|
CHG MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
HCPCS 72156
|
| Min. Negotiated Rate |
$125.60 |
| Max. Negotiated Rate |
$424.74 |
| Rate for Payer: Aetna Commercial |
$395.25
|
| Rate for Payer: Aetna Medicare |
$294.96
|
| Rate for Payer: BCBS Complete |
$125.60
|
| Rate for Payer: BCBS MAPPO |
$294.96
|
| Rate for Payer: BCN Medicare Advantage |
$294.96
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cash Price |
$251.20
|
| Rate for Payer: Cofinity Commercial |
$424.74
|
| Rate for Payer: Cofinity Commercial |
$395.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.96
|
| Rate for Payer: Healthscope Commercial |
$353.95
|
| Rate for Payer: Healthscope Whirlpool |
$353.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.71
|
| Rate for Payer: Nomi Health Commercial |
$353.95
|
| Rate for Payer: PACE SWMI |
$294.96
|
| Rate for Payer: PHP Medicare Advantage |
$294.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$204.10
|
| Rate for Payer: Priority Health Medicare |
$294.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.96
|
| Rate for Payer: UHC Medicare Advantage |
$294.96
|
| Rate for Payer: UHCCP DNSP |
$294.96
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
HCPCS 72149
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$358.19 |
| Rate for Payer: Aetna Commercial |
$333.31
|
| Rate for Payer: Aetna Medicare |
$248.74
|
| Rate for Payer: BCBS Complete |
$130.80
|
| Rate for Payer: BCBS MAPPO |
$248.74
|
| Rate for Payer: BCN Medicare Advantage |
$248.74
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cofinity Commercial |
$358.19
|
| Rate for Payer: Cofinity Commercial |
$333.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$248.74
|
| Rate for Payer: Healthscope Commercial |
$298.49
|
| Rate for Payer: Healthscope Whirlpool |
$298.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$261.18
|
| Rate for Payer: Nomi Health Commercial |
$298.49
|
| Rate for Payer: PACE SWMI |
$248.74
|
| Rate for Payer: PHP Medicare Advantage |
$248.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$212.55
|
| Rate for Payer: Priority Health Medicare |
$248.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$248.74
|
| Rate for Payer: UHC Medicare Advantage |
$248.74
|
| Rate for Payer: UHCCP DNSP |
$248.74
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL
|
Professional
|
Both
|
$247.00
|
|
|
Service Code
|
HCPCS 72148
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$254.20 |
| Rate for Payer: Aetna Commercial |
$236.55
|
| Rate for Payer: Aetna Medicare |
$176.53
|
| Rate for Payer: BCBS Complete |
$98.80
|
| Rate for Payer: BCBS MAPPO |
$176.53
|
| Rate for Payer: BCN Medicare Advantage |
$176.53
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cash Price |
$197.60
|
| Rate for Payer: Cofinity Commercial |
$254.20
|
| Rate for Payer: Cofinity Commercial |
$236.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.53
|
| Rate for Payer: Healthscope Commercial |
$211.84
|
| Rate for Payer: Healthscope Whirlpool |
$211.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.36
|
| Rate for Payer: Nomi Health Commercial |
$211.84
|
| Rate for Payer: PACE SWMI |
$176.53
|
| Rate for Payer: PHP Medicare Advantage |
$176.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$160.55
|
| Rate for Payer: Priority Health Medicare |
$176.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.53
|
| Rate for Payer: UHC Medicare Advantage |
$176.53
|
| Rate for Payer: UHCCP DNSP |
$176.53
|
|
|
CHG MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 72158
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$423.89 |
| Rate for Payer: Aetna Commercial |
$394.46
|
| Rate for Payer: Aetna Medicare |
$294.37
|
| Rate for Payer: BCBS Complete |
$119.60
|
| Rate for Payer: BCBS MAPPO |
$294.37
|
| Rate for Payer: BCN Medicare Advantage |
$294.37
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$423.89
|
| Rate for Payer: Cofinity Commercial |
$394.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$294.37
|
| Rate for Payer: Healthscope Commercial |
$353.24
|
| Rate for Payer: Healthscope Whirlpool |
$353.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$309.09
|
| Rate for Payer: Nomi Health Commercial |
$353.24
|
| Rate for Payer: PACE SWMI |
$294.37
|
| Rate for Payer: PHP Medicare Advantage |
$294.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health Medicare |
$294.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$294.37
|
| Rate for Payer: UHC Medicare Advantage |
$294.37
|
| Rate for Payer: UHCCP DNSP |
$294.37
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS 72146
|
| Min. Negotiated Rate |
$108.80 |
| Max. Negotiated Rate |
$253.77 |
| Rate for Payer: Aetna Commercial |
$236.15
|
| Rate for Payer: Aetna Medicare |
$176.23
|
| Rate for Payer: BCBS Complete |
$108.80
|
| Rate for Payer: BCBS MAPPO |
$176.23
|
| Rate for Payer: BCN Medicare Advantage |
$176.23
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cash Price |
$217.60
|
| Rate for Payer: Cofinity Commercial |
$253.77
|
| Rate for Payer: Cofinity Commercial |
$236.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.23
|
| Rate for Payer: Healthscope Commercial |
$211.48
|
| Rate for Payer: Healthscope Whirlpool |
$211.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.04
|
| Rate for Payer: Nomi Health Commercial |
$211.48
|
| Rate for Payer: PACE SWMI |
$176.23
|
| Rate for Payer: PHP Medicare Advantage |
$176.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.80
|
| Rate for Payer: Priority Health Medicare |
$176.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$176.23
|
| Rate for Payer: UHC Medicare Advantage |
$176.23
|
| Rate for Payer: UHCCP DNSP |
$176.23
|
|
|
CHG MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
HCPCS 72157
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$425.59 |
| Rate for Payer: Aetna Commercial |
$396.04
|
| Rate for Payer: Aetna Medicare |
$295.55
|
| Rate for Payer: BCBS Complete |
$132.00
|
| Rate for Payer: BCBS MAPPO |
$295.55
|
| Rate for Payer: BCN Medicare Advantage |
$295.55
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cash Price |
$264.00
|
| Rate for Payer: Cofinity Commercial |
$425.59
|
| Rate for Payer: Cofinity Commercial |
$396.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$295.55
|
| Rate for Payer: Healthscope Commercial |
$354.66
|
| Rate for Payer: Healthscope Whirlpool |
$354.66
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$310.33
|
| Rate for Payer: Nomi Health Commercial |
$354.66
|
| Rate for Payer: PACE SWMI |
$295.55
|
| Rate for Payer: PHP Medicare Advantage |
$295.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$214.50
|
| Rate for Payer: Priority Health Medicare |
$295.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$295.55
|
| Rate for Payer: UHC Medicare Advantage |
$295.55
|
| Rate for Payer: UHCCP DNSP |
$295.55
|
|
|
CHG MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
HCPCS 73218
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$395.38 |
| Rate for Payer: Aetna Commercial |
$367.92
|
| Rate for Payer: Aetna Medicare |
$274.57
|
| Rate for Payer: BCBS Complete |
$52.80
|
| Rate for Payer: BCBS MAPPO |
$274.57
|
| Rate for Payer: BCN Medicare Advantage |
$274.57
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cash Price |
$105.60
|
| Rate for Payer: Cofinity Commercial |
$395.38
|
| Rate for Payer: Cofinity Commercial |
$367.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$274.57
|
| Rate for Payer: Healthscope Commercial |
$329.48
|
| Rate for Payer: Healthscope Whirlpool |
$329.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.30
|
| Rate for Payer: Nomi Health Commercial |
$329.48
|
| Rate for Payer: PACE SWMI |
$274.57
|
| Rate for Payer: PHP Medicare Advantage |
$274.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$85.80
|
| Rate for Payer: Priority Health Medicare |
$274.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$274.57
|
| Rate for Payer: UHC Medicare Advantage |
$274.57
|
| Rate for Payer: UHCCP DNSP |
$274.57
|
|
|
CHG MYELOGRAPY LUMBOSACRAL RS&I
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 72265
|
| Min. Negotiated Rate |
$65.20 |
| Max. Negotiated Rate |
$141.54 |
| Rate for Payer: Aetna Commercial |
$131.71
|
| Rate for Payer: Aetna Medicare |
$98.29
|
| Rate for Payer: BCBS Complete |
$65.20
|
| Rate for Payer: BCBS MAPPO |
$98.29
|
| Rate for Payer: BCN Medicare Advantage |
$98.29
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$141.54
|
| Rate for Payer: Cofinity Commercial |
$131.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$98.29
|
| Rate for Payer: Healthscope Commercial |
$117.95
|
| Rate for Payer: Healthscope Whirlpool |
$117.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$103.20
|
| Rate for Payer: Nomi Health Commercial |
$117.95
|
| Rate for Payer: PACE SWMI |
$98.29
|
| Rate for Payer: PHP Medicare Advantage |
$98.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$105.95
|
| Rate for Payer: Priority Health Medicare |
$98.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$98.29
|
| Rate for Payer: UHC Medicare Advantage |
$98.29
|
| Rate for Payer: UHCCP DNSP |
$98.29
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 78453
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$340.78 |
| Rate for Payer: Aetna Commercial |
$317.11
|
| Rate for Payer: Aetna Medicare |
$236.65
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: BCBS MAPPO |
$236.65
|
| Rate for Payer: BCN Medicare Advantage |
$236.65
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cofinity Commercial |
$340.78
|
| Rate for Payer: Cofinity Commercial |
$317.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.65
|
| Rate for Payer: Healthscope Commercial |
$283.98
|
| Rate for Payer: Healthscope Whirlpool |
$283.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.48
|
| Rate for Payer: Nomi Health Commercial |
$283.98
|
| Rate for Payer: PACE SWMI |
$236.65
|
| Rate for Payer: PHP Medicare Advantage |
$236.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: Priority Health Medicare |
$236.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.65
|
| Rate for Payer: UHC Medicare Advantage |
$236.65
|
| Rate for Payer: UHCCP DNSP |
$236.65
|
|
|
CHG MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
HCPCS 78454
|
| Min. Negotiated Rate |
$63.20 |
| Max. Negotiated Rate |
$503.91 |
| Rate for Payer: Aetna Commercial |
$468.92
|
| Rate for Payer: Aetna Medicare |
$349.94
|
| Rate for Payer: BCBS Complete |
$63.20
|
| Rate for Payer: BCBS MAPPO |
$349.94
|
| Rate for Payer: BCN Medicare Advantage |
$349.94
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cash Price |
$126.40
|
| Rate for Payer: Cofinity Commercial |
$503.91
|
| Rate for Payer: Cofinity Commercial |
$468.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$349.94
|
| Rate for Payer: Healthscope Commercial |
$419.93
|
| Rate for Payer: Healthscope Whirlpool |
$419.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$367.44
|
| Rate for Payer: Nomi Health Commercial |
$419.93
|
| Rate for Payer: PACE SWMI |
$349.94
|
| Rate for Payer: PHP Medicare Advantage |
$349.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$102.70
|
| Rate for Payer: Priority Health Medicare |
$349.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$349.94
|
| Rate for Payer: UHC Medicare Advantage |
$349.94
|
| Rate for Payer: UHCCP DNSP |
$349.94
|
|
|
CHG MYOCARDIAL SPECT MULTIPLE STUDIES
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 78452
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$544.54 |
| Rate for Payer: Aetna Commercial |
$506.72
|
| Rate for Payer: Aetna Commercial |
$506.72
|
| Rate for Payer: Aetna Medicare |
$378.15
|
| Rate for Payer: Aetna Medicare |
$378.15
|
| Rate for Payer: BCBS Complete |
$366.40
|
| Rate for Payer: BCBS Complete |
$76.80
|
| Rate for Payer: BCBS MAPPO |
$378.15
|
| Rate for Payer: BCBS MAPPO |
$378.15
|
| Rate for Payer: BCN Medicare Advantage |
$378.15
|
| Rate for Payer: BCN Medicare Advantage |
$378.15
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$732.80
|
| Rate for Payer: Cofinity Commercial |
$506.72
|
| Rate for Payer: Cofinity Commercial |
$544.54
|
| Rate for Payer: Cofinity Commercial |
$506.72
|
| Rate for Payer: Cofinity Commercial |
$544.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$378.15
|
| Rate for Payer: Healthscope Commercial |
$453.78
|
| Rate for Payer: Healthscope Commercial |
$453.78
|
| Rate for Payer: Healthscope Whirlpool |
$453.78
|
| Rate for Payer: Healthscope Whirlpool |
$453.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$397.06
|
| Rate for Payer: Nomi Health Commercial |
$453.78
|
| Rate for Payer: Nomi Health Commercial |
$453.78
|
| Rate for Payer: PACE SWMI |
$378.15
|
| Rate for Payer: PACE SWMI |
$378.15
|
| Rate for Payer: PHP Medicare Advantage |
$378.15
|
| Rate for Payer: PHP Medicare Advantage |
$378.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$595.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.80
|
| Rate for Payer: Priority Health Medicare |
$378.15
|
| Rate for Payer: Priority Health Medicare |
$378.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$378.15
|
| Rate for Payer: UHC Medicare Advantage |
$378.15
|
| Rate for Payer: UHC Medicare Advantage |
$378.15
|
| Rate for Payer: UHCCP DNSP |
$378.15
|
| Rate for Payer: UHCCP DNSP |
$378.15
|
|
|
CHG MYOCARDIAL SPECT SINGLE STUDY AT REST OR STRESS
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 78451
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$396.23 |
| Rate for Payer: Aetna Commercial |
$368.71
|
| Rate for Payer: Aetna Medicare |
$275.16
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS MAPPO |
$275.16
|
| Rate for Payer: BCN Medicare Advantage |
$275.16
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$396.23
|
| Rate for Payer: Cofinity Commercial |
$368.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$275.16
|
| Rate for Payer: Healthscope Commercial |
$330.19
|
| Rate for Payer: Healthscope Whirlpool |
$330.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$288.92
|
| Rate for Payer: Nomi Health Commercial |
$330.19
|
| Rate for Payer: PACE SWMI |
$275.16
|
| Rate for Payer: PHP Medicare Advantage |
$275.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health Medicare |
$275.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$275.16
|
| Rate for Payer: UHC Medicare Advantage |
$275.16
|
| Rate for Payer: UHCCP DNSP |
$275.16
|
|
|
CHG MYOCRD IMG PET PRFUJ SINGLE STUDY REST/STRESS
|
Professional
|
Both
|
$714.00
|
|
|
Service Code
|
HCPCS 78491
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Aetna Medicare |
$357.00
|
| Rate for Payer: BCBS Complete |
$285.60
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$464.10
|
|
|
CHG NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS
|
Professional
|
Both
|
$1,752.00
|
|
|
Service Code
|
HCPCS 77301
|
| Min. Negotiated Rate |
$700.80 |
| Max. Negotiated Rate |
$2,400.12 |
| Rate for Payer: Aetna Commercial |
$2,233.45
|
| Rate for Payer: Aetna Commercial |
$2,233.45
|
| Rate for Payer: Aetna Commercial |
$2,233.45
|
| Rate for Payer: Aetna Medicare |
$1,666.75
|
| Rate for Payer: Aetna Medicare |
$1,666.75
|
| Rate for Payer: Aetna Medicare |
$1,666.75
|
| Rate for Payer: BCBS Complete |
$1,228.40
|
| Rate for Payer: BCBS Complete |
$700.80
|
| Rate for Payer: BCBS Complete |
$1,528.00
|
| Rate for Payer: BCBS MAPPO |
$1,666.75
|
| Rate for Payer: BCBS MAPPO |
$1,666.75
|
| Rate for Payer: BCBS MAPPO |
$1,666.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,666.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,666.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,666.75
|
| Rate for Payer: Cash Price |
$3,056.00
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cash Price |
$2,456.80
|
| Rate for Payer: Cash Price |
$3,056.00
|
| Rate for Payer: Cash Price |
$2,456.80
|
| Rate for Payer: Cofinity Commercial |
$2,400.12
|
| Rate for Payer: Cofinity Commercial |
$2,400.12
|
| Rate for Payer: Cofinity Commercial |
$2,233.45
|
| Rate for Payer: Cofinity Commercial |
$2,233.45
|
| Rate for Payer: Cofinity Commercial |
$2,400.12
|
| Rate for Payer: Cofinity Commercial |
$2,233.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,666.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,666.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,666.75
|
| Rate for Payer: Healthscope Commercial |
$2,000.10
|
| Rate for Payer: Healthscope Commercial |
$2,000.10
|
| Rate for Payer: Healthscope Commercial |
$2,000.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,000.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,000.10
|
| Rate for Payer: Healthscope Whirlpool |
$2,000.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,750.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,750.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,750.09
|
| Rate for Payer: Nomi Health Commercial |
$2,000.10
|
| Rate for Payer: Nomi Health Commercial |
$2,000.10
|
| Rate for Payer: Nomi Health Commercial |
$2,000.10
|
| Rate for Payer: PACE SWMI |
$1,666.75
|
| Rate for Payer: PACE SWMI |
$1,666.75
|
| Rate for Payer: PACE SWMI |
$1,666.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,666.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,666.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,666.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,996.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,138.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,483.00
|
| Rate for Payer: Priority Health Medicare |
$1,666.75
|
| Rate for Payer: Priority Health Medicare |
$1,666.75
|
| Rate for Payer: Priority Health Medicare |
$1,666.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,666.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,666.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,666.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,666.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,666.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,666.75
|
| Rate for Payer: UHCCP DNSP |
$1,666.75
|
| Rate for Payer: UHCCP DNSP |
$1,666.75
|
| Rate for Payer: UHCCP DNSP |
$1,666.75
|
|
|
CHG OPH BMTRY US ECHOGRAPY A-SCAN IO LENS PWR CAL
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 76519
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$89.05 |
| Rate for Payer: Aetna Commercial |
$82.87
|
| Rate for Payer: Aetna Medicare |
$61.84
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS MAPPO |
$61.84
|
| Rate for Payer: BCN Medicare Advantage |
$61.84
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$89.05
|
| Rate for Payer: Cofinity Commercial |
$82.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.84
|
| Rate for Payer: Healthscope Commercial |
$74.21
|
| Rate for Payer: Healthscope Whirlpool |
$74.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.93
|
| Rate for Payer: Nomi Health Commercial |
$74.21
|
| Rate for Payer: PACE SWMI |
$61.84
|
| Rate for Payer: PHP Medicare Advantage |
$61.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health Medicare |
$61.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.84
|
| Rate for Payer: UHC Medicare Advantage |
$61.84
|
| Rate for Payer: UHCCP DNSP |
$61.84
|
|
|
CHG OPHTHALMIC US DX CORNEAL PACHYMETRY UNI/BI
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 76514
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$15.25 |
| Rate for Payer: Aetna Commercial |
$14.19
|
| Rate for Payer: Aetna Medicare |
$10.59
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$10.59
|
| Rate for Payer: BCN Medicare Advantage |
$10.59
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$15.25
|
| Rate for Payer: Cofinity Commercial |
$14.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$10.59
|
| Rate for Payer: Healthscope Commercial |
$12.71
|
| Rate for Payer: Healthscope Whirlpool |
$12.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$11.12
|
| Rate for Payer: Nomi Health Commercial |
$12.71
|
| Rate for Payer: PACE SWMI |
$10.59
|
| Rate for Payer: PHP Medicare Advantage |
$10.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health Medicare |
$10.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$10.59
|
| Rate for Payer: UHC Medicare Advantage |
$10.59
|
| Rate for Payer: UHCCP DNSP |
$10.59
|
|
|
CHG PARTICLE AGGLUTINATION SCREEN EACH ANTIBODY
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS 86403
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$16.62 |
| Rate for Payer: Aetna Commercial |
$15.46
|
| Rate for Payer: Aetna Medicare |
$11.54
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$11.54
|
| Rate for Payer: BCN Medicare Advantage |
$11.54
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$16.62
|
| Rate for Payer: Cofinity Commercial |
$15.46
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.54
|
| Rate for Payer: Healthscope Commercial |
$13.85
|
| Rate for Payer: Healthscope Whirlpool |
$13.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.12
|
| Rate for Payer: Nomi Health Commercial |
$13.85
|
| Rate for Payer: PACE SWMI |
$11.54
|
| Rate for Payer: PHP Medicare Advantage |
$11.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health Medicare |
$11.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.54
|
| Rate for Payer: UHC Medicare Advantage |
$11.54
|
| Rate for Payer: UHCCP DNSP |
$11.54
|
|
|
CHG PERCUTANEOUS VERTEBROPLASTY, CT GUIDE
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 72292
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$173.55 |
| Rate for Payer: Aetna Medicare |
$133.50
|
| Rate for Payer: BCBS Complete |
$106.80
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$173.55
|
|
|
CHG PERCUTANEOUS VERTEBROPLASTY, FLUOR GUIDE
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 72291
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Aetna Medicare |
$121.00
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
|
|
CHG PERITONEOGRAM RS&I
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS 74190
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$29.90 |
| Rate for Payer: Aetna Medicare |
$23.00
|
| Rate for Payer: BCBS Complete |
$18.40
|
| Rate for Payer: Cash Price |
$36.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.90
|
|
|
CHG PH BODY FLUID NOT ELSEWHERE SPECIFIED
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 83986
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna Commercial |
$4.80
|
| Rate for Payer: Aetna Medicare |
$3.58
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$3.58
|
| Rate for Payer: BCN Medicare Advantage |
$3.58
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$5.16
|
| Rate for Payer: Cofinity Commercial |
$4.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.58
|
| Rate for Payer: Healthscope Commercial |
$4.30
|
| Rate for Payer: Healthscope Whirlpool |
$4.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.76
|
| Rate for Payer: Nomi Health Commercial |
$4.30
|
| Rate for Payer: PACE SWMI |
$3.58
|
| Rate for Payer: PHP Medicare Advantage |
$3.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$3.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.58
|
| Rate for Payer: UHC Medicare Advantage |
$3.58
|
| Rate for Payer: UHCCP DNSP |
$3.58
|
|
|
CHG PLACEMNT,PROX/DIST EXT PROS, INFRARENAL
|
Professional
|
Both
|
$455.00
|
|
|
Service Code
|
HCPCS 75953
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$295.75 |
| Rate for Payer: Aetna Medicare |
$227.50
|
| Rate for Payer: BCBS Complete |
$182.00
|
| Rate for Payer: Cash Price |
$364.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$295.75
|
|
|
CHG PLMT PROX XTN PRSTH EVASC DESC THORAC AORTA RS&I
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
HCPCS 75958
|
| Min. Negotiated Rate |
$151.60 |
| Max. Negotiated Rate |
$246.35 |
| Rate for Payer: Aetna Medicare |
$189.50
|
| Rate for Payer: BCBS Complete |
$151.60
|
| Rate for Payer: Cash Price |
$303.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$246.35
|
|
|
CHG PROTHROMBIN TIME
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS 85610
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$7.15 |
| Rate for Payer: Aetna Commercial |
$5.75
|
| Rate for Payer: Aetna Medicare |
$4.29
|
| Rate for Payer: BCBS Complete |
$4.40
|
| Rate for Payer: BCBS MAPPO |
$4.29
|
| Rate for Payer: BCN Medicare Advantage |
$4.29
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cash Price |
$8.80
|
| Rate for Payer: Cofinity Commercial |
$6.18
|
| Rate for Payer: Cofinity Commercial |
$5.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.29
|
| Rate for Payer: Healthscope Commercial |
$5.15
|
| Rate for Payer: Healthscope Whirlpool |
$5.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.50
|
| Rate for Payer: Nomi Health Commercial |
$5.15
|
| Rate for Payer: PACE SWMI |
$4.29
|
| Rate for Payer: PHP Medicare Advantage |
$4.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.15
|
| Rate for Payer: Priority Health Medicare |
$4.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.29
|
| Rate for Payer: UHC Medicare Advantage |
$4.29
|
| Rate for Payer: UHCCP DNSP |
$4.29
|
|
|
CHG RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 73050
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$37.90 |
| Rate for Payer: Aetna Commercial |
$35.27
|
| Rate for Payer: Aetna Commercial |
$35.27
|
| Rate for Payer: Aetna Commercial |
$35.27
|
| Rate for Payer: Aetna Medicare |
$26.32
|
| Rate for Payer: Aetna Medicare |
$26.32
|
| Rate for Payer: Aetna Medicare |
$26.32
|
| Rate for Payer: BCBS Complete |
$15.20
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCBS Complete |
$28.40
|
| Rate for Payer: BCBS MAPPO |
$26.32
|
| Rate for Payer: BCBS MAPPO |
$26.32
|
| Rate for Payer: BCBS MAPPO |
$26.32
|
| Rate for Payer: BCN Medicare Advantage |
$26.32
|
| Rate for Payer: BCN Medicare Advantage |
$26.32
|
| Rate for Payer: BCN Medicare Advantage |
$26.32
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$30.40
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$35.27
|
| Rate for Payer: Cofinity Commercial |
$37.90
|
| Rate for Payer: Cofinity Commercial |
$37.90
|
| Rate for Payer: Cofinity Commercial |
$35.27
|
| Rate for Payer: Cofinity Commercial |
$37.90
|
| Rate for Payer: Cofinity Commercial |
$35.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.32
|
| Rate for Payer: Healthscope Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$31.58
|
| Rate for Payer: Healthscope Commercial |
$31.58
|
| Rate for Payer: Healthscope Whirlpool |
$31.58
|
| Rate for Payer: Healthscope Whirlpool |
$31.58
|
| Rate for Payer: Healthscope Whirlpool |
$31.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.64
|
| Rate for Payer: Nomi Health Commercial |
$31.58
|
| Rate for Payer: Nomi Health Commercial |
$31.58
|
| Rate for Payer: Nomi Health Commercial |
$31.58
|
| Rate for Payer: PACE SWMI |
$26.32
|
| Rate for Payer: PACE SWMI |
$26.32
|
| Rate for Payer: PACE SWMI |
$26.32
|
| Rate for Payer: PHP Medicare Advantage |
$26.32
|
| Rate for Payer: PHP Medicare Advantage |
$26.32
|
| Rate for Payer: PHP Medicare Advantage |
$26.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$46.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
| Rate for Payer: Priority Health Medicare |
$26.32
|
| Rate for Payer: Priority Health Medicare |
$26.32
|
| Rate for Payer: Priority Health Medicare |
$26.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.32
|
| Rate for Payer: UHC Medicare Advantage |
$26.32
|
| Rate for Payer: UHC Medicare Advantage |
$26.32
|
| Rate for Payer: UHC Medicare Advantage |
$26.32
|
| Rate for Payer: UHCCP DNSP |
$26.32
|
| Rate for Payer: UHCCP DNSP |
$26.32
|
| Rate for Payer: UHCCP DNSP |
$26.32
|
|
