|
PR LABYRINTHOTOMY TRANSCANAL
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
HCPCS 69801
|
| Min. Negotiated Rate |
$68.59 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna Commercial |
$142.21
|
| Rate for Payer: Aetna Medicare |
$110.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$142.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$152.83
|
| Rate for Payer: BCBS Complete |
$72.02
|
| Rate for Payer: BCBS MAPPO |
$106.13
|
| Rate for Payer: BCN Commercial |
$186.75
|
| Rate for Payer: BCN Medicare Advantage |
$106.13
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cash Price |
$336.00
|
| Rate for Payer: Cofinity Commercial |
$152.83
|
| Rate for Payer: Cofinity Commercial |
$142.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$106.13
|
| Rate for Payer: Healthscope Commercial |
$196.34
|
| Rate for Payer: Healthscope Commercial |
$169.81
|
| Rate for Payer: Mclaren Medicaid |
$68.59
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$111.44
|
| Rate for Payer: Meridian Medicaid |
$72.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$116.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$220.27
|
| Rate for Payer: Nomi Health Commercial |
$127.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$315.00
|
| Rate for Payer: PACE SWMI |
$106.13
|
| Rate for Payer: PHP Medicare Advantage |
$106.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$68.59
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$184.52
|
| Rate for Payer: Priority Health Medicare |
$106.13
|
| Rate for Payer: Priority Health SBD |
$184.52
|
| Rate for Payer: Priority Health Tiered Network |
$184.52
|
| Rate for Payer: Railroad Medicare Medicare |
$106.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$216.46
|
| Rate for Payer: UHC Core |
$216.46
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$106.13
|
| Rate for Payer: UHC Exchange |
$216.46
|
| Rate for Payer: UHC Medicaid |
$68.59
|
| Rate for Payer: UHCCP Medicaid |
$68.59
|
|
|
PR LAIV3 VACCINE LIVE FOR INTRANASAL USE
|
Professional
|
Both
|
$71.00
|
|
|
Service Code
|
HCPCS 90660
|
| Min. Negotiated Rate |
$23.61 |
| Max. Negotiated Rate |
$54.96 |
| Rate for Payer: Aetna Commercial |
$39.81
|
| Rate for Payer: Aetna Medicare |
$30.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$42.78
|
| Rate for Payer: BCBS MAPPO |
$29.71
|
| Rate for Payer: BCBS Trust/PPO |
$26.19
|
| Rate for Payer: BCN Commercial |
$24.91
|
| Rate for Payer: BCN Medicare Advantage |
$29.71
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cash Price |
$56.80
|
| Rate for Payer: Cofinity Commercial |
$39.81
|
| Rate for Payer: Cofinity Commercial |
$42.78
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$29.71
|
| Rate for Payer: Healthscope Commercial |
$47.54
|
| Rate for Payer: Healthscope Commercial |
$54.96
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$31.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$32.68
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$23.61
|
| Rate for Payer: Nomi Health Commercial |
$35.65
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$53.25
|
| Rate for Payer: PACE SWMI |
$29.71
|
| Rate for Payer: PHP Medicare Advantage |
$29.71
|
| Rate for Payer: Priority Health Medicare |
$29.71
|
| Rate for Payer: Railroad Medicare Medicare |
$29.71
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25.44
|
| Rate for Payer: UHC Core |
$25.44
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$29.71
|
| Rate for Payer: UHC Exchange |
$25.44
|
|
|
PR LAIV4 VACCINE FOR INTRANASAL USE
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
HCPCS 90672
|
| Min. Negotiated Rate |
$16.50 |
| Max. Negotiated Rate |
$27.79 |
| Rate for Payer: Aetna Commercial |
$27.79
|
| Rate for Payer: Aetna Medicare |
$16.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$27.79
|
| Rate for Payer: BCBS Trust/PPO |
$24.50
|
| Rate for Payer: BCN Commercial |
$23.98
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$24.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$24.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$27.79
|
| Rate for Payer: UHC Core |
$27.79
|
| Rate for Payer: UHC Exchange |
$27.79
|
|
|
PR LAM BX/EXC ISPI NEO IDRL IMED CERVICAL
|
Professional
|
Both
|
$8,508.00
|
|
|
Service Code
|
HCPCS 63285
|
| Min. Negotiated Rate |
$1,609.64 |
| Max. Negotiated Rate |
$6,381.00 |
| Rate for Payer: Aetna Commercial |
$3,383.90
|
| Rate for Payer: Aetna Medicare |
$2,626.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,383.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,636.43
|
| Rate for Payer: BCBS Complete |
$1,690.12
|
| Rate for Payer: BCBS MAPPO |
$2,525.30
|
| Rate for Payer: BCN Commercial |
$4,368.34
|
| Rate for Payer: BCN Medicare Advantage |
$2,525.30
|
| Rate for Payer: Cash Price |
$6,806.40
|
| Rate for Payer: Cash Price |
$6,806.40
|
| Rate for Payer: Cofinity Commercial |
$3,636.43
|
| Rate for Payer: Cofinity Commercial |
$3,383.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,525.30
|
| Rate for Payer: Healthscope Commercial |
$4,671.81
|
| Rate for Payer: Healthscope Commercial |
$4,040.48
|
| Rate for Payer: Mclaren Medicaid |
$1,609.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,651.57
|
| Rate for Payer: Meridian Medicaid |
$1,690.12
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,777.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,742.46
|
| Rate for Payer: Nomi Health Commercial |
$3,030.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,381.00
|
| Rate for Payer: PACE SWMI |
$2,525.30
|
| Rate for Payer: PHP Medicare Advantage |
$2,525.30
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,609.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,618.49
|
| Rate for Payer: Priority Health Medicare |
$2,525.30
|
| Rate for Payer: Priority Health SBD |
$4,618.49
|
| Rate for Payer: Priority Health Tiered Network |
$4,618.49
|
| Rate for Payer: Railroad Medicare Medicare |
$2,525.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,624.61
|
| Rate for Payer: UHC Core |
$4,624.61
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,525.30
|
| Rate for Payer: UHC Exchange |
$4,624.61
|
| Rate for Payer: UHC Medicaid |
$1,609.64
|
| Rate for Payer: UHCCP Medicaid |
$1,609.64
|
|
|
PR LAM BX/EXC ISPI NEO IDRL IMED THORACIC
|
Professional
|
Both
|
$8,526.00
|
|
|
Service Code
|
HCPCS 63286
|
| Min. Negotiated Rate |
$1,590.68 |
| Max. Negotiated Rate |
$6,394.50 |
| Rate for Payer: Aetna Commercial |
$3,343.29
|
| Rate for Payer: Aetna Medicare |
$2,594.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,343.29
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,592.79
|
| Rate for Payer: BCBS Complete |
$1,670.21
|
| Rate for Payer: BCBS MAPPO |
$2,494.99
|
| Rate for Payer: BCN Commercial |
$4,318.56
|
| Rate for Payer: BCN Medicare Advantage |
$2,494.99
|
| Rate for Payer: Cash Price |
$6,820.80
|
| Rate for Payer: Cash Price |
$6,820.80
|
| Rate for Payer: Cofinity Commercial |
$3,592.79
|
| Rate for Payer: Cofinity Commercial |
$3,343.29
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,494.99
|
| Rate for Payer: Healthscope Commercial |
$4,615.73
|
| Rate for Payer: Healthscope Commercial |
$3,991.98
|
| Rate for Payer: Mclaren Medicaid |
$1,590.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,619.74
|
| Rate for Payer: Meridian Medicaid |
$1,670.21
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,744.49
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,695.26
|
| Rate for Payer: Nomi Health Commercial |
$2,993.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,394.50
|
| Rate for Payer: PACE SWMI |
$2,494.99
|
| Rate for Payer: PHP Medicare Advantage |
$2,494.99
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,590.68
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,565.85
|
| Rate for Payer: Priority Health Medicare |
$2,494.99
|
| Rate for Payer: Priority Health SBD |
$4,565.85
|
| Rate for Payer: Priority Health Tiered Network |
$4,565.85
|
| Rate for Payer: Railroad Medicare Medicare |
$2,494.99
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,569.19
|
| Rate for Payer: UHC Core |
$4,569.19
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,494.99
|
| Rate for Payer: UHC Exchange |
$4,569.19
|
| Rate for Payer: UHC Medicaid |
$1,590.68
|
| Rate for Payer: UHCCP Medicaid |
$1,590.68
|
|
|
PR LAM BX/EXC ISPI NEO IDRL IMED THORACOLMBR
|
Professional
|
Both
|
$9,011.00
|
|
|
Service Code
|
HCPCS 63287
|
| Min. Negotiated Rate |
$1,684.19 |
| Max. Negotiated Rate |
$6,758.25 |
| Rate for Payer: Aetna Commercial |
$3,542.65
|
| Rate for Payer: Aetna Medicare |
$2,749.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,542.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,807.03
|
| Rate for Payer: BCBS Complete |
$1,768.40
|
| Rate for Payer: BCBS MAPPO |
$2,643.77
|
| Rate for Payer: BCN Commercial |
$4,578.41
|
| Rate for Payer: BCN Medicare Advantage |
$2,643.77
|
| Rate for Payer: Cash Price |
$7,208.80
|
| Rate for Payer: Cash Price |
$7,208.80
|
| Rate for Payer: Cofinity Commercial |
$3,807.03
|
| Rate for Payer: Cofinity Commercial |
$3,542.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,643.77
|
| Rate for Payer: Healthscope Commercial |
$4,890.97
|
| Rate for Payer: Healthscope Commercial |
$4,230.03
|
| Rate for Payer: Mclaren Medicaid |
$1,684.19
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,775.96
|
| Rate for Payer: Meridian Medicaid |
$1,768.40
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,908.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,974.66
|
| Rate for Payer: Nomi Health Commercial |
$3,172.52
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,758.25
|
| Rate for Payer: PACE SWMI |
$2,643.77
|
| Rate for Payer: PHP Medicare Advantage |
$2,643.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,684.19
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,840.59
|
| Rate for Payer: Priority Health Medicare |
$2,643.77
|
| Rate for Payer: Priority Health SBD |
$4,840.59
|
| Rate for Payer: Priority Health Tiered Network |
$4,840.59
|
| Rate for Payer: Railroad Medicare Medicare |
$2,643.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,855.66
|
| Rate for Payer: UHC Core |
$4,855.66
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,643.77
|
| Rate for Payer: UHC Exchange |
$4,855.66
|
| Rate for Payer: UHC Medicaid |
$1,684.19
|
| Rate for Payer: UHCCP Medicaid |
$1,684.19
|
|
|
PR LAM BX/EXC ISPI NEO IDRL SACRAL
|
Professional
|
Both
|
$6,474.00
|
|
|
Service Code
|
HCPCS 63283
|
| Min. Negotiated Rate |
$1,194.08 |
| Max. Negotiated Rate |
$4,855.50 |
| Rate for Payer: Aetna Commercial |
$2,498.93
|
| Rate for Payer: Aetna Medicare |
$1,939.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,498.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,685.41
|
| Rate for Payer: BCBS Complete |
$1,253.78
|
| Rate for Payer: BCBS MAPPO |
$1,864.87
|
| Rate for Payer: BCN Commercial |
$2,906.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,864.87
|
| Rate for Payer: Cash Price |
$5,179.20
|
| Rate for Payer: Cash Price |
$5,179.20
|
| Rate for Payer: Cofinity Commercial |
$2,685.41
|
| Rate for Payer: Cofinity Commercial |
$2,498.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,864.87
|
| Rate for Payer: Healthscope Commercial |
$3,450.01
|
| Rate for Payer: Healthscope Commercial |
$2,983.79
|
| Rate for Payer: Mclaren Medicaid |
$1,194.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,958.11
|
| Rate for Payer: Meridian Medicaid |
$1,253.78
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,051.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,452.98
|
| Rate for Payer: Nomi Health Commercial |
$2,237.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,855.50
|
| Rate for Payer: PACE SWMI |
$1,864.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,864.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,194.08
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,376.10
|
| Rate for Payer: Priority Health Medicare |
$1,864.87
|
| Rate for Payer: Priority Health SBD |
$3,376.10
|
| Rate for Payer: Priority Health Tiered Network |
$3,376.10
|
| Rate for Payer: Railroad Medicare Medicare |
$1,864.87
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,347.69
|
| Rate for Payer: UHC Core |
$3,347.69
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,864.87
|
| Rate for Payer: UHC Exchange |
$3,347.69
|
| Rate for Payer: UHC Medicaid |
$1,194.08
|
| Rate for Payer: UHCCP Medicaid |
$1,194.08
|
|
|
PR LAM BX/EXC ISPI NEO IDRL XMED CERVICAL
|
Professional
|
Both
|
$7,817.00
|
|
|
Service Code
|
HCPCS 63280
|
| Min. Negotiated Rate |
$1,315.28 |
| Max. Negotiated Rate |
$5,862.75 |
| Rate for Payer: Aetna Commercial |
$2,757.01
|
| Rate for Payer: Aetna Medicare |
$2,139.77
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,757.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,962.76
|
| Rate for Payer: BCBS Complete |
$1,381.04
|
| Rate for Payer: BCBS MAPPO |
$2,057.47
|
| Rate for Payer: BCN Commercial |
$3,537.89
|
| Rate for Payer: BCN Medicare Advantage |
$2,057.47
|
| Rate for Payer: Cash Price |
$6,253.60
|
| Rate for Payer: Cash Price |
$6,253.60
|
| Rate for Payer: Cofinity Commercial |
$2,962.76
|
| Rate for Payer: Cofinity Commercial |
$2,757.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,057.47
|
| Rate for Payer: Healthscope Commercial |
$3,806.32
|
| Rate for Payer: Healthscope Commercial |
$3,291.95
|
| Rate for Payer: Mclaren Medicaid |
$1,315.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,160.34
|
| Rate for Payer: Meridian Medicaid |
$1,381.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,263.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,841.58
|
| Rate for Payer: Nomi Health Commercial |
$2,468.96
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,862.75
|
| Rate for Payer: PACE SWMI |
$2,057.47
|
| Rate for Payer: PHP Medicare Advantage |
$2,057.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,315.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,740.49
|
| Rate for Payer: Priority Health Medicare |
$2,057.47
|
| Rate for Payer: Priority Health SBD |
$3,740.49
|
| Rate for Payer: Priority Health Tiered Network |
$3,740.49
|
| Rate for Payer: Railroad Medicare Medicare |
$2,057.47
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,738.39
|
| Rate for Payer: UHC Core |
$3,738.39
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,057.47
|
| Rate for Payer: UHC Exchange |
$3,738.39
|
| Rate for Payer: UHC Medicaid |
$1,315.28
|
| Rate for Payer: UHCCP Medicaid |
$1,315.28
|
|
|
PR LAM BX/EXC ISPI NEO IDRL XMED LUMBAR
|
Professional
|
Both
|
$8,241.00
|
|
|
Service Code
|
HCPCS 63282
|
| Min. Negotiated Rate |
$1,235.83 |
| Max. Negotiated Rate |
$6,180.75 |
| Rate for Payer: Aetna Commercial |
$2,588.09
|
| Rate for Payer: Aetna Medicare |
$2,008.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,588.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,781.23
|
| Rate for Payer: BCBS Complete |
$1,297.62
|
| Rate for Payer: BCBS MAPPO |
$1,931.41
|
| Rate for Payer: BCN Commercial |
$3,323.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,931.41
|
| Rate for Payer: Cash Price |
$6,592.80
|
| Rate for Payer: Cash Price |
$6,592.80
|
| Rate for Payer: Cofinity Commercial |
$2,781.23
|
| Rate for Payer: Cofinity Commercial |
$2,588.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,931.41
|
| Rate for Payer: Healthscope Commercial |
$3,573.11
|
| Rate for Payer: Healthscope Commercial |
$3,090.26
|
| Rate for Payer: Mclaren Medicaid |
$1,235.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,027.98
|
| Rate for Payer: Meridian Medicaid |
$1,297.62
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,124.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,591.00
|
| Rate for Payer: Nomi Health Commercial |
$2,317.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$6,180.75
|
| Rate for Payer: PACE SWMI |
$1,931.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,931.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,235.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,513.75
|
| Rate for Payer: Priority Health Medicare |
$1,931.41
|
| Rate for Payer: Priority Health SBD |
$3,513.75
|
| Rate for Payer: Priority Health Tiered Network |
$3,513.75
|
| Rate for Payer: Railroad Medicare Medicare |
$1,931.41
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,483.62
|
| Rate for Payer: UHC Core |
$3,483.62
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,931.41
|
| Rate for Payer: UHC Exchange |
$3,483.62
|
| Rate for Payer: UHC Medicaid |
$1,235.83
|
| Rate for Payer: UHCCP Medicaid |
$1,235.83
|
|
|
PR LAM BX/EXC ISPI NEO IDRL XMED THORACIC
|
Professional
|
Both
|
$7,655.00
|
|
|
Service Code
|
HCPCS 63281
|
| Min. Negotiated Rate |
$1,305.05 |
| Max. Negotiated Rate |
$5,741.25 |
| Rate for Payer: Aetna Commercial |
$2,735.50
|
| Rate for Payer: Aetna Medicare |
$2,123.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,735.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,939.64
|
| Rate for Payer: BCBS Complete |
$1,370.30
|
| Rate for Payer: BCBS MAPPO |
$2,041.42
|
| Rate for Payer: BCN Commercial |
$3,512.18
|
| Rate for Payer: BCN Medicare Advantage |
$2,041.42
|
| Rate for Payer: Cash Price |
$6,124.00
|
| Rate for Payer: Cash Price |
$6,124.00
|
| Rate for Payer: Cofinity Commercial |
$2,939.64
|
| Rate for Payer: Cofinity Commercial |
$2,735.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,041.42
|
| Rate for Payer: Healthscope Commercial |
$3,776.63
|
| Rate for Payer: Healthscope Commercial |
$3,266.27
|
| Rate for Payer: Mclaren Medicaid |
$1,305.05
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,143.49
|
| Rate for Payer: Meridian Medicaid |
$1,370.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,245.56
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,803.78
|
| Rate for Payer: Nomi Health Commercial |
$2,449.70
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,741.25
|
| Rate for Payer: PACE SWMI |
$2,041.42
|
| Rate for Payer: PHP Medicare Advantage |
$2,041.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,305.05
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,713.31
|
| Rate for Payer: Priority Health Medicare |
$2,041.42
|
| Rate for Payer: Priority Health SBD |
$3,713.31
|
| Rate for Payer: Priority Health Tiered Network |
$3,713.31
|
| Rate for Payer: Railroad Medicare Medicare |
$2,041.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,695.05
|
| Rate for Payer: UHC Core |
$3,695.05
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,041.42
|
| Rate for Payer: UHC Exchange |
$3,695.05
|
| Rate for Payer: UHC Medicaid |
$1,305.05
|
| Rate for Payer: UHCCP Medicaid |
$1,305.05
|
|
|
PR LAM BX/EXC ISPI NEO XDRL-IDRL LES ANY LVL
|
Professional
|
Both
|
$9,664.00
|
|
|
Service Code
|
HCPCS 63290
|
| Min. Negotiated Rate |
$1,711.88 |
| Max. Negotiated Rate |
$7,248.00 |
| Rate for Payer: Aetna Commercial |
$3,601.68
|
| Rate for Payer: Aetna Medicare |
$2,795.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,601.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,870.46
|
| Rate for Payer: BCBS Complete |
$1,797.47
|
| Rate for Payer: BCBS MAPPO |
$2,687.82
|
| Rate for Payer: BCN Commercial |
$4,655.55
|
| Rate for Payer: BCN Medicare Advantage |
$2,687.82
|
| Rate for Payer: Cash Price |
$7,731.20
|
| Rate for Payer: Cash Price |
$7,731.20
|
| Rate for Payer: Cofinity Commercial |
$3,870.46
|
| Rate for Payer: Cofinity Commercial |
$3,601.68
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,687.82
|
| Rate for Payer: Healthscope Commercial |
$4,972.47
|
| Rate for Payer: Healthscope Commercial |
$4,300.51
|
| Rate for Payer: Mclaren Medicaid |
$1,711.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,822.21
|
| Rate for Payer: Meridian Medicaid |
$1,797.47
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,956.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,059.49
|
| Rate for Payer: Nomi Health Commercial |
$3,225.38
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$7,248.00
|
| Rate for Payer: PACE SWMI |
$2,687.82
|
| Rate for Payer: PHP Medicare Advantage |
$2,687.82
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,711.88
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$4,922.15
|
| Rate for Payer: Priority Health Medicare |
$2,687.82
|
| Rate for Payer: Priority Health SBD |
$4,922.15
|
| Rate for Payer: Priority Health Tiered Network |
$4,922.15
|
| Rate for Payer: Railroad Medicare Medicare |
$2,687.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$4,939.81
|
| Rate for Payer: UHC Core |
$4,939.81
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,687.82
|
| Rate for Payer: UHC Exchange |
$4,939.81
|
| Rate for Payer: UHC Medicaid |
$1,711.88
|
| Rate for Payer: UHCCP Medicaid |
$1,711.88
|
|
|
PR LAM EXC/EVAC ISPI LESION OTH/THN NEO XDRL LUMBAR
|
Professional
|
Both
|
$5,581.00
|
|
|
Service Code
|
HCPCS 63267
|
| Min. Negotiated Rate |
$843.48 |
| Max. Negotiated Rate |
$4,185.75 |
| Rate for Payer: Aetna Commercial |
$1,756.89
|
| Rate for Payer: Aetna Medicare |
$1,363.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,756.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,888.00
|
| Rate for Payer: BCBS Complete |
$885.65
|
| Rate for Payer: BCBS MAPPO |
$1,311.11
|
| Rate for Payer: BCN Commercial |
$2,296.59
|
| Rate for Payer: BCN Medicare Advantage |
$1,311.11
|
| Rate for Payer: Cash Price |
$4,464.80
|
| Rate for Payer: Cash Price |
$4,464.80
|
| Rate for Payer: Cofinity Commercial |
$1,888.00
|
| Rate for Payer: Cofinity Commercial |
$1,756.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,311.11
|
| Rate for Payer: Healthscope Commercial |
$2,425.55
|
| Rate for Payer: Healthscope Commercial |
$2,097.78
|
| Rate for Payer: Mclaren Medicaid |
$843.48
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,376.67
|
| Rate for Payer: Meridian Medicaid |
$885.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,442.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,471.13
|
| Rate for Payer: Nomi Health Commercial |
$1,573.33
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,185.75
|
| Rate for Payer: PACE SWMI |
$1,311.11
|
| Rate for Payer: PHP Medicare Advantage |
$1,311.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$843.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,428.11
|
| Rate for Payer: Priority Health Medicare |
$1,311.11
|
| Rate for Payer: Priority Health SBD |
$2,428.11
|
| Rate for Payer: Priority Health Tiered Network |
$2,428.11
|
| Rate for Payer: Railroad Medicare Medicare |
$1,311.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,416.25
|
| Rate for Payer: UHC Core |
$2,416.25
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,311.11
|
| Rate for Payer: UHC Exchange |
$2,416.25
|
| Rate for Payer: UHC Medicaid |
$843.48
|
| Rate for Payer: UHCCP Medicaid |
$843.48
|
|
|
PR LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL CERVICAL
|
Professional
|
Both
|
$5,994.00
|
|
|
Service Code
|
HCPCS 63265
|
| Min. Negotiated Rate |
$1,029.00 |
| Max. Negotiated Rate |
$4,495.50 |
| Rate for Payer: Aetna Commercial |
$2,151.53
|
| Rate for Payer: Aetna Medicare |
$1,669.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,151.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,312.09
|
| Rate for Payer: BCBS Complete |
$1,080.45
|
| Rate for Payer: BCBS MAPPO |
$1,605.62
|
| Rate for Payer: BCN Commercial |
$2,784.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,605.62
|
| Rate for Payer: Cash Price |
$4,795.20
|
| Rate for Payer: Cash Price |
$4,795.20
|
| Rate for Payer: Cofinity Commercial |
$2,312.09
|
| Rate for Payer: Cofinity Commercial |
$2,151.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,605.62
|
| Rate for Payer: Healthscope Commercial |
$2,970.40
|
| Rate for Payer: Healthscope Commercial |
$2,568.99
|
| Rate for Payer: Mclaren Medicaid |
$1,029.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,685.90
|
| Rate for Payer: Meridian Medicaid |
$1,080.45
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,766.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,019.68
|
| Rate for Payer: Nomi Health Commercial |
$1,926.74
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,495.50
|
| Rate for Payer: PACE SWMI |
$1,605.62
|
| Rate for Payer: PHP Medicare Advantage |
$1,605.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,029.00
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,944.04
|
| Rate for Payer: Priority Health Medicare |
$1,605.62
|
| Rate for Payer: Priority Health SBD |
$2,944.04
|
| Rate for Payer: Priority Health Tiered Network |
$2,944.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,605.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,944.48
|
| Rate for Payer: UHC Core |
$2,944.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,605.62
|
| Rate for Payer: UHC Exchange |
$2,944.48
|
| Rate for Payer: UHC Medicaid |
$1,029.00
|
| Rate for Payer: UHCCP Medicaid |
$1,029.00
|
|
|
PR LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL SACRAL
|
Professional
|
Both
|
$4,735.00
|
|
|
Service Code
|
HCPCS 63268
|
| Min. Negotiated Rate |
$929.53 |
| Max. Negotiated Rate |
$3,551.25 |
| Rate for Payer: Aetna Commercial |
$1,938.94
|
| Rate for Payer: Aetna Medicare |
$1,504.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,938.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,083.64
|
| Rate for Payer: BCBS Complete |
$976.01
|
| Rate for Payer: BCBS MAPPO |
$1,446.97
|
| Rate for Payer: BCN Commercial |
$2,460.16
|
| Rate for Payer: BCN Medicare Advantage |
$1,446.97
|
| Rate for Payer: Cash Price |
$3,788.00
|
| Rate for Payer: Cash Price |
$3,788.00
|
| Rate for Payer: Cofinity Commercial |
$2,083.64
|
| Rate for Payer: Cofinity Commercial |
$1,938.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,446.97
|
| Rate for Payer: Healthscope Commercial |
$2,676.89
|
| Rate for Payer: Healthscope Commercial |
$2,315.15
|
| Rate for Payer: Mclaren Medicaid |
$929.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,519.32
|
| Rate for Payer: Meridian Medicaid |
$976.01
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,591.67
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,522.36
|
| Rate for Payer: Nomi Health Commercial |
$1,736.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,551.25
|
| Rate for Payer: PACE SWMI |
$1,446.97
|
| Rate for Payer: PHP Medicare Advantage |
$1,446.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$929.53
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$2,601.04
|
| Rate for Payer: Priority Health Medicare |
$1,446.97
|
| Rate for Payer: Priority Health SBD |
$2,601.04
|
| Rate for Payer: Priority Health Tiered Network |
$2,601.04
|
| Rate for Payer: Railroad Medicare Medicare |
$1,446.97
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,493.33
|
| Rate for Payer: UHC Core |
$2,493.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,446.97
|
| Rate for Payer: UHC Exchange |
$2,493.33
|
| Rate for Payer: UHC Medicaid |
$929.53
|
| Rate for Payer: UHCCP Medicaid |
$929.53
|
|
|
PR LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL THORACIC
|
Professional
|
Both
|
$6,093.00
|
|
|
Service Code
|
HCPCS 63266
|
| Min. Negotiated Rate |
$1,057.33 |
| Max. Negotiated Rate |
$4,569.75 |
| Rate for Payer: Aetna Commercial |
$2,211.56
|
| Rate for Payer: Aetna Medicare |
$1,716.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,211.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,376.60
|
| Rate for Payer: BCBS Complete |
$1,110.20
|
| Rate for Payer: BCBS MAPPO |
$1,650.42
|
| Rate for Payer: BCN Commercial |
$2,870.47
|
| Rate for Payer: BCN Medicare Advantage |
$1,650.42
|
| Rate for Payer: Cash Price |
$4,874.40
|
| Rate for Payer: Cash Price |
$4,874.40
|
| Rate for Payer: Cofinity Commercial |
$2,376.60
|
| Rate for Payer: Cofinity Commercial |
$2,211.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,650.42
|
| Rate for Payer: Healthscope Commercial |
$3,053.28
|
| Rate for Payer: Healthscope Commercial |
$2,640.67
|
| Rate for Payer: Mclaren Medicaid |
$1,057.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,732.94
|
| Rate for Payer: Meridian Medicaid |
$1,110.20
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,815.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,105.27
|
| Rate for Payer: Nomi Health Commercial |
$1,980.50
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,569.75
|
| Rate for Payer: PACE SWMI |
$1,650.42
|
| Rate for Payer: PHP Medicare Advantage |
$1,650.42
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,057.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,034.84
|
| Rate for Payer: Priority Health Medicare |
$1,650.42
|
| Rate for Payer: Priority Health SBD |
$3,034.84
|
| Rate for Payer: Priority Health Tiered Network |
$3,034.84
|
| Rate for Payer: Railroad Medicare Medicare |
$1,650.42
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,034.80
|
| Rate for Payer: UHC Core |
$3,034.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,650.42
|
| Rate for Payer: UHC Exchange |
$3,034.80
|
| Rate for Payer: UHC Medicaid |
$1,057.33
|
| Rate for Payer: UHCCP Medicaid |
$1,057.33
|
|
|
PR LAM EXC ISPI LES OTH/THN NEO IDRL CERVICAL
|
Professional
|
Both
|
$6,397.00
|
|
|
Service Code
|
HCPCS 63270
|
| Min. Negotiated Rate |
$1,290.14 |
| Max. Negotiated Rate |
$4,797.75 |
| Rate for Payer: Aetna Commercial |
$2,706.96
|
| Rate for Payer: Aetna Medicare |
$2,100.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,706.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,908.97
|
| Rate for Payer: BCBS Complete |
$1,354.65
|
| Rate for Payer: BCBS MAPPO |
$2,020.12
|
| Rate for Payer: BCN Commercial |
$3,165.67
|
| Rate for Payer: BCN Medicare Advantage |
$2,020.12
|
| Rate for Payer: Cash Price |
$5,117.60
|
| Rate for Payer: Cash Price |
$5,117.60
|
| Rate for Payer: Cofinity Commercial |
$2,908.97
|
| Rate for Payer: Cofinity Commercial |
$2,706.96
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,020.12
|
| Rate for Payer: Healthscope Commercial |
$3,737.22
|
| Rate for Payer: Healthscope Commercial |
$3,232.19
|
| Rate for Payer: Mclaren Medicaid |
$1,290.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,121.13
|
| Rate for Payer: Meridian Medicaid |
$1,354.65
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,222.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,771.27
|
| Rate for Payer: Nomi Health Commercial |
$2,424.14
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,797.75
|
| Rate for Payer: PACE SWMI |
$2,020.12
|
| Rate for Payer: PHP Medicare Advantage |
$2,020.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,290.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,676.87
|
| Rate for Payer: Priority Health Medicare |
$2,020.12
|
| Rate for Payer: Priority Health SBD |
$3,676.87
|
| Rate for Payer: Priority Health Tiered Network |
$3,676.87
|
| Rate for Payer: Railroad Medicare Medicare |
$2,020.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,665.36
|
| Rate for Payer: UHC Core |
$3,665.36
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,020.12
|
| Rate for Payer: UHC Exchange |
$3,665.36
|
| Rate for Payer: UHC Medicaid |
$1,290.14
|
| Rate for Payer: UHCCP Medicaid |
$1,290.14
|
|
|
PR LAM EXC ISPI LES OTH/THN NEO IDRL LUMBAR
|
Professional
|
Both
|
$6,742.00
|
|
|
Service Code
|
HCPCS 63272
|
| Min. Negotiated Rate |
$1,166.60 |
| Max. Negotiated Rate |
$5,056.50 |
| Rate for Payer: Priority Health SBD |
$3,333.30
|
| Rate for Payer: Aetna Commercial |
$2,444.37
|
| Rate for Payer: Aetna Medicare |
$1,897.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,444.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,626.79
|
| Rate for Payer: BCBS Complete |
$1,224.93
|
| Rate for Payer: BCBS MAPPO |
$1,824.16
|
| Rate for Payer: BCN Commercial |
$3,152.75
|
| Rate for Payer: BCN Medicare Advantage |
$1,824.16
|
| Rate for Payer: Cash Price |
$5,393.60
|
| Rate for Payer: Cash Price |
$5,393.60
|
| Rate for Payer: Cofinity Commercial |
$2,626.79
|
| Rate for Payer: Cofinity Commercial |
$2,444.37
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,824.16
|
| Rate for Payer: Healthscope Commercial |
$3,374.70
|
| Rate for Payer: Healthscope Commercial |
$2,918.66
|
| Rate for Payer: Mclaren Medicaid |
$1,166.60
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,915.37
|
| Rate for Payer: Meridian Medicaid |
$1,224.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,006.58
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,371.78
|
| Rate for Payer: Nomi Health Commercial |
$2,188.99
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$5,056.50
|
| Rate for Payer: PACE SWMI |
$1,824.16
|
| Rate for Payer: PHP Medicare Advantage |
$1,824.16
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,166.60
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,333.30
|
| Rate for Payer: Priority Health Medicare |
$1,824.16
|
| Rate for Payer: Priority Health Tiered Network |
$3,333.30
|
| Rate for Payer: Railroad Medicare Medicare |
$1,824.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,331.65
|
| Rate for Payer: UHC Core |
$3,331.65
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,824.16
|
| Rate for Payer: UHC Exchange |
$3,331.65
|
| Rate for Payer: UHC Medicaid |
$1,166.60
|
| Rate for Payer: UHCCP Medicaid |
$1,166.60
|
|
|
PR LAM EXC ISPI LES OTH/THN NEO IDRL SACRAL
|
Professional
|
Both
|
$5,916.00
|
|
|
Service Code
|
HCPCS 63273
|
| Min. Negotiated Rate |
$1,167.24 |
| Max. Negotiated Rate |
$4,437.00 |
| Rate for Payer: Aetna Commercial |
$2,445.19
|
| Rate for Payer: Aetna Medicare |
$1,897.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,445.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,627.67
|
| Rate for Payer: BCBS Complete |
$1,225.60
|
| Rate for Payer: BCBS MAPPO |
$1,824.77
|
| Rate for Payer: BCN Commercial |
$3,131.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,824.77
|
| Rate for Payer: Cash Price |
$4,732.80
|
| Rate for Payer: Cash Price |
$4,732.80
|
| Rate for Payer: Cofinity Commercial |
$2,627.67
|
| Rate for Payer: Cofinity Commercial |
$2,445.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,824.77
|
| Rate for Payer: Healthscope Commercial |
$3,375.82
|
| Rate for Payer: Healthscope Commercial |
$2,919.63
|
| Rate for Payer: Mclaren Medicaid |
$1,167.24
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,916.01
|
| Rate for Payer: Meridian Medicaid |
$1,225.60
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,007.25
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,390.73
|
| Rate for Payer: Nomi Health Commercial |
$2,189.72
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,437.00
|
| Rate for Payer: PACE SWMI |
$1,824.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,824.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,167.24
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,310.73
|
| Rate for Payer: Priority Health Medicare |
$1,824.77
|
| Rate for Payer: Priority Health SBD |
$3,310.73
|
| Rate for Payer: Priority Health Tiered Network |
$3,310.73
|
| Rate for Payer: Railroad Medicare Medicare |
$1,824.77
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,288.67
|
| Rate for Payer: UHC Core |
$3,288.67
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,824.77
|
| Rate for Payer: UHC Exchange |
$3,288.67
|
| Rate for Payer: UHC Medicaid |
$1,167.24
|
| Rate for Payer: UHCCP Medicaid |
$1,167.24
|
|
|
PR LAM EXC ISPI LES OTH/THN NEO IDRL THORACIC
|
Professional
|
Both
|
$6,293.00
|
|
|
Service Code
|
HCPCS 63271
|
| Min. Negotiated Rate |
$1,283.33 |
| Max. Negotiated Rate |
$4,719.75 |
| Rate for Payer: Aetna Commercial |
$2,692.10
|
| Rate for Payer: Aetna Medicare |
$2,089.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,692.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,893.00
|
| Rate for Payer: BCBS Complete |
$1,347.50
|
| Rate for Payer: BCBS MAPPO |
$2,009.03
|
| Rate for Payer: BCN Commercial |
$3,473.34
|
| Rate for Payer: BCN Medicare Advantage |
$2,009.03
|
| Rate for Payer: Cash Price |
$5,034.40
|
| Rate for Payer: Cash Price |
$5,034.40
|
| Rate for Payer: Cofinity Commercial |
$2,893.00
|
| Rate for Payer: Cofinity Commercial |
$2,692.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,009.03
|
| Rate for Payer: Healthscope Commercial |
$3,716.71
|
| Rate for Payer: Healthscope Commercial |
$3,214.45
|
| Rate for Payer: Mclaren Medicaid |
$1,283.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,109.48
|
| Rate for Payer: Meridian Medicaid |
$1,347.50
|
| Rate for Payer: Molina Medicare/Medicaid |
$2,209.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,767.33
|
| Rate for Payer: Nomi Health Commercial |
$2,410.84
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,719.75
|
| Rate for Payer: PACE SWMI |
$2,009.03
|
| Rate for Payer: PHP Medicare Advantage |
$2,009.03
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,283.33
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$3,672.23
|
| Rate for Payer: Priority Health Medicare |
$2,009.03
|
| Rate for Payer: Priority Health SBD |
$3,672.23
|
| Rate for Payer: Priority Health Tiered Network |
$3,672.23
|
| Rate for Payer: Railroad Medicare Medicare |
$2,009.03
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,654.77
|
| Rate for Payer: UHC Core |
$3,654.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,009.03
|
| Rate for Payer: UHC Exchange |
$3,654.77
|
| Rate for Payer: UHC Medicaid |
$1,283.33
|
| Rate for Payer: UHCCP Medicaid |
$1,283.33
|
|
|
PR LAM EXC/OCCLUSION AVM SPI CORD THORACOLUMBAR
|
Professional
|
Both
|
$6,662.00
|
|
|
Service Code
|
HCPCS 63252
|
| Min. Negotiated Rate |
$1,851.82 |
| Max. Negotiated Rate |
$5,495.20 |
| Rate for Payer: Aetna Commercial |
$3,899.67
|
| Rate for Payer: Aetna Medicare |
$3,026.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,899.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,190.69
|
| Rate for Payer: BCBS Complete |
$1,944.41
|
| Rate for Payer: BCBS MAPPO |
$2,910.20
|
| Rate for Payer: BCN Commercial |
$4,598.85
|
| Rate for Payer: BCN Medicare Advantage |
$2,910.20
|
| Rate for Payer: Cash Price |
$5,329.60
|
| Rate for Payer: Cash Price |
$5,329.60
|
| Rate for Payer: Cofinity Commercial |
$4,190.69
|
| Rate for Payer: Cofinity Commercial |
$3,899.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,910.20
|
| Rate for Payer: Healthscope Commercial |
$5,383.87
|
| Rate for Payer: Healthscope Commercial |
$4,656.32
|
| Rate for Payer: Mclaren Medicaid |
$1,851.82
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,055.71
|
| Rate for Payer: Meridian Medicaid |
$1,944.41
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,201.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,495.20
|
| Rate for Payer: Nomi Health Commercial |
$3,492.24
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,996.50
|
| Rate for Payer: PACE SWMI |
$2,910.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,910.20
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,851.82
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,341.48
|
| Rate for Payer: Priority Health Medicare |
$2,910.20
|
| Rate for Payer: Priority Health SBD |
$5,341.48
|
| Rate for Payer: Priority Health Tiered Network |
$5,341.48
|
| Rate for Payer: Railroad Medicare Medicare |
$2,910.20
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,375.59
|
| Rate for Payer: UHC Core |
$5,375.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,910.20
|
| Rate for Payer: UHC Exchange |
$5,375.59
|
| Rate for Payer: UHC Medicaid |
$1,851.82
|
| Rate for Payer: UHCCP Medicaid |
$1,851.82
|
|
|
PR LAM EXC/OCCLUSION AVM SPINAL CORD CERVICAL
|
Professional
|
Both
|
$5,023.00
|
|
|
Service Code
|
HCPCS 63250
|
| Min. Negotiated Rate |
$1,807.52 |
| Max. Negotiated Rate |
$5,377.88 |
| Rate for Payer: Aetna Commercial |
$3,808.67
|
| Rate for Payer: Aetna Medicare |
$2,955.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,808.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,092.90
|
| Rate for Payer: BCBS Complete |
$1,897.90
|
| Rate for Payer: BCBS MAPPO |
$2,842.29
|
| Rate for Payer: BCN Commercial |
$4,498.27
|
| Rate for Payer: BCN Medicare Advantage |
$2,842.29
|
| Rate for Payer: Cash Price |
$4,018.40
|
| Rate for Payer: Cash Price |
$4,018.40
|
| Rate for Payer: Cofinity Commercial |
$4,092.90
|
| Rate for Payer: Cofinity Commercial |
$3,808.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,842.29
|
| Rate for Payer: Healthscope Commercial |
$5,258.24
|
| Rate for Payer: Healthscope Commercial |
$4,547.66
|
| Rate for Payer: Mclaren Medicaid |
$1,807.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,984.40
|
| Rate for Payer: Meridian Medicaid |
$1,897.90
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,126.52
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,377.88
|
| Rate for Payer: Nomi Health Commercial |
$3,410.75
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$3,767.25
|
| Rate for Payer: PACE SWMI |
$2,842.29
|
| Rate for Payer: PHP Medicare Advantage |
$2,842.29
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,807.52
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,224.65
|
| Rate for Payer: Priority Health Medicare |
$2,842.29
|
| Rate for Payer: Priority Health SBD |
$5,224.65
|
| Rate for Payer: Priority Health Tiered Network |
$5,224.65
|
| Rate for Payer: Railroad Medicare Medicare |
$2,842.29
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,261.88
|
| Rate for Payer: UHC Core |
$5,261.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,842.29
|
| Rate for Payer: UHC Exchange |
$5,261.88
|
| Rate for Payer: UHC Medicaid |
$1,807.52
|
| Rate for Payer: UHCCP Medicaid |
$1,807.52
|
|
|
PR LAM EXC/OCCLUSION AVM SPINAL CORD THORACIC
|
Professional
|
Both
|
$6,033.00
|
|
|
Service Code
|
HCPCS 63251
|
| Min. Negotiated Rate |
$1,852.25 |
| Max. Negotiated Rate |
$5,497.13 |
| Rate for Payer: Aetna Commercial |
$3,900.53
|
| Rate for Payer: Aetna Medicare |
$3,027.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,900.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,191.61
|
| Rate for Payer: BCBS Complete |
$1,944.86
|
| Rate for Payer: BCBS MAPPO |
$2,910.84
|
| Rate for Payer: BCN Commercial |
$4,599.35
|
| Rate for Payer: BCN Medicare Advantage |
$2,910.84
|
| Rate for Payer: Cash Price |
$4,826.40
|
| Rate for Payer: Cash Price |
$4,826.40
|
| Rate for Payer: Cofinity Commercial |
$4,191.61
|
| Rate for Payer: Cofinity Commercial |
$3,900.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,910.84
|
| Rate for Payer: Healthscope Commercial |
$5,385.05
|
| Rate for Payer: Healthscope Commercial |
$4,657.34
|
| Rate for Payer: Mclaren Medicaid |
$1,852.25
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,056.38
|
| Rate for Payer: Meridian Medicaid |
$1,944.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$3,201.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,497.13
|
| Rate for Payer: Nomi Health Commercial |
$3,493.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$4,524.75
|
| Rate for Payer: PACE SWMI |
$2,910.84
|
| Rate for Payer: PHP Medicare Advantage |
$2,910.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,852.25
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$5,342.06
|
| Rate for Payer: Priority Health Medicare |
$2,910.84
|
| Rate for Payer: Priority Health SBD |
$5,342.06
|
| Rate for Payer: Priority Health Tiered Network |
$5,342.06
|
| Rate for Payer: Railroad Medicare Medicare |
$2,910.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$5,376.79
|
| Rate for Payer: UHC Core |
$5,376.79
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$2,910.84
|
| Rate for Payer: UHC Exchange |
$5,376.79
|
| Rate for Payer: UHC Medicaid |
$1,852.25
|
| Rate for Payer: UHCCP Medicaid |
$1,852.25
|
|
|
PR LAM FACETEC/FORAMOT DRG ARTHRD LMBR EA ADDL SGM
|
Professional
|
Both
|
$505.00
|
|
|
Service Code
|
HCPCS 63053
|
| Min. Negotiated Rate |
$130.57 |
| Max. Negotiated Rate |
$410.51 |
| Rate for Payer: Aetna Commercial |
$276.56
|
| Rate for Payer: Aetna Medicare |
$214.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$276.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$297.20
|
| Rate for Payer: BCBS Complete |
$137.10
|
| Rate for Payer: BCBS MAPPO |
$206.39
|
| Rate for Payer: BCN Commercial |
$342.61
|
| Rate for Payer: BCN Medicare Advantage |
$206.39
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cash Price |
$404.00
|
| Rate for Payer: Cofinity Commercial |
$297.20
|
| Rate for Payer: Cofinity Commercial |
$276.56
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$206.39
|
| Rate for Payer: Healthscope Commercial |
$381.82
|
| Rate for Payer: Healthscope Commercial |
$330.22
|
| Rate for Payer: Mclaren Medicaid |
$130.57
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.71
|
| Rate for Payer: Meridian Medicaid |
$137.10
|
| Rate for Payer: Molina Medicare/Medicaid |
$227.03
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$410.51
|
| Rate for Payer: Nomi Health Commercial |
$247.67
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$378.75
|
| Rate for Payer: PACE SWMI |
$206.39
|
| Rate for Payer: PHP Medicare Advantage |
$206.39
|
| Rate for Payer: Priority Health Choice Medicaid |
$130.57
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$397.93
|
| Rate for Payer: Priority Health Medicare |
$206.39
|
| Rate for Payer: Priority Health SBD |
$397.93
|
| Rate for Payer: Priority Health Tiered Network |
$397.93
|
| Rate for Payer: Railroad Medicare Medicare |
$206.39
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$349.55
|
| Rate for Payer: UHC Core |
$349.55
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$206.39
|
| Rate for Payer: UHC Exchange |
$349.55
|
| Rate for Payer: UHC Medicaid |
$130.57
|
| Rate for Payer: UHCCP Medicaid |
$130.57
|
|
|
PR LAM FACETEC/FORAMOT DRG ARTHRD LUMBAR 1 VRT SGM
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
HCPCS 63052
|
| Min. Negotiated Rate |
$146.54 |
| Max. Negotiated Rate |
$504.75 |
| Rate for Payer: Priority Health SBD |
$449.41
|
| Rate for Payer: Aetna Commercial |
$310.32
|
| Rate for Payer: Aetna Medicare |
$240.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$310.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$333.48
|
| Rate for Payer: BCBS Complete |
$153.87
|
| Rate for Payer: BCBS MAPPO |
$231.58
|
| Rate for Payer: BCN Commercial |
$386.93
|
| Rate for Payer: BCN Medicare Advantage |
$231.58
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cash Price |
$538.40
|
| Rate for Payer: Cofinity Commercial |
$333.48
|
| Rate for Payer: Cofinity Commercial |
$310.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$231.58
|
| Rate for Payer: Healthscope Commercial |
$428.42
|
| Rate for Payer: Healthscope Commercial |
$370.53
|
| Rate for Payer: Mclaren Medicaid |
$146.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$243.16
|
| Rate for Payer: Meridian Medicaid |
$153.87
|
| Rate for Payer: Molina Medicare/Medicaid |
$254.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$463.68
|
| Rate for Payer: Nomi Health Commercial |
$277.90
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$504.75
|
| Rate for Payer: PACE SWMI |
$231.58
|
| Rate for Payer: PHP Medicare Advantage |
$231.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.54
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$449.41
|
| Rate for Payer: Priority Health Medicare |
$231.58
|
| Rate for Payer: Priority Health Tiered Network |
$449.41
|
| Rate for Payer: Railroad Medicare Medicare |
$231.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$467.33
|
| Rate for Payer: UHC Core |
$467.33
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$231.58
|
| Rate for Payer: UHC Exchange |
$467.33
|
| Rate for Payer: UHC Medicaid |
$146.54
|
| Rate for Payer: UHCCP Medicaid |
$146.54
|
|
|
PR LAM FACETECTOMY&FORAMOT 1 VRT SGM EA ADDL SGM
|
Professional
|
Both
|
$2,377.00
|
|
|
Service Code
|
HCPCS 63048
|
| Min. Negotiated Rate |
$119.49 |
| Max. Negotiated Rate |
$1,782.75 |
| Rate for Payer: Aetna Commercial |
$253.03
|
| Rate for Payer: Aetna Medicare |
$196.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$253.03
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$271.92
|
| Rate for Payer: BCBS Complete |
$125.46
|
| Rate for Payer: BCBS MAPPO |
$188.83
|
| Rate for Payer: BCN Commercial |
$346.30
|
| Rate for Payer: BCN Medicare Advantage |
$188.83
|
| Rate for Payer: Cash Price |
$1,901.60
|
| Rate for Payer: Cash Price |
$1,901.60
|
| Rate for Payer: Cofinity Commercial |
$271.92
|
| Rate for Payer: Cofinity Commercial |
$253.03
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$188.83
|
| Rate for Payer: Healthscope Commercial |
$349.34
|
| Rate for Payer: Healthscope Commercial |
$302.13
|
| Rate for Payer: Mclaren Medicaid |
$119.49
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$198.27
|
| Rate for Payer: Meridian Medicaid |
$125.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$207.71
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$377.37
|
| Rate for Payer: Nomi Health Commercial |
$226.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,782.75
|
| Rate for Payer: PACE SWMI |
$188.83
|
| Rate for Payer: PHP Medicare Advantage |
$188.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$119.49
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$366.12
|
| Rate for Payer: Priority Health Medicare |
$188.83
|
| Rate for Payer: Priority Health SBD |
$366.12
|
| Rate for Payer: Priority Health Tiered Network |
$366.12
|
| Rate for Payer: Railroad Medicare Medicare |
$188.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$376.01
|
| Rate for Payer: UHC Core |
$376.01
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$188.83
|
| Rate for Payer: UHC Exchange |
$376.01
|
| Rate for Payer: UHC Medicaid |
$119.49
|
| Rate for Payer: UHCCP Medicaid |
$119.49
|
|
