|
CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 70551
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$2,070.41 |
| Rate for Payer: Aetna Commercial |
$318.81
|
| Rate for Payer: Aetna Medicare |
$162.50
|
| Rate for Payer: BCBS Complete |
$46.52
|
| Rate for Payer: BCBS Trust/PPO |
$2,070.41
|
| Rate for Payer: BCN Commercial |
$298.58
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Meridian Medicaid |
$46.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.25
|
| 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 |
$519.10
|
| Rate for Payer: UHC Exchange |
$519.10
|
| Rate for Payer: UHCCP Medicaid |
$44.30
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 70553
|
| Min. Negotiated Rate |
$69.01 |
| Max. Negotiated Rate |
$968.37 |
| Rate for Payer: Aetna Commercial |
$523.42
|
| Rate for Payer: Aetna Medicare |
$174.00
|
| Rate for Payer: BCBS Complete |
$72.46
|
| Rate for Payer: BCBS Trust/PPO |
$968.37
|
| Rate for Payer: BCN Commercial |
$486.73
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Meridian Medicaid |
$72.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$164.75
|
| Rate for Payer: Priority Health Narrow Network |
$164.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$750.38
|
| Rate for Payer: UHC Exchange |
$750.38
|
| Rate for Payer: UHCCP Medicaid |
$69.01
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 73718
|
| Min. Negotiated Rate |
$40.47 |
| Max. Negotiated Rate |
$508.47 |
| Rate for Payer: Aetna Commercial |
$368.90
|
| Rate for Payer: Aetna Medicare |
$65.50
|
| Rate for Payer: BCBS Complete |
$42.49
|
| Rate for Payer: BCN Commercial |
$342.07
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Meridian Medicaid |
$42.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.00
|
| Rate for Payer: Priority Health Narrow Network |
$97.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$508.47
|
| Rate for Payer: UHC Exchange |
$508.47
|
| Rate for Payer: UHCCP Medicaid |
$40.47
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 73720
|
| Min. Negotiated Rate |
$64.97 |
| Max. Negotiated Rate |
$764.56 |
| Rate for Payer: Aetna Commercial |
$560.16
|
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: BCBS Complete |
$68.22
|
| Rate for Payer: BCN Commercial |
$517.02
|
| 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 |
$154.50
|
| Rate for Payer: Priority Health Narrow Network |
$154.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$764.56
|
| Rate for Payer: UHC Exchange |
$764.56
|
| Rate for Payer: UHCCP Medicaid |
$64.97
|
|
|
CHG MRI ORBIT FACE &/NECK W/O CONTRAST
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 70540
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$504.76 |
| Rate for Payer: Aetna Commercial |
$373.33
|
| Rate for Payer: Aetna Medicare |
$65.00
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCN Commercial |
$345.99
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.00
|
| Rate for Payer: Priority Health Narrow Network |
$97.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$504.76
|
| Rate for Payer: UHC Exchange |
$504.76
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
|
|
CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 70543
|
| Min. Negotiated Rate |
$64.75 |
| Max. Negotiated Rate |
$756.36 |
| Rate for Payer: Aetna Commercial |
$560.16
|
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: BCBS Complete |
$67.99
|
| Rate for Payer: BCN Commercial |
$518.97
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Meridian Medicaid |
$67.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$64.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$154.50
|
| Rate for Payer: Priority Health Narrow Network |
$154.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$756.36
|
| Rate for Payer: UHC Exchange |
$756.36
|
| Rate for Payer: UHCCP Medicaid |
$64.75
|
|
|
CHG MRI PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 72195
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$517.25 |
| Rate for Payer: Aetna Commercial |
$379.81
|
| Rate for Payer: Aetna Medicare |
$71.00
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCN Commercial |
$350.38
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.73
|
| Rate for Payer: Priority Health Narrow Network |
$105.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$517.25
|
| Rate for Payer: UHC Exchange |
$517.25
|
| Rate for Payer: UHCCP Medicaid |
$43.88
|
|
|
CHG MRI PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 72197
|
| Min. Negotiated Rate |
$66.24 |
| Max. Negotiated Rate |
$766.95 |
| Rate for Payer: Aetna Commercial |
$560.40
|
| Rate for Payer: Aetna Medicare |
$107.00
|
| Rate for Payer: BCBS Complete |
$69.55
|
| Rate for Payer: BCN Commercial |
$516.53
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Meridian Medicaid |
$69.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.10
|
| 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 |
$766.95
|
| Rate for Payer: UHC Exchange |
$766.95
|
| Rate for Payer: UHCCP Medicaid |
$66.24
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 72141
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$3,028.22 |
| Rate for Payer: Aetna Commercial |
$311.87
|
| Rate for Payer: Aetna Medicare |
$151.00
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,028.22
|
| Rate for Payer: BCN Commercial |
$290.27
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Meridian Medicaid |
$46.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| 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 |
$473.14
|
| Rate for Payer: UHC Exchange |
$473.14
|
| Rate for Payer: UHCCP Medicaid |
$44.52
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 72156
|
| Min. Negotiated Rate |
$69.23 |
| Max. Negotiated Rate |
$3,620.44 |
| Rate for Payer: Aetna Commercial |
$528.35
|
| Rate for Payer: Aetna Medicare |
$157.00
|
| Rate for Payer: BCBS Complete |
$72.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,620.44
|
| Rate for Payer: BCN Commercial |
$489.17
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Meridian Medicaid |
$72.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.28
|
| Rate for Payer: Priority Health Narrow Network |
$165.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$752.65
|
| Rate for Payer: UHC Exchange |
$752.65
|
| Rate for Payer: UHCCP Medicaid |
$69.23
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 72149
|
| Min. Negotiated Rate |
$53.89 |
| Max. Negotiated Rate |
$3,237.95 |
| Rate for Payer: Aetna Commercial |
$446.00
|
| Rate for Payer: Aetna Medicare |
$163.50
|
| Rate for Payer: BCBS Complete |
$56.58
|
| Rate for Payer: BCBS Trust/PPO |
$3,237.95
|
| Rate for Payer: BCN Commercial |
$413.42
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Meridian Medicaid |
$56.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$53.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$128.83
|
| Rate for Payer: Priority Health Narrow Network |
$128.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$578.85
|
| Rate for Payer: UHC Exchange |
$578.85
|
| Rate for Payer: UHCCP Medicaid |
$53.89
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 72148
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$3,385.35 |
| Rate for Payer: Aetna Commercial |
$312.37
|
| Rate for Payer: Aetna Medicare |
$123.50
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS Trust/PPO |
$3,385.35
|
| Rate for Payer: BCN Commercial |
$291.25
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Meridian Medicaid |
$46.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.27
|
| Rate for Payer: Priority Health Narrow Network |
$107.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$475.94
|
| Rate for Payer: UHC Exchange |
$475.94
|
| Rate for Payer: UHCCP Medicaid |
$44.52
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 72158
|
| Min. Negotiated Rate |
$69.23 |
| Max. Negotiated Rate |
$3,525.87 |
| Rate for Payer: Aetna Commercial |
$527.37
|
| Rate for Payer: Aetna Medicare |
$149.50
|
| Rate for Payer: BCBS Complete |
$72.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,525.87
|
| Rate for Payer: BCN Commercial |
$488.19
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Meridian Medicaid |
$72.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.28
|
| Rate for Payer: Priority Health Narrow Network |
$165.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$740.80
|
| Rate for Payer: UHC Exchange |
$740.80
|
| Rate for Payer: UHCCP Medicaid |
$69.23
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 72146
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$2,911.46 |
| Rate for Payer: Aetna Commercial |
$311.87
|
| Rate for Payer: Aetna Medicare |
$136.00
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS Trust/PPO |
$2,911.46
|
| Rate for Payer: BCN Commercial |
$290.27
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Meridian Medicaid |
$46.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| 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 |
$482.44
|
| Rate for Payer: UHC Exchange |
$482.44
|
| Rate for Payer: UHCCP Medicaid |
$44.52
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 72157
|
| Min. Negotiated Rate |
$69.23 |
| Max. Negotiated Rate |
$3,439.76 |
| Rate for Payer: Aetna Commercial |
$529.34
|
| Rate for Payer: Aetna Medicare |
$165.00
|
| Rate for Payer: BCBS Complete |
$72.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,439.76
|
| Rate for Payer: BCN Commercial |
$490.14
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Meridian Medicaid |
$72.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.28
|
| Rate for Payer: Priority Health Narrow Network |
$165.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$712.05
|
| Rate for Payer: UHC Exchange |
$712.05
|
| Rate for Payer: UHCCP Medicaid |
$69.23
|
|
|
CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 73218
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$516.62 |
| Rate for Payer: Aetna Commercial |
$425.56
|
| Rate for Payer: Aetna Medicare |
$66.00
|
| Rate for Payer: BCBS Complete |
$42.71
|
| Rate for Payer: BCN Commercial |
$466.69
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Meridian Medicaid |
$42.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| 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 |
$516.62
|
| Rate for Payer: UHC Exchange |
$516.62
|
| Rate for Payer: UHCCP Medicaid |
$40.68
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 72265
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$3,085.27 |
| Rate for Payer: Aetna Commercial |
$124.16
|
| Rate for Payer: Aetna Medicare |
$81.50
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: BCBS Trust/PPO |
$3,085.27
|
| Rate for Payer: BCN Commercial |
$160.77
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Meridian Medicaid |
$26.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.57
|
| Rate for Payer: Priority Health Narrow Network |
$60.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.02
|
| Rate for Payer: UHC Exchange |
$147.02
|
| Rate for Payer: UHCCP Medicaid |
$25.35
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 78453
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$398.76 |
| Rate for Payer: Aetna Commercial |
$339.63
|
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: BCBS Complete |
$30.64
|
| Rate for Payer: BCBS Trust/PPO |
$240.38
|
| Rate for Payer: BCN Commercial |
$398.76
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Meridian Medicaid |
$30.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| 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 |
$280.35
|
| Rate for Payer: UHC Exchange |
$280.35
|
| Rate for Payer: UHCCP Medicaid |
$29.18
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 78454
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$594.72 |
| Rate for Payer: Aetna Commercial |
$490.87
|
| Rate for Payer: Aetna Medicare |
$79.00
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: BCBS Trust/PPO |
$256.75
|
| Rate for Payer: BCN Commercial |
$594.72
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Meridian Medicaid |
$42.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$95.98
|
| Rate for Payer: Priority Health Narrow Network |
$95.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$397.47
|
| Rate for Payer: UHC Exchange |
$397.47
|
| Rate for Payer: UHCCP Medicaid |
$40.04
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 78452
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$640.66 |
| Rate for Payer: Aetna Commercial |
$538.09
|
| Rate for Payer: Aetna Commercial |
$538.09
|
| Rate for Payer: Aetna Medicare |
$458.00
|
| Rate for Payer: Aetna Medicare |
$96.00
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS Trust/PPO |
$209.21
|
| Rate for Payer: BCBS Trust/PPO |
$209.21
|
| Rate for Payer: BCN Commercial |
$640.66
|
| Rate for Payer: BCN Commercial |
$640.66
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$114.46
|
| Rate for Payer: Priority Health Narrow Network |
$114.46
|
| Rate for Payer: Priority Health Narrow Network |
$114.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$456.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$456.73
|
| Rate for Payer: UHC Exchange |
$456.73
|
| Rate for Payer: UHC Exchange |
$456.73
|
| Rate for Payer: UHCCP Medicaid |
$47.50
|
| Rate for Payer: UHCCP Medicaid |
$47.50
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 78451
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$517.21 |
| Rate for Payer: Aetna Commercial |
$387.26
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS Trust/PPO |
$517.21
|
| Rate for Payer: BCN Commercial |
$461.80
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Meridian Medicaid |
$42.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.00
|
| Rate for Payer: Priority Health Narrow Network |
$97.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$325.61
|
| Rate for Payer: UHC Exchange |
$325.61
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
|
|
CHG MYOCRD IMG PET PRFUJ SINGLE STUDY REST/STRESS
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 78491
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$1,479.30 |
| Rate for Payer: Aetna Commercial |
$1,378.75
|
| Rate for Payer: Aetna Medicare |
$357.00
|
| Rate for Payer: BCBS Complete |
$47.64
|
| Rate for Payer: BCBS Trust/PPO |
$431.09
|
| Rate for Payer: BCN Commercial |
$1,479.30
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Meridian Medicaid |
$47.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.30
|
| Rate for Payer: Priority Health Narrow Network |
$108.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$469.76
|
| Rate for Payer: UHC Exchange |
$469.76
|
| Rate for Payer: UHCCP Medicaid |
$45.37
|
|
|
CHG NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS
|
Professional
|
Both
|
$1,752.00
|
|
|
Service Code
|
HCPCS 77301
|
| Min. Negotiated Rate |
$270.72 |
| Max. Negotiated Rate |
$2,885.83 |
| Rate for Payer: Aetna Commercial |
$2,146.90
|
| Rate for Payer: Aetna Commercial |
$2,146.90
|
| Rate for Payer: Aetna Commercial |
$2,146.90
|
| Rate for Payer: Aetna Medicare |
$876.00
|
| Rate for Payer: Aetna Medicare |
$1,535.50
|
| Rate for Payer: Aetna Medicare |
$1,910.00
|
| Rate for Payer: BCBS Complete |
$284.26
|
| Rate for Payer: BCBS Complete |
$284.26
|
| Rate for Payer: BCBS Complete |
$284.26
|
| Rate for Payer: BCBS Trust/PPO |
$603.85
|
| Rate for Payer: BCBS Trust/PPO |
$603.85
|
| Rate for Payer: BCBS Trust/PPO |
$603.85
|
| Rate for Payer: BCN Commercial |
$2,787.78
|
| Rate for Payer: BCN Commercial |
$2,787.78
|
| Rate for Payer: BCN Commercial |
$2,787.78
|
| Rate for Payer: Cash Price |
$3,056.00
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$2,456.80
|
| Rate for Payer: Cash Price |
$3,056.00
|
| Rate for Payer: Cash Price |
$2,456.80
|
| Rate for Payer: Meridian Medicaid |
$284.26
|
| Rate for Payer: Meridian Medicaid |
$284.26
|
| Rate for Payer: Meridian Medicaid |
$284.26
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,483.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,138.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,996.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$641.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$641.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$641.06
|
| Rate for Payer: Priority Health Narrow Network |
$641.06
|
| Rate for Payer: Priority Health Narrow Network |
$641.06
|
| Rate for Payer: Priority Health Narrow Network |
$641.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,885.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,885.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,885.83
|
| Rate for Payer: UHC Exchange |
$2,885.83
|
| Rate for Payer: UHC Exchange |
$2,885.83
|
| Rate for Payer: UHC Exchange |
$2,885.83
|
| Rate for Payer: UHCCP Medicaid |
$270.72
|
| Rate for Payer: UHCCP Medicaid |
$270.72
|
| Rate for Payer: UHCCP Medicaid |
$270.72
|
|
|
CHG OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 76519
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$2,288.07 |
| Rate for Payer: Aetna Commercial |
$76.83
|
| Rate for Payer: Aetna Medicare |
$24.50
|
| Rate for Payer: BCBS Complete |
$20.13
|
| Rate for Payer: BCBS Trust/PPO |
$2,288.07
|
| Rate for Payer: BCN Commercial |
$98.23
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Meridian Medicaid |
$20.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$45.69
|
| Rate for Payer: Priority Health Narrow Network |
$45.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.63
|
| Rate for Payer: UHC Exchange |
$78.63
|
| Rate for Payer: UHCCP Medicaid |
$19.17
|
|
|
CHG OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 76514
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$1,479.24 |
| Rate for Payer: Aetna Commercial |
$13.55
|
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,479.24
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Meridian Medicaid |
$5.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.81
|
| Rate for Payer: Priority Health Narrow Network |
$11.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$14.80
|
| Rate for Payer: UHC Exchange |
$14.80
|
| Rate for Payer: UHCCP Medicaid |
$4.90
|
|
