|
HC X-RAY-FEMUR 1 VIEW RT
|
Facility
|
IP
|
$383.87
|
|
|
Service Code
|
CPT 73551 RT
|
| Hospital Charge Code |
11613551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$287.90 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Aetna Commercial |
$331.66
|
| Rate for Payer: Cash Price |
$230.32
|
| Rate for Payer: Cigna All Commercial |
$331.28
|
| Rate for Payer: CORVEL All Commercial |
$357.00
|
| Rate for Payer: Coventry All Commercial |
$337.81
|
| Rate for Payer: Encore All Commercial |
$353.35
|
| Rate for Payer: Frontpath All Commercial |
$353.16
|
| Rate for Payer: Humana ChoiceCare |
$331.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$345.48
|
| Rate for Payer: PHCS All Commercial |
$287.90
|
| Rate for Payer: PHP All Commercial |
$291.13
|
| Rate for Payer: Sagamore Health Network All Products |
$296.35
|
| Rate for Payer: Signature Care EPO |
$318.61
|
| Rate for Payer: Signature Care PPO |
$337.81
|
| Rate for Payer: United Healthcare Commercial |
$302.49
|
|
|
HC X-RAY-FEMUR 2 VIEWS BI
|
Facility
|
OP
|
$767.71
|
|
|
Service Code
|
CPT 73552 50
|
| Hospital Charge Code |
21613550
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$713.97 |
| Rate for Payer: Aetna Commercial |
$647.95
|
| Rate for Payer: Aetna Medicare |
$245.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$237.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$440.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$479.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$282.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$270.23
|
| Rate for Payer: Cash Price |
$460.63
|
| Rate for Payer: Cash Price |
$460.63
|
| Rate for Payer: Centivo All Commercial |
$417.63
|
| Rate for Payer: Cigna All Commercial |
$662.53
|
| Rate for Payer: CORVEL All Commercial |
$713.97
|
| Rate for Payer: Coventry All Commercial |
$675.58
|
| Rate for Payer: Encore All Commercial |
$706.68
|
| Rate for Payer: Frontpath All Commercial |
$706.29
|
| Rate for Payer: Humana ChoiceCare |
$663.07
|
| Rate for Payer: Humana Medicare |
$245.67
|
| Rate for Payer: Lucent All Commercial |
$417.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$690.94
|
| Rate for Payer: Managed Health Services Medicaid |
$15.77
|
| Rate for Payer: MDWise Medicaid |
$15.77
|
| Rate for Payer: PHCS All Commercial |
$575.78
|
| Rate for Payer: PHP All Commercial |
$582.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$299.41
|
| Rate for Payer: Sagamore Health Network All Products |
$592.67
|
| Rate for Payer: Signature Care EPO |
$637.20
|
| Rate for Payer: Signature Care PPO |
$675.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$652.55
|
| Rate for Payer: United Healthcare Commercial |
$604.96
|
| Rate for Payer: United Healthcare Medicare |
$245.67
|
|
|
HC X-RAY-FEMUR 2 VIEWS BI
|
Facility
|
IP
|
$767.71
|
|
|
Service Code
|
CPT 73552 50
|
| Hospital Charge Code |
21613550
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$575.78 |
| Max. Negotiated Rate |
$713.97 |
| Rate for Payer: Aetna Commercial |
$663.30
|
| Rate for Payer: Cash Price |
$460.63
|
| Rate for Payer: Cigna All Commercial |
$662.53
|
| Rate for Payer: CORVEL All Commercial |
$713.97
|
| Rate for Payer: Coventry All Commercial |
$675.58
|
| Rate for Payer: Encore All Commercial |
$706.68
|
| Rate for Payer: Frontpath All Commercial |
$706.29
|
| Rate for Payer: Humana ChoiceCare |
$663.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$690.94
|
| Rate for Payer: PHCS All Commercial |
$575.78
|
| Rate for Payer: PHP All Commercial |
$582.23
|
| Rate for Payer: Sagamore Health Network All Products |
$592.67
|
| Rate for Payer: Signature Care EPO |
$637.20
|
| Rate for Payer: Signature Care PPO |
$675.58
|
| Rate for Payer: United Healthcare Commercial |
$604.96
|
|
|
HC X-RAY-FEMUR 2 VIEWS LT
|
Facility
|
OP
|
$479.68
|
|
|
Service Code
|
CPT 73552 LT
|
| Hospital Charge Code |
1613550
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$446.10 |
| Rate for Payer: Aetna Commercial |
$404.85
|
| Rate for Payer: Aetna Medicare |
$153.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$148.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$275.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$299.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$176.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$168.85
|
| Rate for Payer: Cash Price |
$287.81
|
| Rate for Payer: Cash Price |
$287.81
|
| Rate for Payer: Centivo All Commercial |
$260.95
|
| Rate for Payer: Cigna All Commercial |
$413.96
|
| Rate for Payer: CORVEL All Commercial |
$446.10
|
| Rate for Payer: Coventry All Commercial |
$422.12
|
| Rate for Payer: Encore All Commercial |
$441.55
|
| Rate for Payer: Frontpath All Commercial |
$441.31
|
| Rate for Payer: Humana ChoiceCare |
$414.30
|
| Rate for Payer: Humana Medicare |
$153.50
|
| Rate for Payer: Lucent All Commercial |
$260.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$431.71
|
| Rate for Payer: Managed Health Services Medicaid |
$15.77
|
| Rate for Payer: MDWise Medicaid |
$15.77
|
| Rate for Payer: PHCS All Commercial |
$359.76
|
| Rate for Payer: PHP All Commercial |
$363.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.08
|
| Rate for Payer: Sagamore Health Network All Products |
$370.31
|
| Rate for Payer: Signature Care EPO |
$398.13
|
| Rate for Payer: Signature Care PPO |
$422.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$407.73
|
| Rate for Payer: United Healthcare Commercial |
$377.99
|
| Rate for Payer: United Healthcare Medicare |
$153.50
|
|
|
HC X-RAY-FEMUR 2 VIEWS LT
|
Facility
|
IP
|
$479.68
|
|
|
Service Code
|
CPT 73552 LT
|
| Hospital Charge Code |
1613550
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$359.76 |
| Max. Negotiated Rate |
$446.10 |
| Rate for Payer: Aetna Commercial |
$414.44
|
| Rate for Payer: Cash Price |
$287.81
|
| Rate for Payer: Cigna All Commercial |
$413.96
|
| Rate for Payer: CORVEL All Commercial |
$446.10
|
| Rate for Payer: Coventry All Commercial |
$422.12
|
| Rate for Payer: Encore All Commercial |
$441.55
|
| Rate for Payer: Frontpath All Commercial |
$441.31
|
| Rate for Payer: Humana ChoiceCare |
$414.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$431.71
|
| Rate for Payer: PHCS All Commercial |
$359.76
|
| Rate for Payer: PHP All Commercial |
$363.79
|
| Rate for Payer: Sagamore Health Network All Products |
$370.31
|
| Rate for Payer: Signature Care EPO |
$398.13
|
| Rate for Payer: Signature Care PPO |
$422.12
|
| Rate for Payer: United Healthcare Commercial |
$377.99
|
|
|
HC X-RAY-FEMUR 2 VIEWS RT
|
Facility
|
OP
|
$511.81
|
|
|
Service Code
|
CPT 73552 RT
|
| Hospital Charge Code |
11613550
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$475.98 |
| Rate for Payer: Aetna Commercial |
$431.97
|
| Rate for Payer: Aetna Medicare |
$163.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$158.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$293.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$319.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$188.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$180.16
|
| Rate for Payer: Cash Price |
$307.09
|
| Rate for Payer: Cash Price |
$307.09
|
| Rate for Payer: Centivo All Commercial |
$278.42
|
| Rate for Payer: Cigna All Commercial |
$441.69
|
| Rate for Payer: CORVEL All Commercial |
$475.98
|
| Rate for Payer: Coventry All Commercial |
$450.39
|
| Rate for Payer: Encore All Commercial |
$471.12
|
| Rate for Payer: Frontpath All Commercial |
$470.87
|
| Rate for Payer: Humana ChoiceCare |
$442.05
|
| Rate for Payer: Humana Medicare |
$163.78
|
| Rate for Payer: Lucent All Commercial |
$278.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$460.63
|
| Rate for Payer: Managed Health Services Medicaid |
$15.77
|
| Rate for Payer: MDWise Medicaid |
$15.77
|
| Rate for Payer: PHCS All Commercial |
$383.86
|
| Rate for Payer: PHP All Commercial |
$388.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.61
|
| Rate for Payer: Sagamore Health Network All Products |
$395.12
|
| Rate for Payer: Signature Care EPO |
$424.80
|
| Rate for Payer: Signature Care PPO |
$450.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$435.04
|
| Rate for Payer: United Healthcare Commercial |
$403.31
|
| Rate for Payer: United Healthcare Medicare |
$163.78
|
|
|
HC X-RAY-FEMUR 2 VIEWS RT
|
Facility
|
IP
|
$511.81
|
|
|
Service Code
|
CPT 73552 RT
|
| Hospital Charge Code |
11613550
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$383.86 |
| Max. Negotiated Rate |
$475.98 |
| Rate for Payer: Aetna Commercial |
$442.20
|
| Rate for Payer: Cash Price |
$307.09
|
| Rate for Payer: Cigna All Commercial |
$441.69
|
| Rate for Payer: CORVEL All Commercial |
$475.98
|
| Rate for Payer: Coventry All Commercial |
$450.39
|
| Rate for Payer: Encore All Commercial |
$471.12
|
| Rate for Payer: Frontpath All Commercial |
$470.87
|
| Rate for Payer: Humana ChoiceCare |
$442.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$460.63
|
| Rate for Payer: PHCS All Commercial |
$383.86
|
| Rate for Payer: PHP All Commercial |
$388.16
|
| Rate for Payer: Sagamore Health Network All Products |
$395.12
|
| Rate for Payer: Signature Care EPO |
$424.80
|
| Rate for Payer: Signature Care PPO |
$450.39
|
| Rate for Payer: United Healthcare Commercial |
$403.31
|
|
|
HC X-RAY-FINGER 2+ VIEWS BI
|
Facility
|
OP
|
$667.16
|
|
|
Service Code
|
CPT 73140 50
|
| Hospital Charge Code |
21613140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$620.46 |
| Rate for Payer: Aetna Commercial |
$563.08
|
| Rate for Payer: Aetna Medicare |
$213.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$206.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$383.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$417.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$245.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$234.84
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Centivo All Commercial |
$362.94
|
| Rate for Payer: Cigna All Commercial |
$575.76
|
| Rate for Payer: CORVEL All Commercial |
$620.46
|
| Rate for Payer: Coventry All Commercial |
$587.10
|
| Rate for Payer: Encore All Commercial |
$614.12
|
| Rate for Payer: Frontpath All Commercial |
$613.79
|
| Rate for Payer: Humana ChoiceCare |
$576.23
|
| Rate for Payer: Humana Medicare |
$213.49
|
| Rate for Payer: Lucent All Commercial |
$362.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$600.44
|
| Rate for Payer: Managed Health Services Medicaid |
$18.50
|
| Rate for Payer: MDWise Medicaid |
$18.50
|
| Rate for Payer: PHCS All Commercial |
$500.37
|
| Rate for Payer: PHP All Commercial |
$505.97
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$260.19
|
| Rate for Payer: Sagamore Health Network All Products |
$515.05
|
| Rate for Payer: Signature Care EPO |
$553.74
|
| Rate for Payer: Signature Care PPO |
$587.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$567.09
|
| Rate for Payer: United Healthcare Commercial |
$525.72
|
| Rate for Payer: United Healthcare Medicare |
$213.49
|
|
|
HC X-RAY-FINGER 2+ VIEWS BI
|
Facility
|
IP
|
$667.16
|
|
|
Service Code
|
CPT 73140 50
|
| Hospital Charge Code |
21613140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$500.37 |
| Max. Negotiated Rate |
$620.46 |
| Rate for Payer: Aetna Commercial |
$576.43
|
| Rate for Payer: Cash Price |
$400.30
|
| Rate for Payer: Cigna All Commercial |
$575.76
|
| Rate for Payer: CORVEL All Commercial |
$620.46
|
| Rate for Payer: Coventry All Commercial |
$587.10
|
| Rate for Payer: Encore All Commercial |
$614.12
|
| Rate for Payer: Frontpath All Commercial |
$613.79
|
| Rate for Payer: Humana ChoiceCare |
$576.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$600.44
|
| Rate for Payer: PHCS All Commercial |
$500.37
|
| Rate for Payer: PHP All Commercial |
$505.97
|
| Rate for Payer: Sagamore Health Network All Products |
$515.05
|
| Rate for Payer: Signature Care EPO |
$553.74
|
| Rate for Payer: Signature Care PPO |
$587.10
|
| Rate for Payer: United Healthcare Commercial |
$525.72
|
|
|
HC X-RAY-FINGER 2+ VIEWS LT
|
Facility
|
IP
|
$333.58
|
|
|
Service Code
|
CPT 73140 LT
|
| Hospital Charge Code |
1613140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$250.19 |
| Max. Negotiated Rate |
$310.23 |
| Rate for Payer: Aetna Commercial |
$288.21
|
| Rate for Payer: Cash Price |
$200.15
|
| Rate for Payer: Cigna All Commercial |
$287.88
|
| Rate for Payer: CORVEL All Commercial |
$310.23
|
| Rate for Payer: Coventry All Commercial |
$293.55
|
| Rate for Payer: Encore All Commercial |
$307.06
|
| Rate for Payer: Frontpath All Commercial |
$306.89
|
| Rate for Payer: Humana ChoiceCare |
$288.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$300.22
|
| Rate for Payer: PHCS All Commercial |
$250.19
|
| Rate for Payer: PHP All Commercial |
$252.99
|
| Rate for Payer: Sagamore Health Network All Products |
$257.52
|
| Rate for Payer: Signature Care EPO |
$276.87
|
| Rate for Payer: Signature Care PPO |
$293.55
|
| Rate for Payer: United Healthcare Commercial |
$262.86
|
|
|
HC X-RAY-FINGER 2+ VIEWS LT
|
Facility
|
OP
|
$333.58
|
|
|
Service Code
|
CPT 73140 LT
|
| Hospital Charge Code |
1613140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$310.23 |
| Rate for Payer: Aetna Commercial |
$281.54
|
| Rate for Payer: Aetna Medicare |
$106.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$191.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$208.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$122.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$117.42
|
| Rate for Payer: Cash Price |
$200.15
|
| Rate for Payer: Cash Price |
$200.15
|
| Rate for Payer: Centivo All Commercial |
$181.47
|
| Rate for Payer: Cigna All Commercial |
$287.88
|
| Rate for Payer: CORVEL All Commercial |
$310.23
|
| Rate for Payer: Coventry All Commercial |
$293.55
|
| Rate for Payer: Encore All Commercial |
$307.06
|
| Rate for Payer: Frontpath All Commercial |
$306.89
|
| Rate for Payer: Humana ChoiceCare |
$288.11
|
| Rate for Payer: Humana Medicare |
$106.75
|
| Rate for Payer: Lucent All Commercial |
$181.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$300.22
|
| Rate for Payer: Managed Health Services Medicaid |
$18.50
|
| Rate for Payer: MDWise Medicaid |
$18.50
|
| Rate for Payer: PHCS All Commercial |
$250.19
|
| Rate for Payer: PHP All Commercial |
$252.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$130.10
|
| Rate for Payer: Sagamore Health Network All Products |
$257.52
|
| Rate for Payer: Signature Care EPO |
$276.87
|
| Rate for Payer: Signature Care PPO |
$293.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$283.54
|
| Rate for Payer: United Healthcare Commercial |
$262.86
|
| Rate for Payer: United Healthcare Medicare |
$106.75
|
|
|
HC X-RAY-FINGER 2+ VIEWS RT
|
Facility
|
OP
|
$333.58
|
|
|
Service Code
|
CPT 73140 RT
|
| Hospital Charge Code |
11613140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.50 |
| Max. Negotiated Rate |
$310.23 |
| Rate for Payer: Aetna Commercial |
$281.54
|
| Rate for Payer: Aetna Medicare |
$106.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$191.57
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$208.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$122.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$117.42
|
| Rate for Payer: Cash Price |
$200.15
|
| Rate for Payer: Cash Price |
$200.15
|
| Rate for Payer: Centivo All Commercial |
$181.47
|
| Rate for Payer: Cigna All Commercial |
$287.88
|
| Rate for Payer: CORVEL All Commercial |
$310.23
|
| Rate for Payer: Coventry All Commercial |
$293.55
|
| Rate for Payer: Encore All Commercial |
$307.06
|
| Rate for Payer: Frontpath All Commercial |
$306.89
|
| Rate for Payer: Humana ChoiceCare |
$288.11
|
| Rate for Payer: Humana Medicare |
$106.75
|
| Rate for Payer: Lucent All Commercial |
$181.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$300.22
|
| Rate for Payer: Managed Health Services Medicaid |
$18.50
|
| Rate for Payer: MDWise Medicaid |
$18.50
|
| Rate for Payer: PHCS All Commercial |
$250.19
|
| Rate for Payer: PHP All Commercial |
$252.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$130.10
|
| Rate for Payer: Sagamore Health Network All Products |
$257.52
|
| Rate for Payer: Signature Care EPO |
$276.87
|
| Rate for Payer: Signature Care PPO |
$293.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$283.54
|
| Rate for Payer: United Healthcare Commercial |
$262.86
|
| Rate for Payer: United Healthcare Medicare |
$106.75
|
|
|
HC X-RAY-FINGER 2+ VIEWS RT
|
Facility
|
IP
|
$333.58
|
|
|
Service Code
|
CPT 73140 RT
|
| Hospital Charge Code |
11613140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$250.19 |
| Max. Negotiated Rate |
$310.23 |
| Rate for Payer: Aetna Commercial |
$288.21
|
| Rate for Payer: Cash Price |
$200.15
|
| Rate for Payer: Cigna All Commercial |
$287.88
|
| Rate for Payer: CORVEL All Commercial |
$310.23
|
| Rate for Payer: Coventry All Commercial |
$293.55
|
| Rate for Payer: Encore All Commercial |
$307.06
|
| Rate for Payer: Frontpath All Commercial |
$306.89
|
| Rate for Payer: Humana ChoiceCare |
$288.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$300.22
|
| Rate for Payer: PHCS All Commercial |
$250.19
|
| Rate for Payer: PHP All Commercial |
$252.99
|
| Rate for Payer: Sagamore Health Network All Products |
$257.52
|
| Rate for Payer: Signature Care EPO |
$276.87
|
| Rate for Payer: Signature Care PPO |
$293.55
|
| Rate for Payer: United Healthcare Commercial |
$262.86
|
|
|
HC X-RAY-FLUORO ASSIST UP TO 1 HR
|
Facility
|
OP
|
$1,166.01
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1616307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$1,084.39 |
| Rate for Payer: Aetna Commercial |
$984.11
|
| Rate for Payer: Aetna Medicare |
$373.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$29.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$361.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$669.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$728.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$29.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$429.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$410.44
|
| Rate for Payer: Cash Price |
$699.61
|
| Rate for Payer: Cash Price |
$699.61
|
| Rate for Payer: Centivo All Commercial |
$634.31
|
| Rate for Payer: Cigna All Commercial |
$1,006.27
|
| Rate for Payer: CORVEL All Commercial |
$1,084.39
|
| Rate for Payer: Coventry All Commercial |
$1,026.09
|
| Rate for Payer: Encore All Commercial |
$1,073.31
|
| Rate for Payer: Frontpath All Commercial |
$1,072.73
|
| Rate for Payer: Humana ChoiceCare |
$1,007.08
|
| Rate for Payer: Humana Medicare |
$373.12
|
| Rate for Payer: Lucent All Commercial |
$634.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,049.41
|
| Rate for Payer: Managed Health Services Medicaid |
$29.40
|
| Rate for Payer: MDWise Medicaid |
$29.40
|
| Rate for Payer: PHCS All Commercial |
$874.51
|
| Rate for Payer: PHP All Commercial |
$884.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$454.74
|
| Rate for Payer: Sagamore Health Network All Products |
$900.16
|
| Rate for Payer: Signature Care EPO |
$967.79
|
| Rate for Payer: Signature Care PPO |
$1,026.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$991.11
|
| Rate for Payer: United Healthcare Commercial |
$918.82
|
| Rate for Payer: United Healthcare Medicare |
$373.12
|
|
|
HC X-RAY-FLUORO ASSIST UP TO 1 HR
|
Facility
|
IP
|
$1,166.01
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1616307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$874.51 |
| Max. Negotiated Rate |
$1,084.39 |
| Rate for Payer: Aetna Commercial |
$1,007.43
|
| Rate for Payer: Cash Price |
$699.61
|
| Rate for Payer: Cigna All Commercial |
$1,006.27
|
| Rate for Payer: CORVEL All Commercial |
$1,084.39
|
| Rate for Payer: Coventry All Commercial |
$1,026.09
|
| Rate for Payer: Encore All Commercial |
$1,073.31
|
| Rate for Payer: Frontpath All Commercial |
$1,072.73
|
| Rate for Payer: Humana ChoiceCare |
$1,007.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,049.41
|
| Rate for Payer: PHCS All Commercial |
$874.51
|
| Rate for Payer: PHP All Commercial |
$884.30
|
| Rate for Payer: Sagamore Health Network All Products |
$900.16
|
| Rate for Payer: Signature Care EPO |
$967.79
|
| Rate for Payer: Signature Care PPO |
$1,026.09
|
| Rate for Payer: United Healthcare Commercial |
$918.82
|
|
|
HC X-RAY-FOOT 1 VIEW BI
|
Facility
|
IP
|
$491.19
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
21613620
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$368.39 |
| Max. Negotiated Rate |
$456.81 |
| Rate for Payer: Aetna Commercial |
$424.39
|
| Rate for Payer: Cash Price |
$294.71
|
| Rate for Payer: Cigna All Commercial |
$423.90
|
| Rate for Payer: CORVEL All Commercial |
$456.81
|
| Rate for Payer: Coventry All Commercial |
$432.25
|
| Rate for Payer: Encore All Commercial |
$452.14
|
| Rate for Payer: Frontpath All Commercial |
$451.89
|
| Rate for Payer: Humana ChoiceCare |
$424.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$442.07
|
| Rate for Payer: PHCS All Commercial |
$368.39
|
| Rate for Payer: PHP All Commercial |
$372.52
|
| Rate for Payer: Sagamore Health Network All Products |
$379.20
|
| Rate for Payer: Signature Care EPO |
$407.69
|
| Rate for Payer: Signature Care PPO |
$432.25
|
| Rate for Payer: United Healthcare Commercial |
$387.06
|
|
|
HC X-RAY-FOOT 1 VIEW BI
|
Facility
|
OP
|
$491.19
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
21613620
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$456.81 |
| Rate for Payer: Aetna Commercial |
$414.56
|
| Rate for Payer: Aetna Medicare |
$157.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$152.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$282.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$307.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$180.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$172.90
|
| Rate for Payer: Cash Price |
$294.71
|
| Rate for Payer: Cash Price |
$294.71
|
| Rate for Payer: Centivo All Commercial |
$267.21
|
| Rate for Payer: Cigna All Commercial |
$423.90
|
| Rate for Payer: CORVEL All Commercial |
$456.81
|
| Rate for Payer: Coventry All Commercial |
$432.25
|
| Rate for Payer: Encore All Commercial |
$452.14
|
| Rate for Payer: Frontpath All Commercial |
$451.89
|
| Rate for Payer: Humana ChoiceCare |
$424.24
|
| Rate for Payer: Humana Medicare |
$157.18
|
| Rate for Payer: Lucent All Commercial |
$267.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$442.07
|
| Rate for Payer: Managed Health Services Medicaid |
$13.79
|
| Rate for Payer: MDWise Medicaid |
$13.79
|
| Rate for Payer: PHCS All Commercial |
$368.39
|
| Rate for Payer: PHP All Commercial |
$372.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$191.56
|
| Rate for Payer: Sagamore Health Network All Products |
$379.20
|
| Rate for Payer: Signature Care EPO |
$407.69
|
| Rate for Payer: Signature Care PPO |
$432.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$417.51
|
| Rate for Payer: United Healthcare Commercial |
$387.06
|
| Rate for Payer: United Healthcare Medicare |
$157.18
|
|
|
HC X-RAY-FOOT 1 VIEW LT
|
Facility
|
OP
|
$327.46
|
|
|
Service Code
|
CPT 73620 LT,52
|
| Hospital Charge Code |
1613620
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$304.54 |
| Rate for Payer: Aetna Commercial |
$276.38
|
| Rate for Payer: Aetna Medicare |
$104.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$188.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$204.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.27
|
| Rate for Payer: Cash Price |
$196.48
|
| Rate for Payer: Cash Price |
$196.48
|
| Rate for Payer: Centivo All Commercial |
$178.14
|
| Rate for Payer: Cigna All Commercial |
$282.60
|
| Rate for Payer: CORVEL All Commercial |
$304.54
|
| Rate for Payer: Coventry All Commercial |
$288.16
|
| Rate for Payer: Encore All Commercial |
$301.43
|
| Rate for Payer: Frontpath All Commercial |
$301.26
|
| Rate for Payer: Humana ChoiceCare |
$282.83
|
| Rate for Payer: Humana Medicare |
$104.79
|
| Rate for Payer: Lucent All Commercial |
$178.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.71
|
| Rate for Payer: Managed Health Services Medicaid |
$13.79
|
| Rate for Payer: MDWise Medicaid |
$13.79
|
| Rate for Payer: PHCS All Commercial |
$245.59
|
| Rate for Payer: PHP All Commercial |
$248.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.71
|
| Rate for Payer: Sagamore Health Network All Products |
$252.80
|
| Rate for Payer: Signature Care EPO |
$271.79
|
| Rate for Payer: Signature Care PPO |
$288.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$278.34
|
| Rate for Payer: United Healthcare Commercial |
$258.04
|
| Rate for Payer: United Healthcare Medicare |
$104.79
|
|
|
HC X-RAY-FOOT 1 VIEW LT
|
Facility
|
IP
|
$327.46
|
|
|
Service Code
|
CPT 73620 LT,52
|
| Hospital Charge Code |
1613620
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.59 |
| Max. Negotiated Rate |
$304.54 |
| Rate for Payer: Aetna Commercial |
$282.93
|
| Rate for Payer: Cash Price |
$196.48
|
| Rate for Payer: Cigna All Commercial |
$282.60
|
| Rate for Payer: CORVEL All Commercial |
$304.54
|
| Rate for Payer: Coventry All Commercial |
$288.16
|
| Rate for Payer: Encore All Commercial |
$301.43
|
| Rate for Payer: Frontpath All Commercial |
$301.26
|
| Rate for Payer: Humana ChoiceCare |
$282.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.71
|
| Rate for Payer: PHCS All Commercial |
$245.59
|
| Rate for Payer: PHP All Commercial |
$248.35
|
| Rate for Payer: Sagamore Health Network All Products |
$252.80
|
| Rate for Payer: Signature Care EPO |
$271.79
|
| Rate for Payer: Signature Care PPO |
$288.16
|
| Rate for Payer: United Healthcare Commercial |
$258.04
|
|
|
HC X-RAY-FOOT 1 VIEW RT
|
Facility
|
IP
|
$327.46
|
|
|
Service Code
|
CPT 73620 RT,52
|
| Hospital Charge Code |
11613620
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.59 |
| Max. Negotiated Rate |
$304.54 |
| Rate for Payer: Aetna Commercial |
$282.93
|
| Rate for Payer: Cash Price |
$196.48
|
| Rate for Payer: Cigna All Commercial |
$282.60
|
| Rate for Payer: CORVEL All Commercial |
$304.54
|
| Rate for Payer: Coventry All Commercial |
$288.16
|
| Rate for Payer: Encore All Commercial |
$301.43
|
| Rate for Payer: Frontpath All Commercial |
$301.26
|
| Rate for Payer: Humana ChoiceCare |
$282.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.71
|
| Rate for Payer: PHCS All Commercial |
$245.59
|
| Rate for Payer: PHP All Commercial |
$248.35
|
| Rate for Payer: Sagamore Health Network All Products |
$252.80
|
| Rate for Payer: Signature Care EPO |
$271.79
|
| Rate for Payer: Signature Care PPO |
$288.16
|
| Rate for Payer: United Healthcare Commercial |
$258.04
|
|
|
HC X-RAY-FOOT 1 VIEW RT
|
Facility
|
OP
|
$327.46
|
|
|
Service Code
|
CPT 73620 RT,52
|
| Hospital Charge Code |
11613620
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$304.54 |
| Rate for Payer: Aetna Commercial |
$276.38
|
| Rate for Payer: Aetna Medicare |
$104.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$101.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$188.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$204.70
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.27
|
| Rate for Payer: Cash Price |
$196.48
|
| Rate for Payer: Cash Price |
$196.48
|
| Rate for Payer: Centivo All Commercial |
$178.14
|
| Rate for Payer: Cigna All Commercial |
$282.60
|
| Rate for Payer: CORVEL All Commercial |
$304.54
|
| Rate for Payer: Coventry All Commercial |
$288.16
|
| Rate for Payer: Encore All Commercial |
$301.43
|
| Rate for Payer: Frontpath All Commercial |
$301.26
|
| Rate for Payer: Humana ChoiceCare |
$282.83
|
| Rate for Payer: Humana Medicare |
$104.79
|
| Rate for Payer: Lucent All Commercial |
$178.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.71
|
| Rate for Payer: Managed Health Services Medicaid |
$13.79
|
| Rate for Payer: MDWise Medicaid |
$13.79
|
| Rate for Payer: PHCS All Commercial |
$245.59
|
| Rate for Payer: PHP All Commercial |
$248.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.71
|
| Rate for Payer: Sagamore Health Network All Products |
$252.80
|
| Rate for Payer: Signature Care EPO |
$271.79
|
| Rate for Payer: Signature Care PPO |
$288.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$278.34
|
| Rate for Payer: United Healthcare Commercial |
$258.04
|
| Rate for Payer: United Healthcare Medicare |
$104.79
|
|
|
HC X-RAY-FOOT 2 VIEWS BI
|
Facility
|
IP
|
$654.94
|
|
|
Service Code
|
CPT 73620 50
|
| Hospital Charge Code |
21613631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$491.20 |
| Max. Negotiated Rate |
$609.09 |
| Rate for Payer: Aetna Commercial |
$565.87
|
| Rate for Payer: Cash Price |
$392.96
|
| Rate for Payer: Cigna All Commercial |
$565.21
|
| Rate for Payer: CORVEL All Commercial |
$609.09
|
| Rate for Payer: Coventry All Commercial |
$576.35
|
| Rate for Payer: Encore All Commercial |
$602.87
|
| Rate for Payer: Frontpath All Commercial |
$602.54
|
| Rate for Payer: Humana ChoiceCare |
$565.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.45
|
| Rate for Payer: PHCS All Commercial |
$491.20
|
| Rate for Payer: PHP All Commercial |
$496.71
|
| Rate for Payer: Sagamore Health Network All Products |
$505.61
|
| Rate for Payer: Signature Care EPO |
$543.60
|
| Rate for Payer: Signature Care PPO |
$576.35
|
| Rate for Payer: United Healthcare Commercial |
$516.09
|
|
|
HC X-RAY-FOOT 2 VIEWS BI
|
Facility
|
OP
|
$654.94
|
|
|
Service Code
|
CPT 73620 50
|
| Hospital Charge Code |
21613631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$609.09 |
| Rate for Payer: Aetna Commercial |
$552.77
|
| Rate for Payer: Aetna Medicare |
$209.58
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$203.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$376.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$409.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$241.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$230.54
|
| Rate for Payer: Cash Price |
$392.96
|
| Rate for Payer: Cash Price |
$392.96
|
| Rate for Payer: Centivo All Commercial |
$356.29
|
| Rate for Payer: Cigna All Commercial |
$565.21
|
| Rate for Payer: CORVEL All Commercial |
$609.09
|
| Rate for Payer: Coventry All Commercial |
$576.35
|
| Rate for Payer: Encore All Commercial |
$602.87
|
| Rate for Payer: Frontpath All Commercial |
$602.54
|
| Rate for Payer: Humana ChoiceCare |
$565.67
|
| Rate for Payer: Humana Medicare |
$209.58
|
| Rate for Payer: Lucent All Commercial |
$356.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.45
|
| Rate for Payer: Managed Health Services Medicaid |
$13.79
|
| Rate for Payer: MDWise Medicaid |
$13.79
|
| Rate for Payer: PHCS All Commercial |
$491.20
|
| Rate for Payer: PHP All Commercial |
$496.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$255.43
|
| Rate for Payer: Sagamore Health Network All Products |
$505.61
|
| Rate for Payer: Signature Care EPO |
$543.60
|
| Rate for Payer: Signature Care PPO |
$576.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$556.70
|
| Rate for Payer: United Healthcare Commercial |
$516.09
|
| Rate for Payer: United Healthcare Medicare |
$209.58
|
|
|
HC X-RAY-FOOT 2 VIEWS LT
|
Facility
|
IP
|
$436.62
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
1613631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$327.46 |
| Max. Negotiated Rate |
$406.06 |
| Rate for Payer: Aetna Commercial |
$377.24
|
| Rate for Payer: Cash Price |
$261.97
|
| Rate for Payer: Cigna All Commercial |
$376.80
|
| Rate for Payer: CORVEL All Commercial |
$406.06
|
| Rate for Payer: Coventry All Commercial |
$384.23
|
| Rate for Payer: Encore All Commercial |
$401.91
|
| Rate for Payer: Frontpath All Commercial |
$401.69
|
| Rate for Payer: Humana ChoiceCare |
$377.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$392.96
|
| Rate for Payer: PHCS All Commercial |
$327.46
|
| Rate for Payer: PHP All Commercial |
$331.13
|
| Rate for Payer: Sagamore Health Network All Products |
$337.07
|
| Rate for Payer: Signature Care EPO |
$362.39
|
| Rate for Payer: Signature Care PPO |
$384.23
|
| Rate for Payer: United Healthcare Commercial |
$344.06
|
|
|
HC X-RAY-FOOT 2 VIEWS LT
|
Facility
|
OP
|
$436.62
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
1613631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$406.06 |
| Rate for Payer: Aetna Commercial |
$368.51
|
| Rate for Payer: Aetna Medicare |
$139.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$135.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$250.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$272.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$160.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$153.69
|
| Rate for Payer: Cash Price |
$261.97
|
| Rate for Payer: Cash Price |
$261.97
|
| Rate for Payer: Centivo All Commercial |
$237.52
|
| Rate for Payer: Cigna All Commercial |
$376.80
|
| Rate for Payer: CORVEL All Commercial |
$406.06
|
| Rate for Payer: Coventry All Commercial |
$384.23
|
| Rate for Payer: Encore All Commercial |
$401.91
|
| Rate for Payer: Frontpath All Commercial |
$401.69
|
| Rate for Payer: Humana ChoiceCare |
$377.11
|
| Rate for Payer: Humana Medicare |
$139.72
|
| Rate for Payer: Lucent All Commercial |
$237.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$392.96
|
| Rate for Payer: Managed Health Services Medicaid |
$13.79
|
| Rate for Payer: MDWise Medicaid |
$13.79
|
| Rate for Payer: PHCS All Commercial |
$327.46
|
| Rate for Payer: PHP All Commercial |
$331.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$170.28
|
| Rate for Payer: Sagamore Health Network All Products |
$337.07
|
| Rate for Payer: Signature Care EPO |
$362.39
|
| Rate for Payer: Signature Care PPO |
$384.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$371.13
|
| Rate for Payer: United Healthcare Commercial |
$344.06
|
| Rate for Payer: United Healthcare Medicare |
$139.72
|
|
