|
PR LEUPROLIDE ACETATE /3.75 MG
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
HCPCS J1950
|
| Min. Negotiated Rate |
$441.20 |
| Max. Negotiated Rate |
$2,491.66 |
| 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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,816.84
|
| Rate for Payer: Nomi Health Commercial |
$2,076.38
|
| Rate for Payer: PACE SWMI |
$1,730.32
|
| Rate for Payer: PHP Commercial |
$2,422.45
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$507.38
|
|
|
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: Priority Health Cigna Priority Health |
$24.70
|
| Rate for Payer: UMR Bronson Commercial |
$17.48
|
|
|
PR LEUPROLIDE ACETATE SUSPNSION
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
HCPCS J9217
|
| Min. Negotiated Rate |
$176.45 |
| Max. Negotiated Rate |
$299.65 |
| 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 |
$236.44
|
| Rate for Payer: Cofinity Commercial |
$254.09
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$176.45
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$185.27
|
| Rate for Payer: Nomi Health Commercial |
$211.74
|
| Rate for Payer: PACE SWMI |
$176.45
|
| Rate for Payer: PHP Commercial |
$247.03
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$212.06
|
|
|
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) |
$0.13
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.12
|
| 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 |
$0.13
|
| Rate for Payer: Cofinity Commercial |
$0.12
|
| 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 Commercial |
$0.13
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$2.30
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$258.06
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$385.94
|
|
|
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: 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: 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 Commercial |
$1,087.06
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$227.70
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$1.38
|
|
|
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 |
$916.37
|
| Rate for Payer: Cofinity Commercial |
$984.76
|
| 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 Commercial |
$957.40
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,144.94
|
|
|
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) |
$1,551.95
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,444.17
|
| 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 Commercial |
$1,508.84
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,493.62
|
|
|
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: 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: 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 Commercial |
$789.81
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$477.48
|
|
|
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: 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: 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 Commercial |
$1,142.40
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$690.46
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Facility
|
IP
|
$900.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
37609
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$810.00 |
| Rate for Payer: Aetna American Axle |
$585.00
|
| 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: Kalamazoo County Sherrif's Dept Commercial |
$630.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.00
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$396.00
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.00
|
|
|
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: 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 Commercial |
$271.54
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$414.00
|
|
|
PR LIGATION/BIOPSY TEMPORAL ARTERY
|
Facility
|
OP
|
$900.00
|
|
|
Service Code
|
CPT 37609
|
| Hospital Charge Code |
37609
|
|
Hospital Revenue Code
|
960
|
| Min. Negotiated Rate |
$333.00 |
| Max. Negotiated Rate |
$4,448.08 |
| Rate for Payer: Aetna American Axle |
$585.00
|
| 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 |
$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: Health Alliance Plan Medicare Advantage |
$1,580.19
|
| Rate for Payer: Healthscope Commercial |
$810.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$630.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$675.00
|
| 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 Exchange |
$3,019.90
|
| Rate for Payer: UHC Medicare Advantage |
$1,580.19
|
| Rate for Payer: UHCCP Medicaid |
$846.98
|
| Rate for Payer: UMR Bronson Commercial |
$333.00
|
| Rate for Payer: VA VA |
$1,580.19
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$675.00
|
|
|
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: 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 |
$259.91
|
| Rate for Payer: Cofinity Commercial |
$279.30
|
| 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 Commercial |
$271.54
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$414.00
|
|
|
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: 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: 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 Commercial |
$2,073.71
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,441.64
|
|
|
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
|
| Rate for Payer: UMR Bronson Commercial |
$961.86
|
|
|
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: 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 |
$1,025.38
|
| Rate for Payer: Cofinity Commercial |
$954.17
|
| 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 Commercial |
$996.90
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$918.16
|
|
|
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: Aetna New Business (MI Preferred) |
$931.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,001.43
|
| 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 |
$931.89
|
| Rate for Payer: Cofinity Commercial |
$1,001.43
|
| 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 Commercial |
$973.62
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$697.36
|
|
|
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: 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: 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 Commercial |
$1,785.81
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,504.66
|
|
|
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: 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 Commercial |
$1,540.24
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$1,558.02
|
|
|
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: 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 Commercial |
$524.54
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$494.96
|
|
|
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: 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: 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 Commercial |
$690.33
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$557.98
|
|
|
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: 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 Commercial |
$621.56
|
| 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
|
| Rate for Payer: UMR Bronson Commercial |
$772.34
|
|
