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Michigan rates for HCPCS 64643

Chemodenervation of one extremity; each additional extremity, 1-4 muscle(s) (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.49 / $812.83 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $102.33 / $389.05
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $95.50 / $177.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.78 / $104.71 / $104.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $208.93 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $97.72 / $165.96
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $323.59 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $109.65 / $239.88
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $93.33 / $151.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $1,258.93 / $2,041.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $97.72 / $128.82