|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
64493
|
| Min. Negotiated Rate |
$144.55 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna Commercial |
$201.45
|
| Rate for Payer: BCBS Trust/PPO |
$183.15
|
| Rate for Payer: BCN Commercial |
$183.15
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$203.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.60
|
| Rate for Payer: Healthscope Commercial |
$213.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.45
|
| Rate for Payer: PHP Commercial |
$201.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.56
|
| Rate for Payer: UHC Core |
$197.90
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.75
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
64493
|
| Min. Negotiated Rate |
$56.29 |
| Max. Negotiated Rate |
$627.82 |
| Rate for Payer: Aetna Commercial |
$201.45
|
| Rate for Payer: Aetna Medicare |
$61.62
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$74.06
|
| Rate for Payer: Amish Plain Church Group Commercial |
$74.06
|
| Rate for Payer: BCBS Complete |
$627.82
|
| Rate for Payer: BCBS MAPPO |
$59.25
|
| Rate for Payer: BCBS Trust/PPO |
$184.27
|
| Rate for Payer: BCN Commercial |
$184.27
|
| Rate for Payer: BCN Medicare Advantage |
$59.25
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$203.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.25
|
| Rate for Payer: Healthscope Commercial |
$213.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.75
|
| Rate for Payer: Mclaren Medicaid |
$597.92
|
| Rate for Payer: Meridian Medicaid |
$627.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.21
|
| Rate for Payer: MI Amish Medical Board Commercial |
$68.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.45
|
| Rate for Payer: PACE Senior Care Partners |
$56.29
|
| Rate for Payer: PACE SWMI |
$59.25
|
| Rate for Payer: PHP Commercial |
$201.45
|
| Rate for Payer: PHP Medicare Advantage |
$59.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$597.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$206.19
|
| Rate for Payer: Priority Health Medicare |
$59.25
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$144.55
|
| Rate for Payer: Railroad Medicare Medicare |
$59.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$208.56
|
| Rate for Payer: UHC Core |
$197.90
|
| Rate for Payer: UHC Dual Complete DSNP |
$59.25
|
| Rate for Payer: UHC Medicare Advantage |
$61.03
|
| Rate for Payer: VA VA |
$59.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.75
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 64494
|
| Hospital Charge Code |
64494
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$1,260.52 |
| Rate for Payer: Aetna Commercial |
$67.25
|
| Rate for Payer: Aetna Medicare |
$52.20
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS MAPPO |
$50.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$131.94
|
| Rate for Payer: BCN Medicare Advantage |
$50.19
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$72.27
|
| Rate for Payer: Cofinity Commercial |
$67.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.19
|
| Rate for Payer: Mclaren Medicaid |
$32.16
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.70
|
| Rate for Payer: PACE SWMI |
$50.19
|
| Rate for Payer: PHP Medicare Advantage |
$50.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.50
|
| Rate for Payer: Priority Health Medicare |
$50.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.19
|
| Rate for Payer: UHC Medicare Advantage |
$51.70
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
64494
|
| Min. Negotiated Rate |
$38.95 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Aetna Commercial |
$139.40
|
| Rate for Payer: Aetna Medicare |
$42.64
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$51.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$51.25
|
| Rate for Payer: BCBS Complete |
$65.60
|
| Rate for Payer: BCBS MAPPO |
$41.00
|
| Rate for Payer: BCBS Trust/PPO |
$127.51
|
| Rate for Payer: BCN Commercial |
$127.51
|
| Rate for Payer: BCN Medicare Advantage |
$41.00
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$141.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.00
|
| Rate for Payer: Healthscope Commercial |
$147.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.05
|
| Rate for Payer: MI Amish Medical Board Commercial |
$47.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.40
|
| Rate for Payer: PACE Senior Care Partners |
$38.95
|
| Rate for Payer: PACE SWMI |
$41.00
|
| Rate for Payer: PHP Commercial |
$139.40
|
| Rate for Payer: PHP Medicare Advantage |
$41.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.68
|
| Rate for Payer: Priority Health Medicare |
$41.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.02
|
| Rate for Payer: Railroad Medicare Medicare |
$41.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.32
|
| Rate for Payer: UHC Core |
$136.94
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.00
|
| Rate for Payer: UHC Medicare Advantage |
$42.23
|
| Rate for Payer: VA VA |
$41.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 64494
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$1,260.52 |
| Rate for Payer: Aetna Commercial |
$67.25
|
| Rate for Payer: Aetna Medicare |
$52.20
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS MAPPO |
$50.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$131.94
|
| Rate for Payer: BCN Medicare Advantage |
$50.19
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$72.27
|
| Rate for Payer: Cofinity Commercial |
$67.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.19
|
| Rate for Payer: Mclaren Medicaid |
$32.16
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.70
|
| Rate for Payer: PACE SWMI |
$50.19
|
| Rate for Payer: PHP Medicare Advantage |
$50.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.50
|
| Rate for Payer: Priority Health Medicare |
$50.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.19
|
| Rate for Payer: UHC Medicare Advantage |
$51.70
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
64494
|
| Min. Negotiated Rate |
$100.02 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Aetna Commercial |
$139.40
|
| Rate for Payer: BCBS Trust/PPO |
$126.74
|
| Rate for Payer: BCN Commercial |
$126.74
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$141.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.20
|
| Rate for Payer: Healthscope Commercial |
$147.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.40
|
| Rate for Payer: PHP Commercial |
$139.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$142.68
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$100.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.32
|
| Rate for Payer: UHC Core |
$136.94
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 64495
|
| Hospital Charge Code |
64495
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$184.91 |
| Rate for Payer: Aetna Commercial |
$68.09
|
| Rate for Payer: Aetna Medicare |
$52.84
|
| Rate for Payer: BCBS Complete |
$34.44
|
| Rate for Payer: BCBS MAPPO |
$50.81
|
| Rate for Payer: BCBS Trust/PPO |
$184.91
|
| Rate for Payer: BCN Commercial |
$131.94
|
| Rate for Payer: BCN Medicare Advantage |
$50.81
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$73.17
|
| Rate for Payer: Cofinity Commercial |
$68.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.81
|
| Rate for Payer: Mclaren Medicaid |
$32.80
|
| Rate for Payer: Meridian Medicaid |
$34.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.35
|
| Rate for Payer: PACE SWMI |
$50.81
|
| Rate for Payer: PHP Medicare Advantage |
$50.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.64
|
| Rate for Payer: Priority Health Medicare |
$50.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.81
|
| Rate for Payer: UHC Medicare Advantage |
$52.33
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
64495
|
| Min. Negotiated Rate |
$39.90 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna Commercial |
$142.80
|
| Rate for Payer: Aetna Medicare |
$43.68
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.50
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS MAPPO |
$42.00
|
| Rate for Payer: BCBS Trust/PPO |
$130.62
|
| Rate for Payer: BCN Commercial |
$130.62
|
| Rate for Payer: BCN Medicare Advantage |
$42.00
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$144.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.00
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.80
|
| Rate for Payer: PACE Senior Care Partners |
$39.90
|
| Rate for Payer: PACE SWMI |
$42.00
|
| Rate for Payer: PHP Commercial |
$142.80
|
| Rate for Payer: PHP Medicare Advantage |
$42.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.16
|
| Rate for Payer: Priority Health Medicare |
$42.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.46
|
| Rate for Payer: Railroad Medicare Medicare |
$42.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.84
|
| Rate for Payer: UHC Core |
$140.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.00
|
| Rate for Payer: UHC Medicare Advantage |
$43.26
|
| Rate for Payer: VA VA |
$42.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
64495
|
| Min. Negotiated Rate |
$102.46 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna Commercial |
$142.80
|
| Rate for Payer: BCBS Trust/PPO |
$129.83
|
| Rate for Payer: BCN Commercial |
$129.83
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$144.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.80
|
| Rate for Payer: PHP Commercial |
$142.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.16
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$102.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$147.84
|
| Rate for Payer: UHC Core |
$140.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 64495
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$184.91 |
| Rate for Payer: Aetna Commercial |
$68.09
|
| Rate for Payer: Aetna Medicare |
$52.84
|
| Rate for Payer: BCBS Complete |
$34.44
|
| Rate for Payer: BCBS MAPPO |
$50.81
|
| Rate for Payer: BCBS Trust/PPO |
$184.91
|
| Rate for Payer: BCN Commercial |
$131.94
|
| Rate for Payer: BCN Medicare Advantage |
$50.81
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$73.17
|
| Rate for Payer: Cofinity Commercial |
$68.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.81
|
| Rate for Payer: Mclaren Medicaid |
$32.80
|
| Rate for Payer: Meridian Medicaid |
$34.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.35
|
| Rate for Payer: PACE SWMI |
$50.81
|
| Rate for Payer: PHP Medicare Advantage |
$50.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.64
|
| Rate for Payer: Priority Health Medicare |
$50.81
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$50.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.81
|
| Rate for Payer: UHC Medicare Advantage |
$52.33
|
|
|
PR NJX DX/THER SBST EPIDURAL/SUBARACH LUMBAR/SACRAL
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 62311
|
| Min. Negotiated Rate |
$297.20 |
| Max. Negotiated Rate |
$520.10 |
| Rate for Payer: BCBS Complete |
$297.20
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$520.10
|
|
|
PR NJX DX/THER SBST EPIDURAL/SUBRACH CERV/THORACIC
|
Professional
|
Both
|
$661.00
|
|
|
Service Code
|
HCPCS 62310
|
| Min. Negotiated Rate |
$264.40 |
| Max. Negotiated Rate |
$462.70 |
| Rate for Payer: BCBS Complete |
$264.40
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.70
|
|
|
PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
HCPCS 62321
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$1,592.30 |
| Rate for Payer: Aetna Commercial |
$139.61
|
| Rate for Payer: Aetna Medicare |
$108.36
|
| Rate for Payer: BCBS Complete |
$71.57
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,592.30
|
| Rate for Payer: BCN Commercial |
$383.62
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cofinity Commercial |
$150.03
|
| Rate for Payer: Cofinity Commercial |
$139.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Mclaren Medicaid |
$68.16
|
| Rate for Payer: Meridian Medicaid |
$71.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.35
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$178.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.19
|
| Rate for Payer: UHC Medicare Advantage |
$107.32
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 62323
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$1,879.69 |
| Rate for Payer: Aetna Commercial |
$129.42
|
| Rate for Payer: Aetna Medicare |
$100.44
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCBS MAPPO |
$96.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,879.69
|
| Rate for Payer: BCN Commercial |
$378.23
|
| Rate for Payer: BCN Medicare Advantage |
$96.58
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$139.08
|
| Rate for Payer: Cofinity Commercial |
$129.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.58
|
| Rate for Payer: Mclaren Medicaid |
$63.05
|
| Rate for Payer: Meridian Medicaid |
$66.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$101.41
|
| Rate for Payer: PACE SWMI |
$96.58
|
| Rate for Payer: PHP Medicare Advantage |
$96.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.34
|
| Rate for Payer: Priority Health Medicare |
$96.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.58
|
| Rate for Payer: UHC Medicare Advantage |
$99.48
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
62323
|
| Min. Negotiated Rate |
$184.19 |
| Max. Negotiated Rate |
$271.80 |
| Rate for Payer: Aetna Commercial |
$256.70
|
| Rate for Payer: BCBS Trust/PPO |
$233.39
|
| Rate for Payer: BCN Commercial |
$233.39
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$259.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.60
|
| Rate for Payer: Healthscope Commercial |
$271.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$256.70
|
| Rate for Payer: PHP Commercial |
$256.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$262.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.76
|
| Rate for Payer: UHC Core |
$252.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.50
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
62323
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$476.33 |
| Rate for Payer: Aetna Commercial |
$256.70
|
| Rate for Payer: Aetna Medicare |
$78.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$94.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$94.38
|
| Rate for Payer: BCBS Complete |
$476.33
|
| Rate for Payer: BCBS MAPPO |
$75.50
|
| Rate for Payer: BCBS Trust/PPO |
$234.80
|
| Rate for Payer: BCN Commercial |
$234.80
|
| Rate for Payer: BCN Medicare Advantage |
$75.50
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$259.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$75.50
|
| Rate for Payer: Healthscope Commercial |
$271.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$226.50
|
| Rate for Payer: Mclaren Medicaid |
$453.65
|
| Rate for Payer: Meridian Medicaid |
$476.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$79.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$86.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$256.70
|
| Rate for Payer: PACE Senior Care Partners |
$71.72
|
| Rate for Payer: PACE SWMI |
$75.50
|
| Rate for Payer: PHP Commercial |
$256.70
|
| Rate for Payer: PHP Medicare Advantage |
$75.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$262.74
|
| Rate for Payer: Priority Health Medicare |
$75.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$184.19
|
| Rate for Payer: Railroad Medicare Medicare |
$75.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$265.76
|
| Rate for Payer: UHC Core |
$252.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$75.50
|
| Rate for Payer: UHC Medicare Advantage |
$77.76
|
| Rate for Payer: VA VA |
$75.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$226.50
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
62323
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$1,879.69 |
| Rate for Payer: Aetna Commercial |
$129.42
|
| Rate for Payer: Aetna Medicare |
$100.44
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCBS MAPPO |
$96.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,879.69
|
| Rate for Payer: BCN Commercial |
$378.23
|
| Rate for Payer: BCN Medicare Advantage |
$96.58
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$139.08
|
| Rate for Payer: Cofinity Commercial |
$129.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.58
|
| Rate for Payer: Mclaren Medicaid |
$63.05
|
| Rate for Payer: Meridian Medicaid |
$66.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$101.41
|
| Rate for Payer: PACE SWMI |
$96.58
|
| Rate for Payer: PHP Medicare Advantage |
$96.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.34
|
| Rate for Payer: Priority Health Medicare |
$96.58
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$165.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$96.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$96.58
|
| Rate for Payer: UHC Medicare Advantage |
$99.48
|
|
|
PR NJX INFUS/BOLUS DX/SBST EDRL/SUBARACH LUM/SACRAL
|
Professional
|
Both
|
$855.00
|
|
|
Service Code
|
HCPCS 62319
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$598.50 |
| Rate for Payer: BCBS Complete |
$342.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.50
|
|
|
PR NJX PEYRONIE W/SURG EXPOS PLAQUE
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 54205
|
| Min. Negotiated Rate |
$340.59 |
| Max. Negotiated Rate |
$850.52 |
| Rate for Payer: Aetna Commercial |
$695.31
|
| Rate for Payer: Aetna Medicare |
$539.65
|
| Rate for Payer: BCBS Complete |
$357.62
|
| Rate for Payer: BCBS MAPPO |
$518.89
|
| Rate for Payer: BCBS Trust/PPO |
$414.72
|
| Rate for Payer: BCN Commercial |
$769.17
|
| Rate for Payer: BCN Medicare Advantage |
$518.89
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cofinity Commercial |
$747.20
|
| Rate for Payer: Cofinity Commercial |
$695.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$518.89
|
| Rate for Payer: Mclaren Medicaid |
$340.59
|
| Rate for Payer: Meridian Medicaid |
$357.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$544.83
|
| Rate for Payer: PACE SWMI |
$518.89
|
| Rate for Payer: PHP Medicare Advantage |
$518.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$340.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$850.52
|
| Rate for Payer: Priority Health Medicare |
$518.89
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$850.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$518.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$518.89
|
| Rate for Payer: UHC Medicare Advantage |
$534.46
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 0232T
|
| Min. Negotiated Rate |
$91.43 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$128.61
|
| Rate for Payer: Aetna Commercial |
$128.61
|
| Rate for Payer: BCBS Complete |
$360.00
|
| Rate for Payer: BCBS Complete |
$240.00
|
| Rate for Payer: BCBS Trust/PPO |
$91.43
|
| Rate for Payer: BCBS Trust/PPO |
$91.43
|
| Rate for Payer: BCN Commercial |
$349.25
|
| Rate for Payer: BCN Commercial |
$349.25
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 0232T
|
| Hospital Charge Code |
0232T
|
| Min. Negotiated Rate |
$91.43 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Commercial |
$128.61
|
| Rate for Payer: Aetna Commercial |
$128.61
|
| Rate for Payer: BCBS Complete |
$240.00
|
| Rate for Payer: BCBS Complete |
$360.00
|
| Rate for Payer: BCBS Trust/PPO |
$91.43
|
| Rate for Payer: BCBS Trust/PPO |
$91.43
|
| Rate for Payer: BCN Commercial |
$349.25
|
| Rate for Payer: BCN Commercial |
$349.25
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.00
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
0232T
|
| Min. Negotiated Rate |
$396.44 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$552.50
|
| Rate for Payer: BCBS Trust/PPO |
$502.32
|
| Rate for Payer: BCN Commercial |
$502.32
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$559.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.00
|
| Rate for Payer: Healthscope Commercial |
$585.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.50
|
| Rate for Payer: PHP Commercial |
$552.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$565.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$396.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.00
|
| Rate for Payer: UHC Core |
$542.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.50
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
0232T
|
| Min. Negotiated Rate |
$154.38 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Aetna Commercial |
$552.50
|
| Rate for Payer: Aetna Medicare |
$169.00
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$203.12
|
| Rate for Payer: Amish Plain Church Group Commercial |
$203.12
|
| Rate for Payer: BCBS Complete |
$274.44
|
| Rate for Payer: BCBS MAPPO |
$162.50
|
| Rate for Payer: BCBS Trust/PPO |
$505.38
|
| Rate for Payer: BCN Commercial |
$505.38
|
| Rate for Payer: BCN Medicare Advantage |
$162.50
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$559.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$162.50
|
| Rate for Payer: Healthscope Commercial |
$585.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$487.50
|
| Rate for Payer: Mclaren Medicaid |
$261.37
|
| Rate for Payer: Meridian Medicaid |
$274.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$170.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$186.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.50
|
| Rate for Payer: PACE Senior Care Partners |
$154.38
|
| Rate for Payer: PACE SWMI |
$162.50
|
| Rate for Payer: PHP Commercial |
$552.50
|
| Rate for Payer: PHP Medicare Advantage |
$162.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$261.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$565.50
|
| Rate for Payer: Priority Health Medicare |
$162.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$396.44
|
| Rate for Payer: Railroad Medicare Medicare |
$162.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$572.00
|
| Rate for Payer: UHC Core |
$542.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$162.50
|
| Rate for Payer: UHC Medicare Advantage |
$167.38
|
| Rate for Payer: VA VA |
$162.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$487.50
|
|
|
PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 50431
|
| Min. Negotiated Rate |
$41.54 |
| Max. Negotiated Rate |
$2,577.05 |
| Rate for Payer: Aetna Commercial |
$85.10
|
| Rate for Payer: Aetna Medicare |
$66.05
|
| Rate for Payer: BCBS Complete |
$43.62
|
| Rate for Payer: BCBS MAPPO |
$63.51
|
| Rate for Payer: BCBS Trust/PPO |
$2,577.05
|
| Rate for Payer: BCN Commercial |
$476.46
|
| Rate for Payer: BCN Medicare Advantage |
$63.51
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$91.45
|
| Rate for Payer: Cofinity Commercial |
$85.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.51
|
| Rate for Payer: Mclaren Medicaid |
$41.54
|
| Rate for Payer: Meridian Medicaid |
$43.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.69
|
| Rate for Payer: PACE SWMI |
$63.51
|
| Rate for Payer: PHP Medicare Advantage |
$63.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.29
|
| Rate for Payer: Priority Health Medicare |
$63.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$104.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.51
|
| Rate for Payer: UHC Medicare Advantage |
$65.42
|
|
|
PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 50430
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$2,447.09 |
| Rate for Payer: Aetna Commercial |
$199.71
|
| Rate for Payer: Aetna Medicare |
$155.00
|
| Rate for Payer: BCBS Complete |
$100.64
|
| Rate for Payer: BCBS MAPPO |
$149.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,447.09
|
| Rate for Payer: BCN Commercial |
$931.42
|
| Rate for Payer: BCN Medicare Advantage |
$149.04
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$214.62
|
| Rate for Payer: Cofinity Commercial |
$199.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.04
|
| Rate for Payer: Mclaren Medicaid |
$95.85
|
| Rate for Payer: Meridian Medicaid |
$100.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$156.49
|
| Rate for Payer: PACE SWMI |
$149.04
|
| Rate for Payer: PHP Medicare Advantage |
$149.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.62
|
| Rate for Payer: Priority Health Medicare |
$149.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$242.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$149.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$149.04
|
| Rate for Payer: UHC Medicare Advantage |
$153.51
|
|
