|
CHG TELETHER ISODOSE PLAN COMPLX
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 77315
|
| Min. Negotiated Rate |
$58.00 |
| Max. Negotiated Rate |
$94.25 |
| Rate for Payer: Aetna Medicare |
$72.50
|
| Rate for Payer: Aetna Medicare |
$137.00
|
| Rate for Payer: BCBS Complete |
$58.00
|
| Rate for Payer: BCBS Complete |
$109.60
|
| Rate for Payer: Cash Price |
$219.20
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$178.10
|
|
|
CHG TELETHER ISODOSE PLAN SIMPLE
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
HCPCS 77305
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$63.05 |
| Rate for Payer: Aetna Medicare |
$48.50
|
| Rate for Payer: Aetna Medicare |
$77.50
|
| Rate for Payer: BCBS Complete |
$38.80
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$77.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
|
|
CHG TELETHX ISODOSE PLN CPLX W/BASIC DOSIMETRY
|
Professional
|
Both
|
$439.00
|
|
|
Service Code
|
HCPCS 77307
|
| Min. Negotiated Rate |
$175.60 |
| Max. Negotiated Rate |
$385.82 |
| Rate for Payer: Aetna Commercial |
$359.03
|
| Rate for Payer: Aetna Commercial |
$359.03
|
| Rate for Payer: Aetna Medicare |
$267.93
|
| Rate for Payer: Aetna Medicare |
$267.93
|
| Rate for Payer: BCBS Complete |
$335.20
|
| Rate for Payer: BCBS Complete |
$175.60
|
| Rate for Payer: BCBS MAPPO |
$267.93
|
| Rate for Payer: BCBS MAPPO |
$267.93
|
| Rate for Payer: BCN Medicare Advantage |
$267.93
|
| Rate for Payer: BCN Medicare Advantage |
$267.93
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cash Price |
$351.20
|
| Rate for Payer: Cash Price |
$670.40
|
| Rate for Payer: Cofinity Commercial |
$359.03
|
| Rate for Payer: Cofinity Commercial |
$385.82
|
| Rate for Payer: Cofinity Commercial |
$359.03
|
| Rate for Payer: Cofinity Commercial |
$385.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$267.93
|
| Rate for Payer: Healthscope Commercial |
$321.52
|
| Rate for Payer: Healthscope Commercial |
$321.52
|
| Rate for Payer: Healthscope Whirlpool |
$321.52
|
| Rate for Payer: Healthscope Whirlpool |
$321.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$281.33
|
| Rate for Payer: Nomi Health Commercial |
$321.52
|
| Rate for Payer: Nomi Health Commercial |
$321.52
|
| Rate for Payer: PACE SWMI |
$267.93
|
| Rate for Payer: PACE SWMI |
$267.93
|
| Rate for Payer: PHP Medicare Advantage |
$267.93
|
| Rate for Payer: PHP Medicare Advantage |
$267.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$544.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.35
|
| Rate for Payer: Priority Health Medicare |
$267.93
|
| Rate for Payer: Priority Health Medicare |
$267.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$267.93
|
| Rate for Payer: UHC Medicare Advantage |
$267.93
|
| Rate for Payer: UHC Medicare Advantage |
$267.93
|
| Rate for Payer: UHCCP DNSP |
$267.93
|
| Rate for Payer: UHCCP DNSP |
$267.93
|
|
|
CHG TELETHX ISODOSE PLN SMPL W/DOSIMETRY CALCULATION
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
HCPCS 77306
|
| Min. Negotiated Rate |
$93.20 |
| Max. Negotiated Rate |
$197.61 |
| Rate for Payer: Aetna Commercial |
$183.89
|
| Rate for Payer: Aetna Commercial |
$183.89
|
| Rate for Payer: Aetna Medicare |
$137.23
|
| Rate for Payer: Aetna Medicare |
$137.23
|
| Rate for Payer: BCBS Complete |
$158.40
|
| Rate for Payer: BCBS Complete |
$93.20
|
| Rate for Payer: BCBS MAPPO |
$137.23
|
| Rate for Payer: BCBS MAPPO |
$137.23
|
| Rate for Payer: BCN Medicare Advantage |
$137.23
|
| Rate for Payer: BCN Medicare Advantage |
$137.23
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$186.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cofinity Commercial |
$183.89
|
| Rate for Payer: Cofinity Commercial |
$197.61
|
| Rate for Payer: Cofinity Commercial |
$183.89
|
| Rate for Payer: Cofinity Commercial |
$197.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$137.23
|
| Rate for Payer: Healthscope Commercial |
$164.68
|
| Rate for Payer: Healthscope Commercial |
$164.68
|
| Rate for Payer: Healthscope Whirlpool |
$164.68
|
| Rate for Payer: Healthscope Whirlpool |
$164.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$144.09
|
| Rate for Payer: Nomi Health Commercial |
$164.68
|
| Rate for Payer: Nomi Health Commercial |
$164.68
|
| Rate for Payer: PACE SWMI |
$137.23
|
| Rate for Payer: PACE SWMI |
$137.23
|
| Rate for Payer: PHP Medicare Advantage |
$137.23
|
| Rate for Payer: PHP Medicare Advantage |
$137.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$257.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$151.45
|
| Rate for Payer: Priority Health Medicare |
$137.23
|
| Rate for Payer: Priority Health Medicare |
$137.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$137.23
|
| Rate for Payer: UHC Medicare Advantage |
$137.23
|
| Rate for Payer: UHC Medicare Advantage |
$137.23
|
| Rate for Payer: UHCCP DNSP |
$137.23
|
| Rate for Payer: UHCCP DNSP |
$137.23
|
|
|
CHG THERAPEUTIC ENEMA RDCTJ INTUSSUSCEPTION/OBSTRCJ
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
HCPCS 74283
|
| Min. Negotiated Rate |
$110.80 |
| Max. Negotiated Rate |
$340.27 |
| Rate for Payer: Aetna Commercial |
$316.64
|
| Rate for Payer: Aetna Medicare |
$236.30
|
| Rate for Payer: BCBS Complete |
$110.80
|
| Rate for Payer: BCBS MAPPO |
$236.30
|
| Rate for Payer: BCN Medicare Advantage |
$236.30
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cash Price |
$221.60
|
| Rate for Payer: Cofinity Commercial |
$340.27
|
| Rate for Payer: Cofinity Commercial |
$316.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$236.30
|
| Rate for Payer: Healthscope Commercial |
$283.56
|
| Rate for Payer: Healthscope Whirlpool |
$283.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$248.12
|
| Rate for Payer: Nomi Health Commercial |
$283.56
|
| Rate for Payer: PACE SWMI |
$236.30
|
| Rate for Payer: PHP Medicare Advantage |
$236.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$180.05
|
| Rate for Payer: Priority Health Medicare |
$236.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$236.30
|
| Rate for Payer: UHC Medicare Advantage |
$236.30
|
| Rate for Payer: UHCCP DNSP |
$236.30
|
|
|
CHG THERAPEUTIC RADIOLOGY PORT IMAGE(S)
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
HCPCS 77417
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$22.10 |
| Rate for Payer: Aetna Commercial |
$19.58
|
| Rate for Payer: Aetna Medicare |
$14.61
|
| Rate for Payer: BCBS Complete |
$13.60
|
| Rate for Payer: BCBS MAPPO |
$14.61
|
| Rate for Payer: BCN Medicare Advantage |
$14.61
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cash Price |
$27.20
|
| Rate for Payer: Cofinity Commercial |
$21.04
|
| Rate for Payer: Cofinity Commercial |
$19.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$14.61
|
| Rate for Payer: Healthscope Commercial |
$17.53
|
| Rate for Payer: Healthscope Whirlpool |
$17.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$15.34
|
| Rate for Payer: Nomi Health Commercial |
$17.53
|
| Rate for Payer: PACE SWMI |
$14.61
|
| Rate for Payer: PHP Medicare Advantage |
$14.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$22.10
|
| Rate for Payer: Priority Health Medicare |
$14.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$14.61
|
| Rate for Payer: UHC Medicare Advantage |
$14.61
|
| Rate for Payer: UHCCP DNSP |
$14.61
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING COMPLEX
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 77263
|
| Min. Negotiated Rate |
$120.80 |
| Max. Negotiated Rate |
$232.36 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Medicare |
$161.36
|
| Rate for Payer: BCBS Complete |
$120.80
|
| Rate for Payer: BCBS MAPPO |
$161.36
|
| Rate for Payer: BCN Medicare Advantage |
$161.36
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$232.36
|
| Rate for Payer: Cofinity Commercial |
$216.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$161.36
|
| Rate for Payer: Healthscope Commercial |
$193.63
|
| Rate for Payer: Healthscope Whirlpool |
$193.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$169.43
|
| Rate for Payer: Nomi Health Commercial |
$193.63
|
| Rate for Payer: PACE SWMI |
$161.36
|
| Rate for Payer: PHP Medicare Advantage |
$161.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$196.30
|
| Rate for Payer: Priority Health Medicare |
$161.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$161.36
|
| Rate for Payer: UHC Medicare Advantage |
$161.36
|
| Rate for Payer: UHCCP DNSP |
$161.36
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING INTERMEDIATE
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
HCPCS 77262
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$149.05 |
| Rate for Payer: Aetna Commercial |
$138.70
|
| Rate for Payer: Aetna Medicare |
$103.51
|
| Rate for Payer: BCBS Complete |
$80.80
|
| Rate for Payer: BCBS MAPPO |
$103.51
|
| Rate for Payer: BCN Medicare Advantage |
$103.51
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cash Price |
$161.60
|
| Rate for Payer: Cofinity Commercial |
$149.05
|
| Rate for Payer: Cofinity Commercial |
$138.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$103.51
|
| Rate for Payer: Healthscope Commercial |
$124.21
|
| Rate for Payer: Healthscope Whirlpool |
$124.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$108.69
|
| Rate for Payer: Nomi Health Commercial |
$124.21
|
| Rate for Payer: PACE SWMI |
$103.51
|
| Rate for Payer: PHP Medicare Advantage |
$103.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$131.30
|
| Rate for Payer: Priority Health Medicare |
$103.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$103.51
|
| Rate for Payer: UHC Medicare Advantage |
$103.51
|
| Rate for Payer: UHCCP DNSP |
$103.51
|
|
|
CHG THERAPEUTIC RADIOLOGY TX PLANNING SIMPLE
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS 77261
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$96.08 |
| Rate for Payer: Aetna Commercial |
$89.40
|
| Rate for Payer: Aetna Medicare |
$66.72
|
| Rate for Payer: BCBS Complete |
$54.00
|
| Rate for Payer: BCBS MAPPO |
$66.72
|
| Rate for Payer: BCN Medicare Advantage |
$66.72
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cofinity Commercial |
$96.08
|
| Rate for Payer: Cofinity Commercial |
$89.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.72
|
| Rate for Payer: Healthscope Commercial |
$80.06
|
| Rate for Payer: Healthscope Whirlpool |
$80.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.06
|
| Rate for Payer: Nomi Health Commercial |
$80.06
|
| Rate for Payer: PACE SWMI |
$66.72
|
| Rate for Payer: PHP Medicare Advantage |
$66.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$87.75
|
| Rate for Payer: Priority Health Medicare |
$66.72
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.72
|
| Rate for Payer: UHC Medicare Advantage |
$66.72
|
| Rate for Payer: UHCCP DNSP |
$66.72
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING COMPLEX
|
Professional
|
Both
|
$803.00
|
|
|
Service Code
|
HCPCS 77290
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$568.54 |
| Rate for Payer: Aetna Commercial |
$529.06
|
| Rate for Payer: Aetna Commercial |
$529.06
|
| Rate for Payer: Aetna Medicare |
$394.82
|
| Rate for Payer: Aetna Medicare |
$394.82
|
| Rate for Payer: BCBS Complete |
$321.20
|
| Rate for Payer: BCBS Complete |
$385.60
|
| Rate for Payer: BCBS MAPPO |
$394.82
|
| Rate for Payer: BCBS MAPPO |
$394.82
|
| Rate for Payer: BCN Medicare Advantage |
$394.82
|
| Rate for Payer: BCN Medicare Advantage |
$394.82
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cash Price |
$642.40
|
| Rate for Payer: Cash Price |
$771.20
|
| Rate for Payer: Cofinity Commercial |
$529.06
|
| Rate for Payer: Cofinity Commercial |
$568.54
|
| Rate for Payer: Cofinity Commercial |
$529.06
|
| Rate for Payer: Cofinity Commercial |
$568.54
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$394.82
|
| Rate for Payer: Healthscope Commercial |
$473.78
|
| Rate for Payer: Healthscope Commercial |
$473.78
|
| Rate for Payer: Healthscope Whirlpool |
$473.78
|
| Rate for Payer: Healthscope Whirlpool |
$473.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$414.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$414.56
|
| Rate for Payer: Nomi Health Commercial |
$473.78
|
| Rate for Payer: Nomi Health Commercial |
$473.78
|
| Rate for Payer: PACE SWMI |
$394.82
|
| Rate for Payer: PACE SWMI |
$394.82
|
| Rate for Payer: PHP Medicare Advantage |
$394.82
|
| Rate for Payer: PHP Medicare Advantage |
$394.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$521.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$626.60
|
| Rate for Payer: Priority Health Medicare |
$394.82
|
| Rate for Payer: Priority Health Medicare |
$394.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$394.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$394.82
|
| Rate for Payer: UHC Medicare Advantage |
$394.82
|
| Rate for Payer: UHC Medicare Advantage |
$394.82
|
| Rate for Payer: UHCCP DNSP |
$394.82
|
| Rate for Payer: UHCCP DNSP |
$394.82
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING INTERMED
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 77285
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$571.15 |
| Rate for Payer: Aetna Commercial |
$531.48
|
| Rate for Payer: Aetna Medicare |
$396.63
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$396.63
|
| Rate for Payer: BCN Medicare Advantage |
$396.63
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$571.15
|
| Rate for Payer: Cofinity Commercial |
$531.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$396.63
|
| Rate for Payer: Healthscope Commercial |
$475.96
|
| Rate for Payer: Healthscope Whirlpool |
$475.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$416.46
|
| Rate for Payer: Nomi Health Commercial |
$475.96
|
| Rate for Payer: PACE SWMI |
$396.63
|
| Rate for Payer: PHP Medicare Advantage |
$396.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$396.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$396.63
|
| Rate for Payer: UHC Medicare Advantage |
$396.63
|
| Rate for Payer: UHCCP DNSP |
$396.63
|
|
|
CHG THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE
|
Professional
|
Both
|
$444.00
|
|
|
Service Code
|
HCPCS 77280
|
| Min. Negotiated Rate |
$177.60 |
| Max. Negotiated Rate |
$344.68 |
| Rate for Payer: Aetna Commercial |
$320.74
|
| Rate for Payer: Aetna Commercial |
$320.74
|
| Rate for Payer: Aetna Medicare |
$239.36
|
| Rate for Payer: Aetna Medicare |
$239.36
|
| Rate for Payer: BCBS Complete |
$177.60
|
| Rate for Payer: BCBS Complete |
$206.00
|
| Rate for Payer: BCBS MAPPO |
$239.36
|
| Rate for Payer: BCBS MAPPO |
$239.36
|
| Rate for Payer: BCN Medicare Advantage |
$239.36
|
| Rate for Payer: BCN Medicare Advantage |
$239.36
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cash Price |
$355.20
|
| Rate for Payer: Cash Price |
$412.00
|
| Rate for Payer: Cofinity Commercial |
$320.74
|
| Rate for Payer: Cofinity Commercial |
$344.68
|
| Rate for Payer: Cofinity Commercial |
$320.74
|
| Rate for Payer: Cofinity Commercial |
$344.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$239.36
|
| Rate for Payer: Healthscope Commercial |
$287.23
|
| Rate for Payer: Healthscope Commercial |
$287.23
|
| Rate for Payer: Healthscope Whirlpool |
$287.23
|
| Rate for Payer: Healthscope Whirlpool |
$287.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$251.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$251.33
|
| Rate for Payer: Nomi Health Commercial |
$287.23
|
| Rate for Payer: Nomi Health Commercial |
$287.23
|
| Rate for Payer: PACE SWMI |
$239.36
|
| Rate for Payer: PACE SWMI |
$239.36
|
| Rate for Payer: PHP Medicare Advantage |
$239.36
|
| Rate for Payer: PHP Medicare Advantage |
$239.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$288.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$334.75
|
| Rate for Payer: Priority Health Medicare |
$239.36
|
| Rate for Payer: Priority Health Medicare |
$239.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$239.36
|
| Rate for Payer: UHC Medicare Advantage |
$239.36
|
| Rate for Payer: UHC Medicare Advantage |
$239.36
|
| Rate for Payer: UHCCP DNSP |
$239.36
|
| Rate for Payer: UHCCP DNSP |
$239.36
|
|
|
CHG TISS CUL NON-NEO DISORDERS SKN/OTH SOLID TISS BX
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
HCPCS 88233
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$202.65 |
| Rate for Payer: Aetna Commercial |
$188.58
|
| Rate for Payer: Aetna Medicare |
$140.73
|
| Rate for Payer: BCBS Complete |
$119.60
|
| Rate for Payer: BCBS MAPPO |
$140.73
|
| Rate for Payer: BCN Medicare Advantage |
$140.73
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cash Price |
$239.20
|
| Rate for Payer: Cofinity Commercial |
$202.65
|
| Rate for Payer: Cofinity Commercial |
$188.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$140.73
|
| Rate for Payer: Healthscope Commercial |
$168.88
|
| Rate for Payer: Healthscope Whirlpool |
$168.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$147.77
|
| Rate for Payer: Nomi Health Commercial |
$168.88
|
| Rate for Payer: PACE SWMI |
$140.73
|
| Rate for Payer: PHP Medicare Advantage |
$140.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$194.35
|
| Rate for Payer: Priority Health Medicare |
$140.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$140.73
|
| Rate for Payer: UHC Medicare Advantage |
$140.73
|
| Rate for Payer: UHCCP DNSP |
$140.73
|
|
|
CHG TISS KOH SLIDE SAMPS SKN/HR/NLS FNGI/ECTOPARASIT
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS 87220
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$14.30 |
| Rate for Payer: Aetna Commercial |
$5.72
|
| Rate for Payer: Aetna Medicare |
$4.27
|
| Rate for Payer: BCBS Complete |
$8.80
|
| Rate for Payer: BCBS MAPPO |
$4.27
|
| Rate for Payer: BCN Medicare Advantage |
$4.27
|
| Rate for Payer: Cash Price |
$17.60
|
| Rate for Payer: Cash Price |
$17.60
|
| 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 |
$14.30
|
| 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 TRANSCATHETER EMBOLIZATION ANY METH RS&I
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS 75894
|
| Min. Negotiated Rate |
$143.60 |
| Max. Negotiated Rate |
$233.35 |
| Rate for Payer: Aetna Medicare |
$179.50
|
| Rate for Payer: BCBS Complete |
$143.60
|
| Rate for Payer: Cash Price |
$287.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$233.35
|
|
|
CHG TRANSCATHETER INFUSION OTHER THAN THROMBOLYSIS
|
Professional
|
Both
|
$284.00
|
|
|
Service Code
|
HCPCS 75896
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$184.60 |
| Rate for Payer: Aetna Medicare |
$142.00
|
| Rate for Payer: BCBS Complete |
$113.60
|
| Rate for Payer: Cash Price |
$227.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$184.60
|
|
|
CHG TRANSFERASE ALANINE AMINO ALT SGPT
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 84460
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Aetna Commercial |
$7.10
|
| Rate for Payer: Aetna Medicare |
$5.30
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$5.30
|
| Rate for Payer: BCN Medicare Advantage |
$5.30
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$7.63
|
| Rate for Payer: Cofinity Commercial |
$7.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$6.36
|
| Rate for Payer: Healthscope Whirlpool |
$6.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.57
|
| Rate for Payer: Nomi Health Commercial |
$6.36
|
| Rate for Payer: PACE SWMI |
$5.30
|
| Rate for Payer: PHP Medicare Advantage |
$5.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$5.30
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.30
|
| Rate for Payer: UHC Medicare Advantage |
$5.30
|
| Rate for Payer: UHCCP DNSP |
$5.30
|
|
|
CHG TRANSFERASE ASPARTATE AMINO AST SGOT
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 84450
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Aetna Medicare |
$5.18
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$6.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Healthscope Commercial |
$6.22
|
| Rate for Payer: Healthscope Whirlpool |
$6.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Nomi Health Commercial |
$6.22
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UHCCP DNSP |
$5.18
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION COMPLEX
|
Professional
|
Both
|
$183.00
|
|
|
Service Code
|
HCPCS 77334
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$166.62 |
| Rate for Payer: Aetna Commercial |
$155.05
|
| Rate for Payer: Aetna Commercial |
$155.05
|
| Rate for Payer: Aetna Medicare |
$115.71
|
| Rate for Payer: Aetna Medicare |
$115.71
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS Complete |
$73.20
|
| Rate for Payer: BCBS MAPPO |
$115.71
|
| Rate for Payer: BCBS MAPPO |
$115.71
|
| Rate for Payer: BCN Medicare Advantage |
$115.71
|
| Rate for Payer: BCN Medicare Advantage |
$115.71
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cofinity Commercial |
$155.05
|
| Rate for Payer: Cofinity Commercial |
$166.62
|
| Rate for Payer: Cofinity Commercial |
$155.05
|
| Rate for Payer: Cofinity Commercial |
$166.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.71
|
| Rate for Payer: Healthscope Commercial |
$138.85
|
| Rate for Payer: Healthscope Commercial |
$138.85
|
| Rate for Payer: Healthscope Whirlpool |
$138.85
|
| Rate for Payer: Healthscope Whirlpool |
$138.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$121.50
|
| Rate for Payer: Nomi Health Commercial |
$138.85
|
| Rate for Payer: Nomi Health Commercial |
$138.85
|
| Rate for Payer: PACE SWMI |
$115.71
|
| Rate for Payer: PACE SWMI |
$115.71
|
| Rate for Payer: PHP Medicare Advantage |
$115.71
|
| Rate for Payer: PHP Medicare Advantage |
$115.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$118.95
|
| Rate for Payer: Priority Health Medicare |
$115.71
|
| Rate for Payer: Priority Health Medicare |
$115.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.71
|
| Rate for Payer: UHC Medicare Advantage |
$115.71
|
| Rate for Payer: UHC Medicare Advantage |
$115.71
|
| Rate for Payer: UHCCP DNSP |
$115.71
|
| Rate for Payer: UHCCP DNSP |
$115.71
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION INTERMEDIATE
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
HCPCS 77333
|
| Min. Negotiated Rate |
$64.40 |
| Max. Negotiated Rate |
$178.00 |
| Rate for Payer: Aetna Commercial |
$165.64
|
| Rate for Payer: Aetna Commercial |
$165.64
|
| Rate for Payer: Aetna Medicare |
$123.61
|
| Rate for Payer: Aetna Medicare |
$123.61
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS Complete |
$64.40
|
| Rate for Payer: BCBS MAPPO |
$123.61
|
| Rate for Payer: BCBS MAPPO |
$123.61
|
| Rate for Payer: BCN Medicare Advantage |
$123.61
|
| Rate for Payer: BCN Medicare Advantage |
$123.61
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$128.80
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$165.64
|
| Rate for Payer: Cofinity Commercial |
$178.00
|
| Rate for Payer: Cofinity Commercial |
$165.64
|
| Rate for Payer: Cofinity Commercial |
$178.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.61
|
| Rate for Payer: Healthscope Commercial |
$148.33
|
| Rate for Payer: Healthscope Commercial |
$148.33
|
| Rate for Payer: Healthscope Whirlpool |
$148.33
|
| Rate for Payer: Healthscope Whirlpool |
$148.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$129.79
|
| Rate for Payer: Nomi Health Commercial |
$148.33
|
| Rate for Payer: Nomi Health Commercial |
$148.33
|
| Rate for Payer: PACE SWMI |
$123.61
|
| Rate for Payer: PACE SWMI |
$123.61
|
| Rate for Payer: PHP Medicare Advantage |
$123.61
|
| Rate for Payer: PHP Medicare Advantage |
$123.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$104.65
|
| Rate for Payer: Priority Health Medicare |
$123.61
|
| Rate for Payer: Priority Health Medicare |
$123.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.61
|
| Rate for Payer: UHC Medicare Advantage |
$123.61
|
| Rate for Payer: UHC Medicare Advantage |
$123.61
|
| Rate for Payer: UHCCP DNSP |
$123.61
|
| Rate for Payer: UHCCP DNSP |
$123.61
|
|
|
CHG TX DEVICES DESIGN & CONSTRUCTION SIMPLE
|
Professional
|
Both
|
$155.00
|
|
|
Service Code
|
HCPCS 77332
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$100.75 |
| Rate for Payer: Aetna Commercial |
$50.64
|
| Rate for Payer: Aetna Commercial |
$50.64
|
| Rate for Payer: Aetna Medicare |
$37.79
|
| Rate for Payer: Aetna Medicare |
$37.79
|
| Rate for Payer: BCBS Complete |
$39.60
|
| Rate for Payer: BCBS Complete |
$62.00
|
| Rate for Payer: BCBS MAPPO |
$37.79
|
| Rate for Payer: BCBS MAPPO |
$37.79
|
| Rate for Payer: BCN Medicare Advantage |
$37.79
|
| Rate for Payer: BCN Medicare Advantage |
$37.79
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$124.00
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cofinity Commercial |
$50.64
|
| Rate for Payer: Cofinity Commercial |
$54.42
|
| Rate for Payer: Cofinity Commercial |
$50.64
|
| Rate for Payer: Cofinity Commercial |
$54.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.79
|
| Rate for Payer: Healthscope Commercial |
$45.35
|
| Rate for Payer: Healthscope Commercial |
$45.35
|
| Rate for Payer: Healthscope Whirlpool |
$45.35
|
| Rate for Payer: Healthscope Whirlpool |
$45.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.68
|
| Rate for Payer: Nomi Health Commercial |
$45.35
|
| Rate for Payer: Nomi Health Commercial |
$45.35
|
| Rate for Payer: PACE SWMI |
$37.79
|
| Rate for Payer: PACE SWMI |
$37.79
|
| Rate for Payer: PHP Medicare Advantage |
$37.79
|
| Rate for Payer: PHP Medicare Advantage |
$37.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$64.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$100.75
|
| Rate for Payer: Priority Health Medicare |
$37.79
|
| Rate for Payer: Priority Health Medicare |
$37.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.79
|
| Rate for Payer: UHC Medicare Advantage |
$37.79
|
| Rate for Payer: UHC Medicare Advantage |
$37.79
|
| Rate for Payer: UHCCP DNSP |
$37.79
|
| Rate for Payer: UHCCP DNSP |
$37.79
|
|
|
CHG ULTRASONIC GUIDANCE INTRAOPERATIVE
|
Professional
|
Both
|
$295.00
|
|
|
Service Code
|
HCPCS 76998
|
| Min. Negotiated Rate |
$118.00 |
| Max. Negotiated Rate |
$191.75 |
| Rate for Payer: Aetna Medicare |
$147.50
|
| Rate for Payer: BCBS Complete |
$118.00
|
| Rate for Payer: Cash Price |
$236.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$191.75
|
|
|
CHG ULTRASOUND ELASTOGRAPHY PARENCHYMA
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
HCPCS 76981
|
| Min. Negotiated Rate |
$23.60 |
| Max. Negotiated Rate |
$137.56 |
| Rate for Payer: Aetna Commercial |
$128.01
|
| Rate for Payer: Aetna Medicare |
$95.53
|
| Rate for Payer: BCBS Complete |
$23.60
|
| Rate for Payer: BCBS MAPPO |
$95.53
|
| Rate for Payer: BCN Medicare Advantage |
$95.53
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cash Price |
$47.20
|
| Rate for Payer: Cofinity Commercial |
$137.56
|
| Rate for Payer: Cofinity Commercial |
$128.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.53
|
| Rate for Payer: Healthscope Commercial |
$114.64
|
| Rate for Payer: Healthscope Whirlpool |
$114.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.31
|
| Rate for Payer: Nomi Health Commercial |
$114.64
|
| Rate for Payer: PACE SWMI |
$95.53
|
| Rate for Payer: PHP Medicare Advantage |
$95.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$38.35
|
| Rate for Payer: Priority Health Medicare |
$95.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$95.53
|
| Rate for Payer: UHC Medicare Advantage |
$95.53
|
| Rate for Payer: UHCCP DNSP |
$95.53
|
|
|
CHG ULTRASOUND SPINAL CANAL & CONTENTS
|
Professional
|
Both
|
$91.00
|
|
|
Service Code
|
HCPCS 76800
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Aetna Commercial |
$220.87
|
| Rate for Payer: Aetna Medicare |
$164.83
|
| Rate for Payer: BCBS Complete |
$36.40
|
| Rate for Payer: BCBS MAPPO |
$164.83
|
| Rate for Payer: BCN Medicare Advantage |
$164.83
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cash Price |
$72.80
|
| Rate for Payer: Cofinity Commercial |
$237.36
|
| Rate for Payer: Cofinity Commercial |
$220.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$164.83
|
| Rate for Payer: Healthscope Commercial |
$197.80
|
| Rate for Payer: Healthscope Whirlpool |
$197.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$173.07
|
| Rate for Payer: Nomi Health Commercial |
$197.80
|
| Rate for Payer: PACE SWMI |
$164.83
|
| Rate for Payer: PHP Medicare Advantage |
$164.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.15
|
| Rate for Payer: Priority Health Medicare |
$164.83
|
| Rate for Payer: UHC Dual Complete DSNP |
$164.83
|
| Rate for Payer: UHC Medicare Advantage |
$164.83
|
| Rate for Payer: UHCCP DNSP |
$164.83
|
|
|
CHG UNLISTED FLUOROSCOPIC PROCEDURE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 76496
|
| Min. Negotiated Rate |
$102.00 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
|
