|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
77002
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$1,036.52 |
| 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: BCBS Trust/PPO |
$1,036.52
|
| 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 |
$158.34
|
| Rate for Payer: Cofinity Commercial |
$147.35
|
| 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
|
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 FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME
|
Professional
|
Both
|
$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
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 76000
|
| Min. Negotiated Rate |
$21.60 |
| Max. Negotiated Rate |
$366.11 |
| 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: BCBS Trust/PPO |
$366.11
|
| 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
|
|
|
CHG GASTROESOPHAGEAL REFLUX STUDY
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
HCPCS 78262
|
| Min. Negotiated Rate |
$40.40 |
| Max. Negotiated Rate |
$653.51 |
| Rate for Payer: Aetna Commercial |
$288.78
|
| Rate for Payer: Aetna Medicare |
$224.13
|
| Rate for Payer: BCBS Complete |
$40.40
|
| Rate for Payer: BCBS MAPPO |
$215.51
|
| Rate for Payer: BCBS Trust/PPO |
$653.51
|
| Rate for Payer: BCN Commercial |
$337.19
|
| Rate for Payer: BCN Medicare Advantage |
$215.51
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cash Price |
$80.80
|
| Rate for Payer: Cofinity Commercial |
$310.33
|
| Rate for Payer: Cofinity Commercial |
$288.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$215.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$226.29
|
| Rate for Payer: PACE SWMI |
$215.51
|
| Rate for Payer: PHP Medicare Advantage |
$215.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$353.39
|
| Rate for Payer: Priority Health Medicare |
$215.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$353.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$215.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$215.51
|
| Rate for Payer: UHC Medicare Advantage |
$221.98
|
|
|
CHG GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 82962
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$1,864.90 |
| Rate for Payer: Aetna Commercial |
$4.40
|
| Rate for Payer: Aetna Medicare |
$3.41
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$3.28
|
| Rate for Payer: BCBS Trust/PPO |
$1,864.90
|
| Rate for Payer: BCN Commercial |
$3.28
|
| Rate for Payer: BCN Medicare Advantage |
$3.28
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$4.40
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.44
|
| Rate for Payer: PACE SWMI |
$3.28
|
| Rate for Payer: PHP Medicare Advantage |
$3.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$8.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.52
|
| Rate for Payer: Priority Health Medicare |
$3.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$3.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.28
|
| Rate for Payer: UHC Medicare Advantage |
$3.38
|
|
|
CHG GLUCOSE BLOOD REAGENT STRIP
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 82948
|
| Min. Negotiated Rate |
$3.78 |
| Max. Negotiated Rate |
$2,965.35 |
| Rate for Payer: Aetna Commercial |
$6.75
|
| Rate for Payer: Aetna Medicare |
$5.24
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$5.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,965.35
|
| Rate for Payer: BCN Commercial |
$3.78
|
| Rate for Payer: BCN Medicare Advantage |
$5.04
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$6.75
|
| Rate for Payer: Cofinity Commercial |
$7.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.29
|
| Rate for Payer: PACE SWMI |
$5.04
|
| Rate for Payer: PHP Medicare Advantage |
$5.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.27
|
| Rate for Payer: Priority Health Medicare |
$5.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.04
|
| Rate for Payer: UHC Medicare Advantage |
$5.19
|
|
|
CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS 82947
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$2,179.24 |
| Rate for Payer: Aetna Commercial |
$5.27
|
| Rate for Payer: Aetna Medicare |
$4.09
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$3.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,179.24
|
| Rate for Payer: BCN Commercial |
$1.71
|
| Rate for Payer: BCN Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$5.66
|
| Rate for Payer: Cofinity Commercial |
$5.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.13
|
| Rate for Payer: PACE SWMI |
$3.93
|
| Rate for Payer: PHP Medicare Advantage |
$3.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.22
|
| Rate for Payer: Priority Health Medicare |
$3.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$4.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.93
|
| Rate for Payer: UHC Medicare Advantage |
$4.05
|
|
|
CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 82951
|
| Min. Negotiated Rate |
$9.65 |
| Max. Negotiated Rate |
$3,628.36 |
| Rate for Payer: Aetna Commercial |
$17.25
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCBS Trust/PPO |
$3,628.36
|
| Rate for Payer: BCN Commercial |
$9.65
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Cofinity Commercial |
$17.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.36
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$13.26
|
|
|
CHG GONADOTROPIN CHORIONIC QUALITATIVE
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 84703
|
| Min. Negotiated Rate |
$5.64 |
| Max. Negotiated Rate |
$4,545.49 |
| Rate for Payer: Aetna Commercial |
$10.08
|
| Rate for Payer: Aetna Medicare |
$7.82
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS MAPPO |
$7.52
|
| Rate for Payer: BCBS Trust/PPO |
$4,545.49
|
| Rate for Payer: BCN Commercial |
$5.64
|
| Rate for Payer: BCN Medicare Advantage |
$7.52
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cofinity Commercial |
$10.08
|
| Rate for Payer: Cofinity Commercial |
$10.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7.90
|
| Rate for Payer: PACE SWMI |
$7.52
|
| Rate for Payer: PHP Medicare Advantage |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$7.74
|
| Rate for Payer: Priority Health Medicare |
$7.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$7.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.52
|
| Rate for Payer: UHC Medicare Advantage |
$7.75
|
|
|
CHG GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 77387
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$2,278.56 |
| Rate for Payer: Aetna Commercial |
$130.08
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,278.56
|
| Rate for Payer: BCN Commercial |
$104.62
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$195.65
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 77770
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$529.58 |
| Rate for Payer: Aetna Commercial |
$436.52
|
| Rate for Payer: Aetna Commercial |
$436.52
|
| Rate for Payer: Aetna Medicare |
$338.79
|
| Rate for Payer: Aetna Medicare |
$338.79
|
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: BCBS Complete |
$250.80
|
| Rate for Payer: BCBS MAPPO |
$325.76
|
| Rate for Payer: BCBS MAPPO |
$325.76
|
| Rate for Payer: BCBS Trust/PPO |
$406.79
|
| Rate for Payer: BCBS Trust/PPO |
$406.79
|
| Rate for Payer: BCN Commercial |
$505.29
|
| Rate for Payer: BCN Commercial |
$505.29
|
| Rate for Payer: BCN Medicare Advantage |
$325.76
|
| Rate for Payer: BCN Medicare Advantage |
$325.76
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$501.60
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$469.09
|
| Rate for Payer: Cofinity Commercial |
$469.09
|
| Rate for Payer: Cofinity Commercial |
$436.52
|
| Rate for Payer: Cofinity Commercial |
$436.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$325.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$342.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$342.05
|
| Rate for Payer: PACE SWMI |
$325.76
|
| Rate for Payer: PACE SWMI |
$325.76
|
| Rate for Payer: PHP Medicare Advantage |
$325.76
|
| Rate for Payer: PHP Medicare Advantage |
$325.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$529.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$529.58
|
| Rate for Payer: Priority Health Medicare |
$325.76
|
| Rate for Payer: Priority Health Medicare |
$325.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$529.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$529.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$325.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$325.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$325.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$325.76
|
| Rate for Payer: UHC Medicare Advantage |
$335.53
|
| Rate for Payer: UHC Medicare Advantage |
$335.53
|
|
|
CHG HEMOGLOBIN GLYCOSYLATED A1C
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 83036
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$1,402.11 |
| Rate for Payer: Aetna Commercial |
$13.01
|
| Rate for Payer: Aetna Medicare |
$10.10
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$9.71
|
| Rate for Payer: BCBS Trust/PPO |
$1,402.11
|
| Rate for Payer: BCN Commercial |
$14.71
|
| Rate for Payer: BCN Medicare Advantage |
$9.71
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Cofinity Commercial |
$13.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.20
|
| Rate for Payer: PACE SWMI |
$9.71
|
| Rate for Payer: PHP Medicare Advantage |
$9.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.20
|
| Rate for Payer: Priority Health Medicare |
$9.71
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$10.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$9.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.71
|
| Rate for Payer: UHC Medicare Advantage |
$10.00
|
|
|
CHG HETEROPHILE ANTIBODIES SCREEN
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 86308
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$1,818.41 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,818.41
|
| Rate for Payer: BCN Commercial |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$6.94
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.27
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$5.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.34
|
|
|
CHG HYSTEROSALPINGOGRAPHY RS&I
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 74740
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$147.51 |
| Rate for Payer: Aetna Commercial |
$120.89
|
| Rate for Payer: Aetna Medicare |
$93.83
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: BCBS MAPPO |
$90.22
|
| Rate for Payer: BCBS Trust/PPO |
$133.66
|
| Rate for Payer: BCN Commercial |
$140.74
|
| Rate for Payer: BCN Medicare Advantage |
$90.22
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cofinity Commercial |
$129.92
|
| Rate for Payer: Cofinity Commercial |
$120.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$94.73
|
| Rate for Payer: PACE SWMI |
$90.22
|
| Rate for Payer: PHP Medicare Advantage |
$90.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$147.51
|
| Rate for Payer: Priority Health Medicare |
$90.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$147.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.22
|
| Rate for Payer: UHC Medicare Advantage |
$92.93
|
|
|
CHG IAADIADOO INFLUENZA
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 87804
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$1,216.15 |
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna Medicare |
$17.21
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS MAPPO |
$16.55
|
| Rate for Payer: BCBS Trust/PPO |
$1,216.15
|
| Rate for Payer: BCN Commercial |
$16.55
|
| Rate for Payer: BCN Medicare Advantage |
$16.55
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$23.83
|
| Rate for Payer: Cofinity Commercial |
$22.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.38
|
| Rate for Payer: PACE SWMI |
$16.55
|
| Rate for Payer: PHP Medicare Advantage |
$16.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.22
|
| Rate for Payer: Priority Health Medicare |
$16.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.55
|
| Rate for Payer: UHC Medicare Advantage |
$17.05
|
|
|
CHG IAADIADOO RESPIRATORY SYNCTIAL VIRUS
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 87807
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$114.11 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Medicare |
$13.62
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCBS MAPPO |
$13.10
|
| Rate for Payer: BCBS Trust/PPO |
$114.11
|
| Rate for Payer: BCN Commercial |
$13.10
|
| Rate for Payer: BCN Medicare Advantage |
$13.10
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$17.55
|
| Rate for Payer: Cofinity Commercial |
$18.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13.76
|
| Rate for Payer: PACE SWMI |
$13.10
|
| Rate for Payer: PHP Medicare Advantage |
$13.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.71
|
| Rate for Payer: Priority Health Medicare |
$13.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$13.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.10
|
| Rate for Payer: UHC Medicare Advantage |
$13.49
|
|
|
CHG IAADIADOO STREPTOCOCCUS GROUP A
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 87880
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$164.83 |
| Rate for Payer: Aetna Commercial |
$22.15
|
| Rate for Payer: Aetna Medicare |
$17.19
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS MAPPO |
$16.53
|
| Rate for Payer: BCBS Trust/PPO |
$164.83
|
| Rate for Payer: BCN Commercial |
$16.53
|
| Rate for Payer: BCN Medicare Advantage |
$16.53
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$17.36
|
| Rate for Payer: PACE SWMI |
$16.53
|
| Rate for Payer: PHP Medicare Advantage |
$16.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.22
|
| Rate for Payer: Priority Health Medicare |
$16.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$17.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.53
|
| Rate for Payer: UHC Medicare Advantage |
$17.03
|
|
|
CHG IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 87426
|
| Min. Negotiated Rate |
$16.00 |
| Max. Negotiated Rate |
$1,641.96 |
| Rate for Payer: Aetna Commercial |
$47.34
|
| Rate for Payer: Aetna Medicare |
$36.74
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$35.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,641.96
|
| Rate for Payer: BCN Commercial |
$35.33
|
| Rate for Payer: BCN Medicare Advantage |
$35.33
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cofinity Commercial |
$47.34
|
| Rate for Payer: Cofinity Commercial |
$50.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.10
|
| Rate for Payer: PACE SWMI |
$35.33
|
| Rate for Payer: PHP Medicare Advantage |
$35.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.55
|
| Rate for Payer: Priority Health Medicare |
$35.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.33
|
| Rate for Payer: UHC Medicare Advantage |
$36.39
|
|
|
CHG IAADI BORDETELLA PRTUSSIS/PARAPRTUSSIS
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 87265
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$1,212.98 |
| Rate for Payer: Aetna Commercial |
$16.05
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCBS Trust/PPO |
$1,212.98
|
| Rate for Payer: BCN Commercial |
$8.99
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cofinity Commercial |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$16.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.30
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$12.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$12.34
|
|
|
CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 87491
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$1,449.13 |
| Rate for Payer: Aetna Commercial |
$47.02
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,449.13
|
| Rate for Payer: BCN Commercial |
$26.32
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$50.53
|
| Rate for Payer: Cofinity Commercial |
$47.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.55
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
|
|
CHG IADNA MULTIPLE ORGANISMS DIRECT PROBE TQ
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 87800
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$1,724.37 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Aetna Medicare |
$45.42
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS MAPPO |
$43.67
|
| Rate for Payer: BCBS Trust/PPO |
$1,724.37
|
| Rate for Payer: BCN Commercial |
$32.75
|
| Rate for Payer: BCN Medicare Advantage |
$43.67
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$58.52
|
| Rate for Payer: Cofinity Commercial |
$62.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.85
|
| Rate for Payer: PACE SWMI |
$43.67
|
| Rate for Payer: PHP Medicare Advantage |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.33
|
| Rate for Payer: Priority Health Medicare |
$43.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.67
|
| Rate for Payer: UHC Medicare Advantage |
$44.98
|
|
|
CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 87591
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$593.81 |
| Rate for Payer: Aetna Commercial |
$47.02
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCBS Trust/PPO |
$593.81
|
| Rate for Payer: BCN Commercial |
$26.32
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$50.53
|
| Rate for Payer: Cofinity Commercial |
$47.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.55
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$36.14
|
|
|
CHG IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 87635
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$2,508.37 |
| Rate for Payer: Aetna Commercial |
$68.76
|
| Rate for Payer: Aetna Medicare |
$53.36
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCBS Trust/PPO |
$2,508.37
|
| Rate for Payer: BCN Commercial |
$70.00
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$68.76
|
| Rate for Payer: Cofinity Commercial |
$73.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.07
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$53.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.31
|
| Rate for Payer: UHC Medicare Advantage |
$52.85
|
|
|
CHG IA INFECTIOUS AGT ANTIBODY QUAL/SEMIQ 1STEP METH
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 86318
|
| Min. Negotiated Rate |
$18.09 |
| Max. Negotiated Rate |
$1,735.47 |
| Rate for Payer: Aetna Commercial |
$24.24
|
| Rate for Payer: Aetna Medicare |
$18.81
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS MAPPO |
$18.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,735.47
|
| Rate for Payer: BCN Commercial |
$18.09
|
| Rate for Payer: BCN Medicare Advantage |
$18.09
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$24.24
|
| Rate for Payer: Cofinity Commercial |
$26.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$18.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.99
|
| Rate for Payer: PACE SWMI |
$18.09
|
| Rate for Payer: PHP Medicare Advantage |
$18.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.63
|
| Rate for Payer: Priority Health Medicare |
$18.09
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$18.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$18.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$18.09
|
| Rate for Payer: UHC Medicare Advantage |
$18.63
|
|
