|
HC NEEDLE BIOPSY ACHIEVE
|
Facility
OP
|
$369.95
|
|
| Hospital Charge Code |
41603518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$344.05 |
| Rate for Payer: Aetna Commercial |
$312.24
|
| Rate for Payer: Aetna Medicare |
$122.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.29
|
| Rate for Payer: Cash Price |
$229.37
|
| Rate for Payer: Cash Price |
$229.37
|
| Rate for Payer: Centivo All Commercial |
$188.67
|
| Rate for Payer: Cigna All Commercial |
$319.27
|
| Rate for Payer: CORVEL All Commercial |
$344.05
|
| Rate for Payer: Coventry All Commercial |
$325.56
|
| Rate for Payer: Encore All Commercial |
$340.54
|
| Rate for Payer: Frontpath All Commercial |
$340.35
|
| Rate for Payer: Humana ChoiceCare |
$319.53
|
| Rate for Payer: Humana Medicare |
$188.67
|
| Rate for Payer: Lucent All Commercial |
$188.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$277.46
|
| Rate for Payer: PHP All Commercial |
$280.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.28
|
| Rate for Payer: Sagamore Health Network All Products |
$285.60
|
| Rate for Payer: Signature Care EPO |
$307.06
|
| Rate for Payer: Signature Care PPO |
$325.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$314.46
|
| Rate for Payer: United Healthcare Commercial |
$291.52
|
| Rate for Payer: United Healthcare Medicare |
$122.08
|
|
|
HC NEEDLE BIOPSY ACHIEVE
|
Facility
IP
|
$369.95
|
|
| Hospital Charge Code |
41603518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.46 |
| Max. Negotiated Rate |
$344.05 |
| Rate for Payer: Aetna Commercial |
$319.64
|
| Rate for Payer: Cash Price |
$229.37
|
| Rate for Payer: Cigna All Commercial |
$319.27
|
| Rate for Payer: CORVEL All Commercial |
$344.05
|
| Rate for Payer: Coventry All Commercial |
$325.56
|
| Rate for Payer: Encore All Commercial |
$340.54
|
| Rate for Payer: Frontpath All Commercial |
$340.35
|
| Rate for Payer: Humana ChoiceCare |
$319.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$332.96
|
| Rate for Payer: PHCS All Commercial |
$277.46
|
| Rate for Payer: PHP All Commercial |
$280.57
|
| Rate for Payer: Sagamore Health Network All Products |
$285.60
|
| Rate for Payer: Signature Care EPO |
$307.06
|
| Rate for Payer: Signature Care PPO |
$325.56
|
| Rate for Payer: United Healthcare Commercial |
$291.52
|
|
|
HC NEEDLE BIOPSY CORE 14GX10CM
|
Facility
IP
|
$204.40
|
|
| Hospital Charge Code |
41601336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.30 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$176.60
|
| Rate for Payer: Cash Price |
$126.73
|
| Rate for Payer: Cigna All Commercial |
$176.40
|
| Rate for Payer: CORVEL All Commercial |
$190.09
|
| Rate for Payer: Coventry All Commercial |
$179.87
|
| Rate for Payer: Encore All Commercial |
$188.15
|
| Rate for Payer: Frontpath All Commercial |
$188.05
|
| Rate for Payer: Humana ChoiceCare |
$176.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.96
|
| Rate for Payer: PHCS All Commercial |
$153.30
|
| Rate for Payer: PHP All Commercial |
$155.02
|
| Rate for Payer: Sagamore Health Network All Products |
$157.80
|
| Rate for Payer: Signature Care EPO |
$169.65
|
| Rate for Payer: Signature Care PPO |
$179.87
|
| Rate for Payer: United Healthcare Commercial |
$161.07
|
|
|
HC NEEDLE BIOPSY CORE 14GX10CM
|
Facility
OP
|
$204.40
|
|
| Hospital Charge Code |
41601336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.45 |
| Max. Negotiated Rate |
$190.09 |
| Rate for Payer: Aetna Commercial |
$172.51
|
| Rate for Payer: Aetna Medicare |
$67.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$117.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$127.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$77.57
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$74.20
|
| Rate for Payer: Cash Price |
$126.73
|
| Rate for Payer: Cash Price |
$126.73
|
| Rate for Payer: Centivo All Commercial |
$104.24
|
| Rate for Payer: Cigna All Commercial |
$176.40
|
| Rate for Payer: CORVEL All Commercial |
$190.09
|
| Rate for Payer: Coventry All Commercial |
$179.87
|
| Rate for Payer: Encore All Commercial |
$188.15
|
| Rate for Payer: Frontpath All Commercial |
$188.05
|
| Rate for Payer: Humana ChoiceCare |
$176.54
|
| Rate for Payer: Humana Medicare |
$104.24
|
| Rate for Payer: Lucent All Commercial |
$104.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$183.96
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$153.30
|
| Rate for Payer: PHP All Commercial |
$155.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.72
|
| Rate for Payer: Sagamore Health Network All Products |
$157.80
|
| Rate for Payer: Signature Care EPO |
$169.65
|
| Rate for Payer: Signature Care PPO |
$179.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$173.74
|
| Rate for Payer: United Healthcare Commercial |
$161.07
|
| Rate for Payer: United Healthcare Medicare |
$67.45
|
|
|
HC NEEDLE BIOP TRUE-G 17G 13.8CM
|
Facility
OP
|
$73.99
|
|
| Hospital Charge Code |
41608072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$62.45
|
| Rate for Payer: Aetna Medicare |
$24.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.86
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Centivo All Commercial |
$37.73
|
| Rate for Payer: Cigna All Commercial |
$63.85
|
| Rate for Payer: CORVEL All Commercial |
$68.81
|
| Rate for Payer: Coventry All Commercial |
$65.11
|
| Rate for Payer: Encore All Commercial |
$68.11
|
| Rate for Payer: Frontpath All Commercial |
$68.07
|
| Rate for Payer: Humana ChoiceCare |
$63.91
|
| Rate for Payer: Humana Medicare |
$37.73
|
| Rate for Payer: Lucent All Commercial |
$37.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.59
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$55.49
|
| Rate for Payer: PHP All Commercial |
$56.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.86
|
| Rate for Payer: Sagamore Health Network All Products |
$57.12
|
| Rate for Payer: Signature Care EPO |
$61.41
|
| Rate for Payer: Signature Care PPO |
$65.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.89
|
| Rate for Payer: United Healthcare Commercial |
$58.30
|
| Rate for Payer: United Healthcare Medicare |
$24.42
|
|
|
HC NEEDLE BIOP TRUE-G 17G 13.8CM
|
Facility
IP
|
$73.99
|
|
| Hospital Charge Code |
41608072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.49 |
| Max. Negotiated Rate |
$68.81 |
| Rate for Payer: Aetna Commercial |
$63.93
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Cigna All Commercial |
$63.85
|
| Rate for Payer: CORVEL All Commercial |
$68.81
|
| Rate for Payer: Coventry All Commercial |
$65.11
|
| Rate for Payer: Encore All Commercial |
$68.11
|
| Rate for Payer: Frontpath All Commercial |
$68.07
|
| Rate for Payer: Humana ChoiceCare |
$63.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.59
|
| Rate for Payer: PHCS All Commercial |
$55.49
|
| Rate for Payer: PHP All Commercial |
$56.11
|
| Rate for Payer: Sagamore Health Network All Products |
$57.12
|
| Rate for Payer: Signature Care EPO |
$61.41
|
| Rate for Payer: Signature Care PPO |
$65.11
|
| Rate for Payer: United Healthcare Commercial |
$58.30
|
|
|
HC NEEDLE BIOP TRUE-G 17G 17.8CM
|
Facility
IP
|
$73.99
|
|
| Hospital Charge Code |
41608074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.49 |
| Max. Negotiated Rate |
$68.81 |
| Rate for Payer: Aetna Commercial |
$63.93
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Cigna All Commercial |
$63.85
|
| Rate for Payer: CORVEL All Commercial |
$68.81
|
| Rate for Payer: Coventry All Commercial |
$65.11
|
| Rate for Payer: Encore All Commercial |
$68.11
|
| Rate for Payer: Frontpath All Commercial |
$68.07
|
| Rate for Payer: Humana ChoiceCare |
$63.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.59
|
| Rate for Payer: PHCS All Commercial |
$55.49
|
| Rate for Payer: PHP All Commercial |
$56.11
|
| Rate for Payer: Sagamore Health Network All Products |
$57.12
|
| Rate for Payer: Signature Care EPO |
$61.41
|
| Rate for Payer: Signature Care PPO |
$65.11
|
| Rate for Payer: United Healthcare Commercial |
$58.30
|
|
|
HC NEEDLE BIOP TRUE-G 17G 17.8CM
|
Facility
OP
|
$73.99
|
|
| Hospital Charge Code |
41608074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$62.45
|
| Rate for Payer: Aetna Medicare |
$24.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.86
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Centivo All Commercial |
$37.73
|
| Rate for Payer: Cigna All Commercial |
$63.85
|
| Rate for Payer: CORVEL All Commercial |
$68.81
|
| Rate for Payer: Coventry All Commercial |
$65.11
|
| Rate for Payer: Encore All Commercial |
$68.11
|
| Rate for Payer: Frontpath All Commercial |
$68.07
|
| Rate for Payer: Humana ChoiceCare |
$63.91
|
| Rate for Payer: Humana Medicare |
$37.73
|
| Rate for Payer: Lucent All Commercial |
$37.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.59
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$55.49
|
| Rate for Payer: PHP All Commercial |
$56.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.86
|
| Rate for Payer: Sagamore Health Network All Products |
$57.12
|
| Rate for Payer: Signature Care EPO |
$61.41
|
| Rate for Payer: Signature Care PPO |
$65.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.89
|
| Rate for Payer: United Healthcare Commercial |
$58.30
|
| Rate for Payer: United Healthcare Medicare |
$24.42
|
|
|
HC NEEDLE BIOP TRUE-G 17G 7.8CM
|
Facility
OP
|
$73.99
|
|
| Hospital Charge Code |
41608073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.42 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$62.45
|
| Rate for Payer: Aetna Medicare |
$24.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$24.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$42.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$46.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$28.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.86
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Centivo All Commercial |
$37.73
|
| Rate for Payer: Cigna All Commercial |
$63.85
|
| Rate for Payer: CORVEL All Commercial |
$68.81
|
| Rate for Payer: Coventry All Commercial |
$65.11
|
| Rate for Payer: Encore All Commercial |
$68.11
|
| Rate for Payer: Frontpath All Commercial |
$68.07
|
| Rate for Payer: Humana ChoiceCare |
$63.91
|
| Rate for Payer: Humana Medicare |
$37.73
|
| Rate for Payer: Lucent All Commercial |
$37.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.59
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$55.49
|
| Rate for Payer: PHP All Commercial |
$56.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.86
|
| Rate for Payer: Sagamore Health Network All Products |
$57.12
|
| Rate for Payer: Signature Care EPO |
$61.41
|
| Rate for Payer: Signature Care PPO |
$65.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$62.89
|
| Rate for Payer: United Healthcare Commercial |
$58.30
|
| Rate for Payer: United Healthcare Medicare |
$24.42
|
|
|
HC NEEDLE BIOP TRUE-G 17G 7.8CM
|
Facility
IP
|
$73.99
|
|
| Hospital Charge Code |
41608073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.49 |
| Max. Negotiated Rate |
$68.81 |
| Rate for Payer: Aetna Commercial |
$63.93
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Cigna All Commercial |
$63.85
|
| Rate for Payer: CORVEL All Commercial |
$68.81
|
| Rate for Payer: Coventry All Commercial |
$65.11
|
| Rate for Payer: Encore All Commercial |
$68.11
|
| Rate for Payer: Frontpath All Commercial |
$68.07
|
| Rate for Payer: Humana ChoiceCare |
$63.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.59
|
| Rate for Payer: PHCS All Commercial |
$55.49
|
| Rate for Payer: PHP All Commercial |
$56.11
|
| Rate for Payer: Sagamore Health Network All Products |
$57.12
|
| Rate for Payer: Signature Care EPO |
$61.41
|
| Rate for Payer: Signature Care PPO |
$65.11
|
| Rate for Payer: United Healthcare Commercial |
$58.30
|
|
|
HC NEEDLE CASSETT MINI MAG
|
Facility
IP
|
$350.00
|
|
| Hospital Charge Code |
41601254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.50 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$302.40
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cigna All Commercial |
$302.05
|
| Rate for Payer: CORVEL All Commercial |
$325.50
|
| Rate for Payer: Coventry All Commercial |
$308.00
|
| Rate for Payer: Encore All Commercial |
$322.18
|
| Rate for Payer: Frontpath All Commercial |
$322.00
|
| Rate for Payer: Humana ChoiceCare |
$302.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.00
|
| Rate for Payer: PHCS All Commercial |
$262.50
|
| Rate for Payer: PHP All Commercial |
$265.44
|
| Rate for Payer: Sagamore Health Network All Products |
$270.20
|
| Rate for Payer: Signature Care EPO |
$290.50
|
| Rate for Payer: Signature Care PPO |
$308.00
|
| Rate for Payer: United Healthcare Commercial |
$275.80
|
|
|
HC NEEDLE CASSETT MINI MAG
|
Facility
OP
|
$350.00
|
|
| Hospital Charge Code |
41601254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.50 |
| Max. Negotiated Rate |
$325.50 |
| Rate for Payer: Aetna Commercial |
$295.40
|
| Rate for Payer: Aetna Medicare |
$115.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$115.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$201.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$218.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$127.05
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Cash Price |
$217.00
|
| Rate for Payer: Centivo All Commercial |
$178.50
|
| Rate for Payer: Cigna All Commercial |
$302.05
|
| Rate for Payer: CORVEL All Commercial |
$325.50
|
| Rate for Payer: Coventry All Commercial |
$308.00
|
| Rate for Payer: Encore All Commercial |
$322.18
|
| Rate for Payer: Frontpath All Commercial |
$322.00
|
| Rate for Payer: Humana ChoiceCare |
$302.30
|
| Rate for Payer: Humana Medicare |
$178.50
|
| Rate for Payer: Lucent All Commercial |
$178.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$315.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$262.50
|
| Rate for Payer: PHP All Commercial |
$265.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$136.50
|
| Rate for Payer: Sagamore Health Network All Products |
$270.20
|
| Rate for Payer: Signature Care EPO |
$290.50
|
| Rate for Payer: Signature Care PPO |
$308.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$297.50
|
| Rate for Payer: United Healthcare Commercial |
$275.80
|
| Rate for Payer: United Healthcare Medicare |
$115.50
|
|
|
HC NEEDLE ECHOGENIC PNB 20G
|
Facility
OP
|
$108.94
|
|
| Hospital Charge Code |
41601404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.95 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$91.95
|
| Rate for Payer: Aetna Medicare |
$35.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$35.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.55
|
| Rate for Payer: Cash Price |
$67.54
|
| Rate for Payer: Cash Price |
$67.54
|
| Rate for Payer: Centivo All Commercial |
$55.56
|
| Rate for Payer: Cigna All Commercial |
$94.02
|
| Rate for Payer: CORVEL All Commercial |
$101.31
|
| Rate for Payer: Coventry All Commercial |
$95.87
|
| Rate for Payer: Encore All Commercial |
$100.28
|
| Rate for Payer: Frontpath All Commercial |
$100.22
|
| Rate for Payer: Humana ChoiceCare |
$94.09
|
| Rate for Payer: Humana Medicare |
$55.56
|
| Rate for Payer: Lucent All Commercial |
$55.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.05
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$81.70
|
| Rate for Payer: PHP All Commercial |
$82.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.49
|
| Rate for Payer: Sagamore Health Network All Products |
$84.10
|
| Rate for Payer: Signature Care EPO |
$90.42
|
| Rate for Payer: Signature Care PPO |
$95.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$92.60
|
| Rate for Payer: United Healthcare Commercial |
$85.84
|
| Rate for Payer: United Healthcare Medicare |
$35.95
|
|
|
HC NEEDLE ECHOGENIC PNB 20G
|
Facility
IP
|
$108.94
|
|
| Hospital Charge Code |
41601404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.70 |
| Max. Negotiated Rate |
$101.31 |
| Rate for Payer: Aetna Commercial |
$94.12
|
| Rate for Payer: Cash Price |
$67.54
|
| Rate for Payer: Cigna All Commercial |
$94.02
|
| Rate for Payer: CORVEL All Commercial |
$101.31
|
| Rate for Payer: Coventry All Commercial |
$95.87
|
| Rate for Payer: Encore All Commercial |
$100.28
|
| Rate for Payer: Frontpath All Commercial |
$100.22
|
| Rate for Payer: Humana ChoiceCare |
$94.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.05
|
| Rate for Payer: PHCS All Commercial |
$81.70
|
| Rate for Payer: PHP All Commercial |
$82.62
|
| Rate for Payer: Sagamore Health Network All Products |
$84.10
|
| Rate for Payer: Signature Care EPO |
$90.42
|
| Rate for Payer: Signature Care PPO |
$95.87
|
| Rate for Payer: United Healthcare Commercial |
$85.84
|
|
|
HC NEEDLE EZIO INTRAOSS PLUS 15MM
|
Facility
IP
|
$998.20
|
|
| Hospital Charge Code |
41601265
|
|
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 |
$618.88
|
| 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 EZIO INTRAOSS PLUS 15MM
|
Facility
OP
|
$998.20
|
|
| Hospital Charge Code |
41601265
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$928.33 |
| Rate for Payer: Aetna Commercial |
$842.48
|
| Rate for Payer: Aetna Medicare |
$329.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$329.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$573.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$623.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$378.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$362.35
|
| Rate for Payer: Cash Price |
$618.88
|
| Rate for Payer: Cash Price |
$618.88
|
| Rate for Payer: Centivo All Commercial |
$509.08
|
| 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 |
$509.08
|
| Rate for Payer: Lucent All Commercial |
$509.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$898.38
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| 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 |
$329.41
|
|
|
HC NEEDLE EZIO INTRAOSS PLUS 25MM
|
Facility
OP
|
$998.20
|
|
| Hospital Charge Code |
41601266
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$928.33 |
| Rate for Payer: Aetna Commercial |
$842.48
|
| Rate for Payer: Aetna Medicare |
$329.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$329.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$573.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$623.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$378.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$362.35
|
| Rate for Payer: Cash Price |
$618.88
|
| Rate for Payer: Cash Price |
$618.88
|
| Rate for Payer: Centivo All Commercial |
$509.08
|
| 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 |
$509.08
|
| Rate for Payer: Lucent All Commercial |
$509.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$898.38
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| 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 |
$329.41
|
|
|
HC NEEDLE EZIO INTRAOSS PLUS 25MM
|
Facility
IP
|
$998.20
|
|
| Hospital Charge Code |
41601266
|
|
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 |
$618.88
|
| 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 EZIO INTRAOSS PLUS 45MM
|
Facility
OP
|
$998.20
|
|
| Hospital Charge Code |
41601267
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$96.84 |
| Max. Negotiated Rate |
$928.33 |
| Rate for Payer: Aetna Commercial |
$842.48
|
| Rate for Payer: Aetna Medicare |
$329.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$329.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$573.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$623.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$378.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$362.35
|
| Rate for Payer: Cash Price |
$618.88
|
| Rate for Payer: Cash Price |
$618.88
|
| Rate for Payer: Centivo All Commercial |
$509.08
|
| 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 |
$509.08
|
| Rate for Payer: Lucent All Commercial |
$509.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$898.38
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| 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 |
$329.41
|
|
|
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 |
$618.88
|
| 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
|
$28.48
|
|
| Hospital Charge Code |
41601079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.36 |
| Max. Negotiated Rate |
$26.49 |
| Rate for Payer: Aetna Commercial |
$24.61
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cigna All Commercial |
$24.58
|
| Rate for Payer: CORVEL All Commercial |
$26.49
|
| Rate for Payer: Coventry All Commercial |
$25.06
|
| Rate for Payer: Encore All Commercial |
$26.22
|
| Rate for Payer: Frontpath All Commercial |
$26.20
|
| Rate for Payer: Humana ChoiceCare |
$24.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.63
|
| Rate for Payer: PHCS All Commercial |
$21.36
|
| Rate for Payer: PHP All Commercial |
$21.60
|
| Rate for Payer: Sagamore Health Network All Products |
$21.99
|
| Rate for Payer: Signature Care EPO |
$23.64
|
| Rate for Payer: Signature Care PPO |
$25.06
|
| Rate for Payer: United Healthcare Commercial |
$22.44
|
|
|
HC NEEDLE HUBER 19G X 3/4 IN
|
Facility
OP
|
$28.48
|
|
| Hospital Charge Code |
41601079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$24.04
|
| Rate for Payer: Aetna Medicare |
$9.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$9.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.34
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Cash Price |
$17.66
|
| Rate for Payer: Centivo All Commercial |
$14.52
|
| Rate for Payer: Cigna All Commercial |
$24.58
|
| Rate for Payer: CORVEL All Commercial |
$26.49
|
| Rate for Payer: Coventry All Commercial |
$25.06
|
| Rate for Payer: Encore All Commercial |
$26.22
|
| Rate for Payer: Frontpath All Commercial |
$26.20
|
| Rate for Payer: Humana ChoiceCare |
$24.60
|
| Rate for Payer: Humana Medicare |
$14.52
|
| Rate for Payer: Lucent All Commercial |
$14.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.63
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$21.36
|
| Rate for Payer: PHP All Commercial |
$21.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$11.11
|
| Rate for Payer: Sagamore Health Network All Products |
$21.99
|
| Rate for Payer: Signature Care EPO |
$23.64
|
| Rate for Payer: Signature Care PPO |
$25.06
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.21
|
| Rate for Payer: United Healthcare Commercial |
$22.44
|
| Rate for Payer: United Healthcare Medicare |
$9.40
|
|
|
HC NEEDLE HUBER 20G X 1 1/4 IN
|
Facility
IP
|
$33.47
|
|
| Hospital Charge Code |
41601080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.10 |
| Max. Negotiated Rate |
$31.13 |
| Rate for Payer: Aetna Commercial |
$28.92
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cigna All Commercial |
$28.88
|
| Rate for Payer: CORVEL All Commercial |
$31.13
|
| Rate for Payer: Coventry All Commercial |
$29.45
|
| Rate for Payer: Encore All Commercial |
$30.81
|
| Rate for Payer: Frontpath All Commercial |
$30.79
|
| Rate for Payer: Humana ChoiceCare |
$28.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.12
|
| Rate for Payer: PHCS All Commercial |
$25.10
|
| Rate for Payer: PHP All Commercial |
$25.38
|
| Rate for Payer: Sagamore Health Network All Products |
$25.84
|
| Rate for Payer: Signature Care EPO |
$27.78
|
| Rate for Payer: Signature Care PPO |
$29.45
|
| Rate for Payer: United Healthcare Commercial |
$26.37
|
|
|
HC NEEDLE HUBER 20G X 1 1/4 IN
|
Facility
OP
|
$33.47
|
|
| Hospital Charge Code |
41601080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.05 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$28.25
|
| Rate for Payer: Aetna Medicare |
$11.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$19.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$20.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$12.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.15
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Cash Price |
$20.75
|
| Rate for Payer: Centivo All Commercial |
$17.07
|
| Rate for Payer: Cigna All Commercial |
$28.88
|
| Rate for Payer: CORVEL All Commercial |
$31.13
|
| Rate for Payer: Coventry All Commercial |
$29.45
|
| Rate for Payer: Encore All Commercial |
$30.81
|
| Rate for Payer: Frontpath All Commercial |
$30.79
|
| Rate for Payer: Humana ChoiceCare |
$28.91
|
| Rate for Payer: Humana Medicare |
$17.07
|
| Rate for Payer: Lucent All Commercial |
$17.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$30.12
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$25.10
|
| Rate for Payer: PHP All Commercial |
$25.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$13.05
|
| Rate for Payer: Sagamore Health Network All Products |
$25.84
|
| Rate for Payer: Signature Care EPO |
$27.78
|
| Rate for Payer: Signature Care PPO |
$29.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$28.45
|
| Rate for Payer: United Healthcare Commercial |
$26.37
|
| Rate for Payer: United Healthcare Medicare |
$11.05
|
|
|
HC NEEDLE INJ BOTOX
|
Facility
IP
|
$1,755.00
|
|
| Hospital Charge Code |
41603282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,316.25 |
| Max. Negotiated Rate |
$1,632.15 |
| Rate for Payer: Aetna Commercial |
$1,516.32
|
| Rate for Payer: Cash Price |
$1,088.10
|
| Rate for Payer: Cigna All Commercial |
$1,514.56
|
| Rate for Payer: CORVEL All Commercial |
$1,632.15
|
| Rate for Payer: Coventry All Commercial |
$1,544.40
|
| Rate for Payer: Encore All Commercial |
$1,615.48
|
| Rate for Payer: Frontpath All Commercial |
$1,614.60
|
| Rate for Payer: Humana ChoiceCare |
$1,515.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,579.50
|
| Rate for Payer: PHCS All Commercial |
$1,316.25
|
| Rate for Payer: PHP All Commercial |
$1,330.99
|
| Rate for Payer: Sagamore Health Network All Products |
$1,354.86
|
| Rate for Payer: Signature Care EPO |
$1,456.65
|
| Rate for Payer: Signature Care PPO |
$1,544.40
|
| Rate for Payer: United Healthcare Commercial |
$1,382.94
|
|
