|
CHG CT LIMITED/LOCALIZED FOLLOW UP STUDY
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 76380
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$173.68 |
| Rate for Payer: Aetna Commercial |
$161.62
|
| Rate for Payer: Aetna Medicare |
$120.61
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$120.61
|
| Rate for Payer: BCN Medicare Advantage |
$120.61
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$173.68
|
| Rate for Payer: Cofinity Commercial |
$161.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$120.61
|
| Rate for Payer: Healthscope Commercial |
$144.73
|
| Rate for Payer: Healthscope Whirlpool |
$144.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$126.64
|
| Rate for Payer: Nomi Health Commercial |
$144.73
|
| Rate for Payer: PACE SWMI |
$120.61
|
| Rate for Payer: PHP Medicare Advantage |
$120.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health Medicare |
$120.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$120.61
|
| Rate for Payer: UHC Medicare Advantage |
$120.61
|
| Rate for Payer: UHCCP DNSP |
$120.61
|
|
|
CHG CT LOWER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 73701
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$205.46
|
| Rate for Payer: Aetna Medicare |
$153.33
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: BCBS MAPPO |
$153.33
|
| Rate for Payer: BCN Medicare Advantage |
$153.33
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cofinity Commercial |
$220.80
|
| Rate for Payer: Cofinity Commercial |
$205.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.33
|
| Rate for Payer: Healthscope Commercial |
$184.00
|
| Rate for Payer: Healthscope Whirlpool |
$184.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$161.00
|
| Rate for Payer: Nomi Health Commercial |
$184.00
|
| Rate for Payer: PACE SWMI |
$153.33
|
| Rate for Payer: PHP Medicare Advantage |
$153.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
| Rate for Payer: Priority Health Medicare |
$153.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.33
|
| Rate for Payer: UHC Medicare Advantage |
$153.33
|
| Rate for Payer: UHCCP DNSP |
$153.33
|
|
|
CHG CT LOWER EXTREMITY W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 73700
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$172.37 |
| Rate for Payer: Aetna Commercial |
$160.40
|
| Rate for Payer: Aetna Medicare |
$119.70
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$119.70
|
| Rate for Payer: BCN Medicare Advantage |
$119.70
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$172.37
|
| Rate for Payer: Cofinity Commercial |
$160.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.70
|
| Rate for Payer: Healthscope Commercial |
$143.64
|
| Rate for Payer: Healthscope Whirlpool |
$143.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.69
|
| Rate for Payer: Nomi Health Commercial |
$143.64
|
| Rate for Payer: PACE SWMI |
$119.70
|
| Rate for Payer: PHP Medicare Advantage |
$119.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$119.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.70
|
| Rate for Payer: UHC Medicare Advantage |
$119.70
|
| Rate for Payer: UHCCP DNSP |
$119.70
|
|
|
CHG CT LOWER EXTREMITY W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 73702
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$257.96 |
| Rate for Payer: Aetna Commercial |
$240.05
|
| Rate for Payer: Aetna Medicare |
$179.14
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$179.14
|
| Rate for Payer: BCN Medicare Advantage |
$179.14
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$257.96
|
| Rate for Payer: Cofinity Commercial |
$240.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$179.14
|
| Rate for Payer: Healthscope Commercial |
$214.97
|
| Rate for Payer: Healthscope Whirlpool |
$214.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$188.10
|
| Rate for Payer: Nomi Health Commercial |
$214.97
|
| Rate for Payer: PACE SWMI |
$179.14
|
| Rate for Payer: PHP Medicare Advantage |
$179.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$179.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$179.14
|
| Rate for Payer: UHC Medicare Advantage |
$179.14
|
| Rate for Payer: UHCCP DNSP |
$179.14
|
|
|
CHG CT LUMBAR SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 72132
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$224.44 |
| Rate for Payer: Aetna Commercial |
$208.85
|
| Rate for Payer: Aetna Medicare |
$155.86
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$155.86
|
| Rate for Payer: BCN Medicare Advantage |
$155.86
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$224.44
|
| Rate for Payer: Cofinity Commercial |
$208.85
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$155.86
|
| Rate for Payer: Healthscope Commercial |
$187.03
|
| Rate for Payer: Healthscope Whirlpool |
$187.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$163.65
|
| Rate for Payer: Nomi Health Commercial |
$187.03
|
| Rate for Payer: PACE SWMI |
$155.86
|
| Rate for Payer: PHP Medicare Advantage |
$155.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$155.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$155.86
|
| Rate for Payer: UHC Medicare Advantage |
$155.86
|
| Rate for Payer: UHCCP DNSP |
$155.86
|
|
|
CHG CT LUMBAR SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 72131
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Aetna Commercial |
$160.01
|
| Rate for Payer: Aetna Medicare |
$119.41
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$119.41
|
| Rate for Payer: BCN Medicare Advantage |
$119.41
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$171.95
|
| Rate for Payer: Cofinity Commercial |
$160.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.41
|
| Rate for Payer: Healthscope Commercial |
$143.29
|
| Rate for Payer: Healthscope Whirlpool |
$143.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.38
|
| Rate for Payer: Nomi Health Commercial |
$143.29
|
| Rate for Payer: PACE SWMI |
$119.41
|
| Rate for Payer: PHP Medicare Advantage |
$119.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$119.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.41
|
| Rate for Payer: UHC Medicare Advantage |
$119.41
|
| Rate for Payer: UHCCP DNSP |
$119.41
|
|
|
CHG CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 72133
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$260.42 |
| Rate for Payer: Aetna Commercial |
$242.34
|
| Rate for Payer: Aetna Medicare |
$180.85
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$180.85
|
| Rate for Payer: BCN Medicare Advantage |
$180.85
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$260.42
|
| Rate for Payer: Cofinity Commercial |
$242.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.85
|
| Rate for Payer: Healthscope Commercial |
$217.02
|
| Rate for Payer: Healthscope Whirlpool |
$217.02
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.89
|
| Rate for Payer: Nomi Health Commercial |
$217.02
|
| Rate for Payer: PACE SWMI |
$180.85
|
| Rate for Payer: PHP Medicare Advantage |
$180.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$180.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.85
|
| Rate for Payer: UHC Medicare Advantage |
$180.85
|
| Rate for Payer: UHCCP DNSP |
$180.85
|
|
|
CHG CT MAXILLOFACIAL W/CONTRAST MATERIAL
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
HCPCS 70487
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$202.00 |
| Rate for Payer: Aetna Commercial |
$187.98
|
| Rate for Payer: Aetna Medicare |
$140.28
|
| Rate for Payer: BCBS Complete |
$46.40
|
| Rate for Payer: BCBS MAPPO |
$140.28
|
| Rate for Payer: BCN Medicare Advantage |
$140.28
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cash Price |
$92.80
|
| Rate for Payer: Cofinity Commercial |
$202.00
|
| Rate for Payer: Cofinity Commercial |
$187.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.28
|
| Rate for Payer: Healthscope Commercial |
$168.34
|
| Rate for Payer: Healthscope Whirlpool |
$168.34
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.29
|
| Rate for Payer: Nomi Health Commercial |
$168.34
|
| Rate for Payer: PACE SWMI |
$140.28
|
| Rate for Payer: PHP Medicare Advantage |
$140.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$75.40
|
| Rate for Payer: Priority Health Medicare |
$140.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.28
|
| Rate for Payer: UHC Medicare Advantage |
$140.28
|
| Rate for Payer: UHCCP DNSP |
$140.28
|
|
|
CHG CT MAXILLOFACIAL W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
HCPCS 70486
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$169.62 |
| Rate for Payer: Aetna Commercial |
$157.84
|
| Rate for Payer: Aetna Medicare |
$117.79
|
| Rate for Payer: BCBS Complete |
$35.20
|
| Rate for Payer: BCBS MAPPO |
$117.79
|
| Rate for Payer: BCN Medicare Advantage |
$117.79
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cofinity Commercial |
$169.62
|
| Rate for Payer: Cofinity Commercial |
$157.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$117.79
|
| Rate for Payer: Healthscope Commercial |
$141.35
|
| Rate for Payer: Healthscope Whirlpool |
$141.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$123.68
|
| Rate for Payer: Nomi Health Commercial |
$141.35
|
| Rate for Payer: PACE SWMI |
$117.79
|
| Rate for Payer: PHP Medicare Advantage |
$117.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.20
|
| Rate for Payer: Priority Health Medicare |
$117.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$117.79
|
| Rate for Payer: UHC Medicare Advantage |
$117.79
|
| Rate for Payer: UHCCP DNSP |
$117.79
|
|
|
CHG CT MAXILLOFACIAL W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 70488
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$243.86 |
| Rate for Payer: Aetna Commercial |
$226.93
|
| Rate for Payer: Aetna Medicare |
$169.35
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$169.35
|
| Rate for Payer: BCN Medicare Advantage |
$169.35
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$243.86
|
| Rate for Payer: Cofinity Commercial |
$226.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.35
|
| Rate for Payer: Healthscope Commercial |
$203.22
|
| Rate for Payer: Healthscope Whirlpool |
$203.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$177.82
|
| Rate for Payer: Nomi Health Commercial |
$203.22
|
| Rate for Payer: PACE SWMI |
$169.35
|
| Rate for Payer: PHP Medicare Advantage |
$169.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$169.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.35
|
| Rate for Payer: UHC Medicare Advantage |
$169.35
|
| Rate for Payer: UHCCP DNSP |
$169.35
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL
|
Professional
|
Both
|
$117.00
|
|
|
Service Code
|
HCPCS 70481
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$238.49 |
| Rate for Payer: Aetna Commercial |
$221.93
|
| Rate for Payer: Aetna Medicare |
$165.62
|
| Rate for Payer: BCBS Complete |
$46.80
|
| Rate for Payer: BCBS MAPPO |
$165.62
|
| Rate for Payer: BCN Medicare Advantage |
$165.62
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cofinity Commercial |
$238.49
|
| Rate for Payer: Cofinity Commercial |
$221.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$165.62
|
| Rate for Payer: Healthscope Commercial |
$198.74
|
| Rate for Payer: Healthscope Whirlpool |
$198.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.90
|
| Rate for Payer: Nomi Health Commercial |
$198.74
|
| Rate for Payer: PACE SWMI |
$165.62
|
| Rate for Payer: PHP Medicare Advantage |
$165.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$76.05
|
| Rate for Payer: Priority Health Medicare |
$165.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$165.62
|
| Rate for Payer: UHC Medicare Advantage |
$165.62
|
| Rate for Payer: UHCCP DNSP |
$165.62
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 70480
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$211.67 |
| Rate for Payer: Aetna Commercial |
$196.97
|
| Rate for Payer: Aetna Medicare |
$146.99
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS MAPPO |
$146.99
|
| Rate for Payer: BCN Medicare Advantage |
$146.99
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$211.67
|
| Rate for Payer: Cofinity Commercial |
$196.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$146.99
|
| Rate for Payer: Healthscope Commercial |
$176.39
|
| Rate for Payer: Healthscope Whirlpool |
$176.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.34
|
| Rate for Payer: Nomi Health Commercial |
$176.39
|
| Rate for Payer: PACE SWMI |
$146.99
|
| Rate for Payer: PHP Medicare Advantage |
$146.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health Medicare |
$146.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$146.99
|
| Rate for Payer: UHC Medicare Advantage |
$146.99
|
| Rate for Payer: UHCCP DNSP |
$146.99
|
|
|
CHG CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 70482
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$277.39 |
| Rate for Payer: Aetna Commercial |
$258.12
|
| Rate for Payer: Aetna Medicare |
$192.63
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$192.63
|
| Rate for Payer: BCN Medicare Advantage |
$192.63
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$277.39
|
| Rate for Payer: Cofinity Commercial |
$258.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$192.63
|
| Rate for Payer: Healthscope Commercial |
$231.16
|
| Rate for Payer: Healthscope Whirlpool |
$231.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$202.26
|
| Rate for Payer: Nomi Health Commercial |
$231.16
|
| Rate for Payer: PACE SWMI |
$192.63
|
| Rate for Payer: PHP Medicare Advantage |
$192.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$192.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$192.63
|
| Rate for Payer: UHC Medicare Advantage |
$192.63
|
| Rate for Payer: UHCCP DNSP |
$192.63
|
|
|
CHG CT PELVIS W/CONTRAST MATERIAL
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 72193
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$298.45 |
| Rate for Payer: Aetna Commercial |
$277.73
|
| Rate for Payer: Aetna Medicare |
$207.26
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: BCBS MAPPO |
$207.26
|
| Rate for Payer: BCN Medicare Advantage |
$207.26
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cofinity Commercial |
$298.45
|
| Rate for Payer: Cofinity Commercial |
$277.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.26
|
| Rate for Payer: Healthscope Commercial |
$248.71
|
| Rate for Payer: Healthscope Whirlpool |
$248.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$217.62
|
| Rate for Payer: Nomi Health Commercial |
$248.71
|
| Rate for Payer: PACE SWMI |
$207.26
|
| Rate for Payer: PHP Medicare Advantage |
$207.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
| Rate for Payer: Priority Health Medicare |
$207.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$207.26
|
| Rate for Payer: UHC Medicare Advantage |
$207.26
|
| Rate for Payer: UHCCP DNSP |
$207.26
|
|
|
CHG CT PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
HCPCS 72192
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$177.11 |
| Rate for Payer: Aetna Commercial |
$164.81
|
| Rate for Payer: Aetna Medicare |
$122.99
|
| Rate for Payer: BCBS Complete |
$44.80
|
| Rate for Payer: BCBS MAPPO |
$122.99
|
| Rate for Payer: BCN Medicare Advantage |
$122.99
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cash Price |
$89.60
|
| Rate for Payer: Cofinity Commercial |
$177.11
|
| Rate for Payer: Cofinity Commercial |
$164.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$122.99
|
| Rate for Payer: Healthscope Commercial |
$147.59
|
| Rate for Payer: Healthscope Whirlpool |
$147.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.14
|
| Rate for Payer: Nomi Health Commercial |
$147.59
|
| Rate for Payer: PACE SWMI |
$122.99
|
| Rate for Payer: PHP Medicare Advantage |
$122.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.80
|
| Rate for Payer: Priority Health Medicare |
$122.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$122.99
|
| Rate for Payer: UHC Medicare Advantage |
$122.99
|
| Rate for Payer: UHCCP DNSP |
$122.99
|
|
|
CHG CT PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 72194
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$329.26 |
| Rate for Payer: Aetna Commercial |
$306.39
|
| Rate for Payer: Aetna Medicare |
$228.65
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$228.65
|
| Rate for Payer: BCN Medicare Advantage |
$228.65
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$329.26
|
| Rate for Payer: Cofinity Commercial |
$306.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$228.65
|
| Rate for Payer: Healthscope Commercial |
$274.38
|
| Rate for Payer: Healthscope Whirlpool |
$274.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$240.08
|
| Rate for Payer: Nomi Health Commercial |
$274.38
|
| Rate for Payer: PACE SWMI |
$228.65
|
| Rate for Payer: PHP Medicare Advantage |
$228.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$228.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$228.65
|
| Rate for Payer: UHC Medicare Advantage |
$228.65
|
| Rate for Payer: UHCCP DNSP |
$228.65
|
|
|
CHG CT SOFT TISSUE NECK W/CONTRAST MATERIAL
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 70491
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$244.32 |
| Rate for Payer: Aetna Commercial |
$227.36
|
| Rate for Payer: Aetna Medicare |
$169.67
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: BCBS MAPPO |
$169.67
|
| Rate for Payer: BCN Medicare Advantage |
$169.67
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cofinity Commercial |
$244.32
|
| Rate for Payer: Cofinity Commercial |
$227.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$169.67
|
| Rate for Payer: Healthscope Commercial |
$203.60
|
| Rate for Payer: Healthscope Whirlpool |
$203.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$178.15
|
| Rate for Payer: Nomi Health Commercial |
$203.60
|
| Rate for Payer: PACE SWMI |
$169.67
|
| Rate for Payer: PHP Medicare Advantage |
$169.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: Priority Health Medicare |
$169.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$169.67
|
| Rate for Payer: UHC Medicare Advantage |
$169.67
|
| Rate for Payer: UHCCP DNSP |
$169.67
|
|
|
CHG CT SOFT TISSUE NECK W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
HCPCS 70490
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$200.09 |
| Rate for Payer: Aetna Commercial |
$186.19
|
| Rate for Payer: Aetna Medicare |
$138.95
|
| Rate for Payer: BCBS Complete |
$53.20
|
| Rate for Payer: BCBS MAPPO |
$138.95
|
| Rate for Payer: BCN Medicare Advantage |
$138.95
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cash Price |
$106.40
|
| Rate for Payer: Cofinity Commercial |
$200.09
|
| Rate for Payer: Cofinity Commercial |
$186.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$138.95
|
| Rate for Payer: Healthscope Commercial |
$166.74
|
| Rate for Payer: Healthscope Whirlpool |
$166.74
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$145.90
|
| Rate for Payer: Nomi Health Commercial |
$166.74
|
| Rate for Payer: PACE SWMI |
$138.95
|
| Rate for Payer: PHP Medicare Advantage |
$138.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$86.45
|
| Rate for Payer: Priority Health Medicare |
$138.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$138.95
|
| Rate for Payer: UHC Medicare Advantage |
$138.95
|
| Rate for Payer: UHCCP DNSP |
$138.95
|
|
|
CHG CT SOFT TISSUE NECK W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 70492
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$292.97 |
| Rate for Payer: Aetna Commercial |
$272.62
|
| Rate for Payer: Aetna Medicare |
$203.45
|
| Rate for Payer: BCBS Complete |
$66.40
|
| Rate for Payer: BCBS MAPPO |
$203.45
|
| Rate for Payer: BCN Medicare Advantage |
$203.45
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$292.97
|
| Rate for Payer: Cofinity Commercial |
$272.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$203.45
|
| Rate for Payer: Healthscope Commercial |
$244.14
|
| Rate for Payer: Healthscope Whirlpool |
$244.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$213.62
|
| Rate for Payer: Nomi Health Commercial |
$244.14
|
| Rate for Payer: PACE SWMI |
$203.45
|
| Rate for Payer: PHP Medicare Advantage |
$203.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.90
|
| Rate for Payer: Priority Health Medicare |
$203.45
|
| Rate for Payer: UHC Dual Complete DSNP |
$203.45
|
| Rate for Payer: UHC Medicare Advantage |
$203.45
|
| Rate for Payer: UHCCP DNSP |
$203.45
|
|
|
CHG CT THORACIC SPINE W/CONTRAST MATERIAL
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
HCPCS 72129
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$225.84 |
| Rate for Payer: Aetna Commercial |
$210.15
|
| Rate for Payer: Aetna Medicare |
$156.83
|
| Rate for Payer: BCBS Complete |
$50.40
|
| Rate for Payer: BCBS MAPPO |
$156.83
|
| Rate for Payer: BCN Medicare Advantage |
$156.83
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cofinity Commercial |
$225.84
|
| Rate for Payer: Cofinity Commercial |
$210.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$156.83
|
| Rate for Payer: Healthscope Commercial |
$188.20
|
| Rate for Payer: Healthscope Whirlpool |
$188.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$164.67
|
| Rate for Payer: Nomi Health Commercial |
$188.20
|
| Rate for Payer: PACE SWMI |
$156.83
|
| Rate for Payer: PHP Medicare Advantage |
$156.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.90
|
| Rate for Payer: Priority Health Medicare |
$156.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$156.83
|
| Rate for Payer: UHC Medicare Advantage |
$156.83
|
| Rate for Payer: UHCCP DNSP |
$156.83
|
|
|
CHG CT THORACIC SPINE W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 72128
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$172.37 |
| Rate for Payer: Aetna Commercial |
$160.40
|
| Rate for Payer: Aetna Medicare |
$119.70
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$119.70
|
| Rate for Payer: BCN Medicare Advantage |
$119.70
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$172.37
|
| Rate for Payer: Cofinity Commercial |
$160.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.70
|
| Rate for Payer: Healthscope Commercial |
$143.64
|
| Rate for Payer: Healthscope Whirlpool |
$143.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$125.69
|
| Rate for Payer: Nomi Health Commercial |
$143.64
|
| Rate for Payer: PACE SWMI |
$119.70
|
| Rate for Payer: PHP Medicare Advantage |
$119.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$119.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$119.70
|
| Rate for Payer: UHC Medicare Advantage |
$119.70
|
| Rate for Payer: UHCCP DNSP |
$119.70
|
|
|
CHG CT THORACIC SPINE W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 72130
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$262.96 |
| Rate for Payer: Aetna Commercial |
$244.70
|
| Rate for Payer: Aetna Medicare |
$182.61
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$182.61
|
| Rate for Payer: BCN Medicare Advantage |
$182.61
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$262.96
|
| Rate for Payer: Cofinity Commercial |
$244.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$182.61
|
| Rate for Payer: Healthscope Commercial |
$219.13
|
| Rate for Payer: Healthscope Whirlpool |
$219.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$191.74
|
| Rate for Payer: Nomi Health Commercial |
$219.13
|
| Rate for Payer: PACE SWMI |
$182.61
|
| Rate for Payer: PHP Medicare Advantage |
$182.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health Medicare |
$182.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$182.61
|
| Rate for Payer: UHC Medicare Advantage |
$182.61
|
| Rate for Payer: UHCCP DNSP |
$182.61
|
|
|
CHG CT UPPER EXTREMITY W/CONTRAST MATERIAL
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
HCPCS 73201
|
| Min. Negotiated Rate |
$47.60 |
| Max. Negotiated Rate |
$263.66 |
| Rate for Payer: Aetna Commercial |
$245.35
|
| Rate for Payer: Aetna Medicare |
$183.10
|
| Rate for Payer: BCBS Complete |
$47.60
|
| Rate for Payer: BCBS MAPPO |
$183.10
|
| Rate for Payer: BCN Medicare Advantage |
$183.10
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cash Price |
$95.20
|
| Rate for Payer: Cofinity Commercial |
$263.66
|
| Rate for Payer: Cofinity Commercial |
$245.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$183.10
|
| Rate for Payer: Healthscope Commercial |
$219.72
|
| Rate for Payer: Healthscope Whirlpool |
$219.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$192.25
|
| Rate for Payer: Nomi Health Commercial |
$219.72
|
| Rate for Payer: PACE SWMI |
$183.10
|
| Rate for Payer: PHP Medicare Advantage |
$183.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$77.35
|
| Rate for Payer: Priority Health Medicare |
$183.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$183.10
|
| Rate for Payer: UHC Medicare Advantage |
$183.10
|
| Rate for Payer: UHCCP DNSP |
$183.10
|
|
|
CHG CT UPPER EXTREMITY W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 73200
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$212.37 |
| Rate for Payer: Aetna Commercial |
$197.62
|
| Rate for Payer: Aetna Medicare |
$147.48
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$147.48
|
| Rate for Payer: BCN Medicare Advantage |
$147.48
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$212.37
|
| Rate for Payer: Cofinity Commercial |
$197.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$147.48
|
| Rate for Payer: Healthscope Commercial |
$176.98
|
| Rate for Payer: Healthscope Whirlpool |
$176.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$154.85
|
| Rate for Payer: Nomi Health Commercial |
$176.98
|
| Rate for Payer: PACE SWMI |
$147.48
|
| Rate for Payer: PHP Medicare Advantage |
$147.48
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$147.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$147.48
|
| Rate for Payer: UHC Medicare Advantage |
$147.48
|
| Rate for Payer: UHCCP DNSP |
$147.48
|
|
|
CHG CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 73202
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$323.86 |
| Rate for Payer: Aetna Commercial |
$301.37
|
| Rate for Payer: Aetna Medicare |
$224.90
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$224.90
|
| Rate for Payer: BCN Medicare Advantage |
$224.90
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cofinity Commercial |
$323.86
|
| Rate for Payer: Cofinity Commercial |
$301.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$224.90
|
| Rate for Payer: Healthscope Commercial |
$269.88
|
| Rate for Payer: Healthscope Whirlpool |
$269.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$236.15
|
| Rate for Payer: Nomi Health Commercial |
$269.88
|
| Rate for Payer: PACE SWMI |
$224.90
|
| Rate for Payer: PHP Medicare Advantage |
$224.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$224.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$224.90
|
| Rate for Payer: UHC Medicare Advantage |
$224.90
|
| Rate for Payer: UHCCP DNSP |
$224.90
|
|
