|
HC TRAY SPINAL PENCAN
|
Facility
|
IP
|
$121.74
|
|
| Hospital Charge Code |
41601184
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$91.30 |
| Max. Negotiated Rate |
$113.22 |
| Rate for Payer: Aetna Commercial |
$105.18
|
| Rate for Payer: Cash Price |
$75.48
|
| Rate for Payer: Cigna All Commercial |
$105.06
|
| Rate for Payer: CORVEL All Commercial |
$113.22
|
| Rate for Payer: Coventry All Commercial |
$107.13
|
| Rate for Payer: Encore All Commercial |
$112.06
|
| Rate for Payer: Frontpath All Commercial |
$112.00
|
| Rate for Payer: Humana ChoiceCare |
$105.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$109.57
|
| Rate for Payer: PHCS All Commercial |
$91.30
|
| Rate for Payer: PHP All Commercial |
$92.33
|
| Rate for Payer: Sagamore Health Network All Products |
$93.98
|
| Rate for Payer: Signature Care EPO |
$101.04
|
| Rate for Payer: Signature Care PPO |
$107.13
|
| Rate for Payer: United Healthcare Commercial |
$95.93
|
|
|
HC TRAY THORA/PARACENTESIS
|
Facility
|
OP
|
$294.00
|
|
| Hospital Charge Code |
41606345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.02 |
| Max. Negotiated Rate |
$273.42 |
| Rate for Payer: Aetna Commercial |
$248.14
|
| Rate for Payer: Aetna Medicare |
$97.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$168.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$183.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$111.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$106.72
|
| Rate for Payer: Cash Price |
$182.28
|
| Rate for Payer: Cash Price |
$182.28
|
| Rate for Payer: Centivo All Commercial |
$149.94
|
| Rate for Payer: Cigna All Commercial |
$253.72
|
| Rate for Payer: CORVEL All Commercial |
$273.42
|
| Rate for Payer: Coventry All Commercial |
$258.72
|
| Rate for Payer: Encore All Commercial |
$270.63
|
| Rate for Payer: Frontpath All Commercial |
$270.48
|
| Rate for Payer: Humana ChoiceCare |
$253.93
|
| Rate for Payer: Humana Medicare |
$149.94
|
| Rate for Payer: Lucent All Commercial |
$149.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$264.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$220.50
|
| Rate for Payer: PHP All Commercial |
$222.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$114.66
|
| Rate for Payer: Sagamore Health Network All Products |
$226.97
|
| Rate for Payer: Signature Care EPO |
$244.02
|
| Rate for Payer: Signature Care PPO |
$258.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$249.90
|
| Rate for Payer: United Healthcare Commercial |
$231.67
|
| Rate for Payer: United Healthcare Medicare |
$97.02
|
|
|
HC TRAY THORA/PARACENTESIS
|
Facility
|
IP
|
$294.00
|
|
| Hospital Charge Code |
41606345
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$273.42 |
| Rate for Payer: Aetna Commercial |
$254.02
|
| Rate for Payer: Cash Price |
$182.28
|
| Rate for Payer: Cigna All Commercial |
$253.72
|
| Rate for Payer: CORVEL All Commercial |
$273.42
|
| Rate for Payer: Coventry All Commercial |
$258.72
|
| Rate for Payer: Encore All Commercial |
$270.63
|
| Rate for Payer: Frontpath All Commercial |
$270.48
|
| Rate for Payer: Humana ChoiceCare |
$253.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$264.60
|
| Rate for Payer: PHCS All Commercial |
$220.50
|
| Rate for Payer: PHP All Commercial |
$222.97
|
| Rate for Payer: Sagamore Health Network All Products |
$226.97
|
| Rate for Payer: Signature Care EPO |
$244.02
|
| Rate for Payer: Signature Care PPO |
$258.72
|
| Rate for Payer: United Healthcare Commercial |
$231.67
|
|
|
HC TRAY UROLOGIST HEYMAN SYSTEM
|
Facility
|
IP
|
$1,180.50
|
|
| Hospital Charge Code |
41602073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$885.38 |
| Max. Negotiated Rate |
$1,097.86 |
| Rate for Payer: Aetna Commercial |
$1,019.95
|
| Rate for Payer: Cash Price |
$731.91
|
| Rate for Payer: Cigna All Commercial |
$1,018.77
|
| Rate for Payer: CORVEL All Commercial |
$1,097.86
|
| Rate for Payer: Coventry All Commercial |
$1,038.84
|
| Rate for Payer: Encore All Commercial |
$1,086.65
|
| Rate for Payer: Frontpath All Commercial |
$1,086.06
|
| Rate for Payer: Humana ChoiceCare |
$1,019.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,062.45
|
| Rate for Payer: PHCS All Commercial |
$885.38
|
| Rate for Payer: PHP All Commercial |
$895.29
|
| Rate for Payer: Sagamore Health Network All Products |
$911.35
|
| Rate for Payer: Signature Care EPO |
$979.82
|
| Rate for Payer: Signature Care PPO |
$1,038.84
|
| Rate for Payer: United Healthcare Commercial |
$930.23
|
|
|
HC TRAY UROLOGIST HEYMAN SYSTEM
|
Facility
|
OP
|
$1,180.50
|
|
| Hospital Charge Code |
41602073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,097.86 |
| Rate for Payer: Aetna Commercial |
$996.34
|
| Rate for Payer: Aetna Medicare |
$389.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$389.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$677.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$737.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$448.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$428.52
|
| Rate for Payer: Cash Price |
$731.91
|
| Rate for Payer: Cash Price |
$731.91
|
| Rate for Payer: Centivo All Commercial |
$602.06
|
| Rate for Payer: Cigna All Commercial |
$1,018.77
|
| Rate for Payer: CORVEL All Commercial |
$1,097.86
|
| Rate for Payer: Coventry All Commercial |
$1,038.84
|
| Rate for Payer: Encore All Commercial |
$1,086.65
|
| Rate for Payer: Frontpath All Commercial |
$1,086.06
|
| Rate for Payer: Humana ChoiceCare |
$1,019.60
|
| Rate for Payer: Humana Medicare |
$602.06
|
| Rate for Payer: Lucent All Commercial |
$602.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,062.45
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$885.38
|
| Rate for Payer: PHP All Commercial |
$895.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$460.40
|
| Rate for Payer: Sagamore Health Network All Products |
$911.35
|
| Rate for Payer: Signature Care EPO |
$979.82
|
| Rate for Payer: Signature Care PPO |
$1,038.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,003.42
|
| Rate for Payer: United Healthcare Commercial |
$930.23
|
| Rate for Payer: United Healthcare Medicare |
$389.56
|
|
|
HC TREPONEMA PALLIDUM IGG AB
|
Facility
|
OP
|
$110.16
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
63001972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$102.45 |
| Rate for Payer: Aetna Commercial |
$92.98
|
| Rate for Payer: Aetna Medicare |
$36.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$50.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$13.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.99
|
| Rate for Payer: Cash Price |
$68.30
|
| Rate for Payer: Cash Price |
$68.30
|
| Rate for Payer: Centivo All Commercial |
$56.18
|
| Rate for Payer: Cigna All Commercial |
$95.07
|
| Rate for Payer: CORVEL All Commercial |
$102.45
|
| Rate for Payer: Coventry All Commercial |
$96.94
|
| Rate for Payer: Encore All Commercial |
$101.40
|
| Rate for Payer: Frontpath All Commercial |
$101.35
|
| Rate for Payer: Humana ChoiceCare |
$95.15
|
| Rate for Payer: Humana Medicare |
$56.18
|
| Rate for Payer: Lucent All Commercial |
$56.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.14
|
| Rate for Payer: Managed Health Services Medicaid |
$13.24
|
| Rate for Payer: MDWise Medicaid |
$13.24
|
| Rate for Payer: PHCS All Commercial |
$82.62
|
| Rate for Payer: PHP All Commercial |
$83.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.96
|
| Rate for Payer: Sagamore Health Network All Products |
$85.04
|
| Rate for Payer: Signature Care EPO |
$91.43
|
| Rate for Payer: Signature Care PPO |
$96.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93.64
|
| Rate for Payer: United Healthcare Commercial |
$86.81
|
| Rate for Payer: United Healthcare Medicare |
$36.35
|
|
|
HC TREPONEMA PALLIDUM IGG AB
|
Facility
|
IP
|
$110.16
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
63001972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.62 |
| Max. Negotiated Rate |
$102.45 |
| Rate for Payer: Aetna Commercial |
$95.18
|
| Rate for Payer: Cash Price |
$68.30
|
| Rate for Payer: Cigna All Commercial |
$95.07
|
| Rate for Payer: CORVEL All Commercial |
$102.45
|
| Rate for Payer: Coventry All Commercial |
$96.94
|
| Rate for Payer: Encore All Commercial |
$101.40
|
| Rate for Payer: Frontpath All Commercial |
$101.35
|
| Rate for Payer: Humana ChoiceCare |
$95.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.14
|
| Rate for Payer: PHCS All Commercial |
$82.62
|
| Rate for Payer: PHP All Commercial |
$83.55
|
| Rate for Payer: Sagamore Health Network All Products |
$85.04
|
| Rate for Payer: Signature Care EPO |
$91.43
|
| Rate for Payer: Signature Care PPO |
$96.94
|
| Rate for Payer: United Healthcare Commercial |
$86.81
|
|
|
HC TRICHINELLA ANTIBODY BY ELISA - SERUM
|
Facility
|
IP
|
$145.02
|
|
|
Service Code
|
CPT 86784
|
| Hospital Charge Code |
63001973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.77 |
| Max. Negotiated Rate |
$134.87 |
| Rate for Payer: Aetna Commercial |
$125.30
|
| Rate for Payer: Cash Price |
$89.92
|
| Rate for Payer: Cigna All Commercial |
$125.16
|
| Rate for Payer: CORVEL All Commercial |
$134.87
|
| Rate for Payer: Coventry All Commercial |
$127.62
|
| Rate for Payer: Encore All Commercial |
$133.49
|
| Rate for Payer: Frontpath All Commercial |
$133.42
|
| Rate for Payer: Humana ChoiceCare |
$125.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.52
|
| Rate for Payer: PHCS All Commercial |
$108.77
|
| Rate for Payer: PHP All Commercial |
$109.99
|
| Rate for Payer: Sagamore Health Network All Products |
$111.96
|
| Rate for Payer: Signature Care EPO |
$120.37
|
| Rate for Payer: Signature Care PPO |
$127.62
|
| Rate for Payer: United Healthcare Commercial |
$114.28
|
|
|
HC TRICHINELLA ANTIBODY BY ELISA - SERUM
|
Facility
|
OP
|
$145.02
|
|
|
Service Code
|
CPT 86784
|
| Hospital Charge Code |
63001973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$134.87 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Medicare |
$47.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$47.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$83.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$90.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.64
|
| Rate for Payer: Cash Price |
$89.92
|
| Rate for Payer: Cash Price |
$89.92
|
| Rate for Payer: Centivo All Commercial |
$73.96
|
| Rate for Payer: Cigna All Commercial |
$125.16
|
| Rate for Payer: CORVEL All Commercial |
$134.87
|
| Rate for Payer: Coventry All Commercial |
$127.62
|
| Rate for Payer: Encore All Commercial |
$133.49
|
| Rate for Payer: Frontpath All Commercial |
$133.42
|
| Rate for Payer: Humana ChoiceCare |
$125.26
|
| Rate for Payer: Humana Medicare |
$73.96
|
| Rate for Payer: Lucent All Commercial |
$73.96
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.52
|
| Rate for Payer: Managed Health Services Medicaid |
$12.56
|
| Rate for Payer: MDWise Medicaid |
$12.56
|
| Rate for Payer: PHCS All Commercial |
$108.77
|
| Rate for Payer: PHP All Commercial |
$109.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$56.56
|
| Rate for Payer: Sagamore Health Network All Products |
$111.96
|
| Rate for Payer: Signature Care EPO |
$120.37
|
| Rate for Payer: Signature Care PPO |
$127.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$123.27
|
| Rate for Payer: United Healthcare Commercial |
$114.28
|
| Rate for Payer: United Healthcare Medicare |
$47.86
|
|
|
HC TRIGLYCERIDES
|
Facility
|
OP
|
$103.07
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
63001300
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$95.86 |
| Rate for Payer: Aetna Commercial |
$86.99
|
| Rate for Payer: Aetna Medicare |
$34.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$5.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.41
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Centivo All Commercial |
$52.57
|
| Rate for Payer: Cigna All Commercial |
$88.95
|
| Rate for Payer: CORVEL All Commercial |
$95.86
|
| Rate for Payer: Coventry All Commercial |
$90.70
|
| Rate for Payer: Encore All Commercial |
$94.88
|
| Rate for Payer: Frontpath All Commercial |
$94.83
|
| Rate for Payer: Humana ChoiceCare |
$89.02
|
| Rate for Payer: Humana Medicare |
$52.57
|
| Rate for Payer: Lucent All Commercial |
$52.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.76
|
| Rate for Payer: Managed Health Services Medicaid |
$5.74
|
| Rate for Payer: MDWise Medicaid |
$5.74
|
| Rate for Payer: PHCS All Commercial |
$77.30
|
| Rate for Payer: PHP All Commercial |
$78.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.20
|
| Rate for Payer: Sagamore Health Network All Products |
$79.57
|
| Rate for Payer: Signature Care EPO |
$85.55
|
| Rate for Payer: Signature Care PPO |
$90.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.61
|
| Rate for Payer: United Healthcare Commercial |
$81.22
|
| Rate for Payer: United Healthcare Medicare |
$34.01
|
|
|
HC TRIGLYCERIDES
|
Facility
|
IP
|
$103.07
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
63001300
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.30 |
| Max. Negotiated Rate |
$95.86 |
| Rate for Payer: Aetna Commercial |
$89.05
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna All Commercial |
$88.95
|
| Rate for Payer: CORVEL All Commercial |
$95.86
|
| Rate for Payer: Coventry All Commercial |
$90.70
|
| Rate for Payer: Encore All Commercial |
$94.88
|
| Rate for Payer: Frontpath All Commercial |
$94.83
|
| Rate for Payer: Humana ChoiceCare |
$89.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.76
|
| Rate for Payer: PHCS All Commercial |
$77.30
|
| Rate for Payer: PHP All Commercial |
$78.17
|
| Rate for Payer: Sagamore Health Network All Products |
$79.57
|
| Rate for Payer: Signature Care EPO |
$85.55
|
| Rate for Payer: Signature Care PPO |
$90.70
|
| Rate for Payer: United Healthcare Commercial |
$81.22
|
|
|
HC TRIPLE LUMEN GARD PLUS KIT CVC
|
Facility
|
OP
|
$824.54
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41601264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$766.82 |
| Rate for Payer: Aetna Commercial |
$695.91
|
| Rate for Payer: Aetna Medicare |
$272.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$272.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$473.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$515.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$312.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$299.31
|
| Rate for Payer: Cash Price |
$511.22
|
| Rate for Payer: Cash Price |
$511.22
|
| Rate for Payer: Centivo All Commercial |
$420.52
|
| Rate for Payer: Cigna All Commercial |
$711.58
|
| Rate for Payer: CORVEL All Commercial |
$766.82
|
| Rate for Payer: Coventry All Commercial |
$725.60
|
| Rate for Payer: Encore All Commercial |
$758.99
|
| Rate for Payer: Frontpath All Commercial |
$758.58
|
| Rate for Payer: Humana ChoiceCare |
$712.16
|
| Rate for Payer: Humana Medicare |
$420.52
|
| Rate for Payer: Lucent All Commercial |
$420.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.09
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$618.40
|
| Rate for Payer: PHP All Commercial |
$625.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$321.57
|
| Rate for Payer: Sagamore Health Network All Products |
$636.54
|
| Rate for Payer: Signature Care EPO |
$684.37
|
| Rate for Payer: Signature Care PPO |
$725.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$700.86
|
| Rate for Payer: United Healthcare Commercial |
$649.74
|
| Rate for Payer: United Healthcare Medicare |
$272.10
|
|
|
HC TRIPLE LUMEN GARD PLUS KIT CVC
|
Facility
|
IP
|
$824.54
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
41601264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$618.40 |
| Max. Negotiated Rate |
$766.82 |
| Rate for Payer: Aetna Commercial |
$712.40
|
| Rate for Payer: Cash Price |
$511.22
|
| Rate for Payer: Cigna All Commercial |
$711.58
|
| Rate for Payer: CORVEL All Commercial |
$766.82
|
| Rate for Payer: Coventry All Commercial |
$725.60
|
| Rate for Payer: Encore All Commercial |
$758.99
|
| Rate for Payer: Frontpath All Commercial |
$758.58
|
| Rate for Payer: Humana ChoiceCare |
$712.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$742.09
|
| Rate for Payer: PHCS All Commercial |
$618.40
|
| Rate for Payer: PHP All Commercial |
$625.33
|
| Rate for Payer: Sagamore Health Network All Products |
$636.54
|
| Rate for Payer: Signature Care EPO |
$684.37
|
| Rate for Payer: Signature Care PPO |
$725.60
|
| Rate for Payer: United Healthcare Commercial |
$649.74
|
|
|
HC TROCAR 11MM VERSA STEP
|
Facility
|
OP
|
$343.96
|
|
| Hospital Charge Code |
41601790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$319.88 |
| Rate for Payer: Aetna Commercial |
$290.30
|
| Rate for Payer: Aetna Medicare |
$113.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$113.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$197.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$215.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.86
|
| Rate for Payer: Cash Price |
$213.26
|
| Rate for Payer: Cash Price |
$213.26
|
| Rate for Payer: Centivo All Commercial |
$175.42
|
| 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 |
$175.42
|
| Rate for Payer: Lucent All Commercial |
$175.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$309.56
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$113.51
|
|
|
HC TROCAR 11MM VERSA STEP
|
Facility
|
IP
|
$343.96
|
|
| Hospital Charge Code |
41601790
|
|
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 |
$213.26
|
| 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 12MM BLUNTPORT
|
Facility
|
OP
|
$212.19
|
|
| Hospital Charge Code |
41601786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.02 |
| Max. Negotiated Rate |
$197.34 |
| Rate for Payer: Aetna Commercial |
$179.09
|
| Rate for Payer: Aetna Medicare |
$70.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$70.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$121.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.02
|
| Rate for Payer: Cash Price |
$131.56
|
| Rate for Payer: Cash Price |
$131.56
|
| Rate for Payer: Centivo All Commercial |
$108.22
|
| Rate for Payer: Cigna All Commercial |
$183.12
|
| Rate for Payer: CORVEL All Commercial |
$197.34
|
| Rate for Payer: Coventry All Commercial |
$186.73
|
| Rate for Payer: Encore All Commercial |
$195.32
|
| Rate for Payer: Frontpath All Commercial |
$195.21
|
| Rate for Payer: Humana ChoiceCare |
$183.27
|
| Rate for Payer: Humana Medicare |
$108.22
|
| Rate for Payer: Lucent All Commercial |
$108.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.97
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$159.14
|
| Rate for Payer: PHP All Commercial |
$160.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.75
|
| Rate for Payer: Sagamore Health Network All Products |
$163.81
|
| Rate for Payer: Signature Care EPO |
$176.12
|
| Rate for Payer: Signature Care PPO |
$186.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$180.36
|
| Rate for Payer: United Healthcare Commercial |
$167.21
|
| Rate for Payer: United Healthcare Medicare |
$70.02
|
|
|
HC TROCAR 12MM BLUNTPORT
|
Facility
|
IP
|
$212.19
|
|
| Hospital Charge Code |
41601786
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.14 |
| Max. Negotiated Rate |
$197.34 |
| Rate for Payer: Aetna Commercial |
$183.33
|
| Rate for Payer: Cash Price |
$131.56
|
| Rate for Payer: Cigna All Commercial |
$183.12
|
| Rate for Payer: CORVEL All Commercial |
$197.34
|
| Rate for Payer: Coventry All Commercial |
$186.73
|
| Rate for Payer: Encore All Commercial |
$195.32
|
| Rate for Payer: Frontpath All Commercial |
$195.21
|
| Rate for Payer: Humana ChoiceCare |
$183.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.97
|
| Rate for Payer: PHCS All Commercial |
$159.14
|
| Rate for Payer: PHP All Commercial |
$160.92
|
| Rate for Payer: Sagamore Health Network All Products |
$163.81
|
| Rate for Payer: Signature Care EPO |
$176.12
|
| Rate for Payer: Signature Care PPO |
$186.73
|
| Rate for Payer: United Healthcare Commercial |
$167.21
|
|
|
HC TROCAR 12MM LONG VERSASTEP
|
Facility
|
OP
|
$343.96
|
|
| Hospital Charge Code |
41602505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$319.88 |
| Rate for Payer: Aetna Commercial |
$290.30
|
| Rate for Payer: Aetna Medicare |
$113.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$113.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$197.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$215.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.86
|
| Rate for Payer: Cash Price |
$213.26
|
| Rate for Payer: Cash Price |
$213.26
|
| Rate for Payer: Centivo All Commercial |
$175.42
|
| 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 |
$175.42
|
| Rate for Payer: Lucent All Commercial |
$175.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$309.56
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$113.51
|
|
|
HC TROCAR 12MM LONG VERSASTEP
|
Facility
|
IP
|
$343.96
|
|
| Hospital Charge Code |
41602505
|
|
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 |
$213.26
|
| 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 12MM VERSA STEP
|
Facility
|
OP
|
$343.96
|
|
| Hospital Charge Code |
41602063
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$319.88 |
| Rate for Payer: Aetna Commercial |
$290.30
|
| Rate for Payer: Aetna Medicare |
$113.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$113.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$197.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$215.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.86
|
| Rate for Payer: Cash Price |
$213.26
|
| Rate for Payer: Cash Price |
$213.26
|
| Rate for Payer: Centivo All Commercial |
$175.42
|
| 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 |
$175.42
|
| Rate for Payer: Lucent All Commercial |
$175.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$309.56
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$113.51
|
|
|
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 |
$213.26
|
| 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 15MM VERSASTEP
|
Facility
|
OP
|
$447.23
|
|
| Hospital Charge Code |
41602385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$415.92 |
| Rate for Payer: Aetna Commercial |
$377.46
|
| Rate for Payer: Aetna Medicare |
$147.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$147.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$256.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$279.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$169.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$162.34
|
| Rate for Payer: Cash Price |
$277.28
|
| Rate for Payer: Cash Price |
$277.28
|
| Rate for Payer: Centivo All Commercial |
$228.09
|
| Rate for Payer: Cigna All Commercial |
$385.96
|
| Rate for Payer: CORVEL All Commercial |
$415.92
|
| Rate for Payer: Coventry All Commercial |
$393.56
|
| Rate for Payer: Encore All Commercial |
$411.68
|
| Rate for Payer: Frontpath All Commercial |
$411.45
|
| Rate for Payer: Humana ChoiceCare |
$386.27
|
| Rate for Payer: Humana Medicare |
$228.09
|
| Rate for Payer: Lucent All Commercial |
$228.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$402.51
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$335.42
|
| Rate for Payer: PHP All Commercial |
$339.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$174.42
|
| Rate for Payer: Sagamore Health Network All Products |
$345.26
|
| Rate for Payer: Signature Care EPO |
$371.20
|
| Rate for Payer: Signature Care PPO |
$393.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$380.15
|
| Rate for Payer: United Healthcare Commercial |
$352.42
|
| Rate for Payer: United Healthcare Medicare |
$147.59
|
|
|
HC TROCAR 15MM VERSASTEP
|
Facility
|
IP
|
$447.23
|
|
| Hospital Charge Code |
41602385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$335.42 |
| Max. Negotiated Rate |
$415.92 |
| Rate for Payer: Aetna Commercial |
$386.41
|
| Rate for Payer: Cash Price |
$277.28
|
| Rate for Payer: Cigna All Commercial |
$385.96
|
| Rate for Payer: CORVEL All Commercial |
$415.92
|
| Rate for Payer: Coventry All Commercial |
$393.56
|
| Rate for Payer: Encore All Commercial |
$411.68
|
| Rate for Payer: Frontpath All Commercial |
$411.45
|
| Rate for Payer: Humana ChoiceCare |
$386.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$402.51
|
| Rate for Payer: PHCS All Commercial |
$335.42
|
| Rate for Payer: PHP All Commercial |
$339.18
|
| Rate for Payer: Sagamore Health Network All Products |
$345.26
|
| Rate for Payer: Signature Care EPO |
$371.20
|
| Rate for Payer: Signature Care PPO |
$393.56
|
| Rate for Payer: United Healthcare Commercial |
$352.42
|
|
|
HC TROCAR 5MM-12MM VISIPORT
|
Facility
|
IP
|
$327.83
|
|
| Hospital Charge Code |
41601800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.87 |
| Max. Negotiated Rate |
$304.88 |
| Rate for Payer: Aetna Commercial |
$283.25
|
| Rate for Payer: Cash Price |
$203.26
|
| Rate for Payer: Cigna All Commercial |
$282.92
|
| Rate for Payer: CORVEL All Commercial |
$304.88
|
| Rate for Payer: Coventry All Commercial |
$288.49
|
| Rate for Payer: Encore All Commercial |
$301.77
|
| Rate for Payer: Frontpath All Commercial |
$301.60
|
| Rate for Payer: Humana ChoiceCare |
$283.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$295.05
|
| Rate for Payer: PHCS All Commercial |
$245.87
|
| Rate for Payer: PHP All Commercial |
$248.63
|
| Rate for Payer: Sagamore Health Network All Products |
$253.08
|
| Rate for Payer: Signature Care EPO |
$272.10
|
| Rate for Payer: Signature Care PPO |
$288.49
|
| Rate for Payer: United Healthcare Commercial |
$258.33
|
|
|
HC TROCAR 5MM-12MM VISIPORT
|
Facility
|
OP
|
$327.83
|
|
| Hospital Charge Code |
41601800
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.18 |
| Max. Negotiated Rate |
$304.88 |
| Rate for Payer: Aetna Commercial |
$276.69
|
| Rate for Payer: Aetna Medicare |
$108.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$188.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$204.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$119.00
|
| Rate for Payer: Cash Price |
$203.26
|
| Rate for Payer: Cash Price |
$203.26
|
| Rate for Payer: Centivo All Commercial |
$167.19
|
| Rate for Payer: Cigna All Commercial |
$282.92
|
| Rate for Payer: CORVEL All Commercial |
$304.88
|
| Rate for Payer: Coventry All Commercial |
$288.49
|
| Rate for Payer: Encore All Commercial |
$301.77
|
| Rate for Payer: Frontpath All Commercial |
$301.60
|
| Rate for Payer: Humana ChoiceCare |
$283.15
|
| Rate for Payer: Humana Medicare |
$167.19
|
| Rate for Payer: Lucent All Commercial |
$167.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$295.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$245.87
|
| Rate for Payer: PHP All Commercial |
$248.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.85
|
| Rate for Payer: Sagamore Health Network All Products |
$253.08
|
| Rate for Payer: Signature Care EPO |
$272.10
|
| Rate for Payer: Signature Care PPO |
$288.49
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$278.66
|
| Rate for Payer: United Healthcare Commercial |
$258.33
|
| Rate for Payer: United Healthcare Medicare |
$108.18
|
|
