|
CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 72050
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$81.28 |
| Rate for Payer: Aetna Commercial |
$59.81
|
| Rate for Payer: Aetna Commercial |
$59.81
|
| Rate for Payer: Aetna Commercial |
$59.81
|
| Rate for Payer: Aetna Medicare |
$34.00
|
| Rate for Payer: Aetna Medicare |
$73.50
|
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: BCN Commercial |
$80.67
|
| Rate for Payer: BCN Commercial |
$80.67
|
| Rate for Payer: BCN Commercial |
$80.67
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$40.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$81.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$81.28
|
|
|
CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 72052
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$93.31 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Aetna Medicare |
$45.50
|
| Rate for Payer: Aetna Medicare |
$47.50
|
| Rate for Payer: BCN Commercial |
$92.62
|
| Rate for Payer: BCN Commercial |
$92.62
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$68.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$93.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$93.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.31
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.31
|
|
|
CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 72100
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$59.70 |
| Rate for Payer: Aetna Commercial |
$45.13
|
| Rate for Payer: Aetna Commercial |
$45.13
|
| Rate for Payer: Aetna Commercial |
$45.13
|
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: Aetna Medicare |
$53.50
|
| Rate for Payer: BCN Commercial |
$59.26
|
| Rate for Payer: BCN Commercial |
$59.26
|
| Rate for Payer: BCN Commercial |
$59.26
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$80.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$59.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$59.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$59.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.70
|
|
|
CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 72110
|
| Min. Negotiated Rate |
$57.48 |
| Max. Negotiated Rate |
$117.00 |
| Rate for Payer: Aetna Commercial |
$57.48
|
| Rate for Payer: Aetna Commercial |
$57.48
|
| Rate for Payer: Aetna Commercial |
$57.48
|
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: Aetna Medicare |
$33.00
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: BCN Commercial |
$77.69
|
| Rate for Payer: BCN Commercial |
$77.69
|
| Rate for Payer: BCN Commercial |
$77.69
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$49.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$78.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$78.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$78.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.27
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.27
|
|
|
CHG RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 72120
|
| Min. Negotiated Rate |
$26.00 |
| Max. Negotiated Rate |
$61.21 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: Aetna Medicare |
$26.00
|
| Rate for Payer: BCN Commercial |
$60.76
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.21
|
|
|
CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6
|
Professional
|
Both
|
$68.00
|
|
|
Service Code
|
HCPCS 72114
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$92.32 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Aetna Medicare |
$47.50
|
| Rate for Payer: Aetna Medicare |
$34.00
|
| Rate for Payer: BCN Commercial |
$91.63
|
| Rate for Payer: BCN Commercial |
$91.63
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$54.40
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$92.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$92.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.32
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.32
|
|
|
CHG RADEX SPINE THORACIC 2 VIEWS
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 72070
|
| Min. Negotiated Rate |
$37.04 |
| Max. Negotiated Rate |
$78.75 |
| Rate for Payer: Aetna Commercial |
$37.04
|
| Rate for Payer: Aetna Commercial |
$37.04
|
| Rate for Payer: Aetna Commercial |
$37.04
|
| Rate for Payer: Aetna Medicare |
$19.00
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: BCN Commercial |
$49.30
|
| Rate for Payer: BCN Commercial |
$49.30
|
| Rate for Payer: BCN Commercial |
$49.30
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$49.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$49.67
|
|
|
CHG RADEX SPINE THORACIC 3 VIEWS
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 72072
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Aetna Commercial |
$44.40
|
| Rate for Payer: Aetna Medicare |
$42.00
|
| Rate for Payer: BCN Commercial |
$58.76
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$59.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.21
|
|
|
CHG RADEX SPINE THORACIC MINIMUM 4 VIEWS
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 72074
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$67.23 |
| Rate for Payer: Aetna Commercial |
$50.58
|
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCN Commercial |
$66.73
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$57.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$67.23
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$67.23
|
|
|
CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 72080
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$52.18 |
| Rate for Payer: Aetna Commercial |
$39.37
|
| Rate for Payer: Aetna Commercial |
$39.37
|
| Rate for Payer: Aetna Commercial |
$39.37
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: Aetna Medicare |
$57.00
|
| Rate for Payer: Aetna Medicare |
$20.00
|
| Rate for Payer: BCN Commercial |
$51.79
|
| Rate for Payer: BCN Commercial |
$51.79
|
| Rate for Payer: BCN Commercial |
$51.79
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$30.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$52.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.18
|
|
|
CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 71130
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$61.72 |
| Rate for Payer: Aetna Commercial |
$47.03
|
| Rate for Payer: Aetna Commercial |
$47.03
|
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: BCN Commercial |
$61.25
|
| Rate for Payer: BCN Commercial |
$61.25
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$34.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$39.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$61.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.72
|
|
|
CHG RADEX STERNUM MINIMUM 2 VIEWS
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 71120
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$50.18 |
| Rate for Payer: Aetna Commercial |
$38.18
|
| Rate for Payer: Aetna Commercial |
$38.18
|
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: Aetna Medicare |
$25.00
|
| Rate for Payer: BCN Commercial |
$49.80
|
| Rate for Payer: BCN Commercial |
$49.80
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.18
|
|
|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH BILAT
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 70330
|
| Min. Negotiated Rate |
$13.50 |
| Max. Negotiated Rate |
$79.77 |
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: Aetna Medicare |
$13.50
|
| Rate for Payer: BCN Commercial |
$79.18
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$20.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$79.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$79.77
|
|
|
CHG RADEX TEMPOROMANDBLE JT OPN & CLSD MOUTH UNILAT
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 70328
|
| Min. Negotiated Rate |
$22.50 |
| Max. Negotiated Rate |
$51.68 |
| Rate for Payer: Aetna Commercial |
$39.25
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: BCN Commercial |
$51.29
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$33.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$51.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$51.68
|
|
|
CHG RADEX TOE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 73660
|
| Min. Negotiated Rate |
$23.50 |
| Max. Negotiated Rate |
$43.65 |
| Rate for Payer: Aetna Commercial |
$32.96
|
| Rate for Payer: Aetna Commercial |
$32.96
|
| Rate for Payer: Aetna Commercial |
$32.96
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: Aetna Medicare |
$12.50
|
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: BCN Commercial |
$43.33
|
| Rate for Payer: BCN Commercial |
$43.33
|
| Rate for Payer: BCN Commercial |
$43.33
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$18.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$35.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$43.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$43.65
|
|
|
CHG RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 73092
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$47.17 |
| Rate for Payer: Aetna Commercial |
$35.75
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: BCN Commercial |
$46.81
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$47.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$47.17
|
|
|
CHG RADEX WRIST 2 VIEWS
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 73100
|
| Min. Negotiated Rate |
$14.50 |
| Max. Negotiated Rate |
$50.67 |
| Rate for Payer: Aetna Commercial |
$38.42
|
| Rate for Payer: Aetna Commercial |
$38.42
|
| Rate for Payer: Aetna Medicare |
$43.50
|
| Rate for Payer: Aetna Medicare |
$14.50
|
| Rate for Payer: BCN Commercial |
$50.29
|
| Rate for Payer: BCN Commercial |
$50.29
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$65.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$21.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$50.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$50.67
|
|
|
CHG RADEX WRIST COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 73110
|
| Min. Negotiated Rate |
$45.70 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: Aetna Commercial |
$45.70
|
| Rate for Payer: Aetna Commercial |
$45.70
|
| Rate for Payer: Aetna Commercial |
$45.70
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Aetna Medicare |
$29.00
|
| Rate for Payer: Aetna Medicare |
$50.00
|
| Rate for Payer: BCN Commercial |
$61.75
|
| Rate for Payer: BCN Commercial |
$61.75
|
| Rate for Payer: BCN Commercial |
$61.75
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$43.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$62.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$62.22
|
|
|
CHG RADIATION THERAPY MGMT 1/2 FRACTIONS ONLY
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 77431
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$164.57 |
| Rate for Payer: Aetna Commercial |
$125.01
|
| Rate for Payer: Aetna Medicare |
$109.00
|
| Rate for Payer: BCBS Complete |
$71.35
|
| Rate for Payer: BCN Commercial |
$163.34
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Mclaren Medicaid |
$67.95
|
| Rate for Payer: Meridian Medicaid |
$71.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$163.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$164.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$164.57
|
| Rate for Payer: UHC Medicaid |
$67.95
|
| Rate for Payer: UHCCP Medicaid |
$67.95
|
|
|
CHG RADIATION TREATMENT DELIVERY LEVEL 1
|
Professional
|
Both
|
$373.00
|
|
|
Service Code
|
HCPCS 77402
|
| Min. Negotiated Rate |
$107.86 |
| Max. Negotiated Rate |
$279.75 |
| Rate for Payer: Aetna Commercial |
$158.33
|
| Rate for Payer: Aetna Medicare |
$186.50
|
| Rate for Payer: BCN Commercial |
$107.86
|
| Rate for Payer: Cash Price |
$298.40
|
| Rate for Payer: Cash Price |
$298.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$184.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.13
|
|
|
CHG RADIATION TREATMENT MANAGEMENT 5 TREATMENTS
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS 77427
|
| Min. Negotiated Rate |
$124.61 |
| Max. Negotiated Rate |
$291.50 |
| Rate for Payer: Aetna Commercial |
$223.07
|
| Rate for Payer: Aetna Medicare |
$185.50
|
| Rate for Payer: BCBS Complete |
$130.84
|
| Rate for Payer: BCN Commercial |
$289.33
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Mclaren Medicaid |
$124.61
|
| Rate for Payer: Meridian Medicaid |
$130.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$278.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$124.61
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$291.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$291.50
|
| Rate for Payer: UHC Medicaid |
$124.61
|
| Rate for Payer: UHCCP Medicaid |
$124.61
|
|
|
CHG RADIATION TX DELIVERY SUPERFICIAL&/ORTHO VOLTAGE
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 77401
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$70.50 |
| Rate for Payer: Aetna Commercial |
$48.09
|
| Rate for Payer: Aetna Medicare |
$47.00
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: BCN Commercial |
$61.25
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$70.50
|
|
|
CHG RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 70110
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$65.72 |
| Rate for Payer: Aetna Commercial |
$49.43
|
| Rate for Payer: Aetna Medicare |
$13.00
|
| Rate for Payer: BCN Commercial |
$65.23
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$65.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$65.72
|
|
|
CHG RADIOLOGICAL GUIDANCE PRQ DRG W/PLMT CATH RS&I
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 75989
|
| Min. Negotiated Rate |
$119.00 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Aetna Commercial |
$145.39
|
| Rate for Payer: Aetna Medicare |
$119.00
|
| Rate for Payer: BCN Commercial |
$165.33
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$166.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$166.57
|
|
|
CHG RADIOLOGIC EXAM ABDOMEN 1 VIEW
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 74018
|
| Min. Negotiated Rate |
$27.50 |
| Max. Negotiated Rate |
$45.15 |
| Rate for Payer: Aetna Commercial |
$33.91
|
| Rate for Payer: Aetna Medicare |
$27.50
|
| Rate for Payer: BCN Commercial |
$44.81
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO |
$45.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$45.15
|
|
