|
HC CMA CYTOGENETIC INTERP
|
Facility
|
IP
|
$375.91
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
63002095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$281.93 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Aetna Commercial |
$324.79
|
| Rate for Payer: Cash Price |
$233.07
|
| Rate for Payer: Cigna All Commercial |
$324.41
|
| Rate for Payer: CORVEL All Commercial |
$349.60
|
| Rate for Payer: Coventry All Commercial |
$330.80
|
| Rate for Payer: Encore All Commercial |
$346.03
|
| Rate for Payer: Frontpath All Commercial |
$345.84
|
| Rate for Payer: Humana ChoiceCare |
$324.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$338.32
|
| Rate for Payer: PHCS All Commercial |
$281.93
|
| Rate for Payer: PHP All Commercial |
$285.09
|
| Rate for Payer: Sagamore Health Network All Products |
$290.20
|
| Rate for Payer: Signature Care EPO |
$312.01
|
| Rate for Payer: Signature Care PPO |
$330.80
|
| Rate for Payer: United Healthcare Commercial |
$296.22
|
|
|
HC CMA TISSUE CULTURE -NON-NEOPLASM
|
Facility
|
OP
|
$347.40
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
63002074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.71 |
| Max. Negotiated Rate |
$323.08 |
| Rate for Payer: Aetna Commercial |
$293.21
|
| Rate for Payer: Aetna Medicare |
$114.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$114.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$199.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$217.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$75.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$131.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$126.11
|
| Rate for Payer: Cash Price |
$215.39
|
| Rate for Payer: Cash Price |
$215.39
|
| Rate for Payer: Centivo All Commercial |
$177.17
|
| Rate for Payer: Cigna All Commercial |
$299.81
|
| Rate for Payer: CORVEL All Commercial |
$323.08
|
| Rate for Payer: Coventry All Commercial |
$305.71
|
| Rate for Payer: Encore All Commercial |
$319.78
|
| Rate for Payer: Frontpath All Commercial |
$319.61
|
| Rate for Payer: Humana ChoiceCare |
$300.05
|
| Rate for Payer: Humana Medicare |
$177.17
|
| Rate for Payer: Lucent All Commercial |
$177.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$312.66
|
| Rate for Payer: Managed Health Services Medicaid |
$75.71
|
| Rate for Payer: MDWise Medicaid |
$75.71
|
| Rate for Payer: PHCS All Commercial |
$260.55
|
| Rate for Payer: PHP All Commercial |
$263.47
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$135.49
|
| Rate for Payer: Sagamore Health Network All Products |
$268.19
|
| Rate for Payer: Signature Care EPO |
$288.34
|
| Rate for Payer: Signature Care PPO |
$305.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$295.29
|
| Rate for Payer: United Healthcare Commercial |
$273.75
|
| Rate for Payer: United Healthcare Medicare |
$114.64
|
|
|
HC CMA TISSUE CULTURE -NON-NEOPLASM
|
Facility
|
IP
|
$347.40
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
63002074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$260.55 |
| Max. Negotiated Rate |
$323.08 |
| Rate for Payer: Aetna Commercial |
$300.16
|
| Rate for Payer: Cash Price |
$215.39
|
| Rate for Payer: Cigna All Commercial |
$299.81
|
| Rate for Payer: CORVEL All Commercial |
$323.08
|
| Rate for Payer: Coventry All Commercial |
$305.71
|
| Rate for Payer: Encore All Commercial |
$319.78
|
| Rate for Payer: Frontpath All Commercial |
$319.61
|
| Rate for Payer: Humana ChoiceCare |
$300.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$312.66
|
| Rate for Payer: PHCS All Commercial |
$260.55
|
| Rate for Payer: PHP All Commercial |
$263.47
|
| Rate for Payer: Sagamore Health Network All Products |
$268.19
|
| Rate for Payer: Signature Care EPO |
$288.34
|
| Rate for Payer: Signature Care PPO |
$305.71
|
| Rate for Payer: United Healthcare Commercial |
$273.75
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608491
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608363
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$2,250.00
|
|
| Hospital Charge Code |
41607805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,092.50 |
| Rate for Payer: Aetna Commercial |
$1,899.00
|
| Rate for Payer: Aetna Medicare |
$742.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$742.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,292.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,406.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$853.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$816.75
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Cash Price |
$1,395.00
|
| Rate for Payer: Centivo All Commercial |
$1,147.50
|
| Rate for Payer: Cigna All Commercial |
$1,941.75
|
| Rate for Payer: CORVEL All Commercial |
$2,092.50
|
| Rate for Payer: Coventry All Commercial |
$1,980.00
|
| Rate for Payer: Encore All Commercial |
$2,071.12
|
| Rate for Payer: Frontpath All Commercial |
$2,070.00
|
| Rate for Payer: Humana ChoiceCare |
$1,943.32
|
| Rate for Payer: Humana Medicare |
$1,147.50
|
| Rate for Payer: Lucent All Commercial |
$1,147.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,025.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,687.50
|
| Rate for Payer: PHP All Commercial |
$1,706.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$877.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,737.00
|
| Rate for Payer: Signature Care EPO |
$1,867.50
|
| Rate for Payer: Signature Care PPO |
$1,980.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,912.50
|
| Rate for Payer: United Healthcare Commercial |
$1,773.00
|
| Rate for Payer: United Healthcare Medicare |
$742.50
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608458
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$945.00
|
|
| Hospital Charge Code |
41607807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna Commercial |
$797.58
|
| Rate for Payer: Aetna Medicare |
$311.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$311.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$542.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$590.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$358.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$343.04
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Centivo All Commercial |
$481.95
|
| Rate for Payer: Cigna All Commercial |
$815.54
|
| Rate for Payer: CORVEL All Commercial |
$878.85
|
| Rate for Payer: Coventry All Commercial |
$831.60
|
| Rate for Payer: Encore All Commercial |
$869.87
|
| Rate for Payer: Frontpath All Commercial |
$869.40
|
| Rate for Payer: Humana ChoiceCare |
$816.20
|
| Rate for Payer: Humana Medicare |
$481.95
|
| Rate for Payer: Lucent All Commercial |
$481.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$850.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$708.75
|
| Rate for Payer: PHP All Commercial |
$716.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$368.55
|
| Rate for Payer: Sagamore Health Network All Products |
$729.54
|
| Rate for Payer: Signature Care EPO |
$784.35
|
| Rate for Payer: Signature Care PPO |
$831.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$803.25
|
| Rate for Payer: United Healthcare Commercial |
$744.66
|
| Rate for Payer: United Healthcare Medicare |
$311.85
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608396
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
|
