|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
HCPCS 99385
|
| Min. Negotiated Rate |
$69.00 |
| Max. Negotiated Rate |
$238.26 |
| Rate for Payer: Aetna Commercial |
$99.47
|
| Rate for Payer: Aetna Medicare |
$95.50
|
| Rate for Payer: BCBS Complete |
$72.45
|
| Rate for Payer: BCBS Trust/PPO |
$238.26
|
| Rate for Payer: BCN Commercial |
$137.21
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Cash Price |
$152.80
|
| Rate for Payer: Mclaren Medicaid |
$69.00
|
| Rate for Payer: Meridian Medicaid |
$72.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$69.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$124.15
|
| Rate for Payer: Priority Health HMO/PPO |
$121.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$121.93
|
| Rate for Payer: UHCCP Medicaid |
$69.00
|
|
|
PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 99383
|
| Min. Negotiated Rate |
$40.68 |
| Max. Negotiated Rate |
$125.39 |
| Rate for Payer: Aetna Commercial |
$88.48
|
| Rate for Payer: Aetna Medicare |
$86.50
|
| Rate for Payer: BCBS Complete |
$64.13
|
| Rate for Payer: BCBS Trust/PPO |
$40.68
|
| Rate for Payer: BCN Commercial |
$125.39
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Mclaren Medicaid |
$61.08
|
| Rate for Payer: Meridian Medicaid |
$64.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$61.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$112.45
|
| Rate for Payer: Priority Health HMO/PPO |
$107.90
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$107.90
|
| Rate for Payer: UHCCP Medicaid |
$61.08
|
|
|
PR INITIAL TX 1ST DEGREE BURN LOCAL TX
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 16000
|
| Min. Negotiated Rate |
$29.18 |
| Max. Negotiated Rate |
$569.29 |
| Rate for Payer: Aetna Commercial |
$59.23
|
| Rate for Payer: Aetna Medicare |
$45.97
|
| Rate for Payer: BCBS Complete |
$30.64
|
| Rate for Payer: BCBS MAPPO |
$44.20
|
| Rate for Payer: BCBS Trust/PPO |
$569.29
|
| Rate for Payer: BCN Commercial |
$92.28
|
| Rate for Payer: BCN Medicare Advantage |
$44.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$63.65
|
| Rate for Payer: Cofinity Commercial |
$59.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.20
|
| Rate for Payer: Mclaren Medicaid |
$29.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$46.41
|
| Rate for Payer: Meridian Medicaid |
$30.64
|
| Rate for Payer: Nomi Health Commercial |
$53.04
|
| Rate for Payer: PACE SWMI |
$44.20
|
| Rate for Payer: PHP Medicare Advantage |
$44.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health HMO/PPO |
$61.40
|
| Rate for Payer: Priority Health Medicare |
$44.64
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$61.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$44.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$44.20
|
| Rate for Payer: UHC Exchange |
$44.20
|
| Rate for Payer: UHC Medicare Advantage |
$44.20
|
| Rate for Payer: UHCCP Medicaid |
$29.18
|
|
|
PR INIT/SUB PSYCH CARE M 1ST 30
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
HCPCS G2214
|
| Min. Negotiated Rate |
$24.28 |
| Max. Negotiated Rate |
$590.64 |
| Rate for Payer: Aetna Commercial |
$48.44
|
| Rate for Payer: Aetna Medicare |
$37.60
|
| Rate for Payer: BCBS Complete |
$25.49
|
| Rate for Payer: BCBS MAPPO |
$36.15
|
| Rate for Payer: BCBS Trust/PPO |
$590.64
|
| Rate for Payer: BCN Commercial |
$81.69
|
| Rate for Payer: BCN Medicare Advantage |
$36.15
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cash Price |
$75.20
|
| Rate for Payer: Cofinity Commercial |
$52.06
|
| Rate for Payer: Cofinity Commercial |
$48.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.15
|
| Rate for Payer: Mclaren Medicaid |
$24.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.96
|
| Rate for Payer: Meridian Medicaid |
$25.49
|
| Rate for Payer: Nomi Health Commercial |
$43.38
|
| Rate for Payer: PACE SWMI |
$36.15
|
| Rate for Payer: PHP Medicare Advantage |
$36.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$61.10
|
| Rate for Payer: Priority Health HMO/PPO |
$76.86
|
| Rate for Payer: Priority Health Medicare |
$36.51
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$76.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$36.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.15
|
| Rate for Payer: UHC Exchange |
$36.15
|
| Rate for Payer: UHC Medicare Advantage |
$36.15
|
| Rate for Payer: UHCCP Medicaid |
$24.28
|
|
|
PR INJ DEXAMETHASONE ACETATE
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J1094
|
| Min. Negotiated Rate |
$0.27 |
| Max. Negotiated Rate |
$1.30 |
| 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: Priority Health Cigna Priority Health |
$1.30
|
|
|
PR INJ, DUROLANE 1 MG
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS J7318
|
| Min. Negotiated Rate |
$6.14 |
| Max. Negotiated Rate |
$16.25 |
| Rate for Payer: Aetna Commercial |
$8.96
|
| Rate for Payer: Aetna Medicare |
$6.95
|
| 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 |
$9.62
|
| Rate for Payer: Cofinity Commercial |
$8.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$6.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.02
|
| 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 |
$6.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$6.68
|
| Rate for Payer: UHC Dual Complete DSNP |
$6.68
|
| Rate for Payer: UHC Exchange |
$6.68
|
| Rate for Payer: UHC Medicare Advantage |
$6.68
|
|
|
PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
HCPCS 20550
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$94.25 |
| Rate for Payer: Aetna Commercial |
$50.22
|
| Rate for Payer: Aetna Medicare |
$38.98
|
| 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: 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: 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 |
$59.02
|
| Rate for Payer: Priority Health Medicare |
$37.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.48
|
| Rate for Payer: UHC Exchange |
$37.48
|
| Rate for Payer: UHC Medicare Advantage |
$37.48
|
| Rate for Payer: UHCCP Medicaid |
$24.92
|
|
|
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 |
$94.25 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Aetna Commercial |
$123.25
|
| Rate for Payer: BCBS Trust/PPO |
$118.36
|
| Rate for Payer: BCN Commercial |
$112.06
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$124.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.00
|
| Rate for Payer: Healthscope Commercial |
$130.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.75
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.25
|
| Rate for Payer: Nomi Health Commercial |
$118.90
|
| Rate for Payer: PHP Commercial |
$123.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health HMO/PPO |
$126.15
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.60
|
| Rate for Payer: UHC Core |
$121.08
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.75
|
|
|
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 |
$34.44 |
| Max. Negotiated Rate |
$219.58 |
| Rate for Payer: Aetna Commercial |
$123.25
|
| Rate for Payer: Aetna Medicare |
$37.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$45.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$45.31
|
| Rate for Payer: BCBS Complete |
$219.58
|
| Rate for Payer: BCBS MAPPO |
$36.25
|
| Rate for Payer: BCBS Trust/PPO |
$119.20
|
| Rate for Payer: BCN Commercial |
$112.74
|
| Rate for Payer: BCN Medicare Advantage |
$36.25
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cash Price |
$116.00
|
| Rate for Payer: Cofinity Commercial |
$124.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$116.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$36.25
|
| Rate for Payer: Healthscope Commercial |
$130.50
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$108.75
|
| Rate for Payer: Mclaren Medicaid |
$209.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$38.06
|
| Rate for Payer: Meridian Medicaid |
$219.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$41.69
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$123.25
|
| Rate for Payer: Nomi Health Commercial |
$118.90
|
| Rate for Payer: PACE Senior Care Partners |
$34.44
|
| Rate for Payer: PACE SWMI |
$36.25
|
| Rate for Payer: PHP Commercial |
$123.25
|
| Rate for Payer: PHP Medicare Advantage |
$36.25
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$94.25
|
| Rate for Payer: Priority Health HMO/PPO |
$126.15
|
| Rate for Payer: Priority Health Medicare |
$36.61
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$97.15
|
| Rate for Payer: Railroad Medicare Medicare |
$36.25
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$127.60
|
| Rate for Payer: UHC Core |
$121.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$36.25
|
| Rate for Payer: UHC Exchange |
$36.25
|
| Rate for Payer: UHC Medicare Advantage |
$36.25
|
| Rate for Payer: UHCCP Medicaid |
$209.11
|
| Rate for Payer: VA VA |
$36.25
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$108.75
|
|
|
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 |
$94.25 |
| Rate for Payer: Aetna Commercial |
$50.22
|
| Rate for Payer: Aetna Medicare |
$38.98
|
| 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: 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: 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 |
$59.02
|
| Rate for Payer: Priority Health Medicare |
$37.85
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$59.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$37.48
|
| Rate for Payer: UHC Dual Complete DSNP |
$37.48
|
| Rate for Payer: UHC Exchange |
$37.48
|
| Rate for Payer: UHC Medicare Advantage |
$37.48
|
| Rate for Payer: UHCCP Medicaid |
$24.92
|
|
|
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 |
$234.08 |
| Rate for Payer: Aetna Commercial |
$82.74
|
| Rate for Payer: Aetna Medicare |
$64.22
|
| 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: 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: 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 |
$108.06
|
| Rate for Payer: Priority Health Medicare |
$62.37
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$108.06
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$61.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$61.75
|
| Rate for Payer: UHC Exchange |
$61.75
|
| 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 |
$547.85 |
| Rate for Payer: Aetna Commercial |
$89.39
|
| Rate for Payer: Aetna Medicare |
$69.38
|
| 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: 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: 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 |
$117.15
|
| Rate for Payer: Priority Health Medicare |
$67.38
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$117.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$66.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$66.71
|
| Rate for Payer: UHC Exchange |
$66.71
|
| 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 |
$2,134.86 |
| Rate for Payer: Aetna Commercial |
$81.67
|
| Rate for Payer: Aetna Medicare |
$63.39
|
| 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: 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: 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 |
$106.35
|
| Rate for Payer: Priority Health Medicare |
$61.56
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$106.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$60.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$60.95
|
| Rate for Payer: UHC Exchange |
$60.95
|
| 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
|
| Min. Negotiated Rate |
$52.61 |
| Max. Negotiated Rate |
$550.49 |
| Rate for Payer: Aetna Commercial |
$105.10
|
| Rate for Payer: Aetna Medicare |
$81.57
|
| 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: 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: 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 |
$139.33
|
| Rate for Payer: Priority Health Medicare |
$79.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.43
|
| Rate for Payer: UHC Exchange |
$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
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
HCPCS 64454
|
| Hospital Charge Code |
64454
|
| Min. Negotiated Rate |
$52.61 |
| Max. Negotiated Rate |
$550.49 |
| Rate for Payer: Aetna Commercial |
$105.10
|
| Rate for Payer: Aetna Medicare |
$81.57
|
| 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: 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: 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 |
$139.33
|
| Rate for Payer: Priority Health Medicare |
$79.21
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$139.33
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.43
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.43
|
| Rate for Payer: UHC Exchange |
$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 |
$270.40 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Aetna Commercial |
$353.60
|
| Rate for Payer: BCBS Trust/PPO |
$339.58
|
| Rate for Payer: BCN Commercial |
$321.48
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$357.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.80
|
| Rate for Payer: Healthscope Commercial |
$374.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.60
|
| Rate for Payer: Nomi Health Commercial |
$341.12
|
| Rate for Payer: PHP Commercial |
$353.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.40
|
| Rate for Payer: Priority Health HMO/PPO |
$361.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$278.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.08
|
| Rate for Payer: UHC Core |
$347.36
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.00
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
64454
|
| Min. Negotiated Rate |
$98.80 |
| Max. Negotiated Rate |
$515.13 |
| Rate for Payer: Aetna Commercial |
$353.60
|
| Rate for Payer: Aetna Medicare |
$108.16
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$130.00
|
| Rate for Payer: Amish Plain Church Group Commercial |
$130.00
|
| Rate for Payer: BCBS Complete |
$515.13
|
| Rate for Payer: BCBS MAPPO |
$104.00
|
| Rate for Payer: BCBS Trust/PPO |
$341.99
|
| Rate for Payer: BCN Commercial |
$323.44
|
| Rate for Payer: BCN Medicare Advantage |
$104.00
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$357.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$104.00
|
| Rate for Payer: Healthscope Commercial |
$374.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$312.00
|
| Rate for Payer: Mclaren Medicaid |
$490.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$109.20
|
| Rate for Payer: Meridian Medicaid |
$515.13
|
| Rate for Payer: MI Amish Medical Board Commercial |
$119.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.60
|
| Rate for Payer: Nomi Health Commercial |
$341.12
|
| Rate for Payer: PACE Senior Care Partners |
$98.80
|
| Rate for Payer: PACE SWMI |
$104.00
|
| Rate for Payer: PHP Commercial |
$353.60
|
| Rate for Payer: PHP Medicare Advantage |
$104.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$490.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.40
|
| Rate for Payer: Priority Health HMO/PPO |
$361.92
|
| Rate for Payer: Priority Health Medicare |
$105.04
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$278.72
|
| Rate for Payer: Railroad Medicare Medicare |
$104.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$366.08
|
| Rate for Payer: UHC Core |
$347.36
|
| Rate for Payer: UHC Dual Complete DSNP |
$104.00
|
| Rate for Payer: UHC Exchange |
$104.00
|
| Rate for Payer: UHC Medicare Advantage |
$104.00
|
| Rate for Payer: UHCCP Medicaid |
$490.57
|
| Rate for Payer: VA VA |
$104.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$312.00
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
HCPCS 64405
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$326.30 |
| Rate for Payer: Aetna Commercial |
$68.90
|
| Rate for Payer: Aetna Medicare |
$53.48
|
| 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: 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: 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 |
$89.85
|
| Rate for Payer: Priority Health Medicare |
$51.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.42
|
| Rate for Payer: UHC Exchange |
$51.42
|
| Rate for Payer: UHC Medicare Advantage |
$51.42
|
| Rate for Payer: UHCCP Medicaid |
$33.87
|
|
|
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 |
$119.22 |
| Max. Negotiated Rate |
$451.80 |
| Rate for Payer: Aetna Commercial |
$426.70
|
| Rate for Payer: Aetna Medicare |
$130.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$156.88
|
| Rate for Payer: Amish Plain Church Group Commercial |
$156.88
|
| Rate for Payer: BCBS Complete |
$219.58
|
| Rate for Payer: BCBS MAPPO |
$125.50
|
| Rate for Payer: BCBS Trust/PPO |
$412.69
|
| Rate for Payer: BCN Commercial |
$390.30
|
| Rate for Payer: BCN Medicare Advantage |
$125.50
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cofinity Commercial |
$431.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$125.50
|
| Rate for Payer: Healthscope Commercial |
$451.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$376.50
|
| Rate for Payer: Mclaren Medicaid |
$209.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$131.78
|
| Rate for Payer: Meridian Medicaid |
$219.58
|
| Rate for Payer: MI Amish Medical Board Commercial |
$144.32
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.70
|
| Rate for Payer: Nomi Health Commercial |
$411.64
|
| Rate for Payer: PACE Senior Care Partners |
$119.22
|
| Rate for Payer: PACE SWMI |
$125.50
|
| Rate for Payer: PHP Commercial |
$426.70
|
| Rate for Payer: PHP Medicare Advantage |
$125.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$209.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.30
|
| Rate for Payer: Priority Health HMO/PPO |
$436.74
|
| Rate for Payer: Priority Health Medicare |
$126.76
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$336.34
|
| Rate for Payer: Railroad Medicare Medicare |
$125.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.76
|
| Rate for Payer: UHC Core |
$419.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$125.50
|
| Rate for Payer: UHC Exchange |
$125.50
|
| Rate for Payer: UHC Medicare Advantage |
$125.50
|
| Rate for Payer: UHCCP Medicaid |
$209.11
|
| Rate for Payer: VA VA |
$125.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$376.50
|
|
|
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 |
$326.30 |
| Max. Negotiated Rate |
$451.80 |
| Rate for Payer: Aetna Commercial |
$426.70
|
| Rate for Payer: BCBS Trust/PPO |
$409.78
|
| Rate for Payer: BCN Commercial |
$387.95
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cofinity Commercial |
$431.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.60
|
| Rate for Payer: Healthscope Commercial |
$451.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$376.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.70
|
| Rate for Payer: Nomi Health Commercial |
$411.64
|
| Rate for Payer: PHP Commercial |
$426.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.30
|
| Rate for Payer: Priority Health HMO/PPO |
$436.74
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$336.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$441.76
|
| Rate for Payer: UHC Core |
$419.17
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$376.50
|
|
|
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 |
$326.30 |
| Rate for Payer: Aetna Commercial |
$68.90
|
| Rate for Payer: Aetna Medicare |
$53.48
|
| 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: 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: 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 |
$89.85
|
| Rate for Payer: Priority Health Medicare |
$51.93
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$89.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.42
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.42
|
| Rate for Payer: UHC Exchange |
$51.42
|
| 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 |
$1,001.13 |
| Rate for Payer: Aetna Commercial |
$69.36
|
| Rate for Payer: Aetna Medicare |
$53.83
|
| 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: 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: 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 |
$92.14
|
| Rate for Payer: Priority Health Medicare |
$52.28
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$92.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$51.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.76
|
| Rate for Payer: UHC Exchange |
$51.76
|
| 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 |
$368.75 |
| Rate for Payer: Aetna Commercial |
$31.21
|
| Rate for Payer: Aetna Medicare |
$24.22
|
| 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: 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: 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 |
$42.08
|
| Rate for Payer: Priority Health Medicare |
$23.52
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$42.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$23.29
|
| Rate for Payer: UHC Dual Complete DSNP |
$23.29
|
| Rate for Payer: UHC Exchange |
$23.29
|
| 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 |
$551.55 |
| Rate for Payer: Aetna Commercial |
$75.03
|
| Rate for Payer: Aetna Medicare |
$58.23
|
| 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: 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: 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 |
$98.39
|
| Rate for Payer: Priority Health Medicare |
$56.55
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$98.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$55.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$55.99
|
| Rate for Payer: UHC Exchange |
$55.99
|
| 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 |
$580.60 |
| Rate for Payer: Aetna Commercial |
$104.71
|
| Rate for Payer: Aetna Medicare |
$81.27
|
| 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: 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: 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 |
$138.20
|
| Rate for Payer: Priority Health Medicare |
$78.92
|
| Rate for Payer: Priority Health Narrow/Tiered Network |
$138.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$78.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$78.14
|
| Rate for Payer: UHC Exchange |
$78.14
|
| Rate for Payer: UHC Medicare Advantage |
$78.14
|
| Rate for Payer: UHCCP Medicaid |
$52.40
|
|
