|
PR INJ, DUROLANE 1 MG
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS J7318
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Aetna Commercial |
$8.96
|
| Rate for Payer: Aetna Medicare |
$6.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$8.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.62
|
| Rate for Payer: BCBS Complete |
$8.40
|
| Rate for Payer: BCBS MAPPO |
$6.68
|
| Rate for Payer: BCBS Trust/PPO |
$6.14
|
| Rate for Payer: BCN Commercial |
$16.25
|
| Rate for Payer: BCN Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$8.96
|
| Rate for Payer: Cofinity Commercial |
$9.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.68
|
| Rate for Payer: Healthscope Commercial |
$12.37
|
| Rate for Payer: Healthscope Commercial |
$10.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$628.00
|
| Rate for Payer: Nomi Health Commercial |
$8.02
|
| Rate for Payer: PACE SWMI |
$6.68
|
| Rate for Payer: PHP Medicare Advantage |
$6.68
|
| Rate for Payer: Priority Health Cigna Priority Health |
$13.65
|
| Rate for Payer: Priority Health Medicare |
$6.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$7.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.68
|
| Rate for Payer: UHC Exchange |
$7.10
|
| Rate for Payer: UHC Medicare Advantage |
$6.68
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
20550
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$91.35 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna Commercial |
$123.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.25
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$101.50
|
| Rate for Payer: Cofinity Commercial |
$124.70
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.00
|
| Rate for Payer: Healthscope Commercial |
$130.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.25
|
| Rate for Payer: PHP Commercial |
$123.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health SBD |
$91.35
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 20550
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$6,953.00 |
| Rate for Payer: Aetna Commercial |
$50.22
|
| Rate for Payer: Aetna Medicare |
$38.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.97
|
| Rate for Payer: BCBS Complete |
$26.17
|
| Rate for Payer: BCBS MAPPO |
$37.48
|
| Rate for Payer: BCBS Trust/PPO |
$26.32
|
| Rate for Payer: BCN Commercial |
$67.93
|
| Rate for Payer: BCN Medicare Advantage |
$37.48
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$53.97
|
| Rate for Payer: Cofinity Commercial |
$50.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.48
|
| Rate for Payer: Healthscope Commercial |
$69.34
|
| Rate for Payer: Healthscope Commercial |
$59.97
|
| Rate for Payer: Mclaren Medicaid |
$24.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.35
|
| Rate for Payer: Meridian Medicaid |
$26.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,953.00
|
| Rate for Payer: Nomi Health Commercial |
$44.98
|
| Rate for Payer: PACE SWMI |
$37.48
|
| Rate for Payer: PHP Medicare Advantage |
$37.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.02
|
| Rate for Payer: Priority Health Medicare |
$37.48
|
| Rate for Payer: Priority Health Narrow Network |
$59.02
|
| Rate for Payer: Priority Health SBD |
$59.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.48
|
| Rate for Payer: UHC Exchange |
$104.96
|
| Rate for Payer: UHC Medicare Advantage |
$37.48
|
| Rate for Payer: UHCCP Medicaid |
$24.92
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
20550
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$6,953.00 |
| Rate for Payer: Aetna Commercial |
$50.22
|
| Rate for Payer: Aetna Medicare |
$38.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.97
|
| Rate for Payer: BCBS Complete |
$26.17
|
| Rate for Payer: BCBS MAPPO |
$37.48
|
| Rate for Payer: BCBS Trust/PPO |
$26.32
|
| Rate for Payer: BCN Commercial |
$67.93
|
| Rate for Payer: BCN Medicare Advantage |
$37.48
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$53.97
|
| Rate for Payer: Cofinity Commercial |
$50.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.48
|
| Rate for Payer: Healthscope Commercial |
$69.34
|
| Rate for Payer: Healthscope Commercial |
$59.97
|
| Rate for Payer: Mclaren Medicaid |
$24.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.35
|
| Rate for Payer: Meridian Medicaid |
$26.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,953.00
|
| Rate for Payer: Nomi Health Commercial |
$44.98
|
| Rate for Payer: PACE SWMI |
$37.48
|
| Rate for Payer: PHP Medicare Advantage |
$37.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.92
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.02
|
| Rate for Payer: Priority Health Medicare |
$37.48
|
| Rate for Payer: Priority Health Narrow Network |
$59.02
|
| Rate for Payer: Priority Health SBD |
$59.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.48
|
| Rate for Payer: UHC Exchange |
$104.96
|
| Rate for Payer: UHC Medicare Advantage |
$37.48
|
| Rate for Payer: UHCCP Medicaid |
$24.92
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
20550
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$41.42 |
| Max. Negotiated Rate |
$909.03 |
| Rate for Payer: Aetna Commercial |
$123.25
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$94.25
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$175.02
|
| Rate for Payer: BCN Commercial |
$175.02
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$124.70
|
| Rate for Payer: Cofinity Commercial |
$101.50
|
| Rate for Payer: Cofinity Medicare Advantage |
$101.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$130.50
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.25
|
| Rate for Payer: Nomi Health Commercial |
$607.36
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$123.25
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$909.03
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$727.22
|
| Rate for Payer: Priority Health SBD |
$91.35
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$41.42
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$162.83
|
| Rate for Payer: VA VA |
$289.22
|
|
|
PR INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS 64417
|
| Min. Negotiated Rate |
$41.11 |
| Max. Negotiated Rate |
$11,223.00 |
| Rate for Payer: Aetna Commercial |
$82.74
|
| Rate for Payer: Aetna Medicare |
$64.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$82.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$88.92
|
| Rate for Payer: BCBS Complete |
$43.17
|
| Rate for Payer: BCBS MAPPO |
$61.75
|
| Rate for Payer: BCBS Trust/PPO |
$82.94
|
| Rate for Payer: BCN Commercial |
$234.08
|
| Rate for Payer: BCN Medicare Advantage |
$61.75
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cash Price |
$231.20
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Cofinity Commercial |
$82.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$61.75
|
| Rate for Payer: Healthscope Commercial |
$98.80
|
| Rate for Payer: Healthscope Commercial |
$114.24
|
| Rate for Payer: Mclaren Medicaid |
$41.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.84
|
| Rate for Payer: Meridian Medicaid |
$43.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,223.00
|
| Rate for Payer: Nomi Health Commercial |
$74.10
|
| Rate for Payer: PACE SWMI |
$61.75
|
| Rate for Payer: PHP Medicare Advantage |
$61.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$187.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$108.06
|
| Rate for Payer: Priority Health Medicare |
$61.75
|
| Rate for Payer: Priority Health Narrow Network |
$108.06
|
| Rate for Payer: Priority Health SBD |
$108.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$183.65
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.75
|
| Rate for Payer: UHC Exchange |
$183.65
|
| Rate for Payer: UHC Medicare Advantage |
$61.75
|
| Rate for Payer: UHCCP Medicaid |
$41.11
|
|
|
PR INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN
|
Professional
|
Both
|
$524.00
|
|
|
Service Code
|
HCPCS 64415
|
| Min. Negotiated Rate |
$44.30 |
| Max. Negotiated Rate |
$12,326.00 |
| Rate for Payer: Aetna Commercial |
$89.39
|
| Rate for Payer: Aetna Medicare |
$69.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$89.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.06
|
| Rate for Payer: BCBS Complete |
$46.52
|
| Rate for Payer: BCBS MAPPO |
$66.71
|
| Rate for Payer: BCBS Trust/PPO |
$547.85
|
| Rate for Payer: BCN Commercial |
$196.93
|
| Rate for Payer: BCN Medicare Advantage |
$66.71
|
| Rate for Payer: Cash Price |
$419.20
|
| Rate for Payer: Cash Price |
$419.20
|
| Rate for Payer: Cofinity Commercial |
$96.06
|
| Rate for Payer: Cofinity Commercial |
$89.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.71
|
| Rate for Payer: Healthscope Commercial |
$123.41
|
| Rate for Payer: Healthscope Commercial |
$106.74
|
| Rate for Payer: Mclaren Medicaid |
$44.30
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$70.05
|
| Rate for Payer: Meridian Medicaid |
$46.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$12,326.00
|
| Rate for Payer: Nomi Health Commercial |
$80.05
|
| Rate for Payer: PACE SWMI |
$66.71
|
| Rate for Payer: PHP Medicare Advantage |
$66.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$44.30
|
| Rate for Payer: Priority Health Cigna Priority Health |
$340.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.15
|
| Rate for Payer: Priority Health Medicare |
$66.71
|
| Rate for Payer: Priority Health Narrow Network |
$117.15
|
| Rate for Payer: Priority Health SBD |
$117.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$174.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.71
|
| Rate for Payer: UHC Exchange |
$174.93
|
| Rate for Payer: UHC Medicare Advantage |
$66.71
|
| Rate for Payer: UHCCP Medicaid |
$44.30
|
|
|
PR INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 64447
|
| Min. Negotiated Rate |
$40.47 |
| Max. Negotiated Rate |
$11,174.00 |
| Rate for Payer: Aetna Commercial |
$81.67
|
| Rate for Payer: Aetna Medicare |
$63.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$81.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$87.77
|
| Rate for Payer: BCBS Complete |
$42.49
|
| Rate for Payer: BCBS MAPPO |
$60.95
|
| Rate for Payer: BCBS Trust/PPO |
$2,134.86
|
| Rate for Payer: BCN Commercial |
$170.06
|
| Rate for Payer: BCN Medicare Advantage |
$60.95
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$87.77
|
| Rate for Payer: Cofinity Commercial |
$81.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.95
|
| Rate for Payer: Healthscope Commercial |
$97.52
|
| Rate for Payer: Healthscope Commercial |
$112.76
|
| Rate for Payer: Mclaren Medicaid |
$40.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$64.00
|
| Rate for Payer: Meridian Medicaid |
$42.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$11,174.00
|
| Rate for Payer: Nomi Health Commercial |
$73.14
|
| Rate for Payer: PACE SWMI |
$60.95
|
| Rate for Payer: PHP Medicare Advantage |
$60.95
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$106.35
|
| Rate for Payer: Priority Health Medicare |
$60.95
|
| Rate for Payer: Priority Health Narrow Network |
$106.35
|
| Rate for Payer: Priority Health SBD |
$106.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$84.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.95
|
| Rate for Payer: UHC Exchange |
$84.73
|
| Rate for Payer: UHC Medicare Advantage |
$60.95
|
| Rate for Payer: UHCCP Medicaid |
$40.47
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 64454
|
| Hospital Charge Code |
64454
|
| Min. Negotiated Rate |
$52.61 |
| Max. Negotiated Rate |
$14,414.00 |
| Rate for Payer: Aetna Commercial |
$105.10
|
| Rate for Payer: Aetna Medicare |
$81.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.94
|
| Rate for Payer: BCBS Complete |
$55.24
|
| Rate for Payer: BCBS MAPPO |
$78.43
|
| Rate for Payer: BCBS Trust/PPO |
$550.49
|
| Rate for Payer: BCN Commercial |
$323.50
|
| Rate for Payer: BCN Medicare Advantage |
$78.43
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$112.94
|
| Rate for Payer: Cofinity Commercial |
$105.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.43
|
| Rate for Payer: Healthscope Commercial |
$125.49
|
| Rate for Payer: Healthscope Commercial |
$145.10
|
| Rate for Payer: Mclaren Medicaid |
$52.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.35
|
| Rate for Payer: Meridian Medicaid |
$55.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,414.00
|
| Rate for Payer: Nomi Health Commercial |
$94.12
|
| Rate for Payer: PACE SWMI |
$78.43
|
| Rate for Payer: PHP Medicare Advantage |
$78.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.33
|
| Rate for Payer: Priority Health Medicare |
$78.43
|
| Rate for Payer: Priority Health Narrow Network |
$139.33
|
| Rate for Payer: Priority Health SBD |
$139.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.43
|
| Rate for Payer: UHC Medicare Advantage |
$78.43
|
| Rate for Payer: UHCCP Medicaid |
$52.61
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
64454
|
| Min. Negotiated Rate |
$262.08 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$353.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.40
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$291.20
|
| Rate for Payer: Cofinity Commercial |
$357.76
|
| Rate for Payer: Cofinity Medicare Advantage |
$291.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.80
|
| Rate for Payer: Healthscope Commercial |
$374.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.60
|
| Rate for Payer: PHP Commercial |
$353.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.40
|
| Rate for Payer: Priority Health SBD |
$262.08
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 64454
|
| Min. Negotiated Rate |
$52.61 |
| Max. Negotiated Rate |
$14,414.00 |
| Rate for Payer: Aetna Commercial |
$105.10
|
| Rate for Payer: Aetna Medicare |
$81.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$105.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.94
|
| Rate for Payer: BCBS Complete |
$55.24
|
| Rate for Payer: BCBS MAPPO |
$78.43
|
| Rate for Payer: BCBS Trust/PPO |
$550.49
|
| Rate for Payer: BCN Commercial |
$323.50
|
| Rate for Payer: BCN Medicare Advantage |
$78.43
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$112.94
|
| Rate for Payer: Cofinity Commercial |
$105.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.43
|
| Rate for Payer: Healthscope Commercial |
$125.49
|
| Rate for Payer: Healthscope Commercial |
$145.10
|
| Rate for Payer: Mclaren Medicaid |
$52.61
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.35
|
| Rate for Payer: Meridian Medicaid |
$55.24
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,414.00
|
| Rate for Payer: Nomi Health Commercial |
$94.12
|
| Rate for Payer: PACE SWMI |
$78.43
|
| Rate for Payer: PHP Medicare Advantage |
$78.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$139.33
|
| Rate for Payer: Priority Health Medicare |
$78.43
|
| Rate for Payer: Priority Health Narrow Network |
$139.33
|
| Rate for Payer: Priority Health SBD |
$139.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.43
|
| Rate for Payer: UHC Medicare Advantage |
$78.43
|
| Rate for Payer: UHCCP Medicaid |
$52.61
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
64454
|
| Min. Negotiated Rate |
$86.58 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Commercial |
$353.60
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$270.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$357.76
|
| Rate for Payer: Cofinity Commercial |
$291.20
|
| Rate for Payer: Cofinity Medicare Advantage |
$291.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$374.40
|
| 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 |
$353.60
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$353.60
|
| 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 |
$270.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$262.08
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$86.58
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
64405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$316.26 |
| Max. Negotiated Rate |
$451.80 |
| Rate for Payer: Aetna Commercial |
$426.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.30
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cofinity Commercial |
$351.40
|
| Rate for Payer: Cofinity Commercial |
$431.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$351.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.60
|
| Rate for Payer: Healthscope Commercial |
$451.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.70
|
| Rate for Payer: PHP Commercial |
$426.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.30
|
| Rate for Payer: Priority Health SBD |
$316.26
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
64405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.94 |
| Max. Negotiated Rate |
$940.00 |
| Rate for Payer: Aetna Commercial |
$426.70
|
| Rate for Payer: Aetna Medicare |
$300.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.30
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$175.02
|
| Rate for Payer: BCN Commercial |
$175.02
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cofinity Commercial |
$351.40
|
| Rate for Payer: Cofinity Commercial |
$431.72
|
| Rate for Payer: Cofinity Medicare Advantage |
$351.40
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$451.80
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.70
|
| Rate for Payer: Nomi Health Commercial |
$607.36
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$426.70
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$909.03
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$727.22
|
| Rate for Payer: Priority Health SBD |
$316.26
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.94
|
| Rate for Payer: UHC Core |
$878.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$940.00
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$162.83
|
| Rate for Payer: VA VA |
$289.22
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
HCPCS 64405
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$9,455.00 |
| Rate for Payer: Aetna Commercial |
$68.90
|
| Rate for Payer: Aetna Medicare |
$53.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.04
|
| Rate for Payer: BCBS Complete |
$35.56
|
| Rate for Payer: BCBS MAPPO |
$51.42
|
| Rate for Payer: BCBS Trust/PPO |
$262.57
|
| Rate for Payer: BCN Commercial |
$109.46
|
| Rate for Payer: BCN Medicare Advantage |
$51.42
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cofinity Commercial |
$74.04
|
| Rate for Payer: Cofinity Commercial |
$68.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.42
|
| Rate for Payer: Healthscope Commercial |
$95.13
|
| Rate for Payer: Healthscope Commercial |
$82.27
|
| Rate for Payer: Mclaren Medicaid |
$33.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.99
|
| Rate for Payer: Meridian Medicaid |
$35.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,455.00
|
| Rate for Payer: Nomi Health Commercial |
$61.70
|
| Rate for Payer: PACE SWMI |
$51.42
|
| Rate for Payer: PHP Medicare Advantage |
$51.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.85
|
| Rate for Payer: Priority Health Medicare |
$51.42
|
| Rate for Payer: Priority Health Narrow Network |
$89.85
|
| Rate for Payer: Priority Health SBD |
$89.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.42
|
| Rate for Payer: UHC Exchange |
$118.39
|
| Rate for Payer: UHC Medicare Advantage |
$51.42
|
| Rate for Payer: UHCCP Medicaid |
$33.87
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
64405
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$9,455.00 |
| Rate for Payer: Aetna Commercial |
$68.90
|
| Rate for Payer: Aetna Medicare |
$53.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.04
|
| Rate for Payer: BCBS Complete |
$35.56
|
| Rate for Payer: BCBS MAPPO |
$51.42
|
| Rate for Payer: BCBS Trust/PPO |
$262.57
|
| Rate for Payer: BCN Commercial |
$109.46
|
| Rate for Payer: BCN Medicare Advantage |
$51.42
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cofinity Commercial |
$74.04
|
| Rate for Payer: Cofinity Commercial |
$68.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.42
|
| Rate for Payer: Healthscope Commercial |
$95.13
|
| Rate for Payer: Healthscope Commercial |
$82.27
|
| Rate for Payer: Mclaren Medicaid |
$33.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.99
|
| Rate for Payer: Meridian Medicaid |
$35.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,455.00
|
| Rate for Payer: Nomi Health Commercial |
$61.70
|
| Rate for Payer: PACE SWMI |
$51.42
|
| Rate for Payer: PHP Medicare Advantage |
$51.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.85
|
| Rate for Payer: Priority Health Medicare |
$51.42
|
| Rate for Payer: Priority Health Narrow Network |
$89.85
|
| Rate for Payer: Priority Health SBD |
$89.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$118.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.42
|
| Rate for Payer: UHC Exchange |
$118.39
|
| Rate for Payer: UHC Medicare Advantage |
$51.42
|
| Rate for Payer: UHCCP Medicaid |
$33.87
|
|
|
PR INJECTION AA&/STRD ILIOINGUINAL IH NERVES
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 64425
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$9,646.00 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare |
$53.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$69.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.53
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS MAPPO |
$51.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.13
|
| Rate for Payer: BCN Commercial |
$161.75
|
| Rate for Payer: BCN Medicare Advantage |
$51.76
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cofinity Commercial |
$74.53
|
| Rate for Payer: Cofinity Commercial |
$69.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.76
|
| Rate for Payer: Healthscope Commercial |
$95.76
|
| Rate for Payer: Healthscope Commercial |
$82.82
|
| Rate for Payer: Mclaren Medicaid |
$34.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.35
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$9,646.00
|
| Rate for Payer: Nomi Health Commercial |
$62.11
|
| Rate for Payer: PACE SWMI |
$51.76
|
| Rate for Payer: PHP Medicare Advantage |
$51.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.14
|
| Rate for Payer: Priority Health Medicare |
$51.76
|
| Rate for Payer: Priority Health Narrow Network |
$92.14
|
| Rate for Payer: Priority Health SBD |
$92.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$141.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.76
|
| Rate for Payer: UHC Exchange |
$141.69
|
| Rate for Payer: UHC Medicare Advantage |
$51.76
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
|
|
PR INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 64421
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$4,313.00 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Medicare |
$24.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$31.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$33.54
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCBS MAPPO |
$23.29
|
| Rate for Payer: BCBS Trust/PPO |
$368.75
|
| Rate for Payer: BCN Commercial |
$47.89
|
| Rate for Payer: BCN Medicare Advantage |
$23.29
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cofinity Commercial |
$33.54
|
| Rate for Payer: Cofinity Commercial |
$31.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.29
|
| Rate for Payer: Healthscope Commercial |
$43.09
|
| Rate for Payer: Healthscope Commercial |
$37.26
|
| Rate for Payer: Mclaren Medicaid |
$15.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$24.45
|
| Rate for Payer: Meridian Medicaid |
$16.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,313.00
|
| Rate for Payer: Nomi Health Commercial |
$27.95
|
| Rate for Payer: PACE SWMI |
$23.29
|
| Rate for Payer: PHP Medicare Advantage |
$23.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.08
|
| Rate for Payer: Priority Health Medicare |
$23.29
|
| Rate for Payer: Priority Health Narrow Network |
$42.08
|
| Rate for Payer: Priority Health SBD |
$42.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$301.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.29
|
| Rate for Payer: UHC Exchange |
$301.71
|
| Rate for Payer: UHC Medicare Advantage |
$23.29
|
| Rate for Payer: UHCCP Medicaid |
$15.55
|
|
|
PR INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
HCPCS 64420
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$10,300.00 |
| Rate for Payer: Aetna Commercial |
$75.03
|
| Rate for Payer: Aetna Medicare |
$58.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$75.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$80.63
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS MAPPO |
$55.99
|
| Rate for Payer: BCBS Trust/PPO |
$551.55
|
| Rate for Payer: BCN Commercial |
$142.21
|
| Rate for Payer: BCN Medicare Advantage |
$55.99
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cofinity Commercial |
$80.63
|
| Rate for Payer: Cofinity Commercial |
$75.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$55.99
|
| Rate for Payer: Healthscope Commercial |
$89.58
|
| Rate for Payer: Healthscope Commercial |
$103.58
|
| Rate for Payer: Mclaren Medicaid |
$37.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$58.79
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$10,300.00
|
| Rate for Payer: Nomi Health Commercial |
$67.19
|
| Rate for Payer: PACE SWMI |
$55.99
|
| Rate for Payer: PHP Medicare Advantage |
$55.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.39
|
| Rate for Payer: Priority Health Medicare |
$55.99
|
| Rate for Payer: Priority Health Narrow Network |
$98.39
|
| Rate for Payer: Priority Health SBD |
$98.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$197.69
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.99
|
| Rate for Payer: UHC Exchange |
$197.69
|
| Rate for Payer: UHC Medicare Advantage |
$55.99
|
| Rate for Payer: UHCCP Medicaid |
$37.49
|
|
|
PR INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 64451
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$14,359.00 |
| Rate for Payer: Aetna Commercial |
$104.71
|
| Rate for Payer: Aetna Medicare |
$81.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$112.52
|
| Rate for Payer: BCBS Complete |
$55.02
|
| Rate for Payer: BCBS MAPPO |
$78.14
|
| Rate for Payer: BCBS Trust/PPO |
$580.60
|
| Rate for Payer: BCN Commercial |
$333.28
|
| Rate for Payer: BCN Medicare Advantage |
$78.14
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cofinity Commercial |
$112.52
|
| Rate for Payer: Cofinity Commercial |
$104.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.14
|
| Rate for Payer: Healthscope Commercial |
$125.02
|
| Rate for Payer: Healthscope Commercial |
$144.56
|
| Rate for Payer: Mclaren Medicaid |
$52.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.05
|
| Rate for Payer: Meridian Medicaid |
$55.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$14,359.00
|
| Rate for Payer: Nomi Health Commercial |
$93.77
|
| Rate for Payer: PACE SWMI |
$78.14
|
| Rate for Payer: PHP Medicare Advantage |
$78.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.20
|
| Rate for Payer: Priority Health Medicare |
$78.14
|
| Rate for Payer: Priority Health Narrow Network |
$138.20
|
| Rate for Payer: Priority Health SBD |
$138.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.14
|
| Rate for Payer: UHC Medicare Advantage |
$78.14
|
| Rate for Payer: UHCCP Medicaid |
$52.40
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
64450
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$7,378.00 |
| 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 |
$27.73
|
| Rate for Payer: BCBS MAPPO |
$39.29
|
| Rate for Payer: BCBS Trust/PPO |
$661.43
|
| Rate for Payer: BCN Commercial |
$87.96
|
| 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: Mclaren Medicaid |
$26.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.25
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,378.00
|
| 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 Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.09
|
| Rate for Payer: Priority Health Medicare |
$39.29
|
| Rate for Payer: Priority Health Narrow Network |
$71.09
|
| Rate for Payer: Priority Health SBD |
$71.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.29
|
| Rate for Payer: UHC Exchange |
$104.09
|
| Rate for Payer: UHC Medicare Advantage |
$39.29
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
64450
|
| Min. Negotiated Rate |
$44.28 |
| Max. Negotiated Rate |
$2,132.58 |
| Rate for Payer: Aetna Commercial |
$220.15
|
| Rate for Payer: Aetna Medicare |
$705.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$168.35
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$414.76
|
| Rate for Payer: BCN Commercial |
$414.76
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$222.74
|
| Rate for Payer: Cofinity Commercial |
$181.30
|
| Rate for Payer: Cofinity Medicare Advantage |
$181.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$233.10
|
| 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 |
$220.15
|
| Rate for Payer: Nomi Health Commercial |
$1,424.89
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$220.15
|
| 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 |
$168.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,132.58
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$1,706.06
|
| Rate for Payer: Priority Health SBD |
$163.17
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.28
|
| Rate for Payer: UHC Core |
$1,463.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$382.01
|
| Rate for Payer: VA VA |
$678.52
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 64450
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$7,378.00 |
| 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 |
$27.73
|
| Rate for Payer: BCBS MAPPO |
$39.29
|
| Rate for Payer: BCBS Trust/PPO |
$661.43
|
| Rate for Payer: BCN Commercial |
$87.96
|
| 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: Mclaren Medicaid |
$26.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.25
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,378.00
|
| 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 Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.09
|
| Rate for Payer: Priority Health Medicare |
$39.29
|
| Rate for Payer: Priority Health Narrow Network |
$71.09
|
| Rate for Payer: Priority Health SBD |
$71.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$104.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.29
|
| Rate for Payer: UHC Exchange |
$104.09
|
| Rate for Payer: UHC Medicare Advantage |
$39.29
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
|
|
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 PARACERVICAL NERVE
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
HCPCS 64435
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$7,697.00 |
| Rate for Payer: Aetna Commercial |
$56.09
|
| Rate for Payer: Aetna Medicare |
$43.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.28
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCBS MAPPO |
$41.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,878.11
|
| Rate for Payer: BCN Commercial |
$118.75
|
| 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 |
$77.44
|
| Rate for Payer: Healthscope Commercial |
$66.98
|
| Rate for Payer: Mclaren Medicaid |
$27.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$43.95
|
| Rate for Payer: Meridian Medicaid |
$29.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$7,697.00
|
| 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 Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.51
|
| Rate for Payer: Priority Health Medicare |
$41.86
|
| Rate for Payer: Priority Health Narrow Network |
$74.51
|
| Rate for Payer: Priority Health SBD |
$74.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$166.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$41.86
|
| Rate for Payer: UHC Exchange |
$166.62
|
| Rate for Payer: UHC Medicare Advantage |
$41.86
|
| Rate for Payer: UHCCP Medicaid |
$27.90
|
|
