|
HC X-RAY-KNEE TWO VIEWS LT
|
Facility
IP
|
$458.79
|
|
|
Service Code
|
CPT 73560 LT
|
| Hospital Charge Code |
01613560
|
|
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 TWO VIEWS RT
|
Facility
IP
|
$458.79
|
|
|
Service Code
|
CPT 73560 RT
|
| Hospital Charge Code |
11613560
|
|
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 TWO VIEWS RT
|
Facility
OP
|
$458.79
|
|
|
Service Code
|
CPT 73560 RT
|
| Hospital Charge Code |
11613560
|
|
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-LOWER EXT AP&LAT INF BI
|
Facility
OP
|
$337.74
|
|
|
Service Code
|
CPT 73592 50
|
| Hospital Charge Code |
21613592
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.45 |
| Max. Negotiated Rate |
$314.10 |
| Rate for Payer: Aetna Commercial |
$285.05
|
| Rate for Payer: Aetna Medicare |
$111.45
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$111.45
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$193.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$211.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.60
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Centivo All Commercial |
$172.25
|
| Rate for Payer: Cigna All Commercial |
$291.47
|
| Rate for Payer: CORVEL All Commercial |
$314.10
|
| Rate for Payer: Coventry All Commercial |
$297.21
|
| Rate for Payer: Encore All Commercial |
$310.89
|
| Rate for Payer: Frontpath All Commercial |
$310.72
|
| Rate for Payer: Humana ChoiceCare |
$291.71
|
| Rate for Payer: Humana Medicare |
$172.25
|
| Rate for Payer: Lucent All Commercial |
$172.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.97
|
| Rate for Payer: PHCS All Commercial |
$253.31
|
| Rate for Payer: PHP All Commercial |
$256.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$131.72
|
| Rate for Payer: Sagamore Health Network All Products |
$260.74
|
| Rate for Payer: Signature Care EPO |
$280.33
|
| Rate for Payer: Signature Care PPO |
$297.21
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$287.08
|
| Rate for Payer: United Healthcare Commercial |
$266.14
|
| Rate for Payer: United Healthcare Medicare |
$111.45
|
|
|
HC X-RAY-LOWER EXT AP&LAT INF BI
|
Facility
IP
|
$337.74
|
|
|
Service Code
|
CPT 73592 50
|
| Hospital Charge Code |
21613592
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$253.31 |
| Max. Negotiated Rate |
$314.10 |
| Rate for Payer: Aetna Commercial |
$291.81
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna All Commercial |
$291.47
|
| Rate for Payer: CORVEL All Commercial |
$314.10
|
| Rate for Payer: Coventry All Commercial |
$297.21
|
| Rate for Payer: Encore All Commercial |
$310.89
|
| Rate for Payer: Frontpath All Commercial |
$310.72
|
| Rate for Payer: Humana ChoiceCare |
$291.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$303.97
|
| Rate for Payer: PHCS All Commercial |
$253.31
|
| Rate for Payer: PHP All Commercial |
$256.14
|
| Rate for Payer: Sagamore Health Network All Products |
$260.74
|
| Rate for Payer: Signature Care EPO |
$280.33
|
| Rate for Payer: Signature Care PPO |
$297.21
|
| Rate for Payer: United Healthcare Commercial |
$266.14
|
|
|
HC X-RAY-LOWER EXT AP&LAT INF LT
|
Facility
OP
|
$225.17
|
|
|
Service Code
|
CPT 73592 LT
|
| Hospital Charge Code |
01613592
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.30 |
| Max. Negotiated Rate |
$209.40 |
| Rate for Payer: Aetna Commercial |
$190.04
|
| Rate for Payer: Aetna Medicare |
$74.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$74.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$129.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$140.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$85.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.73
|
| Rate for Payer: Cash Price |
$139.60
|
| Rate for Payer: Centivo All Commercial |
$114.83
|
| Rate for Payer: Cigna All Commercial |
$194.32
|
| Rate for Payer: CORVEL All Commercial |
$209.40
|
| Rate for Payer: Coventry All Commercial |
$198.15
|
| Rate for Payer: Encore All Commercial |
$207.26
|
| Rate for Payer: Frontpath All Commercial |
$207.15
|
| Rate for Payer: Humana ChoiceCare |
$194.48
|
| Rate for Payer: Humana Medicare |
$114.83
|
| Rate for Payer: Lucent All Commercial |
$114.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$202.65
|
| Rate for Payer: PHCS All Commercial |
$168.87
|
| Rate for Payer: PHP All Commercial |
$170.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.81
|
| Rate for Payer: Sagamore Health Network All Products |
$173.83
|
| Rate for Payer: Signature Care EPO |
$186.89
|
| Rate for Payer: Signature Care PPO |
$198.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$191.39
|
| Rate for Payer: United Healthcare Commercial |
$177.43
|
| Rate for Payer: United Healthcare Medicare |
$74.30
|
|
|
HC X-RAY-LOWER EXT AP&LAT INF LT
|
Facility
IP
|
$225.17
|
|
|
Service Code
|
CPT 73592 LT
|
| Hospital Charge Code |
01613592
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.87 |
| Max. Negotiated Rate |
$209.40 |
| Rate for Payer: Aetna Commercial |
$194.54
|
| Rate for Payer: Cash Price |
$139.60
|
| Rate for Payer: Cigna All Commercial |
$194.32
|
| Rate for Payer: CORVEL All Commercial |
$209.40
|
| Rate for Payer: Coventry All Commercial |
$198.15
|
| Rate for Payer: Encore All Commercial |
$207.26
|
| Rate for Payer: Frontpath All Commercial |
$207.15
|
| Rate for Payer: Humana ChoiceCare |
$194.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$202.65
|
| Rate for Payer: PHCS All Commercial |
$168.87
|
| Rate for Payer: PHP All Commercial |
$170.77
|
| Rate for Payer: Sagamore Health Network All Products |
$173.83
|
| Rate for Payer: Signature Care EPO |
$186.89
|
| Rate for Payer: Signature Care PPO |
$198.15
|
| Rate for Payer: United Healthcare Commercial |
$177.43
|
|
|
HC X-RAY-LOWER EXT AP&LAT INF RT
|
Facility
IP
|
$225.17
|
|
|
Service Code
|
CPT 73592 RT
|
| Hospital Charge Code |
11613592
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.87 |
| Max. Negotiated Rate |
$209.40 |
| Rate for Payer: Aetna Commercial |
$194.54
|
| Rate for Payer: Cash Price |
$139.60
|
| Rate for Payer: Cigna All Commercial |
$194.32
|
| Rate for Payer: CORVEL All Commercial |
$209.40
|
| Rate for Payer: Coventry All Commercial |
$198.15
|
| Rate for Payer: Encore All Commercial |
$207.26
|
| Rate for Payer: Frontpath All Commercial |
$207.15
|
| Rate for Payer: Humana ChoiceCare |
$194.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$202.65
|
| Rate for Payer: PHCS All Commercial |
$168.87
|
| Rate for Payer: PHP All Commercial |
$170.77
|
| Rate for Payer: Sagamore Health Network All Products |
$173.83
|
| Rate for Payer: Signature Care EPO |
$186.89
|
| Rate for Payer: Signature Care PPO |
$198.15
|
| Rate for Payer: United Healthcare Commercial |
$177.43
|
|
|
HC X-RAY-LOWER EXT AP&LAT INF RT
|
Facility
OP
|
$225.17
|
|
|
Service Code
|
CPT 73592 RT
|
| Hospital Charge Code |
11613592
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.30 |
| Max. Negotiated Rate |
$209.40 |
| Rate for Payer: Aetna Commercial |
$190.04
|
| Rate for Payer: Aetna Medicare |
$74.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$74.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$129.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$140.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$85.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$81.73
|
| Rate for Payer: Cash Price |
$139.60
|
| Rate for Payer: Centivo All Commercial |
$114.83
|
| Rate for Payer: Cigna All Commercial |
$194.32
|
| Rate for Payer: CORVEL All Commercial |
$209.40
|
| Rate for Payer: Coventry All Commercial |
$198.15
|
| Rate for Payer: Encore All Commercial |
$207.26
|
| Rate for Payer: Frontpath All Commercial |
$207.15
|
| Rate for Payer: Humana ChoiceCare |
$194.48
|
| Rate for Payer: Humana Medicare |
$114.83
|
| Rate for Payer: Lucent All Commercial |
$114.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$202.65
|
| Rate for Payer: PHCS All Commercial |
$168.87
|
| Rate for Payer: PHP All Commercial |
$170.77
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.81
|
| Rate for Payer: Sagamore Health Network All Products |
$173.83
|
| Rate for Payer: Signature Care EPO |
$186.89
|
| Rate for Payer: Signature Care PPO |
$198.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$191.39
|
| Rate for Payer: United Healthcare Commercial |
$177.43
|
| Rate for Payer: United Healthcare Medicare |
$74.30
|
|
|
HC X-RAY-LS SPINE 2 OR 3 VIEWS
|
Facility
OP
|
$610.98
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
01612100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.34 |
| Max. Negotiated Rate |
$568.21 |
| Rate for Payer: Aetna Commercial |
$515.67
|
| Rate for Payer: Aetna Medicare |
$201.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$201.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$350.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$381.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$66.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$231.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$221.79
|
| Rate for Payer: Cash Price |
$378.81
|
| Rate for Payer: Cash Price |
$378.81
|
| Rate for Payer: Centivo All Commercial |
$311.60
|
| Rate for Payer: Cigna All Commercial |
$527.28
|
| Rate for Payer: CORVEL All Commercial |
$568.21
|
| Rate for Payer: Coventry All Commercial |
$537.66
|
| Rate for Payer: Encore All Commercial |
$562.41
|
| Rate for Payer: Frontpath All Commercial |
$562.10
|
| Rate for Payer: Humana ChoiceCare |
$527.70
|
| Rate for Payer: Humana Medicare |
$311.60
|
| Rate for Payer: Lucent All Commercial |
$311.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$549.88
|
| Rate for Payer: Managed Health Services Medicaid |
$66.34
|
| Rate for Payer: MDWise Medicaid |
$66.34
|
| Rate for Payer: PHCS All Commercial |
$458.24
|
| Rate for Payer: PHP All Commercial |
$463.37
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$238.28
|
| Rate for Payer: Sagamore Health Network All Products |
$471.68
|
| Rate for Payer: Signature Care EPO |
$507.11
|
| Rate for Payer: Signature Care PPO |
$537.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$519.33
|
| Rate for Payer: United Healthcare Commercial |
$481.45
|
| Rate for Payer: United Healthcare Medicare |
$201.62
|
|
|
HC X-RAY-LS SPINE 2 OR 3 VIEWS
|
Facility
IP
|
$610.98
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
01612100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$458.24 |
| Max. Negotiated Rate |
$568.21 |
| Rate for Payer: Aetna Commercial |
$527.89
|
| Rate for Payer: Cash Price |
$378.81
|
| Rate for Payer: Cigna All Commercial |
$527.28
|
| Rate for Payer: CORVEL All Commercial |
$568.21
|
| Rate for Payer: Coventry All Commercial |
$537.66
|
| Rate for Payer: Encore All Commercial |
$562.41
|
| Rate for Payer: Frontpath All Commercial |
$562.10
|
| Rate for Payer: Humana ChoiceCare |
$527.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$549.88
|
| Rate for Payer: PHCS All Commercial |
$458.24
|
| Rate for Payer: PHP All Commercial |
$463.37
|
| Rate for Payer: Sagamore Health Network All Products |
$471.68
|
| Rate for Payer: Signature Care EPO |
$507.11
|
| Rate for Payer: Signature Care PPO |
$537.66
|
| Rate for Payer: United Healthcare Commercial |
$481.45
|
|
|
HC X-RAY-LS SPINE BENDING 2-3 VIEWS
|
Facility
OP
|
$796.49
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
01612120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.90 |
| Max. Negotiated Rate |
$740.73 |
| Rate for Payer: Aetna Commercial |
$672.24
|
| Rate for Payer: Aetna Medicare |
$262.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$262.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$457.42
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$497.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$78.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$302.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$289.12
|
| Rate for Payer: Cash Price |
$493.82
|
| Rate for Payer: Cash Price |
$493.82
|
| Rate for Payer: Centivo All Commercial |
$406.21
|
| Rate for Payer: Cigna All Commercial |
$687.37
|
| Rate for Payer: CORVEL All Commercial |
$740.73
|
| Rate for Payer: Coventry All Commercial |
$700.91
|
| Rate for Payer: Encore All Commercial |
$733.17
|
| Rate for Payer: Frontpath All Commercial |
$732.77
|
| Rate for Payer: Humana ChoiceCare |
$687.93
|
| Rate for Payer: Humana Medicare |
$406.21
|
| Rate for Payer: Lucent All Commercial |
$406.21
|
| Rate for Payer: Lutheran Preferred All Commercial |
$716.84
|
| Rate for Payer: Managed Health Services Medicaid |
$78.90
|
| Rate for Payer: MDWise Medicaid |
$78.90
|
| Rate for Payer: PHCS All Commercial |
$597.37
|
| Rate for Payer: PHP All Commercial |
$604.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$310.63
|
| Rate for Payer: Sagamore Health Network All Products |
$614.89
|
| Rate for Payer: Signature Care EPO |
$661.08
|
| Rate for Payer: Signature Care PPO |
$700.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$677.01
|
| Rate for Payer: United Healthcare Commercial |
$627.63
|
| Rate for Payer: United Healthcare Medicare |
$262.84
|
|
|
HC X-RAY-LS SPINE BENDING 2-3 VIEWS
|
Facility
IP
|
$796.49
|
|
|
Service Code
|
CPT 72120
|
| Hospital Charge Code |
01612120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$597.37 |
| Max. Negotiated Rate |
$740.73 |
| Rate for Payer: Aetna Commercial |
$688.17
|
| Rate for Payer: Cash Price |
$493.82
|
| Rate for Payer: Cigna All Commercial |
$687.37
|
| Rate for Payer: CORVEL All Commercial |
$740.73
|
| Rate for Payer: Coventry All Commercial |
$700.91
|
| Rate for Payer: Encore All Commercial |
$733.17
|
| Rate for Payer: Frontpath All Commercial |
$732.77
|
| Rate for Payer: Humana ChoiceCare |
$687.93
|
| Rate for Payer: Lutheran Preferred All Commercial |
$716.84
|
| Rate for Payer: PHCS All Commercial |
$597.37
|
| Rate for Payer: PHP All Commercial |
$604.06
|
| Rate for Payer: Sagamore Health Network All Products |
$614.89
|
| Rate for Payer: Signature Care EPO |
$661.08
|
| Rate for Payer: Signature Care PPO |
$700.91
|
| Rate for Payer: United Healthcare Commercial |
$627.63
|
|
|
HC X-RAY-LS SPINE MIN 4 VIEWS
|
Facility
OP
|
$841.50
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
01612110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.46 |
| Max. Negotiated Rate |
$782.60 |
| Rate for Payer: Aetna Commercial |
$710.23
|
| Rate for Payer: Aetna Medicare |
$277.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$277.70
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$483.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$526.02
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$91.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$319.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$305.46
|
| Rate for Payer: Cash Price |
$521.73
|
| Rate for Payer: Cash Price |
$521.73
|
| Rate for Payer: Centivo All Commercial |
$429.16
|
| Rate for Payer: Cigna All Commercial |
$726.21
|
| Rate for Payer: CORVEL All Commercial |
$782.60
|
| Rate for Payer: Coventry All Commercial |
$740.52
|
| Rate for Payer: Encore All Commercial |
$774.60
|
| Rate for Payer: Frontpath All Commercial |
$774.18
|
| Rate for Payer: Humana ChoiceCare |
$726.80
|
| Rate for Payer: Humana Medicare |
$429.16
|
| Rate for Payer: Lucent All Commercial |
$429.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$757.35
|
| Rate for Payer: Managed Health Services Medicaid |
$91.46
|
| Rate for Payer: MDWise Medicaid |
$91.46
|
| Rate for Payer: PHCS All Commercial |
$631.12
|
| Rate for Payer: PHP All Commercial |
$638.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$328.18
|
| Rate for Payer: Sagamore Health Network All Products |
$649.64
|
| Rate for Payer: Signature Care EPO |
$698.44
|
| Rate for Payer: Signature Care PPO |
$740.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$715.28
|
| Rate for Payer: United Healthcare Commercial |
$663.10
|
| Rate for Payer: United Healthcare Medicare |
$277.70
|
|
|
HC X-RAY-LS SPINE MIN 4 VIEWS
|
Facility
IP
|
$841.50
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
01612110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$631.12 |
| Max. Negotiated Rate |
$782.60 |
| Rate for Payer: Aetna Commercial |
$727.06
|
| Rate for Payer: Cash Price |
$521.73
|
| Rate for Payer: Cigna All Commercial |
$726.21
|
| Rate for Payer: CORVEL All Commercial |
$782.60
|
| Rate for Payer: Coventry All Commercial |
$740.52
|
| Rate for Payer: Encore All Commercial |
$774.60
|
| Rate for Payer: Frontpath All Commercial |
$774.18
|
| Rate for Payer: Humana ChoiceCare |
$726.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$757.35
|
| Rate for Payer: PHCS All Commercial |
$631.12
|
| Rate for Payer: PHP All Commercial |
$638.19
|
| Rate for Payer: Sagamore Health Network All Products |
$649.64
|
| Rate for Payer: Signature Care EPO |
$698.44
|
| Rate for Payer: Signature Care PPO |
$740.52
|
| Rate for Payer: United Healthcare Commercial |
$663.10
|
|
|
HC X-RAY-LS SPINE W/FLEX & EXT 6+ VIEWS
|
Facility
OP
|
$924.25
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
01612105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.12 |
| Max. Negotiated Rate |
$859.55 |
| Rate for Payer: Aetna Commercial |
$780.07
|
| Rate for Payer: Aetna Medicare |
$305.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$305.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$530.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$577.75
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$130.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$350.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$335.50
|
| Rate for Payer: Cash Price |
$573.04
|
| Rate for Payer: Cash Price |
$573.04
|
| Rate for Payer: Centivo All Commercial |
$471.37
|
| Rate for Payer: Cigna All Commercial |
$797.63
|
| Rate for Payer: CORVEL All Commercial |
$859.55
|
| Rate for Payer: Coventry All Commercial |
$813.34
|
| Rate for Payer: Encore All Commercial |
$850.77
|
| Rate for Payer: Frontpath All Commercial |
$850.31
|
| Rate for Payer: Humana ChoiceCare |
$798.28
|
| Rate for Payer: Humana Medicare |
$471.37
|
| Rate for Payer: Lucent All Commercial |
$471.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.83
|
| Rate for Payer: Managed Health Services Medicaid |
$130.12
|
| Rate for Payer: MDWise Medicaid |
$130.12
|
| Rate for Payer: PHCS All Commercial |
$693.19
|
| Rate for Payer: PHP All Commercial |
$700.95
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$360.46
|
| Rate for Payer: Sagamore Health Network All Products |
$713.52
|
| Rate for Payer: Signature Care EPO |
$767.13
|
| Rate for Payer: Signature Care PPO |
$813.34
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$785.61
|
| Rate for Payer: United Healthcare Commercial |
$728.31
|
| Rate for Payer: United Healthcare Medicare |
$305.00
|
|
|
HC X-RAY-LS SPINE W/FLEX & EXT 6+ VIEWS
|
Facility
IP
|
$924.25
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
01612105
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$693.19 |
| Max. Negotiated Rate |
$859.55 |
| Rate for Payer: Aetna Commercial |
$798.55
|
| Rate for Payer: Cash Price |
$573.04
|
| Rate for Payer: Cigna All Commercial |
$797.63
|
| Rate for Payer: CORVEL All Commercial |
$859.55
|
| Rate for Payer: Coventry All Commercial |
$813.34
|
| Rate for Payer: Encore All Commercial |
$850.77
|
| Rate for Payer: Frontpath All Commercial |
$850.31
|
| Rate for Payer: Humana ChoiceCare |
$798.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$831.83
|
| Rate for Payer: PHCS All Commercial |
$693.19
|
| Rate for Payer: PHP All Commercial |
$700.95
|
| Rate for Payer: Sagamore Health Network All Products |
$713.52
|
| Rate for Payer: Signature Care EPO |
$767.13
|
| Rate for Payer: Signature Care PPO |
$813.34
|
| Rate for Payer: United Healthcare Commercial |
$728.31
|
|
|
HC X-RAY-MANDIBLE MIN 4 VIEWS
|
Facility
OP
|
$655.62
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
01610110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.04 |
| Max. Negotiated Rate |
$609.72 |
| Rate for Payer: Aetna Commercial |
$553.34
|
| Rate for Payer: Aetna Medicare |
$216.35
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$216.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$376.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$409.83
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$75.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$248.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$237.99
|
| Rate for Payer: Cash Price |
$406.48
|
| Rate for Payer: Cash Price |
$406.48
|
| Rate for Payer: Centivo All Commercial |
$334.36
|
| Rate for Payer: Cigna All Commercial |
$565.80
|
| Rate for Payer: CORVEL All Commercial |
$609.72
|
| Rate for Payer: Coventry All Commercial |
$576.94
|
| Rate for Payer: Encore All Commercial |
$603.49
|
| Rate for Payer: Frontpath All Commercial |
$603.17
|
| Rate for Payer: Humana ChoiceCare |
$566.25
|
| Rate for Payer: Humana Medicare |
$334.36
|
| Rate for Payer: Lucent All Commercial |
$334.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$590.05
|
| Rate for Payer: Managed Health Services Medicaid |
$75.04
|
| Rate for Payer: MDWise Medicaid |
$75.04
|
| Rate for Payer: PHCS All Commercial |
$491.71
|
| Rate for Payer: PHP All Commercial |
$497.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$255.69
|
| Rate for Payer: Sagamore Health Network All Products |
$506.13
|
| Rate for Payer: Signature Care EPO |
$544.16
|
| Rate for Payer: Signature Care PPO |
$576.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$557.27
|
| Rate for Payer: United Healthcare Commercial |
$516.62
|
| Rate for Payer: United Healthcare Medicare |
$216.35
|
|
|
HC X-RAY-MANDIBLE MIN 4 VIEWS
|
Facility
IP
|
$655.62
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
01610110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$491.71 |
| Max. Negotiated Rate |
$609.72 |
| Rate for Payer: Aetna Commercial |
$566.45
|
| Rate for Payer: Cash Price |
$406.48
|
| Rate for Payer: Cigna All Commercial |
$565.80
|
| Rate for Payer: CORVEL All Commercial |
$609.72
|
| Rate for Payer: Coventry All Commercial |
$576.94
|
| Rate for Payer: Encore All Commercial |
$603.49
|
| Rate for Payer: Frontpath All Commercial |
$603.17
|
| Rate for Payer: Humana ChoiceCare |
$566.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$590.05
|
| Rate for Payer: PHCS All Commercial |
$491.71
|
| Rate for Payer: PHP All Commercial |
$497.22
|
| Rate for Payer: Sagamore Health Network All Products |
$506.13
|
| Rate for Payer: Signature Care EPO |
$544.16
|
| Rate for Payer: Signature Care PPO |
$576.94
|
| Rate for Payer: United Healthcare Commercial |
$516.62
|
|
|
HC X-RAY-NASAL BONES 3+ VIEWS
|
Facility
OP
|
$545.49
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
01610160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.23 |
| Max. Negotiated Rate |
$507.30 |
| Rate for Payer: Aetna Commercial |
$460.39
|
| Rate for Payer: Aetna Medicare |
$180.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$180.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$313.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$340.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$69.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$207.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$198.01
|
| Rate for Payer: Cash Price |
$338.20
|
| Rate for Payer: Cash Price |
$338.20
|
| Rate for Payer: Centivo All Commercial |
$278.20
|
| Rate for Payer: Cigna All Commercial |
$470.75
|
| Rate for Payer: CORVEL All Commercial |
$507.30
|
| Rate for Payer: Coventry All Commercial |
$480.03
|
| Rate for Payer: Encore All Commercial |
$502.12
|
| Rate for Payer: Frontpath All Commercial |
$501.85
|
| Rate for Payer: Humana ChoiceCare |
$471.14
|
| Rate for Payer: Humana Medicare |
$278.20
|
| Rate for Payer: Lucent All Commercial |
$278.20
|
| Rate for Payer: Lutheran Preferred All Commercial |
$490.94
|
| Rate for Payer: Managed Health Services Medicaid |
$69.23
|
| Rate for Payer: MDWise Medicaid |
$69.23
|
| Rate for Payer: PHCS All Commercial |
$409.11
|
| Rate for Payer: PHP All Commercial |
$413.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$212.74
|
| Rate for Payer: Sagamore Health Network All Products |
$421.12
|
| Rate for Payer: Signature Care EPO |
$452.75
|
| Rate for Payer: Signature Care PPO |
$480.03
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$463.66
|
| Rate for Payer: United Healthcare Commercial |
$429.84
|
| Rate for Payer: United Healthcare Medicare |
$180.01
|
|
|
HC X-RAY-NASAL BONES 3+ VIEWS
|
Facility
IP
|
$545.49
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
01610160
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$409.11 |
| Max. Negotiated Rate |
$507.30 |
| Rate for Payer: Aetna Commercial |
$471.30
|
| Rate for Payer: Cash Price |
$338.20
|
| Rate for Payer: Cigna All Commercial |
$470.75
|
| Rate for Payer: CORVEL All Commercial |
$507.30
|
| Rate for Payer: Coventry All Commercial |
$480.03
|
| Rate for Payer: Encore All Commercial |
$502.12
|
| Rate for Payer: Frontpath All Commercial |
$501.85
|
| Rate for Payer: Humana ChoiceCare |
$471.14
|
| Rate for Payer: Lutheran Preferred All Commercial |
$490.94
|
| Rate for Payer: PHCS All Commercial |
$409.11
|
| Rate for Payer: PHP All Commercial |
$413.70
|
| Rate for Payer: Sagamore Health Network All Products |
$421.12
|
| Rate for Payer: Signature Care EPO |
$452.75
|
| Rate for Payer: Signature Care PPO |
$480.03
|
| Rate for Payer: United Healthcare Commercial |
$429.84
|
|
|
HC X-RAY-NECK (SOFT TISSUE)
|
Facility
OP
|
$384.95
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
01610360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.67 |
| Max. Negotiated Rate |
$358.00 |
| Rate for Payer: Aetna Commercial |
$324.90
|
| Rate for Payer: Aetna Medicare |
$127.03
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$127.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$221.08
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$240.63
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$56.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$146.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$139.74
|
| Rate for Payer: Cash Price |
$238.67
|
| Rate for Payer: Cash Price |
$238.67
|
| Rate for Payer: Centivo All Commercial |
$196.32
|
| Rate for Payer: Cigna All Commercial |
$332.21
|
| Rate for Payer: CORVEL All Commercial |
$358.00
|
| Rate for Payer: Coventry All Commercial |
$338.75
|
| Rate for Payer: Encore All Commercial |
$354.34
|
| Rate for Payer: Frontpath All Commercial |
$354.15
|
| Rate for Payer: Humana ChoiceCare |
$332.48
|
| Rate for Payer: Humana Medicare |
$196.32
|
| Rate for Payer: Lucent All Commercial |
$196.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.45
|
| Rate for Payer: Managed Health Services Medicaid |
$56.67
|
| Rate for Payer: MDWise Medicaid |
$56.67
|
| Rate for Payer: PHCS All Commercial |
$288.71
|
| Rate for Payer: PHP All Commercial |
$291.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$150.13
|
| Rate for Payer: Sagamore Health Network All Products |
$297.18
|
| Rate for Payer: Signature Care EPO |
$319.51
|
| Rate for Payer: Signature Care PPO |
$338.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$327.21
|
| Rate for Payer: United Healthcare Commercial |
$303.34
|
| Rate for Payer: United Healthcare Medicare |
$127.03
|
|
|
HC X-RAY-NECK (SOFT TISSUE)
|
Facility
IP
|
$384.95
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
01610360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$288.71 |
| Max. Negotiated Rate |
$358.00 |
| Rate for Payer: Aetna Commercial |
$332.60
|
| Rate for Payer: Cash Price |
$238.67
|
| Rate for Payer: Cigna All Commercial |
$332.21
|
| Rate for Payer: CORVEL All Commercial |
$358.00
|
| Rate for Payer: Coventry All Commercial |
$338.75
|
| Rate for Payer: Encore All Commercial |
$354.34
|
| Rate for Payer: Frontpath All Commercial |
$354.15
|
| Rate for Payer: Humana ChoiceCare |
$332.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$346.45
|
| Rate for Payer: PHCS All Commercial |
$288.71
|
| Rate for Payer: PHP All Commercial |
$291.94
|
| Rate for Payer: Sagamore Health Network All Products |
$297.18
|
| Rate for Payer: Signature Care EPO |
$319.51
|
| Rate for Payer: Signature Care PPO |
$338.75
|
| Rate for Payer: United Healthcare Commercial |
$303.34
|
|
|
HC X-RAY -NOSE-RECTUM FB CHILD
|
Facility
OP
|
$282.00
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
01619010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.92 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna Commercial |
$238.01
|
| Rate for Payer: Aetna Medicare |
$93.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$93.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$161.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$176.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$49.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$107.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$102.37
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Centivo All Commercial |
$143.82
|
| Rate for Payer: Cigna All Commercial |
$243.37
|
| Rate for Payer: CORVEL All Commercial |
$262.26
|
| Rate for Payer: Coventry All Commercial |
$248.16
|
| Rate for Payer: Encore All Commercial |
$259.58
|
| Rate for Payer: Frontpath All Commercial |
$259.44
|
| Rate for Payer: Humana ChoiceCare |
$243.56
|
| Rate for Payer: Humana Medicare |
$143.82
|
| Rate for Payer: Lucent All Commercial |
$143.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.80
|
| Rate for Payer: Managed Health Services Medicaid |
$49.92
|
| Rate for Payer: MDWise Medicaid |
$49.92
|
| Rate for Payer: PHCS All Commercial |
$211.50
|
| Rate for Payer: PHP All Commercial |
$213.87
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.98
|
| Rate for Payer: Sagamore Health Network All Products |
$217.70
|
| Rate for Payer: Signature Care EPO |
$234.06
|
| Rate for Payer: Signature Care PPO |
$248.16
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$239.70
|
| Rate for Payer: United Healthcare Commercial |
$222.22
|
| Rate for Payer: United Healthcare Medicare |
$93.06
|
|
|
HC X-RAY -NOSE-RECTUM FB CHILD
|
Facility
IP
|
$282.00
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
01619010
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$211.50 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna Commercial |
$243.65
|
| Rate for Payer: Cash Price |
$174.84
|
| Rate for Payer: Cigna All Commercial |
$243.37
|
| Rate for Payer: CORVEL All Commercial |
$262.26
|
| Rate for Payer: Coventry All Commercial |
$248.16
|
| Rate for Payer: Encore All Commercial |
$259.58
|
| Rate for Payer: Frontpath All Commercial |
$259.44
|
| Rate for Payer: Humana ChoiceCare |
$243.56
|
| Rate for Payer: Lutheran Preferred All Commercial |
$253.80
|
| Rate for Payer: PHCS All Commercial |
$211.50
|
| Rate for Payer: PHP All Commercial |
$213.87
|
| Rate for Payer: Sagamore Health Network All Products |
$217.70
|
| Rate for Payer: Signature Care EPO |
$234.06
|
| Rate for Payer: Signature Care PPO |
$248.16
|
| Rate for Payer: United Healthcare Commercial |
$222.22
|
|
