|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$324.30
|
|
|
Service Code
|
NDC 67877021901
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.02 |
| Max. Negotiated Rate |
$291.87 |
| Rate for Payer: Aetna Commercial |
$275.66
|
| Rate for Payer: Aetna Medicare |
$84.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$101.34
|
| Rate for Payer: Amish Plain Church Group Commercial |
$101.34
|
| Rate for Payer: BCBS Complete |
$129.72
|
| Rate for Payer: BCBS MAPPO |
$81.08
|
| Rate for Payer: BCBS Trust/PPO |
$266.61
|
| Rate for Payer: BCN Commercial |
$252.14
|
| Rate for Payer: BCN Medicare Advantage |
$81.08
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.08
|
| Rate for Payer: Healthscope Commercial |
$291.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$93.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.66
|
| Rate for Payer: Nomi Health Commercial |
$265.93
|
| Rate for Payer: PACE Senior Care Partners |
$77.02
|
| Rate for Payer: PACE SWMI |
$81.08
|
| Rate for Payer: PHP Commercial |
$275.66
|
| Rate for Payer: PHP Medicare Advantage |
$81.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.80
|
| Rate for Payer: Priority Health HMO/PPO |
$282.14
|
| Rate for Payer: Priority Health Medicare |
$81.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.28
|
| Rate for Payer: Railroad Medicare Medicare |
$81.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.38
|
| Rate for Payer: UHC Core |
$270.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.08
|
| Rate for Payer: UHC Exchange |
$81.08
|
| Rate for Payer: UHC Medicare Advantage |
$81.08
|
| Rate for Payer: VA VA |
$81.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.22
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$324.30
|
|
|
Service Code
|
NDC 67877021901
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.80 |
| Max. Negotiated Rate |
$291.87 |
| Rate for Payer: Aetna Commercial |
$275.66
|
| Rate for Payer: BCBS Trust/PPO |
$264.73
|
| Rate for Payer: BCN Commercial |
$250.62
|
| Rate for Payer: Cash Price |
$259.44
|
| Rate for Payer: Cofinity Commercial |
$278.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.44
|
| Rate for Payer: Healthscope Commercial |
$291.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$275.66
|
| Rate for Payer: Nomi Health Commercial |
$265.93
|
| Rate for Payer: PHP Commercial |
$275.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.80
|
| Rate for Payer: Priority Health HMO/PPO |
$282.14
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$217.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$285.38
|
| Rate for Payer: UHC Core |
$270.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.22
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$192.85
|
|
|
Service Code
|
NDC 00093314701
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$125.35 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: BCBS Trust/PPO |
$157.42
|
| Rate for Payer: BCN Commercial |
$149.03
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Nomi Health Commercial |
$158.14
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health HMO/PPO |
$167.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Core |
$161.03
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$3.16
|
|
|
Service Code
|
NDC 60687016311
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.75 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: Aetna Medicare |
$0.82
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$0.99
|
| Rate for Payer: Amish Plain Church Group Commercial |
$0.99
|
| Rate for Payer: BCBS Complete |
$1.26
|
| Rate for Payer: BCBS MAPPO |
$0.79
|
| Rate for Payer: BCBS Trust/PPO |
$2.60
|
| Rate for Payer: BCN Commercial |
$2.46
|
| Rate for Payer: BCN Medicare Advantage |
$0.79
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.79
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.83
|
| Rate for Payer: MI Amish Medical Board Commercial |
$0.91
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.69
|
| Rate for Payer: Nomi Health Commercial |
$2.59
|
| Rate for Payer: PACE Senior Care Partners |
$0.75
|
| Rate for Payer: PACE SWMI |
$0.79
|
| Rate for Payer: PHP Commercial |
$2.69
|
| Rate for Payer: PHP Medicare Advantage |
$0.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.05
|
| Rate for Payer: Priority Health HMO/PPO |
$2.75
|
| Rate for Payer: Priority Health Medicare |
$0.80
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.12
|
| Rate for Payer: Railroad Medicare Medicare |
$0.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.78
|
| Rate for Payer: UHC Core |
$2.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$0.79
|
| Rate for Payer: UHC Exchange |
$0.79
|
| Rate for Payer: UHC Medicare Advantage |
$0.79
|
| Rate for Payer: VA VA |
$0.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.37
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$128.25
|
|
|
Service Code
|
NDC 50268015215
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: Aetna Medicare |
$33.34
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$40.08
|
| Rate for Payer: Amish Plain Church Group Commercial |
$40.08
|
| Rate for Payer: BCBS Complete |
$51.30
|
| Rate for Payer: BCBS MAPPO |
$32.06
|
| Rate for Payer: BCBS Trust/PPO |
$105.43
|
| Rate for Payer: BCN Commercial |
$99.71
|
| Rate for Payer: BCN Medicare Advantage |
$32.06
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$32.06
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$36.87
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.01
|
| Rate for Payer: Nomi Health Commercial |
$105.16
|
| Rate for Payer: PACE Senior Care Partners |
$30.46
|
| Rate for Payer: PACE SWMI |
$32.06
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: PHP Medicare Advantage |
$32.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.36
|
| Rate for Payer: Priority Health HMO/PPO |
$111.58
|
| Rate for Payer: Priority Health Medicare |
$32.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.93
|
| Rate for Payer: Railroad Medicare Medicare |
$32.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.86
|
| Rate for Payer: UHC Core |
$107.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$32.06
|
| Rate for Payer: UHC Exchange |
$32.06
|
| Rate for Payer: UHC Medicare Advantage |
$32.06
|
| Rate for Payer: VA VA |
$32.06
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.19
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$192.85
|
|
|
Service Code
|
NDC 00093314701
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$173.56 |
| Rate for Payer: Aetna Commercial |
$163.92
|
| Rate for Payer: Aetna Medicare |
$50.14
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$60.27
|
| Rate for Payer: Amish Plain Church Group Commercial |
$60.27
|
| Rate for Payer: BCBS Complete |
$77.14
|
| Rate for Payer: BCBS MAPPO |
$48.21
|
| Rate for Payer: BCBS Trust/PPO |
$158.54
|
| Rate for Payer: BCN Commercial |
$149.94
|
| Rate for Payer: BCN Medicare Advantage |
$48.21
|
| Rate for Payer: Cash Price |
$154.28
|
| Rate for Payer: Cofinity Commercial |
$165.85
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$154.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.21
|
| Rate for Payer: Healthscope Commercial |
$173.56
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$144.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$55.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$163.92
|
| Rate for Payer: Nomi Health Commercial |
$158.14
|
| Rate for Payer: PACE Senior Care Partners |
$45.80
|
| Rate for Payer: PACE SWMI |
$48.21
|
| Rate for Payer: PHP Commercial |
$163.92
|
| Rate for Payer: PHP Medicare Advantage |
$48.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$125.35
|
| Rate for Payer: Priority Health HMO/PPO |
$167.78
|
| Rate for Payer: Priority Health Medicare |
$48.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$129.21
|
| Rate for Payer: Railroad Medicare Medicare |
$48.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.71
|
| Rate for Payer: UHC Core |
$161.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.21
|
| Rate for Payer: UHC Exchange |
$48.21
|
| Rate for Payer: UHC Medicare Advantage |
$48.21
|
| Rate for Payer: VA VA |
$48.21
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$144.64
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$2.57
|
|
|
Service Code
|
NDC 50268015211
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.67 |
| Max. Negotiated Rate |
$2.31 |
| Rate for Payer: Aetna Commercial |
$2.18
|
| Rate for Payer: BCBS Trust/PPO |
$2.10
|
| Rate for Payer: BCN Commercial |
$1.99
|
| Rate for Payer: Cash Price |
$2.06
|
| Rate for Payer: Cofinity Commercial |
$2.21
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.06
|
| Rate for Payer: Healthscope Commercial |
$2.31
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.18
|
| Rate for Payer: Nomi Health Commercial |
$2.11
|
| Rate for Payer: PHP Commercial |
$2.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.67
|
| Rate for Payer: Priority Health HMO/PPO |
$2.24
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$1.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.26
|
| Rate for Payer: UHC Core |
$2.15
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.93
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$128.25
|
|
|
Service Code
|
NDC 50268015215
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$83.36 |
| Max. Negotiated Rate |
$115.42 |
| Rate for Payer: Aetna Commercial |
$109.01
|
| Rate for Payer: BCBS Trust/PPO |
$104.69
|
| Rate for Payer: BCN Commercial |
$99.11
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cofinity Commercial |
$110.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$102.60
|
| Rate for Payer: Healthscope Commercial |
$115.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$96.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.01
|
| Rate for Payer: Nomi Health Commercial |
$105.16
|
| Rate for Payer: PHP Commercial |
$109.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.36
|
| Rate for Payer: Priority Health HMO/PPO |
$111.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$112.86
|
| Rate for Payer: UHC Core |
$107.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$96.19
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
OP
|
$315.40
|
|
|
Service Code
|
NDC 60687016301
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$283.86 |
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: Aetna Medicare |
$82.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$98.56
|
| Rate for Payer: Amish Plain Church Group Commercial |
$98.56
|
| Rate for Payer: BCBS Complete |
$126.16
|
| Rate for Payer: BCBS MAPPO |
$78.85
|
| Rate for Payer: BCBS Trust/PPO |
$259.29
|
| Rate for Payer: BCN Commercial |
$245.22
|
| Rate for Payer: BCN Medicare Advantage |
$78.85
|
| Rate for Payer: Cash Price |
$252.32
|
| Rate for Payer: Cofinity Commercial |
$271.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.85
|
| Rate for Payer: Healthscope Commercial |
$283.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.79
|
| Rate for Payer: MI Amish Medical Board Commercial |
$90.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.09
|
| Rate for Payer: Nomi Health Commercial |
$258.63
|
| Rate for Payer: PACE Senior Care Partners |
$74.91
|
| Rate for Payer: PACE SWMI |
$78.85
|
| Rate for Payer: PHP Commercial |
$268.09
|
| Rate for Payer: PHP Medicare Advantage |
$78.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.01
|
| Rate for Payer: Priority Health HMO/PPO |
$274.40
|
| Rate for Payer: Priority Health Medicare |
$79.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.32
|
| Rate for Payer: Railroad Medicare Medicare |
$78.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.55
|
| Rate for Payer: UHC Core |
$263.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.85
|
| Rate for Payer: UHC Exchange |
$78.85
|
| Rate for Payer: UHC Medicare Advantage |
$78.85
|
| Rate for Payer: VA VA |
$78.85
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.55
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$3.16
|
|
|
Service Code
|
NDC 60687016311
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.05 |
| Max. Negotiated Rate |
$2.84 |
| Rate for Payer: Aetna Commercial |
$2.69
|
| Rate for Payer: BCBS Trust/PPO |
$2.58
|
| Rate for Payer: BCN Commercial |
$2.44
|
| Rate for Payer: Cash Price |
$2.53
|
| Rate for Payer: Cofinity Commercial |
$2.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.53
|
| Rate for Payer: Healthscope Commercial |
$2.84
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$2.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.69
|
| Rate for Payer: Nomi Health Commercial |
$2.59
|
| Rate for Payer: PHP Commercial |
$2.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.05
|
| Rate for Payer: Priority Health HMO/PPO |
$2.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$2.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2.78
|
| Rate for Payer: UHC Core |
$2.64
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$2.37
|
|
|
CEPHALEXIN 500 MG CAPSULE
|
Facility
|
IP
|
$315.40
|
|
|
Service Code
|
NDC 60687016301
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$205.01 |
| Max. Negotiated Rate |
$283.86 |
| Rate for Payer: Aetna Commercial |
$268.09
|
| Rate for Payer: BCBS Trust/PPO |
$257.46
|
| Rate for Payer: BCN Commercial |
$243.74
|
| Rate for Payer: Cash Price |
$252.32
|
| Rate for Payer: Cofinity Commercial |
$271.24
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$252.32
|
| Rate for Payer: Healthscope Commercial |
$283.86
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$236.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$268.09
|
| Rate for Payer: Nomi Health Commercial |
$258.63
|
| Rate for Payer: PHP Commercial |
$268.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$205.01
|
| Rate for Payer: Priority Health HMO/PPO |
$274.40
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$211.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$277.55
|
| Rate for Payer: UHC Core |
$263.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$236.55
|
|
|
CHEMICAL PEELS
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 00172
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.05 |
| Rate for Payer: Aetna Medicare |
$38.50
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
|
|
CHG 3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS
|
Professional
|
Both
|
$1,373.00
|
|
|
Service Code
|
HCPCS 77295
|
| Min. Negotiated Rate |
$145.05 |
| Max. Negotiated Rate |
$892.45 |
| Rate for Payer: Aetna Commercial |
$595.39
|
| Rate for Payer: Aetna Commercial |
$595.39
|
| Rate for Payer: Aetna Medicare |
$462.09
|
| Rate for Payer: Aetna Medicare |
$462.09
|
| Rate for Payer: BCBS Complete |
$152.30
|
| Rate for Payer: BCBS Complete |
$152.30
|
| Rate for Payer: BCBS MAPPO |
$444.32
|
| Rate for Payer: BCBS MAPPO |
$444.32
|
| Rate for Payer: BCBS Trust/PPO |
$192.72
|
| Rate for Payer: BCBS Trust/PPO |
$192.72
|
| Rate for Payer: BCN Commercial |
$699.98
|
| Rate for Payer: BCN Commercial |
$699.98
|
| Rate for Payer: BCN Medicare Advantage |
$444.32
|
| Rate for Payer: BCN Medicare Advantage |
$444.32
|
| Rate for Payer: Cash Price |
$1,398.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cash Price |
$1,398.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cofinity Commercial |
$639.82
|
| Rate for Payer: Cofinity Commercial |
$639.82
|
| Rate for Payer: Cofinity Commercial |
$595.39
|
| Rate for Payer: Cofinity Commercial |
$595.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$444.32
|
| Rate for Payer: Mclaren Medicaid |
$145.05
|
| Rate for Payer: Mclaren Medicaid |
$145.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.54
|
| Rate for Payer: Meridian Medicaid |
$152.30
|
| Rate for Payer: Meridian Medicaid |
$152.30
|
| Rate for Payer: Nomi Health Commercial |
$533.18
|
| Rate for Payer: Nomi Health Commercial |
$533.18
|
| Rate for Payer: PACE SWMI |
$444.32
|
| Rate for Payer: PACE SWMI |
$444.32
|
| Rate for Payer: PHP Medicare Advantage |
$444.32
|
| Rate for Payer: PHP Medicare Advantage |
$444.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.05
|
| Rate for Payer: Priority Health Choice Medicaid |
$145.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$892.45
|
| Rate for Payer: Priority Health HMO/PPO |
$343.89
|
| Rate for Payer: Priority Health HMO/PPO |
$343.89
|
| Rate for Payer: Priority Health Medicare |
$448.76
|
| Rate for Payer: Priority Health Medicare |
$448.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$343.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$343.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$444.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$444.32
|
| Rate for Payer: UHC Exchange |
$444.32
|
| Rate for Payer: UHC Exchange |
$444.32
|
| Rate for Payer: UHC Medicare Advantage |
$444.32
|
| Rate for Payer: UHC Medicare Advantage |
$444.32
|
| Rate for Payer: UHCCP Medicaid |
$145.05
|
| Rate for Payer: UHCCP Medicaid |
$145.05
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 76377
|
| Min. Negotiated Rate |
$23.86 |
| Max. Negotiated Rate |
$904.45 |
| Rate for Payer: Aetna Commercial |
$97.71
|
| Rate for Payer: Aetna Medicare |
$75.84
|
| Rate for Payer: BCBS Complete |
$25.05
|
| Rate for Payer: BCBS MAPPO |
$72.92
|
| Rate for Payer: BCBS Trust/PPO |
$904.45
|
| Rate for Payer: BCN Commercial |
$110.93
|
| Rate for Payer: BCN Medicare Advantage |
$72.92
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cash Price |
$109.60
|
| Rate for Payer: Cofinity Commercial |
$97.71
|
| Rate for Payer: Cofinity Commercial |
$105.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.92
|
| Rate for Payer: Mclaren Medicaid |
$23.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.57
|
| Rate for Payer: Meridian Medicaid |
$25.05
|
| Rate for Payer: Nomi Health Commercial |
$87.50
|
| Rate for Payer: PACE SWMI |
$72.92
|
| Rate for Payer: PHP Medicare Advantage |
$72.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health HMO/PPO |
$57.48
|
| Rate for Payer: Priority Health Medicare |
$73.65
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$57.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.92
|
| Rate for Payer: UHC Exchange |
$72.92
|
| Rate for Payer: UHC Medicare Advantage |
$72.92
|
| Rate for Payer: UHCCP Medicaid |
$23.86
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 76376
|
| Min. Negotiated Rate |
$5.96 |
| Max. Negotiated Rate |
$1,774.03 |
| Rate for Payer: Aetna Commercial |
$31.41
|
| Rate for Payer: Aetna Commercial |
$31.41
|
| Rate for Payer: Aetna Medicare |
$24.38
|
| Rate for Payer: Aetna Medicare |
$24.38
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: BCBS Complete |
$6.26
|
| Rate for Payer: BCBS MAPPO |
$23.44
|
| Rate for Payer: BCBS MAPPO |
$23.44
|
| Rate for Payer: BCBS Trust/PPO |
$1,774.03
|
| Rate for Payer: BCBS Trust/PPO |
$1,774.03
|
| Rate for Payer: BCN Commercial |
$35.19
|
| Rate for Payer: BCN Commercial |
$35.19
|
| Rate for Payer: BCN Medicare Advantage |
$23.44
|
| Rate for Payer: BCN Medicare Advantage |
$23.44
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$33.75
|
| Rate for Payer: Cofinity Commercial |
$31.41
|
| Rate for Payer: Cofinity Commercial |
$33.75
|
| Rate for Payer: Cofinity Commercial |
$31.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.44
|
| Rate for Payer: Mclaren Medicaid |
$5.96
|
| Rate for Payer: Mclaren Medicaid |
$5.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.61
|
| Rate for Payer: Meridian Medicaid |
$6.26
|
| Rate for Payer: Meridian Medicaid |
$6.26
|
| Rate for Payer: Nomi Health Commercial |
$28.13
|
| Rate for Payer: Nomi Health Commercial |
$28.13
|
| Rate for Payer: PACE SWMI |
$23.44
|
| Rate for Payer: PACE SWMI |
$23.44
|
| Rate for Payer: PHP Medicare Advantage |
$23.44
|
| Rate for Payer: PHP Medicare Advantage |
$23.44
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$5.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health HMO/PPO |
$14.37
|
| Rate for Payer: Priority Health HMO/PPO |
$14.37
|
| Rate for Payer: Priority Health Medicare |
$23.67
|
| Rate for Payer: Priority Health Medicare |
$23.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$14.37
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.44
|
| Rate for Payer: UHC Exchange |
$23.44
|
| Rate for Payer: UHC Exchange |
$23.44
|
| Rate for Payer: UHC Medicare Advantage |
$23.44
|
| Rate for Payer: UHC Medicare Advantage |
$23.44
|
| Rate for Payer: UHCCP Medicaid |
$5.96
|
| Rate for Payer: UHCCP Medicaid |
$5.96
|
|
|
CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 78278
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$674.64 |
| Rate for Payer: Aetna Commercial |
$374.82
|
| Rate for Payer: Aetna Medicare |
$290.91
|
| Rate for Payer: BCBS Complete |
$30.64
|
| Rate for Payer: BCBS MAPPO |
$279.72
|
| Rate for Payer: BCBS Trust/PPO |
$674.64
|
| Rate for Payer: BCN Commercial |
$475.00
|
| Rate for Payer: BCN Medicare Advantage |
$279.72
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$402.80
|
| Rate for Payer: Cofinity Commercial |
$374.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.72
|
| Rate for Payer: Mclaren Medicaid |
$29.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.71
|
| Rate for Payer: Meridian Medicaid |
$30.64
|
| Rate for Payer: Nomi Health Commercial |
$335.66
|
| Rate for Payer: PACE SWMI |
$279.72
|
| Rate for Payer: PHP Medicare Advantage |
$279.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health HMO/PPO |
$70.31
|
| Rate for Payer: Priority Health Medicare |
$282.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$279.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.72
|
| Rate for Payer: UHC Exchange |
$279.72
|
| Rate for Payer: UHC Medicare Advantage |
$279.72
|
| Rate for Payer: UHCCP Medicaid |
$29.18
|
|
|
CHG ANGIO ARCH ANGIOGRAM W CATH
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 75650
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$173.55 |
| Rate for Payer: Aetna Medicare |
$133.50
|
| Rate for Payer: BCBS Complete |
$106.80
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.55
|
|
|
CHG ANGIO AV SHUNT COMPLETE EVAL
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 75791
|
| Min. Negotiated Rate |
$123.20 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Medicare |
$154.00
|
| Rate for Payer: Aetna Medicare |
$253.50
|
| Rate for Payer: BCBS Complete |
$202.80
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$405.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$329.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
|
|
CHG ANGIOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$198.00
|
|
|
Service Code
|
HCPCS 75716
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$237.49 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Aetna Medicare |
$157.18
|
| Rate for Payer: BCBS Complete |
$61.06
|
| Rate for Payer: BCBS MAPPO |
$151.13
|
| Rate for Payer: BCBS Trust/PPO |
$112.00
|
| Rate for Payer: BCN Commercial |
$237.49
|
| Rate for Payer: BCN Medicare Advantage |
$151.13
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$202.51
|
| Rate for Payer: Cofinity Commercial |
$217.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.13
|
| Rate for Payer: Mclaren Medicaid |
$58.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.69
|
| Rate for Payer: Meridian Medicaid |
$61.06
|
| Rate for Payer: Nomi Health Commercial |
$181.36
|
| Rate for Payer: PACE SWMI |
$151.13
|
| Rate for Payer: PHP Medicare Advantage |
$151.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$128.70
|
| Rate for Payer: Priority Health HMO/PPO |
$139.60
|
| Rate for Payer: Priority Health Medicare |
$152.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$151.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$151.13
|
| Rate for Payer: UHC Exchange |
$151.13
|
| Rate for Payer: UHC Medicare Advantage |
$151.13
|
| Rate for Payer: UHCCP Medicaid |
$58.15
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 75710
|
| Min. Negotiated Rate |
$51.55 |
| Max. Negotiated Rate |
$279.50 |
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Aetna Commercial |
$184.80
|
| Rate for Payer: Aetna Medicare |
$143.43
|
| Rate for Payer: Aetna Medicare |
$143.43
|
| Rate for Payer: BCBS Complete |
$54.13
|
| Rate for Payer: BCBS Complete |
$54.13
|
| Rate for Payer: BCBS MAPPO |
$137.91
|
| Rate for Payer: BCBS MAPPO |
$137.91
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: BCBS Trust/PPO |
$183.32
|
| Rate for Payer: BCN Commercial |
$219.91
|
| Rate for Payer: BCN Commercial |
$219.91
|
| Rate for Payer: BCN Medicare Advantage |
$137.91
|
| Rate for Payer: BCN Medicare Advantage |
$137.91
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Commercial |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$198.59
|
| Rate for Payer: Cofinity Commercial |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$198.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.91
|
| Rate for Payer: Mclaren Medicaid |
$51.55
|
| Rate for Payer: Mclaren Medicaid |
$51.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.81
|
| Rate for Payer: Meridian Medicaid |
$54.13
|
| Rate for Payer: Meridian Medicaid |
$54.13
|
| Rate for Payer: Nomi Health Commercial |
$165.49
|
| Rate for Payer: Nomi Health Commercial |
$165.49
|
| Rate for Payer: PACE SWMI |
$137.91
|
| Rate for Payer: PACE SWMI |
$137.91
|
| Rate for Payer: PHP Medicare Advantage |
$137.91
|
| Rate for Payer: PHP Medicare Advantage |
$137.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.50
|
| Rate for Payer: Priority Health HMO/PPO |
$124.72
|
| Rate for Payer: Priority Health HMO/PPO |
$124.72
|
| Rate for Payer: Priority Health Medicare |
$139.29
|
| Rate for Payer: Priority Health Medicare |
$139.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.72
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$124.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.91
|
| Rate for Payer: UHC Exchange |
$137.91
|
| Rate for Payer: UHC Exchange |
$137.91
|
| Rate for Payer: UHC Medicare Advantage |
$137.91
|
| Rate for Payer: UHC Medicare Advantage |
$137.91
|
| Rate for Payer: UHCCP Medicaid |
$51.55
|
| Rate for Payer: UHCCP Medicaid |
$51.55
|
|
|
CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 75756
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$236.52 |
| Rate for Payer: Aetna Commercial |
$198.40
|
| Rate for Payer: Aetna Medicare |
$153.98
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS MAPPO |
$148.06
|
| Rate for Payer: BCBS Trust/PPO |
$177.51
|
| Rate for Payer: BCN Commercial |
$236.52
|
| Rate for Payer: BCN Medicare Advantage |
$148.06
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$213.21
|
| Rate for Payer: Cofinity Commercial |
$198.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.06
|
| Rate for Payer: Mclaren Medicaid |
$34.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.46
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Nomi Health Commercial |
$177.67
|
| Rate for Payer: PACE SWMI |
$148.06
|
| Rate for Payer: PHP Medicare Advantage |
$148.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.50
|
| Rate for Payer: Priority Health HMO/PPO |
$82.63
|
| Rate for Payer: Priority Health Medicare |
$149.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$82.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$148.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.06
|
| Rate for Payer: UHC Exchange |
$148.06
|
| Rate for Payer: UHC Medicare Advantage |
$148.06
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
|
|
CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 75736
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$209.15 |
| Rate for Payer: Aetna Commercial |
$176.63
|
| Rate for Payer: Aetna Medicare |
$137.08
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS MAPPO |
$131.81
|
| Rate for Payer: BCBS Trust/PPO |
$182.79
|
| Rate for Payer: BCN Commercial |
$209.15
|
| Rate for Payer: BCN Medicare Advantage |
$131.81
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cash Price |
$255.20
|
| Rate for Payer: Cofinity Commercial |
$189.81
|
| Rate for Payer: Cofinity Commercial |
$176.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$131.81
|
| Rate for Payer: Mclaren Medicaid |
$32.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.40
|
| Rate for Payer: Meridian Medicaid |
$34.22
|
| Rate for Payer: Nomi Health Commercial |
$158.17
|
| Rate for Payer: PACE SWMI |
$131.81
|
| Rate for Payer: PHP Medicare Advantage |
$131.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$207.35
|
| Rate for Payer: Priority Health HMO/PPO |
$78.53
|
| Rate for Payer: Priority Health Medicare |
$133.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$78.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$131.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$131.81
|
| Rate for Payer: UHC Exchange |
$131.81
|
| Rate for Payer: UHC Medicare Advantage |
$131.81
|
| Rate for Payer: UHCCP Medicaid |
$32.59
|
|
|
CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 75741
|
| Min. Negotiated Rate |
$37.70 |
| Max. Negotiated Rate |
$191.56 |
| Rate for Payer: Aetna Commercial |
$159.00
|
| Rate for Payer: Aetna Medicare |
$123.41
|
| Rate for Payer: BCBS Complete |
$39.58
|
| Rate for Payer: BCBS MAPPO |
$118.66
|
| Rate for Payer: BCBS Trust/PPO |
$104.08
|
| Rate for Payer: BCN Commercial |
$191.56
|
| Rate for Payer: BCN Medicare Advantage |
$118.66
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$170.87
|
| Rate for Payer: Cofinity Commercial |
$159.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.66
|
| Rate for Payer: Mclaren Medicaid |
$37.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.59
|
| Rate for Payer: Meridian Medicaid |
$39.58
|
| Rate for Payer: Nomi Health Commercial |
$142.39
|
| Rate for Payer: PACE SWMI |
$118.66
|
| Rate for Payer: PHP Medicare Advantage |
$118.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO |
$90.85
|
| Rate for Payer: Priority Health Medicare |
$119.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$90.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.66
|
| Rate for Payer: UHC Exchange |
$118.66
|
| Rate for Payer: UHC Medicare Advantage |
$118.66
|
| Rate for Payer: UHCCP Medicaid |
$37.70
|
|
|
CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 75705
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$363.58 |
| Rate for Payer: Aetna Commercial |
$318.13
|
| Rate for Payer: Aetna Medicare |
$246.91
|
| Rate for Payer: BCBS Complete |
$78.50
|
| Rate for Payer: BCBS MAPPO |
$237.41
|
| Rate for Payer: BCBS Trust/PPO |
$162.19
|
| Rate for Payer: BCN Commercial |
$363.58
|
| Rate for Payer: BCN Medicare Advantage |
$237.41
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cofinity Commercial |
$341.87
|
| Rate for Payer: Cofinity Commercial |
$318.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.41
|
| Rate for Payer: Mclaren Medicaid |
$74.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.28
|
| Rate for Payer: Meridian Medicaid |
$78.50
|
| Rate for Payer: Nomi Health Commercial |
$284.89
|
| Rate for Payer: PACE SWMI |
$237.41
|
| Rate for Payer: PHP Medicare Advantage |
$237.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$74.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$283.40
|
| Rate for Payer: Priority Health HMO/PPO |
$176.56
|
| Rate for Payer: Priority Health Medicare |
$239.78
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$176.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$237.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.41
|
| Rate for Payer: UHC Exchange |
$237.41
|
| Rate for Payer: UHC Medicare Advantage |
$237.41
|
| Rate for Payer: UHCCP Medicaid |
$74.76
|
|
|
CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 75726
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$250.69 |
| Rate for Payer: Aetna Commercial |
$212.12
|
| Rate for Payer: Aetna Medicare |
$164.63
|
| Rate for Payer: BCBS Complete |
$62.62
|
| Rate for Payer: BCBS MAPPO |
$158.30
|
| Rate for Payer: BCBS Trust/PPO |
$145.81
|
| Rate for Payer: BCN Commercial |
$250.69
|
| Rate for Payer: BCN Medicare Advantage |
$158.30
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$227.95
|
| Rate for Payer: Cofinity Commercial |
$212.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$158.30
|
| Rate for Payer: Mclaren Medicaid |
$59.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$166.22
|
| Rate for Payer: Meridian Medicaid |
$62.62
|
| Rate for Payer: Nomi Health Commercial |
$189.96
|
| Rate for Payer: PACE SWMI |
$158.30
|
| Rate for Payer: PHP Medicare Advantage |
$158.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$59.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.45
|
| Rate for Payer: Priority Health HMO/PPO |
$141.65
|
| Rate for Payer: Priority Health Medicare |
$159.88
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$141.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$158.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$158.30
|
| Rate for Payer: UHC Exchange |
$158.30
|
| Rate for Payer: UHC Medicare Advantage |
$158.30
|
| Rate for Payer: UHCCP Medicaid |
$59.64
|
|
