|
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 |
$67.31 |
| Max. Negotiated Rate |
$278.55 |
| Rate for Payer: Aetna Commercial |
$133.73
|
| Rate for Payer: Aetna Medicare |
$103.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$133.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$143.71
|
| Rate for Payer: BCBS Complete |
$70.68
|
| Rate for Payer: BCBS MAPPO |
$99.80
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: BCN Commercial |
$278.55
|
| 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: Meridian Medicaid |
$70.68
|
| 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 Choice Medicaid |
$67.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.57
|
| Rate for Payer: Priority Health Medicare |
$99.80
|
| Rate for Payer: Priority Health Narrow Network |
$178.57
|
| Rate for Payer: Priority Health SBD |
$178.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$99.80
|
| Rate for Payer: UHC Medicare Advantage |
$99.80
|
| Rate for Payer: UHCCP Medicaid |
$67.31
|
| 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
|
| Hospital Charge Code |
64491
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$344.45 |
| 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 |
$39.81
|
| Rate for Payer: BCBS MAPPO |
$56.89
|
| Rate for Payer: BCBS Trust/PPO |
$344.45
|
| Rate for Payer: BCN Commercial |
$141.23
|
| 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 |
$76.23
|
| Rate for Payer: Cofinity Commercial |
$81.92
|
| 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: Meridian Medicaid |
$39.81
|
| 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 Choice Medicaid |
$37.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.10
|
| Rate for Payer: Priority Health Medicare |
$56.89
|
| Rate for Payer: Priority Health Narrow Network |
$100.10
|
| Rate for Payer: Priority Health SBD |
$100.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.89
|
| Rate for Payer: UHC Medicare Advantage |
$56.89
|
| Rate for Payer: UHCCP Medicaid |
$37.91
|
| 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
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 64491
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$344.45 |
| 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 |
$39.81
|
| Rate for Payer: BCBS MAPPO |
$56.89
|
| Rate for Payer: BCBS Trust/PPO |
$344.45
|
| Rate for Payer: BCN Commercial |
$141.23
|
| 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 |
$76.23
|
| Rate for Payer: Cofinity Commercial |
$81.92
|
| 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: Meridian Medicaid |
$39.81
|
| 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 Choice Medicaid |
$37.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.10
|
| Rate for Payer: Priority Health Medicare |
$56.89
|
| Rate for Payer: Priority Health Narrow Network |
$100.10
|
| Rate for Payer: Priority Health SBD |
$100.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$56.89
|
| Rate for Payer: UHC Medicare Advantage |
$56.89
|
| Rate for Payer: UHCCP Medicaid |
$37.91
|
| Rate for Payer: UMR Bronson Commercial |
$97.52
|
|
|
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 |
$56.91 |
| Max. Negotiated Rate |
$700.00 |
| 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: BCBS Trust/PPO |
$334.82
|
| Rate for Payer: BCN Commercial |
$334.82
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Cofinity Commercial |
$148.40
|
| 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: UHC All Payor (Choice/PPO) |
$62.60
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$56.91
|
| 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
|
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: Aetna New Business (MI Preferred) |
$76.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.22
|
| 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 |
$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 |
$59.96
|
| 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 Commercial |
$79.94
|
| 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/Tiered Network |
$101.79
|
| Rate for Payer: Priority Health Medicare |
$57.10
|
| Rate for Payer: Priority Health Narrow Network |
$101.79
|
| Rate for Payer: Priority Health SBD |
$101.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.10
|
| Rate for Payer: UHC Medicare Advantage |
$57.10
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
| 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 |
$38.13 |
| Max. Negotiated Rate |
$216.07 |
| Rate for Payer: Aetna Commercial |
$76.51
|
| Rate for Payer: Aetna Medicare |
$59.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.22
|
| 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: 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 Commercial |
$79.94
|
| 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/Tiered Network |
$101.79
|
| Rate for Payer: Priority Health Medicare |
$57.10
|
| Rate for Payer: Priority Health Narrow Network |
$101.79
|
| Rate for Payer: Priority Health SBD |
$101.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.10
|
| Rate for Payer: UHC Medicare Advantage |
$57.10
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
| Rate for Payer: UMR Bronson Commercial |
$97.52
|
|
|
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
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
64492
|
| Min. Negotiated Rate |
$57.81 |
| Max. Negotiated Rate |
$700.00 |
| 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: BCBS Trust/PPO |
$336.09
|
| Rate for Payer: BCN Commercial |
$336.09
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$182.32
|
| Rate for Payer: Cofinity Commercial |
$148.40
|
| 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: UHC All Payor (Choice/PPO) |
$63.59
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$57.81
|
| 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 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: Aetna New Business (MI Preferred) |
$115.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.10
|
| 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: 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 Commercial |
$120.65
|
| 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/Tiered Network |
$153.56
|
| Rate for Payer: Priority Health Medicare |
$86.18
|
| Rate for Payer: Priority Health Narrow Network |
$153.56
|
| Rate for Payer: Priority Health SBD |
$153.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.18
|
| Rate for Payer: UHC Medicare Advantage |
$86.18
|
| Rate for Payer: UHCCP Medicaid |
$58.15
|
| Rate for Payer: UMR Bronson Commercial |
$111.32
|
|
|
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 |
$86.26 |
| Max. Negotiated Rate |
$2,741.59 |
| Rate for Payer: Aetna American Axle |
$157.30
|
| Rate for Payer: Aetna Commercial |
$205.70
|
| Rate for Payer: Aetna Medicare |
$907.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$157.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$1,023.05
|
| Rate for Payer: BCN Commercial |
$1,023.05
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| 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: Health Alliance Plan Medicare Advantage |
$872.29
|
| 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: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.70
|
| Rate for Payer: Nomi Health Commercial |
$1,831.81
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$205.70
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,741.59
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$2,193.27
|
| Rate for Payer: Priority Health SBD |
$152.46
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$94.89
|
| Rate for Payer: UHC Core |
$981.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$86.26
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: UMR Bronson Commercial |
$89.54
|
| Rate for Payer: VA VA |
$872.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$181.50
|
|
|
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
|
|
|
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: Aetna New Business (MI Preferred) |
$115.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$124.10
|
| 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 |
$115.48
|
| Rate for Payer: Cofinity Commercial |
$124.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.18
|
| 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 Commercial |
$120.65
|
| 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/Tiered Network |
$153.56
|
| Rate for Payer: Priority Health Medicare |
$86.18
|
| Rate for Payer: Priority Health Narrow Network |
$153.56
|
| Rate for Payer: Priority Health SBD |
$153.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.18
|
| Rate for Payer: UHC Medicare Advantage |
$86.18
|
| Rate for Payer: UHCCP Medicaid |
$58.15
|
| Rate for Payer: UMR Bronson Commercial |
$111.32
|
|
|
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 |
$73.48 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Aetna American Axle |
$108.55
|
| Rate for Payer: Aetna Commercial |
$141.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.55
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$116.90
|
| Rate for Payer: Cofinity Commercial |
$143.62
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.60
|
| Rate for Payer: Healthscope Commercial |
$150.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.95
|
| Rate for Payer: PHP Commercial |
$141.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health SBD |
$105.21
|
| Rate for Payer: UMR Bronson Commercial |
$73.48
|
| 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 |
$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: Aetna New Business (MI Preferred) |
$65.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.87
|
| 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 |
$65.02
|
| Rate for Payer: Cofinity Commercial |
$69.87
|
| 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: Meridian Medicaid |
$34.00
|
| Rate for Payer: Nomi Health Commercial |
$58.22
|
| Rate for Payer: PACE SWMI |
$48.52
|
| Rate for Payer: PHP Commercial |
$67.93
|
| 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/Tiered Network |
$85.87
|
| Rate for Payer: Priority Health Medicare |
$48.52
|
| Rate for Payer: Priority Health Narrow Network |
$85.87
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.52
|
| Rate for Payer: UHC Medicare Advantage |
$48.52
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
| Rate for Payer: UMR Bronson Commercial |
$76.82
|
|
|
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: Aetna New Business (MI Preferred) |
$65.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.87
|
| 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 |
$65.02
|
| Rate for Payer: Cofinity Commercial |
$69.87
|
| 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: Meridian Medicaid |
$34.00
|
| Rate for Payer: Nomi Health Commercial |
$58.22
|
| Rate for Payer: PACE SWMI |
$48.52
|
| Rate for Payer: PHP Commercial |
$67.93
|
| 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/Tiered Network |
$85.87
|
| Rate for Payer: Priority Health Medicare |
$48.52
|
| Rate for Payer: Priority Health Narrow Network |
$85.87
|
| Rate for Payer: Priority Health SBD |
$85.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.52
|
| Rate for Payer: UHC Medicare Advantage |
$48.52
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
| Rate for Payer: UMR Bronson Commercial |
$76.82
|
|
|
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 |
$48.82 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$108.55
|
| Rate for Payer: Aetna Commercial |
$141.95
|
| Rate for Payer: Aetna Medicare |
$83.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.55
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS Trust/PPO |
$308.28
|
| Rate for Payer: BCN Commercial |
$308.28
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$143.62
|
| Rate for Payer: Cofinity Commercial |
$116.90
|
| Rate for Payer: Cofinity Medicare Advantage |
$116.90
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.60
|
| Rate for Payer: Healthscope Commercial |
$150.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$116.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$125.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.95
|
| Rate for Payer: PHP Commercial |
$141.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health SBD |
$105.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.70
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$48.82
|
| Rate for Payer: UMR Bronson Commercial |
$61.79
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$125.25
|
|
|
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 |
$75.24 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna American Axle |
$111.15
|
| Rate for Payer: Aetna Commercial |
$145.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.15
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$119.70
|
| Rate for Payer: Cofinity Commercial |
$147.06
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.80
|
| Rate for Payer: Healthscope Commercial |
$153.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.35
|
| Rate for Payer: PHP Commercial |
$145.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health SBD |
$107.73
|
| Rate for Payer: UMR Bronson Commercial |
$75.24
|
| 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: Aetna New Business (MI Preferred) |
$65.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.04
|
| 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: 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 Commercial |
$68.10
|
| 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/Tiered Network |
$87.58
|
| Rate for Payer: Priority Health Medicare |
$48.64
|
| Rate for Payer: Priority Health Narrow Network |
$87.58
|
| Rate for Payer: Priority Health SBD |
$87.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.64
|
| Rate for Payer: UHC Medicare Advantage |
$48.64
|
| Rate for Payer: UHCCP Medicaid |
$32.59
|
| Rate for Payer: UMR Bronson Commercial |
$78.66
|
|
|
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: Aetna New Business (MI Preferred) |
$65.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.04
|
| 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 |
$65.18
|
| Rate for Payer: Cofinity Commercial |
$70.04
|
| 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: Meridian Medicaid |
$34.22
|
| Rate for Payer: Nomi Health Commercial |
$58.37
|
| Rate for Payer: PACE SWMI |
$48.64
|
| Rate for Payer: PHP Commercial |
$68.10
|
| 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/Tiered Network |
$87.58
|
| Rate for Payer: Priority Health Medicare |
$48.64
|
| Rate for Payer: Priority Health Narrow Network |
$87.58
|
| Rate for Payer: Priority Health SBD |
$87.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.64
|
| Rate for Payer: UHC Medicare Advantage |
$48.64
|
| Rate for Payer: UHCCP Medicaid |
$32.59
|
| Rate for Payer: UMR Bronson Commercial |
$78.66
|
|
|
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 |
$49.71 |
| Max. Negotiated Rate |
$700.00 |
| Rate for Payer: Aetna American Axle |
$111.15
|
| Rate for Payer: Aetna Commercial |
$145.35
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.15
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS Trust/PPO |
$309.54
|
| Rate for Payer: BCN Commercial |
$309.54
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$147.06
|
| Rate for Payer: Cofinity Commercial |
$119.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$119.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.80
|
| Rate for Payer: Healthscope Commercial |
$153.90
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$119.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$128.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.35
|
| Rate for Payer: PHP Commercial |
$145.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health SBD |
$107.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.68
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Exchange |
$49.71
|
| Rate for Payer: UMR Bronson Commercial |
$63.27
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$348.68
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$310.04
|
|
|
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: Aetna New Business (MI Preferred) |
$136.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.49
|
| 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: 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 Commercial |
$142.42
|
| 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/Tiered Network |
$181.99
|
| Rate for Payer: Priority Health Medicare |
$101.73
|
| Rate for Payer: Priority Health Narrow Network |
$181.99
|
| Rate for Payer: Priority Health SBD |
$181.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.73
|
| Rate for Payer: UHC Medicare Advantage |
$101.73
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
| Rate for Payer: UMR Bronson Commercial |
$155.48
|
|
|
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 |
$135.52 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Aetna American Axle |
$200.20
|
| Rate for Payer: Aetna Commercial |
$261.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$200.20
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$215.60
|
| Rate for Payer: Cofinity Commercial |
$264.88
|
| Rate for Payer: Cofinity Medicare Advantage |
$215.60
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.40
|
| Rate for Payer: Healthscope Commercial |
$277.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$215.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$231.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.80
|
| Rate for Payer: PHP Commercial |
$261.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health SBD |
$194.04
|
| Rate for Payer: UMR Bronson Commercial |
$135.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$231.00
|
|
