|
CHG RADEX SPINE THORACIC MINIMUM 4 VIEWS
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 72074
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$376.68 |
| Rate for Payer: Aetna Commercial |
$50.58
|
| Rate for Payer: BCBS Complete |
$29.60
|
| Rate for Payer: BCBS Trust/PPO |
$376.68
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$17.93
|
| Rate for Payer: Priority Health SBD |
$68.12
|
|
|
CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
HCPCS 72080
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$1,847.47 |
| Rate for Payer: Aetna Commercial |
$39.37
|
| Rate for Payer: Aetna Commercial |
$39.37
|
| Rate for Payer: Aetna Commercial |
$39.37
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,847.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,847.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,847.47
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.37
|
| Rate for Payer: Priority Health Narrow Network |
$15.37
|
| Rate for Payer: Priority Health Narrow Network |
$15.37
|
| Rate for Payer: Priority Health Narrow Network |
$15.37
|
| Rate for Payer: Priority Health SBD |
$53.26
|
| Rate for Payer: Priority Health SBD |
$53.26
|
| Rate for Payer: Priority Health SBD |
$53.26
|
|
|
CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 71130
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$5,212.15 |
| Rate for Payer: Aetna Commercial |
$47.03
|
| Rate for Payer: Aetna Commercial |
$47.03
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,212.15
|
| Rate for Payer: BCBS Trust/PPO |
$5,212.15
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.88
|
| Rate for Payer: Priority Health Narrow Network |
$15.88
|
| Rate for Payer: Priority Health Narrow Network |
$15.88
|
| Rate for Payer: Priority Health SBD |
$63.51
|
| Rate for Payer: Priority Health SBD |
$63.51
|
|
|
CHG RADEX STERNUM MINIMUM 2 VIEWS
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 71120
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$2,498.86 |
| Rate for Payer: Aetna Commercial |
$38.18
|
| Rate for Payer: Aetna Commercial |
$38.18
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,498.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,498.86
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.34
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: Priority Health SBD |
$51.73
|
| Rate for Payer: Priority Health SBD |
$51.73
|
|
|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 70328
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$1,498.26 |
| Rate for Payer: Aetna Commercial |
$39.25
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,498.26
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.32
|
| Rate for Payer: Priority Health Narrow Network |
$13.32
|
| Rate for Payer: Priority Health SBD |
$53.26
|
|
|
CHG RADEX TOE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS 73660
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$2,915.69 |
| Rate for Payer: Aetna Commercial |
$32.96
|
| Rate for Payer: Aetna Commercial |
$32.96
|
| Rate for Payer: Aetna Commercial |
$32.96
|
| Rate for Payer: BCBS Complete |
$9.60
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,915.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,915.69
|
| Rate for Payer: BCBS Trust/PPO |
$2,915.69
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.73
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$9.73
|
| Rate for Payer: Priority Health Narrow Network |
$9.73
|
| Rate for Payer: Priority Health Narrow Network |
$9.73
|
| Rate for Payer: Priority Health Narrow Network |
$9.73
|
| Rate for Payer: Priority Health SBD |
$45.07
|
| Rate for Payer: Priority Health SBD |
$45.07
|
| Rate for Payer: Priority Health SBD |
$45.07
|
|
|
CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 73092
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$632.38 |
| Rate for Payer: Aetna Commercial |
$35.75
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$632.38
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.77
|
| Rate for Payer: Priority Health Narrow Network |
$11.77
|
| Rate for Payer: Priority Health SBD |
$48.65
|
|
|
CHG RADEX WRIST 2 VIEWS
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 73100
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$88.75 |
| Rate for Payer: Aetna Commercial |
$38.42
|
| Rate for Payer: Aetna Commercial |
$38.42
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$88.75
|
| Rate for Payer: BCBS Trust/PPO |
$88.75
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health SBD |
$52.23
|
| Rate for Payer: Priority Health SBD |
$52.23
|
|
|
CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 73110
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$115.70 |
| Rate for Payer: Aetna Commercial |
$45.70
|
| Rate for Payer: Aetna Commercial |
$45.70
|
| Rate for Payer: Aetna Commercial |
$45.70
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCBS Complete |
$38.00
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$115.70
|
| Rate for Payer: BCBS Trust/PPO |
$115.70
|
| Rate for Payer: BCBS Trust/PPO |
$115.70
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health SBD |
$62.99
|
| Rate for Payer: Priority Health SBD |
$62.99
|
| Rate for Payer: Priority Health SBD |
$62.99
|
|
|
CHG RADIATION THERAPY MGMT 1/2 FRACTIONS ONLY
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 77431
|
| Min. Negotiated Rate |
$68.59 |
| Max. Negotiated Rate |
$2,159.16 |
| Rate for Payer: Aetna Commercial |
$125.01
|
| Rate for Payer: BCBS Complete |
$72.02
|
| Rate for Payer: BCBS Trust/PPO |
$2,159.16
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Mclaren Medicaid |
$68.59
|
| Rate for Payer: Meridian Medicaid |
$72.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.45
|
| Rate for Payer: Priority Health Narrow Network |
$126.45
|
| Rate for Payer: Priority Health SBD |
$163.38
|
|
|
CHG RADIATION TREATMENT DELIVERY 1 MEV => COMPLEX
|
Professional
|
Both
|
$542.00
|
|
|
Service Code
|
HCPCS 77412
|
| Min. Negotiated Rate |
$216.80 |
| Max. Negotiated Rate |
$696.30 |
| Rate for Payer: Aetna Commercial |
$290.34
|
| Rate for Payer: BCBS Complete |
$216.80
|
| Rate for Payer: BCBS Trust/PPO |
$696.30
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Cash Price |
$433.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$379.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$361.07
|
| Rate for Payer: Priority Health Narrow Network |
$361.07
|
| Rate for Payer: Priority Health SBD |
$361.07
|
|
|
CHG RADIATION TREATMENT DELIVERY 1 MEV+ SIMPLE
|
Professional
|
Both
|
$355.00
|
|
|
Service Code
|
HCPCS 77402
|
| Min. Negotiated Rate |
$142.00 |
| Max. Negotiated Rate |
$1,140.60 |
| Rate for Payer: Aetna Commercial |
$158.33
|
| Rate for Payer: BCBS Complete |
$142.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,140.60
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Cash Price |
$284.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$248.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.69
|
| Rate for Payer: Priority Health Narrow Network |
$197.69
|
| Rate for Payer: Priority Health SBD |
$197.69
|
|
|
CHG RADIATION TREATMENT MANAGEMENT 5 TREATMENTS
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
HCPCS 77427
|
| Min. Negotiated Rate |
$121.41 |
| Max. Negotiated Rate |
$2,101.58 |
| Rate for Payer: Aetna Commercial |
$223.07
|
| Rate for Payer: BCBS Complete |
$127.48
|
| Rate for Payer: BCBS Trust/PPO |
$2,101.58
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Cash Price |
$282.40
|
| Rate for Payer: Mclaren Medicaid |
$121.41
|
| Rate for Payer: Meridian Medicaid |
$127.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$121.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$247.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$291.43
|
| Rate for Payer: Priority Health Narrow Network |
$291.43
|
| Rate for Payer: Priority Health SBD |
$291.43
|
|
|
CHG RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTA
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 77401
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$2,336.14 |
| Rate for Payer: Aetna Commercial |
$48.09
|
| Rate for Payer: BCBS Complete |
$35.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,336.14
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$62.99
|
| Rate for Payer: Priority Health Narrow Network |
$62.99
|
| Rate for Payer: Priority Health SBD |
$62.99
|
|
|
CHG RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS 75989
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$3,322.48 |
| Rate for Payer: Aetna Commercial |
$145.39
|
| Rate for Payer: BCBS Complete |
$90.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,322.48
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$158.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.00
|
| Rate for Payer: Priority Health Narrow Network |
$84.00
|
| Rate for Payer: Priority Health SBD |
$173.11
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 74018
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$2,936.82 |
| Rate for Payer: Aetna Commercial |
$33.91
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,936.82
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.32
|
| Rate for Payer: Priority Health Narrow Network |
$13.32
|
| Rate for Payer: Priority Health SBD |
$46.10
|
|
|
CHG RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 73565
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$113.06 |
| Rate for Payer: Aetna Commercial |
$46.05
|
| Rate for Payer: Aetna Commercial |
$46.05
|
| Rate for Payer: Aetna Commercial |
$46.05
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$113.06
|
| Rate for Payer: BCBS Trust/PPO |
$113.06
|
| Rate for Payer: BCBS Trust/PPO |
$113.06
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health SBD |
$61.45
|
| Rate for Payer: Priority Health SBD |
$61.45
|
| Rate for Payer: Priority Health SBD |
$61.45
|
|
|
CHG RADIOLOGIC EXAM CHEST 2 VIEWS
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 71046
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$1,811.01 |
| Rate for Payer: Aetna Commercial |
$38.26
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,811.01
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.88
|
| Rate for Payer: Priority Health Narrow Network |
$15.88
|
| Rate for Payer: Priority Health SBD |
$51.73
|
|
|
CHG RADIOLOGIC EXAM CHEST 3 VIEWS
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 71047
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$2,027.62 |
| Rate for Payer: Aetna Commercial |
$48.36
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,027.62
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.98
|
| Rate for Payer: Priority Health Narrow Network |
$19.98
|
| Rate for Payer: Priority Health SBD |
$65.05
|
|
|
CHG RADIOLOGIC EXAM CHEST SINGLE VIEW
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 71045
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$1,646.71 |
| Rate for Payer: Aetna Commercial |
$29.34
|
| Rate for Payer: Aetna Commercial |
$29.34
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,646.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,646.71
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.32
|
| Rate for Payer: Priority Health Narrow Network |
$13.32
|
| Rate for Payer: Priority Health Narrow Network |
$13.32
|
| Rate for Payer: Priority Health SBD |
$39.95
|
| Rate for Payer: Priority Health SBD |
$39.95
|
|
|
CHG RADIOLOGIC EXAMINATION ANKLE 2 VIEWS
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 73600
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$1,179.17 |
| Rate for Payer: Aetna Commercial |
$36.89
|
| Rate for Payer: Aetna Commercial |
$36.89
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,179.17
|
| Rate for Payer: BCBS Trust/PPO |
$1,179.17
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health SBD |
$50.19
|
| Rate for Payer: Priority Health SBD |
$50.19
|
|
|
CHG RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 70030
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$5,212.15 |
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$5,212.15
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.32
|
| Rate for Payer: Priority Health Narrow Network |
$13.32
|
| Rate for Payer: Priority Health SBD |
$50.19
|
|
|
CHG RADIOLOGIC EXAMINATION FEMUR 1 VIEW
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 73551
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$2,038.18 |
| Rate for Payer: Aetna Commercial |
$33.46
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,038.18
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health SBD |
$45.07
|
|
|
CHG RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 73552
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$1,676.30 |
| Rate for Payer: Aetna Commercial |
$40.02
|
| Rate for Payer: Aetna Commercial |
$40.02
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.30
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.32
|
| Rate for Payer: Priority Health Narrow Network |
$13.32
|
| Rate for Payer: Priority Health Narrow Network |
$13.32
|
| Rate for Payer: Priority Health SBD |
$54.80
|
| Rate for Payer: Priority Health SBD |
$54.80
|
|
|
CHG RADIOLOGIC EXAMINATION FOOT 2 VIEWS
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
HCPCS 73620
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$954.11 |
| Rate for Payer: Aetna Commercial |
$32.31
|
| Rate for Payer: Aetna Commercial |
$32.31
|
| Rate for Payer: Aetna Commercial |
$32.31
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Complete |
$30.40
|
| Rate for Payer: BCBS Trust/PPO |
$954.11
|
| Rate for Payer: BCBS Trust/PPO |
$954.11
|
| Rate for Payer: BCBS Trust/PPO |
$954.11
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$60.80
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.27
|
| Rate for Payer: Priority Health Narrow Network |
$11.27
|
| Rate for Payer: Priority Health Narrow Network |
$11.27
|
| Rate for Payer: Priority Health Narrow Network |
$11.27
|
| Rate for Payer: Priority Health SBD |
$43.53
|
| Rate for Payer: Priority Health SBD |
$43.53
|
| Rate for Payer: Priority Health SBD |
$43.53
|
|
