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Michigan rates for HCPCS 64612

Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.46 / $464.00 / $4,933.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$304.89 / $842.64 / $2,574.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.75 / $157.71 / $267.58
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$217.52 / $646.23 / $993.59
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.60 / $112.60 / $140.00
Ambetter
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$168.90 / $183.69 / $250.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$392.68 / $460.89 / $624.42
BCBS
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$213.04 / $325.74 / $423.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.03 / $148.44 / $226.90
BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$192.78 / $226.80 / $261.45
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.09 / $139.11 / $166.64
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.67 / $167.45 / $260.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.24 / $156.68 / $267.27
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.30 / $580.90 / $4,933.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$842.63 / $842.64 / $2,574.94
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.69 / $178.39 / $348.13
Health Alliance Plan
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$236.70 / $743.04 / $1,770.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.79 / $101.78 / $144.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $1,418.00 / $2,029.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.47 / $172.33 / $224.18