|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 64495
|
| Hospital Charge Code |
64495
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$184.91 |
| Rate for Payer: Aetna Commercial |
$67.57
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS Trust/PPO |
$184.91
|
| Rate for Payer: BCN Commercial |
$131.94
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Meridian Medicaid |
$34.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.58
|
| Rate for Payer: Priority Health Narrow Network |
$87.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.00
|
| Rate for Payer: UHC Exchange |
$65.00
|
| Rate for Payer: UHCCP Medicaid |
$32.59
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 64495
|
| Min. Negotiated Rate |
$32.59 |
| Max. Negotiated Rate |
$184.91 |
| Rate for Payer: Aetna Commercial |
$67.57
|
| Rate for Payer: Aetna Medicare |
$85.50
|
| Rate for Payer: BCBS Complete |
$34.22
|
| Rate for Payer: BCBS Trust/PPO |
$184.91
|
| Rate for Payer: BCN Commercial |
$131.94
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Meridian Medicaid |
$34.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$32.59
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$87.58
|
| Rate for Payer: Priority Health Narrow Network |
$87.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$65.00
|
| Rate for Payer: UHC Exchange |
$65.00
|
| Rate for Payer: UHCCP Medicaid |
$32.59
|
|
|
PR NJX DX/THER SBST EPIDURAL/SUBARACH LUMBAR/SACRAL
|
Professional
|
Both
|
$758.00
|
|
|
Service Code
|
HCPCS 62311
|
| Min. Negotiated Rate |
$303.20 |
| Max. Negotiated Rate |
$492.70 |
| Rate for Payer: Aetna Medicare |
$379.00
|
| Rate for Payer: BCBS Complete |
$303.20
|
| Rate for Payer: Cash Price |
$606.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$492.70
|
|
|
PR NJX DX/THER SBST EPIDURAL/SUBRACH CERV/THORACIC
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
HCPCS 62310
|
| Min. Negotiated Rate |
$269.60 |
| Max. Negotiated Rate |
$438.10 |
| Rate for Payer: Aetna Medicare |
$337.00
|
| Rate for Payer: BCBS Complete |
$269.60
|
| Rate for Payer: Cash Price |
$539.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$438.10
|
|
|
PR NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN
|
Professional
|
Both
|
$338.00
|
|
|
Service Code
|
HCPCS 62321
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$1,592.30 |
| Rate for Payer: Aetna Commercial |
$138.22
|
| Rate for Payer: Aetna Medicare |
$169.00
|
| Rate for Payer: BCBS Complete |
$71.79
|
| Rate for Payer: BCBS Trust/PPO |
$1,592.30
|
| Rate for Payer: BCN Commercial |
$383.62
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Meridian Medicaid |
$71.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$181.99
|
| Rate for Payer: Priority Health Narrow Network |
$181.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$139.50
|
| Rate for Payer: UHC Exchange |
$139.50
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 62323
|
| Min. Negotiated Rate |
$63.26 |
| Max. Negotiated Rate |
$1,879.69 |
| Rate for Payer: Aetna Commercial |
$127.22
|
| Rate for Payer: Aetna Medicare |
$154.00
|
| Rate for Payer: BCBS Complete |
$66.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,879.69
|
| Rate for Payer: BCN Commercial |
$378.23
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Meridian Medicaid |
$66.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.34
|
| Rate for Payer: Priority Health Narrow Network |
$168.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.12
|
| Rate for Payer: UHC Exchange |
$127.12
|
| Rate for Payer: UHCCP Medicaid |
$63.26
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
62323
|
| Min. Negotiated Rate |
$200.20 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: ASR ASR |
$298.76
|
| Rate for Payer: ASR Commercial |
$298.76
|
| Rate for Payer: BCBS Trust/PPO |
$250.99
|
| Rate for Payer: BCN Commercial |
$238.79
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$289.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.40
|
| Rate for Payer: Healthscope Commercial |
$308.00
|
| Rate for Payer: Healthscope Whirlpool |
$298.76
|
| Rate for Payer: Mclaren Commercial |
$277.20
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.80
|
| Rate for Payer: Nomi Health Commercial |
$252.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.04
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
CPT 62323
|
| Hospital Charge Code |
62323
|
| Min. Negotiated Rate |
$200.20 |
| Max. Negotiated Rate |
$1,051.71 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$298.76
|
| Rate for Payer: ASR Commercial |
$298.76
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$252.22
|
| Rate for Payer: BCN Commercial |
$238.79
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$289.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$246.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$308.00
|
| Rate for Payer: Healthscope Whirlpool |
$298.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$277.20
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.80
|
| Rate for Payer: Nomi Health Commercial |
$252.56
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$269.87
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$215.91
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 62323
|
| Hospital Charge Code |
62323
|
| Min. Negotiated Rate |
$63.26 |
| Max. Negotiated Rate |
$1,879.69 |
| Rate for Payer: Aetna Commercial |
$127.22
|
| Rate for Payer: Aetna Medicare |
$154.00
|
| Rate for Payer: BCBS Complete |
$66.42
|
| Rate for Payer: BCBS Trust/PPO |
$1,879.69
|
| Rate for Payer: BCN Commercial |
$378.23
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Meridian Medicaid |
$66.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$63.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$168.34
|
| Rate for Payer: Priority Health Narrow Network |
$168.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.12
|
| Rate for Payer: UHC Exchange |
$127.12
|
| Rate for Payer: UHCCP Medicaid |
$63.26
|
|
|
PR NJX INFUS/BOLUS DX/SBST EDRL/SUBARACH LUM/SACRAL
|
Professional
|
Both
|
$872.00
|
|
|
Service Code
|
HCPCS 62319
|
| Min. Negotiated Rate |
$348.80 |
| Max. Negotiated Rate |
$566.80 |
| Rate for Payer: Aetna Medicare |
$436.00
|
| Rate for Payer: BCBS Complete |
$348.80
|
| Rate for Payer: Cash Price |
$697.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$566.80
|
|
|
PR NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS
|
Professional
|
Both
|
$2,850.00
|
|
|
Service Code
|
HCPCS 36466
|
| Min. Negotiated Rate |
$95.21 |
| Max. Negotiated Rate |
$2,083.23 |
| Rate for Payer: Aetna Commercial |
$206.96
|
| Rate for Payer: Aetna Medicare |
$1,425.00
|
| Rate for Payer: BCBS Complete |
$99.97
|
| Rate for Payer: BCN Commercial |
$2,083.23
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: Meridian Medicaid |
$99.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$95.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,852.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$236.66
|
| Rate for Payer: Priority Health Narrow Network |
$236.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.70
|
| Rate for Payer: UHC Exchange |
$203.70
|
| Rate for Payer: UHCCP Medicaid |
$95.21
|
|
|
PR NJX NONCMPND SCLEROSANT SINGLE INCMPTNT VEIN
|
Professional
|
Both
|
$2,699.00
|
|
|
Service Code
|
HCPCS 36465
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$1,929.79 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Medicare |
$1,349.50
|
| Rate for Payer: BCBS Complete |
$79.17
|
| Rate for Payer: BCN Commercial |
$1,929.79
|
| Rate for Payer: Cash Price |
$2,159.20
|
| Rate for Payer: Cash Price |
$2,159.20
|
| Rate for Payer: Meridian Medicaid |
$79.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$75.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,754.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$185.60
|
| Rate for Payer: Priority Health Narrow Network |
$185.60
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$160.21
|
| Rate for Payer: UHC Exchange |
$160.21
|
| Rate for Payer: UHCCP Medicaid |
$75.40
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
0232T
|
| Min. Negotiated Rate |
$209.56 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: Aetna Medicare |
$390.97
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$488.71
|
| Rate for Payer: Amish Plain Church Group Commercial |
$488.71
|
| Rate for Payer: ASR ASR |
$593.64
|
| Rate for Payer: ASR Commercial |
$593.64
|
| Rate for Payer: BCBS Complete |
$220.04
|
| Rate for Payer: BCBS MAPPO |
$390.97
|
| Rate for Payer: BCBS Trust/PPO |
$501.17
|
| Rate for Payer: BCN Commercial |
$474.48
|
| Rate for Payer: BCN Medicare Advantage |
$390.97
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$575.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$390.97
|
| Rate for Payer: Healthscope Commercial |
$612.00
|
| Rate for Payer: Healthscope Whirlpool |
$593.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$390.97
|
| Rate for Payer: Mclaren Commercial |
$550.80
|
| Rate for Payer: Mclaren Medicaid |
$209.56
|
| Rate for Payer: Mclaren Medicare |
$390.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$410.52
|
| Rate for Payer: Meridian Medicaid |
$220.04
|
| Rate for Payer: MI Amish Medical Board Commercial |
$449.62
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: Nomi Health Commercial |
$501.84
|
| Rate for Payer: PACE Medicare |
$371.42
|
| Rate for Payer: PACE SWMI |
$390.97
|
| Rate for Payer: PHP Commercial |
$430.07
|
| Rate for Payer: PHP Medicaid |
$209.56
|
| Rate for Payer: PHP Medicare Advantage |
$390.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$536.23
|
| Rate for Payer: Priority Health Medicare |
$390.97
|
| Rate for Payer: Priority Health Narrow Network |
$429.01
|
| Rate for Payer: Railroad Medicare Medicare |
$390.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$538.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$390.97
|
| Rate for Payer: UHC Exchange |
$606.00
|
| Rate for Payer: UHC Medicare Advantage |
$390.97
|
| Rate for Payer: UHCCP DNSP |
$390.97
|
| Rate for Payer: UHCCP Medicaid |
$209.56
|
| Rate for Payer: VA VA |
$390.97
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 0232T
|
| Hospital Charge Code |
0232T
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Commercial |
$128.61
|
| Rate for Payer: Aetna Commercial |
$128.61
|
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: Aetna Medicare |
$459.00
|
| Rate for Payer: BCBS Complete |
$367.20
|
| Rate for Payer: BCBS Complete |
$244.80
|
| 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 |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.00
|
| Rate for Payer: UHC Exchange |
$54.00
|
| Rate for Payer: UHC Exchange |
$54.00
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
0232T
|
| Min. Negotiated Rate |
$397.80 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: ASR ASR |
$593.64
|
| Rate for Payer: ASR Commercial |
$593.64
|
| Rate for Payer: BCBS Trust/PPO |
$498.72
|
| Rate for Payer: BCN Commercial |
$474.48
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cofinity Commercial |
$575.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$489.60
|
| Rate for Payer: Healthscope Commercial |
$612.00
|
| Rate for Payer: Healthscope Whirlpool |
$593.64
|
| Rate for Payer: Mclaren Commercial |
$550.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: Nomi Health Commercial |
$501.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$538.56
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
HCPCS 0232T
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Aetna Commercial |
$128.61
|
| Rate for Payer: Aetna Commercial |
$128.61
|
| Rate for Payer: Aetna Medicare |
$459.00
|
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$367.20
|
| Rate for Payer: BCBS Complete |
$244.80
|
| 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 |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$54.00
|
| Rate for Payer: UHC Exchange |
$54.00
|
| Rate for Payer: UHC Exchange |
$54.00
|
|
|
PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 50431
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$2,577.05 |
| Rate for Payer: Aetna Commercial |
$82.85
|
| Rate for Payer: Aetna Medicare |
$103.50
|
| Rate for Payer: BCBS Complete |
$44.28
|
| Rate for Payer: BCBS Trust/PPO |
$2,577.05
|
| Rate for Payer: BCN Commercial |
$476.46
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Meridian Medicaid |
$44.28
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$103.86
|
| Rate for Payer: Priority Health Narrow Network |
$103.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$80.60
|
| Rate for Payer: UHC Exchange |
$80.60
|
| Rate for Payer: UHCCP Medicaid |
$42.17
|
|
|
PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM NEW ACCESS
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
HCPCS 50430
|
| Min. Negotiated Rate |
$96.70 |
| Max. Negotiated Rate |
$2,447.09 |
| Rate for Payer: Aetna Commercial |
$196.43
|
| Rate for Payer: Aetna Medicare |
$120.00
|
| Rate for Payer: BCBS Complete |
$101.54
|
| Rate for Payer: BCBS Trust/PPO |
$2,447.09
|
| Rate for Payer: BCN Commercial |
$931.42
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Meridian Medicaid |
$101.54
|
| Rate for Payer: Priority Health Choice Medicaid |
$96.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$156.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$239.66
|
| Rate for Payer: Priority Health Narrow Network |
$239.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$203.95
|
| Rate for Payer: UHC Exchange |
$203.95
|
| Rate for Payer: UHCCP Medicaid |
$96.70
|
|
|
PR NJX PX XTR VNGRPH W/INTRO NDL/INTRACATH
|
Professional
|
Both
|
$575.00
|
|
|
Service Code
|
HCPCS 36005
|
| Min. Negotiated Rate |
$29.82 |
| Max. Negotiated Rate |
$1,201.88 |
| Rate for Payer: Aetna Commercial |
$64.54
|
| Rate for Payer: Aetna Medicare |
$287.50
|
| Rate for Payer: BCBS Complete |
$31.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,201.88
|
| Rate for Payer: BCN Commercial |
$414.85
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Cash Price |
$460.00
|
| Rate for Payer: Meridian Medicaid |
$31.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.82
|
| Rate for Payer: Priority Health Cigna Priority Health |
$373.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.92
|
| Rate for Payer: Priority Health Narrow Network |
$73.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$64.74
|
| Rate for Payer: UHC Exchange |
$64.74
|
| Rate for Payer: UHCCP Medicaid |
$29.82
|
|
|
PR NJX RETROGRADE URETHROCSTOGRAPY
|
Professional
|
Both
|
$717.00
|
|
|
Service Code
|
HCPCS 51610
|
| Min. Negotiated Rate |
$41.54 |
| Max. Negotiated Rate |
$1,159.09 |
| Rate for Payer: Aetna Commercial |
$81.03
|
| Rate for Payer: Aetna Medicare |
$358.50
|
| Rate for Payer: BCBS Complete |
$43.62
|
| Rate for Payer: BCBS Trust/PPO |
$1,159.09
|
| Rate for Payer: BCN Commercial |
$189.12
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Cash Price |
$573.60
|
| Rate for Payer: Meridian Medicaid |
$43.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$466.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$101.73
|
| Rate for Payer: Priority Health Narrow Network |
$101.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.47
|
| Rate for Payer: UHC Exchange |
$75.47
|
| Rate for Payer: UHCCP Medicaid |
$41.54
|
|
|
PR NJX VISUALIZATION ILEAL CONDUIT&/URETEROPYELOG
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
HCPCS 50690
|
| Min. Negotiated Rate |
$44.94 |
| Max. Negotiated Rate |
$3,404.37 |
| Rate for Payer: Aetna Commercial |
$88.08
|
| Rate for Payer: Aetna Medicare |
$106.50
|
| Rate for Payer: BCBS Complete |
$47.19
|
| Rate for Payer: BCBS Trust/PPO |
$3,404.37
|
| Rate for Payer: BCN Commercial |
$174.46
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Meridian Medicaid |
$47.19
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.94
|
| Rate for Payer: Priority Health Cigna Priority Health |
$138.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$110.26
|
| Rate for Payer: Priority Health Narrow Network |
$110.26
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$83.00
|
| Rate for Payer: UHC Exchange |
$83.00
|
| Rate for Payer: UHCCP Medicaid |
$44.94
|
|
|
PR NOCTURNAL PENILE TUMESCENCE &/RIGIDITY TEST
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS 54250
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$1,901.35 |
| Rate for Payer: Aetna Commercial |
$155.80
|
| Rate for Payer: Aetna Medicare |
$117.50
|
| Rate for Payer: BCBS Complete |
$94.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,901.35
|
| Rate for Payer: BCN Commercial |
$176.42
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Cash Price |
$188.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$152.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$169.90
|
| Rate for Payer: Priority Health Narrow Network |
$169.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$147.73
|
| Rate for Payer: UHC Exchange |
$147.73
|
|
|
PR NONINVASIVE EAR/PULSE OXIMETRY MULTIPLE DETER
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS 94761
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$498.19 |
| Rate for Payer: Aetna Commercial |
$3.94
|
| Rate for Payer: Aetna Medicare |
$24.00
|
| Rate for Payer: BCBS Complete |
$19.20
|
| Rate for Payer: BCBS Trust/PPO |
$498.19
|
| Rate for Payer: BCN Commercial |
$5.37
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$31.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.42
|
| Rate for Payer: Priority Health Narrow Network |
$5.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.15
|
| Rate for Payer: UHC Exchange |
$4.15
|
|
|
PR NONINVASIVE EAR/PULSE OXIMETRY OVERNIGHT MONITOR
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
HCPCS 94762
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$235.09 |
| Rate for Payer: Aetna Commercial |
$28.15
|
| Rate for Payer: Aetna Medicare |
$21.00
|
| Rate for Payer: BCBS Complete |
$16.80
|
| Rate for Payer: BCBS Trust/PPO |
$235.09
|
| Rate for Payer: BCN Commercial |
$37.14
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$27.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$34.38
|
| Rate for Payer: Priority Health Narrow Network |
$34.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$23.14
|
| Rate for Payer: UHC Exchange |
$23.14
|
|
|
PR NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
HCPCS 94760
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$407.32 |
| Rate for Payer: Aetna Commercial |
$2.52
|
| Rate for Payer: Aetna Medicare |
$22.50
|
| Rate for Payer: BCBS Complete |
$18.00
|
| Rate for Payer: BCBS Trust/PPO |
$407.32
|
| Rate for Payer: BCN Commercial |
$3.42
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$29.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3.61
|
| Rate for Payer: Priority Health Narrow Network |
$3.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.66
|
| Rate for Payer: UHC Exchange |
$2.66
|
|
