|
CHG RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS
|
Professional
|
$111.00
|
|
|
Service Code
|
HCPCS 73564
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$77.70 |
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Commercial |
$58.96
|
| Rate for Payer: Aetna Medicare |
$44.00
|
| Rate for Payer: Aetna Medicare |
$44.00
|
| Rate for Payer: Aetna Medicare |
$44.00
|
| Rate for Payer: BCBS Complete |
$44.40
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: BCBS MAPPO |
$44.00
|
| Rate for Payer: BCBS MAPPO |
$44.00
|
| Rate for Payer: BCBS MAPPO |
$44.00
|
| Rate for Payer: BCN Commercial |
$68.41
|
| Rate for Payer: BCN Commercial |
$68.41
|
| Rate for Payer: BCN Commercial |
$68.41
|
| Rate for Payer: BCN Medicare Advantage |
$44.00
|
| Rate for Payer: BCN Medicare Advantage |
$44.00
|
| Rate for Payer: BCN Medicare Advantage |
$44.00
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$63.36
|
| Rate for Payer: Cofinity Commercial |
$58.96
|
| Rate for Payer: Cofinity Commercial |
$58.96
|
| Rate for Payer: Cofinity Commercial |
$63.36
|
| Rate for Payer: Cofinity Commercial |
$63.36
|
| Rate for Payer: Cofinity Commercial |
$58.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.00
|
| Rate for Payer: Healthscope Commercial |
$52.80
|
| Rate for Payer: Healthscope Commercial |
$52.80
|
| Rate for Payer: Healthscope Commercial |
$52.80
|
| Rate for Payer: Healthscope Whirlpool |
$52.80
|
| Rate for Payer: Healthscope Whirlpool |
$52.80
|
| Rate for Payer: Healthscope Whirlpool |
$52.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.20
|
| Rate for Payer: PACE SWMI |
$44.00
|
| Rate for Payer: PACE SWMI |
$44.00
|
| Rate for Payer: PACE SWMI |
$44.00
|
| Rate for Payer: PHP Medicare Advantage |
$44.00
|
| Rate for Payer: PHP Medicare Advantage |
$44.00
|
| Rate for Payer: PHP Medicare Advantage |
$44.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.70
|
| Rate for Payer: Priority Health Medicare |
$44.00
|
| Rate for Payer: Priority Health Medicare |
$44.00
|
| Rate for Payer: Priority Health Medicare |
$44.00
|
| Rate for Payer: Priority Health Narrow Network |
$71.70
|
| Rate for Payer: Priority Health Narrow Network |
$71.70
|
| Rate for Payer: Priority Health Narrow Network |
$71.70
|
| Rate for Payer: UHC Medicare Advantage |
$45.32
|
| Rate for Payer: UHC Medicare Advantage |
$45.32
|
| Rate for Payer: UHC Medicare Advantage |
$45.32
|
|
|
CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS
|
Professional
|
$54.00
|
|
|
Service Code
|
HCPCS 72190
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$65.05 |
| Rate for Payer: Aetna Commercial |
$53.69
|
| Rate for Payer: Aetna Commercial |
$53.69
|
| Rate for Payer: Aetna Medicare |
$40.07
|
| Rate for Payer: Aetna Medicare |
$40.07
|
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: BCBS MAPPO |
$40.07
|
| Rate for Payer: BCBS MAPPO |
$40.07
|
| Rate for Payer: BCN Commercial |
$62.06
|
| Rate for Payer: BCN Commercial |
$62.06
|
| Rate for Payer: BCN Medicare Advantage |
$40.07
|
| Rate for Payer: BCN Medicare Advantage |
$40.07
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Cofinity Commercial |
$57.70
|
| Rate for Payer: Cofinity Commercial |
$53.69
|
| Rate for Payer: Cofinity Commercial |
$53.69
|
| Rate for Payer: Cofinity Commercial |
$57.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.07
|
| Rate for Payer: Healthscope Commercial |
$48.08
|
| Rate for Payer: Healthscope Commercial |
$48.08
|
| Rate for Payer: Healthscope Whirlpool |
$48.08
|
| Rate for Payer: Healthscope Whirlpool |
$48.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$42.07
|
| Rate for Payer: PACE SWMI |
$40.07
|
| Rate for Payer: PACE SWMI |
$40.07
|
| Rate for Payer: PHP Medicare Advantage |
$40.07
|
| Rate for Payer: PHP Medicare Advantage |
$40.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$65.05
|
| Rate for Payer: Priority Health Medicare |
$40.07
|
| Rate for Payer: Priority Health Medicare |
$40.07
|
| Rate for Payer: Priority Health Narrow Network |
$65.05
|
| Rate for Payer: Priority Health Narrow Network |
$65.05
|
| Rate for Payer: UHC Medicare Advantage |
$41.27
|
| Rate for Payer: UHC Medicare Advantage |
$41.27
|
|
|
CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS
|
Professional
|
$49.00
|
|
|
Service Code
|
HCPCS 72202
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$60.44 |
| Rate for Payer: Aetna Commercial |
$49.89
|
| Rate for Payer: Aetna Commercial |
$49.89
|
| Rate for Payer: Aetna Medicare |
$37.23
|
| Rate for Payer: Aetna Medicare |
$37.23
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS MAPPO |
$37.23
|
| Rate for Payer: BCBS MAPPO |
$37.23
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: BCN Medicare Advantage |
$37.23
|
| Rate for Payer: BCN Medicare Advantage |
$37.23
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$53.61
|
| Rate for Payer: Cofinity Commercial |
$53.61
|
| Rate for Payer: Cofinity Commercial |
$49.89
|
| Rate for Payer: Cofinity Commercial |
$49.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.23
|
| Rate for Payer: Healthscope Commercial |
$44.68
|
| Rate for Payer: Healthscope Commercial |
$44.68
|
| Rate for Payer: Healthscope Whirlpool |
$44.68
|
| Rate for Payer: Healthscope Whirlpool |
$44.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.09
|
| Rate for Payer: PACE SWMI |
$37.23
|
| Rate for Payer: PACE SWMI |
$37.23
|
| Rate for Payer: PHP Medicare Advantage |
$37.23
|
| Rate for Payer: PHP Medicare Advantage |
$37.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.44
|
| Rate for Payer: Priority Health Medicare |
$37.23
|
| Rate for Payer: Priority Health Medicare |
$37.23
|
| Rate for Payer: Priority Health Narrow Network |
$60.44
|
| Rate for Payer: Priority Health Narrow Network |
$60.44
|
| Rate for Payer: UHC Medicare Advantage |
$38.35
|
| Rate for Payer: UHC Medicare Advantage |
$38.35
|
|
|
CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS
|
Professional
|
$58.00
|
|
|
Service Code
|
HCPCS 70260
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$68.63 |
| Rate for Payer: Aetna Commercial |
$56.71
|
| Rate for Payer: Aetna Medicare |
$42.32
|
| Rate for Payer: BCBS Complete |
$23.20
|
| Rate for Payer: BCBS MAPPO |
$42.32
|
| Rate for Payer: BCN Commercial |
$65.48
|
| Rate for Payer: BCN Medicare Advantage |
$42.32
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$60.94
|
| Rate for Payer: Cofinity Commercial |
$56.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.32
|
| Rate for Payer: Healthscope Commercial |
$50.78
|
| Rate for Payer: Healthscope Whirlpool |
$50.78
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.44
|
| Rate for Payer: PACE SWMI |
$42.32
|
| Rate for Payer: PHP Medicare Advantage |
$42.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.63
|
| Rate for Payer: Priority Health Medicare |
$42.32
|
| Rate for Payer: Priority Health Narrow Network |
$68.63
|
| Rate for Payer: UHC Medicare Advantage |
$43.59
|
|
|
CHG RADN RX DELIVERY COMPLX 11-19 MEV
|
Professional
|
$466.00
|
|
|
Service Code
|
HCPCS 77414
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$326.20 |
| Rate for Payer: BCBS Complete |
$186.40
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.20
|
|
|
CHG RADN RX DELIVERY COMPLX 6-10 MEV
|
Professional
|
$414.00
|
|
|
Service Code
|
HCPCS 77413
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: BCBS Complete |
$165.60
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.80
|
|
|
CHG RADN RX DELIVERY SIMPLE 11-19 MEV
|
Professional
|
$256.00
|
|
|
Service Code
|
HCPCS 77404
|
| Min. Negotiated Rate |
$102.40 |
| Max. Negotiated Rate |
$179.20 |
| Rate for Payer: BCBS Complete |
$102.40
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.20
|
|
|
CHG RADN RX DELIVERY SIMPLE 6-10 MEV
|
Professional
|
$229.00
|
|
|
Service Code
|
HCPCS 77403
|
| Min. Negotiated Rate |
$91.60 |
| Max. Negotiated Rate |
$160.30 |
| Rate for Payer: BCBS Complete |
$91.60
|
| Rate for Payer: Cash Price |
$183.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.30
|
|
|
CHG REMOTE AFTLD RADIONUC BRACHYTHERAPY,1 CHANNEL
|
Professional
|
$303.00
|
|
|
Service Code
|
HCPCS 77785
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$312.90 |
| Rate for Payer: BCBS Complete |
$121.20
|
| Rate for Payer: BCBS Complete |
$178.80
|
| Rate for Payer: Cash Price |
$357.60
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$312.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.10
|
|
|
CHG REMOTE AFTLD RADIONUC BRACHYTHERAPY,2-12 CHANNEL
|
Professional
|
$669.00
|
|
|
Service Code
|
HCPCS 77786
|
| Min. Negotiated Rate |
$267.60 |
| Max. Negotiated Rate |
$689.50 |
| Rate for Payer: BCBS Complete |
$267.60
|
| Rate for Payer: BCBS Complete |
$394.00
|
| Rate for Payer: Cash Price |
$788.00
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$689.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$468.30
|
|
|
CHG REPAIR,ILIAC ANRYSM/PSEUDO/AV MALF/TRAUMA W/ ENDOPROSTHESIS
|
Professional
|
$216.00
|
|
|
Service Code
|
HCPCS 75954
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.20
|
|
|
CHG RESPIRATORY MOTION MANAGEMENT SIMULATION
|
Professional
|
$810.00
|
|
|
Service Code
|
HCPCS 77293
|
| Min. Negotiated Rate |
$242.40 |
| Max. Negotiated Rate |
$633.05 |
| Rate for Payer: Aetna Commercial |
$520.28
|
| Rate for Payer: Aetna Commercial |
$520.28
|
| Rate for Payer: Aetna Medicare |
$388.27
|
| Rate for Payer: Aetna Medicare |
$388.27
|
| Rate for Payer: BCBS Complete |
$324.00
|
| Rate for Payer: BCBS Complete |
$242.40
|
| Rate for Payer: BCBS MAPPO |
$388.27
|
| Rate for Payer: BCBS MAPPO |
$388.27
|
| Rate for Payer: BCN Commercial |
$604.01
|
| Rate for Payer: BCN Commercial |
$604.01
|
| Rate for Payer: BCN Medicare Advantage |
$388.27
|
| Rate for Payer: BCN Medicare Advantage |
$388.27
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cash Price |
$648.00
|
| Rate for Payer: Cofinity Commercial |
$559.11
|
| Rate for Payer: Cofinity Commercial |
$520.28
|
| Rate for Payer: Cofinity Commercial |
$520.28
|
| Rate for Payer: Cofinity Commercial |
$559.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$388.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$388.27
|
| Rate for Payer: Healthscope Commercial |
$465.92
|
| Rate for Payer: Healthscope Commercial |
$465.92
|
| Rate for Payer: Healthscope Whirlpool |
$465.92
|
| Rate for Payer: Healthscope Whirlpool |
$465.92
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$407.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$407.68
|
| Rate for Payer: PACE SWMI |
$388.27
|
| Rate for Payer: PACE SWMI |
$388.27
|
| Rate for Payer: PHP Medicare Advantage |
$388.27
|
| Rate for Payer: PHP Medicare Advantage |
$388.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$424.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$567.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$633.05
|
| Rate for Payer: Priority Health Medicare |
$388.27
|
| Rate for Payer: Priority Health Medicare |
$388.27
|
| Rate for Payer: Priority Health Narrow Network |
$633.05
|
| Rate for Payer: Priority Health Narrow Network |
$633.05
|
| Rate for Payer: UHC Medicare Advantage |
$399.92
|
| Rate for Payer: UHC Medicare Advantage |
$399.92
|
|
|
CHG RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG
|
Professional
|
$85.00
|
|
|
Service Code
|
HCPCS 78803
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$544.43 |
| Rate for Payer: Aetna Commercial |
$444.75
|
| Rate for Payer: Aetna Commercial |
$444.75
|
| Rate for Payer: Aetna Commercial |
$444.75
|
| Rate for Payer: Aetna Medicare |
$331.90
|
| Rate for Payer: Aetna Medicare |
$331.90
|
| Rate for Payer: Aetna Medicare |
$331.90
|
| Rate for Payer: BCBS Complete |
$240.00
|
| Rate for Payer: BCBS Complete |
$274.00
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$331.90
|
| Rate for Payer: BCBS MAPPO |
$331.90
|
| Rate for Payer: BCBS MAPPO |
$331.90
|
| Rate for Payer: BCN Commercial |
$519.46
|
| Rate for Payer: BCN Commercial |
$519.46
|
| Rate for Payer: BCN Commercial |
$519.46
|
| Rate for Payer: BCN Medicare Advantage |
$331.90
|
| Rate for Payer: BCN Medicare Advantage |
$331.90
|
| Rate for Payer: BCN Medicare Advantage |
$331.90
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$548.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cofinity Commercial |
$477.94
|
| Rate for Payer: Cofinity Commercial |
$477.94
|
| Rate for Payer: Cofinity Commercial |
$444.75
|
| Rate for Payer: Cofinity Commercial |
$444.75
|
| Rate for Payer: Cofinity Commercial |
$444.75
|
| Rate for Payer: Cofinity Commercial |
$477.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$331.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$331.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$331.90
|
| Rate for Payer: Healthscope Commercial |
$398.28
|
| Rate for Payer: Healthscope Commercial |
$398.28
|
| Rate for Payer: Healthscope Commercial |
$398.28
|
| Rate for Payer: Healthscope Whirlpool |
$398.28
|
| Rate for Payer: Healthscope Whirlpool |
$398.28
|
| Rate for Payer: Healthscope Whirlpool |
$398.28
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$348.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$348.50
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$348.50
|
| Rate for Payer: PACE SWMI |
$331.90
|
| Rate for Payer: PACE SWMI |
$331.90
|
| Rate for Payer: PACE SWMI |
$331.90
|
| Rate for Payer: PHP Medicare Advantage |
$331.90
|
| Rate for Payer: PHP Medicare Advantage |
$331.90
|
| Rate for Payer: PHP Medicare Advantage |
$331.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$479.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$544.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$544.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$544.43
|
| Rate for Payer: Priority Health Medicare |
$331.90
|
| Rate for Payer: Priority Health Medicare |
$331.90
|
| Rate for Payer: Priority Health Medicare |
$331.90
|
| Rate for Payer: Priority Health Narrow Network |
$544.43
|
| Rate for Payer: Priority Health Narrow Network |
$544.43
|
| Rate for Payer: Priority Health Narrow Network |
$544.43
|
| Rate for Payer: UHC Medicare Advantage |
$341.86
|
| Rate for Payer: UHC Medicare Advantage |
$341.86
|
| Rate for Payer: UHC Medicare Advantage |
$341.86
|
|
|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
$517.00
|
|
|
Service Code
|
HCPCS 79101
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$361.90 |
| Rate for Payer: Aetna Commercial |
$189.78
|
| Rate for Payer: Aetna Commercial |
$189.78
|
| Rate for Payer: Aetna Medicare |
$141.63
|
| Rate for Payer: Aetna Medicare |
$141.63
|
| Rate for Payer: BCBS Complete |
$114.80
|
| Rate for Payer: BCBS Complete |
$206.80
|
| Rate for Payer: BCBS MAPPO |
$141.63
|
| Rate for Payer: BCBS MAPPO |
$141.63
|
| Rate for Payer: BCN Commercial |
$214.05
|
| Rate for Payer: BCN Commercial |
$214.05
|
| Rate for Payer: BCN Medicare Advantage |
$141.63
|
| Rate for Payer: BCN Medicare Advantage |
$141.63
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cofinity Commercial |
$203.95
|
| Rate for Payer: Cofinity Commercial |
$189.78
|
| Rate for Payer: Cofinity Commercial |
$203.95
|
| Rate for Payer: Cofinity Commercial |
$189.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.63
|
| Rate for Payer: Healthscope Commercial |
$169.96
|
| Rate for Payer: Healthscope Commercial |
$169.96
|
| Rate for Payer: Healthscope Whirlpool |
$169.96
|
| Rate for Payer: Healthscope Whirlpool |
$169.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.71
|
| Rate for Payer: PACE SWMI |
$141.63
|
| Rate for Payer: PACE SWMI |
$141.63
|
| Rate for Payer: PHP Medicare Advantage |
$141.63
|
| Rate for Payer: PHP Medicare Advantage |
$141.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$361.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.34
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$224.34
|
| Rate for Payer: Priority Health Medicare |
$141.63
|
| Rate for Payer: Priority Health Medicare |
$141.63
|
| Rate for Payer: Priority Health Narrow Network |
$224.34
|
| Rate for Payer: Priority Health Narrow Network |
$224.34
|
| Rate for Payer: UHC Medicare Advantage |
$145.88
|
| Rate for Payer: UHC Medicare Advantage |
$145.88
|
|
|
CHG RP THERAPY ORAL ADMINISTRATION
|
Professional
|
$152.00
|
|
|
Service Code
|
HCPCS 79005
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$205.90 |
| Rate for Payer: Aetna Commercial |
$174.24
|
| Rate for Payer: Aetna Commercial |
$174.24
|
| Rate for Payer: Aetna Medicare |
$130.03
|
| Rate for Payer: Aetna Medicare |
$130.03
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS Complete |
$60.80
|
| Rate for Payer: BCBS MAPPO |
$130.03
|
| Rate for Payer: BCBS MAPPO |
$130.03
|
| Rate for Payer: BCN Commercial |
$196.45
|
| Rate for Payer: BCN Commercial |
$196.45
|
| Rate for Payer: BCN Medicare Advantage |
$130.03
|
| Rate for Payer: BCN Medicare Advantage |
$130.03
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$121.60
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$187.24
|
| Rate for Payer: Cofinity Commercial |
$187.24
|
| Rate for Payer: Cofinity Commercial |
$174.24
|
| Rate for Payer: Cofinity Commercial |
$174.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$130.03
|
| Rate for Payer: Healthscope Commercial |
$156.04
|
| Rate for Payer: Healthscope Commercial |
$156.04
|
| Rate for Payer: Healthscope Whirlpool |
$156.04
|
| Rate for Payer: Healthscope Whirlpool |
$156.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$136.53
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$136.53
|
| Rate for Payer: PACE SWMI |
$130.03
|
| Rate for Payer: PACE SWMI |
$130.03
|
| Rate for Payer: PHP Medicare Advantage |
$130.03
|
| Rate for Payer: PHP Medicare Advantage |
$130.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$106.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.90
|
| Rate for Payer: Priority Health Medicare |
$130.03
|
| Rate for Payer: Priority Health Medicare |
$130.03
|
| Rate for Payer: Priority Health Narrow Network |
$205.90
|
| Rate for Payer: Priority Health Narrow Network |
$205.90
|
| Rate for Payer: UHC Medicare Advantage |
$133.93
|
| Rate for Payer: UHC Medicare Advantage |
$133.93
|
|
|
CHG SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER
|
Professional
|
$235.00
|
|
|
Service Code
|
HCPCS 76831
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$179.27 |
| Rate for Payer: Aetna Commercial |
$147.92
|
| Rate for Payer: Aetna Medicare |
$110.39
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS MAPPO |
$110.39
|
| Rate for Payer: BCN Commercial |
$171.04
|
| Rate for Payer: BCN Medicare Advantage |
$110.39
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$158.96
|
| Rate for Payer: Cofinity Commercial |
$147.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.39
|
| Rate for Payer: Healthscope Commercial |
$132.47
|
| Rate for Payer: Healthscope Whirlpool |
$132.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$115.91
|
| Rate for Payer: PACE SWMI |
$110.39
|
| Rate for Payer: PHP Medicare Advantage |
$110.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$179.27
|
| Rate for Payer: Priority Health Medicare |
$110.39
|
| Rate for Payer: Priority Health Narrow Network |
$179.27
|
| Rate for Payer: UHC Medicare Advantage |
$113.70
|
|
|
CHG SEDIMENTATION RATE RBC NON-AUTOMATED
|
Professional
|
$15.00
|
|
|
Service Code
|
HCPCS 85651
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCN Commercial |
$3.20
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$5.72
|
| Rate for Payer: Cofinity Commercial |
$6.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$5.12
|
| Rate for Payer: Healthscope Whirlpool |
$5.12
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.57
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$4.57
|
| Rate for Payer: UHC Medicare Advantage |
$4.40
|
|
|
CHG SEMEN ALYS MOTILITY&CNT X W/HUHNER TST
|
Professional
|
$21.00
|
|
|
Service Code
|
HCPCS 89310
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$14.70 |
| Rate for Payer: Aetna Commercial |
$11.54
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$8.61
|
| Rate for Payer: BCN Commercial |
$6.46
|
| Rate for Payer: BCN Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| 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 Wellcare - Medicare Advantage |
$9.04
|
| Rate for Payer: PACE SWMI |
$8.61
|
| Rate for Payer: PHP Medicare Advantage |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$12.98
|
| Rate for Payer: Priority Health Medicare |
$8.61
|
| Rate for Payer: Priority Health Narrow Network |
$12.98
|
| Rate for Payer: UHC Medicare Advantage |
$8.87
|
|
|
CHG SEMEN ALYS PRESENCE&/MOTILITY SPRM HUHNER
|
Professional
|
$46.00
|
|
|
Service Code
|
HCPCS 89300
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna Commercial |
$13.19
|
| Rate for Payer: Aetna Medicare |
$9.84
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS MAPPO |
$9.84
|
| Rate for Payer: BCN Commercial |
$7.38
|
| Rate for Payer: BCN Medicare Advantage |
$9.84
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cofinity Commercial |
$13.19
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.84
|
| Rate for Payer: Healthscope Commercial |
$11.81
|
| Rate for Payer: Healthscope Whirlpool |
$11.81
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$10.33
|
| Rate for Payer: PACE SWMI |
$9.84
|
| Rate for Payer: PHP Medicare Advantage |
$9.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.07
|
| Rate for Payer: Priority Health Medicare |
$9.84
|
| Rate for Payer: Priority Health Narrow Network |
$15.07
|
| Rate for Payer: UHC Medicare Advantage |
$10.14
|
|
|
CHG SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM
|
Professional
|
$28.00
|
|
|
Service Code
|
HCPCS 89321
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$19.60 |
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Commercial |
$9.04
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$16.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$14.46
|
| Rate for Payer: Healthscope Whirlpool |
$14.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.70
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$18.70
|
| Rate for Payer: UHC Medicare Advantage |
$12.41
|
|
|
CHG SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I
|
Professional
|
$188.00
|
|
|
Service Code
|
HCPCS 75809
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$131.60 |
| Rate for Payer: Aetna Commercial |
$104.45
|
| Rate for Payer: Aetna Medicare |
$77.95
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS MAPPO |
$77.95
|
| Rate for Payer: BCN Commercial |
$120.70
|
| Rate for Payer: BCN Medicare Advantage |
$77.95
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$112.25
|
| Rate for Payer: Cofinity Commercial |
$104.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.95
|
| Rate for Payer: Healthscope Commercial |
$93.54
|
| Rate for Payer: Healthscope Whirlpool |
$93.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$81.85
|
| Rate for Payer: PACE SWMI |
$77.95
|
| Rate for Payer: PHP Medicare Advantage |
$77.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$126.50
|
| Rate for Payer: Priority Health Medicare |
$77.95
|
| Rate for Payer: Priority Health Narrow Network |
$126.50
|
| Rate for Payer: UHC Medicare Advantage |
$80.29
|
|
|
CHG SKIN TEST TUBERCULOSIS INTRADERMAL
|
Professional
|
$16.00
|
|
|
Service Code
|
HCPCS 86580
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$14.66 |
| Rate for Payer: Aetna Commercial |
$12.49
|
| Rate for Payer: Aetna Medicare |
$9.32
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS MAPPO |
$9.32
|
| Rate for Payer: BCN Commercial |
$14.66
|
| Rate for Payer: BCN Medicare Advantage |
$9.32
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$13.42
|
| Rate for Payer: Cofinity Commercial |
$12.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.32
|
| Rate for Payer: Healthscope Commercial |
$11.18
|
| Rate for Payer: Healthscope Whirlpool |
$11.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$9.79
|
| Rate for Payer: PACE SWMI |
$9.32
|
| Rate for Payer: PHP Medicare Advantage |
$9.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.55
|
| Rate for Payer: Priority Health Medicare |
$9.32
|
| Rate for Payer: Priority Health Narrow Network |
$10.55
|
| Rate for Payer: UHC Medicare Advantage |
$9.60
|
|
|
CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS
|
Professional
|
$48.00
|
|
|
Service Code
|
HCPCS 87209
|
| Min. Negotiated Rate |
$13.49 |
| Max. Negotiated Rate |
$33.60 |
| Rate for Payer: Aetna Commercial |
$24.09
|
| Rate for Payer: Aetna Medicare |
$17.98
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCN Commercial |
$13.49
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cofinity Commercial |
$24.09
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$21.58
|
| Rate for Payer: Healthscope Whirlpool |
$21.58
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$33.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.63
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health Narrow Network |
$18.63
|
| Rate for Payer: UHC Medicare Advantage |
$18.52
|
|
|
CHG SMR PRIM SRC WET MOUNT NFCT AGT
|
Professional
|
$18.00
|
|
|
Service Code
|
HCPCS 87210
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCBS MAPPO |
$5.82
|
| Rate for Payer: BCN Commercial |
$5.82
|
| Rate for Payer: BCN Medicare Advantage |
$5.82
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$8.38
|
| Rate for Payer: Cofinity Commercial |
$7.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.82
|
| Rate for Payer: Healthscope Commercial |
$6.98
|
| Rate for Payer: Healthscope Whirlpool |
$6.98
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$6.11
|
| Rate for Payer: PACE SWMI |
$5.82
|
| Rate for Payer: PHP Medicare Advantage |
$5.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.97
|
| Rate for Payer: Priority Health Medicare |
$5.82
|
| Rate for Payer: Priority Health Narrow Network |
$5.97
|
| Rate for Payer: UHC Medicare Advantage |
$5.99
|
|
|
CHG SONO GUIDE PERICARD TAP
|
Professional
|
$119.00
|
|
|
Service Code
|
HCPCS 76930
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
|
