|
CHG PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&I
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 75958
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$471.24 |
| Rate for Payer: Aetna Commercial |
$229.01
|
| Rate for Payer: BCBS Complete |
$148.80
|
| Rate for Payer: BCBS Trust/PPO |
$471.24
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.76
|
| Rate for Payer: Priority Health Narrow Network |
$284.76
|
| Rate for Payer: Priority Health SBD |
$284.76
|
| Rate for Payer: UMR Bronson Commercial |
$171.12
|
|
|
CHG PROTHROMBIN TIME
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS 85610
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$4,563.98 |
| Rate for Payer: Aetna Commercial |
$4.08
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS Trust/PPO |
$4,563.98
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.57
|
| Rate for Payer: Priority Health Narrow Network |
$4.57
|
| Rate for Payer: Priority Health SBD |
$4.57
|
| Rate for Payer: UMR Bronson Commercial |
$5.06
|
|
|
CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 73050
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$992.68 |
| Rate for Payer: Aetna Commercial |
$32.39
|
| Rate for Payer: Aetna Commercial |
$32.39
|
| Rate for Payer: Aetna Commercial |
$32.39
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS Trust/PPO |
$992.68
|
| Rate for Payer: BCBS Trust/PPO |
$992.68
|
| Rate for Payer: BCBS Trust/PPO |
$992.68
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.83
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.83
|
| Rate for Payer: Priority Health Narrow Network |
$13.83
|
| Rate for Payer: Priority Health Narrow Network |
$13.83
|
| Rate for Payer: Priority Health Narrow Network |
$13.83
|
| Rate for Payer: Priority Health SBD |
$44.04
|
| Rate for Payer: Priority Health SBD |
$44.04
|
| Rate for Payer: Priority Health SBD |
$44.04
|
| Rate for Payer: UMR Bronson Commercial |
$24.84
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
| Rate for Payer: UMR Bronson Commercial |
$32.20
|
|
|
CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 73610
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$1,014.86 |
| Rate for Payer: Aetna Commercial |
$41.51
|
| Rate for Payer: Aetna Commercial |
$41.51
|
| Rate for Payer: Aetna Commercial |
$41.51
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Complete |
$34.80
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,014.86
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health SBD |
$56.84
|
| Rate for Payer: Priority Health SBD |
$56.84
|
| Rate for Payer: Priority Health SBD |
$56.84
|
| Rate for Payer: UMR Bronson Commercial |
$40.02
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
CHG RADEX CALCANEUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 73650
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$2,853.88 |
| Rate for Payer: Aetna Commercial |
$32.70
|
| Rate for Payer: Aetna Commercial |
$32.70
|
| Rate for Payer: Aetna Commercial |
$32.70
|
| Rate for Payer: BCBS Complete |
$29.60
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,853.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,853.88
|
| Rate for Payer: BCBS Trust/PPO |
$2,853.88
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.77
|
| Rate for Payer: Priority Health Narrow Network |
$11.77
|
| Rate for Payer: Priority Health Narrow Network |
$11.77
|
| Rate for Payer: Priority Health Narrow Network |
$11.77
|
| Rate for Payer: Priority Health SBD |
$44.04
|
| Rate for Payer: Priority Health SBD |
$44.04
|
| Rate for Payer: Priority Health SBD |
$44.04
|
| Rate for Payer: UMR Bronson Commercial |
$34.04
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
|
|
CHG RADEX CLAVICLE COMPLETE
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
HCPCS 73000
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$3,301.35 |
| Rate for Payer: Aetna Commercial |
$36.51
|
| Rate for Payer: Aetna Commercial |
$36.51
|
| Rate for Payer: Aetna Commercial |
$36.51
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Trust/PPO |
$3,301.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,301.35
|
| Rate for Payer: BCBS Trust/PPO |
$3,301.35
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health SBD |
$49.68
|
| Rate for Payer: Priority Health SBD |
$49.68
|
| Rate for Payer: Priority Health SBD |
$49.68
|
| Rate for Payer: UMR Bronson Commercial |
$18.40
|
| Rate for Payer: UMR Bronson Commercial |
$13.34
|
| Rate for Payer: UMR Bronson Commercial |
$42.32
|
|
|
CHG RADEX ELBOW 2 VIEWS
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
HCPCS 73070
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$316.45 |
| Rate for Payer: Aetna Commercial |
$33.08
|
| Rate for Payer: Aetna Commercial |
$33.08
|
| Rate for Payer: Aetna Commercial |
$33.08
|
| Rate for Payer: BCBS Complete |
$34.40
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$316.45
|
| Rate for Payer: BCBS Trust/PPO |
$316.45
|
| Rate for Payer: BCBS Trust/PPO |
$316.45
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health SBD |
$45.07
|
| Rate for Payer: Priority Health SBD |
$45.07
|
| Rate for Payer: Priority Health SBD |
$45.07
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
| Rate for Payer: UMR Bronson Commercial |
$39.56
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
CHG RADEX ELBOW ARTHROGRAPHY RS&I
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 73085
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$296.90 |
| Rate for Payer: Aetna Commercial |
$133.37
|
| Rate for Payer: BCBS Complete |
$33.60
|
| Rate for Payer: BCBS Trust/PPO |
$296.90
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$58.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.49
|
| Rate for Payer: Priority Health Narrow Network |
$41.49
|
| Rate for Payer: Priority Health SBD |
$172.09
|
| Rate for Payer: UMR Bronson Commercial |
$38.64
|
|
|
CHG RADEX ELBOW COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 73080
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$379.85 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$379.85
|
| Rate for Payer: BCBS Trust/PPO |
$379.85
|
| Rate for Payer: BCBS Trust/PPO |
$379.85
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health SBD |
$50.19
|
| Rate for Payer: Priority Health SBD |
$50.19
|
| Rate for Payer: Priority Health SBD |
$50.19
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
| Rate for Payer: UMR Bronson Commercial |
$45.54
|
|
|
CHG RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 2/3 VW
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 72082
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$380.38 |
| Rate for Payer: Aetna Commercial |
$79.03
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$380.38
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.05
|
| Rate for Payer: Priority Health Narrow Network |
$23.05
|
| Rate for Payer: Priority Health SBD |
$108.06
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
|
|
CHG RADEX FACIAL BONES < 3 VIEWS
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 70140
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$1,212.45 |
| Rate for Payer: Aetna Commercial |
$36.62
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,212.45
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.86
|
| Rate for Payer: Priority Health Narrow Network |
$14.86
|
| Rate for Payer: Priority Health SBD |
$49.68
|
| Rate for Payer: UMR Bronson Commercial |
$8.28
|
|
|
CHG RADEX FACIAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 70150
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$916.60 |
| Rate for Payer: Aetna Commercial |
$53.67
|
| Rate for Payer: Aetna Commercial |
$53.67
|
| Rate for Payer: Aetna Commercial |
$53.67
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS Trust/PPO |
$916.60
|
| Rate for Payer: BCBS Trust/PPO |
$916.60
|
| Rate for Payer: BCBS Trust/PPO |
$916.60
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.95
|
| Rate for Payer: Priority Health Narrow Network |
$18.95
|
| Rate for Payer: Priority Health Narrow Network |
$18.95
|
| Rate for Payer: Priority Health Narrow Network |
$18.95
|
| Rate for Payer: Priority Health SBD |
$72.21
|
| Rate for Payer: Priority Health SBD |
$72.21
|
| Rate for Payer: Priority Health SBD |
$72.21
|
| Rate for Payer: UMR Bronson Commercial |
$26.22
|
| Rate for Payer: UMR Bronson Commercial |
$11.50
|
| Rate for Payer: UMR Bronson Commercial |
$41.40
|
|
|
CHG RADEX FINGR MINIMUM 2 VIEWS
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 73140
|
| Min. Negotiated Rate |
$10.25 |
| Max. Negotiated Rate |
$349.73 |
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Trust/PPO |
$349.73
|
| Rate for Payer: BCBS Trust/PPO |
$349.73
|
| Rate for Payer: BCBS Trust/PPO |
$349.73
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.25
|
| Rate for Payer: Priority Health Narrow Network |
$10.25
|
| Rate for Payer: Priority Health Narrow Network |
$10.25
|
| Rate for Payer: Priority Health Narrow Network |
$10.25
|
| Rate for Payer: Priority Health SBD |
$58.38
|
| Rate for Payer: Priority Health SBD |
$58.38
|
| Rate for Payer: Priority Health SBD |
$58.38
|
| Rate for Payer: UMR Bronson Commercial |
$10.12
|
| Rate for Payer: UMR Bronson Commercial |
$23.00
|
| Rate for Payer: UMR Bronson Commercial |
$36.34
|
|
|
CHG RADEX FOOT COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 73630
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$910.26 |
| Rate for Payer: Aetna Commercial |
$38.84
|
| Rate for Payer: Aetna Commercial |
$38.84
|
| Rate for Payer: Aetna Commercial |
$38.84
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Trust/PPO |
$910.26
|
| Rate for Payer: BCBS Trust/PPO |
$910.26
|
| Rate for Payer: BCBS Trust/PPO |
$910.26
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health SBD |
$52.75
|
| Rate for Payer: Priority Health SBD |
$52.75
|
| Rate for Payer: Priority Health SBD |
$52.75
|
| Rate for Payer: UMR Bronson Commercial |
$13.34
|
| Rate for Payer: UMR Bronson Commercial |
$39.10
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
|
|
CHG RADEX FOREARM 2 VIEWS
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 73090
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$439.55 |
| Rate for Payer: Aetna Commercial |
$33.08
|
| Rate for Payer: Aetna Commercial |
$33.08
|
| Rate for Payer: Aetna Commercial |
$33.08
|
| Rate for Payer: BCBS Complete |
$35.20
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS Trust/PPO |
$439.55
|
| Rate for Payer: BCBS Trust/PPO |
$439.55
|
| Rate for Payer: BCBS Trust/PPO |
$439.55
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.77
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.77
|
| Rate for Payer: Priority Health Narrow Network |
$11.77
|
| Rate for Payer: Priority Health Narrow Network |
$11.77
|
| Rate for Payer: Priority Health Narrow Network |
$11.77
|
| Rate for Payer: Priority Health SBD |
$45.07
|
| Rate for Payer: Priority Health SBD |
$45.07
|
| Rate for Payer: Priority Health SBD |
$45.07
|
| Rate for Payer: UMR Bronson Commercial |
$40.48
|
| Rate for Payer: UMR Bronson Commercial |
$17.48
|
| Rate for Payer: UMR Bronson Commercial |
$12.88
|
|
|
CHG RADEX HAND 2 VIEWS
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 73120
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$138.94 |
| Rate for Payer: Aetna Commercial |
$35.37
|
| Rate for Payer: Aetna Commercial |
$35.37
|
| Rate for Payer: Aetna Commercial |
$35.37
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: BCBS Trust/PPO |
$138.94
|
| Rate for Payer: BCBS Trust/PPO |
$138.94
|
| Rate for Payer: BCBS Trust/PPO |
$138.94
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health SBD |
$48.14
|
| Rate for Payer: Priority Health SBD |
$48.14
|
| Rate for Payer: Priority Health SBD |
$48.14
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
| Rate for Payer: UMR Bronson Commercial |
$36.80
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
CHG RADEX HAND MINIMUM 3 VIEWS
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 73130
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$325.96 |
| Rate for Payer: Aetna Commercial |
$41.12
|
| Rate for Payer: Aetna Commercial |
$41.12
|
| Rate for Payer: Aetna Commercial |
$41.12
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$325.96
|
| Rate for Payer: BCBS Trust/PPO |
$325.96
|
| Rate for Payer: BCBS Trust/PPO |
$325.96
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health SBD |
$56.84
|
| Rate for Payer: Priority Health SBD |
$56.84
|
| Rate for Payer: Priority Health SBD |
$56.84
|
| Rate for Payer: UMR Bronson Commercial |
$21.16
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
| Rate for Payer: UMR Bronson Commercial |
$43.24
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 73521
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$355.02 |
| Rate for Payer: Aetna Commercial |
$46.65
|
| Rate for Payer: Aetna Commercial |
$46.65
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS Trust/PPO |
$355.02
|
| Rate for Payer: BCBS Trust/PPO |
$355.02
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.38
|
| Rate for Payer: Priority Health Narrow Network |
$16.38
|
| Rate for Payer: Priority Health Narrow Network |
$16.38
|
| Rate for Payer: Priority Health SBD |
$63.51
|
| Rate for Payer: Priority Health SBD |
$63.51
|
| Rate for Payer: UMR Bronson Commercial |
$34.50
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS 3-4 VIEWS
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 73522
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$358.19 |
| Rate for Payer: Aetna Commercial |
$60.64
|
| Rate for Payer: Aetna Commercial |
$60.64
|
| Rate for Payer: Aetna Commercial |
$60.64
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS Trust/PPO |
$358.19
|
| Rate for Payer: BCBS Trust/PPO |
$358.19
|
| Rate for Payer: BCBS Trust/PPO |
$358.19
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$80.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.51
|
| Rate for Payer: Priority Health Narrow Network |
$21.51
|
| Rate for Payer: Priority Health Narrow Network |
$21.51
|
| Rate for Payer: Priority Health Narrow Network |
$21.51
|
| Rate for Payer: Priority Health SBD |
$82.46
|
| Rate for Payer: Priority Health SBD |
$82.46
|
| Rate for Payer: Priority Health SBD |
$82.46
|
| Rate for Payer: UMR Bronson Commercial |
$52.90
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
| Rate for Payer: UMR Bronson Commercial |
$28.52
|
|
|
CHG RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS 73523
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$2,539.54 |
| Rate for Payer: Aetna Commercial |
$69.49
|
| Rate for Payer: Aetna Commercial |
$69.49
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS Complete |
$10.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,539.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,539.54
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$20.00
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.05
|
| Rate for Payer: Priority Health Narrow Network |
$23.05
|
| Rate for Payer: Priority Health Narrow Network |
$23.05
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: UMR Bronson Commercial |
$11.50
|
| Rate for Payer: UMR Bronson Commercial |
$51.52
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 1 VIEW
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 73501
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$471.24 |
| Rate for Payer: Aetna Commercial |
$36.58
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$471.24
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.83
|
| Rate for Payer: Priority Health Narrow Network |
$13.83
|
| Rate for Payer: Priority Health SBD |
$50.71
|
| Rate for Payer: UMR Bronson Commercial |
$25.76
|
|
|
CHG RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 73502
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$267.32 |
| Rate for Payer: Aetna Commercial |
$52.75
|
| Rate for Payer: Aetna Commercial |
$52.75
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS Complete |
$31.20
|
| Rate for Payer: BCBS Trust/PPO |
$267.32
|
| Rate for Payer: BCBS Trust/PPO |
$267.32
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$54.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$15.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.38
|
| Rate for Payer: Priority Health Narrow Network |
$16.38
|
| Rate for Payer: Priority Health Narrow Network |
$16.38
|
| Rate for Payer: Priority Health SBD |
$72.21
|
| Rate for Payer: Priority Health SBD |
$72.21
|
| Rate for Payer: UMR Bronson Commercial |
$10.12
|
| Rate for Payer: UMR Bronson Commercial |
$35.88
|
|
|
CHG RADEX HUMERUS MINIMUM 2 VIEWS
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 73060
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$222.41 |
| Rate for Payer: Aetna Commercial |
$36.51
|
| Rate for Payer: Aetna Commercial |
$36.51
|
| Rate for Payer: Aetna Commercial |
$36.51
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Trust/PPO |
$222.41
|
| Rate for Payer: BCBS Trust/PPO |
$222.41
|
| Rate for Payer: BCBS Trust/PPO |
$222.41
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health SBD |
$49.68
|
| Rate for Payer: Priority Health SBD |
$49.68
|
| Rate for Payer: Priority Health SBD |
$49.68
|
| Rate for Payer: UMR Bronson Commercial |
$14.72
|
| Rate for Payer: UMR Bronson Commercial |
$47.38
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
|
|
CHG RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 70160
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$59.17 |
| Rate for Payer: Aetna Commercial |
$43.03
|
| Rate for Payer: Aetna Commercial |
$43.03
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCBS Trust/PPO |
$59.17
|
| Rate for Payer: BCBS Trust/PPO |
$59.17
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health Narrow Network |
$12.80
|
| Rate for Payer: Priority Health SBD |
$58.90
|
| Rate for Payer: Priority Health SBD |
$58.90
|
| Rate for Payer: UMR Bronson Commercial |
$22.08
|
| Rate for Payer: UMR Bronson Commercial |
$25.30
|
|
|
CHG RADEX OPTIC FORAMINA
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 70190
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$79.77 |
| Rate for Payer: Aetna Commercial |
$43.94
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: BCBS Trust/PPO |
$79.77
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.38
|
| Rate for Payer: Priority Health Narrow Network |
$16.38
|
| Rate for Payer: Priority Health SBD |
$57.87
|
| Rate for Payer: UMR Bronson Commercial |
$28.98
|
|
