|
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 |
$35.60
|
| Rate for Payer: Aetna Medicare |
$26.57
|
| Rate for Payer: BCBS Complete |
$17.67
|
| Rate for Payer: BCBS MAPPO |
$26.57
|
| Rate for Payer: BCBS Trust/PPO |
$737.51
|
| Rate for Payer: BCN Commercial |
$38.61
|
| Rate for Payer: BCN Medicare Advantage |
$26.57
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cash Price |
$59.20
|
| Rate for Payer: Cofinity Commercial |
$38.26
|
| Rate for Payer: Cofinity Commercial |
$35.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.57
|
| Rate for Payer: Healthscope Commercial |
$31.88
|
| Rate for Payer: Healthscope Whirlpool |
$31.88
|
| Rate for Payer: Meridian Medicaid |
$17.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.90
|
| Rate for Payer: PACE SWMI |
$26.57
|
| Rate for Payer: PHP Medicare Advantage |
$26.57
|
| 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 Medicare |
$26.57
|
| Rate for Payer: Priority Health Narrow Network |
$37.36
|
| Rate for Payer: UHC Medicare Advantage |
$27.37
|
|
|
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 |
$35.04
|
| Rate for Payer: Aetna Medicare |
$26.15
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS MAPPO |
$26.15
|
| Rate for Payer: BCBS Trust/PPO |
$911.32
|
| Rate for Payer: BCN Commercial |
$38.12
|
| Rate for Payer: BCN Medicare Advantage |
$26.15
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cash Price |
$225.60
|
| Rate for Payer: Cofinity Commercial |
$37.66
|
| Rate for Payer: Cofinity Commercial |
$35.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.15
|
| Rate for Payer: Healthscope Commercial |
$31.38
|
| Rate for Payer: Healthscope Whirlpool |
$31.38
|
| Rate for Payer: Meridian Medicaid |
$17.00
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$27.46
|
| Rate for Payer: PACE SWMI |
$26.15
|
| Rate for Payer: PHP Medicare Advantage |
$26.15
|
| 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 Medicare |
$26.15
|
| Rate for Payer: Priority Health Narrow Network |
$36.88
|
| Rate for Payer: UHC Medicare Advantage |
$26.93
|
|
|
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 |
$50.02
|
| Rate for Payer: Aetna Medicare |
$37.33
|
| Rate for Payer: BCBS Complete |
$24.60
|
| Rate for Payer: BCBS MAPPO |
$37.33
|
| Rate for Payer: BCBS Trust/PPO |
$907.09
|
| Rate for Payer: BCN Commercial |
$54.24
|
| Rate for Payer: BCN Medicare Advantage |
$37.33
|
| Rate for Payer: Cash Price |
$335.20
|
| Rate for Payer: Cash Price |
$335.20
|
| Rate for Payer: Cofinity Commercial |
$53.76
|
| Rate for Payer: Cofinity Commercial |
$50.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.33
|
| Rate for Payer: Healthscope Commercial |
$44.80
|
| Rate for Payer: Healthscope Whirlpool |
$44.80
|
| Rate for Payer: Meridian Medicaid |
$24.60
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$39.20
|
| Rate for Payer: PACE SWMI |
$37.33
|
| Rate for Payer: PHP Medicare Advantage |
$37.33
|
| 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 Medicare |
$37.33
|
| Rate for Payer: Priority Health Narrow Network |
$52.48
|
| Rate for Payer: UHC Medicare Advantage |
$38.45
|
|
|
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 |
$68.19
|
| Rate for Payer: Aetna Medicare |
$50.89
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS MAPPO |
$50.89
|
| Rate for Payer: BCBS Trust/PPO |
$787.17
|
| Rate for Payer: BCN Commercial |
$74.28
|
| Rate for Payer: BCN Medicare Advantage |
$50.89
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cofinity Commercial |
$68.19
|
| Rate for Payer: Cofinity Commercial |
$73.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.89
|
| Rate for Payer: Healthscope Commercial |
$61.07
|
| Rate for Payer: Healthscope Whirlpool |
$61.07
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.43
|
| Rate for Payer: PACE SWMI |
$50.89
|
| Rate for Payer: PHP Medicare Advantage |
$50.89
|
| 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 Medicare |
$50.89
|
| Rate for Payer: Priority Health Narrow Network |
$71.88
|
| Rate for Payer: UHC Medicare Advantage |
$52.42
|
|
|
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 |
$278.55 |
| Rate for Payer: Aetna Commercial |
$136.95
|
| Rate for Payer: Aetna Medicare |
$102.20
|
| Rate for Payer: BCBS Complete |
$70.22
|
| Rate for Payer: BCBS MAPPO |
$102.20
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: BCN Commercial |
$278.55
|
| Rate for Payer: BCN Medicare Advantage |
$102.20
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$147.17
|
| Rate for Payer: Cofinity Commercial |
$136.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.20
|
| Rate for Payer: Healthscope Commercial |
$122.64
|
| Rate for Payer: Healthscope Whirlpool |
$122.64
|
| Rate for Payer: Meridian Medicaid |
$70.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$107.31
|
| Rate for Payer: PACE SWMI |
$102.20
|
| Rate for Payer: PHP Medicare Advantage |
$102.20
|
| 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 Medicare |
$102.20
|
| Rate for Payer: Priority Health Narrow Network |
$175.53
|
| Rate for Payer: UHC Medicare Advantage |
$105.27
|
|
|
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 |
$232.40 |
| Max. Negotiated Rate |
$1,012.74 |
| Rate for Payer: Aetna Commercial |
$298.80
|
| Rate for Payer: Aetna Medicare |
$810.19
|
| 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: ASR ASR |
$322.04
|
| Rate for Payer: BCBS Complete |
$465.37
|
| Rate for Payer: BCBS MAPPO |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$257.40
|
| Rate for Payer: BCN Commercial |
$257.40
|
| 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 |
$312.08
|
| 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 |
$332.00
|
| Rate for Payer: Healthscope Whirlpool |
$322.04
|
| Rate for Payer: Humana Choice PPO Medicare |
$810.19
|
| Rate for Payer: Mclaren Commercial |
$298.80
|
| 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 |
$891.21
|
| Rate for Payer: PHP Medicaid |
$443.17
|
| 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 |
$302.12
|
| Rate for Payer: Priority Health Medicare |
$810.19
|
| Rate for Payer: Priority Health Narrow Network |
$235.72
|
| Rate for Payer: Railroad Medicare Medicare |
$810.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.16
|
| Rate for Payer: UHC Medicare Advantage |
$834.50
|
| Rate for Payer: VA VA |
$810.19
|
|
|
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 |
$232.40 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: Aetna Commercial |
$298.80
|
| Rate for Payer: ASR ASR |
$322.04
|
| Rate for Payer: BCBS Trust/PPO |
$257.40
|
| Rate for Payer: BCN Commercial |
$257.40
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$312.08
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$265.60
|
| Rate for Payer: Healthscope Commercial |
$332.00
|
| Rate for Payer: Healthscope Whirlpool |
$322.04
|
| Rate for Payer: Mclaren Commercial |
$298.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$282.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$292.16
|
|
|
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 |
$278.55 |
| Rate for Payer: Aetna Commercial |
$136.95
|
| Rate for Payer: Aetna Medicare |
$102.20
|
| Rate for Payer: BCBS Complete |
$70.22
|
| Rate for Payer: BCBS MAPPO |
$102.20
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: BCN Commercial |
$278.55
|
| Rate for Payer: BCN Medicare Advantage |
$102.20
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cash Price |
$265.60
|
| Rate for Payer: Cofinity Commercial |
$147.17
|
| Rate for Payer: Cofinity Commercial |
$136.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.20
|
| Rate for Payer: Healthscope Commercial |
$122.64
|
| Rate for Payer: Healthscope Whirlpool |
$122.64
|
| Rate for Payer: Meridian Medicaid |
$70.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$107.31
|
| Rate for Payer: PACE SWMI |
$102.20
|
| Rate for Payer: PHP Medicare Advantage |
$102.20
|
| 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 Medicare |
$102.20
|
| Rate for Payer: Priority Health Narrow Network |
$175.53
|
| Rate for Payer: UHC Medicare Advantage |
$105.27
|
|
|
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 |
$77.97
|
| Rate for Payer: Aetna Medicare |
$58.19
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$58.19
|
| Rate for Payer: BCBS Trust/PPO |
$344.45
|
| Rate for Payer: BCN Commercial |
$141.23
|
| Rate for Payer: BCN Medicare Advantage |
$58.19
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$83.79
|
| Rate for Payer: Cofinity Commercial |
$77.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.19
|
| Rate for Payer: Healthscope Commercial |
$69.83
|
| Rate for Payer: Healthscope Whirlpool |
$69.83
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.10
|
| Rate for Payer: PACE SWMI |
$58.19
|
| Rate for Payer: PHP Medicare Advantage |
$58.19
|
| 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 Medicare |
$58.19
|
| Rate for Payer: Priority Health Narrow Network |
$99.08
|
| Rate for Payer: UHC Medicare Advantage |
$59.94
|
|
|
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 |
$77.97
|
| Rate for Payer: Aetna Medicare |
$58.19
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$58.19
|
| Rate for Payer: BCBS Trust/PPO |
$344.45
|
| Rate for Payer: BCN Commercial |
$141.23
|
| Rate for Payer: BCN Medicare Advantage |
$58.19
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$77.97
|
| Rate for Payer: Cofinity Commercial |
$83.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$58.19
|
| Rate for Payer: Healthscope Commercial |
$69.83
|
| Rate for Payer: Healthscope Whirlpool |
$69.83
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$61.10
|
| Rate for Payer: PACE SWMI |
$58.19
|
| Rate for Payer: PHP Medicare Advantage |
$58.19
|
| 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 Medicare |
$58.19
|
| Rate for Payer: Priority Health Narrow Network |
$99.08
|
| Rate for Payer: UHC Medicare Advantage |
$59.94
|
|
|
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 |
$83.20 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: ASR ASR |
$201.76
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS Trust/PPO |
$161.26
|
| Rate for Payer: BCN Commercial |
$161.26
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$195.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Healthscope Whirlpool |
$201.76
|
| Rate for Payer: Mclaren Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.28
|
| Rate for Payer: Priority Health Narrow Network |
$147.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.04
|
|
|
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 |
$145.60 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: ASR ASR |
$201.76
|
| Rate for Payer: BCBS Trust/PPO |
$161.26
|
| Rate for Payer: BCN Commercial |
$161.26
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$195.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Healthscope Whirlpool |
$201.76
|
| Rate for Payer: Mclaren Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.04
|
|
|
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 |
$79.22
|
| Rate for Payer: Aetna Medicare |
$59.12
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS MAPPO |
$59.12
|
| Rate for Payer: BCBS Trust/PPO |
$216.07
|
| Rate for Payer: BCN Commercial |
$142.21
|
| Rate for Payer: BCN Medicare Advantage |
$59.12
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$85.13
|
| Rate for Payer: Cofinity Commercial |
$79.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.12
|
| Rate for Payer: Healthscope Commercial |
$70.94
|
| Rate for Payer: Healthscope Whirlpool |
$70.94
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.08
|
| Rate for Payer: PACE SWMI |
$59.12
|
| Rate for Payer: PHP Medicare Advantage |
$59.12
|
| 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 Medicare |
$59.12
|
| Rate for Payer: Priority Health Narrow Network |
$100.79
|
| Rate for Payer: UHC Medicare Advantage |
$60.89
|
|
|
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 |
$83.20 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: ASR ASR |
$201.76
|
| Rate for Payer: BCBS Complete |
$83.20
|
| Rate for Payer: BCBS Trust/PPO |
$161.26
|
| Rate for Payer: BCN Commercial |
$161.26
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$195.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Healthscope Whirlpool |
$201.76
|
| Rate for Payer: Mclaren Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$189.28
|
| Rate for Payer: Priority Health Narrow Network |
$147.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.04
|
|
|
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 |
$79.22
|
| Rate for Payer: Aetna Medicare |
$59.12
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS MAPPO |
$59.12
|
| Rate for Payer: BCBS Trust/PPO |
$216.07
|
| Rate for Payer: BCN Commercial |
$142.21
|
| Rate for Payer: BCN Medicare Advantage |
$59.12
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$85.13
|
| Rate for Payer: Cofinity Commercial |
$79.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$59.12
|
| Rate for Payer: Healthscope Commercial |
$70.94
|
| Rate for Payer: Healthscope Whirlpool |
$70.94
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$62.08
|
| Rate for Payer: PACE SWMI |
$59.12
|
| Rate for Payer: PHP Medicare Advantage |
$59.12
|
| 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 Medicare |
$59.12
|
| Rate for Payer: Priority Health Narrow Network |
$100.79
|
| Rate for Payer: UHC Medicare Advantage |
$60.89
|
|
|
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 |
$145.60 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: ASR ASR |
$201.76
|
| Rate for Payer: BCBS Trust/PPO |
$161.26
|
| Rate for Payer: BCN Commercial |
$161.26
|
| Rate for Payer: Cash Price |
$166.40
|
| Rate for Payer: Cofinity Commercial |
$195.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$166.40
|
| Rate for Payer: Healthscope Commercial |
$208.00
|
| Rate for Payer: Healthscope Whirlpool |
$201.76
|
| Rate for Payer: Mclaren Commercial |
$187.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$176.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$145.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$183.04
|
|
|
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 |
$165.90 |
| Max. Negotiated Rate |
$1,012.74 |
| Rate for Payer: Aetna Commercial |
$213.30
|
| Rate for Payer: Aetna Medicare |
$810.19
|
| 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: ASR ASR |
$229.89
|
| Rate for Payer: BCBS Complete |
$465.37
|
| Rate for Payer: BCBS MAPPO |
$810.19
|
| Rate for Payer: BCBS Trust/PPO |
$183.75
|
| Rate for Payer: BCN Commercial |
$183.75
|
| 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 |
$222.78
|
| 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 |
$237.00
|
| Rate for Payer: Healthscope Whirlpool |
$229.89
|
| Rate for Payer: Humana Choice PPO Medicare |
$810.19
|
| Rate for Payer: Mclaren Commercial |
$213.30
|
| 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 |
$891.21
|
| Rate for Payer: PHP Medicaid |
$443.17
|
| 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 |
$215.67
|
| Rate for Payer: Priority Health Medicare |
$810.19
|
| Rate for Payer: Priority Health Narrow Network |
$168.27
|
| Rate for Payer: Railroad Medicare Medicare |
$810.19
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.56
|
| Rate for Payer: UHC Medicare Advantage |
$834.50
|
| Rate for Payer: VA VA |
$810.19
|
|
|
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 |
$117.87
|
| Rate for Payer: Aetna Medicare |
$87.96
|
| Rate for Payer: BCBS Complete |
$60.39
|
| Rate for Payer: BCBS MAPPO |
$87.96
|
| Rate for Payer: BCBS Trust/PPO |
$609.66
|
| Rate for Payer: BCN Commercial |
$257.53
|
| Rate for Payer: BCN Medicare Advantage |
$87.96
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$126.66
|
| Rate for Payer: Cofinity Commercial |
$117.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.96
|
| Rate for Payer: Healthscope Commercial |
$105.55
|
| Rate for Payer: Healthscope Whirlpool |
$105.55
|
| Rate for Payer: Meridian Medicaid |
$60.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.36
|
| Rate for Payer: PACE SWMI |
$87.96
|
| Rate for Payer: PHP Medicare Advantage |
$87.96
|
| 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 Medicare |
$87.96
|
| Rate for Payer: Priority Health Narrow Network |
$151.18
|
| Rate for Payer: UHC Medicare Advantage |
$90.60
|
|
|
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 |
$165.90 |
| Max. Negotiated Rate |
$237.00 |
| Rate for Payer: Aetna Commercial |
$213.30
|
| Rate for Payer: ASR ASR |
$229.89
|
| Rate for Payer: BCBS Trust/PPO |
$183.75
|
| Rate for Payer: BCN Commercial |
$183.75
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$222.78
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$189.60
|
| Rate for Payer: Healthscope Commercial |
$237.00
|
| Rate for Payer: Healthscope Whirlpool |
$229.89
|
| Rate for Payer: Mclaren Commercial |
$213.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$201.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$208.56
|
|
|
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 |
$117.87
|
| Rate for Payer: Aetna Medicare |
$87.96
|
| Rate for Payer: BCBS Complete |
$60.39
|
| Rate for Payer: BCBS MAPPO |
$87.96
|
| Rate for Payer: BCBS Trust/PPO |
$609.66
|
| Rate for Payer: BCN Commercial |
$257.53
|
| Rate for Payer: BCN Medicare Advantage |
$87.96
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cofinity Commercial |
$126.66
|
| Rate for Payer: Cofinity Commercial |
$117.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$87.96
|
| Rate for Payer: Healthscope Commercial |
$105.55
|
| Rate for Payer: Healthscope Whirlpool |
$105.55
|
| Rate for Payer: Meridian Medicaid |
$60.39
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$92.36
|
| Rate for Payer: PACE SWMI |
$87.96
|
| Rate for Payer: PHP Medicare Advantage |
$87.96
|
| 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 Medicare |
$87.96
|
| Rate for Payer: Priority Health Narrow Network |
$151.18
|
| Rate for Payer: UHC Medicare Advantage |
$90.60
|
|
|
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 |
$65.60 |
| Max. Negotiated Rate |
$164.00 |
| Rate for Payer: Aetna Commercial |
$147.60
|
| Rate for Payer: ASR ASR |
$159.08
|
| Rate for Payer: BCBS Complete |
$65.60
|
| Rate for Payer: BCBS Trust/PPO |
$127.15
|
| Rate for Payer: BCN Commercial |
$127.15
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$154.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.20
|
| Rate for Payer: Healthscope Commercial |
$164.00
|
| Rate for Payer: Healthscope Whirlpool |
$159.08
|
| Rate for Payer: Mclaren Commercial |
$147.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.24
|
| Rate for Payer: Priority Health Narrow Network |
$116.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.32
|
|
|
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 |
$67.25
|
| Rate for Payer: Aetna Medicare |
$50.19
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS MAPPO |
$50.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$131.94
|
| Rate for Payer: BCN Medicare Advantage |
$50.19
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$72.27
|
| Rate for Payer: Cofinity Commercial |
$67.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.19
|
| Rate for Payer: Healthscope Commercial |
$60.23
|
| Rate for Payer: Healthscope Whirlpool |
$60.23
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.70
|
| Rate for Payer: PACE SWMI |
$50.19
|
| Rate for Payer: PHP Medicare Advantage |
$50.19
|
| 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 Medicare |
$50.19
|
| Rate for Payer: Priority Health Narrow Network |
$85.50
|
| Rate for Payer: UHC Medicare Advantage |
$51.70
|
|
|
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 |
$114.80 |
| Max. Negotiated Rate |
$164.00 |
| Rate for Payer: Aetna Commercial |
$147.60
|
| Rate for Payer: ASR ASR |
$159.08
|
| Rate for Payer: BCBS Trust/PPO |
$127.15
|
| Rate for Payer: BCN Commercial |
$127.15
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$154.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.20
|
| Rate for Payer: Healthscope Commercial |
$164.00
|
| Rate for Payer: Healthscope Whirlpool |
$159.08
|
| Rate for Payer: Mclaren Commercial |
$147.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.32
|
|
|
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 |
$67.25
|
| Rate for Payer: Aetna Medicare |
$50.19
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS MAPPO |
$50.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$131.94
|
| Rate for Payer: BCN Medicare Advantage |
$50.19
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$72.27
|
| Rate for Payer: Cofinity Commercial |
$67.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.19
|
| Rate for Payer: Healthscope Commercial |
$60.23
|
| Rate for Payer: Healthscope Whirlpool |
$60.23
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.70
|
| Rate for Payer: PACE SWMI |
$50.19
|
| Rate for Payer: PHP Medicare Advantage |
$50.19
|
| 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 Medicare |
$50.19
|
| Rate for Payer: Priority Health Narrow Network |
$85.50
|
| Rate for Payer: UHC Medicare Advantage |
$51.70
|
|
|
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 |
$117.60 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: ASR ASR |
$162.96
|
| Rate for Payer: BCBS Trust/PPO |
$130.25
|
| Rate for Payer: BCN Commercial |
$130.25
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$157.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$134.40
|
| Rate for Payer: Healthscope Commercial |
$168.00
|
| Rate for Payer: Healthscope Whirlpool |
$162.96
|
| Rate for Payer: Mclaren Commercial |
$151.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$142.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.84
|
|
