|
CHG MRI ORBIT FACE &/NECK W/O CONTRAST
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 70540
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$358.26 |
| Rate for Payer: Aetna Commercial |
$277.39
|
| Rate for Payer: Aetna Medicare |
$215.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$277.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$298.09
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS MAPPO |
$207.01
|
| Rate for Payer: BCN Commercial |
$345.99
|
| 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: Meridian Medicaid |
$42.27
|
| 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 Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$358.26
|
| Rate for Payer: Priority Health Medicare |
$207.01
|
| Rate for Payer: Priority Health Narrow Network |
$358.26
|
| Rate for Payer: Priority Health SBD |
$97.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$207.01
|
| Rate for Payer: UHC Medicare Advantage |
$207.01
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
| 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 |
$64.75 |
| Max. Negotiated Rate |
$536.35 |
| Rate for Payer: Aetna Commercial |
$417.10
|
| Rate for Payer: Aetna Medicare |
$323.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$417.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$448.23
|
| Rate for Payer: BCBS Complete |
$67.99
|
| Rate for Payer: BCBS MAPPO |
$311.27
|
| Rate for Payer: BCN Commercial |
$518.97
|
| 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 |
$417.10
|
| Rate for Payer: Cofinity Commercial |
$448.23
|
| 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: Meridian Medicaid |
$67.99
|
| 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 Choice Medicaid |
$64.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.35
|
| Rate for Payer: Priority Health Medicare |
$311.27
|
| Rate for Payer: Priority Health Narrow Network |
$536.35
|
| Rate for Payer: Priority Health SBD |
$154.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$311.27
|
| Rate for Payer: UHC Medicare Advantage |
$311.27
|
| Rate for Payer: UHCCP Medicaid |
$64.75
|
| 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 |
$43.88 |
| Max. Negotiated Rate |
$362.87 |
| Rate for Payer: Aetna Commercial |
$280.69
|
| Rate for Payer: Aetna Medicare |
$217.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$280.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$301.64
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS MAPPO |
$209.47
|
| Rate for Payer: BCN Commercial |
$350.38
|
| 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: Meridian Medicaid |
$46.07
|
| 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 Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$362.87
|
| Rate for Payer: Priority Health Medicare |
$209.47
|
| Rate for Payer: Priority Health Narrow Network |
$362.87
|
| Rate for Payer: Priority Health SBD |
$105.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.47
|
| Rate for Payer: UHC Medicare Advantage |
$209.47
|
| Rate for Payer: UHCCP Medicaid |
$43.88
|
| 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 |
$66.24 |
| Max. Negotiated Rate |
$533.28 |
| Rate for Payer: Aetna Commercial |
$414.53
|
| Rate for Payer: Aetna Medicare |
$321.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$414.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$445.46
|
| Rate for Payer: BCBS Complete |
$69.55
|
| Rate for Payer: BCBS MAPPO |
$309.35
|
| Rate for Payer: BCN Commercial |
$516.53
|
| 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 |
$414.53
|
| Rate for Payer: Cofinity Commercial |
$445.46
|
| 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: Meridian Medicaid |
$69.55
|
| 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 Choice Medicaid |
$66.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$533.28
|
| Rate for Payer: Priority Health Medicare |
$309.35
|
| Rate for Payer: Priority Health Narrow Network |
$533.28
|
| Rate for Payer: Priority Health SBD |
$158.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.35
|
| Rate for Payer: UHC Medicare Advantage |
$309.35
|
| Rate for Payer: UHCCP Medicaid |
$66.24
|
| 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 |
$44.52 |
| Max. Negotiated Rate |
$3,028.22 |
| Rate for Payer: Aetna Commercial |
$235.76
|
| Rate for Payer: Aetna Medicare |
$182.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$235.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.35
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS MAPPO |
$175.94
|
| Rate for Payer: BCBS Trust/PPO |
$3,028.22
|
| Rate for Payer: BCN Commercial |
$290.27
|
| 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 |
$235.76
|
| Rate for Payer: Cofinity Commercial |
$253.35
|
| 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: Meridian Medicaid |
$46.75
|
| 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 Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.80
|
| Rate for Payer: Priority Health Medicare |
$175.94
|
| Rate for Payer: Priority Health Narrow Network |
$301.80
|
| Rate for Payer: Priority Health SBD |
$106.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.94
|
| Rate for Payer: UHC Medicare Advantage |
$175.94
|
| Rate for Payer: UHCCP Medicaid |
$44.52
|
| 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 |
$69.23 |
| Max. Negotiated Rate |
$3,620.44 |
| Rate for Payer: Aetna Commercial |
$395.25
|
| Rate for Payer: Aetna Medicare |
$306.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$424.74
|
| Rate for Payer: BCBS Complete |
$72.69
|
| Rate for Payer: BCBS MAPPO |
$294.96
|
| Rate for Payer: BCBS Trust/PPO |
$3,620.44
|
| Rate for Payer: BCN Commercial |
$489.17
|
| 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 |
$395.25
|
| Rate for Payer: Cofinity Commercial |
$424.74
|
| 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: Meridian Medicaid |
$72.69
|
| 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 Choice Medicaid |
$69.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$506.59
|
| Rate for Payer: Priority Health Medicare |
$294.96
|
| Rate for Payer: Priority Health Narrow Network |
$506.59
|
| Rate for Payer: Priority Health SBD |
$165.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.96
|
| Rate for Payer: UHC Medicare Advantage |
$294.96
|
| Rate for Payer: UHCCP Medicaid |
$69.23
|
| 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 |
$53.89 |
| Max. Negotiated Rate |
$3,237.95 |
| Rate for Payer: Aetna Commercial |
$333.31
|
| Rate for Payer: Aetna Medicare |
$258.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$358.19
|
| Rate for Payer: BCBS Complete |
$56.58
|
| Rate for Payer: BCBS MAPPO |
$248.74
|
| Rate for Payer: BCBS Trust/PPO |
$3,237.95
|
| Rate for Payer: BCN Commercial |
$413.42
|
| 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 |
$333.31
|
| Rate for Payer: Cofinity Commercial |
$358.19
|
| 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: Meridian Medicaid |
$56.58
|
| 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 Choice Medicaid |
$53.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$428.57
|
| Rate for Payer: Priority Health Medicare |
$248.74
|
| Rate for Payer: Priority Health Narrow Network |
$428.57
|
| Rate for Payer: Priority Health SBD |
$128.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.74
|
| Rate for Payer: UHC Medicare Advantage |
$248.74
|
| Rate for Payer: UHCCP Medicaid |
$53.89
|
| 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 |
$44.52 |
| Max. Negotiated Rate |
$3,385.35 |
| Rate for Payer: Aetna Commercial |
$236.55
|
| Rate for Payer: Aetna Medicare |
$183.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$254.20
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS MAPPO |
$176.53
|
| Rate for Payer: BCBS Trust/PPO |
$3,385.35
|
| Rate for Payer: BCN Commercial |
$291.25
|
| 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 |
$236.55
|
| Rate for Payer: Cofinity Commercial |
$254.20
|
| 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: Meridian Medicaid |
$46.75
|
| 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 Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$302.83
|
| Rate for Payer: Priority Health Medicare |
$176.53
|
| Rate for Payer: Priority Health Narrow Network |
$302.83
|
| Rate for Payer: Priority Health SBD |
$107.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.53
|
| Rate for Payer: UHC Medicare Advantage |
$176.53
|
| Rate for Payer: UHCCP Medicaid |
$44.52
|
| 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 |
$69.23 |
| Max. Negotiated Rate |
$3,525.87 |
| Rate for Payer: Aetna Commercial |
$394.46
|
| Rate for Payer: Aetna Medicare |
$306.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$394.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.89
|
| Rate for Payer: BCBS Complete |
$72.69
|
| Rate for Payer: BCBS MAPPO |
$294.37
|
| Rate for Payer: BCBS Trust/PPO |
$3,525.87
|
| Rate for Payer: BCN Commercial |
$488.19
|
| 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 |
$394.46
|
| Rate for Payer: Cofinity Commercial |
$423.89
|
| 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: Meridian Medicaid |
$72.69
|
| 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 Choice Medicaid |
$69.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$505.56
|
| Rate for Payer: Priority Health Medicare |
$294.37
|
| Rate for Payer: Priority Health Narrow Network |
$505.56
|
| Rate for Payer: Priority Health SBD |
$165.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.37
|
| Rate for Payer: UHC Medicare Advantage |
$294.37
|
| Rate for Payer: UHCCP Medicaid |
$69.23
|
| 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 |
$44.52 |
| Max. Negotiated Rate |
$2,911.46 |
| Rate for Payer: Aetna Commercial |
$236.15
|
| Rate for Payer: Aetna Medicare |
$183.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$236.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.77
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS MAPPO |
$176.23
|
| Rate for Payer: BCBS Trust/PPO |
$2,911.46
|
| Rate for Payer: BCN Commercial |
$290.27
|
| 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 |
$236.15
|
| Rate for Payer: Cofinity Commercial |
$253.77
|
| 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: Meridian Medicaid |
$46.75
|
| 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 Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$301.29
|
| Rate for Payer: Priority Health Medicare |
$176.23
|
| Rate for Payer: Priority Health Narrow Network |
$301.29
|
| Rate for Payer: Priority Health SBD |
$106.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.23
|
| Rate for Payer: UHC Medicare Advantage |
$176.23
|
| Rate for Payer: UHCCP Medicaid |
$44.52
|
| 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 |
$69.23 |
| Max. Negotiated Rate |
$3,439.76 |
| Rate for Payer: Aetna Commercial |
$396.04
|
| Rate for Payer: Aetna Medicare |
$307.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$425.59
|
| Rate for Payer: BCBS Complete |
$72.69
|
| Rate for Payer: BCBS MAPPO |
$295.55
|
| Rate for Payer: BCBS Trust/PPO |
$3,439.76
|
| Rate for Payer: BCN Commercial |
$490.14
|
| 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 |
$396.04
|
| Rate for Payer: Cofinity Commercial |
$425.59
|
| 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: Meridian Medicaid |
$72.69
|
| 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 Choice Medicaid |
$69.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$507.61
|
| Rate for Payer: Priority Health Medicare |
$295.55
|
| Rate for Payer: Priority Health Narrow Network |
$507.61
|
| Rate for Payer: Priority Health SBD |
$165.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.55
|
| Rate for Payer: UHC Medicare Advantage |
$295.55
|
| Rate for Payer: UHCCP Medicaid |
$69.23
|
| 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 |
$40.68 |
| Max. Negotiated Rate |
$480.92 |
| Rate for Payer: Aetna Commercial |
$367.92
|
| Rate for Payer: Aetna Medicare |
$285.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$367.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$395.38
|
| Rate for Payer: BCBS Complete |
$42.71
|
| Rate for Payer: BCBS MAPPO |
$274.57
|
| Rate for Payer: BCN Commercial |
$466.69
|
| 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 |
$367.92
|
| Rate for Payer: Cofinity Commercial |
$395.38
|
| 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: Meridian Medicaid |
$42.71
|
| 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 Choice Medicaid |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$480.92
|
| Rate for Payer: Priority Health Medicare |
$274.57
|
| Rate for Payer: Priority Health Narrow Network |
$480.92
|
| Rate for Payer: Priority Health SBD |
$98.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$274.57
|
| Rate for Payer: UHC Medicare Advantage |
$274.57
|
| Rate for Payer: UHCCP Medicaid |
$40.68
|
| Rate for Payer: UMR Bronson Commercial |
$60.72
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 72265
|
| Min. Negotiated Rate |
$25.35 |
| Max. Negotiated Rate |
$3,085.27 |
| Rate for Payer: Aetna Commercial |
$131.71
|
| Rate for Payer: Aetna Medicare |
$102.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$131.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.54
|
| Rate for Payer: BCBS Complete |
$26.62
|
| Rate for Payer: BCBS MAPPO |
$98.29
|
| Rate for Payer: BCBS Trust/PPO |
$3,085.27
|
| Rate for Payer: BCN Commercial |
$160.77
|
| 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 |
$131.71
|
| Rate for Payer: Cofinity Commercial |
$141.54
|
| 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: Meridian Medicaid |
$26.62
|
| 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 Choice Medicaid |
$25.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$167.84
|
| Rate for Payer: Priority Health Medicare |
$98.29
|
| Rate for Payer: Priority Health Narrow Network |
$167.84
|
| Rate for Payer: Priority Health SBD |
$60.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.29
|
| Rate for Payer: UHC Medicare Advantage |
$98.29
|
| Rate for Payer: UHCCP Medicaid |
$25.35
|
| 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 |
$29.18 |
| Max. Negotiated Rate |
$410.10 |
| Rate for Payer: Aetna Commercial |
$317.11
|
| Rate for Payer: Aetna Medicare |
$246.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$317.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$340.78
|
| Rate for Payer: BCBS Complete |
$30.64
|
| Rate for Payer: BCBS MAPPO |
$236.65
|
| Rate for Payer: BCBS Trust/PPO |
$240.38
|
| Rate for Payer: BCN Commercial |
$398.76
|
| 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 |
$317.11
|
| Rate for Payer: Cofinity Commercial |
$340.78
|
| 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: Meridian Medicaid |
$30.64
|
| 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 Choice Medicaid |
$29.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$410.10
|
| Rate for Payer: Priority Health Medicare |
$236.65
|
| Rate for Payer: Priority Health Narrow Network |
$410.10
|
| Rate for Payer: Priority Health SBD |
$68.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.65
|
| Rate for Payer: UHC Medicare Advantage |
$236.65
|
| Rate for Payer: UHCCP Medicaid |
$29.18
|
| 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 |
$40.04 |
| Max. Negotiated Rate |
$612.83 |
| Rate for Payer: Aetna Commercial |
$468.92
|
| Rate for Payer: Aetna Medicare |
$363.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$468.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$503.91
|
| Rate for Payer: BCBS Complete |
$42.04
|
| Rate for Payer: BCBS MAPPO |
$349.94
|
| Rate for Payer: BCBS Trust/PPO |
$256.75
|
| Rate for Payer: BCN Commercial |
$594.72
|
| 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 |
$468.92
|
| Rate for Payer: Cofinity Commercial |
$503.91
|
| 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: Meridian Medicaid |
$42.04
|
| 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 Choice Medicaid |
$40.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$612.83
|
| Rate for Payer: Priority Health Medicare |
$349.94
|
| Rate for Payer: Priority Health Narrow Network |
$612.83
|
| Rate for Payer: Priority Health SBD |
$95.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.94
|
| Rate for Payer: UHC Medicare Advantage |
$349.94
|
| Rate for Payer: UHCCP Medicaid |
$40.04
|
| Rate for Payer: UMR Bronson Commercial |
$72.68
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
Both
|
$916.00
|
|
|
Service Code
|
HCPCS 78452
|
| Min. Negotiated Rate |
$47.50 |
| Max. Negotiated Rate |
$666.72 |
| 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) |
$544.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$544.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$506.72
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS Complete |
$49.88
|
| Rate for Payer: BCBS MAPPO |
$378.15
|
| Rate for Payer: BCBS MAPPO |
$378.15
|
| Rate for Payer: BCBS Trust/PPO |
$209.21
|
| Rate for Payer: BCBS Trust/PPO |
$209.21
|
| Rate for Payer: BCN Commercial |
$640.66
|
| Rate for Payer: BCN Commercial |
$640.66
|
| 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 |
$153.60
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cofinity Commercial |
$506.72
|
| Rate for Payer: Cofinity Commercial |
$544.54
|
| Rate for Payer: Cofinity Commercial |
$544.54
|
| 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: Meridian Medicaid |
$49.88
|
| Rate for Payer: Meridian Medicaid |
$49.88
|
| 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 Choice Medicaid |
$47.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.50
|
| 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 HMO/PPO/Tiered Network |
$666.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$666.72
|
| Rate for Payer: Priority Health Medicare |
$378.15
|
| Rate for Payer: Priority Health Medicare |
$378.15
|
| Rate for Payer: Priority Health Narrow Network |
$666.72
|
| Rate for Payer: Priority Health Narrow Network |
$666.72
|
| Rate for Payer: Priority Health SBD |
$114.46
|
| Rate for Payer: Priority Health SBD |
$114.46
|
| 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: UHCCP Medicaid |
$47.50
|
| Rate for Payer: UHCCP Medicaid |
$47.50
|
| Rate for Payer: UMR Bronson Commercial |
$88.32
|
| Rate for Payer: UMR Bronson Commercial |
$421.36
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 78451
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$517.21 |
| Rate for Payer: Aetna Commercial |
$368.71
|
| Rate for Payer: Aetna Medicare |
$286.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$368.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$396.23
|
| Rate for Payer: BCBS Complete |
$42.27
|
| Rate for Payer: BCBS MAPPO |
$275.16
|
| Rate for Payer: BCBS Trust/PPO |
$517.21
|
| Rate for Payer: BCN Commercial |
$461.80
|
| 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: Meridian Medicaid |
$42.27
|
| 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 Choice Medicaid |
$40.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$481.95
|
| Rate for Payer: Priority Health Medicare |
$275.16
|
| Rate for Payer: Priority Health Narrow Network |
$481.95
|
| Rate for Payer: Priority Health SBD |
$97.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.16
|
| Rate for Payer: UHC Medicare Advantage |
$275.16
|
| Rate for Payer: UHCCP Medicaid |
$40.26
|
| Rate for Payer: UMR Bronson Commercial |
$77.28
|
|
|
CHG MYOCRD IMG PET PRFUJ SINGLE STUDY REST/STRESS
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 78491
|
| Min. Negotiated Rate |
$45.37 |
| Max. Negotiated Rate |
$1,479.30 |
| Rate for Payer: Aetna Commercial |
$1,378.75
|
| Rate for Payer: Aetna Medicare |
$357.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,378.75
|
| Rate for Payer: BCBS Complete |
$47.64
|
| Rate for Payer: BCBS Trust/PPO |
$431.09
|
| Rate for Payer: BCN Commercial |
$1,479.30
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Meridian Medicaid |
$47.64
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$676.99
|
| Rate for Payer: Priority Health Narrow Network |
$676.99
|
| Rate for Payer: Priority Health SBD |
$108.30
|
| Rate for Payer: UHCCP Medicaid |
$45.37
|
| Rate for Payer: UMR Bronson Commercial |
$328.44
|
|
|
CHG NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS
|
Professional
|
Both
|
$3,071.00
|
|
|
Service Code
|
HCPCS 77301
|
| Min. Negotiated Rate |
$270.72 |
| Max. Negotiated Rate |
$2,841.41 |
| Rate for Payer: Aetna Commercial |
$2,233.44
|
| Rate for Payer: Aetna Commercial |
$2,233.44
|
| Rate for Payer: Aetna Commercial |
$2,233.44
|
| Rate for Payer: Aetna Medicare |
$1,733.42
|
| Rate for Payer: Aetna Medicare |
$1,733.42
|
| Rate for Payer: Aetna Medicare |
$1,733.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,400.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,233.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,233.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,400.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,233.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,400.12
|
| Rate for Payer: BCBS Complete |
$284.26
|
| Rate for Payer: BCBS Complete |
$284.26
|
| Rate for Payer: BCBS Complete |
$284.26
|
| Rate for Payer: BCBS MAPPO |
$1,666.75
|
| Rate for Payer: BCBS MAPPO |
$1,666.75
|
| Rate for Payer: BCBS MAPPO |
$1,666.75
|
| Rate for Payer: BCBS Trust/PPO |
$603.85
|
| Rate for Payer: BCBS Trust/PPO |
$603.85
|
| Rate for Payer: BCBS Trust/PPO |
$603.85
|
| Rate for Payer: BCN Commercial |
$2,787.78
|
| Rate for Payer: BCN Commercial |
$2,787.78
|
| Rate for Payer: BCN Commercial |
$2,787.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,666.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,666.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,666.75
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$3,056.00
|
| Rate for Payer: Cash Price |
$3,056.00
|
| Rate for Payer: Cash Price |
$2,456.80
|
| Rate for Payer: Cash Price |
$2,456.80
|
| Rate for Payer: Cofinity Commercial |
$2,233.44
|
| Rate for Payer: Cofinity Commercial |
$2,233.44
|
| Rate for Payer: Cofinity Commercial |
$2,400.12
|
| Rate for Payer: Cofinity Commercial |
$2,400.12
|
| Rate for Payer: Cofinity Commercial |
$2,400.12
|
| Rate for Payer: Cofinity Commercial |
$2,233.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,666.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,666.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,666.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,750.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,750.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,750.09
|
| Rate for Payer: Meridian Medicaid |
$284.26
|
| Rate for Payer: Meridian Medicaid |
$284.26
|
| Rate for Payer: Meridian Medicaid |
$284.26
|
| Rate for Payer: Nomi Health Commercial |
$2,000.10
|
| Rate for Payer: Nomi Health Commercial |
$2,000.10
|
| Rate for Payer: Nomi Health Commercial |
$2,000.10
|
| Rate for Payer: PACE SWMI |
$1,666.75
|
| Rate for Payer: PACE SWMI |
$1,666.75
|
| Rate for Payer: PACE SWMI |
$1,666.75
|
| Rate for Payer: PHP Commercial |
$2,333.45
|
| Rate for Payer: PHP Commercial |
$2,333.45
|
| Rate for Payer: PHP Commercial |
$2,333.45
|
| Rate for Payer: PHP Medicare Advantage |
$1,666.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,666.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,666.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,138.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,996.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,483.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,841.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,841.41
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,841.41
|
| Rate for Payer: Priority Health Medicare |
$1,666.75
|
| Rate for Payer: Priority Health Medicare |
$1,666.75
|
| Rate for Payer: Priority Health Medicare |
$1,666.75
|
| Rate for Payer: Priority Health Narrow Network |
$2,841.41
|
| Rate for Payer: Priority Health Narrow Network |
$2,841.41
|
| Rate for Payer: Priority Health Narrow Network |
$2,841.41
|
| Rate for Payer: Priority Health SBD |
$641.06
|
| Rate for Payer: Priority Health SBD |
$641.06
|
| Rate for Payer: Priority Health SBD |
$641.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,666.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,666.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,666.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,666.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,666.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,666.75
|
| Rate for Payer: UHCCP Medicaid |
$270.72
|
| Rate for Payer: UHCCP Medicaid |
$270.72
|
| Rate for Payer: UHCCP Medicaid |
$270.72
|
| Rate for Payer: UMR Bronson Commercial |
$805.92
|
| Rate for Payer: UMR Bronson Commercial |
$1,757.20
|
| Rate for Payer: UMR Bronson Commercial |
$1,412.66
|
|
|
CHG OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 76519
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$2,288.07 |
| Rate for Payer: Aetna Commercial |
$82.87
|
| Rate for Payer: Aetna Medicare |
$64.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.05
|
| Rate for Payer: BCBS Complete |
$20.13
|
| Rate for Payer: BCBS MAPPO |
$61.84
|
| Rate for Payer: BCBS Trust/PPO |
$2,288.07
|
| Rate for Payer: BCN Commercial |
$98.23
|
| Rate for Payer: BCN Medicare Advantage |
$61.84
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$82.87
|
| Rate for Payer: Cofinity Commercial |
$89.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.93
|
| Rate for Payer: Meridian Medicaid |
$20.13
|
| Rate for Payer: Nomi Health Commercial |
$74.21
|
| Rate for Payer: PACE SWMI |
$61.84
|
| Rate for Payer: PHP Commercial |
$86.58
|
| Rate for Payer: PHP Medicare Advantage |
$61.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$19.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.71
|
| Rate for Payer: Priority Health Medicare |
$61.84
|
| Rate for Payer: Priority Health Narrow Network |
$104.71
|
| Rate for Payer: Priority Health SBD |
$45.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.84
|
| Rate for Payer: UHC Medicare Advantage |
$61.84
|
| Rate for Payer: UHCCP Medicaid |
$19.17
|
| Rate for Payer: UMR Bronson Commercial |
$22.54
|
|
|
CHG OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 76514
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$1,479.24 |
| Rate for Payer: Aetna Commercial |
$14.19
|
| Rate for Payer: Aetna Medicare |
$11.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.25
|
| Rate for Payer: BCBS Complete |
$5.14
|
| Rate for Payer: BCBS MAPPO |
$10.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,479.24
|
| Rate for Payer: BCN Commercial |
$16.61
|
| Rate for Payer: BCN Medicare Advantage |
$10.59
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$14.19
|
| Rate for Payer: Cofinity Commercial |
$15.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.12
|
| Rate for Payer: Meridian Medicaid |
$5.14
|
| Rate for Payer: Nomi Health Commercial |
$12.71
|
| Rate for Payer: PACE SWMI |
$10.59
|
| Rate for Payer: PHP Commercial |
$14.83
|
| Rate for Payer: PHP Medicare Advantage |
$10.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$4.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$17.45
|
| Rate for Payer: Priority Health Medicare |
$10.59
|
| Rate for Payer: Priority Health Narrow Network |
$17.45
|
| Rate for Payer: Priority Health SBD |
$11.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.59
|
| Rate for Payer: UHC Medicare Advantage |
$10.59
|
| Rate for Payer: UHCCP Medicaid |
$4.90
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
|
|
CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS 86403
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$1,738.64 |
| Rate for Payer: Aetna Commercial |
$15.46
|
| Rate for Payer: Aetna Medicare |
$12.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$15.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.62
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$11.54
|
| Rate for Payer: BCBS Trust/PPO |
$1,738.64
|
| Rate for Payer: BCN Commercial |
$8.66
|
| Rate for Payer: BCN Medicare Advantage |
$11.54
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.12
|
| Rate for Payer: Nomi Health Commercial |
$13.85
|
| Rate for Payer: PACE SWMI |
$11.54
|
| Rate for Payer: PHP Commercial |
$16.16
|
| Rate for Payer: PHP Medicare Advantage |
$11.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$11.65
|
| Rate for Payer: Priority Health Medicare |
$11.54
|
| Rate for Payer: Priority Health Narrow Network |
$11.65
|
| Rate for Payer: Priority Health SBD |
$11.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.54
|
| Rate for Payer: UHC Medicare Advantage |
$11.54
|
| Rate for Payer: UMR Bronson Commercial |
$9.66
|
|
|
CHG PERCUTANEOUS VERTEBROPLASTY, CT GUIDE
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 72292
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$173.55 |
| Rate for Payer: Aetna Medicare |
$133.50
|
| Rate for Payer: BCBS Complete |
$106.80
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.55
|
| Rate for Payer: UMR Bronson Commercial |
$122.82
|
|
|
CHG PERCUTANEOUS VERTEBROPLASTY, FLUOR GUIDE
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 72291
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Aetna Medicare |
$121.00
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: UMR Bronson Commercial |
$111.32
|
|
|
CHG PERITONEOGRAM RS&I
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 74190
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$2,754.03 |
| Rate for Payer: Aetna Commercial |
$534.94
|
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$534.94
|
| Rate for Payer: BCBS Complete |
$14.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,754.03
|
| Rate for Payer: BCN Commercial |
$497.65
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Meridian Medicaid |
$14.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$83.66
|
| Rate for Payer: Priority Health Narrow Network |
$83.66
|
| Rate for Payer: Priority Health SBD |
$33.37
|
| Rate for Payer: UHCCP Medicaid |
$13.85
|
| Rate for Payer: UMR Bronson Commercial |
$21.16
|
|
