|
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
|
|
|
HC X-RAY EXAM HIPS BI 2 VIEWS
|
Facility
OP
|
$613.37
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
01613521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.01 |
| Max. Negotiated Rate |
$570.43 |
| Rate for Payer: Aetna Commercial |
$517.68
|
| Rate for Payer: Aetna Medicare |
$202.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$202.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$352.26
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$383.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$76.01
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$232.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$222.65
|
| Rate for Payer: Cash Price |
$380.29
|
| Rate for Payer: Cash Price |
$380.29
|
| Rate for Payer: Centivo All Commercial |
$312.82
|
| Rate for Payer: Cigna All Commercial |
$529.34
|
| Rate for Payer: CORVEL All Commercial |
$570.43
|
| Rate for Payer: Coventry All Commercial |
$539.76
|
| Rate for Payer: Encore All Commercial |
$564.60
|
| Rate for Payer: Frontpath All Commercial |
$564.30
|
| Rate for Payer: Humana ChoiceCare |
$529.76
|
| Rate for Payer: Humana Medicare |
$312.82
|
| Rate for Payer: Lucent All Commercial |
$312.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$552.03
|
| Rate for Payer: Managed Health Services Medicaid |
$76.01
|
| Rate for Payer: MDWise Medicaid |
$76.01
|
| Rate for Payer: PHCS All Commercial |
$460.03
|
| Rate for Payer: PHP All Commercial |
$465.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$239.21
|
| Rate for Payer: Sagamore Health Network All Products |
$473.52
|
| Rate for Payer: Signature Care EPO |
$509.09
|
| Rate for Payer: Signature Care PPO |
$539.76
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$521.36
|
| Rate for Payer: United Healthcare Commercial |
$483.33
|
| Rate for Payer: United Healthcare Medicare |
$202.41
|
|
|
HC X-RAY EXAM HIPS BI 2 VIEWS
|
Facility
IP
|
$613.37
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
01613521
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$460.03 |
| Max. Negotiated Rate |
$570.43 |
| Rate for Payer: Aetna Commercial |
$529.95
|
| Rate for Payer: Cash Price |
$380.29
|
| Rate for Payer: Cigna All Commercial |
$529.34
|
| Rate for Payer: CORVEL All Commercial |
$570.43
|
| Rate for Payer: Coventry All Commercial |
$539.76
|
| Rate for Payer: Encore All Commercial |
$564.60
|
| Rate for Payer: Frontpath All Commercial |
$564.30
|
| Rate for Payer: Humana ChoiceCare |
$529.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$552.03
|
| Rate for Payer: PHCS All Commercial |
$460.03
|
| Rate for Payer: PHP All Commercial |
$465.18
|
| Rate for Payer: Sagamore Health Network All Products |
$473.52
|
| Rate for Payer: Signature Care EPO |
$509.09
|
| Rate for Payer: Signature Care PPO |
$539.76
|
| Rate for Payer: United Healthcare Commercial |
$483.33
|
|
|
HC X-RAY EXAM HIPS BI 3-4 VIEWS
|
Facility
OP
|
$736.04
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
01613522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.48 |
| Max. Negotiated Rate |
$684.52 |
| Rate for Payer: Aetna Commercial |
$621.22
|
| Rate for Payer: Aetna Medicare |
$242.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$242.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$422.71
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$460.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$90.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$279.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$267.18
|
| Rate for Payer: Cash Price |
$456.35
|
| Rate for Payer: Cash Price |
$456.35
|
| Rate for Payer: Centivo All Commercial |
$375.38
|
| Rate for Payer: Cigna All Commercial |
$635.20
|
| Rate for Payer: CORVEL All Commercial |
$684.52
|
| Rate for Payer: Coventry All Commercial |
$647.72
|
| Rate for Payer: Encore All Commercial |
$677.53
|
| Rate for Payer: Frontpath All Commercial |
$677.16
|
| Rate for Payer: Humana ChoiceCare |
$635.72
|
| Rate for Payer: Humana Medicare |
$375.38
|
| Rate for Payer: Lucent All Commercial |
$375.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$662.44
|
| Rate for Payer: Managed Health Services Medicaid |
$90.48
|
| Rate for Payer: MDWise Medicaid |
$90.48
|
| Rate for Payer: PHCS All Commercial |
$552.03
|
| Rate for Payer: PHP All Commercial |
$558.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$287.06
|
| Rate for Payer: Sagamore Health Network All Products |
$568.22
|
| Rate for Payer: Signature Care EPO |
$610.92
|
| Rate for Payer: Signature Care PPO |
$647.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$625.64
|
| Rate for Payer: United Healthcare Commercial |
$580.00
|
| Rate for Payer: United Healthcare Medicare |
$242.89
|
|
|
HC X-RAY EXAM HIPS BI 3-4 VIEWS
|
Facility
IP
|
$736.04
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
01613522
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$552.03 |
| Max. Negotiated Rate |
$684.52 |
| Rate for Payer: Aetna Commercial |
$635.94
|
| Rate for Payer: Cash Price |
$456.35
|
| Rate for Payer: Cigna All Commercial |
$635.20
|
| Rate for Payer: CORVEL All Commercial |
$684.52
|
| Rate for Payer: Coventry All Commercial |
$647.72
|
| Rate for Payer: Encore All Commercial |
$677.53
|
| Rate for Payer: Frontpath All Commercial |
$677.16
|
| Rate for Payer: Humana ChoiceCare |
$635.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$662.44
|
| Rate for Payer: PHCS All Commercial |
$552.03
|
| Rate for Payer: PHP All Commercial |
$558.21
|
| Rate for Payer: Sagamore Health Network All Products |
$568.22
|
| Rate for Payer: Signature Care EPO |
$610.92
|
| Rate for Payer: Signature Care PPO |
$647.72
|
| Rate for Payer: United Healthcare Commercial |
$580.00
|
|
|
HC X-RAY EXAM HIPS BI 5/> VIEWS
|
Facility
OP
|
$883.25
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
01613523
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.85 |
| Max. Negotiated Rate |
$821.42 |
| Rate for Payer: Aetna Commercial |
$745.46
|
| Rate for Payer: Aetna Medicare |
$291.47
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$291.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$507.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$552.12
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$108.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$335.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$320.62
|
| Rate for Payer: Cash Price |
$547.61
|
| Rate for Payer: Cash Price |
$547.61
|
| Rate for Payer: Centivo All Commercial |
$450.46
|
| Rate for Payer: Cigna All Commercial |
$762.24
|
| Rate for Payer: CORVEL All Commercial |
$821.42
|
| Rate for Payer: Coventry All Commercial |
$777.26
|
| Rate for Payer: Encore All Commercial |
$813.03
|
| Rate for Payer: Frontpath All Commercial |
$812.59
|
| Rate for Payer: Humana ChoiceCare |
$762.86
|
| Rate for Payer: Humana Medicare |
$450.46
|
| Rate for Payer: Lucent All Commercial |
$450.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$794.92
|
| Rate for Payer: Managed Health Services Medicaid |
$108.85
|
| Rate for Payer: MDWise Medicaid |
$108.85
|
| Rate for Payer: PHCS All Commercial |
$662.44
|
| Rate for Payer: PHP All Commercial |
$669.86
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$344.47
|
| Rate for Payer: Sagamore Health Network All Products |
$681.87
|
| Rate for Payer: Signature Care EPO |
$733.10
|
| Rate for Payer: Signature Care PPO |
$777.26
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$750.76
|
| Rate for Payer: United Healthcare Commercial |
$696.00
|
| Rate for Payer: United Healthcare Medicare |
$291.47
|
|
|
HC X-RAY EXAM HIPS BI 5/> VIEWS
|
Facility
IP
|
$883.25
|
|
|
Service Code
|
CPT 73523
|
| Hospital Charge Code |
01613523
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$662.44 |
| Max. Negotiated Rate |
$821.42 |
| Rate for Payer: Aetna Commercial |
$763.13
|
| Rate for Payer: Cash Price |
$547.61
|
| Rate for Payer: Cigna All Commercial |
$762.24
|
| Rate for Payer: CORVEL All Commercial |
$821.42
|
| Rate for Payer: Coventry All Commercial |
$777.26
|
| Rate for Payer: Encore All Commercial |
$813.03
|
| Rate for Payer: Frontpath All Commercial |
$812.59
|
| Rate for Payer: Humana ChoiceCare |
$762.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$794.92
|
| Rate for Payer: PHCS All Commercial |
$662.44
|
| Rate for Payer: PHP All Commercial |
$669.86
|
| Rate for Payer: Sagamore Health Network All Products |
$681.87
|
| Rate for Payer: Signature Care EPO |
$733.10
|
| Rate for Payer: Signature Care PPO |
$777.26
|
| Rate for Payer: United Healthcare Commercial |
$696.00
|
|
|
HC X-RAY EXAM HIP UNI 2-3 VIEWS LT
|
Facility
IP
|
$476.79
|
|
|
Service Code
|
CPT 73502 LT
|
| Hospital Charge Code |
01613510
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$357.59 |
| Max. Negotiated Rate |
$443.41 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Cash Price |
$295.61
|
| Rate for Payer: Cigna All Commercial |
$411.47
|
| Rate for Payer: CORVEL All Commercial |
$443.41
|
| Rate for Payer: Coventry All Commercial |
$419.57
|
| Rate for Payer: Encore All Commercial |
$438.88
|
| Rate for Payer: Frontpath All Commercial |
$438.65
|
| Rate for Payer: Humana ChoiceCare |
$411.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$429.11
|
| Rate for Payer: PHCS All Commercial |
$357.59
|
| Rate for Payer: PHP All Commercial |
$361.60
|
| Rate for Payer: Sagamore Health Network All Products |
$368.08
|
| Rate for Payer: Signature Care EPO |
$395.73
|
| Rate for Payer: Signature Care PPO |
$419.57
|
| Rate for Payer: United Healthcare Commercial |
$375.71
|
|
|
HC X-RAY EXAM HIP UNI 2-3 VIEWS LT
|
Facility
OP
|
$476.79
|
|
|
Service Code
|
CPT 73502 LT
|
| Hospital Charge Code |
01613510
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.34 |
| Max. Negotiated Rate |
$443.41 |
| Rate for Payer: Aetna Commercial |
$402.41
|
| Rate for Payer: Aetna Medicare |
$157.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$157.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$273.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$298.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$180.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$173.07
|
| Rate for Payer: Cash Price |
$295.61
|
| Rate for Payer: Centivo All Commercial |
$243.16
|
| Rate for Payer: Cigna All Commercial |
$411.47
|
| Rate for Payer: CORVEL All Commercial |
$443.41
|
| Rate for Payer: Coventry All Commercial |
$419.57
|
| Rate for Payer: Encore All Commercial |
$438.88
|
| Rate for Payer: Frontpath All Commercial |
$438.65
|
| Rate for Payer: Humana ChoiceCare |
$411.80
|
| Rate for Payer: Humana Medicare |
$243.16
|
| Rate for Payer: Lucent All Commercial |
$243.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$429.11
|
| Rate for Payer: PHCS All Commercial |
$357.59
|
| Rate for Payer: PHP All Commercial |
$361.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.95
|
| Rate for Payer: Sagamore Health Network All Products |
$368.08
|
| Rate for Payer: Signature Care EPO |
$395.73
|
| Rate for Payer: Signature Care PPO |
$419.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$405.27
|
| Rate for Payer: United Healthcare Commercial |
$375.71
|
| Rate for Payer: United Healthcare Medicare |
$157.34
|
|
|
HC X-RAY EXAM HIP UNI 2-3 VIEWS RT
|
Facility
IP
|
$476.79
|
|
|
Service Code
|
CPT 73502 RT
|
| Hospital Charge Code |
11613510
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$357.59 |
| Max. Negotiated Rate |
$443.41 |
| Rate for Payer: Aetna Commercial |
$411.95
|
| Rate for Payer: Cash Price |
$295.61
|
| Rate for Payer: Cigna All Commercial |
$411.47
|
| Rate for Payer: CORVEL All Commercial |
$443.41
|
| Rate for Payer: Coventry All Commercial |
$419.57
|
| Rate for Payer: Encore All Commercial |
$438.88
|
| Rate for Payer: Frontpath All Commercial |
$438.65
|
| Rate for Payer: Humana ChoiceCare |
$411.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$429.11
|
| Rate for Payer: PHCS All Commercial |
$357.59
|
| Rate for Payer: PHP All Commercial |
$361.60
|
| Rate for Payer: Sagamore Health Network All Products |
$368.08
|
| Rate for Payer: Signature Care EPO |
$395.73
|
| Rate for Payer: Signature Care PPO |
$419.57
|
| Rate for Payer: United Healthcare Commercial |
$375.71
|
|
|
HC X-RAY EXAM HIP UNI 2-3 VIEWS RT
|
Facility
OP
|
$476.79
|
|
|
Service Code
|
CPT 73502 RT
|
| Hospital Charge Code |
11613510
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.34 |
| Max. Negotiated Rate |
$443.41 |
| Rate for Payer: Aetna Commercial |
$402.41
|
| Rate for Payer: Aetna Medicare |
$157.34
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$157.34
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$273.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$298.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$180.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$173.07
|
| Rate for Payer: Cash Price |
$295.61
|
| Rate for Payer: Centivo All Commercial |
$243.16
|
| Rate for Payer: Cigna All Commercial |
$411.47
|
| Rate for Payer: CORVEL All Commercial |
$443.41
|
| Rate for Payer: Coventry All Commercial |
$419.57
|
| Rate for Payer: Encore All Commercial |
$438.88
|
| Rate for Payer: Frontpath All Commercial |
$438.65
|
| Rate for Payer: Humana ChoiceCare |
$411.80
|
| Rate for Payer: Humana Medicare |
$243.16
|
| Rate for Payer: Lucent All Commercial |
$243.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$429.11
|
| Rate for Payer: PHCS All Commercial |
$357.59
|
| Rate for Payer: PHP All Commercial |
$361.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$185.95
|
| Rate for Payer: Sagamore Health Network All Products |
$368.08
|
| Rate for Payer: Signature Care EPO |
$395.73
|
| Rate for Payer: Signature Care PPO |
$419.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$405.27
|
| Rate for Payer: United Healthcare Commercial |
$375.71
|
| Rate for Payer: United Healthcare Medicare |
$157.34
|
|
|
HC X-RAY EXAM HIP UNI 4/> VIEWS LT
|
Facility
OP
|
$502.86
|
|
|
Service Code
|
CPT 73503 LT
|
| Hospital Charge Code |
01613503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.94 |
| Max. Negotiated Rate |
$467.66 |
| Rate for Payer: Aetna Commercial |
$424.41
|
| Rate for Payer: Aetna Medicare |
$165.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$165.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$288.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$314.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$190.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$182.54
|
| Rate for Payer: Cash Price |
$311.77
|
| Rate for Payer: Centivo All Commercial |
$256.46
|
| Rate for Payer: Cigna All Commercial |
$433.97
|
| Rate for Payer: CORVEL All Commercial |
$467.66
|
| Rate for Payer: Coventry All Commercial |
$442.52
|
| Rate for Payer: Encore All Commercial |
$462.88
|
| Rate for Payer: Frontpath All Commercial |
$462.63
|
| Rate for Payer: Humana ChoiceCare |
$434.32
|
| Rate for Payer: Humana Medicare |
$256.46
|
| Rate for Payer: Lucent All Commercial |
$256.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$452.57
|
| Rate for Payer: PHCS All Commercial |
$377.14
|
| Rate for Payer: PHP All Commercial |
$381.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$196.12
|
| Rate for Payer: Sagamore Health Network All Products |
$388.21
|
| Rate for Payer: Signature Care EPO |
$417.37
|
| Rate for Payer: Signature Care PPO |
$442.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$427.43
|
| Rate for Payer: United Healthcare Commercial |
$396.25
|
| Rate for Payer: United Healthcare Medicare |
$165.94
|
|
|
HC X-RAY EXAM HIP UNI 4/> VIEWS LT
|
Facility
IP
|
$502.86
|
|
|
Service Code
|
CPT 73503 LT
|
| Hospital Charge Code |
01613503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$377.14 |
| Max. Negotiated Rate |
$467.66 |
| Rate for Payer: Aetna Commercial |
$434.47
|
| Rate for Payer: Cash Price |
$311.77
|
| Rate for Payer: Cigna All Commercial |
$433.97
|
| Rate for Payer: CORVEL All Commercial |
$467.66
|
| Rate for Payer: Coventry All Commercial |
$442.52
|
| Rate for Payer: Encore All Commercial |
$462.88
|
| Rate for Payer: Frontpath All Commercial |
$462.63
|
| Rate for Payer: Humana ChoiceCare |
$434.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$452.57
|
| Rate for Payer: PHCS All Commercial |
$377.14
|
| Rate for Payer: PHP All Commercial |
$381.37
|
| Rate for Payer: Sagamore Health Network All Products |
$388.21
|
| Rate for Payer: Signature Care EPO |
$417.37
|
| Rate for Payer: Signature Care PPO |
$442.52
|
| Rate for Payer: United Healthcare Commercial |
$396.25
|
|
|
HC X-RAY EXAM HIP UNI 4/> VIEWS RT
|
Facility
IP
|
$502.86
|
|
|
Service Code
|
CPT 73503 RT
|
| Hospital Charge Code |
11613503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$377.14 |
| Max. Negotiated Rate |
$467.66 |
| Rate for Payer: Aetna Commercial |
$434.47
|
| Rate for Payer: Cash Price |
$311.77
|
| Rate for Payer: Cigna All Commercial |
$433.97
|
| Rate for Payer: CORVEL All Commercial |
$467.66
|
| Rate for Payer: Coventry All Commercial |
$442.52
|
| Rate for Payer: Encore All Commercial |
$462.88
|
| Rate for Payer: Frontpath All Commercial |
$462.63
|
| Rate for Payer: Humana ChoiceCare |
$434.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$452.57
|
| Rate for Payer: PHCS All Commercial |
$377.14
|
| Rate for Payer: PHP All Commercial |
$381.37
|
| Rate for Payer: Sagamore Health Network All Products |
$388.21
|
| Rate for Payer: Signature Care EPO |
$417.37
|
| Rate for Payer: Signature Care PPO |
$442.52
|
| Rate for Payer: United Healthcare Commercial |
$396.25
|
|
|
HC X-RAY EXAM HIP UNI 4/> VIEWS RT
|
Facility
OP
|
$502.86
|
|
|
Service Code
|
CPT 73503 RT
|
| Hospital Charge Code |
11613503
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.94 |
| Max. Negotiated Rate |
$467.66 |
| Rate for Payer: Aetna Commercial |
$424.41
|
| Rate for Payer: Aetna Medicare |
$165.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$165.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$288.79
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$314.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$190.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$182.54
|
| Rate for Payer: Cash Price |
$311.77
|
| Rate for Payer: Centivo All Commercial |
$256.46
|
| Rate for Payer: Cigna All Commercial |
$433.97
|
| Rate for Payer: CORVEL All Commercial |
$467.66
|
| Rate for Payer: Coventry All Commercial |
$442.52
|
| Rate for Payer: Encore All Commercial |
$462.88
|
| Rate for Payer: Frontpath All Commercial |
$462.63
|
| Rate for Payer: Humana ChoiceCare |
$434.32
|
| Rate for Payer: Humana Medicare |
$256.46
|
| Rate for Payer: Lucent All Commercial |
$256.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$452.57
|
| Rate for Payer: PHCS All Commercial |
$377.14
|
| Rate for Payer: PHP All Commercial |
$381.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$196.12
|
| Rate for Payer: Sagamore Health Network All Products |
$388.21
|
| Rate for Payer: Signature Care EPO |
$417.37
|
| Rate for Payer: Signature Care PPO |
$442.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$427.43
|
| Rate for Payer: United Healthcare Commercial |
$396.25
|
| Rate for Payer: United Healthcare Medicare |
$165.94
|
|
|
HC X-RAY EXAM OF ELBOW 2 VIEWS BIL LTD
|
Facility
OP
|
$527.42
|
|
|
Service Code
|
CPT 73070 52,50
|
| Hospital Charge Code |
21618032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.05 |
| Max. Negotiated Rate |
$490.50 |
| Rate for Payer: Aetna Commercial |
$445.14
|
| Rate for Payer: Aetna Medicare |
$174.05
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$174.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$302.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$329.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$200.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$191.45
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Centivo All Commercial |
$268.99
|
| Rate for Payer: Cigna All Commercial |
$455.16
|
| Rate for Payer: CORVEL All Commercial |
$490.50
|
| Rate for Payer: Coventry All Commercial |
$464.13
|
| Rate for Payer: Encore All Commercial |
$485.49
|
| Rate for Payer: Frontpath All Commercial |
$485.23
|
| Rate for Payer: Humana ChoiceCare |
$455.53
|
| Rate for Payer: Humana Medicare |
$268.99
|
| Rate for Payer: Lucent All Commercial |
$268.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$474.68
|
| Rate for Payer: PHCS All Commercial |
$395.57
|
| Rate for Payer: PHP All Commercial |
$400.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$205.69
|
| Rate for Payer: Sagamore Health Network All Products |
$407.17
|
| Rate for Payer: Signature Care EPO |
$437.76
|
| Rate for Payer: Signature Care PPO |
$464.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$448.31
|
| Rate for Payer: United Healthcare Commercial |
$415.61
|
| Rate for Payer: United Healthcare Medicare |
$174.05
|
|
|
HC X-RAY EXAM OF ELBOW 2 VIEWS BIL LTD
|
Facility
IP
|
$527.42
|
|
|
Service Code
|
CPT 73070 52,50
|
| Hospital Charge Code |
21618032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$395.57 |
| Max. Negotiated Rate |
$490.50 |
| Rate for Payer: Aetna Commercial |
$455.69
|
| Rate for Payer: Cash Price |
$327.00
|
| Rate for Payer: Cigna All Commercial |
$455.16
|
| Rate for Payer: CORVEL All Commercial |
$490.50
|
| Rate for Payer: Coventry All Commercial |
$464.13
|
| Rate for Payer: Encore All Commercial |
$485.49
|
| Rate for Payer: Frontpath All Commercial |
$485.23
|
| Rate for Payer: Humana ChoiceCare |
$455.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$474.68
|
| Rate for Payer: PHCS All Commercial |
$395.57
|
| Rate for Payer: PHP All Commercial |
$400.00
|
| Rate for Payer: Sagamore Health Network All Products |
$407.17
|
| Rate for Payer: Signature Care EPO |
$437.76
|
| Rate for Payer: Signature Care PPO |
$464.13
|
| Rate for Payer: United Healthcare Commercial |
$415.61
|
|
|
HC X-RAY EXAM OF ELBOW 2 VIEWS LT LTD
|
Facility
OP
|
$402.89
|
|
|
Service Code
|
CPT 73070 LT,52
|
| Hospital Charge Code |
01618032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.95 |
| Max. Negotiated Rate |
$374.69 |
| Rate for Payer: Aetna Commercial |
$340.04
|
| Rate for Payer: Aetna Medicare |
$132.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$132.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$231.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$251.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$152.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.25
|
| Rate for Payer: Cash Price |
$249.79
|
| Rate for Payer: Centivo All Commercial |
$205.47
|
| Rate for Payer: Cigna All Commercial |
$347.69
|
| Rate for Payer: CORVEL All Commercial |
$374.69
|
| Rate for Payer: Coventry All Commercial |
$354.54
|
| Rate for Payer: Encore All Commercial |
$370.86
|
| Rate for Payer: Frontpath All Commercial |
$370.66
|
| Rate for Payer: Humana ChoiceCare |
$347.98
|
| Rate for Payer: Humana Medicare |
$205.47
|
| Rate for Payer: Lucent All Commercial |
$205.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$362.60
|
| Rate for Payer: PHCS All Commercial |
$302.17
|
| Rate for Payer: PHP All Commercial |
$305.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$157.13
|
| Rate for Payer: Sagamore Health Network All Products |
$311.03
|
| Rate for Payer: Signature Care EPO |
$334.40
|
| Rate for Payer: Signature Care PPO |
$354.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$342.46
|
| Rate for Payer: United Healthcare Commercial |
$317.48
|
| Rate for Payer: United Healthcare Medicare |
$132.95
|
|
|
HC X-RAY EXAM OF ELBOW 2 VIEWS LT LTD
|
Facility
IP
|
$402.89
|
|
|
Service Code
|
CPT 73070 LT,52
|
| Hospital Charge Code |
01618032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$302.17 |
| Max. Negotiated Rate |
$374.69 |
| Rate for Payer: Aetna Commercial |
$348.10
|
| Rate for Payer: Cash Price |
$249.79
|
| Rate for Payer: Cigna All Commercial |
$347.69
|
| Rate for Payer: CORVEL All Commercial |
$374.69
|
| Rate for Payer: Coventry All Commercial |
$354.54
|
| Rate for Payer: Encore All Commercial |
$370.86
|
| Rate for Payer: Frontpath All Commercial |
$370.66
|
| Rate for Payer: Humana ChoiceCare |
$347.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$362.60
|
| Rate for Payer: PHCS All Commercial |
$302.17
|
| Rate for Payer: PHP All Commercial |
$305.55
|
| Rate for Payer: Sagamore Health Network All Products |
$311.03
|
| Rate for Payer: Signature Care EPO |
$334.40
|
| Rate for Payer: Signature Care PPO |
$354.54
|
| Rate for Payer: United Healthcare Commercial |
$317.48
|
|
|
HC X-RAY EXAM OF ELBOW 2 VIEWS RT LTD
|
Facility
OP
|
$402.89
|
|
|
Service Code
|
CPT 73070 RT,52
|
| Hospital Charge Code |
11618032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.95 |
| Max. Negotiated Rate |
$374.69 |
| Rate for Payer: Aetna Commercial |
$340.04
|
| Rate for Payer: Aetna Medicare |
$132.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$132.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$231.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$251.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$152.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$146.25
|
| Rate for Payer: Cash Price |
$249.79
|
| Rate for Payer: Centivo All Commercial |
$205.47
|
| Rate for Payer: Cigna All Commercial |
$347.69
|
| Rate for Payer: CORVEL All Commercial |
$374.69
|
| Rate for Payer: Coventry All Commercial |
$354.54
|
| Rate for Payer: Encore All Commercial |
$370.86
|
| Rate for Payer: Frontpath All Commercial |
$370.66
|
| Rate for Payer: Humana ChoiceCare |
$347.98
|
| Rate for Payer: Humana Medicare |
$205.47
|
| Rate for Payer: Lucent All Commercial |
$205.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$362.60
|
| Rate for Payer: PHCS All Commercial |
$302.17
|
| Rate for Payer: PHP All Commercial |
$305.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$157.13
|
| Rate for Payer: Sagamore Health Network All Products |
$311.03
|
| Rate for Payer: Signature Care EPO |
$334.40
|
| Rate for Payer: Signature Care PPO |
$354.54
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$342.46
|
| Rate for Payer: United Healthcare Commercial |
$317.48
|
| Rate for Payer: United Healthcare Medicare |
$132.95
|
|
|
HC X-RAY EXAM OF ELBOW 2 VIEWS RT LTD
|
Facility
IP
|
$402.89
|
|
|
Service Code
|
CPT 73070 RT,52
|
| Hospital Charge Code |
11618032
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$302.17 |
| Max. Negotiated Rate |
$374.69 |
| Rate for Payer: Aetna Commercial |
$348.10
|
| Rate for Payer: Cash Price |
$249.79
|
| Rate for Payer: Cigna All Commercial |
$347.69
|
| Rate for Payer: CORVEL All Commercial |
$374.69
|
| Rate for Payer: Coventry All Commercial |
$354.54
|
| Rate for Payer: Encore All Commercial |
$370.86
|
| Rate for Payer: Frontpath All Commercial |
$370.66
|
| Rate for Payer: Humana ChoiceCare |
$347.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$362.60
|
| Rate for Payer: PHCS All Commercial |
$302.17
|
| Rate for Payer: PHP All Commercial |
$305.55
|
| Rate for Payer: Sagamore Health Network All Products |
$311.03
|
| Rate for Payer: Signature Care EPO |
$334.40
|
| Rate for Payer: Signature Care PPO |
$354.54
|
| Rate for Payer: United Healthcare Commercial |
$317.48
|
|
|
HC X-RAY EXAM OF FOREARM 2 VIEWS BIL LTD
|
Facility
OP
|
$448.30
|
|
|
Service Code
|
CPT 73090 52,50
|
| Hospital Charge Code |
21618033
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$147.94 |
| Max. Negotiated Rate |
$416.92 |
| Rate for Payer: Aetna Commercial |
$378.37
|
| Rate for Payer: Aetna Medicare |
$147.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$147.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$257.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$280.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$170.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$162.73
|
| Rate for Payer: Cash Price |
$277.95
|
| Rate for Payer: Centivo All Commercial |
$228.63
|
| Rate for Payer: Cigna All Commercial |
$386.88
|
| Rate for Payer: CORVEL All Commercial |
$416.92
|
| Rate for Payer: Coventry All Commercial |
$394.50
|
| Rate for Payer: Encore All Commercial |
$412.66
|
| Rate for Payer: Frontpath All Commercial |
$412.44
|
| Rate for Payer: Humana ChoiceCare |
$387.20
|
| Rate for Payer: Humana Medicare |
$228.63
|
| Rate for Payer: Lucent All Commercial |
$228.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$403.47
|
| Rate for Payer: PHCS All Commercial |
$336.23
|
| Rate for Payer: PHP All Commercial |
$339.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$174.84
|
| Rate for Payer: Sagamore Health Network All Products |
$346.09
|
| Rate for Payer: Signature Care EPO |
$372.09
|
| Rate for Payer: Signature Care PPO |
$394.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$381.06
|
| Rate for Payer: United Healthcare Commercial |
$353.26
|
| Rate for Payer: United Healthcare Medicare |
$147.94
|
|
|
HC X-RAY EXAM OF FOREARM 2 VIEWS BIL LTD
|
Facility
IP
|
$448.30
|
|
|
Service Code
|
CPT 73090 52,50
|
| Hospital Charge Code |
21618033
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$336.23 |
| Max. Negotiated Rate |
$416.92 |
| Rate for Payer: Aetna Commercial |
$387.33
|
| Rate for Payer: Cash Price |
$277.95
|
| Rate for Payer: Cigna All Commercial |
$386.88
|
| Rate for Payer: CORVEL All Commercial |
$416.92
|
| Rate for Payer: Coventry All Commercial |
$394.50
|
| Rate for Payer: Encore All Commercial |
$412.66
|
| Rate for Payer: Frontpath All Commercial |
$412.44
|
| Rate for Payer: Humana ChoiceCare |
$387.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$403.47
|
| Rate for Payer: PHCS All Commercial |
$336.23
|
| Rate for Payer: PHP All Commercial |
$339.99
|
| Rate for Payer: Sagamore Health Network All Products |
$346.09
|
| Rate for Payer: Signature Care EPO |
$372.09
|
| Rate for Payer: Signature Care PPO |
$394.50
|
| Rate for Payer: United Healthcare Commercial |
$353.26
|
|
|
HC X-RAY EXAM OF FOREARM 2 VIEWS LT LTD
|
Facility
IP
|
$298.87
|
|
|
Service Code
|
CPT 73090 LT,52
|
| Hospital Charge Code |
01618033
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.15 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: Aetna Commercial |
$258.22
|
| Rate for Payer: Cash Price |
$185.30
|
| Rate for Payer: Cigna All Commercial |
$257.92
|
| Rate for Payer: CORVEL All Commercial |
$277.95
|
| Rate for Payer: Coventry All Commercial |
$263.01
|
| Rate for Payer: Encore All Commercial |
$275.11
|
| Rate for Payer: Frontpath All Commercial |
$274.96
|
| Rate for Payer: Humana ChoiceCare |
$258.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$268.98
|
| Rate for Payer: PHCS All Commercial |
$224.15
|
| Rate for Payer: PHP All Commercial |
$226.66
|
| Rate for Payer: Sagamore Health Network All Products |
$230.73
|
| Rate for Payer: Signature Care EPO |
$248.06
|
| Rate for Payer: Signature Care PPO |
$263.01
|
| Rate for Payer: United Healthcare Commercial |
$235.51
|
|
|
HC X-RAY EXAM OF FOREARM 2 VIEWS LT LTD
|
Facility
OP
|
$298.87
|
|
|
Service Code
|
CPT 73090 LT,52
|
| Hospital Charge Code |
01618033
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.63 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: Aetna Commercial |
$252.25
|
| Rate for Payer: Aetna Medicare |
$98.63
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$98.63
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$171.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$186.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$113.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$108.49
|
| Rate for Payer: Cash Price |
$185.30
|
| Rate for Payer: Centivo All Commercial |
$152.42
|
| Rate for Payer: Cigna All Commercial |
$257.92
|
| Rate for Payer: CORVEL All Commercial |
$277.95
|
| Rate for Payer: Coventry All Commercial |
$263.01
|
| Rate for Payer: Encore All Commercial |
$275.11
|
| Rate for Payer: Frontpath All Commercial |
$274.96
|
| Rate for Payer: Humana ChoiceCare |
$258.13
|
| Rate for Payer: Humana Medicare |
$152.42
|
| Rate for Payer: Lucent All Commercial |
$152.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$268.98
|
| Rate for Payer: PHCS All Commercial |
$224.15
|
| Rate for Payer: PHP All Commercial |
$226.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$116.56
|
| Rate for Payer: Sagamore Health Network All Products |
$230.73
|
| Rate for Payer: Signature Care EPO |
$248.06
|
| Rate for Payer: Signature Care PPO |
$263.01
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$254.04
|
| Rate for Payer: United Healthcare Commercial |
$235.51
|
| Rate for Payer: United Healthcare Medicare |
$98.63
|
|
