|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
64454
|
| Min. Negotiated Rate |
$179.52 |
| Max. Negotiated Rate |
$367.20 |
| Rate for Payer: Aetna American Axle |
$265.20
|
| Rate for Payer: Aetna Commercial |
$346.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$265.20
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$285.60
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$285.60
|
| 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 SBD |
$257.04
|
| Rate for Payer: UMR Bronson Commercial |
$179.52
|
| 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 |
$104.95
|
| Rate for Payer: BCBS Complete |
$54.80
|
| Rate for Payer: BCBS Trust/PPO |
$550.49
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Meridian Medicaid |
$54.80
|
| 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 Narrow Network |
$137.03
|
| Rate for Payer: Priority Health SBD |
$137.03
|
| Rate for Payer: UMR Bronson Commercial |
$187.68
|
|
|
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 |
$69.32
|
| Rate for Payer: BCBS Complete |
$35.33
|
| Rate for Payer: BCBS Trust/PPO |
$262.57
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Meridian Medicaid |
$35.33
|
| 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 Narrow Network |
$88.89
|
| Rate for Payer: Priority Health SBD |
$88.89
|
| Rate for Payer: UMR Bronson Commercial |
$226.32
|
|
|
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 |
$216.48 |
| Max. Negotiated Rate |
$442.80 |
| Rate for Payer: Aetna American Axle |
$319.80
|
| Rate for Payer: Aetna Commercial |
$418.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.80
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$344.40
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$344.40
|
| 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 SBD |
$309.96
|
| Rate for Payer: UMR Bronson Commercial |
$216.48
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$369.00
|
|
|
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 |
$51.74 |
| Max. Negotiated Rate |
$828.79 |
| Rate for Payer: Aetna American Axle |
$319.80
|
| Rate for Payer: Aetna Commercial |
$418.20
|
| Rate for Payer: Aetna Medicare |
$273.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$319.80
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$290.76
|
| Rate for Payer: BCN Medicare Advantage |
$263.27
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$344.40
|
| 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 |
$263.27
|
| Rate for Payer: Healthscope Commercial |
$442.80
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$344.40
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$369.00
|
| Rate for Payer: Mclaren Medicaid |
$144.01
|
| Rate for Payer: Mclaren Medicare |
$263.27
|
| Rate for Payer: Meridian Medicaid |
$151.22
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$276.43
|
| Rate for Payer: MI Amish Medical Board Commercial |
$302.76
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$418.20
|
| Rate for Payer: PACE Medicare |
$250.11
|
| Rate for Payer: PACE SWMI |
$263.27
|
| Rate for Payer: PHP Commercial |
$418.20
|
| Rate for Payer: PHP Medicare Advantage |
$263.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$144.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$828.79
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$663.03
|
| Rate for Payer: Priority Health SBD |
$309.96
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$56.91
|
| Rate for Payer: UHC Core |
$700.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$263.27
|
| Rate for Payer: UHC Exchange |
$51.74
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: UMR Bronson Commercial |
$182.04
|
| Rate for Payer: VA VA |
$263.27
|
| 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 |
$69.32
|
| Rate for Payer: BCBS Complete |
$35.33
|
| Rate for Payer: BCBS Trust/PPO |
$262.57
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Meridian Medicaid |
$35.33
|
| 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 Narrow Network |
$88.89
|
| Rate for Payer: Priority Health SBD |
$88.89
|
| Rate for Payer: UMR Bronson Commercial |
$226.32
|
|
|
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 |
$71.32
|
| Rate for Payer: BCBS Complete |
$36.24
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.13
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Cash Price |
$524.80
|
| Rate for Payer: Meridian Medicaid |
$36.24
|
| 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 Narrow Network |
$91.73
|
| Rate for Payer: Priority Health SBD |
$91.73
|
| Rate for Payer: UMR Bronson Commercial |
$301.76
|
|
|
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 |
$32.34
|
| Rate for Payer: BCBS Complete |
$16.55
|
| Rate for Payer: BCBS Trust/PPO |
$368.75
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Cash Price |
$961.60
|
| Rate for Payer: Meridian Medicaid |
$16.55
|
| 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 Narrow Network |
$40.77
|
| Rate for Payer: Priority Health SBD |
$40.77
|
| Rate for Payer: UMR Bronson Commercial |
$552.92
|
|
|
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 |
$76.19
|
| Rate for Payer: BCBS Complete |
$38.69
|
| Rate for Payer: BCBS Trust/PPO |
$551.55
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Cash Price |
$172.00
|
| Rate for Payer: Meridian Medicaid |
$38.69
|
| 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 Narrow Network |
$97.95
|
| Rate for Payer: Priority Health SBD |
$97.95
|
| Rate for Payer: UMR Bronson Commercial |
$98.90
|
|
|
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 |
$101.64
|
| Rate for Payer: BCBS Complete |
$54.35
|
| Rate for Payer: BCBS Trust/PPO |
$580.60
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Cash Price |
$324.80
|
| Rate for Payer: Meridian Medicaid |
$54.35
|
| 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 Narrow Network |
$136.46
|
| Rate for Payer: Priority Health SBD |
$136.46
|
| Rate for Payer: UMR Bronson Commercial |
$186.76
|
|
|
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 |
$54.55
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS Trust/PPO |
$661.43
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Meridian Medicaid |
$27.96
|
| 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 Narrow Network |
$70.21
|
| Rate for Payer: Priority Health SBD |
$70.21
|
| Rate for Payer: UMR Bronson Commercial |
$116.84
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
64450
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Aetna American Axle |
$165.10
|
| Rate for Payer: Aetna Commercial |
$215.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.10
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$177.80
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$177.80
|
| 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 SBD |
$160.02
|
| Rate for Payer: UMR Bronson Commercial |
$111.76
|
| 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 |
$40.93 |
| Max. Negotiated Rate |
$1,935.09 |
| Rate for Payer: Aetna American Axle |
$165.10
|
| Rate for Payer: Aetna Commercial |
$215.90
|
| Rate for Payer: Aetna Medicare |
$639.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$165.10
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$689.06
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$218.44
|
| Rate for Payer: Cofinity Commercial |
$177.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Healthscope Commercial |
$228.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$177.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$190.50
|
| Rate for Payer: Mclaren Medicaid |
$336.24
|
| Rate for Payer: Mclaren Medicare |
$614.70
|
| Rate for Payer: Meridian Medicaid |
$353.08
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$645.44
|
| Rate for Payer: MI Amish Medical Board Commercial |
$706.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.90
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Commercial |
$215.90
|
| Rate for Payer: PHP Medicare Advantage |
$614.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$336.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,935.09
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$1,548.07
|
| Rate for Payer: Priority Health SBD |
$160.02
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$45.02
|
| Rate for Payer: UHC Dual Complete DSNP |
$614.70
|
| Rate for Payer: UHC Exchange |
$40.93
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: UMR Bronson Commercial |
$93.98
|
| Rate for Payer: VA VA |
$614.70
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$190.50
|
|
|
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 |
$54.55
|
| Rate for Payer: BCBS Complete |
$27.96
|
| Rate for Payer: BCBS Trust/PPO |
$661.43
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Meridian Medicaid |
$27.96
|
| 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 Narrow Network |
$70.21
|
| Rate for Payer: Priority Health SBD |
$70.21
|
| Rate for Payer: UMR Bronson Commercial |
$116.84
|
|
|
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 |
$56.32
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,878.11
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Meridian Medicaid |
$29.30
|
| 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 Narrow Network |
$73.04
|
| Rate for Payer: Priority Health SBD |
$73.04
|
| Rate for Payer: UMR Bronson Commercial |
$131.10
|
|
|
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 |
$70.97
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.82
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Cash Price |
$200.00
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| 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 Narrow Network |
$91.73
|
| Rate for Payer: Priority Health SBD |
$91.73
|
| Rate for Payer: UMR Bronson Commercial |
$115.00
|
|
|
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 |
$69.22
|
| Rate for Payer: BCBS Complete |
$47.86
|
| Rate for Payer: BCBS Trust/PPO |
$1,332.90
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Cash Price |
$212.80
|
| Rate for Payer: Meridian Medicaid |
$47.86
|
| 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 Narrow Network |
$122.88
|
| Rate for Payer: Priority Health SBD |
$122.88
|
| Rate for Payer: UMR Bronson Commercial |
$122.36
|
|
|
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 |
$74.30
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS Trust/PPO |
$359.77
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| 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 Narrow Network |
$93.42
|
| Rate for Payer: Priority Health SBD |
$93.42
|
| Rate for Payer: UMR Bronson Commercial |
$81.42
|
|
|
PR INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
HCPCS 64400
|
| Min. Negotiated Rate |
$33.02 |
| Max. Negotiated Rate |
$285.28 |
| Rate for Payer: Aetna Commercial |
$64.36
|
| Rate for Payer: BCBS Complete |
$34.67
|
| Rate for Payer: BCBS Trust/PPO |
$285.28
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Meridian Medicaid |
$34.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$179.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$84.93
|
| Rate for Payer: Priority Health Narrow Network |
$84.93
|
| Rate for Payer: Priority Health SBD |
$84.93
|
| Rate for Payer: UMR Bronson Commercial |
$117.76
|
|
|
PR INJECTION AA&/STRD VAGUS NERVE
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
HCPCS 64408
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$416.83 |
| Rate for Payer: Aetna Commercial |
$56.23
|
| Rate for Payer: BCBS Complete |
$29.97
|
| Rate for Payer: BCBS Trust/PPO |
$416.83
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Meridian Medicaid |
$29.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$115.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$75.88
|
| Rate for Payer: Priority Health Narrow Network |
$75.88
|
| Rate for Payer: Priority Health SBD |
$75.88
|
| Rate for Payer: UMR Bronson Commercial |
$75.90
|
|
|
PR INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
HCPCS 49400
|
| Min. Negotiated Rate |
$56.23 |
| Max. Negotiated Rate |
$2,526.86 |
| Rate for Payer: Aetna Commercial |
$122.24
|
| Rate for Payer: BCBS Complete |
$59.04
|
| Rate for Payer: BCBS Trust/PPO |
$2,526.86
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Meridian Medicaid |
$59.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.23
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$155.81
|
| Rate for Payer: Priority Health Narrow Network |
$155.81
|
| Rate for Payer: Priority Health SBD |
$155.81
|
| Rate for Payer: UMR Bronson Commercial |
$138.46
|
|
|
PR INJECTION ANES AGENT SPHENOPALATINE GANGLION
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 64505
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$195.47 |
| Rate for Payer: Aetna Commercial |
$128.32
|
| Rate for Payer: BCBS Complete |
$70.90
|
| Rate for Payer: BCBS Trust/PPO |
$195.47
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Meridian Medicaid |
$70.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$67.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$176.10
|
| Rate for Payer: Priority Health Narrow Network |
$176.10
|
| Rate for Payer: Priority Health SBD |
$176.10
|
| Rate for Payer: UMR Bronson Commercial |
$80.50
|
|
|
PR INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 64520
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$245.00 |
| Rate for Payer: Aetna Commercial |
$107.54
|
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: BCBS Trust/PPO |
$224.53
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Meridian Medicaid |
$56.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$245.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$140.99
|
| Rate for Payer: Priority Health Narrow Network |
$140.99
|
| Rate for Payer: Priority Health SBD |
$140.99
|
| Rate for Payer: UMR Bronson Commercial |
$161.00
|
|
|
PR INJECTION, BUPIVICAINE HYDRO
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS S0020
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
| Rate for Payer: UMR Bronson Commercial |
$4.60
|
|
|
PR INJECTION ENZYME PALMAR FASCIAL CORD
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 20527
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$114.10 |
| Rate for Payer: Aetna Commercial |
$86.70
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS Trust/PPO |
$52.64
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Meridian Medicaid |
$44.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$41.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$100.09
|
| Rate for Payer: Priority Health Narrow Network |
$100.09
|
| Rate for Payer: Priority Health SBD |
$100.09
|
| Rate for Payer: UMR Bronson Commercial |
$74.98
|
|
