|
CHG CHEST X-RAY 2 VW
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 71020
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: Aetna Medicare |
$22.00
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
|
|
CHG CHOLANGIOGRAPHY&/PANCREATOGRAPHY NTRAOP RS&I
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS 74300
|
| Min. Negotiated Rate |
$11.20 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Aetna Medicare |
$14.00
|
| Rate for Payer: BCBS Complete |
$11.20
|
| Rate for Payer: Cash Price |
$22.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.20
|
| Rate for Payer: UMR Bronson Commercial |
$12.88
|
|
|
CHG CHOLESTEROL SERUM/WHOLE BLOOD TOTAL
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 82465
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Aetna Commercial |
$5.83
|
| Rate for Payer: Aetna Medicare |
$4.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.26
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$4.35
|
| Rate for Payer: BCN Medicare Advantage |
$4.35
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$5.83
|
| Rate for Payer: Cofinity Commercial |
$6.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.57
|
| Rate for Payer: Nomi Health Commercial |
$5.22
|
| Rate for Payer: PACE SWMI |
$4.35
|
| Rate for Payer: PHP Commercial |
$6.09
|
| Rate for Payer: PHP Medicare Advantage |
$4.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$4.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.35
|
| Rate for Payer: UHC Medicare Advantage |
$4.35
|
| Rate for Payer: UMR Bronson Commercial |
$6.44
|
|
|
CHG COMPUTED TOMOGRAPHY THORAX LW DOSE LNG CA SCR C-
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 71271
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$183.12 |
| Rate for Payer: Aetna Commercial |
$170.41
|
| Rate for Payer: Aetna Medicare |
$132.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$170.41
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$127.17
|
| Rate for Payer: BCN Medicare Advantage |
$127.17
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$183.12
|
| Rate for Payer: Cofinity Commercial |
$170.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$127.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$133.53
|
| Rate for Payer: Nomi Health Commercial |
$152.60
|
| Rate for Payer: PACE SWMI |
$127.17
|
| Rate for Payer: PHP Commercial |
$178.04
|
| Rate for Payer: PHP Medicare Advantage |
$127.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health Medicare |
$127.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$127.17
|
| Rate for Payer: UHC Medicare Advantage |
$127.17
|
| Rate for Payer: UMR Bronson Commercial |
$51.52
|
|
|
CHG CONTINUING MEDICAL PHYSICS CONSLTJ PR WK
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
HCPCS 77336
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$117.12 |
| Rate for Payer: Aetna Commercial |
$108.98
|
| Rate for Payer: Aetna Medicare |
$84.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$117.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.98
|
| Rate for Payer: BCBS Complete |
$61.60
|
| Rate for Payer: BCBS MAPPO |
$81.33
|
| Rate for Payer: BCN Medicare Advantage |
$81.33
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cash Price |
$123.20
|
| Rate for Payer: Cofinity Commercial |
$117.12
|
| Rate for Payer: Cofinity Commercial |
$108.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.40
|
| Rate for Payer: Nomi Health Commercial |
$97.60
|
| Rate for Payer: PACE SWMI |
$81.33
|
| Rate for Payer: PHP Commercial |
$113.86
|
| Rate for Payer: PHP Medicare Advantage |
$81.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.10
|
| Rate for Payer: Priority Health Medicare |
$81.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.33
|
| Rate for Payer: UHC Medicare Advantage |
$81.33
|
| Rate for Payer: UMR Bronson Commercial |
$70.84
|
|
|
CHG CREATININE OTHER SOURCE
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS 82570
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$7.46 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.94
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$6.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Nomi Health Commercial |
$6.22
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$7.25
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UMR Bronson Commercial |
$5.06
|
|
|
CHG CRYSTAL ID LIGHT MICROSCOPY ALYS TISS/ANY FLUID
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
HCPCS 89060
|
| Min. Negotiated Rate |
$7.33 |
| Max. Negotiated Rate |
$36.40 |
| Rate for Payer: Aetna Commercial |
$9.82
|
| Rate for Payer: Aetna Medicare |
$7.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.56
|
| Rate for Payer: BCBS Complete |
$22.40
|
| Rate for Payer: BCBS MAPPO |
$7.33
|
| Rate for Payer: BCN Medicare Advantage |
$7.33
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cash Price |
$44.80
|
| Rate for Payer: Cofinity Commercial |
$9.82
|
| Rate for Payer: Cofinity Commercial |
$10.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.70
|
| Rate for Payer: Nomi Health Commercial |
$8.80
|
| Rate for Payer: PACE SWMI |
$7.33
|
| Rate for Payer: PHP Commercial |
$10.26
|
| Rate for Payer: PHP Medicare Advantage |
$7.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$36.40
|
| Rate for Payer: Priority Health Medicare |
$7.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.33
|
| Rate for Payer: UHC Medicare Advantage |
$7.33
|
| Rate for Payer: UMR Bronson Commercial |
$25.76
|
|
|
CHG CTA ABDL AORTA&BI ILIOFEM W/CONTRAST&POSTP
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
HCPCS 75635
|
| Min. Negotiated Rate |
$122.40 |
| Max. Negotiated Rate |
$542.87 |
| Rate for Payer: Aetna Commercial |
$505.17
|
| Rate for Payer: Aetna Medicare |
$392.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$542.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$505.17
|
| Rate for Payer: BCBS Complete |
$122.40
|
| Rate for Payer: BCBS MAPPO |
$376.99
|
| Rate for Payer: BCN Medicare Advantage |
$376.99
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cofinity Commercial |
$542.87
|
| Rate for Payer: Cofinity Commercial |
$505.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$376.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$395.84
|
| Rate for Payer: Nomi Health Commercial |
$452.39
|
| Rate for Payer: PACE SWMI |
$376.99
|
| Rate for Payer: PHP Commercial |
$527.79
|
| Rate for Payer: PHP Medicare Advantage |
$376.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.90
|
| Rate for Payer: Priority Health Medicare |
$376.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$376.99
|
| Rate for Payer: UHC Medicare Advantage |
$376.99
|
| Rate for Payer: UMR Bronson Commercial |
$140.76
|
|
|
CHG CTA ABDOMEN W/CONTRAST&IMG POSTPROCESSING
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
HCPCS 74175
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$404.19 |
| Rate for Payer: Aetna Commercial |
$376.12
|
| Rate for Payer: Aetna Medicare |
$291.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$404.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$376.12
|
| Rate for Payer: BCBS Complete |
$74.80
|
| Rate for Payer: BCBS MAPPO |
$280.69
|
| Rate for Payer: BCN Medicare Advantage |
$280.69
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cash Price |
$149.60
|
| Rate for Payer: Cofinity Commercial |
$404.19
|
| Rate for Payer: Cofinity Commercial |
$376.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$280.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$294.72
|
| Rate for Payer: Nomi Health Commercial |
$336.83
|
| Rate for Payer: PACE SWMI |
$280.69
|
| Rate for Payer: PHP Commercial |
$392.97
|
| Rate for Payer: PHP Medicare Advantage |
$280.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$121.55
|
| Rate for Payer: Priority Health Medicare |
$280.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$280.69
|
| Rate for Payer: UHC Medicare Advantage |
$280.69
|
| Rate for Payer: UMR Bronson Commercial |
$86.02
|
|
|
CHG CTA ABD&PLVS W/CNTRST & IMG POSTPROCESSING
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
HCPCS 74174
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$502.16 |
| Rate for Payer: Aetna Commercial |
$467.28
|
| Rate for Payer: Aetna Medicare |
$362.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$467.28
|
| Rate for Payer: BCBS Complete |
$90.00
|
| Rate for Payer: BCBS MAPPO |
$348.72
|
| Rate for Payer: BCN Medicare Advantage |
$348.72
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cofinity Commercial |
$502.16
|
| Rate for Payer: Cofinity Commercial |
$467.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$348.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$366.16
|
| Rate for Payer: Nomi Health Commercial |
$418.46
|
| Rate for Payer: PACE SWMI |
$348.72
|
| Rate for Payer: PHP Commercial |
$488.21
|
| Rate for Payer: PHP Medicare Advantage |
$348.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.25
|
| Rate for Payer: Priority Health Medicare |
$348.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$348.72
|
| Rate for Payer: UHC Medicare Advantage |
$348.72
|
| Rate for Payer: UMR Bronson Commercial |
$103.50
|
|
|
CHG CT ABDOMEN & PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 74177
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$398.97 |
| Rate for Payer: Aetna Commercial |
$371.26
|
| Rate for Payer: Aetna Medicare |
$288.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$398.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$371.26
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS MAPPO |
$277.06
|
| Rate for Payer: BCN Medicare Advantage |
$277.06
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$398.97
|
| Rate for Payer: Cofinity Commercial |
$371.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$277.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$290.91
|
| Rate for Payer: Nomi Health Commercial |
$332.47
|
| Rate for Payer: PACE SWMI |
$277.06
|
| Rate for Payer: PHP Commercial |
$387.88
|
| Rate for Payer: PHP Medicare Advantage |
$277.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health Medicare |
$277.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$277.06
|
| Rate for Payer: UHC Medicare Advantage |
$277.06
|
| Rate for Payer: UMR Bronson Commercial |
$86.48
|
|
|
CHG CT ABDOMEN & PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 74176
|
| Min. Negotiated Rate |
$72.00 |
| Max. Negotiated Rate |
$245.64 |
| Rate for Payer: Aetna Commercial |
$228.58
|
| Rate for Payer: Aetna Medicare |
$177.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$228.58
|
| Rate for Payer: BCBS Complete |
$72.00
|
| Rate for Payer: BCBS MAPPO |
$170.58
|
| Rate for Payer: BCN Medicare Advantage |
$170.58
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$245.64
|
| Rate for Payer: Cofinity Commercial |
$228.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$170.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$179.11
|
| Rate for Payer: Nomi Health Commercial |
$204.70
|
| Rate for Payer: PACE SWMI |
$170.58
|
| Rate for Payer: PHP Commercial |
$238.81
|
| Rate for Payer: PHP Medicare Advantage |
$170.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.00
|
| Rate for Payer: Priority Health Medicare |
$170.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$170.58
|
| Rate for Payer: UHC Medicare Advantage |
$170.58
|
| Rate for Payer: UMR Bronson Commercial |
$82.80
|
|
|
CHG CT ABDOMEN W/CONTRAST MATERIAL
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 74160
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$304.13 |
| Rate for Payer: Aetna Commercial |
$283.01
|
| Rate for Payer: Aetna Commercial |
$283.01
|
| Rate for Payer: Aetna Medicare |
$219.65
|
| Rate for Payer: Aetna Medicare |
$219.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.01
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$211.20
|
| Rate for Payer: BCBS MAPPO |
$211.20
|
| Rate for Payer: BCN Medicare Advantage |
$211.20
|
| Rate for Payer: BCN Medicare Advantage |
$211.20
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$304.13
|
| Rate for Payer: Cofinity Commercial |
$283.01
|
| Rate for Payer: Cofinity Commercial |
$304.13
|
| Rate for Payer: Cofinity Commercial |
$283.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$211.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$221.76
|
| Rate for Payer: Nomi Health Commercial |
$253.44
|
| Rate for Payer: Nomi Health Commercial |
$253.44
|
| Rate for Payer: PACE SWMI |
$211.20
|
| Rate for Payer: PACE SWMI |
$211.20
|
| Rate for Payer: PHP Commercial |
$295.68
|
| Rate for Payer: PHP Commercial |
$295.68
|
| Rate for Payer: PHP Medicare Advantage |
$211.20
|
| Rate for Payer: PHP Medicare Advantage |
$211.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health Medicare |
$211.20
|
| Rate for Payer: Priority Health Medicare |
$211.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$211.20
|
| Rate for Payer: UHC Medicare Advantage |
$211.20
|
| Rate for Payer: UHC Medicare Advantage |
$211.20
|
| Rate for Payer: UMR Bronson Commercial |
$60.26
|
| Rate for Payer: UMR Bronson Commercial |
$60.72
|
|
|
CHG CT ABDOMEN W/O CONTRAST FLWD BY CONTRAST MATRL
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 74170
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$341.58 |
| Rate for Payer: Aetna Commercial |
$317.86
|
| Rate for Payer: Aetna Medicare |
$246.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$341.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.86
|
| Rate for Payer: BCBS Complete |
$57.60
|
| Rate for Payer: BCBS MAPPO |
$237.21
|
| Rate for Payer: BCN Medicare Advantage |
$237.21
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$341.58
|
| Rate for Payer: Cofinity Commercial |
$317.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.07
|
| Rate for Payer: Nomi Health Commercial |
$284.65
|
| Rate for Payer: PACE SWMI |
$237.21
|
| Rate for Payer: PHP Commercial |
$332.09
|
| Rate for Payer: PHP Medicare Advantage |
$237.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health Medicare |
$237.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.21
|
| Rate for Payer: UHC Medicare Advantage |
$237.21
|
| Rate for Payer: UMR Bronson Commercial |
$66.24
|
|
|
CHG CT ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 74150
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$181.77 |
| Rate for Payer: Aetna Commercial |
$169.15
|
| Rate for Payer: Aetna Medicare |
$131.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$181.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.15
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: BCBS MAPPO |
$126.23
|
| Rate for Payer: BCN Medicare Advantage |
$126.23
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cofinity Commercial |
$181.77
|
| Rate for Payer: Cofinity Commercial |
$169.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.54
|
| Rate for Payer: Nomi Health Commercial |
$151.48
|
| Rate for Payer: PACE SWMI |
$126.23
|
| Rate for Payer: PHP Commercial |
$176.72
|
| Rate for Payer: PHP Medicare Advantage |
$126.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: Priority Health Medicare |
$126.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.23
|
| Rate for Payer: UHC Medicare Advantage |
$126.23
|
| Rate for Payer: UMR Bronson Commercial |
$56.12
|
|
|
CHG CT ABD&PLV W/O CNTRST 1/BTH FLWD CNTRST 1/BTH
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 74178
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$446.56 |
| Rate for Payer: Aetna Commercial |
$415.55
|
| Rate for Payer: Aetna Medicare |
$322.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$446.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$415.55
|
| Rate for Payer: BCBS Complete |
$82.40
|
| Rate for Payer: BCBS MAPPO |
$310.11
|
| Rate for Payer: BCN Medicare Advantage |
$310.11
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$446.56
|
| Rate for Payer: Cofinity Commercial |
$415.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.62
|
| Rate for Payer: Nomi Health Commercial |
$372.13
|
| Rate for Payer: PACE SWMI |
$310.11
|
| Rate for Payer: PHP Commercial |
$434.15
|
| Rate for Payer: PHP Medicare Advantage |
$310.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.90
|
| Rate for Payer: Priority Health Medicare |
$310.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$310.11
|
| Rate for Payer: UHC Medicare Advantage |
$310.11
|
| Rate for Payer: UMR Bronson Commercial |
$94.76
|
|
|
CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 75574
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$429.45 |
| Rate for Payer: Aetna Commercial |
$399.63
|
| Rate for Payer: Aetna Medicare |
$310.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$429.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$399.63
|
| Rate for Payer: BCBS Complete |
$98.40
|
| Rate for Payer: BCBS MAPPO |
$298.23
|
| Rate for Payer: BCN Medicare Advantage |
$298.23
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$429.45
|
| Rate for Payer: Cofinity Commercial |
$399.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.14
|
| Rate for Payer: Nomi Health Commercial |
$357.88
|
| Rate for Payer: PACE SWMI |
$298.23
|
| Rate for Payer: PHP Commercial |
$417.52
|
| Rate for Payer: PHP Medicare Advantage |
$298.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.90
|
| Rate for Payer: Priority Health Medicare |
$298.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.23
|
| Rate for Payer: UHC Medicare Advantage |
$298.23
|
| Rate for Payer: UMR Bronson Commercial |
$113.16
|
|
|
CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 71275
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$373.64 |
| Rate for Payer: Aetna Commercial |
$347.69
|
| Rate for Payer: Aetna Medicare |
$269.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$373.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$347.69
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS MAPPO |
$259.47
|
| Rate for Payer: BCN Medicare Advantage |
$259.47
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$373.64
|
| Rate for Payer: Cofinity Commercial |
$347.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$272.44
|
| Rate for Payer: Nomi Health Commercial |
$311.36
|
| Rate for Payer: PACE SWMI |
$259.47
|
| Rate for Payer: PHP Commercial |
$363.26
|
| Rate for Payer: PHP Medicare Advantage |
$259.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health Medicare |
$259.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.47
|
| Rate for Payer: UHC Medicare Advantage |
$259.47
|
| Rate for Payer: UMR Bronson Commercial |
$86.48
|
|
|
CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 70496
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$365.89 |
| Rate for Payer: Aetna Commercial |
$340.48
|
| Rate for Payer: Aetna Medicare |
$264.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.48
|
| Rate for Payer: BCBS Complete |
$72.40
|
| Rate for Payer: BCBS MAPPO |
$254.09
|
| Rate for Payer: BCN Medicare Advantage |
$254.09
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$365.89
|
| Rate for Payer: Cofinity Commercial |
$340.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$254.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$266.79
|
| Rate for Payer: Nomi Health Commercial |
$304.91
|
| Rate for Payer: PACE SWMI |
$254.09
|
| Rate for Payer: PHP Commercial |
$355.73
|
| Rate for Payer: PHP Medicare Advantage |
$254.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health Medicare |
$254.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$254.09
|
| Rate for Payer: UHC Medicare Advantage |
$254.09
|
| Rate for Payer: UMR Bronson Commercial |
$83.26
|
|
|
CHG CT ANGIOGRAPHY LOWER EXTREMITY
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 73706
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$426.70 |
| Rate for Payer: Aetna Commercial |
$397.07
|
| Rate for Payer: Aetna Medicare |
$308.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$426.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$397.07
|
| Rate for Payer: BCBS Complete |
$77.60
|
| Rate for Payer: BCBS MAPPO |
$296.32
|
| Rate for Payer: BCN Medicare Advantage |
$296.32
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$426.70
|
| Rate for Payer: Cofinity Commercial |
$397.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.14
|
| Rate for Payer: Nomi Health Commercial |
$355.58
|
| Rate for Payer: PACE SWMI |
$296.32
|
| Rate for Payer: PHP Commercial |
$414.85
|
| Rate for Payer: PHP Medicare Advantage |
$296.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.10
|
| Rate for Payer: Priority Health Medicare |
$296.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.32
|
| Rate for Payer: UHC Medicare Advantage |
$296.32
|
| Rate for Payer: UMR Bronson Commercial |
$89.24
|
|
|
CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 70498
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$365.46 |
| Rate for Payer: Aetna Commercial |
$340.08
|
| Rate for Payer: Aetna Medicare |
$263.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.08
|
| Rate for Payer: BCBS Complete |
$72.40
|
| Rate for Payer: BCBS MAPPO |
$253.79
|
| Rate for Payer: BCN Medicare Advantage |
$253.79
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$365.46
|
| Rate for Payer: Cofinity Commercial |
$340.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$253.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$266.48
|
| Rate for Payer: Nomi Health Commercial |
$304.55
|
| Rate for Payer: PACE SWMI |
$253.79
|
| Rate for Payer: PHP Commercial |
$355.31
|
| Rate for Payer: PHP Medicare Advantage |
$253.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health Medicare |
$253.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$253.79
|
| Rate for Payer: UHC Medicare Advantage |
$253.79
|
| Rate for Payer: UMR Bronson Commercial |
$83.26
|
|
|
CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 72191
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$402.45 |
| Rate for Payer: Aetna Commercial |
$374.50
|
| Rate for Payer: Aetna Medicare |
$290.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$402.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$374.50
|
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: BCBS MAPPO |
$279.48
|
| Rate for Payer: BCN Medicare Advantage |
$279.48
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cofinity Commercial |
$402.45
|
| Rate for Payer: Cofinity Commercial |
$374.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.45
|
| Rate for Payer: Nomi Health Commercial |
$335.38
|
| Rate for Payer: PACE SWMI |
$279.48
|
| Rate for Payer: PHP Commercial |
$391.27
|
| Rate for Payer: PHP Medicare Advantage |
$279.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.25
|
| Rate for Payer: Priority Health Medicare |
$279.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.48
|
| Rate for Payer: UHC Medicare Advantage |
$279.48
|
| Rate for Payer: UMR Bronson Commercial |
$85.10
|
|
|
CHG CT ANGIOGRAPHY UPPER EXTREMITY
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 73206
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$393.24 |
| Rate for Payer: Aetna Commercial |
$365.93
|
| Rate for Payer: Aetna Medicare |
$284.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$393.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$365.93
|
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: BCBS MAPPO |
$273.08
|
| Rate for Payer: BCN Medicare Advantage |
$273.08
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cofinity Commercial |
$393.24
|
| Rate for Payer: Cofinity Commercial |
$365.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.73
|
| Rate for Payer: Nomi Health Commercial |
$327.70
|
| Rate for Payer: PACE SWMI |
$273.08
|
| Rate for Payer: PHP Commercial |
$382.31
|
| Rate for Payer: PHP Medicare Advantage |
$273.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.25
|
| Rate for Payer: Priority Health Medicare |
$273.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.08
|
| Rate for Payer: UHC Medicare Advantage |
$273.08
|
| Rate for Payer: UMR Bronson Commercial |
$85.10
|
|
|
CHG CT CERVICAL SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 72126
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$223.59 |
| Rate for Payer: Aetna Commercial |
$208.06
|
| Rate for Payer: Aetna Medicare |
$161.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$223.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.06
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$155.27
|
| Rate for Payer: BCN Medicare Advantage |
$155.27
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$223.59
|
| Rate for Payer: Cofinity Commercial |
$208.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.03
|
| Rate for Payer: Nomi Health Commercial |
$186.32
|
| Rate for Payer: PACE SWMI |
$155.27
|
| Rate for Payer: PHP Commercial |
$217.38
|
| Rate for Payer: PHP Medicare Advantage |
$155.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$155.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.27
|
| Rate for Payer: UHC Medicare Advantage |
$155.27
|
| Rate for Payer: UMR Bronson Commercial |
$57.50
|
|
|
CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 72125
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$172.79 |
| Rate for Payer: Aetna Commercial |
$160.79
|
| Rate for Payer: Aetna Medicare |
$124.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.79
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$119.99
|
| Rate for Payer: BCN Medicare Advantage |
$119.99
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$172.79
|
| Rate for Payer: Cofinity Commercial |
$160.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.99
|
| Rate for Payer: Nomi Health Commercial |
$143.99
|
| Rate for Payer: PACE SWMI |
$119.99
|
| Rate for Payer: PHP Commercial |
$167.99
|
| Rate for Payer: PHP Medicare Advantage |
$119.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$119.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.99
|
| Rate for Payer: UHC Medicare Advantage |
$119.99
|
| Rate for Payer: UMR Bronson Commercial |
$47.38
|
|
