|
HC CT CERVICAL SPINE W/O CONTRAST
|
Facility
|
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
1662148
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$99.00 |
| 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 |
$99.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$537.54
|
| 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 |
$99.00
|
| 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 |
$99.00
|
| Rate for Payer: MDWise Medicaid |
$99.00
|
| 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 CERVICAL SPINE W/O CONTRAST
|
Facility
|
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
1662148
|
|
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 CERVICAL SPINE W/WO CON
|
Facility
|
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
1662127
|
|
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 CERVICAL SPINE W/WO CON
|
Facility
|
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
1662127
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$154.24 |
| 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 |
$154.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$932.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,728.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,880.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$154.24
|
| 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 |
$154.24
|
| Rate for Payer: MDWise Medicaid |
$154.24
|
| 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 CHEST W/CONTRAST
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
1661260
|
|
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 CHEST W/CONTRAST
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
1661260
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$123.28 |
| 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 |
$123.28
|
| 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 |
$123.28
|
| 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 |
$123.28
|
| Rate for Payer: MDWise Medicaid |
$123.28
|
| 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 CHEST W/O CONTRAST
|
Facility
|
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
1661250
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$97.76 |
| 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 |
$97.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$537.54
|
| 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 |
$97.76
|
| 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 |
$97.76
|
| Rate for Payer: MDWise Medicaid |
$97.76
|
| 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 CHEST W/O CONTRAST
|
Facility
|
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 71250
|
| Hospital Charge Code |
1661250
|
|
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 CHEST W/WO CONTRAST
|
Facility
|
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
1661270
|
|
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 CHEST W/WO CONTRAST
|
Facility
|
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 71270
|
| Hospital Charge Code |
1661270
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$153.25 |
| 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 |
$153.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$932.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,728.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,880.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$153.25
|
| 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 |
$153.25
|
| Rate for Payer: MDWise Medicaid |
$153.25
|
| 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 DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS
|
Facility
|
OP
|
$3,605.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
1668222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,106.60 |
| Max. Negotiated Rate |
$3,352.65 |
| Rate for Payer: Aetna Commercial |
$3,042.62
|
| Rate for Payer: Aetna Medicare |
$1,153.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1,106.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,117.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,070.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,253.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$1,106.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,326.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,268.96
|
| Rate for Payer: Cash Price |
$2,163.00
|
| Rate for Payer: Cash Price |
$2,163.00
|
| Rate for Payer: Centivo All Commercial |
$1,961.12
|
| Rate for Payer: Cigna All Commercial |
$3,111.11
|
| Rate for Payer: CORVEL All Commercial |
$3,352.65
|
| Rate for Payer: Coventry All Commercial |
$3,172.40
|
| Rate for Payer: Encore All Commercial |
$3,318.40
|
| Rate for Payer: Frontpath All Commercial |
$3,316.60
|
| Rate for Payer: Humana ChoiceCare |
$3,113.64
|
| Rate for Payer: Humana Medicare |
$1,153.60
|
| Rate for Payer: Lucent All Commercial |
$1,961.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,244.50
|
| Rate for Payer: Managed Health Services Medicaid |
$1,106.60
|
| Rate for Payer: MDWise Medicaid |
$1,106.60
|
| Rate for Payer: PHCS All Commercial |
$2,703.75
|
| Rate for Payer: PHP All Commercial |
$2,734.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,405.95
|
| Rate for Payer: Sagamore Health Network All Products |
$2,783.06
|
| Rate for Payer: Signature Care EPO |
$2,992.15
|
| Rate for Payer: Signature Care PPO |
$3,172.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,064.25
|
| Rate for Payer: United Healthcare Commercial |
$2,840.74
|
| Rate for Payer: United Healthcare Medicare |
$1,153.60
|
|
|
HC CT DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS
|
Facility
|
IP
|
$3,605.00
|
|
|
Service Code
|
CPT 38222
|
| Hospital Charge Code |
1668222
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,703.75 |
| Max. Negotiated Rate |
$3,352.65 |
| Rate for Payer: Aetna Commercial |
$3,114.72
|
| Rate for Payer: Cash Price |
$2,163.00
|
| Rate for Payer: Cigna All Commercial |
$3,111.11
|
| Rate for Payer: CORVEL All Commercial |
$3,352.65
|
| Rate for Payer: Coventry All Commercial |
$3,172.40
|
| Rate for Payer: Encore All Commercial |
$3,318.40
|
| Rate for Payer: Frontpath All Commercial |
$3,316.60
|
| Rate for Payer: Humana ChoiceCare |
$3,113.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,244.50
|
| Rate for Payer: PHCS All Commercial |
$2,703.75
|
| Rate for Payer: PHP All Commercial |
$2,734.03
|
| Rate for Payer: Sagamore Health Network All Products |
$2,783.06
|
| Rate for Payer: Signature Care EPO |
$2,992.15
|
| Rate for Payer: Signature Care PPO |
$3,172.40
|
| Rate for Payer: United Healthcare Commercial |
$2,840.74
|
|
|
HC CT FACE W/CONTRAST
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
1660463
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$128.98 |
| 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 |
$128.98
|
| 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 |
$128.98
|
| 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 |
$128.98
|
| Rate for Payer: MDWise Medicaid |
$128.98
|
| 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 FACE W/CONTRAST
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
1660463
|
|
Hospital Revenue Code
|
351
|
| 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 FACE W/O CONTRAST
|
Facility
|
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
1660453
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$104.21 |
| 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 |
$104.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$537.54
|
| 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 |
$104.21
|
| 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 |
$104.21
|
| Rate for Payer: MDWise Medicaid |
$104.21
|
| 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 FACE W/O CONTRAST
|
Facility
|
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
1660453
|
|
Hospital Revenue Code
|
351
|
| 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 FACE W/WO CONTRAST
|
Facility
|
IP
|
$3,009.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
1660473
|
|
Hospital Revenue Code
|
351
|
| 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 FACE W/WO CONTRAST
|
Facility
|
OP
|
$3,009.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
1660473
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$159.20 |
| 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 |
$159.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$932.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,728.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,880.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$159.20
|
| 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 |
$159.20
|
| Rate for Payer: MDWise Medicaid |
$159.20
|
| 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 GUIDANCE-RADIATION THERAPY
|
Facility
|
IP
|
$1,909.44
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
1546370
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,432.08 |
| Max. Negotiated Rate |
$1,775.78 |
| Rate for Payer: Aetna Commercial |
$1,649.76
|
| Rate for Payer: Cash Price |
$1,145.66
|
| Rate for Payer: Cigna All Commercial |
$1,647.85
|
| Rate for Payer: CORVEL All Commercial |
$1,775.78
|
| Rate for Payer: Coventry All Commercial |
$1,680.31
|
| Rate for Payer: Encore All Commercial |
$1,757.64
|
| Rate for Payer: Frontpath All Commercial |
$1,756.68
|
| Rate for Payer: Humana ChoiceCare |
$1,649.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,718.50
|
| Rate for Payer: PHCS All Commercial |
$1,432.08
|
| Rate for Payer: PHP All Commercial |
$1,448.12
|
| Rate for Payer: Sagamore Health Network All Products |
$1,474.09
|
| Rate for Payer: Signature Care EPO |
$1,584.84
|
| Rate for Payer: Signature Care PPO |
$1,680.31
|
| Rate for Payer: United Healthcare Commercial |
$1,504.64
|
|
|
HC CT GUIDANCE-RADIATION THERAPY
|
Facility
|
OP
|
$1,909.44
|
|
|
Service Code
|
CPT 77014
|
| Hospital Charge Code |
1546370
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$55.16 |
| Max. Negotiated Rate |
$1,775.78 |
| Rate for Payer: Aetna Commercial |
$1,611.57
|
| Rate for Payer: Aetna Medicare |
$611.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$55.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$591.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,096.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,193.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$55.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$702.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$672.12
|
| Rate for Payer: Cash Price |
$1,145.66
|
| Rate for Payer: Cash Price |
$1,145.66
|
| Rate for Payer: Centivo All Commercial |
$1,038.74
|
| Rate for Payer: Cigna All Commercial |
$1,647.85
|
| Rate for Payer: CORVEL All Commercial |
$1,775.78
|
| Rate for Payer: Coventry All Commercial |
$1,680.31
|
| Rate for Payer: Encore All Commercial |
$1,757.64
|
| Rate for Payer: Frontpath All Commercial |
$1,756.68
|
| Rate for Payer: Humana ChoiceCare |
$1,649.18
|
| Rate for Payer: Humana Medicare |
$611.02
|
| Rate for Payer: Lucent All Commercial |
$1,038.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,718.50
|
| Rate for Payer: Managed Health Services Medicaid |
$55.16
|
| Rate for Payer: MDWise Medicaid |
$55.16
|
| Rate for Payer: PHCS All Commercial |
$1,432.08
|
| Rate for Payer: PHP All Commercial |
$1,448.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$744.68
|
| Rate for Payer: Sagamore Health Network All Products |
$1,474.09
|
| Rate for Payer: Signature Care EPO |
$1,584.84
|
| Rate for Payer: Signature Care PPO |
$1,680.31
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,623.02
|
| Rate for Payer: United Healthcare Commercial |
$1,504.64
|
| Rate for Payer: United Healthcare Medicare |
$611.02
|
|
|
HC CT GUIDE BIOPSY COMP
|
Facility
|
IP
|
$1,901.12
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1666361
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$1,425.84 |
| Max. Negotiated Rate |
$1,768.04 |
| Rate for Payer: Aetna Commercial |
$1,642.57
|
| Rate for Payer: Cash Price |
$1,140.67
|
| Rate for Payer: Cigna All Commercial |
$1,640.67
|
| Rate for Payer: CORVEL All Commercial |
$1,768.04
|
| Rate for Payer: Coventry All Commercial |
$1,672.99
|
| Rate for Payer: Encore All Commercial |
$1,749.98
|
| Rate for Payer: Frontpath All Commercial |
$1,749.03
|
| Rate for Payer: Humana ChoiceCare |
$1,642.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,711.01
|
| Rate for Payer: PHCS All Commercial |
$1,425.84
|
| Rate for Payer: PHP All Commercial |
$1,441.81
|
| Rate for Payer: Sagamore Health Network All Products |
$1,467.66
|
| Rate for Payer: Signature Care EPO |
$1,577.93
|
| Rate for Payer: Signature Care PPO |
$1,672.99
|
| Rate for Payer: United Healthcare Commercial |
$1,498.08
|
|
|
HC CT GUIDE BIOPSY COMP
|
Facility
|
OP
|
$1,901.12
|
|
|
Service Code
|
CPT 77012
|
| Hospital Charge Code |
1666361
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$49.46 |
| Max. Negotiated Rate |
$1,768.04 |
| Rate for Payer: Aetna Commercial |
$1,604.55
|
| Rate for Payer: Aetna Medicare |
$608.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$49.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$589.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,091.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,188.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$49.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$699.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$669.19
|
| Rate for Payer: Cash Price |
$1,140.67
|
| Rate for Payer: Cash Price |
$1,140.67
|
| Rate for Payer: Centivo All Commercial |
$1,034.21
|
| Rate for Payer: Cigna All Commercial |
$1,640.67
|
| Rate for Payer: CORVEL All Commercial |
$1,768.04
|
| Rate for Payer: Coventry All Commercial |
$1,672.99
|
| Rate for Payer: Encore All Commercial |
$1,749.98
|
| Rate for Payer: Frontpath All Commercial |
$1,749.03
|
| Rate for Payer: Humana ChoiceCare |
$1,642.00
|
| Rate for Payer: Humana Medicare |
$608.36
|
| Rate for Payer: Lucent All Commercial |
$1,034.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,711.01
|
| Rate for Payer: Managed Health Services Medicaid |
$49.46
|
| Rate for Payer: MDWise Medicaid |
$49.46
|
| Rate for Payer: PHCS All Commercial |
$1,425.84
|
| Rate for Payer: PHP All Commercial |
$1,441.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$741.44
|
| Rate for Payer: Sagamore Health Network All Products |
$1,467.66
|
| Rate for Payer: Signature Care EPO |
$1,577.93
|
| Rate for Payer: Signature Care PPO |
$1,672.99
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,615.95
|
| Rate for Payer: United Healthcare Commercial |
$1,498.08
|
| Rate for Payer: United Healthcare Medicare |
$608.36
|
|
|
HC CT HEAD SCAN W/CONTRAST
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
1660460
|
|
Hospital Revenue Code
|
351
|
| 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 HEAD SCAN W/CONTRAST
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 70460
|
| Hospital Charge Code |
1660460
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$78.44 |
| 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 |
$78.44
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$632.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,170.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,274.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$78.44
|
| 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 |
$78.44
|
| Rate for Payer: MDWise Medicaid |
$78.44
|
| 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 HEAD SCAN W/O CONTRAST
|
Facility
|
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 70450
|
| Hospital Charge Code |
1660450
|
|
Hospital Revenue Code
|
351
|
| Min. Negotiated Rate |
$56.64 |
| 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 |
$56.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$537.54
|
| 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 |
$56.64
|
| 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 |
$56.64
|
| Rate for Payer: MDWise Medicaid |
$56.64
|
| 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
|
|
