|
CHG CYSTOGRAPHY MINIMUM 3 VIEWS RS&I
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 74430
|
| Min. Negotiated Rate |
$37.72 |
| Max. Negotiated Rate |
$69.78 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Medicare |
$39.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.54
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: BCBS MAPPO |
$37.72
|
| Rate for Payer: BCN Medicare Advantage |
$37.72
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$54.32
|
| Rate for Payer: Cofinity Commercial |
$50.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.72
|
| Rate for Payer: Healthscope Commercial |
$60.35
|
| Rate for Payer: Healthscope Commercial |
$69.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.60
|
| Rate for Payer: Nomi Health Commercial |
$45.26
|
| Rate for Payer: PACE SWMI |
$37.72
|
| Rate for Payer: PHP Medicare Advantage |
$37.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.60
|
| Rate for Payer: Priority Health Medicare |
$37.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.72
|
| Rate for Payer: UHC Medicare Advantage |
$37.72
|
|
|
CHG CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 88141
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$42.42 |
| Rate for Payer: Aetna Commercial |
$30.73
|
| Rate for Payer: Aetna Medicare |
$23.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.73
|
| Rate for Payer: BCBS Complete |
$25.60
|
| Rate for Payer: BCBS MAPPO |
$22.93
|
| Rate for Payer: BCN Medicare Advantage |
$22.93
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$33.02
|
| Rate for Payer: Cofinity Commercial |
$30.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.93
|
| Rate for Payer: Healthscope Commercial |
$42.42
|
| Rate for Payer: Healthscope Commercial |
$36.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$41.60
|
| Rate for Payer: Nomi Health Commercial |
$27.52
|
| Rate for Payer: PACE SWMI |
$22.93
|
| Rate for Payer: PHP Medicare Advantage |
$22.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.60
|
| Rate for Payer: Priority Health Medicare |
$22.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.93
|
| Rate for Payer: UHC Medicare Advantage |
$22.93
|
|
|
CHG CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 88142
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$37.48 |
| Rate for Payer: Aetna Commercial |
$27.15
|
| Rate for Payer: Aetna Medicare |
$21.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.15
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$29.17
|
| Rate for Payer: Cofinity Commercial |
$27.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Healthscope Commercial |
$32.42
|
| Rate for Payer: Healthscope Commercial |
$37.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.55
|
| Rate for Payer: Nomi Health Commercial |
$24.31
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.26
|
| Rate for Payer: UHC Medicare Advantage |
$20.26
|
|
|
CHG DEXA,BONE DENSITY,VERTEB FRACT
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS 77082
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.35
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 71270
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$333.37 |
| Rate for Payer: Aetna Commercial |
$241.47
|
| Rate for Payer: Aetna Medicare |
$187.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.49
|
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: BCBS MAPPO |
$180.20
|
| Rate for Payer: BCN Medicare Advantage |
$180.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$259.49
|
| Rate for Payer: Cofinity Commercial |
$241.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.20
|
| Rate for Payer: Healthscope Commercial |
$333.37
|
| Rate for Payer: Healthscope Commercial |
$288.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$83.85
|
| Rate for Payer: Nomi Health Commercial |
$216.24
|
| Rate for Payer: PACE SWMI |
$180.20
|
| Rate for Payer: PHP Medicare Advantage |
$180.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: Priority Health Medicare |
$180.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.20
|
| Rate for Payer: UHC Medicare Advantage |
$180.20
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 71260
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$284.22 |
| Rate for Payer: Aetna Commercial |
$205.86
|
| Rate for Payer: Aetna Medicare |
$159.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.23
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS MAPPO |
$153.63
|
| Rate for Payer: BCN Medicare Advantage |
$153.63
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$205.86
|
| Rate for Payer: Cofinity Commercial |
$221.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.63
|
| Rate for Payer: Healthscope Commercial |
$245.81
|
| Rate for Payer: Healthscope Commercial |
$284.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.00
|
| Rate for Payer: Nomi Health Commercial |
$184.36
|
| Rate for Payer: PACE SWMI |
$153.63
|
| Rate for Payer: PHP Medicare Advantage |
$153.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health Medicare |
$153.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.63
|
| Rate for Payer: UHC Medicare Advantage |
$153.63
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 71250
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$227.48 |
| Rate for Payer: Aetna Commercial |
$164.77
|
| Rate for Payer: Aetna Medicare |
$127.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.77
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$122.96
|
| Rate for Payer: BCN Medicare Advantage |
$122.96
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$177.06
|
| Rate for Payer: Cofinity Commercial |
$164.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.96
|
| Rate for Payer: Healthscope Commercial |
$196.74
|
| Rate for Payer: Healthscope Commercial |
$227.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$72.80
|
| Rate for Payer: Nomi Health Commercial |
$147.55
|
| Rate for Payer: PACE SWMI |
$122.96
|
| Rate for Payer: PHP Medicare Advantage |
$122.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health Medicare |
$122.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.96
|
| Rate for Payer: UHC Medicare Advantage |
$122.96
|
|
|
CHG DIGITAL BREAST TOMOSYNTHESIS UNILATERAL
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 77061
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$42.90 |
| Rate for Payer: Aetna Medicare |
$33.00
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$42.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
|
|
CHG DISKOGRAPY LUMBAR RS&I
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 72295
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Aetna Commercial |
$134.87
|
| Rate for Payer: Aetna Medicare |
$104.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.94
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: BCBS MAPPO |
$100.65
|
| Rate for Payer: BCN Medicare Advantage |
$100.65
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$134.87
|
| Rate for Payer: Cofinity Commercial |
$144.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.65
|
| Rate for Payer: Healthscope Commercial |
$161.04
|
| Rate for Payer: Healthscope Commercial |
$186.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$68.25
|
| Rate for Payer: Nomi Health Commercial |
$120.78
|
| Rate for Payer: PACE SWMI |
$100.65
|
| Rate for Payer: PHP Medicare Advantage |
$100.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health Medicare |
$100.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.65
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
|
|
CHG DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76828
|
| Min. Negotiated Rate |
$44.22 |
| Max. Negotiated Rate |
$94.25 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Aetna Medicare |
$45.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.25
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: BCBS MAPPO |
$44.22
|
| Rate for Payer: BCN Medicare Advantage |
$44.22
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$63.68
|
| Rate for Payer: Cofinity Commercial |
$59.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.22
|
| Rate for Payer: Healthscope Commercial |
$81.81
|
| Rate for Payer: Healthscope Commercial |
$70.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.25
|
| Rate for Payer: Nomi Health Commercial |
$53.06
|
| Rate for Payer: PACE SWMI |
$44.22
|
| Rate for Payer: PHP Medicare Advantage |
$44.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health Medicare |
$44.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.22
|
| Rate for Payer: UHC Medicare Advantage |
$44.22
|
|
|
CHG DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 76827
|
| Min. Negotiated Rate |
$62.63 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Aetna Commercial |
$83.92
|
| Rate for Payer: Aetna Medicare |
$65.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.92
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: BCBS MAPPO |
$62.63
|
| Rate for Payer: BCN Medicare Advantage |
$62.63
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$90.19
|
| Rate for Payer: Cofinity Commercial |
$83.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.63
|
| Rate for Payer: Healthscope Commercial |
$100.21
|
| Rate for Payer: Healthscope Commercial |
$115.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.30
|
| Rate for Payer: Nomi Health Commercial |
$75.16
|
| Rate for Payer: PACE SWMI |
$62.63
|
| Rate for Payer: PHP Medicare Advantage |
$62.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health Medicare |
$62.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.63
|
| Rate for Payer: UHC Medicare Advantage |
$62.63
|
|
|
CHG DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 76821
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$147.57 |
| Rate for Payer: Aetna Commercial |
$106.89
|
| Rate for Payer: Aetna Medicare |
$82.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.89
|
| Rate for Payer: BCBS Complete |
$57.60
|
| Rate for Payer: BCBS MAPPO |
$79.77
|
| Rate for Payer: BCN Medicare Advantage |
$79.77
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$114.87
|
| Rate for Payer: Cofinity Commercial |
$106.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.77
|
| Rate for Payer: Healthscope Commercial |
$147.57
|
| Rate for Payer: Healthscope Commercial |
$127.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$93.60
|
| Rate for Payer: Nomi Health Commercial |
$95.72
|
| Rate for Payer: PACE SWMI |
$79.77
|
| Rate for Payer: PHP Medicare Advantage |
$79.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health Medicare |
$79.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.77
|
| Rate for Payer: UHC Medicare Advantage |
$79.77
|
|
|
CHG DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 76820
|
| Min. Negotiated Rate |
$40.51 |
| Max. Negotiated Rate |
$161.85 |
| Rate for Payer: Aetna Commercial |
$54.28
|
| Rate for Payer: Aetna Medicare |
$42.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.28
|
| Rate for Payer: BCBS Complete |
$99.60
|
| Rate for Payer: BCBS MAPPO |
$40.51
|
| Rate for Payer: BCN Medicare Advantage |
$40.51
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cofinity Commercial |
$58.33
|
| Rate for Payer: Cofinity Commercial |
$54.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.51
|
| Rate for Payer: Healthscope Commercial |
$64.82
|
| Rate for Payer: Healthscope Commercial |
$74.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$161.85
|
| Rate for Payer: Nomi Health Commercial |
$48.61
|
| Rate for Payer: PACE SWMI |
$40.51
|
| Rate for Payer: PHP Medicare Advantage |
$40.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.85
|
| Rate for Payer: Priority Health Medicare |
$40.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.51
|
| Rate for Payer: UHC Medicare Advantage |
$40.51
|
|
|
CHG DRUG SCREEN LIST A ANY NMBR NON TLC DEVICES
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 80300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
|
|
CHG DRUG SCREEN MULT CLASSES
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 80100
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
|
|
CHG DRUG SCREEN, QUAL,1+ DRUG CLASS,NON-CHROMOTOGRAPHIC,EACH
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 80104
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
|
|
CHG DRUG SCREEN SINGL CLASS
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 80101
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
|
|
CHG DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 80305
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Commercial |
$16.88
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.14
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$18.14
|
| Rate for Payer: Cofinity Commercial |
$16.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Healthscope Commercial |
$20.16
|
| Rate for Payer: Healthscope Commercial |
$23.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25.35
|
| Rate for Payer: Nomi Health Commercial |
$15.12
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
|
|
CHG DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 80307
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$114.96 |
| Rate for Payer: Aetna Commercial |
$83.27
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.27
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$89.48
|
| Rate for Payer: Cofinity Commercial |
$83.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Healthscope Commercial |
$99.42
|
| Rate for Payer: Healthscope Commercial |
$114.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$53.30
|
| Rate for Payer: Nomi Health Commercial |
$74.57
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
|
|
CHG DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 80306
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$31.71 |
| Rate for Payer: Aetna Commercial |
$22.97
|
| Rate for Payer: Aetna Medicare |
$17.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.97
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS MAPPO |
$17.14
|
| Rate for Payer: BCN Medicare Advantage |
$17.14
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$22.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.14
|
| Rate for Payer: Healthscope Commercial |
$27.42
|
| Rate for Payer: Healthscope Commercial |
$31.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Nomi Health Commercial |
$20.57
|
| Rate for Payer: PACE SWMI |
$17.14
|
| Rate for Payer: PHP Medicare Advantage |
$17.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: Priority Health Medicare |
$17.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.14
|
| Rate for Payer: UHC Medicare Advantage |
$17.14
|
|
|
CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 77081
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$53.71 |
| Rate for Payer: Aetna Commercial |
$38.90
|
| Rate for Payer: Aetna Commercial |
$38.90
|
| Rate for Payer: Aetna Medicare |
$30.19
|
| Rate for Payer: Aetna Medicare |
$30.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.80
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS MAPPO |
$29.03
|
| Rate for Payer: BCBS MAPPO |
$29.03
|
| Rate for Payer: BCN Medicare Advantage |
$29.03
|
| Rate for Payer: BCN Medicare Advantage |
$29.03
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$38.90
|
| Rate for Payer: Cofinity Commercial |
$41.80
|
| Rate for Payer: Cofinity Commercial |
$38.90
|
| Rate for Payer: Cofinity Commercial |
$41.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.03
|
| Rate for Payer: Healthscope Commercial |
$53.71
|
| Rate for Payer: Healthscope Commercial |
$53.71
|
| Rate for Payer: Healthscope Commercial |
$46.45
|
| Rate for Payer: Healthscope Commercial |
$46.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$17.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.65
|
| Rate for Payer: Nomi Health Commercial |
$34.84
|
| Rate for Payer: Nomi Health Commercial |
$34.84
|
| Rate for Payer: PACE SWMI |
$29.03
|
| Rate for Payer: PACE SWMI |
$29.03
|
| Rate for Payer: PHP Medicare Advantage |
$29.03
|
| Rate for Payer: PHP Medicare Advantage |
$29.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: Priority Health Medicare |
$29.03
|
| Rate for Payer: Priority Health Medicare |
$29.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.03
|
| Rate for Payer: UHC Medicare Advantage |
$29.03
|
| Rate for Payer: UHC Medicare Advantage |
$29.03
|
|
|
CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
HCPCS 77080
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$155.35 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Medicare |
$36.94
|
| Rate for Payer: Aetna Medicare |
$36.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.15
|
| Rate for Payer: BCBS Complete |
$95.60
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$35.52
|
| Rate for Payer: BCBS MAPPO |
$35.52
|
| Rate for Payer: BCN Medicare Advantage |
$35.52
|
| Rate for Payer: BCN Medicare Advantage |
$35.52
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$51.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.52
|
| Rate for Payer: Healthscope Commercial |
$65.71
|
| Rate for Payer: Healthscope Commercial |
$65.71
|
| Rate for Payer: Healthscope Commercial |
$56.83
|
| Rate for Payer: Healthscope Commercial |
$56.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.35
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.15
|
| Rate for Payer: Nomi Health Commercial |
$42.62
|
| Rate for Payer: Nomi Health Commercial |
$42.62
|
| Rate for Payer: PACE SWMI |
$35.52
|
| Rate for Payer: PACE SWMI |
$35.52
|
| Rate for Payer: PHP Medicare Advantage |
$35.52
|
| Rate for Payer: PHP Medicare Advantage |
$35.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.35
|
| Rate for Payer: Priority Health Medicare |
$35.52
|
| Rate for Payer: Priority Health Medicare |
$35.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.52
|
| Rate for Payer: UHC Medicare Advantage |
$35.52
|
| Rate for Payer: UHC Medicare Advantage |
$35.52
|
|
|
CHG DX NTRAOP EPCAR CAR US CHD PLMT MNPJ&IMG ACQUISJ
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 76988
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$137.80 |
| Rate for Payer: Aetna Medicare |
$106.00
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
|
|
CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 76506
|
| Min. Negotiated Rate |
$98.89 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$132.51
|
| Rate for Payer: Aetna Medicare |
$102.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.40
|
| Rate for Payer: BCBS Complete |
$128.00
|
| Rate for Payer: BCBS MAPPO |
$98.89
|
| Rate for Payer: BCN Medicare Advantage |
$98.89
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cofinity Commercial |
$142.40
|
| Rate for Payer: Cofinity Commercial |
$132.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.89
|
| Rate for Payer: Healthscope Commercial |
$182.95
|
| Rate for Payer: Healthscope Commercial |
$158.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$208.00
|
| Rate for Payer: Nomi Health Commercial |
$118.67
|
| Rate for Payer: PACE SWMI |
$98.89
|
| Rate for Payer: PHP Medicare Advantage |
$98.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health Medicare |
$98.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.89
|
| Rate for Payer: UHC Medicare Advantage |
$98.89
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 76825
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$428.13 |
| Rate for Payer: Aetna Commercial |
$310.10
|
| Rate for Payer: Aetna Medicare |
$240.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.24
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: BCBS MAPPO |
$231.42
|
| Rate for Payer: BCN Medicare Advantage |
$231.42
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$310.10
|
| Rate for Payer: Cofinity Commercial |
$333.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.42
|
| Rate for Payer: Healthscope Commercial |
$370.27
|
| Rate for Payer: Healthscope Commercial |
$428.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.70
|
| Rate for Payer: Nomi Health Commercial |
$277.70
|
| Rate for Payer: PACE SWMI |
$231.42
|
| Rate for Payer: PHP Medicare Advantage |
$231.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$231.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.42
|
| Rate for Payer: UHC Medicare Advantage |
$231.42
|
|
