|
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
|
|
|
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 |
$309.77
|
| 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 |
$121.68 |
| Max. Negotiated Rate |
$464.66 |
| Rate for Payer: Aetna Commercial |
$421.69
|
| Rate for Payer: Aetna Medicare |
$164.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$164.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$286.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$312.32
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$189.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$181.37
|
| Rate for Payer: Cash Price |
$309.77
|
| Rate for Payer: Cash Price |
$309.77
|
| Rate for Payer: Centivo All Commercial |
$254.81
|
| 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 |
$254.81
|
| Rate for Payer: Lucent All Commercial |
$254.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$449.67
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$164.88
|
|
|
HC NEEDLE INSUFFLATION S1000000
|
Facility
OP
|
$103.21
|
|
| Hospital Charge Code |
41601957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$87.11
|
| Rate for Payer: Aetna Medicare |
$34.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$64.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.47
|
| Rate for Payer: Cash Price |
$63.99
|
| Rate for Payer: Cash Price |
$63.99
|
| Rate for Payer: Centivo All Commercial |
$52.64
|
| Rate for Payer: Cigna All Commercial |
$89.07
|
| Rate for Payer: CORVEL All Commercial |
$95.99
|
| Rate for Payer: Coventry All Commercial |
$90.82
|
| Rate for Payer: Encore All Commercial |
$95.00
|
| Rate for Payer: Frontpath All Commercial |
$94.95
|
| Rate for Payer: Humana ChoiceCare |
$89.14
|
| Rate for Payer: Humana Medicare |
$52.64
|
| Rate for Payer: Lucent All Commercial |
$52.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.89
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$77.41
|
| Rate for Payer: PHP All Commercial |
$78.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.25
|
| Rate for Payer: Sagamore Health Network All Products |
$79.68
|
| Rate for Payer: Signature Care EPO |
$85.66
|
| Rate for Payer: Signature Care PPO |
$90.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$87.73
|
| Rate for Payer: United Healthcare Commercial |
$81.33
|
| Rate for Payer: United Healthcare Medicare |
$34.06
|
|
|
HC NEEDLE INSUFFLATION S1000000
|
Facility
IP
|
$103.21
|
|
| Hospital Charge Code |
41601957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.41 |
| Max. Negotiated Rate |
$95.99 |
| Rate for Payer: Aetna Commercial |
$89.17
|
| Rate for Payer: Cash Price |
$63.99
|
| Rate for Payer: Cigna All Commercial |
$89.07
|
| Rate for Payer: CORVEL All Commercial |
$95.99
|
| Rate for Payer: Coventry All Commercial |
$90.82
|
| Rate for Payer: Encore All Commercial |
$95.00
|
| Rate for Payer: Frontpath All Commercial |
$94.95
|
| Rate for Payer: Humana ChoiceCare |
$89.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$92.89
|
| Rate for Payer: PHCS All Commercial |
$77.41
|
| Rate for Payer: PHP All Commercial |
$78.27
|
| Rate for Payer: Sagamore Health Network All Products |
$79.68
|
| Rate for Payer: Signature Care EPO |
$85.66
|
| Rate for Payer: Signature Care PPO |
$90.82
|
| Rate for Payer: United Healthcare Commercial |
$81.33
|
|
|
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 |
$107.20
|
| 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 |
$57.06 |
| Max. Negotiated Rate |
$160.80 |
| Rate for Payer: Aetna Commercial |
$145.93
|
| Rate for Payer: Aetna Medicare |
$57.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.76
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Centivo All Commercial |
$88.18
|
| 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 |
$88.18
|
| Rate for Payer: Lucent All Commercial |
$88.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.61
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$146.96
|
| Rate for Payer: United Healthcare Commercial |
$136.25
|
| Rate for Payer: United Healthcare Medicare |
$57.06
|
|
|
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 |
$107.20
|
| 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 |
$57.06 |
| Max. Negotiated Rate |
$160.80 |
| Rate for Payer: Aetna Commercial |
$145.93
|
| Rate for Payer: Aetna Medicare |
$57.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$57.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$99.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$108.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$65.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$62.76
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Centivo All Commercial |
$88.18
|
| 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 |
$88.18
|
| Rate for Payer: Lucent All Commercial |
$88.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$155.61
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$146.96
|
| Rate for Payer: United Healthcare Commercial |
$136.25
|
| Rate for Payer: United Healthcare Medicare |
$57.06
|
|
|
HC NEEDLE KOPANS BREAST LESION 20G 9CM
|
Facility
OP
|
$229.04
|
|
| Hospital Charge Code |
41601826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.58 |
| Max. Negotiated Rate |
$213.01 |
| Rate for Payer: Aetna Commercial |
$193.31
|
| Rate for Payer: Aetna Medicare |
$75.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$75.58
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$131.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$86.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.14
|
| Rate for Payer: Cash Price |
$142.01
|
| Rate for Payer: Cash Price |
$142.01
|
| Rate for Payer: Centivo All Commercial |
$116.81
|
| Rate for Payer: Cigna All Commercial |
$197.66
|
| Rate for Payer: CORVEL All Commercial |
$213.01
|
| Rate for Payer: Coventry All Commercial |
$201.56
|
| Rate for Payer: Encore All Commercial |
$210.83
|
| Rate for Payer: Frontpath All Commercial |
$210.72
|
| Rate for Payer: Humana ChoiceCare |
$197.82
|
| Rate for Payer: Humana Medicare |
$116.81
|
| Rate for Payer: Lucent All Commercial |
$116.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.14
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$171.78
|
| Rate for Payer: PHP All Commercial |
$173.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.33
|
| Rate for Payer: Sagamore Health Network All Products |
$176.82
|
| Rate for Payer: Signature Care EPO |
$190.10
|
| Rate for Payer: Signature Care PPO |
$201.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$194.68
|
| Rate for Payer: United Healthcare Commercial |
$180.48
|
| Rate for Payer: United Healthcare Medicare |
$75.58
|
|
|
HC NEEDLE KOPANS BREAST LESION 20G 9CM
|
Facility
IP
|
$229.04
|
|
| Hospital Charge Code |
41601826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.78 |
| Max. Negotiated Rate |
$213.01 |
| Rate for Payer: Aetna Commercial |
$197.89
|
| Rate for Payer: Cash Price |
$142.01
|
| Rate for Payer: Cigna All Commercial |
$197.66
|
| Rate for Payer: CORVEL All Commercial |
$213.01
|
| Rate for Payer: Coventry All Commercial |
$201.56
|
| Rate for Payer: Encore All Commercial |
$210.83
|
| Rate for Payer: Frontpath All Commercial |
$210.72
|
| Rate for Payer: Humana ChoiceCare |
$197.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$206.14
|
| Rate for Payer: PHCS All Commercial |
$171.78
|
| Rate for Payer: PHP All Commercial |
$173.70
|
| Rate for Payer: Sagamore Health Network All Products |
$176.82
|
| Rate for Payer: Signature Care EPO |
$190.10
|
| Rate for Payer: Signature Care PPO |
$201.56
|
| Rate for Payer: United Healthcare Commercial |
$180.48
|
|
|
HC NEEDLE LOCALIZATION BY XRAY ARTHROGRAM
|
Facility
IP
|
$383.67
|
|
|
Service Code
|
CPT 77002 59
|
| Hospital Charge Code |
01610259
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$287.75 |
| Max. Negotiated Rate |
$356.82 |
| Rate for Payer: Aetna Commercial |
$331.49
|
| Rate for Payer: Cash Price |
$237.88
|
| Rate for Payer: Cigna All Commercial |
$331.11
|
| Rate for Payer: CORVEL All Commercial |
$356.82
|
| Rate for Payer: Coventry All Commercial |
$337.63
|
| Rate for Payer: Encore All Commercial |
$353.17
|
| Rate for Payer: Frontpath All Commercial |
$352.98
|
| Rate for Payer: Humana ChoiceCare |
$331.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$345.31
|
| Rate for Payer: PHCS All Commercial |
$287.75
|
| Rate for Payer: PHP All Commercial |
$290.98
|
| Rate for Payer: Sagamore Health Network All Products |
$296.20
|
| Rate for Payer: Signature Care EPO |
$318.45
|
| Rate for Payer: Signature Care PPO |
$337.63
|
| Rate for Payer: United Healthcare Commercial |
$302.33
|
|
|
HC NEEDLE LOCALIZATION BY XRAY ARTHROGRAM
|
Facility
OP
|
$383.67
|
|
|
Service Code
|
CPT 77002 59
|
| Hospital Charge Code |
01610259
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.61 |
| Max. Negotiated Rate |
$356.82 |
| Rate for Payer: Aetna Commercial |
$323.82
|
| Rate for Payer: Aetna Medicare |
$126.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$220.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$239.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.27
|
| Rate for Payer: Cash Price |
$237.88
|
| Rate for Payer: Centivo All Commercial |
$195.67
|
| Rate for Payer: Cigna All Commercial |
$331.11
|
| Rate for Payer: CORVEL All Commercial |
$356.82
|
| Rate for Payer: Coventry All Commercial |
$337.63
|
| Rate for Payer: Encore All Commercial |
$353.17
|
| Rate for Payer: Frontpath All Commercial |
$352.98
|
| Rate for Payer: Humana ChoiceCare |
$331.38
|
| Rate for Payer: Humana Medicare |
$195.67
|
| Rate for Payer: Lucent All Commercial |
$195.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$345.31
|
| Rate for Payer: PHCS All Commercial |
$287.75
|
| Rate for Payer: PHP All Commercial |
$290.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.63
|
| Rate for Payer: Sagamore Health Network All Products |
$296.20
|
| Rate for Payer: Signature Care EPO |
$318.45
|
| Rate for Payer: Signature Care PPO |
$337.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$326.12
|
| Rate for Payer: United Healthcare Commercial |
$302.33
|
| Rate for Payer: United Healthcare Medicare |
$126.61
|
|
|
HC NEEDLE MAMMALOK ULTRA 20GX10CM
|
Facility
OP
|
$238.00
|
|
| Hospital Charge Code |
41606146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.54 |
| Max. Negotiated Rate |
$221.34 |
| Rate for Payer: Aetna Commercial |
$200.87
|
| Rate for Payer: Aetna Medicare |
$78.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$136.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.39
|
| Rate for Payer: Cash Price |
$147.56
|
| Rate for Payer: Cash Price |
$147.56
|
| Rate for Payer: Centivo All Commercial |
$121.38
|
| 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 |
$121.38
|
| Rate for Payer: Lucent All Commercial |
$121.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$214.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$78.54
|
|
|
HC NEEDLE MAMMALOK ULTRA 20GX10CM
|
Facility
IP
|
$238.00
|
|
| Hospital Charge Code |
41606146
|
|
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 |
$147.56
|
| 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 MAMMALOK ULTRA 20GX5CM
|
Facility
IP
|
$238.00
|
|
| Hospital Charge Code |
41601857
|
|
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 |
$147.56
|
| 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 MAMMALOK ULTRA 20GX5CM
|
Facility
OP
|
$238.00
|
|
| Hospital Charge Code |
41601857
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.54 |
| Max. Negotiated Rate |
$221.34 |
| Rate for Payer: Aetna Commercial |
$200.87
|
| Rate for Payer: Aetna Medicare |
$78.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$136.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.39
|
| Rate for Payer: Cash Price |
$147.56
|
| Rate for Payer: Cash Price |
$147.56
|
| Rate for Payer: Centivo All Commercial |
$121.38
|
| 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 |
$121.38
|
| Rate for Payer: Lucent All Commercial |
$121.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$214.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$78.54
|
|
|
HC NEEDLE MAMMALOK ULTRA 20GX7.5CM
|
Facility
OP
|
$238.00
|
|
| Hospital Charge Code |
41601858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$78.54 |
| Max. Negotiated Rate |
$221.34 |
| Rate for Payer: Aetna Commercial |
$200.87
|
| Rate for Payer: Aetna Medicare |
$78.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$78.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$136.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$148.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$90.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$86.39
|
| Rate for Payer: Cash Price |
$147.56
|
| Rate for Payer: Cash Price |
$147.56
|
| Rate for Payer: Centivo All Commercial |
$121.38
|
| 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 |
$121.38
|
| Rate for Payer: Lucent All Commercial |
$121.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$214.20
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$78.54
|
|
|
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 |
$147.56
|
| 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 SPINAL 22G X 1 1/2 IN
|
Facility
IP
|
$11.06
|
|
| Hospital Charge Code |
41601081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$10.29 |
| Rate for Payer: Aetna Commercial |
$9.56
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cigna All Commercial |
$9.54
|
| Rate for Payer: CORVEL All Commercial |
$10.29
|
| Rate for Payer: Coventry All Commercial |
$9.73
|
| Rate for Payer: Encore All Commercial |
$10.18
|
| Rate for Payer: Frontpath All Commercial |
$10.18
|
| Rate for Payer: Humana ChoiceCare |
$9.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.95
|
| Rate for Payer: PHCS All Commercial |
$8.30
|
| Rate for Payer: PHP All Commercial |
$8.39
|
| Rate for Payer: Sagamore Health Network All Products |
$8.54
|
| Rate for Payer: Signature Care EPO |
$9.18
|
| Rate for Payer: Signature Care PPO |
$9.73
|
| Rate for Payer: United Healthcare Commercial |
$8.72
|
|
|
HC NEEDLE SPINAL 22G X 1 1/2 IN
|
Facility
OP
|
$11.06
|
|
| Hospital Charge Code |
41601081
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$3.65 |
| Max. Negotiated Rate |
$96.84 |
| Rate for Payer: Aetna Commercial |
$9.33
|
| Rate for Payer: Aetna Medicare |
$3.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$96.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.01
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Cash Price |
$6.86
|
| Rate for Payer: Centivo All Commercial |
$5.64
|
| Rate for Payer: Cigna All Commercial |
$9.54
|
| Rate for Payer: CORVEL All Commercial |
$10.29
|
| Rate for Payer: Coventry All Commercial |
$9.73
|
| Rate for Payer: Encore All Commercial |
$10.18
|
| Rate for Payer: Frontpath All Commercial |
$10.18
|
| Rate for Payer: Humana ChoiceCare |
$9.55
|
| Rate for Payer: Humana Medicare |
$5.64
|
| Rate for Payer: Lucent All Commercial |
$5.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.95
|
| Rate for Payer: Managed Health Services Medicaid |
$96.84
|
| Rate for Payer: MDWise Medicaid |
$96.84
|
| Rate for Payer: PHCS All Commercial |
$8.30
|
| Rate for Payer: PHP All Commercial |
$8.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.31
|
| Rate for Payer: Sagamore Health Network All Products |
$8.54
|
| Rate for Payer: Signature Care EPO |
$9.18
|
| Rate for Payer: Signature Care PPO |
$9.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.40
|
| Rate for Payer: United Healthcare Commercial |
$8.72
|
| Rate for Payer: United Healthcare Medicare |
$3.65
|
|
|
HC NEEDLE SPINAL 22G X 5IN
|
Facility
OP
|
$434.00
|
|
| Hospital Charge Code |
41608355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$403.62 |
| Rate for Payer: Aetna Commercial |
$366.30
|
| Rate for Payer: Aetna Medicare |
$143.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$143.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$249.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$271.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$164.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$157.54
|
| Rate for Payer: Cash Price |
$269.08
|
| Rate for Payer: Cash Price |
$269.08
|
| Rate for Payer: Centivo All Commercial |
$221.34
|
| Rate for Payer: Cigna All Commercial |
$374.54
|
| Rate for Payer: CORVEL All Commercial |
$403.62
|
| Rate for Payer: Coventry All Commercial |
$381.92
|
| Rate for Payer: Encore All Commercial |
$399.50
|
| Rate for Payer: Frontpath All Commercial |
$399.28
|
| Rate for Payer: Humana ChoiceCare |
$374.85
|
| Rate for Payer: Humana Medicare |
$221.34
|
| Rate for Payer: Lucent All Commercial |
$221.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$390.60
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$325.50
|
| Rate for Payer: PHP All Commercial |
$329.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$169.26
|
| Rate for Payer: Sagamore Health Network All Products |
$335.05
|
| Rate for Payer: Signature Care EPO |
$360.22
|
| Rate for Payer: Signature Care PPO |
$381.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$368.90
|
| Rate for Payer: United Healthcare Commercial |
$341.99
|
| Rate for Payer: United Healthcare Medicare |
$143.22
|
|
|
HC NEEDLE SPINAL 22G X 5IN
|
Facility
IP
|
$434.00
|
|
| Hospital Charge Code |
41608355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.50 |
| Max. Negotiated Rate |
$403.62 |
| Rate for Payer: Aetna Commercial |
$374.98
|
| Rate for Payer: Cash Price |
$269.08
|
| Rate for Payer: Cigna All Commercial |
$374.54
|
| Rate for Payer: CORVEL All Commercial |
$403.62
|
| Rate for Payer: Coventry All Commercial |
$381.92
|
| Rate for Payer: Encore All Commercial |
$399.50
|
| Rate for Payer: Frontpath All Commercial |
$399.28
|
| Rate for Payer: Humana ChoiceCare |
$374.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$390.60
|
| Rate for Payer: PHCS All Commercial |
$325.50
|
| Rate for Payer: PHP All Commercial |
$329.15
|
| Rate for Payer: Sagamore Health Network All Products |
$335.05
|
| Rate for Payer: Signature Care EPO |
$360.22
|
| Rate for Payer: Signature Care PPO |
$381.92
|
| Rate for Payer: United Healthcare Commercial |
$341.99
|
|
|
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 |
$64.75
|
| 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 22G X 5 IN GERTIE MARX
|
Facility
OP
|
$104.43
|
|
| Hospital Charge Code |
41601451
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.46 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$88.14
|
| Rate for Payer: Aetna Medicare |
$34.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$59.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.91
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Cash Price |
$64.75
|
| Rate for Payer: Centivo All Commercial |
$53.26
|
| 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 |
$53.26
|
| Rate for Payer: Lucent All Commercial |
$53.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$93.99
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$34.46
|
|
