|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 76826
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$256.35 |
| Rate for Payer: Aetna Commercial |
$185.68
|
| Rate for Payer: Aetna Medicare |
$144.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.68
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$138.57
|
| Rate for Payer: BCN Medicare Advantage |
$138.57
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$199.54
|
| Rate for Payer: Cofinity Commercial |
$185.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.57
|
| Rate for Payer: Healthscope Commercial |
$221.71
|
| Rate for Payer: Healthscope Commercial |
$256.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$85.15
|
| Rate for Payer: Nomi Health Commercial |
$166.28
|
| Rate for Payer: PACE SWMI |
$138.57
|
| Rate for Payer: PHP Medicare Advantage |
$138.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$138.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.57
|
| Rate for Payer: UHC Medicare Advantage |
$138.57
|
|
|
CHG ENDOVASC REPAIR AAA
|
Professional
|
Both
|
$512.00
|
|
|
Service Code
|
HCPCS 75952
|
| Min. Negotiated Rate |
$204.80 |
| Max. Negotiated Rate |
$332.80 |
| Rate for Payer: Aetna Medicare |
$256.00
|
| Rate for Payer: BCBS Complete |
$204.80
|
| Rate for Payer: Cash Price |
$409.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$332.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.80
|
|
|
CHG EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 75957
|
| Min. Negotiated Rate |
$237.20 |
| Max. Negotiated Rate |
$385.45 |
| Rate for Payer: Aetna Medicare |
$296.50
|
| Rate for Payer: BCBS Complete |
$237.20
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$385.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.45
|
|
|
CHG EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 75956
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$450.45 |
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: BCBS Complete |
$277.20
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$450.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.45
|
|
|
CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 76818
|
| Min. Negotiated Rate |
$108.35 |
| Max. Negotiated Rate |
$217.75 |
| Rate for Payer: Aetna Commercial |
$145.19
|
| Rate for Payer: Aetna Medicare |
$112.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.02
|
| Rate for Payer: BCBS Complete |
$134.00
|
| Rate for Payer: BCBS MAPPO |
$108.35
|
| Rate for Payer: BCN Medicare Advantage |
$108.35
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$156.02
|
| Rate for Payer: Cofinity Commercial |
$145.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.35
|
| Rate for Payer: Healthscope Commercial |
$200.45
|
| Rate for Payer: Healthscope Commercial |
$173.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$217.75
|
| Rate for Payer: Nomi Health Commercial |
$130.02
|
| Rate for Payer: PACE SWMI |
$108.35
|
| Rate for Payer: PHP Medicare Advantage |
$108.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.75
|
| Rate for Payer: Priority Health Medicare |
$108.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.35
|
| Rate for Payer: UHC Medicare Advantage |
$108.35
|
|
|
CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 76819
|
| Min. Negotiated Rate |
$78.29 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Aetna Commercial |
$104.91
|
| Rate for Payer: Aetna Medicare |
$81.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.74
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCBS MAPPO |
$78.29
|
| Rate for Payer: BCN Medicare Advantage |
$78.29
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$104.91
|
| Rate for Payer: Cofinity Commercial |
$112.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.29
|
| Rate for Payer: Healthscope Commercial |
$125.26
|
| Rate for Payer: Healthscope Commercial |
$144.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$149.50
|
| Rate for Payer: Nomi Health Commercial |
$93.95
|
| Rate for Payer: PACE SWMI |
$78.29
|
| Rate for Payer: PHP Medicare Advantage |
$78.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health Medicare |
$78.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.29
|
| Rate for Payer: UHC Medicare Advantage |
$78.29
|
|
|
CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 77003
|
| Min. Negotiated Rate |
$92.83 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$124.39
|
| Rate for Payer: Aetna Medicare |
$96.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.39
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS MAPPO |
$92.83
|
| Rate for Payer: BCN Medicare Advantage |
$92.83
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$133.68
|
| Rate for Payer: Cofinity Commercial |
$124.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.83
|
| Rate for Payer: Healthscope Commercial |
$148.53
|
| Rate for Payer: Healthscope Commercial |
$171.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$195.00
|
| Rate for Payer: Nomi Health Commercial |
$111.40
|
| Rate for Payer: PACE SWMI |
$92.83
|
| Rate for Payer: PHP Medicare Advantage |
$92.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: Priority Health Medicare |
$92.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.83
|
| Rate for Payer: UHC Medicare Advantage |
$92.83
|
|
|
CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 77001
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$161.45 |
| Rate for Payer: Aetna Commercial |
$116.94
|
| Rate for Payer: Aetna Commercial |
$116.94
|
| Rate for Payer: Aetna Medicare |
$90.76
|
| Rate for Payer: Aetna Medicare |
$90.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.94
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$87.27
|
| Rate for Payer: BCBS MAPPO |
$87.27
|
| Rate for Payer: BCN Medicare Advantage |
$87.27
|
| Rate for Payer: BCN Medicare Advantage |
$87.27
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$116.94
|
| Rate for Payer: Cofinity Commercial |
$116.94
|
| Rate for Payer: Cofinity Commercial |
$125.67
|
| Rate for Payer: Cofinity Commercial |
$125.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.27
|
| Rate for Payer: Healthscope Commercial |
$161.45
|
| Rate for Payer: Healthscope Commercial |
$161.45
|
| Rate for Payer: Healthscope Commercial |
$139.63
|
| Rate for Payer: Healthscope Commercial |
$139.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.63
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.85
|
| Rate for Payer: Nomi Health Commercial |
$104.72
|
| Rate for Payer: Nomi Health Commercial |
$104.72
|
| Rate for Payer: PACE SWMI |
$87.27
|
| Rate for Payer: PACE SWMI |
$87.27
|
| Rate for Payer: PHP Medicare Advantage |
$87.27
|
| Rate for Payer: PHP Medicare Advantage |
$87.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
| Rate for Payer: Priority Health Medicare |
$87.27
|
| Rate for Payer: Priority Health Medicare |
$87.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.27
|
| Rate for Payer: UHC Medicare Advantage |
$87.27
|
| Rate for Payer: UHC Medicare Advantage |
$87.27
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 77002
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$189.40 |
| Rate for Payer: Aetna Commercial |
$137.19
|
| Rate for Payer: Aetna Medicare |
$106.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.19
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$102.38
|
| Rate for Payer: BCN Medicare Advantage |
$102.38
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$147.43
|
| Rate for Payer: Cofinity Commercial |
$137.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.38
|
| Rate for Payer: Healthscope Commercial |
$163.81
|
| Rate for Payer: Healthscope Commercial |
$189.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.10
|
| Rate for Payer: Nomi Health Commercial |
$122.86
|
| Rate for Payer: PACE SWMI |
$102.38
|
| Rate for Payer: PHP Medicare Advantage |
$102.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$102.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.38
|
| Rate for Payer: UHC Medicare Advantage |
$102.38
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
77002
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$189.40 |
| Rate for Payer: Aetna Commercial |
$137.19
|
| Rate for Payer: Aetna Medicare |
$106.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.43
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$102.38
|
| Rate for Payer: BCN Medicare Advantage |
$102.38
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$137.19
|
| Rate for Payer: Cofinity Commercial |
$147.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.38
|
| Rate for Payer: Healthscope Commercial |
$189.40
|
| Rate for Payer: Healthscope Commercial |
$163.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.10
|
| Rate for Payer: Nomi Health Commercial |
$122.86
|
| Rate for Payer: PACE SWMI |
$102.38
|
| Rate for Payer: PHP Medicare Advantage |
$102.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$102.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.38
|
| Rate for Payer: UHC Medicare Advantage |
$102.38
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
77002
|
| Min. Negotiated Rate |
$71.82 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.10
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Cofinity Commercial |
$98.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.20
|
| Rate for Payer: Healthscope Commercial |
$102.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.90
|
| Rate for Payer: PHP Commercial |
$96.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health SBD |
$71.82
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
77002
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Medicare |
$57.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.10
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Cofinity Commercial |
$98.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.20
|
| Rate for Payer: Healthscope Commercial |
$102.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.90
|
| Rate for Payer: PHP Commercial |
$96.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health SBD |
$71.82
|
|
|
CHG FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 76001
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$43.55 |
| Rate for Payer: Aetna Medicare |
$33.50
|
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$43.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
|
|
CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 76000
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$72.56 |
| Rate for Payer: Aetna Commercial |
$52.55
|
| Rate for Payer: Aetna Medicare |
$40.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.48
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCBS MAPPO |
$39.22
|
| Rate for Payer: BCN Medicare Advantage |
$39.22
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Cofinity Commercial |
$56.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.22
|
| Rate for Payer: Healthscope Commercial |
$62.75
|
| Rate for Payer: Healthscope Commercial |
$72.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$35.75
|
| Rate for Payer: Nomi Health Commercial |
$47.06
|
| Rate for Payer: PACE SWMI |
$39.22
|
| Rate for Payer: PHP Medicare Advantage |
$39.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
| Rate for Payer: Priority Health Medicare |
$39.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.22
|
| Rate for Payer: UHC Medicare Advantage |
$39.22
|
|
|
CHG GASTROESOPHAGEAL REFLUX STUDY
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 78262
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$368.87 |
| Rate for Payer: Aetna Commercial |
$267.18
|
| Rate for Payer: Aetna Medicare |
$207.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.18
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$199.39
|
| Rate for Payer: BCN Medicare Advantage |
$199.39
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$287.12
|
| Rate for Payer: Cofinity Commercial |
$267.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.39
|
| Rate for Payer: Healthscope Commercial |
$368.87
|
| Rate for Payer: Healthscope Commercial |
$319.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.95
|
| Rate for Payer: Nomi Health Commercial |
$239.27
|
| Rate for Payer: PACE SWMI |
$199.39
|
| Rate for Payer: PHP Medicare Advantage |
$199.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$199.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.39
|
| Rate for Payer: UHC Medicare Advantage |
$199.39
|
|
|
CHG GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 82962
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna Commercial |
$4.40
|
| Rate for Payer: Aetna Medicare |
$3.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.40
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$3.28
|
| Rate for Payer: BCN Medicare Advantage |
$3.28
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Cofinity Commercial |
$4.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.28
|
| Rate for Payer: Healthscope Commercial |
$5.25
|
| Rate for Payer: Healthscope Commercial |
$6.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.80
|
| Rate for Payer: Nomi Health Commercial |
$3.94
|
| Rate for Payer: PACE SWMI |
$3.28
|
| Rate for Payer: PHP Medicare Advantage |
$3.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health Medicare |
$3.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.28
|
| Rate for Payer: UHC Medicare Advantage |
$3.28
|
|
|
CHG GLUCOSE BLOOD REAGENT STRIP
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 82948
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$9.32 |
| Rate for Payer: Aetna Commercial |
$6.75
|
| Rate for Payer: Aetna Medicare |
$5.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.75
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$5.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.04
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$7.26
|
| Rate for Payer: Cofinity Commercial |
$6.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.04
|
| Rate for Payer: Healthscope Commercial |
$9.32
|
| Rate for Payer: Healthscope Commercial |
$8.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.29
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.10
|
| Rate for Payer: Nomi Health Commercial |
$6.05
|
| Rate for Payer: PACE SWMI |
$5.04
|
| Rate for Payer: PHP Medicare Advantage |
$5.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$5.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.04
|
| Rate for Payer: UHC Medicare Advantage |
$5.04
|
|
|
CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS 82947
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Aetna Commercial |
$5.27
|
| Rate for Payer: Aetna Medicare |
$4.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.27
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$3.93
|
| Rate for Payer: BCN Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$5.66
|
| Rate for Payer: Cofinity Commercial |
$5.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.93
|
| Rate for Payer: Healthscope Commercial |
$6.29
|
| Rate for Payer: Healthscope Commercial |
$7.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11.05
|
| Rate for Payer: Nomi Health Commercial |
$4.72
|
| Rate for Payer: PACE SWMI |
$3.93
|
| Rate for Payer: PHP Medicare Advantage |
$3.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health Medicare |
$3.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.93
|
|
|
CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 82951
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Aetna Commercial |
$17.25
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.25
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Cofinity Commercial |
$17.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Healthscope Commercial |
$23.81
|
| Rate for Payer: Healthscope Commercial |
$20.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$30.55
|
| Rate for Payer: Nomi Health Commercial |
$15.44
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
|
|
CHG GONADOTROPIN CHORIONIC QUALITATIVE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 84703
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Commercial |
$10.08
|
| Rate for Payer: Aetna Medicare |
$7.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.08
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$7.52
|
| Rate for Payer: BCN Medicare Advantage |
$7.52
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$10.83
|
| Rate for Payer: Cofinity Commercial |
$10.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.52
|
| Rate for Payer: Healthscope Commercial |
$12.03
|
| Rate for Payer: Healthscope Commercial |
$13.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16.90
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: PACE SWMI |
$7.52
|
| Rate for Payer: PHP Medicare Advantage |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health Medicare |
$7.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.52
|
| Rate for Payer: UHC Medicare Advantage |
$7.52
|
|
|
CHG GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 77387
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna Medicare |
$30.00
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$39.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.00
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 77770
|
| Min. Negotiated Rate |
$256.00 |
| Max. Negotiated Rate |
$584.14 |
| Rate for Payer: Aetna Commercial |
$423.11
|
| Rate for Payer: Aetna Commercial |
$423.11
|
| Rate for Payer: Aetna Medicare |
$328.38
|
| Rate for Payer: Aetna Medicare |
$328.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.68
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: BCBS Complete |
$256.00
|
| Rate for Payer: BCBS MAPPO |
$315.75
|
| Rate for Payer: BCBS MAPPO |
$315.75
|
| Rate for Payer: BCN Medicare Advantage |
$315.75
|
| Rate for Payer: BCN Medicare Advantage |
$315.75
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cofinity Commercial |
$423.11
|
| Rate for Payer: Cofinity Commercial |
$454.68
|
| Rate for Payer: Cofinity Commercial |
$423.11
|
| Rate for Payer: Cofinity Commercial |
$454.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.75
|
| Rate for Payer: Healthscope Commercial |
$505.20
|
| Rate for Payer: Healthscope Commercial |
$505.20
|
| Rate for Payer: Healthscope Commercial |
$584.14
|
| Rate for Payer: Healthscope Commercial |
$584.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$331.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$331.54
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$134.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$416.00
|
| Rate for Payer: Nomi Health Commercial |
$378.90
|
| Rate for Payer: Nomi Health Commercial |
$378.90
|
| Rate for Payer: PACE SWMI |
$315.75
|
| Rate for Payer: PACE SWMI |
$315.75
|
| Rate for Payer: PHP Medicare Advantage |
$315.75
|
| Rate for Payer: PHP Medicare Advantage |
$315.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.00
|
| Rate for Payer: Priority Health Medicare |
$315.75
|
| Rate for Payer: Priority Health Medicare |
$315.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.75
|
| Rate for Payer: UHC Medicare Advantage |
$315.75
|
| Rate for Payer: UHC Medicare Advantage |
$315.75
|
|
|
CHG HEMOGLOBIN GLYCOSYLATED A1C
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 83036
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$17.96 |
| Rate for Payer: Aetna Commercial |
$13.01
|
| Rate for Payer: Aetna Medicare |
$10.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.01
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$9.71
|
| Rate for Payer: BCN Medicare Advantage |
$9.71
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Cofinity Commercial |
$13.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.71
|
| Rate for Payer: Healthscope Commercial |
$17.96
|
| Rate for Payer: Healthscope Commercial |
$15.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14.95
|
| Rate for Payer: Nomi Health Commercial |
$11.65
|
| Rate for Payer: PACE SWMI |
$9.71
|
| Rate for Payer: PHP Medicare Advantage |
$9.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health Medicare |
$9.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.71
|
| Rate for Payer: UHC Medicare Advantage |
$9.71
|
|
|
CHG HETEROPHILE ANTIBODIES SCREEN
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 86308
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.94
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$6.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$8.29
|
| Rate for Payer: Healthscope Commercial |
$9.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9.75
|
| Rate for Payer: Nomi Health Commercial |
$6.22
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
|
|
CHG HYSTEROSALPINGOGRAPHY RS&I
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 74740
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$150.24 |
| Rate for Payer: Aetna Commercial |
$108.82
|
| Rate for Payer: Aetna Medicare |
$84.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.82
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$81.21
|
| Rate for Payer: BCN Medicare Advantage |
$81.21
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$116.94
|
| Rate for Payer: Cofinity Commercial |
$108.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.21
|
| Rate for Payer: Healthscope Commercial |
$150.24
|
| Rate for Payer: Healthscope Commercial |
$129.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$99.45
|
| Rate for Payer: Nomi Health Commercial |
$97.45
|
| Rate for Payer: PACE SWMI |
$81.21
|
| Rate for Payer: PHP Medicare Advantage |
$81.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health Medicare |
$81.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.21
|
| Rate for Payer: UHC Medicare Advantage |
$81.21
|
|
