|
CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 77778
|
| Min. Negotiated Rate |
$266.00 |
| Max. Negotiated Rate |
$1,331.65 |
| Rate for Payer: Aetna Commercial |
$1,018.17
|
| Rate for Payer: Aetna Commercial |
$1,018.17
|
| Rate for Payer: Aetna Medicare |
$266.00
|
| Rate for Payer: Aetna Medicare |
$854.50
|
| Rate for Payer: BCBS Complete |
$312.00
|
| Rate for Payer: BCBS Complete |
$312.00
|
| Rate for Payer: BCBS Trust/PPO |
$301.66
|
| Rate for Payer: BCBS Trust/PPO |
$301.66
|
| Rate for Payer: BCN Commercial |
$1,331.65
|
| Rate for Payer: BCN Commercial |
$1,331.65
|
| Rate for Payer: Cash Price |
$1,367.20
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$1,367.20
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Meridian Medicaid |
$312.00
|
| Rate for Payer: Meridian Medicaid |
$312.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$297.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$297.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$703.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$703.17
|
| Rate for Payer: Priority Health Narrow Network |
$703.17
|
| Rate for Payer: Priority Health Narrow Network |
$703.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,121.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,121.51
|
| Rate for Payer: UHC Exchange |
$1,121.51
|
| Rate for Payer: UHC Exchange |
$1,121.51
|
| Rate for Payer: UHCCP Medicaid |
$297.14
|
| Rate for Payer: UHCCP Medicaid |
$297.14
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 77761
|
| Min. Negotiated Rate |
$130.57 |
| Max. Negotiated Rate |
$610.36 |
| Rate for Payer: Aetna Commercial |
$469.99
|
| Rate for Payer: Aetna Medicare |
$232.50
|
| Rate for Payer: BCBS Complete |
$137.10
|
| Rate for Payer: BCBS Trust/PPO |
$324.38
|
| Rate for Payer: BCN Commercial |
$610.36
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Meridian Medicaid |
$137.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$308.98
|
| Rate for Payer: Priority Health Narrow Network |
$308.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.05
|
| Rate for Payer: UHC Exchange |
$480.05
|
| Rate for Payer: UHCCP Medicaid |
$130.57
|
|
|
CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 74360
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$2,791.54 |
| Rate for Payer: Aetna Commercial |
$128.38
|
| Rate for Payer: Aetna Medicare |
$45.50
|
| Rate for Payer: BCBS Complete |
$17.89
|
| Rate for Payer: BCBS Trust/PPO |
$2,791.54
|
| Rate for Payer: BCN Commercial |
$214.05
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Meridian Medicaid |
$17.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$41.06
|
| Rate for Payer: Priority Health Narrow Network |
$41.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.42
|
| Rate for Payer: UHC Exchange |
$169.42
|
| Rate for Payer: UHCCP Medicaid |
$17.04
|
|
|
CHG INTRAVASC ULTRASOUND,1ST VESSEL
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
HCPCS 75945
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$145.60 |
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: Aetna Medicare |
$42.50
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.25
|
|
|
CHG INTRAVASC US, RAD SUPERISE/ INTERP, EA ADDN VESSEL
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 75946
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$29.90 |
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
|
|
CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 74340
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$2,030.79 |
| Rate for Payer: Aetna Commercial |
$119.95
|
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,030.79
|
| Rate for Payer: BCN Commercial |
$178.86
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Meridian Medicaid |
$17.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.50
|
| Rate for Payer: Priority Health Narrow Network |
$38.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$145.93
|
| Rate for Payer: UHC Exchange |
$145.93
|
| Rate for Payer: UHCCP Medicaid |
$16.19
|
|
|
CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
HCPCS 77077
|
| Min. Negotiated Rate |
$10.44 |
| Max. Negotiated Rate |
$3,952.74 |
| Rate for Payer: Aetna Commercial |
$53.57
|
| Rate for Payer: Aetna Commercial |
$53.57
|
| Rate for Payer: Aetna Medicare |
$30.50
|
| Rate for Payer: Aetna Medicare |
$69.00
|
| Rate for Payer: BCBS Complete |
$10.96
|
| Rate for Payer: BCBS Complete |
$10.96
|
| Rate for Payer: BCBS Trust/PPO |
$3,952.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,952.74
|
| Rate for Payer: BCN Commercial |
$68.90
|
| Rate for Payer: BCN Commercial |
$68.90
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Meridian Medicaid |
$10.96
|
| Rate for Payer: Meridian Medicaid |
$10.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$10.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$25.15
|
| Rate for Payer: Priority Health Narrow Network |
$25.15
|
| Rate for Payer: Priority Health Narrow Network |
$25.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.77
|
| Rate for Payer: UHC Exchange |
$44.77
|
| Rate for Payer: UHC Exchange |
$44.77
|
| Rate for Payer: UHCCP Medicaid |
$10.44
|
| Rate for Payer: UHCCP Medicaid |
$10.44
|
|
|
CHG LIPID PANEL
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 80061
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$2,009.65 |
| Rate for Payer: Aetna Commercial |
$12.72
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$2,009.65
|
| Rate for Payer: BCN Commercial |
$16.58
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.32
|
| Rate for Payer: Priority Health Narrow Network |
$13.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$10.98
|
| Rate for Payer: UHC Exchange |
$10.98
|
|
|
CHG MANUAL APPL STRESS PHYS/QHP JOINT RADIOGRAPHY
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 77071
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$882.79 |
| Rate for Payer: Aetna Commercial |
$62.73
|
| Rate for Payer: Aetna Commercial |
$62.73
|
| Rate for Payer: Aetna Medicare |
$47.00
|
| Rate for Payer: Aetna Medicare |
$44.50
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS Trust/PPO |
$882.79
|
| Rate for Payer: BCBS Trust/PPO |
$882.79
|
| Rate for Payer: BCN Commercial |
$80.14
|
| Rate for Payer: BCN Commercial |
$80.14
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.68
|
| Rate for Payer: Priority Health Narrow Network |
$84.68
|
| Rate for Payer: Priority Health Narrow Network |
$84.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$45.75
|
| Rate for Payer: UHC Exchange |
$45.75
|
| Rate for Payer: UHC Exchange |
$45.75
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
|
|
CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 75902
|
| Min. Negotiated Rate |
$11.50 |
| Max. Negotiated Rate |
$449.58 |
| Rate for Payer: Aetna Commercial |
$104.59
|
| Rate for Payer: Aetna Medicare |
$19.00
|
| Rate for Payer: BCBS Complete |
$12.08
|
| Rate for Payer: BCBS Trust/PPO |
$449.58
|
| Rate for Payer: BCN Commercial |
$132.92
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Meridian Medicaid |
$12.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$11.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.20
|
| Rate for Payer: Priority Health Narrow Network |
$27.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$79.62
|
| Rate for Payer: UHC Exchange |
$79.62
|
| Rate for Payer: UHCCP Medicaid |
$11.50
|
|
|
CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 75901
|
| Min. Negotiated Rate |
$14.06 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$267.87
|
| Rate for Payer: Aetna Medicare |
$169.50
|
| Rate for Payer: BCBS Complete |
$14.76
|
| Rate for Payer: BCBS Trust/PPO |
$420.00
|
| Rate for Payer: BCN Commercial |
$339.14
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Meridian Medicaid |
$14.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$33.88
|
| Rate for Payer: Priority Health Narrow Network |
$33.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.66
|
| Rate for Payer: UHC Exchange |
$161.66
|
| Rate for Payer: UHCCP Medicaid |
$14.06
|
|
|
CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN
|
Professional
|
Both
|
$971.00
|
|
|
Service Code
|
HCPCS 77338
|
| Min. Negotiated Rate |
$145.05 |
| Max. Negotiated Rate |
$2,953.73 |
| Rate for Payer: Aetna Commercial |
$541.84
|
| Rate for Payer: Aetna Commercial |
$541.84
|
| Rate for Payer: Aetna Commercial |
$541.84
|
| Rate for Payer: Aetna Medicare |
$485.50
|
| Rate for Payer: Aetna Medicare |
$262.50
|
| Rate for Payer: Aetna Medicare |
$476.50
|
| Rate for Payer: BCBS Complete |
$152.30
|
| Rate for Payer: BCBS Complete |
$152.30
|
| Rate for Payer: BCBS Complete |
$152.30
|
| Rate for Payer: BCBS Trust/PPO |
$2,953.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,953.73
|
| Rate for Payer: BCBS Trust/PPO |
$2,953.73
|
| Rate for Payer: BCN Commercial |
$724.75
|
| Rate for Payer: BCN Commercial |
$724.75
|
| Rate for Payer: BCN Commercial |
$724.75
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$762.40
|
| Rate for Payer: Cash Price |
$762.40
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Meridian Medicaid |
$152.30
|
| 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 Choice Medicaid |
$145.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$619.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$344.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$344.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$344.40
|
| Rate for Payer: Priority Health Narrow Network |
$344.40
|
| Rate for Payer: Priority Health Narrow Network |
$344.40
|
| Rate for Payer: Priority Health Narrow Network |
$344.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$644.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$644.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$644.30
|
| Rate for Payer: UHC Exchange |
$644.30
|
| Rate for Payer: UHC Exchange |
$644.30
|
| Rate for Payer: UHC Exchange |
$644.30
|
| Rate for Payer: UHCCP Medicaid |
$145.05
|
| Rate for Payer: UHCCP Medicaid |
$145.05
|
| Rate for Payer: UHCCP Medicaid |
$145.05
|
|
|
CHG MRA ABDOMEN W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 74185
|
| Min. Negotiated Rate |
$53.68 |
| Max. Negotiated Rate |
$597.83 |
| Rate for Payer: Aetna Commercial |
$555.56
|
| Rate for Payer: Aetna Medicare |
$92.00
|
| Rate for Payer: BCBS Complete |
$56.36
|
| Rate for Payer: BCN Commercial |
$515.56
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Meridian Medicaid |
$56.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.32
|
| Rate for Payer: Priority Health Narrow Network |
$128.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$597.83
|
| Rate for Payer: UHC Exchange |
$597.83
|
| Rate for Payer: UHCCP Medicaid |
$53.68
|
|
|
CHG MRA HEAD W/O CONTRST MATERIAL
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 70544
|
| Min. Negotiated Rate |
$35.78 |
| Max. Negotiated Rate |
$1,742.33 |
| Rate for Payer: Aetna Commercial |
$349.94
|
| Rate for Payer: Aetna Commercial |
$349.94
|
| Rate for Payer: Aetna Medicare |
$119.50
|
| Rate for Payer: Aetna Medicare |
$343.00
|
| Rate for Payer: BCBS Complete |
$37.57
|
| Rate for Payer: BCBS Complete |
$37.57
|
| Rate for Payer: BCBS Trust/PPO |
$1,742.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,742.33
|
| Rate for Payer: BCN Commercial |
$328.39
|
| Rate for Payer: BCN Commercial |
$328.39
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Meridian Medicaid |
$37.57
|
| Rate for Payer: Meridian Medicaid |
$37.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.78
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.22
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.22
|
| Rate for Payer: Priority Health Narrow Network |
$86.22
|
| Rate for Payer: Priority Health Narrow Network |
$86.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$595.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$595.74
|
| Rate for Payer: UHC Exchange |
$595.74
|
| Rate for Payer: UHC Exchange |
$595.74
|
| Rate for Payer: UHCCP Medicaid |
$35.78
|
| Rate for Payer: UHCCP Medicaid |
$35.78
|
|
|
CHG MRA HEAD W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 70546
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$940.91 |
| Rate for Payer: Aetna Commercial |
$533.21
|
| Rate for Payer: Aetna Medicare |
$71.50
|
| Rate for Payer: BCBS Complete |
$46.52
|
| Rate for Payer: BCN Commercial |
$502.85
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Meridian Medicaid |
$46.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.76
|
| Rate for Payer: Priority Health Narrow Network |
$106.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$940.91
|
| Rate for Payer: UHC Exchange |
$940.91
|
| Rate for Payer: UHCCP Medicaid |
$44.30
|
|
|
CHG MRA NECK W/O CONTRST MATERIAL
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 70547
|
| Min. Negotiated Rate |
$36.00 |
| Max. Negotiated Rate |
$1,605.50 |
| Rate for Payer: Aetna Commercial |
$351.42
|
| Rate for Payer: Aetna Medicare |
$118.00
|
| Rate for Payer: BCBS Complete |
$37.80
|
| Rate for Payer: BCBS Trust/PPO |
$1,605.50
|
| Rate for Payer: BCN Commercial |
$328.88
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Meridian Medicaid |
$37.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.22
|
| Rate for Payer: Priority Health Narrow Network |
$86.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$594.25
|
| Rate for Payer: UHC Exchange |
$594.25
|
| Rate for Payer: UHCCP Medicaid |
$36.00
|
|
|
CHG MRA NECK W/O &W/CONTRAST MATERIAL
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 70549
|
| Min. Negotiated Rate |
$53.89 |
| Max. Negotiated Rate |
$2,120.07 |
| Rate for Payer: Aetna Commercial |
$560.98
|
| Rate for Payer: Aetna Medicare |
$140.50
|
| Rate for Payer: BCBS Complete |
$56.58
|
| Rate for Payer: BCBS Trust/PPO |
$2,120.07
|
| Rate for Payer: BCN Commercial |
$527.29
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Meridian Medicaid |
$56.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$129.33
|
| Rate for Payer: Priority Health Narrow Network |
$129.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$940.49
|
| Rate for Payer: UHC Exchange |
$940.49
|
| Rate for Payer: UHCCP Medicaid |
$53.89
|
|
|
CHG MRI ABDOMEN W/O CONTRAST FLWD BY W/CONTRAST
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS 74183
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$767.70 |
| Rate for Payer: Aetna Commercial |
$561.39
|
| Rate for Payer: Aetna Medicare |
$113.00
|
| Rate for Payer: BCBS Complete |
$69.55
|
| Rate for Payer: BCN Commercial |
$518.49
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Meridian Medicaid |
$69.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$158.09
|
| Rate for Payer: Priority Health Narrow Network |
$158.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$767.70
|
| Rate for Payer: UHC Exchange |
$767.70
|
| Rate for Payer: UHCCP Medicaid |
$66.24
|
|
|
CHG MRI ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 74181
|
| Min. Negotiated Rate |
$43.67 |
| Max. Negotiated Rate |
$466.18 |
| Rate for Payer: Aetna Commercial |
$322.13
|
| Rate for Payer: Aetna Medicare |
$75.50
|
| Rate for Payer: BCBS Complete |
$45.85
|
| Rate for Payer: BCN Commercial |
$299.56
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Meridian Medicaid |
$45.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.15
|
| 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 |
$466.18
|
| Rate for Payer: UHC Exchange |
$466.18
|
| Rate for Payer: UHCCP Medicaid |
$43.67
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 73721
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$498.84 |
| Rate for Payer: Aetna Commercial |
$329.02
|
| Rate for Payer: Aetna Medicare |
$65.50
|
| Rate for Payer: BCBS Complete |
$42.71
|
| Rate for Payer: BCN Commercial |
$308.36
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Meridian Medicaid |
$42.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.03
|
| Rate for Payer: Priority Health Narrow Network |
$98.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$498.84
|
| Rate for Payer: UHC Exchange |
$498.84
|
| Rate for Payer: UHCCP Medicaid |
$40.68
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 73723
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$727.68 |
| Rate for Payer: Aetna Commercial |
$646.38
|
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: BCBS Complete |
$68.22
|
| Rate for Payer: BCN Commercial |
$592.77
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Meridian Medicaid |
$68.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.01
|
| Rate for Payer: Priority Health Narrow Network |
$155.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$727.68
|
| Rate for Payer: UHC Exchange |
$727.68
|
| Rate for Payer: UHCCP Medicaid |
$64.97
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 73222
|
| Min. Negotiated Rate |
$48.78 |
| Max. Negotiated Rate |
$539.09 |
| Rate for Payer: Aetna Commercial |
$525.05
|
| Rate for Payer: Aetna Medicare |
$79.00
|
| Rate for Payer: BCBS Complete |
$51.22
|
| Rate for Payer: BCN Commercial |
$480.37
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Meridian Medicaid |
$51.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.54
|
| Rate for Payer: Priority Health Narrow Network |
$117.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$539.09
|
| Rate for Payer: UHC Exchange |
$539.09
|
| Rate for Payer: UHCCP Medicaid |
$48.78
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 73221
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$489.90 |
| Rate for Payer: Aetna Commercial |
$330.01
|
| Rate for Payer: Aetna Medicare |
$65.50
|
| Rate for Payer: BCBS Complete |
$42.71
|
| Rate for Payer: BCN Commercial |
$308.85
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Meridian Medicaid |
$42.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.03
|
| Rate for Payer: Priority Health Narrow Network |
$98.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$489.90
|
| Rate for Payer: UHC Exchange |
$489.90
|
| Rate for Payer: UHCCP Medicaid |
$40.68
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 73223
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$729.17 |
| Rate for Payer: Aetna Commercial |
$648.35
|
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: BCBS Complete |
$68.22
|
| Rate for Payer: BCN Commercial |
$594.72
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Meridian Medicaid |
$68.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.52
|
| Rate for Payer: Priority Health Narrow Network |
$155.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$729.17
|
| Rate for Payer: UHC Exchange |
$729.17
|
| Rate for Payer: UHCCP Medicaid |
$64.97
|
|
|
CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 70552
|
| Min. Negotiated Rate |
$53.46 |
| Max. Negotiated Rate |
$1,113.66 |
| Rate for Payer: Aetna Commercial |
$442.56
|
| Rate for Payer: Aetna Medicare |
$188.50
|
| Rate for Payer: BCBS Complete |
$56.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,113.66
|
| Rate for Payer: BCN Commercial |
$413.42
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Meridian Medicaid |
$56.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.32
|
| Rate for Payer: Priority Health Narrow Network |
$128.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$580.35
|
| Rate for Payer: UHC Exchange |
$580.35
|
| Rate for Payer: UHCCP Medicaid |
$53.46
|
|
