|
HC X-RAY-FOOT 1 VIEW BI
|
Facility
IP
|
$491.19
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
21613620
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$368.39 |
| Max. Negotiated Rate |
$456.81 |
| Rate for Payer: Aetna Commercial |
$424.39
|
| Rate for Payer: Cash Price |
$304.54
|
| Rate for Payer: Cigna All Commercial |
$423.90
|
| Rate for Payer: CORVEL All Commercial |
$456.81
|
| Rate for Payer: Coventry All Commercial |
$432.25
|
| Rate for Payer: Encore All Commercial |
$452.14
|
| Rate for Payer: Frontpath All Commercial |
$451.90
|
| Rate for Payer: Humana ChoiceCare |
$424.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$442.07
|
| Rate for Payer: PHCS All Commercial |
$368.39
|
| Rate for Payer: PHP All Commercial |
$372.52
|
| Rate for Payer: Sagamore Health Network All Products |
$379.20
|
| Rate for Payer: Signature Care EPO |
$407.69
|
| Rate for Payer: Signature Care PPO |
$432.25
|
| Rate for Payer: United Healthcare Commercial |
$387.06
|
|
|
HC X-RAY-FOOT 1 VIEW BI
|
Facility
OP
|
$491.19
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
21613620
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.78 |
| Max. Negotiated Rate |
$456.81 |
| Rate for Payer: Aetna Commercial |
$414.57
|
| Rate for Payer: Aetna Medicare |
$162.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$162.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$282.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$307.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$53.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$186.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$178.30
|
| Rate for Payer: Cash Price |
$304.54
|
| Rate for Payer: Cash Price |
$304.54
|
| Rate for Payer: Centivo All Commercial |
$250.51
|
| Rate for Payer: Cigna All Commercial |
$423.90
|
| Rate for Payer: CORVEL All Commercial |
$456.81
|
| Rate for Payer: Coventry All Commercial |
$432.25
|
| Rate for Payer: Encore All Commercial |
$452.14
|
| Rate for Payer: Frontpath All Commercial |
$451.90
|
| Rate for Payer: Humana ChoiceCare |
$424.24
|
| Rate for Payer: Humana Medicare |
$250.51
|
| Rate for Payer: Lucent All Commercial |
$250.51
|
| Rate for Payer: Lutheran Preferred All Commercial |
$442.07
|
| Rate for Payer: Managed Health Services Medicaid |
$53.78
|
| Rate for Payer: MDWise Medicaid |
$53.78
|
| Rate for Payer: PHCS All Commercial |
$368.39
|
| Rate for Payer: PHP All Commercial |
$372.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$191.56
|
| Rate for Payer: Sagamore Health Network All Products |
$379.20
|
| Rate for Payer: Signature Care EPO |
$407.69
|
| Rate for Payer: Signature Care PPO |
$432.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$417.51
|
| Rate for Payer: United Healthcare Commercial |
$387.06
|
| Rate for Payer: United Healthcare Medicare |
$162.09
|
|
|
HC X-RAY-FOOT 1 VIEW LT
|
Facility
IP
|
$327.46
|
|
|
Service Code
|
CPT 73620 LT,52
|
| Hospital Charge Code |
01613620
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.60 |
| Max. Negotiated Rate |
$304.54 |
| Rate for Payer: Aetna Commercial |
$282.93
|
| Rate for Payer: Cash Price |
$203.03
|
| Rate for Payer: Cigna All Commercial |
$282.60
|
| Rate for Payer: CORVEL All Commercial |
$304.54
|
| Rate for Payer: Coventry All Commercial |
$288.17
|
| Rate for Payer: Encore All Commercial |
$301.43
|
| Rate for Payer: Frontpath All Commercial |
$301.26
|
| Rate for Payer: Humana ChoiceCare |
$282.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.71
|
| Rate for Payer: PHCS All Commercial |
$245.60
|
| Rate for Payer: PHP All Commercial |
$248.35
|
| Rate for Payer: Sagamore Health Network All Products |
$252.80
|
| Rate for Payer: Signature Care EPO |
$271.79
|
| Rate for Payer: Signature Care PPO |
$288.17
|
| Rate for Payer: United Healthcare Commercial |
$258.04
|
|
|
HC X-RAY-FOOT 1 VIEW LT
|
Facility
OP
|
$327.46
|
|
|
Service Code
|
CPT 73620 LT,52
|
| Hospital Charge Code |
01613620
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$304.54 |
| Rate for Payer: Aetna Commercial |
$276.38
|
| Rate for Payer: Aetna Medicare |
$108.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$188.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$204.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.87
|
| Rate for Payer: Cash Price |
$203.03
|
| Rate for Payer: Centivo All Commercial |
$167.01
|
| Rate for Payer: Cigna All Commercial |
$282.60
|
| Rate for Payer: CORVEL All Commercial |
$304.54
|
| Rate for Payer: Coventry All Commercial |
$288.17
|
| Rate for Payer: Encore All Commercial |
$301.43
|
| Rate for Payer: Frontpath All Commercial |
$301.26
|
| Rate for Payer: Humana ChoiceCare |
$282.83
|
| Rate for Payer: Humana Medicare |
$167.01
|
| Rate for Payer: Lucent All Commercial |
$167.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.71
|
| Rate for Payer: PHCS All Commercial |
$245.60
|
| Rate for Payer: PHP All Commercial |
$248.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.71
|
| Rate for Payer: Sagamore Health Network All Products |
$252.80
|
| Rate for Payer: Signature Care EPO |
$271.79
|
| Rate for Payer: Signature Care PPO |
$288.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$278.34
|
| Rate for Payer: United Healthcare Commercial |
$258.04
|
| Rate for Payer: United Healthcare Medicare |
$108.06
|
|
|
HC X-RAY-FOOT 1 VIEW RT
|
Facility
IP
|
$327.46
|
|
|
Service Code
|
CPT 73620 RT,52
|
| Hospital Charge Code |
11613620
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.60 |
| Max. Negotiated Rate |
$304.54 |
| Rate for Payer: Aetna Commercial |
$282.93
|
| Rate for Payer: Cash Price |
$203.03
|
| Rate for Payer: Cigna All Commercial |
$282.60
|
| Rate for Payer: CORVEL All Commercial |
$304.54
|
| Rate for Payer: Coventry All Commercial |
$288.17
|
| Rate for Payer: Encore All Commercial |
$301.43
|
| Rate for Payer: Frontpath All Commercial |
$301.26
|
| Rate for Payer: Humana ChoiceCare |
$282.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.71
|
| Rate for Payer: PHCS All Commercial |
$245.60
|
| Rate for Payer: PHP All Commercial |
$248.35
|
| Rate for Payer: Sagamore Health Network All Products |
$252.80
|
| Rate for Payer: Signature Care EPO |
$271.79
|
| Rate for Payer: Signature Care PPO |
$288.17
|
| Rate for Payer: United Healthcare Commercial |
$258.04
|
|
|
HC X-RAY-FOOT 1 VIEW RT
|
Facility
OP
|
$327.46
|
|
|
Service Code
|
CPT 73620 RT,52
|
| Hospital Charge Code |
11613620
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.06 |
| Max. Negotiated Rate |
$304.54 |
| Rate for Payer: Aetna Commercial |
$276.38
|
| Rate for Payer: Aetna Medicare |
$108.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$188.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$204.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$118.87
|
| Rate for Payer: Cash Price |
$203.03
|
| Rate for Payer: Centivo All Commercial |
$167.01
|
| Rate for Payer: Cigna All Commercial |
$282.60
|
| Rate for Payer: CORVEL All Commercial |
$304.54
|
| Rate for Payer: Coventry All Commercial |
$288.17
|
| Rate for Payer: Encore All Commercial |
$301.43
|
| Rate for Payer: Frontpath All Commercial |
$301.26
|
| Rate for Payer: Humana ChoiceCare |
$282.83
|
| Rate for Payer: Humana Medicare |
$167.01
|
| Rate for Payer: Lucent All Commercial |
$167.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$294.71
|
| Rate for Payer: PHCS All Commercial |
$245.60
|
| Rate for Payer: PHP All Commercial |
$248.35
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$127.71
|
| Rate for Payer: Sagamore Health Network All Products |
$252.80
|
| Rate for Payer: Signature Care EPO |
$271.79
|
| Rate for Payer: Signature Care PPO |
$288.17
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$278.34
|
| Rate for Payer: United Healthcare Commercial |
$258.04
|
| Rate for Payer: United Healthcare Medicare |
$108.06
|
|
|
HC X-RAY-FOOT 2 VIEWS BI
|
Facility
OP
|
$654.94
|
|
|
Service Code
|
CPT 73620 50
|
| Hospital Charge Code |
21613631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$216.13 |
| Max. Negotiated Rate |
$609.10 |
| Rate for Payer: Aetna Commercial |
$552.77
|
| Rate for Payer: Aetna Medicare |
$216.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$376.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$409.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$248.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$237.74
|
| Rate for Payer: Cash Price |
$406.06
|
| Rate for Payer: Centivo All Commercial |
$334.02
|
| Rate for Payer: Cigna All Commercial |
$565.21
|
| Rate for Payer: CORVEL All Commercial |
$609.10
|
| Rate for Payer: Coventry All Commercial |
$576.35
|
| Rate for Payer: Encore All Commercial |
$602.87
|
| Rate for Payer: Frontpath All Commercial |
$602.55
|
| Rate for Payer: Humana ChoiceCare |
$565.67
|
| Rate for Payer: Humana Medicare |
$334.02
|
| Rate for Payer: Lucent All Commercial |
$334.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.45
|
| Rate for Payer: PHCS All Commercial |
$491.21
|
| Rate for Payer: PHP All Commercial |
$496.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$255.43
|
| Rate for Payer: Sagamore Health Network All Products |
$505.62
|
| Rate for Payer: Signature Care EPO |
$543.60
|
| Rate for Payer: Signature Care PPO |
$576.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$556.70
|
| Rate for Payer: United Healthcare Commercial |
$516.09
|
| Rate for Payer: United Healthcare Medicare |
$216.13
|
|
|
HC X-RAY-FOOT 2 VIEWS BI
|
Facility
IP
|
$654.94
|
|
|
Service Code
|
CPT 73620 50
|
| Hospital Charge Code |
21613631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$491.21 |
| Max. Negotiated Rate |
$609.10 |
| Rate for Payer: Aetna Commercial |
$565.87
|
| Rate for Payer: Cash Price |
$406.06
|
| Rate for Payer: Cigna All Commercial |
$565.21
|
| Rate for Payer: CORVEL All Commercial |
$609.10
|
| Rate for Payer: Coventry All Commercial |
$576.35
|
| Rate for Payer: Encore All Commercial |
$602.87
|
| Rate for Payer: Frontpath All Commercial |
$602.55
|
| Rate for Payer: Humana ChoiceCare |
$565.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$589.45
|
| Rate for Payer: PHCS All Commercial |
$491.21
|
| Rate for Payer: PHP All Commercial |
$496.71
|
| Rate for Payer: Sagamore Health Network All Products |
$505.62
|
| Rate for Payer: Signature Care EPO |
$543.60
|
| Rate for Payer: Signature Care PPO |
$576.35
|
| Rate for Payer: United Healthcare Commercial |
$516.09
|
|
|
HC X-RAY-FOOT 2 VIEWS LT
|
Facility
OP
|
$436.62
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
01613631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$144.08 |
| Max. Negotiated Rate |
$406.06 |
| Rate for Payer: Aetna Commercial |
$368.51
|
| Rate for Payer: Aetna Medicare |
$144.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$144.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$250.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$272.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$165.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$158.49
|
| Rate for Payer: Cash Price |
$270.71
|
| Rate for Payer: Centivo All Commercial |
$222.68
|
| Rate for Payer: Cigna All Commercial |
$376.80
|
| Rate for Payer: CORVEL All Commercial |
$406.06
|
| Rate for Payer: Coventry All Commercial |
$384.23
|
| Rate for Payer: Encore All Commercial |
$401.91
|
| Rate for Payer: Frontpath All Commercial |
$401.69
|
| Rate for Payer: Humana ChoiceCare |
$377.11
|
| Rate for Payer: Humana Medicare |
$222.68
|
| Rate for Payer: Lucent All Commercial |
$222.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$392.96
|
| Rate for Payer: PHCS All Commercial |
$327.47
|
| Rate for Payer: PHP All Commercial |
$331.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$170.28
|
| Rate for Payer: Sagamore Health Network All Products |
$337.07
|
| Rate for Payer: Signature Care EPO |
$362.40
|
| Rate for Payer: Signature Care PPO |
$384.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$371.13
|
| Rate for Payer: United Healthcare Commercial |
$344.06
|
| Rate for Payer: United Healthcare Medicare |
$144.08
|
|
|
HC X-RAY-FOOT 2 VIEWS LT
|
Facility
IP
|
$436.62
|
|
|
Service Code
|
CPT 73620 LT
|
| Hospital Charge Code |
01613631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$327.47 |
| Max. Negotiated Rate |
$406.06 |
| Rate for Payer: Aetna Commercial |
$377.24
|
| Rate for Payer: Cash Price |
$270.71
|
| Rate for Payer: Cigna All Commercial |
$376.80
|
| Rate for Payer: CORVEL All Commercial |
$406.06
|
| Rate for Payer: Coventry All Commercial |
$384.23
|
| Rate for Payer: Encore All Commercial |
$401.91
|
| Rate for Payer: Frontpath All Commercial |
$401.69
|
| Rate for Payer: Humana ChoiceCare |
$377.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$392.96
|
| Rate for Payer: PHCS All Commercial |
$327.47
|
| Rate for Payer: PHP All Commercial |
$331.13
|
| Rate for Payer: Sagamore Health Network All Products |
$337.07
|
| Rate for Payer: Signature Care EPO |
$362.40
|
| Rate for Payer: Signature Care PPO |
$384.23
|
| Rate for Payer: United Healthcare Commercial |
$344.06
|
|
|
HC X-RAY-FOOT 2 VIEWS RT
|
Facility
OP
|
$436.62
|
|
|
Service Code
|
CPT 73620 RT
|
| Hospital Charge Code |
11613631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$144.08 |
| Max. Negotiated Rate |
$406.06 |
| Rate for Payer: Aetna Commercial |
$368.51
|
| Rate for Payer: Aetna Medicare |
$144.08
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$144.08
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$250.75
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$272.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$165.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$158.49
|
| Rate for Payer: Cash Price |
$270.71
|
| Rate for Payer: Centivo All Commercial |
$222.68
|
| Rate for Payer: Cigna All Commercial |
$376.80
|
| Rate for Payer: CORVEL All Commercial |
$406.06
|
| Rate for Payer: Coventry All Commercial |
$384.23
|
| Rate for Payer: Encore All Commercial |
$401.91
|
| Rate for Payer: Frontpath All Commercial |
$401.69
|
| Rate for Payer: Humana ChoiceCare |
$377.11
|
| Rate for Payer: Humana Medicare |
$222.68
|
| Rate for Payer: Lucent All Commercial |
$222.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$392.96
|
| Rate for Payer: PHCS All Commercial |
$327.47
|
| Rate for Payer: PHP All Commercial |
$331.13
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$170.28
|
| Rate for Payer: Sagamore Health Network All Products |
$337.07
|
| Rate for Payer: Signature Care EPO |
$362.40
|
| Rate for Payer: Signature Care PPO |
$384.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$371.13
|
| Rate for Payer: United Healthcare Commercial |
$344.06
|
| Rate for Payer: United Healthcare Medicare |
$144.08
|
|
|
HC X-RAY-FOOT 2 VIEWS RT
|
Facility
IP
|
$436.62
|
|
|
Service Code
|
CPT 73620 RT
|
| Hospital Charge Code |
11613631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$327.47 |
| Max. Negotiated Rate |
$406.06 |
| Rate for Payer: Aetna Commercial |
$377.24
|
| Rate for Payer: Cash Price |
$270.71
|
| Rate for Payer: Cigna All Commercial |
$376.80
|
| Rate for Payer: CORVEL All Commercial |
$406.06
|
| Rate for Payer: Coventry All Commercial |
$384.23
|
| Rate for Payer: Encore All Commercial |
$401.91
|
| Rate for Payer: Frontpath All Commercial |
$401.69
|
| Rate for Payer: Humana ChoiceCare |
$377.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$392.96
|
| Rate for Payer: PHCS All Commercial |
$327.47
|
| Rate for Payer: PHP All Commercial |
$331.13
|
| Rate for Payer: Sagamore Health Network All Products |
$337.07
|
| Rate for Payer: Signature Care EPO |
$362.40
|
| Rate for Payer: Signature Care PPO |
$384.23
|
| Rate for Payer: United Healthcare Commercial |
$344.06
|
|
|
HC X-RAY-FOOT 3 OR MORE VIEWS BI
|
Facility
OP
|
$768.66
|
|
|
Service Code
|
CPT 73630 50
|
| Hospital Charge Code |
21613630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$253.66 |
| Max. Negotiated Rate |
$714.86 |
| Rate for Payer: Aetna Commercial |
$648.75
|
| Rate for Payer: Aetna Medicare |
$253.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$253.66
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$441.44
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$480.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$291.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$279.02
|
| Rate for Payer: Cash Price |
$476.57
|
| Rate for Payer: Centivo All Commercial |
$392.02
|
| Rate for Payer: Cigna All Commercial |
$663.36
|
| Rate for Payer: CORVEL All Commercial |
$714.86
|
| Rate for Payer: Coventry All Commercial |
$676.42
|
| Rate for Payer: Encore All Commercial |
$707.55
|
| Rate for Payer: Frontpath All Commercial |
$707.17
|
| Rate for Payer: Humana ChoiceCare |
$663.89
|
| Rate for Payer: Humana Medicare |
$392.02
|
| Rate for Payer: Lucent All Commercial |
$392.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$691.80
|
| Rate for Payer: PHCS All Commercial |
$576.50
|
| Rate for Payer: PHP All Commercial |
$582.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$299.78
|
| Rate for Payer: Sagamore Health Network All Products |
$593.41
|
| Rate for Payer: Signature Care EPO |
$637.99
|
| Rate for Payer: Signature Care PPO |
$676.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$653.36
|
| Rate for Payer: United Healthcare Commercial |
$605.71
|
| Rate for Payer: United Healthcare Medicare |
$253.66
|
|
|
HC X-RAY-FOOT 3 OR MORE VIEWS BI
|
Facility
IP
|
$768.66
|
|
|
Service Code
|
CPT 73630 50
|
| Hospital Charge Code |
21613630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$576.50 |
| Max. Negotiated Rate |
$714.86 |
| Rate for Payer: Aetna Commercial |
$664.12
|
| Rate for Payer: Cash Price |
$476.57
|
| Rate for Payer: Cigna All Commercial |
$663.36
|
| Rate for Payer: CORVEL All Commercial |
$714.86
|
| Rate for Payer: Coventry All Commercial |
$676.42
|
| Rate for Payer: Encore All Commercial |
$707.55
|
| Rate for Payer: Frontpath All Commercial |
$707.17
|
| Rate for Payer: Humana ChoiceCare |
$663.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$691.80
|
| Rate for Payer: PHCS All Commercial |
$576.50
|
| Rate for Payer: PHP All Commercial |
$582.95
|
| Rate for Payer: Sagamore Health Network All Products |
$593.41
|
| Rate for Payer: Signature Care EPO |
$637.99
|
| Rate for Payer: Signature Care PPO |
$676.42
|
| Rate for Payer: United Healthcare Commercial |
$605.71
|
|
|
HC X-RAY-FOOT 3 OR MORE VIEWS LT
|
Facility
OP
|
$512.45
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
01613630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.11 |
| Max. Negotiated Rate |
$476.58 |
| Rate for Payer: Aetna Commercial |
$432.51
|
| Rate for Payer: Aetna Medicare |
$169.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$169.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$294.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$186.02
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Centivo All Commercial |
$261.35
|
| Rate for Payer: Cigna All Commercial |
$442.24
|
| Rate for Payer: CORVEL All Commercial |
$476.58
|
| Rate for Payer: Coventry All Commercial |
$450.95
|
| Rate for Payer: Encore All Commercial |
$471.71
|
| Rate for Payer: Frontpath All Commercial |
$471.45
|
| Rate for Payer: Humana ChoiceCare |
$442.60
|
| Rate for Payer: Humana Medicare |
$261.35
|
| Rate for Payer: Lucent All Commercial |
$261.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$461.20
|
| Rate for Payer: PHCS All Commercial |
$384.34
|
| Rate for Payer: PHP All Commercial |
$388.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.85
|
| Rate for Payer: Sagamore Health Network All Products |
$395.61
|
| Rate for Payer: Signature Care EPO |
$425.33
|
| Rate for Payer: Signature Care PPO |
$450.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$435.58
|
| Rate for Payer: United Healthcare Commercial |
$403.81
|
| Rate for Payer: United Healthcare Medicare |
$169.11
|
|
|
HC X-RAY-FOOT 3 OR MORE VIEWS LT
|
Facility
IP
|
$512.45
|
|
|
Service Code
|
CPT 73630 LT
|
| Hospital Charge Code |
01613630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$384.34 |
| Max. Negotiated Rate |
$476.58 |
| Rate for Payer: Aetna Commercial |
$442.76
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Cigna All Commercial |
$442.24
|
| Rate for Payer: CORVEL All Commercial |
$476.58
|
| Rate for Payer: Coventry All Commercial |
$450.95
|
| Rate for Payer: Encore All Commercial |
$471.71
|
| Rate for Payer: Frontpath All Commercial |
$471.45
|
| Rate for Payer: Humana ChoiceCare |
$442.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$461.20
|
| Rate for Payer: PHCS All Commercial |
$384.34
|
| Rate for Payer: PHP All Commercial |
$388.64
|
| Rate for Payer: Sagamore Health Network All Products |
$395.61
|
| Rate for Payer: Signature Care EPO |
$425.33
|
| Rate for Payer: Signature Care PPO |
$450.95
|
| Rate for Payer: United Healthcare Commercial |
$403.81
|
|
|
HC X-RAY-FOOT 3 OR MORE VIEWS RT
|
Facility
OP
|
$512.45
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
11613630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.11 |
| Max. Negotiated Rate |
$476.58 |
| Rate for Payer: Aetna Commercial |
$432.51
|
| Rate for Payer: Aetna Medicare |
$169.11
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$169.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$294.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$320.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$194.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$186.02
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Centivo All Commercial |
$261.35
|
| Rate for Payer: Cigna All Commercial |
$442.24
|
| Rate for Payer: CORVEL All Commercial |
$476.58
|
| Rate for Payer: Coventry All Commercial |
$450.95
|
| Rate for Payer: Encore All Commercial |
$471.71
|
| Rate for Payer: Frontpath All Commercial |
$471.45
|
| Rate for Payer: Humana ChoiceCare |
$442.60
|
| Rate for Payer: Humana Medicare |
$261.35
|
| Rate for Payer: Lucent All Commercial |
$261.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$461.20
|
| Rate for Payer: PHCS All Commercial |
$384.34
|
| Rate for Payer: PHP All Commercial |
$388.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$199.85
|
| Rate for Payer: Sagamore Health Network All Products |
$395.61
|
| Rate for Payer: Signature Care EPO |
$425.33
|
| Rate for Payer: Signature Care PPO |
$450.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$435.58
|
| Rate for Payer: United Healthcare Commercial |
$403.81
|
| Rate for Payer: United Healthcare Medicare |
$169.11
|
|
|
HC X-RAY-FOOT 3 OR MORE VIEWS RT
|
Facility
IP
|
$512.45
|
|
|
Service Code
|
CPT 73630 RT
|
| Hospital Charge Code |
11613630
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$384.34 |
| Max. Negotiated Rate |
$476.58 |
| Rate for Payer: Aetna Commercial |
$442.76
|
| Rate for Payer: Cash Price |
$317.72
|
| Rate for Payer: Cigna All Commercial |
$442.24
|
| Rate for Payer: CORVEL All Commercial |
$476.58
|
| Rate for Payer: Coventry All Commercial |
$450.95
|
| Rate for Payer: Encore All Commercial |
$471.71
|
| Rate for Payer: Frontpath All Commercial |
$471.45
|
| Rate for Payer: Humana ChoiceCare |
$442.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$461.20
|
| Rate for Payer: PHCS All Commercial |
$384.34
|
| Rate for Payer: PHP All Commercial |
$388.64
|
| Rate for Payer: Sagamore Health Network All Products |
$395.61
|
| Rate for Payer: Signature Care EPO |
$425.33
|
| Rate for Payer: Signature Care PPO |
$450.95
|
| Rate for Payer: United Healthcare Commercial |
$403.81
|
|
|
HC X-RAY-FOREARM 2 VIEWS BI
|
Facility
OP
|
$597.73
|
|
|
Service Code
|
CPT 73090 50
|
| Hospital Charge Code |
21613090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$197.25 |
| Max. Negotiated Rate |
$555.89 |
| Rate for Payer: Aetna Commercial |
$504.48
|
| Rate for Payer: Aetna Medicare |
$197.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$197.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$343.28
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$373.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$226.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$216.98
|
| Rate for Payer: Cash Price |
$370.59
|
| Rate for Payer: Centivo All Commercial |
$304.84
|
| Rate for Payer: Cigna All Commercial |
$515.84
|
| Rate for Payer: CORVEL All Commercial |
$555.89
|
| Rate for Payer: Coventry All Commercial |
$526.00
|
| Rate for Payer: Encore All Commercial |
$550.21
|
| Rate for Payer: Frontpath All Commercial |
$549.91
|
| Rate for Payer: Humana ChoiceCare |
$516.26
|
| Rate for Payer: Humana Medicare |
$304.84
|
| Rate for Payer: Lucent All Commercial |
$304.84
|
| Rate for Payer: Lutheran Preferred All Commercial |
$537.96
|
| Rate for Payer: PHCS All Commercial |
$448.30
|
| Rate for Payer: PHP All Commercial |
$453.32
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$233.11
|
| Rate for Payer: Sagamore Health Network All Products |
$461.45
|
| Rate for Payer: Signature Care EPO |
$496.12
|
| Rate for Payer: Signature Care PPO |
$526.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$508.07
|
| Rate for Payer: United Healthcare Commercial |
$471.01
|
| Rate for Payer: United Healthcare Medicare |
$197.25
|
|
|
HC X-RAY-FOREARM 2 VIEWS BI
|
Facility
IP
|
$597.73
|
|
|
Service Code
|
CPT 73090 50
|
| Hospital Charge Code |
21613090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$448.30 |
| Max. Negotiated Rate |
$555.89 |
| Rate for Payer: Aetna Commercial |
$516.44
|
| Rate for Payer: Cash Price |
$370.59
|
| Rate for Payer: Cigna All Commercial |
$515.84
|
| Rate for Payer: CORVEL All Commercial |
$555.89
|
| Rate for Payer: Coventry All Commercial |
$526.00
|
| Rate for Payer: Encore All Commercial |
$550.21
|
| Rate for Payer: Frontpath All Commercial |
$549.91
|
| Rate for Payer: Humana ChoiceCare |
$516.26
|
| Rate for Payer: Lutheran Preferred All Commercial |
$537.96
|
| Rate for Payer: PHCS All Commercial |
$448.30
|
| Rate for Payer: PHP All Commercial |
$453.32
|
| Rate for Payer: Sagamore Health Network All Products |
$461.45
|
| Rate for Payer: Signature Care EPO |
$496.12
|
| Rate for Payer: Signature Care PPO |
$526.00
|
| Rate for Payer: United Healthcare Commercial |
$471.01
|
|
|
HC X-RAY-FOREARM 2 VIEWS LT
|
Facility
OP
|
$398.48
|
|
|
Service Code
|
CPT 73090 LT
|
| Hospital Charge Code |
01613090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.50 |
| Max. Negotiated Rate |
$370.59 |
| Rate for Payer: Aetna Commercial |
$336.32
|
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$228.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$249.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$151.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.65
|
| Rate for Payer: Cash Price |
$247.06
|
| Rate for Payer: Centivo All Commercial |
$203.23
|
| Rate for Payer: Cigna All Commercial |
$343.89
|
| Rate for Payer: CORVEL All Commercial |
$370.59
|
| Rate for Payer: Coventry All Commercial |
$350.67
|
| Rate for Payer: Encore All Commercial |
$366.80
|
| Rate for Payer: Frontpath All Commercial |
$366.60
|
| Rate for Payer: Humana ChoiceCare |
$344.17
|
| Rate for Payer: Humana Medicare |
$203.23
|
| Rate for Payer: Lucent All Commercial |
$203.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.64
|
| Rate for Payer: PHCS All Commercial |
$298.86
|
| Rate for Payer: PHP All Commercial |
$302.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.41
|
| Rate for Payer: Sagamore Health Network All Products |
$307.63
|
| Rate for Payer: Signature Care EPO |
$330.74
|
| Rate for Payer: Signature Care PPO |
$350.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$338.71
|
| Rate for Payer: United Healthcare Commercial |
$314.00
|
| Rate for Payer: United Healthcare Medicare |
$131.50
|
|
|
HC X-RAY-FOREARM 2 VIEWS LT
|
Facility
IP
|
$398.48
|
|
|
Service Code
|
CPT 73090 LT
|
| Hospital Charge Code |
01613090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.86 |
| Max. Negotiated Rate |
$370.59 |
| Rate for Payer: Aetna Commercial |
$344.29
|
| Rate for Payer: Cash Price |
$247.06
|
| Rate for Payer: Cigna All Commercial |
$343.89
|
| Rate for Payer: CORVEL All Commercial |
$370.59
|
| Rate for Payer: Coventry All Commercial |
$350.67
|
| Rate for Payer: Encore All Commercial |
$366.80
|
| Rate for Payer: Frontpath All Commercial |
$366.60
|
| Rate for Payer: Humana ChoiceCare |
$344.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.64
|
| Rate for Payer: PHCS All Commercial |
$298.86
|
| Rate for Payer: PHP All Commercial |
$302.21
|
| Rate for Payer: Sagamore Health Network All Products |
$307.63
|
| Rate for Payer: Signature Care EPO |
$330.74
|
| Rate for Payer: Signature Care PPO |
$350.67
|
| Rate for Payer: United Healthcare Commercial |
$314.00
|
|
|
HC X-RAY-FOREARM 2 VIEWS RT
|
Facility
OP
|
$398.48
|
|
|
Service Code
|
CPT 73090 RT
|
| Hospital Charge Code |
11613090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.50 |
| Max. Negotiated Rate |
$370.59 |
| Rate for Payer: Aetna Commercial |
$336.32
|
| Rate for Payer: Aetna Medicare |
$131.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$131.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$228.85
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$249.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$151.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$144.65
|
| Rate for Payer: Cash Price |
$247.06
|
| Rate for Payer: Centivo All Commercial |
$203.23
|
| Rate for Payer: Cigna All Commercial |
$343.89
|
| Rate for Payer: CORVEL All Commercial |
$370.59
|
| Rate for Payer: Coventry All Commercial |
$350.67
|
| Rate for Payer: Encore All Commercial |
$366.80
|
| Rate for Payer: Frontpath All Commercial |
$366.60
|
| Rate for Payer: Humana ChoiceCare |
$344.17
|
| Rate for Payer: Humana Medicare |
$203.23
|
| Rate for Payer: Lucent All Commercial |
$203.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.64
|
| Rate for Payer: PHCS All Commercial |
$298.86
|
| Rate for Payer: PHP All Commercial |
$302.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$155.41
|
| Rate for Payer: Sagamore Health Network All Products |
$307.63
|
| Rate for Payer: Signature Care EPO |
$330.74
|
| Rate for Payer: Signature Care PPO |
$350.67
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$338.71
|
| Rate for Payer: United Healthcare Commercial |
$314.00
|
| Rate for Payer: United Healthcare Medicare |
$131.50
|
|
|
HC X-RAY-FOREARM 2 VIEWS RT
|
Facility
IP
|
$398.48
|
|
|
Service Code
|
CPT 73090 RT
|
| Hospital Charge Code |
11613090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.86 |
| Max. Negotiated Rate |
$370.59 |
| Rate for Payer: Aetna Commercial |
$344.29
|
| Rate for Payer: Cash Price |
$247.06
|
| Rate for Payer: Cigna All Commercial |
$343.89
|
| Rate for Payer: CORVEL All Commercial |
$370.59
|
| Rate for Payer: Coventry All Commercial |
$350.67
|
| Rate for Payer: Encore All Commercial |
$366.80
|
| Rate for Payer: Frontpath All Commercial |
$366.60
|
| Rate for Payer: Humana ChoiceCare |
$344.17
|
| Rate for Payer: Lutheran Preferred All Commercial |
$358.64
|
| Rate for Payer: PHCS All Commercial |
$298.86
|
| Rate for Payer: PHP All Commercial |
$302.21
|
| Rate for Payer: Sagamore Health Network All Products |
$307.63
|
| Rate for Payer: Signature Care EPO |
$330.74
|
| Rate for Payer: Signature Care PPO |
$350.67
|
| Rate for Payer: United Healthcare Commercial |
$314.00
|
|
|
HC X-RAY-HAND 1 VIEW BI
|
Facility
OP
|
$461.21
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
21615120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.81 |
| Max. Negotiated Rate |
$428.93 |
| Rate for Payer: Aetna Commercial |
$389.26
|
| Rate for Payer: Aetna Medicare |
$152.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$152.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$264.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$288.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$52.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$175.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$167.42
|
| Rate for Payer: Cash Price |
$285.95
|
| Rate for Payer: Cash Price |
$285.95
|
| Rate for Payer: Centivo All Commercial |
$235.22
|
| Rate for Payer: Cigna All Commercial |
$398.03
|
| Rate for Payer: CORVEL All Commercial |
$428.93
|
| Rate for Payer: Coventry All Commercial |
$405.87
|
| Rate for Payer: Encore All Commercial |
$424.55
|
| Rate for Payer: Frontpath All Commercial |
$424.32
|
| Rate for Payer: Humana ChoiceCare |
$398.35
|
| Rate for Payer: Humana Medicare |
$235.22
|
| Rate for Payer: Lucent All Commercial |
$235.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$415.09
|
| Rate for Payer: Managed Health Services Medicaid |
$52.81
|
| Rate for Payer: MDWise Medicaid |
$52.81
|
| Rate for Payer: PHCS All Commercial |
$345.91
|
| Rate for Payer: PHP All Commercial |
$349.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$179.87
|
| Rate for Payer: Sagamore Health Network All Products |
$356.06
|
| Rate for Payer: Signature Care EPO |
$382.81
|
| Rate for Payer: Signature Care PPO |
$405.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$392.03
|
| Rate for Payer: United Healthcare Commercial |
$363.44
|
| Rate for Payer: United Healthcare Medicare |
$152.20
|
|
