|
HC X-RAY-FOOT 2 VIEWS RT
|
Facility
|
IP
|
$436.62
|
|
|
Service Code
|
CPT 73620 RT
|
| Hospital Charge Code |
11613631
|
|
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 RT
|
Facility
|
OP
|
$436.62
|
|
|
Service Code
|
CPT 73620 RT
|
| Hospital Charge Code |
11613631
|
|
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
|
|
|
HC X-RAY-FOOT 3 OR MORE VIEWS BI
|
Facility
|
OP
|
$768.66
|
|
|
Service Code
|
CPT 73630 50
|
| Hospital Charge Code |
21613630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.27 |
| Max. Negotiated Rate |
$714.85 |
| Rate for Payer: Aetna Commercial |
$648.75
|
| Rate for Payer: Aetna Medicare |
$245.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$238.28
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$441.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$480.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$282.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$270.57
|
| Rate for Payer: Cash Price |
$461.20
|
| Rate for Payer: Cash Price |
$461.20
|
| Rate for Payer: Centivo All Commercial |
$418.15
|
| Rate for Payer: Cigna All Commercial |
$663.35
|
| Rate for Payer: CORVEL All Commercial |
$714.85
|
| Rate for Payer: Coventry All Commercial |
$676.42
|
| Rate for Payer: Encore All Commercial |
$707.55
|
| Rate for Payer: Frontpath All Commercial |
$707.17
|
| Rate for Payer: Humana ChoiceCare |
$663.89
|
| Rate for Payer: Humana Medicare |
$245.97
|
| Rate for Payer: Lucent All Commercial |
$418.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$691.79
|
| Rate for Payer: Managed Health Services Medicaid |
$16.27
|
| Rate for Payer: MDWise Medicaid |
$16.27
|
| Rate for Payer: PHCS All Commercial |
$576.50
|
| Rate for Payer: PHP All Commercial |
$582.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$299.78
|
| Rate for Payer: Sagamore Health Network All Products |
$593.41
|
| Rate for Payer: Signature Care EPO |
$637.99
|
| Rate for Payer: Signature Care PPO |
$676.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$653.36
|
| Rate for Payer: United Healthcare Commercial |
$605.70
|
| Rate for Payer: United Healthcare Medicare |
$245.97
|
|
|
HC X-RAY-FOOT 3 OR MORE VIEWS BI
|
Facility
|
IP
|
$768.66
|
|
|
Service Code
|
CPT 73630 50
|
| Hospital Charge Code |
21613630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$576.50 |
| Max. Negotiated Rate |
$714.85 |
| Rate for Payer: Aetna Commercial |
$664.12
|
| Rate for Payer: Cash Price |
$461.20
|
| Rate for Payer: Cigna All Commercial |
$663.35
|
| Rate for Payer: CORVEL All Commercial |
$714.85
|
| Rate for Payer: Coventry All Commercial |
$676.42
|
| Rate for Payer: Encore All Commercial |
$707.55
|
| Rate for Payer: Frontpath All Commercial |
$707.17
|
| Rate for Payer: Humana ChoiceCare |
$663.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$691.79
|
| Rate for Payer: PHCS All Commercial |
$576.50
|
| Rate for Payer: PHP All Commercial |
$582.95
|
| Rate for Payer: Sagamore Health Network All Products |
$593.41
|
| Rate for Payer: Signature Care EPO |
$637.99
|
| Rate for Payer: Signature Care PPO |
$676.42
|
| Rate for Payer: United Healthcare Commercial |
$605.70
|
|
|
HC X-RAY-FOOT 3 OR MORE VIEWS LT
|
Facility
|
OP
|
$512.45
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
1613630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.27 |
| Max. Negotiated Rate |
$476.58 |
| Rate for Payer: Aetna Commercial |
$432.51
|
| Rate for Payer: Aetna Medicare |
$163.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$158.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$294.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$188.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$180.38
|
| Rate for Payer: Cash Price |
$307.47
|
| Rate for Payer: Cash Price |
$307.47
|
| Rate for Payer: Centivo All Commercial |
$278.77
|
| Rate for Payer: Cigna All Commercial |
$442.24
|
| Rate for Payer: CORVEL All Commercial |
$476.58
|
| Rate for Payer: Coventry All Commercial |
$450.96
|
| Rate for Payer: Encore All Commercial |
$471.71
|
| Rate for Payer: Frontpath All Commercial |
$471.45
|
| Rate for Payer: Humana ChoiceCare |
$442.60
|
| Rate for Payer: Humana Medicare |
$163.98
|
| Rate for Payer: Lucent All Commercial |
$278.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$461.20
|
| Rate for Payer: Managed Health Services Medicaid |
$16.27
|
| Rate for Payer: MDWise Medicaid |
$16.27
|
| Rate for Payer: PHCS All Commercial |
$384.34
|
| Rate for Payer: PHP All Commercial |
$388.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.86
|
| Rate for Payer: Sagamore Health Network All Products |
$395.61
|
| Rate for Payer: Signature Care EPO |
$425.33
|
| Rate for Payer: Signature Care PPO |
$450.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$435.58
|
| Rate for Payer: United Healthcare Commercial |
$403.81
|
| Rate for Payer: United Healthcare Medicare |
$163.98
|
|
|
HC X-RAY-FOOT 3 OR MORE VIEWS LT
|
Facility
|
IP
|
$512.45
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
1613630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$384.34 |
| Max. Negotiated Rate |
$476.58 |
| Rate for Payer: Aetna Commercial |
$442.76
|
| Rate for Payer: Cash Price |
$307.47
|
| Rate for Payer: Cigna All Commercial |
$442.24
|
| Rate for Payer: CORVEL All Commercial |
$476.58
|
| Rate for Payer: Coventry All Commercial |
$450.96
|
| Rate for Payer: Encore All Commercial |
$471.71
|
| Rate for Payer: Frontpath All Commercial |
$471.45
|
| Rate for Payer: Humana ChoiceCare |
$442.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$461.20
|
| Rate for Payer: PHCS All Commercial |
$384.34
|
| Rate for Payer: PHP All Commercial |
$388.64
|
| Rate for Payer: Sagamore Health Network All Products |
$395.61
|
| Rate for Payer: Signature Care EPO |
$425.33
|
| Rate for Payer: Signature Care PPO |
$450.96
|
| Rate for Payer: United Healthcare Commercial |
$403.81
|
|
|
HC X-RAY-FOOT 3 OR MORE VIEWS RT
|
Facility
|
IP
|
$512.45
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
11613630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$384.34 |
| Max. Negotiated Rate |
$476.58 |
| Rate for Payer: Aetna Commercial |
$442.76
|
| Rate for Payer: Cash Price |
$307.47
|
| Rate for Payer: Cigna All Commercial |
$442.24
|
| Rate for Payer: CORVEL All Commercial |
$476.58
|
| Rate for Payer: Coventry All Commercial |
$450.96
|
| Rate for Payer: Encore All Commercial |
$471.71
|
| Rate for Payer: Frontpath All Commercial |
$471.45
|
| Rate for Payer: Humana ChoiceCare |
$442.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$461.20
|
| Rate for Payer: PHCS All Commercial |
$384.34
|
| Rate for Payer: PHP All Commercial |
$388.64
|
| Rate for Payer: Sagamore Health Network All Products |
$395.61
|
| Rate for Payer: Signature Care EPO |
$425.33
|
| Rate for Payer: Signature Care PPO |
$450.96
|
| Rate for Payer: United Healthcare Commercial |
$403.81
|
|
|
HC X-RAY-FOOT 3 OR MORE VIEWS RT
|
Facility
|
OP
|
$512.45
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
11613630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.27 |
| Max. Negotiated Rate |
$476.58 |
| Rate for Payer: Aetna Commercial |
$432.51
|
| Rate for Payer: Aetna Medicare |
$163.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$16.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$158.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$294.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$16.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$188.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$180.38
|
| Rate for Payer: Cash Price |
$307.47
|
| Rate for Payer: Cash Price |
$307.47
|
| Rate for Payer: Centivo All Commercial |
$278.77
|
| Rate for Payer: Cigna All Commercial |
$442.24
|
| Rate for Payer: CORVEL All Commercial |
$476.58
|
| Rate for Payer: Coventry All Commercial |
$450.96
|
| Rate for Payer: Encore All Commercial |
$471.71
|
| Rate for Payer: Frontpath All Commercial |
$471.45
|
| Rate for Payer: Humana ChoiceCare |
$442.60
|
| Rate for Payer: Humana Medicare |
$163.98
|
| Rate for Payer: Lucent All Commercial |
$278.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$461.20
|
| Rate for Payer: Managed Health Services Medicaid |
$16.27
|
| Rate for Payer: MDWise Medicaid |
$16.27
|
| Rate for Payer: PHCS All Commercial |
$384.34
|
| Rate for Payer: PHP All Commercial |
$388.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.86
|
| Rate for Payer: Sagamore Health Network All Products |
$395.61
|
| Rate for Payer: Signature Care EPO |
$425.33
|
| Rate for Payer: Signature Care PPO |
$450.96
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$435.58
|
| Rate for Payer: United Healthcare Commercial |
$403.81
|
| Rate for Payer: United Healthcare Medicare |
$163.98
|
|
|
HC X-RAY-FOREARM 2 VIEWS BI
|
Facility
|
IP
|
$597.73
|
|
|
Service Code
|
CPT 73090 50
|
| Hospital Charge Code |
21613090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$448.30 |
| Max. Negotiated Rate |
$555.89 |
| Rate for Payer: Aetna Commercial |
$516.44
|
| Rate for Payer: Cash Price |
$358.64
|
| Rate for Payer: Cigna All Commercial |
$515.84
|
| Rate for Payer: CORVEL All Commercial |
$555.89
|
| Rate for Payer: Coventry All Commercial |
$526.00
|
| Rate for Payer: Encore All Commercial |
$550.21
|
| Rate for Payer: Frontpath All Commercial |
$549.91
|
| Rate for Payer: Humana ChoiceCare |
$516.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$537.96
|
| Rate for Payer: PHCS All Commercial |
$448.30
|
| Rate for Payer: PHP All Commercial |
$453.32
|
| Rate for Payer: Sagamore Health Network All Products |
$461.45
|
| Rate for Payer: Signature Care EPO |
$496.12
|
| Rate for Payer: Signature Care PPO |
$526.00
|
| Rate for Payer: United Healthcare Commercial |
$471.01
|
|
|
HC X-RAY-FOREARM 2 VIEWS BI
|
Facility
|
OP
|
$597.73
|
|
|
Service Code
|
CPT 73090 50
|
| Hospital Charge Code |
21613090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$555.89 |
| Rate for Payer: Aetna Commercial |
$504.48
|
| Rate for Payer: Aetna Medicare |
$191.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$185.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$343.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$373.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$219.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$210.40
|
| Rate for Payer: Cash Price |
$358.64
|
| Rate for Payer: Cash Price |
$358.64
|
| Rate for Payer: Centivo All Commercial |
$325.17
|
| Rate for Payer: Cigna All Commercial |
$515.84
|
| Rate for Payer: CORVEL All Commercial |
$555.89
|
| Rate for Payer: Coventry All Commercial |
$526.00
|
| Rate for Payer: Encore All Commercial |
$550.21
|
| Rate for Payer: Frontpath All Commercial |
$549.91
|
| Rate for Payer: Humana ChoiceCare |
$516.26
|
| Rate for Payer: Humana Medicare |
$191.27
|
| Rate for Payer: Lucent All Commercial |
$325.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$537.96
|
| Rate for Payer: Managed Health Services Medicaid |
$13.79
|
| Rate for Payer: MDWise Medicaid |
$13.79
|
| Rate for Payer: PHCS All Commercial |
$448.30
|
| Rate for Payer: PHP All Commercial |
$453.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$233.11
|
| Rate for Payer: Sagamore Health Network All Products |
$461.45
|
| Rate for Payer: Signature Care EPO |
$496.12
|
| Rate for Payer: Signature Care PPO |
$526.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$508.07
|
| Rate for Payer: United Healthcare Commercial |
$471.01
|
| Rate for Payer: United Healthcare Medicare |
$191.27
|
|
|
HC X-RAY-FOREARM 2 VIEWS LT
|
Facility
|
OP
|
$398.48
|
|
|
Service Code
|
CPT 73090 LT
|
| Hospital Charge Code |
1613090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$370.59 |
| Rate for Payer: Aetna Commercial |
$336.32
|
| Rate for Payer: Aetna Medicare |
$127.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$123.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$228.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$249.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.26
|
| Rate for Payer: Cash Price |
$239.09
|
| Rate for Payer: Cash Price |
$239.09
|
| Rate for Payer: Centivo All Commercial |
$216.77
|
| Rate for Payer: Cigna All Commercial |
$343.89
|
| Rate for Payer: CORVEL All Commercial |
$370.59
|
| Rate for Payer: Coventry All Commercial |
$350.66
|
| Rate for Payer: Encore All Commercial |
$366.80
|
| Rate for Payer: Frontpath All Commercial |
$366.60
|
| Rate for Payer: Humana ChoiceCare |
$344.17
|
| Rate for Payer: Humana Medicare |
$127.51
|
| Rate for Payer: Lucent All Commercial |
$216.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.63
|
| Rate for Payer: Managed Health Services Medicaid |
$13.79
|
| Rate for Payer: MDWise Medicaid |
$13.79
|
| Rate for Payer: PHCS All Commercial |
$298.86
|
| Rate for Payer: PHP All Commercial |
$302.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.41
|
| Rate for Payer: Sagamore Health Network All Products |
$307.63
|
| Rate for Payer: Signature Care EPO |
$330.74
|
| Rate for Payer: Signature Care PPO |
$350.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$338.71
|
| Rate for Payer: United Healthcare Commercial |
$314.00
|
| Rate for Payer: United Healthcare Medicare |
$127.51
|
|
|
HC X-RAY-FOREARM 2 VIEWS LT
|
Facility
|
IP
|
$398.48
|
|
|
Service Code
|
CPT 73090 LT
|
| Hospital Charge Code |
1613090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.86 |
| Max. Negotiated Rate |
$370.59 |
| Rate for Payer: Aetna Commercial |
$344.29
|
| Rate for Payer: Cash Price |
$239.09
|
| Rate for Payer: Cigna All Commercial |
$343.89
|
| Rate for Payer: CORVEL All Commercial |
$370.59
|
| Rate for Payer: Coventry All Commercial |
$350.66
|
| Rate for Payer: Encore All Commercial |
$366.80
|
| Rate for Payer: Frontpath All Commercial |
$366.60
|
| Rate for Payer: Humana ChoiceCare |
$344.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.63
|
| Rate for Payer: PHCS All Commercial |
$298.86
|
| Rate for Payer: PHP All Commercial |
$302.21
|
| Rate for Payer: Sagamore Health Network All Products |
$307.63
|
| Rate for Payer: Signature Care EPO |
$330.74
|
| Rate for Payer: Signature Care PPO |
$350.66
|
| Rate for Payer: United Healthcare Commercial |
$314.00
|
|
|
HC X-RAY-FOREARM 2 VIEWS RT
|
Facility
|
OP
|
$398.48
|
|
|
Service Code
|
CPT 73090 RT
|
| Hospital Charge Code |
11613090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$370.59 |
| Rate for Payer: Aetna Commercial |
$336.32
|
| Rate for Payer: Aetna Medicare |
$127.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.79
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$123.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$228.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$249.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.26
|
| Rate for Payer: Cash Price |
$239.09
|
| Rate for Payer: Cash Price |
$239.09
|
| Rate for Payer: Centivo All Commercial |
$216.77
|
| Rate for Payer: Cigna All Commercial |
$343.89
|
| Rate for Payer: CORVEL All Commercial |
$370.59
|
| Rate for Payer: Coventry All Commercial |
$350.66
|
| Rate for Payer: Encore All Commercial |
$366.80
|
| Rate for Payer: Frontpath All Commercial |
$366.60
|
| Rate for Payer: Humana ChoiceCare |
$344.17
|
| Rate for Payer: Humana Medicare |
$127.51
|
| Rate for Payer: Lucent All Commercial |
$216.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.63
|
| Rate for Payer: Managed Health Services Medicaid |
$13.79
|
| Rate for Payer: MDWise Medicaid |
$13.79
|
| Rate for Payer: PHCS All Commercial |
$298.86
|
| Rate for Payer: PHP All Commercial |
$302.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.41
|
| Rate for Payer: Sagamore Health Network All Products |
$307.63
|
| Rate for Payer: Signature Care EPO |
$330.74
|
| Rate for Payer: Signature Care PPO |
$350.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$338.71
|
| Rate for Payer: United Healthcare Commercial |
$314.00
|
| Rate for Payer: United Healthcare Medicare |
$127.51
|
|
|
HC X-RAY-FOREARM 2 VIEWS RT
|
Facility
|
IP
|
$398.48
|
|
|
Service Code
|
CPT 73090 RT
|
| Hospital Charge Code |
11613090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.86 |
| Max. Negotiated Rate |
$370.59 |
| Rate for Payer: Aetna Commercial |
$344.29
|
| Rate for Payer: Cash Price |
$239.09
|
| Rate for Payer: Cigna All Commercial |
$343.89
|
| Rate for Payer: CORVEL All Commercial |
$370.59
|
| Rate for Payer: Coventry All Commercial |
$350.66
|
| Rate for Payer: Encore All Commercial |
$366.80
|
| Rate for Payer: Frontpath All Commercial |
$366.60
|
| Rate for Payer: Humana ChoiceCare |
$344.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.63
|
| Rate for Payer: PHCS All Commercial |
$298.86
|
| Rate for Payer: PHP All Commercial |
$302.21
|
| Rate for Payer: Sagamore Health Network All Products |
$307.63
|
| Rate for Payer: Signature Care EPO |
$330.74
|
| Rate for Payer: Signature Care PPO |
$350.66
|
| Rate for Payer: United Healthcare Commercial |
$314.00
|
|
|
HC X-RAY-HAND 1 VIEW BI
|
Facility
|
IP
|
$461.21
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
21615120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$345.91 |
| Max. Negotiated Rate |
$428.93 |
| Rate for Payer: Aetna Commercial |
$398.49
|
| Rate for Payer: Cash Price |
$276.73
|
| Rate for Payer: Cigna All Commercial |
$398.02
|
| Rate for Payer: CORVEL All Commercial |
$428.93
|
| Rate for Payer: Coventry All Commercial |
$405.86
|
| Rate for Payer: Encore All Commercial |
$424.54
|
| Rate for Payer: Frontpath All Commercial |
$424.31
|
| Rate for Payer: Humana ChoiceCare |
$398.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$415.09
|
| Rate for Payer: PHCS All Commercial |
$345.91
|
| Rate for Payer: PHP All Commercial |
$349.78
|
| Rate for Payer: Sagamore Health Network All Products |
$356.05
|
| Rate for Payer: Signature Care EPO |
$382.80
|
| Rate for Payer: Signature Care PPO |
$405.86
|
| Rate for Payer: United Healthcare Commercial |
$363.43
|
|
|
HC X-RAY-HAND 1 VIEW BI
|
Facility
|
OP
|
$461.21
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
21615120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$428.93 |
| Rate for Payer: Aetna Commercial |
$389.26
|
| Rate for Payer: Aetna Medicare |
$147.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$142.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$264.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$288.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$169.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$162.35
|
| Rate for Payer: Cash Price |
$276.73
|
| Rate for Payer: Cash Price |
$276.73
|
| Rate for Payer: Centivo All Commercial |
$250.90
|
| Rate for Payer: Cigna All Commercial |
$398.02
|
| Rate for Payer: CORVEL All Commercial |
$428.93
|
| Rate for Payer: Coventry All Commercial |
$405.86
|
| Rate for Payer: Encore All Commercial |
$424.54
|
| Rate for Payer: Frontpath All Commercial |
$424.31
|
| Rate for Payer: Humana ChoiceCare |
$398.35
|
| Rate for Payer: Humana Medicare |
$147.59
|
| Rate for Payer: Lucent All Commercial |
$250.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$415.09
|
| Rate for Payer: Managed Health Services Medicaid |
$13.54
|
| Rate for Payer: MDWise Medicaid |
$13.54
|
| Rate for Payer: PHCS All Commercial |
$345.91
|
| Rate for Payer: PHP All Commercial |
$349.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$179.87
|
| Rate for Payer: Sagamore Health Network All Products |
$356.05
|
| Rate for Payer: Signature Care EPO |
$382.80
|
| Rate for Payer: Signature Care PPO |
$405.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$392.03
|
| Rate for Payer: United Healthcare Commercial |
$363.43
|
| Rate for Payer: United Healthcare Medicare |
$147.59
|
|
|
HC X-RAY-HAND 1 VIEW LT
|
Facility
|
OP
|
$477.13
|
|
|
Service Code
|
CPT 73120 LT,52
|
| Hospital Charge Code |
1615120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$443.73 |
| Rate for Payer: Aetna Commercial |
$402.70
|
| Rate for Payer: Aetna Medicare |
$152.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$147.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$274.02
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$298.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.95
|
| Rate for Payer: Cash Price |
$286.28
|
| Rate for Payer: Cash Price |
$286.28
|
| Rate for Payer: Centivo All Commercial |
$259.56
|
| Rate for Payer: Cigna All Commercial |
$411.76
|
| Rate for Payer: CORVEL All Commercial |
$443.73
|
| Rate for Payer: Coventry All Commercial |
$419.87
|
| Rate for Payer: Encore All Commercial |
$439.20
|
| Rate for Payer: Frontpath All Commercial |
$438.96
|
| Rate for Payer: Humana ChoiceCare |
$412.10
|
| Rate for Payer: Humana Medicare |
$152.68
|
| Rate for Payer: Lucent All Commercial |
$259.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$429.42
|
| Rate for Payer: Managed Health Services Medicaid |
$13.54
|
| Rate for Payer: MDWise Medicaid |
$13.54
|
| Rate for Payer: PHCS All Commercial |
$357.85
|
| Rate for Payer: PHP All Commercial |
$361.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$186.08
|
| Rate for Payer: Sagamore Health Network All Products |
$368.34
|
| Rate for Payer: Signature Care EPO |
$396.02
|
| Rate for Payer: Signature Care PPO |
$419.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$405.56
|
| Rate for Payer: United Healthcare Commercial |
$375.98
|
| Rate for Payer: United Healthcare Medicare |
$152.68
|
|
|
HC X-RAY-HAND 1 VIEW LT
|
Facility
|
IP
|
$477.13
|
|
|
Service Code
|
CPT 73120 LT,52
|
| Hospital Charge Code |
1615120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$357.85 |
| Max. Negotiated Rate |
$443.73 |
| Rate for Payer: Aetna Commercial |
$412.24
|
| Rate for Payer: Cash Price |
$286.28
|
| Rate for Payer: Cigna All Commercial |
$411.76
|
| Rate for Payer: CORVEL All Commercial |
$443.73
|
| Rate for Payer: Coventry All Commercial |
$419.87
|
| Rate for Payer: Encore All Commercial |
$439.20
|
| Rate for Payer: Frontpath All Commercial |
$438.96
|
| Rate for Payer: Humana ChoiceCare |
$412.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$429.42
|
| Rate for Payer: PHCS All Commercial |
$357.85
|
| Rate for Payer: PHP All Commercial |
$361.86
|
| Rate for Payer: Sagamore Health Network All Products |
$368.34
|
| Rate for Payer: Signature Care EPO |
$396.02
|
| Rate for Payer: Signature Care PPO |
$419.87
|
| Rate for Payer: United Healthcare Commercial |
$375.98
|
|
|
HC X-RAY-HAND 1 VIEW RT
|
Facility
|
OP
|
$295.87
|
|
|
Service Code
|
CPT 73120 RT,52
|
| Hospital Charge Code |
11615120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$275.16 |
| Rate for Payer: Aetna Commercial |
$249.71
|
| Rate for Payer: Aetna Medicare |
$94.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$91.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$169.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$184.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$108.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$104.15
|
| Rate for Payer: Cash Price |
$177.52
|
| Rate for Payer: Cash Price |
$177.52
|
| Rate for Payer: Centivo All Commercial |
$160.95
|
| Rate for Payer: Cigna All Commercial |
$255.34
|
| Rate for Payer: CORVEL All Commercial |
$275.16
|
| Rate for Payer: Coventry All Commercial |
$260.37
|
| Rate for Payer: Encore All Commercial |
$272.35
|
| Rate for Payer: Frontpath All Commercial |
$272.20
|
| Rate for Payer: Humana ChoiceCare |
$255.54
|
| Rate for Payer: Humana Medicare |
$94.68
|
| Rate for Payer: Lucent All Commercial |
$160.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$266.28
|
| Rate for Payer: Managed Health Services Medicaid |
$13.54
|
| Rate for Payer: MDWise Medicaid |
$13.54
|
| Rate for Payer: PHCS All Commercial |
$221.90
|
| Rate for Payer: PHP All Commercial |
$224.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$115.39
|
| Rate for Payer: Sagamore Health Network All Products |
$228.41
|
| Rate for Payer: Signature Care EPO |
$245.57
|
| Rate for Payer: Signature Care PPO |
$260.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$251.49
|
| Rate for Payer: United Healthcare Commercial |
$233.15
|
| Rate for Payer: United Healthcare Medicare |
$94.68
|
|
|
HC X-RAY-HAND 1 VIEW RT
|
Facility
|
IP
|
$295.87
|
|
|
Service Code
|
CPT 73120 RT,52
|
| Hospital Charge Code |
11615120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.90 |
| Max. Negotiated Rate |
$275.16 |
| Rate for Payer: Aetna Commercial |
$255.63
|
| Rate for Payer: Cash Price |
$177.52
|
| Rate for Payer: Cigna All Commercial |
$255.34
|
| Rate for Payer: CORVEL All Commercial |
$275.16
|
| Rate for Payer: Coventry All Commercial |
$260.37
|
| Rate for Payer: Encore All Commercial |
$272.35
|
| Rate for Payer: Frontpath All Commercial |
$272.20
|
| Rate for Payer: Humana ChoiceCare |
$255.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$266.28
|
| Rate for Payer: PHCS All Commercial |
$221.90
|
| Rate for Payer: PHP All Commercial |
$224.39
|
| Rate for Payer: Sagamore Health Network All Products |
$228.41
|
| Rate for Payer: Signature Care EPO |
$245.57
|
| Rate for Payer: Signature Care PPO |
$260.37
|
| Rate for Payer: United Healthcare Commercial |
$233.15
|
|
|
HC X-RAY-HAND 2 VIEWS BI
|
Facility
|
IP
|
$591.72
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
21613120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$443.79 |
| Max. Negotiated Rate |
$550.30 |
| Rate for Payer: Aetna Commercial |
$511.25
|
| Rate for Payer: Cash Price |
$355.03
|
| Rate for Payer: Cigna All Commercial |
$510.65
|
| Rate for Payer: CORVEL All Commercial |
$550.30
|
| Rate for Payer: Coventry All Commercial |
$520.71
|
| Rate for Payer: Encore All Commercial |
$544.68
|
| Rate for Payer: Frontpath All Commercial |
$544.38
|
| Rate for Payer: Humana ChoiceCare |
$511.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$532.55
|
| Rate for Payer: PHCS All Commercial |
$443.79
|
| Rate for Payer: PHP All Commercial |
$448.76
|
| Rate for Payer: Sagamore Health Network All Products |
$456.81
|
| Rate for Payer: Signature Care EPO |
$491.13
|
| Rate for Payer: Signature Care PPO |
$520.71
|
| Rate for Payer: United Healthcare Commercial |
$466.28
|
|
|
HC X-RAY-HAND 2 VIEWS BI
|
Facility
|
OP
|
$591.72
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
21613120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$550.30 |
| Rate for Payer: Aetna Commercial |
$499.41
|
| Rate for Payer: Aetna Medicare |
$189.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$183.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$339.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$369.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$217.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$208.29
|
| Rate for Payer: Cash Price |
$355.03
|
| Rate for Payer: Cash Price |
$355.03
|
| Rate for Payer: Centivo All Commercial |
$321.90
|
| Rate for Payer: Cigna All Commercial |
$510.65
|
| Rate for Payer: CORVEL All Commercial |
$550.30
|
| Rate for Payer: Coventry All Commercial |
$520.71
|
| Rate for Payer: Encore All Commercial |
$544.68
|
| Rate for Payer: Frontpath All Commercial |
$544.38
|
| Rate for Payer: Humana ChoiceCare |
$511.07
|
| Rate for Payer: Humana Medicare |
$189.35
|
| Rate for Payer: Lucent All Commercial |
$321.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$532.55
|
| Rate for Payer: Managed Health Services Medicaid |
$13.54
|
| Rate for Payer: MDWise Medicaid |
$13.54
|
| Rate for Payer: PHCS All Commercial |
$443.79
|
| Rate for Payer: PHP All Commercial |
$448.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$230.77
|
| Rate for Payer: Sagamore Health Network All Products |
$456.81
|
| Rate for Payer: Signature Care EPO |
$491.13
|
| Rate for Payer: Signature Care PPO |
$520.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$502.96
|
| Rate for Payer: United Healthcare Commercial |
$466.28
|
| Rate for Payer: United Healthcare Medicare |
$189.35
|
|
|
HC X-RAY-HAND 2 VIEWS LT
|
Facility
|
IP
|
$394.49
|
|
|
Service Code
|
CPT 73120 LT
|
| Hospital Charge Code |
1613120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$295.87 |
| Max. Negotiated Rate |
$366.88 |
| Rate for Payer: Aetna Commercial |
$340.84
|
| Rate for Payer: Cash Price |
$236.69
|
| Rate for Payer: Cigna All Commercial |
$340.44
|
| Rate for Payer: CORVEL All Commercial |
$366.88
|
| Rate for Payer: Coventry All Commercial |
$347.15
|
| Rate for Payer: Encore All Commercial |
$363.13
|
| Rate for Payer: Frontpath All Commercial |
$362.93
|
| Rate for Payer: Humana ChoiceCare |
$340.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$355.04
|
| Rate for Payer: PHCS All Commercial |
$295.87
|
| Rate for Payer: PHP All Commercial |
$299.18
|
| Rate for Payer: Sagamore Health Network All Products |
$304.55
|
| Rate for Payer: Signature Care EPO |
$327.43
|
| Rate for Payer: Signature Care PPO |
$347.15
|
| Rate for Payer: United Healthcare Commercial |
$310.86
|
|
|
HC X-RAY-HAND 2 VIEWS LT
|
Facility
|
OP
|
$394.49
|
|
|
Service Code
|
CPT 73120 LT
|
| Hospital Charge Code |
1613120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$366.88 |
| Rate for Payer: Aetna Commercial |
$332.95
|
| Rate for Payer: Aetna Medicare |
$126.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$13.54
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$226.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$246.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$13.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$138.86
|
| Rate for Payer: Cash Price |
$236.69
|
| Rate for Payer: Cash Price |
$236.69
|
| Rate for Payer: Centivo All Commercial |
$214.60
|
| Rate for Payer: Cigna All Commercial |
$340.44
|
| Rate for Payer: CORVEL All Commercial |
$366.88
|
| Rate for Payer: Coventry All Commercial |
$347.15
|
| Rate for Payer: Encore All Commercial |
$363.13
|
| Rate for Payer: Frontpath All Commercial |
$362.93
|
| Rate for Payer: Humana ChoiceCare |
$340.72
|
| Rate for Payer: Humana Medicare |
$126.24
|
| Rate for Payer: Lucent All Commercial |
$214.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$355.04
|
| Rate for Payer: Managed Health Services Medicaid |
$13.54
|
| Rate for Payer: MDWise Medicaid |
$13.54
|
| Rate for Payer: PHCS All Commercial |
$295.87
|
| Rate for Payer: PHP All Commercial |
$299.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$153.85
|
| Rate for Payer: Sagamore Health Network All Products |
$304.55
|
| Rate for Payer: Signature Care EPO |
$327.43
|
| Rate for Payer: Signature Care PPO |
$347.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$335.32
|
| Rate for Payer: United Healthcare Commercial |
$310.86
|
| Rate for Payer: United Healthcare Medicare |
$126.24
|
|
|
HC X-RAY-HAND 2 VIEWS RT
|
Facility
|
IP
|
$394.49
|
|
|
Service Code
|
CPT 73120 RT
|
| Hospital Charge Code |
11613120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$295.87 |
| Max. Negotiated Rate |
$366.88 |
| Rate for Payer: Aetna Commercial |
$340.84
|
| Rate for Payer: Cash Price |
$236.69
|
| Rate for Payer: Cigna All Commercial |
$340.44
|
| Rate for Payer: CORVEL All Commercial |
$366.88
|
| Rate for Payer: Coventry All Commercial |
$347.15
|
| Rate for Payer: Encore All Commercial |
$363.13
|
| Rate for Payer: Frontpath All Commercial |
$362.93
|
| Rate for Payer: Humana ChoiceCare |
$340.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$355.04
|
| Rate for Payer: PHCS All Commercial |
$295.87
|
| Rate for Payer: PHP All Commercial |
$299.18
|
| Rate for Payer: Sagamore Health Network All Products |
$304.55
|
| Rate for Payer: Signature Care EPO |
$327.43
|
| Rate for Payer: Signature Care PPO |
$347.15
|
| Rate for Payer: United Healthcare Commercial |
$310.86
|
|
