|
CHG CT GUIDANCE &MONITORING VISC TISS ABLATION
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
HCPCS 77013
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$258.05 |
| Rate for Payer: Aetna Medicare |
$198.50
|
| Rate for Payer: BCBS Complete |
$158.80
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.05
|
|
|
CHG CT GUIDANCE NEEDLE PLACEMENT
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 77012
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$167.72 |
| Rate for Payer: Aetna Commercial |
$156.07
|
| Rate for Payer: Aetna Medicare |
$121.13
|
| Rate for Payer: BCBS Complete |
$87.20
|
| Rate for Payer: BCBS MAPPO |
$116.47
|
| Rate for Payer: BCN Medicare Advantage |
$116.47
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cofinity Commercial |
$167.72
|
| Rate for Payer: Cofinity Commercial |
$156.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.29
|
| Rate for Payer: Nomi Health Commercial |
$139.76
|
| Rate for Payer: PACE SWMI |
$116.47
|
| Rate for Payer: PHP Medicare Advantage |
$116.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.70
|
| Rate for Payer: Priority Health Medicare |
$117.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$116.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.47
|
| Rate for Payer: UHC Exchange |
$116.47
|
| Rate for Payer: UHC Medicare Advantage |
$116.47
|
|
|
CHG CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 77014
|
| Min. Negotiated Rate |
$108.36 |
| Max. Negotiated Rate |
$209.30 |
| Rate for Payer: Aetna Commercial |
$145.20
|
| Rate for Payer: Aetna Commercial |
$145.20
|
| Rate for Payer: Aetna Medicare |
$112.69
|
| Rate for Payer: Aetna Medicare |
$112.69
|
| Rate for Payer: BCBS Complete |
$97.20
|
| Rate for Payer: BCBS Complete |
$128.80
|
| Rate for Payer: BCBS MAPPO |
$108.36
|
| Rate for Payer: BCBS MAPPO |
$108.36
|
| Rate for Payer: BCN Medicare Advantage |
$108.36
|
| Rate for Payer: BCN Medicare Advantage |
$108.36
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cofinity Commercial |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$145.20
|
| Rate for Payer: Cofinity Commercial |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$145.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.78
|
| Rate for Payer: Nomi Health Commercial |
$130.03
|
| Rate for Payer: Nomi Health Commercial |
$130.03
|
| Rate for Payer: PACE SWMI |
$108.36
|
| Rate for Payer: PACE SWMI |
$108.36
|
| Rate for Payer: PHP Medicare Advantage |
$108.36
|
| Rate for Payer: PHP Medicare Advantage |
$108.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health Medicare |
$109.44
|
| Rate for Payer: Priority Health Medicare |
$109.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.36
|
| Rate for Payer: UHC Exchange |
$108.36
|
| Rate for Payer: UHC Exchange |
$108.36
|
| Rate for Payer: UHC Medicare Advantage |
$108.36
|
| Rate for Payer: UHC Medicare Advantage |
$108.36
|
|
|
CHG CT GUIDANCE STEREOTACTIC LOCALIZATION
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 77011
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$283.51 |
| Rate for Payer: Aetna Commercial |
$263.82
|
| Rate for Payer: Aetna Commercial |
$263.82
|
| Rate for Payer: Aetna Medicare |
$204.76
|
| Rate for Payer: Aetna Medicare |
$204.76
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: BCBS Complete |
$186.40
|
| Rate for Payer: BCBS MAPPO |
$196.88
|
| Rate for Payer: BCBS MAPPO |
$196.88
|
| Rate for Payer: BCN Medicare Advantage |
$196.88
|
| Rate for Payer: BCN Medicare Advantage |
$196.88
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$283.51
|
| Rate for Payer: Cofinity Commercial |
$263.82
|
| Rate for Payer: Cofinity Commercial |
$283.51
|
| Rate for Payer: Cofinity Commercial |
$263.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.72
|
| Rate for Payer: Nomi Health Commercial |
$236.26
|
| Rate for Payer: Nomi Health Commercial |
$236.26
|
| Rate for Payer: PACE SWMI |
$196.88
|
| Rate for Payer: PACE SWMI |
$196.88
|
| Rate for Payer: PHP Medicare Advantage |
$196.88
|
| Rate for Payer: PHP Medicare Advantage |
$196.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.90
|
| Rate for Payer: Priority Health Medicare |
$198.85
|
| Rate for Payer: Priority Health Medicare |
$198.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$196.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.88
|
| Rate for Payer: UHC Exchange |
$196.88
|
| Rate for Payer: UHC Exchange |
$196.88
|
| Rate for Payer: UHC Medicare Advantage |
$196.88
|
| Rate for Payer: UHC Medicare Advantage |
$196.88
|
|
|
CHG CT HEAD/BRAIN W/CONTRAST MATERIAL
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 70460
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$197.34 |
| Rate for Payer: Aetna Commercial |
$183.63
|
| Rate for Payer: Aetna Medicare |
$142.52
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS MAPPO |
$137.04
|
| Rate for Payer: BCN Medicare Advantage |
$137.04
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$197.34
|
| Rate for Payer: Cofinity Commercial |
$183.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.89
|
| Rate for Payer: Nomi Health Commercial |
$164.45
|
| Rate for Payer: PACE SWMI |
$137.04
|
| Rate for Payer: PHP Medicare Advantage |
$137.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Medicare |
$138.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$137.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.04
|
| Rate for Payer: UHC Exchange |
$137.04
|
| Rate for Payer: UHC Medicare Advantage |
$137.04
|
|
|
CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 70450
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$142.04 |
| Rate for Payer: Aetna Commercial |
$132.18
|
| Rate for Payer: Aetna Medicare |
$102.59
|
| Rate for Payer: BCBS Complete |
$35.20
|
| Rate for Payer: BCBS MAPPO |
$98.64
|
| Rate for Payer: BCN Medicare Advantage |
$98.64
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$142.04
|
| Rate for Payer: Cofinity Commercial |
$132.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.57
|
| Rate for Payer: Nomi Health Commercial |
$118.37
|
| Rate for Payer: PACE SWMI |
$98.64
|
| Rate for Payer: PHP Medicare Advantage |
$98.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.20
|
| Rate for Payer: Priority Health Medicare |
$99.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.64
|
| Rate for Payer: UHC Exchange |
$98.64
|
| Rate for Payer: UHC Medicare Advantage |
$98.64
|
|
|
CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 70470
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$230.28 |
| Rate for Payer: Aetna Commercial |
$214.29
|
| Rate for Payer: Aetna Medicare |
$166.32
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$159.92
|
| Rate for Payer: BCN Medicare Advantage |
$159.92
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$230.28
|
| Rate for Payer: Cofinity Commercial |
$214.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.92
|
| Rate for Payer: Nomi Health Commercial |
$191.90
|
| Rate for Payer: PACE SWMI |
$159.92
|
| Rate for Payer: PHP Medicare Advantage |
$159.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health Medicare |
$161.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$159.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.92
|
| Rate for Payer: UHC Exchange |
$159.92
|
| Rate for Payer: UHC Medicare Advantage |
$159.92
|
|
|
CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 75572
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$302.96 |
| Rate for Payer: Aetna Commercial |
$281.92
|
| Rate for Payer: Aetna Medicare |
$218.81
|
| Rate for Payer: BCBS Complete |
$71.60
|
| Rate for Payer: BCBS MAPPO |
$210.39
|
| Rate for Payer: BCN Medicare Advantage |
$210.39
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cofinity Commercial |
$302.96
|
| Rate for Payer: Cofinity Commercial |
$281.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.91
|
| Rate for Payer: Nomi Health Commercial |
$252.47
|
| Rate for Payer: PACE SWMI |
$210.39
|
| Rate for Payer: PHP Medicare Advantage |
$210.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.35
|
| Rate for Payer: Priority Health Medicare |
$212.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$210.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.39
|
| Rate for Payer: UHC Exchange |
$210.39
|
| Rate for Payer: UHC Medicare Advantage |
$210.39
|
|
|
CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 75571
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$132.85 |
| Rate for Payer: Aetna Commercial |
$123.63
|
| Rate for Payer: Aetna Medicare |
$95.95
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS MAPPO |
$92.26
|
| Rate for Payer: BCN Medicare Advantage |
$92.26
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$132.85
|
| Rate for Payer: Cofinity Commercial |
$123.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.87
|
| Rate for Payer: Nomi Health Commercial |
$110.71
|
| Rate for Payer: PACE SWMI |
$92.26
|
| Rate for Payer: PHP Medicare Advantage |
$92.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health Medicare |
$93.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.26
|
| Rate for Payer: UHC Exchange |
$92.26
|
| Rate for Payer: UHC Medicare Advantage |
$92.26
|
|
|
CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 76380
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$173.68 |
| Rate for Payer: Aetna Commercial |
$161.62
|
| Rate for Payer: Aetna Medicare |
$125.43
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$173.68
|
| Rate for Payer: Cofinity Commercial |
$161.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: Nomi Health Commercial |
$144.73
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health Medicare |
$121.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$120.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.61
|
| Rate for Payer: UHC Exchange |
$120.61
|
| Rate for Payer: UHC Medicare Advantage |
$120.61
|
|
|
CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 73701
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$205.46
|
| Rate for Payer: Aetna Medicare |
$159.46
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: BCBS MAPPO |
$153.33
|
| Rate for Payer: BCN Medicare Advantage |
$153.33
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cofinity Commercial |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$205.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.00
|
| Rate for Payer: Nomi Health Commercial |
$184.00
|
| Rate for Payer: PACE SWMI |
$153.33
|
| Rate for Payer: PHP Medicare Advantage |
$153.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
| Rate for Payer: Priority Health Medicare |
$154.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$153.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.33
|
| Rate for Payer: UHC Exchange |
$153.33
|
| Rate for Payer: UHC Medicare Advantage |
$153.33
|
|
|
CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 73700
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$172.37 |
| Rate for Payer: Aetna Commercial |
$160.40
|
| Rate for Payer: Aetna Medicare |
$124.49
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$119.70
|
| Rate for Payer: BCN Medicare Advantage |
$119.70
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$172.37
|
| Rate for Payer: Cofinity Commercial |
$160.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.69
|
| Rate for Payer: Nomi Health Commercial |
$143.64
|
| Rate for Payer: PACE SWMI |
$119.70
|
| Rate for Payer: PHP Medicare Advantage |
$119.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$120.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.70
|
| Rate for Payer: UHC Exchange |
$119.70
|
| Rate for Payer: UHC Medicare Advantage |
$119.70
|
|
|
CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 73702
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$257.96 |
| Rate for Payer: Aetna Commercial |
$240.05
|
| Rate for Payer: Aetna Medicare |
$186.31
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$179.14
|
| Rate for Payer: BCN Medicare Advantage |
$179.14
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$257.96
|
| Rate for Payer: Cofinity Commercial |
$240.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.10
|
| Rate for Payer: Nomi Health Commercial |
$214.97
|
| Rate for Payer: PACE SWMI |
$179.14
|
| Rate for Payer: PHP Medicare Advantage |
$179.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$180.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$179.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.14
|
| Rate for Payer: UHC Exchange |
$179.14
|
| Rate for Payer: UHC Medicare Advantage |
$179.14
|
|
|
CHG CT LUMBAR SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 72132
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$224.44 |
| Rate for Payer: Aetna Commercial |
$208.85
|
| Rate for Payer: Aetna Medicare |
$162.09
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$155.86
|
| Rate for Payer: BCN Medicare Advantage |
$155.86
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$224.44
|
| Rate for Payer: Cofinity Commercial |
$208.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.65
|
| Rate for Payer: Nomi Health Commercial |
$187.03
|
| Rate for Payer: PACE SWMI |
$155.86
|
| Rate for Payer: PHP Medicare Advantage |
$155.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$157.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$155.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.86
|
| Rate for Payer: UHC Exchange |
$155.86
|
| Rate for Payer: UHC Medicare Advantage |
$155.86
|
|
|
CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 72131
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Aetna Commercial |
$160.01
|
| Rate for Payer: Aetna Medicare |
$124.19
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$119.41
|
| Rate for Payer: BCN Medicare Advantage |
$119.41
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$171.95
|
| Rate for Payer: Cofinity Commercial |
$160.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.38
|
| Rate for Payer: Nomi Health Commercial |
$143.29
|
| Rate for Payer: PACE SWMI |
$119.41
|
| Rate for Payer: PHP Medicare Advantage |
$119.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$120.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.41
|
| Rate for Payer: UHC Exchange |
$119.41
|
| Rate for Payer: UHC Medicare Advantage |
$119.41
|
|
|
CHG CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 72133
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$260.42 |
| Rate for Payer: Aetna Commercial |
$242.34
|
| Rate for Payer: Aetna Medicare |
$188.08
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$180.85
|
| Rate for Payer: BCN Medicare Advantage |
$180.85
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$260.42
|
| Rate for Payer: Cofinity Commercial |
$242.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.89
|
| Rate for Payer: Nomi Health Commercial |
$217.02
|
| Rate for Payer: PACE SWMI |
$180.85
|
| Rate for Payer: PHP Medicare Advantage |
$180.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$182.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.85
|
| Rate for Payer: UHC Exchange |
$180.85
|
| Rate for Payer: UHC Medicare Advantage |
$180.85
|
|
|
CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 70487
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: Aetna Medicare |
$145.89
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: BCBS MAPPO |
$140.28
|
| Rate for Payer: BCN Medicare Advantage |
$140.28
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$202.00
|
| Rate for Payer: Cofinity Commercial |
$187.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.29
|
| Rate for Payer: Nomi Health Commercial |
$168.34
|
| Rate for Payer: PACE SWMI |
$140.28
|
| Rate for Payer: PHP Medicare Advantage |
$140.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
| Rate for Payer: Priority Health Medicare |
$141.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$140.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.28
|
| Rate for Payer: UHC Exchange |
$140.28
|
| Rate for Payer: UHC Medicare Advantage |
$140.28
|
|
|
CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 70486
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$169.62 |
| Rate for Payer: Aetna Commercial |
$157.84
|
| Rate for Payer: Aetna Medicare |
$122.50
|
| Rate for Payer: BCBS Complete |
$35.20
|
| Rate for Payer: BCBS MAPPO |
$117.79
|
| Rate for Payer: BCN Medicare Advantage |
$117.79
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$169.62
|
| Rate for Payer: Cofinity Commercial |
$157.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.68
|
| Rate for Payer: Nomi Health Commercial |
$141.35
|
| Rate for Payer: PACE SWMI |
$117.79
|
| Rate for Payer: PHP Medicare Advantage |
$117.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.20
|
| Rate for Payer: Priority Health Medicare |
$118.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$117.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.79
|
| Rate for Payer: UHC Exchange |
$117.79
|
| Rate for Payer: UHC Medicare Advantage |
$117.79
|
|
|
CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 70488
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$243.86 |
| Rate for Payer: Aetna Commercial |
$226.93
|
| Rate for Payer: Aetna Medicare |
$176.12
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$169.35
|
| Rate for Payer: BCN Medicare Advantage |
$169.35
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$243.86
|
| Rate for Payer: Cofinity Commercial |
$226.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.82
|
| Rate for Payer: Nomi Health Commercial |
$203.22
|
| Rate for Payer: PACE SWMI |
$169.35
|
| Rate for Payer: PHP Medicare Advantage |
$169.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$171.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$169.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.35
|
| Rate for Payer: UHC Exchange |
$169.35
|
| Rate for Payer: UHC Medicare Advantage |
$169.35
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 70481
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$238.49 |
| Rate for Payer: Aetna Commercial |
$221.93
|
| Rate for Payer: Aetna Medicare |
$172.24
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS MAPPO |
$165.62
|
| Rate for Payer: BCN Medicare Advantage |
$165.62
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$238.49
|
| Rate for Payer: Cofinity Commercial |
$221.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.90
|
| Rate for Payer: Nomi Health Commercial |
$198.74
|
| Rate for Payer: PACE SWMI |
$165.62
|
| Rate for Payer: PHP Medicare Advantage |
$165.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Medicare |
$167.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$165.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.62
|
| Rate for Payer: UHC Exchange |
$165.62
|
| Rate for Payer: UHC Medicare Advantage |
$165.62
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 70480
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$211.67 |
| Rate for Payer: Aetna Commercial |
$196.97
|
| Rate for Payer: Aetna Medicare |
$152.87
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS MAPPO |
$146.99
|
| Rate for Payer: BCN Medicare Advantage |
$146.99
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$211.67
|
| Rate for Payer: Cofinity Commercial |
$196.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.34
|
| Rate for Payer: Nomi Health Commercial |
$176.39
|
| Rate for Payer: PACE SWMI |
$146.99
|
| Rate for Payer: PHP Medicare Advantage |
$146.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health Medicare |
$148.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.99
|
| Rate for Payer: UHC Exchange |
$146.99
|
| Rate for Payer: UHC Medicare Advantage |
$146.99
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 70482
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$277.39 |
| Rate for Payer: Aetna Commercial |
$258.12
|
| Rate for Payer: Aetna Medicare |
$200.34
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$192.63
|
| Rate for Payer: BCN Medicare Advantage |
$192.63
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$277.39
|
| Rate for Payer: Cofinity Commercial |
$258.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.26
|
| Rate for Payer: Nomi Health Commercial |
$231.16
|
| Rate for Payer: PACE SWMI |
$192.63
|
| Rate for Payer: PHP Medicare Advantage |
$192.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$194.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$192.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$192.63
|
| Rate for Payer: UHC Exchange |
$192.63
|
| Rate for Payer: UHC Medicare Advantage |
$192.63
|
|
|
CHG CT PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 72193
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$298.45 |
| Rate for Payer: Aetna Commercial |
$277.73
|
| Rate for Payer: Aetna Medicare |
$215.55
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: BCBS MAPPO |
$207.26
|
| Rate for Payer: BCN Medicare Advantage |
$207.26
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cofinity Commercial |
$298.45
|
| Rate for Payer: Cofinity Commercial |
$277.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$217.62
|
| Rate for Payer: Nomi Health Commercial |
$248.71
|
| Rate for Payer: PACE SWMI |
$207.26
|
| Rate for Payer: PHP Medicare Advantage |
$207.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
| Rate for Payer: Priority Health Medicare |
$209.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$207.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$207.26
|
| Rate for Payer: UHC Exchange |
$207.26
|
| Rate for Payer: UHC Medicare Advantage |
$207.26
|
|
|
CHG CT PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 72192
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$177.11 |
| Rate for Payer: Aetna Commercial |
$164.81
|
| Rate for Payer: Aetna Medicare |
$127.91
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$122.99
|
| Rate for Payer: BCN Medicare Advantage |
$122.99
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$177.11
|
| Rate for Payer: Cofinity Commercial |
$164.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.14
|
| Rate for Payer: Nomi Health Commercial |
$147.59
|
| Rate for Payer: PACE SWMI |
$122.99
|
| Rate for Payer: PHP Medicare Advantage |
$122.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health Medicare |
$124.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$122.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.99
|
| Rate for Payer: UHC Exchange |
$122.99
|
| Rate for Payer: UHC Medicare Advantage |
$122.99
|
|
|
CHG CT PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 72194
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$329.26 |
| Rate for Payer: Aetna Commercial |
$306.39
|
| Rate for Payer: Aetna Medicare |
$237.80
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$228.65
|
| Rate for Payer: BCN Medicare Advantage |
$228.65
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$329.26
|
| Rate for Payer: Cofinity Commercial |
$306.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$228.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.08
|
| Rate for Payer: Nomi Health Commercial |
$274.38
|
| Rate for Payer: PACE SWMI |
$228.65
|
| Rate for Payer: PHP Medicare Advantage |
$228.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$230.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$228.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$228.65
|
| Rate for Payer: UHC Exchange |
$228.65
|
| Rate for Payer: UHC Medicare Advantage |
$228.65
|
|
