|
CHG X-RAY SHOULDER 2+ VW
|
Professional
|
$63.12
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
Z12896
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$75.74 |
| Rate for Payer: Aetna Medicare |
$32.35
|
| Rate for Payer: Anthem Exchange |
$51.90
|
| Rate for Payer: Anthem Medicare |
$32.35
|
| Rate for Payer: Anthem PPO |
$51.90
|
| Rate for Payer: Anthem Traditional |
$51.90
|
| Rate for Payer: Caresource Just 4 Me |
$37.20
|
| Rate for Payer: Caresource Medicare |
$35.59
|
| Rate for Payer: Centivo/Paragon All Products |
$50.14
|
| Rate for Payer: Coventry/First Health All Products |
$75.74
|
| Rate for Payer: Frontpath All Products |
$56.46
|
| Rate for Payer: Humana ChoiceCare |
$63.12
|
| Rate for Payer: Humana Medicare |
$32.35
|
| Rate for Payer: Lucent/Coldwater Veneers |
$54.99
|
| Rate for Payer: Lutheran Preferred All Products |
$50.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$47.34
|
| Rate for Payer: PHP All Products |
$41.03
|
| Rate for Payer: Plain Church Group Ministry All Products |
$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 Products |
$47.00
|
| Rate for Payer: United Healthcare Commercial |
$27.11
|
|
|
CHG X-RAY SKULL <4 VW
|
Professional
|
$65.54
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
Z12874
|
| Min. Negotiated Rate |
$32.91 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Anthem Exchange |
$37.99
|
| Rate for Payer: Anthem Medicare |
$33.59
|
| Rate for Payer: Anthem PPO |
$37.99
|
| Rate for Payer: Anthem Traditional |
$37.99
|
| Rate for Payer: Caresource Just 4 Me |
$38.63
|
| Rate for Payer: Caresource Medicare |
$36.95
|
| Rate for Payer: Centivo/Paragon All Products |
$52.06
|
| Rate for Payer: Coventry/First Health All Products |
$78.65
|
| Rate for Payer: Frontpath All Products |
$58.60
|
| Rate for Payer: Humana ChoiceCare |
$65.54
|
| Rate for Payer: Humana Medicare |
$33.59
|
| Rate for Payer: Lucent/Coldwater Veneers |
$57.10
|
| Rate for Payer: Lutheran Preferred All Products |
$52.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$49.16
|
| Rate for Payer: PHP All Products |
$42.60
|
| Rate for Payer: Plain Church Group Ministry All Products |
$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 Products |
$49.00
|
| Rate for Payer: United Healthcare Commercial |
$32.91
|
|
|
CHG X-RAY SKULL 4+ VW
|
Professional
|
$81.78
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
Z12875
|
| Min. Negotiated Rate |
$41.92 |
| Max. Negotiated Rate |
$98.14 |
| Rate for Payer: Aetna Medicare |
$41.92
|
| Rate for Payer: Anthem Medicare |
$41.92
|
| Rate for Payer: Caresource Just 4 Me |
$48.21
|
| Rate for Payer: Caresource Medicare |
$46.11
|
| Rate for Payer: Centivo/Paragon All Products |
$64.98
|
| Rate for Payer: Coventry/First Health All Products |
$98.14
|
| Rate for Payer: Frontpath All Products |
$73.63
|
| Rate for Payer: Humana ChoiceCare |
$81.78
|
| Rate for Payer: Humana Medicare |
$41.92
|
| Rate for Payer: Lucent/Coldwater Veneers |
$71.26
|
| Rate for Payer: PHCS/Multiplan All Products |
$61.34
|
| Rate for Payer: PHP All Products |
$53.16
|
| Rate for Payer: Plain Church Group Ministry All Products |
$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
|
|
|
CHG X-RAY STERNUM 2+ VW
|
Professional
|
$61.44
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
Z12882
|
| Min. Negotiated Rate |
$29.81 |
| Max. Negotiated Rate |
$73.73 |
| Rate for Payer: Aetna Medicare |
$31.49
|
| Rate for Payer: Anthem Medicare |
$31.49
|
| Rate for Payer: Caresource Just 4 Me |
$36.21
|
| Rate for Payer: Caresource Medicare |
$34.64
|
| Rate for Payer: Centivo/Paragon All Products |
$48.81
|
| Rate for Payer: Coventry/First Health All Products |
$73.73
|
| Rate for Payer: Frontpath All Products |
$55.49
|
| Rate for Payer: Humana ChoiceCare |
$61.44
|
| Rate for Payer: Humana Medicare |
$31.49
|
| Rate for Payer: Lucent/Coldwater Veneers |
$53.53
|
| Rate for Payer: PHCS/Multiplan All Products |
$46.08
|
| Rate for Payer: PHP All Products |
$39.94
|
| Rate for Payer: Plain Church Group Ministry All Products |
$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
|
|
|
CHG X-RAY THORACIC SPINE 2 VW
|
Professional
|
$60.24
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
Z12885
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$72.29 |
| Rate for Payer: Aetna Medicare |
$30.87
|
| Rate for Payer: Anthem Exchange |
$36.59
|
| Rate for Payer: Anthem Medicare |
$30.87
|
| Rate for Payer: Anthem PPO |
$36.59
|
| Rate for Payer: Anthem Traditional |
$36.59
|
| Rate for Payer: Caresource Just 4 Me |
$35.50
|
| Rate for Payer: Caresource Medicare |
$33.96
|
| Rate for Payer: Centivo/Paragon All Products |
$47.85
|
| Rate for Payer: Coventry/First Health All Products |
$72.29
|
| Rate for Payer: Frontpath All Products |
$53.87
|
| Rate for Payer: Humana ChoiceCare |
$60.24
|
| Rate for Payer: Humana Medicare |
$30.87
|
| Rate for Payer: Lucent/Coldwater Veneers |
$52.48
|
| Rate for Payer: Lutheran Preferred All Products |
$48.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$45.18
|
| Rate for Payer: PHP All Products |
$39.15
|
| Rate for Payer: Plain Church Group Ministry All Products |
$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 Products |
$45.00
|
| Rate for Payer: United Healthcare Commercial |
$30.87
|
|
|
CHG X-RAY THORACIC SPINE+SWIM 3 VW
|
Professional
|
$71.86
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
Z12886
|
| Min. Negotiated Rate |
$35.06 |
| Max. Negotiated Rate |
$86.23 |
| Rate for Payer: Aetna Medicare |
$36.83
|
| Rate for Payer: Anthem Exchange |
$39.84
|
| Rate for Payer: Anthem Medicare |
$36.83
|
| Rate for Payer: Anthem PPO |
$39.84
|
| Rate for Payer: Anthem Traditional |
$39.84
|
| Rate for Payer: Caresource Just 4 Me |
$42.35
|
| Rate for Payer: Caresource Medicare |
$40.51
|
| Rate for Payer: Centivo/Paragon All Products |
$57.09
|
| Rate for Payer: Coventry/First Health All Products |
$86.23
|
| Rate for Payer: Frontpath All Products |
$64.23
|
| Rate for Payer: Humana ChoiceCare |
$71.86
|
| Rate for Payer: Humana Medicare |
$36.83
|
| Rate for Payer: Lucent/Coldwater Veneers |
$62.61
|
| Rate for Payer: Lutheran Preferred All Products |
$57.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$53.89
|
| Rate for Payer: PHP All Products |
$46.71
|
| Rate for Payer: Plain Church Group Ministry All Products |
$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 Products |
$53.00
|
| Rate for Payer: United Healthcare Commercial |
$35.06
|
|
|
CHG X-RAY TIB + FIB, 2VW
|
Professional
|
$57.58
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
Z12917
|
| Min. Negotiated Rate |
$24.66 |
| Max. Negotiated Rate |
$69.10 |
| Rate for Payer: Aetna Medicare |
$29.51
|
| Rate for Payer: Anthem Exchange |
$29.27
|
| Rate for Payer: Anthem Medicare |
$29.51
|
| Rate for Payer: Anthem PPO |
$29.27
|
| Rate for Payer: Anthem Traditional |
$29.27
|
| Rate for Payer: Caresource Just 4 Me |
$33.94
|
| Rate for Payer: Caresource Medicare |
$32.46
|
| Rate for Payer: Centivo/Paragon All Products |
$45.74
|
| Rate for Payer: Coventry/First Health All Products |
$69.10
|
| Rate for Payer: Frontpath All Products |
$51.53
|
| Rate for Payer: Humana ChoiceCare |
$57.58
|
| Rate for Payer: Humana Medicare |
$29.51
|
| Rate for Payer: Lucent/Coldwater Veneers |
$50.17
|
| Rate for Payer: Lutheran Preferred All Products |
$46.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$43.19
|
| Rate for Payer: PHP All Products |
$37.43
|
| Rate for Payer: Plain Church Group Ministry All Products |
$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 Products |
$43.00
|
| Rate for Payer: United Healthcare Commercial |
$24.66
|
|
|
CHG X-RAY TOE(S)
|
Professional
|
$53.20
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
Z12923
|
| Min. Negotiated Rate |
$24.54 |
| Max. Negotiated Rate |
$63.84 |
| Rate for Payer: Aetna Medicare |
$27.26
|
| Rate for Payer: Anthem Exchange |
$25.25
|
| Rate for Payer: Anthem Medicare |
$27.26
|
| Rate for Payer: Anthem PPO |
$25.25
|
| Rate for Payer: Anthem Traditional |
$25.25
|
| Rate for Payer: Caresource Just 4 Me |
$31.35
|
| Rate for Payer: Caresource Medicare |
$29.99
|
| Rate for Payer: Centivo/Paragon All Products |
$42.25
|
| Rate for Payer: Coventry/First Health All Products |
$63.84
|
| Rate for Payer: Frontpath All Products |
$47.60
|
| Rate for Payer: Humana ChoiceCare |
$53.20
|
| Rate for Payer: Humana Medicare |
$27.26
|
| Rate for Payer: Lucent/Coldwater Veneers |
$46.34
|
| Rate for Payer: Lutheran Preferred All Products |
$42.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$39.90
|
| Rate for Payer: PHP All Products |
$34.58
|
| Rate for Payer: Plain Church Group Ministry All Products |
$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 Products |
$40.00
|
| Rate for Payer: United Healthcare Commercial |
$24.54
|
|
|
CHG X-RAY WRIST 2 VW
|
Professional
|
$61.80
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
Z12904
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$74.16 |
| Rate for Payer: Aetna Medicare |
$31.68
|
| Rate for Payer: Anthem Exchange |
$28.43
|
| Rate for Payer: Anthem Medicare |
$31.68
|
| Rate for Payer: Anthem PPO |
$28.43
|
| Rate for Payer: Anthem Traditional |
$28.43
|
| Rate for Payer: Caresource Just 4 Me |
$36.43
|
| Rate for Payer: Caresource Medicare |
$34.85
|
| Rate for Payer: Centivo/Paragon All Products |
$49.10
|
| Rate for Payer: Coventry/First Health All Products |
$74.16
|
| Rate for Payer: Frontpath All Products |
$55.28
|
| Rate for Payer: Humana ChoiceCare |
$61.80
|
| Rate for Payer: Humana Medicare |
$31.68
|
| Rate for Payer: Lucent/Coldwater Veneers |
$53.86
|
| Rate for Payer: Lutheran Preferred All Products |
$49.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$46.35
|
| Rate for Payer: PHP All Products |
$40.17
|
| Rate for Payer: Plain Church Group Ministry All Products |
$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 Products |
$46.00
|
| Rate for Payer: United Healthcare Commercial |
$25.62
|
|
|
CHG X-RAY WRIST 2 VW
|
Professional
|
$61.80
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
Z12905
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$74.16 |
| Rate for Payer: Aetna Medicare |
$31.68
|
| Rate for Payer: Anthem Exchange |
$28.43
|
| Rate for Payer: Anthem Medicare |
$31.68
|
| Rate for Payer: Anthem PPO |
$28.43
|
| Rate for Payer: Anthem Traditional |
$28.43
|
| Rate for Payer: Caresource Just 4 Me |
$36.43
|
| Rate for Payer: Caresource Medicare |
$34.85
|
| Rate for Payer: Centivo/Paragon All Products |
$49.10
|
| Rate for Payer: Coventry/First Health All Products |
$74.16
|
| Rate for Payer: Frontpath All Products |
$55.28
|
| Rate for Payer: Humana ChoiceCare |
$61.80
|
| Rate for Payer: Humana Medicare |
$31.68
|
| Rate for Payer: Lucent/Coldwater Veneers |
$53.86
|
| Rate for Payer: Lutheran Preferred All Products |
$49.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$46.35
|
| Rate for Payer: PHP All Products |
$40.17
|
| Rate for Payer: Plain Church Group Ministry All Products |
$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 Products |
$46.00
|
| Rate for Payer: United Healthcare Commercial |
$25.62
|
|
|
CHG X-RAY WRIST 2 VW
|
Professional
|
$61.80
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
Z12906
|
| Min. Negotiated Rate |
$25.62 |
| Max. Negotiated Rate |
$74.16 |
| Rate for Payer: Aetna Medicare |
$31.68
|
| Rate for Payer: Anthem Exchange |
$28.43
|
| Rate for Payer: Anthem Medicare |
$31.68
|
| Rate for Payer: Anthem PPO |
$28.43
|
| Rate for Payer: Anthem Traditional |
$28.43
|
| Rate for Payer: Caresource Just 4 Me |
$36.43
|
| Rate for Payer: Caresource Medicare |
$34.85
|
| Rate for Payer: Centivo/Paragon All Products |
$49.10
|
| Rate for Payer: Coventry/First Health All Products |
$74.16
|
| Rate for Payer: Frontpath All Products |
$55.28
|
| Rate for Payer: Humana ChoiceCare |
$61.80
|
| Rate for Payer: Humana Medicare |
$31.68
|
| Rate for Payer: Lucent/Coldwater Veneers |
$53.86
|
| Rate for Payer: Lutheran Preferred All Products |
$49.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$46.35
|
| Rate for Payer: PHP All Products |
$40.17
|
| Rate for Payer: Plain Church Group Ministry All Products |
$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 Products |
$46.00
|
| Rate for Payer: United Healthcare Commercial |
$25.62
|
|
|
CHG X-RAY WRIST 3+ VW
|
Professional
|
$74.52
|
|
|
Service Code
|
CPT 73110
|
| Hospital Charge Code |
Z12907
|
| Min. Negotiated Rate |
$30.62 |
| Max. Negotiated Rate |
$89.42 |
| Rate for Payer: Aetna Medicare |
$38.19
|
| Rate for Payer: Anthem Exchange |
$51.40
|
| Rate for Payer: Anthem Medicare |
$38.19
|
| Rate for Payer: Anthem PPO |
$51.40
|
| Rate for Payer: Anthem Traditional |
$51.40
|
| Rate for Payer: Caresource Just 4 Me |
$43.92
|
| Rate for Payer: Caresource Medicare |
$42.01
|
| Rate for Payer: Centivo/Paragon All Products |
$59.19
|
| Rate for Payer: Coventry/First Health All Products |
$89.42
|
| Rate for Payer: Frontpath All Products |
$66.61
|
| Rate for Payer: Humana ChoiceCare |
$74.52
|
| Rate for Payer: Humana Medicare |
$38.19
|
| Rate for Payer: Lucent/Coldwater Veneers |
$64.92
|
| Rate for Payer: Lutheran Preferred All Products |
$59.00
|
| Rate for Payer: PHCS/Multiplan All Products |
$55.89
|
| Rate for Payer: PHP All Products |
$48.43
|
| Rate for Payer: Plain Church Group Ministry All Products |
$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 Products |
$55.00
|
| Rate for Payer: United Healthcare Commercial |
$30.62
|
|
|
HC 14FR FIRM INTUB STYLET
|
Facility
OP
|
$6.58
|
|
| Hospital Charge Code |
41608050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Signature Care PPO |
$5.79
|
| Rate for Payer: Aetna Commercial |
$5.55
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: Anthem Exchange |
$3.78
|
| Rate for Payer: Anthem Medicare |
$2.17
|
| Rate for Payer: Anthem PPO |
$3.78
|
| Rate for Payer: Anthem Traditional |
$4.11
|
| Rate for Payer: Caresource Just 4 Me |
$2.50
|
| Rate for Payer: Caresource Medicare |
$2.39
|
| Rate for Payer: Centivo/Paragon All Products |
$3.36
|
| Rate for Payer: Cigna All Products |
$5.68
|
| Rate for Payer: Coventry/First Health All Products |
$5.79
|
| Rate for Payer: Encore All Products |
$6.06
|
| Rate for Payer: Frontpath All Products |
$6.05
|
| Rate for Payer: Humana ChoiceCare |
$5.68
|
| Rate for Payer: Humana Medicare |
$3.36
|
| Rate for Payer: Lucent/Coldwater Veneers |
$3.36
|
| Rate for Payer: Lutheran Preferred All Products |
$5.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$4.94
|
| Rate for Payer: PHP All Products |
$4.99
|
| Rate for Payer: Plain Church Group Ministry All Products |
$2.57
|
| Rate for Payer: Sagamore All Products |
$5.08
|
| Rate for Payer: Self Pay/Cash Rate |
$4.08
|
| Rate for Payer: Signature Care EPO |
$5.46
|
| Rate for Payer: Three Rivers Preferred All Products |
$5.59
|
| Rate for Payer: United Healthcare Commercial |
$5.19
|
| Rate for Payer: United Healthcare Medicare |
$2.17
|
|
|
HC 14FR FIRM INTUB STYLET
|
Facility
IP
|
$6.58
|
|
| Hospital Charge Code |
41608050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Aetna Commercial |
$5.69
|
| Rate for Payer: Cigna All Products |
$5.68
|
| Rate for Payer: Coventry/First Health All Products |
$5.79
|
| Rate for Payer: Encore All Products |
$6.06
|
| Rate for Payer: Frontpath All Products |
$6.05
|
| Rate for Payer: Humana ChoiceCare |
$5.68
|
| Rate for Payer: Lutheran Preferred All Products |
$5.92
|
| Rate for Payer: PHCS/Multiplan All Products |
$4.94
|
| Rate for Payer: PHP All Products |
$4.99
|
| Rate for Payer: Sagamore All Products |
$5.08
|
| Rate for Payer: Self Pay/Cash Rate |
$4.08
|
| Rate for Payer: Signature Care EPO |
$5.46
|
| Rate for Payer: Signature Care PPO |
$5.79
|
| Rate for Payer: United Healthcare Commercial |
$5.19
|
|
|
HC 17 HYDROXYPROGESTRERONE-16 & YOUNGER
|
Facility
OP
|
$172.54
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
63001574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$158.82 |
| Rate for Payer: Aetna Commercial |
$145.62
|
| Rate for Payer: Aetna Medicare |
$56.94
|
| Rate for Payer: Anthem Exchange |
$79.30
|
| Rate for Payer: Anthem Medicaid |
$27.17
|
| Rate for Payer: Anthem Medicare |
$56.94
|
| Rate for Payer: Anthem PPO |
$79.30
|
| Rate for Payer: Anthem Traditional |
$79.30
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$27.17
|
| Rate for Payer: Caresource Just 4 Me |
$65.48
|
| Rate for Payer: Caresource Medicare |
$62.63
|
| Rate for Payer: Centivo/Paragon All Products |
$88.00
|
| Rate for Payer: Cigna All Products |
$148.90
|
| Rate for Payer: Coventry/First Health All Products |
$151.84
|
| Rate for Payer: Encore All Products |
$158.82
|
| Rate for Payer: Frontpath All Products |
$158.74
|
| Rate for Payer: Humana ChoiceCare |
$149.02
|
| Rate for Payer: Humana Medicare |
$88.00
|
| Rate for Payer: Lucent/Coldwater Veneers |
$88.00
|
| Rate for Payer: Lutheran Preferred All Products |
$155.29
|
| Rate for Payer: Managed Health Services All Products |
$27.17
|
| Rate for Payer: MDWise All Products |
$27.17
|
| Rate for Payer: PHCS/Multiplan All Products |
$129.41
|
| Rate for Payer: PHP All Products |
$130.85
|
| Rate for Payer: Plain Church Group Ministry All Products |
$67.29
|
| Rate for Payer: Sagamore All Products |
$133.20
|
| Rate for Payer: Self Pay/Cash Rate |
$106.97
|
| Rate for Payer: Signature Care EPO |
$143.21
|
| Rate for Payer: Signature Care PPO |
$151.84
|
| Rate for Payer: Three Rivers Preferred All Products |
$146.66
|
| Rate for Payer: United Healthcare Commercial |
$135.96
|
| Rate for Payer: United Healthcare Medicare |
$56.94
|
|
|
HC 17 HYDROXYPROGESTRERONE-16 & YOUNGER
|
Facility
IP
|
$172.54
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
63001574
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.97 |
| Max. Negotiated Rate |
$158.82 |
| Rate for Payer: Aetna Commercial |
$149.07
|
| Rate for Payer: Cigna All Products |
$148.90
|
| Rate for Payer: Coventry/First Health All Products |
$151.84
|
| Rate for Payer: Encore All Products |
$158.82
|
| Rate for Payer: Frontpath All Products |
$158.74
|
| Rate for Payer: Humana ChoiceCare |
$149.02
|
| Rate for Payer: Lutheran Preferred All Products |
$155.29
|
| Rate for Payer: PHCS/Multiplan All Products |
$129.41
|
| Rate for Payer: PHP All Products |
$130.85
|
| Rate for Payer: Sagamore All Products |
$133.20
|
| Rate for Payer: Self Pay/Cash Rate |
$106.97
|
| Rate for Payer: Signature Care EPO |
$143.21
|
| Rate for Payer: Signature Care PPO |
$151.84
|
| Rate for Payer: United Healthcare Commercial |
$135.96
|
|
|
HC 17 HYDROXYPROGESTRERONE-ADULTS
|
Facility
IP
|
$231.00
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
63001575
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.22 |
| Max. Negotiated Rate |
$212.64 |
| Rate for Payer: Aetna Commercial |
$199.58
|
| Rate for Payer: Cigna All Products |
$199.35
|
| Rate for Payer: Coventry/First Health All Products |
$203.28
|
| Rate for Payer: Encore All Products |
$212.64
|
| Rate for Payer: Frontpath All Products |
$212.52
|
| Rate for Payer: Humana ChoiceCare |
$199.51
|
| Rate for Payer: Lutheran Preferred All Products |
$207.90
|
| Rate for Payer: PHCS/Multiplan All Products |
$173.25
|
| Rate for Payer: PHP All Products |
$175.19
|
| Rate for Payer: Sagamore All Products |
$178.33
|
| Rate for Payer: Self Pay/Cash Rate |
$143.22
|
| Rate for Payer: Signature Care EPO |
$191.73
|
| Rate for Payer: Signature Care PPO |
$203.28
|
| Rate for Payer: United Healthcare Commercial |
$182.03
|
|
|
HC 17 HYDROXYPROGESTRERONE-ADULTS
|
Facility
OP
|
$231.00
|
|
|
Service Code
|
CPT 83498
|
| Hospital Charge Code |
63001575
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.17 |
| Max. Negotiated Rate |
$212.64 |
| Rate for Payer: Aetna Commercial |
$194.96
|
| Rate for Payer: Aetna Medicare |
$76.23
|
| Rate for Payer: Anthem Exchange |
$106.17
|
| Rate for Payer: Anthem Medicaid |
$27.17
|
| Rate for Payer: Anthem Medicare |
$76.23
|
| Rate for Payer: Anthem PPO |
$106.17
|
| Rate for Payer: Anthem Traditional |
$106.17
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$27.17
|
| Rate for Payer: Caresource Just 4 Me |
$87.66
|
| Rate for Payer: Caresource Medicare |
$83.85
|
| Rate for Payer: Centivo/Paragon All Products |
$117.81
|
| Rate for Payer: Cigna All Products |
$199.35
|
| Rate for Payer: Coventry/First Health All Products |
$203.28
|
| Rate for Payer: Encore All Products |
$212.64
|
| Rate for Payer: Frontpath All Products |
$212.52
|
| Rate for Payer: Humana ChoiceCare |
$199.51
|
| Rate for Payer: Humana Medicare |
$117.81
|
| Rate for Payer: Lucent/Coldwater Veneers |
$117.81
|
| Rate for Payer: Lutheran Preferred All Products |
$207.90
|
| Rate for Payer: Managed Health Services All Products |
$27.17
|
| Rate for Payer: MDWise All Products |
$27.17
|
| Rate for Payer: PHCS/Multiplan All Products |
$173.25
|
| Rate for Payer: PHP All Products |
$175.19
|
| Rate for Payer: Plain Church Group Ministry All Products |
$90.09
|
| Rate for Payer: Sagamore All Products |
$178.33
|
| Rate for Payer: Self Pay/Cash Rate |
$143.22
|
| Rate for Payer: Signature Care EPO |
$191.73
|
| Rate for Payer: Signature Care PPO |
$203.28
|
| Rate for Payer: Three Rivers Preferred All Products |
$196.35
|
| Rate for Payer: United Healthcare Commercial |
$182.03
|
| Rate for Payer: United Healthcare Medicare |
$76.23
|
|
|
HC 17 KETOSTEROIDS
|
Facility
OP
|
$171.66
|
|
|
Service Code
|
CPT 83586
|
| Hospital Charge Code |
63001616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$158.01 |
| Rate for Payer: Aetna Commercial |
$144.88
|
| Rate for Payer: Aetna Medicare |
$56.65
|
| Rate for Payer: Anthem Exchange |
$98.58
|
| Rate for Payer: Anthem Medicaid |
$12.80
|
| Rate for Payer: Anthem Medicare |
$56.65
|
| Rate for Payer: Anthem PPO |
$98.58
|
| Rate for Payer: Anthem Traditional |
$107.30
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$12.80
|
| Rate for Payer: Caresource Just 4 Me |
$65.14
|
| Rate for Payer: Caresource Medicare |
$62.31
|
| Rate for Payer: Centivo/Paragon All Products |
$87.55
|
| Rate for Payer: Cigna All Products |
$148.14
|
| Rate for Payer: Coventry/First Health All Products |
$151.06
|
| Rate for Payer: Encore All Products |
$158.01
|
| Rate for Payer: Frontpath All Products |
$157.93
|
| Rate for Payer: Humana ChoiceCare |
$148.26
|
| Rate for Payer: Humana Medicare |
$87.55
|
| Rate for Payer: Lucent/Coldwater Veneers |
$87.55
|
| Rate for Payer: Lutheran Preferred All Products |
$154.49
|
| Rate for Payer: Managed Health Services All Products |
$12.80
|
| Rate for Payer: MDWise All Products |
$12.80
|
| Rate for Payer: PHCS/Multiplan All Products |
$128.75
|
| Rate for Payer: PHP All Products |
$130.19
|
| Rate for Payer: Plain Church Group Ministry All Products |
$66.95
|
| Rate for Payer: Sagamore All Products |
$132.52
|
| Rate for Payer: Self Pay/Cash Rate |
$106.43
|
| Rate for Payer: Signature Care EPO |
$142.48
|
| Rate for Payer: Signature Care PPO |
$151.06
|
| Rate for Payer: Three Rivers Preferred All Products |
$145.91
|
| Rate for Payer: United Healthcare Commercial |
$135.27
|
| Rate for Payer: United Healthcare Medicare |
$56.65
|
|
|
HC 17 KETOSTEROIDS
|
Facility
IP
|
$171.66
|
|
|
Service Code
|
CPT 83586
|
| Hospital Charge Code |
63001616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.43 |
| Max. Negotiated Rate |
$158.01 |
| Rate for Payer: Aetna Commercial |
$148.31
|
| Rate for Payer: Cigna All Products |
$148.14
|
| Rate for Payer: Coventry/First Health All Products |
$151.06
|
| Rate for Payer: Encore All Products |
$158.01
|
| Rate for Payer: Frontpath All Products |
$157.93
|
| Rate for Payer: Humana ChoiceCare |
$148.26
|
| Rate for Payer: Lutheran Preferred All Products |
$154.49
|
| Rate for Payer: PHCS/Multiplan All Products |
$128.75
|
| Rate for Payer: PHP All Products |
$130.19
|
| Rate for Payer: Sagamore All Products |
$132.52
|
| Rate for Payer: Self Pay/Cash Rate |
$106.43
|
| Rate for Payer: Signature Care EPO |
$142.48
|
| Rate for Payer: Signature Care PPO |
$151.06
|
| Rate for Payer: United Healthcare Commercial |
$135.27
|
|
|
HC 24 HR CREATININE
|
Facility
IP
|
$104.43
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63001523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$96.13 |
| Rate for Payer: Aetna Commercial |
$90.23
|
| Rate for Payer: Cigna All Products |
$90.12
|
| Rate for Payer: Coventry/First Health All Products |
$91.90
|
| Rate for Payer: Encore All Products |
$96.13
|
| Rate for Payer: Frontpath All Products |
$96.08
|
| Rate for Payer: Humana ChoiceCare |
$90.20
|
| Rate for Payer: Lutheran Preferred All Products |
$93.99
|
| Rate for Payer: PHCS/Multiplan All Products |
$78.32
|
| Rate for Payer: PHP All Products |
$79.20
|
| Rate for Payer: Sagamore All Products |
$80.62
|
| Rate for Payer: Self Pay/Cash Rate |
$64.75
|
| Rate for Payer: Signature Care EPO |
$86.68
|
| Rate for Payer: Signature Care PPO |
$91.90
|
| Rate for Payer: United Healthcare Commercial |
$82.29
|
|
|
HC 24 HR CREATININE
|
Facility
OP
|
$104.43
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
63001523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$96.13 |
| Rate for Payer: Aetna Commercial |
$88.14
|
| Rate for Payer: Aetna Medicare |
$34.46
|
| Rate for Payer: Anthem Exchange |
$48.00
|
| Rate for Payer: Anthem Medicaid |
$5.18
|
| Rate for Payer: Anthem Medicare |
$34.46
|
| Rate for Payer: Anthem PPO |
$48.00
|
| Rate for Payer: Anthem Traditional |
$48.00
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$5.18
|
| Rate for Payer: Caresource Just 4 Me |
$39.63
|
| Rate for Payer: Caresource Medicare |
$37.91
|
| Rate for Payer: Centivo/Paragon All Products |
$53.26
|
| Rate for Payer: Cigna All Products |
$90.12
|
| Rate for Payer: Coventry/First Health All Products |
$91.90
|
| Rate for Payer: Encore All Products |
$96.13
|
| Rate for Payer: Frontpath All Products |
$96.08
|
| Rate for Payer: Humana ChoiceCare |
$90.20
|
| Rate for Payer: Humana Medicare |
$53.26
|
| Rate for Payer: Lucent/Coldwater Veneers |
$53.26
|
| Rate for Payer: Lutheran Preferred All Products |
$93.99
|
| Rate for Payer: Managed Health Services All Products |
$5.18
|
| Rate for Payer: MDWise All Products |
$5.18
|
| Rate for Payer: PHCS/Multiplan All Products |
$78.32
|
| Rate for Payer: PHP All Products |
$79.20
|
| Rate for Payer: Plain Church Group Ministry All Products |
$40.73
|
| Rate for Payer: Sagamore All Products |
$80.62
|
| Rate for Payer: Self Pay/Cash Rate |
$64.75
|
| Rate for Payer: Signature Care EPO |
$86.68
|
| Rate for Payer: Signature Care PPO |
$91.90
|
| Rate for Payer: Three Rivers Preferred All Products |
$88.77
|
| Rate for Payer: United Healthcare Commercial |
$82.29
|
| Rate for Payer: United Healthcare Medicare |
$34.46
|
|
|
HC 24 HR POTASSIUM
|
Facility
IP
|
$98.45
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
63001662
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.04 |
| Max. Negotiated Rate |
$90.62 |
| Rate for Payer: Aetna Commercial |
$85.06
|
| Rate for Payer: Cigna All Products |
$84.96
|
| Rate for Payer: Coventry/First Health All Products |
$86.64
|
| Rate for Payer: Encore All Products |
$90.62
|
| Rate for Payer: Frontpath All Products |
$90.57
|
| Rate for Payer: Humana ChoiceCare |
$85.03
|
| Rate for Payer: Lutheran Preferred All Products |
$88.61
|
| Rate for Payer: PHCS/Multiplan All Products |
$73.84
|
| Rate for Payer: PHP All Products |
$74.66
|
| Rate for Payer: Sagamore All Products |
$76.00
|
| Rate for Payer: Self Pay/Cash Rate |
$61.04
|
| Rate for Payer: Signature Care EPO |
$81.71
|
| Rate for Payer: Signature Care PPO |
$86.64
|
| Rate for Payer: United Healthcare Commercial |
$77.58
|
|
|
HC 24 HR POTASSIUM
|
Facility
OP
|
$98.45
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
63001662
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$90.62 |
| Rate for Payer: Aetna Commercial |
$83.09
|
| Rate for Payer: Aetna Medicare |
$32.49
|
| Rate for Payer: Anthem Exchange |
$56.54
|
| Rate for Payer: Anthem Medicaid |
$4.70
|
| Rate for Payer: Anthem Medicare |
$32.49
|
| Rate for Payer: Anthem PPO |
$56.54
|
| Rate for Payer: Anthem Traditional |
$61.54
|
| Rate for Payer: Caresource Hoosier Healthwise & HIP |
$4.70
|
| Rate for Payer: Caresource Just 4 Me |
$37.36
|
| Rate for Payer: Caresource Medicare |
$35.74
|
| Rate for Payer: Centivo/Paragon All Products |
$50.21
|
| Rate for Payer: Cigna All Products |
$84.96
|
| Rate for Payer: Coventry/First Health All Products |
$86.64
|
| Rate for Payer: Encore All Products |
$90.62
|
| Rate for Payer: Frontpath All Products |
$90.57
|
| Rate for Payer: Humana ChoiceCare |
$85.03
|
| Rate for Payer: Humana Medicare |
$50.21
|
| Rate for Payer: Lucent/Coldwater Veneers |
$50.21
|
| Rate for Payer: Lutheran Preferred All Products |
$88.61
|
| Rate for Payer: Managed Health Services All Products |
$4.70
|
| Rate for Payer: MDWise All Products |
$4.70
|
| Rate for Payer: PHCS/Multiplan All Products |
$73.84
|
| Rate for Payer: PHP All Products |
$74.66
|
| Rate for Payer: Plain Church Group Ministry All Products |
$38.40
|
| Rate for Payer: Sagamore All Products |
$76.00
|
| Rate for Payer: Self Pay/Cash Rate |
$61.04
|
| Rate for Payer: Signature Care EPO |
$81.71
|
| Rate for Payer: Signature Care PPO |
$86.64
|
| Rate for Payer: Three Rivers Preferred All Products |
$83.68
|
| Rate for Payer: United Healthcare Commercial |
$77.58
|
| Rate for Payer: United Healthcare Medicare |
$32.49
|
|
|
HC 24 HR SODIUM
|
Facility
IP
|
$97.90
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
63001678
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.70 |
| Max. Negotiated Rate |
$90.12 |
| Rate for Payer: Aetna Commercial |
$84.59
|
| Rate for Payer: Cigna All Products |
$84.49
|
| Rate for Payer: Coventry/First Health All Products |
$86.15
|
| Rate for Payer: Encore All Products |
$90.12
|
| Rate for Payer: Frontpath All Products |
$90.07
|
| Rate for Payer: Humana ChoiceCare |
$84.56
|
| Rate for Payer: Lutheran Preferred All Products |
$88.11
|
| Rate for Payer: PHCS/Multiplan All Products |
$73.43
|
| Rate for Payer: PHP All Products |
$74.25
|
| Rate for Payer: Sagamore All Products |
$75.58
|
| Rate for Payer: Self Pay/Cash Rate |
$60.70
|
| Rate for Payer: Signature Care EPO |
$81.26
|
| Rate for Payer: Signature Care PPO |
$86.15
|
| Rate for Payer: United Healthcare Commercial |
$77.15
|
|
