|
CHG CT GUIDANCE &MONITORING VISC TISS ABLATION
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
HCPCS 77013
|
| Min. Negotiated Rate |
$115.45 |
| Max. Negotiated Rate |
$711.03 |
| Rate for Payer: Aetna Commercial |
$620.14
|
| Rate for Payer: Aetna Medicare |
$198.50
|
| Rate for Payer: BCBS Complete |
$121.22
|
| Rate for Payer: BCN Commercial |
$711.03
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Meridian Medicaid |
$121.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$115.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$275.61
|
| Rate for Payer: Priority Health Narrow Network |
$275.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$652.47
|
| Rate for Payer: UHC Exchange |
$652.47
|
| Rate for Payer: UHCCP Medicaid |
$115.45
|
|
|
CHG CT GUIDANCE NEEDLE PLACEMENT
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 77012
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$801.43 |
| Rate for Payer: Aetna Commercial |
$181.02
|
| Rate for Payer: Aetna Medicare |
$109.00
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS Trust/PPO |
$801.43
|
| Rate for Payer: BCN Commercial |
$207.20
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.22
|
| Rate for Payer: Priority Health Narrow Network |
$105.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$177.32
|
| Rate for Payer: UHC Exchange |
$177.32
|
| Rate for Payer: UHCCP Medicaid |
$43.88
|
|
|
CHG CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 77014
|
| Min. Negotiated Rate |
$28.97 |
| Max. Negotiated Rate |
$1,757.13 |
| Rate for Payer: Aetna Commercial |
$149.64
|
| Rate for Payer: Aetna Commercial |
$149.64
|
| Rate for Payer: Aetna Medicare |
$121.50
|
| Rate for Payer: Aetna Medicare |
$161.00
|
| Rate for Payer: BCBS Complete |
$30.42
|
| Rate for Payer: BCBS Complete |
$30.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,757.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,757.13
|
| Rate for Payer: BCN Commercial |
$176.42
|
| Rate for Payer: BCN Commercial |
$176.42
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Meridian Medicaid |
$30.42
|
| Rate for Payer: Meridian Medicaid |
$30.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.26
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.26
|
| Rate for Payer: Priority Health Narrow Network |
$68.26
|
| Rate for Payer: Priority Health Narrow Network |
$68.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$188.78
|
| Rate for Payer: UHC Exchange |
$188.78
|
| Rate for Payer: UHC Exchange |
$188.78
|
| Rate for Payer: UHCCP Medicaid |
$28.97
|
| Rate for Payer: UHCCP Medicaid |
$28.97
|
|
|
CHG CT GUIDANCE STEREOTACTIC LOCALIZATION
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 77011
|
| Min. Negotiated Rate |
$38.98 |
| Max. Negotiated Rate |
$704.79 |
| Rate for Payer: Aetna Commercial |
$283.63
|
| Rate for Payer: Aetna Commercial |
$283.63
|
| Rate for Payer: Aetna Medicare |
$233.00
|
| Rate for Payer: Aetna Medicare |
$67.00
|
| Rate for Payer: BCBS Complete |
$40.93
|
| Rate for Payer: BCBS Complete |
$40.93
|
| Rate for Payer: BCBS Trust/PPO |
$284.23
|
| Rate for Payer: BCBS Trust/PPO |
$284.23
|
| Rate for Payer: BCN Commercial |
$328.39
|
| Rate for Payer: BCN Commercial |
$328.39
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Meridian Medicaid |
$40.93
|
| Rate for Payer: Meridian Medicaid |
$40.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.41
|
| Rate for Payer: Priority Health Narrow Network |
$93.41
|
| Rate for Payer: Priority Health Narrow Network |
$93.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$704.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$704.79
|
| Rate for Payer: UHC Exchange |
$704.79
|
| Rate for Payer: UHC Exchange |
$704.79
|
| Rate for Payer: UHCCP Medicaid |
$38.98
|
| Rate for Payer: UHCCP Medicaid |
$38.98
|
|
|
CHG CT HEAD/BRAIN W/CONTRAST MATERIAL
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 70460
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$260.01 |
| Rate for Payer: Aetna Commercial |
$193.57
|
| Rate for Payer: Aetna Medicare |
$58.50
|
| Rate for Payer: BCBS Complete |
$35.56
|
| Rate for Payer: BCN Commercial |
$224.30
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Meridian Medicaid |
$35.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.61
|
| Rate for Payer: Priority Health Narrow Network |
$81.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$260.01
|
| Rate for Payer: UHC Exchange |
$260.01
|
| Rate for Payer: UHCCP Medicaid |
$33.87
|
|
|
CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 70450
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$199.95 |
| Rate for Payer: Aetna Commercial |
$137.94
|
| Rate for Payer: Aetna Medicare |
$44.00
|
| Rate for Payer: BCBS Complete |
$26.84
|
| Rate for Payer: BCN Commercial |
$160.77
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Meridian Medicaid |
$26.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.07
|
| Rate for Payer: Priority Health Narrow Network |
$61.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.95
|
| Rate for Payer: UHC Exchange |
$199.95
|
| Rate for Payer: UHCCP Medicaid |
$25.56
|
|
|
CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 70470
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$313.90 |
| Rate for Payer: Aetna Commercial |
$227.23
|
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCN Commercial |
$263.88
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.87
|
| Rate for Payer: Priority Health Narrow Network |
$91.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.90
|
| Rate for Payer: UHC Exchange |
$313.90
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
|
|
CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 75572
|
| Min. Negotiated Rate |
$51.97 |
| Max. Negotiated Rate |
$343.54 |
| Rate for Payer: Aetna Commercial |
$311.94
|
| Rate for Payer: Aetna Medicare |
$89.50
|
| Rate for Payer: BCBS Complete |
$54.57
|
| Rate for Payer: BCN Commercial |
$343.54
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Meridian Medicaid |
$54.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$124.72
|
| Rate for Payer: Priority Health Narrow Network |
$124.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.79
|
| Rate for Payer: UHC Exchange |
$316.79
|
| Rate for Payer: UHCCP Medicaid |
$51.97
|
|
|
CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 75571
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$151.00 |
| Rate for Payer: Aetna Commercial |
$127.18
|
| Rate for Payer: Aetna Medicare |
$29.50
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCN Commercial |
$151.00
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Meridian Medicaid |
$18.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.57
|
| Rate for Payer: Priority Health Narrow Network |
$41.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.44
|
| Rate for Payer: UHC Exchange |
$94.44
|
| Rate for Payer: UHCCP Medicaid |
$17.47
|
|
|
CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 76380
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$954.11 |
| Rate for Payer: Aetna Commercial |
$152.20
|
| Rate for Payer: Aetna Medicare |
$76.50
|
| Rate for Payer: BCBS Complete |
$29.97
|
| Rate for Payer: BCBS Trust/PPO |
$954.11
|
| Rate for Payer: BCN Commercial |
$199.38
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Meridian Medicaid |
$29.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.78
|
| Rate for Payer: Priority Health Narrow Network |
$68.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$206.10
|
| Rate for Payer: UHC Exchange |
$206.10
|
| Rate for Payer: UHCCP Medicaid |
$28.54
|
|
|
CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 73701
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$302.56 |
| Rate for Payer: Aetna Commercial |
$217.91
|
| Rate for Payer: Aetna Medicare |
$59.50
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCN Commercial |
$253.14
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.66
|
| Rate for Payer: Priority Health Narrow Network |
$83.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$302.56
|
| Rate for Payer: UHC Exchange |
$302.56
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
|
|
CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 73700
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$251.43 |
| Rate for Payer: Aetna Commercial |
$168.84
|
| Rate for Payer: Aetna Medicare |
$51.50
|
| Rate for Payer: BCBS Complete |
$31.31
|
| Rate for Payer: BCN Commercial |
$195.96
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Meridian Medicaid |
$31.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.85
|
| Rate for Payer: Priority Health Narrow Network |
$71.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$251.43
|
| Rate for Payer: UHC Exchange |
$251.43
|
| Rate for Payer: UHCCP Medicaid |
$29.82
|
|
|
CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 73702
|
| Min. Negotiated Rate |
$36.21 |
| Max. Negotiated Rate |
$384.22 |
| Rate for Payer: Aetna Commercial |
$253.67
|
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$38.02
|
| Rate for Payer: BCN Commercial |
$296.63
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Meridian Medicaid |
$38.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.26
|
| Rate for Payer: Priority Health Narrow Network |
$87.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.22
|
| Rate for Payer: UHC Exchange |
$384.22
|
| Rate for Payer: UHCCP Medicaid |
$36.21
|
|
|
CHG CT LUMBAR SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 72132
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$313.08 |
| Rate for Payer: Aetna Commercial |
$220.57
|
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$38.24
|
| Rate for Payer: BCN Commercial |
$256.56
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Meridian Medicaid |
$38.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.76
|
| Rate for Payer: Priority Health Narrow Network |
$87.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$313.08
|
| Rate for Payer: UHC Exchange |
$313.08
|
| Rate for Payer: UHCCP Medicaid |
$36.42
|
|
|
CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 72131
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$261.96 |
| Rate for Payer: Aetna Commercial |
$168.84
|
| Rate for Payer: Aetna Medicare |
$51.50
|
| Rate for Payer: BCBS Complete |
$31.31
|
| Rate for Payer: BCN Commercial |
$195.47
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Meridian Medicaid |
$31.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.85
|
| Rate for Payer: Priority Health Narrow Network |
$71.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$261.96
|
| Rate for Payer: UHC Exchange |
$261.96
|
| Rate for Payer: UHCCP Medicaid |
$29.82
|
|
|
CHG CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 72133
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$380.56 |
| Rate for Payer: Aetna Commercial |
$258.31
|
| Rate for Payer: Aetna Medicare |
$65.50
|
| Rate for Payer: BCBS Complete |
$39.81
|
| Rate for Payer: BCN Commercial |
$301.02
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Meridian Medicaid |
$39.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.36
|
| Rate for Payer: Priority Health Narrow Network |
$91.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$380.56
|
| Rate for Payer: UHC Exchange |
$380.56
|
| Rate for Payer: UHCCP Medicaid |
$37.91
|
|
|
CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 70487
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$316.18 |
| Rate for Payer: Aetna Commercial |
$198.82
|
| Rate for Payer: Aetna Medicare |
$58.00
|
| Rate for Payer: BCBS Complete |
$35.56
|
| Rate for Payer: BCN Commercial |
$230.66
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Meridian Medicaid |
$35.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.09
|
| Rate for Payer: Priority Health Narrow Network |
$81.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$316.18
|
| Rate for Payer: UHC Exchange |
$316.18
|
| Rate for Payer: UHCCP Medicaid |
$33.87
|
|
|
CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 70486
|
| Min. Negotiated Rate |
$25.77 |
| Max. Negotiated Rate |
$262.26 |
| Rate for Payer: Aetna Commercial |
$166.20
|
| Rate for Payer: Aetna Medicare |
$44.00
|
| Rate for Payer: BCBS Complete |
$27.06
|
| Rate for Payer: BCN Commercial |
$194.49
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Meridian Medicaid |
$27.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.60
|
| Rate for Payer: Priority Health Narrow Network |
$61.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$262.26
|
| Rate for Payer: UHC Exchange |
$262.26
|
| Rate for Payer: UHCCP Medicaid |
$25.77
|
|
|
CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 70488
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$384.18 |
| Rate for Payer: Aetna Commercial |
$242.97
|
| Rate for Payer: Aetna Medicare |
$65.50
|
| Rate for Payer: BCBS Complete |
$39.81
|
| Rate for Payer: BCN Commercial |
$280.99
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Meridian Medicaid |
$39.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.36
|
| Rate for Payer: Priority Health Narrow Network |
$91.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$384.18
|
| Rate for Payer: UHC Exchange |
$384.18
|
| Rate for Payer: UHCCP Medicaid |
$37.91
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 70481
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$362.15 |
| Rate for Payer: Aetna Commercial |
$236.77
|
| Rate for Payer: Aetna Medicare |
$58.50
|
| Rate for Payer: BCBS Complete |
$35.56
|
| Rate for Payer: BCN Commercial |
$274.63
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Meridian Medicaid |
$35.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$81.61
|
| Rate for Payer: Priority Health Narrow Network |
$81.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$362.15
|
| Rate for Payer: UHC Exchange |
$362.15
|
| Rate for Payer: UHCCP Medicaid |
$33.87
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 70480
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$312.42 |
| Rate for Payer: Aetna Commercial |
$206.27
|
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$40.48
|
| Rate for Payer: BCN Commercial |
$240.43
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Meridian Medicaid |
$40.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.90
|
| Rate for Payer: Priority Health Narrow Network |
$92.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$312.42
|
| Rate for Payer: UHC Exchange |
$312.42
|
| Rate for Payer: UHCCP Medicaid |
$38.55
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 70482
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$412.53 |
| Rate for Payer: Aetna Commercial |
$278.12
|
| Rate for Payer: Aetna Medicare |
$65.50
|
| Rate for Payer: BCBS Complete |
$39.81
|
| Rate for Payer: BCN Commercial |
$320.57
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Meridian Medicaid |
$39.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.36
|
| Rate for Payer: Priority Health Narrow Network |
$91.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$412.53
|
| Rate for Payer: UHC Exchange |
$412.53
|
| Rate for Payer: UHCCP Medicaid |
$37.91
|
|
|
CHG CT PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 72193
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$351.36 |
| Rate for Payer: Aetna Commercial |
$277.26
|
| Rate for Payer: Aetna Medicare |
$59.50
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCN Commercial |
$351.36
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.66
|
| Rate for Payer: Priority Health Narrow Network |
$83.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$297.72
|
| Rate for Payer: UHC Exchange |
$297.72
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
|
|
CHG CT PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 72192
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$248.03 |
| Rate for Payer: Aetna Commercial |
$173.63
|
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCN Commercial |
$201.83
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Meridian Medicaid |
$34.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| 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 |
$248.03
|
| Rate for Payer: UHC Exchange |
$248.03
|
| Rate for Payer: UHCCP Medicaid |
$32.59
|
|
|
CHG CT PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 72194
|
| Min. Negotiated Rate |
$36.42 |
| Max. Negotiated Rate |
$387.52 |
| Rate for Payer: Aetna Commercial |
$280.75
|
| Rate for Payer: Aetna Medicare |
$62.50
|
| Rate for Payer: BCBS Complete |
$38.24
|
| Rate for Payer: BCN Commercial |
$387.52
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Meridian Medicaid |
$38.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.26
|
| Rate for Payer: Priority Health Narrow Network |
$87.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$379.00
|
| Rate for Payer: UHC Exchange |
$379.00
|
| Rate for Payer: UHCCP Medicaid |
$36.42
|
|
