|
CHG DRUG SCREEN LIST A ANY NMBR NON TLC DEVICES
|
Professional
|
$38.00
|
|
|
Service Code
|
HCPCS 80300
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
|
|
CHG DRUG SCREEN MULT CLASSES
|
Professional
|
$30.00
|
|
|
Service Code
|
HCPCS 80100
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
|
|
CHG DRUG SCREEN, QUAL,1+ DRUG CLASS,NON-CHROMOTOGRAPHIC,EACH
|
Professional
|
$38.00
|
|
|
Service Code
|
HCPCS 80104
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
|
|
CHG DRUG SCREEN SINGL CLASS
|
Professional
|
$30.00
|
|
|
Service Code
|
HCPCS 80101
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$21.00 |
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
|
|
CHG DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE
|
Professional
|
$38.00
|
|
|
Service Code
|
HCPCS 80305
|
| Min. Negotiated Rate |
$9.45 |
| Max. Negotiated Rate |
$26.60 |
| Rate for Payer: Aetna Commercial |
$16.88
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCN Commercial |
$9.45
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$16.88
|
| Rate for Payer: Cofinity Commercial |
$18.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.01
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.98
|
|
|
CHG DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE
|
Professional
|
$80.00
|
|
|
Service Code
|
HCPCS 80307
|
| Min. Negotiated Rate |
$32.00 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$83.27
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Commercial |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cofinity Commercial |
$89.48
|
| Rate for Payer: Cofinity Commercial |
$83.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$64.31
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$64.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$64.00
|
|
|
CHG DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS
|
Professional
|
$26.00
|
|
|
Service Code
|
HCPCS 80306
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$24.68 |
| Rate for Payer: Aetna Commercial |
$22.97
|
| Rate for Payer: Aetna Medicare |
$17.83
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$17.14
|
| Rate for Payer: BCN Commercial |
$12.86
|
| Rate for Payer: BCN Medicare Advantage |
$17.14
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$22.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.00
|
| Rate for Payer: PACE SWMI |
$17.14
|
| Rate for Payer: PHP Medicare Advantage |
$17.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.92
|
| Rate for Payer: Priority Health Medicare |
$17.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.14
|
| Rate for Payer: UHC Medicare Advantage |
$17.65
|
|
|
CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL
|
Professional
|
$26.00
|
|
|
Service Code
|
HCPCS 77081
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$110.60 |
| Rate for Payer: Aetna Commercial |
$39.84
|
| Rate for Payer: Aetna Commercial |
$39.84
|
| Rate for Payer: Aetna Medicare |
$30.92
|
| Rate for Payer: Aetna Medicare |
$30.92
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$29.73
|
| Rate for Payer: BCBS MAPPO |
$29.73
|
| Rate for Payer: BCN Commercial |
$45.94
|
| Rate for Payer: BCN Commercial |
$45.94
|
| Rate for Payer: BCN Medicare Advantage |
$29.73
|
| Rate for Payer: BCN Medicare Advantage |
$29.73
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$39.84
|
| Rate for Payer: Cofinity Commercial |
$42.81
|
| Rate for Payer: Cofinity Commercial |
$39.84
|
| Rate for Payer: Cofinity Commercial |
$42.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.73
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$31.22
|
| Rate for Payer: PACE SWMI |
$29.73
|
| Rate for Payer: PACE SWMI |
$29.73
|
| Rate for Payer: PHP Medicare Advantage |
$29.73
|
| Rate for Payer: PHP Medicare Advantage |
$29.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$110.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.14
|
| Rate for Payer: Priority Health Medicare |
$29.73
|
| Rate for Payer: Priority Health Medicare |
$29.73
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$48.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.73
|
| Rate for Payer: UHC Medicare Advantage |
$30.62
|
| Rate for Payer: UHC Medicare Advantage |
$30.62
|
|
|
CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL
|
Professional
|
$234.00
|
|
|
Service Code
|
HCPCS 77080
|
| Min. Negotiated Rate |
$35.91 |
| Max. Negotiated Rate |
$163.80 |
| Rate for Payer: Aetna Commercial |
$48.12
|
| Rate for Payer: Aetna Commercial |
$48.12
|
| Rate for Payer: Aetna Medicare |
$37.35
|
| Rate for Payer: Aetna Medicare |
$37.35
|
| Rate for Payer: BCBS Complete |
$93.60
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS MAPPO |
$35.91
|
| Rate for Payer: BCBS MAPPO |
$35.91
|
| Rate for Payer: BCN Commercial |
$55.71
|
| Rate for Payer: BCN Commercial |
$55.71
|
| Rate for Payer: BCN Medicare Advantage |
$35.91
|
| Rate for Payer: BCN Medicare Advantage |
$35.91
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$51.71
|
| Rate for Payer: Cofinity Commercial |
$48.12
|
| Rate for Payer: Cofinity Commercial |
$48.12
|
| Rate for Payer: Cofinity Commercial |
$51.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.71
|
| Rate for Payer: PACE SWMI |
$35.91
|
| Rate for Payer: PACE SWMI |
$35.91
|
| Rate for Payer: PHP Medicare Advantage |
$35.91
|
| Rate for Payer: PHP Medicare Advantage |
$35.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.38
|
| Rate for Payer: Priority Health Medicare |
$35.91
|
| Rate for Payer: Priority Health Medicare |
$35.91
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$58.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.91
|
| Rate for Payer: UHC Medicare Advantage |
$36.99
|
| Rate for Payer: UHC Medicare Advantage |
$36.99
|
|
|
CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING
|
Professional
|
$314.00
|
|
|
Service Code
|
HCPCS 76506
|
| Min. Negotiated Rate |
$107.45 |
| Max. Negotiated Rate |
$219.80 |
| Rate for Payer: Aetna Commercial |
$143.98
|
| Rate for Payer: Aetna Medicare |
$111.75
|
| Rate for Payer: BCBS Complete |
$125.60
|
| Rate for Payer: BCBS MAPPO |
$107.45
|
| Rate for Payer: BCN Commercial |
$166.64
|
| Rate for Payer: BCN Medicare Advantage |
$107.45
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cofinity Commercial |
$143.98
|
| Rate for Payer: Cofinity Commercial |
$154.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$112.82
|
| Rate for Payer: PACE SWMI |
$107.45
|
| Rate for Payer: PHP Medicare Advantage |
$107.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$174.66
|
| Rate for Payer: Priority Health Medicare |
$107.45
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$174.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.45
|
| Rate for Payer: UHC Medicare Advantage |
$110.67
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING
|
Professional
|
$273.00
|
|
|
Service Code
|
HCPCS 76825
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$403.07 |
| Rate for Payer: Aetna Commercial |
$332.91
|
| Rate for Payer: Aetna Medicare |
$258.38
|
| Rate for Payer: BCBS Complete |
$109.20
|
| Rate for Payer: BCBS MAPPO |
$248.44
|
| Rate for Payer: BCN Commercial |
$384.59
|
| Rate for Payer: BCN Medicare Advantage |
$248.44
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$357.75
|
| Rate for Payer: Cofinity Commercial |
$332.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$260.86
|
| Rate for Payer: PACE SWMI |
$248.44
|
| Rate for Payer: PHP Medicare Advantage |
$248.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$403.07
|
| Rate for Payer: Priority Health Medicare |
$248.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$403.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.44
|
| Rate for Payer: UHC Medicare Advantage |
$255.89
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD
|
Professional
|
$128.00
|
|
|
Service Code
|
HCPCS 76826
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$241.23 |
| Rate for Payer: Aetna Commercial |
$198.49
|
| Rate for Payer: Aetna Medicare |
$154.06
|
| Rate for Payer: BCBS Complete |
$51.20
|
| Rate for Payer: BCBS MAPPO |
$148.13
|
| Rate for Payer: BCN Commercial |
$230.17
|
| Rate for Payer: BCN Medicare Advantage |
$148.13
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cash Price |
$102.40
|
| Rate for Payer: Cofinity Commercial |
$213.31
|
| Rate for Payer: Cofinity Commercial |
$198.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$155.54
|
| Rate for Payer: PACE SWMI |
$148.13
|
| Rate for Payer: PHP Medicare Advantage |
$148.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$241.23
|
| Rate for Payer: Priority Health Medicare |
$148.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$241.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.13
|
| Rate for Payer: UHC Medicare Advantage |
$152.57
|
|
|
CHG ENDOVASC REPAIR AAA
|
Professional
|
$502.00
|
|
|
Service Code
|
HCPCS 75952
|
| Min. Negotiated Rate |
$200.80 |
| Max. Negotiated Rate |
$351.40 |
| Rate for Payer: BCBS Complete |
$200.80
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$351.40
|
|
|
CHG EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I
|
Professional
|
$581.00
|
|
|
Service Code
|
HCPCS 75957
|
| Min. Negotiated Rate |
$232.40 |
| Max. Negotiated Rate |
$629.42 |
| Rate for Payer: Aetna Commercial |
$345.53
|
| Rate for Payer: BCBS Complete |
$232.40
|
| Rate for Payer: BCN Commercial |
$629.42
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Cash Price |
$464.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$406.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$429.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$429.19
|
|
|
CHG EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I
|
Professional
|
$679.00
|
|
|
Service Code
|
HCPCS 75956
|
| Min. Negotiated Rate |
$271.60 |
| Max. Negotiated Rate |
$691.96 |
| Rate for Payer: Aetna Commercial |
$403.09
|
| Rate for Payer: BCBS Complete |
$271.60
|
| Rate for Payer: BCN Commercial |
$691.96
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Cash Price |
$543.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$475.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$500.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$500.90
|
|
|
CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING
|
Professional
|
$328.00
|
|
|
Service Code
|
HCPCS 76818
|
| Min. Negotiated Rate |
$111.55 |
| Max. Negotiated Rate |
$229.60 |
| Rate for Payer: Aetna Commercial |
$149.48
|
| Rate for Payer: Aetna Medicare |
$116.01
|
| Rate for Payer: BCBS Complete |
$131.20
|
| Rate for Payer: BCBS MAPPO |
$111.55
|
| Rate for Payer: BCN Commercial |
$171.04
|
| Rate for Payer: BCN Medicare Advantage |
$111.55
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cash Price |
$262.40
|
| Rate for Payer: Cofinity Commercial |
$160.63
|
| Rate for Payer: Cofinity Commercial |
$149.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$117.13
|
| Rate for Payer: PACE SWMI |
$111.55
|
| Rate for Payer: PHP Medicare Advantage |
$111.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$229.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.27
|
| Rate for Payer: Priority Health Medicare |
$111.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$111.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$111.55
|
| Rate for Payer: UHC Medicare Advantage |
$114.90
|
|
|
CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Professional
|
$225.00
|
|
|
Service Code
|
HCPCS 76819
|
| Min. Negotiated Rate |
$80.29 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$107.59
|
| Rate for Payer: Aetna Medicare |
$83.50
|
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: BCBS MAPPO |
$80.29
|
| Rate for Payer: BCN Commercial |
$123.15
|
| Rate for Payer: BCN Medicare Advantage |
$80.29
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$107.59
|
| Rate for Payer: Cofinity Commercial |
$115.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.30
|
| Rate for Payer: PACE SWMI |
$80.29
|
| Rate for Payer: PHP Medicare Advantage |
$80.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.07
|
| Rate for Payer: Priority Health Medicare |
$80.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.29
|
| Rate for Payer: UHC Medicare Advantage |
$82.70
|
|
|
CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
$294.00
|
|
|
Service Code
|
HCPCS 77003
|
| Min. Negotiated Rate |
$100.26 |
| Max. Negotiated Rate |
$205.80 |
| Rate for Payer: Aetna Commercial |
$134.35
|
| Rate for Payer: Aetna Medicare |
$104.27
|
| Rate for Payer: BCBS Complete |
$117.60
|
| Rate for Payer: BCBS MAPPO |
$100.26
|
| Rate for Payer: BCN Commercial |
$155.40
|
| Rate for Payer: BCN Medicare Advantage |
$100.26
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cofinity Commercial |
$144.37
|
| Rate for Payer: Cofinity Commercial |
$134.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$105.27
|
| Rate for Payer: PACE SWMI |
$100.26
|
| Rate for Payer: PHP Medicare Advantage |
$100.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$162.87
|
| Rate for Payer: Priority Health Medicare |
$100.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.26
|
| Rate for Payer: UHC Medicare Advantage |
$103.27
|
|
|
CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
$168.00
|
|
|
Service Code
|
HCPCS 77001
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$154.68 |
| Rate for Payer: Aetna Commercial |
$126.84
|
| Rate for Payer: Aetna Commercial |
$126.84
|
| Rate for Payer: Aetna Medicare |
$98.45
|
| Rate for Payer: Aetna Medicare |
$98.45
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS Complete |
$58.40
|
| Rate for Payer: BCBS MAPPO |
$94.66
|
| Rate for Payer: BCBS MAPPO |
$94.66
|
| Rate for Payer: BCN Commercial |
$147.58
|
| Rate for Payer: BCN Commercial |
$147.58
|
| Rate for Payer: BCN Medicare Advantage |
$94.66
|
| Rate for Payer: BCN Medicare Advantage |
$94.66
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$126.84
|
| Rate for Payer: Cofinity Commercial |
$126.84
|
| Rate for Payer: Cofinity Commercial |
$136.31
|
| Rate for Payer: Cofinity Commercial |
$136.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$99.39
|
| Rate for Payer: PACE SWMI |
$94.66
|
| Rate for Payer: PACE SWMI |
$94.66
|
| Rate for Payer: PHP Medicare Advantage |
$94.66
|
| Rate for Payer: PHP Medicare Advantage |
$94.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.68
|
| Rate for Payer: Priority Health Medicare |
$94.66
|
| Rate for Payer: Priority Health Medicare |
$94.66
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.66
|
| Rate for Payer: UHC Medicare Advantage |
$97.50
|
| Rate for Payer: UHC Medicare Advantage |
$97.50
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Facility
OP
|
$112.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
77002
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$95.20
|
| Rate for Payer: Aetna Medicare |
$29.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.00
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$28.00
|
| Rate for Payer: BCBS Trust/PPO |
$87.08
|
| Rate for Payer: BCN Commercial |
$87.08
|
| Rate for Payer: BCN Medicare Advantage |
$28.00
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$96.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.00
|
| Rate for Payer: Healthscope Commercial |
$100.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$29.40
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.20
|
| Rate for Payer: PACE Senior Care Partners |
$26.60
|
| Rate for Payer: PACE SWMI |
$28.00
|
| Rate for Payer: PHP Commercial |
$95.20
|
| Rate for Payer: PHP Medicare Advantage |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.44
|
| Rate for Payer: Priority Health Medicare |
$28.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.31
|
| Rate for Payer: Railroad Medicare Medicare |
$28.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.56
|
| Rate for Payer: UHC Core |
$93.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.00
|
| Rate for Payer: UHC Medicare Advantage |
$28.84
|
| Rate for Payer: VA VA |
$28.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.00
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Facility
IP
|
$112.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
77002
|
| Min. Negotiated Rate |
$68.31 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Aetna Commercial |
$95.20
|
| Rate for Payer: BCBS Trust/PPO |
$86.55
|
| Rate for Payer: BCN Commercial |
$86.55
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$96.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$89.60
|
| Rate for Payer: Healthscope Commercial |
$100.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$84.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$95.20
|
| Rate for Payer: PHP Commercial |
$95.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$68.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.56
|
| Rate for Payer: UHC Core |
$93.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$84.00
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
$112.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
77002
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$179.27 |
| Rate for Payer: Aetna Commercial |
$147.35
|
| Rate for Payer: Aetna Medicare |
$114.36
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$109.96
|
| Rate for Payer: BCN Commercial |
$171.04
|
| Rate for Payer: BCN Medicare Advantage |
$109.96
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$147.35
|
| Rate for Payer: Cofinity Commercial |
$158.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$115.46
|
| Rate for Payer: PACE SWMI |
$109.96
|
| Rate for Payer: PHP Medicare Advantage |
$109.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.27
|
| Rate for Payer: Priority Health Medicare |
$109.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.96
|
| Rate for Payer: UHC Medicare Advantage |
$113.26
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
$112.00
|
|
|
Service Code
|
HCPCS 77002
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$179.27 |
| Rate for Payer: Aetna Commercial |
$147.35
|
| Rate for Payer: Aetna Medicare |
$114.36
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$109.96
|
| Rate for Payer: BCN Commercial |
$171.04
|
| Rate for Payer: BCN Medicare Advantage |
$109.96
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$147.35
|
| Rate for Payer: Cofinity Commercial |
$158.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$115.46
|
| Rate for Payer: PACE SWMI |
$109.96
|
| Rate for Payer: PHP Medicare Advantage |
$109.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.27
|
| Rate for Payer: Priority Health Medicare |
$109.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$179.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$109.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.96
|
| Rate for Payer: UHC Medicare Advantage |
$113.26
|
|
|
CHG FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME
|
Professional
|
$66.00
|
|
|
Service Code
|
HCPCS 76001
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$46.20 |
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.20
|
|
|
CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME
|
Professional
|
$54.00
|
|
|
Service Code
|
HCPCS 76000
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$66.58 |
| Rate for Payer: Aetna Commercial |
$55.37
|
| Rate for Payer: Aetna Medicare |
$42.97
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS MAPPO |
$41.32
|
| Rate for Payer: BCN Commercial |
$63.53
|
| Rate for Payer: BCN Medicare Advantage |
$41.32
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$55.37
|
| Rate for Payer: Cofinity Commercial |
$59.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.39
|
| Rate for Payer: PACE SWMI |
$41.32
|
| Rate for Payer: PHP Medicare Advantage |
$41.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$66.58
|
| Rate for Payer: Priority Health Medicare |
$41.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$66.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.32
|
| Rate for Payer: UHC Medicare Advantage |
$42.56
|
|
