|
CHG US TRANSRECTAL
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 76872
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$932.45 |
| Rate for Payer: Aetna Commercial |
$252.54
|
| Rate for Payer: Aetna Commercial |
$252.54
|
| Rate for Payer: Aetna Medicare |
$188.46
|
| Rate for Payer: Aetna Medicare |
$188.46
|
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS Complete |
$130.00
|
| Rate for Payer: BCBS MAPPO |
$188.46
|
| Rate for Payer: BCBS MAPPO |
$188.46
|
| 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: BCN Medicare Advantage |
$188.46
|
| Rate for Payer: BCN Medicare Advantage |
$188.46
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Cofinity Commercial |
$271.38
|
| Rate for Payer: Cofinity Commercial |
$252.54
|
| Rate for Payer: Cofinity Commercial |
$271.38
|
| Rate for Payer: Cofinity Commercial |
$252.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.46
|
| Rate for Payer: Healthscope Commercial |
$226.15
|
| Rate for Payer: Healthscope Commercial |
$226.15
|
| Rate for Payer: Healthscope Whirlpool |
$226.15
|
| Rate for Payer: Healthscope Whirlpool |
$226.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$197.88
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$197.88
|
| Rate for Payer: PACE SWMI |
$188.46
|
| Rate for Payer: PACE SWMI |
$188.46
|
| Rate for Payer: PHP Medicare Advantage |
$188.46
|
| Rate for Payer: PHP Medicare Advantage |
$188.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$227.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$308.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$308.84
|
| Rate for Payer: Priority Health Medicare |
$188.46
|
| Rate for Payer: Priority Health Medicare |
$188.46
|
| Rate for Payer: Priority Health Narrow Network |
$308.84
|
| Rate for Payer: Priority Health Narrow Network |
$308.84
|
| Rate for Payer: UHC Medicare Advantage |
$194.11
|
| Rate for Payer: UHC Medicare Advantage |
$194.11
|
|
|
CHG US TRANSVAGINAL
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
HCPCS 76830
|
| Min. Negotiated Rate |
$113.81 |
| Max. Negotiated Rate |
$659.85 |
| Rate for Payer: Aetna Commercial |
$152.51
|
| Rate for Payer: Aetna Medicare |
$113.81
|
| Rate for Payer: BCBS Complete |
$121.60
|
| Rate for Payer: BCBS MAPPO |
$113.81
|
| Rate for Payer: BCBS Trust/PPO |
$659.85
|
| Rate for Payer: BCN Commercial |
$176.42
|
| Rate for Payer: BCN Medicare Advantage |
$113.81
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cofinity Commercial |
$163.89
|
| Rate for Payer: Cofinity Commercial |
$152.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$113.81
|
| Rate for Payer: Healthscope Commercial |
$136.57
|
| Rate for Payer: Healthscope Whirlpool |
$136.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$119.50
|
| Rate for Payer: PACE SWMI |
$113.81
|
| Rate for Payer: PHP Medicare Advantage |
$113.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.89
|
| Rate for Payer: Priority Health Medicare |
$113.81
|
| Rate for Payer: Priority Health Narrow Network |
$184.89
|
| Rate for Payer: UHC Medicare Advantage |
$117.22
|
|
|
CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 76937
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$397.81 |
| Rate for Payer: Aetna Commercial |
$50.33
|
| Rate for Payer: Aetna Commercial |
$50.33
|
| Rate for Payer: Aetna Medicare |
$37.56
|
| Rate for Payer: Aetna Medicare |
$37.56
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS MAPPO |
$37.56
|
| Rate for Payer: BCBS MAPPO |
$37.56
|
| 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: BCN Medicare Advantage |
$37.56
|
| Rate for Payer: BCN Medicare Advantage |
$37.56
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$50.33
|
| Rate for Payer: Cofinity Commercial |
$50.33
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Cofinity Commercial |
$54.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.56
|
| Rate for Payer: Healthscope Commercial |
$45.07
|
| Rate for Payer: Healthscope Commercial |
$45.07
|
| Rate for Payer: Healthscope Whirlpool |
$45.07
|
| Rate for Payer: Healthscope Whirlpool |
$45.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.44
|
| Rate for Payer: PACE SWMI |
$37.56
|
| Rate for Payer: PACE SWMI |
$37.56
|
| Rate for Payer: PHP Medicare Advantage |
$37.56
|
| Rate for Payer: PHP Medicare Advantage |
$37.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.70
|
| 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 |
$37.56
|
| Rate for Payer: Priority Health Medicare |
$37.56
|
| Rate for Payer: Priority Health Narrow Network |
$60.44
|
| Rate for Payer: Priority Health Narrow Network |
$60.44
|
| Rate for Payer: UHC Medicare Advantage |
$38.69
|
| Rate for Payer: UHC Medicare Advantage |
$38.69
|
|
|
CHG VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 75840
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$311.17 |
| Rate for Payer: Aetna Commercial |
$165.72
|
| Rate for Payer: Aetna Medicare |
$123.67
|
| Rate for Payer: BCBS Complete |
$114.40
|
| Rate for Payer: BCBS MAPPO |
$123.67
|
| Rate for Payer: BCBS Trust/PPO |
$311.17
|
| Rate for Payer: BCN Commercial |
$189.61
|
| Rate for Payer: BCN Medicare Advantage |
$123.67
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Cofinity Commercial |
$178.08
|
| Rate for Payer: Cofinity Commercial |
$165.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.67
|
| Rate for Payer: Healthscope Commercial |
$148.40
|
| Rate for Payer: Healthscope Whirlpool |
$148.40
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$129.85
|
| Rate for Payer: PACE SWMI |
$123.67
|
| Rate for Payer: PHP Medicare Advantage |
$123.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$198.72
|
| Rate for Payer: Priority Health Medicare |
$123.67
|
| Rate for Payer: Priority Health Narrow Network |
$198.72
|
| Rate for Payer: UHC Medicare Advantage |
$127.38
|
|
|
CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
HCPCS 75825
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$238.26 |
| Rate for Payer: Aetna Commercial |
$147.21
|
| Rate for Payer: Aetna Medicare |
$109.86
|
| Rate for Payer: BCBS Complete |
$42.40
|
| Rate for Payer: BCBS MAPPO |
$109.86
|
| Rate for Payer: BCBS Trust/PPO |
$238.26
|
| Rate for Payer: BCN Commercial |
$167.13
|
| Rate for Payer: BCN Medicare Advantage |
$109.86
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cash Price |
$84.80
|
| Rate for Payer: Cofinity Commercial |
$147.21
|
| Rate for Payer: Cofinity Commercial |
$158.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.86
|
| Rate for Payer: Healthscope Commercial |
$131.83
|
| Rate for Payer: Healthscope Whirlpool |
$131.83
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$115.35
|
| Rate for Payer: PACE SWMI |
$109.86
|
| Rate for Payer: PHP Medicare Advantage |
$109.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.15
|
| Rate for Payer: Priority Health Medicare |
$109.86
|
| Rate for Payer: Priority Health Narrow Network |
$175.15
|
| Rate for Payer: UHC Medicare Advantage |
$113.16
|
|
|
CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 75827
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$307.47 |
| Rate for Payer: Aetna Commercial |
$153.83
|
| Rate for Payer: Aetna Medicare |
$114.80
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$114.80
|
| Rate for Payer: BCBS Trust/PPO |
$307.47
|
| Rate for Payer: BCN Commercial |
$174.95
|
| Rate for Payer: BCN Medicare Advantage |
$114.80
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$153.83
|
| Rate for Payer: Cofinity Commercial |
$165.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$114.80
|
| Rate for Payer: Healthscope Commercial |
$137.76
|
| Rate for Payer: Healthscope Whirlpool |
$137.76
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$120.54
|
| Rate for Payer: PACE SWMI |
$114.80
|
| Rate for Payer: PHP Medicare Advantage |
$114.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.36
|
| Rate for Payer: Priority Health Medicare |
$114.80
|
| Rate for Payer: Priority Health Narrow Network |
$183.36
|
| Rate for Payer: UHC Medicare Advantage |
$118.24
|
|
|
CHG VENOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 75822
|
| Min. Negotiated Rate |
$55.60 |
| Max. Negotiated Rate |
$265.21 |
| Rate for Payer: Aetna Commercial |
$171.60
|
| Rate for Payer: Aetna Commercial |
$171.60
|
| Rate for Payer: Aetna Medicare |
$128.06
|
| Rate for Payer: Aetna Medicare |
$128.06
|
| Rate for Payer: BCBS Complete |
$55.60
|
| Rate for Payer: BCBS Complete |
$107.60
|
| Rate for Payer: BCBS MAPPO |
$128.06
|
| Rate for Payer: BCBS MAPPO |
$128.06
|
| 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: BCN Medicare Advantage |
$128.06
|
| Rate for Payer: BCN Medicare Advantage |
$128.06
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cofinity Commercial |
$171.60
|
| Rate for Payer: Cofinity Commercial |
$184.41
|
| Rate for Payer: Cofinity Commercial |
$184.41
|
| Rate for Payer: Cofinity Commercial |
$171.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.06
|
| Rate for Payer: Healthscope Commercial |
$153.67
|
| Rate for Payer: Healthscope Commercial |
$153.67
|
| Rate for Payer: Healthscope Whirlpool |
$153.67
|
| Rate for Payer: Healthscope Whirlpool |
$153.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$134.46
|
| Rate for Payer: PACE SWMI |
$128.06
|
| Rate for Payer: PACE SWMI |
$128.06
|
| Rate for Payer: PHP Medicare Advantage |
$128.06
|
| Rate for Payer: PHP Medicare Advantage |
$128.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$188.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.84
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$203.84
|
| Rate for Payer: Priority Health Medicare |
$128.06
|
| Rate for Payer: Priority Health Medicare |
$128.06
|
| Rate for Payer: Priority Health Narrow Network |
$203.84
|
| Rate for Payer: Priority Health Narrow Network |
$203.84
|
| Rate for Payer: UHC Medicare Advantage |
$131.90
|
| Rate for Payer: UHC Medicare Advantage |
$131.90
|
|
|
CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS 75820
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$191.77 |
| Rate for Payer: Aetna Commercial |
$140.19
|
| Rate for Payer: Aetna Medicare |
$104.62
|
| Rate for Payer: BCBS Complete |
$49.60
|
| Rate for Payer: BCBS MAPPO |
$104.62
|
| Rate for Payer: BCBS Trust/PPO |
$191.77
|
| Rate for Payer: BCN Commercial |
$159.79
|
| Rate for Payer: BCN Medicare Advantage |
$104.62
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cash Price |
$99.20
|
| Rate for Payer: Cofinity Commercial |
$140.19
|
| Rate for Payer: Cofinity Commercial |
$150.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.62
|
| Rate for Payer: Healthscope Commercial |
$125.54
|
| Rate for Payer: Healthscope Whirlpool |
$125.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$109.85
|
| Rate for Payer: PACE SWMI |
$104.62
|
| Rate for Payer: PHP Medicare Advantage |
$104.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.48
|
| Rate for Payer: Priority Health Medicare |
$104.62
|
| Rate for Payer: Priority Health Narrow Network |
$167.48
|
| Rate for Payer: UHC Medicare Advantage |
$107.76
|
|
|
CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 75833
|
| Min. Negotiated Rate |
$54.40 |
| Max. Negotiated Rate |
$369.81 |
| Rate for Payer: Aetna Commercial |
$189.54
|
| Rate for Payer: Aetna Medicare |
$141.45
|
| Rate for Payer: BCBS Complete |
$54.40
|
| Rate for Payer: BCBS MAPPO |
$141.45
|
| Rate for Payer: BCBS Trust/PPO |
$369.81
|
| Rate for Payer: BCN Commercial |
$215.02
|
| Rate for Payer: BCN Medicare Advantage |
$141.45
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cofinity Commercial |
$203.69
|
| Rate for Payer: Cofinity Commercial |
$189.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.45
|
| Rate for Payer: Healthscope Commercial |
$169.74
|
| Rate for Payer: Healthscope Whirlpool |
$169.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$148.52
|
| Rate for Payer: PACE SWMI |
$141.45
|
| Rate for Payer: PHP Medicare Advantage |
$141.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$95.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$225.35
|
| Rate for Payer: Priority Health Medicare |
$141.45
|
| Rate for Payer: Priority Health Narrow Network |
$225.35
|
| Rate for Payer: UHC Medicare Advantage |
$145.69
|
|
|
CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 75831
|
| Min. Negotiated Rate |
$107.20 |
| Max. Negotiated Rate |
$187.60 |
| Rate for Payer: Aetna Commercial |
$154.84
|
| Rate for Payer: Aetna Commercial |
$154.84
|
| Rate for Payer: Aetna Medicare |
$115.55
|
| Rate for Payer: Aetna Medicare |
$115.55
|
| Rate for Payer: BCBS Complete |
$43.60
|
| Rate for Payer: BCBS Complete |
$107.20
|
| Rate for Payer: BCBS MAPPO |
$115.55
|
| Rate for Payer: BCBS MAPPO |
$115.55
|
| 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: BCN Medicare Advantage |
$115.55
|
| Rate for Payer: BCN Medicare Advantage |
$115.55
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$87.20
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cofinity Commercial |
$166.39
|
| Rate for Payer: Cofinity Commercial |
$154.84
|
| Rate for Payer: Cofinity Commercial |
$154.84
|
| Rate for Payer: Cofinity Commercial |
$166.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.55
|
| Rate for Payer: Healthscope Commercial |
$138.66
|
| Rate for Payer: Healthscope Commercial |
$138.66
|
| Rate for Payer: Healthscope Whirlpool |
$138.66
|
| Rate for Payer: Healthscope Whirlpool |
$138.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$121.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$121.33
|
| Rate for Payer: PACE SWMI |
$115.55
|
| Rate for Payer: PACE SWMI |
$115.55
|
| Rate for Payer: PHP Medicare Advantage |
$115.55
|
| Rate for Payer: PHP Medicare Advantage |
$115.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$184.89
|
| Rate for Payer: Priority Health Medicare |
$115.55
|
| Rate for Payer: Priority Health Medicare |
$115.55
|
| Rate for Payer: Priority Health Narrow Network |
$184.89
|
| Rate for Payer: Priority Health Narrow Network |
$184.89
|
| Rate for Payer: UHC Medicare Advantage |
$119.02
|
| Rate for Payer: UHC Medicare Advantage |
$119.02
|
|
|
CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 75860
|
| Min. Negotiated Rate |
$110.00 |
| Max. Negotiated Rate |
$310.64 |
| Rate for Payer: Aetna Commercial |
$161.87
|
| Rate for Payer: Aetna Commercial |
$161.87
|
| Rate for Payer: Aetna Medicare |
$120.80
|
| Rate for Payer: Aetna Medicare |
$120.80
|
| Rate for Payer: BCBS Complete |
$143.60
|
| Rate for Payer: BCBS Complete |
$110.00
|
| Rate for Payer: BCBS MAPPO |
$120.80
|
| Rate for Payer: BCBS MAPPO |
$120.80
|
| 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: BCN Medicare Advantage |
$120.80
|
| Rate for Payer: BCN Medicare Advantage |
$120.80
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cofinity Commercial |
$173.95
|
| Rate for Payer: Cofinity Commercial |
$161.87
|
| Rate for Payer: Cofinity Commercial |
$161.87
|
| Rate for Payer: Cofinity Commercial |
$173.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.80
|
| Rate for Payer: Healthscope Commercial |
$144.96
|
| Rate for Payer: Healthscope Commercial |
$144.96
|
| Rate for Payer: Healthscope Whirlpool |
$144.96
|
| Rate for Payer: Healthscope Whirlpool |
$144.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.84
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$126.84
|
| Rate for Payer: PACE SWMI |
$120.80
|
| Rate for Payer: PACE SWMI |
$120.80
|
| Rate for Payer: PHP Medicare Advantage |
$120.80
|
| Rate for Payer: PHP Medicare Advantage |
$120.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$251.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$192.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.59
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$193.59
|
| Rate for Payer: Priority Health Medicare |
$120.80
|
| Rate for Payer: Priority Health Medicare |
$120.80
|
| Rate for Payer: Priority Health Narrow Network |
$193.59
|
| Rate for Payer: Priority Health Narrow Network |
$193.59
|
| Rate for Payer: UHC Medicare Advantage |
$124.42
|
| Rate for Payer: UHC Medicare Advantage |
$124.42
|
|
|
CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 75893
|
| Min. Negotiated Rate |
$97.97 |
| Max. Negotiated Rate |
$353.43 |
| Rate for Payer: Aetna Commercial |
$131.28
|
| Rate for Payer: Aetna Medicare |
$97.97
|
| Rate for Payer: BCBS Complete |
$130.80
|
| Rate for Payer: BCBS MAPPO |
$97.97
|
| Rate for Payer: BCBS Trust/PPO |
$353.43
|
| Rate for Payer: BCN Commercial |
$151.98
|
| Rate for Payer: BCN Medicare Advantage |
$97.97
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cofinity Commercial |
$141.08
|
| Rate for Payer: Cofinity Commercial |
$131.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.97
|
| Rate for Payer: Healthscope Commercial |
$117.56
|
| Rate for Payer: Healthscope Whirlpool |
$117.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$102.87
|
| Rate for Payer: PACE SWMI |
$97.97
|
| Rate for Payer: PHP Medicare Advantage |
$97.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$228.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$159.29
|
| Rate for Payer: Priority Health Medicare |
$97.97
|
| Rate for Payer: Priority Health Narrow Network |
$159.29
|
| Rate for Payer: UHC Medicare Advantage |
$100.91
|
|
|
CHG X-RAY ABDOMEN 1 VW
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 74000
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$24.50 |
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.50
|
|
|
CHG X-RAY ABDOMEN 2 VW
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS 74020
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: BCBS Complete |
$20.80
|
| Rate for Payer: Cash Price |
$41.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
|
|
CHG X-RAY FEMUR 2 VW
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 73550
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$20.30 |
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.30
|
|
|
CHG X-RAY HIPS 4 VW + PELVIS
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 73520
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.10
|
|
|
CHG X-RAY HIP UNI 2+ VW
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 73510
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$37.10 |
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.20
|
|
|
CHG X-RAY HIP UNILAT 1 VW
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
HCPCS 73500
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$68.60 |
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.00
|
|
|
CHG X-RAY PELVIS/HIPS CHILD/INFANT
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 73540
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: BCBS Complete |
$38.00
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.80
|
|
|
CHG X-RAY SPINE SURVEY
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS 72010
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$50.40 |
| Rate for Payer: BCBS Complete |
$28.80
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.40
|
|
|
CHG X-RAY THOR-LUMB SP SCOLIOSIS
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
HCPCS 72090
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$49.00 |
| Rate for Payer: BCBS Complete |
$28.00
|
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: BCBS Complete |
$39.20
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$78.40
|
| Rate for Payer: Cash Price |
$56.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$49.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.60
|
|
|
CHG X-RAY TRUNK SPINE SCOLIOSIS
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 72069
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$41.30 |
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.30
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$473,060.27
|
|
|
Service Code
|
MS-DRG 018
|
| Min. Negotiated Rate |
$297,925.56 |
| Max. Negotiated Rate |
$473,060.27 |
| Rate for Payer: Aetna Medicare |
$313,605.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$392,007.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$392,007.31
|
| Rate for Payer: BCBS MAPPO |
$313,605.85
|
| Rate for Payer: BCN Medicare Advantage |
$313,605.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313,605.85
|
| Rate for Payer: Humana Choice PPO Medicare |
$313,605.85
|
| Rate for Payer: Mclaren Medicare |
$313,605.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$329,286.14
|
| Rate for Payer: MI Amish Medical Board Commercial |
$360,646.73
|
| Rate for Payer: PACE Medicare |
$297,925.56
|
| Rate for Payer: PACE SWMI |
$313,605.85
|
| Rate for Payer: PHP Commercial |
$344,966.44
|
| Rate for Payer: PHP Medicare Advantage |
$313,605.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$473,060.27
|
| Rate for Payer: Priority Health Medicare |
$313,605.85
|
| Rate for Payer: Priority Health Narrow Network |
$378,448.22
|
| Rate for Payer: Railroad Medicare Medicare |
$313,605.85
|
| Rate for Payer: UHC Medicare Advantage |
$323,014.03
|
| Rate for Payer: VA VA |
$313,605.85
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE
|
Facility
|
IP
|
$4.35
|
|
|
Service Code
|
NDC 51079-375-01
|
| Hospital Charge Code |
1622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.04 |
| Max. Negotiated Rate |
$4.35 |
| Rate for Payer: Aetna Commercial |
$3.92
|
| Rate for Payer: ASR ASR |
$4.22
|
| Rate for Payer: BCBS Trust/PPO |
$3.37
|
| Rate for Payer: BCN Commercial |
$3.37
|
| Rate for Payer: Cash Price |
$3.48
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.48
|
| Rate for Payer: Healthscope Commercial |
$4.35
|
| Rate for Payer: Healthscope Whirlpool |
$4.22
|
| Rate for Payer: Mclaren Commercial |
$3.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$3.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.83
|
|
|
CHLORDIAZEPOXIDE 25 MG CAPSULE
|
Facility
|
IP
|
$345.45
|
|
|
Service Code
|
NDC 0555-0159-02
|
| Hospital Charge Code |
1623
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$241.82 |
| Max. Negotiated Rate |
$345.45 |
| Rate for Payer: Aetna Commercial |
$310.90
|
| Rate for Payer: ASR ASR |
$335.09
|
| Rate for Payer: BCBS Trust/PPO |
$267.83
|
| Rate for Payer: BCN Commercial |
$267.83
|
| Rate for Payer: Cash Price |
$276.36
|
| Rate for Payer: Cofinity Commercial |
$324.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$276.36
|
| Rate for Payer: Healthscope Commercial |
$345.45
|
| Rate for Payer: Healthscope Whirlpool |
$335.09
|
| Rate for Payer: Mclaren Commercial |
$310.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$293.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$241.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$304.00
|
|
