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All Charges

Charge Type Setting Price  
Hospital Charge Code 41608403
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608506
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608480
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608390
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608509
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608411
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608447
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608434
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608459
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608500
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608392
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608444
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608397
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608497
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41607805
Hospital Revenue Code 272
Min. Negotiated Rate $1,687.50
Max. Negotiated Rate $2,092.50
Rate for Payer: Aetna Commercial $1,944.00
Rate for Payer: Cash Price $1,395.00
Rate for Payer: Cigna All Commercial $1,941.75
Rate for Payer: CORVEL All Commercial $2,092.50
Rate for Payer: Coventry All Commercial $1,980.00
Rate for Payer: Encore All Commercial $2,071.12
Rate for Payer: Frontpath All Commercial $2,070.00
Rate for Payer: Humana ChoiceCare $1,943.32
Rate for Payer: Lutheran Preferred All Commercial $2,025.00
Rate for Payer: PHCS All Commercial $1,687.50
Rate for Payer: PHP All Commercial $1,706.40
Rate for Payer: Sagamore Health Network All Products $1,737.00
Rate for Payer: Signature Care EPO $1,867.50
Rate for Payer: Signature Care PPO $1,980.00
Rate for Payer: United Healthcare Commercial $1,773.00
Hospital Charge Code 41608421
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608498
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608406
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608512
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608369
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608435
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41606585
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $1,112.28
Rate for Payer: Aetna Commercial $1,009.42
Rate for Payer: Aetna Medicare $394.68
Rate for Payer: Anthem Blue Cross of IN Medicare $394.68
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $686.86
Rate for Payer: Anthem Blue Cross of IN Traditional $747.62
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: CareSource Indiana of IN Just 4 Me $453.88
Rate for Payer: CareSource Indiana of IN Medicare $434.15
Rate for Payer: Cash Price $741.52
Rate for Payer: Cash Price $741.52
Rate for Payer: Centivo All Commercial $609.96
Rate for Payer: Cigna All Commercial $1,032.15
Rate for Payer: CORVEL All Commercial $1,112.28
Rate for Payer: Coventry All Commercial $1,052.48
Rate for Payer: Encore All Commercial $1,100.92
Rate for Payer: Frontpath All Commercial $1,100.32
Rate for Payer: Humana ChoiceCare $1,032.99
Rate for Payer: Humana Medicare $609.96
Rate for Payer: Lucent All Commercial $609.96
Rate for Payer: Lutheran Preferred All Commercial $1,076.40
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Rate for Payer: PHCS All Commercial $897.00
Rate for Payer: PHP All Commercial $907.05
Rate for Payer: Plain Church Group Ministry All Commercial $466.44
Rate for Payer: Sagamore Health Network All Products $923.31
Rate for Payer: Signature Care EPO $992.68
Rate for Payer: Signature Care PPO $1,052.48
Rate for Payer: Three Rivers Preferred All Commercial $1,016.60
Rate for Payer: United Healthcare Commercial $942.45
Rate for Payer: United Healthcare Medicare $394.68
Hospital Charge Code 41608466
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41608492
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $121.68
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Hospital Charge Code 41607805
Hospital Revenue Code 272
Min. Negotiated Rate $121.68
Max. Negotiated Rate $2,092.50
Rate for Payer: Aetna Commercial $1,899.00
Rate for Payer: Aetna Medicare $742.50
Rate for Payer: Anthem Blue Cross of IN Medicare $742.50
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange $1,292.18
Rate for Payer: Anthem Blue Cross of IN Traditional $1,406.48
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise $121.68
Rate for Payer: CareSource Indiana of IN Just 4 Me $853.88
Rate for Payer: CareSource Indiana of IN Medicare $816.75
Rate for Payer: Cash Price $1,395.00
Rate for Payer: Cash Price $1,395.00
Rate for Payer: Centivo All Commercial $1,147.50
Rate for Payer: Cigna All Commercial $1,941.75
Rate for Payer: CORVEL All Commercial $2,092.50
Rate for Payer: Coventry All Commercial $1,980.00
Rate for Payer: Encore All Commercial $2,071.12
Rate for Payer: Frontpath All Commercial $2,070.00
Rate for Payer: Humana ChoiceCare $1,943.32
Rate for Payer: Humana Medicare $1,147.50
Rate for Payer: Lucent All Commercial $1,147.50
Rate for Payer: Lutheran Preferred All Commercial $2,025.00
Rate for Payer: Managed Health Services Medicaid $121.68
Rate for Payer: MDWise Medicaid $121.68
Rate for Payer: PHCS All Commercial $1,687.50
Rate for Payer: PHP All Commercial $1,706.40
Rate for Payer: Plain Church Group Ministry All Commercial $877.50
Rate for Payer: Sagamore Health Network All Products $1,737.00
Rate for Payer: Signature Care EPO $1,867.50
Rate for Payer: Signature Care PPO $1,980.00
Rate for Payer: Three Rivers Preferred All Commercial $1,912.50
Rate for Payer: United Healthcare Commercial $1,773.00
Rate for Payer: United Healthcare Medicare $742.50