Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PRAZOSIN 1 MG CAPSULE

Facility

$483.84

Service Code	NDC 00904702061
Hospital Charge Code	6468
Hospital Revenue Code	637
Min. Negotiated Rate	$304.82
Max. Negotiated Rate	$435.46
Rate for Payer: Aetna Commercial	$411.26
Rate for Payer: Aetna New Business (MI Preferred)	$314.50
Rate for Payer: Cash Price	$387.07
Rate for Payer: Cofinity Advantage	$338.69
Rate for Payer: Cofinity Commercial	$416.10
Rate for Payer: Encore Health Key Benefits Commercial	$387.07
Rate for Payer: Healthscope Commercial	$435.46
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$411.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$362.88
Rate for Payer: PHP Commercial	$411.26
Rate for Payer: Priority Health SBD	$304.82

PRAZOSIN 1 MG CAPSULE

Facility

$532.32

Service Code	NDC 68084099601
Hospital Charge Code	6468
Hospital Revenue Code	637
Min. Negotiated Rate	$209.20
Max. Negotiated Rate	$479.09
Rate for Payer: Aetna Commercial	$452.47
Rate for Payer: Aetna Medicare	$266.16
Rate for Payer: Aetna New Business (MI Preferred)	$346.01
Rate for Payer: BCBS Complete	$212.93
Rate for Payer: Cash Price	$425.86
Rate for Payer: Cofinity Advantage	$372.62
Rate for Payer: Cofinity Commercial	$457.80
Rate for Payer: Encore Health Key Benefits Commercial	$425.86
Rate for Payer: Healthscope Commercial	$479.09
Rate for Payer: MI Amish Medical Board Commercial	$425.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$452.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$399.24
Rate for Payer: PHP Commercial	$452.47
Rate for Payer: Priority Health SBD	$335.36
Rate for Payer: UHC All Payor (Choice/PPO)	$346.01
Rate for Payer: UHC Core	$277.34
Rate for Payer: UHC Exchange	$209.20

PRAZOSIN 1 MG CAPSULE

Facility

$532.32

Service Code	NDC 68084099601
Hospital Charge Code	6468
Hospital Revenue Code	637
Min. Negotiated Rate	$335.36
Max. Negotiated Rate	$479.09
Rate for Payer: Aetna Commercial	$452.47
Rate for Payer: Aetna New Business (MI Preferred)	$346.01
Rate for Payer: Cash Price	$425.86
Rate for Payer: Cofinity Advantage	$372.62
Rate for Payer: Cofinity Commercial	$457.80
Rate for Payer: Encore Health Key Benefits Commercial	$425.86
Rate for Payer: Healthscope Commercial	$479.09
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$452.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$399.24
Rate for Payer: PHP Commercial	$452.47
Rate for Payer: Priority Health SBD	$335.36

PRAZOSIN 1 MG CAPSULE

Facility

$380.00

Service Code	NDC 00093406701
Hospital Charge Code	6468
Hospital Revenue Code	637
Min. Negotiated Rate	$149.34
Max. Negotiated Rate	$342.00
Rate for Payer: Aetna Commercial	$323.00
Rate for Payer: Aetna Medicare	$190.00
Rate for Payer: Aetna New Business (MI Preferred)	$247.00
Rate for Payer: BCBS Complete	$152.00
Rate for Payer: Cash Price	$304.00
Rate for Payer: Cofinity Advantage	$266.00
Rate for Payer: Cofinity Commercial	$326.80
Rate for Payer: Encore Health Key Benefits Commercial	$304.00
Rate for Payer: Healthscope Commercial	$342.00
Rate for Payer: MI Amish Medical Board Commercial	$304.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$323.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$285.00
Rate for Payer: PHP Commercial	$323.00
Rate for Payer: Priority Health SBD	$239.40
Rate for Payer: UHC All Payor (Choice/PPO)	$247.00
Rate for Payer: UHC Core	$197.98
Rate for Payer: UHC Exchange	$149.34

PRAZOSIN 1 MG CAPSULE

Facility

$284.35

Service Code	NDC 70756042911
Hospital Charge Code	6468
Hospital Revenue Code	637
Min. Negotiated Rate	$111.75
Max. Negotiated Rate	$255.91
Rate for Payer: Aetna Commercial	$241.70
Rate for Payer: Aetna Medicare	$142.18
Rate for Payer: Aetna New Business (MI Preferred)	$184.83
Rate for Payer: BCBS Complete	$113.74
Rate for Payer: Cash Price	$227.48
Rate for Payer: Cofinity Advantage	$199.04
Rate for Payer: Cofinity Commercial	$244.54
Rate for Payer: Encore Health Key Benefits Commercial	$227.48
Rate for Payer: Healthscope Commercial	$255.91
Rate for Payer: MI Amish Medical Board Commercial	$227.48
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$241.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$213.26
Rate for Payer: PHP Commercial	$241.70
Rate for Payer: Priority Health SBD	$179.14
Rate for Payer: UHC All Payor (Choice/PPO)	$184.83
Rate for Payer: UHC Core	$148.15
Rate for Payer: UHC Exchange	$111.75

PRAZOSIN 1 MG CAPSULE

Facility

$643.20

Service Code	NDC 51079063020
Hospital Charge Code	6468
Hospital Revenue Code	637
Min. Negotiated Rate	$405.22
Max. Negotiated Rate	$578.88
Rate for Payer: Aetna Commercial	$546.72
Rate for Payer: Aetna New Business (MI Preferred)	$418.08
Rate for Payer: Cash Price	$514.56
Rate for Payer: Cofinity Advantage	$450.24
Rate for Payer: Cofinity Commercial	$553.15
Rate for Payer: Encore Health Key Benefits Commercial	$514.56
Rate for Payer: Healthscope Commercial	$578.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$546.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$482.40
Rate for Payer: PHP Commercial	$546.72
Rate for Payer: Priority Health SBD	$405.22

PRAZOSIN 1 MG CAPSULE

Facility

$5.33

Service Code	NDC 68084099611
Hospital Charge Code	6468
Hospital Revenue Code	637
Min. Negotiated Rate	$3.36
Max. Negotiated Rate	$4.80
Rate for Payer: Aetna Commercial	$4.53
Rate for Payer: Aetna New Business (MI Preferred)	$3.46
Rate for Payer: Cash Price	$4.26
Rate for Payer: Cofinity Advantage	$3.73
Rate for Payer: Cofinity Commercial	$4.58
Rate for Payer: Encore Health Key Benefits Commercial	$4.26
Rate for Payer: Healthscope Commercial	$4.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.00
Rate for Payer: PHP Commercial	$4.53
Rate for Payer: Priority Health SBD	$3.36

PRAZOSIN 1 MG CAPSULE

Facility

$284.35

Service Code	NDC 70756042911
Hospital Charge Code	6468
Hospital Revenue Code	637
Min. Negotiated Rate	$179.14
Max. Negotiated Rate	$255.91
Rate for Payer: Aetna Commercial	$241.70
Rate for Payer: Aetna New Business (MI Preferred)	$184.83
Rate for Payer: Cash Price	$227.48
Rate for Payer: Cofinity Advantage	$199.04
Rate for Payer: Cofinity Commercial	$244.54
Rate for Payer: Encore Health Key Benefits Commercial	$227.48
Rate for Payer: Healthscope Commercial	$255.91
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$241.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$213.26
Rate for Payer: PHP Commercial	$241.70
Rate for Payer: Priority Health SBD	$179.14

PRAZOSIN 1 MG CAPSULE

Facility

$643.20

Service Code	NDC 51079063020
Hospital Charge Code	6468
Hospital Revenue Code	637
Min. Negotiated Rate	$252.78
Max. Negotiated Rate	$578.88
Rate for Payer: Aetna Commercial	$546.72
Rate for Payer: Aetna Medicare	$321.60
Rate for Payer: Aetna New Business (MI Preferred)	$418.08
Rate for Payer: BCBS Complete	$257.28
Rate for Payer: Cash Price	$514.56
Rate for Payer: Cofinity Advantage	$450.24
Rate for Payer: Cofinity Commercial	$553.15
Rate for Payer: Encore Health Key Benefits Commercial	$514.56
Rate for Payer: Healthscope Commercial	$578.88
Rate for Payer: MI Amish Medical Board Commercial	$514.56
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$546.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$482.40
Rate for Payer: PHP Commercial	$546.72
Rate for Payer: Priority Health SBD	$405.22
Rate for Payer: UHC All Payor (Choice/PPO)	$418.08
Rate for Payer: UHC Core	$335.11
Rate for Payer: UHC Exchange	$252.78

PRAZOSIN 5 MG CAPSULE

Facility

$326.61

Service Code	NDC 59762535001
Hospital Charge Code	6470
Hospital Revenue Code	637
Min. Negotiated Rate	$128.36
Max. Negotiated Rate	$293.95
Rate for Payer: Aetna Commercial	$277.62
Rate for Payer: Aetna Medicare	$163.31
Rate for Payer: Aetna New Business (MI Preferred)	$212.30
Rate for Payer: BCBS Complete	$130.64
Rate for Payer: Cash Price	$261.29
Rate for Payer: Cofinity Advantage	$228.63
Rate for Payer: Cofinity Commercial	$280.88
Rate for Payer: Encore Health Key Benefits Commercial	$261.29
Rate for Payer: Healthscope Commercial	$293.95
Rate for Payer: MI Amish Medical Board Commercial	$261.29
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$277.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$244.96
Rate for Payer: PHP Commercial	$277.62
Rate for Payer: Priority Health SBD	$205.76
Rate for Payer: UHC All Payor (Choice/PPO)	$212.30
Rate for Payer: UHC Core	$170.16
Rate for Payer: UHC Exchange	$128.36

PRAZOSIN 5 MG CAPSULE

Facility

$15.61

Service Code	NDC 51079063201
Hospital Charge Code	6470
Hospital Revenue Code	637
Min. Negotiated Rate	$6.13
Max. Negotiated Rate	$14.05
Rate for Payer: Aetna Commercial	$13.27
Rate for Payer: Aetna Medicare	$7.80
Rate for Payer: Aetna New Business (MI Preferred)	$10.15
Rate for Payer: BCBS Complete	$6.24
Rate for Payer: Cash Price	$12.49
Rate for Payer: Cofinity Advantage	$10.93
Rate for Payer: Cofinity Commercial	$13.42
Rate for Payer: Encore Health Key Benefits Commercial	$12.49
Rate for Payer: Healthscope Commercial	$14.05
Rate for Payer: MI Amish Medical Board Commercial	$12.49
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.71
Rate for Payer: PHP Commercial	$13.27
Rate for Payer: Priority Health SBD	$9.83
Rate for Payer: UHC All Payor (Choice/PPO)	$10.15
Rate for Payer: UHC Core	$8.13
Rate for Payer: UHC Exchange	$6.13

PRAZOSIN 5 MG CAPSULE

Facility

$15.61

Service Code	NDC 51079063201
Hospital Charge Code	6470
Hospital Revenue Code	637
Min. Negotiated Rate	$9.83
Max. Negotiated Rate	$14.05
Rate for Payer: Aetna Commercial	$13.27
Rate for Payer: Aetna New Business (MI Preferred)	$10.15
Rate for Payer: Cash Price	$12.49
Rate for Payer: Cofinity Advantage	$10.93
Rate for Payer: Cofinity Commercial	$13.42
Rate for Payer: Encore Health Key Benefits Commercial	$12.49
Rate for Payer: Healthscope Commercial	$14.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$13.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.71
Rate for Payer: PHP Commercial	$13.27
Rate for Payer: Priority Health SBD	$9.83

PRAZOSIN 5 MG CAPSULE

Facility

$1,560.29

Service Code	NDC 51079063220
Hospital Charge Code	6470
Hospital Revenue Code	637
Min. Negotiated Rate	$982.98
Max. Negotiated Rate	$1,404.26
Rate for Payer: Aetna Commercial	$1,326.25
Rate for Payer: Aetna New Business (MI Preferred)	$1,014.19
Rate for Payer: Cash Price	$1,248.23
Rate for Payer: Cofinity Advantage	$1,092.20
Rate for Payer: Cofinity Commercial	$1,341.85
Rate for Payer: Encore Health Key Benefits Commercial	$1,248.23
Rate for Payer: Healthscope Commercial	$1,404.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,326.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,170.22
Rate for Payer: PHP Commercial	$1,326.25
Rate for Payer: Priority Health SBD	$982.98

PRAZOSIN 5 MG CAPSULE

Facility

$1,418.21

Service Code	NDC 00904702261
Hospital Charge Code	6470
Hospital Revenue Code	637
Min. Negotiated Rate	$893.47
Max. Negotiated Rate	$1,276.39
Rate for Payer: Aetna Commercial	$1,205.48
Rate for Payer: Aetna New Business (MI Preferred)	$921.84
Rate for Payer: Cash Price	$1,134.57
Rate for Payer: Cofinity Advantage	$992.75
Rate for Payer: Cofinity Commercial	$1,219.66
Rate for Payer: Encore Health Key Benefits Commercial	$1,134.57
Rate for Payer: Healthscope Commercial	$1,276.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,205.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,063.66
Rate for Payer: PHP Commercial	$1,205.48
Rate for Payer: Priority Health SBD	$893.47

PRAZOSIN 5 MG CAPSULE

Facility

$1,418.21

Service Code	NDC 00904702261
Hospital Charge Code	6470
Hospital Revenue Code	637
Min. Negotiated Rate	$557.36
Max. Negotiated Rate	$1,276.39
Rate for Payer: Aetna Commercial	$1,205.48
Rate for Payer: Aetna Medicare	$709.11
Rate for Payer: Aetna New Business (MI Preferred)	$921.84
Rate for Payer: BCBS Complete	$567.28
Rate for Payer: Cash Price	$1,134.57
Rate for Payer: Cofinity Advantage	$992.75
Rate for Payer: Cofinity Commercial	$1,219.66
Rate for Payer: Encore Health Key Benefits Commercial	$1,134.57
Rate for Payer: Healthscope Commercial	$1,276.39
Rate for Payer: MI Amish Medical Board Commercial	$1,134.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,205.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,063.66
Rate for Payer: PHP Commercial	$1,205.48
Rate for Payer: Priority Health SBD	$893.47
Rate for Payer: UHC All Payor (Choice/PPO)	$921.84
Rate for Payer: UHC Core	$738.89
Rate for Payer: UHC Exchange	$557.36

PRAZOSIN 5 MG CAPSULE

Facility

$326.61

Service Code	NDC 59762535001
Hospital Charge Code	6470
Hospital Revenue Code	637
Min. Negotiated Rate	$205.76
Max. Negotiated Rate	$293.95
Rate for Payer: Aetna Commercial	$277.62
Rate for Payer: Aetna New Business (MI Preferred)	$212.30
Rate for Payer: Cash Price	$261.29
Rate for Payer: Cofinity Advantage	$228.63
Rate for Payer: Cofinity Commercial	$280.88
Rate for Payer: Encore Health Key Benefits Commercial	$261.29
Rate for Payer: Healthscope Commercial	$293.95
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$277.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$244.96
Rate for Payer: PHP Commercial	$277.62
Rate for Payer: Priority Health SBD	$205.76

PRAZOSIN 5 MG CAPSULE

Facility

$1,560.29

Service Code	NDC 51079063220
Hospital Charge Code	6470
Hospital Revenue Code	637
Min. Negotiated Rate	$613.19
Max. Negotiated Rate	$1,404.26
Rate for Payer: Aetna Commercial	$1,326.25
Rate for Payer: Aetna Medicare	$780.14
Rate for Payer: Aetna New Business (MI Preferred)	$1,014.19
Rate for Payer: BCBS Complete	$624.12
Rate for Payer: Cash Price	$1,248.23
Rate for Payer: Cofinity Advantage	$1,092.20
Rate for Payer: Cofinity Commercial	$1,341.85
Rate for Payer: Encore Health Key Benefits Commercial	$1,248.23
Rate for Payer: Healthscope Commercial	$1,404.26
Rate for Payer: MI Amish Medical Board Commercial	$1,248.23
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,326.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,170.22
Rate for Payer: PHP Commercial	$1,326.25
Rate for Payer: Priority Health SBD	$982.98
Rate for Payer: UHC All Payor (Choice/PPO)	$1,014.19
Rate for Payer: UHC Core	$812.91
Rate for Payer: UHC Exchange	$613.19

PR B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA

Professional

Both

$2,239.00

Service Code	HCPCS 27170
Min. Negotiated Rate	$679.26
Max. Negotiated Rate	$2,080.40
Rate for Payer: Aetna Commercial	$1,405.27
Rate for Payer: Aetna Medicare	$1,090.66
Rate for Payer: Aetna New Business (MI Preferred)	$1,405.27
Rate for Payer: Aetna New Business (MI Preferred)	$1,510.14
Rate for Payer: BCBS Complete	$713.22
Rate for Payer: BCBS MAPPO	$1,048.71
Rate for Payer: BCN Commercial	$1,770.32
Rate for Payer: BCN Medicare Advantage	$1,048.71
Rate for Payer: Cash Price	$1,791.20
Rate for Payer: Cash Price	$1,791.20
Rate for Payer: Cofinity Commercial	$1,510.14
Rate for Payer: Cofinity Commercial	$1,405.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,048.71
Rate for Payer: Healthscope Commercial	$1,940.11
Rate for Payer: Healthscope Commercial	$1,677.94
Rate for Payer: Mclaren Medicaid	$679.26
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,101.15
Rate for Payer: Meridian Medicaid	$713.22
Rate for Payer: Molina Medicare/Medicaid	$1,153.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,080.40
Rate for Payer: Nomi Health Commercial	$1,258.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,679.25
Rate for Payer: PACE SWMI	$1,048.71
Rate for Payer: PHP Medicare Advantage	$1,048.71
Rate for Payer: Priority Health Choice Medicaid	$679.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$1,892.43
Rate for Payer: Priority Health Medicare	$1,048.71
Rate for Payer: Priority Health SBD	$1,892.43
Rate for Payer: Priority Health Tiered Network	$1,892.43
Rate for Payer: Railroad Medicare Medicare	$1,048.71
Rate for Payer: UHC All Payor (Choice/PPO)	$2,064.27
Rate for Payer: UHC Core	$2,064.27
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$1,048.71
Rate for Payer: UHC Exchange	$2,064.27
Rate for Payer: UHC Medicaid	$679.26
Rate for Payer: UHCCP Medicaid	$679.26

PR BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL

Professional

Both

$281.00

Service Code	HCPCS 90586
Min. Negotiated Rate	$112.40
Max. Negotiated Rate	$210.75
Rate for Payer: Aetna Commercial	$144.50
Rate for Payer: Aetna Medicare	$140.50
Rate for Payer: Aetna New Business (MI Preferred)	$144.50
Rate for Payer: BCBS Complete	$112.40
Rate for Payer: BCBS Trust/PPO	$181.97
Rate for Payer: BCN Commercial	$173.84
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cash Price	$224.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$145.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$210.75
Rate for Payer: UHC All Payor (Choice/PPO)	$163.97
Rate for Payer: UHC Core	$163.97
Rate for Payer: UHC Exchange	$163.97

PR BALLN ANGIOPLASTY OPEN,BRACHCEPH

Professional

Both

$987.00

Service Code	HCPCS 35458
Min. Negotiated Rate	$394.80
Max. Negotiated Rate	$740.25
Rate for Payer: Aetna Medicare	$493.50
Rate for Payer: BCBS Complete	$394.80
Rate for Payer: Cash Price	$789.60
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$641.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$740.25

PR BALLN ANGIOPLASTY PERC,AORTIC

Professional

Both

$710.00

Service Code	HCPCS 35472
Min. Negotiated Rate	$284.00
Max. Negotiated Rate	$532.50
Rate for Payer: Aetna Medicare	$355.00
Rate for Payer: BCBS Complete	$284.00
Rate for Payer: Cash Price	$568.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$461.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$532.50

PR BALLN ANGIOPLASTY PERC,BRACHIOCEPH

Professional

Both

$2,100.00

Service Code	HCPCS 35475
Min. Negotiated Rate	$840.00
Max. Negotiated Rate	$1,575.00
Rate for Payer: Aetna Medicare	$1,050.00
Rate for Payer: BCBS Complete	$840.00
Rate for Payer: Cash Price	$1,680.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,365.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,575.00

PR BALLN ANGIOPLASTY,PERC VENOUS

Professional

Both

$3,544.00

Service Code	HCPCS 35476
Min. Negotiated Rate	$1,417.60
Max. Negotiated Rate	$2,658.00
Rate for Payer: Aetna Medicare	$1,772.00
Rate for Payer: BCBS Complete	$1,417.60
Rate for Payer: Cash Price	$2,835.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,303.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,658.00

PR BALLN ANGIOPLASTY PERC,VISCERAL

Professional

Both

$2,943.00

Service Code	HCPCS 35471
Min. Negotiated Rate	$1,177.20
Max. Negotiated Rate	$2,207.25
Rate for Payer: Aetna Medicare	$1,471.50
Rate for Payer: BCBS Complete	$1,177.20
Rate for Payer: Cash Price	$2,354.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,912.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,207.25

PR BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS

Professional

Both

$5,070.00

Service Code	HCPCS 61630
Min. Negotiated Rate	$1,257.13
Max. Negotiated Rate	$3,802.50
Rate for Payer: Aetna Commercial	$1,684.55
Rate for Payer: Aetna Medicare	$1,307.42
Rate for Payer: Aetna New Business (MI Preferred)	$1,684.55
Rate for Payer: Aetna New Business (MI Preferred)	$1,810.27
Rate for Payer: BCBS Complete	$2,028.00
Rate for Payer: BCBS MAPPO	$1,257.13
Rate for Payer: BCN Commercial	$2,048.19
Rate for Payer: BCN Medicare Advantage	$1,257.13
Rate for Payer: Cash Price	$4,056.00
Rate for Payer: Cash Price	$4,056.00
Rate for Payer: Cofinity Commercial	$1,684.55
Rate for Payer: Cofinity Commercial	$1,810.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,257.13
Rate for Payer: Healthscope Commercial	$2,011.41
Rate for Payer: Healthscope Commercial	$2,325.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,319.99
Rate for Payer: Molina Medicare/Medicaid	$1,382.84
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,454.73
Rate for Payer: Nomi Health Commercial	$1,508.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,802.50
Rate for Payer: PACE SWMI	$1,257.13
Rate for Payer: PHP Medicare Advantage	$1,257.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$2,378.94
Rate for Payer: Priority Health Medicare	$1,257.13
Rate for Payer: Priority Health SBD	$2,378.94
Rate for Payer: Priority Health Tiered Network	$2,378.94
Rate for Payer: Railroad Medicare Medicare	$1,257.13
Rate for Payer: UHC All Payor (Choice/PPO)	$2,419.84
Rate for Payer: UHC Core	$2,419.84
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$1,257.13
Rate for Payer: UHC Exchange	$2,419.84

Know your out-of-pocket cost for care.

All Charges