|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
HCPCS 64493
|
| Min. Negotiated Rate |
$86.18 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Aetna Commercial |
$115.48
|
| Rate for Payer: Aetna Medicare |
$86.18
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: BCBS MAPPO |
$86.18
|
| Rate for Payer: BCN Medicare Advantage |
$86.18
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$124.10
|
| Rate for Payer: Cofinity Commercial |
$115.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.18
|
| Rate for Payer: Healthscope Commercial |
$103.42
|
| Rate for Payer: Healthscope Whirlpool |
$103.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.49
|
| Rate for Payer: Nomi Health Commercial |
$103.42
|
| Rate for Payer: PACE SWMI |
$86.18
|
| Rate for Payer: PHP Medicare Advantage |
$86.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health Medicare |
$86.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.18
|
| Rate for Payer: UHC Medicare Advantage |
$86.18
|
| Rate for Payer: UHCCP DNSP |
$86.18
|
|
|
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 |
$86.18 |
| Max. Negotiated Rate |
$157.30 |
| Rate for Payer: Aetna Commercial |
$115.48
|
| Rate for Payer: Aetna Medicare |
$86.18
|
| Rate for Payer: BCBS Complete |
$96.80
|
| Rate for Payer: BCBS MAPPO |
$86.18
|
| Rate for Payer: BCN Medicare Advantage |
$86.18
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cash Price |
$193.60
|
| Rate for Payer: Cofinity Commercial |
$124.10
|
| Rate for Payer: Cofinity Commercial |
$115.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$86.18
|
| Rate for Payer: Healthscope Commercial |
$103.42
|
| Rate for Payer: Healthscope Whirlpool |
$103.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.49
|
| Rate for Payer: Nomi Health Commercial |
$103.42
|
| Rate for Payer: PACE SWMI |
$86.18
|
| Rate for Payer: PHP Medicare Advantage |
$86.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$157.30
|
| Rate for Payer: Priority Health Medicare |
$86.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$86.18
|
| Rate for Payer: UHC Medicare Advantage |
$86.18
|
| Rate for Payer: UHCCP DNSP |
$86.18
|
|
|
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 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 |
$48.52 |
| Max. Negotiated Rate |
$108.55 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$48.52
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS MAPPO |
$48.52
|
| Rate for Payer: BCN Medicare Advantage |
$48.52
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$69.87
|
| Rate for Payer: Cofinity Commercial |
$65.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.52
|
| Rate for Payer: Healthscope Commercial |
$58.22
|
| Rate for Payer: Healthscope Whirlpool |
$58.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.95
|
| Rate for Payer: Nomi Health Commercial |
$58.22
|
| Rate for Payer: PACE SWMI |
$48.52
|
| Rate for Payer: PHP Medicare Advantage |
$48.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health Medicare |
$48.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.52
|
| Rate for Payer: UHC Medicare Advantage |
$48.52
|
| Rate for Payer: UHCCP DNSP |
$48.52
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
HCPCS 64494
|
| Min. Negotiated Rate |
$48.52 |
| Max. Negotiated Rate |
$108.55 |
| Rate for Payer: Aetna Commercial |
$65.02
|
| Rate for Payer: Aetna Medicare |
$48.52
|
| Rate for Payer: BCBS Complete |
$66.80
|
| Rate for Payer: BCBS MAPPO |
$48.52
|
| Rate for Payer: BCN Medicare Advantage |
$48.52
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cash Price |
$133.60
|
| Rate for Payer: Cofinity Commercial |
$69.87
|
| Rate for Payer: Cofinity Commercial |
$65.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.52
|
| Rate for Payer: Healthscope Commercial |
$58.22
|
| Rate for Payer: Healthscope Whirlpool |
$58.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.95
|
| Rate for Payer: Nomi Health Commercial |
$58.22
|
| Rate for Payer: PACE SWMI |
$48.52
|
| Rate for Payer: PHP Medicare Advantage |
$48.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$108.55
|
| Rate for Payer: Priority Health Medicare |
$48.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.52
|
| Rate for Payer: UHC Medicare Advantage |
$48.52
|
| Rate for Payer: UHCCP DNSP |
$48.52
|
|
|
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 |
$48.64 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Aetna Commercial |
$65.18
|
| Rate for Payer: Aetna Medicare |
$48.64
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$48.64
|
| Rate for Payer: BCN Medicare Advantage |
$48.64
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$70.04
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.64
|
| Rate for Payer: Healthscope Commercial |
$58.37
|
| Rate for Payer: Healthscope Whirlpool |
$58.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.07
|
| Rate for Payer: Nomi Health Commercial |
$58.37
|
| Rate for Payer: PACE SWMI |
$48.64
|
| Rate for Payer: PHP Medicare Advantage |
$48.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Medicare |
$48.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.64
|
| Rate for Payer: UHC Medicare Advantage |
$48.64
|
| Rate for Payer: UHCCP DNSP |
$48.64
|
|
|
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
|
|
|
PR NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 64495
|
| Min. Negotiated Rate |
$48.64 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Aetna Commercial |
$65.18
|
| Rate for Payer: Aetna Medicare |
$48.64
|
| Rate for Payer: BCBS Complete |
$68.40
|
| Rate for Payer: BCBS MAPPO |
$48.64
|
| Rate for Payer: BCN Medicare Advantage |
$48.64
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$70.04
|
| Rate for Payer: Cofinity Commercial |
$65.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.64
|
| Rate for Payer: Healthscope Commercial |
$58.37
|
| Rate for Payer: Healthscope Whirlpool |
$58.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.07
|
| Rate for Payer: Nomi Health Commercial |
$58.37
|
| Rate for Payer: PACE SWMI |
$48.64
|
| Rate for Payer: PHP Medicare Advantage |
$48.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$111.15
|
| Rate for Payer: Priority Health Medicare |
$48.64
|
| Rate for Payer: UHC Dual Complete DSNP |
$48.64
|
| Rate for Payer: UHC Medicare Advantage |
$48.64
|
| Rate for Payer: UHCCP DNSP |
$48.64
|
|
|
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 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 |
$101.73 |
| Max. Negotiated Rate |
$219.70 |
| Rate for Payer: Aetna Commercial |
$136.32
|
| Rate for Payer: Aetna Medicare |
$101.73
|
| Rate for Payer: BCBS Complete |
$135.20
|
| Rate for Payer: BCBS MAPPO |
$101.73
|
| Rate for Payer: BCN Medicare Advantage |
$101.73
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cash Price |
$270.40
|
| Rate for Payer: Cofinity Commercial |
$146.49
|
| Rate for Payer: Cofinity Commercial |
$136.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.73
|
| Rate for Payer: Healthscope Commercial |
$122.08
|
| Rate for Payer: Healthscope Whirlpool |
$122.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.82
|
| Rate for Payer: Nomi Health Commercial |
$122.08
|
| Rate for Payer: PACE SWMI |
$101.73
|
| Rate for Payer: PHP Medicare Advantage |
$101.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.70
|
| Rate for Payer: Priority Health Medicare |
$101.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.73
|
| Rate for Payer: UHC Medicare Advantage |
$101.73
|
| Rate for Payer: UHCCP DNSP |
$101.73
|
|
|
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 |
$94.14 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$126.15
|
| Rate for Payer: Aetna Medicare |
$94.14
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS MAPPO |
$94.14
|
| Rate for Payer: BCN Medicare Advantage |
$94.14
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$135.56
|
| Rate for Payer: Cofinity Commercial |
$126.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.14
|
| Rate for Payer: Healthscope Commercial |
$112.97
|
| Rate for Payer: Healthscope Whirlpool |
$112.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.85
|
| Rate for Payer: Nomi Health Commercial |
$112.97
|
| Rate for Payer: PACE SWMI |
$94.14
|
| Rate for Payer: PHP Medicare Advantage |
$94.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health Medicare |
$94.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.14
|
| Rate for Payer: UHC Medicare Advantage |
$94.14
|
| Rate for Payer: UHCCP DNSP |
$94.14
|
|
|
PR NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS 62323
|
| Min. Negotiated Rate |
$94.14 |
| Max. Negotiated Rate |
$200.20 |
| Rate for Payer: Aetna Commercial |
$126.15
|
| Rate for Payer: Aetna Medicare |
$94.14
|
| Rate for Payer: BCBS Complete |
$123.20
|
| Rate for Payer: BCBS MAPPO |
$94.14
|
| Rate for Payer: BCN Medicare Advantage |
$94.14
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cash Price |
$246.40
|
| Rate for Payer: Cofinity Commercial |
$135.56
|
| Rate for Payer: Cofinity Commercial |
$126.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$94.14
|
| Rate for Payer: Healthscope Commercial |
$112.97
|
| Rate for Payer: Healthscope Whirlpool |
$112.97
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$98.85
|
| Rate for Payer: Nomi Health Commercial |
$112.97
|
| Rate for Payer: PACE SWMI |
$94.14
|
| Rate for Payer: PHP Medicare Advantage |
$94.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$200.20
|
| Rate for Payer: Priority Health Medicare |
$94.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$94.14
|
| Rate for Payer: UHC Medicare Advantage |
$94.14
|
| Rate for Payer: UHCCP DNSP |
$94.14
|
|
|
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 |
$1,046.87 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Aetna Medicare |
$675.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$844.25
|
| Rate for Payer: Amish Plain Church Group Commercial |
$844.25
|
| Rate for Payer: ASR ASR |
$298.76
|
| Rate for Payer: ASR Commercial |
$298.76
|
| Rate for Payer: BCBS Complete |
$380.12
|
| Rate for Payer: BCBS MAPPO |
$675.40
|
| Rate for Payer: BCBS Trust/PPO |
$252.22
|
| Rate for Payer: BCN Commercial |
$238.79
|
| Rate for Payer: BCN Medicare Advantage |
$675.40
|
| 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 |
$675.40
|
| Rate for Payer: Healthscope Commercial |
$308.00
|
| Rate for Payer: Healthscope Whirlpool |
$298.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$675.40
|
| Rate for Payer: Mclaren Commercial |
$277.20
|
| Rate for Payer: Mclaren Medicaid |
$362.01
|
| Rate for Payer: Mclaren Medicare |
$675.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$709.17
|
| Rate for Payer: Meridian Medicaid |
$380.12
|
| Rate for Payer: MI Amish Medical Board Commercial |
$776.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$261.80
|
| Rate for Payer: Nomi Health Commercial |
$252.56
|
| Rate for Payer: PACE Medicare |
$641.63
|
| Rate for Payer: PACE SWMI |
$675.40
|
| Rate for Payer: PHP Commercial |
$742.94
|
| Rate for Payer: PHP Medicaid |
$362.01
|
| Rate for Payer: PHP Medicare Advantage |
$675.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$362.01
|
| 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 |
$675.40
|
| Rate for Payer: Priority Health Narrow Network |
$215.91
|
| Rate for Payer: Railroad Medicare Medicare |
$675.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$271.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$675.40
|
| Rate for Payer: UHC Exchange |
$1,046.87
|
| Rate for Payer: UHC Medicare Advantage |
$675.40
|
| Rate for Payer: UHCCP DNSP |
$675.40
|
| Rate for Payer: UHCCP Medicaid |
$362.01
|
| Rate for Payer: VA VA |
$675.40
|
|
|
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 |
$145.44 |
| Max. Negotiated Rate |
$1,852.50 |
| Rate for Payer: Aetna Commercial |
$194.89
|
| Rate for Payer: Aetna Medicare |
$145.44
|
| Rate for Payer: BCBS Complete |
$1,140.00
|
| Rate for Payer: BCBS MAPPO |
$145.44
|
| Rate for Payer: BCN Medicare Advantage |
$145.44
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: Cash Price |
$2,280.00
|
| Rate for Payer: Cofinity Commercial |
$209.43
|
| Rate for Payer: Cofinity Commercial |
$194.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$145.44
|
| Rate for Payer: Healthscope Commercial |
$174.53
|
| Rate for Payer: Healthscope Whirlpool |
$174.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$152.71
|
| Rate for Payer: Nomi Health Commercial |
$174.53
|
| Rate for Payer: PACE SWMI |
$145.44
|
| Rate for Payer: PHP Medicare Advantage |
$145.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,852.50
|
| Rate for Payer: Priority Health Medicare |
$145.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$145.44
|
| Rate for Payer: UHC Medicare Advantage |
$145.44
|
| Rate for Payer: UHCCP DNSP |
$145.44
|
|
|
PR NJX NONCMPND SCLEROSANT SINGLE INCMPTNT VEIN
|
Professional
|
Both
|
$2,699.00
|
|
|
Service Code
|
HCPCS 36465
|
| Min. Negotiated Rate |
$115.23 |
| Max. Negotiated Rate |
$1,754.35 |
| Rate for Payer: Aetna Commercial |
$154.41
|
| Rate for Payer: Aetna Medicare |
$115.23
|
| Rate for Payer: BCBS Complete |
$1,079.60
|
| Rate for Payer: BCBS MAPPO |
$115.23
|
| Rate for Payer: BCN Medicare Advantage |
$115.23
|
| Rate for Payer: Cash Price |
$2,159.20
|
| Rate for Payer: Cash Price |
$2,159.20
|
| Rate for Payer: Cofinity Commercial |
$165.93
|
| Rate for Payer: Cofinity Commercial |
$154.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$115.23
|
| Rate for Payer: Healthscope Commercial |
$138.28
|
| Rate for Payer: Healthscope Whirlpool |
$138.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$120.99
|
| Rate for Payer: Nomi Health Commercial |
$138.28
|
| Rate for Payer: PACE SWMI |
$115.23
|
| Rate for Payer: PHP Medicare Advantage |
$115.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,754.35
|
| Rate for Payer: Priority Health Medicare |
$115.23
|
| Rate for Payer: UHC Dual Complete DSNP |
$115.23
|
| Rate for Payer: UHC Medicare Advantage |
$115.23
|
| Rate for Payer: UHCCP DNSP |
$115.23
|
|
|
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 |
$367.20 |
| Max. Negotiated Rate |
$596.70 |
| Rate for Payer: Aetna Medicare |
$459.00
|
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: BCBS Complete |
$367.20
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$596.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 0232T
|
| Hospital Charge Code |
0232T
|
| Min. Negotiated Rate |
$208.60 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: Aetna Medicare |
$389.18
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$486.48
|
| Rate for Payer: Amish Plain Church Group Commercial |
$486.48
|
| Rate for Payer: ASR ASR |
$593.64
|
| Rate for Payer: ASR Commercial |
$593.64
|
| Rate for Payer: BCBS Complete |
$219.03
|
| Rate for Payer: BCBS MAPPO |
$389.18
|
| Rate for Payer: BCBS Trust/PPO |
$501.17
|
| Rate for Payer: BCN Commercial |
$474.48
|
| Rate for Payer: BCN Medicare Advantage |
$389.18
|
| 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 |
$389.18
|
| Rate for Payer: Healthscope Commercial |
$612.00
|
| Rate for Payer: Healthscope Whirlpool |
$593.64
|
| Rate for Payer: Humana Choice PPO Medicare |
$389.18
|
| Rate for Payer: Mclaren Commercial |
$550.80
|
| Rate for Payer: Mclaren Medicaid |
$208.60
|
| Rate for Payer: Mclaren Medicare |
$389.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$408.64
|
| Rate for Payer: Meridian Medicaid |
$219.03
|
| Rate for Payer: MI Amish Medical Board Commercial |
$447.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$520.20
|
| Rate for Payer: Nomi Health Commercial |
$501.84
|
| Rate for Payer: PACE Medicare |
$369.72
|
| Rate for Payer: PACE SWMI |
$389.18
|
| Rate for Payer: PHP Commercial |
$428.10
|
| Rate for Payer: PHP Medicaid |
$208.60
|
| Rate for Payer: PHP Medicare Advantage |
$389.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$208.60
|
| 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 |
$389.18
|
| Rate for Payer: Priority Health Narrow Network |
$429.01
|
| Rate for Payer: Railroad Medicare Medicare |
$389.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$538.56
|
| Rate for Payer: UHC Dual Complete DSNP |
$389.18
|
| Rate for Payer: UHC Exchange |
$603.23
|
| Rate for Payer: UHC Medicare Advantage |
$389.18
|
| Rate for Payer: UHCCP DNSP |
$389.18
|
| Rate for Payer: UHCCP Medicaid |
$208.60
|
| Rate for Payer: VA VA |
$389.18
|
|
|
PR NJX PLTLT PLASMA W/IMG HARVEST/PREPARATION
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 0232T
|
| Hospital Charge Code |
0232T
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| 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: Cash Price |
$489.60
|
| 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
|
|
|
PR NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS 50431
|
| Min. Negotiated Rate |
$62.61 |
| Max. Negotiated Rate |
$134.55 |
| Rate for Payer: Aetna Commercial |
$83.90
|
| Rate for Payer: Aetna Medicare |
$62.61
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: BCBS MAPPO |
$62.61
|
| Rate for Payer: BCN Medicare Advantage |
$62.61
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cofinity Commercial |
$90.16
|
| Rate for Payer: Cofinity Commercial |
$83.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.61
|
| Rate for Payer: Healthscope Commercial |
$75.13
|
| Rate for Payer: Healthscope Whirlpool |
$75.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$65.74
|
| Rate for Payer: Nomi Health Commercial |
$75.13
|
| Rate for Payer: PACE SWMI |
$62.61
|
| Rate for Payer: PHP Medicare Advantage |
$62.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
| Rate for Payer: Priority Health Medicare |
$62.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.61
|
| Rate for Payer: UHC Medicare Advantage |
$62.61
|
| Rate for Payer: UHCCP DNSP |
$62.61
|
|
