|
PR NJX DRG C-CATHJ SLCTV R VNTRC/R ATRIAL ANGRPHS&I
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
HCPCS 93566
|
| Min. Negotiated Rate |
$16.19 |
| Max. Negotiated Rate |
$911.32 |
| Rate for Payer: Aetna Commercial |
$60.76
|
| Rate for Payer: Aetna Medicare |
$144.00
|
| Rate for Payer: BCBS Complete |
$17.00
|
| Rate for Payer: BCBS Trust/PPO |
$911.32
|
| Rate for Payer: BCN Commercial |
$38.12
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Meridian Medicaid |
$17.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$16.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$35.79
|
| Rate for Payer: Priority Health Narrow Network |
$35.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$58.26
|
| Rate for Payer: UHC Exchange |
$58.26
|
| Rate for Payer: UHCCP Medicaid |
$16.19
|
|
|
PR NJX DRG C-CATHJ SUPRAVALVULAR AORTOGRAPHY S&I
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
HCPCS 93567
|
| Min. Negotiated Rate |
$23.43 |
| Max. Negotiated Rate |
$907.09 |
| Rate for Payer: Aetna Commercial |
$69.97
|
| Rate for Payer: Aetna Medicare |
$213.50
|
| Rate for Payer: BCBS Complete |
$24.60
|
| Rate for Payer: BCBS Trust/PPO |
$907.09
|
| Rate for Payer: BCN Commercial |
$54.24
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Cash Price |
$341.60
|
| Rate for Payer: Meridian Medicaid |
$24.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$23.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$277.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$51.80
|
| Rate for Payer: Priority Health Narrow Network |
$51.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.55
|
| Rate for Payer: UHC Exchange |
$65.55
|
| Rate for Payer: UHCCP Medicaid |
$23.43
|
|
|
PR NJX DRG CGEN C-CATHJ SLCTV CORONARY ANGRPH S&I
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 93563
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$787.17 |
| Rate for Payer: Aetna Commercial |
$76.86
|
| Rate for Payer: Aetna Medicare |
$61.00
|
| Rate for Payer: BCBS Complete |
$33.77
|
| Rate for Payer: BCBS Trust/PPO |
$787.17
|
| Rate for Payer: BCN Commercial |
$74.28
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Meridian Medicaid |
$33.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.16
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.09
|
| Rate for Payer: Priority Health Narrow Network |
$71.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.66
|
| Rate for Payer: UHC Exchange |
$75.66
|
| Rate for Payer: UHCCP Medicaid |
$32.16
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 64490
|
| Hospital Charge Code |
64490
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$278.55 |
| Rate for Payer: Aetna Commercial |
$135.62
|
| Rate for Payer: Aetna Medicare |
$169.50
|
| Rate for Payer: BCBS Complete |
$70.68
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: BCN Commercial |
$278.55
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Meridian Medicaid |
$70.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.57
|
| Rate for Payer: Priority Health Narrow Network |
$178.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.14
|
| Rate for Payer: UHC Exchange |
$131.14
|
| Rate for Payer: UHCCP Medicaid |
$67.31
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
64490
|
| Min. Negotiated Rate |
$220.35 |
| Max. Negotiated Rate |
$339.00 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: ASR ASR |
$328.83
|
| Rate for Payer: ASR Commercial |
$328.83
|
| Rate for Payer: BCBS Trust/PPO |
$276.25
|
| Rate for Payer: BCN Commercial |
$262.83
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$318.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.20
|
| Rate for Payer: Healthscope Commercial |
$339.00
|
| Rate for Payer: Healthscope Whirlpool |
$328.83
|
| Rate for Payer: Mclaren Commercial |
$305.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.15
|
| Rate for Payer: Nomi Health Commercial |
$277.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.32
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
64490
|
| Min. Negotiated Rate |
$220.35 |
| Max. Negotiated Rate |
$1,352.05 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Medicare |
$872.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: ASR ASR |
$328.83
|
| Rate for Payer: ASR Commercial |
$328.83
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$277.61
|
| Rate for Payer: BCN Commercial |
$262.83
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cofinity Commercial |
$318.66
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$271.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$339.00
|
| Rate for Payer: Healthscope Whirlpool |
$328.83
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$305.10
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$288.15
|
| Rate for Payer: Nomi Health Commercial |
$277.98
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$959.52
|
| Rate for Payer: PHP Medicaid |
$467.55
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$297.03
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$237.64
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$298.32
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,352.05
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP DNSP |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: VA VA |
$872.29
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL
|
Professional
|
Both
|
$339.00
|
|
|
Service Code
|
HCPCS 64490
|
| Min. Negotiated Rate |
$67.31 |
| Max. Negotiated Rate |
$278.55 |
| Rate for Payer: Aetna Commercial |
$135.62
|
| Rate for Payer: Aetna Medicare |
$169.50
|
| Rate for Payer: BCBS Complete |
$70.68
|
| Rate for Payer: BCBS Trust/PPO |
$140.00
|
| Rate for Payer: BCN Commercial |
$278.55
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Cash Price |
$271.20
|
| Rate for Payer: Meridian Medicaid |
$70.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$220.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$178.57
|
| Rate for Payer: Priority Health Narrow Network |
$178.57
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$131.14
|
| Rate for Payer: UHC Exchange |
$131.14
|
| Rate for Payer: UHCCP Medicaid |
$67.31
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
64491
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Aetna Medicare |
$106.00
|
| Rate for Payer: ASR ASR |
$205.64
|
| Rate for Payer: ASR Commercial |
$205.64
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: BCBS Trust/PPO |
$173.61
|
| Rate for Payer: BCN Commercial |
$164.36
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$199.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$212.00
|
| Rate for Payer: Healthscope Whirlpool |
$205.64
|
| Rate for Payer: Mclaren Commercial |
$190.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.20
|
| Rate for Payer: Nomi Health Commercial |
$173.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.75
|
| Rate for Payer: Priority Health Narrow Network |
$148.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.56
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 64491
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$344.45 |
| Rate for Payer: Aetna Commercial |
$77.81
|
| Rate for Payer: Aetna Medicare |
$106.00
|
| Rate for Payer: BCBS Complete |
$39.81
|
| Rate for Payer: BCBS Trust/PPO |
$344.45
|
| Rate for Payer: BCN Commercial |
$141.23
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Meridian Medicaid |
$39.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.10
|
| Rate for Payer: Priority Health Narrow Network |
$100.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.74
|
| Rate for Payer: UHC Exchange |
$74.74
|
| Rate for Payer: UHCCP Medicaid |
$37.91
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
64491
|
| Min. Negotiated Rate |
$137.80 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: ASR ASR |
$205.64
|
| Rate for Payer: ASR Commercial |
$205.64
|
| Rate for Payer: BCBS Trust/PPO |
$172.76
|
| Rate for Payer: BCN Commercial |
$164.36
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$199.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$212.00
|
| Rate for Payer: Healthscope Whirlpool |
$205.64
|
| Rate for Payer: Mclaren Commercial |
$190.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.20
|
| Rate for Payer: Nomi Health Commercial |
$173.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.56
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 64491
|
| Hospital Charge Code |
64491
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$344.45 |
| Rate for Payer: Aetna Commercial |
$77.81
|
| Rate for Payer: Aetna Medicare |
$106.00
|
| Rate for Payer: BCBS Complete |
$39.81
|
| Rate for Payer: BCBS Trust/PPO |
$344.45
|
| Rate for Payer: BCN Commercial |
$141.23
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Meridian Medicaid |
$39.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.10
|
| Rate for Payer: Priority Health Narrow Network |
$100.10
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$74.74
|
| Rate for Payer: UHC Exchange |
$74.74
|
| Rate for Payer: UHCCP Medicaid |
$37.91
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 64492
|
| Hospital Charge Code |
64492
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$216.07 |
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: Aetna Medicare |
$106.00
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS Trust/PPO |
$216.07
|
| Rate for Payer: BCN Commercial |
$142.21
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.79
|
| Rate for Payer: Priority Health Narrow Network |
$101.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.02
|
| Rate for Payer: UHC Exchange |
$76.02
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 64492
|
| Min. Negotiated Rate |
$38.13 |
| Max. Negotiated Rate |
$216.07 |
| Rate for Payer: Aetna Commercial |
$79.05
|
| Rate for Payer: Aetna Medicare |
$106.00
|
| Rate for Payer: BCBS Complete |
$40.04
|
| Rate for Payer: BCBS Trust/PPO |
$216.07
|
| Rate for Payer: BCN Commercial |
$142.21
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Meridian Medicaid |
$40.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.79
|
| Rate for Payer: Priority Health Narrow Network |
$101.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.02
|
| Rate for Payer: UHC Exchange |
$76.02
|
| Rate for Payer: UHCCP Medicaid |
$38.13
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
64492
|
| Min. Negotiated Rate |
$137.80 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: ASR ASR |
$205.64
|
| Rate for Payer: ASR Commercial |
$205.64
|
| Rate for Payer: BCBS Trust/PPO |
$172.76
|
| Rate for Payer: BCN Commercial |
$164.36
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$199.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$212.00
|
| Rate for Payer: Healthscope Whirlpool |
$205.64
|
| Rate for Payer: Mclaren Commercial |
$190.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.20
|
| Rate for Payer: Nomi Health Commercial |
$173.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.56
|
|
|
PR NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
64492
|
| Min. Negotiated Rate |
$84.80 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Aetna Medicare |
$106.00
|
| Rate for Payer: ASR ASR |
$205.64
|
| Rate for Payer: ASR Commercial |
$205.64
|
| Rate for Payer: BCBS Complete |
$84.80
|
| Rate for Payer: BCBS Trust/PPO |
$173.61
|
| Rate for Payer: BCN Commercial |
$164.36
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cofinity Commercial |
$199.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$169.60
|
| Rate for Payer: Healthscope Commercial |
$212.00
|
| Rate for Payer: Healthscope Whirlpool |
$205.64
|
| Rate for Payer: Mclaren Commercial |
$190.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$180.20
|
| Rate for Payer: Nomi Health Commercial |
$173.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$137.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.75
|
| Rate for Payer: Priority Health Narrow Network |
$148.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$186.56
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
64493
|
| Min. Negotiated Rate |
$157.30 |
| Max. Negotiated Rate |
$1,352.05 |
| Rate for Payer: Aetna Commercial |
$217.80
|
| Rate for Payer: Aetna Medicare |
$872.29
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$1,090.36
|
| Rate for Payer: Amish Plain Church Group Commercial |
$1,090.36
|
| Rate for Payer: ASR ASR |
$234.74
|
| Rate for Payer: ASR Commercial |
$234.74
|
| Rate for Payer: BCBS Complete |
$490.92
|
| Rate for Payer: BCBS MAPPO |
$872.29
|
| Rate for Payer: BCBS Trust/PPO |
$198.17
|
| Rate for Payer: BCN Commercial |
$187.62
|
| Rate for Payer: BCN Medicare Advantage |
$872.29
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$227.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$872.29
|
| Rate for Payer: Healthscope Commercial |
$242.00
|
| Rate for Payer: Healthscope Whirlpool |
$234.74
|
| Rate for Payer: Humana Choice PPO Medicare |
$872.29
|
| Rate for Payer: Mclaren Commercial |
$217.80
|
| Rate for Payer: Mclaren Medicaid |
$467.55
|
| Rate for Payer: Mclaren Medicare |
$872.29
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$915.90
|
| Rate for Payer: Meridian Medicaid |
$490.92
|
| Rate for Payer: MI Amish Medical Board Commercial |
$1,003.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.70
|
| Rate for Payer: Nomi Health Commercial |
$198.44
|
| Rate for Payer: PACE Medicare |
$828.68
|
| Rate for Payer: PACE SWMI |
$872.29
|
| Rate for Payer: PHP Commercial |
$959.52
|
| Rate for Payer: PHP Medicaid |
$467.55
|
| Rate for Payer: PHP Medicare Advantage |
$872.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$467.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$212.04
|
| Rate for Payer: Priority Health Medicare |
$872.29
|
| Rate for Payer: Priority Health Narrow Network |
$169.64
|
| Rate for Payer: Railroad Medicare Medicare |
$872.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$872.29
|
| Rate for Payer: UHC Exchange |
$1,352.05
|
| Rate for Payer: UHC Medicare Advantage |
$872.29
|
| Rate for Payer: UHCCP DNSP |
$872.29
|
| Rate for Payer: UHCCP Medicaid |
$467.55
|
| Rate for Payer: VA VA |
$872.29
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 64493
|
| Hospital Charge Code |
64493
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$609.66 |
| Rate for Payer: Aetna Commercial |
$115.69
|
| Rate for Payer: Aetna Medicare |
$121.00
|
| Rate for Payer: BCBS Complete |
$61.06
|
| Rate for Payer: BCBS Trust/PPO |
$609.66
|
| Rate for Payer: BCN Commercial |
$257.53
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Meridian Medicaid |
$61.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.56
|
| Rate for Payer: Priority Health Narrow Network |
$153.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.35
|
| Rate for Payer: UHC Exchange |
$110.35
|
| Rate for Payer: UHCCP Medicaid |
$58.15
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
64493
|
| Min. Negotiated Rate |
$157.30 |
| Max. Negotiated Rate |
$242.00 |
| Rate for Payer: Aetna Commercial |
$217.80
|
| Rate for Payer: ASR ASR |
$234.74
|
| Rate for Payer: ASR Commercial |
$234.74
|
| Rate for Payer: BCBS Trust/PPO |
$197.21
|
| Rate for Payer: BCN Commercial |
$187.62
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$227.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$193.60
|
| Rate for Payer: Healthscope Commercial |
$242.00
|
| Rate for Payer: Healthscope Whirlpool |
$234.74
|
| Rate for Payer: Mclaren Commercial |
$217.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$205.70
|
| Rate for Payer: Nomi Health Commercial |
$198.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$212.96
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 64493
|
| Min. Negotiated Rate |
$58.15 |
| Max. Negotiated Rate |
$609.66 |
| Rate for Payer: Aetna Commercial |
$115.69
|
| Rate for Payer: Aetna Medicare |
$121.00
|
| Rate for Payer: BCBS Complete |
$61.06
|
| Rate for Payer: BCBS Trust/PPO |
$609.66
|
| Rate for Payer: BCN Commercial |
$257.53
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Meridian Medicaid |
$61.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$58.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$153.56
|
| Rate for Payer: Priority Health Narrow Network |
$153.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$110.35
|
| Rate for Payer: UHC Exchange |
$110.35
|
| Rate for Payer: UHCCP Medicaid |
$58.15
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 64494
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$1,260.52 |
| Rate for Payer: Aetna Commercial |
$66.74
|
| Rate for Payer: Aetna Medicare |
$83.50
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$131.94
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Meridian Medicaid |
$34.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.72
|
| Rate for Payer: UHC Exchange |
$63.72
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
64494
|
| Min. Negotiated Rate |
$108.55 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: Aetna Commercial |
$150.30
|
| Rate for Payer: ASR ASR |
$161.99
|
| Rate for Payer: ASR Commercial |
$161.99
|
| Rate for Payer: BCBS Trust/PPO |
$136.09
|
| Rate for Payer: BCN Commercial |
$129.48
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$156.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.60
|
| Rate for Payer: Healthscope Commercial |
$167.00
|
| Rate for Payer: Healthscope Whirlpool |
$161.99
|
| Rate for Payer: Mclaren Commercial |
$150.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.95
|
| Rate for Payer: Nomi Health Commercial |
$136.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.96
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 64494
|
| Hospital Charge Code |
64494
|
| Min. Negotiated Rate |
$32.38 |
| Max. Negotiated Rate |
$1,260.52 |
| Rate for Payer: Aetna Commercial |
$66.74
|
| Rate for Payer: Aetna Medicare |
$83.50
|
| Rate for Payer: BCBS Complete |
$34.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,260.52
|
| Rate for Payer: BCN Commercial |
$131.94
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Meridian Medicaid |
$34.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$85.87
|
| Rate for Payer: Priority Health Narrow Network |
$85.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$63.72
|
| Rate for Payer: UHC Exchange |
$63.72
|
| Rate for Payer: UHCCP Medicaid |
$32.38
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
64494
|
| Min. Negotiated Rate |
$66.80 |
| Max. Negotiated Rate |
$167.00 |
| Rate for Payer: Aetna Commercial |
$150.30
|
| Rate for Payer: Aetna Medicare |
$83.50
|
| Rate for Payer: ASR ASR |
$161.99
|
| Rate for Payer: ASR Commercial |
$161.99
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS Trust/PPO |
$136.76
|
| Rate for Payer: BCN Commercial |
$129.48
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$156.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$133.60
|
| Rate for Payer: Healthscope Commercial |
$167.00
|
| Rate for Payer: Healthscope Whirlpool |
$161.99
|
| Rate for Payer: Mclaren Commercial |
$150.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$141.95
|
| Rate for Payer: Nomi Health Commercial |
$136.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$146.33
|
| Rate for Payer: Priority Health Narrow Network |
$117.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$146.96
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
64495
|
| Min. Negotiated Rate |
$68.40 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: ASR ASR |
$165.87
|
| Rate for Payer: ASR Commercial |
$165.87
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS Trust/PPO |
$140.03
|
| Rate for Payer: BCN Commercial |
$132.58
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$160.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.80
|
| Rate for Payer: Healthscope Commercial |
$171.00
|
| Rate for Payer: Healthscope Whirlpool |
$165.87
|
| Rate for Payer: Mclaren Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.35
|
| Rate for Payer: Nomi Health Commercial |
$140.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$149.83
|
| Rate for Payer: Priority Health Narrow Network |
$119.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.48
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
64495
|
| Min. Negotiated Rate |
$111.15 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: ASR ASR |
$165.87
|
| Rate for Payer: ASR Commercial |
$165.87
|
| Rate for Payer: BCBS Trust/PPO |
$139.35
|
| Rate for Payer: BCN Commercial |
$132.58
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$160.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$136.80
|
| Rate for Payer: Healthscope Commercial |
$171.00
|
| Rate for Payer: Healthscope Whirlpool |
$165.87
|
| Rate for Payer: Mclaren Commercial |
$153.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$145.35
|
| Rate for Payer: Nomi Health Commercial |
$140.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$150.48
|
|
