|
HC X-RAY-KNEE SINGLE VIEW LT
|
Facility
|
OP
|
$458.79
|
|
|
Service Code
|
CPT 73560 LT
|
| Hospital Charge Code |
1618560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$426.67 |
| Rate for Payer: Aetna Commercial |
$387.22
|
| Rate for Payer: Aetna Medicare |
$146.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$142.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$263.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$286.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$168.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$161.49
|
| Rate for Payer: Cash Price |
$275.27
|
| Rate for Payer: Cash Price |
$275.27
|
| Rate for Payer: Centivo All Commercial |
$249.58
|
| Rate for Payer: Cigna All Commercial |
$395.94
|
| Rate for Payer: CORVEL All Commercial |
$426.67
|
| Rate for Payer: Coventry All Commercial |
$403.74
|
| Rate for Payer: Encore All Commercial |
$422.32
|
| Rate for Payer: Frontpath All Commercial |
$422.09
|
| Rate for Payer: Humana ChoiceCare |
$396.26
|
| Rate for Payer: Humana Medicare |
$146.81
|
| Rate for Payer: Lucent All Commercial |
$249.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.91
|
| Rate for Payer: Managed Health Services Medicaid |
$15.03
|
| Rate for Payer: MDWise Medicaid |
$15.03
|
| Rate for Payer: PHCS All Commercial |
$344.09
|
| Rate for Payer: PHP All Commercial |
$347.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$178.93
|
| Rate for Payer: Sagamore Health Network All Products |
$354.19
|
| Rate for Payer: Signature Care EPO |
$380.80
|
| Rate for Payer: Signature Care PPO |
$403.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$389.97
|
| Rate for Payer: United Healthcare Commercial |
$361.53
|
| Rate for Payer: United Healthcare Medicare |
$146.81
|
|
|
HC X-RAY-KNEE SINGLE VIEW LT
|
Facility
|
IP
|
$458.79
|
|
|
Service Code
|
CPT 73560 LT
|
| Hospital Charge Code |
1618560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$344.09 |
| Max. Negotiated Rate |
$426.67 |
| Rate for Payer: Aetna Commercial |
$396.39
|
| Rate for Payer: Cash Price |
$275.27
|
| Rate for Payer: Cigna All Commercial |
$395.94
|
| Rate for Payer: CORVEL All Commercial |
$426.67
|
| Rate for Payer: Coventry All Commercial |
$403.74
|
| Rate for Payer: Encore All Commercial |
$422.32
|
| Rate for Payer: Frontpath All Commercial |
$422.09
|
| Rate for Payer: Humana ChoiceCare |
$396.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.91
|
| Rate for Payer: PHCS All Commercial |
$344.09
|
| Rate for Payer: PHP All Commercial |
$347.95
|
| Rate for Payer: Sagamore Health Network All Products |
$354.19
|
| Rate for Payer: Signature Care EPO |
$380.80
|
| Rate for Payer: Signature Care PPO |
$403.74
|
| Rate for Payer: United Healthcare Commercial |
$361.53
|
|
|
HC X-RAY-KNEE SINGLE VIEW RT
|
Facility
|
OP
|
$458.79
|
|
|
Service Code
|
CPT 73560 RT
|
| Hospital Charge Code |
11618560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$426.67 |
| Rate for Payer: Aetna Commercial |
$387.22
|
| Rate for Payer: Aetna Medicare |
$146.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$142.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$263.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$286.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$168.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$161.49
|
| Rate for Payer: Cash Price |
$275.27
|
| Rate for Payer: Cash Price |
$275.27
|
| Rate for Payer: Centivo All Commercial |
$249.58
|
| Rate for Payer: Cigna All Commercial |
$395.94
|
| Rate for Payer: CORVEL All Commercial |
$426.67
|
| Rate for Payer: Coventry All Commercial |
$403.74
|
| Rate for Payer: Encore All Commercial |
$422.32
|
| Rate for Payer: Frontpath All Commercial |
$422.09
|
| Rate for Payer: Humana ChoiceCare |
$396.26
|
| Rate for Payer: Humana Medicare |
$146.81
|
| Rate for Payer: Lucent All Commercial |
$249.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.91
|
| Rate for Payer: Managed Health Services Medicaid |
$15.03
|
| Rate for Payer: MDWise Medicaid |
$15.03
|
| Rate for Payer: PHCS All Commercial |
$344.09
|
| Rate for Payer: PHP All Commercial |
$347.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$178.93
|
| Rate for Payer: Sagamore Health Network All Products |
$354.19
|
| Rate for Payer: Signature Care EPO |
$380.80
|
| Rate for Payer: Signature Care PPO |
$403.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$389.97
|
| Rate for Payer: United Healthcare Commercial |
$361.53
|
| Rate for Payer: United Healthcare Medicare |
$146.81
|
|
|
HC X-RAY-KNEE SINGLE VIEW RT
|
Facility
|
IP
|
$458.79
|
|
|
Service Code
|
CPT 73560 RT
|
| Hospital Charge Code |
11618560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$344.09 |
| Max. Negotiated Rate |
$426.67 |
| Rate for Payer: Aetna Commercial |
$396.39
|
| Rate for Payer: Cash Price |
$275.27
|
| Rate for Payer: Cigna All Commercial |
$395.94
|
| Rate for Payer: CORVEL All Commercial |
$426.67
|
| Rate for Payer: Coventry All Commercial |
$403.74
|
| Rate for Payer: Encore All Commercial |
$422.32
|
| Rate for Payer: Frontpath All Commercial |
$422.09
|
| Rate for Payer: Humana ChoiceCare |
$396.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.91
|
| Rate for Payer: PHCS All Commercial |
$344.09
|
| Rate for Payer: PHP All Commercial |
$347.95
|
| Rate for Payer: Sagamore Health Network All Products |
$354.19
|
| Rate for Payer: Signature Care EPO |
$380.80
|
| Rate for Payer: Signature Care PPO |
$403.74
|
| Rate for Payer: United Healthcare Commercial |
$361.53
|
|
|
HC X-RAY-KNEES-STANDING AP
|
Facility
|
IP
|
$423.98
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
1613565
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$317.99 |
| Max. Negotiated Rate |
$394.30 |
| Rate for Payer: Aetna Commercial |
$366.32
|
| Rate for Payer: Cash Price |
$254.39
|
| Rate for Payer: Cigna All Commercial |
$365.89
|
| Rate for Payer: CORVEL All Commercial |
$394.30
|
| Rate for Payer: Coventry All Commercial |
$373.10
|
| Rate for Payer: Encore All Commercial |
$390.27
|
| Rate for Payer: Frontpath All Commercial |
$390.06
|
| Rate for Payer: Humana ChoiceCare |
$366.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.58
|
| Rate for Payer: PHCS All Commercial |
$317.99
|
| Rate for Payer: PHP All Commercial |
$321.55
|
| Rate for Payer: Sagamore Health Network All Products |
$327.31
|
| Rate for Payer: Signature Care EPO |
$351.90
|
| Rate for Payer: Signature Care PPO |
$373.10
|
| Rate for Payer: United Healthcare Commercial |
$334.10
|
|
|
HC X-RAY-KNEES-STANDING AP
|
Facility
|
OP
|
$423.98
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
1613565
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$18.25 |
| Max. Negotiated Rate |
$394.30 |
| Rate for Payer: Aetna Commercial |
$357.84
|
| Rate for Payer: Aetna Medicare |
$135.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$18.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$243.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$18.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$156.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$149.24
|
| Rate for Payer: Cash Price |
$254.39
|
| Rate for Payer: Cash Price |
$254.39
|
| Rate for Payer: Centivo All Commercial |
$230.65
|
| Rate for Payer: Cigna All Commercial |
$365.89
|
| Rate for Payer: CORVEL All Commercial |
$394.30
|
| Rate for Payer: Coventry All Commercial |
$373.10
|
| Rate for Payer: Encore All Commercial |
$390.27
|
| Rate for Payer: Frontpath All Commercial |
$390.06
|
| Rate for Payer: Humana ChoiceCare |
$366.19
|
| Rate for Payer: Humana Medicare |
$135.67
|
| Rate for Payer: Lucent All Commercial |
$230.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.58
|
| Rate for Payer: Managed Health Services Medicaid |
$18.25
|
| Rate for Payer: MDWise Medicaid |
$18.25
|
| Rate for Payer: PHCS All Commercial |
$317.99
|
| Rate for Payer: PHP All Commercial |
$321.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.35
|
| Rate for Payer: Sagamore Health Network All Products |
$327.31
|
| Rate for Payer: Signature Care EPO |
$351.90
|
| Rate for Payer: Signature Care PPO |
$373.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$360.38
|
| Rate for Payer: United Healthcare Commercial |
$334.10
|
| Rate for Payer: United Healthcare Medicare |
$135.67
|
|
|
HC X-RAY-KNEE THREE VIEWS BI
|
Facility
|
OP
|
$816.06
|
|
|
Service Code
|
CPT 73562 50
|
| Hospital Charge Code |
21613581
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$758.94 |
| Rate for Payer: Aetna Commercial |
$688.75
|
| Rate for Payer: Aetna Medicare |
$261.14
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$19.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$252.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$468.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$510.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$300.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$287.25
|
| Rate for Payer: Cash Price |
$489.64
|
| Rate for Payer: Cash Price |
$489.64
|
| Rate for Payer: Centivo All Commercial |
$443.94
|
| Rate for Payer: Cigna All Commercial |
$704.26
|
| Rate for Payer: CORVEL All Commercial |
$758.94
|
| Rate for Payer: Coventry All Commercial |
$718.13
|
| Rate for Payer: Encore All Commercial |
$751.18
|
| Rate for Payer: Frontpath All Commercial |
$750.78
|
| Rate for Payer: Humana ChoiceCare |
$704.83
|
| Rate for Payer: Humana Medicare |
$261.14
|
| Rate for Payer: Lucent All Commercial |
$443.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$734.45
|
| Rate for Payer: Managed Health Services Medicaid |
$19.24
|
| Rate for Payer: MDWise Medicaid |
$19.24
|
| Rate for Payer: PHCS All Commercial |
$612.04
|
| Rate for Payer: PHP All Commercial |
$618.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$318.26
|
| Rate for Payer: Sagamore Health Network All Products |
$630.00
|
| Rate for Payer: Signature Care EPO |
$677.33
|
| Rate for Payer: Signature Care PPO |
$718.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$693.65
|
| Rate for Payer: United Healthcare Commercial |
$643.06
|
| Rate for Payer: United Healthcare Medicare |
$261.14
|
|
|
HC X-RAY-KNEE THREE VIEWS BI
|
Facility
|
IP
|
$816.06
|
|
|
Service Code
|
CPT 73562 50
|
| Hospital Charge Code |
21613581
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$612.04 |
| Max. Negotiated Rate |
$758.94 |
| Rate for Payer: Aetna Commercial |
$705.08
|
| Rate for Payer: Cash Price |
$489.64
|
| Rate for Payer: Cigna All Commercial |
$704.26
|
| Rate for Payer: CORVEL All Commercial |
$758.94
|
| Rate for Payer: Coventry All Commercial |
$718.13
|
| Rate for Payer: Encore All Commercial |
$751.18
|
| Rate for Payer: Frontpath All Commercial |
$750.78
|
| Rate for Payer: Humana ChoiceCare |
$704.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$734.45
|
| Rate for Payer: PHCS All Commercial |
$612.04
|
| Rate for Payer: PHP All Commercial |
$618.90
|
| Rate for Payer: Sagamore Health Network All Products |
$630.00
|
| Rate for Payer: Signature Care EPO |
$677.33
|
| Rate for Payer: Signature Care PPO |
$718.13
|
| Rate for Payer: United Healthcare Commercial |
$643.06
|
|
|
HC X-RAY-KNEE THREE VIEWS LT
|
Facility
|
IP
|
$544.03
|
|
|
Service Code
|
CPT 73562 LT
|
| Hospital Charge Code |
1613581
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$408.02 |
| Max. Negotiated Rate |
$505.95 |
| Rate for Payer: Aetna Commercial |
$470.04
|
| Rate for Payer: Cash Price |
$326.42
|
| Rate for Payer: Cigna All Commercial |
$469.50
|
| Rate for Payer: CORVEL All Commercial |
$505.95
|
| Rate for Payer: Coventry All Commercial |
$478.75
|
| Rate for Payer: Encore All Commercial |
$500.78
|
| Rate for Payer: Frontpath All Commercial |
$500.51
|
| Rate for Payer: Humana ChoiceCare |
$469.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$489.63
|
| Rate for Payer: PHCS All Commercial |
$408.02
|
| Rate for Payer: PHP All Commercial |
$412.59
|
| Rate for Payer: Sagamore Health Network All Products |
$419.99
|
| Rate for Payer: Signature Care EPO |
$451.54
|
| Rate for Payer: Signature Care PPO |
$478.75
|
| Rate for Payer: United Healthcare Commercial |
$428.70
|
|
|
HC X-RAY-KNEE THREE VIEWS LT
|
Facility
|
OP
|
$544.03
|
|
|
Service Code
|
CPT 73562 LT
|
| Hospital Charge Code |
1613581
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$505.95 |
| Rate for Payer: Aetna Commercial |
$459.16
|
| Rate for Payer: Aetna Medicare |
$174.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$19.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$168.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$312.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$340.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$200.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$191.50
|
| Rate for Payer: Cash Price |
$326.42
|
| Rate for Payer: Cash Price |
$326.42
|
| Rate for Payer: Centivo All Commercial |
$295.95
|
| Rate for Payer: Cigna All Commercial |
$469.50
|
| Rate for Payer: CORVEL All Commercial |
$505.95
|
| Rate for Payer: Coventry All Commercial |
$478.75
|
| Rate for Payer: Encore All Commercial |
$500.78
|
| Rate for Payer: Frontpath All Commercial |
$500.51
|
| Rate for Payer: Humana ChoiceCare |
$469.88
|
| Rate for Payer: Humana Medicare |
$174.09
|
| Rate for Payer: Lucent All Commercial |
$295.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$489.63
|
| Rate for Payer: Managed Health Services Medicaid |
$19.24
|
| Rate for Payer: MDWise Medicaid |
$19.24
|
| Rate for Payer: PHCS All Commercial |
$408.02
|
| Rate for Payer: PHP All Commercial |
$412.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$212.17
|
| Rate for Payer: Sagamore Health Network All Products |
$419.99
|
| Rate for Payer: Signature Care EPO |
$451.54
|
| Rate for Payer: Signature Care PPO |
$478.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$462.43
|
| Rate for Payer: United Healthcare Commercial |
$428.70
|
| Rate for Payer: United Healthcare Medicare |
$174.09
|
|
|
HC X-RAY-KNEE THREE VIEWS RT
|
Facility
|
OP
|
$544.03
|
|
|
Service Code
|
CPT 73562 RT
|
| Hospital Charge Code |
11613581
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.24 |
| Max. Negotiated Rate |
$505.95 |
| Rate for Payer: Aetna Commercial |
$459.16
|
| Rate for Payer: Aetna Medicare |
$174.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$19.24
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$168.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$312.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$340.07
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$19.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$200.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$191.50
|
| Rate for Payer: Cash Price |
$326.42
|
| Rate for Payer: Cash Price |
$326.42
|
| Rate for Payer: Centivo All Commercial |
$295.95
|
| Rate for Payer: Cigna All Commercial |
$469.50
|
| Rate for Payer: CORVEL All Commercial |
$505.95
|
| Rate for Payer: Coventry All Commercial |
$478.75
|
| Rate for Payer: Encore All Commercial |
$500.78
|
| Rate for Payer: Frontpath All Commercial |
$500.51
|
| Rate for Payer: Humana ChoiceCare |
$469.88
|
| Rate for Payer: Humana Medicare |
$174.09
|
| Rate for Payer: Lucent All Commercial |
$295.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$489.63
|
| Rate for Payer: Managed Health Services Medicaid |
$19.24
|
| Rate for Payer: MDWise Medicaid |
$19.24
|
| Rate for Payer: PHCS All Commercial |
$408.02
|
| Rate for Payer: PHP All Commercial |
$412.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$212.17
|
| Rate for Payer: Sagamore Health Network All Products |
$419.99
|
| Rate for Payer: Signature Care EPO |
$451.54
|
| Rate for Payer: Signature Care PPO |
$478.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$462.43
|
| Rate for Payer: United Healthcare Commercial |
$428.70
|
| Rate for Payer: United Healthcare Medicare |
$174.09
|
|
|
HC X-RAY-KNEE THREE VIEWS RT
|
Facility
|
IP
|
$544.03
|
|
|
Service Code
|
CPT 73562 RT
|
| Hospital Charge Code |
11613581
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$408.02 |
| Max. Negotiated Rate |
$505.95 |
| Rate for Payer: Aetna Commercial |
$470.04
|
| Rate for Payer: Cash Price |
$326.42
|
| Rate for Payer: Cigna All Commercial |
$469.50
|
| Rate for Payer: CORVEL All Commercial |
$505.95
|
| Rate for Payer: Coventry All Commercial |
$478.75
|
| Rate for Payer: Encore All Commercial |
$500.78
|
| Rate for Payer: Frontpath All Commercial |
$500.51
|
| Rate for Payer: Humana ChoiceCare |
$469.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$489.63
|
| Rate for Payer: PHCS All Commercial |
$408.02
|
| Rate for Payer: PHP All Commercial |
$412.59
|
| Rate for Payer: Sagamore Health Network All Products |
$419.99
|
| Rate for Payer: Signature Care EPO |
$451.54
|
| Rate for Payer: Signature Care PPO |
$478.75
|
| Rate for Payer: United Healthcare Commercial |
$428.70
|
|
|
HC X-RAY-KNEE TWO VIEWS BI
|
Facility
|
OP
|
$688.17
|
|
|
Service Code
|
CPT 73560 50
|
| Hospital Charge Code |
21613560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna Commercial |
$580.82
|
| Rate for Payer: Aetna Medicare |
$220.21
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$213.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$395.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$430.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$253.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$242.24
|
| Rate for Payer: Cash Price |
$412.90
|
| Rate for Payer: Cash Price |
$412.90
|
| Rate for Payer: Centivo All Commercial |
$374.36
|
| Rate for Payer: Cigna All Commercial |
$593.89
|
| Rate for Payer: CORVEL All Commercial |
$640.00
|
| Rate for Payer: Coventry All Commercial |
$605.59
|
| Rate for Payer: Encore All Commercial |
$633.46
|
| Rate for Payer: Frontpath All Commercial |
$633.12
|
| Rate for Payer: Humana ChoiceCare |
$594.37
|
| Rate for Payer: Humana Medicare |
$220.21
|
| Rate for Payer: Lucent All Commercial |
$374.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$619.35
|
| Rate for Payer: Managed Health Services Medicaid |
$15.03
|
| Rate for Payer: MDWise Medicaid |
$15.03
|
| Rate for Payer: PHCS All Commercial |
$516.13
|
| Rate for Payer: PHP All Commercial |
$521.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$268.39
|
| Rate for Payer: Sagamore Health Network All Products |
$531.27
|
| Rate for Payer: Signature Care EPO |
$571.18
|
| Rate for Payer: Signature Care PPO |
$605.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$584.94
|
| Rate for Payer: United Healthcare Commercial |
$542.28
|
| Rate for Payer: United Healthcare Medicare |
$220.21
|
|
|
HC X-RAY-KNEE TWO VIEWS BI
|
Facility
|
IP
|
$688.17
|
|
|
Service Code
|
CPT 73560 50
|
| Hospital Charge Code |
21613560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$516.13 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna Commercial |
$594.58
|
| Rate for Payer: Cash Price |
$412.90
|
| Rate for Payer: Cigna All Commercial |
$593.89
|
| Rate for Payer: CORVEL All Commercial |
$640.00
|
| Rate for Payer: Coventry All Commercial |
$605.59
|
| Rate for Payer: Encore All Commercial |
$633.46
|
| Rate for Payer: Frontpath All Commercial |
$633.12
|
| Rate for Payer: Humana ChoiceCare |
$594.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$619.35
|
| Rate for Payer: PHCS All Commercial |
$516.13
|
| Rate for Payer: PHP All Commercial |
$521.91
|
| Rate for Payer: Sagamore Health Network All Products |
$531.27
|
| Rate for Payer: Signature Care EPO |
$571.18
|
| Rate for Payer: Signature Care PPO |
$605.59
|
| Rate for Payer: United Healthcare Commercial |
$542.28
|
|
|
HC X-RAY-KNEE TWO VIEWS LT
|
Facility
|
OP
|
$458.79
|
|
|
Service Code
|
CPT 73560 LT
|
| Hospital Charge Code |
1613560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$426.67 |
| Rate for Payer: Aetna Commercial |
$387.22
|
| Rate for Payer: Aetna Medicare |
$146.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$142.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$263.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$286.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$168.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$161.49
|
| Rate for Payer: Cash Price |
$275.27
|
| Rate for Payer: Cash Price |
$275.27
|
| Rate for Payer: Centivo All Commercial |
$249.58
|
| Rate for Payer: Cigna All Commercial |
$395.94
|
| Rate for Payer: CORVEL All Commercial |
$426.67
|
| Rate for Payer: Coventry All Commercial |
$403.74
|
| Rate for Payer: Encore All Commercial |
$422.32
|
| Rate for Payer: Frontpath All Commercial |
$422.09
|
| Rate for Payer: Humana ChoiceCare |
$396.26
|
| Rate for Payer: Humana Medicare |
$146.81
|
| Rate for Payer: Lucent All Commercial |
$249.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.91
|
| Rate for Payer: Managed Health Services Medicaid |
$15.03
|
| Rate for Payer: MDWise Medicaid |
$15.03
|
| Rate for Payer: PHCS All Commercial |
$344.09
|
| Rate for Payer: PHP All Commercial |
$347.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$178.93
|
| Rate for Payer: Sagamore Health Network All Products |
$354.19
|
| Rate for Payer: Signature Care EPO |
$380.80
|
| Rate for Payer: Signature Care PPO |
$403.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$389.97
|
| Rate for Payer: United Healthcare Commercial |
$361.53
|
| Rate for Payer: United Healthcare Medicare |
$146.81
|
|
|
HC X-RAY-KNEE TWO VIEWS LT
|
Facility
|
IP
|
$458.79
|
|
|
Service Code
|
CPT 73560 LT
|
| Hospital Charge Code |
1613560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$344.09 |
| Max. Negotiated Rate |
$426.67 |
| Rate for Payer: Aetna Commercial |
$396.39
|
| Rate for Payer: Cash Price |
$275.27
|
| Rate for Payer: Cigna All Commercial |
$395.94
|
| Rate for Payer: CORVEL All Commercial |
$426.67
|
| Rate for Payer: Coventry All Commercial |
$403.74
|
| Rate for Payer: Encore All Commercial |
$422.32
|
| Rate for Payer: Frontpath All Commercial |
$422.09
|
| Rate for Payer: Humana ChoiceCare |
$396.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.91
|
| Rate for Payer: PHCS All Commercial |
$344.09
|
| Rate for Payer: PHP All Commercial |
$347.95
|
| Rate for Payer: Sagamore Health Network All Products |
$354.19
|
| Rate for Payer: Signature Care EPO |
$380.80
|
| Rate for Payer: Signature Care PPO |
$403.74
|
| Rate for Payer: United Healthcare Commercial |
$361.53
|
|
|
HC X-RAY-KNEE TWO VIEWS RT
|
Facility
|
OP
|
$458.79
|
|
|
Service Code
|
CPT 73560 RT
|
| Hospital Charge Code |
11613560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$426.67 |
| Rate for Payer: Aetna Commercial |
$387.22
|
| Rate for Payer: Aetna Medicare |
$146.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$142.22
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$263.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$286.79
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$168.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$161.49
|
| Rate for Payer: Cash Price |
$275.27
|
| Rate for Payer: Cash Price |
$275.27
|
| Rate for Payer: Centivo All Commercial |
$249.58
|
| Rate for Payer: Cigna All Commercial |
$395.94
|
| Rate for Payer: CORVEL All Commercial |
$426.67
|
| Rate for Payer: Coventry All Commercial |
$403.74
|
| Rate for Payer: Encore All Commercial |
$422.32
|
| Rate for Payer: Frontpath All Commercial |
$422.09
|
| Rate for Payer: Humana ChoiceCare |
$396.26
|
| Rate for Payer: Humana Medicare |
$146.81
|
| Rate for Payer: Lucent All Commercial |
$249.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.91
|
| Rate for Payer: Managed Health Services Medicaid |
$15.03
|
| Rate for Payer: MDWise Medicaid |
$15.03
|
| Rate for Payer: PHCS All Commercial |
$344.09
|
| Rate for Payer: PHP All Commercial |
$347.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$178.93
|
| Rate for Payer: Sagamore Health Network All Products |
$354.19
|
| Rate for Payer: Signature Care EPO |
$380.80
|
| Rate for Payer: Signature Care PPO |
$403.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$389.97
|
| Rate for Payer: United Healthcare Commercial |
$361.53
|
| Rate for Payer: United Healthcare Medicare |
$146.81
|
|
|
HC X-RAY-KNEE TWO VIEWS RT
|
Facility
|
IP
|
$458.79
|
|
|
Service Code
|
CPT 73560 RT
|
| Hospital Charge Code |
11613560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$344.09 |
| Max. Negotiated Rate |
$426.67 |
| Rate for Payer: Aetna Commercial |
$396.39
|
| Rate for Payer: Cash Price |
$275.27
|
| Rate for Payer: Cigna All Commercial |
$395.94
|
| Rate for Payer: CORVEL All Commercial |
$426.67
|
| Rate for Payer: Coventry All Commercial |
$403.74
|
| Rate for Payer: Encore All Commercial |
$422.32
|
| Rate for Payer: Frontpath All Commercial |
$422.09
|
| Rate for Payer: Humana ChoiceCare |
$396.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.91
|
| Rate for Payer: PHCS All Commercial |
$344.09
|
| Rate for Payer: PHP All Commercial |
$347.95
|
| Rate for Payer: Sagamore Health Network All Products |
$354.19
|
| Rate for Payer: Signature Care EPO |
$380.80
|
| Rate for Payer: Signature Care PPO |
$403.74
|
| Rate for Payer: United Healthcare Commercial |
$361.53
|
|
|
HC X-RAY-LOWER EXT AP&LAT INF BI
|
Facility
|
IP
|
$337.74
|
|
|
Service Code
|
CPT 73592 50
|
| Hospital Charge Code |
21613592
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$253.31 |
| Max. Negotiated Rate |
$314.10 |
| Rate for Payer: Aetna Commercial |
$291.81
|
| Rate for Payer: Cash Price |
$202.64
|
| Rate for Payer: Cigna All Commercial |
$291.47
|
| Rate for Payer: CORVEL All Commercial |
$314.10
|
| Rate for Payer: Coventry All Commercial |
$297.21
|
| Rate for Payer: Encore All Commercial |
$310.89
|
| Rate for Payer: Frontpath All Commercial |
$310.72
|
| Rate for Payer: Humana ChoiceCare |
$291.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.97
|
| Rate for Payer: PHCS All Commercial |
$253.31
|
| Rate for Payer: PHP All Commercial |
$256.14
|
| Rate for Payer: Sagamore Health Network All Products |
$260.74
|
| Rate for Payer: Signature Care EPO |
$280.32
|
| Rate for Payer: Signature Care PPO |
$297.21
|
| Rate for Payer: United Healthcare Commercial |
$266.14
|
|
|
HC X-RAY-LOWER EXT AP&LAT INF BI
|
Facility
|
OP
|
$337.74
|
|
|
Service Code
|
CPT 73592 50
|
| Hospital Charge Code |
21613592
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$314.10 |
| Rate for Payer: Aetna Commercial |
$285.05
|
| Rate for Payer: Aetna Medicare |
$108.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$104.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$193.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$211.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.88
|
| Rate for Payer: Cash Price |
$202.64
|
| Rate for Payer: Cash Price |
$202.64
|
| Rate for Payer: Centivo All Commercial |
$183.73
|
| Rate for Payer: Cigna All Commercial |
$291.47
|
| Rate for Payer: CORVEL All Commercial |
$314.10
|
| Rate for Payer: Coventry All Commercial |
$297.21
|
| Rate for Payer: Encore All Commercial |
$310.89
|
| Rate for Payer: Frontpath All Commercial |
$310.72
|
| Rate for Payer: Humana ChoiceCare |
$291.71
|
| Rate for Payer: Humana Medicare |
$108.08
|
| Rate for Payer: Lucent All Commercial |
$183.73
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.97
|
| Rate for Payer: Managed Health Services Medicaid |
$14.28
|
| Rate for Payer: MDWise Medicaid |
$14.28
|
| Rate for Payer: PHCS All Commercial |
$253.31
|
| Rate for Payer: PHP All Commercial |
$256.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.72
|
| Rate for Payer: Sagamore Health Network All Products |
$260.74
|
| Rate for Payer: Signature Care EPO |
$280.32
|
| Rate for Payer: Signature Care PPO |
$297.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$287.08
|
| Rate for Payer: United Healthcare Commercial |
$266.14
|
| Rate for Payer: United Healthcare Medicare |
$108.08
|
|
|
HC X-RAY-LOWER EXT AP&LAT INF LT
|
Facility
|
IP
|
$225.17
|
|
|
Service Code
|
CPT 73592 LT
|
| Hospital Charge Code |
1613592
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.88 |
| Max. Negotiated Rate |
$209.41 |
| Rate for Payer: Aetna Commercial |
$194.55
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: Cigna All Commercial |
$194.32
|
| Rate for Payer: CORVEL All Commercial |
$209.41
|
| Rate for Payer: Coventry All Commercial |
$198.15
|
| Rate for Payer: Encore All Commercial |
$207.27
|
| Rate for Payer: Frontpath All Commercial |
$207.16
|
| Rate for Payer: Humana ChoiceCare |
$194.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$202.65
|
| Rate for Payer: PHCS All Commercial |
$168.88
|
| Rate for Payer: PHP All Commercial |
$170.77
|
| Rate for Payer: Sagamore Health Network All Products |
$173.83
|
| Rate for Payer: Signature Care EPO |
$186.89
|
| Rate for Payer: Signature Care PPO |
$198.15
|
| Rate for Payer: United Healthcare Commercial |
$177.43
|
|
|
HC X-RAY-LOWER EXT AP&LAT INF LT
|
Facility
|
OP
|
$225.17
|
|
|
Service Code
|
CPT 73592 LT
|
| Hospital Charge Code |
1613592
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$209.41 |
| Rate for Payer: Aetna Commercial |
$190.04
|
| Rate for Payer: Aetna Medicare |
$72.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$129.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$140.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.26
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: Centivo All Commercial |
$122.49
|
| Rate for Payer: Cigna All Commercial |
$194.32
|
| Rate for Payer: CORVEL All Commercial |
$209.41
|
| Rate for Payer: Coventry All Commercial |
$198.15
|
| Rate for Payer: Encore All Commercial |
$207.27
|
| Rate for Payer: Frontpath All Commercial |
$207.16
|
| Rate for Payer: Humana ChoiceCare |
$194.48
|
| Rate for Payer: Humana Medicare |
$72.05
|
| Rate for Payer: Lucent All Commercial |
$122.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$202.65
|
| Rate for Payer: Managed Health Services Medicaid |
$14.28
|
| Rate for Payer: MDWise Medicaid |
$14.28
|
| Rate for Payer: PHCS All Commercial |
$168.88
|
| Rate for Payer: PHP All Commercial |
$170.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.82
|
| Rate for Payer: Sagamore Health Network All Products |
$173.83
|
| Rate for Payer: Signature Care EPO |
$186.89
|
| Rate for Payer: Signature Care PPO |
$198.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$191.39
|
| Rate for Payer: United Healthcare Commercial |
$177.43
|
| Rate for Payer: United Healthcare Medicare |
$72.05
|
|
|
HC X-RAY-LOWER EXT AP&LAT INF RT
|
Facility
|
IP
|
$225.17
|
|
|
Service Code
|
CPT 73592 RT
|
| Hospital Charge Code |
11613592
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.88 |
| Max. Negotiated Rate |
$209.41 |
| Rate for Payer: Aetna Commercial |
$194.55
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: Cigna All Commercial |
$194.32
|
| Rate for Payer: CORVEL All Commercial |
$209.41
|
| Rate for Payer: Coventry All Commercial |
$198.15
|
| Rate for Payer: Encore All Commercial |
$207.27
|
| Rate for Payer: Frontpath All Commercial |
$207.16
|
| Rate for Payer: Humana ChoiceCare |
$194.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$202.65
|
| Rate for Payer: PHCS All Commercial |
$168.88
|
| Rate for Payer: PHP All Commercial |
$170.77
|
| Rate for Payer: Sagamore Health Network All Products |
$173.83
|
| Rate for Payer: Signature Care EPO |
$186.89
|
| Rate for Payer: Signature Care PPO |
$198.15
|
| Rate for Payer: United Healthcare Commercial |
$177.43
|
|
|
HC X-RAY-LOWER EXT AP&LAT INF RT
|
Facility
|
OP
|
$225.17
|
|
|
Service Code
|
CPT 73592 RT
|
| Hospital Charge Code |
11613592
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$209.41 |
| Rate for Payer: Aetna Commercial |
$190.04
|
| Rate for Payer: Aetna Medicare |
$72.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$14.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$69.80
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$129.32
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$140.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$14.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$79.26
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: Cash Price |
$135.10
|
| Rate for Payer: Centivo All Commercial |
$122.49
|
| Rate for Payer: Cigna All Commercial |
$194.32
|
| Rate for Payer: CORVEL All Commercial |
$209.41
|
| Rate for Payer: Coventry All Commercial |
$198.15
|
| Rate for Payer: Encore All Commercial |
$207.27
|
| Rate for Payer: Frontpath All Commercial |
$207.16
|
| Rate for Payer: Humana ChoiceCare |
$194.48
|
| Rate for Payer: Humana Medicare |
$72.05
|
| Rate for Payer: Lucent All Commercial |
$122.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$202.65
|
| Rate for Payer: Managed Health Services Medicaid |
$14.28
|
| Rate for Payer: MDWise Medicaid |
$14.28
|
| Rate for Payer: PHCS All Commercial |
$168.88
|
| Rate for Payer: PHP All Commercial |
$170.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.82
|
| Rate for Payer: Sagamore Health Network All Products |
$173.83
|
| Rate for Payer: Signature Care EPO |
$186.89
|
| Rate for Payer: Signature Care PPO |
$198.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$191.39
|
| Rate for Payer: United Healthcare Commercial |
$177.43
|
| Rate for Payer: United Healthcare Medicare |
$72.05
|
|
|
HC X-RAY-LS SPINE 2 OR 3 VIEWS
|
Facility
|
IP
|
$610.98
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
1612100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$458.24 |
| Max. Negotiated Rate |
$568.21 |
| Rate for Payer: Aetna Commercial |
$527.89
|
| Rate for Payer: Cash Price |
$366.59
|
| Rate for Payer: Cigna All Commercial |
$527.28
|
| Rate for Payer: CORVEL All Commercial |
$568.21
|
| Rate for Payer: Coventry All Commercial |
$537.66
|
| Rate for Payer: Encore All Commercial |
$562.41
|
| Rate for Payer: Frontpath All Commercial |
$562.10
|
| Rate for Payer: Humana ChoiceCare |
$527.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$549.88
|
| Rate for Payer: PHCS All Commercial |
$458.24
|
| Rate for Payer: PHP All Commercial |
$463.37
|
| Rate for Payer: Sagamore Health Network All Products |
$471.68
|
| Rate for Payer: Signature Care EPO |
$507.11
|
| Rate for Payer: Signature Care PPO |
$537.66
|
| Rate for Payer: United Healthcare Commercial |
$481.45
|
|
