|
HC CTA-ABDOMEN
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
1665175
|
|
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 |
$1,683.00
|
| 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-ABDOMEN
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 74175
|
| Hospital Charge Code |
1665175
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$203.04 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$897.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$203.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$869.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,610.91
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,753.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$203.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,032.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$987.36
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Centivo All Commercial |
$1,525.92
|
| 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 |
$897.60
|
| Rate for Payer: Lucent All Commercial |
$1,525.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: Managed Health Services Medicaid |
$203.04
|
| Rate for Payer: MDWise Medicaid |
$203.04
|
| 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 |
$897.60
|
|
|
HC CTA ABDOMEN & PELVIS
|
Facility
|
OP
|
$3,774.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
1669174
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$301.88 |
| Max. Negotiated Rate |
$3,509.82 |
| Rate for Payer: Aetna Commercial |
$3,185.26
|
| Rate for Payer: Aetna Medicare |
$1,207.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$301.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,169.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$301.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,388.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,328.45
|
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Centivo All Commercial |
$2,053.06
|
| 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 |
$1,207.68
|
| Rate for Payer: Lucent All Commercial |
$2,053.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,396.60
|
| Rate for Payer: Managed Health Services Medicaid |
$301.88
|
| Rate for Payer: MDWise Medicaid |
$301.88
|
| 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 |
$1,207.68
|
|
|
HC CTA ABDOMEN & PELVIS
|
Facility
|
IP
|
$3,774.00
|
|
|
Service Code
|
CPT 74174
|
| Hospital Charge Code |
1669174
|
|
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 |
$2,264.40
|
| 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 CTA-AORTA/BILATERAL LEGS
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
1665635
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$208.33 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$897.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$208.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$869.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$208.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,032.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$987.36
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Centivo All Commercial |
$1,525.92
|
| 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 |
$897.60
|
| Rate for Payer: Lucent All Commercial |
$1,525.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: Managed Health Services Medicaid |
$208.33
|
| Rate for Payer: MDWise Medicaid |
$208.33
|
| 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 |
$897.60
|
|
|
HC CTA-AORTA/BILATERAL LEGS
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 75635
|
| Hospital Charge Code |
1665635
|
|
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 |
$1,683.00
|
| 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 CT ABDOMEN W CONTRAST
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
1664160
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,529.23 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,761.68
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: PHCS All Commercial |
$1,529.23
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
|
|
HC CT ABDOMEN W CONTRAST
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 74160
|
| Hospital Charge Code |
1664160
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$122.78 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,720.90
|
| Rate for Payer: Aetna Medicare |
$652.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$122.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$632.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$122.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$750.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$717.72
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Cash Price |
$1,223.39
|
| Rate for Payer: Centivo All Commercial |
$1,109.21
|
| Rate for Payer: Cigna All Commercial |
$1,759.64
|
| Rate for Payer: CORVEL All Commercial |
$1,896.25
|
| Rate for Payer: Coventry All Commercial |
$1,794.30
|
| Rate for Payer: Encore All Commercial |
$1,876.88
|
| Rate for Payer: Frontpath All Commercial |
$1,875.86
|
| Rate for Payer: Humana ChoiceCare |
$1,761.07
|
| Rate for Payer: Humana Medicare |
$652.47
|
| Rate for Payer: Lucent All Commercial |
$1,109.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: Managed Health Services Medicaid |
$122.78
|
| Rate for Payer: MDWise Medicaid |
$122.78
|
| Rate for Payer: PHCS All Commercial |
$1,529.23
|
| Rate for Payer: PHP All Commercial |
$1,546.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$795.20
|
| Rate for Payer: Sagamore Health Network All Products |
$1,574.09
|
| Rate for Payer: Signature Care EPO |
$1,692.35
|
| Rate for Payer: Signature Care PPO |
$1,794.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,733.13
|
| Rate for Payer: United Healthcare Commercial |
$1,606.72
|
| Rate for Payer: United Healthcare Medicare |
$652.47
|
|
|
HC CT ABDOMEN W/O CONTRAST
|
Facility
|
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
1664150
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,300.50 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,498.18
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
|
|
HC CT ABDOMEN W/O CONTRAST
|
Facility
|
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 74150
|
| Hospital Charge Code |
1664150
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$65.81 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$554.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$65.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$537.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$995.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,083.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$65.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$638.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$610.37
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Centivo All Commercial |
$943.30
|
| Rate for Payer: Cigna All Commercial |
$1,496.44
|
| Rate for Payer: CORVEL All Commercial |
$1,612.62
|
| Rate for Payer: Coventry All Commercial |
$1,525.92
|
| Rate for Payer: Encore All Commercial |
$1,596.15
|
| Rate for Payer: Frontpath All Commercial |
$1,595.28
|
| Rate for Payer: Humana ChoiceCare |
$1,497.66
|
| Rate for Payer: Humana Medicare |
$554.88
|
| Rate for Payer: Lucent All Commercial |
$943.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,560.60
|
| Rate for Payer: Managed Health Services Medicaid |
$65.81
|
| Rate for Payer: MDWise Medicaid |
$65.81
|
| Rate for Payer: PHCS All Commercial |
$1,300.50
|
| Rate for Payer: PHP All Commercial |
$1,315.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$676.26
|
| Rate for Payer: Sagamore Health Network All Products |
$1,338.65
|
| Rate for Payer: Signature Care EPO |
$1,439.22
|
| Rate for Payer: Signature Care PPO |
$1,525.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,473.90
|
| Rate for Payer: United Healthcare Commercial |
$1,366.39
|
| Rate for Payer: United Healthcare Medicare |
$554.88
|
|
|
HC CT ABDOMEN W/WO CONTRAST
|
Facility
|
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
1664170
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$144.34 |
| Max. Negotiated Rate |
$2,798.37 |
| Rate for Payer: Aetna Commercial |
$2,539.60
|
| Rate for Payer: Aetna Medicare |
$962.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$144.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$932.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$144.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,107.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,059.17
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Cash Price |
$1,805.40
|
| Rate for Payer: Centivo All Commercial |
$1,636.90
|
| 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: Humana Medicare |
$962.88
|
| Rate for Payer: Lucent All Commercial |
$1,636.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,708.10
|
| Rate for Payer: Managed Health Services Medicaid |
$144.34
|
| Rate for Payer: MDWise Medicaid |
$144.34
|
| Rate for Payer: PHCS All Commercial |
$2,256.75
|
| Rate for Payer: PHP All Commercial |
$2,282.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,173.51
|
| 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: Three Rivers Preferred All Commercial |
$2,557.65
|
| Rate for Payer: United Healthcare Commercial |
$2,371.09
|
| Rate for Payer: United Healthcare Medicare |
$962.88
|
|
|
HC CT ABDOMEN W/WO CONTRAST
|
Facility
|
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 74170
|
| Hospital Charge Code |
1664170
|
|
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 |
$1,805.40
|
| 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 |
1664177
|
|
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 |
$1,958.40
|
| 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 |
1664177
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$162.17 |
| Max. Negotiated Rate |
$3,035.52 |
| Rate for Payer: Aetna Commercial |
$2,754.82
|
| Rate for Payer: Aetna Medicare |
$1,044.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$162.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,011.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$162.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,201.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,148.93
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Cash Price |
$1,958.40
|
| Rate for Payer: Centivo All Commercial |
$1,775.62
|
| 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 |
$1,044.48
|
| Rate for Payer: Lucent All Commercial |
$1,775.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,937.60
|
| Rate for Payer: Managed Health Services Medicaid |
$162.17
|
| Rate for Payer: MDWise Medicaid |
$162.17
|
| 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 |
$1,044.48
|
|
|
HC CT ABD & PELVIS W/O CONTRAST
|
Facility
|
OP
|
$2,448.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
1664176
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.84 |
| Max. Negotiated Rate |
$2,276.64 |
| Rate for Payer: Aetna Commercial |
$2,066.11
|
| Rate for Payer: Aetna Medicare |
$783.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$89.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$758.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$89.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$900.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$861.70
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Centivo All Commercial |
$1,331.71
|
| 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 |
$783.36
|
| Rate for Payer: Lucent All Commercial |
$1,331.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,203.20
|
| Rate for Payer: Managed Health Services Medicaid |
$89.84
|
| Rate for Payer: MDWise Medicaid |
$89.84
|
| 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 |
$783.36
|
|
|
HC CT ABD & PELVIS W/O CONTRAST
|
Facility
|
IP
|
$2,448.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
1664176
|
|
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 |
$1,468.80
|
| 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 |
1664178
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$192.64 |
| Max. Negotiated Rate |
$3,509.82 |
| Rate for Payer: Aetna Commercial |
$3,185.26
|
| Rate for Payer: Aetna Medicare |
$1,207.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$192.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,169.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$192.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,388.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,328.45
|
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Cash Price |
$2,264.40
|
| Rate for Payer: Centivo All Commercial |
$2,053.06
|
| 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 |
$1,207.68
|
| Rate for Payer: Lucent All Commercial |
$2,053.06
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,396.60
|
| Rate for Payer: Managed Health Services Medicaid |
$192.64
|
| Rate for Payer: MDWise Medicaid |
$192.64
|
| 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 |
$1,207.68
|
|
|
HC CT ABD & PELVIS W/WO CONTRAST
|
Facility
|
IP
|
$3,774.00
|
|
|
Service Code
|
CPT 74178
|
| Hospital Charge Code |
1664178
|
|
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 |
$2,264.40
|
| 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
|
IP
|
$2,448.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
1669176
|
|
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 |
$1,468.80
|
| 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 & PELV/STONE W/O CONTR
|
Facility
|
OP
|
$2,448.00
|
|
|
Service Code
|
CPT 74176
|
| Hospital Charge Code |
1669176
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$89.84 |
| Max. Negotiated Rate |
$2,276.64 |
| Rate for Payer: Aetna Commercial |
$2,066.11
|
| Rate for Payer: Aetna Medicare |
$783.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$89.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$758.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$89.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$900.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$861.70
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Cash Price |
$1,468.80
|
| Rate for Payer: Centivo All Commercial |
$1,331.71
|
| 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 |
$783.36
|
| Rate for Payer: Lucent All Commercial |
$1,331.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,203.20
|
| Rate for Payer: Managed Health Services Medicaid |
$89.84
|
| Rate for Payer: MDWise Medicaid |
$89.84
|
| 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 |
$783.36
|
|
|
HC CTA-CHEST
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
1661275
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$193.13 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$897.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$193.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$869.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$193.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,032.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$987.36
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Centivo All Commercial |
$1,525.92
|
| 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 |
$897.60
|
| Rate for Payer: Lucent All Commercial |
$1,525.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: Managed Health Services Medicaid |
$193.13
|
| Rate for Payer: MDWise Medicaid |
$193.13
|
| 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 |
$897.60
|
|
|
HC CTA-CHEST
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 71275
|
| Hospital Charge Code |
1661275
|
|
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 |
$1,683.00
|
| 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 |
1660496
|
|
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 |
$1,683.00
|
| 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 |
1660496
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$250.11 |
| Max. Negotiated Rate |
$2,608.65 |
| Rate for Payer: Aetna Commercial |
$2,367.42
|
| Rate for Payer: Aetna Medicare |
$897.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$250.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$869.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,267.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,267.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$250.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,032.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$987.36
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Cash Price |
$1,683.00
|
| Rate for Payer: Centivo All Commercial |
$1,525.92
|
| 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 |
$897.60
|
| Rate for Payer: Lucent All Commercial |
$1,525.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,524.50
|
| Rate for Payer: Managed Health Services Medicaid |
$250.11
|
| Rate for Payer: MDWise Medicaid |
$250.11
|
| 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 |
$897.60
|
|
|
HC CTA HEART (CONGENITAL)
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT 75573
|
| Hospital Charge Code |
1660150
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$188.43 |
| Max. Negotiated Rate |
$926.28 |
| Rate for Payer: Aetna Commercial |
$840.62
|
| Rate for Payer: Aetna Medicare |
$318.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$188.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$308.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$572.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$622.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$188.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$366.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$350.59
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Cash Price |
$597.60
|
| Rate for Payer: Centivo All Commercial |
$541.82
|
| Rate for Payer: Cigna All Commercial |
$859.55
|
| Rate for Payer: CORVEL All Commercial |
$926.28
|
| Rate for Payer: Coventry All Commercial |
$876.48
|
| Rate for Payer: Encore All Commercial |
$916.82
|
| Rate for Payer: Frontpath All Commercial |
$916.32
|
| Rate for Payer: Humana ChoiceCare |
$860.25
|
| Rate for Payer: Humana Medicare |
$318.72
|
| Rate for Payer: Lucent All Commercial |
$541.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$896.40
|
| Rate for Payer: Managed Health Services Medicaid |
$188.43
|
| Rate for Payer: MDWise Medicaid |
$188.43
|
| Rate for Payer: PHCS All Commercial |
$747.00
|
| Rate for Payer: PHP All Commercial |
$755.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$388.44
|
| Rate for Payer: Sagamore Health Network All Products |
$768.91
|
| Rate for Payer: Signature Care EPO |
$826.68
|
| Rate for Payer: Signature Care PPO |
$876.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$846.60
|
| Rate for Payer: United Healthcare Commercial |
$784.85
|
| Rate for Payer: United Healthcare Medicare |
$318.72
|
|
