|
CHG RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 72190
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$54.75 |
| Rate for Payer: Aetna Commercial |
$50.95
|
| Rate for Payer: Aetna Commercial |
$50.95
|
| Rate for Payer: Aetna Medicare |
$39.54
|
| Rate for Payer: Aetna Medicare |
$39.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.75
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: BCBS MAPPO |
$38.02
|
| Rate for Payer: BCBS MAPPO |
$38.02
|
| Rate for Payer: BCN Medicare Advantage |
$38.02
|
| Rate for Payer: BCN Medicare Advantage |
$38.02
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$54.75
|
| Rate for Payer: Cofinity Commercial |
$54.75
|
| Rate for Payer: Cofinity Commercial |
$50.95
|
| Rate for Payer: Cofinity Commercial |
$50.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.92
|
| Rate for Payer: Nomi Health Commercial |
$45.62
|
| Rate for Payer: Nomi Health Commercial |
$45.62
|
| Rate for Payer: PACE SWMI |
$38.02
|
| Rate for Payer: PACE SWMI |
$38.02
|
| Rate for Payer: PHP Commercial |
$53.23
|
| Rate for Payer: PHP Commercial |
$53.23
|
| Rate for Payer: PHP Medicare Advantage |
$38.02
|
| Rate for Payer: PHP Medicare Advantage |
$38.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
| Rate for Payer: Priority Health Medicare |
$38.02
|
| Rate for Payer: Priority Health Medicare |
$38.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.02
|
| Rate for Payer: UHC Medicare Advantage |
$38.02
|
| Rate for Payer: UHC Medicare Advantage |
$38.02
|
| Rate for Payer: UMR Bronson Commercial |
$25.30
|
| Rate for Payer: UMR Bronson Commercial |
$24.38
|
|
|
CHG RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 72202
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$51.26 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Medicare |
$37.02
|
| Rate for Payer: Aetna Medicare |
$37.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.26
|
| Rate for Payer: BCBS Complete |
$20.00
|
| Rate for Payer: BCBS Complete |
$16.00
|
| Rate for Payer: BCBS MAPPO |
$35.60
|
| Rate for Payer: BCBS MAPPO |
$35.60
|
| Rate for Payer: BCN Medicare Advantage |
$35.60
|
| Rate for Payer: BCN Medicare Advantage |
$35.60
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$32.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$51.26
|
| Rate for Payer: Cofinity Commercial |
$51.26
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Cofinity Commercial |
$47.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.38
|
| Rate for Payer: Nomi Health Commercial |
$42.72
|
| Rate for Payer: Nomi Health Commercial |
$42.72
|
| Rate for Payer: PACE SWMI |
$35.60
|
| Rate for Payer: PACE SWMI |
$35.60
|
| Rate for Payer: PHP Commercial |
$49.84
|
| Rate for Payer: PHP Commercial |
$49.84
|
| Rate for Payer: PHP Medicare Advantage |
$35.60
|
| Rate for Payer: PHP Medicare Advantage |
$35.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.50
|
| Rate for Payer: Priority Health Medicare |
$35.60
|
| Rate for Payer: Priority Health Medicare |
$35.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.60
|
| Rate for Payer: UHC Medicare Advantage |
$35.60
|
| Rate for Payer: UHC Medicare Advantage |
$35.60
|
| Rate for Payer: UMR Bronson Commercial |
$23.00
|
| Rate for Payer: UMR Bronson Commercial |
$18.40
|
|
|
CHG RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 70260
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$58.26 |
| Rate for Payer: Aetna Commercial |
$54.22
|
| Rate for Payer: Aetna Medicare |
$42.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.22
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS MAPPO |
$40.46
|
| Rate for Payer: BCN Medicare Advantage |
$40.46
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$58.26
|
| Rate for Payer: Cofinity Commercial |
$54.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.48
|
| Rate for Payer: Nomi Health Commercial |
$48.55
|
| Rate for Payer: PACE SWMI |
$40.46
|
| Rate for Payer: PHP Commercial |
$56.64
|
| Rate for Payer: PHP Medicare Advantage |
$40.46
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health Medicare |
$40.46
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.46
|
| Rate for Payer: UHC Medicare Advantage |
$40.46
|
| Rate for Payer: UMR Bronson Commercial |
$27.14
|
|
|
CHG RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 74250
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$156.73 |
| Rate for Payer: Aetna Commercial |
$145.85
|
| Rate for Payer: Aetna Medicare |
$113.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$145.85
|
| Rate for Payer: BCBS Complete |
$94.40
|
| Rate for Payer: BCBS MAPPO |
$108.84
|
| Rate for Payer: BCN Medicare Advantage |
$108.84
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cofinity Commercial |
$156.73
|
| Rate for Payer: Cofinity Commercial |
$145.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$114.28
|
| Rate for Payer: Nomi Health Commercial |
$130.61
|
| Rate for Payer: PACE SWMI |
$108.84
|
| Rate for Payer: PHP Commercial |
$152.38
|
| Rate for Payer: PHP Medicare Advantage |
$108.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.40
|
| Rate for Payer: Priority Health Medicare |
$108.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.84
|
| Rate for Payer: UHC Medicare Advantage |
$108.84
|
| Rate for Payer: UMR Bronson Commercial |
$108.56
|
|
|
CHG RADN RX DELIVERY COMPLX 11-19 MEV
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS 77414
|
| Min. Negotiated Rate |
$190.00 |
| Max. Negotiated Rate |
$308.75 |
| Rate for Payer: Aetna Medicare |
$237.50
|
| Rate for Payer: BCBS Complete |
$190.00
|
| Rate for Payer: Cash Price |
$380.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.75
|
| Rate for Payer: UMR Bronson Commercial |
$218.50
|
|
|
CHG RADN RX DELIVERY COMPLX 6-10 MEV
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
HCPCS 77413
|
| Min. Negotiated Rate |
$168.80 |
| Max. Negotiated Rate |
$274.30 |
| Rate for Payer: Aetna Medicare |
$211.00
|
| Rate for Payer: BCBS Complete |
$168.80
|
| Rate for Payer: Cash Price |
$337.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$274.30
|
| Rate for Payer: UMR Bronson Commercial |
$194.12
|
|
|
CHG RADN RX DELIVERY SIMPLE 11-19 MEV
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 77404
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$169.65 |
| Rate for Payer: Aetna Medicare |
$130.50
|
| Rate for Payer: BCBS Complete |
$104.40
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: UMR Bronson Commercial |
$120.06
|
|
|
CHG RADN RX DELIVERY SIMPLE 6-10 MEV
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
HCPCS 77403
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Aetna Medicare |
$117.00
|
| Rate for Payer: BCBS Complete |
$93.60
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.10
|
| Rate for Payer: UMR Bronson Commercial |
$107.64
|
|
|
CHG REMOTE AFTLD RADIONUC BRACHYTHERAPY,1 CHANNEL
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS 77785
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$200.85 |
| Rate for Payer: Aetna Medicare |
$154.50
|
| Rate for Payer: Aetna Medicare |
$228.00
|
| Rate for Payer: BCBS Complete |
$182.40
|
| Rate for Payer: BCBS Complete |
$123.60
|
| Rate for Payer: Cash Price |
$247.20
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$296.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.85
|
| Rate for Payer: UMR Bronson Commercial |
$142.14
|
| Rate for Payer: UMR Bronson Commercial |
$209.76
|
|
|
CHG REMOTE AFTLD RADIONUC BRACHYTHERAPY,2-12 CHANNEL
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
HCPCS 77786
|
| Min. Negotiated Rate |
$272.80 |
| Max. Negotiated Rate |
$443.30 |
| Rate for Payer: Aetna Medicare |
$341.00
|
| Rate for Payer: Aetna Medicare |
$502.50
|
| Rate for Payer: BCBS Complete |
$402.00
|
| Rate for Payer: BCBS Complete |
$272.80
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cash Price |
$804.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$653.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$443.30
|
| Rate for Payer: UMR Bronson Commercial |
$313.72
|
| Rate for Payer: UMR Bronson Commercial |
$462.30
|
|
|
CHG REPAIR,ILIAC ANRYSM/PSEUDO/AV MALF/TRAUMA W/ ENDOPROSTHESIS
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 75954
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$143.00 |
| Rate for Payer: Aetna Medicare |
$110.00
|
| Rate for Payer: BCBS Complete |
$88.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.00
|
| Rate for Payer: UMR Bronson Commercial |
$101.20
|
|
|
CHG RESPIRATORY MOTION MANAGEMENT SIMULATION
|
Professional
|
Both
|
$826.00
|
|
|
Service Code
|
HCPCS 77293
|
| Min. Negotiated Rate |
$330.40 |
| Max. Negotiated Rate |
$536.90 |
| Rate for Payer: Aetna Commercial |
$485.84
|
| Rate for Payer: Aetna Commercial |
$485.84
|
| Rate for Payer: Aetna Medicare |
$377.07
|
| Rate for Payer: Aetna Medicare |
$377.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$485.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$485.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$522.10
|
| Rate for Payer: BCBS Complete |
$247.20
|
| Rate for Payer: BCBS Complete |
$330.40
|
| Rate for Payer: BCBS MAPPO |
$362.57
|
| Rate for Payer: BCBS MAPPO |
$362.57
|
| Rate for Payer: BCN Medicare Advantage |
$362.57
|
| Rate for Payer: BCN Medicare Advantage |
$362.57
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cash Price |
$660.80
|
| Rate for Payer: Cofinity Commercial |
$522.10
|
| Rate for Payer: Cofinity Commercial |
$485.84
|
| Rate for Payer: Cofinity Commercial |
$522.10
|
| Rate for Payer: Cofinity Commercial |
$485.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$362.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$362.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$380.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$380.70
|
| Rate for Payer: Nomi Health Commercial |
$435.08
|
| Rate for Payer: Nomi Health Commercial |
$435.08
|
| Rate for Payer: PACE SWMI |
$362.57
|
| Rate for Payer: PACE SWMI |
$362.57
|
| Rate for Payer: PHP Commercial |
$507.60
|
| Rate for Payer: PHP Commercial |
$507.60
|
| Rate for Payer: PHP Medicare Advantage |
$362.57
|
| Rate for Payer: PHP Medicare Advantage |
$362.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$536.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$401.70
|
| Rate for Payer: Priority Health Medicare |
$362.57
|
| Rate for Payer: Priority Health Medicare |
$362.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$362.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$362.57
|
| Rate for Payer: UHC Medicare Advantage |
$362.57
|
| Rate for Payer: UHC Medicare Advantage |
$362.57
|
| Rate for Payer: UMR Bronson Commercial |
$284.28
|
| Rate for Payer: UMR Bronson Commercial |
$379.96
|
|
|
CHG RP LOCLZJ TUM SPECT 1 AREA/ACQUISJ 1 DAY IMG
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 78803
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$435.77 |
| Rate for Payer: Aetna Commercial |
$405.51
|
| Rate for Payer: Aetna Commercial |
$405.51
|
| Rate for Payer: Aetna Commercial |
$405.51
|
| Rate for Payer: Aetna Medicare |
$314.72
|
| Rate for Payer: Aetna Medicare |
$314.72
|
| Rate for Payer: Aetna Medicare |
$314.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$435.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$405.51
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: BCBS Complete |
$34.80
|
| Rate for Payer: BCBS Complete |
$279.60
|
| Rate for Payer: BCBS MAPPO |
$302.62
|
| Rate for Payer: BCBS MAPPO |
$302.62
|
| Rate for Payer: BCBS MAPPO |
$302.62
|
| Rate for Payer: BCN Medicare Advantage |
$302.62
|
| Rate for Payer: BCN Medicare Advantage |
$302.62
|
| Rate for Payer: BCN Medicare Advantage |
$302.62
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$559.20
|
| Rate for Payer: Cofinity Commercial |
$435.77
|
| Rate for Payer: Cofinity Commercial |
$405.51
|
| Rate for Payer: Cofinity Commercial |
$405.51
|
| Rate for Payer: Cofinity Commercial |
$435.77
|
| Rate for Payer: Cofinity Commercial |
$405.51
|
| Rate for Payer: Cofinity Commercial |
$435.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$302.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$317.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$317.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$317.75
|
| Rate for Payer: Nomi Health Commercial |
$363.14
|
| Rate for Payer: Nomi Health Commercial |
$363.14
|
| Rate for Payer: Nomi Health Commercial |
$363.14
|
| Rate for Payer: PACE SWMI |
$302.62
|
| Rate for Payer: PACE SWMI |
$302.62
|
| Rate for Payer: PACE SWMI |
$302.62
|
| Rate for Payer: PHP Commercial |
$423.67
|
| Rate for Payer: PHP Commercial |
$423.67
|
| Rate for Payer: PHP Commercial |
$423.67
|
| Rate for Payer: PHP Medicare Advantage |
$302.62
|
| Rate for Payer: PHP Medicare Advantage |
$302.62
|
| Rate for Payer: PHP Medicare Advantage |
$302.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$454.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$56.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health Medicare |
$302.62
|
| Rate for Payer: Priority Health Medicare |
$302.62
|
| Rate for Payer: Priority Health Medicare |
$302.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$302.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$302.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$302.62
|
| Rate for Payer: UHC Medicare Advantage |
$302.62
|
| Rate for Payer: UHC Medicare Advantage |
$302.62
|
| Rate for Payer: UHC Medicare Advantage |
$302.62
|
| Rate for Payer: UMR Bronson Commercial |
$281.52
|
| Rate for Payer: UMR Bronson Commercial |
$321.54
|
| Rate for Payer: UMR Bronson Commercial |
$40.02
|
|
|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
Both
|
$527.00
|
|
|
Service Code
|
HCPCS 79101
|
| Min. Negotiated Rate |
$134.80 |
| Max. Negotiated Rate |
$342.55 |
| Rate for Payer: Aetna Commercial |
$180.63
|
| Rate for Payer: Aetna Commercial |
$180.63
|
| Rate for Payer: Aetna Medicare |
$140.19
|
| Rate for Payer: Aetna Medicare |
$140.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$180.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.11
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS Complete |
$117.20
|
| Rate for Payer: BCBS MAPPO |
$134.80
|
| Rate for Payer: BCBS MAPPO |
$134.80
|
| Rate for Payer: BCN Medicare Advantage |
$134.80
|
| Rate for Payer: BCN Medicare Advantage |
$134.80
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cofinity Commercial |
$194.11
|
| Rate for Payer: Cofinity Commercial |
$194.11
|
| Rate for Payer: Cofinity Commercial |
$180.63
|
| Rate for Payer: Cofinity Commercial |
$180.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.54
|
| Rate for Payer: Nomi Health Commercial |
$161.76
|
| Rate for Payer: Nomi Health Commercial |
$161.76
|
| Rate for Payer: PACE SWMI |
$134.80
|
| Rate for Payer: PACE SWMI |
$134.80
|
| Rate for Payer: PHP Commercial |
$188.72
|
| Rate for Payer: PHP Commercial |
$188.72
|
| Rate for Payer: PHP Medicare Advantage |
$134.80
|
| Rate for Payer: PHP Medicare Advantage |
$134.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.55
|
| Rate for Payer: Priority Health Medicare |
$134.80
|
| Rate for Payer: Priority Health Medicare |
$134.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.80
|
| Rate for Payer: UHC Medicare Advantage |
$134.80
|
| Rate for Payer: UHC Medicare Advantage |
$134.80
|
| Rate for Payer: UMR Bronson Commercial |
$242.42
|
| Rate for Payer: UMR Bronson Commercial |
$134.78
|
|
|
CHG RP THERAPY ORAL ADMINISTRATION
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS 79005
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$179.99 |
| Rate for Payer: Aetna Commercial |
$167.49
|
| Rate for Payer: Aetna Commercial |
$167.49
|
| Rate for Payer: Aetna Medicare |
$129.99
|
| Rate for Payer: Aetna Medicare |
$129.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$179.99
|
| Rate for Payer: BCBS Complete |
$104.00
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: BCBS MAPPO |
$124.99
|
| Rate for Payer: BCBS MAPPO |
$124.99
|
| Rate for Payer: BCN Medicare Advantage |
$124.99
|
| Rate for Payer: BCN Medicare Advantage |
$124.99
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$179.99
|
| Rate for Payer: Cofinity Commercial |
$179.99
|
| Rate for Payer: Cofinity Commercial |
$167.49
|
| Rate for Payer: Cofinity Commercial |
$167.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.24
|
| Rate for Payer: Nomi Health Commercial |
$149.99
|
| Rate for Payer: Nomi Health Commercial |
$149.99
|
| Rate for Payer: PACE SWMI |
$124.99
|
| Rate for Payer: PACE SWMI |
$124.99
|
| Rate for Payer: PHP Commercial |
$174.99
|
| Rate for Payer: PHP Commercial |
$174.99
|
| Rate for Payer: PHP Medicare Advantage |
$124.99
|
| Rate for Payer: PHP Medicare Advantage |
$124.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.00
|
| Rate for Payer: Priority Health Medicare |
$124.99
|
| Rate for Payer: Priority Health Medicare |
$124.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.99
|
| Rate for Payer: UHC Medicare Advantage |
$124.99
|
| Rate for Payer: UHC Medicare Advantage |
$124.99
|
| Rate for Payer: UMR Bronson Commercial |
$119.60
|
| Rate for Payer: UMR Bronson Commercial |
$71.30
|
|
|
CHG SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 76831
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$138.27
|
| Rate for Payer: Aetna Medicare |
$107.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$148.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$138.27
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: BCBS MAPPO |
$103.19
|
| Rate for Payer: BCN Medicare Advantage |
$103.19
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$148.59
|
| Rate for Payer: Cofinity Commercial |
$138.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.35
|
| Rate for Payer: Nomi Health Commercial |
$123.83
|
| Rate for Payer: PACE SWMI |
$103.19
|
| Rate for Payer: PHP Commercial |
$144.47
|
| Rate for Payer: PHP Medicare Advantage |
$103.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health Medicare |
$103.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.19
|
| Rate for Payer: UHC Medicare Advantage |
$103.19
|
| Rate for Payer: UMR Bronson Commercial |
$110.40
|
|
|
CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 77063
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$69.48 |
| Rate for Payer: Aetna Commercial |
$64.66
|
| Rate for Payer: Aetna Medicare |
$50.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.66
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS MAPPO |
$48.25
|
| Rate for Payer: BCN Medicare Advantage |
$48.25
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$69.48
|
| Rate for Payer: Cofinity Commercial |
$64.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.66
|
| Rate for Payer: Nomi Health Commercial |
$57.90
|
| Rate for Payer: PACE SWMI |
$48.25
|
| Rate for Payer: PHP Commercial |
$67.55
|
| Rate for Payer: PHP Medicare Advantage |
$48.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.30
|
| Rate for Payer: Priority Health Medicare |
$48.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.25
|
| Rate for Payer: UHC Medicare Advantage |
$48.25
|
| Rate for Payer: UMR Bronson Commercial |
$28.52
|
|
|
CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 77067
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$167.13 |
| Rate for Payer: Aetna Commercial |
$155.52
|
| Rate for Payer: Aetna Medicare |
$120.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.52
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS MAPPO |
$116.06
|
| Rate for Payer: BCN Medicare Advantage |
$116.06
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$167.13
|
| Rate for Payer: Cofinity Commercial |
$155.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.86
|
| Rate for Payer: Nomi Health Commercial |
$139.27
|
| Rate for Payer: PACE SWMI |
$116.06
|
| Rate for Payer: PHP Commercial |
$162.48
|
| Rate for Payer: PHP Medicare Advantage |
$116.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
| Rate for Payer: Priority Health Medicare |
$116.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.06
|
| Rate for Payer: UHC Medicare Advantage |
$116.06
|
| Rate for Payer: UMR Bronson Commercial |
$36.34
|
|
|
CHG SEDIMENTATION RATE RBC NON-AUTOMATED
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 85651
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna Medicare |
$4.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.72
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$6.15
|
| Rate for Payer: Cofinity Commercial |
$5.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Nomi Health Commercial |
$5.12
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Commercial |
$5.98
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Medicare Advantage |
$4.27
|
| Rate for Payer: UMR Bronson Commercial |
$6.90
|
|
|
CHG SEMEN ALYS MOTILITY&CNT X W/HUHNER TST
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS 89310
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Aetna Commercial |
$11.54
|
| Rate for Payer: Aetna Medicare |
$8.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.54
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$8.61
|
| Rate for Payer: BCN Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.04
|
| Rate for Payer: Nomi Health Commercial |
$10.33
|
| Rate for Payer: PACE SWMI |
$8.61
|
| Rate for Payer: PHP Commercial |
$12.05
|
| Rate for Payer: PHP Medicare Advantage |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health Medicare |
$8.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.61
|
| Rate for Payer: UHC Medicare Advantage |
$8.61
|
| Rate for Payer: UMR Bronson Commercial |
$9.66
|
|
|
CHG SEMEN ALYS PRESENCE&/MOTILITY SPRM HUHNER
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 89300
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Aetna Commercial |
$13.19
|
| Rate for Payer: Aetna Medicare |
$10.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$14.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.19
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$9.84
|
| Rate for Payer: BCN Medicare Advantage |
$9.84
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| Rate for Payer: Cofinity Commercial |
$13.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.33
|
| Rate for Payer: Nomi Health Commercial |
$11.81
|
| Rate for Payer: PACE SWMI |
$9.84
|
| Rate for Payer: PHP Commercial |
$13.78
|
| Rate for Payer: PHP Medicare Advantage |
$9.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Medicare |
$9.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.84
|
| Rate for Payer: UHC Medicare Advantage |
$9.84
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
CHG SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 89321
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Medicare |
$12.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.15
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$16.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Nomi Health Commercial |
$14.46
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Commercial |
$16.87
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UMR Bronson Commercial |
$13.34
|
|
|
CHG SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 75809
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$98.22
|
| Rate for Payer: Aetna Medicare |
$76.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$98.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.55
|
| Rate for Payer: BCBS Complete |
$76.80
|
| Rate for Payer: BCBS MAPPO |
$73.30
|
| Rate for Payer: BCN Medicare Advantage |
$73.30
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Commercial |
$98.22
|
| Rate for Payer: Cofinity Commercial |
$105.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.97
|
| Rate for Payer: Nomi Health Commercial |
$87.96
|
| Rate for Payer: PACE SWMI |
$73.30
|
| Rate for Payer: PHP Commercial |
$102.62
|
| Rate for Payer: PHP Medicare Advantage |
$73.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.80
|
| Rate for Payer: Priority Health Medicare |
$73.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.30
|
| Rate for Payer: UHC Medicare Advantage |
$73.30
|
| Rate for Payer: UMR Bronson Commercial |
$88.32
|
|
|
CHG SKIN TEST TUBERCULOSIS INTRADERMAL
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 86580
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$12.86 |
| Rate for Payer: Aetna Commercial |
$11.97
|
| Rate for Payer: Aetna Medicare |
$9.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$12.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$11.97
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS MAPPO |
$8.93
|
| Rate for Payer: BCN Medicare Advantage |
$8.93
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$12.86
|
| Rate for Payer: Cofinity Commercial |
$11.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.38
|
| Rate for Payer: Nomi Health Commercial |
$10.72
|
| Rate for Payer: PACE SWMI |
$8.93
|
| Rate for Payer: PHP Commercial |
$12.50
|
| Rate for Payer: PHP Medicare Advantage |
$8.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health Medicare |
$8.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.93
|
| Rate for Payer: UHC Medicare Advantage |
$8.93
|
| Rate for Payer: UMR Bronson Commercial |
$7.36
|
|
|
CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 87209
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Aetna Commercial |
$24.09
|
| Rate for Payer: Aetna Medicare |
$18.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$25.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$24.09
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Cofinity Commercial |
$24.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: Nomi Health Commercial |
$21.58
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Commercial |
$25.17
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.98
|
| Rate for Payer: UHC Medicare Advantage |
$17.98
|
| Rate for Payer: UMR Bronson Commercial |
$22.54
|
|
