|
CHG TRANSFERASE ALANINE AMINO ALT SGPT
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 84460
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$1,976.37 |
| Rate for Payer: Aetna Commercial |
$5.04
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,976.37
|
| Rate for Payer: BCN Commercial |
$1.08
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.33
|
| Rate for Payer: Priority Health Narrow Network |
$5.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.48
|
| Rate for Payer: UHC Exchange |
$4.48
|
|
|
CHG TRANSFERASE ASPARTATE AMINO AST SGOT
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 84450
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$2,972.74 |
| Rate for Payer: Aetna Commercial |
$4.92
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,972.74
|
| Rate for Payer: BCN Commercial |
$1.08
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.33
|
| Rate for Payer: Priority Health Narrow Network |
$5.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.45
|
| Rate for Payer: UHC Exchange |
$4.45
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION COMPLEX
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 77334
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$596.98 |
| Rate for Payer: Aetna Commercial |
$144.42
|
| Rate for Payer: Aetna Commercial |
$144.42
|
| Rate for Payer: Aetna Medicare |
$145.50
|
| Rate for Payer: Aetna Medicare |
$91.50
|
| Rate for Payer: BCBS Complete |
$40.71
|
| Rate for Payer: BCBS Complete |
$40.71
|
| Rate for Payer: BCBS Trust/PPO |
$596.98
|
| Rate for Payer: BCBS Trust/PPO |
$596.98
|
| Rate for Payer: BCN Commercial |
$217.82
|
| Rate for Payer: BCN Commercial |
$217.82
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Meridian Medicaid |
$40.71
|
| Rate for Payer: Meridian Medicaid |
$40.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.39
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.39
|
| Rate for Payer: Priority Health Narrow Network |
$92.39
|
| Rate for Payer: Priority Health Narrow Network |
$92.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$202.81
|
| Rate for Payer: UHC Exchange |
$202.81
|
| Rate for Payer: UHC Exchange |
$202.81
|
| Rate for Payer: UHCCP Medicaid |
$38.77
|
| Rate for Payer: UHCCP Medicaid |
$38.77
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 77333
|
| Min. Negotiated Rate |
$25.56 |
| Max. Negotiated Rate |
$828.16 |
| Rate for Payer: Aetna Commercial |
$151.32
|
| Rate for Payer: Aetna Commercial |
$151.32
|
| Rate for Payer: Aetna Medicare |
$80.50
|
| Rate for Payer: Aetna Medicare |
$46.00
|
| Rate for Payer: BCBS Complete |
$26.84
|
| Rate for Payer: BCBS Complete |
$26.84
|
| Rate for Payer: BCBS Trust/PPO |
$828.16
|
| Rate for Payer: BCBS Trust/PPO |
$828.16
|
| Rate for Payer: BCN Commercial |
$75.81
|
| Rate for Payer: BCN Commercial |
$75.81
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Meridian Medicaid |
$26.84
|
| Rate for Payer: Meridian Medicaid |
$26.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$25.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.06
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$60.06
|
| Rate for Payer: Priority Health Narrow Network |
$60.06
|
| Rate for Payer: Priority Health Narrow Network |
$60.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$85.16
|
| Rate for Payer: UHC Exchange |
$85.16
|
| Rate for Payer: UHC Exchange |
$85.16
|
| Rate for Payer: UHCCP Medicaid |
$25.56
|
| Rate for Payer: UHCCP Medicaid |
$25.56
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION SIMPLE
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 77332
|
| Min. Negotiated Rate |
$15.34 |
| Max. Negotiated Rate |
$828.16 |
| Rate for Payer: Aetna Commercial |
$48.30
|
| Rate for Payer: Aetna Commercial |
$48.30
|
| Rate for Payer: Aetna Medicare |
$77.50
|
| Rate for Payer: Aetna Medicare |
$49.50
|
| Rate for Payer: BCBS Complete |
$16.11
|
| Rate for Payer: BCBS Complete |
$16.11
|
| Rate for Payer: BCBS Trust/PPO |
$828.16
|
| Rate for Payer: BCBS Trust/PPO |
$828.16
|
| Rate for Payer: BCN Commercial |
$118.27
|
| Rate for Payer: BCN Commercial |
$118.27
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Meridian Medicaid |
$16.11
|
| Rate for Payer: Meridian Medicaid |
$16.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.44
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.44
|
| Rate for Payer: Priority Health Narrow Network |
$36.44
|
| Rate for Payer: Priority Health Narrow Network |
$36.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$101.76
|
| Rate for Payer: UHC Exchange |
$101.76
|
| Rate for Payer: UHC Exchange |
$101.76
|
| Rate for Payer: UHCCP Medicaid |
$15.34
|
| Rate for Payer: UHCCP Medicaid |
$15.34
|
|
|
CHG ULTRASONIC GUIDANCE INTRAOPERATIVE
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS 76998
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$266.33 |
| Rate for Payer: Aetna Commercial |
$74.11
|
| Rate for Payer: Aetna Medicare |
$147.50
|
| Rate for Payer: BCBS Complete |
$31.09
|
| Rate for Payer: BCBS Trust/PPO |
$125.74
|
| Rate for Payer: BCN Commercial |
$266.33
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Meridian Medicaid |
$31.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.83
|
| Rate for Payer: Priority Health Narrow Network |
$70.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.88
|
| Rate for Payer: UHC Exchange |
$125.88
|
| Rate for Payer: UHCCP Medicaid |
$29.61
|
|
|
CHG ULTRASOUND ELASTOGRAPHY PARENCHYMA
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 76981
|
| Min. Negotiated Rate |
$18.11 |
| Max. Negotiated Rate |
$152.96 |
| Rate for Payer: Aetna Commercial |
$122.12
|
| Rate for Payer: Aetna Medicare |
$29.50
|
| Rate for Payer: BCBS Complete |
$19.02
|
| Rate for Payer: BCN Commercial |
$152.96
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Meridian Medicaid |
$19.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$18.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| 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 |
$119.77
|
| Rate for Payer: UHC Exchange |
$119.77
|
| Rate for Payer: UHCCP Medicaid |
$18.11
|
|
|
CHG ULTRASOUND SPINAL CANAL & CONTENTS
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 76800
|
| Min. Negotiated Rate |
$40.04 |
| Max. Negotiated Rate |
$337.06 |
| Rate for Payer: Aetna Commercial |
$164.90
|
| Rate for Payer: Aetna Medicare |
$45.50
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: BCBS Trust/PPO |
$337.06
|
| Rate for Payer: BCN Commercial |
$229.68
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Meridian Medicaid |
$42.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$94.44
|
| Rate for Payer: Priority Health Narrow Network |
$94.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$134.21
|
| Rate for Payer: UHC Exchange |
$134.21
|
| Rate for Payer: UHCCP Medicaid |
$40.04
|
|
|
CHG UNLISTED FLUOROSCOPIC PROCEDURE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 76496
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS Trust/PPO |
$63.40
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
CHG URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 78740
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$581.13 |
| Rate for Payer: Aetna Commercial |
$249.86
|
| Rate for Payer: Aetna Medicare |
$242.50
|
| Rate for Payer: BCBS Complete |
$17.89
|
| Rate for Payer: BCBS Trust/PPO |
$581.13
|
| Rate for Payer: BCN Commercial |
$298.09
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Meridian Medicaid |
$17.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.03
|
| Rate for Payer: Priority Health Narrow Network |
$40.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$207.00
|
| Rate for Payer: UHC Exchange |
$207.00
|
| Rate for Payer: UHCCP Medicaid |
$17.04
|
|
|
CHG URETHROCYSTOGRAPHY RETROGRADE RS&I
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 74450
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$1,100.98 |
| Rate for Payer: Aetna Commercial |
$256.77
|
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: BCBS Complete |
$10.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,100.98
|
| Rate for Payer: BCN Commercial |
$238.97
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Meridian Medicaid |
$10.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.61
|
| Rate for Payer: Priority Health Narrow Network |
$23.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.46
|
| Rate for Payer: UHC Exchange |
$83.46
|
| Rate for Payer: UHCCP Medicaid |
$9.80
|
|
|
CHG URETHROCYSTOGRAPHY VOIDING RS&I
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 74455
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$153.93 |
| Rate for Payer: Aetna Commercial |
$119.16
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: BCBS Complete |
$10.29
|
| Rate for Payer: BCBS Trust/PPO |
$60.70
|
| Rate for Payer: BCN Commercial |
$153.93
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Meridian Medicaid |
$10.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$9.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.61
|
| Rate for Payer: Priority Health Narrow Network |
$23.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$93.08
|
| Rate for Payer: UHC Exchange |
$93.08
|
| Rate for Payer: UHCCP Medicaid |
$9.80
|
|
|
CHG URINALYSIS MICROSCOPIC ONLY
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 81015
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$2,074.63 |
| Rate for Payer: Aetna Commercial |
$2.90
|
| Rate for Payer: Aetna Medicare |
$3.50
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,074.63
|
| Rate for Payer: BCN Commercial |
$3.05
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.00
|
| Rate for Payer: Priority Health Narrow Network |
$3.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.35
|
| Rate for Payer: UHC Exchange |
$4.35
|
|
|
CHG URINALYSIS QUAL/SEMIQUANT EXCEPT IMMUNOASSAYS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 81005
|
| Min. Negotiated Rate |
$1.63 |
| Max. Negotiated Rate |
$2,140.67 |
| Rate for Payer: Aetna Commercial |
$2.06
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,140.67
|
| Rate for Payer: BCN Commercial |
$1.63
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.33
|
| Rate for Payer: Priority Health Narrow Network |
$2.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.10
|
| Rate for Payer: UHC Exchange |
$3.10
|
|
|
CHG URINARY BLADDER RESIDUAL STUDY
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 78730
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$512.98 |
| Rate for Payer: Aetna Commercial |
$86.80
|
| Rate for Payer: Aetna Medicare |
$119.00
|
| Rate for Payer: BCBS Complete |
$4.92
|
| Rate for Payer: BCBS Trust/PPO |
$512.98
|
| Rate for Payer: BCN Commercial |
$99.69
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Meridian Medicaid |
$4.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.29
|
| Rate for Payer: Priority Health Narrow Network |
$11.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$72.94
|
| Rate for Payer: UHC Exchange |
$72.94
|
| Rate for Payer: UHCCP Medicaid |
$4.69
|
|
|
CHG URINE ALBUMIN SEMIQUANTITATIVE
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 82044
|
| Min. Negotiated Rate |
$3.88 |
| Max. Negotiated Rate |
$3,544.36 |
| Rate for Payer: Aetna Commercial |
$5.92
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$3,544.36
|
| Rate for Payer: BCN Commercial |
$4.67
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$6.32
|
| Rate for Payer: Priority Health Narrow Network |
$6.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.88
|
| Rate for Payer: UHC Exchange |
$3.88
|
|
|
CHG URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 81025
|
| Min. Negotiated Rate |
$8.18 |
| Max. Negotiated Rate |
$2,329.80 |
| Rate for Payer: Aetna Commercial |
$8.18
|
| Rate for Payer: Aetna Medicare |
$11.50
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS Trust/PPO |
$2,329.80
|
| Rate for Payer: BCN Commercial |
$8.61
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$8.65
|
| Rate for Payer: Priority Health Narrow Network |
$8.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$9.06
|
| Rate for Payer: UHC Exchange |
$9.06
|
|
|
CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS 81000
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$2,458.18 |
| Rate for Payer: Aetna Commercial |
$3.82
|
| Rate for Payer: Aetna Medicare |
$8.50
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,458.18
|
| Rate for Payer: BCN Commercial |
$4.02
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.99
|
| Rate for Payer: Priority Health Narrow Network |
$3.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.54
|
| Rate for Payer: UHC Exchange |
$4.54
|
|
|
CHG URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 81001
|
| Min. Negotiated Rate |
$3.01 |
| Max. Negotiated Rate |
$3,145.50 |
| Rate for Payer: Aetna Commercial |
$3.01
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Trust/PPO |
$3,145.50
|
| Rate for Payer: BCN Commercial |
$3.17
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.33
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.54
|
| Rate for Payer: UHC Exchange |
$4.54
|
|
|
CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 81003
|
| Min. Negotiated Rate |
$2.14 |
| Max. Negotiated Rate |
$1,827.92 |
| Rate for Payer: Aetna Commercial |
$2.14
|
| Rate for Payer: Aetna Medicare |
$7.00
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS Trust/PPO |
$1,827.92
|
| Rate for Payer: BCN Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.33
|
| Rate for Payer: Priority Health Narrow Network |
$2.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.22
|
| Rate for Payer: UHC Exchange |
$3.22
|
|
|
CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 81002
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$2,102.11 |
| Rate for Payer: Aetna Commercial |
$3.31
|
| Rate for Payer: Aetna Medicare |
$6.00
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS Trust/PPO |
$2,102.11
|
| Rate for Payer: BCN Commercial |
$3.48
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.33
|
| Rate for Payer: Priority Health Narrow Network |
$3.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3.66
|
| Rate for Payer: UHC Exchange |
$3.66
|
|
|
CHG UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS 74400
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$673.05 |
| Rate for Payer: Aetna Commercial |
$153.73
|
| Rate for Payer: Aetna Commercial |
$153.73
|
| Rate for Payer: Aetna Medicare |
$106.50
|
| Rate for Payer: Aetna Medicare |
$70.00
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Trust/PPO |
$673.05
|
| Rate for Payer: BCBS Trust/PPO |
$673.05
|
| Rate for Payer: BCN Commercial |
$200.36
|
| Rate for Payer: BCN Commercial |
$200.36
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.42
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.42
|
| Rate for Payer: Priority Health Narrow Network |
$35.42
|
| Rate for Payer: Priority Health Narrow Network |
$35.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$114.06
|
| Rate for Payer: UHC Exchange |
$114.06
|
| Rate for Payer: UHC Exchange |
$114.06
|
| Rate for Payer: UHCCP Medicaid |
$14.48
|
| Rate for Payer: UHCCP Medicaid |
$14.48
|
|
|
CHG UROGRAPHY RETROGRADE WITH/WO KUB
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 74420
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$978.41 |
| Rate for Payer: Aetna Commercial |
$87.47
|
| Rate for Payer: Aetna Medicare |
$29.50
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCBS Trust/PPO |
$978.41
|
| Rate for Payer: BCN Commercial |
$112.89
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Meridian Medicaid |
$16.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.96
|
| Rate for Payer: Priority Health Narrow Network |
$36.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$135.73
|
| Rate for Payer: UHC Exchange |
$135.73
|
| Rate for Payer: UHCCP Medicaid |
$15.55
|
|
|
CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 76706
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$156.86 |
| Rate for Payer: Aetna Commercial |
$125.02
|
| Rate for Payer: Aetna Medicare |
$28.50
|
| Rate for Payer: BCBS Complete |
$17.22
|
| Rate for Payer: BCN Commercial |
$156.86
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Meridian Medicaid |
$17.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$39.52
|
| Rate for Payer: Priority Health Narrow Network |
$39.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$116.15
|
| Rate for Payer: UHC Exchange |
$116.15
|
| Rate for Payer: UHCCP Medicaid |
$16.40
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS 76700
|
| Min. Negotiated Rate |
$24.28 |
| Max. Negotiated Rate |
$2,008.07 |
| Rate for Payer: Aetna Commercial |
$139.34
|
| Rate for Payer: Aetna Medicare |
$106.50
|
| Rate for Payer: BCBS Complete |
$25.49
|
| Rate for Payer: BCBS Trust/PPO |
$2,008.07
|
| Rate for Payer: BCN Commercial |
$171.52
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Meridian Medicaid |
$25.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$57.99
|
| Rate for Payer: Priority Health Narrow Network |
$57.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.64
|
| Rate for Payer: UHC Exchange |
$144.64
|
| Rate for Payer: UHCCP Medicaid |
$24.28
|
|
