|
CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL
|
Professional
|
$308.00
|
|
|
Service Code
|
HCPCS 72156
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$512.68 |
| Rate for Payer: Aetna Commercial |
$424.54
|
| Rate for Payer: Aetna Medicare |
$316.82
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS MAPPO |
$316.82
|
| Rate for Payer: BCN Commercial |
$489.17
|
| Rate for Payer: BCN Medicare Advantage |
$316.82
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$456.22
|
| Rate for Payer: Cofinity Commercial |
$424.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.82
|
| Rate for Payer: Healthscope Commercial |
$380.18
|
| Rate for Payer: Healthscope Whirlpool |
$380.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$332.66
|
| Rate for Payer: PACE SWMI |
$316.82
|
| Rate for Payer: PHP Medicare Advantage |
$316.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$512.68
|
| Rate for Payer: Priority Health Medicare |
$316.82
|
| Rate for Payer: Priority Health Narrow Network |
$512.68
|
| Rate for Payer: UHC Medicare Advantage |
$326.32
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL
|
Professional
|
$321.00
|
|
|
Service Code
|
HCPCS 72149
|
| Min. Negotiated Rate |
$128.40 |
| Max. Negotiated Rate |
$433.30 |
| Rate for Payer: Aetna Commercial |
$358.06
|
| Rate for Payer: Aetna Medicare |
$267.21
|
| Rate for Payer: BCBS Complete |
$128.40
|
| Rate for Payer: BCBS MAPPO |
$267.21
|
| Rate for Payer: BCN Commercial |
$413.42
|
| Rate for Payer: BCN Medicare Advantage |
$267.21
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cash Price |
$256.80
|
| Rate for Payer: Cofinity Commercial |
$358.06
|
| Rate for Payer: Cofinity Commercial |
$384.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.21
|
| Rate for Payer: Healthscope Commercial |
$320.65
|
| Rate for Payer: Healthscope Whirlpool |
$320.65
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$280.57
|
| Rate for Payer: PACE SWMI |
$267.21
|
| Rate for Payer: PHP Medicare Advantage |
$267.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$433.30
|
| Rate for Payer: Priority Health Medicare |
$267.21
|
| Rate for Payer: Priority Health Narrow Network |
$433.30
|
| Rate for Payer: UHC Medicare Advantage |
$275.23
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL
|
Professional
|
$242.00
|
|
|
Service Code
|
HCPCS 72148
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$305.26 |
| Rate for Payer: Aetna Commercial |
$253.29
|
| Rate for Payer: Aetna Medicare |
$189.02
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: BCBS MAPPO |
$189.02
|
| Rate for Payer: BCN Commercial |
$291.25
|
| Rate for Payer: BCN Medicare Advantage |
$189.02
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$272.19
|
| Rate for Payer: Cofinity Commercial |
$253.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$189.02
|
| Rate for Payer: Healthscope Commercial |
$226.82
|
| Rate for Payer: Healthscope Whirlpool |
$226.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$198.47
|
| Rate for Payer: PACE SWMI |
$189.02
|
| Rate for Payer: PHP Medicare Advantage |
$189.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$305.26
|
| Rate for Payer: Priority Health Medicare |
$189.02
|
| Rate for Payer: Priority Health Narrow Network |
$305.26
|
| Rate for Payer: UHC Medicare Advantage |
$194.69
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL
|
Professional
|
$293.00
|
|
|
Service Code
|
HCPCS 72158
|
| Min. Negotiated Rate |
$117.20 |
| Max. Negotiated Rate |
$511.65 |
| Rate for Payer: Aetna Commercial |
$423.71
|
| Rate for Payer: Aetna Medicare |
$316.20
|
| Rate for Payer: BCBS Complete |
$117.20
|
| Rate for Payer: BCBS MAPPO |
$316.20
|
| Rate for Payer: BCN Commercial |
$488.19
|
| Rate for Payer: BCN Medicare Advantage |
$316.20
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cofinity Commercial |
$423.71
|
| Rate for Payer: Cofinity Commercial |
$455.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.20
|
| Rate for Payer: Healthscope Commercial |
$379.44
|
| Rate for Payer: Healthscope Whirlpool |
$379.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$332.01
|
| Rate for Payer: PACE SWMI |
$316.20
|
| Rate for Payer: PHP Medicare Advantage |
$316.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$511.65
|
| Rate for Payer: Priority Health Medicare |
$316.20
|
| Rate for Payer: Priority Health Narrow Network |
$511.65
|
| Rate for Payer: UHC Medicare Advantage |
$325.69
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL
|
Professional
|
$267.00
|
|
|
Service Code
|
HCPCS 72146
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$304.23 |
| Rate for Payer: Aetna Commercial |
$252.46
|
| Rate for Payer: Aetna Medicare |
$188.40
|
| Rate for Payer: BCBS Complete |
$106.80
|
| Rate for Payer: BCBS MAPPO |
$188.40
|
| Rate for Payer: BCN Commercial |
$290.27
|
| Rate for Payer: BCN Medicare Advantage |
$188.40
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$271.30
|
| Rate for Payer: Cofinity Commercial |
$252.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.40
|
| Rate for Payer: Healthscope Commercial |
$226.08
|
| Rate for Payer: Healthscope Whirlpool |
$226.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$197.82
|
| Rate for Payer: PACE SWMI |
$188.40
|
| Rate for Payer: PHP Medicare Advantage |
$188.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$304.23
|
| Rate for Payer: Priority Health Medicare |
$188.40
|
| Rate for Payer: Priority Health Narrow Network |
$304.23
|
| Rate for Payer: UHC Medicare Advantage |
$194.05
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL
|
Professional
|
$324.00
|
|
|
Service Code
|
HCPCS 72157
|
| Min. Negotiated Rate |
$129.60 |
| Max. Negotiated Rate |
$513.71 |
| Rate for Payer: Aetna Commercial |
$425.37
|
| Rate for Payer: Aetna Medicare |
$317.44
|
| Rate for Payer: BCBS Complete |
$129.60
|
| Rate for Payer: BCBS MAPPO |
$317.44
|
| Rate for Payer: BCN Commercial |
$490.14
|
| Rate for Payer: BCN Medicare Advantage |
$317.44
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cofinity Commercial |
$457.11
|
| Rate for Payer: Cofinity Commercial |
$425.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$317.44
|
| Rate for Payer: Healthscope Commercial |
$380.93
|
| Rate for Payer: Healthscope Whirlpool |
$380.93
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$333.31
|
| Rate for Payer: PACE SWMI |
$317.44
|
| Rate for Payer: PHP Medicare Advantage |
$317.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$513.71
|
| Rate for Payer: Priority Health Medicare |
$317.44
|
| Rate for Payer: Priority Health Narrow Network |
$513.71
|
| Rate for Payer: UHC Medicare Advantage |
$326.96
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
$160.00
|
|
|
Service Code
|
HCPCS 72265
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$168.50 |
| Rate for Payer: Aetna Commercial |
$139.83
|
| Rate for Payer: Aetna Medicare |
$104.35
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: BCBS MAPPO |
$104.35
|
| Rate for Payer: BCN Commercial |
$160.77
|
| Rate for Payer: BCN Medicare Advantage |
$104.35
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$139.83
|
| Rate for Payer: Cofinity Commercial |
$150.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.35
|
| Rate for Payer: Healthscope Commercial |
$125.22
|
| Rate for Payer: Healthscope Whirlpool |
$125.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$109.57
|
| Rate for Payer: PACE SWMI |
$104.35
|
| Rate for Payer: PHP Medicare Advantage |
$104.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.50
|
| Rate for Payer: Priority Health Medicare |
$104.35
|
| Rate for Payer: Priority Health Narrow Network |
$168.50
|
| Rate for Payer: UHC Medicare Advantage |
$107.48
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS
|
Professional
|
$120.00
|
|
|
Service Code
|
HCPCS 78453
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$417.93 |
| Rate for Payer: Aetna Commercial |
$342.20
|
| Rate for Payer: Aetna Medicare |
$255.37
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS MAPPO |
$255.37
|
| Rate for Payer: BCN Commercial |
$398.76
|
| Rate for Payer: BCN Medicare Advantage |
$255.37
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$367.73
|
| Rate for Payer: Cofinity Commercial |
$342.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$255.37
|
| Rate for Payer: Healthscope Commercial |
$306.44
|
| Rate for Payer: Healthscope Whirlpool |
$306.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$268.14
|
| Rate for Payer: PACE SWMI |
$255.37
|
| Rate for Payer: PHP Medicare Advantage |
$255.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$417.93
|
| Rate for Payer: Priority Health Medicare |
$255.37
|
| Rate for Payer: Priority Health Narrow Network |
$417.93
|
| Rate for Payer: UHC Medicare Advantage |
$263.03
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES
|
Professional
|
$155.00
|
|
|
Service Code
|
HCPCS 78454
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$623.31 |
| Rate for Payer: Aetna Commercial |
$509.91
|
| Rate for Payer: Aetna Medicare |
$380.53
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: BCBS MAPPO |
$380.53
|
| Rate for Payer: BCN Commercial |
$594.72
|
| Rate for Payer: BCN Medicare Advantage |
$380.53
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$547.96
|
| Rate for Payer: Cofinity Commercial |
$509.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$380.53
|
| Rate for Payer: Healthscope Commercial |
$456.64
|
| Rate for Payer: Healthscope Whirlpool |
$456.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$399.56
|
| Rate for Payer: PACE SWMI |
$380.53
|
| Rate for Payer: PHP Medicare Advantage |
$380.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$623.31
|
| Rate for Payer: Priority Health Medicare |
$380.53
|
| Rate for Payer: Priority Health Narrow Network |
$623.31
|
| Rate for Payer: UHC Medicare Advantage |
$391.95
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
$188.00
|
|
|
Service Code
|
HCPCS 78452
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$671.45 |
| Rate for Payer: Aetna Commercial |
$549.84
|
| Rate for Payer: Aetna Commercial |
$549.84
|
| Rate for Payer: Aetna Medicare |
$410.33
|
| Rate for Payer: Aetna Medicare |
$410.33
|
| Rate for Payer: BCBS Complete |
$359.20
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS MAPPO |
$410.33
|
| Rate for Payer: BCBS MAPPO |
$410.33
|
| Rate for Payer: BCN Commercial |
$640.66
|
| Rate for Payer: BCN Commercial |
$640.66
|
| Rate for Payer: BCN Medicare Advantage |
$410.33
|
| Rate for Payer: BCN Medicare Advantage |
$410.33
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$590.88
|
| Rate for Payer: Cofinity Commercial |
$590.88
|
| Rate for Payer: Cofinity Commercial |
$549.84
|
| Rate for Payer: Cofinity Commercial |
$549.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$410.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$410.33
|
| Rate for Payer: Healthscope Commercial |
$492.40
|
| Rate for Payer: Healthscope Commercial |
$492.40
|
| Rate for Payer: Healthscope Whirlpool |
$492.40
|
| Rate for Payer: Healthscope Whirlpool |
$492.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$430.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$430.85
|
| Rate for Payer: PACE SWMI |
$410.33
|
| Rate for Payer: PACE SWMI |
$410.33
|
| Rate for Payer: PHP Medicare Advantage |
$410.33
|
| Rate for Payer: PHP Medicare Advantage |
$410.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$628.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$671.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$671.45
|
| Rate for Payer: Priority Health Medicare |
$410.33
|
| Rate for Payer: Priority Health Medicare |
$410.33
|
| Rate for Payer: Priority Health Narrow Network |
$671.45
|
| Rate for Payer: Priority Health Narrow Network |
$671.45
|
| Rate for Payer: UHC Medicare Advantage |
$422.64
|
| Rate for Payer: UHC Medicare Advantage |
$422.64
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
$165.00
|
|
|
Service Code
|
HCPCS 78451
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$483.99 |
| Rate for Payer: Aetna Commercial |
$397.10
|
| Rate for Payer: Aetna Medicare |
$296.34
|
| Rate for Payer: BCBS Complete |
$66.00
|
| Rate for Payer: BCBS MAPPO |
$296.34
|
| Rate for Payer: BCN Commercial |
$461.80
|
| Rate for Payer: BCN Medicare Advantage |
$296.34
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$426.73
|
| Rate for Payer: Cofinity Commercial |
$397.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.34
|
| Rate for Payer: Healthscope Commercial |
$355.61
|
| Rate for Payer: Healthscope Whirlpool |
$355.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$311.16
|
| Rate for Payer: PACE SWMI |
$296.34
|
| Rate for Payer: PHP Medicare Advantage |
$296.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$483.99
|
| Rate for Payer: Priority Health Medicare |
$296.34
|
| Rate for Payer: Priority Health Narrow Network |
$483.99
|
| Rate for Payer: UHC Medicare Advantage |
$305.23
|
|
|
CHG MYOCRD IMG PET PRFUJ SINGLE STUDY REST/STRESS
|
Professional
|
$700.00
|
|
|
Service Code
|
HCPCS 78491
|
| Min. Negotiated Rate |
$280.00 |
| Max. Negotiated Rate |
$1,479.30 |
| Rate for Payer: Aetna Commercial |
$1,378.75
|
| Rate for Payer: BCBS Complete |
$280.00
|
| Rate for Payer: BCN Commercial |
$1,479.30
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Cash Price |
$560.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$490.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$665.81
|
| Rate for Payer: Priority Health Narrow Network |
$665.81
|
|
|
CHG NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS
|
Professional
|
$1,718.00
|
|
|
Service Code
|
HCPCS 77301
|
| Min. Negotiated Rate |
$687.20 |
| Max. Negotiated Rate |
$2,813.85 |
| Rate for Payer: Aetna Commercial |
$2,309.89
|
| Rate for Payer: Aetna Commercial |
$2,309.89
|
| Rate for Payer: Aetna Commercial |
$2,309.89
|
| Rate for Payer: Aetna Medicare |
$1,723.80
|
| Rate for Payer: Aetna Medicare |
$1,723.80
|
| Rate for Payer: Aetna Medicare |
$1,723.80
|
| Rate for Payer: BCBS Complete |
$1,498.00
|
| Rate for Payer: BCBS Complete |
$687.20
|
| Rate for Payer: BCBS Complete |
$1,204.40
|
| Rate for Payer: BCBS MAPPO |
$1,723.80
|
| Rate for Payer: BCBS MAPPO |
$1,723.80
|
| Rate for Payer: BCBS MAPPO |
$1,723.80
|
| Rate for Payer: BCN Commercial |
$2,787.78
|
| Rate for Payer: BCN Commercial |
$2,787.78
|
| Rate for Payer: BCN Commercial |
$2,787.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,723.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,723.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,723.80
|
| Rate for Payer: Cash Price |
$2,408.80
|
| Rate for Payer: Cash Price |
$2,996.00
|
| Rate for Payer: Cash Price |
$1,374.40
|
| Rate for Payer: Cash Price |
$1,374.40
|
| Rate for Payer: Cash Price |
$2,408.80
|
| Rate for Payer: Cash Price |
$2,996.00
|
| Rate for Payer: Cofinity Commercial |
$2,309.89
|
| Rate for Payer: Cofinity Commercial |
$2,482.27
|
| Rate for Payer: Cofinity Commercial |
$2,482.27
|
| Rate for Payer: Cofinity Commercial |
$2,309.89
|
| Rate for Payer: Cofinity Commercial |
$2,482.27
|
| Rate for Payer: Cofinity Commercial |
$2,309.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,723.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,723.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,723.80
|
| Rate for Payer: Healthscope Commercial |
$2,068.56
|
| Rate for Payer: Healthscope Commercial |
$2,068.56
|
| Rate for Payer: Healthscope Commercial |
$2,068.56
|
| Rate for Payer: Healthscope Whirlpool |
$2,068.56
|
| Rate for Payer: Healthscope Whirlpool |
$2,068.56
|
| Rate for Payer: Healthscope Whirlpool |
$2,068.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,809.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,809.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,809.99
|
| Rate for Payer: PACE SWMI |
$1,723.80
|
| Rate for Payer: PACE SWMI |
$1,723.80
|
| Rate for Payer: PACE SWMI |
$1,723.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,723.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,723.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,723.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,621.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,107.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,202.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,813.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,813.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,813.85
|
| Rate for Payer: Priority Health Medicare |
$1,723.80
|
| Rate for Payer: Priority Health Medicare |
$1,723.80
|
| Rate for Payer: Priority Health Medicare |
$1,723.80
|
| Rate for Payer: Priority Health Narrow Network |
$2,813.85
|
| Rate for Payer: Priority Health Narrow Network |
$2,813.85
|
| Rate for Payer: Priority Health Narrow Network |
$2,813.85
|
| Rate for Payer: UHC Medicare Advantage |
$1,775.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,775.51
|
| Rate for Payer: UHC Medicare Advantage |
$1,775.51
|
|
|
CHG OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL
|
Professional
|
$48.00
|
|
|
Service Code
|
HCPCS 76519
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$102.94 |
| Rate for Payer: Aetna Commercial |
$85.48
|
| Rate for Payer: Aetna Medicare |
$63.79
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS MAPPO |
$63.79
|
| Rate for Payer: BCN Commercial |
$98.23
|
| Rate for Payer: BCN Medicare Advantage |
$63.79
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$91.86
|
| Rate for Payer: Cofinity Commercial |
$85.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.79
|
| Rate for Payer: Healthscope Commercial |
$76.55
|
| Rate for Payer: Healthscope Whirlpool |
$76.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.98
|
| Rate for Payer: PACE SWMI |
$63.79
|
| Rate for Payer: PHP Medicare Advantage |
$63.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.94
|
| Rate for Payer: Priority Health Medicare |
$63.79
|
| Rate for Payer: Priority Health Narrow Network |
$102.94
|
| Rate for Payer: UHC Medicare Advantage |
$65.70
|
|
|
CHG OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI
|
Professional
|
$23.00
|
|
|
Service Code
|
HCPCS 76514
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$17.41 |
| Rate for Payer: Aetna Commercial |
$14.78
|
| Rate for Payer: Aetna Medicare |
$11.03
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$11.03
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: BCN Medicare Advantage |
$11.03
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$15.88
|
| Rate for Payer: Cofinity Commercial |
$14.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.03
|
| Rate for Payer: Healthscope Commercial |
$13.24
|
| Rate for Payer: Healthscope Whirlpool |
$13.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$11.58
|
| Rate for Payer: PACE SWMI |
$11.03
|
| Rate for Payer: PHP Medicare Advantage |
$11.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.41
|
| Rate for Payer: Priority Health Medicare |
$11.03
|
| Rate for Payer: Priority Health Narrow Network |
$17.41
|
| Rate for Payer: UHC Medicare Advantage |
$11.36
|
|
|
CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY
|
Professional
|
$21.00
|
|
|
Service Code
|
HCPCS 86403
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$16.62 |
| Rate for Payer: Aetna Commercial |
$15.46
|
| Rate for Payer: Aetna Medicare |
$11.54
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$11.54
|
| Rate for Payer: BCN Commercial |
$8.66
|
| Rate for Payer: BCN Medicare Advantage |
$11.54
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$13.85
|
| Rate for Payer: Healthscope Whirlpool |
$13.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.12
|
| Rate for Payer: PACE SWMI |
$11.54
|
| Rate for Payer: PHP Medicare Advantage |
$11.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.95
|
| Rate for Payer: Priority Health Medicare |
$11.54
|
| Rate for Payer: Priority Health Narrow Network |
$11.95
|
| Rate for Payer: UHC Medicare Advantage |
$11.89
|
|
|
CHG PERCUTANEOUS VERTEBROPLASTY, CT GUIDE
|
Professional
|
$262.00
|
|
|
Service Code
|
HCPCS 72292
|
| Min. Negotiated Rate |
$104.80 |
| Max. Negotiated Rate |
$183.40 |
| Rate for Payer: BCBS Complete |
$104.80
|
| Rate for Payer: Cash Price |
$209.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.40
|
|
|
CHG PERCUTANEOUS VERTEBROPLASTY, FLUOR GUIDE
|
Professional
|
$237.00
|
|
|
Service Code
|
HCPCS 72291
|
| Min. Negotiated Rate |
$94.80 |
| Max. Negotiated Rate |
$165.90 |
| Rate for Payer: BCBS Complete |
$94.80
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.90
|
|
|
CHG PERITONEOGRAM RS&I
|
Professional
|
$45.00
|
|
|
Service Code
|
HCPCS 74190
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$534.94 |
| Rate for Payer: Aetna Commercial |
$534.94
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCN Commercial |
$497.65
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.50
|
| Rate for Payer: Priority Health Narrow Network |
$84.50
|
|
|
CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED
|
Professional
|
$15.00
|
|
|
Service Code
|
HCPCS 83986
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$4.80
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$3.58
|
| Rate for Payer: BCN Commercial |
$2.69
|
| Rate for Payer: BCN Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$4.80
|
| Rate for Payer: Cofinity Commercial |
$5.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$4.30
|
| Rate for Payer: Healthscope Whirlpool |
$4.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.76
|
| Rate for Payer: PACE SWMI |
$3.58
|
| Rate for Payer: PHP Medicare Advantage |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.87
|
| Rate for Payer: Priority Health Medicare |
$3.58
|
| Rate for Payer: Priority Health Narrow Network |
$3.87
|
| Rate for Payer: UHC Medicare Advantage |
$3.69
|
|
|
CHG PLACEMNT,PROX/DIST EXT PROS, INFRARENAL
|
Professional
|
$446.00
|
|
|
Service Code
|
HCPCS 75953
|
| Min. Negotiated Rate |
$178.40 |
| Max. Negotiated Rate |
$312.20 |
| Rate for Payer: BCBS Complete |
$178.40
|
| Rate for Payer: Cash Price |
$356.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.20
|
|
|
CHG PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&I
|
Professional
|
$372.00
|
|
|
Service Code
|
HCPCS 75958
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$339.14 |
| Rate for Payer: Aetna Commercial |
$229.01
|
| Rate for Payer: BCBS Complete |
$148.80
|
| Rate for Payer: BCN Commercial |
$339.14
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$260.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$284.76
|
| Rate for Payer: Priority Health Narrow Network |
$284.76
|
|
|
CHG PROTHROMBIN TIME
|
Professional
|
$11.00
|
|
|
Service Code
|
HCPCS 85610
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$7.70 |
| Rate for Payer: Aetna Commercial |
$5.75
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS MAPPO |
$4.29
|
| Rate for Payer: BCN Commercial |
$4.29
|
| Rate for Payer: BCN Medicare Advantage |
$4.29
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$5.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$5.15
|
| Rate for Payer: Healthscope Whirlpool |
$5.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.50
|
| Rate for Payer: PACE SWMI |
$4.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.57
|
| Rate for Payer: Priority Health Medicare |
$4.29
|
| Rate for Payer: Priority Health Narrow Network |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$4.42
|
|
|
CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ
|
Professional
|
$37.00
|
|
|
Service Code
|
HCPCS 73050
|
| Min. Negotiated Rate |
$14.80 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: Aetna Commercial |
$36.45
|
| Rate for Payer: Aetna Commercial |
$36.45
|
| Rate for Payer: Aetna Commercial |
$36.45
|
| Rate for Payer: Aetna Medicare |
$27.20
|
| Rate for Payer: Aetna Medicare |
$27.20
|
| Rate for Payer: Aetna Medicare |
$27.20
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$27.20
|
| Rate for Payer: BCBS MAPPO |
$27.20
|
| Rate for Payer: BCBS MAPPO |
$27.20
|
| Rate for Payer: BCN Commercial |
$42.02
|
| Rate for Payer: BCN Commercial |
$42.02
|
| Rate for Payer: BCN Commercial |
$42.02
|
| Rate for Payer: BCN Medicare Advantage |
$27.20
|
| Rate for Payer: BCN Medicare Advantage |
$27.20
|
| Rate for Payer: BCN Medicare Advantage |
$27.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cofinity Commercial |
$36.45
|
| Rate for Payer: Cofinity Commercial |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$36.45
|
| Rate for Payer: Cofinity Commercial |
$36.45
|
| Rate for Payer: Cofinity Commercial |
$39.17
|
| Rate for Payer: Cofinity Commercial |
$39.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.20
|
| Rate for Payer: Healthscope Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$32.64
|
| Rate for Payer: Healthscope Commercial |
$32.64
|
| Rate for Payer: Healthscope Whirlpool |
$32.64
|
| Rate for Payer: Healthscope Whirlpool |
$32.64
|
| Rate for Payer: Healthscope Whirlpool |
$32.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.56
|
| Rate for Payer: PACE SWMI |
$27.20
|
| Rate for Payer: PACE SWMI |
$27.20
|
| Rate for Payer: PACE SWMI |
$27.20
|
| Rate for Payer: PHP Medicare Advantage |
$27.20
|
| Rate for Payer: PHP Medicare Advantage |
$27.20
|
| Rate for Payer: PHP Medicare Advantage |
$27.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.04
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$44.04
|
| Rate for Payer: Priority Health Medicare |
$27.20
|
| Rate for Payer: Priority Health Medicare |
$27.20
|
| Rate for Payer: Priority Health Medicare |
$27.20
|
| Rate for Payer: Priority Health Narrow Network |
$44.04
|
| Rate for Payer: Priority Health Narrow Network |
$44.04
|
| Rate for Payer: Priority Health Narrow Network |
$44.04
|
| Rate for Payer: UHC Medicare Advantage |
$28.02
|
| Rate for Payer: UHC Medicare Advantage |
$28.02
|
| Rate for Payer: UHC Medicare Advantage |
$28.02
|
|
|
CHG RADEX ANKLE COMPLETE MINIMUM 3 VIEWS
|
Professional
|
$30.00
|
|
|
Service Code
|
HCPCS 73610
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$60.90 |
| Rate for Payer: Aetna Commercial |
$46.75
|
| Rate for Payer: Aetna Commercial |
$46.75
|
| Rate for Payer: Aetna Commercial |
$46.75
|
| Rate for Payer: Aetna Medicare |
$34.89
|
| Rate for Payer: Aetna Medicare |
$34.89
|
| Rate for Payer: Aetna Medicare |
$34.89
|
| Rate for Payer: BCBS Complete |
$34.80
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$34.89
|
| Rate for Payer: BCBS MAPPO |
$34.89
|
| Rate for Payer: BCBS MAPPO |
$34.89
|
| Rate for Payer: BCN Commercial |
$54.24
|
| Rate for Payer: BCN Commercial |
$54.24
|
| Rate for Payer: BCN Commercial |
$54.24
|
| Rate for Payer: BCN Medicare Advantage |
$34.89
|
| Rate for Payer: BCN Medicare Advantage |
$34.89
|
| Rate for Payer: BCN Medicare Advantage |
$34.89
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cofinity Commercial |
$50.24
|
| Rate for Payer: Cofinity Commercial |
$46.75
|
| Rate for Payer: Cofinity Commercial |
$50.24
|
| Rate for Payer: Cofinity Commercial |
$46.75
|
| Rate for Payer: Cofinity Commercial |
$46.75
|
| Rate for Payer: Cofinity Commercial |
$50.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$34.89
|
| Rate for Payer: Healthscope Commercial |
$41.87
|
| Rate for Payer: Healthscope Commercial |
$41.87
|
| Rate for Payer: Healthscope Commercial |
$41.87
|
| Rate for Payer: Healthscope Whirlpool |
$41.87
|
| Rate for Payer: Healthscope Whirlpool |
$41.87
|
| Rate for Payer: Healthscope Whirlpool |
$41.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.63
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$36.63
|
| Rate for Payer: PACE SWMI |
$34.89
|
| Rate for Payer: PACE SWMI |
$34.89
|
| Rate for Payer: PACE SWMI |
$34.89
|
| Rate for Payer: PHP Medicare Advantage |
$34.89
|
| Rate for Payer: PHP Medicare Advantage |
$34.89
|
| Rate for Payer: PHP Medicare Advantage |
$34.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$60.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$56.84
|
| Rate for Payer: Priority Health Medicare |
$34.89
|
| Rate for Payer: Priority Health Medicare |
$34.89
|
| Rate for Payer: Priority Health Medicare |
$34.89
|
| Rate for Payer: Priority Health Narrow Network |
$56.84
|
| Rate for Payer: Priority Health Narrow Network |
$56.84
|
| Rate for Payer: Priority Health Narrow Network |
$56.84
|
| Rate for Payer: UHC Medicare Advantage |
$35.94
|
| Rate for Payer: UHC Medicare Advantage |
$35.94
|
| Rate for Payer: UHC Medicare Advantage |
$35.94
|
|
