|
CHG RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 73560
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$1,586.48 |
| Rate for Payer: Aetna Commercial |
$38.80
|
| Rate for Payer: Aetna Commercial |
$38.80
|
| Rate for Payer: Aetna Commercial |
$38.80
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,586.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,586.48
|
| Rate for Payer: BCBS Trust/PPO |
$1,586.48
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.70
|
| 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 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 Narrow Network |
$12.29
|
| Rate for Payer: Priority Health SBD |
$52.75
|
| Rate for Payer: Priority Health SBD |
$52.75
|
| Rate for Payer: Priority Health SBD |
$52.75
|
|
|
CHG RADIOLOGIC EXAMINATION KNEE 3 VIEWS
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 73562
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$2,259.01 |
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: Aetna Commercial |
$45.74
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS Complete |
$37.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,259.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,259.01
|
| Rate for Payer: BCBS Trust/PPO |
$2,259.01
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.83
|
| Rate for Payer: Priority Health Narrow Network |
$13.83
|
| Rate for Payer: Priority Health Narrow Network |
$13.83
|
| Rate for Payer: Priority Health Narrow Network |
$13.83
|
| Rate for Payer: Priority Health SBD |
$62.48
|
| Rate for Payer: Priority Health SBD |
$62.48
|
| Rate for Payer: Priority Health SBD |
$62.48
|
|
|
CHG RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 70100
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$1,040.22 |
| Rate for Payer: Aetna Commercial |
$43.45
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,040.22
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| 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 Narrow Network |
$13.32
|
| Rate for Payer: Priority Health SBD |
$59.41
|
|
|
CHG RADIOLOGIC EXAMINATION NECK SOFT TISSUE
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 70360
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$2,020.75 |
| Rate for Payer: Aetna Commercial |
$35.82
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,020.75
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| 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 |
$48.65
|
|
|
CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 72170
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$1,953.65 |
| Rate for Payer: Aetna Commercial |
$31.59
|
| Rate for Payer: Aetna Commercial |
$31.59
|
| Rate for Payer: Aetna Commercial |
$31.59
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,953.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,953.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,953.65
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| 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 |
$43.03
|
| Rate for Payer: Priority Health SBD |
$43.03
|
| Rate for Payer: Priority Health SBD |
$43.03
|
|
|
CHG RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 72200
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$2,183.46 |
| Rate for Payer: Aetna Commercial |
$37.31
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,183.46
|
| 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 |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health SBD |
$50.71
|
|
|
CHG RADIOLOGIC EXAMINATION SKULL 4< VIEWS
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 70250
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$1,779.84 |
| Rate for Payer: Aetna Commercial |
$40.40
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,779.84
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| 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 |
$55.32
|
|
|
CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 73590
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$598.56 |
| Rate for Payer: Aetna Commercial |
$35.75
|
| Rate for Payer: Aetna Commercial |
$35.75
|
| Rate for Payer: Aetna Commercial |
$35.75
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS Trust/PPO |
$598.56
|
| Rate for Payer: BCBS Trust/PPO |
$598.56
|
| Rate for Payer: BCBS Trust/PPO |
$598.56
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$65.60
|
| 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 |
$20.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.77
|
| 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 Narrow Network |
$11.77
|
| Rate for Payer: Priority Health Narrow Network |
$11.77
|
| Rate for Payer: Priority Health SBD |
$48.65
|
| Rate for Payer: Priority Health SBD |
$48.65
|
| Rate for Payer: Priority Health SBD |
$48.65
|
|
|
CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 73564
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$1,700.07 |
| Rate for Payer: Aetna Commercial |
$51.99
|
| Rate for Payer: Aetna Commercial |
$51.99
|
| Rate for Payer: Aetna Commercial |
$51.99
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,700.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,700.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,700.07
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.90
|
| Rate for Payer: Priority Health Narrow Network |
$16.90
|
| Rate for Payer: Priority Health Narrow Network |
$16.90
|
| Rate for Payer: Priority Health Narrow Network |
$16.90
|
| Rate for Payer: Priority Health SBD |
$71.70
|
| Rate for Payer: Priority Health SBD |
$71.70
|
| Rate for Payer: Priority Health SBD |
$71.70
|
|
|
CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 72190
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$1,716.45 |
| Rate for Payer: Aetna Commercial |
$47.53
|
| Rate for Payer: Aetna Commercial |
$47.53
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,716.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,716.45
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.44
|
| Rate for Payer: Priority Health Narrow Network |
$18.44
|
| Rate for Payer: Priority Health Narrow Network |
$18.44
|
| Rate for Payer: Priority Health SBD |
$65.05
|
| Rate for Payer: Priority Health SBD |
$65.05
|
|
|
CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 72202
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$378.26 |
| Rate for Payer: Aetna Commercial |
$44.40
|
| Rate for Payer: Aetna Commercial |
$44.40
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS Trust/PPO |
$378.26
|
| Rate for Payer: BCBS Trust/PPO |
$378.26
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.38
|
| Rate for Payer: Priority Health Narrow Network |
$16.38
|
| Rate for Payer: Priority Health Narrow Network |
$16.38
|
| Rate for Payer: Priority Health SBD |
$60.44
|
| Rate for Payer: Priority Health SBD |
$60.44
|
|
|
CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 70260
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$2,020.75 |
| Rate for Payer: Aetna Commercial |
$51.07
|
| Rate for Payer: BCBS Complete |
$23.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,020.75
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.48
|
| Rate for Payer: Priority Health Narrow Network |
$20.48
|
| Rate for Payer: Priority Health SBD |
$68.63
|
|
|
CHG RADN RX DELIVERY COMPLX 11-19 MEV
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 77414
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$326.20 |
| Rate for Payer: BCBS Complete |
$186.40
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.20
|
|
|
CHG RADN RX DELIVERY COMPLX 6-10 MEV
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 77413
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: BCBS Complete |
$165.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.80
|
|
|
CHG RADN RX DELIVERY SIMPLE 11-19 MEV
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 77404
|
| Min. Negotiated Rate |
$102.40 |
| Max. Negotiated Rate |
$179.20 |
| Rate for Payer: BCBS Complete |
$102.40
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.20
|
|
|
CHG RADN RX DELIVERY SIMPLE 6-10 MEV
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
HCPCS 77403
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$160.30 |
| Rate for Payer: BCBS Complete |
$91.60
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.30
|
|
|
CHG REMOTE AFTLD RADIONUC BRACHYTHERAPY,1 CHANNEL
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
HCPCS 77785
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$312.90 |
| Rate for Payer: BCBS Complete |
$178.80
|
| Rate for Payer: BCBS Complete |
$121.20
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.10
|
|
|
CHG REMOTE AFTLD RADIONUC BRACHYTHERAPY,2-12 CHANNEL
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 77786
|
| Min. Negotiated Rate |
$267.60 |
| Max. Negotiated Rate |
$468.30 |
| Rate for Payer: BCBS Complete |
$267.60
|
| Rate for Payer: BCBS Complete |
$394.00
|
| Rate for Payer: Cash Price |
$788.00
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$689.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.30
|
|
|
CHG REPAIR,ILIAC ANRYSM/PSEUDO/AV MALF/TRAUMA W/ ENDOPROSTHESIS
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 75954
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.20
|
|
|
CHG RESPIRATORY MOTION MANAGEMENT SIMULATION
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
HCPCS 77293
|
| Min. Negotiated Rate |
$159.80 |
| Max. Negotiated Rate |
$633.05 |
| Rate for Payer: Aetna Commercial |
$505.24
|
| Rate for Payer: Aetna Commercial |
$505.24
|
| Rate for Payer: BCBS Complete |
$242.40
|
| Rate for Payer: BCBS Complete |
$324.00
|
| Rate for Payer: BCBS Trust/PPO |
$218.19
|
| Rate for Payer: BCBS Trust/PPO |
$218.19
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$424.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.80
|
| Rate for Payer: Priority Health Narrow Network |
$159.80
|
| Rate for Payer: Priority Health Narrow Network |
$159.80
|
| Rate for Payer: Priority Health SBD |
$633.05
|
| Rate for Payer: Priority Health SBD |
$633.05
|
|
|
CHG RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
HCPCS 78803
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$1,043.92 |
| Rate for Payer: Aetna Commercial |
$438.41
|
| Rate for Payer: Aetna Commercial |
$438.41
|
| Rate for Payer: Aetna Commercial |
$438.41
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS Complete |
$240.00
|
| Rate for Payer: BCBS Complete |
$274.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,043.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,043.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,043.92
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.80
|
| Rate for Payer: Priority Health Narrow Network |
$75.80
|
| Rate for Payer: Priority Health Narrow Network |
$75.80
|
| Rate for Payer: Priority Health Narrow Network |
$75.80
|
| Rate for Payer: Priority Health SBD |
$544.43
|
| Rate for Payer: Priority Health SBD |
$544.43
|
| Rate for Payer: Priority Health SBD |
$544.43
|
|
|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 79101
|
| Min. Negotiated Rate |
$81.95 |
| Max. Negotiated Rate |
$1,781.96 |
| Rate for Payer: Aetna Commercial |
$172.32
|
| Rate for Payer: Aetna Commercial |
$172.32
|
| Rate for Payer: BCBS Complete |
$206.80
|
| Rate for Payer: BCBS Complete |
$114.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,781.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,781.96
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.95
|
| Rate for Payer: Priority Health Narrow Network |
$81.95
|
| Rate for Payer: Priority Health Narrow Network |
$81.95
|
| Rate for Payer: Priority Health SBD |
$224.34
|
| Rate for Payer: Priority Health SBD |
$224.34
|
|
|
CHG RP THERAPY ORAL ADMINISTRATION
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 79005
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$1,228.83 |
| Rate for Payer: Aetna Commercial |
$158.75
|
| Rate for Payer: Aetna Commercial |
$158.75
|
| Rate for Payer: BCBS Complete |
$60.80
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,228.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,228.83
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.37
|
| Rate for Payer: Priority Health Narrow Network |
$78.37
|
| Rate for Payer: Priority Health Narrow Network |
$78.37
|
| Rate for Payer: Priority Health SBD |
$205.90
|
| Rate for Payer: Priority Health SBD |
$205.90
|
|
|
CHG SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 76831
|
| Min. Negotiated Rate |
$52.23 |
| Max. Negotiated Rate |
$764.98 |
| Rate for Payer: Aetna Commercial |
$138.24
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS Trust/PPO |
$764.98
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.23
|
| Rate for Payer: Priority Health Narrow Network |
$52.23
|
| Rate for Payer: Priority Health SBD |
$179.27
|
|
|
CHG SEDIMENTATION RATE RBC NON-AUTOMATED
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 85651
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$2,682.02 |
| Rate for Payer: Aetna Commercial |
$4.06
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,682.02
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.57
|
| Rate for Payer: Priority Health Narrow Network |
$4.57
|
| Rate for Payer: Priority Health SBD |
$4.57
|
|
