|
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 |
$552.27
|
| 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 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 |
$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 TROCARE ENDOPATH XCEL 11MM
|
Facility
|
OP
|
$166.55
|
|
| Hospital Charge Code |
41602415
|
|
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 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 |
$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 ENDOPATH XCEL 12 OPT
|
Facility
|
OP
|
$161.00
|
|
| Hospital Charge Code |
41608023
|
|
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 ENDOPATH XCEL 5MM LONG
|
Facility
|
OP
|
$166.55
|
|
| Hospital Charge Code |
41602414
|
|
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 ENDOPATH XCEL 5MM LONG
|
Facility
|
IP
|
$166.55
|
|
| Hospital Charge Code |
41602414
|
|
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 ENDOPATH XCEL 5MM OPT
|
Facility
|
OP
|
$166.55
|
|
| Hospital Charge Code |
41608043
|
|
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 ENDOPATH XCEL 5MM OPT
|
Facility
|
IP
|
$166.55
|
|
| Hospital Charge Code |
41608043
|
|
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 SLEEVE STABILITY 5MM
|
Facility
|
OP
|
$115.86
|
|
| Hospital Charge Code |
41601859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.23 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$97.79
|
| Rate for Payer: Aetna Medicare |
$38.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$38.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$66.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.97
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.06
|
| Rate for Payer: Cash Price |
$71.83
|
| Rate for Payer: Cash Price |
$71.83
|
| Rate for Payer: Centivo All Commercial |
$59.09
|
| Rate for Payer: Cigna All Commercial |
$99.99
|
| Rate for Payer: CORVEL All Commercial |
$107.75
|
| Rate for Payer: Coventry All Commercial |
$101.96
|
| Rate for Payer: Encore All Commercial |
$106.65
|
| Rate for Payer: Frontpath All Commercial |
$106.59
|
| Rate for Payer: Humana ChoiceCare |
$100.07
|
| Rate for Payer: Humana Medicare |
$59.09
|
| Rate for Payer: Lucent All Commercial |
$59.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.27
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$86.90
|
| Rate for Payer: PHP All Commercial |
$87.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.19
|
| Rate for Payer: Sagamore Health Network All Products |
$89.44
|
| Rate for Payer: Signature Care EPO |
$96.16
|
| Rate for Payer: Signature Care PPO |
$101.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$98.48
|
| Rate for Payer: United Healthcare Commercial |
$91.30
|
| Rate for Payer: United Healthcare Medicare |
$38.23
|
|
|
HC TROCAR SLEEVE STABILITY 5MM
|
Facility
|
IP
|
$115.86
|
|
| Hospital Charge Code |
41601859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.90 |
| Max. Negotiated Rate |
$107.75 |
| Rate for Payer: Aetna Commercial |
$100.10
|
| Rate for Payer: Cash Price |
$71.83
|
| Rate for Payer: Cigna All Commercial |
$99.99
|
| Rate for Payer: CORVEL All Commercial |
$107.75
|
| Rate for Payer: Coventry All Commercial |
$101.96
|
| Rate for Payer: Encore All Commercial |
$106.65
|
| Rate for Payer: Frontpath All Commercial |
$106.59
|
| Rate for Payer: Humana ChoiceCare |
$100.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$104.27
|
| Rate for Payer: PHCS All Commercial |
$86.90
|
| Rate for Payer: PHP All Commercial |
$87.87
|
| Rate for Payer: Sagamore Health Network All Products |
$89.44
|
| Rate for Payer: Signature Care EPO |
$96.16
|
| Rate for Payer: Signature Care PPO |
$101.96
|
| Rate for Payer: United Healthcare Commercial |
$91.30
|
|
|
HC TROCAR SLEEVE VERSASTEP STANDARD
|
Facility
|
OP
|
$309.55
|
|
| Hospital Charge Code |
41601187
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.15 |
| Max. Negotiated Rate |
$287.88 |
| Rate for Payer: Aetna Commercial |
$261.26
|
| Rate for Payer: Aetna Medicare |
$102.15
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$102.15
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$177.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$193.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$117.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$112.37
|
| Rate for Payer: Cash Price |
$191.92
|
| Rate for Payer: Cash Price |
$191.92
|
| Rate for Payer: Centivo All Commercial |
$157.87
|
| 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 |
$157.87
|
| Rate for Payer: Lucent All Commercial |
$157.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$278.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$102.15
|
|
|
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 |
$191.92
|
| 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 XCEL 11MM
|
Facility
|
OP
|
$734.69
|
|
| Hospital Charge Code |
41602080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$683.26 |
| Rate for Payer: Aetna Commercial |
$620.08
|
| Rate for Payer: Aetna Medicare |
$242.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$242.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$421.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$459.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$278.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$266.69
|
| Rate for Payer: Cash Price |
$455.51
|
| Rate for Payer: Cash Price |
$455.51
|
| Rate for Payer: Centivo All Commercial |
$374.69
|
| 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 |
$374.69
|
| Rate for Payer: Lucent All Commercial |
$374.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$661.22
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$242.45
|
|
|
HC TROCAR XCEL 11MM
|
Facility
|
IP
|
$734.69
|
|
| Hospital Charge Code |
41602080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$551.02 |
| Max. Negotiated Rate |
$683.26 |
| Rate for Payer: Aetna Commercial |
$634.77
|
| Rate for Payer: Cash Price |
$455.51
|
| 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: Lutheran Preferred All Commercial |
$661.22
|
| Rate for Payer: PHCS All Commercial |
$551.02
|
| Rate for Payer: PHP All Commercial |
$557.19
|
| 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: United Healthcare Commercial |
$578.94
|
|
|
HC TROPONIN T
|
Facility
|
OP
|
$259.17
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
63001140
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$241.03 |
| Rate for Payer: Aetna Commercial |
$218.74
|
| Rate for Payer: Aetna Medicare |
$85.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$119.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$119.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$12.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$98.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$94.08
|
| Rate for Payer: Cash Price |
$160.69
|
| Rate for Payer: Cash Price |
$160.69
|
| Rate for Payer: Centivo All Commercial |
$132.18
|
| Rate for Payer: Cigna All Commercial |
$223.67
|
| Rate for Payer: CORVEL All Commercial |
$241.03
|
| Rate for Payer: Coventry All Commercial |
$228.07
|
| Rate for Payer: Encore All Commercial |
$238.57
|
| Rate for Payer: Frontpath All Commercial |
$238.44
|
| Rate for Payer: Humana ChoiceCare |
$223.85
|
| Rate for Payer: Humana Medicare |
$132.18
|
| Rate for Payer: Lucent All Commercial |
$132.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$233.25
|
| Rate for Payer: Managed Health Services Medicaid |
$12.47
|
| Rate for Payer: MDWise Medicaid |
$12.47
|
| Rate for Payer: PHCS All Commercial |
$194.38
|
| Rate for Payer: PHP All Commercial |
$196.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$101.08
|
| Rate for Payer: Sagamore Health Network All Products |
$200.08
|
| Rate for Payer: Signature Care EPO |
$215.11
|
| Rate for Payer: Signature Care PPO |
$228.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$220.30
|
| Rate for Payer: United Healthcare Commercial |
$204.23
|
| Rate for Payer: United Healthcare Medicare |
$85.53
|
|
|
HC TROPONIN T
|
Facility
|
IP
|
$259.17
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
63001140
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$194.38 |
| Max. Negotiated Rate |
$241.03 |
| Rate for Payer: Aetna Commercial |
$223.92
|
| Rate for Payer: Cash Price |
$160.69
|
| Rate for Payer: Cigna All Commercial |
$223.67
|
| Rate for Payer: CORVEL All Commercial |
$241.03
|
| Rate for Payer: Coventry All Commercial |
$228.07
|
| Rate for Payer: Encore All Commercial |
$238.57
|
| Rate for Payer: Frontpath All Commercial |
$238.44
|
| Rate for Payer: Humana ChoiceCare |
$223.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$233.25
|
| Rate for Payer: PHCS All Commercial |
$194.38
|
| Rate for Payer: PHP All Commercial |
$196.56
|
| Rate for Payer: Sagamore Health Network All Products |
$200.08
|
| Rate for Payer: Signature Care EPO |
$215.11
|
| Rate for Payer: Signature Care PPO |
$228.07
|
| Rate for Payer: United Healthcare Commercial |
$204.23
|
|
|
HC TRYPTASE-SERUM/PLASM
|
Facility
|
OP
|
$211.67
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$196.85 |
| Rate for Payer: Aetna Commercial |
$178.65
|
| Rate for Payer: Aetna Medicare |
$69.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$121.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.84
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Centivo All Commercial |
$107.95
|
| Rate for Payer: Cigna All Commercial |
$182.67
|
| Rate for Payer: CORVEL All Commercial |
$196.85
|
| Rate for Payer: Coventry All Commercial |
$186.27
|
| Rate for Payer: Encore All Commercial |
$194.84
|
| Rate for Payer: Frontpath All Commercial |
$194.74
|
| Rate for Payer: Humana ChoiceCare |
$182.82
|
| Rate for Payer: Humana Medicare |
$107.95
|
| Rate for Payer: Lucent All Commercial |
$107.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.50
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: MDWise Medicaid |
$17.27
|
| Rate for Payer: PHCS All Commercial |
$158.75
|
| Rate for Payer: PHP All Commercial |
$160.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.55
|
| Rate for Payer: Sagamore Health Network All Products |
$163.41
|
| Rate for Payer: Signature Care EPO |
$175.69
|
| Rate for Payer: Signature Care PPO |
$186.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$179.92
|
| Rate for Payer: United Healthcare Commercial |
$166.80
|
| Rate for Payer: United Healthcare Medicare |
$69.85
|
|
|
HC TRYPTASE-SERUM/PLASM
|
Facility
|
IP
|
$211.67
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.75 |
| Max. Negotiated Rate |
$196.85 |
| Rate for Payer: Aetna Commercial |
$182.88
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cigna All Commercial |
$182.67
|
| Rate for Payer: CORVEL All Commercial |
$196.85
|
| Rate for Payer: Coventry All Commercial |
$186.27
|
| Rate for Payer: Encore All Commercial |
$194.84
|
| Rate for Payer: Frontpath All Commercial |
$194.74
|
| Rate for Payer: Humana ChoiceCare |
$182.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.50
|
| Rate for Payer: PHCS All Commercial |
$158.75
|
| Rate for Payer: PHP All Commercial |
$160.53
|
| Rate for Payer: Sagamore Health Network All Products |
$163.41
|
| Rate for Payer: Signature Care EPO |
$175.69
|
| Rate for Payer: Signature Care PPO |
$186.27
|
| Rate for Payer: United Healthcare Commercial |
$166.80
|
|
|
HC TSH
|
Facility
|
IP
|
$152.85
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
63001334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.64 |
| Max. Negotiated Rate |
$142.15 |
| Rate for Payer: Aetna Commercial |
$132.06
|
| Rate for Payer: Cash Price |
$94.77
|
| Rate for Payer: Cigna All Commercial |
$131.91
|
| Rate for Payer: CORVEL All Commercial |
$142.15
|
| Rate for Payer: Coventry All Commercial |
$134.51
|
| Rate for Payer: Encore All Commercial |
$140.70
|
| Rate for Payer: Frontpath All Commercial |
$140.62
|
| Rate for Payer: Humana ChoiceCare |
$132.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.56
|
| Rate for Payer: PHCS All Commercial |
$114.64
|
| Rate for Payer: PHP All Commercial |
$115.92
|
| Rate for Payer: Sagamore Health Network All Products |
$118.00
|
| Rate for Payer: Signature Care EPO |
$126.86
|
| Rate for Payer: Signature Care PPO |
$134.51
|
| Rate for Payer: United Healthcare Commercial |
$120.44
|
|
|
HC TSH
|
Facility
|
OP
|
$152.85
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
63001334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$142.15 |
| Rate for Payer: Aetna Commercial |
$129.00
|
| Rate for Payer: Aetna Medicare |
$50.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$50.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$70.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.48
|
| Rate for Payer: Cash Price |
$94.77
|
| Rate for Payer: Cash Price |
$94.77
|
| Rate for Payer: Centivo All Commercial |
$77.95
|
| Rate for Payer: Cigna All Commercial |
$131.91
|
| Rate for Payer: CORVEL All Commercial |
$142.15
|
| Rate for Payer: Coventry All Commercial |
$134.51
|
| Rate for Payer: Encore All Commercial |
$140.70
|
| Rate for Payer: Frontpath All Commercial |
$140.62
|
| Rate for Payer: Humana ChoiceCare |
$132.01
|
| Rate for Payer: Humana Medicare |
$77.95
|
| Rate for Payer: Lucent All Commercial |
$77.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$137.56
|
| Rate for Payer: Managed Health Services Medicaid |
$16.80
|
| Rate for Payer: MDWise Medicaid |
$16.80
|
| Rate for Payer: PHCS All Commercial |
$114.64
|
| Rate for Payer: PHP All Commercial |
$115.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$59.61
|
| Rate for Payer: Sagamore Health Network All Products |
$118.00
|
| Rate for Payer: Signature Care EPO |
$126.86
|
| Rate for Payer: Signature Care PPO |
$134.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$129.92
|
| Rate for Payer: United Healthcare Commercial |
$120.44
|
| Rate for Payer: United Healthcare Medicare |
$50.44
|
|
|
HC TSH 3RD GENERATION
|
Facility
|
IP
|
$60.04
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
63001125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.03 |
| Max. Negotiated Rate |
$55.83 |
| Rate for Payer: Aetna Commercial |
$51.87
|
| Rate for Payer: Cash Price |
$37.22
|
| Rate for Payer: Cigna All Commercial |
$51.81
|
| Rate for Payer: CORVEL All Commercial |
$55.83
|
| Rate for Payer: Coventry All Commercial |
$52.83
|
| Rate for Payer: Encore All Commercial |
$55.26
|
| Rate for Payer: Frontpath All Commercial |
$55.23
|
| Rate for Payer: Humana ChoiceCare |
$51.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.03
|
| Rate for Payer: PHCS All Commercial |
$45.03
|
| Rate for Payer: PHP All Commercial |
$45.53
|
| Rate for Payer: Sagamore Health Network All Products |
$46.35
|
| Rate for Payer: Signature Care EPO |
$49.83
|
| Rate for Payer: Signature Care PPO |
$52.83
|
| Rate for Payer: United Healthcare Commercial |
$47.31
|
|
|
HC TSH 3RD GENERATION
|
Facility
|
OP
|
$60.04
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
63001125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$55.83 |
| Rate for Payer: Aetna Commercial |
$50.67
|
| Rate for Payer: Aetna Medicare |
$19.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$19.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$16.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$22.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$21.79
|
| Rate for Payer: Cash Price |
$37.22
|
| Rate for Payer: Cash Price |
$37.22
|
| Rate for Payer: Centivo All Commercial |
$30.62
|
| Rate for Payer: Cigna All Commercial |
$51.81
|
| Rate for Payer: CORVEL All Commercial |
$55.83
|
| Rate for Payer: Coventry All Commercial |
$52.83
|
| Rate for Payer: Encore All Commercial |
$55.26
|
| Rate for Payer: Frontpath All Commercial |
$55.23
|
| Rate for Payer: Humana ChoiceCare |
$51.85
|
| Rate for Payer: Humana Medicare |
$30.62
|
| Rate for Payer: Lucent All Commercial |
$30.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.03
|
| Rate for Payer: Managed Health Services Medicaid |
$16.80
|
| Rate for Payer: MDWise Medicaid |
$16.80
|
| Rate for Payer: PHCS All Commercial |
$45.03
|
| Rate for Payer: PHP All Commercial |
$45.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.41
|
| Rate for Payer: Sagamore Health Network All Products |
$46.35
|
| Rate for Payer: Signature Care EPO |
$49.83
|
| Rate for Payer: Signature Care PPO |
$52.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.03
|
| Rate for Payer: United Healthcare Commercial |
$47.31
|
| Rate for Payer: United Healthcare Medicare |
$19.81
|
|
|
HC TSH RECEPTOR ANTIBODY
|
Facility
|
OP
|
$211.67
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$196.85 |
| Rate for Payer: Aetna Commercial |
$178.65
|
| Rate for Payer: Aetna Medicare |
$69.85
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$121.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$132.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$17.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$76.84
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Centivo All Commercial |
$107.95
|
| Rate for Payer: Cigna All Commercial |
$182.67
|
| Rate for Payer: CORVEL All Commercial |
$196.85
|
| Rate for Payer: Coventry All Commercial |
$186.27
|
| Rate for Payer: Encore All Commercial |
$194.84
|
| Rate for Payer: Frontpath All Commercial |
$194.74
|
| Rate for Payer: Humana ChoiceCare |
$182.82
|
| Rate for Payer: Humana Medicare |
$107.95
|
| Rate for Payer: Lucent All Commercial |
$107.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.50
|
| Rate for Payer: Managed Health Services Medicaid |
$17.27
|
| Rate for Payer: MDWise Medicaid |
$17.27
|
| Rate for Payer: PHCS All Commercial |
$158.75
|
| Rate for Payer: PHP All Commercial |
$160.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$82.55
|
| Rate for Payer: Sagamore Health Network All Products |
$163.41
|
| Rate for Payer: Signature Care EPO |
$175.69
|
| Rate for Payer: Signature Care PPO |
$186.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$179.92
|
| Rate for Payer: United Healthcare Commercial |
$166.80
|
| Rate for Payer: United Healthcare Medicare |
$69.85
|
|
|
HC TSH RECEPTOR ANTIBODY
|
Facility
|
IP
|
$211.67
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
63001610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.75 |
| Max. Negotiated Rate |
$196.85 |
| Rate for Payer: Aetna Commercial |
$182.88
|
| Rate for Payer: Cash Price |
$131.24
|
| Rate for Payer: Cigna All Commercial |
$182.67
|
| Rate for Payer: CORVEL All Commercial |
$196.85
|
| Rate for Payer: Coventry All Commercial |
$186.27
|
| Rate for Payer: Encore All Commercial |
$194.84
|
| Rate for Payer: Frontpath All Commercial |
$194.74
|
| Rate for Payer: Humana ChoiceCare |
$182.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$190.50
|
| Rate for Payer: PHCS All Commercial |
$158.75
|
| Rate for Payer: PHP All Commercial |
$160.53
|
| Rate for Payer: Sagamore Health Network All Products |
$163.41
|
| Rate for Payer: Signature Care EPO |
$175.69
|
| Rate for Payer: Signature Care PPO |
$186.27
|
| Rate for Payer: United Healthcare Commercial |
$166.80
|
|
