|
CHG SPECIAL TREATMENT PROCEDURE
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 77470
|
| Min. Negotiated Rate |
$136.35 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$182.71
|
| Rate for Payer: Aetna Commercial |
$182.71
|
| Rate for Payer: Aetna Medicare |
$141.80
|
| Rate for Payer: Aetna Medicare |
$141.80
|
| Rate for Payer: BCBS Complete |
$212.80
|
| Rate for Payer: BCBS Complete |
$282.00
|
| Rate for Payer: BCBS MAPPO |
$136.35
|
| Rate for Payer: BCBS MAPPO |
$136.35
|
| Rate for Payer: BCN Medicare Advantage |
$136.35
|
| Rate for Payer: BCN Medicare Advantage |
$136.35
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Cofinity Commercial |
$182.71
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Cofinity Commercial |
$182.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.17
|
| Rate for Payer: Nomi Health Commercial |
$163.62
|
| Rate for Payer: Nomi Health Commercial |
$163.62
|
| Rate for Payer: PACE SWMI |
$136.35
|
| Rate for Payer: PACE SWMI |
$136.35
|
| Rate for Payer: PHP Medicare Advantage |
$136.35
|
| Rate for Payer: PHP Medicare Advantage |
$136.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.25
|
| Rate for Payer: Priority Health Medicare |
$137.71
|
| Rate for Payer: Priority Health Medicare |
$137.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$136.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.35
|
| Rate for Payer: UHC Exchange |
$136.35
|
| Rate for Payer: UHC Exchange |
$136.35
|
| Rate for Payer: UHC Medicare Advantage |
$136.35
|
| Rate for Payer: UHC Medicare Advantage |
$136.35
|
|
|
CHG SPEC MEDICAL RADJ PHYSICS CONSLTJ
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 77370
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$192.90 |
| Rate for Payer: Aetna Commercial |
$179.51
|
| Rate for Payer: Aetna Medicare |
$139.32
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS MAPPO |
$133.96
|
| Rate for Payer: BCN Medicare Advantage |
$133.96
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$192.90
|
| Rate for Payer: Cofinity Commercial |
$179.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.66
|
| Rate for Payer: Nomi Health Commercial |
$160.75
|
| Rate for Payer: PACE SWMI |
$133.96
|
| Rate for Payer: PHP Medicare Advantage |
$133.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health Medicare |
$135.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$133.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.96
|
| Rate for Payer: UHC Exchange |
$133.96
|
| Rate for Payer: UHC Medicare Advantage |
$133.96
|
|
|
CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 77321
|
| Min. Negotiated Rate |
$87.44 |
| Max. Negotiated Rate |
$183.30 |
| Rate for Payer: Aetna Commercial |
$117.17
|
| Rate for Payer: Aetna Commercial |
$117.17
|
| Rate for Payer: Aetna Medicare |
$90.94
|
| Rate for Payer: Aetna Medicare |
$90.94
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: BCBS MAPPO |
$87.44
|
| Rate for Payer: BCBS MAPPO |
$87.44
|
| Rate for Payer: BCN Medicare Advantage |
$87.44
|
| Rate for Payer: BCN Medicare Advantage |
$87.44
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$125.91
|
| Rate for Payer: Cofinity Commercial |
$125.91
|
| Rate for Payer: Cofinity Commercial |
$117.17
|
| Rate for Payer: Cofinity Commercial |
$117.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.81
|
| Rate for Payer: Nomi Health Commercial |
$104.93
|
| Rate for Payer: Nomi Health Commercial |
$104.93
|
| Rate for Payer: PACE SWMI |
$87.44
|
| Rate for Payer: PACE SWMI |
$87.44
|
| Rate for Payer: PHP Medicare Advantage |
$87.44
|
| Rate for Payer: PHP Medicare Advantage |
$87.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health Medicare |
$88.31
|
| Rate for Payer: Priority Health Medicare |
$88.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.44
|
| Rate for Payer: UHC Exchange |
$87.44
|
| Rate for Payer: UHC Exchange |
$87.44
|
| Rate for Payer: UHC Medicare Advantage |
$87.44
|
| Rate for Payer: UHC Medicare Advantage |
$87.44
|
|
|
CHG STEREOSCOPIC X-RAY GUIDANCE
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
HCPCS 77421
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$113.10 |
| Rate for Payer: Aetna Medicare |
$87.00
|
| Rate for Payer: Aetna Medicare |
$103.00
|
| Rate for Payer: BCBS Complete |
$69.60
|
| Rate for Payer: BCBS Complete |
$82.40
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.10
|
|
|
CHG STEREOTACTIC BODY RADIATION MANAGEMENT
|
Professional
|
Both
|
$1,261.00
|
|
|
Service Code
|
HCPCS 77435
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$886.19 |
| Rate for Payer: Aetna Commercial |
$824.65
|
| Rate for Payer: Aetna Medicare |
$640.03
|
| Rate for Payer: BCBS Complete |
$504.40
|
| Rate for Payer: BCBS MAPPO |
$615.41
|
| Rate for Payer: BCN Medicare Advantage |
$615.41
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Cofinity Commercial |
$824.65
|
| Rate for Payer: Cofinity Commercial |
$886.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.18
|
| Rate for Payer: Nomi Health Commercial |
$738.49
|
| Rate for Payer: PACE SWMI |
$615.41
|
| Rate for Payer: PHP Medicare Advantage |
$615.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.65
|
| Rate for Payer: Priority Health Medicare |
$621.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$615.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.41
|
| Rate for Payer: UHC Exchange |
$615.41
|
| Rate for Payer: UHC Medicare Advantage |
$615.41
|
|
|
CHG STEREOTACTIC BODY RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$2,706.00
|
|
|
Service Code
|
HCPCS 77373
|
| Min. Negotiated Rate |
$867.16 |
| Max. Negotiated Rate |
$1,758.90 |
| Rate for Payer: Aetna Commercial |
$1,161.99
|
| Rate for Payer: Aetna Medicare |
$901.85
|
| Rate for Payer: BCBS Complete |
$1,082.40
|
| Rate for Payer: BCBS MAPPO |
$867.16
|
| Rate for Payer: BCN Medicare Advantage |
$867.16
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cofinity Commercial |
$1,248.71
|
| Rate for Payer: Cofinity Commercial |
$1,161.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$867.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$910.52
|
| Rate for Payer: Nomi Health Commercial |
$1,040.59
|
| Rate for Payer: PACE SWMI |
$867.16
|
| Rate for Payer: PHP Medicare Advantage |
$867.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,758.90
|
| Rate for Payer: Priority Health Medicare |
$875.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$867.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$867.16
|
| Rate for Payer: UHC Exchange |
$867.16
|
| Rate for Payer: UHC Medicare Advantage |
$867.16
|
|
|
CHG STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 77432
|
| Min. Negotiated Rate |
$348.80 |
| Max. Negotiated Rate |
$587.06 |
| Rate for Payer: Aetna Commercial |
$546.29
|
| Rate for Payer: Aetna Medicare |
$423.99
|
| Rate for Payer: BCBS Complete |
$348.80
|
| Rate for Payer: BCBS MAPPO |
$407.68
|
| Rate for Payer: BCN Medicare Advantage |
$407.68
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cofinity Commercial |
$587.06
|
| Rate for Payer: Cofinity Commercial |
$546.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.06
|
| Rate for Payer: Nomi Health Commercial |
$489.22
|
| Rate for Payer: PACE SWMI |
$407.68
|
| Rate for Payer: PHP Medicare Advantage |
$407.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.80
|
| Rate for Payer: Priority Health Medicare |
$411.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$407.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.68
|
| Rate for Payer: UHC Exchange |
$407.68
|
| Rate for Payer: UHC Medicare Advantage |
$407.68
|
|
|
CHG SUPERVISION HANDLING LOADING RADIATION SOURCE
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
HCPCS 77790
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$52.65 |
| Rate for Payer: Aetna Commercial |
$22.74
|
| Rate for Payer: Aetna Commercial |
$22.74
|
| Rate for Payer: Aetna Medicare |
$17.65
|
| Rate for Payer: Aetna Medicare |
$17.65
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS MAPPO |
$16.97
|
| Rate for Payer: BCBS MAPPO |
$16.97
|
| Rate for Payer: BCN Medicare Advantage |
$16.97
|
| Rate for Payer: BCN Medicare Advantage |
$16.97
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$22.74
|
| Rate for Payer: Cofinity Commercial |
$22.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.82
|
| Rate for Payer: Nomi Health Commercial |
$20.36
|
| Rate for Payer: Nomi Health Commercial |
$20.36
|
| Rate for Payer: PACE SWMI |
$16.97
|
| Rate for Payer: PACE SWMI |
$16.97
|
| Rate for Payer: PHP Medicare Advantage |
$16.97
|
| Rate for Payer: PHP Medicare Advantage |
$16.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| Rate for Payer: Priority Health Medicare |
$17.14
|
| Rate for Payer: Priority Health Medicare |
$17.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$16.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.97
|
| Rate for Payer: UHC Exchange |
$16.97
|
| Rate for Payer: UHC Exchange |
$16.97
|
| Rate for Payer: UHC Medicare Advantage |
$16.97
|
| Rate for Payer: UHC Medicare Advantage |
$16.97
|
|
|
CHG TBS TECHNICAL CALCULATION ONLY
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 77091
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Aetna Commercial |
$32.49
|
| Rate for Payer: Aetna Medicare |
$25.22
|
| Rate for Payer: BCBS Complete |
$23.20
|
| Rate for Payer: BCBS MAPPO |
$24.25
|
| Rate for Payer: BCN Medicare Advantage |
$24.25
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$32.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.46
|
| Rate for Payer: Nomi Health Commercial |
$29.10
|
| Rate for Payer: PACE SWMI |
$24.25
|
| Rate for Payer: PHP Medicare Advantage |
$24.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health Medicare |
$24.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$24.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.25
|
| Rate for Payer: UHC Exchange |
$24.25
|
| Rate for Payer: UHC Medicare Advantage |
$24.25
|
|
|
CHG TELETHER ISODOSE PLAN COMPLX
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 77315
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$94.25 |
| Rate for Payer: Aetna Medicare |
$72.50
|
| Rate for Payer: Aetna Medicare |
$137.00
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: BCBS Complete |
$109.60
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
|
|
CHG TELETHER ISODOSE PLAN SIMPLE
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 77305
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Aetna Medicare |
$77.50
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
|
|
CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY
|
Professional
|
Both
|
$439.00
|
|
|
Service Code
|
HCPCS 77307
|
| Min. Negotiated Rate |
$175.60 |
| Max. Negotiated Rate |
$385.82 |
| Rate for Payer: Aetna Commercial |
$359.03
|
| Rate for Payer: Aetna Commercial |
$359.03
|
| Rate for Payer: Aetna Medicare |
$278.65
|
| Rate for Payer: Aetna Medicare |
$278.65
|
| Rate for Payer: BCBS Complete |
$175.60
|
| Rate for Payer: BCBS Complete |
$335.20
|
| Rate for Payer: BCBS MAPPO |
$267.93
|
| Rate for Payer: BCBS MAPPO |
$267.93
|
| Rate for Payer: BCN Medicare Advantage |
$267.93
|
| Rate for Payer: BCN Medicare Advantage |
$267.93
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cofinity Commercial |
$385.82
|
| Rate for Payer: Cofinity Commercial |
$359.03
|
| Rate for Payer: Cofinity Commercial |
$385.82
|
| Rate for Payer: Cofinity Commercial |
$359.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.33
|
| Rate for Payer: Nomi Health Commercial |
$321.52
|
| Rate for Payer: Nomi Health Commercial |
$321.52
|
| Rate for Payer: PACE SWMI |
$267.93
|
| Rate for Payer: PACE SWMI |
$267.93
|
| Rate for Payer: PHP Medicare Advantage |
$267.93
|
| Rate for Payer: PHP Medicare Advantage |
$267.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: Priority Health Medicare |
$270.61
|
| Rate for Payer: Priority Health Medicare |
$270.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$267.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.93
|
| Rate for Payer: UHC Exchange |
$267.93
|
| Rate for Payer: UHC Exchange |
$267.93
|
| Rate for Payer: UHC Medicare Advantage |
$267.93
|
| Rate for Payer: UHC Medicare Advantage |
$267.93
|
|
|
CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 77306
|
| Min. Negotiated Rate |
$93.20 |
| Max. Negotiated Rate |
$197.61 |
| Rate for Payer: Aetna Commercial |
$183.89
|
| Rate for Payer: Aetna Commercial |
$183.89
|
| Rate for Payer: Aetna Medicare |
$142.72
|
| Rate for Payer: Aetna Medicare |
$142.72
|
| Rate for Payer: BCBS Complete |
$93.20
|
| Rate for Payer: BCBS Complete |
$158.40
|
| Rate for Payer: BCBS MAPPO |
$137.23
|
| Rate for Payer: BCBS MAPPO |
$137.23
|
| Rate for Payer: BCN Medicare Advantage |
$137.23
|
| Rate for Payer: BCN Medicare Advantage |
$137.23
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cofinity Commercial |
$197.61
|
| Rate for Payer: Cofinity Commercial |
$183.89
|
| Rate for Payer: Cofinity Commercial |
$197.61
|
| Rate for Payer: Cofinity Commercial |
$183.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.09
|
| Rate for Payer: Nomi Health Commercial |
$164.68
|
| Rate for Payer: Nomi Health Commercial |
$164.68
|
| Rate for Payer: PACE SWMI |
$137.23
|
| Rate for Payer: PACE SWMI |
$137.23
|
| Rate for Payer: PHP Medicare Advantage |
$137.23
|
| Rate for Payer: PHP Medicare Advantage |
$137.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.40
|
| Rate for Payer: Priority Health Medicare |
$138.60
|
| Rate for Payer: Priority Health Medicare |
$138.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.23
|
| Rate for Payer: UHC Exchange |
$137.23
|
| Rate for Payer: UHC Exchange |
$137.23
|
| Rate for Payer: UHC Medicare Advantage |
$137.23
|
| Rate for Payer: UHC Medicare Advantage |
$137.23
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 74283
|
| Min. Negotiated Rate |
$110.80 |
| Max. Negotiated Rate |
$340.27 |
| Rate for Payer: Aetna Commercial |
$316.64
|
| Rate for Payer: Aetna Medicare |
$245.75
|
| Rate for Payer: BCBS Complete |
$110.80
|
| Rate for Payer: BCBS MAPPO |
$236.30
|
| Rate for Payer: BCN Medicare Advantage |
$236.30
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cofinity Commercial |
$340.27
|
| Rate for Payer: Cofinity Commercial |
$316.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.12
|
| Rate for Payer: Nomi Health Commercial |
$283.56
|
| Rate for Payer: PACE SWMI |
$236.30
|
| Rate for Payer: PHP Medicare Advantage |
$236.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.05
|
| Rate for Payer: Priority Health Medicare |
$238.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$236.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.30
|
| Rate for Payer: UHC Exchange |
$236.30
|
| Rate for Payer: UHC Medicare Advantage |
$236.30
|
|
|
CHG THERAPEUTIC RADIOLOGY PORT IMAGE(S)
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 77417
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: Aetna Medicare |
$15.19
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: BCBS MAPPO |
$14.61
|
| Rate for Payer: BCN Medicare Advantage |
$14.61
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$21.04
|
| Rate for Payer: Cofinity Commercial |
$19.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.34
|
| Rate for Payer: Nomi Health Commercial |
$17.53
|
| Rate for Payer: PACE SWMI |
$14.61
|
| Rate for Payer: PHP Medicare Advantage |
$14.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.10
|
| Rate for Payer: Priority Health Medicare |
$14.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.61
|
| Rate for Payer: UHC Exchange |
$14.61
|
| Rate for Payer: UHC Medicare Advantage |
$14.61
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 77263
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$232.36 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Medicare |
$167.81
|
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: BCBS MAPPO |
$161.36
|
| Rate for Payer: BCN Medicare Advantage |
$161.36
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$232.36
|
| Rate for Payer: Cofinity Commercial |
$216.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.43
|
| Rate for Payer: Nomi Health Commercial |
$193.63
|
| Rate for Payer: PACE SWMI |
$161.36
|
| Rate for Payer: PHP Medicare Advantage |
$161.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health Medicare |
$162.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$161.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.36
|
| Rate for Payer: UHC Exchange |
$161.36
|
| Rate for Payer: UHC Medicare Advantage |
$161.36
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 77262
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$149.05 |
| Rate for Payer: Aetna Commercial |
$138.70
|
| Rate for Payer: Aetna Medicare |
$107.65
|
| Rate for Payer: BCBS Complete |
$80.80
|
| Rate for Payer: BCBS MAPPO |
$103.51
|
| Rate for Payer: BCN Medicare Advantage |
$103.51
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cofinity Commercial |
$149.05
|
| Rate for Payer: Cofinity Commercial |
$138.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.69
|
| Rate for Payer: Nomi Health Commercial |
$124.21
|
| Rate for Payer: PACE SWMI |
$103.51
|
| Rate for Payer: PHP Medicare Advantage |
$103.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.30
|
| Rate for Payer: Priority Health Medicare |
$104.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$103.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.51
|
| Rate for Payer: UHC Exchange |
$103.51
|
| Rate for Payer: UHC Medicare Advantage |
$103.51
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 77261
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$96.08 |
| Rate for Payer: Aetna Commercial |
$89.40
|
| Rate for Payer: Aetna Medicare |
$69.39
|
| Rate for Payer: BCBS Complete |
$54.00
|
| Rate for Payer: BCBS MAPPO |
$66.72
|
| Rate for Payer: BCN Medicare Advantage |
$66.72
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$96.08
|
| Rate for Payer: Cofinity Commercial |
$89.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.06
|
| Rate for Payer: Nomi Health Commercial |
$80.06
|
| Rate for Payer: PACE SWMI |
$66.72
|
| Rate for Payer: PHP Medicare Advantage |
$66.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.75
|
| Rate for Payer: Priority Health Medicare |
$67.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.72
|
| Rate for Payer: UHC Exchange |
$66.72
|
| Rate for Payer: UHC Medicare Advantage |
$66.72
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX
|
Professional
|
Both
|
$964.00
|
|
|
Service Code
|
HCPCS 77290
|
| Min. Negotiated Rate |
$385.60 |
| Max. Negotiated Rate |
$626.60 |
| Rate for Payer: Aetna Commercial |
$529.06
|
| Rate for Payer: Aetna Commercial |
$529.06
|
| Rate for Payer: Aetna Medicare |
$410.61
|
| Rate for Payer: Aetna Medicare |
$410.61
|
| Rate for Payer: BCBS Complete |
$385.60
|
| Rate for Payer: BCBS Complete |
$321.20
|
| Rate for Payer: BCBS MAPPO |
$394.82
|
| Rate for Payer: BCBS MAPPO |
$394.82
|
| Rate for Payer: BCN Medicare Advantage |
$394.82
|
| Rate for Payer: BCN Medicare Advantage |
$394.82
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cofinity Commercial |
$568.54
|
| Rate for Payer: Cofinity Commercial |
$568.54
|
| Rate for Payer: Cofinity Commercial |
$529.06
|
| Rate for Payer: Cofinity Commercial |
$529.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$414.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$414.56
|
| Rate for Payer: Nomi Health Commercial |
$473.78
|
| Rate for Payer: Nomi Health Commercial |
$473.78
|
| Rate for Payer: PACE SWMI |
$394.82
|
| Rate for Payer: PACE SWMI |
$394.82
|
| Rate for Payer: PHP Medicare Advantage |
$394.82
|
| Rate for Payer: PHP Medicare Advantage |
$394.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.60
|
| Rate for Payer: Priority Health Medicare |
$398.77
|
| Rate for Payer: Priority Health Medicare |
$398.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$394.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$394.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$394.82
|
| Rate for Payer: UHC Exchange |
$394.82
|
| Rate for Payer: UHC Exchange |
$394.82
|
| Rate for Payer: UHC Medicare Advantage |
$394.82
|
| Rate for Payer: UHC Medicare Advantage |
$394.82
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 77285
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$571.15 |
| Rate for Payer: Aetna Commercial |
$531.48
|
| Rate for Payer: Aetna Medicare |
$412.50
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$396.63
|
| Rate for Payer: BCN Medicare Advantage |
$396.63
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$571.15
|
| Rate for Payer: Cofinity Commercial |
$531.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$396.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$416.46
|
| Rate for Payer: Nomi Health Commercial |
$475.96
|
| Rate for Payer: PACE SWMI |
$396.63
|
| Rate for Payer: PHP Medicare Advantage |
$396.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$400.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$396.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$396.63
|
| Rate for Payer: UHC Exchange |
$396.63
|
| Rate for Payer: UHC Medicare Advantage |
$396.63
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE
|
Professional
|
Both
|
$515.00
|
|
|
Service Code
|
HCPCS 77280
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$344.68 |
| Rate for Payer: Aetna Commercial |
$320.74
|
| Rate for Payer: Aetna Commercial |
$320.74
|
| Rate for Payer: Aetna Medicare |
$248.93
|
| Rate for Payer: Aetna Medicare |
$248.93
|
| Rate for Payer: BCBS Complete |
$206.00
|
| Rate for Payer: BCBS Complete |
$177.60
|
| Rate for Payer: BCBS MAPPO |
$239.36
|
| Rate for Payer: BCBS MAPPO |
$239.36
|
| Rate for Payer: BCN Medicare Advantage |
$239.36
|
| Rate for Payer: BCN Medicare Advantage |
$239.36
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cofinity Commercial |
$344.68
|
| Rate for Payer: Cofinity Commercial |
$344.68
|
| Rate for Payer: Cofinity Commercial |
$320.74
|
| Rate for Payer: Cofinity Commercial |
$320.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$251.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$251.33
|
| Rate for Payer: Nomi Health Commercial |
$287.23
|
| Rate for Payer: Nomi Health Commercial |
$287.23
|
| Rate for Payer: PACE SWMI |
$239.36
|
| Rate for Payer: PACE SWMI |
$239.36
|
| Rate for Payer: PHP Medicare Advantage |
$239.36
|
| Rate for Payer: PHP Medicare Advantage |
$239.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.75
|
| Rate for Payer: Priority Health Medicare |
$241.75
|
| Rate for Payer: Priority Health Medicare |
$241.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$239.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.36
|
| Rate for Payer: UHC Exchange |
$239.36
|
| Rate for Payer: UHC Exchange |
$239.36
|
| Rate for Payer: UHC Medicare Advantage |
$239.36
|
| Rate for Payer: UHC Medicare Advantage |
$239.36
|
|
|
CHG TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 88233
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$202.65 |
| Rate for Payer: Aetna Commercial |
$188.58
|
| Rate for Payer: Aetna Medicare |
$146.36
|
| Rate for Payer: BCBS Complete |
$119.60
|
| Rate for Payer: BCBS MAPPO |
$140.73
|
| Rate for Payer: BCN Medicare Advantage |
$140.73
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.77
|
| Rate for Payer: Nomi Health Commercial |
$168.88
|
| Rate for Payer: PACE SWMI |
$140.73
|
| Rate for Payer: PHP Medicare Advantage |
$140.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health Medicare |
$142.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.73
|
| Rate for Payer: UHC Exchange |
$140.73
|
| Rate for Payer: UHC Medicare Advantage |
$140.73
|
|
|
CHG TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 87220
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Nomi Health Commercial |
$5.12
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.30
|
| Rate for Payer: Priority Health Medicare |
$4.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Exchange |
$4.27
|
| Rate for Payer: UHC Medicare Advantage |
$4.27
|
|
|
CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 75894
|
| Min. Negotiated Rate |
$143.60 |
| Max. Negotiated Rate |
$233.35 |
| Rate for Payer: Aetna Medicare |
$179.50
|
| Rate for Payer: BCBS Complete |
$143.60
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.35
|
|
|
CHG TRANSCATHETER INFUSION OTHER THAN THROMBOLYSIS
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 75896
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$184.60 |
| Rate for Payer: Aetna Medicare |
$142.00
|
| Rate for Payer: BCBS Complete |
$113.60
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
|
