|
CHG DOPPLER ECHO FETAL PULS SPECTRAL F/U/REPEAT
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 76828
|
| Min. Negotiated Rate |
$44.22 |
| Max. Negotiated Rate |
$94.25 |
| Rate for Payer: Aetna Commercial |
$59.25
|
| Rate for Payer: Aetna Medicare |
$45.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$63.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$59.25
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: BCBS MAPPO |
$44.22
|
| 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 |
$63.68
|
| Rate for Payer: Cofinity Commercial |
$59.25
|
| 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: 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 Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health Medicare |
$44.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.22
|
| Rate for Payer: UHC Medicare Advantage |
$44.22
|
| 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 |
$62.63 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Aetna Commercial |
$83.92
|
| Rate for Payer: Aetna Medicare |
$65.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.92
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: BCBS MAPPO |
$62.63
|
| 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 |
$90.19
|
| Rate for Payer: Cofinity Commercial |
$83.92
|
| 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: 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 Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health Medicare |
$62.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.63
|
| Rate for Payer: UHC Medicare Advantage |
$62.63
|
| 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 |
$57.60 |
| Max. Negotiated Rate |
$114.87 |
| Rate for Payer: Aetna Commercial |
$106.89
|
| Rate for Payer: Aetna Medicare |
$82.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.89
|
| Rate for Payer: BCBS Complete |
$57.60
|
| Rate for Payer: BCBS MAPPO |
$79.77
|
| 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 |
$114.87
|
| Rate for Payer: Cofinity Commercial |
$106.89
|
| 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: 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 Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health Medicare |
$79.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.77
|
| Rate for Payer: UHC Medicare Advantage |
$79.77
|
| 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 |
$40.51 |
| Max. Negotiated Rate |
$161.85 |
| Rate for Payer: Aetna Commercial |
$54.28
|
| Rate for Payer: Aetna Medicare |
$42.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.28
|
| Rate for Payer: BCBS Complete |
$99.60
|
| Rate for Payer: BCBS MAPPO |
$40.51
|
| 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 |
$58.33
|
| Rate for Payer: Cofinity Commercial |
$54.28
|
| 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: 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 Cigna Priority Health |
$161.85
|
| Rate for Payer: Priority Health Medicare |
$40.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.51
|
| Rate for Payer: UHC Medicare Advantage |
$40.51
|
| 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
|
|
|
CHG DRUG TEST PRSMV READ DIRECT OPTICAL OBS PR DATE
|
Professional
|
Both
|
$39.00
|
|
|
Service Code
|
HCPCS 80305
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$25.35 |
| Rate for Payer: Aetna Commercial |
$16.88
|
| Rate for Payer: Aetna Medicare |
$13.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.14
|
| Rate for Payer: BCBS Complete |
$15.60
|
| Rate for Payer: BCBS MAPPO |
$12.60
|
| Rate for Payer: BCN Medicare Advantage |
$12.60
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cofinity Commercial |
$18.14
|
| Rate for Payer: Cofinity Commercial |
$16.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.23
|
| Rate for Payer: Nomi Health Commercial |
$15.12
|
| Rate for Payer: PACE SWMI |
$12.60
|
| Rate for Payer: PHP Commercial |
$17.64
|
| Rate for Payer: PHP Medicare Advantage |
$12.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$25.35
|
| Rate for Payer: Priority Health Medicare |
$12.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.60
|
| Rate for Payer: UHC Medicare Advantage |
$12.60
|
| Rate for Payer: UMR Bronson Commercial |
$17.94
|
|
|
CHG DRUG TST PRSMV INSTRMNT CHEM ANALYZERS PR DATE
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
HCPCS 80307
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$89.48 |
| Rate for Payer: Aetna Commercial |
$83.27
|
| Rate for Payer: Aetna Medicare |
$64.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$83.27
|
| Rate for Payer: BCBS Complete |
$32.80
|
| Rate for Payer: BCBS MAPPO |
$62.14
|
| Rate for Payer: BCN Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$89.48
|
| Rate for Payer: Cofinity Commercial |
$83.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.25
|
| Rate for Payer: Nomi Health Commercial |
$74.57
|
| Rate for Payer: PACE SWMI |
$62.14
|
| Rate for Payer: PHP Commercial |
$87.00
|
| Rate for Payer: PHP Medicare Advantage |
$62.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health Medicare |
$62.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.14
|
| Rate for Payer: UHC Medicare Advantage |
$62.14
|
| Rate for Payer: UMR Bronson Commercial |
$37.72
|
|
|
CHG DRUG TST PRSMV READ INSTRMNT ASSTD DIR OPT OBS
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 80306
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$24.68 |
| Rate for Payer: Aetna Commercial |
$22.97
|
| Rate for Payer: Aetna Medicare |
$17.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.97
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS MAPPO |
$17.14
|
| Rate for Payer: BCN Medicare Advantage |
$17.14
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$24.68
|
| Rate for Payer: Cofinity Commercial |
$22.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.00
|
| Rate for Payer: Nomi Health Commercial |
$20.57
|
| Rate for Payer: PACE SWMI |
$17.14
|
| Rate for Payer: PHP Commercial |
$24.00
|
| Rate for Payer: PHP Medicare Advantage |
$17.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: Priority Health Medicare |
$17.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.14
|
| Rate for Payer: UHC Medicare Advantage |
$17.14
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
|
|
CHG DXA BONE DENSITY STUDY 1/>SITES APPENDICLR SKEL
|
Professional
|
Both
|
$27.00
|
|
|
Service Code
|
HCPCS 77081
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$41.80 |
| Rate for Payer: Aetna Commercial |
$38.90
|
| Rate for Payer: Aetna Commercial |
$38.90
|
| Rate for Payer: Aetna Medicare |
$30.19
|
| Rate for Payer: Aetna Medicare |
$30.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$38.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$41.80
|
| Rate for Payer: BCBS Complete |
$10.80
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS MAPPO |
$29.03
|
| Rate for Payer: BCBS MAPPO |
$29.03
|
| Rate for Payer: BCN Medicare Advantage |
$29.03
|
| Rate for Payer: BCN Medicare Advantage |
$29.03
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cofinity Commercial |
$41.80
|
| Rate for Payer: Cofinity Commercial |
$41.80
|
| Rate for Payer: Cofinity Commercial |
$38.90
|
| Rate for Payer: Cofinity Commercial |
$38.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$30.48
|
| Rate for Payer: Nomi Health Commercial |
$34.84
|
| Rate for Payer: Nomi Health Commercial |
$34.84
|
| Rate for Payer: PACE SWMI |
$29.03
|
| Rate for Payer: PACE SWMI |
$29.03
|
| Rate for Payer: PHP Commercial |
$40.64
|
| Rate for Payer: PHP Commercial |
$40.64
|
| Rate for Payer: PHP Medicare Advantage |
$29.03
|
| Rate for Payer: PHP Medicare Advantage |
$29.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$17.55
|
| Rate for Payer: Priority Health Medicare |
$29.03
|
| Rate for Payer: Priority Health Medicare |
$29.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.03
|
| Rate for Payer: UHC Medicare Advantage |
$29.03
|
| Rate for Payer: UHC Medicare Advantage |
$29.03
|
| Rate for Payer: UMR Bronson Commercial |
$12.42
|
| Rate for Payer: UMR Bronson Commercial |
$74.06
|
|
|
CHG DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
HCPCS 77080
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$155.35 |
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Commercial |
$47.60
|
| Rate for Payer: Aetna Medicare |
$36.94
|
| Rate for Payer: Aetna Medicare |
$36.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.15
|
| Rate for Payer: BCBS Complete |
$95.60
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$35.52
|
| Rate for Payer: BCBS MAPPO |
$35.52
|
| Rate for Payer: BCN Medicare Advantage |
$35.52
|
| Rate for Payer: BCN Medicare Advantage |
$35.52
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cofinity Commercial |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$51.15
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Cofinity Commercial |
$47.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.30
|
| Rate for Payer: Nomi Health Commercial |
$42.62
|
| Rate for Payer: Nomi Health Commercial |
$42.62
|
| Rate for Payer: PACE SWMI |
$35.52
|
| Rate for Payer: PACE SWMI |
$35.52
|
| Rate for Payer: PHP Commercial |
$49.73
|
| Rate for Payer: PHP Commercial |
$49.73
|
| Rate for Payer: PHP Medicare Advantage |
$35.52
|
| Rate for Payer: PHP Medicare Advantage |
$35.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.35
|
| Rate for Payer: Priority Health Medicare |
$35.52
|
| Rate for Payer: Priority Health Medicare |
$35.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.52
|
| Rate for Payer: UHC Medicare Advantage |
$35.52
|
| Rate for Payer: UHC Medicare Advantage |
$35.52
|
| Rate for Payer: UMR Bronson Commercial |
$109.94
|
| Rate for Payer: UMR Bronson Commercial |
$78.66
|
|
|
CHG DX NTRAOP EPCAR CAR US CHD PLMT MNPJ&IMG ACQUISJ
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 76988
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$137.80 |
| Rate for Payer: Aetna Medicare |
$106.00
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: UMR Bronson Commercial |
$97.52
|
|
|
CHG ECHOENCEPHALOGRAPHY REAL TIME IMAGING
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
HCPCS 76506
|
| Min. Negotiated Rate |
$98.89 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$132.51
|
| Rate for Payer: Aetna Medicare |
$102.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$132.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.40
|
| Rate for Payer: BCBS Complete |
$128.00
|
| Rate for Payer: BCBS MAPPO |
$98.89
|
| Rate for Payer: BCN Medicare Advantage |
$98.89
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cash Price |
$256.00
|
| Rate for Payer: Cofinity Commercial |
$132.51
|
| Rate for Payer: Cofinity Commercial |
$142.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.83
|
| Rate for Payer: Nomi Health Commercial |
$118.67
|
| Rate for Payer: PACE SWMI |
$98.89
|
| Rate for Payer: PHP Commercial |
$138.45
|
| Rate for Payer: PHP Medicare Advantage |
$98.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.00
|
| Rate for Payer: Priority Health Medicare |
$98.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.89
|
| Rate for Payer: UHC Medicare Advantage |
$98.89
|
| Rate for Payer: UMR Bronson Commercial |
$147.20
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE RECORDING
|
Professional
|
Both
|
$278.00
|
|
|
Service Code
|
HCPCS 76825
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$333.24 |
| Rate for Payer: Aetna Commercial |
$310.10
|
| Rate for Payer: Aetna Medicare |
$240.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.10
|
| Rate for Payer: BCBS Complete |
$111.20
|
| Rate for Payer: BCBS MAPPO |
$231.42
|
| Rate for Payer: BCN Medicare Advantage |
$231.42
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cash Price |
$222.40
|
| Rate for Payer: Cofinity Commercial |
$333.24
|
| Rate for Payer: Cofinity Commercial |
$310.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$242.99
|
| Rate for Payer: Nomi Health Commercial |
$277.70
|
| Rate for Payer: PACE SWMI |
$231.42
|
| Rate for Payer: PHP Commercial |
$323.99
|
| Rate for Payer: PHP Medicare Advantage |
$231.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.70
|
| Rate for Payer: Priority Health Medicare |
$231.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$231.42
|
| Rate for Payer: UHC Medicare Advantage |
$231.42
|
| Rate for Payer: UMR Bronson Commercial |
$127.88
|
|
|
CHG ECHO FETAL CARDIOVASC W/WO M-MODE REPEAT STD
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 76826
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$199.54 |
| Rate for Payer: Aetna Commercial |
$185.68
|
| Rate for Payer: Aetna Medicare |
$144.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$185.68
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$138.57
|
| Rate for Payer: BCN Medicare Advantage |
$138.57
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$199.54
|
| Rate for Payer: Cofinity Commercial |
$185.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.50
|
| Rate for Payer: Nomi Health Commercial |
$166.28
|
| Rate for Payer: PACE SWMI |
$138.57
|
| Rate for Payer: PHP Commercial |
$194.00
|
| Rate for Payer: PHP Medicare Advantage |
$138.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$138.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.57
|
| Rate for Payer: UHC Medicare Advantage |
$138.57
|
| Rate for Payer: UMR Bronson Commercial |
$60.26
|
|
|
CHG ENDOVASC REPAIR AAA
|
Professional
|
Both
|
$512.00
|
|
|
Service Code
|
HCPCS 75952
|
| Min. Negotiated Rate |
$204.80 |
| Max. Negotiated Rate |
$332.80 |
| Rate for Payer: Aetna Medicare |
$256.00
|
| Rate for Payer: BCBS Complete |
$204.80
|
| Rate for Payer: Cash Price |
$409.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$332.80
|
| Rate for Payer: UMR Bronson Commercial |
$235.52
|
|
|
CHG EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
HCPCS 75957
|
| Min. Negotiated Rate |
$237.20 |
| Max. Negotiated Rate |
$385.45 |
| Rate for Payer: Aetna Medicare |
$296.50
|
| Rate for Payer: BCBS Complete |
$237.20
|
| Rate for Payer: Cash Price |
$474.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$385.45
|
| Rate for Payer: UMR Bronson Commercial |
$272.78
|
|
|
CHG EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
HCPCS 75956
|
| Min. Negotiated Rate |
$277.20 |
| Max. Negotiated Rate |
$450.45 |
| Rate for Payer: Aetna Medicare |
$346.50
|
| Rate for Payer: BCBS Complete |
$277.20
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$450.45
|
| Rate for Payer: UMR Bronson Commercial |
$318.78
|
|
|
CHG FETAL BIOPHYSICAL PROFILE NON-STRESS TESTING
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
HCPCS 76818
|
| Min. Negotiated Rate |
$108.35 |
| Max. Negotiated Rate |
$217.75 |
| Rate for Payer: Aetna Commercial |
$145.19
|
| Rate for Payer: Aetna Medicare |
$112.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.02
|
| Rate for Payer: BCBS Complete |
$134.00
|
| Rate for Payer: BCBS MAPPO |
$108.35
|
| Rate for Payer: BCN Medicare Advantage |
$108.35
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cash Price |
$268.00
|
| Rate for Payer: Cofinity Commercial |
$145.19
|
| Rate for Payer: Cofinity Commercial |
$156.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.77
|
| Rate for Payer: Nomi Health Commercial |
$130.02
|
| Rate for Payer: PACE SWMI |
$108.35
|
| Rate for Payer: PHP Commercial |
$151.69
|
| Rate for Payer: PHP Medicare Advantage |
$108.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.75
|
| Rate for Payer: Priority Health Medicare |
$108.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.35
|
| Rate for Payer: UHC Medicare Advantage |
$108.35
|
| Rate for Payer: UMR Bronson Commercial |
$154.10
|
|
|
CHG FETAL BIOPHYSICAL PROFILE W/O NON-STRESS TESTING
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 76819
|
| Min. Negotiated Rate |
$78.29 |
| Max. Negotiated Rate |
$149.50 |
| Rate for Payer: Aetna Commercial |
$104.91
|
| Rate for Payer: Aetna Medicare |
$81.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.91
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCBS MAPPO |
$78.29
|
| Rate for Payer: BCN Medicare Advantage |
$78.29
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$112.74
|
| Rate for Payer: Cofinity Commercial |
$104.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.20
|
| Rate for Payer: Nomi Health Commercial |
$93.95
|
| Rate for Payer: PACE SWMI |
$78.29
|
| Rate for Payer: PHP Commercial |
$109.61
|
| Rate for Payer: PHP Medicare Advantage |
$78.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$149.50
|
| Rate for Payer: Priority Health Medicare |
$78.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.29
|
| Rate for Payer: UHC Medicare Advantage |
$78.29
|
| Rate for Payer: UMR Bronson Commercial |
$105.80
|
|
|
CHG FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 77003
|
| Min. Negotiated Rate |
$92.83 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Aetna Commercial |
$124.39
|
| Rate for Payer: Aetna Medicare |
$96.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.39
|
| Rate for Payer: BCBS Complete |
$120.00
|
| Rate for Payer: BCBS MAPPO |
$92.83
|
| Rate for Payer: BCN Medicare Advantage |
$92.83
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$133.68
|
| Rate for Payer: Cofinity Commercial |
$124.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$97.47
|
| Rate for Payer: Nomi Health Commercial |
$111.40
|
| Rate for Payer: PACE SWMI |
$92.83
|
| Rate for Payer: PHP Commercial |
$129.96
|
| Rate for Payer: PHP Medicare Advantage |
$92.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$195.00
|
| Rate for Payer: Priority Health Medicare |
$92.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.83
|
| Rate for Payer: UHC Medicare Advantage |
$92.83
|
| Rate for Payer: UMR Bronson Commercial |
$138.00
|
|
|
CHG FLUORO CENTRAL VENOUS ACCESS DEV PLACEMENT
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 77001
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$125.67 |
| Rate for Payer: Aetna Commercial |
$116.94
|
| Rate for Payer: Aetna Commercial |
$116.94
|
| Rate for Payer: Aetna Medicare |
$90.76
|
| Rate for Payer: Aetna Medicare |
$90.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$125.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.94
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$87.27
|
| Rate for Payer: BCBS MAPPO |
$87.27
|
| Rate for Payer: BCN Medicare Advantage |
$87.27
|
| Rate for Payer: BCN Medicare Advantage |
$87.27
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cofinity Commercial |
$125.67
|
| Rate for Payer: Cofinity Commercial |
$116.94
|
| Rate for Payer: Cofinity Commercial |
$125.67
|
| Rate for Payer: Cofinity Commercial |
$116.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.63
|
| Rate for Payer: Nomi Health Commercial |
$104.72
|
| Rate for Payer: Nomi Health Commercial |
$104.72
|
| Rate for Payer: PACE SWMI |
$87.27
|
| Rate for Payer: PACE SWMI |
$87.27
|
| Rate for Payer: PHP Commercial |
$122.18
|
| Rate for Payer: PHP Commercial |
$122.18
|
| Rate for Payer: PHP Medicare Advantage |
$87.27
|
| Rate for Payer: PHP Medicare Advantage |
$87.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Medicare |
$87.27
|
| Rate for Payer: Priority Health Medicare |
$87.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.27
|
| Rate for Payer: UHC Medicare Advantage |
$87.27
|
| Rate for Payer: UHC Medicare Advantage |
$87.27
|
| Rate for Payer: UMR Bronson Commercial |
$68.54
|
| Rate for Payer: UMR Bronson Commercial |
$78.66
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
77002
|
| Min. Negotiated Rate |
$42.18 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna American Axle |
$74.10
|
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Medicare |
$57.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.10
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Cofinity Commercial |
$98.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.20
|
| Rate for Payer: Healthscope Commercial |
$102.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.90
|
| Rate for Payer: PHP Commercial |
$96.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health SBD |
$71.82
|
| Rate for Payer: UMR Bronson Commercial |
$42.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.50
|
|
