|
HC LEUKEMIA/LYMPHOMA - FLOW CYTOMETRY
|
Facility
IP
|
$140.25
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
63002066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.19 |
| Max. Negotiated Rate |
$130.43 |
| Rate for Payer: Aetna Commercial |
$121.18
|
| Rate for Payer: Cash Price |
$86.96
|
| Rate for Payer: Cigna All Commercial |
$121.04
|
| Rate for Payer: CORVEL All Commercial |
$130.43
|
| Rate for Payer: Coventry All Commercial |
$123.42
|
| Rate for Payer: Encore All Commercial |
$129.10
|
| Rate for Payer: Frontpath All Commercial |
$129.03
|
| Rate for Payer: Humana ChoiceCare |
$121.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$126.22
|
| Rate for Payer: PHCS All Commercial |
$105.19
|
| Rate for Payer: PHP All Commercial |
$106.37
|
| Rate for Payer: Sagamore Health Network All Products |
$108.27
|
| Rate for Payer: Signature Care EPO |
$116.41
|
| Rate for Payer: Signature Care PPO |
$123.42
|
| Rate for Payer: United Healthcare Commercial |
$110.52
|
|
|
HC LEVEL 1 PATH GROSS ONLY
|
Facility
OP
|
$145.86
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
63001248
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$135.65 |
| Rate for Payer: Aetna Commercial |
$123.11
|
| Rate for Payer: Aetna Medicare |
$48.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$48.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$91.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$38.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.95
|
| Rate for Payer: Cash Price |
$90.43
|
| Rate for Payer: Cash Price |
$90.43
|
| Rate for Payer: Centivo All Commercial |
$74.39
|
| Rate for Payer: Cigna All Commercial |
$125.88
|
| Rate for Payer: CORVEL All Commercial |
$135.65
|
| Rate for Payer: Coventry All Commercial |
$128.36
|
| Rate for Payer: Encore All Commercial |
$134.26
|
| Rate for Payer: Frontpath All Commercial |
$134.19
|
| Rate for Payer: Humana ChoiceCare |
$125.98
|
| Rate for Payer: Humana Medicare |
$74.39
|
| Rate for Payer: Lucent All Commercial |
$74.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.27
|
| Rate for Payer: Managed Health Services Medicaid |
$38.22
|
| Rate for Payer: MDWise Medicaid |
$38.22
|
| Rate for Payer: PHCS All Commercial |
$109.40
|
| Rate for Payer: PHP All Commercial |
$110.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.89
|
| Rate for Payer: Sagamore Health Network All Products |
$112.60
|
| Rate for Payer: Signature Care EPO |
$121.06
|
| Rate for Payer: Signature Care PPO |
$128.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.98
|
| Rate for Payer: United Healthcare Commercial |
$114.94
|
| Rate for Payer: United Healthcare Medicare |
$48.13
|
|
|
HC LEVEL 1 PATH GROSS ONLY
|
Facility
IP
|
$145.86
|
|
|
Service Code
|
CPT 88300
|
| Hospital Charge Code |
63001248
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$109.40 |
| Max. Negotiated Rate |
$135.65 |
| Rate for Payer: Aetna Commercial |
$126.02
|
| Rate for Payer: Cash Price |
$90.43
|
| Rate for Payer: Cigna All Commercial |
$125.88
|
| Rate for Payer: CORVEL All Commercial |
$135.65
|
| Rate for Payer: Coventry All Commercial |
$128.36
|
| Rate for Payer: Encore All Commercial |
$134.26
|
| Rate for Payer: Frontpath All Commercial |
$134.19
|
| Rate for Payer: Humana ChoiceCare |
$125.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$131.27
|
| Rate for Payer: PHCS All Commercial |
$109.40
|
| Rate for Payer: PHP All Commercial |
$110.62
|
| Rate for Payer: Sagamore Health Network All Products |
$112.60
|
| Rate for Payer: Signature Care EPO |
$121.06
|
| Rate for Payer: Signature Care PPO |
$128.36
|
| Rate for Payer: United Healthcare Commercial |
$114.94
|
|
|
HC LEVEL 1 VISIT EST
|
Facility
IP
|
$290.70
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
00527788
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$218.02 |
| Max. Negotiated Rate |
$270.35 |
| Rate for Payer: Aetna Commercial |
$251.16
|
| Rate for Payer: Cash Price |
$180.23
|
| Rate for Payer: Cigna All Commercial |
$250.87
|
| Rate for Payer: CORVEL All Commercial |
$270.35
|
| Rate for Payer: Coventry All Commercial |
$255.82
|
| Rate for Payer: Encore All Commercial |
$267.59
|
| Rate for Payer: Frontpath All Commercial |
$267.44
|
| Rate for Payer: Humana ChoiceCare |
$251.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$261.63
|
| Rate for Payer: PHCS All Commercial |
$218.02
|
| Rate for Payer: PHP All Commercial |
$220.47
|
| Rate for Payer: Sagamore Health Network All Products |
$224.42
|
| Rate for Payer: Signature Care EPO |
$241.28
|
| Rate for Payer: Signature Care PPO |
$255.82
|
| Rate for Payer: United Healthcare Commercial |
$229.07
|
|
|
HC LEVEL 1 VISIT EST
|
Facility
OP
|
$290.70
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
00527788
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.93 |
| Max. Negotiated Rate |
$270.35 |
| Rate for Payer: Aetna Commercial |
$245.35
|
| Rate for Payer: Aetna Medicare |
$95.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$166.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$181.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$159.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$110.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$105.52
|
| Rate for Payer: Cash Price |
$180.23
|
| Rate for Payer: Cash Price |
$180.23
|
| Rate for Payer: Centivo All Commercial |
$148.26
|
| Rate for Payer: Cigna All Commercial |
$250.87
|
| Rate for Payer: CORVEL All Commercial |
$270.35
|
| Rate for Payer: Coventry All Commercial |
$255.82
|
| Rate for Payer: Encore All Commercial |
$267.59
|
| Rate for Payer: Frontpath All Commercial |
$267.44
|
| Rate for Payer: Humana ChoiceCare |
$251.08
|
| Rate for Payer: Humana Medicare |
$148.26
|
| Rate for Payer: Lucent All Commercial |
$148.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$261.63
|
| Rate for Payer: Managed Health Services Medicaid |
$159.12
|
| Rate for Payer: MDWise Medicaid |
$159.12
|
| Rate for Payer: PHCS All Commercial |
$218.02
|
| Rate for Payer: PHP All Commercial |
$220.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$113.37
|
| Rate for Payer: Sagamore Health Network All Products |
$224.42
|
| Rate for Payer: Signature Care EPO |
$241.28
|
| Rate for Payer: Signature Care PPO |
$255.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$247.10
|
| Rate for Payer: United Healthcare Commercial |
$229.07
|
| Rate for Payer: United Healthcare Medicare |
$95.93
|
|
|
HC LEVEL 2 MICRO ID PATH
|
Facility
OP
|
$280.50
|
|
|
Service Code
|
CPT 88302 59
|
| Hospital Charge Code |
63002163
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.56 |
| Max. Negotiated Rate |
$260.86 |
| Rate for Payer: Aetna Commercial |
$236.74
|
| Rate for Payer: Aetna Medicare |
$92.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$161.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$175.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$106.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$101.82
|
| Rate for Payer: Cash Price |
$173.91
|
| Rate for Payer: Centivo All Commercial |
$143.06
|
| Rate for Payer: Cigna All Commercial |
$242.07
|
| Rate for Payer: CORVEL All Commercial |
$260.86
|
| Rate for Payer: Coventry All Commercial |
$246.84
|
| Rate for Payer: Encore All Commercial |
$258.20
|
| Rate for Payer: Frontpath All Commercial |
$258.06
|
| Rate for Payer: Humana ChoiceCare |
$242.27
|
| Rate for Payer: Humana Medicare |
$143.06
|
| Rate for Payer: Lucent All Commercial |
$143.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$252.45
|
| Rate for Payer: PHCS All Commercial |
$210.38
|
| Rate for Payer: PHP All Commercial |
$212.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.40
|
| Rate for Payer: Sagamore Health Network All Products |
$216.55
|
| Rate for Payer: Signature Care EPO |
$232.82
|
| Rate for Payer: Signature Care PPO |
$246.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$238.42
|
| Rate for Payer: United Healthcare Commercial |
$221.03
|
| Rate for Payer: United Healthcare Medicare |
$92.56
|
|
|
HC LEVEL 2 MICRO ID PATH
|
Facility
IP
|
$280.50
|
|
|
Service Code
|
CPT 88302 59
|
| Hospital Charge Code |
63002163
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$210.38 |
| Max. Negotiated Rate |
$260.86 |
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: Cash Price |
$173.91
|
| Rate for Payer: Cigna All Commercial |
$242.07
|
| Rate for Payer: CORVEL All Commercial |
$260.86
|
| Rate for Payer: Coventry All Commercial |
$246.84
|
| Rate for Payer: Encore All Commercial |
$258.20
|
| Rate for Payer: Frontpath All Commercial |
$258.06
|
| Rate for Payer: Humana ChoiceCare |
$242.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$252.45
|
| Rate for Payer: PHCS All Commercial |
$210.38
|
| Rate for Payer: PHP All Commercial |
$212.73
|
| Rate for Payer: Sagamore Health Network All Products |
$216.55
|
| Rate for Payer: Signature Care EPO |
$232.82
|
| Rate for Payer: Signature Care PPO |
$246.84
|
| Rate for Payer: United Healthcare Commercial |
$221.03
|
|
|
HC LEVEL 2 PATHOLOGY MICRO ID
|
Facility
OP
|
$280.50
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
63001256
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$62.99 |
| Max. Negotiated Rate |
$260.86 |
| Rate for Payer: Aetna Commercial |
$236.74
|
| Rate for Payer: Aetna Medicare |
$92.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$92.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$161.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$175.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$62.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$106.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$101.82
|
| Rate for Payer: Cash Price |
$173.91
|
| Rate for Payer: Cash Price |
$173.91
|
| Rate for Payer: Centivo All Commercial |
$143.06
|
| Rate for Payer: Cigna All Commercial |
$242.07
|
| Rate for Payer: CORVEL All Commercial |
$260.86
|
| Rate for Payer: Coventry All Commercial |
$246.84
|
| Rate for Payer: Encore All Commercial |
$258.20
|
| Rate for Payer: Frontpath All Commercial |
$258.06
|
| Rate for Payer: Humana ChoiceCare |
$242.27
|
| Rate for Payer: Humana Medicare |
$143.06
|
| Rate for Payer: Lucent All Commercial |
$143.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$252.45
|
| Rate for Payer: Managed Health Services Medicaid |
$62.99
|
| Rate for Payer: MDWise Medicaid |
$62.99
|
| Rate for Payer: PHCS All Commercial |
$210.38
|
| Rate for Payer: PHP All Commercial |
$212.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.40
|
| Rate for Payer: Sagamore Health Network All Products |
$216.55
|
| Rate for Payer: Signature Care EPO |
$232.82
|
| Rate for Payer: Signature Care PPO |
$246.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$238.42
|
| Rate for Payer: United Healthcare Commercial |
$221.03
|
| Rate for Payer: United Healthcare Medicare |
$92.56
|
|
|
HC LEVEL 2 PATHOLOGY MICRO ID
|
Facility
IP
|
$280.50
|
|
|
Service Code
|
CPT 88302
|
| Hospital Charge Code |
63001256
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$210.38 |
| Max. Negotiated Rate |
$260.86 |
| Rate for Payer: Aetna Commercial |
$242.35
|
| Rate for Payer: Cash Price |
$173.91
|
| Rate for Payer: Cigna All Commercial |
$242.07
|
| Rate for Payer: CORVEL All Commercial |
$260.86
|
| Rate for Payer: Coventry All Commercial |
$246.84
|
| Rate for Payer: Encore All Commercial |
$258.20
|
| Rate for Payer: Frontpath All Commercial |
$258.06
|
| Rate for Payer: Humana ChoiceCare |
$242.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$252.45
|
| Rate for Payer: PHCS All Commercial |
$210.38
|
| Rate for Payer: PHP All Commercial |
$212.73
|
| Rate for Payer: Sagamore Health Network All Products |
$216.55
|
| Rate for Payer: Signature Care EPO |
$232.82
|
| Rate for Payer: Signature Care PPO |
$246.84
|
| Rate for Payer: United Healthcare Commercial |
$221.03
|
|
|
HC LEVEL 3 PATH SMALL UNCOMPLICATED
|
Facility
IP
|
$386.29
|
|
|
Service Code
|
CPT 88304 59
|
| Hospital Charge Code |
63002165
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$289.72 |
| Max. Negotiated Rate |
$359.25 |
| Rate for Payer: Aetna Commercial |
$333.76
|
| Rate for Payer: Cash Price |
$239.50
|
| Rate for Payer: Cigna All Commercial |
$333.37
|
| Rate for Payer: CORVEL All Commercial |
$359.25
|
| Rate for Payer: Coventry All Commercial |
$339.94
|
| Rate for Payer: Encore All Commercial |
$355.58
|
| Rate for Payer: Frontpath All Commercial |
$355.39
|
| Rate for Payer: Humana ChoiceCare |
$333.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$347.66
|
| Rate for Payer: PHCS All Commercial |
$289.72
|
| Rate for Payer: PHP All Commercial |
$292.97
|
| Rate for Payer: Sagamore Health Network All Products |
$298.22
|
| Rate for Payer: Signature Care EPO |
$320.62
|
| Rate for Payer: Signature Care PPO |
$339.94
|
| Rate for Payer: United Healthcare Commercial |
$304.40
|
|
|
HC LEVEL 3 PATH SMALL UNCOMPLICATED
|
Facility
OP
|
$386.29
|
|
|
Service Code
|
CPT 88304 59
|
| Hospital Charge Code |
63002165
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$127.48 |
| Max. Negotiated Rate |
$359.25 |
| Rate for Payer: Aetna Commercial |
$326.03
|
| Rate for Payer: Aetna Medicare |
$127.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$127.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$221.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$241.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.22
|
| Rate for Payer: Cash Price |
$239.50
|
| Rate for Payer: Centivo All Commercial |
$197.01
|
| Rate for Payer: Cigna All Commercial |
$333.37
|
| Rate for Payer: CORVEL All Commercial |
$359.25
|
| Rate for Payer: Coventry All Commercial |
$339.94
|
| Rate for Payer: Encore All Commercial |
$355.58
|
| Rate for Payer: Frontpath All Commercial |
$355.39
|
| Rate for Payer: Humana ChoiceCare |
$333.64
|
| Rate for Payer: Humana Medicare |
$197.01
|
| Rate for Payer: Lucent All Commercial |
$197.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$347.66
|
| Rate for Payer: PHCS All Commercial |
$289.72
|
| Rate for Payer: PHP All Commercial |
$292.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.65
|
| Rate for Payer: Sagamore Health Network All Products |
$298.22
|
| Rate for Payer: Signature Care EPO |
$320.62
|
| Rate for Payer: Signature Care PPO |
$339.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$328.35
|
| Rate for Payer: United Healthcare Commercial |
$304.40
|
| Rate for Payer: United Healthcare Medicare |
$127.48
|
|
|
HC LEVEL 3 PATH SMALL UNCOMPLICATED
|
Facility
IP
|
$417.38
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
63001257
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$388.17 |
| Rate for Payer: Aetna Commercial |
$360.62
|
| Rate for Payer: Cash Price |
$258.78
|
| Rate for Payer: Cigna All Commercial |
$360.20
|
| Rate for Payer: CORVEL All Commercial |
$388.17
|
| Rate for Payer: Coventry All Commercial |
$367.30
|
| Rate for Payer: Encore All Commercial |
$384.20
|
| Rate for Payer: Frontpath All Commercial |
$383.99
|
| Rate for Payer: Humana ChoiceCare |
$360.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$375.65
|
| Rate for Payer: PHCS All Commercial |
$313.04
|
| Rate for Payer: PHP All Commercial |
$316.54
|
| Rate for Payer: Sagamore Health Network All Products |
$322.22
|
| Rate for Payer: Signature Care EPO |
$346.43
|
| Rate for Payer: Signature Care PPO |
$367.30
|
| Rate for Payer: United Healthcare Commercial |
$328.90
|
|
|
HC LEVEL 3 PATH SMALL UNCOMPLICATED
|
Facility
OP
|
$417.38
|
|
|
Service Code
|
CPT 88304
|
| Hospital Charge Code |
63001257
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$388.17 |
| Rate for Payer: Aetna Commercial |
$352.27
|
| Rate for Payer: Aetna Medicare |
$137.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$239.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$92.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$158.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.51
|
| Rate for Payer: Cash Price |
$258.78
|
| Rate for Payer: Cash Price |
$258.78
|
| Rate for Payer: Centivo All Commercial |
$212.87
|
| Rate for Payer: Cigna All Commercial |
$360.20
|
| Rate for Payer: CORVEL All Commercial |
$388.17
|
| Rate for Payer: Coventry All Commercial |
$367.30
|
| Rate for Payer: Encore All Commercial |
$384.20
|
| Rate for Payer: Frontpath All Commercial |
$383.99
|
| Rate for Payer: Humana ChoiceCare |
$360.49
|
| Rate for Payer: Humana Medicare |
$212.87
|
| Rate for Payer: Lucent All Commercial |
$212.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$375.65
|
| Rate for Payer: Managed Health Services Medicaid |
$92.00
|
| Rate for Payer: MDWise Medicaid |
$92.00
|
| Rate for Payer: PHCS All Commercial |
$313.04
|
| Rate for Payer: PHP All Commercial |
$316.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.78
|
| Rate for Payer: Sagamore Health Network All Products |
$322.22
|
| Rate for Payer: Signature Care EPO |
$346.43
|
| Rate for Payer: Signature Care PPO |
$367.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$354.78
|
| Rate for Payer: United Healthcare Commercial |
$328.90
|
| Rate for Payer: United Healthcare Medicare |
$137.74
|
|
|
HC LEVEL 4 COMPLICATED PATH X3
|
Facility
OP
|
$337.65
|
|
|
Service Code
|
CPT 88305 59
|
| Hospital Charge Code |
63002174
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$111.42 |
| Max. Negotiated Rate |
$314.02 |
| Rate for Payer: Aetna Commercial |
$284.98
|
| Rate for Payer: Aetna Medicare |
$111.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$193.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$211.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.57
|
| Rate for Payer: Cash Price |
$209.34
|
| Rate for Payer: Centivo All Commercial |
$172.20
|
| Rate for Payer: Cigna All Commercial |
$291.39
|
| Rate for Payer: CORVEL All Commercial |
$314.02
|
| Rate for Payer: Coventry All Commercial |
$297.13
|
| Rate for Payer: Encore All Commercial |
$310.81
|
| Rate for Payer: Frontpath All Commercial |
$310.64
|
| Rate for Payer: Humana ChoiceCare |
$291.63
|
| Rate for Payer: Humana Medicare |
$172.20
|
| Rate for Payer: Lucent All Commercial |
$172.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.89
|
| Rate for Payer: PHCS All Commercial |
$253.24
|
| Rate for Payer: PHP All Commercial |
$256.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.68
|
| Rate for Payer: Sagamore Health Network All Products |
$260.67
|
| Rate for Payer: Signature Care EPO |
$280.25
|
| Rate for Payer: Signature Care PPO |
$297.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$287.00
|
| Rate for Payer: United Healthcare Commercial |
$266.07
|
| Rate for Payer: United Healthcare Medicare |
$111.42
|
|
|
HC LEVEL 4 COMPLICATED PATH X3
|
Facility
IP
|
$337.65
|
|
|
Service Code
|
CPT 88305 59
|
| Hospital Charge Code |
63002174
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$253.24 |
| Max. Negotiated Rate |
$314.02 |
| Rate for Payer: Aetna Commercial |
$291.73
|
| Rate for Payer: Cash Price |
$209.34
|
| Rate for Payer: Cigna All Commercial |
$291.39
|
| Rate for Payer: CORVEL All Commercial |
$314.02
|
| Rate for Payer: Coventry All Commercial |
$297.13
|
| Rate for Payer: Encore All Commercial |
$310.81
|
| Rate for Payer: Frontpath All Commercial |
$310.64
|
| Rate for Payer: Humana ChoiceCare |
$291.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.89
|
| Rate for Payer: PHCS All Commercial |
$253.24
|
| Rate for Payer: PHP All Commercial |
$256.07
|
| Rate for Payer: Sagamore Health Network All Products |
$260.67
|
| Rate for Payer: Signature Care EPO |
$280.25
|
| Rate for Payer: Signature Care PPO |
$297.13
|
| Rate for Payer: United Healthcare Commercial |
$266.07
|
|
|
HC LEVEL 4 PATH COMPLICATED
|
Facility
IP
|
$337.65
|
|
|
Service Code
|
CPT 88305 59
|
| Hospital Charge Code |
63002171
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$253.24 |
| Max. Negotiated Rate |
$314.02 |
| Rate for Payer: Aetna Commercial |
$291.73
|
| Rate for Payer: Cash Price |
$209.34
|
| Rate for Payer: Cigna All Commercial |
$291.39
|
| Rate for Payer: CORVEL All Commercial |
$314.02
|
| Rate for Payer: Coventry All Commercial |
$297.13
|
| Rate for Payer: Encore All Commercial |
$310.81
|
| Rate for Payer: Frontpath All Commercial |
$310.64
|
| Rate for Payer: Humana ChoiceCare |
$291.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.89
|
| Rate for Payer: PHCS All Commercial |
$253.24
|
| Rate for Payer: PHP All Commercial |
$256.07
|
| Rate for Payer: Sagamore Health Network All Products |
$260.67
|
| Rate for Payer: Signature Care EPO |
$280.25
|
| Rate for Payer: Signature Care PPO |
$297.13
|
| Rate for Payer: United Healthcare Commercial |
$266.07
|
|
|
HC LEVEL 4 PATH COMPLICATED
|
Facility
OP
|
$337.65
|
|
|
Service Code
|
CPT 88305 59
|
| Hospital Charge Code |
63002171
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$111.42 |
| Max. Negotiated Rate |
$314.02 |
| Rate for Payer: Aetna Commercial |
$284.98
|
| Rate for Payer: Aetna Medicare |
$111.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$193.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$211.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.57
|
| Rate for Payer: Cash Price |
$209.34
|
| Rate for Payer: Centivo All Commercial |
$172.20
|
| Rate for Payer: Cigna All Commercial |
$291.39
|
| Rate for Payer: CORVEL All Commercial |
$314.02
|
| Rate for Payer: Coventry All Commercial |
$297.13
|
| Rate for Payer: Encore All Commercial |
$310.81
|
| Rate for Payer: Frontpath All Commercial |
$310.64
|
| Rate for Payer: Humana ChoiceCare |
$291.63
|
| Rate for Payer: Humana Medicare |
$172.20
|
| Rate for Payer: Lucent All Commercial |
$172.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.89
|
| Rate for Payer: PHCS All Commercial |
$253.24
|
| Rate for Payer: PHP All Commercial |
$256.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.68
|
| Rate for Payer: Sagamore Health Network All Products |
$260.67
|
| Rate for Payer: Signature Care EPO |
$280.25
|
| Rate for Payer: Signature Care PPO |
$297.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$287.00
|
| Rate for Payer: United Healthcare Commercial |
$266.07
|
| Rate for Payer: United Healthcare Medicare |
$111.42
|
|
|
HC LEVEL 4 PATH COMPLICATED
|
Facility
IP
|
$529.58
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
63001258
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$397.19 |
| Max. Negotiated Rate |
$492.51 |
| Rate for Payer: Aetna Commercial |
$457.56
|
| Rate for Payer: Cash Price |
$328.34
|
| Rate for Payer: Cigna All Commercial |
$457.03
|
| Rate for Payer: CORVEL All Commercial |
$492.51
|
| Rate for Payer: Coventry All Commercial |
$466.03
|
| Rate for Payer: Encore All Commercial |
$487.48
|
| Rate for Payer: Frontpath All Commercial |
$487.22
|
| Rate for Payer: Humana ChoiceCare |
$457.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$476.63
|
| Rate for Payer: PHCS All Commercial |
$397.19
|
| Rate for Payer: PHP All Commercial |
$401.64
|
| Rate for Payer: Sagamore Health Network All Products |
$408.84
|
| Rate for Payer: Signature Care EPO |
$439.55
|
| Rate for Payer: Signature Care PPO |
$466.03
|
| Rate for Payer: United Healthcare Commercial |
$417.31
|
|
|
HC LEVEL 4 PATH COMPLICATED
|
Facility
OP
|
$529.58
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
63001258
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$174.76 |
| Max. Negotiated Rate |
$492.51 |
| Rate for Payer: Aetna Commercial |
$446.97
|
| Rate for Payer: Aetna Medicare |
$174.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$174.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$304.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$331.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$277.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$200.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$192.24
|
| Rate for Payer: Cash Price |
$328.34
|
| Rate for Payer: Cash Price |
$328.34
|
| Rate for Payer: Centivo All Commercial |
$270.09
|
| Rate for Payer: Cigna All Commercial |
$457.03
|
| Rate for Payer: CORVEL All Commercial |
$492.51
|
| Rate for Payer: Coventry All Commercial |
$466.03
|
| Rate for Payer: Encore All Commercial |
$487.48
|
| Rate for Payer: Frontpath All Commercial |
$487.22
|
| Rate for Payer: Humana ChoiceCare |
$457.40
|
| Rate for Payer: Humana Medicare |
$270.09
|
| Rate for Payer: Lucent All Commercial |
$270.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$476.63
|
| Rate for Payer: Managed Health Services Medicaid |
$277.37
|
| Rate for Payer: MDWise Medicaid |
$277.37
|
| Rate for Payer: PHCS All Commercial |
$397.19
|
| Rate for Payer: PHP All Commercial |
$401.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$206.54
|
| Rate for Payer: Sagamore Health Network All Products |
$408.84
|
| Rate for Payer: Signature Care EPO |
$439.55
|
| Rate for Payer: Signature Care PPO |
$466.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$450.15
|
| Rate for Payer: United Healthcare Commercial |
$417.31
|
| Rate for Payer: United Healthcare Medicare |
$174.76
|
|
|
HC LEVEL 4 PATH COMPLICATED X4
|
Facility
OP
|
$337.65
|
|
|
Service Code
|
CPT 88305 59
|
| Hospital Charge Code |
63002176
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$111.42 |
| Max. Negotiated Rate |
$314.02 |
| Rate for Payer: Aetna Commercial |
$284.98
|
| Rate for Payer: Aetna Medicare |
$111.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$193.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$211.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.57
|
| Rate for Payer: Cash Price |
$209.34
|
| Rate for Payer: Centivo All Commercial |
$172.20
|
| Rate for Payer: Cigna All Commercial |
$291.39
|
| Rate for Payer: CORVEL All Commercial |
$314.02
|
| Rate for Payer: Coventry All Commercial |
$297.13
|
| Rate for Payer: Encore All Commercial |
$310.81
|
| Rate for Payer: Frontpath All Commercial |
$310.64
|
| Rate for Payer: Humana ChoiceCare |
$291.63
|
| Rate for Payer: Humana Medicare |
$172.20
|
| Rate for Payer: Lucent All Commercial |
$172.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.89
|
| Rate for Payer: PHCS All Commercial |
$253.24
|
| Rate for Payer: PHP All Commercial |
$256.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.68
|
| Rate for Payer: Sagamore Health Network All Products |
$260.67
|
| Rate for Payer: Signature Care EPO |
$280.25
|
| Rate for Payer: Signature Care PPO |
$297.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$287.00
|
| Rate for Payer: United Healthcare Commercial |
$266.07
|
| Rate for Payer: United Healthcare Medicare |
$111.42
|
|
|
HC LEVEL 4 PATH COMPLICATED X4
|
Facility
IP
|
$337.65
|
|
|
Service Code
|
CPT 88305 59
|
| Hospital Charge Code |
63002176
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$253.24 |
| Max. Negotiated Rate |
$314.02 |
| Rate for Payer: Aetna Commercial |
$291.73
|
| Rate for Payer: Cash Price |
$209.34
|
| Rate for Payer: Cigna All Commercial |
$291.39
|
| Rate for Payer: CORVEL All Commercial |
$314.02
|
| Rate for Payer: Coventry All Commercial |
$297.13
|
| Rate for Payer: Encore All Commercial |
$310.81
|
| Rate for Payer: Frontpath All Commercial |
$310.64
|
| Rate for Payer: Humana ChoiceCare |
$291.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.89
|
| Rate for Payer: PHCS All Commercial |
$253.24
|
| Rate for Payer: PHP All Commercial |
$256.07
|
| Rate for Payer: Sagamore Health Network All Products |
$260.67
|
| Rate for Payer: Signature Care EPO |
$280.25
|
| Rate for Payer: Signature Care PPO |
$297.13
|
| Rate for Payer: United Healthcare Commercial |
$266.07
|
|
|
HC LEVEL 5 COMPLEX PATH
|
Facility
OP
|
$885.26
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
63001259
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$292.14 |
| Max. Negotiated Rate |
$823.29 |
| Rate for Payer: Aetna Commercial |
$747.16
|
| Rate for Payer: Aetna Medicare |
$292.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$292.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$508.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$553.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$368.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$335.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$321.35
|
| Rate for Payer: Cash Price |
$548.86
|
| Rate for Payer: Cash Price |
$548.86
|
| Rate for Payer: Centivo All Commercial |
$451.48
|
| Rate for Payer: Cigna All Commercial |
$763.98
|
| Rate for Payer: CORVEL All Commercial |
$823.29
|
| Rate for Payer: Coventry All Commercial |
$779.03
|
| Rate for Payer: Encore All Commercial |
$814.88
|
| Rate for Payer: Frontpath All Commercial |
$814.44
|
| Rate for Payer: Humana ChoiceCare |
$764.60
|
| Rate for Payer: Humana Medicare |
$451.48
|
| Rate for Payer: Lucent All Commercial |
$451.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.73
|
| Rate for Payer: Managed Health Services Medicaid |
$368.36
|
| Rate for Payer: MDWise Medicaid |
$368.36
|
| Rate for Payer: PHCS All Commercial |
$663.94
|
| Rate for Payer: PHP All Commercial |
$671.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$345.25
|
| Rate for Payer: Sagamore Health Network All Products |
$683.42
|
| Rate for Payer: Signature Care EPO |
$734.76
|
| Rate for Payer: Signature Care PPO |
$779.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$752.47
|
| Rate for Payer: United Healthcare Commercial |
$697.58
|
| Rate for Payer: United Healthcare Medicare |
$292.14
|
|
|
HC LEVEL 5 COMPLEX PATH
|
Facility
IP
|
$885.26
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
63001259
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$663.94 |
| Max. Negotiated Rate |
$823.29 |
| Rate for Payer: Aetna Commercial |
$764.86
|
| Rate for Payer: Cash Price |
$548.86
|
| Rate for Payer: Cigna All Commercial |
$763.98
|
| Rate for Payer: CORVEL All Commercial |
$823.29
|
| Rate for Payer: Coventry All Commercial |
$779.03
|
| Rate for Payer: Encore All Commercial |
$814.88
|
| Rate for Payer: Frontpath All Commercial |
$814.44
|
| Rate for Payer: Humana ChoiceCare |
$764.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.73
|
| Rate for Payer: PHCS All Commercial |
$663.94
|
| Rate for Payer: PHP All Commercial |
$671.38
|
| Rate for Payer: Sagamore Health Network All Products |
$683.42
|
| Rate for Payer: Signature Care EPO |
$734.76
|
| Rate for Payer: Signature Care PPO |
$779.03
|
| Rate for Payer: United Healthcare Commercial |
$697.58
|
|
|
HC LEVEL 5 PATH COMPLEX
|
Facility
OP
|
$885.26
|
|
|
Service Code
|
CPT 88307 59
|
| Hospital Charge Code |
63002178
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$292.14 |
| Max. Negotiated Rate |
$823.29 |
| Rate for Payer: Aetna Commercial |
$747.16
|
| Rate for Payer: Aetna Medicare |
$292.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$292.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$508.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$553.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$335.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$321.35
|
| Rate for Payer: Cash Price |
$548.86
|
| Rate for Payer: Centivo All Commercial |
$451.48
|
| Rate for Payer: Cigna All Commercial |
$763.98
|
| Rate for Payer: CORVEL All Commercial |
$823.29
|
| Rate for Payer: Coventry All Commercial |
$779.03
|
| Rate for Payer: Encore All Commercial |
$814.88
|
| Rate for Payer: Frontpath All Commercial |
$814.44
|
| Rate for Payer: Humana ChoiceCare |
$764.60
|
| Rate for Payer: Humana Medicare |
$451.48
|
| Rate for Payer: Lucent All Commercial |
$451.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.73
|
| Rate for Payer: PHCS All Commercial |
$663.94
|
| Rate for Payer: PHP All Commercial |
$671.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$345.25
|
| Rate for Payer: Sagamore Health Network All Products |
$683.42
|
| Rate for Payer: Signature Care EPO |
$734.76
|
| Rate for Payer: Signature Care PPO |
$779.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$752.47
|
| Rate for Payer: United Healthcare Commercial |
$697.58
|
| Rate for Payer: United Healthcare Medicare |
$292.14
|
|
|
HC LEVEL 5 PATH COMPLEX
|
Facility
IP
|
$885.26
|
|
|
Service Code
|
CPT 88307 59
|
| Hospital Charge Code |
63002178
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$663.94 |
| Max. Negotiated Rate |
$823.29 |
| Rate for Payer: Aetna Commercial |
$764.86
|
| Rate for Payer: Cash Price |
$548.86
|
| Rate for Payer: Cigna All Commercial |
$763.98
|
| Rate for Payer: CORVEL All Commercial |
$823.29
|
| Rate for Payer: Coventry All Commercial |
$779.03
|
| Rate for Payer: Encore All Commercial |
$814.88
|
| Rate for Payer: Frontpath All Commercial |
$814.44
|
| Rate for Payer: Humana ChoiceCare |
$764.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$796.73
|
| Rate for Payer: PHCS All Commercial |
$663.94
|
| Rate for Payer: PHP All Commercial |
$671.38
|
| Rate for Payer: Sagamore Health Network All Products |
$683.42
|
| Rate for Payer: Signature Care EPO |
$734.76
|
| Rate for Payer: Signature Care PPO |
$779.03
|
| Rate for Payer: United Healthcare Commercial |
$697.58
|
|
