|
CHG MECHANICAL RMVL INTRALUMINAL OBSTR MATRL RS&I
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
HCPCS 75902
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$110.74 |
| Rate for Payer: Aetna Commercial |
$103.05
|
| Rate for Payer: Aetna Medicare |
$76.90
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS MAPPO |
$76.90
|
| Rate for Payer: BCN Medicare Advantage |
$76.90
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cofinity Commercial |
$110.74
|
| Rate for Payer: Cofinity Commercial |
$103.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$76.90
|
| Rate for Payer: Healthscope Commercial |
$92.28
|
| Rate for Payer: Healthscope Whirlpool |
$92.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.75
|
| Rate for Payer: Nomi Health Commercial |
$92.28
|
| Rate for Payer: PACE SWMI |
$76.90
|
| Rate for Payer: PHP Medicare Advantage |
$76.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health Medicare |
$76.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$76.90
|
| Rate for Payer: UHC Medicare Advantage |
$76.90
|
| Rate for Payer: UHCCP DNSP |
$76.90
|
|
|
CHG MECHANICAL RMVL PERICATHETER OBSTR MATRL RS&I
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 75901
|
| Min. Negotiated Rate |
$135.60 |
| Max. Negotiated Rate |
$285.25 |
| Rate for Payer: Aetna Commercial |
$265.44
|
| Rate for Payer: Aetna Medicare |
$198.09
|
| Rate for Payer: BCBS Complete |
$135.60
|
| Rate for Payer: BCBS MAPPO |
$198.09
|
| Rate for Payer: BCN Medicare Advantage |
$198.09
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$285.25
|
| Rate for Payer: Cofinity Commercial |
$265.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.09
|
| Rate for Payer: Healthscope Commercial |
$237.71
|
| Rate for Payer: Healthscope Whirlpool |
$237.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.99
|
| Rate for Payer: Nomi Health Commercial |
$237.71
|
| Rate for Payer: PACE SWMI |
$198.09
|
| Rate for Payer: PHP Medicare Advantage |
$198.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health Medicare |
$198.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.09
|
| Rate for Payer: UHC Medicare Advantage |
$198.09
|
| Rate for Payer: UHCCP DNSP |
$198.09
|
|
|
CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN
|
Professional
|
Both
|
$953.00
|
|
|
Service Code
|
HCPCS 77338
|
| Min. Negotiated Rate |
$381.20 |
| Max. Negotiated Rate |
$626.36 |
| Rate for Payer: Aetna Commercial |
$582.86
|
| Rate for Payer: Aetna Commercial |
$582.86
|
| Rate for Payer: Aetna Commercial |
$582.86
|
| Rate for Payer: Aetna Medicare |
$434.97
|
| Rate for Payer: Aetna Medicare |
$434.97
|
| Rate for Payer: Aetna Medicare |
$434.97
|
| Rate for Payer: BCBS Complete |
$210.00
|
| Rate for Payer: BCBS Complete |
$381.20
|
| Rate for Payer: BCBS Complete |
$388.40
|
| Rate for Payer: BCBS MAPPO |
$434.97
|
| Rate for Payer: BCBS MAPPO |
$434.97
|
| Rate for Payer: BCBS MAPPO |
$434.97
|
| Rate for Payer: BCN Medicare Advantage |
$434.97
|
| Rate for Payer: BCN Medicare Advantage |
$434.97
|
| Rate for Payer: BCN Medicare Advantage |
$434.97
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$762.40
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$776.80
|
| Rate for Payer: Cash Price |
$762.40
|
| Rate for Payer: Cofinity Commercial |
$582.86
|
| Rate for Payer: Cofinity Commercial |
$626.36
|
| Rate for Payer: Cofinity Commercial |
$626.36
|
| Rate for Payer: Cofinity Commercial |
$582.86
|
| Rate for Payer: Cofinity Commercial |
$626.36
|
| Rate for Payer: Cofinity Commercial |
$582.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$434.97
|
| Rate for Payer: Healthscope Commercial |
$521.96
|
| Rate for Payer: Healthscope Commercial |
$521.96
|
| Rate for Payer: Healthscope Commercial |
$521.96
|
| Rate for Payer: Healthscope Whirlpool |
$521.96
|
| Rate for Payer: Healthscope Whirlpool |
$521.96
|
| Rate for Payer: Healthscope Whirlpool |
$521.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$456.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$456.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$456.72
|
| Rate for Payer: Nomi Health Commercial |
$521.96
|
| Rate for Payer: Nomi Health Commercial |
$521.96
|
| Rate for Payer: Nomi Health Commercial |
$521.96
|
| Rate for Payer: PACE SWMI |
$434.97
|
| Rate for Payer: PACE SWMI |
$434.97
|
| Rate for Payer: PACE SWMI |
$434.97
|
| Rate for Payer: PHP Medicare Advantage |
$434.97
|
| Rate for Payer: PHP Medicare Advantage |
$434.97
|
| Rate for Payer: PHP Medicare Advantage |
$434.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$631.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$341.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$619.45
|
| Rate for Payer: Priority Health Medicare |
$434.97
|
| Rate for Payer: Priority Health Medicare |
$434.97
|
| Rate for Payer: Priority Health Medicare |
$434.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$434.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$434.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$434.97
|
| Rate for Payer: UHC Medicare Advantage |
$434.97
|
| Rate for Payer: UHC Medicare Advantage |
$434.97
|
| Rate for Payer: UHC Medicare Advantage |
$434.97
|
| Rate for Payer: UHCCP DNSP |
$434.97
|
| Rate for Payer: UHCCP DNSP |
$434.97
|
| Rate for Payer: UHCCP DNSP |
$434.97
|
|
|
CHG MRA ABDOMEN W/WO CONTRAST MATERIAL
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 74185
|
| Min. Negotiated Rate |
$73.60 |
| Max. Negotiated Rate |
$444.11 |
| Rate for Payer: Aetna Commercial |
$413.27
|
| Rate for Payer: Aetna Medicare |
$308.41
|
| Rate for Payer: BCBS Complete |
$73.60
|
| Rate for Payer: BCBS MAPPO |
$308.41
|
| Rate for Payer: BCN Medicare Advantage |
$308.41
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$444.11
|
| Rate for Payer: Cofinity Commercial |
$413.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$308.41
|
| Rate for Payer: Healthscope Commercial |
$370.09
|
| Rate for Payer: Healthscope Whirlpool |
$370.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$323.83
|
| Rate for Payer: Nomi Health Commercial |
$370.09
|
| Rate for Payer: PACE SWMI |
$308.41
|
| Rate for Payer: PHP Medicare Advantage |
$308.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health Medicare |
$308.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$308.41
|
| Rate for Payer: UHC Medicare Advantage |
$308.41
|
| Rate for Payer: UHCCP DNSP |
$308.41
|
|
|
CHG MRA HEAD W/O CONTRST MATERIAL
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
HCPCS 70544
|
| Min. Negotiated Rate |
$95.60 |
| Max. Negotiated Rate |
$284.31 |
| Rate for Payer: Aetna Commercial |
$264.57
|
| Rate for Payer: Aetna Commercial |
$264.57
|
| Rate for Payer: Aetna Medicare |
$197.44
|
| Rate for Payer: Aetna Medicare |
$197.44
|
| Rate for Payer: BCBS Complete |
$95.60
|
| Rate for Payer: BCBS Complete |
$274.40
|
| Rate for Payer: BCBS MAPPO |
$197.44
|
| Rate for Payer: BCBS MAPPO |
$197.44
|
| Rate for Payer: BCN Medicare Advantage |
$197.44
|
| Rate for Payer: BCN Medicare Advantage |
$197.44
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cash Price |
$191.20
|
| Rate for Payer: Cash Price |
$548.80
|
| Rate for Payer: Cofinity Commercial |
$264.57
|
| Rate for Payer: Cofinity Commercial |
$284.31
|
| Rate for Payer: Cofinity Commercial |
$264.57
|
| Rate for Payer: Cofinity Commercial |
$284.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$197.44
|
| Rate for Payer: Healthscope Commercial |
$236.93
|
| Rate for Payer: Healthscope Commercial |
$236.93
|
| Rate for Payer: Healthscope Whirlpool |
$236.93
|
| Rate for Payer: Healthscope Whirlpool |
$236.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.31
|
| Rate for Payer: Nomi Health Commercial |
$236.93
|
| Rate for Payer: Nomi Health Commercial |
$236.93
|
| Rate for Payer: PACE SWMI |
$197.44
|
| Rate for Payer: PACE SWMI |
$197.44
|
| Rate for Payer: PHP Medicare Advantage |
$197.44
|
| Rate for Payer: PHP Medicare Advantage |
$197.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$155.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$445.90
|
| Rate for Payer: Priority Health Medicare |
$197.44
|
| Rate for Payer: Priority Health Medicare |
$197.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$197.44
|
| Rate for Payer: UHC Medicare Advantage |
$197.44
|
| Rate for Payer: UHC Medicare Advantage |
$197.44
|
| Rate for Payer: UHCCP DNSP |
$197.44
|
| Rate for Payer: UHCCP DNSP |
$197.44
|
|
|
CHG MRA HEAD W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$143.00
|
|
|
Service Code
|
HCPCS 70546
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$433.51 |
| Rate for Payer: Aetna Commercial |
$403.41
|
| Rate for Payer: Aetna Medicare |
$301.05
|
| Rate for Payer: BCBS Complete |
$57.20
|
| Rate for Payer: BCBS MAPPO |
$301.05
|
| Rate for Payer: BCN Medicare Advantage |
$301.05
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cofinity Commercial |
$433.51
|
| Rate for Payer: Cofinity Commercial |
$403.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$301.05
|
| Rate for Payer: Healthscope Commercial |
$361.26
|
| Rate for Payer: Healthscope Whirlpool |
$361.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$316.10
|
| Rate for Payer: Nomi Health Commercial |
$361.26
|
| Rate for Payer: PACE SWMI |
$301.05
|
| Rate for Payer: PHP Medicare Advantage |
$301.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.95
|
| Rate for Payer: Priority Health Medicare |
$301.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$301.05
|
| Rate for Payer: UHC Medicare Advantage |
$301.05
|
| Rate for Payer: UHCCP DNSP |
$301.05
|
|
|
CHG MRA NECK W/O CONTRST MATERIAL
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
HCPCS 70547
|
| Min. Negotiated Rate |
$94.40 |
| Max. Negotiated Rate |
$285.16 |
| Rate for Payer: Aetna Commercial |
$265.36
|
| Rate for Payer: Aetna Medicare |
$198.03
|
| Rate for Payer: BCBS Complete |
$94.40
|
| Rate for Payer: BCBS MAPPO |
$198.03
|
| Rate for Payer: BCN Medicare Advantage |
$198.03
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cash Price |
$188.80
|
| Rate for Payer: Cofinity Commercial |
$285.16
|
| Rate for Payer: Cofinity Commercial |
$265.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$198.03
|
| Rate for Payer: Healthscope Commercial |
$237.64
|
| Rate for Payer: Healthscope Whirlpool |
$237.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$207.93
|
| Rate for Payer: Nomi Health Commercial |
$237.64
|
| Rate for Payer: PACE SWMI |
$198.03
|
| Rate for Payer: PHP Medicare Advantage |
$198.03
|
| Rate for Payer: Priority Health Cigna Priority Health |
$153.40
|
| Rate for Payer: Priority Health Medicare |
$198.03
|
| Rate for Payer: UHC Dual Complete DSNP |
$198.03
|
| Rate for Payer: UHC Medicare Advantage |
$198.03
|
| Rate for Payer: UHCCP DNSP |
$198.03
|
|
|
CHG MRA NECK W/O &W/CONTRAST MATERIAL
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS 70549
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$455.33 |
| Rate for Payer: Aetna Commercial |
$423.71
|
| Rate for Payer: Aetna Medicare |
$316.20
|
| Rate for Payer: BCBS Complete |
$112.40
|
| Rate for Payer: BCBS MAPPO |
$316.20
|
| Rate for Payer: BCN Medicare Advantage |
$316.20
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cash Price |
$224.80
|
| Rate for Payer: Cofinity Commercial |
$455.33
|
| Rate for Payer: Cofinity Commercial |
$423.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$316.20
|
| Rate for Payer: Healthscope Commercial |
$379.44
|
| Rate for Payer: Healthscope Whirlpool |
$379.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$332.01
|
| Rate for Payer: Nomi Health Commercial |
$379.44
|
| Rate for Payer: PACE SWMI |
$316.20
|
| Rate for Payer: PHP Medicare Advantage |
$316.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$182.65
|
| Rate for Payer: Priority Health Medicare |
$316.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$316.20
|
| Rate for Payer: UHC Medicare Advantage |
$316.20
|
| Rate for Payer: UHCCP DNSP |
$316.20
|
|
|
CHG MRI ABDOMEN W/O CONTRAST FLWD BY W/CONTRAST
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS 74183
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$447.16 |
| Rate for Payer: Aetna Commercial |
$416.11
|
| Rate for Payer: Aetna Medicare |
$310.53
|
| Rate for Payer: BCBS Complete |
$90.40
|
| Rate for Payer: BCBS MAPPO |
$310.53
|
| Rate for Payer: BCN Medicare Advantage |
$310.53
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$447.16
|
| Rate for Payer: Cofinity Commercial |
$416.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$310.53
|
| Rate for Payer: Healthscope Commercial |
$372.64
|
| Rate for Payer: Healthscope Whirlpool |
$372.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$326.06
|
| Rate for Payer: Nomi Health Commercial |
$372.64
|
| Rate for Payer: PACE SWMI |
$310.53
|
| Rate for Payer: PHP Medicare Advantage |
$310.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.90
|
| Rate for Payer: Priority Health Medicare |
$310.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$310.53
|
| Rate for Payer: UHC Medicare Advantage |
$310.53
|
| Rate for Payer: UHCCP DNSP |
$310.53
|
|
|
CHG MRI ABDOMEN W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
HCPCS 74181
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$259.63 |
| Rate for Payer: Aetna Commercial |
$241.60
|
| Rate for Payer: Aetna Medicare |
$180.30
|
| Rate for Payer: BCBS Complete |
$60.40
|
| Rate for Payer: BCBS MAPPO |
$180.30
|
| Rate for Payer: BCN Medicare Advantage |
$180.30
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cash Price |
$120.80
|
| Rate for Payer: Cofinity Commercial |
$259.63
|
| Rate for Payer: Cofinity Commercial |
$241.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$180.30
|
| Rate for Payer: Healthscope Commercial |
$216.36
|
| Rate for Payer: Healthscope Whirlpool |
$216.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$189.31
|
| Rate for Payer: Nomi Health Commercial |
$216.36
|
| Rate for Payer: PACE SWMI |
$180.30
|
| Rate for Payer: PHP Medicare Advantage |
$180.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.15
|
| Rate for Payer: Priority Health Medicare |
$180.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$180.30
|
| Rate for Payer: UHC Medicare Advantage |
$180.30
|
| Rate for Payer: UHCCP DNSP |
$180.30
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 73721
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$269.35 |
| Rate for Payer: Aetna Commercial |
$250.65
|
| Rate for Payer: Aetna Medicare |
$187.05
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$187.05
|
| Rate for Payer: BCN Medicare Advantage |
$187.05
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$269.35
|
| Rate for Payer: Cofinity Commercial |
$250.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.05
|
| Rate for Payer: Healthscope Commercial |
$224.46
|
| Rate for Payer: Healthscope Whirlpool |
$224.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.40
|
| Rate for Payer: Nomi Health Commercial |
$224.46
|
| Rate for Payer: PACE SWMI |
$187.05
|
| Rate for Payer: PHP Medicare Advantage |
$187.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$187.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.05
|
| Rate for Payer: UHC Medicare Advantage |
$187.05
|
| Rate for Payer: UHCCP DNSP |
$187.05
|
|
|
CHG MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 73723
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$505.94 |
| Rate for Payer: Aetna Commercial |
$470.81
|
| Rate for Payer: Aetna Medicare |
$351.35
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: BCBS MAPPO |
$351.35
|
| Rate for Payer: BCN Medicare Advantage |
$351.35
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$505.94
|
| Rate for Payer: Cofinity Commercial |
$470.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$351.35
|
| Rate for Payer: Healthscope Commercial |
$421.62
|
| Rate for Payer: Healthscope Whirlpool |
$421.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$368.92
|
| Rate for Payer: Nomi Health Commercial |
$421.62
|
| Rate for Payer: PACE SWMI |
$351.35
|
| Rate for Payer: PHP Medicare Advantage |
$351.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health Medicare |
$351.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$351.35
|
| Rate for Payer: UHC Medicare Advantage |
$351.35
|
| Rate for Payer: UHCCP DNSP |
$351.35
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 73222
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$408.93 |
| Rate for Payer: Aetna Commercial |
$380.53
|
| Rate for Payer: Aetna Medicare |
$283.98
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$283.98
|
| Rate for Payer: BCN Medicare Advantage |
$283.98
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$408.93
|
| Rate for Payer: Cofinity Commercial |
$380.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$283.98
|
| Rate for Payer: Healthscope Commercial |
$340.78
|
| Rate for Payer: Healthscope Whirlpool |
$340.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$298.18
|
| Rate for Payer: Nomi Health Commercial |
$340.78
|
| Rate for Payer: PACE SWMI |
$283.98
|
| Rate for Payer: PHP Medicare Advantage |
$283.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health Medicare |
$283.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$283.98
|
| Rate for Payer: UHC Medicare Advantage |
$283.98
|
| Rate for Payer: UHCCP DNSP |
$283.98
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 73221
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$269.78 |
| Rate for Payer: Aetna Commercial |
$251.05
|
| Rate for Payer: Aetna Medicare |
$187.35
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$187.35
|
| Rate for Payer: BCN Medicare Advantage |
$187.35
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$269.78
|
| Rate for Payer: Cofinity Commercial |
$251.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$187.35
|
| Rate for Payer: Healthscope Commercial |
$224.82
|
| Rate for Payer: Healthscope Whirlpool |
$224.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$196.72
|
| Rate for Payer: Nomi Health Commercial |
$224.82
|
| Rate for Payer: PACE SWMI |
$187.35
|
| Rate for Payer: PHP Medicare Advantage |
$187.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$187.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$187.35
|
| Rate for Payer: UHC Medicare Advantage |
$187.35
|
| Rate for Payer: UHCCP DNSP |
$187.35
|
|
|
CHG MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 73223
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$507.21 |
| Rate for Payer: Aetna Commercial |
$471.99
|
| Rate for Payer: Aetna Medicare |
$352.23
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: BCBS MAPPO |
$352.23
|
| Rate for Payer: BCN Medicare Advantage |
$352.23
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$507.21
|
| Rate for Payer: Cofinity Commercial |
$471.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$352.23
|
| Rate for Payer: Healthscope Commercial |
$422.68
|
| Rate for Payer: Healthscope Whirlpool |
$422.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$369.84
|
| Rate for Payer: Nomi Health Commercial |
$422.68
|
| Rate for Payer: PACE SWMI |
$352.23
|
| Rate for Payer: PHP Medicare Advantage |
$352.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health Medicare |
$352.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$352.23
|
| Rate for Payer: UHC Medicare Advantage |
$352.23
|
| Rate for Payer: UHCCP DNSP |
$352.23
|
|
|
CHG MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL
|
Professional
|
Both
|
$377.00
|
|
|
Service Code
|
HCPCS 70552
|
| Min. Negotiated Rate |
$150.80 |
| Max. Negotiated Rate |
$358.37 |
| Rate for Payer: Aetna Commercial |
$333.49
|
| Rate for Payer: Aetna Medicare |
$248.87
|
| Rate for Payer: BCBS Complete |
$150.80
|
| Rate for Payer: BCBS MAPPO |
$248.87
|
| Rate for Payer: BCN Medicare Advantage |
$248.87
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cash Price |
$301.60
|
| Rate for Payer: Cofinity Commercial |
$358.37
|
| Rate for Payer: Cofinity Commercial |
$333.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.87
|
| Rate for Payer: Healthscope Commercial |
$298.64
|
| Rate for Payer: Healthscope Whirlpool |
$298.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.31
|
| Rate for Payer: Nomi Health Commercial |
$298.64
|
| Rate for Payer: PACE SWMI |
$248.87
|
| Rate for Payer: PHP Medicare Advantage |
$248.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.05
|
| Rate for Payer: Priority Health Medicare |
$248.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.87
|
| Rate for Payer: UHC Medicare Advantage |
$248.87
|
| Rate for Payer: UHCCP DNSP |
$248.87
|
|
|
CHG MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$325.00
|
|
|
Service Code
|
HCPCS 70551
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$260.99 |
| Rate for Payer: Aetna Commercial |
$242.86
|
| Rate for Payer: Aetna Medicare |
$181.24
|
| Rate for Payer: BCBS Complete |
$130.00
|
| Rate for Payer: BCBS MAPPO |
$181.24
|
| Rate for Payer: BCN Medicare Advantage |
$181.24
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cash Price |
$260.00
|
| Rate for Payer: Cofinity Commercial |
$260.99
|
| Rate for Payer: Cofinity Commercial |
$242.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$181.24
|
| Rate for Payer: Healthscope Commercial |
$217.49
|
| Rate for Payer: Healthscope Whirlpool |
$217.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$190.30
|
| Rate for Payer: Nomi Health Commercial |
$217.49
|
| Rate for Payer: PACE SWMI |
$181.24
|
| Rate for Payer: PHP Medicare Advantage |
$181.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.25
|
| Rate for Payer: Priority Health Medicare |
$181.24
|
| Rate for Payer: UHC Dual Complete DSNP |
$181.24
|
| Rate for Payer: UHC Medicare Advantage |
$181.24
|
| Rate for Payer: UHCCP DNSP |
$181.24
|
|
|
CHG MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL
|
Professional
|
Both
|
$348.00
|
|
|
Service Code
|
HCPCS 70553
|
| Min. Negotiated Rate |
$139.20 |
| Max. Negotiated Rate |
$423.48 |
| Rate for Payer: Aetna Commercial |
$394.07
|
| Rate for Payer: Aetna Medicare |
$294.08
|
| Rate for Payer: BCBS Complete |
$139.20
|
| Rate for Payer: BCBS MAPPO |
$294.08
|
| Rate for Payer: BCN Medicare Advantage |
$294.08
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cash Price |
$278.40
|
| Rate for Payer: Cofinity Commercial |
$423.48
|
| Rate for Payer: Cofinity Commercial |
$394.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.08
|
| Rate for Payer: Healthscope Commercial |
$352.90
|
| Rate for Payer: Healthscope Whirlpool |
$352.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$308.78
|
| Rate for Payer: Nomi Health Commercial |
$352.90
|
| Rate for Payer: PACE SWMI |
$294.08
|
| Rate for Payer: PHP Medicare Advantage |
$294.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.20
|
| Rate for Payer: Priority Health Medicare |
$294.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.08
|
| Rate for Payer: UHC Medicare Advantage |
$294.08
|
| Rate for Payer: UHCCP DNSP |
$294.08
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
HCPCS 73718
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$293.85 |
| Rate for Payer: Aetna Commercial |
$273.44
|
| Rate for Payer: Aetna Medicare |
$204.06
|
| Rate for Payer: BCBS Complete |
$52.40
|
| Rate for Payer: BCBS MAPPO |
$204.06
|
| Rate for Payer: BCN Medicare Advantage |
$204.06
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cash Price |
$104.80
|
| Rate for Payer: Cofinity Commercial |
$293.85
|
| Rate for Payer: Cofinity Commercial |
$273.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$204.06
|
| Rate for Payer: Healthscope Commercial |
$244.87
|
| Rate for Payer: Healthscope Whirlpool |
$244.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$214.26
|
| Rate for Payer: Nomi Health Commercial |
$244.87
|
| Rate for Payer: PACE SWMI |
$204.06
|
| Rate for Payer: PHP Medicare Advantage |
$204.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.15
|
| Rate for Payer: Priority Health Medicare |
$204.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$204.06
|
| Rate for Payer: UHC Medicare Advantage |
$204.06
|
| Rate for Payer: UHCCP DNSP |
$204.06
|
|
|
CHG MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 73720
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$445.68 |
| Rate for Payer: Aetna Commercial |
$414.73
|
| Rate for Payer: Aetna Medicare |
$309.50
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: BCBS MAPPO |
$309.50
|
| Rate for Payer: BCN Medicare Advantage |
$309.50
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$445.68
|
| Rate for Payer: Cofinity Commercial |
$414.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.50
|
| Rate for Payer: Healthscope Commercial |
$371.40
|
| Rate for Payer: Healthscope Whirlpool |
$371.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.98
|
| Rate for Payer: Nomi Health Commercial |
$371.40
|
| Rate for Payer: PACE SWMI |
$309.50
|
| Rate for Payer: PHP Medicare Advantage |
$309.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health Medicare |
$309.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.50
|
| Rate for Payer: UHC Medicare Advantage |
$309.50
|
| Rate for Payer: UHCCP DNSP |
$309.50
|
|
|
CHG MRI ORBIT FACE &/NECK W/O CONTRAST
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
HCPCS 70540
|
| Min. Negotiated Rate |
$52.00 |
| Max. Negotiated Rate |
$298.09 |
| Rate for Payer: Aetna Commercial |
$277.39
|
| Rate for Payer: Aetna Medicare |
$207.01
|
| Rate for Payer: BCBS Complete |
$52.00
|
| Rate for Payer: BCBS MAPPO |
$207.01
|
| Rate for Payer: BCN Medicare Advantage |
$207.01
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cash Price |
$104.00
|
| Rate for Payer: Cofinity Commercial |
$298.09
|
| Rate for Payer: Cofinity Commercial |
$277.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$207.01
|
| Rate for Payer: Healthscope Commercial |
$248.41
|
| Rate for Payer: Healthscope Whirlpool |
$248.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$217.36
|
| Rate for Payer: Nomi Health Commercial |
$248.41
|
| Rate for Payer: PACE SWMI |
$207.01
|
| Rate for Payer: PHP Medicare Advantage |
$207.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.50
|
| Rate for Payer: Priority Health Medicare |
$207.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$207.01
|
| Rate for Payer: UHC Medicare Advantage |
$207.01
|
| Rate for Payer: UHCCP DNSP |
$207.01
|
|
|
CHG MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 70543
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$448.23 |
| Rate for Payer: Aetna Commercial |
$417.10
|
| Rate for Payer: Aetna Medicare |
$311.27
|
| Rate for Payer: BCBS Complete |
$84.00
|
| Rate for Payer: BCBS MAPPO |
$311.27
|
| Rate for Payer: BCN Medicare Advantage |
$311.27
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$448.23
|
| Rate for Payer: Cofinity Commercial |
$417.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$311.27
|
| Rate for Payer: Healthscope Commercial |
$373.52
|
| Rate for Payer: Healthscope Whirlpool |
$373.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$326.83
|
| Rate for Payer: Nomi Health Commercial |
$373.52
|
| Rate for Payer: PACE SWMI |
$311.27
|
| Rate for Payer: PHP Medicare Advantage |
$311.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$136.50
|
| Rate for Payer: Priority Health Medicare |
$311.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$311.27
|
| Rate for Payer: UHC Medicare Advantage |
$311.27
|
| Rate for Payer: UHCCP DNSP |
$311.27
|
|
|
CHG MRI PELVIS W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 72195
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$301.64 |
| Rate for Payer: Aetna Commercial |
$280.69
|
| Rate for Payer: Aetna Medicare |
$209.47
|
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: BCBS MAPPO |
$209.47
|
| Rate for Payer: BCN Medicare Advantage |
$209.47
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$301.64
|
| Rate for Payer: Cofinity Commercial |
$280.69
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.47
|
| Rate for Payer: Healthscope Commercial |
$251.36
|
| Rate for Payer: Healthscope Whirlpool |
$251.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$219.94
|
| Rate for Payer: Nomi Health Commercial |
$251.36
|
| Rate for Payer: PACE SWMI |
$209.47
|
| Rate for Payer: PHP Medicare Advantage |
$209.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$92.30
|
| Rate for Payer: Priority Health Medicare |
$209.47
|
| Rate for Payer: UHC Dual Complete DSNP |
$209.47
|
| Rate for Payer: UHC Medicare Advantage |
$209.47
|
| Rate for Payer: UHCCP DNSP |
$209.47
|
|
|
CHG MRI PELVIS W/O & W/CONTRAST MATERIAL
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
HCPCS 72197
|
| Min. Negotiated Rate |
$85.60 |
| Max. Negotiated Rate |
$445.46 |
| Rate for Payer: Aetna Commercial |
$414.53
|
| Rate for Payer: Aetna Medicare |
$309.35
|
| Rate for Payer: BCBS Complete |
$85.60
|
| Rate for Payer: BCBS MAPPO |
$309.35
|
| Rate for Payer: BCN Medicare Advantage |
$309.35
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cash Price |
$171.20
|
| Rate for Payer: Cofinity Commercial |
$445.46
|
| Rate for Payer: Cofinity Commercial |
$414.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$309.35
|
| Rate for Payer: Healthscope Commercial |
$371.22
|
| Rate for Payer: Healthscope Whirlpool |
$371.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$324.82
|
| Rate for Payer: Nomi Health Commercial |
$371.22
|
| Rate for Payer: PACE SWMI |
$309.35
|
| Rate for Payer: PHP Medicare Advantage |
$309.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$139.10
|
| Rate for Payer: Priority Health Medicare |
$309.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$309.35
|
| Rate for Payer: UHC Medicare Advantage |
$309.35
|
| Rate for Payer: UHCCP DNSP |
$309.35
|
|
|
CHG MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 72141
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$253.35 |
| Rate for Payer: Aetna Commercial |
$235.76
|
| Rate for Payer: Aetna Medicare |
$175.94
|
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: BCBS MAPPO |
$175.94
|
| Rate for Payer: BCN Medicare Advantage |
$175.94
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$253.35
|
| Rate for Payer: Cofinity Commercial |
$235.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$175.94
|
| Rate for Payer: Healthscope Commercial |
$211.13
|
| Rate for Payer: Healthscope Whirlpool |
$211.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$184.74
|
| Rate for Payer: Nomi Health Commercial |
$211.13
|
| Rate for Payer: PACE SWMI |
$175.94
|
| Rate for Payer: PHP Medicare Advantage |
$175.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health Medicare |
$175.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$175.94
|
| Rate for Payer: UHC Medicare Advantage |
$175.94
|
| Rate for Payer: UHCCP DNSP |
$175.94
|
|
