|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$2.33
|
|
|
Service Code
|
NDC 00904733735
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$2.33 |
| Rate for Payer: Aetna Commercial |
$2.10
|
| Rate for Payer: Aetna Medicare |
$1.16
|
| Rate for Payer: ASR ASR |
$2.26
|
| Rate for Payer: ASR Commercial |
$2.26
|
| Rate for Payer: BCBS Complete |
$0.93
|
| Rate for Payer: BCBS Trust/PPO |
$1.91
|
| Rate for Payer: BCN Commercial |
$1.81
|
| Rate for Payer: Cash Price |
$1.86
|
| Rate for Payer: Cofinity Commercial |
$2.19
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.86
|
| Rate for Payer: Healthscope Commercial |
$2.33
|
| Rate for Payer: Healthscope Whirlpool |
$2.26
|
| Rate for Payer: Mclaren Commercial |
$2.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1.98
|
| Rate for Payer: Nomi Health Commercial |
$1.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.51
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.04
|
| Rate for Payer: Priority Health Narrow Network |
$1.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.05
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$324.30
|
|
|
Service Code
|
NDC 67877021901
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$324.30 |
| Rate for Payer: Aetna Commercial |
$291.87
|
| Rate for Payer: ASR ASR |
$314.57
|
| Rate for Payer: ASR Commercial |
$314.57
|
| Rate for Payer: BCBS Trust/PPO |
$264.27
|
| Rate for Payer: BCN Commercial |
$251.43
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$304.84
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$324.30
|
| Rate for Payer: Healthscope Whirlpool |
$314.57
|
| Rate for Payer: Mclaren Commercial |
$291.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.66
|
| Rate for Payer: Nomi Health Commercial |
$265.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$285.38
|
|
|
CHEMICAL PEELS
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 00172
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
Both
|
$1,373.00
|
|
|
Service Code
|
HCPCS 77295
|
| Min. Negotiated Rate |
$145.05 |
| Max. Negotiated Rate |
$892.45 |
| Rate for Payer: Aetna Commercial |
$553.26
|
| Rate for Payer: Aetna Commercial |
$553.26
|
| Rate for Payer: Aetna Medicare |
$874.00
|
| Rate for Payer: Aetna Medicare |
$686.50
|
| Rate for Payer: BCBS Complete |
$152.30
|
| Rate for Payer: BCBS Complete |
$152.30
|
| Rate for Payer: BCBS Trust/PPO |
$192.72
|
| Rate for Payer: BCBS Trust/PPO |
$192.72
|
| Rate for Payer: BCN Commercial |
$699.98
|
| Rate for Payer: BCN Commercial |
$699.98
|
| Rate for Payer: Cash Price |
$1,398.40
|
| Rate for Payer: Cash Price |
$1,398.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Meridian Medicaid |
$152.30
|
| Rate for Payer: Meridian Medicaid |
$152.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.89
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$343.89
|
| Rate for Payer: Priority Health Narrow Network |
$343.89
|
| Rate for Payer: Priority Health Narrow Network |
$343.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$797.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$797.63
|
| Rate for Payer: UHC Exchange |
$797.63
|
| Rate for Payer: UHC Exchange |
$797.63
|
| Rate for Payer: UHCCP Medicaid |
$145.05
|
| Rate for Payer: UHCCP Medicaid |
$145.05
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 76377
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$904.45 |
| Rate for Payer: Aetna Commercial |
$87.24
|
| Rate for Payer: Aetna Medicare |
$68.50
|
| Rate for Payer: BCBS Complete |
$25.05
|
| Rate for Payer: BCBS Trust/PPO |
$904.45
|
| Rate for Payer: BCN Commercial |
$110.93
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Meridian Medicaid |
$25.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.48
|
| Rate for Payer: Priority Health Narrow Network |
$57.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$99.68
|
| Rate for Payer: UHC Exchange |
$99.68
|
| Rate for Payer: UHCCP Medicaid |
$23.86
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 76376
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$1,774.03 |
| Rate for Payer: Aetna Commercial |
$27.49
|
| Rate for Payer: Aetna Commercial |
$27.49
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,774.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,774.03
|
| Rate for Payer: BCN Commercial |
$35.19
|
| Rate for Payer: BCN Commercial |
$35.19
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Meridian Medicaid |
$6.26
|
| Rate for Payer: Meridian Medicaid |
$6.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.37
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$14.37
|
| Rate for Payer: Priority Health Narrow Network |
$14.37
|
| Rate for Payer: Priority Health Narrow Network |
$14.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.51
|
| Rate for Payer: UHC Exchange |
$74.51
|
| Rate for Payer: UHC Exchange |
$74.51
|
| Rate for Payer: UHCCP Medicaid |
$5.96
|
| Rate for Payer: UHCCP Medicaid |
$5.96
|
|
|
CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 78278
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$674.64 |
| Rate for Payer: Aetna Commercial |
$394.55
|
| Rate for Payer: Aetna Medicare |
$343.00
|
| Rate for Payer: BCBS Complete |
$30.64
|
| Rate for Payer: BCBS Trust/PPO |
$674.64
|
| Rate for Payer: BCN Commercial |
$475.00
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Meridian Medicaid |
$30.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.31
|
| Rate for Payer: Priority Health Narrow Network |
$70.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$328.76
|
| Rate for Payer: UHC Exchange |
$328.76
|
| Rate for Payer: UHCCP Medicaid |
$29.18
|
|
|
CHG ANGIO ARCH ANGIOGRAM W CATH
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 75650
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$173.55 |
| Rate for Payer: Aetna Medicare |
$133.50
|
| Rate for Payer: BCBS Complete |
$106.80
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.55
|
|
|
CHG ANGIO AV SHUNT COMPLETE EVAL
|
Professional
|
Both
|
$507.00
|
|
|
Service Code
|
HCPCS 75791
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$329.55 |
| Rate for Payer: Aetna Medicare |
$253.50
|
| Rate for Payer: Aetna Medicare |
$154.00
|
| Rate for Payer: BCBS Complete |
$202.80
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.55
|
|
|
CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 75716
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$301.35 |
| Rate for Payer: Aetna Commercial |
$198.34
|
| Rate for Payer: Aetna Medicare |
$99.00
|
| Rate for Payer: BCBS Complete |
$61.06
|
| Rate for Payer: BCBS Trust/PPO |
$112.00
|
| Rate for Payer: BCN Commercial |
$237.49
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Meridian Medicaid |
$61.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.60
|
| Rate for Payer: Priority Health Narrow Network |
$139.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$301.35
|
| Rate for Payer: UHC Exchange |
$301.35
|
| Rate for Payer: UHCCP Medicaid |
$58.15
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 75710
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$279.50 |
| Rate for Payer: Aetna Commercial |
$184.17
|
| Rate for Payer: Aetna Commercial |
$184.17
|
| Rate for Payer: Aetna Medicare |
$215.00
|
| Rate for Payer: Aetna Medicare |
$91.00
|
| Rate for Payer: BCBS Complete |
$54.13
|
| Rate for Payer: BCBS Complete |
$54.13
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: BCN Commercial |
$219.91
|
| Rate for Payer: BCN Commercial |
$219.91
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Meridian Medicaid |
$54.13
|
| Rate for Payer: Meridian Medicaid |
$54.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.72
|
| Rate for Payer: Priority Health Narrow Network |
$124.72
|
| Rate for Payer: Priority Health Narrow Network |
$124.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$264.21
|
| Rate for Payer: UHC Exchange |
$264.21
|
| Rate for Payer: UHC Exchange |
$264.21
|
| Rate for Payer: UHCCP Medicaid |
$51.55
|
| Rate for Payer: UHCCP Medicaid |
$51.55
|
|
|
CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 75756
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$274.95 |
| Rate for Payer: Aetna Commercial |
$184.66
|
| Rate for Payer: Aetna Medicare |
$95.00
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS Trust/PPO |
$177.51
|
| Rate for Payer: BCN Commercial |
$236.52
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$82.63
|
| Rate for Payer: Priority Health Narrow Network |
$82.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$274.95
|
| Rate for Payer: UHC Exchange |
$274.95
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
|
|
CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 75736
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna Commercial |
$167.44
|
| Rate for Payer: Aetna Medicare |
$159.50
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS Trust/PPO |
$182.79
|
| Rate for Payer: BCN Commercial |
$209.15
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Meridian Medicaid |
$34.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$78.53
|
| Rate for Payer: Priority Health Narrow Network |
$78.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.26
|
| Rate for Payer: UHC Exchange |
$262.26
|
| Rate for Payer: UHCCP Medicaid |
$32.59
|
|
|
CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 75741
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$251.31 |
| Rate for Payer: Aetna Commercial |
$158.51
|
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$39.58
|
| Rate for Payer: BCBS Trust/PPO |
$104.08
|
| Rate for Payer: BCN Commercial |
$191.56
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Meridian Medicaid |
$39.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$90.85
|
| Rate for Payer: Priority Health Narrow Network |
$90.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.31
|
| Rate for Payer: UHC Exchange |
$251.31
|
| Rate for Payer: UHCCP Medicaid |
$37.70
|
|
|
CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 75705
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$363.58 |
| Rate for Payer: Aetna Commercial |
$287.69
|
| Rate for Payer: Aetna Medicare |
$218.00
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS Trust/PPO |
$162.19
|
| Rate for Payer: BCN Commercial |
$363.58
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Meridian Medicaid |
$78.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.56
|
| Rate for Payer: Priority Health Narrow Network |
$176.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$320.10
|
| Rate for Payer: UHC Exchange |
$320.10
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
|
|
CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 75726
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$261.97 |
| Rate for Payer: Aetna Commercial |
$206.42
|
| Rate for Payer: Aetna Medicare |
$136.50
|
| Rate for Payer: BCBS Complete |
$62.62
|
| Rate for Payer: BCBS Trust/PPO |
$145.81
|
| Rate for Payer: BCN Commercial |
$250.69
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Meridian Medicaid |
$62.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.65
|
| Rate for Payer: Priority Health Narrow Network |
$141.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.97
|
| Rate for Payer: UHC Exchange |
$261.97
|
| Rate for Payer: UHCCP Medicaid |
$59.64
|
|
|
CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 75898
|
| Min. Negotiated Rate |
$57.72 |
| Max. Negotiated Rate |
$3,164.58 |
| Rate for Payer: Aetna Commercial |
$3,164.58
|
| Rate for Payer: Aetna Medicare |
$81.00
|
| Rate for Payer: BCBS Complete |
$60.61
|
| Rate for Payer: BCBS Trust/PPO |
$328.07
|
| Rate for Payer: BCN Commercial |
$2,886.03
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Meridian Medicaid |
$60.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.06
|
| Rate for Payer: Priority Health Narrow Network |
$138.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$143.76
|
| Rate for Payer: UHC Exchange |
$143.76
|
| Rate for Payer: UHCCP Medicaid |
$57.72
|
|
|
CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 75774
|
| Min. Negotiated Rate |
$28.97 |
| Max. Negotiated Rate |
$196.30 |
| Rate for Payer: Aetna Commercial |
$120.01
|
| Rate for Payer: Aetna Medicare |
$151.00
|
| Rate for Payer: BCBS Complete |
$30.42
|
| Rate for Payer: BCBS Trust/PPO |
$186.49
|
| Rate for Payer: BCN Commercial |
$142.21
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Meridian Medicaid |
$30.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.80
|
| Rate for Payer: Priority Health Narrow Network |
$69.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.04
|
| Rate for Payer: UHC Exchange |
$186.04
|
| Rate for Payer: UHCCP Medicaid |
$28.97
|
|
|
CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 75630
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna Commercial |
$192.70
|
| Rate for Payer: Aetna Commercial |
$192.70
|
| Rate for Payer: Aetna Medicare |
$237.50
|
| Rate for Payer: Aetna Medicare |
$146.50
|
| Rate for Payer: BCBS Complete |
$61.95
|
| Rate for Payer: BCBS Complete |
$61.95
|
| Rate for Payer: BCBS Trust/PPO |
$166.41
|
| Rate for Payer: BCBS Trust/PPO |
$166.41
|
| Rate for Payer: BCN Commercial |
$229.19
|
| Rate for Payer: BCN Commercial |
$229.19
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Meridian Medicaid |
$61.95
|
| Rate for Payer: Meridian Medicaid |
$61.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$141.65
|
| Rate for Payer: Priority Health Narrow Network |
$141.65
|
| Rate for Payer: Priority Health Narrow Network |
$141.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$289.94
|
| Rate for Payer: UHC Exchange |
$289.94
|
| Rate for Payer: UHC Exchange |
$289.94
|
| Rate for Payer: UHCCP Medicaid |
$59.00
|
| Rate for Payer: UHCCP Medicaid |
$59.00
|
|
|
CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 75625
|
| Min. Negotiated Rate |
$42.60 |
| Max. Negotiated Rate |
$247.97 |
| Rate for Payer: Aetna Commercial |
$155.85
|
| Rate for Payer: Aetna Commercial |
$155.85
|
| Rate for Payer: Aetna Medicare |
$57.50
|
| Rate for Payer: Aetna Medicare |
$57.00
|
| Rate for Payer: BCBS Complete |
$44.73
|
| Rate for Payer: BCBS Complete |
$44.73
|
| Rate for Payer: BCBS Trust/PPO |
$133.13
|
| Rate for Payer: BCBS Trust/PPO |
$133.13
|
| Rate for Payer: BCN Commercial |
$184.72
|
| Rate for Payer: BCN Commercial |
$184.72
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Meridian Medicaid |
$44.73
|
| Rate for Payer: Meridian Medicaid |
$44.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.14
|
| Rate for Payer: Priority Health Narrow Network |
$102.14
|
| Rate for Payer: Priority Health Narrow Network |
$102.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$247.97
|
| Rate for Payer: UHC Exchange |
$247.97
|
| Rate for Payer: UHC Exchange |
$247.97
|
| Rate for Payer: UHCCP Medicaid |
$42.60
|
| Rate for Payer: UHCCP Medicaid |
$42.60
|
|
|
CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 75605
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$249.44 |
| Rate for Payer: Aetna Commercial |
$145.70
|
| Rate for Payer: Aetna Medicare |
$132.50
|
| Rate for Payer: BCBS Complete |
$35.33
|
| Rate for Payer: BCBS Trust/PPO |
$157.43
|
| Rate for Payer: BCN Commercial |
$176.42
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Meridian Medicaid |
$35.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$80.58
|
| Rate for Payer: Priority Health Narrow Network |
$80.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$249.44
|
| Rate for Payer: UHC Exchange |
$249.44
|
| Rate for Payer: UHCCP Medicaid |
$33.65
|
|
|
CHG AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS 75600
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$299.40 |
| Rate for Payer: Aetna Commercial |
$227.46
|
| Rate for Payer: Aetna Medicare |
$53.50
|
| Rate for Payer: BCBS Complete |
$15.44
|
| Rate for Payer: BCBS Trust/PPO |
$114.11
|
| Rate for Payer: BCN Commercial |
$270.73
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Meridian Medicaid |
$15.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.42
|
| Rate for Payer: Priority Health Narrow Network |
$35.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$299.40
|
| Rate for Payer: UHC Exchange |
$299.40
|
| Rate for Payer: UHCCP Medicaid |
$14.70
|
|
|
CHG ASSAY OF LEAD
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 83655
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$365.58 |
| Rate for Payer: Aetna Commercial |
$11.50
|
| Rate for Payer: Aetna Medicare |
$10.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS Trust/PPO |
$365.58
|
| Rate for Payer: BCN Commercial |
$9.08
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.98
|
| Rate for Payer: Priority Health Narrow Network |
$11.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.40
|
| Rate for Payer: UHC Exchange |
$10.40
|
|
|
CHG ASSAY OF PHOSPHATASE ALKALINE
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 84075
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1,760.30 |
| Rate for Payer: Aetna Commercial |
$4.92
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,760.30
|
| Rate for Payer: BCN Commercial |
$1.08
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.33
|
| Rate for Payer: Priority Health Narrow Network |
$5.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.45
|
| Rate for Payer: UHC Exchange |
$4.45
|
|
|
CHG ASSAY OF PROGESTERONE
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 84144
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$2,469.80 |
| Rate for Payer: Aetna Commercial |
$19.82
|
| Rate for Payer: Aetna Medicare |
$47.00
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,469.80
|
| Rate for Payer: BCN Commercial |
$15.65
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$20.97
|
| Rate for Payer: Priority Health Narrow Network |
$20.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$17.93
|
| Rate for Payer: UHC Exchange |
$17.93
|
|
