|
HC X-RAY-ANKLE 1 VIEW BI
|
Facility
|
IP
|
$468.37
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
21614600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.28 |
| Max. Negotiated Rate |
$435.58 |
| Rate for Payer: Aetna Commercial |
$404.67
|
| Rate for Payer: Cash Price |
$281.02
|
| Rate for Payer: Cigna All Commercial |
$404.20
|
| Rate for Payer: CORVEL All Commercial |
$435.58
|
| Rate for Payer: Coventry All Commercial |
$412.17
|
| Rate for Payer: Encore All Commercial |
$431.13
|
| Rate for Payer: Frontpath All Commercial |
$430.90
|
| Rate for Payer: Humana ChoiceCare |
$404.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$421.53
|
| Rate for Payer: PHCS All Commercial |
$351.28
|
| Rate for Payer: PHP All Commercial |
$355.21
|
| Rate for Payer: Sagamore Health Network All Products |
$361.58
|
| Rate for Payer: Signature Care EPO |
$388.75
|
| Rate for Payer: Signature Care PPO |
$412.17
|
| Rate for Payer: United Healthcare Commercial |
$369.08
|
|
|
HC X-RAY-ANKLE 1 VIEW LT
|
Facility
|
IP
|
$312.26
|
|
|
Service Code
|
CPT 73600 LT,52
|
| Hospital Charge Code |
1614600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.19 |
| Max. Negotiated Rate |
$290.40 |
| Rate for Payer: Aetna Commercial |
$269.79
|
| Rate for Payer: Cash Price |
$187.36
|
| Rate for Payer: Cigna All Commercial |
$269.48
|
| Rate for Payer: CORVEL All Commercial |
$290.40
|
| Rate for Payer: Coventry All Commercial |
$274.79
|
| Rate for Payer: Encore All Commercial |
$287.44
|
| Rate for Payer: Frontpath All Commercial |
$287.28
|
| Rate for Payer: Humana ChoiceCare |
$269.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.03
|
| Rate for Payer: PHCS All Commercial |
$234.19
|
| Rate for Payer: PHP All Commercial |
$236.82
|
| Rate for Payer: Sagamore Health Network All Products |
$241.06
|
| Rate for Payer: Signature Care EPO |
$259.18
|
| Rate for Payer: Signature Care PPO |
$274.79
|
| Rate for Payer: United Healthcare Commercial |
$246.06
|
|
|
HC X-RAY-ANKLE 1 VIEW LT
|
Facility
|
OP
|
$312.26
|
|
|
Service Code
|
CPT 73600 LT,52
|
| Hospital Charge Code |
1614600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$290.40 |
| Rate for Payer: Aetna Commercial |
$263.55
|
| Rate for Payer: Aetna Medicare |
$99.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$96.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$179.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$195.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$114.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$109.92
|
| Rate for Payer: Cash Price |
$187.36
|
| Rate for Payer: Cash Price |
$187.36
|
| Rate for Payer: Centivo All Commercial |
$169.87
|
| Rate for Payer: Cigna All Commercial |
$269.48
|
| Rate for Payer: CORVEL All Commercial |
$290.40
|
| Rate for Payer: Coventry All Commercial |
$274.79
|
| Rate for Payer: Encore All Commercial |
$287.44
|
| Rate for Payer: Frontpath All Commercial |
$287.28
|
| Rate for Payer: Humana ChoiceCare |
$269.70
|
| Rate for Payer: Humana Medicare |
$99.92
|
| Rate for Payer: Lucent All Commercial |
$169.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.03
|
| Rate for Payer: Managed Health Services Medicaid |
$14.28
|
| Rate for Payer: MDWise Medicaid |
$14.28
|
| Rate for Payer: PHCS All Commercial |
$234.19
|
| Rate for Payer: PHP All Commercial |
$236.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.78
|
| Rate for Payer: Sagamore Health Network All Products |
$241.06
|
| Rate for Payer: Signature Care EPO |
$259.18
|
| Rate for Payer: Signature Care PPO |
$274.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$265.42
|
| Rate for Payer: United Healthcare Commercial |
$246.06
|
| Rate for Payer: United Healthcare Medicare |
$99.92
|
|
|
HC X-RAY-ANKLE 1 VIEW RT
|
Facility
|
IP
|
$312.26
|
|
|
Service Code
|
CPT 73600 RT,52
|
| Hospital Charge Code |
11614600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.19 |
| Max. Negotiated Rate |
$290.40 |
| Rate for Payer: Aetna Commercial |
$269.79
|
| Rate for Payer: Cash Price |
$187.36
|
| Rate for Payer: Cigna All Commercial |
$269.48
|
| Rate for Payer: CORVEL All Commercial |
$290.40
|
| Rate for Payer: Coventry All Commercial |
$274.79
|
| Rate for Payer: Encore All Commercial |
$287.44
|
| Rate for Payer: Frontpath All Commercial |
$287.28
|
| Rate for Payer: Humana ChoiceCare |
$269.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.03
|
| Rate for Payer: PHCS All Commercial |
$234.19
|
| Rate for Payer: PHP All Commercial |
$236.82
|
| Rate for Payer: Sagamore Health Network All Products |
$241.06
|
| Rate for Payer: Signature Care EPO |
$259.18
|
| Rate for Payer: Signature Care PPO |
$274.79
|
| Rate for Payer: United Healthcare Commercial |
$246.06
|
|
|
HC X-RAY-ANKLE 1 VIEW RT
|
Facility
|
OP
|
$312.26
|
|
|
Service Code
|
CPT 73600 RT,52
|
| Hospital Charge Code |
11614600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$290.40 |
| Rate for Payer: Aetna Commercial |
$263.55
|
| Rate for Payer: Aetna Medicare |
$99.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$96.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$179.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$195.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$114.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$109.92
|
| Rate for Payer: Cash Price |
$187.36
|
| Rate for Payer: Cash Price |
$187.36
|
| Rate for Payer: Centivo All Commercial |
$169.87
|
| Rate for Payer: Cigna All Commercial |
$269.48
|
| Rate for Payer: CORVEL All Commercial |
$290.40
|
| Rate for Payer: Coventry All Commercial |
$274.79
|
| Rate for Payer: Encore All Commercial |
$287.44
|
| Rate for Payer: Frontpath All Commercial |
$287.28
|
| Rate for Payer: Humana ChoiceCare |
$269.70
|
| Rate for Payer: Humana Medicare |
$99.92
|
| Rate for Payer: Lucent All Commercial |
$169.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.03
|
| Rate for Payer: Managed Health Services Medicaid |
$14.28
|
| Rate for Payer: MDWise Medicaid |
$14.28
|
| Rate for Payer: PHCS All Commercial |
$234.19
|
| Rate for Payer: PHP All Commercial |
$236.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.78
|
| Rate for Payer: Sagamore Health Network All Products |
$241.06
|
| Rate for Payer: Signature Care EPO |
$259.18
|
| Rate for Payer: Signature Care PPO |
$274.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$265.42
|
| Rate for Payer: United Healthcare Commercial |
$246.06
|
| Rate for Payer: United Healthcare Medicare |
$99.92
|
|
|
HC X-RAY-ANKLE 2 VIEWS BI
|
Facility
|
IP
|
$624.51
|
|
|
Service Code
|
CPT 73600 50
|
| Hospital Charge Code |
21613600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$468.38 |
| Max. Negotiated Rate |
$580.79 |
| Rate for Payer: Aetna Commercial |
$539.58
|
| Rate for Payer: Cash Price |
$374.71
|
| Rate for Payer: Cigna All Commercial |
$538.95
|
| Rate for Payer: CORVEL All Commercial |
$580.79
|
| Rate for Payer: Coventry All Commercial |
$549.57
|
| Rate for Payer: Encore All Commercial |
$574.86
|
| Rate for Payer: Frontpath All Commercial |
$574.55
|
| Rate for Payer: Humana ChoiceCare |
$539.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$562.06
|
| Rate for Payer: PHCS All Commercial |
$468.38
|
| Rate for Payer: PHP All Commercial |
$473.63
|
| Rate for Payer: Sagamore Health Network All Products |
$482.12
|
| Rate for Payer: Signature Care EPO |
$518.34
|
| Rate for Payer: Signature Care PPO |
$549.57
|
| Rate for Payer: United Healthcare Commercial |
$492.11
|
|
|
HC X-RAY-ANKLE 2 VIEWS BI
|
Facility
|
OP
|
$624.51
|
|
|
Service Code
|
CPT 73600 50
|
| Hospital Charge Code |
21613600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$580.79 |
| Rate for Payer: Aetna Commercial |
$527.09
|
| Rate for Payer: Aetna Medicare |
$199.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$193.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$358.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$390.38
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$229.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$219.83
|
| Rate for Payer: Cash Price |
$374.71
|
| Rate for Payer: Cash Price |
$374.71
|
| Rate for Payer: Centivo All Commercial |
$339.73
|
| Rate for Payer: Cigna All Commercial |
$538.95
|
| Rate for Payer: CORVEL All Commercial |
$580.79
|
| Rate for Payer: Coventry All Commercial |
$549.57
|
| Rate for Payer: Encore All Commercial |
$574.86
|
| Rate for Payer: Frontpath All Commercial |
$574.55
|
| Rate for Payer: Humana ChoiceCare |
$539.39
|
| Rate for Payer: Humana Medicare |
$199.84
|
| Rate for Payer: Lucent All Commercial |
$339.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$562.06
|
| Rate for Payer: Managed Health Services Medicaid |
$14.28
|
| Rate for Payer: MDWise Medicaid |
$14.28
|
| Rate for Payer: PHCS All Commercial |
$468.38
|
| Rate for Payer: PHP All Commercial |
$473.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$243.56
|
| Rate for Payer: Sagamore Health Network All Products |
$482.12
|
| Rate for Payer: Signature Care EPO |
$518.34
|
| Rate for Payer: Signature Care PPO |
$549.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$530.83
|
| Rate for Payer: United Healthcare Commercial |
$492.11
|
| Rate for Payer: United Healthcare Medicare |
$199.84
|
|
|
HC X-RAY-ANKLE 2 VIEWS LT
|
Facility
|
OP
|
$416.32
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
1613600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$387.18 |
| Rate for Payer: Aetna Commercial |
$351.37
|
| Rate for Payer: Aetna Medicare |
$133.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$239.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$153.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.54
|
| Rate for Payer: Cash Price |
$249.79
|
| Rate for Payer: Cash Price |
$249.79
|
| Rate for Payer: Centivo All Commercial |
$226.48
|
| Rate for Payer: Cigna All Commercial |
$359.28
|
| Rate for Payer: CORVEL All Commercial |
$387.18
|
| Rate for Payer: Coventry All Commercial |
$366.36
|
| Rate for Payer: Encore All Commercial |
$383.22
|
| Rate for Payer: Frontpath All Commercial |
$383.01
|
| Rate for Payer: Humana ChoiceCare |
$359.58
|
| Rate for Payer: Humana Medicare |
$133.22
|
| Rate for Payer: Lucent All Commercial |
$226.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.69
|
| Rate for Payer: Managed Health Services Medicaid |
$14.28
|
| Rate for Payer: MDWise Medicaid |
$14.28
|
| Rate for Payer: PHCS All Commercial |
$312.24
|
| Rate for Payer: PHP All Commercial |
$315.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.36
|
| Rate for Payer: Sagamore Health Network All Products |
$321.40
|
| Rate for Payer: Signature Care EPO |
$345.55
|
| Rate for Payer: Signature Care PPO |
$366.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.87
|
| Rate for Payer: United Healthcare Commercial |
$328.06
|
| Rate for Payer: United Healthcare Medicare |
$133.22
|
|
|
HC X-RAY-ANKLE 2 VIEWS LT
|
Facility
|
IP
|
$416.32
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
1613600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.24 |
| Max. Negotiated Rate |
$387.18 |
| Rate for Payer: Aetna Commercial |
$359.70
|
| Rate for Payer: Cash Price |
$249.79
|
| Rate for Payer: Cigna All Commercial |
$359.28
|
| Rate for Payer: CORVEL All Commercial |
$387.18
|
| Rate for Payer: Coventry All Commercial |
$366.36
|
| Rate for Payer: Encore All Commercial |
$383.22
|
| Rate for Payer: Frontpath All Commercial |
$383.01
|
| Rate for Payer: Humana ChoiceCare |
$359.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.69
|
| Rate for Payer: PHCS All Commercial |
$312.24
|
| Rate for Payer: PHP All Commercial |
$315.74
|
| Rate for Payer: Sagamore Health Network All Products |
$321.40
|
| Rate for Payer: Signature Care EPO |
$345.55
|
| Rate for Payer: Signature Care PPO |
$366.36
|
| Rate for Payer: United Healthcare Commercial |
$328.06
|
|
|
HC X-RAY-ANKLE 2 VIEWS RT
|
Facility
|
OP
|
$416.32
|
|
|
Service Code
|
CPT 73600 RT
|
| Hospital Charge Code |
11613600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$387.18 |
| Rate for Payer: Aetna Commercial |
$351.37
|
| Rate for Payer: Aetna Medicare |
$133.22
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$239.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$153.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.54
|
| Rate for Payer: Cash Price |
$249.79
|
| Rate for Payer: Cash Price |
$249.79
|
| Rate for Payer: Centivo All Commercial |
$226.48
|
| Rate for Payer: Cigna All Commercial |
$359.28
|
| Rate for Payer: CORVEL All Commercial |
$387.18
|
| Rate for Payer: Coventry All Commercial |
$366.36
|
| Rate for Payer: Encore All Commercial |
$383.22
|
| Rate for Payer: Frontpath All Commercial |
$383.01
|
| Rate for Payer: Humana ChoiceCare |
$359.58
|
| Rate for Payer: Humana Medicare |
$133.22
|
| Rate for Payer: Lucent All Commercial |
$226.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.69
|
| Rate for Payer: Managed Health Services Medicaid |
$14.28
|
| Rate for Payer: MDWise Medicaid |
$14.28
|
| Rate for Payer: PHCS All Commercial |
$312.24
|
| Rate for Payer: PHP All Commercial |
$315.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.36
|
| Rate for Payer: Sagamore Health Network All Products |
$321.40
|
| Rate for Payer: Signature Care EPO |
$345.55
|
| Rate for Payer: Signature Care PPO |
$366.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.87
|
| Rate for Payer: United Healthcare Commercial |
$328.06
|
| Rate for Payer: United Healthcare Medicare |
$133.22
|
|
|
HC X-RAY-ANKLE 2 VIEWS RT
|
Facility
|
IP
|
$416.32
|
|
|
Service Code
|
CPT 73600 RT
|
| Hospital Charge Code |
11613600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.24 |
| Max. Negotiated Rate |
$387.18 |
| Rate for Payer: Aetna Commercial |
$359.70
|
| Rate for Payer: Cash Price |
$249.79
|
| Rate for Payer: Cigna All Commercial |
$359.28
|
| Rate for Payer: CORVEL All Commercial |
$387.18
|
| Rate for Payer: Coventry All Commercial |
$366.36
|
| Rate for Payer: Encore All Commercial |
$383.22
|
| Rate for Payer: Frontpath All Commercial |
$383.01
|
| Rate for Payer: Humana ChoiceCare |
$359.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.69
|
| Rate for Payer: PHCS All Commercial |
$312.24
|
| Rate for Payer: PHP All Commercial |
$315.74
|
| Rate for Payer: Sagamore Health Network All Products |
$321.40
|
| Rate for Payer: Signature Care EPO |
$345.55
|
| Rate for Payer: Signature Care PPO |
$366.36
|
| Rate for Payer: United Healthcare Commercial |
$328.06
|
|
|
HC X-RAY-ANKLE MIN 3 VIEWS BI
|
Facility
|
OP
|
$765.59
|
|
|
Service Code
|
CPT 73610 50
|
| Hospital Charge Code |
21613610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$712.00 |
| Rate for Payer: Aetna Commercial |
$646.16
|
| Rate for Payer: Aetna Medicare |
$244.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$237.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$439.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$478.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$281.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$269.49
|
| Rate for Payer: Cash Price |
$459.35
|
| Rate for Payer: Cash Price |
$459.35
|
| Rate for Payer: Centivo All Commercial |
$416.48
|
| Rate for Payer: Cigna All Commercial |
$660.70
|
| Rate for Payer: CORVEL All Commercial |
$712.00
|
| Rate for Payer: Coventry All Commercial |
$673.72
|
| Rate for Payer: Encore All Commercial |
$704.73
|
| Rate for Payer: Frontpath All Commercial |
$704.34
|
| Rate for Payer: Humana ChoiceCare |
$661.24
|
| Rate for Payer: Humana Medicare |
$244.99
|
| Rate for Payer: Lucent All Commercial |
$416.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$689.03
|
| Rate for Payer: Managed Health Services Medicaid |
$17.51
|
| Rate for Payer: MDWise Medicaid |
$17.51
|
| Rate for Payer: PHCS All Commercial |
$574.19
|
| Rate for Payer: PHP All Commercial |
$580.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$298.58
|
| Rate for Payer: Sagamore Health Network All Products |
$591.04
|
| Rate for Payer: Signature Care EPO |
$635.44
|
| Rate for Payer: Signature Care PPO |
$673.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$650.75
|
| Rate for Payer: United Healthcare Commercial |
$603.28
|
| Rate for Payer: United Healthcare Medicare |
$244.99
|
|
|
HC X-RAY-ANKLE MIN 3 VIEWS BI
|
Facility
|
IP
|
$765.59
|
|
|
Service Code
|
CPT 73610 50
|
| Hospital Charge Code |
21613610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$574.19 |
| Max. Negotiated Rate |
$712.00 |
| Rate for Payer: Aetna Commercial |
$661.47
|
| Rate for Payer: Cash Price |
$459.35
|
| Rate for Payer: Cigna All Commercial |
$660.70
|
| Rate for Payer: CORVEL All Commercial |
$712.00
|
| Rate for Payer: Coventry All Commercial |
$673.72
|
| Rate for Payer: Encore All Commercial |
$704.73
|
| Rate for Payer: Frontpath All Commercial |
$704.34
|
| Rate for Payer: Humana ChoiceCare |
$661.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$689.03
|
| Rate for Payer: PHCS All Commercial |
$574.19
|
| Rate for Payer: PHP All Commercial |
$580.62
|
| Rate for Payer: Sagamore Health Network All Products |
$591.04
|
| Rate for Payer: Signature Care EPO |
$635.44
|
| Rate for Payer: Signature Care PPO |
$673.72
|
| Rate for Payer: United Healthcare Commercial |
$603.28
|
|
|
HC X-RAY-ANKLE MIN 3 VIEWS LT
|
Facility
|
OP
|
$510.40
|
|
|
Service Code
|
CPT 73610 LT
|
| Hospital Charge Code |
1613610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$474.67 |
| Rate for Payer: Aetna Commercial |
$430.78
|
| Rate for Payer: Aetna Medicare |
$163.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$158.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$293.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$319.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$187.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$179.66
|
| Rate for Payer: Cash Price |
$306.24
|
| Rate for Payer: Cash Price |
$306.24
|
| Rate for Payer: Centivo All Commercial |
$277.66
|
| Rate for Payer: Cigna All Commercial |
$440.48
|
| Rate for Payer: CORVEL All Commercial |
$474.67
|
| Rate for Payer: Coventry All Commercial |
$449.15
|
| Rate for Payer: Encore All Commercial |
$469.82
|
| Rate for Payer: Frontpath All Commercial |
$469.57
|
| Rate for Payer: Humana ChoiceCare |
$440.83
|
| Rate for Payer: Humana Medicare |
$163.33
|
| Rate for Payer: Lucent All Commercial |
$277.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$459.36
|
| Rate for Payer: Managed Health Services Medicaid |
$17.51
|
| Rate for Payer: MDWise Medicaid |
$17.51
|
| Rate for Payer: PHCS All Commercial |
$382.80
|
| Rate for Payer: PHP All Commercial |
$387.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.06
|
| Rate for Payer: Sagamore Health Network All Products |
$394.03
|
| Rate for Payer: Signature Care EPO |
$423.63
|
| Rate for Payer: Signature Care PPO |
$449.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$433.84
|
| Rate for Payer: United Healthcare Commercial |
$402.20
|
| Rate for Payer: United Healthcare Medicare |
$163.33
|
|
|
HC X-RAY-ANKLE MIN 3 VIEWS LT
|
Facility
|
IP
|
$510.40
|
|
|
Service Code
|
CPT 73610 LT
|
| Hospital Charge Code |
1613610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$382.80 |
| Max. Negotiated Rate |
$474.67 |
| Rate for Payer: Aetna Commercial |
$440.99
|
| Rate for Payer: Cash Price |
$306.24
|
| Rate for Payer: Cigna All Commercial |
$440.48
|
| Rate for Payer: CORVEL All Commercial |
$474.67
|
| Rate for Payer: Coventry All Commercial |
$449.15
|
| Rate for Payer: Encore All Commercial |
$469.82
|
| Rate for Payer: Frontpath All Commercial |
$469.57
|
| Rate for Payer: Humana ChoiceCare |
$440.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$459.36
|
| Rate for Payer: PHCS All Commercial |
$382.80
|
| Rate for Payer: PHP All Commercial |
$387.09
|
| Rate for Payer: Sagamore Health Network All Products |
$394.03
|
| Rate for Payer: Signature Care EPO |
$423.63
|
| Rate for Payer: Signature Care PPO |
$449.15
|
| Rate for Payer: United Healthcare Commercial |
$402.20
|
|
|
HC X-RAY-ANKLE MIN 3 VIEWS RT
|
Facility
|
IP
|
$510.40
|
|
|
Service Code
|
CPT 73610 RT
|
| Hospital Charge Code |
11613610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$382.80 |
| Max. Negotiated Rate |
$474.67 |
| Rate for Payer: Aetna Commercial |
$440.99
|
| Rate for Payer: Cash Price |
$306.24
|
| Rate for Payer: Cigna All Commercial |
$440.48
|
| Rate for Payer: CORVEL All Commercial |
$474.67
|
| Rate for Payer: Coventry All Commercial |
$449.15
|
| Rate for Payer: Encore All Commercial |
$469.82
|
| Rate for Payer: Frontpath All Commercial |
$469.57
|
| Rate for Payer: Humana ChoiceCare |
$440.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$459.36
|
| Rate for Payer: PHCS All Commercial |
$382.80
|
| Rate for Payer: PHP All Commercial |
$387.09
|
| Rate for Payer: Sagamore Health Network All Products |
$394.03
|
| Rate for Payer: Signature Care EPO |
$423.63
|
| Rate for Payer: Signature Care PPO |
$449.15
|
| Rate for Payer: United Healthcare Commercial |
$402.20
|
|
|
HC X-RAY-ANKLE MIN 3 VIEWS RT
|
Facility
|
OP
|
$510.40
|
|
|
Service Code
|
CPT 73610 RT
|
| Hospital Charge Code |
11613610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$474.67 |
| Rate for Payer: Aetna Commercial |
$430.78
|
| Rate for Payer: Aetna Medicare |
$163.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$158.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$293.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$319.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$187.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$179.66
|
| Rate for Payer: Cash Price |
$306.24
|
| Rate for Payer: Cash Price |
$306.24
|
| Rate for Payer: Centivo All Commercial |
$277.66
|
| Rate for Payer: Cigna All Commercial |
$440.48
|
| Rate for Payer: CORVEL All Commercial |
$474.67
|
| Rate for Payer: Coventry All Commercial |
$449.15
|
| Rate for Payer: Encore All Commercial |
$469.82
|
| Rate for Payer: Frontpath All Commercial |
$469.57
|
| Rate for Payer: Humana ChoiceCare |
$440.83
|
| Rate for Payer: Humana Medicare |
$163.33
|
| Rate for Payer: Lucent All Commercial |
$277.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$459.36
|
| Rate for Payer: Managed Health Services Medicaid |
$17.51
|
| Rate for Payer: MDWise Medicaid |
$17.51
|
| Rate for Payer: PHCS All Commercial |
$382.80
|
| Rate for Payer: PHP All Commercial |
$387.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.06
|
| Rate for Payer: Sagamore Health Network All Products |
$394.03
|
| Rate for Payer: Signature Care EPO |
$423.63
|
| Rate for Payer: Signature Care PPO |
$449.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$433.84
|
| Rate for Payer: United Healthcare Commercial |
$402.20
|
| Rate for Payer: United Healthcare Medicare |
$163.33
|
|
|
HC X-RAY-BONE AGE
|
Facility
|
IP
|
$230.44
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
1616020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.83 |
| Max. Negotiated Rate |
$214.31 |
| Rate for Payer: Aetna Commercial |
$199.10
|
| Rate for Payer: Cash Price |
$138.26
|
| Rate for Payer: Cigna All Commercial |
$198.87
|
| Rate for Payer: CORVEL All Commercial |
$214.31
|
| Rate for Payer: Coventry All Commercial |
$202.79
|
| Rate for Payer: Encore All Commercial |
$212.12
|
| Rate for Payer: Frontpath All Commercial |
$212.00
|
| Rate for Payer: Humana ChoiceCare |
$199.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.40
|
| Rate for Payer: PHCS All Commercial |
$172.83
|
| Rate for Payer: PHP All Commercial |
$174.77
|
| Rate for Payer: Sagamore Health Network All Products |
$177.90
|
| Rate for Payer: Signature Care EPO |
$191.27
|
| Rate for Payer: Signature Care PPO |
$202.79
|
| Rate for Payer: United Healthcare Commercial |
$181.59
|
|
|
HC X-RAY-BONE AGE
|
Facility
|
OP
|
$230.44
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
1616020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.83 |
| Max. Negotiated Rate |
$214.31 |
| Rate for Payer: Aetna Commercial |
$194.49
|
| Rate for Payer: Aetna Medicare |
$73.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$9.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$71.44
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$132.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.11
|
| Rate for Payer: Cash Price |
$138.26
|
| Rate for Payer: Cash Price |
$138.26
|
| Rate for Payer: Centivo All Commercial |
$125.36
|
| Rate for Payer: Cigna All Commercial |
$198.87
|
| Rate for Payer: CORVEL All Commercial |
$214.31
|
| Rate for Payer: Coventry All Commercial |
$202.79
|
| Rate for Payer: Encore All Commercial |
$212.12
|
| Rate for Payer: Frontpath All Commercial |
$212.00
|
| Rate for Payer: Humana ChoiceCare |
$199.03
|
| Rate for Payer: Humana Medicare |
$73.74
|
| Rate for Payer: Lucent All Commercial |
$125.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.40
|
| Rate for Payer: Managed Health Services Medicaid |
$9.83
|
| Rate for Payer: MDWise Medicaid |
$9.83
|
| Rate for Payer: PHCS All Commercial |
$172.83
|
| Rate for Payer: PHP All Commercial |
$174.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.87
|
| Rate for Payer: Sagamore Health Network All Products |
$177.90
|
| Rate for Payer: Signature Care EPO |
$191.27
|
| Rate for Payer: Signature Care PPO |
$202.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$195.87
|
| Rate for Payer: United Healthcare Commercial |
$181.59
|
| Rate for Payer: United Healthcare Medicare |
$73.74
|
|
|
HC X-RAY-BONE LENGTH STUDY
|
Facility
|
OP
|
$597.90
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
1617040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$556.05 |
| Rate for Payer: Aetna Commercial |
$504.63
|
| Rate for Payer: Aetna Medicare |
$191.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$185.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$343.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$373.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$220.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$210.46
|
| Rate for Payer: Cash Price |
$358.74
|
| Rate for Payer: Cash Price |
$358.74
|
| Rate for Payer: Centivo All Commercial |
$325.26
|
| Rate for Payer: Cigna All Commercial |
$515.99
|
| Rate for Payer: CORVEL All Commercial |
$556.05
|
| Rate for Payer: Coventry All Commercial |
$526.15
|
| Rate for Payer: Encore All Commercial |
$550.37
|
| Rate for Payer: Frontpath All Commercial |
$550.07
|
| Rate for Payer: Humana ChoiceCare |
$516.41
|
| Rate for Payer: Humana Medicare |
$191.33
|
| Rate for Payer: Lucent All Commercial |
$325.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$538.11
|
| Rate for Payer: Managed Health Services Medicaid |
$16.02
|
| Rate for Payer: MDWise Medicaid |
$16.02
|
| Rate for Payer: PHCS All Commercial |
$448.43
|
| Rate for Payer: PHP All Commercial |
$453.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$233.18
|
| Rate for Payer: Sagamore Health Network All Products |
$461.58
|
| Rate for Payer: Signature Care EPO |
$496.26
|
| Rate for Payer: Signature Care PPO |
$526.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$508.21
|
| Rate for Payer: United Healthcare Commercial |
$471.15
|
| Rate for Payer: United Healthcare Medicare |
$191.33
|
|
|
HC X-RAY-BONE LENGTH STUDY
|
Facility
|
IP
|
$597.90
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
1617040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$448.43 |
| Max. Negotiated Rate |
$556.05 |
| Rate for Payer: Aetna Commercial |
$516.59
|
| Rate for Payer: Cash Price |
$358.74
|
| Rate for Payer: Cigna All Commercial |
$515.99
|
| Rate for Payer: CORVEL All Commercial |
$556.05
|
| Rate for Payer: Coventry All Commercial |
$526.15
|
| Rate for Payer: Encore All Commercial |
$550.37
|
| Rate for Payer: Frontpath All Commercial |
$550.07
|
| Rate for Payer: Humana ChoiceCare |
$516.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$538.11
|
| Rate for Payer: PHCS All Commercial |
$448.43
|
| Rate for Payer: PHP All Commercial |
$453.45
|
| Rate for Payer: Sagamore Health Network All Products |
$461.58
|
| Rate for Payer: Signature Care EPO |
$496.26
|
| Rate for Payer: Signature Care PPO |
$526.15
|
| Rate for Payer: United Healthcare Commercial |
$471.15
|
|
|
HC X-RAY-CARPAL SERIES 3+ VIEWS LT
|
Facility
|
OP
|
$390.93
|
|
|
Service Code
|
CPT 73110 LT
|
| Hospital Charge Code |
1613059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$363.56 |
| Rate for Payer: Aetna Commercial |
$329.94
|
| Rate for Payer: Aetna Medicare |
$125.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$121.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$224.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$244.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$137.61
|
| Rate for Payer: Cash Price |
$234.56
|
| Rate for Payer: Cash Price |
$234.56
|
| Rate for Payer: Centivo All Commercial |
$212.67
|
| Rate for Payer: Cigna All Commercial |
$337.37
|
| Rate for Payer: CORVEL All Commercial |
$363.56
|
| Rate for Payer: Coventry All Commercial |
$344.02
|
| Rate for Payer: Encore All Commercial |
$359.85
|
| Rate for Payer: Frontpath All Commercial |
$359.66
|
| Rate for Payer: Humana ChoiceCare |
$337.65
|
| Rate for Payer: Humana Medicare |
$125.10
|
| Rate for Payer: Lucent All Commercial |
$212.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.84
|
| Rate for Payer: Managed Health Services Medicaid |
$20.48
|
| Rate for Payer: MDWise Medicaid |
$20.48
|
| Rate for Payer: PHCS All Commercial |
$293.20
|
| Rate for Payer: PHP All Commercial |
$296.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.46
|
| Rate for Payer: Sagamore Health Network All Products |
$301.80
|
| Rate for Payer: Signature Care EPO |
$324.47
|
| Rate for Payer: Signature Care PPO |
$344.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$332.29
|
| Rate for Payer: United Healthcare Commercial |
$308.05
|
| Rate for Payer: United Healthcare Medicare |
$125.10
|
|
|
HC X-RAY-CARPAL SERIES 3+ VIEWS LT
|
Facility
|
IP
|
$390.93
|
|
|
Service Code
|
CPT 73110 LT
|
| Hospital Charge Code |
1613059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$293.20 |
| Max. Negotiated Rate |
$363.56 |
| Rate for Payer: Aetna Commercial |
$337.76
|
| Rate for Payer: Cash Price |
$234.56
|
| Rate for Payer: Cigna All Commercial |
$337.37
|
| Rate for Payer: CORVEL All Commercial |
$363.56
|
| Rate for Payer: Coventry All Commercial |
$344.02
|
| Rate for Payer: Encore All Commercial |
$359.85
|
| Rate for Payer: Frontpath All Commercial |
$359.66
|
| Rate for Payer: Humana ChoiceCare |
$337.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.84
|
| Rate for Payer: PHCS All Commercial |
$293.20
|
| Rate for Payer: PHP All Commercial |
$296.48
|
| Rate for Payer: Sagamore Health Network All Products |
$301.80
|
| Rate for Payer: Signature Care EPO |
$324.47
|
| Rate for Payer: Signature Care PPO |
$344.02
|
| Rate for Payer: United Healthcare Commercial |
$308.05
|
|
|
HC X-RAY-CARPAL SERIES 3+ VIEWS RT
|
Facility
|
OP
|
$390.93
|
|
|
Service Code
|
CPT 73110 RT
|
| Hospital Charge Code |
11613059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$363.56 |
| Rate for Payer: Aetna Commercial |
$329.94
|
| Rate for Payer: Aetna Medicare |
$125.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$121.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$224.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$244.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$143.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$137.61
|
| Rate for Payer: Cash Price |
$234.56
|
| Rate for Payer: Cash Price |
$234.56
|
| Rate for Payer: Centivo All Commercial |
$212.67
|
| Rate for Payer: Cigna All Commercial |
$337.37
|
| Rate for Payer: CORVEL All Commercial |
$363.56
|
| Rate for Payer: Coventry All Commercial |
$344.02
|
| Rate for Payer: Encore All Commercial |
$359.85
|
| Rate for Payer: Frontpath All Commercial |
$359.66
|
| Rate for Payer: Humana ChoiceCare |
$337.65
|
| Rate for Payer: Humana Medicare |
$125.10
|
| Rate for Payer: Lucent All Commercial |
$212.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.84
|
| Rate for Payer: Managed Health Services Medicaid |
$20.48
|
| Rate for Payer: MDWise Medicaid |
$20.48
|
| Rate for Payer: PHCS All Commercial |
$293.20
|
| Rate for Payer: PHP All Commercial |
$296.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.46
|
| Rate for Payer: Sagamore Health Network All Products |
$301.80
|
| Rate for Payer: Signature Care EPO |
$324.47
|
| Rate for Payer: Signature Care PPO |
$344.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$332.29
|
| Rate for Payer: United Healthcare Commercial |
$308.05
|
| Rate for Payer: United Healthcare Medicare |
$125.10
|
|
|
HC X-RAY-CARPAL SERIES 3+ VIEWS RT
|
Facility
|
IP
|
$390.93
|
|
|
Service Code
|
CPT 73110 RT
|
| Hospital Charge Code |
11613059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$293.20 |
| Max. Negotiated Rate |
$363.56 |
| Rate for Payer: Aetna Commercial |
$337.76
|
| Rate for Payer: Cash Price |
$234.56
|
| Rate for Payer: Cigna All Commercial |
$337.37
|
| Rate for Payer: CORVEL All Commercial |
$363.56
|
| Rate for Payer: Coventry All Commercial |
$344.02
|
| Rate for Payer: Encore All Commercial |
$359.85
|
| Rate for Payer: Frontpath All Commercial |
$359.66
|
| Rate for Payer: Humana ChoiceCare |
$337.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.84
|
| Rate for Payer: PHCS All Commercial |
$293.20
|
| Rate for Payer: PHP All Commercial |
$296.48
|
| Rate for Payer: Sagamore Health Network All Products |
$301.80
|
| Rate for Payer: Signature Care EPO |
$324.47
|
| Rate for Payer: Signature Care PPO |
$344.02
|
| Rate for Payer: United Healthcare Commercial |
$308.05
|
|
