|
CHG X-RAY NECK SOFT TISSUE
|
Professional
|
Both
|
$57.70
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
z70360
|
| Min. Negotiated Rate |
$24.66 |
| Max. Negotiated Rate |
$51.63 |
| Rate for Payer: Aetna Commercial |
$29.60
|
| Rate for Payer: Aetna Commercial |
$29.60
|
| Rate for Payer: Aetna Medicare |
$29.60
|
| Rate for Payer: Aetna Medicare |
$29.60
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$28.55
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$28.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.04
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.56
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.56
|
| Rate for Payer: Cash Price |
$34.62
|
| Rate for Payer: Cash Price |
$24.86
|
| Rate for Payer: Centivo All Commercial |
$45.88
|
| Rate for Payer: Centivo All Commercial |
$45.88
|
| Rate for Payer: Cigna All Commercial |
$29.60
|
| Rate for Payer: Cigna All Commercial |
$29.60
|
| Rate for Payer: CORVEL All Commercial |
$29.60
|
| Rate for Payer: CORVEL All Commercial |
$29.60
|
| Rate for Payer: Coventry All Commercial |
$35.52
|
| Rate for Payer: Coventry All Commercial |
$35.52
|
| Rate for Payer: Encore All Commercial |
$29.60
|
| Rate for Payer: Encore All Commercial |
$29.60
|
| Rate for Payer: Frontpath All Commercial |
$51.63
|
| Rate for Payer: Frontpath All Commercial |
$51.63
|
| Rate for Payer: Humana ChoiceCare |
$33.06
|
| Rate for Payer: Humana ChoiceCare |
$33.06
|
| Rate for Payer: Humana Medicare |
$29.60
|
| Rate for Payer: Humana Medicare |
$29.60
|
| Rate for Payer: Lucent All Commercial |
$41.44
|
| Rate for Payer: Lucent All Commercial |
$41.44
|
| Rate for Payer: Managed Health Services Medicaid |
$28.55
|
| Rate for Payer: Managed Health Services Medicaid |
$28.55
|
| Rate for Payer: MDWise Medicaid |
$28.55
|
| Rate for Payer: MDWise Medicaid |
$28.55
|
| Rate for Payer: PHCS All Commercial |
$29.60
|
| Rate for Payer: PHCS All Commercial |
$29.60
|
| Rate for Payer: PHP All Commercial |
$37.51
|
| Rate for Payer: PHP All Commercial |
$37.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.60
|
| Rate for Payer: Sagamore Health Network All Products |
$29.60
|
| Rate for Payer: Sagamore Health Network All Products |
$29.60
|
| Rate for Payer: Signature Care EPO |
$29.75
|
| Rate for Payer: Signature Care EPO |
$29.75
|
| Rate for Payer: Signature Care PPO |
$29.75
|
| Rate for Payer: Signature Care PPO |
$29.75
|
| Rate for Payer: United Healthcare Commercial |
$24.66
|
| Rate for Payer: United Healthcare Commercial |
$24.66
|
|
|
CHG X-RAY NOSE-RECTUM CHILD F.B.
|
Professional
|
Both
|
$38.38
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
z76010
|
| Min. Negotiated Rate |
$25.68 |
| Max. Negotiated Rate |
$48.94 |
| Rate for Payer: Aetna Commercial |
$28.04
|
| Rate for Payer: Aetna Commercial |
$28.04
|
| Rate for Payer: Aetna Medicare |
$28.04
|
| Rate for Payer: Aetna Medicare |
$28.04
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.84
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$23.03
|
| Rate for Payer: Centivo All Commercial |
$43.46
|
| Rate for Payer: Centivo All Commercial |
$43.46
|
| Rate for Payer: Cigna All Commercial |
$28.04
|
| Rate for Payer: Cigna All Commercial |
$28.04
|
| Rate for Payer: CORVEL All Commercial |
$28.04
|
| Rate for Payer: CORVEL All Commercial |
$28.04
|
| Rate for Payer: Coventry All Commercial |
$33.65
|
| Rate for Payer: Coventry All Commercial |
$33.65
|
| Rate for Payer: Encore All Commercial |
$28.04
|
| Rate for Payer: Encore All Commercial |
$28.04
|
| Rate for Payer: Frontpath All Commercial |
$48.94
|
| Rate for Payer: Frontpath All Commercial |
$48.94
|
| Rate for Payer: Humana ChoiceCare |
$31.27
|
| Rate for Payer: Humana ChoiceCare |
$31.27
|
| Rate for Payer: Humana Medicare |
$28.04
|
| Rate for Payer: Humana Medicare |
$28.04
|
| Rate for Payer: Lucent All Commercial |
$39.26
|
| Rate for Payer: Lucent All Commercial |
$39.26
|
| Rate for Payer: Managed Health Services Medicaid |
$26.74
|
| Rate for Payer: Managed Health Services Medicaid |
$26.74
|
| Rate for Payer: MDWise Medicaid |
$26.74
|
| Rate for Payer: MDWise Medicaid |
$26.74
|
| Rate for Payer: PHCS All Commercial |
$28.04
|
| Rate for Payer: PHCS All Commercial |
$28.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.04
|
| Rate for Payer: Sagamore Health Network All Products |
$28.04
|
| Rate for Payer: Sagamore Health Network All Products |
$28.04
|
| Rate for Payer: United Healthcare Commercial |
$25.68
|
| Rate for Payer: United Healthcare Commercial |
$25.68
|
|
|
CHG X-RAY ORBITS
|
Professional
|
Both
|
$87.82
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
z70200
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$6,500.00 |
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Commercial |
$45.83
|
| Rate for Payer: Aetna Medicare |
$45.83
|
| Rate for Payer: Aetna Medicare |
$45.83
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$45.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$45.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.51
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$45.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$45.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$45.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$43.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$43.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$52.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.41
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.41
|
| Rate for Payer: Cash Price |
$38.12
|
| Rate for Payer: Cash Price |
$52.69
|
| Rate for Payer: Centivo All Commercial |
$71.04
|
| Rate for Payer: Centivo All Commercial |
$71.04
|
| Rate for Payer: Cigna All Commercial |
$45.83
|
| Rate for Payer: Cigna All Commercial |
$45.83
|
| Rate for Payer: CORVEL All Commercial |
$45.83
|
| Rate for Payer: CORVEL All Commercial |
$45.83
|
| Rate for Payer: Coventry All Commercial |
$55.00
|
| Rate for Payer: Coventry All Commercial |
$55.00
|
| Rate for Payer: Encore All Commercial |
$45.83
|
| Rate for Payer: Encore All Commercial |
$45.83
|
| Rate for Payer: Frontpath All Commercial |
$79.53
|
| Rate for Payer: Frontpath All Commercial |
$79.53
|
| Rate for Payer: Humana ChoiceCare |
$50.68
|
| Rate for Payer: Humana ChoiceCare |
$50.68
|
| Rate for Payer: Humana Medicare |
$45.83
|
| Rate for Payer: Humana Medicare |
$45.83
|
| Rate for Payer: Lucent All Commercial |
$64.16
|
| Rate for Payer: Lucent All Commercial |
$64.16
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.00
|
| Rate for Payer: Managed Health Services Medicaid |
$43.90
|
| Rate for Payer: Managed Health Services Medicaid |
$43.90
|
| Rate for Payer: MDWise Medicaid |
$43.90
|
| Rate for Payer: MDWise Medicaid |
$43.90
|
| Rate for Payer: PHCS All Commercial |
$45.83
|
| Rate for Payer: PHCS All Commercial |
$45.83
|
| Rate for Payer: PHP All Commercial |
$57.08
|
| Rate for Payer: PHP All Commercial |
$57.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.83
|
| Rate for Payer: Sagamore Health Network All Products |
$45.83
|
| Rate for Payer: Sagamore Health Network All Products |
$45.83
|
| Rate for Payer: Signature Care EPO |
$53.55
|
| Rate for Payer: Signature Care EPO |
$53.55
|
| Rate for Payer: Signature Care PPO |
$53.55
|
| Rate for Payer: Signature Care PPO |
$53.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$6,500.00
|
| Rate for Payer: United Healthcare Commercial |
$40.20
|
| Rate for Payer: United Healthcare Commercial |
$40.20
|
|
|
CHG X-RAY PELVIS 1/2 VW
|
Professional
|
Both
|
$51.02
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
z72170
|
| Min. Negotiated Rate |
$23.67 |
| Max. Negotiated Rate |
$45.66 |
| Rate for Payer: Aetna Commercial |
$26.14
|
| Rate for Payer: Aetna Commercial |
$26.14
|
| Rate for Payer: Aetna Medicare |
$26.14
|
| Rate for Payer: Aetna Medicare |
$26.14
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.51
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$25.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.75
|
| Rate for Payer: Cash Price |
$30.61
|
| Rate for Payer: Cash Price |
$21.55
|
| Rate for Payer: Centivo All Commercial |
$40.52
|
| Rate for Payer: Centivo All Commercial |
$40.52
|
| Rate for Payer: Cigna All Commercial |
$26.14
|
| Rate for Payer: Cigna All Commercial |
$26.14
|
| Rate for Payer: CORVEL All Commercial |
$26.14
|
| Rate for Payer: CORVEL All Commercial |
$26.14
|
| Rate for Payer: Coventry All Commercial |
$31.37
|
| Rate for Payer: Coventry All Commercial |
$31.37
|
| Rate for Payer: Encore All Commercial |
$26.14
|
| Rate for Payer: Encore All Commercial |
$26.14
|
| Rate for Payer: Frontpath All Commercial |
$45.66
|
| Rate for Payer: Frontpath All Commercial |
$45.66
|
| Rate for Payer: Humana ChoiceCare |
$29.11
|
| Rate for Payer: Humana ChoiceCare |
$29.11
|
| Rate for Payer: Humana Medicare |
$26.14
|
| Rate for Payer: Humana Medicare |
$26.14
|
| Rate for Payer: Lucent All Commercial |
$36.60
|
| Rate for Payer: Lucent All Commercial |
$36.60
|
| Rate for Payer: Managed Health Services Medicaid |
$25.51
|
| Rate for Payer: Managed Health Services Medicaid |
$25.51
|
| Rate for Payer: MDWise Medicaid |
$25.51
|
| Rate for Payer: MDWise Medicaid |
$25.51
|
| Rate for Payer: PHCS All Commercial |
$26.14
|
| Rate for Payer: PHCS All Commercial |
$26.14
|
| Rate for Payer: PHP All Commercial |
$33.16
|
| Rate for Payer: PHP All Commercial |
$33.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.14
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.14
|
| Rate for Payer: Sagamore Health Network All Products |
$26.14
|
| Rate for Payer: Sagamore Health Network All Products |
$26.14
|
| Rate for Payer: Signature Care EPO |
$34.00
|
| Rate for Payer: Signature Care EPO |
$34.00
|
| Rate for Payer: Signature Care PPO |
$34.00
|
| Rate for Payer: Signature Care PPO |
$34.00
|
| Rate for Payer: United Healthcare Commercial |
$23.67
|
| Rate for Payer: United Healthcare Commercial |
$23.67
|
|
|
CHG X-RAY RIBS 2 VW UNILAT
|
Professional
|
Both
|
$67.58
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
z71100
|
| Min. Negotiated Rate |
$29.87 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Commercial |
$34.72
|
| Rate for Payer: Aetna Commercial |
$34.72
|
| Rate for Payer: Aetna Medicare |
$34.72
|
| Rate for Payer: Aetna Medicare |
$34.72
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$34.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$34.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.52
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$34.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$34.52
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$34.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.52
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$33.48
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$33.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.93
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.19
|
| Rate for Payer: Cash Price |
$28.92
|
| Rate for Payer: Cash Price |
$40.55
|
| Rate for Payer: Centivo All Commercial |
$53.82
|
| Rate for Payer: Centivo All Commercial |
$53.82
|
| Rate for Payer: Cigna All Commercial |
$34.72
|
| Rate for Payer: Cigna All Commercial |
$34.72
|
| Rate for Payer: CORVEL All Commercial |
$34.72
|
| Rate for Payer: CORVEL All Commercial |
$34.72
|
| Rate for Payer: Coventry All Commercial |
$41.66
|
| Rate for Payer: Coventry All Commercial |
$41.66
|
| Rate for Payer: Encore All Commercial |
$34.72
|
| Rate for Payer: Encore All Commercial |
$34.72
|
| Rate for Payer: Frontpath All Commercial |
$60.42
|
| Rate for Payer: Frontpath All Commercial |
$60.42
|
| Rate for Payer: Humana ChoiceCare |
$38.46
|
| Rate for Payer: Humana ChoiceCare |
$38.46
|
| Rate for Payer: Humana Medicare |
$34.72
|
| Rate for Payer: Humana Medicare |
$34.72
|
| Rate for Payer: Lucent All Commercial |
$48.61
|
| Rate for Payer: Lucent All Commercial |
$48.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.00
|
| Rate for Payer: Managed Health Services Medicaid |
$33.48
|
| Rate for Payer: Managed Health Services Medicaid |
$33.48
|
| Rate for Payer: MDWise Medicaid |
$33.48
|
| Rate for Payer: MDWise Medicaid |
$33.48
|
| Rate for Payer: PHCS All Commercial |
$34.72
|
| Rate for Payer: PHCS All Commercial |
$34.72
|
| Rate for Payer: PHP All Commercial |
$43.93
|
| Rate for Payer: PHP All Commercial |
$43.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.72
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.72
|
| Rate for Payer: Sagamore Health Network All Products |
$34.72
|
| Rate for Payer: Sagamore Health Network All Products |
$34.72
|
| Rate for Payer: Signature Care EPO |
$39.95
|
| Rate for Payer: Signature Care EPO |
$39.95
|
| Rate for Payer: Signature Care PPO |
$39.95
|
| Rate for Payer: Signature Care PPO |
$39.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,000.00
|
| Rate for Payer: United Healthcare Commercial |
$29.87
|
| Rate for Payer: United Healthcare Commercial |
$29.87
|
|
|
CHG X-RAY RIBS, CHEST 3+ VW
|
Professional
|
Both
|
$77.52
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
z71101
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$5,800.00 |
| Rate for Payer: Aetna Commercial |
$39.88
|
| Rate for Payer: Aetna Commercial |
$39.88
|
| Rate for Payer: Aetna Medicare |
$39.88
|
| Rate for Payer: Aetna Medicare |
$39.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$38.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$38.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.86
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.86
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.87
|
| Rate for Payer: Cash Price |
$32.60
|
| Rate for Payer: Cash Price |
$46.51
|
| Rate for Payer: Centivo All Commercial |
$61.81
|
| Rate for Payer: Centivo All Commercial |
$61.81
|
| Rate for Payer: Cigna All Commercial |
$39.88
|
| Rate for Payer: Cigna All Commercial |
$39.88
|
| Rate for Payer: CORVEL All Commercial |
$39.88
|
| Rate for Payer: CORVEL All Commercial |
$39.88
|
| Rate for Payer: Coventry All Commercial |
$47.86
|
| Rate for Payer: Coventry All Commercial |
$47.86
|
| Rate for Payer: Encore All Commercial |
$39.88
|
| Rate for Payer: Encore All Commercial |
$39.88
|
| Rate for Payer: Frontpath All Commercial |
$69.27
|
| Rate for Payer: Frontpath All Commercial |
$69.27
|
| Rate for Payer: Humana ChoiceCare |
$44.21
|
| Rate for Payer: Humana ChoiceCare |
$44.21
|
| Rate for Payer: Humana Medicare |
$39.88
|
| Rate for Payer: Humana Medicare |
$39.88
|
| Rate for Payer: Lucent All Commercial |
$55.83
|
| Rate for Payer: Lucent All Commercial |
$55.83
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.00
|
| Rate for Payer: Managed Health Services Medicaid |
$38.74
|
| Rate for Payer: Managed Health Services Medicaid |
$38.74
|
| Rate for Payer: MDWise Medicaid |
$38.74
|
| Rate for Payer: MDWise Medicaid |
$38.74
|
| Rate for Payer: PHCS All Commercial |
$39.88
|
| Rate for Payer: PHCS All Commercial |
$39.88
|
| Rate for Payer: PHP All Commercial |
$50.38
|
| Rate for Payer: PHP All Commercial |
$50.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.88
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.88
|
| Rate for Payer: Sagamore Health Network All Products |
$39.88
|
| Rate for Payer: Sagamore Health Network All Products |
$39.88
|
| Rate for Payer: Signature Care EPO |
$47.60
|
| Rate for Payer: Signature Care EPO |
$47.60
|
| Rate for Payer: Signature Care PPO |
$47.60
|
| Rate for Payer: Signature Care PPO |
$47.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,800.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,800.00
|
| Rate for Payer: United Healthcare Commercial |
$35.98
|
| Rate for Payer: United Healthcare Commercial |
$35.98
|
|
|
CHG X-RAY RIBS, CHEST 4+ VW
|
Professional
|
Both
|
$96.20
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
z71111
|
| Min. Negotiated Rate |
$47.49 |
| Max. Negotiated Rate |
$7,100.00 |
| Rate for Payer: Aetna Commercial |
$49.70
|
| Rate for Payer: Aetna Commercial |
$49.70
|
| Rate for Payer: Aetna Medicare |
$49.70
|
| Rate for Payer: Aetna Medicare |
$49.70
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$52.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$52.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.95
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$52.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$52.95
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$52.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.95
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$48.09
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$48.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.67
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.67
|
| Rate for Payer: Cash Price |
$41.08
|
| Rate for Payer: Cash Price |
$57.72
|
| Rate for Payer: Centivo All Commercial |
$77.03
|
| Rate for Payer: Centivo All Commercial |
$77.03
|
| Rate for Payer: Cigna All Commercial |
$49.70
|
| Rate for Payer: Cigna All Commercial |
$49.70
|
| Rate for Payer: CORVEL All Commercial |
$49.70
|
| Rate for Payer: CORVEL All Commercial |
$49.70
|
| Rate for Payer: Coventry All Commercial |
$59.64
|
| Rate for Payer: Coventry All Commercial |
$59.64
|
| Rate for Payer: Encore All Commercial |
$49.70
|
| Rate for Payer: Encore All Commercial |
$49.70
|
| Rate for Payer: Frontpath All Commercial |
$86.17
|
| Rate for Payer: Frontpath All Commercial |
$86.17
|
| Rate for Payer: Humana ChoiceCare |
$54.99
|
| Rate for Payer: Humana ChoiceCare |
$54.99
|
| Rate for Payer: Humana Medicare |
$49.70
|
| Rate for Payer: Humana Medicare |
$49.70
|
| Rate for Payer: Lucent All Commercial |
$69.58
|
| Rate for Payer: Lucent All Commercial |
$69.58
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.00
|
| Rate for Payer: Managed Health Services Medicaid |
$48.09
|
| Rate for Payer: Managed Health Services Medicaid |
$48.09
|
| Rate for Payer: MDWise Medicaid |
$48.09
|
| Rate for Payer: MDWise Medicaid |
$48.09
|
| Rate for Payer: PHCS All Commercial |
$49.70
|
| Rate for Payer: PHCS All Commercial |
$49.70
|
| Rate for Payer: PHP All Commercial |
$62.52
|
| Rate for Payer: PHP All Commercial |
$62.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.70
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.70
|
| Rate for Payer: Sagamore Health Network All Products |
$49.70
|
| Rate for Payer: Sagamore Health Network All Products |
$49.70
|
| Rate for Payer: Signature Care EPO |
$60.35
|
| Rate for Payer: Signature Care EPO |
$60.35
|
| Rate for Payer: Signature Care PPO |
$60.35
|
| Rate for Payer: Signature Care PPO |
$60.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,100.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7,100.00
|
| Rate for Payer: United Healthcare Commercial |
$47.49
|
| Rate for Payer: United Healthcare Commercial |
$47.49
|
|
|
CHG X-RAY SACROILIAC JTS 3+ VW
|
Professional
|
Both
|
$71.86
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
z72202
|
| Min. Negotiated Rate |
$31.77 |
| Max. Negotiated Rate |
$64.23 |
| Rate for Payer: Aetna Commercial |
$36.94
|
| Rate for Payer: Aetna Commercial |
$36.94
|
| Rate for Payer: Aetna Medicare |
$36.94
|
| Rate for Payer: Aetna Medicare |
$36.94
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.93
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$35.93
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.63
|
| Rate for Payer: Cash Price |
$43.12
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Centivo All Commercial |
$57.26
|
| Rate for Payer: Centivo All Commercial |
$57.26
|
| Rate for Payer: Cigna All Commercial |
$36.94
|
| Rate for Payer: Cigna All Commercial |
$36.94
|
| Rate for Payer: CORVEL All Commercial |
$36.94
|
| Rate for Payer: CORVEL All Commercial |
$36.94
|
| Rate for Payer: Coventry All Commercial |
$44.33
|
| Rate for Payer: Coventry All Commercial |
$44.33
|
| Rate for Payer: Encore All Commercial |
$36.94
|
| Rate for Payer: Encore All Commercial |
$36.94
|
| Rate for Payer: Frontpath All Commercial |
$64.23
|
| Rate for Payer: Frontpath All Commercial |
$64.23
|
| Rate for Payer: Humana ChoiceCare |
$40.97
|
| Rate for Payer: Humana ChoiceCare |
$40.97
|
| Rate for Payer: Humana Medicare |
$36.94
|
| Rate for Payer: Humana Medicare |
$36.94
|
| Rate for Payer: Lucent All Commercial |
$51.72
|
| Rate for Payer: Lucent All Commercial |
$51.72
|
| Rate for Payer: Managed Health Services Medicaid |
$35.93
|
| Rate for Payer: Managed Health Services Medicaid |
$35.93
|
| Rate for Payer: MDWise Medicaid |
$35.93
|
| Rate for Payer: MDWise Medicaid |
$35.93
|
| Rate for Payer: PHCS All Commercial |
$36.94
|
| Rate for Payer: PHCS All Commercial |
$36.94
|
| Rate for Payer: PHP All Commercial |
$46.71
|
| Rate for Payer: PHP All Commercial |
$46.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.94
|
| Rate for Payer: Sagamore Health Network All Products |
$36.94
|
| Rate for Payer: Sagamore Health Network All Products |
$36.94
|
| Rate for Payer: Signature Care EPO |
$39.95
|
| Rate for Payer: Signature Care EPO |
$39.95
|
| Rate for Payer: Signature Care PPO |
$39.95
|
| Rate for Payer: Signature Care PPO |
$39.95
|
| Rate for Payer: United Healthcare Commercial |
$31.77
|
| Rate for Payer: United Healthcare Commercial |
$31.77
|
|
|
CHG X-RAY SACRUM/COCCYX 2+ VW
|
Professional
|
Both
|
$59.46
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
z72220
|
| Min. Negotiated Rate |
$26.75 |
| Max. Negotiated Rate |
$53.18 |
| Rate for Payer: Aetna Commercial |
$30.50
|
| Rate for Payer: Aetna Commercial |
$30.50
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$29.73
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$29.73
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.08
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.55
|
| Rate for Payer: Cash Price |
$35.68
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Centivo All Commercial |
$47.27
|
| Rate for Payer: Centivo All Commercial |
$47.27
|
| Rate for Payer: Cigna All Commercial |
$30.50
|
| Rate for Payer: Cigna All Commercial |
$30.50
|
| Rate for Payer: CORVEL All Commercial |
$30.50
|
| Rate for Payer: CORVEL All Commercial |
$30.50
|
| Rate for Payer: Coventry All Commercial |
$36.60
|
| Rate for Payer: Coventry All Commercial |
$36.60
|
| Rate for Payer: Encore All Commercial |
$30.50
|
| Rate for Payer: Encore All Commercial |
$30.50
|
| Rate for Payer: Frontpath All Commercial |
$53.18
|
| Rate for Payer: Frontpath All Commercial |
$53.18
|
| Rate for Payer: Humana ChoiceCare |
$33.78
|
| Rate for Payer: Humana ChoiceCare |
$33.78
|
| Rate for Payer: Humana Medicare |
$30.50
|
| Rate for Payer: Humana Medicare |
$30.50
|
| Rate for Payer: Lucent All Commercial |
$42.70
|
| Rate for Payer: Lucent All Commercial |
$42.70
|
| Rate for Payer: Managed Health Services Medicaid |
$29.73
|
| Rate for Payer: Managed Health Services Medicaid |
$29.73
|
| Rate for Payer: MDWise Medicaid |
$29.73
|
| Rate for Payer: MDWise Medicaid |
$29.73
|
| Rate for Payer: PHCS All Commercial |
$30.50
|
| Rate for Payer: PHCS All Commercial |
$30.50
|
| Rate for Payer: PHP All Commercial |
$38.65
|
| Rate for Payer: PHP All Commercial |
$38.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.50
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.50
|
| Rate for Payer: Sagamore Health Network All Products |
$30.50
|
| Rate for Payer: Sagamore Health Network All Products |
$30.50
|
| Rate for Payer: Signature Care EPO |
$36.55
|
| Rate for Payer: Signature Care EPO |
$36.55
|
| Rate for Payer: Signature Care PPO |
$36.55
|
| Rate for Payer: Signature Care PPO |
$36.55
|
| Rate for Payer: United Healthcare Commercial |
$26.75
|
| Rate for Payer: United Healthcare Commercial |
$26.75
|
|
|
CHG X-RAY SCAPULA
|
Professional
|
Both
|
$43.20
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
z73010
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Commercial |
$22.40
|
| Rate for Payer: Aetna Medicare |
$22.40
|
| Rate for Payer: Aetna Medicare |
$22.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$29.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$29.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.62
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$29.62
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$29.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.62
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$21.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.64
|
| Rate for Payer: Cash Price |
$16.76
|
| Rate for Payer: Cash Price |
$25.92
|
| Rate for Payer: Centivo All Commercial |
$34.72
|
| Rate for Payer: Centivo All Commercial |
$34.72
|
| Rate for Payer: Cigna All Commercial |
$22.40
|
| Rate for Payer: Cigna All Commercial |
$22.40
|
| Rate for Payer: CORVEL All Commercial |
$22.40
|
| Rate for Payer: CORVEL All Commercial |
$22.40
|
| Rate for Payer: Coventry All Commercial |
$26.88
|
| Rate for Payer: Coventry All Commercial |
$26.88
|
| Rate for Payer: Encore All Commercial |
$22.40
|
| Rate for Payer: Encore All Commercial |
$22.40
|
| Rate for Payer: Frontpath All Commercial |
$39.22
|
| Rate for Payer: Frontpath All Commercial |
$39.22
|
| Rate for Payer: Humana ChoiceCare |
$24.80
|
| Rate for Payer: Humana ChoiceCare |
$24.80
|
| Rate for Payer: Humana Medicare |
$22.40
|
| Rate for Payer: Humana Medicare |
$22.40
|
| Rate for Payer: Lucent All Commercial |
$31.36
|
| Rate for Payer: Lucent All Commercial |
$31.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.00
|
| Rate for Payer: Managed Health Services Medicaid |
$21.88
|
| Rate for Payer: Managed Health Services Medicaid |
$21.88
|
| Rate for Payer: MDWise Medicaid |
$21.88
|
| Rate for Payer: MDWise Medicaid |
$21.88
|
| Rate for Payer: PHCS All Commercial |
$22.40
|
| Rate for Payer: PHCS All Commercial |
$22.40
|
| Rate for Payer: PHP All Commercial |
$28.07
|
| Rate for Payer: PHP All Commercial |
$28.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.40
|
| Rate for Payer: Sagamore Health Network All Products |
$22.40
|
| Rate for Payer: Sagamore Health Network All Products |
$22.40
|
| Rate for Payer: Signature Care EPO |
$34.00
|
| Rate for Payer: Signature Care EPO |
$34.00
|
| Rate for Payer: Signature Care PPO |
$34.00
|
| Rate for Payer: Signature Care PPO |
$34.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,200.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3,200.00
|
| Rate for Payer: United Healthcare Commercial |
$25.65
|
| Rate for Payer: United Healthcare Commercial |
$25.65
|
|
|
CHG X-RAY SHOULDER 2+ VW
|
Professional
|
Both
|
$63.12
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
z73030
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$4,700.00 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: Aetna Medicare |
$32.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$51.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$51.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.90
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$51.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$51.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.87
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$31.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.26
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.64
|
| Rate for Payer: Cash Price |
$28.55
|
| Rate for Payer: Cash Price |
$37.87
|
| Rate for Payer: Centivo All Commercial |
$50.22
|
| Rate for Payer: Centivo All Commercial |
$50.22
|
| Rate for Payer: Cigna All Commercial |
$32.40
|
| Rate for Payer: Cigna All Commercial |
$32.40
|
| Rate for Payer: CORVEL All Commercial |
$32.40
|
| Rate for Payer: CORVEL All Commercial |
$32.40
|
| Rate for Payer: Coventry All Commercial |
$38.88
|
| Rate for Payer: Coventry All Commercial |
$38.88
|
| Rate for Payer: Encore All Commercial |
$32.40
|
| Rate for Payer: Encore All Commercial |
$32.40
|
| Rate for Payer: Frontpath All Commercial |
$56.46
|
| Rate for Payer: Frontpath All Commercial |
$56.46
|
| Rate for Payer: Humana ChoiceCare |
$35.94
|
| Rate for Payer: Humana ChoiceCare |
$35.94
|
| Rate for Payer: Humana Medicare |
$32.40
|
| Rate for Payer: Humana Medicare |
$32.40
|
| Rate for Payer: Lucent All Commercial |
$45.36
|
| Rate for Payer: Lucent All Commercial |
$45.36
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.00
|
| Rate for Payer: Managed Health Services Medicaid |
$31.87
|
| Rate for Payer: Managed Health Services Medicaid |
$31.87
|
| Rate for Payer: MDWise Medicaid |
$31.87
|
| Rate for Payer: MDWise Medicaid |
$31.87
|
| Rate for Payer: PHCS All Commercial |
$32.40
|
| Rate for Payer: PHCS All Commercial |
$32.40
|
| Rate for Payer: PHP All Commercial |
$41.03
|
| Rate for Payer: PHP All Commercial |
$41.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.40
|
| Rate for Payer: Sagamore Health Network All Products |
$32.40
|
| Rate for Payer: Sagamore Health Network All Products |
$32.40
|
| Rate for Payer: Signature Care EPO |
$37.40
|
| Rate for Payer: Signature Care EPO |
$37.40
|
| Rate for Payer: Signature Care PPO |
$37.40
|
| Rate for Payer: Signature Care PPO |
$37.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,700.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,700.00
|
| Rate for Payer: United Healthcare Commercial |
$27.11
|
| Rate for Payer: United Healthcare Commercial |
$27.11
|
|
|
CHG X-RAY SINUSES 3+ VW
|
Professional
|
Both
|
$50.04
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
z70220
|
| Min. Negotiated Rate |
$34.39 |
| Max. Negotiated Rate |
$62.03 |
| Rate for Payer: Aetna Commercial |
$35.65
|
| Rate for Payer: Aetna Commercial |
$35.65
|
| Rate for Payer: Aetna Medicare |
$35.65
|
| Rate for Payer: Aetna Medicare |
$35.65
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$34.39
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$34.39
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.22
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.22
|
| Rate for Payer: Cash Price |
$29.46
|
| Rate for Payer: Cash Price |
$30.02
|
| Rate for Payer: Centivo All Commercial |
$55.26
|
| Rate for Payer: Centivo All Commercial |
$55.26
|
| Rate for Payer: Cigna All Commercial |
$35.65
|
| Rate for Payer: Cigna All Commercial |
$35.65
|
| Rate for Payer: CORVEL All Commercial |
$35.65
|
| Rate for Payer: CORVEL All Commercial |
$35.65
|
| Rate for Payer: Coventry All Commercial |
$42.78
|
| Rate for Payer: Coventry All Commercial |
$42.78
|
| Rate for Payer: Encore All Commercial |
$35.65
|
| Rate for Payer: Encore All Commercial |
$35.65
|
| Rate for Payer: Frontpath All Commercial |
$62.03
|
| Rate for Payer: Frontpath All Commercial |
$62.03
|
| Rate for Payer: Humana ChoiceCare |
$39.53
|
| Rate for Payer: Humana ChoiceCare |
$39.53
|
| Rate for Payer: Humana Medicare |
$35.65
|
| Rate for Payer: Humana Medicare |
$35.65
|
| Rate for Payer: Lucent All Commercial |
$49.91
|
| Rate for Payer: Lucent All Commercial |
$49.91
|
| Rate for Payer: Managed Health Services Medicaid |
$34.39
|
| Rate for Payer: Managed Health Services Medicaid |
$34.39
|
| Rate for Payer: MDWise Medicaid |
$34.39
|
| Rate for Payer: MDWise Medicaid |
$34.39
|
| Rate for Payer: PHCS All Commercial |
$35.65
|
| Rate for Payer: PHCS All Commercial |
$35.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.65
|
| Rate for Payer: Sagamore Health Network All Products |
$35.65
|
| Rate for Payer: Sagamore Health Network All Products |
$35.65
|
| Rate for Payer: United Healthcare Commercial |
$35.48
|
| Rate for Payer: United Healthcare Commercial |
$35.48
|
|
|
CHG X-RAY SKULL <4 VW
|
Professional
|
Both
|
$65.54
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
z70250
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$4,900.00 |
| Rate for Payer: Aetna Commercial |
$33.65
|
| Rate for Payer: Aetna Commercial |
$33.65
|
| Rate for Payer: Aetna Medicare |
$33.65
|
| Rate for Payer: Aetna Medicare |
$33.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$37.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$37.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.99
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$37.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$37.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$37.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$32.78
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$32.78
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.02
|
| Rate for Payer: Cash Price |
$30.02
|
| Rate for Payer: Cash Price |
$39.32
|
| Rate for Payer: Centivo All Commercial |
$52.16
|
| Rate for Payer: Centivo All Commercial |
$52.16
|
| Rate for Payer: Cigna All Commercial |
$33.65
|
| Rate for Payer: Cigna All Commercial |
$33.65
|
| Rate for Payer: CORVEL All Commercial |
$33.65
|
| Rate for Payer: CORVEL All Commercial |
$33.65
|
| Rate for Payer: Coventry All Commercial |
$40.38
|
| Rate for Payer: Coventry All Commercial |
$40.38
|
| Rate for Payer: Encore All Commercial |
$33.65
|
| Rate for Payer: Encore All Commercial |
$33.65
|
| Rate for Payer: Frontpath All Commercial |
$58.60
|
| Rate for Payer: Frontpath All Commercial |
$58.60
|
| Rate for Payer: Humana ChoiceCare |
$37.38
|
| Rate for Payer: Humana ChoiceCare |
$37.38
|
| Rate for Payer: Humana Medicare |
$33.65
|
| Rate for Payer: Humana Medicare |
$33.65
|
| Rate for Payer: Lucent All Commercial |
$47.11
|
| Rate for Payer: Lucent All Commercial |
$47.11
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.00
|
| Rate for Payer: Managed Health Services Medicaid |
$32.78
|
| Rate for Payer: Managed Health Services Medicaid |
$32.78
|
| Rate for Payer: MDWise Medicaid |
$32.78
|
| Rate for Payer: MDWise Medicaid |
$32.78
|
| Rate for Payer: PHCS All Commercial |
$33.65
|
| Rate for Payer: PHCS All Commercial |
$33.65
|
| Rate for Payer: PHP All Commercial |
$42.60
|
| Rate for Payer: PHP All Commercial |
$42.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.65
|
| Rate for Payer: Sagamore Health Network All Products |
$33.65
|
| Rate for Payer: Sagamore Health Network All Products |
$33.65
|
| 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: Three Rivers Preferred All Commercial |
$4,900.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,900.00
|
| Rate for Payer: United Healthcare Commercial |
$32.91
|
| Rate for Payer: United Healthcare Commercial |
$32.91
|
|
|
CHG X-RAY SKULL 4+ VW
|
Professional
|
Both
|
$81.78
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
z70260
|
| Min. Negotiated Rate |
$40.88 |
| Max. Negotiated Rate |
$73.63 |
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna Commercial |
$42.40
|
| Rate for Payer: Aetna Medicare |
$42.40
|
| Rate for Payer: Aetna Medicare |
$42.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.88
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.88
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.76
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.76
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.64
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.64
|
| Rate for Payer: Cash Price |
$49.07
|
| Rate for Payer: Cash Price |
$34.44
|
| Rate for Payer: Centivo All Commercial |
$65.72
|
| Rate for Payer: Centivo All Commercial |
$65.72
|
| Rate for Payer: Cigna All Commercial |
$42.40
|
| Rate for Payer: Cigna All Commercial |
$42.40
|
| Rate for Payer: CORVEL All Commercial |
$42.40
|
| Rate for Payer: CORVEL All Commercial |
$42.40
|
| Rate for Payer: Coventry All Commercial |
$50.88
|
| Rate for Payer: Coventry All Commercial |
$50.88
|
| Rate for Payer: Encore All Commercial |
$42.40
|
| Rate for Payer: Encore All Commercial |
$42.40
|
| Rate for Payer: Frontpath All Commercial |
$73.63
|
| Rate for Payer: Frontpath All Commercial |
$73.63
|
| Rate for Payer: Humana ChoiceCare |
$47.08
|
| Rate for Payer: Humana ChoiceCare |
$47.08
|
| Rate for Payer: Humana Medicare |
$42.40
|
| Rate for Payer: Humana Medicare |
$42.40
|
| Rate for Payer: Lucent All Commercial |
$59.36
|
| Rate for Payer: Lucent All Commercial |
$59.36
|
| Rate for Payer: Managed Health Services Medicaid |
$40.88
|
| Rate for Payer: Managed Health Services Medicaid |
$40.88
|
| Rate for Payer: MDWise Medicaid |
$40.88
|
| Rate for Payer: MDWise Medicaid |
$40.88
|
| Rate for Payer: PHCS All Commercial |
$42.40
|
| Rate for Payer: PHCS All Commercial |
$42.40
|
| Rate for Payer: PHP All Commercial |
$53.16
|
| Rate for Payer: PHP All Commercial |
$53.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$42.40
|
| Rate for Payer: Sagamore Health Network All Products |
$42.40
|
| Rate for Payer: Sagamore Health Network All Products |
$42.40
|
| Rate for Payer: Signature Care EPO |
$61.20
|
| Rate for Payer: Signature Care EPO |
$61.20
|
| Rate for Payer: Signature Care PPO |
$61.20
|
| Rate for Payer: Signature Care PPO |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$43.79
|
| Rate for Payer: United Healthcare Commercial |
$43.79
|
|
|
CHG X-RAY SPINE ONE VIEW
|
Professional
|
Both
|
$30.44
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
z72020
|
| Min. Negotiated Rate |
$21.62 |
| Max. Negotiated Rate |
$40.24 |
| Rate for Payer: Aetna Commercial |
$22.99
|
| Rate for Payer: Aetna Commercial |
$22.99
|
| Rate for Payer: Aetna Medicare |
$22.99
|
| Rate for Payer: Aetna Medicare |
$22.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$22.16
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$22.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.29
|
| Rate for Payer: Cash Price |
$18.24
|
| Rate for Payer: Cash Price |
$18.26
|
| Rate for Payer: Centivo All Commercial |
$35.63
|
| Rate for Payer: Centivo All Commercial |
$35.63
|
| Rate for Payer: Cigna All Commercial |
$22.99
|
| Rate for Payer: Cigna All Commercial |
$22.99
|
| Rate for Payer: CORVEL All Commercial |
$22.99
|
| Rate for Payer: CORVEL All Commercial |
$22.99
|
| Rate for Payer: Coventry All Commercial |
$27.59
|
| Rate for Payer: Coventry All Commercial |
$27.59
|
| Rate for Payer: Encore All Commercial |
$22.99
|
| Rate for Payer: Encore All Commercial |
$22.99
|
| Rate for Payer: Frontpath All Commercial |
$40.24
|
| Rate for Payer: Frontpath All Commercial |
$40.24
|
| Rate for Payer: Humana ChoiceCare |
$25.87
|
| Rate for Payer: Humana ChoiceCare |
$25.87
|
| Rate for Payer: Humana Medicare |
$22.99
|
| Rate for Payer: Humana Medicare |
$22.99
|
| Rate for Payer: Lucent All Commercial |
$32.19
|
| Rate for Payer: Lucent All Commercial |
$32.19
|
| Rate for Payer: Managed Health Services Medicaid |
$22.16
|
| Rate for Payer: Managed Health Services Medicaid |
$22.16
|
| Rate for Payer: MDWise Medicaid |
$22.16
|
| Rate for Payer: MDWise Medicaid |
$22.16
|
| Rate for Payer: PHCS All Commercial |
$22.99
|
| Rate for Payer: PHCS All Commercial |
$22.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.99
|
| Rate for Payer: Sagamore Health Network All Products |
$22.99
|
| Rate for Payer: Sagamore Health Network All Products |
$22.99
|
| Rate for Payer: United Healthcare Commercial |
$21.62
|
| Rate for Payer: United Healthcare Commercial |
$21.62
|
|
|
CHG X-RAY STERNUM 2+ VW
|
Professional
|
Both
|
$61.44
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
z71120
|
| Min. Negotiated Rate |
$29.81 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Aetna Commercial |
$31.85
|
| Rate for Payer: Aetna Commercial |
$31.85
|
| Rate for Payer: Aetna Medicare |
$31.85
|
| Rate for Payer: Aetna Medicare |
$31.85
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.72
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.63
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.03
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.03
|
| Rate for Payer: Cash Price |
$36.86
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Centivo All Commercial |
$49.37
|
| Rate for Payer: Centivo All Commercial |
$49.37
|
| Rate for Payer: Cigna All Commercial |
$31.85
|
| Rate for Payer: Cigna All Commercial |
$31.85
|
| Rate for Payer: CORVEL All Commercial |
$31.85
|
| Rate for Payer: CORVEL All Commercial |
$31.85
|
| Rate for Payer: Coventry All Commercial |
$38.22
|
| Rate for Payer: Coventry All Commercial |
$38.22
|
| Rate for Payer: Encore All Commercial |
$31.85
|
| Rate for Payer: Encore All Commercial |
$31.85
|
| Rate for Payer: Frontpath All Commercial |
$55.49
|
| Rate for Payer: Frontpath All Commercial |
$55.49
|
| Rate for Payer: Humana ChoiceCare |
$35.23
|
| Rate for Payer: Humana ChoiceCare |
$35.23
|
| Rate for Payer: Humana Medicare |
$31.85
|
| Rate for Payer: Humana Medicare |
$31.85
|
| Rate for Payer: Lucent All Commercial |
$44.59
|
| Rate for Payer: Lucent All Commercial |
$44.59
|
| Rate for Payer: Managed Health Services Medicaid |
$30.72
|
| Rate for Payer: Managed Health Services Medicaid |
$30.72
|
| Rate for Payer: MDWise Medicaid |
$30.72
|
| Rate for Payer: MDWise Medicaid |
$30.72
|
| Rate for Payer: PHCS All Commercial |
$31.85
|
| Rate for Payer: PHCS All Commercial |
$31.85
|
| Rate for Payer: PHP All Commercial |
$39.94
|
| Rate for Payer: PHP All Commercial |
$39.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.85
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.85
|
| Rate for Payer: Sagamore Health Network All Products |
$31.85
|
| Rate for Payer: Sagamore Health Network All Products |
$31.85
|
| Rate for Payer: Signature Care EPO |
$46.50
|
| Rate for Payer: Signature Care EPO |
$46.50
|
| Rate for Payer: Signature Care PPO |
$46.50
|
| Rate for Payer: Signature Care PPO |
$46.50
|
| Rate for Payer: United Healthcare Commercial |
$29.81
|
| Rate for Payer: United Healthcare Commercial |
$29.81
|
|
|
CHG X-RAY THORACIC SPINE 2 VW
|
Professional
|
Both
|
$60.24
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
z72070
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: Aetna Commercial |
$30.91
|
| Rate for Payer: Aetna Medicare |
$30.91
|
| Rate for Payer: Aetna Medicare |
$30.91
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$36.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$36.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.59
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$36.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$36.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.59
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.11
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.11
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.55
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.55
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.00
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.00
|
| Rate for Payer: Cash Price |
$25.64
|
| Rate for Payer: Cash Price |
$36.14
|
| Rate for Payer: Centivo All Commercial |
$47.91
|
| Rate for Payer: Centivo All Commercial |
$47.91
|
| Rate for Payer: Cigna All Commercial |
$30.91
|
| Rate for Payer: Cigna All Commercial |
$30.91
|
| Rate for Payer: CORVEL All Commercial |
$30.91
|
| Rate for Payer: CORVEL All Commercial |
$30.91
|
| Rate for Payer: Coventry All Commercial |
$37.09
|
| Rate for Payer: Coventry All Commercial |
$37.09
|
| Rate for Payer: Encore All Commercial |
$30.91
|
| Rate for Payer: Encore All Commercial |
$30.91
|
| Rate for Payer: Frontpath All Commercial |
$53.87
|
| Rate for Payer: Frontpath All Commercial |
$53.87
|
| Rate for Payer: Humana ChoiceCare |
$34.14
|
| Rate for Payer: Humana ChoiceCare |
$34.14
|
| Rate for Payer: Humana Medicare |
$30.91
|
| Rate for Payer: Humana Medicare |
$30.91
|
| Rate for Payer: Lucent All Commercial |
$43.27
|
| Rate for Payer: Lucent All Commercial |
$43.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.00
|
| Rate for Payer: Managed Health Services Medicaid |
$30.11
|
| Rate for Payer: Managed Health Services Medicaid |
$30.11
|
| Rate for Payer: MDWise Medicaid |
$30.11
|
| Rate for Payer: MDWise Medicaid |
$30.11
|
| Rate for Payer: PHCS All Commercial |
$30.91
|
| Rate for Payer: PHCS All Commercial |
$30.91
|
| Rate for Payer: PHP All Commercial |
$39.15
|
| Rate for Payer: PHP All Commercial |
$39.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.91
|
| Rate for Payer: Sagamore Health Network All Products |
$30.91
|
| Rate for Payer: Sagamore Health Network All Products |
$30.91
|
| 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: Three Rivers Preferred All Commercial |
$4,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,500.00
|
| Rate for Payer: United Healthcare Commercial |
$30.87
|
| Rate for Payer: United Healthcare Commercial |
$30.87
|
|
|
CHG X-RAY THORACIC SPINE 4 VW
|
Professional
|
Both
|
$60.48
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
z72074
|
| Min. Negotiated Rate |
$40.81 |
| Max. Negotiated Rate |
$72.93 |
| Rate for Payer: Aetna Commercial |
$41.99
|
| Rate for Payer: Aetna Commercial |
$41.99
|
| Rate for Payer: Aetna Medicare |
$41.99
|
| Rate for Payer: Aetna Medicare |
$41.99
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.81
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$40.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.29
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.19
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.19
|
| Rate for Payer: Cash Price |
$35.24
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Centivo All Commercial |
$65.08
|
| Rate for Payer: Centivo All Commercial |
$65.08
|
| Rate for Payer: Cigna All Commercial |
$41.99
|
| Rate for Payer: Cigna All Commercial |
$41.99
|
| Rate for Payer: CORVEL All Commercial |
$41.99
|
| Rate for Payer: CORVEL All Commercial |
$41.99
|
| Rate for Payer: Coventry All Commercial |
$50.39
|
| Rate for Payer: Coventry All Commercial |
$50.39
|
| Rate for Payer: Encore All Commercial |
$41.99
|
| Rate for Payer: Encore All Commercial |
$41.99
|
| Rate for Payer: Frontpath All Commercial |
$72.93
|
| Rate for Payer: Frontpath All Commercial |
$72.93
|
| Rate for Payer: Humana ChoiceCare |
$46.72
|
| Rate for Payer: Humana ChoiceCare |
$46.72
|
| Rate for Payer: Humana Medicare |
$41.99
|
| Rate for Payer: Humana Medicare |
$41.99
|
| Rate for Payer: Lucent All Commercial |
$58.79
|
| Rate for Payer: Lucent All Commercial |
$58.79
|
| Rate for Payer: Managed Health Services Medicaid |
$40.81
|
| Rate for Payer: Managed Health Services Medicaid |
$40.81
|
| Rate for Payer: MDWise Medicaid |
$40.81
|
| Rate for Payer: MDWise Medicaid |
$40.81
|
| Rate for Payer: PHCS All Commercial |
$41.99
|
| Rate for Payer: PHCS All Commercial |
$41.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.99
|
| Rate for Payer: Sagamore Health Network All Products |
$41.99
|
| Rate for Payer: Sagamore Health Network All Products |
$41.99
|
| Rate for Payer: United Healthcare Commercial |
$40.90
|
| Rate for Payer: United Healthcare Commercial |
$40.90
|
|
|
CHG X-RAY THORACIC SPINE+SWIM 3 VW
|
Professional
|
Both
|
$71.86
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
z72072
|
| Min. Negotiated Rate |
$35.06 |
| Max. Negotiated Rate |
$5,300.00 |
| Rate for Payer: Aetna Commercial |
$36.94
|
| Rate for Payer: Aetna Commercial |
$36.94
|
| Rate for Payer: Aetna Medicare |
$36.94
|
| Rate for Payer: Aetna Medicare |
$36.94
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$39.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$39.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.84
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$39.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$39.84
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$39.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.84
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$36.23
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$36.23
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.48
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.63
|
| Rate for Payer: Cash Price |
$31.87
|
| Rate for Payer: Cash Price |
$43.12
|
| Rate for Payer: Centivo All Commercial |
$57.26
|
| Rate for Payer: Centivo All Commercial |
$57.26
|
| Rate for Payer: Cigna All Commercial |
$36.94
|
| Rate for Payer: Cigna All Commercial |
$36.94
|
| Rate for Payer: CORVEL All Commercial |
$36.94
|
| Rate for Payer: CORVEL All Commercial |
$36.94
|
| Rate for Payer: Coventry All Commercial |
$44.33
|
| Rate for Payer: Coventry All Commercial |
$44.33
|
| Rate for Payer: Encore All Commercial |
$36.94
|
| Rate for Payer: Encore All Commercial |
$36.94
|
| Rate for Payer: Frontpath All Commercial |
$64.23
|
| Rate for Payer: Frontpath All Commercial |
$64.23
|
| Rate for Payer: Humana ChoiceCare |
$40.97
|
| Rate for Payer: Humana ChoiceCare |
$40.97
|
| Rate for Payer: Humana Medicare |
$36.94
|
| Rate for Payer: Humana Medicare |
$36.94
|
| Rate for Payer: Lucent All Commercial |
$51.72
|
| Rate for Payer: Lucent All Commercial |
$51.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.00
|
| Rate for Payer: Managed Health Services Medicaid |
$36.23
|
| Rate for Payer: Managed Health Services Medicaid |
$36.23
|
| Rate for Payer: MDWise Medicaid |
$36.23
|
| Rate for Payer: MDWise Medicaid |
$36.23
|
| Rate for Payer: PHCS All Commercial |
$36.94
|
| Rate for Payer: PHCS All Commercial |
$36.94
|
| Rate for Payer: PHP All Commercial |
$46.71
|
| Rate for Payer: PHP All Commercial |
$46.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.94
|
| Rate for Payer: Sagamore Health Network All Products |
$36.94
|
| Rate for Payer: Sagamore Health Network All Products |
$36.94
|
| Rate for Payer: Signature Care EPO |
$47.60
|
| Rate for Payer: Signature Care EPO |
$47.60
|
| Rate for Payer: Signature Care PPO |
$47.60
|
| Rate for Payer: Signature Care PPO |
$47.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,300.00
|
| Rate for Payer: United Healthcare Commercial |
$35.06
|
| Rate for Payer: United Healthcare Commercial |
$35.06
|
|
|
CHG X-RAY TIB + FIB, 2VW
|
Professional
|
Both
|
$57.58
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
z73590
|
| Min. Negotiated Rate |
$24.66 |
| Max. Negotiated Rate |
$4,300.00 |
| Rate for Payer: Aetna Commercial |
$29.53
|
| Rate for Payer: Aetna Commercial |
$29.53
|
| Rate for Payer: Aetna Medicare |
$29.53
|
| Rate for Payer: Aetna Medicare |
$29.53
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$29.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$29.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.27
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$29.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$29.27
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$29.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.27
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$28.80
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$28.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.96
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.96
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.48
|
| Rate for Payer: Cash Price |
$26.34
|
| Rate for Payer: Cash Price |
$34.55
|
| Rate for Payer: Centivo All Commercial |
$45.77
|
| Rate for Payer: Centivo All Commercial |
$45.77
|
| Rate for Payer: Cigna All Commercial |
$29.53
|
| Rate for Payer: Cigna All Commercial |
$29.53
|
| Rate for Payer: CORVEL All Commercial |
$29.53
|
| Rate for Payer: CORVEL All Commercial |
$29.53
|
| Rate for Payer: Coventry All Commercial |
$35.44
|
| Rate for Payer: Coventry All Commercial |
$35.44
|
| Rate for Payer: Encore All Commercial |
$29.53
|
| Rate for Payer: Encore All Commercial |
$29.53
|
| Rate for Payer: Frontpath All Commercial |
$51.53
|
| Rate for Payer: Frontpath All Commercial |
$51.53
|
| Rate for Payer: Humana ChoiceCare |
$33.06
|
| Rate for Payer: Humana ChoiceCare |
$33.06
|
| Rate for Payer: Humana Medicare |
$29.53
|
| Rate for Payer: Humana Medicare |
$29.53
|
| Rate for Payer: Lucent All Commercial |
$41.34
|
| Rate for Payer: Lucent All Commercial |
$41.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$46.00
|
| Rate for Payer: Managed Health Services Medicaid |
$28.80
|
| Rate for Payer: Managed Health Services Medicaid |
$28.80
|
| Rate for Payer: MDWise Medicaid |
$28.80
|
| Rate for Payer: MDWise Medicaid |
$28.80
|
| Rate for Payer: PHCS All Commercial |
$29.53
|
| Rate for Payer: PHCS All Commercial |
$29.53
|
| Rate for Payer: PHP All Commercial |
$37.43
|
| Rate for Payer: PHP All Commercial |
$37.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.53
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.53
|
| Rate for Payer: Sagamore Health Network All Products |
$29.53
|
| Rate for Payer: Sagamore Health Network All Products |
$29.53
|
| Rate for Payer: Signature Care EPO |
$34.00
|
| Rate for Payer: Signature Care EPO |
$34.00
|
| Rate for Payer: Signature Care PPO |
$34.00
|
| Rate for Payer: Signature Care PPO |
$34.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,300.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,300.00
|
| Rate for Payer: United Healthcare Commercial |
$24.66
|
| Rate for Payer: United Healthcare Commercial |
$24.66
|
|
|
CHG X-RAY TOE(S)
|
Professional
|
Both
|
$53.20
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
z73660
|
| Min. Negotiated Rate |
$24.54 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$27.25
|
| Rate for Payer: Aetna Commercial |
$27.25
|
| Rate for Payer: Aetna Medicare |
$27.25
|
| Rate for Payer: Aetna Medicare |
$27.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$25.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.25
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$25.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.25
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$25.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.25
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.61
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$26.61
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.34
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.98
|
| Rate for Payer: Cash Price |
$25.24
|
| Rate for Payer: Cash Price |
$31.92
|
| Rate for Payer: Centivo All Commercial |
$42.24
|
| Rate for Payer: Centivo All Commercial |
$42.24
|
| Rate for Payer: Cigna All Commercial |
$27.25
|
| Rate for Payer: Cigna All Commercial |
$27.25
|
| Rate for Payer: CORVEL All Commercial |
$27.25
|
| Rate for Payer: CORVEL All Commercial |
$27.25
|
| Rate for Payer: Coventry All Commercial |
$32.70
|
| Rate for Payer: Coventry All Commercial |
$32.70
|
| Rate for Payer: Encore All Commercial |
$27.25
|
| Rate for Payer: Encore All Commercial |
$27.25
|
| Rate for Payer: Frontpath All Commercial |
$47.60
|
| Rate for Payer: Frontpath All Commercial |
$47.60
|
| Rate for Payer: Humana ChoiceCare |
$30.55
|
| Rate for Payer: Humana ChoiceCare |
$30.55
|
| Rate for Payer: Humana Medicare |
$27.25
|
| Rate for Payer: Humana Medicare |
$27.25
|
| Rate for Payer: Lucent All Commercial |
$38.15
|
| Rate for Payer: Lucent All Commercial |
$38.15
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.00
|
| Rate for Payer: Managed Health Services Medicaid |
$26.61
|
| Rate for Payer: Managed Health Services Medicaid |
$26.61
|
| Rate for Payer: MDWise Medicaid |
$26.61
|
| Rate for Payer: MDWise Medicaid |
$26.61
|
| Rate for Payer: PHCS All Commercial |
$27.25
|
| Rate for Payer: PHCS All Commercial |
$27.25
|
| Rate for Payer: PHP All Commercial |
$34.58
|
| Rate for Payer: PHP All Commercial |
$34.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.25
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.25
|
| Rate for Payer: Sagamore Health Network All Products |
$27.25
|
| Rate for Payer: Sagamore Health Network All Products |
$27.25
|
| Rate for Payer: Signature Care EPO |
$26.35
|
| Rate for Payer: Signature Care EPO |
$26.35
|
| Rate for Payer: Signature Care PPO |
$26.35
|
| Rate for Payer: Signature Care PPO |
$26.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,000.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,000.00
|
| Rate for Payer: United Healthcare Commercial |
$24.54
|
| Rate for Payer: United Healthcare Commercial |
$24.54
|
|
|
CHG X-RAY WRIST 2 VW
|
Professional
|
Both
|
$47.58
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
z73100
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$4,600.00 |
| Rate for Payer: Aetna Commercial |
$31.71
|
| Rate for Payer: Aetna Commercial |
$31.71
|
| Rate for Payer: Aetna Commercial |
$31.71
|
| Rate for Payer: Aetna Commercial |
$31.71
|
| Rate for Payer: Aetna Medicare |
$31.71
|
| Rate for Payer: Aetna Medicare |
$31.71
|
| Rate for Payer: Aetna Medicare |
$31.71
|
| Rate for Payer: Aetna Medicare |
$31.71
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$28.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$28.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$28.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$28.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.43
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$28.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$28.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$28.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$28.43
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$28.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.43
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.92
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$30.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.47
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.88
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.88
|
| Rate for Payer: Cash Price |
$37.08
|
| Rate for Payer: Cash Price |
$28.55
|
| Rate for Payer: Cash Price |
$28.54
|
| Rate for Payer: Cash Price |
$57.10
|
| Rate for Payer: Centivo All Commercial |
$49.15
|
| Rate for Payer: Centivo All Commercial |
$49.15
|
| Rate for Payer: Centivo All Commercial |
$49.15
|
| Rate for Payer: Centivo All Commercial |
$49.15
|
| Rate for Payer: Cigna All Commercial |
$31.71
|
| Rate for Payer: Cigna All Commercial |
$31.71
|
| Rate for Payer: Cigna All Commercial |
$31.71
|
| Rate for Payer: Cigna All Commercial |
$31.71
|
| Rate for Payer: CORVEL All Commercial |
$31.71
|
| Rate for Payer: CORVEL All Commercial |
$31.71
|
| Rate for Payer: CORVEL All Commercial |
$31.71
|
| Rate for Payer: CORVEL All Commercial |
$31.71
|
| Rate for Payer: Coventry All Commercial |
$38.05
|
| Rate for Payer: Coventry All Commercial |
$38.05
|
| Rate for Payer: Coventry All Commercial |
$38.05
|
| Rate for Payer: Coventry All Commercial |
$38.05
|
| Rate for Payer: Encore All Commercial |
$31.71
|
| Rate for Payer: Encore All Commercial |
$31.71
|
| Rate for Payer: Encore All Commercial |
$31.71
|
| Rate for Payer: Encore All Commercial |
$31.71
|
| Rate for Payer: Frontpath All Commercial |
$55.28
|
| Rate for Payer: Frontpath All Commercial |
$55.28
|
| Rate for Payer: Frontpath All Commercial |
$55.28
|
| Rate for Payer: Frontpath All Commercial |
$55.28
|
| Rate for Payer: Humana ChoiceCare |
$35.58
|
| Rate for Payer: Humana ChoiceCare |
$35.58
|
| Rate for Payer: Humana ChoiceCare |
$35.58
|
| Rate for Payer: Humana ChoiceCare |
$35.58
|
| Rate for Payer: Humana Medicare |
$31.71
|
| Rate for Payer: Humana Medicare |
$31.71
|
| Rate for Payer: Humana Medicare |
$31.71
|
| Rate for Payer: Humana Medicare |
$31.71
|
| Rate for Payer: Lucent All Commercial |
$44.39
|
| Rate for Payer: Lucent All Commercial |
$44.39
|
| Rate for Payer: Lucent All Commercial |
$44.39
|
| Rate for Payer: Lucent All Commercial |
$44.39
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: Managed Health Services Medicaid |
$30.92
|
| Rate for Payer: Managed Health Services Medicaid |
$30.92
|
| Rate for Payer: Managed Health Services Medicaid |
$30.92
|
| Rate for Payer: Managed Health Services Medicaid |
$30.92
|
| Rate for Payer: MDWise Medicaid |
$30.92
|
| Rate for Payer: MDWise Medicaid |
$30.92
|
| Rate for Payer: MDWise Medicaid |
$30.92
|
| Rate for Payer: MDWise Medicaid |
$30.92
|
| Rate for Payer: PHCS All Commercial |
$31.71
|
| Rate for Payer: PHCS All Commercial |
$31.71
|
| Rate for Payer: PHCS All Commercial |
$31.71
|
| Rate for Payer: PHCS All Commercial |
$31.71
|
| Rate for Payer: PHP All Commercial |
$40.17
|
| Rate for Payer: PHP All Commercial |
$40.17
|
| Rate for Payer: PHP All Commercial |
$40.17
|
| Rate for Payer: PHP All Commercial |
$40.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.71
|
| Rate for Payer: Sagamore Health Network All Products |
$31.71
|
| Rate for Payer: Sagamore Health Network All Products |
$31.71
|
| Rate for Payer: Sagamore Health Network All Products |
$31.71
|
| Rate for Payer: Sagamore Health Network All Products |
$31.71
|
| Rate for Payer: Signature Care EPO |
$32.30
|
| Rate for Payer: Signature Care EPO |
$32.30
|
| Rate for Payer: Signature Care EPO |
$32.30
|
| Rate for Payer: Signature Care EPO |
$32.30
|
| Rate for Payer: Signature Care PPO |
$32.30
|
| Rate for Payer: Signature Care PPO |
$32.30
|
| Rate for Payer: Signature Care PPO |
$32.30
|
| Rate for Payer: Signature Care PPO |
$32.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,600.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$4,600.00
|
| Rate for Payer: United Healthcare Commercial |
$25.62
|
| Rate for Payer: United Healthcare Commercial |
$25.62
|
| Rate for Payer: United Healthcare Commercial |
$25.62
|
| Rate for Payer: United Healthcare Commercial |
$25.62
|
|
|
CHG X-RAY WRIST 3+ VW
|
Professional
|
Both
|
$74.52
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
z73110
|
| Min. Negotiated Rate |
$30.62 |
| Max. Negotiated Rate |
$5,500.00 |
| Rate for Payer: Aetna Commercial |
$38.28
|
| Rate for Payer: Aetna Commercial |
$38.28
|
| Rate for Payer: Aetna Medicare |
$38.28
|
| Rate for Payer: Aetna Medicare |
$38.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$51.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicaid |
$51.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.40
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$51.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$51.40
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$51.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.40
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$37.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise/HIP |
$37.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$44.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.11
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.11
|
| Rate for Payer: Cash Price |
$36.29
|
| Rate for Payer: Cash Price |
$44.71
|
| Rate for Payer: Centivo All Commercial |
$59.33
|
| Rate for Payer: Centivo All Commercial |
$59.33
|
| Rate for Payer: Cigna All Commercial |
$38.28
|
| Rate for Payer: Cigna All Commercial |
$38.28
|
| Rate for Payer: CORVEL All Commercial |
$38.28
|
| Rate for Payer: CORVEL All Commercial |
$38.28
|
| Rate for Payer: Coventry All Commercial |
$45.94
|
| Rate for Payer: Coventry All Commercial |
$45.94
|
| Rate for Payer: Encore All Commercial |
$38.28
|
| Rate for Payer: Encore All Commercial |
$38.28
|
| Rate for Payer: Frontpath All Commercial |
$66.61
|
| Rate for Payer: Frontpath All Commercial |
$66.61
|
| Rate for Payer: Humana ChoiceCare |
$42.41
|
| Rate for Payer: Humana ChoiceCare |
$42.41
|
| Rate for Payer: Humana Medicare |
$38.28
|
| Rate for Payer: Humana Medicare |
$38.28
|
| Rate for Payer: Lucent All Commercial |
$53.59
|
| Rate for Payer: Lucent All Commercial |
$53.59
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.00
|
| Rate for Payer: Managed Health Services Medicaid |
$37.58
|
| Rate for Payer: Managed Health Services Medicaid |
$37.58
|
| Rate for Payer: MDWise Medicaid |
$37.58
|
| Rate for Payer: MDWise Medicaid |
$37.58
|
| Rate for Payer: PHCS All Commercial |
$38.28
|
| Rate for Payer: PHCS All Commercial |
$38.28
|
| Rate for Payer: PHP All Commercial |
$48.43
|
| Rate for Payer: PHP All Commercial |
$48.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.28
|
| Rate for Payer: Sagamore Health Network All Products |
$38.28
|
| Rate for Payer: Sagamore Health Network All Products |
$38.28
|
| Rate for Payer: Signature Care EPO |
$34.85
|
| Rate for Payer: Signature Care EPO |
$34.85
|
| Rate for Payer: Signature Care PPO |
$34.85
|
| Rate for Payer: Signature Care PPO |
$34.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,500.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5,500.00
|
| Rate for Payer: United Healthcare Commercial |
$30.62
|
| Rate for Payer: United Healthcare Commercial |
$30.62
|
|
|
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00555015902
|
| Hospital Charge Code |
1623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.24 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.28
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Pathway |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Centivo All Commercial |
$2.18
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Humana Medicare |
$1.28
|
| Rate for Payer: Lucent All Commercial |
$2.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$1.56
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.40
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
| Rate for Payer: United Healthcare Medicare |
$1.28
|
|
|
CHLORDIAZEPOXIDE HCL 25 MG ORAL CAP
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00555015902
|
| Hospital Charge Code |
1623
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.46
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna All Commercial |
$3.45
|
| Rate for Payer: CORVEL All Commercial |
$3.72
|
| Rate for Payer: Coventry All Commercial |
$3.52
|
| Rate for Payer: Encore All Commercial |
$3.68
|
| Rate for Payer: Frontpath All Commercial |
$3.68
|
| Rate for Payer: Humana ChoiceCare |
$3.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.60
|
| Rate for Payer: PHCS All Commercial |
$3.00
|
| Rate for Payer: PHP All Commercial |
$3.03
|
| Rate for Payer: Sagamore Health Network All Products |
$3.09
|
| Rate for Payer: Signature Care EPO |
$3.32
|
| Rate for Payer: Signature Care PPO |
$3.52
|
| Rate for Payer: United Healthcare Commercial |
$3.15
|
|
