|
HC X-RAY-WRIST 1 VIEW LT
|
Facility
IP
|
$278.08
|
|
|
Service Code
|
CPT 73100 LT,52
|
| Hospital Charge Code |
01615100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.56 |
| Max. Negotiated Rate |
$258.62 |
| Rate for Payer: Aetna Commercial |
$240.26
|
| Rate for Payer: Cash Price |
$172.41
|
| Rate for Payer: Cigna All Commercial |
$239.99
|
| Rate for Payer: CORVEL All Commercial |
$258.62
|
| Rate for Payer: Coventry All Commercial |
$244.71
|
| Rate for Payer: Encore All Commercial |
$255.98
|
| Rate for Payer: Frontpath All Commercial |
$255.84
|
| Rate for Payer: Humana ChoiceCare |
$240.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$250.27
|
| Rate for Payer: PHCS All Commercial |
$208.56
|
| Rate for Payer: PHP All Commercial |
$210.90
|
| Rate for Payer: Sagamore Health Network All Products |
$214.68
|
| Rate for Payer: Signature Care EPO |
$230.81
|
| Rate for Payer: Signature Care PPO |
$244.71
|
| Rate for Payer: United Healthcare Commercial |
$219.13
|
|
|
HC X-RAY-WRIST 1 VIEW RT
|
Facility
IP
|
$278.08
|
|
|
Service Code
|
CPT 73100 RT,52
|
| Hospital Charge Code |
11615100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.56 |
| Max. Negotiated Rate |
$258.62 |
| Rate for Payer: Aetna Commercial |
$240.26
|
| Rate for Payer: Cash Price |
$172.41
|
| Rate for Payer: Cigna All Commercial |
$239.99
|
| Rate for Payer: CORVEL All Commercial |
$258.62
|
| Rate for Payer: Coventry All Commercial |
$244.71
|
| Rate for Payer: Encore All Commercial |
$255.98
|
| Rate for Payer: Frontpath All Commercial |
$255.84
|
| Rate for Payer: Humana ChoiceCare |
$240.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$250.27
|
| Rate for Payer: PHCS All Commercial |
$208.56
|
| Rate for Payer: PHP All Commercial |
$210.90
|
| Rate for Payer: Sagamore Health Network All Products |
$214.68
|
| Rate for Payer: Signature Care EPO |
$230.81
|
| Rate for Payer: Signature Care PPO |
$244.71
|
| Rate for Payer: United Healthcare Commercial |
$219.13
|
|
|
HC X-RAY-WRIST 1 VIEW RT
|
Facility
OP
|
$278.08
|
|
|
Service Code
|
CPT 73100 RT,52
|
| Hospital Charge Code |
11615100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.77 |
| Max. Negotiated Rate |
$258.62 |
| Rate for Payer: Aetna Commercial |
$234.70
|
| Rate for Payer: Aetna Medicare |
$91.77
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$91.77
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$159.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$173.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$105.53
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$100.94
|
| Rate for Payer: Cash Price |
$172.41
|
| Rate for Payer: Centivo All Commercial |
$141.82
|
| Rate for Payer: Cigna All Commercial |
$239.99
|
| Rate for Payer: CORVEL All Commercial |
$258.62
|
| Rate for Payer: Coventry All Commercial |
$244.71
|
| Rate for Payer: Encore All Commercial |
$255.98
|
| Rate for Payer: Frontpath All Commercial |
$255.84
|
| Rate for Payer: Humana ChoiceCare |
$240.18
|
| Rate for Payer: Humana Medicare |
$141.82
|
| Rate for Payer: Lucent All Commercial |
$141.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$250.27
|
| Rate for Payer: PHCS All Commercial |
$208.56
|
| Rate for Payer: PHP All Commercial |
$210.90
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$108.45
|
| Rate for Payer: Sagamore Health Network All Products |
$214.68
|
| Rate for Payer: Signature Care EPO |
$230.81
|
| Rate for Payer: Signature Care PPO |
$244.71
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$236.37
|
| Rate for Payer: United Healthcare Commercial |
$219.13
|
| Rate for Payer: United Healthcare Medicare |
$91.77
|
|
|
HC X-RAY-WRIST 2 VIEWS BI
|
Facility
IP
|
$556.16
|
|
|
Service Code
|
CPT 73100 50
|
| Hospital Charge Code |
21613100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$417.12 |
| Max. Negotiated Rate |
$517.22 |
| Rate for Payer: Aetna Commercial |
$480.52
|
| Rate for Payer: Cash Price |
$344.82
|
| Rate for Payer: Cigna All Commercial |
$479.96
|
| Rate for Payer: CORVEL All Commercial |
$517.22
|
| Rate for Payer: Coventry All Commercial |
$489.42
|
| Rate for Payer: Encore All Commercial |
$511.94
|
| Rate for Payer: Frontpath All Commercial |
$511.66
|
| Rate for Payer: Humana ChoiceCare |
$480.35
|
| Rate for Payer: Lutheran Preferred All Commercial |
$500.54
|
| Rate for Payer: PHCS All Commercial |
$417.12
|
| Rate for Payer: PHP All Commercial |
$421.79
|
| Rate for Payer: Sagamore Health Network All Products |
$429.35
|
| Rate for Payer: Signature Care EPO |
$461.61
|
| Rate for Payer: Signature Care PPO |
$489.42
|
| Rate for Payer: United Healthcare Commercial |
$438.25
|
|
|
HC X-RAY-WRIST 2 VIEWS BI
|
Facility
OP
|
$556.16
|
|
|
Service Code
|
CPT 73100 50
|
| Hospital Charge Code |
21613100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.53 |
| Max. Negotiated Rate |
$517.22 |
| Rate for Payer: Aetna Commercial |
$469.39
|
| Rate for Payer: Aetna Medicare |
$183.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$183.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$319.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$347.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$211.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$201.88
|
| Rate for Payer: Cash Price |
$344.82
|
| Rate for Payer: Centivo All Commercial |
$283.64
|
| Rate for Payer: Cigna All Commercial |
$479.96
|
| Rate for Payer: CORVEL All Commercial |
$517.22
|
| Rate for Payer: Coventry All Commercial |
$489.42
|
| Rate for Payer: Encore All Commercial |
$511.94
|
| Rate for Payer: Frontpath All Commercial |
$511.66
|
| Rate for Payer: Humana ChoiceCare |
$480.35
|
| Rate for Payer: Humana Medicare |
$283.64
|
| Rate for Payer: Lucent All Commercial |
$283.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$500.54
|
| Rate for Payer: PHCS All Commercial |
$417.12
|
| Rate for Payer: PHP All Commercial |
$421.79
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$216.90
|
| Rate for Payer: Sagamore Health Network All Products |
$429.35
|
| Rate for Payer: Signature Care EPO |
$461.61
|
| Rate for Payer: Signature Care PPO |
$489.42
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$472.73
|
| Rate for Payer: United Healthcare Commercial |
$438.25
|
| Rate for Payer: United Healthcare Medicare |
$183.53
|
|
|
HC X-RAY-WRIST 2 VIEWS LT
|
Facility
IP
|
$370.79
|
|
|
Service Code
|
CPT 73100 LT
|
| Hospital Charge Code |
01613100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.09 |
| Max. Negotiated Rate |
$344.84 |
| Rate for Payer: Aetna Commercial |
$320.36
|
| Rate for Payer: Cash Price |
$229.89
|
| Rate for Payer: Cigna All Commercial |
$319.99
|
| Rate for Payer: CORVEL All Commercial |
$344.84
|
| Rate for Payer: Coventry All Commercial |
$326.30
|
| Rate for Payer: Encore All Commercial |
$341.31
|
| Rate for Payer: Frontpath All Commercial |
$341.13
|
| Rate for Payer: Humana ChoiceCare |
$320.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$333.71
|
| Rate for Payer: PHCS All Commercial |
$278.09
|
| Rate for Payer: PHP All Commercial |
$281.21
|
| Rate for Payer: Sagamore Health Network All Products |
$286.25
|
| Rate for Payer: Signature Care EPO |
$307.76
|
| Rate for Payer: Signature Care PPO |
$326.30
|
| Rate for Payer: United Healthcare Commercial |
$292.18
|
|
|
HC X-RAY-WRIST 2 VIEWS LT
|
Facility
OP
|
$370.79
|
|
|
Service Code
|
CPT 73100 LT
|
| Hospital Charge Code |
01613100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.36 |
| Max. Negotiated Rate |
$344.84 |
| Rate for Payer: Aetna Commercial |
$312.95
|
| Rate for Payer: Aetna Medicare |
$122.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.60
|
| Rate for Payer: Cash Price |
$229.89
|
| Rate for Payer: Centivo All Commercial |
$189.10
|
| Rate for Payer: Cigna All Commercial |
$319.99
|
| Rate for Payer: CORVEL All Commercial |
$344.84
|
| Rate for Payer: Coventry All Commercial |
$326.30
|
| Rate for Payer: Encore All Commercial |
$341.31
|
| Rate for Payer: Frontpath All Commercial |
$341.13
|
| Rate for Payer: Humana ChoiceCare |
$320.25
|
| Rate for Payer: Humana Medicare |
$189.10
|
| Rate for Payer: Lucent All Commercial |
$189.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$333.71
|
| Rate for Payer: PHCS All Commercial |
$278.09
|
| Rate for Payer: PHP All Commercial |
$281.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.61
|
| Rate for Payer: Sagamore Health Network All Products |
$286.25
|
| Rate for Payer: Signature Care EPO |
$307.76
|
| Rate for Payer: Signature Care PPO |
$326.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$315.17
|
| Rate for Payer: United Healthcare Commercial |
$292.18
|
| Rate for Payer: United Healthcare Medicare |
$122.36
|
|
|
HC X-RAY-WRIST 2 VIEWS RT
|
Facility
OP
|
$370.79
|
|
|
Service Code
|
CPT 73100 RT
|
| Hospital Charge Code |
11613100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.36 |
| Max. Negotiated Rate |
$344.84 |
| Rate for Payer: Aetna Commercial |
$312.95
|
| Rate for Payer: Aetna Medicare |
$122.36
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$122.36
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$212.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$231.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$140.71
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$134.60
|
| Rate for Payer: Cash Price |
$229.89
|
| Rate for Payer: Centivo All Commercial |
$189.10
|
| Rate for Payer: Cigna All Commercial |
$319.99
|
| Rate for Payer: CORVEL All Commercial |
$344.84
|
| Rate for Payer: Coventry All Commercial |
$326.30
|
| Rate for Payer: Encore All Commercial |
$341.31
|
| Rate for Payer: Frontpath All Commercial |
$341.13
|
| Rate for Payer: Humana ChoiceCare |
$320.25
|
| Rate for Payer: Humana Medicare |
$189.10
|
| Rate for Payer: Lucent All Commercial |
$189.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$333.71
|
| Rate for Payer: PHCS All Commercial |
$278.09
|
| Rate for Payer: PHP All Commercial |
$281.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$144.61
|
| Rate for Payer: Sagamore Health Network All Products |
$286.25
|
| Rate for Payer: Signature Care EPO |
$307.76
|
| Rate for Payer: Signature Care PPO |
$326.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$315.17
|
| Rate for Payer: United Healthcare Commercial |
$292.18
|
| Rate for Payer: United Healthcare Medicare |
$122.36
|
|
|
HC X-RAY-WRIST 2 VIEWS RT
|
Facility
IP
|
$370.79
|
|
|
Service Code
|
CPT 73100 RT
|
| Hospital Charge Code |
11613100
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.09 |
| Max. Negotiated Rate |
$344.84 |
| Rate for Payer: Aetna Commercial |
$320.36
|
| Rate for Payer: Cash Price |
$229.89
|
| Rate for Payer: Cigna All Commercial |
$319.99
|
| Rate for Payer: CORVEL All Commercial |
$344.84
|
| Rate for Payer: Coventry All Commercial |
$326.30
|
| Rate for Payer: Encore All Commercial |
$341.31
|
| Rate for Payer: Frontpath All Commercial |
$341.13
|
| Rate for Payer: Humana ChoiceCare |
$320.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$333.71
|
| Rate for Payer: PHCS All Commercial |
$278.09
|
| Rate for Payer: PHP All Commercial |
$281.21
|
| Rate for Payer: Sagamore Health Network All Products |
$286.25
|
| Rate for Payer: Signature Care EPO |
$307.76
|
| Rate for Payer: Signature Care PPO |
$326.30
|
| Rate for Payer: United Healthcare Commercial |
$292.18
|
|
|
HC X-RAY-WRIST 3 VIEWS BI
|
Facility
OP
|
$621.57
|
|
|
Service Code
|
CPT 73110 50
|
| Hospital Charge Code |
21613110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$205.12 |
| Max. Negotiated Rate |
$578.06 |
| Rate for Payer: Aetna Commercial |
$524.60
|
| Rate for Payer: Aetna Medicare |
$205.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$205.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$356.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$388.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$235.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$225.63
|
| Rate for Payer: Cash Price |
$385.37
|
| Rate for Payer: Centivo All Commercial |
$317.00
|
| Rate for Payer: Cigna All Commercial |
$536.41
|
| Rate for Payer: CORVEL All Commercial |
$578.06
|
| Rate for Payer: Coventry All Commercial |
$546.98
|
| Rate for Payer: Encore All Commercial |
$572.15
|
| Rate for Payer: Frontpath All Commercial |
$571.84
|
| Rate for Payer: Humana ChoiceCare |
$536.85
|
| Rate for Payer: Humana Medicare |
$317.00
|
| Rate for Payer: Lucent All Commercial |
$317.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$559.41
|
| Rate for Payer: PHCS All Commercial |
$466.18
|
| Rate for Payer: PHP All Commercial |
$471.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$242.41
|
| Rate for Payer: Sagamore Health Network All Products |
$479.85
|
| Rate for Payer: Signature Care EPO |
$515.90
|
| Rate for Payer: Signature Care PPO |
$546.98
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$528.33
|
| Rate for Payer: United Healthcare Commercial |
$489.80
|
| Rate for Payer: United Healthcare Medicare |
$205.12
|
|
|
HC X-RAY-WRIST 3 VIEWS BI
|
Facility
IP
|
$621.57
|
|
|
Service Code
|
CPT 73110 50
|
| Hospital Charge Code |
21613110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$466.18 |
| Max. Negotiated Rate |
$578.06 |
| Rate for Payer: Aetna Commercial |
$537.03
|
| Rate for Payer: Cash Price |
$385.37
|
| Rate for Payer: Cigna All Commercial |
$536.41
|
| Rate for Payer: CORVEL All Commercial |
$578.06
|
| Rate for Payer: Coventry All Commercial |
$546.98
|
| Rate for Payer: Encore All Commercial |
$572.15
|
| Rate for Payer: Frontpath All Commercial |
$571.84
|
| Rate for Payer: Humana ChoiceCare |
$536.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$559.41
|
| Rate for Payer: PHCS All Commercial |
$466.18
|
| Rate for Payer: PHP All Commercial |
$471.40
|
| Rate for Payer: Sagamore Health Network All Products |
$479.85
|
| Rate for Payer: Signature Care EPO |
$515.90
|
| Rate for Payer: Signature Care PPO |
$546.98
|
| Rate for Payer: United Healthcare Commercial |
$489.80
|
|
|
HC X-RAY-WRIST 3 VIEWS LT
|
Facility
IP
|
$414.39
|
|
|
Service Code
|
CPT 73110 LT
|
| Hospital Charge Code |
01613110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$310.79 |
| Max. Negotiated Rate |
$385.38 |
| Rate for Payer: Aetna Commercial |
$358.03
|
| Rate for Payer: Cash Price |
$256.92
|
| Rate for Payer: Cigna All Commercial |
$357.61
|
| Rate for Payer: CORVEL All Commercial |
$385.38
|
| Rate for Payer: Coventry All Commercial |
$364.66
|
| Rate for Payer: Encore All Commercial |
$381.44
|
| Rate for Payer: Frontpath All Commercial |
$381.23
|
| Rate for Payer: Humana ChoiceCare |
$357.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$372.95
|
| Rate for Payer: PHCS All Commercial |
$310.79
|
| Rate for Payer: PHP All Commercial |
$314.27
|
| Rate for Payer: Sagamore Health Network All Products |
$319.91
|
| Rate for Payer: Signature Care EPO |
$343.94
|
| Rate for Payer: Signature Care PPO |
$364.66
|
| Rate for Payer: United Healthcare Commercial |
$326.54
|
|
|
HC X-RAY-WRIST 3 VIEWS LT
|
Facility
OP
|
$414.39
|
|
|
Service Code
|
CPT 73110 LT
|
| Hospital Charge Code |
01613110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.75 |
| Max. Negotiated Rate |
$385.38 |
| Rate for Payer: Aetna Commercial |
$349.74
|
| Rate for Payer: Aetna Medicare |
$136.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$136.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$237.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$259.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$150.42
|
| Rate for Payer: Cash Price |
$256.92
|
| Rate for Payer: Centivo All Commercial |
$211.34
|
| Rate for Payer: Cigna All Commercial |
$357.61
|
| Rate for Payer: CORVEL All Commercial |
$385.38
|
| Rate for Payer: Coventry All Commercial |
$364.66
|
| Rate for Payer: Encore All Commercial |
$381.44
|
| Rate for Payer: Frontpath All Commercial |
$381.23
|
| Rate for Payer: Humana ChoiceCare |
$357.90
|
| Rate for Payer: Humana Medicare |
$211.34
|
| Rate for Payer: Lucent All Commercial |
$211.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$372.95
|
| Rate for Payer: PHCS All Commercial |
$310.79
|
| Rate for Payer: PHP All Commercial |
$314.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$161.61
|
| Rate for Payer: Sagamore Health Network All Products |
$319.91
|
| Rate for Payer: Signature Care EPO |
$343.94
|
| Rate for Payer: Signature Care PPO |
$364.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$352.23
|
| Rate for Payer: United Healthcare Commercial |
$326.54
|
| Rate for Payer: United Healthcare Medicare |
$136.75
|
|
|
HC X-RAY-WRIST 3 VIEWS RT
|
Facility
IP
|
$414.39
|
|
|
Service Code
|
CPT 73110 RT
|
| Hospital Charge Code |
11613110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$310.79 |
| Max. Negotiated Rate |
$385.38 |
| Rate for Payer: Aetna Commercial |
$358.03
|
| Rate for Payer: Cash Price |
$256.92
|
| Rate for Payer: Cigna All Commercial |
$357.61
|
| Rate for Payer: CORVEL All Commercial |
$385.38
|
| Rate for Payer: Coventry All Commercial |
$364.66
|
| Rate for Payer: Encore All Commercial |
$381.44
|
| Rate for Payer: Frontpath All Commercial |
$381.23
|
| Rate for Payer: Humana ChoiceCare |
$357.90
|
| Rate for Payer: Lutheran Preferred All Commercial |
$372.95
|
| Rate for Payer: PHCS All Commercial |
$310.79
|
| Rate for Payer: PHP All Commercial |
$314.27
|
| Rate for Payer: Sagamore Health Network All Products |
$319.91
|
| Rate for Payer: Signature Care EPO |
$343.94
|
| Rate for Payer: Signature Care PPO |
$364.66
|
| Rate for Payer: United Healthcare Commercial |
$326.54
|
|
|
HC X-RAY-WRIST 3 VIEWS RT
|
Facility
OP
|
$414.39
|
|
|
Service Code
|
CPT 73110 RT
|
| Hospital Charge Code |
11613110
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.75 |
| Max. Negotiated Rate |
$385.38 |
| Rate for Payer: Aetna Commercial |
$349.74
|
| Rate for Payer: Aetna Medicare |
$136.75
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$136.75
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$237.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$259.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$157.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$150.42
|
| Rate for Payer: Cash Price |
$256.92
|
| Rate for Payer: Centivo All Commercial |
$211.34
|
| Rate for Payer: Cigna All Commercial |
$357.61
|
| Rate for Payer: CORVEL All Commercial |
$385.38
|
| Rate for Payer: Coventry All Commercial |
$364.66
|
| Rate for Payer: Encore All Commercial |
$381.44
|
| Rate for Payer: Frontpath All Commercial |
$381.23
|
| Rate for Payer: Humana ChoiceCare |
$357.90
|
| Rate for Payer: Humana Medicare |
$211.34
|
| Rate for Payer: Lucent All Commercial |
$211.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$372.95
|
| Rate for Payer: PHCS All Commercial |
$310.79
|
| Rate for Payer: PHP All Commercial |
$314.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$161.61
|
| Rate for Payer: Sagamore Health Network All Products |
$319.91
|
| Rate for Payer: Signature Care EPO |
$343.94
|
| Rate for Payer: Signature Care PPO |
$364.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$352.23
|
| Rate for Payer: United Healthcare Commercial |
$326.54
|
| Rate for Payer: United Healthcare Medicare |
$136.75
|
|
|
HC Z 10MM LPS-FLEX PRLG 1-2 CD
|
Facility
IP
|
$4,307.26
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,230.44 |
| Max. Negotiated Rate |
$4,005.75 |
| Rate for Payer: Aetna Commercial |
$3,721.47
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cigna All Commercial |
$3,717.17
|
| Rate for Payer: CORVEL All Commercial |
$4,005.75
|
| Rate for Payer: Coventry All Commercial |
$3,790.39
|
| Rate for Payer: Encore All Commercial |
$3,964.83
|
| Rate for Payer: Frontpath All Commercial |
$3,962.68
|
| Rate for Payer: Humana ChoiceCare |
$3,720.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,876.53
|
| Rate for Payer: PHCS All Commercial |
$3,230.44
|
| Rate for Payer: PHP All Commercial |
$3,266.63
|
| Rate for Payer: Sagamore Health Network All Products |
$3,325.20
|
| Rate for Payer: Signature Care EPO |
$3,575.03
|
| Rate for Payer: Signature Care PPO |
$3,790.39
|
| Rate for Payer: United Healthcare Commercial |
$3,394.12
|
|
|
HC Z 10MM LPS-FLEX PRLG 1-2 CD
|
Facility
OP
|
$4,307.26
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,005.75 |
| Rate for Payer: Aetna Commercial |
$3,635.33
|
| Rate for Payer: Aetna Medicare |
$1,421.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,421.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,473.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,692.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,634.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,563.54
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Centivo All Commercial |
$2,196.70
|
| Rate for Payer: Cigna All Commercial |
$3,717.17
|
| Rate for Payer: CORVEL All Commercial |
$4,005.75
|
| Rate for Payer: Coventry All Commercial |
$3,790.39
|
| Rate for Payer: Encore All Commercial |
$3,964.83
|
| Rate for Payer: Frontpath All Commercial |
$3,962.68
|
| Rate for Payer: Humana ChoiceCare |
$3,720.18
|
| Rate for Payer: Humana Medicare |
$2,196.70
|
| Rate for Payer: Lucent All Commercial |
$2,196.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,876.53
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,230.44
|
| Rate for Payer: PHP All Commercial |
$3,266.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.83
|
| Rate for Payer: Sagamore Health Network All Products |
$3,325.20
|
| Rate for Payer: Signature Care EPO |
$3,575.03
|
| Rate for Payer: Signature Care PPO |
$3,790.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,661.17
|
| Rate for Payer: United Healthcare Commercial |
$3,394.12
|
| Rate for Payer: United Healthcare Medicare |
$1,421.40
|
|
|
HC Z 10MM LPS-FLEX PRLG 1-2 E
|
Facility
IP
|
$4,307.26
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,230.44 |
| Max. Negotiated Rate |
$4,005.75 |
| Rate for Payer: Aetna Commercial |
$3,721.47
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cigna All Commercial |
$3,717.17
|
| Rate for Payer: CORVEL All Commercial |
$4,005.75
|
| Rate for Payer: Coventry All Commercial |
$3,790.39
|
| Rate for Payer: Encore All Commercial |
$3,964.83
|
| Rate for Payer: Frontpath All Commercial |
$3,962.68
|
| Rate for Payer: Humana ChoiceCare |
$3,720.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,876.53
|
| Rate for Payer: PHCS All Commercial |
$3,230.44
|
| Rate for Payer: PHP All Commercial |
$3,266.63
|
| Rate for Payer: Sagamore Health Network All Products |
$3,325.20
|
| Rate for Payer: Signature Care EPO |
$3,575.03
|
| Rate for Payer: Signature Care PPO |
$3,790.39
|
| Rate for Payer: United Healthcare Commercial |
$3,394.12
|
|
|
HC Z 10MM LPS-FLEX PRLG 1-2 E
|
Facility
OP
|
$4,307.26
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605512
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,005.75 |
| Rate for Payer: Aetna Commercial |
$3,635.33
|
| Rate for Payer: Aetna Medicare |
$1,421.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,421.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,473.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,692.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,634.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,563.54
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Centivo All Commercial |
$2,196.70
|
| Rate for Payer: Cigna All Commercial |
$3,717.17
|
| Rate for Payer: CORVEL All Commercial |
$4,005.75
|
| Rate for Payer: Coventry All Commercial |
$3,790.39
|
| Rate for Payer: Encore All Commercial |
$3,964.83
|
| Rate for Payer: Frontpath All Commercial |
$3,962.68
|
| Rate for Payer: Humana ChoiceCare |
$3,720.18
|
| Rate for Payer: Humana Medicare |
$2,196.70
|
| Rate for Payer: Lucent All Commercial |
$2,196.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,876.53
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,230.44
|
| Rate for Payer: PHP All Commercial |
$3,266.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.83
|
| Rate for Payer: Sagamore Health Network All Products |
$3,325.20
|
| Rate for Payer: Signature Care EPO |
$3,575.03
|
| Rate for Payer: Signature Care PPO |
$3,790.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,661.17
|
| Rate for Payer: United Healthcare Commercial |
$3,394.12
|
| Rate for Payer: United Healthcare Medicare |
$1,421.40
|
|
|
HC Z 10MM LPS-FLEX PRLG 3-4 CD
|
Facility
IP
|
$4,307.26
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,230.44 |
| Max. Negotiated Rate |
$4,005.75 |
| Rate for Payer: Aetna Commercial |
$3,721.47
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cigna All Commercial |
$3,717.17
|
| Rate for Payer: CORVEL All Commercial |
$4,005.75
|
| Rate for Payer: Coventry All Commercial |
$3,790.39
|
| Rate for Payer: Encore All Commercial |
$3,964.83
|
| Rate for Payer: Frontpath All Commercial |
$3,962.68
|
| Rate for Payer: Humana ChoiceCare |
$3,720.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,876.53
|
| Rate for Payer: PHCS All Commercial |
$3,230.44
|
| Rate for Payer: PHP All Commercial |
$3,266.63
|
| Rate for Payer: Sagamore Health Network All Products |
$3,325.20
|
| Rate for Payer: Signature Care EPO |
$3,575.03
|
| Rate for Payer: Signature Care PPO |
$3,790.39
|
| Rate for Payer: United Healthcare Commercial |
$3,394.12
|
|
|
HC Z 10MM LPS-FLEX PRLG 3-4 CD
|
Facility
OP
|
$4,307.26
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605517
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,005.75 |
| Rate for Payer: Aetna Commercial |
$3,635.33
|
| Rate for Payer: Aetna Medicare |
$1,421.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,421.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,473.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,692.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,634.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,563.54
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Centivo All Commercial |
$2,196.70
|
| Rate for Payer: Cigna All Commercial |
$3,717.17
|
| Rate for Payer: CORVEL All Commercial |
$4,005.75
|
| Rate for Payer: Coventry All Commercial |
$3,790.39
|
| Rate for Payer: Encore All Commercial |
$3,964.83
|
| Rate for Payer: Frontpath All Commercial |
$3,962.68
|
| Rate for Payer: Humana ChoiceCare |
$3,720.18
|
| Rate for Payer: Humana Medicare |
$2,196.70
|
| Rate for Payer: Lucent All Commercial |
$2,196.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,876.53
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,230.44
|
| Rate for Payer: PHP All Commercial |
$3,266.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.83
|
| Rate for Payer: Sagamore Health Network All Products |
$3,325.20
|
| Rate for Payer: Signature Care EPO |
$3,575.03
|
| Rate for Payer: Signature Care PPO |
$3,790.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,661.17
|
| Rate for Payer: United Healthcare Commercial |
$3,394.12
|
| Rate for Payer: United Healthcare Medicare |
$1,421.40
|
|
|
HC Z 10MM LPS-FLEX PRLG 3-4 EF
|
Facility
IP
|
$4,307.26
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,230.44 |
| Max. Negotiated Rate |
$4,005.75 |
| Rate for Payer: Aetna Commercial |
$3,721.47
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cigna All Commercial |
$3,717.17
|
| Rate for Payer: CORVEL All Commercial |
$4,005.75
|
| Rate for Payer: Coventry All Commercial |
$3,790.39
|
| Rate for Payer: Encore All Commercial |
$3,964.83
|
| Rate for Payer: Frontpath All Commercial |
$3,962.68
|
| Rate for Payer: Humana ChoiceCare |
$3,720.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,876.53
|
| Rate for Payer: PHCS All Commercial |
$3,230.44
|
| Rate for Payer: PHP All Commercial |
$3,266.63
|
| Rate for Payer: Sagamore Health Network All Products |
$3,325.20
|
| Rate for Payer: Signature Care EPO |
$3,575.03
|
| Rate for Payer: Signature Care PPO |
$3,790.39
|
| Rate for Payer: United Healthcare Commercial |
$3,394.12
|
|
|
HC Z 10MM LPS-FLEX PRLG 3-4 EF
|
Facility
OP
|
$4,307.26
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605523
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$4,005.75 |
| Rate for Payer: Aetna Commercial |
$3,635.33
|
| Rate for Payer: Aetna Medicare |
$1,421.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1,421.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2,473.66
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2,692.47
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1,634.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1,563.54
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Cash Price |
$2,670.50
|
| Rate for Payer: Centivo All Commercial |
$2,196.70
|
| Rate for Payer: Cigna All Commercial |
$3,717.17
|
| Rate for Payer: CORVEL All Commercial |
$4,005.75
|
| Rate for Payer: Coventry All Commercial |
$3,790.39
|
| Rate for Payer: Encore All Commercial |
$3,964.83
|
| Rate for Payer: Frontpath All Commercial |
$3,962.68
|
| Rate for Payer: Humana ChoiceCare |
$3,720.18
|
| Rate for Payer: Humana Medicare |
$2,196.70
|
| Rate for Payer: Lucent All Commercial |
$2,196.70
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3,876.53
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$3,230.44
|
| Rate for Payer: PHP All Commercial |
$3,266.63
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1,679.83
|
| Rate for Payer: Sagamore Health Network All Products |
$3,325.20
|
| Rate for Payer: Signature Care EPO |
$3,575.03
|
| Rate for Payer: Signature Care PPO |
$3,790.39
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,661.17
|
| Rate for Payer: United Healthcare Commercial |
$3,394.12
|
| Rate for Payer: United Healthcare Medicare |
$1,421.40
|
|
|
HC Z 10X130 STD BODY STD NK
|
Facility
OP
|
$9,000.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$524.16 |
| Max. Negotiated Rate |
$8,370.00 |
| Rate for Payer: Aetna Commercial |
$7,596.00
|
| Rate for Payer: Aetna Medicare |
$2,970.00
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2,970.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5,168.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5,625.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$524.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3,415.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3,267.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Centivo All Commercial |
$4,590.00
|
| Rate for Payer: Cigna All Commercial |
$7,767.00
|
| Rate for Payer: CORVEL All Commercial |
$8,370.00
|
| Rate for Payer: Coventry All Commercial |
$7,920.00
|
| Rate for Payer: Encore All Commercial |
$8,284.50
|
| Rate for Payer: Frontpath All Commercial |
$8,280.00
|
| Rate for Payer: Humana ChoiceCare |
$7,773.30
|
| Rate for Payer: Humana Medicare |
$4,590.00
|
| Rate for Payer: Lucent All Commercial |
$4,590.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,100.00
|
| Rate for Payer: Managed Health Services Medicaid |
$524.16
|
| Rate for Payer: MDWise Medicaid |
$524.16
|
| Rate for Payer: PHCS All Commercial |
$6,750.00
|
| Rate for Payer: PHP All Commercial |
$6,825.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3,510.00
|
| Rate for Payer: Sagamore Health Network All Products |
$6,948.00
|
| Rate for Payer: Signature Care EPO |
$7,470.00
|
| Rate for Payer: Signature Care PPO |
$7,920.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,650.00
|
| Rate for Payer: United Healthcare Commercial |
$7,092.00
|
| Rate for Payer: United Healthcare Medicare |
$2,970.00
|
|
|
HC Z 10X130 STD BODY STD NK
|
Facility
IP
|
$9,000.00
|
|
|
Service Code
|
CPT C1776
|
| Hospital Charge Code |
41605253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,750.00 |
| Max. Negotiated Rate |
$8,370.00 |
| Rate for Payer: Aetna Commercial |
$7,776.00
|
| Rate for Payer: Cash Price |
$5,580.00
|
| Rate for Payer: Cigna All Commercial |
$7,767.00
|
| Rate for Payer: CORVEL All Commercial |
$8,370.00
|
| Rate for Payer: Coventry All Commercial |
$7,920.00
|
| Rate for Payer: Encore All Commercial |
$8,284.50
|
| Rate for Payer: Frontpath All Commercial |
$8,280.00
|
| Rate for Payer: Humana ChoiceCare |
$7,773.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8,100.00
|
| Rate for Payer: PHCS All Commercial |
$6,750.00
|
| Rate for Payer: PHP All Commercial |
$6,825.60
|
| Rate for Payer: Sagamore Health Network All Products |
$6,948.00
|
| Rate for Payer: Signature Care EPO |
$7,470.00
|
| Rate for Payer: Signature Care PPO |
$7,920.00
|
| Rate for Payer: United Healthcare Commercial |
$7,092.00
|
|
