|
CHG CT ABDOMEN W/O CONTRAST FLWD BY CONTRAST MATRL
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
HCPCS 74170
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$341.58 |
| Rate for Payer: Aetna Commercial |
$317.86
|
| Rate for Payer: Aetna Medicare |
$237.21
|
| Rate for Payer: BCBS Complete |
$57.60
|
| Rate for Payer: BCBS MAPPO |
$237.21
|
| Rate for Payer: BCN Medicare Advantage |
$237.21
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cofinity Commercial |
$341.58
|
| Rate for Payer: Cofinity Commercial |
$317.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$237.21
|
| Rate for Payer: Healthscope Commercial |
$284.65
|
| Rate for Payer: Healthscope Whirlpool |
$284.65
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$249.07
|
| Rate for Payer: Nomi Health Commercial |
$284.65
|
| Rate for Payer: PACE SWMI |
$237.21
|
| Rate for Payer: PHP Medicare Advantage |
$237.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$93.60
|
| Rate for Payer: Priority Health Medicare |
$237.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$237.21
|
| Rate for Payer: UHC Medicare Advantage |
$237.21
|
| Rate for Payer: UHCCP DNSP |
$237.21
|
|
|
CHG CT ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 74150
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$181.77 |
| Rate for Payer: Aetna Commercial |
$169.15
|
| Rate for Payer: Aetna Medicare |
$126.23
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: BCBS MAPPO |
$126.23
|
| Rate for Payer: BCN Medicare Advantage |
$126.23
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cofinity Commercial |
$181.77
|
| Rate for Payer: Cofinity Commercial |
$169.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.23
|
| Rate for Payer: Healthscope Commercial |
$151.48
|
| Rate for Payer: Healthscope Whirlpool |
$151.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$132.54
|
| Rate for Payer: Nomi Health Commercial |
$151.48
|
| Rate for Payer: PACE SWMI |
$126.23
|
| Rate for Payer: PHP Medicare Advantage |
$126.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: Priority Health Medicare |
$126.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.23
|
| Rate for Payer: UHC Medicare Advantage |
$126.23
|
| Rate for Payer: UHCCP DNSP |
$126.23
|
|
|
CHG CT ABD&PLV W/O CNTRST 1/BTH FLWD CNTRST 1/BTH
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 74178
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$446.56 |
| Rate for Payer: Aetna Commercial |
$415.55
|
| Rate for Payer: Aetna Medicare |
$310.11
|
| Rate for Payer: BCBS Complete |
$82.40
|
| Rate for Payer: BCBS MAPPO |
$310.11
|
| Rate for Payer: BCN Medicare Advantage |
$310.11
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cofinity Commercial |
$446.56
|
| Rate for Payer: Cofinity Commercial |
$415.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.11
|
| Rate for Payer: Healthscope Commercial |
$372.13
|
| Rate for Payer: Healthscope Whirlpool |
$372.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$325.62
|
| Rate for Payer: Nomi Health Commercial |
$372.13
|
| Rate for Payer: PACE SWMI |
$310.11
|
| Rate for Payer: PHP Medicare Advantage |
$310.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.90
|
| Rate for Payer: Priority Health Medicare |
$310.11
|
| Rate for Payer: UHC Dual Complete DSNP |
$310.11
|
| Rate for Payer: UHC Medicare Advantage |
$310.11
|
| Rate for Payer: UHCCP DNSP |
$310.11
|
|
|
CHG CTA HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST
|
Professional
|
Both
|
$246.00
|
|
|
Service Code
|
HCPCS 75574
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$429.45 |
| Rate for Payer: Aetna Commercial |
$399.63
|
| Rate for Payer: Aetna Medicare |
$298.23
|
| Rate for Payer: BCBS Complete |
$98.40
|
| Rate for Payer: BCBS MAPPO |
$298.23
|
| Rate for Payer: BCN Medicare Advantage |
$298.23
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cofinity Commercial |
$429.45
|
| Rate for Payer: Cofinity Commercial |
$399.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$298.23
|
| Rate for Payer: Healthscope Commercial |
$357.88
|
| Rate for Payer: Healthscope Whirlpool |
$357.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$313.14
|
| Rate for Payer: Nomi Health Commercial |
$357.88
|
| Rate for Payer: PACE SWMI |
$298.23
|
| Rate for Payer: PHP Medicare Advantage |
$298.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$159.90
|
| Rate for Payer: Priority Health Medicare |
$298.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$298.23
|
| Rate for Payer: UHC Medicare Advantage |
$298.23
|
| Rate for Payer: UHCCP DNSP |
$298.23
|
|
|
CHG CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 71275
|
| Min. Negotiated Rate |
$75.20 |
| Max. Negotiated Rate |
$373.64 |
| Rate for Payer: Aetna Commercial |
$347.69
|
| Rate for Payer: Aetna Medicare |
$259.47
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS MAPPO |
$259.47
|
| Rate for Payer: BCN Medicare Advantage |
$259.47
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cofinity Commercial |
$373.64
|
| Rate for Payer: Cofinity Commercial |
$347.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$259.47
|
| Rate for Payer: Healthscope Commercial |
$311.36
|
| Rate for Payer: Healthscope Whirlpool |
$311.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$272.44
|
| Rate for Payer: Nomi Health Commercial |
$311.36
|
| Rate for Payer: PACE SWMI |
$259.47
|
| Rate for Payer: PHP Medicare Advantage |
$259.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health Medicare |
$259.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$259.47
|
| Rate for Payer: UHC Medicare Advantage |
$259.47
|
| Rate for Payer: UHCCP DNSP |
$259.47
|
|
|
CHG CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 70496
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$365.89 |
| Rate for Payer: Aetna Commercial |
$340.48
|
| Rate for Payer: Aetna Medicare |
$254.09
|
| Rate for Payer: BCBS Complete |
$72.40
|
| Rate for Payer: BCBS MAPPO |
$254.09
|
| Rate for Payer: BCN Medicare Advantage |
$254.09
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$365.89
|
| Rate for Payer: Cofinity Commercial |
$340.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$254.09
|
| Rate for Payer: Healthscope Commercial |
$304.91
|
| Rate for Payer: Healthscope Whirlpool |
$304.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$266.79
|
| Rate for Payer: Nomi Health Commercial |
$304.91
|
| Rate for Payer: PACE SWMI |
$254.09
|
| Rate for Payer: PHP Medicare Advantage |
$254.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health Medicare |
$254.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$254.09
|
| Rate for Payer: UHC Medicare Advantage |
$254.09
|
| Rate for Payer: UHCCP DNSP |
$254.09
|
|
|
CHG CT ANGIOGRAPHY LOWER EXTREMITY
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS 73706
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$426.70 |
| Rate for Payer: Aetna Commercial |
$397.07
|
| Rate for Payer: Aetna Medicare |
$296.32
|
| Rate for Payer: BCBS Complete |
$77.60
|
| Rate for Payer: BCBS MAPPO |
$296.32
|
| Rate for Payer: BCN Medicare Advantage |
$296.32
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cash Price |
$155.20
|
| Rate for Payer: Cofinity Commercial |
$426.70
|
| Rate for Payer: Cofinity Commercial |
$397.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$296.32
|
| Rate for Payer: Healthscope Commercial |
$355.58
|
| Rate for Payer: Healthscope Whirlpool |
$355.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$311.14
|
| Rate for Payer: Nomi Health Commercial |
$355.58
|
| Rate for Payer: PACE SWMI |
$296.32
|
| Rate for Payer: PHP Medicare Advantage |
$296.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.10
|
| Rate for Payer: Priority Health Medicare |
$296.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$296.32
|
| Rate for Payer: UHC Medicare Advantage |
$296.32
|
| Rate for Payer: UHCCP DNSP |
$296.32
|
|
|
CHG CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 70498
|
| Min. Negotiated Rate |
$72.40 |
| Max. Negotiated Rate |
$365.46 |
| Rate for Payer: Aetna Commercial |
$340.08
|
| Rate for Payer: Aetna Medicare |
$253.79
|
| Rate for Payer: BCBS Complete |
$72.40
|
| Rate for Payer: BCBS MAPPO |
$253.79
|
| Rate for Payer: BCN Medicare Advantage |
$253.79
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$365.46
|
| Rate for Payer: Cofinity Commercial |
$340.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$253.79
|
| Rate for Payer: Healthscope Commercial |
$304.55
|
| Rate for Payer: Healthscope Whirlpool |
$304.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$266.48
|
| Rate for Payer: Nomi Health Commercial |
$304.55
|
| Rate for Payer: PACE SWMI |
$253.79
|
| Rate for Payer: PHP Medicare Advantage |
$253.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health Medicare |
$253.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$253.79
|
| Rate for Payer: UHC Medicare Advantage |
$253.79
|
| Rate for Payer: UHCCP DNSP |
$253.79
|
|
|
CHG CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 72191
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$402.45 |
| Rate for Payer: Aetna Commercial |
$374.50
|
| Rate for Payer: Aetna Medicare |
$279.48
|
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: BCBS MAPPO |
$279.48
|
| Rate for Payer: BCN Medicare Advantage |
$279.48
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cofinity Commercial |
$402.45
|
| Rate for Payer: Cofinity Commercial |
$374.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$279.48
|
| Rate for Payer: Healthscope Commercial |
$335.38
|
| Rate for Payer: Healthscope Whirlpool |
$335.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$293.45
|
| Rate for Payer: Nomi Health Commercial |
$335.38
|
| Rate for Payer: PACE SWMI |
$279.48
|
| Rate for Payer: PHP Medicare Advantage |
$279.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.25
|
| Rate for Payer: Priority Health Medicare |
$279.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$279.48
|
| Rate for Payer: UHC Medicare Advantage |
$279.48
|
| Rate for Payer: UHCCP DNSP |
$279.48
|
|
|
CHG CT ANGIOGRAPHY UPPER EXTREMITY
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
HCPCS 73206
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$393.24 |
| Rate for Payer: Aetna Commercial |
$365.93
|
| Rate for Payer: Aetna Medicare |
$273.08
|
| Rate for Payer: BCBS Complete |
$74.00
|
| Rate for Payer: BCBS MAPPO |
$273.08
|
| Rate for Payer: BCN Medicare Advantage |
$273.08
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cash Price |
$148.00
|
| Rate for Payer: Cofinity Commercial |
$393.24
|
| Rate for Payer: Cofinity Commercial |
$365.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$273.08
|
| Rate for Payer: Healthscope Commercial |
$327.70
|
| Rate for Payer: Healthscope Whirlpool |
$327.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$286.73
|
| Rate for Payer: Nomi Health Commercial |
$327.70
|
| Rate for Payer: PACE SWMI |
$273.08
|
| Rate for Payer: PHP Medicare Advantage |
$273.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.25
|
| Rate for Payer: Priority Health Medicare |
$273.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$273.08
|
| Rate for Payer: UHC Medicare Advantage |
$273.08
|
| Rate for Payer: UHCCP DNSP |
$273.08
|
|
|
CHG CT CERVICAL SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 72126
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$223.59 |
| Rate for Payer: Aetna Commercial |
$208.06
|
| Rate for Payer: Aetna Medicare |
$155.27
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$155.27
|
| Rate for Payer: BCN Medicare Advantage |
$155.27
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$223.59
|
| Rate for Payer: Cofinity Commercial |
$208.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.27
|
| Rate for Payer: Healthscope Commercial |
$186.32
|
| Rate for Payer: Healthscope Whirlpool |
$186.32
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.03
|
| Rate for Payer: Nomi Health Commercial |
$186.32
|
| Rate for Payer: PACE SWMI |
$155.27
|
| Rate for Payer: PHP Medicare Advantage |
$155.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$155.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.27
|
| Rate for Payer: UHC Medicare Advantage |
$155.27
|
| Rate for Payer: UHCCP DNSP |
$155.27
|
|
|
CHG CT CERVICAL SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 72125
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$172.79 |
| Rate for Payer: Aetna Commercial |
$160.79
|
| Rate for Payer: Aetna Medicare |
$119.99
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$119.99
|
| Rate for Payer: BCN Medicare Advantage |
$119.99
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$172.79
|
| Rate for Payer: Cofinity Commercial |
$160.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.99
|
| Rate for Payer: Healthscope Commercial |
$143.99
|
| Rate for Payer: Healthscope Whirlpool |
$143.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.99
|
| Rate for Payer: Nomi Health Commercial |
$143.99
|
| Rate for Payer: PACE SWMI |
$119.99
|
| Rate for Payer: PHP Medicare Advantage |
$119.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$119.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.99
|
| Rate for Payer: UHC Medicare Advantage |
$119.99
|
| Rate for Payer: UHCCP DNSP |
$119.99
|
|
|
CHG CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 72127
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$259.99 |
| Rate for Payer: Aetna Commercial |
$241.94
|
| Rate for Payer: Aetna Medicare |
$180.55
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$180.55
|
| Rate for Payer: BCN Medicare Advantage |
$180.55
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$259.99
|
| Rate for Payer: Cofinity Commercial |
$241.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.55
|
| Rate for Payer: Healthscope Commercial |
$216.66
|
| Rate for Payer: Healthscope Whirlpool |
$216.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.58
|
| Rate for Payer: Nomi Health Commercial |
$216.66
|
| Rate for Payer: PACE SWMI |
$180.55
|
| Rate for Payer: PHP Medicare Advantage |
$180.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$180.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.55
|
| Rate for Payer: UHC Medicare Advantage |
$180.55
|
| Rate for Payer: UHCCP DNSP |
$180.55
|
|
|
CHG CT COLONOGRAPHY SCREENING IMAGE POSTPROCESSING
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 74263
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$928.81 |
| Rate for Payer: Aetna Commercial |
$864.31
|
| Rate for Payer: Aetna Medicare |
$645.01
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS MAPPO |
$645.01
|
| Rate for Payer: BCN Medicare Advantage |
$645.01
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$928.81
|
| Rate for Payer: Cofinity Commercial |
$864.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$645.01
|
| Rate for Payer: Healthscope Commercial |
$774.01
|
| Rate for Payer: Healthscope Whirlpool |
$774.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$677.26
|
| Rate for Payer: Nomi Health Commercial |
$774.01
|
| Rate for Payer: PACE SWMI |
$645.01
|
| Rate for Payer: PHP Medicare Advantage |
$645.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health Medicare |
$645.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$645.01
|
| Rate for Payer: UHC Medicare Advantage |
$645.01
|
| Rate for Payer: UHCCP DNSP |
$645.01
|
|
|
CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/CONTRAST
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
HCPCS 74262
|
| Min. Negotiated Rate |
$103.20 |
| Max. Negotiated Rate |
$608.50 |
| Rate for Payer: Aetna Commercial |
$566.24
|
| Rate for Payer: Aetna Medicare |
$422.57
|
| Rate for Payer: BCBS Complete |
$103.20
|
| Rate for Payer: BCBS MAPPO |
$422.57
|
| Rate for Payer: BCN Medicare Advantage |
$422.57
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cash Price |
$206.40
|
| Rate for Payer: Cofinity Commercial |
$608.50
|
| Rate for Payer: Cofinity Commercial |
$566.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$422.57
|
| Rate for Payer: Healthscope Commercial |
$507.08
|
| Rate for Payer: Healthscope Whirlpool |
$507.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$443.70
|
| Rate for Payer: Nomi Health Commercial |
$507.08
|
| Rate for Payer: PACE SWMI |
$422.57
|
| Rate for Payer: PHP Medicare Advantage |
$422.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$167.70
|
| Rate for Payer: Priority Health Medicare |
$422.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$422.57
|
| Rate for Payer: UHC Medicare Advantage |
$422.57
|
| Rate for Payer: UHCCP DNSP |
$422.57
|
|
|
CHG CT COLONOGRPHY DX IMAGE POSTPROCESS W/O CONTRAST
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 74261
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$542.32 |
| Rate for Payer: Aetna Commercial |
$504.66
|
| Rate for Payer: Aetna Commercial |
$504.66
|
| Rate for Payer: Aetna Medicare |
$376.61
|
| Rate for Payer: Aetna Medicare |
$376.61
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS Complete |
$367.20
|
| Rate for Payer: BCBS MAPPO |
$376.61
|
| Rate for Payer: BCBS MAPPO |
$376.61
|
| Rate for Payer: BCN Medicare Advantage |
$376.61
|
| Rate for Payer: BCN Medicare Advantage |
$376.61
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cofinity Commercial |
$504.66
|
| Rate for Payer: Cofinity Commercial |
$542.32
|
| Rate for Payer: Cofinity Commercial |
$504.66
|
| Rate for Payer: Cofinity Commercial |
$542.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$376.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$376.61
|
| Rate for Payer: Healthscope Commercial |
$451.93
|
| Rate for Payer: Healthscope Commercial |
$451.93
|
| Rate for Payer: Healthscope Whirlpool |
$451.93
|
| Rate for Payer: Healthscope Whirlpool |
$451.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$395.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$395.44
|
| Rate for Payer: Nomi Health Commercial |
$451.93
|
| Rate for Payer: Nomi Health Commercial |
$451.93
|
| Rate for Payer: PACE SWMI |
$376.61
|
| Rate for Payer: PACE SWMI |
$376.61
|
| Rate for Payer: PHP Medicare Advantage |
$376.61
|
| Rate for Payer: PHP Medicare Advantage |
$376.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health Medicare |
$376.61
|
| Rate for Payer: Priority Health Medicare |
$376.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$376.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$376.61
|
| Rate for Payer: UHC Medicare Advantage |
$376.61
|
| Rate for Payer: UHC Medicare Advantage |
$376.61
|
| Rate for Payer: UHCCP DNSP |
$376.61
|
| Rate for Payer: UHCCP DNSP |
$376.61
|
|
|
CHG CT GUIDANCE &MONITORING VISC TISS ABLATION
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
HCPCS 77013
|
| Min. Negotiated Rate |
$158.80 |
| Max. Negotiated Rate |
$258.05 |
| Rate for Payer: Aetna Medicare |
$198.50
|
| Rate for Payer: BCBS Complete |
$158.80
|
| Rate for Payer: Cash Price |
$317.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$258.05
|
|
|
CHG CT GUIDANCE NEEDLE PLACEMENT
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
HCPCS 77012
|
| Min. Negotiated Rate |
$87.20 |
| Max. Negotiated Rate |
$167.72 |
| Rate for Payer: Aetna Commercial |
$156.07
|
| Rate for Payer: Aetna Medicare |
$116.47
|
| Rate for Payer: BCBS Complete |
$87.20
|
| Rate for Payer: BCBS MAPPO |
$116.47
|
| Rate for Payer: BCN Medicare Advantage |
$116.47
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cash Price |
$174.40
|
| Rate for Payer: Cofinity Commercial |
$156.07
|
| Rate for Payer: Cofinity Commercial |
$167.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.47
|
| Rate for Payer: Healthscope Commercial |
$139.76
|
| Rate for Payer: Healthscope Whirlpool |
$139.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$122.29
|
| Rate for Payer: Nomi Health Commercial |
$139.76
|
| Rate for Payer: PACE SWMI |
$116.47
|
| Rate for Payer: PHP Medicare Advantage |
$116.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$141.70
|
| Rate for Payer: Priority Health Medicare |
$116.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.47
|
| Rate for Payer: UHC Medicare Advantage |
$116.47
|
| Rate for Payer: UHCCP DNSP |
$116.47
|
|
|
CHG CT GUIDANCE RADIATION THERAPY FLDS PLACEMENT
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS 77014
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$157.95 |
| Rate for Payer: Aetna Commercial |
$145.20
|
| Rate for Payer: Aetna Commercial |
$145.20
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: BCBS Complete |
$128.80
|
| Rate for Payer: BCBS Complete |
$97.20
|
| Rate for Payer: BCBS MAPPO |
$108.36
|
| Rate for Payer: BCBS MAPPO |
$108.36
|
| Rate for Payer: BCN Medicare Advantage |
$108.36
|
| Rate for Payer: BCN Medicare Advantage |
$108.36
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$194.40
|
| Rate for Payer: Cash Price |
$257.60
|
| Rate for Payer: Cofinity Commercial |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$145.20
|
| Rate for Payer: Cofinity Commercial |
$156.04
|
| Rate for Payer: Cofinity Commercial |
$145.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$108.36
|
| Rate for Payer: Healthscope Commercial |
$130.03
|
| Rate for Payer: Healthscope Commercial |
$130.03
|
| Rate for Payer: Healthscope Whirlpool |
$130.03
|
| Rate for Payer: Healthscope Whirlpool |
$130.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.78
|
| Rate for Payer: Nomi Health Commercial |
$130.03
|
| Rate for Payer: Nomi Health Commercial |
$130.03
|
| Rate for Payer: PACE SWMI |
$108.36
|
| Rate for Payer: PACE SWMI |
$108.36
|
| Rate for Payer: PHP Medicare Advantage |
$108.36
|
| Rate for Payer: PHP Medicare Advantage |
$108.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$209.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.95
|
| Rate for Payer: Priority Health Medicare |
$108.36
|
| Rate for Payer: Priority Health Medicare |
$108.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$108.36
|
| Rate for Payer: UHC Medicare Advantage |
$108.36
|
| Rate for Payer: UHC Medicare Advantage |
$108.36
|
| Rate for Payer: UHCCP DNSP |
$108.36
|
| Rate for Payer: UHCCP DNSP |
$108.36
|
|
|
CHG CT GUIDANCE STEREOTACTIC LOCALIZATION
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
HCPCS 77011
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$283.51 |
| Rate for Payer: Aetna Commercial |
$263.82
|
| Rate for Payer: Aetna Commercial |
$263.82
|
| Rate for Payer: Aetna Medicare |
$196.88
|
| Rate for Payer: Aetna Medicare |
$196.88
|
| Rate for Payer: BCBS Complete |
$186.40
|
| Rate for Payer: BCBS Complete |
$53.60
|
| Rate for Payer: BCBS MAPPO |
$196.88
|
| Rate for Payer: BCBS MAPPO |
$196.88
|
| Rate for Payer: BCN Medicare Advantage |
$196.88
|
| Rate for Payer: BCN Medicare Advantage |
$196.88
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$107.20
|
| Rate for Payer: Cash Price |
$372.80
|
| Rate for Payer: Cofinity Commercial |
$263.82
|
| Rate for Payer: Cofinity Commercial |
$283.51
|
| Rate for Payer: Cofinity Commercial |
$263.82
|
| Rate for Payer: Cofinity Commercial |
$283.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.88
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$196.88
|
| Rate for Payer: Healthscope Commercial |
$236.26
|
| Rate for Payer: Healthscope Commercial |
$236.26
|
| Rate for Payer: Healthscope Whirlpool |
$236.26
|
| Rate for Payer: Healthscope Whirlpool |
$236.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$206.72
|
| Rate for Payer: Nomi Health Commercial |
$236.26
|
| Rate for Payer: Nomi Health Commercial |
$236.26
|
| Rate for Payer: PACE SWMI |
$196.88
|
| Rate for Payer: PACE SWMI |
$196.88
|
| Rate for Payer: PHP Medicare Advantage |
$196.88
|
| Rate for Payer: PHP Medicare Advantage |
$196.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$302.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.10
|
| Rate for Payer: Priority Health Medicare |
$196.88
|
| Rate for Payer: Priority Health Medicare |
$196.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.88
|
| Rate for Payer: UHC Dual Complete DSNP |
$196.88
|
| Rate for Payer: UHC Medicare Advantage |
$196.88
|
| Rate for Payer: UHC Medicare Advantage |
$196.88
|
| Rate for Payer: UHCCP DNSP |
$196.88
|
| Rate for Payer: UHCCP DNSP |
$196.88
|
|
|
CHG CT HEAD/BRAIN W/CONTRAST MATERIAL
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 70460
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$197.34 |
| Rate for Payer: Aetna Commercial |
$183.63
|
| Rate for Payer: Aetna Medicare |
$137.04
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS MAPPO |
$137.04
|
| Rate for Payer: BCN Medicare Advantage |
$137.04
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$197.34
|
| Rate for Payer: Cofinity Commercial |
$183.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.04
|
| Rate for Payer: Healthscope Commercial |
$164.45
|
| Rate for Payer: Healthscope Whirlpool |
$164.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.89
|
| Rate for Payer: Nomi Health Commercial |
$164.45
|
| Rate for Payer: PACE SWMI |
$137.04
|
| Rate for Payer: PHP Medicare Advantage |
$137.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Medicare |
$137.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.04
|
| Rate for Payer: UHC Medicare Advantage |
$137.04
|
| Rate for Payer: UHCCP DNSP |
$137.04
|
|
|
CHG CT HEAD/BRAIN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 70450
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$142.04 |
| Rate for Payer: Aetna Commercial |
$132.18
|
| Rate for Payer: Aetna Medicare |
$98.64
|
| Rate for Payer: BCBS Complete |
$35.20
|
| Rate for Payer: BCBS MAPPO |
$98.64
|
| Rate for Payer: BCN Medicare Advantage |
$98.64
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$142.04
|
| Rate for Payer: Cofinity Commercial |
$132.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.64
|
| Rate for Payer: Healthscope Commercial |
$118.37
|
| Rate for Payer: Healthscope Whirlpool |
$118.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.57
|
| Rate for Payer: Nomi Health Commercial |
$118.37
|
| Rate for Payer: PACE SWMI |
$98.64
|
| Rate for Payer: PHP Medicare Advantage |
$98.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.20
|
| Rate for Payer: Priority Health Medicare |
$98.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.64
|
| Rate for Payer: UHC Medicare Advantage |
$98.64
|
| Rate for Payer: UHCCP DNSP |
$98.64
|
|
|
CHG CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 70470
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$230.28 |
| Rate for Payer: Aetna Commercial |
$214.29
|
| Rate for Payer: Aetna Medicare |
$159.92
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$159.92
|
| Rate for Payer: BCN Medicare Advantage |
$159.92
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$230.28
|
| Rate for Payer: Cofinity Commercial |
$214.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$159.92
|
| Rate for Payer: Healthscope Commercial |
$191.90
|
| Rate for Payer: Healthscope Whirlpool |
$191.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$167.92
|
| Rate for Payer: Nomi Health Commercial |
$191.90
|
| Rate for Payer: PACE SWMI |
$159.92
|
| Rate for Payer: PHP Medicare Advantage |
$159.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health Medicare |
$159.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$159.92
|
| Rate for Payer: UHC Medicare Advantage |
$159.92
|
| Rate for Payer: UHCCP DNSP |
$159.92
|
|
|
CHG CT HEART CONTRAST EVAL CARDIAC STRUCTURE&MORPH
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 75572
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$302.96 |
| Rate for Payer: Aetna Commercial |
$281.92
|
| Rate for Payer: Aetna Medicare |
$210.39
|
| Rate for Payer: BCBS Complete |
$71.60
|
| Rate for Payer: BCBS MAPPO |
$210.39
|
| Rate for Payer: BCN Medicare Advantage |
$210.39
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cofinity Commercial |
$302.96
|
| Rate for Payer: Cofinity Commercial |
$281.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$210.39
|
| Rate for Payer: Healthscope Commercial |
$252.47
|
| Rate for Payer: Healthscope Whirlpool |
$252.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$220.91
|
| Rate for Payer: Nomi Health Commercial |
$252.47
|
| Rate for Payer: PACE SWMI |
$210.39
|
| Rate for Payer: PHP Medicare Advantage |
$210.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.35
|
| Rate for Payer: Priority Health Medicare |
$210.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$210.39
|
| Rate for Payer: UHC Medicare Advantage |
$210.39
|
| Rate for Payer: UHCCP DNSP |
$210.39
|
|
|
CHG CT HEART NO CONTRAST QUANT EVAL CORONRY CALCIUM
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 75571
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$132.85 |
| Rate for Payer: Aetna Commercial |
$123.63
|
| Rate for Payer: Aetna Medicare |
$92.26
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS MAPPO |
$92.26
|
| Rate for Payer: BCN Medicare Advantage |
$92.26
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$132.85
|
| Rate for Payer: Cofinity Commercial |
$123.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$92.26
|
| Rate for Payer: Healthscope Commercial |
$110.71
|
| Rate for Payer: Healthscope Whirlpool |
$110.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$96.87
|
| Rate for Payer: Nomi Health Commercial |
$110.71
|
| Rate for Payer: PACE SWMI |
$92.26
|
| Rate for Payer: PHP Medicare Advantage |
$92.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health Medicare |
$92.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$92.26
|
| Rate for Payer: UHC Medicare Advantage |
$92.26
|
| Rate for Payer: UHCCP DNSP |
$92.26
|
|
