|
CHG RADEX ORBITS COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 70200
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$120.45 |
| Rate for Payer: Aetna Commercial |
$54.89
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Trust/PPO |
$120.45
|
| 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 |
$20.48
|
| Rate for Payer: Priority Health Narrow Network |
$20.48
|
| Rate for Payer: Priority Health SBD |
$73.76
|
| Rate for Payer: UMR Bronson Commercial |
$25.76
|
|
|
CHG RADEX RIBS BILATERAL 3 VIEWS
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 71110
|
| Min. Negotiated Rate |
$20.99 |
| Max. Negotiated Rate |
$3,046.18 |
| Rate for Payer: Aetna Commercial |
$49.96
|
| Rate for Payer: Aetna Commercial |
$49.96
|
| Rate for Payer: BCBS Complete |
$43.20
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS Trust/PPO |
$3,046.18
|
| Rate for Payer: BCBS Trust/PPO |
$3,046.18
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.99
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.99
|
| Rate for Payer: Priority Health Narrow Network |
$20.99
|
| Rate for Payer: Priority Health Narrow Network |
$20.99
|
| Rate for Payer: Priority Health SBD |
$67.60
|
| Rate for Payer: Priority Health SBD |
$67.60
|
| Rate for Payer: UMR Bronson Commercial |
$23.92
|
| Rate for Payer: UMR Bronson Commercial |
$49.68
|
|
|
CHG RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 71111
|
| Min. Negotiated Rate |
$23.56 |
| Max. Negotiated Rate |
$2,693.80 |
| Rate for Payer: Aetna Commercial |
$59.61
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,693.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.56
|
| Rate for Payer: Priority Health Narrow Network |
$23.56
|
| Rate for Payer: Priority Health SBD |
$80.92
|
| Rate for Payer: UMR Bronson Commercial |
$32.66
|
|
|
CHG RADEX RIBS UNILATERAL 2 VIEWS
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 71100
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$3,087.39 |
| Rate for Payer: Aetna Commercial |
$41.69
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,087.39
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
| 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 |
$56.84
|
| Rate for Payer: UMR Bronson Commercial |
$22.54
|
|
|
CHG RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS 71101
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$2,607.16 |
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: Aetna Commercial |
$47.98
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,607.16
|
| Rate for Payer: BCBS Trust/PPO |
$2,607.16
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.47
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.47
|
| Rate for Payer: Priority Health Narrow Network |
$19.47
|
| Rate for Payer: Priority Health Narrow Network |
$19.47
|
| Rate for Payer: Priority Health SBD |
$65.05
|
| Rate for Payer: Priority Health SBD |
$65.05
|
| Rate for Payer: UMR Bronson Commercial |
$27.60
|
| Rate for Payer: UMR Bronson Commercial |
$23.46
|
|
|
CHG RADEX SACRUM & COCCYX MINIMUM 2 VIEWS
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 72220
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$2,093.12 |
| 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 |
$15.60
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Complete |
$49.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,093.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,093.12
|
| Rate for Payer: BCBS Trust/PPO |
$2,093.12
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| 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 |
$19.32
|
| Rate for Payer: UMR Bronson Commercial |
$57.04
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
|
|
CHG RADEX SCAPULA COMPLETE
|
Professional
|
Both
|
$43.00
|
|
|
Service Code
|
HCPCS 73010
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$2,600.29 |
| Rate for Payer: Aetna Commercial |
$27.01
|
| Rate for Payer: Aetna Commercial |
$27.01
|
| Rate for Payer: Aetna Commercial |
$27.01
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,600.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,600.29
|
| Rate for Payer: BCBS Trust/PPO |
$2,600.29
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.32
|
| Rate for Payer: Priority Health Narrow Network |
$13.32
|
| Rate for Payer: Priority Health Narrow Network |
$13.32
|
| Rate for Payer: Priority Health Narrow Network |
$13.32
|
| Rate for Payer: Priority Health SBD |
$36.36
|
| Rate for Payer: Priority Health SBD |
$36.36
|
| Rate for Payer: Priority Health SBD |
$36.36
|
| Rate for Payer: UMR Bronson Commercial |
$19.78
|
| Rate for Payer: UMR Bronson Commercial |
$48.30
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
|
|
CHG RADEX SHOULDER 1 VIEW
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 73020
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$940.90 |
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: Aetna Commercial |
$24.65
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Trust/PPO |
$940.90
|
| Rate for Payer: BCBS Trust/PPO |
$940.90
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.27
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.27
|
| Rate for Payer: Priority Health Narrow Network |
$11.27
|
| Rate for Payer: Priority Health Narrow Network |
$11.27
|
| Rate for Payer: Priority Health SBD |
$33.30
|
| Rate for Payer: Priority Health SBD |
$33.30
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
| Rate for Payer: UMR Bronson Commercial |
$36.34
|
|
|
CHG RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 73030
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$2,232.07 |
| Rate for Payer: Aetna Commercial |
$38.87
|
| Rate for Payer: Aetna Commercial |
$38.87
|
| Rate for Payer: Aetna Commercial |
$38.87
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,232.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,232.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,232.07
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.40
|
| 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 |
$53.26
|
| Rate for Payer: Priority Health SBD |
$53.26
|
| Rate for Payer: Priority Health SBD |
$53.26
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
| Rate for Payer: UMR Bronson Commercial |
$51.52
|
| Rate for Payer: UMR Bronson Commercial |
$18.40
|
|
|
CHG RADEX SINUSES PARANASAL <3 VIEWS
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 70210
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$163.24 |
| Rate for Payer: Aetna Commercial |
$36.55
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$163.24
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| 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 SBD |
$49.68
|
| Rate for Payer: UMR Bronson Commercial |
$19.32
|
|
|
CHG RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 70220
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$57.87 |
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: Aetna Commercial |
$42.84
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCBS Trust/PPO |
$57.58
|
| Rate for Payer: BCBS Trust/PPO |
$57.58
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.88
|
| Rate for Payer: Priority Health Narrow Network |
$15.88
|
| Rate for Payer: Priority Health Narrow Network |
$15.88
|
| Rate for Payer: Priority Health SBD |
$57.87
|
| Rate for Payer: Priority Health SBD |
$57.87
|
| Rate for Payer: UMR Bronson Commercial |
$23.00
|
| Rate for Payer: UMR Bronson Commercial |
$29.90
|
|
|
CHG RADEX SPINE 1 VIEW SPECIFY LEVEL
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 72020
|
| Min. Negotiated Rate |
$11.77 |
| Max. Negotiated Rate |
$527.77 |
| Rate for Payer: Aetna Commercial |
$28.12
|
| Rate for Payer: Aetna Commercial |
$28.12
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Trust/PPO |
$527.77
|
| Rate for Payer: BCBS Trust/PPO |
$527.77
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| 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 SBD |
$37.91
|
| Rate for Payer: Priority Health SBD |
$37.91
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
CHG RADEX SPINE CERVICAL 2 OR 3 VIEWS
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 72040
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$1,719.09 |
| Rate for Payer: Aetna Commercial |
$44.74
|
| Rate for Payer: Aetna Commercial |
$44.74
|
| Rate for Payer: Aetna Commercial |
$44.74
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,719.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,719.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,719.09
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| 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 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 Narrow Network |
$16.38
|
| Rate for Payer: Priority Health SBD |
$60.95
|
| Rate for Payer: Priority Health SBD |
$60.95
|
| Rate for Payer: Priority Health SBD |
$60.95
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
| Rate for Payer: UMR Bronson Commercial |
$46.00
|
| Rate for Payer: UMR Bronson Commercial |
$22.54
|
|
|
CHG RADEX SPINE CERVICAL 4 OR 5 VIEWS
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 72050
|
| Min. Negotiated Rate |
$19.98 |
| Max. Negotiated Rate |
$1,535.24 |
| Rate for Payer: Aetna Commercial |
$59.81
|
| Rate for Payer: Aetna Commercial |
$59.81
|
| Rate for Payer: Aetna Commercial |
$59.81
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCBS Complete |
$20.40
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,535.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,535.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,535.24
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$19.98
|
| Rate for Payer: Priority Health Narrow Network |
$19.98
|
| Rate for Payer: Priority Health Narrow Network |
$19.98
|
| Rate for Payer: Priority Health Narrow Network |
$19.98
|
| Rate for Payer: Priority Health SBD |
$81.95
|
| Rate for Payer: Priority Health SBD |
$81.95
|
| Rate for Payer: Priority Health SBD |
$81.95
|
| Rate for Payer: UMR Bronson Commercial |
$23.46
|
| Rate for Payer: UMR Bronson Commercial |
$64.40
|
| Rate for Payer: UMR Bronson Commercial |
$29.90
|
|
|
CHG RADEX SPINE CERVICAL 6 OR MORE VIEWS
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
HCPCS 72052
|
| Min. Negotiated Rate |
$22.02 |
| Max. Negotiated Rate |
$1,477.13 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS Complete |
$34.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,477.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,477.13
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.02
|
| Rate for Payer: Priority Health Narrow Network |
$22.02
|
| Rate for Payer: Priority Health Narrow Network |
$22.02
|
| Rate for Payer: Priority Health SBD |
$95.78
|
| Rate for Payer: Priority Health SBD |
$95.78
|
| Rate for Payer: UMR Bronson Commercial |
$39.56
|
| Rate for Payer: UMR Bronson Commercial |
$41.40
|
|
|
CHG RADEX SPINE LUMBOSACRAL 2/3 VIEWS
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 72100
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$2,071.46 |
| Rate for Payer: Aetna Commercial |
$45.13
|
| Rate for Payer: Aetna Commercial |
$45.13
|
| Rate for Payer: Aetna Commercial |
$45.13
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS Complete |
$40.80
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,071.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,071.46
|
| Rate for Payer: BCBS Trust/PPO |
$2,071.46
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$71.40
|
| 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 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 Narrow Network |
$16.38
|
| Rate for Payer: Priority Health SBD |
$61.45
|
| Rate for Payer: Priority Health SBD |
$61.45
|
| Rate for Payer: Priority Health SBD |
$61.45
|
| Rate for Payer: UMR Bronson Commercial |
$21.16
|
| Rate for Payer: UMR Bronson Commercial |
$46.92
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
CHG RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
HCPCS 72110
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$2,111.09 |
| Rate for Payer: Aetna Commercial |
$57.48
|
| Rate for Payer: Aetna Commercial |
$57.48
|
| Rate for Payer: Aetna Commercial |
$57.48
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS Complete |
$25.20
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.09
|
| Rate for Payer: BCBS Trust/PPO |
$2,111.09
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| 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 |
$78.88
|
| Rate for Payer: Priority Health SBD |
$78.88
|
| Rate for Payer: Priority Health SBD |
$78.88
|
| Rate for Payer: UMR Bronson Commercial |
$23.92
|
| Rate for Payer: UMR Bronson Commercial |
$28.98
|
| Rate for Payer: UMR Bronson Commercial |
$68.08
|
|
|
CHG RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 72120
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$3,290.25 |
| Rate for Payer: Aetna Commercial |
$46.27
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,290.25
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
| 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 |
$62.48
|
| Rate for Payer: UMR Bronson Commercial |
$22.54
|
|
|
CHG RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6
|
Professional
|
Both
|
$65.00
|
|
|
Service Code
|
HCPCS 72114
|
| Min. Negotiated Rate |
$22.53 |
| Max. Negotiated Rate |
$2,773.58 |
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: Aetna Commercial |
$70.22
|
| Rate for Payer: BCBS Complete |
$26.00
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,773.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,773.58
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$52.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$22.53
|
| Rate for Payer: Priority Health Narrow Network |
$22.53
|
| Rate for Payer: Priority Health Narrow Network |
$22.53
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: Priority Health SBD |
$95.26
|
| Rate for Payer: UMR Bronson Commercial |
$29.90
|
| Rate for Payer: UMR Bronson Commercial |
$41.40
|
|
|
CHG RADEX SPINE THORACIC 2 VIEWS
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 72070
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$165.36 |
| Rate for Payer: Aetna Commercial |
$37.04
|
| Rate for Payer: Aetna Commercial |
$37.04
|
| Rate for Payer: Aetna Commercial |
$37.04
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Complete |
$17.20
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Trust/PPO |
$165.36
|
| Rate for Payer: BCBS Trust/PPO |
$165.36
|
| Rate for Payer: BCBS Trust/PPO |
$165.36
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Cash Price |
$34.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.86
|
| 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 Narrow Network |
$14.86
|
| Rate for Payer: Priority Health Narrow Network |
$14.86
|
| Rate for Payer: Priority Health SBD |
$50.71
|
| Rate for Payer: Priority Health SBD |
$50.71
|
| Rate for Payer: Priority Health SBD |
$50.71
|
| Rate for Payer: UMR Bronson Commercial |
$46.00
|
| Rate for Payer: UMR Bronson Commercial |
$19.78
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
CHG RADEX SPINE THORACIC 3 VIEWS
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
HCPCS 72072
|
| Min. Negotiated Rate |
$16.38 |
| Max. Negotiated Rate |
$1,922.48 |
| Rate for Payer: Aetna Commercial |
$44.40
|
| Rate for Payer: BCBS Complete |
$32.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,922.48
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Cash Price |
$64.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.00
|
| 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 |
$60.44
|
| Rate for Payer: UMR Bronson Commercial |
$36.80
|
|
|
CHG RADEX SPINE THORACIC MINIMUM 4 VIEWS
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 72074
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$376.68 |
| Rate for Payer: Aetna Commercial |
$50.58
|
| Rate for Payer: BCBS Complete |
$29.60
|
| Rate for Payer: BCBS Trust/PPO |
$376.68
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.93
|
| Rate for Payer: Priority Health Narrow Network |
$17.93
|
| Rate for Payer: Priority Health SBD |
$68.12
|
| Rate for Payer: UMR Bronson Commercial |
$34.04
|
|
|
CHG RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 72080
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$1,847.47 |
| Rate for Payer: Aetna Commercial |
$39.37
|
| Rate for Payer: Aetna Commercial |
$39.37
|
| Rate for Payer: Aetna Commercial |
$39.37
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,847.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,847.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,847.47
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.37
|
| Rate for Payer: Priority Health Narrow Network |
$15.37
|
| Rate for Payer: Priority Health Narrow Network |
$15.37
|
| Rate for Payer: Priority Health Narrow Network |
$15.37
|
| Rate for Payer: Priority Health SBD |
$53.26
|
| Rate for Payer: Priority Health SBD |
$53.26
|
| Rate for Payer: Priority Health SBD |
$53.26
|
| Rate for Payer: UMR Bronson Commercial |
$50.14
|
| Rate for Payer: UMR Bronson Commercial |
$17.48
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
CHG RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 71130
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$5,212.15 |
| Rate for Payer: Aetna Commercial |
$47.03
|
| Rate for Payer: Aetna Commercial |
$47.03
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,212.15
|
| Rate for Payer: BCBS Trust/PPO |
$5,212.15
|
| 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: Priority Health Cigna Priority Health |
$35.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.88
|
| Rate for Payer: Priority Health Narrow Network |
$15.88
|
| Rate for Payer: Priority Health Narrow Network |
$15.88
|
| Rate for Payer: Priority Health SBD |
$63.51
|
| Rate for Payer: Priority Health SBD |
$63.51
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
| Rate for Payer: UMR Bronson Commercial |
$23.00
|
|
|
CHG RADEX STERNUM MINIMUM 2 VIEWS
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 71120
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$2,498.86 |
| Rate for Payer: Aetna Commercial |
$38.18
|
| Rate for Payer: Aetna Commercial |
$38.18
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,498.86
|
| Rate for Payer: BCBS Trust/PPO |
$2,498.86
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.34
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: Priority Health Narrow Network |
$14.34
|
| Rate for Payer: Priority Health SBD |
$51.73
|
| Rate for Payer: Priority Health SBD |
$51.73
|
| Rate for Payer: UMR Bronson Commercial |
$19.32
|
| Rate for Payer: UMR Bronson Commercial |
$22.08
|
|
