|
HC MRI-LOWER EXTREMITY W/O CON LT
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 73718 LT
|
| Hospital Charge Code |
1573720
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$208.99 |
| 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 |
$208.99
|
| 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 |
$208.99
|
| 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 |
$208.99
|
| Rate for Payer: MDWise Medicaid |
$208.99
|
| 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-LOWER EXTREMITY W/O CON RT
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 73718 RT
|
| Hospital Charge Code |
11573720
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$208.99 |
| 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 |
$208.99
|
| 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 |
$208.99
|
| 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 |
$208.99
|
| Rate for Payer: MDWise Medicaid |
$208.99
|
| 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-LOWER EXTREMITY W/O CON RT
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 73718 RT
|
| Hospital Charge Code |
11573720
|
|
Hospital Revenue Code
|
610
|
| 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-LOWER EXTREMITY W/WO CON B
|
Facility
|
IP
|
$4,335.00
|
|
|
Service Code
|
CPT 73720 50
|
| Hospital Charge Code |
21573718
|
|
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-LOWER EXTREMITY W/WO CON B
|
Facility
|
OP
|
$4,335.00
|
|
|
Service Code
|
CPT 73720 50
|
| Hospital Charge Code |
21573718
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$284.54 |
| 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 |
$284.54
|
| 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 |
$284.54
|
| 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 |
$284.54
|
| Rate for Payer: MDWise Medicaid |
$284.54
|
| 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-LOWER EXTREMITY W/WO CON L
|
Facility
|
IP
|
$2,652.00
|
|
|
Service Code
|
CPT 73720 LT
|
| Hospital Charge Code |
1573718
|
|
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-LOWER EXTREMITY W/WO CON L
|
Facility
|
OP
|
$2,652.00
|
|
|
Service Code
|
CPT 73720 LT
|
| Hospital Charge Code |
1573718
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$284.54 |
| 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 |
$284.54
|
| 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 |
$284.54
|
| 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 |
$284.54
|
| Rate for Payer: MDWise Medicaid |
$284.54
|
| 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-LOWER EXTREMITY W/WO CON R
|
Facility
|
IP
|
$2,652.00
|
|
|
Service Code
|
CPT 73720 RT
|
| Hospital Charge Code |
11573718
|
|
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-LOWER EXTREMITY W/WO CON R
|
Facility
|
OP
|
$2,652.00
|
|
|
Service Code
|
CPT 73720 RT
|
| Hospital Charge Code |
11573718
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$284.54 |
| 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 |
$284.54
|
| 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 |
$284.54
|
| 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 |
$284.54
|
| Rate for Payer: MDWise Medicaid |
$284.54
|
| 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-LUMBAR SPINE W/CONTRAST
|
Facility
|
OP
|
$2,244.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
1572149
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$167.37 |
| 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 |
$167.37
|
| 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 |
$167.37
|
| 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 |
$167.37
|
| Rate for Payer: MDWise Medicaid |
$167.37
|
| 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-LUMBAR SPINE W/CONTRAST
|
Facility
|
IP
|
$2,244.00
|
|
|
Service Code
|
CPT 72149
|
| Hospital Charge Code |
1572149
|
|
Hospital Revenue Code
|
612
|
| 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-LUMBAR SPINE W/O CONTRAST
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
1572148
|
|
Hospital Revenue Code
|
612
|
| 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-LUMBAR SPINE W/O CONTRAST
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 72148
|
| Hospital Charge Code |
1572148
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$117.33 |
| 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 |
$117.33
|
| 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 |
$117.33
|
| 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 |
$117.33
|
| Rate for Payer: MDWise Medicaid |
$117.33
|
| 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-LUMBAR SPINE W/WO CONTRAST
|
Facility
|
OP
|
$2,652.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
1572158
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$192.89 |
| 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 |
$192.89
|
| 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 |
$192.89
|
| 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 |
$192.89
|
| Rate for Payer: MDWise Medicaid |
$192.89
|
| 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-LUMBAR SPINE W/WO CONTRAST
|
Facility
|
IP
|
$2,652.00
|
|
|
Service Code
|
CPT 72158
|
| Hospital Charge Code |
1572158
|
|
Hospital Revenue Code
|
612
|
| 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-MRCP
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 74181 52
|
| Hospital Charge Code |
1574180
|
|
Hospital Revenue Code
|
610
|
| 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-MRCP
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 74181 52
|
| Hospital Charge Code |
1574180
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$183.97 |
| 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 |
$183.97
|
| 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 |
$183.97
|
| 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 |
$183.97
|
| Rate for Payer: MDWise Medicaid |
$183.97
|
| 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-ORBIT FACE & NECK W/O CON
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
1570540
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$204.78 |
| 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 |
$204.78
|
| 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 |
$204.78
|
| 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 |
$204.78
|
| Rate for Payer: MDWise Medicaid |
$204.78
|
| 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 MRI-ORBIT FACE & NECK W/O CON
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 70540
|
| Hospital Charge Code |
1570540
|
|
Hospital Revenue Code
|
610
|
| 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-ORBIT FACE & NECK W/WO CON
|
Facility
|
OP
|
$2,652.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
1570543
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$277.61 |
| 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 |
$277.61
|
| 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 |
$277.61
|
| 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 |
$277.61
|
| Rate for Payer: MDWise Medicaid |
$277.61
|
| 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-ORBIT FACE & NECK W/WO CON
|
Facility
|
IP
|
$2,652.00
|
|
|
Service Code
|
CPT 70543
|
| Hospital Charge Code |
1570543
|
|
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-PELVIS W/CONTRAST
|
Facility
|
OP
|
$2,244.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
1573196
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$235.00 |
| 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 |
$235.00
|
| 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 |
$235.00
|
| 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 |
$235.00
|
| Rate for Payer: MDWise Medicaid |
$235.00
|
| 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-PELVIS W/CONTRAST
|
Facility
|
IP
|
$2,244.00
|
|
|
Service Code
|
CPT 72196
|
| Hospital Charge Code |
1573196
|
|
Hospital Revenue Code
|
610
|
| 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-PELVIS W/O CONTRAST
|
Facility
|
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
1572196
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.96 |
| 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 |
$211.96
|
| 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 |
$211.96
|
| 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 |
$211.96
|
| Rate for Payer: MDWise Medicaid |
$211.96
|
| 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-PELVIS W/O CONTRAST
|
Facility
|
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 72195
|
| Hospital Charge Code |
1572196
|
|
Hospital Revenue Code
|
610
|
| 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
|
|
