|
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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,066.47
|
| 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 |
$1,987.75
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,968.07
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,968.07
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,185.19
|
| 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 |
$2,101.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,081.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,081.13
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,905.88
|
| 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 |
$2,795.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,767.50
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,767.50
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,417.23
|
| 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 |
$1,363.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,349.74
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,349.74
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,725.92
|
| 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 |
$1,660.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,643.73
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,643.73
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,525.17
|
| 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 |
$1,467.07
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,452.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,452.54
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,779.95
|
| 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 |
$1,712.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,695.19
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,695.19
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,166.10
|
| 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 |
$2,083.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,062.95
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,062.95
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,955.51
|
| 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 |
$1,881.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,862.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,862.39
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,947.90
|
| 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 |
$1,873.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,855.14
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,855.14
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$2,162.30
|
| 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 |
$2,079.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,059.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,059.33
|
| Rate for Payer: UHC Exchange |
$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 |
$4,327.68 |
| Rate for Payer: Aetna Commercial |
$4,027.14
|
| Rate for Payer: Aetna Medicare |
$3,125.54
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,155.60
|
| 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 |
$3,035.38
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,005.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,005.33
|
| Rate for Payer: UHC Exchange |
$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 |
$4,235.11 |
| Rate for Payer: Aetna Commercial |
$3,941.01
|
| Rate for Payer: Aetna Medicare |
$3,058.69
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,088.10
|
| 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 |
$2,970.46
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,941.05
|
| Rate for Payer: UHC Dual Complete DSNP |
$2,941.05
|
| Rate for Payer: UHC Exchange |
$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 |
$4,328.15 |
| Rate for Payer: Aetna Commercial |
$4,027.58
|
| Rate for Payer: Aetna Medicare |
$3,125.89
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,155.94
|
| 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 |
$3,035.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$3,005.66
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,005.66
|
| Rate for Payer: UHC Exchange |
$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 |
$322.01 |
| Rate for Payer: Aetna Commercial |
$299.65
|
| Rate for Payer: Aetna Medicare |
$232.56
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$234.80
|
| 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 |
$225.86
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$223.62
|
| Rate for Payer: UHC Dual Complete DSNP |
$223.62
|
| Rate for Payer: UHC Exchange |
$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 |
$424.45 |
| Rate for Payer: Aetna Commercial |
$338.77
|
| Rate for Payer: Aetna Medicare |
$262.92
|
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$265.45
|
| 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 |
$255.34
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$252.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$252.81
|
| Rate for Payer: UHC Exchange |
$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$216.13
|
| 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 |
$207.90
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$205.84
|
| Rate for Payer: UHC Dual Complete DSNP |
$205.84
|
| Rate for Payer: UHC Exchange |
$205.84
|
| Rate for Payer: UHC Medicare Advantage |
$205.84
|
|
|
PR LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM CERVICAL
|
Professional
|
Both
|
$2,678.00
|
|
|
Service Code
|
HCPCS 63045
|
| Min. Negotiated Rate |
$1,071.20 |
| Max. Negotiated Rate |
$1,823.41 |
| Rate for Payer: Aetna Commercial |
$1,696.79
|
| Rate for Payer: Aetna Medicare |
$1,316.91
|
| Rate for Payer: BCBS Complete |
$1,071.20
|
| Rate for Payer: BCBS MAPPO |
$1,266.26
|
| Rate for Payer: BCN Medicare Advantage |
$1,266.26
|
| Rate for Payer: Cash Price |
$2,142.40
|
| Rate for Payer: Cash Price |
$2,142.40
|
| Rate for Payer: Cofinity Commercial |
$1,823.41
|
| Rate for Payer: Cofinity Commercial |
$1,696.79
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,266.26
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,329.57
|
| Rate for Payer: Nomi Health Commercial |
$1,519.51
|
| Rate for Payer: PACE SWMI |
$1,266.26
|
| Rate for Payer: PHP Medicare Advantage |
$1,266.26
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,740.70
|
| Rate for Payer: Priority Health Medicare |
$1,278.92
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,266.26
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,266.26
|
| Rate for Payer: UHC Exchange |
$1,266.26
|
| Rate for Payer: UHC Medicare Advantage |
$1,266.26
|
|
|
PR LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM LUMBAR
|
Professional
|
Both
|
$2,286.00
|
|
|
Service Code
|
HCPCS 63047
|
| Min. Negotiated Rate |
$914.40 |
| Max. Negotiated Rate |
$1,559.52 |
| Rate for Payer: Aetna Commercial |
$1,451.22
|
| Rate for Payer: Aetna Medicare |
$1,126.32
|
| Rate for Payer: BCBS Complete |
$914.40
|
| Rate for Payer: BCBS MAPPO |
$1,083.00
|
| Rate for Payer: BCN Medicare Advantage |
$1,083.00
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cash Price |
$1,828.80
|
| Rate for Payer: Cofinity Commercial |
$1,559.52
|
| Rate for Payer: Cofinity Commercial |
$1,451.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,083.00
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,137.15
|
| Rate for Payer: Nomi Health Commercial |
$1,299.60
|
| Rate for Payer: PACE SWMI |
$1,083.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,083.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,485.90
|
| Rate for Payer: Priority Health Medicare |
$1,093.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,083.00
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,083.00
|
| Rate for Payer: UHC Exchange |
$1,083.00
|
| Rate for Payer: UHC Medicare Advantage |
$1,083.00
|
|
|
PR LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM THORACIC
|
Professional
|
Both
|
$2,551.00
|
|
|
Service Code
|
HCPCS 63046
|
| Min. Negotiated Rate |
$1,020.40 |
| Max. Negotiated Rate |
$1,738.21 |
| Rate for Payer: Aetna Commercial |
$1,617.50
|
| Rate for Payer: Aetna Medicare |
$1,255.37
|
| Rate for Payer: BCBS Complete |
$1,020.40
|
| Rate for Payer: BCBS MAPPO |
$1,207.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,207.09
|
| Rate for Payer: Cash Price |
$2,040.80
|
| Rate for Payer: Cash Price |
$2,040.80
|
| Rate for Payer: Cofinity Commercial |
$1,738.21
|
| Rate for Payer: Cofinity Commercial |
$1,617.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,207.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,267.44
|
| Rate for Payer: Nomi Health Commercial |
$1,448.51
|
| Rate for Payer: PACE SWMI |
$1,207.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,207.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,658.15
|
| Rate for Payer: Priority Health Medicare |
$1,219.16
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,207.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,207.09
|
| Rate for Payer: UHC Exchange |
$1,207.09
|
| Rate for Payer: UHC Medicare Advantage |
$1,207.09
|
|
|
PR LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL
|
Professional
|
Both
|
$1,720.00
|
|
|
Service Code
|
HCPCS 63655
|
| Min. Negotiated Rate |
$688.00 |
| Max. Negotiated Rate |
$1,186.85 |
| Rate for Payer: Aetna Commercial |
$1,104.43
|
| Rate for Payer: Aetna Medicare |
$857.17
|
| Rate for Payer: BCBS Complete |
$688.00
|
| Rate for Payer: BCBS MAPPO |
$824.20
|
| Rate for Payer: BCN Medicare Advantage |
$824.20
|
| Rate for Payer: Cash Price |
$1,376.00
|
| Rate for Payer: Cash Price |
$1,376.00
|
| Rate for Payer: Cofinity Commercial |
$1,186.85
|
| Rate for Payer: Cofinity Commercial |
$1,104.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$824.20
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$865.41
|
| Rate for Payer: Nomi Health Commercial |
$989.04
|
| Rate for Payer: PACE SWMI |
$824.20
|
| Rate for Payer: PHP Medicare Advantage |
$824.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,118.00
|
| Rate for Payer: Priority Health Medicare |
$832.44
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$824.20
|
| Rate for Payer: UHC Dual Complete DSNP |
$824.20
|
| Rate for Payer: UHC Exchange |
$824.20
|
| Rate for Payer: UHC Medicare Advantage |
$824.20
|
|
|
PR LAMINECTOMY BX/EXC ISPI NEO XDRL CERVICAL
|
Professional
|
Both
|
$6,802.00
|
|
|
Service Code
|
HCPCS 63275
|
| Min. Negotiated Rate |
$1,778.77 |
| Max. Negotiated Rate |
$4,421.30 |
| Rate for Payer: Aetna Commercial |
$2,383.55
|
| Rate for Payer: Aetna Medicare |
$1,849.92
|
| Rate for Payer: BCBS Complete |
$2,720.80
|
| Rate for Payer: BCBS MAPPO |
$1,778.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,778.77
|
| Rate for Payer: Cash Price |
$5,441.60
|
| Rate for Payer: Cash Price |
$5,441.60
|
| Rate for Payer: Cofinity Commercial |
$2,561.43
|
| Rate for Payer: Cofinity Commercial |
$2,383.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,778.77
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,867.71
|
| Rate for Payer: Nomi Health Commercial |
$2,134.52
|
| Rate for Payer: PACE SWMI |
$1,778.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,778.77
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,421.30
|
| Rate for Payer: Priority Health Medicare |
$1,796.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,778.77
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,778.77
|
| Rate for Payer: UHC Exchange |
$1,778.77
|
| Rate for Payer: UHC Medicare Advantage |
$1,778.77
|
|
|
PR LAMINECTOMY BX/EXC ISPI NEO XDRL LUMBAR
|
Professional
|
Both
|
$6,212.00
|
|
|
Service Code
|
HCPCS 63277
|
| Min. Negotiated Rate |
$1,541.27 |
| Max. Negotiated Rate |
$4,037.80 |
| Rate for Payer: Aetna Commercial |
$2,065.30
|
| Rate for Payer: Aetna Medicare |
$1,602.92
|
| Rate for Payer: BCBS Complete |
$2,484.80
|
| Rate for Payer: BCBS MAPPO |
$1,541.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,541.27
|
| Rate for Payer: Cash Price |
$4,969.60
|
| Rate for Payer: Cash Price |
$4,969.60
|
| Rate for Payer: Cofinity Commercial |
$2,219.43
|
| Rate for Payer: Cofinity Commercial |
$2,065.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,541.27
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,618.33
|
| Rate for Payer: Nomi Health Commercial |
$1,849.52
|
| Rate for Payer: PACE SWMI |
$1,541.27
|
| Rate for Payer: PHP Medicare Advantage |
$1,541.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,037.80
|
| Rate for Payer: Priority Health Medicare |
$1,556.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,541.27
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,541.27
|
| Rate for Payer: UHC Exchange |
$1,541.27
|
| Rate for Payer: UHC Medicare Advantage |
$1,541.27
|
|
|
PR LAMINECTOMY BX/EXC ISPI NEO XDRL SACRAL
|
Professional
|
Both
|
$5,404.00
|
|
|
Service Code
|
HCPCS 63278
|
| Min. Negotiated Rate |
$1,584.21 |
| Max. Negotiated Rate |
$3,512.60 |
| Rate for Payer: Aetna Commercial |
$2,122.84
|
| Rate for Payer: Aetna Medicare |
$1,647.58
|
| Rate for Payer: BCBS Complete |
$2,161.60
|
| Rate for Payer: BCBS MAPPO |
$1,584.21
|
| Rate for Payer: BCN Medicare Advantage |
$1,584.21
|
| Rate for Payer: Cash Price |
$4,323.20
|
| Rate for Payer: Cash Price |
$4,323.20
|
| Rate for Payer: Cofinity Commercial |
$2,281.26
|
| Rate for Payer: Cofinity Commercial |
$2,122.84
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,584.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,663.42
|
| Rate for Payer: Nomi Health Commercial |
$1,901.05
|
| Rate for Payer: PACE SWMI |
$1,584.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,584.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,512.60
|
| Rate for Payer: Priority Health Medicare |
$1,600.05
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,584.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,584.21
|
| Rate for Payer: UHC Exchange |
$1,584.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,584.21
|
|
|
PR LAMINECTOMY BX/EXC ISPI NEO XDRL THORACIC
|
Professional
|
Both
|
$6,924.00
|
|
|
Service Code
|
HCPCS 63276
|
| Min. Negotiated Rate |
$1,767.37 |
| Max. Negotiated Rate |
$4,500.60 |
| Rate for Payer: Aetna Commercial |
$2,368.28
|
| Rate for Payer: Aetna Medicare |
$1,838.06
|
| Rate for Payer: BCBS Complete |
$2,769.60
|
| Rate for Payer: BCBS MAPPO |
$1,767.37
|
| Rate for Payer: BCN Medicare Advantage |
$1,767.37
|
| Rate for Payer: Cash Price |
$5,539.20
|
| Rate for Payer: Cash Price |
$5,539.20
|
| Rate for Payer: Cofinity Commercial |
$2,545.01
|
| Rate for Payer: Cofinity Commercial |
$2,368.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,767.37
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,855.74
|
| Rate for Payer: Nomi Health Commercial |
$2,120.84
|
| Rate for Payer: PACE SWMI |
$1,767.37
|
| Rate for Payer: PHP Medicare Advantage |
$1,767.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,500.60
|
| Rate for Payer: Priority Health Medicare |
$1,785.04
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,767.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,767.37
|
| Rate for Payer: UHC Exchange |
$1,767.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,767.37
|
|
