|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
64450
|
| Min. Negotiated Rate |
$163.17 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Aetna Commercial |
$220.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.35
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$181.30
|
| Rate for Payer: Cofinity Commercial |
$222.74
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.20
|
| Rate for Payer: Healthscope Commercial |
$233.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.15
|
| Rate for Payer: PHP Commercial |
$220.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health SBD |
$163.17
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 64450
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$168.35 |
| Rate for Payer: Aetna Commercial |
$52.65
|
| Rate for Payer: Aetna Medicare |
$40.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.65
|
| Rate for Payer: BCBS Complete |
$103.60
|
| Rate for Payer: BCBS MAPPO |
$39.29
|
| Rate for Payer: BCN Medicare Advantage |
$39.29
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$56.58
|
| Rate for Payer: Cofinity Commercial |
$52.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.29
|
| Rate for Payer: Healthscope Commercial |
$72.69
|
| Rate for Payer: Healthscope Commercial |
$62.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.35
|
| Rate for Payer: Nomi Health Commercial |
$47.15
|
| Rate for Payer: PACE SWMI |
$39.29
|
| Rate for Payer: PHP Medicare Advantage |
$39.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health Medicare |
$39.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.29
|
| Rate for Payer: UHC Medicare Advantage |
$39.29
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
64450
|
| Min. Negotiated Rate |
$39.29 |
| Max. Negotiated Rate |
$168.35 |
| Rate for Payer: Aetna Commercial |
$52.65
|
| Rate for Payer: Aetna Medicare |
$40.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.58
|
| Rate for Payer: BCBS Complete |
$103.60
|
| Rate for Payer: BCBS MAPPO |
$39.29
|
| Rate for Payer: BCN Medicare Advantage |
$39.29
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$56.58
|
| Rate for Payer: Cofinity Commercial |
$52.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.29
|
| Rate for Payer: Healthscope Commercial |
$62.86
|
| Rate for Payer: Healthscope Commercial |
$72.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$168.35
|
| Rate for Payer: Nomi Health Commercial |
$47.15
|
| Rate for Payer: PACE SWMI |
$39.29
|
| Rate for Payer: PHP Medicare Advantage |
$39.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health Medicare |
$39.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.29
|
| Rate for Payer: UHC Medicare Advantage |
$39.29
|
|
|
PR INJECTION AA&/STRD PARACERVICAL NERVE
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 64435
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$189.15 |
| Rate for Payer: Aetna Commercial |
$56.09
|
| Rate for Payer: Aetna Medicare |
$43.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.09
|
| Rate for Payer: BCBS Complete |
$116.40
|
| Rate for Payer: BCBS MAPPO |
$41.86
|
| Rate for Payer: BCN Medicare Advantage |
$41.86
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cofinity Commercial |
$60.28
|
| Rate for Payer: Cofinity Commercial |
$56.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$41.86
|
| Rate for Payer: Healthscope Commercial |
$66.98
|
| Rate for Payer: Healthscope Commercial |
$77.44
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$189.15
|
| Rate for Payer: Nomi Health Commercial |
$50.23
|
| Rate for Payer: PACE SWMI |
$41.86
|
| Rate for Payer: PHP Medicare Advantage |
$41.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.15
|
| Rate for Payer: Priority Health Medicare |
$41.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.86
|
| Rate for Payer: UHC Medicare Advantage |
$41.86
|
|
|
PR INJECTION AA&/STRD PUDENDAL NERVE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 64430
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$165.75 |
| Rate for Payer: Aetna Commercial |
$70.48
|
| Rate for Payer: Aetna Medicare |
$54.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$70.48
|
| Rate for Payer: BCBS Complete |
$102.00
|
| Rate for Payer: BCBS MAPPO |
$52.60
|
| Rate for Payer: BCN Medicare Advantage |
$52.60
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cofinity Commercial |
$75.74
|
| Rate for Payer: Cofinity Commercial |
$70.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.60
|
| Rate for Payer: Healthscope Commercial |
$97.31
|
| Rate for Payer: Healthscope Commercial |
$84.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$165.75
|
| Rate for Payer: Nomi Health Commercial |
$63.12
|
| Rate for Payer: PACE SWMI |
$52.60
|
| Rate for Payer: PHP Medicare Advantage |
$52.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health Medicare |
$52.60
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.60
|
| Rate for Payer: UHC Medicare Advantage |
$52.60
|
|
|
PR INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 64445
|
| Min. Negotiated Rate |
$69.01 |
| Max. Negotiated Rate |
$176.15 |
| Rate for Payer: Aetna Commercial |
$92.47
|
| Rate for Payer: Aetna Medicare |
$71.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$99.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$92.47
|
| Rate for Payer: BCBS Complete |
$108.40
|
| Rate for Payer: BCBS MAPPO |
$69.01
|
| Rate for Payer: BCN Medicare Advantage |
$69.01
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cofinity Commercial |
$99.37
|
| Rate for Payer: Cofinity Commercial |
$92.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$69.01
|
| Rate for Payer: Healthscope Commercial |
$110.42
|
| Rate for Payer: Healthscope Commercial |
$127.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$72.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$176.15
|
| Rate for Payer: Nomi Health Commercial |
$82.81
|
| Rate for Payer: PACE SWMI |
$69.01
|
| Rate for Payer: PHP Medicare Advantage |
$69.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.15
|
| Rate for Payer: Priority Health Medicare |
$69.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$69.01
|
| Rate for Payer: UHC Medicare Advantage |
$69.01
|
|
|
PR INJECTION AA&/STRD SUPRASCAPULAR NERVE
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 64418
|
| Min. Negotiated Rate |
$53.18 |
| Max. Negotiated Rate |
$117.65 |
| Rate for Payer: Aetna Commercial |
$71.26
|
| Rate for Payer: Aetna Medicare |
$55.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$76.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$71.26
|
| Rate for Payer: BCBS Complete |
$72.40
|
| Rate for Payer: BCBS MAPPO |
$53.18
|
| Rate for Payer: BCN Medicare Advantage |
$53.18
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cofinity Commercial |
$76.58
|
| Rate for Payer: Cofinity Commercial |
$71.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.18
|
| Rate for Payer: Healthscope Commercial |
$98.38
|
| Rate for Payer: Healthscope Commercial |
$85.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$55.84
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$117.65
|
| Rate for Payer: Nomi Health Commercial |
$63.82
|
| Rate for Payer: PACE SWMI |
$53.18
|
| Rate for Payer: PHP Medicare Advantage |
$53.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health Medicare |
$53.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.18
|
| Rate for Payer: UHC Medicare Advantage |
$53.18
|
|
|
PR INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 64400
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$169.65 |
| Rate for Payer: Aetna Commercial |
$67.27
|
| Rate for Payer: Aetna Medicare |
$52.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$72.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.27
|
| Rate for Payer: BCBS Complete |
$104.40
|
| Rate for Payer: BCBS MAPPO |
$50.20
|
| Rate for Payer: BCN Medicare Advantage |
$50.20
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cofinity Commercial |
$72.29
|
| Rate for Payer: Cofinity Commercial |
$67.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$50.20
|
| Rate for Payer: Healthscope Commercial |
$80.32
|
| Rate for Payer: Healthscope Commercial |
$92.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$52.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$169.65
|
| Rate for Payer: Nomi Health Commercial |
$60.24
|
| Rate for Payer: PACE SWMI |
$50.20
|
| Rate for Payer: PHP Medicare Advantage |
$50.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health Medicare |
$50.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$50.20
|
| Rate for Payer: UHC Medicare Advantage |
$50.20
|
|
|
PR INJECTION AA&/STRD VAGUS NERVE
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 64408
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$109.20 |
| Rate for Payer: Aetna Commercial |
$57.95
|
| Rate for Payer: Aetna Medicare |
$44.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.95
|
| Rate for Payer: BCBS Complete |
$67.20
|
| Rate for Payer: BCBS MAPPO |
$43.25
|
| Rate for Payer: BCN Medicare Advantage |
$43.25
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cofinity Commercial |
$62.28
|
| Rate for Payer: Cofinity Commercial |
$57.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.25
|
| Rate for Payer: Healthscope Commercial |
$80.01
|
| Rate for Payer: Healthscope Commercial |
$69.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.41
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$109.20
|
| Rate for Payer: Nomi Health Commercial |
$51.90
|
| Rate for Payer: PACE SWMI |
$43.25
|
| Rate for Payer: PHP Medicare Advantage |
$43.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health Medicare |
$43.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.25
|
| Rate for Payer: UHC Medicare Advantage |
$43.25
|
|
|
PR INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS 49400
|
| Min. Negotiated Rate |
$85.87 |
| Max. Negotiated Rate |
$199.55 |
| Rate for Payer: Aetna Commercial |
$115.07
|
| Rate for Payer: Aetna Medicare |
$89.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.07
|
| Rate for Payer: BCBS Complete |
$122.80
|
| Rate for Payer: BCBS MAPPO |
$85.87
|
| Rate for Payer: BCN Medicare Advantage |
$85.87
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Cofinity Commercial |
$123.65
|
| Rate for Payer: Cofinity Commercial |
$115.07
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$85.87
|
| Rate for Payer: Healthscope Commercial |
$137.39
|
| Rate for Payer: Healthscope Commercial |
$158.86
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$90.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$199.55
|
| Rate for Payer: Nomi Health Commercial |
$103.04
|
| Rate for Payer: PACE SWMI |
$85.87
|
| Rate for Payer: PHP Medicare Advantage |
$85.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.55
|
| Rate for Payer: Priority Health Medicare |
$85.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$85.87
|
| Rate for Payer: UHC Medicare Advantage |
$85.87
|
|
|
PR INJECTION ANES AGENT SPHENOPALATINE GANGLION
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 64505
|
| Min. Negotiated Rate |
$71.60 |
| Max. Negotiated Rate |
$188.35 |
| Rate for Payer: Aetna Commercial |
$136.43
|
| Rate for Payer: Aetna Medicare |
$105.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$146.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$136.43
|
| Rate for Payer: BCBS Complete |
$71.60
|
| Rate for Payer: BCBS MAPPO |
$101.81
|
| Rate for Payer: BCN Medicare Advantage |
$101.81
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cofinity Commercial |
$146.61
|
| Rate for Payer: Cofinity Commercial |
$136.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$101.81
|
| Rate for Payer: Healthscope Commercial |
$162.90
|
| Rate for Payer: Healthscope Commercial |
$188.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$106.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$116.35
|
| Rate for Payer: Nomi Health Commercial |
$122.17
|
| Rate for Payer: PACE SWMI |
$101.81
|
| Rate for Payer: PHP Medicare Advantage |
$101.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.35
|
| Rate for Payer: Priority Health Medicare |
$101.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$101.81
|
| Rate for Payer: UHC Medicare Advantage |
$101.81
|
|
|
PR INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 64520
|
| Min. Negotiated Rate |
$80.13 |
| Max. Negotiated Rate |
$232.05 |
| Rate for Payer: Aetna Commercial |
$107.37
|
| Rate for Payer: Aetna Commercial |
$107.37
|
| Rate for Payer: Aetna Medicare |
$83.34
|
| Rate for Payer: Aetna Medicare |
$83.34
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$115.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$107.37
|
| Rate for Payer: BCBS Complete |
$82.40
|
| Rate for Payer: BCBS Complete |
$142.80
|
| Rate for Payer: BCBS MAPPO |
$80.13
|
| Rate for Payer: BCBS MAPPO |
$80.13
|
| Rate for Payer: BCN Medicare Advantage |
$80.13
|
| Rate for Payer: BCN Medicare Advantage |
$80.13
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cofinity Commercial |
$107.37
|
| Rate for Payer: Cofinity Commercial |
$107.37
|
| Rate for Payer: Cofinity Commercial |
$115.39
|
| Rate for Payer: Cofinity Commercial |
$115.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.13
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.13
|
| Rate for Payer: Healthscope Commercial |
$148.24
|
| Rate for Payer: Healthscope Commercial |
$148.24
|
| Rate for Payer: Healthscope Commercial |
$128.21
|
| Rate for Payer: Healthscope Commercial |
$128.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$84.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$232.05
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$133.90
|
| Rate for Payer: Nomi Health Commercial |
$96.16
|
| Rate for Payer: Nomi Health Commercial |
$96.16
|
| Rate for Payer: PACE SWMI |
$80.13
|
| Rate for Payer: PACE SWMI |
$80.13
|
| Rate for Payer: PHP Medicare Advantage |
$80.13
|
| Rate for Payer: PHP Medicare Advantage |
$80.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.90
|
| Rate for Payer: Priority Health Medicare |
$80.13
|
| Rate for Payer: Priority Health Medicare |
$80.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.13
|
| Rate for Payer: UHC Medicare Advantage |
$80.13
|
| Rate for Payer: UHC Medicare Advantage |
$80.13
|
|
|
PR INJECTION, BUPIVICAINE HYDRO
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS S0020
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Medicare |
$5.00
|
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6.50
|
|
|
PR INJECTION CORPORA CAVERNOSA PHARMACOLOGIC AGENT
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 54235
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$130.96 |
| Rate for Payer: Aetna Commercial |
$94.86
|
| Rate for Payer: Aetna Medicare |
$73.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$101.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.86
|
| Rate for Payer: BCBS Complete |
$70.00
|
| Rate for Payer: BCBS MAPPO |
$70.79
|
| Rate for Payer: BCN Medicare Advantage |
$70.79
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$94.86
|
| Rate for Payer: Cofinity Commercial |
$101.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$70.79
|
| Rate for Payer: Healthscope Commercial |
$130.96
|
| Rate for Payer: Healthscope Commercial |
$113.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$74.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$113.75
|
| Rate for Payer: Nomi Health Commercial |
$84.95
|
| Rate for Payer: PACE SWMI |
$70.79
|
| Rate for Payer: PHP Medicare Advantage |
$70.79
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health Medicare |
$70.79
|
| Rate for Payer: UHC Dual Complete DSNP |
$70.79
|
| Rate for Payer: UHC Medicare Advantage |
$70.79
|
|
|
PR INJECTION ENZYME PALMAR FASCIAL CORD
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
HCPCS 20527
|
| Min. Negotiated Rate |
$63.04 |
| Max. Negotiated Rate |
$116.62 |
| Rate for Payer: Aetna Commercial |
$84.47
|
| Rate for Payer: Aetna Medicare |
$65.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.78
|
| Rate for Payer: BCBS Complete |
$66.40
|
| Rate for Payer: BCBS MAPPO |
$63.04
|
| Rate for Payer: BCN Medicare Advantage |
$63.04
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cash Price |
$132.80
|
| Rate for Payer: Cofinity Commercial |
$84.47
|
| Rate for Payer: Cofinity Commercial |
$90.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.04
|
| Rate for Payer: Healthscope Commercial |
$100.86
|
| Rate for Payer: Healthscope Commercial |
$116.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$107.90
|
| Rate for Payer: Nomi Health Commercial |
$75.65
|
| Rate for Payer: PACE SWMI |
$63.04
|
| Rate for Payer: PHP Medicare Advantage |
$63.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$107.90
|
| Rate for Payer: Priority Health Medicare |
$63.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.04
|
| Rate for Payer: UHC Medicare Advantage |
$63.04
|
|
|
PR INJECTION EPIDURAL BLOOD/CLOT PATCH
|
Professional
|
Both
|
$471.00
|
|
|
Service Code
|
HCPCS 62273
|
| Min. Negotiated Rate |
$107.86 |
| Max. Negotiated Rate |
$306.15 |
| Rate for Payer: Aetna Commercial |
$144.53
|
| Rate for Payer: Aetna Medicare |
$112.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$155.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$144.53
|
| Rate for Payer: BCBS Complete |
$188.40
|
| Rate for Payer: BCBS MAPPO |
$107.86
|
| Rate for Payer: BCN Medicare Advantage |
$107.86
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cofinity Commercial |
$155.32
|
| Rate for Payer: Cofinity Commercial |
$144.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$107.86
|
| Rate for Payer: Healthscope Commercial |
$199.54
|
| Rate for Payer: Healthscope Commercial |
$172.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$113.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$306.15
|
| Rate for Payer: Nomi Health Commercial |
$129.43
|
| Rate for Payer: PACE SWMI |
$107.86
|
| Rate for Payer: PHP Medicare Advantage |
$107.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$306.15
|
| Rate for Payer: Priority Health Medicare |
$107.86
|
| Rate for Payer: UHC Dual Complete DSNP |
$107.86
|
| Rate for Payer: UHC Medicare Advantage |
$107.86
|
|
|
PR INJECTION INTRALESIONAL >7 LESIONS
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
HCPCS 11901
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$79.30 |
| Rate for Payer: Aetna Commercial |
$57.19
|
| Rate for Payer: Aetna Medicare |
$44.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$61.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$57.19
|
| Rate for Payer: BCBS Complete |
$48.80
|
| Rate for Payer: BCBS MAPPO |
$42.68
|
| Rate for Payer: BCN Medicare Advantage |
$42.68
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cash Price |
$97.60
|
| Rate for Payer: Cofinity Commercial |
$61.46
|
| Rate for Payer: Cofinity Commercial |
$57.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.68
|
| Rate for Payer: Healthscope Commercial |
$68.29
|
| Rate for Payer: Healthscope Commercial |
$78.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$44.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$79.30
|
| Rate for Payer: Nomi Health Commercial |
$51.22
|
| Rate for Payer: PACE SWMI |
$42.68
|
| Rate for Payer: PHP Medicare Advantage |
$42.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$79.30
|
| Rate for Payer: Priority Health Medicare |
$42.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.68
|
| Rate for Payer: UHC Medicare Advantage |
$42.68
|
|
|
PR INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
HCPCS 11900
|
| Min. Negotiated Rate |
$27.85 |
| Max. Negotiated Rate |
$59.80 |
| Rate for Payer: Aetna Commercial |
$37.32
|
| Rate for Payer: Aetna Medicare |
$28.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$40.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$37.32
|
| Rate for Payer: BCBS Complete |
$36.80
|
| Rate for Payer: BCBS MAPPO |
$27.85
|
| Rate for Payer: BCN Medicare Advantage |
$27.85
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cash Price |
$73.60
|
| Rate for Payer: Cofinity Commercial |
$40.10
|
| Rate for Payer: Cofinity Commercial |
$37.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$27.85
|
| Rate for Payer: Healthscope Commercial |
$44.56
|
| Rate for Payer: Healthscope Commercial |
$51.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$29.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.80
|
| Rate for Payer: Nomi Health Commercial |
$33.42
|
| Rate for Payer: PACE SWMI |
$27.85
|
| Rate for Payer: PHP Medicare Advantage |
$27.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$59.80
|
| Rate for Payer: Priority Health Medicare |
$27.85
|
| Rate for Payer: UHC Dual Complete DSNP |
$27.85
|
| Rate for Payer: UHC Medicare Advantage |
$27.85
|
|
|
PR INJECTION KNEE ARTHROGRAPHY
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
HCPCS 27370
|
| Min. Negotiated Rate |
$114.40 |
| Max. Negotiated Rate |
$185.90 |
| Rate for Payer: Aetna Medicare |
$143.00
|
| Rate for Payer: BCBS Complete |
$114.40
|
| Rate for Payer: Cash Price |
$228.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$185.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$185.90
|
|
|
PR INJECTION,ONABOTULINUMTOXINA
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J0585
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$12.03 |
| Rate for Payer: Aetna Commercial |
$8.71
|
| Rate for Payer: Aetna Medicare |
$6.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.36
|
| Rate for Payer: BCBS Complete |
$3.20
|
| Rate for Payer: BCBS MAPPO |
$6.50
|
| Rate for Payer: BCN Medicare Advantage |
$6.50
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cash Price |
$6.40
|
| Rate for Payer: Cofinity Commercial |
$8.71
|
| Rate for Payer: Cofinity Commercial |
$9.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.50
|
| Rate for Payer: Healthscope Commercial |
$10.40
|
| Rate for Payer: Healthscope Commercial |
$12.03
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$6.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.20
|
| Rate for Payer: Nomi Health Commercial |
$7.80
|
| Rate for Payer: PACE SWMI |
$6.50
|
| Rate for Payer: PHP Medicare Advantage |
$6.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5.20
|
| Rate for Payer: Priority Health Medicare |
$6.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.50
|
| Rate for Payer: UHC Medicare Advantage |
$6.50
|
|
|
PR INJECTION, PLATELET RICH PLASMA, ANY SITE INCLUDING IMAGE GUIDANCE, HARVESTING AND PREPARATION WHEN PERFORMED
|
Professional
|
Both
|
$612.00
|
|
|
Service Code
|
HCPCS 00671
|
|
Hospital Revenue Code
|
990
|
| Min. Negotiated Rate |
$244.80 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Aetna Medicare |
$306.00
|
| Rate for Payer: BCBS Complete |
$244.80
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$397.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$397.80
|
|
|
PR INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
HCPCS 24220
|
| Min. Negotiated Rate |
$62.92 |
| Max. Negotiated Rate |
$186.55 |
| Rate for Payer: Aetna Commercial |
$84.31
|
| Rate for Payer: Aetna Medicare |
$65.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$84.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.60
|
| Rate for Payer: BCBS Complete |
$114.80
|
| Rate for Payer: BCBS MAPPO |
$62.92
|
| Rate for Payer: BCN Medicare Advantage |
$62.92
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cash Price |
$229.60
|
| Rate for Payer: Cofinity Commercial |
$90.60
|
| Rate for Payer: Cofinity Commercial |
$84.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.92
|
| Rate for Payer: Healthscope Commercial |
$116.40
|
| Rate for Payer: Healthscope Commercial |
$100.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$66.07
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$186.55
|
| Rate for Payer: Nomi Health Commercial |
$75.50
|
| Rate for Payer: PACE SWMI |
$62.92
|
| Rate for Payer: PHP Medicare Advantage |
$62.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.55
|
| Rate for Payer: Priority Health Medicare |
$62.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.92
|
| Rate for Payer: UHC Medicare Advantage |
$62.92
|
|
|
PR INJECTION PROCEDURE FOR PEYRONIE DISEASE
|
Professional
|
Both
|
$221.00
|
|
|
Service Code
|
HCPCS 54200
|
| Min. Negotiated Rate |
$83.44 |
| Max. Negotiated Rate |
$154.36 |
| Rate for Payer: Aetna Commercial |
$111.81
|
| Rate for Payer: Aetna Medicare |
$86.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$111.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$120.15
|
| Rate for Payer: BCBS Complete |
$88.40
|
| Rate for Payer: BCBS MAPPO |
$83.44
|
| Rate for Payer: BCN Medicare Advantage |
$83.44
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cash Price |
$176.80
|
| Rate for Payer: Cofinity Commercial |
$111.81
|
| Rate for Payer: Cofinity Commercial |
$120.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$83.44
|
| Rate for Payer: Healthscope Commercial |
$133.50
|
| Rate for Payer: Healthscope Commercial |
$154.36
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$87.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$143.65
|
| Rate for Payer: Nomi Health Commercial |
$100.13
|
| Rate for Payer: PACE SWMI |
$83.44
|
| Rate for Payer: PHP Medicare Advantage |
$83.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$143.65
|
| Rate for Payer: Priority Health Medicare |
$83.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$83.44
|
| Rate for Payer: UHC Medicare Advantage |
$83.44
|
|
|
PR INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
HCPCS 62284
|
| Min. Negotiated Rate |
$78.57 |
| Max. Negotiated Rate |
$391.30 |
| Rate for Payer: Aetna Commercial |
$105.28
|
| Rate for Payer: Aetna Medicare |
$81.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.14
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.28
|
| Rate for Payer: BCBS Complete |
$240.80
|
| Rate for Payer: BCBS MAPPO |
$78.57
|
| Rate for Payer: BCN Medicare Advantage |
$78.57
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cash Price |
$481.60
|
| Rate for Payer: Cofinity Commercial |
$113.14
|
| Rate for Payer: Cofinity Commercial |
$105.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.57
|
| Rate for Payer: Healthscope Commercial |
$145.35
|
| Rate for Payer: Healthscope Commercial |
$125.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$391.30
|
| Rate for Payer: Nomi Health Commercial |
$94.28
|
| Rate for Payer: PACE SWMI |
$78.57
|
| Rate for Payer: PHP Medicare Advantage |
$78.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$391.30
|
| Rate for Payer: Priority Health Medicare |
$78.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.57
|
| Rate for Payer: UHC Medicare Advantage |
$78.57
|
|
|
PR INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR
|
Professional
|
Both
|
$1,440.00
|
|
|
Service Code
|
HCPCS 62290
|
| Min. Negotiated Rate |
$148.92 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$199.55
|
| Rate for Payer: Aetna Medicare |
$154.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$214.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$199.55
|
| Rate for Payer: BCBS Complete |
$576.00
|
| Rate for Payer: BCBS MAPPO |
$148.92
|
| Rate for Payer: BCN Medicare Advantage |
$148.92
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Cash Price |
$1,152.00
|
| Rate for Payer: Cofinity Commercial |
$214.44
|
| Rate for Payer: Cofinity Commercial |
$199.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$148.92
|
| Rate for Payer: Healthscope Commercial |
$238.27
|
| Rate for Payer: Healthscope Commercial |
$275.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$156.37
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$936.00
|
| Rate for Payer: Nomi Health Commercial |
$178.70
|
| Rate for Payer: PACE SWMI |
$148.92
|
| Rate for Payer: PHP Medicare Advantage |
$148.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$936.00
|
| Rate for Payer: Priority Health Medicare |
$148.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$148.92
|
| Rate for Payer: UHC Medicare Advantage |
$148.92
|
|
