|
CHG SPECIAL TREATMENT PROCEDURE
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 77470
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$519.32 |
| Rate for Payer: Aetna Commercial |
$155.09
|
| Rate for Payer: Aetna Commercial |
$155.09
|
| Rate for Payer: Aetna Medicare |
$266.00
|
| Rate for Payer: Aetna Medicare |
$352.50
|
| Rate for Payer: BCBS Complete |
$72.24
|
| Rate for Payer: BCBS Complete |
$72.24
|
| Rate for Payer: BCBS Trust/PPO |
$519.32
|
| Rate for Payer: BCBS Trust/PPO |
$519.32
|
| Rate for Payer: BCN Commercial |
$202.80
|
| Rate for Payer: BCN Commercial |
$202.80
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Meridian Medicaid |
$72.24
|
| Rate for Payer: Meridian Medicaid |
$72.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$163.21
|
| Rate for Payer: Priority Health Narrow Network |
$163.21
|
| Rate for Payer: Priority Health Narrow Network |
$163.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$293.67
|
| Rate for Payer: UHC Exchange |
$293.67
|
| Rate for Payer: UHC Exchange |
$293.67
|
| Rate for Payer: UHCCP Medicaid |
$68.80
|
| Rate for Payer: UHCCP Medicaid |
$68.80
|
|
|
CHG SPEC MEDICAL RADJ PHYSICS CONSLTJ
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 77370
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$1,979.54 |
| Rate for Payer: Aetna Commercial |
$143.41
|
| Rate for Payer: Aetna Medicare |
$108.00
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,979.54
|
| Rate for Payer: BCN Commercial |
$202.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.76
|
| Rate for Payer: Priority Health Narrow Network |
$222.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.68
|
| Rate for Payer: UHC Exchange |
$147.68
|
|
|
CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 77321
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$5,378.09 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Medicare |
$141.00
|
| Rate for Payer: Aetna Medicare |
$101.50
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS Trust/PPO |
$5,378.09
|
| Rate for Payer: BCBS Trust/PPO |
$5,378.09
|
| Rate for Payer: BCN Commercial |
$136.83
|
| Rate for Payer: BCN Commercial |
$136.83
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.48
|
| Rate for Payer: Priority Health Narrow Network |
$76.48
|
| Rate for Payer: Priority Health Narrow Network |
$76.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$148.10
|
| Rate for Payer: UHC Exchange |
$148.10
|
| Rate for Payer: UHC Exchange |
$148.10
|
| Rate for Payer: UHCCP Medicaid |
$32.16
|
| Rate for Payer: UHCCP Medicaid |
$32.16
|
|
|
CHG STEREOSCOPIC X-RAY GUIDANCE
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 77421
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Aetna Medicare |
$87.00
|
| Rate for Payer: Aetna Medicare |
$103.00
|
| Rate for Payer: BCBS Complete |
$82.40
|
| Rate for Payer: BCBS Complete |
$69.60
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.10
|
|
|
CHG STEREOTACTIC BODY RADIATION MANAGEMENT
|
Professional
|
Both
|
$1,261.00
|
|
|
Service Code
|
HCPCS 77435
|
| Min. Negotiated Rate |
$414.50 |
| Max. Negotiated Rate |
$1,387.84 |
| Rate for Payer: Aetna Commercial |
$753.89
|
| Rate for Payer: Aetna Medicare |
$630.50
|
| Rate for Payer: BCBS Complete |
$435.22
|
| Rate for Payer: BCBS Trust/PPO |
$1,387.84
|
| Rate for Payer: BCN Commercial |
$932.88
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Meridian Medicaid |
$435.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$983.41
|
| Rate for Payer: Priority Health Narrow Network |
$983.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$933.93
|
| Rate for Payer: UHC Exchange |
$933.93
|
| Rate for Payer: UHCCP Medicaid |
$414.50
|
|
|
CHG STEREOTACTIC BODY RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$2,706.00
|
|
|
Service Code
|
HCPCS 77373
|
| Min. Negotiated Rate |
$1,082.40 |
| Max. Negotiated Rate |
$1,987.99 |
| Rate for Payer: Aetna Commercial |
$1,281.89
|
| Rate for Payer: Aetna Medicare |
$1,353.00
|
| Rate for Payer: BCBS Complete |
$1,082.40
|
| Rate for Payer: BCBS Trust/PPO |
$1,987.99
|
| Rate for Payer: BCN Commercial |
$1,469.46
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,758.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,532.08
|
| Rate for Payer: Priority Health Narrow Network |
$1,532.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,979.94
|
| Rate for Payer: UHC Exchange |
$1,979.94
|
|
|
CHG STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 77432
|
| Min. Negotiated Rate |
$274.34 |
| Max. Negotiated Rate |
$2,005.43 |
| Rate for Payer: Aetna Commercial |
$499.97
|
| Rate for Payer: Aetna Medicare |
$436.00
|
| Rate for Payer: BCBS Complete |
$288.06
|
| Rate for Payer: BCBS Trust/PPO |
$2,005.43
|
| Rate for Payer: BCN Commercial |
$617.69
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Meridian Medicaid |
$288.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$572.76
|
| Rate for Payer: Priority Health Narrow Network |
$572.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$562.83
|
| Rate for Payer: UHC Exchange |
$562.83
|
| Rate for Payer: UHCCP Medicaid |
$274.34
|
|
|
CHG SUPERVISION HANDLING LOADING RADIATION SOURCE
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 77790
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$148.98 |
| Rate for Payer: Aetna Commercial |
$17.19
|
| Rate for Payer: Aetna Commercial |
$17.19
|
| Rate for Payer: Aetna Medicare |
$94.00
|
| Rate for Payer: Aetna Medicare |
$40.50
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS Trust/PPO |
$148.98
|
| Rate for Payer: BCBS Trust/PPO |
$148.98
|
| Rate for Payer: BCN Commercial |
$25.41
|
| Rate for Payer: BCN Commercial |
$25.41
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: Priority Health Narrow Network |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$119.56
|
| Rate for Payer: UHC Exchange |
$119.56
|
| Rate for Payer: UHC Exchange |
$119.56
|
|
|
CHG TBS TECHNICAL CALCULATION ONLY
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 77091
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$43.11 |
| Rate for Payer: Aetna Commercial |
$31.43
|
| Rate for Payer: Aetna Medicare |
$29.00
|
| Rate for Payer: BCBS Complete |
$23.20
|
| Rate for Payer: BCN Commercial |
$41.05
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.11
|
| Rate for Payer: Priority Health Narrow Network |
$43.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$24.48
|
| Rate for Payer: UHC Exchange |
$24.48
|
|
|
CHG TELETHER ISODOSE PLAN COMPLX
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 77315
|
| Min. Negotiated Rate |
$109.60 |
| Max. Negotiated Rate |
$178.10 |
| Rate for Payer: Aetna Medicare |
$137.00
|
| Rate for Payer: Aetna Medicare |
$72.50
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: BCBS Complete |
$109.60
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
|
|
CHG TELETHER ISODOSE PLAN SIMPLE
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 77305
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: Aetna Medicare |
$77.50
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
|
|
CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY
|
Professional
|
Both
|
$838.00
|
|
|
Service Code
|
HCPCS 77307
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$1,915.09 |
| Rate for Payer: Aetna Commercial |
$330.89
|
| Rate for Payer: Aetna Commercial |
$330.89
|
| Rate for Payer: Aetna Medicare |
$419.00
|
| Rate for Payer: Aetna Medicare |
$219.50
|
| Rate for Payer: BCBS Complete |
$103.33
|
| Rate for Payer: BCBS Complete |
$103.33
|
| Rate for Payer: BCBS Trust/PPO |
$1,915.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,915.09
|
| Rate for Payer: BCN Commercial |
$417.33
|
| Rate for Payer: BCN Commercial |
$417.33
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Meridian Medicaid |
$103.33
|
| Rate for Payer: Meridian Medicaid |
$103.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$232.50
|
| Rate for Payer: Priority Health Narrow Network |
$232.50
|
| Rate for Payer: Priority Health Narrow Network |
$232.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$388.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$388.17
|
| Rate for Payer: UHC Exchange |
$388.17
|
| Rate for Payer: UHC Exchange |
$388.17
|
| Rate for Payer: UHCCP Medicaid |
$98.41
|
| Rate for Payer: UHCCP Medicaid |
$98.41
|
|
|
CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 77306
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$215.51 |
| Rate for Payer: Aetna Commercial |
$169.82
|
| Rate for Payer: Aetna Commercial |
$169.82
|
| Rate for Payer: Aetna Medicare |
$198.00
|
| Rate for Payer: Aetna Medicare |
$116.50
|
| Rate for Payer: BCBS Complete |
$49.65
|
| Rate for Payer: BCBS Complete |
$49.65
|
| Rate for Payer: BCBS Trust/PPO |
$150.66
|
| Rate for Payer: BCBS Trust/PPO |
$150.66
|
| Rate for Payer: BCN Commercial |
$215.51
|
| Rate for Payer: BCN Commercial |
$215.51
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Meridian Medicaid |
$49.65
|
| Rate for Payer: Meridian Medicaid |
$49.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$112.40
|
| Rate for Payer: Priority Health Narrow Network |
$112.40
|
| Rate for Payer: Priority Health Narrow Network |
$112.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$197.96
|
| Rate for Payer: UHC Exchange |
$197.96
|
| Rate for Payer: UHC Exchange |
$197.96
|
| Rate for Payer: UHCCP Medicaid |
$47.29
|
| Rate for Payer: UHCCP Medicaid |
$47.29
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 74283
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$1,701.65 |
| Rate for Payer: Aetna Commercial |
$302.67
|
| Rate for Payer: Aetna Medicare |
$138.50
|
| Rate for Payer: BCBS Complete |
$67.10
|
| Rate for Payer: BCBS Trust/PPO |
$1,701.65
|
| Rate for Payer: BCN Commercial |
$376.28
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Meridian Medicaid |
$67.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.41
|
| Rate for Payer: Priority Health Narrow Network |
$151.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$217.57
|
| Rate for Payer: UHC Exchange |
$217.57
|
| Rate for Payer: UHCCP Medicaid |
$63.90
|
|
|
CHG THERAPEUTIC RADIOLOGY PORT IMAGE(S)
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 77417
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$3,385.87 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna Medicare |
$17.00
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,385.87
|
| Rate for Payer: BCN Commercial |
$20.04
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.10
|
| Rate for Payer: Priority Health Narrow Network |
$23.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$19.70
|
| Rate for Payer: UHC Exchange |
$19.70
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 77263
|
| Min. Negotiated Rate |
$108.63 |
| Max. Negotiated Rate |
$1,737.05 |
| Rate for Payer: Aetna Commercial |
$198.09
|
| Rate for Payer: Aetna Medicare |
$151.00
|
| Rate for Payer: BCBS Complete |
$114.06
|
| Rate for Payer: BCBS Trust/PPO |
$1,737.05
|
| Rate for Payer: BCN Commercial |
$245.32
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Meridian Medicaid |
$114.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.14
|
| Rate for Payer: Priority Health Narrow Network |
$257.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$222.57
|
| Rate for Payer: UHC Exchange |
$222.57
|
| Rate for Payer: UHCCP Medicaid |
$108.63
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 77262
|
| Min. Negotiated Rate |
$69.86 |
| Max. Negotiated Rate |
$381.96 |
| Rate for Payer: Aetna Commercial |
$127.25
|
| Rate for Payer: Aetna Medicare |
$101.00
|
| Rate for Payer: BCBS Complete |
$73.35
|
| Rate for Payer: BCBS Trust/PPO |
$381.96
|
| Rate for Payer: BCN Commercial |
$156.86
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Meridian Medicaid |
$73.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.79
|
| Rate for Payer: Priority Health Narrow Network |
$165.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$149.88
|
| Rate for Payer: UHC Exchange |
$149.88
|
| Rate for Payer: UHCCP Medicaid |
$69.86
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 77261
|
| Min. Negotiated Rate |
$45.16 |
| Max. Negotiated Rate |
$984.75 |
| Rate for Payer: Aetna Commercial |
$83.68
|
| Rate for Payer: Aetna Medicare |
$67.50
|
| Rate for Payer: BCBS Complete |
$47.42
|
| Rate for Payer: BCBS Trust/PPO |
$984.75
|
| Rate for Payer: BCN Commercial |
$102.62
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Meridian Medicaid |
$47.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$237.50
|
| Rate for Payer: Priority Health Narrow Network |
$237.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$98.82
|
| Rate for Payer: UHC Exchange |
$98.82
|
| Rate for Payer: UHCCP Medicaid |
$45.16
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX
|
Professional
|
Both
|
$964.00
|
|
|
Service Code
|
HCPCS 77290
|
| Min. Negotiated Rate |
$52.82 |
| Max. Negotiated Rate |
$661.67 |
| Rate for Payer: Aetna Commercial |
$554.16
|
| Rate for Payer: Aetna Commercial |
$554.16
|
| Rate for Payer: Aetna Medicare |
$482.00
|
| Rate for Payer: Aetna Medicare |
$401.50
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS Complete |
$55.46
|
| Rate for Payer: BCBS Trust/PPO |
$222.94
|
| Rate for Payer: BCBS Trust/PPO |
$222.94
|
| Rate for Payer: BCN Commercial |
$661.67
|
| Rate for Payer: BCN Commercial |
$661.67
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Meridian Medicaid |
$55.46
|
| Rate for Payer: Meridian Medicaid |
$55.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.74
|
| Rate for Payer: Priority Health Narrow Network |
$125.74
|
| Rate for Payer: Priority Health Narrow Network |
$125.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$655.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$655.05
|
| Rate for Payer: UHC Exchange |
$655.05
|
| Rate for Payer: UHC Exchange |
$655.05
|
| Rate for Payer: UHCCP Medicaid |
$52.82
|
| Rate for Payer: UHCCP Medicaid |
$52.82
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 77285
|
| Min. Negotiated Rate |
$36.21 |
| Max. Negotiated Rate |
$645.54 |
| Rate for Payer: Aetna Commercial |
$528.58
|
| Rate for Payer: Aetna Medicare |
$57.00
|
| Rate for Payer: BCBS Complete |
$38.02
|
| Rate for Payer: BCBS Trust/PPO |
$212.38
|
| Rate for Payer: BCN Commercial |
$645.54
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Meridian Medicaid |
$38.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.75
|
| Rate for Payer: Priority Health Narrow Network |
$86.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$415.07
|
| Rate for Payer: UHC Exchange |
$415.07
|
| Rate for Payer: UHCCP Medicaid |
$36.21
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 77280
|
| Min. Negotiated Rate |
$24.07 |
| Max. Negotiated Rate |
$1,443.32 |
| Rate for Payer: Aetna Commercial |
$319.36
|
| Rate for Payer: Aetna Commercial |
$319.36
|
| Rate for Payer: Aetna Medicare |
$257.50
|
| Rate for Payer: Aetna Medicare |
$222.00
|
| Rate for Payer: BCBS Complete |
$25.27
|
| Rate for Payer: BCBS Complete |
$25.27
|
| Rate for Payer: BCBS Trust/PPO |
$1,443.32
|
| Rate for Payer: BCBS Trust/PPO |
$1,443.32
|
| Rate for Payer: BCN Commercial |
$394.36
|
| Rate for Payer: BCN Commercial |
$394.36
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Meridian Medicaid |
$25.27
|
| Rate for Payer: Meridian Medicaid |
$25.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.07
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.48
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.48
|
| Rate for Payer: Priority Health Narrow Network |
$57.48
|
| Rate for Payer: Priority Health Narrow Network |
$57.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$239.02
|
| Rate for Payer: UHC Exchange |
$239.02
|
| Rate for Payer: UHC Exchange |
$239.02
|
| Rate for Payer: UHCCP Medicaid |
$24.07
|
| Rate for Payer: UHCCP Medicaid |
$24.07
|
|
|
CHG TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 88233
|
| Min. Negotiated Rate |
$105.55 |
| Max. Negotiated Rate |
$218.18 |
| Rate for Payer: Aetna Commercial |
$133.69
|
| Rate for Payer: Aetna Medicare |
$149.50
|
| Rate for Payer: BCBS Complete |
$119.60
|
| Rate for Payer: BCBS Trust/PPO |
$183.85
|
| Rate for Payer: BCN Commercial |
$105.55
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.18
|
| Rate for Payer: Priority Health Narrow Network |
$218.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$157.91
|
| Rate for Payer: UHC Exchange |
$157.91
|
|
|
CHG TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 87220
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$4,124.97 |
| Rate for Payer: Aetna Commercial |
$4.06
|
| Rate for Payer: Aetna Medicare |
$11.00
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS Trust/PPO |
$4,124.97
|
| Rate for Payer: BCN Commercial |
$3.20
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.33
|
| Rate for Payer: Priority Health Narrow Network |
$4.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$6.11
|
| Rate for Payer: UHC Exchange |
$6.11
|
|
|
CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 75894
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$1,451.37 |
| Rate for Payer: Aetna Commercial |
$1,126.65
|
| Rate for Payer: Aetna Medicare |
$179.50
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$393.58
|
| Rate for Payer: BCN Commercial |
$1,451.37
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Meridian Medicaid |
$47.86
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.35
|
| 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 |
$1,127.37
|
| Rate for Payer: UHC Exchange |
$1,127.37
|
| Rate for Payer: UHCCP Medicaid |
$45.58
|
|
|
CHG TRANSCATHETER INFUSION OTHER THAN THROMBOLYSIS
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 75896
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$184.60 |
| Rate for Payer: Aetna Medicare |
$142.00
|
| Rate for Payer: BCBS Complete |
$113.60
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
|
