|
HC AR PASSPORT BUTTON 12X4
|
Facility
IP
|
$462.00
|
|
| Hospital Charge Code |
41607022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.50 |
| Max. Negotiated Rate |
$429.66 |
| Rate for Payer: Aetna Commercial |
$399.17
|
| Rate for Payer: Cash Price |
$286.44
|
| Rate for Payer: Cigna All Commercial |
$398.71
|
| Rate for Payer: CORVEL All Commercial |
$429.66
|
| Rate for Payer: Coventry All Commercial |
$406.56
|
| Rate for Payer: Encore All Commercial |
$425.27
|
| Rate for Payer: Frontpath All Commercial |
$425.04
|
| Rate for Payer: Humana ChoiceCare |
$399.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$415.80
|
| Rate for Payer: PHCS All Commercial |
$346.50
|
| Rate for Payer: PHP All Commercial |
$350.38
|
| Rate for Payer: Sagamore Health Network All Products |
$356.66
|
| Rate for Payer: Signature Care EPO |
$383.46
|
| Rate for Payer: Signature Care PPO |
$406.56
|
| Rate for Payer: United Healthcare Commercial |
$364.06
|
|
|
HC AR PASSPORT BUTTON 12X4
|
Facility
OP
|
$462.00
|
|
| Hospital Charge Code |
41607022
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$429.66 |
| Rate for Payer: Aetna Commercial |
$389.93
|
| Rate for Payer: Aetna Medicare |
$152.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$152.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$265.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$288.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.71
|
| Rate for Payer: Cash Price |
$286.44
|
| Rate for Payer: Cash Price |
$286.44
|
| Rate for Payer: Centivo All Commercial |
$235.62
|
| Rate for Payer: Cigna All Commercial |
$398.71
|
| Rate for Payer: CORVEL All Commercial |
$429.66
|
| Rate for Payer: Coventry All Commercial |
$406.56
|
| Rate for Payer: Encore All Commercial |
$425.27
|
| Rate for Payer: Frontpath All Commercial |
$425.04
|
| Rate for Payer: Humana ChoiceCare |
$399.03
|
| Rate for Payer: Humana Medicare |
$235.62
|
| Rate for Payer: Lucent All Commercial |
$235.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$415.80
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$346.50
|
| Rate for Payer: PHP All Commercial |
$350.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$180.18
|
| Rate for Payer: Sagamore Health Network All Products |
$356.66
|
| Rate for Payer: Signature Care EPO |
$383.46
|
| Rate for Payer: Signature Care PPO |
$406.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$392.70
|
| Rate for Payer: United Healthcare Commercial |
$364.06
|
| Rate for Payer: United Healthcare Medicare |
$152.46
|
|
|
HC AR PASSPORT BUTTON 6X3
|
Facility
IP
|
$246.40
|
|
| Hospital Charge Code |
41606548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR PASSPORT BUTTON 6X3
|
Facility
OP
|
$246.40
|
|
| Hospital Charge Code |
41606548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.44
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Centivo All Commercial |
$125.66
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$125.66
|
| Rate for Payer: Lucent All Commercial |
$125.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$81.31
|
|
|
HC AR PASSPORT BUTTON 6X4
|
Facility
OP
|
$246.40
|
|
| Hospital Charge Code |
41606206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.44
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Centivo All Commercial |
$125.66
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$125.66
|
| Rate for Payer: Lucent All Commercial |
$125.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$81.31
|
|
|
HC AR PASSPORT BUTTON 6X4
|
Facility
IP
|
$246.40
|
|
| Hospital Charge Code |
41606206
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR PASSPORT BUTTON 8X3
|
Facility
OP
|
$246.40
|
|
| Hospital Charge Code |
41606124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.44
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Centivo All Commercial |
$125.66
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$125.66
|
| Rate for Payer: Lucent All Commercial |
$125.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$81.31
|
|
|
HC AR PASSPORT BUTTON 8X3
|
Facility
IP
|
$246.40
|
|
| Hospital Charge Code |
41606124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR PASSPORT BUTTON 8X4
|
Facility
IP
|
$246.40
|
|
| Hospital Charge Code |
41606200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR PASSPORT BUTTON 8X4
|
Facility
OP
|
$246.40
|
|
| Hospital Charge Code |
41606200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.44
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Centivo All Commercial |
$125.66
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$125.66
|
| Rate for Payer: Lucent All Commercial |
$125.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$81.31
|
|
|
HC AR PASSPORT BUTTON 8X5
|
Facility
OP
|
$246.40
|
|
| Hospital Charge Code |
41606205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.44
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Centivo All Commercial |
$125.66
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$125.66
|
| Rate for Payer: Lucent All Commercial |
$125.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$81.31
|
|
|
HC AR PASSPORT BUTTON 8X5
|
Facility
IP
|
$246.40
|
|
| Hospital Charge Code |
41606205
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR PASSPORT BUTTTON 8X6
|
Facility
IP
|
$246.40
|
|
| Hospital Charge Code |
41607819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$212.89
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
|
|
HC AR PASSPORT BUTTTON 8X6
|
Facility
OP
|
$246.40
|
|
| Hospital Charge Code |
41607819
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.31 |
| Max. Negotiated Rate |
$229.15 |
| Rate for Payer: Aetna Commercial |
$207.96
|
| Rate for Payer: Aetna Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$141.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$154.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$93.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$89.44
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Cash Price |
$152.77
|
| Rate for Payer: Centivo All Commercial |
$125.66
|
| Rate for Payer: Cigna All Commercial |
$212.64
|
| Rate for Payer: CORVEL All Commercial |
$229.15
|
| Rate for Payer: Coventry All Commercial |
$216.83
|
| Rate for Payer: Encore All Commercial |
$226.81
|
| Rate for Payer: Frontpath All Commercial |
$226.69
|
| Rate for Payer: Humana ChoiceCare |
$212.82
|
| Rate for Payer: Humana Medicare |
$125.66
|
| Rate for Payer: Lucent All Commercial |
$125.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$184.80
|
| Rate for Payer: PHP All Commercial |
$186.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$96.10
|
| Rate for Payer: Sagamore Health Network All Products |
$190.22
|
| Rate for Payer: Signature Care EPO |
$204.51
|
| Rate for Payer: Signature Care PPO |
$216.83
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$209.44
|
| Rate for Payer: United Healthcare Commercial |
$194.16
|
| Rate for Payer: United Healthcare Medicare |
$81.31
|
|
|
HC AR PEEK SWVLK 4.75 W/BL
|
Facility
IP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,227.50 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna Commercial |
$2,566.08
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cigna All Commercial |
$2,563.11
|
| Rate for Payer: CORVEL All Commercial |
$2,762.10
|
| Rate for Payer: Coventry All Commercial |
$2,613.60
|
| Rate for Payer: Encore All Commercial |
$2,733.88
|
| Rate for Payer: Frontpath All Commercial |
$2,732.40
|
| Rate for Payer: Humana ChoiceCare |
$2,565.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,673.00
|
| Rate for Payer: PHCS All Commercial |
$2,227.50
|
| Rate for Payer: PHP All Commercial |
$2,252.45
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.84
|
| Rate for Payer: Signature Care EPO |
$2,465.10
|
| Rate for Payer: Signature Care PPO |
$2,613.60
|
| Rate for Payer: United Healthcare Commercial |
$2,340.36
|
|
|
HC AR PEEK SWVLK 4.75 W/BL
|
Facility
OP
|
$2,970.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608268
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,762.10 |
| Rate for Payer: Aetna Commercial |
$2,506.68
|
| Rate for Payer: Aetna Medicare |
$980.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$980.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,705.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,856.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,127.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,078.11
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Centivo All Commercial |
$1,514.70
|
| Rate for Payer: Cigna All Commercial |
$2,563.11
|
| Rate for Payer: CORVEL All Commercial |
$2,762.10
|
| Rate for Payer: Coventry All Commercial |
$2,613.60
|
| Rate for Payer: Encore All Commercial |
$2,733.88
|
| Rate for Payer: Frontpath All Commercial |
$2,732.40
|
| Rate for Payer: Humana ChoiceCare |
$2,565.19
|
| Rate for Payer: Humana Medicare |
$1,514.70
|
| Rate for Payer: Lucent All Commercial |
$1,514.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,673.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,227.50
|
| Rate for Payer: PHP All Commercial |
$2,252.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,158.30
|
| Rate for Payer: Sagamore Health Network All Products |
$2,292.84
|
| Rate for Payer: Signature Care EPO |
$2,465.10
|
| Rate for Payer: Signature Care PPO |
$2,613.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,524.50
|
| Rate for Payer: United Healthcare Commercial |
$2,340.36
|
| Rate for Payer: United Healthcare Medicare |
$980.10
|
|
|
HC AR PEEK SWVLK SECONDARY FIX
|
Facility
IP
|
$4,352.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,264.30 |
| Max. Negotiated Rate |
$4,047.73 |
| Rate for Payer: Aetna Commercial |
$3,760.47
|
| Rate for Payer: Cash Price |
$2,698.49
|
| Rate for Payer: Cigna All Commercial |
$3,756.12
|
| Rate for Payer: CORVEL All Commercial |
$4,047.73
|
| Rate for Payer: Coventry All Commercial |
$3,830.11
|
| Rate for Payer: Encore All Commercial |
$4,006.38
|
| Rate for Payer: Frontpath All Commercial |
$4,004.21
|
| Rate for Payer: Humana ChoiceCare |
$3,759.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,917.16
|
| Rate for Payer: PHCS All Commercial |
$3,264.30
|
| Rate for Payer: PHP All Commercial |
$3,300.86
|
| Rate for Payer: Sagamore Health Network All Products |
$3,360.05
|
| Rate for Payer: Signature Care EPO |
$3,612.49
|
| Rate for Payer: Signature Care PPO |
$3,830.11
|
| Rate for Payer: United Healthcare Commercial |
$3,429.69
|
|
|
HC AR PEEK SWVLK SECONDARY FIX
|
Facility
OP
|
$4,352.40
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41606573
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,047.73 |
| Rate for Payer: Aetna Commercial |
$3,673.43
|
| Rate for Payer: Aetna Medicare |
$1,436.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,436.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,499.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,720.69
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,651.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,579.92
|
| Rate for Payer: Cash Price |
$2,698.49
|
| Rate for Payer: Cash Price |
$2,698.49
|
| Rate for Payer: Centivo All Commercial |
$2,219.72
|
| Rate for Payer: Cigna All Commercial |
$3,756.12
|
| Rate for Payer: CORVEL All Commercial |
$4,047.73
|
| Rate for Payer: Coventry All Commercial |
$3,830.11
|
| Rate for Payer: Encore All Commercial |
$4,006.38
|
| Rate for Payer: Frontpath All Commercial |
$4,004.21
|
| Rate for Payer: Humana ChoiceCare |
$3,759.17
|
| Rate for Payer: Humana Medicare |
$2,219.72
|
| Rate for Payer: Lucent All Commercial |
$2,219.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,917.16
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,264.30
|
| Rate for Payer: PHP All Commercial |
$3,300.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,697.44
|
| Rate for Payer: Sagamore Health Network All Products |
$3,360.05
|
| Rate for Payer: Signature Care EPO |
$3,612.49
|
| Rate for Payer: Signature Care PPO |
$3,830.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,699.54
|
| Rate for Payer: United Healthcare Commercial |
$3,429.69
|
| Rate for Payer: United Healthcare Medicare |
$1,436.29
|
|
|
HC AR PERC INST KIT 2.9 PUSH LK
|
Facility
IP
|
$1,210.00
|
|
| Hospital Charge Code |
41606210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$907.50 |
| Max. Negotiated Rate |
$1,125.30 |
| Rate for Payer: Aetna Commercial |
$1,045.44
|
| Rate for Payer: Cash Price |
$750.20
|
| Rate for Payer: Cigna All Commercial |
$1,044.23
|
| Rate for Payer: CORVEL All Commercial |
$1,125.30
|
| Rate for Payer: Coventry All Commercial |
$1,064.80
|
| Rate for Payer: Encore All Commercial |
$1,113.80
|
| Rate for Payer: Frontpath All Commercial |
$1,113.20
|
| Rate for Payer: Humana ChoiceCare |
$1,045.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,089.00
|
| Rate for Payer: PHCS All Commercial |
$907.50
|
| Rate for Payer: PHP All Commercial |
$917.66
|
| Rate for Payer: Sagamore Health Network All Products |
$934.12
|
| Rate for Payer: Signature Care EPO |
$1,004.30
|
| Rate for Payer: Signature Care PPO |
$1,064.80
|
| Rate for Payer: United Healthcare Commercial |
$953.48
|
|
|
HC AR PERC INST KIT 2.9 PUSH LK
|
Facility
OP
|
$1,210.00
|
|
| Hospital Charge Code |
41606210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$121.68 |
| Max. Negotiated Rate |
$1,125.30 |
| Rate for Payer: Aetna Commercial |
$1,021.24
|
| Rate for Payer: Aetna Medicare |
$399.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$399.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$694.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$756.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$459.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$439.23
|
| Rate for Payer: Cash Price |
$750.20
|
| Rate for Payer: Cash Price |
$750.20
|
| Rate for Payer: Centivo All Commercial |
$617.10
|
| Rate for Payer: Cigna All Commercial |
$1,044.23
|
| Rate for Payer: CORVEL All Commercial |
$1,125.30
|
| Rate for Payer: Coventry All Commercial |
$1,064.80
|
| Rate for Payer: Encore All Commercial |
$1,113.80
|
| Rate for Payer: Frontpath All Commercial |
$1,113.20
|
| Rate for Payer: Humana ChoiceCare |
$1,045.08
|
| Rate for Payer: Humana Medicare |
$617.10
|
| Rate for Payer: Lucent All Commercial |
$617.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,089.00
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$907.50
|
| Rate for Payer: PHP All Commercial |
$917.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$471.90
|
| Rate for Payer: Sagamore Health Network All Products |
$934.12
|
| Rate for Payer: Signature Care EPO |
$1,004.30
|
| Rate for Payer: Signature Care PPO |
$1,064.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,028.50
|
| Rate for Payer: United Healthcare Commercial |
$953.48
|
| Rate for Payer: United Healthcare Medicare |
$399.30
|
|
|
HC AR PLATE 8H TUB LOCK
|
Facility
IP
|
$2,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,657.50 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Commercial |
$1,909.44
|
| Rate for Payer: Cash Price |
$1,370.20
|
| Rate for Payer: Cigna All Commercial |
$1,907.23
|
| Rate for Payer: CORVEL All Commercial |
$2,055.30
|
| Rate for Payer: Coventry All Commercial |
$1,944.80
|
| Rate for Payer: Encore All Commercial |
$2,034.30
|
| Rate for Payer: Frontpath All Commercial |
$2,033.20
|
| Rate for Payer: Humana ChoiceCare |
$1,908.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,989.00
|
| Rate for Payer: PHCS All Commercial |
$1,657.50
|
| Rate for Payer: PHP All Commercial |
$1,676.06
|
| Rate for Payer: Sagamore Health Network All Products |
$1,706.12
|
| Rate for Payer: Signature Care EPO |
$1,834.30
|
| Rate for Payer: Signature Care PPO |
$1,944.80
|
| Rate for Payer: United Healthcare Commercial |
$1,741.48
|
|
|
HC AR PLATE 8H TUB LOCK
|
Facility
OP
|
$2,210.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608153
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$2,055.30 |
| Rate for Payer: Aetna Commercial |
$1,865.24
|
| Rate for Payer: Aetna Medicare |
$729.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$729.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,269.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,381.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$838.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$802.23
|
| Rate for Payer: Cash Price |
$1,370.20
|
| Rate for Payer: Cash Price |
$1,370.20
|
| Rate for Payer: Centivo All Commercial |
$1,127.10
|
| Rate for Payer: Cigna All Commercial |
$1,907.23
|
| Rate for Payer: CORVEL All Commercial |
$2,055.30
|
| Rate for Payer: Coventry All Commercial |
$1,944.80
|
| Rate for Payer: Encore All Commercial |
$2,034.30
|
| Rate for Payer: Frontpath All Commercial |
$2,033.20
|
| Rate for Payer: Humana ChoiceCare |
$1,908.78
|
| Rate for Payer: Humana Medicare |
$1,127.10
|
| Rate for Payer: Lucent All Commercial |
$1,127.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,989.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,657.50
|
| Rate for Payer: PHP All Commercial |
$1,676.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$861.90
|
| Rate for Payer: Sagamore Health Network All Products |
$1,706.12
|
| Rate for Payer: Signature Care EPO |
$1,834.30
|
| Rate for Payer: Signature Care PPO |
$1,944.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,878.50
|
| Rate for Payer: United Healthcare Commercial |
$1,741.48
|
| Rate for Payer: United Healthcare Medicare |
$729.30
|
|
|
HC AR PLATE DIST FIB 4H LOCK L
|
Facility
OP
|
$3,600.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,348.00 |
| Rate for Payer: Aetna Commercial |
$3,038.40
|
| Rate for Payer: Aetna Medicare |
$1,188.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,188.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,067.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,250.36
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,366.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,306.80
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Centivo All Commercial |
$1,836.00
|
| Rate for Payer: Cigna All Commercial |
$3,106.80
|
| Rate for Payer: CORVEL All Commercial |
$3,348.00
|
| Rate for Payer: Coventry All Commercial |
$3,168.00
|
| Rate for Payer: Encore All Commercial |
$3,313.80
|
| Rate for Payer: Frontpath All Commercial |
$3,312.00
|
| Rate for Payer: Humana ChoiceCare |
$3,109.32
|
| Rate for Payer: Humana Medicare |
$1,836.00
|
| Rate for Payer: Lucent All Commercial |
$1,836.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,240.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,700.00
|
| Rate for Payer: PHP All Commercial |
$2,730.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,404.00
|
| Rate for Payer: Sagamore Health Network All Products |
$2,779.20
|
| Rate for Payer: Signature Care EPO |
$2,988.00
|
| Rate for Payer: Signature Care PPO |
$3,168.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,060.00
|
| Rate for Payer: United Healthcare Commercial |
$2,836.80
|
| Rate for Payer: United Healthcare Medicare |
$1,188.00
|
|
|
HC AR PLATE DIST FIB 4H LOCK L
|
Facility
IP
|
$3,600.00
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,700.00 |
| Max. Negotiated Rate |
$3,348.00 |
| Rate for Payer: Aetna Commercial |
$3,110.40
|
| Rate for Payer: Cash Price |
$2,232.00
|
| Rate for Payer: Cigna All Commercial |
$3,106.80
|
| Rate for Payer: CORVEL All Commercial |
$3,348.00
|
| Rate for Payer: Coventry All Commercial |
$3,168.00
|
| Rate for Payer: Encore All Commercial |
$3,313.80
|
| Rate for Payer: Frontpath All Commercial |
$3,312.00
|
| Rate for Payer: Humana ChoiceCare |
$3,109.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,240.00
|
| Rate for Payer: PHCS All Commercial |
$2,700.00
|
| Rate for Payer: PHP All Commercial |
$2,730.24
|
| Rate for Payer: Sagamore Health Network All Products |
$2,779.20
|
| Rate for Payer: Signature Care EPO |
$2,988.00
|
| Rate for Payer: Signature Care PPO |
$3,168.00
|
| Rate for Payer: United Healthcare Commercial |
$2,836.80
|
|
|
HC AR PLATE DIST FIB 5H LOCK L
|
Facility
IP
|
$4,201.20
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41608307
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,150.90 |
| Max. Negotiated Rate |
$3,907.12 |
| Rate for Payer: Aetna Commercial |
$3,629.84
|
| Rate for Payer: Cash Price |
$2,604.74
|
| Rate for Payer: Cigna All Commercial |
$3,625.64
|
| Rate for Payer: CORVEL All Commercial |
$3,907.12
|
| Rate for Payer: Coventry All Commercial |
$3,697.06
|
| Rate for Payer: Encore All Commercial |
$3,867.20
|
| Rate for Payer: Frontpath All Commercial |
$3,865.10
|
| Rate for Payer: Humana ChoiceCare |
$3,628.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,781.08
|
| Rate for Payer: PHCS All Commercial |
$3,150.90
|
| Rate for Payer: PHP All Commercial |
$3,186.19
|
| Rate for Payer: Sagamore Health Network All Products |
$3,243.33
|
| Rate for Payer: Signature Care EPO |
$3,487.00
|
| Rate for Payer: Signature Care PPO |
$3,697.06
|
| Rate for Payer: United Healthcare Commercial |
$3,310.55
|
|
