Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR DILATION CERVICAL CANAL INSTRUMENTAL SPX

Professional

Both

$201.00

Service Code	HCPCS 57800
Min. Negotiated Rate	$30.89
Max. Negotiated Rate	$1,422.71
Rate for Payer: Aetna Commercial	$57.02
Rate for Payer: BCBS Complete	$32.43
Rate for Payer: BCBS Trust/PPO	$1,422.71
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cash Price	$160.80
Rate for Payer: Mclaren Medicaid	$30.89
Rate for Payer: Meridian Medicaid	$32.43
Rate for Payer: Priority Health Choice Medicaid	$30.89
Rate for Payer: Priority Health Cigna Priority Health	$140.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.23
Rate for Payer: Priority Health Narrow Network	$67.23
Rate for Payer: Priority Health SBD	$67.23

PR DILATION & CURETTAGE CERVICAL STUMP

Professional

Both

$267.00

Service Code	HCPCS 57558
Min. Negotiated Rate	$83.28
Max. Negotiated Rate	$1,924.60
Rate for Payer: Aetna Commercial	$149.43
Rate for Payer: BCBS Complete	$87.44
Rate for Payer: BCBS Trust/PPO	$1,924.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Mclaren Medicaid	$83.28
Rate for Payer: Meridian Medicaid	$87.44
Rate for Payer: Priority Health Choice Medicaid	$83.28
Rate for Payer: Priority Health Cigna Priority Health	$186.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$183.69
Rate for Payer: Priority Health Narrow Network	$183.69
Rate for Payer: Priority Health SBD	$183.69

PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC

Facility

$845.00

Service Code	CPT 58120
Hospital Charge Code	58120
Min. Negotiated Rate	$231.17
Max. Negotiated Rate	$3,477.26
Rate for Payer: Aetna Commercial	$718.25
Rate for Payer: Aetna Medicare	$2,893.08
Rate for Payer: Aetna New Business (MI Preferred)	$549.25
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,477.26
Rate for Payer: Amish Plain Church Group Commercial	$3,477.26
Rate for Payer: BCBS Complete	$1,597.87
Rate for Payer: BCBS MAPPO	$2,781.81
Rate for Payer: BCBS Trust/PPO	$1,363.71
Rate for Payer: BCN Medicare Advantage	$2,781.81
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cofinity Commercial	$726.70
Rate for Payer: Cofinity Commercial	$591.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,781.81
Rate for Payer: Healthscope Commercial	$760.50
Rate for Payer: Mclaren Medicaid	$1,521.65
Rate for Payer: Mclaren Medicare	$2,781.81
Rate for Payer: Meridian Medicaid	$1,597.87
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,920.90
Rate for Payer: MI Amish Medical Board Commercial	$3,199.08
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$718.25
Rate for Payer: PACE Medicare	$2,642.72
Rate for Payer: PACE SWMI	$2,781.81
Rate for Payer: PHP Commercial	$718.25
Rate for Payer: PHP Medicare Advantage	$2,781.81
Rate for Payer: Priority Health Choice Medicaid	$1,521.65
Rate for Payer: Priority Health Cigna Priority Health	$591.50
Rate for Payer: Priority Health Medicare	$2,781.81
Rate for Payer: Priority Health SBD	$532.35
Rate for Payer: Railroad Medicare Medicare	$2,781.81
Rate for Payer: UHC All Payor (Choice/PPO)	$254.29
Rate for Payer: UHC Dual Complete DSNP	$2,781.81
Rate for Payer: UHC Exchange	$231.17
Rate for Payer: UHC Medicare Advantage	$2,865.26
Rate for Payer: VA VA	$2,781.81

PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC

Professional

Both

$845.00

Service Code	HCPCS 58120
Min. Negotiated Rate	$150.38
Max. Negotiated Rate	$1,908.75
Rate for Payer: Aetna Commercial	$275.18
Rate for Payer: BCBS Complete	$157.90
Rate for Payer: BCBS Trust/PPO	$1,908.75
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Mclaren Medicaid	$150.38
Rate for Payer: Meridian Medicaid	$157.90
Rate for Payer: Priority Health Choice Medicaid	$150.38
Rate for Payer: Priority Health Cigna Priority Health	$591.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$331.87
Rate for Payer: Priority Health Narrow Network	$331.87
Rate for Payer: Priority Health SBD	$331.87

PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC

Professional

Both

$845.00

Service Code	HCPCS 58120
Hospital Charge Code	58120
Min. Negotiated Rate	$150.38
Max. Negotiated Rate	$1,908.75
Rate for Payer: Aetna Commercial	$275.18
Rate for Payer: BCBS Complete	$157.90
Rate for Payer: BCBS Trust/PPO	$1,908.75
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Mclaren Medicaid	$150.38
Rate for Payer: Meridian Medicaid	$157.90
Rate for Payer: Priority Health Choice Medicaid	$150.38
Rate for Payer: Priority Health Cigna Priority Health	$591.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$331.87
Rate for Payer: Priority Health Narrow Network	$331.87
Rate for Payer: Priority Health SBD	$331.87

PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC

Facility

$845.00

Service Code	CPT 58120
Hospital Charge Code	58120
Min. Negotiated Rate	$532.35
Max. Negotiated Rate	$760.50
Rate for Payer: Aetna Commercial	$718.25
Rate for Payer: Aetna New Business (MI Preferred)	$549.25
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cofinity Commercial	$591.50
Rate for Payer: Cofinity Commercial	$726.70
Rate for Payer: Healthscope Commercial	$760.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$718.25
Rate for Payer: PHP Commercial	$718.25
Rate for Payer: Priority Health Cigna Priority Health	$591.50
Rate for Payer: Priority Health SBD	$532.35

PR DILATION ESOPHAGUS GUIDE WIRE

Professional

Both

$507.00

Service Code	HCPCS 43453
Min. Negotiated Rate	$54.95
Max. Negotiated Rate	$1,014.34
Rate for Payer: Aetna Commercial	$113.71
Rate for Payer: BCBS Complete	$57.70
Rate for Payer: BCBS Trust/PPO	$1,014.34
Rate for Payer: Cash Price	$405.60
Rate for Payer: Cash Price	$405.60
Rate for Payer: Mclaren Medicaid	$54.95
Rate for Payer: Meridian Medicaid	$57.70
Rate for Payer: Priority Health Choice Medicaid	$54.95
Rate for Payer: Priority Health Cigna Priority Health	$354.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$149.93
Rate for Payer: Priority Health Narrow Network	$149.93
Rate for Payer: Priority Health SBD	$149.93

PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS

Professional

Both

$322.00

Service Code	HCPCS 43450
Min. Negotiated Rate	$50.48
Max. Negotiated Rate	$1,202.94
Rate for Payer: Aetna Commercial	$104.98
Rate for Payer: BCBS Complete	$53.00
Rate for Payer: BCBS Trust/PPO	$1,202.94
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cash Price	$257.60
Rate for Payer: Mclaren Medicaid	$50.48
Rate for Payer: Meridian Medicaid	$53.00
Rate for Payer: Priority Health Choice Medicaid	$50.48
Rate for Payer: Priority Health Cigna Priority Health	$225.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$138.76
Rate for Payer: Priority Health Narrow Network	$138.76
Rate for Payer: Priority Health SBD	$138.76

PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS

Professional

Both

$322.00

Service Code	HCPCS 43450
Hospital Charge Code	43450
Min. Negotiated Rate	$50.48
Max. Negotiated Rate	$1,202.94
Rate for Payer: Aetna Commercial	$104.98
Rate for Payer: BCBS Complete	$53.00
Rate for Payer: BCBS Trust/PPO	$1,202.94
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cash Price	$257.60
Rate for Payer: Mclaren Medicaid	$50.48
Rate for Payer: Meridian Medicaid	$53.00
Rate for Payer: Priority Health Choice Medicaid	$50.48
Rate for Payer: Priority Health Cigna Priority Health	$225.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$138.76
Rate for Payer: Priority Health Narrow Network	$138.76
Rate for Payer: Priority Health SBD	$138.76

PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS

Facility

$322.00

Service Code	CPT 43450
Hospital Charge Code	43450
Min. Negotiated Rate	$77.60
Max. Negotiated Rate	$2,519.41
Rate for Payer: Aetna Commercial	$273.70
Rate for Payer: Aetna Medicare	$838.84
Rate for Payer: Aetna New Business (MI Preferred)	$209.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,008.22
Rate for Payer: Amish Plain Church Group Commercial	$1,008.22
Rate for Payer: BCBS Complete	$463.30
Rate for Payer: BCBS MAPPO	$806.58
Rate for Payer: BCBS Trust/PPO	$382.97
Rate for Payer: BCN Medicare Advantage	$806.58
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cofinity Commercial	$276.92
Rate for Payer: Cofinity Commercial	$225.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$806.58
Rate for Payer: Healthscope Commercial	$289.80
Rate for Payer: Mclaren Medicaid	$441.20
Rate for Payer: Mclaren Medicare	$806.58
Rate for Payer: Meridian Medicaid	$463.30
Rate for Payer: Meridian Wellcare - Medicare Advantage	$846.91
Rate for Payer: MI Amish Medical Board Commercial	$927.57
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$273.70
Rate for Payer: PACE Medicare	$766.25
Rate for Payer: PACE SWMI	$806.58
Rate for Payer: PHP Commercial	$273.70
Rate for Payer: PHP Medicare Advantage	$806.58
Rate for Payer: Priority Health Choice Medicaid	$441.20
Rate for Payer: Priority Health Cigna Priority Health	$225.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,519.41
Rate for Payer: Priority Health Medicare	$806.58
Rate for Payer: Priority Health Narrow Network	$2,015.53
Rate for Payer: Priority Health SBD	$202.86
Rate for Payer: Railroad Medicare Medicare	$806.58
Rate for Payer: UHC All Payor (Choice/PPO)	$85.36
Rate for Payer: UHC Dual Complete DSNP	$806.58
Rate for Payer: UHC Exchange	$77.60
Rate for Payer: UHC Medicare Advantage	$830.78
Rate for Payer: VA VA	$806.58

PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS

Facility

$322.00

Service Code	CPT 43450
Hospital Charge Code	43450
Min. Negotiated Rate	$202.86
Max. Negotiated Rate	$289.80
Rate for Payer: Aetna Commercial	$273.70
Rate for Payer: Aetna New Business (MI Preferred)	$209.30
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cofinity Commercial	$225.40
Rate for Payer: Cofinity Commercial	$276.92
Rate for Payer: Healthscope Commercial	$289.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$273.70
Rate for Payer: PHP Commercial	$273.70
Rate for Payer: Priority Health Cigna Priority Health	$225.40
Rate for Payer: Priority Health SBD	$202.86

PR DILATION LACRIMAL PUNCTUM W/WO IRRGATION

Professional

Both

$212.00

Service Code	HCPCS 68801
Min. Negotiated Rate	$50.69
Max. Negotiated Rate	$1,061.88
Rate for Payer: Aetna Commercial	$100.58
Rate for Payer: BCBS Complete	$53.22
Rate for Payer: BCBS Trust/PPO	$1,061.88
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$169.60
Rate for Payer: Mclaren Medicaid	$50.69
Rate for Payer: Meridian Medicaid	$53.22
Rate for Payer: Priority Health Choice Medicaid	$50.69
Rate for Payer: Priority Health Cigna Priority Health	$148.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$136.41
Rate for Payer: Priority Health Narrow Network	$136.41
Rate for Payer: Priority Health SBD	$136.41

PR DILATION SALIVARY DUCT

Professional

Both

$123.00

Service Code	HCPCS 42650
Min. Negotiated Rate	$37.91
Max. Negotiated Rate	$619.17
Rate for Payer: Aetna Commercial	$75.67
Rate for Payer: BCBS Complete	$39.81
Rate for Payer: BCBS Trust/PPO	$619.17
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cash Price	$98.40
Rate for Payer: Mclaren Medicaid	$37.91
Rate for Payer: Meridian Medicaid	$39.81
Rate for Payer: Priority Health Choice Medicaid	$37.91
Rate for Payer: Priority Health Cigna Priority Health	$86.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$103.48
Rate for Payer: Priority Health Narrow Network	$103.48
Rate for Payer: Priority Health SBD	$103.48

PR DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL

Professional

Both

$363.00

Service Code	HCPCS 57400
Min. Negotiated Rate	$83.28
Max. Negotiated Rate	$1,877.58
Rate for Payer: Aetna Commercial	$156.29
Rate for Payer: BCBS Complete	$87.44
Rate for Payer: BCBS Trust/PPO	$1,877.58
Rate for Payer: Cash Price	$290.40
Rate for Payer: Cash Price	$290.40
Rate for Payer: Mclaren Medicaid	$83.28
Rate for Payer: Meridian Medicaid	$87.44
Rate for Payer: Priority Health Choice Medicaid	$83.28
Rate for Payer: Priority Health Cigna Priority Health	$254.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$182.74
Rate for Payer: Priority Health Narrow Network	$182.74
Rate for Payer: Priority Health SBD	$182.74

PR DILAT RCT STRIX SPX UNDER ANES OTH/THN LOCAL

Professional

Both

$1,294.00

Service Code	HCPCS 45910
Min. Negotiated Rate	$123.97
Max. Negotiated Rate	$1,149.58
Rate for Payer: Aetna Commercial	$255.45
Rate for Payer: BCBS Complete	$130.17
Rate for Payer: BCBS Trust/PPO	$1,149.58
Rate for Payer: Cash Price	$1,035.20
Rate for Payer: Cash Price	$1,035.20
Rate for Payer: Mclaren Medicaid	$123.97
Rate for Payer: Meridian Medicaid	$130.17
Rate for Payer: Priority Health Choice Medicaid	$123.97
Rate for Payer: Priority Health Cigna Priority Health	$905.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$339.26
Rate for Payer: Priority Health Narrow Network	$339.26
Rate for Payer: Priority Health SBD	$339.26

PR DILAT URETHRAL STRIX DILATOR MALE 1ST

Professional

Both

$169.00

Service Code	HCPCS 53600
Min. Negotiated Rate	$40.04
Max. Negotiated Rate	$549.43
Rate for Payer: Aetna Commercial	$81.77
Rate for Payer: BCBS Complete	$42.04
Rate for Payer: BCBS Trust/PPO	$549.43
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Mclaren Medicaid	$40.04
Rate for Payer: Meridian Medicaid	$42.04
Rate for Payer: Priority Health Choice Medicaid	$40.04
Rate for Payer: Priority Health Cigna Priority Health	$118.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$102.13
Rate for Payer: Priority Health Narrow Network	$102.13
Rate for Payer: Priority Health SBD	$102.13

PR DILAT URETHRAL STRIX DILATOR MALE SBSQ

Professional

Both

$160.00

Service Code	HCPCS 53601
Min. Negotiated Rate	$33.65
Max. Negotiated Rate	$244.07
Rate for Payer: Aetna Commercial	$68.82
Rate for Payer: BCBS Complete	$35.33
Rate for Payer: BCBS Trust/PPO	$244.07
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Mclaren Medicaid	$33.65
Rate for Payer: Meridian Medicaid	$35.33
Rate for Payer: Priority Health Choice Medicaid	$33.65
Rate for Payer: Priority Health Cigna Priority Health	$112.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$84.83
Rate for Payer: Priority Health Narrow Network	$84.83
Rate for Payer: Priority Health SBD	$84.83

PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE 1ST

Professional

Both

$256.00

Service Code	HCPCS 53620
Min. Negotiated Rate	$54.95
Max. Negotiated Rate	$1,543.16
Rate for Payer: Aetna Commercial	$111.68
Rate for Payer: BCBS Complete	$57.70
Rate for Payer: BCBS Trust/PPO	$1,543.16
Rate for Payer: Cash Price	$204.80
Rate for Payer: Cash Price	$204.80
Rate for Payer: Mclaren Medicaid	$54.95
Rate for Payer: Meridian Medicaid	$57.70
Rate for Payer: Priority Health Choice Medicaid	$54.95
Rate for Payer: Priority Health Cigna Priority Health	$179.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$137.79
Rate for Payer: Priority Health Narrow Network	$137.79
Rate for Payer: Priority Health SBD	$137.79

PR DILAT URETHRAL STRIX FILIFORM & FOLLWR MALE SBSQ

Professional

Both

$241.00

Service Code	HCPCS 53621
Min. Negotiated Rate	$45.37
Max. Negotiated Rate	$924.00
Rate for Payer: Aetna Commercial	$91.87
Rate for Payer: BCBS Complete	$47.64
Rate for Payer: BCBS Trust/PPO	$924.00
Rate for Payer: Cash Price	$192.80
Rate for Payer: Cash Price	$192.80
Rate for Payer: Mclaren Medicaid	$45.37
Rate for Payer: Meridian Medicaid	$47.64
Rate for Payer: Priority Health Choice Medicaid	$45.37
Rate for Payer: Priority Health Cigna Priority Health	$168.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$114.01
Rate for Payer: Priority Health Narrow Network	$114.01
Rate for Payer: Priority Health SBD	$114.01

PR DILAT URETHRAL STRIX/VESICAL NCK DILAT MALE ANES

Professional

Both

$123.00

Service Code	HCPCS 53605
Min. Negotiated Rate	$40.26
Max. Negotiated Rate	$1,411.09
Rate for Payer: Aetna Commercial	$82.91
Rate for Payer: BCBS Complete	$42.27
Rate for Payer: BCBS Trust/PPO	$1,411.09
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cash Price	$98.40
Rate for Payer: Mclaren Medicaid	$40.26
Rate for Payer: Meridian Medicaid	$42.27
Rate for Payer: Priority Health Choice Medicaid	$40.26
Rate for Payer: Priority Health Cigna Priority Health	$86.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$102.13
Rate for Payer: Priority Health Narrow Network	$102.13
Rate for Payer: Priority Health SBD	$102.13

PR DIPHENHYDRAMINE HCL INJECTIO

Professional

Both

$20.00

Service Code	HCPCS J1200
Min. Negotiated Rate	$0.39
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$0.83
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: BCBS Trust/PPO	$0.39
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00

PR DIPHTH TETANUS TOX ACELL PERTUSSIS VACC<7 YR IM

Professional

Both

$47.00

Service Code	HCPCS 90700
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$34.91
Rate for Payer: Aetna Commercial	$29.53
Rate for Payer: BCBS Complete	$18.80
Rate for Payer: BCBS Trust/PPO	$34.91
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cash Price	$37.60
Rate for Payer: Priority Health Cigna Priority Health	$32.90

PR DIR/PTCH CLS SINUS VENOSUS W/WO ANOM PUL VEN DRG

Professional

Both

$7,478.00

Service Code	HCPCS 33645
Min. Negotiated Rate	$1,086.30
Max. Negotiated Rate	$5,234.60
Rate for Payer: Aetna Commercial	$2,324.74
Rate for Payer: BCBS Complete	$1,140.62
Rate for Payer: BCBS Trust/PPO	$1,139.01
Rate for Payer: Cash Price	$5,982.40
Rate for Payer: Cash Price	$5,982.40
Rate for Payer: Mclaren Medicaid	$1,086.30
Rate for Payer: Meridian Medicaid	$1,140.62
Rate for Payer: Priority Health Choice Medicaid	$1,086.30
Rate for Payer: Priority Health Cigna Priority Health	$5,234.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,702.34
Rate for Payer: Priority Health Narrow Network	$2,702.34
Rate for Payer: Priority Health SBD	$2,702.34

PR DIR RPR ANEURYSM ABDOM AORTA W/ILIAC VESSELS

Professional

Both

$3,648.00

Service Code	HCPCS 35102
Min. Negotiated Rate	$1,173.42
Max. Negotiated Rate	$2,910.88
Rate for Payer: Aetna Commercial	$2,527.67
Rate for Payer: BCBS Complete	$1,232.09
Rate for Payer: BCBS Trust/PPO	$1,938.33
Rate for Payer: Cash Price	$2,918.40
Rate for Payer: Cash Price	$2,918.40
Rate for Payer: Mclaren Medicaid	$1,173.42
Rate for Payer: Meridian Medicaid	$1,232.09
Rate for Payer: Priority Health Choice Medicaid	$1,173.42
Rate for Payer: Priority Health Cigna Priority Health	$2,553.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,910.88
Rate for Payer: Priority Health Narrow Network	$2,910.88
Rate for Payer: Priority Health SBD	$2,910.88

PR DIR RPR ANEURYSM ABDOM AORTA W/VISCERAL VESSELS

Professional

Both

$3,503.00

Service Code	HCPCS 35091
Min. Negotiated Rate	$1,108.45
Max. Negotiated Rate	$2,761.38
Rate for Payer: Aetna Commercial	$2,414.09
Rate for Payer: BCBS Complete	$1,163.87
Rate for Payer: BCBS Trust/PPO	$1,517.81
Rate for Payer: Cash Price	$2,802.40
Rate for Payer: Cash Price	$2,802.40
Rate for Payer: Mclaren Medicaid	$1,108.45
Rate for Payer: Meridian Medicaid	$1,163.87
Rate for Payer: Priority Health Choice Medicaid	$1,108.45
Rate for Payer: Priority Health Cigna Priority Health	$2,452.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,761.38
Rate for Payer: Priority Health Narrow Network	$2,761.38
Rate for Payer: Priority Health SBD	$2,761.38

Know your out-of-pocket cost for care.

All Charges