|
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 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
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 64494
|
| Hospital Charge Code |
64494
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$108.55 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$50.46
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS MAPPO |
$48.52
|
| Rate for Payer: BCN Medicare Advantage |
$48.52
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$69.87
|
| Rate for Payer: Cofinity Commercial |
$65.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.95
|
| Rate for Payer: Nomi Health Commercial |
$58.22
|
| Rate for Payer: PACE SWMI |
$48.52
|
| Rate for Payer: PHP Medicare Advantage |
$48.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health Medicare |
$49.01
|
| 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
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 64494
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$108.55 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$50.46
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS MAPPO |
$48.52
|
| Rate for Payer: BCN Medicare Advantage |
$48.52
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$69.87
|
| Rate for Payer: Cofinity Commercial |
$65.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.95
|
| Rate for Payer: Nomi Health Commercial |
$58.22
|
| Rate for Payer: PACE SWMI |
$48.52
|
| Rate for Payer: PHP Medicare Advantage |
$48.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health Medicare |
$49.01
|
| 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
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 64495
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Aetna Commercial |
$65.18
|
| Rate for Payer: Aetna Medicare |
$50.59
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$48.64
|
| Rate for Payer: BCN Medicare Advantage |
$48.64
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$70.04
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.07
|
| Rate for Payer: Nomi Health Commercial |
$58.37
|
| Rate for Payer: PACE SWMI |
$48.64
|
| Rate for Payer: PHP Medicare Advantage |
$48.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Medicare |
$49.13
|
| 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
|
|
|
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
|
| Hospital Charge Code |
64495
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Aetna Commercial |
$65.18
|
| Rate for Payer: Aetna Medicare |
$50.59
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$48.64
|
| Rate for Payer: BCN Medicare Advantage |
$48.64
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$70.04
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.07
|
| Rate for Payer: Nomi Health Commercial |
$58.37
|
| Rate for Payer: PACE SWMI |
$48.64
|
| Rate for Payer: PHP Medicare Advantage |
$48.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Medicare |
$49.13
|
| 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
|
|
|
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 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 |
$101.73 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Aetna Commercial |
$136.32
|
| Rate for Payer: Aetna Medicare |
$105.80
|
| Rate for Payer: BCBS Complete |
$135.20
|
| Rate for Payer: BCBS MAPPO |
$101.73
|
| Rate for Payer: BCN Medicare Advantage |
$101.73
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$136.32
|
| Rate for Payer: Cofinity Commercial |
$146.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.82
|
| Rate for Payer: Nomi Health Commercial |
$122.08
|
| Rate for Payer: PACE SWMI |
$101.73
|
| Rate for Payer: PHP Medicare Advantage |
$101.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: Priority Health Medicare |
$102.75
|
| 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
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 62323
|
| Min. Negotiated Rate |
$94.14 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$126.15
|
| Rate for Payer: Aetna Medicare |
$97.91
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS MAPPO |
$94.14
|
| Rate for Payer: BCN Medicare Advantage |
$94.14
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$135.56
|
| Rate for Payer: Cofinity Commercial |
$126.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.85
|
| Rate for Payer: Nomi Health Commercial |
$112.97
|
| Rate for Payer: PACE SWMI |
$94.14
|
| Rate for Payer: PHP Medicare Advantage |
$94.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health Medicare |
$95.08
|
| 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
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
62323
|
| Min. Negotiated Rate |
$94.14 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$126.15
|
| Rate for Payer: Aetna Medicare |
$97.91
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS MAPPO |
$94.14
|
| Rate for Payer: BCN Medicare Advantage |
$94.14
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$135.56
|
| Rate for Payer: Cofinity Commercial |
$126.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.85
|
| Rate for Payer: Nomi Health Commercial |
$112.97
|
| Rate for Payer: PACE SWMI |
$94.14
|
| Rate for Payer: PHP Medicare Advantage |
$94.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health Medicare |
$95.08
|
| 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
|
|
|
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
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
62323
|
| Min. Negotiated Rate |
$73.15 |
| Max. Negotiated Rate |
$525.76 |
| 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 |
$525.76
|
| 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 |
$500.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$80.85
|
| Rate for Payer: Meridian Medicaid |
$525.76
|
| 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 |
$500.69
|
| 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 |
$500.69
|
| Rate for Payer: VA VA |
$77.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.00
|
|
|
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
|
|
|
PR NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Professional
|
Both
|
$2,850.00
|
|
|
Service Code
|
HCPCS 36466
|
| Min. Negotiated Rate |
$145.44 |
| Max. Negotiated Rate |
$1,852.50 |
| Rate for Payer: Aetna Commercial |
$194.89
|
| Rate for Payer: Aetna Medicare |
$151.26
|
| Rate for Payer: BCBS Complete |
$1,140.00
|
| Rate for Payer: BCBS MAPPO |
$145.44
|
| Rate for Payer: BCN Medicare Advantage |
$145.44
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: Cofinity Commercial |
$209.43
|
| Rate for Payer: Cofinity Commercial |
$194.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.71
|
| Rate for Payer: Nomi Health Commercial |
$174.53
|
| Rate for Payer: PACE SWMI |
$145.44
|
| Rate for Payer: PHP Medicare Advantage |
$145.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,852.50
|
| Rate for Payer: Priority Health Medicare |
$146.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$145.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.44
|
| Rate for Payer: UHC Exchange |
$145.44
|
| Rate for Payer: UHC Medicare Advantage |
$145.44
|
|
|
PR NJX NONCMPND SCLEROSANT SINGLE INCMPTNT VEIN
|
Professional
|
Both
|
$2,699.00
|
|
|
Service Code
|
HCPCS 36465
|
| Min. Negotiated Rate |
$115.23 |
| Max. Negotiated Rate |
$1,754.35 |
| Rate for Payer: Aetna Commercial |
$154.41
|
| Rate for Payer: Aetna Medicare |
$119.84
|
| Rate for Payer: BCBS Complete |
$1,079.60
|
| Rate for Payer: BCBS MAPPO |
$115.23
|
| Rate for Payer: BCN Medicare Advantage |
$115.23
|
| Rate for Payer: Cash Price |
$2,159.20
|
| Rate for Payer: Cash Price |
$2,159.20
|
| Rate for Payer: Cofinity Commercial |
$154.41
|
| Rate for Payer: Cofinity Commercial |
$165.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.23
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.99
|
| Rate for Payer: Nomi Health Commercial |
$138.28
|
| Rate for Payer: PACE SWMI |
$115.23
|
| Rate for Payer: PHP Medicare Advantage |
$115.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,754.35
|
| Rate for Payer: Priority Health Medicare |
$116.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$115.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.23
|
| Rate for Payer: UHC Exchange |
$115.23
|
| Rate for Payer: UHC Medicare Advantage |
$115.23
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
0232T
|
| Min. Negotiated Rate |
$397.80 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: BCBS Trust/PPO |
$499.58
|
| Rate for Payer: BCN Commercial |
$472.95
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$526.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Healthscope Commercial |
$550.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: Nomi Health Commercial |
$501.84
|
| Rate for Payer: PHP Commercial |
$520.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health HMO/PPO |
$532.44
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$410.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.56
|
| Rate for Payer: UHC Core |
$511.02
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.00
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 0232T
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: Aetna Medicare |
$459.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: BCBS Complete |
$367.20
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
0232T
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$550.80 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Aetna Medicare |
$159.12
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$191.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$191.25
|
| Rate for Payer: BCBS Complete |
$302.95
|
| Rate for Payer: BCBS MAPPO |
$153.00
|
| Rate for Payer: BCBS Trust/PPO |
$503.13
|
| Rate for Payer: BCN Commercial |
$475.83
|
| Rate for Payer: BCN Medicare Advantage |
$153.00
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$526.32
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$153.00
|
| Rate for Payer: Healthscope Commercial |
$550.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$459.00
|
| Rate for Payer: Mclaren Medicaid |
$288.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$160.65
|
| Rate for Payer: Meridian Medicaid |
$302.95
|
| Rate for Payer: MI Amish Medical Board Commercial |
$175.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: Nomi Health Commercial |
$501.84
|
| Rate for Payer: PACE Senior Care Partners |
$145.35
|
| Rate for Payer: PACE SWMI |
$153.00
|
| Rate for Payer: PHP Commercial |
$520.20
|
| Rate for Payer: PHP Medicare Advantage |
$153.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$288.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health HMO/PPO |
$532.44
|
| Rate for Payer: Priority Health Medicare |
$154.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$410.04
|
| Rate for Payer: Railroad Medicare Medicare |
$153.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$538.56
|
| Rate for Payer: UHC Core |
$511.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$153.00
|
| Rate for Payer: UHC Exchange |
$153.00
|
| Rate for Payer: UHC Medicare Advantage |
$153.00
|
| Rate for Payer: UHCCP Medicaid |
$288.51
|
| Rate for Payer: VA VA |
$153.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$459.00
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 0232T
|
| Hospital Charge Code |
0232T
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: Aetna Medicare |
$459.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: BCBS Complete |
$367.20
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
|
|
PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 50431
|
| Min. Negotiated Rate |
$62.61 |
| Max. Negotiated Rate |
$134.55 |
| Rate for Payer: Aetna Commercial |
$83.90
|
| Rate for Payer: Aetna Medicare |
$65.11
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: BCBS MAPPO |
$62.61
|
| Rate for Payer: BCN Medicare Advantage |
$62.61
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cofinity Commercial |
$83.90
|
| Rate for Payer: Cofinity Commercial |
$90.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.74
|
| Rate for Payer: Nomi Health Commercial |
$75.13
|
| Rate for Payer: PACE SWMI |
$62.61
|
| Rate for Payer: PHP Medicare Advantage |
$62.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
| Rate for Payer: Priority Health Medicare |
$63.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.61
|
| Rate for Payer: UHC Exchange |
$62.61
|
| Rate for Payer: UHC Medicare Advantage |
$62.61
|
|
|
PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 50430
|
| Min. Negotiated Rate |
$96.00 |
| Max. Negotiated Rate |
$208.32 |
| Rate for Payer: Aetna Commercial |
$193.86
|
| Rate for Payer: Aetna Medicare |
$150.46
|
| Rate for Payer: BCBS Complete |
$96.00
|
| Rate for Payer: BCBS MAPPO |
$144.67
|
| Rate for Payer: BCN Medicare Advantage |
$144.67
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cofinity Commercial |
$208.32
|
| Rate for Payer: Cofinity Commercial |
$193.86
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$144.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$151.90
|
| Rate for Payer: Nomi Health Commercial |
$173.60
|
| Rate for Payer: PACE SWMI |
$144.67
|
| Rate for Payer: PHP Medicare Advantage |
$144.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health Medicare |
$146.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$144.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$144.67
|
| Rate for Payer: UHC Exchange |
$144.67
|
| Rate for Payer: UHC Medicare Advantage |
$144.67
|
|
|
PR NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 36005
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$373.75 |
| Rate for Payer: Aetna Commercial |
$60.77
|
| Rate for Payer: Aetna Medicare |
$47.16
|
| Rate for Payer: BCBS Complete |
$230.00
|
| Rate for Payer: BCBS MAPPO |
$45.35
|
| Rate for Payer: BCN Medicare Advantage |
$45.35
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cofinity Commercial |
$65.30
|
| Rate for Payer: Cofinity Commercial |
$60.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$45.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$47.62
|
| Rate for Payer: Nomi Health Commercial |
$54.42
|
| Rate for Payer: PACE SWMI |
$45.35
|
| Rate for Payer: PHP Medicare Advantage |
$45.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.75
|
| Rate for Payer: Priority Health Medicare |
$45.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$45.35
|
| Rate for Payer: UHC Exchange |
$45.35
|
| Rate for Payer: UHC Medicare Advantage |
$45.35
|
|
