|
HC X-RAY-HUMERUS MIN 2 VIEWS RT
|
Facility
IP
|
$427.33
|
|
|
Service Code
|
CPT 73060 RT
|
| Hospital Charge Code |
11613060
|
|
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 RT
|
Facility
OP
|
$427.33
|
|
|
Service Code
|
CPT 73060 RT
|
| Hospital Charge Code |
11613060
|
|
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
|
|
|
HC X-RAY-IVP WITHOUT TOMO
|
Facility
IP
|
$1,263.77
|
|
|
Service Code
|
CPT 74410
|
| Hospital Charge Code |
01618410
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$947.83 |
| Max. Negotiated Rate |
$1,175.31 |
| Rate for Payer: Aetna Commercial |
$1,091.90
|
| Rate for Payer: Cash Price |
$783.54
|
| Rate for Payer: Cigna All Commercial |
$1,090.63
|
| Rate for Payer: CORVEL All Commercial |
$1,175.31
|
| Rate for Payer: Coventry All Commercial |
$1,112.12
|
| Rate for Payer: Encore All Commercial |
$1,163.30
|
| Rate for Payer: Frontpath All Commercial |
$1,162.67
|
| Rate for Payer: Humana ChoiceCare |
$1,091.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,137.39
|
| Rate for Payer: PHCS All Commercial |
$947.83
|
| Rate for Payer: PHP All Commercial |
$958.44
|
| Rate for Payer: Sagamore Health Network All Products |
$975.63
|
| Rate for Payer: Signature Care EPO |
$1,048.93
|
| Rate for Payer: Signature Care PPO |
$1,112.12
|
| Rate for Payer: United Healthcare Commercial |
$995.85
|
|
|
HC X-RAY-IVP WITHOUT TOMO
|
Facility
OP
|
$1,263.77
|
|
|
Service Code
|
CPT 74410
|
| Hospital Charge Code |
01618410
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$239.27 |
| Max. Negotiated Rate |
$1,175.31 |
| Rate for Payer: Aetna Commercial |
$1,066.62
|
| Rate for Payer: Aetna Medicare |
$417.04
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$417.04
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$725.78
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$789.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$239.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$479.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$458.75
|
| Rate for Payer: Cash Price |
$783.54
|
| Rate for Payer: Cash Price |
$783.54
|
| Rate for Payer: Centivo All Commercial |
$644.52
|
| Rate for Payer: Cigna All Commercial |
$1,090.63
|
| Rate for Payer: CORVEL All Commercial |
$1,175.31
|
| Rate for Payer: Coventry All Commercial |
$1,112.12
|
| Rate for Payer: Encore All Commercial |
$1,163.30
|
| Rate for Payer: Frontpath All Commercial |
$1,162.67
|
| Rate for Payer: Humana ChoiceCare |
$1,091.52
|
| Rate for Payer: Humana Medicare |
$644.52
|
| Rate for Payer: Lucent All Commercial |
$644.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1,137.39
|
| Rate for Payer: Managed Health Services Medicaid |
$239.27
|
| Rate for Payer: MDWise Medicaid |
$239.27
|
| Rate for Payer: PHCS All Commercial |
$947.83
|
| Rate for Payer: PHP All Commercial |
$958.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$492.87
|
| Rate for Payer: Sagamore Health Network All Products |
$975.63
|
| Rate for Payer: Signature Care EPO |
$1,048.93
|
| Rate for Payer: Signature Care PPO |
$1,112.12
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,074.20
|
| Rate for Payer: United Healthcare Commercial |
$995.85
|
| Rate for Payer: United Healthcare Medicare |
$417.04
|
|
|
HC X-RAY-KNEE - 4 VWS OR MORE BI
|
Facility
OP
|
$892.30
|
|
|
Service Code
|
CPT 73564 50
|
| Hospital Charge Code |
21613564
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$294.46 |
| Max. Negotiated Rate |
$829.84 |
| Rate for Payer: Aetna Commercial |
$753.10
|
| Rate for Payer: Aetna Medicare |
$294.46
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$294.46
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$512.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$557.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$338.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$323.90
|
| Rate for Payer: Cash Price |
$553.22
|
| Rate for Payer: Centivo All Commercial |
$455.07
|
| Rate for Payer: Cigna All Commercial |
$770.05
|
| Rate for Payer: CORVEL All Commercial |
$829.84
|
| Rate for Payer: Coventry All Commercial |
$785.22
|
| Rate for Payer: Encore All Commercial |
$821.36
|
| Rate for Payer: Frontpath All Commercial |
$820.91
|
| Rate for Payer: Humana ChoiceCare |
$770.68
|
| Rate for Payer: Humana Medicare |
$455.07
|
| Rate for Payer: Lucent All Commercial |
$455.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$803.07
|
| Rate for Payer: PHCS All Commercial |
$669.22
|
| Rate for Payer: PHP All Commercial |
$676.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$348.00
|
| Rate for Payer: Sagamore Health Network All Products |
$688.85
|
| Rate for Payer: Signature Care EPO |
$740.61
|
| Rate for Payer: Signature Care PPO |
$785.22
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$758.45
|
| Rate for Payer: United Healthcare Commercial |
$703.13
|
| Rate for Payer: United Healthcare Medicare |
$294.46
|
|
|
HC X-RAY-KNEE - 4 VWS OR MORE BI
|
Facility
IP
|
$892.30
|
|
|
Service Code
|
CPT 73564 50
|
| Hospital Charge Code |
21613564
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$669.22 |
| Max. Negotiated Rate |
$829.84 |
| Rate for Payer: Aetna Commercial |
$770.94
|
| Rate for Payer: Cash Price |
$553.22
|
| Rate for Payer: Cigna All Commercial |
$770.05
|
| Rate for Payer: CORVEL All Commercial |
$829.84
|
| Rate for Payer: Coventry All Commercial |
$785.22
|
| Rate for Payer: Encore All Commercial |
$821.36
|
| Rate for Payer: Frontpath All Commercial |
$820.91
|
| Rate for Payer: Humana ChoiceCare |
$770.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$803.07
|
| Rate for Payer: PHCS All Commercial |
$669.22
|
| Rate for Payer: PHP All Commercial |
$676.72
|
| Rate for Payer: Sagamore Health Network All Products |
$688.85
|
| Rate for Payer: Signature Care EPO |
$740.61
|
| Rate for Payer: Signature Care PPO |
$785.22
|
| Rate for Payer: United Healthcare Commercial |
$703.13
|
|
|
HC X-RAY-KNEE - 4 VWS OR MORE LT
|
Facility
IP
|
$594.86
|
|
|
Service Code
|
CPT 73564 LT
|
| Hospital Charge Code |
01613564
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$446.15 |
| Max. Negotiated Rate |
$553.22 |
| Rate for Payer: Aetna Commercial |
$513.96
|
| Rate for Payer: Cash Price |
$368.82
|
| Rate for Payer: Cigna All Commercial |
$513.37
|
| Rate for Payer: CORVEL All Commercial |
$553.22
|
| Rate for Payer: Coventry All Commercial |
$523.48
|
| Rate for Payer: Encore All Commercial |
$547.57
|
| Rate for Payer: Frontpath All Commercial |
$547.27
|
| Rate for Payer: Humana ChoiceCare |
$513.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$535.38
|
| Rate for Payer: PHCS All Commercial |
$446.15
|
| Rate for Payer: PHP All Commercial |
$451.14
|
| Rate for Payer: Sagamore Health Network All Products |
$459.24
|
| Rate for Payer: Signature Care EPO |
$493.74
|
| Rate for Payer: Signature Care PPO |
$523.48
|
| Rate for Payer: United Healthcare Commercial |
$468.75
|
|
|
HC X-RAY-KNEE - 4 VWS OR MORE LT
|
Facility
OP
|
$594.86
|
|
|
Service Code
|
CPT 73564 LT
|
| Hospital Charge Code |
01613564
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.31 |
| Max. Negotiated Rate |
$553.22 |
| Rate for Payer: Aetna Commercial |
$502.07
|
| Rate for Payer: Aetna Medicare |
$196.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$196.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$341.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$371.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$225.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$215.94
|
| Rate for Payer: Cash Price |
$368.82
|
| Rate for Payer: Centivo All Commercial |
$303.38
|
| Rate for Payer: Cigna All Commercial |
$513.37
|
| Rate for Payer: CORVEL All Commercial |
$553.22
|
| Rate for Payer: Coventry All Commercial |
$523.48
|
| Rate for Payer: Encore All Commercial |
$547.57
|
| Rate for Payer: Frontpath All Commercial |
$547.27
|
| Rate for Payer: Humana ChoiceCare |
$513.78
|
| Rate for Payer: Humana Medicare |
$303.38
|
| Rate for Payer: Lucent All Commercial |
$303.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$535.38
|
| Rate for Payer: PHCS All Commercial |
$446.15
|
| Rate for Payer: PHP All Commercial |
$451.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$232.00
|
| Rate for Payer: Sagamore Health Network All Products |
$459.24
|
| Rate for Payer: Signature Care EPO |
$493.74
|
| Rate for Payer: Signature Care PPO |
$523.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$505.63
|
| Rate for Payer: United Healthcare Commercial |
$468.75
|
| Rate for Payer: United Healthcare Medicare |
$196.31
|
|
|
HC X-RAY-KNEE - 4 VWS OR MORE RT
|
Facility
OP
|
$594.86
|
|
|
Service Code
|
CPT 73564 RT
|
| Hospital Charge Code |
11613564
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.31 |
| Max. Negotiated Rate |
$553.22 |
| Rate for Payer: Aetna Commercial |
$502.07
|
| Rate for Payer: Aetna Medicare |
$196.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$196.31
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$341.63
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$371.85
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$225.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$215.94
|
| Rate for Payer: Cash Price |
$368.82
|
| Rate for Payer: Centivo All Commercial |
$303.38
|
| Rate for Payer: Cigna All Commercial |
$513.37
|
| Rate for Payer: CORVEL All Commercial |
$553.22
|
| Rate for Payer: Coventry All Commercial |
$523.48
|
| Rate for Payer: Encore All Commercial |
$547.57
|
| Rate for Payer: Frontpath All Commercial |
$547.27
|
| Rate for Payer: Humana ChoiceCare |
$513.78
|
| Rate for Payer: Humana Medicare |
$303.38
|
| Rate for Payer: Lucent All Commercial |
$303.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$535.38
|
| Rate for Payer: PHCS All Commercial |
$446.15
|
| Rate for Payer: PHP All Commercial |
$451.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$232.00
|
| Rate for Payer: Sagamore Health Network All Products |
$459.24
|
| Rate for Payer: Signature Care EPO |
$493.74
|
| Rate for Payer: Signature Care PPO |
$523.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$505.63
|
| Rate for Payer: United Healthcare Commercial |
$468.75
|
| Rate for Payer: United Healthcare Medicare |
$196.31
|
|
|
HC X-RAY-KNEE - 4 VWS OR MORE RT
|
Facility
IP
|
$594.86
|
|
|
Service Code
|
CPT 73564 RT
|
| Hospital Charge Code |
11613564
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$446.15 |
| Max. Negotiated Rate |
$553.22 |
| Rate for Payer: Aetna Commercial |
$513.96
|
| Rate for Payer: Cash Price |
$368.82
|
| Rate for Payer: Cigna All Commercial |
$513.37
|
| Rate for Payer: CORVEL All Commercial |
$553.22
|
| Rate for Payer: Coventry All Commercial |
$523.48
|
| Rate for Payer: Encore All Commercial |
$547.57
|
| Rate for Payer: Frontpath All Commercial |
$547.27
|
| Rate for Payer: Humana ChoiceCare |
$513.78
|
| Rate for Payer: Lutheran Preferred All Commercial |
$535.38
|
| Rate for Payer: PHCS All Commercial |
$446.15
|
| Rate for Payer: PHP All Commercial |
$451.14
|
| Rate for Payer: Sagamore Health Network All Products |
$459.24
|
| Rate for Payer: Signature Care EPO |
$493.74
|
| Rate for Payer: Signature Care PPO |
$523.48
|
| Rate for Payer: United Healthcare Commercial |
$468.75
|
|
|
HC X-RAY-KNEE SINGLE VIEW LT
|
Facility
IP
|
$458.79
|
|
|
Service Code
|
CPT 73560 LT
|
| Hospital Charge Code |
01618560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$344.09 |
| Max. Negotiated Rate |
$426.67 |
| Rate for Payer: Aetna Commercial |
$396.39
|
| Rate for Payer: Cash Price |
$284.45
|
| Rate for Payer: Cigna All Commercial |
$395.93
|
| Rate for Payer: CORVEL All Commercial |
$426.67
|
| Rate for Payer: Coventry All Commercial |
$403.73
|
| Rate for Payer: Encore All Commercial |
$422.31
|
| Rate for Payer: Frontpath All Commercial |
$422.08
|
| Rate for Payer: Humana ChoiceCare |
$396.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.91
|
| Rate for Payer: PHCS All Commercial |
$344.09
|
| Rate for Payer: PHP All Commercial |
$347.94
|
| Rate for Payer: Sagamore Health Network All Products |
$354.18
|
| Rate for Payer: Signature Care EPO |
$380.79
|
| Rate for Payer: Signature Care PPO |
$403.73
|
| Rate for Payer: United Healthcare Commercial |
$361.52
|
|
|
HC X-RAY-KNEE SINGLE VIEW LT
|
Facility
OP
|
$458.79
|
|
|
Service Code
|
CPT 73560 LT
|
| Hospital Charge Code |
01618560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$426.67 |
| Rate for Payer: Aetna Commercial |
$387.22
|
| Rate for Payer: Aetna Medicare |
$151.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$151.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$263.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$286.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$174.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$166.54
|
| Rate for Payer: Cash Price |
$284.45
|
| Rate for Payer: Centivo All Commercial |
$233.98
|
| Rate for Payer: Cigna All Commercial |
$395.93
|
| Rate for Payer: CORVEL All Commercial |
$426.67
|
| Rate for Payer: Coventry All Commercial |
$403.73
|
| Rate for Payer: Encore All Commercial |
$422.31
|
| Rate for Payer: Frontpath All Commercial |
$422.08
|
| Rate for Payer: Humana ChoiceCare |
$396.25
|
| Rate for Payer: Humana Medicare |
$233.98
|
| Rate for Payer: Lucent All Commercial |
$233.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.91
|
| Rate for Payer: PHCS All Commercial |
$344.09
|
| Rate for Payer: PHP All Commercial |
$347.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$178.93
|
| Rate for Payer: Sagamore Health Network All Products |
$354.18
|
| Rate for Payer: Signature Care EPO |
$380.79
|
| Rate for Payer: Signature Care PPO |
$403.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$389.97
|
| Rate for Payer: United Healthcare Commercial |
$361.52
|
| Rate for Payer: United Healthcare Medicare |
$151.40
|
|
|
HC X-RAY-KNEE SINGLE VIEW RT
|
Facility
OP
|
$458.79
|
|
|
Service Code
|
CPT 73560 RT
|
| Hospital Charge Code |
11618560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$426.67 |
| Rate for Payer: Aetna Commercial |
$387.22
|
| Rate for Payer: Aetna Medicare |
$151.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$151.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$263.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$286.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$174.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$166.54
|
| Rate for Payer: Cash Price |
$284.45
|
| Rate for Payer: Centivo All Commercial |
$233.98
|
| Rate for Payer: Cigna All Commercial |
$395.93
|
| Rate for Payer: CORVEL All Commercial |
$426.67
|
| Rate for Payer: Coventry All Commercial |
$403.73
|
| Rate for Payer: Encore All Commercial |
$422.31
|
| Rate for Payer: Frontpath All Commercial |
$422.08
|
| Rate for Payer: Humana ChoiceCare |
$396.25
|
| Rate for Payer: Humana Medicare |
$233.98
|
| Rate for Payer: Lucent All Commercial |
$233.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.91
|
| Rate for Payer: PHCS All Commercial |
$344.09
|
| Rate for Payer: PHP All Commercial |
$347.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$178.93
|
| Rate for Payer: Sagamore Health Network All Products |
$354.18
|
| Rate for Payer: Signature Care EPO |
$380.79
|
| Rate for Payer: Signature Care PPO |
$403.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$389.97
|
| Rate for Payer: United Healthcare Commercial |
$361.52
|
| Rate for Payer: United Healthcare Medicare |
$151.40
|
|
|
HC X-RAY-KNEE SINGLE VIEW RT
|
Facility
IP
|
$458.79
|
|
|
Service Code
|
CPT 73560 RT
|
| Hospital Charge Code |
11618560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$344.09 |
| Max. Negotiated Rate |
$426.67 |
| Rate for Payer: Aetna Commercial |
$396.39
|
| Rate for Payer: Cash Price |
$284.45
|
| Rate for Payer: Cigna All Commercial |
$395.93
|
| Rate for Payer: CORVEL All Commercial |
$426.67
|
| Rate for Payer: Coventry All Commercial |
$403.73
|
| Rate for Payer: Encore All Commercial |
$422.31
|
| Rate for Payer: Frontpath All Commercial |
$422.08
|
| Rate for Payer: Humana ChoiceCare |
$396.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.91
|
| Rate for Payer: PHCS All Commercial |
$344.09
|
| Rate for Payer: PHP All Commercial |
$347.94
|
| Rate for Payer: Sagamore Health Network All Products |
$354.18
|
| Rate for Payer: Signature Care EPO |
$380.79
|
| Rate for Payer: Signature Care PPO |
$403.73
|
| Rate for Payer: United Healthcare Commercial |
$361.52
|
|
|
HC X-RAY-KNEES-STANDING AP
|
Facility
IP
|
$423.98
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
01613565
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$317.99 |
| Max. Negotiated Rate |
$394.30 |
| Rate for Payer: Aetna Commercial |
$366.32
|
| Rate for Payer: Cash Price |
$262.87
|
| Rate for Payer: Cigna All Commercial |
$365.90
|
| Rate for Payer: CORVEL All Commercial |
$394.30
|
| Rate for Payer: Coventry All Commercial |
$373.11
|
| Rate for Payer: Encore All Commercial |
$390.28
|
| Rate for Payer: Frontpath All Commercial |
$390.06
|
| Rate for Payer: Humana ChoiceCare |
$366.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.59
|
| Rate for Payer: PHCS All Commercial |
$317.99
|
| Rate for Payer: PHP All Commercial |
$321.55
|
| Rate for Payer: Sagamore Health Network All Products |
$327.32
|
| Rate for Payer: Signature Care EPO |
$351.91
|
| Rate for Payer: Signature Care PPO |
$373.11
|
| Rate for Payer: United Healthcare Commercial |
$334.10
|
|
|
HC X-RAY-KNEES-STANDING AP
|
Facility
OP
|
$423.98
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
01613565
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.18 |
| Max. Negotiated Rate |
$394.30 |
| Rate for Payer: Aetna Commercial |
$357.84
|
| Rate for Payer: Aetna Medicare |
$139.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$139.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$243.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$265.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$71.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$160.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$153.91
|
| Rate for Payer: Cash Price |
$262.87
|
| Rate for Payer: Cash Price |
$262.87
|
| Rate for Payer: Centivo All Commercial |
$216.23
|
| Rate for Payer: Cigna All Commercial |
$365.90
|
| Rate for Payer: CORVEL All Commercial |
$394.30
|
| Rate for Payer: Coventry All Commercial |
$373.11
|
| Rate for Payer: Encore All Commercial |
$390.28
|
| Rate for Payer: Frontpath All Commercial |
$390.06
|
| Rate for Payer: Humana ChoiceCare |
$366.19
|
| Rate for Payer: Humana Medicare |
$216.23
|
| Rate for Payer: Lucent All Commercial |
$216.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$381.59
|
| Rate for Payer: Managed Health Services Medicaid |
$71.18
|
| Rate for Payer: MDWise Medicaid |
$71.18
|
| Rate for Payer: PHCS All Commercial |
$317.99
|
| Rate for Payer: PHP All Commercial |
$321.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$165.35
|
| Rate for Payer: Sagamore Health Network All Products |
$327.32
|
| Rate for Payer: Signature Care EPO |
$351.91
|
| Rate for Payer: Signature Care PPO |
$373.11
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$360.39
|
| Rate for Payer: United Healthcare Commercial |
$334.10
|
| Rate for Payer: United Healthcare Medicare |
$139.91
|
|
|
HC X-RAY-KNEE THREE VIEWS BI
|
Facility
IP
|
$816.06
|
|
|
Service Code
|
CPT 73562 50
|
| Hospital Charge Code |
21613581
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$612.05 |
| Max. Negotiated Rate |
$758.94 |
| Rate for Payer: Aetna Commercial |
$705.08
|
| Rate for Payer: Cash Price |
$505.96
|
| Rate for Payer: Cigna All Commercial |
$704.26
|
| Rate for Payer: CORVEL All Commercial |
$758.94
|
| Rate for Payer: Coventry All Commercial |
$718.13
|
| Rate for Payer: Encore All Commercial |
$751.18
|
| Rate for Payer: Frontpath All Commercial |
$750.78
|
| Rate for Payer: Humana ChoiceCare |
$704.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$734.46
|
| Rate for Payer: PHCS All Commercial |
$612.05
|
| Rate for Payer: PHP All Commercial |
$618.90
|
| Rate for Payer: Sagamore Health Network All Products |
$630.00
|
| Rate for Payer: Signature Care EPO |
$677.33
|
| Rate for Payer: Signature Care PPO |
$718.13
|
| Rate for Payer: United Healthcare Commercial |
$643.06
|
|
|
HC X-RAY-KNEE THREE VIEWS BI
|
Facility
OP
|
$816.06
|
|
|
Service Code
|
CPT 73562 50
|
| Hospital Charge Code |
21613581
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.30 |
| Max. Negotiated Rate |
$758.94 |
| Rate for Payer: Aetna Commercial |
$688.76
|
| Rate for Payer: Aetna Medicare |
$269.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$269.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$468.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$510.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$309.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$296.23
|
| Rate for Payer: Cash Price |
$505.96
|
| Rate for Payer: Centivo All Commercial |
$416.19
|
| Rate for Payer: Cigna All Commercial |
$704.26
|
| Rate for Payer: CORVEL All Commercial |
$758.94
|
| Rate for Payer: Coventry All Commercial |
$718.13
|
| Rate for Payer: Encore All Commercial |
$751.18
|
| Rate for Payer: Frontpath All Commercial |
$750.78
|
| Rate for Payer: Humana ChoiceCare |
$704.83
|
| Rate for Payer: Humana Medicare |
$416.19
|
| Rate for Payer: Lucent All Commercial |
$416.19
|
| Rate for Payer: Lutheran Preferred All Commercial |
$734.46
|
| Rate for Payer: PHCS All Commercial |
$612.05
|
| Rate for Payer: PHP All Commercial |
$618.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$318.26
|
| Rate for Payer: Sagamore Health Network All Products |
$630.00
|
| Rate for Payer: Signature Care EPO |
$677.33
|
| Rate for Payer: Signature Care PPO |
$718.13
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$693.65
|
| Rate for Payer: United Healthcare Commercial |
$643.06
|
| Rate for Payer: United Healthcare Medicare |
$269.30
|
|
|
HC X-RAY-KNEE THREE VIEWS LT
|
Facility
OP
|
$544.03
|
|
|
Service Code
|
CPT 73562 LT
|
| Hospital Charge Code |
01613581
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.53 |
| Max. Negotiated Rate |
$505.95 |
| Rate for Payer: Aetna Commercial |
$459.16
|
| Rate for Payer: Aetna Medicare |
$179.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$179.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$312.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$340.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$206.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$197.48
|
| Rate for Payer: Cash Price |
$337.30
|
| Rate for Payer: Centivo All Commercial |
$277.45
|
| Rate for Payer: Cigna All Commercial |
$469.50
|
| Rate for Payer: CORVEL All Commercial |
$505.95
|
| Rate for Payer: Coventry All Commercial |
$478.74
|
| Rate for Payer: Encore All Commercial |
$500.78
|
| Rate for Payer: Frontpath All Commercial |
$500.51
|
| Rate for Payer: Humana ChoiceCare |
$469.88
|
| Rate for Payer: Humana Medicare |
$277.45
|
| Rate for Payer: Lucent All Commercial |
$277.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$489.62
|
| Rate for Payer: PHCS All Commercial |
$408.02
|
| Rate for Payer: PHP All Commercial |
$412.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$212.17
|
| Rate for Payer: Sagamore Health Network All Products |
$419.99
|
| Rate for Payer: Signature Care EPO |
$451.54
|
| Rate for Payer: Signature Care PPO |
$478.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$462.42
|
| Rate for Payer: United Healthcare Commercial |
$428.69
|
| Rate for Payer: United Healthcare Medicare |
$179.53
|
|
|
HC X-RAY-KNEE THREE VIEWS LT
|
Facility
IP
|
$544.03
|
|
|
Service Code
|
CPT 73562 LT
|
| Hospital Charge Code |
01613581
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$408.02 |
| Max. Negotiated Rate |
$505.95 |
| Rate for Payer: Aetna Commercial |
$470.04
|
| Rate for Payer: Cash Price |
$337.30
|
| Rate for Payer: Cigna All Commercial |
$469.50
|
| Rate for Payer: CORVEL All Commercial |
$505.95
|
| Rate for Payer: Coventry All Commercial |
$478.74
|
| Rate for Payer: Encore All Commercial |
$500.78
|
| Rate for Payer: Frontpath All Commercial |
$500.51
|
| Rate for Payer: Humana ChoiceCare |
$469.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$489.62
|
| Rate for Payer: PHCS All Commercial |
$408.02
|
| Rate for Payer: PHP All Commercial |
$412.59
|
| Rate for Payer: Sagamore Health Network All Products |
$419.99
|
| Rate for Payer: Signature Care EPO |
$451.54
|
| Rate for Payer: Signature Care PPO |
$478.74
|
| Rate for Payer: United Healthcare Commercial |
$428.69
|
|
|
HC X-RAY-KNEE THREE VIEWS RT
|
Facility
IP
|
$544.03
|
|
|
Service Code
|
CPT 73562 RT
|
| Hospital Charge Code |
11613581
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$408.02 |
| Max. Negotiated Rate |
$505.95 |
| Rate for Payer: Aetna Commercial |
$470.04
|
| Rate for Payer: Cash Price |
$337.30
|
| Rate for Payer: Cigna All Commercial |
$469.50
|
| Rate for Payer: CORVEL All Commercial |
$505.95
|
| Rate for Payer: Coventry All Commercial |
$478.74
|
| Rate for Payer: Encore All Commercial |
$500.78
|
| Rate for Payer: Frontpath All Commercial |
$500.51
|
| Rate for Payer: Humana ChoiceCare |
$469.88
|
| Rate for Payer: Lutheran Preferred All Commercial |
$489.62
|
| Rate for Payer: PHCS All Commercial |
$408.02
|
| Rate for Payer: PHP All Commercial |
$412.59
|
| Rate for Payer: Sagamore Health Network All Products |
$419.99
|
| Rate for Payer: Signature Care EPO |
$451.54
|
| Rate for Payer: Signature Care PPO |
$478.74
|
| Rate for Payer: United Healthcare Commercial |
$428.69
|
|
|
HC X-RAY-KNEE THREE VIEWS RT
|
Facility
OP
|
$544.03
|
|
|
Service Code
|
CPT 73562 RT
|
| Hospital Charge Code |
11613581
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.53 |
| Max. Negotiated Rate |
$505.95 |
| Rate for Payer: Aetna Commercial |
$459.16
|
| Rate for Payer: Aetna Medicare |
$179.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$179.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$312.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$340.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$206.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$197.48
|
| Rate for Payer: Cash Price |
$337.30
|
| Rate for Payer: Centivo All Commercial |
$277.45
|
| Rate for Payer: Cigna All Commercial |
$469.50
|
| Rate for Payer: CORVEL All Commercial |
$505.95
|
| Rate for Payer: Coventry All Commercial |
$478.74
|
| Rate for Payer: Encore All Commercial |
$500.78
|
| Rate for Payer: Frontpath All Commercial |
$500.51
|
| Rate for Payer: Humana ChoiceCare |
$469.88
|
| Rate for Payer: Humana Medicare |
$277.45
|
| Rate for Payer: Lucent All Commercial |
$277.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$489.62
|
| Rate for Payer: PHCS All Commercial |
$408.02
|
| Rate for Payer: PHP All Commercial |
$412.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$212.17
|
| Rate for Payer: Sagamore Health Network All Products |
$419.99
|
| Rate for Payer: Signature Care EPO |
$451.54
|
| Rate for Payer: Signature Care PPO |
$478.74
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$462.42
|
| Rate for Payer: United Healthcare Commercial |
$428.69
|
| Rate for Payer: United Healthcare Medicare |
$179.53
|
|
|
HC X-RAY-KNEE TWO VIEWS BI
|
Facility
OP
|
$688.17
|
|
|
Service Code
|
CPT 73560 50
|
| Hospital Charge Code |
21613560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.10 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna Commercial |
$580.82
|
| Rate for Payer: Aetna Medicare |
$227.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$227.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$395.22
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$430.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$261.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$249.81
|
| Rate for Payer: Cash Price |
$426.67
|
| Rate for Payer: Centivo All Commercial |
$350.97
|
| Rate for Payer: Cigna All Commercial |
$593.89
|
| Rate for Payer: CORVEL All Commercial |
$640.00
|
| Rate for Payer: Coventry All Commercial |
$605.59
|
| Rate for Payer: Encore All Commercial |
$633.46
|
| Rate for Payer: Frontpath All Commercial |
$633.12
|
| Rate for Payer: Humana ChoiceCare |
$594.38
|
| Rate for Payer: Humana Medicare |
$350.97
|
| Rate for Payer: Lucent All Commercial |
$350.97
|
| Rate for Payer: Lutheran Preferred All Commercial |
$619.36
|
| Rate for Payer: PHCS All Commercial |
$516.13
|
| Rate for Payer: PHP All Commercial |
$521.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$268.39
|
| Rate for Payer: Sagamore Health Network All Products |
$531.27
|
| Rate for Payer: Signature Care EPO |
$571.18
|
| Rate for Payer: Signature Care PPO |
$605.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$584.95
|
| Rate for Payer: United Healthcare Commercial |
$542.28
|
| Rate for Payer: United Healthcare Medicare |
$227.10
|
|
|
HC X-RAY-KNEE TWO VIEWS BI
|
Facility
IP
|
$688.17
|
|
|
Service Code
|
CPT 73560 50
|
| Hospital Charge Code |
21613560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$516.13 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna Commercial |
$594.58
|
| Rate for Payer: Cash Price |
$426.67
|
| Rate for Payer: Cigna All Commercial |
$593.89
|
| Rate for Payer: CORVEL All Commercial |
$640.00
|
| Rate for Payer: Coventry All Commercial |
$605.59
|
| Rate for Payer: Encore All Commercial |
$633.46
|
| Rate for Payer: Frontpath All Commercial |
$633.12
|
| Rate for Payer: Humana ChoiceCare |
$594.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$619.36
|
| Rate for Payer: PHCS All Commercial |
$516.13
|
| Rate for Payer: PHP All Commercial |
$521.91
|
| Rate for Payer: Sagamore Health Network All Products |
$531.27
|
| Rate for Payer: Signature Care EPO |
$571.18
|
| Rate for Payer: Signature Care PPO |
$605.59
|
| Rate for Payer: United Healthcare Commercial |
$542.28
|
|
|
HC X-RAY-KNEE TWO VIEWS LT
|
Facility
OP
|
$458.79
|
|
|
Service Code
|
CPT 73560 LT
|
| Hospital Charge Code |
01613560
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$426.67 |
| Rate for Payer: Aetna Commercial |
$387.22
|
| Rate for Payer: Aetna Medicare |
$151.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$151.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$263.48
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$286.79
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$174.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$166.54
|
| Rate for Payer: Cash Price |
$284.45
|
| Rate for Payer: Centivo All Commercial |
$233.98
|
| Rate for Payer: Cigna All Commercial |
$395.93
|
| Rate for Payer: CORVEL All Commercial |
$426.67
|
| Rate for Payer: Coventry All Commercial |
$403.73
|
| Rate for Payer: Encore All Commercial |
$422.31
|
| Rate for Payer: Frontpath All Commercial |
$422.08
|
| Rate for Payer: Humana ChoiceCare |
$396.25
|
| Rate for Payer: Humana Medicare |
$233.98
|
| Rate for Payer: Lucent All Commercial |
$233.98
|
| Rate for Payer: Lutheran Preferred All Commercial |
$412.91
|
| Rate for Payer: PHCS All Commercial |
$344.09
|
| Rate for Payer: PHP All Commercial |
$347.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$178.93
|
| Rate for Payer: Sagamore Health Network All Products |
$354.18
|
| Rate for Payer: Signature Care EPO |
$380.79
|
| Rate for Payer: Signature Care PPO |
$403.73
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$389.97
|
| Rate for Payer: United Healthcare Commercial |
$361.52
|
| Rate for Payer: United Healthcare Medicare |
$151.40
|
|
