|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
64454
|
| Min. Negotiated Rate |
$270.40 |
| Max. Negotiated Rate |
$416.00 |
| Rate for Payer: Aetna Commercial |
$374.40
|
| Rate for Payer: ASR ASR |
$403.52
|
| Rate for Payer: ASR Commercial |
$403.52
|
| Rate for Payer: BCBS Trust/PPO |
$339.00
|
| Rate for Payer: BCN Commercial |
$322.52
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$391.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.80
|
| Rate for Payer: Healthscope Commercial |
$416.00
|
| Rate for Payer: Healthscope Whirlpool |
$403.52
|
| Rate for Payer: Mclaren Commercial |
$374.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.60
|
| Rate for Payer: Nomi Health Commercial |
$341.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.40
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.08
|
|
|
PR INJECTION AA&/STRD GENICULAR NRV BRANCHES W/IMG
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT 64454
|
| Hospital Charge Code |
64454
|
| Min. Negotiated Rate |
$270.40 |
| Max. Negotiated Rate |
$1,051.71 |
| Rate for Payer: Aetna Commercial |
$374.40
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$403.52
|
| Rate for Payer: ASR Commercial |
$403.52
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$340.66
|
| Rate for Payer: BCN Commercial |
$322.52
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cash Price |
$332.80
|
| Rate for Payer: Cofinity Commercial |
$391.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$332.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$416.00
|
| Rate for Payer: Healthscope Whirlpool |
$403.52
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$374.40
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$353.60
|
| Rate for Payer: Nomi Health Commercial |
$341.12
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$270.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$715.54
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$572.43
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$366.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
64405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$326.30 |
| Max. Negotiated Rate |
$502.00 |
| Rate for Payer: Aetna Commercial |
$451.80
|
| Rate for Payer: ASR ASR |
$486.94
|
| Rate for Payer: ASR Commercial |
$486.94
|
| Rate for Payer: BCBS Trust/PPO |
$409.08
|
| Rate for Payer: BCN Commercial |
$389.20
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cofinity Commercial |
$471.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.60
|
| Rate for Payer: Healthscope Commercial |
$502.00
|
| Rate for Payer: Healthscope Whirlpool |
$486.94
|
| Rate for Payer: Mclaren Commercial |
$451.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.70
|
| Rate for Payer: Nomi Health Commercial |
$411.64
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$441.76
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
HCPCS 64405
|
| Hospital Charge Code |
64405
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$326.30 |
| Rate for Payer: Aetna Commercial |
$69.32
|
| Rate for Payer: Aetna Medicare |
$251.00
|
| Rate for Payer: BCBS Complete |
$35.56
|
| Rate for Payer: BCBS Trust/PPO |
$262.57
|
| Rate for Payer: BCN Commercial |
$109.46
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Meridian Medicaid |
$35.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.85
|
| Rate for Payer: Priority Health Narrow Network |
$89.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.34
|
| Rate for Payer: UHC Exchange |
$91.34
|
| Rate for Payer: UHCCP Medicaid |
$33.87
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
64405
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.02 |
| Max. Negotiated Rate |
$502.00 |
| Rate for Payer: Aetna Commercial |
$451.80
|
| Rate for Payer: Aetna Medicare |
$289.22
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$361.52
|
| Rate for Payer: Amish Plain Church Group Commercial |
$361.52
|
| Rate for Payer: ASR ASR |
$486.94
|
| Rate for Payer: ASR Commercial |
$486.94
|
| Rate for Payer: BCBS Complete |
$162.77
|
| Rate for Payer: BCBS MAPPO |
$289.22
|
| Rate for Payer: BCBS Trust/PPO |
$411.09
|
| Rate for Payer: BCN Commercial |
$389.20
|
| Rate for Payer: BCN Medicare Advantage |
$289.22
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cofinity Commercial |
$471.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$401.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$289.22
|
| Rate for Payer: Healthscope Commercial |
$502.00
|
| Rate for Payer: Healthscope Whirlpool |
$486.94
|
| Rate for Payer: Humana Choice PPO Medicare |
$289.22
|
| Rate for Payer: Mclaren Commercial |
$451.80
|
| Rate for Payer: Mclaren Medicaid |
$155.02
|
| Rate for Payer: Mclaren Medicare |
$289.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$303.68
|
| Rate for Payer: Meridian Medicaid |
$162.77
|
| Rate for Payer: MI Amish Medical Board Commercial |
$332.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$426.70
|
| Rate for Payer: Nomi Health Commercial |
$411.64
|
| Rate for Payer: PACE Medicare |
$274.76
|
| Rate for Payer: PACE SWMI |
$289.22
|
| Rate for Payer: PHP Commercial |
$318.14
|
| Rate for Payer: PHP Medicaid |
$155.02
|
| Rate for Payer: PHP Medicare Advantage |
$289.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$155.02
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$439.85
|
| Rate for Payer: Priority Health Medicare |
$289.22
|
| Rate for Payer: Priority Health Narrow Network |
$351.90
|
| Rate for Payer: Railroad Medicare Medicare |
$289.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$441.76
|
| Rate for Payer: UHC Dual Complete DSNP |
$289.22
|
| Rate for Payer: UHC Exchange |
$448.29
|
| Rate for Payer: UHC Medicare Advantage |
$289.22
|
| Rate for Payer: UHCCP DNSP |
$289.22
|
| Rate for Payer: UHCCP Medicaid |
$155.02
|
| Rate for Payer: VA VA |
$289.22
|
|
|
PR INJECTION AA&/STRD GREATER OCCIPITAL NERVE
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
HCPCS 64405
|
| Min. Negotiated Rate |
$33.87 |
| Max. Negotiated Rate |
$326.30 |
| Rate for Payer: Aetna Commercial |
$69.32
|
| Rate for Payer: Aetna Medicare |
$251.00
|
| Rate for Payer: BCBS Complete |
$35.56
|
| Rate for Payer: BCBS Trust/PPO |
$262.57
|
| Rate for Payer: BCN Commercial |
$109.46
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Cash Price |
$401.60
|
| Rate for Payer: Meridian Medicaid |
$35.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$326.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$89.85
|
| Rate for Payer: Priority Health Narrow Network |
$89.85
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$91.34
|
| Rate for Payer: UHC Exchange |
$91.34
|
| Rate for Payer: UHCCP Medicaid |
$33.87
|
|
|
PR INJECTION AA&/STRD ILIOINGUINAL IH NERVES
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
HCPCS 64425
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$1,001.13 |
| Rate for Payer: Aetna Commercial |
$71.32
|
| Rate for Payer: Aetna Medicare |
$334.50
|
| Rate for Payer: BCBS Complete |
$36.46
|
| Rate for Payer: BCBS Trust/PPO |
$1,001.13
|
| Rate for Payer: BCN Commercial |
$161.75
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Cash Price |
$535.20
|
| Rate for Payer: Meridian Medicaid |
$36.46
|
| Rate for Payer: Priority Health Choice Medicaid |
$34.72
|
| Rate for Payer: Priority Health Cigna Priority Health |
$434.85
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.14
|
| Rate for Payer: Priority Health Narrow Network |
$92.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$111.01
|
| Rate for Payer: UHC Exchange |
$111.01
|
| Rate for Payer: UHCCP Medicaid |
$34.72
|
|
|
PR INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
HCPCS 64421
|
| Min. Negotiated Rate |
$15.55 |
| Max. Negotiated Rate |
$368.75 |
| Rate for Payer: Aetna Commercial |
$32.34
|
| Rate for Payer: Aetna Medicare |
$102.00
|
| Rate for Payer: BCBS Complete |
$16.33
|
| Rate for Payer: BCBS Trust/PPO |
$368.75
|
| Rate for Payer: BCN Commercial |
$47.89
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Cash Price |
$163.20
|
| Rate for Payer: Meridian Medicaid |
$16.33
|
| Rate for Payer: Priority Health Choice Medicaid |
$15.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$132.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$42.08
|
| Rate for Payer: Priority Health Narrow Network |
$42.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$107.92
|
| Rate for Payer: UHC Exchange |
$107.92
|
| Rate for Payer: UHCCP Medicaid |
$15.55
|
|
|
PR INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
HCPCS 64420
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$551.55 |
| Rate for Payer: Aetna Commercial |
$76.19
|
| Rate for Payer: Aetna Medicare |
$109.50
|
| Rate for Payer: BCBS Complete |
$39.36
|
| Rate for Payer: BCBS Trust/PPO |
$551.55
|
| Rate for Payer: BCN Commercial |
$142.21
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Cash Price |
$175.20
|
| Rate for Payer: Meridian Medicaid |
$39.36
|
| Rate for Payer: Priority Health Choice Medicaid |
$37.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$142.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$98.39
|
| Rate for Payer: Priority Health Narrow Network |
$98.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.81
|
| Rate for Payer: UHC Exchange |
$77.81
|
| Rate for Payer: UHCCP Medicaid |
$37.49
|
|
|
PR INJECTION AA&/STRD NERVES NRVTG SI JOINT W/IMG
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
HCPCS 64451
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$580.60 |
| Rate for Payer: Aetna Commercial |
$101.64
|
| Rate for Payer: Aetna Medicare |
$207.00
|
| Rate for Payer: BCBS Complete |
$55.02
|
| Rate for Payer: BCBS Trust/PPO |
$580.60
|
| Rate for Payer: BCN Commercial |
$333.28
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Meridian Medicaid |
$55.02
|
| Rate for Payer: Priority Health Choice Medicaid |
$52.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$269.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$138.20
|
| Rate for Payer: Priority Health Narrow Network |
$138.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.84
|
| Rate for Payer: UHC Exchange |
$100.84
|
| Rate for Payer: UHCCP Medicaid |
$52.40
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 64450
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$661.43 |
| Rate for Payer: Aetna Commercial |
$54.55
|
| Rate for Payer: Aetna Medicare |
$129.50
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS Trust/PPO |
$661.43
|
| Rate for Payer: BCN Commercial |
$87.96
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.09
|
| Rate for Payer: Priority Health Narrow Network |
$71.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.73
|
| Rate for Payer: UHC Exchange |
$81.73
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
HCPCS 64450
|
| Hospital Charge Code |
64450
|
| Min. Negotiated Rate |
$26.41 |
| Max. Negotiated Rate |
$661.43 |
| Rate for Payer: Aetna Commercial |
$54.55
|
| Rate for Payer: Aetna Medicare |
$129.50
|
| Rate for Payer: BCBS Complete |
$27.73
|
| Rate for Payer: BCBS Trust/PPO |
$661.43
|
| Rate for Payer: BCN Commercial |
$87.96
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Meridian Medicaid |
$27.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$26.41
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$71.09
|
| Rate for Payer: Priority Health Narrow Network |
$71.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$81.73
|
| Rate for Payer: UHC Exchange |
$81.73
|
| Rate for Payer: UHCCP Medicaid |
$26.41
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
64450
|
| Min. Negotiated Rate |
$168.35 |
| Max. Negotiated Rate |
$1,051.71 |
| Rate for Payer: Aetna Commercial |
$233.10
|
| Rate for Payer: Aetna Medicare |
$678.52
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$848.15
|
| Rate for Payer: Amish Plain Church Group Commercial |
$848.15
|
| Rate for Payer: ASR ASR |
$251.23
|
| Rate for Payer: ASR Commercial |
$251.23
|
| Rate for Payer: BCBS Complete |
$381.87
|
| Rate for Payer: BCBS MAPPO |
$678.52
|
| Rate for Payer: BCBS Trust/PPO |
$212.10
|
| Rate for Payer: BCN Commercial |
$200.80
|
| Rate for Payer: BCN Medicare Advantage |
$678.52
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$243.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$678.52
|
| Rate for Payer: Healthscope Commercial |
$259.00
|
| Rate for Payer: Healthscope Whirlpool |
$251.23
|
| Rate for Payer: Humana Choice PPO Medicare |
$678.52
|
| Rate for Payer: Mclaren Commercial |
$233.10
|
| Rate for Payer: Mclaren Medicaid |
$363.69
|
| Rate for Payer: Mclaren Medicare |
$678.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$712.45
|
| Rate for Payer: Meridian Medicaid |
$381.87
|
| Rate for Payer: MI Amish Medical Board Commercial |
$780.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.15
|
| Rate for Payer: Nomi Health Commercial |
$212.38
|
| Rate for Payer: PACE Medicare |
$644.59
|
| Rate for Payer: PACE SWMI |
$678.52
|
| Rate for Payer: PHP Commercial |
$746.37
|
| Rate for Payer: PHP Medicaid |
$363.69
|
| Rate for Payer: PHP Medicare Advantage |
$678.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$363.69
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$596.21
|
| Rate for Payer: Priority Health Medicare |
$678.52
|
| Rate for Payer: Priority Health Narrow Network |
$476.97
|
| Rate for Payer: Railroad Medicare Medicare |
$678.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.92
|
| Rate for Payer: UHC Dual Complete DSNP |
$678.52
|
| Rate for Payer: UHC Exchange |
$1,051.71
|
| Rate for Payer: UHC Medicare Advantage |
$678.52
|
| Rate for Payer: UHCCP DNSP |
$678.52
|
| Rate for Payer: UHCCP Medicaid |
$363.69
|
| Rate for Payer: VA VA |
$678.52
|
|
|
PR INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
64450
|
| Min. Negotiated Rate |
$168.35 |
| Max. Negotiated Rate |
$259.00 |
| Rate for Payer: Aetna Commercial |
$233.10
|
| Rate for Payer: ASR ASR |
$251.23
|
| Rate for Payer: ASR Commercial |
$251.23
|
| Rate for Payer: BCBS Trust/PPO |
$211.06
|
| Rate for Payer: BCN Commercial |
$200.80
|
| Rate for Payer: Cash Price |
$207.20
|
| Rate for Payer: Cofinity Commercial |
$243.46
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$207.20
|
| Rate for Payer: Healthscope Commercial |
$259.00
|
| Rate for Payer: Healthscope Whirlpool |
$251.23
|
| Rate for Payer: Mclaren Commercial |
$233.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.15
|
| Rate for Payer: Nomi Health Commercial |
$212.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$168.35
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$227.92
|
|
|
PR INJECTION AA&/STRD PARACERVICAL NERVE
|
Professional
|
Both
|
$291.00
|
|
|
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: Aetna Medicare |
$145.50
|
| Rate for Payer: BCBS Complete |
$29.30
|
| Rate for Payer: BCBS Trust/PPO |
$1,878.11
|
| Rate for Payer: BCN Commercial |
$118.75
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Cash Price |
$232.80
|
| Rate for Payer: Meridian Medicaid |
$29.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$27.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$189.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$74.51
|
| Rate for Payer: Priority Health Narrow Network |
$74.51
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.03
|
| Rate for Payer: UHC Exchange |
$100.03
|
| Rate for Payer: UHCCP Medicaid |
$27.90
|
|
|
PR INJECTION AA&/STRD PUDENDAL NERVE
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
HCPCS 64430
|
| Min. Negotiated Rate |
$35.15 |
| Max. Negotiated Rate |
$1,676.82 |
| Rate for Payer: Aetna Commercial |
$70.97
|
| Rate for Payer: Aetna Medicare |
$127.50
|
| Rate for Payer: BCBS Complete |
$36.91
|
| Rate for Payer: BCBS Trust/PPO |
$1,676.82
|
| Rate for Payer: BCN Commercial |
$144.16
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Meridian Medicaid |
$36.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$165.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$92.70
|
| Rate for Payer: Priority Health Narrow Network |
$92.70
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$100.46
|
| Rate for Payer: UHC Exchange |
$100.46
|
| Rate for Payer: UHCCP Medicaid |
$35.15
|
|
|
PR INJECTION AA&/STRD SCIATIC NERVE W/IMG GDN
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
HCPCS 64445
|
| Min. Negotiated Rate |
$46.01 |
| Max. Negotiated Rate |
$1,332.90 |
| Rate for Payer: Aetna Commercial |
$69.22
|
| Rate for Payer: Aetna Medicare |
$135.50
|
| Rate for Payer: BCBS Complete |
$48.31
|
| Rate for Payer: BCBS Trust/PPO |
$1,332.90
|
| Rate for Payer: BCN Commercial |
$189.26
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Cash Price |
$216.80
|
| Rate for Payer: Meridian Medicaid |
$48.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$46.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$176.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$121.71
|
| Rate for Payer: Priority Health Narrow Network |
$121.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$94.64
|
| Rate for Payer: UHC Exchange |
$94.64
|
| Rate for Payer: UHCCP Medicaid |
$46.01
|
|
|
PR INJECTION AA&/STRD SUPRASCAPULAR NERVE
|
Professional
|
Both
|
$181.00
|
|
|
Service Code
|
HCPCS 64418
|
| Min. Negotiated Rate |
$35.36 |
| Max. Negotiated Rate |
$359.77 |
| Rate for Payer: Aetna Commercial |
$74.30
|
| Rate for Payer: Aetna Medicare |
$90.50
|
| Rate for Payer: BCBS Complete |
$37.13
|
| Rate for Payer: BCBS Trust/PPO |
$359.77
|
| Rate for Payer: BCN Commercial |
$127.06
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Cash Price |
$144.80
|
| Rate for Payer: Meridian Medicaid |
$37.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$35.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$117.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$93.83
|
| Rate for Payer: Priority Health Narrow Network |
$93.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$86.14
|
| Rate for Payer: UHC Exchange |
$86.14
|
| Rate for Payer: UHCCP Medicaid |
$35.36
|
|
|
PR INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
HCPCS 64400
|
| Min. Negotiated Rate |
$33.44 |
| Max. Negotiated Rate |
$285.28 |
| Rate for Payer: Aetna Commercial |
$64.36
|
| Rate for Payer: Aetna Medicare |
$130.50
|
| Rate for Payer: BCBS Complete |
$35.11
|
| Rate for Payer: BCBS Trust/PPO |
$285.28
|
| Rate for Payer: BCN Commercial |
$164.20
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Meridian Medicaid |
$35.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$33.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$169.65
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$88.16
|
| Rate for Payer: Priority Health Narrow Network |
$88.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$77.05
|
| Rate for Payer: UHC Exchange |
$77.05
|
| Rate for Payer: UHCCP Medicaid |
$33.44
|
|
|
PR INJECTION AA&/STRD VAGUS NERVE
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
HCPCS 64408
|
| Min. Negotiated Rate |
$28.97 |
| Max. Negotiated Rate |
$416.83 |
| Rate for Payer: Aetna Commercial |
$56.23
|
| Rate for Payer: Aetna Medicare |
$84.00
|
| Rate for Payer: BCBS Complete |
$30.42
|
| Rate for Payer: BCBS Trust/PPO |
$416.83
|
| Rate for Payer: BCN Commercial |
$120.21
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Meridian Medicaid |
$30.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$28.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$109.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$76.22
|
| Rate for Payer: Priority Health Narrow Network |
$76.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$104.32
|
| Rate for Payer: UHC Exchange |
$104.32
|
| Rate for Payer: UHCCP Medicaid |
$28.97
|
|
|
PR INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS 49400
|
| Min. Negotiated Rate |
$56.87 |
| Max. Negotiated Rate |
$2,526.86 |
| Rate for Payer: Aetna Commercial |
$122.24
|
| Rate for Payer: Aetna Medicare |
$153.50
|
| Rate for Payer: BCBS Complete |
$59.71
|
| Rate for Payer: BCBS Trust/PPO |
$2,526.86
|
| Rate for Payer: BCN Commercial |
$219.42
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Cash Price |
$245.60
|
| Rate for Payer: Meridian Medicaid |
$59.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$56.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$199.55
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$157.50
|
| Rate for Payer: Priority Health Narrow Network |
$157.50
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$125.35
|
| Rate for Payer: UHC Exchange |
$125.35
|
| Rate for Payer: UHCCP Medicaid |
$56.87
|
|
|
PR INJECTION ANES AGENT SPHENOPALATINE GANGLION
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
HCPCS 64505
|
| Min. Negotiated Rate |
$68.37 |
| Max. Negotiated Rate |
$210.13 |
| Rate for Payer: Aetna Commercial |
$128.32
|
| Rate for Payer: Aetna Medicare |
$89.50
|
| Rate for Payer: BCBS Complete |
$71.79
|
| Rate for Payer: BCBS Trust/PPO |
$195.47
|
| Rate for Payer: BCN Commercial |
$210.13
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Cash Price |
$143.20
|
| Rate for Payer: Meridian Medicaid |
$71.79
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$116.35
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$180.28
|
| Rate for Payer: Priority Health Narrow Network |
$180.28
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$95.46
|
| Rate for Payer: UHC Exchange |
$95.46
|
| Rate for Payer: UHCCP Medicaid |
$68.37
|
|
|
PR INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC
|
Professional
|
Both
|
$357.00
|
|
|
Service Code
|
HCPCS 64520
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$335.72 |
| Rate for Payer: Aetna Commercial |
$107.54
|
| Rate for Payer: Aetna Commercial |
$107.54
|
| Rate for Payer: Aetna Medicare |
$178.50
|
| Rate for Payer: Aetna Medicare |
$103.00
|
| Rate for Payer: BCBS Complete |
$57.04
|
| Rate for Payer: BCBS Complete |
$57.04
|
| Rate for Payer: BCBS Trust/PPO |
$224.53
|
| Rate for Payer: BCBS Trust/PPO |
$224.53
|
| Rate for Payer: BCN Commercial |
$335.72
|
| Rate for Payer: BCN Commercial |
$335.72
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cash Price |
$164.80
|
| Rate for Payer: Meridian Medicaid |
$57.04
|
| Rate for Payer: Meridian Medicaid |
$57.04
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$54.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$232.05
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$144.45
|
| Rate for Payer: Priority Health Narrow Network |
$144.45
|
| Rate for Payer: Priority Health Narrow Network |
$144.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.96
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$89.96
|
| Rate for Payer: UHC Exchange |
$89.96
|
| Rate for Payer: UHC Exchange |
$89.96
|
| Rate for Payer: UHCCP Medicaid |
$54.32
|
| Rate for Payer: UHCCP Medicaid |
$54.32
|
|
|
PR INJECTION, BUPIVICAINE HYDRO
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS S0020
|
| Min. Negotiated Rate |
$1.19 |
| Max. Negotiated Rate |
$6.50 |
| Rate for Payer: Aetna Medicare |
$5.00
|
| 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 |
$6.50
|
|
|
PR INJECTION CORPORA CAVERNOSA PHARMACOLOGIC AGENT
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
HCPCS 54235
|
| Min. Negotiated Rate |
$47.71 |
| Max. Negotiated Rate |
$573.21 |
| Rate for Payer: Aetna Commercial |
$92.84
|
| Rate for Payer: Aetna Medicare |
$87.50
|
| Rate for Payer: BCBS Complete |
$50.10
|
| Rate for Payer: BCBS Trust/PPO |
$573.21
|
| Rate for Payer: BCN Commercial |
$130.96
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Cash Price |
$140.00
|
| Rate for Payer: Meridian Medicaid |
$50.10
|
| Rate for Payer: Priority Health Choice Medicaid |
$47.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$113.75
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$117.71
|
| Rate for Payer: Priority Health Narrow Network |
$117.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$87.58
|
| Rate for Payer: UHC Exchange |
$87.58
|
| Rate for Payer: UHCCP Medicaid |
$47.71
|
|
