|
HC X-RAY-ELBOW MIN 3 VIEWS LT
|
Facility
|
IP
|
$507.77
|
|
|
Service Code
|
CPT 73080 LT
|
| Hospital Charge Code |
1613070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$380.83 |
| Max. Negotiated Rate |
$472.23 |
| Rate for Payer: Aetna Commercial |
$438.71
|
| Rate for Payer: Cash Price |
$304.66
|
| Rate for Payer: Cigna All Commercial |
$438.21
|
| Rate for Payer: CORVEL All Commercial |
$472.23
|
| Rate for Payer: Coventry All Commercial |
$446.84
|
| Rate for Payer: Encore All Commercial |
$467.40
|
| Rate for Payer: Frontpath All Commercial |
$467.15
|
| Rate for Payer: Humana ChoiceCare |
$438.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$456.99
|
| Rate for Payer: PHCS All Commercial |
$380.83
|
| Rate for Payer: PHP All Commercial |
$385.09
|
| Rate for Payer: Sagamore Health Network All Products |
$392.00
|
| Rate for Payer: Signature Care EPO |
$421.45
|
| Rate for Payer: Signature Care PPO |
$446.84
|
| Rate for Payer: United Healthcare Commercial |
$400.12
|
|
|
HC X-RAY-ELBOW MIN 3 VIEWS RT
|
Facility
|
IP
|
$507.77
|
|
|
Service Code
|
CPT 73080 RT
|
| Hospital Charge Code |
11613070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$380.83 |
| Max. Negotiated Rate |
$472.23 |
| Rate for Payer: Aetna Commercial |
$438.71
|
| Rate for Payer: Cash Price |
$304.66
|
| Rate for Payer: Cigna All Commercial |
$438.21
|
| Rate for Payer: CORVEL All Commercial |
$472.23
|
| Rate for Payer: Coventry All Commercial |
$446.84
|
| Rate for Payer: Encore All Commercial |
$467.40
|
| Rate for Payer: Frontpath All Commercial |
$467.15
|
| Rate for Payer: Humana ChoiceCare |
$438.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$456.99
|
| Rate for Payer: PHCS All Commercial |
$380.83
|
| Rate for Payer: PHP All Commercial |
$385.09
|
| Rate for Payer: Sagamore Health Network All Products |
$392.00
|
| Rate for Payer: Signature Care EPO |
$421.45
|
| Rate for Payer: Signature Care PPO |
$446.84
|
| Rate for Payer: United Healthcare Commercial |
$400.12
|
|
|
HC X-RAY-ELBOW MIN 3 VIEWS RT
|
Facility
|
OP
|
$507.77
|
|
|
Service Code
|
CPT 73080 RT
|
| Hospital Charge Code |
11613070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.51 |
| Max. Negotiated Rate |
$472.23 |
| Rate for Payer: Aetna Commercial |
$428.56
|
| Rate for Payer: Aetna Medicare |
$162.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$157.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$291.61
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$317.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$17.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$186.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$178.74
|
| Rate for Payer: Cash Price |
$304.66
|
| Rate for Payer: Cash Price |
$304.66
|
| Rate for Payer: Centivo All Commercial |
$276.23
|
| Rate for Payer: Cigna All Commercial |
$438.21
|
| Rate for Payer: CORVEL All Commercial |
$472.23
|
| Rate for Payer: Coventry All Commercial |
$446.84
|
| Rate for Payer: Encore All Commercial |
$467.40
|
| Rate for Payer: Frontpath All Commercial |
$467.15
|
| Rate for Payer: Humana ChoiceCare |
$438.56
|
| Rate for Payer: Humana Medicare |
$162.49
|
| Rate for Payer: Lucent All Commercial |
$276.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$456.99
|
| Rate for Payer: Managed Health Services Medicaid |
$17.51
|
| Rate for Payer: MDWise Medicaid |
$17.51
|
| Rate for Payer: PHCS All Commercial |
$380.83
|
| Rate for Payer: PHP All Commercial |
$385.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$198.03
|
| Rate for Payer: Sagamore Health Network All Products |
$392.00
|
| Rate for Payer: Signature Care EPO |
$421.45
|
| Rate for Payer: Signature Care PPO |
$446.84
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$431.60
|
| Rate for Payer: United Healthcare Commercial |
$400.12
|
| Rate for Payer: United Healthcare Medicare |
$162.49
|
|
|
HC X-RAY EXAM ABDOMEN 1 VIEW
|
Facility
|
IP
|
$506.23
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
1614018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$379.67 |
| Max. Negotiated Rate |
$470.79 |
| Rate for Payer: Aetna Commercial |
$437.38
|
| Rate for Payer: Cash Price |
$303.74
|
| Rate for Payer: Cigna All Commercial |
$436.88
|
| Rate for Payer: CORVEL All Commercial |
$470.79
|
| Rate for Payer: Coventry All Commercial |
$445.48
|
| Rate for Payer: Encore All Commercial |
$465.98
|
| Rate for Payer: Frontpath All Commercial |
$465.73
|
| Rate for Payer: Humana ChoiceCare |
$437.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$455.61
|
| Rate for Payer: PHCS All Commercial |
$379.67
|
| Rate for Payer: PHP All Commercial |
$383.92
|
| Rate for Payer: Sagamore Health Network All Products |
$390.81
|
| Rate for Payer: Signature Care EPO |
$420.17
|
| Rate for Payer: Signature Care PPO |
$445.48
|
| Rate for Payer: United Healthcare Commercial |
$398.91
|
|
|
HC X-RAY EXAM ABDOMEN 1 VIEW
|
Facility
|
OP
|
$506.23
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
1614018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.12 |
| Max. Negotiated Rate |
$470.79 |
| Rate for Payer: Aetna Commercial |
$427.26
|
| Rate for Payer: Aetna Medicare |
$161.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$62.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$156.93
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$290.73
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$316.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$62.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$186.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$178.19
|
| Rate for Payer: Cash Price |
$303.74
|
| Rate for Payer: Cash Price |
$303.74
|
| Rate for Payer: Centivo All Commercial |
$275.39
|
| Rate for Payer: Cigna All Commercial |
$436.88
|
| Rate for Payer: CORVEL All Commercial |
$470.79
|
| Rate for Payer: Coventry All Commercial |
$445.48
|
| Rate for Payer: Encore All Commercial |
$465.98
|
| Rate for Payer: Frontpath All Commercial |
$465.73
|
| Rate for Payer: Humana ChoiceCare |
$437.23
|
| Rate for Payer: Humana Medicare |
$161.99
|
| Rate for Payer: Lucent All Commercial |
$275.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$455.61
|
| Rate for Payer: Managed Health Services Medicaid |
$62.12
|
| Rate for Payer: MDWise Medicaid |
$62.12
|
| Rate for Payer: PHCS All Commercial |
$379.67
|
| Rate for Payer: PHP All Commercial |
$383.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$197.43
|
| Rate for Payer: Sagamore Health Network All Products |
$390.81
|
| Rate for Payer: Signature Care EPO |
$420.17
|
| Rate for Payer: Signature Care PPO |
$445.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$430.30
|
| Rate for Payer: United Healthcare Commercial |
$398.91
|
| Rate for Payer: United Healthcare Medicare |
$161.99
|
|
|
HC X-RAY EXAM ABDOMEN 2 VIEWS
|
Facility
|
OP
|
$582.18
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
1614010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.46 |
| Max. Negotiated Rate |
$541.43 |
| Rate for Payer: Aetna Commercial |
$491.36
|
| Rate for Payer: Aetna Medicare |
$186.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$180.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$334.35
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$363.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$214.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$204.93
|
| Rate for Payer: Cash Price |
$349.31
|
| Rate for Payer: Cash Price |
$349.31
|
| Rate for Payer: Centivo All Commercial |
$316.71
|
| Rate for Payer: Cigna All Commercial |
$502.42
|
| Rate for Payer: CORVEL All Commercial |
$541.43
|
| Rate for Payer: Coventry All Commercial |
$512.32
|
| Rate for Payer: Encore All Commercial |
$535.90
|
| Rate for Payer: Frontpath All Commercial |
$535.61
|
| Rate for Payer: Humana ChoiceCare |
$502.83
|
| Rate for Payer: Humana Medicare |
$186.30
|
| Rate for Payer: Lucent All Commercial |
$316.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$523.96
|
| Rate for Payer: Managed Health Services Medicaid |
$114.46
|
| Rate for Payer: MDWise Medicaid |
$114.46
|
| Rate for Payer: PHCS All Commercial |
$436.63
|
| Rate for Payer: PHP All Commercial |
$441.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$227.05
|
| Rate for Payer: Sagamore Health Network All Products |
$449.44
|
| Rate for Payer: Signature Care EPO |
$483.21
|
| Rate for Payer: Signature Care PPO |
$512.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$494.85
|
| Rate for Payer: United Healthcare Commercial |
$458.76
|
| Rate for Payer: United Healthcare Medicare |
$186.30
|
|
|
HC X-RAY EXAM ABDOMEN 2 VIEWS
|
Facility
|
IP
|
$582.18
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
1614010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$436.63 |
| Max. Negotiated Rate |
$541.43 |
| Rate for Payer: Aetna Commercial |
$503.00
|
| Rate for Payer: Cash Price |
$349.31
|
| Rate for Payer: Cigna All Commercial |
$502.42
|
| Rate for Payer: CORVEL All Commercial |
$541.43
|
| Rate for Payer: Coventry All Commercial |
$512.32
|
| Rate for Payer: Encore All Commercial |
$535.90
|
| Rate for Payer: Frontpath All Commercial |
$535.61
|
| Rate for Payer: Humana ChoiceCare |
$502.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$523.96
|
| Rate for Payer: PHCS All Commercial |
$436.63
|
| Rate for Payer: PHP All Commercial |
$441.53
|
| Rate for Payer: Sagamore Health Network All Products |
$449.44
|
| Rate for Payer: Signature Care EPO |
$483.21
|
| Rate for Payer: Signature Care PPO |
$512.32
|
| Rate for Payer: United Healthcare Commercial |
$458.76
|
|
|
HC X-RAY EXAM ABDOMEN 3+ VIEWS
|
Facility
|
OP
|
$669.50
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
1614021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.46 |
| Max. Negotiated Rate |
$622.63 |
| Rate for Payer: Aetna Commercial |
$565.06
|
| Rate for Payer: Aetna Medicare |
$214.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$207.54
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$384.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$418.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$246.38
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$235.66
|
| Rate for Payer: Cash Price |
$401.70
|
| Rate for Payer: Cash Price |
$401.70
|
| Rate for Payer: Centivo All Commercial |
$364.21
|
| Rate for Payer: Cigna All Commercial |
$577.78
|
| Rate for Payer: CORVEL All Commercial |
$622.63
|
| Rate for Payer: Coventry All Commercial |
$589.16
|
| Rate for Payer: Encore All Commercial |
$616.27
|
| Rate for Payer: Frontpath All Commercial |
$615.94
|
| Rate for Payer: Humana ChoiceCare |
$578.25
|
| Rate for Payer: Humana Medicare |
$214.24
|
| Rate for Payer: Lucent All Commercial |
$364.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$602.55
|
| Rate for Payer: Managed Health Services Medicaid |
$114.46
|
| Rate for Payer: MDWise Medicaid |
$114.46
|
| Rate for Payer: PHCS All Commercial |
$502.12
|
| Rate for Payer: PHP All Commercial |
$507.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$261.11
|
| Rate for Payer: Sagamore Health Network All Products |
$516.85
|
| Rate for Payer: Signature Care EPO |
$555.68
|
| Rate for Payer: Signature Care PPO |
$589.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$569.08
|
| Rate for Payer: United Healthcare Commercial |
$527.57
|
| Rate for Payer: United Healthcare Medicare |
$214.24
|
|
|
HC X-RAY EXAM ABDOMEN 3+ VIEWS
|
Facility
|
IP
|
$669.50
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
1614021
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$502.12 |
| Max. Negotiated Rate |
$622.63 |
| Rate for Payer: Aetna Commercial |
$578.45
|
| Rate for Payer: Cash Price |
$401.70
|
| Rate for Payer: Cigna All Commercial |
$577.78
|
| Rate for Payer: CORVEL All Commercial |
$622.63
|
| Rate for Payer: Coventry All Commercial |
$589.16
|
| Rate for Payer: Encore All Commercial |
$616.27
|
| Rate for Payer: Frontpath All Commercial |
$615.94
|
| Rate for Payer: Humana ChoiceCare |
$578.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$602.55
|
| Rate for Payer: PHCS All Commercial |
$502.12
|
| Rate for Payer: PHP All Commercial |
$507.75
|
| Rate for Payer: Sagamore Health Network All Products |
$516.85
|
| Rate for Payer: Signature Care EPO |
$555.68
|
| Rate for Payer: Signature Care PPO |
$589.16
|
| Rate for Payer: United Healthcare Commercial |
$527.57
|
|
|
HC X-RAY EXAM CHEST 1 VIEW
|
Facility
|
OP
|
$360.33
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
1611010
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$62.12 |
| Max. Negotiated Rate |
$335.11 |
| Rate for Payer: Aetna Commercial |
$304.12
|
| Rate for Payer: Aetna Medicare |
$115.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$62.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$206.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$225.24
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$62.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$132.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$126.84
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Centivo All Commercial |
$196.02
|
| Rate for Payer: Cigna All Commercial |
$310.96
|
| Rate for Payer: CORVEL All Commercial |
$335.11
|
| Rate for Payer: Coventry All Commercial |
$317.09
|
| Rate for Payer: Encore All Commercial |
$331.68
|
| Rate for Payer: Frontpath All Commercial |
$331.50
|
| Rate for Payer: Humana ChoiceCare |
$311.22
|
| Rate for Payer: Humana Medicare |
$115.31
|
| Rate for Payer: Lucent All Commercial |
$196.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$324.30
|
| Rate for Payer: Managed Health Services Medicaid |
$62.12
|
| Rate for Payer: MDWise Medicaid |
$62.12
|
| Rate for Payer: PHCS All Commercial |
$270.25
|
| Rate for Payer: PHP All Commercial |
$273.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$140.53
|
| Rate for Payer: Sagamore Health Network All Products |
$278.17
|
| Rate for Payer: Signature Care EPO |
$299.07
|
| Rate for Payer: Signature Care PPO |
$317.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$306.28
|
| Rate for Payer: United Healthcare Commercial |
$283.94
|
| Rate for Payer: United Healthcare Medicare |
$115.31
|
|
|
HC X-RAY EXAM CHEST 1 VIEW
|
Facility
|
IP
|
$360.33
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
1611010
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$270.25 |
| Max. Negotiated Rate |
$335.11 |
| Rate for Payer: Aetna Commercial |
$311.33
|
| Rate for Payer: Cash Price |
$216.20
|
| Rate for Payer: Cigna All Commercial |
$310.96
|
| Rate for Payer: CORVEL All Commercial |
$335.11
|
| Rate for Payer: Coventry All Commercial |
$317.09
|
| Rate for Payer: Encore All Commercial |
$331.68
|
| Rate for Payer: Frontpath All Commercial |
$331.50
|
| Rate for Payer: Humana ChoiceCare |
$311.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$324.30
|
| Rate for Payer: PHCS All Commercial |
$270.25
|
| Rate for Payer: PHP All Commercial |
$273.27
|
| Rate for Payer: Sagamore Health Network All Products |
$278.17
|
| Rate for Payer: Signature Care EPO |
$299.07
|
| Rate for Payer: Signature Care PPO |
$317.09
|
| Rate for Payer: United Healthcare Commercial |
$283.94
|
|
|
HC X-RAY EXAM CHEST 2 VIEWS
|
Facility
|
OP
|
$414.38
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
1611046
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$62.12 |
| Max. Negotiated Rate |
$385.37 |
| Rate for Payer: Aetna Commercial |
$349.74
|
| Rate for Payer: Aetna Medicare |
$132.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$62.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$128.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$237.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$259.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$62.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$152.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$145.86
|
| Rate for Payer: Cash Price |
$248.63
|
| Rate for Payer: Cash Price |
$248.63
|
| Rate for Payer: Centivo All Commercial |
$225.42
|
| Rate for Payer: Cigna All Commercial |
$357.61
|
| Rate for Payer: CORVEL All Commercial |
$385.37
|
| Rate for Payer: Coventry All Commercial |
$364.65
|
| Rate for Payer: Encore All Commercial |
$381.44
|
| Rate for Payer: Frontpath All Commercial |
$381.23
|
| Rate for Payer: Humana ChoiceCare |
$357.90
|
| Rate for Payer: Humana Medicare |
$132.60
|
| Rate for Payer: Lucent All Commercial |
$225.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$372.94
|
| Rate for Payer: Managed Health Services Medicaid |
$62.12
|
| Rate for Payer: MDWise Medicaid |
$62.12
|
| Rate for Payer: PHCS All Commercial |
$310.79
|
| Rate for Payer: PHP All Commercial |
$314.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$161.61
|
| Rate for Payer: Sagamore Health Network All Products |
$319.90
|
| Rate for Payer: Signature Care EPO |
$343.94
|
| Rate for Payer: Signature Care PPO |
$364.65
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$352.22
|
| Rate for Payer: United Healthcare Commercial |
$326.53
|
| Rate for Payer: United Healthcare Medicare |
$132.60
|
|
|
HC X-RAY EXAM CHEST 2 VIEWS
|
Facility
|
IP
|
$414.38
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
1611046
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$310.79 |
| Max. Negotiated Rate |
$385.37 |
| Rate for Payer: Aetna Commercial |
$358.02
|
| Rate for Payer: Cash Price |
$248.63
|
| Rate for Payer: Cigna All Commercial |
$357.61
|
| Rate for Payer: CORVEL All Commercial |
$385.37
|
| Rate for Payer: Coventry All Commercial |
$364.65
|
| Rate for Payer: Encore All Commercial |
$381.44
|
| Rate for Payer: Frontpath All Commercial |
$381.23
|
| Rate for Payer: Humana ChoiceCare |
$357.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$372.94
|
| Rate for Payer: PHCS All Commercial |
$310.79
|
| Rate for Payer: PHP All Commercial |
$314.27
|
| Rate for Payer: Sagamore Health Network All Products |
$319.90
|
| Rate for Payer: Signature Care EPO |
$343.94
|
| Rate for Payer: Signature Care PPO |
$364.65
|
| Rate for Payer: United Healthcare Commercial |
$326.53
|
|
|
HC X-RAY EXAM CHEST 3 VIEWS
|
Facility
|
OP
|
$476.52
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
1611047
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$62.12 |
| Max. Negotiated Rate |
$443.16 |
| Rate for Payer: Aetna Commercial |
$402.18
|
| Rate for Payer: Aetna Medicare |
$152.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$62.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$147.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$273.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$297.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$62.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.74
|
| Rate for Payer: Cash Price |
$285.91
|
| Rate for Payer: Cash Price |
$285.91
|
| Rate for Payer: Centivo All Commercial |
$259.23
|
| Rate for Payer: Cigna All Commercial |
$411.24
|
| Rate for Payer: CORVEL All Commercial |
$443.16
|
| Rate for Payer: Coventry All Commercial |
$419.34
|
| Rate for Payer: Encore All Commercial |
$438.64
|
| Rate for Payer: Frontpath All Commercial |
$438.40
|
| Rate for Payer: Humana ChoiceCare |
$411.57
|
| Rate for Payer: Humana Medicare |
$152.49
|
| Rate for Payer: Lucent All Commercial |
$259.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.87
|
| Rate for Payer: Managed Health Services Medicaid |
$62.12
|
| Rate for Payer: MDWise Medicaid |
$62.12
|
| Rate for Payer: PHCS All Commercial |
$357.39
|
| Rate for Payer: PHP All Commercial |
$361.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.84
|
| Rate for Payer: Sagamore Health Network All Products |
$367.87
|
| Rate for Payer: Signature Care EPO |
$395.51
|
| Rate for Payer: Signature Care PPO |
$419.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$405.04
|
| Rate for Payer: United Healthcare Commercial |
$375.50
|
| Rate for Payer: United Healthcare Medicare |
$152.49
|
|
|
HC X-RAY EXAM CHEST 3 VIEWS
|
Facility
|
IP
|
$476.52
|
|
|
Service Code
|
CPT 71047
|
| Hospital Charge Code |
1611047
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$357.39 |
| Max. Negotiated Rate |
$443.16 |
| Rate for Payer: Aetna Commercial |
$411.71
|
| Rate for Payer: Cash Price |
$285.91
|
| Rate for Payer: Cigna All Commercial |
$411.24
|
| Rate for Payer: CORVEL All Commercial |
$443.16
|
| Rate for Payer: Coventry All Commercial |
$419.34
|
| Rate for Payer: Encore All Commercial |
$438.64
|
| Rate for Payer: Frontpath All Commercial |
$438.40
|
| Rate for Payer: Humana ChoiceCare |
$411.57
|
| Rate for Payer: Lutheran Preferred All Commercial |
$428.87
|
| Rate for Payer: PHCS All Commercial |
$357.39
|
| Rate for Payer: PHP All Commercial |
$361.39
|
| Rate for Payer: Sagamore Health Network All Products |
$367.87
|
| Rate for Payer: Signature Care EPO |
$395.51
|
| Rate for Payer: Signature Care PPO |
$419.34
|
| Rate for Payer: United Healthcare Commercial |
$375.50
|
|
|
HC X-RAY EXAM CHEST 4+ VIEWS
|
Facility
|
IP
|
$897.69
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
1611039
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$673.27 |
| Max. Negotiated Rate |
$834.85 |
| Rate for Payer: Aetna Commercial |
$775.60
|
| Rate for Payer: Cash Price |
$538.61
|
| Rate for Payer: Cigna All Commercial |
$774.71
|
| Rate for Payer: CORVEL All Commercial |
$834.85
|
| Rate for Payer: Coventry All Commercial |
$789.97
|
| Rate for Payer: Encore All Commercial |
$826.32
|
| Rate for Payer: Frontpath All Commercial |
$825.87
|
| Rate for Payer: Humana ChoiceCare |
$775.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$807.92
|
| Rate for Payer: PHCS All Commercial |
$673.27
|
| Rate for Payer: PHP All Commercial |
$680.81
|
| Rate for Payer: Sagamore Health Network All Products |
$693.02
|
| Rate for Payer: Signature Care EPO |
$745.08
|
| Rate for Payer: Signature Care PPO |
$789.97
|
| Rate for Payer: United Healthcare Commercial |
$707.38
|
|
|
HC X-RAY EXAM CHEST 4+ VIEWS
|
Facility
|
OP
|
$897.69
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
1611039
|
|
Hospital Revenue Code
|
324
|
| Min. Negotiated Rate |
$114.46 |
| Max. Negotiated Rate |
$834.85 |
| Rate for Payer: Aetna Commercial |
$757.65
|
| Rate for Payer: Aetna Medicare |
$287.26
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$114.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$278.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$515.54
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$561.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$114.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$330.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$315.99
|
| Rate for Payer: Cash Price |
$538.61
|
| Rate for Payer: Cash Price |
$538.61
|
| Rate for Payer: Centivo All Commercial |
$488.34
|
| Rate for Payer: Cigna All Commercial |
$774.71
|
| Rate for Payer: CORVEL All Commercial |
$834.85
|
| Rate for Payer: Coventry All Commercial |
$789.97
|
| Rate for Payer: Encore All Commercial |
$826.32
|
| Rate for Payer: Frontpath All Commercial |
$825.87
|
| Rate for Payer: Humana ChoiceCare |
$775.33
|
| Rate for Payer: Humana Medicare |
$287.26
|
| Rate for Payer: Lucent All Commercial |
$488.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$807.92
|
| Rate for Payer: Managed Health Services Medicaid |
$114.46
|
| Rate for Payer: MDWise Medicaid |
$114.46
|
| Rate for Payer: PHCS All Commercial |
$673.27
|
| Rate for Payer: PHP All Commercial |
$680.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$350.10
|
| Rate for Payer: Sagamore Health Network All Products |
$693.02
|
| Rate for Payer: Signature Care EPO |
$745.08
|
| Rate for Payer: Signature Care PPO |
$789.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$763.04
|
| Rate for Payer: United Healthcare Commercial |
$707.38
|
| Rate for Payer: United Healthcare Medicare |
$287.26
|
|
|
HC X-RAY EXAM ESOPHAGUS SINGLE CONT INC SCOUT FILMS STUDY
|
Facility
|
IP
|
$939.51
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1614220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$704.63 |
| Max. Negotiated Rate |
$873.74 |
| Rate for Payer: Aetna Commercial |
$811.74
|
| Rate for Payer: Cash Price |
$563.71
|
| Rate for Payer: Cigna All Commercial |
$810.80
|
| Rate for Payer: CORVEL All Commercial |
$873.74
|
| Rate for Payer: Coventry All Commercial |
$826.77
|
| Rate for Payer: Encore All Commercial |
$864.82
|
| Rate for Payer: Frontpath All Commercial |
$864.35
|
| Rate for Payer: Humana ChoiceCare |
$811.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$845.56
|
| Rate for Payer: PHCS All Commercial |
$704.63
|
| Rate for Payer: PHP All Commercial |
$712.52
|
| Rate for Payer: Sagamore Health Network All Products |
$725.30
|
| Rate for Payer: Signature Care EPO |
$779.79
|
| Rate for Payer: Signature Care PPO |
$826.77
|
| Rate for Payer: United Healthcare Commercial |
$740.33
|
|
|
HC X-RAY EXAM ESOPHAGUS SINGLE CONT INC SCOUT FILMS STUDY
|
Facility
|
OP
|
$939.51
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1614220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$873.74 |
| Rate for Payer: Aetna Commercial |
$792.95
|
| Rate for Payer: Aetna Medicare |
$300.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$48.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$291.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$539.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$587.29
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$48.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$345.74
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$330.71
|
| Rate for Payer: Cash Price |
$563.71
|
| Rate for Payer: Cash Price |
$563.71
|
| Rate for Payer: Centivo All Commercial |
$511.09
|
| Rate for Payer: Cigna All Commercial |
$810.80
|
| Rate for Payer: CORVEL All Commercial |
$873.74
|
| Rate for Payer: Coventry All Commercial |
$826.77
|
| Rate for Payer: Encore All Commercial |
$864.82
|
| Rate for Payer: Frontpath All Commercial |
$864.35
|
| Rate for Payer: Humana ChoiceCare |
$811.45
|
| Rate for Payer: Humana Medicare |
$300.64
|
| Rate for Payer: Lucent All Commercial |
$511.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$845.56
|
| Rate for Payer: Managed Health Services Medicaid |
$48.47
|
| Rate for Payer: MDWise Medicaid |
$48.47
|
| Rate for Payer: PHCS All Commercial |
$704.63
|
| Rate for Payer: PHP All Commercial |
$712.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$366.41
|
| Rate for Payer: Sagamore Health Network All Products |
$725.30
|
| Rate for Payer: Signature Care EPO |
$779.79
|
| Rate for Payer: Signature Care PPO |
$826.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$798.58
|
| Rate for Payer: United Healthcare Commercial |
$740.33
|
| Rate for Payer: United Healthcare Medicare |
$300.64
|
|
|
HC X-RAY EXAM HIPS BI 2 VIEWS
|
Facility
|
IP
|
$613.37
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
1613521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$460.03 |
| Max. Negotiated Rate |
$570.43 |
| Rate for Payer: Aetna Commercial |
$529.95
|
| Rate for Payer: Cash Price |
$368.02
|
| Rate for Payer: Cigna All Commercial |
$529.34
|
| Rate for Payer: CORVEL All Commercial |
$570.43
|
| Rate for Payer: Coventry All Commercial |
$539.77
|
| Rate for Payer: Encore All Commercial |
$564.61
|
| Rate for Payer: Frontpath All Commercial |
$564.30
|
| Rate for Payer: Humana ChoiceCare |
$529.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$552.03
|
| Rate for Payer: PHCS All Commercial |
$460.03
|
| Rate for Payer: PHP All Commercial |
$465.18
|
| Rate for Payer: Sagamore Health Network All Products |
$473.52
|
| Rate for Payer: Signature Care EPO |
$509.10
|
| Rate for Payer: Signature Care PPO |
$539.77
|
| Rate for Payer: United Healthcare Commercial |
$483.34
|
|
|
HC X-RAY EXAM HIPS BI 2 VIEWS
|
Facility
|
OP
|
$613.37
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
1613521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$570.43 |
| Rate for Payer: Aetna Commercial |
$517.68
|
| Rate for Payer: Aetna Medicare |
$196.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$19.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$190.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$352.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$383.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$225.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$215.91
|
| Rate for Payer: Cash Price |
$368.02
|
| Rate for Payer: Cash Price |
$368.02
|
| Rate for Payer: Centivo All Commercial |
$333.67
|
| Rate for Payer: Cigna All Commercial |
$529.34
|
| Rate for Payer: CORVEL All Commercial |
$570.43
|
| Rate for Payer: Coventry All Commercial |
$539.77
|
| Rate for Payer: Encore All Commercial |
$564.61
|
| Rate for Payer: Frontpath All Commercial |
$564.30
|
| Rate for Payer: Humana ChoiceCare |
$529.77
|
| Rate for Payer: Humana Medicare |
$196.28
|
| Rate for Payer: Lucent All Commercial |
$333.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$552.03
|
| Rate for Payer: Managed Health Services Medicaid |
$19.49
|
| Rate for Payer: MDWise Medicaid |
$19.49
|
| Rate for Payer: PHCS All Commercial |
$460.03
|
| Rate for Payer: PHP All Commercial |
$465.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$239.21
|
| Rate for Payer: Sagamore Health Network All Products |
$473.52
|
| Rate for Payer: Signature Care EPO |
$509.10
|
| Rate for Payer: Signature Care PPO |
$539.77
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$521.36
|
| Rate for Payer: United Healthcare Commercial |
$483.34
|
| Rate for Payer: United Healthcare Medicare |
$196.28
|
|
|
HC X-RAY EXAM HIPS BI 3-4 VIEWS
|
Facility
|
IP
|
$736.04
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
1613522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$552.03 |
| Max. Negotiated Rate |
$684.52 |
| Rate for Payer: Aetna Commercial |
$635.94
|
| Rate for Payer: Cash Price |
$441.62
|
| Rate for Payer: Cigna All Commercial |
$635.20
|
| Rate for Payer: CORVEL All Commercial |
$684.52
|
| Rate for Payer: Coventry All Commercial |
$647.72
|
| Rate for Payer: Encore All Commercial |
$677.52
|
| Rate for Payer: Frontpath All Commercial |
$677.16
|
| Rate for Payer: Humana ChoiceCare |
$635.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$662.44
|
| Rate for Payer: PHCS All Commercial |
$552.03
|
| Rate for Payer: PHP All Commercial |
$558.21
|
| Rate for Payer: Sagamore Health Network All Products |
$568.22
|
| Rate for Payer: Signature Care EPO |
$610.91
|
| Rate for Payer: Signature Care PPO |
$647.72
|
| Rate for Payer: United Healthcare Commercial |
$580.00
|
|
|
HC X-RAY EXAM HIPS BI 3-4 VIEWS
|
Facility
|
OP
|
$736.04
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
1613522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$684.52 |
| Rate for Payer: Aetna Commercial |
$621.22
|
| Rate for Payer: Aetna Medicare |
$235.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$23.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$228.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$422.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$460.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$23.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$270.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$259.09
|
| Rate for Payer: Cash Price |
$441.62
|
| Rate for Payer: Cash Price |
$441.62
|
| Rate for Payer: Centivo All Commercial |
$400.41
|
| Rate for Payer: Cigna All Commercial |
$635.20
|
| Rate for Payer: CORVEL All Commercial |
$684.52
|
| Rate for Payer: Coventry All Commercial |
$647.72
|
| Rate for Payer: Encore All Commercial |
$677.52
|
| Rate for Payer: Frontpath All Commercial |
$677.16
|
| Rate for Payer: Humana ChoiceCare |
$635.72
|
| Rate for Payer: Humana Medicare |
$235.53
|
| Rate for Payer: Lucent All Commercial |
$400.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$662.44
|
| Rate for Payer: Managed Health Services Medicaid |
$23.20
|
| Rate for Payer: MDWise Medicaid |
$23.20
|
| Rate for Payer: PHCS All Commercial |
$552.03
|
| Rate for Payer: PHP All Commercial |
$558.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$287.06
|
| Rate for Payer: Sagamore Health Network All Products |
$568.22
|
| Rate for Payer: Signature Care EPO |
$610.91
|
| Rate for Payer: Signature Care PPO |
$647.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$625.63
|
| Rate for Payer: United Healthcare Commercial |
$580.00
|
| Rate for Payer: United Healthcare Medicare |
$235.53
|
|
|
HC X-RAY EXAM HIP UNI 2-3 VIEWS LT
|
Facility
|
IP
|
$476.79
|
|
|
Service Code
|
CPT 73502 LT
|
| Hospital Charge Code |
1613510
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$357.59 |
| Max. Negotiated Rate |
$443.41 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Cash Price |
$286.07
|
| Rate for Payer: Cigna All Commercial |
$411.47
|
| Rate for Payer: CORVEL All Commercial |
$443.41
|
| Rate for Payer: Coventry All Commercial |
$419.58
|
| Rate for Payer: Encore All Commercial |
$438.89
|
| Rate for Payer: Frontpath All Commercial |
$438.65
|
| Rate for Payer: Humana ChoiceCare |
$411.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$429.11
|
| Rate for Payer: PHCS All Commercial |
$357.59
|
| Rate for Payer: PHP All Commercial |
$361.60
|
| Rate for Payer: Sagamore Health Network All Products |
$368.08
|
| Rate for Payer: Signature Care EPO |
$395.74
|
| Rate for Payer: Signature Care PPO |
$419.58
|
| Rate for Payer: United Healthcare Commercial |
$375.71
|
|
|
HC X-RAY EXAM HIP UNI 2-3 VIEWS LT
|
Facility
|
OP
|
$476.79
|
|
|
Service Code
|
CPT 73502 LT
|
| Hospital Charge Code |
1613510
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.73 |
| Max. Negotiated Rate |
$443.41 |
| Rate for Payer: Aetna Commercial |
$402.41
|
| Rate for Payer: Aetna Medicare |
$152.57
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$20.73
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$147.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$273.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$298.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$20.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.83
|
| Rate for Payer: Cash Price |
$286.07
|
| Rate for Payer: Cash Price |
$286.07
|
| Rate for Payer: Centivo All Commercial |
$259.37
|
| Rate for Payer: Cigna All Commercial |
$411.47
|
| Rate for Payer: CORVEL All Commercial |
$443.41
|
| Rate for Payer: Coventry All Commercial |
$419.58
|
| Rate for Payer: Encore All Commercial |
$438.89
|
| Rate for Payer: Frontpath All Commercial |
$438.65
|
| Rate for Payer: Humana ChoiceCare |
$411.80
|
| Rate for Payer: Humana Medicare |
$152.57
|
| Rate for Payer: Lucent All Commercial |
$259.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$429.11
|
| Rate for Payer: Managed Health Services Medicaid |
$20.73
|
| Rate for Payer: MDWise Medicaid |
$20.73
|
| Rate for Payer: PHCS All Commercial |
$357.59
|
| Rate for Payer: PHP All Commercial |
$361.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.95
|
| Rate for Payer: Sagamore Health Network All Products |
$368.08
|
| Rate for Payer: Signature Care EPO |
$395.74
|
| Rate for Payer: Signature Care PPO |
$419.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$405.27
|
| Rate for Payer: United Healthcare Commercial |
$375.71
|
| Rate for Payer: United Healthcare Medicare |
$152.57
|
|
