|
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
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 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 CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608375
|
|
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 |
41608487
|
|
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 |
41608447
|
|
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 |
41608509
|
|
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 |
41608425
|
|
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 |
41608374
|
|
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 |
41608406
|
|
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
IP
|
$1,512.50
|
|
| Hospital Charge Code |
41607812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,134.38 |
| Max. Negotiated Rate |
$1,406.62 |
| Rate for Payer: Aetna Commercial |
$1,306.80
|
| Rate for Payer: Cash Price |
$937.75
|
| Rate for Payer: Cigna All Commercial |
$1,305.29
|
| Rate for Payer: CORVEL All Commercial |
$1,406.62
|
| Rate for Payer: Coventry All Commercial |
$1,331.00
|
| Rate for Payer: Encore All Commercial |
$1,392.26
|
| Rate for Payer: Frontpath All Commercial |
$1,391.50
|
| Rate for Payer: Humana ChoiceCare |
$1,306.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,361.25
|
| Rate for Payer: PHCS All Commercial |
$1,134.38
|
| Rate for Payer: PHP All Commercial |
$1,147.08
|
| Rate for Payer: Sagamore Health Network All Products |
$1,167.65
|
| Rate for Payer: Signature Care EPO |
$1,255.38
|
| Rate for Payer: Signature Care PPO |
$1,331.00
|
| Rate for Payer: United Healthcare Commercial |
$1,191.85
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608472
|
|
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 |
41608481
|
|
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 |
41608486
|
|
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
IP
|
$7,491.74
|
|
| Hospital Charge Code |
41608311
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,618.80 |
| Max. Negotiated Rate |
$6,967.32 |
| Rate for Payer: Aetna Commercial |
$6,472.86
|
| Rate for Payer: Cash Price |
$4,644.88
|
| Rate for Payer: Cigna All Commercial |
$6,465.37
|
| Rate for Payer: CORVEL All Commercial |
$6,967.32
|
| Rate for Payer: Coventry All Commercial |
$6,592.73
|
| Rate for Payer: Encore All Commercial |
$6,896.15
|
| Rate for Payer: Frontpath All Commercial |
$6,892.40
|
| Rate for Payer: Humana ChoiceCare |
$6,470.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$6,742.57
|
| Rate for Payer: PHCS All Commercial |
$5,618.80
|
| Rate for Payer: PHP All Commercial |
$5,681.74
|
| Rate for Payer: Sagamore Health Network All Products |
$5,783.62
|
| Rate for Payer: Signature Care EPO |
$6,218.14
|
| Rate for Payer: Signature Care PPO |
$6,592.73
|
| Rate for Payer: United Healthcare Commercial |
$5,903.49
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608415
|
|
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 |
41608356
|
|
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
|
$1,512.50
|
|
| Hospital Charge Code |
41607812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,406.62 |
| Rate for Payer: Aetna Commercial |
$1,276.55
|
| Rate for Payer: Aetna Medicare |
$499.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$499.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$868.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$945.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$573.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$549.04
|
| Rate for Payer: Cash Price |
$937.75
|
| Rate for Payer: Cash Price |
$937.75
|
| Rate for Payer: Centivo All Commercial |
$771.38
|
| Rate for Payer: Cigna All Commercial |
$1,305.29
|
| Rate for Payer: CORVEL All Commercial |
$1,406.62
|
| Rate for Payer: Coventry All Commercial |
$1,331.00
|
| Rate for Payer: Encore All Commercial |
$1,392.26
|
| Rate for Payer: Frontpath All Commercial |
$1,391.50
|
| Rate for Payer: Humana ChoiceCare |
$1,306.35
|
| Rate for Payer: Humana Medicare |
$771.38
|
| Rate for Payer: Lucent All Commercial |
$771.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,361.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,134.38
|
| Rate for Payer: PHP All Commercial |
$1,147.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$589.88
|
| Rate for Payer: Sagamore Health Network All Products |
$1,167.65
|
| Rate for Payer: Signature Care EPO |
$1,255.38
|
| Rate for Payer: Signature Care PPO |
$1,331.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,285.62
|
| Rate for Payer: United Healthcare Commercial |
$1,191.85
|
| Rate for Payer: United Healthcare Medicare |
$499.12
|
|
|
HC CMCH NEW SUPPLY
|
Facility
IP
|
$945.00
|
|
| Hospital Charge Code |
41607807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$708.75 |
| Max. Negotiated Rate |
$878.85 |
| Rate for Payer: Aetna Commercial |
$816.48
|
| Rate for Payer: Cash Price |
$585.90
|
| 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: Lutheran Preferred All Commercial |
$850.50
|
| Rate for Payer: PHCS All Commercial |
$708.75
|
| Rate for Payer: PHP All Commercial |
$716.69
|
| 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: United Healthcare Commercial |
$744.66
|
|
|
HC CMCH NEW SUPPLY
|
Facility
IP
|
$1,341.50
|
|
| Hospital Charge Code |
41607811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,006.12 |
| Max. Negotiated Rate |
$1,247.60 |
| Rate for Payer: Aetna Commercial |
$1,159.06
|
| Rate for Payer: Cash Price |
$831.73
|
| Rate for Payer: Cigna All Commercial |
$1,157.71
|
| Rate for Payer: CORVEL All Commercial |
$1,247.60
|
| Rate for Payer: Coventry All Commercial |
$1,180.52
|
| Rate for Payer: Encore All Commercial |
$1,234.85
|
| Rate for Payer: Frontpath All Commercial |
$1,234.18
|
| Rate for Payer: Humana ChoiceCare |
$1,158.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,207.35
|
| Rate for Payer: PHCS All Commercial |
$1,006.12
|
| Rate for Payer: PHP All Commercial |
$1,017.39
|
| Rate for Payer: Sagamore Health Network All Products |
$1,035.64
|
| Rate for Payer: Signature Care EPO |
$1,113.44
|
| Rate for Payer: Signature Care PPO |
$1,180.52
|
| Rate for Payer: United Healthcare Commercial |
$1,057.10
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$5,920.20
|
|
| Hospital Charge Code |
41607813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$5,505.79 |
| Rate for Payer: Aetna Commercial |
$4,996.65
|
| Rate for Payer: Aetna Medicare |
$1,953.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,953.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,399.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,700.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,246.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2,149.03
|
| Rate for Payer: Cash Price |
$3,670.52
|
| Rate for Payer: Cash Price |
$3,670.52
|
| Rate for Payer: Centivo All Commercial |
$3,019.30
|
| Rate for Payer: Cigna All Commercial |
$5,109.13
|
| Rate for Payer: CORVEL All Commercial |
$5,505.79
|
| Rate for Payer: Coventry All Commercial |
$5,209.78
|
| Rate for Payer: Encore All Commercial |
$5,449.54
|
| Rate for Payer: Frontpath All Commercial |
$5,446.58
|
| Rate for Payer: Humana ChoiceCare |
$5,113.28
|
| Rate for Payer: Humana Medicare |
$3,019.30
|
| Rate for Payer: Lucent All Commercial |
$3,019.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5,328.18
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$4,440.15
|
| Rate for Payer: PHP All Commercial |
$4,489.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,308.88
|
| Rate for Payer: Sagamore Health Network All Products |
$4,570.39
|
| Rate for Payer: Signature Care EPO |
$4,913.77
|
| Rate for Payer: Signature Care PPO |
$5,209.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,032.17
|
| Rate for Payer: United Healthcare Commercial |
$4,665.12
|
| Rate for Payer: United Healthcare Medicare |
$1,953.67
|
|
|
HC CMCH NEW SUPPLY
|
Facility
OP
|
$121.68
|
|
| Hospital Charge Code |
41608364
|
|
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
|
|
