATIENT MSDRG 989: NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
IP
|
$10,817.85
|
|
|
Service Code
|
MS-DRG 989
|
| Hospital Charge Code |
MSDRG 989
|
| Min. Negotiated Rate |
$6,203.84 |
| Max. Negotiated Rate |
$10,817.85 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9,170.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10,817.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6,203.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,102.64
|
|
|
Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach
|
Facility
OP
|
$8,683.74
|
|
|
Service Code
|
CPT 66183
|
| Hospital Charge Code |
CPT-66183
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,683.74 |
| Max. Negotiated Rate |
$8,683.74 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8,683.74
|
| Rate for Payer: Managed Health Services Medicaid |
$8,683.74
|
| Rate for Payer: MDWise Medicaid |
$8,683.74
|
|
|
Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal
|
Facility
OP
|
$4,211.34
|
|
|
Service Code
|
CPT 66985
|
| Hospital Charge Code |
CPT-66985
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,211.34 |
| Max. Negotiated Rate |
$4,211.34 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4,211.34
|
| Rate for Payer: Managed Health Services Medicaid |
$4,211.34
|
| Rate for Payer: MDWise Medicaid |
$4,211.34
|
|
|
Insertion of intrauterine device (IUD)
|
Facility
OP
|
$648.18
|
|
|
Service Code
|
CPT 58300
|
| Hospital Charge Code |
CPT-58300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$648.18 |
| Max. Negotiated Rate |
$648.18 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$648.18
|
| Rate for Payer: Managed Health Services Medicaid |
$648.18
|
| Rate for Payer: MDWise Medicaid |
$648.18
|
|
|
Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular
|
Facility
OP
|
$8,683.74
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
CPT-33208
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,683.74 |
| Max. Negotiated Rate |
$8,683.74 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8,683.74
|
| Rate for Payer: Managed Health Services Medicaid |
$8,683.74
|
| Rate for Payer: MDWise Medicaid |
$8,683.74
|
|
|
Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular
|
Facility
OP
|
$8,683.74
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
CPT-33207
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,683.74 |
| Max. Negotiated Rate |
$8,683.74 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8,683.74
|
| Rate for Payer: Managed Health Services Medicaid |
$8,683.74
|
| Rate for Payer: MDWise Medicaid |
$8,683.74
|
|
|
Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older
|
Facility
OP
|
$1,242.31
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
CPT-36556
|
|
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
|
|
|
Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of implantable defibrillator or pacemaker pulse generator (eg, for upgrade to dual chamber system) (List separately in addition to code for primary procedure)
|
Facility
OP
|
$2,273.62
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
CPT-33225
|
|
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
|
|
|
Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; age 5 years or older
|
Facility
OP
|
$4,211.34
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
CPT-36573
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,211.34 |
| Max. Negotiated Rate |
$4,211.34 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$4,211.34
|
| Rate for Payer: Managed Health Services Medicaid |
$4,211.34
|
| Rate for Payer: MDWise Medicaid |
$4,211.34
|
|
|
Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older
|
Facility
OP
|
$4,315.74
|
|
|
Service Code
|
CPT 36561
|
| Hospital Charge Code |
CPT-36561
|
|
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
|
|
|
Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber
|
Facility
OP
|
$13,051.74
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
CPT-33249
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13,051.74 |
| Max. Negotiated Rate |
$13,051.74 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13,051.74
|
| Rate for Payer: Managed Health Services Medicaid |
$13,051.74
|
| Rate for Payer: MDWise Medicaid |
$13,051.74
|
|
|
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN
|
Facility
IP
|
$171.53
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
114723
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$128.64 |
| Max. Negotiated Rate |
$159.52 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Cash Price |
$106.35
|
| Rate for Payer: Cigna All Commercial |
$148.03
|
| Rate for Payer: CORVEL All Commercial |
$159.52
|
| Rate for Payer: Coventry All Commercial |
$150.94
|
| Rate for Payer: Encore All Commercial |
$157.89
|
| Rate for Payer: Frontpath All Commercial |
$157.80
|
| Rate for Payer: Humana ChoiceCare |
$148.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.37
|
| Rate for Payer: PHCS All Commercial |
$128.64
|
| Rate for Payer: PHP All Commercial |
$130.08
|
| Rate for Payer: Sagamore Health Network All Products |
$132.42
|
| Rate for Payer: Signature Care EPO |
$142.37
|
| Rate for Payer: Signature Care PPO |
$150.94
|
| Rate for Payer: United Healthcare Commercial |
$135.16
|
|
|
INSULIN ASP PRT-INSULIN ASPART 100 UNIT/ML (70-30) SUBQ SOLN
|
Facility
OP
|
$171.53
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
114723
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$56.60 |
| Max. Negotiated Rate |
$159.52 |
| Rate for Payer: Aetna Commercial |
$144.77
|
| Rate for Payer: Aetna Medicare |
$56.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$56.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$98.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.26
|
| Rate for Payer: Cash Price |
$106.35
|
| Rate for Payer: Centivo All Commercial |
$87.48
|
| Rate for Payer: Cigna All Commercial |
$148.03
|
| Rate for Payer: CORVEL All Commercial |
$159.52
|
| Rate for Payer: Coventry All Commercial |
$150.94
|
| Rate for Payer: Encore All Commercial |
$157.89
|
| Rate for Payer: Frontpath All Commercial |
$157.80
|
| Rate for Payer: Humana ChoiceCare |
$148.15
|
| Rate for Payer: Humana Medicare |
$87.48
|
| Rate for Payer: Lucent All Commercial |
$87.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$154.37
|
| Rate for Payer: PHCS All Commercial |
$128.64
|
| Rate for Payer: PHP All Commercial |
$130.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$66.89
|
| Rate for Payer: Sagamore Health Network All Products |
$132.42
|
| Rate for Payer: Signature Care EPO |
$142.37
|
| Rate for Payer: Signature Care PPO |
$150.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$145.80
|
| Rate for Payer: United Healthcare Commercial |
$135.16
|
| Rate for Payer: United Healthcare Medicare |
$56.60
|
|
|
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN
|
Facility
OP
|
$64.00
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
118974
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$59.52 |
| Rate for Payer: Aetna Commercial |
$54.01
|
| Rate for Payer: Aetna Medicare |
$21.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$40.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.23
|
| Rate for Payer: Cash Price |
$39.68
|
| Rate for Payer: Centivo All Commercial |
$32.64
|
| Rate for Payer: Cigna All Commercial |
$55.23
|
| Rate for Payer: CORVEL All Commercial |
$59.52
|
| Rate for Payer: Coventry All Commercial |
$56.32
|
| Rate for Payer: Encore All Commercial |
$58.91
|
| Rate for Payer: Frontpath All Commercial |
$58.88
|
| Rate for Payer: Humana ChoiceCare |
$55.28
|
| Rate for Payer: Humana Medicare |
$32.64
|
| Rate for Payer: Lucent All Commercial |
$32.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.60
|
| Rate for Payer: PHCS All Commercial |
$48.00
|
| Rate for Payer: PHP All Commercial |
$48.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.96
|
| Rate for Payer: Sagamore Health Network All Products |
$49.41
|
| Rate for Payer: Signature Care EPO |
$53.12
|
| Rate for Payer: Signature Care PPO |
$56.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.40
|
| Rate for Payer: United Healthcare Commercial |
$50.43
|
| Rate for Payer: United Healthcare Medicare |
$21.12
|
|
|
INSULIN GLARGINE 100 UNIT/ML (3 ML) SUBQ INPN
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
118974
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$59.52 |
| Rate for Payer: Aetna Commercial |
$55.29
|
| Rate for Payer: Cash Price |
$39.68
|
| Rate for Payer: Cigna All Commercial |
$55.23
|
| Rate for Payer: CORVEL All Commercial |
$59.52
|
| Rate for Payer: Coventry All Commercial |
$56.32
|
| Rate for Payer: Encore All Commercial |
$58.91
|
| Rate for Payer: Frontpath All Commercial |
$58.88
|
| Rate for Payer: Humana ChoiceCare |
$55.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.60
|
| Rate for Payer: PHCS All Commercial |
$48.00
|
| Rate for Payer: PHP All Commercial |
$48.54
|
| Rate for Payer: Sagamore Health Network All Products |
$49.41
|
| Rate for Payer: Signature Care EPO |
$53.12
|
| Rate for Payer: Signature Care PPO |
$56.32
|
| Rate for Payer: United Healthcare Commercial |
$50.43
|
|
|
INSULIN LISPRO 100 UNITS/ML SUBQ SOLN
|
Facility
IP
|
$111.63
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
17405
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.72 |
| Max. Negotiated Rate |
$103.81 |
| Rate for Payer: Aetna Commercial |
$96.45
|
| Rate for Payer: Cash Price |
$69.21
|
| Rate for Payer: Cigna All Commercial |
$96.33
|
| Rate for Payer: CORVEL All Commercial |
$103.81
|
| Rate for Payer: Coventry All Commercial |
$98.23
|
| Rate for Payer: Encore All Commercial |
$102.75
|
| Rate for Payer: Frontpath All Commercial |
$102.70
|
| Rate for Payer: Humana ChoiceCare |
$96.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.46
|
| Rate for Payer: PHCS All Commercial |
$83.72
|
| Rate for Payer: PHP All Commercial |
$84.66
|
| Rate for Payer: Sagamore Health Network All Products |
$86.18
|
| Rate for Payer: Signature Care EPO |
$92.65
|
| Rate for Payer: Signature Care PPO |
$98.23
|
| Rate for Payer: United Healthcare Commercial |
$87.96
|
|
|
INSULIN LISPRO 100 UNITS/ML SUBQ SOLN
|
Facility
OP
|
$111.63
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
17405
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$36.84 |
| Max. Negotiated Rate |
$103.81 |
| Rate for Payer: Aetna Commercial |
$94.21
|
| Rate for Payer: Aetna Medicare |
$36.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$64.11
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$69.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.52
|
| Rate for Payer: Cash Price |
$69.21
|
| Rate for Payer: Centivo All Commercial |
$56.93
|
| Rate for Payer: Cigna All Commercial |
$96.33
|
| Rate for Payer: CORVEL All Commercial |
$103.81
|
| Rate for Payer: Coventry All Commercial |
$98.23
|
| Rate for Payer: Encore All Commercial |
$102.75
|
| Rate for Payer: Frontpath All Commercial |
$102.70
|
| Rate for Payer: Humana ChoiceCare |
$96.41
|
| Rate for Payer: Humana Medicare |
$56.93
|
| Rate for Payer: Lucent All Commercial |
$56.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.46
|
| Rate for Payer: PHCS All Commercial |
$83.72
|
| Rate for Payer: PHP All Commercial |
$84.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.53
|
| Rate for Payer: Sagamore Health Network All Products |
$86.18
|
| Rate for Payer: Signature Care EPO |
$92.65
|
| Rate for Payer: Signature Care PPO |
$98.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$94.88
|
| Rate for Payer: United Healthcare Commercial |
$87.96
|
| Rate for Payer: United Healthcare Medicare |
$36.84
|
|
|
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP
|
Facility
OP
|
$146.58
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
70693
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$48.37 |
| Max. Negotiated Rate |
$136.32 |
| Rate for Payer: Aetna Commercial |
$123.71
|
| Rate for Payer: Aetna Medicare |
$48.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$84.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$53.21
|
| Rate for Payer: Cash Price |
$90.88
|
| Rate for Payer: Centivo All Commercial |
$74.76
|
| Rate for Payer: Cigna All Commercial |
$126.50
|
| Rate for Payer: CORVEL All Commercial |
$136.32
|
| Rate for Payer: Coventry All Commercial |
$128.99
|
| Rate for Payer: Encore All Commercial |
$134.93
|
| Rate for Payer: Frontpath All Commercial |
$134.85
|
| Rate for Payer: Humana ChoiceCare |
$126.60
|
| Rate for Payer: Humana Medicare |
$74.76
|
| Rate for Payer: Lucent All Commercial |
$74.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.92
|
| Rate for Payer: PHCS All Commercial |
$109.94
|
| Rate for Payer: PHP All Commercial |
$111.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$57.17
|
| Rate for Payer: Sagamore Health Network All Products |
$113.16
|
| Rate for Payer: Signature Care EPO |
$121.66
|
| Rate for Payer: Signature Care PPO |
$128.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$124.59
|
| Rate for Payer: United Healthcare Commercial |
$115.51
|
| Rate for Payer: United Healthcare Medicare |
$48.37
|
|
|
INSULIN LISPRO PROTAMIN-LISPRO 100 UNIT/ML (75-25) SUBQ SUSP
|
Facility
IP
|
$146.58
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
70693
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$109.94 |
| Max. Negotiated Rate |
$136.32 |
| Rate for Payer: Aetna Commercial |
$126.65
|
| Rate for Payer: Cash Price |
$90.88
|
| Rate for Payer: Cigna All Commercial |
$126.50
|
| Rate for Payer: CORVEL All Commercial |
$136.32
|
| Rate for Payer: Coventry All Commercial |
$128.99
|
| Rate for Payer: Encore All Commercial |
$134.93
|
| Rate for Payer: Frontpath All Commercial |
$134.85
|
| Rate for Payer: Humana ChoiceCare |
$126.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.92
|
| Rate for Payer: PHCS All Commercial |
$109.94
|
| Rate for Payer: PHP All Commercial |
$111.17
|
| Rate for Payer: Sagamore Health Network All Products |
$113.16
|
| Rate for Payer: Signature Care EPO |
$121.66
|
| Rate for Payer: Signature Care PPO |
$128.99
|
| Rate for Payer: United Healthcare Commercial |
$115.51
|
|
|
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP
|
Facility
IP
|
$57.89
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10286
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$43.42 |
| Max. Negotiated Rate |
$53.84 |
| Rate for Payer: Aetna Commercial |
$50.02
|
| Rate for Payer: Cash Price |
$35.89
|
| Rate for Payer: Cigna All Commercial |
$49.96
|
| Rate for Payer: CORVEL All Commercial |
$53.84
|
| Rate for Payer: Coventry All Commercial |
$50.94
|
| Rate for Payer: Encore All Commercial |
$53.29
|
| Rate for Payer: Frontpath All Commercial |
$53.26
|
| Rate for Payer: Humana ChoiceCare |
$50.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.10
|
| Rate for Payer: PHCS All Commercial |
$43.42
|
| Rate for Payer: PHP All Commercial |
$43.90
|
| Rate for Payer: Sagamore Health Network All Products |
$44.69
|
| Rate for Payer: Signature Care EPO |
$48.05
|
| Rate for Payer: Signature Care PPO |
$50.94
|
| Rate for Payer: United Healthcare Commercial |
$45.62
|
|
|
INSULIN NPH AND REGULAR HUMAN 100 UNIT/ML (70-30) SUBQ SUSP
|
Facility
OP
|
$57.89
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10286
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$53.84 |
| Rate for Payer: Aetna Commercial |
$48.86
|
| Rate for Payer: Aetna Medicare |
$19.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.01
|
| Rate for Payer: Cash Price |
$35.89
|
| Rate for Payer: Centivo All Commercial |
$29.52
|
| Rate for Payer: Cigna All Commercial |
$49.96
|
| Rate for Payer: CORVEL All Commercial |
$53.84
|
| Rate for Payer: Coventry All Commercial |
$50.94
|
| Rate for Payer: Encore All Commercial |
$53.29
|
| Rate for Payer: Frontpath All Commercial |
$53.26
|
| Rate for Payer: Humana ChoiceCare |
$50.00
|
| Rate for Payer: Humana Medicare |
$29.52
|
| Rate for Payer: Lucent All Commercial |
$29.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.10
|
| Rate for Payer: PHCS All Commercial |
$43.42
|
| Rate for Payer: PHP All Commercial |
$43.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.58
|
| Rate for Payer: Sagamore Health Network All Products |
$44.69
|
| Rate for Payer: Signature Care EPO |
$48.05
|
| Rate for Payer: Signature Care PPO |
$50.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.21
|
| Rate for Payer: United Healthcare Commercial |
$45.62
|
| Rate for Payer: United Healthcare Medicare |
$19.10
|
|
|
INSULIN NPH ISOPH U-100 HUMAN 100 UNITS/ML SUBQ SUSP
|
Facility
OP
|
$49.67
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10284
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$46.19 |
| Rate for Payer: Aetna Commercial |
$41.92
|
| Rate for Payer: Aetna Medicare |
$16.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$16.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$31.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$18.03
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Centivo All Commercial |
$25.33
|
| Rate for Payer: Cigna All Commercial |
$42.86
|
| Rate for Payer: CORVEL All Commercial |
$46.19
|
| Rate for Payer: Coventry All Commercial |
$43.71
|
| Rate for Payer: Encore All Commercial |
$45.72
|
| Rate for Payer: Frontpath All Commercial |
$45.69
|
| Rate for Payer: Humana ChoiceCare |
$42.90
|
| Rate for Payer: Humana Medicare |
$25.33
|
| Rate for Payer: Lucent All Commercial |
$25.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.70
|
| Rate for Payer: PHCS All Commercial |
$37.25
|
| Rate for Payer: PHP All Commercial |
$37.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$19.37
|
| Rate for Payer: Sagamore Health Network All Products |
$38.34
|
| Rate for Payer: Signature Care EPO |
$41.22
|
| Rate for Payer: Signature Care PPO |
$43.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$42.22
|
| Rate for Payer: United Healthcare Commercial |
$39.14
|
| Rate for Payer: United Healthcare Medicare |
$16.39
|
|
|
INSULIN NPH ISOPH U-100 HUMAN 100 UNITS/ML SUBQ SUSP
|
Facility
IP
|
$49.67
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
10284
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.25 |
| Max. Negotiated Rate |
$46.19 |
| Rate for Payer: Aetna Commercial |
$42.91
|
| Rate for Payer: Cash Price |
$30.79
|
| Rate for Payer: Cigna All Commercial |
$42.86
|
| Rate for Payer: CORVEL All Commercial |
$46.19
|
| Rate for Payer: Coventry All Commercial |
$43.71
|
| Rate for Payer: Encore All Commercial |
$45.72
|
| Rate for Payer: Frontpath All Commercial |
$45.69
|
| Rate for Payer: Humana ChoiceCare |
$42.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$44.70
|
| Rate for Payer: PHCS All Commercial |
$37.25
|
| Rate for Payer: PHP All Commercial |
$37.67
|
| Rate for Payer: Sagamore Health Network All Products |
$38.34
|
| Rate for Payer: Signature Care EPO |
$41.22
|
| Rate for Payer: Signature Care PPO |
$43.71
|
| Rate for Payer: United Healthcare Commercial |
$39.14
|
|
