|
PR NJX DRG C-CATHJ SLCTV L VNTRC/R ATRIAL ANGRPHS&I
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
HCPCS 93565
|
| Min. Negotiated Rate |
$16.83 |
| Max. Negotiated Rate |
$737.51 |
| Rate for Payer: Aetna Commercial |
$59.84
|
| Rate for Payer: BCBS Complete |
$17.67
|
| Rate for Payer: BCBS Trust/PPO |
$737.51
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Meridian Medicaid |
$17.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$51.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$37.36
|
| Rate for Payer: Priority Health Narrow Network |
$37.36
|
| Rate for Payer: Priority Health SBD |
$37.36
|
| Rate for Payer: UMR Bronson Commercial |
$34.04
|
|
|
PR NJX DRG C-CATHJ SLCTV R VNTRC/R ATRIAL ANGRPHS&I
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
HCPCS 93566
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$911.32 |
| Rate for Payer: Aetna Commercial |
$60.76
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$911.32
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Meridian Medicaid |
$17.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$197.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$36.88
|
| Rate for Payer: Priority Health Narrow Network |
$36.88
|
| Rate for Payer: Priority Health SBD |
$36.88
|
| Rate for Payer: UMR Bronson Commercial |
$129.72
|
|
|
PR NJX DRG C-CATHJ SUPRAVALVULAR AORTOGRAPHY S&I
|
Professional
|
Both
|
$419.00
|
|
|
Service Code
|
HCPCS 93567
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$907.09 |
| Rate for Payer: Aetna Commercial |
$69.97
|
| Rate for Payer: BCBS Complete |
$24.60
|
| Rate for Payer: BCBS Trust/PPO |
$907.09
|
| Rate for Payer: Cash Price |
$335.20
|
| Rate for Payer: Cash Price |
$335.20
|
| Rate for Payer: Meridian Medicaid |
$24.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$293.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$52.48
|
| Rate for Payer: Priority Health Narrow Network |
$52.48
|
| Rate for Payer: Priority Health SBD |
$52.48
|
| Rate for Payer: UMR Bronson Commercial |
$192.74
|
|
|
PR NJX DRG CGEN C-CATHJ SLCTV CORONARY ANGRPH S&I
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS 93563
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$787.17 |
| Rate for Payer: Aetna Commercial |
$76.86
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS Trust/PPO |
$787.17
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$84.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.88
|
| Rate for Payer: Priority Health Narrow Network |
$71.88
|
| Rate for Payer: Priority Health SBD |
$71.88
|
| Rate for Payer: UMR Bronson Commercial |
$55.20
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
64490
|
| Min. Negotiated Rate |
$102.82 |
| Max. Negotiated Rate |
$2,550.52 |
| Rate for Payer: Aetna American Axle |
$215.80
|
| Rate for Payer: Aetna Commercial |
$282.20
|
| Rate for Payer: Aetna Medicare |
$842.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,012.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,012.74
|
| Rate for Payer: BCBS Complete |
$465.37
|
| Rate for Payer: BCBS MAPPO |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,355.00
|
| Rate for Payer: BCN Medicare Advantage |
$810.19
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$232.40
|
| Rate for Payer: Cofinity Commercial |
$285.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.19
|
| Rate for Payer: Healthscope Commercial |
$298.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.00
|
| Rate for Payer: Mclaren Medicaid |
$443.17
|
| Rate for Payer: Mclaren Medicare |
$810.19
|
| Rate for Payer: Meridian Medicaid |
$465.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$850.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$931.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.20
|
| Rate for Payer: PACE Medicare |
$769.68
|
| Rate for Payer: PACE SWMI |
$810.19
|
| Rate for Payer: PHP Commercial |
$282.20
|
| Rate for Payer: PHP Medicare Advantage |
$810.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,550.52
|
| Rate for Payer: Priority Health Medicare |
$810.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,040.42
|
| Rate for Payer: Priority Health SBD |
$209.16
|
| Rate for Payer: Railroad Medicare Medicare |
$810.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$113.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$810.19
|
| Rate for Payer: UHC Exchange |
$102.82
|
| Rate for Payer: UHC Medicare Advantage |
$834.50
|
| Rate for Payer: UMR Bronson Commercial |
$122.84
|
| Rate for Payer: VA VA |
$810.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 64490
|
| Hospital Charge Code |
64490
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$232.40 |
| Rate for Payer: Aetna Commercial |
$135.62
|
| Rate for Payer: BCBS Complete |
$70.22
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Meridian Medicaid |
$70.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.53
|
| Rate for Payer: Priority Health Narrow Network |
$175.53
|
| Rate for Payer: Priority Health SBD |
$175.53
|
| Rate for Payer: UMR Bronson Commercial |
$152.72
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
64490
|
| Min. Negotiated Rate |
$146.08 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Aetna American Axle |
$215.80
|
| Rate for Payer: Aetna Commercial |
$282.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$215.80
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$232.40
|
| Rate for Payer: Cofinity Commercial |
$285.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.60
|
| Rate for Payer: Healthscope Commercial |
$298.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$232.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$249.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.20
|
| Rate for Payer: PHP Commercial |
$282.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.40
|
| Rate for Payer: Priority Health SBD |
$209.16
|
| Rate for Payer: UMR Bronson Commercial |
$146.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$249.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
HCPCS 64490
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$232.40 |
| Rate for Payer: Aetna Commercial |
$135.62
|
| Rate for Payer: BCBS Complete |
$70.22
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Meridian Medicaid |
$70.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$66.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$175.53
|
| Rate for Payer: Priority Health Narrow Network |
$175.53
|
| Rate for Payer: Priority Health SBD |
$175.53
|
| Rate for Payer: UMR Bronson Commercial |
$152.72
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 64491
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$344.45 |
| Rate for Payer: Aetna Commercial |
$77.81
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS Trust/PPO |
$344.45
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.08
|
| Rate for Payer: Priority Health Narrow Network |
$99.08
|
| Rate for Payer: Priority Health SBD |
$99.08
|
| Rate for Payer: UMR Bronson Commercial |
$95.68
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 64491
|
| Hospital Charge Code |
64491
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$344.45 |
| Rate for Payer: Aetna Commercial |
$77.81
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS Trust/PPO |
$344.45
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$99.08
|
| Rate for Payer: Priority Health Narrow Network |
$99.08
|
| Rate for Payer: Priority Health SBD |
$99.08
|
| Rate for Payer: UMR Bronson Commercial |
$95.68
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
64491
|
| Min. Negotiated Rate |
$57.63 |
| Max. Negotiated Rate |
$319.24 |
| Rate for Payer: Aetna American Axle |
$135.20
|
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS Trust/PPO |
$319.24
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.80
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health SBD |
$131.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$63.39
|
| Rate for Payer: UHC Exchange |
$57.63
|
| Rate for Payer: UMR Bronson Commercial |
$76.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
64491
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna American Axle |
$135.20
|
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.80
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health SBD |
$131.04
|
| Rate for Payer: UMR Bronson Commercial |
$91.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 64492
|
| Hospital Charge Code |
64492
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$216.07 |
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS Trust/PPO |
$216.07
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.79
|
| Rate for Payer: Priority Health Narrow Network |
$100.79
|
| Rate for Payer: Priority Health SBD |
$100.79
|
| Rate for Payer: UMR Bronson Commercial |
$95.68
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
64492
|
| Min. Negotiated Rate |
$58.61 |
| Max. Negotiated Rate |
$320.45 |
| Rate for Payer: Aetna American Axle |
$135.20
|
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS Trust/PPO |
$320.45
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.80
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health SBD |
$131.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$64.47
|
| Rate for Payer: UHC Exchange |
$58.61
|
| Rate for Payer: UMR Bronson Commercial |
$76.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
64492
|
| Min. Negotiated Rate |
$91.52 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Aetna American Axle |
$135.20
|
| Rate for Payer: Aetna Commercial |
$176.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$135.20
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$145.60
|
| Rate for Payer: Cofinity Commercial |
$178.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$187.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$145.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$156.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.80
|
| Rate for Payer: PHP Commercial |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health SBD |
$131.04
|
| Rate for Payer: UMR Bronson Commercial |
$91.52
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$156.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
HCPCS 64492
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$216.07 |
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS Trust/PPO |
$216.07
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.79
|
| Rate for Payer: Priority Health Narrow Network |
$100.79
|
| Rate for Payer: Priority Health SBD |
$100.79
|
| Rate for Payer: UMR Bronson Commercial |
$95.68
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
64493
|
| Min. Negotiated Rate |
$57.51 |
| Max. Negotiated Rate |
$609.66 |
| Rate for Payer: Aetna Commercial |
$115.69
|
| Rate for Payer: BCBS Complete |
$60.39
|
| Rate for Payer: BCBS Trust/PPO |
$609.66
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Meridian Medicaid |
$60.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.18
|
| Rate for Payer: Priority Health Narrow Network |
$151.18
|
| Rate for Payer: Priority Health SBD |
$151.18
|
| Rate for Payer: UMR Bronson Commercial |
$109.02
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
64493
|
| Min. Negotiated Rate |
$87.69 |
| Max. Negotiated Rate |
$2,550.52 |
| Rate for Payer: Aetna American Axle |
$154.05
|
| Rate for Payer: Aetna Commercial |
$201.45
|
| Rate for Payer: Aetna Medicare |
$842.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.05
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,012.74
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,012.74
|
| Rate for Payer: BCBS Complete |
$465.37
|
| Rate for Payer: BCBS MAPPO |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$975.43
|
| Rate for Payer: BCN Medicare Advantage |
$810.19
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$165.90
|
| Rate for Payer: Cofinity Commercial |
$203.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$810.19
|
| Rate for Payer: Healthscope Commercial |
$213.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.75
|
| Rate for Payer: Mclaren Medicaid |
$443.17
|
| Rate for Payer: Mclaren Medicare |
$810.19
|
| Rate for Payer: Meridian Medicaid |
$465.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$850.70
|
| Rate for Payer: MI Amish Medical Board Commercial |
$931.72
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.45
|
| Rate for Payer: PACE Medicare |
$769.68
|
| Rate for Payer: PACE SWMI |
$810.19
|
| Rate for Payer: PHP Commercial |
$201.45
|
| Rate for Payer: PHP Medicare Advantage |
$810.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$443.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,550.52
|
| Rate for Payer: Priority Health Medicare |
$810.19
|
| Rate for Payer: Priority Health Narrow Network |
$2,040.42
|
| Rate for Payer: Priority Health SBD |
$149.31
|
| Rate for Payer: Railroad Medicare Medicare |
$810.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$97.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$810.19
|
| Rate for Payer: UHC Exchange |
$88.41
|
| Rate for Payer: UHC Medicare Advantage |
$834.50
|
| Rate for Payer: UMR Bronson Commercial |
$87.69
|
| Rate for Payer: VA VA |
$810.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.75
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
HCPCS 64493
|
| Min. Negotiated Rate |
$57.51 |
| Max. Negotiated Rate |
$609.66 |
| Rate for Payer: Aetna Commercial |
$115.69
|
| Rate for Payer: BCBS Complete |
$60.39
|
| Rate for Payer: BCBS Trust/PPO |
$609.66
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Meridian Medicaid |
$60.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$57.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$151.18
|
| Rate for Payer: Priority Health Narrow Network |
$151.18
|
| Rate for Payer: Priority Health SBD |
$151.18
|
| Rate for Payer: UMR Bronson Commercial |
$109.02
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
64493
|
| Min. Negotiated Rate |
$104.28 |
| Max. Negotiated Rate |
$213.30 |
| Rate for Payer: Aetna American Axle |
$154.05
|
| Rate for Payer: Aetna Commercial |
$201.45
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$154.05
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$165.90
|
| Rate for Payer: Cofinity Commercial |
$203.82
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.60
|
| Rate for Payer: Healthscope Commercial |
$213.30
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$165.90
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$177.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.45
|
| Rate for Payer: PHP Commercial |
$201.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.90
|
| Rate for Payer: Priority Health SBD |
$149.31
|
| Rate for Payer: UMR Bronson Commercial |
$104.28
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$177.75
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 64494
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$1,260.52 |
| Rate for Payer: Aetna Commercial |
$66.74
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.50
|
| Rate for Payer: Priority Health Narrow Network |
$85.50
|
| Rate for Payer: Priority Health SBD |
$85.50
|
| Rate for Payer: UMR Bronson Commercial |
$75.44
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
64494
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$293.94 |
| Rate for Payer: Aetna American Axle |
$106.60
|
| Rate for Payer: Aetna Commercial |
$139.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.60
|
| Rate for Payer: BCBS Complete |
$65.60
|
| Rate for Payer: BCBS Trust/PPO |
$293.94
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$114.80
|
| Rate for Payer: Cofinity Commercial |
$141.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.20
|
| Rate for Payer: Healthscope Commercial |
$147.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.40
|
| Rate for Payer: PHP Commercial |
$139.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: Priority Health SBD |
$103.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.38
|
| Rate for Payer: UHC Exchange |
$49.44
|
| Rate for Payer: UMR Bronson Commercial |
$60.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
64494
|
| Min. Negotiated Rate |
$72.16 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Aetna American Axle |
$106.60
|
| Rate for Payer: Aetna Commercial |
$139.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.60
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$114.80
|
| Rate for Payer: Cofinity Commercial |
$141.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.20
|
| Rate for Payer: Healthscope Commercial |
$147.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.40
|
| Rate for Payer: PHP Commercial |
$139.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: Priority Health SBD |
$103.32
|
| Rate for Payer: UMR Bronson Commercial |
$72.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.00
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
HCPCS 64494
|
| Hospital Charge Code |
64494
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$1,260.52 |
| Rate for Payer: Aetna Commercial |
$66.74
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.50
|
| Rate for Payer: Priority Health Narrow Network |
$85.50
|
| Rate for Payer: Priority Health SBD |
$85.50
|
| Rate for Payer: UMR Bronson Commercial |
$75.44
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
64495
|
| Min. Negotiated Rate |
$73.92 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Aetna American Axle |
$109.20
|
| Rate for Payer: Aetna Commercial |
$142.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$109.20
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$117.60
|
| Rate for Payer: Cofinity Commercial |
$144.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Healthscope Commercial |
$151.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$117.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$126.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.80
|
| Rate for Payer: PHP Commercial |
$142.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health SBD |
$105.84
|
| Rate for Payer: UMR Bronson Commercial |
$73.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$126.00
|
|
