|
CHG CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 72127
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$259.99 |
| Rate for Payer: Aetna Commercial |
$241.94
|
| Rate for Payer: Aetna Medicare |
$187.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.94
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$180.55
|
| Rate for Payer: BCN Medicare Advantage |
$180.55
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$259.99
|
| Rate for Payer: Cofinity Commercial |
$241.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.58
|
| Rate for Payer: Nomi Health Commercial |
$216.66
|
| Rate for Payer: PACE SWMI |
$180.55
|
| Rate for Payer: PHP Commercial |
$252.77
|
| Rate for Payer: PHP Medicare Advantage |
$180.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$180.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.55
|
| Rate for Payer: UHC Medicare Advantage |
$180.55
|
| Rate for Payer: UMR Bronson Commercial |
$60.26
|
|
|
CHG CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 74263
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$928.81 |
| Rate for Payer: Aetna Commercial |
$864.31
|
| Rate for Payer: Aetna Medicare |
$670.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$928.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$864.31
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS MAPPO |
$645.01
|
| Rate for Payer: BCN Medicare Advantage |
$645.01
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$928.81
|
| Rate for Payer: Cofinity Commercial |
$864.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$645.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$677.26
|
| Rate for Payer: Nomi Health Commercial |
$774.01
|
| Rate for Payer: PACE SWMI |
$645.01
|
| Rate for Payer: PHP Commercial |
$903.01
|
| Rate for Payer: PHP Medicare Advantage |
$645.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health Medicare |
$645.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$645.01
|
| Rate for Payer: UHC Medicare Advantage |
$645.01
|
| Rate for Payer: UMR Bronson Commercial |
$108.10
|
|
|
CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
HCPCS 74262
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$608.50 |
| Rate for Payer: Aetna Commercial |
$566.24
|
| Rate for Payer: Aetna Medicare |
$439.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$608.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$566.24
|
| Rate for Payer: BCBS Complete |
$103.20
|
| Rate for Payer: BCBS MAPPO |
$422.57
|
| Rate for Payer: BCN Medicare Advantage |
$422.57
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cofinity Commercial |
$608.50
|
| Rate for Payer: Cofinity Commercial |
$566.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$422.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$443.70
|
| Rate for Payer: Nomi Health Commercial |
$507.08
|
| Rate for Payer: PACE SWMI |
$422.57
|
| Rate for Payer: PHP Commercial |
$591.60
|
| Rate for Payer: PHP Medicare Advantage |
$422.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.70
|
| Rate for Payer: Priority Health Medicare |
$422.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$422.57
|
| Rate for Payer: UHC Medicare Advantage |
$422.57
|
| Rate for Payer: UMR Bronson Commercial |
$118.68
|
|
|
CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 74261
|
| Min. Negotiated Rate |
$367.20 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Aetna Commercial |
$504.66
|
| Rate for Payer: Aetna Commercial |
$504.66
|
| Rate for Payer: Aetna Medicare |
$391.67
|
| Rate for Payer: Aetna Medicare |
$391.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$542.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$542.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$504.66
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS Complete |
$367.20
|
| Rate for Payer: BCBS MAPPO |
$376.61
|
| Rate for Payer: BCBS MAPPO |
$376.61
|
| Rate for Payer: BCN Medicare Advantage |
$376.61
|
| Rate for Payer: BCN Medicare Advantage |
$376.61
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$542.32
|
| Rate for Payer: Cofinity Commercial |
$504.66
|
| Rate for Payer: Cofinity Commercial |
$542.32
|
| Rate for Payer: Cofinity Commercial |
$504.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$376.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$376.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$395.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$395.44
|
| Rate for Payer: Nomi Health Commercial |
$451.93
|
| Rate for Payer: Nomi Health Commercial |
$451.93
|
| Rate for Payer: PACE SWMI |
$376.61
|
| Rate for Payer: PACE SWMI |
$376.61
|
| Rate for Payer: PHP Commercial |
$527.25
|
| Rate for Payer: PHP Commercial |
$527.25
|
| Rate for Payer: PHP Medicare Advantage |
$376.61
|
| Rate for Payer: PHP Medicare Advantage |
$376.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health Medicare |
$376.61
|
| Rate for Payer: Priority Health Medicare |
$376.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$376.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$376.61
|
| Rate for Payer: UHC Medicare Advantage |
$376.61
|
| Rate for Payer: UHC Medicare Advantage |
$376.61
|
| Rate for Payer: UMR Bronson Commercial |
$113.62
|
| Rate for Payer: UMR Bronson Commercial |
$422.28
|
|
|
CHG CT GUIDANCE &MONITORING VISC TISS ABLATION
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
HCPCS 77013
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$258.05 |
| Rate for Payer: Aetna Medicare |
$198.50
|
| Rate for Payer: BCBS Complete |
$158.80
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.05
|
| Rate for Payer: UMR Bronson Commercial |
$182.62
|
|
|
CHG CT GUIDANCE NEEDLE PLACEMENT
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 77012
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$167.72 |
| Rate for Payer: Aetna Commercial |
$156.07
|
| Rate for Payer: Aetna Medicare |
$121.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.72
|
| Rate for Payer: BCBS Complete |
$87.20
|
| Rate for Payer: BCBS MAPPO |
$116.47
|
| Rate for Payer: BCN Medicare Advantage |
$116.47
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cofinity Commercial |
$167.72
|
| Rate for Payer: Cofinity Commercial |
$156.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.29
|
| Rate for Payer: Nomi Health Commercial |
$139.76
|
| Rate for Payer: PACE SWMI |
$116.47
|
| Rate for Payer: PHP Commercial |
$163.06
|
| Rate for Payer: PHP Medicare Advantage |
$116.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.70
|
| Rate for Payer: Priority Health Medicare |
$116.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.47
|
| Rate for Payer: UHC Medicare Advantage |
$116.47
|
| Rate for Payer: UMR Bronson Commercial |
$100.28
|
|
|
CHG CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
HCPCS 77014
|
| Min. Negotiated Rate |
$108.36 |
| Max. Negotiated Rate |
$209.30 |
| Rate for Payer: Aetna Commercial |
$145.20
|
| Rate for Payer: Aetna Commercial |
$145.20
|
| Rate for Payer: Aetna Medicare |
$112.69
|
| Rate for Payer: Aetna Medicare |
$112.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.04
|
| Rate for Payer: BCBS Complete |
$97.20
|
| Rate for Payer: BCBS Complete |
$128.80
|
| Rate for Payer: BCBS MAPPO |
$108.36
|
| Rate for Payer: BCBS MAPPO |
$108.36
|
| Rate for Payer: BCN Medicare Advantage |
$108.36
|
| Rate for Payer: BCN Medicare Advantage |
$108.36
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$145.20
|
| Rate for Payer: Cofinity Commercial |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$145.20
|
| Rate for Payer: Cofinity Commercial |
$156.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.78
|
| Rate for Payer: Nomi Health Commercial |
$130.03
|
| Rate for Payer: Nomi Health Commercial |
$130.03
|
| Rate for Payer: PACE SWMI |
$108.36
|
| Rate for Payer: PACE SWMI |
$108.36
|
| Rate for Payer: PHP Commercial |
$151.70
|
| Rate for Payer: PHP Commercial |
$151.70
|
| Rate for Payer: PHP Medicare Advantage |
$108.36
|
| Rate for Payer: PHP Medicare Advantage |
$108.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health Medicare |
$108.36
|
| Rate for Payer: Priority Health Medicare |
$108.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.36
|
| Rate for Payer: UHC Medicare Advantage |
$108.36
|
| Rate for Payer: UHC Medicare Advantage |
$108.36
|
| Rate for Payer: UMR Bronson Commercial |
$111.78
|
| Rate for Payer: UMR Bronson Commercial |
$148.12
|
|
|
CHG CT GUIDANCE STEREOTACTIC LOCALIZATION
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
HCPCS 77011
|
| Min. Negotiated Rate |
$186.40 |
| Max. Negotiated Rate |
$302.90 |
| Rate for Payer: Aetna Commercial |
$263.82
|
| Rate for Payer: Aetna Commercial |
$263.82
|
| Rate for Payer: Aetna Medicare |
$204.76
|
| Rate for Payer: Aetna Medicare |
$204.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$283.51
|
| Rate for Payer: BCBS Complete |
$186.40
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: BCBS MAPPO |
$196.88
|
| Rate for Payer: BCBS MAPPO |
$196.88
|
| Rate for Payer: BCN Medicare Advantage |
$196.88
|
| Rate for Payer: BCN Medicare Advantage |
$196.88
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cofinity Commercial |
$283.51
|
| Rate for Payer: Cofinity Commercial |
$283.51
|
| Rate for Payer: Cofinity Commercial |
$263.82
|
| Rate for Payer: Cofinity Commercial |
$263.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.72
|
| Rate for Payer: Nomi Health Commercial |
$236.26
|
| Rate for Payer: Nomi Health Commercial |
$236.26
|
| Rate for Payer: PACE SWMI |
$196.88
|
| Rate for Payer: PACE SWMI |
$196.88
|
| Rate for Payer: PHP Commercial |
$275.63
|
| Rate for Payer: PHP Commercial |
$275.63
|
| Rate for Payer: PHP Medicare Advantage |
$196.88
|
| Rate for Payer: PHP Medicare Advantage |
$196.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.90
|
| Rate for Payer: Priority Health Medicare |
$196.88
|
| Rate for Payer: Priority Health Medicare |
$196.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.88
|
| Rate for Payer: UHC Medicare Advantage |
$196.88
|
| Rate for Payer: UHC Medicare Advantage |
$196.88
|
| Rate for Payer: UMR Bronson Commercial |
$214.36
|
| Rate for Payer: UMR Bronson Commercial |
$61.64
|
|
|
CHG CT HEAD/BRAIN W/CONTRAST MATERIAL
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 70460
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$197.34 |
| Rate for Payer: Aetna Commercial |
$183.63
|
| Rate for Payer: Aetna Medicare |
$142.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$183.63
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS MAPPO |
$137.04
|
| Rate for Payer: BCN Medicare Advantage |
$137.04
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$197.34
|
| Rate for Payer: Cofinity Commercial |
$183.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.89
|
| Rate for Payer: Nomi Health Commercial |
$164.45
|
| Rate for Payer: PACE SWMI |
$137.04
|
| Rate for Payer: PHP Commercial |
$191.86
|
| Rate for Payer: PHP Medicare Advantage |
$137.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Medicare |
$137.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.04
|
| Rate for Payer: UHC Medicare Advantage |
$137.04
|
| Rate for Payer: UMR Bronson Commercial |
$53.82
|
|
|
CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 70450
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$142.04 |
| Rate for Payer: Aetna Commercial |
$132.18
|
| Rate for Payer: Aetna Medicare |
$102.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.18
|
| Rate for Payer: BCBS Complete |
$35.20
|
| Rate for Payer: BCBS MAPPO |
$98.64
|
| Rate for Payer: BCN Medicare Advantage |
$98.64
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$142.04
|
| Rate for Payer: Cofinity Commercial |
$132.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.57
|
| Rate for Payer: Nomi Health Commercial |
$118.37
|
| Rate for Payer: PACE SWMI |
$98.64
|
| Rate for Payer: PHP Commercial |
$138.10
|
| Rate for Payer: PHP Medicare Advantage |
$98.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.20
|
| Rate for Payer: Priority Health Medicare |
$98.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.64
|
| Rate for Payer: UHC Medicare Advantage |
$98.64
|
| Rate for Payer: UMR Bronson Commercial |
$40.48
|
|
|
CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 70470
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$230.28 |
| Rate for Payer: Aetna Commercial |
$214.29
|
| Rate for Payer: Aetna Medicare |
$166.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$230.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.29
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$159.92
|
| Rate for Payer: BCN Medicare Advantage |
$159.92
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$230.28
|
| Rate for Payer: Cofinity Commercial |
$214.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.92
|
| Rate for Payer: Nomi Health Commercial |
$191.90
|
| Rate for Payer: PACE SWMI |
$159.92
|
| Rate for Payer: PHP Commercial |
$223.89
|
| Rate for Payer: PHP Medicare Advantage |
$159.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health Medicare |
$159.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.92
|
| Rate for Payer: UHC Medicare Advantage |
$159.92
|
| Rate for Payer: UMR Bronson Commercial |
$60.72
|
|
|
CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 75572
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$302.96 |
| Rate for Payer: Aetna Commercial |
$281.92
|
| Rate for Payer: Aetna Medicare |
$218.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$302.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$281.92
|
| Rate for Payer: BCBS Complete |
$71.60
|
| Rate for Payer: BCBS MAPPO |
$210.39
|
| Rate for Payer: BCN Medicare Advantage |
$210.39
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cofinity Commercial |
$302.96
|
| Rate for Payer: Cofinity Commercial |
$281.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.91
|
| Rate for Payer: Nomi Health Commercial |
$252.47
|
| Rate for Payer: PACE SWMI |
$210.39
|
| Rate for Payer: PHP Commercial |
$294.55
|
| Rate for Payer: PHP Medicare Advantage |
$210.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.35
|
| Rate for Payer: Priority Health Medicare |
$210.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.39
|
| Rate for Payer: UHC Medicare Advantage |
$210.39
|
| Rate for Payer: UMR Bronson Commercial |
$82.34
|
|
|
CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 75571
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$132.85 |
| Rate for Payer: Aetna Commercial |
$123.63
|
| Rate for Payer: Aetna Medicare |
$95.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.63
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS MAPPO |
$92.26
|
| Rate for Payer: BCN Medicare Advantage |
$92.26
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$132.85
|
| Rate for Payer: Cofinity Commercial |
$123.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.87
|
| Rate for Payer: Nomi Health Commercial |
$110.71
|
| Rate for Payer: PACE SWMI |
$92.26
|
| Rate for Payer: PHP Commercial |
$129.16
|
| Rate for Payer: PHP Medicare Advantage |
$92.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health Medicare |
$92.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.26
|
| Rate for Payer: UHC Medicare Advantage |
$92.26
|
| Rate for Payer: UMR Bronson Commercial |
$27.14
|
|
|
CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 76380
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$173.68 |
| Rate for Payer: Aetna Commercial |
$161.62
|
| Rate for Payer: Aetna Medicare |
$125.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$173.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$161.62
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$173.68
|
| Rate for Payer: Cofinity Commercial |
$161.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: Nomi Health Commercial |
$144.73
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PHP Commercial |
$168.85
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.61
|
| Rate for Payer: UHC Medicare Advantage |
$120.61
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 73701
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$205.46
|
| Rate for Payer: Aetna Medicare |
$159.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.46
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: BCBS MAPPO |
$153.33
|
| Rate for Payer: BCN Medicare Advantage |
$153.33
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cofinity Commercial |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$205.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.00
|
| Rate for Payer: Nomi Health Commercial |
$184.00
|
| Rate for Payer: PACE SWMI |
$153.33
|
| Rate for Payer: PHP Commercial |
$214.66
|
| Rate for Payer: PHP Medicare Advantage |
$153.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
| Rate for Payer: Priority Health Medicare |
$153.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.33
|
| Rate for Payer: UHC Medicare Advantage |
$153.33
|
| Rate for Payer: UMR Bronson Commercial |
$54.74
|
|
|
CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 73700
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$172.37 |
| Rate for Payer: Aetna Commercial |
$160.40
|
| Rate for Payer: Aetna Medicare |
$124.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.40
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$119.70
|
| Rate for Payer: BCN Medicare Advantage |
$119.70
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$172.37
|
| Rate for Payer: Cofinity Commercial |
$160.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.69
|
| Rate for Payer: Nomi Health Commercial |
$143.64
|
| Rate for Payer: PACE SWMI |
$119.70
|
| Rate for Payer: PHP Commercial |
$167.58
|
| Rate for Payer: PHP Medicare Advantage |
$119.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$119.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.70
|
| Rate for Payer: UHC Medicare Advantage |
$119.70
|
| Rate for Payer: UMR Bronson Commercial |
$47.38
|
|
|
CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 73702
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$257.96 |
| Rate for Payer: Aetna Commercial |
$240.05
|
| Rate for Payer: Aetna Medicare |
$186.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$257.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$240.05
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$179.14
|
| Rate for Payer: BCN Medicare Advantage |
$179.14
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$257.96
|
| Rate for Payer: Cofinity Commercial |
$240.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.10
|
| Rate for Payer: Nomi Health Commercial |
$214.97
|
| Rate for Payer: PACE SWMI |
$179.14
|
| Rate for Payer: PHP Commercial |
$250.80
|
| Rate for Payer: PHP Medicare Advantage |
$179.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$179.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.14
|
| Rate for Payer: UHC Medicare Advantage |
$179.14
|
| Rate for Payer: UMR Bronson Commercial |
$57.50
|
|
|
CHG CT LUMBAR SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 72132
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$224.44 |
| Rate for Payer: Aetna Commercial |
$208.85
|
| Rate for Payer: Aetna Medicare |
$162.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$224.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$208.85
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$155.86
|
| Rate for Payer: BCN Medicare Advantage |
$155.86
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$224.44
|
| Rate for Payer: Cofinity Commercial |
$208.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.65
|
| Rate for Payer: Nomi Health Commercial |
$187.03
|
| Rate for Payer: PACE SWMI |
$155.86
|
| Rate for Payer: PHP Commercial |
$218.20
|
| Rate for Payer: PHP Medicare Advantage |
$155.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$155.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.86
|
| Rate for Payer: UHC Medicare Advantage |
$155.86
|
| Rate for Payer: UMR Bronson Commercial |
$57.50
|
|
|
CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 72131
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Aetna Commercial |
$160.01
|
| Rate for Payer: Aetna Medicare |
$124.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.01
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$119.41
|
| Rate for Payer: BCN Medicare Advantage |
$119.41
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$171.95
|
| Rate for Payer: Cofinity Commercial |
$160.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.38
|
| Rate for Payer: Nomi Health Commercial |
$143.29
|
| Rate for Payer: PACE SWMI |
$119.41
|
| Rate for Payer: PHP Commercial |
$167.17
|
| Rate for Payer: PHP Medicare Advantage |
$119.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$119.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.41
|
| Rate for Payer: UHC Medicare Advantage |
$119.41
|
| Rate for Payer: UMR Bronson Commercial |
$47.38
|
|
|
CHG CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 72133
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$260.42 |
| Rate for Payer: Aetna Commercial |
$242.34
|
| Rate for Payer: Aetna Medicare |
$188.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.34
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$180.85
|
| Rate for Payer: BCN Medicare Advantage |
$180.85
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$260.42
|
| Rate for Payer: Cofinity Commercial |
$242.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.89
|
| Rate for Payer: Nomi Health Commercial |
$217.02
|
| Rate for Payer: PACE SWMI |
$180.85
|
| Rate for Payer: PHP Commercial |
$253.19
|
| Rate for Payer: PHP Medicare Advantage |
$180.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$180.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.85
|
| Rate for Payer: UHC Medicare Advantage |
$180.85
|
| Rate for Payer: UMR Bronson Commercial |
$60.26
|
|
|
CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 70487
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: Aetna Medicare |
$145.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$202.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$187.98
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: BCBS MAPPO |
$140.28
|
| Rate for Payer: BCN Medicare Advantage |
$140.28
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$202.00
|
| Rate for Payer: Cofinity Commercial |
$187.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.29
|
| Rate for Payer: Nomi Health Commercial |
$168.34
|
| Rate for Payer: PACE SWMI |
$140.28
|
| Rate for Payer: PHP Commercial |
$196.39
|
| Rate for Payer: PHP Medicare Advantage |
$140.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
| Rate for Payer: Priority Health Medicare |
$140.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.28
|
| Rate for Payer: UHC Medicare Advantage |
$140.28
|
| Rate for Payer: UMR Bronson Commercial |
$53.36
|
|
|
CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 70486
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$169.62 |
| Rate for Payer: Aetna Commercial |
$157.84
|
| Rate for Payer: Aetna Medicare |
$122.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$169.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.84
|
| Rate for Payer: BCBS Complete |
$35.20
|
| Rate for Payer: BCBS MAPPO |
$117.79
|
| Rate for Payer: BCN Medicare Advantage |
$117.79
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$169.62
|
| Rate for Payer: Cofinity Commercial |
$157.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.68
|
| Rate for Payer: Nomi Health Commercial |
$141.35
|
| Rate for Payer: PACE SWMI |
$117.79
|
| Rate for Payer: PHP Commercial |
$164.91
|
| Rate for Payer: PHP Medicare Advantage |
$117.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.20
|
| Rate for Payer: Priority Health Medicare |
$117.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.79
|
| Rate for Payer: UHC Medicare Advantage |
$117.79
|
| Rate for Payer: UMR Bronson Commercial |
$40.48
|
|
|
CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 70488
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$243.86 |
| Rate for Payer: Aetna Commercial |
$226.93
|
| Rate for Payer: Aetna Medicare |
$176.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$243.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$226.93
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$169.35
|
| Rate for Payer: BCN Medicare Advantage |
$169.35
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$243.86
|
| Rate for Payer: Cofinity Commercial |
$226.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.82
|
| Rate for Payer: Nomi Health Commercial |
$203.22
|
| Rate for Payer: PACE SWMI |
$169.35
|
| Rate for Payer: PHP Commercial |
$237.09
|
| Rate for Payer: PHP Medicare Advantage |
$169.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$169.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.35
|
| Rate for Payer: UHC Medicare Advantage |
$169.35
|
| Rate for Payer: UMR Bronson Commercial |
$60.26
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 70481
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$238.49 |
| Rate for Payer: Aetna Commercial |
$221.93
|
| Rate for Payer: Aetna Medicare |
$172.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$238.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.93
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS MAPPO |
$165.62
|
| Rate for Payer: BCN Medicare Advantage |
$165.62
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$238.49
|
| Rate for Payer: Cofinity Commercial |
$221.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.90
|
| Rate for Payer: Nomi Health Commercial |
$198.74
|
| Rate for Payer: PACE SWMI |
$165.62
|
| Rate for Payer: PHP Commercial |
$231.87
|
| Rate for Payer: PHP Medicare Advantage |
$165.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Medicare |
$165.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.62
|
| Rate for Payer: UHC Medicare Advantage |
$165.62
|
| Rate for Payer: UMR Bronson Commercial |
$53.82
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 70480
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$211.67 |
| Rate for Payer: Aetna Commercial |
$196.97
|
| Rate for Payer: Aetna Medicare |
$152.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$211.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.97
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS MAPPO |
$146.99
|
| Rate for Payer: BCN Medicare Advantage |
$146.99
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$211.67
|
| Rate for Payer: Cofinity Commercial |
$196.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.34
|
| Rate for Payer: Nomi Health Commercial |
$176.39
|
| Rate for Payer: PACE SWMI |
$146.99
|
| Rate for Payer: PHP Commercial |
$205.79
|
| Rate for Payer: PHP Medicare Advantage |
$146.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health Medicare |
$146.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.99
|
| Rate for Payer: UHC Medicare Advantage |
$146.99
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
|
