|
HC X-RAY-HAND 1 VIEW BI
|
Facility
IP
|
$461.21
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
21615120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$345.91 |
| Max. Negotiated Rate |
$428.93 |
| Rate for Payer: Aetna Commercial |
$398.49
|
| Rate for Payer: Cash Price |
$285.95
|
| 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: Lutheran Preferred All Commercial |
$415.09
|
| Rate for Payer: PHCS All Commercial |
$345.91
|
| Rate for Payer: PHP All Commercial |
$349.78
|
| 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: United Healthcare Commercial |
$363.44
|
|
|
HC X-RAY-HAND 1 VIEW LT
|
Facility
IP
|
$477.13
|
|
|
Service Code
|
CPT 73120 LT,52
|
| Hospital Charge Code |
01615120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$357.84 |
| Max. Negotiated Rate |
$443.73 |
| Rate for Payer: Aetna Commercial |
$412.24
|
| Rate for Payer: Cash Price |
$295.82
|
| Rate for Payer: Cigna All Commercial |
$411.76
|
| Rate for Payer: CORVEL All Commercial |
$443.73
|
| Rate for Payer: Coventry All Commercial |
$419.87
|
| Rate for Payer: Encore All Commercial |
$439.19
|
| Rate for Payer: Frontpath All Commercial |
$438.96
|
| Rate for Payer: Humana ChoiceCare |
$412.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$429.41
|
| Rate for Payer: PHCS All Commercial |
$357.84
|
| Rate for Payer: PHP All Commercial |
$361.85
|
| Rate for Payer: Sagamore Health Network All Products |
$368.34
|
| Rate for Payer: Signature Care EPO |
$396.01
|
| Rate for Payer: Signature Care PPO |
$419.87
|
| Rate for Payer: United Healthcare Commercial |
$375.97
|
|
|
HC X-RAY-HAND 1 VIEW LT
|
Facility
OP
|
$477.13
|
|
|
Service Code
|
CPT 73120 LT,52
|
| Hospital Charge Code |
01615120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.45 |
| Max. Negotiated Rate |
$443.73 |
| Rate for Payer: Aetna Commercial |
$402.69
|
| Rate for Payer: Aetna Medicare |
$157.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$157.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$274.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$298.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$181.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$173.20
|
| Rate for Payer: Cash Price |
$295.82
|
| Rate for Payer: Centivo All Commercial |
$243.33
|
| Rate for Payer: Cigna All Commercial |
$411.76
|
| Rate for Payer: CORVEL All Commercial |
$443.73
|
| Rate for Payer: Coventry All Commercial |
$419.87
|
| Rate for Payer: Encore All Commercial |
$439.19
|
| Rate for Payer: Frontpath All Commercial |
$438.96
|
| Rate for Payer: Humana ChoiceCare |
$412.09
|
| Rate for Payer: Humana Medicare |
$243.33
|
| Rate for Payer: Lucent All Commercial |
$243.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$429.41
|
| Rate for Payer: PHCS All Commercial |
$357.84
|
| Rate for Payer: PHP All Commercial |
$361.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$186.08
|
| Rate for Payer: Sagamore Health Network All Products |
$368.34
|
| Rate for Payer: Signature Care EPO |
$396.01
|
| Rate for Payer: Signature Care PPO |
$419.87
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$405.56
|
| Rate for Payer: United Healthcare Commercial |
$375.97
|
| Rate for Payer: United Healthcare Medicare |
$157.45
|
|
|
HC X-RAY-HAND 1 VIEW RT
|
Facility
IP
|
$295.87
|
|
|
Service Code
|
CPT 73120 RT,52
|
| Hospital Charge Code |
11615120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.90 |
| Max. Negotiated Rate |
$275.16 |
| Rate for Payer: Aetna Commercial |
$255.63
|
| Rate for Payer: Cash Price |
$183.44
|
| Rate for Payer: Cigna All Commercial |
$255.34
|
| Rate for Payer: CORVEL All Commercial |
$275.16
|
| Rate for Payer: Coventry All Commercial |
$260.37
|
| Rate for Payer: Encore All Commercial |
$272.35
|
| Rate for Payer: Frontpath All Commercial |
$272.20
|
| Rate for Payer: Humana ChoiceCare |
$255.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$266.28
|
| Rate for Payer: PHCS All Commercial |
$221.90
|
| Rate for Payer: PHP All Commercial |
$224.39
|
| Rate for Payer: Sagamore Health Network All Products |
$228.41
|
| Rate for Payer: Signature Care EPO |
$245.57
|
| Rate for Payer: Signature Care PPO |
$260.37
|
| Rate for Payer: United Healthcare Commercial |
$233.15
|
|
|
HC X-RAY-HAND 1 VIEW RT
|
Facility
OP
|
$295.87
|
|
|
Service Code
|
CPT 73120 RT,52
|
| Hospital Charge Code |
11615120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.64 |
| Max. Negotiated Rate |
$275.16 |
| Rate for Payer: Aetna Commercial |
$249.72
|
| Rate for Payer: Aetna Medicare |
$97.64
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$97.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$169.92
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$184.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$112.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$107.40
|
| Rate for Payer: Cash Price |
$183.44
|
| Rate for Payer: Centivo All Commercial |
$150.89
|
| Rate for Payer: Cigna All Commercial |
$255.34
|
| Rate for Payer: CORVEL All Commercial |
$275.16
|
| Rate for Payer: Coventry All Commercial |
$260.37
|
| Rate for Payer: Encore All Commercial |
$272.35
|
| Rate for Payer: Frontpath All Commercial |
$272.20
|
| Rate for Payer: Humana ChoiceCare |
$255.54
|
| Rate for Payer: Humana Medicare |
$150.89
|
| Rate for Payer: Lucent All Commercial |
$150.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$266.28
|
| Rate for Payer: PHCS All Commercial |
$221.90
|
| Rate for Payer: PHP All Commercial |
$224.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$115.39
|
| Rate for Payer: Sagamore Health Network All Products |
$228.41
|
| Rate for Payer: Signature Care EPO |
$245.57
|
| Rate for Payer: Signature Care PPO |
$260.37
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$251.49
|
| Rate for Payer: United Healthcare Commercial |
$233.15
|
| Rate for Payer: United Healthcare Medicare |
$97.64
|
|
|
HC X-RAY-HAND 2 VIEWS BI
|
Facility
OP
|
$591.72
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
21613120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.27 |
| Max. Negotiated Rate |
$550.30 |
| Rate for Payer: Aetna Commercial |
$499.41
|
| Rate for Payer: Aetna Medicare |
$195.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$195.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$339.83
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$369.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$224.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$214.80
|
| Rate for Payer: Cash Price |
$366.87
|
| Rate for Payer: Centivo All Commercial |
$301.78
|
| Rate for Payer: Cigna All Commercial |
$510.66
|
| Rate for Payer: CORVEL All Commercial |
$550.30
|
| Rate for Payer: Coventry All Commercial |
$520.72
|
| Rate for Payer: Encore All Commercial |
$544.68
|
| Rate for Payer: Frontpath All Commercial |
$544.38
|
| Rate for Payer: Humana ChoiceCare |
$511.07
|
| Rate for Payer: Humana Medicare |
$301.78
|
| Rate for Payer: Lucent All Commercial |
$301.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$532.55
|
| Rate for Payer: PHCS All Commercial |
$443.79
|
| Rate for Payer: PHP All Commercial |
$448.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$230.77
|
| Rate for Payer: Sagamore Health Network All Products |
$456.81
|
| Rate for Payer: Signature Care EPO |
$491.13
|
| Rate for Payer: Signature Care PPO |
$520.72
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$502.96
|
| Rate for Payer: United Healthcare Commercial |
$466.28
|
| Rate for Payer: United Healthcare Medicare |
$195.27
|
|
|
HC X-RAY-HAND 2 VIEWS BI
|
Facility
IP
|
$591.72
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
21613120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$443.79 |
| Max. Negotiated Rate |
$550.30 |
| Rate for Payer: Aetna Commercial |
$511.25
|
| Rate for Payer: Cash Price |
$366.87
|
| Rate for Payer: Cigna All Commercial |
$510.66
|
| Rate for Payer: CORVEL All Commercial |
$550.30
|
| Rate for Payer: Coventry All Commercial |
$520.72
|
| Rate for Payer: Encore All Commercial |
$544.68
|
| Rate for Payer: Frontpath All Commercial |
$544.38
|
| Rate for Payer: Humana ChoiceCare |
$511.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$532.55
|
| Rate for Payer: PHCS All Commercial |
$443.79
|
| Rate for Payer: PHP All Commercial |
$448.76
|
| Rate for Payer: Sagamore Health Network All Products |
$456.81
|
| Rate for Payer: Signature Care EPO |
$491.13
|
| Rate for Payer: Signature Care PPO |
$520.72
|
| Rate for Payer: United Healthcare Commercial |
$466.28
|
|
|
HC X-RAY-HAND 2 VIEWS LT
|
Facility
OP
|
$394.49
|
|
|
Service Code
|
CPT 73120 LT
|
| Hospital Charge Code |
01613120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.18 |
| Max. Negotiated Rate |
$366.87 |
| Rate for Payer: Aetna Commercial |
$332.95
|
| Rate for Payer: Aetna Medicare |
$130.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$130.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$226.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$246.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$149.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$143.20
|
| Rate for Payer: Cash Price |
$244.58
|
| Rate for Payer: Centivo All Commercial |
$201.19
|
| Rate for Payer: Cigna All Commercial |
$340.44
|
| Rate for Payer: CORVEL All Commercial |
$366.87
|
| Rate for Payer: Coventry All Commercial |
$347.15
|
| Rate for Payer: Encore All Commercial |
$363.12
|
| Rate for Payer: Frontpath All Commercial |
$362.93
|
| Rate for Payer: Humana ChoiceCare |
$340.72
|
| Rate for Payer: Humana Medicare |
$201.19
|
| Rate for Payer: Lucent All Commercial |
$201.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$355.04
|
| Rate for Payer: PHCS All Commercial |
$295.86
|
| Rate for Payer: PHP All Commercial |
$299.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$153.85
|
| Rate for Payer: Sagamore Health Network All Products |
$304.54
|
| Rate for Payer: Signature Care EPO |
$327.42
|
| Rate for Payer: Signature Care PPO |
$347.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$335.31
|
| Rate for Payer: United Healthcare Commercial |
$310.85
|
| Rate for Payer: United Healthcare Medicare |
$130.18
|
|
|
HC X-RAY-HAND 2 VIEWS LT
|
Facility
IP
|
$394.49
|
|
|
Service Code
|
CPT 73120 LT
|
| Hospital Charge Code |
01613120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$295.86 |
| Max. Negotiated Rate |
$366.87 |
| Rate for Payer: Aetna Commercial |
$340.84
|
| Rate for Payer: Cash Price |
$244.58
|
| Rate for Payer: Cigna All Commercial |
$340.44
|
| Rate for Payer: CORVEL All Commercial |
$366.87
|
| Rate for Payer: Coventry All Commercial |
$347.15
|
| Rate for Payer: Encore All Commercial |
$363.12
|
| Rate for Payer: Frontpath All Commercial |
$362.93
|
| Rate for Payer: Humana ChoiceCare |
$340.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$355.04
|
| Rate for Payer: PHCS All Commercial |
$295.86
|
| Rate for Payer: PHP All Commercial |
$299.18
|
| Rate for Payer: Sagamore Health Network All Products |
$304.54
|
| Rate for Payer: Signature Care EPO |
$327.42
|
| Rate for Payer: Signature Care PPO |
$347.15
|
| Rate for Payer: United Healthcare Commercial |
$310.85
|
|
|
HC X-RAY-HAND 2 VIEWS RT
|
Facility
IP
|
$394.49
|
|
|
Service Code
|
CPT 73120 RT
|
| Hospital Charge Code |
11613120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$295.86 |
| Max. Negotiated Rate |
$366.87 |
| Rate for Payer: Aetna Commercial |
$340.84
|
| Rate for Payer: Cash Price |
$244.58
|
| Rate for Payer: Cigna All Commercial |
$340.44
|
| Rate for Payer: CORVEL All Commercial |
$366.87
|
| Rate for Payer: Coventry All Commercial |
$347.15
|
| Rate for Payer: Encore All Commercial |
$363.12
|
| Rate for Payer: Frontpath All Commercial |
$362.93
|
| Rate for Payer: Humana ChoiceCare |
$340.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$355.04
|
| Rate for Payer: PHCS All Commercial |
$295.86
|
| Rate for Payer: PHP All Commercial |
$299.18
|
| Rate for Payer: Sagamore Health Network All Products |
$304.54
|
| Rate for Payer: Signature Care EPO |
$327.42
|
| Rate for Payer: Signature Care PPO |
$347.15
|
| Rate for Payer: United Healthcare Commercial |
$310.85
|
|
|
HC X-RAY-HAND 2 VIEWS RT
|
Facility
OP
|
$394.49
|
|
|
Service Code
|
CPT 73120 RT
|
| Hospital Charge Code |
11613120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.18 |
| Max. Negotiated Rate |
$366.87 |
| Rate for Payer: Aetna Commercial |
$332.95
|
| Rate for Payer: Aetna Medicare |
$130.18
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$130.18
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$226.55
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$246.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$149.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$143.20
|
| Rate for Payer: Cash Price |
$244.58
|
| Rate for Payer: Centivo All Commercial |
$201.19
|
| Rate for Payer: Cigna All Commercial |
$340.44
|
| Rate for Payer: CORVEL All Commercial |
$366.87
|
| Rate for Payer: Coventry All Commercial |
$347.15
|
| Rate for Payer: Encore All Commercial |
$363.12
|
| Rate for Payer: Frontpath All Commercial |
$362.93
|
| Rate for Payer: Humana ChoiceCare |
$340.72
|
| Rate for Payer: Humana Medicare |
$201.19
|
| Rate for Payer: Lucent All Commercial |
$201.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$355.04
|
| Rate for Payer: PHCS All Commercial |
$295.86
|
| Rate for Payer: PHP All Commercial |
$299.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$153.85
|
| Rate for Payer: Sagamore Health Network All Products |
$304.54
|
| Rate for Payer: Signature Care EPO |
$327.42
|
| Rate for Payer: Signature Care PPO |
$347.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$335.31
|
| Rate for Payer: United Healthcare Commercial |
$310.85
|
| Rate for Payer: United Healthcare Medicare |
$130.18
|
|
|
HC X-RAY-HAND MIN 3 VIEWS BI
|
Facility
OP
|
$674.24
|
|
|
Service Code
|
CPT 73130 50
|
| Hospital Charge Code |
21613130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$222.50 |
| Max. Negotiated Rate |
$627.04 |
| Rate for Payer: Aetna Commercial |
$569.06
|
| Rate for Payer: Aetna Medicare |
$222.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$222.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$387.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$421.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$255.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$244.75
|
| Rate for Payer: Cash Price |
$418.03
|
| Rate for Payer: Centivo All Commercial |
$343.86
|
| Rate for Payer: Cigna All Commercial |
$581.87
|
| Rate for Payer: CORVEL All Commercial |
$627.04
|
| Rate for Payer: Coventry All Commercial |
$593.33
|
| Rate for Payer: Encore All Commercial |
$620.64
|
| Rate for Payer: Frontpath All Commercial |
$620.30
|
| Rate for Payer: Humana ChoiceCare |
$582.34
|
| Rate for Payer: Humana Medicare |
$343.86
|
| Rate for Payer: Lucent All Commercial |
$343.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$606.82
|
| Rate for Payer: PHCS All Commercial |
$505.68
|
| Rate for Payer: PHP All Commercial |
$511.34
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$262.95
|
| Rate for Payer: Sagamore Health Network All Products |
$520.51
|
| Rate for Payer: Signature Care EPO |
$559.62
|
| Rate for Payer: Signature Care PPO |
$593.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$573.10
|
| Rate for Payer: United Healthcare Commercial |
$531.30
|
| Rate for Payer: United Healthcare Medicare |
$222.50
|
|
|
HC X-RAY-HAND MIN 3 VIEWS BI
|
Facility
IP
|
$674.24
|
|
|
Service Code
|
CPT 73130 50
|
| Hospital Charge Code |
21613130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$505.68 |
| Max. Negotiated Rate |
$627.04 |
| Rate for Payer: Aetna Commercial |
$582.54
|
| Rate for Payer: Cash Price |
$418.03
|
| Rate for Payer: Cigna All Commercial |
$581.87
|
| Rate for Payer: CORVEL All Commercial |
$627.04
|
| Rate for Payer: Coventry All Commercial |
$593.33
|
| Rate for Payer: Encore All Commercial |
$620.64
|
| Rate for Payer: Frontpath All Commercial |
$620.30
|
| Rate for Payer: Humana ChoiceCare |
$582.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$606.82
|
| Rate for Payer: PHCS All Commercial |
$505.68
|
| Rate for Payer: PHP All Commercial |
$511.34
|
| Rate for Payer: Sagamore Health Network All Products |
$520.51
|
| Rate for Payer: Signature Care EPO |
$559.62
|
| Rate for Payer: Signature Care PPO |
$593.33
|
| Rate for Payer: United Healthcare Commercial |
$531.30
|
|
|
HC X-RAY-HAND MIN 3 VIEWS LT
|
Facility
OP
|
$449.48
|
|
|
Service Code
|
CPT 73130 LT
|
| Hospital Charge Code |
01613130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.33 |
| Max. Negotiated Rate |
$418.02 |
| Rate for Payer: Aetna Commercial |
$379.36
|
| Rate for Payer: Aetna Medicare |
$148.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$148.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$258.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$280.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$170.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$163.16
|
| Rate for Payer: Cash Price |
$278.68
|
| Rate for Payer: Centivo All Commercial |
$229.24
|
| Rate for Payer: Cigna All Commercial |
$387.90
|
| Rate for Payer: CORVEL All Commercial |
$418.02
|
| Rate for Payer: Coventry All Commercial |
$395.55
|
| Rate for Payer: Encore All Commercial |
$413.75
|
| Rate for Payer: Frontpath All Commercial |
$413.52
|
| Rate for Payer: Humana ChoiceCare |
$388.22
|
| Rate for Payer: Humana Medicare |
$229.24
|
| Rate for Payer: Lucent All Commercial |
$229.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$404.54
|
| Rate for Payer: PHCS All Commercial |
$337.11
|
| Rate for Payer: PHP All Commercial |
$340.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$175.30
|
| Rate for Payer: Sagamore Health Network All Products |
$347.00
|
| Rate for Payer: Signature Care EPO |
$373.07
|
| Rate for Payer: Signature Care PPO |
$395.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$382.06
|
| Rate for Payer: United Healthcare Commercial |
$354.19
|
| Rate for Payer: United Healthcare Medicare |
$148.33
|
|
|
HC X-RAY-HAND MIN 3 VIEWS LT
|
Facility
IP
|
$449.48
|
|
|
Service Code
|
CPT 73130 LT
|
| Hospital Charge Code |
01613130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$337.11 |
| Max. Negotiated Rate |
$418.02 |
| Rate for Payer: Aetna Commercial |
$388.35
|
| Rate for Payer: Cash Price |
$278.68
|
| Rate for Payer: Cigna All Commercial |
$387.90
|
| Rate for Payer: CORVEL All Commercial |
$418.02
|
| Rate for Payer: Coventry All Commercial |
$395.55
|
| Rate for Payer: Encore All Commercial |
$413.75
|
| Rate for Payer: Frontpath All Commercial |
$413.52
|
| Rate for Payer: Humana ChoiceCare |
$388.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$404.54
|
| Rate for Payer: PHCS All Commercial |
$337.11
|
| Rate for Payer: PHP All Commercial |
$340.89
|
| Rate for Payer: Sagamore Health Network All Products |
$347.00
|
| Rate for Payer: Signature Care EPO |
$373.07
|
| Rate for Payer: Signature Care PPO |
$395.55
|
| Rate for Payer: United Healthcare Commercial |
$354.19
|
|
|
HC X-RAY-HAND MIN 3 VIEWS RT
|
Facility
IP
|
$449.48
|
|
|
Service Code
|
CPT 73130 RT
|
| Hospital Charge Code |
11613130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$337.11 |
| Max. Negotiated Rate |
$418.02 |
| Rate for Payer: Aetna Commercial |
$388.35
|
| Rate for Payer: Cash Price |
$278.68
|
| Rate for Payer: Cigna All Commercial |
$387.90
|
| Rate for Payer: CORVEL All Commercial |
$418.02
|
| Rate for Payer: Coventry All Commercial |
$395.55
|
| Rate for Payer: Encore All Commercial |
$413.75
|
| Rate for Payer: Frontpath All Commercial |
$413.52
|
| Rate for Payer: Humana ChoiceCare |
$388.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$404.54
|
| Rate for Payer: PHCS All Commercial |
$337.11
|
| Rate for Payer: PHP All Commercial |
$340.89
|
| Rate for Payer: Sagamore Health Network All Products |
$347.00
|
| Rate for Payer: Signature Care EPO |
$373.07
|
| Rate for Payer: Signature Care PPO |
$395.55
|
| Rate for Payer: United Healthcare Commercial |
$354.19
|
|
|
HC X-RAY-HAND MIN 3 VIEWS RT
|
Facility
OP
|
$449.48
|
|
|
Service Code
|
CPT 73130 RT
|
| Hospital Charge Code |
11613130
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.33 |
| Max. Negotiated Rate |
$418.02 |
| Rate for Payer: Aetna Commercial |
$379.36
|
| Rate for Payer: Aetna Medicare |
$148.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$148.33
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$258.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$280.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$170.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$163.16
|
| Rate for Payer: Cash Price |
$278.68
|
| Rate for Payer: Centivo All Commercial |
$229.24
|
| Rate for Payer: Cigna All Commercial |
$387.90
|
| Rate for Payer: CORVEL All Commercial |
$418.02
|
| Rate for Payer: Coventry All Commercial |
$395.55
|
| Rate for Payer: Encore All Commercial |
$413.75
|
| Rate for Payer: Frontpath All Commercial |
$413.52
|
| Rate for Payer: Humana ChoiceCare |
$388.22
|
| Rate for Payer: Humana Medicare |
$229.24
|
| Rate for Payer: Lucent All Commercial |
$229.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$404.54
|
| Rate for Payer: PHCS All Commercial |
$337.11
|
| Rate for Payer: PHP All Commercial |
$340.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$175.30
|
| Rate for Payer: Sagamore Health Network All Products |
$347.00
|
| Rate for Payer: Signature Care EPO |
$373.07
|
| Rate for Payer: Signature Care PPO |
$395.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$382.06
|
| Rate for Payer: United Healthcare Commercial |
$354.19
|
| Rate for Payer: United Healthcare Medicare |
$148.33
|
|
|
HC X-RAY-HIP AP ONLY LT
|
Facility
IP
|
$329.07
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
01613500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$306.04 |
| Rate for Payer: Aetna Commercial |
$284.32
|
| Rate for Payer: Cash Price |
$204.03
|
| Rate for Payer: Cigna All Commercial |
$283.99
|
| Rate for Payer: CORVEL All Commercial |
$306.04
|
| Rate for Payer: Coventry All Commercial |
$289.58
|
| Rate for Payer: Encore All Commercial |
$302.91
|
| Rate for Payer: Frontpath All Commercial |
$302.75
|
| Rate for Payer: Humana ChoiceCare |
$284.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$296.17
|
| Rate for Payer: PHCS All Commercial |
$246.80
|
| Rate for Payer: PHP All Commercial |
$249.57
|
| Rate for Payer: Sagamore Health Network All Products |
$254.04
|
| Rate for Payer: Signature Care EPO |
$273.13
|
| Rate for Payer: Signature Care PPO |
$289.58
|
| Rate for Payer: United Healthcare Commercial |
$259.31
|
|
|
HC X-RAY-HIP AP ONLY LT
|
Facility
OP
|
$329.07
|
|
|
Service Code
|
CPT 73501 LT
|
| Hospital Charge Code |
01613500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.59 |
| Max. Negotiated Rate |
$306.04 |
| Rate for Payer: Aetna Commercial |
$277.74
|
| Rate for Payer: Aetna Medicare |
$108.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$188.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$205.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$119.45
|
| Rate for Payer: Cash Price |
$204.03
|
| Rate for Payer: Centivo All Commercial |
$167.83
|
| Rate for Payer: Cigna All Commercial |
$283.99
|
| Rate for Payer: CORVEL All Commercial |
$306.04
|
| Rate for Payer: Coventry All Commercial |
$289.58
|
| Rate for Payer: Encore All Commercial |
$302.91
|
| Rate for Payer: Frontpath All Commercial |
$302.75
|
| Rate for Payer: Humana ChoiceCare |
$284.22
|
| Rate for Payer: Humana Medicare |
$167.83
|
| Rate for Payer: Lucent All Commercial |
$167.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$296.17
|
| Rate for Payer: PHCS All Commercial |
$246.80
|
| Rate for Payer: PHP All Commercial |
$249.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.34
|
| Rate for Payer: Sagamore Health Network All Products |
$254.04
|
| Rate for Payer: Signature Care EPO |
$273.13
|
| Rate for Payer: Signature Care PPO |
$289.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$279.71
|
| Rate for Payer: United Healthcare Commercial |
$259.31
|
| Rate for Payer: United Healthcare Medicare |
$108.59
|
|
|
HC X-RAY-HIP AP ONLY RT
|
Facility
IP
|
$329.07
|
|
|
Service Code
|
CPT 73501 RT
|
| Hospital Charge Code |
11613500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$306.04 |
| Rate for Payer: Aetna Commercial |
$284.32
|
| Rate for Payer: Cash Price |
$204.03
|
| Rate for Payer: Cigna All Commercial |
$283.99
|
| Rate for Payer: CORVEL All Commercial |
$306.04
|
| Rate for Payer: Coventry All Commercial |
$289.58
|
| Rate for Payer: Encore All Commercial |
$302.91
|
| Rate for Payer: Frontpath All Commercial |
$302.75
|
| Rate for Payer: Humana ChoiceCare |
$284.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$296.17
|
| Rate for Payer: PHCS All Commercial |
$246.80
|
| Rate for Payer: PHP All Commercial |
$249.57
|
| Rate for Payer: Sagamore Health Network All Products |
$254.04
|
| Rate for Payer: Signature Care EPO |
$273.13
|
| Rate for Payer: Signature Care PPO |
$289.58
|
| Rate for Payer: United Healthcare Commercial |
$259.31
|
|
|
HC X-RAY-HIP AP ONLY RT
|
Facility
OP
|
$329.07
|
|
|
Service Code
|
CPT 73501 RT
|
| Hospital Charge Code |
11613500
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.59 |
| Max. Negotiated Rate |
$306.04 |
| Rate for Payer: Aetna Commercial |
$277.74
|
| Rate for Payer: Aetna Medicare |
$108.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$108.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$188.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$205.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$124.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$119.45
|
| Rate for Payer: Cash Price |
$204.03
|
| Rate for Payer: Centivo All Commercial |
$167.83
|
| Rate for Payer: Cigna All Commercial |
$283.99
|
| Rate for Payer: CORVEL All Commercial |
$306.04
|
| Rate for Payer: Coventry All Commercial |
$289.58
|
| Rate for Payer: Encore All Commercial |
$302.91
|
| Rate for Payer: Frontpath All Commercial |
$302.75
|
| Rate for Payer: Humana ChoiceCare |
$284.22
|
| Rate for Payer: Humana Medicare |
$167.83
|
| Rate for Payer: Lucent All Commercial |
$167.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$296.17
|
| Rate for Payer: PHCS All Commercial |
$246.80
|
| Rate for Payer: PHP All Commercial |
$249.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.34
|
| Rate for Payer: Sagamore Health Network All Products |
$254.04
|
| Rate for Payer: Signature Care EPO |
$273.13
|
| Rate for Payer: Signature Care PPO |
$289.58
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$279.71
|
| Rate for Payer: United Healthcare Commercial |
$259.31
|
| Rate for Payer: United Healthcare Medicare |
$108.59
|
|
|
HC X-RAY-HUMERUS MIN 2 VIEWS BI
|
Facility
OP
|
$641.01
|
|
|
Service Code
|
CPT 73060 50
|
| Hospital Charge Code |
21613060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$211.53 |
| Max. Negotiated Rate |
$596.14 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna Medicare |
$211.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$211.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$368.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$400.69
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$243.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$232.69
|
| Rate for Payer: Cash Price |
$397.43
|
| Rate for Payer: Centivo All Commercial |
$326.91
|
| Rate for Payer: Cigna All Commercial |
$553.19
|
| Rate for Payer: CORVEL All Commercial |
$596.14
|
| Rate for Payer: Coventry All Commercial |
$564.09
|
| Rate for Payer: Encore All Commercial |
$590.05
|
| Rate for Payer: Frontpath All Commercial |
$589.73
|
| Rate for Payer: Humana ChoiceCare |
$553.64
|
| Rate for Payer: Humana Medicare |
$326.91
|
| Rate for Payer: Lucent All Commercial |
$326.91
|
| Rate for Payer: Lutheran Preferred All Commercial |
$576.91
|
| Rate for Payer: PHCS All Commercial |
$480.76
|
| Rate for Payer: PHP All Commercial |
$486.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$249.99
|
| Rate for Payer: Sagamore Health Network All Products |
$494.86
|
| Rate for Payer: Signature Care EPO |
$532.04
|
| Rate for Payer: Signature Care PPO |
$564.09
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$544.86
|
| Rate for Payer: United Healthcare Commercial |
$505.11
|
| Rate for Payer: United Healthcare Medicare |
$211.53
|
|
|
HC X-RAY-HUMERUS MIN 2 VIEWS BI
|
Facility
IP
|
$641.01
|
|
|
Service Code
|
CPT 73060 50
|
| Hospital Charge Code |
21613060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$480.76 |
| Max. Negotiated Rate |
$596.14 |
| Rate for Payer: Aetna Commercial |
$553.83
|
| Rate for Payer: Cash Price |
$397.43
|
| Rate for Payer: Cigna All Commercial |
$553.19
|
| Rate for Payer: CORVEL All Commercial |
$596.14
|
| Rate for Payer: Coventry All Commercial |
$564.09
|
| Rate for Payer: Encore All Commercial |
$590.05
|
| Rate for Payer: Frontpath All Commercial |
$589.73
|
| Rate for Payer: Humana ChoiceCare |
$553.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$576.91
|
| Rate for Payer: PHCS All Commercial |
$480.76
|
| Rate for Payer: PHP All Commercial |
$486.14
|
| Rate for Payer: Sagamore Health Network All Products |
$494.86
|
| Rate for Payer: Signature Care EPO |
$532.04
|
| Rate for Payer: Signature Care PPO |
$564.09
|
| Rate for Payer: United Healthcare Commercial |
$505.11
|
|
|
HC X-RAY-HUMERUS MIN 2 VIEWS LT
|
Facility
IP
|
$427.33
|
|
|
Service Code
|
CPT 73060 LT
|
| Hospital Charge Code |
01613060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$320.50 |
| Max. Negotiated Rate |
$397.42 |
| Rate for Payer: Aetna Commercial |
$369.21
|
| Rate for Payer: Cash Price |
$264.94
|
| Rate for Payer: Cigna All Commercial |
$368.78
|
| Rate for Payer: CORVEL All Commercial |
$397.42
|
| Rate for Payer: Coventry All Commercial |
$376.05
|
| Rate for Payer: Encore All Commercial |
$393.36
|
| Rate for Payer: Frontpath All Commercial |
$393.14
|
| Rate for Payer: Humana ChoiceCare |
$369.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$384.60
|
| Rate for Payer: PHCS All Commercial |
$320.50
|
| Rate for Payer: PHP All Commercial |
$324.09
|
| Rate for Payer: Sagamore Health Network All Products |
$329.90
|
| Rate for Payer: Signature Care EPO |
$354.68
|
| Rate for Payer: Signature Care PPO |
$376.05
|
| Rate for Payer: United Healthcare Commercial |
$336.74
|
|
|
HC X-RAY-HUMERUS MIN 2 VIEWS LT
|
Facility
OP
|
$427.33
|
|
|
Service Code
|
CPT 73060 LT
|
| Hospital Charge Code |
01613060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$141.02 |
| Max. Negotiated Rate |
$397.42 |
| Rate for Payer: Aetna Commercial |
$360.67
|
| Rate for Payer: Aetna Medicare |
$141.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$141.02
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$245.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$267.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$162.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$155.12
|
| Rate for Payer: Cash Price |
$264.94
|
| Rate for Payer: Centivo All Commercial |
$217.94
|
| Rate for Payer: Cigna All Commercial |
$368.78
|
| Rate for Payer: CORVEL All Commercial |
$397.42
|
| Rate for Payer: Coventry All Commercial |
$376.05
|
| Rate for Payer: Encore All Commercial |
$393.36
|
| Rate for Payer: Frontpath All Commercial |
$393.14
|
| Rate for Payer: Humana ChoiceCare |
$369.08
|
| Rate for Payer: Humana Medicare |
$217.94
|
| Rate for Payer: Lucent All Commercial |
$217.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$384.60
|
| Rate for Payer: PHCS All Commercial |
$320.50
|
| Rate for Payer: PHP All Commercial |
$324.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.66
|
| Rate for Payer: Sagamore Health Network All Products |
$329.90
|
| Rate for Payer: Signature Care EPO |
$354.68
|
| Rate for Payer: Signature Care PPO |
$376.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$363.23
|
| Rate for Payer: United Healthcare Commercial |
$336.74
|
| Rate for Payer: United Healthcare Medicare |
$141.02
|
|
