|
PR NJX AA&/STRD TFRML EPI CERVICAL/THORACIC 1 LEVEL
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
HCPCS 64479
|
| Min. Negotiated Rate |
$82.86 |
| Max. Negotiated Rate |
$1,300.67 |
| Rate for Payer: Aetna Commercial |
$170.17
|
| Rate for Payer: Aetna Medicare |
$132.07
|
| Rate for Payer: BCBS Complete |
$87.00
|
| Rate for Payer: BCBS MAPPO |
$126.99
|
| Rate for Payer: BCBS Trust/PPO |
$1,300.67
|
| Rate for Payer: BCN Commercial |
$387.52
|
| Rate for Payer: BCN Medicare Advantage |
$126.99
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cash Price |
$700.00
|
| Rate for Payer: Cofinity Commercial |
$182.87
|
| Rate for Payer: Cofinity Commercial |
$170.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$126.99
|
| Rate for Payer: Mclaren Medicaid |
$82.86
|
| Rate for Payer: Meridian Medicaid |
$87.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$133.34
|
| Rate for Payer: PACE SWMI |
$126.99
|
| Rate for Payer: PHP Medicare Advantage |
$126.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$82.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$612.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$218.00
|
| Rate for Payer: Priority Health Medicare |
$126.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$218.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$126.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$126.99
|
| Rate for Payer: UHC Medicare Advantage |
$130.80
|
|
|
PR NJX AA&/STRD TFRML EPI CERVICAL/THORACIC EA ADDL
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 64480
|
| Min. Negotiated Rate |
$38.55 |
| Max. Negotiated Rate |
$967.32 |
| Rate for Payer: Aetna Commercial |
$80.63
|
| Rate for Payer: Aetna Medicare |
$62.58
|
| Rate for Payer: BCBS Complete |
$40.48
|
| Rate for Payer: BCBS MAPPO |
$60.17
|
| Rate for Payer: BCBS Trust/PPO |
$967.32
|
| Rate for Payer: BCN Commercial |
$196.45
|
| Rate for Payer: BCN Medicare Advantage |
$60.17
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$86.64
|
| Rate for Payer: Cofinity Commercial |
$80.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.17
|
| Rate for Payer: Mclaren Medicaid |
$38.55
|
| Rate for Payer: Meridian Medicaid |
$40.48
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$63.18
|
| Rate for Payer: PACE SWMI |
$60.17
|
| Rate for Payer: PHP Medicare Advantage |
$60.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$237.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.49
|
| Rate for Payer: Priority Health Medicare |
$60.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.17
|
| Rate for Payer: UHC Medicare Advantage |
$61.98
|
|
|
PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
HCPCS 64483
|
| Min. Negotiated Rate |
$70.72 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna Commercial |
$144.30
|
| Rate for Payer: Aetna Medicare |
$112.00
|
| Rate for Payer: BCBS Complete |
$74.26
|
| Rate for Payer: BCBS MAPPO |
$107.69
|
| Rate for Payer: BCBS Trust/PPO |
$96.15
|
| Rate for Payer: BCN Commercial |
$359.67
|
| Rate for Payer: BCN Medicare Advantage |
$107.69
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cash Price |
$800.00
|
| Rate for Payer: Cofinity Commercial |
$144.30
|
| Rate for Payer: Cofinity Commercial |
$155.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.69
|
| Rate for Payer: Mclaren Medicaid |
$70.72
|
| Rate for Payer: Meridian Medicaid |
$74.26
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$113.07
|
| Rate for Payer: PACE SWMI |
$107.69
|
| Rate for Payer: PHP Medicare Advantage |
$107.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$70.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$700.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.15
|
| Rate for Payer: Priority Health Medicare |
$107.69
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$185.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$107.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.69
|
| Rate for Payer: UHC Medicare Advantage |
$110.92
|
|
|
PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL EA ADDL
|
Professional
|
Both
|
$436.00
|
|
|
Service Code
|
HCPCS 64484
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$566.87 |
| Rate for Payer: Aetna Commercial |
$67.67
|
| Rate for Payer: Aetna Medicare |
$52.52
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS MAPPO |
$50.50
|
| Rate for Payer: BCBS Trust/PPO |
$566.87
|
| Rate for Payer: BCN Commercial |
$163.22
|
| Rate for Payer: BCN Medicare Advantage |
$50.50
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cash Price |
$348.80
|
| Rate for Payer: Cofinity Commercial |
$72.72
|
| Rate for Payer: Cofinity Commercial |
$67.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.50
|
| Rate for Payer: Mclaren Medicaid |
$32.59
|
| Rate for Payer: Meridian Medicaid |
$34.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.02
|
| Rate for Payer: PACE SWMI |
$50.50
|
| Rate for Payer: PHP Medicare Advantage |
$50.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$305.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.07
|
| Rate for Payer: Priority Health Medicare |
$50.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.50
|
| Rate for Payer: UHC Medicare Advantage |
$52.02
|
|
|
PR NJX BONE SUB MATRL INTO SUBCHONDRAL BONE DEFECT
|
Professional
|
Both
|
$3,000.00
|
|
|
Service Code
|
HCPCS 0707T
|
| Min. Negotiated Rate |
$262.22 |
| Max. Negotiated Rate |
$2,753.41 |
| Rate for Payer: Aetna Commercial |
$368.07
|
| Rate for Payer: BCBS Complete |
$1,200.00
|
| Rate for Payer: BCBS Trust/PPO |
$262.22
|
| Rate for Payer: BCN Commercial |
$2,753.41
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Cash Price |
$2,400.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,100.00
|
|
|
PR NJX C/P/A CAVERNOSA W/PHARMACOLOGIC AGT
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
HCPCS 54235
|
| Min. Negotiated Rate |
$47.07 |
| Max. Negotiated Rate |
$573.21 |
| Rate for Payer: Aetna Commercial |
$96.68
|
| Rate for Payer: Aetna Medicare |
$75.04
|
| Rate for Payer: BCBS Complete |
$49.42
|
| Rate for Payer: BCBS MAPPO |
$72.15
|
| Rate for Payer: BCBS Trust/PPO |
$573.21
|
| Rate for Payer: BCN Commercial |
$130.96
|
| Rate for Payer: BCN Medicare Advantage |
$72.15
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cash Price |
$137.60
|
| Rate for Payer: Cofinity Commercial |
$96.68
|
| Rate for Payer: Cofinity Commercial |
$103.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.15
|
| Rate for Payer: Mclaren Medicaid |
$47.07
|
| Rate for Payer: Meridian Medicaid |
$49.42
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$75.76
|
| Rate for Payer: PACE SWMI |
$72.15
|
| Rate for Payer: PHP Medicare Advantage |
$72.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$120.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$118.33
|
| Rate for Payer: Priority Health Medicare |
$72.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$118.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.15
|
| Rate for Payer: UHC Medicare Advantage |
$74.31
|
|
|
PR NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
HCPCS 51600
|
| Min. Negotiated Rate |
$27.26 |
| Max. Negotiated Rate |
$2,020.75 |
| Rate for Payer: Aetna Commercial |
$57.67
|
| Rate for Payer: Aetna Medicare |
$44.76
|
| Rate for Payer: BCBS Complete |
$28.62
|
| Rate for Payer: BCBS MAPPO |
$43.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,020.75
|
| Rate for Payer: BCN Commercial |
$313.24
|
| Rate for Payer: BCN Medicare Advantage |
$43.04
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cofinity Commercial |
$61.98
|
| Rate for Payer: Cofinity Commercial |
$57.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.04
|
| Rate for Payer: Mclaren Medicaid |
$27.26
|
| Rate for Payer: Meridian Medicaid |
$28.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$45.19
|
| Rate for Payer: PACE SWMI |
$43.04
|
| Rate for Payer: PHP Medicare Advantage |
$43.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$472.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$69.70
|
| Rate for Payer: Priority Health Medicare |
$43.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$69.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$43.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.04
|
| Rate for Payer: UHC Medicare Advantage |
$44.33
|
|
|
PR NJX DRG C-CATHJ SLCTV L VNTRC/R ATRIAL ANGRPHS&I
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 93565
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$737.51 |
| Rate for Payer: Aetna Commercial |
$35.60
|
| Rate for Payer: Aetna Medicare |
$27.63
|
| Rate for Payer: BCBS Complete |
$17.67
|
| Rate for Payer: BCBS MAPPO |
$26.57
|
| Rate for Payer: BCBS Trust/PPO |
$737.51
|
| Rate for Payer: BCN Commercial |
$38.61
|
| Rate for Payer: BCN Medicare Advantage |
$26.57
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Cofinity Commercial |
$38.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.57
|
| Rate for Payer: Mclaren Medicaid |
$16.83
|
| Rate for Payer: Meridian Medicaid |
$17.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.90
|
| Rate for Payer: PACE SWMI |
$26.57
|
| Rate for Payer: PHP Medicare Advantage |
$26.57
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.36
|
| Rate for Payer: Priority Health Medicare |
$26.57
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$37.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.57
|
| Rate for Payer: UHC Medicare Advantage |
$27.37
|
|
|
PR NJX DRG C-CATHJ SLCTV R VNTRC/R ATRIAL ANGRPHS&I
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 93566
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$911.32 |
| Rate for Payer: Aetna Commercial |
$35.04
|
| Rate for Payer: Aetna Medicare |
$27.20
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS MAPPO |
$26.15
|
| Rate for Payer: BCBS Trust/PPO |
$911.32
|
| Rate for Payer: BCN Commercial |
$38.12
|
| Rate for Payer: BCN Medicare Advantage |
$26.15
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$37.66
|
| Rate for Payer: Cofinity Commercial |
$35.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.15
|
| Rate for Payer: Mclaren Medicaid |
$16.19
|
| Rate for Payer: Meridian Medicaid |
$17.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.46
|
| Rate for Payer: PACE SWMI |
$26.15
|
| Rate for Payer: PHP Medicare Advantage |
$26.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.88
|
| Rate for Payer: Priority Health Medicare |
$26.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$36.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$26.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.15
|
| Rate for Payer: UHC Medicare Advantage |
$26.93
|
|
|
PR NJX DRG C-CATHJ SUPRAVALVULAR AORTOGRAPHY S&I
|
Professional
|
Both
|
$419.00
|
|
|
Service Code
|
HCPCS 93567
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$907.09 |
| Rate for Payer: Aetna Commercial |
$50.02
|
| Rate for Payer: Aetna Medicare |
$38.82
|
| Rate for Payer: BCBS Complete |
$24.60
|
| Rate for Payer: BCBS MAPPO |
$37.33
|
| Rate for Payer: BCBS Trust/PPO |
$907.09
|
| Rate for Payer: BCN Commercial |
$54.24
|
| Rate for Payer: BCN Medicare Advantage |
$37.33
|
| Rate for Payer: Cash Price |
$335.20
|
| Rate for Payer: Cash Price |
$335.20
|
| Rate for Payer: Cofinity Commercial |
$53.76
|
| Rate for Payer: Cofinity Commercial |
$50.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.33
|
| Rate for Payer: Mclaren Medicaid |
$23.43
|
| Rate for Payer: Meridian Medicaid |
$24.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.20
|
| Rate for Payer: PACE SWMI |
$37.33
|
| Rate for Payer: PHP Medicare Advantage |
$37.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.48
|
| Rate for Payer: Priority Health Medicare |
$37.33
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$52.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.33
|
| Rate for Payer: UHC Medicare Advantage |
$38.45
|
|
|
PR NJX DRG CGEN C-CATHJ SLCTV CORONARY ANGRPH S&I
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 93563
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$787.17 |
| Rate for Payer: Aetna Commercial |
$68.19
|
| Rate for Payer: Aetna Medicare |
$52.93
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS MAPPO |
$50.89
|
| Rate for Payer: BCBS Trust/PPO |
$787.17
|
| Rate for Payer: BCN Commercial |
$74.28
|
| Rate for Payer: BCN Medicare Advantage |
$50.89
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$73.28
|
| Rate for Payer: Cofinity Commercial |
$68.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.89
|
| Rate for Payer: Mclaren Medicaid |
$32.16
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.43
|
| Rate for Payer: PACE SWMI |
$50.89
|
| Rate for Payer: PHP Medicare Advantage |
$50.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.88
|
| Rate for Payer: Priority Health Medicare |
$50.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$71.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.89
|
| Rate for Payer: UHC Medicare Advantage |
$52.42
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
64490
|
| Min. Negotiated Rate |
$202.49 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Aetna Commercial |
$282.20
|
| Rate for Payer: BCBS Trust/PPO |
$256.57
|
| Rate for Payer: BCN Commercial |
$256.57
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$285.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.60
|
| Rate for Payer: Healthscope Commercial |
$298.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.20
|
| Rate for Payer: PHP Commercial |
$282.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.84
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.16
|
| Rate for Payer: UHC Core |
$277.22
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
64490
|
| Min. Negotiated Rate |
$78.85 |
| Max. Negotiated Rate |
$627.82 |
| Rate for Payer: Aetna Commercial |
$282.20
|
| Rate for Payer: Aetna Medicare |
$86.32
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$103.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$103.75
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$83.00
|
| Rate for Payer: BCBS Trust/PPO |
$258.13
|
| Rate for Payer: BCN Commercial |
$258.13
|
| Rate for Payer: BCN Medicare Advantage |
$83.00
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$285.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.00
|
| Rate for Payer: Healthscope Commercial |
$298.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.00
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$87.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$95.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.20
|
| Rate for Payer: PACE Senior Care Partners |
$78.85
|
| Rate for Payer: PACE SWMI |
$83.00
|
| Rate for Payer: PHP Commercial |
$282.20
|
| Rate for Payer: PHP Medicare Advantage |
$83.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$288.84
|
| Rate for Payer: Priority Health Medicare |
$83.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$202.49
|
| Rate for Payer: Railroad Medicare Medicare |
$83.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$292.16
|
| Rate for Payer: UHC Core |
$277.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.00
|
| Rate for Payer: UHC Medicare Advantage |
$85.49
|
| Rate for Payer: VA VA |
$83.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 64490
|
| Hospital Charge Code |
64490
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$278.55 |
| Rate for Payer: Aetna Commercial |
$136.95
|
| Rate for Payer: Aetna Medicare |
$106.29
|
| Rate for Payer: BCBS Complete |
$70.22
|
| Rate for Payer: BCBS MAPPO |
$102.20
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: BCN Commercial |
$278.55
|
| Rate for Payer: BCN Medicare Advantage |
$102.20
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$136.95
|
| Rate for Payer: Cofinity Commercial |
$147.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.20
|
| Rate for Payer: Mclaren Medicaid |
$66.88
|
| Rate for Payer: Meridian Medicaid |
$70.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$107.31
|
| Rate for Payer: PACE SWMI |
$102.20
|
| Rate for Payer: PHP Medicare Advantage |
$102.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.53
|
| Rate for Payer: Priority Health Medicare |
$102.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.20
|
| Rate for Payer: UHC Medicare Advantage |
$105.27
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 64490
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$278.55 |
| Rate for Payer: Aetna Commercial |
$136.95
|
| Rate for Payer: Aetna Medicare |
$106.29
|
| Rate for Payer: BCBS Complete |
$70.22
|
| Rate for Payer: BCBS MAPPO |
$102.20
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: BCN Commercial |
$278.55
|
| Rate for Payer: BCN Medicare Advantage |
$102.20
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$147.17
|
| Rate for Payer: Cofinity Commercial |
$136.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.20
|
| Rate for Payer: Mclaren Medicaid |
$66.88
|
| Rate for Payer: Meridian Medicaid |
$70.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$107.31
|
| Rate for Payer: PACE SWMI |
$102.20
|
| Rate for Payer: PHP Medicare Advantage |
$102.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.53
|
| Rate for Payer: Priority Health Medicare |
$102.20
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$175.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$102.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.20
|
| Rate for Payer: UHC Medicare Advantage |
$105.27
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 64491
|
| Hospital Charge Code |
64491
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$344.45 |
| Rate for Payer: Aetna Commercial |
$77.97
|
| Rate for Payer: Aetna Medicare |
$60.52
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$58.19
|
| Rate for Payer: BCBS Trust/PPO |
$344.45
|
| Rate for Payer: BCN Commercial |
$141.23
|
| Rate for Payer: BCN Medicare Advantage |
$58.19
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$77.97
|
| Rate for Payer: Cofinity Commercial |
$83.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.19
|
| Rate for Payer: Mclaren Medicaid |
$37.49
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.10
|
| Rate for Payer: PACE SWMI |
$58.19
|
| Rate for Payer: PHP Medicare Advantage |
$58.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.08
|
| Rate for Payer: Priority Health Medicare |
$58.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.19
|
| Rate for Payer: UHC Medicare Advantage |
$59.94
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
64491
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna Medicare |
$54.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.00
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS MAPPO |
$52.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.72
|
| Rate for Payer: BCN Commercial |
$161.72
|
| Rate for Payer: BCN Medicare Advantage |
$52.00
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.80
|
| Rate for Payer: PACE Senior Care Partners |
$49.40
|
| Rate for Payer: PACE SWMI |
$52.00
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: PHP Medicare Advantage |
$52.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.96
|
| Rate for Payer: Priority Health Medicare |
$52.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.86
|
| Rate for Payer: Railroad Medicare Medicare |
$52.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.04
|
| Rate for Payer: UHC Core |
$173.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.00
|
| Rate for Payer: UHC Medicare Advantage |
$53.56
|
| Rate for Payer: VA VA |
$52.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
64491
|
| Min. Negotiated Rate |
$126.86 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: BCBS Trust/PPO |
$160.74
|
| Rate for Payer: BCN Commercial |
$160.74
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.80
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.04
|
| Rate for Payer: UHC Core |
$173.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 64491
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$344.45 |
| Rate for Payer: Aetna Commercial |
$77.97
|
| Rate for Payer: Aetna Medicare |
$60.52
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$58.19
|
| Rate for Payer: BCBS Trust/PPO |
$344.45
|
| Rate for Payer: BCN Commercial |
$141.23
|
| Rate for Payer: BCN Medicare Advantage |
$58.19
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$83.79
|
| Rate for Payer: Cofinity Commercial |
$77.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.19
|
| Rate for Payer: Mclaren Medicaid |
$37.49
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.10
|
| Rate for Payer: PACE SWMI |
$58.19
|
| Rate for Payer: PHP Medicare Advantage |
$58.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.08
|
| Rate for Payer: Priority Health Medicare |
$58.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$99.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$58.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.19
|
| Rate for Payer: UHC Medicare Advantage |
$59.94
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
64492
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna Medicare |
$54.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$65.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$65.00
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS MAPPO |
$52.00
|
| Rate for Payer: BCBS Trust/PPO |
$161.72
|
| Rate for Payer: BCN Commercial |
$161.72
|
| Rate for Payer: BCN Medicare Advantage |
$52.00
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.00
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$54.60
|
| Rate for Payer: MI Amish Medical Board Commercial |
$59.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.80
|
| Rate for Payer: PACE Senior Care Partners |
$49.40
|
| Rate for Payer: PACE SWMI |
$52.00
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: PHP Medicare Advantage |
$52.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.96
|
| Rate for Payer: Priority Health Medicare |
$52.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.86
|
| Rate for Payer: Railroad Medicare Medicare |
$52.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.04
|
| Rate for Payer: UHC Core |
$173.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.00
|
| Rate for Payer: UHC Medicare Advantage |
$53.56
|
| Rate for Payer: VA VA |
$52.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
64492
|
| Min. Negotiated Rate |
$126.86 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: BCBS Trust/PPO |
$160.74
|
| Rate for Payer: BCN Commercial |
$160.74
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.80
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$126.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.04
|
| Rate for Payer: UHC Core |
$173.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 64492
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$216.07 |
| Rate for Payer: Aetna Commercial |
$79.22
|
| Rate for Payer: Aetna Medicare |
$61.48
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS MAPPO |
$59.12
|
| Rate for Payer: BCBS Trust/PPO |
$216.07
|
| Rate for Payer: BCN Commercial |
$142.21
|
| Rate for Payer: BCN Medicare Advantage |
$59.12
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$85.13
|
| Rate for Payer: Cofinity Commercial |
$79.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.12
|
| Rate for Payer: Mclaren Medicaid |
$38.13
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.08
|
| Rate for Payer: PACE SWMI |
$59.12
|
| Rate for Payer: PHP Medicare Advantage |
$59.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.79
|
| Rate for Payer: Priority Health Medicare |
$59.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.12
|
| Rate for Payer: UHC Medicare Advantage |
$60.89
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 64492
|
| Hospital Charge Code |
64492
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$216.07 |
| Rate for Payer: Aetna Commercial |
$79.22
|
| Rate for Payer: Aetna Medicare |
$61.48
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS MAPPO |
$59.12
|
| Rate for Payer: BCBS Trust/PPO |
$216.07
|
| Rate for Payer: BCN Commercial |
$142.21
|
| Rate for Payer: BCN Medicare Advantage |
$59.12
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$85.13
|
| Rate for Payer: Cofinity Commercial |
$79.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.12
|
| Rate for Payer: Mclaren Medicaid |
$38.13
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.08
|
| Rate for Payer: PACE SWMI |
$59.12
|
| Rate for Payer: PHP Medicare Advantage |
$59.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.79
|
| Rate for Payer: Priority Health Medicare |
$59.12
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$59.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.12
|
| Rate for Payer: UHC Medicare Advantage |
$60.89
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 64493
|
| Min. Negotiated Rate |
$57.51 |
| Max. Negotiated Rate |
$609.66 |
| Rate for Payer: Aetna Commercial |
$117.87
|
| Rate for Payer: Aetna Medicare |
$91.48
|
| Rate for Payer: BCBS Complete |
$60.39
|
| Rate for Payer: BCBS MAPPO |
$87.96
|
| Rate for Payer: BCBS Trust/PPO |
$609.66
|
| Rate for Payer: BCN Commercial |
$257.53
|
| Rate for Payer: BCN Medicare Advantage |
$87.96
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$117.87
|
| Rate for Payer: Cofinity Commercial |
$126.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.96
|
| Rate for Payer: Mclaren Medicaid |
$57.51
|
| Rate for Payer: Meridian Medicaid |
$60.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.36
|
| Rate for Payer: PACE SWMI |
$87.96
|
| Rate for Payer: PHP Medicare Advantage |
$87.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.18
|
| Rate for Payer: Priority Health Medicare |
$87.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.96
|
| Rate for Payer: UHC Medicare Advantage |
$90.60
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
64493
|
| Min. Negotiated Rate |
$57.51 |
| Max. Negotiated Rate |
$609.66 |
| Rate for Payer: Aetna Commercial |
$117.87
|
| Rate for Payer: Aetna Medicare |
$91.48
|
| Rate for Payer: BCBS Complete |
$60.39
|
| Rate for Payer: BCBS MAPPO |
$87.96
|
| Rate for Payer: BCBS Trust/PPO |
$609.66
|
| Rate for Payer: BCN Commercial |
$257.53
|
| Rate for Payer: BCN Medicare Advantage |
$87.96
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$126.66
|
| Rate for Payer: Cofinity Commercial |
$117.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.96
|
| Rate for Payer: Mclaren Medicaid |
$57.51
|
| Rate for Payer: Meridian Medicaid |
$60.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.36
|
| Rate for Payer: PACE SWMI |
$87.96
|
| Rate for Payer: PHP Medicare Advantage |
$87.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.18
|
| Rate for Payer: Priority Health Medicare |
$87.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$151.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$87.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$87.96
|
| Rate for Payer: UHC Medicare Advantage |
$90.60
|
|
