|
HC X-RAY-FACIAL BONES 3+ VIEWS
|
Facility
IP
|
$622.16
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
01610150
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$466.62 |
| Max. Negotiated Rate |
$578.61 |
| Rate for Payer: Aetna Commercial |
$537.55
|
| Rate for Payer: Cash Price |
$385.74
|
| 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: Lutheran Preferred All Commercial |
$559.94
|
| Rate for Payer: PHCS All Commercial |
$466.62
|
| Rate for Payer: PHP All Commercial |
$471.85
|
| 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: United Healthcare Commercial |
$490.26
|
|
|
HC X-RAY FB IN EYE 1V BIL
|
Facility
IP
|
$250.98
|
|
|
Service Code
|
CPT 70030 50
|
| Hospital Charge Code |
01615031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$188.24 |
| Max. Negotiated Rate |
$233.41 |
| Rate for Payer: Aetna Commercial |
$216.85
|
| Rate for Payer: Cash Price |
$155.61
|
| Rate for Payer: Cigna All Commercial |
$216.60
|
| Rate for Payer: CORVEL All Commercial |
$233.41
|
| Rate for Payer: Coventry All Commercial |
$220.86
|
| Rate for Payer: Encore All Commercial |
$231.03
|
| Rate for Payer: Frontpath All Commercial |
$230.90
|
| Rate for Payer: Humana ChoiceCare |
$216.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$225.88
|
| Rate for Payer: PHCS All Commercial |
$188.24
|
| Rate for Payer: PHP All Commercial |
$190.34
|
| Rate for Payer: Sagamore Health Network All Products |
$193.76
|
| Rate for Payer: Signature Care EPO |
$208.31
|
| Rate for Payer: Signature Care PPO |
$220.86
|
| Rate for Payer: United Healthcare Commercial |
$197.77
|
|
|
HC X-RAY FB IN EYE 1V BIL
|
Facility
OP
|
$250.98
|
|
|
Service Code
|
CPT 70030 50
|
| Hospital Charge Code |
01615031
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.82 |
| Max. Negotiated Rate |
$233.41 |
| Rate for Payer: Aetna Commercial |
$211.83
|
| Rate for Payer: Aetna Medicare |
$82.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$82.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$144.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$156.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$95.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$91.11
|
| Rate for Payer: Cash Price |
$155.61
|
| Rate for Payer: Centivo All Commercial |
$128.00
|
| Rate for Payer: Cigna All Commercial |
$216.60
|
| Rate for Payer: CORVEL All Commercial |
$233.41
|
| Rate for Payer: Coventry All Commercial |
$220.86
|
| Rate for Payer: Encore All Commercial |
$231.03
|
| Rate for Payer: Frontpath All Commercial |
$230.90
|
| Rate for Payer: Humana ChoiceCare |
$216.77
|
| Rate for Payer: Humana Medicare |
$128.00
|
| Rate for Payer: Lucent All Commercial |
$128.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$225.88
|
| Rate for Payer: PHCS All Commercial |
$188.24
|
| Rate for Payer: PHP All Commercial |
$190.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$97.88
|
| Rate for Payer: Sagamore Health Network All Products |
$193.76
|
| Rate for Payer: Signature Care EPO |
$208.31
|
| Rate for Payer: Signature Care PPO |
$220.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$213.33
|
| Rate for Payer: United Healthcare Commercial |
$197.77
|
| Rate for Payer: United Healthcare Medicare |
$82.82
|
|
|
HC X-RAY FB IN EYE 3V BIL
|
Facility
OP
|
$334.64
|
|
|
Service Code
|
CPT 70030 50
|
| Hospital Charge Code |
01615030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.43 |
| Max. Negotiated Rate |
$311.22 |
| Rate for Payer: Aetna Commercial |
$282.44
|
| Rate for Payer: Aetna Medicare |
$110.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$192.18
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$209.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$127.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.47
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Centivo All Commercial |
$170.67
|
| Rate for Payer: Cigna All Commercial |
$288.80
|
| Rate for Payer: CORVEL All Commercial |
$311.22
|
| Rate for Payer: Coventry All Commercial |
$294.48
|
| Rate for Payer: Encore All Commercial |
$308.04
|
| Rate for Payer: Frontpath All Commercial |
$307.87
|
| Rate for Payer: Humana ChoiceCare |
$289.03
|
| Rate for Payer: Humana Medicare |
$170.67
|
| Rate for Payer: Lucent All Commercial |
$170.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$301.18
|
| Rate for Payer: PHCS All Commercial |
$250.98
|
| Rate for Payer: PHP All Commercial |
$253.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$130.51
|
| Rate for Payer: Sagamore Health Network All Products |
$258.34
|
| Rate for Payer: Signature Care EPO |
$277.75
|
| Rate for Payer: Signature Care PPO |
$294.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$284.45
|
| Rate for Payer: United Healthcare Commercial |
$263.70
|
| Rate for Payer: United Healthcare Medicare |
$110.43
|
|
|
HC X-RAY FB IN EYE 3V BIL
|
Facility
IP
|
$334.64
|
|
|
Service Code
|
CPT 70030 50
|
| Hospital Charge Code |
01615030
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$250.98 |
| Max. Negotiated Rate |
$311.22 |
| Rate for Payer: Aetna Commercial |
$289.13
|
| Rate for Payer: Cash Price |
$207.48
|
| Rate for Payer: Cigna All Commercial |
$288.80
|
| Rate for Payer: CORVEL All Commercial |
$311.22
|
| Rate for Payer: Coventry All Commercial |
$294.48
|
| Rate for Payer: Encore All Commercial |
$308.04
|
| Rate for Payer: Frontpath All Commercial |
$307.87
|
| Rate for Payer: Humana ChoiceCare |
$289.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$301.18
|
| Rate for Payer: PHCS All Commercial |
$250.98
|
| Rate for Payer: PHP All Commercial |
$253.79
|
| Rate for Payer: Sagamore Health Network All Products |
$258.34
|
| Rate for Payer: Signature Care EPO |
$277.75
|
| Rate for Payer: Signature Care PPO |
$294.48
|
| Rate for Payer: United Healthcare Commercial |
$263.70
|
|
|
HC X-RAY-FEMUR 1 VIEW BILATERAL
|
Facility
IP
|
$575.79
|
|
|
Service Code
|
CPT 73551 50
|
| Hospital Charge Code |
21613551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$431.84 |
| Max. Negotiated Rate |
$535.48 |
| Rate for Payer: Aetna Commercial |
$497.48
|
| Rate for Payer: Cash Price |
$356.99
|
| Rate for Payer: Cigna All Commercial |
$496.91
|
| Rate for Payer: CORVEL All Commercial |
$535.48
|
| Rate for Payer: Coventry All Commercial |
$506.70
|
| Rate for Payer: Encore All Commercial |
$530.01
|
| Rate for Payer: Frontpath All Commercial |
$529.73
|
| Rate for Payer: Humana ChoiceCare |
$497.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$518.21
|
| Rate for Payer: PHCS All Commercial |
$431.84
|
| Rate for Payer: PHP All Commercial |
$436.68
|
| Rate for Payer: Sagamore Health Network All Products |
$444.51
|
| Rate for Payer: Signature Care EPO |
$477.91
|
| Rate for Payer: Signature Care PPO |
$506.70
|
| Rate for Payer: United Healthcare Commercial |
$453.72
|
|
|
HC X-RAY-FEMUR 1 VIEW BILATERAL
|
Facility
OP
|
$575.79
|
|
|
Service Code
|
CPT 73551 50
|
| Hospital Charge Code |
21613551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$190.01 |
| Max. Negotiated Rate |
$535.48 |
| Rate for Payer: Aetna Commercial |
$485.97
|
| Rate for Payer: Aetna Medicare |
$190.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$190.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$330.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$359.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$218.51
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$209.01
|
| Rate for Payer: Cash Price |
$356.99
|
| Rate for Payer: Centivo All Commercial |
$293.65
|
| Rate for Payer: Cigna All Commercial |
$496.91
|
| Rate for Payer: CORVEL All Commercial |
$535.48
|
| Rate for Payer: Coventry All Commercial |
$506.70
|
| Rate for Payer: Encore All Commercial |
$530.01
|
| Rate for Payer: Frontpath All Commercial |
$529.73
|
| Rate for Payer: Humana ChoiceCare |
$497.31
|
| Rate for Payer: Humana Medicare |
$293.65
|
| Rate for Payer: Lucent All Commercial |
$293.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$518.21
|
| Rate for Payer: PHCS All Commercial |
$431.84
|
| Rate for Payer: PHP All Commercial |
$436.68
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$224.56
|
| Rate for Payer: Sagamore Health Network All Products |
$444.51
|
| Rate for Payer: Signature Care EPO |
$477.91
|
| Rate for Payer: Signature Care PPO |
$506.70
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$489.42
|
| Rate for Payer: United Healthcare Commercial |
$453.72
|
| Rate for Payer: United Healthcare Medicare |
$190.01
|
|
|
HC X-RAY-FEMUR 1 VIEW LT
|
Facility
OP
|
$383.87
|
|
|
Service Code
|
CPT 73551 LT
|
| Hospital Charge Code |
01613551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.68 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Aetna Commercial |
$323.98
|
| Rate for Payer: Aetna Medicare |
$126.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$220.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$239.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.34
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Centivo All Commercial |
$195.77
|
| Rate for Payer: Cigna All Commercial |
$331.28
|
| Rate for Payer: CORVEL All Commercial |
$357.00
|
| Rate for Payer: Coventry All Commercial |
$337.80
|
| Rate for Payer: Encore All Commercial |
$353.35
|
| Rate for Payer: Frontpath All Commercial |
$353.16
|
| Rate for Payer: Humana ChoiceCare |
$331.55
|
| Rate for Payer: Humana Medicare |
$195.77
|
| Rate for Payer: Lucent All Commercial |
$195.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$345.48
|
| Rate for Payer: PHCS All Commercial |
$287.90
|
| Rate for Payer: PHP All Commercial |
$291.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.71
|
| Rate for Payer: Sagamore Health Network All Products |
$296.35
|
| Rate for Payer: Signature Care EPO |
$318.61
|
| Rate for Payer: Signature Care PPO |
$337.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$326.29
|
| Rate for Payer: United Healthcare Commercial |
$302.49
|
| Rate for Payer: United Healthcare Medicare |
$126.68
|
|
|
HC X-RAY-FEMUR 1 VIEW LT
|
Facility
IP
|
$383.87
|
|
|
Service Code
|
CPT 73551 LT
|
| Hospital Charge Code |
01613551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$287.90 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Aetna Commercial |
$331.66
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cigna All Commercial |
$331.28
|
| Rate for Payer: CORVEL All Commercial |
$357.00
|
| Rate for Payer: Coventry All Commercial |
$337.80
|
| Rate for Payer: Encore All Commercial |
$353.35
|
| Rate for Payer: Frontpath All Commercial |
$353.16
|
| Rate for Payer: Humana ChoiceCare |
$331.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$345.48
|
| Rate for Payer: PHCS All Commercial |
$287.90
|
| Rate for Payer: PHP All Commercial |
$291.12
|
| Rate for Payer: Sagamore Health Network All Products |
$296.35
|
| Rate for Payer: Signature Care EPO |
$318.61
|
| Rate for Payer: Signature Care PPO |
$337.80
|
| Rate for Payer: United Healthcare Commercial |
$302.49
|
|
|
HC X-RAY-FEMUR 1 VIEW RT
|
Facility
OP
|
$383.87
|
|
|
Service Code
|
CPT 73551 RT
|
| Hospital Charge Code |
11613551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.68 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Aetna Commercial |
$323.98
|
| Rate for Payer: Aetna Medicare |
$126.68
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$220.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$239.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$145.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.34
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Centivo All Commercial |
$195.77
|
| Rate for Payer: Cigna All Commercial |
$331.28
|
| Rate for Payer: CORVEL All Commercial |
$357.00
|
| Rate for Payer: Coventry All Commercial |
$337.80
|
| Rate for Payer: Encore All Commercial |
$353.35
|
| Rate for Payer: Frontpath All Commercial |
$353.16
|
| Rate for Payer: Humana ChoiceCare |
$331.55
|
| Rate for Payer: Humana Medicare |
$195.77
|
| Rate for Payer: Lucent All Commercial |
$195.77
|
| Rate for Payer: Lutheran Preferred All Commercial |
$345.48
|
| Rate for Payer: PHCS All Commercial |
$287.90
|
| Rate for Payer: PHP All Commercial |
$291.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$149.71
|
| Rate for Payer: Sagamore Health Network All Products |
$296.35
|
| Rate for Payer: Signature Care EPO |
$318.61
|
| Rate for Payer: Signature Care PPO |
$337.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$326.29
|
| Rate for Payer: United Healthcare Commercial |
$302.49
|
| Rate for Payer: United Healthcare Medicare |
$126.68
|
|
|
HC X-RAY-FEMUR 1 VIEW RT
|
Facility
IP
|
$383.87
|
|
|
Service Code
|
CPT 73551 RT
|
| Hospital Charge Code |
11613551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$287.90 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Aetna Commercial |
$331.66
|
| Rate for Payer: Cash Price |
$238.00
|
| Rate for Payer: Cigna All Commercial |
$331.28
|
| Rate for Payer: CORVEL All Commercial |
$357.00
|
| Rate for Payer: Coventry All Commercial |
$337.80
|
| Rate for Payer: Encore All Commercial |
$353.35
|
| Rate for Payer: Frontpath All Commercial |
$353.16
|
| Rate for Payer: Humana ChoiceCare |
$331.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$345.48
|
| Rate for Payer: PHCS All Commercial |
$287.90
|
| Rate for Payer: PHP All Commercial |
$291.12
|
| Rate for Payer: Sagamore Health Network All Products |
$296.35
|
| Rate for Payer: Signature Care EPO |
$318.61
|
| Rate for Payer: Signature Care PPO |
$337.80
|
| Rate for Payer: United Healthcare Commercial |
$302.49
|
|
|
HC X-RAY-FEMUR 2 VIEWS BI
|
Facility
OP
|
$767.71
|
|
|
Service Code
|
CPT 73552 50
|
| Hospital Charge Code |
21613550
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$253.35 |
| Max. Negotiated Rate |
$713.97 |
| Rate for Payer: Aetna Commercial |
$647.95
|
| Rate for Payer: Aetna Medicare |
$253.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$253.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$440.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$479.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$291.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$278.68
|
| Rate for Payer: Cash Price |
$475.98
|
| Rate for Payer: Centivo All Commercial |
$391.53
|
| Rate for Payer: Cigna All Commercial |
$662.54
|
| Rate for Payer: CORVEL All Commercial |
$713.97
|
| Rate for Payer: Coventry All Commercial |
$675.59
|
| Rate for Payer: Encore All Commercial |
$706.68
|
| Rate for Payer: Frontpath All Commercial |
$706.30
|
| Rate for Payer: Humana ChoiceCare |
$663.07
|
| Rate for Payer: Humana Medicare |
$391.53
|
| Rate for Payer: Lucent All Commercial |
$391.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$690.94
|
| Rate for Payer: PHCS All Commercial |
$575.78
|
| Rate for Payer: PHP All Commercial |
$582.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$299.41
|
| Rate for Payer: Sagamore Health Network All Products |
$592.67
|
| Rate for Payer: Signature Care EPO |
$637.20
|
| Rate for Payer: Signature Care PPO |
$675.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$652.56
|
| Rate for Payer: United Healthcare Commercial |
$604.96
|
| Rate for Payer: United Healthcare Medicare |
$253.35
|
|
|
HC X-RAY-FEMUR 2 VIEWS BI
|
Facility
IP
|
$767.71
|
|
|
Service Code
|
CPT 73552 50
|
| Hospital Charge Code |
21613550
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$575.78 |
| Max. Negotiated Rate |
$713.97 |
| Rate for Payer: Aetna Commercial |
$663.30
|
| Rate for Payer: Cash Price |
$475.98
|
| Rate for Payer: Cigna All Commercial |
$662.54
|
| Rate for Payer: CORVEL All Commercial |
$713.97
|
| Rate for Payer: Coventry All Commercial |
$675.59
|
| Rate for Payer: Encore All Commercial |
$706.68
|
| Rate for Payer: Frontpath All Commercial |
$706.30
|
| Rate for Payer: Humana ChoiceCare |
$663.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$690.94
|
| Rate for Payer: PHCS All Commercial |
$575.78
|
| Rate for Payer: PHP All Commercial |
$582.23
|
| Rate for Payer: Sagamore Health Network All Products |
$592.67
|
| Rate for Payer: Signature Care EPO |
$637.20
|
| Rate for Payer: Signature Care PPO |
$675.59
|
| Rate for Payer: United Healthcare Commercial |
$604.96
|
|
|
HC X-RAY-FEMUR 2 VIEWS LT
|
Facility
IP
|
$479.68
|
|
|
Service Code
|
CPT 73552 LT
|
| Hospital Charge Code |
01613550
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$359.76 |
| Max. Negotiated Rate |
$446.10 |
| Rate for Payer: Aetna Commercial |
$414.44
|
| Rate for Payer: Cash Price |
$297.40
|
| Rate for Payer: Cigna All Commercial |
$413.96
|
| Rate for Payer: CORVEL All Commercial |
$446.10
|
| Rate for Payer: Coventry All Commercial |
$422.11
|
| Rate for Payer: Encore All Commercial |
$441.54
|
| Rate for Payer: Frontpath All Commercial |
$441.30
|
| Rate for Payer: Humana ChoiceCare |
$414.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$431.71
|
| Rate for Payer: PHCS All Commercial |
$359.76
|
| Rate for Payer: PHP All Commercial |
$363.79
|
| Rate for Payer: Sagamore Health Network All Products |
$370.31
|
| Rate for Payer: Signature Care EPO |
$398.13
|
| Rate for Payer: Signature Care PPO |
$422.11
|
| Rate for Payer: United Healthcare Commercial |
$377.98
|
|
|
HC X-RAY-FEMUR 2 VIEWS LT
|
Facility
OP
|
$479.68
|
|
|
Service Code
|
CPT 73552 LT
|
| Hospital Charge Code |
01613550
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$158.29 |
| Max. Negotiated Rate |
$446.10 |
| Rate for Payer: Aetna Commercial |
$404.85
|
| Rate for Payer: Aetna Medicare |
$158.29
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$158.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$275.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$299.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$182.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$174.12
|
| Rate for Payer: Cash Price |
$297.40
|
| Rate for Payer: Centivo All Commercial |
$244.63
|
| Rate for Payer: Cigna All Commercial |
$413.96
|
| Rate for Payer: CORVEL All Commercial |
$446.10
|
| Rate for Payer: Coventry All Commercial |
$422.11
|
| Rate for Payer: Encore All Commercial |
$441.54
|
| Rate for Payer: Frontpath All Commercial |
$441.30
|
| Rate for Payer: Humana ChoiceCare |
$414.30
|
| Rate for Payer: Humana Medicare |
$244.63
|
| Rate for Payer: Lucent All Commercial |
$244.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$431.71
|
| Rate for Payer: PHCS All Commercial |
$359.76
|
| Rate for Payer: PHP All Commercial |
$363.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$187.07
|
| Rate for Payer: Sagamore Health Network All Products |
$370.31
|
| Rate for Payer: Signature Care EPO |
$398.13
|
| Rate for Payer: Signature Care PPO |
$422.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$407.72
|
| Rate for Payer: United Healthcare Commercial |
$377.98
|
| Rate for Payer: United Healthcare Medicare |
$158.29
|
|
|
HC X-RAY-FEMUR 2 VIEWS RT
|
Facility
IP
|
$511.81
|
|
|
Service Code
|
CPT 73552 RT
|
| Hospital Charge Code |
11613550
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$383.85 |
| Max. Negotiated Rate |
$475.98 |
| Rate for Payer: Aetna Commercial |
$442.20
|
| Rate for Payer: Cash Price |
$317.32
|
| Rate for Payer: Cigna All Commercial |
$441.69
|
| Rate for Payer: CORVEL All Commercial |
$475.98
|
| Rate for Payer: Coventry All Commercial |
$450.39
|
| Rate for Payer: Encore All Commercial |
$471.12
|
| Rate for Payer: Frontpath All Commercial |
$470.86
|
| Rate for Payer: Humana ChoiceCare |
$442.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$460.62
|
| Rate for Payer: PHCS All Commercial |
$383.85
|
| Rate for Payer: PHP All Commercial |
$388.15
|
| Rate for Payer: Sagamore Health Network All Products |
$395.11
|
| Rate for Payer: Signature Care EPO |
$424.80
|
| Rate for Payer: Signature Care PPO |
$450.39
|
| Rate for Payer: United Healthcare Commercial |
$403.30
|
|
|
HC X-RAY-FEMUR 2 VIEWS RT
|
Facility
OP
|
$511.81
|
|
|
Service Code
|
CPT 73552 RT
|
| Hospital Charge Code |
11613550
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.90 |
| Max. Negotiated Rate |
$475.98 |
| Rate for Payer: Aetna Commercial |
$431.96
|
| Rate for Payer: Aetna Medicare |
$168.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$168.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$293.93
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$319.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$185.79
|
| Rate for Payer: Cash Price |
$317.32
|
| Rate for Payer: Centivo All Commercial |
$261.02
|
| Rate for Payer: Cigna All Commercial |
$441.69
|
| Rate for Payer: CORVEL All Commercial |
$475.98
|
| Rate for Payer: Coventry All Commercial |
$450.39
|
| Rate for Payer: Encore All Commercial |
$471.12
|
| Rate for Payer: Frontpath All Commercial |
$470.86
|
| Rate for Payer: Humana ChoiceCare |
$442.05
|
| Rate for Payer: Humana Medicare |
$261.02
|
| Rate for Payer: Lucent All Commercial |
$261.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$460.62
|
| Rate for Payer: PHCS All Commercial |
$383.85
|
| Rate for Payer: PHP All Commercial |
$388.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.60
|
| Rate for Payer: Sagamore Health Network All Products |
$395.11
|
| Rate for Payer: Signature Care EPO |
$424.80
|
| Rate for Payer: Signature Care PPO |
$450.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$435.03
|
| Rate for Payer: United Healthcare Commercial |
$403.30
|
| Rate for Payer: United Healthcare Medicare |
$168.90
|
|
|
HC X-RAY-FINGER 2+ VIEWS BI
|
Facility
OP
|
$667.16
|
|
|
Service Code
|
CPT 73140 50
|
| Hospital Charge Code |
21613140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$220.16 |
| Max. Negotiated Rate |
$620.46 |
| Rate for Payer: Aetna Commercial |
$563.08
|
| Rate for Payer: Aetna Medicare |
$220.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$220.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$383.15
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$417.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$253.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$242.18
|
| Rate for Payer: Cash Price |
$413.64
|
| Rate for Payer: Centivo All Commercial |
$340.25
|
| Rate for Payer: Cigna All Commercial |
$575.76
|
| Rate for Payer: CORVEL All Commercial |
$620.46
|
| Rate for Payer: Coventry All Commercial |
$587.10
|
| Rate for Payer: Encore All Commercial |
$614.12
|
| Rate for Payer: Frontpath All Commercial |
$613.79
|
| Rate for Payer: Humana ChoiceCare |
$576.23
|
| Rate for Payer: Humana Medicare |
$340.25
|
| Rate for Payer: Lucent All Commercial |
$340.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$600.45
|
| Rate for Payer: PHCS All Commercial |
$500.37
|
| Rate for Payer: PHP All Commercial |
$505.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$260.19
|
| Rate for Payer: Sagamore Health Network All Products |
$515.05
|
| Rate for Payer: Signature Care EPO |
$553.74
|
| Rate for Payer: Signature Care PPO |
$587.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$567.09
|
| Rate for Payer: United Healthcare Commercial |
$525.72
|
| Rate for Payer: United Healthcare Medicare |
$220.16
|
|
|
HC X-RAY-FINGER 2+ VIEWS BI
|
Facility
IP
|
$667.16
|
|
|
Service Code
|
CPT 73140 50
|
| Hospital Charge Code |
21613140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$500.37 |
| Max. Negotiated Rate |
$620.46 |
| Rate for Payer: Aetna Commercial |
$576.43
|
| Rate for Payer: Cash Price |
$413.64
|
| Rate for Payer: Cigna All Commercial |
$575.76
|
| Rate for Payer: CORVEL All Commercial |
$620.46
|
| Rate for Payer: Coventry All Commercial |
$587.10
|
| Rate for Payer: Encore All Commercial |
$614.12
|
| Rate for Payer: Frontpath All Commercial |
$613.79
|
| Rate for Payer: Humana ChoiceCare |
$576.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$600.45
|
| Rate for Payer: PHCS All Commercial |
$500.37
|
| Rate for Payer: PHP All Commercial |
$505.98
|
| Rate for Payer: Sagamore Health Network All Products |
$515.05
|
| Rate for Payer: Signature Care EPO |
$553.74
|
| Rate for Payer: Signature Care PPO |
$587.10
|
| Rate for Payer: United Healthcare Commercial |
$525.72
|
|
|
HC X-RAY-FINGER 2+ VIEWS LT
|
Facility
IP
|
$333.58
|
|
|
Service Code
|
CPT 73140 LT
|
| Hospital Charge Code |
01613140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$250.19 |
| Max. Negotiated Rate |
$310.23 |
| Rate for Payer: Aetna Commercial |
$288.21
|
| Rate for Payer: Cash Price |
$206.82
|
| Rate for Payer: Cigna All Commercial |
$287.88
|
| Rate for Payer: CORVEL All Commercial |
$310.23
|
| Rate for Payer: Coventry All Commercial |
$293.55
|
| Rate for Payer: Encore All Commercial |
$307.06
|
| Rate for Payer: Frontpath All Commercial |
$306.89
|
| Rate for Payer: Humana ChoiceCare |
$288.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$300.22
|
| Rate for Payer: PHCS All Commercial |
$250.19
|
| Rate for Payer: PHP All Commercial |
$252.99
|
| Rate for Payer: Sagamore Health Network All Products |
$257.52
|
| Rate for Payer: Signature Care EPO |
$276.87
|
| Rate for Payer: Signature Care PPO |
$293.55
|
| Rate for Payer: United Healthcare Commercial |
$262.86
|
|
|
HC X-RAY-FINGER 2+ VIEWS LT
|
Facility
OP
|
$333.58
|
|
|
Service Code
|
CPT 73140 LT
|
| Hospital Charge Code |
01613140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.08 |
| Max. Negotiated Rate |
$310.23 |
| Rate for Payer: Aetna Commercial |
$281.54
|
| Rate for Payer: Aetna Medicare |
$110.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$191.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$208.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$126.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.09
|
| Rate for Payer: Cash Price |
$206.82
|
| Rate for Payer: Centivo All Commercial |
$170.13
|
| Rate for Payer: Cigna All Commercial |
$287.88
|
| Rate for Payer: CORVEL All Commercial |
$310.23
|
| Rate for Payer: Coventry All Commercial |
$293.55
|
| Rate for Payer: Encore All Commercial |
$307.06
|
| Rate for Payer: Frontpath All Commercial |
$306.89
|
| Rate for Payer: Humana ChoiceCare |
$288.11
|
| Rate for Payer: Humana Medicare |
$170.13
|
| Rate for Payer: Lucent All Commercial |
$170.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$300.22
|
| Rate for Payer: PHCS All Commercial |
$250.19
|
| Rate for Payer: PHP All Commercial |
$252.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$130.10
|
| Rate for Payer: Sagamore Health Network All Products |
$257.52
|
| Rate for Payer: Signature Care EPO |
$276.87
|
| Rate for Payer: Signature Care PPO |
$293.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$283.54
|
| Rate for Payer: United Healthcare Commercial |
$262.86
|
| Rate for Payer: United Healthcare Medicare |
$110.08
|
|
|
HC X-RAY-FINGER 2+ VIEWS RT
|
Facility
OP
|
$333.58
|
|
|
Service Code
|
CPT 73140 RT
|
| Hospital Charge Code |
11613140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.08 |
| Max. Negotiated Rate |
$310.23 |
| Rate for Payer: Aetna Commercial |
$281.54
|
| Rate for Payer: Aetna Medicare |
$110.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$191.58
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$208.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$126.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$121.09
|
| Rate for Payer: Cash Price |
$206.82
|
| Rate for Payer: Centivo All Commercial |
$170.13
|
| Rate for Payer: Cigna All Commercial |
$287.88
|
| Rate for Payer: CORVEL All Commercial |
$310.23
|
| Rate for Payer: Coventry All Commercial |
$293.55
|
| Rate for Payer: Encore All Commercial |
$307.06
|
| Rate for Payer: Frontpath All Commercial |
$306.89
|
| Rate for Payer: Humana ChoiceCare |
$288.11
|
| Rate for Payer: Humana Medicare |
$170.13
|
| Rate for Payer: Lucent All Commercial |
$170.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$300.22
|
| Rate for Payer: PHCS All Commercial |
$250.19
|
| Rate for Payer: PHP All Commercial |
$252.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$130.10
|
| Rate for Payer: Sagamore Health Network All Products |
$257.52
|
| Rate for Payer: Signature Care EPO |
$276.87
|
| Rate for Payer: Signature Care PPO |
$293.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$283.54
|
| Rate for Payer: United Healthcare Commercial |
$262.86
|
| Rate for Payer: United Healthcare Medicare |
$110.08
|
|
|
HC X-RAY-FINGER 2+ VIEWS RT
|
Facility
IP
|
$333.58
|
|
|
Service Code
|
CPT 73140 RT
|
| Hospital Charge Code |
11613140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$250.19 |
| Max. Negotiated Rate |
$310.23 |
| Rate for Payer: Aetna Commercial |
$288.21
|
| Rate for Payer: Cash Price |
$206.82
|
| Rate for Payer: Cigna All Commercial |
$287.88
|
| Rate for Payer: CORVEL All Commercial |
$310.23
|
| Rate for Payer: Coventry All Commercial |
$293.55
|
| Rate for Payer: Encore All Commercial |
$307.06
|
| Rate for Payer: Frontpath All Commercial |
$306.89
|
| Rate for Payer: Humana ChoiceCare |
$288.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$300.22
|
| Rate for Payer: PHCS All Commercial |
$250.19
|
| Rate for Payer: PHP All Commercial |
$252.99
|
| Rate for Payer: Sagamore Health Network All Products |
$257.52
|
| Rate for Payer: Signature Care EPO |
$276.87
|
| Rate for Payer: Signature Care PPO |
$293.55
|
| Rate for Payer: United Healthcare Commercial |
$262.86
|
|
|
HC X-RAY-FLUORO ASSIST UP TO 1 HR
|
Facility
IP
|
$1,166.01
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
01616307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$874.51 |
| Max. Negotiated Rate |
$1,084.39 |
| Rate for Payer: Aetna Commercial |
$1,007.44
|
| Rate for Payer: Cash Price |
$722.93
|
| Rate for Payer: Cigna All Commercial |
$1,006.27
|
| Rate for Payer: CORVEL All Commercial |
$1,084.39
|
| Rate for Payer: Coventry All Commercial |
$1,026.09
|
| Rate for Payer: Encore All Commercial |
$1,073.31
|
| Rate for Payer: Frontpath All Commercial |
$1,072.73
|
| Rate for Payer: Humana ChoiceCare |
$1,007.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,049.41
|
| Rate for Payer: PHCS All Commercial |
$874.51
|
| Rate for Payer: PHP All Commercial |
$884.30
|
| Rate for Payer: Sagamore Health Network All Products |
$900.16
|
| Rate for Payer: Signature Care EPO |
$967.79
|
| Rate for Payer: Signature Care PPO |
$1,026.09
|
| Rate for Payer: United Healthcare Commercial |
$918.82
|
|
|
HC X-RAY-FLUORO ASSIST UP TO 1 HR
|
Facility
OP
|
$1,166.01
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
01616307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$1,084.39 |
| Rate for Payer: Aetna Commercial |
$984.11
|
| Rate for Payer: Aetna Medicare |
$384.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$384.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$669.64
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$728.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$114.66
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$442.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$423.26
|
| Rate for Payer: Cash Price |
$722.93
|
| Rate for Payer: Cash Price |
$722.93
|
| Rate for Payer: Centivo All Commercial |
$594.67
|
| Rate for Payer: Cigna All Commercial |
$1,006.27
|
| Rate for Payer: CORVEL All Commercial |
$1,084.39
|
| Rate for Payer: Coventry All Commercial |
$1,026.09
|
| Rate for Payer: Encore All Commercial |
$1,073.31
|
| Rate for Payer: Frontpath All Commercial |
$1,072.73
|
| Rate for Payer: Humana ChoiceCare |
$1,007.09
|
| Rate for Payer: Humana Medicare |
$594.67
|
| Rate for Payer: Lucent All Commercial |
$594.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,049.41
|
| Rate for Payer: Managed Health Services Medicaid |
$114.66
|
| Rate for Payer: MDWise Medicaid |
$114.66
|
| Rate for Payer: PHCS All Commercial |
$874.51
|
| Rate for Payer: PHP All Commercial |
$884.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$454.75
|
| Rate for Payer: Sagamore Health Network All Products |
$900.16
|
| Rate for Payer: Signature Care EPO |
$967.79
|
| Rate for Payer: Signature Care PPO |
$1,026.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$991.11
|
| Rate for Payer: United Healthcare Commercial |
$918.82
|
| Rate for Payer: United Healthcare Medicare |
$384.78
|
|
