|
PR LAIV4 VACCINE FOR INTRANASAL USE
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
HCPCS 90672
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$38.70 |
| Rate for Payer: Aetna Commercial |
$36.01
|
| Rate for Payer: Aetna Medicare |
$26.88
|
| Rate for Payer: BCBS Complete |
$12.40
|
| Rate for Payer: BCBS MAPPO |
$26.88
|
| Rate for Payer: BCBS Trust/PPO |
$27.54
|
| Rate for Payer: BCN Commercial |
$27.54
|
| Rate for Payer: BCN Medicare Advantage |
$26.88
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cash Price |
$24.80
|
| Rate for Payer: Cofinity Commercial |
$38.70
|
| Rate for Payer: Cofinity Commercial |
$36.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$26.88
|
| Rate for Payer: Healthscope Commercial |
$32.25
|
| Rate for Payer: Healthscope Whirlpool |
$32.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$28.22
|
| Rate for Payer: PACE SWMI |
$26.88
|
| Rate for Payer: PHP Medicare Advantage |
$26.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$21.70
|
| Rate for Payer: Priority Health Medicare |
$26.88
|
| Rate for Payer: UHC Medicare Advantage |
$27.68
|
|
|
PR LAM BX/EXC ISPI NEO IDRL IMED CERVICAL
|
Professional
|
Both
|
$8,098.00
|
|
|
Service Code
|
HCPCS 63285
|
| Min. Negotiated Rate |
$381.43 |
| Max. Negotiated Rate |
$5,668.60 |
| Rate for Payer: Aetna Commercial |
$3,530.50
|
| Rate for Payer: Aetna Medicare |
$2,634.70
|
| Rate for Payer: BCBS Complete |
$1,778.24
|
| Rate for Payer: BCBS MAPPO |
$2,634.70
|
| Rate for Payer: BCBS Trust/PPO |
$381.43
|
| Rate for Payer: BCN Commercial |
$4,242.16
|
| Rate for Payer: BCN Medicare Advantage |
$2,634.70
|
| Rate for Payer: Cash Price |
$6,478.40
|
| Rate for Payer: Cash Price |
$6,478.40
|
| Rate for Payer: Cofinity Commercial |
$3,530.50
|
| Rate for Payer: Cofinity Commercial |
$3,793.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,634.70
|
| Rate for Payer: Healthscope Commercial |
$3,161.64
|
| Rate for Payer: Healthscope Whirlpool |
$3,161.64
|
| Rate for Payer: Meridian Medicaid |
$1,778.24
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,766.44
|
| Rate for Payer: PACE SWMI |
$2,634.70
|
| Rate for Payer: PHP Medicare Advantage |
$2,634.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,693.56
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,668.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,464.11
|
| Rate for Payer: Priority Health Medicare |
$2,634.70
|
| Rate for Payer: Priority Health Narrow Network |
$4,464.11
|
| Rate for Payer: UHC Medicare Advantage |
$2,713.74
|
|
|
PR LAM BX/EXC ISPI NEO IDRL IMED THORACIC
|
Professional
|
Both
|
$8,116.00
|
|
|
Service Code
|
HCPCS 63286
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$5,681.20 |
| Rate for Payer: Aetna Commercial |
$3,495.36
|
| Rate for Payer: Aetna Medicare |
$2,608.48
|
| Rate for Payer: BCBS Complete |
$1,749.16
|
| Rate for Payer: BCBS MAPPO |
$2,608.48
|
| Rate for Payer: BCBS Trust/PPO |
$172.75
|
| Rate for Payer: BCN Commercial |
$4,200.19
|
| Rate for Payer: BCN Medicare Advantage |
$2,608.48
|
| Rate for Payer: Cash Price |
$6,492.80
|
| Rate for Payer: Cash Price |
$6,492.80
|
| Rate for Payer: Cofinity Commercial |
$3,495.36
|
| Rate for Payer: Cofinity Commercial |
$3,756.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,608.48
|
| Rate for Payer: Healthscope Commercial |
$3,130.18
|
| Rate for Payer: Healthscope Whirlpool |
$3,130.18
|
| Rate for Payer: Meridian Medicaid |
$1,749.16
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,738.90
|
| Rate for Payer: PACE SWMI |
$2,608.48
|
| Rate for Payer: PHP Medicare Advantage |
$2,608.48
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,665.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,681.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,419.93
|
| Rate for Payer: Priority Health Medicare |
$2,608.48
|
| Rate for Payer: Priority Health Narrow Network |
$4,419.93
|
| Rate for Payer: UHC Medicare Advantage |
$2,686.73
|
|
|
PR LAM BX/EXC ISPI NEO IDRL IMED THORACOLMBR
|
Professional
|
Both
|
$8,577.00
|
|
|
Service Code
|
HCPCS 63287
|
| Min. Negotiated Rate |
$174.34 |
| Max. Negotiated Rate |
$6,003.90 |
| Rate for Payer: Aetna Commercial |
$3,703.36
|
| Rate for Payer: Aetna Medicare |
$2,763.70
|
| Rate for Payer: BCBS Complete |
$1,864.13
|
| Rate for Payer: BCBS MAPPO |
$2,763.70
|
| Rate for Payer: BCBS Trust/PPO |
$174.34
|
| Rate for Payer: BCN Commercial |
$4,448.24
|
| Rate for Payer: BCN Medicare Advantage |
$2,763.70
|
| Rate for Payer: Cash Price |
$6,861.60
|
| Rate for Payer: Cash Price |
$6,861.60
|
| Rate for Payer: Cofinity Commercial |
$3,703.36
|
| Rate for Payer: Cofinity Commercial |
$3,979.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,763.70
|
| Rate for Payer: Healthscope Commercial |
$3,316.44
|
| Rate for Payer: Healthscope Whirlpool |
$3,316.44
|
| Rate for Payer: Meridian Medicaid |
$1,864.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,901.88
|
| Rate for Payer: PACE SWMI |
$2,763.70
|
| Rate for Payer: PHP Medicare Advantage |
$2,763.70
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,775.36
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,003.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,680.96
|
| Rate for Payer: Priority Health Medicare |
$2,763.70
|
| Rate for Payer: Priority Health Narrow Network |
$4,680.96
|
| Rate for Payer: UHC Medicare Advantage |
$2,846.61
|
|
|
PR LAM BX/EXC ISPI NEO IDRL SACRAL
|
Professional
|
Both
|
$6,162.00
|
|
|
Service Code
|
HCPCS 63283
|
| Min. Negotiated Rate |
$481.28 |
| Max. Negotiated Rate |
$4,313.40 |
| Rate for Payer: Aetna Commercial |
$2,570.55
|
| Rate for Payer: Aetna Medicare |
$1,918.32
|
| Rate for Payer: BCBS Complete |
$1,299.41
|
| Rate for Payer: BCBS MAPPO |
$1,918.32
|
| Rate for Payer: BCBS Trust/PPO |
$481.28
|
| Rate for Payer: BCN Commercial |
$2,812.82
|
| Rate for Payer: BCN Medicare Advantage |
$1,918.32
|
| Rate for Payer: Cash Price |
$4,929.60
|
| Rate for Payer: Cash Price |
$4,929.60
|
| Rate for Payer: Cofinity Commercial |
$2,762.38
|
| Rate for Payer: Cofinity Commercial |
$2,570.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,918.32
|
| Rate for Payer: Healthscope Commercial |
$2,301.98
|
| Rate for Payer: Healthscope Whirlpool |
$2,301.98
|
| Rate for Payer: Meridian Medicaid |
$1,299.41
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,014.24
|
| Rate for Payer: PACE SWMI |
$1,918.32
|
| Rate for Payer: PHP Medicare Advantage |
$1,918.32
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,237.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,313.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,259.19
|
| Rate for Payer: Priority Health Medicare |
$1,918.32
|
| Rate for Payer: Priority Health Narrow Network |
$3,259.19
|
| Rate for Payer: UHC Medicare Advantage |
$1,975.87
|
|
|
PR LAM BX/EXC ISPI NEO IDRL XMED CERVICAL
|
Professional
|
Both
|
$7,440.00
|
|
|
Service Code
|
HCPCS 63280
|
| Min. Negotiated Rate |
$499.24 |
| Max. Negotiated Rate |
$5,208.00 |
| Rate for Payer: Aetna Commercial |
$2,859.84
|
| Rate for Payer: Aetna Medicare |
$2,134.21
|
| Rate for Payer: BCBS Complete |
$1,444.11
|
| Rate for Payer: BCBS MAPPO |
$2,134.21
|
| Rate for Payer: BCBS Trust/PPO |
$499.24
|
| Rate for Payer: BCN Commercial |
$3,442.59
|
| Rate for Payer: BCN Medicare Advantage |
$2,134.21
|
| Rate for Payer: Cash Price |
$5,952.00
|
| Rate for Payer: Cash Price |
$5,952.00
|
| Rate for Payer: Cofinity Commercial |
$2,859.84
|
| Rate for Payer: Cofinity Commercial |
$3,073.26
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,134.21
|
| Rate for Payer: Healthscope Commercial |
$2,561.05
|
| Rate for Payer: Healthscope Whirlpool |
$2,561.05
|
| Rate for Payer: Meridian Medicaid |
$1,444.11
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,240.92
|
| Rate for Payer: PACE SWMI |
$2,134.21
|
| Rate for Payer: PHP Medicare Advantage |
$2,134.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,375.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,208.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,622.69
|
| Rate for Payer: Priority Health Medicare |
$2,134.21
|
| Rate for Payer: Priority Health Narrow Network |
$3,622.69
|
| Rate for Payer: UHC Medicare Advantage |
$2,198.24
|
|
|
PR LAM BX/EXC ISPI NEO IDRL XMED LUMBAR
|
Professional
|
Both
|
$7,844.00
|
|
|
Service Code
|
HCPCS 63282
|
| Min. Negotiated Rate |
$1,285.67 |
| Max. Negotiated Rate |
$5,490.80 |
| Rate for Payer: Aetna Commercial |
$2,673.30
|
| Rate for Payer: Aetna Medicare |
$1,995.00
|
| Rate for Payer: BCBS Complete |
$1,349.95
|
| Rate for Payer: BCBS MAPPO |
$1,995.00
|
| Rate for Payer: BCBS Trust/PPO |
$1,388.14
|
| Rate for Payer: BCN Commercial |
$3,220.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,995.00
|
| Rate for Payer: Cash Price |
$6,275.20
|
| Rate for Payer: Cash Price |
$6,275.20
|
| Rate for Payer: Cofinity Commercial |
$2,872.80
|
| Rate for Payer: Cofinity Commercial |
$2,673.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,995.00
|
| Rate for Payer: Healthscope Commercial |
$2,394.00
|
| Rate for Payer: Healthscope Whirlpool |
$2,394.00
|
| Rate for Payer: Meridian Medicaid |
$1,349.95
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,094.75
|
| Rate for Payer: PACE SWMI |
$1,995.00
|
| Rate for Payer: PHP Medicare Advantage |
$1,995.00
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,285.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,490.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,388.85
|
| Rate for Payer: Priority Health Medicare |
$1,995.00
|
| Rate for Payer: Priority Health Narrow Network |
$3,388.85
|
| Rate for Payer: UHC Medicare Advantage |
$2,054.85
|
|
|
PR LAM BX/EXC ISPI NEO IDRL XMED THORACIC
|
Professional
|
Both
|
$7,286.00
|
|
|
Service Code
|
HCPCS 63281
|
| Min. Negotiated Rate |
$1,364.05 |
| Max. Negotiated Rate |
$5,100.20 |
| Rate for Payer: Aetna Commercial |
$2,831.70
|
| Rate for Payer: Aetna Medicare |
$2,113.21
|
| Rate for Payer: BCBS Complete |
$1,432.25
|
| Rate for Payer: BCBS MAPPO |
$2,113.21
|
| Rate for Payer: BCBS Trust/PPO |
$1,388.14
|
| Rate for Payer: BCN Commercial |
$3,409.23
|
| Rate for Payer: BCN Medicare Advantage |
$2,113.21
|
| Rate for Payer: Cash Price |
$5,828.80
|
| Rate for Payer: Cash Price |
$5,828.80
|
| Rate for Payer: Cofinity Commercial |
$2,831.70
|
| Rate for Payer: Cofinity Commercial |
$3,043.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,113.21
|
| Rate for Payer: Healthscope Commercial |
$2,535.85
|
| Rate for Payer: Healthscope Whirlpool |
$2,535.85
|
| Rate for Payer: Meridian Medicaid |
$1,432.25
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,218.87
|
| Rate for Payer: PACE SWMI |
$2,113.21
|
| Rate for Payer: PHP Medicare Advantage |
$2,113.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,364.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,100.20
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,587.59
|
| Rate for Payer: Priority Health Medicare |
$2,113.21
|
| Rate for Payer: Priority Health Narrow Network |
$3,587.59
|
| Rate for Payer: UHC Medicare Advantage |
$2,176.61
|
|
|
PR LAM BX/EXC ISPI NEO XDRL-IDRL LES ANY LVL
|
Professional
|
Both
|
$9,199.00
|
|
|
Service Code
|
HCPCS 63290
|
| Min. Negotiated Rate |
$213.43 |
| Max. Negotiated Rate |
$6,439.30 |
| Rate for Payer: Aetna Commercial |
$3,766.51
|
| Rate for Payer: Aetna Medicare |
$2,810.83
|
| Rate for Payer: BCBS Complete |
$1,895.44
|
| Rate for Payer: BCBS MAPPO |
$2,810.83
|
| Rate for Payer: BCBS Trust/PPO |
$213.43
|
| Rate for Payer: BCN Commercial |
$4,523.57
|
| Rate for Payer: BCN Medicare Advantage |
$2,810.83
|
| Rate for Payer: Cash Price |
$7,359.20
|
| Rate for Payer: Cash Price |
$7,359.20
|
| Rate for Payer: Cofinity Commercial |
$3,766.51
|
| Rate for Payer: Cofinity Commercial |
$4,047.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,810.83
|
| Rate for Payer: Healthscope Commercial |
$3,373.00
|
| Rate for Payer: Healthscope Whirlpool |
$3,373.00
|
| Rate for Payer: Meridian Medicaid |
$1,895.44
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,951.37
|
| Rate for Payer: PACE SWMI |
$2,810.83
|
| Rate for Payer: PHP Medicare Advantage |
$2,810.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,805.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$6,439.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4,760.25
|
| Rate for Payer: Priority Health Medicare |
$2,810.83
|
| Rate for Payer: Priority Health Narrow Network |
$4,760.25
|
| Rate for Payer: UHC Medicare Advantage |
$2,895.15
|
|
|
PR LAM EXC/EVAC ISPI LESION OTH/THN NEO XDRL LUMBAR
|
Professional
|
Both
|
$5,312.00
|
|
|
Service Code
|
HCPCS 63267
|
| Min. Negotiated Rate |
$244.07 |
| Max. Negotiated Rate |
$3,718.40 |
| Rate for Payer: Aetna Commercial |
$1,839.62
|
| Rate for Payer: Aetna Medicare |
$1,372.85
|
| Rate for Payer: BCBS Complete |
$933.51
|
| Rate for Payer: BCBS MAPPO |
$1,372.85
|
| Rate for Payer: BCBS Trust/PPO |
$244.07
|
| Rate for Payer: BCN Commercial |
$2,226.54
|
| Rate for Payer: BCN Medicare Advantage |
$1,372.85
|
| Rate for Payer: Cash Price |
$4,249.60
|
| Rate for Payer: Cash Price |
$4,249.60
|
| Rate for Payer: Cofinity Commercial |
$1,976.90
|
| Rate for Payer: Cofinity Commercial |
$1,839.62
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,372.85
|
| Rate for Payer: Healthscope Commercial |
$1,647.42
|
| Rate for Payer: Healthscope Whirlpool |
$1,647.42
|
| Rate for Payer: Meridian Medicaid |
$933.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,441.49
|
| Rate for Payer: PACE SWMI |
$1,372.85
|
| Rate for Payer: PHP Medicare Advantage |
$1,372.85
|
| Rate for Payer: Priority Health Choice Medicaid |
$889.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,718.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,343.03
|
| Rate for Payer: Priority Health Medicare |
$1,372.85
|
| Rate for Payer: Priority Health Narrow Network |
$2,343.03
|
| Rate for Payer: UHC Medicare Advantage |
$1,414.04
|
|
|
PR LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL CERVICAL
|
Professional
|
Both
|
$5,705.00
|
|
|
Service Code
|
HCPCS 63265
|
| Min. Negotiated Rate |
$399.92 |
| Max. Negotiated Rate |
$3,993.50 |
| Rate for Payer: Aetna Commercial |
$2,247.98
|
| Rate for Payer: Aetna Medicare |
$1,677.60
|
| Rate for Payer: BCBS Complete |
$1,137.49
|
| Rate for Payer: BCBS MAPPO |
$1,677.60
|
| Rate for Payer: BCBS Trust/PPO |
$399.92
|
| Rate for Payer: BCN Commercial |
$2,712.42
|
| Rate for Payer: BCN Medicare Advantage |
$1,677.60
|
| Rate for Payer: Cash Price |
$4,564.00
|
| Rate for Payer: Cash Price |
$4,564.00
|
| Rate for Payer: Cofinity Commercial |
$2,247.98
|
| Rate for Payer: Cofinity Commercial |
$2,415.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,677.60
|
| Rate for Payer: Healthscope Commercial |
$2,013.12
|
| Rate for Payer: Healthscope Whirlpool |
$2,013.12
|
| Rate for Payer: Meridian Medicaid |
$1,137.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,761.48
|
| Rate for Payer: PACE SWMI |
$1,677.60
|
| Rate for Payer: PHP Medicare Advantage |
$1,677.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,083.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,993.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,854.33
|
| Rate for Payer: Priority Health Medicare |
$1,677.60
|
| Rate for Payer: Priority Health Narrow Network |
$2,854.33
|
| Rate for Payer: UHC Medicare Advantage |
$1,727.93
|
|
|
PR LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL SACRAL
|
Professional
|
Both
|
$4,507.00
|
|
|
Service Code
|
HCPCS 63268
|
| Min. Negotiated Rate |
$312.75 |
| Max. Negotiated Rate |
$3,154.90 |
| Rate for Payer: Aetna Commercial |
$1,877.76
|
| Rate for Payer: Aetna Medicare |
$1,401.31
|
| Rate for Payer: BCBS Complete |
$1,000.61
|
| Rate for Payer: BCBS MAPPO |
$1,401.31
|
| Rate for Payer: BCBS Trust/PPO |
$312.75
|
| Rate for Payer: BCN Commercial |
$2,272.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,401.31
|
| Rate for Payer: Cash Price |
$3,605.60
|
| Rate for Payer: Cash Price |
$3,605.60
|
| Rate for Payer: Cofinity Commercial |
$2,017.89
|
| Rate for Payer: Cofinity Commercial |
$1,877.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,401.31
|
| Rate for Payer: Healthscope Commercial |
$1,681.57
|
| Rate for Payer: Healthscope Whirlpool |
$1,681.57
|
| Rate for Payer: Meridian Medicaid |
$1,000.61
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,471.38
|
| Rate for Payer: PACE SWMI |
$1,401.31
|
| Rate for Payer: PHP Medicare Advantage |
$1,401.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$952.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,154.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,391.17
|
| Rate for Payer: Priority Health Medicare |
$1,401.31
|
| Rate for Payer: Priority Health Narrow Network |
$2,391.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,443.35
|
|
|
PR LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL THORACIC
|
Professional
|
Both
|
$5,800.00
|
|
|
Service Code
|
HCPCS 63266
|
| Min. Negotiated Rate |
$600.15 |
| Max. Negotiated Rate |
$4,060.00 |
| Rate for Payer: Aetna Commercial |
$2,311.70
|
| Rate for Payer: Aetna Medicare |
$1,725.15
|
| Rate for Payer: BCBS Complete |
$1,167.45
|
| Rate for Payer: BCBS MAPPO |
$1,725.15
|
| Rate for Payer: BCBS Trust/PPO |
$600.15
|
| Rate for Payer: BCN Commercial |
$2,788.83
|
| Rate for Payer: BCN Medicare Advantage |
$1,725.15
|
| Rate for Payer: Cash Price |
$4,640.00
|
| Rate for Payer: Cash Price |
$4,640.00
|
| Rate for Payer: Cofinity Commercial |
$2,311.70
|
| Rate for Payer: Cofinity Commercial |
$2,484.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,725.15
|
| Rate for Payer: Healthscope Commercial |
$2,070.18
|
| Rate for Payer: Healthscope Whirlpool |
$2,070.18
|
| Rate for Payer: Meridian Medicaid |
$1,167.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,811.41
|
| Rate for Payer: PACE SWMI |
$1,725.15
|
| Rate for Payer: PHP Medicare Advantage |
$1,725.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,111.86
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,060.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,934.73
|
| Rate for Payer: Priority Health Medicare |
$1,725.15
|
| Rate for Payer: Priority Health Narrow Network |
$2,934.73
|
| Rate for Payer: UHC Medicare Advantage |
$1,776.90
|
|
|
PR LAM EXC ISPI LES OTH/THN NEO IDRL CERVICAL
|
Professional
|
Both
|
$6,089.00
|
|
|
Service Code
|
HCPCS 63270
|
| Min. Negotiated Rate |
$440.60 |
| Max. Negotiated Rate |
$4,262.30 |
| Rate for Payer: Aetna Commercial |
$2,807.50
|
| Rate for Payer: Aetna Medicare |
$2,095.15
|
| Rate for Payer: BCBS Complete |
$1,415.70
|
| Rate for Payer: BCBS MAPPO |
$2,095.15
|
| Rate for Payer: BCBS Trust/PPO |
$440.60
|
| Rate for Payer: BCN Commercial |
$3,067.43
|
| Rate for Payer: BCN Medicare Advantage |
$2,095.15
|
| Rate for Payer: Cash Price |
$4,871.20
|
| Rate for Payer: Cash Price |
$4,871.20
|
| Rate for Payer: Cofinity Commercial |
$3,017.02
|
| Rate for Payer: Cofinity Commercial |
$2,807.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,095.15
|
| Rate for Payer: Healthscope Commercial |
$2,514.18
|
| Rate for Payer: Healthscope Whirlpool |
$2,514.18
|
| Rate for Payer: Meridian Medicaid |
$1,415.70
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,199.91
|
| Rate for Payer: PACE SWMI |
$2,095.15
|
| Rate for Payer: PHP Medicare Advantage |
$2,095.15
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,348.29
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,262.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,554.19
|
| Rate for Payer: Priority Health Medicare |
$2,095.15
|
| Rate for Payer: Priority Health Narrow Network |
$3,554.19
|
| Rate for Payer: UHC Medicare Advantage |
$2,158.00
|
|
|
PR LAM EXC ISPI LES OTH/THN NEO IDRL LUMBAR
|
Professional
|
Both
|
$6,418.00
|
|
|
Service Code
|
HCPCS 63272
|
| Min. Negotiated Rate |
$318.56 |
| Max. Negotiated Rate |
$4,492.60 |
| Rate for Payer: Aetna Commercial |
$2,510.10
|
| Rate for Payer: Aetna Medicare |
$1,873.21
|
| Rate for Payer: BCBS Complete |
$1,272.79
|
| Rate for Payer: BCBS MAPPO |
$1,873.21
|
| Rate for Payer: BCBS Trust/PPO |
$318.56
|
| Rate for Payer: BCN Commercial |
$3,028.27
|
| Rate for Payer: BCN Medicare Advantage |
$1,873.21
|
| Rate for Payer: Cash Price |
$5,134.40
|
| Rate for Payer: Cash Price |
$5,134.40
|
| Rate for Payer: Cofinity Commercial |
$2,697.42
|
| Rate for Payer: Cofinity Commercial |
$2,510.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,873.21
|
| Rate for Payer: Healthscope Commercial |
$2,247.85
|
| Rate for Payer: Healthscope Whirlpool |
$2,247.85
|
| Rate for Payer: Meridian Medicaid |
$1,272.79
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,966.87
|
| Rate for Payer: PACE SWMI |
$1,873.21
|
| Rate for Payer: PHP Medicare Advantage |
$1,873.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,212.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,492.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,186.70
|
| Rate for Payer: Priority Health Medicare |
$1,873.21
|
| Rate for Payer: Priority Health Narrow Network |
$3,186.70
|
| Rate for Payer: UHC Medicare Advantage |
$1,929.41
|
|
|
PR LAM EXC ISPI LES OTH/THN NEO IDRL SACRAL
|
Professional
|
Both
|
$5,631.00
|
|
|
Service Code
|
HCPCS 63273
|
| Min. Negotiated Rate |
$580.07 |
| Max. Negotiated Rate |
$3,941.70 |
| Rate for Payer: Aetna Commercial |
$2,524.21
|
| Rate for Payer: Aetna Medicare |
$1,883.74
|
| Rate for Payer: BCBS Complete |
$1,274.80
|
| Rate for Payer: BCBS MAPPO |
$1,883.74
|
| Rate for Payer: BCBS Trust/PPO |
$580.07
|
| Rate for Payer: BCN Commercial |
$3,039.57
|
| Rate for Payer: BCN Medicare Advantage |
$1,883.74
|
| Rate for Payer: Cash Price |
$4,504.80
|
| Rate for Payer: Cash Price |
$4,504.80
|
| Rate for Payer: Cofinity Commercial |
$2,524.21
|
| Rate for Payer: Cofinity Commercial |
$2,712.59
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,883.74
|
| Rate for Payer: Healthscope Commercial |
$2,260.49
|
| Rate for Payer: Healthscope Whirlpool |
$2,260.49
|
| Rate for Payer: Meridian Medicaid |
$1,274.80
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,977.93
|
| Rate for Payer: PACE SWMI |
$1,883.74
|
| Rate for Payer: PHP Medicare Advantage |
$1,883.74
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,214.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,941.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,198.60
|
| Rate for Payer: Priority Health Medicare |
$1,883.74
|
| Rate for Payer: Priority Health Narrow Network |
$3,198.60
|
| Rate for Payer: UHC Medicare Advantage |
$1,940.25
|
|
|
PR LAM EXC ISPI LES OTH/THN NEO IDRL THORACIC
|
Professional
|
Both
|
$5,990.00
|
|
|
Service Code
|
HCPCS 63271
|
| Min. Negotiated Rate |
$1,344.24 |
| Max. Negotiated Rate |
$4,193.00 |
| Rate for Payer: Aetna Commercial |
$2,804.57
|
| Rate for Payer: Aetna Medicare |
$2,092.96
|
| Rate for Payer: BCBS Complete |
$1,411.45
|
| Rate for Payer: BCBS MAPPO |
$2,092.96
|
| Rate for Payer: BCBS Trust/PPO |
$1,388.14
|
| Rate for Payer: BCN Commercial |
$3,374.79
|
| Rate for Payer: BCN Medicare Advantage |
$2,092.96
|
| Rate for Payer: Cash Price |
$4,792.00
|
| Rate for Payer: Cash Price |
$4,792.00
|
| Rate for Payer: Cofinity Commercial |
$3,013.86
|
| Rate for Payer: Cofinity Commercial |
$2,804.57
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,092.96
|
| Rate for Payer: Healthscope Commercial |
$2,511.55
|
| Rate for Payer: Healthscope Whirlpool |
$2,511.55
|
| Rate for Payer: Meridian Medicaid |
$1,411.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$2,197.61
|
| Rate for Payer: PACE SWMI |
$2,092.96
|
| Rate for Payer: PHP Medicare Advantage |
$2,092.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,344.24
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,193.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,551.36
|
| Rate for Payer: Priority Health Medicare |
$2,092.96
|
| Rate for Payer: Priority Health Narrow Network |
$3,551.36
|
| Rate for Payer: UHC Medicare Advantage |
$2,155.75
|
|
|
PR LAM EXC/OCCLUSION AVM SPI CORD THORACOLUMBAR
|
Professional
|
Both
|
$6,341.00
|
|
|
Service Code
|
HCPCS 63252
|
| Min. Negotiated Rate |
$1,061.35 |
| Max. Negotiated Rate |
$5,167.36 |
| Rate for Payer: Aetna Commercial |
$4,090.87
|
| Rate for Payer: Aetna Medicare |
$3,052.89
|
| Rate for Payer: BCBS Complete |
$2,056.91
|
| Rate for Payer: BCBS MAPPO |
$3,052.89
|
| Rate for Payer: BCBS Trust/PPO |
$1,061.35
|
| Rate for Payer: BCN Commercial |
$4,459.67
|
| Rate for Payer: BCN Medicare Advantage |
$3,052.89
|
| Rate for Payer: Cash Price |
$5,072.80
|
| Rate for Payer: Cash Price |
$5,072.80
|
| Rate for Payer: Cofinity Commercial |
$4,396.16
|
| Rate for Payer: Cofinity Commercial |
$4,090.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,052.89
|
| Rate for Payer: Healthscope Commercial |
$3,663.47
|
| Rate for Payer: Healthscope Whirlpool |
$3,663.47
|
| Rate for Payer: Meridian Medicaid |
$2,056.91
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,205.53
|
| Rate for Payer: PACE SWMI |
$3,052.89
|
| Rate for Payer: PHP Medicare Advantage |
$3,052.89
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,958.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,438.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,167.36
|
| Rate for Payer: Priority Health Medicare |
$3,052.89
|
| Rate for Payer: Priority Health Narrow Network |
$5,167.36
|
| Rate for Payer: UHC Medicare Advantage |
$3,144.48
|
|
|
PR LAM EXC/OCCLUSION AVM SPINAL CORD CERVICAL
|
Professional
|
Both
|
$4,781.00
|
|
|
Service Code
|
HCPCS 63250
|
| Min. Negotiated Rate |
$331.77 |
| Max. Negotiated Rate |
$5,055.24 |
| Rate for Payer: Aetna Commercial |
$4,003.53
|
| Rate for Payer: Aetna Medicare |
$2,987.71
|
| Rate for Payer: BCBS Complete |
$2,011.96
|
| Rate for Payer: BCBS MAPPO |
$2,987.71
|
| Rate for Payer: BCBS Trust/PPO |
$331.77
|
| Rate for Payer: BCN Commercial |
$4,362.91
|
| Rate for Payer: BCN Medicare Advantage |
$2,987.71
|
| Rate for Payer: Cash Price |
$3,824.80
|
| Rate for Payer: Cash Price |
$3,824.80
|
| Rate for Payer: Cofinity Commercial |
$4,003.53
|
| Rate for Payer: Cofinity Commercial |
$4,302.30
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$2,987.71
|
| Rate for Payer: Healthscope Commercial |
$3,585.25
|
| Rate for Payer: Healthscope Whirlpool |
$3,585.25
|
| Rate for Payer: Meridian Medicaid |
$2,011.96
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,137.10
|
| Rate for Payer: PACE SWMI |
$2,987.71
|
| Rate for Payer: PHP Medicare Advantage |
$2,987.71
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,916.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,346.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,055.24
|
| Rate for Payer: Priority Health Medicare |
$2,987.71
|
| Rate for Payer: Priority Health Narrow Network |
$5,055.24
|
| Rate for Payer: UHC Medicare Advantage |
$3,077.34
|
|
|
PR LAM EXC/OCCLUSION AVM SPINAL CORD THORACIC
|
Professional
|
Both
|
$5,742.00
|
|
|
Service Code
|
HCPCS 63251
|
| Min. Negotiated Rate |
$725.36 |
| Max. Negotiated Rate |
$5,169.05 |
| Rate for Payer: Aetna Commercial |
$4,092.31
|
| Rate for Payer: Aetna Medicare |
$3,053.96
|
| Rate for Payer: BCBS Complete |
$2,057.13
|
| Rate for Payer: BCBS MAPPO |
$3,053.96
|
| Rate for Payer: BCBS Trust/PPO |
$725.36
|
| Rate for Payer: BCN Commercial |
$4,461.14
|
| Rate for Payer: BCN Medicare Advantage |
$3,053.96
|
| Rate for Payer: Cash Price |
$4,593.60
|
| Rate for Payer: Cash Price |
$4,593.60
|
| Rate for Payer: Cofinity Commercial |
$4,092.31
|
| Rate for Payer: Cofinity Commercial |
$4,397.70
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,053.96
|
| Rate for Payer: Healthscope Commercial |
$3,664.75
|
| Rate for Payer: Healthscope Whirlpool |
$3,664.75
|
| Rate for Payer: Meridian Medicaid |
$2,057.13
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$3,206.66
|
| Rate for Payer: PACE SWMI |
$3,053.96
|
| Rate for Payer: PHP Medicare Advantage |
$3,053.96
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,959.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,019.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5,169.05
|
| Rate for Payer: Priority Health Medicare |
$3,053.96
|
| Rate for Payer: Priority Health Narrow Network |
$5,169.05
|
| Rate for Payer: UHC Medicare Advantage |
$3,145.58
|
|
|
PR LAM FACETEC/FORAMOT DRG ARTHRD LMBR EA ADDL SGM
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
HCPCS 63053
|
| Min. Negotiated Rate |
$146.12 |
| Max. Negotiated Rate |
$385.60 |
| Rate for Payer: Aetna Commercial |
$305.60
|
| Rate for Payer: Aetna Medicare |
$228.06
|
| Rate for Payer: BCBS Complete |
$153.43
|
| Rate for Payer: BCBS MAPPO |
$228.06
|
| Rate for Payer: BCBS Trust/PPO |
$175.40
|
| Rate for Payer: BCN Commercial |
$332.79
|
| Rate for Payer: BCN Medicare Advantage |
$228.06
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cofinity Commercial |
$328.41
|
| Rate for Payer: Cofinity Commercial |
$305.60
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$228.06
|
| Rate for Payer: Healthscope Commercial |
$273.67
|
| Rate for Payer: Healthscope Whirlpool |
$273.67
|
| Rate for Payer: Meridian Medicaid |
$153.43
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$239.46
|
| Rate for Payer: PACE SWMI |
$228.06
|
| Rate for Payer: PHP Medicare Advantage |
$228.06
|
| Rate for Payer: Priority Health Choice Medicaid |
$146.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$336.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$385.60
|
| Rate for Payer: Priority Health Medicare |
$228.06
|
| Rate for Payer: Priority Health Narrow Network |
$385.60
|
| Rate for Payer: UHC Medicare Advantage |
$234.90
|
|
|
PR LAM FACETEC/FORAMOT DRG ARTHRD LUMBAR 1 VRT SGM
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 63052
|
| Min. Negotiated Rate |
$164.44 |
| Max. Negotiated Rate |
$449.06 |
| Rate for Payer: Aetna Commercial |
$345.18
|
| Rate for Payer: Aetna Medicare |
$257.60
|
| Rate for Payer: BCBS Complete |
$172.66
|
| Rate for Payer: BCBS MAPPO |
$257.60
|
| Rate for Payer: BCBS Trust/PPO |
$449.06
|
| Rate for Payer: BCN Commercial |
$375.79
|
| Rate for Payer: BCN Medicare Advantage |
$257.60
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cofinity Commercial |
$370.94
|
| Rate for Payer: Cofinity Commercial |
$345.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$257.60
|
| Rate for Payer: Healthscope Commercial |
$309.12
|
| Rate for Payer: Healthscope Whirlpool |
$309.12
|
| Rate for Payer: Meridian Medicaid |
$172.66
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$270.48
|
| Rate for Payer: PACE SWMI |
$257.60
|
| Rate for Payer: PHP Medicare Advantage |
$257.60
|
| Rate for Payer: Priority Health Choice Medicaid |
$164.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$448.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$435.42
|
| Rate for Payer: Priority Health Medicare |
$257.60
|
| Rate for Payer: Priority Health Narrow Network |
$435.42
|
| Rate for Payer: UHC Medicare Advantage |
$265.33
|
|
|
PR LAM FACETECTOMY&FORAMOT 1 VRT SGM EA ADDL SGM
|
Professional
|
Both
|
$2,263.00
|
|
|
Service Code
|
HCPCS 63048
|
| Min. Negotiated Rate |
$134.19 |
| Max. Negotiated Rate |
$1,584.10 |
| Rate for Payer: Aetna Commercial |
$280.93
|
| Rate for Payer: Aetna Medicare |
$209.65
|
| Rate for Payer: BCBS Complete |
$140.90
|
| Rate for Payer: BCBS MAPPO |
$209.65
|
| Rate for Payer: BCBS Trust/PPO |
$347.09
|
| Rate for Payer: BCN Commercial |
$336.83
|
| Rate for Payer: BCN Medicare Advantage |
$209.65
|
| Rate for Payer: Cash Price |
$1,810.40
|
| Rate for Payer: Cash Price |
$1,810.40
|
| Rate for Payer: Cofinity Commercial |
$280.93
|
| Rate for Payer: Cofinity Commercial |
$301.90
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$209.65
|
| Rate for Payer: Healthscope Commercial |
$251.58
|
| Rate for Payer: Healthscope Whirlpool |
$251.58
|
| Rate for Payer: Meridian Medicaid |
$140.90
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$220.13
|
| Rate for Payer: PACE SWMI |
$209.65
|
| Rate for Payer: PHP Medicare Advantage |
$209.65
|
| Rate for Payer: Priority Health Choice Medicaid |
$134.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,584.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$354.45
|
| Rate for Payer: Priority Health Medicare |
$209.65
|
| Rate for Payer: Priority Health Narrow Network |
$354.45
|
| Rate for Payer: UHC Medicare Advantage |
$215.94
|
|
|
PR LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM CERVICAL
|
Professional
|
Both
|
$2,625.32
|
|
|
Service Code
|
HCPCS 63045
|
| Min. Negotiated Rate |
$166.94 |
| Max. Negotiated Rate |
$2,199.21 |
| Rate for Payer: Aetna Commercial |
$1,726.16
|
| Rate for Payer: Aetna Medicare |
$1,288.18
|
| Rate for Payer: BCBS Complete |
$876.71
|
| Rate for Payer: BCBS MAPPO |
$1,288.18
|
| Rate for Payer: BCBS Trust/PPO |
$166.94
|
| Rate for Payer: BCN Commercial |
$2,089.87
|
| Rate for Payer: BCN Medicare Advantage |
$1,288.18
|
| Rate for Payer: Cash Price |
$2,100.26
|
| Rate for Payer: Cash Price |
$2,100.26
|
| Rate for Payer: Cofinity Commercial |
$1,854.98
|
| Rate for Payer: Cofinity Commercial |
$1,726.16
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,288.18
|
| Rate for Payer: Healthscope Commercial |
$1,545.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,545.82
|
| Rate for Payer: Meridian Medicaid |
$876.71
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,352.59
|
| Rate for Payer: PACE SWMI |
$1,288.18
|
| Rate for Payer: PHP Medicare Advantage |
$1,288.18
|
| Rate for Payer: Priority Health Choice Medicaid |
$834.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,837.72
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,199.21
|
| Rate for Payer: Priority Health Medicare |
$1,288.18
|
| Rate for Payer: Priority Health Narrow Network |
$2,199.21
|
| Rate for Payer: UHC Medicare Advantage |
$1,326.83
|
|
|
PR LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM LUMBAR
|
Professional
|
Both
|
$2,240.74
|
|
|
Service Code
|
HCPCS 63047
|
| Min. Negotiated Rate |
$364.00 |
| Max. Negotiated Rate |
$1,886.65 |
| Rate for Payer: Aetna Commercial |
$1,476.52
|
| Rate for Payer: Aetna Medicare |
$1,101.88
|
| Rate for Payer: BCBS Complete |
$751.68
|
| Rate for Payer: BCBS MAPPO |
$1,101.88
|
| Rate for Payer: BCBS Trust/PPO |
$364.00
|
| Rate for Payer: BCN Commercial |
$1,792.85
|
| Rate for Payer: BCN Medicare Advantage |
$1,101.88
|
| Rate for Payer: Cash Price |
$1,792.59
|
| Rate for Payer: Cash Price |
$1,792.59
|
| Rate for Payer: Cofinity Commercial |
$1,586.71
|
| Rate for Payer: Cofinity Commercial |
$1,476.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,101.88
|
| Rate for Payer: Healthscope Commercial |
$1,322.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,322.26
|
| Rate for Payer: Meridian Medicaid |
$751.68
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,156.97
|
| Rate for Payer: PACE SWMI |
$1,101.88
|
| Rate for Payer: PHP Medicare Advantage |
$1,101.88
|
| Rate for Payer: Priority Health Choice Medicaid |
$715.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,568.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,886.65
|
| Rate for Payer: Priority Health Medicare |
$1,101.88
|
| Rate for Payer: Priority Health Narrow Network |
$1,886.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,134.94
|
|
