|
HC MRI-ABDOMEN W/WO CONTRAST
|
Facility
|
IP
|
$2,652.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
1574183
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$2,466.36 |
| Rate for Payer: Aetna Commercial |
$2,291.33
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cigna All Commercial |
$2,288.68
|
| Rate for Payer: CORVEL All Commercial |
$2,466.36
|
| Rate for Payer: Coventry All Commercial |
$2,333.76
|
| Rate for Payer: Encore All Commercial |
$2,441.17
|
| Rate for Payer: Frontpath All Commercial |
$2,439.84
|
| Rate for Payer: Humana ChoiceCare |
$2,290.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,386.80
|
| Rate for Payer: PHCS All Commercial |
$1,989.00
|
| Rate for Payer: PHP All Commercial |
$2,011.28
|
| Rate for Payer: Sagamore Health Network All Products |
$2,047.34
|
| Rate for Payer: Signature Care EPO |
$2,201.16
|
| Rate for Payer: Signature Care PPO |
$2,333.76
|
| Rate for Payer: United Healthcare Commercial |
$2,089.78
|
|
|
HC MRI-ABDOMEN W/WO CONTRAST
|
Facility
|
OP
|
$2,652.00
|
|
|
Service Code
|
CPT 74183
|
| Hospital Charge Code |
1574183
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$283.55 |
| Max. Negotiated Rate |
$2,466.36 |
| Rate for Payer: Aetna Commercial |
$2,238.29
|
| Rate for Payer: Aetna Medicare |
$848.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$283.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$822.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,705.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,705.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$283.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$975.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$933.50
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Centivo All Commercial |
$1,442.69
|
| Rate for Payer: Cigna All Commercial |
$2,288.68
|
| Rate for Payer: CORVEL All Commercial |
$2,466.36
|
| Rate for Payer: Coventry All Commercial |
$2,333.76
|
| Rate for Payer: Encore All Commercial |
$2,441.17
|
| Rate for Payer: Frontpath All Commercial |
$2,439.84
|
| Rate for Payer: Humana ChoiceCare |
$2,290.53
|
| Rate for Payer: Humana Medicare |
$848.64
|
| Rate for Payer: Lucent All Commercial |
$1,442.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,386.80
|
| Rate for Payer: Managed Health Services Medicaid |
$283.55
|
| Rate for Payer: MDWise Medicaid |
$283.55
|
| Rate for Payer: PHCS All Commercial |
$1,989.00
|
| Rate for Payer: PHP All Commercial |
$2,011.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,034.28
|
| Rate for Payer: Sagamore Health Network All Products |
$2,047.34
|
| Rate for Payer: Signature Care EPO |
$2,201.16
|
| Rate for Payer: Signature Care PPO |
$2,333.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,254.20
|
| Rate for Payer: United Healthcare Commercial |
$2,089.78
|
| Rate for Payer: United Healthcare Medicare |
$848.64
|
|
|
HC MRI-BRAIN W/CONTRAST
|
Facility
|
IP
|
$2,244.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
1570552
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,683.00 |
| Max. Negotiated Rate |
$2,086.92 |
| Rate for Payer: Aetna Commercial |
$1,938.82
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cigna All Commercial |
$1,936.57
|
| Rate for Payer: CORVEL All Commercial |
$2,086.92
|
| Rate for Payer: Coventry All Commercial |
$1,974.72
|
| Rate for Payer: Encore All Commercial |
$2,065.60
|
| Rate for Payer: Frontpath All Commercial |
$2,064.48
|
| Rate for Payer: Humana ChoiceCare |
$1,938.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,019.60
|
| Rate for Payer: PHCS All Commercial |
$1,683.00
|
| Rate for Payer: PHP All Commercial |
$1,701.85
|
| Rate for Payer: Sagamore Health Network All Products |
$1,732.37
|
| Rate for Payer: Signature Care EPO |
$1,862.52
|
| Rate for Payer: Signature Care PPO |
$1,974.72
|
| Rate for Payer: United Healthcare Commercial |
$1,768.27
|
|
|
HC MRI-BRAIN W/CONTRAST
|
Facility
|
OP
|
$2,244.00
|
|
|
Service Code
|
CPT 70552
|
| Hospital Charge Code |
1570552
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$169.60 |
| Max. Negotiated Rate |
$2,086.92 |
| Rate for Payer: Aetna Commercial |
$1,893.94
|
| Rate for Payer: Aetna Medicare |
$718.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$169.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$695.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,288.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,402.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$169.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$825.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$789.89
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Cash Price |
$1,346.40
|
| Rate for Payer: Centivo All Commercial |
$1,220.74
|
| Rate for Payer: Cigna All Commercial |
$1,936.57
|
| Rate for Payer: CORVEL All Commercial |
$2,086.92
|
| Rate for Payer: Coventry All Commercial |
$1,974.72
|
| Rate for Payer: Encore All Commercial |
$2,065.60
|
| Rate for Payer: Frontpath All Commercial |
$2,064.48
|
| Rate for Payer: Humana ChoiceCare |
$1,938.14
|
| Rate for Payer: Humana Medicare |
$718.08
|
| Rate for Payer: Lucent All Commercial |
$1,220.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,019.60
|
| Rate for Payer: Managed Health Services Medicaid |
$169.60
|
| Rate for Payer: MDWise Medicaid |
$169.60
|
| Rate for Payer: PHCS All Commercial |
$1,683.00
|
| Rate for Payer: PHP All Commercial |
$1,701.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$875.16
|
| Rate for Payer: Sagamore Health Network All Products |
$1,732.37
|
| Rate for Payer: Signature Care EPO |
$1,862.52
|
| Rate for Payer: Signature Care PPO |
$1,974.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,907.40
|
| Rate for Payer: United Healthcare Commercial |
$1,768.27
|
| Rate for Payer: United Healthcare Medicare |
$718.08
|
|
|
HC MRI-BRAIN W/O CONTRAST
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
1570551
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$119.07 |
| 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 |
$119.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$632.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,705.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,705.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$119.07
|
| 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 |
$119.07
|
| Rate for Payer: MDWise Medicaid |
$119.07
|
| 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 MRI-BRAIN W/O CONTRAST
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 70551
|
| Hospital Charge Code |
1570551
|
|
Hospital Revenue Code
|
611
|
| 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 MRI BRAIN WO CONTRAST LTD
|
Facility
|
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 70551 52
|
| Hospital Charge Code |
1575251
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$1,705.00 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$554.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$119.07
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$537.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,705.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,705.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$119.07
|
| 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 |
$119.07
|
| Rate for Payer: MDWise Medicaid |
$119.07
|
| 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 MRI BRAIN WO CONTRAST LTD
|
Facility
|
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 70551 52
|
| Hospital Charge Code |
1575251
|
|
Hospital Revenue Code
|
611
|
| 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 MRI-BRAIN W/WO CONTRAST
|
Facility
|
OP
|
$2,652.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
1570553
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$193.88 |
| Max. Negotiated Rate |
$2,466.36 |
| Rate for Payer: Aetna Commercial |
$2,238.29
|
| Rate for Payer: Aetna Medicare |
$848.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$193.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$822.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,705.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,705.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$193.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$975.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$933.50
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Centivo All Commercial |
$1,442.69
|
| Rate for Payer: Cigna All Commercial |
$2,288.68
|
| Rate for Payer: CORVEL All Commercial |
$2,466.36
|
| Rate for Payer: Coventry All Commercial |
$2,333.76
|
| Rate for Payer: Encore All Commercial |
$2,441.17
|
| Rate for Payer: Frontpath All Commercial |
$2,439.84
|
| Rate for Payer: Humana ChoiceCare |
$2,290.53
|
| Rate for Payer: Humana Medicare |
$848.64
|
| Rate for Payer: Lucent All Commercial |
$1,442.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,386.80
|
| Rate for Payer: Managed Health Services Medicaid |
$193.88
|
| Rate for Payer: MDWise Medicaid |
$193.88
|
| Rate for Payer: PHCS All Commercial |
$1,989.00
|
| Rate for Payer: PHP All Commercial |
$2,011.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,034.28
|
| Rate for Payer: Sagamore Health Network All Products |
$2,047.34
|
| Rate for Payer: Signature Care EPO |
$2,201.16
|
| Rate for Payer: Signature Care PPO |
$2,333.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,254.20
|
| Rate for Payer: United Healthcare Commercial |
$2,089.78
|
| Rate for Payer: United Healthcare Medicare |
$848.64
|
|
|
HC MRI-BRAIN W/WO CONTRAST
|
Facility
|
IP
|
$2,652.00
|
|
|
Service Code
|
CPT 70553
|
| Hospital Charge Code |
1570553
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$1,989.00 |
| Max. Negotiated Rate |
$2,466.36 |
| Rate for Payer: Aetna Commercial |
$2,291.33
|
| Rate for Payer: Cash Price |
$1,591.20
|
| Rate for Payer: Cigna All Commercial |
$2,288.68
|
| Rate for Payer: CORVEL All Commercial |
$2,466.36
|
| Rate for Payer: Coventry All Commercial |
$2,333.76
|
| Rate for Payer: Encore All Commercial |
$2,441.17
|
| Rate for Payer: Frontpath All Commercial |
$2,439.84
|
| Rate for Payer: Humana ChoiceCare |
$2,290.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,386.80
|
| Rate for Payer: PHCS All Commercial |
$1,989.00
|
| Rate for Payer: PHP All Commercial |
$2,011.28
|
| Rate for Payer: Sagamore Health Network All Products |
$2,047.34
|
| Rate for Payer: Signature Care EPO |
$2,201.16
|
| Rate for Payer: Signature Care PPO |
$2,333.76
|
| Rate for Payer: United Healthcare Commercial |
$2,089.78
|
|
|
HC MRI BREAST BILATERAL WO CON
|
Facility
|
OP
|
$4,335.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
1578907
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$230.56 |
| Max. Negotiated Rate |
$4,031.55 |
| Rate for Payer: Aetna Commercial |
$3,658.74
|
| Rate for Payer: Aetna Medicare |
$1,387.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$230.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,343.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,489.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,709.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$230.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,595.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,525.92
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Centivo All Commercial |
$2,358.24
|
| Rate for Payer: Cigna All Commercial |
$3,741.11
|
| Rate for Payer: CORVEL All Commercial |
$4,031.55
|
| Rate for Payer: Coventry All Commercial |
$3,814.80
|
| Rate for Payer: Encore All Commercial |
$3,990.37
|
| Rate for Payer: Frontpath All Commercial |
$3,988.20
|
| Rate for Payer: Humana ChoiceCare |
$3,744.14
|
| Rate for Payer: Humana Medicare |
$1,387.20
|
| Rate for Payer: Lucent All Commercial |
$2,358.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,901.50
|
| Rate for Payer: Managed Health Services Medicaid |
$230.56
|
| Rate for Payer: MDWise Medicaid |
$230.56
|
| Rate for Payer: PHCS All Commercial |
$3,251.25
|
| Rate for Payer: PHP All Commercial |
$3,287.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,690.65
|
| Rate for Payer: Sagamore Health Network All Products |
$3,346.62
|
| Rate for Payer: Signature Care EPO |
$3,598.05
|
| Rate for Payer: Signature Care PPO |
$3,814.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,684.75
|
| Rate for Payer: United Healthcare Commercial |
$3,415.98
|
| Rate for Payer: United Healthcare Medicare |
$1,387.20
|
|
|
HC MRI BREAST BILATERAL WO CON
|
Facility
|
OP
|
$4,335.00
|
|
|
Service Code
|
CPT C8907
|
| Hospital Charge Code |
1578907
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,343.85 |
| Max. Negotiated Rate |
$4,031.55 |
| Rate for Payer: Aetna Commercial |
$3,658.74
|
| Rate for Payer: Aetna Medicare |
$1,387.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,343.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,489.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,709.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,595.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,525.92
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Centivo All Commercial |
$2,358.24
|
| Rate for Payer: Cigna All Commercial |
$3,741.11
|
| Rate for Payer: CORVEL All Commercial |
$4,031.55
|
| Rate for Payer: Coventry All Commercial |
$3,814.80
|
| Rate for Payer: Encore All Commercial |
$3,990.37
|
| Rate for Payer: Frontpath All Commercial |
$3,988.20
|
| Rate for Payer: Humana ChoiceCare |
$3,744.14
|
| Rate for Payer: Humana Medicare |
$1,387.20
|
| Rate for Payer: Lucent All Commercial |
$2,358.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,901.50
|
| Rate for Payer: PHCS All Commercial |
$3,251.25
|
| Rate for Payer: PHP All Commercial |
$3,287.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,690.65
|
| Rate for Payer: Sagamore Health Network All Products |
$3,346.62
|
| Rate for Payer: Signature Care EPO |
$3,598.05
|
| Rate for Payer: Signature Care PPO |
$3,814.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,684.75
|
| Rate for Payer: United Healthcare Commercial |
$3,415.98
|
| Rate for Payer: United Healthcare Medicare |
$1,387.20
|
|
|
HC MRI BREAST BILATERAL WO CON
|
Facility
|
IP
|
$4,335.00
|
|
|
Service Code
|
CPT 77047
|
| Hospital Charge Code |
1578907
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,251.25 |
| Max. Negotiated Rate |
$4,031.55 |
| Rate for Payer: Aetna Commercial |
$3,745.44
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cigna All Commercial |
$3,741.11
|
| Rate for Payer: CORVEL All Commercial |
$4,031.55
|
| Rate for Payer: Coventry All Commercial |
$3,814.80
|
| Rate for Payer: Encore All Commercial |
$3,990.37
|
| Rate for Payer: Frontpath All Commercial |
$3,988.20
|
| Rate for Payer: Humana ChoiceCare |
$3,744.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,901.50
|
| Rate for Payer: PHCS All Commercial |
$3,251.25
|
| Rate for Payer: PHP All Commercial |
$3,287.66
|
| Rate for Payer: Sagamore Health Network All Products |
$3,346.62
|
| Rate for Payer: Signature Care EPO |
$3,598.05
|
| Rate for Payer: Signature Care PPO |
$3,814.80
|
| Rate for Payer: United Healthcare Commercial |
$3,415.98
|
|
|
HC MRI BREAST BILATERAL W/WO CON
|
Facility
|
OP
|
$4,335.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
1578908
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$650.25 |
| Max. Negotiated Rate |
$4,031.55 |
| Rate for Payer: Aetna Commercial |
$3,658.74
|
| Rate for Payer: Aetna Medicare |
$1,387.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$650.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,343.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,705.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,705.00
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$650.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,595.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,525.92
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Centivo All Commercial |
$2,358.24
|
| Rate for Payer: Cigna All Commercial |
$3,741.11
|
| Rate for Payer: CORVEL All Commercial |
$4,031.55
|
| Rate for Payer: Coventry All Commercial |
$3,814.80
|
| Rate for Payer: Encore All Commercial |
$3,990.37
|
| Rate for Payer: Frontpath All Commercial |
$3,988.20
|
| Rate for Payer: Humana ChoiceCare |
$3,744.14
|
| Rate for Payer: Humana Medicare |
$1,387.20
|
| Rate for Payer: Lucent All Commercial |
$2,358.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,901.50
|
| Rate for Payer: Managed Health Services Medicaid |
$650.25
|
| Rate for Payer: MDWise Medicaid |
$650.25
|
| Rate for Payer: PHCS All Commercial |
$3,251.25
|
| Rate for Payer: PHP All Commercial |
$3,287.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,690.65
|
| Rate for Payer: Sagamore Health Network All Products |
$3,346.62
|
| Rate for Payer: Signature Care EPO |
$3,598.05
|
| Rate for Payer: Signature Care PPO |
$3,814.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,684.75
|
| Rate for Payer: United Healthcare Commercial |
$3,415.98
|
| Rate for Payer: United Healthcare Medicare |
$1,387.20
|
|
|
HC MRI BREAST BILATERAL W/WO CON
|
Facility
|
IP
|
$4,335.00
|
|
|
Service Code
|
CPT 77049
|
| Hospital Charge Code |
1578908
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,251.25 |
| Max. Negotiated Rate |
$4,031.55 |
| Rate for Payer: Aetna Commercial |
$3,745.44
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Cigna All Commercial |
$3,741.11
|
| Rate for Payer: CORVEL All Commercial |
$4,031.55
|
| Rate for Payer: Coventry All Commercial |
$3,814.80
|
| Rate for Payer: Encore All Commercial |
$3,990.37
|
| Rate for Payer: Frontpath All Commercial |
$3,988.20
|
| Rate for Payer: Humana ChoiceCare |
$3,744.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,901.50
|
| Rate for Payer: PHCS All Commercial |
$3,251.25
|
| Rate for Payer: PHP All Commercial |
$3,287.66
|
| Rate for Payer: Sagamore Health Network All Products |
$3,346.62
|
| Rate for Payer: Signature Care EPO |
$3,598.05
|
| Rate for Payer: Signature Care PPO |
$3,814.80
|
| Rate for Payer: United Healthcare Commercial |
$3,415.98
|
|
|
HC MRI BREAST BILATERAL W/WO CON
|
Facility
|
OP
|
$4,335.00
|
|
|
Service Code
|
CPT C8908
|
| Hospital Charge Code |
1578908
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,343.85 |
| Max. Negotiated Rate |
$4,031.55 |
| Rate for Payer: Aetna Commercial |
$3,658.74
|
| Rate for Payer: Aetna Medicare |
$1,387.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,343.85
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,489.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,709.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,595.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,525.92
|
| Rate for Payer: Cash Price |
$2,601.00
|
| Rate for Payer: Centivo All Commercial |
$2,358.24
|
| Rate for Payer: Cigna All Commercial |
$3,741.11
|
| Rate for Payer: CORVEL All Commercial |
$4,031.55
|
| Rate for Payer: Coventry All Commercial |
$3,814.80
|
| Rate for Payer: Encore All Commercial |
$3,990.37
|
| Rate for Payer: Frontpath All Commercial |
$3,988.20
|
| Rate for Payer: Humana ChoiceCare |
$3,744.14
|
| Rate for Payer: Humana Medicare |
$1,387.20
|
| Rate for Payer: Lucent All Commercial |
$2,358.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,901.50
|
| Rate for Payer: PHCS All Commercial |
$3,251.25
|
| Rate for Payer: PHP All Commercial |
$3,287.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,690.65
|
| Rate for Payer: Sagamore Health Network All Products |
$3,346.62
|
| Rate for Payer: Signature Care EPO |
$3,598.05
|
| Rate for Payer: Signature Care PPO |
$3,814.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,684.75
|
| Rate for Payer: United Healthcare Commercial |
$3,415.98
|
| Rate for Payer: United Healthcare Medicare |
$1,387.20
|
|
|
HC MRI BREAST UNILATERAL W/WO CON
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
1578905
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$382.50 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Aetna Commercial |
$2,152.20
|
| Rate for Payer: Aetna Medicare |
$816.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$382.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$790.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,464.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,594.01
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$382.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$938.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$897.60
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Centivo All Commercial |
$1,387.20
|
| Rate for Payer: Cigna All Commercial |
$2,200.65
|
| Rate for Payer: CORVEL All Commercial |
$2,371.50
|
| Rate for Payer: Coventry All Commercial |
$2,244.00
|
| Rate for Payer: Encore All Commercial |
$2,347.28
|
| Rate for Payer: Frontpath All Commercial |
$2,346.00
|
| Rate for Payer: Humana ChoiceCare |
$2,202.43
|
| Rate for Payer: Humana Medicare |
$816.00
|
| Rate for Payer: Lucent All Commercial |
$1,387.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,295.00
|
| Rate for Payer: Managed Health Services Medicaid |
$382.50
|
| Rate for Payer: MDWise Medicaid |
$382.50
|
| Rate for Payer: PHCS All Commercial |
$1,912.50
|
| Rate for Payer: PHP All Commercial |
$1,933.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$994.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,968.60
|
| Rate for Payer: Signature Care EPO |
$2,116.50
|
| Rate for Payer: Signature Care PPO |
$2,244.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,167.50
|
| Rate for Payer: United Healthcare Commercial |
$2,009.40
|
| Rate for Payer: United Healthcare Medicare |
$816.00
|
|
|
HC MRI BREAST UNILATERAL W/WO CON
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
CPT 77048
|
| Hospital Charge Code |
1578905
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,912.50 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Aetna Commercial |
$2,203.20
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Cigna All Commercial |
$2,200.65
|
| Rate for Payer: CORVEL All Commercial |
$2,371.50
|
| Rate for Payer: Coventry All Commercial |
$2,244.00
|
| Rate for Payer: Encore All Commercial |
$2,347.28
|
| Rate for Payer: Frontpath All Commercial |
$2,346.00
|
| Rate for Payer: Humana ChoiceCare |
$2,202.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,295.00
|
| Rate for Payer: PHCS All Commercial |
$1,912.50
|
| Rate for Payer: PHP All Commercial |
$1,933.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,968.60
|
| Rate for Payer: Signature Care EPO |
$2,116.50
|
| Rate for Payer: Signature Care PPO |
$2,244.00
|
| Rate for Payer: United Healthcare Commercial |
$2,009.40
|
|
|
HC MRI BREAST UNILATERAL W/WO CON
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
CPT C8905
|
| Hospital Charge Code |
1578905
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$790.50 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Aetna Commercial |
$2,152.20
|
| Rate for Payer: Aetna Medicare |
$816.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$790.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,464.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,594.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$938.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$897.60
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Centivo All Commercial |
$1,387.20
|
| Rate for Payer: Cigna All Commercial |
$2,200.65
|
| Rate for Payer: CORVEL All Commercial |
$2,371.50
|
| Rate for Payer: Coventry All Commercial |
$2,244.00
|
| Rate for Payer: Encore All Commercial |
$2,347.28
|
| Rate for Payer: Frontpath All Commercial |
$2,346.00
|
| Rate for Payer: Humana ChoiceCare |
$2,202.43
|
| Rate for Payer: Humana Medicare |
$816.00
|
| Rate for Payer: Lucent All Commercial |
$1,387.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,295.00
|
| Rate for Payer: PHCS All Commercial |
$1,912.50
|
| Rate for Payer: PHP All Commercial |
$1,933.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$994.50
|
| Rate for Payer: Sagamore Health Network All Products |
$1,968.60
|
| Rate for Payer: Signature Care EPO |
$2,116.50
|
| Rate for Payer: Signature Care PPO |
$2,244.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,167.50
|
| Rate for Payer: United Healthcare Commercial |
$2,009.40
|
| Rate for Payer: United Healthcare Medicare |
$816.00
|
|
|
HC MRI BREAST UNILATERAL W/WO CON
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
CPT C8905
|
| Hospital Charge Code |
1578905
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,912.50 |
| Max. Negotiated Rate |
$2,371.50 |
| Rate for Payer: Aetna Commercial |
$2,203.20
|
| Rate for Payer: Cash Price |
$1,530.00
|
| Rate for Payer: Cigna All Commercial |
$2,200.65
|
| Rate for Payer: CORVEL All Commercial |
$2,371.50
|
| Rate for Payer: Coventry All Commercial |
$2,244.00
|
| Rate for Payer: Encore All Commercial |
$2,347.28
|
| Rate for Payer: Frontpath All Commercial |
$2,346.00
|
| Rate for Payer: Humana ChoiceCare |
$2,202.43
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,295.00
|
| Rate for Payer: PHCS All Commercial |
$1,912.50
|
| Rate for Payer: PHP All Commercial |
$1,933.92
|
| Rate for Payer: Sagamore Health Network All Products |
$1,968.60
|
| Rate for Payer: Signature Care EPO |
$2,116.50
|
| Rate for Payer: Signature Care PPO |
$2,244.00
|
| Rate for Payer: United Healthcare Commercial |
$2,009.40
|
|
|
HC MRI-CARDIAC FOR MORPH W/O CON
|
Facility
|
OP
|
$1,763.00
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
1575557
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$147.80 |
| Max. Negotiated Rate |
$1,639.59 |
| Rate for Payer: Aetna Commercial |
$1,487.97
|
| Rate for Payer: Aetna Medicare |
$564.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$147.80
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$546.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1,012.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,102.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$147.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$648.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$620.58
|
| Rate for Payer: Cash Price |
$1,057.80
|
| Rate for Payer: Cash Price |
$1,057.80
|
| Rate for Payer: Centivo All Commercial |
$959.07
|
| Rate for Payer: Cigna All Commercial |
$1,521.47
|
| Rate for Payer: CORVEL All Commercial |
$1,639.59
|
| Rate for Payer: Coventry All Commercial |
$1,551.44
|
| Rate for Payer: Encore All Commercial |
$1,622.84
|
| Rate for Payer: Frontpath All Commercial |
$1,621.96
|
| Rate for Payer: Humana ChoiceCare |
$1,522.70
|
| Rate for Payer: Humana Medicare |
$564.16
|
| Rate for Payer: Lucent All Commercial |
$959.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,586.70
|
| Rate for Payer: Managed Health Services Medicaid |
$147.80
|
| Rate for Payer: MDWise Medicaid |
$147.80
|
| Rate for Payer: PHCS All Commercial |
$1,322.25
|
| Rate for Payer: PHP All Commercial |
$1,337.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$687.57
|
| Rate for Payer: Sagamore Health Network All Products |
$1,361.04
|
| Rate for Payer: Signature Care EPO |
$1,463.29
|
| Rate for Payer: Signature Care PPO |
$1,551.44
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,498.55
|
| Rate for Payer: United Healthcare Commercial |
$1,389.24
|
| Rate for Payer: United Healthcare Medicare |
$564.16
|
|
|
HC MRI-CARDIAC FOR MORPH W/O CON
|
Facility
|
IP
|
$1,763.00
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
1575557
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,322.25 |
| Max. Negotiated Rate |
$1,639.59 |
| Rate for Payer: Aetna Commercial |
$1,523.23
|
| Rate for Payer: Cash Price |
$1,057.80
|
| Rate for Payer: Cigna All Commercial |
$1,521.47
|
| Rate for Payer: CORVEL All Commercial |
$1,639.59
|
| Rate for Payer: Coventry All Commercial |
$1,551.44
|
| Rate for Payer: Encore All Commercial |
$1,622.84
|
| Rate for Payer: Frontpath All Commercial |
$1,621.96
|
| Rate for Payer: Humana ChoiceCare |
$1,522.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,586.70
|
| Rate for Payer: PHCS All Commercial |
$1,322.25
|
| Rate for Payer: PHP All Commercial |
$1,337.06
|
| Rate for Payer: Sagamore Health Network All Products |
$1,361.04
|
| Rate for Payer: Signature Care EPO |
$1,463.29
|
| Rate for Payer: Signature Care PPO |
$1,551.44
|
| Rate for Payer: United Healthcare Commercial |
$1,389.24
|
|
|
HC MRI-CARDIAC MORPH W/WO CON
|
Facility
|
OP
|
$3,532.00
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
1575561
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$212.21 |
| Max. Negotiated Rate |
$3,284.76 |
| Rate for Payer: Aetna Commercial |
$2,981.01
|
| Rate for Payer: Aetna Medicare |
$1,130.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$212.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,094.92
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2,028.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,207.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$212.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,299.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,243.26
|
| Rate for Payer: Cash Price |
$2,119.20
|
| Rate for Payer: Cash Price |
$2,119.20
|
| Rate for Payer: Centivo All Commercial |
$1,921.41
|
| Rate for Payer: Cigna All Commercial |
$3,048.12
|
| Rate for Payer: CORVEL All Commercial |
$3,284.76
|
| Rate for Payer: Coventry All Commercial |
$3,108.16
|
| Rate for Payer: Encore All Commercial |
$3,251.21
|
| Rate for Payer: Frontpath All Commercial |
$3,249.44
|
| Rate for Payer: Humana ChoiceCare |
$3,050.59
|
| Rate for Payer: Humana Medicare |
$1,130.24
|
| Rate for Payer: Lucent All Commercial |
$1,921.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,178.80
|
| Rate for Payer: Managed Health Services Medicaid |
$212.21
|
| Rate for Payer: MDWise Medicaid |
$212.21
|
| Rate for Payer: PHCS All Commercial |
$2,649.00
|
| Rate for Payer: PHP All Commercial |
$2,678.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,377.48
|
| Rate for Payer: Sagamore Health Network All Products |
$2,726.70
|
| Rate for Payer: Signature Care EPO |
$2,931.56
|
| Rate for Payer: Signature Care PPO |
$3,108.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,002.20
|
| Rate for Payer: United Healthcare Commercial |
$2,783.22
|
| Rate for Payer: United Healthcare Medicare |
$1,130.24
|
|
|
HC MRI-CARDIAC MORPH W/WO CON
|
Facility
|
IP
|
$3,532.00
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
1575561
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,649.00 |
| Max. Negotiated Rate |
$3,284.76 |
| Rate for Payer: Aetna Commercial |
$3,051.65
|
| Rate for Payer: Cash Price |
$2,119.20
|
| Rate for Payer: Cigna All Commercial |
$3,048.12
|
| Rate for Payer: CORVEL All Commercial |
$3,284.76
|
| Rate for Payer: Coventry All Commercial |
$3,108.16
|
| Rate for Payer: Encore All Commercial |
$3,251.21
|
| Rate for Payer: Frontpath All Commercial |
$3,249.44
|
| Rate for Payer: Humana ChoiceCare |
$3,050.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,178.80
|
| Rate for Payer: PHCS All Commercial |
$2,649.00
|
| Rate for Payer: PHP All Commercial |
$2,678.67
|
| Rate for Payer: Sagamore Health Network All Products |
$2,726.70
|
| Rate for Payer: Signature Care EPO |
$2,931.56
|
| Rate for Payer: Signature Care PPO |
$3,108.16
|
| Rate for Payer: United Healthcare Commercial |
$2,783.22
|
|
|
HC MRI-CARDIAC VELOCITY FLOW MAP ADD-ON
|
Facility
|
OP
|
$957.00
|
|
|
Service Code
|
CPT 75565
|
| Hospital Charge Code |
1575565
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$30.14 |
| Max. Negotiated Rate |
$890.01 |
| Rate for Payer: Aetna Commercial |
$807.71
|
| Rate for Payer: Aetna Medicare |
$306.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$30.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$296.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$549.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$598.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$352.18
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$336.86
|
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Cash Price |
$574.20
|
| Rate for Payer: Centivo All Commercial |
$520.61
|
| Rate for Payer: Cigna All Commercial |
$825.89
|
| Rate for Payer: CORVEL All Commercial |
$890.01
|
| Rate for Payer: Coventry All Commercial |
$842.16
|
| Rate for Payer: Encore All Commercial |
$880.92
|
| Rate for Payer: Frontpath All Commercial |
$880.44
|
| Rate for Payer: Humana ChoiceCare |
$826.56
|
| Rate for Payer: Humana Medicare |
$306.24
|
| Rate for Payer: Lucent All Commercial |
$520.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$861.30
|
| Rate for Payer: Managed Health Services Medicaid |
$30.14
|
| Rate for Payer: MDWise Medicaid |
$30.14
|
| Rate for Payer: PHCS All Commercial |
$717.75
|
| Rate for Payer: PHP All Commercial |
$725.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$373.23
|
| Rate for Payer: Sagamore Health Network All Products |
$738.80
|
| Rate for Payer: Signature Care EPO |
$794.31
|
| Rate for Payer: Signature Care PPO |
$842.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$813.45
|
| Rate for Payer: United Healthcare Commercial |
$754.12
|
| Rate for Payer: United Healthcare Medicare |
$306.24
|
|
