|
CHG GLYCOSYLATED HEMOGLOBIN TEST
|
Professional
|
Both
|
$19.42
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
z83036
|
| Min. Negotiated Rate |
$8.50 |
| Max. Negotiated Rate |
$14.56 |
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Cash Price |
$12.04
|
| Rate for Payer: Frontpath All Commercial |
$9.71
|
| Rate for Payer: Humana ChoiceCare |
$9.71
|
| Rate for Payer: PHCS All Commercial |
$14.56
|
| Rate for Payer: PHP All Commercial |
$8.54
|
| Rate for Payer: United Healthcare Commercial |
$8.50
|
|
|
CHG HEMOGLOBIN
|
Professional
|
Both
|
$4.74
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
z85018
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$3.56 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$1.76
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$1.76
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Cash Price |
$2.94
|
| Rate for Payer: Frontpath All Commercial |
$2.37
|
| Rate for Payer: Humana ChoiceCare |
$2.37
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.00
|
| Rate for Payer: PHCS All Commercial |
$3.56
|
| Rate for Payer: PHP All Commercial |
$2.09
|
| Rate for Payer: Signature Care EPO |
$3.40
|
| Rate for Payer: Signature Care PPO |
$3.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.00
|
| Rate for Payer: United Healthcare Commercial |
$3.46
|
|
|
CHG HETEROPHILE ANTIBODIES,SCREEN
|
Professional
|
Both
|
$10.36
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
z86308
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$7.77 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.45
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.45
|
| Rate for Payer: Cash Price |
$6.42
|
| Rate for Payer: Cash Price |
$6.42
|
| Rate for Payer: Frontpath All Commercial |
$5.18
|
| Rate for Payer: Humana ChoiceCare |
$5.18
|
| Rate for Payer: Lutheran Preferred All Commercial |
$7.00
|
| Rate for Payer: PHCS All Commercial |
$7.77
|
| Rate for Payer: PHP All Commercial |
$4.56
|
| Rate for Payer: Signature Care EPO |
$6.80
|
| Rate for Payer: Signature Care PPO |
$6.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$7.00
|
| Rate for Payer: United Healthcare Commercial |
$7.56
|
|
|
CHG IAADIADOO INFLUENZA
|
Professional
|
Both
|
$33.10
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
z87804
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$24.82 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.00
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.00
|
| Rate for Payer: Cash Price |
$20.52
|
| Rate for Payer: Cash Price |
$20.52
|
| Rate for Payer: Frontpath All Commercial |
$16.55
|
| Rate for Payer: Humana ChoiceCare |
$16.55
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.00
|
| Rate for Payer: PHCS All Commercial |
$24.82
|
| Rate for Payer: PHP All Commercial |
$14.56
|
| Rate for Payer: Signature Care EPO |
$15.30
|
| Rate for Payer: Signature Care PPO |
$15.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$22.00
|
| Rate for Payer: United Healthcare Commercial |
$17.52
|
|
|
CHG IAADIADOO RESPIRATORY SYNCTIAL VIRUS
|
Professional
|
Both
|
$26.20
|
|
|
Service Code
|
CPT 87807
|
| Hospital Charge Code |
z87807
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$19.65 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$11.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$11.68
|
| Rate for Payer: Cash Price |
$16.24
|
| Rate for Payer: Cash Price |
$16.24
|
| Rate for Payer: Frontpath All Commercial |
$13.10
|
| Rate for Payer: Humana ChoiceCare |
$13.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$18.00
|
| Rate for Payer: PHCS All Commercial |
$19.65
|
| Rate for Payer: PHP All Commercial |
$11.53
|
| Rate for Payer: Signature Care EPO |
$15.30
|
| Rate for Payer: Signature Care PPO |
$15.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$17.00
|
| Rate for Payer: United Healthcare Commercial |
$10.51
|
|
|
CHG IAADIADOO STREPTOCOCCUS GROUP A
|
Professional
|
Both
|
$33.06
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
z87880
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$24.80 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$16.53
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$16.53
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Cash Price |
$20.50
|
| Rate for Payer: Frontpath All Commercial |
$16.53
|
| Rate for Payer: Humana ChoiceCare |
$16.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$23.00
|
| Rate for Payer: PHCS All Commercial |
$24.80
|
| Rate for Payer: PHP All Commercial |
$14.55
|
| Rate for Payer: Signature Care EPO |
$15.30
|
| Rate for Payer: Signature Care PPO |
$15.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$21.00
|
| Rate for Payer: United Healthcare Commercial |
$17.52
|
|
|
CHG IAAD IA INFLUENZA A/B EACH
|
Professional
|
Both
|
$28.26
|
|
|
Service Code
|
CPT 87400
|
| Hospital Charge Code |
z87400
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$21.20 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.67
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.67
|
| Rate for Payer: Cash Price |
$17.52
|
| Rate for Payer: Cash Price |
$17.52
|
| Rate for Payer: Frontpath All Commercial |
$14.13
|
| Rate for Payer: Humana ChoiceCare |
$14.13
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.00
|
| Rate for Payer: PHCS All Commercial |
$21.20
|
| Rate for Payer: PHP All Commercial |
$12.43
|
| Rate for Payer: Signature Care EPO |
$15.30
|
| Rate for Payer: Signature Care PPO |
$15.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$18.00
|
| Rate for Payer: United Healthcare Commercial |
$10.51
|
|
|
CHG IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS
|
Professional
|
Both
|
$70.66
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
z87426
|
| Min. Negotiated Rate |
$24.83 |
| Max. Negotiated Rate |
$53.00 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.30
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Frontpath All Commercial |
$31.59
|
| Rate for Payer: Humana ChoiceCare |
$35.33
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: PHCS All Commercial |
$53.00
|
| Rate for Payer: PHP All Commercial |
$31.09
|
| Rate for Payer: Signature Care EPO |
$51.00
|
| Rate for Payer: Signature Care PPO |
$51.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.00
|
| Rate for Payer: United Healthcare Commercial |
$24.83
|
|
|
CHG IA INFECTIOUS AGT ANTIBODY QUAL/SEMIQ 1STEP METH
|
Professional
|
Both
|
$36.18
|
|
|
Service Code
|
CPT 86318
|
| Hospital Charge Code |
z86318
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$27.14 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.12
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Cash Price |
$22.43
|
| Rate for Payer: Frontpath All Commercial |
$18.09
|
| Rate for Payer: Humana ChoiceCare |
$18.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$25.00
|
| Rate for Payer: PHCS All Commercial |
$27.14
|
| Rate for Payer: PHP All Commercial |
$15.92
|
| Rate for Payer: Signature Care EPO |
$17.00
|
| Rate for Payer: Signature Care PPO |
$17.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$24.00
|
| Rate for Payer: United Healthcare Commercial |
$18.91
|
|
|
CHG INFECTIOUS AGENT DNA/RNA INFLUENZA 1ST 2 TYPES
|
Professional
|
Both
|
$191.60
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
z87502
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$143.70 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.90
|
| Rate for Payer: Cash Price |
$118.79
|
| Rate for Payer: Cash Price |
$118.79
|
| Rate for Payer: Frontpath All Commercial |
$95.80
|
| Rate for Payer: Humana ChoiceCare |
$95.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$134.00
|
| Rate for Payer: PHCS All Commercial |
$143.70
|
| Rate for Payer: PHP All Commercial |
$84.30
|
| Rate for Payer: Signature Care EPO |
$111.97
|
| Rate for Payer: Signature Care PPO |
$111.97
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$125.00
|
| Rate for Payer: United Healthcare Commercial |
$71.85
|
|
|
CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS
|
Professional
|
Both
|
$99.18
|
|
|
Service Code
|
CPT 77071
|
| Hospital Charge Code |
z77071
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$91.58 |
| Rate for Payer: Aetna Medicare |
$50.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$58.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.91
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Cash Price |
$61.49
|
| Rate for Payer: Coventry All Commercial |
$61.00
|
| Rate for Payer: Frontpath All Commercial |
$91.58
|
| Rate for Payer: Humana ChoiceCare |
$33.20
|
| Rate for Payer: Humana Medicare |
$50.83
|
| Rate for Payer: Lucent All Commercial |
$86.41
|
| Rate for Payer: PHCS All Commercial |
$74.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.83
|
| Rate for Payer: United Healthcare Commercial |
$36.61
|
| Rate for Payer: United Healthcare Medicare |
$50.83
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
Both
|
$795.48
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
z78452
|
| Min. Negotiated Rate |
$389.30 |
| Max. Negotiated Rate |
$730.71 |
| Rate for Payer: Aetna Medicare |
$407.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$422.14
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$422.14
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$468.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$448.46
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Coventry All Commercial |
$489.23
|
| Rate for Payer: Frontpath All Commercial |
$730.71
|
| Rate for Payer: Humana ChoiceCare |
$501.00
|
| Rate for Payer: Humana Medicare |
$407.69
|
| Rate for Payer: Lucent All Commercial |
$693.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$632.00
|
| Rate for Payer: PHCS All Commercial |
$596.61
|
| Rate for Payer: PHP All Commercial |
$517.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$407.69
|
| Rate for Payer: Signature Care EPO |
$389.30
|
| Rate for Payer: Signature Care PPO |
$389.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$591.00
|
| Rate for Payer: United Healthcare Commercial |
$514.77
|
| Rate for Payer: United Healthcare Medicare |
$407.69
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
Both
|
$575.06
|
|
|
Service Code
|
CPT 78451
|
| Hospital Charge Code |
z78451
|
| Min. Negotiated Rate |
$248.24 |
| Max. Negotiated Rate |
$525.38 |
| Rate for Payer: Aetna Medicare |
$294.71
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$248.24
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$248.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$338.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$324.18
|
| Rate for Payer: Cash Price |
$356.54
|
| Rate for Payer: Cash Price |
$356.54
|
| Rate for Payer: Coventry All Commercial |
$353.65
|
| Rate for Payer: Frontpath All Commercial |
$525.38
|
| Rate for Payer: Humana ChoiceCare |
$359.76
|
| Rate for Payer: Humana Medicare |
$294.71
|
| Rate for Payer: Lucent All Commercial |
$501.01
|
| Rate for Payer: Lutheran Preferred All Commercial |
$457.00
|
| Rate for Payer: PHCS All Commercial |
$431.30
|
| Rate for Payer: PHP All Commercial |
$373.78
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$294.71
|
| Rate for Payer: Signature Care EPO |
$279.59
|
| Rate for Payer: Signature Care PPO |
$279.59
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$427.00
|
| Rate for Payer: United Healthcare Commercial |
$332.88
|
| Rate for Payer: United Healthcare Medicare |
$294.71
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS
|
Professional
|
Both
|
$98.12
|
|
|
Service Code
|
CPT 73522
|
| Hospital Charge Code |
z73522
|
| Min. Negotiated Rate |
$45.87 |
| Max. Negotiated Rate |
$87.64 |
| Rate for Payer: Aetna Medicare |
$50.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$55.31
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Cash Price |
$60.83
|
| Rate for Payer: Coventry All Commercial |
$60.34
|
| Rate for Payer: Frontpath All Commercial |
$87.64
|
| Rate for Payer: Humana ChoiceCare |
$57.54
|
| Rate for Payer: Humana Medicare |
$50.28
|
| Rate for Payer: Lucent All Commercial |
$85.48
|
| Rate for Payer: PHCS All Commercial |
$73.59
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$50.28
|
| Rate for Payer: United Healthcare Commercial |
$45.87
|
| Rate for Payer: United Healthcare Medicare |
$50.28
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS
|
Professional
|
Both
|
$85.66
|
|
|
Service Code
|
CPT 73502
|
| Hospital Charge Code |
z73502
|
| Min. Negotiated Rate |
$38.83 |
| Max. Negotiated Rate |
$76.53 |
| Rate for Payer: Aetna Medicare |
$43.90
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$50.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$50.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.29
|
| Rate for Payer: Cash Price |
$53.11
|
| Rate for Payer: Cash Price |
$53.11
|
| Rate for Payer: Coventry All Commercial |
$52.68
|
| Rate for Payer: Frontpath All Commercial |
$76.53
|
| Rate for Payer: Humana ChoiceCare |
$48.71
|
| Rate for Payer: Humana Medicare |
$43.90
|
| Rate for Payer: Lucent All Commercial |
$74.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.00
|
| Rate for Payer: PHCS All Commercial |
$64.24
|
| Rate for Payer: PHP All Commercial |
$55.67
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.90
|
| Rate for Payer: Signature Care EPO |
$49.32
|
| Rate for Payer: Signature Care PPO |
$49.32
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$64.00
|
| Rate for Payer: United Healthcare Commercial |
$38.83
|
| Rate for Payer: United Healthcare Medicare |
$43.90
|
|
|
CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS
|
Professional
|
Both
|
$72.40
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
z72040
|
| Min. Negotiated Rate |
$33.52 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Aetna Medicare |
$37.10
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.56
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.56
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.66
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.81
|
| Rate for Payer: Cash Price |
$44.89
|
| Rate for Payer: Cash Price |
$44.89
|
| Rate for Payer: Coventry All Commercial |
$44.52
|
| Rate for Payer: Frontpath All Commercial |
$64.72
|
| Rate for Payer: Humana ChoiceCare |
$41.33
|
| Rate for Payer: Humana Medicare |
$37.10
|
| Rate for Payer: Lucent All Commercial |
$63.07
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.00
|
| Rate for Payer: PHCS All Commercial |
$54.30
|
| Rate for Payer: PHP All Commercial |
$47.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.10
|
| Rate for Payer: Signature Care EPO |
$40.80
|
| Rate for Payer: Signature Care PPO |
$40.80
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.00
|
| Rate for Payer: United Healthcare Commercial |
$33.52
|
| Rate for Payer: United Healthcare Medicare |
$37.10
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW
|
Professional
|
Both
|
$54.70
|
|
|
Service Code
|
CPT 74018
|
| Hospital Charge Code |
z74018
|
| Min. Negotiated Rate |
$25.41 |
| Max. Negotiated Rate |
$49.47 |
| Rate for Payer: Aetna Medicare |
$28.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$32.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.83
|
| Rate for Payer: Cash Price |
$33.91
|
| Rate for Payer: Cash Price |
$33.91
|
| Rate for Payer: Coventry All Commercial |
$33.64
|
| Rate for Payer: Frontpath All Commercial |
$49.47
|
| Rate for Payer: Humana ChoiceCare |
$32.02
|
| Rate for Payer: Humana Medicare |
$28.03
|
| Rate for Payer: Lucent All Commercial |
$47.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$43.00
|
| Rate for Payer: PHCS All Commercial |
$41.02
|
| Rate for Payer: PHP All Commercial |
$35.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$28.03
|
| Rate for Payer: Signature Care EPO |
$30.23
|
| Rate for Payer: Signature Care PPO |
$30.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$41.00
|
| Rate for Payer: United Healthcare Commercial |
$25.80
|
| Rate for Payer: United Healthcare Medicare |
$28.03
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 2 VIEWS
|
Professional
|
Both
|
$67.64
|
|
|
Service Code
|
CPT 74019
|
| Hospital Charge Code |
z74019
|
| Min. Negotiated Rate |
$31.57 |
| Max. Negotiated Rate |
$60.47 |
| Rate for Payer: Aetna Medicare |
$34.67
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.87
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.14
|
| Rate for Payer: Cash Price |
$41.94
|
| Rate for Payer: Cash Price |
$41.94
|
| Rate for Payer: Coventry All Commercial |
$41.60
|
| Rate for Payer: Frontpath All Commercial |
$60.47
|
| Rate for Payer: Humana ChoiceCare |
$39.21
|
| Rate for Payer: Humana Medicare |
$34.67
|
| Rate for Payer: Lucent All Commercial |
$58.94
|
| Rate for Payer: PHCS All Commercial |
$50.73
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.67
|
| Rate for Payer: United Healthcare Commercial |
$31.57
|
| Rate for Payer: United Healthcare Medicare |
$34.67
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 3+ VIEWS
|
Professional
|
Both
|
$78.72
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
z74021
|
| Min. Negotiated Rate |
$36.87 |
| Max. Negotiated Rate |
$70.89 |
| Rate for Payer: Aetna Medicare |
$40.34
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.37
|
| Rate for Payer: Cash Price |
$48.81
|
| Rate for Payer: Cash Price |
$48.81
|
| Rate for Payer: Coventry All Commercial |
$48.41
|
| Rate for Payer: Frontpath All Commercial |
$70.89
|
| Rate for Payer: Humana ChoiceCare |
$45.73
|
| Rate for Payer: Humana Medicare |
$40.34
|
| Rate for Payer: Lucent All Commercial |
$68.58
|
| Rate for Payer: PHCS All Commercial |
$59.04
|
| Rate for Payer: PHP All Commercial |
$51.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.34
|
| Rate for Payer: Signature Care EPO |
$43.19
|
| Rate for Payer: Signature Care PPO |
$43.19
|
| Rate for Payer: United Healthcare Commercial |
$36.87
|
| Rate for Payer: United Healthcare Medicare |
$40.34
|
|
|
CHG RADIOLOGIC EXAM CHEST 2 VIEWS
|
Professional
|
Both
|
$61.56
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
z71046
|
| Min. Negotiated Rate |
$28.46 |
| Max. Negotiated Rate |
$55.05 |
| Rate for Payer: Aetna Medicare |
$31.55
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.46
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.46
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.70
|
| Rate for Payer: Cash Price |
$38.17
|
| Rate for Payer: Cash Price |
$38.17
|
| Rate for Payer: Coventry All Commercial |
$37.86
|
| Rate for Payer: Frontpath All Commercial |
$55.05
|
| Rate for Payer: Humana ChoiceCare |
$35.86
|
| Rate for Payer: Humana Medicare |
$31.55
|
| Rate for Payer: Lucent All Commercial |
$53.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: PHCS All Commercial |
$46.17
|
| Rate for Payer: PHP All Commercial |
$40.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.55
|
| Rate for Payer: Signature Care EPO |
$33.86
|
| Rate for Payer: Signature Care PPO |
$33.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.00
|
| Rate for Payer: United Healthcare Commercial |
$28.89
|
| Rate for Payer: United Healthcare Medicare |
$31.55
|
|
|
CHG RADIOLOGIC EXAM CHEST SINGLE VIEW
|
Professional
|
Both
|
$47.46
|
|
|
Service Code
|
CPT 71045
|
| Hospital Charge Code |
z71045
|
| Min. Negotiated Rate |
$18.84 |
| Max. Negotiated Rate |
$42.50 |
| Rate for Payer: Aetna Medicare |
$24.33
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$27.98
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$26.76
|
| Rate for Payer: Cash Price |
$29.43
|
| Rate for Payer: Cash Price |
$29.43
|
| Rate for Payer: Coventry All Commercial |
$29.20
|
| Rate for Payer: Frontpath All Commercial |
$42.50
|
| Rate for Payer: Humana ChoiceCare |
$23.26
|
| Rate for Payer: Humana Medicare |
$24.33
|
| Rate for Payer: Lucent All Commercial |
$41.36
|
| Rate for Payer: PHCS All Commercial |
$35.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$24.33
|
| Rate for Payer: United Healthcare Commercial |
$18.84
|
| Rate for Payer: United Healthcare Medicare |
$24.33
|
|
|
CHG RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES
|
Professional
|
Both
|
$91.38
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
z74022
|
| Min. Negotiated Rate |
$44.29 |
| Max. Negotiated Rate |
$81.89 |
| Rate for Payer: Aetna Medicare |
$46.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$47.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$47.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.85
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$51.51
|
| Rate for Payer: Cash Price |
$56.66
|
| Rate for Payer: Cash Price |
$56.66
|
| Rate for Payer: Coventry All Commercial |
$56.20
|
| Rate for Payer: Frontpath All Commercial |
$81.89
|
| Rate for Payer: Humana ChoiceCare |
$52.11
|
| Rate for Payer: Humana Medicare |
$46.83
|
| Rate for Payer: Lucent All Commercial |
$79.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$73.00
|
| Rate for Payer: PHCS All Commercial |
$68.54
|
| Rate for Payer: PHP All Commercial |
$59.39
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.83
|
| Rate for Payer: Signature Care EPO |
$53.55
|
| Rate for Payer: Signature Care PPO |
$53.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$68.00
|
| Rate for Payer: United Healthcare Commercial |
$44.29
|
| Rate for Payer: United Healthcare Medicare |
$46.83
|
|
|
CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS
|
Professional
|
Both
|
$64.94
|
|
|
Service Code
|
CPT 73552
|
| Hospital Charge Code |
z73552
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$57.53 |
| Rate for Payer: Aetna Medicare |
$33.28
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.27
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.61
|
| Rate for Payer: Cash Price |
$40.26
|
| Rate for Payer: Cash Price |
$40.26
|
| Rate for Payer: Coventry All Commercial |
$39.94
|
| Rate for Payer: Frontpath All Commercial |
$57.53
|
| Rate for Payer: Humana ChoiceCare |
$38.18
|
| Rate for Payer: Humana Medicare |
$33.28
|
| Rate for Payer: Lucent All Commercial |
$56.58
|
| Rate for Payer: PHCS All Commercial |
$48.70
|
| Rate for Payer: PHP All Commercial |
$42.21
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.28
|
| Rate for Payer: Signature Care EPO |
$38.63
|
| Rate for Payer: Signature Care PPO |
$38.63
|
| Rate for Payer: United Healthcare Commercial |
$30.43
|
| Rate for Payer: United Healthcare Medicare |
$33.28
|
|
|
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 |
$8.73 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.49
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.49
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Frontpath All Commercial |
$5.82
|
| Rate for Payer: Humana ChoiceCare |
$5.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$8.00
|
| Rate for Payer: PHCS All Commercial |
$8.73
|
| Rate for Payer: PHP All Commercial |
$5.12
|
| Rate for Payer: Signature Care EPO |
$5.95
|
| Rate for Payer: Signature Care PPO |
$5.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$8.00
|
| 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 |
$107.30 |
| Max. Negotiated Rate |
$192.75 |
| Rate for Payer: Aetna Medicare |
$109.78
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$107.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$126.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$120.76
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Coventry All Commercial |
$131.74
|
| Rate for Payer: Frontpath All Commercial |
$192.75
|
| Rate for Payer: Humana ChoiceCare |
$127.59
|
| Rate for Payer: Humana Medicare |
$109.78
|
| Rate for Payer: Lucent All Commercial |
$186.63
|
| Rate for Payer: Lutheran Preferred All Commercial |
$170.00
|
| Rate for Payer: PHCS All Commercial |
$160.65
|
| Rate for Payer: PHP All Commercial |
$139.23
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$109.78
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$114.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.00
|
| Rate for Payer: United Healthcare Commercial |
$110.22
|
| Rate for Payer: United Healthcare Medicare |
$109.78
|
|
