Northside Anesthesia – https://www.nasllc.org
PRICE TRANSPARENCY
Anesthesia Services
Pathology and Laboratory Services
Quest diagnostics – https://insurance.questdiagnostics.com
Insurance
Ascension Health does all our commercial insurance billing. – https://healthcare.ascension.org
Policy and Protections
The two standard and commercial charges worksheets below display the hospital’s gross charges, discounted cash prices, payer negotiated rates, and minimum and maximum payer negotiated rates. The hospital may have payer negotiated rates for services or service packages that are not included in the hospital’s charge master. If the hospital’s charge master does not include a service or service package, the applicable gross charge and cash charge cells will indicate “N/A.” If a payer does not have a negotiated rate for the applicable service, the applicable cell will indicate “N/A.”
Hospital: Ascension St Vincent Hospital – Indianapolis
EIN: 35-0869066
Last Updated: September 30, 2021
Standard Insurance Charges
(Commercial Insurance Charges in next table)| Code Type | Description | Medicare | Medicare Advantage | Self-Pay (w/o Assistance) | Self-Pay (w/Assistance) | Medicaid | Medicaid Advantage | Healthy Indiana Plan (HIP) |
|---|---|---|---|---|---|---|---|---|
| 19120 | EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $3,141 | $3,161 | $23,286 | $13,971 | $488 | $488 | $503 |
| 29881 | REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOSCOPE | $2,816 | $2,833 | $50,322 | $30,193 | $582 | $582 | $600 |
| 43235 | ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $805 | $810 | $13,031 | $7,818 | $582 | $582 | $600 |
| 43239 | EGD TRANSORAL BIOPSY SINGLE/MULTIPLE | $805 | $810 | $13,236 | $7,941 | $582 | $582 | $600 |
| 45378 | COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | $789 | $794 | $10,892 | $6,535 | $582 | $582 | $600 |
| 45380 | COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE | $1,031 | $1,038 | $13,161 | $7,896 | $800 | $800 | $824 |
| 45385 | COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ | $1,031 | $1,038 | $14,331 | $8,598 | $800 | $800 | $824 |
| 45391 | COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX | $1,031 | $1,038 | $18,778 | $11,266 | $800 | $800 | $824 |
| 47562 | LAPAROSCOPY SURG CHOLECYSTECTOMY | $5,034 | $5,066 | $50,178 | $30,106 | $1,079 | $1,079 | $1,112 |
| 49505 | RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE | $3,167 | $3,187 | $34,527 | $20,716 | $582 | $582 | $600 |
| 55700 | PROSTATE NEEDLE BIOPSY ANY APPROACH | $1,783 | $1,795 | $15,156 | $9,093 | $443 | $443 | $456 |
| 55866 | LAPS PROSTECT RETROPUBIC RAD W/NRV SPARING ROBOT | $8,862 | $8,918 | $62,586 | $37,551 | $6,693 | $6,693 | $6,893 |
| 62322 | NJX INTERLAMINAR LMBR/SAC | $631 | $635 | $35,345 | $21,207 | $488 | $488 | $503 |
| 62323 | NJX INTERLAMINAR LMBR/SAC | $631 | $635 | $62,380 | $37,428 | $488 | $488 | $503 |
| 66984 | CATARACT REMOVAL INSERTION OF LENS | $2,068 | $2,081 | $21,171 | $12,702 | $1,106 | $1,106 | $1,139 |
| 14060 | ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/< | $1,706 | $1,717 | $17,151 | $10,290 | $488 | $488 | $503 |
| 19318 | REDUCTION MAMMAPLASTY | $5,506 | $5,540 | $52,868 | $31,720 | $582 | $582 | $600 |
| 21235 | GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR | $5,060 | $5,092 | $43,954 | $26,372 | $1,014 | $1,014 | $1,045 |
| 21320 | CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION | $2,722 | $2,739 | $10,357 | $6,214 | $443 | $443 | $456 |
| 28285 | CORRECTION HAMMERTOE | $2,816 | $2,833 | $38,942 | $23,365 | $488 | $488 | $503 |
| 28289 | HALLUX RIGIDUS CORRECT W/CHEILECTOMY 1ST MP JT | $2,816 | $2,833 | $28,463 | $17,077 | $2,226 | $2,226 | $2,293 |
| 28297 | CORRJ HALLUX VALGUS W/WO SESMDC LAPIDUS-TYP PX | $6,233 | $6,272 | $78,213 | $46,927 | $3,346 | $3,346 | $3,446 |
| 28740 | ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT | $6,233 | $6,272 | $66,855 | $40,113 | $582 | $582 | $600 |
| 28750 | ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT | $6,233 | $6,272 | $57,696 | $34,617 | $582 | $582 | $600 |
| 30140 | SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL | $2,722 | $2,739 | $26,801 | $16,080 | $443 | $443 | $456 |
| 30420 | RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR | $5,060 | $5,092 | $31,714 | $19,028 | $800 | $800 | $824 |
| 30465 | REPAIR NASAL VESTIBULAR STENOSIS | $5,060 | $5,092 | $31,373 | $18,823 | $488 | $488 | $503 |
| 30520 | SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF | $2,722 | $2,739 | $27,406 | $16,443 | $582 | $582 | $600 |
| 31255 | NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY TOTAL | $5,793 | $5,829 | $36,373 | $21,823 | $800 | $800 | $824 |
| 31267 | NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS | $5,793 | $5,829 | $34,645 | $20,787 | $488 | $488 | $503 |
| 42820 | TONSILLECTOMY & ADENOIDECTOMY | $5,060 | $5,092 | $19,725 | $11,835 | $800 | $800 | $824 |
|
| 42821 | TONSILLECTOMY & ADENOIDECTOMY AGE 12/> | $2,722 | $2,739 | $24,534 | $14,720 | $800 | $800 | $824 |
| 42826 | TONSILLECTOMY ONE-HALF AGE 12/> | $2,722 | $2,739 | $23,900 | $14,340 | $582 | $582 | $600 |
| 42830 | ADENOIDECTOMY PRIMARY | $2,722 | $2,739 | $20,581 | $12,348 | $582 | $582 | $600 |
|
| 43239 | EGD TRANSORAL BIOPSY SINGLE/MULTIPLE | $805 | $810 | $13,236 | $7,941 | $582 | $582 | $600 |
| 45380 | COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE | $1,031 | $1,038 | $13,161 | $7,896 | $800 | $800 | $824 |
| 50590 | LITHOTRIPSY XTRCORP SHOCK WAVE | $3,060 | $3,079 | $41,247 | $24,748 | $2,226 | $2,226 | $2,293 |
| 52281 | CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS | $1,783 | $1,795 | $27,921 | $16,752 | $443 | $443 | $456 |
| 52356 | CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT | $4,391 | $4,419 | $36,019 | $21,611 | $2,226 | $2,226 | $2,293 |
| 55700 | PROSTATE NEEDLE BIOPSY ANY APPROACH | $1,783 | $1,795 | $15,156 | $9,093 | $443 | $443 | $456 |
| 58558 | HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C | $2,610 | $2,626 | $27,405 | $16,443 | $488 | $488 | $503 |
| 69436 | TYMPANOSTOMY GENERAL ANESTHESIA | $1,345 | $1,354 | $,9213 | $5,527 | $488 | $488 | $503 |
| 69620 | MYRINGOPLASTY | $,2722 | $2,739 | $14,775 | $8,865 | $443 | $443 | $456 |
| 69631 | TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ | $5,060 | $5,092 | $30,746 | $18,447 | $800 | $800 | $824 |
Commercial Insurance Charges
(Scroll right in table for more options)| Code Type | Description | Average Gross Charge | Minimum Negotiated Rate | Maximum Negotiated Rate | Aetna | Anthem | Cigna | Humana | Sagamore | Smart Health | United Healthcare | Encore Health Network | Indiana Health Network |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 19120 | EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $23,286 | $11,841 | $20,491 | $14,868 | $11,841 | $17,394 | $17175 | $17,425 | $12,341 | $14,386 | $17,580 | $20,491 |
| 29881 | REMOVAL OF ONE KNEE CARTILAGE USING AN ENDOSCOPE | $50,322 | $25,590 | $44,283 | $32,130 | $25,590 | $37,590 | $37117 | $37,657 | $26,670 | $31,090 | $37,993 | $44,283 |
| 43235 | ESOPHAGOGASTRODUODENOSCOPY TRANSORAL DIAGNOSTIC | $13,031 | $6,626 | $11,467 | $8,320 | $6,626 | $9,734 | $9611 | $9,751 | $6,906 | $8,050 | $9,838 | $11,467 |
| 43239 | EGD TRANSORAL BIOPSY SINGLE/MULTIPLE | $13,236 | $6,730 | $11,647 | $8,451 | $6,730 | $9,887 | $9762 | $9,904 | $7,015 | $8,177 | $9,993 | $11,647 |
| 45378 | COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD | $10,892 | $5,538 | $9,584 | $6,954 | $5,538 | $8,136 | $8033 | $8,150 | $5,772 | $6,729 | $8,223 | $9,584 |
| 45380 | COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE | $13,161 | $6,692 | $11,581 | $8,403 | $6,692 | $9,831 | $9707 | $9,848 | $6,975 | $8,131 | $9,936 | $11,581 |
| 45385 | COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ | $14,331 | $7,287 | $12,611 | $9,150 | $7,287 | $10,705 | $10570 | $10,724 | $7,595 | $8,854 | $10,819 | $12,611 |
| 45391 | COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX | $18,778 | $9,549 | $16,524 | $11,989 | $9,549 | $14,027 | $13850 | $14,052 | $9,952 | $11,601 | $14,177 | $16,524 |
| 47562 | LAPAROSCOPY SURG CHOLECYSTECTOMY | $50,178 | $25,517 | $44,156 | $32,038 | $25,517 | $37,482 | $37011 | $37,549 | $26,594 | $31,001 | $37,884 | $44,156 |
| 49505 | RPR 1ST INGUN HRNA AGE 5 YRS/> REDUCIBLE | $34,527 | $17,558 | $30,383 | $22,045 | $17,558 | $25,791 | $25467 | $25,837 | $18,299 | $21,331 | $26,067 | $30,383 |
| 55700 | PROSTATE NEEDLE BIOPSY ANY APPROACH | $15,156 | $7,707 | $13,337 | $9,677 | $7,707 | $11,321 | $11179 | $11,341 | $8,032 | $9,363 | $11,442 | $13,337 |
| 55866 | LAPS PROSTECT RETROPUBIC RAD W/NRV SPARING ROBOT | $62,586 | $31,827 | $55,075 | $39,961 | $31,827 | $46,751 | $46163 | $46,835 | $33,170 | $38,667 | $47,252 | $55,075 |
| 62322 | NJX INTERLAMINAR LMBR/SAC | $35,345 | $17,974 | $31,103 | $22,567 | $17,974 | $26,402 | $26070 | $26,449 | $18,732 | $21,837 | $26,685 | $31,103 |
| 62323 | NJX INTERLAMINAR LMBR/SAC | $62,380 | $31,722 | $54,894 | $39,829 | $31,722 | $46,597 | $46011 | $46,681 | $33,061 | $38,539 | $47,096 | $54,894 |
| 66984 | CATARACT REMOVAL INSERTION OF LENS | $21,171 | $10,766 | $18,630 | $13,517 | $10,766 | $15,814 | $15615 | $15,842 | $11,220 | $13,079 | $15,984 | $18,630 |
| 14060 | ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/< | $17,151 | $8,721 | $15,092 | $10,950 | $8,721 | $12,811 | $12650 | $12,834 | $9,090 | $10,596 | $12,949 | $15,092 |
| 19318 | REDUCTION MAMMAPLASTY | $52,868 | $26,885 | $46,523 | $33,756 | $26,885 | $39,492 | $38995 | $39,562 | $28,020 | $32,663 | $39,915 | $46,523 |
| 21235 | GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR | $43,954 | $22,352 | $38,679 | $28,064 | $22,352 | $32,833 | $32420 | $32,892 | $23,295 | $27,155 | $33,185 | $38,679 |
| 21320 | CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION | $10,357 | $5,266 | $9,114 | $6,612 | $5,266 | $7,736 | $7639 | $7,750 | $5,489 | $6,398 | $7,819 | $9,114 |
| 28285 | CORRECTION HAMMERTOE | $38,942 | $19,803 | $34,268 | $24,864 | $19,803 | $29,089 | $28723 | $29,141 | $20,639 | $24,059 | $29,401 | $34,268 |
| 28289 | HALLUX RIGIDUS CORRECT W/CHEILECTOMY 1ST MP JT | $28,463 | $14,474 | $25,047 | $18,173 | $14,474 | $21,261 | $20,994 | $21,299 | $15,085 | $17,585 | $21,489 | $25,047 |
| 28297 | CORRJ HALLUX VALGUS W/WO SESMDC LAPIDUS-TYP PX | $78,213 | $39,773 | $68,827 | $49,939 | $39,773 | $58,425 | $57,689 | $58,529 | $41,452 | $48,321 | $59,050 | $68,827 |
| 28740 | ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT | $66,855 | $33,997 | $58,832 | $42,686 | $33,997 | $49,940 | $49,312 | $50,029 | $35,433 | $41,304 | $50,475 | $58,832 |
| 28750 | ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT | $57,696 | $29,340 | $50,772 | $36,838 | $29,340 | $43,098 | $42,556 | $43,175 | $30,578 | $35,646 | $43,560 | $50,772 |
| 30140 | SUBMUCOUS RESCJ INFERIOR TURBINATE PRTL/COMPL | $26,801 | $13,629 | $23,584 | $17,112 | $13,629 | $20,020 | $19,768 | $20,056 | $14,204 | $16,558 | $20,234 | $23,584 |
| 30420 | RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR | $31,714 | $16,127 | $27,908 | $20,249 | $16,127 | $23,690 | $23,392 | $23,732 | $16,808 | $19,593 | $23,944 | $27,908 |
| 30465 | REPAIR NASAL VESTIBULAR STENOSIS | $31,373 | $15,954 | $27,608 | $20,031 | $15,954 | $23,435 | $23,140 | $23,477 | $16,627 | $19,383 | $23,686 | $27,608 |
| 30520 | SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF | $27,406 | $13,936 | $24,117 | $17,498 | $13,936 | $20,472 | $20,214 | $20,508 | $14,525 | $16,932 | $20,691 | $24,117 |
| 31255 | NASAL/SINUS ENDOSCOPY W/ETHMOIDECTOMY TOTAL | $36,373 | $18,496 | $32,008 | $23,224 | $18,496 | $27,170 | $26,828 | $27,219 | $19,277 | $22,472 | $27,461 | $32,008 |
| 31267 | NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS | $34,645 | $17,618 | $30,487 | $22,120 | $17,618 | $25,879 | $25,554 | $25,926 | $18,361 | $21,404 | $26,156 | $30,487 |
| 42820 | TONSILLECTOMY & ADENOIDECTOMY | $19,725 | $10,030 | $17,358 | $12,594 | $10,030 | $14,734 | $14,549 | $14,760 | $10,454 | $12,186 | $14,892 | $17,358 |
|
| 42821 | TONSILLECTOMY & ADENOIDECTOMY AGE 12/> | $24,534 | $12,476 | $21,589 | $15,664 | $12,476 | $18,326 | $18,096 | $18,359 | $13,003 | $15,157 | $18,523 | $21,589 |
| 42826 | TONSILLECTOMY ONE-HALF AGE 12/> | $23,900 | $12,153 | $21,032 | $15,260 | $12,153 | $17,853 | $17,628 | $17,885 | $12,667 | $14,766 | $18,044 | $21,032 |
| 42830 | ADENOIDECTOMY PRIMARY | $20,581 | $10,466 | $18,111 | $13,140 | $10,466 | $15,374 | $15,180 | $15,401 | $10,907 | $12,715 | $15,538 | $18,111 |
|
| 43239 | EGD TRANSORAL BIOPSY SINGLE/MULTIPLE | $13,236 | $6,730 | $11,647 | $8,451 | $6,730 | $9,887 | $9,762 | $9,904 | $7,015 | $8,177 | $9,993 | $11,647 |
| 45380 | COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE | $13,161 | $6,692 | $11,581 | $8,403 | $6,692 | $9,831 | $9,707 | $9,848 | $6,975 | $8,131 | $9,936 | $11,581 |
| 50590 | LITHOTRIPSY XTRCORP SHOCK WAVE | $41,247 | $20,975 | $36,297 | $26,336 | $20,975 | $30,811 | $30,423 | $30,866 | $21,860 | $25,483 | $31,141 | $36,297 |
| 52281 | CYSTO CALIBRATION DILAT URTL STRIX/STENOSIS | $27,921 | $14,198 | $24,570 | $17,827 | $14,198 | $20,856 | $20,594 | $20,894 | $14,798 | $17,250 | $21,080 | $24,570 |
| 52356 | CYSTO/URETERO W/LITHOTRIPSY &INDWELL STENT INSRT | $36,019 | $18,316 | $13,337 | $22,998 | $18,316 | $26,906 | $26,567 | $26,954 | $19,090 | $22,253 | $27,194 | $31,696 |
| 55700 | PROSTATE NEEDLE BIOPSY ANY APPROACH | $15,156 | $7,707 | $13,337 | $9,677 | $7,707 | $11,321 | $11,179 | $11,341 | $8,032 | $9,363 | $11,442 | $13,337 |
| 58558 | HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C | $27,405 | $13,936 | $24,116 | $17,498 | $13,936 | $20,471 | $20,213 | $20,508 | $14,524 | $16,931 | $20,690 | $24,116 |
| 69436 | TYMPANOSTOMY GENERAL ANESTHESIA | $9,213 | $4,685 | $8,107 | $5,882 | $4,685 | $6,882 | $6,795 | $6,894 | $4,882 | $5,692 | $6,955 | $8,107 |
| 69620 | MYRINGOPLASTY | $14,775 | $7,513 | $13,002 | $9,433 | $7,513 | $11,036 | $10,898 | $11,056 | $7,830 | $9,128 | $11,155 | $13,002 |
| 69631 | TYMPANOPLASTY W/O MASTOIDECT W/O OSSICLE RECNSTJ | $30,746 | $15,635 | $27,056 | $19,631 | $15,635 | $22,967 | $22,678 | $23,008 | $16,295 | $18,995 | $23,213 | $27,056 |
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