|
HC NEEDLE EZIO INTRAOSS PLUS 45MM
|
Facility
|
OP
|
$998.20
|
|
| Hospital Charge Code |
41601267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$928.33 |
| Rate for Payer: Aetna Commercial |
$842.48
|
| Rate for Payer: Aetna Medicare |
$319.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$309.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$573.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$623.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$367.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$351.37
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Centivo All Commercial |
$543.02
|
| Rate for Payer: Cigna All Commercial |
$861.45
|
| Rate for Payer: CORVEL All Commercial |
$928.33
|
| Rate for Payer: Coventry All Commercial |
$878.42
|
| Rate for Payer: Encore All Commercial |
$918.84
|
| Rate for Payer: Frontpath All Commercial |
$918.34
|
| Rate for Payer: Humana ChoiceCare |
$862.15
|
| Rate for Payer: Humana Medicare |
$319.42
|
| Rate for Payer: Lucent All Commercial |
$543.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$898.38
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$748.65
|
| Rate for Payer: PHP All Commercial |
$757.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$389.30
|
| Rate for Payer: Sagamore Health Network All Products |
$770.61
|
| Rate for Payer: Signature Care EPO |
$828.51
|
| Rate for Payer: Signature Care PPO |
$878.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$848.47
|
| Rate for Payer: United Healthcare Commercial |
$786.58
|
| Rate for Payer: United Healthcare Medicare |
$319.42
|
|
|
HC NEEDLE EZIO INTRAOSS PLUS 45MM
|
Facility
|
IP
|
$998.20
|
|
| Hospital Charge Code |
41601267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$748.65 |
| Max. Negotiated Rate |
$928.33 |
| Rate for Payer: Aetna Commercial |
$862.44
|
| Rate for Payer: Cash Price |
$598.92
|
| Rate for Payer: Cigna All Commercial |
$861.45
|
| Rate for Payer: CORVEL All Commercial |
$928.33
|
| Rate for Payer: Coventry All Commercial |
$878.42
|
| Rate for Payer: Encore All Commercial |
$918.84
|
| Rate for Payer: Frontpath All Commercial |
$918.34
|
| Rate for Payer: Humana ChoiceCare |
$862.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$898.38
|
| Rate for Payer: PHCS All Commercial |
$748.65
|
| Rate for Payer: PHP All Commercial |
$757.03
|
| Rate for Payer: Sagamore Health Network All Products |
$770.61
|
| Rate for Payer: Signature Care EPO |
$828.51
|
| Rate for Payer: Signature Care PPO |
$878.42
|
| Rate for Payer: United Healthcare Commercial |
$786.58
|
|
|
HC NEEDLE HUBER 19G X 3/4 IN
|
Facility
|
IP
|
$41.37
|
|
| Hospital Charge Code |
41601079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.03 |
| Max. Negotiated Rate |
$38.47 |
| Rate for Payer: Aetna Commercial |
$35.74
|
| Rate for Payer: Cash Price |
$24.82
|
| Rate for Payer: Cigna All Commercial |
$35.70
|
| Rate for Payer: CORVEL All Commercial |
$38.47
|
| Rate for Payer: Coventry All Commercial |
$36.41
|
| Rate for Payer: Encore All Commercial |
$38.08
|
| Rate for Payer: Frontpath All Commercial |
$38.06
|
| Rate for Payer: Humana ChoiceCare |
$35.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.23
|
| Rate for Payer: PHCS All Commercial |
$31.03
|
| Rate for Payer: PHP All Commercial |
$31.38
|
| Rate for Payer: Sagamore Health Network All Products |
$31.94
|
| Rate for Payer: Signature Care EPO |
$34.34
|
| Rate for Payer: Signature Care PPO |
$36.41
|
| Rate for Payer: United Healthcare Commercial |
$32.60
|
|
|
HC NEEDLE HUBER 19G X 3/4 IN
|
Facility
|
OP
|
$41.37
|
|
| Hospital Charge Code |
41601079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$38.47 |
| Rate for Payer: Aetna Commercial |
$34.92
|
| Rate for Payer: Aetna Medicare |
$13.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.56
|
| Rate for Payer: Cash Price |
$24.82
|
| Rate for Payer: Cash Price |
$24.82
|
| Rate for Payer: Centivo All Commercial |
$22.51
|
| Rate for Payer: Cigna All Commercial |
$35.70
|
| Rate for Payer: CORVEL All Commercial |
$38.47
|
| Rate for Payer: Coventry All Commercial |
$36.41
|
| Rate for Payer: Encore All Commercial |
$38.08
|
| Rate for Payer: Frontpath All Commercial |
$38.06
|
| Rate for Payer: Humana ChoiceCare |
$35.73
|
| Rate for Payer: Humana Medicare |
$13.24
|
| Rate for Payer: Lucent All Commercial |
$22.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.23
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$31.03
|
| Rate for Payer: PHP All Commercial |
$31.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.13
|
| Rate for Payer: Sagamore Health Network All Products |
$31.94
|
| Rate for Payer: Signature Care EPO |
$34.34
|
| Rate for Payer: Signature Care PPO |
$36.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.16
|
| Rate for Payer: United Healthcare Commercial |
$32.60
|
| Rate for Payer: United Healthcare Medicare |
$13.24
|
|
|
HC NEEDLE HUBER 20G X 1 1/4 IN
|
Facility
|
OP
|
$41.37
|
|
| Hospital Charge Code |
41601080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.82 |
| Max. Negotiated Rate |
$38.47 |
| Rate for Payer: Aetna Commercial |
$34.92
|
| Rate for Payer: Aetna Medicare |
$13.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$12.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$23.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$15.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$14.56
|
| Rate for Payer: Cash Price |
$24.82
|
| Rate for Payer: Cash Price |
$24.82
|
| Rate for Payer: Centivo All Commercial |
$22.51
|
| Rate for Payer: Cigna All Commercial |
$35.70
|
| Rate for Payer: CORVEL All Commercial |
$38.47
|
| Rate for Payer: Coventry All Commercial |
$36.41
|
| Rate for Payer: Encore All Commercial |
$38.08
|
| Rate for Payer: Frontpath All Commercial |
$38.06
|
| Rate for Payer: Humana ChoiceCare |
$35.73
|
| Rate for Payer: Humana Medicare |
$13.24
|
| Rate for Payer: Lucent All Commercial |
$22.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.23
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$31.03
|
| Rate for Payer: PHP All Commercial |
$31.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$16.13
|
| Rate for Payer: Sagamore Health Network All Products |
$31.94
|
| Rate for Payer: Signature Care EPO |
$34.34
|
| Rate for Payer: Signature Care PPO |
$36.41
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$35.16
|
| Rate for Payer: United Healthcare Commercial |
$32.60
|
| Rate for Payer: United Healthcare Medicare |
$13.24
|
|
|
HC NEEDLE HUBER 20G X 1 1/4 IN
|
Facility
|
IP
|
$41.37
|
|
| Hospital Charge Code |
41601080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.03 |
| Max. Negotiated Rate |
$38.47 |
| Rate for Payer: Aetna Commercial |
$35.74
|
| Rate for Payer: Cash Price |
$24.82
|
| Rate for Payer: Cigna All Commercial |
$35.70
|
| Rate for Payer: CORVEL All Commercial |
$38.47
|
| Rate for Payer: Coventry All Commercial |
$36.41
|
| Rate for Payer: Encore All Commercial |
$38.08
|
| Rate for Payer: Frontpath All Commercial |
$38.06
|
| Rate for Payer: Humana ChoiceCare |
$35.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.23
|
| Rate for Payer: PHCS All Commercial |
$31.03
|
| Rate for Payer: PHP All Commercial |
$31.38
|
| Rate for Payer: Sagamore Health Network All Products |
$31.94
|
| Rate for Payer: Signature Care EPO |
$34.34
|
| Rate for Payer: Signature Care PPO |
$36.41
|
| Rate for Payer: United Healthcare Commercial |
$32.60
|
|
|
HC NEEDLE INJ COLON
|
Facility
|
IP
|
$499.63
|
|
| Hospital Charge Code |
41601956
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.72 |
| Max. Negotiated Rate |
$464.66 |
| Rate for Payer: Aetna Commercial |
$431.68
|
| Rate for Payer: Cash Price |
$299.78
|
| Rate for Payer: Cigna All Commercial |
$431.18
|
| Rate for Payer: CORVEL All Commercial |
$464.66
|
| Rate for Payer: Coventry All Commercial |
$439.67
|
| Rate for Payer: Encore All Commercial |
$459.91
|
| Rate for Payer: Frontpath All Commercial |
$459.66
|
| Rate for Payer: Humana ChoiceCare |
$431.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$449.67
|
| Rate for Payer: PHCS All Commercial |
$374.72
|
| Rate for Payer: PHP All Commercial |
$378.92
|
| Rate for Payer: Sagamore Health Network All Products |
$385.71
|
| Rate for Payer: Signature Care EPO |
$414.69
|
| Rate for Payer: Signature Care PPO |
$439.67
|
| Rate for Payer: United Healthcare Commercial |
$393.71
|
|
|
HC NEEDLE INJ COLON
|
Facility
|
OP
|
$499.63
|
|
| Hospital Charge Code |
41601956
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$464.66 |
| Rate for Payer: Aetna Commercial |
$421.69
|
| Rate for Payer: Aetna Medicare |
$159.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$154.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$286.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$312.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$183.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$175.87
|
| Rate for Payer: Cash Price |
$299.78
|
| Rate for Payer: Cash Price |
$299.78
|
| Rate for Payer: Centivo All Commercial |
$271.80
|
| Rate for Payer: Cigna All Commercial |
$431.18
|
| Rate for Payer: CORVEL All Commercial |
$464.66
|
| Rate for Payer: Coventry All Commercial |
$439.67
|
| Rate for Payer: Encore All Commercial |
$459.91
|
| Rate for Payer: Frontpath All Commercial |
$459.66
|
| Rate for Payer: Humana ChoiceCare |
$431.53
|
| Rate for Payer: Humana Medicare |
$159.88
|
| Rate for Payer: Lucent All Commercial |
$271.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$449.67
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$374.72
|
| Rate for Payer: PHP All Commercial |
$378.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$194.86
|
| Rate for Payer: Sagamore Health Network All Products |
$385.71
|
| Rate for Payer: Signature Care EPO |
$414.69
|
| Rate for Payer: Signature Care PPO |
$439.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$424.69
|
| Rate for Payer: United Healthcare Commercial |
$393.71
|
| Rate for Payer: United Healthcare Medicare |
$159.88
|
|
|
HC NEEDLE INSUFFLATION S1000000
|
Facility
|
IP
|
$99.96
|
|
| Hospital Charge Code |
41601957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$92.96 |
| Rate for Payer: Aetna Commercial |
$86.37
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cigna All Commercial |
$86.27
|
| Rate for Payer: CORVEL All Commercial |
$92.96
|
| Rate for Payer: Coventry All Commercial |
$87.96
|
| Rate for Payer: Encore All Commercial |
$92.01
|
| Rate for Payer: Frontpath All Commercial |
$91.96
|
| Rate for Payer: Humana ChoiceCare |
$86.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.96
|
| Rate for Payer: PHCS All Commercial |
$74.97
|
| Rate for Payer: PHP All Commercial |
$75.81
|
| Rate for Payer: Sagamore Health Network All Products |
$77.17
|
| Rate for Payer: Signature Care EPO |
$82.97
|
| Rate for Payer: Signature Care PPO |
$87.96
|
| Rate for Payer: United Healthcare Commercial |
$78.77
|
|
|
HC NEEDLE INSUFFLATION S1000000
|
Facility
|
OP
|
$99.96
|
|
| Hospital Charge Code |
41601957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.99 |
| Max. Negotiated Rate |
$92.96 |
| Rate for Payer: Aetna Commercial |
$84.37
|
| Rate for Payer: Aetna Medicare |
$31.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$57.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.19
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Cash Price |
$59.98
|
| Rate for Payer: Centivo All Commercial |
$54.38
|
| Rate for Payer: Cigna All Commercial |
$86.27
|
| Rate for Payer: CORVEL All Commercial |
$92.96
|
| Rate for Payer: Coventry All Commercial |
$87.96
|
| Rate for Payer: Encore All Commercial |
$92.01
|
| Rate for Payer: Frontpath All Commercial |
$91.96
|
| Rate for Payer: Humana ChoiceCare |
$86.34
|
| Rate for Payer: Humana Medicare |
$31.99
|
| Rate for Payer: Lucent All Commercial |
$54.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$89.96
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$74.97
|
| Rate for Payer: PHP All Commercial |
$75.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.98
|
| Rate for Payer: Sagamore Health Network All Products |
$77.17
|
| Rate for Payer: Signature Care EPO |
$82.97
|
| Rate for Payer: Signature Care PPO |
$87.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$84.97
|
| Rate for Payer: United Healthcare Commercial |
$78.77
|
| Rate for Payer: United Healthcare Medicare |
$31.99
|
|
|
HC NEEDLE KOPANS BREAST LESION 20G 5CM
|
Facility
|
IP
|
$172.90
|
|
| Hospital Charge Code |
41601835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.68 |
| Max. Negotiated Rate |
$160.80 |
| Rate for Payer: Aetna Commercial |
$149.39
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna All Commercial |
$149.21
|
| Rate for Payer: CORVEL All Commercial |
$160.80
|
| Rate for Payer: Coventry All Commercial |
$152.15
|
| Rate for Payer: Encore All Commercial |
$159.15
|
| Rate for Payer: Frontpath All Commercial |
$159.07
|
| Rate for Payer: Humana ChoiceCare |
$149.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.61
|
| Rate for Payer: PHCS All Commercial |
$129.68
|
| Rate for Payer: PHP All Commercial |
$131.13
|
| Rate for Payer: Sagamore Health Network All Products |
$133.48
|
| Rate for Payer: Signature Care EPO |
$143.51
|
| Rate for Payer: Signature Care PPO |
$152.15
|
| Rate for Payer: United Healthcare Commercial |
$136.25
|
|
|
HC NEEDLE KOPANS BREAST LESION 20G 5CM
|
Facility
|
OP
|
$172.90
|
|
| Hospital Charge Code |
41601835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$160.80 |
| Rate for Payer: Aetna Commercial |
$145.93
|
| Rate for Payer: Aetna Medicare |
$55.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$99.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.86
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Centivo All Commercial |
$94.06
|
| Rate for Payer: Cigna All Commercial |
$149.21
|
| Rate for Payer: CORVEL All Commercial |
$160.80
|
| Rate for Payer: Coventry All Commercial |
$152.15
|
| Rate for Payer: Encore All Commercial |
$159.15
|
| Rate for Payer: Frontpath All Commercial |
$159.07
|
| Rate for Payer: Humana ChoiceCare |
$149.33
|
| Rate for Payer: Humana Medicare |
$55.33
|
| Rate for Payer: Lucent All Commercial |
$94.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.61
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$129.68
|
| Rate for Payer: PHP All Commercial |
$131.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.43
|
| Rate for Payer: Sagamore Health Network All Products |
$133.48
|
| Rate for Payer: Signature Care EPO |
$143.51
|
| Rate for Payer: Signature Care PPO |
$152.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$146.97
|
| Rate for Payer: United Healthcare Commercial |
$136.25
|
| Rate for Payer: United Healthcare Medicare |
$55.33
|
|
|
HC NEEDLE KOPANS BREAST LESION 20G 7CM
|
Facility
|
IP
|
$172.90
|
|
| Hospital Charge Code |
41601839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.68 |
| Max. Negotiated Rate |
$160.80 |
| Rate for Payer: Aetna Commercial |
$149.39
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cigna All Commercial |
$149.21
|
| Rate for Payer: CORVEL All Commercial |
$160.80
|
| Rate for Payer: Coventry All Commercial |
$152.15
|
| Rate for Payer: Encore All Commercial |
$159.15
|
| Rate for Payer: Frontpath All Commercial |
$159.07
|
| Rate for Payer: Humana ChoiceCare |
$149.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.61
|
| Rate for Payer: PHCS All Commercial |
$129.68
|
| Rate for Payer: PHP All Commercial |
$131.13
|
| Rate for Payer: Sagamore Health Network All Products |
$133.48
|
| Rate for Payer: Signature Care EPO |
$143.51
|
| Rate for Payer: Signature Care PPO |
$152.15
|
| Rate for Payer: United Healthcare Commercial |
$136.25
|
|
|
HC NEEDLE KOPANS BREAST LESION 20G 7CM
|
Facility
|
OP
|
$172.90
|
|
| Hospital Charge Code |
41601839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$160.80 |
| Rate for Payer: Aetna Commercial |
$145.93
|
| Rate for Payer: Aetna Medicare |
$55.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$53.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$99.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.86
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Cash Price |
$103.74
|
| Rate for Payer: Centivo All Commercial |
$94.06
|
| Rate for Payer: Cigna All Commercial |
$149.21
|
| Rate for Payer: CORVEL All Commercial |
$160.80
|
| Rate for Payer: Coventry All Commercial |
$152.15
|
| Rate for Payer: Encore All Commercial |
$159.15
|
| Rate for Payer: Frontpath All Commercial |
$159.07
|
| Rate for Payer: Humana ChoiceCare |
$149.33
|
| Rate for Payer: Humana Medicare |
$55.33
|
| Rate for Payer: Lucent All Commercial |
$94.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.61
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$129.68
|
| Rate for Payer: PHP All Commercial |
$131.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$67.43
|
| Rate for Payer: Sagamore Health Network All Products |
$133.48
|
| Rate for Payer: Signature Care EPO |
$143.51
|
| Rate for Payer: Signature Care PPO |
$152.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$146.97
|
| Rate for Payer: United Healthcare Commercial |
$136.25
|
| Rate for Payer: United Healthcare Medicare |
$55.33
|
|
|
HC NEEDLE MAMMALOK ULTRA 20GX7.5CM
|
Facility
|
OP
|
$238.00
|
|
| Hospital Charge Code |
41601858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$221.34 |
| Rate for Payer: Aetna Commercial |
$200.87
|
| Rate for Payer: Aetna Medicare |
$76.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$73.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$136.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.78
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Centivo All Commercial |
$129.47
|
| Rate for Payer: Cigna All Commercial |
$205.39
|
| Rate for Payer: CORVEL All Commercial |
$221.34
|
| Rate for Payer: Coventry All Commercial |
$209.44
|
| Rate for Payer: Encore All Commercial |
$219.08
|
| Rate for Payer: Frontpath All Commercial |
$218.96
|
| Rate for Payer: Humana ChoiceCare |
$205.56
|
| Rate for Payer: Humana Medicare |
$76.16
|
| Rate for Payer: Lucent All Commercial |
$129.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$214.20
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$178.50
|
| Rate for Payer: PHP All Commercial |
$180.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$92.82
|
| Rate for Payer: Sagamore Health Network All Products |
$183.74
|
| Rate for Payer: Signature Care EPO |
$197.54
|
| Rate for Payer: Signature Care PPO |
$209.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$202.30
|
| Rate for Payer: United Healthcare Commercial |
$187.54
|
| Rate for Payer: United Healthcare Medicare |
$76.16
|
|
|
HC NEEDLE MAMMALOK ULTRA 20GX7.5CM
|
Facility
|
IP
|
$238.00
|
|
| Hospital Charge Code |
41601858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.50 |
| Max. Negotiated Rate |
$221.34 |
| Rate for Payer: Aetna Commercial |
$205.63
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna All Commercial |
$205.39
|
| Rate for Payer: CORVEL All Commercial |
$221.34
|
| Rate for Payer: Coventry All Commercial |
$209.44
|
| Rate for Payer: Encore All Commercial |
$219.08
|
| Rate for Payer: Frontpath All Commercial |
$218.96
|
| Rate for Payer: Humana ChoiceCare |
$205.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$214.20
|
| Rate for Payer: PHCS All Commercial |
$178.50
|
| Rate for Payer: PHP All Commercial |
$180.50
|
| Rate for Payer: Sagamore Health Network All Products |
$183.74
|
| Rate for Payer: Signature Care EPO |
$197.54
|
| Rate for Payer: Signature Care PPO |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$187.54
|
|
|
HC NEEDLE RETROBULBAR 25X1 1/2
|
Facility
|
IP
|
$22.68
|
|
| Hospital Charge Code |
41608444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.01 |
| Max. Negotiated Rate |
$21.09 |
| Rate for Payer: Aetna Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Cigna All Commercial |
$19.57
|
| Rate for Payer: CORVEL All Commercial |
$21.09
|
| Rate for Payer: Coventry All Commercial |
$19.96
|
| Rate for Payer: Encore All Commercial |
$20.88
|
| Rate for Payer: Frontpath All Commercial |
$20.87
|
| Rate for Payer: Humana ChoiceCare |
$19.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.41
|
| Rate for Payer: PHCS All Commercial |
$17.01
|
| Rate for Payer: PHP All Commercial |
$17.20
|
| Rate for Payer: Sagamore Health Network All Products |
$17.51
|
| Rate for Payer: Signature Care EPO |
$18.82
|
| Rate for Payer: Signature Care PPO |
$19.96
|
| Rate for Payer: United Healthcare Commercial |
$17.87
|
|
|
HC NEEDLE RETROBULBAR 25X1 1/2
|
Facility
|
OP
|
$22.68
|
|
| Hospital Charge Code |
41608444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$19.14
|
| Rate for Payer: Aetna Medicare |
$7.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$13.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.98
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Cash Price |
$13.61
|
| Rate for Payer: Centivo All Commercial |
$12.34
|
| Rate for Payer: Cigna All Commercial |
$19.57
|
| Rate for Payer: CORVEL All Commercial |
$21.09
|
| Rate for Payer: Coventry All Commercial |
$19.96
|
| Rate for Payer: Encore All Commercial |
$20.88
|
| Rate for Payer: Frontpath All Commercial |
$20.87
|
| Rate for Payer: Humana ChoiceCare |
$19.59
|
| Rate for Payer: Humana Medicare |
$7.26
|
| Rate for Payer: Lucent All Commercial |
$12.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.41
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$17.01
|
| Rate for Payer: PHP All Commercial |
$17.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.85
|
| Rate for Payer: Sagamore Health Network All Products |
$17.51
|
| Rate for Payer: Signature Care EPO |
$18.82
|
| Rate for Payer: Signature Care PPO |
$19.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.28
|
| Rate for Payer: United Healthcare Commercial |
$17.87
|
| Rate for Payer: United Healthcare Medicare |
$7.26
|
|
|
HC NEEDLE SPINAL 22G X 1 1/2 IN
|
Facility
|
IP
|
$5.69
|
|
| Hospital Charge Code |
41601081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$5.29 |
| Rate for Payer: Aetna Commercial |
$4.92
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cigna All Commercial |
$4.91
|
| Rate for Payer: CORVEL All Commercial |
$5.29
|
| Rate for Payer: Coventry All Commercial |
$5.01
|
| Rate for Payer: Encore All Commercial |
$5.24
|
| Rate for Payer: Frontpath All Commercial |
$5.23
|
| Rate for Payer: Humana ChoiceCare |
$4.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.12
|
| Rate for Payer: PHCS All Commercial |
$4.27
|
| Rate for Payer: PHP All Commercial |
$4.32
|
| Rate for Payer: Sagamore Health Network All Products |
$4.39
|
| Rate for Payer: Signature Care EPO |
$4.72
|
| Rate for Payer: Signature Care PPO |
$5.01
|
| Rate for Payer: United Healthcare Commercial |
$4.48
|
|
|
HC NEEDLE SPINAL 22G X 1 1/2 IN
|
Facility
|
OP
|
$5.69
|
|
| Hospital Charge Code |
41601081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$24.83 |
| Rate for Payer: Aetna Commercial |
$4.80
|
| Rate for Payer: Aetna Medicare |
$1.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$24.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$24.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.00
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Cash Price |
$3.41
|
| Rate for Payer: Centivo All Commercial |
$3.10
|
| Rate for Payer: Cigna All Commercial |
$4.91
|
| Rate for Payer: CORVEL All Commercial |
$5.29
|
| Rate for Payer: Coventry All Commercial |
$5.01
|
| Rate for Payer: Encore All Commercial |
$5.24
|
| Rate for Payer: Frontpath All Commercial |
$5.23
|
| Rate for Payer: Humana ChoiceCare |
$4.91
|
| Rate for Payer: Humana Medicare |
$1.82
|
| Rate for Payer: Lucent All Commercial |
$3.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.12
|
| Rate for Payer: Managed Health Services Medicaid |
$24.83
|
| Rate for Payer: MDWise Medicaid |
$24.83
|
| Rate for Payer: PHCS All Commercial |
$4.27
|
| Rate for Payer: PHP All Commercial |
$4.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.22
|
| Rate for Payer: Sagamore Health Network All Products |
$4.39
|
| Rate for Payer: Signature Care EPO |
$4.72
|
| Rate for Payer: Signature Care PPO |
$5.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4.84
|
| Rate for Payer: United Healthcare Commercial |
$4.48
|
| Rate for Payer: United Healthcare Medicare |
$1.82
|
|
|
HC NEEDLE SPINAL 22G X 5IN
|
Facility
|
OP
|
$35.35
|
|
| Hospital Charge Code |
41608355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.96 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Aetna Commercial |
$29.84
|
| Rate for Payer: Aetna Medicare |
$11.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.44
|
| Rate for Payer: Cash Price |
$21.21
|
| Rate for Payer: Cash Price |
$21.21
|
| Rate for Payer: Centivo All Commercial |
$19.23
|
| Rate for Payer: Cigna All Commercial |
$30.51
|
| Rate for Payer: CORVEL All Commercial |
$32.88
|
| Rate for Payer: Coventry All Commercial |
$31.11
|
| Rate for Payer: Encore All Commercial |
$32.54
|
| Rate for Payer: Frontpath All Commercial |
$32.52
|
| Rate for Payer: Humana ChoiceCare |
$30.53
|
| Rate for Payer: Humana Medicare |
$11.31
|
| Rate for Payer: Lucent All Commercial |
$19.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.82
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$26.51
|
| Rate for Payer: PHP All Commercial |
$26.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.79
|
| Rate for Payer: Sagamore Health Network All Products |
$27.29
|
| Rate for Payer: Signature Care EPO |
$29.34
|
| Rate for Payer: Signature Care PPO |
$31.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.05
|
| Rate for Payer: United Healthcare Commercial |
$27.86
|
| Rate for Payer: United Healthcare Medicare |
$11.31
|
|
|
HC NEEDLE SPINAL 22G X 5IN
|
Facility
|
IP
|
$35.35
|
|
| Hospital Charge Code |
41608355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.51 |
| Max. Negotiated Rate |
$32.88 |
| Rate for Payer: Aetna Commercial |
$30.54
|
| Rate for Payer: Cash Price |
$21.21
|
| Rate for Payer: Cigna All Commercial |
$30.51
|
| Rate for Payer: CORVEL All Commercial |
$32.88
|
| Rate for Payer: Coventry All Commercial |
$31.11
|
| Rate for Payer: Encore All Commercial |
$32.54
|
| Rate for Payer: Frontpath All Commercial |
$32.52
|
| Rate for Payer: Humana ChoiceCare |
$30.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.82
|
| Rate for Payer: PHCS All Commercial |
$26.51
|
| Rate for Payer: PHP All Commercial |
$26.81
|
| Rate for Payer: Sagamore Health Network All Products |
$27.29
|
| Rate for Payer: Signature Care EPO |
$29.34
|
| Rate for Payer: Signature Care PPO |
$31.11
|
| Rate for Payer: United Healthcare Commercial |
$27.86
|
|
|
HC NEEDLE SPINAL 22G X 5 IN GERTIE MARX
|
Facility
|
OP
|
$104.43
|
|
| Hospital Charge Code |
41601451
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$97.12 |
| Rate for Payer: Aetna Commercial |
$88.14
|
| Rate for Payer: Aetna Medicare |
$33.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$32.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$59.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.76
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Centivo All Commercial |
$56.81
|
| Rate for Payer: Cigna All Commercial |
$90.12
|
| Rate for Payer: CORVEL All Commercial |
$97.12
|
| Rate for Payer: Coventry All Commercial |
$91.90
|
| Rate for Payer: Encore All Commercial |
$96.13
|
| Rate for Payer: Frontpath All Commercial |
$96.08
|
| Rate for Payer: Humana ChoiceCare |
$90.20
|
| Rate for Payer: Humana Medicare |
$33.42
|
| Rate for Payer: Lucent All Commercial |
$56.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.99
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$78.32
|
| Rate for Payer: PHP All Commercial |
$79.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.73
|
| Rate for Payer: Sagamore Health Network All Products |
$80.62
|
| Rate for Payer: Signature Care EPO |
$86.68
|
| Rate for Payer: Signature Care PPO |
$91.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$88.77
|
| Rate for Payer: United Healthcare Commercial |
$82.29
|
| Rate for Payer: United Healthcare Medicare |
$33.42
|
|
|
HC NEEDLE SPINAL 22G X 5 IN GERTIE MARX
|
Facility
|
IP
|
$104.43
|
|
| Hospital Charge Code |
41601451
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.32 |
| Max. Negotiated Rate |
$97.12 |
| Rate for Payer: Aetna Commercial |
$90.23
|
| Rate for Payer: Cash Price |
$62.66
|
| Rate for Payer: Cigna All Commercial |
$90.12
|
| Rate for Payer: CORVEL All Commercial |
$97.12
|
| Rate for Payer: Coventry All Commercial |
$91.90
|
| Rate for Payer: Encore All Commercial |
$96.13
|
| Rate for Payer: Frontpath All Commercial |
$96.08
|
| Rate for Payer: Humana ChoiceCare |
$90.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.99
|
| Rate for Payer: PHCS All Commercial |
$78.32
|
| Rate for Payer: PHP All Commercial |
$79.20
|
| Rate for Payer: Sagamore Health Network All Products |
$80.62
|
| Rate for Payer: Signature Care EPO |
$86.68
|
| Rate for Payer: Signature Care PPO |
$91.90
|
| Rate for Payer: United Healthcare Commercial |
$82.29
|
|
|
HC NEEDLE SPINAL 22X4 3/4 SPINOCAN 50/CS
|
Facility
|
OP
|
$22.31
|
|
| Hospital Charge Code |
41601082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.92 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$18.83
|
| Rate for Payer: Aetna Medicare |
$7.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$12.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$7.85
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Cash Price |
$13.39
|
| Rate for Payer: Centivo All Commercial |
$12.14
|
| Rate for Payer: Cigna All Commercial |
$19.25
|
| Rate for Payer: CORVEL All Commercial |
$20.75
|
| Rate for Payer: Coventry All Commercial |
$19.63
|
| Rate for Payer: Encore All Commercial |
$20.54
|
| Rate for Payer: Frontpath All Commercial |
$20.53
|
| Rate for Payer: Humana ChoiceCare |
$19.27
|
| Rate for Payer: Humana Medicare |
$7.14
|
| Rate for Payer: Lucent All Commercial |
$12.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.08
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$16.73
|
| Rate for Payer: PHP All Commercial |
$16.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.70
|
| Rate for Payer: Sagamore Health Network All Products |
$17.22
|
| Rate for Payer: Signature Care EPO |
$18.52
|
| Rate for Payer: Signature Care PPO |
$19.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.96
|
| Rate for Payer: United Healthcare Commercial |
$17.58
|
| Rate for Payer: United Healthcare Medicare |
$7.14
|
|
