|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
20550
|
|
Hospital Revenue Code
|
521
|
| Min. Negotiated Rate |
$33.72 |
| Max. Negotiated Rate |
$204.01 |
| Rate for Payer: Aetna Commercial |
$120.70
|
| Rate for Payer: Aetna Medicare |
$36.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$44.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$44.38
|
| Rate for Payer: BCBS Complete |
$204.01
|
| Rate for Payer: BCBS MAPPO |
$35.50
|
| Rate for Payer: BCBS Trust/PPO |
$110.40
|
| Rate for Payer: BCN Commercial |
$110.40
|
| Rate for Payer: BCN Medicare Advantage |
$35.50
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$122.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$113.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.50
|
| Rate for Payer: Healthscope Commercial |
$127.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$106.50
|
| Rate for Payer: Mclaren Medicaid |
$194.29
|
| Rate for Payer: Meridian Medicaid |
$204.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$37.28
|
| Rate for Payer: MI Amish Medical Board Commercial |
$40.82
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$120.70
|
| Rate for Payer: PACE Senior Care Partners |
$33.72
|
| Rate for Payer: PACE SWMI |
$35.50
|
| Rate for Payer: PHP Commercial |
$120.70
|
| Rate for Payer: PHP Medicare Advantage |
$35.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$123.54
|
| Rate for Payer: Priority Health Medicare |
$35.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$86.61
|
| Rate for Payer: Railroad Medicare Medicare |
$35.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$124.96
|
| Rate for Payer: UHC Core |
$118.57
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.50
|
| Rate for Payer: UHC Medicare Advantage |
$36.56
|
| Rate for Payer: VA VA |
$35.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$106.50
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS 20550
|
| Hospital Charge Code |
20550
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$99.40 |
| Rate for Payer: Aetna Commercial |
$51.76
|
| Rate for Payer: Aetna Medicare |
$40.18
|
| Rate for Payer: BCBS Complete |
$25.95
|
| Rate for Payer: BCBS MAPPO |
$38.63
|
| Rate for Payer: BCBS Trust/PPO |
$26.32
|
| Rate for Payer: BCN Commercial |
$67.93
|
| Rate for Payer: BCN Medicare Advantage |
$38.63
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cash Price |
$113.60
|
| Rate for Payer: Cofinity Commercial |
$55.63
|
| Rate for Payer: Cofinity Commercial |
$51.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.63
|
| Rate for Payer: Mclaren Medicaid |
$24.71
|
| Rate for Payer: Meridian Medicaid |
$25.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$40.56
|
| Rate for Payer: PACE SWMI |
$38.63
|
| Rate for Payer: PHP Medicare Advantage |
$38.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$59.24
|
| Rate for Payer: Priority Health Medicare |
$38.63
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$38.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$38.63
|
| Rate for Payer: UHC Medicare Advantage |
$39.79
|
|
|
PR INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN
|
Professional
|
Both
|
$283.00
|
|
|
Service Code
|
HCPCS 64417
|
| Min. Negotiated Rate |
$40.47 |
| Max. Negotiated Rate |
$234.08 |
| Rate for Payer: Aetna Commercial |
$83.55
|
| Rate for Payer: Aetna Medicare |
$64.84
|
| Rate for Payer: BCBS Complete |
$42.49
|
| Rate for Payer: BCBS MAPPO |
$62.35
|
| Rate for Payer: BCBS Trust/PPO |
$82.94
|
| Rate for Payer: BCN Commercial |
$234.08
|
| Rate for Payer: BCN Medicare Advantage |
$62.35
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cash Price |
$226.40
|
| Rate for Payer: Cofinity Commercial |
$89.78
|
| Rate for Payer: Cofinity Commercial |
$83.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.35
|
| Rate for Payer: Mclaren Medicaid |
$40.47
|
| Rate for Payer: Meridian Medicaid |
$42.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.47
|
| Rate for Payer: PACE SWMI |
$62.35
|
| Rate for Payer: PHP Medicare Advantage |
$62.35
|
| Rate for Payer: Priority Health Choice Medicaid |
$40.47
|
| Rate for Payer: Priority Health Cigna Priority Health |
$198.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.89
|
| Rate for Payer: Priority Health Medicare |
$62.35
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.35
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.35
|
| Rate for Payer: UHC Medicare Advantage |
$64.22
|
|
|
PR INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN
|
Professional
|
Both
|
$514.00
|
|
|
Service Code
|
HCPCS 64415
|
| Min. Negotiated Rate |
$43.88 |
| Max. Negotiated Rate |
$547.85 |
| Rate for Payer: Aetna Commercial |
$91.76
|
| Rate for Payer: Aetna Medicare |
$71.22
|
| Rate for Payer: BCBS Complete |
$46.07
|
| Rate for Payer: BCBS MAPPO |
$68.48
|
| Rate for Payer: BCBS Trust/PPO |
$547.85
|
| Rate for Payer: BCN Commercial |
$196.93
|
| Rate for Payer: BCN Medicare Advantage |
$68.48
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cash Price |
$411.20
|
| Rate for Payer: Cofinity Commercial |
$98.61
|
| Rate for Payer: Cofinity Commercial |
$91.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$68.48
|
| Rate for Payer: Mclaren Medicaid |
$43.88
|
| Rate for Payer: Meridian Medicaid |
$46.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$71.90
|
| Rate for Payer: PACE SWMI |
$68.48
|
| Rate for Payer: PHP Medicare Advantage |
$68.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$359.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$116.08
|
| Rate for Payer: Priority Health Medicare |
$68.48
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$116.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$68.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$68.48
|
| Rate for Payer: UHC Medicare Advantage |
$70.53
|
|
|
PR INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 64447
|
| Min. Negotiated Rate |
$39.83 |
| Max. Negotiated Rate |
$2,134.86 |
| Rate for Payer: Aetna Commercial |
$83.19
|
| Rate for Payer: Aetna Medicare |
$64.56
|
| Rate for Payer: BCBS Complete |
$41.82
|
| Rate for Payer: BCBS MAPPO |
$62.08
|
| Rate for Payer: BCBS Trust/PPO |
$2,134.86
|
| Rate for Payer: BCN Commercial |
$170.06
|
| Rate for Payer: BCN Medicare Advantage |
$62.08
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$89.40
|
| Rate for Payer: Cofinity Commercial |
$83.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$62.08
|
| Rate for Payer: Mclaren Medicaid |
$39.83
|
| Rate for Payer: Meridian Medicaid |
$41.82
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$65.18
|
| Rate for Payer: PACE SWMI |
$62.08
|
| Rate for Payer: PHP Medicare Advantage |
$62.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$39.83
|
| Rate for Payer: Priority Health Cigna Priority Health |
$126.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$105.32
|
| Rate for Payer: Priority Health Medicare |
$62.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$105.32
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$62.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$62.08
|
| Rate for Payer: UHC Medicare Advantage |
$63.94
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
64454
|
| Min. Negotiated Rate |
$248.84 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna Commercial |
$346.80
|
| Rate for Payer: BCBS Trust/PPO |
$315.30
|
| Rate for Payer: BCN Commercial |
$315.30
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$350.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Healthscope Commercial |
$367.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$346.80
|
| Rate for Payer: PHP Commercial |
$346.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$354.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.04
|
| Rate for Payer: UHC Core |
$340.68
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.00
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
64454
|
| Min. Negotiated Rate |
$96.90 |
| Max. Negotiated Rate |
$476.33 |
| Rate for Payer: Aetna Commercial |
$346.80
|
| Rate for Payer: Aetna Medicare |
$106.08
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$127.50
|
| Rate for Payer: Amish Plain Church Group Commercial |
$127.50
|
| Rate for Payer: BCBS Complete |
$476.33
|
| Rate for Payer: BCBS MAPPO |
$102.00
|
| Rate for Payer: BCBS Trust/PPO |
$317.22
|
| Rate for Payer: BCN Commercial |
$317.22
|
| Rate for Payer: BCN Medicare Advantage |
$102.00
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$350.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.00
|
| Rate for Payer: Healthscope Commercial |
$367.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$306.00
|
| Rate for Payer: Mclaren Medicaid |
$453.65
|
| Rate for Payer: Meridian Medicaid |
$476.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$107.10
|
| Rate for Payer: MI Amish Medical Board Commercial |
$117.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$346.80
|
| Rate for Payer: PACE Senior Care Partners |
$96.90
|
| Rate for Payer: PACE SWMI |
$102.00
|
| Rate for Payer: PHP Commercial |
$346.80
|
| Rate for Payer: PHP Medicare Advantage |
$102.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$354.96
|
| Rate for Payer: Priority Health Medicare |
$102.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$248.84
|
| Rate for Payer: Railroad Medicare Medicare |
$102.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$359.04
|
| Rate for Payer: UHC Core |
$340.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.00
|
| Rate for Payer: UHC Medicare Advantage |
$105.06
|
| Rate for Payer: VA VA |
$102.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$306.00
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 64454
|
| Hospital Charge Code |
64454
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$550.49 |
| Rate for Payer: Aetna Commercial |
$107.31
|
| Rate for Payer: Aetna Medicare |
$83.28
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$80.08
|
| Rate for Payer: BCBS Trust/PPO |
$550.49
|
| Rate for Payer: BCN Commercial |
$323.50
|
| Rate for Payer: BCN Medicare Advantage |
$80.08
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$115.32
|
| Rate for Payer: Cofinity Commercial |
$107.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.08
|
| Rate for Payer: Mclaren Medicaid |
$52.19
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.08
|
| Rate for Payer: PACE SWMI |
$80.08
|
| Rate for Payer: PHP Medicare Advantage |
$80.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.03
|
| Rate for Payer: Priority Health Medicare |
$80.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.08
|
| Rate for Payer: UHC Medicare Advantage |
$82.48
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 64454
|
| Min. Negotiated Rate |
$52.19 |
| Max. Negotiated Rate |
$550.49 |
| Rate for Payer: Aetna Commercial |
$107.31
|
| Rate for Payer: Aetna Medicare |
$83.28
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS MAPPO |
$80.08
|
| Rate for Payer: BCBS Trust/PPO |
$550.49
|
| Rate for Payer: BCN Commercial |
$323.50
|
| Rate for Payer: BCN Medicare Advantage |
$80.08
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$107.31
|
| Rate for Payer: Cofinity Commercial |
$115.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$80.08
|
| Rate for Payer: Mclaren Medicaid |
$52.19
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$84.08
|
| Rate for Payer: PACE SWMI |
$80.08
|
| Rate for Payer: PHP Medicare Advantage |
$80.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$285.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$137.03
|
| Rate for Payer: Priority Health Medicare |
$80.08
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$137.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$80.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$80.08
|
| Rate for Payer: UHC Medicare Advantage |
$82.48
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Facility
|
OP
|
$492.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
64405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$116.85 |
| Max. Negotiated Rate |
$442.80 |
| Rate for Payer: Aetna Commercial |
$418.20
|
| Rate for Payer: Aetna Medicare |
$127.92
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$153.75
|
| Rate for Payer: Amish Plain Church Group Commercial |
$153.75
|
| Rate for Payer: BCBS Complete |
$204.01
|
| Rate for Payer: BCBS MAPPO |
$123.00
|
| Rate for Payer: BCBS Trust/PPO |
$382.53
|
| Rate for Payer: BCN Commercial |
$382.53
|
| Rate for Payer: BCN Medicare Advantage |
$123.00
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$423.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$123.00
|
| Rate for Payer: Healthscope Commercial |
$442.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.00
|
| Rate for Payer: Mclaren Medicaid |
$194.29
|
| Rate for Payer: Meridian Medicaid |
$204.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$129.15
|
| Rate for Payer: MI Amish Medical Board Commercial |
$141.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$418.20
|
| Rate for Payer: PACE Senior Care Partners |
$116.85
|
| Rate for Payer: PACE SWMI |
$123.00
|
| Rate for Payer: PHP Commercial |
$418.20
|
| Rate for Payer: PHP Medicare Advantage |
$123.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$194.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$428.04
|
| Rate for Payer: Priority Health Medicare |
$123.00
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.07
|
| Rate for Payer: Railroad Medicare Medicare |
$123.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.96
|
| Rate for Payer: UHC Core |
$410.82
|
| Rate for Payer: UHC Dual Complete DSNP |
$123.00
|
| Rate for Payer: UHC Medicare Advantage |
$126.69
|
| Rate for Payer: VA VA |
$123.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.00
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 64405
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$344.40 |
| Rate for Payer: Aetna Commercial |
$70.39
|
| Rate for Payer: Aetna Medicare |
$54.63
|
| Rate for Payer: BCBS Complete |
$35.33
|
| Rate for Payer: BCBS MAPPO |
$52.53
|
| Rate for Payer: BCBS Trust/PPO |
$262.57
|
| Rate for Payer: BCN Commercial |
$109.46
|
| Rate for Payer: BCN Medicare Advantage |
$52.53
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$70.39
|
| Rate for Payer: Cofinity Commercial |
$75.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.53
|
| Rate for Payer: Mclaren Medicaid |
$33.65
|
| Rate for Payer: Meridian Medicaid |
$35.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55.16
|
| Rate for Payer: PACE SWMI |
$52.53
|
| Rate for Payer: PHP Medicare Advantage |
$52.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.89
|
| Rate for Payer: Priority Health Medicare |
$52.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.53
|
| Rate for Payer: UHC Medicare Advantage |
$54.11
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Professional
|
Both
|
$492.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
64405
|
| Min. Negotiated Rate |
$33.65 |
| Max. Negotiated Rate |
$344.40 |
| Rate for Payer: Aetna Commercial |
$70.39
|
| Rate for Payer: Aetna Medicare |
$54.63
|
| Rate for Payer: BCBS Complete |
$35.33
|
| Rate for Payer: BCBS MAPPO |
$52.53
|
| Rate for Payer: BCBS Trust/PPO |
$262.57
|
| Rate for Payer: BCN Commercial |
$109.46
|
| Rate for Payer: BCN Medicare Advantage |
$52.53
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$75.64
|
| Rate for Payer: Cofinity Commercial |
$70.39
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$52.53
|
| Rate for Payer: Mclaren Medicaid |
$33.65
|
| Rate for Payer: Meridian Medicaid |
$35.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$55.16
|
| Rate for Payer: PACE SWMI |
$52.53
|
| Rate for Payer: PHP Medicare Advantage |
$52.53
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.89
|
| Rate for Payer: Priority Health Medicare |
$52.53
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$88.89
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$52.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$52.53
|
| Rate for Payer: UHC Medicare Advantage |
$54.11
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Facility
|
IP
|
$492.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
64405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$300.07 |
| Max. Negotiated Rate |
$442.80 |
| Rate for Payer: Aetna Commercial |
$418.20
|
| Rate for Payer: BCBS Trust/PPO |
$380.22
|
| Rate for Payer: BCN Commercial |
$380.22
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$423.12
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.60
|
| Rate for Payer: Healthscope Commercial |
$442.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$418.20
|
| Rate for Payer: PHP Commercial |
$418.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$428.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$300.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$432.96
|
| Rate for Payer: UHC Core |
$410.82
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.00
|
|
|
PR INJECTION AA&/STRD ILIOINGUINAL IH NERVES
|
Professional
|
Both
|
$656.00
|
|
|
Service Code
|
HCPCS 64425
|
| Min. Negotiated Rate |
$34.51 |
| Max. Negotiated Rate |
$1,001.13 |
| Rate for Payer: Aetna Commercial |
$71.81
|
| Rate for Payer: Aetna Medicare |
$55.73
|
| Rate for Payer: BCBS Complete |
$36.24
|
| Rate for Payer: BCBS MAPPO |
$53.59
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.13
|
| Rate for Payer: BCN Commercial |
$161.75
|
| Rate for Payer: BCN Medicare Advantage |
$53.59
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cofinity Commercial |
$77.17
|
| Rate for Payer: Cofinity Commercial |
$71.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.59
|
| Rate for Payer: Mclaren Medicaid |
$34.51
|
| Rate for Payer: Meridian Medicaid |
$36.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56.27
|
| Rate for Payer: PACE SWMI |
$53.59
|
| Rate for Payer: PHP Medicare Advantage |
$53.59
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$459.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.73
|
| Rate for Payer: Priority Health Medicare |
$53.59
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.59
|
| Rate for Payer: UHC Medicare Advantage |
$55.20
|
|
|
PR INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL
|
Professional
|
Both
|
$1,202.00
|
|
|
Service Code
|
HCPCS 64421
|
| Min. Negotiated Rate |
$15.76 |
| Max. Negotiated Rate |
$841.40 |
| Rate for Payer: Aetna Commercial |
$32.11
|
| Rate for Payer: Aetna Medicare |
$24.92
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS MAPPO |
$23.96
|
| Rate for Payer: BCBS Trust/PPO |
$368.75
|
| Rate for Payer: BCN Commercial |
$47.89
|
| Rate for Payer: BCN Medicare Advantage |
$23.96
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cofinity Commercial |
$32.11
|
| Rate for Payer: Cofinity Commercial |
$34.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.96
|
| Rate for Payer: Mclaren Medicaid |
$15.76
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$25.16
|
| Rate for Payer: PACE SWMI |
$23.96
|
| Rate for Payer: PHP Medicare Advantage |
$23.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$841.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$40.77
|
| Rate for Payer: Priority Health Medicare |
$23.96
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$40.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.96
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.96
|
| Rate for Payer: UHC Medicare Advantage |
$24.68
|
|
|
PR INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL
|
Professional
|
Both
|
$215.00
|
|
|
Service Code
|
HCPCS 64420
|
| Min. Negotiated Rate |
$36.85 |
| Max. Negotiated Rate |
$551.55 |
| Rate for Payer: Aetna Commercial |
$76.67
|
| Rate for Payer: Aetna Medicare |
$59.51
|
| Rate for Payer: BCBS Complete |
$38.69
|
| Rate for Payer: BCBS MAPPO |
$57.22
|
| Rate for Payer: BCBS Trust/PPO |
$551.55
|
| Rate for Payer: BCN Commercial |
$142.21
|
| Rate for Payer: BCN Medicare Advantage |
$57.22
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cofinity Commercial |
$76.67
|
| Rate for Payer: Cofinity Commercial |
$82.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.22
|
| Rate for Payer: Mclaren Medicaid |
$36.85
|
| Rate for Payer: Meridian Medicaid |
$38.69
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$60.08
|
| Rate for Payer: PACE SWMI |
$57.22
|
| Rate for Payer: PHP Medicare Advantage |
$57.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$36.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$150.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$97.95
|
| Rate for Payer: Priority Health Medicare |
$57.22
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.95
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$57.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$57.22
|
| Rate for Payer: UHC Medicare Advantage |
$58.94
|
|
|
PR INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
HCPCS 64451
|
| Min. Negotiated Rate |
$51.76 |
| Max. Negotiated Rate |
$580.60 |
| Rate for Payer: Aetna Commercial |
$106.89
|
| Rate for Payer: Aetna Medicare |
$82.96
|
| Rate for Payer: BCBS Complete |
$54.35
|
| Rate for Payer: BCBS MAPPO |
$79.77
|
| Rate for Payer: BCBS Trust/PPO |
$580.60
|
| Rate for Payer: BCN Commercial |
$333.28
|
| Rate for Payer: BCN Medicare Advantage |
$79.77
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cofinity Commercial |
$114.87
|
| Rate for Payer: Cofinity Commercial |
$106.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.77
|
| Rate for Payer: Mclaren Medicaid |
$51.76
|
| Rate for Payer: Meridian Medicaid |
$54.35
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$83.76
|
| Rate for Payer: PACE SWMI |
$79.77
|
| Rate for Payer: PHP Medicare Advantage |
$79.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$51.76
|
| Rate for Payer: Priority Health Cigna Priority Health |
$284.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$136.46
|
| Rate for Payer: Priority Health Medicare |
$79.77
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$136.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$79.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$79.77
|
| Rate for Payer: UHC Medicare Advantage |
$82.16
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
64450
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$661.43 |
| Rate for Payer: Aetna Commercial |
$54.93
|
| Rate for Payer: Aetna Medicare |
$42.63
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS MAPPO |
$40.99
|
| Rate for Payer: BCBS Trust/PPO |
$661.43
|
| Rate for Payer: BCN Commercial |
$87.96
|
| Rate for Payer: BCN Medicare Advantage |
$40.99
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$59.03
|
| Rate for Payer: Cofinity Commercial |
$54.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.99
|
| Rate for Payer: Mclaren Medicaid |
$26.63
|
| Rate for Payer: Meridian Medicaid |
$27.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.04
|
| Rate for Payer: PACE SWMI |
$40.99
|
| Rate for Payer: PHP Medicare Advantage |
$40.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.21
|
| Rate for Payer: Priority Health Medicare |
$40.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.99
|
| Rate for Payer: UHC Medicare Advantage |
$42.22
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
HCPCS 64450
|
| Min. Negotiated Rate |
$26.63 |
| Max. Negotiated Rate |
$661.43 |
| Rate for Payer: Aetna Commercial |
$54.93
|
| Rate for Payer: Aetna Medicare |
$42.63
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS MAPPO |
$40.99
|
| Rate for Payer: BCBS Trust/PPO |
$661.43
|
| Rate for Payer: BCN Commercial |
$87.96
|
| Rate for Payer: BCN Medicare Advantage |
$40.99
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$54.93
|
| Rate for Payer: Cofinity Commercial |
$59.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$40.99
|
| Rate for Payer: Mclaren Medicaid |
$26.63
|
| Rate for Payer: Meridian Medicaid |
$27.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$43.04
|
| Rate for Payer: PACE SWMI |
$40.99
|
| Rate for Payer: PHP Medicare Advantage |
$40.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.63
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$70.21
|
| Rate for Payer: Priority Health Medicare |
$40.99
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$70.21
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$40.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$40.99
|
| Rate for Payer: UHC Medicare Advantage |
$42.22
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
64450
|
| Min. Negotiated Rate |
$154.91 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Aetna Commercial |
$215.90
|
| Rate for Payer: BCBS Trust/PPO |
$196.29
|
| Rate for Payer: BCN Commercial |
$196.29
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$218.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.20
|
| Rate for Payer: Healthscope Commercial |
$228.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.90
|
| Rate for Payer: PHP Commercial |
$215.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.98
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.52
|
| Rate for Payer: UHC Core |
$212.09
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.50
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
64450
|
| Min. Negotiated Rate |
$60.32 |
| Max. Negotiated Rate |
$476.33 |
| Rate for Payer: Aetna Commercial |
$215.90
|
| Rate for Payer: Aetna Medicare |
$66.04
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$79.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$79.38
|
| Rate for Payer: BCBS Complete |
$476.33
|
| Rate for Payer: BCBS MAPPO |
$63.50
|
| Rate for Payer: BCBS Trust/PPO |
$197.48
|
| Rate for Payer: BCN Commercial |
$197.48
|
| Rate for Payer: BCN Medicare Advantage |
$63.50
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$218.44
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$63.50
|
| Rate for Payer: Healthscope Commercial |
$228.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.50
|
| Rate for Payer: Mclaren Medicaid |
$453.65
|
| Rate for Payer: Meridian Medicaid |
$476.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$66.68
|
| Rate for Payer: MI Amish Medical Board Commercial |
$73.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.90
|
| Rate for Payer: PACE Senior Care Partners |
$60.32
|
| Rate for Payer: PACE SWMI |
$63.50
|
| Rate for Payer: PHP Commercial |
$215.90
|
| Rate for Payer: PHP Medicare Advantage |
$63.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$453.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$220.98
|
| Rate for Payer: Priority Health Medicare |
$63.50
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$154.91
|
| Rate for Payer: Railroad Medicare Medicare |
$63.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.52
|
| Rate for Payer: UHC Core |
$212.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$63.50
|
| Rate for Payer: UHC Medicare Advantage |
$65.40
|
| Rate for Payer: VA VA |
$63.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.50
|
|
|
PR INJECTION AA&/STRD PARACERVICAL NERVE
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
HCPCS 64435
|
| Min. Negotiated Rate |
$27.90 |
| Max. Negotiated Rate |
$1,878.11 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: Aetna Medicare |
$44.47
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCBS MAPPO |
$42.76
|
| Rate for Payer: BCBS Trust/PPO |
$1,878.11
|
| Rate for Payer: BCN Commercial |
$118.75
|
| Rate for Payer: BCN Medicare Advantage |
$42.76
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cofinity Commercial |
$61.57
|
| Rate for Payer: Cofinity Commercial |
$57.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.76
|
| Rate for Payer: Mclaren Medicaid |
$27.90
|
| Rate for Payer: Meridian Medicaid |
$29.30
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$44.90
|
| Rate for Payer: PACE SWMI |
$42.76
|
| Rate for Payer: PHP Medicare Advantage |
$42.76
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$73.04
|
| Rate for Payer: Priority Health Medicare |
$42.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$73.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$42.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$42.76
|
| Rate for Payer: UHC Medicare Advantage |
$44.04
|
|
|
PR INJECTION AA&/STRD PUDENDAL NERVE
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
HCPCS 64430
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$1,676.82 |
| Rate for Payer: Aetna Commercial |
$71.96
|
| Rate for Payer: Aetna Medicare |
$55.85
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS MAPPO |
$53.70
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.82
|
| Rate for Payer: BCN Commercial |
$144.16
|
| Rate for Payer: BCN Medicare Advantage |
$53.70
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cofinity Commercial |
$71.96
|
| Rate for Payer: Cofinity Commercial |
$77.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.70
|
| Rate for Payer: Mclaren Medicaid |
$34.72
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$56.38
|
| Rate for Payer: PACE SWMI |
$53.70
|
| Rate for Payer: PHP Medicare Advantage |
$53.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$175.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$91.73
|
| Rate for Payer: Priority Health Medicare |
$53.70
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$91.73
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$53.70
|
| Rate for Payer: UHC Dual Complete DSNP |
$53.70
|
| Rate for Payer: UHC Medicare Advantage |
$55.31
|
|
|
PR INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
HCPCS 64445
|
| Min. Negotiated Rate |
$45.58 |
| Max. Negotiated Rate |
$1,332.90 |
| Rate for Payer: Aetna Commercial |
$96.65
|
| Rate for Payer: Aetna Medicare |
$75.02
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS MAPPO |
$72.13
|
| Rate for Payer: BCBS Trust/PPO |
$1,332.90
|
| Rate for Payer: BCN Commercial |
$189.26
|
| Rate for Payer: BCN Medicare Advantage |
$72.13
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cofinity Commercial |
$103.87
|
| Rate for Payer: Cofinity Commercial |
$96.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.13
|
| Rate for Payer: Mclaren Medicaid |
$45.58
|
| Rate for Payer: Meridian Medicaid |
$47.86
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$75.74
|
| Rate for Payer: PACE SWMI |
$72.13
|
| Rate for Payer: PHP Medicare Advantage |
$72.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$45.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$186.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$122.88
|
| Rate for Payer: Priority Health Medicare |
$72.13
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$122.88
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$72.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.13
|
| Rate for Payer: UHC Medicare Advantage |
$74.29
|
|
|
PR INJECTION AA&/STRD SUPRASCAPULAR NERVE
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
HCPCS 64418
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$359.77 |
| Rate for Payer: Aetna Commercial |
$73.61
|
| Rate for Payer: Aetna Medicare |
$57.13
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS MAPPO |
$54.93
|
| Rate for Payer: BCBS Trust/PPO |
$359.77
|
| Rate for Payer: BCN Commercial |
$127.06
|
| Rate for Payer: BCN Medicare Advantage |
$54.93
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cofinity Commercial |
$79.10
|
| Rate for Payer: Cofinity Commercial |
$73.61
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.93
|
| Rate for Payer: Mclaren Medicaid |
$35.15
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$57.68
|
| Rate for Payer: PACE SWMI |
$54.93
|
| Rate for Payer: PHP Medicare Advantage |
$54.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.42
|
| Rate for Payer: Priority Health Medicare |
$54.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$93.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$54.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$54.93
|
| Rate for Payer: UHC Medicare Advantage |
$56.58
|
|
