|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 70482
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$277.39 |
| Rate for Payer: Aetna Commercial |
$258.12
|
| Rate for Payer: Aetna Medicare |
$200.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$258.12
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$192.63
|
| Rate for Payer: BCN Medicare Advantage |
$192.63
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$277.39
|
| Rate for Payer: Cofinity Commercial |
$258.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.26
|
| Rate for Payer: Nomi Health Commercial |
$231.16
|
| Rate for Payer: PACE SWMI |
$192.63
|
| Rate for Payer: PHP Commercial |
$269.68
|
| Rate for Payer: PHP Medicare Advantage |
$192.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$192.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$192.63
|
| Rate for Payer: UHC Medicare Advantage |
$192.63
|
| Rate for Payer: UMR Bronson Commercial |
$60.26
|
|
|
CHG CT PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 72193
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$298.45 |
| Rate for Payer: Aetna Commercial |
$277.73
|
| Rate for Payer: Aetna Medicare |
$215.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.73
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: BCBS MAPPO |
$207.26
|
| Rate for Payer: BCN Medicare Advantage |
$207.26
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cofinity Commercial |
$298.45
|
| Rate for Payer: Cofinity Commercial |
$277.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$217.62
|
| Rate for Payer: Nomi Health Commercial |
$248.71
|
| Rate for Payer: PACE SWMI |
$207.26
|
| Rate for Payer: PHP Commercial |
$290.16
|
| Rate for Payer: PHP Medicare Advantage |
$207.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
| Rate for Payer: Priority Health Medicare |
$207.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$207.26
|
| Rate for Payer: UHC Medicare Advantage |
$207.26
|
| Rate for Payer: UMR Bronson Commercial |
$54.74
|
|
|
CHG CT PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 72192
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$177.11 |
| Rate for Payer: Aetna Commercial |
$164.81
|
| Rate for Payer: Aetna Medicare |
$127.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.81
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$122.99
|
| Rate for Payer: BCN Medicare Advantage |
$122.99
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$177.11
|
| Rate for Payer: Cofinity Commercial |
$164.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.14
|
| Rate for Payer: Nomi Health Commercial |
$147.59
|
| Rate for Payer: PACE SWMI |
$122.99
|
| Rate for Payer: PHP Commercial |
$172.19
|
| Rate for Payer: PHP Medicare Advantage |
$122.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health Medicare |
$122.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.99
|
| Rate for Payer: UHC Medicare Advantage |
$122.99
|
| Rate for Payer: UMR Bronson Commercial |
$51.52
|
|
|
CHG CT PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 72194
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$329.26 |
| Rate for Payer: Aetna Commercial |
$306.39
|
| Rate for Payer: Aetna Medicare |
$237.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$306.39
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$228.65
|
| Rate for Payer: BCN Medicare Advantage |
$228.65
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$329.26
|
| Rate for Payer: Cofinity Commercial |
$306.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$228.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.08
|
| Rate for Payer: Nomi Health Commercial |
$274.38
|
| Rate for Payer: PACE SWMI |
$228.65
|
| Rate for Payer: PHP Commercial |
$320.11
|
| Rate for Payer: PHP Medicare Advantage |
$228.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$228.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$228.65
|
| Rate for Payer: UHC Medicare Advantage |
$228.65
|
| Rate for Payer: UMR Bronson Commercial |
$57.50
|
|
|
CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 70491
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$244.32 |
| Rate for Payer: Aetna Commercial |
$227.36
|
| Rate for Payer: Aetna Medicare |
$176.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$227.36
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: BCBS MAPPO |
$169.67
|
| Rate for Payer: BCN Medicare Advantage |
$169.67
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cofinity Commercial |
$244.32
|
| Rate for Payer: Cofinity Commercial |
$227.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.15
|
| Rate for Payer: Nomi Health Commercial |
$203.60
|
| Rate for Payer: PACE SWMI |
$169.67
|
| Rate for Payer: PHP Commercial |
$237.54
|
| Rate for Payer: PHP Medicare Advantage |
$169.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: Priority Health Medicare |
$169.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.67
|
| Rate for Payer: UHC Medicare Advantage |
$169.67
|
| Rate for Payer: UMR Bronson Commercial |
$65.78
|
|
|
CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 70490
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$200.09 |
| Rate for Payer: Aetna Commercial |
$186.19
|
| Rate for Payer: Aetna Medicare |
$144.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$186.19
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS MAPPO |
$138.95
|
| Rate for Payer: BCN Medicare Advantage |
$138.95
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$200.09
|
| Rate for Payer: Cofinity Commercial |
$186.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.90
|
| Rate for Payer: Nomi Health Commercial |
$166.74
|
| Rate for Payer: PACE SWMI |
$138.95
|
| Rate for Payer: PHP Commercial |
$194.53
|
| Rate for Payer: PHP Medicare Advantage |
$138.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health Medicare |
$138.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.95
|
| Rate for Payer: UHC Medicare Advantage |
$138.95
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
|
|
CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 70492
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$292.97 |
| Rate for Payer: Aetna Commercial |
$272.62
|
| Rate for Payer: Aetna Medicare |
$211.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$292.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$272.62
|
| Rate for Payer: BCBS Complete |
$66.40
|
| Rate for Payer: BCBS MAPPO |
$203.45
|
| Rate for Payer: BCN Medicare Advantage |
$203.45
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$292.97
|
| Rate for Payer: Cofinity Commercial |
$272.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.62
|
| Rate for Payer: Nomi Health Commercial |
$244.14
|
| Rate for Payer: PACE SWMI |
$203.45
|
| Rate for Payer: PHP Commercial |
$284.83
|
| Rate for Payer: PHP Medicare Advantage |
$203.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.90
|
| Rate for Payer: Priority Health Medicare |
$203.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.45
|
| Rate for Payer: UHC Medicare Advantage |
$203.45
|
| Rate for Payer: UMR Bronson Commercial |
$76.36
|
|
|
CHG CT THORACIC SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 72129
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$225.84 |
| Rate for Payer: Aetna Commercial |
$210.15
|
| Rate for Payer: Aetna Medicare |
$163.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$225.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.15
|
| Rate for Payer: BCBS Complete |
$50.40
|
| Rate for Payer: BCBS MAPPO |
$156.83
|
| Rate for Payer: BCN Medicare Advantage |
$156.83
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$225.84
|
| Rate for Payer: Cofinity Commercial |
$210.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$164.67
|
| Rate for Payer: Nomi Health Commercial |
$188.20
|
| Rate for Payer: PACE SWMI |
$156.83
|
| Rate for Payer: PHP Commercial |
$219.56
|
| Rate for Payer: PHP Medicare Advantage |
$156.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health Medicare |
$156.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$156.83
|
| Rate for Payer: UHC Medicare Advantage |
$156.83
|
| Rate for Payer: UMR Bronson Commercial |
$57.96
|
|
|
CHG CT THORACIC SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 72128
|
| 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 THORACIC SPINE W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 72130
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$262.96 |
| Rate for Payer: Aetna Commercial |
$244.70
|
| Rate for Payer: Aetna Medicare |
$189.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.70
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$182.61
|
| Rate for Payer: BCN Medicare Advantage |
$182.61
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$262.96
|
| Rate for Payer: Cofinity Commercial |
$244.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.74
|
| Rate for Payer: Nomi Health Commercial |
$219.13
|
| Rate for Payer: PACE SWMI |
$182.61
|
| Rate for Payer: PHP Commercial |
$255.65
|
| Rate for Payer: PHP Medicare Advantage |
$182.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health Medicare |
$182.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.61
|
| Rate for Payer: UHC Medicare Advantage |
$182.61
|
| Rate for Payer: UMR Bronson Commercial |
$60.72
|
|
|
CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 73201
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$263.66 |
| Rate for Payer: Aetna Commercial |
$245.35
|
| Rate for Payer: Aetna Medicare |
$190.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.35
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: BCBS MAPPO |
$183.10
|
| Rate for Payer: BCN Medicare Advantage |
$183.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cofinity Commercial |
$263.66
|
| Rate for Payer: Cofinity Commercial |
$245.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.25
|
| Rate for Payer: Nomi Health Commercial |
$219.72
|
| Rate for Payer: PACE SWMI |
$183.10
|
| Rate for Payer: PHP Commercial |
$256.34
|
| Rate for Payer: PHP Medicare Advantage |
$183.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
| Rate for Payer: Priority Health Medicare |
$183.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.10
|
| Rate for Payer: UHC Medicare Advantage |
$183.10
|
| Rate for Payer: UMR Bronson Commercial |
$54.74
|
|
|
CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 73200
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$212.37 |
| Rate for Payer: Aetna Commercial |
$197.62
|
| Rate for Payer: Aetna Medicare |
$153.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.62
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$147.48
|
| Rate for Payer: BCN Medicare Advantage |
$147.48
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$212.37
|
| Rate for Payer: Cofinity Commercial |
$197.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.85
|
| Rate for Payer: Nomi Health Commercial |
$176.98
|
| Rate for Payer: PACE SWMI |
$147.48
|
| Rate for Payer: PHP Commercial |
$206.47
|
| Rate for Payer: PHP Medicare Advantage |
$147.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$147.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.48
|
| Rate for Payer: UHC Medicare Advantage |
$147.48
|
| Rate for Payer: UMR Bronson Commercial |
$47.38
|
|
|
CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 73202
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$323.86 |
| Rate for Payer: Aetna Commercial |
$301.37
|
| Rate for Payer: Aetna Medicare |
$233.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.37
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$224.90
|
| Rate for Payer: BCN Medicare Advantage |
$224.90
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$323.86
|
| Rate for Payer: Cofinity Commercial |
$301.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$224.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.15
|
| Rate for Payer: Nomi Health Commercial |
$269.88
|
| Rate for Payer: PACE SWMI |
$224.90
|
| Rate for Payer: PHP Commercial |
$314.86
|
| Rate for Payer: PHP Medicare Advantage |
$224.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$224.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$224.90
|
| Rate for Payer: UHC Medicare Advantage |
$224.90
|
| Rate for Payer: UMR Bronson Commercial |
$57.50
|
|
|
CHG CUL BACT XCPT URINE BLOOD/STOOL AEROBIC ISOL
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS 87070
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$24.05 |
| Rate for Payer: Aetna Commercial |
$11.55
|
| Rate for Payer: Aetna Medicare |
$8.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.55
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$8.62
|
| Rate for Payer: BCN Medicare Advantage |
$8.62
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| Rate for Payer: Cofinity Commercial |
$11.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.05
|
| Rate for Payer: Nomi Health Commercial |
$10.34
|
| Rate for Payer: PACE SWMI |
$8.62
|
| Rate for Payer: PHP Commercial |
$12.07
|
| Rate for Payer: PHP Medicare Advantage |
$8.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: Priority Health Medicare |
$8.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.62
|
| Rate for Payer: UHC Medicare Advantage |
$8.62
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
|
|
CHG CUL PRSMPTV PTHGNC ORGANISM SCRN W/COLONY ESTIMJ
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS 87081
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Aetna Commercial |
$8.88
|
| Rate for Payer: Aetna Medicare |
$6.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.88
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$6.63
|
| Rate for Payer: BCN Medicare Advantage |
$6.63
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$9.55
|
| Rate for Payer: Cofinity Commercial |
$8.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.96
|
| Rate for Payer: Nomi Health Commercial |
$7.96
|
| Rate for Payer: PACE SWMI |
$6.63
|
| Rate for Payer: PHP Commercial |
$9.28
|
| Rate for Payer: PHP Medicare Advantage |
$6.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health Medicare |
$6.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.63
|
| Rate for Payer: UHC Medicare Advantage |
$6.63
|
| Rate for Payer: UMR Bronson Commercial |
$9.66
|
|
|
CHG CULTURE BACTERIAL QUANTTATIVE COLONY COUNT URINE
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS 87086
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Aetna Commercial |
$10.81
|
| Rate for Payer: Aetna Medicare |
$8.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.81
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: BCBS MAPPO |
$8.07
|
| Rate for Payer: BCN Medicare Advantage |
$8.07
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Cofinity Commercial |
$11.62
|
| Rate for Payer: Cofinity Commercial |
$10.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.07
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$8.47
|
| Rate for Payer: Nomi Health Commercial |
$9.68
|
| Rate for Payer: PACE SWMI |
$8.07
|
| Rate for Payer: PHP Commercial |
$11.30
|
| Rate for Payer: PHP Medicare Advantage |
$8.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.35
|
| Rate for Payer: Priority Health Medicare |
$8.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.07
|
| Rate for Payer: UHC Medicare Advantage |
$8.07
|
| Rate for Payer: UMR Bronson Commercial |
$8.74
|
|
|
CHG CYSTOGRAPHY MINIMUM 3 VIEWS RS&I
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
HCPCS 74430
|
| Min. Negotiated Rate |
$37.72 |
| Max. Negotiated Rate |
$67.60 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Medicare |
$39.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.54
|
| Rate for Payer: BCBS Complete |
$41.60
|
| Rate for Payer: BCBS MAPPO |
$37.72
|
| Rate for Payer: BCN Medicare Advantage |
$37.72
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cash Price |
$83.20
|
| Rate for Payer: Cofinity Commercial |
$54.32
|
| Rate for Payer: Cofinity Commercial |
$50.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.61
|
| Rate for Payer: Nomi Health Commercial |
$45.26
|
| Rate for Payer: PACE SWMI |
$37.72
|
| Rate for Payer: PHP Commercial |
$52.81
|
| Rate for Payer: PHP Medicare Advantage |
$37.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.60
|
| Rate for Payer: Priority Health Medicare |
$37.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.72
|
| Rate for Payer: UHC Medicare Advantage |
$37.72
|
| Rate for Payer: UMR Bronson Commercial |
$47.84
|
|
|
CHG CYTP CERVICAL/VAGINAL REQ INTERP PHYSICIAN
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS 88141
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$41.60 |
| Rate for Payer: Aetna Commercial |
$30.73
|
| Rate for Payer: Aetna Medicare |
$23.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.73
|
| Rate for Payer: BCBS Complete |
$25.60
|
| Rate for Payer: BCBS MAPPO |
$22.93
|
| Rate for Payer: BCN Medicare Advantage |
$22.93
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cash Price |
$51.20
|
| Rate for Payer: Cofinity Commercial |
$33.02
|
| Rate for Payer: Cofinity Commercial |
$30.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$22.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.08
|
| Rate for Payer: Nomi Health Commercial |
$27.52
|
| Rate for Payer: PACE SWMI |
$22.93
|
| Rate for Payer: PHP Commercial |
$32.10
|
| Rate for Payer: PHP Medicare Advantage |
$22.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.60
|
| Rate for Payer: Priority Health Medicare |
$22.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.93
|
| Rate for Payer: UHC Medicare Advantage |
$22.93
|
| Rate for Payer: UMR Bronson Commercial |
$29.44
|
|
|
CHG CYTP CERV/VAG AUTO THIN LAYER PREP MNL SCREEN
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 88142
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Aetna Commercial |
$27.15
|
| Rate for Payer: Aetna Medicare |
$21.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.15
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCN Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$29.17
|
| Rate for Payer: Cofinity Commercial |
$27.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$20.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$21.27
|
| Rate for Payer: Nomi Health Commercial |
$24.31
|
| Rate for Payer: PACE SWMI |
$20.26
|
| Rate for Payer: PHP Commercial |
$28.36
|
| Rate for Payer: PHP Medicare Advantage |
$20.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$20.26
|
| Rate for Payer: UHC Medicare Advantage |
$20.26
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
CHG DEXA,BONE DENSITY,VERTEB FRACT
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
HCPCS 77082
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Aetna Medicare |
$9.50
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: Cash Price |
$15.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$12.35
|
| Rate for Payer: UMR Bronson Commercial |
$8.74
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX C-/C+
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
HCPCS 71270
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$259.49 |
| Rate for Payer: Aetna Commercial |
$241.47
|
| Rate for Payer: Aetna Medicare |
$187.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$241.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$259.49
|
| Rate for Payer: BCBS Complete |
$51.60
|
| Rate for Payer: BCBS MAPPO |
$180.20
|
| Rate for Payer: BCN Medicare Advantage |
$180.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cofinity Commercial |
$241.47
|
| Rate for Payer: Cofinity Commercial |
$259.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.21
|
| Rate for Payer: Nomi Health Commercial |
$216.24
|
| Rate for Payer: PACE SWMI |
$180.20
|
| Rate for Payer: PHP Commercial |
$252.28
|
| Rate for Payer: PHP Medicare Advantage |
$180.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: Priority Health Medicare |
$180.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.20
|
| Rate for Payer: UHC Medicare Advantage |
$180.20
|
| Rate for Payer: UMR Bronson Commercial |
$59.34
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/CONTRAST
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 71260
|
| Min. Negotiated Rate |
$48.00 |
| Max. Negotiated Rate |
$221.23 |
| Rate for Payer: Aetna Commercial |
$205.86
|
| Rate for Payer: Aetna Medicare |
$159.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.86
|
| Rate for Payer: BCBS Complete |
$48.00
|
| Rate for Payer: BCBS MAPPO |
$153.63
|
| Rate for Payer: BCN Medicare Advantage |
$153.63
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$221.23
|
| Rate for Payer: Cofinity Commercial |
$205.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.31
|
| Rate for Payer: Nomi Health Commercial |
$184.36
|
| Rate for Payer: PACE SWMI |
$153.63
|
| Rate for Payer: PHP Commercial |
$215.08
|
| Rate for Payer: PHP Medicare Advantage |
$153.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health Medicare |
$153.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.63
|
| Rate for Payer: UHC Medicare Advantage |
$153.63
|
| Rate for Payer: UMR Bronson Commercial |
$55.20
|
|
|
CHG DIAGNOSTIC COMPUTED TOMOGRAPHY THORAX W/O CNTRST
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 71250
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$177.06 |
| Rate for Payer: Aetna Commercial |
$164.77
|
| Rate for Payer: Aetna Medicare |
$127.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.77
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$122.96
|
| Rate for Payer: BCN Medicare Advantage |
$122.96
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$177.06
|
| Rate for Payer: Cofinity Commercial |
$164.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.11
|
| Rate for Payer: Nomi Health Commercial |
$147.55
|
| Rate for Payer: PACE SWMI |
$122.96
|
| Rate for Payer: PHP Commercial |
$172.14
|
| Rate for Payer: PHP Medicare Advantage |
$122.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health Medicare |
$122.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.96
|
| Rate for Payer: UHC Medicare Advantage |
$122.96
|
| Rate for Payer: UMR Bronson Commercial |
$51.52
|
|
|
CHG DIGITAL BREAST TOMOSYNTHESIS UNILATERAL
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
HCPCS 77061
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$42.90 |
| Rate for Payer: Aetna Medicare |
$33.00
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: UMR Bronson Commercial |
$30.36
|
|
|
CHG DISKOGRAPY LUMBAR RS&I
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 72295
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$144.94 |
| Rate for Payer: Aetna Commercial |
$134.87
|
| Rate for Payer: Aetna Medicare |
$104.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$134.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.94
|
| Rate for Payer: BCBS Complete |
$42.00
|
| Rate for Payer: BCBS MAPPO |
$100.65
|
| Rate for Payer: BCN Medicare Advantage |
$100.65
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$134.87
|
| Rate for Payer: Cofinity Commercial |
$144.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.68
|
| Rate for Payer: Nomi Health Commercial |
$120.78
|
| Rate for Payer: PACE SWMI |
$100.65
|
| Rate for Payer: PHP Commercial |
$140.91
|
| Rate for Payer: PHP Medicare Advantage |
$100.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health Medicare |
$100.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.65
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: UMR Bronson Commercial |
$48.30
|
|
