Bronson South Haven Hospital

All Charges

Charge

Type

Setting

Price

PR LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL THORACIC

Professional

Both

$5,916.00

Service Code	HCPCS 63266
Min. Negotiated Rate	$600.15
Max. Negotiated Rate	$3,845.40
Rate for Payer: Aetna Commercial	$2,225.81
Rate for Payer: Aetna Medicare	$2,958.00
Rate for Payer: BCBS Complete	$1,173.49
Rate for Payer: BCBS Trust/PPO	$600.15
Rate for Payer: BCN Commercial	$2,788.83
Rate for Payer: Cash Price	$4,732.80
Rate for Payer: Cash Price	$4,732.80
Rate for Payer: Meridian Medicaid	$1,173.49
Rate for Payer: Priority Health Choice Medicaid	$1,117.61
Rate for Payer: Priority Health Cigna Priority Health	$3,845.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,968.70
Rate for Payer: Priority Health Narrow Network	$2,968.70
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,992.13
Rate for Payer: UHC Exchange	$1,992.13
Rate for Payer: UHCCP Medicaid	$1,117.61

PR LAM EXC ISPI LES OTH/THN NEO IDRL CERVICAL

Professional

Both

$6,211.00

Service Code	HCPCS 63270
Min. Negotiated Rate	$440.60
Max. Negotiated Rate	$4,037.15
Rate for Payer: Aetna Commercial	$2,685.45
Rate for Payer: Aetna Medicare	$3,105.50
Rate for Payer: BCBS Complete	$1,421.74
Rate for Payer: BCBS Trust/PPO	$440.60
Rate for Payer: BCN Commercial	$3,067.43
Rate for Payer: Cash Price	$4,968.80
Rate for Payer: Cash Price	$4,968.80
Rate for Payer: Meridian Medicaid	$1,421.74
Rate for Payer: Priority Health Choice Medicaid	$1,354.04
Rate for Payer: Priority Health Cigna Priority Health	$4,037.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,599.97
Rate for Payer: Priority Health Narrow Network	$3,599.97
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,400.60
Rate for Payer: UHC Exchange	$2,400.60
Rate for Payer: UHCCP Medicaid	$1,354.04

PR LAM EXC ISPI LES OTH/THN NEO IDRL LUMBAR

Professional

Both

$6,546.00

Service Code	HCPCS 63272
Min. Negotiated Rate	$318.56
Max. Negotiated Rate	$4,254.90
Rate for Payer: Aetna Commercial	$2,414.96
Rate for Payer: Aetna Medicare	$3,273.00
Rate for Payer: BCBS Complete	$1,288.90
Rate for Payer: BCBS Trust/PPO	$318.56
Rate for Payer: BCN Commercial	$3,028.27
Rate for Payer: Cash Price	$5,236.80
Rate for Payer: Cash Price	$5,236.80
Rate for Payer: Meridian Medicaid	$1,288.90
Rate for Payer: Priority Health Choice Medicaid	$1,227.52
Rate for Payer: Priority Health Cigna Priority Health	$4,254.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,236.56
Rate for Payer: Priority Health Narrow Network	$3,236.56
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,212.24
Rate for Payer: UHC Exchange	$2,212.24
Rate for Payer: UHCCP Medicaid	$1,227.52

PR LAM EXC ISPI LES OTH/THN NEO IDRL SACRAL

Professional

Both

$5,744.00

Service Code	HCPCS 63273
Min. Negotiated Rate	$580.07
Max. Negotiated Rate	$3,733.60
Rate for Payer: Aetna Commercial	$2,414.10
Rate for Payer: Aetna Medicare	$2,872.00
Rate for Payer: BCBS Complete	$1,280.17
Rate for Payer: BCBS Trust/PPO	$580.07
Rate for Payer: BCN Commercial	$3,039.57
Rate for Payer: Cash Price	$4,595.20
Rate for Payer: Cash Price	$4,595.20
Rate for Payer: Meridian Medicaid	$1,280.17
Rate for Payer: Priority Health Choice Medicaid	$1,219.21
Rate for Payer: Priority Health Cigna Priority Health	$3,733.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,241.68
Rate for Payer: Priority Health Narrow Network	$3,241.68
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,123.35
Rate for Payer: UHC Exchange	$2,123.35
Rate for Payer: UHCCP Medicaid	$1,219.21

PR LAM EXC ISPI LES OTH/THN NEO IDRL THORACIC

Professional

Both

$6,110.00

Service Code	HCPCS 63271
Min. Negotiated Rate	$1,352.34
Max. Negotiated Rate	$3,971.50
Rate for Payer: Aetna Commercial	$2,678.93
Rate for Payer: Aetna Medicare	$3,055.00
Rate for Payer: BCBS Complete	$1,419.96
Rate for Payer: BCBS Trust/PPO	$1,388.14
Rate for Payer: BCN Commercial	$3,374.79
Rate for Payer: Cash Price	$4,888.00
Rate for Payer: Cash Price	$4,888.00
Rate for Payer: Meridian Medicaid	$1,419.96
Rate for Payer: Priority Health Choice Medicaid	$1,352.34
Rate for Payer: Priority Health Cigna Priority Health	$3,971.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,589.16
Rate for Payer: Priority Health Narrow Network	$3,589.16
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,404.94
Rate for Payer: UHC Exchange	$2,404.94
Rate for Payer: UHCCP Medicaid	$1,352.34

PR LAM EXC/OCCLUSION AVM SPI CORD THORACOLUMBAR

Professional

Both

$6,468.00

Service Code	HCPCS 63252
Min. Negotiated Rate	$1,061.35
Max. Negotiated Rate	$5,230.47
Rate for Payer: Aetna Commercial	$3,918.18
Rate for Payer: Aetna Medicare	$3,234.00
Rate for Payer: BCBS Complete	$2,065.41
Rate for Payer: BCBS Trust/PPO	$1,061.35
Rate for Payer: BCN Commercial	$4,459.67
Rate for Payer: Cash Price	$5,174.40
Rate for Payer: Cash Price	$5,174.40
Rate for Payer: Meridian Medicaid	$2,065.41
Rate for Payer: Priority Health Choice Medicaid	$1,967.06
Rate for Payer: Priority Health Cigna Priority Health	$4,204.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,230.47
Rate for Payer: Priority Health Narrow Network	$5,230.47
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,534.04
Rate for Payer: UHC Exchange	$3,534.04
Rate for Payer: UHCCP Medicaid	$1,967.06

PR LAM EXC/OCCLUSION AVM SPINAL CORD CERVICAL

Professional

Both

$4,877.00

Service Code	HCPCS 63250
Min. Negotiated Rate	$331.77
Max. Negotiated Rate	$5,116.16
Rate for Payer: Aetna Commercial	$3,834.83
Rate for Payer: Aetna Medicare	$2,438.50
Rate for Payer: BCBS Complete	$2,020.23
Rate for Payer: BCBS Trust/PPO	$331.77
Rate for Payer: BCN Commercial	$4,362.91
Rate for Payer: Cash Price	$3,901.60
Rate for Payer: Cash Price	$3,901.60
Rate for Payer: Meridian Medicaid	$2,020.23
Rate for Payer: Priority Health Choice Medicaid	$1,924.03
Rate for Payer: Priority Health Cigna Priority Health	$3,170.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,116.16
Rate for Payer: Priority Health Narrow Network	$5,116.16
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,452.02
Rate for Payer: UHC Exchange	$3,452.02
Rate for Payer: UHCCP Medicaid	$1,924.03

PR LAM EXC/OCCLUSION AVM SPINAL CORD THORACIC

Professional

Both

$5,857.00

Service Code	HCPCS 63251
Min. Negotiated Rate	$725.36
Max. Negotiated Rate	$5,231.04
Rate for Payer: Aetna Commercial	$3,919.07
Rate for Payer: Aetna Medicare	$2,928.50
Rate for Payer: BCBS Complete	$2,065.63
Rate for Payer: BCBS Trust/PPO	$725.36
Rate for Payer: BCN Commercial	$4,461.14
Rate for Payer: Cash Price	$4,685.60
Rate for Payer: Cash Price	$4,685.60
Rate for Payer: Meridian Medicaid	$2,065.63
Rate for Payer: Priority Health Choice Medicaid	$1,967.27
Rate for Payer: Priority Health Cigna Priority Health	$3,807.05
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,231.04
Rate for Payer: Priority Health Narrow Network	$5,231.04
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$3,537.02
Rate for Payer: UHC Exchange	$3,537.02
Rate for Payer: UHCCP Medicaid	$1,967.27

PR LAM FACETEC/FORAMOT DRG ARTHRD LMBR EA ADDL SGM

Professional

Both

$490.00

Service Code	HCPCS 63053
Min. Negotiated Rate	$146.54
Max. Negotiated Rate	$390.13
Rate for Payer: Aetna Commercial	$249.29
Rate for Payer: Aetna Medicare	$245.00
Rate for Payer: BCBS Complete	$153.87
Rate for Payer: BCBS Trust/PPO	$175.40
Rate for Payer: BCN Commercial	$332.79
Rate for Payer: Cash Price	$392.00
Rate for Payer: Cash Price	$392.00
Rate for Payer: Meridian Medicaid	$153.87
Rate for Payer: Priority Health Choice Medicaid	$146.54
Rate for Payer: Priority Health Cigna Priority Health	$318.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$390.13
Rate for Payer: Priority Health Narrow Network	$390.13
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$253.08
Rate for Payer: UHC Exchange	$253.08
Rate for Payer: UHCCP Medicaid	$146.54

PR LAM FACETEC/FORAMOT DRG ARTHRD LUMBAR 1 VRT SGM

Professional

Both

$653.00

Service Code	HCPCS 63052
Min. Negotiated Rate	$165.50
Max. Negotiated Rate	$449.06
Rate for Payer: Aetna Commercial	$333.27
Rate for Payer: Aetna Medicare	$326.50
Rate for Payer: BCBS Complete	$173.78
Rate for Payer: BCBS Trust/PPO	$449.06
Rate for Payer: BCN Commercial	$375.79
Rate for Payer: Cash Price	$522.40
Rate for Payer: Cash Price	$522.40
Rate for Payer: Meridian Medicaid	$173.78
Rate for Payer: Priority Health Choice Medicaid	$165.50
Rate for Payer: Priority Health Cigna Priority Health	$424.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$439.05
Rate for Payer: Priority Health Narrow Network	$439.05
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$338.41
Rate for Payer: UHC Exchange	$338.41
Rate for Payer: UHCCP Medicaid	$165.50

PR LAM FACETECTOMY&FORAMOT 1 VRT SGM EA ADDL SGM

Professional

Both

$2,308.00

Service Code	HCPCS 63048
Min. Negotiated Rate	$134.83
Max. Negotiated Rate	$1,500.20
Rate for Payer: Aetna Commercial	$273.78
Rate for Payer: Aetna Medicare	$1,154.00
Rate for Payer: BCBS Complete	$141.57
Rate for Payer: BCBS Trust/PPO	$347.09
Rate for Payer: BCN Commercial	$336.83
Rate for Payer: Cash Price	$1,846.40
Rate for Payer: Cash Price	$1,846.40
Rate for Payer: Meridian Medicaid	$141.57
Rate for Payer: Priority Health Choice Medicaid	$134.83
Rate for Payer: Priority Health Cigna Priority Health	$1,500.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$358.29
Rate for Payer: Priority Health Narrow Network	$358.29
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$254.56
Rate for Payer: UHC Exchange	$254.56
Rate for Payer: UHCCP Medicaid	$134.83

PR LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM CERVICAL

Professional

Both

$2,678.00

Service Code	HCPCS 63045
Min. Negotiated Rate	$166.94
Max. Negotiated Rate	$2,229.36
Rate for Payer: Aetna Commercial	$1,661.20
Rate for Payer: Aetna Medicare	$1,339.00
Rate for Payer: BCBS Complete	$881.18
Rate for Payer: BCBS Trust/PPO	$166.94
Rate for Payer: BCN Commercial	$2,089.87
Rate for Payer: Cash Price	$2,142.40
Rate for Payer: Cash Price	$2,142.40
Rate for Payer: Meridian Medicaid	$881.18
Rate for Payer: Priority Health Choice Medicaid	$839.22
Rate for Payer: Priority Health Cigna Priority Health	$1,740.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,229.36
Rate for Payer: Priority Health Narrow Network	$2,229.36
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,468.04
Rate for Payer: UHC Exchange	$1,468.04
Rate for Payer: UHCCP Medicaid	$839.22

PR LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM LUMBAR

Professional

Both

$2,286.00

Service Code	HCPCS 63047
Min. Negotiated Rate	$364.00
Max. Negotiated Rate	$1,911.45
Rate for Payer: Aetna Commercial	$1,424.42
Rate for Payer: Aetna Medicare	$1,143.00
Rate for Payer: BCBS Complete	$757.06
Rate for Payer: BCBS Trust/PPO	$364.00
Rate for Payer: BCN Commercial	$1,792.85
Rate for Payer: Cash Price	$1,828.80
Rate for Payer: Cash Price	$1,828.80
Rate for Payer: Meridian Medicaid	$757.06
Rate for Payer: Priority Health Choice Medicaid	$721.01
Rate for Payer: Priority Health Cigna Priority Health	$1,485.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,911.45
Rate for Payer: Priority Health Narrow Network	$1,911.45
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,268.66
Rate for Payer: UHC Exchange	$1,268.66
Rate for Payer: UHCCP Medicaid	$721.01

PR LAM FACETECTOMY & FORAMOTOMY 1 VRT SGM THORACIC

Professional

Both

$2,551.00

Service Code	HCPCS 63046
Min. Negotiated Rate	$189.66
Max. Negotiated Rate	$2,126.99
Rate for Payer: Aetna Commercial	$1,585.22
Rate for Payer: Aetna Medicare	$1,275.50
Rate for Payer: BCBS Complete	$841.60
Rate for Payer: BCBS Trust/PPO	$189.66
Rate for Payer: BCN Commercial	$1,992.49
Rate for Payer: Cash Price	$2,040.80
Rate for Payer: Cash Price	$2,040.80
Rate for Payer: Meridian Medicaid	$841.60
Rate for Payer: Priority Health Choice Medicaid	$801.52
Rate for Payer: Priority Health Cigna Priority Health	$1,658.15
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,126.99
Rate for Payer: Priority Health Narrow Network	$2,126.99
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,399.44
Rate for Payer: UHC Exchange	$1,399.44
Rate for Payer: UHCCP Medicaid	$801.52

PR LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL

Professional

Both

$1,720.00

Service Code	HCPCS 63655
Min. Negotiated Rate	$297.43
Max. Negotiated Rate	$1,455.91
Rate for Payer: Aetna Commercial	$1,075.11
Rate for Payer: Aetna Medicare	$860.00
Rate for Payer: BCBS Complete	$577.24
Rate for Payer: BCBS Trust/PPO	$297.43
Rate for Payer: BCN Commercial	$1,362.40
Rate for Payer: Cash Price	$1,376.00
Rate for Payer: Cash Price	$1,376.00
Rate for Payer: Meridian Medicaid	$577.24
Rate for Payer: Priority Health Choice Medicaid	$549.75
Rate for Payer: Priority Health Cigna Priority Health	$1,118.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,455.91
Rate for Payer: Priority Health Narrow Network	$1,455.91
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$982.48
Rate for Payer: UHC Exchange	$982.48
Rate for Payer: UHCCP Medicaid	$549.75

PR LAMINECTOMY BX/EXC ISPI NEO XDRL CERVICAL

Professional

Both

$6,802.00

Service Code	HCPCS 63275
Min. Negotiated Rate	$191.77
Max. Negotiated Rate	$4,421.30
Rate for Payer: Aetna Commercial	$2,334.21
Rate for Payer: Aetna Medicare	$3,401.00
Rate for Payer: BCBS Complete	$1,230.30
Rate for Payer: BCBS Trust/PPO	$191.77
Rate for Payer: BCN Commercial	$2,936.80
Rate for Payer: Cash Price	$5,441.60
Rate for Payer: Cash Price	$5,441.60
Rate for Payer: Meridian Medicaid	$1,230.30
Rate for Payer: Priority Health Choice Medicaid	$1,171.71
Rate for Payer: Priority Health Cigna Priority Health	$4,421.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,115.42
Rate for Payer: Priority Health Narrow Network	$3,115.42
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,081.34
Rate for Payer: UHC Exchange	$2,081.34
Rate for Payer: UHCCP Medicaid	$1,171.71

PR LAMINECTOMY BX/EXC ISPI NEO XDRL LUMBAR

Professional

Both

$6,212.00

Service Code	HCPCS 63277
Min. Negotiated Rate	$453.81
Max. Negotiated Rate	$4,037.80
Rate for Payer: Aetna Commercial	$2,017.05
Rate for Payer: Aetna Medicare	$3,106.00
Rate for Payer: BCBS Complete	$1,069.27
Rate for Payer: BCBS Trust/PPO	$453.81
Rate for Payer: BCN Commercial	$2,538.09
Rate for Payer: Cash Price	$4,969.60
Rate for Payer: Cash Price	$4,969.60
Rate for Payer: Meridian Medicaid	$1,069.27
Rate for Payer: Priority Health Choice Medicaid	$1,018.35
Rate for Payer: Priority Health Cigna Priority Health	$4,037.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,700.26
Rate for Payer: Priority Health Narrow Network	$2,700.26
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,797.18
Rate for Payer: UHC Exchange	$1,797.18
Rate for Payer: UHCCP Medicaid	$1,018.35

PR LAMINECTOMY BX/EXC ISPI NEO XDRL SACRAL

Professional

Both

$5,404.00

Service Code	HCPCS 63278
Min. Negotiated Rate	$351.32
Max. Negotiated Rate	$3,512.60
Rate for Payer: Aetna Commercial	$2,058.50
Rate for Payer: Aetna Medicare	$2,702.00
Rate for Payer: BCBS Complete	$1,095.43
Rate for Payer: BCBS Trust/PPO	$351.32
Rate for Payer: BCN Commercial	$2,597.28
Rate for Payer: Cash Price	$4,323.20
Rate for Payer: Cash Price	$4,323.20
Rate for Payer: Meridian Medicaid	$1,095.43
Rate for Payer: Priority Health Choice Medicaid	$1,043.27
Rate for Payer: Priority Health Cigna Priority Health	$3,512.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,771.35
Rate for Payer: Priority Health Narrow Network	$2,771.35
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,814.52
Rate for Payer: UHC Exchange	$1,814.52
Rate for Payer: UHCCP Medicaid	$1,043.27

PR LAMINECTOMY BX/EXC ISPI NEO XDRL THORACIC

Professional

Both

$6,924.00

Service Code	HCPCS 63276
Min. Negotiated Rate	$311.70
Max. Negotiated Rate	$4,500.60
Rate for Payer: Aetna Commercial	$2,318.43
Rate for Payer: Aetna Medicare	$3,462.00
Rate for Payer: BCBS Complete	$1,222.47
Rate for Payer: BCBS Trust/PPO	$311.70
Rate for Payer: BCN Commercial	$2,902.36
Rate for Payer: Cash Price	$5,539.20
Rate for Payer: Cash Price	$5,539.20
Rate for Payer: Meridian Medicaid	$1,222.47
Rate for Payer: Priority Health Choice Medicaid	$1,164.26
Rate for Payer: Priority Health Cigna Priority Health	$4,500.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,096.08
Rate for Payer: Priority Health Narrow Network	$3,096.08
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$2,068.27
Rate for Payer: UHC Exchange	$2,068.27
Rate for Payer: UHCCP Medicaid	$1,164.26

PR LAMINECTOMY RELEASE TETHERED SPINAL CORD LUMBAR

Professional

Both

$5,916.00

Service Code	HCPCS 63200
Min. Negotiated Rate	$291.09
Max. Negotiated Rate	$3,845.40
Rate for Payer: Aetna Commercial	$1,964.99
Rate for Payer: Aetna Medicare	$2,958.00
Rate for Payer: BCBS Complete	$1,062.12
Rate for Payer: BCBS Trust/PPO	$291.09
Rate for Payer: BCN Commercial	$2,479.43
Rate for Payer: Cash Price	$4,732.80
Rate for Payer: Cash Price	$4,732.80
Rate for Payer: Meridian Medicaid	$1,062.12
Rate for Payer: Priority Health Choice Medicaid	$1,011.54
Rate for Payer: Priority Health Cigna Priority Health	$3,845.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,659.89
Rate for Payer: Priority Health Narrow Network	$2,659.89
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,756.60
Rate for Payer: UHC Exchange	$1,756.60
Rate for Payer: UHCCP Medicaid	$1,011.54

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

Professional

Both

$5,033.00

Service Code	HCPCS 63005
Min. Negotiated Rate	$233.48
Max. Negotiated Rate	$3,271.45
Rate for Payer: Aetna Commercial	$1,542.52
Rate for Payer: Aetna Medicare	$2,516.50
Rate for Payer: BCBS Complete	$826.61
Rate for Payer: BCBS Trust/PPO	$233.48
Rate for Payer: BCN Commercial	$1,947.28
Rate for Payer: Cash Price	$4,026.40
Rate for Payer: Cash Price	$4,026.40
Rate for Payer: Meridian Medicaid	$826.61
Rate for Payer: Priority Health Choice Medicaid	$787.25
Rate for Payer: Priority Health Cigna Priority Health	$3,271.45
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,081.49
Rate for Payer: Priority Health Narrow Network	$2,081.49
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,359.48
Rate for Payer: UHC Exchange	$1,359.48
Rate for Payer: UHCCP Medicaid	$787.25

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

Professional

Both

$2,241.00

Service Code	HCPCS 63011
Min. Negotiated Rate	$449.06
Max. Negotiated Rate	$1,877.33
Rate for Payer: Aetna Commercial	$1,416.81
Rate for Payer: Aetna Medicare	$1,120.50
Rate for Payer: BCBS Complete	$742.30
Rate for Payer: BCBS Trust/PPO	$449.06
Rate for Payer: BCN Commercial	$1,606.77
Rate for Payer: Cash Price	$1,792.80
Rate for Payer: Cash Price	$1,792.80
Rate for Payer: Meridian Medicaid	$742.30
Rate for Payer: Priority Health Choice Medicaid	$706.95
Rate for Payer: Priority Health Cigna Priority Health	$1,456.65
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,877.33
Rate for Payer: Priority Health Narrow Network	$1,877.33
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,253.98
Rate for Payer: UHC Exchange	$1,253.98
Rate for Payer: UHCCP Medicaid	$706.95

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

Professional

Both

$6,183.00

Service Code	HCPCS 63003
Min. Negotiated Rate	$194.94
Max. Negotiated Rate	$4,018.95
Rate for Payer: Aetna Commercial	$1,595.23
Rate for Payer: Aetna Medicare	$3,091.50
Rate for Payer: BCBS Complete	$848.08
Rate for Payer: BCBS Trust/PPO	$194.94
Rate for Payer: BCN Commercial	$2,002.71
Rate for Payer: Cash Price	$4,946.40
Rate for Payer: Cash Price	$4,946.40
Rate for Payer: Meridian Medicaid	$848.08
Rate for Payer: Priority Health Choice Medicaid	$807.70
Rate for Payer: Priority Health Cigna Priority Health	$4,018.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,137.23
Rate for Payer: Priority Health Narrow Network	$2,137.23
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,431.98
Rate for Payer: UHC Exchange	$1,431.98
Rate for Payer: UHCCP Medicaid	$807.70

PR LAMINECTOMY W/O FFD > 2 VERT SEG CERVICAL

Professional

Both

$6,256.00

Service Code	HCPCS 63015
Min. Negotiated Rate	$422.11
Max. Negotiated Rate	$4,066.40
Rate for Payer: Aetna Commercial	$1,910.12
Rate for Payer: Aetna Medicare	$3,128.00
Rate for Payer: BCBS Complete	$1,016.49
Rate for Payer: BCBS Trust/PPO	$422.11
Rate for Payer: BCN Commercial	$2,404.11
Rate for Payer: Cash Price	$5,004.80
Rate for Payer: Cash Price	$5,004.80
Rate for Payer: Meridian Medicaid	$1,016.49
Rate for Payer: Priority Health Choice Medicaid	$968.09
Rate for Payer: Priority Health Cigna Priority Health	$4,066.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,566.60
Rate for Payer: Priority Health Narrow Network	$2,566.60
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,711.64
Rate for Payer: UHC Exchange	$1,711.64
Rate for Payer: UHCCP Medicaid	$968.09

PR LAMINECTOMY W/O FFD > 2 VERT SEG LUMBAR

Professional

Both

$6,258.00

Service Code	HCPCS 63017
Min. Negotiated Rate	$263.09
Max. Negotiated Rate	$4,067.70
Rate for Payer: Aetna Commercial	$1,628.24
Rate for Payer: Aetna Medicare	$3,129.00
Rate for Payer: BCBS Complete	$869.33
Rate for Payer: BCBS Trust/PPO	$263.09
Rate for Payer: BCN Commercial	$2,056.52
Rate for Payer: Cash Price	$5,006.40
Rate for Payer: Cash Price	$5,006.40
Rate for Payer: Meridian Medicaid	$869.33
Rate for Payer: Priority Health Choice Medicaid	$827.93
Rate for Payer: Priority Health Cigna Priority Health	$4,067.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,194.66
Rate for Payer: Priority Health Narrow Network	$2,194.66
Rate for Payer: UHC All Payor (Choice/PPO) + Core	$1,436.57
Rate for Payer: UHC Exchange	$1,436.57
Rate for Payer: UHCCP Medicaid	$827.93

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