|
HC NEEDLE SPINAL 22X4 3/4 SPINOCAN 50/CS
|
Facility
OP
|
$22.31
|
|
| Hospital Charge Code |
41601082
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$18.83
|
| Rate for Payer: Aetna Medicare |
$7.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$12.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$13.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.10
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Cash Price |
$13.83
|
| Rate for Payer: Centivo All Commercial |
$11.38
|
| Rate for Payer: Cigna All Commercial |
$19.25
|
| Rate for Payer: CORVEL All Commercial |
$20.75
|
| Rate for Payer: Coventry All Commercial |
$19.63
|
| Rate for Payer: Encore All Commercial |
$20.54
|
| Rate for Payer: Frontpath All Commercial |
$20.53
|
| Rate for Payer: Humana ChoiceCare |
$19.27
|
| Rate for Payer: Humana Medicare |
$11.38
|
| Rate for Payer: Lucent All Commercial |
$11.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.08
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$16.73
|
| Rate for Payer: PHP All Commercial |
$16.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.70
|
| Rate for Payer: Sagamore Health Network All Products |
$17.22
|
| Rate for Payer: Signature Care EPO |
$18.52
|
| Rate for Payer: Signature Care PPO |
$19.63
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.96
|
| Rate for Payer: United Healthcare Commercial |
$17.58
|
| Rate for Payer: United Healthcare Medicare |
$7.36
|
|
|
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 |
$13.83
|
| 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 HAL 25 X 5
|
Facility
OP
|
$85.53
|
|
| Hospital Charge Code |
41603467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.22 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$72.19
|
| Rate for Payer: Aetna Medicare |
$28.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$53.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$31.05
|
| Rate for Payer: Cash Price |
$53.03
|
| Rate for Payer: Cash Price |
$53.03
|
| Rate for Payer: Centivo All Commercial |
$43.62
|
| Rate for Payer: Cigna All Commercial |
$73.81
|
| Rate for Payer: CORVEL All Commercial |
$79.54
|
| Rate for Payer: Coventry All Commercial |
$75.27
|
| Rate for Payer: Encore All Commercial |
$78.73
|
| Rate for Payer: Frontpath All Commercial |
$78.69
|
| Rate for Payer: Humana ChoiceCare |
$73.87
|
| Rate for Payer: Humana Medicare |
$43.62
|
| Rate for Payer: Lucent All Commercial |
$43.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.98
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$64.15
|
| Rate for Payer: PHP All Commercial |
$64.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.36
|
| Rate for Payer: Sagamore Health Network All Products |
$66.03
|
| Rate for Payer: Signature Care EPO |
$70.99
|
| Rate for Payer: Signature Care PPO |
$75.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.70
|
| Rate for Payer: United Healthcare Commercial |
$67.40
|
| Rate for Payer: United Healthcare Medicare |
$28.22
|
|
|
HC NEEDLE SPINAL HAL 25 X 5
|
Facility
IP
|
$85.53
|
|
| Hospital Charge Code |
41603467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.15 |
| Max. Negotiated Rate |
$79.54 |
| Rate for Payer: Aetna Commercial |
$73.90
|
| Rate for Payer: Cash Price |
$53.03
|
| Rate for Payer: Cigna All Commercial |
$73.81
|
| Rate for Payer: CORVEL All Commercial |
$79.54
|
| Rate for Payer: Coventry All Commercial |
$75.27
|
| Rate for Payer: Encore All Commercial |
$78.73
|
| Rate for Payer: Frontpath All Commercial |
$78.69
|
| Rate for Payer: Humana ChoiceCare |
$73.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.98
|
| Rate for Payer: PHCS All Commercial |
$64.15
|
| Rate for Payer: PHP All Commercial |
$64.87
|
| Rate for Payer: Sagamore Health Network All Products |
$66.03
|
| Rate for Payer: Signature Care EPO |
$70.99
|
| Rate for Payer: Signature Care PPO |
$75.27
|
| Rate for Payer: United Healthcare Commercial |
$67.40
|
|
|
HC NEEDLE SPINAL QUIN 20X5 YELLOW
|
Facility
OP
|
$24.47
|
|
| Hospital Charge Code |
41607094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$20.65
|
| Rate for Payer: Aetna Medicare |
$8.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$8.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$14.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.88
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: Centivo All Commercial |
$12.48
|
| Rate for Payer: Cigna All Commercial |
$21.12
|
| Rate for Payer: CORVEL All Commercial |
$22.76
|
| Rate for Payer: Coventry All Commercial |
$21.53
|
| Rate for Payer: Encore All Commercial |
$22.52
|
| Rate for Payer: Frontpath All Commercial |
$22.51
|
| Rate for Payer: Humana ChoiceCare |
$21.13
|
| Rate for Payer: Humana Medicare |
$12.48
|
| Rate for Payer: Lucent All Commercial |
$12.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$18.35
|
| Rate for Payer: PHP All Commercial |
$18.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.54
|
| Rate for Payer: Sagamore Health Network All Products |
$18.89
|
| Rate for Payer: Signature Care EPO |
$20.31
|
| Rate for Payer: Signature Care PPO |
$21.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$20.80
|
| Rate for Payer: United Healthcare Commercial |
$19.28
|
| Rate for Payer: United Healthcare Medicare |
$8.08
|
|
|
HC NEEDLE SPINAL QUIN 20X5 YELLOW
|
Facility
IP
|
$24.47
|
|
| Hospital Charge Code |
41607094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$22.76 |
| Rate for Payer: Aetna Commercial |
$21.14
|
| Rate for Payer: Cash Price |
$15.17
|
| Rate for Payer: Cigna All Commercial |
$21.12
|
| Rate for Payer: CORVEL All Commercial |
$22.76
|
| Rate for Payer: Coventry All Commercial |
$21.53
|
| Rate for Payer: Encore All Commercial |
$22.52
|
| Rate for Payer: Frontpath All Commercial |
$22.51
|
| Rate for Payer: Humana ChoiceCare |
$21.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.02
|
| Rate for Payer: PHCS All Commercial |
$18.35
|
| Rate for Payer: PHP All Commercial |
$18.56
|
| Rate for Payer: Sagamore Health Network All Products |
$18.89
|
| Rate for Payer: Signature Care EPO |
$20.31
|
| Rate for Payer: Signature Care PPO |
$21.53
|
| Rate for Payer: United Healthcare Commercial |
$19.28
|
|
|
HC NEEDLE SPINAL QUINCKE 18 X 3 1/2
|
Facility
OP
|
$16.01
|
|
| Hospital Charge Code |
41601962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$13.51
|
| Rate for Payer: Aetna Medicare |
$5.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.81
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Centivo All Commercial |
$8.17
|
| Rate for Payer: Cigna All Commercial |
$13.82
|
| Rate for Payer: CORVEL All Commercial |
$14.89
|
| Rate for Payer: Coventry All Commercial |
$14.09
|
| Rate for Payer: Encore All Commercial |
$14.74
|
| Rate for Payer: Frontpath All Commercial |
$14.73
|
| Rate for Payer: Humana ChoiceCare |
$13.83
|
| Rate for Payer: Humana Medicare |
$8.17
|
| Rate for Payer: Lucent All Commercial |
$8.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.41
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$12.01
|
| Rate for Payer: PHP All Commercial |
$12.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.24
|
| Rate for Payer: Sagamore Health Network All Products |
$12.36
|
| Rate for Payer: Signature Care EPO |
$13.29
|
| Rate for Payer: Signature Care PPO |
$14.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.61
|
| Rate for Payer: United Healthcare Commercial |
$12.62
|
| Rate for Payer: United Healthcare Medicare |
$5.28
|
|
|
HC NEEDLE SPINAL QUINCKE 18 X 3 1/2
|
Facility
IP
|
$16.01
|
|
| Hospital Charge Code |
41601962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$14.89 |
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Cigna All Commercial |
$13.82
|
| Rate for Payer: CORVEL All Commercial |
$14.89
|
| Rate for Payer: Coventry All Commercial |
$14.09
|
| Rate for Payer: Encore All Commercial |
$14.74
|
| Rate for Payer: Frontpath All Commercial |
$14.73
|
| Rate for Payer: Humana ChoiceCare |
$13.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.41
|
| Rate for Payer: PHCS All Commercial |
$12.01
|
| Rate for Payer: PHP All Commercial |
$12.14
|
| Rate for Payer: Sagamore Health Network All Products |
$12.36
|
| Rate for Payer: Signature Care EPO |
$13.29
|
| Rate for Payer: Signature Care PPO |
$14.09
|
| Rate for Payer: United Healthcare Commercial |
$12.62
|
|
|
HC NEEDLE SPINAL QUINCKE 20 X 3 1/2
|
Facility
OP
|
$16.08
|
|
| Hospital Charge Code |
41601958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$13.57
|
| Rate for Payer: Aetna Medicare |
$5.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.23
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$10.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.84
|
| Rate for Payer: Cash Price |
$9.97
|
| Rate for Payer: Cash Price |
$9.97
|
| Rate for Payer: Centivo All Commercial |
$8.20
|
| Rate for Payer: Cigna All Commercial |
$13.88
|
| Rate for Payer: CORVEL All Commercial |
$14.95
|
| Rate for Payer: Coventry All Commercial |
$14.15
|
| Rate for Payer: Encore All Commercial |
$14.80
|
| Rate for Payer: Frontpath All Commercial |
$14.79
|
| Rate for Payer: Humana ChoiceCare |
$13.89
|
| Rate for Payer: Humana Medicare |
$8.20
|
| Rate for Payer: Lucent All Commercial |
$8.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.47
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$12.06
|
| Rate for Payer: PHP All Commercial |
$12.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.27
|
| Rate for Payer: Sagamore Health Network All Products |
$12.41
|
| Rate for Payer: Signature Care EPO |
$13.35
|
| Rate for Payer: Signature Care PPO |
$14.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.67
|
| Rate for Payer: United Healthcare Commercial |
$12.67
|
| Rate for Payer: United Healthcare Medicare |
$5.31
|
|
|
HC NEEDLE SPINAL QUINCKE 20 X 3 1/2
|
Facility
IP
|
$16.08
|
|
| Hospital Charge Code |
41601958
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.06 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Aetna Commercial |
$13.89
|
| Rate for Payer: Cash Price |
$9.97
|
| Rate for Payer: Cigna All Commercial |
$13.88
|
| Rate for Payer: CORVEL All Commercial |
$14.95
|
| Rate for Payer: Coventry All Commercial |
$14.15
|
| Rate for Payer: Encore All Commercial |
$14.80
|
| Rate for Payer: Frontpath All Commercial |
$14.79
|
| Rate for Payer: Humana ChoiceCare |
$13.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.47
|
| Rate for Payer: PHCS All Commercial |
$12.06
|
| Rate for Payer: PHP All Commercial |
$12.20
|
| Rate for Payer: Sagamore Health Network All Products |
$12.41
|
| Rate for Payer: Signature Care EPO |
$13.35
|
| Rate for Payer: Signature Care PPO |
$14.15
|
| Rate for Payer: United Healthcare Commercial |
$12.67
|
|
|
HC NEEDLE SPINAL QUINCKE 22G X 7 IN
|
Facility
OP
|
$35.41
|
|
| Hospital Charge Code |
41601960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna Medicare |
$11.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.85
|
| Rate for Payer: Cash Price |
$21.95
|
| Rate for Payer: Cash Price |
$21.95
|
| Rate for Payer: Centivo All Commercial |
$18.06
|
| 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 |
$18.06
|
| Rate for Payer: Lucent All Commercial |
$18.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.87
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$11.69
|
|
|
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 |
$21.95
|
| 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
IP
|
$15.50
|
|
| Hospital Charge Code |
41601959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.62 |
| Max. Negotiated Rate |
$14.42 |
| Rate for Payer: Aetna Commercial |
$13.39
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cigna All Commercial |
$13.38
|
| Rate for Payer: CORVEL All Commercial |
$14.42
|
| Rate for Payer: Coventry All Commercial |
$13.64
|
| Rate for Payer: Encore All Commercial |
$14.27
|
| Rate for Payer: Frontpath All Commercial |
$14.26
|
| Rate for Payer: Humana ChoiceCare |
$13.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.95
|
| Rate for Payer: PHCS All Commercial |
$11.62
|
| Rate for Payer: PHP All Commercial |
$11.76
|
| Rate for Payer: Sagamore Health Network All Products |
$11.97
|
| Rate for Payer: Signature Care EPO |
$12.86
|
| Rate for Payer: Signature Care PPO |
$13.64
|
| Rate for Payer: United Healthcare Commercial |
$12.21
|
|
|
HC NEEDLE SPINAL QUINCKE 22 X 3 1/2
|
Facility
OP
|
$15.50
|
|
| Hospital Charge Code |
41601959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.12 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$13.08
|
| Rate for Payer: Aetna Medicare |
$5.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.63
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Centivo All Commercial |
$7.90
|
| Rate for Payer: Cigna All Commercial |
$13.38
|
| Rate for Payer: CORVEL All Commercial |
$14.42
|
| Rate for Payer: Coventry All Commercial |
$13.64
|
| Rate for Payer: Encore All Commercial |
$14.27
|
| Rate for Payer: Frontpath All Commercial |
$14.26
|
| Rate for Payer: Humana ChoiceCare |
$13.39
|
| Rate for Payer: Humana Medicare |
$7.90
|
| Rate for Payer: Lucent All Commercial |
$7.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.95
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.62
|
| Rate for Payer: PHP All Commercial |
$11.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.04
|
| Rate for Payer: Sagamore Health Network All Products |
$11.97
|
| Rate for Payer: Signature Care EPO |
$12.86
|
| Rate for Payer: Signature Care PPO |
$13.64
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.18
|
| Rate for Payer: United Healthcare Commercial |
$12.21
|
| Rate for Payer: United Healthcare Medicare |
$5.12
|
|
|
HC NEEDLE SPINAL QUINCKE 25 X 3 1/2
|
Facility
OP
|
$12.50
|
|
| Hospital Charge Code |
41601961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$10.55
|
| Rate for Payer: Aetna Medicare |
$4.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$7.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$7.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$4.54
|
| Rate for Payer: Cash Price |
$7.75
|
| Rate for Payer: Cash Price |
$7.75
|
| Rate for Payer: Centivo All Commercial |
$6.38
|
| Rate for Payer: Cigna All Commercial |
$10.79
|
| Rate for Payer: CORVEL All Commercial |
$11.62
|
| Rate for Payer: Coventry All Commercial |
$11.00
|
| Rate for Payer: Encore All Commercial |
$11.51
|
| Rate for Payer: Frontpath All Commercial |
$11.50
|
| Rate for Payer: Humana ChoiceCare |
$10.80
|
| Rate for Payer: Humana Medicare |
$6.38
|
| Rate for Payer: Lucent All Commercial |
$6.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.25
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$9.38
|
| Rate for Payer: PHP All Commercial |
$9.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.88
|
| Rate for Payer: Sagamore Health Network All Products |
$9.65
|
| Rate for Payer: Signature Care EPO |
$10.38
|
| Rate for Payer: Signature Care PPO |
$11.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10.62
|
| Rate for Payer: United Healthcare Commercial |
$9.85
|
| Rate for Payer: United Healthcare Medicare |
$4.12
|
|
|
HC NEEDLE SPINAL QUINCKE 25 X 3 1/2
|
Facility
IP
|
$12.50
|
|
| Hospital Charge Code |
41601961
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$11.62 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Cash Price |
$7.75
|
| Rate for Payer: Cigna All Commercial |
$10.79
|
| Rate for Payer: CORVEL All Commercial |
$11.62
|
| Rate for Payer: Coventry All Commercial |
$11.00
|
| Rate for Payer: Encore All Commercial |
$11.51
|
| Rate for Payer: Frontpath All Commercial |
$11.50
|
| Rate for Payer: Humana ChoiceCare |
$10.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$11.25
|
| Rate for Payer: PHCS All Commercial |
$9.38
|
| Rate for Payer: PHP All Commercial |
$9.48
|
| Rate for Payer: Sagamore Health Network All Products |
$9.65
|
| Rate for Payer: Signature Care EPO |
$10.38
|
| Rate for Payer: Signature Care PPO |
$11.00
|
| Rate for Payer: United Healthcare Commercial |
$9.85
|
|
|
HC NEEDLE SPINAL QUINCKE 25 X 4 1
|
Facility
OP
|
$35.41
|
|
| Hospital Charge Code |
41602361
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.69 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$29.89
|
| Rate for Payer: Aetna Medicare |
$11.69
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$11.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$20.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$22.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$12.85
|
| Rate for Payer: Cash Price |
$21.95
|
| Rate for Payer: Cash Price |
$21.95
|
| Rate for Payer: Centivo All Commercial |
$18.06
|
| 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 |
$18.06
|
| Rate for Payer: Lucent All Commercial |
$18.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$31.87
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$11.69
|
|
|
HC NEEDLE SPINAL QUINCKE 25 X 4 1
|
Facility
IP
|
$35.41
|
|
| Hospital Charge Code |
41602361
|
|
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 |
$21.95
|
| 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 SPROTTE 25G X 3 1/2
|
Facility
IP
|
$89.34
|
|
| Hospital Charge Code |
41601450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$83.09 |
| Rate for Payer: Aetna Commercial |
$77.19
|
| Rate for Payer: Cash Price |
$55.39
|
| Rate for Payer: Cigna All Commercial |
$77.10
|
| Rate for Payer: CORVEL All Commercial |
$83.09
|
| Rate for Payer: Coventry All Commercial |
$78.62
|
| Rate for Payer: Encore All Commercial |
$82.24
|
| Rate for Payer: Frontpath All Commercial |
$82.19
|
| Rate for Payer: Humana ChoiceCare |
$77.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.41
|
| Rate for Payer: PHCS All Commercial |
$67.00
|
| Rate for Payer: PHP All Commercial |
$67.76
|
| Rate for Payer: Sagamore Health Network All Products |
$68.97
|
| Rate for Payer: Signature Care EPO |
$74.15
|
| Rate for Payer: Signature Care PPO |
$78.62
|
| Rate for Payer: United Healthcare Commercial |
$70.40
|
|
|
HC NEEDLE SPINAL SPROTTE 25G X 3 1/2
|
Facility
OP
|
$89.34
|
|
| Hospital Charge Code |
41601450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$75.40
|
| Rate for Payer: Aetna Medicare |
$29.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$55.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.43
|
| Rate for Payer: Cash Price |
$55.39
|
| Rate for Payer: Cash Price |
$55.39
|
| Rate for Payer: Centivo All Commercial |
$45.56
|
| Rate for Payer: Cigna All Commercial |
$77.10
|
| Rate for Payer: CORVEL All Commercial |
$83.09
|
| Rate for Payer: Coventry All Commercial |
$78.62
|
| Rate for Payer: Encore All Commercial |
$82.24
|
| Rate for Payer: Frontpath All Commercial |
$82.19
|
| Rate for Payer: Humana ChoiceCare |
$77.16
|
| Rate for Payer: Humana Medicare |
$45.56
|
| Rate for Payer: Lucent All Commercial |
$45.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$80.41
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$67.00
|
| Rate for Payer: PHP All Commercial |
$67.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.84
|
| Rate for Payer: Sagamore Health Network All Products |
$68.97
|
| Rate for Payer: Signature Care EPO |
$74.15
|
| Rate for Payer: Signature Care PPO |
$78.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$75.94
|
| Rate for Payer: United Healthcare Commercial |
$70.40
|
| Rate for Payer: United Healthcare Medicare |
$29.48
|
|
|
HC NEEDLE SPINAL SPROTTE 25G X 4 3/4 IN
|
Facility
IP
|
$132.85
|
|
| Hospital Charge Code |
41601434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.64 |
| Max. Negotiated Rate |
$123.55 |
| Rate for Payer: Aetna Commercial |
$114.78
|
| Rate for Payer: Cash Price |
$82.37
|
| Rate for Payer: Cigna All Commercial |
$114.65
|
| Rate for Payer: CORVEL All Commercial |
$123.55
|
| Rate for Payer: Coventry All Commercial |
$116.91
|
| Rate for Payer: Encore All Commercial |
$122.29
|
| Rate for Payer: Frontpath All Commercial |
$122.22
|
| Rate for Payer: Humana ChoiceCare |
$114.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.56
|
| Rate for Payer: PHCS All Commercial |
$99.64
|
| Rate for Payer: PHP All Commercial |
$100.75
|
| Rate for Payer: Sagamore Health Network All Products |
$102.56
|
| Rate for Payer: Signature Care EPO |
$110.27
|
| Rate for Payer: Signature Care PPO |
$116.91
|
| Rate for Payer: United Healthcare Commercial |
$104.69
|
|
|
HC NEEDLE SPINAL SPROTTE 25G X 4 3/4 IN
|
Facility
OP
|
$132.85
|
|
| Hospital Charge Code |
41601434
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.84 |
| Max. Negotiated Rate |
$123.55 |
| Rate for Payer: Aetna Commercial |
$112.13
|
| Rate for Payer: Aetna Medicare |
$43.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$76.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$83.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.22
|
| Rate for Payer: Cash Price |
$82.37
|
| Rate for Payer: Cash Price |
$82.37
|
| Rate for Payer: Centivo All Commercial |
$67.75
|
| Rate for Payer: Cigna All Commercial |
$114.65
|
| Rate for Payer: CORVEL All Commercial |
$123.55
|
| Rate for Payer: Coventry All Commercial |
$116.91
|
| Rate for Payer: Encore All Commercial |
$122.29
|
| Rate for Payer: Frontpath All Commercial |
$122.22
|
| Rate for Payer: Humana ChoiceCare |
$114.74
|
| Rate for Payer: Humana Medicare |
$67.75
|
| Rate for Payer: Lucent All Commercial |
$67.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.56
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$99.64
|
| Rate for Payer: PHP All Commercial |
$100.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.81
|
| Rate for Payer: Sagamore Health Network All Products |
$102.56
|
| Rate for Payer: Signature Care EPO |
$110.27
|
| Rate for Payer: Signature Care PPO |
$116.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.92
|
| Rate for Payer: United Healthcare Commercial |
$104.69
|
| Rate for Payer: United Healthcare Medicare |
$43.84
|
|
|
HC NEEDLE STIM ULTRA 20G 4 INCH
|
Facility
OP
|
$92.04
|
|
| Hospital Charge Code |
41606633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.37 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$77.68
|
| Rate for Payer: Aetna Medicare |
$30.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$30.37
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$57.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.41
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Cash Price |
$57.07
|
| Rate for Payer: Centivo All Commercial |
$46.94
|
| 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 |
$46.94
|
| Rate for Payer: Lucent All Commercial |
$46.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$82.84
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| 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 |
$30.37
|
|
|
HC NEEDLE STIM ULTRA 20G 4 INCH
|
Facility
IP
|
$92.04
|
|
| Hospital Charge Code |
41606633
|
|
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 |
$57.07
|
| 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: 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 STIM ULTRA 22G 2 INCH
|
Facility
OP
|
$78.91
|
|
| Hospital Charge Code |
41606634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Aetna Medicare |
$26.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$26.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$29.95
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.64
|
| Rate for Payer: Cash Price |
$48.92
|
| Rate for Payer: Cash Price |
$48.92
|
| Rate for Payer: Centivo All Commercial |
$40.24
|
| Rate for Payer: Cigna All Commercial |
$68.10
|
| Rate for Payer: CORVEL All Commercial |
$73.39
|
| Rate for Payer: Coventry All Commercial |
$69.44
|
| Rate for Payer: Encore All Commercial |
$72.64
|
| Rate for Payer: Frontpath All Commercial |
$72.60
|
| Rate for Payer: Humana ChoiceCare |
$68.15
|
| Rate for Payer: Humana Medicare |
$40.24
|
| Rate for Payer: Lucent All Commercial |
$40.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$71.02
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$59.18
|
| Rate for Payer: PHP All Commercial |
$59.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.77
|
| Rate for Payer: Sagamore Health Network All Products |
$60.92
|
| Rate for Payer: Signature Care EPO |
$65.50
|
| Rate for Payer: Signature Care PPO |
$69.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$67.07
|
| Rate for Payer: United Healthcare Commercial |
$62.18
|
| Rate for Payer: United Healthcare Medicare |
$26.04
|
|
