|
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
|
|
|
HC X-RAY-CARPAL SERIES 3+ VIEWS LT
|
Facility
OP
|
$390.93
|
|
|
Service Code
|
CPT 73110 LT
|
| Hospital Charge Code |
01613059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.01 |
| Max. Negotiated Rate |
$363.56 |
| Rate for Payer: Aetna Commercial |
$329.94
|
| Rate for Payer: Aetna Medicare |
$129.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$224.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$244.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$148.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.91
|
| Rate for Payer: Cash Price |
$242.37
|
| Rate for Payer: Centivo All Commercial |
$199.37
|
| Rate for Payer: Cigna All Commercial |
$337.37
|
| Rate for Payer: CORVEL All Commercial |
$363.56
|
| Rate for Payer: Coventry All Commercial |
$344.01
|
| Rate for Payer: Encore All Commercial |
$359.85
|
| Rate for Payer: Frontpath All Commercial |
$359.65
|
| Rate for Payer: Humana ChoiceCare |
$337.64
|
| Rate for Payer: Humana Medicare |
$199.37
|
| Rate for Payer: Lucent All Commercial |
$199.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.83
|
| Rate for Payer: PHCS All Commercial |
$293.19
|
| Rate for Payer: PHP All Commercial |
$296.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.46
|
| Rate for Payer: Sagamore Health Network All Products |
$301.79
|
| Rate for Payer: Signature Care EPO |
$324.47
|
| Rate for Payer: Signature Care PPO |
$344.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$332.29
|
| Rate for Payer: United Healthcare Commercial |
$308.05
|
| Rate for Payer: United Healthcare Medicare |
$129.01
|
|
|
HC X-RAY-CARPAL SERIES 3+ VIEWS LT
|
Facility
IP
|
$390.93
|
|
|
Service Code
|
CPT 73110 LT
|
| Hospital Charge Code |
01613059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$293.19 |
| Max. Negotiated Rate |
$363.56 |
| Rate for Payer: Aetna Commercial |
$337.76
|
| Rate for Payer: Cash Price |
$242.37
|
| Rate for Payer: Cigna All Commercial |
$337.37
|
| Rate for Payer: CORVEL All Commercial |
$363.56
|
| Rate for Payer: Coventry All Commercial |
$344.01
|
| Rate for Payer: Encore All Commercial |
$359.85
|
| Rate for Payer: Frontpath All Commercial |
$359.65
|
| Rate for Payer: Humana ChoiceCare |
$337.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.83
|
| Rate for Payer: PHCS All Commercial |
$293.19
|
| Rate for Payer: PHP All Commercial |
$296.48
|
| Rate for Payer: Sagamore Health Network All Products |
$301.79
|
| Rate for Payer: Signature Care EPO |
$324.47
|
| Rate for Payer: Signature Care PPO |
$344.01
|
| Rate for Payer: United Healthcare Commercial |
$308.05
|
|
|
HC X-RAY-CARPAL SERIES 3+ VIEWS RT
|
Facility
IP
|
$390.93
|
|
|
Service Code
|
CPT 73110 RT
|
| Hospital Charge Code |
11613059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$293.19 |
| Max. Negotiated Rate |
$363.56 |
| Rate for Payer: Aetna Commercial |
$337.76
|
| Rate for Payer: Cash Price |
$242.37
|
| Rate for Payer: Cigna All Commercial |
$337.37
|
| Rate for Payer: CORVEL All Commercial |
$363.56
|
| Rate for Payer: Coventry All Commercial |
$344.01
|
| Rate for Payer: Encore All Commercial |
$359.85
|
| Rate for Payer: Frontpath All Commercial |
$359.65
|
| Rate for Payer: Humana ChoiceCare |
$337.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.83
|
| Rate for Payer: PHCS All Commercial |
$293.19
|
| Rate for Payer: PHP All Commercial |
$296.48
|
| Rate for Payer: Sagamore Health Network All Products |
$301.79
|
| Rate for Payer: Signature Care EPO |
$324.47
|
| Rate for Payer: Signature Care PPO |
$344.01
|
| Rate for Payer: United Healthcare Commercial |
$308.05
|
|
|
HC X-RAY-CARPAL SERIES 3+ VIEWS RT
|
Facility
OP
|
$390.93
|
|
|
Service Code
|
CPT 73110 RT
|
| Hospital Charge Code |
11613059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.01 |
| Max. Negotiated Rate |
$363.56 |
| Rate for Payer: Aetna Commercial |
$329.94
|
| Rate for Payer: Aetna Medicare |
$129.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$129.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$224.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$244.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$148.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.91
|
| Rate for Payer: Cash Price |
$242.37
|
| Rate for Payer: Centivo All Commercial |
$199.37
|
| Rate for Payer: Cigna All Commercial |
$337.37
|
| Rate for Payer: CORVEL All Commercial |
$363.56
|
| Rate for Payer: Coventry All Commercial |
$344.01
|
| Rate for Payer: Encore All Commercial |
$359.85
|
| Rate for Payer: Frontpath All Commercial |
$359.65
|
| Rate for Payer: Humana ChoiceCare |
$337.64
|
| Rate for Payer: Humana Medicare |
$199.37
|
| Rate for Payer: Lucent All Commercial |
$199.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$351.83
|
| Rate for Payer: PHCS All Commercial |
$293.19
|
| Rate for Payer: PHP All Commercial |
$296.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$152.46
|
| Rate for Payer: Sagamore Health Network All Products |
$301.79
|
| Rate for Payer: Signature Care EPO |
$324.47
|
| Rate for Payer: Signature Care PPO |
$344.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$332.29
|
| Rate for Payer: United Healthcare Commercial |
$308.05
|
| Rate for Payer: United Healthcare Medicare |
$129.01
|
|
|
HC X-RAY-CERVICAL SPINE MIN 4-5 VIEWS
|
Facility
OP
|
$640.38
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
01612050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.51 |
| Max. Negotiated Rate |
$595.55 |
| Rate for Payer: Aetna Commercial |
$540.48
|
| Rate for Payer: Aetna Medicare |
$211.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$211.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$367.77
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$400.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$89.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$243.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$232.46
|
| Rate for Payer: Cash Price |
$397.03
|
| Rate for Payer: Cash Price |
$397.03
|
| Rate for Payer: Centivo All Commercial |
$326.59
|
| Rate for Payer: Cigna All Commercial |
$552.64
|
| Rate for Payer: CORVEL All Commercial |
$595.55
|
| Rate for Payer: Coventry All Commercial |
$563.53
|
| Rate for Payer: Encore All Commercial |
$589.47
|
| Rate for Payer: Frontpath All Commercial |
$589.15
|
| Rate for Payer: Humana ChoiceCare |
$553.09
|
| Rate for Payer: Humana Medicare |
$326.59
|
| Rate for Payer: Lucent All Commercial |
$326.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$576.34
|
| Rate for Payer: Managed Health Services Medicaid |
$89.51
|
| Rate for Payer: MDWise Medicaid |
$89.51
|
| Rate for Payer: PHCS All Commercial |
$480.28
|
| Rate for Payer: PHP All Commercial |
$485.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$249.75
|
| Rate for Payer: Sagamore Health Network All Products |
$494.37
|
| Rate for Payer: Signature Care EPO |
$531.51
|
| Rate for Payer: Signature Care PPO |
$563.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$544.32
|
| Rate for Payer: United Healthcare Commercial |
$504.62
|
| Rate for Payer: United Healthcare Medicare |
$211.32
|
|
|
HC X-RAY-CERVICAL SPINE MIN 4-5 VIEWS
|
Facility
IP
|
$640.38
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
01612050
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$480.28 |
| Max. Negotiated Rate |
$595.55 |
| Rate for Payer: Aetna Commercial |
$553.29
|
| Rate for Payer: Cash Price |
$397.03
|
| Rate for Payer: Cigna All Commercial |
$552.64
|
| Rate for Payer: CORVEL All Commercial |
$595.55
|
| Rate for Payer: Coventry All Commercial |
$563.53
|
| Rate for Payer: Encore All Commercial |
$589.47
|
| Rate for Payer: Frontpath All Commercial |
$589.15
|
| Rate for Payer: Humana ChoiceCare |
$553.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$576.34
|
| Rate for Payer: PHCS All Commercial |
$480.28
|
| Rate for Payer: PHP All Commercial |
$485.66
|
| Rate for Payer: Sagamore Health Network All Products |
$494.37
|
| Rate for Payer: Signature Care EPO |
$531.51
|
| Rate for Payer: Signature Care PPO |
$563.53
|
| Rate for Payer: United Healthcare Commercial |
$504.62
|
|
|
HC X-RAY-CERV SP COMP W FLEX/EXT 6+ VIEWS
|
Facility
OP
|
$698.57
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
01612052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.43 |
| Max. Negotiated Rate |
$649.67 |
| Rate for Payer: Aetna Commercial |
$589.59
|
| Rate for Payer: Aetna Medicare |
$230.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$230.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$401.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$436.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$120.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$265.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$253.58
|
| Rate for Payer: Cash Price |
$433.11
|
| Rate for Payer: Cash Price |
$433.11
|
| Rate for Payer: Centivo All Commercial |
$356.27
|
| Rate for Payer: Cigna All Commercial |
$602.86
|
| Rate for Payer: CORVEL All Commercial |
$649.67
|
| Rate for Payer: Coventry All Commercial |
$614.74
|
| Rate for Payer: Encore All Commercial |
$643.03
|
| Rate for Payer: Frontpath All Commercial |
$642.68
|
| Rate for Payer: Humana ChoiceCare |
$603.35
|
| Rate for Payer: Humana Medicare |
$356.27
|
| Rate for Payer: Lucent All Commercial |
$356.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$628.71
|
| Rate for Payer: Managed Health Services Medicaid |
$120.43
|
| Rate for Payer: MDWise Medicaid |
$120.43
|
| Rate for Payer: PHCS All Commercial |
$523.93
|
| Rate for Payer: PHP All Commercial |
$529.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$272.44
|
| Rate for Payer: Sagamore Health Network All Products |
$539.29
|
| Rate for Payer: Signature Care EPO |
$579.81
|
| Rate for Payer: Signature Care PPO |
$614.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$593.78
|
| Rate for Payer: United Healthcare Commercial |
$550.47
|
| Rate for Payer: United Healthcare Medicare |
$230.53
|
|
|
HC X-RAY-CERV SP COMP W FLEX/EXT 6+ VIEWS
|
Facility
IP
|
$698.57
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
01612052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$523.93 |
| Max. Negotiated Rate |
$649.67 |
| Rate for Payer: Aetna Commercial |
$603.56
|
| Rate for Payer: Cash Price |
$433.11
|
| Rate for Payer: Cigna All Commercial |
$602.86
|
| Rate for Payer: CORVEL All Commercial |
$649.67
|
| Rate for Payer: Coventry All Commercial |
$614.74
|
| Rate for Payer: Encore All Commercial |
$643.03
|
| Rate for Payer: Frontpath All Commercial |
$642.68
|
| Rate for Payer: Humana ChoiceCare |
$603.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$628.71
|
| Rate for Payer: PHCS All Commercial |
$523.93
|
| Rate for Payer: PHP All Commercial |
$529.79
|
| Rate for Payer: Sagamore Health Network All Products |
$539.29
|
| Rate for Payer: Signature Care EPO |
$579.81
|
| Rate for Payer: Signature Care PPO |
$614.74
|
| Rate for Payer: United Healthcare Commercial |
$550.47
|
|
|
HC X-RAY-CERV SPINE 2 OR 3 VIEWS
|
Facility
OP
|
$442.43
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
01612040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.34 |
| Max. Negotiated Rate |
$411.46 |
| Rate for Payer: Aetna Commercial |
$373.41
|
| Rate for Payer: Aetna Medicare |
$146.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$146.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$254.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$276.56
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$66.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$167.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$160.60
|
| Rate for Payer: Cash Price |
$274.30
|
| Rate for Payer: Cash Price |
$274.30
|
| Rate for Payer: Centivo All Commercial |
$225.64
|
| Rate for Payer: Cigna All Commercial |
$381.81
|
| Rate for Payer: CORVEL All Commercial |
$411.46
|
| Rate for Payer: Coventry All Commercial |
$389.33
|
| Rate for Payer: Encore All Commercial |
$407.25
|
| Rate for Payer: Frontpath All Commercial |
$407.03
|
| Rate for Payer: Humana ChoiceCare |
$382.12
|
| Rate for Payer: Humana Medicare |
$225.64
|
| Rate for Payer: Lucent All Commercial |
$225.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$398.18
|
| Rate for Payer: Managed Health Services Medicaid |
$66.34
|
| Rate for Payer: MDWise Medicaid |
$66.34
|
| Rate for Payer: PHCS All Commercial |
$331.82
|
| Rate for Payer: PHP All Commercial |
$335.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$172.55
|
| Rate for Payer: Sagamore Health Network All Products |
$341.55
|
| Rate for Payer: Signature Care EPO |
$367.21
|
| Rate for Payer: Signature Care PPO |
$389.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$376.06
|
| Rate for Payer: United Healthcare Commercial |
$348.63
|
| Rate for Payer: United Healthcare Medicare |
$146.00
|
|
|
HC X-RAY-CERV SPINE 2 OR 3 VIEWS
|
Facility
IP
|
$442.43
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
01612040
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$331.82 |
| Max. Negotiated Rate |
$411.46 |
| Rate for Payer: Aetna Commercial |
$382.26
|
| Rate for Payer: Cash Price |
$274.30
|
| Rate for Payer: Cigna All Commercial |
$381.81
|
| Rate for Payer: CORVEL All Commercial |
$411.46
|
| Rate for Payer: Coventry All Commercial |
$389.33
|
| Rate for Payer: Encore All Commercial |
$407.25
|
| Rate for Payer: Frontpath All Commercial |
$407.03
|
| Rate for Payer: Humana ChoiceCare |
$382.12
|
| Rate for Payer: Lutheran Preferred All Commercial |
$398.18
|
| Rate for Payer: PHCS All Commercial |
$331.82
|
| Rate for Payer: PHP All Commercial |
$335.54
|
| Rate for Payer: Sagamore Health Network All Products |
$341.55
|
| Rate for Payer: Signature Care EPO |
$367.21
|
| Rate for Payer: Signature Care PPO |
$389.33
|
| Rate for Payer: United Healthcare Commercial |
$348.63
|
|
|
HC X-RAY-CLAVICLE BI
|
Facility
OP
|
$625.77
|
|
|
Service Code
|
CPT 73000 50
|
| Hospital Charge Code |
21613000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$206.50 |
| Max. Negotiated Rate |
$581.97 |
| Rate for Payer: Aetna Commercial |
$528.15
|
| Rate for Payer: Aetna Medicare |
$206.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$206.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$359.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$391.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$237.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$227.15
|
| Rate for Payer: Cash Price |
$387.98
|
| Rate for Payer: Centivo All Commercial |
$319.14
|
| Rate for Payer: Cigna All Commercial |
$540.04
|
| Rate for Payer: CORVEL All Commercial |
$581.97
|
| Rate for Payer: Coventry All Commercial |
$550.68
|
| Rate for Payer: Encore All Commercial |
$576.02
|
| Rate for Payer: Frontpath All Commercial |
$575.71
|
| Rate for Payer: Humana ChoiceCare |
$540.48
|
| Rate for Payer: Humana Medicare |
$319.14
|
| Rate for Payer: Lucent All Commercial |
$319.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.19
|
| Rate for Payer: PHCS All Commercial |
$469.33
|
| Rate for Payer: PHP All Commercial |
$474.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$244.05
|
| Rate for Payer: Sagamore Health Network All Products |
$483.09
|
| Rate for Payer: Signature Care EPO |
$519.39
|
| Rate for Payer: Signature Care PPO |
$550.68
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$531.90
|
| Rate for Payer: United Healthcare Commercial |
$493.11
|
| Rate for Payer: United Healthcare Medicare |
$206.50
|
|
|
HC X-RAY-CLAVICLE BI
|
Facility
IP
|
$625.77
|
|
|
Service Code
|
CPT 73000 50
|
| Hospital Charge Code |
21613000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$469.33 |
| Max. Negotiated Rate |
$581.97 |
| Rate for Payer: Aetna Commercial |
$540.67
|
| Rate for Payer: Cash Price |
$387.98
|
| Rate for Payer: Cigna All Commercial |
$540.04
|
| Rate for Payer: CORVEL All Commercial |
$581.97
|
| Rate for Payer: Coventry All Commercial |
$550.68
|
| Rate for Payer: Encore All Commercial |
$576.02
|
| Rate for Payer: Frontpath All Commercial |
$575.71
|
| Rate for Payer: Humana ChoiceCare |
$540.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$563.19
|
| Rate for Payer: PHCS All Commercial |
$469.33
|
| Rate for Payer: PHP All Commercial |
$474.58
|
| Rate for Payer: Sagamore Health Network All Products |
$483.09
|
| Rate for Payer: Signature Care EPO |
$519.39
|
| Rate for Payer: Signature Care PPO |
$550.68
|
| Rate for Payer: United Healthcare Commercial |
$493.11
|
|
|
HC X-RAY-CLAVICLE LT
|
Facility
OP
|
$417.18
|
|
|
Service Code
|
CPT 73000 LT
|
| Hospital Charge Code |
01613000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.67 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna Commercial |
$352.10
|
| Rate for Payer: Aetna Medicare |
$137.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$239.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$158.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.44
|
| Rate for Payer: Cash Price |
$258.65
|
| Rate for Payer: Centivo All Commercial |
$212.76
|
| Rate for Payer: Cigna All Commercial |
$360.03
|
| Rate for Payer: CORVEL All Commercial |
$387.98
|
| Rate for Payer: Coventry All Commercial |
$367.12
|
| Rate for Payer: Encore All Commercial |
$384.01
|
| Rate for Payer: Frontpath All Commercial |
$383.81
|
| Rate for Payer: Humana ChoiceCare |
$360.32
|
| Rate for Payer: Humana Medicare |
$212.76
|
| Rate for Payer: Lucent All Commercial |
$212.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$375.46
|
| Rate for Payer: PHCS All Commercial |
$312.88
|
| Rate for Payer: PHP All Commercial |
$316.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.70
|
| Rate for Payer: Sagamore Health Network All Products |
$322.06
|
| Rate for Payer: Signature Care EPO |
$346.26
|
| Rate for Payer: Signature Care PPO |
$367.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$354.60
|
| Rate for Payer: United Healthcare Commercial |
$328.74
|
| Rate for Payer: United Healthcare Medicare |
$137.67
|
|
|
HC X-RAY-CLAVICLE LT
|
Facility
IP
|
$417.18
|
|
|
Service Code
|
CPT 73000 LT
|
| Hospital Charge Code |
01613000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.88 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna Commercial |
$360.44
|
| Rate for Payer: Cash Price |
$258.65
|
| Rate for Payer: Cigna All Commercial |
$360.03
|
| Rate for Payer: CORVEL All Commercial |
$387.98
|
| Rate for Payer: Coventry All Commercial |
$367.12
|
| Rate for Payer: Encore All Commercial |
$384.01
|
| Rate for Payer: Frontpath All Commercial |
$383.81
|
| Rate for Payer: Humana ChoiceCare |
$360.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$375.46
|
| Rate for Payer: PHCS All Commercial |
$312.88
|
| Rate for Payer: PHP All Commercial |
$316.39
|
| Rate for Payer: Sagamore Health Network All Products |
$322.06
|
| Rate for Payer: Signature Care EPO |
$346.26
|
| Rate for Payer: Signature Care PPO |
$367.12
|
| Rate for Payer: United Healthcare Commercial |
$328.74
|
|
|
HC X-RAY-CLAVICLE RT
|
Facility
IP
|
$417.18
|
|
|
Service Code
|
CPT 73000 RT
|
| Hospital Charge Code |
11613000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.88 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna Commercial |
$360.44
|
| Rate for Payer: Cash Price |
$258.65
|
| Rate for Payer: Cigna All Commercial |
$360.03
|
| Rate for Payer: CORVEL All Commercial |
$387.98
|
| Rate for Payer: Coventry All Commercial |
$367.12
|
| Rate for Payer: Encore All Commercial |
$384.01
|
| Rate for Payer: Frontpath All Commercial |
$383.81
|
| Rate for Payer: Humana ChoiceCare |
$360.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$375.46
|
| Rate for Payer: PHCS All Commercial |
$312.88
|
| Rate for Payer: PHP All Commercial |
$316.39
|
| Rate for Payer: Sagamore Health Network All Products |
$322.06
|
| Rate for Payer: Signature Care EPO |
$346.26
|
| Rate for Payer: Signature Care PPO |
$367.12
|
| Rate for Payer: United Healthcare Commercial |
$328.74
|
|
|
HC X-RAY-CLAVICLE RT
|
Facility
OP
|
$417.18
|
|
|
Service Code
|
CPT 73000 RT
|
| Hospital Charge Code |
11613000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.67 |
| Max. Negotiated Rate |
$387.98 |
| Rate for Payer: Aetna Commercial |
$352.10
|
| Rate for Payer: Aetna Medicare |
$137.67
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$137.67
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$239.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$260.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$158.32
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$151.44
|
| Rate for Payer: Cash Price |
$258.65
|
| Rate for Payer: Centivo All Commercial |
$212.76
|
| Rate for Payer: Cigna All Commercial |
$360.03
|
| Rate for Payer: CORVEL All Commercial |
$387.98
|
| Rate for Payer: Coventry All Commercial |
$367.12
|
| Rate for Payer: Encore All Commercial |
$384.01
|
| Rate for Payer: Frontpath All Commercial |
$383.81
|
| Rate for Payer: Humana ChoiceCare |
$360.32
|
| Rate for Payer: Humana Medicare |
$212.76
|
| Rate for Payer: Lucent All Commercial |
$212.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$375.46
|
| Rate for Payer: PHCS All Commercial |
$312.88
|
| Rate for Payer: PHP All Commercial |
$316.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$162.70
|
| Rate for Payer: Sagamore Health Network All Products |
$322.06
|
| Rate for Payer: Signature Care EPO |
$346.26
|
| Rate for Payer: Signature Care PPO |
$367.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$354.60
|
| Rate for Payer: United Healthcare Commercial |
$328.74
|
| Rate for Payer: United Healthcare Medicare |
$137.67
|
|
|
HC X-RAY-COLON(BE)
|
Facility
IP
|
$1,265.08
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
01614270
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$948.81 |
| Max. Negotiated Rate |
$1,176.52 |
| Rate for Payer: Aetna Commercial |
$1,093.03
|
| Rate for Payer: Cash Price |
$784.35
|
| Rate for Payer: Cigna All Commercial |
$1,091.76
|
| Rate for Payer: CORVEL All Commercial |
$1,176.52
|
| Rate for Payer: Coventry All Commercial |
$1,113.27
|
| Rate for Payer: Encore All Commercial |
$1,164.50
|
| Rate for Payer: Frontpath All Commercial |
$1,163.87
|
| Rate for Payer: Humana ChoiceCare |
$1,092.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,138.57
|
| Rate for Payer: PHCS All Commercial |
$948.81
|
| Rate for Payer: PHP All Commercial |
$959.43
|
| Rate for Payer: Sagamore Health Network All Products |
$976.64
|
| Rate for Payer: Signature Care EPO |
$1,050.01
|
| Rate for Payer: Signature Care PPO |
$1,113.27
|
| Rate for Payer: United Healthcare Commercial |
$996.88
|
|
|
HC X-RAY-COLON(BE)
|
Facility
OP
|
$1,265.08
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
01614270
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$340.70 |
| Max. Negotiated Rate |
$1,176.52 |
| Rate for Payer: Aetna Commercial |
$1,067.72
|
| Rate for Payer: Aetna Medicare |
$417.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$417.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$726.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$790.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$340.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$480.10
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$459.22
|
| Rate for Payer: Cash Price |
$784.35
|
| Rate for Payer: Cash Price |
$784.35
|
| Rate for Payer: Centivo All Commercial |
$645.19
|
| Rate for Payer: Cigna All Commercial |
$1,091.76
|
| Rate for Payer: CORVEL All Commercial |
$1,176.52
|
| Rate for Payer: Coventry All Commercial |
$1,113.27
|
| Rate for Payer: Encore All Commercial |
$1,164.50
|
| Rate for Payer: Frontpath All Commercial |
$1,163.87
|
| Rate for Payer: Humana ChoiceCare |
$1,092.65
|
| Rate for Payer: Humana Medicare |
$645.19
|
| Rate for Payer: Lucent All Commercial |
$645.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,138.57
|
| Rate for Payer: Managed Health Services Medicaid |
$340.70
|
| Rate for Payer: MDWise Medicaid |
$340.70
|
| Rate for Payer: PHCS All Commercial |
$948.81
|
| Rate for Payer: PHP All Commercial |
$959.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$493.38
|
| Rate for Payer: Sagamore Health Network All Products |
$976.64
|
| Rate for Payer: Signature Care EPO |
$1,050.01
|
| Rate for Payer: Signature Care PPO |
$1,113.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,075.31
|
| Rate for Payer: United Healthcare Commercial |
$996.88
|
| Rate for Payer: United Healthcare Medicare |
$417.47
|
|
|
HC X-RAY-COLON DOUBLE CONTRAST
|
Facility
OP
|
$1,469.59
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
01614275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$473.07 |
| Max. Negotiated Rate |
$1,366.71 |
| Rate for Payer: Aetna Commercial |
$1,240.33
|
| Rate for Payer: Aetna Medicare |
$484.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$484.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$843.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$918.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$473.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$557.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$533.46
|
| Rate for Payer: Cash Price |
$911.14
|
| Rate for Payer: Cash Price |
$911.14
|
| Rate for Payer: Centivo All Commercial |
$749.49
|
| Rate for Payer: Cigna All Commercial |
$1,268.25
|
| Rate for Payer: CORVEL All Commercial |
$1,366.71
|
| Rate for Payer: Coventry All Commercial |
$1,293.24
|
| Rate for Payer: Encore All Commercial |
$1,352.75
|
| Rate for Payer: Frontpath All Commercial |
$1,352.02
|
| Rate for Payer: Humana ChoiceCare |
$1,269.28
|
| Rate for Payer: Humana Medicare |
$749.49
|
| Rate for Payer: Lucent All Commercial |
$749.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,322.63
|
| Rate for Payer: Managed Health Services Medicaid |
$473.07
|
| Rate for Payer: MDWise Medicaid |
$473.07
|
| Rate for Payer: PHCS All Commercial |
$1,102.19
|
| Rate for Payer: PHP All Commercial |
$1,114.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$573.14
|
| Rate for Payer: Sagamore Health Network All Products |
$1,134.52
|
| Rate for Payer: Signature Care EPO |
$1,219.76
|
| Rate for Payer: Signature Care PPO |
$1,293.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,249.15
|
| Rate for Payer: United Healthcare Commercial |
$1,158.03
|
| Rate for Payer: United Healthcare Medicare |
$484.96
|
|
|
HC X-RAY-COLON DOUBLE CONTRAST
|
Facility
IP
|
$1,469.59
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
01614275
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,102.19 |
| Max. Negotiated Rate |
$1,366.71 |
| Rate for Payer: Aetna Commercial |
$1,269.72
|
| Rate for Payer: Cash Price |
$911.14
|
| Rate for Payer: Cigna All Commercial |
$1,268.25
|
| Rate for Payer: CORVEL All Commercial |
$1,366.71
|
| Rate for Payer: Coventry All Commercial |
$1,293.24
|
| Rate for Payer: Encore All Commercial |
$1,352.75
|
| Rate for Payer: Frontpath All Commercial |
$1,352.02
|
| Rate for Payer: Humana ChoiceCare |
$1,269.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,322.63
|
| Rate for Payer: PHCS All Commercial |
$1,102.19
|
| Rate for Payer: PHP All Commercial |
$1,114.53
|
| Rate for Payer: Sagamore Health Network All Products |
$1,134.52
|
| Rate for Payer: Signature Care EPO |
$1,219.76
|
| Rate for Payer: Signature Care PPO |
$1,293.24
|
| Rate for Payer: United Healthcare Commercial |
$1,158.03
|
|
|
HC X-RAY-ELBOW 2 VIEWS BI
|
Facility
OP
|
$703.21
|
|
|
Service Code
|
CPT 73070 50
|
| Hospital Charge Code |
21619070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$232.06 |
| Max. Negotiated Rate |
$653.98 |
| Rate for Payer: Aetna Commercial |
$593.51
|
| Rate for Payer: Aetna Medicare |
$232.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$232.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$403.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$439.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$266.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$255.26
|
| Rate for Payer: Cash Price |
$435.99
|
| Rate for Payer: Centivo All Commercial |
$358.64
|
| Rate for Payer: Cigna All Commercial |
$606.87
|
| Rate for Payer: CORVEL All Commercial |
$653.98
|
| Rate for Payer: Coventry All Commercial |
$618.82
|
| Rate for Payer: Encore All Commercial |
$647.30
|
| Rate for Payer: Frontpath All Commercial |
$646.95
|
| Rate for Payer: Humana ChoiceCare |
$607.36
|
| Rate for Payer: Humana Medicare |
$358.64
|
| Rate for Payer: Lucent All Commercial |
$358.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$632.89
|
| Rate for Payer: PHCS All Commercial |
$527.41
|
| Rate for Payer: PHP All Commercial |
$533.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$274.25
|
| Rate for Payer: Sagamore Health Network All Products |
$542.88
|
| Rate for Payer: Signature Care EPO |
$583.66
|
| Rate for Payer: Signature Care PPO |
$618.82
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$597.73
|
| Rate for Payer: United Healthcare Commercial |
$554.13
|
| Rate for Payer: United Healthcare Medicare |
$232.06
|
|
|
HC X-RAY-ELBOW 2 VIEWS BI
|
Facility
IP
|
$703.21
|
|
|
Service Code
|
CPT 73070 50
|
| Hospital Charge Code |
21619070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$527.41 |
| Max. Negotiated Rate |
$653.98 |
| Rate for Payer: Aetna Commercial |
$607.57
|
| Rate for Payer: Cash Price |
$435.99
|
| Rate for Payer: Cigna All Commercial |
$606.87
|
| Rate for Payer: CORVEL All Commercial |
$653.98
|
| Rate for Payer: Coventry All Commercial |
$618.82
|
| Rate for Payer: Encore All Commercial |
$647.30
|
| Rate for Payer: Frontpath All Commercial |
$646.95
|
| Rate for Payer: Humana ChoiceCare |
$607.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$632.89
|
| Rate for Payer: PHCS All Commercial |
$527.41
|
| Rate for Payer: PHP All Commercial |
$533.31
|
| Rate for Payer: Sagamore Health Network All Products |
$542.88
|
| Rate for Payer: Signature Care EPO |
$583.66
|
| Rate for Payer: Signature Care PPO |
$618.82
|
| Rate for Payer: United Healthcare Commercial |
$554.13
|
|
|
HC X-RAY-ELBOW 2 VIEWS LT
|
Facility
OP
|
$468.81
|
|
|
Service Code
|
CPT 73070 LT
|
| Hospital Charge Code |
01619070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.71 |
| Max. Negotiated Rate |
$436.00 |
| Rate for Payer: Aetna Commercial |
$395.68
|
| Rate for Payer: Aetna Medicare |
$154.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$154.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$269.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$293.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$177.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$170.18
|
| Rate for Payer: Cash Price |
$290.66
|
| Rate for Payer: Centivo All Commercial |
$239.09
|
| Rate for Payer: Cigna All Commercial |
$404.59
|
| Rate for Payer: CORVEL All Commercial |
$436.00
|
| Rate for Payer: Coventry All Commercial |
$412.55
|
| Rate for Payer: Encore All Commercial |
$431.54
|
| Rate for Payer: Frontpath All Commercial |
$431.31
|
| Rate for Payer: Humana ChoiceCare |
$404.91
|
| Rate for Payer: Humana Medicare |
$239.09
|
| Rate for Payer: Lucent All Commercial |
$239.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$421.93
|
| Rate for Payer: PHCS All Commercial |
$351.61
|
| Rate for Payer: PHP All Commercial |
$355.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$182.84
|
| Rate for Payer: Sagamore Health Network All Products |
$361.92
|
| Rate for Payer: Signature Care EPO |
$389.11
|
| Rate for Payer: Signature Care PPO |
$412.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$398.49
|
| Rate for Payer: United Healthcare Commercial |
$369.42
|
| Rate for Payer: United Healthcare Medicare |
$154.71
|
|
|
HC X-RAY-ELBOW 2 VIEWS LT
|
Facility
IP
|
$468.81
|
|
|
Service Code
|
CPT 73070 LT
|
| Hospital Charge Code |
01619070
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$351.61 |
| Max. Negotiated Rate |
$436.00 |
| Rate for Payer: Aetna Commercial |
$405.05
|
| Rate for Payer: Cash Price |
$290.66
|
| Rate for Payer: Cigna All Commercial |
$404.59
|
| Rate for Payer: CORVEL All Commercial |
$436.00
|
| Rate for Payer: Coventry All Commercial |
$412.55
|
| Rate for Payer: Encore All Commercial |
$431.54
|
| Rate for Payer: Frontpath All Commercial |
$431.31
|
| Rate for Payer: Humana ChoiceCare |
$404.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$421.93
|
| Rate for Payer: PHCS All Commercial |
$351.61
|
| Rate for Payer: PHP All Commercial |
$355.55
|
| Rate for Payer: Sagamore Health Network All Products |
$361.92
|
| Rate for Payer: Signature Care EPO |
$389.11
|
| Rate for Payer: Signature Care PPO |
$412.55
|
| Rate for Payer: United Healthcare Commercial |
$369.42
|
|
