|
CHG US ABDOMINAL REAL TIME W/IMAGE LIMITED
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 76705
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$2,317.65 |
| Rate for Payer: Aetna Commercial |
$104.19
|
| Rate for Payer: Aetna Commercial |
$104.19
|
| Rate for Payer: Aetna Medicare |
$54.00
|
| Rate for Payer: Aetna Medicare |
$90.00
|
| Rate for Payer: BCBS Complete |
$18.56
|
| Rate for Payer: BCBS Complete |
$18.56
|
| Rate for Payer: BCBS Trust/PPO |
$2,317.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,317.65
|
| Rate for Payer: BCN Commercial |
$129.50
|
| Rate for Payer: BCN Commercial |
$129.50
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Meridian Medicaid |
$18.56
|
| Rate for Payer: Meridian Medicaid |
$18.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.68
|
| 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 HMO/PPO/Tiered Network |
$42.09
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.09
|
| Rate for Payer: Priority Health Narrow Network |
$42.09
|
| Rate for Payer: Priority Health Narrow Network |
$42.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$109.53
|
| Rate for Payer: UHC Exchange |
$109.53
|
| Rate for Payer: UHC Exchange |
$109.53
|
| Rate for Payer: UHCCP Medicaid |
$17.68
|
| Rate for Payer: UHCCP Medicaid |
$17.68
|
|
|
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 |
$17.25 |
| Max. Negotiated Rate |
$2,617.20 |
| Rate for Payer: Aetna Commercial |
$77.11
|
| Rate for Payer: Aetna Medicare |
$28.50
|
| Rate for Payer: BCBS Complete |
$18.11
|
| Rate for Payer: BCBS Trust/PPO |
$2,617.20
|
| Rate for Payer: BCN Commercial |
$83.07
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Meridian Medicaid |
$18.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.06
|
| Rate for Payer: Priority Health Narrow Network |
$41.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$90.74
|
| Rate for Payer: UHC Exchange |
$90.74
|
| Rate for Payer: UHCCP Medicaid |
$17.25
|
|
|
CHG US CMPRN RPR ARTL PSEUDOARYSM/ARVEN FSTL
|
Professional
|
Both
|
$429.00
|
|
|
Service Code
|
HCPCS 76936
|
| Min. Negotiated Rate |
$59.21 |
| Max. Negotiated Rate |
$379.21 |
| Rate for Payer: Aetna Commercial |
$310.24
|
| Rate for Payer: Aetna Medicare |
$214.50
|
| Rate for Payer: BCBS Complete |
$62.17
|
| Rate for Payer: BCBS Trust/PPO |
$293.21
|
| Rate for Payer: BCN Commercial |
$379.21
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Meridian Medicaid |
$62.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$278.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.65
|
| Rate for Payer: Priority Health Narrow Network |
$141.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$327.03
|
| Rate for Payer: UHC Exchange |
$327.03
|
| Rate for Payer: UHCCP Medicaid |
$59.21
|
|
|
CHG US COMPL JOINT R-T W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 76881
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$763.39 |
| Rate for Payer: Aetna Commercial |
$76.43
|
| Rate for Payer: Aetna Commercial |
$76.43
|
| Rate for Payer: Aetna Medicare |
$155.00
|
| Rate for Payer: Aetna Medicare |
$43.00
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS Trust/PPO |
$763.39
|
| Rate for Payer: BCBS Trust/PPO |
$763.39
|
| Rate for Payer: BCN Commercial |
$78.68
|
| Rate for Payer: BCN Commercial |
$78.68
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$68.80
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Meridian Medicaid |
$28.62
|
| Rate for Payer: Meridian Medicaid |
$28.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.70
|
| Rate for Payer: Priority Health Narrow Network |
$65.70
|
| Rate for Payer: Priority Health Narrow Network |
$65.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$133.43
|
| Rate for Payer: UHC Exchange |
$133.43
|
| Rate for Payer: UHC Exchange |
$133.43
|
| Rate for Payer: UHCCP Medicaid |
$27.26
|
| Rate for Payer: UHCCP Medicaid |
$27.26
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY 1ST GESTATION
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 76813
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$675.17 |
| Rate for Payer: Aetna Commercial |
$140.72
|
| Rate for Payer: Aetna Medicare |
$146.00
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS Trust/PPO |
$675.17
|
| Rate for Payer: BCN Commercial |
$172.01
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.21
|
| Rate for Payer: Priority Health Narrow Network |
$85.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.29
|
| Rate for Payer: UHC Exchange |
$134.29
|
| Rate for Payer: UHCCP Medicaid |
$35.36
|
|
|
CHG US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION
|
Professional
|
Both
|
$195.00
|
|
|
Service Code
|
HCPCS 76814
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$696.30 |
| Rate for Payer: Aetna Commercial |
$91.18
|
| Rate for Payer: Aetna Medicare |
$97.50
|
| Rate for Payer: BCBS Complete |
$31.09
|
| Rate for Payer: BCBS Trust/PPO |
$696.30
|
| Rate for Payer: BCN Commercial |
$109.46
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Cash Price |
$156.00
|
| Rate for Payer: Meridian Medicaid |
$31.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.34
|
| Rate for Payer: Priority Health Narrow Network |
$71.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.74
|
| Rate for Payer: UHC Exchange |
$86.74
|
| Rate for Payer: UHCCP Medicaid |
$29.61
|
|
|
CHG US GUIDANCE AMNIOCENTESIS IMG S&I
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 76946
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$37.71
|
| Rate for Payer: Aetna Medicare |
$160.00
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS Trust/PPO |
$194.41
|
| Rate for Payer: BCN Commercial |
$47.89
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.72
|
| Rate for Payer: Priority Health Narrow Network |
$27.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$43.22
|
| Rate for Payer: UHC Exchange |
$43.22
|
| Rate for Payer: UHCCP Medicaid |
$11.50
|
|
|
CHG US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 76965
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$173.55 |
| Rate for Payer: Aetna Commercial |
$108.13
|
| Rate for Payer: Aetna Commercial |
$108.13
|
| Rate for Payer: Aetna Medicare |
$133.50
|
| Rate for Payer: Aetna Medicare |
$189.50
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS Complete |
$45.18
|
| Rate for Payer: BCBS Trust/PPO |
$133.13
|
| Rate for Payer: BCBS Trust/PPO |
$133.13
|
| Rate for Payer: BCN Commercial |
$136.35
|
| Rate for Payer: BCN Commercial |
$136.35
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| Rate for Payer: Meridian Medicaid |
$45.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.03
|
| 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 HMO/PPO/Tiered Network |
$102.66
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.66
|
| Rate for Payer: Priority Health Narrow Network |
$102.66
|
| Rate for Payer: Priority Health Narrow Network |
$102.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.76
|
| Rate for Payer: UHC Exchange |
$139.76
|
| Rate for Payer: UHC Exchange |
$139.76
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
| Rate for Payer: UHCCP Medicaid |
$43.03
|
|
|
CHG US GUIDANCE NEEDLE PLACEMENT IMG S&I
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
HCPCS 76942
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$197.49 |
| Rate for Payer: Aetna Commercial |
$67.10
|
| Rate for Payer: Aetna Commercial |
$67.10
|
| Rate for Payer: Aetna Medicare |
$56.50
|
| Rate for Payer: Aetna Medicare |
$233.00
|
| Rate for Payer: BCBS Complete |
$20.13
|
| Rate for Payer: BCBS Complete |
$20.13
|
| Rate for Payer: BCBS Trust/PPO |
$103.55
|
| Rate for Payer: BCBS Trust/PPO |
$103.55
|
| Rate for Payer: BCN Commercial |
$85.03
|
| Rate for Payer: BCN Commercial |
$85.03
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Cash Price |
$90.40
|
| Rate for Payer: Meridian Medicaid |
$20.13
|
| Rate for Payer: Meridian Medicaid |
$20.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$73.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.69
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.69
|
| Rate for Payer: Priority Health Narrow Network |
$45.69
|
| Rate for Payer: Priority Health Narrow Network |
$45.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.49
|
| Rate for Payer: UHC Exchange |
$197.49
|
| Rate for Payer: UHC Exchange |
$197.49
|
| Rate for Payer: UHCCP Medicaid |
$19.17
|
| Rate for Payer: UHCCP Medicaid |
$19.17
|
|
|
CHG US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 76941
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$171.52 |
| Rate for Payer: Aetna Commercial |
$138.84
|
| Rate for Payer: Aetna Medicare |
$93.50
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$145.81
|
| Rate for Payer: BCN Commercial |
$171.52
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.00
|
| Rate for Payer: Priority Health Narrow Network |
$97.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.61
|
| Rate for Payer: UHC Exchange |
$147.61
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
|
|
CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
HCPCS 76882
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$884.90 |
| Rate for Payer: Aetna Commercial |
$64.85
|
| Rate for Payer: Aetna Commercial |
$64.85
|
| Rate for Payer: Aetna Medicare |
$44.50
|
| Rate for Payer: Aetna Medicare |
$33.50
|
| Rate for Payer: BCBS Complete |
$21.91
|
| Rate for Payer: BCBS Complete |
$21.91
|
| Rate for Payer: BCBS Trust/PPO |
$884.90
|
| Rate for Payer: BCBS Trust/PPO |
$884.90
|
| Rate for Payer: BCN Commercial |
$61.58
|
| Rate for Payer: BCN Commercial |
$61.58
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Meridian Medicaid |
$21.91
|
| Rate for Payer: Meridian Medicaid |
$21.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.79
|
| Rate for Payer: Priority Health Narrow Network |
$49.79
|
| Rate for Payer: Priority Health Narrow Network |
$49.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$35.55
|
| Rate for Payer: UHC Exchange |
$35.55
|
| Rate for Payer: UHC Exchange |
$35.55
|
| Rate for Payer: UHCCP Medicaid |
$20.87
|
| Rate for Payer: UHCCP Medicaid |
$20.87
|
|
|
CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 76857
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$839.47 |
| Rate for Payer: Aetna Commercial |
$55.35
|
| Rate for Payer: Aetna Medicare |
$112.50
|
| Rate for Payer: BCBS Complete |
$15.66
|
| Rate for Payer: BCBS Trust/PPO |
$839.47
|
| Rate for Payer: BCN Commercial |
$71.35
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Meridian Medicaid |
$15.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.42
|
| Rate for Payer: Priority Health Narrow Network |
$35.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.30
|
| Rate for Payer: UHC Exchange |
$105.30
|
| Rate for Payer: UHCCP Medicaid |
$14.91
|
|
|
CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 76856
|
| Min. Negotiated Rate |
$20.66 |
| Max. Negotiated Rate |
$764.98 |
| Rate for Payer: Aetna Commercial |
$125.54
|
| Rate for Payer: Aetna Medicare |
$150.50
|
| Rate for Payer: BCBS Complete |
$21.69
|
| Rate for Payer: BCBS Trust/PPO |
$764.98
|
| Rate for Payer: BCN Commercial |
$155.40
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Meridian Medicaid |
$21.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.28
|
| Rate for Payer: Priority Health Narrow Network |
$49.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.63
|
| Rate for Payer: UHC Exchange |
$127.63
|
| Rate for Payer: UHCCP Medicaid |
$20.66
|
|
|
CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 76801
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$269.43 |
| Rate for Payer: Aetna Commercial |
$139.63
|
| Rate for Payer: Aetna Medicare |
$142.50
|
| Rate for Payer: BCBS Complete |
$31.31
|
| Rate for Payer: BCBS Trust/PPO |
$269.43
|
| Rate for Payer: BCN Commercial |
$172.99
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Meridian Medicaid |
$31.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.34
|
| Rate for Payer: Priority Health Narrow Network |
$71.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.68
|
| Rate for Payer: UHC Exchange |
$136.68
|
| Rate for Payer: UHCCP Medicaid |
$29.82
|
|
|
CHG US PREGNANT UTERUS LIMITED 1/> FETUSES
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 76815
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$172.25 |
| Rate for Payer: Aetna Commercial |
$96.78
|
| Rate for Payer: Aetna Medicare |
$132.50
|
| Rate for Payer: BCBS Complete |
$20.58
|
| Rate for Payer: BCBS Trust/PPO |
$160.60
|
| Rate for Payer: BCN Commercial |
$119.72
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Meridian Medicaid |
$20.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$46.70
|
| Rate for Payer: Priority Health Narrow Network |
$46.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.14
|
| Rate for Payer: UHC Exchange |
$95.14
|
| Rate for Payer: UHCCP Medicaid |
$19.60
|
|
|
CHG US PREG UTERUS 14 WK TRANSABDL EACH GESTATION
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 76802
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$304.83 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: BCBS Complete |
$26.17
|
| Rate for Payer: BCBS Trust/PPO |
$304.83
|
| Rate for Payer: BCN Commercial |
$89.43
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Meridian Medicaid |
$26.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.06
|
| Rate for Payer: Priority Health Narrow Network |
$60.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.96
|
| Rate for Payer: UHC Exchange |
$75.96
|
| Rate for Payer: UHCCP Medicaid |
$24.92
|
|
|
CHG US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO
|
Professional
|
Both
|
$423.00
|
|
|
Service Code
|
HCPCS 76810
|
| Min. Negotiated Rate |
$29.39 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$105.64
|
| Rate for Payer: Aetna Medicare |
$211.50
|
| Rate for Payer: BCBS Complete |
$30.86
|
| Rate for Payer: BCBS Trust/PPO |
$164.30
|
| Rate for Payer: BCN Commercial |
$129.50
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Meridian Medicaid |
$30.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.83
|
| Rate for Payer: Priority Health Narrow Network |
$70.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$103.10
|
| Rate for Payer: UHC Exchange |
$103.10
|
| Rate for Payer: UHCCP Medicaid |
$29.39
|
|
|
CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION
|
Professional
|
Both
|
$361.00
|
|
|
Service Code
|
HCPCS 76805
|
| Min. Negotiated Rate |
$30.03 |
| Max. Negotiated Rate |
$362.41 |
| Rate for Payer: Aetna Commercial |
$160.23
|
| Rate for Payer: Aetna Medicare |
$180.50
|
| Rate for Payer: BCBS Complete |
$31.53
|
| Rate for Payer: BCBS Trust/PPO |
$362.41
|
| Rate for Payer: BCN Commercial |
$199.38
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Cash Price |
$288.80
|
| Rate for Payer: Meridian Medicaid |
$31.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$234.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.85
|
| Rate for Payer: Priority Health Narrow Network |
$71.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$154.24
|
| Rate for Payer: UHC Exchange |
$154.24
|
| Rate for Payer: UHCCP Medicaid |
$30.03
|
|
|
CHG US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 76812
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$280.99 |
| Rate for Payer: Aetna Commercial |
$228.84
|
| Rate for Payer: Aetna Medicare |
$173.00
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS Trust/PPO |
$136.83
|
| Rate for Payer: BCN Commercial |
$280.99
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.83
|
| Rate for Payer: Priority Health Narrow Network |
$128.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$210.57
|
| Rate for Payer: UHC Exchange |
$210.57
|
| Rate for Payer: UHCCP Medicaid |
$53.46
|
|
|
CHG US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 76816
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$773.43 |
| Rate for Payer: Aetna Commercial |
$130.33
|
| Rate for Payer: Aetna Medicare |
$110.50
|
| Rate for Payer: BCBS Complete |
$26.84
|
| Rate for Payer: BCBS Trust/PPO |
$773.43
|
| Rate for Payer: BCN Commercial |
$160.77
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Meridian Medicaid |
$26.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.60
|
| Rate for Payer: Priority Health Narrow Network |
$61.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$120.08
|
| Rate for Payer: UHC Exchange |
$120.08
|
| Rate for Payer: UHCCP Medicaid |
$25.56
|
|
|
CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 76817
|
| Min. Negotiated Rate |
$22.58 |
| Max. Negotiated Rate |
$432.68 |
| Rate for Payer: Aetna Commercial |
$110.51
|
| Rate for Payer: Aetna Medicare |
$142.50
|
| Rate for Payer: BCBS Complete |
$23.71
|
| Rate for Payer: BCBS Trust/PPO |
$432.68
|
| Rate for Payer: BCN Commercial |
$136.35
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Meridian Medicaid |
$23.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.40
|
| Rate for Payer: Priority Health Narrow Network |
$54.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.82
|
| Rate for Payer: UHC Exchange |
$107.82
|
| Rate for Payer: UHCCP Medicaid |
$22.58
|
|
|
CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
HCPCS 76811
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$257.53 |
| Rate for Payer: Aetna Commercial |
$203.73
|
| Rate for Payer: Aetna Medicare |
$189.00
|
| Rate for Payer: BCBS Complete |
$59.71
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: BCN Commercial |
$257.53
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Cash Price |
$302.40
|
| Rate for Payer: Meridian Medicaid |
$59.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.04
|
| Rate for Payer: Priority Health Narrow Network |
$137.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.86
|
| Rate for Payer: UHC Exchange |
$206.86
|
| Rate for Payer: UHCCP Medicaid |
$56.87
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 76770
|
| Min. Negotiated Rate |
$22.15 |
| Max. Negotiated Rate |
$159.79 |
| Rate for Payer: Aetna Commercial |
$128.78
|
| Rate for Payer: Aetna Medicare |
$36.00
|
| Rate for Payer: BCBS Complete |
$23.26
|
| Rate for Payer: BCN Commercial |
$159.79
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Meridian Medicaid |
$23.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$53.38
|
| Rate for Payer: Priority Health Narrow Network |
$53.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$137.51
|
| Rate for Payer: UHC Exchange |
$137.51
|
| Rate for Payer: UHCCP Medicaid |
$22.15
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE LIMITED
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 76775
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$2,427.54 |
| Rate for Payer: Aetna Commercial |
$67.91
|
| Rate for Payer: Aetna Medicare |
$97.00
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCBS Trust/PPO |
$2,427.54
|
| Rate for Payer: BCN Commercial |
$86.50
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Meridian Medicaid |
$18.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.57
|
| Rate for Payer: Priority Health Narrow Network |
$41.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.15
|
| Rate for Payer: UHC Exchange |
$116.15
|
| Rate for Payer: UHCCP Medicaid |
$17.47
|
|
