|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
64454
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$768.38 |
| Rate for Payer: Aetna Commercial |
$367.20
|
| Rate for Payer: Aetna Medicare |
$614.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: ASR ASR |
$395.76
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$316.32
|
| Rate for Payer: BCN Commercial |
$316.32
|
| Rate for Payer: BCN Medicare Advantage |
$614.70
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$383.52
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$326.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$614.70
|
| Rate for Payer: Healthscope Commercial |
$408.00
|
| Rate for Payer: Healthscope Whirlpool |
$395.76
|
| Rate for Payer: Humana Choice PPO Medicare |
$614.70
|
| Rate for Payer: Mclaren Commercial |
$367.20
|
| 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 |
$346.80
|
| Rate for Payer: PACE Medicare |
$583.96
|
| Rate for Payer: PACE SWMI |
$614.70
|
| Rate for Payer: PHP Commercial |
$676.17
|
| Rate for Payer: PHP Medicaid |
$336.24
|
| 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 |
$285.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$668.73
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$534.98
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$359.04
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: VA VA |
$614.70
|
|
|
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 |
$80.08
|
| 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: Healthscope Commercial |
$96.10
|
| Rate for Payer: Healthscope Whirlpool |
$96.10
|
| 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 Network |
$137.03
|
| 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 |
$144.01 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna Commercial |
$442.80
|
| Rate for Payer: Aetna Medicare |
$263.27
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$329.09
|
| Rate for Payer: Amish Plain Church Group Commercial |
$329.09
|
| Rate for Payer: ASR ASR |
$477.24
|
| Rate for Payer: BCBS Complete |
$151.22
|
| Rate for Payer: BCBS MAPPO |
$263.27
|
| Rate for Payer: BCBS Trust/PPO |
$381.45
|
| Rate for Payer: BCN Commercial |
$381.45
|
| 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 |
$462.48
|
| 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 |
$492.00
|
| Rate for Payer: Healthscope Whirlpool |
$477.24
|
| Rate for Payer: Humana Choice PPO Medicare |
$263.27
|
| Rate for Payer: Mclaren Commercial |
$442.80
|
| 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 |
$289.60
|
| Rate for Payer: PHP Medicaid |
$144.01
|
| 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 |
$447.72
|
| Rate for Payer: Priority Health Medicare |
$263.27
|
| Rate for Payer: Priority Health Narrow Network |
$349.32
|
| Rate for Payer: Railroad Medicare Medicare |
$263.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.96
|
| Rate for Payer: UHC Medicare Advantage |
$271.17
|
| Rate for Payer: VA VA |
$263.27
|
|
|
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 |
$344.40 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna Commercial |
$442.80
|
| Rate for Payer: ASR ASR |
$477.24
|
| Rate for Payer: BCBS Trust/PPO |
$381.45
|
| Rate for Payer: BCN Commercial |
$381.45
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cofinity Commercial |
$462.48
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$393.60
|
| Rate for Payer: Healthscope Commercial |
$492.00
|
| Rate for Payer: Healthscope Whirlpool |
$477.24
|
| Rate for Payer: Mclaren Commercial |
$442.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$418.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$344.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$432.96
|
|
|
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 |
$52.53
|
| 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: Healthscope Commercial |
$63.04
|
| Rate for Payer: Healthscope Whirlpool |
$63.04
|
| 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 Network |
$88.89
|
| 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 |
$52.53
|
| 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: Healthscope Commercial |
$63.04
|
| Rate for Payer: Healthscope Whirlpool |
$63.04
|
| 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 Network |
$88.89
|
| Rate for Payer: UHC Medicare Advantage |
$54.11
|
|
|
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 |
$53.59
|
| 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 |
$71.81
|
| Rate for Payer: Cofinity Commercial |
$77.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$53.59
|
| Rate for Payer: Healthscope Commercial |
$64.31
|
| Rate for Payer: Healthscope Whirlpool |
$64.31
|
| 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 Network |
$91.73
|
| 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 |
$23.96
|
| 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 |
$34.50
|
| Rate for Payer: Cofinity Commercial |
$32.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$23.96
|
| Rate for Payer: Healthscope Commercial |
$28.75
|
| Rate for Payer: Healthscope Whirlpool |
$28.75
|
| 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 Network |
$40.77
|
| 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 |
$57.22
|
| 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 |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$76.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.22
|
| Rate for Payer: Healthscope Commercial |
$68.66
|
| Rate for Payer: Healthscope Whirlpool |
$68.66
|
| 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 Network |
$97.95
|
| 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 |
$79.77
|
| 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 |
$106.89
|
| Rate for Payer: Cofinity Commercial |
$114.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$79.77
|
| Rate for Payer: Healthscope Commercial |
$95.72
|
| Rate for Payer: Healthscope Whirlpool |
$95.72
|
| 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 Network |
$136.46
|
| Rate for Payer: UHC Medicare Advantage |
$82.16
|
|
|
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 |
$40.99
|
| 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: Healthscope Commercial |
$49.19
|
| Rate for Payer: Healthscope Whirlpool |
$49.19
|
| 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 Network |
$70.21
|
| Rate for Payer: UHC Medicare Advantage |
$42.22
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
64450
|
| Min. Negotiated Rate |
$177.80 |
| Max. Negotiated Rate |
$768.38 |
| Rate for Payer: Aetna Commercial |
$228.60
|
| Rate for Payer: Aetna Medicare |
$614.70
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$768.38
|
| Rate for Payer: Amish Plain Church Group Commercial |
$768.38
|
| Rate for Payer: ASR ASR |
$246.38
|
| Rate for Payer: BCBS Complete |
$353.08
|
| Rate for Payer: BCBS MAPPO |
$614.70
|
| Rate for Payer: BCBS Trust/PPO |
$196.93
|
| Rate for Payer: BCN Commercial |
$196.93
|
| 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 |
$238.76
|
| 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 |
$254.00
|
| Rate for Payer: Healthscope Whirlpool |
$246.38
|
| Rate for Payer: Humana Choice PPO Medicare |
$614.70
|
| Rate for Payer: Mclaren Commercial |
$228.60
|
| 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 |
$676.17
|
| Rate for Payer: PHP Medicaid |
$336.24
|
| 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 |
$557.21
|
| Rate for Payer: Priority Health Medicare |
$614.70
|
| Rate for Payer: Priority Health Narrow Network |
$445.77
|
| Rate for Payer: Railroad Medicare Medicare |
$614.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.52
|
| Rate for Payer: UHC Medicare Advantage |
$633.14
|
| Rate for Payer: VA VA |
$614.70
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
64450
|
| Min. Negotiated Rate |
$177.80 |
| Max. Negotiated Rate |
$254.00 |
| Rate for Payer: Aetna Commercial |
$228.60
|
| Rate for Payer: ASR ASR |
$246.38
|
| Rate for Payer: BCBS Trust/PPO |
$196.93
|
| Rate for Payer: BCN Commercial |
$196.93
|
| Rate for Payer: Cash Price |
$203.20
|
| Rate for Payer: Cofinity Commercial |
$238.76
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$203.20
|
| Rate for Payer: Healthscope Commercial |
$254.00
|
| Rate for Payer: Healthscope Whirlpool |
$246.38
|
| Rate for Payer: Mclaren Commercial |
$228.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$215.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$177.80
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$223.52
|
|
|
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 |
$40.99
|
| 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: Healthscope Commercial |
$49.19
|
| Rate for Payer: Healthscope Whirlpool |
$49.19
|
| 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 Network |
$70.21
|
| Rate for Payer: UHC Medicare Advantage |
$42.22
|
|
|
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 |
$42.76
|
| 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 |
$57.30
|
| Rate for Payer: Cofinity Commercial |
$61.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$42.76
|
| Rate for Payer: Healthscope Commercial |
$51.31
|
| Rate for Payer: Healthscope Whirlpool |
$51.31
|
| 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 Network |
$73.04
|
| 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 |
$53.70
|
| 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: Healthscope Commercial |
$64.44
|
| Rate for Payer: Healthscope Whirlpool |
$64.44
|
| 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 Network |
$91.73
|
| 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 |
$72.13
|
| 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: Healthscope Commercial |
$86.56
|
| Rate for Payer: Healthscope Whirlpool |
$86.56
|
| 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 Network |
$122.88
|
| 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 |
$54.93
|
| 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 |
$73.61
|
| Rate for Payer: Cofinity Commercial |
$79.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$54.93
|
| Rate for Payer: Healthscope Commercial |
$65.92
|
| Rate for Payer: Healthscope Whirlpool |
$65.92
|
| 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 Network |
$93.42
|
| Rate for Payer: UHC Medicare Advantage |
$56.58
|
|
|
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 |
$66.50
|
| Rate for Payer: Aetna Medicare |
$49.63
|
| Rate for Payer: BCBS Complete |
$34.67
|
| Rate for Payer: BCBS MAPPO |
$49.63
|
| Rate for Payer: BCBS Trust/PPO |
$285.28
|
| Rate for Payer: BCN Commercial |
$164.20
|
| Rate for Payer: BCN Medicare Advantage |
$49.63
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cash Price |
$204.80
|
| Rate for Payer: Cofinity Commercial |
$71.47
|
| Rate for Payer: Cofinity Commercial |
$66.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$49.63
|
| Rate for Payer: Healthscope Commercial |
$59.56
|
| Rate for Payer: Healthscope Whirlpool |
$59.56
|
| Rate for Payer: Meridian Medicaid |
$34.67
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$52.11
|
| Rate for Payer: PACE SWMI |
$49.63
|
| Rate for Payer: PHP Medicare Advantage |
$49.63
|
| 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 Medicare |
$49.63
|
| Rate for Payer: Priority Health Narrow Network |
$84.93
|
| Rate for Payer: UHC Medicare Advantage |
$51.12
|
|
|
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 |
$59.28
|
| Rate for Payer: Aetna Medicare |
$44.24
|
| Rate for Payer: BCBS Complete |
$29.97
|
| Rate for Payer: BCBS MAPPO |
$44.24
|
| Rate for Payer: BCBS Trust/PPO |
$416.83
|
| Rate for Payer: BCN Commercial |
$120.21
|
| Rate for Payer: BCN Medicare Advantage |
$44.24
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cofinity Commercial |
$63.71
|
| Rate for Payer: Cofinity Commercial |
$59.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$44.24
|
| Rate for Payer: Healthscope Commercial |
$53.09
|
| Rate for Payer: Healthscope Whirlpool |
$53.09
|
| Rate for Payer: Meridian Medicaid |
$29.97
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$46.45
|
| Rate for Payer: PACE SWMI |
$44.24
|
| Rate for Payer: PHP Medicare Advantage |
$44.24
|
| 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 Medicare |
$44.24
|
| Rate for Payer: Priority Health Narrow Network |
$75.88
|
| Rate for Payer: UHC Medicare Advantage |
$45.57
|
|
|
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 |
$118.72
|
| Rate for Payer: Aetna Medicare |
$88.60
|
| Rate for Payer: BCBS Complete |
$59.04
|
| Rate for Payer: BCBS MAPPO |
$88.60
|
| Rate for Payer: BCBS Trust/PPO |
$2,526.86
|
| Rate for Payer: BCN Commercial |
$219.42
|
| Rate for Payer: BCN Medicare Advantage |
$88.60
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cofinity Commercial |
$127.58
|
| Rate for Payer: Cofinity Commercial |
$118.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$88.60
|
| Rate for Payer: Healthscope Commercial |
$106.32
|
| Rate for Payer: Healthscope Whirlpool |
$106.32
|
| Rate for Payer: Meridian Medicaid |
$59.04
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$93.03
|
| Rate for Payer: PACE SWMI |
$88.60
|
| Rate for Payer: PHP Medicare Advantage |
$88.60
|
| 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 Medicare |
$88.60
|
| Rate for Payer: Priority Health Narrow Network |
$155.81
|
| Rate for Payer: UHC Medicare Advantage |
$91.26
|
|
|
PR INJECTION ANES AGENT SPHENOPALATINE GANGLION
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 64505
|
| Min. Negotiated Rate |
$67.52 |
| Max. Negotiated Rate |
$210.13 |
| Rate for Payer: Aetna Commercial |
$136.84
|
| Rate for Payer: Aetna Medicare |
$102.12
|
| Rate for Payer: BCBS Complete |
$70.90
|
| Rate for Payer: BCBS MAPPO |
$102.12
|
| Rate for Payer: BCBS Trust/PPO |
$195.47
|
| Rate for Payer: BCN Commercial |
$210.13
|
| Rate for Payer: BCN Medicare Advantage |
$102.12
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cofinity Commercial |
$136.84
|
| Rate for Payer: Cofinity Commercial |
$147.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.12
|
| Rate for Payer: Healthscope Commercial |
$122.54
|
| Rate for Payer: Healthscope Whirlpool |
$122.54
|
| Rate for Payer: Meridian Medicaid |
$70.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$107.23
|
| Rate for Payer: PACE SWMI |
$102.12
|
| Rate for Payer: PHP Medicare Advantage |
$102.12
|
| 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 Medicare |
$102.12
|
| Rate for Payer: Priority Health Narrow Network |
$176.10
|
| Rate for Payer: UHC Medicare Advantage |
$105.18
|
|
|
PR INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
HCPCS 64520
|
| Min. Negotiated Rate |
$54.10 |
| Max. Negotiated Rate |
$335.72 |
| Rate for Payer: Aetna Commercial |
$109.36
|
| Rate for Payer: Aetna Medicare |
$81.61
|
| Rate for Payer: BCBS Complete |
$56.80
|
| Rate for Payer: BCBS MAPPO |
$81.61
|
| Rate for Payer: BCBS Trust/PPO |
$224.53
|
| Rate for Payer: BCN Commercial |
$335.72
|
| Rate for Payer: BCN Medicare Advantage |
$81.61
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cash Price |
$280.00
|
| Rate for Payer: Cofinity Commercial |
$117.52
|
| Rate for Payer: Cofinity Commercial |
$109.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.61
|
| Rate for Payer: Healthscope Commercial |
$97.93
|
| Rate for Payer: Healthscope Whirlpool |
$97.93
|
| Rate for Payer: Meridian Medicaid |
$56.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$85.69
|
| Rate for Payer: PACE SWMI |
$81.61
|
| Rate for Payer: PHP Medicare Advantage |
$81.61
|
| 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 Medicare |
$81.61
|
| Rate for Payer: Priority Health Narrow Network |
$140.99
|
| Rate for Payer: UHC Medicare Advantage |
$84.06
|
|
|
PR INJECTION, BUPIVICAINE HYDRO
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS S0020
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$7.00 |
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: BCN Commercial |
$1.19
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.00
|
|
|
PR INJECTION ENZYME PALMAR FASCIAL CORD
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
HCPCS 20527
|
| Min. Negotiated Rate |
$41.96 |
| Max. Negotiated Rate |
$128.52 |
| Rate for Payer: Aetna Commercial |
$86.55
|
| Rate for Payer: Aetna Medicare |
$64.59
|
| Rate for Payer: BCBS Complete |
$44.06
|
| Rate for Payer: BCBS MAPPO |
$64.59
|
| Rate for Payer: BCBS Trust/PPO |
$52.64
|
| Rate for Payer: BCN Commercial |
$128.52
|
| Rate for Payer: BCN Medicare Advantage |
$64.59
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cash Price |
$130.40
|
| Rate for Payer: Cofinity Commercial |
$86.55
|
| Rate for Payer: Cofinity Commercial |
$93.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$64.59
|
| Rate for Payer: Healthscope Commercial |
$77.51
|
| Rate for Payer: Healthscope Whirlpool |
$77.51
|
| Rate for Payer: Meridian Medicaid |
$44.06
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$67.82
|
| Rate for Payer: PACE SWMI |
$64.59
|
| Rate for Payer: PHP Medicare Advantage |
$64.59
|
| 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 Medicare |
$64.59
|
| Rate for Payer: Priority Health Narrow Network |
$100.09
|
| Rate for Payer: UHC Medicare Advantage |
$66.53
|
|
