|
HC NEEDLE SPINAL 22X4 3/4 SPINOCAN 50/CS
|
Facility
|
IP
|
$22.31
|
|
| Hospital Charge Code |
41601082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.73 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Aetna Commercial |
$19.28
|
| Rate for Payer: Cash Price |
$13.39
|
| 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: Lutheran Preferred All Commercial |
$20.08
|
| Rate for Payer: PHCS All Commercial |
$16.73
|
| Rate for Payer: PHP All Commercial |
$16.92
|
| 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: United Healthcare Commercial |
$17.58
|
|
|
HC NEEDLE SPINAL QUINCKE 18 X 3 1/2
|
Facility
|
IP
|
$14.57
|
|
| Hospital Charge Code |
41601962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna Commercial |
$12.59
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Cigna All Commercial |
$12.57
|
| Rate for Payer: CORVEL All Commercial |
$13.55
|
| Rate for Payer: Coventry All Commercial |
$12.82
|
| Rate for Payer: Encore All Commercial |
$13.41
|
| Rate for Payer: Frontpath All Commercial |
$13.40
|
| Rate for Payer: Humana ChoiceCare |
$12.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.11
|
| Rate for Payer: PHCS All Commercial |
$10.93
|
| Rate for Payer: PHP All Commercial |
$11.05
|
| Rate for Payer: Sagamore Health Network All Products |
$11.25
|
| Rate for Payer: Signature Care EPO |
$12.09
|
| Rate for Payer: Signature Care PPO |
$12.82
|
| Rate for Payer: United Healthcare Commercial |
$11.48
|
|
|
HC NEEDLE SPINAL QUINCKE 18 X 3 1/2
|
Facility
|
OP
|
$14.57
|
|
| Hospital Charge Code |
41601962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$12.30
|
| Rate for Payer: Aetna Medicare |
$4.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.13
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Centivo All Commercial |
$7.93
|
| Rate for Payer: Cigna All Commercial |
$12.57
|
| Rate for Payer: CORVEL All Commercial |
$13.55
|
| Rate for Payer: Coventry All Commercial |
$12.82
|
| Rate for Payer: Encore All Commercial |
$13.41
|
| Rate for Payer: Frontpath All Commercial |
$13.40
|
| Rate for Payer: Humana ChoiceCare |
$12.58
|
| Rate for Payer: Humana Medicare |
$4.66
|
| Rate for Payer: Lucent All Commercial |
$7.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.11
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$10.93
|
| Rate for Payer: PHP All Commercial |
$11.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.68
|
| Rate for Payer: Sagamore Health Network All Products |
$11.25
|
| Rate for Payer: Signature Care EPO |
$12.09
|
| Rate for Payer: Signature Care PPO |
$12.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.38
|
| Rate for Payer: United Healthcare Commercial |
$11.48
|
| Rate for Payer: United Healthcare Medicare |
$4.66
|
|
|
HC NEEDLE SPINAL QUINCKE 20 X 3 1/2
|
Facility
|
IP
|
$14.57
|
|
| Hospital Charge Code |
41601958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna Commercial |
$12.59
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Cigna All Commercial |
$12.57
|
| Rate for Payer: CORVEL All Commercial |
$13.55
|
| Rate for Payer: Coventry All Commercial |
$12.82
|
| Rate for Payer: Encore All Commercial |
$13.41
|
| Rate for Payer: Frontpath All Commercial |
$13.40
|
| Rate for Payer: Humana ChoiceCare |
$12.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.11
|
| Rate for Payer: PHCS All Commercial |
$10.93
|
| Rate for Payer: PHP All Commercial |
$11.05
|
| Rate for Payer: Sagamore Health Network All Products |
$11.25
|
| Rate for Payer: Signature Care EPO |
$12.09
|
| Rate for Payer: Signature Care PPO |
$12.82
|
| Rate for Payer: United Healthcare Commercial |
$11.48
|
|
|
HC NEEDLE SPINAL QUINCKE 20 X 3 1/2
|
Facility
|
OP
|
$14.57
|
|
| Hospital Charge Code |
41601958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$12.30
|
| Rate for Payer: Aetna Medicare |
$4.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.13
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Centivo All Commercial |
$7.93
|
| Rate for Payer: Cigna All Commercial |
$12.57
|
| Rate for Payer: CORVEL All Commercial |
$13.55
|
| Rate for Payer: Coventry All Commercial |
$12.82
|
| Rate for Payer: Encore All Commercial |
$13.41
|
| Rate for Payer: Frontpath All Commercial |
$13.40
|
| Rate for Payer: Humana ChoiceCare |
$12.58
|
| Rate for Payer: Humana Medicare |
$4.66
|
| Rate for Payer: Lucent All Commercial |
$7.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.11
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$10.93
|
| Rate for Payer: PHP All Commercial |
$11.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.68
|
| Rate for Payer: Sagamore Health Network All Products |
$11.25
|
| Rate for Payer: Signature Care EPO |
$12.09
|
| Rate for Payer: Signature Care PPO |
$12.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.38
|
| Rate for Payer: United Healthcare Commercial |
$11.48
|
| Rate for Payer: United Healthcare Medicare |
$4.66
|
|
|
HC NEEDLE SPINAL QUINCKE 22G X 7 IN
|
Facility
|
OP
|
$35.41
|
|
| Hospital Charge Code |
41601960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$32.93 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna Medicare |
$11.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$20.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.46
|
| Rate for Payer: Cash Price |
$21.25
|
| Rate for Payer: Cash Price |
$21.25
|
| Rate for Payer: Centivo All Commercial |
$19.26
|
| Rate for Payer: Cigna All Commercial |
$30.56
|
| Rate for Payer: CORVEL All Commercial |
$32.93
|
| Rate for Payer: Coventry All Commercial |
$31.16
|
| Rate for Payer: Encore All Commercial |
$32.59
|
| Rate for Payer: Frontpath All Commercial |
$32.58
|
| Rate for Payer: Humana ChoiceCare |
$30.58
|
| Rate for Payer: Humana Medicare |
$11.33
|
| Rate for Payer: Lucent All Commercial |
$19.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.87
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$26.56
|
| Rate for Payer: PHP All Commercial |
$26.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.81
|
| Rate for Payer: Sagamore Health Network All Products |
$27.34
|
| Rate for Payer: Signature Care EPO |
$29.39
|
| Rate for Payer: Signature Care PPO |
$31.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$30.10
|
| Rate for Payer: United Healthcare Commercial |
$27.90
|
| Rate for Payer: United Healthcare Medicare |
$11.33
|
|
|
HC NEEDLE SPINAL QUINCKE 22G X 7 IN
|
Facility
|
IP
|
$35.41
|
|
| Hospital Charge Code |
41601960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.56 |
| Max. Negotiated Rate |
$32.93 |
| Rate for Payer: Aetna Commercial |
$30.59
|
| Rate for Payer: Cash Price |
$21.25
|
| Rate for Payer: Cigna All Commercial |
$30.56
|
| Rate for Payer: CORVEL All Commercial |
$32.93
|
| Rate for Payer: Coventry All Commercial |
$31.16
|
| Rate for Payer: Encore All Commercial |
$32.59
|
| Rate for Payer: Frontpath All Commercial |
$32.58
|
| Rate for Payer: Humana ChoiceCare |
$30.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.87
|
| Rate for Payer: PHCS All Commercial |
$26.56
|
| Rate for Payer: PHP All Commercial |
$26.85
|
| Rate for Payer: Sagamore Health Network All Products |
$27.34
|
| Rate for Payer: Signature Care EPO |
$29.39
|
| Rate for Payer: Signature Care PPO |
$31.16
|
| Rate for Payer: United Healthcare Commercial |
$27.90
|
|
|
HC NEEDLE SPINAL QUINCKE 22 X 3 1/2
|
Facility
|
OP
|
$14.57
|
|
| Hospital Charge Code |
41601959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.52 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$12.30
|
| Rate for Payer: Aetna Medicare |
$4.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$8.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.13
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Centivo All Commercial |
$7.93
|
| Rate for Payer: Cigna All Commercial |
$12.57
|
| Rate for Payer: CORVEL All Commercial |
$13.55
|
| Rate for Payer: Coventry All Commercial |
$12.82
|
| Rate for Payer: Encore All Commercial |
$13.41
|
| Rate for Payer: Frontpath All Commercial |
$13.40
|
| Rate for Payer: Humana ChoiceCare |
$12.58
|
| Rate for Payer: Humana Medicare |
$4.66
|
| Rate for Payer: Lucent All Commercial |
$7.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.11
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$10.93
|
| Rate for Payer: PHP All Commercial |
$11.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.68
|
| Rate for Payer: Sagamore Health Network All Products |
$11.25
|
| Rate for Payer: Signature Care EPO |
$12.09
|
| Rate for Payer: Signature Care PPO |
$12.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.38
|
| Rate for Payer: United Healthcare Commercial |
$11.48
|
| Rate for Payer: United Healthcare Medicare |
$4.66
|
|
|
HC NEEDLE SPINAL QUINCKE 22 X 3 1/2
|
Facility
|
IP
|
$14.57
|
|
| Hospital Charge Code |
41601959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.93 |
| Max. Negotiated Rate |
$13.55 |
| Rate for Payer: Aetna Commercial |
$12.59
|
| Rate for Payer: Cash Price |
$8.74
|
| Rate for Payer: Cigna All Commercial |
$12.57
|
| Rate for Payer: CORVEL All Commercial |
$13.55
|
| Rate for Payer: Coventry All Commercial |
$12.82
|
| Rate for Payer: Encore All Commercial |
$13.41
|
| Rate for Payer: Frontpath All Commercial |
$13.40
|
| Rate for Payer: Humana ChoiceCare |
$12.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.11
|
| Rate for Payer: PHCS All Commercial |
$10.93
|
| Rate for Payer: PHP All Commercial |
$11.05
|
| Rate for Payer: Sagamore Health Network All Products |
$11.25
|
| Rate for Payer: Signature Care EPO |
$12.09
|
| Rate for Payer: Signature Care PPO |
$12.82
|
| Rate for Payer: United Healthcare Commercial |
$11.48
|
|
|
HC NEEDLE SPINAL QUINCKE 25 X 3 1/2
|
Facility
|
IP
|
$12.44
|
|
| Hospital Charge Code |
41601961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.33 |
| Max. Negotiated Rate |
$11.57 |
| Rate for Payer: Aetna Commercial |
$10.75
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cigna All Commercial |
$10.74
|
| Rate for Payer: CORVEL All Commercial |
$11.57
|
| Rate for Payer: Coventry All Commercial |
$10.95
|
| Rate for Payer: Encore All Commercial |
$11.45
|
| Rate for Payer: Frontpath All Commercial |
$11.44
|
| Rate for Payer: Humana ChoiceCare |
$10.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.20
|
| Rate for Payer: PHCS All Commercial |
$9.33
|
| Rate for Payer: PHP All Commercial |
$9.43
|
| Rate for Payer: Sagamore Health Network All Products |
$9.60
|
| Rate for Payer: Signature Care EPO |
$10.33
|
| Rate for Payer: Signature Care PPO |
$10.95
|
| Rate for Payer: United Healthcare Commercial |
$9.80
|
|
|
HC NEEDLE SPINAL QUINCKE 25 X 3 1/2
|
Facility
|
OP
|
$12.44
|
|
| Hospital Charge Code |
41601961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$10.50
|
| Rate for Payer: Aetna Medicare |
$3.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$7.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.38
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Cash Price |
$7.46
|
| Rate for Payer: Centivo All Commercial |
$6.77
|
| Rate for Payer: Cigna All Commercial |
$10.74
|
| Rate for Payer: CORVEL All Commercial |
$11.57
|
| Rate for Payer: Coventry All Commercial |
$10.95
|
| Rate for Payer: Encore All Commercial |
$11.45
|
| Rate for Payer: Frontpath All Commercial |
$11.44
|
| Rate for Payer: Humana ChoiceCare |
$10.74
|
| Rate for Payer: Humana Medicare |
$3.98
|
| Rate for Payer: Lucent All Commercial |
$6.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.20
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$9.33
|
| Rate for Payer: PHP All Commercial |
$9.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.85
|
| Rate for Payer: Sagamore Health Network All Products |
$9.60
|
| Rate for Payer: Signature Care EPO |
$10.33
|
| Rate for Payer: Signature Care PPO |
$10.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.57
|
| Rate for Payer: United Healthcare Commercial |
$9.80
|
| Rate for Payer: United Healthcare Medicare |
$3.98
|
|
|
HC NEEDLE SPINAL QUINCKE 25 X 4 1
|
Facility
|
IP
|
$11.37
|
|
| Hospital Charge Code |
41602361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.53 |
| Max. Negotiated Rate |
$10.57 |
| Rate for Payer: Aetna Commercial |
$9.82
|
| Rate for Payer: Cash Price |
$6.82
|
| Rate for Payer: Cigna All Commercial |
$9.81
|
| Rate for Payer: CORVEL All Commercial |
$10.57
|
| Rate for Payer: Coventry All Commercial |
$10.01
|
| Rate for Payer: Encore All Commercial |
$10.47
|
| Rate for Payer: Frontpath All Commercial |
$10.46
|
| Rate for Payer: Humana ChoiceCare |
$9.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.23
|
| Rate for Payer: PHCS All Commercial |
$8.53
|
| Rate for Payer: PHP All Commercial |
$8.62
|
| Rate for Payer: Sagamore Health Network All Products |
$8.78
|
| Rate for Payer: Signature Care EPO |
$9.44
|
| Rate for Payer: Signature Care PPO |
$10.01
|
| Rate for Payer: United Healthcare Commercial |
$8.96
|
|
|
HC NEEDLE SPINAL QUINCKE 25 X 4 1
|
Facility
|
OP
|
$11.37
|
|
| Hospital Charge Code |
41602361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$9.60
|
| Rate for Payer: Aetna Medicare |
$3.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.00
|
| Rate for Payer: Cash Price |
$6.82
|
| Rate for Payer: Cash Price |
$6.82
|
| Rate for Payer: Centivo All Commercial |
$6.19
|
| Rate for Payer: Cigna All Commercial |
$9.81
|
| Rate for Payer: CORVEL All Commercial |
$10.57
|
| Rate for Payer: Coventry All Commercial |
$10.01
|
| Rate for Payer: Encore All Commercial |
$10.47
|
| Rate for Payer: Frontpath All Commercial |
$10.46
|
| Rate for Payer: Humana ChoiceCare |
$9.82
|
| Rate for Payer: Humana Medicare |
$3.64
|
| Rate for Payer: Lucent All Commercial |
$6.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$10.23
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$8.53
|
| Rate for Payer: PHP All Commercial |
$8.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.43
|
| Rate for Payer: Sagamore Health Network All Products |
$8.78
|
| Rate for Payer: Signature Care EPO |
$9.44
|
| Rate for Payer: Signature Care PPO |
$10.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.66
|
| Rate for Payer: United Healthcare Commercial |
$8.96
|
| Rate for Payer: United Healthcare Medicare |
$3.64
|
|
|
HC NEEDLE SPINAL SPROTTE 25G X 3 1/2
|
Facility
|
OP
|
$74.76
|
|
| Hospital Charge Code |
41601450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$69.53 |
| Rate for Payer: Aetna Commercial |
$63.10
|
| Rate for Payer: Aetna Medicare |
$23.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$42.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.32
|
| Rate for Payer: Cash Price |
$44.86
|
| Rate for Payer: Cash Price |
$44.86
|
| Rate for Payer: Centivo All Commercial |
$40.67
|
| Rate for Payer: Cigna All Commercial |
$64.52
|
| Rate for Payer: CORVEL All Commercial |
$69.53
|
| Rate for Payer: Coventry All Commercial |
$65.79
|
| Rate for Payer: Encore All Commercial |
$68.82
|
| Rate for Payer: Frontpath All Commercial |
$68.78
|
| Rate for Payer: Humana ChoiceCare |
$64.57
|
| Rate for Payer: Humana Medicare |
$23.92
|
| Rate for Payer: Lucent All Commercial |
$40.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.28
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$56.07
|
| Rate for Payer: PHP All Commercial |
$56.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.16
|
| Rate for Payer: Sagamore Health Network All Products |
$57.71
|
| Rate for Payer: Signature Care EPO |
$62.05
|
| Rate for Payer: Signature Care PPO |
$65.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63.55
|
| Rate for Payer: United Healthcare Commercial |
$58.91
|
| Rate for Payer: United Healthcare Medicare |
$23.92
|
|
|
HC NEEDLE SPINAL SPROTTE 25G X 3 1/2
|
Facility
|
IP
|
$74.76
|
|
| Hospital Charge Code |
41601450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.07 |
| Max. Negotiated Rate |
$69.53 |
| Rate for Payer: Aetna Commercial |
$64.59
|
| Rate for Payer: Cash Price |
$44.86
|
| Rate for Payer: Cigna All Commercial |
$64.52
|
| Rate for Payer: CORVEL All Commercial |
$69.53
|
| Rate for Payer: Coventry All Commercial |
$65.79
|
| Rate for Payer: Encore All Commercial |
$68.82
|
| Rate for Payer: Frontpath All Commercial |
$68.78
|
| Rate for Payer: Humana ChoiceCare |
$64.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$67.28
|
| Rate for Payer: PHCS All Commercial |
$56.07
|
| Rate for Payer: PHP All Commercial |
$56.70
|
| Rate for Payer: Sagamore Health Network All Products |
$57.71
|
| Rate for Payer: Signature Care EPO |
$62.05
|
| Rate for Payer: Signature Care PPO |
$65.79
|
| Rate for Payer: United Healthcare Commercial |
$58.91
|
|
|
HC NEEDLE SPINAL SPROTTE 25G X 4 3/4 IN
|
Facility
|
OP
|
$80.50
|
|
| Hospital Charge Code |
41601434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.95 |
| Max. Negotiated Rate |
$74.86 |
| Rate for Payer: Aetna Commercial |
$67.94
|
| Rate for Payer: Aetna Medicare |
$25.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$46.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.34
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Centivo All Commercial |
$43.79
|
| Rate for Payer: Cigna All Commercial |
$69.47
|
| Rate for Payer: CORVEL All Commercial |
$74.86
|
| Rate for Payer: Coventry All Commercial |
$70.84
|
| Rate for Payer: Encore All Commercial |
$74.10
|
| Rate for Payer: Frontpath All Commercial |
$74.06
|
| Rate for Payer: Humana ChoiceCare |
$69.53
|
| Rate for Payer: Humana Medicare |
$25.76
|
| Rate for Payer: Lucent All Commercial |
$43.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.45
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$60.38
|
| Rate for Payer: PHP All Commercial |
$61.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.39
|
| Rate for Payer: Sagamore Health Network All Products |
$62.15
|
| Rate for Payer: Signature Care EPO |
$66.81
|
| Rate for Payer: Signature Care PPO |
$70.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68.42
|
| Rate for Payer: United Healthcare Commercial |
$63.43
|
| Rate for Payer: United Healthcare Medicare |
$25.76
|
|
|
HC NEEDLE SPINAL SPROTTE 25G X 4 3/4 IN
|
Facility
|
IP
|
$80.50
|
|
| Hospital Charge Code |
41601434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.38 |
| Max. Negotiated Rate |
$74.86 |
| Rate for Payer: Aetna Commercial |
$69.55
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cigna All Commercial |
$69.47
|
| Rate for Payer: CORVEL All Commercial |
$74.86
|
| Rate for Payer: Coventry All Commercial |
$70.84
|
| Rate for Payer: Encore All Commercial |
$74.10
|
| Rate for Payer: Frontpath All Commercial |
$74.06
|
| Rate for Payer: Humana ChoiceCare |
$69.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.45
|
| Rate for Payer: PHCS All Commercial |
$60.38
|
| Rate for Payer: PHP All Commercial |
$61.05
|
| Rate for Payer: Sagamore Health Network All Products |
$62.15
|
| Rate for Payer: Signature Care EPO |
$66.81
|
| Rate for Payer: Signature Care PPO |
$70.84
|
| Rate for Payer: United Healthcare Commercial |
$63.43
|
|
|
HC NEEDLE STIM ULTRA 20G 4 INCH
|
Facility
|
IP
|
$89.14
|
|
| Hospital Charge Code |
41606633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.86 |
| Max. Negotiated Rate |
$82.90 |
| Rate for Payer: Aetna Commercial |
$77.02
|
| Rate for Payer: Cash Price |
$53.48
|
| Rate for Payer: Cigna All Commercial |
$76.93
|
| Rate for Payer: CORVEL All Commercial |
$82.90
|
| Rate for Payer: Coventry All Commercial |
$78.44
|
| Rate for Payer: Encore All Commercial |
$82.05
|
| Rate for Payer: Frontpath All Commercial |
$82.01
|
| Rate for Payer: Humana ChoiceCare |
$76.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.23
|
| Rate for Payer: PHCS All Commercial |
$66.86
|
| Rate for Payer: PHP All Commercial |
$67.60
|
| Rate for Payer: Sagamore Health Network All Products |
$68.82
|
| Rate for Payer: Signature Care EPO |
$73.99
|
| Rate for Payer: Signature Care PPO |
$78.44
|
| Rate for Payer: United Healthcare Commercial |
$70.24
|
|
|
HC NEEDLE STIM ULTRA 20G 4 INCH
|
Facility
|
OP
|
$89.14
|
|
| Hospital Charge Code |
41606633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$82.90 |
| Rate for Payer: Aetna Commercial |
$75.23
|
| Rate for Payer: Aetna Medicare |
$28.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$27.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$51.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$55.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.38
|
| Rate for Payer: Cash Price |
$53.48
|
| Rate for Payer: Cash Price |
$53.48
|
| Rate for Payer: Centivo All Commercial |
$48.49
|
| Rate for Payer: Cigna All Commercial |
$76.93
|
| Rate for Payer: CORVEL All Commercial |
$82.90
|
| Rate for Payer: Coventry All Commercial |
$78.44
|
| Rate for Payer: Encore All Commercial |
$82.05
|
| Rate for Payer: Frontpath All Commercial |
$82.01
|
| Rate for Payer: Humana ChoiceCare |
$76.99
|
| Rate for Payer: Humana Medicare |
$28.52
|
| Rate for Payer: Lucent All Commercial |
$48.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.23
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$66.86
|
| Rate for Payer: PHP All Commercial |
$67.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.76
|
| Rate for Payer: Sagamore Health Network All Products |
$68.82
|
| Rate for Payer: Signature Care EPO |
$73.99
|
| Rate for Payer: Signature Care PPO |
$78.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$75.77
|
| Rate for Payer: United Healthcare Commercial |
$70.24
|
| Rate for Payer: United Healthcare Medicare |
$28.52
|
|
|
HC NEEDLE STIM ULTRA 22G 2 INCH
|
Facility
|
OP
|
$76.43
|
|
| Hospital Charge Code |
41606634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$71.08 |
| Rate for Payer: Aetna Commercial |
$64.51
|
| Rate for Payer: Aetna Medicare |
$24.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$43.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.90
|
| Rate for Payer: Cash Price |
$45.86
|
| Rate for Payer: Cash Price |
$45.86
|
| Rate for Payer: Centivo All Commercial |
$41.58
|
| Rate for Payer: Cigna All Commercial |
$65.96
|
| Rate for Payer: CORVEL All Commercial |
$71.08
|
| Rate for Payer: Coventry All Commercial |
$67.26
|
| Rate for Payer: Encore All Commercial |
$70.35
|
| Rate for Payer: Frontpath All Commercial |
$70.32
|
| Rate for Payer: Humana ChoiceCare |
$66.01
|
| Rate for Payer: Humana Medicare |
$24.46
|
| Rate for Payer: Lucent All Commercial |
$41.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.79
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$57.32
|
| Rate for Payer: PHP All Commercial |
$57.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.81
|
| Rate for Payer: Sagamore Health Network All Products |
$59.00
|
| Rate for Payer: Signature Care EPO |
$63.44
|
| Rate for Payer: Signature Care PPO |
$67.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$64.97
|
| Rate for Payer: United Healthcare Commercial |
$60.23
|
| Rate for Payer: United Healthcare Medicare |
$24.46
|
|
|
HC NEEDLE STIM ULTRA 22G 2 INCH
|
Facility
|
IP
|
$76.43
|
|
| Hospital Charge Code |
41606634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.32 |
| Max. Negotiated Rate |
$71.08 |
| Rate for Payer: Aetna Commercial |
$66.04
|
| Rate for Payer: Cash Price |
$45.86
|
| Rate for Payer: Cigna All Commercial |
$65.96
|
| Rate for Payer: CORVEL All Commercial |
$71.08
|
| Rate for Payer: Coventry All Commercial |
$67.26
|
| Rate for Payer: Encore All Commercial |
$70.35
|
| Rate for Payer: Frontpath All Commercial |
$70.32
|
| Rate for Payer: Humana ChoiceCare |
$66.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.79
|
| Rate for Payer: PHCS All Commercial |
$57.32
|
| Rate for Payer: PHP All Commercial |
$57.96
|
| Rate for Payer: Sagamore Health Network All Products |
$59.00
|
| Rate for Payer: Signature Care EPO |
$63.44
|
| Rate for Payer: Signature Care PPO |
$67.26
|
| Rate for Payer: United Healthcare Commercial |
$60.23
|
|
|
HC NEEDLE STIMUPLEX 21G 4 INCH
|
Facility
|
IP
|
$92.04
|
|
| Hospital Charge Code |
41601083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.03 |
| Max. Negotiated Rate |
$85.60 |
| Rate for Payer: Aetna Commercial |
$79.52
|
| Rate for Payer: Cash Price |
$55.22
|
| Rate for Payer: Cigna All Commercial |
$79.43
|
| Rate for Payer: CORVEL All Commercial |
$85.60
|
| Rate for Payer: Coventry All Commercial |
$81.00
|
| Rate for Payer: Encore All Commercial |
$84.72
|
| Rate for Payer: Frontpath All Commercial |
$84.68
|
| Rate for Payer: Humana ChoiceCare |
$79.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.84
|
| Rate for Payer: PHCS All Commercial |
$69.03
|
| Rate for Payer: PHP All Commercial |
$69.80
|
| Rate for Payer: Sagamore Health Network All Products |
$71.05
|
| Rate for Payer: Signature Care EPO |
$76.39
|
| Rate for Payer: Signature Care PPO |
$81.00
|
| Rate for Payer: United Healthcare Commercial |
$72.53
|
|
|
HC NEEDLE STIMUPLEX 21G 4 INCH
|
Facility
|
OP
|
$92.04
|
|
| Hospital Charge Code |
41601083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.53 |
| Max. Negotiated Rate |
$85.60 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: Aetna Medicare |
$29.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$52.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.40
|
| Rate for Payer: Cash Price |
$55.22
|
| Rate for Payer: Cash Price |
$55.22
|
| Rate for Payer: Centivo All Commercial |
$50.07
|
| Rate for Payer: Cigna All Commercial |
$79.43
|
| Rate for Payer: CORVEL All Commercial |
$85.60
|
| Rate for Payer: Coventry All Commercial |
$81.00
|
| Rate for Payer: Encore All Commercial |
$84.72
|
| Rate for Payer: Frontpath All Commercial |
$84.68
|
| Rate for Payer: Humana ChoiceCare |
$79.49
|
| Rate for Payer: Humana Medicare |
$29.45
|
| Rate for Payer: Lucent All Commercial |
$50.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.84
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$69.03
|
| Rate for Payer: PHP All Commercial |
$69.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.90
|
| Rate for Payer: Sagamore Health Network All Products |
$71.05
|
| Rate for Payer: Signature Care EPO |
$76.39
|
| Rate for Payer: Signature Care PPO |
$81.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$78.23
|
| Rate for Payer: United Healthcare Commercial |
$72.53
|
| Rate for Payer: United Healthcare Medicare |
$29.45
|
|
|
HC NEEDLE STIMUPLEX 22G 2 INCH
|
Facility
|
OP
|
$33.13
|
|
| Hospital Charge Code |
41601084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.27 |
| Max. Negotiated Rate |
$31.20 |
| Rate for Payer: Aetna Commercial |
$27.96
|
| Rate for Payer: Aetna Medicare |
$10.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$31.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$10.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$19.03
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$11.66
|
| Rate for Payer: Cash Price |
$19.88
|
| Rate for Payer: Cash Price |
$19.88
|
| Rate for Payer: Centivo All Commercial |
$18.02
|
| Rate for Payer: Cigna All Commercial |
$28.59
|
| Rate for Payer: CORVEL All Commercial |
$30.81
|
| Rate for Payer: Coventry All Commercial |
$29.15
|
| Rate for Payer: Encore All Commercial |
$30.50
|
| Rate for Payer: Frontpath All Commercial |
$30.48
|
| Rate for Payer: Humana ChoiceCare |
$28.61
|
| Rate for Payer: Humana Medicare |
$10.60
|
| Rate for Payer: Lucent All Commercial |
$18.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.82
|
| Rate for Payer: Managed Health Services Medicaid |
$31.20
|
| Rate for Payer: MDWise Medicaid |
$31.20
|
| Rate for Payer: PHCS All Commercial |
$24.85
|
| Rate for Payer: PHP All Commercial |
$25.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.92
|
| Rate for Payer: Sagamore Health Network All Products |
$25.58
|
| Rate for Payer: Signature Care EPO |
$27.50
|
| Rate for Payer: Signature Care PPO |
$29.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28.16
|
| Rate for Payer: United Healthcare Commercial |
$26.11
|
| Rate for Payer: United Healthcare Medicare |
$10.60
|
|
|
HC NEEDLE STIMUPLEX 22G 2 INCH
|
Facility
|
IP
|
$33.13
|
|
| Hospital Charge Code |
41601084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.85 |
| Max. Negotiated Rate |
$30.81 |
| Rate for Payer: Aetna Commercial |
$28.62
|
| Rate for Payer: Cash Price |
$19.88
|
| Rate for Payer: Cigna All Commercial |
$28.59
|
| Rate for Payer: CORVEL All Commercial |
$30.81
|
| Rate for Payer: Coventry All Commercial |
$29.15
|
| Rate for Payer: Encore All Commercial |
$30.50
|
| Rate for Payer: Frontpath All Commercial |
$30.48
|
| Rate for Payer: Humana ChoiceCare |
$28.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$29.82
|
| Rate for Payer: PHCS All Commercial |
$24.85
|
| Rate for Payer: PHP All Commercial |
$25.13
|
| Rate for Payer: Sagamore Health Network All Products |
$25.58
|
| Rate for Payer: Signature Care EPO |
$27.50
|
| Rate for Payer: Signature Care PPO |
$29.15
|
| Rate for Payer: United Healthcare Commercial |
$26.11
|
|
