|
CHG CT THORACIC SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 72128
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$204.80 |
| Rate for Payer: Aetna Commercial |
$160.40
|
| Rate for Payer: Aetna Medicare |
$124.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$160.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$172.37
|
| Rate for Payer: BCBS Complete |
$31.31
|
| Rate for Payer: BCBS MAPPO |
$119.70
|
| Rate for Payer: BCN Commercial |
$196.45
|
| 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 |
$125.68
|
| Rate for Payer: Meridian Medicaid |
$31.31
|
| 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 Choice Medicaid |
$29.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$204.80
|
| Rate for Payer: Priority Health Medicare |
$119.70
|
| Rate for Payer: Priority Health Narrow Network |
$204.80
|
| Rate for Payer: Priority Health SBD |
$71.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.70
|
| Rate for Payer: UHC Medicare Advantage |
$119.70
|
| Rate for Payer: UHCCP Medicaid |
$29.82
|
| 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 |
$38.13 |
| Max. Negotiated Rate |
$314.12 |
| Rate for Payer: Aetna Commercial |
$244.70
|
| Rate for Payer: Aetna Medicare |
$189.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$244.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$262.96
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS MAPPO |
$182.61
|
| Rate for Payer: BCN Commercial |
$302.98
|
| 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 |
$244.70
|
| Rate for Payer: Cofinity Commercial |
$262.96
|
| 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: Meridian Medicaid |
$40.04
|
| 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 Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$314.12
|
| Rate for Payer: Priority Health Medicare |
$182.61
|
| Rate for Payer: Priority Health Narrow Network |
$314.12
|
| Rate for Payer: Priority Health SBD |
$91.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.61
|
| Rate for Payer: UHC Medicare Advantage |
$182.61
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
| 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 |
$34.72 |
| Max. Negotiated Rate |
$317.20 |
| Rate for Payer: Aetna Commercial |
$245.35
|
| Rate for Payer: Aetna Medicare |
$190.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$245.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$263.66
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS MAPPO |
$183.10
|
| Rate for Payer: BCN Commercial |
$306.89
|
| 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 |
$192.26
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| 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 Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$317.20
|
| Rate for Payer: Priority Health Medicare |
$183.10
|
| Rate for Payer: Priority Health Narrow Network |
$317.20
|
| Rate for Payer: Priority Health SBD |
$83.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.10
|
| Rate for Payer: UHC Medicare Advantage |
$183.10
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
| 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 |
$29.82 |
| Max. Negotiated Rate |
$254.58 |
| Rate for Payer: Aetna Commercial |
$197.62
|
| Rate for Payer: Aetna Medicare |
$153.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$197.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$212.37
|
| Rate for Payer: BCBS Complete |
$31.31
|
| Rate for Payer: BCBS MAPPO |
$147.48
|
| Rate for Payer: BCN Commercial |
$245.80
|
| 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 |
$197.62
|
| Rate for Payer: Cofinity Commercial |
$212.37
|
| 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: Meridian Medicaid |
$31.31
|
| 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 Choice Medicaid |
$29.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$254.58
|
| Rate for Payer: Priority Health Medicare |
$147.48
|
| Rate for Payer: Priority Health Narrow Network |
$254.58
|
| Rate for Payer: Priority Health SBD |
$71.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.48
|
| Rate for Payer: UHC Medicare Advantage |
$147.48
|
| Rate for Payer: UHCCP Medicaid |
$29.82
|
| 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 |
$36.21 |
| Max. Negotiated Rate |
$393.15 |
| Rate for Payer: Aetna Commercial |
$301.37
|
| Rate for Payer: Aetna Medicare |
$233.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$323.86
|
| Rate for Payer: BCBS Complete |
$38.02
|
| Rate for Payer: BCBS MAPPO |
$224.90
|
| Rate for Payer: BCN Commercial |
$380.68
|
| 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 |
$236.14
|
| Rate for Payer: Meridian Medicaid |
$38.02
|
| 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 Choice Medicaid |
$36.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$393.15
|
| Rate for Payer: Priority Health Medicare |
$224.90
|
| Rate for Payer: Priority Health Narrow Network |
$393.15
|
| Rate for Payer: Priority Health SBD |
$87.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$224.90
|
| Rate for Payer: UHC Medicare Advantage |
$224.90
|
| Rate for Payer: UHCCP Medicaid |
$36.21
|
| 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 |
$6.47 |
| Max. Negotiated Rate |
$2,125.88 |
| Rate for Payer: Aetna Commercial |
$11.55
|
| Rate for Payer: Aetna Medicare |
$8.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.41
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS MAPPO |
$8.62
|
| Rate for Payer: BCBS Trust/PPO |
$2,125.88
|
| Rate for Payer: BCN Commercial |
$6.47
|
| 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 |
$11.55
|
| Rate for Payer: Cofinity Commercial |
$12.41
|
| 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 HMO/PPO/Tiered Network |
$8.65
|
| Rate for Payer: Priority Health Medicare |
$8.62
|
| Rate for Payer: Priority Health Narrow Network |
$8.65
|
| Rate for Payer: Priority Health SBD |
$8.65
|
| 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 |
$4.97 |
| Max. Negotiated Rate |
$2,824.29 |
| Rate for Payer: Aetna Commercial |
$8.88
|
| Rate for Payer: Aetna Medicare |
$6.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.55
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$6.63
|
| Rate for Payer: BCBS Trust/PPO |
$2,824.29
|
| Rate for Payer: BCN Commercial |
$4.97
|
| 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 HMO/PPO/Tiered Network |
$6.66
|
| Rate for Payer: Priority Health Medicare |
$6.63
|
| Rate for Payer: Priority Health Narrow Network |
$6.66
|
| Rate for Payer: Priority Health SBD |
$6.66
|
| 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 |
$6.05 |
| Max. Negotiated Rate |
$2,635.16 |
| Rate for Payer: Aetna Commercial |
$10.81
|
| Rate for Payer: Aetna Medicare |
$8.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.62
|
| Rate for Payer: BCBS Complete |
$7.60
|
| Rate for Payer: BCBS MAPPO |
$8.07
|
| Rate for Payer: BCBS Trust/PPO |
$2,635.16
|
| Rate for Payer: BCN Commercial |
$6.05
|
| 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 HMO/PPO/Tiered Network |
$7.99
|
| Rate for Payer: Priority Health Medicare |
$8.07
|
| Rate for Payer: Priority Health Narrow Network |
$7.99
|
| Rate for Payer: Priority Health SBD |
$7.99
|
| 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 |
$9.59 |
| Max. Negotiated Rate |
$1,300.67 |
| 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 |
$10.07
|
| Rate for Payer: BCBS MAPPO |
$37.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,300.67
|
| Rate for Payer: BCN Commercial |
$60.60
|
| 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: Meridian Medicaid |
$10.07
|
| 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 Choice Medicaid |
$9.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$67.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$63.65
|
| Rate for Payer: Priority Health Medicare |
$37.72
|
| Rate for Payer: Priority Health Narrow Network |
$63.65
|
| Rate for Payer: Priority Health SBD |
$23.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.72
|
| Rate for Payer: UHC Medicare Advantage |
$37.72
|
| Rate for Payer: UHCCP Medicaid |
$9.59
|
| 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 |
$15.98 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$30.73
|
| Rate for Payer: Aetna Medicare |
$23.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$30.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.02
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS MAPPO |
$22.93
|
| Rate for Payer: BCBS Trust/PPO |
$168.00
|
| Rate for Payer: BCN Commercial |
$33.23
|
| 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: Meridian Medicaid |
$16.78
|
| 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 Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$41.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.14
|
| Rate for Payer: Priority Health Medicare |
$22.93
|
| Rate for Payer: Priority Health Narrow Network |
$37.14
|
| Rate for Payer: Priority Health SBD |
$37.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$22.93
|
| Rate for Payer: UHC Medicare Advantage |
$22.93
|
| Rate for Payer: UHCCP Medicaid |
$15.98
|
| 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 |
$15.20 |
| Max. Negotiated Rate |
$129.43 |
| Rate for Payer: Aetna Commercial |
$27.15
|
| Rate for Payer: Aetna Medicare |
$21.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$29.17
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$20.26
|
| Rate for Payer: BCBS Trust/PPO |
$129.43
|
| Rate for Payer: BCN Commercial |
$15.20
|
| 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 HMO/PPO/Tiered Network |
$31.47
|
| Rate for Payer: Priority Health Medicare |
$20.26
|
| Rate for Payer: Priority Health Narrow Network |
$31.47
|
| Rate for Payer: Priority Health SBD |
$31.47
|
| 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 |
$37.49 |
| Max. Negotiated Rate |
$310.01 |
| 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 |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$180.20
|
| Rate for Payer: BCN Commercial |
$298.58
|
| 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 |
$259.49
|
| Rate for Payer: Cofinity Commercial |
$241.47
|
| 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: Meridian Medicaid |
$39.36
|
| 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 Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$83.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$310.01
|
| Rate for Payer: Priority Health Medicare |
$180.20
|
| Rate for Payer: Priority Health Narrow Network |
$310.01
|
| Rate for Payer: Priority Health SBD |
$89.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.20
|
| Rate for Payer: UHC Medicare Advantage |
$180.20
|
| Rate for Payer: UHCCP Medicaid |
$37.49
|
| 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 |
$34.93 |
| Max. Negotiated Rate |
$263.82 |
| Rate for Payer: Aetna Commercial |
$205.86
|
| Rate for Payer: Aetna Medicare |
$159.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$205.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$221.23
|
| Rate for Payer: BCBS Complete |
$36.68
|
| Rate for Payer: BCBS MAPPO |
$153.63
|
| Rate for Payer: BCN Commercial |
$253.14
|
| 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 |
$205.86
|
| Rate for Payer: Cofinity Commercial |
$221.23
|
| 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: Meridian Medicaid |
$36.68
|
| 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 Choice Medicaid |
$34.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$263.82
|
| Rate for Payer: Priority Health Medicare |
$153.63
|
| Rate for Payer: Priority Health Narrow Network |
$263.82
|
| Rate for Payer: Priority Health SBD |
$84.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.63
|
| Rate for Payer: UHC Medicare Advantage |
$153.63
|
| Rate for Payer: UHCCP Medicaid |
$34.93
|
| 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 |
$32.38 |
| Max. Negotiated Rate |
$209.93 |
| Rate for Payer: Aetna Commercial |
$164.77
|
| Rate for Payer: Aetna Medicare |
$127.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$177.06
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$122.96
|
| Rate for Payer: BCN Commercial |
$201.83
|
| 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: Meridian Medicaid |
$34.00
|
| 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 Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$209.93
|
| Rate for Payer: Priority Health Medicare |
$122.96
|
| Rate for Payer: Priority Health Narrow Network |
$209.93
|
| Rate for Payer: Priority Health SBD |
$78.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.96
|
| Rate for Payer: UHC Medicare Advantage |
$122.96
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
| 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 |
$192.98 |
| Rate for Payer: Aetna Commercial |
$146.59
|
| Rate for Payer: Aetna Medicare |
$33.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.59
|
| Rate for Payer: BCBS Complete |
$26.40
|
| Rate for Payer: BCN Commercial |
$84.16
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$42.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.98
|
| Rate for Payer: Priority Health Narrow Network |
$192.98
|
| Rate for Payer: Priority Health SBD |
$58.52
|
| Rate for Payer: UMR Bronson Commercial |
$30.36
|
|
|
CHG DISKOGRAPY LUMBAR RS&I
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 72295
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$2,771.99 |
| 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 |
$26.39
|
| Rate for Payer: BCBS MAPPO |
$100.65
|
| Rate for Payer: BCBS Trust/PPO |
$2,771.99
|
| Rate for Payer: BCN Commercial |
$162.73
|
| 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 |
$144.94
|
| Rate for Payer: Cofinity Commercial |
$134.87
|
| 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: Meridian Medicaid |
$26.39
|
| 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 Choice Medicaid |
$25.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$171.43
|
| Rate for Payer: Priority Health Medicare |
$100.65
|
| Rate for Payer: Priority Health Narrow Network |
$171.43
|
| Rate for Payer: Priority Health SBD |
$60.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$100.65
|
| Rate for Payer: UHC Medicare Advantage |
$100.65
|
| Rate for Payer: UHCCP Medicaid |
$25.13
|
| Rate for Payer: UMR Bronson Commercial |
$48.30
|
|
|
CHG DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76828
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$563.70 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Aetna Medicare |
$45.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.68
|
| Rate for Payer: BCBS Complete |
$17.44
|
| Rate for Payer: BCBS MAPPO |
$44.22
|
| Rate for Payer: BCBS Trust/PPO |
$563.70
|
| Rate for Payer: BCN Commercial |
$71.84
|
| Rate for Payer: BCN Medicare Advantage |
$44.22
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$59.25
|
| Rate for Payer: Cofinity Commercial |
$63.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.43
|
| Rate for Payer: Meridian Medicaid |
$17.44
|
| Rate for Payer: Nomi Health Commercial |
$53.06
|
| Rate for Payer: PACE SWMI |
$44.22
|
| Rate for Payer: PHP Commercial |
$61.91
|
| Rate for Payer: PHP Medicare Advantage |
$44.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.94
|
| Rate for Payer: Priority Health Medicare |
$44.22
|
| Rate for Payer: Priority Health Narrow Network |
$74.94
|
| Rate for Payer: Priority Health SBD |
$40.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.22
|
| Rate for Payer: UHC Medicare Advantage |
$44.22
|
| Rate for Payer: UHCCP Medicaid |
$16.61
|
| Rate for Payer: UMR Bronson Commercial |
$66.70
|
|
|
CHG DOPPLER ECHO FETAL SPECTRAL DISPLAY COMPLETE
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 76827
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$506.11 |
| Rate for Payer: Aetna Commercial |
$83.92
|
| Rate for Payer: Aetna Medicare |
$65.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.19
|
| Rate for Payer: BCBS Complete |
$18.34
|
| Rate for Payer: BCBS MAPPO |
$62.63
|
| Rate for Payer: BCBS Trust/PPO |
$506.11
|
| Rate for Payer: BCN Commercial |
$102.13
|
| Rate for Payer: BCN Medicare Advantage |
$62.63
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$83.92
|
| Rate for Payer: Cofinity Commercial |
$90.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.76
|
| Rate for Payer: Meridian Medicaid |
$18.34
|
| Rate for Payer: Nomi Health Commercial |
$75.16
|
| Rate for Payer: PACE SWMI |
$62.63
|
| Rate for Payer: PHP Commercial |
$87.68
|
| Rate for Payer: PHP Medicare Advantage |
$62.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$17.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$107.78
|
| Rate for Payer: Priority Health Medicare |
$62.63
|
| Rate for Payer: Priority Health Narrow Network |
$107.78
|
| Rate for Payer: Priority Health SBD |
$42.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.63
|
| Rate for Payer: UHC Medicare Advantage |
$62.63
|
| Rate for Payer: UHCCP Medicaid |
$17.47
|
| Rate for Payer: UMR Bronson Commercial |
$111.32
|
|
|
CHG DOPPLER VELOCIMETRY FETAL MIDDLE CEREBRAL ART
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 76821
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$192.30 |
| Rate for Payer: Aetna Commercial |
$106.89
|
| Rate for Payer: Aetna Medicare |
$82.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.87
|
| Rate for Payer: BCBS Complete |
$22.14
|
| Rate for Payer: BCBS MAPPO |
$79.77
|
| Rate for Payer: BCBS Trust/PPO |
$192.30
|
| Rate for Payer: BCN Commercial |
$129.99
|
| Rate for Payer: BCN Medicare Advantage |
$79.77
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$106.89
|
| Rate for Payer: Cofinity Commercial |
$114.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$83.76
|
| Rate for Payer: Meridian Medicaid |
$22.14
|
| Rate for Payer: Nomi Health Commercial |
$95.72
|
| Rate for Payer: PACE SWMI |
$79.77
|
| Rate for Payer: PHP Commercial |
$111.68
|
| Rate for Payer: PHP Medicare Advantage |
$79.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$21.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.04
|
| Rate for Payer: Priority Health Medicare |
$79.77
|
| Rate for Payer: Priority Health Narrow Network |
$137.04
|
| Rate for Payer: Priority Health SBD |
$50.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.77
|
| Rate for Payer: UHC Medicare Advantage |
$79.77
|
| Rate for Payer: UHCCP Medicaid |
$21.09
|
| Rate for Payer: UMR Bronson Commercial |
$66.24
|
|
|
CHG DOPPLER VELOCIMETRY FETAL UMBILICAL ARTERY
|
Professional
|
Both
|
$249.00
|
|
|
Service Code
|
HCPCS 76820
|
| Min. Negotiated Rate |
$14.91 |
| Max. Negotiated Rate |
$536.22 |
| Rate for Payer: Aetna Commercial |
$54.28
|
| Rate for Payer: Aetna Medicare |
$42.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.33
|
| Rate for Payer: BCBS Complete |
$15.66
|
| Rate for Payer: BCBS MAPPO |
$40.51
|
| Rate for Payer: BCBS Trust/PPO |
$536.22
|
| Rate for Payer: BCN Commercial |
$65.48
|
| Rate for Payer: BCN Medicare Advantage |
$40.51
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cofinity Commercial |
$54.28
|
| Rate for Payer: Cofinity Commercial |
$58.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.54
|
| Rate for Payer: Meridian Medicaid |
$15.66
|
| Rate for Payer: Nomi Health Commercial |
$48.61
|
| Rate for Payer: PACE SWMI |
$40.51
|
| Rate for Payer: PHP Commercial |
$56.71
|
| Rate for Payer: PHP Medicare Advantage |
$40.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$14.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$68.78
|
| Rate for Payer: Priority Health Medicare |
$40.51
|
| Rate for Payer: Priority Health Narrow Network |
$68.78
|
| Rate for Payer: Priority Health SBD |
$35.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.51
|
| Rate for Payer: UHC Medicare Advantage |
$40.51
|
| Rate for Payer: UHCCP Medicaid |
$14.91
|
| Rate for Payer: UMR Bronson Commercial |
$114.54
|
|
|
CHG DRUG SCREEN LIST A ANY NMBR NON TLC DEVICES
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 80300
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
|
|
CHG DRUG SCREEN MULT CLASSES
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 80100
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
CHG DRUG SCREEN, QUAL,1+ DRUG CLASS,NON-CHROMOTOGRAPHIC,EACH
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 80104
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Medicare |
$19.50
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
|
|
CHG DRUG SCREEN SINGL CLASS
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 80101
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
