|
PR LABYRINTHOTOMY TRANSCANAL
|
Professional
|
Both
|
$408.00
|
|
|
Service Code
|
HCPCS 69801
|
| Min. Negotiated Rate |
$118.89 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Aetna Commercial |
$159.31
|
| Rate for Payer: Aetna Medicare |
$123.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$171.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$159.31
|
| Rate for Payer: BCBS Complete |
$163.20
|
| Rate for Payer: BCBS MAPPO |
$118.89
|
| Rate for Payer: BCN Medicare Advantage |
$118.89
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cash Price |
$326.40
|
| Rate for Payer: Cofinity Commercial |
$171.20
|
| Rate for Payer: Cofinity Commercial |
$159.31
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$118.89
|
| Rate for Payer: Healthscope Commercial |
$219.95
|
| Rate for Payer: Healthscope Commercial |
$190.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$124.83
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$265.20
|
| Rate for Payer: Nomi Health Commercial |
$142.67
|
| Rate for Payer: PACE SWMI |
$118.89
|
| Rate for Payer: PHP Medicare Advantage |
$118.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$265.20
|
| Rate for Payer: Priority Health Medicare |
$118.89
|
| Rate for Payer: UHC Dual Complete DSNP |
$118.89
|
| Rate for Payer: UHC Medicare Advantage |
$118.89
|
|
|
PR LAIV3 VACCINE LIVE FOR INTRANASAL USE
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
HCPCS 90660
|
| Min. Negotiated Rate |
$27.60 |
| 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) |
$42.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$39.81
|
| Rate for Payer: BCBS Complete |
$27.60
|
| Rate for Payer: BCBS MAPPO |
$29.71
|
| Rate for Payer: BCN Medicare Advantage |
$29.71
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cofinity Commercial |
$42.78
|
| Rate for Payer: Cofinity Commercial |
$39.81
|
| 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: Multiplan/Beech St/PHCS Commercial |
$44.85
|
| Rate for Payer: Nomi Health Commercial |
$35.65
|
| Rate for Payer: PACE SWMI |
$29.71
|
| Rate for Payer: PHP Medicare Advantage |
$29.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$44.85
|
| Rate for Payer: Priority Health Medicare |
$29.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$29.71
|
| Rate for Payer: UHC Medicare Advantage |
$29.71
|
|
|
PR LAIV4 VACCINE FOR INTRANASAL USE
|
Professional
|
Both
|
$32.00
|
|
|
Service Code
|
HCPCS 90672
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$20.80 |
| Rate for Payer: Aetna Medicare |
$16.00
|
| Rate for Payer: BCBS Complete |
$12.80
|
| Rate for Payer: Cash Price |
$25.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$20.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$20.80
|
|
|
PR LAM BX/EXC ISPI NEO IDRL IMED CERVICAL
|
Professional
|
Both
|
$8,260.00
|
|
|
Service Code
|
HCPCS 63285
|
| Min. Negotiated Rate |
$2,595.25 |
| Max. Negotiated Rate |
$5,369.00 |
| Rate for Payer: Aetna Commercial |
$3,477.64
|
| Rate for Payer: Aetna Medicare |
$2,699.06
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,477.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,737.16
|
| Rate for Payer: BCBS Complete |
$3,304.00
|
| Rate for Payer: BCBS MAPPO |
$2,595.25
|
| Rate for Payer: BCN Medicare Advantage |
$2,595.25
|
| Rate for Payer: Cash Price |
$6,608.00
|
| Rate for Payer: Cash Price |
$6,608.00
|
| Rate for Payer: Cofinity Commercial |
$3,737.16
|
| Rate for Payer: Cofinity Commercial |
$3,477.64
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,595.25
|
| Rate for Payer: Healthscope Commercial |
$4,801.21
|
| Rate for Payer: Healthscope Commercial |
$4,152.40
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,725.01
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,369.00
|
| Rate for Payer: Nomi Health Commercial |
$3,114.30
|
| Rate for Payer: PACE SWMI |
$2,595.25
|
| Rate for Payer: PHP Medicare Advantage |
$2,595.25
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,369.00
|
| Rate for Payer: Priority Health Medicare |
$2,595.25
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,595.25
|
| Rate for Payer: UHC Medicare Advantage |
$2,595.25
|
|
|
PR LAM BX/EXC ISPI NEO IDRL IMED THORACIC
|
Professional
|
Both
|
$8,278.00
|
|
|
Service Code
|
HCPCS 63286
|
| Min. Negotiated Rate |
$2,564.91 |
| Max. Negotiated Rate |
$5,380.70 |
| Rate for Payer: Aetna Commercial |
$3,436.98
|
| Rate for Payer: Aetna Medicare |
$2,667.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,436.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,693.47
|
| Rate for Payer: BCBS Complete |
$3,311.20
|
| Rate for Payer: BCBS MAPPO |
$2,564.91
|
| Rate for Payer: BCN Medicare Advantage |
$2,564.91
|
| Rate for Payer: Cash Price |
$6,622.40
|
| Rate for Payer: Cash Price |
$6,622.40
|
| Rate for Payer: Cofinity Commercial |
$3,436.98
|
| Rate for Payer: Cofinity Commercial |
$3,693.47
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,564.91
|
| Rate for Payer: Healthscope Commercial |
$4,103.86
|
| Rate for Payer: Healthscope Commercial |
$4,745.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,693.16
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,380.70
|
| Rate for Payer: Nomi Health Commercial |
$3,077.89
|
| Rate for Payer: PACE SWMI |
$2,564.91
|
| Rate for Payer: PHP Medicare Advantage |
$2,564.91
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,380.70
|
| Rate for Payer: Priority Health Medicare |
$2,564.91
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,564.91
|
| Rate for Payer: UHC Medicare Advantage |
$2,564.91
|
|
|
PR LAM BX/EXC ISPI NEO IDRL IMED THORACOLMBR
|
Professional
|
Both
|
$8,749.00
|
|
|
Service Code
|
HCPCS 63287
|
| Min. Negotiated Rate |
$2,721.20 |
| Max. Negotiated Rate |
$5,686.85 |
| Rate for Payer: Aetna Commercial |
$3,646.41
|
| Rate for Payer: Aetna Medicare |
$2,830.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,918.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,646.41
|
| Rate for Payer: BCBS Complete |
$3,499.60
|
| Rate for Payer: BCBS MAPPO |
$2,721.20
|
| Rate for Payer: BCN Medicare Advantage |
$2,721.20
|
| Rate for Payer: Cash Price |
$6,999.20
|
| Rate for Payer: Cash Price |
$6,999.20
|
| Rate for Payer: Cofinity Commercial |
$3,918.53
|
| Rate for Payer: Cofinity Commercial |
$3,646.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,721.20
|
| Rate for Payer: Healthscope Commercial |
$5,034.22
|
| Rate for Payer: Healthscope Commercial |
$4,353.92
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,857.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,686.85
|
| Rate for Payer: Nomi Health Commercial |
$3,265.44
|
| Rate for Payer: PACE SWMI |
$2,721.20
|
| Rate for Payer: PHP Medicare Advantage |
$2,721.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,686.85
|
| Rate for Payer: Priority Health Medicare |
$2,721.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,721.20
|
| Rate for Payer: UHC Medicare Advantage |
$2,721.20
|
|
|
PR LAM BX/EXC ISPI NEO IDRL SACRAL
|
Professional
|
Both
|
$6,285.00
|
|
|
Service Code
|
HCPCS 63283
|
| Min. Negotiated Rate |
$1,890.37 |
| Max. Negotiated Rate |
$4,085.25 |
| Rate for Payer: Aetna Commercial |
$2,533.10
|
| Rate for Payer: Aetna Medicare |
$1,965.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,722.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,533.10
|
| Rate for Payer: BCBS Complete |
$2,514.00
|
| Rate for Payer: BCBS MAPPO |
$1,890.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,890.37
|
| Rate for Payer: Cash Price |
$5,028.00
|
| Rate for Payer: Cash Price |
$5,028.00
|
| Rate for Payer: Cofinity Commercial |
$2,722.13
|
| Rate for Payer: Cofinity Commercial |
$2,533.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,890.37
|
| Rate for Payer: Healthscope Commercial |
$3,024.59
|
| Rate for Payer: Healthscope Commercial |
$3,497.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,984.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,085.25
|
| Rate for Payer: Nomi Health Commercial |
$2,268.44
|
| Rate for Payer: PACE SWMI |
$1,890.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,890.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,085.25
|
| Rate for Payer: Priority Health Medicare |
$1,890.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,890.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,890.37
|
|
|
PR LAM BX/EXC ISPI NEO IDRL XMED CERVICAL
|
Professional
|
Both
|
$7,589.00
|
|
|
Service Code
|
HCPCS 63280
|
| Min. Negotiated Rate |
$2,096.01 |
| Max. Negotiated Rate |
$4,932.85 |
| Rate for Payer: Aetna Commercial |
$2,808.65
|
| Rate for Payer: Aetna Medicare |
$2,179.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,018.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,808.65
|
| Rate for Payer: BCBS Complete |
$3,035.60
|
| Rate for Payer: BCBS MAPPO |
$2,096.01
|
| Rate for Payer: BCN Medicare Advantage |
$2,096.01
|
| Rate for Payer: Cash Price |
$6,071.20
|
| Rate for Payer: Cash Price |
$6,071.20
|
| Rate for Payer: Cofinity Commercial |
$3,018.25
|
| Rate for Payer: Cofinity Commercial |
$2,808.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,096.01
|
| Rate for Payer: Healthscope Commercial |
$3,877.62
|
| Rate for Payer: Healthscope Commercial |
$3,353.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,200.81
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,932.85
|
| Rate for Payer: Nomi Health Commercial |
$2,515.21
|
| Rate for Payer: PACE SWMI |
$2,096.01
|
| Rate for Payer: PHP Medicare Advantage |
$2,096.01
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,932.85
|
| Rate for Payer: Priority Health Medicare |
$2,096.01
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,096.01
|
| Rate for Payer: UHC Medicare Advantage |
$2,096.01
|
|
|
PR LAM BX/EXC ISPI NEO IDRL XMED LUMBAR
|
Professional
|
Both
|
$8,001.00
|
|
|
Service Code
|
HCPCS 63282
|
| Min. Negotiated Rate |
$1,968.07 |
| Max. Negotiated Rate |
$5,200.65 |
| Rate for Payer: Aetna Commercial |
$2,637.21
|
| Rate for Payer: Aetna Medicare |
$2,046.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,834.02
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,637.21
|
| Rate for Payer: BCBS Complete |
$3,200.40
|
| Rate for Payer: BCBS MAPPO |
$1,968.07
|
| Rate for Payer: BCN Medicare Advantage |
$1,968.07
|
| Rate for Payer: Cash Price |
$6,400.80
|
| Rate for Payer: Cash Price |
$6,400.80
|
| Rate for Payer: Cofinity Commercial |
$2,834.02
|
| Rate for Payer: Cofinity Commercial |
$2,637.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,968.07
|
| Rate for Payer: Healthscope Commercial |
$3,148.91
|
| Rate for Payer: Healthscope Commercial |
$3,640.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,066.47
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5,200.65
|
| Rate for Payer: Nomi Health Commercial |
$2,361.68
|
| Rate for Payer: PACE SWMI |
$1,968.07
|
| Rate for Payer: PHP Medicare Advantage |
$1,968.07
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,200.65
|
| Rate for Payer: Priority Health Medicare |
$1,968.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,968.07
|
| Rate for Payer: UHC Medicare Advantage |
$1,968.07
|
|
|
PR LAM BX/EXC ISPI NEO IDRL XMED THORACIC
|
Professional
|
Both
|
$7,432.00
|
|
|
Service Code
|
HCPCS 63281
|
| Min. Negotiated Rate |
$2,081.13 |
| Max. Negotiated Rate |
$4,830.80 |
| Rate for Payer: Aetna Commercial |
$2,788.71
|
| Rate for Payer: Aetna Medicare |
$2,164.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,996.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,788.71
|
| Rate for Payer: BCBS Complete |
$2,972.80
|
| Rate for Payer: BCBS MAPPO |
$2,081.13
|
| Rate for Payer: BCN Medicare Advantage |
$2,081.13
|
| Rate for Payer: Cash Price |
$5,945.60
|
| Rate for Payer: Cash Price |
$5,945.60
|
| Rate for Payer: Cofinity Commercial |
$2,996.83
|
| Rate for Payer: Cofinity Commercial |
$2,788.71
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,081.13
|
| Rate for Payer: Healthscope Commercial |
$3,850.09
|
| Rate for Payer: Healthscope Commercial |
$3,329.81
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,185.19
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,830.80
|
| Rate for Payer: Nomi Health Commercial |
$2,497.36
|
| Rate for Payer: PACE SWMI |
$2,081.13
|
| Rate for Payer: PHP Medicare Advantage |
$2,081.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,830.80
|
| Rate for Payer: Priority Health Medicare |
$2,081.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,081.13
|
| Rate for Payer: UHC Medicare Advantage |
$2,081.13
|
|
|
PR LAM BX/EXC ISPI NEO XDRL-IDRL LES ANY LVL
|
Professional
|
Both
|
$9,383.00
|
|
|
Service Code
|
HCPCS 63290
|
| Min. Negotiated Rate |
$2,767.50 |
| Max. Negotiated Rate |
$6,098.95 |
| Rate for Payer: Aetna Commercial |
$3,708.45
|
| Rate for Payer: Aetna Medicare |
$2,878.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,985.20
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,708.45
|
| Rate for Payer: BCBS Complete |
$3,753.20
|
| Rate for Payer: BCBS MAPPO |
$2,767.50
|
| Rate for Payer: BCN Medicare Advantage |
$2,767.50
|
| Rate for Payer: Cash Price |
$7,506.40
|
| Rate for Payer: Cash Price |
$7,506.40
|
| Rate for Payer: Cofinity Commercial |
$3,985.20
|
| Rate for Payer: Cofinity Commercial |
$3,708.45
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,767.50
|
| Rate for Payer: Healthscope Commercial |
$4,428.00
|
| Rate for Payer: Healthscope Commercial |
$5,119.88
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,905.88
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$6,098.95
|
| Rate for Payer: Nomi Health Commercial |
$3,321.00
|
| Rate for Payer: PACE SWMI |
$2,767.50
|
| Rate for Payer: PHP Medicare Advantage |
$2,767.50
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,098.95
|
| Rate for Payer: Priority Health Medicare |
$2,767.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,767.50
|
| Rate for Payer: UHC Medicare Advantage |
$2,767.50
|
|
|
PR LAM EXC/EVAC ISPI LESION OTH/THN NEO XDRL LUMBAR
|
Professional
|
Both
|
$5,418.00
|
|
|
Service Code
|
HCPCS 63267
|
| Min. Negotiated Rate |
$1,349.74 |
| Max. Negotiated Rate |
$3,521.70 |
| Rate for Payer: Aetna Commercial |
$1,808.65
|
| Rate for Payer: Aetna Medicare |
$1,403.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,943.63
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,808.65
|
| Rate for Payer: BCBS Complete |
$2,167.20
|
| Rate for Payer: BCBS MAPPO |
$1,349.74
|
| Rate for Payer: BCN Medicare Advantage |
$1,349.74
|
| Rate for Payer: Cash Price |
$4,334.40
|
| Rate for Payer: Cash Price |
$4,334.40
|
| Rate for Payer: Cofinity Commercial |
$1,943.63
|
| Rate for Payer: Cofinity Commercial |
$1,808.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,349.74
|
| Rate for Payer: Healthscope Commercial |
$2,497.02
|
| Rate for Payer: Healthscope Commercial |
$2,159.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,417.23
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,521.70
|
| Rate for Payer: Nomi Health Commercial |
$1,619.69
|
| Rate for Payer: PACE SWMI |
$1,349.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,349.74
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,521.70
|
| Rate for Payer: Priority Health Medicare |
$1,349.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,349.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,349.74
|
|
|
PR LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL CERVICAL
|
Professional
|
Both
|
$5,819.00
|
|
|
Service Code
|
HCPCS 63265
|
| Min. Negotiated Rate |
$1,643.73 |
| Max. Negotiated Rate |
$3,782.35 |
| Rate for Payer: Aetna Commercial |
$2,202.60
|
| Rate for Payer: Aetna Medicare |
$1,709.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,366.97
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,202.60
|
| Rate for Payer: BCBS Complete |
$2,327.60
|
| Rate for Payer: BCBS MAPPO |
$1,643.73
|
| Rate for Payer: BCN Medicare Advantage |
$1,643.73
|
| Rate for Payer: Cash Price |
$4,655.20
|
| Rate for Payer: Cash Price |
$4,655.20
|
| Rate for Payer: Cofinity Commercial |
$2,366.97
|
| Rate for Payer: Cofinity Commercial |
$2,202.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,643.73
|
| Rate for Payer: Healthscope Commercial |
$2,629.97
|
| Rate for Payer: Healthscope Commercial |
$3,040.90
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,725.92
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,782.35
|
| Rate for Payer: Nomi Health Commercial |
$1,972.48
|
| Rate for Payer: PACE SWMI |
$1,643.73
|
| Rate for Payer: PHP Medicare Advantage |
$1,643.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,782.35
|
| Rate for Payer: Priority Health Medicare |
$1,643.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,643.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,643.73
|
|
|
PR LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL SACRAL
|
Professional
|
Both
|
$4,597.00
|
|
|
Service Code
|
HCPCS 63268
|
| Min. Negotiated Rate |
$1,452.54 |
| Max. Negotiated Rate |
$2,988.05 |
| Rate for Payer: Aetna Commercial |
$1,946.40
|
| Rate for Payer: Aetna Medicare |
$1,510.64
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,091.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,946.40
|
| Rate for Payer: BCBS Complete |
$1,838.80
|
| Rate for Payer: BCBS MAPPO |
$1,452.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,452.54
|
| Rate for Payer: Cash Price |
$3,677.60
|
| Rate for Payer: Cash Price |
$3,677.60
|
| Rate for Payer: Cofinity Commercial |
$2,091.66
|
| Rate for Payer: Cofinity Commercial |
$1,946.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,452.54
|
| Rate for Payer: Healthscope Commercial |
$2,687.20
|
| Rate for Payer: Healthscope Commercial |
$2,324.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,525.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,988.05
|
| Rate for Payer: Nomi Health Commercial |
$1,743.05
|
| Rate for Payer: PACE SWMI |
$1,452.54
|
| Rate for Payer: PHP Medicare Advantage |
$1,452.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,988.05
|
| Rate for Payer: Priority Health Medicare |
$1,452.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,452.54
|
| Rate for Payer: UHC Medicare Advantage |
$1,452.54
|
|
|
PR LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL THORACIC
|
Professional
|
Both
|
$5,916.00
|
|
|
Service Code
|
HCPCS 63266
|
| Min. Negotiated Rate |
$1,695.19 |
| Max. Negotiated Rate |
$3,845.40 |
| Rate for Payer: Aetna Commercial |
$2,271.55
|
| Rate for Payer: Aetna Medicare |
$1,763.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,441.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,271.55
|
| Rate for Payer: BCBS Complete |
$2,366.40
|
| Rate for Payer: BCBS MAPPO |
$1,695.19
|
| Rate for Payer: BCN Medicare Advantage |
$1,695.19
|
| Rate for Payer: Cash Price |
$4,732.80
|
| Rate for Payer: Cash Price |
$4,732.80
|
| Rate for Payer: Cofinity Commercial |
$2,441.07
|
| Rate for Payer: Cofinity Commercial |
$2,271.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,695.19
|
| Rate for Payer: Healthscope Commercial |
$2,712.30
|
| Rate for Payer: Healthscope Commercial |
$3,136.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,779.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,845.40
|
| Rate for Payer: Nomi Health Commercial |
$2,034.23
|
| Rate for Payer: PACE SWMI |
$1,695.19
|
| Rate for Payer: PHP Medicare Advantage |
$1,695.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,845.40
|
| Rate for Payer: Priority Health Medicare |
$1,695.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,695.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,695.19
|
|
|
PR LAM EXC ISPI LES OTH/THN NEO IDRL CERVICAL
|
Professional
|
Both
|
$6,211.00
|
|
|
Service Code
|
HCPCS 63270
|
| Min. Negotiated Rate |
$2,062.95 |
| Max. Negotiated Rate |
$4,037.15 |
| Rate for Payer: Aetna Commercial |
$2,764.35
|
| Rate for Payer: Aetna Medicare |
$2,145.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,970.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,764.35
|
| Rate for Payer: BCBS Complete |
$2,484.40
|
| Rate for Payer: BCBS MAPPO |
$2,062.95
|
| Rate for Payer: BCN Medicare Advantage |
$2,062.95
|
| Rate for Payer: Cash Price |
$4,968.80
|
| Rate for Payer: Cash Price |
$4,968.80
|
| Rate for Payer: Cofinity Commercial |
$2,970.65
|
| Rate for Payer: Cofinity Commercial |
$2,764.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,062.95
|
| Rate for Payer: Healthscope Commercial |
$3,816.46
|
| Rate for Payer: Healthscope Commercial |
$3,300.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,166.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,037.15
|
| Rate for Payer: Nomi Health Commercial |
$2,475.54
|
| Rate for Payer: PACE SWMI |
$2,062.95
|
| Rate for Payer: PHP Medicare Advantage |
$2,062.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,037.15
|
| Rate for Payer: Priority Health Medicare |
$2,062.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,062.95
|
| Rate for Payer: UHC Medicare Advantage |
$2,062.95
|
|
|
PR LAM EXC ISPI LES OTH/THN NEO IDRL LUMBAR
|
Professional
|
Both
|
$6,546.00
|
|
|
Service Code
|
HCPCS 63272
|
| Min. Negotiated Rate |
$1,862.39 |
| Max. Negotiated Rate |
$4,254.90 |
| Rate for Payer: Aetna Commercial |
$2,495.60
|
| Rate for Payer: Aetna Medicare |
$1,936.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,681.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,495.60
|
| Rate for Payer: BCBS Complete |
$2,618.40
|
| Rate for Payer: BCBS MAPPO |
$1,862.39
|
| Rate for Payer: BCN Medicare Advantage |
$1,862.39
|
| Rate for Payer: Cash Price |
$5,236.80
|
| Rate for Payer: Cash Price |
$5,236.80
|
| Rate for Payer: Cofinity Commercial |
$2,681.84
|
| Rate for Payer: Cofinity Commercial |
$2,495.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,862.39
|
| Rate for Payer: Healthscope Commercial |
$2,979.82
|
| Rate for Payer: Healthscope Commercial |
$3,445.42
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,955.51
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,254.90
|
| Rate for Payer: Nomi Health Commercial |
$2,234.87
|
| Rate for Payer: PACE SWMI |
$1,862.39
|
| Rate for Payer: PHP Medicare Advantage |
$1,862.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,254.90
|
| Rate for Payer: Priority Health Medicare |
$1,862.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,862.39
|
| Rate for Payer: UHC Medicare Advantage |
$1,862.39
|
|
|
PR LAM EXC ISPI LES OTH/THN NEO IDRL SACRAL
|
Professional
|
Both
|
$5,744.00
|
|
|
Service Code
|
HCPCS 63273
|
| Min. Negotiated Rate |
$1,855.14 |
| Max. Negotiated Rate |
$3,733.60 |
| Rate for Payer: Aetna Commercial |
$2,485.89
|
| Rate for Payer: Aetna Medicare |
$1,929.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,671.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,485.89
|
| Rate for Payer: BCBS Complete |
$2,297.60
|
| Rate for Payer: BCBS MAPPO |
$1,855.14
|
| Rate for Payer: BCN Medicare Advantage |
$1,855.14
|
| Rate for Payer: Cash Price |
$4,595.20
|
| Rate for Payer: Cash Price |
$4,595.20
|
| Rate for Payer: Cofinity Commercial |
$2,671.40
|
| Rate for Payer: Cofinity Commercial |
$2,485.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,855.14
|
| Rate for Payer: Healthscope Commercial |
$3,432.01
|
| Rate for Payer: Healthscope Commercial |
$2,968.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,947.90
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,733.60
|
| Rate for Payer: Nomi Health Commercial |
$2,226.17
|
| Rate for Payer: PACE SWMI |
$1,855.14
|
| Rate for Payer: PHP Medicare Advantage |
$1,855.14
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,733.60
|
| Rate for Payer: Priority Health Medicare |
$1,855.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,855.14
|
| Rate for Payer: UHC Medicare Advantage |
$1,855.14
|
|
|
PR LAM EXC ISPI LES OTH/THN NEO IDRL THORACIC
|
Professional
|
Both
|
$6,110.00
|
|
|
Service Code
|
HCPCS 63271
|
| Min. Negotiated Rate |
$2,059.33 |
| Max. Negotiated Rate |
$3,971.50 |
| Rate for Payer: Aetna Commercial |
$2,759.50
|
| Rate for Payer: Aetna Medicare |
$2,141.70
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,965.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,759.50
|
| Rate for Payer: BCBS Complete |
$2,444.00
|
| Rate for Payer: BCBS MAPPO |
$2,059.33
|
| Rate for Payer: BCN Medicare Advantage |
$2,059.33
|
| Rate for Payer: Cash Price |
$4,888.00
|
| Rate for Payer: Cash Price |
$4,888.00
|
| Rate for Payer: Cofinity Commercial |
$2,965.44
|
| Rate for Payer: Cofinity Commercial |
$2,759.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,059.33
|
| Rate for Payer: Healthscope Commercial |
$3,294.93
|
| Rate for Payer: Healthscope Commercial |
$3,809.76
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,162.30
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,971.50
|
| Rate for Payer: Nomi Health Commercial |
$2,471.20
|
| Rate for Payer: PACE SWMI |
$2,059.33
|
| Rate for Payer: PHP Medicare Advantage |
$2,059.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,971.50
|
| Rate for Payer: Priority Health Medicare |
$2,059.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,059.33
|
| Rate for Payer: UHC Medicare Advantage |
$2,059.33
|
|
|
PR LAM EXC/OCCLUSION AVM SPI CORD THORACOLUMBAR
|
Professional
|
Both
|
$6,468.00
|
|
|
Service Code
|
HCPCS 63252
|
| Min. Negotiated Rate |
$2,587.20 |
| Max. Negotiated Rate |
$5,559.86 |
| Rate for Payer: Aetna Commercial |
$4,027.14
|
| Rate for Payer: Aetna Medicare |
$3,125.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,327.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,027.14
|
| Rate for Payer: BCBS Complete |
$2,587.20
|
| Rate for Payer: BCBS MAPPO |
$3,005.33
|
| Rate for Payer: BCN Medicare Advantage |
$3,005.33
|
| Rate for Payer: Cash Price |
$5,174.40
|
| Rate for Payer: Cash Price |
$5,174.40
|
| Rate for Payer: Cofinity Commercial |
$4,327.68
|
| Rate for Payer: Cofinity Commercial |
$4,027.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,005.33
|
| Rate for Payer: Healthscope Commercial |
$5,559.86
|
| Rate for Payer: Healthscope Commercial |
$4,808.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,155.60
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$4,204.20
|
| Rate for Payer: Nomi Health Commercial |
$3,606.40
|
| Rate for Payer: PACE SWMI |
$3,005.33
|
| Rate for Payer: PHP Medicare Advantage |
$3,005.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,204.20
|
| Rate for Payer: Priority Health Medicare |
$3,005.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,005.33
|
| Rate for Payer: UHC Medicare Advantage |
$3,005.33
|
|
|
PR LAM EXC/OCCLUSION AVM SPINAL CORD CERVICAL
|
Professional
|
Both
|
$4,877.00
|
|
|
Service Code
|
HCPCS 63250
|
| Min. Negotiated Rate |
$1,950.80 |
| Max. Negotiated Rate |
$5,440.94 |
| Rate for Payer: Aetna Commercial |
$3,941.01
|
| Rate for Payer: Aetna Medicare |
$3,058.69
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,235.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$3,941.01
|
| Rate for Payer: BCBS Complete |
$1,950.80
|
| Rate for Payer: BCBS MAPPO |
$2,941.05
|
| Rate for Payer: BCN Medicare Advantage |
$2,941.05
|
| Rate for Payer: Cash Price |
$3,901.60
|
| Rate for Payer: Cash Price |
$3,901.60
|
| Rate for Payer: Cofinity Commercial |
$4,235.11
|
| Rate for Payer: Cofinity Commercial |
$3,941.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,941.05
|
| Rate for Payer: Healthscope Commercial |
$4,705.68
|
| Rate for Payer: Healthscope Commercial |
$5,440.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,088.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,170.05
|
| Rate for Payer: Nomi Health Commercial |
$3,529.26
|
| Rate for Payer: PACE SWMI |
$2,941.05
|
| Rate for Payer: PHP Medicare Advantage |
$2,941.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,170.05
|
| Rate for Payer: Priority Health Medicare |
$2,941.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,941.05
|
| Rate for Payer: UHC Medicare Advantage |
$2,941.05
|
|
|
PR LAM EXC/OCCLUSION AVM SPINAL CORD THORACIC
|
Professional
|
Both
|
$5,857.00
|
|
|
Service Code
|
HCPCS 63251
|
| Min. Negotiated Rate |
$2,342.80 |
| Max. Negotiated Rate |
$5,560.47 |
| Rate for Payer: Aetna Commercial |
$4,027.58
|
| Rate for Payer: Aetna Medicare |
$3,125.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,328.15
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4,027.58
|
| Rate for Payer: BCBS Complete |
$2,342.80
|
| Rate for Payer: BCBS MAPPO |
$3,005.66
|
| Rate for Payer: BCN Medicare Advantage |
$3,005.66
|
| Rate for Payer: Cash Price |
$4,685.60
|
| Rate for Payer: Cash Price |
$4,685.60
|
| Rate for Payer: Cofinity Commercial |
$4,328.15
|
| Rate for Payer: Cofinity Commercial |
$4,027.58
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,005.66
|
| Rate for Payer: Healthscope Commercial |
$5,560.47
|
| Rate for Payer: Healthscope Commercial |
$4,809.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,155.94
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3,807.05
|
| Rate for Payer: Nomi Health Commercial |
$3,606.79
|
| Rate for Payer: PACE SWMI |
$3,005.66
|
| Rate for Payer: PHP Medicare Advantage |
$3,005.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,807.05
|
| Rate for Payer: Priority Health Medicare |
$3,005.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,005.66
|
| Rate for Payer: UHC Medicare Advantage |
$3,005.66
|
|
|
PR LAM FACETEC/FORAMOT DRG ARTHRD LMBR EA ADDL SGM
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
HCPCS 63053
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$413.70 |
| Rate for Payer: Aetna Commercial |
$299.65
|
| Rate for Payer: Aetna Medicare |
$232.56
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.01
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$299.65
|
| Rate for Payer: BCBS Complete |
$196.00
|
| Rate for Payer: BCBS MAPPO |
$223.62
|
| Rate for Payer: BCN Medicare Advantage |
$223.62
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cash Price |
$392.00
|
| Rate for Payer: Cofinity Commercial |
$322.01
|
| Rate for Payer: Cofinity Commercial |
$299.65
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$223.62
|
| Rate for Payer: Healthscope Commercial |
$357.79
|
| Rate for Payer: Healthscope Commercial |
$413.70
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$318.50
|
| Rate for Payer: Nomi Health Commercial |
$268.34
|
| Rate for Payer: PACE SWMI |
$223.62
|
| Rate for Payer: PHP Medicare Advantage |
$223.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$318.50
|
| Rate for Payer: Priority Health Medicare |
$223.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.62
|
| Rate for Payer: UHC Medicare Advantage |
$223.62
|
|
|
PR LAM FACETEC/FORAMOT DRG ARTHRD LUMBAR 1 VRT SGM
|
Professional
|
Both
|
$653.00
|
|
|
Service Code
|
HCPCS 63052
|
| Min. Negotiated Rate |
$252.81 |
| Max. Negotiated Rate |
$467.70 |
| Rate for Payer: Aetna Commercial |
$338.77
|
| Rate for Payer: Aetna Medicare |
$262.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$364.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$338.77
|
| Rate for Payer: BCBS Complete |
$261.20
|
| Rate for Payer: BCBS MAPPO |
$252.81
|
| Rate for Payer: BCN Medicare Advantage |
$252.81
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cash Price |
$522.40
|
| Rate for Payer: Cofinity Commercial |
$364.05
|
| Rate for Payer: Cofinity Commercial |
$338.77
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$252.81
|
| Rate for Payer: Healthscope Commercial |
$467.70
|
| Rate for Payer: Healthscope Commercial |
$404.50
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$265.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$424.45
|
| Rate for Payer: Nomi Health Commercial |
$303.37
|
| Rate for Payer: PACE SWMI |
$252.81
|
| Rate for Payer: PHP Medicare Advantage |
$252.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$424.45
|
| Rate for Payer: Priority Health Medicare |
$252.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$252.81
|
| Rate for Payer: UHC Medicare Advantage |
$252.81
|
|
|
PR LAM FACETECTOMY&FORAMOT 1 VRT SGM EA ADDL SGM
|
Professional
|
Both
|
$2,308.00
|
|
|
Service Code
|
HCPCS 63048
|
| Min. Negotiated Rate |
$205.84 |
| Max. Negotiated Rate |
$1,500.20 |
| Rate for Payer: Aetna Commercial |
$275.83
|
| Rate for Payer: Aetna Medicare |
$214.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$296.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$275.83
|
| Rate for Payer: BCBS Complete |
$923.20
|
| Rate for Payer: BCBS MAPPO |
$205.84
|
| Rate for Payer: BCN Medicare Advantage |
$205.84
|
| Rate for Payer: Cash Price |
$1,846.40
|
| Rate for Payer: Cash Price |
$1,846.40
|
| Rate for Payer: Cofinity Commercial |
$296.41
|
| Rate for Payer: Cofinity Commercial |
$275.83
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$205.84
|
| Rate for Payer: Healthscope Commercial |
$329.34
|
| Rate for Payer: Healthscope Commercial |
$380.80
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.13
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,500.20
|
| Rate for Payer: Nomi Health Commercial |
$247.01
|
| Rate for Payer: PACE SWMI |
$205.84
|
| Rate for Payer: PHP Medicare Advantage |
$205.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,500.20
|
| Rate for Payer: Priority Health Medicare |
$205.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.84
|
| Rate for Payer: UHC Medicare Advantage |
$205.84
|
|
