|
HC TROCAR 11MM VERSA STEP
|
Facility
|
OP
|
$333.13
|
|
| Hospital Charge Code |
41601790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$309.81 |
| Rate for Payer: Aetna Commercial |
$281.16
|
| Rate for Payer: Aetna Medicare |
$106.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$191.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$208.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$122.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$117.26
|
| Rate for Payer: Cash Price |
$199.88
|
| Rate for Payer: Cash Price |
$199.88
|
| Rate for Payer: Centivo All Commercial |
$181.22
|
| Rate for Payer: Cigna All Commercial |
$287.49
|
| Rate for Payer: CORVEL All Commercial |
$309.81
|
| Rate for Payer: Coventry All Commercial |
$293.15
|
| Rate for Payer: Encore All Commercial |
$306.65
|
| Rate for Payer: Frontpath All Commercial |
$306.48
|
| Rate for Payer: Humana ChoiceCare |
$287.72
|
| Rate for Payer: Humana Medicare |
$106.60
|
| Rate for Payer: Lucent All Commercial |
$181.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$299.82
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$249.85
|
| Rate for Payer: PHP All Commercial |
$252.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$129.92
|
| Rate for Payer: Sagamore Health Network All Products |
$257.18
|
| Rate for Payer: Signature Care EPO |
$276.50
|
| Rate for Payer: Signature Care PPO |
$293.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$283.16
|
| Rate for Payer: United Healthcare Commercial |
$262.51
|
| Rate for Payer: United Healthcare Medicare |
$106.60
|
|
|
HC TROCAR 11MM VERSA STEP
|
Facility
|
IP
|
$333.13
|
|
| Hospital Charge Code |
41601790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$249.85 |
| Max. Negotiated Rate |
$309.81 |
| Rate for Payer: Aetna Commercial |
$287.82
|
| Rate for Payer: Cash Price |
$199.88
|
| Rate for Payer: Cigna All Commercial |
$287.49
|
| Rate for Payer: CORVEL All Commercial |
$309.81
|
| Rate for Payer: Coventry All Commercial |
$293.15
|
| Rate for Payer: Encore All Commercial |
$306.65
|
| Rate for Payer: Frontpath All Commercial |
$306.48
|
| Rate for Payer: Humana ChoiceCare |
$287.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$299.82
|
| Rate for Payer: PHCS All Commercial |
$249.85
|
| Rate for Payer: PHP All Commercial |
$252.65
|
| Rate for Payer: Sagamore Health Network All Products |
$257.18
|
| Rate for Payer: Signature Care EPO |
$276.50
|
| Rate for Payer: Signature Care PPO |
$293.15
|
| Rate for Payer: United Healthcare Commercial |
$262.51
|
|
|
HC TROCAR 12MM BLUNTPORT
|
Facility
|
OP
|
$205.52
|
|
| Hospital Charge Code |
41601786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$191.13 |
| Rate for Payer: Aetna Commercial |
$173.46
|
| Rate for Payer: Aetna Medicare |
$65.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$63.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$118.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$128.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$75.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$72.34
|
| Rate for Payer: Cash Price |
$123.31
|
| Rate for Payer: Cash Price |
$123.31
|
| Rate for Payer: Centivo All Commercial |
$111.80
|
| Rate for Payer: Cigna All Commercial |
$177.36
|
| Rate for Payer: CORVEL All Commercial |
$191.13
|
| Rate for Payer: Coventry All Commercial |
$180.86
|
| Rate for Payer: Encore All Commercial |
$189.18
|
| Rate for Payer: Frontpath All Commercial |
$189.08
|
| Rate for Payer: Humana ChoiceCare |
$177.51
|
| Rate for Payer: Humana Medicare |
$65.77
|
| Rate for Payer: Lucent All Commercial |
$111.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$184.97
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$154.14
|
| Rate for Payer: PHP All Commercial |
$155.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.15
|
| Rate for Payer: Sagamore Health Network All Products |
$158.66
|
| Rate for Payer: Signature Care EPO |
$170.58
|
| Rate for Payer: Signature Care PPO |
$180.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$174.69
|
| Rate for Payer: United Healthcare Commercial |
$161.95
|
| Rate for Payer: United Healthcare Medicare |
$65.77
|
|
|
HC TROCAR 12MM BLUNTPORT
|
Facility
|
IP
|
$205.52
|
|
| Hospital Charge Code |
41601786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.14 |
| Max. Negotiated Rate |
$191.13 |
| Rate for Payer: Aetna Commercial |
$177.57
|
| Rate for Payer: Cash Price |
$123.31
|
| Rate for Payer: Cigna All Commercial |
$177.36
|
| Rate for Payer: CORVEL All Commercial |
$191.13
|
| Rate for Payer: Coventry All Commercial |
$180.86
|
| Rate for Payer: Encore All Commercial |
$189.18
|
| Rate for Payer: Frontpath All Commercial |
$189.08
|
| Rate for Payer: Humana ChoiceCare |
$177.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$184.97
|
| Rate for Payer: PHCS All Commercial |
$154.14
|
| Rate for Payer: PHP All Commercial |
$155.87
|
| Rate for Payer: Sagamore Health Network All Products |
$158.66
|
| Rate for Payer: Signature Care EPO |
$170.58
|
| Rate for Payer: Signature Care PPO |
$180.86
|
| Rate for Payer: United Healthcare Commercial |
$161.95
|
|
|
HC TROCAR 12MM VERSA STEP
|
Facility
|
OP
|
$343.96
|
|
| Hospital Charge Code |
41602063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$319.88 |
| Rate for Payer: Aetna Commercial |
$290.30
|
| Rate for Payer: Aetna Medicare |
$110.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$106.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$197.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$215.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$126.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.07
|
| Rate for Payer: Cash Price |
$206.38
|
| Rate for Payer: Cash Price |
$206.38
|
| Rate for Payer: Centivo All Commercial |
$187.11
|
| Rate for Payer: Cigna All Commercial |
$296.84
|
| Rate for Payer: CORVEL All Commercial |
$319.88
|
| Rate for Payer: Coventry All Commercial |
$302.68
|
| Rate for Payer: Encore All Commercial |
$316.62
|
| Rate for Payer: Frontpath All Commercial |
$316.44
|
| Rate for Payer: Humana ChoiceCare |
$297.08
|
| Rate for Payer: Humana Medicare |
$110.07
|
| Rate for Payer: Lucent All Commercial |
$187.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$309.56
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$257.97
|
| Rate for Payer: PHP All Commercial |
$260.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$134.14
|
| Rate for Payer: Sagamore Health Network All Products |
$265.54
|
| Rate for Payer: Signature Care EPO |
$285.49
|
| Rate for Payer: Signature Care PPO |
$302.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$292.37
|
| Rate for Payer: United Healthcare Commercial |
$271.04
|
| Rate for Payer: United Healthcare Medicare |
$110.07
|
|
|
HC TROCAR 12MM VERSA STEP
|
Facility
|
IP
|
$343.96
|
|
| Hospital Charge Code |
41602063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.97 |
| Max. Negotiated Rate |
$319.88 |
| Rate for Payer: Aetna Commercial |
$297.18
|
| Rate for Payer: Cash Price |
$206.38
|
| Rate for Payer: Cigna All Commercial |
$296.84
|
| Rate for Payer: CORVEL All Commercial |
$319.88
|
| Rate for Payer: Coventry All Commercial |
$302.68
|
| Rate for Payer: Encore All Commercial |
$316.62
|
| Rate for Payer: Frontpath All Commercial |
$316.44
|
| Rate for Payer: Humana ChoiceCare |
$297.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$309.56
|
| Rate for Payer: PHCS All Commercial |
$257.97
|
| Rate for Payer: PHP All Commercial |
$260.86
|
| Rate for Payer: Sagamore Health Network All Products |
$265.54
|
| Rate for Payer: Signature Care EPO |
$285.49
|
| Rate for Payer: Signature Care PPO |
$302.68
|
| Rate for Payer: United Healthcare Commercial |
$271.04
|
|
|
HC TROCAR 5MM VERSASTEP
|
Facility
|
OP
|
$275.15
|
|
| Hospital Charge Code |
41602216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$255.89 |
| Rate for Payer: Aetna Commercial |
$232.23
|
| Rate for Payer: Aetna Medicare |
$88.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$158.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$172.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$101.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.85
|
| Rate for Payer: Cash Price |
$165.09
|
| Rate for Payer: Cash Price |
$165.09
|
| Rate for Payer: Centivo All Commercial |
$149.68
|
| Rate for Payer: Cigna All Commercial |
$237.45
|
| Rate for Payer: CORVEL All Commercial |
$255.89
|
| Rate for Payer: Coventry All Commercial |
$242.13
|
| Rate for Payer: Encore All Commercial |
$253.28
|
| Rate for Payer: Frontpath All Commercial |
$253.14
|
| Rate for Payer: Humana ChoiceCare |
$237.65
|
| Rate for Payer: Humana Medicare |
$88.05
|
| Rate for Payer: Lucent All Commercial |
$149.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$247.63
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$206.36
|
| Rate for Payer: PHP All Commercial |
$208.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$107.31
|
| Rate for Payer: Sagamore Health Network All Products |
$212.42
|
| Rate for Payer: Signature Care EPO |
$228.37
|
| Rate for Payer: Signature Care PPO |
$242.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$233.88
|
| Rate for Payer: United Healthcare Commercial |
$216.82
|
| Rate for Payer: United Healthcare Medicare |
$88.05
|
|
|
HC TROCAR 5MM VERSASTEP
|
Facility
|
IP
|
$275.15
|
|
| Hospital Charge Code |
41602216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$206.36 |
| Max. Negotiated Rate |
$255.89 |
| Rate for Payer: Aetna Commercial |
$237.73
|
| Rate for Payer: Cash Price |
$165.09
|
| Rate for Payer: Cigna All Commercial |
$237.45
|
| Rate for Payer: CORVEL All Commercial |
$255.89
|
| Rate for Payer: Coventry All Commercial |
$242.13
|
| Rate for Payer: Encore All Commercial |
$253.28
|
| Rate for Payer: Frontpath All Commercial |
$253.14
|
| Rate for Payer: Humana ChoiceCare |
$237.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$247.63
|
| Rate for Payer: PHCS All Commercial |
$206.36
|
| Rate for Payer: PHP All Commercial |
$208.67
|
| Rate for Payer: Sagamore Health Network All Products |
$212.42
|
| Rate for Payer: Signature Care EPO |
$228.37
|
| Rate for Payer: Signature Care PPO |
$242.13
|
| Rate for Payer: United Healthcare Commercial |
$216.82
|
|
|
HC TROCAR BLADELESS XCEL 12 MM
|
Facility
|
OP
|
$161.00
|
|
| Hospital Charge Code |
41607937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$149.73 |
| Rate for Payer: Aetna Commercial |
$135.88
|
| Rate for Payer: Aetna Medicare |
$51.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$92.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.67
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Centivo All Commercial |
$87.58
|
| Rate for Payer: Cigna All Commercial |
$138.94
|
| Rate for Payer: CORVEL All Commercial |
$149.73
|
| Rate for Payer: Coventry All Commercial |
$141.68
|
| Rate for Payer: Encore All Commercial |
$148.20
|
| Rate for Payer: Frontpath All Commercial |
$148.12
|
| Rate for Payer: Humana ChoiceCare |
$139.06
|
| Rate for Payer: Humana Medicare |
$51.52
|
| Rate for Payer: Lucent All Commercial |
$87.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.90
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$120.75
|
| Rate for Payer: PHP All Commercial |
$122.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.79
|
| Rate for Payer: Sagamore Health Network All Products |
$124.29
|
| Rate for Payer: Signature Care EPO |
$133.63
|
| Rate for Payer: Signature Care PPO |
$141.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.85
|
| Rate for Payer: United Healthcare Commercial |
$126.87
|
| Rate for Payer: United Healthcare Medicare |
$51.52
|
|
|
HC TROCAR BLADELESS XCEL 12 MM
|
Facility
|
IP
|
$161.00
|
|
| Hospital Charge Code |
41607937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$149.73 |
| Rate for Payer: Aetna Commercial |
$139.10
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna All Commercial |
$138.94
|
| Rate for Payer: CORVEL All Commercial |
$149.73
|
| Rate for Payer: Coventry All Commercial |
$141.68
|
| Rate for Payer: Encore All Commercial |
$148.20
|
| Rate for Payer: Frontpath All Commercial |
$148.12
|
| Rate for Payer: Humana ChoiceCare |
$139.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.90
|
| Rate for Payer: PHCS All Commercial |
$120.75
|
| Rate for Payer: PHP All Commercial |
$122.10
|
| Rate for Payer: Sagamore Health Network All Products |
$124.29
|
| Rate for Payer: Signature Care EPO |
$133.63
|
| Rate for Payer: Signature Care PPO |
$141.68
|
| Rate for Payer: United Healthcare Commercial |
$126.87
|
|
|
HC TROCAR BLADELESS XCEL B5LT
|
Facility
|
OP
|
$161.00
|
|
| Hospital Charge Code |
41601862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$149.73 |
| Rate for Payer: Aetna Commercial |
$135.88
|
| Rate for Payer: Aetna Medicare |
$51.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$92.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.67
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Centivo All Commercial |
$87.58
|
| Rate for Payer: Cigna All Commercial |
$138.94
|
| Rate for Payer: CORVEL All Commercial |
$149.73
|
| Rate for Payer: Coventry All Commercial |
$141.68
|
| Rate for Payer: Encore All Commercial |
$148.20
|
| Rate for Payer: Frontpath All Commercial |
$148.12
|
| Rate for Payer: Humana ChoiceCare |
$139.06
|
| Rate for Payer: Humana Medicare |
$51.52
|
| Rate for Payer: Lucent All Commercial |
$87.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.90
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$120.75
|
| Rate for Payer: PHP All Commercial |
$122.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.79
|
| Rate for Payer: Sagamore Health Network All Products |
$124.29
|
| Rate for Payer: Signature Care EPO |
$133.63
|
| Rate for Payer: Signature Care PPO |
$141.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.85
|
| Rate for Payer: United Healthcare Commercial |
$126.87
|
| Rate for Payer: United Healthcare Medicare |
$51.52
|
|
|
HC TROCAR BLADELESS XCEL B5LT
|
Facility
|
IP
|
$161.00
|
|
| Hospital Charge Code |
41601862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$149.73 |
| Rate for Payer: Aetna Commercial |
$139.10
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna All Commercial |
$138.94
|
| Rate for Payer: CORVEL All Commercial |
$149.73
|
| Rate for Payer: Coventry All Commercial |
$141.68
|
| Rate for Payer: Encore All Commercial |
$148.20
|
| Rate for Payer: Frontpath All Commercial |
$148.12
|
| Rate for Payer: Humana ChoiceCare |
$139.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.90
|
| Rate for Payer: PHCS All Commercial |
$120.75
|
| Rate for Payer: PHP All Commercial |
$122.10
|
| Rate for Payer: Sagamore Health Network All Products |
$124.29
|
| Rate for Payer: Signature Care EPO |
$133.63
|
| Rate for Payer: Signature Care PPO |
$141.68
|
| Rate for Payer: United Healthcare Commercial |
$126.87
|
|
|
HC TROCAR BLADELESS XCEL B8
|
Facility
|
OP
|
$161.00
|
|
| Hospital Charge Code |
41602061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$149.73 |
| Rate for Payer: Aetna Commercial |
$135.88
|
| Rate for Payer: Aetna Medicare |
$51.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$92.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.67
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Centivo All Commercial |
$87.58
|
| Rate for Payer: Cigna All Commercial |
$138.94
|
| Rate for Payer: CORVEL All Commercial |
$149.73
|
| Rate for Payer: Coventry All Commercial |
$141.68
|
| Rate for Payer: Encore All Commercial |
$148.20
|
| Rate for Payer: Frontpath All Commercial |
$148.12
|
| Rate for Payer: Humana ChoiceCare |
$139.06
|
| Rate for Payer: Humana Medicare |
$51.52
|
| Rate for Payer: Lucent All Commercial |
$87.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.90
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$120.75
|
| Rate for Payer: PHP All Commercial |
$122.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.79
|
| Rate for Payer: Sagamore Health Network All Products |
$124.29
|
| Rate for Payer: Signature Care EPO |
$133.63
|
| Rate for Payer: Signature Care PPO |
$141.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.85
|
| Rate for Payer: United Healthcare Commercial |
$126.87
|
| Rate for Payer: United Healthcare Medicare |
$51.52
|
|
|
HC TROCAR BLADELESS XCEL B8
|
Facility
|
IP
|
$161.00
|
|
| Hospital Charge Code |
41602061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$149.73 |
| Rate for Payer: Aetna Commercial |
$139.10
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna All Commercial |
$138.94
|
| Rate for Payer: CORVEL All Commercial |
$149.73
|
| Rate for Payer: Coventry All Commercial |
$141.68
|
| Rate for Payer: Encore All Commercial |
$148.20
|
| Rate for Payer: Frontpath All Commercial |
$148.12
|
| Rate for Payer: Humana ChoiceCare |
$139.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.90
|
| Rate for Payer: PHCS All Commercial |
$120.75
|
| Rate for Payer: PHP All Commercial |
$122.10
|
| Rate for Payer: Sagamore Health Network All Products |
$124.29
|
| Rate for Payer: Signature Care EPO |
$133.63
|
| Rate for Payer: Signature Care PPO |
$141.68
|
| Rate for Payer: United Healthcare Commercial |
$126.87
|
|
|
HC TROCAR BLUNT TIP H12
|
Facility
|
IP
|
$890.76
|
|
| Hospital Charge Code |
41602062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$668.07 |
| Max. Negotiated Rate |
$828.41 |
| Rate for Payer: Aetna Commercial |
$769.62
|
| Rate for Payer: Cash Price |
$534.46
|
| Rate for Payer: Cigna All Commercial |
$768.73
|
| Rate for Payer: CORVEL All Commercial |
$828.41
|
| Rate for Payer: Coventry All Commercial |
$783.87
|
| Rate for Payer: Encore All Commercial |
$819.94
|
| Rate for Payer: Frontpath All Commercial |
$819.50
|
| Rate for Payer: Humana ChoiceCare |
$769.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$801.68
|
| Rate for Payer: PHCS All Commercial |
$668.07
|
| Rate for Payer: PHP All Commercial |
$675.55
|
| Rate for Payer: Sagamore Health Network All Products |
$687.67
|
| Rate for Payer: Signature Care EPO |
$739.33
|
| Rate for Payer: Signature Care PPO |
$783.87
|
| Rate for Payer: United Healthcare Commercial |
$701.92
|
|
|
HC TROCAR BLUNT TIP H12
|
Facility
|
OP
|
$890.76
|
|
| Hospital Charge Code |
41602062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$828.41 |
| Rate for Payer: Aetna Commercial |
$751.80
|
| Rate for Payer: Aetna Medicare |
$285.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$276.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$511.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$556.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$327.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$313.55
|
| Rate for Payer: Cash Price |
$534.46
|
| Rate for Payer: Cash Price |
$534.46
|
| Rate for Payer: Centivo All Commercial |
$484.57
|
| Rate for Payer: Cigna All Commercial |
$768.73
|
| Rate for Payer: CORVEL All Commercial |
$828.41
|
| Rate for Payer: Coventry All Commercial |
$783.87
|
| Rate for Payer: Encore All Commercial |
$819.94
|
| Rate for Payer: Frontpath All Commercial |
$819.50
|
| Rate for Payer: Humana ChoiceCare |
$769.35
|
| Rate for Payer: Humana Medicare |
$285.04
|
| Rate for Payer: Lucent All Commercial |
$484.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$801.68
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$668.07
|
| Rate for Payer: PHP All Commercial |
$675.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$347.40
|
| Rate for Payer: Sagamore Health Network All Products |
$687.67
|
| Rate for Payer: Signature Care EPO |
$739.33
|
| Rate for Payer: Signature Care PPO |
$783.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$757.15
|
| Rate for Payer: United Healthcare Commercial |
$701.92
|
| Rate for Payer: United Healthcare Medicare |
$285.04
|
|
|
HC TROCARE ENDOPATH XCEL 11MM
|
Facility
|
IP
|
$166.55
|
|
| Hospital Charge Code |
41602415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.91 |
| Max. Negotiated Rate |
$154.89 |
| Rate for Payer: Aetna Commercial |
$143.90
|
| Rate for Payer: Cash Price |
$99.93
|
| Rate for Payer: Cigna All Commercial |
$143.73
|
| Rate for Payer: CORVEL All Commercial |
$154.89
|
| Rate for Payer: Coventry All Commercial |
$146.56
|
| Rate for Payer: Encore All Commercial |
$153.31
|
| Rate for Payer: Frontpath All Commercial |
$153.23
|
| Rate for Payer: Humana ChoiceCare |
$143.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.90
|
| Rate for Payer: PHCS All Commercial |
$124.91
|
| Rate for Payer: PHP All Commercial |
$126.31
|
| Rate for Payer: Sagamore Health Network All Products |
$128.58
|
| Rate for Payer: Signature Care EPO |
$138.24
|
| Rate for Payer: Signature Care PPO |
$146.56
|
| Rate for Payer: United Healthcare Commercial |
$131.24
|
|
|
HC TROCARE ENDOPATH XCEL 11MM
|
Facility
|
OP
|
$166.55
|
|
| Hospital Charge Code |
41602415
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$154.89 |
| Rate for Payer: Aetna Commercial |
$140.57
|
| Rate for Payer: Aetna Medicare |
$53.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$95.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$104.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.63
|
| Rate for Payer: Cash Price |
$99.93
|
| Rate for Payer: Cash Price |
$99.93
|
| Rate for Payer: Centivo All Commercial |
$90.60
|
| Rate for Payer: Cigna All Commercial |
$143.73
|
| Rate for Payer: CORVEL All Commercial |
$154.89
|
| Rate for Payer: Coventry All Commercial |
$146.56
|
| Rate for Payer: Encore All Commercial |
$153.31
|
| Rate for Payer: Frontpath All Commercial |
$153.23
|
| Rate for Payer: Humana ChoiceCare |
$143.85
|
| Rate for Payer: Humana Medicare |
$53.30
|
| Rate for Payer: Lucent All Commercial |
$90.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.90
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$124.91
|
| Rate for Payer: PHP All Commercial |
$126.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$64.95
|
| Rate for Payer: Sagamore Health Network All Products |
$128.58
|
| Rate for Payer: Signature Care EPO |
$138.24
|
| Rate for Payer: Signature Care PPO |
$146.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$141.57
|
| Rate for Payer: United Healthcare Commercial |
$131.24
|
| Rate for Payer: United Healthcare Medicare |
$53.30
|
|
|
HC TROCAR ENDOPATH XCEL 12 OPT
|
Facility
|
IP
|
$161.00
|
|
| Hospital Charge Code |
41608023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.75 |
| Max. Negotiated Rate |
$149.73 |
| Rate for Payer: Aetna Commercial |
$139.10
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna All Commercial |
$138.94
|
| Rate for Payer: CORVEL All Commercial |
$149.73
|
| Rate for Payer: Coventry All Commercial |
$141.68
|
| Rate for Payer: Encore All Commercial |
$148.20
|
| Rate for Payer: Frontpath All Commercial |
$148.12
|
| Rate for Payer: Humana ChoiceCare |
$139.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.90
|
| Rate for Payer: PHCS All Commercial |
$120.75
|
| Rate for Payer: PHP All Commercial |
$122.10
|
| Rate for Payer: Sagamore Health Network All Products |
$124.29
|
| Rate for Payer: Signature Care EPO |
$133.63
|
| Rate for Payer: Signature Care PPO |
$141.68
|
| Rate for Payer: United Healthcare Commercial |
$126.87
|
|
|
HC TROCAR ENDOPATH XCEL 12 OPT
|
Facility
|
OP
|
$161.00
|
|
| Hospital Charge Code |
41608023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$149.73 |
| Rate for Payer: Aetna Commercial |
$135.88
|
| Rate for Payer: Aetna Medicare |
$51.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$49.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$92.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$59.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.67
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Centivo All Commercial |
$87.58
|
| Rate for Payer: Cigna All Commercial |
$138.94
|
| Rate for Payer: CORVEL All Commercial |
$149.73
|
| Rate for Payer: Coventry All Commercial |
$141.68
|
| Rate for Payer: Encore All Commercial |
$148.20
|
| Rate for Payer: Frontpath All Commercial |
$148.12
|
| Rate for Payer: Humana ChoiceCare |
$139.06
|
| Rate for Payer: Humana Medicare |
$51.52
|
| Rate for Payer: Lucent All Commercial |
$87.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.90
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$120.75
|
| Rate for Payer: PHP All Commercial |
$122.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$62.79
|
| Rate for Payer: Sagamore Health Network All Products |
$124.29
|
| Rate for Payer: Signature Care EPO |
$133.63
|
| Rate for Payer: Signature Care PPO |
$141.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$136.85
|
| Rate for Payer: United Healthcare Commercial |
$126.87
|
| Rate for Payer: United Healthcare Medicare |
$51.52
|
|
|
HC TROCAR SLEEVE STABILITY 5MM
|
Facility
|
OP
|
$112.00
|
|
| Hospital Charge Code |
41601859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$104.16 |
| Rate for Payer: Aetna Commercial |
$94.53
|
| Rate for Payer: Aetna Medicare |
$35.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$64.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.42
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Centivo All Commercial |
$60.93
|
| Rate for Payer: Cigna All Commercial |
$96.66
|
| Rate for Payer: CORVEL All Commercial |
$104.16
|
| Rate for Payer: Coventry All Commercial |
$98.56
|
| Rate for Payer: Encore All Commercial |
$103.10
|
| Rate for Payer: Frontpath All Commercial |
$103.04
|
| Rate for Payer: Humana ChoiceCare |
$96.73
|
| Rate for Payer: Humana Medicare |
$35.84
|
| Rate for Payer: Lucent All Commercial |
$60.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.80
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$84.00
|
| Rate for Payer: PHP All Commercial |
$84.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.68
|
| Rate for Payer: Sagamore Health Network All Products |
$86.46
|
| Rate for Payer: Signature Care EPO |
$92.96
|
| Rate for Payer: Signature Care PPO |
$98.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$95.20
|
| Rate for Payer: United Healthcare Commercial |
$88.26
|
| Rate for Payer: United Healthcare Medicare |
$35.84
|
|
|
HC TROCAR SLEEVE STABILITY 5MM
|
Facility
|
IP
|
$112.00
|
|
| Hospital Charge Code |
41601859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$104.16 |
| Rate for Payer: Aetna Commercial |
$96.77
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna All Commercial |
$96.66
|
| Rate for Payer: CORVEL All Commercial |
$104.16
|
| Rate for Payer: Coventry All Commercial |
$98.56
|
| Rate for Payer: Encore All Commercial |
$103.10
|
| Rate for Payer: Frontpath All Commercial |
$103.04
|
| Rate for Payer: Humana ChoiceCare |
$96.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$100.80
|
| Rate for Payer: PHCS All Commercial |
$84.00
|
| Rate for Payer: PHP All Commercial |
$84.94
|
| Rate for Payer: Sagamore Health Network All Products |
$86.46
|
| Rate for Payer: Signature Care EPO |
$92.96
|
| Rate for Payer: Signature Care PPO |
$98.56
|
| Rate for Payer: United Healthcare Commercial |
$88.26
|
|
|
HC TROCAR SLEEVE VERSASTEP STANDARD
|
Facility
|
IP
|
$309.55
|
|
| Hospital Charge Code |
41601187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.16 |
| Max. Negotiated Rate |
$287.88 |
| Rate for Payer: Aetna Commercial |
$267.45
|
| Rate for Payer: Cash Price |
$185.73
|
| Rate for Payer: Cigna All Commercial |
$267.14
|
| Rate for Payer: CORVEL All Commercial |
$287.88
|
| Rate for Payer: Coventry All Commercial |
$272.40
|
| Rate for Payer: Encore All Commercial |
$284.94
|
| Rate for Payer: Frontpath All Commercial |
$284.79
|
| Rate for Payer: Humana ChoiceCare |
$267.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.60
|
| Rate for Payer: PHCS All Commercial |
$232.16
|
| Rate for Payer: PHP All Commercial |
$234.76
|
| Rate for Payer: Sagamore Health Network All Products |
$238.97
|
| Rate for Payer: Signature Care EPO |
$256.93
|
| Rate for Payer: Signature Care PPO |
$272.40
|
| Rate for Payer: United Healthcare Commercial |
$243.93
|
|
|
HC TROCAR SLEEVE VERSASTEP STANDARD
|
Facility
|
OP
|
$309.55
|
|
| Hospital Charge Code |
41601187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$287.88 |
| Rate for Payer: Aetna Commercial |
$261.26
|
| Rate for Payer: Aetna Medicare |
$99.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$177.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.96
|
| Rate for Payer: Cash Price |
$185.73
|
| Rate for Payer: Cash Price |
$185.73
|
| Rate for Payer: Centivo All Commercial |
$168.40
|
| Rate for Payer: Cigna All Commercial |
$267.14
|
| Rate for Payer: CORVEL All Commercial |
$287.88
|
| Rate for Payer: Coventry All Commercial |
$272.40
|
| Rate for Payer: Encore All Commercial |
$284.94
|
| Rate for Payer: Frontpath All Commercial |
$284.79
|
| Rate for Payer: Humana ChoiceCare |
$267.36
|
| Rate for Payer: Humana Medicare |
$99.06
|
| Rate for Payer: Lucent All Commercial |
$168.40
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.60
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$232.16
|
| Rate for Payer: PHP All Commercial |
$234.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$120.72
|
| Rate for Payer: Sagamore Health Network All Products |
$238.97
|
| Rate for Payer: Signature Care EPO |
$256.93
|
| Rate for Payer: Signature Care PPO |
$272.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$263.12
|
| Rate for Payer: United Healthcare Commercial |
$243.93
|
| Rate for Payer: United Healthcare Medicare |
$99.06
|
|
|
HC TROCAR XCEL 11MM
|
Facility
|
OP
|
$734.69
|
|
| Hospital Charge Code |
41602080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$683.26 |
| Rate for Payer: Aetna Commercial |
$620.08
|
| Rate for Payer: Aetna Medicare |
$235.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$227.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$421.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$459.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$270.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$258.61
|
| Rate for Payer: Cash Price |
$440.81
|
| Rate for Payer: Cash Price |
$440.81
|
| Rate for Payer: Centivo All Commercial |
$399.67
|
| Rate for Payer: Cigna All Commercial |
$634.04
|
| Rate for Payer: CORVEL All Commercial |
$683.26
|
| Rate for Payer: Coventry All Commercial |
$646.53
|
| Rate for Payer: Encore All Commercial |
$676.28
|
| Rate for Payer: Frontpath All Commercial |
$675.91
|
| Rate for Payer: Humana ChoiceCare |
$634.55
|
| Rate for Payer: Humana Medicare |
$235.10
|
| Rate for Payer: Lucent All Commercial |
$399.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$661.22
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$551.02
|
| Rate for Payer: PHP All Commercial |
$557.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$286.53
|
| Rate for Payer: Sagamore Health Network All Products |
$567.18
|
| Rate for Payer: Signature Care EPO |
$609.79
|
| Rate for Payer: Signature Care PPO |
$646.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$624.49
|
| Rate for Payer: United Healthcare Commercial |
$578.94
|
| Rate for Payer: United Healthcare Medicare |
$235.10
|
|
