|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
64491
|
| Min. Negotiated Rate |
$137.80 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: BCBS Trust/PPO |
$173.06
|
| Rate for Payer: BCN Commercial |
$163.83
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.20
|
| Rate for Payer: Nomi Health Commercial |
$173.84
|
| Rate for Payer: PHP Commercial |
$180.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health HMO/PPO |
$184.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.56
|
| Rate for Payer: UHC Core |
$177.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 64492
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$216.07 |
| Rate for Payer: Aetna Commercial |
$76.51
|
| Rate for Payer: Aetna Medicare |
$59.38
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS MAPPO |
$57.10
|
| Rate for Payer: BCBS Trust/PPO |
$216.07
|
| Rate for Payer: BCN Commercial |
$142.21
|
| 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: Mclaren Medicaid |
$38.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.96
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| 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 Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health HMO/PPO |
$101.79
|
| Rate for Payer: Priority Health Medicare |
$57.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.10
|
| Rate for Payer: UHC Exchange |
$57.10
|
| Rate for Payer: UHC Medicare Advantage |
$57.10
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
|
|
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 |
$38.13 |
| Max. Negotiated Rate |
$216.07 |
| Rate for Payer: Aetna Commercial |
$76.51
|
| Rate for Payer: Aetna Medicare |
$59.38
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS MAPPO |
$57.10
|
| Rate for Payer: BCBS Trust/PPO |
$216.07
|
| Rate for Payer: BCN Commercial |
$142.21
|
| 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: Mclaren Medicaid |
$38.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.96
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| 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 Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health HMO/PPO |
$101.79
|
| Rate for Payer: Priority Health Medicare |
$57.67
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$101.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.10
|
| Rate for Payer: UHC Exchange |
$57.10
|
| Rate for Payer: UHC Medicare Advantage |
$57.10
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
|
|
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 |
$137.80 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: BCBS Trust/PPO |
$173.06
|
| Rate for Payer: BCN Commercial |
$163.83
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.20
|
| Rate for Payer: Nomi Health Commercial |
$173.84
|
| Rate for Payer: PHP Commercial |
$180.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health HMO/PPO |
$184.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.56
|
| Rate for Payer: UHC Core |
$177.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.00
|
|
|
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 |
$50.35 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: Aetna Medicare |
$55.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$66.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$66.25
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: BCBS MAPPO |
$53.00
|
| Rate for Payer: BCBS Trust/PPO |
$174.29
|
| Rate for Payer: BCN Commercial |
$164.83
|
| Rate for Payer: BCN Medicare Advantage |
$53.00
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.00
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.65
|
| Rate for Payer: MI Amish Medical Board Commercial |
$60.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.20
|
| Rate for Payer: Nomi Health Commercial |
$173.84
|
| Rate for Payer: PACE Senior Care Partners |
$50.35
|
| Rate for Payer: PACE SWMI |
$53.00
|
| Rate for Payer: PHP Commercial |
$180.20
|
| Rate for Payer: PHP Medicare Advantage |
$53.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health HMO/PPO |
$184.44
|
| Rate for Payer: Priority Health Medicare |
$53.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$142.04
|
| Rate for Payer: Railroad Medicare Medicare |
$53.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$186.56
|
| Rate for Payer: UHC Core |
$177.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.00
|
| Rate for Payer: UHC Exchange |
$53.00
|
| Rate for Payer: UHC Medicare Advantage |
$53.00
|
| Rate for Payer: VA VA |
$53.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.00
|
|
|
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 |
$58.15 |
| Max. Negotiated Rate |
$609.66 |
| Rate for Payer: Aetna Commercial |
$115.48
|
| Rate for Payer: Aetna Medicare |
$89.63
|
| Rate for Payer: BCBS Complete |
$61.06
|
| Rate for Payer: BCBS MAPPO |
$86.18
|
| Rate for Payer: BCBS Trust/PPO |
$609.66
|
| Rate for Payer: BCN Commercial |
$257.53
|
| 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: Mclaren Medicaid |
$58.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.49
|
| Rate for Payer: Meridian Medicaid |
$61.06
|
| 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 Choice Medicaid |
$58.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health HMO/PPO |
$153.56
|
| Rate for Payer: Priority Health Medicare |
$87.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.18
|
| Rate for Payer: UHC Exchange |
$86.18
|
| Rate for Payer: UHC Medicare Advantage |
$86.18
|
| Rate for Payer: UHCCP Medicaid |
$58.15
|
|
|
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 |
$157.30 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Aetna Commercial |
$205.70
|
| Rate for Payer: BCBS Trust/PPO |
$197.54
|
| Rate for Payer: BCN Commercial |
$187.02
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$208.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.60
|
| Rate for Payer: Healthscope Commercial |
$217.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.70
|
| Rate for Payer: Nomi Health Commercial |
$198.44
|
| Rate for Payer: PHP Commercial |
$205.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health HMO/PPO |
$210.54
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.96
|
| Rate for Payer: UHC Core |
$202.07
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.50
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 64493
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$609.66 |
| Rate for Payer: Aetna Commercial |
$115.48
|
| Rate for Payer: Aetna Medicare |
$89.63
|
| Rate for Payer: BCBS Complete |
$61.06
|
| Rate for Payer: BCBS MAPPO |
$86.18
|
| Rate for Payer: BCBS Trust/PPO |
$609.66
|
| Rate for Payer: BCN Commercial |
$257.53
|
| 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: Mclaren Medicaid |
$58.15
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.49
|
| Rate for Payer: Meridian Medicaid |
$61.06
|
| 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 Choice Medicaid |
$58.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health HMO/PPO |
$153.56
|
| Rate for Payer: Priority Health Medicare |
$87.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$153.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.18
|
| Rate for Payer: UHC Exchange |
$86.18
|
| Rate for Payer: UHC Medicare Advantage |
$86.18
|
| Rate for Payer: UHCCP Medicaid |
$58.15
|
|
|
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 |
$57.48 |
| Max. Negotiated Rate |
$662.24 |
| Rate for Payer: Aetna Commercial |
$205.70
|
| Rate for Payer: Aetna Medicare |
$62.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$75.62
|
| Rate for Payer: Amish Plain Church Group Commercial |
$75.62
|
| Rate for Payer: BCBS Complete |
$662.24
|
| Rate for Payer: BCBS MAPPO |
$60.50
|
| Rate for Payer: BCBS Trust/PPO |
$198.95
|
| Rate for Payer: BCN Commercial |
$188.16
|
| Rate for Payer: BCN Medicare Advantage |
$60.50
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$208.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.50
|
| Rate for Payer: Healthscope Commercial |
$217.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.50
|
| Rate for Payer: Mclaren Medicaid |
$630.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.52
|
| Rate for Payer: Meridian Medicaid |
$662.24
|
| Rate for Payer: MI Amish Medical Board Commercial |
$69.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.70
|
| Rate for Payer: Nomi Health Commercial |
$198.44
|
| Rate for Payer: PACE Senior Care Partners |
$57.48
|
| Rate for Payer: PACE SWMI |
$60.50
|
| Rate for Payer: PHP Commercial |
$205.70
|
| Rate for Payer: PHP Medicare Advantage |
$60.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$630.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health HMO/PPO |
$210.54
|
| Rate for Payer: Priority Health Medicare |
$61.10
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$162.14
|
| Rate for Payer: Railroad Medicare Medicare |
$60.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$212.96
|
| Rate for Payer: UHC Core |
$202.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.50
|
| Rate for Payer: UHC Exchange |
$60.50
|
| Rate for Payer: UHC Medicare Advantage |
$60.50
|
| Rate for Payer: UHCCP Medicaid |
$630.67
|
| Rate for Payer: VA VA |
$60.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.50
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 64494
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$1,260.52 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$50.46
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$48.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$131.94
|
| 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: Mclaren Medicaid |
$32.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.95
|
| Rate for Payer: Meridian Medicaid |
$34.00
|
| 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 Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health HMO/PPO |
$85.87
|
| Rate for Payer: Priority Health Medicare |
$49.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.52
|
| Rate for Payer: UHC Exchange |
$48.52
|
| Rate for Payer: UHC Medicare Advantage |
$48.52
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
|
|
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 |
$32.38 |
| Max. Negotiated Rate |
$1,260.52 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$50.46
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS MAPPO |
$48.52
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$131.94
|
| 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: Mclaren Medicaid |
$32.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.95
|
| Rate for Payer: Meridian Medicaid |
$34.00
|
| 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 Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health HMO/PPO |
$85.87
|
| Rate for Payer: Priority Health Medicare |
$49.01
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.52
|
| Rate for Payer: UHC Exchange |
$48.52
|
| Rate for Payer: UHC Medicare Advantage |
$48.52
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
|
|
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 |
$108.55 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Aetna Commercial |
$141.95
|
| Rate for Payer: BCBS Trust/PPO |
$136.32
|
| Rate for Payer: BCN Commercial |
$129.06
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$143.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.60
|
| Rate for Payer: Healthscope Commercial |
$150.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.95
|
| Rate for Payer: Nomi Health Commercial |
$136.94
|
| Rate for Payer: PHP Commercial |
$141.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health HMO/PPO |
$145.29
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.96
|
| Rate for Payer: UHC Core |
$139.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.25
|
|
|
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 |
$39.66 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Aetna Commercial |
$141.95
|
| Rate for Payer: Aetna Medicare |
$43.42
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$52.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$52.19
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS MAPPO |
$41.75
|
| Rate for Payer: BCBS Trust/PPO |
$137.29
|
| Rate for Payer: BCN Commercial |
$129.84
|
| Rate for Payer: BCN Medicare Advantage |
$41.75
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$143.62
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.75
|
| Rate for Payer: Healthscope Commercial |
$150.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.84
|
| Rate for Payer: MI Amish Medical Board Commercial |
$48.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.95
|
| Rate for Payer: Nomi Health Commercial |
$136.94
|
| Rate for Payer: PACE Senior Care Partners |
$39.66
|
| Rate for Payer: PACE SWMI |
$41.75
|
| Rate for Payer: PHP Commercial |
$141.95
|
| Rate for Payer: PHP Medicare Advantage |
$41.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health HMO/PPO |
$145.29
|
| Rate for Payer: Priority Health Medicare |
$42.17
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$111.89
|
| Rate for Payer: Railroad Medicare Medicare |
$41.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$146.96
|
| Rate for Payer: UHC Core |
$139.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.75
|
| Rate for Payer: UHC Exchange |
$41.75
|
| Rate for Payer: UHC Medicare Advantage |
$41.75
|
| Rate for Payer: VA VA |
$41.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.25
|
|
|
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 |
$40.61 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna Commercial |
$145.35
|
| Rate for Payer: Aetna Medicare |
$44.46
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$53.44
|
| Rate for Payer: Amish Plain Church Group Commercial |
$53.44
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$42.75
|
| Rate for Payer: BCBS Trust/PPO |
$140.58
|
| Rate for Payer: BCN Commercial |
$132.95
|
| Rate for Payer: BCN Medicare Advantage |
$42.75
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$147.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.75
|
| Rate for Payer: Healthscope Commercial |
$153.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.89
|
| Rate for Payer: MI Amish Medical Board Commercial |
$49.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.35
|
| Rate for Payer: Nomi Health Commercial |
$140.22
|
| Rate for Payer: PACE Senior Care Partners |
$40.61
|
| Rate for Payer: PACE SWMI |
$42.75
|
| Rate for Payer: PHP Commercial |
$145.35
|
| Rate for Payer: PHP Medicare Advantage |
$42.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO |
$148.77
|
| Rate for Payer: Priority Health Medicare |
$43.18
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.57
|
| Rate for Payer: Railroad Medicare Medicare |
$42.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.48
|
| Rate for Payer: UHC Core |
$142.78
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.75
|
| Rate for Payer: UHC Exchange |
$42.75
|
| Rate for Payer: UHC Medicare Advantage |
$42.75
|
| Rate for Payer: VA VA |
$42.75
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.25
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 64495
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$184.91 |
| Rate for Payer: Aetna Commercial |
$65.18
|
| Rate for Payer: Aetna Medicare |
$50.59
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS MAPPO |
$48.64
|
| Rate for Payer: BCBS Trust/PPO |
$184.91
|
| Rate for Payer: BCN Commercial |
$131.94
|
| 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: Mclaren Medicaid |
$32.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.07
|
| Rate for Payer: Meridian Medicaid |
$34.22
|
| 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 Choice Medicaid |
$32.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO |
$87.58
|
| Rate for Payer: Priority Health Medicare |
$49.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.64
|
| Rate for Payer: UHC Exchange |
$48.64
|
| Rate for Payer: UHC Medicare Advantage |
$48.64
|
| Rate for Payer: UHCCP Medicaid |
$32.59
|
|
|
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 |
$111.15 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna Commercial |
$145.35
|
| Rate for Payer: BCBS Trust/PPO |
$139.59
|
| Rate for Payer: BCN Commercial |
$132.15
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$147.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.80
|
| Rate for Payer: Healthscope Commercial |
$153.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.35
|
| Rate for Payer: Nomi Health Commercial |
$140.22
|
| Rate for Payer: PHP Commercial |
$145.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO |
$148.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$114.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$150.48
|
| Rate for Payer: UHC Core |
$142.78
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$128.25
|
|
|
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 |
$32.59 |
| Max. Negotiated Rate |
$184.91 |
| Rate for Payer: Aetna Commercial |
$65.18
|
| Rate for Payer: Aetna Medicare |
$50.59
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS MAPPO |
$48.64
|
| Rate for Payer: BCBS Trust/PPO |
$184.91
|
| Rate for Payer: BCN Commercial |
$131.94
|
| 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: Mclaren Medicaid |
$32.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.07
|
| Rate for Payer: Meridian Medicaid |
$34.22
|
| 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 Choice Medicaid |
$32.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO |
$87.58
|
| Rate for Payer: Priority Health Medicare |
$49.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$87.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$48.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.64
|
| Rate for Payer: UHC Exchange |
$48.64
|
| Rate for Payer: UHC Medicare Advantage |
$48.64
|
| Rate for Payer: UHCCP Medicaid |
$32.59
|
|
|
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: 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: 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 |
$68.37 |
| Max. Negotiated Rate |
$1,592.30 |
| Rate for Payer: Aetna Commercial |
$136.32
|
| Rate for Payer: Aetna Medicare |
$105.80
|
| Rate for Payer: BCBS Complete |
$71.79
|
| Rate for Payer: BCBS MAPPO |
$101.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,592.30
|
| Rate for Payer: BCN Commercial |
$383.62
|
| 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 |
$146.49
|
| Rate for Payer: Cofinity Commercial |
$136.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.73
|
| Rate for Payer: Mclaren Medicaid |
$68.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.82
|
| Rate for Payer: Meridian Medicaid |
$71.79
|
| 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 Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: Priority Health HMO/PPO |
$181.99
|
| Rate for Payer: Priority Health Medicare |
$102.75
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$181.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$101.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.73
|
| Rate for Payer: UHC Exchange |
$101.73
|
| Rate for Payer: UHC Medicare Advantage |
$101.73
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
|
|
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 |
$73.15 |
| Max. Negotiated Rate |
$515.13 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Aetna Medicare |
$80.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$96.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$96.25
|
| Rate for Payer: BCBS Complete |
$515.13
|
| Rate for Payer: BCBS MAPPO |
$77.00
|
| Rate for Payer: BCBS Trust/PPO |
$253.21
|
| Rate for Payer: BCN Commercial |
$239.47
|
| Rate for Payer: BCN Medicare Advantage |
$77.00
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$264.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$77.00
|
| Rate for Payer: Healthscope Commercial |
$277.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.00
|
| Rate for Payer: Mclaren Medicaid |
$490.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.85
|
| Rate for Payer: Meridian Medicaid |
$515.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$88.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.80
|
| Rate for Payer: Nomi Health Commercial |
$252.56
|
| Rate for Payer: PACE Senior Care Partners |
$73.15
|
| Rate for Payer: PACE SWMI |
$77.00
|
| Rate for Payer: PHP Commercial |
$261.80
|
| Rate for Payer: PHP Medicare Advantage |
$77.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health HMO/PPO |
$267.96
|
| Rate for Payer: Priority Health Medicare |
$77.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.36
|
| Rate for Payer: Railroad Medicare Medicare |
$77.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.04
|
| Rate for Payer: UHC Core |
$257.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$77.00
|
| Rate for Payer: UHC Exchange |
$77.00
|
| Rate for Payer: UHC Medicare Advantage |
$77.00
|
| Rate for Payer: UHCCP Medicaid |
$490.57
|
| Rate for Payer: VA VA |
$77.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.00
|
|
|
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 |
$63.26 |
| Max. Negotiated Rate |
$1,879.69 |
| Rate for Payer: Aetna Commercial |
$126.15
|
| Rate for Payer: Aetna Medicare |
$97.91
|
| Rate for Payer: BCBS Complete |
$66.42
|
| Rate for Payer: BCBS MAPPO |
$94.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,879.69
|
| Rate for Payer: BCN Commercial |
$378.23
|
| 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: Mclaren Medicaid |
$63.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.85
|
| Rate for Payer: Meridian Medicaid |
$66.42
|
| 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 Choice Medicaid |
$63.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health HMO/PPO |
$168.34
|
| Rate for Payer: Priority Health Medicare |
$95.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.14
|
| Rate for Payer: UHC Exchange |
$94.14
|
| Rate for Payer: UHC Medicare Advantage |
$94.14
|
| Rate for Payer: UHCCP Medicaid |
$63.26
|
|
|
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 |
$200.20 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: BCBS Trust/PPO |
$251.42
|
| Rate for Payer: BCN Commercial |
$238.02
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$264.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.40
|
| Rate for Payer: Healthscope Commercial |
$277.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.80
|
| Rate for Payer: Nomi Health Commercial |
$252.56
|
| Rate for Payer: PHP Commercial |
$261.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health HMO/PPO |
$267.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$206.36
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$271.04
|
| Rate for Payer: UHC Core |
$257.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.00
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 62323
|
| Min. Negotiated Rate |
$63.26 |
| Max. Negotiated Rate |
$1,879.69 |
| Rate for Payer: Aetna Commercial |
$126.15
|
| Rate for Payer: Aetna Medicare |
$97.91
|
| Rate for Payer: BCBS Complete |
$66.42
|
| Rate for Payer: BCBS MAPPO |
$94.14
|
| Rate for Payer: BCBS Trust/PPO |
$1,879.69
|
| Rate for Payer: BCN Commercial |
$378.23
|
| 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: Mclaren Medicaid |
$63.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.85
|
| Rate for Payer: Meridian Medicaid |
$66.42
|
| 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 Choice Medicaid |
$63.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health HMO/PPO |
$168.34
|
| Rate for Payer: Priority Health Medicare |
$95.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$168.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.14
|
| Rate for Payer: UHC Exchange |
$94.14
|
| Rate for Payer: UHC Medicare Advantage |
$94.14
|
| Rate for Payer: UHCCP Medicaid |
$63.26
|
|
|
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: Priority Health Cigna Priority Health |
$566.80
|
|
