|
PR LIGATION MAJOR ARTERY ABDOMEN
|
Professional
|
Both
|
$3,271.00
|
|
|
Service Code
|
HCPCS 37617
|
| Min. Negotiated Rate |
$1,275.58 |
| Max. Negotiated Rate |
$2,359.82 |
| Rate for Payer: Aetna Commercial |
$1,709.28
|
| Rate for Payer: Aetna Medicare |
$1,326.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,836.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,709.28
|
| Rate for Payer: BCBS Complete |
$1,308.40
|
| Rate for Payer: BCBS MAPPO |
$1,275.58
|
| Rate for Payer: BCN Medicare Advantage |
$1,275.58
|
| Rate for Payer: Cash Price |
$2,616.80
|
| Rate for Payer: Cash Price |
$2,616.80
|
| Rate for Payer: Cofinity Commercial |
$1,836.84
|
| Rate for Payer: Cofinity Commercial |
$1,709.28
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,275.58
|
| Rate for Payer: Healthscope Commercial |
$2,359.82
|
| Rate for Payer: Healthscope Commercial |
$2,040.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,339.36
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,126.15
|
| Rate for Payer: Nomi Health Commercial |
$1,530.70
|
| Rate for Payer: PACE SWMI |
$1,275.58
|
| Rate for Payer: PHP Medicare Advantage |
$1,275.58
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,126.15
|
| Rate for Payer: Priority Health Medicare |
$1,275.58
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,275.58
|
| Rate for Payer: UHC Medicare Advantage |
$1,275.58
|
|
|
PR LIGATION MAJOR ARTERY CHEST
|
Professional
|
Both
|
$3,387.00
|
|
|
Service Code
|
HCPCS 37616
|
| Min. Negotiated Rate |
$1,100.17 |
| Max. Negotiated Rate |
$2,201.55 |
| Rate for Payer: Aetna Commercial |
$1,474.23
|
| Rate for Payer: Aetna Medicare |
$1,144.18
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,584.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,474.23
|
| Rate for Payer: BCBS Complete |
$1,354.80
|
| Rate for Payer: BCBS MAPPO |
$1,100.17
|
| Rate for Payer: BCN Medicare Advantage |
$1,100.17
|
| Rate for Payer: Cash Price |
$2,709.60
|
| Rate for Payer: Cash Price |
$2,709.60
|
| Rate for Payer: Cofinity Commercial |
$1,584.24
|
| Rate for Payer: Cofinity Commercial |
$1,474.23
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,100.17
|
| Rate for Payer: Healthscope Commercial |
$1,760.27
|
| Rate for Payer: Healthscope Commercial |
$2,035.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,155.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,201.55
|
| Rate for Payer: Nomi Health Commercial |
$1,320.20
|
| Rate for Payer: PACE SWMI |
$1,100.17
|
| Rate for Payer: PHP Medicare Advantage |
$1,100.17
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,201.55
|
| Rate for Payer: Priority Health Medicare |
$1,100.17
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,100.17
|
| Rate for Payer: UHC Medicare Advantage |
$1,100.17
|
|
|
PR LIGATION MAJOR ARTERY EXTREMITY
|
Professional
|
Both
|
$1,076.00
|
|
|
Service Code
|
HCPCS 37618
|
| Min. Negotiated Rate |
$374.67 |
| Max. Negotiated Rate |
$699.40 |
| Rate for Payer: Aetna Commercial |
$502.06
|
| Rate for Payer: Aetna Medicare |
$389.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$539.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$502.06
|
| Rate for Payer: BCBS Complete |
$430.40
|
| Rate for Payer: BCBS MAPPO |
$374.67
|
| Rate for Payer: BCN Medicare Advantage |
$374.67
|
| Rate for Payer: Cash Price |
$860.80
|
| Rate for Payer: Cash Price |
$860.80
|
| Rate for Payer: Cofinity Commercial |
$539.52
|
| Rate for Payer: Cofinity Commercial |
$502.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$374.67
|
| Rate for Payer: Healthscope Commercial |
$693.14
|
| Rate for Payer: Healthscope Commercial |
$599.47
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$393.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$699.40
|
| Rate for Payer: Nomi Health Commercial |
$449.60
|
| Rate for Payer: PACE SWMI |
$374.67
|
| Rate for Payer: PHP Medicare Advantage |
$374.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$699.40
|
| Rate for Payer: Priority Health Medicare |
$374.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$374.67
|
| Rate for Payer: UHC Medicare Advantage |
$374.67
|
|
|
PR LIGATION MAJOR ARTERY NECK
|
Professional
|
Both
|
$1,213.00
|
|
|
Service Code
|
HCPCS 37615
|
| Min. Negotiated Rate |
$485.20 |
| Max. Negotiated Rate |
$912.22 |
| Rate for Payer: Aetna Commercial |
$660.74
|
| Rate for Payer: Aetna Medicare |
$512.81
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$710.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$660.74
|
| Rate for Payer: BCBS Complete |
$485.20
|
| Rate for Payer: BCBS MAPPO |
$493.09
|
| Rate for Payer: BCN Medicare Advantage |
$493.09
|
| Rate for Payer: Cash Price |
$970.40
|
| Rate for Payer: Cash Price |
$970.40
|
| Rate for Payer: Cofinity Commercial |
$710.05
|
| Rate for Payer: Cofinity Commercial |
$660.74
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$493.09
|
| Rate for Payer: Healthscope Commercial |
$788.94
|
| Rate for Payer: Healthscope Commercial |
$912.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$517.74
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$788.45
|
| Rate for Payer: Nomi Health Commercial |
$591.71
|
| Rate for Payer: PACE SWMI |
$493.09
|
| Rate for Payer: PHP Medicare Advantage |
$493.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$788.45
|
| Rate for Payer: Priority Health Medicare |
$493.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$493.09
|
| Rate for Payer: UHC Medicare Advantage |
$493.09
|
|
|
PR LIGATION OF FEMORAL VEIN
|
Professional
|
Both
|
$1,679.00
|
|
|
Service Code
|
HCPCS 37650
|
| Min. Negotiated Rate |
$443.97 |
| Max. Negotiated Rate |
$1,091.35 |
| Rate for Payer: Aetna Commercial |
$594.92
|
| Rate for Payer: Aetna Medicare |
$461.73
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$639.32
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$594.92
|
| Rate for Payer: BCBS Complete |
$671.60
|
| Rate for Payer: BCBS MAPPO |
$443.97
|
| Rate for Payer: BCN Medicare Advantage |
$443.97
|
| Rate for Payer: Cash Price |
$1,343.20
|
| Rate for Payer: Cash Price |
$1,343.20
|
| Rate for Payer: Cofinity Commercial |
$639.32
|
| Rate for Payer: Cofinity Commercial |
$594.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$443.97
|
| Rate for Payer: Healthscope Commercial |
$821.34
|
| Rate for Payer: Healthscope Commercial |
$710.35
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$466.17
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,091.35
|
| Rate for Payer: Nomi Health Commercial |
$532.76
|
| Rate for Payer: PACE SWMI |
$443.97
|
| Rate for Payer: PHP Medicare Advantage |
$443.97
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,091.35
|
| Rate for Payer: Priority Health Medicare |
$443.97
|
| Rate for Payer: UHC Dual Complete DSNP |
$443.97
|
| Rate for Payer: UHC Medicare Advantage |
$443.97
|
|
|
PR LIGATION OF INFERIOR VENA CAVA
|
Professional
|
Both
|
$3,441.00
|
|
|
Service Code
|
HCPCS 37619
|
| Min. Negotiated Rate |
$1,376.40 |
| Max. Negotiated Rate |
$3,101.41 |
| Rate for Payer: Aetna Commercial |
$2,246.43
|
| Rate for Payer: Aetna Medicare |
$1,743.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,414.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$2,246.43
|
| Rate for Payer: BCBS Complete |
$1,376.40
|
| Rate for Payer: BCBS MAPPO |
$1,676.44
|
| Rate for Payer: BCN Medicare Advantage |
$1,676.44
|
| Rate for Payer: Cash Price |
$2,752.80
|
| Rate for Payer: Cash Price |
$2,752.80
|
| Rate for Payer: Cofinity Commercial |
$2,414.07
|
| Rate for Payer: Cofinity Commercial |
$2,246.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,676.44
|
| Rate for Payer: Healthscope Commercial |
$2,682.30
|
| Rate for Payer: Healthscope Commercial |
$3,101.41
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,760.26
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2,236.65
|
| Rate for Payer: Nomi Health Commercial |
$2,011.73
|
| Rate for Payer: PACE SWMI |
$1,676.44
|
| Rate for Payer: PHP Medicare Advantage |
$1,676.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$2,236.65
|
| Rate for Payer: Priority Health Medicare |
$1,676.44
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,676.44
|
| Rate for Payer: UHC Medicare Advantage |
$1,676.44
|
|
|
PR LIGATION OF SPERM DUCT
|
Professional
|
Both
|
$651.00
|
|
|
Service Code
|
HCPCS 55450
|
| Min. Negotiated Rate |
$260.40 |
| Max. Negotiated Rate |
$423.15 |
| Rate for Payer: Aetna Medicare |
$325.50
|
| Rate for Payer: BCBS Complete |
$260.40
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$423.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$423.15
|
|
|
PR LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA
|
Professional
|
Both
|
$1,098.00
|
|
|
Service Code
|
HCPCS 37607
|
| Min. Negotiated Rate |
$357.54 |
| Max. Negotiated Rate |
$713.70 |
| Rate for Payer: Aetna Commercial |
$479.10
|
| Rate for Payer: Aetna Medicare |
$371.84
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$479.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$514.86
|
| Rate for Payer: BCBS Complete |
$439.20
|
| Rate for Payer: BCBS MAPPO |
$357.54
|
| Rate for Payer: BCN Medicare Advantage |
$357.54
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cash Price |
$878.40
|
| Rate for Payer: Cofinity Commercial |
$514.86
|
| Rate for Payer: Cofinity Commercial |
$479.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$357.54
|
| Rate for Payer: Healthscope Commercial |
$661.45
|
| Rate for Payer: Healthscope Commercial |
$572.06
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$375.42
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$713.70
|
| Rate for Payer: Nomi Health Commercial |
$429.05
|
| Rate for Payer: PACE SWMI |
$357.54
|
| Rate for Payer: PHP Medicare Advantage |
$357.54
|
| Rate for Payer: Priority Health Cigna Priority Health |
$713.70
|
| Rate for Payer: Priority Health Medicare |
$357.54
|
| Rate for Payer: UHC Dual Complete DSNP |
$357.54
|
| Rate for Payer: UHC Medicare Advantage |
$357.54
|
|
|
PR LIG&DIV&COMPL STRPG LONG/SHRT SAPHENOUS VN W/EXC
|
Professional
|
Both
|
$855.78
|
|
|
Service Code
|
HCPCS 37735
|
| Min. Negotiated Rate |
$342.31 |
| Max. Negotiated Rate |
$1,038.13 |
| Rate for Payer: Aetna Commercial |
$751.94
|
| Rate for Payer: Aetna Medicare |
$583.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$751.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.06
|
| Rate for Payer: BCBS Complete |
$342.31
|
| Rate for Payer: BCBS MAPPO |
$561.15
|
| Rate for Payer: BCN Medicare Advantage |
$561.15
|
| Rate for Payer: Cash Price |
$684.62
|
| Rate for Payer: Cash Price |
$684.62
|
| Rate for Payer: Cofinity Commercial |
$751.94
|
| Rate for Payer: Cofinity Commercial |
$808.06
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$561.15
|
| Rate for Payer: Healthscope Commercial |
$1,038.13
|
| Rate for Payer: Healthscope Commercial |
$897.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$589.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.26
|
| Rate for Payer: Nomi Health Commercial |
$673.38
|
| Rate for Payer: PACE SWMI |
$561.15
|
| Rate for Payer: PHP Medicare Advantage |
$561.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$556.26
|
| Rate for Payer: Priority Health Medicare |
$561.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$561.15
|
| Rate for Payer: UHC Medicare Advantage |
$561.15
|
|
|
PR LIG&DIV&COMPL STRPG LONG/SHRT SAPHENOUS VN W/EXC
|
Professional
|
Both
|
$855.78
|
|
|
Service Code
|
HCPCS 37735
|
| Hospital Charge Code |
37735
|
| Min. Negotiated Rate |
$342.31 |
| Max. Negotiated Rate |
$1,038.13 |
| Rate for Payer: Aetna Commercial |
$751.94
|
| Rate for Payer: Aetna Medicare |
$583.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$751.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$808.06
|
| Rate for Payer: BCBS Complete |
$342.31
|
| Rate for Payer: BCBS MAPPO |
$561.15
|
| Rate for Payer: BCN Medicare Advantage |
$561.15
|
| Rate for Payer: Cash Price |
$684.62
|
| Rate for Payer: Cash Price |
$684.62
|
| Rate for Payer: Cofinity Commercial |
$808.06
|
| Rate for Payer: Cofinity Commercial |
$751.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$561.15
|
| Rate for Payer: Healthscope Commercial |
$1,038.13
|
| Rate for Payer: Healthscope Commercial |
$897.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$589.21
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$556.26
|
| Rate for Payer: Nomi Health Commercial |
$673.38
|
| Rate for Payer: PACE SWMI |
$561.15
|
| Rate for Payer: PHP Medicare Advantage |
$561.15
|
| Rate for Payer: Priority Health Cigna Priority Health |
$556.26
|
| Rate for Payer: Priority Health Medicare |
$561.15
|
| Rate for Payer: UHC Dual Complete DSNP |
$561.15
|
| Rate for Payer: UHC Medicare Advantage |
$561.15
|
|
|
PR LIG&DIV&COMPL STRPG LONG/SHRT SAPHENOUS VN W/EXC
|
Facility
|
OP
|
$856.00
|
|
|
Service Code
|
CPT 37735
|
| Hospital Charge Code |
37735
|
| Min. Negotiated Rate |
$539.28 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Commercial |
$727.60
|
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$556.40
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cofinity Commercial |
$599.20
|
| Rate for Payer: Cofinity Commercial |
$736.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$599.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$684.80
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$770.40
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$727.60
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$727.60
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$556.40
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health SBD |
$539.28
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,728.24
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
PR LIG&DIV&COMPL STRPG LONG/SHRT SAPHENOUS VN W/EXC
|
Facility
|
IP
|
$856.00
|
|
|
Service Code
|
CPT 37735
|
| Hospital Charge Code |
37735
|
| Min. Negotiated Rate |
$539.28 |
| Max. Negotiated Rate |
$770.40 |
| Rate for Payer: Aetna Commercial |
$727.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$556.40
|
| Rate for Payer: Cash Price |
$684.80
|
| Rate for Payer: Cofinity Commercial |
$599.20
|
| Rate for Payer: Cofinity Commercial |
$736.16
|
| Rate for Payer: Cofinity Medicare Advantage |
$599.20
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$684.80
|
| Rate for Payer: Healthscope Commercial |
$770.40
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$727.60
|
| Rate for Payer: PHP Commercial |
$727.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$556.40
|
| Rate for Payer: Priority Health SBD |
$539.28
|
|
|
PR LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ
|
Professional
|
Both
|
$474.00
|
|
|
Service Code
|
HCPCS 37700
|
| Min. Negotiated Rate |
$189.60 |
| Max. Negotiated Rate |
$433.05 |
| Rate for Payer: Aetna Commercial |
$313.67
|
| Rate for Payer: Aetna Medicare |
$243.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$337.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$313.67
|
| Rate for Payer: BCBS Complete |
$189.60
|
| Rate for Payer: BCBS MAPPO |
$234.08
|
| Rate for Payer: BCN Medicare Advantage |
$234.08
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cash Price |
$379.20
|
| Rate for Payer: Cofinity Commercial |
$337.08
|
| Rate for Payer: Cofinity Commercial |
$313.67
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$234.08
|
| Rate for Payer: Healthscope Commercial |
$433.05
|
| Rate for Payer: Healthscope Commercial |
$374.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$245.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$308.10
|
| Rate for Payer: Nomi Health Commercial |
$280.90
|
| Rate for Payer: PACE SWMI |
$234.08
|
| Rate for Payer: PHP Medicare Advantage |
$234.08
|
| Rate for Payer: Priority Health Cigna Priority Health |
$308.10
|
| Rate for Payer: Priority Health Medicare |
$234.08
|
| Rate for Payer: UHC Dual Complete DSNP |
$234.08
|
| Rate for Payer: UHC Medicare Advantage |
$234.08
|
|
|
PR LIG DIV & STRIPPING SHORT SAPHENOUS VEIN
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
HCPCS 37718
|
| Min. Negotiated Rate |
$328.80 |
| Max. Negotiated Rate |
$702.46 |
| Rate for Payer: Aetna Commercial |
$508.81
|
| Rate for Payer: Aetna Medicare |
$394.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$546.78
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$508.81
|
| Rate for Payer: BCBS Complete |
$328.80
|
| Rate for Payer: BCBS MAPPO |
$379.71
|
| Rate for Payer: BCN Medicare Advantage |
$379.71
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cofinity Commercial |
$546.78
|
| Rate for Payer: Cofinity Commercial |
$508.81
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$379.71
|
| Rate for Payer: Healthscope Commercial |
$607.54
|
| Rate for Payer: Healthscope Commercial |
$702.46
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$398.70
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$534.30
|
| Rate for Payer: Nomi Health Commercial |
$455.65
|
| Rate for Payer: PACE SWMI |
$379.71
|
| Rate for Payer: PHP Medicare Advantage |
$379.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$534.30
|
| Rate for Payer: Priority Health Medicare |
$379.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$379.71
|
| Rate for Payer: UHC Medicare Advantage |
$379.71
|
|
|
PR LIG DIV&STRPG LONG SAPH SAPHFEM JUNCT KNE/BELW
|
Professional
|
Both
|
$948.00
|
|
|
Service Code
|
HCPCS 37722
|
| Min. Negotiated Rate |
$379.20 |
| Max. Negotiated Rate |
$815.13 |
| Rate for Payer: Aetna Commercial |
$590.42
|
| Rate for Payer: Aetna Medicare |
$458.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$634.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$590.42
|
| Rate for Payer: BCBS Complete |
$379.20
|
| Rate for Payer: BCBS MAPPO |
$440.61
|
| Rate for Payer: BCN Medicare Advantage |
$440.61
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cash Price |
$758.40
|
| Rate for Payer: Cofinity Commercial |
$634.48
|
| Rate for Payer: Cofinity Commercial |
$590.42
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$440.61
|
| Rate for Payer: Healthscope Commercial |
$815.13
|
| Rate for Payer: Healthscope Commercial |
$704.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$462.64
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$616.20
|
| Rate for Payer: Nomi Health Commercial |
$528.73
|
| Rate for Payer: PACE SWMI |
$440.61
|
| Rate for Payer: PHP Medicare Advantage |
$440.61
|
| Rate for Payer: Priority Health Cigna Priority Health |
$616.20
|
| Rate for Payer: Priority Health Medicare |
$440.61
|
| Rate for Payer: UHC Dual Complete DSNP |
$440.61
|
| Rate for Payer: UHC Medicare Advantage |
$440.61
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
37785
|
| Min. Negotiated Rate |
$610.47 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.85
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$678.30
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$678.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health SBD |
$610.47
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT 37785
|
| Hospital Charge Code |
37785
|
| Min. Negotiated Rate |
$610.47 |
| Max. Negotiated Rate |
$8,640.87 |
| Rate for Payer: Aetna Commercial |
$823.65
|
| Rate for Payer: Aetna Medicare |
$3,192.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$629.85
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$3,837.11
|
| Rate for Payer: Amish Plain Church Group Commercial |
$3,837.11
|
| Rate for Payer: BCBS Complete |
$1,727.62
|
| Rate for Payer: BCBS MAPPO |
$3,069.69
|
| Rate for Payer: BCN Medicare Advantage |
$3,069.69
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$678.30
|
| Rate for Payer: Cofinity Commercial |
$833.34
|
| Rate for Payer: Cofinity Medicare Advantage |
$678.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$775.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3,069.69
|
| Rate for Payer: Healthscope Commercial |
$872.10
|
| Rate for Payer: Mclaren Medicaid |
$1,645.35
|
| Rate for Payer: Mclaren Medicare |
$3,069.69
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3,223.17
|
| Rate for Payer: Meridian Medicaid |
$1,727.62
|
| Rate for Payer: MI Amish Medical Board Commercial |
$3,530.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$823.65
|
| Rate for Payer: PACE Medicare |
$2,916.21
|
| Rate for Payer: PACE SWMI |
$3,069.69
|
| Rate for Payer: PHP Commercial |
$823.65
|
| Rate for Payer: PHP Medicare Advantage |
$3,069.69
|
| Rate for Payer: Priority Health Choice Medicaid |
$1,645.35
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health Medicare |
$3,069.69
|
| Rate for Payer: Priority Health SBD |
$610.47
|
| Rate for Payer: Railroad Medicare Medicare |
$3,069.69
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$8,640.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$3,069.69
|
| Rate for Payer: UHC Medicare Advantage |
$3,069.69
|
| Rate for Payer: UHCCP Medicaid |
$1,728.24
|
| Rate for Payer: VA VA |
$3,069.69
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 37785
|
| Hospital Charge Code |
37785
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Aetna Commercial |
$322.10
|
| Rate for Payer: Aetna Medicare |
$249.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.13
|
| Rate for Payer: BCBS Complete |
$387.60
|
| Rate for Payer: BCBS MAPPO |
$240.37
|
| Rate for Payer: BCN Medicare Advantage |
$240.37
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$346.13
|
| Rate for Payer: Cofinity Commercial |
$322.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.37
|
| Rate for Payer: Healthscope Commercial |
$384.59
|
| Rate for Payer: Healthscope Commercial |
$444.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$629.85
|
| Rate for Payer: Nomi Health Commercial |
$288.44
|
| Rate for Payer: PACE SWMI |
$240.37
|
| Rate for Payer: PHP Medicare Advantage |
$240.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health Medicare |
$240.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$240.37
|
| Rate for Payer: UHC Medicare Advantage |
$240.37
|
|
|
PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
HCPCS 37785
|
| Min. Negotiated Rate |
$240.37 |
| Max. Negotiated Rate |
$629.85 |
| Rate for Payer: Aetna Commercial |
$322.10
|
| Rate for Payer: Aetna Medicare |
$249.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$346.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$322.10
|
| Rate for Payer: BCBS Complete |
$387.60
|
| Rate for Payer: BCBS MAPPO |
$240.37
|
| Rate for Payer: BCN Medicare Advantage |
$240.37
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cofinity Commercial |
$346.13
|
| Rate for Payer: Cofinity Commercial |
$322.10
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$240.37
|
| Rate for Payer: Healthscope Commercial |
$384.59
|
| Rate for Payer: Healthscope Commercial |
$444.68
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$252.39
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$629.85
|
| Rate for Payer: Nomi Health Commercial |
$288.44
|
| Rate for Payer: PACE SWMI |
$240.37
|
| Rate for Payer: PHP Medicare Advantage |
$240.37
|
| Rate for Payer: Priority Health Cigna Priority Health |
$629.85
|
| Rate for Payer: Priority Health Medicare |
$240.37
|
| Rate for Payer: UHC Dual Complete DSNP |
$240.37
|
| Rate for Payer: UHC Medicare Advantage |
$240.37
|
|
|
PR LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX
|
Professional
|
Both
|
$483.00
|
|
|
Service Code
|
HCPCS 37780
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$419.93 |
| Rate for Payer: Aetna Commercial |
$304.17
|
| Rate for Payer: Aetna Medicare |
$236.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$326.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$304.17
|
| Rate for Payer: BCBS Complete |
$193.20
|
| Rate for Payer: BCBS MAPPO |
$226.99
|
| Rate for Payer: BCN Medicare Advantage |
$226.99
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cofinity Commercial |
$326.87
|
| Rate for Payer: Cofinity Commercial |
$304.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$226.99
|
| Rate for Payer: Healthscope Commercial |
$419.93
|
| Rate for Payer: Healthscope Commercial |
$363.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$238.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$313.95
|
| Rate for Payer: Nomi Health Commercial |
$272.39
|
| Rate for Payer: PACE SWMI |
$226.99
|
| Rate for Payer: PHP Medicare Advantage |
$226.99
|
| Rate for Payer: Priority Health Cigna Priority Health |
$313.95
|
| Rate for Payer: Priority Health Medicare |
$226.99
|
| Rate for Payer: UHC Dual Complete DSNP |
$226.99
|
| Rate for Payer: UHC Medicare Advantage |
$226.99
|
|
|
PR LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR
|
Professional
|
Both
|
$2,234.00
|
|
|
Service Code
|
HCPCS 27429
|
| Min. Negotiated Rate |
$893.60 |
| Max. Negotiated Rate |
$2,247.99 |
| Rate for Payer: Aetna Commercial |
$1,628.27
|
| Rate for Payer: Aetna Medicare |
$1,263.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,749.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,628.27
|
| Rate for Payer: BCBS Complete |
$893.60
|
| Rate for Payer: BCBS MAPPO |
$1,215.13
|
| Rate for Payer: BCN Medicare Advantage |
$1,215.13
|
| Rate for Payer: Cash Price |
$1,787.20
|
| Rate for Payer: Cash Price |
$1,787.20
|
| Rate for Payer: Cofinity Commercial |
$1,749.79
|
| Rate for Payer: Cofinity Commercial |
$1,628.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,215.13
|
| Rate for Payer: Healthscope Commercial |
$1,944.21
|
| Rate for Payer: Healthscope Commercial |
$2,247.99
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,275.89
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$1,452.10
|
| Rate for Payer: Nomi Health Commercial |
$1,458.16
|
| Rate for Payer: PACE SWMI |
$1,215.13
|
| Rate for Payer: PHP Medicare Advantage |
$1,215.13
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1,452.10
|
| Rate for Payer: Priority Health Medicare |
$1,215.13
|
| Rate for Payer: UHC Dual Complete DSNP |
$1,215.13
|
| Rate for Payer: UHC Medicare Advantage |
$1,215.13
|
|
|
PR LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG
|
Professional
|
Both
|
$1,126.00
|
|
|
Service Code
|
HCPCS 37761
|
| Min. Negotiated Rate |
$450.40 |
| Max. Negotiated Rate |
$943.68 |
| Rate for Payer: Aetna Commercial |
$683.53
|
| Rate for Payer: Aetna Medicare |
$530.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$734.54
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$683.53
|
| Rate for Payer: BCBS Complete |
$450.40
|
| Rate for Payer: BCBS MAPPO |
$510.10
|
| Rate for Payer: BCN Medicare Advantage |
$510.10
|
| Rate for Payer: Cash Price |
$900.80
|
| Rate for Payer: Cash Price |
$900.80
|
| Rate for Payer: Cofinity Commercial |
$734.54
|
| Rate for Payer: Cofinity Commercial |
$683.53
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$510.10
|
| Rate for Payer: Healthscope Commercial |
$943.68
|
| Rate for Payer: Healthscope Commercial |
$816.16
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$535.61
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$731.90
|
| Rate for Payer: Nomi Health Commercial |
$612.12
|
| Rate for Payer: PACE SWMI |
$510.10
|
| Rate for Payer: PHP Medicare Advantage |
$510.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$731.90
|
| Rate for Payer: Priority Health Medicare |
$510.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$510.10
|
| Rate for Payer: UHC Medicare Advantage |
$510.10
|
|
|
PR LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS 58611
|
| Min. Negotiated Rate |
$72.51 |
| Max. Negotiated Rate |
$219.05 |
| Rate for Payer: Aetna Commercial |
$97.16
|
| Rate for Payer: Aetna Medicare |
$75.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$97.16
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$104.41
|
| Rate for Payer: BCBS Complete |
$134.80
|
| Rate for Payer: BCBS MAPPO |
$72.51
|
| Rate for Payer: BCN Medicare Advantage |
$72.51
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cash Price |
$269.60
|
| Rate for Payer: Cofinity Commercial |
$97.16
|
| Rate for Payer: Cofinity Commercial |
$104.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$72.51
|
| Rate for Payer: Healthscope Commercial |
$116.02
|
| Rate for Payer: Healthscope Commercial |
$134.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$76.14
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$219.05
|
| Rate for Payer: Nomi Health Commercial |
$87.01
|
| Rate for Payer: PACE SWMI |
$72.51
|
| Rate for Payer: PHP Medicare Advantage |
$72.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$219.05
|
| Rate for Payer: Priority Health Medicare |
$72.51
|
| Rate for Payer: UHC Dual Complete DSNP |
$72.51
|
| Rate for Payer: UHC Medicare Advantage |
$72.51
|
|
|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
HCPCS 58600
|
| Min. Negotiated Rate |
$355.53 |
| Max. Negotiated Rate |
$835.25 |
| Rate for Payer: Aetna Commercial |
$476.41
|
| Rate for Payer: Aetna Medicare |
$369.75
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$511.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$476.41
|
| Rate for Payer: BCBS Complete |
$514.00
|
| Rate for Payer: BCBS MAPPO |
$355.53
|
| Rate for Payer: BCN Medicare Advantage |
$355.53
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cash Price |
$1,028.00
|
| Rate for Payer: Cofinity Commercial |
$511.96
|
| Rate for Payer: Cofinity Commercial |
$476.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$355.53
|
| Rate for Payer: Healthscope Commercial |
$657.73
|
| Rate for Payer: Healthscope Commercial |
$568.85
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$373.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$835.25
|
| Rate for Payer: Nomi Health Commercial |
$426.64
|
| Rate for Payer: PACE SWMI |
$355.53
|
| Rate for Payer: PHP Medicare Advantage |
$355.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$835.25
|
| Rate for Payer: Priority Health Medicare |
$355.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$355.53
|
| Rate for Payer: UHC Medicare Advantage |
$355.53
|
|
|
PR LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX
|
Professional
|
Both
|
$865.00
|
|
|
Service Code
|
HCPCS 58605
|
| Min. Negotiated Rate |
$322.34 |
| Max. Negotiated Rate |
$596.33 |
| Rate for Payer: Aetna Commercial |
$431.94
|
| Rate for Payer: Aetna Medicare |
$335.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$464.17
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$431.94
|
| Rate for Payer: BCBS Complete |
$346.00
|
| Rate for Payer: BCBS MAPPO |
$322.34
|
| Rate for Payer: BCN Medicare Advantage |
$322.34
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cash Price |
$692.00
|
| Rate for Payer: Cofinity Commercial |
$464.17
|
| Rate for Payer: Cofinity Commercial |
$431.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$322.34
|
| Rate for Payer: Healthscope Commercial |
$515.74
|
| Rate for Payer: Healthscope Commercial |
$596.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$338.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$562.25
|
| Rate for Payer: Nomi Health Commercial |
$386.81
|
| Rate for Payer: PACE SWMI |
$322.34
|
| Rate for Payer: PHP Medicare Advantage |
$322.34
|
| Rate for Payer: Priority Health Cigna Priority Health |
$562.25
|
| Rate for Payer: Priority Health Medicare |
$322.34
|
| Rate for Payer: UHC Dual Complete DSNP |
$322.34
|
| Rate for Payer: UHC Medicare Advantage |
$322.34
|
|
