Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR BYPASS W/VEIN AORTOBI-ILIAC

Professional

Both

$6,595.00

Service Code	HCPCS 35538
Min. Negotiated Rate	$1,350.85
Max. Negotiated Rate	$4,946.25
Rate for Payer: Aetna Commercial	$3,144.83
Rate for Payer: Aetna Medicare	$3,297.50
Rate for Payer: BCBS Complete	$1,418.39
Rate for Payer: BCN Commercial	$3,408.68
Rate for Payer: Cash Price	$5,276.00
Rate for Payer: Cash Price	$5,276.00
Rate for Payer: Mclaren Medicaid	$1,350.85
Rate for Payer: Meridian Medicaid	$1,418.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,946.25
Rate for Payer: Priority Health Choice Medicaid	$1,350.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,665.61
Rate for Payer: Priority Health Narrow/Tiered Network	$3,665.61
Rate for Payer: UHC Medicaid	$1,350.85
Rate for Payer: UHCCP Medicaid	$1,350.85

PR BYPASS W/VEIN AORTOCELIAC/AORTOMESENTERIC

Professional

Both

$4,405.00

Service Code	HCPCS 35531
Min. Negotiated Rate	$1,128.90
Max. Negotiated Rate	$3,303.75
Rate for Payer: Aetna Commercial	$2,623.52
Rate for Payer: Aetna Medicare	$2,202.50
Rate for Payer: BCBS Complete	$1,185.35
Rate for Payer: BCN Commercial	$2,846.95
Rate for Payer: Cash Price	$3,524.00
Rate for Payer: Cash Price	$3,524.00
Rate for Payer: Mclaren Medicaid	$1,128.90
Rate for Payer: Meridian Medicaid	$1,185.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,303.75
Rate for Payer: Priority Health Choice Medicaid	$1,128.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,061.54
Rate for Payer: Priority Health Narrow/Tiered Network	$3,061.54
Rate for Payer: UHC Medicaid	$1,128.90
Rate for Payer: UHCCP Medicaid	$1,128.90

PR BYPASS W/VEIN AORTOILIAC

Professional

Both

$4,535.00

Service Code	HCPCS 35537
Min. Negotiated Rate	$1,206.43
Max. Negotiated Rate	$3,401.25
Rate for Payer: Aetna Commercial	$2,806.89
Rate for Payer: Aetna Medicare	$2,267.50
Rate for Payer: BCBS Complete	$1,266.75
Rate for Payer: BCN Commercial	$3,042.16
Rate for Payer: Cash Price	$3,628.00
Rate for Payer: Cash Price	$3,628.00
Rate for Payer: Mclaren Medicaid	$1,206.43
Rate for Payer: Meridian Medicaid	$1,266.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,401.25
Rate for Payer: Priority Health Choice Medicaid	$1,206.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,271.47
Rate for Payer: Priority Health Narrow/Tiered Network	$3,271.47
Rate for Payer: UHC Medicaid	$1,206.43
Rate for Payer: UHCCP Medicaid	$1,206.43

PR BYPASS W/VEIN AORTOSUBCLAV/CAROTID/INNOMINATE

Professional

Both

$3,787.00

Service Code	HCPCS 35526
Min. Negotiated Rate	$1,042.42
Max. Negotiated Rate	$2,840.25
Rate for Payer: Aetna Commercial	$2,325.27
Rate for Payer: Aetna Medicare	$1,893.50
Rate for Payer: BCBS Complete	$1,094.54
Rate for Payer: BCN Commercial	$2,535.72
Rate for Payer: Cash Price	$3,029.60
Rate for Payer: Cash Price	$3,029.60
Rate for Payer: Mclaren Medicaid	$1,042.42
Rate for Payer: Meridian Medicaid	$1,094.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,840.25
Rate for Payer: Priority Health Choice Medicaid	$1,042.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,726.84
Rate for Payer: Priority Health Narrow/Tiered Network	$2,726.84
Rate for Payer: UHC Medicaid	$1,042.42
Rate for Payer: UHCCP Medicaid	$1,042.42

PR BYPASS W/VEIN AXILLARY-BRACHIAL

Professional

Both

$2,482.00

Service Code	HCPCS 35522
Min. Negotiated Rate	$678.83
Max. Negotiated Rate	$1,861.50
Rate for Payer: Aetna Commercial	$1,641.02
Rate for Payer: Aetna Medicare	$1,241.00
Rate for Payer: BCBS Complete	$712.77
Rate for Payer: BCN Commercial	$1,710.56
Rate for Payer: Cash Price	$1,985.60
Rate for Payer: Cash Price	$1,985.60
Rate for Payer: Mclaren Medicaid	$678.83
Rate for Payer: Meridian Medicaid	$712.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,861.50
Rate for Payer: Priority Health Choice Medicaid	$678.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,839.49
Rate for Payer: Priority Health Narrow/Tiered Network	$1,839.49
Rate for Payer: UHC Medicaid	$678.83
Rate for Payer: UHCCP Medicaid	$678.83

PR BYPASS W/VEIN BRACHIAL-BRACHIAL

Professional

Both

$4,316.00

Service Code	HCPCS 35525
Min. Negotiated Rate	$638.36
Max. Negotiated Rate	$3,237.00
Rate for Payer: Aetna Commercial	$1,525.84
Rate for Payer: Aetna Medicare	$2,158.00
Rate for Payer: BCBS Complete	$670.28
Rate for Payer: BCN Commercial	$1,609.47
Rate for Payer: Cash Price	$3,452.80
Rate for Payer: Cash Price	$3,452.80
Rate for Payer: Mclaren Medicaid	$638.36
Rate for Payer: Meridian Medicaid	$670.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,237.00
Rate for Payer: Priority Health Choice Medicaid	$638.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,730.79
Rate for Payer: Priority Health Narrow/Tiered Network	$1,730.79
Rate for Payer: UHC Medicaid	$638.36
Rate for Payer: UHCCP Medicaid	$638.36

PR BYPASS W/VEIN BRACHIAL-ULNAR/-RADIAL

Professional

Both

$2,611.00

Service Code	HCPCS 35523
Min. Negotiated Rate	$714.19
Max. Negotiated Rate	$1,958.25
Rate for Payer: Aetna Commercial	$1,713.84
Rate for Payer: Aetna Medicare	$1,305.50
Rate for Payer: BCBS Complete	$749.90
Rate for Payer: BCN Commercial	$1,799.71
Rate for Payer: Cash Price	$2,088.80
Rate for Payer: Cash Price	$2,088.80
Rate for Payer: Mclaren Medicaid	$714.19
Rate for Payer: Meridian Medicaid	$749.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,958.25
Rate for Payer: Priority Health Choice Medicaid	$714.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,935.35
Rate for Payer: Priority Health Narrow/Tiered Network	$1,935.35
Rate for Payer: UHC Medicaid	$714.19
Rate for Payer: UHCCP Medicaid	$714.19

PR BYPASS W/VEIN CAROTID-BRACHIAL

Professional

Both

$2,675.00

Service Code	HCPCS 35510
Min. Negotiated Rate	$713.34
Max. Negotiated Rate	$2,006.25
Rate for Payer: Aetna Commercial	$1,653.58
Rate for Payer: Aetna Medicare	$1,337.50
Rate for Payer: BCBS Complete	$749.01
Rate for Payer: BCN Commercial	$1,797.21
Rate for Payer: Cash Price	$2,140.00
Rate for Payer: Cash Price	$2,140.00
Rate for Payer: Mclaren Medicaid	$713.34
Rate for Payer: Meridian Medicaid	$749.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,006.25
Rate for Payer: Priority Health Choice Medicaid	$713.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,932.68
Rate for Payer: Priority Health Narrow/Tiered Network	$1,932.68
Rate for Payer: UHC Medicaid	$713.34
Rate for Payer: UHCCP Medicaid	$713.34

PR BYPASS W/VEIN CAROTID-SUBCLV/SUBCLAVIAN CAROTID

Professional

Both

$2,748.00

Service Code	HCPCS 35506
Min. Negotiated Rate	$739.11
Max. Negotiated Rate	$2,061.00
Rate for Payer: Aetna Commercial	$1,712.70
Rate for Payer: Aetna Medicare	$1,374.00
Rate for Payer: BCBS Complete	$776.07
Rate for Payer: BCN Commercial	$1,863.45
Rate for Payer: Cash Price	$2,198.40
Rate for Payer: Cash Price	$2,198.40
Rate for Payer: Mclaren Medicaid	$739.11
Rate for Payer: Meridian Medicaid	$776.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,061.00
Rate for Payer: Priority Health Choice Medicaid	$739.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,003.91
Rate for Payer: Priority Health Narrow/Tiered Network	$2,003.91
Rate for Payer: UHC Medicaid	$739.11
Rate for Payer: UHCCP Medicaid	$739.11

PR BYPASS W/VEIN COMMON-IPSILATERAL CAROTID

Professional

Both

$3,175.00

Service Code	HCPCS 35501
Min. Negotiated Rate	$846.25
Max. Negotiated Rate	$2,381.25
Rate for Payer: Aetna Commercial	$1,963.57
Rate for Payer: Aetna Medicare	$1,587.50
Rate for Payer: BCBS Complete	$888.56
Rate for Payer: BCN Commercial	$2,130.87
Rate for Payer: Cash Price	$2,540.00
Rate for Payer: Cash Price	$2,540.00
Rate for Payer: Mclaren Medicaid	$846.25
Rate for Payer: Meridian Medicaid	$888.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,381.25
Rate for Payer: Priority Health Choice Medicaid	$846.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,291.48
Rate for Payer: Priority Health Narrow/Tiered Network	$2,291.48
Rate for Payer: UHC Medicaid	$846.25
Rate for Payer: UHCCP Medicaid	$846.25

PR BYPASS W/VEIN FEMORAL-FEMORAL

Professional

Both

$2,485.00

Service Code	HCPCS 35558
Min. Negotiated Rate	$703.54
Max. Negotiated Rate	$1,920.37
Rate for Payer: Aetna Commercial	$1,647.15
Rate for Payer: Aetna Medicare	$1,242.50
Rate for Payer: BCBS Complete	$738.72
Rate for Payer: BCN Commercial	$1,785.76
Rate for Payer: Cash Price	$1,988.00
Rate for Payer: Cash Price	$1,988.00
Rate for Payer: Mclaren Medicaid	$703.54
Rate for Payer: Meridian Medicaid	$738.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,863.75
Rate for Payer: Priority Health Choice Medicaid	$703.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,920.37
Rate for Payer: Priority Health Narrow/Tiered Network	$1,920.37
Rate for Payer: UHC Medicaid	$703.54
Rate for Payer: UHCCP Medicaid	$703.54

PR BYPASS W/VEIN FEMORAL-POPLITEAL

Professional

Both

$2,833.00

Service Code	HCPCS 35556
Min. Negotiated Rate	$804.71
Max. Negotiated Rate	$2,186.51
Rate for Payer: Aetna Commercial	$1,881.82
Rate for Payer: Aetna Medicare	$1,416.50
Rate for Payer: BCBS Complete	$844.95
Rate for Payer: BCN Commercial	$2,033.26
Rate for Payer: Cash Price	$2,266.40
Rate for Payer: Cash Price	$2,266.40
Rate for Payer: Mclaren Medicaid	$804.71
Rate for Payer: Meridian Medicaid	$844.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,124.75
Rate for Payer: Priority Health Choice Medicaid	$804.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,186.51
Rate for Payer: Priority Health Narrow/Tiered Network	$2,186.51
Rate for Payer: UHC Medicaid	$804.71
Rate for Payer: UHCCP Medicaid	$804.71

PR BYPASS W/VEIN HEPATORENAL

Professional

Both

$4,052.00

Service Code	HCPCS 35535
Min. Negotiated Rate	$1,102.06
Max. Negotiated Rate	$3,039.00
Rate for Payer: Aetna Commercial	$2,561.64
Rate for Payer: Aetna Medicare	$2,026.00
Rate for Payer: BCBS Complete	$1,157.16
Rate for Payer: BCN Commercial	$2,778.74
Rate for Payer: Cash Price	$3,241.60
Rate for Payer: Cash Price	$3,241.60
Rate for Payer: Mclaren Medicaid	$1,102.06
Rate for Payer: Meridian Medicaid	$1,157.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,039.00
Rate for Payer: Priority Health Choice Medicaid	$1,102.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,988.17
Rate for Payer: Priority Health Narrow/Tiered Network	$2,988.17
Rate for Payer: UHC Medicaid	$1,102.06
Rate for Payer: UHCCP Medicaid	$1,102.06

PR BYPASS W/VEIN ILIOFEMORAL

Professional

Both

$2,679.00

Service Code	HCPCS 35565
Min. Negotiated Rate	$740.60
Max. Negotiated Rate	$2,056.39
Rate for Payer: Aetna Commercial	$1,764.26
Rate for Payer: Aetna Medicare	$1,339.50
Rate for Payer: BCBS Complete	$777.63
Rate for Payer: BCN Commercial	$1,912.24
Rate for Payer: Cash Price	$2,143.20
Rate for Payer: Cash Price	$2,143.20
Rate for Payer: Mclaren Medicaid	$740.60
Rate for Payer: Meridian Medicaid	$777.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,009.25
Rate for Payer: Priority Health Choice Medicaid	$740.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,056.39
Rate for Payer: Priority Health Narrow/Tiered Network	$2,056.39
Rate for Payer: UHC Medicaid	$740.60
Rate for Payer: UHCCP Medicaid	$740.60

PR BYPASS W/VEIN ILIOILIAC

Professional

Both

$2,899.00

Service Code	HCPCS 35563
Min. Negotiated Rate	$768.08
Max. Negotiated Rate	$2,174.25
Rate for Payer: Aetna Commercial	$1,779.77
Rate for Payer: Aetna Medicare	$1,449.50
Rate for Payer: BCBS Complete	$806.48
Rate for Payer: BCN Commercial	$1,937.14
Rate for Payer: Cash Price	$2,319.20
Rate for Payer: Cash Price	$2,319.20
Rate for Payer: Mclaren Medicaid	$768.08
Rate for Payer: Meridian Medicaid	$806.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,174.25
Rate for Payer: Priority Health Choice Medicaid	$768.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,083.16
Rate for Payer: Priority Health Narrow/Tiered Network	$2,083.16
Rate for Payer: UHC Medicaid	$768.08
Rate for Payer: UHCCP Medicaid	$768.08

PR BYPASS W/VEIN SPLENORENAL

Professional

Both

$5,052.00

Service Code	HCPCS 35536
Min. Negotiated Rate	$979.16
Max. Negotiated Rate	$3,789.00
Rate for Payer: Aetna Commercial	$2,274.13
Rate for Payer: Aetna Medicare	$2,526.00
Rate for Payer: BCBS Complete	$1,028.12
Rate for Payer: BCN Commercial	$2,469.48
Rate for Payer: Cash Price	$4,041.60
Rate for Payer: Cash Price	$4,041.60
Rate for Payer: Mclaren Medicaid	$979.16
Rate for Payer: Meridian Medicaid	$1,028.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,789.00
Rate for Payer: Priority Health Choice Medicaid	$979.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,655.62
Rate for Payer: Priority Health Narrow/Tiered Network	$2,655.62
Rate for Payer: UHC Medicaid	$979.16
Rate for Payer: UHCCP Medicaid	$979.16

PR BYPASS W/VEIN SUBCLAVIAN-BRACHIAL

Professional

Both

$2,620.00

Service Code	HCPCS 35512
Min. Negotiated Rate	$699.71
Max. Negotiated Rate	$1,965.00
Rate for Payer: Aetna Commercial	$1,621.03
Rate for Payer: Aetna Medicare	$1,310.00
Rate for Payer: BCBS Complete	$734.70
Rate for Payer: BCN Commercial	$1,762.85
Rate for Payer: Cash Price	$2,096.00
Rate for Payer: Cash Price	$2,096.00
Rate for Payer: Mclaren Medicaid	$699.71
Rate for Payer: Meridian Medicaid	$734.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,965.00
Rate for Payer: Priority Health Choice Medicaid	$699.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,895.73
Rate for Payer: Priority Health Narrow/Tiered Network	$1,895.73
Rate for Payer: UHC Medicaid	$699.71
Rate for Payer: UHCCP Medicaid	$699.71

PR BYPASS W/VEIN SUBCLAVIAN-SUBCLAVIAN

Professional

Both

$4,311.00

Service Code	HCPCS 35511
Min. Negotiated Rate	$650.29
Max. Negotiated Rate	$3,233.25
Rate for Payer: Aetna Commercial	$1,507.56
Rate for Payer: Aetna Medicare	$2,155.50
Rate for Payer: BCBS Complete	$682.80
Rate for Payer: BCN Commercial	$1,638.35
Rate for Payer: Cash Price	$3,448.80
Rate for Payer: Cash Price	$3,448.80
Rate for Payer: Mclaren Medicaid	$650.29
Rate for Payer: Meridian Medicaid	$682.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,233.25
Rate for Payer: Priority Health Choice Medicaid	$650.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,761.85
Rate for Payer: Priority Health Narrow/Tiered Network	$1,761.85
Rate for Payer: UHC Medicaid	$650.29
Rate for Payer: UHCCP Medicaid	$650.29

PR BYP AUTOG COMPOSIT 2 SEG VEINS FROM 2 LOCATIONS

Professional

Both

$727.00

Service Code	HCPCS 35682
Min. Negotiated Rate	$201.07
Max. Negotiated Rate	$549.98
Rate for Payer: Aetna Commercial	$476.87
Rate for Payer: Aetna Medicare	$363.50
Rate for Payer: BCBS Complete	$211.12
Rate for Payer: BCN Commercial	$511.43
Rate for Payer: Cash Price	$581.60
Rate for Payer: Cash Price	$581.60
Rate for Payer: Mclaren Medicaid	$201.07
Rate for Payer: Meridian Medicaid	$211.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$545.25
Rate for Payer: Priority Health Choice Medicaid	$201.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$549.98
Rate for Payer: Priority Health Narrow/Tiered Network	$549.98
Rate for Payer: UHC Medicaid	$201.07
Rate for Payer: UHCCP Medicaid	$201.07

PR BYP AUTOG COMPOSIT 3/> SEG FROM 2/> LOCATION

Professional

Both

$892.00

Service Code	HCPCS 35683
Min. Negotiated Rate	$235.37
Max. Negotiated Rate	$669.00
Rate for Payer: Aetna Commercial	$551.97
Rate for Payer: Aetna Medicare	$446.00
Rate for Payer: BCBS Complete	$247.14
Rate for Payer: BCN Commercial	$596.08
Rate for Payer: Cash Price	$713.60
Rate for Payer: Cash Price	$713.60
Rate for Payer: Mclaren Medicaid	$235.37
Rate for Payer: Meridian Medicaid	$247.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$669.00
Rate for Payer: Priority Health Choice Medicaid	$235.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$641.02
Rate for Payer: Priority Health Narrow/Tiered Network	$641.02
Rate for Payer: UHC Medicaid	$235.37
Rate for Payer: UHCCP Medicaid	$235.37

PR BYP FEM-ANT TIBL PST TIBL PRONEAL ART/OTH DSTL

Professional

Both

$4,975.00

Service Code	HCPCS 35566
Min. Negotiated Rate	$957.65
Max. Negotiated Rate	$3,731.25
Rate for Payer: Aetna Commercial	$2,244.41
Rate for Payer: Aetna Medicare	$2,487.50
Rate for Payer: BCBS Complete	$1,005.53
Rate for Payer: BCN Commercial	$2,420.69
Rate for Payer: Cash Price	$3,980.00
Rate for Payer: Cash Price	$3,980.00
Rate for Payer: Mclaren Medicaid	$957.65
Rate for Payer: Meridian Medicaid	$1,005.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,731.25
Rate for Payer: Priority Health Choice Medicaid	$957.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,603.14
Rate for Payer: Priority Health Narrow/Tiered Network	$2,603.14
Rate for Payer: UHC Medicaid	$957.65
Rate for Payer: UHCCP Medicaid	$957.65

PR BYP GRF W/DESCENDING THORACIC AORTA RPR NECK INC

Professional

Both

$2,023.00

Service Code	HCPCS 33891
Min. Negotiated Rate	$809.20
Max. Negotiated Rate	$1,517.25
Rate for Payer: Aetna Commercial	$1,300.03
Rate for Payer: Aetna Medicare	$1,011.50
Rate for Payer: BCBS Complete	$809.20
Rate for Payer: BCN Commercial	$1,401.32
Rate for Payer: Cash Price	$1,618.40
Rate for Payer: Cash Price	$1,618.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,517.25

PR BYP TIBL-TIBL/PRONEAL-TIBL/TIBL/PRONEAL TRK-TIBL

Professional

Both

$2,882.00

Service Code	HCPCS 35570
Min. Negotiated Rate	$854.98
Max. Negotiated Rate	$2,316.64
Rate for Payer: Aetna Commercial	$1,981.51
Rate for Payer: Aetna Medicare	$1,441.00
Rate for Payer: BCBS Complete	$897.73
Rate for Payer: BCN Commercial	$2,154.27
Rate for Payer: Cash Price	$2,305.60
Rate for Payer: Cash Price	$2,305.60
Rate for Payer: Mclaren Medicaid	$854.98
Rate for Payer: Meridian Medicaid	$897.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,161.50
Rate for Payer: Priority Health Choice Medicaid	$854.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,316.64
Rate for Payer: Priority Health Narrow/Tiered Network	$2,316.64
Rate for Payer: UHC Medicaid	$854.98
Rate for Payer: UHCCP Medicaid	$854.98

PR BYP W/VEIN POP-TIBL-PRONEAL ART/OTH DSTL VSL

Professional

Both

$5,395.00

Service Code	HCPCS 35571
Min. Negotiated Rate	$765.52
Max. Negotiated Rate	$4,046.25
Rate for Payer: Aetna Commercial	$1,782.25
Rate for Payer: Aetna Medicare	$2,697.50
Rate for Payer: BCBS Complete	$803.80
Rate for Payer: BCN Commercial	$1,931.17
Rate for Payer: Cash Price	$4,316.00
Rate for Payer: Cash Price	$4,316.00
Rate for Payer: Mclaren Medicaid	$765.52
Rate for Payer: Meridian Medicaid	$803.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,046.25
Rate for Payer: Priority Health Choice Medicaid	$765.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,076.73
Rate for Payer: Priority Health Narrow/Tiered Network	$2,076.73
Rate for Payer: UHC Medicaid	$765.52
Rate for Payer: UHCCP Medicaid	$765.52

PR CABG W/ARTERIAL GRAFT FOUR/>ARTERIAL GRAFTS

Professional

Both

$5,667.00

Service Code	HCPCS 33536
Min. Negotiated Rate	$1,569.17
Max. Negotiated Rate	$4,250.25
Rate for Payer: Aetna Commercial	$3,540.72
Rate for Payer: Aetna Medicare	$2,833.50
Rate for Payer: BCBS Complete	$1,647.63
Rate for Payer: BCN Commercial	$3,871.30
Rate for Payer: Cash Price	$4,533.60
Rate for Payer: Cash Price	$4,533.60
Rate for Payer: Mclaren Medicaid	$1,569.17
Rate for Payer: Meridian Medicaid	$1,647.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,250.25
Rate for Payer: Priority Health Choice Medicaid	$1,569.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4,163.10
Rate for Payer: Priority Health Narrow/Tiered Network	$4,163.10
Rate for Payer: UHC Medicaid	$1,569.17
Rate for Payer: UHCCP Medicaid	$1,569.17

Know your out-of-pocket cost for care.

All Charges