|
HC CT ABDOMEN W/WO CONTRAST
|
Facility
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
01664170
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,256.75 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,599.78
|
| Rate for Payer: Cash Price |
$1,865.58
|
| Rate for Payer: Cigna All Commercial |
$2,596.77
|
| Rate for Payer: CORVEL All Commercial |
$2,798.37
|
| Rate for Payer: Coventry All Commercial |
$2,647.92
|
| Rate for Payer: Encore All Commercial |
$2,769.78
|
| Rate for Payer: Frontpath All Commercial |
$2,768.28
|
| Rate for Payer: Humana ChoiceCare |
$2,598.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Sagamore Health Network All Products |
$2,322.95
|
| Rate for Payer: Signature Care EPO |
$2,497.47
|
| Rate for Payer: Signature Care PPO |
$2,647.92
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
|
|
HC CT ABD & PELVIS W/CONTRAST
|
Facility
IP
|
$3,264.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
01664177
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,448.00 |
| Max. Negotiated Rate |
$3,035.52 |
| Rate for Payer: Aetna Commercial |
$2,820.10
|
| Rate for Payer: Cash Price |
$2,023.68
|
| Rate for Payer: Cigna All Commercial |
$2,816.83
|
| Rate for Payer: CORVEL All Commercial |
$3,035.52
|
| Rate for Payer: Coventry All Commercial |
$2,872.32
|
| Rate for Payer: Encore All Commercial |
$3,004.51
|
| Rate for Payer: Frontpath All Commercial |
$3,002.88
|
| Rate for Payer: Humana ChoiceCare |
$2,819.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,937.60
|
| Rate for Payer: PHCS All Commercial |
$2,448.00
|
| Rate for Payer: PHP All Commercial |
$2,475.42
|
| Rate for Payer: Sagamore Health Network All Products |
$2,519.81
|
| Rate for Payer: Signature Care EPO |
$2,709.12
|
| Rate for Payer: Signature Care PPO |
$2,872.32
|
| Rate for Payer: United Healthcare Commercial |
$2,572.03
|
|
|
HC CT ABD & PELVIS W/CONTRAST
|
Facility
OP
|
$3,264.00
|
|
|
Service Code
|
CPT 74177
|
| Hospital Charge Code |
01664177
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$632.46 |
| Max. Negotiated Rate |
$3,035.52 |
| Rate for Payer: Aetna Commercial |
$2,754.82
|
| Rate for Payer: Aetna Medicare |
$1,077.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,077.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$632.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,238.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,184.83
|
| Rate for Payer: Cash Price |
$2,023.68
|
| Rate for Payer: Cash Price |
$2,023.68
|
| Rate for Payer: Centivo All Commercial |
$1,664.64
|
| Rate for Payer: Cigna All Commercial |
$2,816.83
|
| Rate for Payer: CORVEL All Commercial |
$3,035.52
|
| Rate for Payer: Coventry All Commercial |
$2,872.32
|
| Rate for Payer: Encore All Commercial |
$3,004.51
|
| Rate for Payer: Frontpath All Commercial |
$3,002.88
|
| Rate for Payer: Humana ChoiceCare |
$2,819.12
|
| Rate for Payer: Humana Medicare |
$1,664.64
|
| Rate for Payer: Lucent All Commercial |
$1,664.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,937.60
|
| Rate for Payer: Managed Health Services Medicaid |
$632.46
|
| Rate for Payer: MDWise Medicaid |
$632.46
|
| Rate for Payer: PHCS All Commercial |
$2,448.00
|
| Rate for Payer: PHP All Commercial |
$2,475.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,272.96
|
| Rate for Payer: Sagamore Health Network All Products |
$2,519.81
|
| Rate for Payer: Signature Care EPO |
$2,709.12
|
| Rate for Payer: Signature Care PPO |
$2,872.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,774.40
|
| Rate for Payer: United Healthcare Commercial |
$2,572.03
|
| Rate for Payer: United Healthcare Medicare |
$1,077.12
|
|
|
HC CT ABD & PELVIS W/O CONTRAST
|
Facility
OP
|
$2,448.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
01664176
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$350.38 |
| Max. Negotiated Rate |
$2,276.64 |
| Rate for Payer: Aetna Commercial |
$2,066.11
|
| Rate for Payer: Aetna Medicare |
$807.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$807.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$350.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$929.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$888.62
|
| Rate for Payer: Cash Price |
$1,517.76
|
| Rate for Payer: Cash Price |
$1,517.76
|
| Rate for Payer: Centivo All Commercial |
$1,248.48
|
| Rate for Payer: Cigna All Commercial |
$2,112.62
|
| Rate for Payer: CORVEL All Commercial |
$2,276.64
|
| Rate for Payer: Coventry All Commercial |
$2,154.24
|
| Rate for Payer: Encore All Commercial |
$2,253.38
|
| Rate for Payer: Frontpath All Commercial |
$2,252.16
|
| Rate for Payer: Humana ChoiceCare |
$2,114.34
|
| Rate for Payer: Humana Medicare |
$1,248.48
|
| Rate for Payer: Lucent All Commercial |
$1,248.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,203.20
|
| Rate for Payer: Managed Health Services Medicaid |
$350.38
|
| Rate for Payer: MDWise Medicaid |
$350.38
|
| Rate for Payer: PHCS All Commercial |
$1,836.00
|
| Rate for Payer: PHP All Commercial |
$1,856.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$954.72
|
| Rate for Payer: Sagamore Health Network All Products |
$1,889.86
|
| Rate for Payer: Signature Care EPO |
$2,031.84
|
| Rate for Payer: Signature Care PPO |
$2,154.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,080.80
|
| Rate for Payer: United Healthcare Commercial |
$1,929.02
|
| Rate for Payer: United Healthcare Medicare |
$807.84
|
|
|
HC CT ABD & PELVIS W/O CONTRAST
|
Facility
IP
|
$2,448.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
01664176
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,836.00 |
| Max. Negotiated Rate |
$2,276.64 |
| Rate for Payer: Aetna Commercial |
$2,115.07
|
| Rate for Payer: Cash Price |
$1,517.76
|
| Rate for Payer: Cigna All Commercial |
$2,112.62
|
| Rate for Payer: CORVEL All Commercial |
$2,276.64
|
| Rate for Payer: Coventry All Commercial |
$2,154.24
|
| Rate for Payer: Encore All Commercial |
$2,253.38
|
| Rate for Payer: Frontpath All Commercial |
$2,252.16
|
| Rate for Payer: Humana ChoiceCare |
$2,114.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,203.20
|
| Rate for Payer: PHCS All Commercial |
$1,836.00
|
| Rate for Payer: PHP All Commercial |
$1,856.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,889.86
|
| Rate for Payer: Signature Care EPO |
$2,031.84
|
| Rate for Payer: Signature Care PPO |
$2,154.24
|
| Rate for Payer: United Healthcare Commercial |
$1,929.02
|
|
|
HC CT ABD & PELVIS W/WO CONTRAST
|
Facility
OP
|
$3,774.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
01664178
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$751.30 |
| Max. Negotiated Rate |
$3,509.82 |
| Rate for Payer: Aetna Commercial |
$3,185.26
|
| Rate for Payer: Aetna Medicare |
$1,245.42
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,245.42
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$751.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,432.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,369.96
|
| Rate for Payer: Cash Price |
$2,339.88
|
| Rate for Payer: Cash Price |
$2,339.88
|
| Rate for Payer: Centivo All Commercial |
$1,924.74
|
| Rate for Payer: Cigna All Commercial |
$3,256.96
|
| Rate for Payer: CORVEL All Commercial |
$3,509.82
|
| Rate for Payer: Coventry All Commercial |
$3,321.12
|
| Rate for Payer: Encore All Commercial |
$3,473.97
|
| Rate for Payer: Frontpath All Commercial |
$3,472.08
|
| Rate for Payer: Humana ChoiceCare |
$3,259.60
|
| Rate for Payer: Humana Medicare |
$1,924.74
|
| Rate for Payer: Lucent All Commercial |
$1,924.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,396.60
|
| Rate for Payer: Managed Health Services Medicaid |
$751.30
|
| Rate for Payer: MDWise Medicaid |
$751.30
|
| Rate for Payer: PHCS All Commercial |
$2,830.50
|
| Rate for Payer: PHP All Commercial |
$2,862.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,471.86
|
| Rate for Payer: Sagamore Health Network All Products |
$2,913.53
|
| Rate for Payer: Signature Care EPO |
$3,132.42
|
| Rate for Payer: Signature Care PPO |
$3,321.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,207.90
|
| Rate for Payer: United Healthcare Commercial |
$2,973.91
|
| Rate for Payer: United Healthcare Medicare |
$1,245.42
|
|
|
HC CT ABD & PELVIS W/WO CONTRAST
|
Facility
IP
|
$3,774.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
01664178
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,830.50 |
| Max. Negotiated Rate |
$3,509.82 |
| Rate for Payer: Aetna Commercial |
$3,260.74
|
| Rate for Payer: Cash Price |
$2,339.88
|
| Rate for Payer: Cigna All Commercial |
$3,256.96
|
| Rate for Payer: CORVEL All Commercial |
$3,509.82
|
| Rate for Payer: Coventry All Commercial |
$3,321.12
|
| Rate for Payer: Encore All Commercial |
$3,473.97
|
| Rate for Payer: Frontpath All Commercial |
$3,472.08
|
| Rate for Payer: Humana ChoiceCare |
$3,259.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,396.60
|
| Rate for Payer: PHCS All Commercial |
$2,830.50
|
| Rate for Payer: PHP All Commercial |
$2,862.20
|
| Rate for Payer: Sagamore Health Network All Products |
$2,913.53
|
| Rate for Payer: Signature Care EPO |
$3,132.42
|
| Rate for Payer: Signature Care PPO |
$3,321.12
|
| Rate for Payer: United Healthcare Commercial |
$2,973.91
|
|
|
HC CT ABD & PELV/STONE W/O CONTR
|
Facility
OP
|
$2,448.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
01669176
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$350.38 |
| Max. Negotiated Rate |
$2,276.64 |
| Rate for Payer: Aetna Commercial |
$2,066.11
|
| Rate for Payer: Aetna Medicare |
$807.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$807.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$350.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$929.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$888.62
|
| Rate for Payer: Cash Price |
$1,517.76
|
| Rate for Payer: Cash Price |
$1,517.76
|
| Rate for Payer: Centivo All Commercial |
$1,248.48
|
| Rate for Payer: Cigna All Commercial |
$2,112.62
|
| Rate for Payer: CORVEL All Commercial |
$2,276.64
|
| Rate for Payer: Coventry All Commercial |
$2,154.24
|
| Rate for Payer: Encore All Commercial |
$2,253.38
|
| Rate for Payer: Frontpath All Commercial |
$2,252.16
|
| Rate for Payer: Humana ChoiceCare |
$2,114.34
|
| Rate for Payer: Humana Medicare |
$1,248.48
|
| Rate for Payer: Lucent All Commercial |
$1,248.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,203.20
|
| Rate for Payer: Managed Health Services Medicaid |
$350.38
|
| Rate for Payer: MDWise Medicaid |
$350.38
|
| Rate for Payer: PHCS All Commercial |
$1,836.00
|
| Rate for Payer: PHP All Commercial |
$1,856.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$954.72
|
| Rate for Payer: Sagamore Health Network All Products |
$1,889.86
|
| Rate for Payer: Signature Care EPO |
$2,031.84
|
| Rate for Payer: Signature Care PPO |
$2,154.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,080.80
|
| Rate for Payer: United Healthcare Commercial |
$1,929.02
|
| Rate for Payer: United Healthcare Medicare |
$807.84
|
|
|
HC CT ABD & PELV/STONE W/O CONTR
|
Facility
IP
|
$2,448.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
01669176
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,836.00 |
| Max. Negotiated Rate |
$2,276.64 |
| Rate for Payer: Aetna Commercial |
$2,115.07
|
| Rate for Payer: Cash Price |
$1,517.76
|
| Rate for Payer: Cigna All Commercial |
$2,112.62
|
| Rate for Payer: CORVEL All Commercial |
$2,276.64
|
| Rate for Payer: Coventry All Commercial |
$2,154.24
|
| Rate for Payer: Encore All Commercial |
$2,253.38
|
| Rate for Payer: Frontpath All Commercial |
$2,252.16
|
| Rate for Payer: Humana ChoiceCare |
$2,114.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,203.20
|
| Rate for Payer: PHCS All Commercial |
$1,836.00
|
| Rate for Payer: PHP All Commercial |
$1,856.56
|
| Rate for Payer: Sagamore Health Network All Products |
$1,889.86
|
| Rate for Payer: Signature Care EPO |
$2,031.84
|
| Rate for Payer: Signature Care PPO |
$2,154.24
|
| Rate for Payer: United Healthcare Commercial |
$1,929.02
|
|
|
HC CTA-CHEST
|
Facility
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
01661275
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$753.21 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$753.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,064.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,018.22
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Centivo All Commercial |
$1,430.55
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Humana Medicare |
$1,430.55
|
| Rate for Payer: Lucent All Commercial |
$1,430.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: Managed Health Services Medicaid |
$753.21
|
| Rate for Payer: MDWise Medicaid |
$753.21
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,093.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,384.25
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
| Rate for Payer: United Healthcare Medicare |
$925.65
|
|
|
HC CTA-CHEST
|
Facility
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
01661275
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,103.75 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,423.52
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
|
|
HC CTA-HEAD
|
Facility
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
01660496
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$2,103.75 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,423.52
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
|
|
HC CTA-HEAD
|
Facility
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 70496
|
| Hospital Charge Code |
01660496
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$925.65 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$975.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,064.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,018.22
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Centivo All Commercial |
$1,430.55
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Humana Medicare |
$1,430.55
|
| Rate for Payer: Lucent All Commercial |
$1,430.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: Managed Health Services Medicaid |
$975.43
|
| Rate for Payer: MDWise Medicaid |
$975.43
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,093.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,384.25
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
| Rate for Payer: United Healthcare Medicare |
$925.65
|
|
|
HC CTA-LOWER EXTREMITY BILATERAL
|
Facility
OP
|
$4,564.50
|
|
|
Service Code
|
CPT 73706 50
|
| Hospital Charge Code |
21663706
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,506.28 |
| Max. Negotiated Rate |
$4,244.98 |
| Rate for Payer: Aetna Commercial |
$3,852.44
|
| Rate for Payer: Aetna Medicare |
$1,506.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,506.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,621.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,853.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,732.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,656.91
|
| Rate for Payer: Cash Price |
$2,829.99
|
| Rate for Payer: Centivo All Commercial |
$2,327.90
|
| Rate for Payer: Cigna All Commercial |
$3,939.16
|
| Rate for Payer: CORVEL All Commercial |
$4,244.98
|
| Rate for Payer: Coventry All Commercial |
$4,016.76
|
| Rate for Payer: Encore All Commercial |
$4,201.62
|
| Rate for Payer: Frontpath All Commercial |
$4,199.34
|
| Rate for Payer: Humana ChoiceCare |
$3,942.36
|
| Rate for Payer: Humana Medicare |
$2,327.90
|
| Rate for Payer: Lucent All Commercial |
$2,327.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,108.05
|
| Rate for Payer: PHCS All Commercial |
$3,423.38
|
| Rate for Payer: PHP All Commercial |
$3,461.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,780.16
|
| Rate for Payer: Sagamore Health Network All Products |
$3,523.79
|
| Rate for Payer: Signature Care EPO |
$3,788.54
|
| Rate for Payer: Signature Care PPO |
$4,016.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,879.82
|
| Rate for Payer: United Healthcare Commercial |
$3,596.83
|
| Rate for Payer: United Healthcare Medicare |
$1,506.28
|
|
|
HC CTA-LOWER EXTREMITY BILATERAL
|
Facility
IP
|
$4,564.50
|
|
|
Service Code
|
CPT 73706 50
|
| Hospital Charge Code |
21663706
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$3,423.38 |
| Max. Negotiated Rate |
$4,244.98 |
| Rate for Payer: Aetna Commercial |
$3,943.73
|
| Rate for Payer: Cash Price |
$2,829.99
|
| Rate for Payer: Cigna All Commercial |
$3,939.16
|
| Rate for Payer: CORVEL All Commercial |
$4,244.98
|
| Rate for Payer: Coventry All Commercial |
$4,016.76
|
| Rate for Payer: Encore All Commercial |
$4,201.62
|
| Rate for Payer: Frontpath All Commercial |
$4,199.34
|
| Rate for Payer: Humana ChoiceCare |
$3,942.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$4,108.05
|
| Rate for Payer: PHCS All Commercial |
$3,423.38
|
| Rate for Payer: PHP All Commercial |
$3,461.72
|
| Rate for Payer: Sagamore Health Network All Products |
$3,523.79
|
| Rate for Payer: Signature Care EPO |
$3,788.54
|
| Rate for Payer: Signature Care PPO |
$4,016.76
|
| Rate for Payer: United Healthcare Commercial |
$3,596.83
|
|
|
HC CTA-LOWER EXTREMITY LEFT
|
Facility
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 73706 LT
|
| Hospital Charge Code |
01663706
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,103.75 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,423.52
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
|
|
HC CTA-LOWER EXTREMITY LEFT
|
Facility
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 73706 LT
|
| Hospital Charge Code |
01663706
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$925.65 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,610.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,753.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,064.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,018.22
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Centivo All Commercial |
$1,430.55
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Humana Medicare |
$1,430.55
|
| Rate for Payer: Lucent All Commercial |
$1,430.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,093.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,384.25
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
| Rate for Payer: United Healthcare Medicare |
$925.65
|
|
|
HC CTA-LOWER EXTREMITY RIGHT
|
Facility
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 73706 RT
|
| Hospital Charge Code |
11663706
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$925.65 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,610.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,753.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,064.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,018.22
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Centivo All Commercial |
$1,430.55
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Humana Medicare |
$1,430.55
|
| Rate for Payer: Lucent All Commercial |
$1,430.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,093.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,384.25
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
| Rate for Payer: United Healthcare Medicare |
$925.65
|
|
|
HC CTA-LOWER EXTREMITY RIGHT
|
Facility
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 73706 RT
|
| Hospital Charge Code |
11663706
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,103.75 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,423.52
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
|
|
HC CTA-NECK
|
Facility
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
01660498
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$925.65 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,177.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,177.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,022.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,064.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,018.22
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Centivo All Commercial |
$1,430.55
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Humana Medicare |
$1,430.55
|
| Rate for Payer: Lucent All Commercial |
$1,430.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: Managed Health Services Medicaid |
$1,022.78
|
| Rate for Payer: MDWise Medicaid |
$1,022.78
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,093.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,384.25
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
| Rate for Payer: United Healthcare Medicare |
$925.65
|
|
|
HC CTA-NECK
|
Facility
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 70498
|
| Hospital Charge Code |
01660498
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$2,103.75 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,423.52
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
|
|
HC CTA-PELVIS
|
Facility
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
01662191
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,103.75 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,423.52
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
|
|
HC CTA-PELVIS
|
Facility
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 72191
|
| Hospital Charge Code |
01662191
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$809.25 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,610.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,753.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$809.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,064.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,018.22
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Centivo All Commercial |
$1,430.55
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Humana Medicare |
$1,430.55
|
| Rate for Payer: Lucent All Commercial |
$1,430.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: Managed Health Services Medicaid |
$809.25
|
| Rate for Payer: MDWise Medicaid |
$809.25
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,093.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,384.25
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
| Rate for Payer: United Healthcare Medicare |
$925.65
|
|
|
HC CTA-UPPER EXTREMITY LEFT
|
Facility
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 73206 LT
|
| Hospital Charge Code |
01663206
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$925.65 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$925.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,610.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,753.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,064.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,018.22
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Centivo All Commercial |
$1,430.55
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Humana Medicare |
$1,430.55
|
| Rate for Payer: Lucent All Commercial |
$1,430.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,093.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,384.25
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
| Rate for Payer: United Healthcare Medicare |
$925.65
|
|
|
HC CTA-UPPER EXTREMITY LEFT
|
Facility
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 73206 LT
|
| Hospital Charge Code |
01663206
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$2,103.75 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,423.52
|
| Rate for Payer: Cash Price |
$1,739.10
|
| Rate for Payer: Cigna All Commercial |
$2,420.72
|
| Rate for Payer: CORVEL All Commercial |
$2,608.65
|
| Rate for Payer: Coventry All Commercial |
$2,468.40
|
| Rate for Payer: Encore All Commercial |
$2,582.00
|
| Rate for Payer: Frontpath All Commercial |
$2,580.60
|
| Rate for Payer: Humana ChoiceCare |
$2,422.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: PHCS All Commercial |
$2,103.75
|
| Rate for Payer: PHP All Commercial |
$2,127.31
|
| Rate for Payer: Sagamore Health Network All Products |
$2,165.46
|
| Rate for Payer: Signature Care EPO |
$2,328.15
|
| Rate for Payer: Signature Care PPO |
$2,468.40
|
| Rate for Payer: United Healthcare Commercial |
$2,210.34
|
|
