|
CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
HCPCS 76811
|
| Min. Negotiated Rate |
$132.65 |
| Max. Negotiated Rate |
$269.92 |
| Rate for Payer: Aetna Commercial |
$203.73
|
| Rate for Payer: BCBS Complete |
$148.40
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$259.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$132.65
|
| Rate for Payer: Priority Health Narrow Network |
$132.65
|
| Rate for Payer: Priority Health SBD |
$269.92
|
| Rate for Payer: UMR Bronson Commercial |
$170.66
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE LIMITED
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 76775
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$2,427.54 |
| Rate for Payer: Aetna Commercial |
$67.91
|
| Rate for Payer: BCBS Complete |
$76.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,427.54
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.00
|
| Rate for Payer: Priority Health Narrow Network |
$42.00
|
| Rate for Payer: Priority Health SBD |
$90.65
|
| Rate for Payer: UMR Bronson Commercial |
$87.40
|
|
|
CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 76536
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$1,090.94 |
| Rate for Payer: Aetna Commercial |
$132.69
|
| Rate for Payer: Aetna Commercial |
$132.69
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Complete |
$89.20
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.94
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$178.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.49
|
| 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 Narrow Network |
$41.49
|
| Rate for Payer: Priority Health SBD |
$171.57
|
| Rate for Payer: Priority Health SBD |
$171.57
|
| Rate for Payer: UMR Bronson Commercial |
$102.58
|
| Rate for Payer: UMR Bronson Commercial |
$46.00
|
|
|
CHG US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 76873
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$669.36 |
| Rate for Payer: Aetna Commercial |
$203.54
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS Trust/PPO |
$669.36
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$115.76
|
| Rate for Payer: Priority Health Narrow Network |
$115.76
|
| Rate for Payer: Priority Health SBD |
$267.86
|
| Rate for Payer: UMR Bronson Commercial |
$117.30
|
|
|
CHG US TRANSRECTAL
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 76872
|
| Min. Negotiated Rate |
$48.65 |
| Max. Negotiated Rate |
$932.45 |
| Rate for Payer: Aetna Commercial |
$158.29
|
| Rate for Payer: Aetna Commercial |
$158.29
|
| Rate for Payer: BCBS Complete |
$130.00
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS Trust/PPO |
$932.45
|
| Rate for Payer: BCBS Trust/PPO |
$932.45
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$48.65
|
| Rate for Payer: Priority Health Narrow Network |
$48.65
|
| Rate for Payer: Priority Health Narrow Network |
$48.65
|
| Rate for Payer: Priority Health SBD |
$308.84
|
| Rate for Payer: Priority Health SBD |
$308.84
|
| Rate for Payer: UMR Bronson Commercial |
$149.50
|
| Rate for Payer: UMR Bronson Commercial |
$32.20
|
|
|
CHG US TRANSVAGINAL
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
HCPCS 76830
|
| Min. Negotiated Rate |
$50.71 |
| Max. Negotiated Rate |
$659.85 |
| Rate for Payer: Aetna Commercial |
$141.56
|
| Rate for Payer: BCBS Complete |
$121.60
|
| Rate for Payer: BCBS Trust/PPO |
$659.85
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$50.71
|
| Rate for Payer: Priority Health Narrow Network |
$50.71
|
| Rate for Payer: Priority Health SBD |
$184.89
|
| Rate for Payer: UMR Bronson Commercial |
$139.84
|
|
|
CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 76937
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$397.81 |
| Rate for Payer: Aetna Commercial |
$43.90
|
| Rate for Payer: Aetna Commercial |
$43.90
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS Trust/PPO |
$397.81
|
| Rate for Payer: BCBS Trust/PPO |
$397.81
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| 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 SBD |
$60.44
|
| Rate for Payer: Priority Health SBD |
$60.44
|
| Rate for Payer: UMR Bronson Commercial |
$25.76
|
| Rate for Payer: UMR Bronson Commercial |
$28.06
|
|
|
CHG VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 75840
|
| Min. Negotiated Rate |
$82.98 |
| Max. Negotiated Rate |
$311.17 |
| Rate for Payer: Aetna Commercial |
$155.47
|
| Rate for Payer: BCBS Complete |
$114.40
|
| Rate for Payer: BCBS Trust/PPO |
$311.17
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.98
|
| Rate for Payer: Priority Health Narrow Network |
$82.98
|
| Rate for Payer: Priority Health SBD |
$198.72
|
| Rate for Payer: UMR Bronson Commercial |
$131.56
|
|
|
CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 75825
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$238.26 |
| Rate for Payer: Aetna Commercial |
$140.09
|
| Rate for Payer: BCBS Complete |
$42.40
|
| Rate for Payer: BCBS Trust/PPO |
$238.26
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.41
|
| Rate for Payer: Priority Health Narrow Network |
$80.41
|
| Rate for Payer: Priority Health SBD |
$175.15
|
| Rate for Payer: UMR Bronson Commercial |
$48.76
|
|
|
CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 75827
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$307.47 |
| Rate for Payer: Aetna Commercial |
$146.19
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS Trust/PPO |
$307.47
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.43
|
| Rate for Payer: Priority Health Narrow Network |
$81.43
|
| Rate for Payer: Priority Health SBD |
$183.36
|
| Rate for Payer: UMR Bronson Commercial |
$47.38
|
|
|
CHG VENOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 75822
|
| Min. Negotiated Rate |
$100.39 |
| Max. Negotiated Rate |
$265.21 |
| Rate for Payer: Aetna Commercial |
$163.45
|
| Rate for Payer: Aetna Commercial |
$163.45
|
| Rate for Payer: BCBS Complete |
$107.60
|
| Rate for Payer: BCBS Complete |
$55.60
|
| Rate for Payer: BCBS Trust/PPO |
$265.21
|
| Rate for Payer: BCBS Trust/PPO |
$265.21
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| 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 |
$97.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.39
|
| Rate for Payer: Priority Health Narrow Network |
$100.39
|
| Rate for Payer: Priority Health Narrow Network |
$100.39
|
| Rate for Payer: Priority Health SBD |
$203.84
|
| Rate for Payer: Priority Health SBD |
$203.84
|
| Rate for Payer: UMR Bronson Commercial |
$63.94
|
| Rate for Payer: UMR Bronson Commercial |
$123.74
|
|
|
CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 75820
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$191.77 |
| Rate for Payer: Aetna Commercial |
$135.80
|
| Rate for Payer: BCBS Complete |
$49.60
|
| Rate for Payer: BCBS Trust/PPO |
$191.77
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.78
|
| Rate for Payer: Priority Health Narrow Network |
$74.78
|
| Rate for Payer: Priority Health SBD |
$167.48
|
| Rate for Payer: UMR Bronson Commercial |
$57.04
|
|
|
CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 75833
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$369.81 |
| Rate for Payer: Aetna Commercial |
$175.46
|
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: BCBS Trust/PPO |
$369.81
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.51
|
| Rate for Payer: Priority Health Narrow Network |
$105.51
|
| Rate for Payer: Priority Health SBD |
$225.35
|
| Rate for Payer: UMR Bronson Commercial |
$62.56
|
|
|
CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 75831
|
| Min. Negotiated Rate |
$78.88 |
| Max. Negotiated Rate |
$187.60 |
| Rate for Payer: Aetna Commercial |
$144.53
|
| Rate for Payer: Aetna Commercial |
$144.53
|
| Rate for Payer: BCBS Complete |
$107.20
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS Trust/PPO |
$156.38
|
| Rate for Payer: BCBS Trust/PPO |
$156.38
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.88
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.88
|
| Rate for Payer: Priority Health Narrow Network |
$78.88
|
| Rate for Payer: Priority Health Narrow Network |
$78.88
|
| Rate for Payer: Priority Health SBD |
$184.89
|
| Rate for Payer: Priority Health SBD |
$184.89
|
| Rate for Payer: UMR Bronson Commercial |
$123.28
|
| Rate for Payer: UMR Bronson Commercial |
$50.14
|
|
|
CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 75860
|
| Min. Negotiated Rate |
$81.43 |
| Max. Negotiated Rate |
$310.64 |
| Rate for Payer: Aetna Commercial |
$153.68
|
| Rate for Payer: Aetna Commercial |
$153.68
|
| Rate for Payer: BCBS Complete |
$143.60
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.43
|
| Rate for Payer: Priority Health Narrow Network |
$81.43
|
| Rate for Payer: Priority Health Narrow Network |
$81.43
|
| Rate for Payer: Priority Health SBD |
$193.59
|
| Rate for Payer: Priority Health SBD |
$193.59
|
| Rate for Payer: UMR Bronson Commercial |
$126.50
|
| Rate for Payer: UMR Bronson Commercial |
$165.14
|
|
|
CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 75893
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$353.43 |
| Rate for Payer: Aetna Commercial |
$125.74
|
| Rate for Payer: BCBS Complete |
$130.80
|
| Rate for Payer: BCBS Trust/PPO |
$353.43
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.91
|
| Rate for Payer: Priority Health Narrow Network |
$37.91
|
| Rate for Payer: Priority Health SBD |
$159.29
|
| Rate for Payer: UMR Bronson Commercial |
$150.42
|
|
|
CHG X-RAY ABDOMEN 1 VW
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 74000
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
|
|
CHG X-RAY ABDOMEN 2 VW
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 74020
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: UMR Bronson Commercial |
$23.92
|
|
|
CHG X-RAY FEMUR 2 VW
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 73550
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$20.30 |
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: UMR Bronson Commercial |
$13.34
|
| Rate for Payer: UMR Bronson Commercial |
$42.32
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
CHG X-RAY HIPS 4 VW + PELVIS
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 73520
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: UMR Bronson Commercial |
$54.74
|
| Rate for Payer: UMR Bronson Commercial |
$21.16
|
| Rate for Payer: UMR Bronson Commercial |
$24.38
|
|
|
CHG X-RAY HIP UNI 2+ VW
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 73510
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$25.20 |
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.20
|
| Rate for Payer: UMR Bronson Commercial |
$45.08
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
| Rate for Payer: UMR Bronson Commercial |
$24.38
|
|
|
CHG X-RAY HIP UNILAT 1 VW
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
HCPCS 73500
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$68.60 |
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: UMR Bronson Commercial |
$45.08
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
|
|
CHG X-RAY PELVIS/HIPS CHILD/INFANT
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 73540
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: BCBS Complete |
$38.00
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.80
|
| Rate for Payer: UMR Bronson Commercial |
$43.70
|
| Rate for Payer: UMR Bronson Commercial |
$15.64
|
|
|
CHG X-RAY SPINE SURVEY
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 72010
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
| Rate for Payer: UMR Bronson Commercial |
$33.12
|
|
|
CHG X-RAY THOR-LUMB SP SCOLIOSIS
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 72090
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$91.00 |
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: UMR Bronson Commercial |
$59.80
|
| Rate for Payer: UMR Bronson Commercial |
$45.08
|
| Rate for Payer: UMR Bronson Commercial |
$32.20
|
|
