|
CHG US SCROTUM & CONTENTS
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 76870
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$148.56 |
| Rate for Payer: Aetna Commercial |
$120.01
|
| Rate for Payer: Aetna Medicare |
$31.00
|
| Rate for Payer: BCBS Complete |
$20.13
|
| Rate for Payer: BCN Commercial |
$148.56
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Meridian Medicaid |
$20.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.69
|
| Rate for Payer: Priority Health Narrow Network |
$45.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$126.43
|
| Rate for Payer: UHC Exchange |
$126.43
|
| Rate for Payer: UHCCP Medicaid |
$19.17
|
|
|
CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
HCPCS 76536
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$1,090.94 |
| Rate for Payer: Aetna Commercial |
$132.69
|
| Rate for Payer: Aetna Commercial |
$132.69
|
| Rate for Payer: Aetna Medicare |
$51.00
|
| Rate for Payer: Aetna Medicare |
$113.50
|
| Rate for Payer: BCBS Complete |
$17.89
|
| Rate for Payer: BCBS Complete |
$17.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.94
|
| Rate for Payer: BCBS Trust/PPO |
$1,090.94
|
| Rate for Payer: BCN Commercial |
$163.71
|
| Rate for Payer: BCN Commercial |
$163.71
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$181.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Meridian Medicaid |
$17.89
|
| Rate for Payer: Meridian Medicaid |
$17.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$147.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.55
|
| Rate for Payer: Priority Health Narrow Network |
$40.55
|
| Rate for Payer: Priority Health Narrow Network |
$40.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$118.46
|
| Rate for Payer: UHC Exchange |
$118.46
|
| Rate for Payer: UHC Exchange |
$118.46
|
| Rate for Payer: UHCCP Medicaid |
$17.04
|
| Rate for Payer: UHCCP Medicaid |
$17.04
|
|
|
CHG US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 76873
|
| Min. Negotiated Rate |
$48.35 |
| Max. Negotiated Rate |
$669.36 |
| Rate for Payer: Aetna Commercial |
$203.54
|
| Rate for Payer: Aetna Medicare |
$130.00
|
| Rate for Payer: BCBS Complete |
$50.77
|
| Rate for Payer: BCBS Trust/PPO |
$669.36
|
| Rate for Payer: BCN Commercial |
$255.58
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Meridian Medicaid |
$50.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.00
|
| Rate for Payer: Priority Health Narrow Network |
$116.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$189.63
|
| Rate for Payer: UHC Exchange |
$189.63
|
| Rate for Payer: UHCCP Medicaid |
$48.35
|
|
|
CHG US TRANSRECTAL
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 76872
|
| Min. Negotiated Rate |
$20.45 |
| Max. Negotiated Rate |
$932.45 |
| Rate for Payer: Aetna Commercial |
$158.29
|
| Rate for Payer: Aetna Commercial |
$158.29
|
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: Aetna Medicare |
$166.00
|
| Rate for Payer: BCBS Complete |
$21.47
|
| Rate for Payer: BCBS Complete |
$21.47
|
| Rate for Payer: BCBS Trust/PPO |
$932.45
|
| Rate for Payer: BCBS Trust/PPO |
$932.45
|
| Rate for Payer: BCN Commercial |
$294.67
|
| Rate for Payer: BCN Commercial |
$294.67
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Meridian Medicaid |
$21.47
|
| Rate for Payer: Meridian Medicaid |
$21.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.28
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.28
|
| Rate for Payer: Priority Health Narrow Network |
$49.28
|
| Rate for Payer: Priority Health Narrow Network |
$49.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.58
|
| Rate for Payer: UHC Exchange |
$147.58
|
| Rate for Payer: UHC Exchange |
$147.58
|
| Rate for Payer: UHCCP Medicaid |
$20.45
|
| Rate for Payer: UHCCP Medicaid |
$20.45
|
|
|
CHG US TRANSVAGINAL
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 76830
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$659.85 |
| Rate for Payer: Aetna Commercial |
$141.56
|
| Rate for Payer: Aetna Medicare |
$155.00
|
| Rate for Payer: BCBS Complete |
$21.91
|
| Rate for Payer: BCBS Trust/PPO |
$659.85
|
| Rate for Payer: BCN Commercial |
$176.42
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Meridian Medicaid |
$21.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$49.79
|
| Rate for Payer: Priority Health Narrow Network |
$49.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.24
|
| Rate for Payer: UHC Exchange |
$127.24
|
| Rate for Payer: UHCCP Medicaid |
$20.87
|
|
|
CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 76937
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$397.81 |
| Rate for Payer: Aetna Commercial |
$43.90
|
| Rate for Payer: Aetna Commercial |
$43.90
|
| Rate for Payer: Aetna Medicare |
$31.00
|
| Rate for Payer: Aetna Medicare |
$28.50
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: BCBS Trust/PPO |
$397.81
|
| Rate for Payer: BCBS Trust/PPO |
$397.81
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Meridian Medicaid |
$8.95
|
| Rate for Payer: Meridian Medicaid |
$8.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$21.05
|
| Rate for Payer: Priority Health Narrow Network |
$21.05
|
| Rate for Payer: Priority Health Narrow Network |
$21.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$36.89
|
| Rate for Payer: UHC Exchange |
$36.89
|
| Rate for Payer: UHC Exchange |
$36.89
|
| Rate for Payer: UHCCP Medicaid |
$8.52
|
| Rate for Payer: UHCCP Medicaid |
$8.52
|
|
|
CHG VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 75840
|
| Min. Negotiated Rate |
$34.29 |
| Max. Negotiated Rate |
$311.17 |
| Rate for Payer: Aetna Commercial |
$155.47
|
| Rate for Payer: Aetna Medicare |
$146.00
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS Trust/PPO |
$311.17
|
| Rate for Payer: BCN Commercial |
$189.61
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.12
|
| Rate for Payer: Priority Health Narrow Network |
$82.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$243.05
|
| Rate for Payer: UHC Exchange |
$243.05
|
| Rate for Payer: UHCCP Medicaid |
$34.29
|
|
|
CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 75825
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$238.26 |
| Rate for Payer: Aetna Commercial |
$140.09
|
| Rate for Payer: Aetna Medicare |
$54.00
|
| Rate for Payer: BCBS Complete |
$35.56
|
| Rate for Payer: BCBS Trust/PPO |
$238.26
|
| Rate for Payer: BCN Commercial |
$167.13
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Meridian Medicaid |
$35.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.58
|
| Rate for Payer: Priority Health Narrow Network |
$80.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$237.78
|
| Rate for Payer: UHC Exchange |
$237.78
|
| Rate for Payer: UHCCP Medicaid |
$33.87
|
|
|
CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 75827
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$307.47 |
| Rate for Payer: Aetna Commercial |
$146.19
|
| Rate for Payer: Aetna Medicare |
$52.50
|
| Rate for Payer: BCBS Complete |
$35.33
|
| Rate for Payer: BCBS Trust/PPO |
$307.47
|
| Rate for Payer: BCN Commercial |
$174.95
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Meridian Medicaid |
$35.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.09
|
| Rate for Payer: Priority Health Narrow Network |
$81.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$238.50
|
| Rate for Payer: UHC Exchange |
$238.50
|
| Rate for Payer: UHCCP Medicaid |
$33.65
|
|
|
CHG VENOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 75822
|
| Min. Negotiated Rate |
$43.45 |
| Max. Negotiated Rate |
$265.21 |
| Rate for Payer: Aetna Commercial |
$163.45
|
| Rate for Payer: Aetna Commercial |
$163.45
|
| Rate for Payer: Aetna Medicare |
$71.00
|
| Rate for Payer: Aetna Medicare |
$137.00
|
| Rate for Payer: BCBS Complete |
$45.62
|
| Rate for Payer: BCBS Complete |
$45.62
|
| Rate for Payer: BCBS Trust/PPO |
$265.21
|
| Rate for Payer: BCBS Trust/PPO |
$265.21
|
| Rate for Payer: BCN Commercial |
$194.49
|
| Rate for Payer: BCN Commercial |
$194.49
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Meridian Medicaid |
$45.62
|
| Rate for Payer: Meridian Medicaid |
$45.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.19
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$104.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.62
|
| Rate for Payer: UHC Exchange |
$157.62
|
| Rate for Payer: UHC Exchange |
$157.62
|
| Rate for Payer: UHCCP Medicaid |
$43.45
|
| Rate for Payer: UHCCP Medicaid |
$43.45
|
|
|
CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 75820
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$191.77 |
| Rate for Payer: Aetna Commercial |
$135.80
|
| Rate for Payer: Aetna Commercial |
$135.80
|
| Rate for Payer: Aetna Medicare |
$54.00
|
| Rate for Payer: Aetna Medicare |
$115.50
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: BCBS Trust/PPO |
$191.77
|
| Rate for Payer: BCBS Trust/PPO |
$191.77
|
| Rate for Payer: BCN Commercial |
$159.79
|
| Rate for Payer: BCN Commercial |
$159.79
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Meridian Medicaid |
$32.20
|
| Rate for Payer: Meridian Medicaid |
$32.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.43
|
| Rate for Payer: Priority Health Narrow Network |
$74.43
|
| Rate for Payer: Priority Health Narrow Network |
$74.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$128.48
|
| Rate for Payer: UHC Exchange |
$128.48
|
| Rate for Payer: UHC Exchange |
$128.48
|
| Rate for Payer: UHCCP Medicaid |
$30.67
|
| Rate for Payer: UHCCP Medicaid |
$30.67
|
|
|
CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 75833
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$369.81 |
| Rate for Payer: Aetna Commercial |
$175.46
|
| Rate for Payer: Aetna Medicare |
$69.50
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS Trust/PPO |
$369.81
|
| Rate for Payer: BCN Commercial |
$215.02
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.73
|
| Rate for Payer: Priority Health Narrow Network |
$105.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.60
|
| Rate for Payer: UHC Exchange |
$274.60
|
| Rate for Payer: UHCCP Medicaid |
$43.88
|
|
|
CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 75831
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$246.55 |
| Rate for Payer: Aetna Commercial |
$144.53
|
| Rate for Payer: Aetna Commercial |
$144.53
|
| Rate for Payer: Aetna Medicare |
$136.50
|
| Rate for Payer: Aetna Medicare |
$55.50
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS Trust/PPO |
$156.38
|
| Rate for Payer: BCBS Trust/PPO |
$156.38
|
| Rate for Payer: BCN Commercial |
$176.42
|
| Rate for Payer: BCN Commercial |
$176.42
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Meridian Medicaid |
$34.00
|
| Rate for Payer: Meridian Medicaid |
$34.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.02
|
| Rate for Payer: Priority Health Narrow Network |
$78.02
|
| Rate for Payer: Priority Health Narrow Network |
$78.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$246.55
|
| Rate for Payer: UHC Exchange |
$246.55
|
| Rate for Payer: UHC Exchange |
$246.55
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
|
|
CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 75860
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$310.64 |
| Rate for Payer: Aetna Commercial |
$153.68
|
| Rate for Payer: Aetna Commercial |
$153.68
|
| Rate for Payer: Aetna Medicare |
$183.00
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: BCN Commercial |
$184.72
|
| Rate for Payer: BCN Commercial |
$184.72
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.58
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.58
|
| Rate for Payer: Priority Health Narrow Network |
$80.58
|
| Rate for Payer: Priority Health Narrow Network |
$80.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$245.58
|
| Rate for Payer: UHC Exchange |
$245.58
|
| Rate for Payer: UHC Exchange |
$245.58
|
| Rate for Payer: UHCCP Medicaid |
$34.08
|
| Rate for Payer: UHCCP Medicaid |
$34.08
|
|
|
CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
HCPCS 75893
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$353.43 |
| Rate for Payer: Aetna Commercial |
$125.74
|
| Rate for Payer: Aetna Medicare |
$167.00
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS Trust/PPO |
$353.43
|
| Rate for Payer: BCN Commercial |
$151.98
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.50
|
| Rate for Payer: Priority Health Narrow Network |
$38.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$205.39
|
| Rate for Payer: UHC Exchange |
$205.39
|
| Rate for Payer: UHCCP Medicaid |
$15.98
|
|
|
CHG VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 78457
|
| Min. Negotiated Rate |
$22.79 |
| Max. Negotiated Rate |
$229.68 |
| Rate for Payer: Aetna Commercial |
$204.12
|
| Rate for Payer: Aetna Commercial |
$204.12
|
| Rate for Payer: Aetna Medicare |
$166.00
|
| Rate for Payer: Aetna Medicare |
$41.00
|
| Rate for Payer: BCBS Complete |
$23.93
|
| Rate for Payer: BCBS Complete |
$23.93
|
| Rate for Payer: BCN Commercial |
$229.68
|
| Rate for Payer: BCN Commercial |
$229.68
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Meridian Medicaid |
$23.93
|
| Rate for Payer: Meridian Medicaid |
$23.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$54.40
|
| Rate for Payer: Priority Health Narrow Network |
$54.40
|
| Rate for Payer: Priority Health Narrow Network |
$54.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.71
|
| Rate for Payer: UHC Exchange |
$188.71
|
| Rate for Payer: UHC Exchange |
$188.71
|
| Rate for Payer: UHCCP Medicaid |
$22.79
|
| Rate for Payer: UHCCP Medicaid |
$22.79
|
|
|
CHG X-RAY ABDOMEN 1 VW
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 74000
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
|
|
CHG X-RAY ABDOMEN 2 VW
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 74020
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$34.45 |
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
|
|
CHG X-RAY FEMUR 2 VW
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 73550
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Aetna Medicare |
$19.00
|
| Rate for Payer: Aetna Medicare |
$15.00
|
| Rate for Payer: Aetna Medicare |
$47.00
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
|
|
CHG X-RAY HIPS 4 VW + PELVIS
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 73520
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: Aetna Medicare |
$60.50
|
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Complete |
$48.40
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
|
|
CHG X-RAY HIP UNI 2+ VW
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 73510
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Medicare |
$50.00
|
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
|
|
CHG X-RAY HIP UNILAT 1 VW
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 73500
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Medicare |
$50.00
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
|
|
CHG X-RAY PELVIS/HIPS CHILD/INFANT
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 73540
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
|
|
CHG X-RAY SPINE SURVEY
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 72010
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna Medicare |
$36.50
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
|
|
CHG X-RAY THOR-LUMB SP SCOLIOSIS
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 72090
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$86.45 |
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: Aetna Medicare |
$50.00
|
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.15
|
|
