|
HC X-RAY-ACROMIOCLAVICULAR JOINTS
|
Facility
|
OP
|
$539.08
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
01613050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$501.34 |
| Rate for Payer: Aetna Commercial |
$454.98
|
| Rate for Payer: Aetna Medicare |
$177.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$177.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$309.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$336.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$78.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$204.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$195.69
|
| Rate for Payer: Cash Price |
$334.23
|
| Rate for Payer: Cash Price |
$334.23
|
| Rate for Payer: Centivo All Commercial |
$274.93
|
| Rate for Payer: Cigna All Commercial |
$465.23
|
| Rate for Payer: CORVEL All Commercial |
$501.34
|
| Rate for Payer: Coventry All Commercial |
$474.39
|
| Rate for Payer: Encore All Commercial |
$496.22
|
| Rate for Payer: Frontpath All Commercial |
$495.95
|
| Rate for Payer: Humana ChoiceCare |
$465.60
|
| Rate for Payer: Humana Medicare |
$274.93
|
| Rate for Payer: Lucent All Commercial |
$274.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$485.17
|
| Rate for Payer: Managed Health Services Medicaid |
$78.90
|
| Rate for Payer: MDWise Medicaid |
$78.90
|
| Rate for Payer: PHCS All Commercial |
$404.31
|
| Rate for Payer: PHP All Commercial |
$408.84
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$210.24
|
| Rate for Payer: Sagamore Health Network All Products |
$416.17
|
| Rate for Payer: Signature Care EPO |
$447.44
|
| Rate for Payer: Signature Care PPO |
$474.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$458.22
|
| Rate for Payer: United Healthcare Commercial |
$424.80
|
| Rate for Payer: United Healthcare Medicare |
$177.90
|
|
|
HC X-RAY-ACROMIOCLAVICULAR JOINTS
|
Facility
|
IP
|
$539.08
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
01613050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$404.31 |
| Max. Negotiated Rate |
$501.34 |
| Rate for Payer: Aetna Commercial |
$465.77
|
| Rate for Payer: Cash Price |
$334.23
|
| Rate for Payer: Cigna All Commercial |
$465.23
|
| Rate for Payer: CORVEL All Commercial |
$501.34
|
| Rate for Payer: Coventry All Commercial |
$474.39
|
| Rate for Payer: Encore All Commercial |
$496.22
|
| Rate for Payer: Frontpath All Commercial |
$495.95
|
| Rate for Payer: Humana ChoiceCare |
$465.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$485.17
|
| Rate for Payer: PHCS All Commercial |
$404.31
|
| Rate for Payer: PHP All Commercial |
$408.84
|
| Rate for Payer: Sagamore Health Network All Products |
$416.17
|
| Rate for Payer: Signature Care EPO |
$447.44
|
| Rate for Payer: Signature Care PPO |
$474.39
|
| Rate for Payer: United Healthcare Commercial |
$424.80
|
|
|
HC X-RAY-ACUTE ABDOMINAL
|
Facility
|
OP
|
$989.71
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
01614020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.46 |
| Max. Negotiated Rate |
$920.43 |
| Rate for Payer: Aetna Commercial |
$835.31
|
| Rate for Payer: Aetna Medicare |
$326.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$326.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$568.39
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$618.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$91.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$375.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$359.26
|
| Rate for Payer: Cash Price |
$613.62
|
| Rate for Payer: Cash Price |
$613.62
|
| Rate for Payer: Centivo All Commercial |
$504.75
|
| Rate for Payer: Cigna All Commercial |
$854.12
|
| Rate for Payer: CORVEL All Commercial |
$920.43
|
| Rate for Payer: Coventry All Commercial |
$870.94
|
| Rate for Payer: Encore All Commercial |
$911.02
|
| Rate for Payer: Frontpath All Commercial |
$910.53
|
| Rate for Payer: Humana ChoiceCare |
$854.81
|
| Rate for Payer: Humana Medicare |
$504.75
|
| Rate for Payer: Lucent All Commercial |
$504.75
|
| Rate for Payer: Lutheran Preferred All Commercial |
$890.74
|
| Rate for Payer: Managed Health Services Medicaid |
$91.46
|
| Rate for Payer: MDWise Medicaid |
$91.46
|
| Rate for Payer: PHCS All Commercial |
$742.28
|
| Rate for Payer: PHP All Commercial |
$750.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$385.99
|
| Rate for Payer: Sagamore Health Network All Products |
$764.05
|
| Rate for Payer: Signature Care EPO |
$821.46
|
| Rate for Payer: Signature Care PPO |
$870.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$841.25
|
| Rate for Payer: United Healthcare Commercial |
$779.89
|
| Rate for Payer: United Healthcare Medicare |
$326.60
|
|
|
HC X-RAY-ACUTE ABDOMINAL
|
Facility
|
IP
|
$989.71
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
01614020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$742.28 |
| Max. Negotiated Rate |
$920.43 |
| Rate for Payer: Aetna Commercial |
$855.11
|
| Rate for Payer: Cash Price |
$613.62
|
| Rate for Payer: Cigna All Commercial |
$854.12
|
| Rate for Payer: CORVEL All Commercial |
$920.43
|
| Rate for Payer: Coventry All Commercial |
$870.94
|
| Rate for Payer: Encore All Commercial |
$911.02
|
| Rate for Payer: Frontpath All Commercial |
$910.53
|
| Rate for Payer: Humana ChoiceCare |
$854.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$890.74
|
| Rate for Payer: PHCS All Commercial |
$742.28
|
| Rate for Payer: PHP All Commercial |
$750.59
|
| Rate for Payer: Sagamore Health Network All Products |
$764.05
|
| Rate for Payer: Signature Care EPO |
$821.46
|
| Rate for Payer: Signature Care PPO |
$870.94
|
| Rate for Payer: United Healthcare Commercial |
$779.89
|
|
|
HC X-RAY-ANKLE 1 VIEW BI
|
Facility
|
IP
|
$468.37
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
21614600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.28 |
| Max. Negotiated Rate |
$435.59 |
| Rate for Payer: Aetna Commercial |
$404.67
|
| Rate for Payer: Cash Price |
$290.39
|
| Rate for Payer: Cigna All Commercial |
$404.21
|
| Rate for Payer: CORVEL All Commercial |
$435.59
|
| Rate for Payer: Coventry All Commercial |
$412.17
|
| Rate for Payer: Encore All Commercial |
$431.14
|
| Rate for Payer: Frontpath All Commercial |
$430.90
|
| Rate for Payer: Humana ChoiceCare |
$404.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$421.54
|
| Rate for Payer: PHCS All Commercial |
$351.28
|
| Rate for Payer: PHP All Commercial |
$355.21
|
| Rate for Payer: Sagamore Health Network All Products |
$361.58
|
| Rate for Payer: Signature Care EPO |
$388.75
|
| Rate for Payer: Signature Care PPO |
$412.17
|
| Rate for Payer: United Healthcare Commercial |
$369.08
|
|
|
HC X-RAY-ANKLE 1 VIEW BI
|
Facility
|
OP
|
$468.37
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
21614600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$55.69 |
| Max. Negotiated Rate |
$435.59 |
| Rate for Payer: Aetna Commercial |
$395.31
|
| Rate for Payer: Aetna Medicare |
$154.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$154.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$268.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$292.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$55.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$177.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$170.02
|
| Rate for Payer: Cash Price |
$290.39
|
| Rate for Payer: Cash Price |
$290.39
|
| Rate for Payer: Centivo All Commercial |
$238.87
|
| Rate for Payer: Cigna All Commercial |
$404.21
|
| Rate for Payer: CORVEL All Commercial |
$435.59
|
| Rate for Payer: Coventry All Commercial |
$412.17
|
| Rate for Payer: Encore All Commercial |
$431.14
|
| Rate for Payer: Frontpath All Commercial |
$430.90
|
| Rate for Payer: Humana ChoiceCare |
$404.53
|
| Rate for Payer: Humana Medicare |
$238.87
|
| Rate for Payer: Lucent All Commercial |
$238.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$421.54
|
| Rate for Payer: Managed Health Services Medicaid |
$55.69
|
| Rate for Payer: MDWise Medicaid |
$55.69
|
| Rate for Payer: PHCS All Commercial |
$351.28
|
| Rate for Payer: PHP All Commercial |
$355.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$182.67
|
| Rate for Payer: Sagamore Health Network All Products |
$361.58
|
| Rate for Payer: Signature Care EPO |
$388.75
|
| Rate for Payer: Signature Care PPO |
$412.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$398.12
|
| Rate for Payer: United Healthcare Commercial |
$369.08
|
| Rate for Payer: United Healthcare Medicare |
$154.56
|
|
|
HC X-RAY-ANKLE 1 VIEW LT
|
Facility
|
OP
|
$312.26
|
|
|
Service Code
|
CPT 73600 LT,52
|
| Hospital Charge Code |
01614600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.05 |
| Max. Negotiated Rate |
$290.40 |
| Rate for Payer: Aetna Commercial |
$263.55
|
| Rate for Payer: Aetna Medicare |
$103.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$179.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$195.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.35
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Centivo All Commercial |
$159.25
|
| Rate for Payer: Cigna All Commercial |
$269.48
|
| Rate for Payer: CORVEL All Commercial |
$290.40
|
| Rate for Payer: Coventry All Commercial |
$274.79
|
| Rate for Payer: Encore All Commercial |
$287.44
|
| Rate for Payer: Frontpath All Commercial |
$287.28
|
| Rate for Payer: Humana ChoiceCare |
$269.70
|
| Rate for Payer: Humana Medicare |
$159.25
|
| Rate for Payer: Lucent All Commercial |
$159.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.04
|
| Rate for Payer: PHCS All Commercial |
$234.20
|
| Rate for Payer: PHP All Commercial |
$236.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.78
|
| Rate for Payer: Sagamore Health Network All Products |
$241.07
|
| Rate for Payer: Signature Care EPO |
$259.18
|
| Rate for Payer: Signature Care PPO |
$274.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$265.42
|
| Rate for Payer: United Healthcare Commercial |
$246.06
|
| Rate for Payer: United Healthcare Medicare |
$103.05
|
|
|
HC X-RAY-ANKLE 1 VIEW LT
|
Facility
|
IP
|
$312.26
|
|
|
Service Code
|
CPT 73600 LT,52
|
| Hospital Charge Code |
01614600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.20 |
| Max. Negotiated Rate |
$290.40 |
| Rate for Payer: Aetna Commercial |
$269.80
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cigna All Commercial |
$269.48
|
| Rate for Payer: CORVEL All Commercial |
$290.40
|
| Rate for Payer: Coventry All Commercial |
$274.79
|
| Rate for Payer: Encore All Commercial |
$287.44
|
| Rate for Payer: Frontpath All Commercial |
$287.28
|
| Rate for Payer: Humana ChoiceCare |
$269.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.04
|
| Rate for Payer: PHCS All Commercial |
$234.20
|
| Rate for Payer: PHP All Commercial |
$236.82
|
| Rate for Payer: Sagamore Health Network All Products |
$241.07
|
| Rate for Payer: Signature Care EPO |
$259.18
|
| Rate for Payer: Signature Care PPO |
$274.79
|
| Rate for Payer: United Healthcare Commercial |
$246.06
|
|
|
HC X-RAY-ANKLE 1 VIEW RT
|
Facility
|
IP
|
$312.26
|
|
|
Service Code
|
CPT 73600 RT,52
|
| Hospital Charge Code |
11614600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.20 |
| Max. Negotiated Rate |
$290.40 |
| Rate for Payer: Aetna Commercial |
$269.80
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cigna All Commercial |
$269.48
|
| Rate for Payer: CORVEL All Commercial |
$290.40
|
| Rate for Payer: Coventry All Commercial |
$274.79
|
| Rate for Payer: Encore All Commercial |
$287.44
|
| Rate for Payer: Frontpath All Commercial |
$287.28
|
| Rate for Payer: Humana ChoiceCare |
$269.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.04
|
| Rate for Payer: PHCS All Commercial |
$234.20
|
| Rate for Payer: PHP All Commercial |
$236.82
|
| Rate for Payer: Sagamore Health Network All Products |
$241.07
|
| Rate for Payer: Signature Care EPO |
$259.18
|
| Rate for Payer: Signature Care PPO |
$274.79
|
| Rate for Payer: United Healthcare Commercial |
$246.06
|
|
|
HC X-RAY-ANKLE 1 VIEW RT
|
Facility
|
OP
|
$312.26
|
|
|
Service Code
|
CPT 73600 RT,52
|
| Hospital Charge Code |
11614600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.05 |
| Max. Negotiated Rate |
$290.40 |
| Rate for Payer: Aetna Commercial |
$263.55
|
| Rate for Payer: Aetna Medicare |
$103.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$103.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$179.33
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$195.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.35
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Centivo All Commercial |
$159.25
|
| Rate for Payer: Cigna All Commercial |
$269.48
|
| Rate for Payer: CORVEL All Commercial |
$290.40
|
| Rate for Payer: Coventry All Commercial |
$274.79
|
| Rate for Payer: Encore All Commercial |
$287.44
|
| Rate for Payer: Frontpath All Commercial |
$287.28
|
| Rate for Payer: Humana ChoiceCare |
$269.70
|
| Rate for Payer: Humana Medicare |
$159.25
|
| Rate for Payer: Lucent All Commercial |
$159.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$281.04
|
| Rate for Payer: PHCS All Commercial |
$234.20
|
| Rate for Payer: PHP All Commercial |
$236.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.78
|
| Rate for Payer: Sagamore Health Network All Products |
$241.07
|
| Rate for Payer: Signature Care EPO |
$259.18
|
| Rate for Payer: Signature Care PPO |
$274.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$265.42
|
| Rate for Payer: United Healthcare Commercial |
$246.06
|
| Rate for Payer: United Healthcare Medicare |
$103.05
|
|
|
HC X-RAY-ANKLE 2 VIEWS BI
|
Facility
|
IP
|
$624.51
|
|
|
Service Code
|
CPT 73600 50
|
| Hospital Charge Code |
21613600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$468.38 |
| Max. Negotiated Rate |
$580.79 |
| Rate for Payer: Aetna Commercial |
$539.57
|
| Rate for Payer: Cash Price |
$387.19
|
| Rate for Payer: Cigna All Commercial |
$538.95
|
| Rate for Payer: CORVEL All Commercial |
$580.79
|
| Rate for Payer: Coventry All Commercial |
$549.56
|
| Rate for Payer: Encore All Commercial |
$574.86
|
| Rate for Payer: Frontpath All Commercial |
$574.54
|
| Rate for Payer: Humana ChoiceCare |
$539.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$562.05
|
| Rate for Payer: PHCS All Commercial |
$468.38
|
| Rate for Payer: PHP All Commercial |
$473.62
|
| Rate for Payer: Sagamore Health Network All Products |
$482.12
|
| Rate for Payer: Signature Care EPO |
$518.34
|
| Rate for Payer: Signature Care PPO |
$549.56
|
| Rate for Payer: United Healthcare Commercial |
$492.11
|
|
|
HC X-RAY-ANKLE 2 VIEWS BI
|
Facility
|
OP
|
$624.51
|
|
|
Service Code
|
CPT 73600 50
|
| Hospital Charge Code |
21613600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$206.09 |
| Max. Negotiated Rate |
$580.79 |
| Rate for Payer: Aetna Commercial |
$527.08
|
| Rate for Payer: Aetna Medicare |
$206.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$206.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$358.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$390.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$237.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$226.70
|
| Rate for Payer: Cash Price |
$387.19
|
| Rate for Payer: Centivo All Commercial |
$318.50
|
| Rate for Payer: Cigna All Commercial |
$538.95
|
| Rate for Payer: CORVEL All Commercial |
$580.79
|
| Rate for Payer: Coventry All Commercial |
$549.56
|
| Rate for Payer: Encore All Commercial |
$574.86
|
| Rate for Payer: Frontpath All Commercial |
$574.54
|
| Rate for Payer: Humana ChoiceCare |
$539.39
|
| Rate for Payer: Humana Medicare |
$318.50
|
| Rate for Payer: Lucent All Commercial |
$318.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$562.05
|
| Rate for Payer: PHCS All Commercial |
$468.38
|
| Rate for Payer: PHP All Commercial |
$473.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$243.56
|
| Rate for Payer: Sagamore Health Network All Products |
$482.12
|
| Rate for Payer: Signature Care EPO |
$518.34
|
| Rate for Payer: Signature Care PPO |
$549.56
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$530.83
|
| Rate for Payer: United Healthcare Commercial |
$492.11
|
| Rate for Payer: United Healthcare Medicare |
$206.09
|
|
|
HC X-RAY-ANKLE 2 VIEWS LT
|
Facility
|
OP
|
$416.32
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
01613600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$387.18 |
| Rate for Payer: Aetna Commercial |
$351.38
|
| Rate for Payer: Aetna Medicare |
$137.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$239.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.13
|
| Rate for Payer: Cash Price |
$258.12
|
| Rate for Payer: Centivo All Commercial |
$212.32
|
| Rate for Payer: Cigna All Commercial |
$359.29
|
| Rate for Payer: CORVEL All Commercial |
$387.18
|
| Rate for Payer: Coventry All Commercial |
$366.36
|
| Rate for Payer: Encore All Commercial |
$383.23
|
| Rate for Payer: Frontpath All Commercial |
$383.02
|
| Rate for Payer: Humana ChoiceCare |
$359.58
|
| Rate for Payer: Humana Medicare |
$212.32
|
| Rate for Payer: Lucent All Commercial |
$212.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.69
|
| Rate for Payer: PHCS All Commercial |
$312.24
|
| Rate for Payer: PHP All Commercial |
$315.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.37
|
| Rate for Payer: Sagamore Health Network All Products |
$321.40
|
| Rate for Payer: Signature Care EPO |
$345.55
|
| Rate for Payer: Signature Care PPO |
$366.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.87
|
| Rate for Payer: United Healthcare Commercial |
$328.06
|
| Rate for Payer: United Healthcare Medicare |
$137.39
|
|
|
HC X-RAY-ANKLE 2 VIEWS LT
|
Facility
|
IP
|
$416.32
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
01613600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.24 |
| Max. Negotiated Rate |
$387.18 |
| Rate for Payer: Aetna Commercial |
$359.70
|
| Rate for Payer: Cash Price |
$258.12
|
| Rate for Payer: Cigna All Commercial |
$359.29
|
| Rate for Payer: CORVEL All Commercial |
$387.18
|
| Rate for Payer: Coventry All Commercial |
$366.36
|
| Rate for Payer: Encore All Commercial |
$383.23
|
| Rate for Payer: Frontpath All Commercial |
$383.02
|
| Rate for Payer: Humana ChoiceCare |
$359.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.69
|
| Rate for Payer: PHCS All Commercial |
$312.24
|
| Rate for Payer: PHP All Commercial |
$315.74
|
| Rate for Payer: Sagamore Health Network All Products |
$321.40
|
| Rate for Payer: Signature Care EPO |
$345.55
|
| Rate for Payer: Signature Care PPO |
$366.36
|
| Rate for Payer: United Healthcare Commercial |
$328.06
|
|
|
HC X-RAY-ANKLE 2 VIEWS RT
|
Facility
|
IP
|
$416.32
|
|
|
Service Code
|
CPT 73600 RT
|
| Hospital Charge Code |
11613600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.24 |
| Max. Negotiated Rate |
$387.18 |
| Rate for Payer: Aetna Commercial |
$359.70
|
| Rate for Payer: Cash Price |
$258.12
|
| Rate for Payer: Cigna All Commercial |
$359.29
|
| Rate for Payer: CORVEL All Commercial |
$387.18
|
| Rate for Payer: Coventry All Commercial |
$366.36
|
| Rate for Payer: Encore All Commercial |
$383.23
|
| Rate for Payer: Frontpath All Commercial |
$383.02
|
| Rate for Payer: Humana ChoiceCare |
$359.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.69
|
| Rate for Payer: PHCS All Commercial |
$312.24
|
| Rate for Payer: PHP All Commercial |
$315.74
|
| Rate for Payer: Sagamore Health Network All Products |
$321.40
|
| Rate for Payer: Signature Care EPO |
$345.55
|
| Rate for Payer: Signature Care PPO |
$366.36
|
| Rate for Payer: United Healthcare Commercial |
$328.06
|
|
|
HC X-RAY-ANKLE 2 VIEWS RT
|
Facility
|
OP
|
$416.32
|
|
|
Service Code
|
CPT 73600 RT
|
| Hospital Charge Code |
11613600
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.39 |
| Max. Negotiated Rate |
$387.18 |
| Rate for Payer: Aetna Commercial |
$351.38
|
| Rate for Payer: Aetna Medicare |
$137.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.39
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$239.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.99
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.13
|
| Rate for Payer: Cash Price |
$258.12
|
| Rate for Payer: Centivo All Commercial |
$212.32
|
| Rate for Payer: Cigna All Commercial |
$359.29
|
| Rate for Payer: CORVEL All Commercial |
$387.18
|
| Rate for Payer: Coventry All Commercial |
$366.36
|
| Rate for Payer: Encore All Commercial |
$383.23
|
| Rate for Payer: Frontpath All Commercial |
$383.02
|
| Rate for Payer: Humana ChoiceCare |
$359.58
|
| Rate for Payer: Humana Medicare |
$212.32
|
| Rate for Payer: Lucent All Commercial |
$212.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$374.69
|
| Rate for Payer: PHCS All Commercial |
$312.24
|
| Rate for Payer: PHP All Commercial |
$315.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.37
|
| Rate for Payer: Sagamore Health Network All Products |
$321.40
|
| Rate for Payer: Signature Care EPO |
$345.55
|
| Rate for Payer: Signature Care PPO |
$366.36
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$353.87
|
| Rate for Payer: United Healthcare Commercial |
$328.06
|
| Rate for Payer: United Healthcare Medicare |
$137.39
|
|
|
HC X-RAY-ANKLE MIN 3 VIEWS BI
|
Facility
|
OP
|
$765.59
|
|
|
Service Code
|
CPT 73610 50
|
| Hospital Charge Code |
21613610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.65 |
| Max. Negotiated Rate |
$712.00 |
| Rate for Payer: Aetna Commercial |
$646.16
|
| Rate for Payer: Aetna Medicare |
$252.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$252.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$439.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$478.57
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$290.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$277.91
|
| Rate for Payer: Cash Price |
$474.67
|
| Rate for Payer: Centivo All Commercial |
$390.45
|
| Rate for Payer: Cigna All Commercial |
$660.71
|
| Rate for Payer: CORVEL All Commercial |
$712.00
|
| Rate for Payer: Coventry All Commercial |
$673.72
|
| Rate for Payer: Encore All Commercial |
$704.73
|
| Rate for Payer: Frontpath All Commercial |
$704.34
|
| Rate for Payer: Humana ChoiceCare |
$661.24
|
| Rate for Payer: Humana Medicare |
$390.45
|
| Rate for Payer: Lucent All Commercial |
$390.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$689.03
|
| Rate for Payer: PHCS All Commercial |
$574.19
|
| Rate for Payer: PHP All Commercial |
$580.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$298.58
|
| Rate for Payer: Sagamore Health Network All Products |
$591.04
|
| Rate for Payer: Signature Care EPO |
$635.44
|
| Rate for Payer: Signature Care PPO |
$673.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$650.75
|
| Rate for Payer: United Healthcare Commercial |
$603.29
|
| Rate for Payer: United Healthcare Medicare |
$252.65
|
|
|
HC X-RAY-ANKLE MIN 3 VIEWS BI
|
Facility
|
IP
|
$765.59
|
|
|
Service Code
|
CPT 73610 50
|
| Hospital Charge Code |
21613610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$574.19 |
| Max. Negotiated Rate |
$712.00 |
| Rate for Payer: Aetna Commercial |
$661.47
|
| Rate for Payer: Cash Price |
$474.67
|
| Rate for Payer: Cigna All Commercial |
$660.71
|
| Rate for Payer: CORVEL All Commercial |
$712.00
|
| Rate for Payer: Coventry All Commercial |
$673.72
|
| Rate for Payer: Encore All Commercial |
$704.73
|
| Rate for Payer: Frontpath All Commercial |
$704.34
|
| Rate for Payer: Humana ChoiceCare |
$661.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$689.03
|
| Rate for Payer: PHCS All Commercial |
$574.19
|
| Rate for Payer: PHP All Commercial |
$580.62
|
| Rate for Payer: Sagamore Health Network All Products |
$591.04
|
| Rate for Payer: Signature Care EPO |
$635.44
|
| Rate for Payer: Signature Care PPO |
$673.72
|
| Rate for Payer: United Healthcare Commercial |
$603.29
|
|
|
HC X-RAY-ANKLE MIN 3 VIEWS LT
|
Facility
|
OP
|
$510.40
|
|
|
Service Code
|
CPT 73610 LT
|
| Hospital Charge Code |
01613610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.43 |
| Max. Negotiated Rate |
$474.67 |
| Rate for Payer: Aetna Commercial |
$430.78
|
| Rate for Payer: Aetna Medicare |
$168.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$168.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$293.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$319.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$193.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$185.27
|
| Rate for Payer: Cash Price |
$316.45
|
| Rate for Payer: Centivo All Commercial |
$260.30
|
| Rate for Payer: Cigna All Commercial |
$440.47
|
| Rate for Payer: CORVEL All Commercial |
$474.67
|
| Rate for Payer: Coventry All Commercial |
$449.15
|
| Rate for Payer: Encore All Commercial |
$469.82
|
| Rate for Payer: Frontpath All Commercial |
$469.57
|
| Rate for Payer: Humana ChoiceCare |
$440.83
|
| Rate for Payer: Humana Medicare |
$260.30
|
| Rate for Payer: Lucent All Commercial |
$260.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$459.36
|
| Rate for Payer: PHCS All Commercial |
$382.80
|
| Rate for Payer: PHP All Commercial |
$387.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.06
|
| Rate for Payer: Sagamore Health Network All Products |
$394.03
|
| Rate for Payer: Signature Care EPO |
$423.63
|
| Rate for Payer: Signature Care PPO |
$449.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$433.84
|
| Rate for Payer: United Healthcare Commercial |
$402.19
|
| Rate for Payer: United Healthcare Medicare |
$168.43
|
|
|
HC X-RAY-ANKLE MIN 3 VIEWS LT
|
Facility
|
IP
|
$510.40
|
|
|
Service Code
|
CPT 73610 LT
|
| Hospital Charge Code |
01613610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$382.80 |
| Max. Negotiated Rate |
$474.67 |
| Rate for Payer: Aetna Commercial |
$440.98
|
| Rate for Payer: Cash Price |
$316.45
|
| Rate for Payer: Cigna All Commercial |
$440.47
|
| Rate for Payer: CORVEL All Commercial |
$474.67
|
| Rate for Payer: Coventry All Commercial |
$449.15
|
| Rate for Payer: Encore All Commercial |
$469.82
|
| Rate for Payer: Frontpath All Commercial |
$469.57
|
| Rate for Payer: Humana ChoiceCare |
$440.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$459.36
|
| Rate for Payer: PHCS All Commercial |
$382.80
|
| Rate for Payer: PHP All Commercial |
$387.09
|
| Rate for Payer: Sagamore Health Network All Products |
$394.03
|
| Rate for Payer: Signature Care EPO |
$423.63
|
| Rate for Payer: Signature Care PPO |
$449.15
|
| Rate for Payer: United Healthcare Commercial |
$402.19
|
|
|
HC X-RAY-ANKLE MIN 3 VIEWS RT
|
Facility
|
OP
|
$510.40
|
|
|
Service Code
|
CPT 73610 RT
|
| Hospital Charge Code |
11613610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.43 |
| Max. Negotiated Rate |
$474.67 |
| Rate for Payer: Aetna Commercial |
$430.78
|
| Rate for Payer: Aetna Medicare |
$168.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$168.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$293.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$319.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$193.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$185.27
|
| Rate for Payer: Cash Price |
$316.45
|
| Rate for Payer: Centivo All Commercial |
$260.30
|
| Rate for Payer: Cigna All Commercial |
$440.47
|
| Rate for Payer: CORVEL All Commercial |
$474.67
|
| Rate for Payer: Coventry All Commercial |
$449.15
|
| Rate for Payer: Encore All Commercial |
$469.82
|
| Rate for Payer: Frontpath All Commercial |
$469.57
|
| Rate for Payer: Humana ChoiceCare |
$440.83
|
| Rate for Payer: Humana Medicare |
$260.30
|
| Rate for Payer: Lucent All Commercial |
$260.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$459.36
|
| Rate for Payer: PHCS All Commercial |
$382.80
|
| Rate for Payer: PHP All Commercial |
$387.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.06
|
| Rate for Payer: Sagamore Health Network All Products |
$394.03
|
| Rate for Payer: Signature Care EPO |
$423.63
|
| Rate for Payer: Signature Care PPO |
$449.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$433.84
|
| Rate for Payer: United Healthcare Commercial |
$402.19
|
| Rate for Payer: United Healthcare Medicare |
$168.43
|
|
|
HC X-RAY-ANKLE MIN 3 VIEWS RT
|
Facility
|
IP
|
$510.40
|
|
|
Service Code
|
CPT 73610 RT
|
| Hospital Charge Code |
11613610
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$382.80 |
| Max. Negotiated Rate |
$474.67 |
| Rate for Payer: Aetna Commercial |
$440.98
|
| Rate for Payer: Cash Price |
$316.45
|
| Rate for Payer: Cigna All Commercial |
$440.47
|
| Rate for Payer: CORVEL All Commercial |
$474.67
|
| Rate for Payer: Coventry All Commercial |
$449.15
|
| Rate for Payer: Encore All Commercial |
$469.82
|
| Rate for Payer: Frontpath All Commercial |
$469.57
|
| Rate for Payer: Humana ChoiceCare |
$440.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$459.36
|
| Rate for Payer: PHCS All Commercial |
$382.80
|
| Rate for Payer: PHP All Commercial |
$387.09
|
| Rate for Payer: Sagamore Health Network All Products |
$394.03
|
| Rate for Payer: Signature Care EPO |
$423.63
|
| Rate for Payer: Signature Care PPO |
$449.15
|
| Rate for Payer: United Healthcare Commercial |
$402.19
|
|
|
HC X-RAY-BONE AGE
|
Facility
|
IP
|
$230.44
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
01616020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.83 |
| Max. Negotiated Rate |
$214.31 |
| Rate for Payer: Aetna Commercial |
$199.10
|
| Rate for Payer: Cash Price |
$142.87
|
| Rate for Payer: Cigna All Commercial |
$198.87
|
| Rate for Payer: CORVEL All Commercial |
$214.31
|
| Rate for Payer: Coventry All Commercial |
$202.79
|
| Rate for Payer: Encore All Commercial |
$212.12
|
| Rate for Payer: Frontpath All Commercial |
$212.00
|
| Rate for Payer: Humana ChoiceCare |
$199.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.39
|
| Rate for Payer: PHCS All Commercial |
$172.83
|
| Rate for Payer: PHP All Commercial |
$174.76
|
| Rate for Payer: Sagamore Health Network All Products |
$177.90
|
| Rate for Payer: Signature Care EPO |
$191.26
|
| Rate for Payer: Signature Care PPO |
$202.79
|
| Rate for Payer: United Healthcare Commercial |
$181.59
|
|
|
HC X-RAY-BONE AGE
|
Facility
|
OP
|
$230.44
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
01616020
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$38.34 |
| Max. Negotiated Rate |
$214.31 |
| Rate for Payer: Aetna Commercial |
$194.49
|
| Rate for Payer: Aetna Medicare |
$76.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$76.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$132.34
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$144.05
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$38.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$87.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$83.65
|
| Rate for Payer: Cash Price |
$142.87
|
| Rate for Payer: Cash Price |
$142.87
|
| Rate for Payer: Centivo All Commercial |
$117.52
|
| Rate for Payer: Cigna All Commercial |
$198.87
|
| Rate for Payer: CORVEL All Commercial |
$214.31
|
| Rate for Payer: Coventry All Commercial |
$202.79
|
| Rate for Payer: Encore All Commercial |
$212.12
|
| Rate for Payer: Frontpath All Commercial |
$212.00
|
| Rate for Payer: Humana ChoiceCare |
$199.03
|
| Rate for Payer: Humana Medicare |
$117.52
|
| Rate for Payer: Lucent All Commercial |
$117.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$207.39
|
| Rate for Payer: Managed Health Services Medicaid |
$38.34
|
| Rate for Payer: MDWise Medicaid |
$38.34
|
| Rate for Payer: PHCS All Commercial |
$172.83
|
| Rate for Payer: PHP All Commercial |
$174.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.87
|
| Rate for Payer: Sagamore Health Network All Products |
$177.90
|
| Rate for Payer: Signature Care EPO |
$191.26
|
| Rate for Payer: Signature Care PPO |
$202.79
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$195.87
|
| Rate for Payer: United Healthcare Commercial |
$181.59
|
| Rate for Payer: United Healthcare Medicare |
$76.04
|
|
|
HC X-RAY-BONE LENGTH STUDY
|
Facility
|
IP
|
$597.90
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
01617040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$448.43 |
| Max. Negotiated Rate |
$556.05 |
| Rate for Payer: Aetna Commercial |
$516.59
|
| Rate for Payer: Cash Price |
$370.70
|
| Rate for Payer: Cigna All Commercial |
$515.99
|
| Rate for Payer: CORVEL All Commercial |
$556.05
|
| Rate for Payer: Coventry All Commercial |
$526.16
|
| Rate for Payer: Encore All Commercial |
$550.37
|
| Rate for Payer: Frontpath All Commercial |
$550.07
|
| Rate for Payer: Humana ChoiceCare |
$516.41
|
| Rate for Payer: Lutheran Preferred All Commercial |
$538.11
|
| Rate for Payer: PHCS All Commercial |
$448.43
|
| Rate for Payer: PHP All Commercial |
$453.45
|
| Rate for Payer: Sagamore Health Network All Products |
$461.58
|
| Rate for Payer: Signature Care EPO |
$496.26
|
| Rate for Payer: Signature Care PPO |
$526.16
|
| Rate for Payer: United Healthcare Commercial |
$471.15
|
|
