Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.09
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 All Payor (Choice/PPO)	$0.09
Rate for Payer: UHC Dual Complete DSNP	$0.09
Rate for Payer: UHC Exchange	$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: 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: 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	$1,118.12
Rate for Payer: Aetna Commercial	$1,040.47
Rate for Payer: Aetna Medicare	$807.53
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	$1,118.12
Rate for Payer: Cofinity Commercial	$1,040.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$776.47
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$815.29
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	$784.23
Rate for Payer: UHC All Payor (Choice/PPO)	$776.47
Rate for Payer: UHC Dual Complete DSNP	$776.47
Rate for Payer: UHC Exchange	$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: 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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$718.05
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	$690.70
Rate for Payer: UHC All Payor (Choice/PPO)	$683.86
Rate for Payer: UHC Dual Complete DSNP	$683.86
Rate for Payer: UHC Exchange	$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: 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	$1,551.95
Rate for Payer: Cofinity Commercial	$1,444.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,077.74
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,131.63
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	$1,088.52
Rate for Payer: UHC All Payor (Choice/PPO)	$1,077.74
Rate for Payer: UHC Dual Complete DSNP	$1,077.74
Rate for Payer: UHC Exchange	$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	$812.38
Rate for Payer: Aetna Commercial	$755.96
Rate for Payer: Aetna Medicare	$586.72
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$592.36
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	$569.79
Rate for Payer: UHC All Payor (Choice/PPO)	$564.15
Rate for Payer: UHC Dual Complete DSNP	$564.15
Rate for Payer: UHC Exchange	$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	$1,175.04
Rate for Payer: Aetna Commercial	$1,093.44
Rate for Payer: Aetna Medicare	$848.64
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$856.80
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	$824.16
Rate for Payer: UHC All Payor (Choice/PPO)	$816.00
Rate for Payer: UHC Dual Complete DSNP	$816.00
Rate for Payer: UHC Exchange	$816.00
Rate for Payer: UHC Medicare Advantage	$816.00

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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$203.66
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	$195.90
Rate for Payer: UHC All Payor (Choice/PPO)	$193.96
Rate for Payer: UHC Dual Complete DSNP	$193.96
Rate for Payer: UHC Exchange	$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$203.66
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	$195.90
Rate for Payer: UHC All Payor (Choice/PPO)	$193.96
Rate for Payer: UHC Dual Complete DSNP	$193.96
Rate for Payer: UHC Exchange	$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	$585.00
Max. Negotiated Rate	$810.00
Rate for Payer: Aetna Commercial	$765.00
Rate for Payer: BCBS Trust/PPO	$734.67
Rate for Payer: BCN Commercial	$695.52
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cofinity Commercial	$774.00
Rate for Payer: Encore Health Key Benefits Commercial	$720.00
Rate for Payer: Healthscope Commercial	$810.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$675.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$765.00
Rate for Payer: Nomi Health Commercial	$738.00
Rate for Payer: PHP Commercial	$765.00
Rate for Payer: Priority Health Cigna Priority Health	$585.00
Rate for Payer: Priority Health HMO/PPO	$783.00
Rate for Payer: Priority Health Narrow/Tiered Network	$603.00
Rate for Payer: UHC All Payor (Choice/PPO)	$792.00
Rate for Payer: UHC Core	$751.50
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$675.00

PR LIGATION/BIOPSY TEMPORAL ARTERY

Facility

$900.00

Service Code	CPT 37609
Hospital Charge Code	37609
Hospital Revenue Code	960
Min. Negotiated Rate	$213.75
Max. Negotiated Rate	$1,230.09
Rate for Payer: Aetna Commercial	$765.00
Rate for Payer: Aetna Medicare	$234.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$281.25
Rate for Payer: Amish Plain Church Group Commercial	$281.25
Rate for Payer: BCBS Complete	$1,230.09
Rate for Payer: BCBS MAPPO	$225.00
Rate for Payer: BCBS Trust/PPO	$739.89
Rate for Payer: BCN Commercial	$699.75
Rate for Payer: BCN Medicare Advantage	$225.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cash Price	$720.00
Rate for Payer: Cofinity Commercial	$774.00
Rate for Payer: Encore Health Key Benefits Commercial	$720.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$225.00
Rate for Payer: Healthscope Commercial	$810.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$675.00
Rate for Payer: Mclaren Medicaid	$1,171.43
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$236.25
Rate for Payer: Meridian Medicaid	$1,230.09
Rate for Payer: MI Amish Medical Board Commercial	$258.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$765.00
Rate for Payer: Nomi Health Commercial	$738.00
Rate for Payer: PACE Senior Care Partners	$213.75
Rate for Payer: PACE SWMI	$225.00
Rate for Payer: PHP Commercial	$765.00
Rate for Payer: PHP Medicare Advantage	$225.00
Rate for Payer: Priority Health Choice Medicaid	$1,171.43
Rate for Payer: Priority Health Cigna Priority Health	$585.00
Rate for Payer: Priority Health HMO/PPO	$783.00
Rate for Payer: Priority Health Medicare	$227.25
Rate for Payer: Priority Health Narrow/Tiered Network	$603.00
Rate for Payer: Railroad Medicare Medicare	$225.00
Rate for Payer: UHC All Payor (Choice/PPO)	$792.00
Rate for Payer: UHC Core	$751.50
Rate for Payer: UHC Dual Complete DSNP	$225.00
Rate for Payer: UHC Exchange	$225.00
Rate for Payer: UHC Medicare Advantage	$225.00
Rate for Payer: UHCCP Medicaid	$1,171.43
Rate for Payer: VA VA	$225.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$675.00

PR LIGATION DIRECT ESOPHAGEAL VARICES

Professional

Both

$3,134.00

Service Code	HCPCS 43400
Min. Negotiated Rate	$1,253.60
Max. Negotiated Rate	$2,132.96
Rate for Payer: Aetna Commercial	$1,984.83
Rate for Payer: Aetna Medicare	$1,540.47
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,555.28
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	$1,496.03
Rate for Payer: UHC All Payor (Choice/PPO)	$1,481.22
Rate for Payer: UHC Dual Complete DSNP	$1,481.22
Rate for Payer: UHC Exchange	$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: 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	$1,297.40
Rate for Payer: Aetna Commercial	$954.17
Rate for Payer: Aetna Medicare	$740.55
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$747.67
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	$719.19
Rate for Payer: UHC All Payor (Choice/PPO)	$712.07
Rate for Payer: UHC Dual Complete DSNP	$712.07
Rate for Payer: UHC Exchange	$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	$1,001.43
Rate for Payer: Aetna Commercial	$931.89
Rate for Payer: Aetna Medicare	$723.26
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$730.21
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	$702.39
Rate for Payer: UHC All Payor (Choice/PPO)	$695.44
Rate for Payer: UHC Dual Complete DSNP	$695.44
Rate for Payer: UHC Exchange	$695.44
Rate for Payer: UHC Medicare Advantage	$695.44

PR LIGATION MAJOR ARTERY ABDOMEN

Professional

Both

$3,271.00

Service Code	HCPCS 37617
Min. Negotiated Rate	$1,275.58
Max. Negotiated Rate	$2,126.15
Rate for Payer: Aetna Commercial	$1,709.28
Rate for Payer: Aetna Medicare	$1,326.60
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,339.36
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	$1,288.34
Rate for Payer: UHC All Payor (Choice/PPO)	$1,275.58
Rate for Payer: UHC Dual Complete DSNP	$1,275.58
Rate for Payer: UHC Exchange	$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,155.18
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	$1,111.17
Rate for Payer: UHC All Payor (Choice/PPO)	$1,100.17
Rate for Payer: UHC Dual Complete DSNP	$1,100.17
Rate for Payer: UHC Exchange	$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$393.40
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	$378.42
Rate for Payer: UHC All Payor (Choice/PPO)	$374.67
Rate for Payer: UHC Dual Complete DSNP	$374.67
Rate for Payer: UHC Exchange	$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	$788.45
Rate for Payer: Aetna Commercial	$660.74
Rate for Payer: Aetna Medicare	$512.81
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$517.74
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	$498.02
Rate for Payer: UHC All Payor (Choice/PPO)	$493.09
Rate for Payer: UHC Dual Complete DSNP	$493.09
Rate for Payer: UHC Exchange	$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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$466.17
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	$448.41
Rate for Payer: UHC All Payor (Choice/PPO)	$443.97
Rate for Payer: UHC Dual Complete DSNP	$443.97
Rate for Payer: UHC Exchange	$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	$2,414.07
Rate for Payer: Aetna Commercial	$2,246.43
Rate for Payer: Aetna Medicare	$1,743.50
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,760.26
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	$1,693.20
Rate for Payer: UHC All Payor (Choice/PPO)	$1,676.44
Rate for Payer: UHC Dual Complete DSNP	$1,676.44
Rate for Payer: UHC Exchange	$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: 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: 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$375.42
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	$361.12
Rate for Payer: UHC All Payor (Choice/PPO)	$357.54
Rate for Payer: UHC Dual Complete DSNP	$357.54
Rate for Payer: UHC Exchange	$357.54
Rate for Payer: UHC Medicare Advantage	$357.54

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