|
CHG INTERSTITIAL RADIATION SOURCE APPLIC COMPLEX
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 77778
|
| Min. Negotiated Rate |
$212.80 |
| Max. Negotiated Rate |
$1,233.68 |
| Rate for Payer: Aetna Commercial |
$1,148.00
|
| Rate for Payer: Aetna Commercial |
$1,148.00
|
| Rate for Payer: Aetna Medicare |
$890.99
|
| Rate for Payer: Aetna Medicare |
$890.99
|
| Rate for Payer: BCBS Complete |
$212.80
|
| Rate for Payer: BCBS Complete |
$683.60
|
| Rate for Payer: BCBS MAPPO |
$856.72
|
| Rate for Payer: BCBS MAPPO |
$856.72
|
| Rate for Payer: BCN Medicare Advantage |
$856.72
|
| Rate for Payer: BCN Medicare Advantage |
$856.72
|
| Rate for Payer: Cash Price |
$1,367.20
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$1,367.20
|
| Rate for Payer: Cofinity Commercial |
$1,148.00
|
| Rate for Payer: Cofinity Commercial |
$1,233.68
|
| Rate for Payer: Cofinity Commercial |
$1,233.68
|
| Rate for Payer: Cofinity Commercial |
$1,148.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$856.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$856.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$899.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$899.56
|
| Rate for Payer: Nomi Health Commercial |
$1,028.06
|
| Rate for Payer: Nomi Health Commercial |
$1,028.06
|
| Rate for Payer: PACE SWMI |
$856.72
|
| Rate for Payer: PACE SWMI |
$856.72
|
| Rate for Payer: PHP Medicare Advantage |
$856.72
|
| Rate for Payer: PHP Medicare Advantage |
$856.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,110.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health Medicare |
$865.29
|
| Rate for Payer: Priority Health Medicare |
$865.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$856.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$856.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$856.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$856.72
|
| Rate for Payer: UHC Exchange |
$856.72
|
| Rate for Payer: UHC Exchange |
$856.72
|
| Rate for Payer: UHC Medicare Advantage |
$856.72
|
| Rate for Payer: UHC Medicare Advantage |
$856.72
|
|
|
CHG INTRACAVITARY RADIATION SOURCE APPLIC SIMPLE
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
HCPCS 77761
|
| Min. Negotiated Rate |
$186.00 |
| Max. Negotiated Rate |
$562.33 |
| Rate for Payer: Aetna Commercial |
$523.28
|
| Rate for Payer: Aetna Medicare |
$406.13
|
| Rate for Payer: BCBS Complete |
$186.00
|
| Rate for Payer: BCBS MAPPO |
$390.51
|
| Rate for Payer: BCN Medicare Advantage |
$390.51
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cofinity Commercial |
$523.28
|
| Rate for Payer: Cofinity Commercial |
$562.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.04
|
| Rate for Payer: Nomi Health Commercial |
$468.61
|
| Rate for Payer: PACE SWMI |
$390.51
|
| Rate for Payer: PHP Medicare Advantage |
$390.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.25
|
| Rate for Payer: Priority Health Medicare |
$394.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$390.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.51
|
| Rate for Payer: UHC Exchange |
$390.51
|
| Rate for Payer: UHC Medicare Advantage |
$390.51
|
|
|
CHG INTRALUMINAL DILATION STRICTURES&/OBSTRCJS RS&I
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 74360
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$59.15 |
| Rate for Payer: Aetna Medicare |
$45.50
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
|
|
CHG INTRAVASC ULTRASOUND,1ST VESSEL
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
HCPCS 75945
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Aetna Medicare |
$42.50
|
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: BCBS Complete |
$89.60
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: Cash Price |
$179.20
|
| Rate for Payer: Cash Price |
$68.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
|
|
CHG INTRAVASC US, RAD SUPERISE/ INTERP, EA ADDN VESSEL
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 75946
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$101.40 |
| Rate for Payer: Aetna Medicare |
$78.00
|
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: BCBS Complete |
$62.40
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$101.40
|
|
|
CHG INTRO LONG GI TUBE W/MULT FLUORO & IMAGES RS&I
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 74340
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$136.50 |
| Rate for Payer: Aetna Medicare |
$105.00
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
|
|
CHG JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 77077
|
| Min. Negotiated Rate |
$42.16 |
| Max. Negotiated Rate |
$89.70 |
| Rate for Payer: Aetna Commercial |
$56.49
|
| Rate for Payer: Aetna Commercial |
$56.49
|
| Rate for Payer: Aetna Medicare |
$43.85
|
| Rate for Payer: Aetna Medicare |
$43.85
|
| Rate for Payer: BCBS Complete |
$24.40
|
| Rate for Payer: BCBS Complete |
$55.20
|
| Rate for Payer: BCBS MAPPO |
$42.16
|
| Rate for Payer: BCBS MAPPO |
$42.16
|
| Rate for Payer: BCN Medicare Advantage |
$42.16
|
| Rate for Payer: BCN Medicare Advantage |
$42.16
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$48.80
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cofinity Commercial |
$56.49
|
| Rate for Payer: Cofinity Commercial |
$60.71
|
| Rate for Payer: Cofinity Commercial |
$60.71
|
| Rate for Payer: Cofinity Commercial |
$56.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.27
|
| Rate for Payer: Nomi Health Commercial |
$50.59
|
| Rate for Payer: Nomi Health Commercial |
$50.59
|
| Rate for Payer: PACE SWMI |
$42.16
|
| Rate for Payer: PACE SWMI |
$42.16
|
| Rate for Payer: PHP Medicare Advantage |
$42.16
|
| Rate for Payer: PHP Medicare Advantage |
$42.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.65
|
| Rate for Payer: Priority Health Medicare |
$42.58
|
| Rate for Payer: Priority Health Medicare |
$42.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.16
|
| Rate for Payer: UHC Exchange |
$42.16
|
| Rate for Payer: UHC Exchange |
$42.16
|
| Rate for Payer: UHC Medicare Advantage |
$42.16
|
| Rate for Payer: UHC Medicare Advantage |
$42.16
|
|
|
CHG LIPID PANEL
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 80061
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$29.25 |
| Rate for Payer: Aetna Commercial |
$17.94
|
| Rate for Payer: Aetna Medicare |
$13.93
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS MAPPO |
$13.39
|
| Rate for Payer: BCN Medicare Advantage |
$13.39
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cofinity Commercial |
$19.28
|
| Rate for Payer: Cofinity Commercial |
$17.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$14.06
|
| Rate for Payer: Nomi Health Commercial |
$16.07
|
| Rate for Payer: PACE SWMI |
$13.39
|
| Rate for Payer: PHP Medicare Advantage |
$13.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Medicare |
$13.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.39
|
| Rate for Payer: UHC Exchange |
$13.39
|
| Rate for Payer: UHC Medicare Advantage |
$13.39
|
|
|
CHG MANUAL APPL STRESS PHYS/QHP JOINT RADIOGRAPHY
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS 77071
|
| Min. Negotiated Rate |
$37.60 |
| Max. Negotiated Rate |
$71.60 |
| Rate for Payer: Aetna Commercial |
$66.62
|
| Rate for Payer: Aetna Commercial |
$66.62
|
| Rate for Payer: Aetna Medicare |
$51.71
|
| Rate for Payer: Aetna Medicare |
$51.71
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: BCBS Complete |
$35.60
|
| Rate for Payer: BCBS MAPPO |
$49.72
|
| Rate for Payer: BCBS MAPPO |
$49.72
|
| Rate for Payer: BCN Medicare Advantage |
$49.72
|
| Rate for Payer: BCN Medicare Advantage |
$49.72
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$71.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$71.60
|
| Rate for Payer: Cofinity Commercial |
$71.60
|
| Rate for Payer: Cofinity Commercial |
$66.62
|
| Rate for Payer: Cofinity Commercial |
$66.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.21
|
| Rate for Payer: Nomi Health Commercial |
$59.66
|
| Rate for Payer: Nomi Health Commercial |
$59.66
|
| Rate for Payer: PACE SWMI |
$49.72
|
| Rate for Payer: PACE SWMI |
$49.72
|
| Rate for Payer: PHP Medicare Advantage |
$49.72
|
| Rate for Payer: PHP Medicare Advantage |
$49.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health Medicare |
$50.22
|
| Rate for Payer: Priority Health Medicare |
$50.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$49.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$49.72
|
| Rate for Payer: UHC Exchange |
$49.72
|
| Rate for Payer: UHC Exchange |
$49.72
|
| Rate for Payer: UHC Medicare Advantage |
$49.72
|
| Rate for Payer: UHC Medicare Advantage |
$49.72
|
|
|
CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 75902
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$110.74 |
| Rate for Payer: Aetna Commercial |
$103.05
|
| Rate for Payer: Aetna Medicare |
$79.98
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$76.90
|
| Rate for Payer: BCN Medicare Advantage |
$76.90
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$110.74
|
| Rate for Payer: Cofinity Commercial |
$103.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.75
|
| Rate for Payer: Nomi Health Commercial |
$92.28
|
| Rate for Payer: PACE SWMI |
$76.90
|
| Rate for Payer: PHP Medicare Advantage |
$76.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health Medicare |
$77.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$76.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.90
|
| Rate for Payer: UHC Exchange |
$76.90
|
| Rate for Payer: UHC Medicare Advantage |
$76.90
|
|
|
CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 75901
|
| Min. Negotiated Rate |
$135.60 |
| Max. Negotiated Rate |
$285.25 |
| Rate for Payer: Aetna Commercial |
$265.44
|
| Rate for Payer: Aetna Medicare |
$206.01
|
| Rate for Payer: BCBS Complete |
$135.60
|
| Rate for Payer: BCBS MAPPO |
$198.09
|
| Rate for Payer: BCN Medicare Advantage |
$198.09
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$285.25
|
| Rate for Payer: Cofinity Commercial |
$265.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.99
|
| Rate for Payer: Nomi Health Commercial |
$237.71
|
| Rate for Payer: PACE SWMI |
$198.09
|
| Rate for Payer: PHP Medicare Advantage |
$198.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health Medicare |
$200.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.09
|
| Rate for Payer: UHC Exchange |
$198.09
|
| Rate for Payer: UHC Medicare Advantage |
$198.09
|
|
|
CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
HCPCS 77338
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$626.36 |
| Rate for Payer: Aetna Commercial |
$582.86
|
| Rate for Payer: Aetna Commercial |
$582.86
|
| Rate for Payer: Aetna Commercial |
$582.86
|
| Rate for Payer: Aetna Medicare |
$452.37
|
| Rate for Payer: Aetna Medicare |
$452.37
|
| Rate for Payer: Aetna Medicare |
$452.37
|
| Rate for Payer: BCBS Complete |
$381.20
|
| Rate for Payer: BCBS Complete |
$210.00
|
| Rate for Payer: BCBS Complete |
$388.40
|
| Rate for Payer: BCBS MAPPO |
$434.97
|
| Rate for Payer: BCBS MAPPO |
$434.97
|
| Rate for Payer: BCBS MAPPO |
$434.97
|
| Rate for Payer: BCN Medicare Advantage |
$434.97
|
| Rate for Payer: BCN Medicare Advantage |
$434.97
|
| Rate for Payer: BCN Medicare Advantage |
$434.97
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$762.40
|
| Rate for Payer: Cash Price |
$762.40
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Cofinity Commercial |
$582.86
|
| Rate for Payer: Cofinity Commercial |
$626.36
|
| Rate for Payer: Cofinity Commercial |
$626.36
|
| Rate for Payer: Cofinity Commercial |
$582.86
|
| Rate for Payer: Cofinity Commercial |
$626.36
|
| Rate for Payer: Cofinity Commercial |
$582.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$456.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$456.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$456.72
|
| Rate for Payer: Nomi Health Commercial |
$521.96
|
| Rate for Payer: Nomi Health Commercial |
$521.96
|
| Rate for Payer: Nomi Health Commercial |
$521.96
|
| Rate for Payer: PACE SWMI |
$434.97
|
| Rate for Payer: PACE SWMI |
$434.97
|
| Rate for Payer: PACE SWMI |
$434.97
|
| Rate for Payer: PHP Medicare Advantage |
$434.97
|
| Rate for Payer: PHP Medicare Advantage |
$434.97
|
| Rate for Payer: PHP Medicare Advantage |
$434.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$619.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.25
|
| Rate for Payer: Priority Health Medicare |
$439.32
|
| Rate for Payer: Priority Health Medicare |
$439.32
|
| Rate for Payer: Priority Health Medicare |
$439.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$434.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$434.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$434.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$434.97
|
| Rate for Payer: UHC Exchange |
$434.97
|
| Rate for Payer: UHC Exchange |
$434.97
|
| Rate for Payer: UHC Exchange |
$434.97
|
| Rate for Payer: UHC Medicare Advantage |
$434.97
|
| Rate for Payer: UHC Medicare Advantage |
$434.97
|
| Rate for Payer: UHC Medicare Advantage |
$434.97
|
|
|
CHG MRA ABDOMEN W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 74185
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$444.11 |
| Rate for Payer: Aetna Commercial |
$413.27
|
| Rate for Payer: Aetna Medicare |
$320.75
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS MAPPO |
$308.41
|
| Rate for Payer: BCN Medicare Advantage |
$308.41
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$444.11
|
| Rate for Payer: Cofinity Commercial |
$413.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$323.83
|
| Rate for Payer: Nomi Health Commercial |
$370.09
|
| Rate for Payer: PACE SWMI |
$308.41
|
| Rate for Payer: PHP Medicare Advantage |
$308.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health Medicare |
$311.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$308.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.41
|
| Rate for Payer: UHC Exchange |
$308.41
|
| Rate for Payer: UHC Medicare Advantage |
$308.41
|
|
|
CHG MRA HEAD W/O CONTRST MATERIAL
|
Professional
|
Both
|
$686.00
|
|
|
Service Code
|
HCPCS 70544
|
| Min. Negotiated Rate |
$197.44 |
| Max. Negotiated Rate |
$445.90 |
| Rate for Payer: Aetna Commercial |
$264.57
|
| Rate for Payer: Aetna Commercial |
$264.57
|
| Rate for Payer: Aetna Medicare |
$205.34
|
| Rate for Payer: Aetna Medicare |
$205.34
|
| Rate for Payer: BCBS Complete |
$274.40
|
| Rate for Payer: BCBS Complete |
$95.60
|
| Rate for Payer: BCBS MAPPO |
$197.44
|
| Rate for Payer: BCBS MAPPO |
$197.44
|
| Rate for Payer: BCN Medicare Advantage |
$197.44
|
| Rate for Payer: BCN Medicare Advantage |
$197.44
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$284.31
|
| Rate for Payer: Cofinity Commercial |
$284.31
|
| Rate for Payer: Cofinity Commercial |
$264.57
|
| Rate for Payer: Cofinity Commercial |
$264.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.31
|
| Rate for Payer: Nomi Health Commercial |
$236.93
|
| Rate for Payer: Nomi Health Commercial |
$236.93
|
| Rate for Payer: PACE SWMI |
$197.44
|
| Rate for Payer: PACE SWMI |
$197.44
|
| Rate for Payer: PHP Medicare Advantage |
$197.44
|
| Rate for Payer: PHP Medicare Advantage |
$197.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health Medicare |
$199.41
|
| Rate for Payer: Priority Health Medicare |
$199.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.44
|
| Rate for Payer: UHC Exchange |
$197.44
|
| Rate for Payer: UHC Exchange |
$197.44
|
| Rate for Payer: UHC Medicare Advantage |
$197.44
|
| Rate for Payer: UHC Medicare Advantage |
$197.44
|
|
|
CHG MRA HEAD W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 70546
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$433.51 |
| Rate for Payer: Aetna Commercial |
$403.41
|
| Rate for Payer: Aetna Medicare |
$313.09
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: BCBS MAPPO |
$301.05
|
| Rate for Payer: BCN Medicare Advantage |
$301.05
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cofinity Commercial |
$433.51
|
| Rate for Payer: Cofinity Commercial |
$403.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$316.10
|
| Rate for Payer: Nomi Health Commercial |
$361.26
|
| Rate for Payer: PACE SWMI |
$301.05
|
| Rate for Payer: PHP Medicare Advantage |
$301.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: Priority Health Medicare |
$304.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.05
|
| Rate for Payer: UHC Exchange |
$301.05
|
| Rate for Payer: UHC Medicare Advantage |
$301.05
|
|
|
CHG MRA NECK W/O CONTRST MATERIAL
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 70547
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$285.16 |
| Rate for Payer: Aetna Commercial |
$265.36
|
| Rate for Payer: Aetna Medicare |
$205.95
|
| Rate for Payer: BCBS Complete |
$94.40
|
| Rate for Payer: BCBS MAPPO |
$198.03
|
| Rate for Payer: BCN Medicare Advantage |
$198.03
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cofinity Commercial |
$285.16
|
| Rate for Payer: Cofinity Commercial |
$265.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.93
|
| Rate for Payer: Nomi Health Commercial |
$237.64
|
| Rate for Payer: PACE SWMI |
$198.03
|
| Rate for Payer: PHP Medicare Advantage |
$198.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.40
|
| Rate for Payer: Priority Health Medicare |
$200.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$198.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.03
|
| Rate for Payer: UHC Exchange |
$198.03
|
| Rate for Payer: UHC Medicare Advantage |
$198.03
|
|
|
CHG MRA NECK W/O &W/CONTRAST MATERIAL
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 70549
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$455.33 |
| Rate for Payer: Aetna Commercial |
$423.71
|
| Rate for Payer: Aetna Medicare |
$328.85
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$316.20
|
| Rate for Payer: BCN Medicare Advantage |
$316.20
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$455.33
|
| Rate for Payer: Cofinity Commercial |
$423.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.01
|
| Rate for Payer: Nomi Health Commercial |
$379.44
|
| Rate for Payer: PACE SWMI |
$316.20
|
| Rate for Payer: PHP Medicare Advantage |
$316.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Medicare |
$319.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.20
|
| Rate for Payer: UHC Exchange |
$316.20
|
| Rate for Payer: UHC Medicare Advantage |
$316.20
|
|
|
CHG MRI ABDOMEN W/O CONTRAST FLWD BY W/CONTRAST
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS 74183
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$447.16 |
| Rate for Payer: Aetna Commercial |
$416.11
|
| Rate for Payer: Aetna Medicare |
$322.95
|
| Rate for Payer: BCBS Complete |
$90.40
|
| Rate for Payer: BCBS MAPPO |
$310.53
|
| Rate for Payer: BCN Medicare Advantage |
$310.53
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$447.16
|
| Rate for Payer: Cofinity Commercial |
$416.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$326.06
|
| Rate for Payer: Nomi Health Commercial |
$372.64
|
| Rate for Payer: PACE SWMI |
$310.53
|
| Rate for Payer: PHP Medicare Advantage |
$310.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
| Rate for Payer: Priority Health Medicare |
$313.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$310.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$310.53
|
| Rate for Payer: UHC Exchange |
$310.53
|
| Rate for Payer: UHC Medicare Advantage |
$310.53
|
|
|
CHG MRI ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 74181
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$259.63 |
| Rate for Payer: Aetna Commercial |
$241.60
|
| Rate for Payer: Aetna Medicare |
$187.51
|
| Rate for Payer: BCBS Complete |
$60.40
|
| Rate for Payer: BCBS MAPPO |
$180.30
|
| Rate for Payer: BCN Medicare Advantage |
$180.30
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cofinity Commercial |
$259.63
|
| Rate for Payer: Cofinity Commercial |
$241.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.31
|
| Rate for Payer: Nomi Health Commercial |
$216.36
|
| Rate for Payer: PACE SWMI |
$180.30
|
| Rate for Payer: PHP Medicare Advantage |
$180.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.15
|
| Rate for Payer: Priority Health Medicare |
$182.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$180.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.30
|
| Rate for Payer: UHC Exchange |
$180.30
|
| Rate for Payer: UHC Medicare Advantage |
$180.30
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 73721
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$269.35 |
| Rate for Payer: Aetna Commercial |
$250.65
|
| Rate for Payer: Aetna Medicare |
$194.53
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$187.05
|
| Rate for Payer: BCN Medicare Advantage |
$187.05
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$269.35
|
| Rate for Payer: Cofinity Commercial |
$250.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.40
|
| Rate for Payer: Nomi Health Commercial |
$224.46
|
| Rate for Payer: PACE SWMI |
$187.05
|
| Rate for Payer: PHP Medicare Advantage |
$187.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$188.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.05
|
| Rate for Payer: UHC Exchange |
$187.05
|
| Rate for Payer: UHC Medicare Advantage |
$187.05
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 73723
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$505.94 |
| Rate for Payer: Aetna Commercial |
$470.81
|
| Rate for Payer: Aetna Medicare |
$365.40
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: BCBS MAPPO |
$351.35
|
| Rate for Payer: BCN Medicare Advantage |
$351.35
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$505.94
|
| Rate for Payer: Cofinity Commercial |
$470.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$351.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$368.92
|
| Rate for Payer: Nomi Health Commercial |
$421.62
|
| Rate for Payer: PACE SWMI |
$351.35
|
| Rate for Payer: PHP Medicare Advantage |
$351.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health Medicare |
$354.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$351.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$351.35
|
| Rate for Payer: UHC Exchange |
$351.35
|
| Rate for Payer: UHC Medicare Advantage |
$351.35
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 73222
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$408.93 |
| Rate for Payer: Aetna Commercial |
$380.53
|
| Rate for Payer: Aetna Medicare |
$295.34
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$283.98
|
| Rate for Payer: BCN Medicare Advantage |
$283.98
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$408.93
|
| Rate for Payer: Cofinity Commercial |
$380.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$283.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.18
|
| Rate for Payer: Nomi Health Commercial |
$340.78
|
| Rate for Payer: PACE SWMI |
$283.98
|
| Rate for Payer: PHP Medicare Advantage |
$283.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health Medicare |
$286.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$283.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$283.98
|
| Rate for Payer: UHC Exchange |
$283.98
|
| Rate for Payer: UHC Medicare Advantage |
$283.98
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 73221
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$269.78 |
| Rate for Payer: Aetna Commercial |
$251.05
|
| Rate for Payer: Aetna Medicare |
$194.84
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$187.35
|
| Rate for Payer: BCN Medicare Advantage |
$187.35
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$251.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.72
|
| Rate for Payer: Nomi Health Commercial |
$224.82
|
| Rate for Payer: PACE SWMI |
$187.35
|
| Rate for Payer: PHP Medicare Advantage |
$187.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$189.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$187.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.35
|
| Rate for Payer: UHC Exchange |
$187.35
|
| Rate for Payer: UHC Medicare Advantage |
$187.35
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 73223
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$507.21 |
| Rate for Payer: Aetna Commercial |
$471.99
|
| Rate for Payer: Aetna Medicare |
$366.32
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: BCBS MAPPO |
$352.23
|
| Rate for Payer: BCN Medicare Advantage |
$352.23
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$507.21
|
| Rate for Payer: Cofinity Commercial |
$471.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.84
|
| Rate for Payer: Nomi Health Commercial |
$422.68
|
| Rate for Payer: PACE SWMI |
$352.23
|
| Rate for Payer: PHP Medicare Advantage |
$352.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health Medicare |
$355.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$352.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.23
|
| Rate for Payer: UHC Exchange |
$352.23
|
| Rate for Payer: UHC Medicare Advantage |
$352.23
|
|
|
CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 70552
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$358.37 |
| Rate for Payer: Aetna Commercial |
$333.49
|
| Rate for Payer: Aetna Medicare |
$258.82
|
| Rate for Payer: BCBS Complete |
$150.80
|
| Rate for Payer: BCBS MAPPO |
$248.87
|
| Rate for Payer: BCN Medicare Advantage |
$248.87
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cofinity Commercial |
$358.37
|
| Rate for Payer: Cofinity Commercial |
$333.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.31
|
| Rate for Payer: Nomi Health Commercial |
$298.64
|
| Rate for Payer: PACE SWMI |
$248.87
|
| Rate for Payer: PHP Medicare Advantage |
$248.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health Medicare |
$251.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$248.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.87
|
| Rate for Payer: UHC Exchange |
$248.87
|
| Rate for Payer: UHC Medicare Advantage |
$248.87
|
|
