|
CEPHALEXIN 250 MG CAPSULE
|
Facility
IP
|
$220.90
|
|
|
Service Code
|
NDC 67877-220-01
|
| Hospital Charge Code |
9499
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$134.73 |
| Max. Negotiated Rate |
$198.81 |
| Rate for Payer: Aetna Commercial |
$187.76
|
| Rate for Payer: BCBS Trust/PPO |
$170.71
|
| Rate for Payer: BCN Commercial |
$170.71
|
| Rate for Payer: Cash Price |
$176.72
|
| Rate for Payer: Cofinity Commercial |
$189.97
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$176.72
|
| Rate for Payer: Healthscope Commercial |
$198.81
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$165.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$187.76
|
| Rate for Payer: PHP Commercial |
$187.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.63
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$134.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$194.39
|
| Rate for Payer: UHC Core |
$184.45
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$165.68
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
IP
|
$3.11
|
|
|
Service Code
|
NDC 60687-163-11
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$2.80 |
| Rate for Payer: Aetna Commercial |
$2.64
|
| Rate for Payer: BCBS Trust/PPO |
$2.40
|
| Rate for Payer: BCN Commercial |
$2.40
|
| Rate for Payer: Cash Price |
$2.49
|
| Rate for Payer: Cofinity Commercial |
$2.67
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.49
|
| Rate for Payer: Healthscope Commercial |
$2.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.64
|
| Rate for Payer: PHP Commercial |
$2.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.74
|
| Rate for Payer: UHC Core |
$2.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.33
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
IP
|
$127.30
|
|
|
Service Code
|
NDC 50268-152-15
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.64 |
| Max. Negotiated Rate |
$114.57 |
| Rate for Payer: Aetna Commercial |
$108.20
|
| Rate for Payer: BCBS Trust/PPO |
$98.38
|
| Rate for Payer: BCN Commercial |
$98.38
|
| Rate for Payer: Cash Price |
$101.84
|
| Rate for Payer: Cofinity Commercial |
$109.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$101.84
|
| Rate for Payer: Healthscope Commercial |
$114.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$95.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$108.20
|
| Rate for Payer: PHP Commercial |
$108.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$77.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.02
|
| Rate for Payer: UHC Core |
$106.30
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$95.48
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
IP
|
$310.65
|
|
|
Service Code
|
NDC 60687-163-01
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$189.47 |
| Max. Negotiated Rate |
$279.58 |
| Rate for Payer: Aetna Commercial |
$264.05
|
| Rate for Payer: BCBS Trust/PPO |
$240.07
|
| Rate for Payer: BCN Commercial |
$240.07
|
| Rate for Payer: Cash Price |
$248.52
|
| Rate for Payer: Cofinity Commercial |
$267.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$248.52
|
| Rate for Payer: Healthscope Commercial |
$279.58
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$232.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$264.05
|
| Rate for Payer: PHP Commercial |
$264.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$270.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$189.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$273.37
|
| Rate for Payer: UHC Core |
$259.39
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$232.99
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
IP
|
$192.85
|
|
|
Service Code
|
NDC 0093-3147-01
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$117.62 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: BCBS Trust/PPO |
$149.03
|
| Rate for Payer: BCN Commercial |
$149.03
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$163.92
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Core |
$161.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
IP
|
$277.30
|
|
|
Service Code
|
NDC 67877-219-01
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$169.13 |
| Max. Negotiated Rate |
$249.57 |
| Rate for Payer: Aetna Commercial |
$235.70
|
| Rate for Payer: BCBS Trust/PPO |
$214.30
|
| Rate for Payer: BCN Commercial |
$214.30
|
| Rate for Payer: Cash Price |
$221.84
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$221.84
|
| Rate for Payer: Healthscope Commercial |
$249.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$207.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$235.70
|
| Rate for Payer: PHP Commercial |
$235.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.11
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.02
|
| Rate for Payer: UHC Core |
$231.55
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$207.98
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
IP
|
$2.55
|
|
|
Service Code
|
NDC 50268-152-11
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Aetna Commercial |
$2.17
|
| Rate for Payer: BCBS Trust/PPO |
$1.97
|
| Rate for Payer: BCN Commercial |
$1.97
|
| Rate for Payer: Cash Price |
$2.04
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.04
|
| Rate for Payer: Healthscope Commercial |
$2.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$2.17
|
| Rate for Payer: PHP Commercial |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.78
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.24
|
| Rate for Payer: UHC Core |
$2.13
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.91
|
|
|
CHEMICAL PEELS
|
Professional
|
$75.00
|
|
|
Service Code
|
HCPCS 00172
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$52.50 |
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
|
|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
$1,346.00
|
|
|
Service Code
|
HCPCS 77295
|
| Min. Negotiated Rate |
$455.49 |
| Max. Negotiated Rate |
$1,199.80 |
| Rate for Payer: Aetna Commercial |
$610.36
|
| Rate for Payer: Aetna Commercial |
$610.36
|
| Rate for Payer: Aetna Medicare |
$473.71
|
| Rate for Payer: Aetna Medicare |
$473.71
|
| Rate for Payer: BCBS Complete |
$685.60
|
| Rate for Payer: BCBS Complete |
$538.40
|
| Rate for Payer: BCBS MAPPO |
$455.49
|
| Rate for Payer: BCBS MAPPO |
$455.49
|
| Rate for Payer: BCN Commercial |
$699.98
|
| Rate for Payer: BCN Commercial |
$699.98
|
| Rate for Payer: BCN Medicare Advantage |
$455.49
|
| Rate for Payer: BCN Medicare Advantage |
$455.49
|
| Rate for Payer: Cash Price |
$1,371.20
|
| Rate for Payer: Cash Price |
$1,371.20
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cash Price |
$1,076.80
|
| Rate for Payer: Cofinity Commercial |
$610.36
|
| Rate for Payer: Cofinity Commercial |
$610.36
|
| Rate for Payer: Cofinity Commercial |
$655.91
|
| Rate for Payer: Cofinity Commercial |
$655.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$455.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$455.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$478.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$478.26
|
| Rate for Payer: PACE SWMI |
$455.49
|
| Rate for Payer: PACE SWMI |
$455.49
|
| Rate for Payer: PHP Medicare Advantage |
$455.49
|
| Rate for Payer: PHP Medicare Advantage |
$455.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$942.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,199.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$731.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$731.89
|
| Rate for Payer: Priority Health Medicare |
$455.49
|
| Rate for Payer: Priority Health Medicare |
$455.49
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$731.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$731.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$455.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$455.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$455.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$455.49
|
| Rate for Payer: UHC Medicare Advantage |
$469.15
|
| Rate for Payer: UHC Medicare Advantage |
$469.15
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
$134.00
|
|
|
Service Code
|
HCPCS 76377
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$116.26 |
| Rate for Payer: Aetna Commercial |
$97.47
|
| Rate for Payer: Aetna Medicare |
$75.65
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: BCBS MAPPO |
$72.74
|
| Rate for Payer: BCN Commercial |
$110.93
|
| Rate for Payer: BCN Medicare Advantage |
$72.74
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$97.47
|
| Rate for Payer: Cofinity Commercial |
$104.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$76.38
|
| Rate for Payer: PACE SWMI |
$72.74
|
| Rate for Payer: PHP Medicare Advantage |
$72.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.26
|
| Rate for Payer: Priority Health Medicare |
$72.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.74
|
| Rate for Payer: UHC Medicare Advantage |
$74.92
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
$44.00
|
|
|
Service Code
|
HCPCS 76376
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$36.88 |
| Rate for Payer: Aetna Commercial |
$30.74
|
| Rate for Payer: Aetna Commercial |
$30.74
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: Aetna Medicare |
$23.86
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCBS MAPPO |
$22.94
|
| Rate for Payer: BCN Commercial |
$35.19
|
| Rate for Payer: BCN Commercial |
$35.19
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: BCN Medicare Advantage |
$22.94
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$30.74
|
| Rate for Payer: Cofinity Commercial |
$33.03
|
| Rate for Payer: Cofinity Commercial |
$30.74
|
| Rate for Payer: Cofinity Commercial |
$33.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.94
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.09
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PACE SWMI |
$22.94
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: PHP Medicare Advantage |
$22.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.88
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health Medicare |
$22.94
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$22.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.94
|
| Rate for Payer: UHC Medicare Advantage |
$23.63
|
| Rate for Payer: UHC Medicare Advantage |
$23.63
|
|
|
CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
|
Professional
|
$673.00
|
|
|
Service Code
|
HCPCS 78278
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$497.82 |
| Rate for Payer: Aetna Commercial |
$406.69
|
| Rate for Payer: Aetna Medicare |
$315.64
|
| Rate for Payer: BCBS Complete |
$269.20
|
| Rate for Payer: BCBS MAPPO |
$303.50
|
| Rate for Payer: BCN Commercial |
$475.00
|
| Rate for Payer: BCN Medicare Advantage |
$303.50
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cofinity Commercial |
$406.69
|
| Rate for Payer: Cofinity Commercial |
$437.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$303.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$318.68
|
| Rate for Payer: PACE SWMI |
$303.50
|
| Rate for Payer: PHP Medicare Advantage |
$303.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$497.82
|
| Rate for Payer: Priority Health Medicare |
$303.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$497.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$303.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$303.50
|
| Rate for Payer: UHC Medicare Advantage |
$312.60
|
|
|
CHG ANGIO ARCH ANGIOGRAM W CATH
|
Professional
|
$262.00
|
|
|
Service Code
|
HCPCS 75650
|
| Min. Negotiated Rate |
$104.80 |
| Max. Negotiated Rate |
$183.40 |
| Rate for Payer: BCBS Complete |
$104.80
|
| Rate for Payer: Cash Price |
$209.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.40
|
|
|
CHG ANGIO AV SHUNT COMPLETE EVAL
|
Professional
|
$302.00
|
|
|
Service Code
|
HCPCS 75791
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$347.90 |
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: BCBS Complete |
$198.80
|
| Rate for Payer: Cash Price |
$397.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$347.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.40
|
|
|
CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
$194.00
|
|
|
Service Code
|
HCPCS 75716
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$248.91 |
| Rate for Payer: Aetna Commercial |
$210.66
|
| Rate for Payer: Aetna Medicare |
$163.50
|
| Rate for Payer: BCBS Complete |
$77.60
|
| Rate for Payer: BCBS MAPPO |
$157.21
|
| Rate for Payer: BCN Commercial |
$237.49
|
| Rate for Payer: BCN Medicare Advantage |
$157.21
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$226.38
|
| Rate for Payer: Cofinity Commercial |
$210.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$157.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$165.07
|
| Rate for Payer: PACE SWMI |
$157.21
|
| Rate for Payer: PHP Medicare Advantage |
$157.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$135.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$248.91
|
| Rate for Payer: Priority Health Medicare |
$157.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$157.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$157.21
|
| Rate for Payer: UHC Medicare Advantage |
$161.93
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
$178.00
|
|
|
Service Code
|
HCPCS 75710
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$295.40 |
| Rate for Payer: Aetna Commercial |
$195.02
|
| Rate for Payer: Aetna Commercial |
$195.02
|
| Rate for Payer: Aetna Medicare |
$151.36
|
| Rate for Payer: Aetna Medicare |
$151.36
|
| Rate for Payer: BCBS Complete |
$168.80
|
| Rate for Payer: BCBS Complete |
$71.20
|
| Rate for Payer: BCBS MAPPO |
$145.54
|
| Rate for Payer: BCBS MAPPO |
$145.54
|
| Rate for Payer: BCN Commercial |
$219.91
|
| Rate for Payer: BCN Commercial |
$219.91
|
| Rate for Payer: BCN Medicare Advantage |
$145.54
|
| Rate for Payer: BCN Medicare Advantage |
$145.54
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cash Price |
$142.40
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Cofinity Commercial |
$209.58
|
| Rate for Payer: Cofinity Commercial |
$209.58
|
| Rate for Payer: Cofinity Commercial |
$195.02
|
| Rate for Payer: Cofinity Commercial |
$195.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$152.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$152.82
|
| Rate for Payer: PACE SWMI |
$145.54
|
| Rate for Payer: PACE SWMI |
$145.54
|
| Rate for Payer: PHP Medicare Advantage |
$145.54
|
| Rate for Payer: PHP Medicare Advantage |
$145.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.47
|
| Rate for Payer: Priority Health Medicare |
$145.54
|
| Rate for Payer: Priority Health Medicare |
$145.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.47
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$230.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.54
|
| Rate for Payer: UHC Medicare Advantage |
$149.91
|
| Rate for Payer: UHC Medicare Advantage |
$149.91
|
|
|
CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I
|
Professional
|
$186.00
|
|
|
Service Code
|
HCPCS 75756
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$247.88 |
| Rate for Payer: Aetna Commercial |
$206.02
|
| Rate for Payer: Aetna Medicare |
$159.90
|
| Rate for Payer: BCBS Complete |
$74.40
|
| Rate for Payer: BCBS MAPPO |
$153.75
|
| Rate for Payer: BCN Commercial |
$236.52
|
| Rate for Payer: BCN Medicare Advantage |
$153.75
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cofinity Commercial |
$206.02
|
| Rate for Payer: Cofinity Commercial |
$221.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.75
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$161.44
|
| Rate for Payer: PACE SWMI |
$153.75
|
| Rate for Payer: PHP Medicare Advantage |
$153.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$130.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$247.88
|
| Rate for Payer: Priority Health Medicare |
$153.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$247.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.75
|
| Rate for Payer: UHC Medicare Advantage |
$158.36
|
|
|
CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I
|
Professional
|
$313.00
|
|
|
Service Code
|
HCPCS 75736
|
| Min. Negotiated Rate |
$125.20 |
| Max. Negotiated Rate |
$219.21 |
| Rate for Payer: Aetna Commercial |
$182.71
|
| Rate for Payer: Aetna Medicare |
$141.80
|
| Rate for Payer: BCBS Complete |
$125.20
|
| Rate for Payer: BCBS MAPPO |
$136.35
|
| Rate for Payer: BCN Commercial |
$209.15
|
| Rate for Payer: BCN Medicare Advantage |
$136.35
|
| Rate for Payer: Cash Price |
$250.40
|
| Rate for Payer: Cash Price |
$250.40
|
| Rate for Payer: Cofinity Commercial |
$182.71
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$143.17
|
| Rate for Payer: PACE SWMI |
$136.35
|
| Rate for Payer: PHP Medicare Advantage |
$136.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$219.21
|
| Rate for Payer: Priority Health Medicare |
$136.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$219.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.35
|
| Rate for Payer: UHC Medicare Advantage |
$140.44
|
|
|
CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I
|
Professional
|
$123.00
|
|
|
Service Code
|
HCPCS 75741
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$200.77 |
| Rate for Payer: Aetna Commercial |
$168.36
|
| Rate for Payer: Aetna Medicare |
$130.67
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS MAPPO |
$125.64
|
| Rate for Payer: BCN Commercial |
$191.56
|
| Rate for Payer: BCN Medicare Advantage |
$125.64
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cofinity Commercial |
$168.36
|
| Rate for Payer: Cofinity Commercial |
$180.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$131.92
|
| Rate for Payer: PACE SWMI |
$125.64
|
| Rate for Payer: PHP Medicare Advantage |
$125.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$200.77
|
| Rate for Payer: Priority Health Medicare |
$125.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$200.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$125.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.64
|
| Rate for Payer: UHC Medicare Advantage |
$129.41
|
|
|
CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I
|
Professional
|
$427.00
|
|
|
Service Code
|
HCPCS 75705
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$381.05 |
| Rate for Payer: Aetna Commercial |
$320.10
|
| Rate for Payer: Aetna Medicare |
$248.44
|
| Rate for Payer: BCBS Complete |
$170.80
|
| Rate for Payer: BCBS MAPPO |
$238.88
|
| Rate for Payer: BCN Commercial |
$363.58
|
| Rate for Payer: BCN Medicare Advantage |
$238.88
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cofinity Commercial |
$343.99
|
| Rate for Payer: Cofinity Commercial |
$320.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$250.82
|
| Rate for Payer: PACE SWMI |
$238.88
|
| Rate for Payer: PHP Medicare Advantage |
$238.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$298.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$381.05
|
| Rate for Payer: Priority Health Medicare |
$238.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$381.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$238.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.88
|
| Rate for Payer: UHC Medicare Advantage |
$246.05
|
|
|
CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I
|
Professional
|
$268.00
|
|
|
Service Code
|
HCPCS 75726
|
| Min. Negotiated Rate |
$107.20 |
| Max. Negotiated Rate |
$262.74 |
| Rate for Payer: Aetna Commercial |
$221.92
|
| Rate for Payer: Aetna Medicare |
$172.23
|
| Rate for Payer: BCBS Complete |
$107.20
|
| Rate for Payer: BCBS MAPPO |
$165.61
|
| Rate for Payer: BCN Commercial |
$250.69
|
| Rate for Payer: BCN Medicare Advantage |
$165.61
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cofinity Commercial |
$238.48
|
| Rate for Payer: Cofinity Commercial |
$221.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$173.89
|
| Rate for Payer: PACE SWMI |
$165.61
|
| Rate for Payer: PHP Medicare Advantage |
$165.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$262.74
|
| Rate for Payer: Priority Health Medicare |
$165.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$262.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.61
|
| Rate for Payer: UHC Medicare Advantage |
$170.58
|
|
|
CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS
|
Professional
|
$159.00
|
|
|
Service Code
|
HCPCS 75898
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$3,164.58 |
| Rate for Payer: Aetna Commercial |
$3,164.58
|
| Rate for Payer: BCBS Complete |
$63.60
|
| Rate for Payer: BCN Commercial |
$2,886.03
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.36
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$204.36
|
|
|
CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I
|
Professional
|
$296.00
|
|
|
Service Code
|
HCPCS 75774
|
| Min. Negotiated Rate |
$93.38 |
| Max. Negotiated Rate |
$207.20 |
| Rate for Payer: Aetna Commercial |
$125.13
|
| Rate for Payer: Aetna Medicare |
$97.12
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: BCBS MAPPO |
$93.38
|
| Rate for Payer: BCN Commercial |
$142.21
|
| Rate for Payer: BCN Medicare Advantage |
$93.38
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cofinity Commercial |
$134.47
|
| Rate for Payer: Cofinity Commercial |
$125.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$93.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$98.05
|
| Rate for Payer: PACE SWMI |
$93.38
|
| Rate for Payer: PHP Medicare Advantage |
$93.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.04
|
| Rate for Payer: Priority Health Medicare |
$93.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$149.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$93.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$93.38
|
| Rate for Payer: UHC Medicare Advantage |
$96.18
|
|
|
CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I
|
Professional
|
$466.00
|
|
|
Service Code
|
HCPCS 75630
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$326.20 |
| Rate for Payer: Aetna Commercial |
$203.67
|
| Rate for Payer: Aetna Commercial |
$203.67
|
| Rate for Payer: Aetna Medicare |
$158.07
|
| Rate for Payer: Aetna Medicare |
$158.07
|
| Rate for Payer: BCBS Complete |
$186.40
|
| Rate for Payer: BCBS Complete |
$114.80
|
| Rate for Payer: BCBS MAPPO |
$151.99
|
| Rate for Payer: BCBS MAPPO |
$151.99
|
| Rate for Payer: BCN Commercial |
$229.19
|
| Rate for Payer: BCN Commercial |
$229.19
|
| Rate for Payer: BCN Medicare Advantage |
$151.99
|
| Rate for Payer: BCN Medicare Advantage |
$151.99
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cofinity Commercial |
$218.87
|
| Rate for Payer: Cofinity Commercial |
$203.67
|
| Rate for Payer: Cofinity Commercial |
$218.87
|
| Rate for Payer: Cofinity Commercial |
$203.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.59
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$159.59
|
| Rate for Payer: PACE SWMI |
$151.99
|
| Rate for Payer: PACE SWMI |
$151.99
|
| Rate for Payer: PHP Medicare Advantage |
$151.99
|
| Rate for Payer: PHP Medicare Advantage |
$151.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$240.21
|
| Rate for Payer: Priority Health Medicare |
$151.99
|
| Rate for Payer: Priority Health Medicare |
$151.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$240.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.99
|
| Rate for Payer: UHC Medicare Advantage |
$156.55
|
| Rate for Payer: UHC Medicare Advantage |
$156.55
|
|
|
CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I
|
Professional
|
$113.00
|
|
|
Service Code
|
HCPCS 75625
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$193.59 |
| Rate for Payer: Aetna Commercial |
$163.68
|
| Rate for Payer: Aetna Commercial |
$163.68
|
| Rate for Payer: Aetna Medicare |
$127.04
|
| Rate for Payer: Aetna Medicare |
$127.04
|
| Rate for Payer: BCBS Complete |
$45.20
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$122.15
|
| Rate for Payer: BCBS MAPPO |
$122.15
|
| Rate for Payer: BCN Commercial |
$184.72
|
| Rate for Payer: BCN Commercial |
$184.72
|
| Rate for Payer: BCN Medicare Advantage |
$122.15
|
| Rate for Payer: BCN Medicare Advantage |
$122.15
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cofinity Commercial |
$175.90
|
| Rate for Payer: Cofinity Commercial |
$163.68
|
| Rate for Payer: Cofinity Commercial |
$163.68
|
| Rate for Payer: Cofinity Commercial |
$175.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$128.26
|
| Rate for Payer: PACE SWMI |
$122.15
|
| Rate for Payer: PACE SWMI |
$122.15
|
| Rate for Payer: PHP Medicare Advantage |
$122.15
|
| Rate for Payer: PHP Medicare Advantage |
$122.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.59
|
| Rate for Payer: Priority Health Medicare |
$122.15
|
| Rate for Payer: Priority Health Medicare |
$122.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$193.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.15
|
| Rate for Payer: UHC Medicare Advantage |
$125.81
|
| Rate for Payer: UHC Medicare Advantage |
$125.81
|
|
