|
HC SN PL PLATE 3.5 5-H COMP
|
Facility
OP
|
$964.32
|
|
| Hospital Charge Code |
41601774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$318.23 |
| Max. Negotiated Rate |
$896.82 |
| Rate for Payer: Aetna Commercial |
$813.89
|
| Rate for Payer: Aetna Medicare |
$318.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$318.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$553.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$602.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$365.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$350.05
|
| Rate for Payer: Cash Price |
$597.88
|
| Rate for Payer: Cash Price |
$597.88
|
| Rate for Payer: Centivo All Commercial |
$491.80
|
| Rate for Payer: Cigna All Commercial |
$832.21
|
| Rate for Payer: CORVEL All Commercial |
$896.82
|
| Rate for Payer: Coventry All Commercial |
$848.60
|
| Rate for Payer: Encore All Commercial |
$887.66
|
| Rate for Payer: Frontpath All Commercial |
$887.17
|
| Rate for Payer: Humana ChoiceCare |
$832.88
|
| Rate for Payer: Humana Medicare |
$491.80
|
| Rate for Payer: Lucent All Commercial |
$491.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$867.89
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$723.24
|
| Rate for Payer: PHP All Commercial |
$731.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$376.08
|
| Rate for Payer: Sagamore Health Network All Products |
$744.46
|
| Rate for Payer: Signature Care EPO |
$800.39
|
| Rate for Payer: Signature Care PPO |
$848.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$819.67
|
| Rate for Payer: United Healthcare Commercial |
$759.88
|
| Rate for Payer: United Healthcare Medicare |
$318.23
|
|
|
HC SN PL PLATE 3.5 5-H COMP
|
Facility
IP
|
$964.32
|
|
| Hospital Charge Code |
41601774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$723.24 |
| Max. Negotiated Rate |
$896.82 |
| Rate for Payer: Aetna Commercial |
$833.17
|
| Rate for Payer: Cash Price |
$597.88
|
| Rate for Payer: Cigna All Commercial |
$832.21
|
| Rate for Payer: CORVEL All Commercial |
$896.82
|
| Rate for Payer: Coventry All Commercial |
$848.60
|
| Rate for Payer: Encore All Commercial |
$887.66
|
| Rate for Payer: Frontpath All Commercial |
$887.17
|
| Rate for Payer: Humana ChoiceCare |
$832.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$867.89
|
| Rate for Payer: PHCS All Commercial |
$723.24
|
| Rate for Payer: PHP All Commercial |
$731.34
|
| Rate for Payer: Sagamore Health Network All Products |
$744.46
|
| Rate for Payer: Signature Care EPO |
$800.39
|
| Rate for Payer: Signature Care PPO |
$848.60
|
| Rate for Payer: United Healthcare Commercial |
$759.88
|
|
|
HC SN PL PLATE 3.5 5-H PROX HUM L
|
Facility
IP
|
$5,399.57
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.68 |
| Max. Negotiated Rate |
$5,021.60 |
| Rate for Payer: Aetna Commercial |
$4,665.23
|
| Rate for Payer: Cash Price |
$3,347.73
|
| Rate for Payer: Cigna All Commercial |
$4,659.83
|
| Rate for Payer: CORVEL All Commercial |
$5,021.60
|
| Rate for Payer: Coventry All Commercial |
$4,751.62
|
| Rate for Payer: Encore All Commercial |
$4,970.30
|
| Rate for Payer: Frontpath All Commercial |
$4,967.60
|
| Rate for Payer: Humana ChoiceCare |
$4,663.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,859.61
|
| Rate for Payer: PHCS All Commercial |
$4,049.68
|
| Rate for Payer: PHP All Commercial |
$4,095.03
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.47
|
| Rate for Payer: Signature Care EPO |
$4,481.64
|
| Rate for Payer: Signature Care PPO |
$4,751.62
|
| Rate for Payer: United Healthcare Commercial |
$4,254.86
|
|
|
HC SN PL PLATE 3.5 5-H PROX HUM L
|
Facility
OP
|
$5,399.57
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,021.60 |
| Rate for Payer: Aetna Commercial |
$4,557.24
|
| Rate for Payer: Aetna Medicare |
$1,781.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,781.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,100.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,375.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,049.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,960.04
|
| Rate for Payer: Cash Price |
$3,347.73
|
| Rate for Payer: Cash Price |
$3,347.73
|
| Rate for Payer: Centivo All Commercial |
$2,753.78
|
| Rate for Payer: Cigna All Commercial |
$4,659.83
|
| Rate for Payer: CORVEL All Commercial |
$5,021.60
|
| Rate for Payer: Coventry All Commercial |
$4,751.62
|
| Rate for Payer: Encore All Commercial |
$4,970.30
|
| Rate for Payer: Frontpath All Commercial |
$4,967.60
|
| Rate for Payer: Humana ChoiceCare |
$4,663.61
|
| Rate for Payer: Humana Medicare |
$2,753.78
|
| Rate for Payer: Lucent All Commercial |
$2,753.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,859.61
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,049.68
|
| Rate for Payer: PHP All Commercial |
$4,095.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,105.83
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.47
|
| Rate for Payer: Signature Care EPO |
$4,481.64
|
| Rate for Payer: Signature Care PPO |
$4,751.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,589.63
|
| Rate for Payer: United Healthcare Commercial |
$4,254.86
|
| Rate for Payer: United Healthcare Medicare |
$1,781.86
|
|
|
HC SN PL PLATE 3.5 5-H PROX HUM R
|
Facility
OP
|
$5,399.57
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$5,021.60 |
| Rate for Payer: Aetna Commercial |
$4,557.24
|
| Rate for Payer: Aetna Medicare |
$1,781.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,781.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3,100.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3,375.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2,049.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,960.04
|
| Rate for Payer: Cash Price |
$3,347.73
|
| Rate for Payer: Cash Price |
$3,347.73
|
| Rate for Payer: Centivo All Commercial |
$2,753.78
|
| Rate for Payer: Cigna All Commercial |
$4,659.83
|
| Rate for Payer: CORVEL All Commercial |
$5,021.60
|
| Rate for Payer: Coventry All Commercial |
$4,751.62
|
| Rate for Payer: Encore All Commercial |
$4,970.30
|
| Rate for Payer: Frontpath All Commercial |
$4,967.60
|
| Rate for Payer: Humana ChoiceCare |
$4,663.61
|
| Rate for Payer: Humana Medicare |
$2,753.78
|
| Rate for Payer: Lucent All Commercial |
$2,753.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,859.61
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$4,049.68
|
| Rate for Payer: PHP All Commercial |
$4,095.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2,105.83
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.47
|
| Rate for Payer: Signature Care EPO |
$4,481.64
|
| Rate for Payer: Signature Care PPO |
$4,751.62
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,589.63
|
| Rate for Payer: United Healthcare Commercial |
$4,254.86
|
| Rate for Payer: United Healthcare Medicare |
$1,781.86
|
|
|
HC SN PL PLATE 3.5 5-H PROX HUM R
|
Facility
IP
|
$5,399.57
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41603466
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,049.68 |
| Max. Negotiated Rate |
$5,021.60 |
| Rate for Payer: Aetna Commercial |
$4,665.23
|
| Rate for Payer: Cash Price |
$3,347.73
|
| Rate for Payer: Cigna All Commercial |
$4,659.83
|
| Rate for Payer: CORVEL All Commercial |
$5,021.60
|
| Rate for Payer: Coventry All Commercial |
$4,751.62
|
| Rate for Payer: Encore All Commercial |
$4,970.30
|
| Rate for Payer: Frontpath All Commercial |
$4,967.60
|
| Rate for Payer: Humana ChoiceCare |
$4,663.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,859.61
|
| Rate for Payer: PHCS All Commercial |
$4,049.68
|
| Rate for Payer: PHP All Commercial |
$4,095.03
|
| Rate for Payer: Sagamore Health Network All Products |
$4,168.47
|
| Rate for Payer: Signature Care EPO |
$4,481.64
|
| Rate for Payer: Signature Care PPO |
$4,751.62
|
| Rate for Payer: United Healthcare Commercial |
$4,254.86
|
|
|
HC SN PL PLATE 3.5 5-H VLP
|
Facility
OP
|
$3,331.58
|
|
| Hospital Charge Code |
41602511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$3,098.37 |
| Rate for Payer: Aetna Commercial |
$2,811.85
|
| Rate for Payer: Aetna Medicare |
$1,099.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,099.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,913.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,082.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,264.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,209.36
|
| Rate for Payer: Cash Price |
$2,065.58
|
| Rate for Payer: Cash Price |
$2,065.58
|
| Rate for Payer: Centivo All Commercial |
$1,699.11
|
| Rate for Payer: Cigna All Commercial |
$2,875.15
|
| Rate for Payer: CORVEL All Commercial |
$3,098.37
|
| Rate for Payer: Coventry All Commercial |
$2,931.79
|
| Rate for Payer: Encore All Commercial |
$3,066.72
|
| Rate for Payer: Frontpath All Commercial |
$3,065.05
|
| Rate for Payer: Humana ChoiceCare |
$2,877.49
|
| Rate for Payer: Humana Medicare |
$1,699.11
|
| Rate for Payer: Lucent All Commercial |
$1,699.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,998.42
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$2,498.68
|
| Rate for Payer: PHP All Commercial |
$2,526.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,299.32
|
| Rate for Payer: Sagamore Health Network All Products |
$2,571.98
|
| Rate for Payer: Signature Care EPO |
$2,765.21
|
| Rate for Payer: Signature Care PPO |
$2,931.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,831.84
|
| Rate for Payer: United Healthcare Commercial |
$2,625.29
|
| Rate for Payer: United Healthcare Medicare |
$1,099.42
|
|
|
HC SN PL PLATE 3.5 5-H VLP
|
Facility
IP
|
$3,331.58
|
|
| Hospital Charge Code |
41602511
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,498.68 |
| Max. Negotiated Rate |
$3,098.37 |
| Rate for Payer: Aetna Commercial |
$2,878.49
|
| Rate for Payer: Cash Price |
$2,065.58
|
| Rate for Payer: Cigna All Commercial |
$2,875.15
|
| Rate for Payer: CORVEL All Commercial |
$3,098.37
|
| Rate for Payer: Coventry All Commercial |
$2,931.79
|
| Rate for Payer: Encore All Commercial |
$3,066.72
|
| Rate for Payer: Frontpath All Commercial |
$3,065.05
|
| Rate for Payer: Humana ChoiceCare |
$2,877.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,998.42
|
| Rate for Payer: PHCS All Commercial |
$2,498.68
|
| Rate for Payer: PHP All Commercial |
$2,526.67
|
| Rate for Payer: Sagamore Health Network All Products |
$2,571.98
|
| Rate for Payer: Signature Care EPO |
$2,765.21
|
| Rate for Payer: Signature Care PPO |
$2,931.79
|
| Rate for Payer: United Healthcare Commercial |
$2,625.29
|
|
|
HC SN PL PLATE 3.5 6-H COMP
|
Facility
IP
|
$712.32
|
|
| Hospital Charge Code |
41601775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$662.46 |
| Rate for Payer: Aetna Commercial |
$615.44
|
| Rate for Payer: Cash Price |
$441.64
|
| Rate for Payer: Cigna All Commercial |
$614.73
|
| Rate for Payer: CORVEL All Commercial |
$662.46
|
| Rate for Payer: Coventry All Commercial |
$626.84
|
| Rate for Payer: Encore All Commercial |
$655.69
|
| Rate for Payer: Frontpath All Commercial |
$655.33
|
| Rate for Payer: Humana ChoiceCare |
$615.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$641.09
|
| Rate for Payer: PHCS All Commercial |
$534.24
|
| Rate for Payer: PHP All Commercial |
$540.22
|
| Rate for Payer: Sagamore Health Network All Products |
$549.91
|
| Rate for Payer: Signature Care EPO |
$591.23
|
| Rate for Payer: Signature Care PPO |
$626.84
|
| Rate for Payer: United Healthcare Commercial |
$561.31
|
|
|
HC SN PL PLATE 3.5 6-H COMP
|
Facility
OP
|
$712.32
|
|
| Hospital Charge Code |
41601775
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.07 |
| Max. Negotiated Rate |
$662.46 |
| Rate for Payer: Aetna Commercial |
$601.20
|
| Rate for Payer: Aetna Medicare |
$235.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$235.07
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$409.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$445.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$270.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$258.57
|
| Rate for Payer: Cash Price |
$441.64
|
| Rate for Payer: Cash Price |
$441.64
|
| Rate for Payer: Centivo All Commercial |
$363.28
|
| Rate for Payer: Cigna All Commercial |
$614.73
|
| Rate for Payer: CORVEL All Commercial |
$662.46
|
| Rate for Payer: Coventry All Commercial |
$626.84
|
| Rate for Payer: Encore All Commercial |
$655.69
|
| Rate for Payer: Frontpath All Commercial |
$655.33
|
| Rate for Payer: Humana ChoiceCare |
$615.23
|
| Rate for Payer: Humana Medicare |
$363.28
|
| Rate for Payer: Lucent All Commercial |
$363.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$641.09
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$534.24
|
| Rate for Payer: PHP All Commercial |
$540.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$277.80
|
| Rate for Payer: Sagamore Health Network All Products |
$549.91
|
| Rate for Payer: Signature Care EPO |
$591.23
|
| Rate for Payer: Signature Care PPO |
$626.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$605.47
|
| Rate for Payer: United Healthcare Commercial |
$561.31
|
| Rate for Payer: United Healthcare Medicare |
$235.07
|
|
|
HC SN PL PLATE 3.5 6-H LOCK COMP
|
Facility
IP
|
$1,069.05
|
|
| Hospital Charge Code |
41601780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$801.79 |
| Max. Negotiated Rate |
$994.22 |
| Rate for Payer: Aetna Commercial |
$923.66
|
| Rate for Payer: Cash Price |
$662.81
|
| Rate for Payer: Cigna All Commercial |
$922.59
|
| Rate for Payer: CORVEL All Commercial |
$994.22
|
| Rate for Payer: Coventry All Commercial |
$940.76
|
| Rate for Payer: Encore All Commercial |
$984.06
|
| Rate for Payer: Frontpath All Commercial |
$983.53
|
| Rate for Payer: Humana ChoiceCare |
$923.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$962.14
|
| Rate for Payer: PHCS All Commercial |
$801.79
|
| Rate for Payer: PHP All Commercial |
$810.77
|
| Rate for Payer: Sagamore Health Network All Products |
$825.31
|
| Rate for Payer: Signature Care EPO |
$887.31
|
| Rate for Payer: Signature Care PPO |
$940.76
|
| Rate for Payer: United Healthcare Commercial |
$842.41
|
|
|
HC SN PL PLATE 3.5 6-H LOCK COMP
|
Facility
OP
|
$1,069.05
|
|
| Hospital Charge Code |
41601780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.79 |
| Max. Negotiated Rate |
$994.22 |
| Rate for Payer: Aetna Commercial |
$902.28
|
| Rate for Payer: Aetna Medicare |
$352.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$352.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$613.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$668.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$405.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$388.07
|
| Rate for Payer: Cash Price |
$662.81
|
| Rate for Payer: Cash Price |
$662.81
|
| Rate for Payer: Centivo All Commercial |
$545.22
|
| Rate for Payer: Cigna All Commercial |
$922.59
|
| Rate for Payer: CORVEL All Commercial |
$994.22
|
| Rate for Payer: Coventry All Commercial |
$940.76
|
| Rate for Payer: Encore All Commercial |
$984.06
|
| Rate for Payer: Frontpath All Commercial |
$983.53
|
| Rate for Payer: Humana ChoiceCare |
$923.34
|
| Rate for Payer: Humana Medicare |
$545.22
|
| Rate for Payer: Lucent All Commercial |
$545.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$962.14
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$801.79
|
| Rate for Payer: PHP All Commercial |
$810.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$416.93
|
| Rate for Payer: Sagamore Health Network All Products |
$825.31
|
| Rate for Payer: Signature Care EPO |
$887.31
|
| Rate for Payer: Signature Care PPO |
$940.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$908.69
|
| Rate for Payer: United Healthcare Commercial |
$842.41
|
| Rate for Payer: United Healthcare Medicare |
$352.79
|
|
|
HC SN PL PLATE 3.5 6-H LOCK RECN
|
Facility
IP
|
$1,686.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,264.61 |
| Max. Negotiated Rate |
$1,568.12 |
| Rate for Payer: Aetna Commercial |
$1,456.83
|
| Rate for Payer: Cash Price |
$1,045.41
|
| Rate for Payer: Cigna All Commercial |
$1,455.15
|
| Rate for Payer: CORVEL All Commercial |
$1,568.12
|
| Rate for Payer: Coventry All Commercial |
$1,483.81
|
| Rate for Payer: Encore All Commercial |
$1,552.10
|
| Rate for Payer: Frontpath All Commercial |
$1,551.26
|
| Rate for Payer: Humana ChoiceCare |
$1,456.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,517.54
|
| Rate for Payer: PHCS All Commercial |
$1,264.61
|
| Rate for Payer: PHP All Commercial |
$1,278.78
|
| Rate for Payer: Sagamore Health Network All Products |
$1,301.71
|
| Rate for Payer: Signature Care EPO |
$1,399.50
|
| Rate for Payer: Signature Care PPO |
$1,483.81
|
| Rate for Payer: United Healthcare Commercial |
$1,328.69
|
|
|
HC SN PL PLATE 3.5 6-H LOCK RECN
|
Facility
OP
|
$1,686.15
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601765
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$1,568.12 |
| Rate for Payer: Aetna Commercial |
$1,423.11
|
| Rate for Payer: Aetna Medicare |
$556.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$556.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$968.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,054.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$639.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$612.07
|
| Rate for Payer: Cash Price |
$1,045.41
|
| Rate for Payer: Cash Price |
$1,045.41
|
| Rate for Payer: Centivo All Commercial |
$859.94
|
| Rate for Payer: Cigna All Commercial |
$1,455.15
|
| Rate for Payer: CORVEL All Commercial |
$1,568.12
|
| Rate for Payer: Coventry All Commercial |
$1,483.81
|
| Rate for Payer: Encore All Commercial |
$1,552.10
|
| Rate for Payer: Frontpath All Commercial |
$1,551.26
|
| Rate for Payer: Humana ChoiceCare |
$1,456.33
|
| Rate for Payer: Humana Medicare |
$859.94
|
| Rate for Payer: Lucent All Commercial |
$859.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,517.54
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$1,264.61
|
| Rate for Payer: PHP All Commercial |
$1,278.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$657.60
|
| Rate for Payer: Sagamore Health Network All Products |
$1,301.71
|
| Rate for Payer: Signature Care EPO |
$1,399.50
|
| Rate for Payer: Signature Care PPO |
$1,483.81
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,433.23
|
| Rate for Payer: United Healthcare Commercial |
$1,328.69
|
| Rate for Payer: United Healthcare Medicare |
$556.43
|
|
|
HC SN PL PLATE 3.5 6-H LOCK TUB
|
Facility
IP
|
$1,023.12
|
|
| Hospital Charge Code |
41601377
|
|
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 6-H LOCK TUB
|
Facility
OP
|
$1,023.12
|
|
| Hospital Charge Code |
41601377
|
|
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
|
|
|
HC SN PL PLATE 3.5 7-H COMP
|
Facility
OP
|
$1,044.26
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$344.61 |
| Max. Negotiated Rate |
$971.16 |
| Rate for Payer: Aetna Commercial |
$881.36
|
| Rate for Payer: Aetna Medicare |
$344.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$344.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$599.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$652.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$396.30
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$379.07
|
| Rate for Payer: Cash Price |
$647.44
|
| Rate for Payer: Cash Price |
$647.44
|
| Rate for Payer: Centivo All Commercial |
$532.57
|
| Rate for Payer: Cigna All Commercial |
$901.20
|
| Rate for Payer: CORVEL All Commercial |
$971.16
|
| Rate for Payer: Coventry All Commercial |
$918.95
|
| Rate for Payer: Encore All Commercial |
$961.24
|
| Rate for Payer: Frontpath All Commercial |
$960.72
|
| Rate for Payer: Humana ChoiceCare |
$901.93
|
| Rate for Payer: Humana Medicare |
$532.57
|
| Rate for Payer: Lucent All Commercial |
$532.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$939.83
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$783.20
|
| Rate for Payer: PHP All Commercial |
$791.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$407.26
|
| Rate for Payer: Sagamore Health Network All Products |
$806.17
|
| Rate for Payer: Signature Care EPO |
$866.74
|
| Rate for Payer: Signature Care PPO |
$918.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$887.62
|
| Rate for Payer: United Healthcare Commercial |
$822.88
|
| Rate for Payer: United Healthcare Medicare |
$344.61
|
|
|
HC SN PL PLATE 3.5 7-H COMP
|
Facility
IP
|
$1,044.26
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601375
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$783.20 |
| Max. Negotiated Rate |
$971.16 |
| Rate for Payer: Aetna Commercial |
$902.24
|
| Rate for Payer: Cash Price |
$647.44
|
| Rate for Payer: Cigna All Commercial |
$901.20
|
| Rate for Payer: CORVEL All Commercial |
$971.16
|
| Rate for Payer: Coventry All Commercial |
$918.95
|
| Rate for Payer: Encore All Commercial |
$961.24
|
| Rate for Payer: Frontpath All Commercial |
$960.72
|
| Rate for Payer: Humana ChoiceCare |
$901.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$939.83
|
| Rate for Payer: PHCS All Commercial |
$783.20
|
| Rate for Payer: PHP All Commercial |
$791.97
|
| Rate for Payer: Sagamore Health Network All Products |
$806.17
|
| Rate for Payer: Signature Care EPO |
$866.74
|
| Rate for Payer: Signature Care PPO |
$918.95
|
| Rate for Payer: United Healthcare Commercial |
$822.88
|
|
|
HC SN PL PLATE 3.5 7-H LOCK COMP
|
Facility
OP
|
$1,023.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$337.61 |
| Max. Negotiated Rate |
$951.44 |
| Rate for Payer: Aetna Commercial |
$863.45
|
| Rate for Payer: Aetna Medicare |
$337.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$337.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$587.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$639.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$388.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$371.37
|
| Rate for Payer: Cash Price |
$634.29
|
| Rate for Payer: Cash Price |
$634.29
|
| Rate for Payer: Centivo All Commercial |
$521.76
|
| Rate for Payer: Cigna All Commercial |
$882.89
|
| Rate for Payer: CORVEL All Commercial |
$951.44
|
| Rate for Payer: Coventry All Commercial |
$900.28
|
| Rate for Payer: Encore All Commercial |
$941.72
|
| Rate for Payer: Frontpath All Commercial |
$941.21
|
| Rate for Payer: Humana ChoiceCare |
$883.61
|
| Rate for Payer: Humana Medicare |
$521.76
|
| Rate for Payer: Lucent All Commercial |
$521.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$920.74
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$767.29
|
| Rate for Payer: PHP All Commercial |
$775.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$398.99
|
| Rate for Payer: Sagamore Health Network All Products |
$789.79
|
| Rate for Payer: Signature Care EPO |
$849.13
|
| Rate for Payer: Signature Care PPO |
$900.28
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$869.59
|
| Rate for Payer: United Healthcare Commercial |
$806.16
|
| Rate for Payer: United Healthcare Medicare |
$337.61
|
|
|
HC SN PL PLATE 3.5 7-H LOCK COMP
|
Facility
IP
|
$1,023.05
|
|
|
Service Code
|
CPT C1713
|
| Hospital Charge Code |
41601781
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$767.29 |
| Max. Negotiated Rate |
$951.44 |
| Rate for Payer: Aetna Commercial |
$883.92
|
| Rate for Payer: Cash Price |
$634.29
|
| Rate for Payer: Cigna All Commercial |
$882.89
|
| Rate for Payer: CORVEL All Commercial |
$951.44
|
| Rate for Payer: Coventry All Commercial |
$900.28
|
| Rate for Payer: Encore All Commercial |
$941.72
|
| Rate for Payer: Frontpath All Commercial |
$941.21
|
| Rate for Payer: Humana ChoiceCare |
$883.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$920.74
|
| Rate for Payer: PHCS All Commercial |
$767.29
|
| Rate for Payer: PHP All Commercial |
$775.88
|
| Rate for Payer: Sagamore Health Network All Products |
$789.79
|
| Rate for Payer: Signature Care EPO |
$849.13
|
| Rate for Payer: Signature Care PPO |
$900.28
|
| Rate for Payer: United Healthcare Commercial |
$806.16
|
|
|
HC SN PL PLATE 3.5 7-H LOCK TUB
|
Facility
OP
|
$1,043.84
|
|
| Hospital Charge Code |
41601769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$344.47 |
| Max. Negotiated Rate |
$970.77 |
| Rate for Payer: Aetna Commercial |
$881.00
|
| Rate for Payer: Aetna Medicare |
$344.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$344.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$599.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$652.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$396.14
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$378.91
|
| Rate for Payer: Cash Price |
$647.18
|
| Rate for Payer: Cash Price |
$647.18
|
| Rate for Payer: Centivo All Commercial |
$532.36
|
| Rate for Payer: Cigna All Commercial |
$900.83
|
| Rate for Payer: CORVEL All Commercial |
$970.77
|
| Rate for Payer: Coventry All Commercial |
$918.58
|
| Rate for Payer: Encore All Commercial |
$960.85
|
| Rate for Payer: Frontpath All Commercial |
$960.33
|
| Rate for Payer: Humana ChoiceCare |
$901.56
|
| Rate for Payer: Humana Medicare |
$532.36
|
| Rate for Payer: Lucent All Commercial |
$532.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$939.46
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$782.88
|
| Rate for Payer: PHP All Commercial |
$791.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$407.10
|
| Rate for Payer: Sagamore Health Network All Products |
$805.84
|
| Rate for Payer: Signature Care EPO |
$866.39
|
| Rate for Payer: Signature Care PPO |
$918.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$887.26
|
| Rate for Payer: United Healthcare Commercial |
$822.55
|
| Rate for Payer: United Healthcare Medicare |
$344.47
|
|
|
HC SN PL PLATE 3.5 7-H LOCK TUB
|
Facility
IP
|
$1,043.84
|
|
| Hospital Charge Code |
41601769
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$782.88 |
| Max. Negotiated Rate |
$970.77 |
| Rate for Payer: Aetna Commercial |
$901.88
|
| Rate for Payer: Cash Price |
$647.18
|
| Rate for Payer: Cigna All Commercial |
$900.83
|
| Rate for Payer: CORVEL All Commercial |
$970.77
|
| Rate for Payer: Coventry All Commercial |
$918.58
|
| Rate for Payer: Encore All Commercial |
$960.85
|
| Rate for Payer: Frontpath All Commercial |
$960.33
|
| Rate for Payer: Humana ChoiceCare |
$901.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$939.46
|
| Rate for Payer: PHCS All Commercial |
$782.88
|
| Rate for Payer: PHP All Commercial |
$791.65
|
| Rate for Payer: Sagamore Health Network All Products |
$805.84
|
| Rate for Payer: Signature Care EPO |
$866.39
|
| Rate for Payer: Signature Care PPO |
$918.58
|
| Rate for Payer: United Healthcare Commercial |
$822.55
|
|
|
HC SN PL PLATE 3.5 8-H COMP
|
Facility
OP
|
$784.35
|
|
| Hospital Charge Code |
41601776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$258.84 |
| Max. Negotiated Rate |
$729.45 |
| Rate for Payer: Aetna Commercial |
$661.99
|
| Rate for Payer: Aetna Medicare |
$258.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$258.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$450.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$490.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$297.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$284.72
|
| Rate for Payer: Cash Price |
$486.30
|
| Rate for Payer: Cash Price |
$486.30
|
| Rate for Payer: Centivo All Commercial |
$400.02
|
| Rate for Payer: Cigna All Commercial |
$676.89
|
| Rate for Payer: CORVEL All Commercial |
$729.45
|
| Rate for Payer: Coventry All Commercial |
$690.23
|
| Rate for Payer: Encore All Commercial |
$721.99
|
| Rate for Payer: Frontpath All Commercial |
$721.60
|
| Rate for Payer: Humana ChoiceCare |
$677.44
|
| Rate for Payer: Humana Medicare |
$400.02
|
| Rate for Payer: Lucent All Commercial |
$400.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$705.92
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$588.26
|
| Rate for Payer: PHP All Commercial |
$594.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$305.90
|
| Rate for Payer: Sagamore Health Network All Products |
$605.52
|
| Rate for Payer: Signature Care EPO |
$651.01
|
| Rate for Payer: Signature Care PPO |
$690.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$666.70
|
| Rate for Payer: United Healthcare Commercial |
$618.07
|
| Rate for Payer: United Healthcare Medicare |
$258.84
|
|
|
HC SN PL PLATE 3.5 8-H COMP
|
Facility
IP
|
$784.35
|
|
| Hospital Charge Code |
41601776
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.26 |
| Max. Negotiated Rate |
$729.45 |
| Rate for Payer: Aetna Commercial |
$677.68
|
| Rate for Payer: Cash Price |
$486.30
|
| Rate for Payer: Cigna All Commercial |
$676.89
|
| Rate for Payer: CORVEL All Commercial |
$729.45
|
| Rate for Payer: Coventry All Commercial |
$690.23
|
| Rate for Payer: Encore All Commercial |
$721.99
|
| Rate for Payer: Frontpath All Commercial |
$721.60
|
| Rate for Payer: Humana ChoiceCare |
$677.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$705.92
|
| Rate for Payer: PHCS All Commercial |
$588.26
|
| Rate for Payer: PHP All Commercial |
$594.85
|
| Rate for Payer: Sagamore Health Network All Products |
$605.52
|
| Rate for Payer: Signature Care EPO |
$651.01
|
| Rate for Payer: Signature Care PPO |
$690.23
|
| Rate for Payer: United Healthcare Commercial |
$618.07
|
|
|
HC SN PL PLATE 3.5 8-H LOCK COMP
|
Facility
OP
|
$1,174.60
|
|
| Hospital Charge Code |
41601782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$387.62 |
| Max. Negotiated Rate |
$1,092.38 |
| Rate for Payer: Aetna Commercial |
$991.36
|
| Rate for Payer: Aetna Medicare |
$387.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$387.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$674.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$734.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$445.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$426.38
|
| Rate for Payer: Cash Price |
$728.25
|
| Rate for Payer: Cash Price |
$728.25
|
| Rate for Payer: Centivo All Commercial |
$599.05
|
| Rate for Payer: Cigna All Commercial |
$1,013.68
|
| Rate for Payer: CORVEL All Commercial |
$1,092.38
|
| Rate for Payer: Coventry All Commercial |
$1,033.65
|
| Rate for Payer: Encore All Commercial |
$1,081.22
|
| Rate for Payer: Frontpath All Commercial |
$1,080.63
|
| Rate for Payer: Humana ChoiceCare |
$1,014.50
|
| Rate for Payer: Humana Medicare |
$599.05
|
| Rate for Payer: Lucent All Commercial |
$599.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,057.14
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$880.95
|
| Rate for Payer: PHP All Commercial |
$890.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$458.09
|
| Rate for Payer: Sagamore Health Network All Products |
$906.79
|
| Rate for Payer: Signature Care EPO |
$974.92
|
| Rate for Payer: Signature Care PPO |
$1,033.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$998.41
|
| Rate for Payer: United Healthcare Commercial |
$925.58
|
| Rate for Payer: United Healthcare Medicare |
$387.62
|
|
