|
HC MRA-HEAD W/O CONTRAST
|
Facility
OP
|
$2,958.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
01570544
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$937.76 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,496.55
|
| Rate for Payer: Aetna Medicare |
$976.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$976.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,698.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,849.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$937.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,122.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,073.75
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Centivo All Commercial |
$1,508.58
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Humana Medicare |
$1,508.58
|
| Rate for Payer: Lucent All Commercial |
$1,508.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: Managed Health Services Medicaid |
$937.76
|
| Rate for Payer: MDWise Medicaid |
$937.76
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,153.62
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,514.30
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
| Rate for Payer: United Healthcare Medicare |
$976.14
|
|
|
HC MRA-HEAD W/O CONTRAST
|
Facility
IP
|
$2,958.00
|
|
|
Service Code
|
CPT 70544
|
| Hospital Charge Code |
01570544
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,218.50 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,555.71
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
|
|
HC MRA-HEAD W/WO CONTRAST
|
Facility
IP
|
$2,958.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
01570546
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$2,218.50 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,555.71
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
|
|
HC MRA-HEAD W/WO CONTRAST
|
Facility
OP
|
$2,958.00
|
|
|
Service Code
|
CPT 70546
|
| Hospital Charge Code |
01570546
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$976.14 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,496.55
|
| Rate for Payer: Aetna Medicare |
$976.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$976.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,698.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,849.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,410.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,122.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,073.75
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Centivo All Commercial |
$1,508.58
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Humana Medicare |
$1,508.58
|
| Rate for Payer: Lucent All Commercial |
$1,508.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: Managed Health Services Medicaid |
$1,410.16
|
| Rate for Payer: MDWise Medicaid |
$1,410.16
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,153.62
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,514.30
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
| Rate for Payer: United Healthcare Medicare |
$976.14
|
|
|
HC MRA; HEAD W & WO CONTRAST LTD
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 70546 52
|
| Hospital Charge Code |
01575246
|
|
Hospital Revenue Code
|
615
|
| 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 |
$1,075.08
|
| 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 MRA; HEAD W & WO CONTRAST LTD
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 70546 52
|
| Hospital Charge Code |
01575246
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$572.22 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$995.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,083.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$658.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$629.44
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Centivo All Commercial |
$884.34
|
| 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 |
$884.34
|
| Rate for Payer: Lucent All Commercial |
$884.34
|
| 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: 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 |
$572.22
|
|
|
HC MRA LOWER EXTREM W/WO CONTR LT
|
Facility
OP
|
$2,958.00
|
|
|
Service Code
|
CPT 73725 LT
|
| Hospital Charge Code |
01579945
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$976.14 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,496.55
|
| Rate for Payer: Aetna Medicare |
$976.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$976.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,698.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,849.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,122.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,073.75
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Centivo All Commercial |
$1,508.58
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Humana Medicare |
$1,508.58
|
| Rate for Payer: Lucent All Commercial |
$1,508.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,153.62
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,514.30
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
| Rate for Payer: United Healthcare Medicare |
$976.14
|
|
|
HC MRA LOWER EXTREM W/WO CONTR LT
|
Facility
IP
|
$2,958.00
|
|
|
Service Code
|
CPT 73725 LT
|
| Hospital Charge Code |
01579945
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$2,218.50 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,555.71
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
|
|
HC MRA LOWER EXTREM W/WO CONTR RT
|
Facility
OP
|
$2,958.00
|
|
|
Service Code
|
CPT 73725 RT
|
| Hospital Charge Code |
01579946
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$976.14 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,496.55
|
| Rate for Payer: Aetna Medicare |
$976.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$976.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,698.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,849.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,122.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,073.75
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Centivo All Commercial |
$1,508.58
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Humana Medicare |
$1,508.58
|
| Rate for Payer: Lucent All Commercial |
$1,508.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,153.62
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,514.30
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
| Rate for Payer: United Healthcare Medicare |
$976.14
|
|
|
HC MRA LOWER EXTREM W/WO CONTR RT
|
Facility
IP
|
$2,958.00
|
|
|
Service Code
|
CPT 73725 RT
|
| Hospital Charge Code |
01579946
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$2,218.50 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,555.71
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
|
|
HC MRA-LOWER EXT W/WO CONTRAST LT
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
CPT C8914 LT
|
| Hospital Charge Code |
01578914
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$572.22 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$995.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,083.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$658.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$629.44
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Centivo All Commercial |
$884.34
|
| 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 |
$884.34
|
| Rate for Payer: Lucent All Commercial |
$884.34
|
| 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: 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 |
$572.22
|
|
|
HC MRA-LOWER EXT W/WO CONTRAST LT
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
CPT C8914 LT
|
| Hospital Charge Code |
01578914
|
|
Hospital Revenue Code
|
616
|
| 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 |
$1,075.08
|
| 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 MRA-LOWER EXT W/WO CONTRAST RT
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
CPT C8914 RT
|
| Hospital Charge Code |
11578914
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$572.22 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$995.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,083.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$658.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$629.44
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Centivo All Commercial |
$884.34
|
| 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 |
$884.34
|
| Rate for Payer: Lucent All Commercial |
$884.34
|
| 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: 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 |
$572.22
|
|
|
HC MRA-LOWER EXT W/WO CONTRAST RT
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
CPT C8914 RT
|
| Hospital Charge Code |
11578914
|
|
Hospital Revenue Code
|
616
|
| 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 |
$1,075.08
|
| 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 MRA LOWER EXT W/WO CONTR BIL LTD
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 73725 52,50
|
| Hospital Charge Code |
01579944
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$572.22 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$995.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,083.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$658.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$629.44
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Centivo All Commercial |
$884.34
|
| 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 |
$884.34
|
| Rate for Payer: Lucent All Commercial |
$884.34
|
| 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: 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 |
$572.22
|
|
|
HC MRA LOWER EXT W/WO CONTR BIL LTD
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 73725 52,50
|
| Hospital Charge Code |
01579944
|
|
Hospital Revenue Code
|
616
|
| 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 |
$1,075.08
|
| 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 MRA LWR EXTREM W/WO CONTR BIL
|
Facility
OP
|
$3,876.00
|
|
|
Service Code
|
CPT 73725 50
|
| Hospital Charge Code |
01579943
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$1,279.08 |
| Max. Negotiated Rate |
$3,604.68 |
| Rate for Payer: Aetna Commercial |
$3,271.34
|
| Rate for Payer: Aetna Medicare |
$1,279.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,279.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,225.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,422.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,470.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,406.99
|
| Rate for Payer: Cash Price |
$2,403.12
|
| Rate for Payer: Centivo All Commercial |
$1,976.76
|
| Rate for Payer: Cigna All Commercial |
$3,344.99
|
| Rate for Payer: CORVEL All Commercial |
$3,604.68
|
| Rate for Payer: Coventry All Commercial |
$3,410.88
|
| Rate for Payer: Encore All Commercial |
$3,567.86
|
| Rate for Payer: Frontpath All Commercial |
$3,565.92
|
| Rate for Payer: Humana ChoiceCare |
$3,347.70
|
| Rate for Payer: Humana Medicare |
$1,976.76
|
| Rate for Payer: Lucent All Commercial |
$1,976.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,488.40
|
| Rate for Payer: PHCS All Commercial |
$2,907.00
|
| Rate for Payer: PHP All Commercial |
$2,939.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,511.64
|
| Rate for Payer: Sagamore Health Network All Products |
$2,992.27
|
| Rate for Payer: Signature Care EPO |
$3,217.08
|
| Rate for Payer: Signature Care PPO |
$3,410.88
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,294.60
|
| Rate for Payer: United Healthcare Commercial |
$3,054.29
|
| Rate for Payer: United Healthcare Medicare |
$1,279.08
|
|
|
HC MRA LWR EXTREM W/WO CONTR BIL
|
Facility
IP
|
$3,876.00
|
|
|
Service Code
|
CPT 73725 50
|
| Hospital Charge Code |
01579943
|
|
Hospital Revenue Code
|
616
|
| Min. Negotiated Rate |
$2,907.00 |
| Max. Negotiated Rate |
$3,604.68 |
| Rate for Payer: Aetna Commercial |
$3,348.86
|
| Rate for Payer: Cash Price |
$2,403.12
|
| Rate for Payer: Cigna All Commercial |
$3,344.99
|
| Rate for Payer: CORVEL All Commercial |
$3,604.68
|
| Rate for Payer: Coventry All Commercial |
$3,410.88
|
| Rate for Payer: Encore All Commercial |
$3,567.86
|
| Rate for Payer: Frontpath All Commercial |
$3,565.92
|
| Rate for Payer: Humana ChoiceCare |
$3,347.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,488.40
|
| Rate for Payer: PHCS All Commercial |
$2,907.00
|
| Rate for Payer: PHP All Commercial |
$2,939.56
|
| Rate for Payer: Sagamore Health Network All Products |
$2,992.27
|
| Rate for Payer: Signature Care EPO |
$3,217.08
|
| Rate for Payer: Signature Care PPO |
$3,410.88
|
| Rate for Payer: United Healthcare Commercial |
$3,054.29
|
|
|
HC MRA-NECK W/CONTRAST
|
Facility
OP
|
$2,244.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
01570548
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$740.52 |
| Max. Negotiated Rate |
$2,086.92 |
| Rate for Payer: Aetna Commercial |
$1,893.94
|
| Rate for Payer: Aetna Medicare |
$740.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$740.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,288.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,402.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$995.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$851.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$814.57
|
| Rate for Payer: Cash Price |
$1,391.28
|
| Rate for Payer: Cash Price |
$1,391.28
|
| Rate for Payer: Centivo All Commercial |
$1,144.44
|
| 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 |
$1,144.44
|
| Rate for Payer: Lucent All Commercial |
$1,144.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,019.60
|
| Rate for Payer: Managed Health Services Medicaid |
$995.71
|
| Rate for Payer: MDWise Medicaid |
$995.71
|
| 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 |
$740.52
|
|
|
HC MRA-NECK W/CONTRAST
|
Facility
IP
|
$2,244.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
01570548
|
|
Hospital Revenue Code
|
615
|
| 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 |
$1,391.28
|
| 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 MRA-NECK W/O CONTRAST
|
Facility
IP
|
$2,038.98
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
01570547
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$1,529.24 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,761.68
|
| Rate for Payer: Cash Price |
$1,264.17
|
| 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 |
$1,529.24
|
| 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 MRA-NECK W/O CONTRAST
|
Facility
OP
|
$2,038.98
|
|
|
Service Code
|
CPT 70547
|
| Hospital Charge Code |
01570547
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$672.86 |
| Max. Negotiated Rate |
$1,896.25 |
| Rate for Payer: Aetna Commercial |
$1,720.90
|
| Rate for Payer: Aetna Medicare |
$672.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$672.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,170.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,274.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$940.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$773.79
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$740.15
|
| Rate for Payer: Cash Price |
$1,264.17
|
| Rate for Payer: Cash Price |
$1,264.17
|
| Rate for Payer: Centivo All Commercial |
$1,039.88
|
| 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 |
$1,039.88
|
| Rate for Payer: Lucent All Commercial |
$1,039.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,835.08
|
| Rate for Payer: Managed Health Services Medicaid |
$940.64
|
| Rate for Payer: MDWise Medicaid |
$940.64
|
| Rate for Payer: PHCS All Commercial |
$1,529.24
|
| 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 |
$672.86
|
|
|
HC MRA; NECK WO CONTRAST LTD
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
CPT 70547 52
|
| Hospital Charge Code |
01575247
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$572.22 |
| Max. Negotiated Rate |
$1,612.62 |
| Rate for Payer: Aetna Commercial |
$1,463.50
|
| Rate for Payer: Aetna Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$572.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$995.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,083.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$658.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$629.44
|
| Rate for Payer: Cash Price |
$1,075.08
|
| Rate for Payer: Centivo All Commercial |
$884.34
|
| 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 |
$884.34
|
| Rate for Payer: Lucent All Commercial |
$884.34
|
| 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: 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 |
$572.22
|
|
|
HC MRA; NECK WO CONTRAST LTD
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
CPT 70547 52
|
| Hospital Charge Code |
01575247
|
|
Hospital Revenue Code
|
615
|
| 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 |
$1,075.08
|
| 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 MRA-NECK W/WO CONTRAST
|
Facility
OP
|
$2,958.00
|
|
|
Service Code
|
CPT 70549
|
| Hospital Charge Code |
01570549
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$976.14 |
| Max. Negotiated Rate |
$2,750.94 |
| Rate for Payer: Aetna Commercial |
$2,496.55
|
| Rate for Payer: Aetna Medicare |
$976.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$976.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1,698.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1,849.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$1,421.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,122.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,073.75
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Cash Price |
$1,833.96
|
| Rate for Payer: Centivo All Commercial |
$1,508.58
|
| Rate for Payer: Cigna All Commercial |
$2,552.75
|
| Rate for Payer: CORVEL All Commercial |
$2,750.94
|
| Rate for Payer: Coventry All Commercial |
$2,603.04
|
| Rate for Payer: Encore All Commercial |
$2,722.84
|
| Rate for Payer: Frontpath All Commercial |
$2,721.36
|
| Rate for Payer: Humana ChoiceCare |
$2,554.82
|
| Rate for Payer: Humana Medicare |
$1,508.58
|
| Rate for Payer: Lucent All Commercial |
$1,508.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$2,662.20
|
| Rate for Payer: Managed Health Services Medicaid |
$1,421.75
|
| Rate for Payer: MDWise Medicaid |
$1,421.75
|
| Rate for Payer: PHCS All Commercial |
$2,218.50
|
| Rate for Payer: PHP All Commercial |
$2,243.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,153.62
|
| Rate for Payer: Sagamore Health Network All Products |
$2,283.58
|
| Rate for Payer: Signature Care EPO |
$2,455.14
|
| Rate for Payer: Signature Care PPO |
$2,603.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,514.30
|
| Rate for Payer: United Healthcare Commercial |
$2,330.90
|
| Rate for Payer: United Healthcare Medicare |
$976.14
|
|
