|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
HCPCS 70553
|
| Min. Negotiated Rate |
$268.50 |
| Max. Negotiated Rate |
$516.01 |
| Rate for Payer: Aetna Commercial |
$398.02
|
| Rate for Payer: Aetna Medicare |
$297.03
|
| Rate for Payer: BCBS MAPPO |
$297.03
|
| Rate for Payer: BCN Commercial |
$483.54
|
| Rate for Payer: BCN Medicare Advantage |
$297.03
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cash Price |
$286.40
|
| Rate for Payer: Cofinity Commercial |
$398.02
|
| Rate for Payer: Cofinity Commercial |
$427.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.03
|
| Rate for Payer: Healthscope Commercial |
$356.44
|
| Rate for Payer: Healthscope Whirlpool |
$356.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$326.73
|
| Rate for Payer: Nomi Health Commercial |
$356.44
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$268.50
|
| Rate for Payer: PACE SWMI |
$297.03
|
| Rate for Payer: PHP Medicare Advantage |
$297.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$487.17
|
| Rate for Payer: Priority Health Medicare |
$297.03
|
| Rate for Payer: Priority Health Narrow Network |
$487.17
|
| Rate for Payer: Railroad Medicare Medicare |
$297.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$516.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$297.03
|
| Rate for Payer: UHC Exchange |
$516.01
|
| Rate for Payer: UHCCP DNSP |
$297.03
|
|
|
CHG MRI GUIDANCE NEEDLE PLACEMENT RS&I
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 77021
|
| Min. Negotiated Rate |
$126.00 |
| Max. Negotiated Rate |
$651.33 |
| Rate for Payer: Aetna Commercial |
$528.70
|
| Rate for Payer: Aetna Medicare |
$394.55
|
| Rate for Payer: BCBS MAPPO |
$394.55
|
| Rate for Payer: BCN Commercial |
$620.98
|
| Rate for Payer: BCN Medicare Advantage |
$394.55
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$528.70
|
| Rate for Payer: Cofinity Commercial |
$568.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.55
|
| Rate for Payer: Healthscope Commercial |
$473.46
|
| Rate for Payer: Healthscope Whirlpool |
$473.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$414.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$434.00
|
| Rate for Payer: Nomi Health Commercial |
$473.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: PACE SWMI |
$394.55
|
| Rate for Payer: PHP Medicare Advantage |
$394.55
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$625.66
|
| Rate for Payer: Priority Health Medicare |
$394.55
|
| Rate for Payer: Priority Health Narrow Network |
$625.66
|
| Rate for Payer: Railroad Medicare Medicare |
$394.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$651.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$394.55
|
| Rate for Payer: UHC Exchange |
$651.33
|
| Rate for Payer: UHCCP DNSP |
$394.55
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 73718
|
| Min. Negotiated Rate |
$101.25 |
| Max. Negotiated Rate |
$363.00 |
| Rate for Payer: Aetna Commercial |
$278.16
|
| Rate for Payer: Aetna Medicare |
$207.58
|
| Rate for Payer: BCBS MAPPO |
$207.58
|
| Rate for Payer: BCN Commercial |
$337.13
|
| Rate for Payer: BCN Medicare Advantage |
$207.58
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$278.16
|
| Rate for Payer: Cofinity Commercial |
$298.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.58
|
| Rate for Payer: Healthscope Commercial |
$249.10
|
| Rate for Payer: Healthscope Whirlpool |
$249.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$217.96
|
| Rate for Payer: Molina Medicare/Medicaid |
$228.34
|
| Rate for Payer: Nomi Health Commercial |
$249.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$101.25
|
| Rate for Payer: PACE SWMI |
$207.58
|
| Rate for Payer: PHP Medicare Advantage |
$207.58
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$339.68
|
| Rate for Payer: Priority Health Medicare |
$207.58
|
| Rate for Payer: Priority Health Narrow Network |
$339.68
|
| Rate for Payer: Railroad Medicare Medicare |
$207.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$363.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$207.58
|
| Rate for Payer: UHC Exchange |
$363.00
|
| Rate for Payer: UHCCP DNSP |
$207.58
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 73720
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$550.20 |
| Rate for Payer: Aetna Commercial |
$419.49
|
| Rate for Payer: Aetna Medicare |
$313.05
|
| Rate for Payer: BCBS MAPPO |
$313.05
|
| Rate for Payer: BCN Commercial |
$510.44
|
| Rate for Payer: BCN Medicare Advantage |
$313.05
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$419.49
|
| Rate for Payer: Cofinity Commercial |
$450.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$313.05
|
| Rate for Payer: Healthscope Commercial |
$375.66
|
| Rate for Payer: Healthscope Whirlpool |
$375.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$344.36
|
| Rate for Payer: Nomi Health Commercial |
$375.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.00
|
| Rate for Payer: PACE SWMI |
$313.05
|
| Rate for Payer: PHP Medicare Advantage |
$313.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$514.27
|
| Rate for Payer: Priority Health Medicare |
$313.05
|
| Rate for Payer: Priority Health Narrow Network |
$514.27
|
| Rate for Payer: Railroad Medicare Medicare |
$313.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$550.20
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$313.05
|
| Rate for Payer: UHC Exchange |
$550.20
|
| Rate for Payer: UHCCP DNSP |
$313.05
|
|
|
CHG MRI ORBIT FACE &/NECK W/O CONTRAST
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 70540
|
| Min. Negotiated Rate |
$100.50 |
| Max. Negotiated Rate |
$367.44 |
| Rate for Payer: Aetna Commercial |
$280.61
|
| Rate for Payer: Aetna Medicare |
$209.41
|
| Rate for Payer: BCBS MAPPO |
$209.41
|
| Rate for Payer: BCN Commercial |
$342.12
|
| Rate for Payer: BCN Medicare Advantage |
$209.41
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cofinity Commercial |
$280.61
|
| Rate for Payer: Cofinity Commercial |
$301.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.41
|
| Rate for Payer: Healthscope Commercial |
$251.29
|
| Rate for Payer: Healthscope Whirlpool |
$251.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$230.35
|
| Rate for Payer: Nomi Health Commercial |
$251.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$100.50
|
| Rate for Payer: PACE SWMI |
$209.41
|
| Rate for Payer: PHP Medicare Advantage |
$209.41
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$344.69
|
| Rate for Payer: Priority Health Medicare |
$209.41
|
| Rate for Payer: Priority Health Narrow Network |
$344.69
|
| Rate for Payer: Railroad Medicare Medicare |
$209.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$367.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$209.41
|
| Rate for Payer: UHC Exchange |
$367.44
|
| Rate for Payer: UHCCP DNSP |
$209.41
|
|
|
CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 70543
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$549.22 |
| Rate for Payer: Aetna Commercial |
$421.94
|
| Rate for Payer: Aetna Medicare |
$314.88
|
| Rate for Payer: BCBS MAPPO |
$314.88
|
| Rate for Payer: BCN Commercial |
$513.42
|
| Rate for Payer: BCN Medicare Advantage |
$314.88
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$421.94
|
| Rate for Payer: Cofinity Commercial |
$453.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$314.88
|
| Rate for Payer: Healthscope Commercial |
$377.86
|
| Rate for Payer: Healthscope Whirlpool |
$377.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$330.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$346.37
|
| Rate for Payer: Nomi Health Commercial |
$377.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$162.00
|
| Rate for Payer: PACE SWMI |
$314.88
|
| Rate for Payer: PHP Medicare Advantage |
$314.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$517.28
|
| Rate for Payer: Priority Health Medicare |
$314.88
|
| Rate for Payer: Priority Health Narrow Network |
$517.28
|
| Rate for Payer: Railroad Medicare Medicare |
$314.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$549.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$314.88
|
| Rate for Payer: UHC Exchange |
$549.22
|
| Rate for Payer: UHCCP DNSP |
$314.88
|
|
|
CHG MRI PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS 72195
|
| Min. Negotiated Rate |
$109.50 |
| Max. Negotiated Rate |
$375.41 |
| Rate for Payer: Aetna Commercial |
$284.68
|
| Rate for Payer: Aetna Medicare |
$212.45
|
| Rate for Payer: BCBS MAPPO |
$212.45
|
| Rate for Payer: BCN Commercial |
$345.59
|
| Rate for Payer: BCN Medicare Advantage |
$212.45
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cash Price |
$116.80
|
| Rate for Payer: Cofinity Commercial |
$284.68
|
| Rate for Payer: Cofinity Commercial |
$305.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$212.45
|
| Rate for Payer: Healthscope Commercial |
$254.94
|
| Rate for Payer: Healthscope Whirlpool |
$254.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$223.07
|
| Rate for Payer: Molina Medicare/Medicaid |
$233.69
|
| Rate for Payer: Nomi Health Commercial |
$254.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$109.50
|
| Rate for Payer: PACE SWMI |
$212.45
|
| Rate for Payer: PHP Medicare Advantage |
$212.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$348.19
|
| Rate for Payer: Priority Health Medicare |
$212.45
|
| Rate for Payer: Priority Health Narrow Network |
$348.19
|
| Rate for Payer: Railroad Medicare Medicare |
$212.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$375.41
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$212.45
|
| Rate for Payer: UHC Exchange |
$375.41
|
| Rate for Payer: UHCCP DNSP |
$212.45
|
|
|
CHG MRI PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
HCPCS 72197
|
| Min. Negotiated Rate |
$165.00 |
| Max. Negotiated Rate |
$550.92 |
| Rate for Payer: Aetna Commercial |
$418.96
|
| Rate for Payer: Aetna Medicare |
$312.66
|
| Rate for Payer: BCBS MAPPO |
$312.66
|
| Rate for Payer: BCN Commercial |
$509.93
|
| Rate for Payer: BCN Medicare Advantage |
$312.66
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cofinity Commercial |
$418.96
|
| Rate for Payer: Cofinity Commercial |
$450.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$312.66
|
| Rate for Payer: Healthscope Commercial |
$375.19
|
| Rate for Payer: Healthscope Whirlpool |
$375.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$328.29
|
| Rate for Payer: Molina Medicare/Medicaid |
$343.93
|
| Rate for Payer: Nomi Health Commercial |
$375.19
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$165.00
|
| Rate for Payer: PACE SWMI |
$312.66
|
| Rate for Payer: PHP Medicare Advantage |
$312.66
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$513.78
|
| Rate for Payer: Priority Health Medicare |
$312.66
|
| Rate for Payer: Priority Health Narrow Network |
$513.78
|
| Rate for Payer: Railroad Medicare Medicare |
$312.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$550.92
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$312.66
|
| Rate for Payer: UHC Exchange |
$550.92
|
| Rate for Payer: UHCCP DNSP |
$312.66
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 72141
|
| Min. Negotiated Rate |
$179.03 |
| Max. Negotiated Rate |
$307.60 |
| Rate for Payer: Aetna Commercial |
$239.90
|
| Rate for Payer: Aetna Medicare |
$179.03
|
| Rate for Payer: BCBS MAPPO |
$179.03
|
| Rate for Payer: BCN Commercial |
$288.83
|
| Rate for Payer: BCN Medicare Advantage |
$179.03
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Commercial |
$239.90
|
| Rate for Payer: Cofinity Commercial |
$257.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.03
|
| Rate for Payer: Healthscope Commercial |
$214.84
|
| Rate for Payer: Healthscope Whirlpool |
$214.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$196.93
|
| Rate for Payer: Nomi Health Commercial |
$214.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.25
|
| Rate for Payer: PACE SWMI |
$179.03
|
| Rate for Payer: PHP Medicare Advantage |
$179.03
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$291.00
|
| Rate for Payer: Priority Health Medicare |
$179.03
|
| Rate for Payer: Priority Health Narrow Network |
$291.00
|
| Rate for Payer: Railroad Medicare Medicare |
$179.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$307.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$179.03
|
| Rate for Payer: UHC Exchange |
$307.60
|
| Rate for Payer: UHCCP DNSP |
$179.03
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
HCPCS 72156
|
| Min. Negotiated Rate |
$242.25 |
| Max. Negotiated Rate |
$519.96 |
| Rate for Payer: Aetna Commercial |
$399.25
|
| Rate for Payer: Aetna Medicare |
$297.95
|
| Rate for Payer: BCBS MAPPO |
$297.95
|
| Rate for Payer: BCN Commercial |
$485.03
|
| Rate for Payer: BCN Medicare Advantage |
$297.95
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cash Price |
$258.40
|
| Rate for Payer: Cofinity Commercial |
$399.25
|
| Rate for Payer: Cofinity Commercial |
$429.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$297.95
|
| Rate for Payer: Healthscope Commercial |
$357.54
|
| Rate for Payer: Healthscope Whirlpool |
$357.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$312.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$327.75
|
| Rate for Payer: Nomi Health Commercial |
$357.54
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$242.25
|
| Rate for Payer: PACE SWMI |
$297.95
|
| Rate for Payer: PHP Medicare Advantage |
$297.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$488.68
|
| Rate for Payer: Priority Health Medicare |
$297.95
|
| Rate for Payer: Priority Health Narrow Network |
$488.68
|
| Rate for Payer: Railroad Medicare Medicare |
$297.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$519.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$297.95
|
| Rate for Payer: UHC Exchange |
$519.96
|
| Rate for Payer: UHCCP DNSP |
$297.95
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 72149
|
| Min. Negotiated Rate |
$252.02 |
| Max. Negotiated Rate |
$438.38 |
| Rate for Payer: Aetna Commercial |
$337.71
|
| Rate for Payer: Aetna Medicare |
$252.02
|
| Rate for Payer: BCBS MAPPO |
$252.02
|
| Rate for Payer: BCN Commercial |
$409.84
|
| Rate for Payer: BCN Medicare Advantage |
$252.02
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$337.71
|
| Rate for Payer: Cofinity Commercial |
$362.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$252.02
|
| Rate for Payer: Healthscope Commercial |
$302.42
|
| Rate for Payer: Healthscope Whirlpool |
$302.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$264.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$277.22
|
| Rate for Payer: Nomi Health Commercial |
$302.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$252.75
|
| Rate for Payer: PACE SWMI |
$252.02
|
| Rate for Payer: PHP Medicare Advantage |
$252.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$412.92
|
| Rate for Payer: Priority Health Medicare |
$252.02
|
| Rate for Payer: Priority Health Narrow Network |
$412.92
|
| Rate for Payer: Railroad Medicare Medicare |
$252.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$438.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$252.02
|
| Rate for Payer: UHC Exchange |
$438.38
|
| Rate for Payer: UHCCP DNSP |
$252.02
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 72148
|
| Min. Negotiated Rate |
$179.95 |
| Max. Negotiated Rate |
$308.09 |
| Rate for Payer: Aetna Commercial |
$241.13
|
| Rate for Payer: Aetna Medicare |
$179.95
|
| Rate for Payer: BCBS MAPPO |
$179.95
|
| Rate for Payer: BCN Commercial |
$289.82
|
| Rate for Payer: BCN Medicare Advantage |
$179.95
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$241.13
|
| Rate for Payer: Cofinity Commercial |
$259.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.95
|
| Rate for Payer: Healthscope Commercial |
$215.94
|
| Rate for Payer: Healthscope Whirlpool |
$215.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$197.94
|
| Rate for Payer: Nomi Health Commercial |
$215.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$190.50
|
| Rate for Payer: PACE SWMI |
$179.95
|
| Rate for Payer: PHP Medicare Advantage |
$179.95
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$292.01
|
| Rate for Payer: Priority Health Medicare |
$179.95
|
| Rate for Payer: Priority Health Narrow Network |
$292.01
|
| Rate for Payer: Railroad Medicare Medicare |
$179.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$308.09
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$179.95
|
| Rate for Payer: UHC Exchange |
$308.09
|
| Rate for Payer: UHCCP DNSP |
$179.95
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 72158
|
| Min. Negotiated Rate |
$231.00 |
| Max. Negotiated Rate |
$518.98 |
| Rate for Payer: Aetna Commercial |
$399.65
|
| Rate for Payer: Aetna Medicare |
$298.25
|
| Rate for Payer: BCBS MAPPO |
$298.25
|
| Rate for Payer: BCN Commercial |
$484.04
|
| Rate for Payer: BCN Medicare Advantage |
$298.25
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$399.65
|
| Rate for Payer: Cofinity Commercial |
$429.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.25
|
| Rate for Payer: Healthscope Commercial |
$357.90
|
| Rate for Payer: Healthscope Whirlpool |
$357.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.16
|
| Rate for Payer: Molina Medicare/Medicaid |
$328.07
|
| Rate for Payer: Nomi Health Commercial |
$357.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.00
|
| Rate for Payer: PACE SWMI |
$298.25
|
| Rate for Payer: PHP Medicare Advantage |
$298.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$487.69
|
| Rate for Payer: Priority Health Medicare |
$298.25
|
| Rate for Payer: Priority Health Narrow Network |
$487.69
|
| Rate for Payer: Railroad Medicare Medicare |
$298.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$518.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$298.25
|
| Rate for Payer: UHC Exchange |
$518.98
|
| Rate for Payer: UHCCP DNSP |
$298.25
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
HCPCS 72146
|
| Min. Negotiated Rate |
$178.73 |
| Max. Negotiated Rate |
$307.60 |
| Rate for Payer: Aetna Commercial |
$239.50
|
| Rate for Payer: Aetna Medicare |
$178.73
|
| Rate for Payer: BCBS MAPPO |
$178.73
|
| Rate for Payer: BCN Commercial |
$289.33
|
| Rate for Payer: BCN Medicare Advantage |
$178.73
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cash Price |
$224.00
|
| Rate for Payer: Cofinity Commercial |
$239.50
|
| Rate for Payer: Cofinity Commercial |
$257.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$178.73
|
| Rate for Payer: Healthscope Commercial |
$214.48
|
| Rate for Payer: Healthscope Whirlpool |
$214.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$187.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$196.60
|
| Rate for Payer: Nomi Health Commercial |
$214.48
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$210.00
|
| Rate for Payer: PACE SWMI |
$178.73
|
| Rate for Payer: PHP Medicare Advantage |
$178.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$291.50
|
| Rate for Payer: Priority Health Medicare |
$178.73
|
| Rate for Payer: Priority Health Narrow Network |
$291.50
|
| Rate for Payer: Railroad Medicare Medicare |
$178.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$307.60
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$178.73
|
| Rate for Payer: UHC Exchange |
$307.60
|
| Rate for Payer: UHCCP DNSP |
$178.73
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
HCPCS 72157
|
| Min. Negotiated Rate |
$255.00 |
| Max. Negotiated Rate |
$520.94 |
| Rate for Payer: Aetna Commercial |
$400.07
|
| Rate for Payer: Aetna Medicare |
$298.56
|
| Rate for Payer: BCBS MAPPO |
$298.56
|
| Rate for Payer: BCN Commercial |
$486.03
|
| Rate for Payer: BCN Medicare Advantage |
$298.56
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cash Price |
$272.00
|
| Rate for Payer: Cofinity Commercial |
$400.07
|
| Rate for Payer: Cofinity Commercial |
$429.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.56
|
| Rate for Payer: Healthscope Commercial |
$358.27
|
| Rate for Payer: Healthscope Whirlpool |
$358.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.49
|
| Rate for Payer: Molina Medicare/Medicaid |
$328.42
|
| Rate for Payer: Nomi Health Commercial |
$358.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$255.00
|
| Rate for Payer: PACE SWMI |
$298.56
|
| Rate for Payer: PHP Medicare Advantage |
$298.56
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$489.69
|
| Rate for Payer: Priority Health Medicare |
$298.56
|
| Rate for Payer: Priority Health Narrow Network |
$489.69
|
| Rate for Payer: Railroad Medicare Medicare |
$298.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$520.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$298.56
|
| Rate for Payer: UHC Exchange |
$520.94
|
| Rate for Payer: UHCCP DNSP |
$298.56
|
|
|
CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS 73218
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$494.78 |
| Rate for Payer: Aetna Commercial |
$377.14
|
| Rate for Payer: Aetna Medicare |
$281.45
|
| Rate for Payer: BCBS MAPPO |
$281.45
|
| Rate for Payer: BCN Commercial |
$456.15
|
| Rate for Payer: BCN Medicare Advantage |
$281.45
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cash Price |
$108.80
|
| Rate for Payer: Cofinity Commercial |
$377.14
|
| Rate for Payer: Cofinity Commercial |
$405.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$281.45
|
| Rate for Payer: Healthscope Commercial |
$337.74
|
| Rate for Payer: Healthscope Whirlpool |
$337.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$295.52
|
| Rate for Payer: Molina Medicare/Medicaid |
$309.60
|
| Rate for Payer: Nomi Health Commercial |
$337.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$102.00
|
| Rate for Payer: PACE SWMI |
$281.45
|
| Rate for Payer: PHP Medicare Advantage |
$281.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$459.58
|
| Rate for Payer: Priority Health Medicare |
$281.45
|
| Rate for Payer: Priority Health Narrow Network |
$459.58
|
| Rate for Payer: Railroad Medicare Medicare |
$281.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$494.78
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$281.45
|
| Rate for Payer: UHC Exchange |
$494.78
|
| Rate for Payer: UHCCP DNSP |
$281.45
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 72265
|
| Min. Negotiated Rate |
$103.42 |
| Max. Negotiated Rate |
$162.56 |
| Rate for Payer: Aetna Commercial |
$138.58
|
| Rate for Payer: Aetna Medicare |
$103.42
|
| Rate for Payer: BCBS MAPPO |
$103.42
|
| Rate for Payer: BCN Commercial |
$161.34
|
| Rate for Payer: BCN Medicare Advantage |
$103.42
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$138.58
|
| Rate for Payer: Cofinity Commercial |
$148.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.42
|
| Rate for Payer: Healthscope Commercial |
$124.10
|
| Rate for Payer: Healthscope Whirlpool |
$124.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.59
|
| Rate for Payer: Molina Medicare/Medicaid |
$113.76
|
| Rate for Payer: Nomi Health Commercial |
$124.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$126.00
|
| Rate for Payer: PACE SWMI |
$103.42
|
| Rate for Payer: PHP Medicare Advantage |
$103.42
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$162.56
|
| Rate for Payer: Priority Health Medicare |
$103.42
|
| Rate for Payer: Priority Health Narrow Network |
$162.56
|
| Rate for Payer: Railroad Medicare Medicare |
$103.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$103.42
|
| Rate for Payer: UHC Exchange |
$146.65
|
| Rate for Payer: UHCCP DNSP |
$103.42
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 78453
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$430.83 |
| Rate for Payer: Aetna Commercial |
$326.38
|
| Rate for Payer: Aetna Medicare |
$243.57
|
| Rate for Payer: BCBS MAPPO |
$243.57
|
| Rate for Payer: BCN Commercial |
$393.91
|
| Rate for Payer: BCN Medicare Advantage |
$243.57
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$326.38
|
| Rate for Payer: Cofinity Commercial |
$350.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$243.57
|
| Rate for Payer: Healthscope Commercial |
$292.28
|
| Rate for Payer: Healthscope Whirlpool |
$292.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$255.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$267.93
|
| Rate for Payer: Nomi Health Commercial |
$292.28
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$94.50
|
| Rate for Payer: PACE SWMI |
$243.57
|
| Rate for Payer: PHP Medicare Advantage |
$243.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$396.87
|
| Rate for Payer: Priority Health Medicare |
$243.57
|
| Rate for Payer: Priority Health Narrow Network |
$396.87
|
| Rate for Payer: Railroad Medicare Medicare |
$243.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$430.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$243.57
|
| Rate for Payer: UHC Exchange |
$430.83
|
| Rate for Payer: UHCCP DNSP |
$243.57
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 78454
|
| Min. Negotiated Rate |
$122.25 |
| Max. Negotiated Rate |
$617.35 |
| Rate for Payer: Aetna Commercial |
$473.93
|
| Rate for Payer: Aetna Medicare |
$353.68
|
| Rate for Payer: BCBS MAPPO |
$353.68
|
| Rate for Payer: BCN Commercial |
$583.13
|
| Rate for Payer: BCN Medicare Advantage |
$353.68
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$473.93
|
| Rate for Payer: Cofinity Commercial |
$509.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$353.68
|
| Rate for Payer: Healthscope Commercial |
$424.42
|
| Rate for Payer: Healthscope Whirlpool |
$424.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$371.36
|
| Rate for Payer: Molina Medicare/Medicaid |
$389.05
|
| Rate for Payer: Nomi Health Commercial |
$424.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$122.25
|
| Rate for Payer: PACE SWMI |
$353.68
|
| Rate for Payer: PHP Medicare Advantage |
$353.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$587.53
|
| Rate for Payer: Priority Health Medicare |
$353.68
|
| Rate for Payer: Priority Health Narrow Network |
$587.53
|
| Rate for Payer: Railroad Medicare Medicare |
$353.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$617.35
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$353.68
|
| Rate for Payer: UHC Exchange |
$617.35
|
| Rate for Payer: UHCCP DNSP |
$353.68
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
Both
|
$943.00
|
|
|
Service Code
|
HCPCS 78452
|
| Min. Negotiated Rate |
$396.17 |
| Max. Negotiated Rate |
$707.25 |
| Rate for Payer: Aetna Commercial |
$530.87
|
| Rate for Payer: Aetna Commercial |
$530.87
|
| Rate for Payer: Aetna Medicare |
$396.17
|
| Rate for Payer: Aetna Medicare |
$396.17
|
| Rate for Payer: BCBS MAPPO |
$396.17
|
| Rate for Payer: BCBS MAPPO |
$396.17
|
| Rate for Payer: BCN Commercial |
$629.45
|
| Rate for Payer: BCN Commercial |
$629.45
|
| Rate for Payer: BCN Medicare Advantage |
$396.17
|
| Rate for Payer: BCN Medicare Advantage |
$396.17
|
| Rate for Payer: Cash Price |
$754.40
|
| Rate for Payer: Cash Price |
$754.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cofinity Commercial |
$570.48
|
| Rate for Payer: Cofinity Commercial |
$530.87
|
| Rate for Payer: Cofinity Commercial |
$570.48
|
| Rate for Payer: Cofinity Commercial |
$530.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$396.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$396.17
|
| Rate for Payer: Healthscope Commercial |
$475.40
|
| Rate for Payer: Healthscope Commercial |
$475.40
|
| Rate for Payer: Healthscope Whirlpool |
$475.40
|
| Rate for Payer: Healthscope Whirlpool |
$475.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$415.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$415.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$435.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$435.79
|
| Rate for Payer: Nomi Health Commercial |
$475.40
|
| Rate for Payer: Nomi Health Commercial |
$475.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$148.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$707.25
|
| Rate for Payer: PACE SWMI |
$396.17
|
| Rate for Payer: PACE SWMI |
$396.17
|
| Rate for Payer: PHP Medicare Advantage |
$396.17
|
| Rate for Payer: PHP Medicare Advantage |
$396.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$634.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$634.19
|
| Rate for Payer: Priority Health Medicare |
$396.17
|
| Rate for Payer: Priority Health Medicare |
$396.17
|
| Rate for Payer: Priority Health Narrow Network |
$634.19
|
| Rate for Payer: Priority Health Narrow Network |
$634.19
|
| Rate for Payer: Railroad Medicare Medicare |
$396.17
|
| Rate for Payer: Railroad Medicare Medicare |
$396.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$668.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$668.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$396.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$396.17
|
| Rate for Payer: UHC Exchange |
$668.38
|
| Rate for Payer: UHC Exchange |
$668.38
|
| Rate for Payer: UHCCP DNSP |
$396.17
|
| Rate for Payer: UHCCP DNSP |
$396.17
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 78451
|
| Min. Negotiated Rate |
$129.75 |
| Max. Negotiated Rate |
$480.26 |
| Rate for Payer: Aetna Commercial |
$387.07
|
| Rate for Payer: Aetna Medicare |
$288.86
|
| Rate for Payer: BCBS MAPPO |
$288.86
|
| Rate for Payer: BCN Commercial |
$457.15
|
| Rate for Payer: BCN Medicare Advantage |
$288.86
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cofinity Commercial |
$415.96
|
| Rate for Payer: Cofinity Commercial |
$387.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$288.86
|
| Rate for Payer: Healthscope Commercial |
$346.63
|
| Rate for Payer: Healthscope Whirlpool |
$346.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$317.75
|
| Rate for Payer: Nomi Health Commercial |
$346.63
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.75
|
| Rate for Payer: PACE SWMI |
$288.86
|
| Rate for Payer: PHP Medicare Advantage |
$288.86
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$460.59
|
| Rate for Payer: Priority Health Medicare |
$288.86
|
| Rate for Payer: Priority Health Narrow Network |
$460.59
|
| Rate for Payer: Railroad Medicare Medicare |
$288.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$480.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$288.86
|
| Rate for Payer: UHC Exchange |
$480.26
|
| Rate for Payer: UHCCP DNSP |
$288.86
|
|
|
CHG MYOCRD IMG PET PRFUJ MLT STD RST&STRS CNCRNT CT
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 78431
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$3,204.13 |
| Rate for Payer: Aetna Commercial |
$2,093.10
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCN Commercial |
$128.98
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$191.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$928.20
|
| Rate for Payer: Priority Health Narrow Network |
$928.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$3,204.13
|
| Rate for Payer: UHC Exchange |
$3,204.13
|
|
|
CHG MYOCRD IMG PET PRFUJ SINGLE STUDY REST/STRESS
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
HCPCS 78491
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$2,075.96 |
| Rate for Payer: Aetna Commercial |
$1,378.75
|
| Rate for Payer: BCN Commercial |
$106.08
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$551.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$667.80
|
| Rate for Payer: Priority Health Narrow Network |
$667.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,075.96
|
| Rate for Payer: UHC Exchange |
$2,075.96
|
|
|
CHG NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS
|
Professional
|
Both
|
$3,935.00
|
|
|
Service Code
|
HCPCS 77301
|
| Min. Negotiated Rate |
$1,817.44 |
| Max. Negotiated Rate |
$2,951.25 |
| Rate for Payer: Aetna Commercial |
$2,435.37
|
| Rate for Payer: Aetna Commercial |
$2,435.37
|
| Rate for Payer: Aetna Commercial |
$2,435.37
|
| Rate for Payer: Aetna Medicare |
$1,817.44
|
| Rate for Payer: Aetna Medicare |
$1,817.44
|
| Rate for Payer: Aetna Medicare |
$1,817.44
|
| Rate for Payer: BCBS MAPPO |
$1,817.44
|
| Rate for Payer: BCBS MAPPO |
$1,817.44
|
| Rate for Payer: BCBS MAPPO |
$1,817.44
|
| Rate for Payer: BCN Commercial |
$2,817.92
|
| Rate for Payer: BCN Commercial |
$2,817.92
|
| Rate for Payer: BCN Commercial |
$2,817.92
|
| Rate for Payer: BCN Medicare Advantage |
$1,817.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,817.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,817.44
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Cash Price |
$2,530.40
|
| Rate for Payer: Cash Price |
$1,444.00
|
| Rate for Payer: Cash Price |
$3,148.00
|
| Rate for Payer: Cash Price |
$3,148.00
|
| Rate for Payer: Cash Price |
$2,530.40
|
| Rate for Payer: Cofinity Commercial |
$2,617.11
|
| Rate for Payer: Cofinity Commercial |
$2,435.37
|
| Rate for Payer: Cofinity Commercial |
$2,435.37
|
| Rate for Payer: Cofinity Commercial |
$2,617.11
|
| Rate for Payer: Cofinity Commercial |
$2,617.11
|
| Rate for Payer: Cofinity Commercial |
$2,435.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,817.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,817.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,817.44
|
| Rate for Payer: Healthscope Commercial |
$2,180.93
|
| Rate for Payer: Healthscope Commercial |
$2,180.93
|
| Rate for Payer: Healthscope Commercial |
$2,180.93
|
| Rate for Payer: Healthscope Whirlpool |
$2,180.93
|
| Rate for Payer: Healthscope Whirlpool |
$2,180.93
|
| Rate for Payer: Healthscope Whirlpool |
$2,180.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,908.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,908.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,908.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,999.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,999.18
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,999.18
|
| Rate for Payer: Nomi Health Commercial |
$2,180.93
|
| Rate for Payer: Nomi Health Commercial |
$2,180.93
|
| Rate for Payer: Nomi Health Commercial |
$2,180.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,951.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,372.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,353.75
|
| Rate for Payer: PACE SWMI |
$1,817.44
|
| Rate for Payer: PACE SWMI |
$1,817.44
|
| Rate for Payer: PACE SWMI |
$1,817.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,817.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,817.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,817.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,788.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,788.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$2,788.62
|
| Rate for Payer: Priority Health Medicare |
$1,817.44
|
| Rate for Payer: Priority Health Medicare |
$1,817.44
|
| Rate for Payer: Priority Health Medicare |
$1,817.44
|
| Rate for Payer: Priority Health Narrow Network |
$2,788.62
|
| Rate for Payer: Priority Health Narrow Network |
$2,788.62
|
| Rate for Payer: Priority Health Narrow Network |
$2,788.62
|
| Rate for Payer: Railroad Medicare Medicare |
$1,817.44
|
| Rate for Payer: Railroad Medicare Medicare |
$1,817.44
|
| Rate for Payer: Railroad Medicare Medicare |
$1,817.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,694.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,694.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2,694.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,817.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,817.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,817.44
|
| Rate for Payer: UHC Exchange |
$2,694.69
|
| Rate for Payer: UHC Exchange |
$2,694.69
|
| Rate for Payer: UHC Exchange |
$2,694.69
|
| Rate for Payer: UHCCP DNSP |
$1,817.44
|
| Rate for Payer: UHCCP DNSP |
$1,817.44
|
| Rate for Payer: UHCCP DNSP |
$1,817.44
|
|
|
CHG OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
HCPCS 76519
|
| Min. Negotiated Rate |
$37.50 |
| Max. Negotiated Rate |
$102.36 |
| Rate for Payer: Aetna Commercial |
$87.25
|
| Rate for Payer: Aetna Medicare |
$65.11
|
| Rate for Payer: BCBS MAPPO |
$65.11
|
| Rate for Payer: BCN Commercial |
$101.59
|
| Rate for Payer: BCN Medicare Advantage |
$65.11
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cash Price |
$40.00
|
| Rate for Payer: Cofinity Commercial |
$87.25
|
| Rate for Payer: Cofinity Commercial |
$93.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.11
|
| Rate for Payer: Healthscope Commercial |
$78.13
|
| Rate for Payer: Healthscope Whirlpool |
$78.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.37
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.62
|
| Rate for Payer: Nomi Health Commercial |
$78.13
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$37.50
|
| Rate for Payer: PACE SWMI |
$65.11
|
| Rate for Payer: PHP Medicare Advantage |
$65.11
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$102.36
|
| Rate for Payer: Priority Health Medicare |
$65.11
|
| Rate for Payer: Priority Health Narrow Network |
$102.36
|
| Rate for Payer: Railroad Medicare Medicare |
$65.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.00
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$65.11
|
| Rate for Payer: UHC Exchange |
$95.00
|
| Rate for Payer: UHCCP DNSP |
$65.11
|
|
