|
CHG MANUAL APPL STRESS PHYS/QHP JOINT RADIOGRAPHY
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 77071
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$81.77 |
| Rate for Payer: Aetna Commercial |
$73.74
|
| Rate for Payer: Aetna Commercial |
$73.74
|
| Rate for Payer: Aetna Medicare |
$57.23
|
| Rate for Payer: Aetna Medicare |
$57.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$79.24
|
| Rate for Payer: BCBS Complete |
$39.14
|
| Rate for Payer: BCBS Complete |
$39.14
|
| Rate for Payer: BCBS MAPPO |
$55.03
|
| Rate for Payer: BCBS MAPPO |
$55.03
|
| Rate for Payer: BCN Commercial |
$81.17
|
| Rate for Payer: BCN Commercial |
$81.17
|
| Rate for Payer: BCN Medicare Advantage |
$55.03
|
| Rate for Payer: BCN Medicare Advantage |
$55.03
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Cofinity Commercial |
$73.74
|
| Rate for Payer: Cofinity Commercial |
$79.24
|
| Rate for Payer: Cofinity Commercial |
$73.74
|
| Rate for Payer: Cofinity Commercial |
$79.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$57.78
|
| Rate for Payer: Meridian Medicaid |
$39.14
|
| Rate for Payer: Meridian Medicaid |
$39.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$60.53
|
| Rate for Payer: Nomi Health Commercial |
$66.04
|
| Rate for Payer: Nomi Health Commercial |
$66.04
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$69.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$72.75
|
| Rate for Payer: PACE SWMI |
$55.03
|
| Rate for Payer: PACE SWMI |
$55.03
|
| Rate for Payer: PHP Commercial |
$77.04
|
| Rate for Payer: PHP Commercial |
$77.04
|
| Rate for Payer: PHP Medicare Advantage |
$55.03
|
| Rate for Payer: PHP Medicare Advantage |
$55.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$81.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$81.77
|
| Rate for Payer: Priority Health Medicare |
$55.03
|
| Rate for Payer: Priority Health Medicare |
$55.03
|
| Rate for Payer: Priority Health SBD |
$81.77
|
| Rate for Payer: Priority Health SBD |
$81.77
|
| Rate for Payer: Priority Health Tiered Network |
$81.77
|
| Rate for Payer: Priority Health Tiered Network |
$81.77
|
| Rate for Payer: Railroad Medicare Medicare |
$55.03
|
| Rate for Payer: Railroad Medicare Medicare |
$55.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.98
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$75.98
|
| Rate for Payer: UHC Core |
$75.98
|
| Rate for Payer: UHC Core |
$75.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$55.03
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$55.03
|
| Rate for Payer: UHC Exchange |
$75.98
|
| Rate for Payer: UHC Exchange |
$75.98
|
| Rate for Payer: UHC Medicaid |
$37.28
|
| Rate for Payer: UHC Medicaid |
$37.28
|
| Rate for Payer: UHCCP Medicaid |
$37.28
|
| Rate for Payer: UHCCP Medicaid |
$37.28
|
| Rate for Payer: UMR Bronson Commercial |
$42.32
|
| Rate for Payer: UMR Bronson Commercial |
$44.62
|
|
|
CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 75902
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$128.45 |
| Rate for Payer: Aetna Commercial |
$107.39
|
| Rate for Payer: Aetna Medicare |
$83.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.40
|
| Rate for Payer: BCBS MAPPO |
$80.14
|
| Rate for Payer: BCN Commercial |
$127.49
|
| Rate for Payer: BCN Medicare Advantage |
$80.14
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$107.39
|
| Rate for Payer: Cofinity Commercial |
$115.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.15
|
| Rate for Payer: Molina Medicare/Medicaid |
$88.15
|
| Rate for Payer: Nomi Health Commercial |
$96.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$29.25
|
| Rate for Payer: PACE SWMI |
$80.14
|
| Rate for Payer: PHP Commercial |
$112.20
|
| Rate for Payer: PHP Medicare Advantage |
$80.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$128.45
|
| Rate for Payer: Priority Health Medicare |
$80.14
|
| Rate for Payer: Priority Health SBD |
$128.45
|
| Rate for Payer: Priority Health Tiered Network |
$128.45
|
| Rate for Payer: Railroad Medicare Medicare |
$80.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$119.97
|
| Rate for Payer: UHC Core |
$119.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$80.14
|
| Rate for Payer: UHC Exchange |
$119.97
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
|
|
CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
HCPCS 75901
|
| Min. Negotiated Rate |
$160.54 |
| Max. Negotiated Rate |
$334.16 |
| Rate for Payer: Aetna Commercial |
$281.13
|
| Rate for Payer: Aetna Medicare |
$218.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.11
|
| Rate for Payer: BCBS MAPPO |
$209.80
|
| Rate for Payer: BCN Commercial |
$331.65
|
| Rate for Payer: BCN Medicare Advantage |
$209.80
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cash Price |
$279.20
|
| Rate for Payer: Cofinity Commercial |
$302.11
|
| Rate for Payer: Cofinity Commercial |
$281.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$230.78
|
| Rate for Payer: Nomi Health Commercial |
$251.76
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$261.75
|
| Rate for Payer: PACE SWMI |
$209.80
|
| Rate for Payer: PHP Commercial |
$293.72
|
| Rate for Payer: PHP Medicare Advantage |
$209.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$334.16
|
| Rate for Payer: Priority Health Medicare |
$209.80
|
| Rate for Payer: Priority Health SBD |
$334.16
|
| Rate for Payer: Priority Health Tiered Network |
$334.16
|
| Rate for Payer: Railroad Medicare Medicare |
$209.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$304.86
|
| Rate for Payer: UHC Core |
$304.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$209.80
|
| Rate for Payer: UHC Exchange |
$304.86
|
| Rate for Payer: UMR Bronson Commercial |
$160.54
|
|
|
CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN
|
Professional
|
Both
|
$982.00
|
|
|
Service Code
|
HCPCS 77338
|
| Min. Negotiated Rate |
$447.59 |
| Max. Negotiated Rate |
$736.50 |
| Rate for Payer: Aetna Commercial |
$599.77
|
| Rate for Payer: Aetna Commercial |
$599.77
|
| Rate for Payer: Aetna Commercial |
$599.77
|
| Rate for Payer: Aetna Medicare |
$465.49
|
| Rate for Payer: Aetna Medicare |
$465.49
|
| Rate for Payer: Aetna Medicare |
$465.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$599.77
|
| Rate for Payer: BCBS MAPPO |
$447.59
|
| Rate for Payer: BCBS MAPPO |
$447.59
|
| Rate for Payer: BCBS MAPPO |
$447.59
|
| Rate for Payer: BCN Commercial |
$732.58
|
| Rate for Payer: BCN Commercial |
$732.58
|
| Rate for Payer: BCN Commercial |
$732.58
|
| Rate for Payer: BCN Medicare Advantage |
$447.59
|
| Rate for Payer: BCN Medicare Advantage |
$447.59
|
| Rate for Payer: BCN Medicare Advantage |
$447.59
|
| Rate for Payer: Cash Price |
$432.80
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$432.80
|
| Rate for Payer: Cash Price |
$785.60
|
| Rate for Payer: Cash Price |
$785.60
|
| Rate for Payer: Cofinity Commercial |
$644.53
|
| Rate for Payer: Cofinity Commercial |
$644.53
|
| Rate for Payer: Cofinity Commercial |
$599.77
|
| Rate for Payer: Cofinity Commercial |
$599.77
|
| Rate for Payer: Cofinity Commercial |
$599.77
|
| Rate for Payer: Cofinity Commercial |
$644.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$447.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$469.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$492.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$492.35
|
| Rate for Payer: Molina Medicare/Medicaid |
$492.35
|
| Rate for Payer: Nomi Health Commercial |
$537.11
|
| Rate for Payer: Nomi Health Commercial |
$537.11
|
| Rate for Payer: Nomi Health Commercial |
$537.11
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$750.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$736.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$405.75
|
| Rate for Payer: PACE SWMI |
$447.59
|
| Rate for Payer: PACE SWMI |
$447.59
|
| Rate for Payer: PACE SWMI |
$447.59
|
| Rate for Payer: PHP Commercial |
$626.63
|
| Rate for Payer: PHP Commercial |
$626.63
|
| Rate for Payer: PHP Commercial |
$626.63
|
| Rate for Payer: PHP Medicare Advantage |
$447.59
|
| Rate for Payer: PHP Medicare Advantage |
$447.59
|
| Rate for Payer: PHP Medicare Advantage |
$447.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$715.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$715.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$715.96
|
| Rate for Payer: Priority Health Medicare |
$447.59
|
| Rate for Payer: Priority Health Medicare |
$447.59
|
| Rate for Payer: Priority Health Medicare |
$447.59
|
| Rate for Payer: Priority Health SBD |
$715.96
|
| Rate for Payer: Priority Health SBD |
$715.96
|
| Rate for Payer: Priority Health SBD |
$715.96
|
| Rate for Payer: Priority Health Tiered Network |
$715.96
|
| Rate for Payer: Priority Health Tiered Network |
$715.96
|
| Rate for Payer: Priority Health Tiered Network |
$715.96
|
| Rate for Payer: Railroad Medicare Medicare |
$447.59
|
| Rate for Payer: Railroad Medicare Medicare |
$447.59
|
| Rate for Payer: Railroad Medicare Medicare |
$447.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$698.19
|
| Rate for Payer: UHC Core |
$698.19
|
| Rate for Payer: UHC Core |
$698.19
|
| Rate for Payer: UHC Core |
$698.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$447.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$447.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$447.59
|
| Rate for Payer: UHC Exchange |
$698.19
|
| Rate for Payer: UHC Exchange |
$698.19
|
| Rate for Payer: UHC Exchange |
$698.19
|
| Rate for Payer: UMR Bronson Commercial |
$451.72
|
| Rate for Payer: UMR Bronson Commercial |
$460.00
|
| Rate for Payer: UMR Bronson Commercial |
$248.86
|
|
|
CHG MRA ABDOMEN W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 74185
|
| Min. Negotiated Rate |
$87.40 |
| Max. Negotiated Rate |
$545.21 |
| Rate for Payer: Aetna Commercial |
$418.98
|
| Rate for Payer: Aetna Medicare |
$325.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.24
|
| Rate for Payer: BCBS MAPPO |
$312.67
|
| Rate for Payer: BCN Commercial |
$510.44
|
| Rate for Payer: BCN Medicare Advantage |
$312.67
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$450.24
|
| Rate for Payer: Cofinity Commercial |
$418.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$343.94
|
| Rate for Payer: Nomi Health Commercial |
$375.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.50
|
| Rate for Payer: PACE SWMI |
$312.67
|
| Rate for Payer: PHP Commercial |
$437.74
|
| Rate for Payer: PHP Medicare Advantage |
$312.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$514.27
|
| Rate for Payer: Priority Health Medicare |
$312.67
|
| Rate for Payer: Priority Health SBD |
$514.27
|
| Rate for Payer: Priority Health Tiered Network |
$514.27
|
| Rate for Payer: Railroad Medicare Medicare |
$312.67
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$545.21
|
| Rate for Payer: UHC Core |
$545.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$312.67
|
| Rate for Payer: UHC Exchange |
$545.21
|
| Rate for Payer: UMR Bronson Commercial |
$87.40
|
|
|
CHG MRA HEAD W/O CONTRST MATERIAL
|
Professional
|
Both
|
$707.00
|
|
|
Service Code
|
HCPCS 70544
|
| Min. Negotiated Rate |
$200.20 |
| Max. Negotiated Rate |
$530.25 |
| Rate for Payer: Aetna Commercial |
$268.27
|
| Rate for Payer: Aetna Commercial |
$268.27
|
| Rate for Payer: Aetna Medicare |
$208.21
|
| Rate for Payer: Aetna Medicare |
$208.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.27
|
| Rate for Payer: BCBS MAPPO |
$200.20
|
| Rate for Payer: BCBS MAPPO |
$200.20
|
| Rate for Payer: BCN Commercial |
$326.68
|
| Rate for Payer: BCN Commercial |
$326.68
|
| Rate for Payer: BCN Medicare Advantage |
$200.20
|
| Rate for Payer: BCN Medicare Advantage |
$200.20
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$565.60
|
| Rate for Payer: Cofinity Commercial |
$268.27
|
| Rate for Payer: Cofinity Commercial |
$288.29
|
| Rate for Payer: Cofinity Commercial |
$288.29
|
| Rate for Payer: Cofinity Commercial |
$268.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$220.22
|
| Rate for Payer: Molina Medicare/Medicaid |
$220.22
|
| Rate for Payer: Nomi Health Commercial |
$240.24
|
| Rate for Payer: Nomi Health Commercial |
$240.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$184.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$530.25
|
| Rate for Payer: PACE SWMI |
$200.20
|
| Rate for Payer: PACE SWMI |
$200.20
|
| Rate for Payer: PHP Commercial |
$280.28
|
| Rate for Payer: PHP Commercial |
$280.28
|
| Rate for Payer: PHP Medicare Advantage |
$200.20
|
| Rate for Payer: PHP Medicare Advantage |
$200.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$329.13
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$329.13
|
| Rate for Payer: Priority Health Medicare |
$200.20
|
| Rate for Payer: Priority Health Medicare |
$200.20
|
| Rate for Payer: Priority Health SBD |
$329.13
|
| Rate for Payer: Priority Health SBD |
$329.13
|
| Rate for Payer: Priority Health Tiered Network |
$329.13
|
| Rate for Payer: Priority Health Tiered Network |
$329.13
|
| Rate for Payer: Railroad Medicare Medicare |
$200.20
|
| Rate for Payer: Railroad Medicare Medicare |
$200.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$345.12
|
| Rate for Payer: UHC Core |
$345.12
|
| Rate for Payer: UHC Core |
$345.12
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$200.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$200.20
|
| Rate for Payer: UHC Exchange |
$345.12
|
| Rate for Payer: UHC Exchange |
$345.12
|
| Rate for Payer: UMR Bronson Commercial |
$325.22
|
| Rate for Payer: UMR Bronson Commercial |
$113.16
|
|
|
CHG MRA HEAD W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
HCPCS 70546
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$521.57 |
| Rate for Payer: Aetna Commercial |
$407.64
|
| Rate for Payer: Aetna Medicare |
$316.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$407.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$438.06
|
| Rate for Payer: BCBS MAPPO |
$304.21
|
| Rate for Payer: BCN Commercial |
$499.97
|
| Rate for Payer: BCN Medicare Advantage |
$304.21
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cash Price |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$407.64
|
| Rate for Payer: Cofinity Commercial |
$438.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$304.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$319.42
|
| Rate for Payer: Molina Medicare/Medicaid |
$334.63
|
| Rate for Payer: Nomi Health Commercial |
$365.05
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$110.25
|
| Rate for Payer: PACE SWMI |
$304.21
|
| Rate for Payer: PHP Commercial |
$425.89
|
| Rate for Payer: PHP Medicare Advantage |
$304.21
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$503.74
|
| Rate for Payer: Priority Health Medicare |
$304.21
|
| Rate for Payer: Priority Health SBD |
$503.74
|
| Rate for Payer: Priority Health Tiered Network |
$503.74
|
| Rate for Payer: Railroad Medicare Medicare |
$304.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$521.57
|
| Rate for Payer: UHC Core |
$521.57
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$304.21
|
| Rate for Payer: UHC Exchange |
$521.57
|
| Rate for Payer: UMR Bronson Commercial |
$67.62
|
|
|
CHG MRA NECK W/O CONTRST MATERIAL
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 70547
|
| Min. Negotiated Rate |
$111.78 |
| Max. Negotiated Rate |
$346.59 |
| Rate for Payer: Aetna Commercial |
$268.27
|
| Rate for Payer: Aetna Medicare |
$208.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$268.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$288.29
|
| Rate for Payer: BCBS MAPPO |
$200.20
|
| Rate for Payer: BCN Commercial |
$327.67
|
| Rate for Payer: BCN Medicare Advantage |
$200.20
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cofinity Commercial |
$288.29
|
| Rate for Payer: Cofinity Commercial |
$268.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$200.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$210.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$220.22
|
| Rate for Payer: Nomi Health Commercial |
$240.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$182.25
|
| Rate for Payer: PACE SWMI |
$200.20
|
| Rate for Payer: PHP Commercial |
$280.28
|
| Rate for Payer: PHP Medicare Advantage |
$200.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$330.14
|
| Rate for Payer: Priority Health Medicare |
$200.20
|
| Rate for Payer: Priority Health SBD |
$330.14
|
| Rate for Payer: Priority Health Tiered Network |
$330.14
|
| Rate for Payer: Railroad Medicare Medicare |
$200.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$346.59
|
| Rate for Payer: UHC Core |
$346.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$200.20
|
| Rate for Payer: UHC Exchange |
$346.59
|
| Rate for Payer: UMR Bronson Commercial |
$111.78
|
|
|
CHG MRA NECK W/O &W/CONTRAST MATERIAL
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 70549
|
| Min. Negotiated Rate |
$132.94 |
| Max. Negotiated Rate |
$548.16 |
| Rate for Payer: Aetna Commercial |
$428.18
|
| Rate for Payer: Aetna Medicare |
$332.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$428.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$460.14
|
| Rate for Payer: BCBS MAPPO |
$319.54
|
| Rate for Payer: BCN Commercial |
$523.88
|
| Rate for Payer: BCN Medicare Advantage |
$319.54
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cofinity Commercial |
$428.18
|
| Rate for Payer: Cofinity Commercial |
$460.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$319.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$335.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$351.49
|
| Rate for Payer: Nomi Health Commercial |
$383.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$216.75
|
| Rate for Payer: PACE SWMI |
$319.54
|
| Rate for Payer: PHP Commercial |
$447.36
|
| Rate for Payer: PHP Medicare Advantage |
$319.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$527.83
|
| Rate for Payer: Priority Health Medicare |
$319.54
|
| Rate for Payer: Priority Health SBD |
$527.83
|
| Rate for Payer: Priority Health Tiered Network |
$527.83
|
| Rate for Payer: Railroad Medicare Medicare |
$319.54
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$548.16
|
| Rate for Payer: UHC Core |
$548.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$319.54
|
| Rate for Payer: UHC Exchange |
$548.16
|
| Rate for Payer: UMR Bronson Commercial |
$132.94
|
|
|
CHG MRI ABDOMEN W/O CONTRAST FLWD BY W/CONTRAST
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 74183
|
| Min. Negotiated Rate |
$107.18 |
| Max. Negotiated Rate |
$551.90 |
| Rate for Payer: Aetna Commercial |
$421.00
|
| Rate for Payer: Aetna Medicare |
$326.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$452.42
|
| Rate for Payer: BCBS MAPPO |
$314.18
|
| Rate for Payer: BCN Commercial |
$511.92
|
| Rate for Payer: BCN Medicare Advantage |
$314.18
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cofinity Commercial |
$452.42
|
| Rate for Payer: Cofinity Commercial |
$421.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$329.89
|
| Rate for Payer: Molina Medicare/Medicaid |
$345.60
|
| Rate for Payer: Nomi Health Commercial |
$377.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$174.75
|
| Rate for Payer: PACE SWMI |
$314.18
|
| Rate for Payer: PHP Commercial |
$439.85
|
| Rate for Payer: PHP Medicare Advantage |
$314.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$515.78
|
| Rate for Payer: Priority Health Medicare |
$314.18
|
| Rate for Payer: Priority Health SBD |
$515.78
|
| Rate for Payer: Priority Health Tiered Network |
$515.78
|
| Rate for Payer: Railroad Medicare Medicare |
$314.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$551.90
|
| Rate for Payer: UHC Core |
$551.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$314.18
|
| Rate for Payer: UHC Exchange |
$551.90
|
| Rate for Payer: UMR Bronson Commercial |
$107.18
|
|
|
CHG MRI ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
HCPCS 74181
|
| Min. Negotiated Rate |
$71.76 |
| Max. Negotiated Rate |
$318.81 |
| Rate for Payer: Aetna Commercial |
$243.41
|
| Rate for Payer: Aetna Medicare |
$188.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$261.58
|
| Rate for Payer: BCBS MAPPO |
$181.65
|
| Rate for Payer: BCN Commercial |
$296.30
|
| Rate for Payer: BCN Medicare Advantage |
$181.65
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cofinity Commercial |
$243.41
|
| Rate for Payer: Cofinity Commercial |
$261.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$190.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$199.81
|
| Rate for Payer: Nomi Health Commercial |
$217.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$117.00
|
| Rate for Payer: PACE SWMI |
$181.65
|
| Rate for Payer: PHP Commercial |
$254.31
|
| Rate for Payer: PHP Medicare Advantage |
$181.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$298.53
|
| Rate for Payer: Priority Health Medicare |
$181.65
|
| Rate for Payer: Priority Health SBD |
$298.53
|
| Rate for Payer: Priority Health Tiered Network |
$298.53
|
| Rate for Payer: Railroad Medicare Medicare |
$181.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$318.81
|
| Rate for Payer: UHC Core |
$318.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$181.65
|
| Rate for Payer: UHC Exchange |
$318.81
|
| Rate for Payer: UMR Bronson Commercial |
$71.76
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 73721
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$323.19 |
| Rate for Payer: Aetna Commercial |
$256.09
|
| Rate for Payer: Aetna Medicare |
$198.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.20
|
| Rate for Payer: BCBS MAPPO |
$191.11
|
| Rate for Payer: BCN Commercial |
$308.25
|
| Rate for Payer: BCN Medicare Advantage |
$191.11
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$275.20
|
| Rate for Payer: Cofinity Commercial |
$256.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$200.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$210.22
|
| Rate for Payer: Nomi Health Commercial |
$229.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.25
|
| Rate for Payer: PACE SWMI |
$191.11
|
| Rate for Payer: PHP Commercial |
$267.55
|
| Rate for Payer: PHP Medicare Advantage |
$191.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$310.56
|
| Rate for Payer: Priority Health Medicare |
$191.11
|
| Rate for Payer: Priority Health SBD |
$310.56
|
| Rate for Payer: Priority Health Tiered Network |
$310.56
|
| Rate for Payer: Railroad Medicare Medicare |
$191.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$323.19
|
| Rate for Payer: UHC Core |
$323.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$191.11
|
| Rate for Payer: UHC Exchange |
$323.19
|
| Rate for Payer: UMR Bronson Commercial |
$62.10
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 73723
|
| Min. Negotiated Rate |
$99.36 |
| Max. Negotiated Rate |
$634.78 |
| Rate for Payer: Aetna Commercial |
$476.29
|
| Rate for Payer: Aetna Medicare |
$369.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.83
|
| Rate for Payer: BCBS MAPPO |
$355.44
|
| Rate for Payer: BCN Commercial |
$581.14
|
| Rate for Payer: BCN Medicare Advantage |
$355.44
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$476.29
|
| Rate for Payer: Cofinity Commercial |
$511.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$355.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$373.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$390.98
|
| Rate for Payer: Nomi Health Commercial |
$426.53
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.00
|
| Rate for Payer: PACE SWMI |
$355.44
|
| Rate for Payer: PHP Commercial |
$497.62
|
| Rate for Payer: PHP Medicare Advantage |
$355.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$585.51
|
| Rate for Payer: Priority Health Medicare |
$355.44
|
| Rate for Payer: Priority Health SBD |
$585.51
|
| Rate for Payer: Priority Health Tiered Network |
$585.51
|
| Rate for Payer: Railroad Medicare Medicare |
$355.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$634.78
|
| Rate for Payer: UHC Core |
$634.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$355.44
|
| Rate for Payer: UHC Exchange |
$634.78
|
| Rate for Payer: UMR Bronson Commercial |
$99.36
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 73222
|
| Min. Negotiated Rate |
$74.98 |
| Max. Negotiated Rate |
$513.85 |
| Rate for Payer: Aetna Commercial |
$389.70
|
| Rate for Payer: Aetna Medicare |
$302.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$389.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$418.78
|
| Rate for Payer: BCBS MAPPO |
$290.82
|
| Rate for Payer: BCN Commercial |
$470.59
|
| Rate for Payer: BCN Medicare Advantage |
$290.82
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$418.78
|
| Rate for Payer: Cofinity Commercial |
$389.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$290.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$305.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$319.90
|
| Rate for Payer: Nomi Health Commercial |
$348.98
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.25
|
| Rate for Payer: PACE SWMI |
$290.82
|
| Rate for Payer: PHP Commercial |
$407.15
|
| Rate for Payer: PHP Medicare Advantage |
$290.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$474.13
|
| Rate for Payer: Priority Health Medicare |
$290.82
|
| Rate for Payer: Priority Health SBD |
$474.13
|
| Rate for Payer: Priority Health Tiered Network |
$474.13
|
| Rate for Payer: Railroad Medicare Medicare |
$290.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$513.85
|
| Rate for Payer: UHC Core |
$513.85
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$290.82
|
| Rate for Payer: UHC Exchange |
$513.85
|
| Rate for Payer: UMR Bronson Commercial |
$74.98
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 73221
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$324.75 |
| Rate for Payer: Aetna Commercial |
$256.90
|
| Rate for Payer: Aetna Medicare |
$199.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$256.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.08
|
| Rate for Payer: BCBS MAPPO |
$191.72
|
| Rate for Payer: BCN Commercial |
$308.75
|
| Rate for Payer: BCN Medicare Advantage |
$191.72
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$256.90
|
| Rate for Payer: Cofinity Commercial |
$276.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$191.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$201.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$210.89
|
| Rate for Payer: Nomi Health Commercial |
$230.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.25
|
| Rate for Payer: PACE SWMI |
$191.72
|
| Rate for Payer: PHP Commercial |
$268.41
|
| Rate for Payer: PHP Medicare Advantage |
$191.72
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$311.08
|
| Rate for Payer: Priority Health Medicare |
$191.72
|
| Rate for Payer: Priority Health SBD |
$311.08
|
| Rate for Payer: Priority Health Tiered Network |
$311.08
|
| Rate for Payer: Railroad Medicare Medicare |
$191.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$324.75
|
| Rate for Payer: UHC Core |
$324.75
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$191.72
|
| Rate for Payer: UHC Exchange |
$324.75
|
| Rate for Payer: UMR Bronson Commercial |
$62.10
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 73223
|
| Min. Negotiated Rate |
$99.36 |
| Max. Negotiated Rate |
$635.76 |
| Rate for Payer: Aetna Commercial |
$478.33
|
| Rate for Payer: Aetna Medicare |
$371.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$478.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.02
|
| Rate for Payer: BCBS MAPPO |
$356.96
|
| Rate for Payer: BCN Commercial |
$582.64
|
| Rate for Payer: BCN Medicare Advantage |
$356.96
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$514.02
|
| Rate for Payer: Cofinity Commercial |
$478.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$356.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$374.81
|
| Rate for Payer: Molina Medicare/Medicaid |
$392.66
|
| Rate for Payer: Nomi Health Commercial |
$428.35
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.00
|
| Rate for Payer: PACE SWMI |
$356.96
|
| Rate for Payer: PHP Commercial |
$499.74
|
| Rate for Payer: PHP Medicare Advantage |
$356.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$587.02
|
| Rate for Payer: Priority Health Medicare |
$356.96
|
| Rate for Payer: Priority Health SBD |
$587.02
|
| Rate for Payer: Priority Health Tiered Network |
$587.02
|
| Rate for Payer: Railroad Medicare Medicare |
$356.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$635.76
|
| Rate for Payer: UHC Core |
$635.76
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$356.96
|
| Rate for Payer: UHC Exchange |
$635.76
|
| Rate for Payer: UMR Bronson Commercial |
$99.36
|
|
|
CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
HCPCS 70552
|
| Min. Negotiated Rate |
$178.48 |
| Max. Negotiated Rate |
$435.90 |
| Rate for Payer: Aetna Commercial |
$336.89
|
| Rate for Payer: Aetna Medicare |
$261.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$336.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$362.03
|
| Rate for Payer: BCBS MAPPO |
$251.41
|
| Rate for Payer: BCN Commercial |
$410.33
|
| Rate for Payer: BCN Medicare Advantage |
$251.41
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cash Price |
$310.40
|
| Rate for Payer: Cofinity Commercial |
$336.89
|
| Rate for Payer: Cofinity Commercial |
$362.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$251.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$263.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$276.55
|
| Rate for Payer: Nomi Health Commercial |
$301.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$291.00
|
| Rate for Payer: PACE SWMI |
$251.41
|
| Rate for Payer: PHP Commercial |
$351.97
|
| Rate for Payer: PHP Medicare Advantage |
$251.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$413.43
|
| Rate for Payer: Priority Health Medicare |
$251.41
|
| Rate for Payer: Priority Health SBD |
$413.43
|
| Rate for Payer: Priority Health Tiered Network |
$413.43
|
| Rate for Payer: Railroad Medicare Medicare |
$251.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$435.90
|
| Rate for Payer: UHC Core |
$435.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$251.41
|
| Rate for Payer: UHC Exchange |
$435.90
|
| Rate for Payer: UMR Bronson Commercial |
$178.48
|
|
|
CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 70551
|
| Min. Negotiated Rate |
$154.10 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: Aetna Commercial |
$245.62
|
| Rate for Payer: Aetna Medicare |
$190.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.95
|
| Rate for Payer: BCBS MAPPO |
$183.30
|
| Rate for Payer: BCN Commercial |
$297.79
|
| Rate for Payer: BCN Medicare Advantage |
$183.30
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$263.95
|
| Rate for Payer: Cofinity Commercial |
$245.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$201.63
|
| Rate for Payer: Nomi Health Commercial |
$219.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$251.25
|
| Rate for Payer: PACE SWMI |
$183.30
|
| Rate for Payer: PHP Commercial |
$256.62
|
| Rate for Payer: PHP Medicare Advantage |
$183.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$300.03
|
| Rate for Payer: Priority Health Medicare |
$183.30
|
| Rate for Payer: Priority Health SBD |
$300.03
|
| Rate for Payer: Priority Health Tiered Network |
$300.03
|
| Rate for Payer: Railroad Medicare Medicare |
$183.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$316.00
|
| Rate for Payer: UHC Core |
$316.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$183.30
|
| Rate for Payer: UHC Exchange |
$316.00
|
| Rate for Payer: UMR Bronson Commercial |
$154.10
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 70553
|
| Min. Negotiated Rate |
$164.68 |
| Max. Negotiated Rate |
$516.01 |
| Rate for Payer: Aetna Commercial |
$398.02
|
| Rate for Payer: Aetna Medicare |
$308.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$427.72
|
| Rate for Payer: BCBS MAPPO |
$297.03
|
| Rate for Payer: BCN Commercial |
$483.54
|
| Rate for Payer: BCN Medicare Advantage |
$297.03
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cofinity Commercial |
$398.02
|
| Rate for Payer: Cofinity Commercial |
$427.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$326.73
|
| Rate for Payer: Nomi Health Commercial |
$356.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.50
|
| Rate for Payer: PACE SWMI |
$297.03
|
| Rate for Payer: PHP Commercial |
$415.84
|
| Rate for Payer: PHP Medicare Advantage |
$297.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$487.17
|
| Rate for Payer: Priority Health Medicare |
$297.03
|
| Rate for Payer: Priority Health SBD |
$487.17
|
| Rate for Payer: Priority Health Tiered Network |
$487.17
|
| Rate for Payer: Railroad Medicare Medicare |
$297.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$516.01
|
| Rate for Payer: UHC Core |
$516.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$297.03
|
| Rate for Payer: UHC Exchange |
$516.01
|
| Rate for Payer: UMR Bronson Commercial |
$164.68
|
|
|
CHG MRI GUIDANCE NEEDLE PLACEMENT RS&I
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 77021
|
| Min. Negotiated Rate |
$77.28 |
| Max. Negotiated Rate |
$651.33 |
| Rate for Payer: Aetna Commercial |
$528.70
|
| Rate for Payer: Aetna Medicare |
$410.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$528.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$568.15
|
| Rate for Payer: BCBS MAPPO |
$394.55
|
| Rate for Payer: BCN Commercial |
$620.98
|
| Rate for Payer: BCN Medicare Advantage |
$394.55
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$568.15
|
| Rate for Payer: Cofinity Commercial |
$528.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$414.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$434.00
|
| Rate for Payer: Nomi Health Commercial |
$473.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: PACE SWMI |
$394.55
|
| Rate for Payer: PHP Commercial |
$552.37
|
| Rate for Payer: PHP Medicare Advantage |
$394.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$625.66
|
| Rate for Payer: Priority Health Medicare |
$394.55
|
| Rate for Payer: Priority Health SBD |
$625.66
|
| Rate for Payer: Priority Health Tiered Network |
$625.66
|
| Rate for Payer: Railroad Medicare Medicare |
$394.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$651.33
|
| Rate for Payer: UHC Core |
$651.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$394.55
|
| Rate for Payer: UHC Exchange |
$651.33
|
| Rate for Payer: UMR Bronson Commercial |
$77.28
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 73718
|
| Min. Negotiated Rate |
$62.10 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Aetna Commercial |
$278.16
|
| Rate for Payer: Aetna Medicare |
$215.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$278.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.92
|
| Rate for Payer: BCBS MAPPO |
$207.58
|
| Rate for Payer: BCN Commercial |
$337.13
|
| Rate for Payer: BCN Medicare Advantage |
$207.58
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$278.16
|
| Rate for Payer: Cofinity Commercial |
$298.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$217.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$228.34
|
| Rate for Payer: Nomi Health Commercial |
$249.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.25
|
| Rate for Payer: PACE SWMI |
$207.58
|
| Rate for Payer: PHP Commercial |
$290.61
|
| Rate for Payer: PHP Medicare Advantage |
$207.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$339.68
|
| Rate for Payer: Priority Health Medicare |
$207.58
|
| Rate for Payer: Priority Health SBD |
$339.68
|
| Rate for Payer: Priority Health Tiered Network |
$339.68
|
| Rate for Payer: Railroad Medicare Medicare |
$207.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$363.00
|
| Rate for Payer: UHC Core |
$363.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$207.58
|
| Rate for Payer: UHC Exchange |
$363.00
|
| Rate for Payer: UMR Bronson Commercial |
$62.10
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 73720
|
| Min. Negotiated Rate |
$99.36 |
| Max. Negotiated Rate |
$550.20 |
| Rate for Payer: Aetna Commercial |
$419.49
|
| Rate for Payer: Aetna Medicare |
$325.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$419.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$450.79
|
| Rate for Payer: BCBS MAPPO |
$313.05
|
| Rate for Payer: BCN Commercial |
$510.44
|
| Rate for Payer: BCN Medicare Advantage |
$313.05
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$450.79
|
| Rate for Payer: Cofinity Commercial |
$419.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$344.36
|
| Rate for Payer: Nomi Health Commercial |
$375.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.00
|
| Rate for Payer: PACE SWMI |
$313.05
|
| Rate for Payer: PHP Commercial |
$438.27
|
| Rate for Payer: PHP Medicare Advantage |
$313.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$514.27
|
| Rate for Payer: Priority Health Medicare |
$313.05
|
| Rate for Payer: Priority Health SBD |
$514.27
|
| Rate for Payer: Priority Health Tiered Network |
$514.27
|
| Rate for Payer: Railroad Medicare Medicare |
$313.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$550.20
|
| Rate for Payer: UHC Core |
$550.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$313.05
|
| Rate for Payer: UHC Exchange |
$550.20
|
| Rate for Payer: UMR Bronson Commercial |
$99.36
|
|
|
CHG MRI ORBIT FACE &/NECK W/O CONTRAST
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 70540
|
| Min. Negotiated Rate |
$61.64 |
| Max. Negotiated Rate |
$367.44 |
| Rate for Payer: Aetna Commercial |
$280.61
|
| Rate for Payer: Aetna Medicare |
$217.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.55
|
| Rate for Payer: BCBS MAPPO |
$209.41
|
| Rate for Payer: BCN Commercial |
$342.12
|
| Rate for Payer: BCN Medicare Advantage |
$209.41
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$280.61
|
| Rate for Payer: Cofinity Commercial |
$301.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$230.35
|
| Rate for Payer: Nomi Health Commercial |
$251.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.50
|
| Rate for Payer: PACE SWMI |
$209.41
|
| Rate for Payer: PHP Commercial |
$293.17
|
| Rate for Payer: PHP Medicare Advantage |
$209.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$344.69
|
| Rate for Payer: Priority Health Medicare |
$209.41
|
| Rate for Payer: Priority Health SBD |
$344.69
|
| Rate for Payer: Priority Health Tiered Network |
$344.69
|
| Rate for Payer: Railroad Medicare Medicare |
$209.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$367.44
|
| Rate for Payer: UHC Core |
$367.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$209.41
|
| Rate for Payer: UHC Exchange |
$367.44
|
| Rate for Payer: UMR Bronson Commercial |
$61.64
|
|
|
CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 70543
|
| Min. Negotiated Rate |
$99.36 |
| Max. Negotiated Rate |
$549.22 |
| Rate for Payer: Aetna Commercial |
$421.94
|
| Rate for Payer: Aetna Medicare |
$327.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$421.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$453.43
|
| Rate for Payer: BCBS MAPPO |
$314.88
|
| Rate for Payer: BCN Commercial |
$513.42
|
| Rate for Payer: BCN Medicare Advantage |
$314.88
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$453.43
|
| Rate for Payer: Cofinity Commercial |
$421.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$346.37
|
| Rate for Payer: Nomi Health Commercial |
$377.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.00
|
| Rate for Payer: PACE SWMI |
$314.88
|
| Rate for Payer: PHP Commercial |
$440.83
|
| Rate for Payer: PHP Medicare Advantage |
$314.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$517.28
|
| Rate for Payer: Priority Health Medicare |
$314.88
|
| Rate for Payer: Priority Health SBD |
$517.28
|
| Rate for Payer: Priority Health Tiered Network |
$517.28
|
| Rate for Payer: Railroad Medicare Medicare |
$314.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$549.22
|
| Rate for Payer: UHC Core |
$549.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$314.88
|
| Rate for Payer: UHC Exchange |
$549.22
|
| Rate for Payer: UMR Bronson Commercial |
$99.36
|
|
|
CHG MRI PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 72195
|
| Min. Negotiated Rate |
$67.16 |
| Max. Negotiated Rate |
$375.41 |
| Rate for Payer: Aetna Commercial |
$284.68
|
| Rate for Payer: Aetna Medicare |
$220.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$284.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$305.93
|
| Rate for Payer: BCBS MAPPO |
$212.45
|
| Rate for Payer: BCN Commercial |
$345.59
|
| Rate for Payer: BCN Medicare Advantage |
$212.45
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$284.68
|
| Rate for Payer: Cofinity Commercial |
$305.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.69
|
| Rate for Payer: Nomi Health Commercial |
$254.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.50
|
| Rate for Payer: PACE SWMI |
$212.45
|
| Rate for Payer: PHP Commercial |
$297.43
|
| Rate for Payer: PHP Medicare Advantage |
$212.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$348.19
|
| Rate for Payer: Priority Health Medicare |
$212.45
|
| Rate for Payer: Priority Health SBD |
$348.19
|
| Rate for Payer: Priority Health Tiered Network |
$348.19
|
| Rate for Payer: Railroad Medicare Medicare |
$212.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$375.41
|
| Rate for Payer: UHC Core |
$375.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$212.45
|
| Rate for Payer: UHC Exchange |
$375.41
|
| Rate for Payer: UMR Bronson Commercial |
$67.16
|
|
