|
CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 71111
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$87.76 |
| Rate for Payer: Aetna Commercial |
$63.57
|
| Rate for Payer: Aetna Commercial |
$63.57
|
| Rate for Payer: Aetna Medicare |
$49.34
|
| Rate for Payer: Aetna Medicare |
$49.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.31
|
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$47.44
|
| Rate for Payer: BCBS MAPPO |
$47.44
|
| Rate for Payer: BCN Medicare Advantage |
$47.44
|
| Rate for Payer: BCN Medicare Advantage |
$47.44
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Cofinity Commercial |
$68.31
|
| Rate for Payer: Cofinity Commercial |
$63.57
|
| Rate for Payer: Cofinity Commercial |
$68.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.44
|
| Rate for Payer: Healthscope Commercial |
$87.76
|
| Rate for Payer: Healthscope Commercial |
$87.76
|
| Rate for Payer: Healthscope Commercial |
$75.90
|
| Rate for Payer: Healthscope Commercial |
$75.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$21.45
|
| Rate for Payer: Nomi Health Commercial |
$56.93
|
| Rate for Payer: Nomi Health Commercial |
$56.93
|
| Rate for Payer: PACE SWMI |
$47.44
|
| Rate for Payer: PACE SWMI |
$47.44
|
| Rate for Payer: PHP Medicare Advantage |
$47.44
|
| Rate for Payer: PHP Medicare Advantage |
$47.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.80
|
| Rate for Payer: Priority Health Medicare |
$47.44
|
| Rate for Payer: Priority Health Medicare |
$47.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.44
|
| Rate for Payer: UHC Medicare Advantage |
$47.44
|
| Rate for Payer: UHC Medicare Advantage |
$47.44
|
|
|
CHG RADEX RIBS UNILATERAL 2 VIEWS
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 71100
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$61.46 |
| Rate for Payer: Aetna Commercial |
$44.51
|
| Rate for Payer: Aetna Medicare |
$34.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.51
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$33.22
|
| Rate for Payer: BCN Medicare Advantage |
$33.22
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$47.84
|
| Rate for Payer: Cofinity Commercial |
$44.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$33.22
|
| Rate for Payer: Healthscope Commercial |
$53.15
|
| Rate for Payer: Healthscope Commercial |
$61.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.50
|
| Rate for Payer: Nomi Health Commercial |
$39.86
|
| Rate for Payer: PACE SWMI |
$33.22
|
| Rate for Payer: PHP Medicare Advantage |
$33.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health Medicare |
$33.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$33.22
|
| Rate for Payer: UHC Medicare Advantage |
$33.22
|
|
|
CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 71101
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$70.45 |
| Rate for Payer: Aetna Commercial |
$51.03
|
| Rate for Payer: Aetna Commercial |
$51.03
|
| Rate for Payer: Aetna Medicare |
$39.60
|
| Rate for Payer: Aetna Medicare |
$39.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.03
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS MAPPO |
$38.08
|
| Rate for Payer: BCBS MAPPO |
$38.08
|
| Rate for Payer: BCN Medicare Advantage |
$38.08
|
| Rate for Payer: BCN Medicare Advantage |
$38.08
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cofinity Commercial |
$51.03
|
| Rate for Payer: Cofinity Commercial |
$51.03
|
| Rate for Payer: Cofinity Commercial |
$54.84
|
| Rate for Payer: Cofinity Commercial |
$54.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.08
|
| Rate for Payer: Healthscope Commercial |
$70.45
|
| Rate for Payer: Healthscope Commercial |
$70.45
|
| Rate for Payer: Healthscope Commercial |
$60.93
|
| Rate for Payer: Healthscope Commercial |
$60.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.80
|
| Rate for Payer: Nomi Health Commercial |
$45.70
|
| Rate for Payer: Nomi Health Commercial |
$45.70
|
| Rate for Payer: PACE SWMI |
$38.08
|
| Rate for Payer: PACE SWMI |
$38.08
|
| Rate for Payer: PHP Medicare Advantage |
$38.08
|
| Rate for Payer: PHP Medicare Advantage |
$38.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.80
|
| Rate for Payer: Priority Health Medicare |
$38.08
|
| Rate for Payer: Priority Health Medicare |
$38.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.08
|
| Rate for Payer: UHC Medicare Advantage |
$38.08
|
| Rate for Payer: UHC Medicare Advantage |
$38.08
|
|
|
CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 72220
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$54.65 |
| Rate for Payer: Aetna Commercial |
$39.58
|
| Rate for Payer: Aetna Commercial |
$39.58
|
| Rate for Payer: Aetna Commercial |
$39.58
|
| Rate for Payer: Aetna Medicare |
$30.72
|
| Rate for Payer: Aetna Medicare |
$30.72
|
| Rate for Payer: Aetna Medicare |
$30.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.58
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Complete |
$50.40
|
| Rate for Payer: BCBS MAPPO |
$29.54
|
| Rate for Payer: BCBS MAPPO |
$29.54
|
| Rate for Payer: BCBS MAPPO |
$29.54
|
| Rate for Payer: BCN Medicare Advantage |
$29.54
|
| Rate for Payer: BCN Medicare Advantage |
$29.54
|
| Rate for Payer: BCN Medicare Advantage |
$29.54
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$42.54
|
| Rate for Payer: Cofinity Commercial |
$42.54
|
| Rate for Payer: Cofinity Commercial |
$39.58
|
| Rate for Payer: Cofinity Commercial |
$42.54
|
| Rate for Payer: Cofinity Commercial |
$39.58
|
| Rate for Payer: Cofinity Commercial |
$39.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.54
|
| Rate for Payer: Healthscope Commercial |
$54.65
|
| Rate for Payer: Healthscope Commercial |
$54.65
|
| Rate for Payer: Healthscope Commercial |
$47.26
|
| Rate for Payer: Healthscope Commercial |
$47.26
|
| Rate for Payer: Healthscope Commercial |
$54.65
|
| Rate for Payer: Healthscope Commercial |
$47.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.00
|
| Rate for Payer: Nomi Health Commercial |
$35.45
|
| Rate for Payer: Nomi Health Commercial |
$35.45
|
| Rate for Payer: Nomi Health Commercial |
$35.45
|
| Rate for Payer: PACE SWMI |
$29.54
|
| Rate for Payer: PACE SWMI |
$29.54
|
| Rate for Payer: PACE SWMI |
$29.54
|
| Rate for Payer: PHP Medicare Advantage |
$29.54
|
| Rate for Payer: PHP Medicare Advantage |
$29.54
|
| Rate for Payer: PHP Medicare Advantage |
$29.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health Medicare |
$29.54
|
| Rate for Payer: Priority Health Medicare |
$29.54
|
| Rate for Payer: Priority Health Medicare |
$29.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.54
|
| Rate for Payer: UHC Medicare Advantage |
$29.54
|
| Rate for Payer: UHC Medicare Advantage |
$29.54
|
| Rate for Payer: UHC Medicare Advantage |
$29.54
|
|
|
CHG RADEX SCAPULA COMPLETE
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 73010
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$29.32
|
| Rate for Payer: Aetna Commercial |
$29.32
|
| Rate for Payer: Aetna Commercial |
$29.32
|
| Rate for Payer: Aetna Medicare |
$22.76
|
| Rate for Payer: Aetna Medicare |
$22.76
|
| Rate for Payer: Aetna Medicare |
$22.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.32
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Complete |
$42.80
|
| Rate for Payer: BCBS MAPPO |
$21.88
|
| Rate for Payer: BCBS MAPPO |
$21.88
|
| Rate for Payer: BCBS MAPPO |
$21.88
|
| Rate for Payer: BCN Medicare Advantage |
$21.88
|
| Rate for Payer: BCN Medicare Advantage |
$21.88
|
| Rate for Payer: BCN Medicare Advantage |
$21.88
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$31.51
|
| Rate for Payer: Cofinity Commercial |
$31.51
|
| Rate for Payer: Cofinity Commercial |
$29.32
|
| Rate for Payer: Cofinity Commercial |
$31.51
|
| Rate for Payer: Cofinity Commercial |
$29.32
|
| Rate for Payer: Cofinity Commercial |
$29.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.88
|
| Rate for Payer: Healthscope Commercial |
$40.48
|
| Rate for Payer: Healthscope Commercial |
$40.48
|
| Rate for Payer: Healthscope Commercial |
$35.01
|
| Rate for Payer: Healthscope Commercial |
$35.01
|
| Rate for Payer: Healthscope Commercial |
$40.48
|
| Rate for Payer: Healthscope Commercial |
$35.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$69.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Nomi Health Commercial |
$26.26
|
| Rate for Payer: Nomi Health Commercial |
$26.26
|
| Rate for Payer: Nomi Health Commercial |
$26.26
|
| Rate for Payer: PACE SWMI |
$21.88
|
| Rate for Payer: PACE SWMI |
$21.88
|
| Rate for Payer: PACE SWMI |
$21.88
|
| Rate for Payer: PHP Medicare Advantage |
$21.88
|
| Rate for Payer: PHP Medicare Advantage |
$21.88
|
| Rate for Payer: PHP Medicare Advantage |
$21.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.55
|
| Rate for Payer: Priority Health Medicare |
$21.88
|
| Rate for Payer: Priority Health Medicare |
$21.88
|
| Rate for Payer: Priority Health Medicare |
$21.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$21.88
|
| Rate for Payer: UHC Medicare Advantage |
$21.88
|
| Rate for Payer: UHC Medicare Advantage |
$21.88
|
| Rate for Payer: UHC Medicare Advantage |
$21.88
|
|
|
CHG RADEX SHOULDER 1 VIEW
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 73020
|
| Min. Negotiated Rate |
$19.76 |
| Max. Negotiated Rate |
$52.65 |
| Rate for Payer: Aetna Commercial |
$26.48
|
| Rate for Payer: Aetna Commercial |
$26.48
|
| Rate for Payer: Aetna Medicare |
$20.55
|
| Rate for Payer: Aetna Medicare |
$20.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$26.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$28.45
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS MAPPO |
$19.76
|
| Rate for Payer: BCBS MAPPO |
$19.76
|
| Rate for Payer: BCN Medicare Advantage |
$19.76
|
| Rate for Payer: BCN Medicare Advantage |
$19.76
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$26.48
|
| Rate for Payer: Cofinity Commercial |
$28.45
|
| Rate for Payer: Cofinity Commercial |
$26.48
|
| Rate for Payer: Cofinity Commercial |
$28.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$19.76
|
| Rate for Payer: Healthscope Commercial |
$36.56
|
| Rate for Payer: Healthscope Commercial |
$36.56
|
| Rate for Payer: Healthscope Commercial |
$31.62
|
| Rate for Payer: Healthscope Commercial |
$31.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$20.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$52.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Nomi Health Commercial |
$23.71
|
| Rate for Payer: Nomi Health Commercial |
$23.71
|
| Rate for Payer: PACE SWMI |
$19.76
|
| Rate for Payer: PACE SWMI |
$19.76
|
| Rate for Payer: PHP Medicare Advantage |
$19.76
|
| Rate for Payer: PHP Medicare Advantage |
$19.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| Rate for Payer: Priority Health Medicare |
$19.76
|
| Rate for Payer: Priority Health Medicare |
$19.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$19.76
|
| Rate for Payer: UHC Medicare Advantage |
$19.76
|
| Rate for Payer: UHC Medicare Advantage |
$19.76
|
|
|
CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 73030
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$41.98
|
| Rate for Payer: Aetna Commercial |
$41.98
|
| Rate for Payer: Aetna Commercial |
$41.98
|
| Rate for Payer: Aetna Medicare |
$32.58
|
| Rate for Payer: Aetna Medicare |
$32.58
|
| Rate for Payer: Aetna Medicare |
$32.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.98
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$31.33
|
| Rate for Payer: BCBS MAPPO |
$31.33
|
| Rate for Payer: BCBS MAPPO |
$31.33
|
| Rate for Payer: BCN Medicare Advantage |
$31.33
|
| Rate for Payer: BCN Medicare Advantage |
$31.33
|
| Rate for Payer: BCN Medicare Advantage |
$31.33
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$45.12
|
| Rate for Payer: Cofinity Commercial |
$45.12
|
| Rate for Payer: Cofinity Commercial |
$41.98
|
| Rate for Payer: Cofinity Commercial |
$45.12
|
| Rate for Payer: Cofinity Commercial |
$41.98
|
| Rate for Payer: Cofinity Commercial |
$41.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.33
|
| Rate for Payer: Healthscope Commercial |
$57.96
|
| Rate for Payer: Healthscope Commercial |
$57.96
|
| Rate for Payer: Healthscope Commercial |
$50.13
|
| Rate for Payer: Healthscope Commercial |
$50.13
|
| Rate for Payer: Healthscope Commercial |
$57.96
|
| Rate for Payer: Healthscope Commercial |
$50.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.40
|
| Rate for Payer: Nomi Health Commercial |
$37.60
|
| Rate for Payer: Nomi Health Commercial |
$37.60
|
| Rate for Payer: Nomi Health Commercial |
$37.60
|
| Rate for Payer: PACE SWMI |
$31.33
|
| Rate for Payer: PACE SWMI |
$31.33
|
| Rate for Payer: PACE SWMI |
$31.33
|
| Rate for Payer: PHP Medicare Advantage |
$31.33
|
| Rate for Payer: PHP Medicare Advantage |
$31.33
|
| Rate for Payer: PHP Medicare Advantage |
$31.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$31.33
|
| Rate for Payer: Priority Health Medicare |
$31.33
|
| Rate for Payer: Priority Health Medicare |
$31.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.33
|
| Rate for Payer: UHC Medicare Advantage |
$31.33
|
| Rate for Payer: UHC Medicare Advantage |
$31.33
|
| Rate for Payer: UHC Medicare Advantage |
$31.33
|
|
|
CHG RADEX SINUSES PARANASAL <3 VIEWS
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 70210
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$54.09 |
| Rate for Payer: Aetna Commercial |
$39.18
|
| Rate for Payer: Aetna Commercial |
$39.18
|
| Rate for Payer: Aetna Medicare |
$30.41
|
| Rate for Payer: Aetna Medicare |
$30.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.11
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCBS MAPPO |
$29.24
|
| Rate for Payer: BCBS MAPPO |
$29.24
|
| Rate for Payer: BCN Medicare Advantage |
$29.24
|
| Rate for Payer: BCN Medicare Advantage |
$29.24
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$39.18
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Cofinity Commercial |
$39.18
|
| Rate for Payer: Cofinity Commercial |
$42.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.24
|
| Rate for Payer: Healthscope Commercial |
$54.09
|
| Rate for Payer: Healthscope Commercial |
$54.09
|
| Rate for Payer: Healthscope Commercial |
$46.78
|
| Rate for Payer: Healthscope Commercial |
$46.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.70
|
| Rate for Payer: Nomi Health Commercial |
$35.09
|
| Rate for Payer: Nomi Health Commercial |
$35.09
|
| Rate for Payer: PACE SWMI |
$29.24
|
| Rate for Payer: PACE SWMI |
$29.24
|
| Rate for Payer: PHP Medicare Advantage |
$29.24
|
| Rate for Payer: PHP Medicare Advantage |
$29.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Medicare |
$29.24
|
| Rate for Payer: Priority Health Medicare |
$29.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.24
|
| Rate for Payer: UHC Medicare Advantage |
$29.24
|
| Rate for Payer: UHC Medicare Advantage |
$29.24
|
|
|
CHG RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 70220
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$63.09 |
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Commercial |
$45.69
|
| Rate for Payer: Aetna Medicare |
$35.46
|
| Rate for Payer: Aetna Medicare |
$35.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.10
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS MAPPO |
$34.10
|
| Rate for Payer: BCBS MAPPO |
$34.10
|
| Rate for Payer: BCN Medicare Advantage |
$34.10
|
| Rate for Payer: BCN Medicare Advantage |
$34.10
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cofinity Commercial |
$45.69
|
| Rate for Payer: Cofinity Commercial |
$49.10
|
| Rate for Payer: Cofinity Commercial |
$45.69
|
| Rate for Payer: Cofinity Commercial |
$49.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.10
|
| Rate for Payer: Healthscope Commercial |
$63.09
|
| Rate for Payer: Healthscope Commercial |
$63.09
|
| Rate for Payer: Healthscope Commercial |
$54.56
|
| Rate for Payer: Healthscope Commercial |
$54.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$35.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.15
|
| Rate for Payer: Nomi Health Commercial |
$40.92
|
| Rate for Payer: Nomi Health Commercial |
$40.92
|
| Rate for Payer: PACE SWMI |
$34.10
|
| Rate for Payer: PACE SWMI |
$34.10
|
| Rate for Payer: PHP Medicare Advantage |
$34.10
|
| Rate for Payer: PHP Medicare Advantage |
$34.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health Medicare |
$34.10
|
| Rate for Payer: Priority Health Medicare |
$34.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$34.10
|
| Rate for Payer: UHC Medicare Advantage |
$34.10
|
| Rate for Payer: UHC Medicare Advantage |
$34.10
|
|
|
CHG RADEX SPINE 1 VIEW SPECIFY LEVEL
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 72020
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$40.96 |
| Rate for Payer: Aetna Commercial |
$29.67
|
| Rate for Payer: Aetna Commercial |
$29.67
|
| Rate for Payer: Aetna Medicare |
$23.03
|
| Rate for Payer: Aetna Medicare |
$23.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.88
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS MAPPO |
$22.14
|
| Rate for Payer: BCBS MAPPO |
$22.14
|
| Rate for Payer: BCN Medicare Advantage |
$22.14
|
| Rate for Payer: BCN Medicare Advantage |
$22.14
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$29.67
|
| Rate for Payer: Cofinity Commercial |
$31.88
|
| Rate for Payer: Cofinity Commercial |
$29.67
|
| Rate for Payer: Cofinity Commercial |
$31.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.14
|
| Rate for Payer: Healthscope Commercial |
$40.96
|
| Rate for Payer: Healthscope Commercial |
$40.96
|
| Rate for Payer: Healthscope Commercial |
$35.42
|
| Rate for Payer: Healthscope Commercial |
$35.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$23.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Nomi Health Commercial |
$26.57
|
| Rate for Payer: Nomi Health Commercial |
$26.57
|
| Rate for Payer: PACE SWMI |
$22.14
|
| Rate for Payer: PACE SWMI |
$22.14
|
| Rate for Payer: PHP Medicare Advantage |
$22.14
|
| Rate for Payer: PHP Medicare Advantage |
$22.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$22.14
|
| Rate for Payer: Priority Health Medicare |
$22.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.14
|
| Rate for Payer: UHC Medicare Advantage |
$22.14
|
| Rate for Payer: UHC Medicare Advantage |
$22.14
|
|
|
CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 72040
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$66.36 |
| Rate for Payer: Aetna Commercial |
$48.07
|
| Rate for Payer: Aetna Commercial |
$48.07
|
| Rate for Payer: Aetna Commercial |
$48.07
|
| Rate for Payer: Aetna Medicare |
$37.30
|
| Rate for Payer: Aetna Medicare |
$37.30
|
| Rate for Payer: Aetna Medicare |
$37.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.07
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS MAPPO |
$35.87
|
| Rate for Payer: BCBS MAPPO |
$35.87
|
| Rate for Payer: BCBS MAPPO |
$35.87
|
| Rate for Payer: BCN Medicare Advantage |
$35.87
|
| Rate for Payer: BCN Medicare Advantage |
$35.87
|
| Rate for Payer: BCN Medicare Advantage |
$35.87
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$51.65
|
| Rate for Payer: Cofinity Commercial |
$51.65
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Cofinity Commercial |
$51.65
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.87
|
| Rate for Payer: Healthscope Commercial |
$66.36
|
| Rate for Payer: Healthscope Commercial |
$66.36
|
| Rate for Payer: Healthscope Commercial |
$57.39
|
| Rate for Payer: Healthscope Commercial |
$57.39
|
| Rate for Payer: Healthscope Commercial |
$66.36
|
| Rate for Payer: Healthscope Commercial |
$57.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: Nomi Health Commercial |
$43.04
|
| Rate for Payer: Nomi Health Commercial |
$43.04
|
| Rate for Payer: Nomi Health Commercial |
$43.04
|
| Rate for Payer: PACE SWMI |
$35.87
|
| Rate for Payer: PACE SWMI |
$35.87
|
| Rate for Payer: PACE SWMI |
$35.87
|
| Rate for Payer: PHP Medicare Advantage |
$35.87
|
| Rate for Payer: PHP Medicare Advantage |
$35.87
|
| Rate for Payer: PHP Medicare Advantage |
$35.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health Medicare |
$35.87
|
| Rate for Payer: Priority Health Medicare |
$35.87
|
| Rate for Payer: Priority Health Medicare |
$35.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.87
|
| Rate for Payer: UHC Medicare Advantage |
$35.87
|
| Rate for Payer: UHC Medicare Advantage |
$35.87
|
| Rate for Payer: UHC Medicare Advantage |
$35.87
|
|
|
CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 72050
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$90.06 |
| Rate for Payer: Aetna Commercial |
$65.23
|
| Rate for Payer: Aetna Commercial |
$65.23
|
| Rate for Payer: Aetna Commercial |
$65.23
|
| Rate for Payer: Aetna Medicare |
$50.63
|
| Rate for Payer: Aetna Medicare |
$50.63
|
| Rate for Payer: Aetna Medicare |
$50.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.23
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: BCBS MAPPO |
$48.68
|
| Rate for Payer: BCBS MAPPO |
$48.68
|
| Rate for Payer: BCBS MAPPO |
$48.68
|
| Rate for Payer: BCN Medicare Advantage |
$48.68
|
| Rate for Payer: BCN Medicare Advantage |
$48.68
|
| Rate for Payer: BCN Medicare Advantage |
$48.68
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$70.10
|
| Rate for Payer: Cofinity Commercial |
$70.10
|
| Rate for Payer: Cofinity Commercial |
$65.23
|
| Rate for Payer: Cofinity Commercial |
$70.10
|
| Rate for Payer: Cofinity Commercial |
$65.23
|
| Rate for Payer: Cofinity Commercial |
$65.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.68
|
| Rate for Payer: Healthscope Commercial |
$90.06
|
| Rate for Payer: Healthscope Commercial |
$90.06
|
| Rate for Payer: Healthscope Commercial |
$77.89
|
| Rate for Payer: Healthscope Commercial |
$77.89
|
| Rate for Payer: Healthscope Commercial |
$90.06
|
| Rate for Payer: Healthscope Commercial |
$77.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$92.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.80
|
| Rate for Payer: Nomi Health Commercial |
$58.42
|
| Rate for Payer: Nomi Health Commercial |
$58.42
|
| Rate for Payer: Nomi Health Commercial |
$58.42
|
| Rate for Payer: PACE SWMI |
$48.68
|
| Rate for Payer: PACE SWMI |
$48.68
|
| Rate for Payer: PACE SWMI |
$48.68
|
| Rate for Payer: PHP Medicare Advantage |
$48.68
|
| Rate for Payer: PHP Medicare Advantage |
$48.68
|
| Rate for Payer: PHP Medicare Advantage |
$48.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: Priority Health Medicare |
$48.68
|
| Rate for Payer: Priority Health Medicare |
$48.68
|
| Rate for Payer: Priority Health Medicare |
$48.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.68
|
| Rate for Payer: UHC Medicare Advantage |
$48.68
|
| Rate for Payer: UHC Medicare Advantage |
$48.68
|
| Rate for Payer: UHC Medicare Advantage |
$48.68
|
|
|
CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 72052
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$103.47 |
| Rate for Payer: Aetna Commercial |
$74.95
|
| Rate for Payer: Aetna Commercial |
$74.95
|
| Rate for Payer: Aetna Medicare |
$58.17
|
| Rate for Payer: Aetna Medicare |
$58.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.54
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS Complete |
$35.20
|
| Rate for Payer: BCBS MAPPO |
$55.93
|
| Rate for Payer: BCBS MAPPO |
$55.93
|
| Rate for Payer: BCN Medicare Advantage |
$55.93
|
| Rate for Payer: BCN Medicare Advantage |
$55.93
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$74.95
|
| Rate for Payer: Cofinity Commercial |
$80.54
|
| Rate for Payer: Cofinity Commercial |
$74.95
|
| Rate for Payer: Cofinity Commercial |
$80.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.93
|
| Rate for Payer: Healthscope Commercial |
$89.49
|
| Rate for Payer: Healthscope Commercial |
$89.49
|
| Rate for Payer: Healthscope Commercial |
$103.47
|
| Rate for Payer: Healthscope Commercial |
$103.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.20
|
| Rate for Payer: Nomi Health Commercial |
$67.12
|
| Rate for Payer: Nomi Health Commercial |
$67.12
|
| Rate for Payer: PACE SWMI |
$55.93
|
| Rate for Payer: PACE SWMI |
$55.93
|
| Rate for Payer: PHP Medicare Advantage |
$55.93
|
| Rate for Payer: PHP Medicare Advantage |
$55.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health Medicare |
$55.93
|
| Rate for Payer: Priority Health Medicare |
$55.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.93
|
| Rate for Payer: UHC Medicare Advantage |
$55.93
|
| Rate for Payer: UHC Medicare Advantage |
$55.93
|
|
|
CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 72100
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$66.36 |
| Rate for Payer: Aetna Commercial |
$48.07
|
| Rate for Payer: Aetna Commercial |
$48.07
|
| Rate for Payer: Aetna Commercial |
$48.07
|
| Rate for Payer: Aetna Medicare |
$37.30
|
| Rate for Payer: Aetna Medicare |
$37.30
|
| Rate for Payer: Aetna Medicare |
$37.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$48.07
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: BCBS MAPPO |
$35.87
|
| Rate for Payer: BCBS MAPPO |
$35.87
|
| Rate for Payer: BCBS MAPPO |
$35.87
|
| Rate for Payer: BCN Medicare Advantage |
$35.87
|
| Rate for Payer: BCN Medicare Advantage |
$35.87
|
| Rate for Payer: BCN Medicare Advantage |
$35.87
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$51.65
|
| Rate for Payer: Cofinity Commercial |
$51.65
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Cofinity Commercial |
$51.65
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Cofinity Commercial |
$48.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.87
|
| Rate for Payer: Healthscope Commercial |
$66.36
|
| Rate for Payer: Healthscope Commercial |
$66.36
|
| Rate for Payer: Healthscope Commercial |
$57.39
|
| Rate for Payer: Healthscope Commercial |
$57.39
|
| Rate for Payer: Healthscope Commercial |
$66.36
|
| Rate for Payer: Healthscope Commercial |
$57.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.70
|
| Rate for Payer: Nomi Health Commercial |
$43.04
|
| Rate for Payer: Nomi Health Commercial |
$43.04
|
| Rate for Payer: Nomi Health Commercial |
$43.04
|
| Rate for Payer: PACE SWMI |
$35.87
|
| Rate for Payer: PACE SWMI |
$35.87
|
| Rate for Payer: PACE SWMI |
$35.87
|
| Rate for Payer: PHP Medicare Advantage |
$35.87
|
| Rate for Payer: PHP Medicare Advantage |
$35.87
|
| Rate for Payer: PHP Medicare Advantage |
$35.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.60
|
| Rate for Payer: Priority Health Medicare |
$35.87
|
| Rate for Payer: Priority Health Medicare |
$35.87
|
| Rate for Payer: Priority Health Medicare |
$35.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.87
|
| Rate for Payer: UHC Medicare Advantage |
$35.87
|
| Rate for Payer: UHC Medicare Advantage |
$35.87
|
| Rate for Payer: UHC Medicare Advantage |
$35.87
|
|
|
CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 72110
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$86.75 |
| Rate for Payer: Aetna Commercial |
$62.83
|
| Rate for Payer: Aetna Commercial |
$62.83
|
| Rate for Payer: Aetna Commercial |
$62.83
|
| Rate for Payer: Aetna Medicare |
$48.77
|
| Rate for Payer: Aetna Medicare |
$48.77
|
| Rate for Payer: Aetna Medicare |
$48.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.83
|
| Rate for Payer: BCBS Complete |
$25.60
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS Complete |
$60.40
|
| Rate for Payer: BCBS MAPPO |
$46.89
|
| Rate for Payer: BCBS MAPPO |
$46.89
|
| Rate for Payer: BCBS MAPPO |
$46.89
|
| Rate for Payer: BCN Medicare Advantage |
$46.89
|
| Rate for Payer: BCN Medicare Advantage |
$46.89
|
| Rate for Payer: BCN Medicare Advantage |
$46.89
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cofinity Commercial |
$67.52
|
| Rate for Payer: Cofinity Commercial |
$67.52
|
| Rate for Payer: Cofinity Commercial |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$67.52
|
| Rate for Payer: Cofinity Commercial |
$62.83
|
| Rate for Payer: Cofinity Commercial |
$62.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.89
|
| Rate for Payer: Healthscope Commercial |
$86.75
|
| Rate for Payer: Healthscope Commercial |
$86.75
|
| Rate for Payer: Healthscope Commercial |
$75.02
|
| Rate for Payer: Healthscope Commercial |
$75.02
|
| Rate for Payer: Healthscope Commercial |
$86.75
|
| Rate for Payer: Healthscope Commercial |
$75.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$98.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$34.45
|
| Rate for Payer: Nomi Health Commercial |
$56.27
|
| Rate for Payer: Nomi Health Commercial |
$56.27
|
| Rate for Payer: Nomi Health Commercial |
$56.27
|
| Rate for Payer: PACE SWMI |
$46.89
|
| Rate for Payer: PACE SWMI |
$46.89
|
| Rate for Payer: PACE SWMI |
$46.89
|
| Rate for Payer: PHP Medicare Advantage |
$46.89
|
| Rate for Payer: PHP Medicare Advantage |
$46.89
|
| Rate for Payer: PHP Medicare Advantage |
$46.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.15
|
| Rate for Payer: Priority Health Medicare |
$46.89
|
| Rate for Payer: Priority Health Medicare |
$46.89
|
| Rate for Payer: Priority Health Medicare |
$46.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$46.89
|
| Rate for Payer: UHC Medicare Advantage |
$46.89
|
| Rate for Payer: UHC Medicare Advantage |
$46.89
|
| Rate for Payer: UHC Medicare Advantage |
$46.89
|
|
|
CHG RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 72120
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$67.99 |
| Rate for Payer: Aetna Commercial |
$49.24
|
| Rate for Payer: Aetna Medicare |
$38.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.24
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS MAPPO |
$36.75
|
| Rate for Payer: BCN Medicare Advantage |
$36.75
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$52.92
|
| Rate for Payer: Cofinity Commercial |
$49.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.75
|
| Rate for Payer: Healthscope Commercial |
$58.80
|
| Rate for Payer: Healthscope Commercial |
$67.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$32.50
|
| Rate for Payer: Nomi Health Commercial |
$44.10
|
| Rate for Payer: PACE SWMI |
$36.75
|
| Rate for Payer: PHP Medicare Advantage |
$36.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health Medicare |
$36.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.75
|
| Rate for Payer: UHC Medicare Advantage |
$36.75
|
|
|
CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 72114
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$74.16
|
| Rate for Payer: Aetna Commercial |
$74.16
|
| Rate for Payer: Aetna Medicare |
$57.55
|
| Rate for Payer: Aetna Medicare |
$57.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.16
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS MAPPO |
$55.34
|
| Rate for Payer: BCBS MAPPO |
$55.34
|
| Rate for Payer: BCN Medicare Advantage |
$55.34
|
| Rate for Payer: BCN Medicare Advantage |
$55.34
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$74.16
|
| Rate for Payer: Cofinity Commercial |
$74.16
|
| Rate for Payer: Cofinity Commercial |
$79.69
|
| Rate for Payer: Cofinity Commercial |
$79.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.34
|
| Rate for Payer: Healthscope Commercial |
$88.54
|
| Rate for Payer: Healthscope Commercial |
$88.54
|
| Rate for Payer: Healthscope Commercial |
$102.38
|
| Rate for Payer: Healthscope Commercial |
$102.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.90
|
| Rate for Payer: Nomi Health Commercial |
$66.41
|
| Rate for Payer: Nomi Health Commercial |
$66.41
|
| Rate for Payer: PACE SWMI |
$55.34
|
| Rate for Payer: PACE SWMI |
$55.34
|
| Rate for Payer: PHP Medicare Advantage |
$55.34
|
| Rate for Payer: PHP Medicare Advantage |
$55.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health Medicare |
$55.34
|
| Rate for Payer: Priority Health Medicare |
$55.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.34
|
| Rate for Payer: UHC Medicare Advantage |
$55.34
|
| Rate for Payer: UHC Medicare Advantage |
$55.34
|
|
|
CHG RADEX SPINE THORACIC 2 VIEWS
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 72070
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$55.35 |
| Rate for Payer: Aetna Commercial |
$40.09
|
| Rate for Payer: Aetna Commercial |
$40.09
|
| Rate for Payer: Aetna Commercial |
$40.09
|
| Rate for Payer: Aetna Medicare |
$31.12
|
| Rate for Payer: Aetna Medicare |
$31.12
|
| Rate for Payer: Aetna Medicare |
$31.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.09
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS MAPPO |
$29.92
|
| Rate for Payer: BCBS MAPPO |
$29.92
|
| Rate for Payer: BCBS MAPPO |
$29.92
|
| Rate for Payer: BCN Medicare Advantage |
$29.92
|
| Rate for Payer: BCN Medicare Advantage |
$29.92
|
| Rate for Payer: BCN Medicare Advantage |
$29.92
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$43.08
|
| Rate for Payer: Cofinity Commercial |
$43.08
|
| Rate for Payer: Cofinity Commercial |
$40.09
|
| Rate for Payer: Cofinity Commercial |
$43.08
|
| Rate for Payer: Cofinity Commercial |
$40.09
|
| Rate for Payer: Cofinity Commercial |
$40.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.92
|
| Rate for Payer: Healthscope Commercial |
$55.35
|
| Rate for Payer: Healthscope Commercial |
$55.35
|
| Rate for Payer: Healthscope Commercial |
$47.87
|
| Rate for Payer: Healthscope Commercial |
$47.87
|
| Rate for Payer: Healthscope Commercial |
$55.35
|
| Rate for Payer: Healthscope Commercial |
$47.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.05
|
| Rate for Payer: Nomi Health Commercial |
$35.90
|
| Rate for Payer: Nomi Health Commercial |
$35.90
|
| Rate for Payer: Nomi Health Commercial |
$35.90
|
| Rate for Payer: PACE SWMI |
$29.92
|
| Rate for Payer: PACE SWMI |
$29.92
|
| Rate for Payer: PACE SWMI |
$29.92
|
| Rate for Payer: PHP Medicare Advantage |
$29.92
|
| Rate for Payer: PHP Medicare Advantage |
$29.92
|
| Rate for Payer: PHP Medicare Advantage |
$29.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health Medicare |
$29.92
|
| Rate for Payer: Priority Health Medicare |
$29.92
|
| Rate for Payer: Priority Health Medicare |
$29.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.92
|
| Rate for Payer: UHC Medicare Advantage |
$29.92
|
| Rate for Payer: UHC Medicare Advantage |
$29.92
|
| Rate for Payer: UHC Medicare Advantage |
$29.92
|
|
|
CHG RADEX SPINE THORACIC 3 VIEWS
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 72072
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$65.86 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Medicare |
$37.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.70
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS MAPPO |
$35.60
|
| Rate for Payer: BCN Medicare Advantage |
$35.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$51.26
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.60
|
| Rate for Payer: Healthscope Commercial |
$65.86
|
| Rate for Payer: Healthscope Commercial |
$56.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Nomi Health Commercial |
$42.72
|
| Rate for Payer: PACE SWMI |
$35.60
|
| Rate for Payer: PHP Medicare Advantage |
$35.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$35.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.60
|
| Rate for Payer: UHC Medicare Advantage |
$35.60
|
|
|
CHG RADEX SPINE THORACIC MINIMUM 4 VIEWS
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 72074
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$74.70 |
| Rate for Payer: Aetna Commercial |
$54.11
|
| Rate for Payer: Aetna Medicare |
$42.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.11
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS MAPPO |
$40.38
|
| Rate for Payer: BCN Medicare Advantage |
$40.38
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$58.15
|
| Rate for Payer: Cofinity Commercial |
$54.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.38
|
| Rate for Payer: Healthscope Commercial |
$64.61
|
| Rate for Payer: Healthscope Commercial |
$74.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.75
|
| Rate for Payer: Nomi Health Commercial |
$48.46
|
| Rate for Payer: PACE SWMI |
$40.38
|
| Rate for Payer: PHP Medicare Advantage |
$40.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health Medicare |
$40.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.38
|
| Rate for Payer: UHC Medicare Advantage |
$40.38
|
|
|
CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 72080
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$58.13 |
| Rate for Payer: Aetna Commercial |
$42.10
|
| Rate for Payer: Aetna Commercial |
$42.10
|
| Rate for Payer: Aetna Commercial |
$42.10
|
| Rate for Payer: Aetna Medicare |
$32.68
|
| Rate for Payer: Aetna Medicare |
$32.68
|
| Rate for Payer: Aetna Medicare |
$32.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.10
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS MAPPO |
$31.42
|
| Rate for Payer: BCBS MAPPO |
$31.42
|
| Rate for Payer: BCBS MAPPO |
$31.42
|
| Rate for Payer: BCN Medicare Advantage |
$31.42
|
| Rate for Payer: BCN Medicare Advantage |
$31.42
|
| Rate for Payer: BCN Medicare Advantage |
$31.42
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$45.24
|
| Rate for Payer: Cofinity Commercial |
$45.24
|
| Rate for Payer: Cofinity Commercial |
$42.10
|
| Rate for Payer: Cofinity Commercial |
$45.24
|
| Rate for Payer: Cofinity Commercial |
$42.10
|
| Rate for Payer: Cofinity Commercial |
$42.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.42
|
| Rate for Payer: Healthscope Commercial |
$58.13
|
| Rate for Payer: Healthscope Commercial |
$58.13
|
| Rate for Payer: Healthscope Commercial |
$50.27
|
| Rate for Payer: Healthscope Commercial |
$50.27
|
| Rate for Payer: Healthscope Commercial |
$58.13
|
| Rate for Payer: Healthscope Commercial |
$50.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: Nomi Health Commercial |
$37.70
|
| Rate for Payer: Nomi Health Commercial |
$37.70
|
| Rate for Payer: Nomi Health Commercial |
$37.70
|
| Rate for Payer: PACE SWMI |
$31.42
|
| Rate for Payer: PACE SWMI |
$31.42
|
| Rate for Payer: PACE SWMI |
$31.42
|
| Rate for Payer: PHP Medicare Advantage |
$31.42
|
| Rate for Payer: PHP Medicare Advantage |
$31.42
|
| Rate for Payer: PHP Medicare Advantage |
$31.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health Medicare |
$31.42
|
| Rate for Payer: Priority Health Medicare |
$31.42
|
| Rate for Payer: Priority Health Medicare |
$31.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.42
|
| Rate for Payer: UHC Medicare Advantage |
$31.42
|
| Rate for Payer: UHC Medicare Advantage |
$31.42
|
| Rate for Payer: UHC Medicare Advantage |
$31.42
|
|
|
CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 71130
|
| Min. Negotiated Rate |
$20.40 |
| Max. Negotiated Rate |
$68.54 |
| Rate for Payer: Aetna Commercial |
$49.65
|
| Rate for Payer: Aetna Commercial |
$49.65
|
| Rate for Payer: Aetna Medicare |
$38.53
|
| Rate for Payer: Aetna Medicare |
$38.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$49.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.35
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$37.05
|
| Rate for Payer: BCBS MAPPO |
$37.05
|
| Rate for Payer: BCN Medicare Advantage |
$37.05
|
| Rate for Payer: BCN Medicare Advantage |
$37.05
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$49.65
|
| Rate for Payer: Cofinity Commercial |
$53.35
|
| Rate for Payer: Cofinity Commercial |
$49.65
|
| Rate for Payer: Cofinity Commercial |
$53.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.05
|
| Rate for Payer: Healthscope Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$68.54
|
| Rate for Payer: Healthscope Commercial |
$59.28
|
| Rate for Payer: Healthscope Commercial |
$59.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$33.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.25
|
| Rate for Payer: Nomi Health Commercial |
$44.46
|
| Rate for Payer: Nomi Health Commercial |
$44.46
|
| Rate for Payer: PACE SWMI |
$37.05
|
| Rate for Payer: PACE SWMI |
$37.05
|
| Rate for Payer: PHP Medicare Advantage |
$37.05
|
| Rate for Payer: PHP Medicare Advantage |
$37.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.15
|
| Rate for Payer: Priority Health Medicare |
$37.05
|
| Rate for Payer: Priority Health Medicare |
$37.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.05
|
| Rate for Payer: UHC Medicare Advantage |
$37.05
|
| Rate for Payer: UHC Medicare Advantage |
$37.05
|
|
|
CHG RADEX STERNUM MINIMUM 2 VIEWS
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 71120
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$55.89 |
| Rate for Payer: Aetna Commercial |
$40.48
|
| Rate for Payer: Aetna Commercial |
$40.48
|
| Rate for Payer: Aetna Medicare |
$31.42
|
| Rate for Payer: Aetna Medicare |
$31.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.50
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$30.21
|
| Rate for Payer: BCBS MAPPO |
$30.21
|
| Rate for Payer: BCN Medicare Advantage |
$30.21
|
| Rate for Payer: BCN Medicare Advantage |
$30.21
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$40.48
|
| Rate for Payer: Cofinity Commercial |
$43.50
|
| Rate for Payer: Cofinity Commercial |
$40.48
|
| Rate for Payer: Cofinity Commercial |
$43.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.21
|
| Rate for Payer: Healthscope Commercial |
$55.89
|
| Rate for Payer: Healthscope Commercial |
$55.89
|
| Rate for Payer: Healthscope Commercial |
$48.34
|
| Rate for Payer: Healthscope Commercial |
$48.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$31.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27.95
|
| Rate for Payer: Nomi Health Commercial |
$36.25
|
| Rate for Payer: Nomi Health Commercial |
$36.25
|
| Rate for Payer: PACE SWMI |
$30.21
|
| Rate for Payer: PACE SWMI |
$30.21
|
| Rate for Payer: PHP Medicare Advantage |
$30.21
|
| Rate for Payer: PHP Medicare Advantage |
$30.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health Medicare |
$30.21
|
| Rate for Payer: Priority Health Medicare |
$30.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.21
|
| Rate for Payer: UHC Medicare Advantage |
$30.21
|
| Rate for Payer: UHC Medicare Advantage |
$30.21
|
|
|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 70330
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$88.26 |
| Rate for Payer: Aetna Commercial |
$63.93
|
| Rate for Payer: Aetna Medicare |
$49.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.93
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$47.71
|
| Rate for Payer: BCN Medicare Advantage |
$47.71
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$68.70
|
| Rate for Payer: Cofinity Commercial |
$63.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.71
|
| Rate for Payer: Healthscope Commercial |
$88.26
|
| Rate for Payer: Healthscope Commercial |
$76.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.90
|
| Rate for Payer: Nomi Health Commercial |
$57.25
|
| Rate for Payer: PACE SWMI |
$47.71
|
| Rate for Payer: PHP Medicare Advantage |
$47.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health Medicare |
$47.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$47.71
|
| Rate for Payer: UHC Medicare Advantage |
$47.71
|
|
|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 70328
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$57.42 |
| Rate for Payer: Aetna Commercial |
$41.59
|
| Rate for Payer: Aetna Medicare |
$32.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$44.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.59
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS MAPPO |
$31.04
|
| Rate for Payer: BCN Medicare Advantage |
$31.04
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$44.70
|
| Rate for Payer: Cofinity Commercial |
$41.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.04
|
| Rate for Payer: Healthscope Commercial |
$49.66
|
| Rate for Payer: Healthscope Commercial |
$57.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28.60
|
| Rate for Payer: Nomi Health Commercial |
$37.25
|
| Rate for Payer: PACE SWMI |
$31.04
|
| Rate for Payer: PHP Medicare Advantage |
$31.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: Priority Health Medicare |
$31.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.04
|
| Rate for Payer: UHC Medicare Advantage |
$31.04
|
|
