Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR LENGTHENING TENDON FLEXOR HAND/FINGER EACH

Professional

Both

$2,040.00

Service Code	HCPCS 26478
Min. Negotiated Rate	$615.57
Max. Negotiated Rate	$1,326.00
Rate for Payer: Aetna Commercial	$824.86
Rate for Payer: Aetna Medicare	$640.19
Rate for Payer: Aetna New Business (MI Preferred)	$886.42
Rate for Payer: Aetna New Business (MI Preferred)	$824.86
Rate for Payer: BCBS Complete	$816.00
Rate for Payer: BCBS MAPPO	$615.57
Rate for Payer: BCN Medicare Advantage	$615.57
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Cofinity Commercial	$886.42
Rate for Payer: Cofinity Commercial	$824.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$615.57
Rate for Payer: Healthscope Commercial	$1,138.80
Rate for Payer: Healthscope Commercial	$984.91
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$646.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,326.00
Rate for Payer: Nomi Health Commercial	$738.68
Rate for Payer: PACE SWMI	$615.57
Rate for Payer: PHP Medicare Advantage	$615.57
Rate for Payer: Priority Health Cigna Priority Health	$1,326.00
Rate for Payer: Priority Health Medicare	$615.57
Rate for Payer: UHC Dual Complete DSNP	$615.57
Rate for Payer: UHC Medicare Advantage	$615.57

PR LESION <15

Professional

Both

$128.00

Service Code	HCPCS 00074
Hospital Revenue Code	990
Min. Negotiated Rate	$51.20
Max. Negotiated Rate	$83.20
Rate for Payer: Aetna Medicare	$64.00
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: Cash Price	$102.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$83.20
Rate for Payer: Priority Health Cigna Priority Health	$83.20

PR LESION FL FACE/NECK

Professional

Both

$255.00

Service Code	HCPCS 00075
Hospital Revenue Code	990
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$165.75
Rate for Payer: Aetna Medicare	$127.50
Rate for Payer: BCBS Complete	$102.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$165.75
Rate for Payer: Priority Health Cigna Priority Health	$165.75

PR LESION REMOVAL COLONOSCOPY

Professional

Both

$1,584.00

Service Code	HCPCS G6024
Min. Negotiated Rate	$633.60
Max. Negotiated Rate	$1,029.60
Rate for Payer: Aetna Medicare	$792.00
Rate for Payer: BCBS Complete	$633.60
Rate for Payer: Cash Price	$1,267.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,029.60
Rate for Payer: Priority Health Cigna Priority Health	$1,029.60

PR LESION SINGLE

Professional

Both

$36.00

Service Code	HCPCS 00073
Hospital Revenue Code	990
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna Medicare	$18.00
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$23.40
Rate for Payer: Priority Health Cigna Priority Health	$23.40

PR LEUPROLIDE ACETATE /3.75 MG

Professional

Both

$1,103.00

Service Code	HCPCS J1950
Min. Negotiated Rate	$441.20
Max. Negotiated Rate	$3,201.09
Rate for Payer: Aetna Commercial	$2,318.63
Rate for Payer: Aetna Medicare	$1,799.53
Rate for Payer: Aetna New Business (MI Preferred)	$2,318.63
Rate for Payer: Aetna New Business (MI Preferred)	$2,491.66
Rate for Payer: BCBS Complete	$441.20
Rate for Payer: BCBS MAPPO	$1,730.32
Rate for Payer: BCN Medicare Advantage	$1,730.32
Rate for Payer: Cash Price	$882.40
Rate for Payer: Cash Price	$882.40
Rate for Payer: Cofinity Commercial	$2,491.66
Rate for Payer: Cofinity Commercial	$2,318.63
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,730.32
Rate for Payer: Healthscope Commercial	$2,768.51
Rate for Payer: Healthscope Commercial	$3,201.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,816.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$716.95
Rate for Payer: Nomi Health Commercial	$2,076.38
Rate for Payer: PACE SWMI	$1,730.32
Rate for Payer: PHP Medicare Advantage	$1,730.32
Rate for Payer: Priority Health Cigna Priority Health	$716.95
Rate for Payer: Priority Health Medicare	$1,730.32
Rate for Payer: UHC Dual Complete DSNP	$1,730.32
Rate for Payer: UHC Medicare Advantage	$1,730.32

PR LEUPROLIDE ACETATE INJECITON

Professional

Both

$38.00

Service Code	HCPCS J9218
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$24.70
Rate for Payer: Aetna Medicare	$19.00
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: Cash Price	$30.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$24.70
Rate for Payer: Priority Health Cigna Priority Health	$24.70

PR LEUPROLIDE ACETATE SUSPNSION

Professional

Both

$461.00

Service Code	HCPCS J9217
Min. Negotiated Rate	$176.45
Max. Negotiated Rate	$326.43
Rate for Payer: Aetna Commercial	$236.44
Rate for Payer: Aetna Medicare	$183.51
Rate for Payer: Aetna New Business (MI Preferred)	$236.44
Rate for Payer: Aetna New Business (MI Preferred)	$254.09
Rate for Payer: BCBS Complete	$184.40
Rate for Payer: BCBS MAPPO	$176.45
Rate for Payer: BCN Medicare Advantage	$176.45
Rate for Payer: Cash Price	$368.80
Rate for Payer: Cash Price	$368.80
Rate for Payer: Cofinity Commercial	$254.09
Rate for Payer: Cofinity Commercial	$236.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$176.45
Rate for Payer: Healthscope Commercial	$326.43
Rate for Payer: Healthscope Commercial	$282.32
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$185.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$299.65
Rate for Payer: Nomi Health Commercial	$211.74
Rate for Payer: PACE SWMI	$176.45
Rate for Payer: PHP Medicare Advantage	$176.45
Rate for Payer: Priority Health Cigna Priority Health	$299.65
Rate for Payer: Priority Health Medicare	$176.45
Rate for Payer: UHC Dual Complete DSNP	$176.45
Rate for Payer: UHC Medicare Advantage	$176.45

PR LEVALBUTEROL NON-COMP UNIT

Professional

Both

$5.00

Service Code	HCPCS J7614
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Commercial	$0.12
Rate for Payer: Aetna Medicare	$0.09
Rate for Payer: Aetna New Business (MI Preferred)	$0.12
Rate for Payer: Aetna New Business (MI Preferred)	$0.13
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: BCBS MAPPO	$0.09
Rate for Payer: BCN Medicare Advantage	$0.09
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cofinity Commercial	$0.12
Rate for Payer: Cofinity Commercial	$0.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.09
Rate for Payer: Healthscope Commercial	$0.14
Rate for Payer: Healthscope Commercial	$0.17
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3.25
Rate for Payer: Nomi Health Commercial	$0.11
Rate for Payer: PACE SWMI	$0.09
Rate for Payer: PHP Medicare Advantage	$0.09
Rate for Payer: Priority Health Cigna Priority Health	$3.25
Rate for Payer: Priority Health Medicare	$0.09
Rate for Payer: UHC Dual Complete DSNP	$0.09
Rate for Payer: UHC Medicare Advantage	$0.09

PR LEVONORGESTREL IMPLANT SYS

Professional

Both

$561.00

Service Code	HCPCS J7306
Min. Negotiated Rate	$224.40
Max. Negotiated Rate	$364.65
Rate for Payer: Aetna Medicare	$280.50
Rate for Payer: BCBS Complete	$224.40
Rate for Payer: Cash Price	$448.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$364.65
Rate for Payer: Priority Health Cigna Priority Health	$364.65

PR LEVONORGESTREL IU CONTRACEPT

Professional

Both

$839.00

Service Code	HCPCS J7302
Min. Negotiated Rate	$335.60
Max. Negotiated Rate	$545.35
Rate for Payer: Aetna Medicare	$419.50
Rate for Payer: BCBS Complete	$335.60
Rate for Payer: Cash Price	$671.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$545.35
Rate for Payer: Priority Health Cigna Priority Health	$545.35

PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I

Professional

Both

$495.00

Service Code	HCPCS 93452
Min. Negotiated Rate	$198.00
Max. Negotiated Rate	$1,436.47
Rate for Payer: Aetna Commercial	$1,040.47
Rate for Payer: Aetna Medicare	$807.53
Rate for Payer: Aetna New Business (MI Preferred)	$1,118.12
Rate for Payer: Aetna New Business (MI Preferred)	$1,040.47
Rate for Payer: BCBS Complete	$198.00
Rate for Payer: BCBS MAPPO	$776.47
Rate for Payer: BCN Medicare Advantage	$776.47
Rate for Payer: Cash Price	$396.00
Rate for Payer: Cash Price	$396.00
Rate for Payer: Cofinity Commercial	$1,040.47
Rate for Payer: Cofinity Commercial	$1,118.12
Rate for Payer: Health Alliance Plan Medicare Advantage	$776.47
Rate for Payer: Healthscope Commercial	$1,436.47
Rate for Payer: Healthscope Commercial	$1,242.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$815.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$321.75
Rate for Payer: Nomi Health Commercial	$931.76
Rate for Payer: PACE SWMI	$776.47
Rate for Payer: PHP Medicare Advantage	$776.47
Rate for Payer: Priority Health Cigna Priority Health	$321.75
Rate for Payer: Priority Health Medicare	$776.47
Rate for Payer: UHC Dual Complete DSNP	$776.47
Rate for Payer: UHC Medicare Advantage	$776.47

PR LIDOCAINE INJECTION

Professional

Both

$3.00

Service Code	HCPCS J2001
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1.95
Rate for Payer: Priority Health Cigna Priority Health	$1.95

PR LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR

Professional

Both

$2,489.00

Service Code	HCPCS 27427
Min. Negotiated Rate	$683.86
Max. Negotiated Rate	$1,617.85
Rate for Payer: Aetna Commercial	$916.37
Rate for Payer: Aetna Medicare	$711.21
Rate for Payer: Aetna New Business (MI Preferred)	$916.37
Rate for Payer: Aetna New Business (MI Preferred)	$984.76
Rate for Payer: BCBS Complete	$995.60
Rate for Payer: BCBS MAPPO	$683.86
Rate for Payer: BCN Medicare Advantage	$683.86
Rate for Payer: Cash Price	$1,991.20
Rate for Payer: Cash Price	$1,991.20
Rate for Payer: Cofinity Commercial	$984.76
Rate for Payer: Cofinity Commercial	$916.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$683.86
Rate for Payer: Healthscope Commercial	$1,265.14
Rate for Payer: Healthscope Commercial	$1,094.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$718.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,617.85
Rate for Payer: Nomi Health Commercial	$820.63
Rate for Payer: PACE SWMI	$683.86
Rate for Payer: PHP Medicare Advantage	$683.86
Rate for Payer: Priority Health Cigna Priority Health	$1,617.85
Rate for Payer: Priority Health Medicare	$683.86
Rate for Payer: UHC Dual Complete DSNP	$683.86
Rate for Payer: UHC Medicare Advantage	$683.86

PR LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR

Professional

Both

$3,247.00

Service Code	HCPCS 27428
Min. Negotiated Rate	$1,077.74
Max. Negotiated Rate	$2,110.55
Rate for Payer: Aetna Commercial	$1,444.17
Rate for Payer: Aetna Medicare	$1,120.85
Rate for Payer: Aetna New Business (MI Preferred)	$1,444.17
Rate for Payer: Aetna New Business (MI Preferred)	$1,551.95
Rate for Payer: BCBS Complete	$1,298.80
Rate for Payer: BCBS MAPPO	$1,077.74
Rate for Payer: BCN Medicare Advantage	$1,077.74
Rate for Payer: Cash Price	$2,597.60
Rate for Payer: Cash Price	$2,597.60
Rate for Payer: Cofinity Commercial	$1,444.17
Rate for Payer: Cofinity Commercial	$1,551.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,077.74
Rate for Payer: Healthscope Commercial	$1,724.38
Rate for Payer: Healthscope Commercial	$1,993.82
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,131.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,110.55
Rate for Payer: Nomi Health Commercial	$1,293.29
Rate for Payer: PACE SWMI	$1,077.74
Rate for Payer: PHP Medicare Advantage	$1,077.74
Rate for Payer: Priority Health Cigna Priority Health	$2,110.55
Rate for Payer: Priority Health Medicare	$1,077.74
Rate for Payer: UHC Dual Complete DSNP	$1,077.74
Rate for Payer: UHC Medicare Advantage	$1,077.74

PR LIGATION ARTERIES ETHMOIDAL

Professional

Both

$1,038.00

Service Code	HCPCS 30915
Min. Negotiated Rate	$415.20
Max. Negotiated Rate	$1,043.68
Rate for Payer: Aetna Commercial	$755.96
Rate for Payer: Aetna Medicare	$586.72
Rate for Payer: Aetna New Business (MI Preferred)	$812.38
Rate for Payer: Aetna New Business (MI Preferred)	$755.96
Rate for Payer: BCBS Complete	$415.20
Rate for Payer: BCBS MAPPO	$564.15
Rate for Payer: BCN Medicare Advantage	$564.15
Rate for Payer: Cash Price	$830.40
Rate for Payer: Cash Price	$830.40
Rate for Payer: Cofinity Commercial	$812.38
Rate for Payer: Cofinity Commercial	$755.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$564.15
Rate for Payer: Healthscope Commercial	$902.64
Rate for Payer: Healthscope Commercial	$1,043.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$592.36
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$674.70
Rate for Payer: Nomi Health Commercial	$676.98
Rate for Payer: PACE SWMI	$564.15
Rate for Payer: PHP Medicare Advantage	$564.15
Rate for Payer: Priority Health Cigna Priority Health	$674.70
Rate for Payer: Priority Health Medicare	$564.15
Rate for Payer: UHC Dual Complete DSNP	$564.15
Rate for Payer: UHC Medicare Advantage	$564.15

PR LIGATION ARTERIES INT MAXILLARY TRANSANTRAL

Professional

Both

$1,501.00

Service Code	HCPCS 30920
Min. Negotiated Rate	$600.40
Max. Negotiated Rate	$1,509.60
Rate for Payer: Aetna Commercial	$1,093.44
Rate for Payer: Aetna Medicare	$848.64
Rate for Payer: Aetna New Business (MI Preferred)	$1,175.04
Rate for Payer: Aetna New Business (MI Preferred)	$1,093.44
Rate for Payer: BCBS Complete	$600.40
Rate for Payer: BCBS MAPPO	$816.00
Rate for Payer: BCN Medicare Advantage	$816.00
Rate for Payer: Cash Price	$1,200.80
Rate for Payer: Cash Price	$1,200.80
Rate for Payer: Cofinity Commercial	$1,175.04
Rate for Payer: Cofinity Commercial	$1,093.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$816.00
Rate for Payer: Healthscope Commercial	$1,305.60
Rate for Payer: Healthscope Commercial	$1,509.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$856.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$975.65
Rate for Payer: Nomi Health Commercial	$979.20
Rate for Payer: PACE SWMI	$816.00
Rate for Payer: PHP Medicare Advantage	$816.00
Rate for Payer: Priority Health Cigna Priority Health	$975.65
Rate for Payer: Priority Health Medicare	$816.00
Rate for Payer: UHC Dual Complete DSNP	$816.00
Rate for Payer: UHC Medicare Advantage	$816.00

PR LIGATION/BIOPSY TEMPORAL ARTERY

Facility

$900.00

Service Code	CPT 37609
Hospital Charge Code	37609
Hospital Revenue Code	960
Min. Negotiated Rate	$567.00
Max. Negotiated Rate	$4,448.08
Rate for Payer: Aetna Commercial	$765.00
Rate for Payer: Aetna Medicare	$1,643.40
Rate for Payer: Aetna New Business (MI Preferred)	$585.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,975.24
Rate for Payer: Amish Plain Church Group Commercial	$1,975.24
Rate for Payer: BCBS Complete	$889.33
Rate for Payer: BCBS MAPPO	$1,580.19
Rate for Payer: BCN Medicare Advantage	$1,580.19
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cofinity Commercial	$774.00
Rate for Payer: Cofinity Commercial	$630.00
Rate for Payer: Cofinity Medicare Advantage	$630.00
Rate for Payer: Encore Health Key Benefits Commercial	$720.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,580.19
Rate for Payer: Healthscope Commercial	$810.00
Rate for Payer: Mclaren Medicaid	$846.98
Rate for Payer: Mclaren Medicare	$1,580.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,659.20
Rate for Payer: Meridian Medicaid	$889.33
Rate for Payer: MI Amish Medical Board Commercial	$1,817.22
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$765.00
Rate for Payer: PACE Medicare	$1,501.18
Rate for Payer: PACE SWMI	$1,580.19
Rate for Payer: PHP Commercial	$765.00
Rate for Payer: PHP Medicare Advantage	$1,580.19
Rate for Payer: Priority Health Choice Medicaid	$846.98
Rate for Payer: Priority Health Cigna Priority Health	$585.00
Rate for Payer: Priority Health Medicare	$1,580.19
Rate for Payer: Priority Health SBD	$567.00
Rate for Payer: Railroad Medicare Medicare	$1,580.19
Rate for Payer: UHC All Payor (Choice/PPO)	$4,448.08
Rate for Payer: UHC Dual Complete DSNP	$1,580.19
Rate for Payer: UHC Medicare Advantage	$1,580.19
Rate for Payer: UHCCP Medicaid	$889.65
Rate for Payer: VA VA	$1,580.19

PR LIGATION/BIOPSY TEMPORAL ARTERY

Professional

Both

$900.00

Service Code	HCPCS 37609
Hospital Charge Code	37609
Min. Negotiated Rate	$193.96
Max. Negotiated Rate	$585.00
Rate for Payer: Aetna Commercial	$259.91
Rate for Payer: Aetna Medicare	$201.72
Rate for Payer: Aetna New Business (MI Preferred)	$259.91
Rate for Payer: Aetna New Business (MI Preferred)	$279.30
Rate for Payer: BCBS Complete	$360.00
Rate for Payer: BCBS MAPPO	$193.96
Rate for Payer: BCN Medicare Advantage	$193.96
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cofinity Commercial	$259.91
Rate for Payer: Cofinity Commercial	$279.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$193.96
Rate for Payer: Healthscope Commercial	$358.83
Rate for Payer: Healthscope Commercial	$310.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$203.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$585.00
Rate for Payer: Nomi Health Commercial	$232.75
Rate for Payer: PACE SWMI	$193.96
Rate for Payer: PHP Medicare Advantage	$193.96
Rate for Payer: Priority Health Cigna Priority Health	$585.00
Rate for Payer: Priority Health Medicare	$193.96
Rate for Payer: UHC Dual Complete DSNP	$193.96
Rate for Payer: UHC Medicare Advantage	$193.96

PR LIGATION/BIOPSY TEMPORAL ARTERY

Professional

Both

$900.00

Service Code	HCPCS 37609
Min. Negotiated Rate	$193.96
Max. Negotiated Rate	$585.00
Rate for Payer: Aetna Commercial	$259.91
Rate for Payer: Aetna Medicare	$201.72
Rate for Payer: Aetna New Business (MI Preferred)	$279.30
Rate for Payer: Aetna New Business (MI Preferred)	$259.91
Rate for Payer: BCBS Complete	$360.00
Rate for Payer: BCBS MAPPO	$193.96
Rate for Payer: BCN Medicare Advantage	$193.96
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cofinity Commercial	$279.30
Rate for Payer: Cofinity Commercial	$259.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$193.96
Rate for Payer: Healthscope Commercial	$358.83
Rate for Payer: Healthscope Commercial	$310.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$203.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$585.00
Rate for Payer: Nomi Health Commercial	$232.75
Rate for Payer: PACE SWMI	$193.96
Rate for Payer: PHP Medicare Advantage	$193.96
Rate for Payer: Priority Health Cigna Priority Health	$585.00
Rate for Payer: Priority Health Medicare	$193.96
Rate for Payer: UHC Dual Complete DSNP	$193.96
Rate for Payer: UHC Medicare Advantage	$193.96

PR LIGATION/BIOPSY TEMPORAL ARTERY

Facility

$900.00

Service Code	CPT 37609
Hospital Charge Code	37609
Hospital Revenue Code	960
Min. Negotiated Rate	$567.00
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$765.00
Rate for Payer: Aetna New Business (MI Preferred)	$585.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cofinity Commercial	$630.00
Rate for Payer: Cofinity Commercial	$774.00
Rate for Payer: Cofinity Medicare Advantage	$630.00
Rate for Payer: Encore Health Key Benefits Commercial	$720.00
Rate for Payer: Healthscope Commercial	$810.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$765.00
Rate for Payer: PHP Commercial	$765.00
Rate for Payer: Priority Health Cigna Priority Health	$585.00
Rate for Payer: Priority Health SBD	$567.00

PR LIGATION DIRECT ESOPHAGEAL VARICES

Professional

Both

$3,134.00

Service Code	HCPCS 43400
Min. Negotiated Rate	$1,253.60
Max. Negotiated Rate	$2,740.26
Rate for Payer: Aetna Commercial	$1,984.83
Rate for Payer: Aetna Medicare	$1,540.47
Rate for Payer: Aetna New Business (MI Preferred)	$2,132.96
Rate for Payer: Aetna New Business (MI Preferred)	$1,984.83
Rate for Payer: BCBS Complete	$1,253.60
Rate for Payer: BCBS MAPPO	$1,481.22
Rate for Payer: BCN Medicare Advantage	$1,481.22
Rate for Payer: Cash Price	$2,507.20
Rate for Payer: Cash Price	$2,507.20
Rate for Payer: Cofinity Commercial	$2,132.96
Rate for Payer: Cofinity Commercial	$1,984.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,481.22
Rate for Payer: Healthscope Commercial	$2,369.95
Rate for Payer: Healthscope Commercial	$2,740.26
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,555.28
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,037.10
Rate for Payer: Nomi Health Commercial	$1,777.46
Rate for Payer: PACE SWMI	$1,481.22
Rate for Payer: PHP Medicare Advantage	$1,481.22
Rate for Payer: Priority Health Cigna Priority Health	$2,037.10
Rate for Payer: Priority Health Medicare	$1,481.22
Rate for Payer: UHC Dual Complete DSNP	$1,481.22
Rate for Payer: UHC Medicare Advantage	$1,481.22

PR LIGATION HEMORRHOID BUNDLE W/US

Professional

Both

$2,091.00

Service Code	HCPCS 0249T
Min. Negotiated Rate	$836.40
Max. Negotiated Rate	$1,359.15
Rate for Payer: Aetna Medicare	$1,045.50
Rate for Payer: BCBS Complete	$836.40
Rate for Payer: Cash Price	$1,672.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,359.15
Rate for Payer: Priority Health Cigna Priority Health	$1,359.15

PR LIGATION INTERNAL/COMMON CAROTID ARTERY

Professional

Both

$1,996.00

Service Code	HCPCS 37605
Min. Negotiated Rate	$712.07
Max. Negotiated Rate	$1,317.33
Rate for Payer: Aetna Commercial	$954.17
Rate for Payer: Aetna Medicare	$740.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,025.38
Rate for Payer: Aetna New Business (MI Preferred)	$954.17
Rate for Payer: BCBS Complete	$798.40
Rate for Payer: BCBS MAPPO	$712.07
Rate for Payer: BCN Medicare Advantage	$712.07
Rate for Payer: Cash Price	$1,596.80
Rate for Payer: Cash Price	$1,596.80
Rate for Payer: Cofinity Commercial	$954.17
Rate for Payer: Cofinity Commercial	$1,025.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$712.07
Rate for Payer: Healthscope Commercial	$1,317.33
Rate for Payer: Healthscope Commercial	$1,139.31
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$747.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,297.40
Rate for Payer: Nomi Health Commercial	$854.48
Rate for Payer: PACE SWMI	$712.07
Rate for Payer: PHP Medicare Advantage	$712.07
Rate for Payer: Priority Health Cigna Priority Health	$1,297.40
Rate for Payer: Priority Health Medicare	$712.07
Rate for Payer: UHC Dual Complete DSNP	$712.07
Rate for Payer: UHC Medicare Advantage	$712.07

PR LIGATION INTERNAL JUGULAR VEIN

Professional

Both

$1,516.00

Service Code	HCPCS 37565
Min. Negotiated Rate	$606.40
Max. Negotiated Rate	$1,286.56
Rate for Payer: Aetna Commercial	$931.89
Rate for Payer: Aetna Medicare	$723.26
Rate for Payer: Aetna New Business (MI Preferred)	$1,001.43
Rate for Payer: Aetna New Business (MI Preferred)	$931.89
Rate for Payer: BCBS Complete	$606.40
Rate for Payer: BCBS MAPPO	$695.44
Rate for Payer: BCN Medicare Advantage	$695.44
Rate for Payer: Cash Price	$1,212.80
Rate for Payer: Cash Price	$1,212.80
Rate for Payer: Cofinity Commercial	$1,001.43
Rate for Payer: Cofinity Commercial	$931.89
Rate for Payer: Health Alliance Plan Medicare Advantage	$695.44
Rate for Payer: Healthscope Commercial	$1,112.70
Rate for Payer: Healthscope Commercial	$1,286.56
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$730.21
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$985.40
Rate for Payer: Nomi Health Commercial	$834.53
Rate for Payer: PACE SWMI	$695.44
Rate for Payer: PHP Medicare Advantage	$695.44
Rate for Payer: Priority Health Cigna Priority Health	$985.40
Rate for Payer: Priority Health Medicare	$695.44
Rate for Payer: UHC Dual Complete DSNP	$695.44
Rate for Payer: UHC Medicare Advantage	$695.44

Know your out-of-pocket cost for care.

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