|
HC TROCAR 5MM VERSAPORT OPTICAL
|
Facility
|
IP
|
$127.35
|
|
| Hospital Charge Code |
41601185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.51 |
| Max. Negotiated Rate |
$118.44 |
| Rate for Payer: Aetna Commercial |
$110.03
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cigna All Commercial |
$109.90
|
| Rate for Payer: CORVEL All Commercial |
$118.44
|
| Rate for Payer: Coventry All Commercial |
$112.07
|
| Rate for Payer: Encore All Commercial |
$117.23
|
| Rate for Payer: Frontpath All Commercial |
$117.16
|
| Rate for Payer: Humana ChoiceCare |
$109.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.62
|
| Rate for Payer: PHCS All Commercial |
$95.51
|
| Rate for Payer: PHP All Commercial |
$96.58
|
| Rate for Payer: Sagamore Health Network All Products |
$98.31
|
| Rate for Payer: Signature Care EPO |
$105.70
|
| Rate for Payer: Signature Care PPO |
$112.07
|
| Rate for Payer: United Healthcare Commercial |
$100.35
|
|
|
HC TROCAR 5MM VERSAPORT OPTICAL
|
Facility
|
OP
|
$127.35
|
|
| Hospital Charge Code |
41601185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.03 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$107.48
|
| Rate for Payer: Aetna Medicare |
$42.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$42.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$73.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.23
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Centivo All Commercial |
$64.95
|
| Rate for Payer: Cigna All Commercial |
$109.90
|
| Rate for Payer: CORVEL All Commercial |
$118.44
|
| Rate for Payer: Coventry All Commercial |
$112.07
|
| Rate for Payer: Encore All Commercial |
$117.23
|
| Rate for Payer: Frontpath All Commercial |
$117.16
|
| Rate for Payer: Humana ChoiceCare |
$109.99
|
| Rate for Payer: Humana Medicare |
$64.95
|
| Rate for Payer: Lucent All Commercial |
$64.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$114.62
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$95.51
|
| Rate for Payer: PHP All Commercial |
$96.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.67
|
| Rate for Payer: Sagamore Health Network All Products |
$98.31
|
| Rate for Payer: Signature Care EPO |
$105.70
|
| Rate for Payer: Signature Care PPO |
$112.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$108.25
|
| Rate for Payer: United Healthcare Commercial |
$100.35
|
| Rate for Payer: United Healthcare Medicare |
$42.03
|
|
|
HC TROCAR 5MM VERSAPORT OPTICAL CANNULA
|
Facility
|
OP
|
$57.75
|
|
| Hospital Charge Code |
41601186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$48.74
|
| Rate for Payer: Aetna Medicare |
$19.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$33.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$21.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$20.96
|
| Rate for Payer: Cash Price |
$35.81
|
| Rate for Payer: Cash Price |
$35.81
|
| Rate for Payer: Centivo All Commercial |
$29.45
|
| Rate for Payer: Cigna All Commercial |
$49.84
|
| Rate for Payer: CORVEL All Commercial |
$53.71
|
| Rate for Payer: Coventry All Commercial |
$50.82
|
| Rate for Payer: Encore All Commercial |
$53.16
|
| Rate for Payer: Frontpath All Commercial |
$53.13
|
| Rate for Payer: Humana ChoiceCare |
$49.88
|
| Rate for Payer: Humana Medicare |
$29.45
|
| Rate for Payer: Lucent All Commercial |
$29.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.98
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$43.31
|
| Rate for Payer: PHP All Commercial |
$43.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.52
|
| Rate for Payer: Sagamore Health Network All Products |
$44.58
|
| Rate for Payer: Signature Care EPO |
$47.93
|
| Rate for Payer: Signature Care PPO |
$50.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.09
|
| Rate for Payer: United Healthcare Commercial |
$45.51
|
| Rate for Payer: United Healthcare Medicare |
$19.06
|
|
|
HC TROCAR 5MM VERSAPORT OPTICAL CANNULA
|
Facility
|
IP
|
$57.75
|
|
| Hospital Charge Code |
41601186
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.31 |
| Max. Negotiated Rate |
$53.71 |
| Rate for Payer: Aetna Commercial |
$49.90
|
| Rate for Payer: Cash Price |
$35.81
|
| Rate for Payer: Cigna All Commercial |
$49.84
|
| Rate for Payer: CORVEL All Commercial |
$53.71
|
| Rate for Payer: Coventry All Commercial |
$50.82
|
| Rate for Payer: Encore All Commercial |
$53.16
|
| Rate for Payer: Frontpath All Commercial |
$53.13
|
| Rate for Payer: Humana ChoiceCare |
$49.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$51.98
|
| Rate for Payer: PHCS All Commercial |
$43.31
|
| Rate for Payer: PHP All Commercial |
$43.80
|
| Rate for Payer: Sagamore Health Network All Products |
$44.58
|
| Rate for Payer: Signature Care EPO |
$47.93
|
| Rate for Payer: Signature Care PPO |
$50.82
|
| Rate for Payer: United Healthcare Commercial |
$45.51
|
|
|
HC TROCAR 5MM VERSA STEP
|
Facility
|
IP
|
$275.15
|
|
| Hospital Charge Code |
41601791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.36 |
| Max. Negotiated Rate |
$255.89 |
| Rate for Payer: Aetna Commercial |
$237.73
|
| Rate for Payer: Cash Price |
$170.59
|
| 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 |
$247.64
|
| 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 5MM VERSA STEP
|
Facility
|
OP
|
$275.15
|
|
| Hospital Charge Code |
41601791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$255.89 |
| Rate for Payer: Aetna Commercial |
$232.23
|
| Rate for Payer: Aetna Medicare |
$90.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$158.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$172.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$104.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.88
|
| Rate for Payer: Cash Price |
$170.59
|
| Rate for Payer: Cash Price |
$170.59
|
| Rate for Payer: Centivo All Commercial |
$140.33
|
| 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 |
$140.33
|
| Rate for Payer: Lucent All Commercial |
$140.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$247.64
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$90.80
|
|
|
HC TROCAR 5MM VERSASTEP
|
Facility
|
OP
|
$275.15
|
|
| Hospital Charge Code |
41602216
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$90.80 |
| Max. Negotiated Rate |
$255.89 |
| Rate for Payer: Aetna Commercial |
$232.23
|
| Rate for Payer: Aetna Medicare |
$90.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$90.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$158.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$172.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$104.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$99.88
|
| Rate for Payer: Cash Price |
$170.59
|
| Rate for Payer: Cash Price |
$170.59
|
| Rate for Payer: Centivo All Commercial |
$140.33
|
| 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 |
$140.33
|
| Rate for Payer: Lucent All Commercial |
$140.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$247.64
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| 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 |
$90.80
|
|
|
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 |
$170.59
|
| 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 |
$247.64
|
| 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 BALLOON DISSECTOR
|
Facility
|
IP
|
$2,242.80
|
|
| Hospital Charge Code |
41602174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,682.10 |
| Max. Negotiated Rate |
$2,085.80 |
| Rate for Payer: Aetna Commercial |
$1,937.78
|
| Rate for Payer: Cash Price |
$1,390.54
|
| Rate for Payer: Cigna All Commercial |
$1,935.54
|
| Rate for Payer: CORVEL All Commercial |
$2,085.80
|
| Rate for Payer: Coventry All Commercial |
$1,973.66
|
| Rate for Payer: Encore All Commercial |
$2,064.50
|
| Rate for Payer: Frontpath All Commercial |
$2,063.38
|
| Rate for Payer: Humana ChoiceCare |
$1,937.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,018.52
|
| Rate for Payer: PHCS All Commercial |
$1,682.10
|
| Rate for Payer: PHP All Commercial |
$1,700.94
|
| Rate for Payer: Sagamore Health Network All Products |
$1,731.44
|
| Rate for Payer: Signature Care EPO |
$1,861.52
|
| Rate for Payer: Signature Care PPO |
$1,973.66
|
| Rate for Payer: United Healthcare Commercial |
$1,767.33
|
|
|
HC TROCAR BALLOON DISSECTOR
|
Facility
|
OP
|
$2,242.80
|
|
| Hospital Charge Code |
41602174
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$2,085.80 |
| Rate for Payer: Aetna Commercial |
$1,892.92
|
| Rate for Payer: Aetna Medicare |
$740.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$740.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,288.04
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,401.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$851.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$814.14
|
| Rate for Payer: Cash Price |
$1,390.54
|
| Rate for Payer: Cash Price |
$1,390.54
|
| Rate for Payer: Centivo All Commercial |
$1,143.83
|
| Rate for Payer: Cigna All Commercial |
$1,935.54
|
| Rate for Payer: CORVEL All Commercial |
$2,085.80
|
| Rate for Payer: Coventry All Commercial |
$1,973.66
|
| Rate for Payer: Encore All Commercial |
$2,064.50
|
| Rate for Payer: Frontpath All Commercial |
$2,063.38
|
| Rate for Payer: Humana ChoiceCare |
$1,937.11
|
| Rate for Payer: Humana Medicare |
$1,143.83
|
| Rate for Payer: Lucent All Commercial |
$1,143.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,018.52
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,682.10
|
| Rate for Payer: PHP All Commercial |
$1,700.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$874.69
|
| Rate for Payer: Sagamore Health Network All Products |
$1,731.44
|
| Rate for Payer: Signature Care EPO |
$1,861.52
|
| Rate for Payer: Signature Care PPO |
$1,973.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,906.38
|
| Rate for Payer: United Healthcare Commercial |
$1,767.33
|
| Rate for Payer: United Healthcare Medicare |
$740.12
|
|
|
HC TROCAR BLADELESS 11MM
|
Facility
|
OP
|
$210.04
|
|
| Hospital Charge Code |
41602087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$195.34 |
| Rate for Payer: Aetna Commercial |
$177.27
|
| Rate for Payer: Aetna Medicare |
$69.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$120.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$131.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$79.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.24
|
| Rate for Payer: Cash Price |
$130.23
|
| Rate for Payer: Cash Price |
$130.23
|
| Rate for Payer: Centivo All Commercial |
$107.12
|
| Rate for Payer: Cigna All Commercial |
$181.26
|
| Rate for Payer: CORVEL All Commercial |
$195.34
|
| Rate for Payer: Coventry All Commercial |
$184.84
|
| Rate for Payer: Encore All Commercial |
$193.34
|
| Rate for Payer: Frontpath All Commercial |
$193.24
|
| Rate for Payer: Humana ChoiceCare |
$181.41
|
| Rate for Payer: Humana Medicare |
$107.12
|
| Rate for Payer: Lucent All Commercial |
$107.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.04
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$157.53
|
| Rate for Payer: PHP All Commercial |
$159.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$81.92
|
| Rate for Payer: Sagamore Health Network All Products |
$162.15
|
| Rate for Payer: Signature Care EPO |
$174.33
|
| Rate for Payer: Signature Care PPO |
$184.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$178.53
|
| Rate for Payer: United Healthcare Commercial |
$165.51
|
| Rate for Payer: United Healthcare Medicare |
$69.31
|
|
|
HC TROCAR BLADELESS 11MM
|
Facility
|
IP
|
$210.04
|
|
| Hospital Charge Code |
41602087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.53 |
| Max. Negotiated Rate |
$195.34 |
| Rate for Payer: Aetna Commercial |
$181.47
|
| Rate for Payer: Cash Price |
$130.23
|
| Rate for Payer: Cigna All Commercial |
$181.26
|
| Rate for Payer: CORVEL All Commercial |
$195.34
|
| Rate for Payer: Coventry All Commercial |
$184.84
|
| Rate for Payer: Encore All Commercial |
$193.34
|
| Rate for Payer: Frontpath All Commercial |
$193.24
|
| Rate for Payer: Humana ChoiceCare |
$181.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$189.04
|
| Rate for Payer: PHCS All Commercial |
$157.53
|
| Rate for Payer: PHP All Commercial |
$159.29
|
| Rate for Payer: Sagamore Health Network All Products |
$162.15
|
| Rate for Payer: Signature Care EPO |
$174.33
|
| Rate for Payer: Signature Care PPO |
$184.84
|
| Rate for Payer: United Healthcare Commercial |
$165.51
|
|
|
HC TROCAR BLADELESS 12MM
|
Facility
|
OP
|
$205.82
|
|
| Hospital Charge Code |
41602240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.92 |
| Max. Negotiated Rate |
$191.41 |
| Rate for Payer: Aetna Commercial |
$173.71
|
| Rate for Payer: Aetna Medicare |
$67.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$118.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$128.66
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$78.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.71
|
| Rate for Payer: Cash Price |
$127.61
|
| Rate for Payer: Cash Price |
$127.61
|
| Rate for Payer: Centivo All Commercial |
$104.97
|
| Rate for Payer: Cigna All Commercial |
$177.62
|
| Rate for Payer: CORVEL All Commercial |
$191.41
|
| Rate for Payer: Coventry All Commercial |
$181.12
|
| Rate for Payer: Encore All Commercial |
$189.46
|
| Rate for Payer: Frontpath All Commercial |
$189.35
|
| Rate for Payer: Humana ChoiceCare |
$177.77
|
| Rate for Payer: Humana Medicare |
$104.97
|
| Rate for Payer: Lucent All Commercial |
$104.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.24
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$154.36
|
| Rate for Payer: PHP All Commercial |
$156.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$80.27
|
| Rate for Payer: Sagamore Health Network All Products |
$158.89
|
| Rate for Payer: Signature Care EPO |
$170.83
|
| Rate for Payer: Signature Care PPO |
$181.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$174.95
|
| Rate for Payer: United Healthcare Commercial |
$162.19
|
| Rate for Payer: United Healthcare Medicare |
$67.92
|
|
|
HC TROCAR BLADELESS 12MM
|
Facility
|
IP
|
$205.82
|
|
| Hospital Charge Code |
41602240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.36 |
| Max. Negotiated Rate |
$191.41 |
| Rate for Payer: Aetna Commercial |
$177.83
|
| Rate for Payer: Cash Price |
$127.61
|
| Rate for Payer: Cigna All Commercial |
$177.62
|
| Rate for Payer: CORVEL All Commercial |
$191.41
|
| Rate for Payer: Coventry All Commercial |
$181.12
|
| Rate for Payer: Encore All Commercial |
$189.46
|
| Rate for Payer: Frontpath All Commercial |
$189.35
|
| Rate for Payer: Humana ChoiceCare |
$177.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$185.24
|
| Rate for Payer: PHCS All Commercial |
$154.36
|
| Rate for Payer: PHP All Commercial |
$156.09
|
| Rate for Payer: Sagamore Health Network All Products |
$158.89
|
| Rate for Payer: Signature Care EPO |
$170.83
|
| Rate for Payer: Signature Care PPO |
$181.12
|
| Rate for Payer: United Healthcare Commercial |
$162.19
|
|
|
HC TROCAR BLADELESS 5MM
|
Facility
|
OP
|
$163.88
|
|
| Hospital Charge Code |
41602086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$152.41 |
| Rate for Payer: Aetna Commercial |
$138.31
|
| Rate for Payer: Aetna Medicare |
$54.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$102.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$62.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$59.49
|
| Rate for Payer: Cash Price |
$101.61
|
| Rate for Payer: Cash Price |
$101.61
|
| Rate for Payer: Centivo All Commercial |
$83.58
|
| Rate for Payer: Cigna All Commercial |
$141.43
|
| Rate for Payer: CORVEL All Commercial |
$152.41
|
| Rate for Payer: Coventry All Commercial |
$144.21
|
| Rate for Payer: Encore All Commercial |
$150.85
|
| Rate for Payer: Frontpath All Commercial |
$150.77
|
| Rate for Payer: Humana ChoiceCare |
$141.54
|
| Rate for Payer: Humana Medicare |
$83.58
|
| Rate for Payer: Lucent All Commercial |
$83.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.49
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$122.91
|
| Rate for Payer: PHP All Commercial |
$124.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$63.91
|
| Rate for Payer: Sagamore Health Network All Products |
$126.52
|
| Rate for Payer: Signature Care EPO |
$136.02
|
| Rate for Payer: Signature Care PPO |
$144.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$139.30
|
| Rate for Payer: United Healthcare Commercial |
$129.14
|
| Rate for Payer: United Healthcare Medicare |
$54.08
|
|
|
HC TROCAR BLADELESS 5MM
|
Facility
|
IP
|
$163.88
|
|
| Hospital Charge Code |
41602086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.91 |
| Max. Negotiated Rate |
$152.41 |
| Rate for Payer: Aetna Commercial |
$141.59
|
| Rate for Payer: Cash Price |
$101.61
|
| Rate for Payer: Cigna All Commercial |
$141.43
|
| Rate for Payer: CORVEL All Commercial |
$152.41
|
| Rate for Payer: Coventry All Commercial |
$144.21
|
| Rate for Payer: Encore All Commercial |
$150.85
|
| Rate for Payer: Frontpath All Commercial |
$150.77
|
| Rate for Payer: Humana ChoiceCare |
$141.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$147.49
|
| Rate for Payer: PHCS All Commercial |
$122.91
|
| Rate for Payer: PHP All Commercial |
$124.29
|
| Rate for Payer: Sagamore Health Network All Products |
$126.52
|
| Rate for Payer: Signature Care EPO |
$136.02
|
| Rate for Payer: Signature Care PPO |
$144.21
|
| Rate for Payer: United Healthcare Commercial |
$129.14
|
|
|
HC TROCAR BLADELESS XCEL 12 MM
|
Facility
|
IP
|
$166.55
|
|
| Hospital Charge Code |
41607937
|
|
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 |
$103.26
|
| 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 TROCAR BLADELESS XCEL 12 MM
|
Facility
|
OP
|
$166.55
|
|
| Hospital Charge Code |
41607937
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$154.89 |
| Rate for Payer: Aetna Commercial |
$140.57
|
| Rate for Payer: Aetna Medicare |
$54.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$95.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$104.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.46
|
| Rate for Payer: Cash Price |
$103.26
|
| Rate for Payer: Cash Price |
$103.26
|
| Rate for Payer: Centivo All Commercial |
$84.94
|
| 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 |
$84.94
|
| Rate for Payer: Lucent All Commercial |
$84.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.90
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$54.96
|
|
|
HC TROCAR BLADELESS XCEL B12
|
Facility
|
OP
|
$2,142.50
|
|
| Hospital Charge Code |
41602287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,992.52 |
| Rate for Payer: Aetna Commercial |
$1,808.27
|
| Rate for Payer: Aetna Medicare |
$707.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$707.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,230.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,339.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$813.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$777.73
|
| Rate for Payer: Cash Price |
$1,328.35
|
| Rate for Payer: Cash Price |
$1,328.35
|
| Rate for Payer: Centivo All Commercial |
$1,092.68
|
| Rate for Payer: Cigna All Commercial |
$1,848.98
|
| Rate for Payer: CORVEL All Commercial |
$1,992.52
|
| Rate for Payer: Coventry All Commercial |
$1,885.40
|
| Rate for Payer: Encore All Commercial |
$1,972.17
|
| Rate for Payer: Frontpath All Commercial |
$1,971.10
|
| Rate for Payer: Humana ChoiceCare |
$1,850.48
|
| Rate for Payer: Humana Medicare |
$1,092.68
|
| Rate for Payer: Lucent All Commercial |
$1,092.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,928.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$1,606.88
|
| Rate for Payer: PHP All Commercial |
$1,624.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$835.58
|
| Rate for Payer: Sagamore Health Network All Products |
$1,654.01
|
| Rate for Payer: Signature Care EPO |
$1,778.28
|
| Rate for Payer: Signature Care PPO |
$1,885.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,821.12
|
| Rate for Payer: United Healthcare Commercial |
$1,688.29
|
| Rate for Payer: United Healthcare Medicare |
$707.02
|
|
|
HC TROCAR BLADELESS XCEL B12
|
Facility
|
IP
|
$2,142.50
|
|
| Hospital Charge Code |
41602287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,606.88 |
| Max. Negotiated Rate |
$1,992.52 |
| Rate for Payer: Aetna Commercial |
$1,851.12
|
| Rate for Payer: Cash Price |
$1,328.35
|
| Rate for Payer: Cigna All Commercial |
$1,848.98
|
| Rate for Payer: CORVEL All Commercial |
$1,992.52
|
| Rate for Payer: Coventry All Commercial |
$1,885.40
|
| Rate for Payer: Encore All Commercial |
$1,972.17
|
| Rate for Payer: Frontpath All Commercial |
$1,971.10
|
| Rate for Payer: Humana ChoiceCare |
$1,850.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,928.25
|
| Rate for Payer: PHCS All Commercial |
$1,606.88
|
| Rate for Payer: PHP All Commercial |
$1,624.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1,654.01
|
| Rate for Payer: Signature Care EPO |
$1,778.28
|
| Rate for Payer: Signature Care PPO |
$1,885.40
|
| Rate for Payer: United Healthcare Commercial |
$1,688.29
|
|
|
HC TROCAR BLADELESS XCEL B5LT
|
Facility
|
OP
|
$166.55
|
|
| Hospital Charge Code |
41601862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$154.89 |
| Rate for Payer: Aetna Commercial |
$140.57
|
| Rate for Payer: Aetna Medicare |
$54.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$54.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$95.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$104.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.46
|
| Rate for Payer: Cash Price |
$103.26
|
| Rate for Payer: Cash Price |
$103.26
|
| Rate for Payer: Centivo All Commercial |
$84.94
|
| 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 |
$84.94
|
| Rate for Payer: Lucent All Commercial |
$84.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$149.90
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$54.96
|
|
|
HC TROCAR BLADELESS XCEL B5LT
|
Facility
|
IP
|
$166.55
|
|
| Hospital Charge Code |
41601862
|
|
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 |
$103.26
|
| 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 TROCAR BLADELESS XCEL B8
|
Facility
|
OP
|
$161.00
|
|
| Hospital Charge Code |
41602061
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.13 |
| Max. Negotiated Rate |
$149.73 |
| Rate for Payer: Aetna Commercial |
$135.88
|
| Rate for Payer: Aetna Medicare |
$53.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$92.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$100.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.44
|
| Rate for Payer: Cash Price |
$99.82
|
| Rate for Payer: Cash Price |
$99.82
|
| Rate for Payer: Centivo All Commercial |
$82.11
|
| 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 |
$82.11
|
| Rate for Payer: Lucent All Commercial |
$82.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$144.90
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$53.13
|
|
|
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 |
$99.82
|
| 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
|
OP
|
$890.76
|
|
| Hospital Charge Code |
41602062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$828.41 |
| Rate for Payer: Aetna Commercial |
$751.80
|
| Rate for Payer: Aetna Medicare |
$293.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$293.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$511.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$556.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$338.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$323.35
|
| Rate for Payer: Cash Price |
$552.27
|
| Rate for Payer: Cash Price |
$552.27
|
| Rate for Payer: Centivo All Commercial |
$454.29
|
| 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 |
$454.29
|
| Rate for Payer: Lucent All Commercial |
$454.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$801.68
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$293.95
|
|
