|
HC X-RAY EXAM OF FOREARM 2 VIEWS RT LTD
|
Facility
OP
|
$298.87
|
|
|
Service Code
|
CPT 73090 RT,52
|
| Hospital Charge Code |
11618033
|
|
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
|
|
|
HC X-RAY EXAM OF FOREARM 2 VIEWS RT LTD
|
Facility
IP
|
$298.87
|
|
|
Service Code
|
CPT 73090 RT,52
|
| Hospital Charge Code |
11618033
|
|
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 HAND 2 VIEWS BIL LTD
|
Facility
OP
|
$443.80
|
|
|
Service Code
|
CPT 73120 52,50
|
| Hospital Charge Code |
01618034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.45 |
| Max. Negotiated Rate |
$412.74 |
| Rate for Payer: Aetna Commercial |
$374.57
|
| Rate for Payer: Aetna Medicare |
$146.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$146.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$254.88
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$277.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$168.42
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$161.10
|
| Rate for Payer: Cash Price |
$275.16
|
| Rate for Payer: Centivo All Commercial |
$226.34
|
| Rate for Payer: Cigna All Commercial |
$383.00
|
| Rate for Payer: CORVEL All Commercial |
$412.74
|
| Rate for Payer: Coventry All Commercial |
$390.55
|
| Rate for Payer: Encore All Commercial |
$408.52
|
| Rate for Payer: Frontpath All Commercial |
$408.30
|
| Rate for Payer: Humana ChoiceCare |
$383.31
|
| Rate for Payer: Humana Medicare |
$226.34
|
| Rate for Payer: Lucent All Commercial |
$226.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$399.42
|
| Rate for Payer: PHCS All Commercial |
$332.85
|
| Rate for Payer: PHP All Commercial |
$336.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$173.08
|
| Rate for Payer: Sagamore Health Network All Products |
$342.62
|
| Rate for Payer: Signature Care EPO |
$368.36
|
| Rate for Payer: Signature Care PPO |
$390.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$377.23
|
| Rate for Payer: United Healthcare Commercial |
$349.72
|
| Rate for Payer: United Healthcare Medicare |
$146.45
|
|
|
HC X-RAY EXAM OF HAND 2 VIEWS BIL LTD
|
Facility
IP
|
$443.80
|
|
|
Service Code
|
CPT 73120 52,50
|
| Hospital Charge Code |
01618034
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$332.85 |
| Max. Negotiated Rate |
$412.74 |
| Rate for Payer: Aetna Commercial |
$383.44
|
| Rate for Payer: Cash Price |
$275.16
|
| Rate for Payer: Cigna All Commercial |
$383.00
|
| Rate for Payer: CORVEL All Commercial |
$412.74
|
| Rate for Payer: Coventry All Commercial |
$390.55
|
| Rate for Payer: Encore All Commercial |
$408.52
|
| Rate for Payer: Frontpath All Commercial |
$408.30
|
| Rate for Payer: Humana ChoiceCare |
$383.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$399.42
|
| Rate for Payer: PHCS All Commercial |
$332.85
|
| Rate for Payer: PHP All Commercial |
$336.58
|
| Rate for Payer: Sagamore Health Network All Products |
$342.62
|
| Rate for Payer: Signature Care EPO |
$368.36
|
| Rate for Payer: Signature Care PPO |
$390.55
|
| Rate for Payer: United Healthcare Commercial |
$349.72
|
|
|
HC X-RAY EXAM OF HUMERUS 2 VIEWS BIL LTD
|
Facility
IP
|
$480.76
|
|
|
Service Code
|
CPT 73060 52,50
|
| Hospital Charge Code |
21618031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$360.57 |
| Max. Negotiated Rate |
$447.10 |
| Rate for Payer: Aetna Commercial |
$415.37
|
| Rate for Payer: Cash Price |
$298.07
|
| Rate for Payer: Cigna All Commercial |
$414.89
|
| Rate for Payer: CORVEL All Commercial |
$447.10
|
| Rate for Payer: Coventry All Commercial |
$423.07
|
| Rate for Payer: Encore All Commercial |
$442.54
|
| Rate for Payer: Frontpath All Commercial |
$442.30
|
| Rate for Payer: Humana ChoiceCare |
$415.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$432.68
|
| Rate for Payer: PHCS All Commercial |
$360.57
|
| Rate for Payer: PHP All Commercial |
$364.61
|
| Rate for Payer: Sagamore Health Network All Products |
$371.14
|
| Rate for Payer: Signature Care EPO |
$399.03
|
| Rate for Payer: Signature Care PPO |
$423.07
|
| Rate for Payer: United Healthcare Commercial |
$378.84
|
|
|
HC X-RAY EXAM OF HUMERUS 2 VIEWS BIL LTD
|
Facility
OP
|
$480.76
|
|
|
Service Code
|
CPT 73060 52,50
|
| Hospital Charge Code |
21618031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$158.65 |
| Max. Negotiated Rate |
$447.10 |
| Rate for Payer: Aetna Commercial |
$405.76
|
| Rate for Payer: Aetna Medicare |
$158.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$158.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$276.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$300.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$182.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.51
|
| Rate for Payer: Cash Price |
$298.07
|
| Rate for Payer: Centivo All Commercial |
$245.19
|
| Rate for Payer: Cigna All Commercial |
$414.89
|
| Rate for Payer: CORVEL All Commercial |
$447.10
|
| Rate for Payer: Coventry All Commercial |
$423.07
|
| Rate for Payer: Encore All Commercial |
$442.54
|
| Rate for Payer: Frontpath All Commercial |
$442.30
|
| Rate for Payer: Humana ChoiceCare |
$415.23
|
| Rate for Payer: Humana Medicare |
$245.19
|
| Rate for Payer: Lucent All Commercial |
$245.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$432.68
|
| Rate for Payer: PHCS All Commercial |
$360.57
|
| Rate for Payer: PHP All Commercial |
$364.61
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.50
|
| Rate for Payer: Sagamore Health Network All Products |
$371.14
|
| Rate for Payer: Signature Care EPO |
$399.03
|
| Rate for Payer: Signature Care PPO |
$423.07
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$408.64
|
| Rate for Payer: United Healthcare Commercial |
$378.84
|
| Rate for Payer: United Healthcare Medicare |
$158.65
|
|
|
HC X-RAY EXAM OF HUMERUS 2+ VIEWS LT LTD
|
Facility
OP
|
$320.50
|
|
|
Service Code
|
CPT 73060 LT,52
|
| Hospital Charge Code |
01618031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.77 |
| Max. Negotiated Rate |
$298.07 |
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: Aetna Medicare |
$105.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$184.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$200.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$121.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$116.34
|
| Rate for Payer: Cash Price |
$198.71
|
| Rate for Payer: Centivo All Commercial |
$163.46
|
| Rate for Payer: Cigna All Commercial |
$276.60
|
| Rate for Payer: CORVEL All Commercial |
$298.07
|
| Rate for Payer: Coventry All Commercial |
$282.04
|
| Rate for Payer: Encore All Commercial |
$295.02
|
| Rate for Payer: Frontpath All Commercial |
$294.86
|
| Rate for Payer: Humana ChoiceCare |
$276.82
|
| Rate for Payer: Humana Medicare |
$163.46
|
| Rate for Payer: Lucent All Commercial |
$163.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$288.45
|
| Rate for Payer: PHCS All Commercial |
$240.38
|
| Rate for Payer: PHP All Commercial |
$243.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$125.00
|
| Rate for Payer: Sagamore Health Network All Products |
$247.43
|
| Rate for Payer: Signature Care EPO |
$266.02
|
| Rate for Payer: Signature Care PPO |
$282.04
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$272.43
|
| Rate for Payer: United Healthcare Commercial |
$252.56
|
| Rate for Payer: United Healthcare Medicare |
$105.77
|
|
|
HC X-RAY EXAM OF HUMERUS 2+ VIEWS LT LTD
|
Facility
IP
|
$320.50
|
|
|
Service Code
|
CPT 73060 LT,52
|
| Hospital Charge Code |
01618031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$240.38 |
| Max. Negotiated Rate |
$298.07 |
| Rate for Payer: Aetna Commercial |
$276.92
|
| Rate for Payer: Cash Price |
$198.71
|
| Rate for Payer: Cigna All Commercial |
$276.60
|
| Rate for Payer: CORVEL All Commercial |
$298.07
|
| Rate for Payer: Coventry All Commercial |
$282.04
|
| Rate for Payer: Encore All Commercial |
$295.02
|
| Rate for Payer: Frontpath All Commercial |
$294.86
|
| Rate for Payer: Humana ChoiceCare |
$276.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$288.45
|
| Rate for Payer: PHCS All Commercial |
$240.38
|
| Rate for Payer: PHP All Commercial |
$243.07
|
| Rate for Payer: Sagamore Health Network All Products |
$247.43
|
| Rate for Payer: Signature Care EPO |
$266.02
|
| Rate for Payer: Signature Care PPO |
$282.04
|
| Rate for Payer: United Healthcare Commercial |
$252.56
|
|
|
HC X-RAY EXAM OF HUMERUS 2+ VIEWS RT LTD
|
Facility
IP
|
$320.51
|
|
|
Service Code
|
CPT 73060 RT,52
|
| Hospital Charge Code |
11618031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$240.39 |
| Max. Negotiated Rate |
$298.08 |
| Rate for Payer: Aetna Commercial |
$276.92
|
| Rate for Payer: Cash Price |
$198.72
|
| Rate for Payer: Cigna All Commercial |
$276.60
|
| Rate for Payer: CORVEL All Commercial |
$298.08
|
| Rate for Payer: Coventry All Commercial |
$282.05
|
| Rate for Payer: Encore All Commercial |
$295.03
|
| Rate for Payer: Frontpath All Commercial |
$294.87
|
| Rate for Payer: Humana ChoiceCare |
$276.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$288.46
|
| Rate for Payer: PHCS All Commercial |
$240.39
|
| Rate for Payer: PHP All Commercial |
$243.08
|
| Rate for Payer: Sagamore Health Network All Products |
$247.44
|
| Rate for Payer: Signature Care EPO |
$266.03
|
| Rate for Payer: Signature Care PPO |
$282.05
|
| Rate for Payer: United Healthcare Commercial |
$252.57
|
|
|
HC X-RAY EXAM OF HUMERUS 2+ VIEWS RT LTD
|
Facility
OP
|
$320.51
|
|
|
Service Code
|
CPT 73060 RT,52
|
| Hospital Charge Code |
11618031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.77 |
| Max. Negotiated Rate |
$298.08 |
| Rate for Payer: Aetna Commercial |
$270.51
|
| Rate for Payer: Aetna Medicare |
$105.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$105.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$184.07
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$200.35
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$121.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$116.35
|
| Rate for Payer: Cash Price |
$198.72
|
| Rate for Payer: Centivo All Commercial |
$163.46
|
| Rate for Payer: Cigna All Commercial |
$276.60
|
| Rate for Payer: CORVEL All Commercial |
$298.08
|
| Rate for Payer: Coventry All Commercial |
$282.05
|
| Rate for Payer: Encore All Commercial |
$295.03
|
| Rate for Payer: Frontpath All Commercial |
$294.87
|
| Rate for Payer: Humana ChoiceCare |
$276.83
|
| Rate for Payer: Humana Medicare |
$163.46
|
| Rate for Payer: Lucent All Commercial |
$163.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$288.46
|
| Rate for Payer: PHCS All Commercial |
$240.39
|
| Rate for Payer: PHP All Commercial |
$243.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$125.00
|
| Rate for Payer: Sagamore Health Network All Products |
$247.44
|
| Rate for Payer: Signature Care EPO |
$266.03
|
| Rate for Payer: Signature Care PPO |
$282.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$272.44
|
| Rate for Payer: United Healthcare Commercial |
$252.57
|
| Rate for Payer: United Healthcare Medicare |
$105.77
|
|
|
HC X-RAY EXAM OF JAW <4 VIEWS
|
Facility
IP
|
$913.04
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
01610100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$684.78 |
| Max. Negotiated Rate |
$849.13 |
| Rate for Payer: Aetna Commercial |
$788.87
|
| Rate for Payer: Cash Price |
$566.09
|
| Rate for Payer: Cigna All Commercial |
$787.96
|
| Rate for Payer: CORVEL All Commercial |
$849.13
|
| Rate for Payer: Coventry All Commercial |
$803.48
|
| Rate for Payer: Encore All Commercial |
$840.46
|
| Rate for Payer: Frontpath All Commercial |
$840.00
|
| Rate for Payer: Humana ChoiceCare |
$788.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$821.74
|
| Rate for Payer: PHCS All Commercial |
$684.78
|
| Rate for Payer: PHP All Commercial |
$692.45
|
| Rate for Payer: Sagamore Health Network All Products |
$704.87
|
| Rate for Payer: Signature Care EPO |
$757.83
|
| Rate for Payer: Signature Care PPO |
$803.48
|
| Rate for Payer: United Healthcare Commercial |
$719.48
|
|
|
HC X-RAY EXAM OF JAW <4 VIEWS
|
Facility
OP
|
$913.04
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
01610100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.20 |
| Max. Negotiated Rate |
$849.13 |
| Rate for Payer: Aetna Commercial |
$770.61
|
| Rate for Payer: Aetna Medicare |
$301.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$301.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$524.36
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$570.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$70.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$346.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$331.43
|
| Rate for Payer: Cash Price |
$566.09
|
| Rate for Payer: Cash Price |
$566.09
|
| Rate for Payer: Centivo All Commercial |
$465.65
|
| Rate for Payer: Cigna All Commercial |
$787.96
|
| Rate for Payer: CORVEL All Commercial |
$849.13
|
| Rate for Payer: Coventry All Commercial |
$803.48
|
| Rate for Payer: Encore All Commercial |
$840.46
|
| Rate for Payer: Frontpath All Commercial |
$840.00
|
| Rate for Payer: Humana ChoiceCare |
$788.60
|
| Rate for Payer: Humana Medicare |
$465.65
|
| Rate for Payer: Lucent All Commercial |
$465.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$821.74
|
| Rate for Payer: Managed Health Services Medicaid |
$70.20
|
| Rate for Payer: MDWise Medicaid |
$70.20
|
| Rate for Payer: PHCS All Commercial |
$684.78
|
| Rate for Payer: PHP All Commercial |
$692.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$356.09
|
| Rate for Payer: Sagamore Health Network All Products |
$704.87
|
| Rate for Payer: Signature Care EPO |
$757.83
|
| Rate for Payer: Signature Care PPO |
$803.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$776.09
|
| Rate for Payer: United Healthcare Commercial |
$719.48
|
| Rate for Payer: United Healthcare Medicare |
$301.30
|
|
|
HC X-RAY EXAM OF LOWER LEG 2 VIEWS BIL LTD
|
Facility
IP
|
$467.35
|
|
|
Service Code
|
CPT 73590 52,50
|
| Hospital Charge Code |
21618035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$350.52 |
| Max. Negotiated Rate |
$434.64 |
| Rate for Payer: Aetna Commercial |
$403.79
|
| Rate for Payer: Cash Price |
$289.76
|
| Rate for Payer: Cigna All Commercial |
$403.33
|
| Rate for Payer: CORVEL All Commercial |
$434.64
|
| Rate for Payer: Coventry All Commercial |
$411.27
|
| Rate for Payer: Encore All Commercial |
$430.20
|
| Rate for Payer: Frontpath All Commercial |
$429.97
|
| Rate for Payer: Humana ChoiceCare |
$403.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$420.62
|
| Rate for Payer: PHCS All Commercial |
$350.52
|
| Rate for Payer: PHP All Commercial |
$354.44
|
| Rate for Payer: Sagamore Health Network All Products |
$360.80
|
| Rate for Payer: Signature Care EPO |
$387.90
|
| Rate for Payer: Signature Care PPO |
$411.27
|
| Rate for Payer: United Healthcare Commercial |
$368.27
|
|
|
HC X-RAY EXAM OF LOWER LEG 2 VIEWS BIL LTD
|
Facility
OP
|
$467.35
|
|
|
Service Code
|
CPT 73590 52,50
|
| Hospital Charge Code |
21618035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$154.23 |
| Max. Negotiated Rate |
$434.64 |
| Rate for Payer: Aetna Commercial |
$394.45
|
| Rate for Payer: Aetna Medicare |
$154.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$154.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$268.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$292.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$177.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$169.65
|
| Rate for Payer: Cash Price |
$289.76
|
| Rate for Payer: Centivo All Commercial |
$238.35
|
| Rate for Payer: Cigna All Commercial |
$403.33
|
| Rate for Payer: CORVEL All Commercial |
$434.64
|
| Rate for Payer: Coventry All Commercial |
$411.27
|
| Rate for Payer: Encore All Commercial |
$430.20
|
| Rate for Payer: Frontpath All Commercial |
$429.97
|
| Rate for Payer: Humana ChoiceCare |
$403.65
|
| Rate for Payer: Humana Medicare |
$238.35
|
| Rate for Payer: Lucent All Commercial |
$238.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$420.62
|
| Rate for Payer: PHCS All Commercial |
$350.52
|
| Rate for Payer: PHP All Commercial |
$354.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$182.27
|
| Rate for Payer: Sagamore Health Network All Products |
$360.80
|
| Rate for Payer: Signature Care EPO |
$387.90
|
| Rate for Payer: Signature Care PPO |
$411.27
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$397.25
|
| Rate for Payer: United Healthcare Commercial |
$368.27
|
| Rate for Payer: United Healthcare Medicare |
$154.23
|
|
|
HC X-RAY EXAM OF LOWER LEG 2 VIEWS LT LTD
|
Facility
OP
|
$311.57
|
|
|
Service Code
|
CPT 73590 LT,52
|
| Hospital Charge Code |
01618035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.82 |
| Max. Negotiated Rate |
$289.76 |
| Rate for Payer: Aetna Commercial |
$262.96
|
| Rate for Payer: Aetna Medicare |
$102.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$102.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$178.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$194.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.10
|
| Rate for Payer: Cash Price |
$193.17
|
| Rate for Payer: Centivo All Commercial |
$158.90
|
| Rate for Payer: Cigna All Commercial |
$268.88
|
| Rate for Payer: CORVEL All Commercial |
$289.76
|
| Rate for Payer: Coventry All Commercial |
$274.18
|
| Rate for Payer: Encore All Commercial |
$286.80
|
| Rate for Payer: Frontpath All Commercial |
$286.64
|
| Rate for Payer: Humana ChoiceCare |
$269.10
|
| Rate for Payer: Humana Medicare |
$158.90
|
| Rate for Payer: Lucent All Commercial |
$158.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$280.41
|
| Rate for Payer: PHCS All Commercial |
$233.68
|
| Rate for Payer: PHP All Commercial |
$236.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.51
|
| Rate for Payer: Sagamore Health Network All Products |
$240.53
|
| Rate for Payer: Signature Care EPO |
$258.60
|
| Rate for Payer: Signature Care PPO |
$274.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$264.83
|
| Rate for Payer: United Healthcare Commercial |
$245.52
|
| Rate for Payer: United Healthcare Medicare |
$102.82
|
|
|
HC X-RAY EXAM OF LOWER LEG 2 VIEWS LT LTD
|
Facility
IP
|
$311.57
|
|
|
Service Code
|
CPT 73590 LT,52
|
| Hospital Charge Code |
01618035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$233.68 |
| Max. Negotiated Rate |
$289.76 |
| Rate for Payer: Aetna Commercial |
$269.20
|
| Rate for Payer: Cash Price |
$193.17
|
| Rate for Payer: Cigna All Commercial |
$268.88
|
| Rate for Payer: CORVEL All Commercial |
$289.76
|
| Rate for Payer: Coventry All Commercial |
$274.18
|
| Rate for Payer: Encore All Commercial |
$286.80
|
| Rate for Payer: Frontpath All Commercial |
$286.64
|
| Rate for Payer: Humana ChoiceCare |
$269.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$280.41
|
| Rate for Payer: PHCS All Commercial |
$233.68
|
| Rate for Payer: PHP All Commercial |
$236.29
|
| Rate for Payer: Sagamore Health Network All Products |
$240.53
|
| Rate for Payer: Signature Care EPO |
$258.60
|
| Rate for Payer: Signature Care PPO |
$274.18
|
| Rate for Payer: United Healthcare Commercial |
$245.52
|
|
|
HC X-RAY EXAM OF LOWER LEG 2 VIEWS RT LTD
|
Facility
IP
|
$311.57
|
|
|
Service Code
|
CPT 73590 RT,52
|
| Hospital Charge Code |
11618035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$233.68 |
| Max. Negotiated Rate |
$289.76 |
| Rate for Payer: Aetna Commercial |
$269.20
|
| Rate for Payer: Cash Price |
$193.17
|
| Rate for Payer: Cigna All Commercial |
$268.88
|
| Rate for Payer: CORVEL All Commercial |
$289.76
|
| Rate for Payer: Coventry All Commercial |
$274.18
|
| Rate for Payer: Encore All Commercial |
$286.80
|
| Rate for Payer: Frontpath All Commercial |
$286.64
|
| Rate for Payer: Humana ChoiceCare |
$269.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$280.41
|
| Rate for Payer: PHCS All Commercial |
$233.68
|
| Rate for Payer: PHP All Commercial |
$236.29
|
| Rate for Payer: Sagamore Health Network All Products |
$240.53
|
| Rate for Payer: Signature Care EPO |
$258.60
|
| Rate for Payer: Signature Care PPO |
$274.18
|
| Rate for Payer: United Healthcare Commercial |
$245.52
|
|
|
HC X-RAY EXAM OF LOWER LEG 2 VIEWS RT LTD
|
Facility
OP
|
$311.57
|
|
|
Service Code
|
CPT 73590 RT,52
|
| Hospital Charge Code |
11618035
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$102.82 |
| Max. Negotiated Rate |
$289.76 |
| Rate for Payer: Aetna Commercial |
$262.96
|
| Rate for Payer: Aetna Medicare |
$102.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$102.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$178.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$194.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.10
|
| Rate for Payer: Cash Price |
$193.17
|
| Rate for Payer: Centivo All Commercial |
$158.90
|
| Rate for Payer: Cigna All Commercial |
$268.88
|
| Rate for Payer: CORVEL All Commercial |
$289.76
|
| Rate for Payer: Coventry All Commercial |
$274.18
|
| Rate for Payer: Encore All Commercial |
$286.80
|
| Rate for Payer: Frontpath All Commercial |
$286.64
|
| Rate for Payer: Humana ChoiceCare |
$269.10
|
| Rate for Payer: Humana Medicare |
$158.90
|
| Rate for Payer: Lucent All Commercial |
$158.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$280.41
|
| Rate for Payer: PHCS All Commercial |
$233.68
|
| Rate for Payer: PHP All Commercial |
$236.29
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$121.51
|
| Rate for Payer: Sagamore Health Network All Products |
$240.53
|
| Rate for Payer: Signature Care EPO |
$258.60
|
| Rate for Payer: Signature Care PPO |
$274.18
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$264.83
|
| Rate for Payer: United Healthcare Commercial |
$245.52
|
| Rate for Payer: United Healthcare Medicare |
$102.82
|
|
|
HC X-RAY EXAM OF SHOULDER 2 VIEWS BIL LTD
|
Facility
IP
|
$584.74
|
|
|
Service Code
|
CPT 73030 52,50
|
| Hospital Charge Code |
01618030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$438.55 |
| Max. Negotiated Rate |
$543.80 |
| Rate for Payer: Aetna Commercial |
$505.21
|
| Rate for Payer: Cash Price |
$362.54
|
| Rate for Payer: Cigna All Commercial |
$504.63
|
| Rate for Payer: CORVEL All Commercial |
$543.80
|
| Rate for Payer: Coventry All Commercial |
$514.57
|
| Rate for Payer: Encore All Commercial |
$538.25
|
| Rate for Payer: Frontpath All Commercial |
$537.96
|
| Rate for Payer: Humana ChoiceCare |
$505.04
|
| Rate for Payer: Lutheran Preferred All Commercial |
$526.26
|
| Rate for Payer: PHCS All Commercial |
$438.55
|
| Rate for Payer: PHP All Commercial |
$443.46
|
| Rate for Payer: Sagamore Health Network All Products |
$451.42
|
| Rate for Payer: Signature Care EPO |
$485.33
|
| Rate for Payer: Signature Care PPO |
$514.57
|
| Rate for Payer: United Healthcare Commercial |
$460.77
|
|
|
HC X-RAY EXAM OF SHOULDER 2 VIEWS BIL LTD
|
Facility
OP
|
$584.74
|
|
|
Service Code
|
CPT 73030 52,50
|
| Hospital Charge Code |
01618030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$192.96 |
| Max. Negotiated Rate |
$543.80 |
| Rate for Payer: Aetna Commercial |
$493.52
|
| Rate for Payer: Aetna Medicare |
$192.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$192.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$335.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$365.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$221.91
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$212.26
|
| Rate for Payer: Cash Price |
$362.54
|
| Rate for Payer: Centivo All Commercial |
$298.22
|
| Rate for Payer: Cigna All Commercial |
$504.63
|
| Rate for Payer: CORVEL All Commercial |
$543.80
|
| Rate for Payer: Coventry All Commercial |
$514.57
|
| Rate for Payer: Encore All Commercial |
$538.25
|
| Rate for Payer: Frontpath All Commercial |
$537.96
|
| Rate for Payer: Humana ChoiceCare |
$505.04
|
| Rate for Payer: Humana Medicare |
$298.22
|
| Rate for Payer: Lucent All Commercial |
$298.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$526.26
|
| Rate for Payer: PHCS All Commercial |
$438.55
|
| Rate for Payer: PHP All Commercial |
$443.46
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$228.05
|
| Rate for Payer: Sagamore Health Network All Products |
$451.42
|
| Rate for Payer: Signature Care EPO |
$485.33
|
| Rate for Payer: Signature Care PPO |
$514.57
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$497.03
|
| Rate for Payer: United Healthcare Commercial |
$460.77
|
| Rate for Payer: United Healthcare Medicare |
$192.96
|
|
|
HC X-RAY-EYE-FOREIGN BODY
|
Facility
OP
|
$485.24
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
01610030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.64 |
| Max. Negotiated Rate |
$451.28 |
| Rate for Payer: Aetna Commercial |
$409.55
|
| Rate for Payer: Aetna Medicare |
$160.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$160.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$278.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$303.33
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$57.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$184.15
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$176.14
|
| Rate for Payer: Cash Price |
$300.85
|
| Rate for Payer: Cash Price |
$300.85
|
| Rate for Payer: Centivo All Commercial |
$247.47
|
| Rate for Payer: Cigna All Commercial |
$418.77
|
| Rate for Payer: CORVEL All Commercial |
$451.28
|
| Rate for Payer: Coventry All Commercial |
$427.02
|
| Rate for Payer: Encore All Commercial |
$446.67
|
| Rate for Payer: Frontpath All Commercial |
$446.43
|
| Rate for Payer: Humana ChoiceCare |
$419.11
|
| Rate for Payer: Humana Medicare |
$247.47
|
| Rate for Payer: Lucent All Commercial |
$247.47
|
| Rate for Payer: Lutheran Preferred All Commercial |
$436.72
|
| Rate for Payer: Managed Health Services Medicaid |
$57.64
|
| Rate for Payer: MDWise Medicaid |
$57.64
|
| Rate for Payer: PHCS All Commercial |
$363.93
|
| Rate for Payer: PHP All Commercial |
$368.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$189.25
|
| Rate for Payer: Sagamore Health Network All Products |
$374.61
|
| Rate for Payer: Signature Care EPO |
$402.75
|
| Rate for Payer: Signature Care PPO |
$427.02
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$412.46
|
| Rate for Payer: United Healthcare Commercial |
$382.37
|
| Rate for Payer: United Healthcare Medicare |
$160.13
|
|
|
HC X-RAY-EYE-FOREIGN BODY
|
Facility
IP
|
$485.24
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
01610030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$363.93 |
| Max. Negotiated Rate |
$451.28 |
| Rate for Payer: Aetna Commercial |
$419.25
|
| Rate for Payer: Cash Price |
$300.85
|
| Rate for Payer: Cigna All Commercial |
$418.77
|
| Rate for Payer: CORVEL All Commercial |
$451.28
|
| Rate for Payer: Coventry All Commercial |
$427.02
|
| Rate for Payer: Encore All Commercial |
$446.67
|
| Rate for Payer: Frontpath All Commercial |
$446.43
|
| Rate for Payer: Humana ChoiceCare |
$419.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$436.72
|
| Rate for Payer: PHCS All Commercial |
$363.93
|
| Rate for Payer: PHP All Commercial |
$368.01
|
| Rate for Payer: Sagamore Health Network All Products |
$374.61
|
| Rate for Payer: Signature Care EPO |
$402.75
|
| Rate for Payer: Signature Care PPO |
$427.02
|
| Rate for Payer: United Healthcare Commercial |
$382.37
|
|
|
HC X-RAY-FACIAL BONES < 3 VIEWS
|
Facility
IP
|
$538.90
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
01610140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$404.17 |
| Max. Negotiated Rate |
$501.17 |
| Rate for Payer: Aetna Commercial |
$465.61
|
| Rate for Payer: Cash Price |
$334.12
|
| Rate for Payer: Cigna All Commercial |
$465.07
|
| Rate for Payer: CORVEL All Commercial |
$501.17
|
| Rate for Payer: Coventry All Commercial |
$474.23
|
| Rate for Payer: Encore All Commercial |
$496.05
|
| Rate for Payer: Frontpath All Commercial |
$495.78
|
| Rate for Payer: Humana ChoiceCare |
$465.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$485.01
|
| Rate for Payer: PHCS All Commercial |
$404.17
|
| Rate for Payer: PHP All Commercial |
$408.70
|
| Rate for Payer: Sagamore Health Network All Products |
$416.03
|
| Rate for Payer: Signature Care EPO |
$447.28
|
| Rate for Payer: Signature Care PPO |
$474.23
|
| Rate for Payer: United Healthcare Commercial |
$424.65
|
|
|
HC X-RAY-FACIAL BONES < 3 VIEWS
|
Facility
OP
|
$538.90
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
01610140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.76 |
| Max. Negotiated Rate |
$501.17 |
| Rate for Payer: Aetna Commercial |
$454.83
|
| Rate for Payer: Aetna Medicare |
$177.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$177.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$309.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$336.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$54.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$204.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$195.62
|
| Rate for Payer: Cash Price |
$334.12
|
| Rate for Payer: Cash Price |
$334.12
|
| Rate for Payer: Centivo All Commercial |
$274.84
|
| Rate for Payer: Cigna All Commercial |
$465.07
|
| Rate for Payer: CORVEL All Commercial |
$501.17
|
| Rate for Payer: Coventry All Commercial |
$474.23
|
| Rate for Payer: Encore All Commercial |
$496.05
|
| Rate for Payer: Frontpath All Commercial |
$495.78
|
| Rate for Payer: Humana ChoiceCare |
$465.44
|
| Rate for Payer: Humana Medicare |
$274.84
|
| Rate for Payer: Lucent All Commercial |
$274.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$485.01
|
| Rate for Payer: Managed Health Services Medicaid |
$54.76
|
| Rate for Payer: MDWise Medicaid |
$54.76
|
| Rate for Payer: PHCS All Commercial |
$404.17
|
| Rate for Payer: PHP All Commercial |
$408.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$210.17
|
| Rate for Payer: Sagamore Health Network All Products |
$416.03
|
| Rate for Payer: Signature Care EPO |
$447.28
|
| Rate for Payer: Signature Care PPO |
$474.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$458.06
|
| Rate for Payer: United Healthcare Commercial |
$424.65
|
| Rate for Payer: United Healthcare Medicare |
$177.84
|
|
|
HC X-RAY-FACIAL BONES 3+ VIEWS
|
Facility
OP
|
$622.16
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
01610150
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.78 |
| Max. Negotiated Rate |
$578.61 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Medicare |
$205.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$205.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$357.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$388.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$81.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$236.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$225.84
|
| Rate for Payer: Cash Price |
$385.74
|
| Rate for Payer: Cash Price |
$385.74
|
| Rate for Payer: Centivo All Commercial |
$317.30
|
| Rate for Payer: Cigna All Commercial |
$536.92
|
| Rate for Payer: CORVEL All Commercial |
$578.61
|
| Rate for Payer: Coventry All Commercial |
$547.50
|
| Rate for Payer: Encore All Commercial |
$572.70
|
| Rate for Payer: Frontpath All Commercial |
$572.39
|
| Rate for Payer: Humana ChoiceCare |
$537.36
|
| Rate for Payer: Humana Medicare |
$317.30
|
| Rate for Payer: Lucent All Commercial |
$317.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$559.94
|
| Rate for Payer: Managed Health Services Medicaid |
$81.78
|
| Rate for Payer: MDWise Medicaid |
$81.78
|
| Rate for Payer: PHCS All Commercial |
$466.62
|
| Rate for Payer: PHP All Commercial |
$471.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$242.64
|
| Rate for Payer: Sagamore Health Network All Products |
$480.31
|
| Rate for Payer: Signature Care EPO |
$516.39
|
| Rate for Payer: Signature Care PPO |
$547.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$528.84
|
| Rate for Payer: United Healthcare Commercial |
$490.26
|
| Rate for Payer: United Healthcare Medicare |
$205.31
|
|
