|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 64495
|
| Hospital Charge Code |
64495
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$184.91 |
| Rate for Payer: Aetna Commercial |
$68.09
|
| Rate for Payer: Aetna Medicare |
$50.81
|
| Rate for Payer: BCBS Complete |
$34.44
|
| Rate for Payer: BCBS MAPPO |
$50.81
|
| Rate for Payer: BCBS Trust/PPO |
$184.91
|
| Rate for Payer: BCN Commercial |
$131.94
|
| Rate for Payer: BCN Medicare Advantage |
$50.81
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$73.17
|
| Rate for Payer: Cofinity Commercial |
$68.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.81
|
| Rate for Payer: Healthscope Commercial |
$60.97
|
| Rate for Payer: Healthscope Whirlpool |
$60.97
|
| Rate for Payer: Meridian Medicaid |
$34.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.35
|
| Rate for Payer: PACE SWMI |
$50.81
|
| Rate for Payer: PHP Medicare Advantage |
$50.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.64
|
| Rate for Payer: Priority Health Medicare |
$50.81
|
| Rate for Payer: Priority Health Narrow Network |
$86.64
|
| Rate for Payer: UHC Medicare Advantage |
$52.33
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
64495
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: ASR ASR |
$162.96
|
| Rate for Payer: BCBS Complete |
$67.20
|
| 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: Priority Health HMO/PPO/Tiered Network |
$152.88
|
| Rate for Payer: Priority Health Narrow Network |
$119.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.84
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 64495
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$184.91 |
| Rate for Payer: Aetna Commercial |
$68.09
|
| Rate for Payer: Aetna Medicare |
$50.81
|
| Rate for Payer: BCBS Complete |
$34.44
|
| Rate for Payer: BCBS MAPPO |
$50.81
|
| Rate for Payer: BCBS Trust/PPO |
$184.91
|
| Rate for Payer: BCN Commercial |
$131.94
|
| Rate for Payer: BCN Medicare Advantage |
$50.81
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$73.17
|
| Rate for Payer: Cofinity Commercial |
$68.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.81
|
| Rate for Payer: Healthscope Commercial |
$60.97
|
| Rate for Payer: Healthscope Whirlpool |
$60.97
|
| Rate for Payer: Meridian Medicaid |
$34.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$53.35
|
| Rate for Payer: PACE SWMI |
$50.81
|
| Rate for Payer: PHP Medicare Advantage |
$50.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$86.64
|
| Rate for Payer: Priority Health Medicare |
$50.81
|
| Rate for Payer: Priority Health Narrow Network |
$86.64
|
| Rate for Payer: UHC Medicare Advantage |
$52.33
|
|
|
PR NJX DX/THER SBST EPIDURAL/SUBARACH LUMBAR/SACRAL
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
HCPCS 62311
|
| Min. Negotiated Rate |
$297.20 |
| Max. Negotiated Rate |
$520.10 |
| Rate for Payer: BCBS Complete |
$297.20
|
| Rate for Payer: Cash Price |
$594.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$520.10
|
|
|
PR NJX DX/THER SBST EPIDURAL/SUBRACH CERV/THORACIC
|
Professional
|
Both
|
$661.00
|
|
|
Service Code
|
HCPCS 62310
|
| Min. Negotiated Rate |
$264.40 |
| Max. Negotiated Rate |
$462.70 |
| Rate for Payer: BCBS Complete |
$264.40
|
| Rate for Payer: Cash Price |
$528.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$462.70
|
|
|
PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
HCPCS 62321
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$1,592.30 |
| Rate for Payer: Aetna Commercial |
$139.61
|
| Rate for Payer: Aetna Medicare |
$104.19
|
| Rate for Payer: BCBS Complete |
$71.57
|
| Rate for Payer: BCBS MAPPO |
$104.19
|
| Rate for Payer: BCBS Trust/PPO |
$1,592.30
|
| Rate for Payer: BCN Commercial |
$383.62
|
| Rate for Payer: BCN Medicare Advantage |
$104.19
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cash Price |
$264.80
|
| Rate for Payer: Cofinity Commercial |
$150.03
|
| Rate for Payer: Cofinity Commercial |
$139.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.19
|
| Rate for Payer: Healthscope Commercial |
$125.03
|
| Rate for Payer: Healthscope Whirlpool |
$125.03
|
| Rate for Payer: Meridian Medicaid |
$71.57
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$109.40
|
| Rate for Payer: PACE SWMI |
$104.19
|
| Rate for Payer: PHP Medicare Advantage |
$104.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$231.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.35
|
| Rate for Payer: Priority Health Medicare |
$104.19
|
| Rate for Payer: Priority Health Narrow Network |
$178.35
|
| Rate for Payer: UHC Medicare Advantage |
$107.32
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
62323
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$302.00 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: ASR ASR |
$292.94
|
| Rate for Payer: BCBS Trust/PPO |
$234.14
|
| Rate for Payer: BCN Commercial |
$234.14
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$283.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.60
|
| Rate for Payer: Healthscope Commercial |
$302.00
|
| Rate for Payer: Healthscope Whirlpool |
$292.94
|
| Rate for Payer: Mclaren Commercial |
$271.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$256.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.76
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
62323
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$1,879.69 |
| Rate for Payer: Aetna Commercial |
$129.42
|
| Rate for Payer: Aetna Medicare |
$96.58
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCBS MAPPO |
$96.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,879.69
|
| Rate for Payer: BCN Commercial |
$378.23
|
| Rate for Payer: BCN Medicare Advantage |
$96.58
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$139.08
|
| Rate for Payer: Cofinity Commercial |
$129.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.58
|
| Rate for Payer: Healthscope Commercial |
$115.90
|
| Rate for Payer: Healthscope Whirlpool |
$115.90
|
| Rate for Payer: Meridian Medicaid |
$66.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$101.41
|
| Rate for Payer: PACE SWMI |
$96.58
|
| Rate for Payer: PHP Medicare Advantage |
$96.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.34
|
| Rate for Payer: Priority Health Medicare |
$96.58
|
| Rate for Payer: Priority Health Narrow Network |
$165.34
|
| Rate for Payer: UHC Medicare Advantage |
$99.48
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
HCPCS 62323
|
| Min. Negotiated Rate |
$63.05 |
| Max. Negotiated Rate |
$1,879.69 |
| Rate for Payer: Aetna Commercial |
$129.42
|
| Rate for Payer: Aetna Medicare |
$96.58
|
| Rate for Payer: BCBS Complete |
$66.20
|
| Rate for Payer: BCBS MAPPO |
$96.58
|
| Rate for Payer: BCBS Trust/PPO |
$1,879.69
|
| Rate for Payer: BCN Commercial |
$378.23
|
| Rate for Payer: BCN Medicare Advantage |
$96.58
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$139.08
|
| Rate for Payer: Cofinity Commercial |
$129.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$96.58
|
| Rate for Payer: Healthscope Commercial |
$115.90
|
| Rate for Payer: Healthscope Whirlpool |
$115.90
|
| Rate for Payer: Meridian Medicaid |
$66.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$101.41
|
| Rate for Payer: PACE SWMI |
$96.58
|
| Rate for Payer: PHP Medicare Advantage |
$96.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$165.34
|
| Rate for Payer: Priority Health Medicare |
$96.58
|
| Rate for Payer: Priority Health Narrow Network |
$165.34
|
| Rate for Payer: UHC Medicare Advantage |
$99.48
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
62323
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$768.38 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Aetna Medicare |
$614.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: ASR ASR |
$292.94
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$234.14
|
| Rate for Payer: BCN Commercial |
$234.14
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cash Price |
$241.60
|
| Rate for Payer: Cofinity Commercial |
$283.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$241.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Healthscope Commercial |
$302.00
|
| Rate for Payer: Healthscope Whirlpool |
$292.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$614.70
|
| Rate for Payer: Mclaren Commercial |
$271.80
|
| Rate for Payer: Mclaren Medicaid |
$336.24
|
| Rate for Payer: Mclaren Medicare |
$614.70
|
| Rate for Payer: Meridian Medicaid |
$353.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$256.70
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Commercial |
$676.17
|
| Rate for Payer: PHP Medicaid |
$336.24
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$211.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$274.82
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$214.42
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$265.76
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: VA VA |
$614.70
|
|
|
PR NJX INFUS/BOLUS DX/SBST EDRL/SUBARACH LUM/SACRAL
|
Professional
|
Both
|
$855.00
|
|
|
Service Code
|
HCPCS 62319
|
| Min. Negotiated Rate |
$342.00 |
| Max. Negotiated Rate |
$598.50 |
| Rate for Payer: BCBS Complete |
$342.00
|
| Rate for Payer: Cash Price |
$684.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$598.50
|
|
|
PR NJX PEYRONIE W/SURG EXPOS PLAQUE
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
HCPCS 54205
|
| Min. Negotiated Rate |
$340.59 |
| Max. Negotiated Rate |
$850.52 |
| Rate for Payer: Aetna Commercial |
$695.31
|
| Rate for Payer: Aetna Medicare |
$518.89
|
| Rate for Payer: BCBS Complete |
$357.62
|
| Rate for Payer: BCBS MAPPO |
$518.89
|
| Rate for Payer: BCBS Trust/PPO |
$414.72
|
| Rate for Payer: BCN Commercial |
$769.17
|
| Rate for Payer: BCN Medicare Advantage |
$518.89
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cash Price |
$856.00
|
| Rate for Payer: Cofinity Commercial |
$695.31
|
| Rate for Payer: Cofinity Commercial |
$747.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$518.89
|
| Rate for Payer: Healthscope Commercial |
$622.67
|
| Rate for Payer: Healthscope Whirlpool |
$622.67
|
| Rate for Payer: Meridian Medicaid |
$357.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$544.83
|
| Rate for Payer: PACE SWMI |
$518.89
|
| Rate for Payer: PHP Medicare Advantage |
$518.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$340.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$749.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$850.52
|
| Rate for Payer: Priority Health Medicare |
$518.89
|
| Rate for Payer: Priority Health Narrow Network |
$850.52
|
| Rate for Payer: UHC Medicare Advantage |
$534.46
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
0232T
|
| Min. Negotiated Rate |
$455.00 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$585.00
|
| Rate for Payer: ASR ASR |
$630.50
|
| Rate for Payer: BCBS Trust/PPO |
$503.94
|
| Rate for Payer: BCN Commercial |
$503.94
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$611.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.00
|
| Rate for Payer: Healthscope Commercial |
$650.00
|
| Rate for Payer: Healthscope Whirlpool |
$630.50
|
| Rate for Payer: Mclaren Commercial |
$585.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$572.00
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
HCPCS 0232T
|
| Hospital Charge Code |
0232T
|
| Min. Negotiated Rate |
$91.43 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$128.61
|
| Rate for Payer: Aetna Commercial |
$128.61
|
| Rate for Payer: BCBS Complete |
$360.00
|
| Rate for Payer: BCBS Complete |
$240.00
|
| Rate for Payer: BCBS Trust/PPO |
$91.43
|
| Rate for Payer: BCBS Trust/PPO |
$91.43
|
| Rate for Payer: BCN Commercial |
$349.25
|
| Rate for Payer: BCN Commercial |
$349.25
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.00
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
0232T
|
| Min. Negotiated Rate |
$193.73 |
| Max. Negotiated Rate |
$650.00 |
| Rate for Payer: Aetna Commercial |
$585.00
|
| Rate for Payer: Aetna Medicare |
$354.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$442.70
|
| Rate for Payer: Amish Plain Church Group Commercial |
$442.70
|
| Rate for Payer: ASR ASR |
$630.50
|
| Rate for Payer: BCBS Complete |
$203.43
|
| Rate for Payer: BCBS MAPPO |
$354.16
|
| Rate for Payer: BCBS Trust/PPO |
$503.94
|
| Rate for Payer: BCN Commercial |
$503.94
|
| Rate for Payer: BCN Medicare Advantage |
$354.16
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cash Price |
$520.00
|
| Rate for Payer: Cofinity Commercial |
$611.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$520.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$354.16
|
| Rate for Payer: Healthscope Commercial |
$650.00
|
| Rate for Payer: Healthscope Whirlpool |
$630.50
|
| Rate for Payer: Humana Choice PPO Medicare |
$354.16
|
| Rate for Payer: Mclaren Commercial |
$585.00
|
| Rate for Payer: Mclaren Medicaid |
$193.73
|
| Rate for Payer: Mclaren Medicare |
$354.16
|
| Rate for Payer: Meridian Medicaid |
$203.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$371.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$407.28
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$552.50
|
| Rate for Payer: PACE Medicare |
$336.45
|
| Rate for Payer: PACE SWMI |
$354.16
|
| Rate for Payer: PHP Commercial |
$389.58
|
| Rate for Payer: PHP Medicaid |
$193.73
|
| Rate for Payer: PHP Medicare Advantage |
$354.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$193.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$455.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$591.50
|
| Rate for Payer: Priority Health Medicare |
$354.16
|
| Rate for Payer: Priority Health Narrow Network |
$461.50
|
| Rate for Payer: Railroad Medicare Medicare |
$354.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$572.00
|
| Rate for Payer: UHC Medicare Advantage |
$364.78
|
| Rate for Payer: VA VA |
$354.16
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Professional
|
Both
|
$900.00
|
|
|
Service Code
|
HCPCS 0232T
|
| Min. Negotiated Rate |
$91.43 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna Commercial |
$128.61
|
| Rate for Payer: Aetna Commercial |
$128.61
|
| Rate for Payer: BCBS Complete |
$360.00
|
| Rate for Payer: BCBS Complete |
$240.00
|
| Rate for Payer: BCBS Trust/PPO |
$91.43
|
| Rate for Payer: BCBS Trust/PPO |
$91.43
|
| Rate for Payer: BCN Commercial |
$349.25
|
| Rate for Payer: BCN Commercial |
$349.25
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Cash Price |
$480.00
|
| Rate for Payer: Cash Price |
$720.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$420.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$630.00
|
|
|
PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS
|
Professional
|
Both
|
$203.00
|
|
|
Service Code
|
HCPCS 50431
|
| Min. Negotiated Rate |
$41.54 |
| Max. Negotiated Rate |
$2,577.05 |
| Rate for Payer: Aetna Commercial |
$85.10
|
| Rate for Payer: Aetna Medicare |
$63.51
|
| Rate for Payer: BCBS Complete |
$43.62
|
| Rate for Payer: BCBS MAPPO |
$63.51
|
| Rate for Payer: BCBS Trust/PPO |
$2,577.05
|
| Rate for Payer: BCN Commercial |
$476.46
|
| Rate for Payer: BCN Medicare Advantage |
$63.51
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cash Price |
$162.40
|
| Rate for Payer: Cofinity Commercial |
$91.45
|
| Rate for Payer: Cofinity Commercial |
$85.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.51
|
| Rate for Payer: Healthscope Commercial |
$76.21
|
| Rate for Payer: Healthscope Whirlpool |
$76.21
|
| Rate for Payer: Meridian Medicaid |
$43.62
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.69
|
| Rate for Payer: PACE SWMI |
$63.51
|
| Rate for Payer: PHP Medicare Advantage |
$63.51
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$104.29
|
| Rate for Payer: Priority Health Medicare |
$63.51
|
| Rate for Payer: Priority Health Narrow Network |
$104.29
|
| Rate for Payer: UHC Medicare Advantage |
$65.42
|
|
|
PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 50430
|
| Min. Negotiated Rate |
$95.85 |
| Max. Negotiated Rate |
$2,447.09 |
| Rate for Payer: Aetna Commercial |
$199.71
|
| Rate for Payer: Aetna Medicare |
$149.04
|
| Rate for Payer: BCBS Complete |
$100.64
|
| Rate for Payer: BCBS MAPPO |
$149.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,447.09
|
| Rate for Payer: BCN Commercial |
$931.42
|
| Rate for Payer: BCN Medicare Advantage |
$149.04
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cofinity Commercial |
$199.71
|
| Rate for Payer: Cofinity Commercial |
$214.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$149.04
|
| Rate for Payer: Healthscope Commercial |
$178.85
|
| Rate for Payer: Healthscope Whirlpool |
$178.85
|
| Rate for Payer: Meridian Medicaid |
$100.64
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$156.49
|
| Rate for Payer: PACE SWMI |
$149.04
|
| Rate for Payer: PHP Medicare Advantage |
$149.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$164.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$242.62
|
| Rate for Payer: Priority Health Medicare |
$149.04
|
| Rate for Payer: Priority Health Narrow Network |
$242.62
|
| Rate for Payer: UHC Medicare Advantage |
$153.51
|
|
|
PR NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
HCPCS 36005
|
| Min. Negotiated Rate |
$29.61 |
| Max. Negotiated Rate |
$1,201.88 |
| Rate for Payer: Aetna Commercial |
$63.44
|
| Rate for Payer: Aetna Medicare |
$47.34
|
| Rate for Payer: BCBS Complete |
$31.09
|
| Rate for Payer: BCBS MAPPO |
$47.34
|
| Rate for Payer: BCBS Trust/PPO |
$1,201.88
|
| Rate for Payer: BCN Commercial |
$414.85
|
| Rate for Payer: BCN Medicare Advantage |
$47.34
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cofinity Commercial |
$63.44
|
| Rate for Payer: Cofinity Commercial |
$68.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.34
|
| Rate for Payer: Healthscope Commercial |
$56.81
|
| Rate for Payer: Healthscope Whirlpool |
$56.81
|
| Rate for Payer: Meridian Medicaid |
$31.09
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$49.71
|
| Rate for Payer: PACE SWMI |
$47.34
|
| Rate for Payer: PHP Medicare Advantage |
$47.34
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$394.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.00
|
| Rate for Payer: Priority Health Medicare |
$47.34
|
| Rate for Payer: Priority Health Narrow Network |
$75.00
|
| Rate for Payer: UHC Medicare Advantage |
$48.76
|
|
|
PR NJX RETROGRADE URETHROCSTOGRAPY
|
Professional
|
Both
|
$703.00
|
|
|
Service Code
|
HCPCS 51610
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$1,159.09 |
| Rate for Payer: Aetna Commercial |
$83.32
|
| Rate for Payer: Aetna Medicare |
$62.18
|
| Rate for Payer: BCBS Complete |
$42.71
|
| Rate for Payer: BCBS MAPPO |
$62.18
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.09
|
| Rate for Payer: BCN Commercial |
$189.12
|
| Rate for Payer: BCN Medicare Advantage |
$62.18
|
| Rate for Payer: Cash Price |
$562.40
|
| Rate for Payer: Cash Price |
$562.40
|
| Rate for Payer: Cofinity Commercial |
$89.54
|
| Rate for Payer: Cofinity Commercial |
$83.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.18
|
| Rate for Payer: Healthscope Commercial |
$74.62
|
| Rate for Payer: Healthscope Whirlpool |
$74.62
|
| Rate for Payer: Meridian Medicaid |
$42.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.29
|
| Rate for Payer: PACE SWMI |
$62.18
|
| Rate for Payer: PHP Medicare Advantage |
$62.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$102.13
|
| Rate for Payer: Priority Health Medicare |
$62.18
|
| Rate for Payer: Priority Health Narrow Network |
$102.13
|
| Rate for Payer: UHC Medicare Advantage |
$64.05
|
|
|
PR NJX VISUALIZATION ILEAL CONDUIT&/URETEROPYELOG
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
HCPCS 50690
|
| Min. Negotiated Rate |
$44.09 |
| Max. Negotiated Rate |
$3,404.37 |
| Rate for Payer: Aetna Commercial |
$90.80
|
| Rate for Payer: Aetna Medicare |
$67.76
|
| Rate for Payer: BCBS Complete |
$46.29
|
| Rate for Payer: BCBS MAPPO |
$67.76
|
| Rate for Payer: BCBS Trust/PPO |
$3,404.37
|
| Rate for Payer: BCN Commercial |
$174.46
|
| Rate for Payer: BCN Medicare Advantage |
$67.76
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cash Price |
$167.20
|
| Rate for Payer: Cofinity Commercial |
$97.57
|
| Rate for Payer: Cofinity Commercial |
$90.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$67.76
|
| Rate for Payer: Healthscope Commercial |
$81.31
|
| Rate for Payer: Healthscope Whirlpool |
$81.31
|
| Rate for Payer: Meridian Medicaid |
$46.29
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.15
|
| Rate for Payer: PACE SWMI |
$67.76
|
| Rate for Payer: PHP Medicare Advantage |
$67.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$146.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$111.32
|
| Rate for Payer: Priority Health Medicare |
$67.76
|
| Rate for Payer: Priority Health Narrow Network |
$111.32
|
| Rate for Payer: UHC Medicare Advantage |
$69.79
|
|
|
PR NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST
|
Professional
|
Both
|
$230.00
|
|
|
Service Code
|
HCPCS 54250
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$1,901.35 |
| Rate for Payer: Aetna Commercial |
$159.81
|
| Rate for Payer: Aetna Medicare |
$119.26
|
| Rate for Payer: BCBS Complete |
$92.00
|
| Rate for Payer: BCBS MAPPO |
$119.26
|
| Rate for Payer: BCBS Trust/PPO |
$1,901.35
|
| Rate for Payer: BCN Commercial |
$176.42
|
| Rate for Payer: BCN Medicare Advantage |
$119.26
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cash Price |
$184.00
|
| Rate for Payer: Cofinity Commercial |
$171.73
|
| Rate for Payer: Cofinity Commercial |
$159.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$119.26
|
| Rate for Payer: Healthscope Commercial |
$143.11
|
| Rate for Payer: Healthscope Whirlpool |
$143.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$125.22
|
| Rate for Payer: PACE SWMI |
$119.26
|
| Rate for Payer: PHP Medicare Advantage |
$119.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$161.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$195.06
|
| Rate for Payer: Priority Health Medicare |
$119.26
|
| Rate for Payer: Priority Health Narrow Network |
$195.06
|
| Rate for Payer: UHC Medicare Advantage |
$122.84
|
|
|
PR NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 94761
|
| Min. Negotiated Rate |
$3.45 |
| Max. Negotiated Rate |
$498.19 |
| Rate for Payer: Aetna Commercial |
$4.62
|
| Rate for Payer: Aetna Medicare |
$3.45
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$3.45
|
| Rate for Payer: BCBS Trust/PPO |
$498.19
|
| Rate for Payer: BCN Commercial |
$5.37
|
| Rate for Payer: BCN Medicare Advantage |
$3.45
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$4.97
|
| Rate for Payer: Cofinity Commercial |
$4.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.45
|
| Rate for Payer: Healthscope Commercial |
$4.14
|
| Rate for Payer: Healthscope Whirlpool |
$4.14
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3.62
|
| Rate for Payer: PACE SWMI |
$3.45
|
| Rate for Payer: PHP Medicare Advantage |
$3.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$32.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.94
|
| Rate for Payer: Priority Health Medicare |
$3.45
|
| Rate for Payer: Priority Health Narrow Network |
$4.94
|
| Rate for Payer: UHC Medicare Advantage |
$3.55
|
|
|
PR NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 94762
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$235.09 |
| Rate for Payer: Aetna Commercial |
$31.52
|
| Rate for Payer: Aetna Medicare |
$23.52
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS MAPPO |
$23.52
|
| Rate for Payer: BCBS Trust/PPO |
$235.09
|
| Rate for Payer: BCN Commercial |
$37.14
|
| Rate for Payer: BCN Medicare Advantage |
$23.52
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$31.52
|
| Rate for Payer: Cofinity Commercial |
$33.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.52
|
| Rate for Payer: Healthscope Commercial |
$28.22
|
| Rate for Payer: Healthscope Whirlpool |
$28.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$24.70
|
| Rate for Payer: PACE SWMI |
$23.52
|
| Rate for Payer: PHP Medicare Advantage |
$23.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.13
|
| Rate for Payer: Priority Health Medicare |
$23.52
|
| Rate for Payer: Priority Health Narrow Network |
$34.13
|
| Rate for Payer: UHC Medicare Advantage |
$24.23
|
|
|
PR NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 94760
|
| Min. Negotiated Rate |
$2.22 |
| Max. Negotiated Rate |
$407.32 |
| Rate for Payer: Aetna Commercial |
$2.97
|
| Rate for Payer: Aetna Medicare |
$2.22
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS MAPPO |
$2.22
|
| Rate for Payer: BCBS Trust/PPO |
$407.32
|
| Rate for Payer: BCN Commercial |
$3.42
|
| Rate for Payer: BCN Medicare Advantage |
$2.22
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$2.97
|
| Rate for Payer: Cofinity Commercial |
$3.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2.22
|
| Rate for Payer: Healthscope Commercial |
$2.66
|
| Rate for Payer: Healthscope Whirlpool |
$2.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2.33
|
| Rate for Payer: PACE SWMI |
$2.22
|
| Rate for Payer: PHP Medicare Advantage |
$2.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.14
|
| Rate for Payer: Priority Health Medicare |
$2.22
|
| Rate for Payer: Priority Health Narrow Network |
$3.14
|
| Rate for Payer: UHC Medicare Advantage |
$2.29
|
|
