Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

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	$1,833.95
Rate for Payer: Aetna Medicare	$2,367.50
Rate for Payer: BCBS Complete	$976.01
Rate for Payer: BCN Commercial	$2,460.16
Rate for Payer: Cash Price	$3,788.00
Rate for Payer: Cash Price	$3,788.00
Rate for Payer: Mclaren Medicaid	$929.53
Rate for Payer: Meridian Medicaid	$976.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,551.25
Rate for Payer: Priority Health Choice Medicaid	$929.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,601.04
Rate for Payer: Priority Health Narrow/Tiered Network	$2,601.04
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	$2,225.81
Rate for Payer: Aetna Medicare	$3,046.50
Rate for Payer: BCBS Complete	$1,110.20
Rate for Payer: BCN Commercial	$2,870.47
Rate for Payer: Cash Price	$4,874.40
Rate for Payer: Cash Price	$4,874.40
Rate for Payer: Mclaren Medicaid	$1,057.33
Rate for Payer: Meridian Medicaid	$1,110.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,569.75
Rate for Payer: Priority Health Choice Medicaid	$1,057.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,034.84
Rate for Payer: Priority Health Narrow/Tiered Network	$3,034.84
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	$2,685.45
Rate for Payer: Aetna Medicare	$3,198.50
Rate for Payer: BCBS Complete	$1,354.65
Rate for Payer: BCN Commercial	$3,165.67
Rate for Payer: Cash Price	$5,117.60
Rate for Payer: Cash Price	$5,117.60
Rate for Payer: Mclaren Medicaid	$1,290.14
Rate for Payer: Meridian Medicaid	$1,354.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,797.75
Rate for Payer: Priority Health Choice Medicaid	$1,290.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,676.87
Rate for Payer: Priority Health Narrow/Tiered Network	$3,676.87
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: Aetna Commercial	$2,414.96
Rate for Payer: Aetna Medicare	$3,371.00
Rate for Payer: BCBS Complete	$1,224.93
Rate for Payer: BCN Commercial	$3,152.75
Rate for Payer: Cash Price	$5,393.60
Rate for Payer: Cash Price	$5,393.60
Rate for Payer: Mclaren Medicaid	$1,166.60
Rate for Payer: Meridian Medicaid	$1,224.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,056.50
Rate for Payer: Priority Health Choice Medicaid	$1,166.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,333.30
Rate for Payer: Priority Health Narrow/Tiered Network	$3,333.30
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	$2,414.10
Rate for Payer: Aetna Medicare	$2,958.00
Rate for Payer: BCBS Complete	$1,225.60
Rate for Payer: BCN Commercial	$3,131.42
Rate for Payer: Cash Price	$4,732.80
Rate for Payer: Cash Price	$4,732.80
Rate for Payer: Mclaren Medicaid	$1,167.24
Rate for Payer: Meridian Medicaid	$1,225.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,437.00
Rate for Payer: Priority Health Choice Medicaid	$1,167.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,310.73
Rate for Payer: Priority Health Narrow/Tiered Network	$3,310.73
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	$2,678.93
Rate for Payer: Aetna Medicare	$3,146.50
Rate for Payer: BCBS Complete	$1,347.50
Rate for Payer: BCN Commercial	$3,473.34
Rate for Payer: Cash Price	$5,034.40
Rate for Payer: Cash Price	$5,034.40
Rate for Payer: Mclaren Medicaid	$1,283.33
Rate for Payer: Meridian Medicaid	$1,347.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,719.75
Rate for Payer: Priority Health Choice Medicaid	$1,283.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,672.23
Rate for Payer: Priority Health Narrow/Tiered Network	$3,672.23
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	$5,341.48
Rate for Payer: Aetna Commercial	$3,918.18
Rate for Payer: Aetna Medicare	$3,331.00
Rate for Payer: BCBS Complete	$1,944.41
Rate for Payer: BCN Commercial	$4,598.85
Rate for Payer: Cash Price	$5,329.60
Rate for Payer: Cash Price	$5,329.60
Rate for Payer: Mclaren Medicaid	$1,851.82
Rate for Payer: Meridian Medicaid	$1,944.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,996.50
Rate for Payer: Priority Health Choice Medicaid	$1,851.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,341.48
Rate for Payer: Priority Health Narrow/Tiered Network	$5,341.48
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	$5,224.65
Rate for Payer: Aetna Commercial	$3,834.83
Rate for Payer: Aetna Medicare	$2,511.50
Rate for Payer: BCBS Complete	$1,897.90
Rate for Payer: BCN Commercial	$4,498.27
Rate for Payer: Cash Price	$4,018.40
Rate for Payer: Cash Price	$4,018.40
Rate for Payer: Mclaren Medicaid	$1,807.52
Rate for Payer: Meridian Medicaid	$1,897.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,767.25
Rate for Payer: Priority Health Choice Medicaid	$1,807.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,224.65
Rate for Payer: Priority Health Narrow/Tiered Network	$5,224.65
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	$5,342.06
Rate for Payer: Aetna Commercial	$3,919.07
Rate for Payer: Aetna Medicare	$3,016.50
Rate for Payer: BCBS Complete	$1,944.86
Rate for Payer: BCN Commercial	$4,599.35
Rate for Payer: Cash Price	$4,826.40
Rate for Payer: Cash Price	$4,826.40
Rate for Payer: Mclaren Medicaid	$1,852.25
Rate for Payer: Meridian Medicaid	$1,944.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,524.75
Rate for Payer: Priority Health Choice Medicaid	$1,852.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,342.06
Rate for Payer: Priority Health Narrow/Tiered Network	$5,342.06
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	$397.93
Rate for Payer: Aetna Commercial	$249.29
Rate for Payer: Aetna Medicare	$252.50
Rate for Payer: BCBS Complete	$137.10
Rate for Payer: BCN Commercial	$342.61
Rate for Payer: Cash Price	$404.00
Rate for Payer: Cash Price	$404.00
Rate for Payer: Mclaren Medicaid	$130.57
Rate for Payer: Meridian Medicaid	$137.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$378.75
Rate for Payer: Priority Health Choice Medicaid	$130.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$397.93
Rate for Payer: Priority Health Narrow/Tiered Network	$397.93
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: Aetna Commercial	$333.27
Rate for Payer: Aetna Medicare	$336.50
Rate for Payer: BCBS Complete	$153.87
Rate for Payer: BCN Commercial	$386.93
Rate for Payer: Cash Price	$538.40
Rate for Payer: Cash Price	$538.40
Rate for Payer: Mclaren Medicaid	$146.54
Rate for Payer: Meridian Medicaid	$153.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$504.75
Rate for Payer: Priority Health Choice Medicaid	$146.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$449.41
Rate for Payer: Priority Health Narrow/Tiered Network	$449.41
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	$273.78
Rate for Payer: Aetna Medicare	$1,188.50
Rate for Payer: BCBS Complete	$125.46
Rate for Payer: BCN Commercial	$346.30
Rate for Payer: Cash Price	$1,901.60
Rate for Payer: Cash Price	$1,901.60
Rate for Payer: Mclaren Medicaid	$119.49
Rate for Payer: Meridian Medicaid	$125.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,782.75
Rate for Payer: Priority Health Choice Medicaid	$119.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$366.12
Rate for Payer: Priority Health Narrow/Tiered Network	$366.12
Rate for Payer: UHC Medicaid	$119.49
Rate for Payer: UHCCP Medicaid	$119.49

PR LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM CERVICAL

Professional

Both

$2,758.00

Service Code	HCPCS 63045
Min. Negotiated Rate	$796.83
Max. Negotiated Rate	$2,278.87
Rate for Payer: Aetna Commercial	$1,661.20
Rate for Payer: Aetna Medicare	$1,379.00
Rate for Payer: BCBS Complete	$836.67
Rate for Payer: BCN Commercial	$2,155.45
Rate for Payer: Cash Price	$2,206.40
Rate for Payer: Cash Price	$2,206.40
Rate for Payer: Mclaren Medicaid	$796.83
Rate for Payer: Meridian Medicaid	$836.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,068.50
Rate for Payer: Priority Health Choice Medicaid	$796.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,278.87
Rate for Payer: Priority Health Narrow/Tiered Network	$2,278.87
Rate for Payer: UHC Medicaid	$796.83
Rate for Payer: UHCCP Medicaid	$796.83

PR LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM LUMBAR

Professional

Both

$2,355.00

Service Code	HCPCS 63047
Min. Negotiated Rate	$679.47
Max. Negotiated Rate	$1,957.87
Rate for Payer: Aetna Commercial	$1,424.42
Rate for Payer: Aetna Medicare	$1,177.50
Rate for Payer: BCBS Complete	$713.44
Rate for Payer: BCN Commercial	$1,851.82
Rate for Payer: Cash Price	$1,884.00
Rate for Payer: Cash Price	$1,884.00
Rate for Payer: Mclaren Medicaid	$679.47
Rate for Payer: Meridian Medicaid	$713.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,766.25
Rate for Payer: Priority Health Choice Medicaid	$679.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,957.87
Rate for Payer: Priority Health Narrow/Tiered Network	$1,957.87
Rate for Payer: UHC Medicaid	$679.47
Rate for Payer: UHCCP Medicaid	$679.47

PR LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM THORACIC

Professional

Both

$2,628.00

Service Code	HCPCS 63046
Min. Negotiated Rate	$755.30
Max. Negotiated Rate	$2,176.50
Rate for Payer: Aetna Commercial	$1,585.22
Rate for Payer: Aetna Medicare	$1,314.00
Rate for Payer: BCBS Complete	$793.07
Rate for Payer: BCN Commercial	$2,058.62
Rate for Payer: Cash Price	$2,102.40
Rate for Payer: Cash Price	$2,102.40
Rate for Payer: Mclaren Medicaid	$755.30
Rate for Payer: Meridian Medicaid	$793.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,971.00
Rate for Payer: Priority Health Choice Medicaid	$755.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,176.50
Rate for Payer: Priority Health Narrow/Tiered Network	$2,176.50
Rate for Payer: UHC Medicaid	$755.30
Rate for Payer: UHCCP Medicaid	$755.30

PR LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL

Professional

Both

$1,772.00

Service Code	HCPCS 63655
Min. Negotiated Rate	$534.84
Max. Negotiated Rate	$1,492.83
Rate for Payer: Aetna Commercial	$1,075.11
Rate for Payer: Aetna Medicare	$886.00
Rate for Payer: BCBS Complete	$561.58
Rate for Payer: BCN Commercial	$1,411.98
Rate for Payer: Cash Price	$1,417.60
Rate for Payer: Cash Price	$1,417.60
Rate for Payer: Mclaren Medicaid	$534.84
Rate for Payer: Meridian Medicaid	$561.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,329.00
Rate for Payer: Priority Health Choice Medicaid	$534.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,492.83
Rate for Payer: Priority Health Narrow/Tiered Network	$1,492.83
Rate for Payer: UHC Medicaid	$534.84
Rate for Payer: UHCCP Medicaid	$534.84

PR LAMINECTOMY BX/EXC ISPI NEO XDRL CERVICAL

Professional

Both

$7,006.00

Service Code	HCPCS 63275
Min. Negotiated Rate	$1,104.41
Max. Negotiated Rate	$5,254.50
Rate for Payer: Aetna Commercial	$2,334.21
Rate for Payer: Aetna Medicare	$3,503.00
Rate for Payer: BCBS Complete	$1,159.63
Rate for Payer: BCN Commercial	$3,009.43
Rate for Payer: Cash Price	$5,604.80
Rate for Payer: Cash Price	$5,604.80
Rate for Payer: Mclaren Medicaid	$1,104.41
Rate for Payer: Meridian Medicaid	$1,159.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,254.50
Rate for Payer: Priority Health Choice Medicaid	$1,104.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,181.75
Rate for Payer: Priority Health Narrow/Tiered Network	$3,181.75
Rate for Payer: UHC Medicaid	$1,104.41
Rate for Payer: UHCCP Medicaid	$1,104.41

PR LAMINECTOMY BX/EXC ISPI NEO XDRL LUMBAR

Professional

Both

$6,398.00

Service Code	HCPCS 63277
Min. Negotiated Rate	$958.07
Max. Negotiated Rate	$4,798.50
Rate for Payer: Aetna Commercial	$2,017.05
Rate for Payer: Aetna Medicare	$3,199.00
Rate for Payer: BCBS Complete	$1,005.97
Rate for Payer: BCN Commercial	$2,615.53
Rate for Payer: Cash Price	$5,118.40
Rate for Payer: Cash Price	$5,118.40
Rate for Payer: Mclaren Medicaid	$958.07
Rate for Payer: Meridian Medicaid	$1,005.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,798.50
Rate for Payer: Priority Health Choice Medicaid	$958.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,765.32
Rate for Payer: Priority Health Narrow/Tiered Network	$2,765.32
Rate for Payer: UHC Medicaid	$958.07
Rate for Payer: UHCCP Medicaid	$958.07

PR LAMINECTOMY BX/EXC ISPI NEO XDRL SACRAL

Professional

Both

$5,566.00

Service Code	HCPCS 63278
Min. Negotiated Rate	$1,007.28
Max. Negotiated Rate	$4,174.50
Rate for Payer: Aetna Commercial	$2,058.50
Rate for Payer: Aetna Medicare	$2,783.00
Rate for Payer: BCBS Complete	$1,057.64
Rate for Payer: BCN Commercial	$2,679.54
Rate for Payer: Cash Price	$4,452.80
Rate for Payer: Cash Price	$4,452.80
Rate for Payer: Mclaren Medicaid	$1,007.28
Rate for Payer: Meridian Medicaid	$1,057.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,174.50
Rate for Payer: Priority Health Choice Medicaid	$1,007.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,832.98
Rate for Payer: Priority Health Narrow/Tiered Network	$2,832.98
Rate for Payer: UHC Medicaid	$1,007.28
Rate for Payer: UHCCP Medicaid	$1,007.28

PR LAMINECTOMY BX/EXC ISPI NEO XDRL THORACIC

Professional

Both

$7,132.00

Service Code	HCPCS 63276
Min. Negotiated Rate	$1,101.42
Max. Negotiated Rate	$5,349.00
Rate for Payer: Aetna Commercial	$2,318.43
Rate for Payer: Aetna Medicare	$3,566.00
Rate for Payer: BCBS Complete	$1,156.49
Rate for Payer: BCN Commercial	$2,990.28
Rate for Payer: Cash Price	$5,705.60
Rate for Payer: Cash Price	$5,705.60
Rate for Payer: Mclaren Medicaid	$1,101.42
Rate for Payer: Meridian Medicaid	$1,156.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,349.00
Rate for Payer: Priority Health Choice Medicaid	$1,101.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,161.51
Rate for Payer: Priority Health Narrow/Tiered Network	$3,161.51
Rate for Payer: UHC Medicaid	$1,101.42
Rate for Payer: UHCCP Medicaid	$1,101.42

PR LAMINECTOMY RELEASE TETHERED SPINAL CORD LUMBAR

Professional

Both

$6,093.00

Service Code	HCPCS 63200
Min. Negotiated Rate	$978.95
Max. Negotiated Rate	$4,569.75
Rate for Payer: Aetna Commercial	$1,964.99
Rate for Payer: Aetna Medicare	$3,046.50
Rate for Payer: BCBS Complete	$1,027.90
Rate for Payer: BCN Commercial	$2,598.03
Rate for Payer: Cash Price	$4,874.40
Rate for Payer: Cash Price	$4,874.40
Rate for Payer: Mclaren Medicaid	$978.95
Rate for Payer: Meridian Medicaid	$1,027.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,569.75
Rate for Payer: Priority Health Choice Medicaid	$978.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,746.81
Rate for Payer: Priority Health Narrow/Tiered Network	$2,746.81
Rate for Payer: UHC Medicaid	$978.95
Rate for Payer: UHCCP Medicaid	$978.95

PR LAMINECTOMY W/O FFD 1/2 VERT SEG LUMBAR

Professional

Both

$5,184.00

Service Code	HCPCS 63005
Min. Negotiated Rate	$760.41
Max. Negotiated Rate	$3,888.00
Rate for Payer: Aetna Commercial	$1,542.52
Rate for Payer: Aetna Medicare	$2,592.00
Rate for Payer: BCBS Complete	$798.43
Rate for Payer: BCN Commercial	$2,021.97
Rate for Payer: Cash Price	$4,147.20
Rate for Payer: Cash Price	$4,147.20
Rate for Payer: Mclaren Medicaid	$760.41
Rate for Payer: Meridian Medicaid	$798.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,888.00
Rate for Payer: Priority Health Choice Medicaid	$760.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,137.76
Rate for Payer: Priority Health Narrow/Tiered Network	$2,137.76
Rate for Payer: UHC Medicaid	$760.41
Rate for Payer: UHCCP Medicaid	$760.41

PR LAMINECTOMY W/O FFD 1/2 VERT SEG SACRAL

Professional

Both

$2,308.00

Service Code	HCPCS 63011
Min. Negotiated Rate	$644.54
Max. Negotiated Rate	$1,919.69
Rate for Payer: Aetna Commercial	$1,416.81
Rate for Payer: Aetna Medicare	$1,154.00
Rate for Payer: BCBS Complete	$676.77
Rate for Payer: BCN Commercial	$1,652.80
Rate for Payer: Cash Price	$1,846.40
Rate for Payer: Cash Price	$1,846.40
Rate for Payer: Mclaren Medicaid	$644.54
Rate for Payer: Meridian Medicaid	$676.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,731.00
Rate for Payer: Priority Health Choice Medicaid	$644.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,919.69
Rate for Payer: Priority Health Narrow/Tiered Network	$1,919.69
Rate for Payer: UHC Medicaid	$644.54
Rate for Payer: UHCCP Medicaid	$644.54

PR LAMINECTOMY W/O FFD 1/2 VERT SEG THORACIC

Professional

Both

$6,368.00

Service Code	HCPCS 63003
Min. Negotiated Rate	$764.03
Max. Negotiated Rate	$4,776.00
Rate for Payer: Aetna Commercial	$1,595.23
Rate for Payer: Aetna Medicare	$3,184.00
Rate for Payer: BCBS Complete	$802.23
Rate for Payer: BCN Commercial	$2,074.48
Rate for Payer: Cash Price	$5,094.40
Rate for Payer: Cash Price	$5,094.40
Rate for Payer: Mclaren Medicaid	$764.03
Rate for Payer: Meridian Medicaid	$802.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,776.00
Rate for Payer: Priority Health Choice Medicaid	$764.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,193.28
Rate for Payer: Priority Health Narrow/Tiered Network	$2,193.28
Rate for Payer: UHC Medicaid	$764.03
Rate for Payer: UHCCP Medicaid	$764.03

PR LAMINECTOMY W/O FFD > 2 VERT SEG CERVICAL

Professional

Both

$6,444.00

Service Code	HCPCS 63015
Min. Negotiated Rate	$921.23
Max. Negotiated Rate	$4,833.00
Rate for Payer: Aetna Commercial	$1,910.12
Rate for Payer: Aetna Medicare	$3,222.00
Rate for Payer: BCBS Complete	$967.29
Rate for Payer: BCN Commercial	$2,486.43
Rate for Payer: Cash Price	$5,155.20
Rate for Payer: Cash Price	$5,155.20
Rate for Payer: Mclaren Medicaid	$921.23
Rate for Payer: Meridian Medicaid	$967.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,833.00
Rate for Payer: Priority Health Choice Medicaid	$921.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,628.81
Rate for Payer: Priority Health Narrow/Tiered Network	$2,628.81
Rate for Payer: UHC Medicaid	$921.23
Rate for Payer: UHCCP Medicaid	$921.23

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