|
CHG SEMEN ALYS PRESENCE&/MOTILITY SPRM HUHNER
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 89300
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$3,455.08 |
| Rate for Payer: Aetna Commercial |
$13.19
|
| Rate for Payer: Aetna Medicare |
$10.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.17
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$9.84
|
| Rate for Payer: BCBS Trust/PPO |
$3,455.08
|
| Rate for Payer: BCN Commercial |
$7.38
|
| Rate for Payer: BCN Medicare Advantage |
$9.84
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| Rate for Payer: Cofinity Commercial |
$13.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.84
|
| Rate for Payer: Healthscope Commercial |
$15.74
|
| Rate for Payer: Healthscope Commercial |
$18.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,476.00
|
| Rate for Payer: Nomi Health Commercial |
$11.81
|
| Rate for Payer: PACE SWMI |
$9.84
|
| Rate for Payer: PHP Medicare Advantage |
$9.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$15.48
|
| Rate for Payer: Priority Health Medicare |
$9.84
|
| Rate for Payer: Priority Health Narrow Network |
$15.48
|
| Rate for Payer: Priority Health SBD |
$15.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$10.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.84
|
| Rate for Payer: UHC Exchange |
$10.47
|
| Rate for Payer: UHC Medicare Advantage |
$9.84
|
|
|
CHG SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 89321
|
| Min. Negotiated Rate |
$9.04 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.35
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCBS Trust/PPO |
$1,251.54
|
| Rate for Payer: BCN Commercial |
$9.04
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$16.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$19.28
|
| Rate for Payer: Healthscope Commercial |
$22.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,808.00
|
| Rate for Payer: Nomi Health Commercial |
$14.46
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$18.56
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: Priority Health Narrow Network |
$18.56
|
| Rate for Payer: Priority Health SBD |
$18.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$19.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Exchange |
$19.99
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
|
|
CHG SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 75809
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$14,031.00 |
| Rate for Payer: Aetna Commercial |
$98.22
|
| Rate for Payer: Aetna Medicare |
$76.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.22
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$73.30
|
| Rate for Payer: BCBS Trust/PPO |
$122.04
|
| Rate for Payer: BCN Commercial |
$120.70
|
| Rate for Payer: BCN Medicare Advantage |
$73.30
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Commercial |
$98.22
|
| Rate for Payer: Cofinity Commercial |
$105.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.30
|
| Rate for Payer: Healthscope Commercial |
$135.60
|
| Rate for Payer: Healthscope Commercial |
$117.28
|
| Rate for Payer: Mclaren Medicaid |
$14.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.96
|
| Rate for Payer: Meridian Medicaid |
$15.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,031.00
|
| Rate for Payer: Nomi Health Commercial |
$87.96
|
| Rate for Payer: PACE SWMI |
$73.30
|
| Rate for Payer: PHP Medicare Advantage |
$73.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$125.74
|
| Rate for Payer: Priority Health Medicare |
$73.30
|
| Rate for Payer: Priority Health Narrow Network |
$125.74
|
| Rate for Payer: Priority Health SBD |
$34.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.30
|
| Rate for Payer: UHC Exchange |
$59.52
|
| Rate for Payer: UHC Medicare Advantage |
$73.30
|
| Rate for Payer: UHCCP Medicaid |
$14.48
|
|
|
CHG SKIN TEST TUBERCULOSIS INTRADERMAL
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 86580
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$2,063.01 |
| Rate for Payer: Aetna Commercial |
$11.97
|
| Rate for Payer: Aetna Medicare |
$9.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.86
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS MAPPO |
$8.93
|
| Rate for Payer: BCBS Trust/PPO |
$2,063.01
|
| Rate for Payer: BCN Commercial |
$14.66
|
| Rate for Payer: BCN Medicare Advantage |
$8.93
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$12.86
|
| Rate for Payer: Cofinity Commercial |
$11.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.93
|
| Rate for Payer: Healthscope Commercial |
$14.29
|
| Rate for Payer: Healthscope Commercial |
$16.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.38
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,678.00
|
| Rate for Payer: Nomi Health Commercial |
$10.72
|
| Rate for Payer: PACE SWMI |
$8.93
|
| Rate for Payer: PHP Medicare Advantage |
$8.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$10.32
|
| Rate for Payer: Priority Health Medicare |
$8.93
|
| Rate for Payer: Priority Health Narrow Network |
$10.32
|
| Rate for Payer: Priority Health SBD |
$10.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$11.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.93
|
| Rate for Payer: UHC Exchange |
$11.08
|
| Rate for Payer: UHC Medicare Advantage |
$8.93
|
|
|
CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 87209
|
| Min. Negotiated Rate |
$13.49 |
| Max. Negotiated Rate |
$2,697.00 |
| Rate for Payer: Aetna Commercial |
$24.09
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.89
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCBS Trust/PPO |
$378.81
|
| Rate for Payer: BCN Commercial |
$13.49
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Cofinity Commercial |
$24.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$28.77
|
| Rate for Payer: Healthscope Commercial |
$33.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,697.00
|
| Rate for Payer: Nomi Health Commercial |
$21.58
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.98
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: Priority Health Narrow Network |
$17.98
|
| Rate for Payer: Priority Health SBD |
$17.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.98
|
| Rate for Payer: UHC Exchange |
$26.62
|
| Rate for Payer: UHC Medicare Advantage |
$17.98
|
|
|
CHG SMR PRIM SRC WET MOUNT NFCT AGT
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 87210
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$873.00 |
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: Aetna Medicare |
$6.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.38
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCBS MAPPO |
$5.82
|
| Rate for Payer: BCBS Trust/PPO |
$368.23
|
| Rate for Payer: BCN Commercial |
$5.82
|
| Rate for Payer: BCN Medicare Advantage |
$5.82
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$8.38
|
| Rate for Payer: Cofinity Commercial |
$7.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.82
|
| Rate for Payer: Healthscope Commercial |
$9.31
|
| Rate for Payer: Healthscope Commercial |
$10.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$873.00
|
| Rate for Payer: Nomi Health Commercial |
$6.98
|
| Rate for Payer: PACE SWMI |
$5.82
|
| Rate for Payer: PHP Medicare Advantage |
$5.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.66
|
| Rate for Payer: Priority Health Medicare |
$5.82
|
| Rate for Payer: Priority Health Narrow Network |
$5.66
|
| Rate for Payer: Priority Health SBD |
$5.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.82
|
| Rate for Payer: UHC Exchange |
$8.10
|
| Rate for Payer: UHC Medicare Advantage |
$5.82
|
|
|
CHG SONO GUIDE PERICARD TAP
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 76930
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Medicare |
$60.50
|
| Rate for Payer: BCBS Complete |
$48.40
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$78.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.65
|
|
|
CHG SONO GUIDE RAD THERAPY FIELDS
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 76950
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$89.70 |
| Rate for Payer: Aetna Medicare |
$69.00
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS Complete |
$55.20
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$48.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$89.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
|
|
CHG SPEC DOSIM ONLY PRESCRIBED TREATING PHYS
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 77331
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$11,246.00 |
| Rate for Payer: Aetna Commercial |
$81.71
|
| Rate for Payer: Aetna Commercial |
$81.71
|
| Rate for Payer: Aetna Medicare |
$63.42
|
| Rate for Payer: Aetna Medicare |
$63.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.81
|
| Rate for Payer: BCBS Complete |
$31.09
|
| Rate for Payer: BCBS Complete |
$31.09
|
| Rate for Payer: BCBS MAPPO |
$60.98
|
| Rate for Payer: BCBS MAPPO |
$60.98
|
| Rate for Payer: BCBS Trust/PPO |
$5,193.72
|
| Rate for Payer: BCBS Trust/PPO |
$5,193.72
|
| Rate for Payer: BCN Commercial |
$94.31
|
| Rate for Payer: BCN Commercial |
$94.31
|
| Rate for Payer: BCN Medicare Advantage |
$60.98
|
| Rate for Payer: BCN Medicare Advantage |
$60.98
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$87.81
|
| Rate for Payer: Cofinity Commercial |
$87.81
|
| Rate for Payer: Cofinity Commercial |
$81.71
|
| Rate for Payer: Cofinity Commercial |
$81.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.98
|
| Rate for Payer: Healthscope Commercial |
$97.57
|
| Rate for Payer: Healthscope Commercial |
$112.81
|
| Rate for Payer: Healthscope Commercial |
$112.81
|
| Rate for Payer: Healthscope Commercial |
$97.57
|
| Rate for Payer: Mclaren Medicaid |
$29.61
|
| Rate for Payer: Mclaren Medicaid |
$29.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.03
|
| Rate for Payer: Meridian Medicaid |
$31.09
|
| Rate for Payer: Meridian Medicaid |
$31.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,246.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,246.00
|
| Rate for Payer: Nomi Health Commercial |
$73.18
|
| Rate for Payer: Nomi Health Commercial |
$73.18
|
| Rate for Payer: PACE SWMI |
$60.98
|
| Rate for Payer: PACE SWMI |
$60.98
|
| Rate for Payer: PHP Medicare Advantage |
$60.98
|
| Rate for Payer: PHP Medicare Advantage |
$60.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.08
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.08
|
| Rate for Payer: Priority Health Medicare |
$60.98
|
| Rate for Payer: Priority Health Medicare |
$60.98
|
| Rate for Payer: Priority Health Narrow Network |
$100.08
|
| Rate for Payer: Priority Health Narrow Network |
$100.08
|
| Rate for Payer: Priority Health SBD |
$70.31
|
| Rate for Payer: Priority Health SBD |
$70.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.98
|
| Rate for Payer: UHC Exchange |
$72.43
|
| Rate for Payer: UHC Exchange |
$72.43
|
| Rate for Payer: UHC Medicare Advantage |
$60.98
|
| Rate for Payer: UHC Medicare Advantage |
$60.98
|
| Rate for Payer: UHCCP Medicaid |
$29.61
|
| Rate for Payer: UHCCP Medicaid |
$29.61
|
|
|
CHG SPECIAL TREATMENT PROCEDURE
|
Professional
|
Both
|
$705.00
|
|
|
Service Code
|
HCPCS 77470
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$24,284.00 |
| Rate for Payer: Aetna Commercial |
$182.71
|
| Rate for Payer: Aetna Commercial |
$182.71
|
| Rate for Payer: Aetna Medicare |
$141.80
|
| Rate for Payer: Aetna Medicare |
$141.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.71
|
| Rate for Payer: BCBS Complete |
$72.24
|
| Rate for Payer: BCBS Complete |
$72.24
|
| Rate for Payer: BCBS MAPPO |
$136.35
|
| Rate for Payer: BCBS MAPPO |
$136.35
|
| Rate for Payer: BCBS Trust/PPO |
$519.32
|
| Rate for Payer: BCBS Trust/PPO |
$519.32
|
| Rate for Payer: BCN Commercial |
$202.80
|
| Rate for Payer: BCN Commercial |
$202.80
|
| Rate for Payer: BCN Medicare Advantage |
$136.35
|
| Rate for Payer: BCN Medicare Advantage |
$136.35
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Cofinity Commercial |
$182.71
|
| Rate for Payer: Cofinity Commercial |
$182.71
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.35
|
| Rate for Payer: Healthscope Commercial |
$218.16
|
| Rate for Payer: Healthscope Commercial |
$252.25
|
| Rate for Payer: Healthscope Commercial |
$218.16
|
| Rate for Payer: Healthscope Commercial |
$252.25
|
| Rate for Payer: Mclaren Medicaid |
$68.80
|
| Rate for Payer: Mclaren Medicaid |
$68.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.17
|
| Rate for Payer: Meridian Medicaid |
$72.24
|
| Rate for Payer: Meridian Medicaid |
$72.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,284.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24,284.00
|
| Rate for Payer: Nomi Health Commercial |
$163.62
|
| Rate for Payer: Nomi Health Commercial |
$163.62
|
| Rate for Payer: PACE SWMI |
$136.35
|
| Rate for Payer: PACE SWMI |
$136.35
|
| Rate for Payer: PHP Medicare Advantage |
$136.35
|
| Rate for Payer: PHP Medicare Advantage |
$136.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.64
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.64
|
| Rate for Payer: Priority Health Medicare |
$136.35
|
| Rate for Payer: Priority Health Medicare |
$136.35
|
| Rate for Payer: Priority Health Narrow Network |
$218.64
|
| Rate for Payer: Priority Health Narrow Network |
$218.64
|
| Rate for Payer: Priority Health SBD |
$163.21
|
| Rate for Payer: Priority Health SBD |
$163.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$595.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$595.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.35
|
| Rate for Payer: UHC Exchange |
$595.32
|
| Rate for Payer: UHC Exchange |
$595.32
|
| Rate for Payer: UHC Medicare Advantage |
$136.35
|
| Rate for Payer: UHC Medicare Advantage |
$136.35
|
| Rate for Payer: UHCCP Medicaid |
$68.80
|
| Rate for Payer: UHCCP Medicaid |
$68.80
|
|
|
CHG SPEC MEDICAL RADJ PHYSICS CONSLTJ
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 77370
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$23,202.00 |
| Rate for Payer: Aetna Commercial |
$179.51
|
| Rate for Payer: Aetna Medicare |
$139.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$192.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.51
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS MAPPO |
$133.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,979.54
|
| Rate for Payer: BCN Commercial |
$202.80
|
| Rate for Payer: BCN Medicare Advantage |
$133.96
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$192.90
|
| Rate for Payer: Cofinity Commercial |
$179.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.96
|
| Rate for Payer: Healthscope Commercial |
$247.83
|
| Rate for Payer: Healthscope Commercial |
$214.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.66
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23,202.00
|
| Rate for Payer: Nomi Health Commercial |
$160.75
|
| Rate for Payer: PACE SWMI |
$133.96
|
| Rate for Payer: PHP Medicare Advantage |
$133.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$222.76
|
| Rate for Payer: Priority Health Medicare |
$133.96
|
| Rate for Payer: Priority Health Narrow Network |
$222.76
|
| Rate for Payer: Priority Health SBD |
$222.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.96
|
| Rate for Payer: UHC Exchange |
$147.66
|
| Rate for Payer: UHC Medicare Advantage |
$133.96
|
|
|
CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 77321
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$16,124.00 |
| Rate for Payer: Aetna Commercial |
$117.17
|
| Rate for Payer: Aetna Commercial |
$117.17
|
| Rate for Payer: Aetna Medicare |
$90.94
|
| Rate for Payer: Aetna Medicare |
$90.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.91
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS MAPPO |
$87.44
|
| Rate for Payer: BCBS MAPPO |
$87.44
|
| Rate for Payer: BCBS Trust/PPO |
$5,378.09
|
| Rate for Payer: BCBS Trust/PPO |
$5,378.09
|
| Rate for Payer: BCN Commercial |
$136.83
|
| Rate for Payer: BCN Commercial |
$136.83
|
| Rate for Payer: BCN Medicare Advantage |
$87.44
|
| Rate for Payer: BCN Medicare Advantage |
$87.44
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$117.17
|
| Rate for Payer: Cofinity Commercial |
$125.91
|
| Rate for Payer: Cofinity Commercial |
$117.17
|
| Rate for Payer: Cofinity Commercial |
$125.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.44
|
| Rate for Payer: Healthscope Commercial |
$161.76
|
| Rate for Payer: Healthscope Commercial |
$139.90
|
| Rate for Payer: Healthscope Commercial |
$139.90
|
| Rate for Payer: Healthscope Commercial |
$161.76
|
| Rate for Payer: Mclaren Medicaid |
$32.16
|
| Rate for Payer: Mclaren Medicaid |
$32.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.81
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,124.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$16,124.00
|
| Rate for Payer: Nomi Health Commercial |
$104.93
|
| Rate for Payer: Nomi Health Commercial |
$104.93
|
| Rate for Payer: PACE SWMI |
$87.44
|
| Rate for Payer: PACE SWMI |
$87.44
|
| Rate for Payer: PHP Medicare Advantage |
$87.44
|
| Rate for Payer: PHP Medicare Advantage |
$87.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$145.25
|
| Rate for Payer: Priority Health Medicare |
$87.44
|
| Rate for Payer: Priority Health Medicare |
$87.44
|
| Rate for Payer: Priority Health Narrow Network |
$145.25
|
| Rate for Payer: Priority Health Narrow Network |
$145.25
|
| Rate for Payer: Priority Health SBD |
$76.48
|
| Rate for Payer: Priority Health SBD |
$76.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$245.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.44
|
| Rate for Payer: UHC Exchange |
$245.91
|
| Rate for Payer: UHC Exchange |
$245.91
|
| Rate for Payer: UHC Medicare Advantage |
$87.44
|
| Rate for Payer: UHC Medicare Advantage |
$87.44
|
| Rate for Payer: UHCCP Medicaid |
$32.16
|
| Rate for Payer: UHCCP Medicaid |
$32.16
|
|
|
CHG STEREOSCOPIC X-RAY GUIDANCE
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 77421
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Aetna Medicare |
$87.00
|
| Rate for Payer: Aetna Medicare |
$103.00
|
| Rate for Payer: BCBS Complete |
$69.60
|
| Rate for Payer: BCBS Complete |
$82.40
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.90
|
|
|
CHG STEREOTACTIC BODY RADIATION MANAGEMENT
|
Professional
|
Both
|
$1,261.00
|
|
|
Service Code
|
HCPCS 77435
|
| Min. Negotiated Rate |
$414.50 |
| Max. Negotiated Rate |
$113,440.00 |
| Rate for Payer: Aetna Commercial |
$824.65
|
| Rate for Payer: Aetna Medicare |
$640.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$824.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$886.19
|
| Rate for Payer: BCBS Complete |
$435.22
|
| Rate for Payer: BCBS MAPPO |
$615.41
|
| Rate for Payer: BCBS Trust/PPO |
$1,387.84
|
| Rate for Payer: BCN Commercial |
$932.88
|
| Rate for Payer: BCN Medicare Advantage |
$615.41
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Cofinity Commercial |
$824.65
|
| Rate for Payer: Cofinity Commercial |
$886.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.41
|
| Rate for Payer: Healthscope Commercial |
$1,138.51
|
| Rate for Payer: Healthscope Commercial |
$984.66
|
| Rate for Payer: Mclaren Medicaid |
$414.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.18
|
| Rate for Payer: Meridian Medicaid |
$435.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113,440.00
|
| Rate for Payer: Nomi Health Commercial |
$738.49
|
| Rate for Payer: PACE SWMI |
$615.41
|
| Rate for Payer: PHP Medicare Advantage |
$615.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$983.41
|
| Rate for Payer: Priority Health Medicare |
$615.41
|
| Rate for Payer: Priority Health Narrow Network |
$983.41
|
| Rate for Payer: Priority Health SBD |
$983.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$886.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.41
|
| Rate for Payer: UHC Exchange |
$886.98
|
| Rate for Payer: UHC Medicare Advantage |
$615.41
|
| Rate for Payer: UHCCP Medicaid |
$414.50
|
|
|
CHG STEREOTACTIC BODY RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$2,706.00
|
|
|
Service Code
|
HCPCS 77373
|
| Min. Negotiated Rate |
$867.16 |
| Max. Negotiated Rate |
$167,324.00 |
| Rate for Payer: Aetna Commercial |
$1,161.99
|
| Rate for Payer: Aetna Medicare |
$901.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,161.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,248.71
|
| Rate for Payer: BCBS Complete |
$1,082.40
|
| Rate for Payer: BCBS MAPPO |
$867.16
|
| Rate for Payer: BCBS Trust/PPO |
$1,987.99
|
| Rate for Payer: BCN Commercial |
$1,469.46
|
| Rate for Payer: BCN Medicare Advantage |
$867.16
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cofinity Commercial |
$1,248.71
|
| Rate for Payer: Cofinity Commercial |
$1,161.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$867.16
|
| Rate for Payer: Healthscope Commercial |
$1,387.46
|
| Rate for Payer: Healthscope Commercial |
$1,604.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$910.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$167,324.00
|
| Rate for Payer: Nomi Health Commercial |
$1,040.59
|
| Rate for Payer: PACE SWMI |
$867.16
|
| Rate for Payer: PHP Medicare Advantage |
$867.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,758.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,532.08
|
| Rate for Payer: Priority Health Medicare |
$867.16
|
| Rate for Payer: Priority Health Narrow Network |
$1,532.08
|
| Rate for Payer: Priority Health SBD |
$1,532.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,077.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$867.16
|
| Rate for Payer: UHC Exchange |
$2,077.31
|
| Rate for Payer: UHC Medicare Advantage |
$867.16
|
|
|
CHG STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 77432
|
| Min. Negotiated Rate |
$274.34 |
| Max. Negotiated Rate |
$75,141.00 |
| Rate for Payer: Aetna Commercial |
$546.29
|
| Rate for Payer: Aetna Medicare |
$423.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.06
|
| Rate for Payer: BCBS Complete |
$288.06
|
| Rate for Payer: BCBS MAPPO |
$407.68
|
| Rate for Payer: BCBS Trust/PPO |
$2,005.43
|
| Rate for Payer: BCN Commercial |
$617.69
|
| Rate for Payer: BCN Medicare Advantage |
$407.68
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cofinity Commercial |
$587.06
|
| Rate for Payer: Cofinity Commercial |
$546.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.68
|
| Rate for Payer: Healthscope Commercial |
$754.21
|
| Rate for Payer: Healthscope Commercial |
$652.29
|
| Rate for Payer: Mclaren Medicaid |
$274.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.06
|
| Rate for Payer: Meridian Medicaid |
$288.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75,141.00
|
| Rate for Payer: Nomi Health Commercial |
$489.22
|
| Rate for Payer: PACE SWMI |
$407.68
|
| Rate for Payer: PHP Medicare Advantage |
$407.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$274.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$650.30
|
| Rate for Payer: Priority Health Medicare |
$407.68
|
| Rate for Payer: Priority Health Narrow Network |
$650.30
|
| Rate for Payer: Priority Health SBD |
$572.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$490.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.68
|
| Rate for Payer: UHC Exchange |
$490.31
|
| Rate for Payer: UHC Medicare Advantage |
$407.68
|
| Rate for Payer: UHCCP Medicaid |
$274.34
|
|
|
CHG SUPERVISION HANDLING LOADING RADIATION SOURCE
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 77790
|
| Min. Negotiated Rate |
$16.42 |
| Max. Negotiated Rate |
$2,909.00 |
| Rate for Payer: Aetna Commercial |
$22.74
|
| Rate for Payer: Aetna Commercial |
$22.74
|
| Rate for Payer: Aetna Medicare |
$17.65
|
| Rate for Payer: Aetna Medicare |
$17.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.44
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS MAPPO |
$16.97
|
| Rate for Payer: BCBS MAPPO |
$16.97
|
| Rate for Payer: BCBS Trust/PPO |
$148.98
|
| Rate for Payer: BCBS Trust/PPO |
$148.98
|
| Rate for Payer: BCN Commercial |
$25.41
|
| Rate for Payer: BCN Commercial |
$25.41
|
| Rate for Payer: BCN Medicare Advantage |
$16.97
|
| Rate for Payer: BCN Medicare Advantage |
$16.97
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$22.74
|
| Rate for Payer: Cofinity Commercial |
$22.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.97
|
| Rate for Payer: Healthscope Commercial |
$31.39
|
| Rate for Payer: Healthscope Commercial |
$27.15
|
| Rate for Payer: Healthscope Commercial |
$31.39
|
| Rate for Payer: Healthscope Commercial |
$27.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,909.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,909.00
|
| Rate for Payer: Nomi Health Commercial |
$20.36
|
| Rate for Payer: Nomi Health Commercial |
$20.36
|
| Rate for Payer: PACE SWMI |
$16.97
|
| Rate for Payer: PACE SWMI |
$16.97
|
| Rate for Payer: PHP Medicare Advantage |
$16.97
|
| Rate for Payer: PHP Medicare Advantage |
$16.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27.72
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Narrow Network |
$27.72
|
| Rate for Payer: Priority Health Narrow Network |
$27.72
|
| Rate for Payer: Priority Health SBD |
$16.42
|
| Rate for Payer: Priority Health SBD |
$16.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.97
|
| Rate for Payer: UHC Exchange |
$80.25
|
| Rate for Payer: UHC Exchange |
$80.25
|
| Rate for Payer: UHC Medicare Advantage |
$16.97
|
| Rate for Payer: UHC Medicare Advantage |
$16.97
|
|
|
CHG TBS TECHNICAL CALCULATION ONLY
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 77091
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$4,678.00 |
| Rate for Payer: Aetna Commercial |
$32.50
|
| Rate for Payer: Aetna Medicare |
$25.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$34.92
|
| Rate for Payer: BCBS Complete |
$23.20
|
| Rate for Payer: BCBS MAPPO |
$24.25
|
| Rate for Payer: BCN Commercial |
$41.05
|
| Rate for Payer: BCN Medicare Advantage |
$24.25
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$32.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.25
|
| Rate for Payer: Healthscope Commercial |
$44.86
|
| Rate for Payer: Healthscope Commercial |
$38.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,678.00
|
| Rate for Payer: Nomi Health Commercial |
$29.10
|
| Rate for Payer: PACE SWMI |
$24.25
|
| Rate for Payer: PHP Medicare Advantage |
$24.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$43.11
|
| Rate for Payer: Priority Health Medicare |
$24.25
|
| Rate for Payer: Priority Health Narrow Network |
$43.11
|
| Rate for Payer: Priority Health SBD |
$43.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.25
|
| Rate for Payer: UHC Medicare Advantage |
$24.25
|
|
|
CHG TELETHER ISODOSE PLAN COMPLX
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
HCPCS 77315
|
| Min. Negotiated Rate |
$109.60 |
| Max. Negotiated Rate |
$178.10 |
| Rate for Payer: Aetna Medicare |
$137.00
|
| Rate for Payer: Aetna Medicare |
$72.50
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: BCBS Complete |
$109.60
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$94.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$178.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
|
|
CHG TELETHER ISODOSE PLAN SIMPLE
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 77305
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: Aetna Medicare |
$77.50
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
|
|
CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY
|
Professional
|
Both
|
$439.00
|
|
|
Service Code
|
HCPCS 77307
|
| Min. Negotiated Rate |
$98.41 |
| Max. Negotiated Rate |
$49,190.00 |
| Rate for Payer: Aetna Commercial |
$359.03
|
| Rate for Payer: Aetna Commercial |
$359.03
|
| Rate for Payer: Aetna Medicare |
$278.65
|
| Rate for Payer: Aetna Medicare |
$278.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$359.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$385.82
|
| Rate for Payer: BCBS Complete |
$103.33
|
| Rate for Payer: BCBS Complete |
$103.33
|
| Rate for Payer: BCBS MAPPO |
$267.93
|
| Rate for Payer: BCBS MAPPO |
$267.93
|
| Rate for Payer: BCBS Trust/PPO |
$1,915.09
|
| Rate for Payer: BCBS Trust/PPO |
$1,915.09
|
| Rate for Payer: BCN Commercial |
$417.33
|
| Rate for Payer: BCN Commercial |
$417.33
|
| Rate for Payer: BCN Medicare Advantage |
$267.93
|
| Rate for Payer: BCN Medicare Advantage |
$267.93
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cofinity Commercial |
$359.03
|
| Rate for Payer: Cofinity Commercial |
$385.82
|
| Rate for Payer: Cofinity Commercial |
$385.82
|
| Rate for Payer: Cofinity Commercial |
$359.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.93
|
| Rate for Payer: Healthscope Commercial |
$495.67
|
| Rate for Payer: Healthscope Commercial |
$428.69
|
| Rate for Payer: Healthscope Commercial |
$495.67
|
| Rate for Payer: Healthscope Commercial |
$428.69
|
| Rate for Payer: Mclaren Medicaid |
$98.41
|
| Rate for Payer: Mclaren Medicaid |
$98.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.33
|
| Rate for Payer: Meridian Medicaid |
$103.33
|
| Rate for Payer: Meridian Medicaid |
$103.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49,190.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$49,190.00
|
| Rate for Payer: Nomi Health Commercial |
$321.52
|
| Rate for Payer: Nomi Health Commercial |
$321.52
|
| Rate for Payer: PACE SWMI |
$267.93
|
| Rate for Payer: PACE SWMI |
$267.93
|
| Rate for Payer: PHP Medicare Advantage |
$267.93
|
| Rate for Payer: PHP Medicare Advantage |
$267.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$98.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$442.43
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$442.43
|
| Rate for Payer: Priority Health Medicare |
$267.93
|
| Rate for Payer: Priority Health Medicare |
$267.93
|
| Rate for Payer: Priority Health Narrow Network |
$442.43
|
| Rate for Payer: Priority Health Narrow Network |
$442.43
|
| Rate for Payer: Priority Health SBD |
$232.50
|
| Rate for Payer: Priority Health SBD |
$232.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.93
|
| Rate for Payer: UHC Medicare Advantage |
$267.93
|
| Rate for Payer: UHC Medicare Advantage |
$267.93
|
| Rate for Payer: UHCCP Medicaid |
$98.41
|
| Rate for Payer: UHCCP Medicaid |
$98.41
|
|
|
CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
HCPCS 77306
|
| Min. Negotiated Rate |
$47.29 |
| Max. Negotiated Rate |
$25,346.00 |
| Rate for Payer: Aetna Commercial |
$183.89
|
| Rate for Payer: Aetna Commercial |
$183.89
|
| Rate for Payer: Aetna Medicare |
$142.72
|
| Rate for Payer: Aetna Medicare |
$142.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.89
|
| Rate for Payer: BCBS Complete |
$49.65
|
| Rate for Payer: BCBS Complete |
$49.65
|
| Rate for Payer: BCBS MAPPO |
$137.23
|
| Rate for Payer: BCBS MAPPO |
$137.23
|
| Rate for Payer: BCBS Trust/PPO |
$150.66
|
| Rate for Payer: BCBS Trust/PPO |
$150.66
|
| Rate for Payer: BCN Commercial |
$215.51
|
| Rate for Payer: BCN Commercial |
$215.51
|
| Rate for Payer: BCN Medicare Advantage |
$137.23
|
| Rate for Payer: BCN Medicare Advantage |
$137.23
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cofinity Commercial |
$183.89
|
| Rate for Payer: Cofinity Commercial |
$197.61
|
| Rate for Payer: Cofinity Commercial |
$183.89
|
| Rate for Payer: Cofinity Commercial |
$197.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.23
|
| Rate for Payer: Healthscope Commercial |
$219.57
|
| Rate for Payer: Healthscope Commercial |
$253.88
|
| Rate for Payer: Healthscope Commercial |
$253.88
|
| Rate for Payer: Healthscope Commercial |
$219.57
|
| Rate for Payer: Mclaren Medicaid |
$47.29
|
| Rate for Payer: Mclaren Medicaid |
$47.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.09
|
| Rate for Payer: Meridian Medicaid |
$49.65
|
| Rate for Payer: Meridian Medicaid |
$49.65
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,346.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$25,346.00
|
| Rate for Payer: Nomi Health Commercial |
$164.68
|
| Rate for Payer: Nomi Health Commercial |
$164.68
|
| Rate for Payer: PACE SWMI |
$137.23
|
| Rate for Payer: PACE SWMI |
$137.23
|
| Rate for Payer: PHP Medicare Advantage |
$137.23
|
| Rate for Payer: PHP Medicare Advantage |
$137.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$228.40
|
| Rate for Payer: Priority Health Medicare |
$137.23
|
| Rate for Payer: Priority Health Medicare |
$137.23
|
| Rate for Payer: Priority Health Narrow Network |
$228.40
|
| Rate for Payer: Priority Health Narrow Network |
$228.40
|
| Rate for Payer: Priority Health SBD |
$112.40
|
| Rate for Payer: Priority Health SBD |
$112.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.23
|
| Rate for Payer: UHC Medicare Advantage |
$137.23
|
| Rate for Payer: UHC Medicare Advantage |
$137.23
|
| Rate for Payer: UHCCP Medicaid |
$47.29
|
| Rate for Payer: UHCCP Medicaid |
$47.29
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 74283
|
| Min. Negotiated Rate |
$63.90 |
| Max. Negotiated Rate |
$44,005.00 |
| Rate for Payer: Aetna Commercial |
$316.64
|
| Rate for Payer: Aetna Medicare |
$245.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$316.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.27
|
| Rate for Payer: BCBS Complete |
$67.10
|
| Rate for Payer: BCBS MAPPO |
$236.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,701.65
|
| Rate for Payer: BCN Commercial |
$376.28
|
| Rate for Payer: BCN Medicare Advantage |
$236.30
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cofinity Commercial |
$340.27
|
| Rate for Payer: Cofinity Commercial |
$316.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.30
|
| Rate for Payer: Healthscope Commercial |
$437.16
|
| Rate for Payer: Healthscope Commercial |
$378.08
|
| Rate for Payer: Mclaren Medicaid |
$63.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.12
|
| Rate for Payer: Meridian Medicaid |
$67.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$44,005.00
|
| Rate for Payer: Nomi Health Commercial |
$283.56
|
| Rate for Payer: PACE SWMI |
$236.30
|
| Rate for Payer: PHP Medicare Advantage |
$236.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$392.14
|
| Rate for Payer: Priority Health Medicare |
$236.30
|
| Rate for Payer: Priority Health Narrow Network |
$392.14
|
| Rate for Payer: Priority Health SBD |
$151.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.30
|
| Rate for Payer: UHC Exchange |
$221.78
|
| Rate for Payer: UHC Medicare Advantage |
$236.30
|
| Rate for Payer: UHCCP Medicaid |
$63.90
|
|
|
CHG THERAPEUTIC RADIOLOGY PORT IMAGE(S)
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 77417
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$3,385.87 |
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: Aetna Medicare |
$15.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$19.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$21.04
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: BCBS MAPPO |
$14.61
|
| Rate for Payer: BCBS Trust/PPO |
$3,385.87
|
| Rate for Payer: BCN Commercial |
$20.04
|
| Rate for Payer: BCN Medicare Advantage |
$14.61
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$21.04
|
| Rate for Payer: Cofinity Commercial |
$19.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.61
|
| Rate for Payer: Healthscope Commercial |
$23.38
|
| Rate for Payer: Healthscope Commercial |
$27.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,288.00
|
| Rate for Payer: Nomi Health Commercial |
$17.53
|
| Rate for Payer: PACE SWMI |
$14.61
|
| Rate for Payer: PHP Medicare Advantage |
$14.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23.10
|
| Rate for Payer: Priority Health Medicare |
$14.61
|
| Rate for Payer: Priority Health Narrow Network |
$23.10
|
| Rate for Payer: Priority Health SBD |
$23.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.61
|
| Rate for Payer: UHC Exchange |
$27.83
|
| Rate for Payer: UHC Medicare Advantage |
$14.61
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 77263
|
| Min. Negotiated Rate |
$108.63 |
| Max. Negotiated Rate |
$29,851.00 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Medicare |
$167.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$216.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$232.36
|
| Rate for Payer: BCBS Complete |
$114.06
|
| Rate for Payer: BCBS MAPPO |
$161.36
|
| Rate for Payer: BCBS Trust/PPO |
$1,737.05
|
| Rate for Payer: BCN Commercial |
$245.32
|
| Rate for Payer: BCN Medicare Advantage |
$161.36
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$232.36
|
| Rate for Payer: Cofinity Commercial |
$216.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.36
|
| Rate for Payer: Healthscope Commercial |
$298.52
|
| Rate for Payer: Healthscope Commercial |
$258.18
|
| Rate for Payer: Mclaren Medicaid |
$108.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.43
|
| Rate for Payer: Meridian Medicaid |
$114.06
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29,851.00
|
| Rate for Payer: Nomi Health Commercial |
$193.63
|
| Rate for Payer: PACE SWMI |
$161.36
|
| Rate for Payer: PHP Medicare Advantage |
$161.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$108.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$257.14
|
| Rate for Payer: Priority Health Medicare |
$161.36
|
| Rate for Payer: Priority Health Narrow Network |
$257.14
|
| Rate for Payer: Priority Health SBD |
$257.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$244.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.36
|
| Rate for Payer: UHC Exchange |
$244.75
|
| Rate for Payer: UHC Medicare Advantage |
$161.36
|
| Rate for Payer: UHCCP Medicaid |
$108.63
|
|
