|
CHG TRANSFERASE ALANINE AMINO ALT SGPT
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 84460
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Aetna Commercial |
$7.10
|
| Rate for Payer: Aetna Medicare |
$5.51
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$5.30
|
| 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 |
$7.10
|
| Rate for Payer: Cofinity Commercial |
$7.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.57
|
| Rate for Payer: Nomi Health Commercial |
$6.36
|
| Rate for Payer: PACE SWMI |
$5.30
|
| Rate for Payer: PHP Medicare Advantage |
$5.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$5.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.30
|
| Rate for Payer: UHC Exchange |
$5.30
|
| Rate for Payer: UHC Medicare Advantage |
$5.30
|
|
|
CHG TRANSFERASE ASPARTATE AMINO AST SGOT
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 84450
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Nomi Health Commercial |
$6.22
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$5.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Exchange |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION COMPLEX
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 77334
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$166.62 |
| Rate for Payer: Aetna Commercial |
$155.05
|
| Rate for Payer: Aetna Commercial |
$155.05
|
| Rate for Payer: Aetna Medicare |
$120.34
|
| Rate for Payer: Aetna Medicare |
$120.34
|
| Rate for Payer: BCBS Complete |
$73.20
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$115.71
|
| Rate for Payer: BCBS MAPPO |
$115.71
|
| Rate for Payer: BCN Medicare Advantage |
$115.71
|
| Rate for Payer: BCN Medicare Advantage |
$115.71
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cofinity Commercial |
$166.62
|
| Rate for Payer: Cofinity Commercial |
$155.05
|
| Rate for Payer: Cofinity Commercial |
$166.62
|
| Rate for Payer: Cofinity Commercial |
$155.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.50
|
| Rate for Payer: Nomi Health Commercial |
$138.85
|
| Rate for Payer: Nomi Health Commercial |
$138.85
|
| Rate for Payer: PACE SWMI |
$115.71
|
| Rate for Payer: PACE SWMI |
$115.71
|
| Rate for Payer: PHP Medicare Advantage |
$115.71
|
| Rate for Payer: PHP Medicare Advantage |
$115.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.15
|
| Rate for Payer: Priority Health Medicare |
$116.87
|
| Rate for Payer: Priority Health Medicare |
$116.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.71
|
| Rate for Payer: UHC Exchange |
$115.71
|
| Rate for Payer: UHC Exchange |
$115.71
|
| Rate for Payer: UHC Medicare Advantage |
$115.71
|
| Rate for Payer: UHC Medicare Advantage |
$115.71
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 77333
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$178.00 |
| Rate for Payer: Aetna Commercial |
$165.64
|
| Rate for Payer: Aetna Commercial |
$165.64
|
| Rate for Payer: Aetna Medicare |
$128.55
|
| Rate for Payer: Aetna Medicare |
$128.55
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS MAPPO |
$123.61
|
| Rate for Payer: BCBS MAPPO |
$123.61
|
| Rate for Payer: BCN Medicare Advantage |
$123.61
|
| Rate for Payer: BCN Medicare Advantage |
$123.61
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$178.00
|
| Rate for Payer: Cofinity Commercial |
$165.64
|
| Rate for Payer: Cofinity Commercial |
$178.00
|
| Rate for Payer: Cofinity Commercial |
$165.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.79
|
| Rate for Payer: Nomi Health Commercial |
$148.33
|
| Rate for Payer: Nomi Health Commercial |
$148.33
|
| Rate for Payer: PACE SWMI |
$123.61
|
| Rate for Payer: PACE SWMI |
$123.61
|
| Rate for Payer: PHP Medicare Advantage |
$123.61
|
| Rate for Payer: PHP Medicare Advantage |
$123.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health Medicare |
$124.85
|
| Rate for Payer: Priority Health Medicare |
$124.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$123.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.61
|
| Rate for Payer: UHC Exchange |
$123.61
|
| Rate for Payer: UHC Exchange |
$123.61
|
| Rate for Payer: UHC Medicare Advantage |
$123.61
|
| Rate for Payer: UHC Medicare Advantage |
$123.61
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION SIMPLE
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 77332
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Aetna Commercial |
$50.64
|
| Rate for Payer: Aetna Commercial |
$50.64
|
| Rate for Payer: Aetna Medicare |
$39.30
|
| Rate for Payer: Aetna Medicare |
$39.30
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: BCBS MAPPO |
$37.79
|
| Rate for Payer: BCBS MAPPO |
$37.79
|
| Rate for Payer: BCN Medicare Advantage |
$37.79
|
| Rate for Payer: BCN Medicare Advantage |
$37.79
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cofinity Commercial |
$54.42
|
| Rate for Payer: Cofinity Commercial |
$50.64
|
| Rate for Payer: Cofinity Commercial |
$54.42
|
| Rate for Payer: Cofinity Commercial |
$50.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.68
|
| Rate for Payer: Nomi Health Commercial |
$45.35
|
| Rate for Payer: Nomi Health Commercial |
$45.35
|
| Rate for Payer: PACE SWMI |
$37.79
|
| Rate for Payer: PACE SWMI |
$37.79
|
| Rate for Payer: PHP Medicare Advantage |
$37.79
|
| Rate for Payer: PHP Medicare Advantage |
$37.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: Priority Health Medicare |
$38.17
|
| Rate for Payer: Priority Health Medicare |
$38.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.79
|
| Rate for Payer: UHC Exchange |
$37.79
|
| Rate for Payer: UHC Exchange |
$37.79
|
| Rate for Payer: UHC Medicare Advantage |
$37.79
|
| Rate for Payer: UHC Medicare Advantage |
$37.79
|
|
|
CHG ULTRASONIC GUIDANCE INTRAOPERATIVE
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS 76998
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$191.75 |
| Rate for Payer: Aetna Medicare |
$147.50
|
| Rate for Payer: BCBS Complete |
$118.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.75
|
|
|
CHG ULTRASOUND ELASTOGRAPHY PARENCHYMA
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 76981
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$137.56 |
| Rate for Payer: Aetna Commercial |
$128.01
|
| Rate for Payer: Aetna Medicare |
$99.35
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS MAPPO |
$95.53
|
| Rate for Payer: BCN Medicare Advantage |
$95.53
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$137.56
|
| Rate for Payer: Cofinity Commercial |
$128.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.31
|
| Rate for Payer: Nomi Health Commercial |
$114.64
|
| Rate for Payer: PACE SWMI |
$95.53
|
| Rate for Payer: PHP Medicare Advantage |
$95.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health Medicare |
$96.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$95.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.53
|
| Rate for Payer: UHC Exchange |
$95.53
|
| Rate for Payer: UHC Medicare Advantage |
$95.53
|
|
|
CHG ULTRASOUND SPINAL CANAL & CONTENTS
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 76800
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Aetna Commercial |
$220.87
|
| Rate for Payer: Aetna Medicare |
$171.42
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS MAPPO |
$164.83
|
| Rate for Payer: BCN Medicare Advantage |
$164.83
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$220.87
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.07
|
| Rate for Payer: Nomi Health Commercial |
$197.80
|
| Rate for Payer: PACE SWMI |
$164.83
|
| Rate for Payer: PHP Medicare Advantage |
$164.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$166.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$164.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.83
|
| Rate for Payer: UHC Exchange |
$164.83
|
| Rate for Payer: UHC Medicare Advantage |
$164.83
|
|
|
CHG UNLISTED FLUOROSCOPIC PROCEDURE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 76496
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
|
CHG URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 78740
|
| Min. Negotiated Rate |
$186.91 |
| Max. Negotiated Rate |
$315.25 |
| Rate for Payer: Aetna Commercial |
$250.46
|
| Rate for Payer: Aetna Medicare |
$194.39
|
| Rate for Payer: BCBS Complete |
$194.00
|
| Rate for Payer: BCBS MAPPO |
$186.91
|
| Rate for Payer: BCN Medicare Advantage |
$186.91
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$250.46
|
| Rate for Payer: Cofinity Commercial |
$269.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$186.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.26
|
| Rate for Payer: Nomi Health Commercial |
$224.29
|
| Rate for Payer: PACE SWMI |
$186.91
|
| Rate for Payer: PHP Medicare Advantage |
$186.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$315.25
|
| Rate for Payer: Priority Health Medicare |
$188.78
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$186.91
|
| Rate for Payer: UHC Exchange |
$186.91
|
| Rate for Payer: UHC Medicare Advantage |
$186.91
|
|
|
CHG URETHROCYSTOGRAPHY RETROGRADE RS&I
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 74450
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$72.80 |
| Rate for Payer: Aetna Medicare |
$56.00
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
|
|
CHG URETHROCYSTOGRAPHY VOIDING RS&I
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 74455
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$130.61 |
| Rate for Payer: Aetna Commercial |
$121.54
|
| Rate for Payer: Aetna Medicare |
$94.33
|
| Rate for Payer: BCBS Complete |
$13.20
|
| Rate for Payer: BCBS MAPPO |
$90.70
|
| Rate for Payer: BCN Medicare Advantage |
$90.70
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cofinity Commercial |
$121.54
|
| Rate for Payer: Cofinity Commercial |
$130.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$90.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$95.23
|
| Rate for Payer: Nomi Health Commercial |
$108.84
|
| Rate for Payer: PACE SWMI |
$90.70
|
| Rate for Payer: PHP Medicare Advantage |
$90.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.45
|
| Rate for Payer: Priority Health Medicare |
$91.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$90.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$90.70
|
| Rate for Payer: UHC Exchange |
$90.70
|
| Rate for Payer: UHC Medicare Advantage |
$90.70
|
|
|
CHG URINALYSIS MICROSCOPIC ONLY
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS 81015
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$4.55 |
| Rate for Payer: Aetna Commercial |
$4.09
|
| Rate for Payer: Aetna Medicare |
$3.17
|
| Rate for Payer: BCBS Complete |
$2.80
|
| Rate for Payer: BCBS MAPPO |
$3.05
|
| Rate for Payer: BCN Medicare Advantage |
$3.05
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cofinity Commercial |
$4.39
|
| Rate for Payer: Cofinity Commercial |
$4.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.20
|
| Rate for Payer: Nomi Health Commercial |
$3.66
|
| Rate for Payer: PACE SWMI |
$3.05
|
| Rate for Payer: PHP Medicare Advantage |
$3.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.55
|
| Rate for Payer: Priority Health Medicare |
$3.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.05
|
| Rate for Payer: UHC Exchange |
$3.05
|
| Rate for Payer: UHC Medicare Advantage |
$3.05
|
|
|
CHG URINALYSIS QUAL/SEMIQUANT EXCEPT IMMUNOASSAYS
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 81005
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Aetna Commercial |
$2.91
|
| Rate for Payer: Aetna Medicare |
$2.26
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$2.17
|
| Rate for Payer: BCN Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$3.12
|
| Rate for Payer: Cofinity Commercial |
$2.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.28
|
| Rate for Payer: Nomi Health Commercial |
$2.60
|
| Rate for Payer: PACE SWMI |
$2.17
|
| Rate for Payer: PHP Medicare Advantage |
$2.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$2.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.17
|
| Rate for Payer: UHC Exchange |
$2.17
|
| Rate for Payer: UHC Medicare Advantage |
$2.17
|
|
|
CHG URINARY BLADDER RESIDUAL STUDY
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
HCPCS 78730
|
| Min. Negotiated Rate |
$58.86 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Aetna Commercial |
$78.87
|
| Rate for Payer: Aetna Medicare |
$61.21
|
| Rate for Payer: BCBS Complete |
$95.20
|
| Rate for Payer: BCBS MAPPO |
$58.86
|
| Rate for Payer: BCN Medicare Advantage |
$58.86
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cash Price |
$190.40
|
| Rate for Payer: Cofinity Commercial |
$84.76
|
| Rate for Payer: Cofinity Commercial |
$78.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.80
|
| Rate for Payer: Nomi Health Commercial |
$70.63
|
| Rate for Payer: PACE SWMI |
$58.86
|
| Rate for Payer: PHP Medicare Advantage |
$58.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$154.70
|
| Rate for Payer: Priority Health Medicare |
$59.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.86
|
| Rate for Payer: UHC Exchange |
$58.86
|
| Rate for Payer: UHC Medicare Advantage |
$58.86
|
|
|
CHG URINE ALBUMIN SEMIQUANTITATIVE
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 82044
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Aetna Commercial |
$8.35
|
| Rate for Payer: Aetna Medicare |
$6.48
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$6.23
|
| Rate for Payer: BCN Medicare Advantage |
$6.23
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$8.97
|
| Rate for Payer: Cofinity Commercial |
$8.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.54
|
| Rate for Payer: Nomi Health Commercial |
$7.48
|
| Rate for Payer: PACE SWMI |
$6.23
|
| Rate for Payer: PHP Medicare Advantage |
$6.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$6.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.23
|
| Rate for Payer: UHC Exchange |
$6.23
|
| Rate for Payer: UHC Medicare Advantage |
$6.23
|
|
|
CHG URINE PREGNANCY TEST VISUAL COLOR CMPRSN METHS
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 81025
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Aetna Commercial |
$11.54
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$8.61
|
| Rate for Payer: BCN Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.04
|
| Rate for Payer: Nomi Health Commercial |
$10.33
|
| Rate for Payer: PACE SWMI |
$8.61
|
| Rate for Payer: PHP Medicare Advantage |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health Medicare |
$8.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.61
|
| Rate for Payer: UHC Exchange |
$8.61
|
| Rate for Payer: UHC Medicare Advantage |
$8.61
|
|
|
CHG URINLS DIP STICK/TABLET REAGNT NON-AUTO MICRSCPY
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS 81000
|
| Min. Negotiated Rate |
$4.02 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Aetna Commercial |
$5.39
|
| Rate for Payer: Aetna Medicare |
$4.18
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$4.02
|
| Rate for Payer: BCN Medicare Advantage |
$4.02
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$5.79
|
| Rate for Payer: Cofinity Commercial |
$5.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.22
|
| Rate for Payer: Nomi Health Commercial |
$4.82
|
| Rate for Payer: PACE SWMI |
$4.02
|
| Rate for Payer: PHP Medicare Advantage |
$4.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health Medicare |
$4.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.02
|
| Rate for Payer: UHC Exchange |
$4.02
|
| Rate for Payer: UHC Medicare Advantage |
$4.02
|
|
|
CHG URNLS DIP STICK/TABLET REAGENT AUTO MICROSCOPY
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 81001
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Commercial |
$4.25
|
| Rate for Payer: Aetna Medicare |
$3.30
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$3.17
|
| Rate for Payer: BCN Medicare Advantage |
$3.17
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$4.56
|
| Rate for Payer: Cofinity Commercial |
$4.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.33
|
| Rate for Payer: Nomi Health Commercial |
$3.80
|
| Rate for Payer: PACE SWMI |
$3.17
|
| Rate for Payer: PHP Medicare Advantage |
$3.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Medicare |
$3.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.17
|
| Rate for Payer: UHC Exchange |
$3.17
|
| Rate for Payer: UHC Medicare Advantage |
$3.17
|
|
|
CHG URNLS DIP STICK/TABLET RGNT AUTO W/O MICROSCOPY
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 81003
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Aetna Commercial |
$3.02
|
| Rate for Payer: Aetna Medicare |
$2.34
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$2.25
|
| Rate for Payer: BCN Medicare Advantage |
$2.25
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$3.24
|
| Rate for Payer: Cofinity Commercial |
$3.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2.36
|
| Rate for Payer: Nomi Health Commercial |
$2.70
|
| Rate for Payer: PACE SWMI |
$2.25
|
| Rate for Payer: PHP Medicare Advantage |
$2.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$2.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$2.25
|
| Rate for Payer: UHC Exchange |
$2.25
|
| Rate for Payer: UHC Medicare Advantage |
$2.25
|
|
|
CHG URNLS DIP STICK/TABLET RGNT NON-AUTO W/O MICRSCP
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 81002
|
| Min. Negotiated Rate |
$3.48 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna Commercial |
$4.66
|
| Rate for Payer: Aetna Medicare |
$3.62
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$3.48
|
| Rate for Payer: BCN Medicare Advantage |
$3.48
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$5.01
|
| Rate for Payer: Cofinity Commercial |
$4.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.65
|
| Rate for Payer: Nomi Health Commercial |
$4.18
|
| Rate for Payer: PACE SWMI |
$3.48
|
| Rate for Payer: PHP Medicare Advantage |
$3.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health Medicare |
$3.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.48
|
| Rate for Payer: UHC Exchange |
$3.48
|
| Rate for Payer: UHC Medicare Advantage |
$3.48
|
|
|
CHG UROGRAPHY IV W/WO KUB W/WO TOMOGRAPHY
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS 74400
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$170.99 |
| Rate for Payer: Aetna Commercial |
$159.11
|
| Rate for Payer: Aetna Commercial |
$159.11
|
| Rate for Payer: Aetna Medicare |
$123.49
|
| Rate for Payer: Aetna Medicare |
$123.49
|
| Rate for Payer: BCBS Complete |
$85.20
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCBS MAPPO |
$118.74
|
| Rate for Payer: BCBS MAPPO |
$118.74
|
| Rate for Payer: BCN Medicare Advantage |
$118.74
|
| Rate for Payer: BCN Medicare Advantage |
$118.74
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cofinity Commercial |
$170.99
|
| Rate for Payer: Cofinity Commercial |
$170.99
|
| Rate for Payer: Cofinity Commercial |
$159.11
|
| Rate for Payer: Cofinity Commercial |
$159.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.68
|
| Rate for Payer: Nomi Health Commercial |
$142.49
|
| Rate for Payer: Nomi Health Commercial |
$142.49
|
| Rate for Payer: PACE SWMI |
$118.74
|
| Rate for Payer: PACE SWMI |
$118.74
|
| Rate for Payer: PHP Medicare Advantage |
$118.74
|
| Rate for Payer: PHP Medicare Advantage |
$118.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$91.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.45
|
| Rate for Payer: Priority Health Medicare |
$119.93
|
| Rate for Payer: Priority Health Medicare |
$119.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.74
|
| Rate for Payer: UHC Exchange |
$118.74
|
| Rate for Payer: UHC Exchange |
$118.74
|
| Rate for Payer: UHC Medicare Advantage |
$118.74
|
| Rate for Payer: UHC Medicare Advantage |
$118.74
|
|
|
CHG UROGRAPHY RETROGRADE WITH/WO KUB
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 74420
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$101.82 |
| Rate for Payer: Aetna Commercial |
$94.75
|
| Rate for Payer: Aetna Medicare |
$73.54
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS MAPPO |
$70.71
|
| Rate for Payer: BCN Medicare Advantage |
$70.71
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$94.75
|
| Rate for Payer: Cofinity Commercial |
$101.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.25
|
| Rate for Payer: Nomi Health Commercial |
$84.85
|
| Rate for Payer: PACE SWMI |
$70.71
|
| Rate for Payer: PHP Medicare Advantage |
$70.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health Medicare |
$71.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$70.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.71
|
| Rate for Payer: UHC Exchange |
$70.71
|
| Rate for Payer: UHC Medicare Advantage |
$70.71
|
|
|
CHG US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 76706
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$138.56 |
| Rate for Payer: Aetna Commercial |
$128.93
|
| Rate for Payer: Aetna Medicare |
$100.07
|
| Rate for Payer: BCBS Complete |
$22.80
|
| Rate for Payer: BCBS MAPPO |
$96.22
|
| Rate for Payer: BCN Medicare Advantage |
$96.22
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cofinity Commercial |
$138.56
|
| Rate for Payer: Cofinity Commercial |
$128.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$101.03
|
| Rate for Payer: Nomi Health Commercial |
$115.46
|
| Rate for Payer: PACE SWMI |
$96.22
|
| Rate for Payer: PHP Medicare Advantage |
$96.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health Medicare |
$97.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.22
|
| Rate for Payer: UHC Exchange |
$96.22
|
| Rate for Payer: UHC Medicare Advantage |
$96.22
|
|
|
CHG US ABDOMINAL REAL TIME W/IMAGE DOCUMENTATION
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS 76700
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$150.91 |
| Rate for Payer: Aetna Commercial |
$140.43
|
| Rate for Payer: Aetna Medicare |
$108.99
|
| Rate for Payer: BCBS Complete |
$85.20
|
| Rate for Payer: BCBS MAPPO |
$104.80
|
| Rate for Payer: BCN Medicare Advantage |
$104.80
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cofinity Commercial |
$150.91
|
| Rate for Payer: Cofinity Commercial |
$140.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.04
|
| Rate for Payer: Nomi Health Commercial |
$125.76
|
| Rate for Payer: PACE SWMI |
$104.80
|
| Rate for Payer: PHP Medicare Advantage |
$104.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.45
|
| Rate for Payer: Priority Health Medicare |
$105.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.80
|
| Rate for Payer: UHC Exchange |
$104.80
|
| Rate for Payer: UHC Medicare Advantage |
$104.80
|
|
