Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR BX/EXC LYMPH NODE OPEN SUPERFICIAL

Facility

$928.00

Service Code	CPT 38500
Hospital Charge Code	38500
Hospital Revenue Code	960
Min. Negotiated Rate	$252.13
Max. Negotiated Rate	$4,239.58
Rate for Payer: Aetna Commercial	$788.80
Rate for Payer: Aetna Medicare	$3,527.33
Rate for Payer: Aetna New Business (MI Preferred)	$603.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,239.58
Rate for Payer: Amish Plain Church Group Commercial	$4,239.58
Rate for Payer: BCBS Complete	$1,948.17
Rate for Payer: BCBS MAPPO	$3,391.66
Rate for Payer: BCBS Trust/PPO	$1,802.73
Rate for Payer: BCN Medicare Advantage	$3,391.66
Rate for Payer: Cash Price	$742.40
Rate for Payer: Cash Price	$742.40
Rate for Payer: Cofinity Commercial	$798.08
Rate for Payer: Cofinity Commercial	$649.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,391.66
Rate for Payer: Healthscope Commercial	$835.20
Rate for Payer: Mclaren Medicaid	$1,855.24
Rate for Payer: Mclaren Medicare	$3,391.66
Rate for Payer: Meridian Medicaid	$1,948.17
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,561.24
Rate for Payer: MI Amish Medical Board Commercial	$3,900.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$788.80
Rate for Payer: PACE Medicare	$3,222.08
Rate for Payer: PACE SWMI	$3,391.66
Rate for Payer: PHP Commercial	$788.80
Rate for Payer: PHP Medicare Advantage	$3,391.66
Rate for Payer: Priority Health Choice Medicaid	$1,855.24
Rate for Payer: Priority Health Cigna Priority Health	$649.60
Rate for Payer: Priority Health Medicare	$3,391.66
Rate for Payer: Priority Health SBD	$584.64
Rate for Payer: Railroad Medicare Medicare	$3,391.66
Rate for Payer: UHC All Payor (Choice/PPO)	$277.34
Rate for Payer: UHC Dual Complete DSNP	$3,391.66
Rate for Payer: UHC Exchange	$252.13
Rate for Payer: UHC Medicare Advantage	$3,493.41
Rate for Payer: VA VA	$3,391.66

PR BX/EXC LYMPH NODE OPEN SUPERFICIAL

Professional

Both

$928.00

Service Code	HCPCS 38500
Hospital Charge Code	38500
Min. Negotiated Rate	$164.01
Max. Negotiated Rate	$649.60
Rate for Payer: Aetna Commercial	$316.46
Rate for Payer: BCBS Complete	$172.21
Rate for Payer: BCBS Trust/PPO	$512.45
Rate for Payer: Cash Price	$742.40
Rate for Payer: Cash Price	$742.40
Rate for Payer: Mclaren Medicaid	$164.01
Rate for Payer: Meridian Medicaid	$172.21
Rate for Payer: Priority Health Choice Medicaid	$164.01
Rate for Payer: Priority Health Cigna Priority Health	$649.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$554.13
Rate for Payer: Priority Health Narrow Network	$554.13
Rate for Payer: Priority Health SBD	$554.13

PR BX/EXC LYMPH NODE OPEN SUPERFICIAL

Facility

$928.00

Service Code	CPT 38500
Hospital Charge Code	38500
Hospital Revenue Code	960
Min. Negotiated Rate	$584.64
Max. Negotiated Rate	$835.20
Rate for Payer: Aetna Commercial	$788.80
Rate for Payer: Aetna New Business (MI Preferred)	$603.20
Rate for Payer: Cash Price	$742.40
Rate for Payer: Cofinity Commercial	$649.60
Rate for Payer: Cofinity Commercial	$798.08
Rate for Payer: Healthscope Commercial	$835.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$788.80
Rate for Payer: PHP Commercial	$788.80
Rate for Payer: Priority Health Cigna Priority Health	$649.60
Rate for Payer: Priority Health SBD	$584.64

PR BX/EXC LYMPH NODE OPEN SUPERFICIAL

Professional

Both

$928.00

Service Code	HCPCS 38500
Min. Negotiated Rate	$164.01
Max. Negotiated Rate	$649.60
Rate for Payer: Aetna Commercial	$316.46
Rate for Payer: BCBS Complete	$172.21
Rate for Payer: BCBS Trust/PPO	$512.45
Rate for Payer: Cash Price	$742.40
Rate for Payer: Cash Price	$742.40
Rate for Payer: Mclaren Medicaid	$164.01
Rate for Payer: Meridian Medicaid	$172.21
Rate for Payer: Priority Health Choice Medicaid	$164.01
Rate for Payer: Priority Health Cigna Priority Health	$649.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$554.13
Rate for Payer: Priority Health Narrow Network	$554.13
Rate for Payer: Priority Health SBD	$554.13

PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD

Facility

$1,811.00

Service Code	CPT 38520
Hospital Charge Code	38520
Min. Negotiated Rate	$462.02
Max. Negotiated Rate	$4,239.58
Rate for Payer: Aetna Commercial	$1,539.35
Rate for Payer: Aetna Medicare	$3,527.33
Rate for Payer: Aetna New Business (MI Preferred)	$1,177.15
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,239.58
Rate for Payer: Amish Plain Church Group Commercial	$4,239.58
Rate for Payer: BCBS Complete	$1,948.17
Rate for Payer: BCBS MAPPO	$3,391.66
Rate for Payer: BCBS Trust/PPO	$1,019.29
Rate for Payer: BCN Medicare Advantage	$3,391.66
Rate for Payer: Cash Price	$1,448.80
Rate for Payer: Cash Price	$1,448.80
Rate for Payer: Cofinity Commercial	$1,557.46
Rate for Payer: Cofinity Commercial	$1,267.70
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,391.66
Rate for Payer: Healthscope Commercial	$1,629.90
Rate for Payer: Mclaren Medicaid	$1,855.24
Rate for Payer: Mclaren Medicare	$3,391.66
Rate for Payer: Meridian Medicaid	$1,948.17
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,561.24
Rate for Payer: MI Amish Medical Board Commercial	$3,900.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,539.35
Rate for Payer: PACE Medicare	$3,222.08
Rate for Payer: PACE SWMI	$3,391.66
Rate for Payer: PHP Commercial	$1,539.35
Rate for Payer: PHP Medicare Advantage	$3,391.66
Rate for Payer: Priority Health Choice Medicaid	$1,855.24
Rate for Payer: Priority Health Cigna Priority Health	$1,267.70
Rate for Payer: Priority Health Medicare	$3,391.66
Rate for Payer: Priority Health SBD	$1,140.93
Rate for Payer: Railroad Medicare Medicare	$3,391.66
Rate for Payer: UHC All Payor (Choice/PPO)	$508.22
Rate for Payer: UHC Dual Complete DSNP	$3,391.66
Rate for Payer: UHC Exchange	$462.02
Rate for Payer: UHC Medicare Advantage	$3,493.41
Rate for Payer: VA VA	$3,391.66

PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD

Professional

Both

$1,811.00

Service Code	HCPCS 38520
Hospital Charge Code	38520
Min. Negotiated Rate	$300.54
Max. Negotiated Rate	$1,267.70
Rate for Payer: Aetna Commercial	$576.38
Rate for Payer: BCBS Complete	$315.57
Rate for Payer: BCBS Trust/PPO	$460.15
Rate for Payer: Cash Price	$1,448.80
Rate for Payer: Cash Price	$1,448.80
Rate for Payer: Mclaren Medicaid	$300.54
Rate for Payer: Meridian Medicaid	$315.57
Rate for Payer: Priority Health Choice Medicaid	$300.54
Rate for Payer: Priority Health Cigna Priority Health	$1,267.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,016.26
Rate for Payer: Priority Health Narrow Network	$1,016.26
Rate for Payer: Priority Health SBD	$1,016.26

PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD

Facility

$1,811.00

Service Code	CPT 38520
Hospital Charge Code	38520
Min. Negotiated Rate	$1,140.93
Max. Negotiated Rate	$1,629.90
Rate for Payer: Aetna Commercial	$1,539.35
Rate for Payer: Aetna New Business (MI Preferred)	$1,177.15
Rate for Payer: Cash Price	$1,448.80
Rate for Payer: Cofinity Commercial	$1,557.46
Rate for Payer: Cofinity Commercial	$1,267.70
Rate for Payer: Healthscope Commercial	$1,629.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,539.35
Rate for Payer: PHP Commercial	$1,539.35
Rate for Payer: Priority Health Cigna Priority Health	$1,267.70
Rate for Payer: Priority Health SBD	$1,140.93

PR BX/EXC LYMPH NODE OPN DP CRV NODE W/EXC FAT PAD

Professional

Both

$1,811.00

Service Code	HCPCS 38520
Min. Negotiated Rate	$300.54
Max. Negotiated Rate	$1,267.70
Rate for Payer: Aetna Commercial	$576.38
Rate for Payer: BCBS Complete	$315.57
Rate for Payer: BCBS Trust/PPO	$460.15
Rate for Payer: Cash Price	$1,448.80
Rate for Payer: Cash Price	$1,448.80
Rate for Payer: Mclaren Medicaid	$300.54
Rate for Payer: Meridian Medicaid	$315.57
Rate for Payer: Priority Health Choice Medicaid	$300.54
Rate for Payer: Priority Health Cigna Priority Health	$1,267.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,016.26
Rate for Payer: Priority Health Narrow Network	$1,016.26
Rate for Payer: Priority Health SBD	$1,016.26

PR BX INTESTINE CAPSULE TUBE PRORAL 1/> SPECIMENS

Professional

Both

$358.00

Service Code	HCPCS 44100
Min. Negotiated Rate	$67.10
Max. Negotiated Rate	$2,539.54
Rate for Payer: Aetna Commercial	$142.56
Rate for Payer: BCBS Complete	$70.46
Rate for Payer: BCBS Trust/PPO	$2,539.54
Rate for Payer: Cash Price	$286.40
Rate for Payer: Cash Price	$286.40
Rate for Payer: Mclaren Medicaid	$67.10
Rate for Payer: Meridian Medicaid	$70.46
Rate for Payer: Priority Health Choice Medicaid	$67.10
Rate for Payer: Priority Health Cigna Priority Health	$250.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$184.04
Rate for Payer: Priority Health Narrow Network	$184.04
Rate for Payer: Priority Health SBD	$184.04

PR BX LVR NDL DONE PURPOSE TM OTH MAJOR PX

Professional

Both

$224.00

Service Code	HCPCS 47001
Min. Negotiated Rate	$65.39
Max. Negotiated Rate	$1,355.62
Rate for Payer: Aetna Commercial	$140.29
Rate for Payer: BCBS Complete	$68.66
Rate for Payer: BCBS Trust/PPO	$1,355.62
Rate for Payer: Cash Price	$179.20
Rate for Payer: Cash Price	$179.20
Rate for Payer: Mclaren Medicaid	$65.39
Rate for Payer: Meridian Medicaid	$68.66
Rate for Payer: Priority Health Choice Medicaid	$65.39
Rate for Payer: Priority Health Cigna Priority Health	$156.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$180.50
Rate for Payer: Priority Health Narrow Network	$180.50
Rate for Payer: Priority Health SBD	$180.50

PR BX NASOPHARYNX SURVEY UNKNOWN PRIMARY LESION

Professional

Both

$396.00

Service Code	HCPCS 42806
Min. Negotiated Rate	$91.59
Max. Negotiated Rate	$314.34
Rate for Payer: Aetna Commercial	$178.76
Rate for Payer: BCBS Complete	$96.17
Rate for Payer: BCBS Trust/PPO	$314.34
Rate for Payer: Cash Price	$316.80
Rate for Payer: Cash Price	$316.80
Rate for Payer: Mclaren Medicaid	$91.59
Rate for Payer: Meridian Medicaid	$96.17
Rate for Payer: Priority Health Choice Medicaid	$91.59
Rate for Payer: Priority Health Cigna Priority Health	$277.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$249.89
Rate for Payer: Priority Health Narrow Network	$249.89
Rate for Payer: Priority Health SBD	$249.89

PR BX OF BREAST, NEEDLE CORE, IMAGE GUIDE

Professional

Both

$406.00

Service Code	HCPCS 19102
Min. Negotiated Rate	$162.40
Max. Negotiated Rate	$284.20
Rate for Payer: BCBS Complete	$162.40
Rate for Payer: Cash Price	$324.80
Rate for Payer: Priority Health Cigna Priority Health	$284.20

PR BX PROSTATE STRTCTC SATURATION SAMPLING IMG GID

Professional

Both

$701.00

Service Code	HCPCS 55706
Min. Negotiated Rate	$239.84
Max. Negotiated Rate	$1,743.92
Rate for Payer: Aetna Commercial	$479.18
Rate for Payer: BCBS Complete	$251.83
Rate for Payer: BCBS Trust/PPO	$1,743.92
Rate for Payer: Cash Price	$560.80
Rate for Payer: Cash Price	$560.80
Rate for Payer: Mclaren Medicaid	$239.84
Rate for Payer: Meridian Medicaid	$251.83
Rate for Payer: Priority Health Choice Medicaid	$239.84
Rate for Payer: Priority Health Cigna Priority Health	$490.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$600.88
Rate for Payer: Priority Health Narrow Network	$600.88
Rate for Payer: Priority Health SBD	$600.88

PR BYPASS COMPOSITE GRAFT PROSTHETIC & VEIN

Professional

Both

$311.00

Service Code	HCPCS 35681
Min. Negotiated Rate	$49.63
Max. Negotiated Rate	$1,298.03
Rate for Payer: Aetna Commercial	$108.37
Rate for Payer: BCBS Complete	$52.11
Rate for Payer: BCBS Trust/PPO	$1,298.03
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cash Price	$248.80
Rate for Payer: Mclaren Medicaid	$49.63
Rate for Payer: Meridian Medicaid	$52.11
Rate for Payer: Priority Health Choice Medicaid	$49.63
Rate for Payer: Priority Health Cigna Priority Health	$217.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$123.42
Rate for Payer: Priority Health Narrow Network	$123.42
Rate for Payer: Priority Health SBD	$123.42

PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-CELIAC

Professional

Both

$3,240.00

Service Code	HCPCS 35632
Min. Negotiated Rate	$1,126.34
Max. Negotiated Rate	$2,799.69
Rate for Payer: Aetna Commercial	$2,431.56
Rate for Payer: BCBS Complete	$1,182.66
Rate for Payer: BCBS Trust/PPO	$1,188.68
Rate for Payer: Cash Price	$2,592.00
Rate for Payer: Cash Price	$2,592.00
Rate for Payer: Mclaren Medicaid	$1,126.34
Rate for Payer: Meridian Medicaid	$1,182.66
Rate for Payer: Priority Health Choice Medicaid	$1,126.34
Rate for Payer: Priority Health Cigna Priority Health	$2,268.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,799.69
Rate for Payer: Priority Health Narrow Network	$2,799.69
Rate for Payer: Priority Health SBD	$2,799.69

PR BYPASS GRAFT W/OTHER THAN VEIN ILIO-MESENTERIC

Professional

Both

$3,629.00

Service Code	HCPCS 35633
Min. Negotiated Rate	$1,181.81
Max. Negotiated Rate	$3,074.18
Rate for Payer: Aetna Commercial	$2,665.69
Rate for Payer: BCBS Complete	$1,297.17
Rate for Payer: BCBS Trust/PPO	$1,181.81
Rate for Payer: Cash Price	$2,903.20
Rate for Payer: Cash Price	$2,903.20
Rate for Payer: Mclaren Medicaid	$1,235.40
Rate for Payer: Meridian Medicaid	$1,297.17
Rate for Payer: Priority Health Choice Medicaid	$1,235.40
Rate for Payer: Priority Health Cigna Priority Health	$2,540.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,074.18
Rate for Payer: Priority Health Narrow Network	$3,074.18
Rate for Payer: Priority Health SBD	$3,074.18

PR BYPASS GRAFT W/OTHER THAN VEIN ILIORENAL

Professional

Both

$3,169.00

Service Code	HCPCS 35634
Min. Negotiated Rate	$1,102.28
Max. Negotiated Rate	$2,740.65
Rate for Payer: Aetna Commercial	$2,379.07
Rate for Payer: BCBS Complete	$1,157.39
Rate for Payer: BCBS Trust/PPO	$1,193.43
Rate for Payer: Cash Price	$2,535.20
Rate for Payer: Cash Price	$2,535.20
Rate for Payer: Mclaren Medicaid	$1,102.28
Rate for Payer: Meridian Medicaid	$1,157.39
Rate for Payer: Priority Health Choice Medicaid	$1,102.28
Rate for Payer: Priority Health Cigna Priority Health	$2,218.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,740.65
Rate for Payer: Priority Health Narrow Network	$2,740.65
Rate for Payer: Priority Health SBD	$2,740.65

PR BYPASS NOT VEIN AORTOSUBCLA/CAROTID/INNOMINATE

Professional

Both

$4,667.00

Service Code	HCPCS 35626
Min. Negotiated Rate	$991.09
Max. Negotiated Rate	$3,266.90
Rate for Payer: Aetna Commercial	$2,142.20
Rate for Payer: BCBS Complete	$1,040.64
Rate for Payer: BCBS Trust/PPO	$1,555.32
Rate for Payer: Cash Price	$3,733.60
Rate for Payer: Cash Price	$3,733.60
Rate for Payer: Mclaren Medicaid	$991.09
Rate for Payer: Meridian Medicaid	$1,040.64
Rate for Payer: Priority Health Choice Medicaid	$991.09
Rate for Payer: Priority Health Cigna Priority Health	$3,266.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,476.26
Rate for Payer: Priority Health Narrow Network	$2,476.26
Rate for Payer: Priority Health SBD	$2,476.26

PR BYPASS W/VEIN AORTOBI-ILIAC

Professional

Both

$6,277.00

Service Code	HCPCS 35538
Min. Negotiated Rate	$971.54
Max. Negotiated Rate	$4,393.90
Rate for Payer: Aetna Commercial	$3,144.83
Rate for Payer: BCBS Complete	$1,527.75
Rate for Payer: BCBS Trust/PPO	$971.54
Rate for Payer: Cash Price	$5,021.60
Rate for Payer: Cash Price	$5,021.60
Rate for Payer: Mclaren Medicaid	$1,455.00
Rate for Payer: Meridian Medicaid	$1,527.75
Rate for Payer: Priority Health Choice Medicaid	$1,455.00
Rate for Payer: Priority Health Cigna Priority Health	$4,393.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,618.91
Rate for Payer: Priority Health Narrow Network	$3,618.91
Rate for Payer: Priority Health SBD	$3,618.91

PR BYPASS W/VEIN AORTOCELIAC/AORTOMESENTERIC

Professional

Both

$4,193.00

Service Code	HCPCS 35531
Min. Negotiated Rate	$63.40
Max. Negotiated Rate	$3,022.58
Rate for Payer: Aetna Commercial	$2,623.52
Rate for Payer: BCBS Complete	$1,276.37
Rate for Payer: BCBS Trust/PPO	$63.40
Rate for Payer: Cash Price	$3,354.40
Rate for Payer: Cash Price	$3,354.40
Rate for Payer: Mclaren Medicaid	$1,215.59
Rate for Payer: Meridian Medicaid	$1,276.37
Rate for Payer: Priority Health Choice Medicaid	$1,215.59
Rate for Payer: Priority Health Cigna Priority Health	$2,935.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,022.58
Rate for Payer: Priority Health Narrow Network	$3,022.58
Rate for Payer: Priority Health SBD	$3,022.58

PR BYPASS W/VEIN AORTOILIAC

Professional

Both

$4,317.00

Service Code	HCPCS 35537
Min. Negotiated Rate	$1,299.30
Max. Negotiated Rate	$3,228.98
Rate for Payer: Aetna Commercial	$2,806.89
Rate for Payer: BCBS Complete	$1,364.26
Rate for Payer: BCBS Trust/PPO	$1,308.07
Rate for Payer: Cash Price	$3,453.60
Rate for Payer: Cash Price	$3,453.60
Rate for Payer: Mclaren Medicaid	$1,299.30
Rate for Payer: Meridian Medicaid	$1,364.26
Rate for Payer: Priority Health Choice Medicaid	$1,299.30
Rate for Payer: Priority Health Cigna Priority Health	$3,021.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,228.98
Rate for Payer: Priority Health Narrow Network	$3,228.98
Rate for Payer: Priority Health SBD	$3,228.98

PR BYPASS W/VEIN AORTOSUBCLAV/CAROTID/INNOMINATE

Professional

Both

$3,605.00

Service Code	HCPCS 35526
Min. Negotiated Rate	$1,080.34
Max. Negotiated Rate	$3,230.55
Rate for Payer: Aetna Commercial	$2,325.27
Rate for Payer: BCBS Complete	$1,134.36
Rate for Payer: BCBS Trust/PPO	$3,230.55
Rate for Payer: Cash Price	$2,884.00
Rate for Payer: Cash Price	$2,884.00
Rate for Payer: Mclaren Medicaid	$1,080.34
Rate for Payer: Meridian Medicaid	$1,134.36
Rate for Payer: Priority Health Choice Medicaid	$1,080.34
Rate for Payer: Priority Health Cigna Priority Health	$2,523.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,693.84
Rate for Payer: Priority Health Narrow Network	$2,693.84
Rate for Payer: Priority Health SBD	$2,693.84

PR BYPASS W/VEIN AXILLARY-BRACHIAL

Professional

Both

$2,363.00

Service Code	HCPCS 35522
Min. Negotiated Rate	$430.04
Max. Negotiated Rate	$1,813.97
Rate for Payer: Aetna Commercial	$1,641.02
Rate for Payer: BCBS Complete	$766.23
Rate for Payer: BCBS Trust/PPO	$430.04
Rate for Payer: Cash Price	$1,890.40
Rate for Payer: Cash Price	$1,890.40
Rate for Payer: Mclaren Medicaid	$729.74
Rate for Payer: Meridian Medicaid	$766.23
Rate for Payer: Priority Health Choice Medicaid	$729.74
Rate for Payer: Priority Health Cigna Priority Health	$1,654.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,813.97
Rate for Payer: Priority Health Narrow Network	$1,813.97
Rate for Payer: Priority Health SBD	$1,813.97

PR BYPASS W/VEIN BRACHIAL-BRACHIAL

Professional

Both

$4,108.00

Service Code	HCPCS 35525
Min. Negotiated Rate	$706.73
Max. Negotiated Rate	$2,875.60
Rate for Payer: Aetna Commercial	$1,525.84
Rate for Payer: BCBS Complete	$742.07
Rate for Payer: BCBS Trust/PPO	$2,468.75
Rate for Payer: Cash Price	$3,286.40
Rate for Payer: Cash Price	$3,286.40
Rate for Payer: Mclaren Medicaid	$706.73
Rate for Payer: Meridian Medicaid	$742.07
Rate for Payer: Priority Health Choice Medicaid	$706.73
Rate for Payer: Priority Health Cigna Priority Health	$2,875.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,759.18
Rate for Payer: Priority Health Narrow Network	$1,759.18
Rate for Payer: Priority Health SBD	$1,759.18

PR BYPASS W/VEIN BRACHIAL-ULNAR/-RADIAL

Professional

Both

$2,485.00

Service Code	HCPCS 35523
Min. Negotiated Rate	$767.87
Max. Negotiated Rate	$1,967.18
Rate for Payer: Aetna Commercial	$1,713.84
Rate for Payer: BCBS Complete	$806.26
Rate for Payer: BCBS Trust/PPO	$1,439.62
Rate for Payer: Cash Price	$1,988.00
Rate for Payer: Cash Price	$1,988.00
Rate for Payer: Mclaren Medicaid	$767.87
Rate for Payer: Meridian Medicaid	$806.26
Rate for Payer: Priority Health Choice Medicaid	$767.87
Rate for Payer: Priority Health Cigna Priority Health	$1,739.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,967.18
Rate for Payer: Priority Health Narrow Network	$1,967.18
Rate for Payer: Priority Health SBD	$1,967.18

Know your out-of-pocket cost for care.

All Charges