|
CHG RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 72170
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$1,953.65 |
| Rate for Payer: Aetna Commercial |
$31.59
|
| Rate for Payer: Aetna Commercial |
$31.59
|
| Rate for Payer: Aetna Commercial |
$31.59
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,953.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,953.65
|
| Rate for Payer: BCBS Trust/PPO |
$1,953.65
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| 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 |
$43.03
|
| Rate for Payer: Priority Health SBD |
$43.03
|
| Rate for Payer: Priority Health SBD |
$43.03
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
| Rate for Payer: UMR Bronson Commercial |
$53.82
|
| Rate for Payer: UMR Bronson Commercial |
$17.48
|
|
|
CHG RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 72200
|
| Min. Negotiated Rate |
$12.29 |
| Max. Negotiated Rate |
$2,183.46 |
| Rate for Payer: Aetna Commercial |
$37.31
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,183.46
|
| 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 |
$12.29
|
| Rate for Payer: Priority Health Narrow Network |
$12.29
|
| Rate for Payer: Priority Health SBD |
$50.71
|
| Rate for Payer: UMR Bronson Commercial |
$19.32
|
|
|
CHG RADIOLOGIC EXAMINATION SKULL 4< VIEWS
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 70250
|
| Min. Negotiated Rate |
$13.32 |
| Max. Negotiated Rate |
$1,779.84 |
| Rate for Payer: Aetna Commercial |
$40.40
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,779.84
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| 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 SBD |
$55.32
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
CHG RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 73590
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$598.56 |
| Rate for Payer: Aetna Commercial |
$35.75
|
| Rate for Payer: Aetna Commercial |
$35.75
|
| Rate for Payer: Aetna Commercial |
$35.75
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Trust/PPO |
$598.56
|
| Rate for Payer: BCBS Trust/PPO |
$598.56
|
| Rate for Payer: BCBS Trust/PPO |
$598.56
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.40
|
| 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 |
$48.65
|
| Rate for Payer: Priority Health SBD |
$48.65
|
| Rate for Payer: Priority Health SBD |
$48.65
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
| Rate for Payer: UMR Bronson Commercial |
$13.34
|
| Rate for Payer: UMR Bronson Commercial |
$37.72
|
|
|
CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 73564
|
| Min. Negotiated Rate |
$16.90 |
| Max. Negotiated Rate |
$1,700.07 |
| Rate for Payer: Aetna Commercial |
$51.99
|
| Rate for Payer: Aetna Commercial |
$51.99
|
| Rate for Payer: Aetna Commercial |
$51.99
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,700.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,700.07
|
| Rate for Payer: BCBS Trust/PPO |
$1,700.07
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$31.20
|
| 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 |
$27.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.90
|
| Rate for Payer: Priority Health Narrow Network |
$16.90
|
| Rate for Payer: Priority Health Narrow Network |
$16.90
|
| Rate for Payer: Priority Health Narrow Network |
$16.90
|
| Rate for Payer: Priority Health SBD |
$71.70
|
| Rate for Payer: Priority Health SBD |
$71.70
|
| Rate for Payer: Priority Health SBD |
$71.70
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
| Rate for Payer: UMR Bronson Commercial |
$51.06
|
| Rate for Payer: UMR Bronson Commercial |
$27.60
|
|
|
CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS 72190
|
| Min. Negotiated Rate |
$18.44 |
| Max. Negotiated Rate |
$1,716.45 |
| Rate for Payer: Aetna Commercial |
$47.53
|
| Rate for Payer: Aetna Commercial |
$47.53
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,716.45
|
| Rate for Payer: BCBS Trust/PPO |
$1,716.45
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.44
|
| Rate for Payer: Priority Health Narrow Network |
$18.44
|
| Rate for Payer: Priority Health Narrow Network |
$18.44
|
| Rate for Payer: Priority Health SBD |
$65.05
|
| Rate for Payer: Priority Health SBD |
$65.05
|
| Rate for Payer: UMR Bronson Commercial |
$23.92
|
| Rate for Payer: UMR Bronson Commercial |
$24.84
|
|
|
CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 72202
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$378.26 |
| Rate for Payer: Aetna Commercial |
$44.40
|
| Rate for Payer: Aetna Commercial |
$44.40
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS Trust/PPO |
$378.26
|
| Rate for Payer: BCBS Trust/PPO |
$378.26
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| 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 |
$60.44
|
| Rate for Payer: Priority Health SBD |
$60.44
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
| Rate for Payer: UMR Bronson Commercial |
$22.54
|
|
|
CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 70260
|
| Min. Negotiated Rate |
$20.48 |
| Max. Negotiated Rate |
$2,020.75 |
| Rate for Payer: Aetna Commercial |
$51.07
|
| Rate for Payer: BCBS Complete |
$23.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,020.75
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.60
|
| 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 |
$68.63
|
| Rate for Payer: UMR Bronson Commercial |
$26.68
|
|
|
CHG RADN RX DELIVERY COMPLX 11-19 MEV
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 77414
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$326.20 |
| Rate for Payer: BCBS Complete |
$186.40
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.20
|
| Rate for Payer: UMR Bronson Commercial |
$214.36
|
|
|
CHG RADN RX DELIVERY COMPLX 6-10 MEV
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 77413
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: BCBS Complete |
$165.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.80
|
| Rate for Payer: UMR Bronson Commercial |
$190.44
|
|
|
CHG RADN RX DELIVERY SIMPLE 11-19 MEV
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 77404
|
| Min. Negotiated Rate |
$102.40 |
| Max. Negotiated Rate |
$179.20 |
| Rate for Payer: BCBS Complete |
$102.40
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.20
|
| Rate for Payer: UMR Bronson Commercial |
$117.76
|
|
|
CHG RADN RX DELIVERY SIMPLE 6-10 MEV
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
HCPCS 77403
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$160.30 |
| Rate for Payer: BCBS Complete |
$91.60
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.30
|
| Rate for Payer: UMR Bronson Commercial |
$105.34
|
|
|
CHG REMOTE AFTLD RADIONUC BRACHYTHERAPY,1 CHANNEL
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
HCPCS 77785
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$312.90 |
| Rate for Payer: BCBS Complete |
$178.80
|
| Rate for Payer: BCBS Complete |
$121.20
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.90
|
| Rate for Payer: UMR Bronson Commercial |
$139.38
|
| Rate for Payer: UMR Bronson Commercial |
$205.62
|
|
|
CHG REMOTE AFTLD RADIONUC BRACHYTHERAPY,2-12 CHANNEL
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 77786
|
| Min. Negotiated Rate |
$267.60 |
| Max. Negotiated Rate |
$468.30 |
| Rate for Payer: BCBS Complete |
$267.60
|
| Rate for Payer: BCBS Complete |
$394.00
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$788.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$689.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.30
|
| Rate for Payer: UMR Bronson Commercial |
$453.10
|
| Rate for Payer: UMR Bronson Commercial |
$307.74
|
|
|
CHG REPAIR,ILIAC ANRYSM/PSEUDO/AV MALF/TRAUMA W/ ENDOPROSTHESIS
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 75954
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.20
|
| Rate for Payer: UMR Bronson Commercial |
$99.36
|
|
|
CHG RESPIRATORY MOTION MANAGEMENT SIMULATION
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
HCPCS 77293
|
| Min. Negotiated Rate |
$159.80 |
| Max. Negotiated Rate |
$633.05 |
| Rate for Payer: Aetna Commercial |
$505.24
|
| Rate for Payer: Aetna Commercial |
$505.24
|
| Rate for Payer: BCBS Complete |
$324.00
|
| Rate for Payer: BCBS Complete |
$242.40
|
| Rate for Payer: BCBS Trust/PPO |
$218.19
|
| Rate for Payer: BCBS Trust/PPO |
$218.19
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$424.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.80
|
| Rate for Payer: Priority Health Narrow Network |
$159.80
|
| Rate for Payer: Priority Health Narrow Network |
$159.80
|
| Rate for Payer: Priority Health SBD |
$633.05
|
| Rate for Payer: Priority Health SBD |
$633.05
|
| Rate for Payer: UMR Bronson Commercial |
$372.60
|
| Rate for Payer: UMR Bronson Commercial |
$278.76
|
|
|
CHG RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 78803
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$1,043.92 |
| Rate for Payer: Aetna Commercial |
$438.41
|
| Rate for Payer: Aetna Commercial |
$438.41
|
| Rate for Payer: Aetna Commercial |
$438.41
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS Complete |
$240.00
|
| Rate for Payer: BCBS Complete |
$274.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,043.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,043.92
|
| Rate for Payer: BCBS Trust/PPO |
$1,043.92
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.80
|
| Rate for Payer: Priority Health Narrow Network |
$75.80
|
| Rate for Payer: Priority Health Narrow Network |
$75.80
|
| Rate for Payer: Priority Health Narrow Network |
$75.80
|
| Rate for Payer: Priority Health SBD |
$544.43
|
| Rate for Payer: Priority Health SBD |
$544.43
|
| Rate for Payer: Priority Health SBD |
$544.43
|
| Rate for Payer: UMR Bronson Commercial |
$315.10
|
| Rate for Payer: UMR Bronson Commercial |
$276.00
|
| Rate for Payer: UMR Bronson Commercial |
$39.10
|
|
|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
HCPCS 79101
|
| Min. Negotiated Rate |
$81.95 |
| Max. Negotiated Rate |
$1,781.96 |
| Rate for Payer: Aetna Commercial |
$172.32
|
| Rate for Payer: Aetna Commercial |
$172.32
|
| Rate for Payer: BCBS Complete |
$114.80
|
| Rate for Payer: BCBS Complete |
$206.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,781.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,781.96
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.95
|
| Rate for Payer: Priority Health Narrow Network |
$81.95
|
| Rate for Payer: Priority Health Narrow Network |
$81.95
|
| Rate for Payer: Priority Health SBD |
$224.34
|
| Rate for Payer: Priority Health SBD |
$224.34
|
| Rate for Payer: UMR Bronson Commercial |
$132.02
|
| Rate for Payer: UMR Bronson Commercial |
$237.82
|
|
|
CHG RP THERAPY ORAL ADMINISTRATION
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 79005
|
| Min. Negotiated Rate |
$78.37 |
| Max. Negotiated Rate |
$1,228.83 |
| Rate for Payer: Aetna Commercial |
$158.75
|
| Rate for Payer: Aetna Commercial |
$158.75
|
| Rate for Payer: BCBS Complete |
$60.80
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,228.83
|
| Rate for Payer: BCBS Trust/PPO |
$1,228.83
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.37
|
| Rate for Payer: Priority Health Narrow Network |
$78.37
|
| Rate for Payer: Priority Health Narrow Network |
$78.37
|
| Rate for Payer: Priority Health SBD |
$205.90
|
| Rate for Payer: Priority Health SBD |
$205.90
|
| Rate for Payer: UMR Bronson Commercial |
$69.92
|
| Rate for Payer: UMR Bronson Commercial |
$117.30
|
|
|
CHG SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 76831
|
| Min. Negotiated Rate |
$52.23 |
| Max. Negotiated Rate |
$764.98 |
| Rate for Payer: Aetna Commercial |
$138.24
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS Trust/PPO |
$764.98
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.23
|
| Rate for Payer: Priority Health Narrow Network |
$52.23
|
| Rate for Payer: Priority Health SBD |
$179.27
|
| Rate for Payer: UMR Bronson Commercial |
$108.10
|
|
|
CHG SEDIMENTATION RATE RBC NON-AUTOMATED
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 85651
|
| Min. Negotiated Rate |
$4.06 |
| Max. Negotiated Rate |
$2,682.02 |
| Rate for Payer: Aetna Commercial |
$4.06
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,682.02
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
| 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 |
$6.90
|
|
|
CHG SEMEN ALYS MOTILITY&CNT X W/HUHNER TST
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS 89310
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$940.90 |
| Rate for Payer: Aetna Commercial |
$8.18
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS Trust/PPO |
$940.90
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.98
|
| Rate for Payer: Priority Health Narrow Network |
$12.98
|
| Rate for Payer: Priority Health SBD |
$12.98
|
| Rate for Payer: UMR Bronson Commercial |
$9.66
|
|
|
CHG SEMEN ALYS PRESENCE&/MOTILITY SPRM HUHNER
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 89300
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$3,455.08 |
| Rate for Payer: Aetna Commercial |
$9.35
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,455.08
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.07
|
| Rate for Payer: Priority Health Narrow Network |
$15.07
|
| Rate for Payer: Priority Health SBD |
$15.07
|
| Rate for Payer: UMR Bronson Commercial |
$21.16
|
|
|
CHG SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 89321
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$1,251.54 |
| Rate for Payer: Aetna Commercial |
$11.45
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,251.54
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.70
|
| Rate for Payer: Priority Health Narrow Network |
$18.70
|
| Rate for Payer: Priority Health SBD |
$18.70
|
| Rate for Payer: UMR Bronson Commercial |
$12.88
|
|
|
CHG SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 75809
|
| Min. Negotiated Rate |
$35.34 |
| Max. Negotiated Rate |
$131.60 |
| Rate for Payer: Aetna Commercial |
$101.45
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS Trust/PPO |
$122.04
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.34
|
| Rate for Payer: Priority Health Narrow Network |
$35.34
|
| Rate for Payer: Priority Health SBD |
$126.50
|
| Rate for Payer: UMR Bronson Commercial |
$86.48
|
|
