|
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 |
$60.42 |
| Rate for Payer: Aetna Medicare |
$34.64
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$34.52
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$34.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$39.84
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.10
|
| Rate for Payer: Cash Price |
$41.90
|
| Rate for Payer: Cash Price |
$41.90
|
| Rate for Payer: Coventry All Commercial |
$41.57
|
| Rate for Payer: Frontpath All Commercial |
$60.42
|
| Rate for Payer: Humana ChoiceCare |
$38.46
|
| Rate for Payer: Humana Medicare |
$34.64
|
| Rate for Payer: Lucent All Commercial |
$58.89
|
| Rate for Payer: Lutheran Preferred All Commercial |
$54.00
|
| Rate for Payer: PHCS All Commercial |
$50.68
|
| Rate for Payer: PHP All Commercial |
$43.93
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$34.64
|
| Rate for Payer: Signature Care EPO |
$39.95
|
| Rate for Payer: Signature Care PPO |
$39.95
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$50.00
|
| Rate for Payer: United Healthcare Commercial |
$29.87
|
| Rate for Payer: United Healthcare Medicare |
$34.64
|
|
|
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 |
$69.27 |
| Rate for Payer: Aetna Medicare |
$39.73
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$41.16
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$41.16
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$45.69
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$43.70
|
| Rate for Payer: Cash Price |
$48.06
|
| Rate for Payer: Cash Price |
$48.06
|
| Rate for Payer: Coventry All Commercial |
$47.68
|
| Rate for Payer: Frontpath All Commercial |
$69.27
|
| Rate for Payer: Humana ChoiceCare |
$44.21
|
| Rate for Payer: Humana Medicare |
$39.73
|
| Rate for Payer: Lucent All Commercial |
$67.54
|
| Rate for Payer: Lutheran Preferred All Commercial |
$62.00
|
| Rate for Payer: PHCS All Commercial |
$58.14
|
| Rate for Payer: PHP All Commercial |
$50.38
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$39.73
|
| Rate for Payer: Signature Care EPO |
$47.60
|
| Rate for Payer: Signature Care PPO |
$47.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$58.00
|
| Rate for Payer: United Healthcare Commercial |
$35.98
|
| Rate for Payer: United Healthcare Medicare |
$39.73
|
|
|
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 |
$86.17 |
| Rate for Payer: Aetna Medicare |
$49.30
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$52.95
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$52.95
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$56.70
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$54.23
|
| Rate for Payer: Cash Price |
$59.64
|
| Rate for Payer: Cash Price |
$59.64
|
| Rate for Payer: Coventry All Commercial |
$59.16
|
| Rate for Payer: Frontpath All Commercial |
$86.17
|
| Rate for Payer: Humana ChoiceCare |
$54.99
|
| Rate for Payer: Humana Medicare |
$49.30
|
| Rate for Payer: Lucent All Commercial |
$83.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$76.00
|
| Rate for Payer: PHCS All Commercial |
$72.15
|
| Rate for Payer: PHP All Commercial |
$62.52
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$49.30
|
| Rate for Payer: Signature Care EPO |
$60.35
|
| Rate for Payer: Signature Care PPO |
$60.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$71.00
|
| Rate for Payer: United Healthcare Commercial |
$47.49
|
| Rate for Payer: United Healthcare Medicare |
$49.30
|
|
|
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 Medicare |
$36.83
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.51
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Coventry All Commercial |
$44.20
|
| Rate for Payer: Frontpath All Commercial |
$64.23
|
| Rate for Payer: Humana ChoiceCare |
$40.97
|
| Rate for Payer: Humana Medicare |
$36.83
|
| Rate for Payer: Lucent All Commercial |
$62.61
|
| Rate for Payer: PHCS All Commercial |
$53.90
|
| Rate for Payer: PHP All Commercial |
$46.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.83
|
| Rate for Payer: Signature Care EPO |
$39.95
|
| Rate for Payer: Signature Care PPO |
$39.95
|
| Rate for Payer: United Healthcare Commercial |
$31.77
|
| Rate for Payer: United Healthcare Medicare |
$36.83
|
|
|
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 Medicare |
$30.47
|
| 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: 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: United Healthcare Commercial |
$26.75
|
| Rate for Payer: United Healthcare Medicare |
$30.47
|
|
|
CHG X-RAY SCAPULA
|
Professional
|
Both
|
$43.20
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
z73010
|
| Min. Negotiated Rate |
$22.14 |
| Max. Negotiated Rate |
$39.22 |
| Rate for Payer: Aetna Medicare |
$22.14
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.62
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.62
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$25.46
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$24.35
|
| Rate for Payer: Cash Price |
$26.78
|
| Rate for Payer: Cash Price |
$26.78
|
| Rate for Payer: Coventry All Commercial |
$26.57
|
| Rate for Payer: Frontpath All Commercial |
$39.22
|
| Rate for Payer: Humana ChoiceCare |
$24.80
|
| Rate for Payer: Humana Medicare |
$22.14
|
| Rate for Payer: Lucent All Commercial |
$37.64
|
| Rate for Payer: Lutheran Preferred All Commercial |
$34.00
|
| Rate for Payer: PHCS All Commercial |
$32.40
|
| Rate for Payer: PHP All Commercial |
$28.07
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$22.14
|
| Rate for Payer: Signature Care EPO |
$34.00
|
| Rate for Payer: Signature Care PPO |
$34.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$32.00
|
| Rate for Payer: United Healthcare Commercial |
$25.65
|
| Rate for Payer: United Healthcare Medicare |
$22.14
|
|
|
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 |
$56.46 |
| Rate for Payer: Aetna Medicare |
$32.35
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$51.90
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$51.90
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$37.20
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$35.58
|
| Rate for Payer: Cash Price |
$39.13
|
| Rate for Payer: Cash Price |
$39.13
|
| Rate for Payer: Coventry All Commercial |
$38.82
|
| Rate for Payer: Frontpath All Commercial |
$56.46
|
| Rate for Payer: Humana ChoiceCare |
$35.94
|
| Rate for Payer: Humana Medicare |
$32.35
|
| Rate for Payer: Lucent All Commercial |
$55.00
|
| Rate for Payer: Lutheran Preferred All Commercial |
$50.00
|
| Rate for Payer: PHCS All Commercial |
$47.34
|
| Rate for Payer: PHP All Commercial |
$41.03
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$32.35
|
| Rate for Payer: Signature Care EPO |
$37.40
|
| Rate for Payer: Signature Care PPO |
$37.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$47.00
|
| Rate for Payer: United Healthcare Commercial |
$27.11
|
| Rate for Payer: United Healthcare Medicare |
$32.35
|
|
|
CHG X-RAY SINUSES 3+ VW
|
Professional
|
Both
|
$49.10
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
z70220
|
| Min. Negotiated Rate |
$35.25 |
| Max. Negotiated Rate |
$62.03 |
| Rate for Payer: Aetna Medicare |
$35.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$40.54
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$38.78
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Cash Price |
$30.44
|
| Rate for Payer: Coventry All Commercial |
$42.30
|
| Rate for Payer: Frontpath All Commercial |
$62.03
|
| Rate for Payer: Humana ChoiceCare |
$39.53
|
| Rate for Payer: Humana Medicare |
$35.25
|
| Rate for Payer: Lucent All Commercial |
$59.92
|
| Rate for Payer: PHCS All Commercial |
$36.82
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$35.25
|
| Rate for Payer: United Healthcare Commercial |
$35.48
|
| Rate for Payer: United Healthcare Medicare |
$35.25
|
|
|
CHG X-RAY SKULL <4 VW
|
Professional
|
Both
|
$65.54
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
z70250
|
| Min. Negotiated Rate |
$32.91 |
| Max. Negotiated Rate |
$58.60 |
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$37.99
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$37.99
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$38.63
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$36.95
|
| Rate for Payer: Cash Price |
$40.63
|
| Rate for Payer: Cash Price |
$40.63
|
| Rate for Payer: Coventry All Commercial |
$40.31
|
| Rate for Payer: Frontpath All Commercial |
$58.60
|
| Rate for Payer: Humana ChoiceCare |
$37.38
|
| Rate for Payer: Humana Medicare |
$33.59
|
| Rate for Payer: Lucent All Commercial |
$57.10
|
| Rate for Payer: Lutheran Preferred All Commercial |
$52.00
|
| Rate for Payer: PHCS All Commercial |
$49.16
|
| Rate for Payer: PHP All Commercial |
$42.60
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$33.59
|
| Rate for Payer: Signature Care EPO |
$43.35
|
| Rate for Payer: Signature Care PPO |
$43.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$49.00
|
| Rate for Payer: United Healthcare Commercial |
$32.91
|
| Rate for Payer: United Healthcare Medicare |
$33.59
|
|
|
CHG X-RAY SKULL 4+ VW
|
Professional
|
Both
|
$81.78
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
z70260
|
| Min. Negotiated Rate |
$41.92 |
| Max. Negotiated Rate |
$73.63 |
| Rate for Payer: Aetna Medicare |
$41.92
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$48.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$46.11
|
| Rate for Payer: Cash Price |
$50.70
|
| Rate for Payer: Cash Price |
$50.70
|
| Rate for Payer: Coventry All Commercial |
$50.30
|
| Rate for Payer: Frontpath All Commercial |
$73.63
|
| Rate for Payer: Humana ChoiceCare |
$47.08
|
| Rate for Payer: Humana Medicare |
$41.92
|
| Rate for Payer: Lucent All Commercial |
$71.26
|
| Rate for Payer: PHCS All Commercial |
$61.34
|
| Rate for Payer: PHP All Commercial |
$53.16
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.92
|
| Rate for Payer: Signature Care EPO |
$61.20
|
| Rate for Payer: Signature Care PPO |
$61.20
|
| Rate for Payer: United Healthcare Commercial |
$43.79
|
| Rate for Payer: United Healthcare Medicare |
$41.92
|
|
|
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: Humana Medicare |
$23.03
|
| Rate for Payer: Aetna Medicare |
$23.03
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$26.48
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$25.33
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Cash Price |
$18.87
|
| Rate for Payer: Coventry All Commercial |
$27.64
|
| Rate for Payer: Frontpath All Commercial |
$40.24
|
| Rate for Payer: Humana ChoiceCare |
$25.87
|
| Rate for Payer: Lucent All Commercial |
$39.15
|
| Rate for Payer: PHCS All Commercial |
$22.83
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$23.03
|
| Rate for Payer: United Healthcare Commercial |
$21.62
|
| Rate for Payer: United Healthcare Medicare |
$23.03
|
|
|
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 Medicare |
$31.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.21
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.64
|
| Rate for Payer: Cash Price |
$38.09
|
| Rate for Payer: Cash Price |
$38.09
|
| Rate for Payer: Coventry All Commercial |
$37.79
|
| Rate for Payer: Frontpath All Commercial |
$55.49
|
| Rate for Payer: Humana ChoiceCare |
$35.23
|
| Rate for Payer: Humana Medicare |
$31.49
|
| Rate for Payer: Lucent All Commercial |
$53.53
|
| Rate for Payer: PHCS All Commercial |
$46.08
|
| Rate for Payer: PHP All Commercial |
$39.94
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.49
|
| Rate for Payer: Signature Care EPO |
$46.50
|
| Rate for Payer: Signature Care PPO |
$46.50
|
| Rate for Payer: United Healthcare Commercial |
$29.81
|
| Rate for Payer: United Healthcare Medicare |
$31.49
|
|
|
CHG X-RAY THORACIC SPINE 2 VW
|
Professional
|
Both
|
$60.24
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
z72070
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$53.87 |
| Rate for Payer: Aetna Medicare |
$30.87
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$36.59
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$36.59
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$35.50
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$33.96
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Cash Price |
$37.35
|
| Rate for Payer: Coventry All Commercial |
$37.04
|
| Rate for Payer: Frontpath All Commercial |
$53.87
|
| Rate for Payer: Humana ChoiceCare |
$34.14
|
| Rate for Payer: Humana Medicare |
$30.87
|
| Rate for Payer: Lucent All Commercial |
$52.48
|
| Rate for Payer: Lutheran Preferred All Commercial |
$48.00
|
| Rate for Payer: PHCS All Commercial |
$45.18
|
| Rate for Payer: PHP All Commercial |
$39.15
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$30.87
|
| Rate for Payer: Signature Care EPO |
$43.35
|
| Rate for Payer: Signature Care PPO |
$43.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$45.00
|
| Rate for Payer: United Healthcare Commercial |
$30.87
|
| Rate for Payer: United Healthcare Medicare |
$30.87
|
|
|
CHG X-RAY THORACIC SPINE 4 VW
|
Professional
|
Both
|
$58.74
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
z72074
|
| Min. Negotiated Rate |
$40.90 |
| Max. Negotiated Rate |
$72.93 |
| Rate for Payer: Aetna Medicare |
$41.52
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$47.75
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$45.67
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Cash Price |
$36.42
|
| Rate for Payer: Coventry All Commercial |
$49.82
|
| Rate for Payer: Frontpath All Commercial |
$72.93
|
| Rate for Payer: Humana ChoiceCare |
$46.72
|
| Rate for Payer: Humana Medicare |
$41.52
|
| Rate for Payer: Lucent All Commercial |
$70.58
|
| Rate for Payer: PHCS All Commercial |
$44.06
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$41.52
|
| Rate for Payer: United Healthcare Commercial |
$40.90
|
| Rate for Payer: United Healthcare Medicare |
$41.52
|
|
|
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 |
$64.23 |
| Rate for Payer: Aetna Medicare |
$36.83
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$39.84
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$39.84
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$42.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$40.51
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Coventry All Commercial |
$44.20
|
| Rate for Payer: Frontpath All Commercial |
$64.23
|
| Rate for Payer: Humana ChoiceCare |
$40.97
|
| Rate for Payer: Humana Medicare |
$36.83
|
| Rate for Payer: Lucent All Commercial |
$62.61
|
| Rate for Payer: Lutheran Preferred All Commercial |
$57.00
|
| Rate for Payer: PHCS All Commercial |
$53.90
|
| Rate for Payer: PHP All Commercial |
$46.71
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$36.83
|
| Rate for Payer: Signature Care EPO |
$47.60
|
| Rate for Payer: Signature Care PPO |
$47.60
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$53.00
|
| Rate for Payer: United Healthcare Commercial |
$35.06
|
| Rate for Payer: United Healthcare Medicare |
$36.83
|
|
|
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 |
$51.53 |
| Rate for Payer: Aetna Medicare |
$29.51
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$29.27
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$29.27
|
| 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 |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Coventry All Commercial |
$35.41
|
| Rate for Payer: Frontpath All Commercial |
$51.53
|
| 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: Lutheran Preferred All Commercial |
$46.00
|
| Rate for Payer: PHCS All Commercial |
$43.18
|
| Rate for Payer: PHP All Commercial |
$37.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$29.51
|
| Rate for Payer: Signature Care EPO |
$34.00
|
| Rate for Payer: Signature Care PPO |
$34.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$43.00
|
| Rate for Payer: United Healthcare Commercial |
$24.66
|
| Rate for Payer: United Healthcare Medicare |
$29.51
|
|
|
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 |
$47.60 |
| Rate for Payer: Aetna Medicare |
$27.26
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$25.25
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$25.25
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$31.35
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$29.99
|
| Rate for Payer: Cash Price |
$32.98
|
| Rate for Payer: Cash Price |
$32.98
|
| Rate for Payer: Coventry All Commercial |
$32.71
|
| Rate for Payer: Frontpath All Commercial |
$47.60
|
| Rate for Payer: Humana ChoiceCare |
$30.55
|
| Rate for Payer: Humana Medicare |
$27.26
|
| Rate for Payer: Lucent All Commercial |
$46.34
|
| Rate for Payer: Lutheran Preferred All Commercial |
$42.00
|
| Rate for Payer: PHCS All Commercial |
$39.90
|
| Rate for Payer: PHP All Commercial |
$34.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$27.26
|
| Rate for Payer: Signature Care EPO |
$26.35
|
| Rate for Payer: Signature Care PPO |
$26.35
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$40.00
|
| Rate for Payer: United Healthcare Commercial |
$24.54
|
| Rate for Payer: United Healthcare Medicare |
$27.26
|
|
|
CHG X-RAY WRIST 2 VW
|
Professional
|
Both
|
$61.80
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
z73100
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$55.28 |
| Rate for Payer: Aetna Medicare |
$31.68
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$28.43
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$28.43
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$36.43
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$34.85
|
| Rate for Payer: Cash Price |
$38.32
|
| Rate for Payer: Cash Price |
$38.32
|
| Rate for Payer: Coventry All Commercial |
$38.02
|
| Rate for Payer: Frontpath All Commercial |
$55.28
|
| Rate for Payer: Humana ChoiceCare |
$35.58
|
| Rate for Payer: Humana Medicare |
$31.68
|
| Rate for Payer: Lucent All Commercial |
$53.86
|
| Rate for Payer: Lutheran Preferred All Commercial |
$49.00
|
| Rate for Payer: PHCS All Commercial |
$46.35
|
| Rate for Payer: PHP All Commercial |
$40.17
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$31.68
|
| Rate for Payer: Signature Care EPO |
$32.30
|
| Rate for Payer: Signature Care PPO |
$32.30
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$46.00
|
| Rate for Payer: United Healthcare Commercial |
$25.62
|
| Rate for Payer: United Healthcare Medicare |
$31.68
|
|
|
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 |
$66.61 |
| Rate for Payer: Aetna Medicare |
$38.19
|
| 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 |
$43.92
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$42.01
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Coventry All Commercial |
$45.83
|
| Rate for Payer: Frontpath All Commercial |
$66.61
|
| Rate for Payer: Humana ChoiceCare |
$42.41
|
| Rate for Payer: Humana Medicare |
$38.19
|
| Rate for Payer: Lucent All Commercial |
$64.92
|
| Rate for Payer: Lutheran Preferred All Commercial |
$59.00
|
| Rate for Payer: PHCS All Commercial |
$55.89
|
| Rate for Payer: PHP All Commercial |
$48.43
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$38.19
|
| Rate for Payer: Signature Care EPO |
$34.85
|
| Rate for Payer: Signature Care PPO |
$34.85
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$55.00
|
| Rate for Payer: United Healthcare Commercial |
$30.62
|
| Rate for Payer: United Healthcare Medicare |
$38.19
|
|
|
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 |
$2.48
|
| 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
|
|
|
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 |
$1.32 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.45
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Centivo All Commercial |
$2.04
|
| 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 |
$2.04
|
| Rate for Payer: Lucent All Commercial |
$2.04
|
| 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 |
$1.32
|
|
|
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
NDC 00555015802
|
| Hospital Charge Code |
1624
|
|
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 |
$2.48
|
| 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
|
|
|
CHLORDIAZEPOXIDE HCL 5 MG ORAL CAP
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
NDC 00555015802
|
| Hospital Charge Code |
1624
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$3.72 |
| Rate for Payer: Aetna Commercial |
$3.38
|
| Rate for Payer: Aetna Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$1.32
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$2.30
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$2.50
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$1.52
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$1.45
|
| Rate for Payer: Cash Price |
$2.48
|
| Rate for Payer: Centivo All Commercial |
$2.04
|
| 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 |
$2.04
|
| Rate for Payer: Lucent All Commercial |
$2.04
|
| 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 |
$1.32
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MM MWSH
|
Facility
|
OP
|
$23.18
|
|
|
Service Code
|
NDC 00116200116
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$7.65 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Aetna Commercial |
$19.56
|
| Rate for Payer: Aetna Medicare |
$7.65
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$7.65
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$13.31
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$14.49
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$8.80
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$8.41
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: Centivo All Commercial |
$11.82
|
| Rate for Payer: Cigna All Commercial |
$20.00
|
| Rate for Payer: CORVEL All Commercial |
$21.55
|
| Rate for Payer: Coventry All Commercial |
$20.40
|
| Rate for Payer: Encore All Commercial |
$21.33
|
| Rate for Payer: Frontpath All Commercial |
$21.32
|
| Rate for Payer: Humana ChoiceCare |
$20.02
|
| Rate for Payer: Humana Medicare |
$11.82
|
| Rate for Payer: Lucent All Commercial |
$11.82
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.86
|
| Rate for Payer: PHCS All Commercial |
$17.38
|
| Rate for Payer: PHP All Commercial |
$17.58
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$9.04
|
| Rate for Payer: Sagamore Health Network All Products |
$17.89
|
| Rate for Payer: Signature Care EPO |
$19.24
|
| Rate for Payer: Signature Care PPO |
$20.40
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$19.70
|
| Rate for Payer: United Healthcare Commercial |
$18.26
|
| Rate for Payer: United Healthcare Medicare |
$7.65
|
|
|
CHLORHEXIDINE GLUCONATE 0.12 % MM MWSH
|
Facility
|
IP
|
$23.18
|
|
|
Service Code
|
NDC 00116200116
|
| Hospital Charge Code |
9516
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Aetna Commercial |
$20.02
|
| Rate for Payer: Cash Price |
$14.37
|
| Rate for Payer: Cigna All Commercial |
$20.00
|
| Rate for Payer: CORVEL All Commercial |
$21.55
|
| Rate for Payer: Coventry All Commercial |
$20.40
|
| Rate for Payer: Encore All Commercial |
$21.33
|
| Rate for Payer: Frontpath All Commercial |
$21.32
|
| Rate for Payer: Humana ChoiceCare |
$20.02
|
| Rate for Payer: Lutheran Preferred All Commercial |
$20.86
|
| Rate for Payer: PHCS All Commercial |
$17.38
|
| Rate for Payer: PHP All Commercial |
$17.58
|
| Rate for Payer: Sagamore Health Network All Products |
$17.89
|
| Rate for Payer: Signature Care EPO |
$19.24
|
| Rate for Payer: Signature Care PPO |
$20.40
|
| Rate for Payer: United Healthcare Commercial |
$18.26
|
|
