|
HC OR GENERAL LEVEL 2 INIT'L 15 MIN
|
Facility
IP
|
$2,259.87
|
|
| Hospital Charge Code |
01206652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,694.90 |
| Max. Negotiated Rate |
$2,101.68 |
| Rate for Payer: Aetna Commercial |
$1,952.53
|
| Rate for Payer: Cash Price |
$1,401.12
|
| Rate for Payer: Cigna All Commercial |
$1,950.27
|
| Rate for Payer: CORVEL All Commercial |
$2,101.68
|
| Rate for Payer: Coventry All Commercial |
$1,988.69
|
| Rate for Payer: Encore All Commercial |
$2,080.21
|
| Rate for Payer: Frontpath All Commercial |
$2,079.08
|
| Rate for Payer: Humana ChoiceCare |
$1,951.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,033.88
|
| Rate for Payer: PHCS All Commercial |
$1,694.90
|
| Rate for Payer: PHP All Commercial |
$1,713.89
|
| Rate for Payer: Sagamore Health Network All Products |
$1,744.62
|
| Rate for Payer: Signature Care EPO |
$1,875.69
|
| Rate for Payer: Signature Care PPO |
$1,988.69
|
| Rate for Payer: United Healthcare Commercial |
$1,780.78
|
|
|
HC OR GENERAL LEVEL 2 INIT'L 15 MIN
|
Facility
OP
|
$2,259.87
|
|
| Hospital Charge Code |
01206652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$745.76 |
| Max. Negotiated Rate |
$2,101.68 |
| Rate for Payer: Aetna Commercial |
$1,907.33
|
| Rate for Payer: Aetna Medicare |
$745.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$745.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,297.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,412.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$857.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$820.33
|
| Rate for Payer: Cash Price |
$1,401.12
|
| Rate for Payer: Centivo All Commercial |
$1,152.53
|
| Rate for Payer: Cigna All Commercial |
$1,950.27
|
| Rate for Payer: CORVEL All Commercial |
$2,101.68
|
| Rate for Payer: Coventry All Commercial |
$1,988.69
|
| Rate for Payer: Encore All Commercial |
$2,080.21
|
| Rate for Payer: Frontpath All Commercial |
$2,079.08
|
| Rate for Payer: Humana ChoiceCare |
$1,951.85
|
| Rate for Payer: Humana Medicare |
$1,152.53
|
| Rate for Payer: Lucent All Commercial |
$1,152.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,033.88
|
| Rate for Payer: PHCS All Commercial |
$1,694.90
|
| Rate for Payer: PHP All Commercial |
$1,713.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$881.35
|
| Rate for Payer: Sagamore Health Network All Products |
$1,744.62
|
| Rate for Payer: Signature Care EPO |
$1,875.69
|
| Rate for Payer: Signature Care PPO |
$1,988.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,920.89
|
| Rate for Payer: United Healthcare Commercial |
$1,780.78
|
| Rate for Payer: United Healthcare Medicare |
$745.76
|
|
|
HC OR GENERAL LEVEL 3 INIT'L 15 MIN
|
Facility
OP
|
$2,542.32
|
|
| Hospital Charge Code |
01206654
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$838.97 |
| Max. Negotiated Rate |
$2,364.36 |
| Rate for Payer: Aetna Commercial |
$2,145.72
|
| Rate for Payer: Aetna Medicare |
$838.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$838.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,460.05
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,589.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$964.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$922.86
|
| Rate for Payer: Cash Price |
$1,576.24
|
| Rate for Payer: Centivo All Commercial |
$1,296.58
|
| Rate for Payer: Cigna All Commercial |
$2,194.02
|
| Rate for Payer: CORVEL All Commercial |
$2,364.36
|
| Rate for Payer: Coventry All Commercial |
$2,237.24
|
| Rate for Payer: Encore All Commercial |
$2,340.21
|
| Rate for Payer: Frontpath All Commercial |
$2,338.93
|
| Rate for Payer: Humana ChoiceCare |
$2,195.80
|
| Rate for Payer: Humana Medicare |
$1,296.58
|
| Rate for Payer: Lucent All Commercial |
$1,296.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,288.09
|
| Rate for Payer: PHCS All Commercial |
$1,906.74
|
| Rate for Payer: PHP All Commercial |
$1,928.10
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$991.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,962.67
|
| Rate for Payer: Signature Care EPO |
$2,110.13
|
| Rate for Payer: Signature Care PPO |
$2,237.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,160.97
|
| Rate for Payer: United Healthcare Commercial |
$2,003.35
|
| Rate for Payer: United Healthcare Medicare |
$838.97
|
|
|
HC OR GENERAL LEVEL 3 INIT'L 15 MIN
|
Facility
IP
|
$2,542.32
|
|
| Hospital Charge Code |
01206654
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,906.74 |
| Max. Negotiated Rate |
$2,364.36 |
| Rate for Payer: Aetna Commercial |
$2,196.56
|
| Rate for Payer: Cash Price |
$1,576.24
|
| Rate for Payer: Cigna All Commercial |
$2,194.02
|
| Rate for Payer: CORVEL All Commercial |
$2,364.36
|
| Rate for Payer: Coventry All Commercial |
$2,237.24
|
| Rate for Payer: Encore All Commercial |
$2,340.21
|
| Rate for Payer: Frontpath All Commercial |
$2,338.93
|
| Rate for Payer: Humana ChoiceCare |
$2,195.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,288.09
|
| Rate for Payer: PHCS All Commercial |
$1,906.74
|
| Rate for Payer: PHP All Commercial |
$1,928.10
|
| Rate for Payer: Sagamore Health Network All Products |
$1,962.67
|
| Rate for Payer: Signature Care EPO |
$2,110.13
|
| Rate for Payer: Signature Care PPO |
$2,237.24
|
| Rate for Payer: United Healthcare Commercial |
$2,003.35
|
|
|
HC OR GENERAL LEVEL 4 INIT'L 15 MIN
|
Facility
OP
|
$2,824.82
|
|
| Hospital Charge Code |
01206662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$932.19 |
| Max. Negotiated Rate |
$2,627.08 |
| Rate for Payer: Aetna Commercial |
$2,384.15
|
| Rate for Payer: Aetna Medicare |
$932.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$932.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,622.29
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,765.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,072.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,025.41
|
| Rate for Payer: Cash Price |
$1,751.39
|
| Rate for Payer: Centivo All Commercial |
$1,440.66
|
| Rate for Payer: Cigna All Commercial |
$2,437.82
|
| Rate for Payer: CORVEL All Commercial |
$2,627.08
|
| Rate for Payer: Coventry All Commercial |
$2,485.84
|
| Rate for Payer: Encore All Commercial |
$2,600.25
|
| Rate for Payer: Frontpath All Commercial |
$2,598.83
|
| Rate for Payer: Humana ChoiceCare |
$2,439.80
|
| Rate for Payer: Humana Medicare |
$1,440.66
|
| Rate for Payer: Lucent All Commercial |
$1,440.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,542.34
|
| Rate for Payer: PHCS All Commercial |
$2,118.61
|
| Rate for Payer: PHP All Commercial |
$2,142.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,101.68
|
| Rate for Payer: Sagamore Health Network All Products |
$2,180.76
|
| Rate for Payer: Signature Care EPO |
$2,344.60
|
| Rate for Payer: Signature Care PPO |
$2,485.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,401.10
|
| Rate for Payer: United Healthcare Commercial |
$2,225.96
|
| Rate for Payer: United Healthcare Medicare |
$932.19
|
|
|
HC OR GENERAL LEVEL 4 INIT'L 15 MIN
|
Facility
IP
|
$2,824.82
|
|
| Hospital Charge Code |
01206662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,118.61 |
| Max. Negotiated Rate |
$2,627.08 |
| Rate for Payer: Aetna Commercial |
$2,440.64
|
| Rate for Payer: Cash Price |
$1,751.39
|
| Rate for Payer: Cigna All Commercial |
$2,437.82
|
| Rate for Payer: CORVEL All Commercial |
$2,627.08
|
| Rate for Payer: Coventry All Commercial |
$2,485.84
|
| Rate for Payer: Encore All Commercial |
$2,600.25
|
| Rate for Payer: Frontpath All Commercial |
$2,598.83
|
| Rate for Payer: Humana ChoiceCare |
$2,439.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,542.34
|
| Rate for Payer: PHCS All Commercial |
$2,118.61
|
| Rate for Payer: PHP All Commercial |
$2,142.34
|
| Rate for Payer: Sagamore Health Network All Products |
$2,180.76
|
| Rate for Payer: Signature Care EPO |
$2,344.60
|
| Rate for Payer: Signature Care PPO |
$2,485.84
|
| Rate for Payer: United Healthcare Commercial |
$2,225.96
|
|
|
HC OR GENERAL LVL 1 EA ADD MIN
|
Facility
OP
|
$70.60
|
|
| Hospital Charge Code |
01206651
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$23.30 |
| Max. Negotiated Rate |
$65.66 |
| Rate for Payer: Aetna Commercial |
$59.59
|
| Rate for Payer: Aetna Medicare |
$23.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$23.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$40.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$44.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.63
|
| Rate for Payer: Cash Price |
$43.78
|
| Rate for Payer: Centivo All Commercial |
$36.01
|
| Rate for Payer: Cigna All Commercial |
$60.93
|
| Rate for Payer: CORVEL All Commercial |
$65.66
|
| Rate for Payer: Coventry All Commercial |
$62.13
|
| Rate for Payer: Encore All Commercial |
$64.99
|
| Rate for Payer: Frontpath All Commercial |
$64.96
|
| Rate for Payer: Humana ChoiceCare |
$60.98
|
| Rate for Payer: Humana Medicare |
$36.01
|
| Rate for Payer: Lucent All Commercial |
$36.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.54
|
| Rate for Payer: PHCS All Commercial |
$52.95
|
| Rate for Payer: PHP All Commercial |
$53.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.54
|
| Rate for Payer: Sagamore Health Network All Products |
$54.51
|
| Rate for Payer: Signature Care EPO |
$58.60
|
| Rate for Payer: Signature Care PPO |
$62.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$60.01
|
| Rate for Payer: United Healthcare Commercial |
$55.64
|
| Rate for Payer: United Healthcare Medicare |
$23.30
|
|
|
HC OR GENERAL LVL 1 EA ADD MIN
|
Facility
IP
|
$70.60
|
|
| Hospital Charge Code |
01206651
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$52.95 |
| Max. Negotiated Rate |
$65.66 |
| Rate for Payer: Aetna Commercial |
$61.00
|
| Rate for Payer: Cash Price |
$43.78
|
| Rate for Payer: Cigna All Commercial |
$60.93
|
| Rate for Payer: CORVEL All Commercial |
$65.66
|
| Rate for Payer: Coventry All Commercial |
$62.13
|
| Rate for Payer: Encore All Commercial |
$64.99
|
| Rate for Payer: Frontpath All Commercial |
$64.96
|
| Rate for Payer: Humana ChoiceCare |
$60.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$63.54
|
| Rate for Payer: PHCS All Commercial |
$52.95
|
| Rate for Payer: PHP All Commercial |
$53.55
|
| Rate for Payer: Sagamore Health Network All Products |
$54.51
|
| Rate for Payer: Signature Care EPO |
$58.60
|
| Rate for Payer: Signature Care PPO |
$62.13
|
| Rate for Payer: United Healthcare Commercial |
$55.64
|
|
|
HC OR GENERAL LVL 4 EA ADD MIN
|
Facility
IP
|
$113.46
|
|
| Hospital Charge Code |
01206663
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$105.52 |
| Rate for Payer: Aetna Commercial |
$98.03
|
| Rate for Payer: Cash Price |
$70.35
|
| Rate for Payer: Cigna All Commercial |
$97.92
|
| Rate for Payer: CORVEL All Commercial |
$105.52
|
| Rate for Payer: Coventry All Commercial |
$99.85
|
| Rate for Payer: Encore All Commercial |
$104.44
|
| Rate for Payer: Frontpath All Commercial |
$104.39
|
| Rate for Payer: Humana ChoiceCare |
$98.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.12
|
| Rate for Payer: PHCS All Commercial |
$85.10
|
| Rate for Payer: PHP All Commercial |
$86.05
|
| Rate for Payer: Sagamore Health Network All Products |
$87.59
|
| Rate for Payer: Signature Care EPO |
$94.18
|
| Rate for Payer: Signature Care PPO |
$99.85
|
| Rate for Payer: United Healthcare Commercial |
$89.41
|
|
|
HC OR GENERAL LVL 4 EA ADD MIN
|
Facility
OP
|
$113.46
|
|
| Hospital Charge Code |
01206663
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$105.52 |
| Rate for Payer: Aetna Commercial |
$95.76
|
| Rate for Payer: Aetna Medicare |
$37.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$70.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.19
|
| Rate for Payer: Cash Price |
$70.35
|
| Rate for Payer: Centivo All Commercial |
$57.87
|
| Rate for Payer: Cigna All Commercial |
$97.92
|
| Rate for Payer: CORVEL All Commercial |
$105.52
|
| Rate for Payer: Coventry All Commercial |
$99.85
|
| Rate for Payer: Encore All Commercial |
$104.44
|
| Rate for Payer: Frontpath All Commercial |
$104.39
|
| Rate for Payer: Humana ChoiceCare |
$98.00
|
| Rate for Payer: Humana Medicare |
$57.87
|
| Rate for Payer: Lucent All Commercial |
$57.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$102.12
|
| Rate for Payer: PHCS All Commercial |
$85.10
|
| Rate for Payer: PHP All Commercial |
$86.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.25
|
| Rate for Payer: Sagamore Health Network All Products |
$87.59
|
| Rate for Payer: Signature Care EPO |
$94.18
|
| Rate for Payer: Signature Care PPO |
$99.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$96.45
|
| Rate for Payer: United Healthcare Commercial |
$89.41
|
| Rate for Payer: United Healthcare Medicare |
$37.44
|
|
|
HC OR ORTHO LEVEL 1 EA ADD MIN
|
Facility
IP
|
$110.32
|
|
| Hospital Charge Code |
01206657
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$82.74 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna Commercial |
$95.32
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna All Commercial |
$95.21
|
| Rate for Payer: CORVEL All Commercial |
$102.60
|
| Rate for Payer: Coventry All Commercial |
$97.08
|
| Rate for Payer: Encore All Commercial |
$101.55
|
| Rate for Payer: Frontpath All Commercial |
$101.50
|
| Rate for Payer: Humana ChoiceCare |
$95.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.29
|
| Rate for Payer: PHCS All Commercial |
$82.74
|
| Rate for Payer: PHP All Commercial |
$83.67
|
| Rate for Payer: Sagamore Health Network All Products |
$85.17
|
| Rate for Payer: Signature Care EPO |
$91.57
|
| Rate for Payer: Signature Care PPO |
$97.08
|
| Rate for Payer: United Healthcare Commercial |
$86.93
|
|
|
HC OR ORTHO LEVEL 1 EA ADD MIN
|
Facility
OP
|
$110.32
|
|
| Hospital Charge Code |
01206657
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$36.41 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna Commercial |
$93.11
|
| Rate for Payer: Aetna Medicare |
$36.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$63.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$68.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.05
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Centivo All Commercial |
$56.26
|
| Rate for Payer: Cigna All Commercial |
$95.21
|
| Rate for Payer: CORVEL All Commercial |
$102.60
|
| Rate for Payer: Coventry All Commercial |
$97.08
|
| Rate for Payer: Encore All Commercial |
$101.55
|
| Rate for Payer: Frontpath All Commercial |
$101.50
|
| Rate for Payer: Humana ChoiceCare |
$95.29
|
| Rate for Payer: Humana Medicare |
$56.26
|
| Rate for Payer: Lucent All Commercial |
$56.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$99.29
|
| Rate for Payer: PHCS All Commercial |
$82.74
|
| Rate for Payer: PHP All Commercial |
$83.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.03
|
| Rate for Payer: Sagamore Health Network All Products |
$85.17
|
| Rate for Payer: Signature Care EPO |
$91.57
|
| Rate for Payer: Signature Care PPO |
$97.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$93.77
|
| Rate for Payer: United Healthcare Commercial |
$86.93
|
| Rate for Payer: United Healthcare Medicare |
$36.41
|
|
|
HC OR ORTHO LEVEL 1 INITIAL 15 MIN
|
Facility
IP
|
$3,089.67
|
|
| Hospital Charge Code |
01206656
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,317.25 |
| Max. Negotiated Rate |
$2,873.39 |
| Rate for Payer: Aetna Commercial |
$2,669.48
|
| Rate for Payer: Cash Price |
$1,915.60
|
| Rate for Payer: Cigna All Commercial |
$2,666.39
|
| Rate for Payer: CORVEL All Commercial |
$2,873.39
|
| Rate for Payer: Coventry All Commercial |
$2,718.91
|
| Rate for Payer: Encore All Commercial |
$2,844.04
|
| Rate for Payer: Frontpath All Commercial |
$2,842.50
|
| Rate for Payer: Humana ChoiceCare |
$2,668.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,780.70
|
| Rate for Payer: PHCS All Commercial |
$2,317.25
|
| Rate for Payer: PHP All Commercial |
$2,343.21
|
| Rate for Payer: Sagamore Health Network All Products |
$2,385.23
|
| Rate for Payer: Signature Care EPO |
$2,564.43
|
| Rate for Payer: Signature Care PPO |
$2,718.91
|
| Rate for Payer: United Healthcare Commercial |
$2,434.66
|
|
|
HC OR ORTHO LEVEL 1 INITIAL 15 MIN
|
Facility
OP
|
$3,089.67
|
|
| Hospital Charge Code |
01206656
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,019.59 |
| Max. Negotiated Rate |
$2,873.39 |
| Rate for Payer: Aetna Commercial |
$2,607.68
|
| Rate for Payer: Aetna Medicare |
$1,019.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,019.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,774.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,931.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,172.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,121.55
|
| Rate for Payer: Cash Price |
$1,915.60
|
| Rate for Payer: Centivo All Commercial |
$1,575.73
|
| Rate for Payer: Cigna All Commercial |
$2,666.39
|
| Rate for Payer: CORVEL All Commercial |
$2,873.39
|
| Rate for Payer: Coventry All Commercial |
$2,718.91
|
| Rate for Payer: Encore All Commercial |
$2,844.04
|
| Rate for Payer: Frontpath All Commercial |
$2,842.50
|
| Rate for Payer: Humana ChoiceCare |
$2,668.55
|
| Rate for Payer: Humana Medicare |
$1,575.73
|
| Rate for Payer: Lucent All Commercial |
$1,575.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,780.70
|
| Rate for Payer: PHCS All Commercial |
$2,317.25
|
| Rate for Payer: PHP All Commercial |
$2,343.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,204.97
|
| Rate for Payer: Sagamore Health Network All Products |
$2,385.23
|
| Rate for Payer: Signature Care EPO |
$2,564.43
|
| Rate for Payer: Signature Care PPO |
$2,718.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,626.22
|
| Rate for Payer: United Healthcare Commercial |
$2,434.66
|
| Rate for Payer: United Healthcare Medicare |
$1,019.59
|
|
|
HC OR ORTHO LEVEL 2 EA ADD MIN
|
Facility
IP
|
$132.69
|
|
| Hospital Charge Code |
01206659
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$99.52 |
| Max. Negotiated Rate |
$123.40 |
| Rate for Payer: Aetna Commercial |
$114.65
|
| Rate for Payer: Cash Price |
$82.27
|
| Rate for Payer: Cigna All Commercial |
$114.51
|
| Rate for Payer: CORVEL All Commercial |
$123.40
|
| Rate for Payer: Coventry All Commercial |
$116.77
|
| Rate for Payer: Encore All Commercial |
$122.14
|
| Rate for Payer: Frontpath All Commercial |
$122.08
|
| Rate for Payer: Humana ChoiceCare |
$114.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.42
|
| Rate for Payer: PHCS All Commercial |
$99.52
|
| Rate for Payer: PHP All Commercial |
$100.63
|
| Rate for Payer: Sagamore Health Network All Products |
$102.44
|
| Rate for Payer: Signature Care EPO |
$110.13
|
| Rate for Payer: Signature Care PPO |
$116.77
|
| Rate for Payer: United Healthcare Commercial |
$104.56
|
|
|
HC OR ORTHO LEVEL 2 EA ADD MIN
|
Facility
OP
|
$132.69
|
|
| Hospital Charge Code |
01206659
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$43.79 |
| Max. Negotiated Rate |
$123.40 |
| Rate for Payer: Aetna Commercial |
$111.99
|
| Rate for Payer: Aetna Medicare |
$43.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$43.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$76.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$82.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.17
|
| Rate for Payer: Cash Price |
$82.27
|
| Rate for Payer: Centivo All Commercial |
$67.67
|
| Rate for Payer: Cigna All Commercial |
$114.51
|
| Rate for Payer: CORVEL All Commercial |
$123.40
|
| Rate for Payer: Coventry All Commercial |
$116.77
|
| Rate for Payer: Encore All Commercial |
$122.14
|
| Rate for Payer: Frontpath All Commercial |
$122.08
|
| Rate for Payer: Humana ChoiceCare |
$114.61
|
| Rate for Payer: Humana Medicare |
$67.67
|
| Rate for Payer: Lucent All Commercial |
$67.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.42
|
| Rate for Payer: PHCS All Commercial |
$99.52
|
| Rate for Payer: PHP All Commercial |
$100.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$51.75
|
| Rate for Payer: Sagamore Health Network All Products |
$102.44
|
| Rate for Payer: Signature Care EPO |
$110.13
|
| Rate for Payer: Signature Care PPO |
$116.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$112.79
|
| Rate for Payer: United Healthcare Commercial |
$104.56
|
| Rate for Payer: United Healthcare Medicare |
$43.79
|
|
|
HC OR ORTHO LEVEL 2 INITIAL 15 MIN
|
Facility
IP
|
$3,531.06
|
|
| Hospital Charge Code |
01206658
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,648.29 |
| Max. Negotiated Rate |
$3,283.88 |
| Rate for Payer: Aetna Commercial |
$3,050.83
|
| Rate for Payer: Cash Price |
$2,189.26
|
| Rate for Payer: Cigna All Commercial |
$3,047.30
|
| Rate for Payer: CORVEL All Commercial |
$3,283.88
|
| Rate for Payer: Coventry All Commercial |
$3,107.33
|
| Rate for Payer: Encore All Commercial |
$3,250.34
|
| Rate for Payer: Frontpath All Commercial |
$3,248.57
|
| Rate for Payer: Humana ChoiceCare |
$3,049.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,177.95
|
| Rate for Payer: PHCS All Commercial |
$2,648.29
|
| Rate for Payer: PHP All Commercial |
$2,677.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,725.98
|
| Rate for Payer: Signature Care EPO |
$2,930.78
|
| Rate for Payer: Signature Care PPO |
$3,107.33
|
| Rate for Payer: United Healthcare Commercial |
$2,782.47
|
|
|
HC OR ORTHO LEVEL 2 INITIAL 15 MIN
|
Facility
OP
|
$3,531.06
|
|
| Hospital Charge Code |
01206658
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,165.25 |
| Max. Negotiated Rate |
$3,283.88 |
| Rate for Payer: Aetna Commercial |
$2,980.21
|
| Rate for Payer: Aetna Medicare |
$1,165.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,165.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,027.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,207.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,340.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,281.77
|
| Rate for Payer: Cash Price |
$2,189.26
|
| Rate for Payer: Centivo All Commercial |
$1,800.84
|
| Rate for Payer: Cigna All Commercial |
$3,047.30
|
| Rate for Payer: CORVEL All Commercial |
$3,283.88
|
| Rate for Payer: Coventry All Commercial |
$3,107.33
|
| Rate for Payer: Encore All Commercial |
$3,250.34
|
| Rate for Payer: Frontpath All Commercial |
$3,248.57
|
| Rate for Payer: Humana ChoiceCare |
$3,049.77
|
| Rate for Payer: Humana Medicare |
$1,800.84
|
| Rate for Payer: Lucent All Commercial |
$1,800.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,177.95
|
| Rate for Payer: PHCS All Commercial |
$2,648.29
|
| Rate for Payer: PHP All Commercial |
$2,677.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,377.11
|
| Rate for Payer: Sagamore Health Network All Products |
$2,725.98
|
| Rate for Payer: Signature Care EPO |
$2,930.78
|
| Rate for Payer: Signature Care PPO |
$3,107.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,001.40
|
| Rate for Payer: United Healthcare Commercial |
$2,782.47
|
| Rate for Payer: United Healthcare Medicare |
$1,165.25
|
|
|
HC OR ORTHO LEVEL 3 EA ADD MIN
|
Facility
IP
|
$154.96
|
|
| Hospital Charge Code |
01206661
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$116.22 |
| Max. Negotiated Rate |
$144.11 |
| Rate for Payer: Aetna Commercial |
$133.88
|
| Rate for Payer: Cash Price |
$96.07
|
| Rate for Payer: Cigna All Commercial |
$133.73
|
| Rate for Payer: CORVEL All Commercial |
$144.11
|
| Rate for Payer: Coventry All Commercial |
$136.36
|
| Rate for Payer: Encore All Commercial |
$142.64
|
| Rate for Payer: Frontpath All Commercial |
$142.56
|
| Rate for Payer: Humana ChoiceCare |
$133.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.46
|
| Rate for Payer: PHCS All Commercial |
$116.22
|
| Rate for Payer: PHP All Commercial |
$117.52
|
| Rate for Payer: Sagamore Health Network All Products |
$119.63
|
| Rate for Payer: Signature Care EPO |
$128.62
|
| Rate for Payer: Signature Care PPO |
$136.36
|
| Rate for Payer: United Healthcare Commercial |
$122.11
|
|
|
HC OR ORTHO LEVEL 3 EA ADD MIN
|
Facility
OP
|
$154.96
|
|
| Hospital Charge Code |
01206661
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$51.14 |
| Max. Negotiated Rate |
$144.11 |
| Rate for Payer: Aetna Commercial |
$130.78
|
| Rate for Payer: Aetna Medicare |
$51.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$88.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$96.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$56.25
|
| Rate for Payer: Cash Price |
$96.07
|
| Rate for Payer: Centivo All Commercial |
$79.03
|
| Rate for Payer: Cigna All Commercial |
$133.73
|
| Rate for Payer: CORVEL All Commercial |
$144.11
|
| Rate for Payer: Coventry All Commercial |
$136.36
|
| Rate for Payer: Encore All Commercial |
$142.64
|
| Rate for Payer: Frontpath All Commercial |
$142.56
|
| Rate for Payer: Humana ChoiceCare |
$133.84
|
| Rate for Payer: Humana Medicare |
$79.03
|
| Rate for Payer: Lucent All Commercial |
$79.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.46
|
| Rate for Payer: PHCS All Commercial |
$116.22
|
| Rate for Payer: PHP All Commercial |
$117.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$60.43
|
| Rate for Payer: Sagamore Health Network All Products |
$119.63
|
| Rate for Payer: Signature Care EPO |
$128.62
|
| Rate for Payer: Signature Care PPO |
$136.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$131.71
|
| Rate for Payer: United Healthcare Commercial |
$122.11
|
| Rate for Payer: United Healthcare Medicare |
$51.14
|
|
|
HC OR ORTHO LEVEL 3 INITIAL 15 MIN
|
Facility
OP
|
$3,972.38
|
|
| Hospital Charge Code |
01206660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,310.89 |
| Max. Negotiated Rate |
$3,694.31 |
| Rate for Payer: Aetna Commercial |
$3,352.69
|
| Rate for Payer: Aetna Medicare |
$1,310.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,310.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,281.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,483.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,507.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,441.97
|
| Rate for Payer: Cash Price |
$2,462.88
|
| Rate for Payer: Centivo All Commercial |
$2,025.91
|
| Rate for Payer: Cigna All Commercial |
$3,428.16
|
| Rate for Payer: CORVEL All Commercial |
$3,694.31
|
| Rate for Payer: Coventry All Commercial |
$3,495.69
|
| Rate for Payer: Encore All Commercial |
$3,656.58
|
| Rate for Payer: Frontpath All Commercial |
$3,654.59
|
| Rate for Payer: Humana ChoiceCare |
$3,430.94
|
| Rate for Payer: Humana Medicare |
$2,025.91
|
| Rate for Payer: Lucent All Commercial |
$2,025.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,575.14
|
| Rate for Payer: PHCS All Commercial |
$2,979.28
|
| Rate for Payer: PHP All Commercial |
$3,012.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,549.23
|
| Rate for Payer: Sagamore Health Network All Products |
$3,066.68
|
| Rate for Payer: Signature Care EPO |
$3,297.08
|
| Rate for Payer: Signature Care PPO |
$3,495.69
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,376.52
|
| Rate for Payer: United Healthcare Commercial |
$3,130.24
|
| Rate for Payer: United Healthcare Medicare |
$1,310.89
|
|
|
HC OR ORTHO LEVEL 3 INITIAL 15 MIN
|
Facility
IP
|
$3,972.38
|
|
| Hospital Charge Code |
01206660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,979.28 |
| Max. Negotiated Rate |
$3,694.31 |
| Rate for Payer: Aetna Commercial |
$3,432.14
|
| Rate for Payer: Cash Price |
$2,462.88
|
| Rate for Payer: Cigna All Commercial |
$3,428.16
|
| Rate for Payer: CORVEL All Commercial |
$3,694.31
|
| Rate for Payer: Coventry All Commercial |
$3,495.69
|
| Rate for Payer: Encore All Commercial |
$3,656.58
|
| Rate for Payer: Frontpath All Commercial |
$3,654.59
|
| Rate for Payer: Humana ChoiceCare |
$3,430.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,575.14
|
| Rate for Payer: PHCS All Commercial |
$2,979.28
|
| Rate for Payer: PHP All Commercial |
$3,012.65
|
| Rate for Payer: Sagamore Health Network All Products |
$3,066.68
|
| Rate for Payer: Signature Care EPO |
$3,297.08
|
| Rate for Payer: Signature Care PPO |
$3,495.69
|
| Rate for Payer: United Healthcare Commercial |
$3,130.24
|
|
|
HC OR ORTHO LEVEL 4 EA ADD MIN
|
Facility
IP
|
$177.30
|
|
| Hospital Charge Code |
01206665
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.97 |
| Max. Negotiated Rate |
$164.89 |
| Rate for Payer: Aetna Commercial |
$153.18
|
| Rate for Payer: Cash Price |
$109.92
|
| Rate for Payer: Cigna All Commercial |
$153.01
|
| Rate for Payer: CORVEL All Commercial |
$164.89
|
| Rate for Payer: Coventry All Commercial |
$156.02
|
| Rate for Payer: Encore All Commercial |
$163.20
|
| Rate for Payer: Frontpath All Commercial |
$163.11
|
| Rate for Payer: Humana ChoiceCare |
$153.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$159.57
|
| Rate for Payer: PHCS All Commercial |
$132.97
|
| Rate for Payer: PHP All Commercial |
$134.46
|
| Rate for Payer: Sagamore Health Network All Products |
$136.87
|
| Rate for Payer: Signature Care EPO |
$147.16
|
| Rate for Payer: Signature Care PPO |
$156.02
|
| Rate for Payer: United Healthcare Commercial |
$139.71
|
|
|
HC OR ORTHO LEVEL 4 EA ADD MIN
|
Facility
OP
|
$177.30
|
|
| Hospital Charge Code |
01206665
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$58.51 |
| Max. Negotiated Rate |
$164.89 |
| Rate for Payer: Aetna Commercial |
$149.64
|
| Rate for Payer: Aetna Medicare |
$58.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$58.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$101.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$110.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.36
|
| Rate for Payer: Cash Price |
$109.92
|
| Rate for Payer: Centivo All Commercial |
$90.42
|
| Rate for Payer: Cigna All Commercial |
$153.01
|
| Rate for Payer: CORVEL All Commercial |
$164.89
|
| Rate for Payer: Coventry All Commercial |
$156.02
|
| Rate for Payer: Encore All Commercial |
$163.20
|
| Rate for Payer: Frontpath All Commercial |
$163.11
|
| Rate for Payer: Humana ChoiceCare |
$153.13
|
| Rate for Payer: Humana Medicare |
$90.42
|
| Rate for Payer: Lucent All Commercial |
$90.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$159.57
|
| Rate for Payer: PHCS All Commercial |
$132.97
|
| Rate for Payer: PHP All Commercial |
$134.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$69.15
|
| Rate for Payer: Sagamore Health Network All Products |
$136.87
|
| Rate for Payer: Signature Care EPO |
$147.16
|
| Rate for Payer: Signature Care PPO |
$156.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$150.70
|
| Rate for Payer: United Healthcare Commercial |
$139.71
|
| Rate for Payer: United Healthcare Medicare |
$58.51
|
|
|
HC OR ORTHO LEVEL 4 INITIAL 15 MIN
|
Facility
IP
|
$4,413.77
|
|
| Hospital Charge Code |
01206664
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,310.33 |
| Max. Negotiated Rate |
$4,104.81 |
| Rate for Payer: Aetna Commercial |
$3,813.50
|
| Rate for Payer: Cash Price |
$2,736.54
|
| Rate for Payer: Cigna All Commercial |
$3,809.09
|
| Rate for Payer: CORVEL All Commercial |
$4,104.81
|
| Rate for Payer: Coventry All Commercial |
$3,884.12
|
| Rate for Payer: Encore All Commercial |
$4,062.88
|
| Rate for Payer: Frontpath All Commercial |
$4,060.67
|
| Rate for Payer: Humana ChoiceCare |
$3,812.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,972.40
|
| Rate for Payer: PHCS All Commercial |
$3,310.33
|
| Rate for Payer: PHP All Commercial |
$3,347.41
|
| Rate for Payer: Sagamore Health Network All Products |
$3,407.43
|
| Rate for Payer: Signature Care EPO |
$3,663.43
|
| Rate for Payer: Signature Care PPO |
$3,884.12
|
| Rate for Payer: United Healthcare Commercial |
$3,478.05
|
|
