|
CHG X-RAY CLAVICLE
|
Professional
|
Both
|
$58.80
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
z73000
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$52.60 |
| Rate for Payer: Aetna Medicare |
$30.13
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.14
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Coventry All Commercial |
$36.16
|
| Rate for Payer: Frontpath All Commercial |
$52.60
|
| Rate for Payer: Humana ChoiceCare |
$33.78
|
| Rate for Payer: Humana Medicare |
$30.13
|
| Rate for Payer: Lucent All Commercial |
$51.22
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.00
|
| Rate for Payer: PHCS All Commercial |
$44.10
|
| Rate for Payer: PHP All Commercial |
$38.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.13
|
| Rate for Payer: Signature Care EPO |
$33.15
|
| Rate for Payer: Signature Care PPO |
$33.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44.00
|
| Rate for Payer: United Healthcare Commercial |
$24.96
|
| Rate for Payer: United Healthcare Medicare |
$30.13
|
|
|
CHG X-RAY ELBOW 2 VW
|
Professional
|
Both
|
$53.38
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
z73070
|
| Min. Negotiated Rate |
$24.27 |
| Max. Negotiated Rate |
$47.77 |
| Rate for Payer: Aetna Medicare |
$27.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.87
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.87
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.08
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Coventry All Commercial |
$32.82
|
| Rate for Payer: Frontpath All Commercial |
$47.77
|
| Rate for Payer: Humana ChoiceCare |
$30.55
|
| Rate for Payer: Humana Medicare |
$27.35
|
| Rate for Payer: Lucent All Commercial |
$46.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.00
|
| Rate for Payer: PHCS All Commercial |
$40.04
|
| Rate for Payer: PHP All Commercial |
$34.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.35
|
| Rate for Payer: Signature Care EPO |
$33.15
|
| Rate for Payer: Signature Care PPO |
$33.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.00
|
| Rate for Payer: United Healthcare Commercial |
$24.27
|
| Rate for Payer: United Healthcare Medicare |
$27.35
|
|
|
CHG X-RAY ELBOW 3+ VW
|
Professional
|
Both
|
$59.46
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
z73080
|
| Min. Negotiated Rate |
$30.47 |
| Max. Negotiated Rate |
$53.18 |
| Rate for Payer: Aetna Medicare |
$30.47
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$32.70
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$32.70
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.04
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.52
|
| Rate for Payer: Cash Price |
$36.87
|
| Rate for Payer: Cash Price |
$36.87
|
| Rate for Payer: Coventry All Commercial |
$36.56
|
| Rate for Payer: Frontpath All Commercial |
$53.18
|
| Rate for Payer: Humana ChoiceCare |
$33.78
|
| Rate for Payer: Humana Medicare |
$30.47
|
| Rate for Payer: Lucent All Commercial |
$51.80
|
| Rate for Payer: Lutheran Preferred All Commercial |
$47.00
|
| Rate for Payer: PHCS All Commercial |
$44.60
|
| Rate for Payer: PHP All Commercial |
$38.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.47
|
| Rate for Payer: Signature Care EPO |
$36.55
|
| Rate for Payer: Signature Care PPO |
$36.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$44.00
|
| Rate for Payer: United Healthcare Commercial |
$31.05
|
| Rate for Payer: United Healthcare Medicare |
$30.47
|
|
|
CHG X-RAY EXAM OF FINGER(S)
|
Professional
|
Both
|
$68.86
|
|
|
Service Code
|
CPT 73140
|
| Hospital Charge Code |
z73140
|
| Min. Negotiated Rate |
$25.86 |
| Max. Negotiated Rate |
$61.03 |
| Rate for Payer: Aetna Medicare |
$35.29
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$49.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$49.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.58
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.82
|
| Rate for Payer: Cash Price |
$42.69
|
| Rate for Payer: Cash Price |
$42.69
|
| Rate for Payer: Coventry All Commercial |
$42.35
|
| Rate for Payer: Frontpath All Commercial |
$61.03
|
| Rate for Payer: Humana ChoiceCare |
$39.17
|
| Rate for Payer: Humana Medicare |
$35.29
|
| Rate for Payer: Lucent All Commercial |
$59.99
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.00
|
| Rate for Payer: PHCS All Commercial |
$51.64
|
| Rate for Payer: PHP All Commercial |
$44.76
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.29
|
| Rate for Payer: Signature Care EPO |
$29.78
|
| Rate for Payer: Signature Care PPO |
$29.78
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$51.00
|
| Rate for Payer: United Healthcare Commercial |
$25.86
|
| Rate for Payer: United Healthcare Medicare |
$35.29
|
|
|
CHG X-RAY FACIAL BONES <3 VW
|
Professional
|
Both
|
$58.98
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
z70140
|
| Min. Negotiated Rate |
$27.14 |
| Max. Negotiated Rate |
$52.75 |
| Rate for Payer: Aetna Medicare |
$30.22
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.24
|
| Rate for Payer: Cash Price |
$36.57
|
| Rate for Payer: Cash Price |
$36.57
|
| Rate for Payer: Coventry All Commercial |
$36.26
|
| Rate for Payer: Frontpath All Commercial |
$52.75
|
| Rate for Payer: Humana ChoiceCare |
$33.78
|
| Rate for Payer: Humana Medicare |
$30.22
|
| Rate for Payer: Lucent All Commercial |
$51.37
|
| Rate for Payer: PHCS All Commercial |
$44.24
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.22
|
| Rate for Payer: United Healthcare Commercial |
$27.14
|
| Rate for Payer: United Healthcare Medicare |
$30.22
|
|
|
CHG X-RAY FACIAL BONES 3+ VW
|
Professional
|
Both
|
$85.88
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
z70150
|
| Min. Negotiated Rate |
$38.82 |
| Max. Negotiated Rate |
$77.81 |
| Rate for Payer: Aetna Medicare |
$44.02
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.62
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$48.42
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Cash Price |
$53.25
|
| Rate for Payer: Coventry All Commercial |
$52.82
|
| Rate for Payer: Frontpath All Commercial |
$77.81
|
| Rate for Payer: Humana ChoiceCare |
$49.59
|
| Rate for Payer: Humana Medicare |
$44.02
|
| Rate for Payer: Lucent All Commercial |
$74.83
|
| Rate for Payer: PHCS All Commercial |
$64.41
|
| Rate for Payer: PHP All Commercial |
$55.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$44.02
|
| Rate for Payer: Signature Care EPO |
$52.70
|
| Rate for Payer: Signature Care PPO |
$52.70
|
| Rate for Payer: United Healthcare Commercial |
$38.82
|
| Rate for Payer: United Healthcare Medicare |
$44.02
|
|
|
CHG X-RAY FOOT 2 VW
|
Professional
|
Both
|
$51.56
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
z73620
|
| Min. Negotiated Rate |
$23.64 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Aetna Medicare |
$26.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.39
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.07
|
| Rate for Payer: Cash Price |
$31.97
|
| Rate for Payer: Cash Price |
$31.97
|
| Rate for Payer: Coventry All Commercial |
$31.72
|
| Rate for Payer: Frontpath All Commercial |
$46.15
|
| Rate for Payer: Humana ChoiceCare |
$29.83
|
| Rate for Payer: Humana Medicare |
$26.43
|
| Rate for Payer: Lucent All Commercial |
$44.93
|
| Rate for Payer: PHCS All Commercial |
$38.67
|
| Rate for Payer: PHP All Commercial |
$33.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.43
|
| Rate for Payer: Signature Care EPO |
$32.30
|
| Rate for Payer: Signature Care PPO |
$32.30
|
| Rate for Payer: United Healthcare Commercial |
$23.64
|
| Rate for Payer: United Healthcare Medicare |
$26.43
|
|
|
CHG X-RAY FOOT 3+ VW
|
Professional
|
Both
|
$62.46
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
z73630
|
| Min. Negotiated Rate |
$27.64 |
| Max. Negotiated Rate |
$56.41 |
| Rate for Payer: Aetna Medicare |
$32.01
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$34.40
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.40
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.21
|
| Rate for Payer: Cash Price |
$38.73
|
| Rate for Payer: Cash Price |
$38.73
|
| Rate for Payer: Coventry All Commercial |
$38.41
|
| Rate for Payer: Frontpath All Commercial |
$56.41
|
| Rate for Payer: Humana ChoiceCare |
$35.94
|
| Rate for Payer: Humana Medicare |
$32.01
|
| Rate for Payer: Lucent All Commercial |
$54.42
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.00
|
| Rate for Payer: PHCS All Commercial |
$46.84
|
| Rate for Payer: PHP All Commercial |
$40.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.01
|
| Rate for Payer: Signature Care EPO |
$34.85
|
| Rate for Payer: Signature Care PPO |
$34.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.00
|
| Rate for Payer: United Healthcare Commercial |
$27.64
|
| Rate for Payer: United Healthcare Medicare |
$32.01
|
|
|
CHG X-RAY FOREARM 2 VW
|
Professional
|
Both
|
$53.38
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
z73090
|
| Min. Negotiated Rate |
$24.63 |
| Max. Negotiated Rate |
$47.77 |
| Rate for Payer: Aetna Medicare |
$27.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.37
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.37
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.45
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$30.08
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Cash Price |
$33.10
|
| Rate for Payer: Coventry All Commercial |
$32.82
|
| Rate for Payer: Frontpath All Commercial |
$47.77
|
| Rate for Payer: Humana ChoiceCare |
$30.55
|
| Rate for Payer: Humana Medicare |
$27.35
|
| Rate for Payer: Lucent All Commercial |
$46.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.00
|
| Rate for Payer: PHCS All Commercial |
$40.04
|
| Rate for Payer: PHP All Commercial |
$34.69
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.35
|
| Rate for Payer: Signature Care EPO |
$33.15
|
| Rate for Payer: Signature Care PPO |
$33.15
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.00
|
| Rate for Payer: United Healthcare Commercial |
$24.63
|
| Rate for Payer: United Healthcare Medicare |
$27.35
|
|
|
CHG X-RAY HAND 2 VW
|
Professional
|
Both
|
$56.98
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
z73120
|
| Min. Negotiated Rate |
$24.30 |
| Max. Negotiated Rate |
$50.98 |
| Rate for Payer: Aetna Medicare |
$29.21
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$33.59
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.13
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Cash Price |
$35.33
|
| Rate for Payer: Coventry All Commercial |
$35.05
|
| Rate for Payer: Frontpath All Commercial |
$50.98
|
| Rate for Payer: Humana ChoiceCare |
$32.70
|
| Rate for Payer: Humana Medicare |
$29.21
|
| Rate for Payer: Lucent All Commercial |
$49.66
|
| Rate for Payer: PHCS All Commercial |
$42.74
|
| Rate for Payer: PHP All Commercial |
$37.04
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.21
|
| Rate for Payer: Signature Care EPO |
$32.30
|
| Rate for Payer: Signature Care PPO |
$32.30
|
| Rate for Payer: United Healthcare Commercial |
$24.30
|
| Rate for Payer: United Healthcare Medicare |
$29.21
|
|
|
CHG X-RAY HAND 3+ VW
|
Professional
|
Both
|
$67.28
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
z73130
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$59.64 |
| 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 |
$59.64
|
| Rate for Payer: Humana ChoiceCare |
$38.10
|
| 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 HEEL
|
Professional
|
Both
|
$52.16
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
z73650
|
| Min. Negotiated Rate |
$23.97 |
| Max. Negotiated Rate |
$47.23 |
| Rate for Payer: Aetna Medicare |
$26.74
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$27.74
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$27.74
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.41
|
| Rate for Payer: Cash Price |
$32.34
|
| Rate for Payer: Cash Price |
$32.34
|
| Rate for Payer: Coventry All Commercial |
$32.09
|
| Rate for Payer: Frontpath All Commercial |
$47.23
|
| Rate for Payer: Humana ChoiceCare |
$30.19
|
| Rate for Payer: Humana Medicare |
$26.74
|
| Rate for Payer: Lucent All Commercial |
$45.46
|
| Rate for Payer: Lutheran Preferred All Commercial |
$41.00
|
| Rate for Payer: PHCS All Commercial |
$39.12
|
| Rate for Payer: PHP All Commercial |
$33.91
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.74
|
| Rate for Payer: Signature Care EPO |
$31.45
|
| Rate for Payer: Signature Care PPO |
$31.45
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$39.00
|
| Rate for Payer: United Healthcare Commercial |
$23.97
|
| Rate for Payer: United Healthcare Medicare |
$26.74
|
|
|
CHG X-RAY HUMERUS
|
Professional
|
Both
|
$58.80
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
z73060
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$52.05 |
| Rate for Payer: Aetna Medicare |
$30.13
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.65
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.14
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Cash Price |
$36.46
|
| Rate for Payer: Coventry All Commercial |
$36.16
|
| Rate for Payer: Frontpath All Commercial |
$52.05
|
| Rate for Payer: Humana ChoiceCare |
$33.78
|
| Rate for Payer: Humana Medicare |
$30.13
|
| Rate for Payer: Lucent All Commercial |
$51.22
|
| Rate for Payer: PHCS All Commercial |
$44.10
|
| Rate for Payer: PHP All Commercial |
$38.22
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.13
|
| Rate for Payer: Signature Care EPO |
$36.55
|
| Rate for Payer: Signature Care PPO |
$36.55
|
| Rate for Payer: United Healthcare Commercial |
$26.41
|
| Rate for Payer: United Healthcare Medicare |
$30.13
|
|
|
CHG X-RAY HYSTEROSALPINGOGRAM
|
Professional
|
Both
|
$174.86
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
z74740
|
| Min. Negotiated Rate |
$70.94 |
| Max. Negotiated Rate |
$160.17 |
| Rate for Payer: Aetna Medicare |
$89.61
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$73.38
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$73.38
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$103.05
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$98.57
|
| Rate for Payer: Cash Price |
$108.41
|
| Rate for Payer: Cash Price |
$108.41
|
| Rate for Payer: Coventry All Commercial |
$107.53
|
| Rate for Payer: Frontpath All Commercial |
$160.17
|
| Rate for Payer: Humana ChoiceCare |
$102.78
|
| Rate for Payer: Humana Medicare |
$89.61
|
| Rate for Payer: Lucent All Commercial |
$152.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$139.00
|
| Rate for Payer: PHCS All Commercial |
$131.14
|
| Rate for Payer: PHP All Commercial |
$113.65
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$89.61
|
| Rate for Payer: Signature Care EPO |
$83.30
|
| Rate for Payer: Signature Care PPO |
$83.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$130.00
|
| Rate for Payer: United Healthcare Commercial |
$70.94
|
| Rate for Payer: United Healthcare Medicare |
$89.61
|
|
|
CHG X-RAY JAW <4 VW
|
Professional
|
Both
|
$53.92
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
z70100
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$62.90 |
| Rate for Payer: Aetna Medicare |
$36.06
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.47
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.67
|
| Rate for Payer: Cash Price |
$33.43
|
| Rate for Payer: Cash Price |
$33.43
|
| Rate for Payer: Coventry All Commercial |
$43.27
|
| Rate for Payer: Frontpath All Commercial |
$62.90
|
| Rate for Payer: Humana ChoiceCare |
$40.25
|
| Rate for Payer: Humana Medicare |
$36.06
|
| Rate for Payer: Lucent All Commercial |
$61.30
|
| Rate for Payer: PHCS All Commercial |
$40.44
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.06
|
| Rate for Payer: United Healthcare Commercial |
$27.67
|
| Rate for Payer: United Healthcare Medicare |
$36.06
|
|
|
CHG X-RAY JAW 4+ VW
|
Professional
|
Both
|
$79.20
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
z70110
|
| Min. Negotiated Rate |
$35.92 |
| Max. Negotiated Rate |
$71.86 |
| Rate for Payer: Aetna Medicare |
$40.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$46.68
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$44.65
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Cash Price |
$49.10
|
| Rate for Payer: Coventry All Commercial |
$48.71
|
| Rate for Payer: Frontpath All Commercial |
$71.86
|
| Rate for Payer: Humana ChoiceCare |
$45.64
|
| Rate for Payer: Humana Medicare |
$40.59
|
| Rate for Payer: Lucent All Commercial |
$69.00
|
| Rate for Payer: PHCS All Commercial |
$59.40
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$40.59
|
| Rate for Payer: United Healthcare Commercial |
$35.92
|
| Rate for Payer: United Healthcare Medicare |
$40.59
|
|
|
CHG X-RAY KNEE 1 OR 2 VIEW
|
Professional
|
Both
|
$62.40
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
z73560
|
| Min. Negotiated Rate |
$25.65 |
| Max. Negotiated Rate |
$55.81 |
| Rate for Payer: Aetna Medicare |
$31.98
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.78
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.18
|
| Rate for Payer: Cash Price |
$38.69
|
| Rate for Payer: Cash Price |
$38.69
|
| Rate for Payer: Coventry All Commercial |
$38.38
|
| Rate for Payer: Frontpath All Commercial |
$55.81
|
| Rate for Payer: Humana ChoiceCare |
$35.94
|
| Rate for Payer: Humana Medicare |
$31.98
|
| Rate for Payer: Lucent All Commercial |
$54.37
|
| Rate for Payer: PHCS All Commercial |
$46.80
|
| Rate for Payer: PHP All Commercial |
$40.57
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.98
|
| Rate for Payer: Signature Care EPO |
$34.00
|
| Rate for Payer: Signature Care PPO |
$34.00
|
| Rate for Payer: United Healthcare Commercial |
$25.65
|
| Rate for Payer: United Healthcare Medicare |
$31.98
|
|
|
CHG X-RAY KNEE 3 VIEW
|
Professional
|
Both
|
$73.98
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
z73562
|
| Min. Negotiated Rate |
$30.75 |
| Max. Negotiated Rate |
$72.30 |
| Rate for Payer: Aetna Medicare |
$37.91
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$72.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$72.30
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.60
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.70
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Cash Price |
$45.87
|
| Rate for Payer: Coventry All Commercial |
$45.49
|
| Rate for Payer: Frontpath All Commercial |
$66.66
|
| Rate for Payer: Humana ChoiceCare |
$42.41
|
| Rate for Payer: Humana Medicare |
$37.91
|
| Rate for Payer: Lucent All Commercial |
$64.45
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.00
|
| Rate for Payer: PHCS All Commercial |
$55.48
|
| Rate for Payer: PHP All Commercial |
$48.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.91
|
| Rate for Payer: Signature Care EPO |
$37.40
|
| Rate for Payer: Signature Care PPO |
$37.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.00
|
| Rate for Payer: United Healthcare Commercial |
$30.75
|
| Rate for Payer: United Healthcare Medicare |
$37.91
|
|
|
CHG X-RAY KNEE 4+ VIEW
|
Professional
|
Both
|
$85.04
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
z73564
|
| Min. Negotiated Rate |
$35.83 |
| Max. Negotiated Rate |
$75.46 |
| Rate for Payer: Aetna Medicare |
$43.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$54.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$54.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$50.13
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$47.95
|
| Rate for Payer: Cash Price |
$52.72
|
| Rate for Payer: Cash Price |
$52.72
|
| Rate for Payer: Coventry All Commercial |
$52.31
|
| Rate for Payer: Frontpath All Commercial |
$75.46
|
| Rate for Payer: Humana ChoiceCare |
$48.16
|
| Rate for Payer: Humana Medicare |
$43.59
|
| Rate for Payer: Lucent All Commercial |
$74.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$68.00
|
| Rate for Payer: PHCS All Commercial |
$63.78
|
| Rate for Payer: PHP All Commercial |
$55.28
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$43.59
|
| Rate for Payer: Signature Care EPO |
$42.50
|
| Rate for Payer: Signature Care PPO |
$42.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$63.00
|
| Rate for Payer: United Healthcare Commercial |
$35.83
|
| Rate for Payer: United Healthcare Medicare |
$43.59
|
|
|
CHG X-RAY LUMBAR SPINE 2/3 VW
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
z72100
|
| Min. Negotiated Rate |
$35.17 |
| Max. Negotiated Rate |
$65.26 |
| Rate for Payer: Aetna Medicare |
$37.41
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.60
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.60
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$43.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$41.15
|
| Rate for Payer: Cash Price |
$45.26
|
| Rate for Payer: Cash Price |
$45.26
|
| Rate for Payer: Coventry All Commercial |
$44.89
|
| Rate for Payer: Frontpath All Commercial |
$65.26
|
| Rate for Payer: Humana ChoiceCare |
$41.69
|
| Rate for Payer: Humana Medicare |
$37.41
|
| Rate for Payer: Lucent All Commercial |
$63.60
|
| Rate for Payer: Lutheran Preferred All Commercial |
$58.00
|
| Rate for Payer: PHCS All Commercial |
$54.75
|
| Rate for Payer: PHP All Commercial |
$47.45
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$37.41
|
| Rate for Payer: Signature Care EPO |
$44.20
|
| Rate for Payer: Signature Care PPO |
$44.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$54.00
|
| Rate for Payer: United Healthcare Commercial |
$35.17
|
| Rate for Payer: United Healthcare Medicare |
$37.41
|
|
|
CHG X-RAY LUMBAR SPINE 4 VW
|
Professional
|
Both
|
$93.72
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
z72110
|
| Min. Negotiated Rate |
$48.03 |
| Max. Negotiated Rate |
$83.72 |
| Rate for Payer: Aetna Medicare |
$48.03
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$62.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$62.10
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$55.23
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$52.83
|
| Rate for Payer: Cash Price |
$58.11
|
| Rate for Payer: Cash Price |
$58.11
|
| Rate for Payer: Coventry All Commercial |
$57.64
|
| Rate for Payer: Frontpath All Commercial |
$83.72
|
| Rate for Payer: Humana ChoiceCare |
$53.19
|
| Rate for Payer: Humana Medicare |
$48.03
|
| Rate for Payer: Lucent All Commercial |
$81.65
|
| Rate for Payer: Lutheran Preferred All Commercial |
$74.00
|
| Rate for Payer: PHCS All Commercial |
$70.29
|
| Rate for Payer: PHP All Commercial |
$60.92
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$48.03
|
| Rate for Payer: Signature Care EPO |
$61.20
|
| Rate for Payer: Signature Care PPO |
$61.20
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$70.00
|
| Rate for Payer: United Healthcare Commercial |
$49.11
|
| Rate for Payer: United Healthcare Medicare |
$48.03
|
|
|
CHG X-RAY NASAL BONES
|
Professional
|
Both
|
$69.70
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
z70160
|
| Min. Negotiated Rate |
$28.96 |
| Max. Negotiated Rate |
$62.32 |
| Rate for Payer: Aetna Medicare |
$35.72
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$30.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$30.31
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$41.08
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$39.29
|
| Rate for Payer: Cash Price |
$43.21
|
| Rate for Payer: Cash Price |
$43.21
|
| Rate for Payer: Coventry All Commercial |
$42.86
|
| Rate for Payer: Frontpath All Commercial |
$62.32
|
| Rate for Payer: Humana ChoiceCare |
$39.89
|
| Rate for Payer: Humana Medicare |
$35.72
|
| Rate for Payer: Lucent All Commercial |
$60.72
|
| Rate for Payer: Lutheran Preferred All Commercial |
$55.00
|
| Rate for Payer: PHCS All Commercial |
$52.28
|
| Rate for Payer: PHP All Commercial |
$45.30
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.72
|
| Rate for Payer: Signature Care EPO |
$34.00
|
| Rate for Payer: Signature Care PPO |
$34.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$52.00
|
| Rate for Payer: United Healthcare Commercial |
$28.96
|
| Rate for Payer: United Healthcare Medicare |
$35.72
|
|
|
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 Medicare |
$29.58
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$34.02
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$32.54
|
| Rate for Payer: Cash Price |
$35.77
|
| Rate for Payer: Cash Price |
$35.77
|
| Rate for Payer: Coventry All Commercial |
$35.50
|
| Rate for Payer: Frontpath All Commercial |
$51.63
|
| Rate for Payer: Humana ChoiceCare |
$33.06
|
| Rate for Payer: Humana Medicare |
$29.58
|
| Rate for Payer: Lucent All Commercial |
$50.29
|
| Rate for Payer: PHCS All Commercial |
$43.28
|
| Rate for Payer: PHP All Commercial |
$37.51
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.58
|
| Rate for Payer: Signature Care EPO |
$29.75
|
| Rate for Payer: Signature Care PPO |
$29.75
|
| Rate for Payer: United Healthcare Commercial |
$24.66
|
| Rate for Payer: United Healthcare Medicare |
$29.58
|
|
|
CHG X-RAY ORBITS
|
Professional
|
Both
|
$87.82
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
z70200
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$79.53 |
| Rate for Payer: Aetna Medicare |
$45.00
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$45.51
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$45.51
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$51.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$49.50
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Coventry All Commercial |
$54.00
|
| Rate for Payer: Frontpath All Commercial |
$79.53
|
| Rate for Payer: Humana ChoiceCare |
$50.68
|
| Rate for Payer: Humana Medicare |
$45.00
|
| Rate for Payer: Lucent All Commercial |
$76.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$70.00
|
| Rate for Payer: PHCS All Commercial |
$65.86
|
| Rate for Payer: PHP All Commercial |
$57.08
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$45.00
|
| Rate for Payer: Signature Care EPO |
$53.55
|
| Rate for Payer: Signature Care PPO |
$53.55
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$65.00
|
| Rate for Payer: United Healthcare Commercial |
$40.20
|
| Rate for Payer: United Healthcare Medicare |
$45.00
|
|
|
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 Medicare |
$26.15
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$30.07
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$28.76
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Cash Price |
$31.63
|
| Rate for Payer: Coventry All Commercial |
$31.38
|
| Rate for Payer: Frontpath All Commercial |
$45.66
|
| Rate for Payer: Humana ChoiceCare |
$29.11
|
| Rate for Payer: Humana Medicare |
$26.15
|
| Rate for Payer: Lucent All Commercial |
$44.46
|
| Rate for Payer: PHCS All Commercial |
$38.26
|
| Rate for Payer: PHP All Commercial |
$33.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$26.15
|
| Rate for Payer: Signature Care EPO |
$34.00
|
| Rate for Payer: Signature Care PPO |
$34.00
|
| Rate for Payer: United Healthcare Commercial |
$23.67
|
| Rate for Payer: United Healthcare Medicare |
$26.15
|
|
