|
CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 76705
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Commercial |
$105.39
|
| Rate for Payer: Aetna Commercial |
$105.39
|
| Rate for Payer: Aetna Medicare |
$81.80
|
| Rate for Payer: Aetna Medicare |
$81.80
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS Complete |
$43.20
|
| Rate for Payer: BCBS MAPPO |
$78.65
|
| Rate for Payer: BCBS MAPPO |
$78.65
|
| Rate for Payer: BCN Medicare Advantage |
$78.65
|
| Rate for Payer: BCN Medicare Advantage |
$78.65
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$113.26
|
| Rate for Payer: Cofinity Commercial |
$113.26
|
| Rate for Payer: Cofinity Commercial |
$105.39
|
| Rate for Payer: Cofinity Commercial |
$105.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.58
|
| Rate for Payer: Nomi Health Commercial |
$94.38
|
| Rate for Payer: Nomi Health Commercial |
$94.38
|
| Rate for Payer: PACE SWMI |
$78.65
|
| Rate for Payer: PACE SWMI |
$78.65
|
| Rate for Payer: PHP Medicare Advantage |
$78.65
|
| Rate for Payer: PHP Medicare Advantage |
$78.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health Medicare |
$79.44
|
| Rate for Payer: Priority Health Medicare |
$79.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.65
|
| Rate for Payer: UHC Exchange |
$78.65
|
| Rate for Payer: UHC Exchange |
$78.65
|
| Rate for Payer: UHC Medicare Advantage |
$78.65
|
| Rate for Payer: UHC Medicare Advantage |
$78.65
|
|
|
CHG US, BREAST(S), REAL TIME
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 76645
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Aetna Medicare |
$75.00
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
|
|
CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 76604
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$76.77 |
| Rate for Payer: Aetna Commercial |
$71.44
|
| Rate for Payer: Aetna Medicare |
$55.44
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS MAPPO |
$53.31
|
| Rate for Payer: BCN Medicare Advantage |
$53.31
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$76.77
|
| Rate for Payer: Cofinity Commercial |
$71.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.98
|
| Rate for Payer: Nomi Health Commercial |
$63.97
|
| Rate for Payer: PACE SWMI |
$53.31
|
| Rate for Payer: PHP Medicare Advantage |
$53.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health Medicare |
$53.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.31
|
| Rate for Payer: UHC Exchange |
$53.31
|
| Rate for Payer: UHC Medicare Advantage |
$53.31
|
|
|
CHG US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 76936
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$338.76 |
| Rate for Payer: Aetna Commercial |
$315.24
|
| Rate for Payer: Aetna Medicare |
$244.66
|
| Rate for Payer: BCBS Complete |
$171.60
|
| Rate for Payer: BCBS MAPPO |
$235.25
|
| Rate for Payer: BCN Medicare Advantage |
$235.25
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cofinity Commercial |
$315.24
|
| Rate for Payer: Cofinity Commercial |
$338.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.01
|
| Rate for Payer: Nomi Health Commercial |
$282.30
|
| Rate for Payer: PACE SWMI |
$235.25
|
| Rate for Payer: PHP Medicare Advantage |
$235.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.85
|
| Rate for Payer: Priority Health Medicare |
$237.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$235.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.25
|
| Rate for Payer: UHC Exchange |
$235.25
|
| Rate for Payer: UHC Medicare Advantage |
$235.25
|
|
|
CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 76881
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$201.50 |
| Rate for Payer: Aetna Commercial |
$67.21
|
| Rate for Payer: Aetna Commercial |
$67.21
|
| Rate for Payer: Aetna Medicare |
$52.17
|
| Rate for Payer: Aetna Medicare |
$52.17
|
| Rate for Payer: BCBS Complete |
$124.00
|
| Rate for Payer: BCBS Complete |
$34.40
|
| Rate for Payer: BCBS MAPPO |
$50.16
|
| Rate for Payer: BCBS MAPPO |
$50.16
|
| Rate for Payer: BCN Medicare Advantage |
$50.16
|
| Rate for Payer: BCN Medicare Advantage |
$50.16
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$72.23
|
| Rate for Payer: Cofinity Commercial |
$67.21
|
| Rate for Payer: Cofinity Commercial |
$72.23
|
| Rate for Payer: Cofinity Commercial |
$67.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.67
|
| Rate for Payer: Nomi Health Commercial |
$60.19
|
| Rate for Payer: Nomi Health Commercial |
$60.19
|
| Rate for Payer: PACE SWMI |
$50.16
|
| Rate for Payer: PACE SWMI |
$50.16
|
| Rate for Payer: PHP Medicare Advantage |
$50.16
|
| Rate for Payer: PHP Medicare Advantage |
$50.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.90
|
| Rate for Payer: Priority Health Medicare |
$50.66
|
| Rate for Payer: Priority Health Medicare |
$50.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.16
|
| Rate for Payer: UHC Exchange |
$50.16
|
| Rate for Payer: UHC Exchange |
$50.16
|
| Rate for Payer: UHC Medicare Advantage |
$50.16
|
| Rate for Payer: UHC Medicare Advantage |
$50.16
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 76813
|
| Min. Negotiated Rate |
$103.93 |
| Max. Negotiated Rate |
$189.80 |
| Rate for Payer: Aetna Commercial |
$139.27
|
| Rate for Payer: Aetna Medicare |
$108.09
|
| Rate for Payer: BCBS Complete |
$116.80
|
| Rate for Payer: BCBS MAPPO |
$103.93
|
| Rate for Payer: BCN Medicare Advantage |
$103.93
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cofinity Commercial |
$149.66
|
| Rate for Payer: Cofinity Commercial |
$139.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.13
|
| Rate for Payer: Nomi Health Commercial |
$124.72
|
| Rate for Payer: PACE SWMI |
$103.93
|
| Rate for Payer: PHP Medicare Advantage |
$103.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health Medicare |
$104.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.93
|
| Rate for Payer: UHC Exchange |
$103.93
|
| Rate for Payer: UHC Medicare Advantage |
$103.93
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 76814
|
| Min. Negotiated Rate |
$67.93 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna Medicare |
$70.65
|
| Rate for Payer: BCBS Complete |
$78.00
|
| Rate for Payer: BCBS MAPPO |
$67.93
|
| Rate for Payer: BCN Medicare Advantage |
$67.93
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$97.82
|
| Rate for Payer: Cofinity Commercial |
$91.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.33
|
| Rate for Payer: Nomi Health Commercial |
$81.52
|
| Rate for Payer: PACE SWMI |
$67.93
|
| Rate for Payer: PHP Medicare Advantage |
$67.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.75
|
| Rate for Payer: Priority Health Medicare |
$68.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$67.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.93
|
| Rate for Payer: UHC Exchange |
$67.93
|
| Rate for Payer: UHC Medicare Advantage |
$67.93
|
|
|
CHG US GUIDANCE AMNIOCENTESIS IMG S&I
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 76946
|
| Min. Negotiated Rate |
$30.73 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Medicare |
$31.96
|
| Rate for Payer: BCBS Complete |
$128.00
|
| Rate for Payer: BCBS MAPPO |
$30.73
|
| Rate for Payer: BCN Medicare Advantage |
$30.73
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cofinity Commercial |
$44.25
|
| Rate for Payer: Cofinity Commercial |
$41.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.27
|
| Rate for Payer: Nomi Health Commercial |
$36.88
|
| Rate for Payer: PACE SWMI |
$30.73
|
| Rate for Payer: PHP Medicare Advantage |
$30.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health Medicare |
$31.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$30.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.73
|
| Rate for Payer: UHC Exchange |
$30.73
|
| Rate for Payer: UHC Medicare Advantage |
$30.73
|
|
|
CHG US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 76965
|
| Min. Negotiated Rate |
$88.56 |
| Max. Negotiated Rate |
$246.35 |
| Rate for Payer: Aetna Commercial |
$118.67
|
| Rate for Payer: Aetna Commercial |
$118.67
|
| Rate for Payer: Aetna Medicare |
$92.10
|
| Rate for Payer: Aetna Medicare |
$92.10
|
| Rate for Payer: BCBS Complete |
$151.60
|
| Rate for Payer: BCBS Complete |
$106.80
|
| Rate for Payer: BCBS MAPPO |
$88.56
|
| Rate for Payer: BCBS MAPPO |
$88.56
|
| Rate for Payer: BCN Medicare Advantage |
$88.56
|
| Rate for Payer: BCN Medicare Advantage |
$88.56
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cofinity Commercial |
$127.53
|
| Rate for Payer: Cofinity Commercial |
$127.53
|
| Rate for Payer: Cofinity Commercial |
$118.67
|
| Rate for Payer: Cofinity Commercial |
$118.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.99
|
| Rate for Payer: Nomi Health Commercial |
$106.27
|
| Rate for Payer: Nomi Health Commercial |
$106.27
|
| Rate for Payer: PACE SWMI |
$88.56
|
| Rate for Payer: PACE SWMI |
$88.56
|
| Rate for Payer: PHP Medicare Advantage |
$88.56
|
| Rate for Payer: PHP Medicare Advantage |
$88.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.35
|
| Rate for Payer: Priority Health Medicare |
$89.45
|
| Rate for Payer: Priority Health Medicare |
$89.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.56
|
| Rate for Payer: UHC Exchange |
$88.56
|
| Rate for Payer: UHC Exchange |
$88.56
|
| Rate for Payer: UHC Medicare Advantage |
$88.56
|
| Rate for Payer: UHC Medicare Advantage |
$88.56
|
|
|
CHG US GUIDANCE NEEDLE PLACEMENT IMG S&I
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 76942
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$78.38 |
| Rate for Payer: Aetna Commercial |
$72.94
|
| Rate for Payer: Aetna Commercial |
$72.94
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: Aetna Medicare |
$56.61
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: BCBS Complete |
$186.40
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCBS MAPPO |
$54.43
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: BCN Medicare Advantage |
$54.43
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$78.38
|
| Rate for Payer: Cofinity Commercial |
$72.94
|
| Rate for Payer: Cofinity Commercial |
$78.38
|
| Rate for Payer: Cofinity Commercial |
$72.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.15
|
| Rate for Payer: Nomi Health Commercial |
$65.32
|
| Rate for Payer: Nomi Health Commercial |
$65.32
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PACE SWMI |
$54.43
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: PHP Medicare Advantage |
$54.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.90
|
| Rate for Payer: Priority Health Medicare |
$54.97
|
| Rate for Payer: Priority Health Medicare |
$54.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.43
|
| Rate for Payer: UHC Exchange |
$54.43
|
| Rate for Payer: UHC Exchange |
$54.43
|
| Rate for Payer: UHC Medicare Advantage |
$54.43
|
| Rate for Payer: UHC Medicare Advantage |
$54.43
|
|
|
CHG US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 76941
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: Aetna Medicare |
$93.50
|
| Rate for Payer: BCBS Complete |
$74.80
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.55
|
|
|
CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 76882
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$85.36 |
| Rate for Payer: Aetna Commercial |
$79.44
|
| Rate for Payer: Aetna Commercial |
$79.44
|
| Rate for Payer: Aetna Medicare |
$61.65
|
| Rate for Payer: Aetna Medicare |
$61.65
|
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: BCBS Complete |
$35.60
|
| Rate for Payer: BCBS MAPPO |
$59.28
|
| Rate for Payer: BCBS MAPPO |
$59.28
|
| Rate for Payer: BCN Medicare Advantage |
$59.28
|
| Rate for Payer: BCN Medicare Advantage |
$59.28
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cofinity Commercial |
$85.36
|
| Rate for Payer: Cofinity Commercial |
$79.44
|
| Rate for Payer: Cofinity Commercial |
$85.36
|
| Rate for Payer: Cofinity Commercial |
$79.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$62.24
|
| Rate for Payer: Nomi Health Commercial |
$71.14
|
| Rate for Payer: Nomi Health Commercial |
$71.14
|
| Rate for Payer: PACE SWMI |
$59.28
|
| Rate for Payer: PACE SWMI |
$59.28
|
| Rate for Payer: PHP Medicare Advantage |
$59.28
|
| Rate for Payer: PHP Medicare Advantage |
$59.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: Priority Health Medicare |
$59.87
|
| Rate for Payer: Priority Health Medicare |
$59.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.28
|
| Rate for Payer: UHC Exchange |
$59.28
|
| Rate for Payer: UHC Exchange |
$59.28
|
| Rate for Payer: UHC Medicare Advantage |
$59.28
|
| Rate for Payer: UHC Medicare Advantage |
$59.28
|
|
|
CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 76857
|
| Min. Negotiated Rate |
$45.90 |
| Max. Negotiated Rate |
$146.25 |
| Rate for Payer: Aetna Commercial |
$61.51
|
| Rate for Payer: Aetna Medicare |
$47.74
|
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: BCBS MAPPO |
$45.90
|
| Rate for Payer: BCN Medicare Advantage |
$45.90
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$66.10
|
| Rate for Payer: Cofinity Commercial |
$61.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.20
|
| Rate for Payer: Nomi Health Commercial |
$55.08
|
| Rate for Payer: PACE SWMI |
$45.90
|
| Rate for Payer: PHP Medicare Advantage |
$45.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.25
|
| Rate for Payer: Priority Health Medicare |
$46.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.90
|
| Rate for Payer: UHC Exchange |
$45.90
|
| Rate for Payer: UHC Medicare Advantage |
$45.90
|
|
|
CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 76856
|
| Min. Negotiated Rate |
$94.94 |
| Max. Negotiated Rate |
$195.65 |
| Rate for Payer: Aetna Commercial |
$127.22
|
| Rate for Payer: Aetna Medicare |
$98.74
|
| Rate for Payer: BCBS Complete |
$120.40
|
| Rate for Payer: BCBS MAPPO |
$94.94
|
| Rate for Payer: BCN Medicare Advantage |
$94.94
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cofinity Commercial |
$136.71
|
| Rate for Payer: Cofinity Commercial |
$127.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.69
|
| Rate for Payer: Nomi Health Commercial |
$113.93
|
| Rate for Payer: PACE SWMI |
$94.94
|
| Rate for Payer: PHP Medicare Advantage |
$94.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.65
|
| Rate for Payer: Priority Health Medicare |
$95.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.94
|
| Rate for Payer: UHC Exchange |
$94.94
|
| Rate for Payer: UHC Medicare Advantage |
$94.94
|
|
|
CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 76801
|
| Min. Negotiated Rate |
$106.12 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: Aetna Medicare |
$110.36
|
| Rate for Payer: BCBS Complete |
$114.00
|
| Rate for Payer: BCBS MAPPO |
$106.12
|
| Rate for Payer: BCN Medicare Advantage |
$106.12
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$152.81
|
| Rate for Payer: Cofinity Commercial |
$142.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.43
|
| Rate for Payer: Nomi Health Commercial |
$127.34
|
| Rate for Payer: PACE SWMI |
$106.12
|
| Rate for Payer: PHP Medicare Advantage |
$106.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.25
|
| Rate for Payer: Priority Health Medicare |
$107.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.12
|
| Rate for Payer: UHC Exchange |
$106.12
|
| Rate for Payer: UHC Medicare Advantage |
$106.12
|
|
|
CHG US PREGNANT UTERUS LIMITED 1/> FETUSES
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 76815
|
| Min. Negotiated Rate |
$73.52 |
| Max. Negotiated Rate |
$172.25 |
| Rate for Payer: Aetna Commercial |
$98.52
|
| Rate for Payer: Aetna Medicare |
$76.46
|
| Rate for Payer: BCBS Complete |
$106.00
|
| Rate for Payer: BCBS MAPPO |
$73.52
|
| Rate for Payer: BCN Medicare Advantage |
$73.52
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cofinity Commercial |
$98.52
|
| Rate for Payer: Cofinity Commercial |
$105.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$77.20
|
| Rate for Payer: Nomi Health Commercial |
$88.22
|
| Rate for Payer: PACE SWMI |
$73.52
|
| Rate for Payer: PHP Medicare Advantage |
$73.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.25
|
| Rate for Payer: Priority Health Medicare |
$74.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$73.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.52
|
| Rate for Payer: UHC Exchange |
$73.52
|
| Rate for Payer: UHC Medicare Advantage |
$73.52
|
|
|
CHG US PREG UTERUS 14 WK TRANSABDL EACH GESTATION
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 76802
|
| Min. Negotiated Rate |
$55.39 |
| Max. Negotiated Rate |
$92.95 |
| Rate for Payer: Aetna Commercial |
$74.22
|
| Rate for Payer: Aetna Medicare |
$57.61
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: BCBS MAPPO |
$55.39
|
| Rate for Payer: BCN Medicare Advantage |
$55.39
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cofinity Commercial |
$79.76
|
| Rate for Payer: Cofinity Commercial |
$74.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.16
|
| Rate for Payer: Nomi Health Commercial |
$66.47
|
| Rate for Payer: PACE SWMI |
$55.39
|
| Rate for Payer: PHP Medicare Advantage |
$55.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: Priority Health Medicare |
$55.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.39
|
| Rate for Payer: UHC Exchange |
$55.39
|
| Rate for Payer: UHC Medicare Advantage |
$55.39
|
|
|
CHG US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO
|
Professional
|
Both
|
$423.00
|
|
|
Service Code
|
HCPCS 76810
|
| Min. Negotiated Rate |
$79.40 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$106.40
|
| Rate for Payer: Aetna Medicare |
$82.58
|
| Rate for Payer: BCBS Complete |
$169.20
|
| Rate for Payer: BCBS MAPPO |
$79.40
|
| Rate for Payer: BCN Medicare Advantage |
$79.40
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cofinity Commercial |
$114.34
|
| Rate for Payer: Cofinity Commercial |
$106.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.37
|
| Rate for Payer: Nomi Health Commercial |
$95.28
|
| Rate for Payer: PACE SWMI |
$79.40
|
| Rate for Payer: PHP Medicare Advantage |
$79.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.95
|
| Rate for Payer: Priority Health Medicare |
$80.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.40
|
| Rate for Payer: UHC Exchange |
$79.40
|
| Rate for Payer: UHC Medicare Advantage |
$79.40
|
|
|
CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
HCPCS 76805
|
| Min. Negotiated Rate |
$121.82 |
| Max. Negotiated Rate |
$234.65 |
| Rate for Payer: Aetna Commercial |
$163.24
|
| Rate for Payer: Aetna Medicare |
$126.69
|
| Rate for Payer: BCBS Complete |
$144.40
|
| Rate for Payer: BCBS MAPPO |
$121.82
|
| Rate for Payer: BCN Medicare Advantage |
$121.82
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cofinity Commercial |
$175.42
|
| Rate for Payer: Cofinity Commercial |
$163.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$121.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$127.91
|
| Rate for Payer: Nomi Health Commercial |
$146.18
|
| Rate for Payer: PACE SWMI |
$121.82
|
| Rate for Payer: PHP Medicare Advantage |
$121.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: Priority Health Medicare |
$123.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$121.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$121.82
|
| Rate for Payer: UHC Exchange |
$121.82
|
| Rate for Payer: UHC Medicare Advantage |
$121.82
|
|
|
CHG US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 76812
|
| Min. Negotiated Rate |
$138.40 |
| Max. Negotiated Rate |
$248.70 |
| Rate for Payer: Aetna Commercial |
$231.43
|
| Rate for Payer: Aetna Medicare |
$179.62
|
| Rate for Payer: BCBS Complete |
$138.40
|
| Rate for Payer: BCBS MAPPO |
$172.71
|
| Rate for Payer: BCN Medicare Advantage |
$172.71
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cofinity Commercial |
$248.70
|
| Rate for Payer: Cofinity Commercial |
$231.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$181.35
|
| Rate for Payer: Nomi Health Commercial |
$207.25
|
| Rate for Payer: PACE SWMI |
$172.71
|
| Rate for Payer: PHP Medicare Advantage |
$172.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.90
|
| Rate for Payer: Priority Health Medicare |
$174.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$172.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$172.71
|
| Rate for Payer: UHC Exchange |
$172.71
|
| Rate for Payer: UHC Medicare Advantage |
$172.71
|
|
|
CHG US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 76816
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$143.65 |
| Rate for Payer: Aetna Commercial |
$131.95
|
| Rate for Payer: Aetna Medicare |
$102.41
|
| Rate for Payer: BCBS Complete |
$88.40
|
| Rate for Payer: BCBS MAPPO |
$98.47
|
| Rate for Payer: BCN Medicare Advantage |
$98.47
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cofinity Commercial |
$141.80
|
| Rate for Payer: Cofinity Commercial |
$131.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.39
|
| Rate for Payer: Nomi Health Commercial |
$118.16
|
| Rate for Payer: PACE SWMI |
$98.47
|
| Rate for Payer: PHP Medicare Advantage |
$98.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.65
|
| Rate for Payer: Priority Health Medicare |
$99.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.47
|
| Rate for Payer: UHC Exchange |
$98.47
|
| Rate for Payer: UHC Medicare Advantage |
$98.47
|
|
|
CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 76817
|
| Min. Negotiated Rate |
$83.53 |
| Max. Negotiated Rate |
$185.25 |
| Rate for Payer: Aetna Commercial |
$111.93
|
| Rate for Payer: Aetna Medicare |
$86.87
|
| Rate for Payer: BCBS Complete |
$114.00
|
| Rate for Payer: BCBS MAPPO |
$83.53
|
| Rate for Payer: BCN Medicare Advantage |
$83.53
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$120.28
|
| Rate for Payer: Cofinity Commercial |
$111.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.71
|
| Rate for Payer: Nomi Health Commercial |
$100.24
|
| Rate for Payer: PACE SWMI |
$83.53
|
| Rate for Payer: PHP Medicare Advantage |
$83.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.25
|
| Rate for Payer: Priority Health Medicare |
$84.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$83.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.53
|
| Rate for Payer: UHC Exchange |
$83.53
|
| Rate for Payer: UHC Medicare Advantage |
$83.53
|
|
|
CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 76811
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Aetna Commercial |
$218.19
|
| Rate for Payer: Aetna Medicare |
$169.34
|
| Rate for Payer: BCBS Complete |
$151.20
|
| Rate for Payer: BCBS MAPPO |
$162.83
|
| Rate for Payer: BCN Medicare Advantage |
$162.83
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cofinity Commercial |
$234.48
|
| Rate for Payer: Cofinity Commercial |
$218.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$170.97
|
| Rate for Payer: Nomi Health Commercial |
$195.40
|
| Rate for Payer: PACE SWMI |
$162.83
|
| Rate for Payer: PHP Medicare Advantage |
$162.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.70
|
| Rate for Payer: Priority Health Medicare |
$164.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$162.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.83
|
| Rate for Payer: UHC Exchange |
$162.83
|
| Rate for Payer: UHC Medicare Advantage |
$162.83
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 76770
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$140.86 |
| Rate for Payer: Aetna Commercial |
$131.08
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: BCBS MAPPO |
$97.82
|
| Rate for Payer: BCN Medicare Advantage |
$97.82
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cofinity Commercial |
$140.86
|
| Rate for Payer: Cofinity Commercial |
$131.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.71
|
| Rate for Payer: Nomi Health Commercial |
$117.38
|
| Rate for Payer: PACE SWMI |
$97.82
|
| Rate for Payer: PHP Medicare Advantage |
$97.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.80
|
| Rate for Payer: Priority Health Medicare |
$98.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.82
|
| Rate for Payer: UHC Exchange |
$97.82
|
| Rate for Payer: UHC Medicare Advantage |
$97.82
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE LIMITED
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 76775
|
| Min. Negotiated Rate |
$55.64 |
| Max. Negotiated Rate |
$126.10 |
| Rate for Payer: Aetna Commercial |
$74.56
|
| Rate for Payer: Aetna Medicare |
$57.87
|
| Rate for Payer: BCBS Complete |
$77.60
|
| Rate for Payer: BCBS MAPPO |
$55.64
|
| Rate for Payer: BCN Medicare Advantage |
$55.64
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$80.12
|
| Rate for Payer: Cofinity Commercial |
$74.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.42
|
| Rate for Payer: Nomi Health Commercial |
$66.77
|
| Rate for Payer: PACE SWMI |
$55.64
|
| Rate for Payer: PHP Medicare Advantage |
$55.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.10
|
| Rate for Payer: Priority Health Medicare |
$56.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.64
|
| Rate for Payer: UHC Exchange |
$55.64
|
| Rate for Payer: UHC Medicare Advantage |
$55.64
|
|
