Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR INJ DEXAMETHASONE ACETATE

Professional

Both

$2.00

Service Code	HCPCS J1094
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Commercial	$0.27
Rate for Payer: Aetna Medicare	$1.00
Rate for Payer: BCBS Complete	$0.80
Rate for Payer: Cash Price	$1.60
Rate for Payer: Cash Price	$1.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.50

PR INJ, DUROLANE 1 MG

Professional

Both

$22.00

Service Code	HCPCS J7318
Min. Negotiated Rate	$6.33
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$6.33
Rate for Payer: Aetna Medicare	$11.00
Rate for Payer: BCBS Trust/PPO	$6.51
Rate for Payer: BCN Commercial	$16.25
Rate for Payer: Cash Price	$17.60
Rate for Payer: Cash Price	$17.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$16.50

PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS

Facility

$149.00

Service Code	CPT 20550
Hospital Charge Code	20550
Hospital Revenue Code	521
Min. Negotiated Rate	$103.70
Max. Negotiated Rate	$134.10
Rate for Payer: Aetna Commercial	$126.65
Rate for Payer: BCBS Trust/PPO	$123.06
Rate for Payer: BCN Commercial	$123.06
Rate for Payer: Cash Price	$119.20
Rate for Payer: Cofinity Commercial	$128.14
Rate for Payer: Encore Health Key Benefits Commercial	$119.20
Rate for Payer: Healthscope Commercial	$134.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$111.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$126.65
Rate for Payer: Nomi Health Commercial	$122.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.75
Rate for Payer: PHP Commercial	$126.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$129.63
Rate for Payer: Priority Health Narrow/Tiered Network	$103.70
Rate for Payer: UHC Core	$124.42
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$111.75

PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS

Professional

Both

$149.00

Service Code	HCPCS 20550
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$111.75
Rate for Payer: Aetna Commercial	$52.35
Rate for Payer: Aetna Medicare	$74.50
Rate for Payer: BCBS Complete	$22.36
Rate for Payer: BCN Commercial	$45.95
Rate for Payer: Cash Price	$119.20
Rate for Payer: Cash Price	$119.20
Rate for Payer: Mclaren Medicaid	$21.30
Rate for Payer: Meridian Medicaid	$22.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.75
Rate for Payer: Priority Health Choice Medicaid	$21.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$62.29
Rate for Payer: Priority Health Narrow/Tiered Network	$62.29
Rate for Payer: UHC Medicaid	$21.30
Rate for Payer: UHCCP Medicaid	$21.30

PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS

Professional

Both

$149.00

Service Code	HCPCS 20550
Hospital Charge Code	20550
Min. Negotiated Rate	$21.30
Max. Negotiated Rate	$111.75
Rate for Payer: Aetna Commercial	$52.35
Rate for Payer: Aetna Medicare	$74.50
Rate for Payer: BCBS Complete	$22.36
Rate for Payer: BCN Commercial	$45.95
Rate for Payer: Cash Price	$119.20
Rate for Payer: Cash Price	$119.20
Rate for Payer: Mclaren Medicaid	$21.30
Rate for Payer: Meridian Medicaid	$22.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.75
Rate for Payer: Priority Health Choice Medicaid	$21.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$62.29
Rate for Payer: Priority Health Narrow/Tiered Network	$62.29
Rate for Payer: UHC Medicaid	$21.30
Rate for Payer: UHCCP Medicaid	$21.30

PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS

Facility

$149.00

Service Code	CPT 20550
Hospital Charge Code	20550
Hospital Revenue Code	521
Min. Negotiated Rate	$26.27
Max. Negotiated Rate	$134.10
Rate for Payer: Aetna Commercial	$126.65
Rate for Payer: Aetna Medicare	$38.74
Rate for Payer: Allen County Amish Medical Aid Commercial	$46.56
Rate for Payer: Amish Plain Church Group Commercial	$46.56
Rate for Payer: BCBS Complete	$27.58
Rate for Payer: BCBS MAPPO	$37.25
Rate for Payer: BCBS Trust/PPO	$122.49
Rate for Payer: BCN Commercial	$122.49
Rate for Payer: BCN Medicare Advantage	$37.25
Rate for Payer: Cash Price	$119.20
Rate for Payer: Cofinity Commercial	$128.14
Rate for Payer: Encore Health Key Benefits Commercial	$119.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$37.25
Rate for Payer: Healthscope Commercial	$134.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$111.75
Rate for Payer: Mclaren Medicaid	$26.27
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$39.11
Rate for Payer: Meridian Medicaid	$27.58
Rate for Payer: MI Amish Medical Board Commercial	$42.84
Rate for Payer: Molina Medicare/Medicaid	$40.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$126.65
Rate for Payer: Nomi Health Commercial	$122.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.75
Rate for Payer: PACE Senior Care Partners	$35.39
Rate for Payer: PACE SWMI	$37.25
Rate for Payer: PHP Commercial	$126.65
Rate for Payer: PHP Medicare Advantage	$37.25
Rate for Payer: Priority Health Choice Medicaid	$26.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$129.63
Rate for Payer: Priority Health Medicare	$37.62
Rate for Payer: Priority Health Narrow/Tiered Network	$103.70
Rate for Payer: Railroad Medicare Medicare	$37.25
Rate for Payer: UHC Core	$124.42
Rate for Payer: UHC Exchange	$37.25
Rate for Payer: UHC Medicaid	$26.27
Rate for Payer: UHC Medicare Advantage	$37.25
Rate for Payer: UHCCP Medicaid	$26.27
Rate for Payer: VA VA	$37.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$111.75

PR INJECTION AA&/STRD AXILLARY NERVE W/IMG GDN

Professional

Both

$298.00

Service Code	HCPCS 64417
Min. Negotiated Rate	$39.19
Max. Negotiated Rate	$223.50
Rate for Payer: Aetna Commercial	$78.61
Rate for Payer: Aetna Medicare	$149.00
Rate for Payer: BCBS Complete	$41.15
Rate for Payer: BCN Commercial	$96.11
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cash Price	$238.40
Rate for Payer: Mclaren Medicaid	$39.19
Rate for Payer: Meridian Medicaid	$41.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$223.50
Rate for Payer: Priority Health Choice Medicaid	$39.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$111.63
Rate for Payer: Priority Health Narrow/Tiered Network	$111.63
Rate for Payer: UHC Medicaid	$39.19
Rate for Payer: UHCCP Medicaid	$39.19

PR INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN

Professional

Both

$540.00

Service Code	HCPCS 64415
Min. Negotiated Rate	$42.39
Max. Negotiated Rate	$405.00
Rate for Payer: Aetna Commercial	$81.83
Rate for Payer: Aetna Medicare	$270.00
Rate for Payer: BCBS Complete	$44.51
Rate for Payer: BCN Commercial	$103.58
Rate for Payer: Cash Price	$432.00
Rate for Payer: Cash Price	$432.00
Rate for Payer: Mclaren Medicaid	$42.39
Rate for Payer: Meridian Medicaid	$44.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$405.00
Rate for Payer: Priority Health Choice Medicaid	$42.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$120.30
Rate for Payer: Priority Health Narrow/Tiered Network	$120.30
Rate for Payer: UHC Medicaid	$42.39
Rate for Payer: UHCCP Medicaid	$42.39

PR INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN

Professional

Both

$190.00

Service Code	HCPCS 64447
Min. Negotiated Rate	$38.77
Max. Negotiated Rate	$142.50
Rate for Payer: Aetna Commercial	$68.36
Rate for Payer: Aetna Medicare	$95.00
Rate for Payer: BCBS Complete	$40.71
Rate for Payer: BCN Commercial	$94.61
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Mclaren Medicaid	$38.77
Rate for Payer: Meridian Medicaid	$40.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$142.50
Rate for Payer: Priority Health Choice Medicaid	$38.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$109.90
Rate for Payer: Priority Health Narrow/Tiered Network	$109.90
Rate for Payer: UHC Medicaid	$38.77
Rate for Payer: UHCCP Medicaid	$38.77

PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG

Professional

Both

$428.00

Service Code	HCPCS 64454
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$321.00
Rate for Payer: Aetna Commercial	$104.95
Rate for Payer: Aetna Medicare	$214.00
Rate for Payer: BCBS Complete	$48.98
Rate for Payer: BCN Commercial	$123.00
Rate for Payer: Cash Price	$342.40
Rate for Payer: Cash Price	$342.40
Rate for Payer: Mclaren Medicaid	$46.65
Rate for Payer: Meridian Medicaid	$48.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$321.00
Rate for Payer: Priority Health Choice Medicaid	$46.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$142.87
Rate for Payer: Priority Health Narrow/Tiered Network	$142.87
Rate for Payer: UHC Medicaid	$46.65
Rate for Payer: UHCCP Medicaid	$46.65

PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE

Professional

Both

$517.00

Service Code	HCPCS 64405
Hospital Charge Code	64405
Min. Negotiated Rate	$29.39
Max. Negotiated Rate	$387.75
Rate for Payer: Aetna Commercial	$69.32
Rate for Payer: Aetna Medicare	$258.50
Rate for Payer: BCBS Complete	$30.86
Rate for Payer: BCN Commercial	$79.18
Rate for Payer: Cash Price	$413.60
Rate for Payer: Cash Price	$413.60
Rate for Payer: Mclaren Medicaid	$29.39
Rate for Payer: Meridian Medicaid	$30.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$387.75
Rate for Payer: Priority Health Choice Medicaid	$29.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$91.96
Rate for Payer: Priority Health Narrow/Tiered Network	$91.96
Rate for Payer: UHC Medicaid	$29.39
Rate for Payer: UHCCP Medicaid	$29.39

PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE

Professional

Both

$517.00

Service Code	HCPCS 64405
Min. Negotiated Rate	$29.39
Max. Negotiated Rate	$387.75
Rate for Payer: Aetna Commercial	$69.32
Rate for Payer: Aetna Medicare	$258.50
Rate for Payer: BCBS Complete	$30.86
Rate for Payer: BCN Commercial	$79.18
Rate for Payer: Cash Price	$413.60
Rate for Payer: Cash Price	$413.60
Rate for Payer: Mclaren Medicaid	$29.39
Rate for Payer: Meridian Medicaid	$30.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$387.75
Rate for Payer: Priority Health Choice Medicaid	$29.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$91.96
Rate for Payer: Priority Health Narrow/Tiered Network	$91.96
Rate for Payer: UHC Medicaid	$29.39
Rate for Payer: UHCCP Medicaid	$29.39

PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE

Facility

$517.00

Service Code	CPT 64405
Hospital Charge Code	64405
Hospital Revenue Code	361
Min. Negotiated Rate	$91.15
Max. Negotiated Rate	$465.30
Rate for Payer: Aetna Commercial	$439.45
Rate for Payer: Aetna Medicare	$134.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$161.56
Rate for Payer: Amish Plain Church Group Commercial	$161.56
Rate for Payer: BCBS Complete	$95.70
Rate for Payer: BCBS MAPPO	$129.25
Rate for Payer: BCBS Trust/PPO	$425.03
Rate for Payer: BCN Commercial	$425.03
Rate for Payer: BCN Medicare Advantage	$129.25
Rate for Payer: Cash Price	$413.60
Rate for Payer: Cofinity Commercial	$444.62
Rate for Payer: Encore Health Key Benefits Commercial	$413.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$129.25
Rate for Payer: Healthscope Commercial	$465.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$387.75
Rate for Payer: Mclaren Medicaid	$91.15
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$135.71
Rate for Payer: Meridian Medicaid	$95.70
Rate for Payer: MI Amish Medical Board Commercial	$148.64
Rate for Payer: Molina Medicare/Medicaid	$142.18
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$439.45
Rate for Payer: Nomi Health Commercial	$423.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$387.75
Rate for Payer: PACE Senior Care Partners	$122.79
Rate for Payer: PACE SWMI	$129.25
Rate for Payer: PHP Commercial	$439.45
Rate for Payer: PHP Medicare Advantage	$129.25
Rate for Payer: Priority Health Choice Medicaid	$91.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$449.79
Rate for Payer: Priority Health Medicare	$130.54
Rate for Payer: Priority Health Narrow/Tiered Network	$359.83
Rate for Payer: Railroad Medicare Medicare	$129.25
Rate for Payer: UHC All Payor (Choice/PPO)	$454.96
Rate for Payer: UHC Core	$431.69
Rate for Payer: UHC Exchange	$129.25
Rate for Payer: UHC Medicaid	$91.15
Rate for Payer: UHC Medicare Advantage	$129.25
Rate for Payer: UHCCP Medicaid	$91.15
Rate for Payer: VA VA	$129.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$387.75

PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE

Facility

$517.00

Service Code	CPT 64405
Hospital Charge Code	64405
Hospital Revenue Code	361
Min. Negotiated Rate	$359.83
Max. Negotiated Rate	$465.30
Rate for Payer: Aetna Commercial	$439.45
Rate for Payer: BCBS Trust/PPO	$426.99
Rate for Payer: BCN Commercial	$426.99
Rate for Payer: Cash Price	$413.60
Rate for Payer: Cofinity Commercial	$444.62
Rate for Payer: Encore Health Key Benefits Commercial	$413.60
Rate for Payer: Healthscope Commercial	$465.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$387.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$439.45
Rate for Payer: Nomi Health Commercial	$423.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$387.75
Rate for Payer: PHP Commercial	$439.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$449.79
Rate for Payer: Priority Health Narrow/Tiered Network	$359.83
Rate for Payer: UHC All Payor (Choice/PPO)	$454.96
Rate for Payer: UHC Core	$431.69
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$387.75

PR INJECTION AA&/STRD ILIOINGUINAL IH NERVES

Professional

Both

$689.00

Service Code	HCPCS 64425
Min. Negotiated Rate	$31.74
Max. Negotiated Rate	$516.75
Rate for Payer: Aetna Commercial	$71.32
Rate for Payer: Aetna Medicare	$344.50
Rate for Payer: BCBS Complete	$33.33
Rate for Payer: BCN Commercial	$81.17
Rate for Payer: Cash Price	$551.20
Rate for Payer: Cash Price	$551.20
Rate for Payer: Mclaren Medicaid	$31.74
Rate for Payer: Meridian Medicaid	$33.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$516.75
Rate for Payer: Priority Health Choice Medicaid	$31.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$94.27
Rate for Payer: Priority Health Narrow/Tiered Network	$94.27
Rate for Payer: UHC Medicaid	$31.74
Rate for Payer: UHCCP Medicaid	$31.74

PR INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL

Professional

Both

$210.00

Service Code	HCPCS 64421
Min. Negotiated Rate	$13.85
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Commercial	$32.34
Rate for Payer: Aetna Medicare	$105.00
Rate for Payer: BCBS Complete	$14.54
Rate for Payer: BCN Commercial	$36.35
Rate for Payer: Cash Price	$168.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Mclaren Medicaid	$13.85
Rate for Payer: Meridian Medicaid	$14.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$157.50
Rate for Payer: Priority Health Choice Medicaid	$13.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$42.22
Rate for Payer: Priority Health Narrow/Tiered Network	$42.22
Rate for Payer: UHC Medicaid	$13.85
Rate for Payer: UHCCP Medicaid	$13.85

PR INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL

Professional

Both

$226.00

Service Code	HCPCS 64420
Min. Negotiated Rate	$33.44
Max. Negotiated Rate	$169.50
Rate for Payer: Aetna Commercial	$76.19
Rate for Payer: Aetna Medicare	$113.00
Rate for Payer: BCBS Complete	$35.11
Rate for Payer: BCN Commercial	$87.65
Rate for Payer: Cash Price	$180.80
Rate for Payer: Cash Price	$180.80
Rate for Payer: Mclaren Medicaid	$33.44
Rate for Payer: Meridian Medicaid	$35.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$169.50
Rate for Payer: Priority Health Choice Medicaid	$33.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$101.80
Rate for Payer: Priority Health Narrow/Tiered Network	$101.80
Rate for Payer: UHC Medicaid	$33.44
Rate for Payer: UHCCP Medicaid	$33.44

PR INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG

Professional

Both

$426.00

Service Code	HCPCS 64451
Min. Negotiated Rate	$46.22
Max. Negotiated Rate	$319.50
Rate for Payer: Aetna Commercial	$101.64
Rate for Payer: Aetna Medicare	$213.00
Rate for Payer: BCBS Complete	$48.53
Rate for Payer: BCN Commercial	$122.50
Rate for Payer: Cash Price	$340.80
Rate for Payer: Cash Price	$340.80
Rate for Payer: Mclaren Medicaid	$46.22
Rate for Payer: Meridian Medicaid	$48.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$319.50
Rate for Payer: Priority Health Choice Medicaid	$46.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$142.28
Rate for Payer: Priority Health Narrow/Tiered Network	$142.28
Rate for Payer: UHC Medicaid	$46.22
Rate for Payer: UHCCP Medicaid	$46.22

PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH

Professional

Both

$267.00

Service Code	HCPCS 64450
Min. Negotiated Rate	$24.50
Max. Negotiated Rate	$200.25
Rate for Payer: Aetna Commercial	$54.55
Rate for Payer: Aetna Medicare	$133.50
Rate for Payer: BCBS Complete	$25.73
Rate for Payer: BCN Commercial	$48.69
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Mclaren Medicaid	$24.50
Rate for Payer: Meridian Medicaid	$25.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$200.25
Rate for Payer: Priority Health Choice Medicaid	$24.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$71.72
Rate for Payer: Priority Health Narrow/Tiered Network	$71.72
Rate for Payer: UHC Medicaid	$24.50
Rate for Payer: UHCCP Medicaid	$24.50

PR INJECTION AA&/STRD PARACERVICAL NERVE

Professional

Both

$300.00

Service Code	HCPCS 64435
Min. Negotiated Rate	$24.71
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Commercial	$56.32
Rate for Payer: Aetna Medicare	$150.00
Rate for Payer: BCBS Complete	$25.95
Rate for Payer: BCN Commercial	$65.23
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Mclaren Medicaid	$24.71
Rate for Payer: Meridian Medicaid	$25.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$225.00
Rate for Payer: Priority Health Choice Medicaid	$24.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$75.76
Rate for Payer: Priority Health Narrow/Tiered Network	$75.76
Rate for Payer: UHC Medicaid	$24.71
Rate for Payer: UHCCP Medicaid	$24.71

PR INJECTION AA&/STRD PUDENDAL NERVE

Professional

Both

$263.00

Service Code	HCPCS 64430
Min. Negotiated Rate	$31.10
Max. Negotiated Rate	$197.25
Rate for Payer: Aetna Commercial	$70.97
Rate for Payer: Aetna Medicare	$131.50
Rate for Payer: BCBS Complete	$32.66
Rate for Payer: BCN Commercial	$82.17
Rate for Payer: Cash Price	$210.40
Rate for Payer: Cash Price	$210.40
Rate for Payer: Mclaren Medicaid	$31.10
Rate for Payer: Meridian Medicaid	$32.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$197.25
Rate for Payer: Priority Health Choice Medicaid	$31.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$95.43
Rate for Payer: Priority Health Narrow/Tiered Network	$95.43
Rate for Payer: UHC Medicaid	$31.10
Rate for Payer: UHCCP Medicaid	$31.10

PR INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN

Professional

Both

$279.00

Service Code	HCPCS 64445
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$209.25
Rate for Payer: Aetna Commercial	$69.22
Rate for Payer: Aetna Medicare	$139.50
Rate for Payer: BCBS Complete	$44.28
Rate for Payer: BCN Commercial	$84.82
Rate for Payer: Cash Price	$223.20
Rate for Payer: Cash Price	$223.20
Rate for Payer: Mclaren Medicaid	$42.17
Rate for Payer: Meridian Medicaid	$44.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$209.25
Rate for Payer: Priority Health Choice Medicaid	$42.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$124.94
Rate for Payer: Priority Health Narrow/Tiered Network	$124.94
Rate for Payer: UHC Medicaid	$42.17
Rate for Payer: UHCCP Medicaid	$42.17

PR INJECTION AA&/STRD SUPRASCAPULAR NERVE

Professional

Both

$186.00

Service Code	HCPCS 64418
Min. Negotiated Rate	$30.67
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna Commercial	$74.30
Rate for Payer: Aetna Medicare	$93.00
Rate for Payer: BCBS Complete	$32.20
Rate for Payer: BCN Commercial	$82.66
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cash Price	$148.80
Rate for Payer: Mclaren Medicaid	$30.67
Rate for Payer: Meridian Medicaid	$32.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$139.50
Rate for Payer: Priority Health Choice Medicaid	$30.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$96.02
Rate for Payer: Priority Health Narrow/Tiered Network	$96.02
Rate for Payer: UHC Medicaid	$30.67
Rate for Payer: UHCCP Medicaid	$30.67

PR INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH

Professional

Both

$269.00

Service Code	HCPCS 64400
Min. Negotiated Rate	$30.25
Max. Negotiated Rate	$201.75
Rate for Payer: Aetna Commercial	$64.36
Rate for Payer: Aetna Medicare	$134.50
Rate for Payer: BCBS Complete	$31.76
Rate for Payer: BCN Commercial	$78.18
Rate for Payer: Cash Price	$215.20
Rate for Payer: Cash Price	$215.20
Rate for Payer: Mclaren Medicaid	$30.25
Rate for Payer: Meridian Medicaid	$31.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$201.75
Rate for Payer: Priority Health Choice Medicaid	$30.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$90.80
Rate for Payer: Priority Health Narrow/Tiered Network	$90.80
Rate for Payer: UHC Medicaid	$30.25
Rate for Payer: UHCCP Medicaid	$30.25

PR INJECTION AA&/STRD VAGUS NERVE

Professional

Both

$173.00

Service Code	HCPCS 64408
Min. Negotiated Rate	$24.71
Max. Negotiated Rate	$129.75
Rate for Payer: Aetna Commercial	$56.23
Rate for Payer: Aetna Medicare	$86.50
Rate for Payer: BCBS Complete	$25.95
Rate for Payer: BCN Commercial	$67.72
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cash Price	$138.40
Rate for Payer: Mclaren Medicaid	$24.71
Rate for Payer: Meridian Medicaid	$25.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$129.75
Rate for Payer: Priority Health Choice Medicaid	$24.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$78.66
Rate for Payer: Priority Health Narrow/Tiered Network	$78.66
Rate for Payer: UHC Medicaid	$24.71
Rate for Payer: UHCCP Medicaid	$24.71

Know your out-of-pocket cost for care.

All Charges