|
CHG US TRANSVAGINAL
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS 76830
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$659.85 |
| Rate for Payer: Aetna Commercial |
$142.62
|
| Rate for Payer: Aetna Medicare |
$110.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$153.26
|
| Rate for Payer: BCBS Complete |
$21.91
|
| Rate for Payer: BCBS MAPPO |
$106.43
|
| Rate for Payer: BCBS Trust/PPO |
$659.85
|
| Rate for Payer: BCN Commercial |
$176.42
|
| Rate for Payer: BCN Medicare Advantage |
$106.43
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cash Price |
$248.00
|
| Rate for Payer: Cofinity Commercial |
$142.62
|
| Rate for Payer: Cofinity Commercial |
$153.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.75
|
| Rate for Payer: Meridian Medicaid |
$21.91
|
| Rate for Payer: Nomi Health Commercial |
$127.72
|
| Rate for Payer: PACE SWMI |
$106.43
|
| Rate for Payer: PHP Commercial |
$149.00
|
| Rate for Payer: PHP Medicare Advantage |
$106.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$20.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$201.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.75
|
| Rate for Payer: Priority Health Medicare |
$106.43
|
| Rate for Payer: Priority Health Narrow Network |
$183.75
|
| Rate for Payer: Priority Health SBD |
$49.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$106.43
|
| Rate for Payer: UHC Medicare Advantage |
$106.43
|
| Rate for Payer: UHCCP Medicaid |
$20.87
|
| Rate for Payer: UMR Bronson Commercial |
$142.60
|
|
|
CHG US VASC ACCESS SITS VSL PATENCY NDL ENTRY
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
HCPCS 76937
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$397.81 |
| Rate for Payer: Aetna Commercial |
$46.91
|
| Rate for Payer: Aetna Commercial |
$46.91
|
| Rate for Payer: Aetna Medicare |
$36.41
|
| Rate for Payer: Aetna Medicare |
$36.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$46.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.41
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: BCBS Complete |
$8.95
|
| Rate for Payer: BCBS MAPPO |
$35.01
|
| Rate for Payer: BCBS MAPPO |
$35.01
|
| Rate for Payer: BCBS Trust/PPO |
$397.81
|
| Rate for Payer: BCBS Trust/PPO |
$397.81
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: BCN Commercial |
$57.66
|
| Rate for Payer: BCN Medicare Advantage |
$35.01
|
| Rate for Payer: BCN Medicare Advantage |
$35.01
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$46.91
|
| Rate for Payer: Cofinity Commercial |
$50.41
|
| Rate for Payer: Cofinity Commercial |
$50.41
|
| Rate for Payer: Cofinity Commercial |
$46.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.76
|
| Rate for Payer: Meridian Medicaid |
$8.95
|
| Rate for Payer: Meridian Medicaid |
$8.95
|
| Rate for Payer: Nomi Health Commercial |
$42.01
|
| Rate for Payer: Nomi Health Commercial |
$42.01
|
| Rate for Payer: PACE SWMI |
$35.01
|
| Rate for Payer: PACE SWMI |
$35.01
|
| Rate for Payer: PHP Commercial |
$49.01
|
| Rate for Payer: PHP Commercial |
$49.01
|
| Rate for Payer: PHP Medicare Advantage |
$35.01
|
| Rate for Payer: PHP Medicare Advantage |
$35.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$8.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.02
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.02
|
| Rate for Payer: Priority Health Medicare |
$35.01
|
| Rate for Payer: Priority Health Medicare |
$35.01
|
| Rate for Payer: Priority Health Narrow Network |
$59.02
|
| Rate for Payer: Priority Health Narrow Network |
$59.02
|
| Rate for Payer: Priority Health SBD |
$21.05
|
| Rate for Payer: Priority Health SBD |
$21.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.01
|
| Rate for Payer: UHC Medicare Advantage |
$35.01
|
| Rate for Payer: UHC Medicare Advantage |
$35.01
|
| Rate for Payer: UHCCP Medicaid |
$8.52
|
| Rate for Payer: UHCCP Medicaid |
$8.52
|
| Rate for Payer: UMR Bronson Commercial |
$28.52
|
| Rate for Payer: UMR Bronson Commercial |
$26.22
|
|
|
CHG VENOGRAPHY ADRENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
HCPCS 75840
|
| Min. Negotiated Rate |
$34.29 |
| Max. Negotiated Rate |
$311.17 |
| Rate for Payer: Aetna Commercial |
$156.82
|
| Rate for Payer: Aetna Medicare |
$121.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$156.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.52
|
| Rate for Payer: BCBS Complete |
$36.00
|
| Rate for Payer: BCBS MAPPO |
$117.03
|
| Rate for Payer: BCBS Trust/PPO |
$311.17
|
| Rate for Payer: BCN Commercial |
$189.61
|
| Rate for Payer: BCN Medicare Advantage |
$117.03
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cash Price |
$233.60
|
| Rate for Payer: Cofinity Commercial |
$156.82
|
| Rate for Payer: Cofinity Commercial |
$168.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.88
|
| Rate for Payer: Meridian Medicaid |
$36.00
|
| Rate for Payer: Nomi Health Commercial |
$140.44
|
| Rate for Payer: PACE SWMI |
$117.03
|
| Rate for Payer: PHP Commercial |
$163.84
|
| Rate for Payer: PHP Medicare Advantage |
$117.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$197.61
|
| Rate for Payer: Priority Health Medicare |
$117.03
|
| Rate for Payer: Priority Health Narrow Network |
$197.61
|
| Rate for Payer: Priority Health SBD |
$82.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.03
|
| Rate for Payer: UHC Medicare Advantage |
$117.03
|
| Rate for Payer: UHCCP Medicaid |
$34.29
|
| Rate for Payer: UMR Bronson Commercial |
$134.32
|
|
|
CHG VENOGRAPHY CAVAL INFERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
HCPCS 75825
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$238.26 |
| Rate for Payer: Aetna Commercial |
$141.26
|
| Rate for Payer: Aetna Medicare |
$109.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$141.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.80
|
| Rate for Payer: BCBS Complete |
$35.56
|
| Rate for Payer: BCBS MAPPO |
$105.42
|
| Rate for Payer: BCBS Trust/PPO |
$238.26
|
| Rate for Payer: BCN Commercial |
$167.13
|
| Rate for Payer: BCN Medicare Advantage |
$105.42
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cofinity Commercial |
$141.26
|
| Rate for Payer: Cofinity Commercial |
$151.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$105.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.69
|
| Rate for Payer: Meridian Medicaid |
$35.56
|
| Rate for Payer: Nomi Health Commercial |
$126.50
|
| Rate for Payer: PACE SWMI |
$105.42
|
| Rate for Payer: PHP Commercial |
$147.59
|
| Rate for Payer: PHP Medicare Advantage |
$105.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.53
|
| Rate for Payer: Priority Health Medicare |
$105.42
|
| Rate for Payer: Priority Health Narrow Network |
$175.53
|
| Rate for Payer: Priority Health SBD |
$80.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$105.42
|
| Rate for Payer: UHC Medicare Advantage |
$105.42
|
| Rate for Payer: UHCCP Medicaid |
$33.87
|
| Rate for Payer: UMR Bronson Commercial |
$49.68
|
|
|
CHG VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
HCPCS 75827
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$307.47 |
| Rate for Payer: Aetna Commercial |
$144.97
|
| Rate for Payer: Aetna Medicare |
$112.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.79
|
| Rate for Payer: BCBS Complete |
$35.33
|
| Rate for Payer: BCBS MAPPO |
$108.19
|
| Rate for Payer: BCBS Trust/PPO |
$307.47
|
| Rate for Payer: BCN Commercial |
$174.95
|
| Rate for Payer: BCN Medicare Advantage |
$108.19
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cofinity Commercial |
$144.97
|
| Rate for Payer: Cofinity Commercial |
$155.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.60
|
| Rate for Payer: Meridian Medicaid |
$35.33
|
| Rate for Payer: Nomi Health Commercial |
$129.83
|
| Rate for Payer: PACE SWMI |
$108.19
|
| Rate for Payer: PHP Commercial |
$151.47
|
| Rate for Payer: PHP Medicare Advantage |
$108.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$68.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$182.72
|
| Rate for Payer: Priority Health Medicare |
$108.19
|
| Rate for Payer: Priority Health Narrow Network |
$182.72
|
| Rate for Payer: Priority Health SBD |
$81.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.19
|
| Rate for Payer: UHC Medicare Advantage |
$108.19
|
| Rate for Payer: UHCCP Medicaid |
$33.65
|
| Rate for Payer: UMR Bronson Commercial |
$48.30
|
|
|
CHG VENOGRAPHY EXTREMITY BILATERAL RS&I
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 75822
|
| Min. Negotiated Rate |
$43.45 |
| Max. Negotiated Rate |
$265.21 |
| Rate for Payer: Aetna Commercial |
$164.46
|
| Rate for Payer: Aetna Commercial |
$164.46
|
| Rate for Payer: Aetna Medicare |
$127.64
|
| Rate for Payer: Aetna Medicare |
$127.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$164.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$176.73
|
| Rate for Payer: BCBS Complete |
$45.62
|
| Rate for Payer: BCBS Complete |
$45.62
|
| Rate for Payer: BCBS MAPPO |
$122.73
|
| Rate for Payer: BCBS MAPPO |
$122.73
|
| Rate for Payer: BCBS Trust/PPO |
$265.21
|
| Rate for Payer: BCBS Trust/PPO |
$265.21
|
| Rate for Payer: BCN Commercial |
$194.49
|
| Rate for Payer: BCN Commercial |
$194.49
|
| Rate for Payer: BCN Medicare Advantage |
$122.73
|
| Rate for Payer: BCN Medicare Advantage |
$122.73
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cofinity Commercial |
$164.46
|
| Rate for Payer: Cofinity Commercial |
$176.73
|
| Rate for Payer: Cofinity Commercial |
$176.73
|
| Rate for Payer: Cofinity Commercial |
$164.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$128.87
|
| Rate for Payer: Meridian Medicaid |
$45.62
|
| Rate for Payer: Meridian Medicaid |
$45.62
|
| Rate for Payer: Nomi Health Commercial |
$147.28
|
| Rate for Payer: Nomi Health Commercial |
$147.28
|
| Rate for Payer: PACE SWMI |
$122.73
|
| Rate for Payer: PACE SWMI |
$122.73
|
| Rate for Payer: PHP Commercial |
$171.82
|
| Rate for Payer: PHP Commercial |
$171.82
|
| Rate for Payer: PHP Medicare Advantage |
$122.73
|
| Rate for Payer: PHP Medicare Advantage |
$122.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$205.30
|
| Rate for Payer: Priority Health Medicare |
$122.73
|
| Rate for Payer: Priority Health Medicare |
$122.73
|
| Rate for Payer: Priority Health Narrow Network |
$205.30
|
| Rate for Payer: Priority Health Narrow Network |
$205.30
|
| Rate for Payer: Priority Health SBD |
$104.19
|
| Rate for Payer: Priority Health SBD |
$104.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.73
|
| Rate for Payer: UHC Medicare Advantage |
$122.73
|
| Rate for Payer: UHC Medicare Advantage |
$122.73
|
| Rate for Payer: UHCCP Medicaid |
$43.45
|
| Rate for Payer: UHCCP Medicaid |
$43.45
|
| Rate for Payer: UMR Bronson Commercial |
$126.04
|
| Rate for Payer: UMR Bronson Commercial |
$65.32
|
|
|
CHG VENOGRAPHY EXTREMITY UNILATERAL RS&I
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
HCPCS 75820
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$191.77 |
| Rate for Payer: Aetna Commercial |
$130.53
|
| Rate for Payer: Aetna Commercial |
$130.53
|
| Rate for Payer: Aetna Medicare |
$101.31
|
| Rate for Payer: Aetna Medicare |
$101.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$130.53
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: BCBS MAPPO |
$97.41
|
| Rate for Payer: BCBS MAPPO |
$97.41
|
| Rate for Payer: BCBS Trust/PPO |
$191.77
|
| Rate for Payer: BCBS Trust/PPO |
$191.77
|
| Rate for Payer: BCN Commercial |
$159.79
|
| Rate for Payer: BCN Commercial |
$159.79
|
| Rate for Payer: BCN Medicare Advantage |
$97.41
|
| Rate for Payer: BCN Medicare Advantage |
$97.41
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cofinity Commercial |
$130.53
|
| Rate for Payer: Cofinity Commercial |
$140.27
|
| Rate for Payer: Cofinity Commercial |
$140.27
|
| Rate for Payer: Cofinity Commercial |
$130.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$97.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$102.28
|
| Rate for Payer: Meridian Medicaid |
$32.20
|
| Rate for Payer: Meridian Medicaid |
$32.20
|
| Rate for Payer: Nomi Health Commercial |
$116.89
|
| Rate for Payer: Nomi Health Commercial |
$116.89
|
| Rate for Payer: PACE SWMI |
$97.41
|
| Rate for Payer: PACE SWMI |
$97.41
|
| Rate for Payer: PHP Commercial |
$136.37
|
| Rate for Payer: PHP Commercial |
$136.37
|
| Rate for Payer: PHP Medicare Advantage |
$97.41
|
| Rate for Payer: PHP Medicare Advantage |
$97.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$70.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.79
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.79
|
| Rate for Payer: Priority Health Medicare |
$97.41
|
| Rate for Payer: Priority Health Medicare |
$97.41
|
| Rate for Payer: Priority Health Narrow Network |
$165.79
|
| Rate for Payer: Priority Health Narrow Network |
$165.79
|
| Rate for Payer: Priority Health SBD |
$74.43
|
| Rate for Payer: Priority Health SBD |
$74.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$97.41
|
| Rate for Payer: UHC Medicare Advantage |
$97.41
|
| Rate for Payer: UHC Medicare Advantage |
$97.41
|
| Rate for Payer: UHCCP Medicaid |
$30.67
|
| Rate for Payer: UHCCP Medicaid |
$30.67
|
| Rate for Payer: UMR Bronson Commercial |
$49.68
|
| Rate for Payer: UMR Bronson Commercial |
$106.26
|
|
|
CHG VENOGRAPHY RENAL BILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 75833
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$369.81 |
| Rate for Payer: Aetna Commercial |
$182.55
|
| Rate for Payer: Aetna Medicare |
$141.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$182.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$196.17
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS MAPPO |
$136.23
|
| Rate for Payer: BCBS Trust/PPO |
$369.81
|
| Rate for Payer: BCN Commercial |
$215.02
|
| Rate for Payer: BCN Medicare Advantage |
$136.23
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cofinity Commercial |
$182.55
|
| Rate for Payer: Cofinity Commercial |
$196.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.04
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Nomi Health Commercial |
$163.48
|
| Rate for Payer: PACE SWMI |
$136.23
|
| Rate for Payer: PHP Commercial |
$190.72
|
| Rate for Payer: PHP Medicare Advantage |
$136.23
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$90.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$227.89
|
| Rate for Payer: Priority Health Medicare |
$136.23
|
| Rate for Payer: Priority Health Narrow Network |
$227.89
|
| Rate for Payer: Priority Health SBD |
$105.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.23
|
| Rate for Payer: UHC Medicare Advantage |
$136.23
|
| Rate for Payer: UHCCP Medicaid |
$43.88
|
| Rate for Payer: UMR Bronson Commercial |
$63.94
|
|
|
CHG VENOGRAPHY RENAL UNILATERAL SELECTIVE RS&I
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
HCPCS 75831
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$183.75 |
| Rate for Payer: Aetna Commercial |
$147.29
|
| Rate for Payer: Aetna Commercial |
$147.29
|
| Rate for Payer: Aetna Medicare |
$114.32
|
| Rate for Payer: Aetna Medicare |
$114.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$158.28
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$109.92
|
| Rate for Payer: BCBS MAPPO |
$109.92
|
| Rate for Payer: BCBS Trust/PPO |
$156.38
|
| Rate for Payer: BCBS Trust/PPO |
$156.38
|
| Rate for Payer: BCN Commercial |
$176.42
|
| Rate for Payer: BCN Commercial |
$176.42
|
| Rate for Payer: BCN Medicare Advantage |
$109.92
|
| Rate for Payer: BCN Medicare Advantage |
$109.92
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cofinity Commercial |
$147.29
|
| Rate for Payer: Cofinity Commercial |
$158.28
|
| Rate for Payer: Cofinity Commercial |
$158.28
|
| Rate for Payer: Cofinity Commercial |
$147.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$109.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$115.42
|
| Rate for Payer: Meridian Medicaid |
$34.00
|
| Rate for Payer: Meridian Medicaid |
$34.00
|
| Rate for Payer: Nomi Health Commercial |
$131.90
|
| Rate for Payer: Nomi Health Commercial |
$131.90
|
| Rate for Payer: PACE SWMI |
$109.92
|
| Rate for Payer: PACE SWMI |
$109.92
|
| Rate for Payer: PHP Commercial |
$153.89
|
| Rate for Payer: PHP Commercial |
$153.89
|
| Rate for Payer: PHP Medicare Advantage |
$109.92
|
| Rate for Payer: PHP Medicare Advantage |
$109.92
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$183.75
|
| Rate for Payer: Priority Health Medicare |
$109.92
|
| Rate for Payer: Priority Health Medicare |
$109.92
|
| Rate for Payer: Priority Health Narrow Network |
$183.75
|
| Rate for Payer: Priority Health Narrow Network |
$183.75
|
| Rate for Payer: Priority Health SBD |
$78.02
|
| Rate for Payer: Priority Health SBD |
$78.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$109.92
|
| Rate for Payer: UHC Medicare Advantage |
$109.92
|
| Rate for Payer: UHC Medicare Advantage |
$109.92
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
| Rate for Payer: UMR Bronson Commercial |
$125.58
|
| Rate for Payer: UMR Bronson Commercial |
$51.06
|
|
|
CHG VENOGRAPHY VENOUS SINUS/JUGULAR CATH RS&I
|
Professional
|
Both
|
$366.00
|
|
|
Service Code
|
HCPCS 75860
|
| Min. Negotiated Rate |
$34.08 |
| Max. Negotiated Rate |
$310.64 |
| Rate for Payer: Aetna Commercial |
$155.41
|
| Rate for Payer: Aetna Commercial |
$155.41
|
| Rate for Payer: Aetna Medicare |
$120.62
|
| Rate for Payer: Aetna Medicare |
$120.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$167.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.41
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS Complete |
$35.78
|
| Rate for Payer: BCBS MAPPO |
$115.98
|
| Rate for Payer: BCBS MAPPO |
$115.98
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: BCBS Trust/PPO |
$310.64
|
| Rate for Payer: BCN Commercial |
$184.72
|
| Rate for Payer: BCN Commercial |
$184.72
|
| Rate for Payer: BCN Medicare Advantage |
$115.98
|
| Rate for Payer: BCN Medicare Advantage |
$115.98
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cofinity Commercial |
$155.41
|
| Rate for Payer: Cofinity Commercial |
$167.01
|
| Rate for Payer: Cofinity Commercial |
$167.01
|
| Rate for Payer: Cofinity Commercial |
$155.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.78
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Meridian Medicaid |
$35.78
|
| Rate for Payer: Nomi Health Commercial |
$139.18
|
| Rate for Payer: Nomi Health Commercial |
$139.18
|
| Rate for Payer: PACE SWMI |
$115.98
|
| Rate for Payer: PACE SWMI |
$115.98
|
| Rate for Payer: PHP Commercial |
$162.37
|
| Rate for Payer: PHP Commercial |
$162.37
|
| Rate for Payer: PHP Medicare Advantage |
$115.98
|
| Rate for Payer: PHP Medicare Advantage |
$115.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.98
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$192.98
|
| Rate for Payer: Priority Health Medicare |
$115.98
|
| Rate for Payer: Priority Health Medicare |
$115.98
|
| Rate for Payer: Priority Health Narrow Network |
$192.98
|
| Rate for Payer: Priority Health Narrow Network |
$192.98
|
| Rate for Payer: Priority Health SBD |
$80.58
|
| Rate for Payer: Priority Health SBD |
$80.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.98
|
| Rate for Payer: UHC Medicare Advantage |
$115.98
|
| Rate for Payer: UHC Medicare Advantage |
$115.98
|
| Rate for Payer: UHCCP Medicaid |
$34.08
|
| Rate for Payer: UHCCP Medicaid |
$34.08
|
| Rate for Payer: UMR Bronson Commercial |
$129.26
|
| Rate for Payer: UMR Bronson Commercial |
$168.36
|
|
|
CHG VENOUS SAMPLING THRU CATH W/WO ANGIOGRAPHY RS&
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
HCPCS 75893
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$353.43 |
| Rate for Payer: Aetna Commercial |
$127.54
|
| Rate for Payer: Aetna Medicare |
$98.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$127.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.06
|
| Rate for Payer: BCBS Complete |
$16.78
|
| Rate for Payer: BCBS MAPPO |
$95.18
|
| Rate for Payer: BCBS Trust/PPO |
$353.43
|
| Rate for Payer: BCN Commercial |
$151.98
|
| Rate for Payer: BCN Medicare Advantage |
$95.18
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Cash Price |
$267.20
|
| Rate for Payer: Cofinity Commercial |
$127.54
|
| Rate for Payer: Cofinity Commercial |
$137.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$99.94
|
| Rate for Payer: Meridian Medicaid |
$16.78
|
| Rate for Payer: Nomi Health Commercial |
$114.22
|
| Rate for Payer: PACE SWMI |
$95.18
|
| Rate for Payer: PHP Commercial |
$133.25
|
| Rate for Payer: PHP Medicare Advantage |
$95.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$217.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$161.68
|
| Rate for Payer: Priority Health Medicare |
$95.18
|
| Rate for Payer: Priority Health Narrow Network |
$161.68
|
| Rate for Payer: Priority Health SBD |
$38.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.18
|
| Rate for Payer: UHC Medicare Advantage |
$95.18
|
| Rate for Payer: UHCCP Medicaid |
$15.98
|
| Rate for Payer: UMR Bronson Commercial |
$153.64
|
|
|
CHG VENOUS THROMBOSIS IMAGING VENOGRAM UNILATERAL
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 78457
|
| Min. Negotiated Rate |
$22.79 |
| Max. Negotiated Rate |
$238.15 |
| Rate for Payer: Aetna Commercial |
$189.70
|
| Rate for Payer: Aetna Commercial |
$189.70
|
| Rate for Payer: Aetna Medicare |
$147.23
|
| Rate for Payer: Aetna Medicare |
$147.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$203.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$189.70
|
| Rate for Payer: BCBS Complete |
$23.93
|
| Rate for Payer: BCBS Complete |
$23.93
|
| Rate for Payer: BCBS MAPPO |
$141.57
|
| Rate for Payer: BCBS MAPPO |
$141.57
|
| Rate for Payer: BCN Commercial |
$229.68
|
| Rate for Payer: BCN Commercial |
$229.68
|
| Rate for Payer: BCN Medicare Advantage |
$141.57
|
| Rate for Payer: BCN Medicare Advantage |
$141.57
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$65.60
|
| Rate for Payer: Cofinity Commercial |
$203.86
|
| Rate for Payer: Cofinity Commercial |
$189.70
|
| Rate for Payer: Cofinity Commercial |
$203.86
|
| Rate for Payer: Cofinity Commercial |
$189.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.65
|
| Rate for Payer: Meridian Medicaid |
$23.93
|
| Rate for Payer: Meridian Medicaid |
$23.93
|
| Rate for Payer: Nomi Health Commercial |
$169.88
|
| Rate for Payer: Nomi Health Commercial |
$169.88
|
| Rate for Payer: PACE SWMI |
$141.57
|
| Rate for Payer: PACE SWMI |
$141.57
|
| Rate for Payer: PHP Commercial |
$198.20
|
| Rate for Payer: PHP Commercial |
$198.20
|
| Rate for Payer: PHP Medicare Advantage |
$141.57
|
| Rate for Payer: PHP Medicare Advantage |
$141.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$22.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$215.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$238.15
|
| Rate for Payer: Priority Health Medicare |
$141.57
|
| Rate for Payer: Priority Health Medicare |
$141.57
|
| Rate for Payer: Priority Health Narrow Network |
$238.15
|
| Rate for Payer: Priority Health Narrow Network |
$238.15
|
| Rate for Payer: Priority Health SBD |
$54.40
|
| Rate for Payer: Priority Health SBD |
$54.40
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$141.57
|
| Rate for Payer: UHC Medicare Advantage |
$141.57
|
| Rate for Payer: UHC Medicare Advantage |
$141.57
|
| Rate for Payer: UHCCP Medicaid |
$22.79
|
| Rate for Payer: UHCCP Medicaid |
$22.79
|
| Rate for Payer: UMR Bronson Commercial |
$37.72
|
| Rate for Payer: UMR Bronson Commercial |
$152.72
|
|
|
CHG X-RAY ABDOMEN 1 VW
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 74000
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.40 |
| Rate for Payer: Aetna Medicare |
$18.00
|
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
CHG X-RAY ABDOMEN 2 VW
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS 74020
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$34.45 |
| Rate for Payer: Aetna Medicare |
$26.50
|
| Rate for Payer: BCBS Complete |
$21.20
|
| Rate for Payer: Cash Price |
$42.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$34.45
|
| Rate for Payer: UMR Bronson Commercial |
$24.38
|
|
|
CHG X-RAY FEMUR 2 VW
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 73550
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$24.70 |
| Rate for Payer: Aetna Medicare |
$19.00
|
| Rate for Payer: Aetna Medicare |
$47.00
|
| Rate for Payer: Aetna Medicare |
$15.00
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS Complete |
$37.60
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: UMR Bronson Commercial |
$17.48
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
| Rate for Payer: UMR Bronson Commercial |
$43.24
|
|
|
CHG X-RAY HIPS 4 VW + PELVIS
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 73520
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Aetna Medicare |
$23.50
|
| Rate for Payer: Aetna Medicare |
$60.50
|
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS Complete |
$48.40
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: UMR Bronson Commercial |
$24.84
|
| Rate for Payer: UMR Bronson Commercial |
$55.66
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
CHG X-RAY HIP UNI 2+ VW
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 73510
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$65.00 |
| Rate for Payer: Aetna Medicare |
$50.00
|
| Rate for Payer: Aetna Medicare |
$27.00
|
| Rate for Payer: Aetna Medicare |
$18.50
|
| Rate for Payer: BCBS Complete |
$14.80
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Complete |
$21.60
|
| Rate for Payer: Cash Price |
$29.60
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.05
|
| Rate for Payer: UMR Bronson Commercial |
$17.02
|
| Rate for Payer: UMR Bronson Commercial |
$46.00
|
| Rate for Payer: UMR Bronson Commercial |
$24.84
|
|
|
CHG X-RAY HIP UNILAT 1 VW
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 73500
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$20.15 |
| Rate for Payer: Aetna Medicare |
$15.50
|
| Rate for Payer: Aetna Medicare |
$50.00
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| Rate for Payer: UMR Bronson Commercial |
$46.00
|
| Rate for Payer: UMR Bronson Commercial |
$14.26
|
|
|
CHG X-RAY PELVIS/HIPS CHILD/INFANT
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 73540
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$22.75 |
| Rate for Payer: Aetna Medicare |
$17.50
|
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: BCBS Complete |
$14.00
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.75
|
| Rate for Payer: UMR Bronson Commercial |
$16.10
|
| Rate for Payer: UMR Bronson Commercial |
$44.62
|
|
|
CHG X-RAY SPINE SURVEY
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS 72010
|
| Min. Negotiated Rate |
$29.20 |
| Max. Negotiated Rate |
$47.45 |
| Rate for Payer: Aetna Medicare |
$36.50
|
| Rate for Payer: BCBS Complete |
$29.20
|
| Rate for Payer: Cash Price |
$58.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$47.45
|
| Rate for Payer: UMR Bronson Commercial |
$33.58
|
|
|
CHG X-RAY THOR-LUMB SP SCOLIOSIS
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 72090
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$46.15 |
| Rate for Payer: Aetna Medicare |
$35.50
|
| Rate for Payer: Aetna Medicare |
$50.00
|
| Rate for Payer: Aetna Medicare |
$66.50
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.15
|
| Rate for Payer: UMR Bronson Commercial |
$61.18
|
| Rate for Payer: UMR Bronson Commercial |
$32.66
|
| Rate for Payer: UMR Bronson Commercial |
$46.00
|
|
|
CHG X-RAY TRUNK SPINE SCOLIOSIS
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 72069
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna Medicare |
$30.00
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.00
|
| Rate for Payer: UMR Bronson Commercial |
$27.60
|
| Rate for Payer: UMR Bronson Commercial |
$20.70
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE
|
Facility
|
OP
|
$4.36
|
|
|
Service Code
|
NDC 51079037501
|
| Hospital Charge Code |
1622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$3.92 |
| Rate for Payer: Aetna American Axle |
$2.83
|
| Rate for Payer: Aetna Commercial |
$3.71
|
| Rate for Payer: Aetna Medicare |
$2.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2.83
|
| Rate for Payer: BCBS Complete |
$1.74
|
| Rate for Payer: Cash Price |
$3.49
|
| Rate for Payer: Cofinity Commercial |
$3.05
|
| Rate for Payer: Cofinity Commercial |
$3.75
|
| Rate for Payer: Cofinity Medicare Advantage |
$3.05
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.49
|
| Rate for Payer: Healthscope Commercial |
$3.92
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$3.05
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$3.27
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.71
|
| Rate for Payer: PHP Commercial |
$3.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2.83
|
| Rate for Payer: Priority Health SBD |
$2.75
|
| Rate for Payer: UMR Bronson Commercial |
$1.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$3.27
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE
|
Facility
|
IP
|
$435.10
|
|
|
Service Code
|
NDC 51079037520
|
| Hospital Charge Code |
1622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$191.44 |
| Max. Negotiated Rate |
$391.59 |
| Rate for Payer: Aetna American Axle |
$282.82
|
| Rate for Payer: Aetna Commercial |
$369.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.82
|
| Rate for Payer: Cash Price |
$348.08
|
| Rate for Payer: Cofinity Commercial |
$304.57
|
| Rate for Payer: Cofinity Commercial |
$374.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.08
|
| Rate for Payer: Healthscope Commercial |
$391.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$326.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.84
|
| Rate for Payer: PHP Commercial |
$369.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.82
|
| Rate for Payer: Priority Health SBD |
$274.11
|
| Rate for Payer: UMR Bronson Commercial |
$191.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$326.32
|
|
|
CHLORDIAZEPOXIDE 10 MG CAPSULE
|
Facility
|
OP
|
$435.10
|
|
|
Service Code
|
NDC 51079037520
|
| Hospital Charge Code |
1622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$160.99 |
| Max. Negotiated Rate |
$391.59 |
| Rate for Payer: Aetna American Axle |
$282.82
|
| Rate for Payer: Aetna Commercial |
$369.84
|
| Rate for Payer: Aetna Medicare |
$217.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$282.82
|
| Rate for Payer: BCBS Complete |
$174.04
|
| Rate for Payer: Cash Price |
$348.08
|
| Rate for Payer: Cofinity Commercial |
$304.57
|
| Rate for Payer: Cofinity Commercial |
$374.19
|
| Rate for Payer: Cofinity Medicare Advantage |
$304.57
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$348.08
|
| Rate for Payer: Healthscope Commercial |
$391.59
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$304.57
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$326.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$369.84
|
| Rate for Payer: PHP Commercial |
$369.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$282.82
|
| Rate for Payer: Priority Health SBD |
$274.11
|
| Rate for Payer: UMR Bronson Commercial |
$160.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$326.32
|
|
