|
PR NITRIC OXIDE EXPIRED GAS DETERMINATION
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS 95012
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$23.89 |
| Rate for Payer: Aetna Commercial |
$22.23
|
| Rate for Payer: Aetna Medicare |
$17.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.23
|
| Rate for Payer: BCBS Complete |
$14.40
|
| Rate for Payer: BCBS MAPPO |
$16.59
|
| Rate for Payer: BCN Medicare Advantage |
$16.59
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cofinity Commercial |
$23.89
|
| Rate for Payer: Cofinity Commercial |
$22.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.42
|
| Rate for Payer: Nomi Health Commercial |
$19.91
|
| Rate for Payer: PACE SWMI |
$16.59
|
| Rate for Payer: PHP Commercial |
$23.23
|
| Rate for Payer: PHP Medicare Advantage |
$16.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$23.40
|
| Rate for Payer: Priority Health Medicare |
$16.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.59
|
| Rate for Payer: UHC Medicare Advantage |
$16.59
|
| Rate for Payer: UMR Bronson Commercial |
$16.56
|
|
|
PR NJX AA&/STRD PLANTAR COMMON DIGITAL NERVES
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
HCPCS 64455
|
| Min. Negotiated Rate |
$31.76 |
| Max. Negotiated Rate |
$206.05 |
| Rate for Payer: Aetna Commercial |
$42.56
|
| Rate for Payer: Aetna Medicare |
$33.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$45.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.56
|
| Rate for Payer: BCBS Complete |
$126.80
|
| Rate for Payer: BCBS MAPPO |
$31.76
|
| Rate for Payer: BCN Medicare Advantage |
$31.76
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$45.73
|
| Rate for Payer: Cofinity Commercial |
$42.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$31.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$33.35
|
| Rate for Payer: Nomi Health Commercial |
$38.11
|
| Rate for Payer: PACE SWMI |
$31.76
|
| Rate for Payer: PHP Commercial |
$44.46
|
| Rate for Payer: PHP Medicare Advantage |
$31.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.05
|
| Rate for Payer: Priority Health Medicare |
$31.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$31.76
|
| Rate for Payer: UHC Medicare Advantage |
$31.76
|
| Rate for Payer: UMR Bronson Commercial |
$145.82
|
|
|
PR NJX AA&/STRD TFRML EPI CERVICAL/THORACIC 1 LEVEL
|
Professional
|
Both
|
$893.00
|
|
|
Service Code
|
HCPCS 64479
|
| Min. Negotiated Rate |
$123.89 |
| Max. Negotiated Rate |
$580.45 |
| Rate for Payer: Aetna Commercial |
$166.01
|
| Rate for Payer: Aetna Commercial |
$166.01
|
| Rate for Payer: Aetna Medicare |
$128.85
|
| Rate for Payer: Aetna Medicare |
$128.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$178.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$166.01
|
| Rate for Payer: BCBS Complete |
$126.80
|
| Rate for Payer: BCBS Complete |
$357.20
|
| Rate for Payer: BCBS MAPPO |
$123.89
|
| Rate for Payer: BCBS MAPPO |
$123.89
|
| Rate for Payer: BCN Medicare Advantage |
$123.89
|
| Rate for Payer: BCN Medicare Advantage |
$123.89
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$714.40
|
| Rate for Payer: Cash Price |
$253.60
|
| Rate for Payer: Cofinity Commercial |
$178.40
|
| Rate for Payer: Cofinity Commercial |
$166.01
|
| Rate for Payer: Cofinity Commercial |
$178.40
|
| Rate for Payer: Cofinity Commercial |
$166.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$130.08
|
| Rate for Payer: Nomi Health Commercial |
$148.67
|
| Rate for Payer: Nomi Health Commercial |
$148.67
|
| Rate for Payer: PACE SWMI |
$123.89
|
| Rate for Payer: PACE SWMI |
$123.89
|
| Rate for Payer: PHP Commercial |
$173.45
|
| Rate for Payer: PHP Commercial |
$173.45
|
| Rate for Payer: PHP Medicare Advantage |
$123.89
|
| Rate for Payer: PHP Medicare Advantage |
$123.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$206.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$580.45
|
| Rate for Payer: Priority Health Medicare |
$123.89
|
| Rate for Payer: Priority Health Medicare |
$123.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.89
|
| Rate for Payer: UHC Medicare Advantage |
$123.89
|
| Rate for Payer: UHC Medicare Advantage |
$123.89
|
| Rate for Payer: UMR Bronson Commercial |
$145.82
|
| Rate for Payer: UMR Bronson Commercial |
$410.78
|
|
|
PR NJX AA&/STRD TFRML EPI CERVICAL/THORACIC EA ADDL
|
Professional
|
Both
|
$346.00
|
|
|
Service Code
|
HCPCS 64480
|
| Min. Negotiated Rate |
$58.69 |
| Max. Negotiated Rate |
$224.90 |
| Rate for Payer: Aetna Commercial |
$78.64
|
| Rate for Payer: Aetna Medicare |
$61.04
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$78.64
|
| Rate for Payer: BCBS Complete |
$138.40
|
| Rate for Payer: BCBS MAPPO |
$58.69
|
| Rate for Payer: BCN Medicare Advantage |
$58.69
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cash Price |
$276.80
|
| Rate for Payer: Cofinity Commercial |
$84.51
|
| Rate for Payer: Cofinity Commercial |
$78.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$61.62
|
| Rate for Payer: Nomi Health Commercial |
$70.43
|
| Rate for Payer: PACE SWMI |
$58.69
|
| Rate for Payer: PHP Commercial |
$82.17
|
| Rate for Payer: PHP Medicare Advantage |
$58.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$224.90
|
| Rate for Payer: Priority Health Medicare |
$58.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$58.69
|
| Rate for Payer: UHC Medicare Advantage |
$58.69
|
| Rate for Payer: UMR Bronson Commercial |
$159.16
|
|
|
PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL 1 LEVEL
|
Professional
|
Both
|
$270.00
|
|
|
Service Code
|
HCPCS 64483
|
| Min. Negotiated Rate |
$104.95 |
| Max. Negotiated Rate |
$175.50 |
| Rate for Payer: Aetna Commercial |
$140.63
|
| Rate for Payer: Aetna Commercial |
$140.63
|
| Rate for Payer: Aetna Medicare |
$109.15
|
| Rate for Payer: Aetna Medicare |
$109.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$151.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$140.63
|
| Rate for Payer: BCBS Complete |
$408.00
|
| Rate for Payer: BCBS Complete |
$108.00
|
| Rate for Payer: BCBS MAPPO |
$104.95
|
| Rate for Payer: BCBS MAPPO |
$104.95
|
| Rate for Payer: BCN Medicare Advantage |
$104.95
|
| Rate for Payer: BCN Medicare Advantage |
$104.95
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cash Price |
$816.00
|
| Rate for Payer: Cofinity Commercial |
$151.13
|
| Rate for Payer: Cofinity Commercial |
$140.63
|
| Rate for Payer: Cofinity Commercial |
$151.13
|
| Rate for Payer: Cofinity Commercial |
$140.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$110.20
|
| Rate for Payer: Nomi Health Commercial |
$125.94
|
| Rate for Payer: Nomi Health Commercial |
$125.94
|
| Rate for Payer: PACE SWMI |
$104.95
|
| Rate for Payer: PACE SWMI |
$104.95
|
| Rate for Payer: PHP Commercial |
$146.93
|
| Rate for Payer: PHP Commercial |
$146.93
|
| Rate for Payer: PHP Medicare Advantage |
$104.95
|
| Rate for Payer: PHP Medicare Advantage |
$104.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$663.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.50
|
| Rate for Payer: Priority Health Medicare |
$104.95
|
| Rate for Payer: Priority Health Medicare |
$104.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.95
|
| Rate for Payer: UHC Medicare Advantage |
$104.95
|
| Rate for Payer: UHC Medicare Advantage |
$104.95
|
| Rate for Payer: UMR Bronson Commercial |
$469.20
|
| Rate for Payer: UMR Bronson Commercial |
$124.20
|
|
|
PR NJX AA&/STRD TFRML EPI LUMBAR/SACRAL EA ADDL
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS 64484
|
| Min. Negotiated Rate |
$48.05 |
| Max. Negotiated Rate |
$289.25 |
| Rate for Payer: Aetna Commercial |
$64.39
|
| Rate for Payer: Aetna Medicare |
$49.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.39
|
| Rate for Payer: BCBS Complete |
$178.00
|
| Rate for Payer: BCBS MAPPO |
$48.05
|
| Rate for Payer: BCN Medicare Advantage |
$48.05
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cash Price |
$356.00
|
| Rate for Payer: Cofinity Commercial |
$69.19
|
| Rate for Payer: Cofinity Commercial |
$64.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.45
|
| Rate for Payer: Nomi Health Commercial |
$57.66
|
| Rate for Payer: PACE SWMI |
$48.05
|
| Rate for Payer: PHP Commercial |
$67.27
|
| Rate for Payer: PHP Medicare Advantage |
$48.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$289.25
|
| Rate for Payer: Priority Health Medicare |
$48.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.05
|
| Rate for Payer: UHC Medicare Advantage |
$48.05
|
| Rate for Payer: UMR Bronson Commercial |
$204.70
|
|
|
PR NJX BONE SUB MATRL INTO SUBCHONDRAL BONE DEFECT
|
Professional
|
Both
|
$3,060.00
|
|
|
Service Code
|
HCPCS 0707T
|
| Min. Negotiated Rate |
$1,224.00 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Aetna Medicare |
$1,530.00
|
| Rate for Payer: BCBS Complete |
$1,224.00
|
| Rate for Payer: Cash Price |
$2,448.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,989.00
|
| Rate for Payer: UMR Bronson Commercial |
$1,407.60
|
|
|
PR NJX CSTOGRAPY/VOIDING URETHROCSTOGRAPY
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 51600
|
| Min. Negotiated Rate |
$40.93 |
| Max. Negotiated Rate |
$447.85 |
| Rate for Payer: Aetna Commercial |
$54.85
|
| Rate for Payer: Aetna Medicare |
$42.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$54.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.94
|
| Rate for Payer: BCBS Complete |
$275.60
|
| Rate for Payer: BCBS MAPPO |
$40.93
|
| Rate for Payer: BCN Medicare Advantage |
$40.93
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cofinity Commercial |
$54.85
|
| Rate for Payer: Cofinity Commercial |
$58.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$42.98
|
| Rate for Payer: Nomi Health Commercial |
$49.12
|
| Rate for Payer: PACE SWMI |
$40.93
|
| Rate for Payer: PHP Commercial |
$57.30
|
| Rate for Payer: PHP Medicare Advantage |
$40.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$447.85
|
| Rate for Payer: Priority Health Medicare |
$40.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.93
|
| Rate for Payer: UHC Medicare Advantage |
$40.93
|
| Rate for Payer: UMR Bronson Commercial |
$316.94
|
|
|
PR NJX DRG C-CATHJ SLCTV L VNTRC/R ATRIAL ANGRPHS&I
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
HCPCS 93565
|
| Min. Negotiated Rate |
$26.12 |
| Max. Negotiated Rate |
$48.75 |
| Rate for Payer: Aetna Commercial |
$35.00
|
| Rate for Payer: Aetna Medicare |
$27.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.00
|
| Rate for Payer: BCBS Complete |
$30.00
|
| Rate for Payer: BCBS MAPPO |
$26.12
|
| Rate for Payer: BCN Medicare Advantage |
$26.12
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cofinity Commercial |
$37.61
|
| Rate for Payer: Cofinity Commercial |
$35.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$27.43
|
| Rate for Payer: Nomi Health Commercial |
$31.34
|
| Rate for Payer: PACE SWMI |
$26.12
|
| Rate for Payer: PHP Commercial |
$36.57
|
| Rate for Payer: PHP Medicare Advantage |
$26.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$48.75
|
| Rate for Payer: Priority Health Medicare |
$26.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$26.12
|
| Rate for Payer: UHC Medicare Advantage |
$26.12
|
| Rate for Payer: UMR Bronson Commercial |
$34.50
|
|
|
PR NJX DRG C-CATHJ SLCTV R VNTRC/R ATRIAL ANGRPHS&I
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 93566
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna Commercial |
$32.84
|
| Rate for Payer: Aetna Medicare |
$25.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$35.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$32.84
|
| Rate for Payer: BCBS Complete |
$115.20
|
| Rate for Payer: BCBS MAPPO |
$24.51
|
| Rate for Payer: BCN Medicare Advantage |
$24.51
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cofinity Commercial |
$35.29
|
| Rate for Payer: Cofinity Commercial |
$32.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$24.51
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$25.74
|
| Rate for Payer: Nomi Health Commercial |
$29.41
|
| Rate for Payer: PACE SWMI |
$24.51
|
| Rate for Payer: PHP Commercial |
$34.31
|
| Rate for Payer: PHP Medicare Advantage |
$24.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.20
|
| Rate for Payer: Priority Health Medicare |
$24.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$24.51
|
| Rate for Payer: UHC Medicare Advantage |
$24.51
|
| Rate for Payer: UMR Bronson Commercial |
$132.48
|
|
|
PR NJX DRG C-CATHJ SUPRAVALVULAR AORTOGRAPHY S&I
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 93567
|
| Min. Negotiated Rate |
$35.79 |
| Max. Negotiated Rate |
$277.55 |
| Rate for Payer: Aetna Commercial |
$47.96
|
| Rate for Payer: Aetna Medicare |
$37.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.96
|
| Rate for Payer: BCBS Complete |
$170.80
|
| Rate for Payer: BCBS MAPPO |
$35.79
|
| Rate for Payer: BCN Medicare Advantage |
$35.79
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cofinity Commercial |
$51.54
|
| Rate for Payer: Cofinity Commercial |
$47.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.58
|
| Rate for Payer: Nomi Health Commercial |
$42.95
|
| Rate for Payer: PACE SWMI |
$35.79
|
| Rate for Payer: PHP Commercial |
$50.11
|
| Rate for Payer: PHP Medicare Advantage |
$35.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.55
|
| Rate for Payer: Priority Health Medicare |
$35.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.79
|
| Rate for Payer: UHC Medicare Advantage |
$35.79
|
| Rate for Payer: UMR Bronson Commercial |
$196.42
|
|
|
PR NJX DRG CGEN C-CATHJ SLCTV CORONARY ANGRPH S&I
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 93563
|
| Min. Negotiated Rate |
$48.73 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Aetna Commercial |
$65.30
|
| Rate for Payer: Aetna Medicare |
$50.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$65.30
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: BCBS MAPPO |
$48.73
|
| Rate for Payer: BCN Medicare Advantage |
$48.73
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cofinity Commercial |
$70.17
|
| Rate for Payer: Cofinity Commercial |
$65.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.73
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.17
|
| Rate for Payer: Nomi Health Commercial |
$58.48
|
| Rate for Payer: PACE SWMI |
$48.73
|
| Rate for Payer: PHP Commercial |
$68.22
|
| Rate for Payer: PHP Medicare Advantage |
$48.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: Priority Health Medicare |
$48.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.73
|
| Rate for Payer: UHC Medicare Advantage |
$48.73
|
| Rate for Payer: UMR Bronson Commercial |
$56.12
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
64490
|
| Min. Negotiated Rate |
$125.43 |
| Max. Negotiated Rate |
$2,444.12 |
| Rate for Payer: Aetna American Axle |
$220.35
|
| Rate for Payer: Aetna Commercial |
$288.15
|
| Rate for Payer: Aetna Medicare |
$903.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,085.35
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,085.35
|
| Rate for Payer: BCBS Complete |
$488.67
|
| Rate for Payer: BCBS MAPPO |
$868.28
|
| Rate for Payer: BCN Medicare Advantage |
$868.28
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$237.30
|
| Rate for Payer: Cofinity Commercial |
$291.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$868.28
|
| Rate for Payer: Healthscope Commercial |
$305.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.25
|
| Rate for Payer: Mclaren Medicaid |
$465.40
|
| Rate for Payer: Mclaren Medicare |
$868.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$911.69
|
| Rate for Payer: Meridian Medicaid |
$488.67
|
| Rate for Payer: MI Amish Medical Board Commercial |
$998.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.15
|
| Rate for Payer: PACE Medicare |
$824.87
|
| Rate for Payer: PACE SWMI |
$868.28
|
| Rate for Payer: PHP Commercial |
$288.15
|
| Rate for Payer: PHP Medicare Advantage |
$868.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$465.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health Medicare |
$868.28
|
| Rate for Payer: Priority Health SBD |
$213.57
|
| Rate for Payer: Railroad Medicare Medicare |
$868.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,444.12
|
| Rate for Payer: UHC Dual Complete DSNP |
$868.28
|
| Rate for Payer: UHC Exchange |
$1,659.37
|
| Rate for Payer: UHC Medicare Advantage |
$868.28
|
| Rate for Payer: UHCCP Medicaid |
$465.40
|
| Rate for Payer: UMR Bronson Commercial |
$125.43
|
| Rate for Payer: VA VA |
$868.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.25
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 64490
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$220.35 |
| Rate for Payer: Aetna Commercial |
$133.73
|
| Rate for Payer: Aetna Medicare |
$103.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.73
|
| Rate for Payer: BCBS Complete |
$135.60
|
| Rate for Payer: BCBS MAPPO |
$99.80
|
| Rate for Payer: BCN Medicare Advantage |
$99.80
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$143.71
|
| Rate for Payer: Cofinity Commercial |
$133.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.79
|
| Rate for Payer: Nomi Health Commercial |
$119.76
|
| Rate for Payer: PACE SWMI |
$99.80
|
| Rate for Payer: PHP Commercial |
$139.72
|
| Rate for Payer: PHP Medicare Advantage |
$99.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health Medicare |
$99.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.80
|
| Rate for Payer: UHC Medicare Advantage |
$99.80
|
| Rate for Payer: UMR Bronson Commercial |
$155.94
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
64490
|
| Min. Negotiated Rate |
$149.16 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Aetna American Axle |
$220.35
|
| Rate for Payer: Aetna Commercial |
$288.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$220.35
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$237.30
|
| Rate for Payer: Cofinity Commercial |
$291.54
|
| Rate for Payer: Cofinity Medicare Advantage |
$237.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.20
|
| Rate for Payer: Healthscope Commercial |
$305.10
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$237.30
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$254.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.15
|
| Rate for Payer: PHP Commercial |
$288.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health SBD |
$213.57
|
| Rate for Payer: UMR Bronson Commercial |
$149.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$254.25
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 64490
|
| Hospital Charge Code |
64490
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$220.35 |
| Rate for Payer: Aetna Commercial |
$133.73
|
| Rate for Payer: Aetna Medicare |
$103.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.73
|
| Rate for Payer: BCBS Complete |
$135.60
|
| Rate for Payer: BCBS MAPPO |
$99.80
|
| Rate for Payer: BCN Medicare Advantage |
$99.80
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$133.73
|
| Rate for Payer: Cofinity Commercial |
$143.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$99.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$104.79
|
| Rate for Payer: Nomi Health Commercial |
$119.76
|
| Rate for Payer: PACE SWMI |
$99.80
|
| Rate for Payer: PHP Commercial |
$139.72
|
| Rate for Payer: PHP Medicare Advantage |
$99.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health Medicare |
$99.80
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.80
|
| Rate for Payer: UHC Medicare Advantage |
$99.80
|
| Rate for Payer: UMR Bronson Commercial |
$155.94
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 64491
|
| Min. Negotiated Rate |
$56.89 |
| Max. Negotiated Rate |
$137.80 |
| Rate for Payer: Aetna Commercial |
$76.23
|
| Rate for Payer: Aetna Medicare |
$59.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.23
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: BCBS MAPPO |
$56.89
|
| Rate for Payer: BCN Medicare Advantage |
$56.89
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$81.92
|
| Rate for Payer: Cofinity Commercial |
$76.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.73
|
| Rate for Payer: Nomi Health Commercial |
$68.27
|
| Rate for Payer: PACE SWMI |
$56.89
|
| Rate for Payer: PHP Commercial |
$79.65
|
| Rate for Payer: PHP Medicare Advantage |
$56.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health Medicare |
$56.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.89
|
| Rate for Payer: UHC Medicare Advantage |
$56.89
|
| Rate for Payer: UMR Bronson Commercial |
$97.52
|
|
|
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 |
$93.28 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna American Axle |
$137.80
|
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.80
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$148.40
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.20
|
| Rate for Payer: PHP Commercial |
$180.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health SBD |
$133.56
|
| Rate for Payer: UMR Bronson Commercial |
$93.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
64491
|
| Min. Negotiated Rate |
$78.44 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna American Axle |
$137.80
|
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: Aetna Medicare |
$106.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.80
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$148.40
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.20
|
| Rate for Payer: PHP Commercial |
$180.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health SBD |
$133.56
|
| Rate for Payer: UMR Bronson Commercial |
$78.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 64491
|
| Hospital Charge Code |
64491
|
| Min. Negotiated Rate |
$56.89 |
| Max. Negotiated Rate |
$137.80 |
| Rate for Payer: Aetna Commercial |
$76.23
|
| Rate for Payer: Aetna Medicare |
$59.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.92
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: BCBS MAPPO |
$56.89
|
| Rate for Payer: BCN Medicare Advantage |
$56.89
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$81.92
|
| Rate for Payer: Cofinity Commercial |
$76.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$56.89
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.73
|
| Rate for Payer: Nomi Health Commercial |
$68.27
|
| Rate for Payer: PACE SWMI |
$56.89
|
| Rate for Payer: PHP Commercial |
$79.65
|
| Rate for Payer: PHP Medicare Advantage |
$56.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health Medicare |
$56.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.89
|
| Rate for Payer: UHC Medicare Advantage |
$56.89
|
| Rate for Payer: UMR Bronson Commercial |
$97.52
|
|
|
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 |
$78.44 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna American Axle |
$137.80
|
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: Aetna Medicare |
$106.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.80
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$148.40
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.20
|
| Rate for Payer: PHP Commercial |
$180.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health SBD |
$133.56
|
| Rate for Payer: UMR Bronson Commercial |
$78.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$159.00
|
|
|
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 |
$93.28 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Aetna American Axle |
$137.80
|
| Rate for Payer: Aetna Commercial |
$180.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.80
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$148.40
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Cofinity Medicare Advantage |
$148.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$190.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$148.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$159.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.20
|
| Rate for Payer: PHP Commercial |
$180.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health SBD |
$133.56
|
| Rate for Payer: UMR Bronson Commercial |
$93.28
|
| 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 |
$57.10 |
| Max. Negotiated Rate |
$137.80 |
| Rate for Payer: Aetna Commercial |
$76.51
|
| Rate for Payer: Aetna Medicare |
$59.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.51
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: BCBS MAPPO |
$57.10
|
| Rate for Payer: BCN Medicare Advantage |
$57.10
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$82.22
|
| Rate for Payer: Cofinity Commercial |
$76.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.95
|
| Rate for Payer: Nomi Health Commercial |
$68.52
|
| Rate for Payer: PACE SWMI |
$57.10
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: PHP Medicare Advantage |
$57.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health Medicare |
$57.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.10
|
| Rate for Payer: UHC Medicare Advantage |
$57.10
|
| Rate for Payer: UMR Bronson Commercial |
$97.52
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 64492
|
| Hospital Charge Code |
64492
|
| Min. Negotiated Rate |
$57.10 |
| Max. Negotiated Rate |
$137.80 |
| Rate for Payer: Aetna Commercial |
$76.51
|
| Rate for Payer: Aetna Medicare |
$59.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.51
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: BCBS MAPPO |
$57.10
|
| Rate for Payer: BCN Medicare Advantage |
$57.10
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$76.51
|
| Rate for Payer: Cofinity Commercial |
$82.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$59.95
|
| Rate for Payer: Nomi Health Commercial |
$68.52
|
| Rate for Payer: PACE SWMI |
$57.10
|
| Rate for Payer: PHP Commercial |
$79.94
|
| Rate for Payer: PHP Medicare Advantage |
$57.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health Medicare |
$57.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.10
|
| Rate for Payer: UHC Medicare Advantage |
$57.10
|
| Rate for Payer: UMR Bronson Commercial |
$97.52
|
|
|
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 |
$106.48 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Aetna American Axle |
$157.30
|
| Rate for Payer: Aetna Commercial |
$205.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.30
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$169.40
|
| Rate for Payer: Cofinity Commercial |
$208.12
|
| Rate for Payer: Cofinity Medicare Advantage |
$169.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.60
|
| Rate for Payer: Healthscope Commercial |
$217.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$169.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$181.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.70
|
| Rate for Payer: PHP Commercial |
$205.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health SBD |
$152.46
|
| Rate for Payer: UMR Bronson Commercial |
$106.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.50
|
|
