|
CHG URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 78740
|
| Min. Negotiated Rate |
$186.91 |
| Max. Negotiated Rate |
$315.25 |
| Rate for Payer: Aetna Commercial |
$250.46
|
| Rate for Payer: Aetna Medicare |
$186.91
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: BCBS MAPPO |
$186.91
|
| Rate for Payer: BCN Medicare Advantage |
$186.91
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$250.46
|
| Rate for Payer: Cofinity Commercial |
$269.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.91
|
| Rate for Payer: Healthscope Commercial |
$224.29
|
| Rate for Payer: Healthscope Whirlpool |
$224.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.26
|
| Rate for Payer: Nomi Health Commercial |
$224.29
|
| Rate for Payer: PACE SWMI |
$186.91
|
| Rate for Payer: PHP Medicare Advantage |
$186.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health Medicare |
$186.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.91
|
| Rate for Payer: UHC Medicare Advantage |
$186.91
|
| Rate for Payer: UHCCP DNSP |
$186.91
|
|
|
CHG URETHROCYSTOGRAPHY RETROGRADE RS&I
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 74450
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
|
|
CHG URETHROCYSTOGRAPHY VOIDING RS&I
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 74455
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$130.61 |
| Rate for Payer: Aetna Commercial |
$121.54
|
| Rate for Payer: Aetna Medicare |
$90.70
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$90.70
|
| Rate for Payer: BCN Medicare Advantage |
$90.70
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$130.61
|
| Rate for Payer: Cofinity Commercial |
$121.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.70
|
| Rate for Payer: Healthscope Commercial |
$108.84
|
| Rate for Payer: Healthscope Whirlpool |
$108.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.23
|
| Rate for Payer: Nomi Health Commercial |
$108.84
|
| Rate for Payer: PACE SWMI |
$90.70
|
| Rate for Payer: PHP Medicare Advantage |
$90.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health Medicare |
$90.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.70
|
| Rate for Payer: UHC Medicare Advantage |
$90.70
|
| Rate for Payer: UHCCP DNSP |
$90.70
|
|
|
CHG URINALYSIS MICROSCOPIC ONLY
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 81015
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Commercial |
$4.09
|
| Rate for Payer: Aetna Medicare |
$3.05
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$3.05
|
| Rate for Payer: BCN Medicare Advantage |
$3.05
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.05
|
| Rate for Payer: Healthscope Commercial |
$3.66
|
| Rate for Payer: Healthscope Whirlpool |
$3.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.20
|
| Rate for Payer: Nomi Health Commercial |
$3.66
|
| Rate for Payer: PACE SWMI |
$3.05
|
| Rate for Payer: PHP Medicare Advantage |
$3.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: Priority Health Medicare |
$3.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.05
|
| Rate for Payer: UHC Medicare Advantage |
$3.05
|
| Rate for Payer: UHCCP DNSP |
$3.05
|
|
|
CHG URINALYSIS QUAL/SEMIQUANT EXCEPT IMMUNOASSAYS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 81005
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Aetna Medicare |
$2.17
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Healthscope Commercial |
$2.60
|
| Rate for Payer: Healthscope Whirlpool |
$2.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.60
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$2.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.17
|
| Rate for Payer: UHC Medicare Advantage |
$2.17
|
| Rate for Payer: UHCCP DNSP |
$2.17
|
|
|
CHG URINARY BLADDER RESIDUAL STUDY
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 78730
|
| Min. Negotiated Rate |
$58.86 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Aetna Commercial |
$78.87
|
| Rate for Payer: Aetna Medicare |
$58.86
|
| Rate for Payer: BCBS Complete |
$95.20
|
| Rate for Payer: BCBS MAPPO |
$58.86
|
| Rate for Payer: BCN Medicare Advantage |
$58.86
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cofinity Commercial |
$84.76
|
| Rate for Payer: Cofinity Commercial |
$78.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.86
|
| Rate for Payer: Healthscope Commercial |
$70.63
|
| Rate for Payer: Healthscope Whirlpool |
$70.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.80
|
| Rate for Payer: Nomi Health Commercial |
$70.63
|
| Rate for Payer: PACE SWMI |
$58.86
|
| Rate for Payer: PHP Medicare Advantage |
$58.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.70
|
| Rate for Payer: Priority Health Medicare |
$58.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.86
|
| Rate for Payer: UHC Medicare Advantage |
$58.86
|
| Rate for Payer: UHCCP DNSP |
$58.86
|
|
|
CHG URINE ALBUMIN SEMIQUANTITATIVE
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 82044
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Aetna Commercial |
$8.35
|
| Rate for Payer: Aetna Medicare |
$6.23
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$6.23
|
| Rate for Payer: BCN Medicare Advantage |
$6.23
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$8.97
|
| Rate for Payer: Cofinity Commercial |
$8.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.23
|
| Rate for Payer: Healthscope Commercial |
$7.48
|
| Rate for Payer: Healthscope Whirlpool |
$7.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.54
|
| Rate for Payer: Nomi Health Commercial |
$7.48
|
| Rate for Payer: PACE SWMI |
$6.23
|
| Rate for Payer: PHP Medicare Advantage |
$6.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$6.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.23
|
| Rate for Payer: UHC Medicare Advantage |
$6.23
|
| Rate for Payer: UHCCP DNSP |
$6.23
|
|
|
CHG URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 81025
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Aetna Commercial |
$11.54
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$8.61
|
| Rate for Payer: BCN Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.61
|
| Rate for Payer: Healthscope Commercial |
$10.33
|
| Rate for Payer: Healthscope Whirlpool |
$10.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.04
|
| Rate for Payer: Nomi Health Commercial |
$10.33
|
| Rate for Payer: PACE SWMI |
$8.61
|
| Rate for Payer: PHP Medicare Advantage |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health Medicare |
$8.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.61
|
| Rate for Payer: UHC Medicare Advantage |
$8.61
|
| Rate for Payer: UHCCP DNSP |
$8.61
|
|
|
CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS 81000
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: Aetna Medicare |
$4.02
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$4.02
|
| Rate for Payer: BCN Medicare Advantage |
$4.02
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$5.79
|
| Rate for Payer: Cofinity Commercial |
$5.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.02
|
| Rate for Payer: Healthscope Commercial |
$4.82
|
| Rate for Payer: Healthscope Whirlpool |
$4.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.22
|
| Rate for Payer: Nomi Health Commercial |
$4.82
|
| Rate for Payer: PACE SWMI |
$4.02
|
| Rate for Payer: PHP Medicare Advantage |
$4.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health Medicare |
$4.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.02
|
| Rate for Payer: UHC Medicare Advantage |
$4.02
|
| Rate for Payer: UHCCP DNSP |
$4.02
|
|
|
CHG URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 81001
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$4.25
|
| Rate for Payer: Aetna Medicare |
$3.17
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$3.17
|
| Rate for Payer: BCN Medicare Advantage |
$3.17
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$4.56
|
| Rate for Payer: Cofinity Commercial |
$4.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.17
|
| Rate for Payer: Healthscope Commercial |
$3.80
|
| Rate for Payer: Healthscope Whirlpool |
$3.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.33
|
| Rate for Payer: Nomi Health Commercial |
$3.80
|
| Rate for Payer: PACE SWMI |
$3.17
|
| Rate for Payer: PHP Medicare Advantage |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$3.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.17
|
| Rate for Payer: UHC Medicare Advantage |
$3.17
|
| Rate for Payer: UHCCP DNSP |
$3.17
|
|
|
CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 81003
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna Medicare |
$2.25
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$2.25
|
| Rate for Payer: BCN Medicare Advantage |
$2.25
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$3.24
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.25
|
| Rate for Payer: Healthscope Commercial |
$2.70
|
| Rate for Payer: Healthscope Whirlpool |
$2.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.36
|
| Rate for Payer: Nomi Health Commercial |
$2.70
|
| Rate for Payer: PACE SWMI |
$2.25
|
| Rate for Payer: PHP Medicare Advantage |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$2.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.25
|
| Rate for Payer: UHC Medicare Advantage |
$2.25
|
| Rate for Payer: UHCCP DNSP |
$2.25
|
|
|
CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 81002
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna Commercial |
$4.66
|
| Rate for Payer: Aetna Medicare |
$3.48
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$3.48
|
| Rate for Payer: BCN Medicare Advantage |
$3.48
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$5.01
|
| Rate for Payer: Cofinity Commercial |
$4.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$4.18
|
| Rate for Payer: Healthscope Whirlpool |
$4.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.65
|
| Rate for Payer: Nomi Health Commercial |
$4.18
|
| Rate for Payer: PACE SWMI |
$3.48
|
| Rate for Payer: PHP Medicare Advantage |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health Medicare |
$3.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.48
|
| Rate for Payer: UHC Medicare Advantage |
$3.48
|
| Rate for Payer: UHCCP DNSP |
$3.48
|
|
|
CHG UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
HCPCS 74400
|
| Min. Negotiated Rate |
$56.00 |
| Max. Negotiated Rate |
$170.99 |
| Rate for Payer: Aetna Commercial |
$159.11
|
| Rate for Payer: Aetna Commercial |
$159.11
|
| Rate for Payer: Aetna Medicare |
$118.74
|
| Rate for Payer: Aetna Medicare |
$118.74
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCBS Complete |
$85.20
|
| Rate for Payer: BCBS MAPPO |
$118.74
|
| Rate for Payer: BCBS MAPPO |
$118.74
|
| Rate for Payer: BCN Medicare Advantage |
$118.74
|
| Rate for Payer: BCN Medicare Advantage |
$118.74
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cofinity Commercial |
$159.11
|
| Rate for Payer: Cofinity Commercial |
$170.99
|
| Rate for Payer: Cofinity Commercial |
$159.11
|
| Rate for Payer: Cofinity Commercial |
$170.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.74
|
| Rate for Payer: Healthscope Commercial |
$142.49
|
| Rate for Payer: Healthscope Commercial |
$142.49
|
| Rate for Payer: Healthscope Whirlpool |
$142.49
|
| Rate for Payer: Healthscope Whirlpool |
$142.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.68
|
| Rate for Payer: Nomi Health Commercial |
$142.49
|
| Rate for Payer: Nomi Health Commercial |
$142.49
|
| Rate for Payer: PACE SWMI |
$118.74
|
| Rate for Payer: PACE SWMI |
$118.74
|
| Rate for Payer: PHP Medicare Advantage |
$118.74
|
| Rate for Payer: PHP Medicare Advantage |
$118.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.45
|
| Rate for Payer: Priority Health Medicare |
$118.74
|
| Rate for Payer: Priority Health Medicare |
$118.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.74
|
| Rate for Payer: UHC Medicare Advantage |
$118.74
|
| Rate for Payer: UHC Medicare Advantage |
$118.74
|
| Rate for Payer: UHCCP DNSP |
$118.74
|
| Rate for Payer: UHCCP DNSP |
$118.74
|
|
|
CHG UROGRAPHY RETROGRADE WITH/WO KUB
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 74420
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$101.82 |
| Rate for Payer: Aetna Commercial |
$94.75
|
| Rate for Payer: Aetna Medicare |
$70.71
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS MAPPO |
$70.71
|
| Rate for Payer: BCN Medicare Advantage |
$70.71
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$94.75
|
| Rate for Payer: Cofinity Commercial |
$101.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.71
|
| Rate for Payer: Healthscope Commercial |
$84.85
|
| Rate for Payer: Healthscope Whirlpool |
$84.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.25
|
| Rate for Payer: Nomi Health Commercial |
$84.85
|
| Rate for Payer: PACE SWMI |
$70.71
|
| Rate for Payer: PHP Medicare Advantage |
$70.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health Medicare |
$70.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.71
|
| Rate for Payer: UHC Medicare Advantage |
$70.71
|
| Rate for Payer: UHCCP DNSP |
$70.71
|
|
|
CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 76706
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$138.56 |
| Rate for Payer: Aetna Commercial |
$128.93
|
| Rate for Payer: Aetna Medicare |
$96.22
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS MAPPO |
$96.22
|
| Rate for Payer: BCN Medicare Advantage |
$96.22
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$138.56
|
| Rate for Payer: Cofinity Commercial |
$128.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.22
|
| Rate for Payer: Healthscope Commercial |
$115.46
|
| Rate for Payer: Healthscope Whirlpool |
$115.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.03
|
| Rate for Payer: Nomi Health Commercial |
$115.46
|
| Rate for Payer: PACE SWMI |
$96.22
|
| Rate for Payer: PHP Medicare Advantage |
$96.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health Medicare |
$96.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.22
|
| Rate for Payer: UHC Medicare Advantage |
$96.22
|
| Rate for Payer: UHCCP DNSP |
$96.22
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS 76700
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$150.91 |
| Rate for Payer: Aetna Commercial |
$140.43
|
| Rate for Payer: Aetna Medicare |
$104.80
|
| Rate for Payer: BCBS Complete |
$85.20
|
| Rate for Payer: BCBS MAPPO |
$104.80
|
| Rate for Payer: BCN Medicare Advantage |
$104.80
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cofinity Commercial |
$150.91
|
| Rate for Payer: Cofinity Commercial |
$140.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.80
|
| Rate for Payer: Healthscope Commercial |
$125.76
|
| Rate for Payer: Healthscope Whirlpool |
$125.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.04
|
| Rate for Payer: Nomi Health Commercial |
$125.76
|
| Rate for Payer: PACE SWMI |
$104.80
|
| Rate for Payer: PHP Medicare Advantage |
$104.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.45
|
| Rate for Payer: Priority Health Medicare |
$104.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.80
|
| Rate for Payer: UHC Medicare Advantage |
$104.80
|
| Rate for Payer: UHCCP DNSP |
$104.80
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 76705
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$113.26 |
| Rate for Payer: Aetna Commercial |
$105.39
|
| Rate for Payer: Aetna Commercial |
$105.39
|
| Rate for Payer: Aetna Medicare |
$78.65
|
| Rate for Payer: Aetna Medicare |
$78.65
|
| Rate for Payer: BCBS Complete |
$43.20
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS MAPPO |
$78.65
|
| Rate for Payer: BCBS MAPPO |
$78.65
|
| Rate for Payer: BCN Medicare Advantage |
$78.65
|
| Rate for Payer: BCN Medicare Advantage |
$78.65
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$105.39
|
| Rate for Payer: Cofinity Commercial |
$113.26
|
| Rate for Payer: Cofinity Commercial |
$105.39
|
| Rate for Payer: Cofinity Commercial |
$113.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.65
|
| Rate for Payer: Healthscope Commercial |
$94.38
|
| Rate for Payer: Healthscope Commercial |
$94.38
|
| Rate for Payer: Healthscope Whirlpool |
$94.38
|
| Rate for Payer: Healthscope Whirlpool |
$94.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.58
|
| Rate for Payer: Nomi Health Commercial |
$94.38
|
| Rate for Payer: Nomi Health Commercial |
$94.38
|
| Rate for Payer: PACE SWMI |
$78.65
|
| Rate for Payer: PACE SWMI |
$78.65
|
| Rate for Payer: PHP Medicare Advantage |
$78.65
|
| Rate for Payer: PHP Medicare Advantage |
$78.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health Medicare |
$78.65
|
| Rate for Payer: Priority Health Medicare |
$78.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.65
|
| Rate for Payer: UHC Medicare Advantage |
$78.65
|
| Rate for Payer: UHC Medicare Advantage |
$78.65
|
| Rate for Payer: UHCCP DNSP |
$78.65
|
| Rate for Payer: UHCCP DNSP |
$78.65
|
|
|
CHG US, BREAST(S), REAL TIME
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
HCPCS 76645
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$97.50 |
| Rate for Payer: Aetna Medicare |
$75.00
|
| Rate for Payer: BCBS Complete |
$60.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.50
|
|
|
CHG US CHEST REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 76604
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$76.77 |
| Rate for Payer: Aetna Commercial |
$71.44
|
| Rate for Payer: Aetna Medicare |
$53.31
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS MAPPO |
$53.31
|
| Rate for Payer: BCN Medicare Advantage |
$53.31
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$76.77
|
| Rate for Payer: Cofinity Commercial |
$71.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.31
|
| Rate for Payer: Healthscope Commercial |
$63.97
|
| Rate for Payer: Healthscope Whirlpool |
$63.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.98
|
| Rate for Payer: Nomi Health Commercial |
$63.97
|
| Rate for Payer: PACE SWMI |
$53.31
|
| Rate for Payer: PHP Medicare Advantage |
$53.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health Medicare |
$53.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.31
|
| Rate for Payer: UHC Medicare Advantage |
$53.31
|
| Rate for Payer: UHCCP DNSP |
$53.31
|
|
|
CHG US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 76936
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$338.76 |
| Rate for Payer: Aetna Commercial |
$315.24
|
| Rate for Payer: Aetna Medicare |
$235.25
|
| Rate for Payer: BCBS Complete |
$171.60
|
| Rate for Payer: BCBS MAPPO |
$235.25
|
| Rate for Payer: BCN Medicare Advantage |
$235.25
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cofinity Commercial |
$338.76
|
| Rate for Payer: Cofinity Commercial |
$315.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$235.25
|
| Rate for Payer: Healthscope Commercial |
$282.30
|
| Rate for Payer: Healthscope Whirlpool |
$282.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$247.01
|
| Rate for Payer: Nomi Health Commercial |
$282.30
|
| Rate for Payer: PACE SWMI |
$235.25
|
| Rate for Payer: PHP Medicare Advantage |
$235.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.85
|
| Rate for Payer: Priority Health Medicare |
$235.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$235.25
|
| Rate for Payer: UHC Medicare Advantage |
$235.25
|
| Rate for Payer: UHCCP DNSP |
$235.25
|
|
|
CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 76881
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$201.50 |
| Rate for Payer: Aetna Commercial |
$67.21
|
| Rate for Payer: Aetna Commercial |
$67.21
|
| Rate for Payer: Aetna Medicare |
$50.16
|
| Rate for Payer: Aetna Medicare |
$50.16
|
| Rate for Payer: BCBS Complete |
$34.40
|
| Rate for Payer: BCBS Complete |
$124.00
|
| Rate for Payer: BCBS MAPPO |
$50.16
|
| Rate for Payer: BCBS MAPPO |
$50.16
|
| Rate for Payer: BCN Medicare Advantage |
$50.16
|
| Rate for Payer: BCN Medicare Advantage |
$50.16
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cofinity Commercial |
$67.21
|
| Rate for Payer: Cofinity Commercial |
$72.23
|
| Rate for Payer: Cofinity Commercial |
$67.21
|
| Rate for Payer: Cofinity Commercial |
$72.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.16
|
| Rate for Payer: Healthscope Commercial |
$60.19
|
| Rate for Payer: Healthscope Commercial |
$60.19
|
| Rate for Payer: Healthscope Whirlpool |
$60.19
|
| Rate for Payer: Healthscope Whirlpool |
$60.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.67
|
| Rate for Payer: Nomi Health Commercial |
$60.19
|
| Rate for Payer: Nomi Health Commercial |
$60.19
|
| Rate for Payer: PACE SWMI |
$50.16
|
| Rate for Payer: PACE SWMI |
$50.16
|
| Rate for Payer: PHP Medicare Advantage |
$50.16
|
| Rate for Payer: PHP Medicare Advantage |
$50.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health Medicare |
$50.16
|
| Rate for Payer: Priority Health Medicare |
$50.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.16
|
| Rate for Payer: UHC Medicare Advantage |
$50.16
|
| Rate for Payer: UHC Medicare Advantage |
$50.16
|
| Rate for Payer: UHCCP DNSP |
$50.16
|
| Rate for Payer: UHCCP DNSP |
$50.16
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 76813
|
| Min. Negotiated Rate |
$103.93 |
| Max. Negotiated Rate |
$189.80 |
| Rate for Payer: Aetna Commercial |
$139.27
|
| Rate for Payer: Aetna Medicare |
$103.93
|
| Rate for Payer: BCBS Complete |
$116.80
|
| Rate for Payer: BCBS MAPPO |
$103.93
|
| Rate for Payer: BCN Medicare Advantage |
$103.93
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cofinity Commercial |
$149.66
|
| Rate for Payer: Cofinity Commercial |
$139.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.93
|
| Rate for Payer: Healthscope Commercial |
$124.72
|
| Rate for Payer: Healthscope Whirlpool |
$124.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.13
|
| Rate for Payer: Nomi Health Commercial |
$124.72
|
| Rate for Payer: PACE SWMI |
$103.93
|
| Rate for Payer: PHP Medicare Advantage |
$103.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health Medicare |
$103.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.93
|
| Rate for Payer: UHC Medicare Advantage |
$103.93
|
| Rate for Payer: UHCCP DNSP |
$103.93
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 76814
|
| Min. Negotiated Rate |
$67.93 |
| Max. Negotiated Rate |
$126.75 |
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna Medicare |
$67.93
|
| Rate for Payer: BCBS Complete |
$78.00
|
| Rate for Payer: BCBS MAPPO |
$67.93
|
| Rate for Payer: BCN Medicare Advantage |
$67.93
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cofinity Commercial |
$97.82
|
| Rate for Payer: Cofinity Commercial |
$91.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.93
|
| Rate for Payer: Healthscope Commercial |
$81.52
|
| Rate for Payer: Healthscope Whirlpool |
$81.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.33
|
| Rate for Payer: Nomi Health Commercial |
$81.52
|
| Rate for Payer: PACE SWMI |
$67.93
|
| Rate for Payer: PHP Medicare Advantage |
$67.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.75
|
| Rate for Payer: Priority Health Medicare |
$67.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$67.93
|
| Rate for Payer: UHC Medicare Advantage |
$67.93
|
| Rate for Payer: UHCCP DNSP |
$67.93
|
|
|
CHG US GUIDANCE AMNIOCENTESIS IMG S&I
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 76946
|
| Min. Negotiated Rate |
$30.73 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Medicare |
$30.73
|
| Rate for Payer: BCBS Complete |
$128.00
|
| Rate for Payer: BCBS MAPPO |
$30.73
|
| Rate for Payer: BCN Medicare Advantage |
$30.73
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cofinity Commercial |
$44.25
|
| Rate for Payer: Cofinity Commercial |
$41.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$30.73
|
| Rate for Payer: Healthscope Commercial |
$36.88
|
| Rate for Payer: Healthscope Whirlpool |
$36.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$32.27
|
| Rate for Payer: Nomi Health Commercial |
$36.88
|
| Rate for Payer: PACE SWMI |
$30.73
|
| Rate for Payer: PHP Medicare Advantage |
$30.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health Medicare |
$30.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$30.73
|
| Rate for Payer: UHC Medicare Advantage |
$30.73
|
| Rate for Payer: UHCCP DNSP |
$30.73
|
|
|
CHG US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 76965
|
| Min. Negotiated Rate |
$88.56 |
| Max. Negotiated Rate |
$173.55 |
| Rate for Payer: Aetna Commercial |
$118.67
|
| Rate for Payer: Aetna Commercial |
$118.67
|
| Rate for Payer: Aetna Medicare |
$88.56
|
| Rate for Payer: Aetna Medicare |
$88.56
|
| Rate for Payer: BCBS Complete |
$106.80
|
| Rate for Payer: BCBS Complete |
$151.60
|
| Rate for Payer: BCBS MAPPO |
$88.56
|
| Rate for Payer: BCBS MAPPO |
$88.56
|
| Rate for Payer: BCN Medicare Advantage |
$88.56
|
| Rate for Payer: BCN Medicare Advantage |
$88.56
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cofinity Commercial |
$118.67
|
| Rate for Payer: Cofinity Commercial |
$127.53
|
| Rate for Payer: Cofinity Commercial |
$118.67
|
| Rate for Payer: Cofinity Commercial |
$127.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.56
|
| Rate for Payer: Healthscope Commercial |
$106.27
|
| Rate for Payer: Healthscope Commercial |
$106.27
|
| Rate for Payer: Healthscope Whirlpool |
$106.27
|
| Rate for Payer: Healthscope Whirlpool |
$106.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.99
|
| Rate for Payer: Nomi Health Commercial |
$106.27
|
| Rate for Payer: Nomi Health Commercial |
$106.27
|
| Rate for Payer: PACE SWMI |
$88.56
|
| Rate for Payer: PACE SWMI |
$88.56
|
| Rate for Payer: PHP Medicare Advantage |
$88.56
|
| Rate for Payer: PHP Medicare Advantage |
$88.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.35
|
| Rate for Payer: Priority Health Medicare |
$88.56
|
| Rate for Payer: Priority Health Medicare |
$88.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.56
|
| Rate for Payer: UHC Medicare Advantage |
$88.56
|
| Rate for Payer: UHC Medicare Advantage |
$88.56
|
| Rate for Payer: UHCCP DNSP |
$88.56
|
| Rate for Payer: UHCCP DNSP |
$88.56
|
|
