|
PR INJECTION AA&/STRD BRACHIAL PLEXUS W/IMG GDN
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
HCPCS 64415
|
| Min. Negotiated Rate |
$42.39 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Aetna Commercial |
$88.16
|
| Rate for Payer: Aetna Medicare |
$65.79
|
| Rate for Payer: BCBS Complete |
$44.51
|
| Rate for Payer: BCBS MAPPO |
$65.79
|
| Rate for Payer: BCN Commercial |
$103.58
|
| Rate for Payer: BCN Medicare Advantage |
$65.79
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cash Price |
$432.00
|
| Rate for Payer: Cofinity Commercial |
$94.74
|
| Rate for Payer: Cofinity Commercial |
$88.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.79
|
| Rate for Payer: Healthscope Commercial |
$78.95
|
| Rate for Payer: Healthscope Whirlpool |
$78.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.08
|
| Rate for Payer: Meridian Medicaid |
$44.51
|
| Rate for Payer: Molina Medicare/Medicaid |
$72.37
|
| Rate for Payer: Nomi Health Commercial |
$78.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$405.00
|
| Rate for Payer: PACE SWMI |
$65.79
|
| Rate for Payer: PHP Medicare Advantage |
$65.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$120.30
|
| Rate for Payer: Priority Health Medicare |
$65.79
|
| Rate for Payer: Priority Health Narrow Network |
$120.30
|
| Rate for Payer: Railroad Medicare Medicare |
$65.79
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$112.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$65.79
|
| Rate for Payer: UHC Exchange |
$112.93
|
| Rate for Payer: UHC Medicaid |
$42.39
|
| Rate for Payer: UHCCP DNSP |
$65.79
|
| Rate for Payer: UHCCP Medicaid |
$42.39
|
|
|
PR INJECTION AA&/STRD FEMORAL NERVE W/IMG GDN
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
HCPCS 64447
|
| Min. Negotiated Rate |
$38.77 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Aetna Commercial |
$80.63
|
| Rate for Payer: Aetna Medicare |
$60.17
|
| Rate for Payer: BCBS Complete |
$40.71
|
| Rate for Payer: BCBS MAPPO |
$60.17
|
| Rate for Payer: BCN Commercial |
$94.61
|
| Rate for Payer: BCN Medicare Advantage |
$60.17
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cash Price |
$152.00
|
| Rate for Payer: Cofinity Commercial |
$86.64
|
| Rate for Payer: Cofinity Commercial |
$80.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$60.17
|
| Rate for Payer: Healthscope Commercial |
$72.20
|
| Rate for Payer: Healthscope Whirlpool |
$72.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$63.18
|
| Rate for Payer: Meridian Medicaid |
$40.71
|
| Rate for Payer: Molina Medicare/Medicaid |
$66.19
|
| Rate for Payer: Nomi Health Commercial |
$72.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$142.50
|
| Rate for Payer: PACE SWMI |
$60.17
|
| Rate for Payer: PHP Medicare Advantage |
$60.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$38.77
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$109.90
|
| Rate for Payer: Priority Health Medicare |
$60.17
|
| Rate for Payer: Priority Health Narrow Network |
$109.90
|
| Rate for Payer: Railroad Medicare Medicare |
$60.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$60.17
|
| Rate for Payer: UHC Exchange |
$94.26
|
| Rate for Payer: UHC Medicaid |
$38.77
|
| Rate for Payer: UHCCP DNSP |
$60.17
|
| Rate for Payer: UHCCP Medicaid |
$38.77
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
HCPCS 64454
|
| Min. Negotiated Rate |
$46.65 |
| Max. Negotiated Rate |
$321.00 |
| Rate for Payer: Aetna Commercial |
$96.51
|
| Rate for Payer: Aetna Medicare |
$72.02
|
| Rate for Payer: BCBS Complete |
$48.98
|
| Rate for Payer: BCBS MAPPO |
$72.02
|
| Rate for Payer: BCN Commercial |
$123.00
|
| Rate for Payer: BCN Medicare Advantage |
$72.02
|
| Rate for Payer: Cash Price |
$342.40
|
| Rate for Payer: Cash Price |
$342.40
|
| Rate for Payer: Cofinity Commercial |
$96.51
|
| Rate for Payer: Cofinity Commercial |
$103.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.02
|
| Rate for Payer: Healthscope Commercial |
$86.42
|
| Rate for Payer: Healthscope Whirlpool |
$86.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.62
|
| Rate for Payer: Meridian Medicaid |
$48.98
|
| Rate for Payer: Molina Medicare/Medicaid |
$79.22
|
| Rate for Payer: Nomi Health Commercial |
$86.42
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$321.00
|
| Rate for Payer: PACE SWMI |
$72.02
|
| Rate for Payer: PHP Medicare Advantage |
$72.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$142.87
|
| Rate for Payer: Priority Health Medicare |
$72.02
|
| Rate for Payer: Priority Health Narrow Network |
$142.87
|
| Rate for Payer: Railroad Medicare Medicare |
$72.02
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.51
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$72.02
|
| Rate for Payer: UHC Exchange |
$144.51
|
| Rate for Payer: UHC Medicaid |
$46.65
|
| Rate for Payer: UHCCP DNSP |
$72.02
|
| Rate for Payer: UHCCP Medicaid |
$46.65
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
64405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$387.75 |
| Max. Negotiated Rate |
$517.00 |
| Rate for Payer: Aetna Commercial |
$465.30
|
| Rate for Payer: ASR ASR |
$501.49
|
| Rate for Payer: BCBS Trust/PPO |
$424.56
|
| Rate for Payer: BCN Commercial |
$424.56
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$485.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.60
|
| Rate for Payer: Healthscope Commercial |
$501.49
|
| Rate for Payer: Healthscope Whirlpool |
$517.00
|
| Rate for Payer: Mclaren Commercial |
$465.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.45
|
| Rate for Payer: Nomi Health Commercial |
$423.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$454.96
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
64405
|
| Min. Negotiated Rate |
$29.39 |
| Max. Negotiated Rate |
$387.75 |
| Rate for Payer: Aetna Commercial |
$62.00
|
| Rate for Payer: Aetna Medicare |
$46.27
|
| Rate for Payer: BCBS Complete |
$30.86
|
| Rate for Payer: BCBS MAPPO |
$46.27
|
| Rate for Payer: BCN Commercial |
$79.18
|
| Rate for Payer: BCN Medicare Advantage |
$46.27
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$62.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.27
|
| Rate for Payer: Healthscope Commercial |
$55.52
|
| Rate for Payer: Healthscope Whirlpool |
$55.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.58
|
| Rate for Payer: Meridian Medicaid |
$30.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.90
|
| Rate for Payer: Nomi Health Commercial |
$55.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.75
|
| Rate for Payer: PACE SWMI |
$46.27
|
| Rate for Payer: PHP Medicare Advantage |
$46.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$91.96
|
| Rate for Payer: Priority Health Medicare |
$46.27
|
| Rate for Payer: Priority Health Narrow Network |
$91.96
|
| Rate for Payer: Railroad Medicare Medicare |
$46.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.27
|
| Rate for Payer: UHC Exchange |
$95.18
|
| Rate for Payer: UHC Medicaid |
$29.39
|
| Rate for Payer: UHCCP DNSP |
$46.27
|
| Rate for Payer: UHCCP Medicaid |
$29.39
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
64405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.96 |
| Max. Negotiated Rate |
$517.00 |
| Rate for Payer: Aetna Commercial |
$465.30
|
| Rate for Payer: Aetna Medicare |
$305.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$382.31
|
| Rate for Payer: Amish Plain Church Group Commercial |
$382.31
|
| Rate for Payer: ASR ASR |
$501.49
|
| Rate for Payer: BCBS Complete |
$167.97
|
| Rate for Payer: BCBS MAPPO |
$305.85
|
| Rate for Payer: BCBS Trust/PPO |
$426.27
|
| Rate for Payer: BCN Commercial |
$426.27
|
| Rate for Payer: BCN Medicare Advantage |
$305.85
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$485.98
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$413.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$305.85
|
| Rate for Payer: Healthscope Commercial |
$501.49
|
| Rate for Payer: Healthscope Whirlpool |
$517.00
|
| Rate for Payer: Humana Choice PPO Medicare |
$305.85
|
| Rate for Payer: Mclaren Commercial |
$465.30
|
| Rate for Payer: Mclaren Medicaid |
$305.85
|
| Rate for Payer: Mclaren Medicare |
$305.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$321.14
|
| Rate for Payer: Meridian Medicaid |
$167.97
|
| Rate for Payer: MI Amish Medical Board Commercial |
$351.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$336.44
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$439.45
|
| Rate for Payer: Nomi Health Commercial |
$423.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.75
|
| Rate for Payer: PACE Medicare |
$290.56
|
| Rate for Payer: PACE SWMI |
$305.85
|
| Rate for Payer: PHP Commercial |
$336.44
|
| Rate for Payer: PHP Medicaid |
$163.94
|
| Rate for Payer: PHP Medicare Advantage |
$305.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$159.96
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$453.00
|
| Rate for Payer: Priority Health Medicare |
$305.85
|
| Rate for Payer: Priority Health Narrow Network |
$362.42
|
| Rate for Payer: Railroad Medicare Medicare |
$305.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$454.96
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$305.85
|
| Rate for Payer: UHC Exchange |
$474.07
|
| Rate for Payer: UHC Medicaid |
$159.96
|
| Rate for Payer: UHCCP DNSP |
$305.85
|
| Rate for Payer: UHCCP Medicaid |
$159.96
|
| Rate for Payer: VA VA |
$305.85
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
HCPCS 64405
|
| Min. Negotiated Rate |
$29.39 |
| Max. Negotiated Rate |
$387.75 |
| Rate for Payer: Aetna Commercial |
$62.00
|
| Rate for Payer: Aetna Medicare |
$46.27
|
| Rate for Payer: BCBS Complete |
$30.86
|
| Rate for Payer: BCBS MAPPO |
$46.27
|
| Rate for Payer: BCN Commercial |
$79.18
|
| Rate for Payer: BCN Medicare Advantage |
$46.27
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cash Price |
$413.60
|
| Rate for Payer: Cofinity Commercial |
$66.63
|
| Rate for Payer: Cofinity Commercial |
$62.00
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.27
|
| Rate for Payer: Healthscope Commercial |
$55.52
|
| Rate for Payer: Healthscope Whirlpool |
$55.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$48.58
|
| Rate for Payer: Meridian Medicaid |
$30.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$50.90
|
| Rate for Payer: Nomi Health Commercial |
$55.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$387.75
|
| Rate for Payer: PACE SWMI |
$46.27
|
| Rate for Payer: PHP Medicare Advantage |
$46.27
|
| Rate for Payer: Priority Health Choice Medicaid |
$29.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$91.96
|
| Rate for Payer: Priority Health Medicare |
$46.27
|
| Rate for Payer: Priority Health Narrow Network |
$91.96
|
| Rate for Payer: Railroad Medicare Medicare |
$46.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.18
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.27
|
| Rate for Payer: UHC Exchange |
$95.18
|
| Rate for Payer: UHC Medicaid |
$29.39
|
| Rate for Payer: UHCCP DNSP |
$46.27
|
| Rate for Payer: UHCCP Medicaid |
$29.39
|
|
|
PR INJECTION AA&/STRD ILIOINGUINAL IH NERVES
|
Professional
|
Both
|
$689.00
|
|
|
Service Code
|
HCPCS 64425
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$516.75 |
| Rate for Payer: Aetna Commercial |
$65.57
|
| Rate for Payer: Aetna Medicare |
$48.93
|
| Rate for Payer: BCBS Complete |
$33.33
|
| Rate for Payer: BCBS MAPPO |
$48.93
|
| Rate for Payer: BCN Commercial |
$81.17
|
| Rate for Payer: BCN Medicare Advantage |
$48.93
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cash Price |
$551.20
|
| Rate for Payer: Cofinity Commercial |
$70.46
|
| Rate for Payer: Cofinity Commercial |
$65.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.93
|
| Rate for Payer: Healthscope Commercial |
$58.72
|
| Rate for Payer: Healthscope Whirlpool |
$58.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$51.38
|
| Rate for Payer: Meridian Medicaid |
$33.33
|
| Rate for Payer: Molina Medicare/Medicaid |
$53.82
|
| Rate for Payer: Nomi Health Commercial |
$58.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$516.75
|
| Rate for Payer: PACE SWMI |
$48.93
|
| Rate for Payer: PHP Medicare Advantage |
$48.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.74
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$94.27
|
| Rate for Payer: Priority Health Medicare |
$48.93
|
| Rate for Payer: Priority Health Narrow Network |
$94.27
|
| Rate for Payer: Railroad Medicare Medicare |
$48.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48.93
|
| Rate for Payer: UHC Exchange |
$97.86
|
| Rate for Payer: UHC Medicaid |
$31.74
|
| Rate for Payer: UHCCP DNSP |
$48.93
|
| Rate for Payer: UHCCP Medicaid |
$31.74
|
|
|
PR INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
HCPCS 64421
|
| Min. Negotiated Rate |
$13.85 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Aetna Commercial |
$28.96
|
| Rate for Payer: Aetna Medicare |
$21.61
|
| Rate for Payer: BCBS Complete |
$14.54
|
| Rate for Payer: BCBS MAPPO |
$21.61
|
| Rate for Payer: BCN Commercial |
$36.35
|
| Rate for Payer: BCN Medicare Advantage |
$21.61
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cofinity Commercial |
$31.12
|
| Rate for Payer: Cofinity Commercial |
$28.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$21.61
|
| Rate for Payer: Healthscope Commercial |
$25.93
|
| Rate for Payer: Healthscope Whirlpool |
$25.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$22.69
|
| Rate for Payer: Meridian Medicaid |
$14.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$23.77
|
| Rate for Payer: Nomi Health Commercial |
$25.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$157.50
|
| Rate for Payer: PACE SWMI |
$21.61
|
| Rate for Payer: PHP Medicare Advantage |
$21.61
|
| Rate for Payer: Priority Health Choice Medicaid |
$13.85
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$42.22
|
| Rate for Payer: Priority Health Medicare |
$21.61
|
| Rate for Payer: Priority Health Narrow Network |
$42.22
|
| Rate for Payer: Railroad Medicare Medicare |
$21.61
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$44.87
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$21.61
|
| Rate for Payer: UHC Exchange |
$44.87
|
| Rate for Payer: UHC Medicaid |
$13.85
|
| Rate for Payer: UHCCP DNSP |
$21.61
|
| Rate for Payer: UHCCP Medicaid |
$13.85
|
|
|
PR INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
HCPCS 64420
|
| Min. Negotiated Rate |
$33.44 |
| Max. Negotiated Rate |
$169.50 |
| Rate for Payer: Aetna Commercial |
$69.12
|
| Rate for Payer: Aetna Medicare |
$51.58
|
| Rate for Payer: BCBS Complete |
$35.11
|
| Rate for Payer: BCBS MAPPO |
$51.58
|
| Rate for Payer: BCN Commercial |
$87.65
|
| Rate for Payer: BCN Medicare Advantage |
$51.58
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cash Price |
$180.80
|
| Rate for Payer: Cofinity Commercial |
$74.28
|
| Rate for Payer: Cofinity Commercial |
$69.12
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.58
|
| Rate for Payer: Healthscope Commercial |
$61.90
|
| Rate for Payer: Healthscope Whirlpool |
$61.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$54.16
|
| Rate for Payer: Meridian Medicaid |
$35.11
|
| Rate for Payer: Molina Medicare/Medicaid |
$56.74
|
| Rate for Payer: Nomi Health Commercial |
$61.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$169.50
|
| Rate for Payer: PACE SWMI |
$51.58
|
| Rate for Payer: PHP Medicare Advantage |
$51.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.44
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$101.80
|
| Rate for Payer: Priority Health Medicare |
$51.58
|
| Rate for Payer: Priority Health Narrow Network |
$101.80
|
| Rate for Payer: Railroad Medicare Medicare |
$51.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$105.17
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$51.58
|
| Rate for Payer: UHC Exchange |
$105.17
|
| Rate for Payer: UHC Medicaid |
$33.44
|
| Rate for Payer: UHCCP DNSP |
$51.58
|
| Rate for Payer: UHCCP Medicaid |
$33.44
|
|
|
PR INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG
|
Professional
|
Both
|
$426.00
|
|
|
Service Code
|
HCPCS 64451
|
| Min. Negotiated Rate |
$46.22 |
| Max. Negotiated Rate |
$319.50 |
| Rate for Payer: Aetna Commercial |
$95.78
|
| Rate for Payer: Aetna Medicare |
$71.48
|
| Rate for Payer: BCBS Complete |
$48.53
|
| Rate for Payer: BCBS MAPPO |
$71.48
|
| Rate for Payer: BCN Commercial |
$122.50
|
| Rate for Payer: BCN Medicare Advantage |
$71.48
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cofinity Commercial |
$95.78
|
| Rate for Payer: Cofinity Commercial |
$102.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$71.48
|
| Rate for Payer: Healthscope Commercial |
$85.78
|
| Rate for Payer: Healthscope Whirlpool |
$85.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$75.05
|
| Rate for Payer: Meridian Medicaid |
$48.53
|
| Rate for Payer: Molina Medicare/Medicaid |
$78.63
|
| Rate for Payer: Nomi Health Commercial |
$85.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$319.50
|
| Rate for Payer: PACE SWMI |
$71.48
|
| Rate for Payer: PHP Medicare Advantage |
$71.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$142.28
|
| Rate for Payer: Priority Health Medicare |
$71.48
|
| Rate for Payer: Priority Health Narrow Network |
$142.28
|
| Rate for Payer: Railroad Medicare Medicare |
$71.48
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$140.49
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$71.48
|
| Rate for Payer: UHC Exchange |
$140.49
|
| Rate for Payer: UHC Medicaid |
$46.22
|
| Rate for Payer: UHCCP DNSP |
$71.48
|
| Rate for Payer: UHCCP Medicaid |
$46.22
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Professional
|
Both
|
$267.00
|
|
|
Service Code
|
HCPCS 64450
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$200.25 |
| Rate for Payer: Aetna Commercial |
$50.52
|
| Rate for Payer: Aetna Medicare |
$37.70
|
| Rate for Payer: BCBS Complete |
$25.73
|
| Rate for Payer: BCBS MAPPO |
$37.70
|
| Rate for Payer: BCN Commercial |
$48.69
|
| Rate for Payer: BCN Medicare Advantage |
$37.70
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cash Price |
$213.60
|
| Rate for Payer: Cofinity Commercial |
$54.29
|
| Rate for Payer: Cofinity Commercial |
$50.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$37.70
|
| Rate for Payer: Healthscope Commercial |
$45.24
|
| Rate for Payer: Healthscope Whirlpool |
$45.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$39.59
|
| Rate for Payer: Meridian Medicaid |
$25.73
|
| Rate for Payer: Molina Medicare/Medicaid |
$41.47
|
| Rate for Payer: Nomi Health Commercial |
$45.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$200.25
|
| Rate for Payer: PACE SWMI |
$37.70
|
| Rate for Payer: PHP Medicare Advantage |
$37.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.50
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$71.72
|
| Rate for Payer: Priority Health Medicare |
$37.70
|
| Rate for Payer: Priority Health Narrow Network |
$71.72
|
| Rate for Payer: Railroad Medicare Medicare |
$37.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$75.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$37.70
|
| Rate for Payer: UHC Exchange |
$75.15
|
| Rate for Payer: UHC Medicaid |
$24.50
|
| Rate for Payer: UHCCP DNSP |
$37.70
|
| Rate for Payer: UHCCP Medicaid |
$24.50
|
|
|
PR INJECTION AA&/STRD PARACERVICAL NERVE
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
HCPCS 64435
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna Commercial |
$51.50
|
| Rate for Payer: Aetna Medicare |
$38.43
|
| Rate for Payer: BCBS Complete |
$25.95
|
| Rate for Payer: BCBS MAPPO |
$38.43
|
| Rate for Payer: BCN Commercial |
$65.23
|
| Rate for Payer: BCN Medicare Advantage |
$38.43
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cofinity Commercial |
$55.34
|
| Rate for Payer: Cofinity Commercial |
$51.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.43
|
| Rate for Payer: Healthscope Commercial |
$46.12
|
| Rate for Payer: Healthscope Whirlpool |
$46.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.35
|
| Rate for Payer: Meridian Medicaid |
$25.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.27
|
| Rate for Payer: Nomi Health Commercial |
$46.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$225.00
|
| Rate for Payer: PACE SWMI |
$38.43
|
| Rate for Payer: PHP Medicare Advantage |
$38.43
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$75.76
|
| Rate for Payer: Priority Health Medicare |
$38.43
|
| Rate for Payer: Priority Health Narrow Network |
$75.76
|
| Rate for Payer: Railroad Medicare Medicare |
$38.43
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.98
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.43
|
| Rate for Payer: UHC Exchange |
$76.98
|
| Rate for Payer: UHC Medicaid |
$24.71
|
| Rate for Payer: UHCCP DNSP |
$38.43
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
|
|
PR INJECTION AA&/STRD PUDENDAL NERVE
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
HCPCS 64430
|
| Min. Negotiated Rate |
$31.10 |
| Max. Negotiated Rate |
$197.25 |
| Rate for Payer: Aetna Commercial |
$64.53
|
| Rate for Payer: Aetna Medicare |
$48.16
|
| Rate for Payer: BCBS Complete |
$32.66
|
| Rate for Payer: BCBS MAPPO |
$48.16
|
| Rate for Payer: BCN Commercial |
$82.17
|
| Rate for Payer: BCN Medicare Advantage |
$48.16
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cash Price |
$210.40
|
| Rate for Payer: Cofinity Commercial |
$69.35
|
| Rate for Payer: Cofinity Commercial |
$64.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$48.16
|
| Rate for Payer: Healthscope Commercial |
$57.79
|
| Rate for Payer: Healthscope Whirlpool |
$57.79
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.57
|
| Rate for Payer: Meridian Medicaid |
$32.66
|
| Rate for Payer: Molina Medicare/Medicaid |
$52.98
|
| Rate for Payer: Nomi Health Commercial |
$57.79
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$197.25
|
| Rate for Payer: PACE SWMI |
$48.16
|
| Rate for Payer: PHP Medicare Advantage |
$48.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$31.10
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$95.43
|
| Rate for Payer: Priority Health Medicare |
$48.16
|
| Rate for Payer: Priority Health Narrow Network |
$95.43
|
| Rate for Payer: Railroad Medicare Medicare |
$48.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$97.28
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$48.16
|
| Rate for Payer: UHC Exchange |
$97.28
|
| Rate for Payer: UHC Medicaid |
$31.10
|
| Rate for Payer: UHCCP DNSP |
$48.16
|
| Rate for Payer: UHCCP Medicaid |
$31.10
|
|
|
PR INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
HCPCS 64445
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$209.25 |
| Rate for Payer: Aetna Commercial |
$87.65
|
| Rate for Payer: Aetna Medicare |
$65.41
|
| Rate for Payer: BCBS Complete |
$44.28
|
| Rate for Payer: BCBS MAPPO |
$65.41
|
| Rate for Payer: BCN Commercial |
$84.82
|
| Rate for Payer: BCN Medicare Advantage |
$65.41
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cofinity Commercial |
$94.19
|
| Rate for Payer: Cofinity Commercial |
$87.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$65.41
|
| Rate for Payer: Healthscope Commercial |
$78.49
|
| Rate for Payer: Healthscope Whirlpool |
$78.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$68.68
|
| Rate for Payer: Meridian Medicaid |
$44.28
|
| Rate for Payer: Molina Medicare/Medicaid |
$71.95
|
| Rate for Payer: Nomi Health Commercial |
$78.49
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$209.25
|
| Rate for Payer: PACE SWMI |
$65.41
|
| Rate for Payer: PHP Medicare Advantage |
$65.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$42.17
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$124.94
|
| Rate for Payer: Priority Health Medicare |
$65.41
|
| Rate for Payer: Priority Health Narrow Network |
$124.94
|
| Rate for Payer: Railroad Medicare Medicare |
$65.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.86
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$65.41
|
| Rate for Payer: UHC Exchange |
$94.86
|
| Rate for Payer: UHC Medicaid |
$42.17
|
| Rate for Payer: UHCCP DNSP |
$65.41
|
| Rate for Payer: UHCCP Medicaid |
$42.17
|
|
|
PR INJECTION AA&/STRD SUPRASCAPULAR NERVE
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
HCPCS 64418
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$139.50 |
| Rate for Payer: Aetna Commercial |
$64.08
|
| Rate for Payer: Aetna Medicare |
$47.82
|
| Rate for Payer: BCBS Complete |
$32.20
|
| Rate for Payer: BCBS MAPPO |
$47.82
|
| Rate for Payer: BCN Commercial |
$82.66
|
| Rate for Payer: BCN Medicare Advantage |
$47.82
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cofinity Commercial |
$68.86
|
| Rate for Payer: Cofinity Commercial |
$64.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$47.82
|
| Rate for Payer: Healthscope Commercial |
$57.38
|
| Rate for Payer: Healthscope Whirlpool |
$57.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$50.21
|
| Rate for Payer: Meridian Medicaid |
$32.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$52.60
|
| Rate for Payer: Nomi Health Commercial |
$57.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$139.50
|
| Rate for Payer: PACE SWMI |
$47.82
|
| Rate for Payer: PHP Medicare Advantage |
$47.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.67
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$96.02
|
| Rate for Payer: Priority Health Medicare |
$47.82
|
| Rate for Payer: Priority Health Narrow Network |
$96.02
|
| Rate for Payer: Railroad Medicare Medicare |
$47.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$47.82
|
| Rate for Payer: UHC Exchange |
$100.73
|
| Rate for Payer: UHC Medicaid |
$30.67
|
| Rate for Payer: UHCCP DNSP |
$47.82
|
| Rate for Payer: UHCCP Medicaid |
$30.67
|
|
|
PR INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
HCPCS 64400
|
| Min. Negotiated Rate |
$30.25 |
| Max. Negotiated Rate |
$201.75 |
| Rate for Payer: Aetna Commercial |
$62.90
|
| Rate for Payer: Aetna Medicare |
$46.94
|
| Rate for Payer: BCBS Complete |
$31.76
|
| Rate for Payer: BCBS MAPPO |
$46.94
|
| Rate for Payer: BCN Commercial |
$78.18
|
| Rate for Payer: BCN Medicare Advantage |
$46.94
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cash Price |
$215.20
|
| Rate for Payer: Cofinity Commercial |
$67.59
|
| Rate for Payer: Cofinity Commercial |
$62.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$46.94
|
| Rate for Payer: Healthscope Commercial |
$56.33
|
| Rate for Payer: Healthscope Whirlpool |
$56.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$49.29
|
| Rate for Payer: Meridian Medicaid |
$31.76
|
| Rate for Payer: Molina Medicare/Medicaid |
$51.63
|
| Rate for Payer: Nomi Health Commercial |
$56.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$201.75
|
| Rate for Payer: PACE SWMI |
$46.94
|
| Rate for Payer: PHP Medicare Advantage |
$46.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$30.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$90.80
|
| Rate for Payer: Priority Health Medicare |
$46.94
|
| Rate for Payer: Priority Health Narrow Network |
$90.80
|
| Rate for Payer: Railroad Medicare Medicare |
$46.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$46.94
|
| Rate for Payer: UHC Exchange |
$87.70
|
| Rate for Payer: UHC Medicaid |
$30.25
|
| Rate for Payer: UHCCP DNSP |
$46.94
|
| Rate for Payer: UHCCP Medicaid |
$30.25
|
|
|
PR INJECTION AA&/STRD VAGUS NERVE
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS 64408
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$129.75 |
| Rate for Payer: Aetna Commercial |
$51.31
|
| Rate for Payer: Aetna Medicare |
$38.29
|
| Rate for Payer: BCBS Complete |
$25.95
|
| Rate for Payer: BCBS MAPPO |
$38.29
|
| Rate for Payer: BCN Commercial |
$67.72
|
| Rate for Payer: BCN Medicare Advantage |
$38.29
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cash Price |
$138.40
|
| Rate for Payer: Cofinity Commercial |
$55.14
|
| Rate for Payer: Cofinity Commercial |
$51.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$38.29
|
| Rate for Payer: Healthscope Commercial |
$45.95
|
| Rate for Payer: Healthscope Whirlpool |
$45.95
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$40.20
|
| Rate for Payer: Meridian Medicaid |
$25.95
|
| Rate for Payer: Molina Medicare/Medicaid |
$42.12
|
| Rate for Payer: Nomi Health Commercial |
$45.95
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$129.75
|
| Rate for Payer: PACE SWMI |
$38.29
|
| Rate for Payer: PHP Medicare Advantage |
$38.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$24.71
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$78.66
|
| Rate for Payer: Priority Health Medicare |
$38.29
|
| Rate for Payer: Priority Health Narrow Network |
$78.66
|
| Rate for Payer: Railroad Medicare Medicare |
$38.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$76.30
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$38.29
|
| Rate for Payer: UHC Exchange |
$76.30
|
| Rate for Payer: UHC Medicaid |
$24.71
|
| Rate for Payer: UHCCP DNSP |
$38.29
|
| Rate for Payer: UHCCP Medicaid |
$24.71
|
|
|
PR INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
HCPCS 49400
|
| Min. Negotiated Rate |
$50.06 |
| Max. Negotiated Rate |
$237.00 |
| Rate for Payer: Aetna Commercial |
$105.19
|
| Rate for Payer: Aetna Medicare |
$78.50
|
| Rate for Payer: BCBS Complete |
$52.56
|
| Rate for Payer: BCBS MAPPO |
$78.50
|
| Rate for Payer: BCN Commercial |
$132.96
|
| Rate for Payer: BCN Medicare Advantage |
$78.50
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cash Price |
$252.80
|
| Rate for Payer: Cofinity Commercial |
$113.04
|
| Rate for Payer: Cofinity Commercial |
$105.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$78.50
|
| Rate for Payer: Healthscope Commercial |
$94.20
|
| Rate for Payer: Healthscope Whirlpool |
$94.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$82.42
|
| Rate for Payer: Meridian Medicaid |
$52.56
|
| Rate for Payer: Molina Medicare/Medicaid |
$86.35
|
| Rate for Payer: Nomi Health Commercial |
$94.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$237.00
|
| Rate for Payer: PACE SWMI |
$78.50
|
| Rate for Payer: PHP Medicare Advantage |
$78.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$50.06
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$162.01
|
| Rate for Payer: Priority Health Medicare |
$78.50
|
| Rate for Payer: Priority Health Narrow Network |
$162.01
|
| Rate for Payer: Railroad Medicare Medicare |
$78.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$165.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$78.50
|
| Rate for Payer: UHC Exchange |
$165.13
|
| Rate for Payer: UHC Medicaid |
$50.06
|
| Rate for Payer: UHCCP DNSP |
$78.50
|
| Rate for Payer: UHCCP Medicaid |
$50.06
|
|
|
PR INJECTION ANES AGENT SPHENOPALATINE GANGLION
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
HCPCS 64505
|
| Min. Negotiated Rate |
$62.20 |
| Max. Negotiated Rate |
$185.66 |
| Rate for Payer: Aetna Commercial |
$128.17
|
| Rate for Payer: Aetna Medicare |
$95.65
|
| Rate for Payer: BCBS Complete |
$65.31
|
| Rate for Payer: BCBS MAPPO |
$95.65
|
| Rate for Payer: BCN Commercial |
$159.85
|
| Rate for Payer: BCN Medicare Advantage |
$95.65
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cash Price |
$147.20
|
| Rate for Payer: Cofinity Commercial |
$137.74
|
| Rate for Payer: Cofinity Commercial |
$128.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$95.65
|
| Rate for Payer: Healthscope Commercial |
$114.78
|
| Rate for Payer: Healthscope Whirlpool |
$114.78
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$100.43
|
| Rate for Payer: Meridian Medicaid |
$65.31
|
| Rate for Payer: Molina Medicare/Medicaid |
$105.22
|
| Rate for Payer: Nomi Health Commercial |
$114.78
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$138.00
|
| Rate for Payer: PACE SWMI |
$95.65
|
| Rate for Payer: PHP Medicare Advantage |
$95.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$62.20
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$185.66
|
| Rate for Payer: Priority Health Medicare |
$95.65
|
| Rate for Payer: Priority Health Narrow Network |
$185.66
|
| Rate for Payer: Railroad Medicare Medicare |
$95.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$169.04
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$95.65
|
| Rate for Payer: UHC Exchange |
$169.04
|
| Rate for Payer: UHC Medicaid |
$62.20
|
| Rate for Payer: UHCCP DNSP |
$95.65
|
| Rate for Payer: UHCCP Medicaid |
$62.20
|
|
|
PR INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
HCPCS 64520
|
| Min. Negotiated Rate |
$48.99 |
| Max. Negotiated Rate |
$159.00 |
| Rate for Payer: Aetna Commercial |
$100.29
|
| Rate for Payer: Aetna Commercial |
$100.29
|
| Rate for Payer: Aetna Medicare |
$74.84
|
| Rate for Payer: Aetna Medicare |
$74.84
|
| Rate for Payer: BCBS Complete |
$51.44
|
| Rate for Payer: BCBS Complete |
$51.44
|
| Rate for Payer: BCBS MAPPO |
$74.84
|
| Rate for Payer: BCBS MAPPO |
$74.84
|
| Rate for Payer: BCN Commercial |
$126.98
|
| Rate for Payer: BCN Commercial |
$126.98
|
| Rate for Payer: BCN Medicare Advantage |
$74.84
|
| Rate for Payer: BCN Medicare Advantage |
$74.84
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$169.60
|
| Rate for Payer: Cash Price |
$294.40
|
| Rate for Payer: Cofinity Commercial |
$100.29
|
| Rate for Payer: Cofinity Commercial |
$107.77
|
| Rate for Payer: Cofinity Commercial |
$100.29
|
| Rate for Payer: Cofinity Commercial |
$107.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$74.84
|
| Rate for Payer: Healthscope Commercial |
$89.81
|
| Rate for Payer: Healthscope Commercial |
$89.81
|
| Rate for Payer: Healthscope Whirlpool |
$89.81
|
| Rate for Payer: Healthscope Whirlpool |
$89.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$78.58
|
| Rate for Payer: Meridian Medicaid |
$51.44
|
| Rate for Payer: Meridian Medicaid |
$51.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$82.32
|
| Rate for Payer: Nomi Health Commercial |
$89.81
|
| Rate for Payer: Nomi Health Commercial |
$89.81
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$159.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$276.00
|
| Rate for Payer: PACE SWMI |
$74.84
|
| Rate for Payer: PACE SWMI |
$74.84
|
| Rate for Payer: PHP Medicare Advantage |
$74.84
|
| Rate for Payer: PHP Medicare Advantage |
$74.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$48.99
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$147.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$147.48
|
| Rate for Payer: Priority Health Medicare |
$74.84
|
| Rate for Payer: Priority Health Medicare |
$74.84
|
| Rate for Payer: Priority Health Narrow Network |
$147.48
|
| Rate for Payer: Priority Health Narrow Network |
$147.48
|
| Rate for Payer: Railroad Medicare Medicare |
$74.84
|
| Rate for Payer: Railroad Medicare Medicare |
$74.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.65
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$144.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$74.84
|
| Rate for Payer: UHC Exchange |
$144.65
|
| Rate for Payer: UHC Exchange |
$144.65
|
| Rate for Payer: UHC Medicaid |
$48.99
|
| Rate for Payer: UHC Medicaid |
$48.99
|
| Rate for Payer: UHCCP DNSP |
$74.84
|
| Rate for Payer: UHCCP DNSP |
$74.84
|
| Rate for Payer: UHCCP Medicaid |
$48.99
|
| Rate for Payer: UHCCP Medicaid |
$48.99
|
|
|
PR INJECTION, BUPIVICAINE HYDRO
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS S0020
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$7.50 |
| Rate for Payer: BCBS Complete |
$4.00
|
| Rate for Payer: Cash Price |
$8.00
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7.50
|
|
|
PR INJECTION CORPORA CAVERNOSA PHARMACOLOGIC AGENT
|
Professional
|
Both
|
$180.00
|
|
|
Service Code
|
HCPCS 54235
|
| Min. Negotiated Rate |
$43.45 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Aetna Commercial |
$89.32
|
| Rate for Payer: Aetna Medicare |
$66.66
|
| Rate for Payer: BCBS Complete |
$45.62
|
| Rate for Payer: BCBS MAPPO |
$66.66
|
| Rate for Payer: BCN Commercial |
$111.55
|
| Rate for Payer: BCN Medicare Advantage |
$66.66
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cofinity Commercial |
$89.32
|
| Rate for Payer: Cofinity Commercial |
$95.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$66.66
|
| Rate for Payer: Healthscope Commercial |
$79.99
|
| Rate for Payer: Healthscope Whirlpool |
$79.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$69.99
|
| Rate for Payer: Meridian Medicaid |
$45.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$73.33
|
| Rate for Payer: Nomi Health Commercial |
$79.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$135.00
|
| Rate for Payer: PACE SWMI |
$66.66
|
| Rate for Payer: PHP Medicare Advantage |
$66.66
|
| Rate for Payer: Priority Health Choice Medicaid |
$43.45
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$121.52
|
| Rate for Payer: Priority Health Medicare |
$66.66
|
| Rate for Payer: Priority Health Narrow Network |
$121.52
|
| Rate for Payer: Railroad Medicare Medicare |
$66.66
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$127.70
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$66.66
|
| Rate for Payer: UHC Exchange |
$127.70
|
| Rate for Payer: UHC Medicaid |
$43.45
|
| Rate for Payer: UHCCP DNSP |
$66.66
|
| Rate for Payer: UHCCP Medicaid |
$43.45
|
|
|
PR INJECTION ENZYME PALMAR FASCIAL CORD
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
HCPCS 20527
|
| Min. Negotiated Rate |
$37.28 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Aetna Commercial |
$77.16
|
| Rate for Payer: Aetna Medicare |
$57.58
|
| Rate for Payer: BCBS Complete |
$39.14
|
| Rate for Payer: BCBS MAPPO |
$57.58
|
| Rate for Payer: BCN Commercial |
$99.10
|
| Rate for Payer: BCN Medicare Advantage |
$57.58
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cofinity Commercial |
$82.92
|
| Rate for Payer: Cofinity Commercial |
$77.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$57.58
|
| Rate for Payer: Healthscope Commercial |
$69.10
|
| Rate for Payer: Healthscope Whirlpool |
$69.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$60.46
|
| Rate for Payer: Meridian Medicaid |
$39.14
|
| Rate for Payer: Molina Medicare/Medicaid |
$63.34
|
| Rate for Payer: Nomi Health Commercial |
$69.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$128.25
|
| Rate for Payer: PACE SWMI |
$57.58
|
| Rate for Payer: PHP Medicare Advantage |
$57.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$105.93
|
| Rate for Payer: Priority Health Medicare |
$57.58
|
| Rate for Payer: Priority Health Narrow Network |
$105.93
|
| Rate for Payer: Railroad Medicare Medicare |
$57.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$115.47
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$57.58
|
| Rate for Payer: UHC Exchange |
$115.47
|
| Rate for Payer: UHC Medicaid |
$37.28
|
| Rate for Payer: UHCCP DNSP |
$57.58
|
| Rate for Payer: UHCCP Medicaid |
$37.28
|
|
|
PR INJECTION EPIDURAL BLOOD/CLOT PATCH
|
Professional
|
Both
|
$485.00
|
|
|
Service Code
|
HCPCS 62273
|
| Min. Negotiated Rate |
$65.18 |
| Max. Negotiated Rate |
$363.75 |
| Rate for Payer: Aetna Commercial |
$135.25
|
| Rate for Payer: Aetna Medicare |
$100.93
|
| Rate for Payer: BCBS Complete |
$68.44
|
| Rate for Payer: BCBS MAPPO |
$100.93
|
| Rate for Payer: BCN Commercial |
$185.46
|
| Rate for Payer: BCN Medicare Advantage |
$100.93
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cash Price |
$388.00
|
| Rate for Payer: Cofinity Commercial |
$145.34
|
| Rate for Payer: Cofinity Commercial |
$135.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$100.93
|
| Rate for Payer: Healthscope Commercial |
$121.12
|
| Rate for Payer: Healthscope Whirlpool |
$121.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$105.98
|
| Rate for Payer: Meridian Medicaid |
$68.44
|
| Rate for Payer: Molina Medicare/Medicaid |
$111.02
|
| Rate for Payer: Nomi Health Commercial |
$121.12
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$363.75
|
| Rate for Payer: PACE SWMI |
$100.93
|
| Rate for Payer: PHP Medicare Advantage |
$100.93
|
| Rate for Payer: Priority Health Choice Medicaid |
$65.18
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Tiered Network |
$196.07
|
| Rate for Payer: Priority Health Medicare |
$100.93
|
| Rate for Payer: Priority Health Narrow Network |
$196.07
|
| Rate for Payer: Railroad Medicare Medicare |
$100.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$199.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$100.93
|
| Rate for Payer: UHC Exchange |
$199.79
|
| Rate for Payer: UHC Medicaid |
$65.18
|
| Rate for Payer: UHCCP DNSP |
$100.93
|
| Rate for Payer: UHCCP Medicaid |
$65.18
|
|
