|
HC HARMONIC 1100 SHEAR 20CM
|
Facility
IP
|
$2,201.40
|
|
| Hospital Charge Code |
41607743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,651.05 |
| Max. Negotiated Rate |
$2,047.30 |
| Rate for Payer: Aetna Commercial |
$1,902.01
|
| Rate for Payer: Cash Price |
$1,364.87
|
| Rate for Payer: Cigna All Commercial |
$1,899.81
|
| Rate for Payer: CORVEL All Commercial |
$2,047.30
|
| Rate for Payer: Coventry All Commercial |
$1,937.23
|
| Rate for Payer: Encore All Commercial |
$2,026.39
|
| Rate for Payer: Frontpath All Commercial |
$2,025.29
|
| Rate for Payer: Humana ChoiceCare |
$1,901.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,981.26
|
| Rate for Payer: PHCS All Commercial |
$1,651.05
|
| Rate for Payer: PHP All Commercial |
$1,669.54
|
| Rate for Payer: Sagamore Health Network All Products |
$1,699.48
|
| Rate for Payer: Signature Care EPO |
$1,827.16
|
| Rate for Payer: Signature Care PPO |
$1,937.23
|
| Rate for Payer: United Healthcare Commercial |
$1,734.70
|
|
|
HC HARMONIC 1100 SHEAR 36CM
|
Facility
OP
|
$2,506.74
|
|
| Hospital Charge Code |
41607744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,331.27 |
| Rate for Payer: Aetna Commercial |
$2,115.69
|
| Rate for Payer: Aetna Medicare |
$827.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$827.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,439.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,566.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$951.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$909.95
|
| Rate for Payer: Cash Price |
$1,554.18
|
| Rate for Payer: Cash Price |
$1,554.18
|
| Rate for Payer: Centivo All Commercial |
$1,278.44
|
| Rate for Payer: Cigna All Commercial |
$2,163.32
|
| Rate for Payer: CORVEL All Commercial |
$2,331.27
|
| Rate for Payer: Coventry All Commercial |
$2,205.93
|
| Rate for Payer: Encore All Commercial |
$2,307.45
|
| Rate for Payer: Frontpath All Commercial |
$2,306.20
|
| Rate for Payer: Humana ChoiceCare |
$2,165.07
|
| Rate for Payer: Humana Medicare |
$1,278.44
|
| Rate for Payer: Lucent All Commercial |
$1,278.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,256.07
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,880.06
|
| Rate for Payer: PHP All Commercial |
$1,901.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$977.63
|
| Rate for Payer: Sagamore Health Network All Products |
$1,935.20
|
| Rate for Payer: Signature Care EPO |
$2,080.59
|
| Rate for Payer: Signature Care PPO |
$2,205.93
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,130.73
|
| Rate for Payer: United Healthcare Commercial |
$1,975.31
|
| Rate for Payer: United Healthcare Medicare |
$827.22
|
|
|
HC HARMONIC 1100 SHEAR 36CM
|
Facility
IP
|
$2,506.74
|
|
| Hospital Charge Code |
41607744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,880.06 |
| Max. Negotiated Rate |
$2,331.27 |
| Rate for Payer: Aetna Commercial |
$2,165.82
|
| Rate for Payer: Cash Price |
$1,554.18
|
| Rate for Payer: Cigna All Commercial |
$2,163.32
|
| Rate for Payer: CORVEL All Commercial |
$2,331.27
|
| Rate for Payer: Coventry All Commercial |
$2,205.93
|
| Rate for Payer: Encore All Commercial |
$2,307.45
|
| Rate for Payer: Frontpath All Commercial |
$2,306.20
|
| Rate for Payer: Humana ChoiceCare |
$2,165.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,256.07
|
| Rate for Payer: PHCS All Commercial |
$1,880.06
|
| Rate for Payer: PHP All Commercial |
$1,901.11
|
| Rate for Payer: Sagamore Health Network All Products |
$1,935.20
|
| Rate for Payer: Signature Care EPO |
$2,080.59
|
| Rate for Payer: Signature Care PPO |
$2,205.93
|
| Rate for Payer: United Healthcare Commercial |
$1,975.31
|
|
|
HC HARMONIC FOCUS 9CM
|
Facility
IP
|
$1,851.23
|
|
| Hospital Charge Code |
41606645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,388.42 |
| Max. Negotiated Rate |
$1,721.64 |
| Rate for Payer: Signature Care EPO |
$1,536.52
|
| Rate for Payer: Signature Care PPO |
$1,629.08
|
| Rate for Payer: United Healthcare Commercial |
$1,458.77
|
| Rate for Payer: Aetna Commercial |
$1,599.46
|
| Rate for Payer: Cash Price |
$1,147.76
|
| Rate for Payer: Cigna All Commercial |
$1,597.61
|
| Rate for Payer: CORVEL All Commercial |
$1,721.64
|
| Rate for Payer: Coventry All Commercial |
$1,629.08
|
| Rate for Payer: Encore All Commercial |
$1,704.06
|
| Rate for Payer: Frontpath All Commercial |
$1,703.13
|
| Rate for Payer: Humana ChoiceCare |
$1,598.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,666.11
|
| Rate for Payer: PHCS All Commercial |
$1,388.42
|
| Rate for Payer: PHP All Commercial |
$1,403.97
|
| Rate for Payer: Sagamore Health Network All Products |
$1,429.15
|
|
|
HC HARMONIC FOCUS 9CM
|
Facility
OP
|
$1,851.23
|
|
| Hospital Charge Code |
41606645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,721.64 |
| Rate for Payer: Aetna Commercial |
$1,562.44
|
| Rate for Payer: Aetna Medicare |
$610.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$610.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,063.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,157.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$702.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$672.00
|
| Rate for Payer: Cash Price |
$1,147.76
|
| Rate for Payer: Cash Price |
$1,147.76
|
| Rate for Payer: Centivo All Commercial |
$944.13
|
| Rate for Payer: Cigna All Commercial |
$1,597.61
|
| Rate for Payer: CORVEL All Commercial |
$1,721.64
|
| Rate for Payer: Coventry All Commercial |
$1,629.08
|
| Rate for Payer: Encore All Commercial |
$1,704.06
|
| Rate for Payer: Frontpath All Commercial |
$1,703.13
|
| Rate for Payer: Humana ChoiceCare |
$1,598.91
|
| Rate for Payer: Humana Medicare |
$944.13
|
| Rate for Payer: Lucent All Commercial |
$944.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,666.11
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,388.42
|
| Rate for Payer: PHP All Commercial |
$1,403.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$721.98
|
| Rate for Payer: Sagamore Health Network All Products |
$1,429.15
|
| Rate for Payer: Signature Care EPO |
$1,536.52
|
| Rate for Payer: Signature Care PPO |
$1,629.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,573.55
|
| Rate for Payer: United Healthcare Commercial |
$1,458.77
|
| Rate for Payer: United Healthcare Medicare |
$610.91
|
|
|
HC HARMONIC SHEAR 20CM
|
Facility
IP
|
$2,526.90
|
|
| Hospital Charge Code |
41606643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,895.18 |
| Max. Negotiated Rate |
$2,350.02 |
| Rate for Payer: Aetna Commercial |
$2,183.24
|
| Rate for Payer: Cash Price |
$1,566.68
|
| Rate for Payer: Cigna All Commercial |
$2,180.71
|
| Rate for Payer: CORVEL All Commercial |
$2,350.02
|
| Rate for Payer: Coventry All Commercial |
$2,223.67
|
| Rate for Payer: Encore All Commercial |
$2,326.01
|
| Rate for Payer: Frontpath All Commercial |
$2,324.75
|
| Rate for Payer: Humana ChoiceCare |
$2,182.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,274.21
|
| Rate for Payer: PHCS All Commercial |
$1,895.18
|
| Rate for Payer: PHP All Commercial |
$1,916.40
|
| Rate for Payer: Sagamore Health Network All Products |
$1,950.77
|
| Rate for Payer: Signature Care EPO |
$2,097.33
|
| Rate for Payer: Signature Care PPO |
$2,223.67
|
| Rate for Payer: United Healthcare Commercial |
$1,991.20
|
|
|
HC HARMONIC SHEAR 20CM
|
Facility
OP
|
$2,526.90
|
|
| Hospital Charge Code |
41606643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,350.02 |
| Rate for Payer: Aetna Commercial |
$2,132.70
|
| Rate for Payer: Aetna Medicare |
$833.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$833.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,451.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,579.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$958.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$917.26
|
| Rate for Payer: Cash Price |
$1,566.68
|
| Rate for Payer: Cash Price |
$1,566.68
|
| Rate for Payer: Centivo All Commercial |
$1,288.72
|
| Rate for Payer: Cigna All Commercial |
$2,180.71
|
| Rate for Payer: CORVEL All Commercial |
$2,350.02
|
| Rate for Payer: Coventry All Commercial |
$2,223.67
|
| Rate for Payer: Encore All Commercial |
$2,326.01
|
| Rate for Payer: Frontpath All Commercial |
$2,324.75
|
| Rate for Payer: Humana ChoiceCare |
$2,182.48
|
| Rate for Payer: Humana Medicare |
$1,288.72
|
| Rate for Payer: Lucent All Commercial |
$1,288.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,274.21
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,895.18
|
| Rate for Payer: PHP All Commercial |
$1,916.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$985.49
|
| Rate for Payer: Sagamore Health Network All Products |
$1,950.77
|
| Rate for Payer: Signature Care EPO |
$2,097.33
|
| Rate for Payer: Signature Care PPO |
$2,223.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,147.86
|
| Rate for Payer: United Healthcare Commercial |
$1,991.20
|
| Rate for Payer: United Healthcare Medicare |
$833.88
|
|
|
HC HARMONIC SHEAR 23
|
Facility
IP
|
$2,906.65
|
|
| Hospital Charge Code |
41601919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,179.99 |
| Max. Negotiated Rate |
$2,703.18 |
| Rate for Payer: Aetna Commercial |
$2,511.35
|
| Rate for Payer: Cash Price |
$1,802.12
|
| Rate for Payer: Cigna All Commercial |
$2,508.44
|
| Rate for Payer: CORVEL All Commercial |
$2,703.18
|
| Rate for Payer: Coventry All Commercial |
$2,557.85
|
| Rate for Payer: Encore All Commercial |
$2,675.57
|
| Rate for Payer: Frontpath All Commercial |
$2,674.12
|
| Rate for Payer: Humana ChoiceCare |
$2,510.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,615.98
|
| Rate for Payer: PHCS All Commercial |
$2,179.99
|
| Rate for Payer: PHP All Commercial |
$2,204.40
|
| Rate for Payer: Sagamore Health Network All Products |
$2,243.93
|
| Rate for Payer: Signature Care EPO |
$2,412.52
|
| Rate for Payer: Signature Care PPO |
$2,557.85
|
| Rate for Payer: United Healthcare Commercial |
$2,290.44
|
|
|
HC HARMONIC SHEAR 23
|
Facility
OP
|
$2,906.65
|
|
| Hospital Charge Code |
41601919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,703.18 |
| Rate for Payer: Aetna Commercial |
$2,453.21
|
| Rate for Payer: Aetna Medicare |
$959.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$959.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,669.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,816.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,103.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,055.11
|
| Rate for Payer: Cash Price |
$1,802.12
|
| Rate for Payer: Cash Price |
$1,802.12
|
| Rate for Payer: Centivo All Commercial |
$1,482.39
|
| Rate for Payer: Cigna All Commercial |
$2,508.44
|
| Rate for Payer: CORVEL All Commercial |
$2,703.18
|
| Rate for Payer: Coventry All Commercial |
$2,557.85
|
| Rate for Payer: Encore All Commercial |
$2,675.57
|
| Rate for Payer: Frontpath All Commercial |
$2,674.12
|
| Rate for Payer: Humana ChoiceCare |
$2,510.47
|
| Rate for Payer: Humana Medicare |
$1,482.39
|
| Rate for Payer: Lucent All Commercial |
$1,482.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,615.98
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,179.99
|
| Rate for Payer: PHP All Commercial |
$2,204.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,133.59
|
| Rate for Payer: Sagamore Health Network All Products |
$2,243.93
|
| Rate for Payer: Signature Care EPO |
$2,412.52
|
| Rate for Payer: Signature Care PPO |
$2,557.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,470.65
|
| Rate for Payer: United Healthcare Commercial |
$2,290.44
|
| Rate for Payer: United Healthcare Medicare |
$959.19
|
|
|
HC HARMONIC SHEAR 36
|
Facility
OP
|
$3,308.66
|
|
| Hospital Charge Code |
41601920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$3,077.05 |
| Rate for Payer: Aetna Commercial |
$2,792.51
|
| Rate for Payer: Aetna Medicare |
$1,091.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,091.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,900.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,068.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,255.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,201.04
|
| Rate for Payer: Cash Price |
$2,051.37
|
| Rate for Payer: Cash Price |
$2,051.37
|
| Rate for Payer: Centivo All Commercial |
$1,687.42
|
| Rate for Payer: Cigna All Commercial |
$2,855.37
|
| Rate for Payer: CORVEL All Commercial |
$3,077.05
|
| Rate for Payer: Coventry All Commercial |
$2,911.62
|
| Rate for Payer: Encore All Commercial |
$3,045.62
|
| Rate for Payer: Frontpath All Commercial |
$3,043.97
|
| Rate for Payer: Humana ChoiceCare |
$2,857.69
|
| Rate for Payer: Humana Medicare |
$1,687.42
|
| Rate for Payer: Lucent All Commercial |
$1,687.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,977.79
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,481.50
|
| Rate for Payer: PHP All Commercial |
$2,509.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,290.38
|
| Rate for Payer: Sagamore Health Network All Products |
$2,554.29
|
| Rate for Payer: Signature Care EPO |
$2,746.19
|
| Rate for Payer: Signature Care PPO |
$2,911.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,812.36
|
| Rate for Payer: United Healthcare Commercial |
$2,607.22
|
| Rate for Payer: United Healthcare Medicare |
$1,091.86
|
|
|
HC HARMONIC SHEAR 36
|
Facility
IP
|
$3,308.66
|
|
| Hospital Charge Code |
41601920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,481.50 |
| Max. Negotiated Rate |
$3,077.05 |
| Rate for Payer: Aetna Commercial |
$2,858.68
|
| Rate for Payer: Cash Price |
$2,051.37
|
| Rate for Payer: Cigna All Commercial |
$2,855.37
|
| Rate for Payer: CORVEL All Commercial |
$3,077.05
|
| Rate for Payer: Coventry All Commercial |
$2,911.62
|
| Rate for Payer: Encore All Commercial |
$3,045.62
|
| Rate for Payer: Frontpath All Commercial |
$3,043.97
|
| Rate for Payer: Humana ChoiceCare |
$2,857.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,977.79
|
| Rate for Payer: PHCS All Commercial |
$2,481.50
|
| Rate for Payer: PHP All Commercial |
$2,509.29
|
| Rate for Payer: Sagamore Health Network All Products |
$2,554.29
|
| Rate for Payer: Signature Care EPO |
$2,746.19
|
| Rate for Payer: Signature Care PPO |
$2,911.62
|
| Rate for Payer: United Healthcare Commercial |
$2,607.22
|
|
|
HC HARMONIC SHEAR 36CM
|
Facility
OP
|
$2,877.38
|
|
| Hospital Charge Code |
41606644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,675.96 |
| Rate for Payer: Aetna Commercial |
$2,428.51
|
| Rate for Payer: Aetna Medicare |
$949.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$949.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,652.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,798.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,091.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,044.49
|
| Rate for Payer: Cash Price |
$1,783.98
|
| Rate for Payer: Cash Price |
$1,783.98
|
| Rate for Payer: Centivo All Commercial |
$1,467.46
|
| Rate for Payer: Cigna All Commercial |
$2,483.18
|
| Rate for Payer: CORVEL All Commercial |
$2,675.96
|
| Rate for Payer: Coventry All Commercial |
$2,532.09
|
| Rate for Payer: Encore All Commercial |
$2,648.63
|
| Rate for Payer: Frontpath All Commercial |
$2,647.19
|
| Rate for Payer: Humana ChoiceCare |
$2,485.19
|
| Rate for Payer: Humana Medicare |
$1,467.46
|
| Rate for Payer: Lucent All Commercial |
$1,467.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,589.64
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$2,158.04
|
| Rate for Payer: PHP All Commercial |
$2,182.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,122.18
|
| Rate for Payer: Sagamore Health Network All Products |
$2,221.34
|
| Rate for Payer: Signature Care EPO |
$2,388.23
|
| Rate for Payer: Signature Care PPO |
$2,532.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,445.77
|
| Rate for Payer: United Healthcare Commercial |
$2,267.38
|
| Rate for Payer: United Healthcare Medicare |
$949.54
|
|
|
HC HARMONIC SHEAR 36CM
|
Facility
IP
|
$2,877.38
|
|
| Hospital Charge Code |
41606644
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,158.04 |
| Max. Negotiated Rate |
$2,675.96 |
| Rate for Payer: Aetna Commercial |
$2,486.06
|
| Rate for Payer: Cash Price |
$1,783.98
|
| Rate for Payer: Cigna All Commercial |
$2,483.18
|
| Rate for Payer: CORVEL All Commercial |
$2,675.96
|
| Rate for Payer: Coventry All Commercial |
$2,532.09
|
| Rate for Payer: Encore All Commercial |
$2,648.63
|
| Rate for Payer: Frontpath All Commercial |
$2,647.19
|
| Rate for Payer: Humana ChoiceCare |
$2,485.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,589.64
|
| Rate for Payer: PHCS All Commercial |
$2,158.04
|
| Rate for Payer: PHP All Commercial |
$2,182.20
|
| Rate for Payer: Sagamore Health Network All Products |
$2,221.34
|
| Rate for Payer: Signature Care EPO |
$2,388.23
|
| Rate for Payer: Signature Care PPO |
$2,532.09
|
| Rate for Payer: United Healthcare Commercial |
$2,267.38
|
|
|
HC HARMONIC WAVE
|
Facility
OP
|
$2,122.55
|
|
| Hospital Charge Code |
41601921
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,973.97 |
| Rate for Payer: Aetna Commercial |
$1,791.43
|
| Rate for Payer: Aetna Medicare |
$700.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$700.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,218.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,326.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$805.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$770.49
|
| Rate for Payer: Cash Price |
$1,315.98
|
| Rate for Payer: Cash Price |
$1,315.98
|
| Rate for Payer: Centivo All Commercial |
$1,082.50
|
| Rate for Payer: Cigna All Commercial |
$1,831.76
|
| Rate for Payer: CORVEL All Commercial |
$1,973.97
|
| Rate for Payer: Coventry All Commercial |
$1,867.84
|
| Rate for Payer: Encore All Commercial |
$1,953.81
|
| Rate for Payer: Frontpath All Commercial |
$1,952.75
|
| Rate for Payer: Humana ChoiceCare |
$1,833.25
|
| Rate for Payer: Humana Medicare |
$1,082.50
|
| Rate for Payer: Lucent All Commercial |
$1,082.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,910.30
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,591.91
|
| Rate for Payer: PHP All Commercial |
$1,609.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$827.79
|
| Rate for Payer: Sagamore Health Network All Products |
$1,638.61
|
| Rate for Payer: Signature Care EPO |
$1,761.72
|
| Rate for Payer: Signature Care PPO |
$1,867.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,804.17
|
| Rate for Payer: United Healthcare Commercial |
$1,672.57
|
| Rate for Payer: United Healthcare Medicare |
$700.44
|
|
|
HC HARMONIC WAVE
|
Facility
IP
|
$2,122.55
|
|
| Hospital Charge Code |
41601921
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,591.91 |
| Max. Negotiated Rate |
$1,973.97 |
| Rate for Payer: Aetna Commercial |
$1,833.88
|
| Rate for Payer: Cash Price |
$1,315.98
|
| Rate for Payer: Cigna All Commercial |
$1,831.76
|
| Rate for Payer: CORVEL All Commercial |
$1,973.97
|
| Rate for Payer: Coventry All Commercial |
$1,867.84
|
| Rate for Payer: Encore All Commercial |
$1,953.81
|
| Rate for Payer: Frontpath All Commercial |
$1,952.75
|
| Rate for Payer: Humana ChoiceCare |
$1,833.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,910.30
|
| Rate for Payer: PHCS All Commercial |
$1,591.91
|
| Rate for Payer: PHP All Commercial |
$1,609.74
|
| Rate for Payer: Sagamore Health Network All Products |
$1,638.61
|
| Rate for Payer: Signature Care EPO |
$1,761.72
|
| Rate for Payer: Signature Care PPO |
$1,867.84
|
| Rate for Payer: United Healthcare Commercial |
$1,672.57
|
|
|
HC HBB (HEMOGLOBIN, SUBUNIT BETA)FULL GENE SQUENCE
|
Facility
IP
|
$3,220.14
|
|
|
Service Code
|
CPT 81364
|
| Hospital Charge Code |
63081364
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,415.10 |
| Max. Negotiated Rate |
$2,994.73 |
| Rate for Payer: Aetna Commercial |
$2,782.20
|
| Rate for Payer: Cash Price |
$1,996.49
|
| Rate for Payer: Cigna All Commercial |
$2,778.98
|
| Rate for Payer: CORVEL All Commercial |
$2,994.73
|
| Rate for Payer: Coventry All Commercial |
$2,833.72
|
| Rate for Payer: Encore All Commercial |
$2,964.14
|
| Rate for Payer: Frontpath All Commercial |
$2,962.53
|
| Rate for Payer: Humana ChoiceCare |
$2,781.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,898.13
|
| Rate for Payer: PHCS All Commercial |
$2,415.10
|
| Rate for Payer: PHP All Commercial |
$2,442.15
|
| Rate for Payer: Sagamore Health Network All Products |
$2,485.95
|
| Rate for Payer: Signature Care EPO |
$2,672.72
|
| Rate for Payer: Signature Care PPO |
$2,833.72
|
| Rate for Payer: United Healthcare Commercial |
$2,537.47
|
|
|
HC HBB (HEMOGLOBIN, SUBUNIT BETA)FULL GENE SQUENCE
|
Facility
OP
|
$3,220.14
|
|
|
Service Code
|
CPT 81364
|
| Hospital Charge Code |
63081364
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$324.58 |
| Max. Negotiated Rate |
$2,994.73 |
| Rate for Payer: Aetna Commercial |
$2,717.80
|
| Rate for Payer: Aetna Medicare |
$1,062.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,062.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,849.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,012.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$324.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,222.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,168.91
|
| Rate for Payer: Cash Price |
$1,996.49
|
| Rate for Payer: Cash Price |
$1,996.49
|
| Rate for Payer: Centivo All Commercial |
$1,642.27
|
| Rate for Payer: Cigna All Commercial |
$2,778.98
|
| Rate for Payer: CORVEL All Commercial |
$2,994.73
|
| Rate for Payer: Coventry All Commercial |
$2,833.72
|
| Rate for Payer: Encore All Commercial |
$2,964.14
|
| Rate for Payer: Frontpath All Commercial |
$2,962.53
|
| Rate for Payer: Humana ChoiceCare |
$2,781.23
|
| Rate for Payer: Humana Medicare |
$1,642.27
|
| Rate for Payer: Lucent All Commercial |
$1,642.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,898.13
|
| Rate for Payer: Managed Health Services Medicaid |
$324.58
|
| Rate for Payer: MDWise Medicaid |
$324.58
|
| Rate for Payer: PHCS All Commercial |
$2,415.10
|
| Rate for Payer: PHP All Commercial |
$2,442.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,255.85
|
| Rate for Payer: Sagamore Health Network All Products |
$2,485.95
|
| Rate for Payer: Signature Care EPO |
$2,672.72
|
| Rate for Payer: Signature Care PPO |
$2,833.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,737.12
|
| Rate for Payer: United Healthcare Commercial |
$2,537.47
|
| Rate for Payer: United Healthcare Medicare |
$1,062.65
|
|
|
HC HCG PREG TEST QUAL
|
Facility
IP
|
$109.40
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
63001331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.05 |
| Max. Negotiated Rate |
$101.74 |
| Rate for Payer: Aetna Commercial |
$94.52
|
| Rate for Payer: Cash Price |
$67.83
|
| Rate for Payer: Cigna All Commercial |
$94.41
|
| Rate for Payer: CORVEL All Commercial |
$101.74
|
| Rate for Payer: Coventry All Commercial |
$96.27
|
| Rate for Payer: Encore All Commercial |
$100.70
|
| Rate for Payer: Frontpath All Commercial |
$100.64
|
| Rate for Payer: Humana ChoiceCare |
$94.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.46
|
| Rate for Payer: PHCS All Commercial |
$82.05
|
| Rate for Payer: PHP All Commercial |
$82.97
|
| Rate for Payer: Sagamore Health Network All Products |
$84.45
|
| Rate for Payer: Signature Care EPO |
$90.80
|
| Rate for Payer: Signature Care PPO |
$96.27
|
| Rate for Payer: United Healthcare Commercial |
$86.20
|
|
|
HC HCG PREG TEST QUAL
|
Facility
OP
|
$109.40
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
63001331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$101.74 |
| Rate for Payer: Aetna Commercial |
$92.33
|
| Rate for Payer: Aetna Medicare |
$36.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$50.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$7.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.71
|
| Rate for Payer: Cash Price |
$67.83
|
| Rate for Payer: Cash Price |
$67.83
|
| Rate for Payer: Centivo All Commercial |
$55.79
|
| Rate for Payer: Cigna All Commercial |
$94.41
|
| Rate for Payer: CORVEL All Commercial |
$101.74
|
| Rate for Payer: Coventry All Commercial |
$96.27
|
| Rate for Payer: Encore All Commercial |
$100.70
|
| Rate for Payer: Frontpath All Commercial |
$100.64
|
| Rate for Payer: Humana ChoiceCare |
$94.48
|
| Rate for Payer: Humana Medicare |
$55.79
|
| Rate for Payer: Lucent All Commercial |
$55.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.46
|
| Rate for Payer: Managed Health Services Medicaid |
$7.52
|
| Rate for Payer: MDWise Medicaid |
$7.52
|
| Rate for Payer: PHCS All Commercial |
$82.05
|
| Rate for Payer: PHP All Commercial |
$82.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.66
|
| Rate for Payer: Sagamore Health Network All Products |
$84.45
|
| Rate for Payer: Signature Care EPO |
$90.80
|
| Rate for Payer: Signature Care PPO |
$96.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.99
|
| Rate for Payer: United Healthcare Commercial |
$86.20
|
| Rate for Payer: United Healthcare Medicare |
$36.10
|
|
|
HC HCT
|
Facility
OP
|
$57.22
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
63001237
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$53.22 |
| Rate for Payer: Aetna Commercial |
$48.30
|
| Rate for Payer: Aetna Medicare |
$18.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$18.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$26.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$26.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.77
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Centivo All Commercial |
$29.18
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.22
|
| Rate for Payer: Coventry All Commercial |
$50.36
|
| Rate for Payer: Encore All Commercial |
$52.67
|
| Rate for Payer: Frontpath All Commercial |
$52.64
|
| Rate for Payer: Humana ChoiceCare |
$49.42
|
| Rate for Payer: Humana Medicare |
$29.18
|
| Rate for Payer: Lucent All Commercial |
$29.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: Managed Health Services Medicaid |
$2.37
|
| Rate for Payer: MDWise Medicaid |
$2.37
|
| Rate for Payer: PHCS All Commercial |
$42.92
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.32
|
| Rate for Payer: Sagamore Health Network All Products |
$44.18
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$48.64
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
| Rate for Payer: United Healthcare Medicare |
$18.88
|
|
|
HC HCT
|
Facility
IP
|
$57.22
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
63001237
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.92 |
| Max. Negotiated Rate |
$53.22 |
| Rate for Payer: Aetna Commercial |
$49.44
|
| Rate for Payer: Cash Price |
$35.48
|
| Rate for Payer: Cigna All Commercial |
$49.38
|
| Rate for Payer: CORVEL All Commercial |
$53.22
|
| Rate for Payer: Coventry All Commercial |
$50.36
|
| Rate for Payer: Encore All Commercial |
$52.67
|
| Rate for Payer: Frontpath All Commercial |
$52.64
|
| Rate for Payer: Humana ChoiceCare |
$49.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.50
|
| Rate for Payer: PHCS All Commercial |
$42.92
|
| Rate for Payer: PHP All Commercial |
$43.40
|
| Rate for Payer: Sagamore Health Network All Products |
$44.18
|
| Rate for Payer: Signature Care EPO |
$47.49
|
| Rate for Payer: Signature Care PPO |
$50.36
|
| Rate for Payer: United Healthcare Commercial |
$45.09
|
|
|
HC HCT*
|
Facility
IP
|
$37.70
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
63001238
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.27 |
| Max. Negotiated Rate |
$35.06 |
| Rate for Payer: Aetna Commercial |
$32.57
|
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: Cigna All Commercial |
$32.53
|
| Rate for Payer: CORVEL All Commercial |
$35.06
|
| Rate for Payer: Coventry All Commercial |
$33.18
|
| Rate for Payer: Encore All Commercial |
$34.70
|
| Rate for Payer: Frontpath All Commercial |
$34.68
|
| Rate for Payer: Humana ChoiceCare |
$32.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.93
|
| Rate for Payer: PHCS All Commercial |
$28.27
|
| Rate for Payer: PHP All Commercial |
$28.59
|
| Rate for Payer: Sagamore Health Network All Products |
$29.10
|
| Rate for Payer: Signature Care EPO |
$31.29
|
| Rate for Payer: Signature Care PPO |
$33.18
|
| Rate for Payer: United Healthcare Commercial |
$29.71
|
|
|
HC HCT*
|
Facility
OP
|
$37.70
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
63001238
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$35.06 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Medicare |
$12.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$2.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.68
|
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: Cash Price |
$23.37
|
| Rate for Payer: Centivo All Commercial |
$19.23
|
| Rate for Payer: Cigna All Commercial |
$32.53
|
| Rate for Payer: CORVEL All Commercial |
$35.06
|
| Rate for Payer: Coventry All Commercial |
$33.18
|
| Rate for Payer: Encore All Commercial |
$34.70
|
| Rate for Payer: Frontpath All Commercial |
$34.68
|
| Rate for Payer: Humana ChoiceCare |
$32.56
|
| Rate for Payer: Humana Medicare |
$19.23
|
| Rate for Payer: Lucent All Commercial |
$19.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$33.93
|
| Rate for Payer: Managed Health Services Medicaid |
$2.37
|
| Rate for Payer: MDWise Medicaid |
$2.37
|
| Rate for Payer: PHCS All Commercial |
$28.27
|
| Rate for Payer: PHP All Commercial |
$28.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$14.70
|
| Rate for Payer: Sagamore Health Network All Products |
$29.10
|
| Rate for Payer: Signature Care EPO |
$31.29
|
| Rate for Payer: Signature Care PPO |
$33.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.04
|
| Rate for Payer: United Healthcare Commercial |
$29.71
|
| Rate for Payer: United Healthcare Medicare |
$12.44
|
|
|
HC HDL
|
Facility
OP
|
$73.27
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
63001319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$68.14 |
| Rate for Payer: Aetna Commercial |
$61.84
|
| Rate for Payer: Aetna Medicare |
$24.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$8.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.60
|
| Rate for Payer: Cash Price |
$45.43
|
| Rate for Payer: Cash Price |
$45.43
|
| Rate for Payer: Centivo All Commercial |
$37.37
|
| Rate for Payer: Cigna All Commercial |
$63.23
|
| Rate for Payer: CORVEL All Commercial |
$68.14
|
| Rate for Payer: Coventry All Commercial |
$64.47
|
| Rate for Payer: Encore All Commercial |
$67.44
|
| Rate for Payer: Frontpath All Commercial |
$67.41
|
| Rate for Payer: Humana ChoiceCare |
$63.28
|
| Rate for Payer: Humana Medicare |
$37.37
|
| Rate for Payer: Lucent All Commercial |
$37.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.94
|
| Rate for Payer: Managed Health Services Medicaid |
$8.19
|
| Rate for Payer: MDWise Medicaid |
$8.19
|
| Rate for Payer: PHCS All Commercial |
$54.95
|
| Rate for Payer: PHP All Commercial |
$55.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.57
|
| Rate for Payer: Sagamore Health Network All Products |
$56.56
|
| Rate for Payer: Signature Care EPO |
$60.81
|
| Rate for Payer: Signature Care PPO |
$64.47
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.28
|
| Rate for Payer: United Healthcare Commercial |
$57.73
|
| Rate for Payer: United Healthcare Medicare |
$24.18
|
|
|
HC HDL
|
Facility
IP
|
$73.27
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
63001319
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.95 |
| Max. Negotiated Rate |
$68.14 |
| Rate for Payer: Aetna Commercial |
$63.30
|
| Rate for Payer: Cash Price |
$45.43
|
| Rate for Payer: Cigna All Commercial |
$63.23
|
| Rate for Payer: CORVEL All Commercial |
$68.14
|
| Rate for Payer: Coventry All Commercial |
$64.47
|
| Rate for Payer: Encore All Commercial |
$67.44
|
| Rate for Payer: Frontpath All Commercial |
$67.41
|
| Rate for Payer: Humana ChoiceCare |
$63.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$65.94
|
| Rate for Payer: PHCS All Commercial |
$54.95
|
| Rate for Payer: PHP All Commercial |
$55.57
|
| Rate for Payer: Sagamore Health Network All Products |
$56.56
|
| Rate for Payer: Signature Care EPO |
$60.81
|
| Rate for Payer: Signature Care PPO |
$64.47
|
| Rate for Payer: United Healthcare Commercial |
$57.73
|
|
