|
CHG SKIN TEST TUBERCULOSIS INTRADERMAL
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 86580
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$2,063.01 |
| Rate for Payer: Aetna Commercial |
$8.78
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS Trust/PPO |
$2,063.01
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.55
|
| Rate for Payer: Priority Health Narrow Network |
$10.55
|
| Rate for Payer: Priority Health SBD |
$10.55
|
| Rate for Payer: UMR Bronson Commercial |
$7.36
|
|
|
CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 87209
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$378.81 |
| Rate for Payer: Aetna Commercial |
$17.08
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS Trust/PPO |
$378.81
|
| 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 HMO/PPO/Tiered Network |
$18.63
|
| Rate for Payer: Priority Health Narrow Network |
$18.63
|
| Rate for Payer: Priority Health SBD |
$18.63
|
| Rate for Payer: UMR Bronson Commercial |
$22.08
|
|
|
CHG SMR PRIM SRC WET MOUNT NFCT AGT
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 87210
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$368.23 |
| Rate for Payer: Aetna Commercial |
$5.53
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCBS Trust/PPO |
$368.23
|
| 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 |
$5.97
|
| Rate for Payer: Priority Health Narrow Network |
$5.97
|
| Rate for Payer: Priority Health SBD |
$5.97
|
| Rate for Payer: UMR Bronson Commercial |
$8.28
|
|
|
CHG SONO GUIDE PERICARD TAP
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 76930
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: UMR Bronson Commercial |
$54.74
|
|
|
CHG SONO GUIDE RAD THERAPY FIELDS
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 76950
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: BCBS Complete |
$54.00
|
| Rate for Payer: BCBS Complete |
$29.60
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: UMR Bronson Commercial |
$34.04
|
| Rate for Payer: UMR Bronson Commercial |
$62.10
|
|
|
CHG SPEC DOSIM ONLY PRESCRIBED TREATING PHYS
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 77331
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$5,193.72 |
| Rate for Payer: Aetna Commercial |
$75.48
|
| Rate for Payer: Aetna Commercial |
$75.48
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS Complete |
$49.20
|
| Rate for Payer: BCBS Trust/PPO |
$5,193.72
|
| Rate for Payer: BCBS Trust/PPO |
$5,193.72
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$29.20
|
| Rate for Payer: Priority Health Narrow Network |
$29.20
|
| Rate for Payer: Priority Health Narrow Network |
$29.20
|
| Rate for Payer: Priority Health SBD |
$98.84
|
| Rate for Payer: Priority Health SBD |
$98.84
|
| Rate for Payer: UMR Bronson Commercial |
$56.58
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
|
|
CHG SPECIAL TREATMENT PROCEDURE
|
Professional
|
Both
|
$691.00
|
|
|
Service Code
|
HCPCS 77470
|
| Min. Negotiated Rate |
$49.68 |
| Max. Negotiated Rate |
$519.32 |
| Rate for Payer: Aetna Commercial |
$155.09
|
| Rate for Payer: Aetna Commercial |
$155.09
|
| Rate for Payer: BCBS Complete |
$208.80
|
| Rate for Payer: BCBS Complete |
$276.40
|
| Rate for Payer: BCBS Trust/PPO |
$519.32
|
| Rate for Payer: BCBS Trust/PPO |
$519.32
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$552.80
|
| Rate for Payer: Cash Price |
$417.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$365.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$483.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.68
|
| Rate for Payer: Priority Health Narrow Network |
$49.68
|
| Rate for Payer: Priority Health Narrow Network |
$49.68
|
| Rate for Payer: Priority Health SBD |
$212.55
|
| Rate for Payer: Priority Health SBD |
$212.55
|
| Rate for Payer: UMR Bronson Commercial |
$240.12
|
| Rate for Payer: UMR Bronson Commercial |
$317.86
|
|
|
CHG SPEC MEDICAL RADJ PHYSICS CONSLTJ
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 77370
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$1,979.54 |
| Rate for Payer: Aetna Commercial |
$143.41
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,979.54
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$148.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.55
|
| Rate for Payer: Priority Health Narrow Network |
$212.55
|
| Rate for Payer: Priority Health SBD |
$212.55
|
| Rate for Payer: UMR Bronson Commercial |
$97.52
|
|
|
CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
HCPCS 77321
|
| Min. Negotiated Rate |
$67.09 |
| Max. Negotiated Rate |
$5,378.09 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: BCBS Complete |
$110.40
|
| Rate for Payer: BCBS Complete |
$79.60
|
| Rate for Payer: BCBS Trust/PPO |
$5,378.09
|
| Rate for Payer: BCBS Trust/PPO |
$5,378.09
|
| Rate for Payer: Cash Price |
$159.20
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Cash Price |
$159.20
|
| Rate for Payer: Cash Price |
$220.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$193.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$67.09
|
| Rate for Payer: Priority Health Narrow Network |
$67.09
|
| Rate for Payer: Priority Health Narrow Network |
$67.09
|
| Rate for Payer: Priority Health SBD |
$143.40
|
| Rate for Payer: Priority Health SBD |
$143.40
|
| Rate for Payer: UMR Bronson Commercial |
$126.96
|
| Rate for Payer: UMR Bronson Commercial |
$91.54
|
|
|
CHG STEREOSCOPIC X-RAY GUIDANCE
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 77421
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$141.40 |
| Rate for Payer: BCBS Complete |
$80.80
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.40
|
| Rate for Payer: UMR Bronson Commercial |
$78.66
|
| Rate for Payer: UMR Bronson Commercial |
$92.92
|
|
|
CHG STEREOTACTIC BODY RADIATION DELIVERY
|
Professional
|
Both
|
$2,653.00
|
|
|
Service Code
|
HCPCS 77373
|
| Min. Negotiated Rate |
$1,061.20 |
| Max. Negotiated Rate |
$1,987.99 |
| Rate for Payer: Aetna Commercial |
$1,281.89
|
| Rate for Payer: BCBS Complete |
$1,061.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,987.99
|
| Rate for Payer: Cash Price |
$2,122.40
|
| Rate for Payer: Cash Price |
$2,122.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,857.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,540.09
|
| Rate for Payer: Priority Health Narrow Network |
$1,540.09
|
| Rate for Payer: Priority Health SBD |
$1,540.09
|
| Rate for Payer: UMR Bronson Commercial |
$1,220.38
|
|
|
CHG STEREOTACTIC BODY RADIATION MANAGEMENT
|
Professional
|
Both
|
$1,236.00
|
|
|
Service Code
|
HCPCS 77435
|
| Min. Negotiated Rate |
$408.11 |
| Max. Negotiated Rate |
$1,387.84 |
| Rate for Payer: Aetna Commercial |
$753.89
|
| Rate for Payer: BCBS Complete |
$428.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,387.84
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Cash Price |
$988.80
|
| Rate for Payer: Meridian Medicaid |
$428.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$865.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$977.73
|
| Rate for Payer: Priority Health Narrow Network |
$977.73
|
| Rate for Payer: Priority Health SBD |
$977.73
|
| Rate for Payer: UMR Bronson Commercial |
$568.56
|
|
|
CHG STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION
|
Professional
|
Both
|
$855.00
|
|
|
Service Code
|
HCPCS 77432
|
| Min. Negotiated Rate |
$269.87 |
| Max. Negotiated Rate |
$2,005.43 |
| Rate for Payer: Aetna Commercial |
$499.97
|
| Rate for Payer: BCBS Complete |
$283.36
|
| Rate for Payer: BCBS Trust/PPO |
$2,005.43
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Meridian Medicaid |
$283.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$269.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$572.76
|
| Rate for Payer: Priority Health Narrow Network |
$572.76
|
| Rate for Payer: Priority Health SBD |
$647.37
|
| Rate for Payer: UMR Bronson Commercial |
$393.30
|
|
|
CHG SUPERVISION HANDLING LOADING RADIATION SOURCE
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 77790
|
| Min. Negotiated Rate |
$10.76 |
| Max. Negotiated Rate |
$148.98 |
| Rate for Payer: Aetna Commercial |
$17.19
|
| Rate for Payer: Aetna Commercial |
$17.19
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS Trust/PPO |
$148.98
|
| Rate for Payer: BCBS Trust/PPO |
$148.98
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.76
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.76
|
| Rate for Payer: Priority Health Narrow Network |
$10.76
|
| Rate for Payer: Priority Health Narrow Network |
$10.76
|
| Rate for Payer: Priority Health SBD |
$26.63
|
| Rate for Payer: Priority Health SBD |
$26.63
|
| Rate for Payer: UMR Bronson Commercial |
$36.34
|
| Rate for Payer: UMR Bronson Commercial |
$84.64
|
|
|
CHG TELETHER ISODOSE PLAN COMPLX
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 77315
|
| Min. Negotiated Rate |
$107.60 |
| Max. Negotiated Rate |
$188.30 |
| Rate for Payer: BCBS Complete |
$107.60
|
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.40
|
| Rate for Payer: UMR Bronson Commercial |
$65.32
|
| Rate for Payer: UMR Bronson Commercial |
$123.74
|
|
|
CHG TELETHER ISODOSE PLAN SIMPLE
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS 77305
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: BCBS Complete |
$60.80
|
| Rate for Payer: BCBS Complete |
$38.00
|
| Rate for Payer: Cash Price |
$76.00
|
| 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 |
$66.50
|
| Rate for Payer: UMR Bronson Commercial |
$69.92
|
| Rate for Payer: UMR Bronson Commercial |
$43.70
|
|
|
CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 77307
|
| Min. Negotiated Rate |
$205.38 |
| Max. Negotiated Rate |
$1,915.09 |
| Rate for Payer: Aetna Commercial |
$330.89
|
| Rate for Payer: Aetna Commercial |
$330.89
|
| Rate for Payer: BCBS Complete |
$172.00
|
| Rate for Payer: BCBS Complete |
$328.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,915.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,915.09
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$575.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$301.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.38
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.38
|
| Rate for Payer: Priority Health Narrow Network |
$205.38
|
| Rate for Payer: Priority Health Narrow Network |
$205.38
|
| Rate for Payer: Priority Health SBD |
$437.40
|
| Rate for Payer: Priority Health SBD |
$437.40
|
| Rate for Payer: UMR Bronson Commercial |
$378.12
|
| Rate for Payer: UMR Bronson Commercial |
$197.80
|
|
|
CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 77306
|
| Min. Negotiated Rate |
$112.16 |
| Max. Negotiated Rate |
$271.60 |
| Rate for Payer: Aetna Commercial |
$169.82
|
| Rate for Payer: Aetna Commercial |
$169.82
|
| Rate for Payer: BCBS Complete |
$91.20
|
| Rate for Payer: BCBS Complete |
$155.20
|
| Rate for Payer: BCBS Trust/PPO |
$150.66
|
| Rate for Payer: BCBS Trust/PPO |
$150.66
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$271.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.16
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.16
|
| Rate for Payer: Priority Health Narrow Network |
$112.16
|
| Rate for Payer: Priority Health Narrow Network |
$112.16
|
| Rate for Payer: Priority Health SBD |
$225.86
|
| Rate for Payer: Priority Health SBD |
$225.86
|
| Rate for Payer: UMR Bronson Commercial |
$104.88
|
| Rate for Payer: UMR Bronson Commercial |
$178.48
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 74283
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$1,701.65 |
| Rate for Payer: Aetna Commercial |
$302.67
|
| Rate for Payer: BCBS Complete |
$108.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,701.65
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.61
|
| Rate for Payer: Priority Health Narrow Network |
$151.61
|
| Rate for Payer: Priority Health SBD |
$394.37
|
| Rate for Payer: UMR Bronson Commercial |
$125.12
|
|
|
CHG THERAPEUTIC RADIOLOGY PORT IMAGES(S)
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 77417
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$3,385.87 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS Trust/PPO |
$3,385.87
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.10
|
| 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 SBD |
$20.99
|
| Rate for Payer: UMR Bronson Commercial |
$15.18
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
HCPCS 77263
|
| Min. Negotiated Rate |
$106.71 |
| Max. Negotiated Rate |
$1,737.05 |
| Rate for Payer: Aetna Commercial |
$198.09
|
| Rate for Payer: BCBS Complete |
$112.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,737.05
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Cash Price |
$236.80
|
| Rate for Payer: Meridian Medicaid |
$112.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$106.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.10
|
| Rate for Payer: Priority Health Narrow Network |
$257.10
|
| Rate for Payer: Priority Health SBD |
$257.10
|
| Rate for Payer: UMR Bronson Commercial |
$136.16
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 77262
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$381.96 |
| Rate for Payer: Aetna Commercial |
$127.25
|
| Rate for Payer: BCBS Complete |
$72.24
|
| Rate for Payer: BCBS Trust/PPO |
$381.96
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Meridian Medicaid |
$72.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.41
|
| Rate for Payer: Priority Health Narrow Network |
$164.41
|
| Rate for Payer: Priority Health SBD |
$164.41
|
| Rate for Payer: UMR Bronson Commercial |
$91.08
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 77261
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$984.75 |
| Rate for Payer: Aetna Commercial |
$83.68
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS Trust/PPO |
$984.75
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.55
|
| Rate for Payer: Priority Health Narrow Network |
$107.55
|
| Rate for Payer: Priority Health SBD |
$107.55
|
| Rate for Payer: UMR Bronson Commercial |
$60.72
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX
|
Professional
|
Both
|
$787.00
|
|
|
Service Code
|
HCPCS 77290
|
| Min. Negotiated Rate |
$125.48 |
| Max. Negotiated Rate |
$693.47 |
| Rate for Payer: Aetna Commercial |
$554.16
|
| Rate for Payer: Aetna Commercial |
$554.16
|
| Rate for Payer: BCBS Complete |
$314.80
|
| Rate for Payer: BCBS Complete |
$378.00
|
| Rate for Payer: BCBS Trust/PPO |
$222.94
|
| Rate for Payer: BCBS Trust/PPO |
$222.94
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Cash Price |
$629.60
|
| Rate for Payer: Cash Price |
$756.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$550.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$661.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.48
|
| Rate for Payer: Priority Health Narrow Network |
$125.48
|
| Rate for Payer: Priority Health Narrow Network |
$125.48
|
| Rate for Payer: Priority Health SBD |
$693.47
|
| Rate for Payer: Priority Health SBD |
$693.47
|
| Rate for Payer: UMR Bronson Commercial |
$362.02
|
| Rate for Payer: UMR Bronson Commercial |
$434.70
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 77285
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$676.57 |
| Rate for Payer: Aetna Commercial |
$528.58
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.56
|
| Rate for Payer: Priority Health Narrow Network |
$86.56
|
| Rate for Payer: Priority Health SBD |
$676.57
|
| Rate for Payer: UMR Bronson Commercial |
$51.52
|
|
