|
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
|
$237.30
|
|
| Hospital Charge Code |
41607809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.31 |
| Max. Negotiated Rate |
$220.69 |
| Rate for Payer: Aetna Commercial |
$200.28
|
| Rate for Payer: Aetna Medicare |
$78.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$136.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.34
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.14
|
| Rate for Payer: Cash Price |
$147.13
|
| Rate for Payer: Cash Price |
$147.13
|
| Rate for Payer: Centivo All Commercial |
$121.02
|
| Rate for Payer: Cigna All Commercial |
$204.79
|
| Rate for Payer: CORVEL All Commercial |
$220.69
|
| Rate for Payer: Coventry All Commercial |
$208.82
|
| Rate for Payer: Encore All Commercial |
$218.43
|
| Rate for Payer: Frontpath All Commercial |
$218.32
|
| Rate for Payer: Humana ChoiceCare |
$204.96
|
| Rate for Payer: Humana Medicare |
$121.02
|
| Rate for Payer: Lucent All Commercial |
$121.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$213.57
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$177.98
|
| Rate for Payer: PHP All Commercial |
$179.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.55
|
| Rate for Payer: Sagamore Health Network All Products |
$183.20
|
| Rate for Payer: Signature Care EPO |
$196.96
|
| Rate for Payer: Signature Care PPO |
$208.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$201.70
|
| Rate for Payer: United Healthcare Commercial |
$186.99
|
| Rate for Payer: United Healthcare Medicare |
$78.31
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608442
|
|
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 |
41608372
|
|
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 |
41608461
|
|
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 |
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 |
41608478
|
|
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 |
41608506
|
|
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 |
41608514
|
|
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 |
41608409
|
|
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
|
$1,625.00
|
|
| Hospital Charge Code |
41608312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,511.25 |
| Rate for Payer: Aetna Commercial |
$1,371.50
|
| Rate for Payer: Aetna Medicare |
$536.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$536.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$933.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,015.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$616.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$589.88
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Cash Price |
$1,007.50
|
| Rate for Payer: Centivo All Commercial |
$828.75
|
| Rate for Payer: Cigna All Commercial |
$1,402.38
|
| Rate for Payer: CORVEL All Commercial |
$1,511.25
|
| Rate for Payer: Coventry All Commercial |
$1,430.00
|
| Rate for Payer: Encore All Commercial |
$1,495.81
|
| Rate for Payer: Frontpath All Commercial |
$1,495.00
|
| Rate for Payer: Humana ChoiceCare |
$1,403.51
|
| Rate for Payer: Humana Medicare |
$828.75
|
| Rate for Payer: Lucent All Commercial |
$828.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,462.50
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,218.75
|
| Rate for Payer: PHP All Commercial |
$1,232.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$633.75
|
| Rate for Payer: Sagamore Health Network All Products |
$1,254.50
|
| Rate for Payer: Signature Care EPO |
$1,348.75
|
| Rate for Payer: Signature Care PPO |
$1,430.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,381.25
|
| Rate for Payer: United Healthcare Commercial |
$1,280.50
|
| Rate for Payer: United Healthcare Medicare |
$536.25
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
IP
|
$1,425.45
|
|
| Hospital Charge Code |
41607803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,069.09 |
| Max. Negotiated Rate |
$1,325.67 |
| Rate for Payer: Aetna Commercial |
$1,231.59
|
| Rate for Payer: Cash Price |
$883.78
|
| Rate for Payer: Cigna All Commercial |
$1,230.16
|
| Rate for Payer: CORVEL All Commercial |
$1,325.67
|
| Rate for Payer: Coventry All Commercial |
$1,254.40
|
| Rate for Payer: Encore All Commercial |
$1,312.13
|
| Rate for Payer: Frontpath All Commercial |
$1,311.41
|
| Rate for Payer: Humana ChoiceCare |
$1,231.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,282.90
|
| Rate for Payer: PHCS All Commercial |
$1,069.09
|
| Rate for Payer: PHP All Commercial |
$1,081.06
|
| Rate for Payer: Sagamore Health Network All Products |
$1,100.45
|
| Rate for Payer: Signature Care EPO |
$1,183.12
|
| Rate for Payer: Signature Care PPO |
$1,254.40
|
| Rate for Payer: United Healthcare Commercial |
$1,123.25
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608489
|
|
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 |
41608515
|
|
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
|
$1,545.50
|
|
| Hospital Charge Code |
41607810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,437.32 |
| Rate for Payer: Aetna Commercial |
$1,304.40
|
| Rate for Payer: Aetna Medicare |
$510.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$510.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$887.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$966.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$586.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$561.02
|
| Rate for Payer: Cash Price |
$958.21
|
| Rate for Payer: Cash Price |
$958.21
|
| Rate for Payer: Centivo All Commercial |
$788.20
|
| Rate for Payer: Cigna All Commercial |
$1,333.77
|
| Rate for Payer: CORVEL All Commercial |
$1,437.32
|
| Rate for Payer: Coventry All Commercial |
$1,360.04
|
| Rate for Payer: Encore All Commercial |
$1,422.63
|
| Rate for Payer: Frontpath All Commercial |
$1,421.86
|
| Rate for Payer: Humana ChoiceCare |
$1,334.85
|
| Rate for Payer: Humana Medicare |
$788.20
|
| Rate for Payer: Lucent All Commercial |
$788.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,390.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,159.12
|
| Rate for Payer: PHP All Commercial |
$1,172.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$602.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,193.13
|
| Rate for Payer: Signature Care EPO |
$1,282.76
|
| Rate for Payer: Signature Care PPO |
$1,360.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,313.68
|
| Rate for Payer: United Healthcare Commercial |
$1,217.85
|
| Rate for Payer: United Healthcare Medicare |
$510.02
|
|
|
HC CMCH NEW SUPPLY
|
Facility
|
OP
|
$121.68
|
|
| Hospital Charge Code |
41608379
|
|
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 |
41608410
|
|
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 |
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
|
IP
|
$1,375.00
|
|
| Hospital Charge Code |
41607815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.25 |
| Max. Negotiated Rate |
$1,278.75 |
| Rate for Payer: Aetna Commercial |
$1,188.00
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cigna All Commercial |
$1,186.62
|
| Rate for Payer: CORVEL All Commercial |
$1,278.75
|
| Rate for Payer: Coventry All Commercial |
$1,210.00
|
| Rate for Payer: Encore All Commercial |
$1,265.69
|
| Rate for Payer: Frontpath All Commercial |
$1,265.00
|
| Rate for Payer: Humana ChoiceCare |
$1,187.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,237.50
|
| Rate for Payer: PHCS All Commercial |
$1,031.25
|
| Rate for Payer: PHP All Commercial |
$1,042.80
|
| Rate for Payer: Sagamore Health Network All Products |
$1,061.50
|
| Rate for Payer: Signature Care EPO |
$1,141.25
|
| Rate for Payer: Signature Care PPO |
$1,210.00
|
| Rate for Payer: United Healthcare Commercial |
$1,083.50
|
|
|
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 |
41608438
|
|
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
|
|
