|
PR LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM THORACIC
|
Professional
|
Both
|
$2,500.74
|
|
|
Service Code
|
HCPCS 63046
|
| Min. Negotiated Rate |
$189.66 |
| Max. Negotiated Rate |
$2,096.72 |
| Rate for Payer: Aetna Commercial |
$1,643.74
|
| Rate for Payer: Aetna Medicare |
$1,226.67
|
| Rate for Payer: BCBS Complete |
$836.45
|
| Rate for Payer: BCBS MAPPO |
$1,226.67
|
| Rate for Payer: BCBS Trust/PPO |
$189.66
|
| Rate for Payer: BCN Commercial |
$1,992.49
|
| Rate for Payer: BCN Medicare Advantage |
$1,226.67
|
| Rate for Payer: Cash Price |
$2,000.59
|
| Rate for Payer: Cash Price |
$2,000.59
|
| Rate for Payer: Cofinity Commercial |
$1,766.40
|
| Rate for Payer: Cofinity Commercial |
$1,643.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,226.67
|
| Rate for Payer: Healthscope Commercial |
$1,472.00
|
| Rate for Payer: Healthscope Whirlpool |
$1,472.00
|
| Rate for Payer: Meridian Medicaid |
$836.45
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,288.00
|
| Rate for Payer: PACE SWMI |
$1,226.67
|
| Rate for Payer: PHP Medicare Advantage |
$1,226.67
|
| Rate for Payer: Priority Health Choice Medicaid |
$796.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,750.52
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,096.72
|
| Rate for Payer: Priority Health Medicare |
$1,226.67
|
| Rate for Payer: Priority Health Narrow Network |
$2,096.72
|
| Rate for Payer: UHC Medicare Advantage |
$1,263.47
|
|
|
PR LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL
|
Professional
|
Both
|
$1,686.18
|
|
|
Service Code
|
HCPCS 63655
|
| Min. Negotiated Rate |
$297.43 |
| Max. Negotiated Rate |
$1,433.67 |
| Rate for Payer: Aetna Commercial |
$1,119.50
|
| Rate for Payer: Aetna Medicare |
$835.45
|
| Rate for Payer: BCBS Complete |
$572.54
|
| Rate for Payer: BCBS MAPPO |
$835.45
|
| Rate for Payer: BCBS Trust/PPO |
$297.43
|
| Rate for Payer: BCN Commercial |
$1,362.40
|
| Rate for Payer: BCN Medicare Advantage |
$835.45
|
| Rate for Payer: Cash Price |
$1,348.94
|
| Rate for Payer: Cash Price |
$1,348.94
|
| Rate for Payer: Cofinity Commercial |
$1,203.05
|
| Rate for Payer: Cofinity Commercial |
$1,119.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$835.45
|
| Rate for Payer: Healthscope Commercial |
$1,002.54
|
| Rate for Payer: Healthscope Whirlpool |
$1,002.54
|
| Rate for Payer: Meridian Medicaid |
$572.54
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$877.22
|
| Rate for Payer: PACE SWMI |
$835.45
|
| Rate for Payer: PHP Medicare Advantage |
$835.45
|
| Rate for Payer: Priority Health Choice Medicaid |
$545.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,180.33
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,433.67
|
| Rate for Payer: Priority Health Medicare |
$835.45
|
| Rate for Payer: Priority Health Narrow Network |
$1,433.67
|
| Rate for Payer: UHC Medicare Advantage |
$860.51
|
|
|
PR LAMINECTOMY BX/EXC ISPI NEO XDRL CERVICAL
|
Professional
|
Both
|
$6,669.00
|
|
|
Service Code
|
HCPCS 63275
|
| Min. Negotiated Rate |
$191.77 |
| Max. Negotiated Rate |
$4,668.30 |
| Rate for Payer: Aetna Commercial |
$2,436.67
|
| Rate for Payer: Aetna Medicare |
$1,818.41
|
| Rate for Payer: BCBS Complete |
$1,225.15
|
| Rate for Payer: BCBS MAPPO |
$1,818.41
|
| Rate for Payer: BCBS Trust/PPO |
$191.77
|
| Rate for Payer: BCN Commercial |
$2,936.80
|
| Rate for Payer: BCN Medicare Advantage |
$1,818.41
|
| Rate for Payer: Cash Price |
$5,335.20
|
| Rate for Payer: Cash Price |
$5,335.20
|
| Rate for Payer: Cofinity Commercial |
$2,436.67
|
| Rate for Payer: Cofinity Commercial |
$2,618.51
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,818.41
|
| Rate for Payer: Healthscope Commercial |
$2,182.09
|
| Rate for Payer: Healthscope Whirlpool |
$2,182.09
|
| Rate for Payer: Meridian Medicaid |
$1,225.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,909.33
|
| Rate for Payer: PACE SWMI |
$1,818.41
|
| Rate for Payer: PHP Medicare Advantage |
$1,818.41
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,166.81
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,668.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,090.44
|
| Rate for Payer: Priority Health Medicare |
$1,818.41
|
| Rate for Payer: Priority Health Narrow Network |
$3,090.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,872.96
|
|
|
PR LAMINECTOMY BX/EXC ISPI NEO XDRL LUMBAR
|
Professional
|
Both
|
$6,090.00
|
|
|
Service Code
|
HCPCS 63277
|
| Min. Negotiated Rate |
$453.81 |
| Max. Negotiated Rate |
$4,263.00 |
| Rate for Payer: Aetna Commercial |
$2,100.99
|
| Rate for Payer: Aetna Medicare |
$1,567.90
|
| Rate for Payer: BCBS Complete |
$1,061.89
|
| Rate for Payer: BCBS MAPPO |
$1,567.90
|
| Rate for Payer: BCBS Trust/PPO |
$453.81
|
| Rate for Payer: BCN Commercial |
$2,538.09
|
| Rate for Payer: BCN Medicare Advantage |
$1,567.90
|
| Rate for Payer: Cash Price |
$4,872.00
|
| Rate for Payer: Cash Price |
$4,872.00
|
| Rate for Payer: Cofinity Commercial |
$2,257.78
|
| Rate for Payer: Cofinity Commercial |
$2,100.99
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,567.90
|
| Rate for Payer: Healthscope Commercial |
$1,881.48
|
| Rate for Payer: Healthscope Whirlpool |
$1,881.48
|
| Rate for Payer: Meridian Medicaid |
$1,061.89
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,646.30
|
| Rate for Payer: PACE SWMI |
$1,567.90
|
| Rate for Payer: PHP Medicare Advantage |
$1,567.90
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,011.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,263.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,670.88
|
| Rate for Payer: Priority Health Medicare |
$1,567.90
|
| Rate for Payer: Priority Health Narrow Network |
$2,670.88
|
| Rate for Payer: UHC Medicare Advantage |
$1,614.94
|
|
|
PR LAMINECTOMY BX/EXC ISPI NEO XDRL SACRAL
|
Professional
|
Both
|
$5,298.00
|
|
|
Service Code
|
HCPCS 63278
|
| Min. Negotiated Rate |
$351.32 |
| Max. Negotiated Rate |
$3,708.60 |
| Rate for Payer: Aetna Commercial |
$2,153.26
|
| Rate for Payer: Aetna Medicare |
$1,606.91
|
| Rate for Payer: BCBS Complete |
$1,089.85
|
| Rate for Payer: BCBS MAPPO |
$1,606.91
|
| Rate for Payer: BCBS Trust/PPO |
$351.32
|
| Rate for Payer: BCN Commercial |
$2,597.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,606.91
|
| Rate for Payer: Cash Price |
$4,238.40
|
| Rate for Payer: Cash Price |
$4,238.40
|
| Rate for Payer: Cofinity Commercial |
$2,153.26
|
| Rate for Payer: Cofinity Commercial |
$2,313.95
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,606.91
|
| Rate for Payer: Healthscope Commercial |
$1,928.29
|
| Rate for Payer: Healthscope Whirlpool |
$1,928.29
|
| Rate for Payer: Meridian Medicaid |
$1,089.85
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,687.26
|
| Rate for Payer: PACE SWMI |
$1,606.91
|
| Rate for Payer: PHP Medicare Advantage |
$1,606.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,037.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,708.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,733.17
|
| Rate for Payer: Priority Health Medicare |
$1,606.91
|
| Rate for Payer: Priority Health Narrow Network |
$2,733.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,655.12
|
|
|
PR LAMINECTOMY BX/EXC ISPI NEO XDRL THORACIC
|
Professional
|
Both
|
$6,788.00
|
|
|
Service Code
|
HCPCS 63276
|
| Min. Negotiated Rate |
$311.70 |
| Max. Negotiated Rate |
$4,751.60 |
| Rate for Payer: Aetna Commercial |
$2,407.42
|
| Rate for Payer: Aetna Medicare |
$1,796.58
|
| Rate for Payer: BCBS Complete |
$1,217.55
|
| Rate for Payer: BCBS MAPPO |
$1,796.58
|
| Rate for Payer: BCBS Trust/PPO |
$311.70
|
| Rate for Payer: BCN Commercial |
$2,902.36
|
| Rate for Payer: BCN Medicare Advantage |
$1,796.58
|
| Rate for Payer: Cash Price |
$5,430.40
|
| Rate for Payer: Cash Price |
$5,430.40
|
| Rate for Payer: Cofinity Commercial |
$2,407.42
|
| Rate for Payer: Cofinity Commercial |
$2,587.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,796.58
|
| Rate for Payer: Healthscope Commercial |
$2,155.90
|
| Rate for Payer: Healthscope Whirlpool |
$2,155.90
|
| Rate for Payer: Meridian Medicaid |
$1,217.55
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,886.41
|
| Rate for Payer: PACE SWMI |
$1,796.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,796.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,159.57
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,751.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$3,054.22
|
| Rate for Payer: Priority Health Medicare |
$1,796.58
|
| Rate for Payer: Priority Health Narrow Network |
$3,054.22
|
| Rate for Payer: UHC Medicare Advantage |
$1,850.48
|
|
|
PR LAMINECTOMY RELEASE TETHERED SPINAL CORD LUMBAR
|
Professional
|
Both
|
$5,800.00
|
|
|
Service Code
|
HCPCS 63200
|
| Min. Negotiated Rate |
$291.09 |
| Max. Negotiated Rate |
$4,060.00 |
| Rate for Payer: Aetna Commercial |
$2,052.50
|
| Rate for Payer: Aetna Medicare |
$1,531.72
|
| Rate for Payer: BCBS Complete |
$1,046.01
|
| Rate for Payer: BCBS MAPPO |
$1,531.72
|
| Rate for Payer: BCBS Trust/PPO |
$291.09
|
| Rate for Payer: BCN Commercial |
$2,479.43
|
| Rate for Payer: BCN Medicare Advantage |
$1,531.72
|
| Rate for Payer: Cash Price |
$4,640.00
|
| Rate for Payer: Cash Price |
$4,640.00
|
| Rate for Payer: Cofinity Commercial |
$2,205.68
|
| Rate for Payer: Cofinity Commercial |
$2,052.50
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,531.72
|
| Rate for Payer: Healthscope Commercial |
$1,838.06
|
| Rate for Payer: Healthscope Whirlpool |
$1,838.06
|
| Rate for Payer: Meridian Medicaid |
$1,046.01
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,608.31
|
| Rate for Payer: PACE SWMI |
$1,531.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,531.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$996.20
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,060.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,609.15
|
| Rate for Payer: Priority Health Medicare |
$1,531.72
|
| Rate for Payer: Priority Health Narrow Network |
$2,609.15
|
| Rate for Payer: UHC Medicare Advantage |
$1,577.67
|
|
|
PR LAMINECTOMY W/O FFD 1/2 VERT SEG LUMBAR
|
Professional
|
Both
|
$4,934.00
|
|
|
Service Code
|
HCPCS 63005
|
| Min. Negotiated Rate |
$233.48 |
| Max. Negotiated Rate |
$3,453.80 |
| Rate for Payer: Aetna Commercial |
$1,607.32
|
| Rate for Payer: Aetna Medicare |
$1,199.49
|
| Rate for Payer: BCBS Complete |
$818.56
|
| Rate for Payer: BCBS MAPPO |
$1,199.49
|
| Rate for Payer: BCBS Trust/PPO |
$233.48
|
| Rate for Payer: BCN Commercial |
$1,947.28
|
| Rate for Payer: BCN Medicare Advantage |
$1,199.49
|
| Rate for Payer: Cash Price |
$3,947.20
|
| Rate for Payer: Cash Price |
$3,947.20
|
| Rate for Payer: Cofinity Commercial |
$1,607.32
|
| Rate for Payer: Cofinity Commercial |
$1,727.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,199.49
|
| Rate for Payer: Healthscope Commercial |
$1,439.39
|
| Rate for Payer: Healthscope Whirlpool |
$1,439.39
|
| Rate for Payer: Meridian Medicaid |
$818.56
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,259.46
|
| Rate for Payer: PACE SWMI |
$1,199.49
|
| Rate for Payer: PHP Medicare Advantage |
$1,199.49
|
| Rate for Payer: Priority Health Choice Medicaid |
$779.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,453.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,049.17
|
| Rate for Payer: Priority Health Medicare |
$1,199.49
|
| Rate for Payer: Priority Health Narrow Network |
$2,049.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,235.47
|
|
|
PR LAMINECTOMY W/O FFD 1/2 VERT SEG SACRAL
|
Professional
|
Both
|
$2,197.00
|
|
|
Service Code
|
HCPCS 63011
|
| Min. Negotiated Rate |
$449.06 |
| Max. Negotiated Rate |
$1,861.74 |
| Rate for Payer: Aetna Commercial |
$1,455.78
|
| Rate for Payer: Aetna Medicare |
$1,086.40
|
| Rate for Payer: BCBS Complete |
$738.27
|
| Rate for Payer: BCBS MAPPO |
$1,086.40
|
| Rate for Payer: BCBS Trust/PPO |
$449.06
|
| Rate for Payer: BCN Commercial |
$1,606.77
|
| Rate for Payer: BCN Medicare Advantage |
$1,086.40
|
| Rate for Payer: Cash Price |
$1,757.60
|
| Rate for Payer: Cash Price |
$1,757.60
|
| Rate for Payer: Cofinity Commercial |
$1,455.78
|
| Rate for Payer: Cofinity Commercial |
$1,564.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,086.40
|
| Rate for Payer: Healthscope Commercial |
$1,303.68
|
| Rate for Payer: Healthscope Whirlpool |
$1,303.68
|
| Rate for Payer: Meridian Medicaid |
$738.27
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,140.72
|
| Rate for Payer: PACE SWMI |
$1,086.40
|
| Rate for Payer: PHP Medicare Advantage |
$1,086.40
|
| Rate for Payer: Priority Health Choice Medicaid |
$703.11
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,537.90
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,861.74
|
| Rate for Payer: Priority Health Medicare |
$1,086.40
|
| Rate for Payer: Priority Health Narrow Network |
$1,861.74
|
| Rate for Payer: UHC Medicare Advantage |
$1,118.99
|
|
|
PR LAMINECTOMY W/O FFD 1/2 VERT SEG THORACIC
|
Professional
|
Both
|
$6,062.00
|
|
|
Service Code
|
HCPCS 63003
|
| Min. Negotiated Rate |
$194.94 |
| Max. Negotiated Rate |
$4,243.40 |
| Rate for Payer: Aetna Commercial |
$1,657.70
|
| Rate for Payer: Aetna Medicare |
$1,237.09
|
| Rate for Payer: BCBS Complete |
$840.47
|
| Rate for Payer: BCBS MAPPO |
$1,237.09
|
| Rate for Payer: BCBS Trust/PPO |
$194.94
|
| Rate for Payer: BCN Commercial |
$2,002.71
|
| Rate for Payer: BCN Medicare Advantage |
$1,237.09
|
| Rate for Payer: Cash Price |
$4,849.60
|
| Rate for Payer: Cash Price |
$4,849.60
|
| Rate for Payer: Cofinity Commercial |
$1,657.70
|
| Rate for Payer: Cofinity Commercial |
$1,781.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,237.09
|
| Rate for Payer: Healthscope Commercial |
$1,484.51
|
| Rate for Payer: Healthscope Whirlpool |
$1,484.51
|
| Rate for Payer: Meridian Medicaid |
$840.47
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,298.94
|
| Rate for Payer: PACE SWMI |
$1,237.09
|
| Rate for Payer: PHP Medicare Advantage |
$1,237.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$800.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,243.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,107.48
|
| Rate for Payer: Priority Health Medicare |
$1,237.09
|
| Rate for Payer: Priority Health Narrow Network |
$2,107.48
|
| Rate for Payer: UHC Medicare Advantage |
$1,274.20
|
|
|
PR LAMINECTOMY W/O FFD > 2 VERT SEG CERVICAL
|
Professional
|
Both
|
$6,133.00
|
|
|
Service Code
|
HCPCS 63015
|
| Min. Negotiated Rate |
$422.11 |
| Max. Negotiated Rate |
$4,293.10 |
| Rate for Payer: Aetna Commercial |
$1,989.87
|
| Rate for Payer: Aetna Medicare |
$1,484.98
|
| Rate for Payer: BCBS Complete |
$1,009.33
|
| Rate for Payer: BCBS MAPPO |
$1,484.98
|
| Rate for Payer: BCBS Trust/PPO |
$422.11
|
| Rate for Payer: BCN Commercial |
$2,404.11
|
| Rate for Payer: BCN Medicare Advantage |
$1,484.98
|
| Rate for Payer: Cash Price |
$4,906.40
|
| Rate for Payer: Cash Price |
$4,906.40
|
| Rate for Payer: Cofinity Commercial |
$2,138.37
|
| Rate for Payer: Cofinity Commercial |
$1,989.87
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,484.98
|
| Rate for Payer: Healthscope Commercial |
$1,781.98
|
| Rate for Payer: Healthscope Whirlpool |
$1,781.98
|
| Rate for Payer: Meridian Medicaid |
$1,009.33
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,559.23
|
| Rate for Payer: PACE SWMI |
$1,484.98
|
| Rate for Payer: PHP Medicare Advantage |
$1,484.98
|
| Rate for Payer: Priority Health Choice Medicaid |
$961.27
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,293.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,529.89
|
| Rate for Payer: Priority Health Medicare |
$1,484.98
|
| Rate for Payer: Priority Health Narrow Network |
$2,529.89
|
| Rate for Payer: UHC Medicare Advantage |
$1,529.53
|
|
|
PR LAMINECTOMY W/O FFD > 2 VERT SEG LUMBAR
|
Professional
|
Both
|
$6,135.00
|
|
|
Service Code
|
HCPCS 63017
|
| Min. Negotiated Rate |
$263.09 |
| Max. Negotiated Rate |
$4,294.50 |
| Rate for Payer: Aetna Commercial |
$1,699.35
|
| Rate for Payer: Aetna Medicare |
$1,268.17
|
| Rate for Payer: BCBS Complete |
$863.07
|
| Rate for Payer: BCBS MAPPO |
$1,268.17
|
| Rate for Payer: BCBS Trust/PPO |
$263.09
|
| Rate for Payer: BCN Commercial |
$2,056.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,268.17
|
| Rate for Payer: Cash Price |
$4,908.00
|
| Rate for Payer: Cash Price |
$4,908.00
|
| Rate for Payer: Cofinity Commercial |
$1,826.16
|
| Rate for Payer: Cofinity Commercial |
$1,699.35
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,268.17
|
| Rate for Payer: Healthscope Commercial |
$1,521.80
|
| Rate for Payer: Healthscope Whirlpool |
$1,521.80
|
| Rate for Payer: Meridian Medicaid |
$863.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,331.58
|
| Rate for Payer: PACE SWMI |
$1,268.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,268.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$821.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,294.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,164.11
|
| Rate for Payer: Priority Health Medicare |
$1,268.17
|
| Rate for Payer: Priority Health Narrow Network |
$2,164.11
|
| Rate for Payer: UHC Medicare Advantage |
$1,306.22
|
|
|
PR LAMINECTOMY W/O FFD > 2 VERT SEG THORACIC
|
Professional
|
Both
|
$6,640.00
|
|
|
Service Code
|
HCPCS 63016
|
| Min. Negotiated Rate |
$313.28 |
| Max. Negotiated Rate |
$4,648.00 |
| Rate for Payer: Aetna Commercial |
$2,054.89
|
| Rate for Payer: Aetna Medicare |
$1,533.50
|
| Rate for Payer: BCBS Complete |
$1,037.74
|
| Rate for Payer: BCBS MAPPO |
$1,533.50
|
| Rate for Payer: BCBS Trust/PPO |
$313.28
|
| Rate for Payer: BCN Commercial |
$2,480.52
|
| Rate for Payer: BCN Medicare Advantage |
$1,533.50
|
| Rate for Payer: Cash Price |
$5,312.00
|
| Rate for Payer: Cash Price |
$5,312.00
|
| Rate for Payer: Cofinity Commercial |
$2,208.24
|
| Rate for Payer: Cofinity Commercial |
$2,054.89
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,533.50
|
| Rate for Payer: Healthscope Commercial |
$1,840.20
|
| Rate for Payer: Healthscope Whirlpool |
$1,840.20
|
| Rate for Payer: Meridian Medicaid |
$1,037.74
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,610.18
|
| Rate for Payer: PACE SWMI |
$1,533.50
|
| Rate for Payer: PHP Medicare Advantage |
$1,533.50
|
| Rate for Payer: Priority Health Choice Medicaid |
$988.32
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,648.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,610.29
|
| Rate for Payer: Priority Health Medicare |
$1,533.50
|
| Rate for Payer: Priority Health Narrow Network |
$2,610.29
|
| Rate for Payer: UHC Medicare Advantage |
$1,579.50
|
|
|
PR LAMINECTOMY W/RHIZOTOMY 1/2 SEGMENTS
|
Professional
|
Both
|
$5,671.00
|
|
|
Service Code
|
HCPCS 63185
|
| Min. Negotiated Rate |
$801.95 |
| Max. Negotiated Rate |
$4,716.13 |
| Rate for Payer: Aetna Commercial |
$1,523.24
|
| Rate for Payer: Aetna Medicare |
$1,136.75
|
| Rate for Payer: BCBS Complete |
$842.05
|
| Rate for Payer: BCBS MAPPO |
$1,136.75
|
| Rate for Payer: BCBS Trust/PPO |
$4,716.13
|
| Rate for Payer: BCN Commercial |
$1,680.08
|
| Rate for Payer: BCN Medicare Advantage |
$1,136.75
|
| Rate for Payer: Cash Price |
$4,536.80
|
| Rate for Payer: Cash Price |
$4,536.80
|
| Rate for Payer: Cofinity Commercial |
$1,636.92
|
| Rate for Payer: Cofinity Commercial |
$1,523.24
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,136.75
|
| Rate for Payer: Healthscope Commercial |
$1,364.10
|
| Rate for Payer: Healthscope Whirlpool |
$1,364.10
|
| Rate for Payer: Meridian Medicaid |
$842.05
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,193.59
|
| Rate for Payer: PACE SWMI |
$1,136.75
|
| Rate for Payer: PHP Medicare Advantage |
$1,136.75
|
| Rate for Payer: Priority Health Choice Medicaid |
$801.95
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,969.70
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,946.67
|
| Rate for Payer: Priority Health Medicare |
$1,136.75
|
| Rate for Payer: Priority Health Narrow Network |
$1,946.67
|
| Rate for Payer: UHC Medicare Advantage |
$1,170.85
|
|
|
PR LAMINECTOMY W/RMVL ABNORMAL FACETS LUMBAR
|
Professional
|
Both
|
$6,034.00
|
|
|
Service Code
|
HCPCS 63012
|
| Min. Negotiated Rate |
$479.17 |
| Max. Negotiated Rate |
$4,223.80 |
| Rate for Payer: Aetna Commercial |
$1,602.21
|
| Rate for Payer: Aetna Medicare |
$1,195.68
|
| Rate for Payer: BCBS Complete |
$812.07
|
| Rate for Payer: BCBS MAPPO |
$1,195.68
|
| Rate for Payer: BCBS Trust/PPO |
$479.17
|
| Rate for Payer: BCN Commercial |
$1,940.29
|
| Rate for Payer: BCN Medicare Advantage |
$1,195.68
|
| Rate for Payer: Cash Price |
$4,827.20
|
| Rate for Payer: Cash Price |
$4,827.20
|
| Rate for Payer: Cofinity Commercial |
$1,721.78
|
| Rate for Payer: Cofinity Commercial |
$1,602.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,195.68
|
| Rate for Payer: Healthscope Commercial |
$1,434.82
|
| Rate for Payer: Healthscope Whirlpool |
$1,434.82
|
| Rate for Payer: Meridian Medicaid |
$812.07
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,255.46
|
| Rate for Payer: PACE SWMI |
$1,195.68
|
| Rate for Payer: PHP Medicare Advantage |
$1,195.68
|
| Rate for Payer: Priority Health Choice Medicaid |
$773.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,223.80
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,041.80
|
| Rate for Payer: Priority Health Medicare |
$1,195.68
|
| Rate for Payer: Priority Health Narrow Network |
$2,041.80
|
| Rate for Payer: UHC Medicare Advantage |
$1,231.55
|
|
|
PR LAMINECTOMY W/SECTION SPINAL ACCESSORY NERVE
|
Professional
|
Both
|
$2,188.00
|
|
|
Service Code
|
HCPCS 63191
|
| Min. Negotiated Rate |
$243.55 |
| Max. Negotiated Rate |
$2,369.65 |
| Rate for Payer: Aetna Commercial |
$1,865.01
|
| Rate for Payer: Aetna Medicare |
$1,391.80
|
| Rate for Payer: BCBS Complete |
$945.37
|
| Rate for Payer: BCBS MAPPO |
$1,391.80
|
| Rate for Payer: BCBS Trust/PPO |
$243.55
|
| Rate for Payer: BCN Commercial |
$2,045.12
|
| Rate for Payer: BCN Medicare Advantage |
$1,391.80
|
| Rate for Payer: Cash Price |
$1,750.40
|
| Rate for Payer: Cash Price |
$1,750.40
|
| Rate for Payer: Cofinity Commercial |
$2,004.19
|
| Rate for Payer: Cofinity Commercial |
$1,865.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,391.80
|
| Rate for Payer: Healthscope Commercial |
$1,670.16
|
| Rate for Payer: Healthscope Whirlpool |
$1,670.16
|
| Rate for Payer: Meridian Medicaid |
$945.37
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,461.39
|
| Rate for Payer: PACE SWMI |
$1,391.80
|
| Rate for Payer: PHP Medicare Advantage |
$1,391.80
|
| Rate for Payer: Priority Health Choice Medicaid |
$900.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,531.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,369.65
|
| Rate for Payer: Priority Health Medicare |
$1,391.80
|
| Rate for Payer: Priority Health Narrow Network |
$2,369.65
|
| Rate for Payer: UHC Medicare Advantage |
$1,433.55
|
|
|
PR LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC CERVC
|
Professional
|
Both
|
$5,633.00
|
|
|
Service Code
|
HCPCS 63020
|
| Min. Negotiated Rate |
$230.34 |
| Max. Negotiated Rate |
$3,943.10 |
| Rate for Payer: Aetna Commercial |
$1,462.97
|
| Rate for Payer: Aetna Medicare |
$1,091.77
|
| Rate for Payer: BCBS Complete |
$746.99
|
| Rate for Payer: BCBS MAPPO |
$1,091.77
|
| Rate for Payer: BCBS Trust/PPO |
$230.34
|
| Rate for Payer: BCN Commercial |
$1,778.33
|
| Rate for Payer: BCN Medicare Advantage |
$1,091.77
|
| Rate for Payer: Cash Price |
$4,506.40
|
| Rate for Payer: Cash Price |
$4,506.40
|
| Rate for Payer: Cofinity Commercial |
$1,572.15
|
| Rate for Payer: Cofinity Commercial |
$1,462.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,091.77
|
| Rate for Payer: Healthscope Commercial |
$1,310.12
|
| Rate for Payer: Healthscope Whirlpool |
$1,310.12
|
| Rate for Payer: Meridian Medicaid |
$746.99
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,146.36
|
| Rate for Payer: PACE SWMI |
$1,091.77
|
| Rate for Payer: PHP Medicare Advantage |
$1,091.77
|
| Rate for Payer: Priority Health Choice Medicaid |
$711.42
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,943.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,871.37
|
| Rate for Payer: Priority Health Medicare |
$1,091.77
|
| Rate for Payer: Priority Health Narrow Network |
$1,871.37
|
| Rate for Payer: UHC Medicare Advantage |
$1,124.52
|
|
|
PR LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR
|
Professional
|
Both
|
$5,455.00
|
|
|
Service Code
|
HCPCS 63030
|
| Min. Negotiated Rate |
$318.04 |
| Max. Negotiated Rate |
$3,818.50 |
| Rate for Payer: Aetna Commercial |
$1,215.66
|
| Rate for Payer: Aetna Medicare |
$907.21
|
| Rate for Payer: BCBS Complete |
$622.87
|
| Rate for Payer: BCBS MAPPO |
$907.21
|
| Rate for Payer: BCBS Trust/PPO |
$318.04
|
| Rate for Payer: BCN Commercial |
$1,146.75
|
| Rate for Payer: BCN Medicare Advantage |
$907.21
|
| Rate for Payer: Cash Price |
$4,364.00
|
| Rate for Payer: Cash Price |
$4,364.00
|
| Rate for Payer: Cofinity Commercial |
$1,306.38
|
| Rate for Payer: Cofinity Commercial |
$1,215.66
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$907.21
|
| Rate for Payer: Healthscope Commercial |
$1,088.65
|
| Rate for Payer: Healthscope Whirlpool |
$1,088.65
|
| Rate for Payer: Meridian Medicaid |
$622.87
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$952.57
|
| Rate for Payer: PACE SWMI |
$907.21
|
| Rate for Payer: PHP Medicare Advantage |
$907.21
|
| Rate for Payer: Priority Health Choice Medicaid |
$593.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3,818.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,558.81
|
| Rate for Payer: Priority Health Medicare |
$907.21
|
| Rate for Payer: Priority Health Narrow Network |
$1,558.81
|
| Rate for Payer: UHC Medicare Advantage |
$934.43
|
|
|
PR LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR
|
Professional
|
Both
|
$1,783.00
|
|
|
Service Code
|
HCPCS 63035
|
| Min. Negotiated Rate |
$148.67 |
| Max. Negotiated Rate |
$1,248.10 |
| Rate for Payer: Aetna Commercial |
$312.85
|
| Rate for Payer: Aetna Medicare |
$233.47
|
| Rate for Payer: BCBS Complete |
$156.10
|
| Rate for Payer: BCBS MAPPO |
$233.47
|
| Rate for Payer: BCBS Trust/PPO |
$1,004.30
|
| Rate for Payer: BCN Commercial |
$375.03
|
| Rate for Payer: BCN Medicare Advantage |
$233.47
|
| Rate for Payer: Cash Price |
$1,426.40
|
| Rate for Payer: Cash Price |
$1,426.40
|
| Rate for Payer: Cofinity Commercial |
$312.85
|
| Rate for Payer: Cofinity Commercial |
$336.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$233.47
|
| Rate for Payer: Healthscope Commercial |
$280.16
|
| Rate for Payer: Healthscope Whirlpool |
$280.16
|
| Rate for Payer: Meridian Medicaid |
$156.10
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$245.14
|
| Rate for Payer: PACE SWMI |
$233.47
|
| Rate for Payer: PHP Medicare Advantage |
$233.47
|
| Rate for Payer: Priority Health Choice Medicaid |
$148.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,248.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$394.65
|
| Rate for Payer: Priority Health Medicare |
$233.47
|
| Rate for Payer: Priority Health Narrow Network |
$394.65
|
| Rate for Payer: UHC Medicare Advantage |
$240.47
|
|
|
PR LAMOPLASTY CERVICAL DCMPRN CORD 2/> SEG RCNSTJ
|
Professional
|
Both
|
$8,375.00
|
|
|
Service Code
|
HCPCS 63051
|
| Min. Negotiated Rate |
$405.21 |
| Max. Negotiated Rate |
$5,862.50 |
| Rate for Payer: Aetna Commercial |
$2,261.67
|
| Rate for Payer: Aetna Medicare |
$1,687.81
|
| Rate for Payer: BCBS Complete |
$1,144.20
|
| Rate for Payer: BCBS MAPPO |
$1,687.81
|
| Rate for Payer: BCBS Trust/PPO |
$405.21
|
| Rate for Payer: BCN Commercial |
$2,484.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,687.81
|
| Rate for Payer: Cash Price |
$6,700.00
|
| Rate for Payer: Cash Price |
$6,700.00
|
| Rate for Payer: Cofinity Commercial |
$2,430.45
|
| Rate for Payer: Cofinity Commercial |
$2,261.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,687.81
|
| Rate for Payer: Healthscope Commercial |
$2,025.37
|
| Rate for Payer: Healthscope Whirlpool |
$2,025.37
|
| Rate for Payer: Meridian Medicaid |
$1,144.20
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,772.20
|
| Rate for Payer: PACE SWMI |
$1,687.81
|
| Rate for Payer: PHP Medicare Advantage |
$1,687.81
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,089.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$5,862.50
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,878.69
|
| Rate for Payer: Priority Health Medicare |
$1,687.81
|
| Rate for Payer: Priority Health Narrow Network |
$2,878.69
|
| Rate for Payer: UHC Medicare Advantage |
$1,738.44
|
|
|
PR LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC CERVICAL
|
Professional
|
Both
|
$6,542.00
|
|
|
Service Code
|
HCPCS 63040
|
| Min. Negotiated Rate |
$889.06 |
| Max. Negotiated Rate |
$4,579.40 |
| Rate for Payer: Aetna Commercial |
$1,846.14
|
| Rate for Payer: Aetna Medicare |
$1,377.72
|
| Rate for Payer: BCBS Complete |
$933.51
|
| Rate for Payer: BCBS MAPPO |
$1,377.72
|
| Rate for Payer: BCBS Trust/PPO |
$1,073.51
|
| Rate for Payer: BCN Commercial |
$2,234.62
|
| Rate for Payer: BCN Medicare Advantage |
$1,377.72
|
| Rate for Payer: Cash Price |
$5,233.60
|
| Rate for Payer: Cash Price |
$5,233.60
|
| Rate for Payer: Cofinity Commercial |
$1,983.92
|
| Rate for Payer: Cofinity Commercial |
$1,846.14
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,377.72
|
| Rate for Payer: Healthscope Commercial |
$1,653.26
|
| Rate for Payer: Healthscope Whirlpool |
$1,653.26
|
| Rate for Payer: Meridian Medicaid |
$933.51
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,446.61
|
| Rate for Payer: PACE SWMI |
$1,377.72
|
| Rate for Payer: PHP Medicare Advantage |
$1,377.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$889.06
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,579.40
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,351.53
|
| Rate for Payer: Priority Health Medicare |
$1,377.72
|
| Rate for Payer: Priority Health Narrow Network |
$2,351.53
|
| Rate for Payer: UHC Medicare Advantage |
$1,419.05
|
|
|
PR LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC EA CRV
|
Professional
|
Both
|
$2,139.00
|
|
|
Service Code
|
HCPCS 63043
|
| Min. Negotiated Rate |
$191.17 |
| Max. Negotiated Rate |
$1,862.26 |
| Rate for Payer: Aetna Commercial |
$780.02
|
| Rate for Payer: BCBS Complete |
$200.73
|
| Rate for Payer: BCBS Trust/PPO |
$1,862.26
|
| Rate for Payer: BCN Commercial |
$374.64
|
| Rate for Payer: Cash Price |
$1,711.20
|
| Rate for Payer: Cash Price |
$1,711.20
|
| Rate for Payer: Meridian Medicaid |
$200.73
|
| Rate for Payer: Priority Health Choice Medicaid |
$191.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,497.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$1,024.87
|
| Rate for Payer: Priority Health Narrow Network |
$1,024.87
|
|
|
PR LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR
|
Professional
|
Both
|
$2,640.46
|
|
|
Service Code
|
HCPCS 63042
|
| Min. Negotiated Rate |
$836.88 |
| Max. Negotiated Rate |
$2,204.31 |
| Rate for Payer: Aetna Commercial |
$1,727.09
|
| Rate for Payer: Aetna Medicare |
$1,288.87
|
| Rate for Payer: BCBS Complete |
$878.72
|
| Rate for Payer: BCBS MAPPO |
$1,288.87
|
| Rate for Payer: BCBS Trust/PPO |
$1,376.75
|
| Rate for Payer: BCN Commercial |
$2,094.72
|
| Rate for Payer: BCN Medicare Advantage |
$1,288.87
|
| Rate for Payer: Cash Price |
$2,112.37
|
| Rate for Payer: Cash Price |
$2,112.37
|
| Rate for Payer: Cofinity Commercial |
$1,855.97
|
| Rate for Payer: Cofinity Commercial |
$1,727.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,288.87
|
| Rate for Payer: Healthscope Commercial |
$1,546.64
|
| Rate for Payer: Healthscope Whirlpool |
$1,546.64
|
| Rate for Payer: Meridian Medicaid |
$878.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,353.31
|
| Rate for Payer: PACE SWMI |
$1,288.87
|
| Rate for Payer: PHP Medicare Advantage |
$1,288.87
|
| Rate for Payer: Priority Health Choice Medicaid |
$836.88
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,848.32
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,204.31
|
| Rate for Payer: Priority Health Medicare |
$1,288.87
|
| Rate for Payer: Priority Health Narrow Network |
$2,204.31
|
| Rate for Payer: UHC Medicare Advantage |
$1,327.54
|
|
|
PR LAMOT W/PRTL FFD HRNA8 REEXPL 1 NTRSPC EA LMBR
|
Professional
|
Both
|
$2,083.00
|
|
|
Service Code
|
HCPCS 63044
|
| Min. Negotiated Rate |
$179.97 |
| Max. Negotiated Rate |
$1,908.75 |
| Rate for Payer: Aetna Commercial |
$741.31
|
| Rate for Payer: BCBS Complete |
$188.97
|
| Rate for Payer: BCBS Trust/PPO |
$1,908.75
|
| Rate for Payer: BCN Commercial |
$374.64
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Cash Price |
$1,666.40
|
| Rate for Payer: Meridian Medicaid |
$188.97
|
| Rate for Payer: Priority Health Choice Medicaid |
$179.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,458.10
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$973.90
|
| Rate for Payer: Priority Health Narrow Network |
$973.90
|
|
|
PR LAM W/DRG INTRMEDULLARY CYST/SYRINX SUBARACHNOID
|
Professional
|
Both
|
$6,198.00
|
|
|
Service Code
|
HCPCS 63172
|
| Min. Negotiated Rate |
$919.73 |
| Max. Negotiated Rate |
$4,338.60 |
| Rate for Payer: Aetna Commercial |
$1,909.08
|
| Rate for Payer: Aetna Medicare |
$1,424.69
|
| Rate for Payer: BCBS Complete |
$965.72
|
| Rate for Payer: BCBS MAPPO |
$1,424.69
|
| Rate for Payer: BCBS Trust/PPO |
$3,470.40
|
| Rate for Payer: BCN Commercial |
$2,301.34
|
| Rate for Payer: BCN Medicare Advantage |
$1,424.69
|
| Rate for Payer: Cash Price |
$4,958.40
|
| Rate for Payer: Cash Price |
$4,958.40
|
| Rate for Payer: Cofinity Commercial |
$2,051.55
|
| Rate for Payer: Cofinity Commercial |
$1,909.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,424.69
|
| Rate for Payer: Healthscope Commercial |
$1,709.63
|
| Rate for Payer: Healthscope Whirlpool |
$1,709.63
|
| Rate for Payer: Meridian Medicaid |
$965.72
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$1,495.92
|
| Rate for Payer: PACE SWMI |
$1,424.69
|
| Rate for Payer: PHP Medicare Advantage |
$1,424.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$919.73
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4,338.60
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2,421.75
|
| Rate for Payer: Priority Health Medicare |
$1,424.69
|
| Rate for Payer: Priority Health Narrow Network |
$2,421.75
|
| Rate for Payer: UHC Medicare Advantage |
$1,467.43
|
|
