|
CHG US FETAL NUCHAL TRANSLUCENCY EA ADDL GESTATION
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
HCPCS 76814
|
| Min. Negotiated Rate |
$71.49 |
| Max. Negotiated Rate |
$150.75 |
| Rate for Payer: Aetna Commercial |
$95.80
|
| Rate for Payer: Aetna Medicare |
$74.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$95.80
|
| Rate for Payer: BCBS MAPPO |
$71.49
|
| Rate for Payer: BCN Commercial |
$109.55
|
| Rate for Payer: BCN Medicare Advantage |
$71.49
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cash Price |
$160.80
|
| Rate for Payer: Cofinity Commercial |
$95.80
|
| Rate for Payer: Cofinity Commercial |
$102.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.49
|
| Rate for Payer: Healthscope Commercial |
$132.26
|
| Rate for Payer: Healthscope Commercial |
$114.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$130.16
|
| Rate for Payer: Nomi Health Commercial |
$85.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.75
|
| Rate for Payer: PACE SWMI |
$71.49
|
| Rate for Payer: PHP Medicare Advantage |
$71.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$110.38
|
| Rate for Payer: Priority Health Medicare |
$71.49
|
| Rate for Payer: Priority Health SBD |
$110.38
|
| Rate for Payer: Priority Health Tiered Network |
$110.38
|
| Rate for Payer: Railroad Medicare Medicare |
$71.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.86
|
| Rate for Payer: UHC Core |
$113.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.49
|
| Rate for Payer: UHC Exchange |
$113.86
|
|
|
CHG US GUIDANCE AMNIOCENTESIS IMG S&I
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 76946
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$247.50 |
| Rate for Payer: Aetna Commercial |
$43.42
|
| Rate for Payer: Aetna Medicare |
$33.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$43.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.66
|
| Rate for Payer: BCBS MAPPO |
$32.40
|
| Rate for Payer: BCN Commercial |
$49.80
|
| Rate for Payer: BCN Medicare Advantage |
$32.40
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$46.66
|
| Rate for Payer: Cofinity Commercial |
$43.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.40
|
| Rate for Payer: Healthscope Commercial |
$59.94
|
| Rate for Payer: Healthscope Commercial |
$51.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$34.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$35.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$56.72
|
| Rate for Payer: Nomi Health Commercial |
$38.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$247.50
|
| Rate for Payer: PACE SWMI |
$32.40
|
| Rate for Payer: PHP Medicare Advantage |
$32.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$50.18
|
| Rate for Payer: Priority Health Medicare |
$32.40
|
| Rate for Payer: Priority Health SBD |
$50.18
|
| Rate for Payer: Priority Health Tiered Network |
$50.18
|
| Rate for Payer: Railroad Medicare Medicare |
$32.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$46.58
|
| Rate for Payer: UHC Core |
$46.58
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$32.40
|
| Rate for Payer: UHC Exchange |
$46.58
|
|
|
CHG US GUIDANCE INTERSTITIAL RADIOELMENT APPLICATION
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
HCPCS 76965
|
| Min. Negotiated Rate |
$92.37 |
| Max. Negotiated Rate |
$206.25 |
| Rate for Payer: Aetna Commercial |
$123.78
|
| Rate for Payer: Aetna Commercial |
$123.78
|
| Rate for Payer: Aetna Medicare |
$96.06
|
| Rate for Payer: Aetna Medicare |
$96.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.01
|
| Rate for Payer: BCBS MAPPO |
$92.37
|
| Rate for Payer: BCBS MAPPO |
$92.37
|
| Rate for Payer: BCN Commercial |
$142.42
|
| Rate for Payer: BCN Commercial |
$142.42
|
| Rate for Payer: BCN Medicare Advantage |
$92.37
|
| Rate for Payer: BCN Medicare Advantage |
$92.37
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$312.00
|
| Rate for Payer: Cofinity Commercial |
$123.78
|
| Rate for Payer: Cofinity Commercial |
$133.01
|
| Rate for Payer: Cofinity Commercial |
$123.78
|
| Rate for Payer: Cofinity Commercial |
$133.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.37
|
| Rate for Payer: Healthscope Commercial |
$170.88
|
| Rate for Payer: Healthscope Commercial |
$170.88
|
| Rate for Payer: Healthscope Commercial |
$147.79
|
| Rate for Payer: Healthscope Commercial |
$147.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$101.61
|
| Rate for Payer: Molina Medicare/Medicaid |
$101.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$162.81
|
| Rate for Payer: Nomi Health Commercial |
$110.84
|
| Rate for Payer: Nomi Health Commercial |
$110.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$292.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$206.25
|
| Rate for Payer: PACE SWMI |
$92.37
|
| Rate for Payer: PACE SWMI |
$92.37
|
| Rate for Payer: PHP Medicare Advantage |
$92.37
|
| Rate for Payer: PHP Medicare Advantage |
$92.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$143.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$143.49
|
| Rate for Payer: Priority Health Medicare |
$92.37
|
| Rate for Payer: Priority Health Medicare |
$92.37
|
| Rate for Payer: Priority Health SBD |
$143.49
|
| Rate for Payer: Priority Health SBD |
$143.49
|
| Rate for Payer: Priority Health Tiered Network |
$143.49
|
| Rate for Payer: Priority Health Tiered Network |
$143.49
|
| Rate for Payer: Railroad Medicare Medicare |
$92.37
|
| Rate for Payer: Railroad Medicare Medicare |
$92.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.20
|
| Rate for Payer: UHC Core |
$136.20
|
| Rate for Payer: UHC Core |
$136.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$92.37
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$92.37
|
| Rate for Payer: UHC Exchange |
$136.20
|
| Rate for Payer: UHC Exchange |
$136.20
|
|
|
CHG US GUIDANCE NEEDLE PLACEMENT IMG S&I
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 76942
|
| Min. Negotiated Rate |
$60.73 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$81.38
|
| Rate for Payer: Aetna Commercial |
$81.38
|
| Rate for Payer: Aetna Medicare |
$63.16
|
| Rate for Payer: Aetna Medicare |
$63.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.38
|
| Rate for Payer: BCBS MAPPO |
$60.73
|
| Rate for Payer: BCBS MAPPO |
$60.73
|
| Rate for Payer: BCN Commercial |
$88.14
|
| Rate for Payer: BCN Commercial |
$88.14
|
| Rate for Payer: BCN Medicare Advantage |
$60.73
|
| Rate for Payer: BCN Medicare Advantage |
$60.73
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cofinity Commercial |
$87.45
|
| Rate for Payer: Cofinity Commercial |
$81.38
|
| Rate for Payer: Cofinity Commercial |
$81.38
|
| Rate for Payer: Cofinity Commercial |
$87.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.73
|
| Rate for Payer: Healthscope Commercial |
$97.17
|
| Rate for Payer: Healthscope Commercial |
$97.17
|
| Rate for Payer: Healthscope Commercial |
$112.35
|
| Rate for Payer: Healthscope Commercial |
$112.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.80
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$100.84
|
| Rate for Payer: Nomi Health Commercial |
$72.88
|
| Rate for Payer: Nomi Health Commercial |
$72.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$360.00
|
| Rate for Payer: PACE SWMI |
$60.73
|
| Rate for Payer: PACE SWMI |
$60.73
|
| Rate for Payer: PHP Medicare Advantage |
$60.73
|
| Rate for Payer: PHP Medicare Advantage |
$60.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$88.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$88.80
|
| Rate for Payer: Priority Health Medicare |
$60.73
|
| Rate for Payer: Priority Health Medicare |
$60.73
|
| Rate for Payer: Priority Health SBD |
$88.80
|
| Rate for Payer: Priority Health SBD |
$88.80
|
| Rate for Payer: Priority Health Tiered Network |
$88.80
|
| Rate for Payer: Priority Health Tiered Network |
$88.80
|
| Rate for Payer: Railroad Medicare Medicare |
$60.73
|
| Rate for Payer: Railroad Medicare Medicare |
$60.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$82.89
|
| Rate for Payer: UHC Core |
$82.89
|
| Rate for Payer: UHC Core |
$82.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$60.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$60.73
|
| Rate for Payer: UHC Exchange |
$82.89
|
| Rate for Payer: UHC Exchange |
$82.89
|
|
|
CHG US INTRAUTERINE FTL TFUJ/CORDOCNTS IMG S&I
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
HCPCS 76941
|
| Min. Negotiated Rate |
$94.13 |
| Max. Negotiated Rate |
$205.35 |
| Rate for Payer: Aetna Commercial |
$138.84
|
| Rate for Payer: Aetna Medicare |
$96.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.84
|
| Rate for Payer: BCN Commercial |
$94.13
|
| Rate for Payer: Cash Price |
$154.40
|
| Rate for Payer: Cash Price |
$154.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.08
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$144.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$175.60
|
| Rate for Payer: Priority Health SBD |
$175.60
|
| Rate for Payer: Priority Health Tiered Network |
$175.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.35
|
| Rate for Payer: UHC Core |
$205.35
|
| Rate for Payer: UHC Exchange |
$205.35
|
|
|
CHG US LMTD JT/FCL EVAL NONVASC XTR STRUX R-T W/IMG
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 76882
|
| Min. Negotiated Rate |
$51.75 |
| Max. Negotiated Rate |
$112.59 |
| Rate for Payer: Aetna Commercial |
$81.55
|
| Rate for Payer: Aetna Commercial |
$81.55
|
| Rate for Payer: Aetna Medicare |
$63.29
|
| Rate for Payer: Aetna Medicare |
$63.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.64
|
| Rate for Payer: BCBS MAPPO |
$60.86
|
| Rate for Payer: BCBS MAPPO |
$60.86
|
| Rate for Payer: BCN Commercial |
$96.11
|
| Rate for Payer: BCN Commercial |
$96.11
|
| Rate for Payer: BCN Medicare Advantage |
$60.86
|
| Rate for Payer: BCN Medicare Advantage |
$60.86
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$87.64
|
| Rate for Payer: Cofinity Commercial |
$81.55
|
| Rate for Payer: Cofinity Commercial |
$81.55
|
| Rate for Payer: Cofinity Commercial |
$87.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.86
|
| Rate for Payer: Healthscope Commercial |
$112.59
|
| Rate for Payer: Healthscope Commercial |
$97.38
|
| Rate for Payer: Healthscope Commercial |
$112.59
|
| Rate for Payer: Healthscope Commercial |
$97.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$74.27
|
| Rate for Payer: Nomi Health Commercial |
$73.03
|
| Rate for Payer: Nomi Health Commercial |
$73.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$51.75
|
| Rate for Payer: PACE SWMI |
$60.86
|
| Rate for Payer: PACE SWMI |
$60.86
|
| Rate for Payer: PHP Medicare Advantage |
$60.86
|
| Rate for Payer: PHP Medicare Advantage |
$60.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$96.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$96.84
|
| Rate for Payer: Priority Health Medicare |
$60.86
|
| Rate for Payer: Priority Health Medicare |
$60.86
|
| Rate for Payer: Priority Health SBD |
$96.84
|
| Rate for Payer: Priority Health SBD |
$96.84
|
| Rate for Payer: Priority Health Tiered Network |
$96.84
|
| Rate for Payer: Priority Health Tiered Network |
$96.84
|
| Rate for Payer: Railroad Medicare Medicare |
$60.86
|
| Rate for Payer: Railroad Medicare Medicare |
$60.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$81.54
|
| Rate for Payer: UHC Core |
$81.54
|
| Rate for Payer: UHC Core |
$81.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$60.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$60.86
|
| Rate for Payer: UHC Exchange |
$81.54
|
| Rate for Payer: UHC Exchange |
$81.54
|
|
|
CHG US PELVIC NONOBSTETRIC IMAGE DCMTN LIMITED/F/U
|
Professional
|
Both
|
$232.00
|
|
|
Service Code
|
HCPCS 76857
|
| Min. Negotiated Rate |
$48.37 |
| Max. Negotiated Rate |
$174.00 |
| Rate for Payer: Aetna Commercial |
$64.82
|
| Rate for Payer: Aetna Medicare |
$50.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.82
|
| Rate for Payer: BCBS MAPPO |
$48.37
|
| Rate for Payer: BCN Commercial |
$74.70
|
| Rate for Payer: BCN Medicare Advantage |
$48.37
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cash Price |
$185.60
|
| Rate for Payer: Cofinity Commercial |
$69.65
|
| Rate for Payer: Cofinity Commercial |
$64.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.37
|
| Rate for Payer: Healthscope Commercial |
$89.48
|
| Rate for Payer: Healthscope Commercial |
$77.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$84.15
|
| Rate for Payer: Nomi Health Commercial |
$58.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.00
|
| Rate for Payer: PACE SWMI |
$48.37
|
| Rate for Payer: PHP Medicare Advantage |
$48.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$75.26
|
| Rate for Payer: Priority Health Medicare |
$48.37
|
| Rate for Payer: Priority Health SBD |
$75.26
|
| Rate for Payer: Priority Health Tiered Network |
$75.26
|
| Rate for Payer: Railroad Medicare Medicare |
$48.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$69.77
|
| Rate for Payer: UHC Core |
$69.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48.37
|
| Rate for Payer: UHC Exchange |
$69.77
|
|
|
CHG US PELVIC NONOBSTETRIC REAL-TIME IMAGE COMPLETE
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 76856
|
| Min. Negotiated Rate |
$98.37 |
| Max. Negotiated Rate |
$232.50 |
| Rate for Payer: Aetna Commercial |
$131.82
|
| Rate for Payer: Aetna Medicare |
$102.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.65
|
| Rate for Payer: BCBS MAPPO |
$98.37
|
| Rate for Payer: BCN Commercial |
$156.37
|
| Rate for Payer: BCN Medicare Advantage |
$98.37
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$141.65
|
| Rate for Payer: Cofinity Commercial |
$131.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.37
|
| Rate for Payer: Healthscope Commercial |
$181.98
|
| Rate for Payer: Healthscope Commercial |
$157.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$108.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.95
|
| Rate for Payer: Nomi Health Commercial |
$118.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$232.50
|
| Rate for Payer: PACE SWMI |
$98.37
|
| Rate for Payer: PHP Medicare Advantage |
$98.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$157.55
|
| Rate for Payer: Priority Health Medicare |
$98.37
|
| Rate for Payer: Priority Health SBD |
$157.55
|
| Rate for Payer: Priority Health Tiered Network |
$157.55
|
| Rate for Payer: Railroad Medicare Medicare |
$98.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.27
|
| Rate for Payer: UHC Core |
$155.27
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$98.37
|
| Rate for Payer: UHC Exchange |
$155.27
|
|
|
CHG US PREGNANT UTERUS 14 WK TRANSABDL 1/1ST GESTAT
|
Professional
|
Both
|
$294.00
|
|
|
Service Code
|
HCPCS 76801
|
| Min. Negotiated Rate |
$109.98 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$147.37
|
| Rate for Payer: Aetna Medicare |
$114.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.37
|
| Rate for Payer: BCBS MAPPO |
$109.98
|
| Rate for Payer: BCN Commercial |
$173.80
|
| Rate for Payer: BCN Medicare Advantage |
$109.98
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cofinity Commercial |
$158.37
|
| Rate for Payer: Cofinity Commercial |
$147.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.98
|
| Rate for Payer: Healthscope Commercial |
$203.46
|
| Rate for Payer: Healthscope Commercial |
$175.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$120.98
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$202.59
|
| Rate for Payer: Nomi Health Commercial |
$131.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.50
|
| Rate for Payer: PACE SWMI |
$109.98
|
| Rate for Payer: PHP Medicare Advantage |
$109.98
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$175.11
|
| Rate for Payer: Priority Health Medicare |
$109.98
|
| Rate for Payer: Priority Health SBD |
$175.11
|
| Rate for Payer: Priority Health Tiered Network |
$175.11
|
| Rate for Payer: Railroad Medicare Medicare |
$109.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.42
|
| Rate for Payer: UHC Core |
$174.42
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$109.98
|
| Rate for Payer: UHC Exchange |
$174.42
|
|
|
CHG US PREGNANT UTERUS LIMITED 1/> FETUSES
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 76815
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$102.64
|
| Rate for Payer: Aetna Medicare |
$79.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$102.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$110.30
|
| Rate for Payer: BCBS MAPPO |
$76.60
|
| Rate for Payer: BCN Commercial |
$120.51
|
| Rate for Payer: BCN Medicare Advantage |
$76.60
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Cofinity Commercial |
$102.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.60
|
| Rate for Payer: Healthscope Commercial |
$141.71
|
| Rate for Payer: Healthscope Commercial |
$122.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.43
|
| Rate for Payer: Molina Medicare/Medicaid |
$84.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$140.17
|
| Rate for Payer: Nomi Health Commercial |
$91.92
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$204.75
|
| Rate for Payer: PACE SWMI |
$76.60
|
| Rate for Payer: PHP Medicare Advantage |
$76.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$121.42
|
| Rate for Payer: Priority Health Medicare |
$76.60
|
| Rate for Payer: Priority Health SBD |
$121.42
|
| Rate for Payer: Priority Health Tiered Network |
$121.42
|
| Rate for Payer: Railroad Medicare Medicare |
$76.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.69
|
| Rate for Payer: UHC Core |
$119.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$76.60
|
| Rate for Payer: UHC Exchange |
$119.69
|
|
|
CHG US PREG UTERUS 14 WK TRANSABDL EACH GESTATION
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 76802
|
| Min. Negotiated Rate |
$57.84 |
| Max. Negotiated Rate |
$110.25 |
| Rate for Payer: Aetna Commercial |
$77.51
|
| Rate for Payer: Aetna Medicare |
$60.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$77.51
|
| Rate for Payer: BCBS MAPPO |
$57.84
|
| Rate for Payer: BCN Commercial |
$89.14
|
| Rate for Payer: BCN Medicare Advantage |
$57.84
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$83.29
|
| Rate for Payer: Cofinity Commercial |
$77.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.84
|
| Rate for Payer: Healthscope Commercial |
$92.54
|
| Rate for Payer: Healthscope Commercial |
$107.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$106.60
|
| Rate for Payer: Nomi Health Commercial |
$69.41
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.25
|
| Rate for Payer: PACE SWMI |
$57.84
|
| Rate for Payer: PHP Medicare Advantage |
$57.84
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$89.81
|
| Rate for Payer: Priority Health Medicare |
$57.84
|
| Rate for Payer: Priority Health SBD |
$89.81
|
| Rate for Payer: Priority Health Tiered Network |
$89.81
|
| Rate for Payer: Railroad Medicare Medicare |
$57.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$91.45
|
| Rate for Payer: UHC Core |
$91.45
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.84
|
| Rate for Payer: UHC Exchange |
$91.45
|
|
|
CHG US PREG UTERUS > 1ST TRIMESTER ABDL EA GESTATIO
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 76810
|
| Min. Negotiated Rate |
$84.03 |
| Max. Negotiated Rate |
$327.00 |
| Rate for Payer: Aetna Commercial |
$112.60
|
| Rate for Payer: Aetna Medicare |
$87.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$121.00
|
| Rate for Payer: BCBS MAPPO |
$84.03
|
| Rate for Payer: BCN Commercial |
$128.97
|
| Rate for Payer: BCN Medicare Advantage |
$84.03
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cofinity Commercial |
$121.00
|
| Rate for Payer: Cofinity Commercial |
$112.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$84.03
|
| Rate for Payer: Healthscope Commercial |
$155.46
|
| Rate for Payer: Healthscope Commercial |
$134.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$88.23
|
| Rate for Payer: Molina Medicare/Medicaid |
$92.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$153.07
|
| Rate for Payer: Nomi Health Commercial |
$100.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$327.00
|
| Rate for Payer: PACE SWMI |
$84.03
|
| Rate for Payer: PHP Medicare Advantage |
$84.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$129.95
|
| Rate for Payer: Priority Health Medicare |
$84.03
|
| Rate for Payer: Priority Health SBD |
$129.95
|
| Rate for Payer: Priority Health Tiered Network |
$129.95
|
| Rate for Payer: Railroad Medicare Medicare |
$84.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$132.10
|
| Rate for Payer: UHC Core |
$132.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$84.03
|
| Rate for Payer: UHC Exchange |
$132.10
|
|
|
CHG US PREG UTERUS AFTER 1ST TRIMEST 1/1ST GESTATION
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
HCPCS 76805
|
| Min. Negotiated Rate |
$127.44 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Aetna Commercial |
$170.77
|
| Rate for Payer: Aetna Medicare |
$132.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.77
|
| Rate for Payer: BCBS MAPPO |
$127.44
|
| Rate for Payer: BCN Commercial |
$200.19
|
| Rate for Payer: BCN Medicare Advantage |
$127.44
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cofinity Commercial |
$183.51
|
| Rate for Payer: Cofinity Commercial |
$170.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.44
|
| Rate for Payer: Healthscope Commercial |
$235.76
|
| Rate for Payer: Healthscope Commercial |
$203.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$140.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.70
|
| Rate for Payer: Nomi Health Commercial |
$152.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$279.00
|
| Rate for Payer: PACE SWMI |
$127.44
|
| Rate for Payer: PHP Medicare Advantage |
$127.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$201.69
|
| Rate for Payer: Priority Health Medicare |
$127.44
|
| Rate for Payer: Priority Health SBD |
$201.69
|
| Rate for Payer: Priority Health Tiered Network |
$201.69
|
| Rate for Payer: Railroad Medicare Medicare |
$127.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$199.02
|
| Rate for Payer: UHC Core |
$199.02
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$127.44
|
| Rate for Payer: UHC Exchange |
$199.02
|
|
|
CHG US PREG UTERUS DETAIL FETAL ANAT EXAM EA GESTAT
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
HCPCS 76812
|
| Min. Negotiated Rate |
$183.26 |
| Max. Negotiated Rate |
$339.03 |
| Rate for Payer: Aetna Commercial |
$245.57
|
| Rate for Payer: Aetna Medicare |
$190.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.89
|
| Rate for Payer: BCBS MAPPO |
$183.26
|
| Rate for Payer: BCN Commercial |
$282.35
|
| Rate for Payer: BCN Medicare Advantage |
$183.26
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cash Price |
$284.80
|
| Rate for Payer: Cofinity Commercial |
$263.89
|
| Rate for Payer: Cofinity Commercial |
$245.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.26
|
| Rate for Payer: Healthscope Commercial |
$339.03
|
| Rate for Payer: Healthscope Commercial |
$293.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$201.59
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$329.78
|
| Rate for Payer: Nomi Health Commercial |
$219.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$267.00
|
| Rate for Payer: PACE SWMI |
$183.26
|
| Rate for Payer: PHP Medicare Advantage |
$183.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$284.47
|
| Rate for Payer: Priority Health Medicare |
$183.26
|
| Rate for Payer: Priority Health SBD |
$284.47
|
| Rate for Payer: Priority Health Tiered Network |
$284.47
|
| Rate for Payer: Railroad Medicare Medicare |
$183.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$284.34
|
| Rate for Payer: UHC Core |
$284.34
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$183.26
|
| Rate for Payer: UHC Exchange |
$284.34
|
|
|
CHG US PREG UTERUS REAL TIME F/U TRNSABDL PER FETUS
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
HCPCS 76816
|
| Min. Negotiated Rate |
$104.32 |
| Max. Negotiated Rate |
$192.99 |
| Rate for Payer: Aetna Commercial |
$139.79
|
| Rate for Payer: Aetna Medicare |
$108.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$139.79
|
| Rate for Payer: BCBS MAPPO |
$104.32
|
| Rate for Payer: BCN Commercial |
$161.85
|
| Rate for Payer: BCN Medicare Advantage |
$104.32
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cash Price |
$182.40
|
| Rate for Payer: Cofinity Commercial |
$150.22
|
| Rate for Payer: Cofinity Commercial |
$139.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.32
|
| Rate for Payer: Healthscope Commercial |
$192.99
|
| Rate for Payer: Healthscope Commercial |
$166.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$187.74
|
| Rate for Payer: Nomi Health Commercial |
$125.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$171.00
|
| Rate for Payer: PACE SWMI |
$104.32
|
| Rate for Payer: PHP Medicare Advantage |
$104.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$163.07
|
| Rate for Payer: Priority Health Medicare |
$104.32
|
| Rate for Payer: Priority Health SBD |
$163.07
|
| Rate for Payer: Priority Health Tiered Network |
$163.07
|
| Rate for Payer: Railroad Medicare Medicare |
$104.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.92
|
| Rate for Payer: UHC Core |
$160.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.32
|
| Rate for Payer: UHC Exchange |
$160.92
|
|
|
CHG US PREG UTERUS REAL TIME W/IMAGE DCMTN TRANSVAG
|
Professional
|
Both
|
$294.00
|
|
|
Service Code
|
HCPCS 76817
|
| Min. Negotiated Rate |
$87.26 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Aetna Commercial |
$116.93
|
| Rate for Payer: Aetna Medicare |
$90.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.65
|
| Rate for Payer: BCBS MAPPO |
$87.26
|
| Rate for Payer: BCN Commercial |
$136.95
|
| Rate for Payer: BCN Medicare Advantage |
$87.26
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cofinity Commercial |
$125.65
|
| Rate for Payer: Cofinity Commercial |
$116.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.26
|
| Rate for Payer: Healthscope Commercial |
$161.43
|
| Rate for Payer: Healthscope Commercial |
$139.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$95.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$159.61
|
| Rate for Payer: Nomi Health Commercial |
$104.71
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$220.50
|
| Rate for Payer: PACE SWMI |
$87.26
|
| Rate for Payer: PHP Medicare Advantage |
$87.26
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$137.97
|
| Rate for Payer: Priority Health Medicare |
$87.26
|
| Rate for Payer: Priority Health SBD |
$137.97
|
| Rate for Payer: Priority Health Tiered Network |
$137.97
|
| Rate for Payer: Railroad Medicare Medicare |
$87.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.36
|
| Rate for Payer: UHC Core |
$136.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$87.26
|
| Rate for Payer: UHC Exchange |
$136.36
|
|
|
CHG US PREG UTERUS W/DETAIL FETAL ANAT 1ST GESTATION
|
Professional
|
Both
|
$389.00
|
|
|
Service Code
|
HCPCS 76811
|
| Min. Negotiated Rate |
$172.37 |
| Max. Negotiated Rate |
$318.88 |
| Rate for Payer: Aetna Commercial |
$230.98
|
| Rate for Payer: Aetna Medicare |
$179.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$248.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.98
|
| Rate for Payer: BCBS MAPPO |
$172.37
|
| Rate for Payer: BCN Commercial |
$264.92
|
| Rate for Payer: BCN Medicare Advantage |
$172.37
|
| Rate for Payer: Cash Price |
$311.20
|
| Rate for Payer: Cash Price |
$311.20
|
| Rate for Payer: Cofinity Commercial |
$248.21
|
| Rate for Payer: Cofinity Commercial |
$230.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$172.37
|
| Rate for Payer: Healthscope Commercial |
$318.88
|
| Rate for Payer: Healthscope Commercial |
$275.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$180.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$189.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$303.97
|
| Rate for Payer: Nomi Health Commercial |
$206.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.75
|
| Rate for Payer: PACE SWMI |
$172.37
|
| Rate for Payer: PHP Medicare Advantage |
$172.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$266.92
|
| Rate for Payer: Priority Health Medicare |
$172.37
|
| Rate for Payer: Priority Health SBD |
$266.92
|
| Rate for Payer: Priority Health Tiered Network |
$266.92
|
| Rate for Payer: Railroad Medicare Medicare |
$172.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$255.38
|
| Rate for Payer: UHC Core |
$255.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$172.37
|
| Rate for Payer: UHC Exchange |
$255.38
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE COMPLETE
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 76770
|
| Min. Negotiated Rate |
$55.50 |
| Max. Negotiated Rate |
$186.23 |
| Rate for Payer: Aetna Commercial |
$133.24
|
| Rate for Payer: Aetna Medicare |
$103.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.18
|
| Rate for Payer: BCBS MAPPO |
$99.43
|
| Rate for Payer: BCN Commercial |
$160.85
|
| Rate for Payer: BCN Medicare Advantage |
$99.43
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$143.18
|
| Rate for Payer: Cofinity Commercial |
$133.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.43
|
| Rate for Payer: Healthscope Commercial |
$183.95
|
| Rate for Payer: Healthscope Commercial |
$159.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$109.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.23
|
| Rate for Payer: Nomi Health Commercial |
$119.32
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$55.50
|
| Rate for Payer: PACE SWMI |
$99.43
|
| Rate for Payer: PHP Medicare Advantage |
$99.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$162.06
|
| Rate for Payer: Priority Health Medicare |
$99.43
|
| Rate for Payer: Priority Health SBD |
$162.06
|
| Rate for Payer: Priority Health Tiered Network |
$162.06
|
| Rate for Payer: Railroad Medicare Medicare |
$99.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$160.41
|
| Rate for Payer: UHC Core |
$160.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$99.43
|
| Rate for Payer: UHC Exchange |
$160.41
|
|
|
CHG US RETROPERITONEAL REAL TIME W/IMAGE LIMITED
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
HCPCS 76775
|
| Min. Negotiated Rate |
$57.45 |
| Max. Negotiated Rate |
$150.00 |
| Rate for Payer: Aetna Commercial |
$76.98
|
| Rate for Payer: Aetna Medicare |
$59.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.98
|
| Rate for Payer: BCBS MAPPO |
$57.45
|
| Rate for Payer: BCN Commercial |
$90.63
|
| Rate for Payer: BCN Medicare Advantage |
$57.45
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cash Price |
$160.00
|
| Rate for Payer: Cofinity Commercial |
$82.73
|
| Rate for Payer: Cofinity Commercial |
$76.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.45
|
| Rate for Payer: Healthscope Commercial |
$91.92
|
| Rate for Payer: Healthscope Commercial |
$106.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$102.01
|
| Rate for Payer: Nomi Health Commercial |
$68.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$150.00
|
| Rate for Payer: PACE SWMI |
$57.45
|
| Rate for Payer: PHP Medicare Advantage |
$57.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$91.31
|
| Rate for Payer: Priority Health Medicare |
$57.45
|
| Rate for Payer: Priority Health SBD |
$91.31
|
| Rate for Payer: Priority Health Tiered Network |
$91.31
|
| Rate for Payer: Railroad Medicare Medicare |
$57.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.46
|
| Rate for Payer: UHC Core |
$84.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.45
|
| Rate for Payer: UHC Exchange |
$84.46
|
|
|
CHG US SCROTUM & CONTENTS
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 76870
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$172.91 |
| Rate for Payer: Aetna Commercial |
$123.44
|
| Rate for Payer: Aetna Medicare |
$95.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.65
|
| Rate for Payer: BCBS MAPPO |
$92.12
|
| Rate for Payer: BCN Commercial |
$148.90
|
| Rate for Payer: BCN Medicare Advantage |
$92.12
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$132.65
|
| Rate for Payer: Cofinity Commercial |
$123.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.12
|
| Rate for Payer: Healthscope Commercial |
$170.42
|
| Rate for Payer: Healthscope Commercial |
$147.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$101.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$172.91
|
| Rate for Payer: Nomi Health Commercial |
$110.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.00
|
| Rate for Payer: PACE SWMI |
$92.12
|
| Rate for Payer: PHP Medicare Advantage |
$92.12
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$150.02
|
| Rate for Payer: Priority Health Medicare |
$92.12
|
| Rate for Payer: Priority Health SBD |
$150.02
|
| Rate for Payer: Priority Health Tiered Network |
$150.02
|
| Rate for Payer: Railroad Medicare Medicare |
$92.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.65
|
| Rate for Payer: UHC Core |
$148.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$92.12
|
| Rate for Payer: UHC Exchange |
$148.65
|
|
|
CHG US SOFT TISSUE HEAD & NECK REAL TIME IMGE DOCM
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 76536
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$189.70 |
| Rate for Payer: Aetna Commercial |
$135.34
|
| Rate for Payer: Aetna Commercial |
$135.34
|
| Rate for Payer: Aetna Medicare |
$105.04
|
| Rate for Payer: Aetna Medicare |
$105.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.34
|
| Rate for Payer: BCBS MAPPO |
$101.00
|
| Rate for Payer: BCBS MAPPO |
$101.00
|
| Rate for Payer: BCN Commercial |
$163.34
|
| Rate for Payer: BCN Commercial |
$163.34
|
| Rate for Payer: BCN Medicare Advantage |
$101.00
|
| Rate for Payer: BCN Medicare Advantage |
$101.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cofinity Commercial |
$145.44
|
| Rate for Payer: Cofinity Commercial |
$135.34
|
| Rate for Payer: Cofinity Commercial |
$135.34
|
| Rate for Payer: Cofinity Commercial |
$145.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.00
|
| Rate for Payer: Healthscope Commercial |
$186.85
|
| Rate for Payer: Healthscope Commercial |
$186.85
|
| Rate for Payer: Healthscope Commercial |
$161.60
|
| Rate for Payer: Healthscope Commercial |
$161.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.70
|
| Rate for Payer: Nomi Health Commercial |
$121.20
|
| Rate for Payer: Nomi Health Commercial |
$121.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$78.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$175.50
|
| Rate for Payer: PACE SWMI |
$101.00
|
| Rate for Payer: PACE SWMI |
$101.00
|
| Rate for Payer: PHP Medicare Advantage |
$101.00
|
| Rate for Payer: PHP Medicare Advantage |
$101.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$164.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$164.57
|
| Rate for Payer: Priority Health Medicare |
$101.00
|
| Rate for Payer: Priority Health Medicare |
$101.00
|
| Rate for Payer: Priority Health SBD |
$164.57
|
| Rate for Payer: Priority Health SBD |
$164.57
|
| Rate for Payer: Priority Health Tiered Network |
$164.57
|
| Rate for Payer: Priority Health Tiered Network |
$164.57
|
| Rate for Payer: Railroad Medicare Medicare |
$101.00
|
| Rate for Payer: Railroad Medicare Medicare |
$101.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$163.52
|
| Rate for Payer: UHC Core |
$163.52
|
| Rate for Payer: UHC Core |
$163.52
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$101.00
|
| Rate for Payer: UHC Exchange |
$163.52
|
| Rate for Payer: UHC Exchange |
$163.52
|
|
|
CHG US TRANSRCT PRSTATE VOL BRACHYTX PLNNING SPX
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
HCPCS 76873
|
| Min. Negotiated Rate |
$168.11 |
| Max. Negotiated Rate |
$311.00 |
| Rate for Payer: Aetna Commercial |
$225.27
|
| Rate for Payer: Aetna Medicare |
$174.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.08
|
| Rate for Payer: BCBS MAPPO |
$168.11
|
| Rate for Payer: BCN Commercial |
$260.94
|
| Rate for Payer: BCN Medicare Advantage |
$168.11
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cash Price |
$214.40
|
| Rate for Payer: Cofinity Commercial |
$242.08
|
| Rate for Payer: Cofinity Commercial |
$225.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$168.11
|
| Rate for Payer: Healthscope Commercial |
$311.00
|
| Rate for Payer: Healthscope Commercial |
$268.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$176.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$184.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$299.84
|
| Rate for Payer: Nomi Health Commercial |
$201.73
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.00
|
| Rate for Payer: PACE SWMI |
$168.11
|
| Rate for Payer: PHP Medicare Advantage |
$168.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$262.91
|
| Rate for Payer: Priority Health Medicare |
$168.11
|
| Rate for Payer: Priority Health SBD |
$262.91
|
| Rate for Payer: Priority Health Tiered Network |
$262.91
|
| Rate for Payer: Railroad Medicare Medicare |
$168.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$251.24
|
| Rate for Payer: UHC Core |
$251.24
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$168.11
|
| Rate for Payer: UHC Exchange |
$251.24
|
|
|
CHG US TRANSRECTAL
|
Professional
|
Both
|
$342.00
|
|
|
Service Code
|
HCPCS 76872
|
| Min. Negotiated Rate |
$111.96 |
| Max. Negotiated Rate |
$295.52 |
| Rate for Payer: Aetna Commercial |
$150.03
|
| Rate for Payer: Aetna Commercial |
$150.03
|
| Rate for Payer: Aetna Medicare |
$116.44
|
| Rate for Payer: Aetna Medicare |
$116.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$150.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.22
|
| Rate for Payer: BCBS MAPPO |
$111.96
|
| Rate for Payer: BCBS MAPPO |
$111.96
|
| Rate for Payer: BCN Commercial |
$293.31
|
| Rate for Payer: BCN Commercial |
$293.31
|
| Rate for Payer: BCN Medicare Advantage |
$111.96
|
| Rate for Payer: BCN Medicare Advantage |
$111.96
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Cofinity Commercial |
$150.03
|
| Rate for Payer: Cofinity Commercial |
$161.22
|
| Rate for Payer: Cofinity Commercial |
$150.03
|
| Rate for Payer: Cofinity Commercial |
$161.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$111.96
|
| Rate for Payer: Healthscope Commercial |
$207.13
|
| Rate for Payer: Healthscope Commercial |
$207.13
|
| Rate for Payer: Healthscope Commercial |
$179.14
|
| Rate for Payer: Healthscope Commercial |
$179.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$117.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$123.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$231.88
|
| Rate for Payer: Nomi Health Commercial |
$134.35
|
| Rate for Payer: Nomi Health Commercial |
$134.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$54.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$256.50
|
| Rate for Payer: PACE SWMI |
$111.96
|
| Rate for Payer: PACE SWMI |
$111.96
|
| Rate for Payer: PHP Medicare Advantage |
$111.96
|
| Rate for Payer: PHP Medicare Advantage |
$111.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$295.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$295.52
|
| Rate for Payer: Priority Health Medicare |
$111.96
|
| Rate for Payer: Priority Health Medicare |
$111.96
|
| Rate for Payer: Priority Health SBD |
$295.52
|
| Rate for Payer: Priority Health SBD |
$295.52
|
| Rate for Payer: Priority Health Tiered Network |
$295.52
|
| Rate for Payer: Priority Health Tiered Network |
$295.52
|
| Rate for Payer: Railroad Medicare Medicare |
$111.96
|
| Rate for Payer: Railroad Medicare Medicare |
$111.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$221.10
|
| Rate for Payer: UHC Core |
$221.10
|
| Rate for Payer: UHC Core |
$221.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$111.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$111.96
|
| Rate for Payer: UHC Exchange |
$221.10
|
| Rate for Payer: UHC Exchange |
$221.10
|
|
|
CHG US TRANSVAGINAL
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 76830
|
| Min. Negotiated Rate |
$109.72 |
| Max. Negotiated Rate |
$239.25 |
| Rate for Payer: Aetna Commercial |
$147.02
|
| Rate for Payer: Aetna Medicare |
$114.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.00
|
| Rate for Payer: BCBS MAPPO |
$109.72
|
| Rate for Payer: BCN Commercial |
$175.79
|
| Rate for Payer: BCN Medicare Advantage |
$109.72
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cofinity Commercial |
$158.00
|
| Rate for Payer: Cofinity Commercial |
$147.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.72
|
| Rate for Payer: Healthscope Commercial |
$202.98
|
| Rate for Payer: Healthscope Commercial |
$175.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$120.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$204.86
|
| Rate for Payer: Nomi Health Commercial |
$131.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$239.25
|
| Rate for Payer: PACE SWMI |
$109.72
|
| Rate for Payer: PHP Medicare Advantage |
$109.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$177.11
|
| Rate for Payer: Priority Health Medicare |
$109.72
|
| Rate for Payer: Priority Health SBD |
$177.11
|
| Rate for Payer: Priority Health Tiered Network |
$177.11
|
| Rate for Payer: Railroad Medicare Medicare |
$109.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$173.94
|
| Rate for Payer: UHC Core |
$173.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$109.72
|
| Rate for Payer: UHC Exchange |
$173.94
|
|
|
CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 76937
|
| Min. Negotiated Rate |
$38.03 |
| Max. Negotiated Rate |
$70.36 |
| Rate for Payer: Aetna Commercial |
$50.96
|
| Rate for Payer: Aetna Commercial |
$50.96
|
| Rate for Payer: Aetna Medicare |
$39.55
|
| Rate for Payer: Aetna Medicare |
$39.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.76
|
| Rate for Payer: BCBS MAPPO |
$38.03
|
| Rate for Payer: BCBS MAPPO |
$38.03
|
| Rate for Payer: BCN Commercial |
$57.27
|
| Rate for Payer: BCN Commercial |
$57.27
|
| Rate for Payer: BCN Medicare Advantage |
$38.03
|
| Rate for Payer: BCN Medicare Advantage |
$38.03
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Cofinity Commercial |
$50.96
|
| Rate for Payer: Cofinity Commercial |
$54.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.03
|
| Rate for Payer: Healthscope Commercial |
$70.36
|
| Rate for Payer: Healthscope Commercial |
$70.36
|
| Rate for Payer: Healthscope Commercial |
$60.85
|
| Rate for Payer: Healthscope Commercial |
$60.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$67.61
|
| Rate for Payer: Nomi Health Commercial |
$45.64
|
| Rate for Payer: Nomi Health Commercial |
$45.64
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$48.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$44.25
|
| Rate for Payer: PACE SWMI |
$38.03
|
| Rate for Payer: PACE SWMI |
$38.03
|
| Rate for Payer: PHP Medicare Advantage |
$38.03
|
| Rate for Payer: PHP Medicare Advantage |
$38.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$57.70
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$57.70
|
| Rate for Payer: Priority Health Medicare |
$38.03
|
| Rate for Payer: Priority Health Medicare |
$38.03
|
| Rate for Payer: Priority Health SBD |
$57.70
|
| Rate for Payer: Priority Health SBD |
$57.70
|
| Rate for Payer: Priority Health Tiered Network |
$57.70
|
| Rate for Payer: Priority Health Tiered Network |
$57.70
|
| Rate for Payer: Railroad Medicare Medicare |
$38.03
|
| Rate for Payer: Railroad Medicare Medicare |
$38.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.10
|
| Rate for Payer: UHC Core |
$52.10
|
| Rate for Payer: UHC Core |
$52.10
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.03
|
| Rate for Payer: UHC Exchange |
$52.10
|
| Rate for Payer: UHC Exchange |
$52.10
|
|
