HC X-RAY-ELBOW 2 VIEWS RT
|
Facility
IP
|
$468.81
|
|
Service Code
|
CPT 73070 RT
|
Hospital Charge Code |
11619070
|
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
|
|
HC X-RAY-ELBOW 2 VIEWS RT
|
Facility
OP
|
$468.81
|
|
Service Code
|
CPT 73070 RT
|
Hospital Charge Code |
11619070
|
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 MIN 3 VIEWS BI
|
Facility
OP
|
$761.65
|
|
Service Code
|
CPT 73080 50
|
Hospital Charge Code |
21613070
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$251.35 |
Max. Negotiated Rate |
$708.34 |
Rate for Payer: Aetna Commercial |
$642.84
|
Rate for Payer: Aetna Medicare |
$251.35
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$251.35
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$437.42
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$476.11
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$289.05
|
Rate for Payer: CareSource Indiana of IN Medicare |
$276.48
|
Rate for Payer: Cash Price |
$472.23
|
Rate for Payer: Centivo All Commercial |
$388.44
|
Rate for Payer: Cigna All Commercial |
$657.31
|
Rate for Payer: CORVEL All Commercial |
$708.34
|
Rate for Payer: Coventry All Commercial |
$670.26
|
Rate for Payer: Encore All Commercial |
$701.10
|
Rate for Payer: Frontpath All Commercial |
$700.72
|
Rate for Payer: Humana ChoiceCare |
$657.84
|
Rate for Payer: Humana Medicare |
$388.44
|
Rate for Payer: Lucent All Commercial |
$388.44
|
Rate for Payer: Lutheran Preferred All Commercial |
$685.49
|
Rate for Payer: PHCS All Commercial |
$571.24
|
Rate for Payer: PHP All Commercial |
$577.64
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$297.05
|
Rate for Payer: Sagamore Health Network All Products |
$588.00
|
Rate for Payer: Signature Care EPO |
$632.17
|
Rate for Payer: Signature Care PPO |
$670.26
|
Rate for Payer: Three Rivers Preferred All Commercial |
$647.41
|
Rate for Payer: United Healthcare Commercial |
$600.18
|
Rate for Payer: United Healthcare Medicare |
$251.35
|
|
HC X-RAY-ELBOW MIN 3 VIEWS BI
|
Facility
IP
|
$761.65
|
|
Service Code
|
CPT 73080 50
|
Hospital Charge Code |
21613070
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$571.24 |
Max. Negotiated Rate |
$708.34 |
Rate for Payer: Aetna Commercial |
$658.07
|
Rate for Payer: Cash Price |
$472.23
|
Rate for Payer: Cigna All Commercial |
$657.31
|
Rate for Payer: CORVEL All Commercial |
$708.34
|
Rate for Payer: Coventry All Commercial |
$670.26
|
Rate for Payer: Encore All Commercial |
$701.10
|
Rate for Payer: Frontpath All Commercial |
$700.72
|
Rate for Payer: Humana ChoiceCare |
$657.84
|
Rate for Payer: Lutheran Preferred All Commercial |
$685.49
|
Rate for Payer: PHCS All Commercial |
$571.24
|
Rate for Payer: PHP All Commercial |
$577.64
|
Rate for Payer: Sagamore Health Network All Products |
$588.00
|
Rate for Payer: Signature Care EPO |
$632.17
|
Rate for Payer: Signature Care PPO |
$670.26
|
Rate for Payer: United Healthcare Commercial |
$600.18
|
|
HC X-RAY-ELBOW MIN 3 VIEWS LT
|
Facility
IP
|
$507.77
|
|
Service Code
|
CPT 73080 LT
|
Hospital Charge Code |
01613070
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$380.82 |
Max. Negotiated Rate |
$472.22 |
Rate for Payer: Aetna Commercial |
$438.71
|
Rate for Payer: Cash Price |
$314.82
|
Rate for Payer: Cigna All Commercial |
$438.20
|
Rate for Payer: CORVEL All Commercial |
$472.22
|
Rate for Payer: Coventry All Commercial |
$446.83
|
Rate for Payer: Encore All Commercial |
$467.40
|
Rate for Payer: Frontpath All Commercial |
$467.14
|
Rate for Payer: Humana ChoiceCare |
$438.56
|
Rate for Payer: Lutheran Preferred All Commercial |
$456.99
|
Rate for Payer: PHCS All Commercial |
$380.82
|
Rate for Payer: PHP All Commercial |
$385.09
|
Rate for Payer: Sagamore Health Network All Products |
$392.00
|
Rate for Payer: Signature Care EPO |
$421.45
|
Rate for Payer: Signature Care PPO |
$446.83
|
Rate for Payer: United Healthcare Commercial |
$400.12
|
|
HC X-RAY-ELBOW MIN 3 VIEWS LT
|
Facility
OP
|
$507.77
|
|
Service Code
|
CPT 73080 LT
|
Hospital Charge Code |
01613070
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$167.56 |
Max. Negotiated Rate |
$472.22 |
Rate for Payer: Aetna Commercial |
$428.55
|
Rate for Payer: Aetna Medicare |
$167.56
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$167.56
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$291.61
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$317.40
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$192.70
|
Rate for Payer: CareSource Indiana of IN Medicare |
$184.32
|
Rate for Payer: Cash Price |
$314.82
|
Rate for Payer: Centivo All Commercial |
$258.96
|
Rate for Payer: Cigna All Commercial |
$438.20
|
Rate for Payer: CORVEL All Commercial |
$472.22
|
Rate for Payer: Coventry All Commercial |
$446.83
|
Rate for Payer: Encore All Commercial |
$467.40
|
Rate for Payer: Frontpath All Commercial |
$467.14
|
Rate for Payer: Humana ChoiceCare |
$438.56
|
Rate for Payer: Humana Medicare |
$258.96
|
Rate for Payer: Lucent All Commercial |
$258.96
|
Rate for Payer: Lutheran Preferred All Commercial |
$456.99
|
Rate for Payer: PHCS All Commercial |
$380.82
|
Rate for Payer: PHP All Commercial |
$385.09
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$198.03
|
Rate for Payer: Sagamore Health Network All Products |
$392.00
|
Rate for Payer: Signature Care EPO |
$421.45
|
Rate for Payer: Signature Care PPO |
$446.83
|
Rate for Payer: Three Rivers Preferred All Commercial |
$431.60
|
Rate for Payer: United Healthcare Commercial |
$400.12
|
Rate for Payer: United Healthcare Medicare |
$167.56
|
|
HC X-RAY-ELBOW MIN 3 VIEWS RT
|
Facility
OP
|
$507.77
|
|
Service Code
|
CPT 73080 RT
|
Hospital Charge Code |
11613070
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$167.56 |
Max. Negotiated Rate |
$472.22 |
Rate for Payer: Aetna Commercial |
$428.55
|
Rate for Payer: Aetna Medicare |
$167.56
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$167.56
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$291.61
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$317.40
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$192.70
|
Rate for Payer: CareSource Indiana of IN Medicare |
$184.32
|
Rate for Payer: Cash Price |
$314.82
|
Rate for Payer: Centivo All Commercial |
$258.96
|
Rate for Payer: Cigna All Commercial |
$438.20
|
Rate for Payer: CORVEL All Commercial |
$472.22
|
Rate for Payer: Coventry All Commercial |
$446.83
|
Rate for Payer: Encore All Commercial |
$467.40
|
Rate for Payer: Frontpath All Commercial |
$467.14
|
Rate for Payer: Humana ChoiceCare |
$438.56
|
Rate for Payer: Humana Medicare |
$258.96
|
Rate for Payer: Lucent All Commercial |
$258.96
|
Rate for Payer: Lutheran Preferred All Commercial |
$456.99
|
Rate for Payer: PHCS All Commercial |
$380.82
|
Rate for Payer: PHP All Commercial |
$385.09
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$198.03
|
Rate for Payer: Sagamore Health Network All Products |
$392.00
|
Rate for Payer: Signature Care EPO |
$421.45
|
Rate for Payer: Signature Care PPO |
$446.83
|
Rate for Payer: Three Rivers Preferred All Commercial |
$431.60
|
Rate for Payer: United Healthcare Commercial |
$400.12
|
Rate for Payer: United Healthcare Medicare |
$167.56
|
|
HC X-RAY-ELBOW MIN 3 VIEWS RT
|
Facility
IP
|
$507.77
|
|
Service Code
|
CPT 73080 RT
|
Hospital Charge Code |
11613070
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$380.82 |
Max. Negotiated Rate |
$472.22 |
Rate for Payer: Aetna Commercial |
$438.71
|
Rate for Payer: Cash Price |
$314.82
|
Rate for Payer: Cigna All Commercial |
$438.20
|
Rate for Payer: CORVEL All Commercial |
$472.22
|
Rate for Payer: Coventry All Commercial |
$446.83
|
Rate for Payer: Encore All Commercial |
$467.40
|
Rate for Payer: Frontpath All Commercial |
$467.14
|
Rate for Payer: Humana ChoiceCare |
$438.56
|
Rate for Payer: Lutheran Preferred All Commercial |
$456.99
|
Rate for Payer: PHCS All Commercial |
$380.82
|
Rate for Payer: PHP All Commercial |
$385.09
|
Rate for Payer: Sagamore Health Network All Products |
$392.00
|
Rate for Payer: Signature Care EPO |
$421.45
|
Rate for Payer: Signature Care PPO |
$446.83
|
Rate for Payer: United Healthcare Commercial |
$400.12
|
|
HC X-RAY EXAM ABDOMEN 1 VIEW
|
Facility
IP
|
$506.23
|
|
Service Code
|
CPT 74018
|
Hospital Charge Code |
01614018
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$379.67 |
Max. Negotiated Rate |
$470.79 |
Rate for Payer: Aetna Commercial |
$437.38
|
Rate for Payer: Cash Price |
$313.86
|
Rate for Payer: Cigna All Commercial |
$436.87
|
Rate for Payer: CORVEL All Commercial |
$470.79
|
Rate for Payer: Coventry All Commercial |
$445.48
|
Rate for Payer: Encore All Commercial |
$465.98
|
Rate for Payer: Frontpath All Commercial |
$465.73
|
Rate for Payer: Humana ChoiceCare |
$437.23
|
Rate for Payer: Lutheran Preferred All Commercial |
$455.60
|
Rate for Payer: PHCS All Commercial |
$379.67
|
Rate for Payer: PHP All Commercial |
$383.92
|
Rate for Payer: Sagamore Health Network All Products |
$390.81
|
Rate for Payer: Signature Care EPO |
$420.17
|
Rate for Payer: Signature Care PPO |
$445.48
|
Rate for Payer: United Healthcare Commercial |
$398.91
|
|
HC X-RAY EXAM ABDOMEN 1 VIEW
|
Facility
OP
|
$506.23
|
|
Service Code
|
CPT 74018
|
Hospital Charge Code |
01614018
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$167.05 |
Max. Negotiated Rate |
$470.79 |
Rate for Payer: Aetna Commercial |
$427.25
|
Rate for Payer: Aetna Medicare |
$167.05
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$167.05
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$290.73
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$316.44
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$242.27
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$192.11
|
Rate for Payer: CareSource Indiana of IN Medicare |
$183.76
|
Rate for Payer: Cash Price |
$313.86
|
Rate for Payer: Cash Price |
$313.86
|
Rate for Payer: Centivo All Commercial |
$258.18
|
Rate for Payer: Cigna All Commercial |
$436.87
|
Rate for Payer: CORVEL All Commercial |
$470.79
|
Rate for Payer: Coventry All Commercial |
$445.48
|
Rate for Payer: Encore All Commercial |
$465.98
|
Rate for Payer: Frontpath All Commercial |
$465.73
|
Rate for Payer: Humana ChoiceCare |
$437.23
|
Rate for Payer: Humana Medicare |
$258.18
|
Rate for Payer: Lucent All Commercial |
$258.18
|
Rate for Payer: Lutheran Preferred All Commercial |
$455.60
|
Rate for Payer: Managed Health Services Medicaid |
$242.27
|
Rate for Payer: MDWise Medicaid |
$242.27
|
Rate for Payer: PHCS All Commercial |
$379.67
|
Rate for Payer: PHP All Commercial |
$383.92
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$197.43
|
Rate for Payer: Sagamore Health Network All Products |
$390.81
|
Rate for Payer: Signature Care EPO |
$420.17
|
Rate for Payer: Signature Care PPO |
$445.48
|
Rate for Payer: Three Rivers Preferred All Commercial |
$430.29
|
Rate for Payer: United Healthcare Commercial |
$398.91
|
Rate for Payer: United Healthcare Medicare |
$167.05
|
|
HC X-RAY EXAM ABDOMEN 2 VIEWS
|
Facility
OP
|
$582.18
|
|
Service Code
|
CPT 74019
|
Hospital Charge Code |
01614010
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$192.12 |
Max. Negotiated Rate |
$541.42 |
Rate for Payer: Aetna Commercial |
$491.36
|
Rate for Payer: Aetna Medicare |
$192.12
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$192.12
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$334.34
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$363.92
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$446.39
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$220.94
|
Rate for Payer: CareSource Indiana of IN Medicare |
$211.33
|
Rate for Payer: Cash Price |
$360.95
|
Rate for Payer: Cash Price |
$360.95
|
Rate for Payer: Centivo All Commercial |
$296.91
|
Rate for Payer: Cigna All Commercial |
$502.42
|
Rate for Payer: CORVEL All Commercial |
$541.42
|
Rate for Payer: Coventry All Commercial |
$512.31
|
Rate for Payer: Encore All Commercial |
$535.89
|
Rate for Payer: Frontpath All Commercial |
$535.60
|
Rate for Payer: Humana ChoiceCare |
$502.82
|
Rate for Payer: Humana Medicare |
$296.91
|
Rate for Payer: Lucent All Commercial |
$296.91
|
Rate for Payer: Lutheran Preferred All Commercial |
$523.96
|
Rate for Payer: Managed Health Services Medicaid |
$446.39
|
Rate for Payer: MDWise Medicaid |
$446.39
|
Rate for Payer: PHCS All Commercial |
$436.63
|
Rate for Payer: PHP All Commercial |
$441.52
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$227.05
|
Rate for Payer: Sagamore Health Network All Products |
$449.44
|
Rate for Payer: Signature Care EPO |
$483.21
|
Rate for Payer: Signature Care PPO |
$512.31
|
Rate for Payer: Three Rivers Preferred All Commercial |
$494.85
|
Rate for Payer: United Healthcare Commercial |
$458.75
|
Rate for Payer: United Healthcare Medicare |
$192.12
|
|
HC X-RAY EXAM ABDOMEN 2 VIEWS
|
Facility
IP
|
$582.18
|
|
Service Code
|
CPT 74019
|
Hospital Charge Code |
01614010
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$436.63 |
Max. Negotiated Rate |
$541.42 |
Rate for Payer: Aetna Commercial |
$503.00
|
Rate for Payer: Cash Price |
$360.95
|
Rate for Payer: Cigna All Commercial |
$502.42
|
Rate for Payer: CORVEL All Commercial |
$541.42
|
Rate for Payer: Coventry All Commercial |
$512.31
|
Rate for Payer: Encore All Commercial |
$535.89
|
Rate for Payer: Frontpath All Commercial |
$535.60
|
Rate for Payer: Humana ChoiceCare |
$502.82
|
Rate for Payer: Lutheran Preferred All Commercial |
$523.96
|
Rate for Payer: PHCS All Commercial |
$436.63
|
Rate for Payer: PHP All Commercial |
$441.52
|
Rate for Payer: Sagamore Health Network All Products |
$449.44
|
Rate for Payer: Signature Care EPO |
$483.21
|
Rate for Payer: Signature Care PPO |
$512.31
|
Rate for Payer: United Healthcare Commercial |
$458.75
|
|
HC X-RAY EXAM ABDOMEN 3+ VIEWS
|
Facility
OP
|
$669.50
|
|
Service Code
|
CPT 74021
|
Hospital Charge Code |
01614021
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$220.93 |
Max. Negotiated Rate |
$622.63 |
Rate for Payer: Aetna Commercial |
$565.06
|
Rate for Payer: Aetna Medicare |
$220.93
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$220.93
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$384.49
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$418.50
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$446.39
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$254.07
|
Rate for Payer: CareSource Indiana of IN Medicare |
$243.03
|
Rate for Payer: Cash Price |
$415.09
|
Rate for Payer: Cash Price |
$415.09
|
Rate for Payer: Centivo All Commercial |
$341.44
|
Rate for Payer: Cigna All Commercial |
$577.78
|
Rate for Payer: CORVEL All Commercial |
$622.63
|
Rate for Payer: Coventry All Commercial |
$589.16
|
Rate for Payer: Encore All Commercial |
$616.27
|
Rate for Payer: Frontpath All Commercial |
$615.94
|
Rate for Payer: Humana ChoiceCare |
$578.24
|
Rate for Payer: Humana Medicare |
$341.44
|
Rate for Payer: Lucent All Commercial |
$341.44
|
Rate for Payer: Lutheran Preferred All Commercial |
$602.55
|
Rate for Payer: Managed Health Services Medicaid |
$446.39
|
Rate for Payer: MDWise Medicaid |
$446.39
|
Rate for Payer: PHCS All Commercial |
$502.12
|
Rate for Payer: PHP All Commercial |
$507.75
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$261.10
|
Rate for Payer: Sagamore Health Network All Products |
$516.85
|
Rate for Payer: Signature Care EPO |
$555.68
|
Rate for Payer: Signature Care PPO |
$589.16
|
Rate for Payer: Three Rivers Preferred All Commercial |
$569.07
|
Rate for Payer: United Healthcare Commercial |
$527.56
|
Rate for Payer: United Healthcare Medicare |
$220.93
|
|
HC X-RAY EXAM ABDOMEN 3+ VIEWS
|
Facility
IP
|
$669.50
|
|
Service Code
|
CPT 74021
|
Hospital Charge Code |
01614021
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$502.12 |
Max. Negotiated Rate |
$622.63 |
Rate for Payer: Aetna Commercial |
$578.45
|
Rate for Payer: Cash Price |
$415.09
|
Rate for Payer: Cigna All Commercial |
$577.78
|
Rate for Payer: CORVEL All Commercial |
$622.63
|
Rate for Payer: Coventry All Commercial |
$589.16
|
Rate for Payer: Encore All Commercial |
$616.27
|
Rate for Payer: Frontpath All Commercial |
$615.94
|
Rate for Payer: Humana ChoiceCare |
$578.24
|
Rate for Payer: Lutheran Preferred All Commercial |
$602.55
|
Rate for Payer: PHCS All Commercial |
$502.12
|
Rate for Payer: PHP All Commercial |
$507.75
|
Rate for Payer: Sagamore Health Network All Products |
$516.85
|
Rate for Payer: Signature Care EPO |
$555.68
|
Rate for Payer: Signature Care PPO |
$589.16
|
Rate for Payer: United Healthcare Commercial |
$527.56
|
|
HC X-RAY EXAM CHEST 1 VIEW
|
Facility
IP
|
$360.33
|
|
Service Code
|
CPT 71045
|
Hospital Charge Code |
01611010
|
Hospital Revenue Code
|
324
|
Min. Negotiated Rate |
$270.24 |
Max. Negotiated Rate |
$335.10 |
Rate for Payer: Aetna Commercial |
$311.32
|
Rate for Payer: Cash Price |
$223.40
|
Rate for Payer: Cigna All Commercial |
$310.96
|
Rate for Payer: CORVEL All Commercial |
$335.10
|
Rate for Payer: Coventry All Commercial |
$317.09
|
Rate for Payer: Encore All Commercial |
$331.68
|
Rate for Payer: Frontpath All Commercial |
$331.50
|
Rate for Payer: Humana ChoiceCare |
$311.21
|
Rate for Payer: Lutheran Preferred All Commercial |
$324.29
|
Rate for Payer: PHCS All Commercial |
$270.24
|
Rate for Payer: PHP All Commercial |
$273.27
|
Rate for Payer: Sagamore Health Network All Products |
$278.17
|
Rate for Payer: Signature Care EPO |
$299.07
|
Rate for Payer: Signature Care PPO |
$317.09
|
Rate for Payer: United Healthcare Commercial |
$283.94
|
|
HC X-RAY EXAM CHEST 1 VIEW
|
Facility
OP
|
$360.33
|
|
Service Code
|
CPT 71045
|
Hospital Charge Code |
01611010
|
Hospital Revenue Code
|
324
|
Min. Negotiated Rate |
$118.91 |
Max. Negotiated Rate |
$335.10 |
Rate for Payer: Aetna Commercial |
$304.11
|
Rate for Payer: Aetna Medicare |
$118.91
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$118.91
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$206.93
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$225.24
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$242.27
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$136.74
|
Rate for Payer: CareSource Indiana of IN Medicare |
$130.80
|
Rate for Payer: Cash Price |
$223.40
|
Rate for Payer: Cash Price |
$223.40
|
Rate for Payer: Centivo All Commercial |
$183.77
|
Rate for Payer: Cigna All Commercial |
$310.96
|
Rate for Payer: CORVEL All Commercial |
$335.10
|
Rate for Payer: Coventry All Commercial |
$317.09
|
Rate for Payer: Encore All Commercial |
$331.68
|
Rate for Payer: Frontpath All Commercial |
$331.50
|
Rate for Payer: Humana ChoiceCare |
$311.21
|
Rate for Payer: Humana Medicare |
$183.77
|
Rate for Payer: Lucent All Commercial |
$183.77
|
Rate for Payer: Lutheran Preferred All Commercial |
$324.29
|
Rate for Payer: Managed Health Services Medicaid |
$242.27
|
Rate for Payer: MDWise Medicaid |
$242.27
|
Rate for Payer: PHCS All Commercial |
$270.24
|
Rate for Payer: PHP All Commercial |
$273.27
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$140.53
|
Rate for Payer: Sagamore Health Network All Products |
$278.17
|
Rate for Payer: Signature Care EPO |
$299.07
|
Rate for Payer: Signature Care PPO |
$317.09
|
Rate for Payer: Three Rivers Preferred All Commercial |
$306.28
|
Rate for Payer: United Healthcare Commercial |
$283.94
|
Rate for Payer: United Healthcare Medicare |
$118.91
|
|
HC X-RAY EXAM CHEST 2 VIEWS
|
Facility
IP
|
$414.38
|
|
Service Code
|
CPT 71046
|
Hospital Charge Code |
01611046
|
Hospital Revenue Code
|
324
|
Min. Negotiated Rate |
$310.78 |
Max. Negotiated Rate |
$385.37 |
Rate for Payer: Aetna Commercial |
$358.02
|
Rate for Payer: Cash Price |
$256.91
|
Rate for Payer: Cigna All Commercial |
$357.61
|
Rate for Payer: CORVEL All Commercial |
$385.37
|
Rate for Payer: Coventry All Commercial |
$364.65
|
Rate for Payer: Encore All Commercial |
$381.43
|
Rate for Payer: Frontpath All Commercial |
$381.22
|
Rate for Payer: Humana ChoiceCare |
$357.90
|
Rate for Payer: Lutheran Preferred All Commercial |
$372.94
|
Rate for Payer: PHCS All Commercial |
$310.78
|
Rate for Payer: PHP All Commercial |
$314.26
|
Rate for Payer: Sagamore Health Network All Products |
$319.90
|
Rate for Payer: Signature Care EPO |
$343.93
|
Rate for Payer: Signature Care PPO |
$364.65
|
Rate for Payer: United Healthcare Commercial |
$326.53
|
|
HC X-RAY EXAM CHEST 2 VIEWS
|
Facility
OP
|
$414.38
|
|
Service Code
|
CPT 71046
|
Hospital Charge Code |
01611046
|
Hospital Revenue Code
|
324
|
Min. Negotiated Rate |
$136.74 |
Max. Negotiated Rate |
$385.37 |
Rate for Payer: Aetna Commercial |
$349.73
|
Rate for Payer: Aetna Medicare |
$136.74
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$136.74
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$237.98
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$259.03
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$242.27
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.26
|
Rate for Payer: CareSource Indiana of IN Medicare |
$150.42
|
Rate for Payer: Cash Price |
$256.91
|
Rate for Payer: Cash Price |
$256.91
|
Rate for Payer: Centivo All Commercial |
$211.33
|
Rate for Payer: Cigna All Commercial |
$357.61
|
Rate for Payer: CORVEL All Commercial |
$385.37
|
Rate for Payer: Coventry All Commercial |
$364.65
|
Rate for Payer: Encore All Commercial |
$381.43
|
Rate for Payer: Frontpath All Commercial |
$381.22
|
Rate for Payer: Humana ChoiceCare |
$357.90
|
Rate for Payer: Humana Medicare |
$211.33
|
Rate for Payer: Lucent All Commercial |
$211.33
|
Rate for Payer: Lutheran Preferred All Commercial |
$372.94
|
Rate for Payer: Managed Health Services Medicaid |
$242.27
|
Rate for Payer: MDWise Medicaid |
$242.27
|
Rate for Payer: PHCS All Commercial |
$310.78
|
Rate for Payer: PHP All Commercial |
$314.26
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$161.61
|
Rate for Payer: Sagamore Health Network All Products |
$319.90
|
Rate for Payer: Signature Care EPO |
$343.93
|
Rate for Payer: Signature Care PPO |
$364.65
|
Rate for Payer: Three Rivers Preferred All Commercial |
$352.22
|
Rate for Payer: United Healthcare Commercial |
$326.53
|
Rate for Payer: United Healthcare Medicare |
$136.74
|
|
HC X-RAY EXAM CHEST 3 VIEWS
|
Facility
OP
|
$476.52
|
|
Service Code
|
CPT 71047
|
Hospital Charge Code |
01611047
|
Hospital Revenue Code
|
324
|
Min. Negotiated Rate |
$157.25 |
Max. Negotiated Rate |
$443.17 |
Rate for Payer: Aetna Commercial |
$402.19
|
Rate for Payer: Aetna Medicare |
$157.25
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$157.25
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$273.67
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$297.87
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$242.27
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$180.84
|
Rate for Payer: CareSource Indiana of IN Medicare |
$172.98
|
Rate for Payer: Cash Price |
$295.45
|
Rate for Payer: Cash Price |
$295.45
|
Rate for Payer: Centivo All Commercial |
$243.03
|
Rate for Payer: Cigna All Commercial |
$411.24
|
Rate for Payer: CORVEL All Commercial |
$443.17
|
Rate for Payer: Coventry All Commercial |
$419.34
|
Rate for Payer: Encore All Commercial |
$438.64
|
Rate for Payer: Frontpath All Commercial |
$438.40
|
Rate for Payer: Humana ChoiceCare |
$411.57
|
Rate for Payer: Humana Medicare |
$243.03
|
Rate for Payer: Lucent All Commercial |
$243.03
|
Rate for Payer: Lutheran Preferred All Commercial |
$428.87
|
Rate for Payer: Managed Health Services Medicaid |
$242.27
|
Rate for Payer: MDWise Medicaid |
$242.27
|
Rate for Payer: PHCS All Commercial |
$357.39
|
Rate for Payer: PHP All Commercial |
$361.40
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$185.84
|
Rate for Payer: Sagamore Health Network All Products |
$367.88
|
Rate for Payer: Signature Care EPO |
$395.51
|
Rate for Payer: Signature Care PPO |
$419.34
|
Rate for Payer: Three Rivers Preferred All Commercial |
$405.05
|
Rate for Payer: United Healthcare Commercial |
$375.50
|
Rate for Payer: United Healthcare Medicare |
$157.25
|
|
HC X-RAY EXAM CHEST 3 VIEWS
|
Facility
IP
|
$476.52
|
|
Service Code
|
CPT 71047
|
Hospital Charge Code |
01611047
|
Hospital Revenue Code
|
324
|
Min. Negotiated Rate |
$357.39 |
Max. Negotiated Rate |
$443.17 |
Rate for Payer: Aetna Commercial |
$411.72
|
Rate for Payer: Cash Price |
$295.45
|
Rate for Payer: Cigna All Commercial |
$411.24
|
Rate for Payer: CORVEL All Commercial |
$443.17
|
Rate for Payer: Coventry All Commercial |
$419.34
|
Rate for Payer: Encore All Commercial |
$438.64
|
Rate for Payer: Frontpath All Commercial |
$438.40
|
Rate for Payer: Humana ChoiceCare |
$411.57
|
Rate for Payer: Lutheran Preferred All Commercial |
$428.87
|
Rate for Payer: PHCS All Commercial |
$357.39
|
Rate for Payer: PHP All Commercial |
$361.40
|
Rate for Payer: Sagamore Health Network All Products |
$367.88
|
Rate for Payer: Signature Care EPO |
$395.51
|
Rate for Payer: Signature Care PPO |
$419.34
|
Rate for Payer: United Healthcare Commercial |
$375.50
|
|
HC X-RAY EXAM CHEST 4+ VIEWS
|
Facility
OP
|
$897.69
|
|
Service Code
|
CPT 71048
|
Hospital Charge Code |
01611039
|
Hospital Revenue Code
|
324
|
Min. Negotiated Rate |
$296.24 |
Max. Negotiated Rate |
$834.85 |
Rate for Payer: Aetna Commercial |
$757.65
|
Rate for Payer: Aetna Medicare |
$296.24
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$296.24
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$515.54
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$561.15
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$446.39
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$340.67
|
Rate for Payer: CareSource Indiana of IN Medicare |
$325.86
|
Rate for Payer: Cash Price |
$556.57
|
Rate for Payer: Cash Price |
$556.57
|
Rate for Payer: Centivo All Commercial |
$457.82
|
Rate for Payer: Cigna All Commercial |
$774.71
|
Rate for Payer: CORVEL All Commercial |
$834.85
|
Rate for Payer: Coventry All Commercial |
$789.97
|
Rate for Payer: Encore All Commercial |
$826.33
|
Rate for Payer: Frontpath All Commercial |
$825.88
|
Rate for Payer: Humana ChoiceCare |
$775.34
|
Rate for Payer: Humana Medicare |
$457.82
|
Rate for Payer: Lucent All Commercial |
$457.82
|
Rate for Payer: Lutheran Preferred All Commercial |
$807.92
|
Rate for Payer: Managed Health Services Medicaid |
$446.39
|
Rate for Payer: MDWise Medicaid |
$446.39
|
Rate for Payer: PHCS All Commercial |
$673.27
|
Rate for Payer: PHP All Commercial |
$680.81
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$350.10
|
Rate for Payer: Sagamore Health Network All Products |
$693.02
|
Rate for Payer: Signature Care EPO |
$745.08
|
Rate for Payer: Signature Care PPO |
$789.97
|
Rate for Payer: Three Rivers Preferred All Commercial |
$763.04
|
Rate for Payer: United Healthcare Commercial |
$707.38
|
Rate for Payer: United Healthcare Medicare |
$296.24
|
|
HC X-RAY EXAM CHEST 4+ VIEWS
|
Facility
IP
|
$897.69
|
|
Service Code
|
CPT 71048
|
Hospital Charge Code |
01611039
|
Hospital Revenue Code
|
324
|
Min. Negotiated Rate |
$673.27 |
Max. Negotiated Rate |
$834.85 |
Rate for Payer: Aetna Commercial |
$775.61
|
Rate for Payer: Cash Price |
$556.57
|
Rate for Payer: Cigna All Commercial |
$774.71
|
Rate for Payer: CORVEL All Commercial |
$834.85
|
Rate for Payer: Coventry All Commercial |
$789.97
|
Rate for Payer: Encore All Commercial |
$826.33
|
Rate for Payer: Frontpath All Commercial |
$825.88
|
Rate for Payer: Humana ChoiceCare |
$775.34
|
Rate for Payer: Lutheran Preferred All Commercial |
$807.92
|
Rate for Payer: PHCS All Commercial |
$673.27
|
Rate for Payer: PHP All Commercial |
$680.81
|
Rate for Payer: Sagamore Health Network All Products |
$693.02
|
Rate for Payer: Signature Care EPO |
$745.08
|
Rate for Payer: Signature Care PPO |
$789.97
|
Rate for Payer: United Healthcare Commercial |
$707.38
|
|
HC X-RAY EXAM ENTIRE SPI 6/> VW
|
Facility
OP
|
$1,140.36
|
|
Service Code
|
CPT 72084
|
Hospital Charge Code |
01612084
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$185.17 |
Max. Negotiated Rate |
$1,060.53 |
Rate for Payer: Aetna Commercial |
$962.46
|
Rate for Payer: Aetna Medicare |
$376.32
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$376.32
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$654.91
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$712.84
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$185.17
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$432.77
|
Rate for Payer: CareSource Indiana of IN Medicare |
$413.95
|
Rate for Payer: Cash Price |
$707.02
|
Rate for Payer: Cash Price |
$707.02
|
Rate for Payer: Centivo All Commercial |
$581.58
|
Rate for Payer: Cigna All Commercial |
$984.13
|
Rate for Payer: CORVEL All Commercial |
$1,060.53
|
Rate for Payer: Coventry All Commercial |
$1,003.52
|
Rate for Payer: Encore All Commercial |
$1,049.70
|
Rate for Payer: Frontpath All Commercial |
$1,049.13
|
Rate for Payer: Humana ChoiceCare |
$984.93
|
Rate for Payer: Humana Medicare |
$581.58
|
Rate for Payer: Lucent All Commercial |
$581.58
|
Rate for Payer: Lutheran Preferred All Commercial |
$1,026.32
|
Rate for Payer: Managed Health Services Medicaid |
$185.17
|
Rate for Payer: MDWise Medicaid |
$185.17
|
Rate for Payer: PHCS All Commercial |
$855.27
|
Rate for Payer: PHP All Commercial |
$864.85
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$444.74
|
Rate for Payer: Sagamore Health Network All Products |
$880.36
|
Rate for Payer: Signature Care EPO |
$946.50
|
Rate for Payer: Signature Care PPO |
$1,003.52
|
Rate for Payer: Three Rivers Preferred All Commercial |
$969.31
|
Rate for Payer: United Healthcare Commercial |
$898.60
|
Rate for Payer: United Healthcare Medicare |
$376.32
|
|
HC X-RAY EXAM ENTIRE SPI 6/> VW
|
Facility
IP
|
$1,140.36
|
|
Service Code
|
CPT 72084
|
Hospital Charge Code |
01612084
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$855.27 |
Max. Negotiated Rate |
$1,060.53 |
Rate for Payer: Aetna Commercial |
$985.27
|
Rate for Payer: Cash Price |
$707.02
|
Rate for Payer: Cigna All Commercial |
$984.13
|
Rate for Payer: CORVEL All Commercial |
$1,060.53
|
Rate for Payer: Coventry All Commercial |
$1,003.52
|
Rate for Payer: Encore All Commercial |
$1,049.70
|
Rate for Payer: Frontpath All Commercial |
$1,049.13
|
Rate for Payer: Humana ChoiceCare |
$984.93
|
Rate for Payer: Lutheran Preferred All Commercial |
$1,026.32
|
Rate for Payer: PHCS All Commercial |
$855.27
|
Rate for Payer: PHP All Commercial |
$864.85
|
Rate for Payer: Sagamore Health Network All Products |
$880.36
|
Rate for Payer: Signature Care EPO |
$946.50
|
Rate for Payer: Signature Care PPO |
$1,003.52
|
Rate for Payer: United Healthcare Commercial |
$898.60
|
|
HC X-RAY EXAM ESOPHAGUS SINGLE CONT INC SCOUT FILMS STUDY
|
Facility
OP
|
$939.51
|
|
Service Code
|
CPT 74220
|
Hospital Charge Code |
01614220
|
Hospital Revenue Code
|
320
|
Min. Negotiated Rate |
$189.03 |
Max. Negotiated Rate |
$873.75 |
Rate for Payer: Aetna Commercial |
$792.95
|
Rate for Payer: Aetna Medicare |
$310.04
|
Rate for Payer: Anthem Blue Cross of IN Medicare |
$310.04
|
Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$539.56
|
Rate for Payer: Anthem Blue Cross of IN Traditional |
$587.29
|
Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$189.03
|
Rate for Payer: CareSource Indiana of IN Just 4 Me |
$356.54
|
Rate for Payer: CareSource Indiana of IN Medicare |
$341.04
|
Rate for Payer: Cash Price |
$582.50
|
Rate for Payer: Cash Price |
$582.50
|
Rate for Payer: Centivo All Commercial |
$479.15
|
Rate for Payer: Cigna All Commercial |
$810.80
|
Rate for Payer: CORVEL All Commercial |
$873.75
|
Rate for Payer: Coventry All Commercial |
$826.77
|
Rate for Payer: Encore All Commercial |
$864.82
|
Rate for Payer: Frontpath All Commercial |
$864.35
|
Rate for Payer: Humana ChoiceCare |
$811.46
|
Rate for Payer: Humana Medicare |
$479.15
|
Rate for Payer: Lucent All Commercial |
$479.15
|
Rate for Payer: Lutheran Preferred All Commercial |
$845.56
|
Rate for Payer: Managed Health Services Medicaid |
$189.03
|
Rate for Payer: MDWise Medicaid |
$189.03
|
Rate for Payer: PHCS All Commercial |
$704.63
|
Rate for Payer: PHP All Commercial |
$712.53
|
Rate for Payer: Plain Church Group Ministry All Commercial |
$366.41
|
Rate for Payer: Sagamore Health Network All Products |
$725.30
|
Rate for Payer: Signature Care EPO |
$779.79
|
Rate for Payer: Signature Care PPO |
$826.77
|
Rate for Payer: Three Rivers Preferred All Commercial |
$798.59
|
Rate for Payer: United Healthcare Commercial |
$740.34
|
Rate for Payer: United Healthcare Medicare |
$310.04
|
|