|
CHG RP THERAPY INTRAVENOUS ADMINISTRATION
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
HCPCS 79101
|
| Min. Negotiated Rate |
$117.20 |
| Max. Negotiated Rate |
$194.11 |
| Rate for Payer: Aetna Commercial |
$180.63
|
| Rate for Payer: Aetna Commercial |
$180.63
|
| Rate for Payer: Aetna Medicare |
$134.80
|
| Rate for Payer: Aetna Medicare |
$134.80
|
| Rate for Payer: BCBS Complete |
$210.80
|
| Rate for Payer: BCBS Complete |
$117.20
|
| Rate for Payer: BCBS MAPPO |
$134.80
|
| Rate for Payer: BCBS MAPPO |
$134.80
|
| Rate for Payer: BCN Medicare Advantage |
$134.80
|
| Rate for Payer: BCN Medicare Advantage |
$134.80
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$234.40
|
| Rate for Payer: Cash Price |
$421.60
|
| Rate for Payer: Cofinity Commercial |
$180.63
|
| Rate for Payer: Cofinity Commercial |
$194.11
|
| Rate for Payer: Cofinity Commercial |
$180.63
|
| Rate for Payer: Cofinity Commercial |
$194.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$134.80
|
| Rate for Payer: Healthscope Commercial |
$161.76
|
| Rate for Payer: Healthscope Commercial |
$161.76
|
| Rate for Payer: Healthscope Whirlpool |
$161.76
|
| Rate for Payer: Healthscope Whirlpool |
$161.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$141.54
|
| Rate for Payer: Nomi Health Commercial |
$161.76
|
| Rate for Payer: Nomi Health Commercial |
$161.76
|
| Rate for Payer: PACE SWMI |
$134.80
|
| Rate for Payer: PACE SWMI |
$134.80
|
| Rate for Payer: PHP Medicare Advantage |
$134.80
|
| Rate for Payer: PHP Medicare Advantage |
$134.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$342.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$190.45
|
| Rate for Payer: Priority Health Medicare |
$134.80
|
| Rate for Payer: Priority Health Medicare |
$134.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$134.80
|
| Rate for Payer: UHC Medicare Advantage |
$134.80
|
| Rate for Payer: UHC Medicare Advantage |
$134.80
|
| Rate for Payer: UHCCP DNSP |
$134.80
|
| Rate for Payer: UHCCP DNSP |
$134.80
|
|
|
CHG RP THERAPY ORAL ADMINISTRATION
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 79005
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$179.99 |
| Rate for Payer: Aetna Commercial |
$167.49
|
| Rate for Payer: Aetna Commercial |
$167.49
|
| Rate for Payer: Aetna Medicare |
$124.99
|
| Rate for Payer: Aetna Medicare |
$124.99
|
| Rate for Payer: BCBS Complete |
$104.00
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: BCBS MAPPO |
$124.99
|
| Rate for Payer: BCBS MAPPO |
$124.99
|
| Rate for Payer: BCN Medicare Advantage |
$124.99
|
| Rate for Payer: BCN Medicare Advantage |
$124.99
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$208.00
|
| Rate for Payer: Cofinity Commercial |
$167.49
|
| Rate for Payer: Cofinity Commercial |
$179.99
|
| Rate for Payer: Cofinity Commercial |
$167.49
|
| Rate for Payer: Cofinity Commercial |
$179.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$124.99
|
| Rate for Payer: Healthscope Commercial |
$149.99
|
| Rate for Payer: Healthscope Commercial |
$149.99
|
| Rate for Payer: Healthscope Whirlpool |
$149.99
|
| Rate for Payer: Healthscope Whirlpool |
$149.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.24
|
| Rate for Payer: Nomi Health Commercial |
$149.99
|
| Rate for Payer: Nomi Health Commercial |
$149.99
|
| Rate for Payer: PACE SWMI |
$124.99
|
| Rate for Payer: PACE SWMI |
$124.99
|
| Rate for Payer: PHP Medicare Advantage |
$124.99
|
| Rate for Payer: PHP Medicare Advantage |
$124.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
| Rate for Payer: Priority Health Medicare |
$124.99
|
| Rate for Payer: Priority Health Medicare |
$124.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$124.99
|
| Rate for Payer: UHC Medicare Advantage |
$124.99
|
| Rate for Payer: UHC Medicare Advantage |
$124.99
|
| Rate for Payer: UHCCP DNSP |
$124.99
|
| Rate for Payer: UHCCP DNSP |
$124.99
|
|
|
CHG SALINE INFUS SONOHYSTEROGRAPHY W/COLOR DOPPLER
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 76831
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$156.00 |
| Rate for Payer: Aetna Commercial |
$138.27
|
| Rate for Payer: Aetna Medicare |
$103.19
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: BCBS MAPPO |
$103.19
|
| Rate for Payer: BCN Medicare Advantage |
$103.19
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$148.59
|
| Rate for Payer: Cofinity Commercial |
$138.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.19
|
| Rate for Payer: Healthscope Commercial |
$123.83
|
| Rate for Payer: Healthscope Whirlpool |
$123.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.35
|
| Rate for Payer: Nomi Health Commercial |
$123.83
|
| Rate for Payer: PACE SWMI |
$103.19
|
| Rate for Payer: PHP Medicare Advantage |
$103.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health Medicare |
$103.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.19
|
| Rate for Payer: UHC Medicare Advantage |
$103.19
|
| Rate for Payer: UHCCP DNSP |
$103.19
|
|
|
CHG SCREENING DIGITAL BREAST TOMOSYNTHESIS BI
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS 77063
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$69.48 |
| Rate for Payer: Aetna Commercial |
$64.66
|
| Rate for Payer: Aetna Medicare |
$48.25
|
| Rate for Payer: BCBS Complete |
$24.80
|
| Rate for Payer: BCBS MAPPO |
$48.25
|
| Rate for Payer: BCN Medicare Advantage |
$48.25
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cash Price |
$49.60
|
| Rate for Payer: Cofinity Commercial |
$69.48
|
| Rate for Payer: Cofinity Commercial |
$64.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.25
|
| Rate for Payer: Healthscope Commercial |
$57.90
|
| Rate for Payer: Healthscope Whirlpool |
$57.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.66
|
| Rate for Payer: Nomi Health Commercial |
$57.90
|
| Rate for Payer: PACE SWMI |
$48.25
|
| Rate for Payer: PHP Medicare Advantage |
$48.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$40.30
|
| Rate for Payer: Priority Health Medicare |
$48.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.25
|
| Rate for Payer: UHC Medicare Advantage |
$48.25
|
| Rate for Payer: UHCCP DNSP |
$48.25
|
|
|
CHG SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
HCPCS 77067
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$167.13 |
| Rate for Payer: Aetna Commercial |
$155.52
|
| Rate for Payer: Aetna Medicare |
$116.06
|
| Rate for Payer: BCBS Complete |
$31.60
|
| Rate for Payer: BCBS MAPPO |
$116.06
|
| Rate for Payer: BCN Medicare Advantage |
$116.06
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cash Price |
$63.20
|
| Rate for Payer: Cofinity Commercial |
$167.13
|
| Rate for Payer: Cofinity Commercial |
$155.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$116.06
|
| Rate for Payer: Healthscope Commercial |
$139.27
|
| Rate for Payer: Healthscope Whirlpool |
$139.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.86
|
| Rate for Payer: Nomi Health Commercial |
$139.27
|
| Rate for Payer: PACE SWMI |
$116.06
|
| Rate for Payer: PHP Medicare Advantage |
$116.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.35
|
| Rate for Payer: Priority Health Medicare |
$116.06
|
| Rate for Payer: UHC Dual Complete DSNP |
$116.06
|
| Rate for Payer: UHC Medicare Advantage |
$116.06
|
| Rate for Payer: UHCCP DNSP |
$116.06
|
|
|
CHG SEDIMENTATION RATE RBC NON-AUTOMATED
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 85651
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$6.15
|
| Rate for Payer: Cofinity Commercial |
$5.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$4.27
|
| Rate for Payer: Healthscope Commercial |
$5.12
|
| Rate for Payer: Healthscope Whirlpool |
$5.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.48
|
| Rate for Payer: Nomi Health Commercial |
$5.12
|
| Rate for Payer: PACE SWMI |
$4.27
|
| Rate for Payer: PHP Medicare Advantage |
$4.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$4.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$4.27
|
| Rate for Payer: UHC Medicare Advantage |
$4.27
|
| Rate for Payer: UHCCP DNSP |
$4.27
|
|
|
CHG SEMEN ALYS MOTILITY&CNT X W/HUHNER TST
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS 89310
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Aetna Commercial |
$11.54
|
| Rate for Payer: Aetna Medicare |
$8.61
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$8.61
|
| Rate for Payer: BCN Medicare Advantage |
$8.61
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$12.40
|
| Rate for Payer: Cofinity Commercial |
$11.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.61
|
| Rate for Payer: Healthscope Commercial |
$10.33
|
| Rate for Payer: Healthscope Whirlpool |
$10.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.04
|
| Rate for Payer: Nomi Health Commercial |
$10.33
|
| Rate for Payer: PACE SWMI |
$8.61
|
| Rate for Payer: PHP Medicare Advantage |
$8.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health Medicare |
$8.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.61
|
| Rate for Payer: UHC Medicare Advantage |
$8.61
|
| Rate for Payer: UHCCP DNSP |
$8.61
|
|
|
CHG SEMEN ALYS PRESENCE&/MOTILITY SPRM HUHNER
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 89300
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Aetna Commercial |
$13.19
|
| Rate for Payer: Aetna Medicare |
$9.84
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$9.84
|
| Rate for Payer: BCN Medicare Advantage |
$9.84
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$14.17
|
| Rate for Payer: Cofinity Commercial |
$13.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.84
|
| Rate for Payer: Healthscope Commercial |
$11.81
|
| Rate for Payer: Healthscope Whirlpool |
$11.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.33
|
| Rate for Payer: Nomi Health Commercial |
$11.81
|
| Rate for Payer: PACE SWMI |
$9.84
|
| Rate for Payer: PHP Medicare Advantage |
$9.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Medicare |
$9.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.84
|
| Rate for Payer: UHC Medicare Advantage |
$9.84
|
| Rate for Payer: UHCCP DNSP |
$9.84
|
|
|
CHG SEMEN ANALYSIS SPERM PRESENCE&/MOTILITY SPRM
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 89321
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$18.85 |
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Medicare |
$12.05
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS MAPPO |
$12.05
|
| Rate for Payer: BCN Medicare Advantage |
$12.05
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$17.35
|
| Rate for Payer: Cofinity Commercial |
$16.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.05
|
| Rate for Payer: Healthscope Commercial |
$14.46
|
| Rate for Payer: Healthscope Whirlpool |
$14.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.65
|
| Rate for Payer: Nomi Health Commercial |
$14.46
|
| Rate for Payer: PACE SWMI |
$12.05
|
| Rate for Payer: PHP Medicare Advantage |
$12.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Medicare |
$12.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.05
|
| Rate for Payer: UHC Medicare Advantage |
$12.05
|
| Rate for Payer: UHCCP DNSP |
$12.05
|
|
|
CHG SHUNTOGRAM INDWELLING NONVASCULAR SHUNT RS&I
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
HCPCS 75809
|
| Min. Negotiated Rate |
$73.30 |
| Max. Negotiated Rate |
$124.80 |
| Rate for Payer: Aetna Commercial |
$98.22
|
| Rate for Payer: Aetna Medicare |
$73.30
|
| Rate for Payer: BCBS Complete |
$76.80
|
| Rate for Payer: BCBS MAPPO |
$73.30
|
| Rate for Payer: BCN Medicare Advantage |
$73.30
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cofinity Commercial |
$98.22
|
| Rate for Payer: Cofinity Commercial |
$105.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$73.30
|
| Rate for Payer: Healthscope Commercial |
$87.96
|
| Rate for Payer: Healthscope Whirlpool |
$87.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.97
|
| Rate for Payer: Nomi Health Commercial |
$87.96
|
| Rate for Payer: PACE SWMI |
$73.30
|
| Rate for Payer: PHP Medicare Advantage |
$73.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.80
|
| Rate for Payer: Priority Health Medicare |
$73.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$73.30
|
| Rate for Payer: UHC Medicare Advantage |
$73.30
|
| Rate for Payer: UHCCP DNSP |
$73.30
|
|
|
CHG SKIN TEST TUBERCULOSIS INTRADERMAL
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
HCPCS 86580
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$12.86 |
| Rate for Payer: Aetna Commercial |
$11.97
|
| Rate for Payer: Aetna Medicare |
$8.93
|
| Rate for Payer: BCBS Complete |
$6.40
|
| Rate for Payer: BCBS MAPPO |
$8.93
|
| Rate for Payer: BCN Medicare Advantage |
$8.93
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Cofinity Commercial |
$12.86
|
| Rate for Payer: Cofinity Commercial |
$11.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$8.93
|
| Rate for Payer: Healthscope Commercial |
$10.72
|
| Rate for Payer: Healthscope Whirlpool |
$10.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$9.38
|
| Rate for Payer: Nomi Health Commercial |
$10.72
|
| Rate for Payer: PACE SWMI |
$8.93
|
| Rate for Payer: PHP Medicare Advantage |
$8.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.40
|
| Rate for Payer: Priority Health Medicare |
$8.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$8.93
|
| Rate for Payer: UHC Medicare Advantage |
$8.93
|
| Rate for Payer: UHCCP DNSP |
$8.93
|
|
|
CHG SMR PRIM SRC CPLX SPEC STAIN OVA&PARASITS
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
HCPCS 87209
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$31.85 |
| Rate for Payer: Aetna Commercial |
$24.09
|
| Rate for Payer: Aetna Medicare |
$17.98
|
| Rate for Payer: BCBS Complete |
$19.60
|
| Rate for Payer: BCBS MAPPO |
$17.98
|
| Rate for Payer: BCN Medicare Advantage |
$17.98
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cash Price |
$39.20
|
| Rate for Payer: Cofinity Commercial |
$25.89
|
| Rate for Payer: Cofinity Commercial |
$24.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$17.98
|
| Rate for Payer: Healthscope Commercial |
$21.58
|
| Rate for Payer: Healthscope Whirlpool |
$21.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$18.88
|
| Rate for Payer: Nomi Health Commercial |
$21.58
|
| Rate for Payer: PACE SWMI |
$17.98
|
| Rate for Payer: PHP Medicare Advantage |
$17.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.85
|
| Rate for Payer: Priority Health Medicare |
$17.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$17.98
|
| Rate for Payer: UHC Medicare Advantage |
$17.98
|
| Rate for Payer: UHCCP DNSP |
$17.98
|
|
|
CHG SMR PRIM SRC WET MOUNT NFCT AGT
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 87210
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Aetna Commercial |
$7.80
|
| Rate for Payer: Aetna Medicare |
$5.82
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCBS MAPPO |
$5.82
|
| Rate for Payer: BCN Medicare Advantage |
$5.82
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$8.38
|
| Rate for Payer: Cofinity Commercial |
$7.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.82
|
| Rate for Payer: Healthscope Commercial |
$6.98
|
| Rate for Payer: Healthscope Whirlpool |
$6.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.11
|
| Rate for Payer: Nomi Health Commercial |
$6.98
|
| Rate for Payer: PACE SWMI |
$5.82
|
| Rate for Payer: PHP Medicare Advantage |
$5.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.70
|
| Rate for Payer: Priority Health Medicare |
$5.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.82
|
| Rate for Payer: UHC Medicare Advantage |
$5.82
|
| Rate for Payer: UHCCP DNSP |
$5.82
|
|
|
CHG SONO GUIDE PERICARD TAP
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS 76930
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$78.65 |
| Rate for Payer: Aetna Medicare |
$60.50
|
| Rate for Payer: BCBS Complete |
$48.40
|
| Rate for Payer: Cash Price |
$96.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$78.65
|
|
|
CHG SONO GUIDE RAD THERAPY FIELDS
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
HCPCS 76950
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$89.70 |
| Rate for Payer: Aetna Medicare |
$69.00
|
| Rate for Payer: Aetna Medicare |
$37.50
|
| Rate for Payer: BCBS Complete |
$55.20
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$89.70
|
|
|
CHG SPEC DOSIM ONLY PRESCRIBED TREATING PHYS
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
HCPCS 77331
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$87.81 |
| Rate for Payer: Aetna Commercial |
$81.71
|
| Rate for Payer: Aetna Commercial |
$81.71
|
| Rate for Payer: Aetna Medicare |
$60.98
|
| Rate for Payer: Aetna Medicare |
$60.98
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS Complete |
$50.00
|
| Rate for Payer: BCBS MAPPO |
$60.98
|
| Rate for Payer: BCBS MAPPO |
$60.98
|
| Rate for Payer: BCN Medicare Advantage |
$60.98
|
| Rate for Payer: BCN Medicare Advantage |
$60.98
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$100.00
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$81.71
|
| Rate for Payer: Cofinity Commercial |
$87.81
|
| Rate for Payer: Cofinity Commercial |
$81.71
|
| Rate for Payer: Cofinity Commercial |
$87.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.98
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.98
|
| Rate for Payer: Healthscope Commercial |
$73.18
|
| Rate for Payer: Healthscope Commercial |
$73.18
|
| Rate for Payer: Healthscope Whirlpool |
$73.18
|
| Rate for Payer: Healthscope Whirlpool |
$73.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.03
|
| Rate for Payer: Nomi Health Commercial |
$73.18
|
| Rate for Payer: Nomi Health Commercial |
$73.18
|
| Rate for Payer: PACE SWMI |
$60.98
|
| Rate for Payer: PACE SWMI |
$60.98
|
| Rate for Payer: PHP Medicare Advantage |
$60.98
|
| Rate for Payer: PHP Medicare Advantage |
$60.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$81.25
|
| Rate for Payer: Priority Health Medicare |
$60.98
|
| Rate for Payer: Priority Health Medicare |
$60.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.98
|
| Rate for Payer: UHC Medicare Advantage |
$60.98
|
| Rate for Payer: UHC Medicare Advantage |
$60.98
|
| Rate for Payer: UHCCP DNSP |
$60.98
|
| Rate for Payer: UHCCP DNSP |
$60.98
|
|
|
CHG SPECIAL TREATMENT PROCEDURE
|
Professional
|
Both
|
$532.00
|
|
|
Service Code
|
HCPCS 77470
|
| Min. Negotiated Rate |
$136.35 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$182.71
|
| Rate for Payer: Aetna Commercial |
$182.71
|
| Rate for Payer: Aetna Medicare |
$136.35
|
| Rate for Payer: Aetna Medicare |
$136.35
|
| Rate for Payer: BCBS Complete |
$282.00
|
| Rate for Payer: BCBS Complete |
$212.80
|
| Rate for Payer: BCBS MAPPO |
$136.35
|
| Rate for Payer: BCBS MAPPO |
$136.35
|
| Rate for Payer: BCN Medicare Advantage |
$136.35
|
| Rate for Payer: BCN Medicare Advantage |
$136.35
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$425.60
|
| Rate for Payer: Cash Price |
$564.00
|
| Rate for Payer: Cofinity Commercial |
$182.71
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Cofinity Commercial |
$182.71
|
| Rate for Payer: Cofinity Commercial |
$196.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$136.35
|
| Rate for Payer: Healthscope Commercial |
$163.62
|
| Rate for Payer: Healthscope Commercial |
$163.62
|
| Rate for Payer: Healthscope Whirlpool |
$163.62
|
| Rate for Payer: Healthscope Whirlpool |
$163.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$143.17
|
| Rate for Payer: Nomi Health Commercial |
$163.62
|
| Rate for Payer: Nomi Health Commercial |
$163.62
|
| Rate for Payer: PACE SWMI |
$136.35
|
| Rate for Payer: PACE SWMI |
$136.35
|
| Rate for Payer: PHP Medicare Advantage |
$136.35
|
| Rate for Payer: PHP Medicare Advantage |
$136.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$458.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$345.80
|
| Rate for Payer: Priority Health Medicare |
$136.35
|
| Rate for Payer: Priority Health Medicare |
$136.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$136.35
|
| Rate for Payer: UHC Medicare Advantage |
$136.35
|
| Rate for Payer: UHC Medicare Advantage |
$136.35
|
| Rate for Payer: UHCCP DNSP |
$136.35
|
| Rate for Payer: UHCCP DNSP |
$136.35
|
|
|
CHG SPEC MEDICAL RADJ PHYSICS CONSLTJ
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
HCPCS 77370
|
| Min. Negotiated Rate |
$86.40 |
| Max. Negotiated Rate |
$192.90 |
| Rate for Payer: Aetna Commercial |
$179.51
|
| Rate for Payer: Aetna Medicare |
$133.96
|
| Rate for Payer: BCBS Complete |
$86.40
|
| Rate for Payer: BCBS MAPPO |
$133.96
|
| Rate for Payer: BCN Medicare Advantage |
$133.96
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cash Price |
$172.80
|
| Rate for Payer: Cofinity Commercial |
$192.90
|
| Rate for Payer: Cofinity Commercial |
$179.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$133.96
|
| Rate for Payer: Healthscope Commercial |
$160.75
|
| Rate for Payer: Healthscope Whirlpool |
$160.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$140.66
|
| Rate for Payer: Nomi Health Commercial |
$160.75
|
| Rate for Payer: PACE SWMI |
$133.96
|
| Rate for Payer: PHP Medicare Advantage |
$133.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$140.40
|
| Rate for Payer: Priority Health Medicare |
$133.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$133.96
|
| Rate for Payer: UHC Medicare Advantage |
$133.96
|
| Rate for Payer: UHCCP DNSP |
$133.96
|
|
|
CHG SPEC TELETHX PORT PLN PARTS HEMIBDY TOT BDY
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 77321
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$131.95 |
| Rate for Payer: Aetna Commercial |
$117.17
|
| Rate for Payer: Aetna Commercial |
$117.17
|
| Rate for Payer: Aetna Medicare |
$87.44
|
| Rate for Payer: Aetna Medicare |
$87.44
|
| Rate for Payer: BCBS Complete |
$81.20
|
| Rate for Payer: BCBS Complete |
$112.80
|
| Rate for Payer: BCBS MAPPO |
$87.44
|
| Rate for Payer: BCBS MAPPO |
$87.44
|
| Rate for Payer: BCN Medicare Advantage |
$87.44
|
| Rate for Payer: BCN Medicare Advantage |
$87.44
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$117.17
|
| Rate for Payer: Cofinity Commercial |
$125.91
|
| Rate for Payer: Cofinity Commercial |
$117.17
|
| Rate for Payer: Cofinity Commercial |
$125.91
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.44
|
| Rate for Payer: Healthscope Commercial |
$104.93
|
| Rate for Payer: Healthscope Commercial |
$104.93
|
| Rate for Payer: Healthscope Whirlpool |
$104.93
|
| Rate for Payer: Healthscope Whirlpool |
$104.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$91.81
|
| Rate for Payer: Nomi Health Commercial |
$104.93
|
| Rate for Payer: Nomi Health Commercial |
$104.93
|
| Rate for Payer: PACE SWMI |
$87.44
|
| Rate for Payer: PACE SWMI |
$87.44
|
| Rate for Payer: PHP Medicare Advantage |
$87.44
|
| Rate for Payer: PHP Medicare Advantage |
$87.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$183.30
|
| Rate for Payer: Priority Health Medicare |
$87.44
|
| Rate for Payer: Priority Health Medicare |
$87.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.44
|
| Rate for Payer: UHC Medicare Advantage |
$87.44
|
| Rate for Payer: UHC Medicare Advantage |
$87.44
|
| Rate for Payer: UHCCP DNSP |
$87.44
|
| Rate for Payer: UHCCP DNSP |
$87.44
|
|
|
CHG STEREOSCOPIC X-RAY GUIDANCE
|
Professional
|
Both
|
$206.00
|
|
|
Service Code
|
HCPCS 77421
|
| Min. Negotiated Rate |
$82.40 |
| Max. Negotiated Rate |
$133.90 |
| Rate for Payer: Aetna Medicare |
$103.00
|
| Rate for Payer: Aetna Medicare |
$87.00
|
| Rate for Payer: BCBS Complete |
$69.60
|
| Rate for Payer: BCBS Complete |
$82.40
|
| Rate for Payer: Cash Price |
$139.20
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.10
|
|
|
CHG STEREOTACTIC BODY RADIATION MANAGEMENT
|
Professional
|
Both
|
$1,261.00
|
|
|
Service Code
|
HCPCS 77435
|
| Min. Negotiated Rate |
$504.40 |
| Max. Negotiated Rate |
$886.19 |
| Rate for Payer: Aetna Commercial |
$824.65
|
| Rate for Payer: Aetna Medicare |
$615.41
|
| Rate for Payer: BCBS Complete |
$504.40
|
| Rate for Payer: BCBS MAPPO |
$615.41
|
| Rate for Payer: BCN Medicare Advantage |
$615.41
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Cash Price |
$1,008.80
|
| Rate for Payer: Cofinity Commercial |
$886.19
|
| Rate for Payer: Cofinity Commercial |
$824.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$615.41
|
| Rate for Payer: Healthscope Commercial |
$738.49
|
| Rate for Payer: Healthscope Whirlpool |
$738.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$646.18
|
| Rate for Payer: Nomi Health Commercial |
$738.49
|
| Rate for Payer: PACE SWMI |
$615.41
|
| Rate for Payer: PHP Medicare Advantage |
$615.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$819.65
|
| Rate for Payer: Priority Health Medicare |
$615.41
|
| Rate for Payer: UHC Dual Complete DSNP |
$615.41
|
| Rate for Payer: UHC Medicare Advantage |
$615.41
|
| Rate for Payer: UHCCP DNSP |
$615.41
|
|
|
CHG STEREOTACTIC BODY RADIATION TREATMENT DELIVERY
|
Professional
|
Both
|
$2,706.00
|
|
|
Service Code
|
HCPCS 77373
|
| Min. Negotiated Rate |
$867.16 |
| Max. Negotiated Rate |
$1,758.90 |
| Rate for Payer: Aetna Commercial |
$1,161.99
|
| Rate for Payer: Aetna Medicare |
$867.16
|
| Rate for Payer: BCBS Complete |
$1,082.40
|
| Rate for Payer: BCBS MAPPO |
$867.16
|
| Rate for Payer: BCN Medicare Advantage |
$867.16
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cash Price |
$2,164.80
|
| Rate for Payer: Cofinity Commercial |
$1,248.71
|
| Rate for Payer: Cofinity Commercial |
$1,161.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$867.16
|
| Rate for Payer: Healthscope Commercial |
$1,040.59
|
| Rate for Payer: Healthscope Whirlpool |
$1,040.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$910.52
|
| Rate for Payer: Nomi Health Commercial |
$1,040.59
|
| Rate for Payer: PACE SWMI |
$867.16
|
| Rate for Payer: PHP Medicare Advantage |
$867.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,758.90
|
| Rate for Payer: Priority Health Medicare |
$867.16
|
| Rate for Payer: UHC Dual Complete DSNP |
$867.16
|
| Rate for Payer: UHC Medicare Advantage |
$867.16
|
| Rate for Payer: UHCCP DNSP |
$867.16
|
|
|
CHG STERETCTC RADIATION TX MANAGEMENT CRANIAL LESION
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 77432
|
| Min. Negotiated Rate |
$348.80 |
| Max. Negotiated Rate |
$587.06 |
| Rate for Payer: Aetna Commercial |
$546.29
|
| Rate for Payer: Aetna Medicare |
$407.68
|
| Rate for Payer: BCBS Complete |
$348.80
|
| Rate for Payer: BCBS MAPPO |
$407.68
|
| Rate for Payer: BCN Medicare Advantage |
$407.68
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Cofinity Commercial |
$587.06
|
| Rate for Payer: Cofinity Commercial |
$546.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$407.68
|
| Rate for Payer: Healthscope Commercial |
$489.22
|
| Rate for Payer: Healthscope Whirlpool |
$489.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$428.06
|
| Rate for Payer: Nomi Health Commercial |
$489.22
|
| Rate for Payer: PACE SWMI |
$407.68
|
| Rate for Payer: PHP Medicare Advantage |
$407.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.80
|
| Rate for Payer: Priority Health Medicare |
$407.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$407.68
|
| Rate for Payer: UHC Medicare Advantage |
$407.68
|
| Rate for Payer: UHCCP DNSP |
$407.68
|
|
|
CHG SUPERVISION HANDLING LOADING RADIATION SOURCE
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
HCPCS 77790
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$122.20 |
| Rate for Payer: Aetna Commercial |
$22.74
|
| Rate for Payer: Aetna Commercial |
$22.74
|
| Rate for Payer: Aetna Medicare |
$16.97
|
| Rate for Payer: Aetna Medicare |
$16.97
|
| Rate for Payer: BCBS Complete |
$75.20
|
| Rate for Payer: BCBS Complete |
$32.40
|
| Rate for Payer: BCBS MAPPO |
$16.97
|
| Rate for Payer: BCBS MAPPO |
$16.97
|
| Rate for Payer: BCN Medicare Advantage |
$16.97
|
| Rate for Payer: BCN Medicare Advantage |
$16.97
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$150.40
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cofinity Commercial |
$22.74
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Cofinity Commercial |
$22.74
|
| Rate for Payer: Cofinity Commercial |
$24.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.97
|
| Rate for Payer: Healthscope Commercial |
$20.36
|
| Rate for Payer: Healthscope Commercial |
$20.36
|
| Rate for Payer: Healthscope Whirlpool |
$20.36
|
| Rate for Payer: Healthscope Whirlpool |
$20.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.82
|
| Rate for Payer: Nomi Health Commercial |
$20.36
|
| Rate for Payer: Nomi Health Commercial |
$20.36
|
| Rate for Payer: PACE SWMI |
$16.97
|
| Rate for Payer: PACE SWMI |
$16.97
|
| Rate for Payer: PHP Medicare Advantage |
$16.97
|
| Rate for Payer: PHP Medicare Advantage |
$16.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$52.65
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: Priority Health Medicare |
$16.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.97
|
| Rate for Payer: UHC Medicare Advantage |
$16.97
|
| Rate for Payer: UHC Medicare Advantage |
$16.97
|
| Rate for Payer: UHCCP DNSP |
$16.97
|
| Rate for Payer: UHCCP DNSP |
$16.97
|
|
|
CHG TBS TECHNICAL CALCULATION ONLY
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
HCPCS 77091
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$37.70 |
| Rate for Payer: Aetna Commercial |
$32.49
|
| Rate for Payer: Aetna Medicare |
$24.25
|
| Rate for Payer: BCBS Complete |
$23.20
|
| Rate for Payer: BCBS MAPPO |
$24.25
|
| Rate for Payer: BCN Medicare Advantage |
$24.25
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cash Price |
$46.40
|
| Rate for Payer: Cofinity Commercial |
$34.92
|
| Rate for Payer: Cofinity Commercial |
$32.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.25
|
| Rate for Payer: Healthscope Commercial |
$29.10
|
| Rate for Payer: Healthscope Whirlpool |
$29.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.46
|
| Rate for Payer: Nomi Health Commercial |
$29.10
|
| Rate for Payer: PACE SWMI |
$24.25
|
| Rate for Payer: PHP Medicare Advantage |
$24.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$37.70
|
| Rate for Payer: Priority Health Medicare |
$24.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.25
|
| Rate for Payer: UHC Medicare Advantage |
$24.25
|
| Rate for Payer: UHCCP DNSP |
$24.25
|
|
