|
CHG SONO GUIDE NEEDLE BIOPSY
|
Professional
|
Both
|
$107.32
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
z76942
|
| Min. Negotiated Rate |
$55.00 |
| Max. Negotiated Rate |
$169.34 |
| Rate for Payer: Aetna Medicare |
$55.00
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$63.25
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$60.50
|
| Rate for Payer: Cash Price |
$66.54
|
| Rate for Payer: Cash Price |
$66.54
|
| Rate for Payer: Coventry All Commercial |
$66.00
|
| Rate for Payer: Frontpath All Commercial |
$96.34
|
| Rate for Payer: Humana ChoiceCare |
$157.91
|
| Rate for Payer: Humana Medicare |
$55.00
|
| Rate for Payer: Lucent All Commercial |
$93.50
|
| Rate for Payer: PHCS All Commercial |
$80.49
|
| Rate for Payer: PHP All Commercial |
$69.75
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$55.00
|
| Rate for Payer: Signature Care EPO |
$93.74
|
| Rate for Payer: Signature Care PPO |
$93.74
|
| Rate for Payer: United Healthcare Commercial |
$169.34
|
| Rate for Payer: United Healthcare Medicare |
$55.00
|
|
|
CHG SONO PELVIS LIMITED
|
Professional
|
Both
|
$90.02
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
z76857
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$91.92 |
| Rate for Payer: Aetna Medicare |
$46.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$67.50
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$67.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$53.06
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$50.75
|
| Rate for Payer: Cash Price |
$55.81
|
| Rate for Payer: Cash Price |
$55.81
|
| Rate for Payer: Coventry All Commercial |
$55.37
|
| Rate for Payer: Frontpath All Commercial |
$79.15
|
| Rate for Payer: Humana ChoiceCare |
$50.32
|
| Rate for Payer: Humana Medicare |
$46.14
|
| Rate for Payer: Lucent All Commercial |
$78.44
|
| Rate for Payer: Lutheran Preferred All Commercial |
$72.00
|
| Rate for Payer: PHCS All Commercial |
$67.52
|
| Rate for Payer: PHP All Commercial |
$58.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$46.14
|
| Rate for Payer: Signature Care EPO |
$76.48
|
| Rate for Payer: Signature Care PPO |
$76.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$67.00
|
| Rate for Payer: United Healthcare Commercial |
$91.92
|
| Rate for Payer: United Healthcare Medicare |
$46.14
|
|
|
CHG STREP A, DNA, AMP PROBE
|
Professional
|
Both
|
$70.18
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
z87651
|
| Min. Negotiated Rate |
$17.13 |
| Max. Negotiated Rate |
$52.64 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$17.13
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$17.13
|
| Rate for Payer: Cash Price |
$43.51
|
| Rate for Payer: Cash Price |
$43.51
|
| Rate for Payer: Frontpath All Commercial |
$35.09
|
| Rate for Payer: Humana ChoiceCare |
$35.09
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: PHCS All Commercial |
$52.64
|
| Rate for Payer: PHP All Commercial |
$30.88
|
| Rate for Payer: Signature Care EPO |
$45.90
|
| Rate for Payer: Signature Care PPO |
$45.90
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.00
|
| Rate for Payer: United Healthcare Commercial |
$30.75
|
|
|
CHG TB INTRADERMAL TEST
|
Professional
|
Both
|
$17.78
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
z86580
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$15.49 |
| Rate for Payer: Aetna Medicare |
$9.11
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$4.12
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$4.12
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$10.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$10.02
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: Cash Price |
$11.02
|
| Rate for Payer: Coventry All Commercial |
$10.93
|
| Rate for Payer: Frontpath All Commercial |
$9.86
|
| Rate for Payer: Humana ChoiceCare |
$9.11
|
| Rate for Payer: Humana Medicare |
$9.11
|
| Rate for Payer: Lucent All Commercial |
$15.49
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.00
|
| Rate for Payer: PHCS All Commercial |
$13.34
|
| Rate for Payer: PHP All Commercial |
$7.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.11
|
| Rate for Payer: Signature Care EPO |
$8.50
|
| Rate for Payer: Signature Care PPO |
$8.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$12.00
|
| Rate for Payer: United Healthcare Commercial |
$6.39
|
| Rate for Payer: United Healthcare Medicare |
$9.11
|
|
|
CHG URINALYSIS, AUTO, W/O SCOPE
|
Professional
|
Both
|
$4.50
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
z81003
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$3.38 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$3.06
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$3.06
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Frontpath All Commercial |
$2.25
|
| Rate for Payer: Humana ChoiceCare |
$2.25
|
| Rate for Payer: Lutheran Preferred All Commercial |
$3.00
|
| Rate for Payer: PHCS All Commercial |
$3.38
|
| Rate for Payer: PHP All Commercial |
$1.98
|
| Rate for Payer: Signature Care EPO |
$2.60
|
| Rate for Payer: Signature Care PPO |
$2.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$3.00
|
| Rate for Payer: United Healthcare Commercial |
$3.28
|
|
|
CHG URINALYSIS NONAUTO W/O SCOPE
|
Professional
|
Both
|
$6.96
|
|
|
Service Code
|
CPT 81002
|
| Hospital Charge Code |
z81002
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$5.22 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.09
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Frontpath All Commercial |
$3.48
|
| Rate for Payer: Humana ChoiceCare |
$3.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$5.00
|
| Rate for Payer: PHCS All Commercial |
$5.22
|
| Rate for Payer: PHP All Commercial |
$3.06
|
| Rate for Payer: Signature Care EPO |
$3.40
|
| Rate for Payer: Signature Care PPO |
$3.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$5.00
|
| Rate for Payer: United Healthcare Commercial |
$3.74
|
|
|
CHG URINE PREGNANCY TEST
|
Professional
|
Both
|
$17.22
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
z81025
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$12.92 |
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$5.17
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$5.17
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: Cash Price |
$10.68
|
| Rate for Payer: Frontpath All Commercial |
$8.61
|
| Rate for Payer: Humana ChoiceCare |
$8.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$12.00
|
| Rate for Payer: PHCS All Commercial |
$12.92
|
| Rate for Payer: PHP All Commercial |
$7.58
|
| Rate for Payer: Signature Care EPO |
$8.50
|
| Rate for Payer: Signature Care PPO |
$8.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$11.00
|
| Rate for Payer: United Healthcare Commercial |
$9.24
|
|
|
CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG
|
Professional
|
Both
|
$76.06
|
|
|
Service Code
|
CPT 76882
|
| Hospital Charge Code |
z76882
|
| Min. Negotiated Rate |
$30.22 |
| Max. Negotiated Rate |
$92.53 |
| Rate for Payer: Aetna Medicare |
$40.24
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.28
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.26
|
| Rate for Payer: Cash Price |
$47.16
|
| Rate for Payer: Cash Price |
$47.16
|
| Rate for Payer: Coventry All Commercial |
$48.29
|
| Rate for Payer: Frontpath All Commercial |
$92.53
|
| Rate for Payer: Humana ChoiceCare |
$59.30
|
| Rate for Payer: Humana Medicare |
$40.24
|
| Rate for Payer: Lucent All Commercial |
$68.41
|
| Rate for Payer: PHCS All Commercial |
$57.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.24
|
| Rate for Payer: United Healthcare Commercial |
$30.22
|
| Rate for Payer: United Healthcare Medicare |
$40.24
|
|
|
CHG US, OB < 14 WKS, ADD'L FETUS
|
Professional
|
Both
|
$113.96
|
|
|
Service Code
|
CPT 76802
|
| Hospital Charge Code |
z76802
|
| Min. Negotiated Rate |
$58.41 |
| Max. Negotiated Rate |
$102.42 |
| Rate for Payer: Aetna Medicare |
$58.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$65.09
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$65.09
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$67.17
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$64.25
|
| Rate for Payer: Cash Price |
$70.66
|
| Rate for Payer: Cash Price |
$70.66
|
| Rate for Payer: Coventry All Commercial |
$70.09
|
| Rate for Payer: Frontpath All Commercial |
$102.42
|
| Rate for Payer: Humana ChoiceCare |
$65.77
|
| Rate for Payer: Humana Medicare |
$58.41
|
| Rate for Payer: Lucent All Commercial |
$99.30
|
| Rate for Payer: Lutheran Preferred All Commercial |
$91.00
|
| Rate for Payer: PHCS All Commercial |
$85.47
|
| Rate for Payer: PHP All Commercial |
$74.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$58.41
|
| Rate for Payer: Signature Care EPO |
$100.23
|
| Rate for Payer: Signature Care PPO |
$100.23
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$85.00
|
| Rate for Payer: United Healthcare Commercial |
$68.82
|
| Rate for Payer: United Healthcare Medicare |
$58.41
|
|
|
CHG US, OB >/= 14 WKS, ADDL FETUS
|
Professional
|
Both
|
$163.96
|
|
|
Service Code
|
CPT 76810
|
| Hospital Charge Code |
z76810
|
| Min. Negotiated Rate |
$84.03 |
| Max. Negotiated Rate |
$170.72 |
| Rate for Payer: Aetna Medicare |
$84.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$170.72
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$170.72
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$96.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$92.43
|
| Rate for Payer: Cash Price |
$101.66
|
| Rate for Payer: Cash Price |
$101.66
|
| Rate for Payer: Coventry All Commercial |
$100.84
|
| Rate for Payer: Frontpath All Commercial |
$146.81
|
| Rate for Payer: Humana ChoiceCare |
$95.95
|
| Rate for Payer: Humana Medicare |
$84.03
|
| Rate for Payer: Lucent All Commercial |
$142.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$130.00
|
| Rate for Payer: PHCS All Commercial |
$122.97
|
| Rate for Payer: PHP All Commercial |
$106.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$84.03
|
| Rate for Payer: Signature Care EPO |
$114.75
|
| Rate for Payer: Signature Care PPO |
$114.75
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$122.00
|
| Rate for Payer: United Healthcare Commercial |
$93.27
|
| Rate for Payer: United Healthcare Medicare |
$84.03
|
|
|
CHG US, OB < 14 WKS, SINGLE FETUS
|
Professional
|
Both
|
$217.62
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
z76801
|
| Min. Negotiated Rate |
$111.53 |
| Max. Negotiated Rate |
$194.67 |
| Rate for Payer: Aetna Medicare |
$111.53
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$134.41
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$134.41
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.68
|
| Rate for Payer: Cash Price |
$134.92
|
| Rate for Payer: Cash Price |
$134.92
|
| Rate for Payer: Coventry All Commercial |
$133.84
|
| Rate for Payer: Frontpath All Commercial |
$194.67
|
| Rate for Payer: Humana ChoiceCare |
$127.95
|
| Rate for Payer: Humana Medicare |
$111.53
|
| Rate for Payer: Lucent All Commercial |
$189.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.00
|
| Rate for Payer: PHCS All Commercial |
$163.22
|
| Rate for Payer: PHP All Commercial |
$141.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$111.53
|
| Rate for Payer: Signature Care EPO |
$165.33
|
| Rate for Payer: Signature Care PPO |
$165.33
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$162.00
|
| Rate for Payer: United Healthcare Commercial |
$120.94
|
| Rate for Payer: United Healthcare Medicare |
$111.53
|
|
|
CHG US, OB >/= 14 WKS, SNGL FETUS
|
Professional
|
Both
|
$249.86
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
z76805
|
| Min. Negotiated Rate |
$128.05 |
| Max. Negotiated Rate |
$223.14 |
| Rate for Payer: Aetna Medicare |
$128.05
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$143.89
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$143.89
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$147.26
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$140.86
|
| Rate for Payer: Cash Price |
$154.91
|
| Rate for Payer: Cash Price |
$154.91
|
| Rate for Payer: Coventry All Commercial |
$153.66
|
| Rate for Payer: Frontpath All Commercial |
$223.14
|
| Rate for Payer: Humana ChoiceCare |
$147.35
|
| Rate for Payer: Humana Medicare |
$128.05
|
| Rate for Payer: Lucent All Commercial |
$217.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$198.00
|
| Rate for Payer: PHCS All Commercial |
$187.40
|
| Rate for Payer: PHP All Commercial |
$162.41
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$128.05
|
| Rate for Payer: Signature Care EPO |
$158.10
|
| Rate for Payer: Signature Care PPO |
$158.10
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$186.00
|
| Rate for Payer: United Healthcare Commercial |
$134.52
|
| Rate for Payer: United Healthcare Medicare |
$128.05
|
|
|
CHG US,PREGNANT UTERUS,F/U,TRANSABD APP
|
Professional
|
Both
|
$202.32
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
z76816
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$181.59 |
| Rate for Payer: Aetna Medicare |
$103.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$119.24
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$114.06
|
| Rate for Payer: Cash Price |
$125.44
|
| Rate for Payer: Cash Price |
$125.44
|
| Rate for Payer: Coventry All Commercial |
$124.43
|
| Rate for Payer: Frontpath All Commercial |
$181.59
|
| Rate for Payer: Humana ChoiceCare |
$119.68
|
| Rate for Payer: Humana Medicare |
$103.69
|
| Rate for Payer: Lucent All Commercial |
$176.27
|
| Rate for Payer: Lutheran Preferred All Commercial |
$161.00
|
| Rate for Payer: PHCS All Commercial |
$151.74
|
| Rate for Payer: PHP All Commercial |
$131.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$103.69
|
| Rate for Payer: Signature Care EPO |
$92.55
|
| Rate for Payer: Signature Care PPO |
$92.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$150.00
|
| Rate for Payer: United Healthcare Commercial |
$103.01
|
| Rate for Payer: United Healthcare Medicare |
$103.69
|
|
|
CHG US,PREGNANT UTERUS,LIMITED, 1/> FETUSES
|
Professional
|
Both
|
$149.96
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
z76815
|
| Min. Negotiated Rate |
$76.86 |
| Max. Negotiated Rate |
$134.91 |
| Rate for Payer: Aetna Medicare |
$76.86
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$94.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$94.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$88.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$84.55
|
| Rate for Payer: Cash Price |
$92.98
|
| Rate for Payer: Cash Price |
$92.98
|
| Rate for Payer: Coventry All Commercial |
$92.23
|
| Rate for Payer: Frontpath All Commercial |
$134.91
|
| Rate for Payer: Humana ChoiceCare |
$88.78
|
| Rate for Payer: Humana Medicare |
$76.86
|
| Rate for Payer: Lucent All Commercial |
$130.66
|
| Rate for Payer: Lutheran Preferred All Commercial |
$119.00
|
| Rate for Payer: PHCS All Commercial |
$112.47
|
| Rate for Payer: PHP All Commercial |
$97.48
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$76.86
|
| Rate for Payer: Signature Care EPO |
$106.25
|
| Rate for Payer: Signature Care PPO |
$106.25
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$111.00
|
| Rate for Payer: United Healthcare Commercial |
$83.76
|
| Rate for Payer: United Healthcare Medicare |
$76.86
|
|
|
CHG US,PREGNANT UTERUS,TRANSVAGINAL
|
Professional
|
Both
|
$171.04
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
z76817
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$154.22 |
| Rate for Payer: Aetna Medicare |
$87.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$96.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$96.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$100.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$96.42
|
| Rate for Payer: Cash Price |
$106.04
|
| Rate for Payer: Cash Price |
$106.04
|
| Rate for Payer: Coventry All Commercial |
$105.18
|
| Rate for Payer: Frontpath All Commercial |
$154.22
|
| Rate for Payer: Humana ChoiceCare |
$101.35
|
| Rate for Payer: Humana Medicare |
$87.65
|
| Rate for Payer: Lucent All Commercial |
$149.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$136.00
|
| Rate for Payer: PHCS All Commercial |
$128.28
|
| Rate for Payer: PHP All Commercial |
$111.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$87.65
|
| Rate for Payer: Signature Care EPO |
$150.86
|
| Rate for Payer: Signature Care PPO |
$150.86
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$127.00
|
| Rate for Payer: United Healthcare Commercial |
$93.56
|
| Rate for Payer: United Healthcare Medicare |
$87.65
|
|
|
CHG US,PREG UTER,FET & MAT,+ DETL FET,ADDL
|
Professional
|
Both
|
$355.10
|
|
|
Service Code
|
CPT 76812
|
| Hospital Charge Code |
z76812
|
| Min. Negotiated Rate |
$109.81 |
| Max. Negotiated Rate |
$320.52 |
| Rate for Payer: Aetna Medicare |
$181.99
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$109.81
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$109.81
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$209.29
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$200.19
|
| Rate for Payer: Cash Price |
$220.16
|
| Rate for Payer: Cash Price |
$220.16
|
| Rate for Payer: Coventry All Commercial |
$218.39
|
| Rate for Payer: Frontpath All Commercial |
$320.52
|
| Rate for Payer: Humana ChoiceCare |
$209.17
|
| Rate for Payer: Humana Medicare |
$181.99
|
| Rate for Payer: Lucent All Commercial |
$309.38
|
| Rate for Payer: Lutheran Preferred All Commercial |
$282.00
|
| Rate for Payer: PHCS All Commercial |
$266.32
|
| Rate for Payer: PHP All Commercial |
$230.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$181.99
|
| Rate for Payer: Signature Care EPO |
$166.35
|
| Rate for Payer: Signature Care PPO |
$166.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$264.00
|
| Rate for Payer: United Healthcare Commercial |
$186.03
|
| Rate for Payer: United Healthcare Medicare |
$181.99
|
|
|
CHG US,PREG UTER,FET & MAT,+ DETL FET EXM
|
Professional
|
Both
|
$326.32
|
|
|
Service Code
|
CPT 76811
|
| Hospital Charge Code |
z76811
|
| Min. Negotiated Rate |
$167.24 |
| Max. Negotiated Rate |
$289.66 |
| Rate for Payer: Aetna Medicare |
$167.24
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$239.97
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$239.97
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$192.33
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$183.96
|
| Rate for Payer: Cash Price |
$202.32
|
| Rate for Payer: Cash Price |
$202.32
|
| Rate for Payer: Coventry All Commercial |
$200.69
|
| Rate for Payer: Frontpath All Commercial |
$289.66
|
| Rate for Payer: Humana ChoiceCare |
$185.09
|
| Rate for Payer: Humana Medicare |
$167.24
|
| Rate for Payer: Lucent All Commercial |
$284.31
|
| Rate for Payer: Lutheran Preferred All Commercial |
$259.00
|
| Rate for Payer: PHCS All Commercial |
$244.74
|
| Rate for Payer: PHP All Commercial |
$212.11
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$167.24
|
| Rate for Payer: Signature Care EPO |
$283.15
|
| Rate for Payer: Signature Care PPO |
$283.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$242.00
|
| Rate for Payer: United Healthcare Commercial |
$190.01
|
| Rate for Payer: United Healthcare Medicare |
$167.24
|
|
|
CHG US,PREG UTER,NUCHAL MEAS, 1ST TRI,ADDL GEST
|
Professional
|
Both
|
$139.90
|
|
|
Service Code
|
CPT 76814
|
| Hospital Charge Code |
z76814
|
| Min. Negotiated Rate |
$71.69 |
| Max. Negotiated Rate |
$126.99 |
| Rate for Payer: Aetna Medicare |
$71.69
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$85.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$85.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$82.44
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$78.86
|
| Rate for Payer: Cash Price |
$86.74
|
| Rate for Payer: Cash Price |
$86.74
|
| Rate for Payer: Coventry All Commercial |
$86.03
|
| Rate for Payer: Frontpath All Commercial |
$126.99
|
| Rate for Payer: Humana ChoiceCare |
$89.79
|
| Rate for Payer: Humana Medicare |
$71.69
|
| Rate for Payer: Lucent All Commercial |
$121.87
|
| Rate for Payer: Lutheran Preferred All Commercial |
$111.00
|
| Rate for Payer: PHCS All Commercial |
$104.92
|
| Rate for Payer: PHP All Commercial |
$90.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$71.69
|
| Rate for Payer: Signature Care EPO |
$96.05
|
| Rate for Payer: Signature Care PPO |
$96.05
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$104.00
|
| Rate for Payer: United Healthcare Commercial |
$77.56
|
| Rate for Payer: United Healthcare Medicare |
$71.69
|
|
|
CHG US,PREG UTER,NUCHAL MEAS, 1ST TRIMEST, SINGLETON
|
Professional
|
Both
|
$217.54
|
|
|
Service Code
|
CPT 76813
|
| Hospital Charge Code |
z76813
|
| Min. Negotiated Rate |
$111.49 |
| Max. Negotiated Rate |
$196.18 |
| Rate for Payer: Aetna Medicare |
$111.49
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$126.19
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$126.19
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$128.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$122.64
|
| Rate for Payer: Cash Price |
$134.87
|
| Rate for Payer: Cash Price |
$134.87
|
| Rate for Payer: Coventry All Commercial |
$133.79
|
| Rate for Payer: Frontpath All Commercial |
$196.18
|
| Rate for Payer: Humana ChoiceCare |
$136.64
|
| Rate for Payer: Humana Medicare |
$111.49
|
| Rate for Payer: Lucent All Commercial |
$189.53
|
| Rate for Payer: Lutheran Preferred All Commercial |
$173.00
|
| Rate for Payer: PHCS All Commercial |
$163.16
|
| Rate for Payer: PHP All Commercial |
$141.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$111.49
|
| Rate for Payer: Signature Care EPO |
$145.35
|
| Rate for Payer: Signature Care PPO |
$145.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$162.00
|
| Rate for Payer: United Healthcare Commercial |
$118.51
|
| Rate for Payer: United Healthcare Medicare |
$111.49
|
|
|
CHG VENOGRAM EXTREM UNILAT
|
Professional
|
Both
|
$200.56
|
|
|
Service Code
|
CPT 75820
|
| Hospital Charge Code |
z75820
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$183.68 |
| Rate for Payer: Aetna Medicare |
$102.79
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$81.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$81.20
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$118.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$113.07
|
| Rate for Payer: Cash Price |
$124.35
|
| Rate for Payer: Cash Price |
$124.35
|
| Rate for Payer: Coventry All Commercial |
$123.35
|
| Rate for Payer: Frontpath All Commercial |
$183.68
|
| Rate for Payer: Humana ChoiceCare |
$123.99
|
| Rate for Payer: Humana Medicare |
$102.79
|
| Rate for Payer: Lucent All Commercial |
$174.74
|
| Rate for Payer: Lutheran Preferred All Commercial |
$159.00
|
| Rate for Payer: PHCS All Commercial |
$150.42
|
| Rate for Payer: PHP All Commercial |
$130.36
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$102.79
|
| Rate for Payer: Signature Care EPO |
$91.91
|
| Rate for Payer: Signature Care PPO |
$91.91
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$149.00
|
| Rate for Payer: United Healthcare Commercial |
$109.63
|
| Rate for Payer: United Healthcare Medicare |
$102.79
|
|
|
CHG X-RAY AC JTS
|
Professional
|
Both
|
$52.28
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
z73050
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$46.78 |
| Rate for Payer: Aetna Medicare |
$26.80
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.82
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.48
|
| Rate for Payer: Cash Price |
$32.41
|
| Rate for Payer: Cash Price |
$32.41
|
| Rate for Payer: Coventry All Commercial |
$32.16
|
| Rate for Payer: Frontpath All Commercial |
$46.78
|
| Rate for Payer: Humana ChoiceCare |
$29.83
|
| Rate for Payer: Humana Medicare |
$26.80
|
| Rate for Payer: Lucent All Commercial |
$45.56
|
| Rate for Payer: PHCS All Commercial |
$39.21
|
| Rate for Payer: PHP All Commercial |
$33.99
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.80
|
| Rate for Payer: Signature Care EPO |
$43.35
|
| Rate for Payer: Signature Care PPO |
$43.35
|
| Rate for Payer: United Healthcare Commercial |
$32.46
|
| Rate for Payer: United Healthcare Medicare |
$26.80
|
|
|
CHG X-RAY ANKLE 2 VW
|
Professional
|
Both
|
$59.40
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
z73600
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$52.60 |
| Rate for Payer: Aetna Medicare |
$30.44
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.48
|
| Rate for Payer: Cash Price |
$36.83
|
| Rate for Payer: Cash Price |
$36.83
|
| Rate for Payer: Coventry All Commercial |
$36.53
|
| Rate for Payer: Frontpath All Commercial |
$52.60
|
| Rate for Payer: Humana ChoiceCare |
$34.14
|
| Rate for Payer: Humana Medicare |
$30.44
|
| Rate for Payer: Lucent All Commercial |
$51.75
|
| Rate for Payer: PHCS All Commercial |
$44.55
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.44
|
| Rate for Payer: United Healthcare Commercial |
$24.30
|
| Rate for Payer: United Healthcare Medicare |
$30.44
|
|
|
CHG X-RAY ANKLE 3+ VW
|
Professional
|
Both
|
$67.28
|
|
|
Service Code
|
CPT 73610
|
| Hospital Charge Code |
z73610
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$60.16 |
| Rate for Payer: Aetna Medicare |
$34.48
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$37.93
|
| Rate for Payer: Cash Price |
$41.71
|
| Rate for Payer: Cash Price |
$41.71
|
| Rate for Payer: Coventry All Commercial |
$41.38
|
| Rate for Payer: Frontpath All Commercial |
$60.16
|
| Rate for Payer: Humana ChoiceCare |
$38.46
|
| Rate for Payer: Humana Medicare |
$34.48
|
| Rate for Payer: Lucent All Commercial |
$58.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$53.00
|
| Rate for Payer: PHCS All Commercial |
$50.46
|
| Rate for Payer: PHP All Commercial |
$43.74
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.48
|
| Rate for Payer: Signature Care EPO |
$34.85
|
| Rate for Payer: Signature Care PPO |
$34.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50.00
|
| Rate for Payer: United Healthcare Commercial |
$27.97
|
| Rate for Payer: United Healthcare Medicare |
$34.48
|
|
|
CHG X-RAY ARM, INFANT
|
Professional
|
Both
|
$43.08
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
z73092
|
| Min. Negotiated Rate |
$25.29 |
| Max. Negotiated Rate |
$52.05 |
| Rate for Payer: Aetna Medicare |
$29.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.94
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.46
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Cash Price |
$26.71
|
| Rate for Payer: Coventry All Commercial |
$35.41
|
| Rate for Payer: Frontpath All Commercial |
$52.05
|
| Rate for Payer: Humana ChoiceCare |
$33.06
|
| Rate for Payer: Humana Medicare |
$29.51
|
| Rate for Payer: Lucent All Commercial |
$50.17
|
| Rate for Payer: PHCS All Commercial |
$32.31
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.51
|
| Rate for Payer: United Healthcare Commercial |
$25.29
|
| Rate for Payer: United Healthcare Medicare |
$29.51
|
|
|
CHG X-RAY CERV SPINE 4 VW
|
Professional
|
Both
|
$97.40
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
z72050
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$110.10 |
| Rate for Payer: Aetna Medicare |
$49.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$110.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$110.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$57.40
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.90
|
| Rate for Payer: Cash Price |
$60.39
|
| Rate for Payer: Cash Price |
$60.39
|
| Rate for Payer: Coventry All Commercial |
$59.89
|
| Rate for Payer: Frontpath All Commercial |
$86.99
|
| Rate for Payer: Humana ChoiceCare |
$55.35
|
| Rate for Payer: Humana Medicare |
$49.91
|
| Rate for Payer: Lucent All Commercial |
$84.85
|
| Rate for Payer: Lutheran Preferred All Commercial |
$77.00
|
| Rate for Payer: PHCS All Commercial |
$73.05
|
| Rate for Payer: PHP All Commercial |
$63.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.91
|
| Rate for Payer: Signature Care EPO |
$60.35
|
| Rate for Payer: Signature Care PPO |
$60.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$72.00
|
| Rate for Payer: United Healthcare Commercial |
$47.46
|
| Rate for Payer: United Healthcare Medicare |
$49.91
|
|
