|
CHG DRUG SCREEN LIST A ANY NMBR NON TLC DEVICES
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 80300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
|
|
CHG DRUG SCREEN MULT CLASSES
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 80100
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
|
|
CHG DRUG SCREEN, QUAL,1+ DRUG CLASS,NON-CHROMOTOGRAPHIC,EACH
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 80104
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
|
|
CHG DRUG SCREEN SINGL CLASS
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 80101
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
|
|
CHG DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 80305
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Commercial |
$16.88
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$16.88
|
| Rate for Payer: Cofinity Commercial |
$18.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Nomi Health Commercial |
$15.12
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Medicare |
$12.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$12.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Exchange |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
|
|
CHG DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 80307
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$83.27
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$89.48
|
| Rate for Payer: Cofinity Commercial |
$83.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Nomi Health Commercial |
$74.57
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$62.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Exchange |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
|
|
CHG DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 80306
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$24.68 |
| Rate for Payer: Aetna Commercial |
$22.97
|
| Rate for Payer: Aetna Medicare |
$17.83
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS MAPPO |
$17.14
|
| Rate for Payer: BCN Medicare Advantage |
$17.14
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$22.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.00
|
| Rate for Payer: Nomi Health Commercial |
$20.57
|
| Rate for Payer: PACE SWMI |
$17.14
|
| Rate for Payer: PHP Medicare Advantage |
$17.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: Priority Health Medicare |
$17.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$17.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.14
|
| Rate for Payer: UHC Exchange |
$17.14
|
| Rate for Payer: UHC Medicare Advantage |
$17.14
|
|
|
CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 77081
|
| Min. Negotiated Rate |
$29.03 |
| Max. Negotiated Rate |
$104.65 |
| Rate for Payer: Aetna Commercial |
$38.90
|
| Rate for Payer: Aetna Commercial |
$38.90
|
| Rate for Payer: Aetna Medicare |
$30.19
|
| Rate for Payer: Aetna Medicare |
$30.19
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS MAPPO |
$29.03
|
| Rate for Payer: BCBS MAPPO |
$29.03
|
| Rate for Payer: BCN Medicare Advantage |
$29.03
|
| Rate for Payer: BCN Medicare Advantage |
$29.03
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cofinity Commercial |
$41.80
|
| Rate for Payer: Cofinity Commercial |
$38.90
|
| Rate for Payer: Cofinity Commercial |
$41.80
|
| Rate for Payer: Cofinity Commercial |
$38.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.48
|
| Rate for Payer: Nomi Health Commercial |
$34.84
|
| Rate for Payer: Nomi Health Commercial |
$34.84
|
| Rate for Payer: PACE SWMI |
$29.03
|
| Rate for Payer: PACE SWMI |
$29.03
|
| Rate for Payer: PHP Medicare Advantage |
$29.03
|
| Rate for Payer: PHP Medicare Advantage |
$29.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: Priority Health Medicare |
$29.32
|
| Rate for Payer: Priority Health Medicare |
$29.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.03
|
| Rate for Payer: UHC Exchange |
$29.03
|
| Rate for Payer: UHC Exchange |
$29.03
|
| Rate for Payer: UHC Medicare Advantage |
$29.03
|
| Rate for Payer: UHC Medicare Advantage |
$29.03
|
|
|
CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 77080
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Medicare |
$36.94
|
| Rate for Payer: Aetna Medicare |
$36.94
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS Complete |
$95.60
|
| Rate for Payer: BCBS MAPPO |
$35.52
|
| Rate for Payer: BCBS MAPPO |
$35.52
|
| Rate for Payer: BCN Medicare Advantage |
$35.52
|
| Rate for Payer: BCN Medicare Advantage |
$35.52
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.30
|
| Rate for Payer: Nomi Health Commercial |
$42.62
|
| Rate for Payer: Nomi Health Commercial |
$42.62
|
| Rate for Payer: PACE SWMI |
$35.52
|
| Rate for Payer: PACE SWMI |
$35.52
|
| Rate for Payer: PHP Medicare Advantage |
$35.52
|
| Rate for Payer: PHP Medicare Advantage |
$35.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.35
|
| Rate for Payer: Priority Health Medicare |
$35.88
|
| Rate for Payer: Priority Health Medicare |
$35.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$35.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.52
|
| Rate for Payer: UHC Exchange |
$35.52
|
| Rate for Payer: UHC Exchange |
$35.52
|
| Rate for Payer: UHC Medicare Advantage |
$35.52
|
| Rate for Payer: UHC Medicare Advantage |
$35.52
|
|
|
CHG DX NTRAOP EPCAR CAR US CHD PLMT MNPJ&IMG ACQUISJ
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 76988
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$137.80 |
| Rate for Payer: Aetna Medicare |
$106.00
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
|
|
CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 76506
|
| Min. Negotiated Rate |
$98.89 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$132.51
|
| Rate for Payer: Aetna Medicare |
$102.85
|
| Rate for Payer: BCBS Complete |
$128.00
|
| Rate for Payer: BCBS MAPPO |
$98.89
|
| Rate for Payer: BCN Medicare Advantage |
$98.89
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cofinity Commercial |
$142.40
|
| Rate for Payer: Cofinity Commercial |
$132.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.83
|
| Rate for Payer: Nomi Health Commercial |
$118.67
|
| Rate for Payer: PACE SWMI |
$98.89
|
| Rate for Payer: PHP Medicare Advantage |
$98.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health Medicare |
$99.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$98.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.89
|
| Rate for Payer: UHC Exchange |
$98.89
|
| Rate for Payer: UHC Medicare Advantage |
$98.89
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 76825
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$333.24 |
| Rate for Payer: Aetna Commercial |
$310.10
|
| Rate for Payer: Aetna Medicare |
$240.68
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: BCBS MAPPO |
$231.42
|
| Rate for Payer: BCN Medicare Advantage |
$231.42
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$310.10
|
| Rate for Payer: Cofinity Commercial |
$333.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.99
|
| Rate for Payer: Nomi Health Commercial |
$277.70
|
| Rate for Payer: PACE SWMI |
$231.42
|
| Rate for Payer: PHP Medicare Advantage |
$231.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$233.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$231.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.42
|
| Rate for Payer: UHC Exchange |
$231.42
|
| Rate for Payer: UHC Medicare Advantage |
$231.42
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 76826
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$199.54 |
| Rate for Payer: Aetna Commercial |
$185.68
|
| Rate for Payer: Aetna Medicare |
$144.11
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$138.57
|
| Rate for Payer: BCN Medicare Advantage |
$138.57
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$185.68
|
| Rate for Payer: Cofinity Commercial |
$199.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.50
|
| Rate for Payer: Nomi Health Commercial |
$166.28
|
| Rate for Payer: PACE SWMI |
$138.57
|
| Rate for Payer: PHP Medicare Advantage |
$138.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$139.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$138.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.57
|
| Rate for Payer: UHC Exchange |
$138.57
|
| Rate for Payer: UHC Medicare Advantage |
$138.57
|
|
|
CHG ENDOVASC REPAIR AAA
|
Professional
|
Both
|
$512.00
|
|
|
Service Code
|
HCPCS 75952
|
| Min. Negotiated Rate |
$204.80 |
| Max. Negotiated Rate |
$332.80 |
| Rate for Payer: Aetna Medicare |
$256.00
|
| Rate for Payer: BCBS Complete |
$204.80
|
| Rate for Payer: Cash Price |
$409.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.80
|
|
|
CHG EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 75957
|
| Min. Negotiated Rate |
$237.20 |
| Max. Negotiated Rate |
$385.45 |
| Rate for Payer: Aetna Medicare |
$296.50
|
| Rate for Payer: BCBS Complete |
$237.20
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.45
|
|
|
CHG EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 75956
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$450.45 |
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: BCBS Complete |
$277.20
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.45
|
|
|
CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 76818
|
| Min. Negotiated Rate |
$108.35 |
| Max. Negotiated Rate |
$217.75 |
| Rate for Payer: Aetna Commercial |
$145.19
|
| Rate for Payer: Aetna Medicare |
$112.68
|
| Rate for Payer: BCBS Complete |
$134.00
|
| Rate for Payer: BCBS MAPPO |
$108.35
|
| Rate for Payer: BCN Medicare Advantage |
$108.35
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$156.02
|
| Rate for Payer: Cofinity Commercial |
$145.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.77
|
| Rate for Payer: Nomi Health Commercial |
$130.02
|
| Rate for Payer: PACE SWMI |
$108.35
|
| Rate for Payer: PHP Medicare Advantage |
$108.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.75
|
| Rate for Payer: Priority Health Medicare |
$109.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$108.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.35
|
| Rate for Payer: UHC Exchange |
$108.35
|
| Rate for Payer: UHC Medicare Advantage |
$108.35
|
|
|
CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 76819
|
| Min. Negotiated Rate |
$78.29 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Aetna Commercial |
$104.91
|
| Rate for Payer: Aetna Medicare |
$81.42
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCBS MAPPO |
$78.29
|
| Rate for Payer: BCN Medicare Advantage |
$78.29
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$112.74
|
| Rate for Payer: Cofinity Commercial |
$104.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.20
|
| Rate for Payer: Nomi Health Commercial |
$93.95
|
| Rate for Payer: PACE SWMI |
$78.29
|
| Rate for Payer: PHP Medicare Advantage |
$78.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health Medicare |
$79.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.29
|
| Rate for Payer: UHC Exchange |
$78.29
|
| Rate for Payer: UHC Medicare Advantage |
$78.29
|
|
|
CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 77003
|
| Min. Negotiated Rate |
$92.83 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$124.39
|
| Rate for Payer: Aetna Medicare |
$96.54
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS MAPPO |
$92.83
|
| Rate for Payer: BCN Medicare Advantage |
$92.83
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$133.68
|
| Rate for Payer: Cofinity Commercial |
$124.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.47
|
| Rate for Payer: Nomi Health Commercial |
$111.40
|
| Rate for Payer: PACE SWMI |
$92.83
|
| Rate for Payer: PHP Medicare Advantage |
$92.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: Priority Health Medicare |
$93.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$92.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.83
|
| Rate for Payer: UHC Exchange |
$92.83
|
| Rate for Payer: UHC Medicare Advantage |
$92.83
|
|
|
CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 77001
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$125.67 |
| Rate for Payer: Aetna Commercial |
$116.94
|
| Rate for Payer: Aetna Commercial |
$116.94
|
| Rate for Payer: Aetna Medicare |
$90.76
|
| Rate for Payer: Aetna Medicare |
$90.76
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: BCBS MAPPO |
$87.27
|
| Rate for Payer: BCBS MAPPO |
$87.27
|
| Rate for Payer: BCN Medicare Advantage |
$87.27
|
| Rate for Payer: BCN Medicare Advantage |
$87.27
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$125.67
|
| Rate for Payer: Cofinity Commercial |
$125.67
|
| Rate for Payer: Cofinity Commercial |
$116.94
|
| Rate for Payer: Cofinity Commercial |
$116.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.63
|
| Rate for Payer: Nomi Health Commercial |
$104.72
|
| Rate for Payer: Nomi Health Commercial |
$104.72
|
| Rate for Payer: PACE SWMI |
$87.27
|
| Rate for Payer: PACE SWMI |
$87.27
|
| Rate for Payer: PHP Medicare Advantage |
$87.27
|
| Rate for Payer: PHP Medicare Advantage |
$87.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Medicare |
$88.14
|
| Rate for Payer: Priority Health Medicare |
$88.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.27
|
| Rate for Payer: UHC Exchange |
$87.27
|
| Rate for Payer: UHC Exchange |
$87.27
|
| Rate for Payer: UHC Medicare Advantage |
$87.27
|
| Rate for Payer: UHC Medicare Advantage |
$87.27
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 77002
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$147.43 |
| Rate for Payer: Aetna Commercial |
$137.19
|
| Rate for Payer: Aetna Medicare |
$106.48
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$102.38
|
| Rate for Payer: BCN Medicare Advantage |
$102.38
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$147.43
|
| Rate for Payer: Cofinity Commercial |
$137.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.50
|
| Rate for Payer: Nomi Health Commercial |
$122.86
|
| Rate for Payer: PACE SWMI |
$102.38
|
| Rate for Payer: PHP Medicare Advantage |
$102.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$103.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.38
|
| Rate for Payer: UHC Exchange |
$102.38
|
| Rate for Payer: UHC Medicare Advantage |
$102.38
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
77002
|
| Min. Negotiated Rate |
$74.10 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: BCBS Trust/PPO |
$93.06
|
| Rate for Payer: BCN Commercial |
$88.10
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$98.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.20
|
| Rate for Payer: Healthscope Commercial |
$102.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.90
|
| Rate for Payer: Nomi Health Commercial |
$93.48
|
| Rate for Payer: PHP Commercial |
$96.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO |
$99.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.32
|
| Rate for Payer: UHC Core |
$95.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.50
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 77002
|
| Hospital Charge Code |
77002
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$147.43 |
| Rate for Payer: Aetna Commercial |
$137.19
|
| Rate for Payer: Aetna Medicare |
$106.48
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$102.38
|
| Rate for Payer: BCN Medicare Advantage |
$102.38
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$147.43
|
| Rate for Payer: Cofinity Commercial |
$137.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.50
|
| Rate for Payer: Nomi Health Commercial |
$122.86
|
| Rate for Payer: PACE SWMI |
$102.38
|
| Rate for Payer: PHP Medicare Advantage |
$102.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$103.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.38
|
| Rate for Payer: UHC Exchange |
$102.38
|
| Rate for Payer: UHC Medicare Advantage |
$102.38
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
77002
|
| Min. Negotiated Rate |
$27.07 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Medicare |
$29.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$35.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$35.62
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$28.50
|
| Rate for Payer: BCBS Trust/PPO |
$93.72
|
| Rate for Payer: BCN Commercial |
$88.64
|
| Rate for Payer: BCN Medicare Advantage |
$28.50
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$98.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$28.50
|
| Rate for Payer: Healthscope Commercial |
$102.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.93
|
| Rate for Payer: MI Amish Medical Board Commercial |
$32.77
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.90
|
| Rate for Payer: Nomi Health Commercial |
$93.48
|
| Rate for Payer: PACE Senior Care Partners |
$27.07
|
| Rate for Payer: PACE SWMI |
$28.50
|
| Rate for Payer: PHP Commercial |
$96.90
|
| Rate for Payer: PHP Medicare Advantage |
$28.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO |
$99.18
|
| Rate for Payer: Priority Health Medicare |
$28.79
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.38
|
| Rate for Payer: Railroad Medicare Medicare |
$28.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$100.32
|
| Rate for Payer: UHC Core |
$95.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$28.50
|
| Rate for Payer: UHC Exchange |
$28.50
|
| Rate for Payer: UHC Medicare Advantage |
$28.50
|
| Rate for Payer: VA VA |
$28.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.50
|
|
|
CHG FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 76001
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$43.55 |
| Rate for Payer: Aetna Medicare |
$33.50
|
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
|
