|
CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 73222
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$408.93 |
| Rate for Payer: Aetna Commercial |
$380.53
|
| Rate for Payer: Aetna Medicare |
$295.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$408.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$380.53
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$283.98
|
| Rate for Payer: BCN Medicare Advantage |
$283.98
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$408.93
|
| Rate for Payer: Cofinity Commercial |
$380.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$283.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.18
|
| Rate for Payer: Nomi Health Commercial |
$340.78
|
| Rate for Payer: PACE SWMI |
$283.98
|
| Rate for Payer: PHP Commercial |
$397.57
|
| Rate for Payer: PHP Medicare Advantage |
$283.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health Medicare |
$283.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$283.98
|
| Rate for Payer: UHC Medicare Advantage |
$283.98
|
| Rate for Payer: UMR Bronson Commercial |
$72.68
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 73221
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$269.78 |
| Rate for Payer: Aetna Commercial |
$251.05
|
| Rate for Payer: Aetna Medicare |
$194.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$269.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$251.05
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$187.35
|
| Rate for Payer: BCN Medicare Advantage |
$187.35
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$251.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.72
|
| Rate for Payer: Nomi Health Commercial |
$224.82
|
| Rate for Payer: PACE SWMI |
$187.35
|
| Rate for Payer: PHP Commercial |
$262.29
|
| Rate for Payer: PHP Medicare Advantage |
$187.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$187.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.35
|
| Rate for Payer: UHC Medicare Advantage |
$187.35
|
| Rate for Payer: UMR Bronson Commercial |
$60.26
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 73223
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$507.21 |
| Rate for Payer: Aetna Commercial |
$471.99
|
| Rate for Payer: Aetna Medicare |
$366.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$507.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$471.99
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: BCBS MAPPO |
$352.23
|
| Rate for Payer: BCN Medicare Advantage |
$352.23
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$507.21
|
| Rate for Payer: Cofinity Commercial |
$471.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.84
|
| Rate for Payer: Nomi Health Commercial |
$422.68
|
| Rate for Payer: PACE SWMI |
$352.23
|
| Rate for Payer: PHP Commercial |
$493.12
|
| Rate for Payer: PHP Medicare Advantage |
$352.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health Medicare |
$352.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.23
|
| Rate for Payer: UHC Medicare Advantage |
$352.23
|
| Rate for Payer: UMR Bronson Commercial |
$96.60
|
|
|
CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 70552
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$358.37 |
| Rate for Payer: Aetna Commercial |
$333.49
|
| Rate for Payer: Aetna Medicare |
$258.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.49
|
| Rate for Payer: BCBS Complete |
$150.80
|
| Rate for Payer: BCBS MAPPO |
$248.87
|
| Rate for Payer: BCN Medicare Advantage |
$248.87
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cofinity Commercial |
$358.37
|
| Rate for Payer: Cofinity Commercial |
$333.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.31
|
| Rate for Payer: Nomi Health Commercial |
$298.64
|
| Rate for Payer: PACE SWMI |
$248.87
|
| Rate for Payer: PHP Commercial |
$348.42
|
| Rate for Payer: PHP Medicare Advantage |
$248.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health Medicare |
$248.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.87
|
| Rate for Payer: UHC Medicare Advantage |
$248.87
|
| Rate for Payer: UMR Bronson Commercial |
$173.42
|
|
|
CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 70551
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$260.99 |
| Rate for Payer: Aetna Commercial |
$242.86
|
| Rate for Payer: Aetna Medicare |
$188.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$260.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$242.86
|
| Rate for Payer: BCBS Complete |
$130.00
|
| Rate for Payer: BCBS MAPPO |
$181.24
|
| Rate for Payer: BCN Medicare Advantage |
$181.24
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$260.99
|
| Rate for Payer: Cofinity Commercial |
$242.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$190.30
|
| Rate for Payer: Nomi Health Commercial |
$217.49
|
| Rate for Payer: PACE SWMI |
$181.24
|
| Rate for Payer: PHP Commercial |
$253.74
|
| Rate for Payer: PHP Medicare Advantage |
$181.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.25
|
| Rate for Payer: Priority Health Medicare |
$181.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$181.24
|
| Rate for Payer: UHC Medicare Advantage |
$181.24
|
| Rate for Payer: UMR Bronson Commercial |
$149.50
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 70553
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$423.48 |
| Rate for Payer: Aetna Commercial |
$394.07
|
| Rate for Payer: Aetna Medicare |
$305.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$394.07
|
| Rate for Payer: BCBS Complete |
$139.20
|
| Rate for Payer: BCBS MAPPO |
$294.08
|
| Rate for Payer: BCN Medicare Advantage |
$294.08
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cofinity Commercial |
$423.48
|
| Rate for Payer: Cofinity Commercial |
$394.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$308.78
|
| Rate for Payer: Nomi Health Commercial |
$352.90
|
| Rate for Payer: PACE SWMI |
$294.08
|
| Rate for Payer: PHP Commercial |
$411.71
|
| Rate for Payer: PHP Medicare Advantage |
$294.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.20
|
| Rate for Payer: Priority Health Medicare |
$294.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.08
|
| Rate for Payer: UHC Medicare Advantage |
$294.08
|
| Rate for Payer: UMR Bronson Commercial |
$160.08
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 73718
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$293.85 |
| Rate for Payer: Aetna Commercial |
$273.44
|
| Rate for Payer: Aetna Medicare |
$212.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$293.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$273.44
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$204.06
|
| Rate for Payer: BCN Medicare Advantage |
$204.06
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$293.85
|
| Rate for Payer: Cofinity Commercial |
$273.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.26
|
| Rate for Payer: Nomi Health Commercial |
$244.87
|
| Rate for Payer: PACE SWMI |
$204.06
|
| Rate for Payer: PHP Commercial |
$285.68
|
| Rate for Payer: PHP Medicare Advantage |
$204.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$204.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.06
|
| Rate for Payer: UHC Medicare Advantage |
$204.06
|
| Rate for Payer: UMR Bronson Commercial |
$60.26
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 73720
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$445.68 |
| Rate for Payer: Aetna Commercial |
$414.73
|
| Rate for Payer: Aetna Medicare |
$321.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.73
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: BCBS MAPPO |
$309.50
|
| Rate for Payer: BCN Medicare Advantage |
$309.50
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$445.68
|
| Rate for Payer: Cofinity Commercial |
$414.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.98
|
| Rate for Payer: Nomi Health Commercial |
$371.40
|
| Rate for Payer: PACE SWMI |
$309.50
|
| Rate for Payer: PHP Commercial |
$433.30
|
| Rate for Payer: PHP Medicare Advantage |
$309.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health Medicare |
$309.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.50
|
| Rate for Payer: UHC Medicare Advantage |
$309.50
|
| Rate for Payer: UMR Bronson Commercial |
$96.60
|
|
|
CHG MRI ORBIT FACE &/NECK W/O CONTRAST
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 70540
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$298.09 |
| Rate for Payer: Aetna Commercial |
$277.39
|
| Rate for Payer: Aetna Medicare |
$215.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.39
|
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: BCBS MAPPO |
$207.01
|
| Rate for Payer: BCN Medicare Advantage |
$207.01
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$298.09
|
| Rate for Payer: Cofinity Commercial |
$277.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$217.36
|
| Rate for Payer: Nomi Health Commercial |
$248.41
|
| Rate for Payer: PACE SWMI |
$207.01
|
| Rate for Payer: PHP Commercial |
$289.81
|
| Rate for Payer: PHP Medicare Advantage |
$207.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.50
|
| Rate for Payer: Priority Health Medicare |
$207.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$207.01
|
| Rate for Payer: UHC Medicare Advantage |
$207.01
|
| Rate for Payer: UMR Bronson Commercial |
$59.80
|
|
|
CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 70543
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$448.23 |
| Rate for Payer: Aetna Commercial |
$417.10
|
| Rate for Payer: Aetna Medicare |
$323.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.10
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: BCBS MAPPO |
$311.27
|
| Rate for Payer: BCN Medicare Advantage |
$311.27
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$448.23
|
| Rate for Payer: Cofinity Commercial |
$417.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$326.83
|
| Rate for Payer: Nomi Health Commercial |
$373.52
|
| Rate for Payer: PACE SWMI |
$311.27
|
| Rate for Payer: PHP Commercial |
$435.78
|
| Rate for Payer: PHP Medicare Advantage |
$311.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health Medicare |
$311.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$311.27
|
| Rate for Payer: UHC Medicare Advantage |
$311.27
|
| Rate for Payer: UMR Bronson Commercial |
$96.60
|
|
|
CHG MRI PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 72195
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$301.64 |
| Rate for Payer: Aetna Commercial |
$280.69
|
| Rate for Payer: Aetna Medicare |
$217.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.69
|
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: BCBS MAPPO |
$209.47
|
| Rate for Payer: BCN Medicare Advantage |
$209.47
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$301.64
|
| Rate for Payer: Cofinity Commercial |
$280.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.94
|
| Rate for Payer: Nomi Health Commercial |
$251.36
|
| Rate for Payer: PACE SWMI |
$209.47
|
| Rate for Payer: PHP Commercial |
$293.26
|
| Rate for Payer: PHP Medicare Advantage |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.30
|
| Rate for Payer: Priority Health Medicare |
$209.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.47
|
| Rate for Payer: UHC Medicare Advantage |
$209.47
|
| Rate for Payer: UMR Bronson Commercial |
$65.32
|
|
|
CHG MRI PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 72197
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$445.46 |
| Rate for Payer: Aetna Commercial |
$414.53
|
| Rate for Payer: Aetna Medicare |
$321.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.53
|
| Rate for Payer: BCBS Complete |
$85.60
|
| Rate for Payer: BCBS MAPPO |
$309.35
|
| Rate for Payer: BCN Medicare Advantage |
$309.35
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cofinity Commercial |
$445.46
|
| Rate for Payer: Cofinity Commercial |
$414.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.82
|
| Rate for Payer: Nomi Health Commercial |
$371.22
|
| Rate for Payer: PACE SWMI |
$309.35
|
| Rate for Payer: PHP Commercial |
$433.09
|
| Rate for Payer: PHP Medicare Advantage |
$309.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.10
|
| Rate for Payer: Priority Health Medicare |
$309.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.35
|
| Rate for Payer: UHC Medicare Advantage |
$309.35
|
| Rate for Payer: UMR Bronson Commercial |
$98.44
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 72141
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$253.35 |
| Rate for Payer: Aetna Commercial |
$235.76
|
| Rate for Payer: Aetna Medicare |
$182.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.76
|
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: BCBS MAPPO |
$175.94
|
| Rate for Payer: BCN Medicare Advantage |
$175.94
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$253.35
|
| Rate for Payer: Cofinity Commercial |
$235.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.74
|
| Rate for Payer: Nomi Health Commercial |
$211.13
|
| Rate for Payer: PACE SWMI |
$175.94
|
| Rate for Payer: PHP Commercial |
$246.32
|
| Rate for Payer: PHP Medicare Advantage |
$175.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health Medicare |
$175.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.94
|
| Rate for Payer: UHC Medicare Advantage |
$175.94
|
| Rate for Payer: UMR Bronson Commercial |
$138.92
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 72156
|
| Min. Negotiated Rate |
$125.60 |
| Max. Negotiated Rate |
$424.74 |
| Rate for Payer: Aetna Commercial |
$395.25
|
| Rate for Payer: Aetna Medicare |
$306.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.25
|
| Rate for Payer: BCBS Complete |
$125.60
|
| Rate for Payer: BCBS MAPPO |
$294.96
|
| Rate for Payer: BCN Medicare Advantage |
$294.96
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cofinity Commercial |
$424.74
|
| Rate for Payer: Cofinity Commercial |
$395.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.71
|
| Rate for Payer: Nomi Health Commercial |
$353.95
|
| Rate for Payer: PACE SWMI |
$294.96
|
| Rate for Payer: PHP Commercial |
$412.94
|
| Rate for Payer: PHP Medicare Advantage |
$294.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.10
|
| Rate for Payer: Priority Health Medicare |
$294.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.96
|
| Rate for Payer: UHC Medicare Advantage |
$294.96
|
| Rate for Payer: UMR Bronson Commercial |
$144.44
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 72149
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$358.19 |
| Rate for Payer: Aetna Commercial |
$333.31
|
| Rate for Payer: Aetna Medicare |
$258.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.31
|
| Rate for Payer: BCBS Complete |
$130.80
|
| Rate for Payer: BCBS MAPPO |
$248.74
|
| Rate for Payer: BCN Medicare Advantage |
$248.74
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cofinity Commercial |
$358.19
|
| Rate for Payer: Cofinity Commercial |
$333.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.18
|
| Rate for Payer: Nomi Health Commercial |
$298.49
|
| Rate for Payer: PACE SWMI |
$248.74
|
| Rate for Payer: PHP Commercial |
$348.24
|
| Rate for Payer: PHP Medicare Advantage |
$248.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.55
|
| Rate for Payer: Priority Health Medicare |
$248.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.74
|
| Rate for Payer: UHC Medicare Advantage |
$248.74
|
| Rate for Payer: UMR Bronson Commercial |
$150.42
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 72148
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$254.20 |
| Rate for Payer: Aetna Commercial |
$236.55
|
| Rate for Payer: Aetna Medicare |
$183.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.55
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS MAPPO |
$176.53
|
| Rate for Payer: BCN Medicare Advantage |
$176.53
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$254.20
|
| Rate for Payer: Cofinity Commercial |
$236.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.36
|
| Rate for Payer: Nomi Health Commercial |
$211.84
|
| Rate for Payer: PACE SWMI |
$176.53
|
| Rate for Payer: PHP Commercial |
$247.14
|
| Rate for Payer: PHP Medicare Advantage |
$176.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health Medicare |
$176.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.53
|
| Rate for Payer: UHC Medicare Advantage |
$176.53
|
| Rate for Payer: UMR Bronson Commercial |
$113.62
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 72158
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$423.89 |
| Rate for Payer: Aetna Commercial |
$394.46
|
| Rate for Payer: Aetna Medicare |
$306.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$394.46
|
| Rate for Payer: BCBS Complete |
$119.60
|
| Rate for Payer: BCBS MAPPO |
$294.37
|
| Rate for Payer: BCN Medicare Advantage |
$294.37
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$423.89
|
| Rate for Payer: Cofinity Commercial |
$394.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.09
|
| Rate for Payer: Nomi Health Commercial |
$353.24
|
| Rate for Payer: PACE SWMI |
$294.37
|
| Rate for Payer: PHP Commercial |
$412.12
|
| Rate for Payer: PHP Medicare Advantage |
$294.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health Medicare |
$294.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.37
|
| Rate for Payer: UHC Medicare Advantage |
$294.37
|
| Rate for Payer: UMR Bronson Commercial |
$137.54
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 72146
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$253.77 |
| Rate for Payer: Aetna Commercial |
$236.15
|
| Rate for Payer: Aetna Medicare |
$183.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.15
|
| Rate for Payer: BCBS Complete |
$108.80
|
| Rate for Payer: BCBS MAPPO |
$176.23
|
| Rate for Payer: BCN Medicare Advantage |
$176.23
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$253.77
|
| Rate for Payer: Cofinity Commercial |
$236.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.04
|
| Rate for Payer: Nomi Health Commercial |
$211.48
|
| Rate for Payer: PACE SWMI |
$176.23
|
| Rate for Payer: PHP Commercial |
$246.72
|
| Rate for Payer: PHP Medicare Advantage |
$176.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health Medicare |
$176.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.23
|
| Rate for Payer: UHC Medicare Advantage |
$176.23
|
| Rate for Payer: UMR Bronson Commercial |
$125.12
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 72157
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$425.59 |
| Rate for Payer: Aetna Commercial |
$396.04
|
| Rate for Payer: Aetna Medicare |
$307.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.04
|
| Rate for Payer: BCBS Complete |
$132.00
|
| Rate for Payer: BCBS MAPPO |
$295.55
|
| Rate for Payer: BCN Medicare Advantage |
$295.55
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$425.59
|
| Rate for Payer: Cofinity Commercial |
$396.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$310.33
|
| Rate for Payer: Nomi Health Commercial |
$354.66
|
| Rate for Payer: PACE SWMI |
$295.55
|
| Rate for Payer: PHP Commercial |
$413.77
|
| Rate for Payer: PHP Medicare Advantage |
$295.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.50
|
| Rate for Payer: Priority Health Medicare |
$295.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.55
|
| Rate for Payer: UHC Medicare Advantage |
$295.55
|
| Rate for Payer: UMR Bronson Commercial |
$151.80
|
|
|
CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 73218
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$395.38 |
| Rate for Payer: Aetna Commercial |
$367.92
|
| Rate for Payer: Aetna Medicare |
$285.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.92
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$274.57
|
| Rate for Payer: BCN Medicare Advantage |
$274.57
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$395.38
|
| Rate for Payer: Cofinity Commercial |
$367.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.30
|
| Rate for Payer: Nomi Health Commercial |
$329.48
|
| Rate for Payer: PACE SWMI |
$274.57
|
| Rate for Payer: PHP Commercial |
$384.40
|
| Rate for Payer: PHP Medicare Advantage |
$274.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health Medicare |
$274.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$274.57
|
| Rate for Payer: UHC Medicare Advantage |
$274.57
|
| Rate for Payer: UMR Bronson Commercial |
$60.72
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 72265
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$141.54 |
| Rate for Payer: Aetna Commercial |
$131.71
|
| Rate for Payer: Aetna Medicare |
$102.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.71
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: BCBS MAPPO |
$98.29
|
| Rate for Payer: BCN Medicare Advantage |
$98.29
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$141.54
|
| Rate for Payer: Cofinity Commercial |
$131.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.20
|
| Rate for Payer: Nomi Health Commercial |
$117.95
|
| Rate for Payer: PACE SWMI |
$98.29
|
| Rate for Payer: PHP Commercial |
$137.61
|
| Rate for Payer: PHP Medicare Advantage |
$98.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health Medicare |
$98.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.29
|
| Rate for Payer: UHC Medicare Advantage |
$98.29
|
| Rate for Payer: UMR Bronson Commercial |
$74.98
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 78453
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$340.78 |
| Rate for Payer: Aetna Commercial |
$317.11
|
| Rate for Payer: Aetna Medicare |
$246.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.11
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: BCBS MAPPO |
$236.65
|
| Rate for Payer: BCN Medicare Advantage |
$236.65
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cofinity Commercial |
$340.78
|
| Rate for Payer: Cofinity Commercial |
$317.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.48
|
| Rate for Payer: Nomi Health Commercial |
$283.98
|
| Rate for Payer: PACE SWMI |
$236.65
|
| Rate for Payer: PHP Commercial |
$331.31
|
| Rate for Payer: PHP Medicare Advantage |
$236.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: Priority Health Medicare |
$236.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.65
|
| Rate for Payer: UHC Medicare Advantage |
$236.65
|
| Rate for Payer: UMR Bronson Commercial |
$56.12
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 78454
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$503.91 |
| Rate for Payer: Aetna Commercial |
$468.92
|
| Rate for Payer: Aetna Medicare |
$363.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.92
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$349.94
|
| Rate for Payer: BCN Medicare Advantage |
$349.94
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$503.91
|
| Rate for Payer: Cofinity Commercial |
$468.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.44
|
| Rate for Payer: Nomi Health Commercial |
$419.93
|
| Rate for Payer: PACE SWMI |
$349.94
|
| Rate for Payer: PHP Commercial |
$489.92
|
| Rate for Payer: PHP Medicare Advantage |
$349.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health Medicare |
$349.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.94
|
| Rate for Payer: UHC Medicare Advantage |
$349.94
|
| Rate for Payer: UMR Bronson Commercial |
$72.68
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
Both
|
$916.00
|
|
|
Service Code
|
HCPCS 78452
|
| Min. Negotiated Rate |
$366.40 |
| Max. Negotiated Rate |
$595.40 |
| Rate for Payer: Aetna Commercial |
$506.72
|
| Rate for Payer: Aetna Commercial |
$506.72
|
| Rate for Payer: Aetna Medicare |
$393.28
|
| Rate for Payer: Aetna Medicare |
$393.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$506.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$506.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$544.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$544.54
|
| Rate for Payer: BCBS Complete |
$366.40
|
| Rate for Payer: BCBS Complete |
$76.80
|
| Rate for Payer: BCBS MAPPO |
$378.15
|
| Rate for Payer: BCBS MAPPO |
$378.15
|
| Rate for Payer: BCN Medicare Advantage |
$378.15
|
| Rate for Payer: BCN Medicare Advantage |
$378.15
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cofinity Commercial |
$544.54
|
| Rate for Payer: Cofinity Commercial |
$544.54
|
| Rate for Payer: Cofinity Commercial |
$506.72
|
| Rate for Payer: Cofinity Commercial |
$506.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.06
|
| Rate for Payer: Nomi Health Commercial |
$453.78
|
| Rate for Payer: Nomi Health Commercial |
$453.78
|
| Rate for Payer: PACE SWMI |
$378.15
|
| Rate for Payer: PACE SWMI |
$378.15
|
| Rate for Payer: PHP Commercial |
$529.41
|
| Rate for Payer: PHP Commercial |
$529.41
|
| Rate for Payer: PHP Medicare Advantage |
$378.15
|
| Rate for Payer: PHP Medicare Advantage |
$378.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.40
|
| Rate for Payer: Priority Health Medicare |
$378.15
|
| Rate for Payer: Priority Health Medicare |
$378.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.15
|
| Rate for Payer: UHC Medicare Advantage |
$378.15
|
| Rate for Payer: UHC Medicare Advantage |
$378.15
|
| Rate for Payer: UMR Bronson Commercial |
$421.36
|
| Rate for Payer: UMR Bronson Commercial |
$88.32
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 78451
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$396.23 |
| Rate for Payer: Aetna Commercial |
$368.71
|
| Rate for Payer: Aetna Medicare |
$286.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.71
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS MAPPO |
$275.16
|
| Rate for Payer: BCN Medicare Advantage |
$275.16
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$396.23
|
| Rate for Payer: Cofinity Commercial |
$368.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.92
|
| Rate for Payer: Nomi Health Commercial |
$330.19
|
| Rate for Payer: PACE SWMI |
$275.16
|
| Rate for Payer: PHP Commercial |
$385.22
|
| Rate for Payer: PHP Medicare Advantage |
$275.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health Medicare |
$275.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.16
|
| Rate for Payer: UHC Medicare Advantage |
$275.16
|
| Rate for Payer: UMR Bronson Commercial |
$77.28
|
|
