|
CHG US SCROTUM & CONTENTS
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 76870
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$150.02 |
| Rate for Payer: Aetna Commercial |
$123.44
|
| Rate for Payer: Aetna Medicare |
$92.12
|
| Rate for Payer: BCBS MAPPO |
$92.12
|
| Rate for Payer: BCN Commercial |
$148.90
|
| Rate for Payer: BCN Medicare Advantage |
$92.12
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$123.44
|
| Rate for Payer: Cofinity Commercial |
$132.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.12
|
| Rate for Payer: Healthscope Commercial |
$110.54
|
| Rate for Payer: Healthscope Whirlpool |
$110.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$101.33
|
| Rate for Payer: Nomi Health Commercial |
$110.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.00
|
| Rate for Payer: PACE SWMI |
$92.12
|
| Rate for Payer: PHP Medicare Advantage |
$92.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$150.02
|
| Rate for Payer: Priority Health Medicare |
$92.12
|
| Rate for Payer: Priority Health Narrow Network |
$150.02
|
| Rate for Payer: Railroad Medicare Medicare |
$92.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$92.12
|
| Rate for Payer: UHC Exchange |
$148.65
|
| Rate for Payer: UHCCP DNSP |
$92.12
|
|
|
CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 76536
|
| Min. Negotiated Rate |
$78.75 |
| Max. Negotiated Rate |
$164.57 |
| Rate for Payer: Aetna Commercial |
$135.34
|
| Rate for Payer: Aetna Commercial |
$135.34
|
| Rate for Payer: Aetna Medicare |
$101.00
|
| Rate for Payer: Aetna Medicare |
$101.00
|
| Rate for Payer: BCBS MAPPO |
$101.00
|
| Rate for Payer: BCBS MAPPO |
$101.00
|
| Rate for Payer: BCN Commercial |
$163.34
|
| Rate for Payer: BCN Commercial |
$163.34
|
| Rate for Payer: BCN Medicare Advantage |
$101.00
|
| Rate for Payer: BCN Medicare Advantage |
$101.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$135.34
|
| Rate for Payer: Cofinity Commercial |
$145.44
|
| Rate for Payer: Cofinity Commercial |
$135.34
|
| Rate for Payer: Cofinity Commercial |
$145.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.00
|
| Rate for Payer: Healthscope Commercial |
$121.20
|
| Rate for Payer: Healthscope Commercial |
$121.20
|
| Rate for Payer: Healthscope Whirlpool |
$121.20
|
| Rate for Payer: Healthscope Whirlpool |
$121.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.10
|
| Rate for Payer: Nomi Health Commercial |
$121.20
|
| Rate for Payer: Nomi Health Commercial |
$121.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
| Rate for Payer: PACE SWMI |
$101.00
|
| Rate for Payer: PACE SWMI |
$101.00
|
| Rate for Payer: PHP Medicare Advantage |
$101.00
|
| Rate for Payer: PHP Medicare Advantage |
$101.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$164.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$164.57
|
| Rate for Payer: Priority Health Medicare |
$101.00
|
| Rate for Payer: Priority Health Medicare |
$101.00
|
| Rate for Payer: Priority Health Narrow Network |
$164.57
|
| Rate for Payer: Priority Health Narrow Network |
$164.57
|
| Rate for Payer: Railroad Medicare Medicare |
$101.00
|
| Rate for Payer: Railroad Medicare Medicare |
$101.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$163.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.00
|
| Rate for Payer: UHC Exchange |
$163.52
|
| Rate for Payer: UHC Exchange |
$163.52
|
| Rate for Payer: UHCCP DNSP |
$101.00
|
| Rate for Payer: UHCCP DNSP |
$101.00
|
|
|
CHG US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 76873
|
| Min. Negotiated Rate |
$168.11 |
| Max. Negotiated Rate |
$262.91 |
| Rate for Payer: Aetna Commercial |
$225.27
|
| Rate for Payer: Aetna Medicare |
$168.11
|
| Rate for Payer: BCBS MAPPO |
$168.11
|
| Rate for Payer: BCN Commercial |
$260.94
|
| Rate for Payer: BCN Medicare Advantage |
$168.11
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cofinity Commercial |
$225.27
|
| Rate for Payer: Cofinity Commercial |
$242.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.11
|
| Rate for Payer: Healthscope Commercial |
$201.73
|
| Rate for Payer: Healthscope Whirlpool |
$201.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$184.92
|
| Rate for Payer: Nomi Health Commercial |
$201.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.00
|
| Rate for Payer: PACE SWMI |
$168.11
|
| Rate for Payer: PHP Medicare Advantage |
$168.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$262.91
|
| Rate for Payer: Priority Health Medicare |
$168.11
|
| Rate for Payer: Priority Health Narrow Network |
$262.91
|
| Rate for Payer: Railroad Medicare Medicare |
$168.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$168.11
|
| Rate for Payer: UHC Exchange |
$251.24
|
| Rate for Payer: UHCCP DNSP |
$168.11
|
|
|
CHG US TRANSRECTAL
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 76872
|
| Min. Negotiated Rate |
$54.75 |
| Max. Negotiated Rate |
$295.52 |
| Rate for Payer: Aetna Commercial |
$150.03
|
| Rate for Payer: Aetna Commercial |
$150.03
|
| Rate for Payer: Aetna Medicare |
$111.96
|
| Rate for Payer: Aetna Medicare |
$111.96
|
| Rate for Payer: BCBS MAPPO |
$111.96
|
| Rate for Payer: BCBS MAPPO |
$111.96
|
| Rate for Payer: BCN Commercial |
$293.31
|
| Rate for Payer: BCN Commercial |
$293.31
|
| Rate for Payer: BCN Medicare Advantage |
$111.96
|
| Rate for Payer: BCN Medicare Advantage |
$111.96
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$161.22
|
| Rate for Payer: Cofinity Commercial |
$150.03
|
| Rate for Payer: Cofinity Commercial |
$161.22
|
| Rate for Payer: Cofinity Commercial |
$150.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.96
|
| Rate for Payer: Healthscope Commercial |
$134.35
|
| Rate for Payer: Healthscope Commercial |
$134.35
|
| Rate for Payer: Healthscope Whirlpool |
$134.35
|
| Rate for Payer: Healthscope Whirlpool |
$134.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.16
|
| Rate for Payer: Nomi Health Commercial |
$134.35
|
| Rate for Payer: Nomi Health Commercial |
$134.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$256.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.75
|
| Rate for Payer: PACE SWMI |
$111.96
|
| Rate for Payer: PACE SWMI |
$111.96
|
| Rate for Payer: PHP Medicare Advantage |
$111.96
|
| Rate for Payer: PHP Medicare Advantage |
$111.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$295.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$295.52
|
| Rate for Payer: Priority Health Medicare |
$111.96
|
| Rate for Payer: Priority Health Medicare |
$111.96
|
| Rate for Payer: Priority Health Narrow Network |
$295.52
|
| Rate for Payer: Priority Health Narrow Network |
$295.52
|
| Rate for Payer: Railroad Medicare Medicare |
$111.96
|
| Rate for Payer: Railroad Medicare Medicare |
$111.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$221.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$111.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$111.96
|
| Rate for Payer: UHC Exchange |
$221.10
|
| Rate for Payer: UHC Exchange |
$221.10
|
| Rate for Payer: UHCCP DNSP |
$111.96
|
| Rate for Payer: UHCCP DNSP |
$111.96
|
|
|
CHG US TRANSVAGINAL
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 76830
|
| Min. Negotiated Rate |
$109.72 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Aetna Commercial |
$147.02
|
| Rate for Payer: Aetna Medicare |
$109.72
|
| Rate for Payer: BCBS MAPPO |
$109.72
|
| Rate for Payer: BCN Commercial |
$175.79
|
| Rate for Payer: BCN Medicare Advantage |
$109.72
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cofinity Commercial |
$147.02
|
| Rate for Payer: Cofinity Commercial |
$158.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.72
|
| Rate for Payer: Healthscope Commercial |
$131.66
|
| Rate for Payer: Healthscope Whirlpool |
$131.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$120.69
|
| Rate for Payer: Nomi Health Commercial |
$131.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$239.25
|
| Rate for Payer: PACE SWMI |
$109.72
|
| Rate for Payer: PHP Medicare Advantage |
$109.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$177.11
|
| Rate for Payer: Priority Health Medicare |
$109.72
|
| Rate for Payer: Priority Health Narrow Network |
$177.11
|
| Rate for Payer: Railroad Medicare Medicare |
$109.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$109.72
|
| Rate for Payer: UHC Exchange |
$173.94
|
| Rate for Payer: UHCCP DNSP |
$109.72
|
|
|
CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 76937
|
| Min. Negotiated Rate |
$38.03 |
| Max. Negotiated Rate |
$57.70 |
| Rate for Payer: Aetna Commercial |
$50.96
|
| Rate for Payer: Aetna Commercial |
$50.96
|
| Rate for Payer: Aetna Medicare |
$38.03
|
| Rate for Payer: Aetna Medicare |
$38.03
|
| Rate for Payer: BCBS MAPPO |
$38.03
|
| Rate for Payer: BCBS MAPPO |
$38.03
|
| Rate for Payer: BCN Commercial |
$57.27
|
| Rate for Payer: BCN Commercial |
$57.27
|
| Rate for Payer: BCN Medicare Advantage |
$38.03
|
| Rate for Payer: BCN Medicare Advantage |
$38.03
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Cofinity Commercial |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Cofinity Commercial |
$50.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.03
|
| Rate for Payer: Healthscope Commercial |
$45.64
|
| Rate for Payer: Healthscope Commercial |
$45.64
|
| Rate for Payer: Healthscope Whirlpool |
$45.64
|
| Rate for Payer: Healthscope Whirlpool |
$45.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.83
|
| Rate for Payer: Nomi Health Commercial |
$45.64
|
| Rate for Payer: Nomi Health Commercial |
$45.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.00
|
| Rate for Payer: PACE SWMI |
$38.03
|
| Rate for Payer: PACE SWMI |
$38.03
|
| Rate for Payer: PHP Medicare Advantage |
$38.03
|
| Rate for Payer: PHP Medicare Advantage |
$38.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$57.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$57.70
|
| Rate for Payer: Priority Health Medicare |
$38.03
|
| Rate for Payer: Priority Health Medicare |
$38.03
|
| Rate for Payer: Priority Health Narrow Network |
$57.70
|
| Rate for Payer: Priority Health Narrow Network |
$57.70
|
| Rate for Payer: Railroad Medicare Medicare |
$38.03
|
| Rate for Payer: Railroad Medicare Medicare |
$38.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$52.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.03
|
| Rate for Payer: UHC Exchange |
$52.10
|
| Rate for Payer: UHC Exchange |
$52.10
|
| Rate for Payer: UHCCP DNSP |
$38.03
|
| Rate for Payer: UHCCP DNSP |
$38.03
|
|
|
CHG VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 75840
|
| Min. Negotiated Rate |
$118.54 |
| Max. Negotiated Rate |
$225.75 |
| Rate for Payer: Aetna Commercial |
$158.84
|
| Rate for Payer: Aetna Medicare |
$118.54
|
| Rate for Payer: BCBS MAPPO |
$118.54
|
| Rate for Payer: BCN Commercial |
$191.23
|
| Rate for Payer: BCN Medicare Advantage |
$118.54
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cofinity Commercial |
$158.84
|
| Rate for Payer: Cofinity Commercial |
$170.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.54
|
| Rate for Payer: Healthscope Commercial |
$142.25
|
| Rate for Payer: Healthscope Whirlpool |
$142.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$130.39
|
| Rate for Payer: Nomi Health Commercial |
$142.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.75
|
| Rate for Payer: PACE SWMI |
$118.54
|
| Rate for Payer: PHP Medicare Advantage |
$118.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$192.66
|
| Rate for Payer: Priority Health Medicare |
$118.54
|
| Rate for Payer: Priority Health Narrow Network |
$192.66
|
| Rate for Payer: Railroad Medicare Medicare |
$118.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$200.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$118.54
|
| Rate for Payer: UHC Exchange |
$200.69
|
| Rate for Payer: UHCCP DNSP |
$118.54
|
|
|
CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 75825
|
| Min. Negotiated Rate |
$83.25 |
| Max. Negotiated Rate |
$180.35 |
| Rate for Payer: Aetna Commercial |
$144.61
|
| Rate for Payer: Aetna Medicare |
$107.92
|
| Rate for Payer: BCBS MAPPO |
$107.92
|
| Rate for Payer: BCN Commercial |
$170.31
|
| Rate for Payer: BCN Medicare Advantage |
$107.92
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cofinity Commercial |
$144.61
|
| Rate for Payer: Cofinity Commercial |
$155.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.92
|
| Rate for Payer: Healthscope Commercial |
$129.50
|
| Rate for Payer: Healthscope Whirlpool |
$129.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$118.71
|
| Rate for Payer: Nomi Health Commercial |
$129.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.25
|
| Rate for Payer: PACE SWMI |
$107.92
|
| Rate for Payer: PHP Medicare Advantage |
$107.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$171.60
|
| Rate for Payer: Priority Health Medicare |
$107.92
|
| Rate for Payer: Priority Health Narrow Network |
$171.60
|
| Rate for Payer: Railroad Medicare Medicare |
$107.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$107.92
|
| Rate for Payer: UHC Exchange |
$180.35
|
| Rate for Payer: UHCCP DNSP |
$107.92
|
|
|
CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 75827
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$187.27 |
| Rate for Payer: Aetna Commercial |
$151.25
|
| Rate for Payer: Aetna Medicare |
$112.87
|
| Rate for Payer: BCBS MAPPO |
$112.87
|
| Rate for Payer: BCN Commercial |
$175.29
|
| Rate for Payer: BCN Medicare Advantage |
$112.87
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$151.25
|
| Rate for Payer: Cofinity Commercial |
$162.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.87
|
| Rate for Payer: Healthscope Commercial |
$135.44
|
| Rate for Payer: Healthscope Whirlpool |
$135.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$124.16
|
| Rate for Payer: Nomi Health Commercial |
$135.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$81.00
|
| Rate for Payer: PACE SWMI |
$112.87
|
| Rate for Payer: PHP Medicare Advantage |
$112.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$176.61
|
| Rate for Payer: Priority Health Medicare |
$112.87
|
| Rate for Payer: Priority Health Narrow Network |
$176.61
|
| Rate for Payer: Railroad Medicare Medicare |
$112.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$112.87
|
| Rate for Payer: UHC Exchange |
$187.27
|
| Rate for Payer: UHCCP DNSP |
$112.87
|
|
|
CHG VENOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 75822
|
| Min. Negotiated Rate |
$126.87 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: Aetna Commercial |
$170.01
|
| Rate for Payer: Aetna Commercial |
$170.01
|
| Rate for Payer: Aetna Medicare |
$126.87
|
| Rate for Payer: Aetna Medicare |
$126.87
|
| Rate for Payer: BCBS MAPPO |
$126.87
|
| Rate for Payer: BCBS MAPPO |
$126.87
|
| Rate for Payer: BCN Commercial |
$198.19
|
| Rate for Payer: BCN Commercial |
$198.19
|
| Rate for Payer: BCN Medicare Advantage |
$126.87
|
| Rate for Payer: BCN Medicare Advantage |
$126.87
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$182.69
|
| Rate for Payer: Cofinity Commercial |
$170.01
|
| Rate for Payer: Cofinity Commercial |
$182.69
|
| Rate for Payer: Cofinity Commercial |
$170.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.87
|
| Rate for Payer: Healthscope Commercial |
$152.24
|
| Rate for Payer: Healthscope Commercial |
$152.24
|
| Rate for Payer: Healthscope Whirlpool |
$152.24
|
| Rate for Payer: Healthscope Whirlpool |
$152.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$139.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$139.56
|
| Rate for Payer: Nomi Health Commercial |
$152.24
|
| Rate for Payer: Nomi Health Commercial |
$152.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: PACE SWMI |
$126.87
|
| Rate for Payer: PACE SWMI |
$126.87
|
| Rate for Payer: PHP Medicare Advantage |
$126.87
|
| Rate for Payer: PHP Medicare Advantage |
$126.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$199.69
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$199.69
|
| Rate for Payer: Priority Health Medicare |
$126.87
|
| Rate for Payer: Priority Health Medicare |
$126.87
|
| Rate for Payer: Priority Health Narrow Network |
$199.69
|
| Rate for Payer: Priority Health Narrow Network |
$199.69
|
| Rate for Payer: Railroad Medicare Medicare |
$126.87
|
| Rate for Payer: Railroad Medicare Medicare |
$126.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$180.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$126.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$126.87
|
| Rate for Payer: UHC Exchange |
$180.33
|
| Rate for Payer: UHC Exchange |
$180.33
|
| Rate for Payer: UHCCP DNSP |
$126.87
|
| Rate for Payer: UHCCP DNSP |
$126.87
|
|
|
CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 75820
|
| Min. Negotiated Rate |
$83.25 |
| Max. Negotiated Rate |
$159.55 |
| Rate for Payer: Aetna Commercial |
$136.01
|
| Rate for Payer: Aetna Commercial |
$136.01
|
| Rate for Payer: Aetna Medicare |
$101.50
|
| Rate for Payer: Aetna Medicare |
$101.50
|
| Rate for Payer: BCBS MAPPO |
$101.50
|
| Rate for Payer: BCBS MAPPO |
$101.50
|
| Rate for Payer: BCN Commercial |
$158.36
|
| Rate for Payer: BCN Commercial |
$158.36
|
| Rate for Payer: BCN Medicare Advantage |
$101.50
|
| Rate for Payer: BCN Medicare Advantage |
$101.50
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cofinity Commercial |
$136.01
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Cofinity Commercial |
$136.01
|
| Rate for Payer: Cofinity Commercial |
$146.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.50
|
| Rate for Payer: Healthscope Commercial |
$121.80
|
| Rate for Payer: Healthscope Commercial |
$121.80
|
| Rate for Payer: Healthscope Whirlpool |
$121.80
|
| Rate for Payer: Healthscope Whirlpool |
$121.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.58
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.65
|
| Rate for Payer: Nomi Health Commercial |
$121.80
|
| Rate for Payer: Nomi Health Commercial |
$121.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$178.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$83.25
|
| Rate for Payer: PACE SWMI |
$101.50
|
| Rate for Payer: PACE SWMI |
$101.50
|
| Rate for Payer: PHP Medicare Advantage |
$101.50
|
| Rate for Payer: PHP Medicare Advantage |
$101.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$159.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$159.55
|
| Rate for Payer: Priority Health Medicare |
$101.50
|
| Rate for Payer: Priority Health Medicare |
$101.50
|
| Rate for Payer: Priority Health Narrow Network |
$159.55
|
| Rate for Payer: Priority Health Narrow Network |
$159.55
|
| Rate for Payer: Railroad Medicare Medicare |
$101.50
|
| Rate for Payer: Railroad Medicare Medicare |
$101.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$152.99
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.50
|
| Rate for Payer: UHC Exchange |
$152.99
|
| Rate for Payer: UHC Exchange |
$152.99
|
| Rate for Payer: UHCCP DNSP |
$101.50
|
| Rate for Payer: UHCCP DNSP |
$101.50
|
|
|
CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 75833
|
| Min. Negotiated Rate |
$107.25 |
| Max. Negotiated Rate |
$226.51 |
| Rate for Payer: Aetna Commercial |
$199.42
|
| Rate for Payer: Aetna Medicare |
$148.82
|
| Rate for Payer: BCBS MAPPO |
$148.82
|
| Rate for Payer: BCN Commercial |
$220.11
|
| Rate for Payer: BCN Medicare Advantage |
$148.82
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cofinity Commercial |
$199.42
|
| Rate for Payer: Cofinity Commercial |
$214.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.82
|
| Rate for Payer: Healthscope Commercial |
$178.58
|
| Rate for Payer: Healthscope Whirlpool |
$178.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.26
|
| Rate for Payer: Molina Medicare/Medicaid |
$163.70
|
| Rate for Payer: Nomi Health Commercial |
$178.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$107.25
|
| Rate for Payer: PACE SWMI |
$148.82
|
| Rate for Payer: PHP Medicare Advantage |
$148.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$221.76
|
| Rate for Payer: Priority Health Medicare |
$148.82
|
| Rate for Payer: Priority Health Narrow Network |
$221.76
|
| Rate for Payer: Railroad Medicare Medicare |
$148.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$226.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$148.82
|
| Rate for Payer: UHC Exchange |
$226.51
|
| Rate for Payer: UHCCP DNSP |
$148.82
|
|
|
CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 75831
|
| Min. Negotiated Rate |
$112.58 |
| Max. Negotiated Rate |
$210.75 |
| Rate for Payer: Aetna Commercial |
$150.86
|
| Rate for Payer: Aetna Commercial |
$150.86
|
| Rate for Payer: Aetna Medicare |
$112.58
|
| Rate for Payer: Aetna Medicare |
$112.58
|
| Rate for Payer: BCBS MAPPO |
$112.58
|
| Rate for Payer: BCBS MAPPO |
$112.58
|
| Rate for Payer: BCN Commercial |
$178.77
|
| Rate for Payer: BCN Commercial |
$178.77
|
| Rate for Payer: BCN Medicare Advantage |
$112.58
|
| Rate for Payer: BCN Medicare Advantage |
$112.58
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$162.12
|
| Rate for Payer: Cofinity Commercial |
$150.86
|
| Rate for Payer: Cofinity Commercial |
$162.12
|
| Rate for Payer: Cofinity Commercial |
$150.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$112.58
|
| Rate for Payer: Healthscope Commercial |
$135.10
|
| Rate for Payer: Healthscope Commercial |
$135.10
|
| Rate for Payer: Healthscope Whirlpool |
$135.10
|
| Rate for Payer: Healthscope Whirlpool |
$135.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$118.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.84
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.84
|
| Rate for Payer: Nomi Health Commercial |
$135.10
|
| Rate for Payer: Nomi Health Commercial |
$135.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$85.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.75
|
| Rate for Payer: PACE SWMI |
$112.58
|
| Rate for Payer: PACE SWMI |
$112.58
|
| Rate for Payer: PHP Medicare Advantage |
$112.58
|
| Rate for Payer: PHP Medicare Advantage |
$112.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$180.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$180.12
|
| Rate for Payer: Priority Health Medicare |
$112.58
|
| Rate for Payer: Priority Health Medicare |
$112.58
|
| Rate for Payer: Priority Health Narrow Network |
$180.12
|
| Rate for Payer: Priority Health Narrow Network |
$180.12
|
| Rate for Payer: Railroad Medicare Medicare |
$112.58
|
| Rate for Payer: Railroad Medicare Medicare |
$112.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$187.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$112.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$112.58
|
| Rate for Payer: UHC Exchange |
$187.58
|
| Rate for Payer: UHC Exchange |
$187.58
|
| Rate for Payer: UHCCP DNSP |
$112.58
|
| Rate for Payer: UHCCP DNSP |
$112.58
|
|
|
CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 75860
|
| Min. Negotiated Rate |
$122.48 |
| Max. Negotiated Rate |
$216.75 |
| Rate for Payer: Aetna Commercial |
$164.12
|
| Rate for Payer: Aetna Commercial |
$164.12
|
| Rate for Payer: Aetna Medicare |
$122.48
|
| Rate for Payer: Aetna Medicare |
$122.48
|
| Rate for Payer: BCBS MAPPO |
$122.48
|
| Rate for Payer: BCBS MAPPO |
$122.48
|
| Rate for Payer: BCN Commercial |
$188.74
|
| Rate for Payer: BCN Commercial |
$188.74
|
| Rate for Payer: BCN Medicare Advantage |
$122.48
|
| Rate for Payer: BCN Medicare Advantage |
$122.48
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cofinity Commercial |
$164.12
|
| Rate for Payer: Cofinity Commercial |
$176.37
|
| Rate for Payer: Cofinity Commercial |
$164.12
|
| Rate for Payer: Cofinity Commercial |
$176.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.48
|
| Rate for Payer: Healthscope Commercial |
$146.98
|
| Rate for Payer: Healthscope Commercial |
$146.98
|
| Rate for Payer: Healthscope Whirlpool |
$146.98
|
| Rate for Payer: Healthscope Whirlpool |
$146.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$134.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$134.73
|
| Rate for Payer: Nomi Health Commercial |
$146.98
|
| Rate for Payer: Nomi Health Commercial |
$146.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$282.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: PACE SWMI |
$122.48
|
| Rate for Payer: PACE SWMI |
$122.48
|
| Rate for Payer: PHP Medicare Advantage |
$122.48
|
| Rate for Payer: PHP Medicare Advantage |
$122.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$190.15
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$190.15
|
| Rate for Payer: Priority Health Medicare |
$122.48
|
| Rate for Payer: Priority Health Medicare |
$122.48
|
| Rate for Payer: Priority Health Narrow Network |
$190.15
|
| Rate for Payer: Priority Health Narrow Network |
$190.15
|
| Rate for Payer: Railroad Medicare Medicare |
$122.48
|
| Rate for Payer: Railroad Medicare Medicare |
$122.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$122.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$122.48
|
| Rate for Payer: UHC Exchange |
$196.94
|
| Rate for Payer: UHC Exchange |
$196.94
|
| Rate for Payer: UHCCP DNSP |
$122.48
|
| Rate for Payer: UHCCP DNSP |
$122.48
|
|
|
CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
HCPCS 75893
|
| Min. Negotiated Rate |
$103.06 |
| Max. Negotiated Rate |
$258.00 |
| Rate for Payer: Aetna Commercial |
$138.10
|
| Rate for Payer: Aetna Medicare |
$103.06
|
| Rate for Payer: BCBS MAPPO |
$103.06
|
| Rate for Payer: BCN Commercial |
$157.36
|
| Rate for Payer: BCN Medicare Advantage |
$103.06
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cash Price |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$138.10
|
| Rate for Payer: Cofinity Commercial |
$148.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.06
|
| Rate for Payer: Healthscope Commercial |
$123.67
|
| Rate for Payer: Healthscope Whirlpool |
$123.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$113.37
|
| Rate for Payer: Nomi Health Commercial |
$123.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$258.00
|
| Rate for Payer: PACE SWMI |
$103.06
|
| Rate for Payer: PHP Medicare Advantage |
$103.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$158.54
|
| Rate for Payer: Priority Health Medicare |
$103.06
|
| Rate for Payer: Priority Health Narrow Network |
$158.54
|
| Rate for Payer: Railroad Medicare Medicare |
$103.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$162.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$103.06
|
| Rate for Payer: UHC Exchange |
$162.54
|
| Rate for Payer: UHCCP DNSP |
$103.06
|
|
|
CHG VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS 78457
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$250.61 |
| Rate for Payer: Aetna Commercial |
$208.32
|
| Rate for Payer: Aetna Commercial |
$208.32
|
| Rate for Payer: Aetna Medicare |
$155.46
|
| Rate for Payer: Aetna Medicare |
$155.46
|
| Rate for Payer: BCBS MAPPO |
$155.46
|
| Rate for Payer: BCBS MAPPO |
$155.46
|
| Rate for Payer: BCN Commercial |
$233.06
|
| Rate for Payer: BCN Commercial |
$233.06
|
| Rate for Payer: BCN Medicare Advantage |
$155.46
|
| Rate for Payer: BCN Medicare Advantage |
$155.46
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cofinity Commercial |
$223.86
|
| Rate for Payer: Cofinity Commercial |
$208.32
|
| Rate for Payer: Cofinity Commercial |
$223.86
|
| Rate for Payer: Cofinity Commercial |
$208.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.46
|
| Rate for Payer: Healthscope Commercial |
$186.55
|
| Rate for Payer: Healthscope Commercial |
$186.55
|
| Rate for Payer: Healthscope Whirlpool |
$186.55
|
| Rate for Payer: Healthscope Whirlpool |
$186.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$171.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$171.01
|
| Rate for Payer: Nomi Health Commercial |
$186.55
|
| Rate for Payer: Nomi Health Commercial |
$186.55
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$256.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$63.00
|
| Rate for Payer: PACE SWMI |
$155.46
|
| Rate for Payer: PACE SWMI |
$155.46
|
| Rate for Payer: PHP Medicare Advantage |
$155.46
|
| Rate for Payer: PHP Medicare Advantage |
$155.46
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$234.81
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$234.81
|
| Rate for Payer: Priority Health Medicare |
$155.46
|
| Rate for Payer: Priority Health Medicare |
$155.46
|
| Rate for Payer: Priority Health Narrow Network |
$234.81
|
| Rate for Payer: Priority Health Narrow Network |
$234.81
|
| Rate for Payer: Railroad Medicare Medicare |
$155.46
|
| Rate for Payer: Railroad Medicare Medicare |
$155.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$250.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$155.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$155.46
|
| Rate for Payer: UHC Exchange |
$250.61
|
| Rate for Payer: UHC Exchange |
$250.61
|
| Rate for Payer: UHCCP DNSP |
$155.46
|
| Rate for Payer: UHCCP DNSP |
$155.46
|
|
|
CHG X-RAY ABDOMEN 1 VW
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 74000
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.75
|
|
|
CHG X-RAY ABDOMEN 2 VW
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 74020
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$41.25
|
|
|
CHG X-RAY FEMUR 2 VW
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 73550
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$23.25
|
|
|
CHG X-RAY HIPS 4 VW + PELVIS
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 73520
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$93.75 |
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$93.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$36.00
|
|
|
CHG X-RAY HIP UNI 2+ VW
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 73510
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$28.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$42.00
|
|
|
CHG X-RAY HIP UNILAT 1 VW
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 73500
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.25
|
|
|
CHG X-RAY PELVIS/HIPS CHILD/INFANT
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 73540
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$27.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.00
|
|
|
CHG X-RAY SPINE SURVEY
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 72010
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$56.25 |
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$56.25
|
|
|
CHG X-RAY THOR-LUMB SP SCOLIOSIS
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 72090
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$77.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.75
|
|
