|
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 |
$105.17
|
| 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
|
IP
|
$324.30
|
|
|
Service Code
|
NDC 67877021901
|
| Hospital Charge Code |
9500
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$210.79 |
| Max. Negotiated Rate |
$291.87 |
| Rate for Payer: Aetna Commercial |
$275.65
|
| 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 |
$275.65
|
| Rate for Payer: Nomi Health Commercial |
$265.93
|
| Rate for Payer: PHP Commercial |
$275.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.79
|
| 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
|
|
|
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 |
$444.32 |
| 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 |
$549.20
|
| Rate for Payer: BCBS Complete |
$699.20
|
| Rate for Payer: BCBS MAPPO |
$444.32
|
| Rate for Payer: BCBS MAPPO |
$444.32
|
| 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 |
$1,398.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cash Price |
$1,098.40
|
| Rate for Payer: Cofinity Commercial |
$639.82
|
| Rate for Payer: Cofinity Commercial |
$595.39
|
| Rate for Payer: Cofinity Commercial |
$639.82
|
| 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: 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: 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 Cigna Priority Health |
$892.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,136.20
|
| Rate for Payer: Priority Health Medicare |
$448.76
|
| Rate for Payer: Priority Health Medicare |
$448.76
|
| 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
|
|
|
CHG 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
HCPCS 76377
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$105.00 |
| Rate for Payer: Aetna Commercial |
$97.71
|
| Rate for Payer: Aetna Medicare |
$75.84
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$72.92
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.57
|
| 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 Cigna Priority Health |
$89.05
|
| Rate for Payer: Priority Health Medicare |
$73.65
|
| 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
|
|
|
CHG 3D RENDERING W/INTERP & POSTPROCESS SUPERVISION
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 76376
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$33.75 |
| 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 |
$18.00
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$23.44
|
| Rate for Payer: BCBS MAPPO |
$23.44
|
| 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 |
$33.75
|
| Rate for Payer: Cofinity Commercial |
$31.41
|
| 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: 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: 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 Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Medicare |
$23.67
|
| Rate for Payer: Priority Health Medicare |
$23.67
|
| 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
|
|
|
CHG ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 78278
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$445.90 |
| Rate for Payer: Aetna Commercial |
$374.82
|
| Rate for Payer: Aetna Medicare |
$290.91
|
| Rate for Payer: BCBS Complete |
$274.40
|
| Rate for Payer: BCBS MAPPO |
$279.72
|
| 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 |
$374.82
|
| Rate for Payer: Cofinity Commercial |
$402.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.71
|
| 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 Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health Medicare |
$282.52
|
| 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
|
|
|
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
|
$507.00
|
|
|
Service Code
|
HCPCS 75791
|
| Min. Negotiated Rate |
$202.80 |
| Max. Negotiated Rate |
$329.55 |
| Rate for Payer: Aetna Medicare |
$253.50
|
| Rate for Payer: Aetna Medicare |
$154.00
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS Complete |
$202.80
|
| 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 |
$79.20 |
| Max. Negotiated Rate |
$217.63 |
| Rate for Payer: Aetna Commercial |
$202.51
|
| Rate for Payer: Aetna Medicare |
$157.18
|
| Rate for Payer: BCBS Complete |
$79.20
|
| Rate for Payer: BCBS MAPPO |
$151.13
|
| 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 |
$217.63
|
| Rate for Payer: Cofinity Commercial |
$202.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$151.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$158.69
|
| 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 Cigna Priority Health |
$128.70
|
| Rate for Payer: Priority Health Medicare |
$152.64
|
| 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
|
|
|
CHG ANGIOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
HCPCS 75710
|
| Min. Negotiated Rate |
$137.91 |
| 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 |
$172.00
|
| Rate for Payer: BCBS Complete |
$72.80
|
| Rate for Payer: BCBS MAPPO |
$137.91
|
| Rate for Payer: BCBS MAPPO |
$137.91
|
| 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 |
$344.00
|
| Rate for Payer: Cash Price |
$145.60
|
| Rate for Payer: Cash Price |
$344.00
|
| Rate for Payer: Cofinity Commercial |
$198.59
|
| Rate for Payer: Cofinity Commercial |
$198.59
|
| Rate for Payer: Cofinity Commercial |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$184.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.91
|
| 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: 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 Cigna Priority Health |
$118.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$279.50
|
| Rate for Payer: Priority Health Medicare |
$139.29
|
| Rate for Payer: Priority Health Medicare |
$139.29
|
| 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
|
|
|
CHG ANGIOGRAPHY INTERNAL MAMMARY RS&I
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 75756
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$213.21 |
| Rate for Payer: Aetna Commercial |
$198.40
|
| Rate for Payer: Aetna Medicare |
$153.98
|
| Rate for Payer: BCBS Complete |
$76.00
|
| Rate for Payer: BCBS MAPPO |
$148.06
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$155.46
|
| 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 Cigna Priority Health |
$123.50
|
| Rate for Payer: Priority Health Medicare |
$149.54
|
| 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
|
|
|
CHG ANGIOGRAPHY PELVIC SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$319.00
|
|
|
Service Code
|
HCPCS 75736
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$207.35 |
| Rate for Payer: Aetna Commercial |
$176.63
|
| Rate for Payer: Aetna Medicare |
$137.08
|
| Rate for Payer: BCBS Complete |
$127.60
|
| Rate for Payer: BCBS MAPPO |
$131.81
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$138.40
|
| 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 Cigna Priority Health |
$207.35
|
| Rate for Payer: Priority Health Medicare |
$133.13
|
| 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
|
|
|
CHG ANGIOGRAPHY PULMONARY UNILATERAL SLCTV RS&I
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 75741
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$170.87 |
| Rate for Payer: Aetna Commercial |
$159.00
|
| Rate for Payer: Aetna Medicare |
$123.41
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$118.66
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.59
|
| 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 Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$119.85
|
| 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
|
|
|
CHG ANGIOGRAPHY SPINAL SELECTIVE RS&I
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 75705
|
| Min. Negotiated Rate |
$174.40 |
| Max. Negotiated Rate |
$341.87 |
| Rate for Payer: Aetna Commercial |
$318.13
|
| Rate for Payer: Aetna Medicare |
$246.91
|
| Rate for Payer: BCBS Complete |
$174.40
|
| Rate for Payer: BCBS MAPPO |
$237.41
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.28
|
| 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 Cigna Priority Health |
$283.40
|
| Rate for Payer: Priority Health Medicare |
$239.78
|
| 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
|
|
|
CHG ANGIOGRAPHY VISCERAL SLCTV/SUPRASLCTV RS&I
|
Professional
|
Both
|
$273.00
|
|
|
Service Code
|
HCPCS 75726
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$227.95 |
| Rate for Payer: Aetna Commercial |
$212.12
|
| Rate for Payer: Aetna Medicare |
$164.63
|
| Rate for Payer: BCBS Complete |
$109.20
|
| Rate for Payer: BCBS MAPPO |
$158.30
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$166.22
|
| 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 Cigna Priority Health |
$177.45
|
| Rate for Payer: Priority Health Medicare |
$159.88
|
| 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
|
|
|
CHG ANGRPH CATH F-UP STD TCAT OTHER THAN THROMBYLSIS
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
HCPCS 75898
|
| Min. Negotiated Rate |
$64.80 |
| Max. Negotiated Rate |
$105.30 |
| Rate for Payer: Aetna Medicare |
$81.00
|
| Rate for Payer: BCBS Complete |
$64.80
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.30
|
|
|
CHG ANGRPH SLCTV EA VSL STUDIED AFTER BASIC XM RS&I
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 75774
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$196.30 |
| Rate for Payer: Aetna Commercial |
$118.13
|
| Rate for Payer: Aetna Medicare |
$91.69
|
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: BCBS MAPPO |
$88.16
|
| Rate for Payer: BCN Medicare Advantage |
$88.16
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$126.95
|
| Rate for Payer: Cofinity Commercial |
$118.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$92.57
|
| Rate for Payer: Nomi Health Commercial |
$105.79
|
| Rate for Payer: PACE SWMI |
$88.16
|
| Rate for Payer: PHP Medicare Advantage |
$88.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health Medicare |
$89.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$88.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$88.16
|
| Rate for Payer: UHC Exchange |
$88.16
|
| Rate for Payer: UHC Medicare Advantage |
$88.16
|
|
|
CHG AORTOGRAPHY ABDL BI ILIOFEM LOW EXTREM CATH RS&I
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
HCPCS 75630
|
| Min. Negotiated Rate |
$117.20 |
| Max. Negotiated Rate |
$209.69 |
| Rate for Payer: Aetna Commercial |
$195.13
|
| Rate for Payer: Aetna Commercial |
$195.13
|
| Rate for Payer: Aetna Medicare |
$151.44
|
| Rate for Payer: Aetna Medicare |
$151.44
|
| Rate for Payer: BCBS Complete |
$117.20
|
| Rate for Payer: BCBS Complete |
$190.00
|
| Rate for Payer: BCBS MAPPO |
$145.62
|
| Rate for Payer: BCBS MAPPO |
$145.62
|
| Rate for Payer: BCN Medicare Advantage |
$145.62
|
| Rate for Payer: BCN Medicare Advantage |
$145.62
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cofinity Commercial |
$209.69
|
| Rate for Payer: Cofinity Commercial |
$195.13
|
| Rate for Payer: Cofinity Commercial |
$209.69
|
| Rate for Payer: Cofinity Commercial |
$195.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.90
|
| Rate for Payer: Nomi Health Commercial |
$174.74
|
| Rate for Payer: Nomi Health Commercial |
$174.74
|
| Rate for Payer: PACE SWMI |
$145.62
|
| Rate for Payer: PACE SWMI |
$145.62
|
| Rate for Payer: PHP Medicare Advantage |
$145.62
|
| Rate for Payer: PHP Medicare Advantage |
$145.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.75
|
| Rate for Payer: Priority Health Medicare |
$147.08
|
| Rate for Payer: Priority Health Medicare |
$147.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.62
|
| Rate for Payer: UHC Exchange |
$145.62
|
| Rate for Payer: UHC Exchange |
$145.62
|
| Rate for Payer: UHC Medicare Advantage |
$145.62
|
| Rate for Payer: UHC Medicare Advantage |
$145.62
|
|
|
CHG AORTOGRAPHY ABDOMINAL SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 75625
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$168.21 |
| Rate for Payer: Aetna Commercial |
$156.53
|
| Rate for Payer: Aetna Commercial |
$156.53
|
| Rate for Payer: Aetna Medicare |
$121.48
|
| Rate for Payer: Aetna Medicare |
$121.48
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS Complete |
$46.00
|
| Rate for Payer: BCBS MAPPO |
$116.81
|
| Rate for Payer: BCBS MAPPO |
$116.81
|
| Rate for Payer: BCN Medicare Advantage |
$116.81
|
| Rate for Payer: BCN Medicare Advantage |
$116.81
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$92.00
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$168.21
|
| Rate for Payer: Cofinity Commercial |
$156.53
|
| Rate for Payer: Cofinity Commercial |
$168.21
|
| Rate for Payer: Cofinity Commercial |
$156.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.65
|
| Rate for Payer: Nomi Health Commercial |
$140.17
|
| Rate for Payer: Nomi Health Commercial |
$140.17
|
| Rate for Payer: PACE SWMI |
$116.81
|
| Rate for Payer: PACE SWMI |
$116.81
|
| Rate for Payer: PHP Medicare Advantage |
$116.81
|
| Rate for Payer: PHP Medicare Advantage |
$116.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.75
|
| Rate for Payer: Priority Health Medicare |
$117.98
|
| Rate for Payer: Priority Health Medicare |
$117.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.81
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.81
|
| Rate for Payer: UHC Exchange |
$116.81
|
| Rate for Payer: UHC Exchange |
$116.81
|
| Rate for Payer: UHC Medicare Advantage |
$116.81
|
| Rate for Payer: UHC Medicare Advantage |
$116.81
|
|
|
CHG AORTOGRAPHY THORACIC SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
HCPCS 75605
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$172.25 |
| Rate for Payer: Aetna Commercial |
$148.54
|
| Rate for Payer: Aetna Medicare |
$115.28
|
| Rate for Payer: BCBS Complete |
$106.00
|
| Rate for Payer: BCBS MAPPO |
$110.85
|
| Rate for Payer: BCN Medicare Advantage |
$110.85
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cofinity Commercial |
$159.62
|
| Rate for Payer: Cofinity Commercial |
$148.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$110.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$116.39
|
| Rate for Payer: Nomi Health Commercial |
$133.02
|
| Rate for Payer: PACE SWMI |
$110.85
|
| Rate for Payer: PHP Medicare Advantage |
$110.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$172.25
|
| Rate for Payer: Priority Health Medicare |
$111.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$110.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$110.85
|
| Rate for Payer: UHC Exchange |
$110.85
|
| Rate for Payer: UHC Medicare Advantage |
$110.85
|
|
|
CHG AORTOGRAPHY THORACIC W/O SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
HCPCS 75600
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$223.66 |
| Rate for Payer: Aetna Commercial |
$208.13
|
| Rate for Payer: Aetna Medicare |
$161.53
|
| Rate for Payer: BCBS Complete |
$42.80
|
| Rate for Payer: BCBS MAPPO |
$155.32
|
| Rate for Payer: BCN Medicare Advantage |
$155.32
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cash Price |
$85.60
|
| Rate for Payer: Cofinity Commercial |
$223.66
|
| Rate for Payer: Cofinity Commercial |
$208.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.09
|
| Rate for Payer: Nomi Health Commercial |
$186.38
|
| Rate for Payer: PACE SWMI |
$155.32
|
| Rate for Payer: PHP Medicare Advantage |
$155.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.55
|
| Rate for Payer: Priority Health Medicare |
$156.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.32
|
| Rate for Payer: UHC Exchange |
$155.32
|
| Rate for Payer: UHC Medicare Advantage |
$155.32
|
|
|
CHG ASSAY OF LEAD
|
Professional
|
Both
|
$20.00
|
|
|
Service Code
|
HCPCS 83655
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$17.44 |
| Rate for Payer: Aetna Commercial |
$16.23
|
| Rate for Payer: Aetna Medicare |
$12.59
|
| Rate for Payer: BCBS Complete |
$8.00
|
| Rate for Payer: BCBS MAPPO |
$12.11
|
| Rate for Payer: BCN Medicare Advantage |
$12.11
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cash Price |
$16.00
|
| Rate for Payer: Cofinity Commercial |
$17.44
|
| Rate for Payer: Cofinity Commercial |
$16.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.72
|
| Rate for Payer: Nomi Health Commercial |
$14.53
|
| Rate for Payer: PACE SWMI |
$12.11
|
| Rate for Payer: PHP Medicare Advantage |
$12.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.00
|
| Rate for Payer: Priority Health Medicare |
$12.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.11
|
| Rate for Payer: UHC Exchange |
$12.11
|
| Rate for Payer: UHC Medicare Advantage |
$12.11
|
|
|
CHG ASSAY OF PHOSPHATASE ALKALINE
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 84075
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| 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 |
$7.80
|
| 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 ASSAY OF PROGESTERONE
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 84144
|
| Min. Negotiated Rate |
$20.86 |
| Max. Negotiated Rate |
$61.10 |
| Rate for Payer: Aetna Commercial |
$27.95
|
| Rate for Payer: Aetna Medicare |
$21.69
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: BCBS MAPPO |
$20.86
|
| Rate for Payer: BCN Medicare Advantage |
$20.86
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$30.04
|
| Rate for Payer: Cofinity Commercial |
$27.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.90
|
| Rate for Payer: Nomi Health Commercial |
$25.03
|
| Rate for Payer: PACE SWMI |
$20.86
|
| Rate for Payer: PHP Medicare Advantage |
$20.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health Medicare |
$21.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$20.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.86
|
| Rate for Payer: UHC Exchange |
$20.86
|
| Rate for Payer: UHC Medicare Advantage |
$20.86
|
|
