|
HC SN PL PLATE 3.5 10-H COMP
|
Facility
IP
|
$810.88
|
|
| Hospital Charge Code |
41601778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$608.16 |
| Max. Negotiated Rate |
$754.12 |
| Rate for Payer: Aetna Commercial |
$700.60
|
| Rate for Payer: Cash Price |
$502.75
|
| Rate for Payer: Cigna All Commercial |
$699.79
|
| Rate for Payer: CORVEL All Commercial |
$754.12
|
| Rate for Payer: Coventry All Commercial |
$713.57
|
| Rate for Payer: Encore All Commercial |
$746.42
|
| Rate for Payer: Frontpath All Commercial |
$746.01
|
| Rate for Payer: Humana ChoiceCare |
$700.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$729.79
|
| Rate for Payer: PHCS All Commercial |
$608.16
|
| Rate for Payer: PHP All Commercial |
$614.97
|
| Rate for Payer: Sagamore Health Network All Products |
$626.00
|
| Rate for Payer: Signature Care EPO |
$673.03
|
| Rate for Payer: Signature Care PPO |
$713.57
|
| Rate for Payer: United Healthcare Commercial |
$638.97
|
|
|
HC SN PL PLATE 3.5 10-H LOCK COMP
|
Facility
IP
|
$1,990.55
|
|
| Hospital Charge Code |
41601783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,492.91 |
| Max. Negotiated Rate |
$1,851.21 |
| Rate for Payer: Aetna Commercial |
$1,719.84
|
| Rate for Payer: Cash Price |
$1,234.14
|
| Rate for Payer: Cigna All Commercial |
$1,717.84
|
| Rate for Payer: CORVEL All Commercial |
$1,851.21
|
| Rate for Payer: Coventry All Commercial |
$1,751.68
|
| Rate for Payer: Encore All Commercial |
$1,832.30
|
| Rate for Payer: Frontpath All Commercial |
$1,831.31
|
| Rate for Payer: Humana ChoiceCare |
$1,719.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,791.50
|
| Rate for Payer: PHCS All Commercial |
$1,492.91
|
| Rate for Payer: PHP All Commercial |
$1,509.63
|
| Rate for Payer: Sagamore Health Network All Products |
$1,536.70
|
| Rate for Payer: Signature Care EPO |
$1,652.16
|
| Rate for Payer: Signature Care PPO |
$1,751.68
|
| Rate for Payer: United Healthcare Commercial |
$1,568.55
|
|
|
HC SN PL PLATE 3.5 10-H LOCK COMP
|
Facility
OP
|
$1,990.55
|
|
| Hospital Charge Code |
41601783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,851.21 |
| Rate for Payer: Aetna Commercial |
$1,680.02
|
| Rate for Payer: Aetna Medicare |
$656.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$656.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,143.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,244.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$755.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$722.57
|
| Rate for Payer: Cash Price |
$1,234.14
|
| Rate for Payer: Cash Price |
$1,234.14
|
| Rate for Payer: Centivo All Commercial |
$1,015.18
|
| Rate for Payer: Cigna All Commercial |
$1,717.84
|
| Rate for Payer: CORVEL All Commercial |
$1,851.21
|
| Rate for Payer: Coventry All Commercial |
$1,751.68
|
| Rate for Payer: Encore All Commercial |
$1,832.30
|
| Rate for Payer: Frontpath All Commercial |
$1,831.31
|
| Rate for Payer: Humana ChoiceCare |
$1,719.24
|
| Rate for Payer: Humana Medicare |
$1,015.18
|
| Rate for Payer: Lucent All Commercial |
$1,015.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,791.50
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,492.91
|
| Rate for Payer: PHP All Commercial |
$1,509.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$776.31
|
| Rate for Payer: Sagamore Health Network All Products |
$1,536.70
|
| Rate for Payer: Signature Care EPO |
$1,652.16
|
| Rate for Payer: Signature Care PPO |
$1,751.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,691.97
|
| Rate for Payer: United Healthcare Commercial |
$1,568.55
|
| Rate for Payer: United Healthcare Medicare |
$656.88
|
|
|
HC SN PL PLATE 3.5 10-H LOCK RECN
|
Facility
IP
|
$1,932.45
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.34 |
| Max. Negotiated Rate |
$1,797.18 |
| Rate for Payer: Aetna Commercial |
$1,669.64
|
| Rate for Payer: Cash Price |
$1,198.12
|
| Rate for Payer: Cigna All Commercial |
$1,667.70
|
| Rate for Payer: CORVEL All Commercial |
$1,797.18
|
| Rate for Payer: Coventry All Commercial |
$1,700.56
|
| Rate for Payer: Encore All Commercial |
$1,778.82
|
| Rate for Payer: Frontpath All Commercial |
$1,777.85
|
| Rate for Payer: Humana ChoiceCare |
$1,669.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,739.20
|
| Rate for Payer: PHCS All Commercial |
$1,449.34
|
| Rate for Payer: PHP All Commercial |
$1,465.57
|
| Rate for Payer: Sagamore Health Network All Products |
$1,491.85
|
| Rate for Payer: Signature Care EPO |
$1,603.93
|
| Rate for Payer: Signature Care PPO |
$1,700.56
|
| Rate for Payer: United Healthcare Commercial |
$1,522.77
|
|
|
HC SN PL PLATE 3.5 10-H LOCK RECN
|
Facility
OP
|
$1,932.45
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601767
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,797.18 |
| Rate for Payer: Aetna Commercial |
$1,630.99
|
| Rate for Payer: Aetna Medicare |
$637.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$637.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,109.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,207.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$733.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$701.48
|
| Rate for Payer: Cash Price |
$1,198.12
|
| Rate for Payer: Cash Price |
$1,198.12
|
| Rate for Payer: Centivo All Commercial |
$985.55
|
| Rate for Payer: Cigna All Commercial |
$1,667.70
|
| Rate for Payer: CORVEL All Commercial |
$1,797.18
|
| Rate for Payer: Coventry All Commercial |
$1,700.56
|
| Rate for Payer: Encore All Commercial |
$1,778.82
|
| Rate for Payer: Frontpath All Commercial |
$1,777.85
|
| Rate for Payer: Humana ChoiceCare |
$1,669.06
|
| Rate for Payer: Humana Medicare |
$985.55
|
| Rate for Payer: Lucent All Commercial |
$985.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,739.20
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,449.34
|
| Rate for Payer: PHP All Commercial |
$1,465.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$753.66
|
| Rate for Payer: Sagamore Health Network All Products |
$1,491.85
|
| Rate for Payer: Signature Care EPO |
$1,603.93
|
| Rate for Payer: Signature Care PPO |
$1,700.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,642.58
|
| Rate for Payer: United Healthcare Commercial |
$1,522.77
|
| Rate for Payer: United Healthcare Medicare |
$637.71
|
|
|
HC SN PL PLATE 3.5 10-H LOCK TUB
|
Facility
IP
|
$829.78
|
|
| Hospital Charge Code |
41601771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$622.34 |
| Max. Negotiated Rate |
$771.70 |
| Rate for Payer: Aetna Commercial |
$716.93
|
| Rate for Payer: Cash Price |
$514.46
|
| Rate for Payer: Cigna All Commercial |
$716.10
|
| Rate for Payer: CORVEL All Commercial |
$771.70
|
| Rate for Payer: Coventry All Commercial |
$730.21
|
| Rate for Payer: Encore All Commercial |
$763.81
|
| Rate for Payer: Frontpath All Commercial |
$763.40
|
| Rate for Payer: Humana ChoiceCare |
$716.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$746.80
|
| Rate for Payer: PHCS All Commercial |
$622.34
|
| Rate for Payer: PHP All Commercial |
$629.31
|
| Rate for Payer: Sagamore Health Network All Products |
$640.59
|
| Rate for Payer: Signature Care EPO |
$688.72
|
| Rate for Payer: Signature Care PPO |
$730.21
|
| Rate for Payer: United Healthcare Commercial |
$653.87
|
|
|
HC SN PL PLATE 3.5 10-H LOCK TUB
|
Facility
OP
|
$829.78
|
|
| Hospital Charge Code |
41601771
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.83 |
| Max. Negotiated Rate |
$771.70 |
| Rate for Payer: Aetna Commercial |
$700.33
|
| Rate for Payer: Aetna Medicare |
$273.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$273.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$476.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$518.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$314.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$301.21
|
| Rate for Payer: Cash Price |
$514.46
|
| Rate for Payer: Cash Price |
$514.46
|
| Rate for Payer: Centivo All Commercial |
$423.19
|
| Rate for Payer: Cigna All Commercial |
$716.10
|
| Rate for Payer: CORVEL All Commercial |
$771.70
|
| Rate for Payer: Coventry All Commercial |
$730.21
|
| Rate for Payer: Encore All Commercial |
$763.81
|
| Rate for Payer: Frontpath All Commercial |
$763.40
|
| Rate for Payer: Humana ChoiceCare |
$716.68
|
| Rate for Payer: Humana Medicare |
$423.19
|
| Rate for Payer: Lucent All Commercial |
$423.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$746.80
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$622.34
|
| Rate for Payer: PHP All Commercial |
$629.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$323.61
|
| Rate for Payer: Sagamore Health Network All Products |
$640.59
|
| Rate for Payer: Signature Care EPO |
$688.72
|
| Rate for Payer: Signature Care PPO |
$730.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$705.31
|
| Rate for Payer: United Healthcare Commercial |
$653.87
|
| Rate for Payer: United Healthcare Medicare |
$273.83
|
|
|
HC SN PL PLATE 3.5 12-H LOCK COMP
|
Facility
OP
|
$1,383.00
|
|
| Hospital Charge Code |
41601784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.39 |
| Max. Negotiated Rate |
$1,286.19 |
| Rate for Payer: Aetna Commercial |
$1,167.25
|
| Rate for Payer: Aetna Medicare |
$456.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$456.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$794.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$864.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$524.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$502.03
|
| Rate for Payer: Cash Price |
$857.46
|
| Rate for Payer: Cash Price |
$857.46
|
| Rate for Payer: Centivo All Commercial |
$705.33
|
| Rate for Payer: Cigna All Commercial |
$1,193.53
|
| Rate for Payer: CORVEL All Commercial |
$1,286.19
|
| Rate for Payer: Coventry All Commercial |
$1,217.04
|
| Rate for Payer: Encore All Commercial |
$1,273.05
|
| Rate for Payer: Frontpath All Commercial |
$1,272.36
|
| Rate for Payer: Humana ChoiceCare |
$1,194.50
|
| Rate for Payer: Humana Medicare |
$705.33
|
| Rate for Payer: Lucent All Commercial |
$705.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,244.70
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,037.25
|
| Rate for Payer: PHP All Commercial |
$1,048.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$539.37
|
| Rate for Payer: Sagamore Health Network All Products |
$1,067.68
|
| Rate for Payer: Signature Care EPO |
$1,147.89
|
| Rate for Payer: Signature Care PPO |
$1,217.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,175.55
|
| Rate for Payer: United Healthcare Commercial |
$1,089.80
|
| Rate for Payer: United Healthcare Medicare |
$456.39
|
|
|
HC SN PL PLATE 3.5 12-H LOCK COMP
|
Facility
IP
|
$1,383.00
|
|
| Hospital Charge Code |
41601784
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,037.25 |
| Max. Negotiated Rate |
$1,286.19 |
| Rate for Payer: Aetna Commercial |
$1,194.91
|
| Rate for Payer: Cash Price |
$857.46
|
| Rate for Payer: Cigna All Commercial |
$1,193.53
|
| Rate for Payer: CORVEL All Commercial |
$1,286.19
|
| Rate for Payer: Coventry All Commercial |
$1,217.04
|
| Rate for Payer: Encore All Commercial |
$1,273.05
|
| Rate for Payer: Frontpath All Commercial |
$1,272.36
|
| Rate for Payer: Humana ChoiceCare |
$1,194.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,244.70
|
| Rate for Payer: PHCS All Commercial |
$1,037.25
|
| Rate for Payer: PHP All Commercial |
$1,048.87
|
| Rate for Payer: Sagamore Health Network All Products |
$1,067.68
|
| Rate for Payer: Signature Care EPO |
$1,147.89
|
| Rate for Payer: Signature Care PPO |
$1,217.04
|
| Rate for Payer: United Healthcare Commercial |
$1,089.80
|
|
|
HC SN PL PLATE 3.5 12-H LOCK RECN
|
Facility
IP
|
$2,070.45
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,552.84 |
| Max. Negotiated Rate |
$1,925.52 |
| Rate for Payer: Aetna Commercial |
$1,788.87
|
| Rate for Payer: Cash Price |
$1,283.68
|
| Rate for Payer: Cigna All Commercial |
$1,786.80
|
| Rate for Payer: CORVEL All Commercial |
$1,925.52
|
| Rate for Payer: Coventry All Commercial |
$1,822.00
|
| Rate for Payer: Encore All Commercial |
$1,905.85
|
| Rate for Payer: Frontpath All Commercial |
$1,904.81
|
| Rate for Payer: Humana ChoiceCare |
$1,788.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,863.40
|
| Rate for Payer: PHCS All Commercial |
$1,552.84
|
| Rate for Payer: PHP All Commercial |
$1,570.23
|
| Rate for Payer: Sagamore Health Network All Products |
$1,598.39
|
| Rate for Payer: Signature Care EPO |
$1,718.47
|
| Rate for Payer: Signature Care PPO |
$1,822.00
|
| Rate for Payer: United Healthcare Commercial |
$1,631.51
|
|
|
HC SN PL PLATE 3.5 12-H LOCK RECN
|
Facility
OP
|
$2,070.45
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601768
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,925.52 |
| Rate for Payer: Aetna Commercial |
$1,747.46
|
| Rate for Payer: Aetna Medicare |
$683.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$683.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,189.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,294.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$785.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$751.57
|
| Rate for Payer: Cash Price |
$1,283.68
|
| Rate for Payer: Cash Price |
$1,283.68
|
| Rate for Payer: Centivo All Commercial |
$1,055.93
|
| Rate for Payer: Cigna All Commercial |
$1,786.80
|
| Rate for Payer: CORVEL All Commercial |
$1,925.52
|
| Rate for Payer: Coventry All Commercial |
$1,822.00
|
| Rate for Payer: Encore All Commercial |
$1,905.85
|
| Rate for Payer: Frontpath All Commercial |
$1,904.81
|
| Rate for Payer: Humana ChoiceCare |
$1,788.25
|
| Rate for Payer: Humana Medicare |
$1,055.93
|
| Rate for Payer: Lucent All Commercial |
$1,055.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,863.40
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,552.84
|
| Rate for Payer: PHP All Commercial |
$1,570.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$807.48
|
| Rate for Payer: Sagamore Health Network All Products |
$1,598.39
|
| Rate for Payer: Signature Care EPO |
$1,718.47
|
| Rate for Payer: Signature Care PPO |
$1,822.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,759.88
|
| Rate for Payer: United Healthcare Commercial |
$1,631.51
|
| Rate for Payer: United Healthcare Medicare |
$683.25
|
|
|
HC SN PL PLATE 3.5 3-H COMP
|
Facility
IP
|
$602.49
|
|
| Hospital Charge Code |
41601772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$451.87 |
| Max. Negotiated Rate |
$560.32 |
| Rate for Payer: Aetna Commercial |
$520.55
|
| Rate for Payer: Cash Price |
$373.54
|
| Rate for Payer: Cigna All Commercial |
$519.95
|
| Rate for Payer: CORVEL All Commercial |
$560.32
|
| Rate for Payer: Coventry All Commercial |
$530.19
|
| Rate for Payer: Encore All Commercial |
$554.59
|
| Rate for Payer: Frontpath All Commercial |
$554.29
|
| Rate for Payer: Humana ChoiceCare |
$520.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$542.24
|
| Rate for Payer: PHCS All Commercial |
$451.87
|
| Rate for Payer: PHP All Commercial |
$456.93
|
| Rate for Payer: Sagamore Health Network All Products |
$465.12
|
| Rate for Payer: Signature Care EPO |
$500.07
|
| Rate for Payer: Signature Care PPO |
$530.19
|
| Rate for Payer: United Healthcare Commercial |
$474.76
|
|
|
HC SN PL PLATE 3.5 3-H COMP
|
Facility
OP
|
$602.49
|
|
| Hospital Charge Code |
41601772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$198.82 |
| Max. Negotiated Rate |
$560.32 |
| Rate for Payer: Aetna Commercial |
$508.50
|
| Rate for Payer: Aetna Medicare |
$198.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$198.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$346.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$376.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$228.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$218.70
|
| Rate for Payer: Cash Price |
$373.54
|
| Rate for Payer: Cash Price |
$373.54
|
| Rate for Payer: Centivo All Commercial |
$307.27
|
| Rate for Payer: Cigna All Commercial |
$519.95
|
| Rate for Payer: CORVEL All Commercial |
$560.32
|
| Rate for Payer: Coventry All Commercial |
$530.19
|
| Rate for Payer: Encore All Commercial |
$554.59
|
| Rate for Payer: Frontpath All Commercial |
$554.29
|
| Rate for Payer: Humana ChoiceCare |
$520.37
|
| Rate for Payer: Humana Medicare |
$307.27
|
| Rate for Payer: Lucent All Commercial |
$307.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$542.24
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$451.87
|
| Rate for Payer: PHP All Commercial |
$456.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$234.97
|
| Rate for Payer: Sagamore Health Network All Products |
$465.12
|
| Rate for Payer: Signature Care EPO |
$500.07
|
| Rate for Payer: Signature Care PPO |
$530.19
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$512.12
|
| Rate for Payer: United Healthcare Commercial |
$474.76
|
| Rate for Payer: United Healthcare Medicare |
$198.82
|
|
|
HC SN PL PLATE 3.5 3-H PROX HUM L
|
Facility
IP
|
$5,249.23
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,936.92 |
| Max. Negotiated Rate |
$4,881.78 |
| Rate for Payer: Aetna Commercial |
$4,535.33
|
| Rate for Payer: Cash Price |
$3,254.52
|
| Rate for Payer: Cigna All Commercial |
$4,530.09
|
| Rate for Payer: CORVEL All Commercial |
$4,881.78
|
| Rate for Payer: Coventry All Commercial |
$4,619.32
|
| Rate for Payer: Encore All Commercial |
$4,831.92
|
| Rate for Payer: Frontpath All Commercial |
$4,829.29
|
| Rate for Payer: Humana ChoiceCare |
$4,533.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,724.31
|
| Rate for Payer: PHCS All Commercial |
$3,936.92
|
| Rate for Payer: PHP All Commercial |
$3,981.02
|
| Rate for Payer: Sagamore Health Network All Products |
$4,052.41
|
| Rate for Payer: Signature Care EPO |
$4,356.86
|
| Rate for Payer: Signature Care PPO |
$4,619.32
|
| Rate for Payer: United Healthcare Commercial |
$4,136.39
|
|
|
HC SN PL PLATE 3.5 3-H PROX HUM L
|
Facility
OP
|
$5,249.23
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603463
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,881.78 |
| Rate for Payer: Aetna Commercial |
$4,430.35
|
| Rate for Payer: Aetna Medicare |
$1,732.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,732.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,014.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,281.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,992.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,905.47
|
| Rate for Payer: Cash Price |
$3,254.52
|
| Rate for Payer: Cash Price |
$3,254.52
|
| Rate for Payer: Centivo All Commercial |
$2,677.11
|
| Rate for Payer: Cigna All Commercial |
$4,530.09
|
| Rate for Payer: CORVEL All Commercial |
$4,881.78
|
| Rate for Payer: Coventry All Commercial |
$4,619.32
|
| Rate for Payer: Encore All Commercial |
$4,831.92
|
| Rate for Payer: Frontpath All Commercial |
$4,829.29
|
| Rate for Payer: Humana ChoiceCare |
$4,533.76
|
| Rate for Payer: Humana Medicare |
$2,677.11
|
| Rate for Payer: Lucent All Commercial |
$2,677.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,724.31
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,936.92
|
| Rate for Payer: PHP All Commercial |
$3,981.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,047.20
|
| Rate for Payer: Sagamore Health Network All Products |
$4,052.41
|
| Rate for Payer: Signature Care EPO |
$4,356.86
|
| Rate for Payer: Signature Care PPO |
$4,619.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,461.85
|
| Rate for Payer: United Healthcare Commercial |
$4,136.39
|
| Rate for Payer: United Healthcare Medicare |
$1,732.25
|
|
|
HC SN PL PLATE 3.5 3-H PROX HUM R
|
Facility
OP
|
$5,249.23
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,881.78 |
| Rate for Payer: Aetna Commercial |
$4,430.35
|
| Rate for Payer: Aetna Medicare |
$1,732.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,732.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,014.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,281.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,992.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,905.47
|
| Rate for Payer: Cash Price |
$3,254.52
|
| Rate for Payer: Cash Price |
$3,254.52
|
| Rate for Payer: Centivo All Commercial |
$2,677.11
|
| Rate for Payer: Cigna All Commercial |
$4,530.09
|
| Rate for Payer: CORVEL All Commercial |
$4,881.78
|
| Rate for Payer: Coventry All Commercial |
$4,619.32
|
| Rate for Payer: Encore All Commercial |
$4,831.92
|
| Rate for Payer: Frontpath All Commercial |
$4,829.29
|
| Rate for Payer: Humana ChoiceCare |
$4,533.76
|
| Rate for Payer: Humana Medicare |
$2,677.11
|
| Rate for Payer: Lucent All Commercial |
$2,677.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,724.31
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,936.92
|
| Rate for Payer: PHP All Commercial |
$3,981.02
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,047.20
|
| Rate for Payer: Sagamore Health Network All Products |
$4,052.41
|
| Rate for Payer: Signature Care EPO |
$4,356.86
|
| Rate for Payer: Signature Care PPO |
$4,619.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,461.85
|
| Rate for Payer: United Healthcare Commercial |
$4,136.39
|
| Rate for Payer: United Healthcare Medicare |
$1,732.25
|
|
|
HC SN PL PLATE 3.5 3-H PROX HUM R
|
Facility
IP
|
$5,249.23
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603464
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,936.92 |
| Max. Negotiated Rate |
$4,881.78 |
| Rate for Payer: Aetna Commercial |
$4,535.33
|
| Rate for Payer: Cash Price |
$3,254.52
|
| Rate for Payer: Cigna All Commercial |
$4,530.09
|
| Rate for Payer: CORVEL All Commercial |
$4,881.78
|
| Rate for Payer: Coventry All Commercial |
$4,619.32
|
| Rate for Payer: Encore All Commercial |
$4,831.92
|
| Rate for Payer: Frontpath All Commercial |
$4,829.29
|
| Rate for Payer: Humana ChoiceCare |
$4,533.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,724.31
|
| Rate for Payer: PHCS All Commercial |
$3,936.92
|
| Rate for Payer: PHP All Commercial |
$3,981.02
|
| Rate for Payer: Sagamore Health Network All Products |
$4,052.41
|
| Rate for Payer: Signature Care EPO |
$4,356.86
|
| Rate for Payer: Signature Care PPO |
$4,619.32
|
| Rate for Payer: United Healthcare Commercial |
$4,136.39
|
|
|
HC SN PL PLATE 3.5 4-H COMP
|
Facility
IP
|
$889.07
|
|
| Hospital Charge Code |
41601773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$666.80 |
| Max. Negotiated Rate |
$826.84 |
| Rate for Payer: Aetna Commercial |
$768.16
|
| Rate for Payer: Cash Price |
$551.22
|
| Rate for Payer: Cigna All Commercial |
$767.27
|
| Rate for Payer: CORVEL All Commercial |
$826.84
|
| Rate for Payer: Coventry All Commercial |
$782.38
|
| Rate for Payer: Encore All Commercial |
$818.39
|
| Rate for Payer: Frontpath All Commercial |
$817.94
|
| Rate for Payer: Humana ChoiceCare |
$767.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$800.16
|
| Rate for Payer: PHCS All Commercial |
$666.80
|
| Rate for Payer: PHP All Commercial |
$674.27
|
| Rate for Payer: Sagamore Health Network All Products |
$686.36
|
| Rate for Payer: Signature Care EPO |
$737.93
|
| Rate for Payer: Signature Care PPO |
$782.38
|
| Rate for Payer: United Healthcare Commercial |
$700.59
|
|
|
HC SN PL PLATE 3.5 4-H COMP
|
Facility
OP
|
$889.07
|
|
| Hospital Charge Code |
41601773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$293.39 |
| Max. Negotiated Rate |
$826.84 |
| Rate for Payer: Aetna Commercial |
$750.38
|
| Rate for Payer: Aetna Medicare |
$293.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$293.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$510.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$555.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$337.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$322.73
|
| Rate for Payer: Cash Price |
$551.22
|
| Rate for Payer: Cash Price |
$551.22
|
| Rate for Payer: Centivo All Commercial |
$453.43
|
| Rate for Payer: Cigna All Commercial |
$767.27
|
| Rate for Payer: CORVEL All Commercial |
$826.84
|
| Rate for Payer: Coventry All Commercial |
$782.38
|
| Rate for Payer: Encore All Commercial |
$818.39
|
| Rate for Payer: Frontpath All Commercial |
$817.94
|
| Rate for Payer: Humana ChoiceCare |
$767.89
|
| Rate for Payer: Humana Medicare |
$453.43
|
| Rate for Payer: Lucent All Commercial |
$453.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$800.16
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$666.80
|
| Rate for Payer: PHP All Commercial |
$674.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$346.74
|
| Rate for Payer: Sagamore Health Network All Products |
$686.36
|
| Rate for Payer: Signature Care EPO |
$737.93
|
| Rate for Payer: Signature Care PPO |
$782.38
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$755.71
|
| Rate for Payer: United Healthcare Commercial |
$700.59
|
| Rate for Payer: United Healthcare Medicare |
$293.39
|
|
|
HC SN PL PLATE 3.5 4-H LOCK COMP
|
Facility
IP
|
$944.55
|
|
| Hospital Charge Code |
41601779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$708.41 |
| Max. Negotiated Rate |
$878.43 |
| Rate for Payer: Aetna Commercial |
$816.09
|
| Rate for Payer: Cash Price |
$585.62
|
| Rate for Payer: Cigna All Commercial |
$815.15
|
| Rate for Payer: CORVEL All Commercial |
$878.43
|
| Rate for Payer: Coventry All Commercial |
$831.20
|
| Rate for Payer: Encore All Commercial |
$869.46
|
| Rate for Payer: Frontpath All Commercial |
$868.99
|
| Rate for Payer: Humana ChoiceCare |
$815.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$850.10
|
| Rate for Payer: PHCS All Commercial |
$708.41
|
| Rate for Payer: PHP All Commercial |
$716.35
|
| Rate for Payer: Sagamore Health Network All Products |
$729.19
|
| Rate for Payer: Signature Care EPO |
$783.98
|
| Rate for Payer: Signature Care PPO |
$831.20
|
| Rate for Payer: United Healthcare Commercial |
$744.31
|
|
|
HC SN PL PLATE 3.5 4-H LOCK COMP
|
Facility
OP
|
$944.55
|
|
| Hospital Charge Code |
41601779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$311.70 |
| Max. Negotiated Rate |
$878.43 |
| Rate for Payer: Aetna Commercial |
$797.20
|
| Rate for Payer: Aetna Medicare |
$311.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$311.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$542.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$590.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$358.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$342.87
|
| Rate for Payer: Cash Price |
$585.62
|
| Rate for Payer: Cash Price |
$585.62
|
| Rate for Payer: Centivo All Commercial |
$481.72
|
| Rate for Payer: Cigna All Commercial |
$815.15
|
| Rate for Payer: CORVEL All Commercial |
$878.43
|
| Rate for Payer: Coventry All Commercial |
$831.20
|
| Rate for Payer: Encore All Commercial |
$869.46
|
| Rate for Payer: Frontpath All Commercial |
$868.99
|
| Rate for Payer: Humana ChoiceCare |
$815.81
|
| Rate for Payer: Humana Medicare |
$481.72
|
| Rate for Payer: Lucent All Commercial |
$481.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$850.10
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$708.41
|
| Rate for Payer: PHP All Commercial |
$716.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$368.37
|
| Rate for Payer: Sagamore Health Network All Products |
$729.19
|
| Rate for Payer: Signature Care EPO |
$783.98
|
| Rate for Payer: Signature Care PPO |
$831.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$802.87
|
| Rate for Payer: United Healthcare Commercial |
$744.31
|
| Rate for Payer: United Healthcare Medicare |
$311.70
|
|
|
HC SN PL PLATE 3.5 4-H LOCK RECN
|
Facility
IP
|
$1,445.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,083.94 |
| Max. Negotiated Rate |
$1,344.08 |
| Rate for Payer: Aetna Commercial |
$1,248.70
|
| Rate for Payer: Cash Price |
$896.06
|
| Rate for Payer: Cigna All Commercial |
$1,247.25
|
| Rate for Payer: CORVEL All Commercial |
$1,344.08
|
| Rate for Payer: Coventry All Commercial |
$1,271.82
|
| Rate for Payer: Encore All Commercial |
$1,330.35
|
| Rate for Payer: Frontpath All Commercial |
$1,329.63
|
| Rate for Payer: Humana ChoiceCare |
$1,248.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,300.72
|
| Rate for Payer: PHCS All Commercial |
$1,083.94
|
| Rate for Payer: PHP All Commercial |
$1,096.08
|
| Rate for Payer: Sagamore Health Network All Products |
$1,115.73
|
| Rate for Payer: Signature Care EPO |
$1,199.56
|
| Rate for Payer: Signature Care PPO |
$1,271.82
|
| Rate for Payer: United Healthcare Commercial |
$1,138.86
|
|
|
HC SN PL PLATE 3.5 4-H LOCK RECN
|
Facility
OP
|
$1,445.25
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601764
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$476.93 |
| Max. Negotiated Rate |
$1,344.08 |
| Rate for Payer: Aetna Commercial |
$1,219.79
|
| Rate for Payer: Aetna Medicare |
$476.93
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$476.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$830.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$903.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$548.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$524.63
|
| Rate for Payer: Cash Price |
$896.06
|
| Rate for Payer: Cash Price |
$896.06
|
| Rate for Payer: Centivo All Commercial |
$737.08
|
| Rate for Payer: Cigna All Commercial |
$1,247.25
|
| Rate for Payer: CORVEL All Commercial |
$1,344.08
|
| Rate for Payer: Coventry All Commercial |
$1,271.82
|
| Rate for Payer: Encore All Commercial |
$1,330.35
|
| Rate for Payer: Frontpath All Commercial |
$1,329.63
|
| Rate for Payer: Humana ChoiceCare |
$1,248.26
|
| Rate for Payer: Humana Medicare |
$737.08
|
| Rate for Payer: Lucent All Commercial |
$737.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,300.72
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,083.94
|
| Rate for Payer: PHP All Commercial |
$1,096.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$563.65
|
| Rate for Payer: Sagamore Health Network All Products |
$1,115.73
|
| Rate for Payer: Signature Care EPO |
$1,199.56
|
| Rate for Payer: Signature Care PPO |
$1,271.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,228.46
|
| Rate for Payer: United Healthcare Commercial |
$1,138.86
|
| Rate for Payer: United Healthcare Medicare |
$476.93
|
|
|
HC SN PL PLATE 3.5 4-H LOCK TUB
|
Facility
IP
|
$1,023.12
|
|
| Hospital Charge Code |
41601376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$767.34 |
| Max. Negotiated Rate |
$951.50 |
| Rate for Payer: Aetna Commercial |
$883.98
|
| Rate for Payer: Cash Price |
$634.33
|
| Rate for Payer: Cigna All Commercial |
$882.95
|
| Rate for Payer: CORVEL All Commercial |
$951.50
|
| Rate for Payer: Coventry All Commercial |
$900.35
|
| Rate for Payer: Encore All Commercial |
$941.78
|
| Rate for Payer: Frontpath All Commercial |
$941.27
|
| Rate for Payer: Humana ChoiceCare |
$883.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$920.81
|
| Rate for Payer: PHCS All Commercial |
$767.34
|
| Rate for Payer: PHP All Commercial |
$775.93
|
| Rate for Payer: Sagamore Health Network All Products |
$789.85
|
| Rate for Payer: Signature Care EPO |
$849.19
|
| Rate for Payer: Signature Care PPO |
$900.35
|
| Rate for Payer: United Healthcare Commercial |
$806.22
|
|
|
HC SN PL PLATE 3.5 4-H LOCK TUB
|
Facility
OP
|
$1,023.12
|
|
| Hospital Charge Code |
41601376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.63 |
| Max. Negotiated Rate |
$951.50 |
| Rate for Payer: Aetna Commercial |
$863.51
|
| Rate for Payer: Aetna Medicare |
$337.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$337.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$587.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$639.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$388.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$371.39
|
| Rate for Payer: Cash Price |
$634.33
|
| Rate for Payer: Cash Price |
$634.33
|
| Rate for Payer: Centivo All Commercial |
$521.79
|
| Rate for Payer: Cigna All Commercial |
$882.95
|
| Rate for Payer: CORVEL All Commercial |
$951.50
|
| Rate for Payer: Coventry All Commercial |
$900.35
|
| Rate for Payer: Encore All Commercial |
$941.78
|
| Rate for Payer: Frontpath All Commercial |
$941.27
|
| Rate for Payer: Humana ChoiceCare |
$883.67
|
| Rate for Payer: Humana Medicare |
$521.79
|
| Rate for Payer: Lucent All Commercial |
$521.79
|
| Rate for Payer: Lutheran Preferred All Commercial |
$920.81
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$767.34
|
| Rate for Payer: PHP All Commercial |
$775.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$399.02
|
| Rate for Payer: Sagamore Health Network All Products |
$789.85
|
| Rate for Payer: Signature Care EPO |
$849.19
|
| Rate for Payer: Signature Care PPO |
$900.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$869.65
|
| Rate for Payer: United Healthcare Commercial |
$806.22
|
| Rate for Payer: United Healthcare Medicare |
$337.63
|
|
