|
CHG INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE
|
Professional
|
$456.00
|
|
|
Service Code
|
HCPCS 77761
|
| Min. Negotiated Rate |
$182.40 |
| Max. Negotiated Rate |
$639.70 |
| Rate for Payer: Aetna Commercial |
$534.04
|
| Rate for Payer: Aetna Medicare |
$414.48
|
| Rate for Payer: BCBS Complete |
$182.40
|
| Rate for Payer: BCBS MAPPO |
$398.54
|
| Rate for Payer: BCN Commercial |
$610.36
|
| Rate for Payer: BCN Medicare Advantage |
$398.54
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cofinity Commercial |
$534.04
|
| Rate for Payer: Cofinity Commercial |
$573.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$398.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$418.47
|
| Rate for Payer: PACE SWMI |
$398.54
|
| Rate for Payer: PHP Medicare Advantage |
$398.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$319.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$639.70
|
| Rate for Payer: Priority Health Medicare |
$398.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$639.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$398.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$398.54
|
| Rate for Payer: UHC Medicare Advantage |
$410.50
|
|
|
CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I
|
Professional
|
$89.00
|
|
|
Service Code
|
HCPCS 74360
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$214.05 |
| Rate for Payer: Aetna Commercial |
$128.38
|
| Rate for Payer: BCBS Complete |
$35.60
|
| Rate for Payer: BCN Commercial |
$214.05
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$62.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$169.02
|
|
|
CHG INTRAVASC ULTRASOUND,1ST VESSEL
|
Professional
|
$83.00
|
|
|
Service Code
|
HCPCS 75945
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$154.00 |
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.10
|
|
|
CHG INTRAVASC US, RAD SUPERISE/ INTERP, EA ADDN VESSEL
|
Professional
|
$153.00
|
|
|
Service Code
|
HCPCS 75946
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$107.10 |
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.10
|
|
|
CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I
|
Professional
|
$206.00
|
|
|
Service Code
|
HCPCS 74340
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$178.86 |
| Rate for Payer: Aetna Commercial |
$119.95
|
| Rate for Payer: BCBS Complete |
$82.40
|
| Rate for Payer: BCN Commercial |
$178.86
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$144.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$157.74
|
|
|
CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS
|
Professional
|
$60.00
|
|
|
Service Code
|
HCPCS 77077
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Aetna Commercial |
$59.88
|
| Rate for Payer: Aetna Commercial |
$59.88
|
| Rate for Payer: Aetna Medicare |
$46.48
|
| Rate for Payer: Aetna Medicare |
$46.48
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS Complete |
$54.00
|
| Rate for Payer: BCBS MAPPO |
$44.69
|
| Rate for Payer: BCBS MAPPO |
$44.69
|
| Rate for Payer: BCN Commercial |
$68.90
|
| Rate for Payer: BCN Commercial |
$68.90
|
| Rate for Payer: BCN Medicare Advantage |
$44.69
|
| Rate for Payer: BCN Medicare Advantage |
$44.69
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$64.35
|
| Rate for Payer: Cofinity Commercial |
$59.88
|
| Rate for Payer: Cofinity Commercial |
$59.88
|
| Rate for Payer: Cofinity Commercial |
$64.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.92
|
| Rate for Payer: PACE SWMI |
$44.69
|
| Rate for Payer: PACE SWMI |
$44.69
|
| Rate for Payer: PHP Medicare Advantage |
$44.69
|
| Rate for Payer: PHP Medicare Advantage |
$44.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$72.21
|
| Rate for Payer: Priority Health Medicare |
$44.69
|
| Rate for Payer: Priority Health Medicare |
$44.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$72.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.69
|
| Rate for Payer: UHC Medicare Advantage |
$46.03
|
| Rate for Payer: UHC Medicare Advantage |
$46.03
|
|
|
CHG LIPID PANEL
|
Professional
|
$44.00
|
|
|
Service Code
|
HCPCS 80061
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$30.80 |
| Rate for Payer: Aetna Commercial |
$17.94
|
| Rate for Payer: Aetna Medicare |
$13.93
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS MAPPO |
$13.39
|
| Rate for Payer: BCN Commercial |
$16.58
|
| Rate for Payer: BCN Medicare Advantage |
$13.39
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Cofinity Commercial |
$19.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$14.06
|
| Rate for Payer: PACE SWMI |
$13.39
|
| Rate for Payer: PHP Medicare Advantage |
$13.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.05
|
| Rate for Payer: Priority Health Medicare |
$13.39
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.39
|
| Rate for Payer: UHC Medicare Advantage |
$13.79
|
|
|
CHG MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS
|
Professional
|
$87.00
|
|
|
Service Code
|
HCPCS 77071
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna Commercial |
$70.03
|
| Rate for Payer: Aetna Commercial |
$70.03
|
| Rate for Payer: Aetna Medicare |
$54.35
|
| Rate for Payer: Aetna Medicare |
$54.35
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS MAPPO |
$52.26
|
| Rate for Payer: BCBS MAPPO |
$52.26
|
| Rate for Payer: BCN Commercial |
$80.14
|
| Rate for Payer: BCN Commercial |
$80.14
|
| Rate for Payer: BCN Medicare Advantage |
$52.26
|
| Rate for Payer: BCN Medicare Advantage |
$52.26
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$75.25
|
| Rate for Payer: Cofinity Commercial |
$75.25
|
| Rate for Payer: Cofinity Commercial |
$70.03
|
| Rate for Payer: Cofinity Commercial |
$70.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.26
|
| Rate for Payer: Mclaren Medicaid |
$35.15
|
| Rate for Payer: Mclaren Medicaid |
$35.15
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54.87
|
| Rate for Payer: PACE SWMI |
$52.26
|
| Rate for Payer: PACE SWMI |
$52.26
|
| Rate for Payer: PHP Medicare Advantage |
$52.26
|
| Rate for Payer: PHP Medicare Advantage |
$52.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.00
|
| Rate for Payer: Priority Health Medicare |
$52.26
|
| Rate for Payer: Priority Health Medicare |
$52.26
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$84.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.26
|
| Rate for Payer: UHC Medicare Advantage |
$53.83
|
| Rate for Payer: UHC Medicare Advantage |
$53.83
|
|
|
CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I
|
Professional
|
$37.00
|
|
|
Service Code
|
HCPCS 75902
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$139.30 |
| Rate for Payer: Aetna Commercial |
$114.48
|
| Rate for Payer: Aetna Medicare |
$88.85
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$85.43
|
| Rate for Payer: BCN Commercial |
$132.92
|
| Rate for Payer: BCN Medicare Advantage |
$85.43
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$114.48
|
| Rate for Payer: Cofinity Commercial |
$123.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$89.70
|
| Rate for Payer: PACE SWMI |
$85.43
|
| Rate for Payer: PHP Medicare Advantage |
$85.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.30
|
| Rate for Payer: Priority Health Medicare |
$85.43
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$85.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.43
|
| Rate for Payer: UHC Medicare Advantage |
$87.99
|
|
|
CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I
|
Professional
|
$332.00
|
|
|
Service Code
|
HCPCS 75901
|
| Min. Negotiated Rate |
$132.80 |
| Max. Negotiated Rate |
$355.45 |
| Rate for Payer: Aetna Commercial |
$289.52
|
| Rate for Payer: Aetna Medicare |
$224.70
|
| Rate for Payer: BCBS Complete |
$132.80
|
| Rate for Payer: BCBS MAPPO |
$216.06
|
| Rate for Payer: BCN Commercial |
$339.14
|
| Rate for Payer: BCN Medicare Advantage |
$216.06
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$311.13
|
| Rate for Payer: Cofinity Commercial |
$289.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$216.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$226.86
|
| Rate for Payer: PACE SWMI |
$216.06
|
| Rate for Payer: PHP Medicare Advantage |
$216.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$355.45
|
| Rate for Payer: Priority Health Medicare |
$216.06
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$355.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$216.06
|
| Rate for Payer: UHC Medicare Advantage |
$222.54
|
|
|
CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN
|
Professional
|
$515.00
|
|
|
Service Code
|
HCPCS 77338
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$724.75 |
| Rate for Payer: Aetna Commercial |
$592.64
|
| Rate for Payer: Aetna Commercial |
$592.64
|
| Rate for Payer: Aetna Commercial |
$592.64
|
| Rate for Payer: Aetna Medicare |
$459.96
|
| Rate for Payer: Aetna Medicare |
$459.96
|
| Rate for Payer: Aetna Medicare |
$459.96
|
| Rate for Payer: BCBS Complete |
$373.60
|
| Rate for Payer: BCBS Complete |
$380.80
|
| Rate for Payer: BCBS Complete |
$206.00
|
| Rate for Payer: BCBS MAPPO |
$442.27
|
| Rate for Payer: BCBS MAPPO |
$442.27
|
| Rate for Payer: BCBS MAPPO |
$442.27
|
| Rate for Payer: BCN Commercial |
$724.75
|
| Rate for Payer: BCN Commercial |
$724.75
|
| Rate for Payer: BCN Commercial |
$724.75
|
| Rate for Payer: BCN Medicare Advantage |
$442.27
|
| Rate for Payer: BCN Medicare Advantage |
$442.27
|
| Rate for Payer: BCN Medicare Advantage |
$442.27
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$761.60
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cash Price |
$747.20
|
| Rate for Payer: Cash Price |
$747.20
|
| Rate for Payer: Cofinity Commercial |
$636.87
|
| Rate for Payer: Cofinity Commercial |
$636.87
|
| Rate for Payer: Cofinity Commercial |
$636.87
|
| Rate for Payer: Cofinity Commercial |
$592.64
|
| Rate for Payer: Cofinity Commercial |
$592.64
|
| Rate for Payer: Cofinity Commercial |
$592.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$442.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$442.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$442.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$464.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$464.38
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$464.38
|
| Rate for Payer: PACE SWMI |
$442.27
|
| Rate for Payer: PACE SWMI |
$442.27
|
| Rate for Payer: PACE SWMI |
$442.27
|
| Rate for Payer: PHP Medicare Advantage |
$442.27
|
| Rate for Payer: PHP Medicare Advantage |
$442.27
|
| Rate for Payer: PHP Medicare Advantage |
$442.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$360.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$653.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$666.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$709.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$709.87
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$709.87
|
| Rate for Payer: Priority Health Medicare |
$442.27
|
| Rate for Payer: Priority Health Medicare |
$442.27
|
| Rate for Payer: Priority Health Medicare |
$442.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$709.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$709.87
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$709.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$442.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$442.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$442.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$442.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$442.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$442.27
|
| Rate for Payer: UHC Medicare Advantage |
$455.54
|
| Rate for Payer: UHC Medicare Advantage |
$455.54
|
| Rate for Payer: UHC Medicare Advantage |
$455.54
|
|
|
CHG MRA HEAD W/O CONTRST MATERIAL
|
Professional
|
$673.00
|
|
|
Service Code
|
HCPCS 70544
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$471.10 |
| Rate for Payer: Aetna Commercial |
$283.44
|
| Rate for Payer: Aetna Commercial |
$283.44
|
| Rate for Payer: Aetna Medicare |
$219.98
|
| Rate for Payer: Aetna Medicare |
$219.98
|
| Rate for Payer: BCBS Complete |
$269.20
|
| Rate for Payer: BCBS Complete |
$93.60
|
| Rate for Payer: BCBS MAPPO |
$211.52
|
| Rate for Payer: BCBS MAPPO |
$211.52
|
| Rate for Payer: BCN Commercial |
$328.39
|
| Rate for Payer: BCN Commercial |
$328.39
|
| Rate for Payer: BCN Medicare Advantage |
$211.52
|
| Rate for Payer: BCN Medicare Advantage |
$211.52
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cofinity Commercial |
$283.44
|
| Rate for Payer: Cofinity Commercial |
$283.44
|
| Rate for Payer: Cofinity Commercial |
$304.59
|
| Rate for Payer: Cofinity Commercial |
$304.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.52
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$222.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$222.10
|
| Rate for Payer: PACE SWMI |
$211.52
|
| Rate for Payer: PACE SWMI |
$211.52
|
| Rate for Payer: PHP Medicare Advantage |
$211.52
|
| Rate for Payer: PHP Medicare Advantage |
$211.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$163.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$471.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$344.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$344.17
|
| Rate for Payer: Priority Health Medicare |
$211.52
|
| Rate for Payer: Priority Health Medicare |
$211.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.52
|
| Rate for Payer: UHC Medicare Advantage |
$217.87
|
| Rate for Payer: UHC Medicare Advantage |
$217.87
|
|
|
CHG MRA NECK W/O CONTRST MATERIAL
|
Professional
|
$231.00
|
|
|
Service Code
|
HCPCS 70547
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$344.69 |
| Rate for Payer: Aetna Commercial |
$283.85
|
| Rate for Payer: Aetna Medicare |
$220.30
|
| Rate for Payer: BCBS Complete |
$92.40
|
| Rate for Payer: BCBS MAPPO |
$211.83
|
| Rate for Payer: BCN Commercial |
$328.88
|
| Rate for Payer: BCN Medicare Advantage |
$211.83
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$283.85
|
| Rate for Payer: Cofinity Commercial |
$305.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$222.42
|
| Rate for Payer: PACE SWMI |
$211.83
|
| Rate for Payer: PHP Medicare Advantage |
$211.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$344.69
|
| Rate for Payer: Priority Health Medicare |
$211.83
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$344.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$211.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.83
|
| Rate for Payer: UHC Medicare Advantage |
$218.18
|
|
|
CHG MRA NECK W/O &W/CONTRAST MATERIAL
|
Professional
|
$275.00
|
|
|
Service Code
|
HCPCS 70549
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$552.62 |
| Rate for Payer: Aetna Commercial |
$454.68
|
| Rate for Payer: Aetna Medicare |
$352.88
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS MAPPO |
$339.31
|
| Rate for Payer: BCN Commercial |
$527.29
|
| Rate for Payer: BCN Medicare Advantage |
$339.31
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cofinity Commercial |
$488.61
|
| Rate for Payer: Cofinity Commercial |
$454.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$339.31
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$356.28
|
| Rate for Payer: PACE SWMI |
$339.31
|
| Rate for Payer: PHP Medicare Advantage |
$339.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$552.62
|
| Rate for Payer: Priority Health Medicare |
$339.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$552.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$339.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$339.31
|
| Rate for Payer: UHC Medicare Advantage |
$349.49
|
|
|
CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL
|
Professional
|
$370.00
|
|
|
Service Code
|
HCPCS 70552
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$433.30 |
| Rate for Payer: Aetna Commercial |
$358.21
|
| Rate for Payer: Aetna Medicare |
$278.01
|
| Rate for Payer: BCBS Complete |
$148.00
|
| Rate for Payer: BCBS MAPPO |
$267.32
|
| Rate for Payer: BCN Commercial |
$413.42
|
| Rate for Payer: BCN Medicare Advantage |
$267.32
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$384.94
|
| Rate for Payer: Cofinity Commercial |
$358.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.32
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$280.69
|
| Rate for Payer: PACE SWMI |
$267.32
|
| Rate for Payer: PHP Medicare Advantage |
$267.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$433.30
|
| Rate for Payer: Priority Health Medicare |
$267.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$433.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.32
|
| Rate for Payer: UHC Medicare Advantage |
$275.34
|
|
|
CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL
|
Professional
|
$319.00
|
|
|
Service Code
|
HCPCS 70551
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$312.93 |
| Rate for Payer: Aetna Commercial |
$259.49
|
| Rate for Payer: Aetna Medicare |
$201.40
|
| Rate for Payer: BCBS Complete |
$127.60
|
| Rate for Payer: BCBS MAPPO |
$193.65
|
| Rate for Payer: BCN Commercial |
$298.58
|
| Rate for Payer: BCN Medicare Advantage |
$193.65
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cofinity Commercial |
$278.86
|
| Rate for Payer: Cofinity Commercial |
$259.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$193.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$203.33
|
| Rate for Payer: PACE SWMI |
$193.65
|
| Rate for Payer: PHP Medicare Advantage |
$193.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$223.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$312.93
|
| Rate for Payer: Priority Health Medicare |
$193.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$312.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$193.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$193.65
|
| Rate for Payer: UHC Medicare Advantage |
$199.46
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
$341.00
|
|
|
Service Code
|
HCPCS 70553
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$510.12 |
| Rate for Payer: Aetna Commercial |
$422.48
|
| Rate for Payer: Aetna Medicare |
$327.89
|
| Rate for Payer: BCBS Complete |
$136.40
|
| Rate for Payer: BCBS MAPPO |
$315.28
|
| Rate for Payer: BCN Commercial |
$486.73
|
| Rate for Payer: BCN Medicare Advantage |
$315.28
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cash Price |
$272.80
|
| Rate for Payer: Cofinity Commercial |
$454.00
|
| Rate for Payer: Cofinity Commercial |
$422.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$331.04
|
| Rate for Payer: PACE SWMI |
$315.28
|
| Rate for Payer: PHP Medicare Advantage |
$315.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$238.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$510.12
|
| Rate for Payer: Priority Health Medicare |
$315.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$510.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$315.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.28
|
| Rate for Payer: UHC Medicare Advantage |
$324.74
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
$296.00
|
|
|
Service Code
|
HCPCS 72141
|
| Min. Negotiated Rate |
$118.40 |
| Max. Negotiated Rate |
$304.23 |
| Rate for Payer: Aetna Commercial |
$252.46
|
| Rate for Payer: Aetna Medicare |
$195.94
|
| Rate for Payer: BCBS Complete |
$118.40
|
| Rate for Payer: BCBS MAPPO |
$188.40
|
| Rate for Payer: BCN Commercial |
$290.27
|
| Rate for Payer: BCN Medicare Advantage |
$188.40
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cofinity Commercial |
$252.46
|
| Rate for Payer: Cofinity Commercial |
$271.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$197.82
|
| Rate for Payer: PACE SWMI |
$188.40
|
| Rate for Payer: PHP Medicare Advantage |
$188.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.23
|
| Rate for Payer: Priority Health Medicare |
$188.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$304.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.40
|
| Rate for Payer: UHC Medicare Advantage |
$194.05
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL
|
Professional
|
$308.00
|
|
|
Service Code
|
HCPCS 72156
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$512.68 |
| Rate for Payer: Aetna Commercial |
$424.54
|
| Rate for Payer: Aetna Medicare |
$329.49
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS MAPPO |
$316.82
|
| Rate for Payer: BCN Commercial |
$489.17
|
| Rate for Payer: BCN Medicare Advantage |
$316.82
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$456.22
|
| Rate for Payer: Cofinity Commercial |
$424.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$332.66
|
| Rate for Payer: PACE SWMI |
$316.82
|
| Rate for Payer: PHP Medicare Advantage |
$316.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$512.68
|
| Rate for Payer: Priority Health Medicare |
$316.82
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$512.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.82
|
| Rate for Payer: UHC Medicare Advantage |
$326.32
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL
|
Professional
|
$321.00
|
|
|
Service Code
|
HCPCS 72149
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$433.30 |
| Rate for Payer: Aetna Commercial |
$358.06
|
| Rate for Payer: Aetna Medicare |
$277.90
|
| Rate for Payer: BCBS Complete |
$128.40
|
| Rate for Payer: BCBS MAPPO |
$267.21
|
| Rate for Payer: BCN Commercial |
$413.42
|
| Rate for Payer: BCN Medicare Advantage |
$267.21
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cofinity Commercial |
$384.78
|
| Rate for Payer: Cofinity Commercial |
$358.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.21
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$280.57
|
| Rate for Payer: PACE SWMI |
$267.21
|
| Rate for Payer: PHP Medicare Advantage |
$267.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$433.30
|
| Rate for Payer: Priority Health Medicare |
$267.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$433.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.21
|
| Rate for Payer: UHC Medicare Advantage |
$275.23
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL
|
Professional
|
$242.00
|
|
|
Service Code
|
HCPCS 72148
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$305.26 |
| Rate for Payer: Aetna Commercial |
$253.29
|
| Rate for Payer: Aetna Medicare |
$196.58
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: BCBS MAPPO |
$189.02
|
| Rate for Payer: BCN Commercial |
$291.25
|
| Rate for Payer: BCN Medicare Advantage |
$189.02
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$272.19
|
| Rate for Payer: Cofinity Commercial |
$253.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.02
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$198.47
|
| Rate for Payer: PACE SWMI |
$189.02
|
| Rate for Payer: PHP Medicare Advantage |
$189.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$305.26
|
| Rate for Payer: Priority Health Medicare |
$189.02
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$305.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$189.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$189.02
|
| Rate for Payer: UHC Medicare Advantage |
$194.69
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL
|
Professional
|
$293.00
|
|
|
Service Code
|
HCPCS 72158
|
| Min. Negotiated Rate |
$117.20 |
| Max. Negotiated Rate |
$511.65 |
| Rate for Payer: Aetna Commercial |
$423.71
|
| Rate for Payer: Aetna Medicare |
$328.85
|
| Rate for Payer: BCBS Complete |
$117.20
|
| Rate for Payer: BCBS MAPPO |
$316.20
|
| Rate for Payer: BCN Commercial |
$488.19
|
| Rate for Payer: BCN Medicare Advantage |
$316.20
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cofinity Commercial |
$455.33
|
| Rate for Payer: Cofinity Commercial |
$423.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$332.01
|
| Rate for Payer: PACE SWMI |
$316.20
|
| Rate for Payer: PHP Medicare Advantage |
$316.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$511.65
|
| Rate for Payer: Priority Health Medicare |
$316.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$511.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.20
|
| Rate for Payer: UHC Medicare Advantage |
$325.69
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL
|
Professional
|
$267.00
|
|
|
Service Code
|
HCPCS 72146
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$304.23 |
| Rate for Payer: Aetna Commercial |
$252.46
|
| Rate for Payer: Aetna Medicare |
$195.94
|
| Rate for Payer: BCBS Complete |
$106.80
|
| Rate for Payer: BCBS MAPPO |
$188.40
|
| Rate for Payer: BCN Commercial |
$290.27
|
| Rate for Payer: BCN Medicare Advantage |
$188.40
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$252.46
|
| Rate for Payer: Cofinity Commercial |
$271.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$197.82
|
| Rate for Payer: PACE SWMI |
$188.40
|
| Rate for Payer: PHP Medicare Advantage |
$188.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.23
|
| Rate for Payer: Priority Health Medicare |
$188.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$304.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$188.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$188.40
|
| Rate for Payer: UHC Medicare Advantage |
$194.05
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL
|
Professional
|
$324.00
|
|
|
Service Code
|
HCPCS 72157
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$513.71 |
| Rate for Payer: Aetna Commercial |
$425.37
|
| Rate for Payer: Aetna Medicare |
$330.14
|
| Rate for Payer: BCBS Complete |
$129.60
|
| Rate for Payer: BCBS MAPPO |
$317.44
|
| Rate for Payer: BCN Commercial |
$490.14
|
| Rate for Payer: BCN Medicare Advantage |
$317.44
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cofinity Commercial |
$425.37
|
| Rate for Payer: Cofinity Commercial |
$457.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$333.31
|
| Rate for Payer: PACE SWMI |
$317.44
|
| Rate for Payer: PHP Medicare Advantage |
$317.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$513.71
|
| Rate for Payer: Priority Health Medicare |
$317.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$513.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$317.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$317.44
|
| Rate for Payer: UHC Medicare Advantage |
$326.96
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
$160.00
|
|
|
Service Code
|
HCPCS 72265
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$168.50 |
| Rate for Payer: Aetna Commercial |
$139.83
|
| Rate for Payer: Aetna Medicare |
$108.52
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS MAPPO |
$104.35
|
| Rate for Payer: BCN Commercial |
$160.77
|
| Rate for Payer: BCN Medicare Advantage |
$104.35
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$139.83
|
| Rate for Payer: Cofinity Commercial |
$150.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$109.57
|
| Rate for Payer: PACE SWMI |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.50
|
| Rate for Payer: Priority Health Medicare |
$104.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.35
|
| Rate for Payer: UHC Medicare Advantage |
$107.48
|
|
