|
CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT
|
Facility
|
IP
|
$21,549.94
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
91495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13,576.46 |
| Max. Negotiated Rate |
$19,394.95 |
| Rate for Payer: Aetna Commercial |
$18,317.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,007.46
|
| Rate for Payer: Cash Price |
$17,239.95
|
| Rate for Payer: Cofinity Commercial |
$15,084.96
|
| Rate for Payer: Cofinity Commercial |
$18,532.95
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,084.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,239.95
|
| Rate for Payer: Healthscope Commercial |
$19,394.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,317.45
|
| Rate for Payer: PHP Commercial |
$18,317.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,007.46
|
| Rate for Payer: Priority Health SBD |
$13,576.46
|
|
|
CERTOLIZUMAB PEGOL 400 MG (200 MG X 2 VIALS) SUBCUTANEOUS KIT
|
Facility
|
OP
|
$21,549.94
|
|
|
Service Code
|
HCPCS J0717
|
| Hospital Charge Code |
91495
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.09 |
| Max. Negotiated Rate |
$19,394.95 |
| Rate for Payer: Aetna Commercial |
$18,317.45
|
| Rate for Payer: Aetna Medicare |
$4.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14,007.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$4.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$4.88
|
| Rate for Payer: BCBS Complete |
$2.19
|
| Rate for Payer: BCBS MAPPO |
$3.90
|
| Rate for Payer: BCBS Trust/PPO |
$13.11
|
| Rate for Payer: BCN Commercial |
$13.11
|
| Rate for Payer: BCN Medicare Advantage |
$3.90
|
| Rate for Payer: Cash Price |
$17,239.95
|
| Rate for Payer: Cash Price |
$17,239.95
|
| Rate for Payer: Cofinity Commercial |
$18,532.95
|
| Rate for Payer: Cofinity Commercial |
$15,084.96
|
| Rate for Payer: Cofinity Medicare Advantage |
$15,084.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$17,239.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.90
|
| Rate for Payer: Healthscope Commercial |
$19,394.95
|
| Rate for Payer: Mclaren Medicaid |
$2.09
|
| Rate for Payer: Mclaren Medicare |
$3.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.10
|
| Rate for Payer: Meridian Medicaid |
$2.19
|
| Rate for Payer: MI Amish Medical Board Commercial |
$4.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$18,317.45
|
| Rate for Payer: Nomi Health Commercial |
$11.70
|
| Rate for Payer: PACE Medicare |
$3.70
|
| Rate for Payer: PACE SWMI |
$3.90
|
| Rate for Payer: PHP Commercial |
$18,317.45
|
| Rate for Payer: PHP Medicare Advantage |
$3.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$2.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14,007.46
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13.40
|
| Rate for Payer: Priority Health Medicare |
$3.90
|
| Rate for Payer: Priority Health Narrow Network |
$10.72
|
| Rate for Payer: Priority Health SBD |
$13,576.46
|
| Rate for Payer: Railroad Medicare Medicare |
$3.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.90
|
| Rate for Payer: UHC Medicare Advantage |
$3.90
|
| Rate for Payer: UHCCP Medicaid |
$2.20
|
| Rate for Payer: VA VA |
$3.90
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$3,555.41
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
37989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,239.91 |
| Max. Negotiated Rate |
$3,199.87 |
| Rate for Payer: Aetna Commercial |
$3,022.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,311.02
|
| Rate for Payer: Cash Price |
$2,844.33
|
| Rate for Payer: Cofinity Commercial |
$2,488.79
|
| Rate for Payer: Cofinity Commercial |
$3,057.65
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,488.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,844.33
|
| Rate for Payer: Healthscope Commercial |
$3,199.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,022.10
|
| Rate for Payer: PHP Commercial |
$3,022.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,311.02
|
| Rate for Payer: Priority Health SBD |
$2,239.91
|
|
|
CETUXIMAB 100 MG/50 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$3,555.41
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
37989
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.33 |
| Max. Negotiated Rate |
$3,199.87 |
| Rate for Payer: Aetna Commercial |
$3,022.10
|
| Rate for Payer: Aetna Medicare |
$80.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,311.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.38
|
| Rate for Payer: BCBS Complete |
$43.39
|
| Rate for Payer: BCBS MAPPO |
$77.10
|
| Rate for Payer: BCBS Trust/PPO |
$209.24
|
| Rate for Payer: BCN Commercial |
$209.24
|
| Rate for Payer: BCN Medicare Advantage |
$77.10
|
| Rate for Payer: Cash Price |
$2,844.33
|
| Rate for Payer: Cash Price |
$2,844.33
|
| Rate for Payer: Cofinity Commercial |
$3,057.65
|
| Rate for Payer: Cofinity Commercial |
$2,488.79
|
| Rate for Payer: Cofinity Medicare Advantage |
$2,488.79
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2,844.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$3,199.87
|
| Rate for Payer: Mclaren Medicaid |
$41.33
|
| Rate for Payer: Mclaren Medicare |
$77.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.96
|
| Rate for Payer: Meridian Medicaid |
$43.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,022.10
|
| Rate for Payer: Nomi Health Commercial |
$231.30
|
| Rate for Payer: PACE Medicare |
$73.24
|
| Rate for Payer: PACE SWMI |
$77.10
|
| Rate for Payer: PHP Commercial |
$3,022.10
|
| Rate for Payer: PHP Medicare Advantage |
$77.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,311.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.24
|
| Rate for Payer: Priority Health Medicare |
$77.10
|
| Rate for Payer: Priority Health Narrow Network |
$173.79
|
| Rate for Payer: Priority Health SBD |
$2,239.91
|
| Rate for Payer: Railroad Medicare Medicare |
$77.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.10
|
| Rate for Payer: UHC Medicare Advantage |
$77.10
|
| Rate for Payer: UHCCP Medicaid |
$43.41
|
| Rate for Payer: VA VA |
$77.10
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$7,110.37
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
118617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,479.53 |
| Max. Negotiated Rate |
$6,399.33 |
| Rate for Payer: Aetna Commercial |
$6,043.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,621.74
|
| Rate for Payer: Cash Price |
$5,688.30
|
| Rate for Payer: Cofinity Commercial |
$4,977.26
|
| Rate for Payer: Cofinity Commercial |
$6,114.92
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,977.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,688.30
|
| Rate for Payer: Healthscope Commercial |
$6,399.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,043.81
|
| Rate for Payer: PHP Commercial |
$6,043.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,621.74
|
| Rate for Payer: Priority Health SBD |
$4,479.53
|
|
|
CETUXIMAB 200 MG/100 ML INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$7,110.37
|
|
|
Service Code
|
HCPCS J9055
|
| Hospital Charge Code |
118617
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$41.33 |
| Max. Negotiated Rate |
$6,399.33 |
| Rate for Payer: Aetna Commercial |
$6,043.81
|
| Rate for Payer: Aetna Medicare |
$80.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,621.74
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.38
|
| Rate for Payer: BCBS Complete |
$43.39
|
| Rate for Payer: BCBS MAPPO |
$77.10
|
| Rate for Payer: BCBS Trust/PPO |
$209.24
|
| Rate for Payer: BCN Commercial |
$209.24
|
| Rate for Payer: BCN Medicare Advantage |
$77.10
|
| Rate for Payer: Cash Price |
$5,688.30
|
| Rate for Payer: Cash Price |
$5,688.30
|
| Rate for Payer: Cofinity Commercial |
$6,114.92
|
| Rate for Payer: Cofinity Commercial |
$4,977.26
|
| Rate for Payer: Cofinity Medicare Advantage |
$4,977.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5,688.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.10
|
| Rate for Payer: Healthscope Commercial |
$6,399.33
|
| Rate for Payer: Mclaren Medicaid |
$41.33
|
| Rate for Payer: Mclaren Medicare |
$77.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.96
|
| Rate for Payer: Meridian Medicaid |
$43.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,043.81
|
| Rate for Payer: Nomi Health Commercial |
$231.30
|
| Rate for Payer: PACE Medicare |
$73.24
|
| Rate for Payer: PACE SWMI |
$77.10
|
| Rate for Payer: PHP Commercial |
$6,043.81
|
| Rate for Payer: PHP Medicare Advantage |
$77.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,621.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$217.24
|
| Rate for Payer: Priority Health Medicare |
$77.10
|
| Rate for Payer: Priority Health Narrow Network |
$173.79
|
| Rate for Payer: Priority Health SBD |
$4,479.53
|
| Rate for Payer: Railroad Medicare Medicare |
$77.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$217.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.10
|
| Rate for Payer: UHC Medicare Advantage |
$77.10
|
| Rate for Payer: UHCCP Medicaid |
$43.41
|
| Rate for Payer: VA VA |
$77.10
|
|
|
CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
|
Facility
|
OP
|
$2,055.42
|
|
|
Service Code
|
CPT 51710
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$84.36 |
| Max. Negotiated Rate |
$2,055.42 |
| Rate for Payer: Aetna Medicare |
$680.13
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$817.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$817.46
|
| Rate for Payer: BCBS Complete |
$368.05
|
| Rate for Payer: BCBS MAPPO |
$653.97
|
| Rate for Payer: BCBS Trust/PPO |
$309.63
|
| Rate for Payer: BCN Commercial |
$309.63
|
| Rate for Payer: BCN Medicare Advantage |
$653.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.97
|
| Rate for Payer: Mclaren Medicaid |
$350.53
|
| Rate for Payer: Mclaren Medicare |
$653.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.67
|
| Rate for Payer: Meridian Medicaid |
$368.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$752.07
|
| Rate for Payer: Nomi Health Commercial |
$1,373.34
|
| Rate for Payer: PACE Medicare |
$621.27
|
| Rate for Payer: PACE SWMI |
$653.97
|
| Rate for Payer: PHP Medicare Advantage |
$653.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$350.53
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,055.42
|
| Rate for Payer: Priority Health Medicare |
$653.97
|
| Rate for Payer: Priority Health Narrow Network |
$1,644.34
|
| Rate for Payer: Railroad Medicare Medicare |
$653.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.36
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$653.97
|
| Rate for Payer: UHC Exchange |
$1,566.00
|
| Rate for Payer: UHC Medicare Advantage |
$653.97
|
| Rate for Payer: UHCCP Medicaid |
$368.19
|
| Rate for Payer: VA VA |
$653.97
|
|
|
CHANGE OF CYSTOSTOMY TUBE; SIMPLE
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 51705
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$54.45 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Medicare |
$247.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$297.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$297.86
|
| Rate for Payer: BCBS Complete |
$134.11
|
| Rate for Payer: BCBS MAPPO |
$238.29
|
| Rate for Payer: BCBS Trust/PPO |
$138.31
|
| Rate for Payer: BCN Commercial |
$138.31
|
| Rate for Payer: BCN Medicare Advantage |
$238.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$238.29
|
| Rate for Payer: Mclaren Medicaid |
$127.72
|
| Rate for Payer: Mclaren Medicare |
$238.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$250.20
|
| Rate for Payer: Meridian Medicaid |
$134.11
|
| Rate for Payer: MI Amish Medical Board Commercial |
$274.03
|
| Rate for Payer: Nomi Health Commercial |
$500.41
|
| Rate for Payer: PACE Medicare |
$226.38
|
| Rate for Payer: PACE SWMI |
$238.29
|
| Rate for Payer: PHP Medicare Advantage |
$238.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$127.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$748.94
|
| Rate for Payer: Priority Health Medicare |
$238.29
|
| Rate for Payer: Priority Health Narrow Network |
$599.15
|
| Rate for Payer: Railroad Medicare Medicare |
$238.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.45
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$238.29
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$238.29
|
| Rate for Payer: UHCCP Medicaid |
$134.16
|
| Rate for Payer: VA VA |
$238.29
|
|
|
CHEMICAL PEELS
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 00172
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$5,000.00 |
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,000.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
CHEMODENERVATION OF INTERNAL ANAL SPHINCTER
|
Facility
|
OP
|
$3,630.90
|
|
|
Service Code
|
CPT 46505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$263.03 |
| Max. Negotiated Rate |
$3,630.90 |
| Rate for Payer: Aetna Medicare |
$1,201.45
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,444.05
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,444.05
|
| Rate for Payer: BCBS Complete |
$650.17
|
| Rate for Payer: BCBS MAPPO |
$1,155.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,199.78
|
| Rate for Payer: BCN Commercial |
$1,199.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,155.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,155.24
|
| Rate for Payer: Mclaren Medicaid |
$619.21
|
| Rate for Payer: Mclaren Medicare |
$1,155.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,213.00
|
| Rate for Payer: Meridian Medicaid |
$650.17
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,328.53
|
| Rate for Payer: Nomi Health Commercial |
$2,426.00
|
| Rate for Payer: PACE Medicare |
$1,097.48
|
| Rate for Payer: PACE SWMI |
$1,155.24
|
| Rate for Payer: PHP Medicare Advantage |
$1,155.24
|
| Rate for Payer: Priority Health Choice Medicaid |
$619.21
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,630.90
|
| Rate for Payer: Priority Health Medicare |
$1,155.24
|
| Rate for Payer: Priority Health Narrow Network |
$2,904.72
|
| Rate for Payer: Railroad Medicare Medicare |
$1,155.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$263.03
|
| Rate for Payer: UHC Core |
$3,138.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,155.24
|
| Rate for Payer: UHC Exchange |
$3,362.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,155.24
|
| Rate for Payer: UHCCP Medicaid |
$650.40
|
| Rate for Payer: VA VA |
$1,155.24
|
|
|
CHERRY FLAVOR (BULK) ORAL LIQUID
|
Facility
|
OP
|
$153.26
|
|
|
Service Code
|
NDC 00395266216
|
| Hospital Charge Code |
1562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.30 |
| Max. Negotiated Rate |
$137.93 |
| Rate for Payer: Aetna Commercial |
$130.27
|
| Rate for Payer: Aetna Medicare |
$76.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.62
|
| Rate for Payer: BCBS Complete |
$61.30
|
| Rate for Payer: Cash Price |
$122.61
|
| Rate for Payer: Cofinity Commercial |
$107.28
|
| Rate for Payer: Cofinity Commercial |
$131.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.61
|
| Rate for Payer: Healthscope Commercial |
$137.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.27
|
| Rate for Payer: PHP Commercial |
$130.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.62
|
| Rate for Payer: Priority Health SBD |
$96.55
|
|
|
CHERRY FLAVOR (BULK) ORAL LIQUID
|
Facility
|
IP
|
$153.26
|
|
|
Service Code
|
NDC 00395266216
|
| Hospital Charge Code |
1562
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$96.55 |
| Max. Negotiated Rate |
$137.93 |
| Rate for Payer: Aetna Commercial |
$130.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.62
|
| Rate for Payer: Cash Price |
$122.61
|
| Rate for Payer: Cofinity Commercial |
$107.28
|
| Rate for Payer: Cofinity Commercial |
$131.80
|
| Rate for Payer: Cofinity Medicare Advantage |
$107.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$122.61
|
| Rate for Payer: Healthscope Commercial |
$137.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.27
|
| Rate for Payer: PHP Commercial |
$130.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.62
|
| Rate for Payer: Priority Health SBD |
$96.55
|
|
|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
Both
|
$1,748.00
|
|
|
Service Code
|
HCPCS 77295
|
| Min. Negotiated Rate |
$145.05 |
| Max. Negotiated Rate |
$81,988.00 |
| Rate for Payer: Aetna Commercial |
$595.39
|
| Rate for Payer: Aetna Commercial |
$595.39
|
| Rate for Payer: Aetna Medicare |
$462.09
|
| Rate for Payer: Aetna Medicare |
$462.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$595.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.82
|
| Rate for Payer: BCBS Complete |
$152.30
|
| Rate for Payer: BCBS Complete |
$152.30
|
| Rate for Payer: BCBS MAPPO |
$444.32
|
| Rate for Payer: BCBS MAPPO |
$444.32
|
| Rate for Payer: BCBS Trust/PPO |
$192.72
|
| Rate for Payer: BCBS Trust/PPO |
$192.72
|
| Rate for Payer: BCN Commercial |
$699.98
|
| Rate for Payer: BCN Commercial |
$699.98
|
| Rate for Payer: BCN Medicare Advantage |
$444.32
|
| Rate for Payer: BCN Medicare Advantage |
$444.32
|
| Rate for Payer: Cash Price |
$1,398.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cash Price |
$1,398.40
|
| Rate for Payer: Cofinity Commercial |
$595.39
|
| Rate for Payer: Cofinity Commercial |
$639.82
|
| Rate for Payer: Cofinity Commercial |
$595.39
|
| Rate for Payer: Cofinity Commercial |
$639.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.32
|
| Rate for Payer: Healthscope Commercial |
$821.99
|
| Rate for Payer: Healthscope Commercial |
$710.91
|
| Rate for Payer: Healthscope Commercial |
$710.91
|
| Rate for Payer: Healthscope Commercial |
$821.99
|
| Rate for Payer: Mclaren Medicaid |
$145.05
|
| Rate for Payer: Mclaren Medicaid |
$145.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.54
|
| Rate for Payer: Meridian Medicaid |
$152.30
|
| Rate for Payer: Meridian Medicaid |
$152.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81,988.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$81,988.00
|
| Rate for Payer: Nomi Health Commercial |
$533.18
|
| Rate for Payer: Nomi Health Commercial |
$533.18
|
| Rate for Payer: PACE SWMI |
$444.32
|
| Rate for Payer: PACE SWMI |
$444.32
|
| Rate for Payer: PHP Medicare Advantage |
$444.32
|
| Rate for Payer: PHP Medicare Advantage |
$444.32
|
| 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 |
$1,136.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$740.13
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$740.13
|
| Rate for Payer: Priority Health Medicare |
$444.32
|
| Rate for Payer: Priority Health Medicare |
$444.32
|
| Rate for Payer: Priority Health Narrow Network |
$740.13
|
| Rate for Payer: Priority Health Narrow Network |
$740.13
|
| Rate for Payer: Priority Health SBD |
$343.89
|
| Rate for Payer: Priority Health SBD |
$343.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,577.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,577.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.32
|
| Rate for Payer: UHC Exchange |
$1,577.26
|
| Rate for Payer: UHC Exchange |
$1,577.26
|
| Rate for Payer: UHC Medicare Advantage |
$444.32
|
| Rate for Payer: UHC Medicare Advantage |
$444.32
|
| Rate for Payer: UHCCP Medicaid |
$145.05
|
| Rate for Payer: UHCCP Medicaid |
$145.05
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 76377
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$13,093.00 |
| Rate for Payer: Aetna Commercial |
$97.71
|
| Rate for Payer: Aetna Medicare |
$75.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.71
|
| Rate for Payer: BCBS Complete |
$25.05
|
| Rate for Payer: BCBS MAPPO |
$72.92
|
| Rate for Payer: BCBS Trust/PPO |
$904.45
|
| Rate for Payer: BCN Commercial |
$110.93
|
| Rate for Payer: BCN Medicare Advantage |
$72.92
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cofinity Commercial |
$97.71
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.92
|
| Rate for Payer: Healthscope Commercial |
$134.90
|
| Rate for Payer: Healthscope Commercial |
$116.67
|
| Rate for Payer: Mclaren Medicaid |
$23.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.57
|
| Rate for Payer: Meridian Medicaid |
$25.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$13,093.00
|
| Rate for Payer: Nomi Health Commercial |
$87.50
|
| Rate for Payer: PACE SWMI |
$72.92
|
| Rate for Payer: PHP Medicare Advantage |
$72.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$120.10
|
| Rate for Payer: Priority Health Medicare |
$72.92
|
| Rate for Payer: Priority Health Narrow Network |
$120.10
|
| Rate for Payer: Priority Health SBD |
$57.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.92
|
| Rate for Payer: UHC Exchange |
$192.41
|
| Rate for Payer: UHC Medicare Advantage |
$72.92
|
| Rate for Payer: UHCCP Medicaid |
$23.86
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 76376
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$4,129.00 |
| Rate for Payer: Aetna Commercial |
$31.41
|
| Rate for Payer: Aetna Commercial |
$31.41
|
| Rate for Payer: Aetna Medicare |
$24.38
|
| Rate for Payer: Aetna Medicare |
$24.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.41
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: BCBS MAPPO |
$23.44
|
| Rate for Payer: BCBS MAPPO |
$23.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,774.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,774.03
|
| Rate for Payer: BCN Commercial |
$35.19
|
| Rate for Payer: BCN Commercial |
$35.19
|
| Rate for Payer: BCN Medicare Advantage |
$23.44
|
| Rate for Payer: BCN Medicare Advantage |
$23.44
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$33.75
|
| Rate for Payer: Cofinity Commercial |
$31.41
|
| Rate for Payer: Cofinity Commercial |
$31.41
|
| Rate for Payer: Cofinity Commercial |
$33.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.44
|
| Rate for Payer: Healthscope Commercial |
$37.50
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Healthscope Commercial |
$37.50
|
| Rate for Payer: Healthscope Commercial |
$43.36
|
| Rate for Payer: Mclaren Medicaid |
$5.96
|
| Rate for Payer: Mclaren Medicaid |
$5.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.61
|
| Rate for Payer: Meridian Medicaid |
$6.26
|
| Rate for Payer: Meridian Medicaid |
$6.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,129.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,129.00
|
| Rate for Payer: Nomi Health Commercial |
$28.13
|
| Rate for Payer: Nomi Health Commercial |
$28.13
|
| Rate for Payer: PACE SWMI |
$23.44
|
| Rate for Payer: PACE SWMI |
$23.44
|
| Rate for Payer: PHP Medicare Advantage |
$23.44
|
| Rate for Payer: PHP Medicare Advantage |
$23.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$38.50
|
| Rate for Payer: Priority Health Medicare |
$23.44
|
| Rate for Payer: Priority Health Medicare |
$23.44
|
| Rate for Payer: Priority Health Narrow Network |
$38.50
|
| Rate for Payer: Priority Health Narrow Network |
$38.50
|
| Rate for Payer: Priority Health SBD |
$14.37
|
| Rate for Payer: Priority Health SBD |
$14.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$143.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.44
|
| Rate for Payer: UHC Exchange |
$143.62
|
| Rate for Payer: UHC Exchange |
$143.62
|
| Rate for Payer: UHC Medicare Advantage |
$23.44
|
| Rate for Payer: UHC Medicare Advantage |
$23.44
|
| Rate for Payer: UHCCP Medicaid |
$5.96
|
| Rate for Payer: UHCCP Medicaid |
$5.96
|
|
|
CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 78278
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$54,630.00 |
| Rate for Payer: Aetna Commercial |
$374.82
|
| Rate for Payer: Aetna Medicare |
$290.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.80
|
| Rate for Payer: BCBS Complete |
$30.64
|
| Rate for Payer: BCBS MAPPO |
$279.72
|
| Rate for Payer: BCBS Trust/PPO |
$674.64
|
| Rate for Payer: BCN Commercial |
$475.00
|
| Rate for Payer: BCN Medicare Advantage |
$279.72
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$402.80
|
| Rate for Payer: Cofinity Commercial |
$374.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.72
|
| Rate for Payer: Healthscope Commercial |
$517.48
|
| Rate for Payer: Healthscope Commercial |
$447.55
|
| Rate for Payer: Mclaren Medicaid |
$29.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.71
|
| Rate for Payer: Meridian Medicaid |
$30.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$54,630.00
|
| Rate for Payer: Nomi Health Commercial |
$335.66
|
| Rate for Payer: PACE SWMI |
$279.72
|
| Rate for Payer: PHP Medicare Advantage |
$279.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$490.68
|
| Rate for Payer: Priority Health Medicare |
$279.72
|
| Rate for Payer: Priority Health Narrow Network |
$490.68
|
| Rate for Payer: Priority Health SBD |
$70.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$258.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.72
|
| Rate for Payer: UHC Exchange |
$258.05
|
| Rate for Payer: UHC Medicare Advantage |
$279.72
|
| Rate for Payer: UHCCP Medicaid |
$29.18
|
|
|
CHG ANGIO ARCH ANGIOGRAM W CATH
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 75650
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$173.55 |
| Rate for Payer: Aetna Medicare |
$133.50
|
| Rate for Payer: BCBS Complete |
$106.80
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$173.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.55
|
|
|
CHG ANGIO AV SHUNT COMPLETE EVAL
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 75791
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Medicare |
$154.00
|
| Rate for Payer: Aetna Medicare |
$253.50
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS Complete |
$202.80
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.55
|
|
|
CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 75716
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$28,298.00 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Aetna Medicare |
$157.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$217.63
|
| Rate for Payer: BCBS Complete |
$61.06
|
| Rate for Payer: BCBS MAPPO |
$151.13
|
| Rate for Payer: BCBS Trust/PPO |
$112.00
|
| Rate for Payer: BCN Commercial |
$237.49
|
| Rate for Payer: BCN Medicare Advantage |
$151.13
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$217.63
|
| Rate for Payer: Cofinity Commercial |
$202.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.13
|
| Rate for Payer: Healthscope Commercial |
$279.59
|
| Rate for Payer: Healthscope Commercial |
$241.81
|
| Rate for Payer: Mclaren Medicaid |
$58.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.69
|
| Rate for Payer: Meridian Medicaid |
$61.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$28,298.00
|
| Rate for Payer: Nomi Health Commercial |
$181.36
|
| Rate for Payer: PACE SWMI |
$151.13
|
| Rate for Payer: PHP Medicare Advantage |
$151.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$250.47
|
| Rate for Payer: Priority Health Medicare |
$151.13
|
| Rate for Payer: Priority Health Narrow Network |
$250.47
|
| Rate for Payer: Priority Health SBD |
$139.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$597.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.13
|
| Rate for Payer: UHC Exchange |
$597.62
|
| Rate for Payer: UHC Medicare Advantage |
$151.13
|
| Rate for Payer: UHCCP Medicaid |
$58.15
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 75710
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$26,197.00 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Aetna Medicare |
$143.43
|
| Rate for Payer: Aetna Medicare |
$143.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.80
|
| Rate for Payer: BCBS Complete |
$54.13
|
| Rate for Payer: BCBS Complete |
$54.13
|
| Rate for Payer: BCBS MAPPO |
$137.91
|
| Rate for Payer: BCBS MAPPO |
$137.91
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: BCN Commercial |
$219.91
|
| Rate for Payer: BCN Commercial |
$219.91
|
| Rate for Payer: BCN Medicare Advantage |
$137.91
|
| Rate for Payer: BCN Medicare Advantage |
$137.91
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Commercial |
$198.59
|
| Rate for Payer: Cofinity Commercial |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$198.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.91
|
| Rate for Payer: Healthscope Commercial |
$220.66
|
| Rate for Payer: Healthscope Commercial |
$255.13
|
| Rate for Payer: Healthscope Commercial |
$220.66
|
| Rate for Payer: Healthscope Commercial |
$255.13
|
| Rate for Payer: Mclaren Medicaid |
$51.55
|
| Rate for Payer: Mclaren Medicaid |
$51.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.81
|
| Rate for Payer: Meridian Medicaid |
$54.13
|
| Rate for Payer: Meridian Medicaid |
$54.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,197.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$26,197.00
|
| Rate for Payer: Nomi Health Commercial |
$165.49
|
| Rate for Payer: Nomi Health Commercial |
$165.49
|
| Rate for Payer: PACE SWMI |
$137.91
|
| Rate for Payer: PACE SWMI |
$137.91
|
| Rate for Payer: PHP Medicare Advantage |
$137.91
|
| Rate for Payer: PHP Medicare Advantage |
$137.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.96
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$230.96
|
| Rate for Payer: Priority Health Medicare |
$137.91
|
| Rate for Payer: Priority Health Medicare |
$137.91
|
| Rate for Payer: Priority Health Narrow Network |
$230.96
|
| Rate for Payer: Priority Health Narrow Network |
$230.96
|
| Rate for Payer: Priority Health SBD |
$124.72
|
| Rate for Payer: Priority Health SBD |
$124.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$588.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$588.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.91
|
| Rate for Payer: UHC Exchange |
$588.91
|
| Rate for Payer: UHC Exchange |
$588.91
|
| Rate for Payer: UHC Medicare Advantage |
$137.91
|
| Rate for Payer: UHC Medicare Advantage |
$137.91
|
| Rate for Payer: UHCCP Medicaid |
$51.55
|
| Rate for Payer: UHCCP Medicaid |
$51.55
|
|
|
CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 75756
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$27,675.00 |
| Rate for Payer: Aetna Commercial |
$198.40
|
| Rate for Payer: Aetna Medicare |
$153.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$198.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$213.21
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS MAPPO |
$148.06
|
| Rate for Payer: BCBS Trust/PPO |
$177.51
|
| Rate for Payer: BCN Commercial |
$236.52
|
| Rate for Payer: BCN Medicare Advantage |
$148.06
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$213.21
|
| Rate for Payer: Cofinity Commercial |
$198.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.06
|
| Rate for Payer: Healthscope Commercial |
$273.91
|
| Rate for Payer: Healthscope Commercial |
$236.90
|
| Rate for Payer: Mclaren Medicaid |
$34.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.46
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$27,675.00
|
| Rate for Payer: Nomi Health Commercial |
$177.67
|
| Rate for Payer: PACE SWMI |
$148.06
|
| Rate for Payer: PHP Medicare Advantage |
$148.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.06
|
| Rate for Payer: Priority Health Medicare |
$148.06
|
| Rate for Payer: Priority Health Narrow Network |
$254.06
|
| Rate for Payer: Priority Health SBD |
$82.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$590.49
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.06
|
| Rate for Payer: UHC Exchange |
$590.49
|
| Rate for Payer: UHC Medicare Advantage |
$148.06
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
|
|
CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 75736
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$24,543.00 |
| Rate for Payer: Aetna Commercial |
$176.63
|
| Rate for Payer: Aetna Medicare |
$137.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.81
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS MAPPO |
$131.81
|
| Rate for Payer: BCBS Trust/PPO |
$182.79
|
| Rate for Payer: BCN Commercial |
$209.15
|
| Rate for Payer: BCN Medicare Advantage |
$131.81
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cofinity Commercial |
$189.81
|
| Rate for Payer: Cofinity Commercial |
$176.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.81
|
| Rate for Payer: Healthscope Commercial |
$243.85
|
| Rate for Payer: Healthscope Commercial |
$210.90
|
| Rate for Payer: Mclaren Medicaid |
$32.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.40
|
| Rate for Payer: Meridian Medicaid |
$34.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,543.00
|
| Rate for Payer: Nomi Health Commercial |
$158.17
|
| Rate for Payer: PACE SWMI |
$131.81
|
| Rate for Payer: PHP Medicare Advantage |
$131.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.71
|
| Rate for Payer: Priority Health Medicare |
$131.81
|
| Rate for Payer: Priority Health Narrow Network |
$220.71
|
| Rate for Payer: Priority Health SBD |
$78.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$588.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.81
|
| Rate for Payer: UHC Exchange |
$588.12
|
| Rate for Payer: UHC Medicare Advantage |
$131.81
|
| Rate for Payer: UHCCP Medicaid |
$32.59
|
|
|
CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 75741
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$22,615.00 |
| Rate for Payer: Aetna Commercial |
$159.00
|
| Rate for Payer: Aetna Medicare |
$123.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.87
|
| Rate for Payer: BCBS Complete |
$39.58
|
| Rate for Payer: BCBS MAPPO |
$118.66
|
| Rate for Payer: BCBS Trust/PPO |
$104.08
|
| Rate for Payer: BCN Commercial |
$191.56
|
| Rate for Payer: BCN Medicare Advantage |
$118.66
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$170.87
|
| Rate for Payer: Cofinity Commercial |
$159.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.66
|
| Rate for Payer: Healthscope Commercial |
$219.52
|
| Rate for Payer: Healthscope Commercial |
$189.86
|
| Rate for Payer: Mclaren Medicaid |
$37.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.59
|
| Rate for Payer: Meridian Medicaid |
$39.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22,615.00
|
| Rate for Payer: Nomi Health Commercial |
$142.39
|
| Rate for Payer: PACE SWMI |
$118.66
|
| Rate for Payer: PHP Medicare Advantage |
$118.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$199.66
|
| Rate for Payer: Priority Health Medicare |
$118.66
|
| Rate for Payer: Priority Health Narrow Network |
$199.66
|
| Rate for Payer: Priority Health SBD |
$90.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$597.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.66
|
| Rate for Payer: UHC Exchange |
$597.62
|
| Rate for Payer: UHC Medicare Advantage |
$118.66
|
| Rate for Payer: UHCCP Medicaid |
$37.70
|
|
|
CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 75705
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$42,998.00 |
| Rate for Payer: Aetna Commercial |
$318.13
|
| Rate for Payer: Aetna Medicare |
$246.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$318.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.87
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS MAPPO |
$237.41
|
| Rate for Payer: BCBS Trust/PPO |
$162.19
|
| Rate for Payer: BCN Commercial |
$363.58
|
| Rate for Payer: BCN Medicare Advantage |
$237.41
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cofinity Commercial |
$341.87
|
| Rate for Payer: Cofinity Commercial |
$318.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.41
|
| Rate for Payer: Healthscope Commercial |
$439.21
|
| Rate for Payer: Healthscope Commercial |
$379.86
|
| Rate for Payer: Mclaren Medicaid |
$74.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.28
|
| Rate for Payer: Meridian Medicaid |
$78.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42,998.00
|
| Rate for Payer: Nomi Health Commercial |
$284.89
|
| Rate for Payer: PACE SWMI |
$237.41
|
| Rate for Payer: PHP Medicare Advantage |
$237.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$385.46
|
| Rate for Payer: Priority Health Medicare |
$237.41
|
| Rate for Payer: Priority Health Narrow Network |
$385.46
|
| Rate for Payer: Priority Health SBD |
$176.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$646.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.41
|
| Rate for Payer: UHC Exchange |
$646.30
|
| Rate for Payer: UHC Medicare Advantage |
$237.41
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
|
|
CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 75726
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$29,810.00 |
| Rate for Payer: Aetna Commercial |
$212.12
|
| Rate for Payer: Aetna Medicare |
$164.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.95
|
| Rate for Payer: BCBS Complete |
$62.62
|
| Rate for Payer: BCBS MAPPO |
$158.30
|
| Rate for Payer: BCBS Trust/PPO |
$145.81
|
| Rate for Payer: BCN Commercial |
$250.69
|
| Rate for Payer: BCN Medicare Advantage |
$158.30
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$227.95
|
| Rate for Payer: Cofinity Commercial |
$212.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$158.30
|
| Rate for Payer: Healthscope Commercial |
$292.86
|
| Rate for Payer: Healthscope Commercial |
$253.28
|
| Rate for Payer: Mclaren Medicaid |
$59.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$166.22
|
| Rate for Payer: Meridian Medicaid |
$62.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,810.00
|
| Rate for Payer: Nomi Health Commercial |
$189.96
|
| Rate for Payer: PACE SWMI |
$158.30
|
| Rate for Payer: PHP Medicare Advantage |
$158.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$261.24
|
| Rate for Payer: Priority Health Medicare |
$158.30
|
| Rate for Payer: Priority Health Narrow Network |
$261.24
|
| Rate for Payer: Priority Health SBD |
$141.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$585.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$158.30
|
| Rate for Payer: UHC Exchange |
$585.09
|
| Rate for Payer: UHC Medicare Advantage |
$158.30
|
| Rate for Payer: UHCCP Medicaid |
$59.64
|
|
