|
CHG SMEAR,STAIN,WET MNT,INTERP
|
Professional
|
Both
|
$11.64
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
z87210
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$800.00 |
| Rate for Payer: Aetna Commercial |
$5.82
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.49
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$5.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.40
|
| Rate for Payer: Cash Price |
$6.98
|
| Rate for Payer: Centivo All Commercial |
$9.02
|
| Rate for Payer: Cigna All Commercial |
$5.82
|
| Rate for Payer: CORVEL All Commercial |
$5.82
|
| Rate for Payer: Coventry All Commercial |
$6.98
|
| Rate for Payer: Encore All Commercial |
$5.82
|
| Rate for Payer: Frontpath All Commercial |
$5.82
|
| Rate for Payer: Humana ChoiceCare |
$5.82
|
| Rate for Payer: Humana Medicare |
$5.82
|
| Rate for Payer: Lucent All Commercial |
$8.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.00
|
| Rate for Payer: Managed Health Services Medicaid |
$5.82
|
| Rate for Payer: MDWise Medicaid |
$5.82
|
| Rate for Payer: PHCS All Commercial |
$5.82
|
| Rate for Payer: PHP All Commercial |
$5.12
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.82
|
| Rate for Payer: Sagamore Health Network All Products |
$5.82
|
| Rate for Payer: Signature Care EPO |
$5.95
|
| Rate for Payer: Signature Care PPO |
$5.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$800.00
|
| Rate for Payer: United Healthcare Commercial |
$6.23
|
|
|
CHG SONO EXAM, HYSTEROSONOGRAPHY
|
Professional
|
Both
|
$214.20
|
|
|
Service Code
|
CPT 76831
|
| Hospital Charge Code |
z76831
|
| Min. Negotiated Rate |
$106.77 |
| Max. Negotiated Rate |
$15,900.00 |
| Rate for Payer: Aetna Commercial |
$111.06
|
| Rate for Payer: Aetna Commercial |
$111.06
|
| Rate for Payer: Aetna Medicare |
$111.06
|
| Rate for Payer: Aetna Medicare |
$111.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$107.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$107.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.30
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$107.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$107.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$107.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.30
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$106.77
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$106.77
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$127.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$127.72
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.17
|
| Rate for Payer: Cash Price |
$90.79
|
| Rate for Payer: Cash Price |
$128.52
|
| Rate for Payer: Centivo All Commercial |
$172.14
|
| Rate for Payer: Centivo All Commercial |
$172.14
|
| Rate for Payer: Cigna All Commercial |
$111.06
|
| Rate for Payer: Cigna All Commercial |
$111.06
|
| Rate for Payer: CORVEL All Commercial |
$111.06
|
| Rate for Payer: CORVEL All Commercial |
$111.06
|
| Rate for Payer: Coventry All Commercial |
$133.27
|
| Rate for Payer: Coventry All Commercial |
$133.27
|
| Rate for Payer: Encore All Commercial |
$111.06
|
| Rate for Payer: Encore All Commercial |
$111.06
|
| Rate for Payer: Frontpath All Commercial |
$192.75
|
| Rate for Payer: Frontpath All Commercial |
$192.75
|
| Rate for Payer: Humana ChoiceCare |
$127.59
|
| Rate for Payer: Humana ChoiceCare |
$127.59
|
| Rate for Payer: Humana Medicare |
$111.06
|
| Rate for Payer: Humana Medicare |
$111.06
|
| Rate for Payer: Lucent All Commercial |
$155.48
|
| Rate for Payer: Lucent All Commercial |
$155.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.00
|
| Rate for Payer: Managed Health Services Medicaid |
$106.77
|
| Rate for Payer: Managed Health Services Medicaid |
$106.77
|
| Rate for Payer: MDWise Medicaid |
$106.77
|
| Rate for Payer: MDWise Medicaid |
$106.77
|
| Rate for Payer: PHCS All Commercial |
$111.06
|
| Rate for Payer: PHCS All Commercial |
$111.06
|
| Rate for Payer: PHP All Commercial |
$139.23
|
| Rate for Payer: PHP All Commercial |
$139.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$111.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$111.06
|
| Rate for Payer: Sagamore Health Network All Products |
$111.06
|
| Rate for Payer: Sagamore Health Network All Products |
$111.06
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$114.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,900.00
|
| Rate for Payer: United Healthcare Commercial |
$110.22
|
| Rate for Payer: United Healthcare Commercial |
$110.22
|
|
|
CHG SONO GUIDE NEEDLE BIOPSY
|
Professional
|
Both
|
$107.32
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
z76942
|
| Min. Negotiated Rate |
$53.67 |
| Max. Negotiated Rate |
$169.34 |
| Rate for Payer: Aetna Commercial |
$55.14
|
| Rate for Payer: Aetna Commercial |
$55.14
|
| Rate for Payer: Aetna Commercial |
$55.14
|
| Rate for Payer: Aetna Medicare |
$55.14
|
| Rate for Payer: Aetna Medicare |
$55.14
|
| Rate for Payer: Aetna Medicare |
$55.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$53.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$53.67
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$53.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.65
|
| Rate for Payer: Cash Price |
$31.13
|
| Rate for Payer: Cash Price |
$64.39
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Centivo All Commercial |
$85.47
|
| Rate for Payer: Centivo All Commercial |
$85.47
|
| Rate for Payer: Centivo All Commercial |
$85.47
|
| Rate for Payer: Cigna All Commercial |
$55.14
|
| Rate for Payer: Cigna All Commercial |
$55.14
|
| Rate for Payer: Cigna All Commercial |
$55.14
|
| Rate for Payer: CORVEL All Commercial |
$55.14
|
| Rate for Payer: CORVEL All Commercial |
$55.14
|
| Rate for Payer: CORVEL All Commercial |
$55.14
|
| Rate for Payer: Coventry All Commercial |
$66.17
|
| Rate for Payer: Coventry All Commercial |
$66.17
|
| Rate for Payer: Coventry All Commercial |
$66.17
|
| Rate for Payer: Encore All Commercial |
$55.14
|
| Rate for Payer: Encore All Commercial |
$55.14
|
| Rate for Payer: Encore All Commercial |
$55.14
|
| Rate for Payer: Frontpath All Commercial |
$96.34
|
| Rate for Payer: Frontpath All Commercial |
$96.34
|
| Rate for Payer: Frontpath All Commercial |
$96.34
|
| Rate for Payer: Humana ChoiceCare |
$157.91
|
| Rate for Payer: Humana ChoiceCare |
$157.91
|
| Rate for Payer: Humana ChoiceCare |
$157.91
|
| Rate for Payer: Humana Medicare |
$55.14
|
| Rate for Payer: Humana Medicare |
$55.14
|
| Rate for Payer: Humana Medicare |
$55.14
|
| Rate for Payer: Lucent All Commercial |
$77.20
|
| Rate for Payer: Lucent All Commercial |
$77.20
|
| Rate for Payer: Lucent All Commercial |
$77.20
|
| Rate for Payer: Managed Health Services Medicaid |
$53.67
|
| Rate for Payer: Managed Health Services Medicaid |
$53.67
|
| Rate for Payer: Managed Health Services Medicaid |
$53.67
|
| Rate for Payer: MDWise Medicaid |
$53.67
|
| Rate for Payer: MDWise Medicaid |
$53.67
|
| Rate for Payer: MDWise Medicaid |
$53.67
|
| Rate for Payer: PHCS All Commercial |
$55.14
|
| Rate for Payer: PHCS All Commercial |
$55.14
|
| Rate for Payer: PHCS All Commercial |
$55.14
|
| Rate for Payer: PHP All Commercial |
$69.75
|
| Rate for Payer: PHP All Commercial |
$69.75
|
| Rate for Payer: PHP All Commercial |
$69.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.14
|
| Rate for Payer: Sagamore Health Network All Products |
$55.14
|
| Rate for Payer: Sagamore Health Network All Products |
$55.14
|
| Rate for Payer: Sagamore Health Network All Products |
$55.14
|
| Rate for Payer: Signature Care EPO |
$93.74
|
| Rate for Payer: Signature Care EPO |
$93.74
|
| Rate for Payer: Signature Care EPO |
$93.74
|
| Rate for Payer: Signature Care PPO |
$93.74
|
| Rate for Payer: Signature Care PPO |
$93.74
|
| Rate for Payer: Signature Care PPO |
$93.74
|
| Rate for Payer: United Healthcare Commercial |
$169.34
|
| Rate for Payer: United Healthcare Commercial |
$169.34
|
| Rate for Payer: United Healthcare Commercial |
$169.34
|
|
|
CHG SONO PELVIS LIMITED
|
Professional
|
Both
|
$90.02
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
z76857
|
| Min. Negotiated Rate |
$45.51 |
| Max. Negotiated Rate |
$6,700.00 |
| Rate for Payer: Aetna Commercial |
$45.51
|
| Rate for Payer: Aetna Commercial |
$45.51
|
| Rate for Payer: Aetna Medicare |
$45.51
|
| Rate for Payer: Aetna Medicare |
$45.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$67.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$67.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$67.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$67.50
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$67.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$45.53
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$45.53
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.06
|
| Rate for Payer: Cash Price |
$28.92
|
| Rate for Payer: Cash Price |
$54.01
|
| Rate for Payer: Centivo All Commercial |
$70.54
|
| Rate for Payer: Centivo All Commercial |
$70.54
|
| Rate for Payer: Cigna All Commercial |
$45.51
|
| Rate for Payer: Cigna All Commercial |
$45.51
|
| Rate for Payer: CORVEL All Commercial |
$45.51
|
| Rate for Payer: CORVEL All Commercial |
$45.51
|
| Rate for Payer: Coventry All Commercial |
$54.61
|
| Rate for Payer: Coventry All Commercial |
$54.61
|
| Rate for Payer: Encore All Commercial |
$45.51
|
| Rate for Payer: Encore All Commercial |
$45.51
|
| Rate for Payer: Frontpath All Commercial |
$79.15
|
| Rate for Payer: Frontpath All Commercial |
$79.15
|
| Rate for Payer: Humana ChoiceCare |
$50.32
|
| Rate for Payer: Humana ChoiceCare |
$50.32
|
| Rate for Payer: Humana Medicare |
$45.51
|
| Rate for Payer: Humana Medicare |
$45.51
|
| Rate for Payer: Lucent All Commercial |
$63.71
|
| Rate for Payer: Lucent All Commercial |
$63.71
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.00
|
| Rate for Payer: Managed Health Services Medicaid |
$45.53
|
| Rate for Payer: Managed Health Services Medicaid |
$45.53
|
| Rate for Payer: MDWise Medicaid |
$45.53
|
| Rate for Payer: MDWise Medicaid |
$45.53
|
| Rate for Payer: PHCS All Commercial |
$45.51
|
| Rate for Payer: PHCS All Commercial |
$45.51
|
| Rate for Payer: PHP All Commercial |
$58.51
|
| Rate for Payer: PHP All Commercial |
$58.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.51
|
| Rate for Payer: Sagamore Health Network All Products |
$45.51
|
| Rate for Payer: Sagamore Health Network All Products |
$45.51
|
| Rate for Payer: Signature Care EPO |
$76.48
|
| Rate for Payer: Signature Care EPO |
$76.48
|
| Rate for Payer: Signature Care PPO |
$76.48
|
| Rate for Payer: Signature Care PPO |
$76.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,700.00
|
| Rate for Payer: United Healthcare Commercial |
$91.92
|
| Rate for Payer: United Healthcare Commercial |
$91.92
|
|
|
CHG STREP A, DNA, AMP PROBE
|
Professional
|
Both
|
$70.18
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
z87651
|
| Min. Negotiated Rate |
$17.13 |
| Max. Negotiated Rate |
$4,600.00 |
| Rate for Payer: Aetna Commercial |
$35.09
|
| Rate for Payer: Aetna Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$17.13
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$17.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$17.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.13
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.60
|
| Rate for Payer: Cash Price |
$42.11
|
| Rate for Payer: Centivo All Commercial |
$54.39
|
| Rate for Payer: Cigna All Commercial |
$35.09
|
| Rate for Payer: CORVEL All Commercial |
$35.09
|
| Rate for Payer: Coventry All Commercial |
$42.11
|
| Rate for Payer: Encore All Commercial |
$35.09
|
| Rate for Payer: Frontpath All Commercial |
$35.09
|
| Rate for Payer: Humana ChoiceCare |
$35.09
|
| Rate for Payer: Humana Medicare |
$35.09
|
| Rate for Payer: Lucent All Commercial |
$49.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: Managed Health Services Medicaid |
$35.09
|
| Rate for Payer: MDWise Medicaid |
$35.09
|
| Rate for Payer: PHCS All Commercial |
$35.09
|
| Rate for Payer: PHP All Commercial |
$30.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.09
|
| Rate for Payer: Sagamore Health Network All Products |
$35.09
|
| Rate for Payer: Signature Care EPO |
$45.90
|
| Rate for Payer: Signature Care PPO |
$45.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,600.00
|
| Rate for Payer: United Healthcare Commercial |
$30.75
|
|
|
CHG TB INTRADERMAL TEST
|
Professional
|
Both
|
$18.74
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
z86580
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$9.50
|
| Rate for Payer: Aetna Commercial |
$9.50
|
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$4.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.12
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$4.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4.12
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$4.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.12
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$7.10
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$7.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.22
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$9.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.45
|
| Rate for Payer: Cash Price |
$10.67
|
| Rate for Payer: Cash Price |
$11.24
|
| Rate for Payer: Centivo All Commercial |
$14.72
|
| Rate for Payer: Centivo All Commercial |
$14.72
|
| Rate for Payer: Cigna All Commercial |
$9.50
|
| Rate for Payer: Cigna All Commercial |
$9.50
|
| Rate for Payer: CORVEL All Commercial |
$9.50
|
| Rate for Payer: CORVEL All Commercial |
$9.50
|
| Rate for Payer: Coventry All Commercial |
$11.40
|
| Rate for Payer: Coventry All Commercial |
$11.40
|
| Rate for Payer: Encore All Commercial |
$9.50
|
| Rate for Payer: Encore All Commercial |
$9.50
|
| Rate for Payer: Frontpath All Commercial |
$9.86
|
| Rate for Payer: Frontpath All Commercial |
$9.86
|
| Rate for Payer: Humana ChoiceCare |
$9.11
|
| Rate for Payer: Humana ChoiceCare |
$9.11
|
| Rate for Payer: Humana Medicare |
$9.50
|
| Rate for Payer: Humana Medicare |
$9.50
|
| Rate for Payer: Lucent All Commercial |
$13.30
|
| Rate for Payer: Lucent All Commercial |
$13.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.00
|
| Rate for Payer: Managed Health Services Medicaid |
$9.22
|
| Rate for Payer: Managed Health Services Medicaid |
$9.22
|
| Rate for Payer: MDWise Medicaid |
$9.22
|
| Rate for Payer: MDWise Medicaid |
$9.22
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$7.10
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$7.10
|
| Rate for Payer: PHCS All Commercial |
$9.50
|
| Rate for Payer: PHCS All Commercial |
$9.50
|
| Rate for Payer: PHP All Commercial |
$7.82
|
| Rate for Payer: PHP All Commercial |
$7.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.50
|
| Rate for Payer: Sagamore Health Network All Products |
$9.50
|
| Rate for Payer: Sagamore Health Network All Products |
$9.50
|
| Rate for Payer: Signature Care EPO |
$8.50
|
| Rate for Payer: Signature Care EPO |
$8.50
|
| Rate for Payer: Signature Care PPO |
$8.50
|
| Rate for Payer: Signature Care PPO |
$8.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,200.00
|
| Rate for Payer: United Healthcare Commercial |
$6.39
|
| Rate for Payer: United Healthcare Commercial |
$6.39
|
| Rate for Payer: United Healthcare Medicare |
$8.89
|
| Rate for Payer: United Healthcare Medicare |
$8.89
|
|
|
CHG URINALYSIS, AUTO, W/O SCOPE
|
Professional
|
Both
|
$4.50
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
z81003
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$2.25
|
| Rate for Payer: Aetna Medicare |
$2.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$3.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$3.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.06
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$2.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$2.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$2.48
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Centivo All Commercial |
$3.49
|
| Rate for Payer: Cigna All Commercial |
$2.25
|
| Rate for Payer: CORVEL All Commercial |
$2.25
|
| Rate for Payer: Coventry All Commercial |
$2.70
|
| Rate for Payer: Encore All Commercial |
$2.25
|
| Rate for Payer: Frontpath All Commercial |
$2.25
|
| Rate for Payer: Humana ChoiceCare |
$2.25
|
| Rate for Payer: Humana Medicare |
$2.25
|
| Rate for Payer: Lucent All Commercial |
$3.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.00
|
| Rate for Payer: Managed Health Services Medicaid |
$2.25
|
| Rate for Payer: MDWise Medicaid |
$2.25
|
| Rate for Payer: PHCS All Commercial |
$2.25
|
| Rate for Payer: PHP All Commercial |
$1.98
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$2.25
|
| Rate for Payer: Sagamore Health Network All Products |
$2.25
|
| Rate for Payer: Signature Care EPO |
$2.60
|
| Rate for Payer: Signature Care PPO |
$2.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$300.00
|
| Rate for Payer: United Healthcare Commercial |
$3.28
|
|
|
CHG URINALYSIS NONAUTO W/O SCOPE
|
Professional
|
Both
|
$6.96
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
z81002
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$500.00 |
| Rate for Payer: Aetna Commercial |
$3.48
|
| Rate for Payer: Aetna Medicare |
$3.48
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$2.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$2.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.09
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$2.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$3.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.83
|
| Rate for Payer: Cash Price |
$4.18
|
| Rate for Payer: Centivo All Commercial |
$5.39
|
| Rate for Payer: Cigna All Commercial |
$3.48
|
| Rate for Payer: CORVEL All Commercial |
$3.48
|
| Rate for Payer: Coventry All Commercial |
$4.18
|
| Rate for Payer: Encore All Commercial |
$3.48
|
| Rate for Payer: Frontpath All Commercial |
$3.48
|
| Rate for Payer: Humana ChoiceCare |
$3.48
|
| Rate for Payer: Humana Medicare |
$3.48
|
| Rate for Payer: Lucent All Commercial |
$4.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.00
|
| Rate for Payer: Managed Health Services Medicaid |
$3.48
|
| Rate for Payer: MDWise Medicaid |
$3.48
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$2.61
|
| Rate for Payer: PHCS All Commercial |
$3.48
|
| Rate for Payer: PHP All Commercial |
$3.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$3.48
|
| Rate for Payer: Sagamore Health Network All Products |
$3.48
|
| Rate for Payer: Signature Care EPO |
$3.40
|
| Rate for Payer: Signature Care PPO |
$3.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$500.00
|
| Rate for Payer: United Healthcare Commercial |
$3.74
|
|
|
CHG URINE ALBUMIN SEMIQUANTITATIVE
|
Professional
|
Both
|
$12.46
|
|
|
Service Code
|
CPT 82044
|
| Hospital Charge Code |
z82044
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$9.66 |
| Rate for Payer: Aetna Commercial |
$6.23
|
| Rate for Payer: Aetna Medicare |
$6.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$6.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$7.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$6.85
|
| Rate for Payer: Cash Price |
$7.48
|
| Rate for Payer: Centivo All Commercial |
$9.66
|
| Rate for Payer: Cigna All Commercial |
$6.23
|
| Rate for Payer: CORVEL All Commercial |
$6.23
|
| Rate for Payer: Coventry All Commercial |
$7.48
|
| Rate for Payer: Encore All Commercial |
$6.23
|
| Rate for Payer: Frontpath All Commercial |
$6.23
|
| Rate for Payer: Humana ChoiceCare |
$6.23
|
| Rate for Payer: Humana Medicare |
$6.23
|
| Rate for Payer: Lucent All Commercial |
$8.72
|
| Rate for Payer: Managed Health Services Medicaid |
$6.23
|
| Rate for Payer: MDWise Medicaid |
$6.23
|
| Rate for Payer: PHCS All Commercial |
$6.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.23
|
| Rate for Payer: Sagamore Health Network All Products |
$6.23
|
| Rate for Payer: United Healthcare Commercial |
$4.23
|
|
|
CHG URINE PREGNANCY TEST
|
Professional
|
Both
|
$17.22
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
z81025
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$8.61
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$5.17
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.17
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$5.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.17
|
| Rate for Payer: Buckeye Health Medicaid OOS |
$6.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$8.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$9.90
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$9.47
|
| Rate for Payer: Cash Price |
$10.33
|
| Rate for Payer: Centivo All Commercial |
$13.35
|
| Rate for Payer: Cigna All Commercial |
$8.61
|
| Rate for Payer: CORVEL All Commercial |
$8.61
|
| Rate for Payer: Coventry All Commercial |
$10.33
|
| Rate for Payer: Encore All Commercial |
$8.61
|
| Rate for Payer: Frontpath All Commercial |
$8.61
|
| Rate for Payer: Humana ChoiceCare |
$8.61
|
| Rate for Payer: Humana Medicare |
$8.61
|
| Rate for Payer: Lucent All Commercial |
$12.05
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.00
|
| Rate for Payer: Managed Health Services Medicaid |
$8.61
|
| Rate for Payer: MDWise Medicaid |
$8.61
|
| Rate for Payer: Molina Healthcare of OH Medicaid OOS/Medicare |
$6.46
|
| Rate for Payer: PHCS All Commercial |
$8.61
|
| Rate for Payer: PHP All Commercial |
$7.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$8.61
|
| Rate for Payer: Sagamore Health Network All Products |
$8.61
|
| Rate for Payer: Signature Care EPO |
$8.50
|
| Rate for Payer: Signature Care PPO |
$8.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$1,100.00
|
| Rate for Payer: United Healthcare Commercial |
$9.24
|
|
|
CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG
|
Professional
|
Both
|
$56.80
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
z76882
|
| Min. Negotiated Rate |
$30.22 |
| Max. Negotiated Rate |
$92.53 |
| Rate for Payer: Aetna Commercial |
$53.26
|
| Rate for Payer: Aetna Commercial |
$53.26
|
| Rate for Payer: Aetna Medicare |
$53.26
|
| Rate for Payer: Aetna Medicare |
$53.26
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$58.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$58.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$61.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$58.59
|
| Rate for Payer: Cash Price |
$45.64
|
| Rate for Payer: Cash Price |
$34.08
|
| Rate for Payer: Centivo All Commercial |
$82.55
|
| Rate for Payer: Centivo All Commercial |
$82.55
|
| Rate for Payer: Cigna All Commercial |
$53.26
|
| Rate for Payer: Cigna All Commercial |
$53.26
|
| Rate for Payer: CORVEL All Commercial |
$53.26
|
| Rate for Payer: CORVEL All Commercial |
$53.26
|
| Rate for Payer: Coventry All Commercial |
$63.91
|
| Rate for Payer: Coventry All Commercial |
$63.91
|
| Rate for Payer: Encore All Commercial |
$53.26
|
| Rate for Payer: Encore All Commercial |
$53.26
|
| Rate for Payer: Frontpath All Commercial |
$92.53
|
| Rate for Payer: Frontpath All Commercial |
$92.53
|
| Rate for Payer: Humana ChoiceCare |
$59.30
|
| Rate for Payer: Humana ChoiceCare |
$59.30
|
| Rate for Payer: Humana Medicare |
$53.26
|
| Rate for Payer: Humana Medicare |
$53.26
|
| Rate for Payer: Lucent All Commercial |
$74.56
|
| Rate for Payer: Lucent All Commercial |
$74.56
|
| Rate for Payer: Managed Health Services Medicaid |
$58.41
|
| Rate for Payer: Managed Health Services Medicaid |
$58.41
|
| Rate for Payer: MDWise Medicaid |
$58.41
|
| Rate for Payer: MDWise Medicaid |
$58.41
|
| Rate for Payer: PHCS All Commercial |
$53.26
|
| Rate for Payer: PHCS All Commercial |
$53.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.26
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$53.26
|
| Rate for Payer: Sagamore Health Network All Products |
$53.26
|
| Rate for Payer: Sagamore Health Network All Products |
$53.26
|
| Rate for Payer: United Healthcare Commercial |
$30.22
|
| Rate for Payer: United Healthcare Commercial |
$30.22
|
|
|
CHG US, OB < 14 WKS, ADD'L FETUS
|
Professional
|
Both
|
$38.68
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
z76802
|
| Min. Negotiated Rate |
$56.03 |
| Max. Negotiated Rate |
$8,500.00 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Medicare |
$58.96
|
| Rate for Payer: Aetna Medicare |
$58.96
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$65.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$65.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.09
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$65.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$65.09
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$65.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$56.03
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$56.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.86
|
| Rate for Payer: Cash Price |
$68.38
|
| Rate for Payer: Cash Price |
$23.21
|
| Rate for Payer: Centivo All Commercial |
$91.39
|
| Rate for Payer: Centivo All Commercial |
$91.39
|
| Rate for Payer: Cigna All Commercial |
$58.96
|
| Rate for Payer: Cigna All Commercial |
$58.96
|
| Rate for Payer: CORVEL All Commercial |
$58.96
|
| Rate for Payer: CORVEL All Commercial |
$58.96
|
| Rate for Payer: Coventry All Commercial |
$70.75
|
| Rate for Payer: Coventry All Commercial |
$70.75
|
| Rate for Payer: Encore All Commercial |
$58.96
|
| Rate for Payer: Encore All Commercial |
$58.96
|
| Rate for Payer: Frontpath All Commercial |
$102.42
|
| Rate for Payer: Frontpath All Commercial |
$102.42
|
| Rate for Payer: Humana ChoiceCare |
$65.77
|
| Rate for Payer: Humana ChoiceCare |
$65.77
|
| Rate for Payer: Humana Medicare |
$58.96
|
| Rate for Payer: Humana Medicare |
$58.96
|
| Rate for Payer: Lucent All Commercial |
$82.54
|
| Rate for Payer: Lucent All Commercial |
$82.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.00
|
| Rate for Payer: Managed Health Services Medicaid |
$56.03
|
| Rate for Payer: Managed Health Services Medicaid |
$56.03
|
| Rate for Payer: MDWise Medicaid |
$56.03
|
| Rate for Payer: MDWise Medicaid |
$56.03
|
| Rate for Payer: PHCS All Commercial |
$58.96
|
| Rate for Payer: PHCS All Commercial |
$58.96
|
| Rate for Payer: PHP All Commercial |
$74.08
|
| Rate for Payer: PHP All Commercial |
$74.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.96
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.96
|
| Rate for Payer: Sagamore Health Network All Products |
$58.96
|
| Rate for Payer: Sagamore Health Network All Products |
$58.96
|
| Rate for Payer: Signature Care EPO |
$100.23
|
| Rate for Payer: Signature Care EPO |
$100.23
|
| Rate for Payer: Signature Care PPO |
$100.23
|
| Rate for Payer: Signature Care PPO |
$100.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8,500.00
|
| Rate for Payer: United Healthcare Commercial |
$68.82
|
| Rate for Payer: United Healthcare Commercial |
$68.82
|
|
|
CHG US, OB >/= 14 WKS, ADDL FETUS
|
Professional
|
Both
|
$75.82
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
z76810
|
| Min. Negotiated Rate |
$81.17 |
| Max. Negotiated Rate |
$12,200.00 |
| Rate for Payer: Aetna Commercial |
$84.55
|
| Rate for Payer: Aetna Commercial |
$84.55
|
| Rate for Payer: Aetna Medicare |
$84.55
|
| Rate for Payer: Aetna Medicare |
$84.55
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$170.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$170.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$170.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$170.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$170.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$170.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$81.17
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$81.17
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$97.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$97.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$93.00
|
| Rate for Payer: Cash Price |
$98.38
|
| Rate for Payer: Cash Price |
$45.49
|
| Rate for Payer: Centivo All Commercial |
$131.05
|
| Rate for Payer: Centivo All Commercial |
$131.05
|
| Rate for Payer: Cigna All Commercial |
$84.55
|
| Rate for Payer: Cigna All Commercial |
$84.55
|
| Rate for Payer: CORVEL All Commercial |
$84.55
|
| Rate for Payer: CORVEL All Commercial |
$84.55
|
| Rate for Payer: Coventry All Commercial |
$101.46
|
| Rate for Payer: Coventry All Commercial |
$101.46
|
| Rate for Payer: Encore All Commercial |
$84.55
|
| Rate for Payer: Encore All Commercial |
$84.55
|
| Rate for Payer: Frontpath All Commercial |
$146.81
|
| Rate for Payer: Frontpath All Commercial |
$146.81
|
| Rate for Payer: Humana ChoiceCare |
$95.95
|
| Rate for Payer: Humana ChoiceCare |
$95.95
|
| Rate for Payer: Humana Medicare |
$84.55
|
| Rate for Payer: Humana Medicare |
$84.55
|
| Rate for Payer: Lucent All Commercial |
$118.37
|
| Rate for Payer: Lucent All Commercial |
$118.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.00
|
| Rate for Payer: Managed Health Services Medicaid |
$81.17
|
| Rate for Payer: Managed Health Services Medicaid |
$81.17
|
| Rate for Payer: MDWise Medicaid |
$81.17
|
| Rate for Payer: MDWise Medicaid |
$81.17
|
| Rate for Payer: PHCS All Commercial |
$84.55
|
| Rate for Payer: PHCS All Commercial |
$84.55
|
| Rate for Payer: PHP All Commercial |
$106.57
|
| Rate for Payer: PHP All Commercial |
$106.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.55
|
| Rate for Payer: Sagamore Health Network All Products |
$84.55
|
| Rate for Payer: Sagamore Health Network All Products |
$84.55
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$114.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,200.00
|
| Rate for Payer: United Healthcare Commercial |
$93.27
|
| Rate for Payer: United Healthcare Commercial |
$93.27
|
|
|
CHG US, OB < 14 WKS, SINGLE FETUS
|
Professional
|
Both
|
$217.62
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
z76801
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$16,200.00 |
| Rate for Payer: Aetna Commercial |
$112.31
|
| Rate for Payer: Aetna Commercial |
$112.31
|
| Rate for Payer: Aetna Medicare |
$112.31
|
| Rate for Payer: Aetna Medicare |
$112.31
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$134.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$134.41
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$134.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$134.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$134.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$134.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$134.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$108.08
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$108.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$129.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$129.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$123.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$123.54
|
| Rate for Payer: Cash Price |
$78.28
|
| Rate for Payer: Cash Price |
$130.57
|
| Rate for Payer: Centivo All Commercial |
$174.08
|
| Rate for Payer: Centivo All Commercial |
$174.08
|
| Rate for Payer: Cigna All Commercial |
$112.31
|
| Rate for Payer: Cigna All Commercial |
$112.31
|
| Rate for Payer: CORVEL All Commercial |
$112.31
|
| Rate for Payer: CORVEL All Commercial |
$112.31
|
| Rate for Payer: Coventry All Commercial |
$134.77
|
| Rate for Payer: Coventry All Commercial |
$134.77
|
| Rate for Payer: Encore All Commercial |
$112.31
|
| Rate for Payer: Encore All Commercial |
$112.31
|
| Rate for Payer: Frontpath All Commercial |
$194.67
|
| Rate for Payer: Frontpath All Commercial |
$194.67
|
| Rate for Payer: Humana ChoiceCare |
$127.95
|
| Rate for Payer: Humana ChoiceCare |
$127.95
|
| Rate for Payer: Humana Medicare |
$112.31
|
| Rate for Payer: Humana Medicare |
$112.31
|
| Rate for Payer: Lucent All Commercial |
$157.23
|
| Rate for Payer: Lucent All Commercial |
$157.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.00
|
| Rate for Payer: Managed Health Services Medicaid |
$108.08
|
| Rate for Payer: Managed Health Services Medicaid |
$108.08
|
| Rate for Payer: MDWise Medicaid |
$108.08
|
| Rate for Payer: MDWise Medicaid |
$108.08
|
| Rate for Payer: PHCS All Commercial |
$112.31
|
| Rate for Payer: PHCS All Commercial |
$112.31
|
| Rate for Payer: PHP All Commercial |
$141.45
|
| Rate for Payer: PHP All Commercial |
$141.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$112.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$112.31
|
| Rate for Payer: Sagamore Health Network All Products |
$112.31
|
| Rate for Payer: Sagamore Health Network All Products |
$112.31
|
| Rate for Payer: Signature Care EPO |
$165.33
|
| Rate for Payer: Signature Care EPO |
$165.33
|
| Rate for Payer: Signature Care PPO |
$165.33
|
| Rate for Payer: Signature Care PPO |
$165.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,200.00
|
| Rate for Payer: United Healthcare Commercial |
$120.94
|
| Rate for Payer: United Healthcare Commercial |
$120.94
|
|
|
CHG US, OB >/= 14 WKS, SNGL FETUS
|
Professional
|
Both
|
$249.86
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
z76805
|
| Min. Negotiated Rate |
$124.54 |
| Max. Negotiated Rate |
$18,600.00 |
| Rate for Payer: Aetna Commercial |
$128.81
|
| Rate for Payer: Aetna Commercial |
$128.81
|
| Rate for Payer: Aetna Medicare |
$128.81
|
| Rate for Payer: Aetna Medicare |
$128.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$143.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$143.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$143.89
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$143.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$143.89
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$143.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.89
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$124.54
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$124.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$148.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$148.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$141.69
|
| Rate for Payer: Cash Price |
$97.98
|
| Rate for Payer: Cash Price |
$149.92
|
| Rate for Payer: Centivo All Commercial |
$199.66
|
| Rate for Payer: Centivo All Commercial |
$199.66
|
| Rate for Payer: Cigna All Commercial |
$128.81
|
| Rate for Payer: Cigna All Commercial |
$128.81
|
| Rate for Payer: CORVEL All Commercial |
$128.81
|
| Rate for Payer: CORVEL All Commercial |
$128.81
|
| Rate for Payer: Coventry All Commercial |
$154.57
|
| Rate for Payer: Coventry All Commercial |
$154.57
|
| Rate for Payer: Encore All Commercial |
$128.81
|
| Rate for Payer: Encore All Commercial |
$128.81
|
| Rate for Payer: Frontpath All Commercial |
$223.14
|
| Rate for Payer: Frontpath All Commercial |
$223.14
|
| Rate for Payer: Humana ChoiceCare |
$147.35
|
| Rate for Payer: Humana ChoiceCare |
$147.35
|
| Rate for Payer: Humana Medicare |
$128.81
|
| Rate for Payer: Humana Medicare |
$128.81
|
| Rate for Payer: Lucent All Commercial |
$180.33
|
| Rate for Payer: Lucent All Commercial |
$180.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$198.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$198.00
|
| Rate for Payer: Managed Health Services Medicaid |
$124.54
|
| Rate for Payer: Managed Health Services Medicaid |
$124.54
|
| Rate for Payer: MDWise Medicaid |
$124.54
|
| Rate for Payer: MDWise Medicaid |
$124.54
|
| Rate for Payer: PHCS All Commercial |
$128.81
|
| Rate for Payer: PHCS All Commercial |
$128.81
|
| Rate for Payer: PHP All Commercial |
$162.41
|
| Rate for Payer: PHP All Commercial |
$162.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.81
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.81
|
| Rate for Payer: Sagamore Health Network All Products |
$128.81
|
| Rate for Payer: Sagamore Health Network All Products |
$128.81
|
| Rate for Payer: Signature Care EPO |
$158.10
|
| Rate for Payer: Signature Care EPO |
$158.10
|
| Rate for Payer: Signature Care PPO |
$158.10
|
| Rate for Payer: Signature Care PPO |
$158.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18,600.00
|
| Rate for Payer: United Healthcare Commercial |
$134.52
|
| Rate for Payer: United Healthcare Commercial |
$134.52
|
|
|
CHG US,PREGNANT UTERUS,F/U,TRANSABD APP
|
Professional
|
Both
|
$202.32
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
z76816
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$15,000.00 |
| Rate for Payer: Aetna Commercial |
$104.66
|
| Rate for Payer: Aetna Commercial |
$104.66
|
| Rate for Payer: Aetna Medicare |
$104.66
|
| Rate for Payer: Aetna Medicare |
$104.66
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$101.37
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$101.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.36
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.36
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.13
|
| Rate for Payer: Cash Price |
$77.17
|
| Rate for Payer: Cash Price |
$121.39
|
| Rate for Payer: Centivo All Commercial |
$162.22
|
| Rate for Payer: Centivo All Commercial |
$162.22
|
| Rate for Payer: Cigna All Commercial |
$104.66
|
| Rate for Payer: Cigna All Commercial |
$104.66
|
| Rate for Payer: CORVEL All Commercial |
$104.66
|
| Rate for Payer: CORVEL All Commercial |
$104.66
|
| Rate for Payer: Coventry All Commercial |
$125.59
|
| Rate for Payer: Coventry All Commercial |
$125.59
|
| Rate for Payer: Encore All Commercial |
$104.66
|
| Rate for Payer: Encore All Commercial |
$104.66
|
| Rate for Payer: Frontpath All Commercial |
$181.59
|
| Rate for Payer: Frontpath All Commercial |
$181.59
|
| Rate for Payer: Humana ChoiceCare |
$119.68
|
| Rate for Payer: Humana ChoiceCare |
$119.68
|
| Rate for Payer: Humana Medicare |
$104.66
|
| Rate for Payer: Humana Medicare |
$104.66
|
| Rate for Payer: Lucent All Commercial |
$146.52
|
| Rate for Payer: Lucent All Commercial |
$146.52
|
| Rate for Payer: Lutheran Preferred All Commercial |
$161.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$161.00
|
| Rate for Payer: Managed Health Services Medicaid |
$101.37
|
| Rate for Payer: Managed Health Services Medicaid |
$101.37
|
| Rate for Payer: MDWise Medicaid |
$101.37
|
| Rate for Payer: MDWise Medicaid |
$101.37
|
| Rate for Payer: PHCS All Commercial |
$104.66
|
| Rate for Payer: PHCS All Commercial |
$104.66
|
| Rate for Payer: PHP All Commercial |
$131.51
|
| Rate for Payer: PHP All Commercial |
$131.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.66
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.66
|
| Rate for Payer: Sagamore Health Network All Products |
$104.66
|
| Rate for Payer: Sagamore Health Network All Products |
$104.66
|
| Rate for Payer: Signature Care EPO |
$92.55
|
| Rate for Payer: Signature Care EPO |
$92.55
|
| Rate for Payer: Signature Care PPO |
$92.55
|
| Rate for Payer: Signature Care PPO |
$92.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$15,000.00
|
| Rate for Payer: United Healthcare Commercial |
$103.01
|
| Rate for Payer: United Healthcare Commercial |
$103.01
|
|
|
CHG US,PREGNANT UTERUS,LIMITED, 1/> FETUSES
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
z76815
|
| Min. Negotiated Rate |
$74.45 |
| Max. Negotiated Rate |
$11,100.00 |
| Rate for Payer: Aetna Commercial |
$77.49
|
| Rate for Payer: Aetna Commercial |
$77.49
|
| Rate for Payer: Aetna Medicare |
$77.49
|
| Rate for Payer: Aetna Medicare |
$77.49
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$94.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$94.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$94.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$94.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$94.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$94.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$74.45
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$74.45
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$89.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$85.24
|
| Rate for Payer: Cash Price |
$89.98
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Centivo All Commercial |
$120.11
|
| Rate for Payer: Centivo All Commercial |
$120.11
|
| Rate for Payer: Cigna All Commercial |
$77.49
|
| Rate for Payer: Cigna All Commercial |
$77.49
|
| Rate for Payer: CORVEL All Commercial |
$77.49
|
| Rate for Payer: CORVEL All Commercial |
$77.49
|
| Rate for Payer: Coventry All Commercial |
$92.99
|
| Rate for Payer: Coventry All Commercial |
$92.99
|
| Rate for Payer: Encore All Commercial |
$77.49
|
| Rate for Payer: Encore All Commercial |
$77.49
|
| Rate for Payer: Frontpath All Commercial |
$134.91
|
| Rate for Payer: Frontpath All Commercial |
$134.91
|
| Rate for Payer: Humana ChoiceCare |
$88.78
|
| Rate for Payer: Humana ChoiceCare |
$88.78
|
| Rate for Payer: Humana Medicare |
$77.49
|
| Rate for Payer: Humana Medicare |
$77.49
|
| Rate for Payer: Lucent All Commercial |
$108.49
|
| Rate for Payer: Lucent All Commercial |
$108.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.00
|
| Rate for Payer: Managed Health Services Medicaid |
$74.45
|
| Rate for Payer: Managed Health Services Medicaid |
$74.45
|
| Rate for Payer: MDWise Medicaid |
$74.45
|
| Rate for Payer: MDWise Medicaid |
$74.45
|
| Rate for Payer: PHCS All Commercial |
$77.49
|
| Rate for Payer: PHCS All Commercial |
$77.49
|
| Rate for Payer: PHP All Commercial |
$97.48
|
| Rate for Payer: PHP All Commercial |
$97.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.49
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$77.49
|
| Rate for Payer: Sagamore Health Network All Products |
$77.49
|
| Rate for Payer: Sagamore Health Network All Products |
$77.49
|
| Rate for Payer: Signature Care EPO |
$106.25
|
| Rate for Payer: Signature Care EPO |
$106.25
|
| Rate for Payer: Signature Care PPO |
$106.25
|
| Rate for Payer: Signature Care PPO |
$106.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11,100.00
|
| Rate for Payer: United Healthcare Commercial |
$83.76
|
| Rate for Payer: United Healthcare Commercial |
$83.76
|
|
|
CHG US,PREGNANT UTERUS,TRANSVAGINAL
|
Professional
|
Both
|
$171.04
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
z76817
|
| Min. Negotiated Rate |
$85.27 |
| Max. Negotiated Rate |
$12,700.00 |
| Rate for Payer: Aetna Commercial |
$88.74
|
| Rate for Payer: Aetna Commercial |
$88.74
|
| Rate for Payer: Aetna Medicare |
$88.74
|
| Rate for Payer: Aetna Medicare |
$88.74
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$96.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$96.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$96.60
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$96.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$96.60
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$96.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$96.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$96.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$85.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$85.27
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.05
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$102.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.61
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$97.61
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cash Price |
$102.62
|
| Rate for Payer: Centivo All Commercial |
$137.55
|
| Rate for Payer: Centivo All Commercial |
$137.55
|
| Rate for Payer: Cigna All Commercial |
$88.74
|
| Rate for Payer: Cigna All Commercial |
$88.74
|
| Rate for Payer: CORVEL All Commercial |
$88.74
|
| Rate for Payer: CORVEL All Commercial |
$88.74
|
| Rate for Payer: Coventry All Commercial |
$106.49
|
| Rate for Payer: Coventry All Commercial |
$106.49
|
| Rate for Payer: Encore All Commercial |
$88.74
|
| Rate for Payer: Encore All Commercial |
$88.74
|
| Rate for Payer: Frontpath All Commercial |
$154.22
|
| Rate for Payer: Frontpath All Commercial |
$154.22
|
| Rate for Payer: Humana ChoiceCare |
$101.35
|
| Rate for Payer: Humana ChoiceCare |
$101.35
|
| Rate for Payer: Humana Medicare |
$88.74
|
| Rate for Payer: Humana Medicare |
$88.74
|
| Rate for Payer: Lucent All Commercial |
$124.24
|
| Rate for Payer: Lucent All Commercial |
$124.24
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.00
|
| Rate for Payer: Managed Health Services Medicaid |
$85.27
|
| Rate for Payer: Managed Health Services Medicaid |
$85.27
|
| Rate for Payer: MDWise Medicaid |
$85.27
|
| Rate for Payer: MDWise Medicaid |
$85.27
|
| Rate for Payer: PHCS All Commercial |
$88.74
|
| Rate for Payer: PHCS All Commercial |
$88.74
|
| Rate for Payer: PHP All Commercial |
$111.17
|
| Rate for Payer: PHP All Commercial |
$111.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$88.74
|
| Rate for Payer: Sagamore Health Network All Products |
$88.74
|
| Rate for Payer: Sagamore Health Network All Products |
$88.74
|
| Rate for Payer: Signature Care EPO |
$150.86
|
| Rate for Payer: Signature Care EPO |
$150.86
|
| Rate for Payer: Signature Care PPO |
$150.86
|
| Rate for Payer: Signature Care PPO |
$150.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12,700.00
|
| Rate for Payer: United Healthcare Commercial |
$93.56
|
| Rate for Payer: United Healthcare Commercial |
$93.56
|
|
|
CHG US,PREG UTER,FET & MAT,+ DETL FET,ADDL
|
Professional
|
Both
|
$355.10
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
z76812
|
| Min. Negotiated Rate |
$109.81 |
| Max. Negotiated Rate |
$26,400.00 |
| Rate for Payer: Aetna Commercial |
$184.83
|
| Rate for Payer: Aetna Commercial |
$184.83
|
| Rate for Payer: Aetna Medicare |
$184.83
|
| Rate for Payer: Aetna Medicare |
$184.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$109.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$109.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$109.81
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$109.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$109.81
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$109.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$109.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$109.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$177.28
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$177.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$212.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.31
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$203.31
|
| Rate for Payer: Cash Price |
$118.98
|
| Rate for Payer: Cash Price |
$213.06
|
| Rate for Payer: Centivo All Commercial |
$286.49
|
| Rate for Payer: Centivo All Commercial |
$286.49
|
| Rate for Payer: Cigna All Commercial |
$184.83
|
| Rate for Payer: Cigna All Commercial |
$184.83
|
| Rate for Payer: CORVEL All Commercial |
$184.83
|
| Rate for Payer: CORVEL All Commercial |
$184.83
|
| Rate for Payer: Coventry All Commercial |
$221.80
|
| Rate for Payer: Coventry All Commercial |
$221.80
|
| Rate for Payer: Encore All Commercial |
$184.83
|
| Rate for Payer: Encore All Commercial |
$184.83
|
| Rate for Payer: Frontpath All Commercial |
$320.52
|
| Rate for Payer: Frontpath All Commercial |
$320.52
|
| Rate for Payer: Humana ChoiceCare |
$209.17
|
| Rate for Payer: Humana ChoiceCare |
$209.17
|
| Rate for Payer: Humana Medicare |
$184.83
|
| Rate for Payer: Humana Medicare |
$184.83
|
| Rate for Payer: Lucent All Commercial |
$258.76
|
| Rate for Payer: Lucent All Commercial |
$258.76
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.00
|
| Rate for Payer: Managed Health Services Medicaid |
$177.28
|
| Rate for Payer: Managed Health Services Medicaid |
$177.28
|
| Rate for Payer: MDWise Medicaid |
$177.28
|
| Rate for Payer: MDWise Medicaid |
$177.28
|
| Rate for Payer: PHCS All Commercial |
$184.83
|
| Rate for Payer: PHCS All Commercial |
$184.83
|
| Rate for Payer: PHP All Commercial |
$230.82
|
| Rate for Payer: PHP All Commercial |
$230.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$184.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$184.83
|
| Rate for Payer: Sagamore Health Network All Products |
$184.83
|
| Rate for Payer: Sagamore Health Network All Products |
$184.83
|
| Rate for Payer: Signature Care EPO |
$166.35
|
| Rate for Payer: Signature Care EPO |
$166.35
|
| Rate for Payer: Signature Care PPO |
$166.35
|
| Rate for Payer: Signature Care PPO |
$166.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$26,400.00
|
| Rate for Payer: United Healthcare Commercial |
$186.03
|
| Rate for Payer: United Healthcare Commercial |
$186.03
|
|
|
CHG US,PREG UTER,FET & MAT,+ DETL FET EXM
|
Professional
|
Both
|
$326.32
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
z76811
|
| Min. Negotiated Rate |
$164.46 |
| Max. Negotiated Rate |
$24,200.00 |
| Rate for Payer: Aetna Commercial |
$166.56
|
| Rate for Payer: Aetna Commercial |
$166.56
|
| Rate for Payer: Aetna Medicare |
$166.56
|
| Rate for Payer: Aetna Medicare |
$166.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$239.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$239.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$239.97
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$239.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$239.97
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$239.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$239.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$239.97
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$164.46
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$164.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.54
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$191.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$183.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$183.22
|
| Rate for Payer: Cash Price |
$97.07
|
| Rate for Payer: Cash Price |
$195.79
|
| Rate for Payer: Centivo All Commercial |
$258.17
|
| Rate for Payer: Centivo All Commercial |
$258.17
|
| Rate for Payer: Cigna All Commercial |
$166.56
|
| Rate for Payer: Cigna All Commercial |
$166.56
|
| Rate for Payer: CORVEL All Commercial |
$166.56
|
| Rate for Payer: CORVEL All Commercial |
$166.56
|
| Rate for Payer: Coventry All Commercial |
$199.87
|
| Rate for Payer: Coventry All Commercial |
$199.87
|
| Rate for Payer: Encore All Commercial |
$166.56
|
| Rate for Payer: Encore All Commercial |
$166.56
|
| Rate for Payer: Frontpath All Commercial |
$289.66
|
| Rate for Payer: Frontpath All Commercial |
$289.66
|
| Rate for Payer: Humana ChoiceCare |
$185.09
|
| Rate for Payer: Humana ChoiceCare |
$185.09
|
| Rate for Payer: Humana Medicare |
$166.56
|
| Rate for Payer: Humana Medicare |
$166.56
|
| Rate for Payer: Lucent All Commercial |
$233.18
|
| Rate for Payer: Lucent All Commercial |
$233.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$259.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$259.00
|
| Rate for Payer: Managed Health Services Medicaid |
$164.46
|
| Rate for Payer: Managed Health Services Medicaid |
$164.46
|
| Rate for Payer: MDWise Medicaid |
$164.46
|
| Rate for Payer: MDWise Medicaid |
$164.46
|
| Rate for Payer: PHCS All Commercial |
$166.56
|
| Rate for Payer: PHCS All Commercial |
$166.56
|
| Rate for Payer: PHP All Commercial |
$212.11
|
| Rate for Payer: PHP All Commercial |
$212.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.56
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$166.56
|
| Rate for Payer: Sagamore Health Network All Products |
$166.56
|
| Rate for Payer: Sagamore Health Network All Products |
$166.56
|
| Rate for Payer: Signature Care EPO |
$283.15
|
| Rate for Payer: Signature Care EPO |
$283.15
|
| Rate for Payer: Signature Care PPO |
$283.15
|
| Rate for Payer: Signature Care PPO |
$283.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24,200.00
|
| Rate for Payer: United Healthcare Commercial |
$190.01
|
| Rate for Payer: United Healthcare Commercial |
$190.01
|
|
|
CHG US,PREG UTER,NUCHAL MEAS, 1ST TRI,ADDL GEST
|
Professional
|
Both
|
$51.52
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
z76814
|
| Min. Negotiated Rate |
$69.42 |
| Max. Negotiated Rate |
$10,400.00 |
| Rate for Payer: Aetna Commercial |
$73.06
|
| Rate for Payer: Aetna Commercial |
$73.06
|
| Rate for Payer: Aetna Medicare |
$73.06
|
| Rate for Payer: Aetna Medicare |
$73.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$85.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$85.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.10
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$85.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$85.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$85.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.10
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$69.42
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$69.42
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$84.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.37
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$80.37
|
| Rate for Payer: Cash Price |
$83.94
|
| Rate for Payer: Cash Price |
$30.91
|
| Rate for Payer: Centivo All Commercial |
$113.24
|
| Rate for Payer: Centivo All Commercial |
$113.24
|
| Rate for Payer: Cigna All Commercial |
$73.06
|
| Rate for Payer: Cigna All Commercial |
$73.06
|
| Rate for Payer: CORVEL All Commercial |
$73.06
|
| Rate for Payer: CORVEL All Commercial |
$73.06
|
| Rate for Payer: Coventry All Commercial |
$87.67
|
| Rate for Payer: Coventry All Commercial |
$87.67
|
| Rate for Payer: Encore All Commercial |
$73.06
|
| Rate for Payer: Encore All Commercial |
$73.06
|
| Rate for Payer: Frontpath All Commercial |
$126.99
|
| Rate for Payer: Frontpath All Commercial |
$126.99
|
| Rate for Payer: Humana ChoiceCare |
$89.79
|
| Rate for Payer: Humana ChoiceCare |
$89.79
|
| Rate for Payer: Humana Medicare |
$73.06
|
| Rate for Payer: Humana Medicare |
$73.06
|
| Rate for Payer: Lucent All Commercial |
$102.28
|
| Rate for Payer: Lucent All Commercial |
$102.28
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.00
|
| Rate for Payer: Managed Health Services Medicaid |
$69.42
|
| Rate for Payer: Managed Health Services Medicaid |
$69.42
|
| Rate for Payer: MDWise Medicaid |
$69.42
|
| Rate for Payer: MDWise Medicaid |
$69.42
|
| Rate for Payer: PHCS All Commercial |
$73.06
|
| Rate for Payer: PHCS All Commercial |
$73.06
|
| Rate for Payer: PHP All Commercial |
$90.93
|
| Rate for Payer: PHP All Commercial |
$90.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.06
|
| Rate for Payer: Sagamore Health Network All Products |
$73.06
|
| Rate for Payer: Sagamore Health Network All Products |
$73.06
|
| Rate for Payer: Signature Care EPO |
$96.05
|
| Rate for Payer: Signature Care EPO |
$96.05
|
| Rate for Payer: Signature Care PPO |
$96.05
|
| Rate for Payer: Signature Care PPO |
$96.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,400.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$10,400.00
|
| Rate for Payer: United Healthcare Commercial |
$77.56
|
| Rate for Payer: United Healthcare Commercial |
$77.56
|
|
|
CHG US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON
|
Professional
|
Both
|
$217.54
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
z76813
|
| Min. Negotiated Rate |
$107.20 |
| Max. Negotiated Rate |
$16,200.00 |
| Rate for Payer: Aetna Commercial |
$113.27
|
| Rate for Payer: Aetna Commercial |
$113.27
|
| Rate for Payer: Aetna Medicare |
$113.27
|
| Rate for Payer: Aetna Medicare |
$113.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$126.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$126.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.19
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$126.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$126.19
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$126.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$126.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$126.19
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$107.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$107.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$130.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$124.60
|
| Rate for Payer: Cash Price |
$66.49
|
| Rate for Payer: Cash Price |
$130.52
|
| Rate for Payer: Centivo All Commercial |
$175.57
|
| Rate for Payer: Centivo All Commercial |
$175.57
|
| Rate for Payer: Cigna All Commercial |
$113.27
|
| Rate for Payer: Cigna All Commercial |
$113.27
|
| Rate for Payer: CORVEL All Commercial |
$113.27
|
| Rate for Payer: CORVEL All Commercial |
$113.27
|
| Rate for Payer: Coventry All Commercial |
$135.92
|
| Rate for Payer: Coventry All Commercial |
$135.92
|
| Rate for Payer: Encore All Commercial |
$113.27
|
| Rate for Payer: Encore All Commercial |
$113.27
|
| Rate for Payer: Frontpath All Commercial |
$196.18
|
| Rate for Payer: Frontpath All Commercial |
$196.18
|
| Rate for Payer: Humana ChoiceCare |
$136.64
|
| Rate for Payer: Humana ChoiceCare |
$136.64
|
| Rate for Payer: Humana Medicare |
$113.27
|
| Rate for Payer: Humana Medicare |
$113.27
|
| Rate for Payer: Lucent All Commercial |
$158.58
|
| Rate for Payer: Lucent All Commercial |
$158.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.00
|
| Rate for Payer: Managed Health Services Medicaid |
$107.20
|
| Rate for Payer: Managed Health Services Medicaid |
$107.20
|
| Rate for Payer: MDWise Medicaid |
$107.20
|
| Rate for Payer: MDWise Medicaid |
$107.20
|
| Rate for Payer: PHCS All Commercial |
$113.27
|
| Rate for Payer: PHCS All Commercial |
$113.27
|
| Rate for Payer: PHP All Commercial |
$141.40
|
| Rate for Payer: PHP All Commercial |
$141.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$113.27
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$113.27
|
| Rate for Payer: Sagamore Health Network All Products |
$113.27
|
| Rate for Payer: Sagamore Health Network All Products |
$113.27
|
| Rate for Payer: Signature Care EPO |
$145.35
|
| Rate for Payer: Signature Care EPO |
$145.35
|
| Rate for Payer: Signature Care PPO |
$145.35
|
| Rate for Payer: Signature Care PPO |
$145.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$16,200.00
|
| Rate for Payer: United Healthcare Commercial |
$118.51
|
| Rate for Payer: United Healthcare Commercial |
$118.51
|
|
|
CHG VENOGRAM EXTREM UNILAT
|
Professional
|
Both
|
$108.96
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
z75820
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$14,900.00 |
| Rate for Payer: Aetna Commercial |
$104.91
|
| Rate for Payer: Aetna Commercial |
$104.91
|
| Rate for Payer: Aetna Medicare |
$104.91
|
| Rate for Payer: Aetna Medicare |
$104.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.20
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$98.91
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$98.91
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.65
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$120.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$115.40
|
| Rate for Payer: Cash Price |
$120.34
|
| Rate for Payer: Cash Price |
$65.38
|
| Rate for Payer: Centivo All Commercial |
$162.61
|
| Rate for Payer: Centivo All Commercial |
$162.61
|
| Rate for Payer: Cigna All Commercial |
$104.91
|
| Rate for Payer: Cigna All Commercial |
$104.91
|
| Rate for Payer: CORVEL All Commercial |
$104.91
|
| Rate for Payer: CORVEL All Commercial |
$104.91
|
| Rate for Payer: Coventry All Commercial |
$125.89
|
| Rate for Payer: Coventry All Commercial |
$125.89
|
| Rate for Payer: Encore All Commercial |
$104.91
|
| Rate for Payer: Encore All Commercial |
$104.91
|
| Rate for Payer: Frontpath All Commercial |
$183.68
|
| Rate for Payer: Frontpath All Commercial |
$183.68
|
| Rate for Payer: Humana ChoiceCare |
$123.99
|
| Rate for Payer: Humana ChoiceCare |
$123.99
|
| Rate for Payer: Humana Medicare |
$104.91
|
| Rate for Payer: Humana Medicare |
$104.91
|
| Rate for Payer: Lucent All Commercial |
$146.87
|
| Rate for Payer: Lucent All Commercial |
$146.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$159.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$159.00
|
| Rate for Payer: Managed Health Services Medicaid |
$98.91
|
| Rate for Payer: Managed Health Services Medicaid |
$98.91
|
| Rate for Payer: MDWise Medicaid |
$98.91
|
| Rate for Payer: MDWise Medicaid |
$98.91
|
| Rate for Payer: PHCS All Commercial |
$104.91
|
| Rate for Payer: PHCS All Commercial |
$104.91
|
| Rate for Payer: PHP All Commercial |
$130.36
|
| Rate for Payer: PHP All Commercial |
$130.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$104.91
|
| Rate for Payer: Sagamore Health Network All Products |
$104.91
|
| Rate for Payer: Sagamore Health Network All Products |
$104.91
|
| Rate for Payer: Signature Care EPO |
$91.91
|
| Rate for Payer: Signature Care EPO |
$91.91
|
| Rate for Payer: Signature Care PPO |
$91.91
|
| Rate for Payer: Signature Care PPO |
$91.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$14,900.00
|
| Rate for Payer: United Healthcare Commercial |
$109.63
|
| Rate for Payer: United Healthcare Commercial |
$109.63
|
|
|
CHG X-RAY AC JTS
|
Professional
|
Both
|
$52.28
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
z73050
|
| Min. Negotiated Rate |
$26.44 |
| Max. Negotiated Rate |
$46.78 |
| Rate for Payer: Aetna Commercial |
$26.80
|
| Rate for Payer: Aetna Commercial |
$26.80
|
| Rate for Payer: Aetna Medicare |
$26.80
|
| Rate for Payer: Aetna Medicare |
$26.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.44
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.82
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.48
|
| Rate for Payer: Cash Price |
$31.37
|
| Rate for Payer: Cash Price |
$21.92
|
| Rate for Payer: Centivo All Commercial |
$41.54
|
| Rate for Payer: Centivo All Commercial |
$41.54
|
| Rate for Payer: Cigna All Commercial |
$26.80
|
| Rate for Payer: Cigna All Commercial |
$26.80
|
| Rate for Payer: CORVEL All Commercial |
$26.80
|
| Rate for Payer: CORVEL All Commercial |
$26.80
|
| Rate for Payer: Coventry All Commercial |
$32.16
|
| Rate for Payer: Coventry All Commercial |
$32.16
|
| Rate for Payer: Encore All Commercial |
$26.80
|
| Rate for Payer: Encore All Commercial |
$26.80
|
| Rate for Payer: Frontpath All Commercial |
$46.78
|
| Rate for Payer: Frontpath All Commercial |
$46.78
|
| Rate for Payer: Humana ChoiceCare |
$29.83
|
| Rate for Payer: Humana ChoiceCare |
$29.83
|
| Rate for Payer: Humana Medicare |
$26.80
|
| Rate for Payer: Humana Medicare |
$26.80
|
| Rate for Payer: Lucent All Commercial |
$37.52
|
| Rate for Payer: Lucent All Commercial |
$37.52
|
| Rate for Payer: Managed Health Services Medicaid |
$26.44
|
| Rate for Payer: Managed Health Services Medicaid |
$26.44
|
| Rate for Payer: MDWise Medicaid |
$26.44
|
| Rate for Payer: MDWise Medicaid |
$26.44
|
| Rate for Payer: PHCS All Commercial |
$26.80
|
| Rate for Payer: PHCS All Commercial |
$26.80
|
| Rate for Payer: PHP All Commercial |
$33.99
|
| Rate for Payer: PHP All Commercial |
$33.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.80
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.80
|
| Rate for Payer: Sagamore Health Network All Products |
$26.80
|
| Rate for Payer: Sagamore Health Network All Products |
$26.80
|
| Rate for Payer: Signature Care EPO |
$43.35
|
| Rate for Payer: Signature Care EPO |
$43.35
|
| Rate for Payer: Signature Care PPO |
$43.35
|
| Rate for Payer: Signature Care PPO |
$43.35
|
| Rate for Payer: United Healthcare Commercial |
$32.46
|
| Rate for Payer: United Healthcare Commercial |
$32.46
|
|
|
CHG X-RAY ANKLE 2 VW
|
Professional
|
Both
|
$59.40
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
z73600
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$52.60 |
| Rate for Payer: Aetna Commercial |
$30.15
|
| Rate for Payer: Aetna Commercial |
$30.15
|
| Rate for Payer: Aetna Medicare |
$30.15
|
| Rate for Payer: Aetna Medicare |
$30.15
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$29.41
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$29.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.16
|
| Rate for Payer: Cash Price |
$27.08
|
| Rate for Payer: Cash Price |
$35.64
|
| Rate for Payer: Centivo All Commercial |
$46.73
|
| Rate for Payer: Centivo All Commercial |
$46.73
|
| Rate for Payer: Cigna All Commercial |
$30.15
|
| Rate for Payer: Cigna All Commercial |
$30.15
|
| Rate for Payer: CORVEL All Commercial |
$30.15
|
| Rate for Payer: CORVEL All Commercial |
$30.15
|
| Rate for Payer: Coventry All Commercial |
$36.18
|
| Rate for Payer: Coventry All Commercial |
$36.18
|
| Rate for Payer: Encore All Commercial |
$30.15
|
| Rate for Payer: Encore All Commercial |
$30.15
|
| Rate for Payer: Frontpath All Commercial |
$52.60
|
| Rate for Payer: Frontpath All Commercial |
$52.60
|
| Rate for Payer: Humana ChoiceCare |
$34.14
|
| Rate for Payer: Humana ChoiceCare |
$34.14
|
| Rate for Payer: Humana Medicare |
$30.15
|
| Rate for Payer: Humana Medicare |
$30.15
|
| Rate for Payer: Lucent All Commercial |
$42.21
|
| Rate for Payer: Lucent All Commercial |
$42.21
|
| Rate for Payer: Managed Health Services Medicaid |
$29.41
|
| Rate for Payer: Managed Health Services Medicaid |
$29.41
|
| Rate for Payer: MDWise Medicaid |
$29.41
|
| Rate for Payer: MDWise Medicaid |
$29.41
|
| Rate for Payer: PHCS All Commercial |
$30.15
|
| Rate for Payer: PHCS All Commercial |
$30.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.15
|
| Rate for Payer: Sagamore Health Network All Products |
$30.15
|
| Rate for Payer: Sagamore Health Network All Products |
$30.15
|
| Rate for Payer: United Healthcare Commercial |
$24.30
|
| Rate for Payer: United Healthcare Commercial |
$24.30
|
|
