|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 64492
|
| Min. Negotiated Rate |
$57.10 |
| Max. Negotiated Rate |
$137.80 |
| Rate for Payer: Aetna Commercial |
$76.51
|
| Rate for Payer: Aetna Medicare |
$59.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.51
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: BCBS MAPPO |
$57.10
|
| Rate for Payer: BCN Medicare Advantage |
$57.10
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$82.22
|
| Rate for Payer: Cofinity Commercial |
$76.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.10
|
| Rate for Payer: Healthscope Commercial |
$91.36
|
| Rate for Payer: Healthscope Commercial |
$105.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.80
|
| Rate for Payer: Nomi Health Commercial |
$68.52
|
| Rate for Payer: PACE SWMI |
$57.10
|
| Rate for Payer: PHP Medicare Advantage |
$57.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health Medicare |
$57.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.10
|
| Rate for Payer: UHC Medicare Advantage |
$57.10
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
64492
|
| Min. Negotiated Rate |
$133.56 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.80
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$148.40
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.20
|
| Rate for Payer: PHP Commercial |
$180.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health SBD |
$133.56
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
64492
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: Aetna Medicare |
$106.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.80
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$148.40
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.20
|
| Rate for Payer: PHP Commercial |
$180.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health SBD |
$133.56
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 64492
|
| Hospital Charge Code |
64492
|
| Min. Negotiated Rate |
$57.10 |
| Max. Negotiated Rate |
$137.80 |
| Rate for Payer: Aetna Commercial |
$76.51
|
| Rate for Payer: Aetna Medicare |
$59.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.22
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: BCBS MAPPO |
$57.10
|
| Rate for Payer: BCN Medicare Advantage |
$57.10
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$76.51
|
| Rate for Payer: Cofinity Commercial |
$82.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.10
|
| Rate for Payer: Healthscope Commercial |
$91.36
|
| Rate for Payer: Healthscope Commercial |
$105.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$137.80
|
| Rate for Payer: Nomi Health Commercial |
$68.52
|
| Rate for Payer: PACE SWMI |
$57.10
|
| Rate for Payer: PHP Medicare Advantage |
$57.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health Medicare |
$57.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.10
|
| Rate for Payer: UHC Medicare Advantage |
$57.10
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
64493
|
| Min. Negotiated Rate |
$152.46 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Aetna Commercial |
$205.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.30
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$169.40
|
| Rate for Payer: Cofinity Commercial |
$208.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$169.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.60
|
| Rate for Payer: Healthscope Commercial |
$217.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.70
|
| Rate for Payer: PHP Commercial |
$205.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health SBD |
$152.46
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
64493
|
| Min. Negotiated Rate |
$86.18 |
| Max. Negotiated Rate |
$159.43 |
| Rate for Payer: Aetna Commercial |
$115.48
|
| Rate for Payer: Aetna Medicare |
$89.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.10
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: BCBS MAPPO |
$86.18
|
| Rate for Payer: BCN Medicare Advantage |
$86.18
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$124.10
|
| Rate for Payer: Cofinity Commercial |
$115.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.18
|
| Rate for Payer: Healthscope Commercial |
$137.89
|
| Rate for Payer: Healthscope Commercial |
$159.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.30
|
| Rate for Payer: Nomi Health Commercial |
$103.42
|
| Rate for Payer: PACE SWMI |
$86.18
|
| Rate for Payer: PHP Medicare Advantage |
$86.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health Medicare |
$86.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.18
|
| Rate for Payer: UHC Medicare Advantage |
$86.18
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
64493
|
| Min. Negotiated Rate |
$152.46 |
| Max. Negotiated Rate |
$2,444.12 |
| Rate for Payer: Aetna Commercial |
$205.70
|
| Rate for Payer: Aetna Medicare |
$903.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$208.12
|
| Rate for Payer: Cofinity Commercial |
$169.40
|
| Rate for Payer: Cofinity Medicare Advantage |
$169.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$217.80
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.70
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$205.70
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health SBD |
$152.46
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,444.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$488.84
|
| Rate for Payer: VA VA |
$868.28
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 64493
|
| Min. Negotiated Rate |
$86.18 |
| Max. Negotiated Rate |
$159.43 |
| Rate for Payer: Aetna Commercial |
$115.48
|
| Rate for Payer: Aetna Medicare |
$89.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.48
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: BCBS MAPPO |
$86.18
|
| Rate for Payer: BCN Medicare Advantage |
$86.18
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$124.10
|
| Rate for Payer: Cofinity Commercial |
$115.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.18
|
| Rate for Payer: Healthscope Commercial |
$137.89
|
| Rate for Payer: Healthscope Commercial |
$159.43
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$157.30
|
| Rate for Payer: Nomi Health Commercial |
$103.42
|
| Rate for Payer: PACE SWMI |
$86.18
|
| Rate for Payer: PHP Medicare Advantage |
$86.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health Medicare |
$86.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.18
|
| Rate for Payer: UHC Medicare Advantage |
$86.18
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
64494
|
| Min. Negotiated Rate |
$66.80 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Aetna Commercial |
$141.95
|
| Rate for Payer: Aetna Medicare |
$83.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.55
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$116.90
|
| Rate for Payer: Cofinity Commercial |
$143.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.60
|
| Rate for Payer: Healthscope Commercial |
$150.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.95
|
| Rate for Payer: PHP Commercial |
$141.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health SBD |
$105.21
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 64494
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$108.55 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$50.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.02
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS MAPPO |
$48.52
|
| Rate for Payer: BCN Medicare Advantage |
$48.52
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$69.87
|
| Rate for Payer: Cofinity Commercial |
$65.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.52
|
| Rate for Payer: Healthscope Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$77.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.55
|
| Rate for Payer: Nomi Health Commercial |
$58.22
|
| Rate for Payer: PACE SWMI |
$48.52
|
| Rate for Payer: PHP Medicare Advantage |
$48.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health Medicare |
$48.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.52
|
| Rate for Payer: UHC Medicare Advantage |
$48.52
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
64494
|
| Min. Negotiated Rate |
$105.21 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Aetna Commercial |
$141.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.55
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$116.90
|
| Rate for Payer: Cofinity Commercial |
$143.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.60
|
| Rate for Payer: Healthscope Commercial |
$150.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.95
|
| Rate for Payer: PHP Commercial |
$141.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health SBD |
$105.21
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 64494
|
| Hospital Charge Code |
64494
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$108.55 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$50.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.87
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS MAPPO |
$48.52
|
| Rate for Payer: BCN Medicare Advantage |
$48.52
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$65.02
|
| Rate for Payer: Cofinity Commercial |
$69.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.52
|
| Rate for Payer: Healthscope Commercial |
$89.76
|
| Rate for Payer: Healthscope Commercial |
$77.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$108.55
|
| Rate for Payer: Nomi Health Commercial |
$58.22
|
| Rate for Payer: PACE SWMI |
$48.52
|
| Rate for Payer: PHP Medicare Advantage |
$48.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health Medicare |
$48.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.52
|
| Rate for Payer: UHC Medicare Advantage |
$48.52
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
64495
|
| Min. Negotiated Rate |
$107.73 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna Commercial |
$145.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.15
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$119.70
|
| Rate for Payer: Cofinity Commercial |
$147.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.80
|
| Rate for Payer: Healthscope Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.35
|
| Rate for Payer: PHP Commercial |
$145.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health SBD |
$107.73
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 64495
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Aetna Commercial |
$65.18
|
| Rate for Payer: Aetna Medicare |
$50.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.18
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$48.64
|
| Rate for Payer: BCN Medicare Advantage |
$48.64
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$70.04
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.64
|
| Rate for Payer: Healthscope Commercial |
$77.82
|
| Rate for Payer: Healthscope Commercial |
$89.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.15
|
| Rate for Payer: Nomi Health Commercial |
$58.37
|
| Rate for Payer: PACE SWMI |
$48.64
|
| Rate for Payer: PHP Medicare Advantage |
$48.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Medicare |
$48.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.64
|
| Rate for Payer: UHC Medicare Advantage |
$48.64
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
64495
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna Commercial |
$145.35
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.15
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$119.70
|
| Rate for Payer: Cofinity Commercial |
$147.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.80
|
| Rate for Payer: Healthscope Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.35
|
| Rate for Payer: PHP Commercial |
$145.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health SBD |
$107.73
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 64495
|
| Hospital Charge Code |
64495
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Aetna Commercial |
$65.18
|
| Rate for Payer: Aetna Medicare |
$50.59
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.04
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$48.64
|
| Rate for Payer: BCN Medicare Advantage |
$48.64
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$70.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.64
|
| Rate for Payer: Healthscope Commercial |
$89.98
|
| Rate for Payer: Healthscope Commercial |
$77.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$111.15
|
| Rate for Payer: Nomi Health Commercial |
$58.37
|
| Rate for Payer: PACE SWMI |
$48.64
|
| Rate for Payer: PHP Medicare Advantage |
$48.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Medicare |
$48.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.64
|
| Rate for Payer: UHC Medicare Advantage |
$48.64
|
|
|
PR NJX DX/THER SBST EPIDURAL/SUBARACH LUMBAR/SACRAL
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
HCPCS 62311
|
| Min. Negotiated Rate |
$303.20 |
| Max. Negotiated Rate |
$492.70 |
| Rate for Payer: Aetna Medicare |
$379.00
|
| Rate for Payer: BCBS Complete |
$303.20
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$492.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.70
|
|
|
PR NJX DX/THER SBST EPIDURAL/SUBRACH CERV/THORACIC
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 62310
|
| Min. Negotiated Rate |
$269.60 |
| Max. Negotiated Rate |
$438.10 |
| Rate for Payer: Aetna Medicare |
$337.00
|
| Rate for Payer: BCBS Complete |
$269.60
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$438.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.10
|
|
|
PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 62321
|
| Min. Negotiated Rate |
$101.73 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Aetna Commercial |
$136.32
|
| Rate for Payer: Aetna Medicare |
$105.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.32
|
| Rate for Payer: BCBS Complete |
$135.20
|
| Rate for Payer: BCBS MAPPO |
$101.73
|
| Rate for Payer: BCN Medicare Advantage |
$101.73
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$146.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.73
|
| Rate for Payer: Healthscope Commercial |
$188.20
|
| Rate for Payer: Healthscope Commercial |
$162.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.70
|
| Rate for Payer: Nomi Health Commercial |
$122.08
|
| Rate for Payer: PACE SWMI |
$101.73
|
| Rate for Payer: PHP Medicare Advantage |
$101.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: Priority Health Medicare |
$101.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.73
|
| Rate for Payer: UHC Medicare Advantage |
$101.73
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
62323
|
| Min. Negotiated Rate |
$94.14 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$126.15
|
| Rate for Payer: Aetna Medicare |
$97.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.15
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS MAPPO |
$94.14
|
| Rate for Payer: BCN Medicare Advantage |
$94.14
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$135.56
|
| Rate for Payer: Cofinity Commercial |
$126.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.14
|
| Rate for Payer: Healthscope Commercial |
$150.62
|
| Rate for Payer: Healthscope Commercial |
$174.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.20
|
| Rate for Payer: Nomi Health Commercial |
$112.97
|
| Rate for Payer: PACE SWMI |
$94.14
|
| Rate for Payer: PHP Medicare Advantage |
$94.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health Medicare |
$94.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.14
|
| Rate for Payer: UHC Medicare Advantage |
$94.14
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
62323
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.20
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$215.60
|
| Rate for Payer: Cofinity Commercial |
$264.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.40
|
| Rate for Payer: Healthscope Commercial |
$277.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.80
|
| Rate for Payer: PHP Commercial |
$261.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health SBD |
$194.04
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 62323
|
| Min. Negotiated Rate |
$94.14 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$126.15
|
| Rate for Payer: Aetna Medicare |
$97.91
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$126.15
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS MAPPO |
$94.14
|
| Rate for Payer: BCN Medicare Advantage |
$94.14
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$135.56
|
| Rate for Payer: Cofinity Commercial |
$126.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.14
|
| Rate for Payer: Healthscope Commercial |
$150.62
|
| Rate for Payer: Healthscope Commercial |
$174.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$200.20
|
| Rate for Payer: Nomi Health Commercial |
$112.97
|
| Rate for Payer: PACE SWMI |
$94.14
|
| Rate for Payer: PHP Medicare Advantage |
$94.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health Medicare |
$94.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.14
|
| Rate for Payer: UHC Medicare Advantage |
$94.14
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
62323
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$1,901.18 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Aetna Medicare |
$702.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.20
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$264.88
|
| Rate for Payer: Cofinity Commercial |
$215.60
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$277.20
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.80
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$261.80
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health Medicare |
$675.40
|
| Rate for Payer: Priority Health SBD |
$194.04
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,901.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$380.25
|
| Rate for Payer: VA VA |
$675.40
|
|
|
PR NJX INFUS/BOLUS DX/SBST EDRL/SUBARACH LUM/SACRAL
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 62319
|
| Min. Negotiated Rate |
$348.80 |
| Max. Negotiated Rate |
$566.80 |
| Rate for Payer: Aetna Medicare |
$436.00
|
| Rate for Payer: BCBS Complete |
$348.80
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$566.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.80
|
|
|
PR NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Professional
|
Both
|
$2,850.00
|
|
|
Service Code
|
HCPCS 36466
|
| Min. Negotiated Rate |
$145.44 |
| Max. Negotiated Rate |
$1,852.50 |
| Rate for Payer: Aetna Commercial |
$194.89
|
| Rate for Payer: Aetna Medicare |
$151.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$194.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$209.43
|
| Rate for Payer: BCBS Complete |
$1,140.00
|
| Rate for Payer: BCBS MAPPO |
$145.44
|
| Rate for Payer: BCN Medicare Advantage |
$145.44
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: Cofinity Commercial |
$194.89
|
| Rate for Payer: Cofinity Commercial |
$209.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.44
|
| Rate for Payer: Healthscope Commercial |
$232.70
|
| Rate for Payer: Healthscope Commercial |
$269.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,852.50
|
| Rate for Payer: Nomi Health Commercial |
$174.53
|
| Rate for Payer: PACE SWMI |
$145.44
|
| Rate for Payer: PHP Medicare Advantage |
$145.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,852.50
|
| Rate for Payer: Priority Health Medicare |
$145.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.44
|
| Rate for Payer: UHC Medicare Advantage |
$145.44
|
|
