|
CHG SPECIAL TREATMENT PROCEDURE
|
Professional
|
Both
|
$548.00
|
|
|
Service Code
|
HCPCS 77470
|
| Min. Negotiated Rate |
$138.82 |
| Max. Negotiated Rate |
$411.00 |
| Rate for Payer: Aetna Commercial |
$186.02
|
| Rate for Payer: Aetna Commercial |
$186.02
|
| Rate for Payer: Aetna Medicare |
$138.82
|
| Rate for Payer: Aetna Medicare |
$138.82
|
| Rate for Payer: BCBS MAPPO |
$138.82
|
| Rate for Payer: BCBS MAPPO |
$138.82
|
| Rate for Payer: BCN Commercial |
$219.11
|
| Rate for Payer: BCN Commercial |
$219.11
|
| Rate for Payer: BCN Medicare Advantage |
$138.82
|
| Rate for Payer: BCN Medicare Advantage |
$138.82
|
| Rate for Payer: Cash Price |
$438.40
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$438.40
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cofinity Commercial |
$186.02
|
| Rate for Payer: Cofinity Commercial |
$199.90
|
| Rate for Payer: Cofinity Commercial |
$186.02
|
| Rate for Payer: Cofinity Commercial |
$199.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.82
|
| Rate for Payer: Healthscope Commercial |
$166.58
|
| Rate for Payer: Healthscope Commercial |
$166.58
|
| Rate for Payer: Healthscope Whirlpool |
$166.58
|
| Rate for Payer: Healthscope Whirlpool |
$166.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$152.70
|
| Rate for Payer: Molina Medicare/Medicaid |
$152.70
|
| Rate for Payer: Nomi Health Commercial |
$166.58
|
| Rate for Payer: Nomi Health Commercial |
$166.58
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$544.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$411.00
|
| Rate for Payer: PACE SWMI |
$138.82
|
| Rate for Payer: PACE SWMI |
$138.82
|
| Rate for Payer: PHP Medicare Advantage |
$138.82
|
| Rate for Payer: PHP Medicare Advantage |
$138.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$220.75
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$220.75
|
| Rate for Payer: Priority Health Medicare |
$138.82
|
| Rate for Payer: Priority Health Medicare |
$138.82
|
| Rate for Payer: Priority Health Narrow Network |
$220.75
|
| Rate for Payer: Priority Health Narrow Network |
$220.75
|
| Rate for Payer: Railroad Medicare Medicare |
$138.82
|
| Rate for Payer: Railroad Medicare Medicare |
$138.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$196.07
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$138.82
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$138.82
|
| Rate for Payer: UHC Exchange |
$196.07
|
| Rate for Payer: UHC Exchange |
$196.07
|
| Rate for Payer: UHCCP DNSP |
$138.82
|
| Rate for Payer: UHCCP DNSP |
$138.82
|
|
|
CHG SPEC MEDICAL RADJ PHYSICS CONSLTJ
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
HCPCS 77370
|
| Min. Negotiated Rate |
$138.92 |
| Max. Negotiated Rate |
$225.78 |
| Rate for Payer: Aetna Commercial |
$186.15
|
| Rate for Payer: Aetna Medicare |
$138.92
|
| Rate for Payer: BCBS MAPPO |
$138.92
|
| Rate for Payer: BCN Commercial |
$224.09
|
| Rate for Payer: BCN Medicare Advantage |
$138.92
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cofinity Commercial |
$186.15
|
| Rate for Payer: Cofinity Commercial |
$200.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.92
|
| Rate for Payer: Healthscope Commercial |
$166.70
|
| Rate for Payer: Healthscope Whirlpool |
$166.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$152.81
|
| Rate for Payer: Nomi Health Commercial |
$166.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$166.50
|
| Rate for Payer: PACE SWMI |
$138.92
|
| Rate for Payer: PHP Medicare Advantage |
$138.92
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$225.78
|
| Rate for Payer: Priority Health Medicare |
$138.92
|
| Rate for Payer: Priority Health Narrow Network |
$225.78
|
| Rate for Payer: Railroad Medicare Medicare |
$138.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$173.08
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$138.92
|
| Rate for Payer: UHC Exchange |
$173.08
|
| Rate for Payer: UHCCP DNSP |
$138.92
|
|
|
CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
HCPCS 77321
|
| Min. Negotiated Rate |
$89.36 |
| Max. Negotiated Rate |
$217.50 |
| Rate for Payer: Aetna Commercial |
$119.74
|
| Rate for Payer: Aetna Commercial |
$119.74
|
| Rate for Payer: Aetna Medicare |
$89.36
|
| Rate for Payer: Aetna Medicare |
$89.36
|
| Rate for Payer: BCBS MAPPO |
$89.36
|
| Rate for Payer: BCBS MAPPO |
$89.36
|
| Rate for Payer: BCN Commercial |
$142.42
|
| Rate for Payer: BCN Commercial |
$142.42
|
| Rate for Payer: BCN Medicare Advantage |
$89.36
|
| Rate for Payer: BCN Medicare Advantage |
$89.36
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$232.00
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$128.68
|
| Rate for Payer: Cofinity Commercial |
$119.74
|
| Rate for Payer: Cofinity Commercial |
$128.68
|
| Rate for Payer: Cofinity Commercial |
$119.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$89.36
|
| Rate for Payer: Healthscope Commercial |
$107.23
|
| Rate for Payer: Healthscope Commercial |
$107.23
|
| Rate for Payer: Healthscope Whirlpool |
$107.23
|
| Rate for Payer: Healthscope Whirlpool |
$107.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$93.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$98.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$98.30
|
| Rate for Payer: Nomi Health Commercial |
$107.23
|
| Rate for Payer: Nomi Health Commercial |
$107.23
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$217.50
|
| Rate for Payer: PACE SWMI |
$89.36
|
| Rate for Payer: PACE SWMI |
$89.36
|
| Rate for Payer: PHP Medicare Advantage |
$89.36
|
| Rate for Payer: PHP Medicare Advantage |
$89.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$143.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$143.49
|
| Rate for Payer: Priority Health Medicare |
$89.36
|
| Rate for Payer: Priority Health Medicare |
$89.36
|
| Rate for Payer: Priority Health Narrow Network |
$143.49
|
| Rate for Payer: Priority Health Narrow Network |
$143.49
|
| Rate for Payer: Railroad Medicare Medicare |
$89.36
|
| Rate for Payer: Railroad Medicare Medicare |
$89.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$136.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$89.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$89.36
|
| Rate for Payer: UHC Exchange |
$136.39
|
| Rate for Payer: UHC Exchange |
$136.39
|
| Rate for Payer: UHCCP DNSP |
$89.36
|
| Rate for Payer: UHCCP DNSP |
$89.36
|
|
|
CHG STEREOSCOPIC X-RAY GUIDANCE
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 77421
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$134.25 |
| Rate for Payer: BCBS Complete |
$71.60
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$134.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.00
|
|
|
CHG STEREOTACTIC BODY RADIATION MANAGEMENT
|
Professional
|
Both
|
$1,299.00
|
|
|
Service Code
|
HCPCS 77435
|
| Min. Negotiated Rate |
$408.96 |
| Max. Negotiated Rate |
$976.36 |
| Rate for Payer: Aetna Commercial |
$838.52
|
| Rate for Payer: Aetna Medicare |
$625.76
|
| Rate for Payer: BCBS Complete |
$429.41
|
| Rate for Payer: BCBS MAPPO |
$625.76
|
| Rate for Payer: BCN Commercial |
$969.07
|
| Rate for Payer: BCN Medicare Advantage |
$625.76
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cofinity Commercial |
$901.09
|
| Rate for Payer: Cofinity Commercial |
$838.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$625.76
|
| Rate for Payer: Healthscope Commercial |
$750.91
|
| Rate for Payer: Healthscope Whirlpool |
$750.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$657.05
|
| Rate for Payer: Meridian Medicaid |
$429.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$688.34
|
| Rate for Payer: Nomi Health Commercial |
$750.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$974.25
|
| Rate for Payer: PACE SWMI |
$625.76
|
| Rate for Payer: PHP Medicare Advantage |
$625.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$408.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$976.36
|
| Rate for Payer: Priority Health Medicare |
$625.76
|
| Rate for Payer: Priority Health Narrow Network |
$976.36
|
| Rate for Payer: Railroad Medicare Medicare |
$625.76
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$960.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$625.76
|
| Rate for Payer: UHC Exchange |
$960.81
|
| Rate for Payer: UHC Medicaid |
$408.96
|
| Rate for Payer: UHCCP DNSP |
$625.76
|
| Rate for Payer: UHCCP Medicaid |
$408.96
|
|
|
CHG STEREOTACTIC BODY RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$2,787.00
|
|
|
Service Code
|
HCPCS 77373
|
| Min. Negotiated Rate |
$895.31 |
| Max. Negotiated Rate |
$2,090.25 |
| Rate for Payer: Aetna Commercial |
$1,199.72
|
| Rate for Payer: Aetna Medicare |
$895.31
|
| Rate for Payer: BCBS MAPPO |
$895.31
|
| Rate for Payer: BCN Commercial |
$1,461.57
|
| Rate for Payer: BCN Medicare Advantage |
$895.31
|
| Rate for Payer: Cash Price |
$2,229.60
|
| Rate for Payer: Cash Price |
$2,229.60
|
| Rate for Payer: Cofinity Commercial |
$1,199.72
|
| Rate for Payer: Cofinity Commercial |
$1,289.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$895.31
|
| Rate for Payer: Healthscope Commercial |
$1,074.37
|
| Rate for Payer: Healthscope Whirlpool |
$1,074.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$940.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$984.84
|
| Rate for Payer: Nomi Health Commercial |
$1,074.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,090.25
|
| Rate for Payer: PACE SWMI |
$895.31
|
| Rate for Payer: PHP Medicare Advantage |
$895.31
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,472.58
|
| Rate for Payer: Priority Health Medicare |
$895.31
|
| Rate for Payer: Priority Health Narrow Network |
$1,472.58
|
| Rate for Payer: Railroad Medicare Medicare |
$895.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,677.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$895.31
|
| Rate for Payer: UHC Exchange |
$1,677.55
|
| Rate for Payer: UHCCP DNSP |
$895.31
|
|
|
CHG STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION
|
Professional
|
Both
|
$898.00
|
|
|
Service Code
|
HCPCS 77432
|
| Min. Negotiated Rate |
$270.51 |
| Max. Negotiated Rate |
$673.50 |
| Rate for Payer: Aetna Commercial |
$554.92
|
| Rate for Payer: Aetna Medicare |
$414.12
|
| Rate for Payer: BCBS Complete |
$284.04
|
| Rate for Payer: BCBS MAPPO |
$414.12
|
| Rate for Payer: BCN Commercial |
$641.40
|
| Rate for Payer: BCN Medicare Advantage |
$414.12
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cash Price |
$718.40
|
| Rate for Payer: Cofinity Commercial |
$596.33
|
| Rate for Payer: Cofinity Commercial |
$554.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$414.12
|
| Rate for Payer: Healthscope Commercial |
$496.94
|
| Rate for Payer: Healthscope Whirlpool |
$496.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$434.83
|
| Rate for Payer: Meridian Medicaid |
$284.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$455.53
|
| Rate for Payer: Nomi Health Commercial |
$496.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$673.50
|
| Rate for Payer: PACE SWMI |
$414.12
|
| Rate for Payer: PHP Medicare Advantage |
$414.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$270.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$646.22
|
| Rate for Payer: Priority Health Medicare |
$414.12
|
| Rate for Payer: Priority Health Narrow Network |
$646.22
|
| Rate for Payer: Railroad Medicare Medicare |
$414.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$636.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$414.12
|
| Rate for Payer: UHC Exchange |
$636.61
|
| Rate for Payer: UHC Medicaid |
$270.51
|
| Rate for Payer: UHCCP DNSP |
$414.12
|
| Rate for Payer: UHCCP Medicaid |
$270.51
|
|
|
CHG SUPERVISION HANDLING LOADING RADIATION SOURCE
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 77790
|
| Min. Negotiated Rate |
$17.22 |
| Max. Negotiated Rate |
$145.50 |
| Rate for Payer: Aetna Commercial |
$23.07
|
| Rate for Payer: Aetna Commercial |
$23.07
|
| Rate for Payer: Aetna Medicare |
$17.22
|
| Rate for Payer: Aetna Medicare |
$17.22
|
| Rate for Payer: BCBS MAPPO |
$17.22
|
| Rate for Payer: BCBS MAPPO |
$17.22
|
| Rate for Payer: BCN Commercial |
$28.39
|
| Rate for Payer: BCN Commercial |
$28.39
|
| Rate for Payer: BCN Medicare Advantage |
$17.22
|
| Rate for Payer: BCN Medicare Advantage |
$17.22
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$23.07
|
| Rate for Payer: Cofinity Commercial |
$24.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.22
|
| Rate for Payer: Healthscope Commercial |
$20.66
|
| Rate for Payer: Healthscope Commercial |
$20.66
|
| Rate for Payer: Healthscope Whirlpool |
$20.66
|
| Rate for Payer: Healthscope Whirlpool |
$20.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.94
|
| Rate for Payer: Molina Medicare/Medicaid |
$18.94
|
| Rate for Payer: Nomi Health Commercial |
$20.66
|
| Rate for Payer: Nomi Health Commercial |
$20.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$62.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$145.50
|
| Rate for Payer: PACE SWMI |
$17.22
|
| Rate for Payer: PACE SWMI |
$17.22
|
| Rate for Payer: PHP Medicare Advantage |
$17.22
|
| Rate for Payer: PHP Medicare Advantage |
$17.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$28.60
|
| Rate for Payer: Priority Health Medicare |
$17.22
|
| Rate for Payer: Priority Health Medicare |
$17.22
|
| Rate for Payer: Priority Health Narrow Network |
$28.60
|
| Rate for Payer: Priority Health Narrow Network |
$28.60
|
| Rate for Payer: Railroad Medicare Medicare |
$17.22
|
| Rate for Payer: Railroad Medicare Medicare |
$17.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$21.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.22
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$17.22
|
| Rate for Payer: UHC Exchange |
$21.19
|
| Rate for Payer: UHC Exchange |
$21.19
|
| Rate for Payer: UHCCP DNSP |
$17.22
|
| Rate for Payer: UHCCP DNSP |
$17.22
|
|
|
CHG TBS TECHNICAL CALCULATION ONLY
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 77091
|
| Min. Negotiated Rate |
$24.47 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Aetna Commercial |
$32.79
|
| Rate for Payer: Aetna Medicare |
$24.47
|
| Rate for Payer: BCBS MAPPO |
$24.47
|
| Rate for Payer: BCN Commercial |
$40.83
|
| Rate for Payer: BCN Medicare Advantage |
$24.47
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cofinity Commercial |
$35.24
|
| Rate for Payer: Cofinity Commercial |
$32.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.47
|
| Rate for Payer: Healthscope Commercial |
$29.36
|
| Rate for Payer: Healthscope Whirlpool |
$29.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$26.92
|
| Rate for Payer: Nomi Health Commercial |
$29.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$45.00
|
| Rate for Payer: PACE SWMI |
$24.47
|
| Rate for Payer: PHP Medicare Advantage |
$24.47
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$41.14
|
| Rate for Payer: Priority Health Medicare |
$24.47
|
| Rate for Payer: Priority Health Narrow Network |
$41.14
|
| Rate for Payer: Railroad Medicare Medicare |
$24.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$40.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$24.47
|
| Rate for Payer: UHC Exchange |
$40.86
|
| Rate for Payer: UHCCP DNSP |
$24.47
|
|
|
CHG TELETHER ISODOSE PLAN COMPLX
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 77315
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$211.50 |
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: BCBS Complete |
$59.60
|
| Rate for Payer: Cash Price |
$119.20
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$211.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$111.75
|
|
|
CHG TELETHER ISODOSE PLAN SIMPLE
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
HCPCS 77305
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$75.00 |
| Rate for Payer: BCBS Complete |
$40.00
|
| Rate for Payer: BCBS Complete |
$64.00
|
| Rate for Payer: Cash Price |
$80.00
|
| Rate for Payer: Cash Price |
$128.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$75.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$120.00
|
|
|
CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY
|
Professional
|
Both
|
$863.00
|
|
|
Service Code
|
HCPCS 77307
|
| Min. Negotiated Rate |
$274.38 |
| Max. Negotiated Rate |
$647.25 |
| Rate for Payer: Aetna Commercial |
$367.67
|
| Rate for Payer: Aetna Commercial |
$367.67
|
| Rate for Payer: Aetna Medicare |
$274.38
|
| Rate for Payer: Aetna Medicare |
$274.38
|
| Rate for Payer: BCBS MAPPO |
$274.38
|
| Rate for Payer: BCBS MAPPO |
$274.38
|
| Rate for Payer: BCN Commercial |
$436.23
|
| Rate for Payer: BCN Commercial |
$436.23
|
| Rate for Payer: BCN Medicare Advantage |
$274.38
|
| Rate for Payer: BCN Medicare Advantage |
$274.38
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Cash Price |
$690.40
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cash Price |
$361.60
|
| Rate for Payer: Cofinity Commercial |
$367.67
|
| Rate for Payer: Cofinity Commercial |
$367.67
|
| Rate for Payer: Cofinity Commercial |
$395.11
|
| Rate for Payer: Cofinity Commercial |
$395.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.38
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.38
|
| Rate for Payer: Healthscope Commercial |
$329.26
|
| Rate for Payer: Healthscope Commercial |
$329.26
|
| Rate for Payer: Healthscope Whirlpool |
$329.26
|
| Rate for Payer: Healthscope Whirlpool |
$329.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$301.82
|
| Rate for Payer: Molina Medicare/Medicaid |
$301.82
|
| Rate for Payer: Nomi Health Commercial |
$329.26
|
| Rate for Payer: Nomi Health Commercial |
$329.26
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$647.25
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$339.00
|
| Rate for Payer: PACE SWMI |
$274.38
|
| Rate for Payer: PACE SWMI |
$274.38
|
| Rate for Payer: PHP Medicare Advantage |
$274.38
|
| Rate for Payer: PHP Medicare Advantage |
$274.38
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$439.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$439.52
|
| Rate for Payer: Priority Health Medicare |
$274.38
|
| Rate for Payer: Priority Health Medicare |
$274.38
|
| Rate for Payer: Priority Health Narrow Network |
$439.52
|
| Rate for Payer: Priority Health Narrow Network |
$439.52
|
| Rate for Payer: Railroad Medicare Medicare |
$274.38
|
| Rate for Payer: Railroad Medicare Medicare |
$274.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$417.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$417.16
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$274.38
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$274.38
|
| Rate for Payer: UHC Exchange |
$417.16
|
| Rate for Payer: UHC Exchange |
$417.16
|
| Rate for Payer: UHCCP DNSP |
$274.38
|
| Rate for Payer: UHCCP DNSP |
$274.38
|
|
|
CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 77306
|
| Min. Negotiated Rate |
$141.79 |
| Max. Negotiated Rate |
$225.78 |
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Medicare |
$141.79
|
| Rate for Payer: Aetna Medicare |
$141.79
|
| Rate for Payer: BCBS MAPPO |
$141.79
|
| Rate for Payer: BCBS MAPPO |
$141.79
|
| Rate for Payer: BCN Commercial |
$224.09
|
| Rate for Payer: BCN Commercial |
$224.09
|
| Rate for Payer: BCN Medicare Advantage |
$141.79
|
| Rate for Payer: BCN Medicare Advantage |
$141.79
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$190.00
|
| Rate for Payer: Cofinity Commercial |
$204.18
|
| Rate for Payer: Cofinity Commercial |
$190.00
|
| Rate for Payer: Cofinity Commercial |
$204.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$141.79
|
| Rate for Payer: Healthscope Commercial |
$170.15
|
| Rate for Payer: Healthscope Commercial |
$170.15
|
| Rate for Payer: Healthscope Whirlpool |
$170.15
|
| Rate for Payer: Healthscope Whirlpool |
$170.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$148.88
|
| Rate for Payer: Molina Medicare/Medicaid |
$155.97
|
| Rate for Payer: Molina Medicare/Medicaid |
$155.97
|
| Rate for Payer: Nomi Health Commercial |
$170.15
|
| Rate for Payer: Nomi Health Commercial |
$170.15
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$306.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$180.00
|
| Rate for Payer: PACE SWMI |
$141.79
|
| Rate for Payer: PACE SWMI |
$141.79
|
| Rate for Payer: PHP Medicare Advantage |
$141.79
|
| Rate for Payer: PHP Medicare Advantage |
$141.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$225.78
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$225.78
|
| Rate for Payer: Priority Health Medicare |
$141.79
|
| Rate for Payer: Priority Health Medicare |
$141.79
|
| Rate for Payer: Priority Health Narrow Network |
$225.78
|
| Rate for Payer: Priority Health Narrow Network |
$225.78
|
| Rate for Payer: Railroad Medicare Medicare |
$141.79
|
| Rate for Payer: Railroad Medicare Medicare |
$141.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$214.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$141.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$141.79
|
| Rate for Payer: UHC Exchange |
$214.70
|
| Rate for Payer: UHC Exchange |
$214.70
|
| Rate for Payer: UHCCP DNSP |
$141.79
|
| Rate for Payer: UHCCP DNSP |
$141.79
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 74283
|
| Min. Negotiated Rate |
$213.75 |
| Max. Negotiated Rate |
$390.85 |
| Rate for Payer: Aetna Commercial |
$351.78
|
| Rate for Payer: Aetna Medicare |
$262.52
|
| Rate for Payer: BCBS MAPPO |
$262.52
|
| Rate for Payer: BCN Commercial |
$387.93
|
| Rate for Payer: BCN Medicare Advantage |
$262.52
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$378.03
|
| Rate for Payer: Cofinity Commercial |
$351.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$262.52
|
| Rate for Payer: Healthscope Commercial |
$315.02
|
| Rate for Payer: Healthscope Whirlpool |
$315.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$275.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$288.77
|
| Rate for Payer: Nomi Health Commercial |
$315.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$213.75
|
| Rate for Payer: PACE SWMI |
$262.52
|
| Rate for Payer: PHP Medicare Advantage |
$262.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$390.85
|
| Rate for Payer: Priority Health Medicare |
$262.52
|
| Rate for Payer: Priority Health Narrow Network |
$390.85
|
| Rate for Payer: Railroad Medicare Medicare |
$262.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$353.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$262.52
|
| Rate for Payer: UHC Exchange |
$353.86
|
| Rate for Payer: UHCCP DNSP |
$262.52
|
|
|
CHG THERAPEUTIC RADIOLOGY PORT IMAGE(S)
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
HCPCS 77417
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$26.25 |
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: BCBS Complete |
$0.45
|
| Rate for Payer: BCN Commercial |
$24.40
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Cash Price |
$28.00
|
| Rate for Payer: Meridian Medicaid |
$0.45
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$26.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$0.43
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$24.59
|
| Rate for Payer: Priority Health Narrow Network |
$24.59
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$15.78
|
| Rate for Payer: UHC Exchange |
$15.78
|
| Rate for Payer: UHC Medicaid |
$0.43
|
| Rate for Payer: UHCCP Medicaid |
$0.43
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
HCPCS 77263
|
| Min. Negotiated Rate |
$107.35 |
| Max. Negotiated Rate |
$255.89 |
| Rate for Payer: Aetna Commercial |
$220.19
|
| Rate for Payer: Aetna Medicare |
$164.32
|
| Rate for Payer: BCBS Complete |
$112.72
|
| Rate for Payer: BCBS MAPPO |
$164.32
|
| Rate for Payer: BCN Commercial |
$253.97
|
| Rate for Payer: BCN Medicare Advantage |
$164.32
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cash Price |
$248.80
|
| Rate for Payer: Cofinity Commercial |
$236.62
|
| Rate for Payer: Cofinity Commercial |
$220.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.32
|
| Rate for Payer: Healthscope Commercial |
$197.18
|
| Rate for Payer: Healthscope Whirlpool |
$197.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$172.54
|
| Rate for Payer: Meridian Medicaid |
$112.72
|
| Rate for Payer: Molina Medicare/Medicaid |
$180.75
|
| Rate for Payer: Nomi Health Commercial |
$197.18
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$233.25
|
| Rate for Payer: PACE SWMI |
$164.32
|
| Rate for Payer: PHP Medicare Advantage |
$164.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$107.35
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$255.89
|
| Rate for Payer: Priority Health Medicare |
$164.32
|
| Rate for Payer: Priority Health Narrow Network |
$255.89
|
| Rate for Payer: Railroad Medicare Medicare |
$164.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$252.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$164.32
|
| Rate for Payer: UHC Exchange |
$252.88
|
| Rate for Payer: UHC Medicaid |
$107.35
|
| Rate for Payer: UHCCP DNSP |
$164.32
|
| Rate for Payer: UHCCP Medicaid |
$107.35
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 77262
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$164.57 |
| Rate for Payer: Aetna Commercial |
$139.92
|
| Rate for Payer: Aetna Medicare |
$104.42
|
| Rate for Payer: BCBS Complete |
$71.79
|
| Rate for Payer: BCBS MAPPO |
$104.42
|
| Rate for Payer: BCN Commercial |
$163.34
|
| Rate for Payer: BCN Medicare Advantage |
$104.42
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$150.36
|
| Rate for Payer: Cofinity Commercial |
$139.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.42
|
| Rate for Payer: Healthscope Commercial |
$125.30
|
| Rate for Payer: Healthscope Whirlpool |
$125.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.64
|
| Rate for Payer: Meridian Medicaid |
$71.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$114.86
|
| Rate for Payer: Nomi Health Commercial |
$125.30
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$156.00
|
| Rate for Payer: PACE SWMI |
$104.42
|
| Rate for Payer: PHP Medicare Advantage |
$104.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$164.57
|
| Rate for Payer: Priority Health Medicare |
$104.42
|
| Rate for Payer: Priority Health Narrow Network |
$164.57
|
| Rate for Payer: Railroad Medicare Medicare |
$104.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$104.42
|
| Rate for Payer: UHC Exchange |
$161.66
|
| Rate for Payer: UHC Medicaid |
$68.37
|
| Rate for Payer: UHCCP DNSP |
$104.42
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
HCPCS 77261
|
| Min. Negotiated Rate |
$44.52 |
| Max. Negotiated Rate |
$106.66 |
| Rate for Payer: Aetna Commercial |
$91.03
|
| Rate for Payer: Aetna Medicare |
$67.93
|
| Rate for Payer: BCBS Complete |
$46.75
|
| Rate for Payer: BCBS MAPPO |
$67.93
|
| Rate for Payer: BCN Commercial |
$105.57
|
| Rate for Payer: BCN Medicare Advantage |
$67.93
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cash Price |
$111.20
|
| Rate for Payer: Cofinity Commercial |
$91.03
|
| Rate for Payer: Cofinity Commercial |
$97.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.93
|
| Rate for Payer: Healthscope Commercial |
$81.52
|
| Rate for Payer: Healthscope Whirlpool |
$81.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$71.33
|
| Rate for Payer: Meridian Medicaid |
$46.75
|
| Rate for Payer: Molina Medicare/Medicaid |
$74.72
|
| Rate for Payer: Nomi Health Commercial |
$81.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$104.25
|
| Rate for Payer: PACE SWMI |
$67.93
|
| Rate for Payer: PHP Medicare Advantage |
$67.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$106.36
|
| Rate for Payer: Priority Health Medicare |
$67.93
|
| Rate for Payer: Priority Health Narrow Network |
$106.36
|
| Rate for Payer: Railroad Medicare Medicare |
$67.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$106.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$67.93
|
| Rate for Payer: UHC Exchange |
$106.66
|
| Rate for Payer: UHC Medicaid |
$44.52
|
| Rate for Payer: UHCCP DNSP |
$67.93
|
| Rate for Payer: UHCCP Medicaid |
$44.52
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX
|
Professional
|
Both
|
$993.00
|
|
|
Service Code
|
HCPCS 77290
|
| Min. Negotiated Rate |
$408.28 |
| Max. Negotiated Rate |
$744.75 |
| Rate for Payer: Aetna Commercial |
$547.10
|
| Rate for Payer: Aetna Commercial |
$547.10
|
| Rate for Payer: Aetna Medicare |
$408.28
|
| Rate for Payer: Aetna Medicare |
$408.28
|
| Rate for Payer: BCBS MAPPO |
$408.28
|
| Rate for Payer: BCBS MAPPO |
$408.28
|
| Rate for Payer: BCN Commercial |
$658.33
|
| Rate for Payer: BCN Commercial |
$658.33
|
| Rate for Payer: BCN Medicare Advantage |
$408.28
|
| Rate for Payer: BCN Medicare Advantage |
$408.28
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cash Price |
$794.40
|
| Rate for Payer: Cash Price |
$661.60
|
| Rate for Payer: Cofinity Commercial |
$547.10
|
| Rate for Payer: Cofinity Commercial |
$587.92
|
| Rate for Payer: Cofinity Commercial |
$547.10
|
| Rate for Payer: Cofinity Commercial |
$587.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$408.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$408.28
|
| Rate for Payer: Healthscope Commercial |
$489.94
|
| Rate for Payer: Healthscope Commercial |
$489.94
|
| Rate for Payer: Healthscope Whirlpool |
$489.94
|
| Rate for Payer: Healthscope Whirlpool |
$489.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$449.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$449.11
|
| Rate for Payer: Nomi Health Commercial |
$489.94
|
| Rate for Payer: Nomi Health Commercial |
$489.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$744.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$620.25
|
| Rate for Payer: PACE SWMI |
$408.28
|
| Rate for Payer: PACE SWMI |
$408.28
|
| Rate for Payer: PHP Medicare Advantage |
$408.28
|
| Rate for Payer: PHP Medicare Advantage |
$408.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$663.29
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$663.29
|
| Rate for Payer: Priority Health Medicare |
$408.28
|
| Rate for Payer: Priority Health Medicare |
$408.28
|
| Rate for Payer: Priority Health Narrow Network |
$663.29
|
| Rate for Payer: Priority Health Narrow Network |
$663.29
|
| Rate for Payer: Railroad Medicare Medicare |
$408.28
|
| Rate for Payer: Railroad Medicare Medicare |
$408.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$699.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$699.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$408.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$408.28
|
| Rate for Payer: UHC Exchange |
$699.80
|
| Rate for Payer: UHC Exchange |
$699.80
|
| Rate for Payer: UHCCP DNSP |
$408.28
|
| Rate for Payer: UHCCP DNSP |
$408.28
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 77285
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$669.31 |
| Rate for Payer: Aetna Commercial |
$558.66
|
| Rate for Payer: Aetna Medicare |
$416.91
|
| Rate for Payer: BCBS MAPPO |
$416.91
|
| Rate for Payer: BCN Commercial |
$664.31
|
| Rate for Payer: BCN Medicare Advantage |
$416.91
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$558.66
|
| Rate for Payer: Cofinity Commercial |
$600.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$416.91
|
| Rate for Payer: Healthscope Commercial |
$500.29
|
| Rate for Payer: Healthscope Whirlpool |
$500.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$437.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$458.60
|
| Rate for Payer: Nomi Health Commercial |
$500.29
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$87.75
|
| Rate for Payer: PACE SWMI |
$416.91
|
| Rate for Payer: PHP Medicare Advantage |
$416.91
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$669.31
|
| Rate for Payer: Priority Health Medicare |
$416.91
|
| Rate for Payer: Priority Health Narrow Network |
$669.31
|
| Rate for Payer: Railroad Medicare Medicare |
$416.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$651.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$416.91
|
| Rate for Payer: UHC Exchange |
$651.69
|
| Rate for Payer: UHCCP DNSP |
$416.91
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
HCPCS 77280
|
| Min. Negotiated Rate |
$248.36 |
| Max. Negotiated Rate |
$403.40 |
| Rate for Payer: Aetna Commercial |
$332.80
|
| Rate for Payer: Aetna Commercial |
$332.80
|
| Rate for Payer: Aetna Medicare |
$248.36
|
| Rate for Payer: Aetna Medicare |
$248.36
|
| Rate for Payer: BCBS MAPPO |
$248.36
|
| Rate for Payer: BCBS MAPPO |
$248.36
|
| Rate for Payer: BCN Commercial |
$400.38
|
| Rate for Payer: BCN Commercial |
$400.38
|
| Rate for Payer: BCN Medicare Advantage |
$248.36
|
| Rate for Payer: BCN Medicare Advantage |
$248.36
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cash Price |
$424.00
|
| Rate for Payer: Cash Price |
$365.60
|
| Rate for Payer: Cash Price |
$365.60
|
| Rate for Payer: Cofinity Commercial |
$357.64
|
| Rate for Payer: Cofinity Commercial |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$357.64
|
| Rate for Payer: Cofinity Commercial |
$332.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.36
|
| Rate for Payer: Healthscope Commercial |
$298.03
|
| Rate for Payer: Healthscope Commercial |
$298.03
|
| Rate for Payer: Healthscope Whirlpool |
$298.03
|
| Rate for Payer: Healthscope Whirlpool |
$298.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$260.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$260.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$273.20
|
| Rate for Payer: Nomi Health Commercial |
$298.03
|
| Rate for Payer: Nomi Health Commercial |
$298.03
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$342.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$397.50
|
| Rate for Payer: PACE SWMI |
$248.36
|
| Rate for Payer: PACE SWMI |
$248.36
|
| Rate for Payer: PHP Medicare Advantage |
$248.36
|
| Rate for Payer: PHP Medicare Advantage |
$248.36
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$403.40
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$403.40
|
| Rate for Payer: Priority Health Medicare |
$248.36
|
| Rate for Payer: Priority Health Medicare |
$248.36
|
| Rate for Payer: Priority Health Narrow Network |
$403.40
|
| Rate for Payer: Priority Health Narrow Network |
$403.40
|
| Rate for Payer: Railroad Medicare Medicare |
$248.36
|
| Rate for Payer: Railroad Medicare Medicare |
$248.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$389.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$248.36
|
| Rate for Payer: UHC Exchange |
$389.36
|
| Rate for Payer: UHC Exchange |
$389.36
|
| Rate for Payer: UHCCP DNSP |
$248.36
|
| Rate for Payer: UHCCP DNSP |
$248.36
|
|
|
CHG TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 88233
|
| Min. Negotiated Rate |
$84.44 |
| Max. Negotiated Rate |
$231.00 |
| Rate for Payer: Aetna Commercial |
$188.58
|
| Rate for Payer: Aetna Medicare |
$140.73
|
| Rate for Payer: BCBS MAPPO |
$140.73
|
| Rate for Payer: BCN Commercial |
$105.55
|
| Rate for Payer: BCN Medicare Advantage |
$140.73
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$188.58
|
| Rate for Payer: Cofinity Commercial |
$202.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.73
|
| Rate for Payer: Healthscope Commercial |
$168.88
|
| Rate for Payer: Healthscope Whirlpool |
$168.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$154.80
|
| Rate for Payer: Nomi Health Commercial |
$168.88
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$231.00
|
| Rate for Payer: PACE SWMI |
$140.73
|
| Rate for Payer: PHP Medicare Advantage |
$140.73
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$218.26
|
| Rate for Payer: Priority Health Medicare |
$140.73
|
| Rate for Payer: Priority Health Narrow Network |
$218.26
|
| Rate for Payer: Railroad Medicare Medicare |
$140.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$84.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$140.73
|
| Rate for Payer: UHC Exchange |
$84.44
|
| Rate for Payer: UHCCP DNSP |
$140.73
|
|
|
CHG TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 87220
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$17.25 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCN Commercial |
$3.20
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$5.72
|
| Rate for Payer: Cofinity Commercial |
$6.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$5.12
|
| Rate for Payer: Healthscope Whirlpool |
$5.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Molina Medicare/Medicaid |
$4.70
|
| Rate for Payer: Nomi Health Commercial |
$5.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$17.25
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$4.38
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: Priority Health Narrow Network |
$4.38
|
| Rate for Payer: Railroad Medicare Medicare |
$4.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.56
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$4.27
|
| Rate for Payer: UHC Exchange |
$2.56
|
| Rate for Payer: UHCCP DNSP |
$4.27
|
|
|
CHG TRANSCATHETER EMBOLIZATION ANY METH RS&I
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
HCPCS 75894
|
| Min. Negotiated Rate |
$106.58 |
| Max. Negotiated Rate |
$1,568.50 |
| Rate for Payer: Aetna Commercial |
$400.85
|
| Rate for Payer: Aetna Medicare |
$299.14
|
| Rate for Payer: BCBS MAPPO |
$299.14
|
| Rate for Payer: BCN Commercial |
$106.58
|
| Rate for Payer: BCN Medicare Advantage |
$299.14
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cash Price |
$296.00
|
| Rate for Payer: Cofinity Commercial |
$400.85
|
| Rate for Payer: Cofinity Commercial |
$430.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$299.14
|
| Rate for Payer: Healthscope Commercial |
$358.97
|
| Rate for Payer: Healthscope Whirlpool |
$358.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$314.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$329.05
|
| Rate for Payer: Nomi Health Commercial |
$358.97
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$277.50
|
| Rate for Payer: PACE SWMI |
$299.14
|
| Rate for Payer: PHP Medicare Advantage |
$299.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$1,533.79
|
| Rate for Payer: Priority Health Medicare |
$299.14
|
| Rate for Payer: Priority Health Narrow Network |
$1,533.79
|
| Rate for Payer: Railroad Medicare Medicare |
$299.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$1,568.50
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$299.14
|
| Rate for Payer: UHC Exchange |
$1,568.50
|
| Rate for Payer: UHCCP DNSP |
$299.14
|
|
|
CHG TRANSCATHETER INFUSION OTHER THAN THROMBOLYSIS
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
HCPCS 75896
|
| Min. Negotiated Rate |
$117.20 |
| Max. Negotiated Rate |
$219.75 |
| Rate for Payer: BCBS Complete |
$117.20
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$219.75
|
|
