|
CHG STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 77432
|
| Min. Negotiated Rate |
$270.51 |
| Max. Negotiated Rate |
$766.12 |
| Rate for Payer: Aetna Commercial |
$554.92
|
| Rate for Payer: Aetna Medicare |
$430.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$554.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$596.33
|
| Rate for Payer: BCBS Complete |
$284.04
|
| Rate for Payer: BCBS MAPPO |
$414.12
|
| Rate for Payer: BCN Commercial |
$641.40
|
| Rate for Payer: BCN Medicare Advantage |
$414.12
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$596.33
|
| Rate for Payer: Cofinity Commercial |
$554.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.12
|
| Rate for Payer: Healthscope Commercial |
$766.12
|
| Rate for Payer: Healthscope Commercial |
$662.59
|
| Rate for Payer: Mclaren Medicaid |
$270.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$434.83
|
| Rate for Payer: Meridian Medicaid |
$284.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$455.53
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$751.41
|
| Rate for Payer: Nomi Health Commercial |
$496.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$673.50
|
| Rate for Payer: PACE SWMI |
$414.12
|
| Rate for Payer: PHP Medicare Advantage |
$414.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$646.22
|
| Rate for Payer: Priority Health Medicare |
$414.12
|
| Rate for Payer: Priority Health SBD |
$646.22
|
| Rate for Payer: Priority Health Tiered Network |
$646.22
|
| Rate for Payer: Railroad Medicare Medicare |
$414.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$636.61
|
| Rate for Payer: UHC Core |
$636.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$414.12
|
| Rate for Payer: UHC Exchange |
$636.61
|
| Rate for Payer: UHC Medicaid |
$270.51
|
| Rate for Payer: UHCCP Medicaid |
$270.51
|
|
|
CHG SUPERVISION HANDLING LOADING RADIATION SOURCE
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 77790
|
| Min. Negotiated Rate |
$17.22 |
| Max. Negotiated Rate |
$62.25 |
| Rate for Payer: Aetna Commercial |
$23.07
|
| Rate for Payer: Aetna Commercial |
$23.07
|
| Rate for Payer: Aetna Medicare |
$17.91
|
| Rate for Payer: Aetna Medicare |
$17.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.07
|
| Rate for Payer: BCBS MAPPO |
$17.22
|
| Rate for Payer: BCBS MAPPO |
$17.22
|
| Rate for Payer: BCN Commercial |
$28.39
|
| Rate for Payer: BCN Commercial |
$28.39
|
| Rate for Payer: BCN Medicare Advantage |
$17.22
|
| Rate for Payer: BCN Medicare Advantage |
$17.22
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.22
|
| Rate for Payer: Healthscope Commercial |
$31.86
|
| Rate for Payer: Healthscope Commercial |
$31.86
|
| Rate for Payer: Healthscope Commercial |
$27.55
|
| Rate for Payer: Healthscope Commercial |
$27.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.09
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$29.09
|
| Rate for Payer: Nomi Health Commercial |
$20.66
|
| Rate for Payer: Nomi Health Commercial |
$20.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.25
|
| Rate for Payer: PACE SWMI |
$17.22
|
| Rate for Payer: PACE SWMI |
$17.22
|
| Rate for Payer: PHP Medicare Advantage |
$17.22
|
| Rate for Payer: PHP Medicare Advantage |
$17.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$28.60
|
| Rate for Payer: Priority Health Medicare |
$17.22
|
| Rate for Payer: Priority Health Medicare |
$17.22
|
| Rate for Payer: Priority Health SBD |
$28.60
|
| Rate for Payer: Priority Health SBD |
$28.60
|
| Rate for Payer: Priority Health Tiered Network |
$28.60
|
| Rate for Payer: Priority Health Tiered Network |
$28.60
|
| Rate for Payer: Railroad Medicare Medicare |
$17.22
|
| Rate for Payer: Railroad Medicare Medicare |
$17.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$21.19
|
| Rate for Payer: UHC Core |
$21.19
|
| Rate for Payer: UHC Core |
$21.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.22
|
| Rate for Payer: UHC Exchange |
$21.19
|
| Rate for Payer: UHC Exchange |
$21.19
|
|
|
CHG TBS TECHNICAL CALCULATION ONLY
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 77091
|
| Min. Negotiated Rate |
$24.47 |
| Max. Negotiated Rate |
$46.78 |
| Rate for Payer: Aetna Commercial |
$32.79
|
| Rate for Payer: Aetna Medicare |
$25.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.24
|
| Rate for Payer: BCBS MAPPO |
$24.47
|
| Rate for Payer: BCN Commercial |
$40.83
|
| Rate for Payer: BCN Medicare Advantage |
$24.47
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$32.79
|
| Rate for Payer: Cofinity Commercial |
$35.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.47
|
| Rate for Payer: Healthscope Commercial |
$39.15
|
| Rate for Payer: Healthscope Commercial |
$45.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$46.78
|
| Rate for Payer: Nomi Health Commercial |
$29.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.00
|
| Rate for Payer: PACE SWMI |
$24.47
|
| Rate for Payer: PHP Medicare Advantage |
$24.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$41.14
|
| Rate for Payer: Priority Health Medicare |
$24.47
|
| Rate for Payer: Priority Health SBD |
$41.14
|
| Rate for Payer: Priority Health Tiered Network |
$41.14
|
| Rate for Payer: Railroad Medicare Medicare |
$24.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.86
|
| Rate for Payer: UHC Core |
$40.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.47
|
| Rate for Payer: UHC Exchange |
$40.86
|
|
|
CHG TELETHER ISODOSE PLAN COMPLX
|
Professional
|
Both
|
$149.00
|
|
|
Service Code
|
HCPCS 77315
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$111.75 |
| Rate for Payer: Aetna Medicare |
$74.50
|
| Rate for Payer: Aetna Medicare |
$141.00
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$183.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.85
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
|
|
CHG TELETHER ISODOSE PLAN SIMPLE
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 77305
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Medicare |
$80.00
|
| Rate for Payer: Aetna Medicare |
$50.00
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$104.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$65.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
|
|
CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY
|
Professional
|
Both
|
$863.00
|
|
|
Service Code
|
HCPCS 77307
|
| Min. Negotiated Rate |
$274.38 |
| Max. Negotiated Rate |
$647.25 |
| Rate for Payer: Aetna Commercial |
$367.67
|
| Rate for Payer: Aetna Commercial |
$367.67
|
| Rate for Payer: Aetna Medicare |
$285.36
|
| Rate for Payer: Aetna Medicare |
$285.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.11
|
| Rate for Payer: BCBS MAPPO |
$274.38
|
| Rate for Payer: BCBS MAPPO |
$274.38
|
| Rate for Payer: BCN Commercial |
$436.23
|
| Rate for Payer: BCN Commercial |
$436.23
|
| Rate for Payer: BCN Medicare Advantage |
$274.38
|
| Rate for Payer: BCN Medicare Advantage |
$274.38
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Cofinity Commercial |
$367.67
|
| Rate for Payer: Cofinity Commercial |
$367.67
|
| Rate for Payer: Cofinity Commercial |
$395.11
|
| Rate for Payer: Cofinity Commercial |
$395.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.38
|
| Rate for Payer: Healthscope Commercial |
$507.60
|
| Rate for Payer: Healthscope Commercial |
$439.01
|
| Rate for Payer: Healthscope Commercial |
$507.60
|
| Rate for Payer: Healthscope Commercial |
$439.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$301.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$301.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$491.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$491.90
|
| Rate for Payer: Nomi Health Commercial |
$329.26
|
| Rate for Payer: Nomi Health Commercial |
$329.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$647.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.00
|
| Rate for Payer: PACE SWMI |
$274.38
|
| Rate for Payer: PACE SWMI |
$274.38
|
| Rate for Payer: PHP Medicare Advantage |
$274.38
|
| Rate for Payer: PHP Medicare Advantage |
$274.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$439.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$439.52
|
| Rate for Payer: Priority Health Medicare |
$274.38
|
| Rate for Payer: Priority Health Medicare |
$274.38
|
| Rate for Payer: Priority Health SBD |
$439.52
|
| Rate for Payer: Priority Health SBD |
$439.52
|
| Rate for Payer: Priority Health Tiered Network |
$439.52
|
| Rate for Payer: Priority Health Tiered Network |
$439.52
|
| Rate for Payer: Railroad Medicare Medicare |
$274.38
|
| Rate for Payer: Railroad Medicare Medicare |
$274.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$417.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$417.16
|
| Rate for Payer: UHC Core |
$417.16
|
| Rate for Payer: UHC Core |
$417.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$274.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$274.38
|
| Rate for Payer: UHC Exchange |
$417.16
|
| Rate for Payer: UHC Exchange |
$417.16
|
|
|
CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 77306
|
| Min. Negotiated Rate |
$141.79 |
| Max. Negotiated Rate |
$306.00 |
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Medicare |
$147.46
|
| Rate for Payer: Aetna Medicare |
$147.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$204.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$190.00
|
| Rate for Payer: BCBS MAPPO |
$141.79
|
| Rate for Payer: BCBS MAPPO |
$141.79
|
| Rate for Payer: BCN Commercial |
$224.09
|
| Rate for Payer: BCN Commercial |
$224.09
|
| Rate for Payer: BCN Medicare Advantage |
$141.79
|
| Rate for Payer: BCN Medicare Advantage |
$141.79
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$204.18
|
| Rate for Payer: Cofinity Commercial |
$190.00
|
| Rate for Payer: Cofinity Commercial |
$190.00
|
| Rate for Payer: Cofinity Commercial |
$204.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.79
|
| Rate for Payer: Healthscope Commercial |
$262.31
|
| Rate for Payer: Healthscope Commercial |
$262.31
|
| Rate for Payer: Healthscope Commercial |
$226.86
|
| Rate for Payer: Healthscope Commercial |
$226.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$155.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$155.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$253.46
|
| Rate for Payer: Nomi Health Commercial |
$170.15
|
| Rate for Payer: Nomi Health Commercial |
$170.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.00
|
| Rate for Payer: PACE SWMI |
$141.79
|
| Rate for Payer: PACE SWMI |
$141.79
|
| Rate for Payer: PHP Medicare Advantage |
$141.79
|
| Rate for Payer: PHP Medicare Advantage |
$141.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$225.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$225.78
|
| Rate for Payer: Priority Health Medicare |
$141.79
|
| Rate for Payer: Priority Health Medicare |
$141.79
|
| Rate for Payer: Priority Health SBD |
$225.78
|
| Rate for Payer: Priority Health SBD |
$225.78
|
| Rate for Payer: Priority Health Tiered Network |
$225.78
|
| Rate for Payer: Priority Health Tiered Network |
$225.78
|
| Rate for Payer: Railroad Medicare Medicare |
$141.79
|
| Rate for Payer: Railroad Medicare Medicare |
$141.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$214.70
|
| Rate for Payer: UHC Core |
$214.70
|
| Rate for Payer: UHC Core |
$214.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$141.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$141.79
|
| Rate for Payer: UHC Exchange |
$214.70
|
| Rate for Payer: UHC Exchange |
$214.70
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 74283
|
| Min. Negotiated Rate |
$213.75 |
| Max. Negotiated Rate |
$485.66 |
| Rate for Payer: Aetna Commercial |
$351.78
|
| Rate for Payer: Aetna Medicare |
$273.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$378.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$351.78
|
| Rate for Payer: BCBS MAPPO |
$262.52
|
| Rate for Payer: BCN Commercial |
$387.93
|
| Rate for Payer: BCN Medicare Advantage |
$262.52
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$378.03
|
| Rate for Payer: Cofinity Commercial |
$351.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.52
|
| Rate for Payer: Healthscope Commercial |
$420.03
|
| Rate for Payer: Healthscope Commercial |
$485.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$275.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$288.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$440.05
|
| Rate for Payer: Nomi Health Commercial |
$315.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.75
|
| Rate for Payer: PACE SWMI |
$262.52
|
| Rate for Payer: PHP Medicare Advantage |
$262.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$390.85
|
| Rate for Payer: Priority Health Medicare |
$262.52
|
| Rate for Payer: Priority Health SBD |
$390.85
|
| Rate for Payer: Priority Health Tiered Network |
$390.85
|
| Rate for Payer: Railroad Medicare Medicare |
$262.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$353.86
|
| Rate for Payer: UHC Core |
$353.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$262.52
|
| Rate for Payer: UHC Exchange |
$353.86
|
|
|
CHG THERAPEUTIC RADIOLOGY PORT IMAGE(S)
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 77417
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.00
|
| Rate for Payer: BCBS Complete |
$0.45
|
| Rate for Payer: BCN Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Mclaren Medicaid |
$0.43
|
| Rate for Payer: Meridian Medicaid |
$0.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$22.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$24.59
|
| Rate for Payer: Priority Health SBD |
$24.59
|
| Rate for Payer: Priority Health Tiered Network |
$24.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$15.78
|
| Rate for Payer: UHC Core |
$15.78
|
| Rate for Payer: UHC Exchange |
$15.78
|
| Rate for Payer: UHC Medicaid |
$0.43
|
| Rate for Payer: UHCCP Medicaid |
$0.43
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 77263
|
| Min. Negotiated Rate |
$107.35 |
| Max. Negotiated Rate |
$303.99 |
| Rate for Payer: Aetna Commercial |
$220.19
|
| Rate for Payer: Aetna Medicare |
$170.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.62
|
| Rate for Payer: BCBS Complete |
$112.72
|
| Rate for Payer: BCBS MAPPO |
$164.32
|
| Rate for Payer: BCN Commercial |
$253.97
|
| Rate for Payer: BCN Medicare Advantage |
$164.32
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Commercial |
$236.62
|
| Rate for Payer: Cofinity Commercial |
$220.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.32
|
| Rate for Payer: Healthscope Commercial |
$303.99
|
| Rate for Payer: Healthscope Commercial |
$262.91
|
| Rate for Payer: Mclaren Medicaid |
$107.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.54
|
| Rate for Payer: Meridian Medicaid |
$112.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$180.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$298.51
|
| Rate for Payer: Nomi Health Commercial |
$197.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.25
|
| Rate for Payer: PACE SWMI |
$164.32
|
| Rate for Payer: PHP Medicare Advantage |
$164.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$255.89
|
| Rate for Payer: Priority Health Medicare |
$164.32
|
| Rate for Payer: Priority Health SBD |
$255.89
|
| Rate for Payer: Priority Health Tiered Network |
$255.89
|
| Rate for Payer: Railroad Medicare Medicare |
$164.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.88
|
| Rate for Payer: UHC Core |
$252.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$164.32
|
| Rate for Payer: UHC Exchange |
$252.88
|
| Rate for Payer: UHC Medicaid |
$107.35
|
| Rate for Payer: UHCCP Medicaid |
$107.35
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 77262
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$193.18 |
| Rate for Payer: Aetna Commercial |
$139.92
|
| Rate for Payer: Aetna Medicare |
$108.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.36
|
| Rate for Payer: BCBS Complete |
$71.79
|
| Rate for Payer: BCBS MAPPO |
$104.42
|
| Rate for Payer: BCN Commercial |
$163.34
|
| Rate for Payer: BCN Medicare Advantage |
$104.42
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$150.36
|
| Rate for Payer: Cofinity Commercial |
$139.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.42
|
| Rate for Payer: Healthscope Commercial |
$193.18
|
| Rate for Payer: Healthscope Commercial |
$167.07
|
| Rate for Payer: Mclaren Medicaid |
$68.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.64
|
| Rate for Payer: Meridian Medicaid |
$71.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.64
|
| Rate for Payer: Nomi Health Commercial |
$125.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.00
|
| Rate for Payer: PACE SWMI |
$104.42
|
| Rate for Payer: PHP Medicare Advantage |
$104.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$164.57
|
| Rate for Payer: Priority Health Medicare |
$104.42
|
| Rate for Payer: Priority Health SBD |
$164.57
|
| Rate for Payer: Priority Health Tiered Network |
$164.57
|
| Rate for Payer: Railroad Medicare Medicare |
$104.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.66
|
| Rate for Payer: UHC Core |
$161.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.42
|
| Rate for Payer: UHC Exchange |
$161.66
|
| Rate for Payer: UHC Medicaid |
$68.37
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 77261
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$125.67 |
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna Medicare |
$70.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.82
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS MAPPO |
$67.93
|
| Rate for Payer: BCN Commercial |
$105.57
|
| Rate for Payer: BCN Medicare Advantage |
$67.93
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cofinity Commercial |
$97.82
|
| Rate for Payer: Cofinity Commercial |
$91.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.93
|
| Rate for Payer: Healthscope Commercial |
$125.67
|
| Rate for Payer: Healthscope Commercial |
$108.69
|
| Rate for Payer: Mclaren Medicaid |
$44.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.33
|
| Rate for Payer: Meridian Medicaid |
$46.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$124.56
|
| Rate for Payer: Nomi Health Commercial |
$81.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.25
|
| Rate for Payer: PACE SWMI |
$67.93
|
| Rate for Payer: PHP Medicare Advantage |
$67.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$106.36
|
| Rate for Payer: Priority Health Medicare |
$67.93
|
| Rate for Payer: Priority Health SBD |
$106.36
|
| Rate for Payer: Priority Health Tiered Network |
$106.36
|
| Rate for Payer: Railroad Medicare Medicare |
$67.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$106.66
|
| Rate for Payer: UHC Core |
$106.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$67.93
|
| Rate for Payer: UHC Exchange |
$106.66
|
| Rate for Payer: UHC Medicaid |
$44.52
|
| Rate for Payer: UHCCP Medicaid |
$44.52
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
HCPCS 77290
|
| Min. Negotiated Rate |
$408.28 |
| Max. Negotiated Rate |
$761.76 |
| Rate for Payer: Aetna Commercial |
$547.10
|
| Rate for Payer: Aetna Commercial |
$547.10
|
| Rate for Payer: Aetna Medicare |
$424.61
|
| Rate for Payer: Aetna Medicare |
$424.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$587.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$547.10
|
| Rate for Payer: BCBS MAPPO |
$408.28
|
| Rate for Payer: BCBS MAPPO |
$408.28
|
| Rate for Payer: BCN Commercial |
$658.33
|
| Rate for Payer: BCN Commercial |
$658.33
|
| Rate for Payer: BCN Medicare Advantage |
$408.28
|
| Rate for Payer: BCN Medicare Advantage |
$408.28
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cofinity Commercial |
$587.92
|
| Rate for Payer: Cofinity Commercial |
$547.10
|
| Rate for Payer: Cofinity Commercial |
$547.10
|
| Rate for Payer: Cofinity Commercial |
$587.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$408.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$408.28
|
| Rate for Payer: Healthscope Commercial |
$755.32
|
| Rate for Payer: Healthscope Commercial |
$755.32
|
| Rate for Payer: Healthscope Commercial |
$653.25
|
| Rate for Payer: Healthscope Commercial |
$653.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$449.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$449.11
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$761.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$761.76
|
| Rate for Payer: Nomi Health Commercial |
$489.94
|
| Rate for Payer: Nomi Health Commercial |
$489.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$620.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$744.75
|
| Rate for Payer: PACE SWMI |
$408.28
|
| Rate for Payer: PACE SWMI |
$408.28
|
| Rate for Payer: PHP Medicare Advantage |
$408.28
|
| Rate for Payer: PHP Medicare Advantage |
$408.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$663.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$663.29
|
| Rate for Payer: Priority Health Medicare |
$408.28
|
| Rate for Payer: Priority Health Medicare |
$408.28
|
| Rate for Payer: Priority Health SBD |
$663.29
|
| Rate for Payer: Priority Health SBD |
$663.29
|
| Rate for Payer: Priority Health Tiered Network |
$663.29
|
| Rate for Payer: Priority Health Tiered Network |
$663.29
|
| Rate for Payer: Railroad Medicare Medicare |
$408.28
|
| Rate for Payer: Railroad Medicare Medicare |
$408.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$699.80
|
| Rate for Payer: UHC Core |
$699.80
|
| Rate for Payer: UHC Core |
$699.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$408.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$408.28
|
| Rate for Payer: UHC Exchange |
$699.80
|
| Rate for Payer: UHC Exchange |
$699.80
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 77285
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$771.28 |
| Rate for Payer: Aetna Commercial |
$558.66
|
| Rate for Payer: Aetna Medicare |
$433.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$558.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$600.35
|
| Rate for Payer: BCBS MAPPO |
$416.91
|
| Rate for Payer: BCN Commercial |
$664.31
|
| Rate for Payer: BCN Medicare Advantage |
$416.91
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$600.35
|
| Rate for Payer: Cofinity Commercial |
$558.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.91
|
| Rate for Payer: Healthscope Commercial |
$771.28
|
| Rate for Payer: Healthscope Commercial |
$667.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$458.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$740.36
|
| Rate for Payer: Nomi Health Commercial |
$500.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.75
|
| Rate for Payer: PACE SWMI |
$416.91
|
| Rate for Payer: PHP Medicare Advantage |
$416.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$669.31
|
| Rate for Payer: Priority Health Medicare |
$416.91
|
| Rate for Payer: Priority Health SBD |
$669.31
|
| Rate for Payer: Priority Health Tiered Network |
$669.31
|
| Rate for Payer: Railroad Medicare Medicare |
$416.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$651.69
|
| Rate for Payer: UHC Core |
$651.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$416.91
|
| Rate for Payer: UHC Exchange |
$651.69
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE
|
Professional
|
Both
|
$457.00
|
|
|
Service Code
|
HCPCS 77280
|
| Min. Negotiated Rate |
$248.36 |
| Max. Negotiated Rate |
$459.47 |
| Rate for Payer: Aetna Commercial |
$332.80
|
| Rate for Payer: Aetna Commercial |
$332.80
|
| Rate for Payer: Aetna Medicare |
$258.29
|
| Rate for Payer: Aetna Medicare |
$258.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$332.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$357.64
|
| Rate for Payer: BCBS MAPPO |
$248.36
|
| Rate for Payer: BCBS MAPPO |
$248.36
|
| Rate for Payer: BCN Commercial |
$400.38
|
| Rate for Payer: BCN Commercial |
$400.38
|
| Rate for Payer: BCN Medicare Advantage |
$248.36
|
| Rate for Payer: BCN Medicare Advantage |
$248.36
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cash Price |
$365.60
|
| Rate for Payer: Cash Price |
$365.60
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cofinity Commercial |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$357.64
|
| Rate for Payer: Cofinity Commercial |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$357.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.36
|
| Rate for Payer: Healthscope Commercial |
$459.47
|
| Rate for Payer: Healthscope Commercial |
$459.47
|
| Rate for Payer: Healthscope Commercial |
$397.38
|
| Rate for Payer: Healthscope Commercial |
$397.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$260.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$260.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$452.74
|
| Rate for Payer: Nomi Health Commercial |
$298.03
|
| Rate for Payer: Nomi Health Commercial |
$298.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.75
|
| Rate for Payer: PACE SWMI |
$248.36
|
| Rate for Payer: PACE SWMI |
$248.36
|
| Rate for Payer: PHP Medicare Advantage |
$248.36
|
| Rate for Payer: PHP Medicare Advantage |
$248.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$403.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$403.40
|
| Rate for Payer: Priority Health Medicare |
$248.36
|
| Rate for Payer: Priority Health Medicare |
$248.36
|
| Rate for Payer: Priority Health SBD |
$403.40
|
| Rate for Payer: Priority Health SBD |
$403.40
|
| Rate for Payer: Priority Health Tiered Network |
$403.40
|
| Rate for Payer: Priority Health Tiered Network |
$403.40
|
| Rate for Payer: Railroad Medicare Medicare |
$248.36
|
| Rate for Payer: Railroad Medicare Medicare |
$248.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$389.36
|
| Rate for Payer: UHC Core |
$389.36
|
| Rate for Payer: UHC Core |
$389.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.36
|
| Rate for Payer: UHC Exchange |
$389.36
|
| Rate for Payer: UHC Exchange |
$389.36
|
|
|
CHG TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 88233
|
| Min. Negotiated Rate |
$84.44 |
| Max. Negotiated Rate |
$260.35 |
| Rate for Payer: Aetna Commercial |
$188.58
|
| Rate for Payer: Aetna Medicare |
$146.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$188.58
|
| Rate for Payer: BCBS MAPPO |
$140.73
|
| Rate for Payer: BCN Commercial |
$105.55
|
| Rate for Payer: BCN Medicare Advantage |
$140.73
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$202.65
|
| Rate for Payer: Cofinity Commercial |
$188.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.73
|
| Rate for Payer: Healthscope Commercial |
$260.35
|
| Rate for Payer: Healthscope Commercial |
$225.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$154.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$211.10
|
| Rate for Payer: Nomi Health Commercial |
$168.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.00
|
| Rate for Payer: PACE SWMI |
$140.73
|
| Rate for Payer: PHP Medicare Advantage |
$140.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$218.26
|
| Rate for Payer: Priority Health Medicare |
$140.73
|
| Rate for Payer: Priority Health SBD |
$218.26
|
| Rate for Payer: Priority Health Tiered Network |
$218.26
|
| Rate for Payer: Railroad Medicare Medicare |
$140.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.44
|
| Rate for Payer: UHC Core |
$84.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$140.73
|
| Rate for Payer: UHC Exchange |
$84.44
|
|
|
CHG TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 87220
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.15
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCN Commercial |
$3.20
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$6.15
|
| Rate for Payer: Cofinity Commercial |
$5.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$7.90
|
| Rate for Payer: Healthscope Commercial |
$6.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.41
|
| Rate for Payer: Nomi Health Commercial |
$5.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.25
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4.38
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health SBD |
$4.38
|
| Rate for Payer: Priority Health Tiered Network |
$4.38
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.56
|
| Rate for Payer: UHC Core |
$2.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.27
|
| Rate for Payer: UHC Exchange |
$2.56
|
|
|
CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 75894
|
| Min. Negotiated Rate |
$106.58 |
| Max. Negotiated Rate |
$1,691.42 |
| Rate for Payer: Aetna Commercial |
$400.85
|
| Rate for Payer: Aetna Medicare |
$311.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$400.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$430.76
|
| Rate for Payer: BCBS MAPPO |
$299.14
|
| Rate for Payer: BCN Commercial |
$106.58
|
| Rate for Payer: BCN Medicare Advantage |
$299.14
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$430.76
|
| Rate for Payer: Cofinity Commercial |
$400.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.14
|
| Rate for Payer: Healthscope Commercial |
$553.41
|
| Rate for Payer: Healthscope Commercial |
$478.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$329.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,691.42
|
| Rate for Payer: Nomi Health Commercial |
$358.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.50
|
| Rate for Payer: PACE SWMI |
$299.14
|
| Rate for Payer: PHP Medicare Advantage |
$299.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,533.79
|
| Rate for Payer: Priority Health Medicare |
$299.14
|
| Rate for Payer: Priority Health SBD |
$1,533.79
|
| Rate for Payer: Priority Health Tiered Network |
$1,533.79
|
| Rate for Payer: Railroad Medicare Medicare |
$299.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,568.50
|
| Rate for Payer: UHC Core |
$1,568.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$299.14
|
| Rate for Payer: UHC Exchange |
$1,568.50
|
|
|
CHG TRANSCATHETER INFUSION OTHER THAN THROMBOLYSIS
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
HCPCS 75896
|
| Min. Negotiated Rate |
$117.20 |
| Max. Negotiated Rate |
$219.75 |
| Rate for Payer: Aetna Medicare |
$146.50
|
| Rate for Payer: BCBS Complete |
$117.20
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$190.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.75
|
|
|
CHG TRANSFERASE ALANINE AMINO ALT SGPT
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 84460
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$7.10
|
| Rate for Payer: Aetna Medicare |
$5.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.10
|
| Rate for Payer: BCBS MAPPO |
$5.30
|
| Rate for Payer: BCN Commercial |
$1.08
|
| Rate for Payer: BCN Medicare Advantage |
$5.30
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$7.63
|
| Rate for Payer: Cofinity Commercial |
$7.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$9.80
|
| Rate for Payer: Healthscope Commercial |
$8.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.95
|
| Rate for Payer: Nomi Health Commercial |
$6.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: PACE SWMI |
$5.30
|
| Rate for Payer: PHP Medicare Advantage |
$5.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.38
|
| Rate for Payer: Priority Health Medicare |
$5.30
|
| Rate for Payer: Priority Health SBD |
$5.38
|
| Rate for Payer: Priority Health Tiered Network |
$5.38
|
| Rate for Payer: Railroad Medicare Medicare |
$5.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.23
|
| Rate for Payer: UHC Core |
$2.23
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.30
|
| Rate for Payer: UHC Exchange |
$2.23
|
|
|
CHG TRANSFERASE ASPARTATE AMINO AST SGOT
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 84450
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$10.50 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.46
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCN Commercial |
$1.08
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| 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 |
$9.58
|
| Rate for Payer: Healthscope Commercial |
$8.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$5.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7.77
|
| Rate for Payer: Nomi Health Commercial |
$6.22
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$10.50
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5.38
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: Priority Health SBD |
$5.38
|
| Rate for Payer: Priority Health Tiered Network |
$5.38
|
| Rate for Payer: Railroad Medicare Medicare |
$5.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.18
|
| Rate for Payer: UHC Core |
$2.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$5.18
|
| Rate for Payer: UHC Exchange |
$2.18
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION COMPLEX
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 77334
|
| Min. Negotiated Rate |
$118.96 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$159.41
|
| Rate for Payer: Aetna Commercial |
$159.41
|
| Rate for Payer: Aetna Medicare |
$123.72
|
| Rate for Payer: Aetna Medicare |
$123.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.41
|
| Rate for Payer: BCBS MAPPO |
$118.96
|
| Rate for Payer: BCBS MAPPO |
$118.96
|
| Rate for Payer: BCN Commercial |
$220.17
|
| Rate for Payer: BCN Commercial |
$220.17
|
| Rate for Payer: BCN Medicare Advantage |
$118.96
|
| Rate for Payer: BCN Medicare Advantage |
$118.96
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$171.30
|
| Rate for Payer: Cofinity Commercial |
$159.41
|
| Rate for Payer: Cofinity Commercial |
$159.41
|
| Rate for Payer: Cofinity Commercial |
$171.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.96
|
| Rate for Payer: Healthscope Commercial |
$220.08
|
| Rate for Payer: Healthscope Commercial |
$220.08
|
| Rate for Payer: Healthscope Commercial |
$190.34
|
| Rate for Payer: Healthscope Commercial |
$190.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.91
|
| Rate for Payer: Molina Medicare/Medicaid |
$130.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$130.86
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$214.02
|
| Rate for Payer: Nomi Health Commercial |
$142.75
|
| Rate for Payer: Nomi Health Commercial |
$142.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$141.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PACE SWMI |
$118.96
|
| Rate for Payer: PACE SWMI |
$118.96
|
| Rate for Payer: PHP Medicare Advantage |
$118.96
|
| Rate for Payer: PHP Medicare Advantage |
$118.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$190.66
|
| Rate for Payer: Priority Health Medicare |
$118.96
|
| Rate for Payer: Priority Health Medicare |
$118.96
|
| Rate for Payer: Priority Health SBD |
$190.66
|
| Rate for Payer: Priority Health SBD |
$190.66
|
| Rate for Payer: Priority Health Tiered Network |
$190.66
|
| Rate for Payer: Priority Health Tiered Network |
$190.66
|
| Rate for Payer: Railroad Medicare Medicare |
$118.96
|
| Rate for Payer: Railroad Medicare Medicare |
$118.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.03
|
| Rate for Payer: UHC Core |
$183.03
|
| Rate for Payer: UHC Core |
$183.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$118.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$118.96
|
| Rate for Payer: UHC Exchange |
$183.03
|
| Rate for Payer: UHC Exchange |
$183.03
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE
|
Professional
|
Both
|
$95.00
|
|
|
Service Code
|
HCPCS 77333
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$236.89 |
| Rate for Payer: Aetna Commercial |
$171.59
|
| Rate for Payer: Aetna Commercial |
$171.59
|
| Rate for Payer: Aetna Medicare |
$133.17
|
| Rate for Payer: Aetna Medicare |
$133.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$184.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.59
|
| Rate for Payer: BCBS MAPPO |
$128.05
|
| Rate for Payer: BCBS MAPPO |
$128.05
|
| Rate for Payer: BCN Commercial |
$76.63
|
| Rate for Payer: BCN Commercial |
$76.63
|
| Rate for Payer: BCN Medicare Advantage |
$128.05
|
| Rate for Payer: BCN Medicare Advantage |
$128.05
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cash Price |
$76.00
|
| Rate for Payer: Cofinity Commercial |
$184.39
|
| Rate for Payer: Cofinity Commercial |
$171.59
|
| Rate for Payer: Cofinity Commercial |
$171.59
|
| Rate for Payer: Cofinity Commercial |
$184.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$128.05
|
| Rate for Payer: Healthscope Commercial |
$236.89
|
| Rate for Payer: Healthscope Commercial |
$236.89
|
| Rate for Payer: Healthscope Commercial |
$204.88
|
| Rate for Payer: Healthscope Commercial |
$204.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$134.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$140.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$140.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$233.51
|
| Rate for Payer: Nomi Health Commercial |
$153.66
|
| Rate for Payer: Nomi Health Commercial |
$153.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$124.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$71.25
|
| Rate for Payer: PACE SWMI |
$128.05
|
| Rate for Payer: PACE SWMI |
$128.05
|
| Rate for Payer: PHP Medicare Advantage |
$128.05
|
| Rate for Payer: PHP Medicare Advantage |
$128.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$206.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$206.21
|
| Rate for Payer: Priority Health Medicare |
$128.05
|
| Rate for Payer: Priority Health Medicare |
$128.05
|
| Rate for Payer: Priority Health SBD |
$206.21
|
| Rate for Payer: Priority Health SBD |
$206.21
|
| Rate for Payer: Priority Health Tiered Network |
$206.21
|
| Rate for Payer: Priority Health Tiered Network |
$206.21
|
| Rate for Payer: Railroad Medicare Medicare |
$128.05
|
| Rate for Payer: Railroad Medicare Medicare |
$128.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$171.28
|
| Rate for Payer: UHC Core |
$171.28
|
| Rate for Payer: UHC Core |
$171.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$128.05
|
| Rate for Payer: UHC Exchange |
$171.28
|
| Rate for Payer: UHC Exchange |
$171.28
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION SIMPLE
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
HCPCS 77332
|
| Min. Negotiated Rate |
$38.70 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$51.86
|
| Rate for Payer: Aetna Commercial |
$51.86
|
| Rate for Payer: Aetna Medicare |
$40.25
|
| Rate for Payer: Aetna Medicare |
$40.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$55.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.86
|
| Rate for Payer: BCBS MAPPO |
$38.70
|
| Rate for Payer: BCBS MAPPO |
$38.70
|
| Rate for Payer: BCN Commercial |
$119.55
|
| Rate for Payer: BCN Commercial |
$119.55
|
| Rate for Payer: BCN Medicare Advantage |
$38.70
|
| Rate for Payer: BCN Medicare Advantage |
$38.70
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Cofinity Commercial |
$55.73
|
| Rate for Payer: Cofinity Commercial |
$51.86
|
| Rate for Payer: Cofinity Commercial |
$51.86
|
| Rate for Payer: Cofinity Commercial |
$55.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.70
|
| Rate for Payer: Healthscope Commercial |
$71.59
|
| Rate for Payer: Healthscope Commercial |
$71.59
|
| Rate for Payer: Healthscope Commercial |
$61.92
|
| Rate for Payer: Healthscope Commercial |
$61.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.63
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.57
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.57
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$66.10
|
| Rate for Payer: Nomi Health Commercial |
$46.44
|
| Rate for Payer: Nomi Health Commercial |
$46.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$76.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
| Rate for Payer: PACE SWMI |
$38.70
|
| Rate for Payer: PACE SWMI |
$38.70
|
| Rate for Payer: PHP Medicare Advantage |
$38.70
|
| Rate for Payer: PHP Medicare Advantage |
$38.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$61.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$61.72
|
| Rate for Payer: Priority Health Medicare |
$38.70
|
| Rate for Payer: Priority Health Medicare |
$38.70
|
| Rate for Payer: Priority Health SBD |
$61.72
|
| Rate for Payer: Priority Health SBD |
$61.72
|
| Rate for Payer: Priority Health Tiered Network |
$61.72
|
| Rate for Payer: Priority Health Tiered Network |
$61.72
|
| Rate for Payer: Railroad Medicare Medicare |
$38.70
|
| Rate for Payer: Railroad Medicare Medicare |
$38.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.08
|
| Rate for Payer: UHC Core |
$68.08
|
| Rate for Payer: UHC Core |
$68.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.70
|
| Rate for Payer: UHC Exchange |
$68.08
|
| Rate for Payer: UHC Exchange |
$68.08
|
|
|
CHG ULTRASONIC GUIDANCE INTRAOPERATIVE
|
Professional
|
Both
|
$304.00
|
|
|
Service Code
|
HCPCS 76998
|
| Min. Negotiated Rate |
$69.23 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$74.11
|
| Rate for Payer: Aetna Medicare |
$152.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.11
|
| Rate for Payer: BCN Commercial |
$69.23
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Cash Price |
$243.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$228.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$69.74
|
| Rate for Payer: Priority Health SBD |
$69.74
|
| Rate for Payer: Priority Health Tiered Network |
$69.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$175.14
|
| Rate for Payer: UHC Core |
$175.14
|
| Rate for Payer: UHC Exchange |
$175.14
|
|
