|
CETIRIZINE 10 MG ORAL TAB
|
Facility
|
IP
|
$0.85
|
|
|
Service Code
|
NDC 00904671761
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$0.79 |
| Rate for Payer: Aetna Commercial |
$0.74
|
| Rate for Payer: Cash Price |
$0.51
|
| Rate for Payer: Cigna All Commercial |
$0.74
|
| Rate for Payer: CORVEL All Commercial |
$0.79
|
| Rate for Payer: Coventry All Commercial |
$0.75
|
| Rate for Payer: Encore All Commercial |
$0.79
|
| Rate for Payer: Frontpath All Commercial |
$0.79
|
| Rate for Payer: Humana ChoiceCare |
$0.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$0.77
|
| Rate for Payer: PHCS All Commercial |
$0.64
|
| Rate for Payer: PHP All Commercial |
$0.65
|
| Rate for Payer: Sagamore Health Network All Products |
$0.66
|
| Rate for Payer: Signature Care EPO |
$0.71
|
| Rate for Payer: Signature Care PPO |
$0.75
|
| Rate for Payer: United Healthcare Commercial |
$0.67
|
|
|
CETIRIZINE 10 MG ORAL TAB
|
Facility
|
OP
|
$1.23
|
|
|
Service Code
|
NDC 51079059720
|
| Hospital Charge Code |
9506
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.14 |
| Rate for Payer: Aetna Commercial |
$1.03
|
| Rate for Payer: Aetna Medicare |
$0.39
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$0.38
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$0.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$0.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$0.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$0.43
|
| Rate for Payer: Cash Price |
$0.74
|
| Rate for Payer: Centivo All Commercial |
$0.67
|
| Rate for Payer: Cigna All Commercial |
$1.06
|
| Rate for Payer: CORVEL All Commercial |
$1.14
|
| Rate for Payer: Coventry All Commercial |
$1.08
|
| Rate for Payer: Encore All Commercial |
$1.13
|
| Rate for Payer: Frontpath All Commercial |
$1.13
|
| Rate for Payer: Humana ChoiceCare |
$1.06
|
| Rate for Payer: Humana Medicare |
$0.39
|
| Rate for Payer: Lucent All Commercial |
$0.67
|
| Rate for Payer: Lutheran Preferred All Commercial |
$1.10
|
| Rate for Payer: PHCS All Commercial |
$0.92
|
| Rate for Payer: PHP All Commercial |
$0.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$0.48
|
| Rate for Payer: Sagamore Health Network All Products |
$0.95
|
| Rate for Payer: Signature Care EPO |
$1.02
|
| Rate for Payer: Signature Care PPO |
$1.08
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1.04
|
| Rate for Payer: United Healthcare Commercial |
$0.97
|
| Rate for Payer: United Healthcare Medicare |
$0.39
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
Both
|
$26.22
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
z76376
|
| Min. Negotiated Rate |
$21.57 |
| Max. Negotiated Rate |
$163.04 |
| Rate for Payer: Aetna Commercial |
$21.57
|
| Rate for Payer: Aetna Commercial |
$21.57
|
| Rate for Payer: Aetna Commercial |
$21.57
|
| Rate for Payer: Aetna Medicare |
$21.57
|
| Rate for Payer: Aetna Medicare |
$21.57
|
| Rate for Payer: Aetna Medicare |
$21.57
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$22.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$22.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$22.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$24.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$23.73
|
| Rate for Payer: Cash Price |
$17.14
|
| Rate for Payer: Cash Price |
$15.73
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Centivo All Commercial |
$33.43
|
| Rate for Payer: Centivo All Commercial |
$33.43
|
| Rate for Payer: Centivo All Commercial |
$33.43
|
| Rate for Payer: Cigna All Commercial |
$21.57
|
| Rate for Payer: Cigna All Commercial |
$21.57
|
| Rate for Payer: Cigna All Commercial |
$21.57
|
| Rate for Payer: CORVEL All Commercial |
$21.57
|
| Rate for Payer: CORVEL All Commercial |
$21.57
|
| Rate for Payer: CORVEL All Commercial |
$21.57
|
| Rate for Payer: Coventry All Commercial |
$25.88
|
| Rate for Payer: Coventry All Commercial |
$25.88
|
| Rate for Payer: Coventry All Commercial |
$25.88
|
| Rate for Payer: Encore All Commercial |
$21.57
|
| Rate for Payer: Encore All Commercial |
$21.57
|
| Rate for Payer: Encore All Commercial |
$21.57
|
| Rate for Payer: Frontpath All Commercial |
$37.76
|
| Rate for Payer: Frontpath All Commercial |
$37.76
|
| Rate for Payer: Frontpath All Commercial |
$37.76
|
| Rate for Payer: Humana ChoiceCare |
$163.04
|
| Rate for Payer: Humana ChoiceCare |
$163.04
|
| Rate for Payer: Humana ChoiceCare |
$163.04
|
| Rate for Payer: Humana Medicare |
$21.57
|
| Rate for Payer: Humana Medicare |
$21.57
|
| Rate for Payer: Humana Medicare |
$21.57
|
| Rate for Payer: Lucent All Commercial |
$30.20
|
| Rate for Payer: Lucent All Commercial |
$30.20
|
| Rate for Payer: Lucent All Commercial |
$30.20
|
| Rate for Payer: Managed Health Services Medicaid |
$22.87
|
| Rate for Payer: Managed Health Services Medicaid |
$22.87
|
| Rate for Payer: Managed Health Services Medicaid |
$22.87
|
| Rate for Payer: MDWise Medicaid |
$22.87
|
| Rate for Payer: MDWise Medicaid |
$22.87
|
| Rate for Payer: MDWise Medicaid |
$22.87
|
| Rate for Payer: PHCS All Commercial |
$21.57
|
| Rate for Payer: PHCS All Commercial |
$21.57
|
| Rate for Payer: PHCS All Commercial |
$21.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$21.57
|
| Rate for Payer: Sagamore Health Network All Products |
$21.57
|
| Rate for Payer: Sagamore Health Network All Products |
$21.57
|
| Rate for Payer: Sagamore Health Network All Products |
$21.57
|
| Rate for Payer: United Healthcare Commercial |
$69.29
|
| Rate for Payer: United Healthcare Commercial |
$69.29
|
| Rate for Payer: United Healthcare Commercial |
$69.29
|
|
|
CHG ASSAY OF ALCOHOL (ETHANOL) BREATH
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
CPT 82075
|
| Hospital Charge Code |
z82075
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$46.50 |
| Rate for Payer: Aetna Commercial |
$30.00
|
| Rate for Payer: Aetna Medicare |
$30.00
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$22.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Centivo All Commercial |
$46.50
|
| Rate for Payer: Cigna All Commercial |
$30.00
|
| Rate for Payer: CORVEL All Commercial |
$30.00
|
| Rate for Payer: Coventry All Commercial |
$36.00
|
| Rate for Payer: Encore All Commercial |
$30.00
|
| Rate for Payer: Frontpath All Commercial |
$30.00
|
| Rate for Payer: Humana Medicare |
$30.00
|
| Rate for Payer: Lucent All Commercial |
$42.00
|
| Rate for Payer: Managed Health Services Medicaid |
$30.00
|
| Rate for Payer: MDWise Medicaid |
$30.00
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$22.50
|
| Rate for Payer: PHCS All Commercial |
$30.00
|
| Rate for Payer: PHP All Commercial |
$26.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.00
|
| Rate for Payer: Sagamore Health Network All Products |
$30.00
|
| Rate for Payer: Signature Care EPO |
$15.30
|
| Rate for Payer: Signature Care PPO |
$15.30
|
| Rate for Payer: United Healthcare Commercial |
$10.56
|
|
|
CHG ASSAY OF LEAD
|
Professional
|
Both
|
$24.22
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
z83655
|
| Min. Negotiated Rate |
$10.60 |
| Max. Negotiated Rate |
$18.77 |
| Rate for Payer: Aetna Commercial |
$12.11
|
| Rate for Payer: Aetna Medicare |
$12.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$13.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.32
|
| Rate for Payer: Cash Price |
$14.53
|
| Rate for Payer: Centivo All Commercial |
$18.77
|
| Rate for Payer: Cigna All Commercial |
$12.11
|
| Rate for Payer: CORVEL All Commercial |
$12.11
|
| Rate for Payer: Coventry All Commercial |
$14.53
|
| Rate for Payer: Encore All Commercial |
$12.11
|
| Rate for Payer: Frontpath All Commercial |
$12.11
|
| Rate for Payer: Humana Medicare |
$12.11
|
| Rate for Payer: Lucent All Commercial |
$16.95
|
| Rate for Payer: Managed Health Services Medicaid |
$12.11
|
| Rate for Payer: MDWise Medicaid |
$12.11
|
| Rate for Payer: PHCS All Commercial |
$12.11
|
| Rate for Payer: PHP All Commercial |
$10.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.11
|
| Rate for Payer: Sagamore Health Network All Products |
$12.11
|
| Rate for Payer: United Healthcare Commercial |
$10.60
|
|
|
CHG ASSAY OF URINE CREATININE
|
Professional
|
Both
|
$10.36
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
z82570
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$8.03 |
| Rate for Payer: Aetna Commercial |
$5.18
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.18
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.70
|
| Rate for Payer: Cash Price |
$6.22
|
| Rate for Payer: Centivo All Commercial |
$8.03
|
| Rate for Payer: Cigna All Commercial |
$5.18
|
| Rate for Payer: CORVEL All Commercial |
$5.18
|
| Rate for Payer: Coventry All Commercial |
$6.22
|
| Rate for Payer: Encore All Commercial |
$5.18
|
| Rate for Payer: Frontpath All Commercial |
$5.18
|
| Rate for Payer: Humana Medicare |
$5.18
|
| Rate for Payer: Lucent All Commercial |
$7.25
|
| Rate for Payer: Managed Health Services Medicaid |
$5.18
|
| Rate for Payer: MDWise Medicaid |
$5.18
|
| Rate for Payer: PHCS All Commercial |
$5.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.18
|
| Rate for Payer: Sagamore Health Network All Products |
$5.18
|
| Rate for Payer: United Healthcare Commercial |
$4.54
|
|
|
CHG BILIRUBIN TOTAL TRANSCUTANEOUS
|
Professional
|
Both
|
$10.04
|
|
|
Service Code
|
CPT 88720
|
| Hospital Charge Code |
z88720
|
| Min. Negotiated Rate |
$2.82 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$5.02
|
| Rate for Payer: Aetna Medicare |
$5.02
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.82
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.82
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.82
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$3.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.52
|
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Centivo All Commercial |
$7.78
|
| Rate for Payer: Cigna All Commercial |
$5.02
|
| Rate for Payer: CORVEL All Commercial |
$5.02
|
| Rate for Payer: Coventry All Commercial |
$6.02
|
| Rate for Payer: Encore All Commercial |
$5.02
|
| Rate for Payer: Frontpath All Commercial |
$5.02
|
| Rate for Payer: Humana Medicare |
$5.02
|
| Rate for Payer: Lucent All Commercial |
$7.03
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.00
|
| Rate for Payer: Managed Health Services Medicaid |
$5.02
|
| Rate for Payer: MDWise Medicaid |
$5.02
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$3.77
|
| Rate for Payer: PHCS All Commercial |
$5.02
|
| Rate for Payer: PHP All Commercial |
$4.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.02
|
| Rate for Payer: Sagamore Health Network All Products |
$5.02
|
| Rate for Payer: Signature Care EPO |
$8.53
|
| Rate for Payer: Signature Care PPO |
$8.53
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$700.00
|
| Rate for Payer: United Healthcare Commercial |
$7.33
|
|
|
CHG BLOOD,OCCULT,FECAL HGB,FECES,1-3 SIMULT
|
Professional
|
Both
|
$31.84
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
z82274
|
| Min. Negotiated Rate |
$14.01 |
| Max. Negotiated Rate |
$2,100.00 |
| Rate for Payer: Aetna Commercial |
$15.92
|
| Rate for Payer: Aetna Medicare |
$15.92
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$21.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$21.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$21.65
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$21.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$15.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$18.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$17.51
|
| Rate for Payer: Cash Price |
$19.10
|
| Rate for Payer: Centivo All Commercial |
$24.68
|
| Rate for Payer: Cigna All Commercial |
$15.92
|
| Rate for Payer: CORVEL All Commercial |
$15.92
|
| Rate for Payer: Coventry All Commercial |
$19.10
|
| Rate for Payer: Encore All Commercial |
$15.92
|
| Rate for Payer: Frontpath All Commercial |
$15.92
|
| Rate for Payer: Humana ChoiceCare |
$15.92
|
| Rate for Payer: Humana Medicare |
$15.92
|
| Rate for Payer: Lucent All Commercial |
$22.29
|
| Rate for Payer: Lutheran Preferred All Commercial |
$22.00
|
| Rate for Payer: Managed Health Services Medicaid |
$15.92
|
| Rate for Payer: MDWise Medicaid |
$15.92
|
| Rate for Payer: PHCS All Commercial |
$15.92
|
| Rate for Payer: PHP All Commercial |
$14.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$15.92
|
| Rate for Payer: Sagamore Health Network All Products |
$15.92
|
| Rate for Payer: Signature Care EPO |
$18.40
|
| Rate for Payer: Signature Care PPO |
$18.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$2,100.00
|
| Rate for Payer: United Healthcare Commercial |
$23.22
|
|
|
CHG CARDIAC MRI FOR VELOCITY FLOW MAPPING
|
Professional
|
Both
|
$21.86
|
|
|
Service Code
|
CPT 75565
|
| Hospital Charge Code |
z75565
|
| Min. Negotiated Rate |
$42.76 |
| Max. Negotiated Rate |
$106.50 |
| Rate for Payer: Aetna Commercial |
$46.19
|
| Rate for Payer: Aetna Medicare |
$46.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$42.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.12
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.81
|
| Rate for Payer: Cash Price |
$13.12
|
| Rate for Payer: Centivo All Commercial |
$71.59
|
| Rate for Payer: Cigna All Commercial |
$46.19
|
| Rate for Payer: CORVEL All Commercial |
$46.19
|
| Rate for Payer: Coventry All Commercial |
$55.43
|
| Rate for Payer: Encore All Commercial |
$46.19
|
| Rate for Payer: Frontpath All Commercial |
$79.80
|
| Rate for Payer: Humana ChoiceCare |
$106.50
|
| Rate for Payer: Humana Medicare |
$46.19
|
| Rate for Payer: Lucent All Commercial |
$64.67
|
| Rate for Payer: Managed Health Services Medicaid |
$42.76
|
| Rate for Payer: MDWise Medicaid |
$42.76
|
| Rate for Payer: PHCS All Commercial |
$46.19
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.19
|
| Rate for Payer: Sagamore Health Network All Products |
$46.19
|
| Rate for Payer: United Healthcare Commercial |
$80.07
|
|
|
CHG CARDIAC MRI MORPHOLOGY & FUNCTION W/O CONTRAST
|
Professional
|
Both
|
$204.68
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
z75557
|
| Min. Negotiated Rate |
$263.32 |
| Max. Negotiated Rate |
$487.37 |
| Rate for Payer: Aetna Commercial |
$281.64
|
| Rate for Payer: Aetna Medicare |
$281.64
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$263.32
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$323.89
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$309.80
|
| Rate for Payer: Cash Price |
$122.81
|
| Rate for Payer: Centivo All Commercial |
$436.54
|
| Rate for Payer: Cigna All Commercial |
$281.64
|
| Rate for Payer: CORVEL All Commercial |
$281.64
|
| Rate for Payer: Coventry All Commercial |
$337.97
|
| Rate for Payer: Encore All Commercial |
$281.64
|
| Rate for Payer: Frontpath All Commercial |
$487.37
|
| Rate for Payer: Humana ChoiceCare |
$329.93
|
| Rate for Payer: Humana Medicare |
$281.64
|
| Rate for Payer: Lucent All Commercial |
$394.30
|
| Rate for Payer: Managed Health Services Medicaid |
$263.32
|
| Rate for Payer: MDWise Medicaid |
$263.32
|
| Rate for Payer: PHCS All Commercial |
$281.64
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$281.64
|
| Rate for Payer: Sagamore Health Network All Products |
$281.64
|
| Rate for Payer: United Healthcare Commercial |
$447.68
|
|
|
CHG CARDIAC MRI W/W/O CONTRAST & FURTHER SEQ
|
Professional
|
Both
|
$226.84
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
z75561
|
| Min. Negotiated Rate |
$343.07 |
| Max. Negotiated Rate |
$637.11 |
| Rate for Payer: Aetna Commercial |
$368.17
|
| Rate for Payer: Aetna Medicare |
$368.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$343.07
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$423.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$404.99
|
| Rate for Payer: Cash Price |
$136.10
|
| Rate for Payer: Centivo All Commercial |
$570.66
|
| Rate for Payer: Cigna All Commercial |
$368.17
|
| Rate for Payer: CORVEL All Commercial |
$368.17
|
| Rate for Payer: Coventry All Commercial |
$441.80
|
| Rate for Payer: Encore All Commercial |
$368.17
|
| Rate for Payer: Frontpath All Commercial |
$637.11
|
| Rate for Payer: Humana ChoiceCare |
$435.59
|
| Rate for Payer: Humana Medicare |
$368.17
|
| Rate for Payer: Lucent All Commercial |
$515.44
|
| Rate for Payer: Managed Health Services Medicaid |
$343.07
|
| Rate for Payer: MDWise Medicaid |
$343.07
|
| Rate for Payer: PHCS All Commercial |
$368.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$368.17
|
| Rate for Payer: Sagamore Health Network All Products |
$368.17
|
| Rate for Payer: United Healthcare Commercial |
$602.67
|
|
|
CHG CT ANGIO HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST
|
Professional
|
Both
|
$209.72
|
|
|
Service Code
|
CPT 75574
|
| Hospital Charge Code |
z75574
|
| Min. Negotiated Rate |
$302.87 |
| Max. Negotiated Rate |
$598.25 |
| Rate for Payer: Aetna Commercial |
$319.21
|
| Rate for Payer: Aetna Medicare |
$319.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$302.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$367.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$351.13
|
| Rate for Payer: Cash Price |
$125.83
|
| Rate for Payer: Centivo All Commercial |
$494.78
|
| Rate for Payer: Cigna All Commercial |
$319.21
|
| Rate for Payer: CORVEL All Commercial |
$319.21
|
| Rate for Payer: Coventry All Commercial |
$383.05
|
| Rate for Payer: Encore All Commercial |
$319.21
|
| Rate for Payer: Frontpath All Commercial |
$476.14
|
| Rate for Payer: Humana ChoiceCare |
$304.06
|
| Rate for Payer: Humana Medicare |
$319.21
|
| Rate for Payer: Lucent All Commercial |
$446.89
|
| Rate for Payer: Managed Health Services Medicaid |
$302.87
|
| Rate for Payer: MDWise Medicaid |
$302.87
|
| Rate for Payer: PHCS All Commercial |
$319.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$319.21
|
| Rate for Payer: Sagamore Health Network All Products |
$319.21
|
| Rate for Payer: United Healthcare Commercial |
$598.25
|
|
|
CHG CT HEART CONTRAST EVAL CARDIAC STRUCT/MORPH
|
Professional
|
Both
|
$152.40
|
|
|
Service Code
|
CPT 75572
|
| Hospital Charge Code |
z75572
|
| Min. Negotiated Rate |
$214.23 |
| Max. Negotiated Rate |
$388.36 |
| Rate for Payer: Aetna Commercial |
$223.51
|
| Rate for Payer: Aetna Medicare |
$223.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$214.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$257.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$245.86
|
| Rate for Payer: Cash Price |
$91.44
|
| Rate for Payer: Centivo All Commercial |
$346.44
|
| Rate for Payer: Cigna All Commercial |
$223.51
|
| Rate for Payer: CORVEL All Commercial |
$223.51
|
| Rate for Payer: Coventry All Commercial |
$268.21
|
| Rate for Payer: Encore All Commercial |
$223.51
|
| Rate for Payer: Frontpath All Commercial |
$388.36
|
| Rate for Payer: Humana ChoiceCare |
$271.34
|
| Rate for Payer: Humana Medicare |
$223.51
|
| Rate for Payer: Lucent All Commercial |
$312.91
|
| Rate for Payer: Managed Health Services Medicaid |
$214.23
|
| Rate for Payer: MDWise Medicaid |
$214.23
|
| Rate for Payer: PHCS All Commercial |
$223.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$223.51
|
| Rate for Payer: Sagamore Health Network All Products |
$223.51
|
| Rate for Payer: United Healthcare Commercial |
$269.52
|
|
|
CHG CYTOPAT,CER/VAG,THIN LAYER,MAN RES,INTER
|
Professional
|
Both
|
$53.22
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
z88175
|
| Min. Negotiated Rate |
$15.01 |
| Max. Negotiated Rate |
$3,500.00 |
| Rate for Payer: Aetna Commercial |
$26.61
|
| Rate for Payer: Aetna Medicare |
$26.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$15.01
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$15.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$15.01
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$15.01
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$19.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.27
|
| Rate for Payer: Cash Price |
$31.93
|
| Rate for Payer: Centivo All Commercial |
$41.25
|
| Rate for Payer: Cigna All Commercial |
$26.61
|
| Rate for Payer: CORVEL All Commercial |
$26.61
|
| Rate for Payer: Coventry All Commercial |
$31.93
|
| Rate for Payer: Encore All Commercial |
$26.61
|
| Rate for Payer: Frontpath All Commercial |
$26.61
|
| Rate for Payer: Humana Medicare |
$26.61
|
| Rate for Payer: Lucent All Commercial |
$37.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$37.00
|
| Rate for Payer: Managed Health Services Medicaid |
$26.61
|
| Rate for Payer: MDWise Medicaid |
$26.61
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$19.96
|
| Rate for Payer: PHCS All Commercial |
$26.61
|
| Rate for Payer: PHP All Commercial |
$23.42
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.61
|
| Rate for Payer: Sagamore Health Network All Products |
$26.61
|
| Rate for Payer: Signature Care EPO |
$45.24
|
| Rate for Payer: Signature Care PPO |
$45.24
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,500.00
|
| Rate for Payer: United Healthcare Commercial |
$37.49
|
|
|
CHG DETECT AGENT, MULT ORGS, DNA, AMP
|
Professional
|
Both
|
$140.40
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
z87801
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$9,100.00 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Medicare |
$70.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$33.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$33.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$33.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$33.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$70.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$80.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$77.22
|
| Rate for Payer: Cash Price |
$84.24
|
| Rate for Payer: Centivo All Commercial |
$108.81
|
| Rate for Payer: Cigna All Commercial |
$70.20
|
| Rate for Payer: CORVEL All Commercial |
$70.20
|
| Rate for Payer: Coventry All Commercial |
$84.24
|
| Rate for Payer: Encore All Commercial |
$70.20
|
| Rate for Payer: Frontpath All Commercial |
$70.20
|
| Rate for Payer: Humana Medicare |
$70.20
|
| Rate for Payer: Lucent All Commercial |
$98.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$98.00
|
| Rate for Payer: Managed Health Services Medicaid |
$70.20
|
| Rate for Payer: MDWise Medicaid |
$70.20
|
| Rate for Payer: PHCS All Commercial |
$70.20
|
| Rate for Payer: PHP All Commercial |
$61.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$70.20
|
| Rate for Payer: Sagamore Health Network All Products |
$70.20
|
| Rate for Payer: Signature Care EPO |
$91.80
|
| Rate for Payer: Signature Care PPO |
$91.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9,100.00
|
| Rate for Payer: United Healthcare Commercial |
$61.49
|
|
|
CHG DOPPLER FETAL UMBILICAL ARTERY
|
Professional
|
Both
|
$83.08
|
|
|
Service Code
|
CPT 76820
|
| Hospital Charge Code |
z76820
|
| Min. Negotiated Rate |
$41.45 |
| Max. Negotiated Rate |
$6,200.00 |
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna Commercial |
$43.33
|
| Rate for Payer: Aetna Medicare |
$43.33
|
| Rate for Payer: Aetna Medicare |
$43.33
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$79.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.86
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$79.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$79.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.86
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$79.86
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$41.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$41.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$49.83
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.66
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$49.85
|
| Rate for Payer: Centivo All Commercial |
$67.16
|
| Rate for Payer: Centivo All Commercial |
$67.16
|
| Rate for Payer: Cigna All Commercial |
$43.33
|
| Rate for Payer: Cigna All Commercial |
$43.33
|
| Rate for Payer: CORVEL All Commercial |
$43.33
|
| Rate for Payer: CORVEL All Commercial |
$43.33
|
| Rate for Payer: Coventry All Commercial |
$52.00
|
| Rate for Payer: Coventry All Commercial |
$52.00
|
| Rate for Payer: Encore All Commercial |
$43.33
|
| Rate for Payer: Encore All Commercial |
$43.33
|
| Rate for Payer: Frontpath All Commercial |
$75.40
|
| Rate for Payer: Frontpath All Commercial |
$75.40
|
| Rate for Payer: Humana ChoiceCare |
$48.87
|
| Rate for Payer: Humana ChoiceCare |
$48.87
|
| Rate for Payer: Humana Medicare |
$43.33
|
| Rate for Payer: Humana Medicare |
$43.33
|
| Rate for Payer: Lucent All Commercial |
$60.66
|
| Rate for Payer: Lucent All Commercial |
$60.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$66.00
|
| Rate for Payer: Managed Health Services Medicaid |
$41.45
|
| Rate for Payer: Managed Health Services Medicaid |
$41.45
|
| Rate for Payer: MDWise Medicaid |
$41.45
|
| Rate for Payer: MDWise Medicaid |
$41.45
|
| Rate for Payer: PHCS All Commercial |
$43.33
|
| Rate for Payer: PHCS All Commercial |
$43.33
|
| Rate for Payer: PHP All Commercial |
$54.00
|
| Rate for Payer: PHP All Commercial |
$54.00
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.33
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.33
|
| Rate for Payer: Sagamore Health Network All Products |
$43.33
|
| Rate for Payer: Sagamore Health Network All Products |
$43.33
|
| Rate for Payer: Signature Care EPO |
$73.66
|
| Rate for Payer: Signature Care EPO |
$73.66
|
| Rate for Payer: Signature Care PPO |
$73.66
|
| Rate for Payer: Signature Care PPO |
$73.66
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,200.00
|
| Rate for Payer: United Healthcare Commercial |
$50.08
|
| Rate for Payer: United Healthcare Commercial |
$50.08
|
|
|
CHG DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE
|
Professional
|
Both
|
$25.20
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
z80305
|
| Min. Negotiated Rate |
$5.94 |
| Max. Negotiated Rate |
$1,600.00 |
| Rate for Payer: Aetna Commercial |
$12.60
|
| Rate for Payer: Aetna Medicare |
$12.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.94
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$12.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$14.49
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$13.86
|
| Rate for Payer: Cash Price |
$15.12
|
| Rate for Payer: Centivo All Commercial |
$19.53
|
| Rate for Payer: Cigna All Commercial |
$12.60
|
| Rate for Payer: CORVEL All Commercial |
$12.60
|
| Rate for Payer: Coventry All Commercial |
$15.12
|
| Rate for Payer: Encore All Commercial |
$12.60
|
| Rate for Payer: Frontpath All Commercial |
$12.60
|
| Rate for Payer: Humana ChoiceCare |
$12.60
|
| Rate for Payer: Humana Medicare |
$12.60
|
| Rate for Payer: Lucent All Commercial |
$17.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.00
|
| Rate for Payer: Managed Health Services Medicaid |
$12.60
|
| Rate for Payer: MDWise Medicaid |
$12.60
|
| Rate for Payer: PHCS All Commercial |
$12.60
|
| Rate for Payer: PHP All Commercial |
$11.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$12.60
|
| Rate for Payer: Sagamore Health Network All Products |
$12.60
|
| Rate for Payer: Signature Care EPO |
$16.92
|
| Rate for Payer: Signature Care PPO |
$16.92
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,600.00
|
| Rate for Payer: United Healthcare Commercial |
$8.98
|
|
|
CHG ECHO,TRANSRECTAL
|
Professional
|
Both
|
$60.18
|
|
|
Service Code
|
CPT 76872
|
| Hospital Charge Code |
z76872
|
| Min. Negotiated Rate |
$130.55 |
| Max. Negotiated Rate |
$297.74 |
| Rate for Payer: Aetna Commercial |
$192.09
|
| Rate for Payer: Aetna Medicare |
$192.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$183.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$220.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$211.30
|
| Rate for Payer: Cash Price |
$36.11
|
| Rate for Payer: Centivo All Commercial |
$297.74
|
| Rate for Payer: Cigna All Commercial |
$192.09
|
| Rate for Payer: CORVEL All Commercial |
$192.09
|
| Rate for Payer: Coventry All Commercial |
$230.51
|
| Rate for Payer: Encore All Commercial |
$192.09
|
| Rate for Payer: Frontpath All Commercial |
$227.29
|
| Rate for Payer: Humana ChoiceCare |
$146.63
|
| Rate for Payer: Humana Medicare |
$192.09
|
| Rate for Payer: Lucent All Commercial |
$268.93
|
| Rate for Payer: Managed Health Services Medicaid |
$183.54
|
| Rate for Payer: MDWise Medicaid |
$183.54
|
| Rate for Payer: PHCS All Commercial |
$192.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$192.09
|
| Rate for Payer: Sagamore Health Network All Products |
$192.09
|
| Rate for Payer: United Healthcare Commercial |
$130.55
|
|
|
CHG FETAL BIOPHYSICAL PROFILE
|
Professional
|
Both
|
$215.28
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
z76818
|
| Min. Negotiated Rate |
$109.25 |
| Max. Negotiated Rate |
$16,000.00 |
| Rate for Payer: Aetna Commercial |
$109.25
|
| Rate for Payer: Aetna Commercial |
$109.25
|
| Rate for Payer: Aetna Medicare |
$109.25
|
| Rate for Payer: Aetna Medicare |
$109.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$110.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$110.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$110.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$110.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$110.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$110.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$110.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$109.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$109.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$125.64
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$125.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$120.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$120.17
|
| Rate for Payer: Cash Price |
$76.08
|
| Rate for Payer: Cash Price |
$129.17
|
| Rate for Payer: Centivo All Commercial |
$169.34
|
| Rate for Payer: Centivo All Commercial |
$169.34
|
| Rate for Payer: Cigna All Commercial |
$109.25
|
| Rate for Payer: Cigna All Commercial |
$109.25
|
| Rate for Payer: CORVEL All Commercial |
$109.25
|
| Rate for Payer: CORVEL All Commercial |
$109.25
|
| Rate for Payer: Coventry All Commercial |
$131.10
|
| Rate for Payer: Coventry All Commercial |
$131.10
|
| Rate for Payer: Encore All Commercial |
$109.25
|
| Rate for Payer: Encore All Commercial |
$109.25
|
| Rate for Payer: Frontpath All Commercial |
$189.70
|
| Rate for Payer: Frontpath All Commercial |
$189.70
|
| Rate for Payer: Humana ChoiceCare |
$122.91
|
| Rate for Payer: Humana ChoiceCare |
$122.91
|
| Rate for Payer: Humana Medicare |
$109.25
|
| Rate for Payer: Humana Medicare |
$109.25
|
| Rate for Payer: Lucent All Commercial |
$152.95
|
| Rate for Payer: Lucent All Commercial |
$152.95
|
| Rate for Payer: Lutheran Preferred All Commercial |
$171.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$171.00
|
| Rate for Payer: Managed Health Services Medicaid |
$109.44
|
| Rate for Payer: Managed Health Services Medicaid |
$109.44
|
| Rate for Payer: MDWise Medicaid |
$109.44
|
| Rate for Payer: MDWise Medicaid |
$109.44
|
| Rate for Payer: PHCS All Commercial |
$109.25
|
| Rate for Payer: PHCS All Commercial |
$109.25
|
| Rate for Payer: PHP All Commercial |
$139.93
|
| Rate for Payer: PHP All Commercial |
$139.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.25
|
| Rate for Payer: Sagamore Health Network All Products |
$109.25
|
| Rate for Payer: Sagamore Health Network All Products |
$109.25
|
| Rate for Payer: Signature Care EPO |
$141.10
|
| Rate for Payer: Signature Care EPO |
$141.10
|
| Rate for Payer: Signature Care PPO |
$141.10
|
| Rate for Payer: Signature Care PPO |
$141.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,000.00
|
| Rate for Payer: United Healthcare Commercial |
$111.96
|
| Rate for Payer: United Healthcare Commercial |
$111.96
|
|
|
CHG FETAL BIOPHYS PROF,W/O NST
|
Professional
|
Both
|
$90.88
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
z76819
|
| Min. Negotiated Rate |
$78.98 |
| Max. Negotiated Rate |
$11,600.00 |
| Rate for Payer: Aetna Commercial |
$79.78
|
| Rate for Payer: Aetna Commercial |
$79.78
|
| Rate for Payer: Aetna Medicare |
$79.78
|
| Rate for Payer: Aetna Medicare |
$79.78
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$95.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$95.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$95.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$95.96
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$95.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.96
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$95.96
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$78.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$78.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$91.75
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$91.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$87.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$87.76
|
| Rate for Payer: Cash Price |
$93.28
|
| Rate for Payer: Cash Price |
$54.53
|
| Rate for Payer: Centivo All Commercial |
$123.66
|
| Rate for Payer: Centivo All Commercial |
$123.66
|
| Rate for Payer: Cigna All Commercial |
$79.78
|
| Rate for Payer: Cigna All Commercial |
$79.78
|
| Rate for Payer: CORVEL All Commercial |
$79.78
|
| Rate for Payer: CORVEL All Commercial |
$79.78
|
| Rate for Payer: Coventry All Commercial |
$95.74
|
| Rate for Payer: Coventry All Commercial |
$95.74
|
| Rate for Payer: Encore All Commercial |
$79.78
|
| Rate for Payer: Encore All Commercial |
$79.78
|
| Rate for Payer: Frontpath All Commercial |
$138.75
|
| Rate for Payer: Frontpath All Commercial |
$138.75
|
| Rate for Payer: Humana ChoiceCare |
$90.93
|
| Rate for Payer: Humana ChoiceCare |
$90.93
|
| Rate for Payer: Humana Medicare |
$79.78
|
| Rate for Payer: Humana Medicare |
$79.78
|
| Rate for Payer: Lucent All Commercial |
$111.69
|
| Rate for Payer: Lucent All Commercial |
$111.69
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$123.00
|
| Rate for Payer: Managed Health Services Medicaid |
$78.98
|
| Rate for Payer: Managed Health Services Medicaid |
$78.98
|
| Rate for Payer: MDWise Medicaid |
$78.98
|
| Rate for Payer: MDWise Medicaid |
$78.98
|
| Rate for Payer: PHCS All Commercial |
$79.78
|
| Rate for Payer: PHCS All Commercial |
$79.78
|
| Rate for Payer: PHP All Commercial |
$101.05
|
| Rate for Payer: PHP All Commercial |
$101.05
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$79.78
|
| Rate for Payer: Sagamore Health Network All Products |
$79.78
|
| Rate for Payer: Sagamore Health Network All Products |
$79.78
|
| Rate for Payer: Signature Care EPO |
$122.40
|
| Rate for Payer: Signature Care EPO |
$122.40
|
| Rate for Payer: Signature Care PPO |
$122.40
|
| Rate for Payer: Signature Care PPO |
$122.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,600.00
|
| Rate for Payer: United Healthcare Commercial |
$86.53
|
| Rate for Payer: United Healthcare Commercial |
$86.53
|
|
|
CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME
|
Professional
|
Both
|
$78.64
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
z76000
|
| Min. Negotiated Rate |
$38.84 |
| Max. Negotiated Rate |
$86.99 |
| Rate for Payer: Aetna Commercial |
$40.15
|
| Rate for Payer: Aetna Commercial |
$40.15
|
| Rate for Payer: Aetna Medicare |
$40.15
|
| Rate for Payer: Aetna Medicare |
$40.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$38.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$38.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.16
|
| Rate for Payer: Cash Price |
$30.77
|
| Rate for Payer: Cash Price |
$47.18
|
| Rate for Payer: Centivo All Commercial |
$62.23
|
| Rate for Payer: Centivo All Commercial |
$62.23
|
| Rate for Payer: Cigna All Commercial |
$40.15
|
| Rate for Payer: Cigna All Commercial |
$40.15
|
| Rate for Payer: CORVEL All Commercial |
$40.15
|
| Rate for Payer: CORVEL All Commercial |
$40.15
|
| Rate for Payer: Coventry All Commercial |
$48.18
|
| Rate for Payer: Coventry All Commercial |
$48.18
|
| Rate for Payer: Encore All Commercial |
$40.15
|
| Rate for Payer: Encore All Commercial |
$40.15
|
| Rate for Payer: Frontpath All Commercial |
$70.82
|
| Rate for Payer: Frontpath All Commercial |
$70.82
|
| Rate for Payer: Humana ChoiceCare |
$44.93
|
| Rate for Payer: Humana ChoiceCare |
$44.93
|
| Rate for Payer: Humana Medicare |
$40.15
|
| Rate for Payer: Humana Medicare |
$40.15
|
| Rate for Payer: Lucent All Commercial |
$56.21
|
| Rate for Payer: Lucent All Commercial |
$56.21
|
| Rate for Payer: Managed Health Services Medicaid |
$38.84
|
| Rate for Payer: Managed Health Services Medicaid |
$38.84
|
| Rate for Payer: MDWise Medicaid |
$38.84
|
| Rate for Payer: MDWise Medicaid |
$38.84
|
| Rate for Payer: PHCS All Commercial |
$40.15
|
| Rate for Payer: PHCS All Commercial |
$40.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.15
|
| Rate for Payer: Sagamore Health Network All Products |
$40.15
|
| Rate for Payer: Sagamore Health Network All Products |
$40.15
|
| Rate for Payer: United Healthcare Commercial |
$86.99
|
| Rate for Payer: United Healthcare Commercial |
$86.99
|
|
|
CHG GLUCOSE BLOOD TEST
|
Professional
|
Both
|
$6.56
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
z82962
|
| Min. Negotiated Rate |
$1.97 |
| Max. Negotiated Rate |
$400.00 |
| Rate for Payer: Aetna Commercial |
$3.28
|
| Rate for Payer: Aetna Medicare |
$3.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.97
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$2.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$3.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$3.77
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.61
|
| Rate for Payer: Cash Price |
$3.94
|
| Rate for Payer: Centivo All Commercial |
$5.08
|
| Rate for Payer: Cigna All Commercial |
$3.28
|
| Rate for Payer: CORVEL All Commercial |
$3.28
|
| Rate for Payer: Coventry All Commercial |
$3.94
|
| Rate for Payer: Encore All Commercial |
$3.28
|
| Rate for Payer: Frontpath All Commercial |
$3.28
|
| Rate for Payer: Humana ChoiceCare |
$3.28
|
| Rate for Payer: Humana Medicare |
$3.28
|
| Rate for Payer: Lucent All Commercial |
$4.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.00
|
| Rate for Payer: Managed Health Services Medicaid |
$3.28
|
| Rate for Payer: MDWise Medicaid |
$3.28
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$2.46
|
| Rate for Payer: PHCS All Commercial |
$3.28
|
| Rate for Payer: PHP All Commercial |
$2.89
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.28
|
| Rate for Payer: Sagamore Health Network All Products |
$3.28
|
| Rate for Payer: Signature Care EPO |
$3.40
|
| Rate for Payer: Signature Care PPO |
$3.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$400.00
|
| Rate for Payer: United Healthcare Commercial |
$3.42
|
|
|
CHG GLYCOSYLATED HEMOGLOBIN, HOME DEVICE
|
Professional
|
Both
|
$19.42
|
|
|
Service Code
|
CPT 83037
|
| Hospital Charge Code |
z83037
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$1,300.00 |
| Rate for Payer: Aetna Commercial |
$9.71
|
| Rate for Payer: Aetna Medicare |
$9.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$6.98
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$6.98
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$6.98
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.98
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.68
|
| Rate for Payer: Cash Price |
$11.65
|
| Rate for Payer: Centivo All Commercial |
$15.05
|
| Rate for Payer: Cigna All Commercial |
$9.71
|
| Rate for Payer: CORVEL All Commercial |
$9.71
|
| Rate for Payer: Coventry All Commercial |
$11.65
|
| Rate for Payer: Encore All Commercial |
$9.71
|
| Rate for Payer: Frontpath All Commercial |
$9.71
|
| Rate for Payer: Humana Medicare |
$9.71
|
| Rate for Payer: Lucent All Commercial |
$13.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.00
|
| Rate for Payer: Managed Health Services Medicaid |
$9.71
|
| Rate for Payer: MDWise Medicaid |
$9.71
|
| Rate for Payer: PHCS All Commercial |
$9.71
|
| Rate for Payer: PHP All Commercial |
$8.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.71
|
| Rate for Payer: Sagamore Health Network All Products |
$9.71
|
| Rate for Payer: Signature Care EPO |
$16.51
|
| Rate for Payer: Signature Care PPO |
$16.51
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,300.00
|
| Rate for Payer: United Healthcare Commercial |
$14.17
|
|
|
CHG GLYCOSYLATED HEMOGLOBIN TEST
|
Professional
|
Both
|
$19.42
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
z83036
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Aetna Commercial |
$9.71
|
| Rate for Payer: Aetna Medicare |
$9.71
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.71
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$11.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.68
|
| Rate for Payer: Cash Price |
$11.65
|
| Rate for Payer: Centivo All Commercial |
$15.05
|
| Rate for Payer: Cigna All Commercial |
$9.71
|
| Rate for Payer: CORVEL All Commercial |
$9.71
|
| Rate for Payer: Coventry All Commercial |
$11.65
|
| Rate for Payer: Encore All Commercial |
$9.71
|
| Rate for Payer: Frontpath All Commercial |
$9.71
|
| Rate for Payer: Humana ChoiceCare |
$9.71
|
| Rate for Payer: Humana Medicare |
$9.71
|
| Rate for Payer: Lucent All Commercial |
$13.59
|
| Rate for Payer: Managed Health Services Medicaid |
$9.71
|
| Rate for Payer: MDWise Medicaid |
$9.71
|
| Rate for Payer: PHCS All Commercial |
$9.71
|
| Rate for Payer: PHP All Commercial |
$8.54
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.71
|
| Rate for Payer: Sagamore Health Network All Products |
$9.71
|
| Rate for Payer: United Healthcare Commercial |
$8.50
|
|
|
CHG HEMOGLOBIN
|
Professional
|
Both
|
$4.74
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
z85018
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$2.37
|
| Rate for Payer: Aetna Medicare |
$2.37
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$1.76
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.76
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$1.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.76
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.73
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.61
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Centivo All Commercial |
$3.67
|
| Rate for Payer: Cigna All Commercial |
$2.37
|
| Rate for Payer: CORVEL All Commercial |
$2.37
|
| Rate for Payer: Coventry All Commercial |
$2.84
|
| Rate for Payer: Encore All Commercial |
$2.37
|
| Rate for Payer: Frontpath All Commercial |
$2.37
|
| Rate for Payer: Humana ChoiceCare |
$2.37
|
| Rate for Payer: Humana Medicare |
$2.37
|
| Rate for Payer: Lucent All Commercial |
$3.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2.37
|
| Rate for Payer: MDWise Medicaid |
$2.37
|
| Rate for Payer: PHCS All Commercial |
$2.37
|
| Rate for Payer: PHP All Commercial |
$2.09
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.37
|
| Rate for Payer: Sagamore Health Network All Products |
$2.37
|
| Rate for Payer: Signature Care EPO |
$3.40
|
| Rate for Payer: Signature Care PPO |
$3.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$300.00
|
| Rate for Payer: United Healthcare Commercial |
$3.46
|
|
