Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR BYP OTH/THN VEIN AXILLARY-AXILLARY

Professional

Both

$2,215.00

Service Code	HCPCS 35650
Min. Negotiated Rate	$886.00
Max. Negotiated Rate	$1,439.75
Rate for Payer: Aetna Commercial	$1,319.48
Rate for Payer: Aetna Medicare	$1,024.08
Rate for Payer: BCBS Complete	$886.00
Rate for Payer: BCBS MAPPO	$984.69
Rate for Payer: BCN Medicare Advantage	$984.69
Rate for Payer: Cash Price	$1,772.00
Rate for Payer: Cash Price	$1,772.00
Rate for Payer: Cofinity Commercial	$1,417.95
Rate for Payer: Cofinity Commercial	$1,319.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$984.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,033.92
Rate for Payer: Nomi Health Commercial	$1,181.63
Rate for Payer: PACE SWMI	$984.69
Rate for Payer: PHP Medicare Advantage	$984.69
Rate for Payer: Priority Health Cigna Priority Health	$1,439.75
Rate for Payer: Priority Health Medicare	$994.54
Rate for Payer: UHC All Payor (Choice/PPO)	$984.69
Rate for Payer: UHC Dual Complete DSNP	$984.69
Rate for Payer: UHC Exchange	$984.69
Rate for Payer: UHC Medicare Advantage	$984.69

PR BYP OTH/THN VEIN AXILLARY-FEMORAL

Professional

Both

$4,190.00

Service Code	HCPCS 35621
Min. Negotiated Rate	$1,050.35
Max. Negotiated Rate	$2,723.50
Rate for Payer: Aetna Commercial	$1,407.47
Rate for Payer: Aetna Medicare	$1,092.36
Rate for Payer: BCBS Complete	$1,676.00
Rate for Payer: BCBS MAPPO	$1,050.35
Rate for Payer: BCN Medicare Advantage	$1,050.35
Rate for Payer: Cash Price	$3,352.00
Rate for Payer: Cash Price	$3,352.00
Rate for Payer: Cofinity Commercial	$1,512.50
Rate for Payer: Cofinity Commercial	$1,407.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,050.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,102.87
Rate for Payer: Nomi Health Commercial	$1,260.42
Rate for Payer: PACE SWMI	$1,050.35
Rate for Payer: PHP Medicare Advantage	$1,050.35
Rate for Payer: Priority Health Cigna Priority Health	$2,723.50
Rate for Payer: Priority Health Medicare	$1,060.85
Rate for Payer: UHC All Payor (Choice/PPO)	$1,050.35
Rate for Payer: UHC Dual Complete DSNP	$1,050.35
Rate for Payer: UHC Exchange	$1,050.35
Rate for Payer: UHC Medicare Advantage	$1,050.35

PR BYP OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL

Professional

Both

$4,922.00

Service Code	HCPCS 35654
Min. Negotiated Rate	$1,310.50
Max. Negotiated Rate	$3,199.30
Rate for Payer: Aetna Commercial	$1,756.07
Rate for Payer: Aetna Medicare	$1,362.92
Rate for Payer: BCBS Complete	$1,968.80
Rate for Payer: BCBS MAPPO	$1,310.50
Rate for Payer: BCN Medicare Advantage	$1,310.50
Rate for Payer: Cash Price	$3,937.60
Rate for Payer: Cash Price	$3,937.60
Rate for Payer: Cofinity Commercial	$1,887.12
Rate for Payer: Cofinity Commercial	$1,756.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,310.50
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,376.03
Rate for Payer: Nomi Health Commercial	$1,572.60
Rate for Payer: PACE SWMI	$1,310.50
Rate for Payer: PHP Medicare Advantage	$1,310.50
Rate for Payer: Priority Health Cigna Priority Health	$3,199.30
Rate for Payer: Priority Health Medicare	$1,323.61
Rate for Payer: UHC All Payor (Choice/PPO)	$1,310.50
Rate for Payer: UHC Dual Complete DSNP	$1,310.50
Rate for Payer: UHC Exchange	$1,310.50
Rate for Payer: UHC Medicare Advantage	$1,310.50

PR BYP OTH/THN VEIN CAROTID-SUBCLAVIAN

Professional

Both

$2,324.00

Service Code	HCPCS 35606
Min. Negotiated Rate	$929.60
Max. Negotiated Rate	$1,621.64
Rate for Payer: Aetna Commercial	$1,509.03
Rate for Payer: Aetna Medicare	$1,171.19
Rate for Payer: BCBS Complete	$929.60
Rate for Payer: BCBS MAPPO	$1,126.14
Rate for Payer: BCN Medicare Advantage	$1,126.14
Rate for Payer: Cash Price	$1,859.20
Rate for Payer: Cash Price	$1,859.20
Rate for Payer: Cofinity Commercial	$1,621.64
Rate for Payer: Cofinity Commercial	$1,509.03
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,126.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,182.45
Rate for Payer: Nomi Health Commercial	$1,351.37
Rate for Payer: PACE SWMI	$1,126.14
Rate for Payer: PHP Medicare Advantage	$1,126.14
Rate for Payer: Priority Health Cigna Priority Health	$1,510.60
Rate for Payer: Priority Health Medicare	$1,137.40
Rate for Payer: UHC All Payor (Choice/PPO)	$1,126.14
Rate for Payer: UHC Dual Complete DSNP	$1,126.14
Rate for Payer: UHC Exchange	$1,126.14
Rate for Payer: UHC Medicare Advantage	$1,126.14

PR BYP OTH/THN VEIN COMMON-IPSILATERAL CAROTID

Professional

Both

$2,942.00

Service Code	HCPCS 35601
Min. Negotiated Rate	$1,176.80
Max. Negotiated Rate	$1,944.81
Rate for Payer: Aetna Commercial	$1,809.75
Rate for Payer: Aetna Medicare	$1,404.58
Rate for Payer: BCBS Complete	$1,176.80
Rate for Payer: BCBS MAPPO	$1,350.56
Rate for Payer: BCN Medicare Advantage	$1,350.56
Rate for Payer: Cash Price	$2,353.60
Rate for Payer: Cash Price	$2,353.60
Rate for Payer: Cofinity Commercial	$1,944.81
Rate for Payer: Cofinity Commercial	$1,809.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,350.56
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,418.09
Rate for Payer: Nomi Health Commercial	$1,620.67
Rate for Payer: PACE SWMI	$1,350.56
Rate for Payer: PHP Medicare Advantage	$1,350.56
Rate for Payer: Priority Health Cigna Priority Health	$1,912.30
Rate for Payer: Priority Health Medicare	$1,364.07
Rate for Payer: UHC All Payor (Choice/PPO)	$1,350.56
Rate for Payer: UHC Dual Complete DSNP	$1,350.56
Rate for Payer: UHC Exchange	$1,350.56
Rate for Payer: UHC Medicare Advantage	$1,350.56

PR BYP OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRONEAL

Professional

Both

$4,208.00

Service Code	HCPCS 35666
Min. Negotiated Rate	$1,227.19
Max. Negotiated Rate	$2,735.20
Rate for Payer: Aetna Commercial	$1,644.43
Rate for Payer: Aetna Medicare	$1,276.28
Rate for Payer: BCBS Complete	$1,683.20
Rate for Payer: BCBS MAPPO	$1,227.19
Rate for Payer: BCN Medicare Advantage	$1,227.19
Rate for Payer: Cash Price	$3,366.40
Rate for Payer: Cash Price	$3,366.40
Rate for Payer: Cofinity Commercial	$1,767.15
Rate for Payer: Cofinity Commercial	$1,644.43
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,227.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,288.55
Rate for Payer: Nomi Health Commercial	$1,472.63
Rate for Payer: PACE SWMI	$1,227.19
Rate for Payer: PHP Medicare Advantage	$1,227.19
Rate for Payer: Priority Health Cigna Priority Health	$2,735.20
Rate for Payer: Priority Health Medicare	$1,239.46
Rate for Payer: UHC All Payor (Choice/PPO)	$1,227.19
Rate for Payer: UHC Dual Complete DSNP	$1,227.19
Rate for Payer: UHC Exchange	$1,227.19
Rate for Payer: UHC Medicare Advantage	$1,227.19

PR BYP OTH/THN VEIN FEMORAL-FEMORAL

Professional

Both

$2,253.00

Service Code	HCPCS 35661
Min. Negotiated Rate	$901.20
Max. Negotiated Rate	$1,493.06
Rate for Payer: Aetna Commercial	$1,389.38
Rate for Payer: Aetna Medicare	$1,078.32
Rate for Payer: BCBS Complete	$901.20
Rate for Payer: BCBS MAPPO	$1,036.85
Rate for Payer: BCN Medicare Advantage	$1,036.85
Rate for Payer: Cash Price	$1,802.40
Rate for Payer: Cash Price	$1,802.40
Rate for Payer: Cofinity Commercial	$1,493.06
Rate for Payer: Cofinity Commercial	$1,389.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,036.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,088.69
Rate for Payer: Nomi Health Commercial	$1,244.22
Rate for Payer: PACE SWMI	$1,036.85
Rate for Payer: PHP Medicare Advantage	$1,036.85
Rate for Payer: Priority Health Cigna Priority Health	$1,464.45
Rate for Payer: Priority Health Medicare	$1,047.22
Rate for Payer: UHC All Payor (Choice/PPO)	$1,036.85
Rate for Payer: UHC Dual Complete DSNP	$1,036.85
Rate for Payer: UHC Exchange	$1,036.85
Rate for Payer: UHC Medicare Advantage	$1,036.85

PR BYP OTH/THN VEIN FEMORAL-POPLITEAL

Professional

Both

$2,278.00

Service Code	HCPCS 35656
Min. Negotiated Rate	$911.20
Max. Negotiated Rate	$1,480.70
Rate for Payer: Aetna Commercial	$1,375.97
Rate for Payer: Aetna Medicare	$1,067.91
Rate for Payer: BCBS Complete	$911.20
Rate for Payer: BCBS MAPPO	$1,026.84
Rate for Payer: BCN Medicare Advantage	$1,026.84
Rate for Payer: Cash Price	$1,822.40
Rate for Payer: Cash Price	$1,822.40
Rate for Payer: Cofinity Commercial	$1,478.65
Rate for Payer: Cofinity Commercial	$1,375.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,026.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,078.18
Rate for Payer: Nomi Health Commercial	$1,232.21
Rate for Payer: PACE SWMI	$1,026.84
Rate for Payer: PHP Medicare Advantage	$1,026.84
Rate for Payer: Priority Health Cigna Priority Health	$1,480.70
Rate for Payer: Priority Health Medicare	$1,037.11
Rate for Payer: UHC All Payor (Choice/PPO)	$1,026.84
Rate for Payer: UHC Dual Complete DSNP	$1,026.84
Rate for Payer: UHC Exchange	$1,026.84
Rate for Payer: UHC Medicare Advantage	$1,026.84

PR BYP OTH/THN VEIN ILIOFEMORAL

Professional

Both

$4,582.00

Service Code	HCPCS 35665
Min. Negotiated Rate	$1,123.50
Max. Negotiated Rate	$2,978.30
Rate for Payer: Aetna Commercial	$1,505.49
Rate for Payer: Aetna Medicare	$1,168.44
Rate for Payer: BCBS Complete	$1,832.80
Rate for Payer: BCBS MAPPO	$1,123.50
Rate for Payer: BCN Medicare Advantage	$1,123.50
Rate for Payer: Cash Price	$3,665.60
Rate for Payer: Cash Price	$3,665.60
Rate for Payer: Cofinity Commercial	$1,617.84
Rate for Payer: Cofinity Commercial	$1,505.49
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,123.50
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,179.67
Rate for Payer: Nomi Health Commercial	$1,348.20
Rate for Payer: PACE SWMI	$1,123.50
Rate for Payer: PHP Medicare Advantage	$1,123.50
Rate for Payer: Priority Health Cigna Priority Health	$2,978.30
Rate for Payer: Priority Health Medicare	$1,134.73
Rate for Payer: UHC All Payor (Choice/PPO)	$1,123.50
Rate for Payer: UHC Dual Complete DSNP	$1,123.50
Rate for Payer: UHC Exchange	$1,123.50
Rate for Payer: UHC Medicare Advantage	$1,123.50

PR BYP OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART

Professional

Both

$2,203.00

Service Code	HCPCS 35671
Min. Negotiated Rate	$881.20
Max. Negotiated Rate	$1,550.22
Rate for Payer: Aetna Commercial	$1,442.56
Rate for Payer: Aetna Medicare	$1,119.60
Rate for Payer: BCBS Complete	$881.20
Rate for Payer: BCBS MAPPO	$1,076.54
Rate for Payer: BCN Medicare Advantage	$1,076.54
Rate for Payer: Cash Price	$1,762.40
Rate for Payer: Cash Price	$1,762.40
Rate for Payer: Cofinity Commercial	$1,550.22
Rate for Payer: Cofinity Commercial	$1,442.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,076.54
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,130.37
Rate for Payer: Nomi Health Commercial	$1,291.85
Rate for Payer: PACE SWMI	$1,076.54
Rate for Payer: PHP Medicare Advantage	$1,076.54
Rate for Payer: Priority Health Cigna Priority Health	$1,431.95
Rate for Payer: Priority Health Medicare	$1,087.31
Rate for Payer: UHC All Payor (Choice/PPO)	$1,076.54
Rate for Payer: UHC Dual Complete DSNP	$1,076.54
Rate for Payer: UHC Exchange	$1,076.54
Rate for Payer: UHC Medicare Advantage	$1,076.54

PR BYP OTH/THN VEIN SUBCLAVIAN-SUBCLAVIAN

Professional

Both

$2,244.00

Service Code	HCPCS 35612
Min. Negotiated Rate	$897.60
Max. Negotiated Rate	$1,458.60
Rate for Payer: Aetna Commercial	$1,350.12
Rate for Payer: Aetna Medicare	$1,047.85
Rate for Payer: BCBS Complete	$897.60
Rate for Payer: BCBS MAPPO	$1,007.55
Rate for Payer: BCN Medicare Advantage	$1,007.55
Rate for Payer: Cash Price	$1,795.20
Rate for Payer: Cash Price	$1,795.20
Rate for Payer: Cofinity Commercial	$1,450.87
Rate for Payer: Cofinity Commercial	$1,350.12
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,007.55
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,057.93
Rate for Payer: Nomi Health Commercial	$1,209.06
Rate for Payer: PACE SWMI	$1,007.55
Rate for Payer: PHP Medicare Advantage	$1,007.55
Rate for Payer: Priority Health Cigna Priority Health	$1,458.60
Rate for Payer: Priority Health Medicare	$1,017.63
Rate for Payer: UHC All Payor (Choice/PPO)	$1,007.55
Rate for Payer: UHC Dual Complete DSNP	$1,007.55
Rate for Payer: UHC Exchange	$1,007.55
Rate for Payer: UHC Medicare Advantage	$1,007.55

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

Professional

Both

$2,798.00

Service Code	HCPCS 35570
Min. Negotiated Rate	$1,119.20
Max. Negotiated Rate	$2,044.01
Rate for Payer: Aetna Commercial	$1,902.06
Rate for Payer: Aetna Medicare	$1,476.23
Rate for Payer: BCBS Complete	$1,119.20
Rate for Payer: BCBS MAPPO	$1,419.45
Rate for Payer: BCN Medicare Advantage	$1,419.45
Rate for Payer: Cash Price	$2,238.40
Rate for Payer: Cash Price	$2,238.40
Rate for Payer: Cofinity Commercial	$2,044.01
Rate for Payer: Cofinity Commercial	$1,902.06
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,419.45
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,490.42
Rate for Payer: Nomi Health Commercial	$1,703.34
Rate for Payer: PACE SWMI	$1,419.45
Rate for Payer: PHP Medicare Advantage	$1,419.45
Rate for Payer: Priority Health Cigna Priority Health	$1,818.70
Rate for Payer: Priority Health Medicare	$1,433.64
Rate for Payer: UHC All Payor (Choice/PPO)	$1,419.45
Rate for Payer: UHC Dual Complete DSNP	$1,419.45
Rate for Payer: UHC Exchange	$1,419.45
Rate for Payer: UHC Medicare Advantage	$1,419.45

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

Professional

Both

$5,238.00

Service Code	HCPCS 35571
Min. Negotiated Rate	$1,269.45
Max. Negotiated Rate	$3,404.70
Rate for Payer: Aetna Commercial	$1,701.06
Rate for Payer: Aetna Medicare	$1,320.23
Rate for Payer: BCBS Complete	$2,095.20
Rate for Payer: BCBS MAPPO	$1,269.45
Rate for Payer: BCN Medicare Advantage	$1,269.45
Rate for Payer: Cash Price	$4,190.40
Rate for Payer: Cash Price	$4,190.40
Rate for Payer: Cofinity Commercial	$1,828.01
Rate for Payer: Cofinity Commercial	$1,701.06
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,269.45
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,332.92
Rate for Payer: Nomi Health Commercial	$1,523.34
Rate for Payer: PACE SWMI	$1,269.45
Rate for Payer: PHP Medicare Advantage	$1,269.45
Rate for Payer: Priority Health Cigna Priority Health	$3,404.70
Rate for Payer: Priority Health Medicare	$1,282.14
Rate for Payer: UHC All Payor (Choice/PPO)	$1,269.45
Rate for Payer: UHC Dual Complete DSNP	$1,269.45
Rate for Payer: UHC Exchange	$1,269.45
Rate for Payer: UHC Medicare Advantage	$1,269.45

PR CABG W/ARTERIAL GRAFT FOUR/>ARTERIAL GRAFTS

Professional

Both

$5,502.00

Service Code	HCPCS 33536
Min. Negotiated Rate	$2,200.80
Max. Negotiated Rate	$3,638.79
Rate for Payer: Aetna Commercial	$3,386.10
Rate for Payer: Aetna Medicare	$2,628.02
Rate for Payer: BCBS Complete	$2,200.80
Rate for Payer: BCBS MAPPO	$2,526.94
Rate for Payer: BCN Medicare Advantage	$2,526.94
Rate for Payer: Cash Price	$4,401.60
Rate for Payer: Cash Price	$4,401.60
Rate for Payer: Cofinity Commercial	$3,638.79
Rate for Payer: Cofinity Commercial	$3,386.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,526.94
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,653.29
Rate for Payer: Nomi Health Commercial	$3,032.33
Rate for Payer: PACE SWMI	$2,526.94
Rate for Payer: PHP Medicare Advantage	$2,526.94
Rate for Payer: Priority Health Cigna Priority Health	$3,576.30
Rate for Payer: Priority Health Medicare	$2,552.21
Rate for Payer: UHC All Payor (Choice/PPO)	$2,526.94
Rate for Payer: UHC Dual Complete DSNP	$2,526.94
Rate for Payer: UHC Exchange	$2,526.94
Rate for Payer: UHC Medicare Advantage	$2,526.94

PR CABG W/ARTERIAL GRAFT SINGLE ARTERIAL GRAFT

Professional

Both

$3,911.00

Service Code	HCPCS 33533
Min. Negotiated Rate	$1,564.40
Max. Negotiated Rate	$2,584.77
Rate for Payer: Aetna Commercial	$2,405.27
Rate for Payer: Aetna Medicare	$1,866.78
Rate for Payer: BCBS Complete	$1,564.40
Rate for Payer: BCBS MAPPO	$1,794.98
Rate for Payer: BCN Medicare Advantage	$1,794.98
Rate for Payer: Cash Price	$3,128.80
Rate for Payer: Cash Price	$3,128.80
Rate for Payer: Cofinity Commercial	$2,584.77
Rate for Payer: Cofinity Commercial	$2,405.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,794.98
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,884.73
Rate for Payer: Nomi Health Commercial	$2,153.98
Rate for Payer: PACE SWMI	$1,794.98
Rate for Payer: PHP Medicare Advantage	$1,794.98
Rate for Payer: Priority Health Cigna Priority Health	$2,542.15
Rate for Payer: Priority Health Medicare	$1,812.93
Rate for Payer: UHC All Payor (Choice/PPO)	$1,794.98
Rate for Payer: UHC Dual Complete DSNP	$1,794.98
Rate for Payer: UHC Exchange	$1,794.98
Rate for Payer: UHC Medicare Advantage	$1,794.98

PR CABG W/ARTERIAL GRAFT THREE ARTERIAL GRAFTS

Professional

Both

$5,136.00

Service Code	HCPCS 33535
Min. Negotiated Rate	$2,054.40
Max. Negotiated Rate	$3,376.31
Rate for Payer: Aetna Commercial	$3,141.84
Rate for Payer: Aetna Medicare	$2,438.45
Rate for Payer: BCBS Complete	$2,054.40
Rate for Payer: BCBS MAPPO	$2,344.66
Rate for Payer: BCN Medicare Advantage	$2,344.66
Rate for Payer: Cash Price	$4,108.80
Rate for Payer: Cash Price	$4,108.80
Rate for Payer: Cofinity Commercial	$3,376.31
Rate for Payer: Cofinity Commercial	$3,141.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,344.66
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,461.89
Rate for Payer: Nomi Health Commercial	$2,813.59
Rate for Payer: PACE SWMI	$2,344.66
Rate for Payer: PHP Medicare Advantage	$2,344.66
Rate for Payer: Priority Health Cigna Priority Health	$3,338.40
Rate for Payer: Priority Health Medicare	$2,368.11
Rate for Payer: UHC All Payor (Choice/PPO)	$2,344.66
Rate for Payer: UHC Dual Complete DSNP	$2,344.66
Rate for Payer: UHC Exchange	$2,344.66
Rate for Payer: UHC Medicare Advantage	$2,344.66

PR CABG W/ARTERIAL GRAFT TWO ARTERIAL GRAFTS

Professional

Both

$4,602.00

Service Code	HCPCS 33534
Min. Negotiated Rate	$1,840.80
Max. Negotiated Rate	$3,037.80
Rate for Payer: Aetna Commercial	$2,826.84
Rate for Payer: Aetna Medicare	$2,193.96
Rate for Payer: BCBS Complete	$1,840.80
Rate for Payer: BCBS MAPPO	$2,109.58
Rate for Payer: BCN Medicare Advantage	$2,109.58
Rate for Payer: Cash Price	$3,681.60
Rate for Payer: Cash Price	$3,681.60
Rate for Payer: Cofinity Commercial	$3,037.80
Rate for Payer: Cofinity Commercial	$2,826.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,109.58
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,215.06
Rate for Payer: Nomi Health Commercial	$2,531.50
Rate for Payer: PACE SWMI	$2,109.58
Rate for Payer: PHP Medicare Advantage	$2,109.58
Rate for Payer: Priority Health Cigna Priority Health	$2,991.30
Rate for Payer: Priority Health Medicare	$2,130.68
Rate for Payer: UHC All Payor (Choice/PPO)	$2,109.58
Rate for Payer: UHC Dual Complete DSNP	$2,109.58
Rate for Payer: UHC Exchange	$2,109.58
Rate for Payer: UHC Medicare Advantage	$2,109.58

PR CALIBRATED MICROCAP TUBE

Professional

Both

$77.00

Service Code	HCPCS A4651
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$50.05
Rate for Payer: Aetna Medicare	$38.50
Rate for Payer: BCBS Complete	$30.80
Rate for Payer: Cash Price	$61.60
Rate for Payer: Priority Health Cigna Priority Health	$50.05

PR CALORIC VESTIBULAR TEST, EACH IRRIGATION, WITH RECORDING

Professional

Both

$19.00

Service Code	HCPCS 92543
Min. Negotiated Rate	$7.60
Max. Negotiated Rate	$12.35
Rate for Payer: Aetna Medicare	$9.50
Rate for Payer: BCBS Complete	$7.60
Rate for Payer: Cash Price	$15.20
Rate for Payer: Priority Health Cigna Priority Health	$12.35

PR CANALITH REPOSITIONING PROCEDURE

Professional

Both

$131.00

Service Code	HCPCS 95992
Min. Negotiated Rate	$33.65
Max. Negotiated Rate	$85.15
Rate for Payer: Aetna Commercial	$45.09
Rate for Payer: Aetna Medicare	$35.00
Rate for Payer: BCBS Complete	$52.40
Rate for Payer: BCBS MAPPO	$33.65
Rate for Payer: BCN Medicare Advantage	$33.65
Rate for Payer: Cash Price	$104.80
Rate for Payer: Cash Price	$104.80
Rate for Payer: Cofinity Commercial	$45.09
Rate for Payer: Cofinity Commercial	$48.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$33.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$35.33
Rate for Payer: Nomi Health Commercial	$40.38
Rate for Payer: PACE SWMI	$33.65
Rate for Payer: PHP Medicare Advantage	$33.65
Rate for Payer: Priority Health Cigna Priority Health	$85.15
Rate for Payer: Priority Health Medicare	$33.99
Rate for Payer: UHC All Payor (Choice/PPO)	$33.65
Rate for Payer: UHC Dual Complete DSNP	$33.65
Rate for Payer: UHC Exchange	$33.65
Rate for Payer: UHC Medicare Advantage	$33.65

PR CANTHOPLASTY

Professional

Both

$1,146.00

Service Code	HCPCS 67950
Min. Negotiated Rate	$427.13
Max. Negotiated Rate	$744.90
Rate for Payer: Aetna Commercial	$572.35
Rate for Payer: Aetna Medicare	$444.22
Rate for Payer: BCBS Complete	$458.40
Rate for Payer: BCBS MAPPO	$427.13
Rate for Payer: BCN Medicare Advantage	$427.13
Rate for Payer: Cash Price	$916.80
Rate for Payer: Cash Price	$916.80
Rate for Payer: Cofinity Commercial	$615.07
Rate for Payer: Cofinity Commercial	$572.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$427.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$448.49
Rate for Payer: Nomi Health Commercial	$512.56
Rate for Payer: PACE SWMI	$427.13
Rate for Payer: PHP Medicare Advantage	$427.13
Rate for Payer: Priority Health Cigna Priority Health	$744.90
Rate for Payer: Priority Health Medicare	$431.40
Rate for Payer: UHC All Payor (Choice/PPO)	$427.13
Rate for Payer: UHC Dual Complete DSNP	$427.13
Rate for Payer: UHC Exchange	$427.13
Rate for Payer: UHC Medicare Advantage	$427.13

PR CANTHOTOMY SEPARATE PROCEDURE

Professional

Both

$374.00

Service Code	HCPCS 67715
Min. Negotiated Rate	$100.57
Max. Negotiated Rate	$243.10
Rate for Payer: Aetna Commercial	$134.76
Rate for Payer: Aetna Medicare	$104.59
Rate for Payer: BCBS Complete	$149.60
Rate for Payer: BCBS MAPPO	$100.57
Rate for Payer: BCN Medicare Advantage	$100.57
Rate for Payer: Cash Price	$299.20
Rate for Payer: Cash Price	$299.20
Rate for Payer: Cofinity Commercial	$144.82
Rate for Payer: Cofinity Commercial	$134.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$100.57
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$105.60
Rate for Payer: Nomi Health Commercial	$120.68
Rate for Payer: PACE SWMI	$100.57
Rate for Payer: PHP Medicare Advantage	$100.57
Rate for Payer: Priority Health Cigna Priority Health	$243.10
Rate for Payer: Priority Health Medicare	$101.58
Rate for Payer: UHC All Payor (Choice/PPO)	$100.57
Rate for Payer: UHC Dual Complete DSNP	$100.57
Rate for Payer: UHC Exchange	$100.57
Rate for Payer: UHC Medicare Advantage	$100.57

PR CAPSLCTOMY/CAPSUL HIP W/RLS HIP FLXR MUSC

Professional

Both

$4,799.00

Service Code	HCPCS 27036
Min. Negotiated Rate	$981.53
Max. Negotiated Rate	$3,119.35
Rate for Payer: Aetna Commercial	$1,315.25
Rate for Payer: Aetna Medicare	$1,020.79
Rate for Payer: BCBS Complete	$1,919.60
Rate for Payer: BCBS MAPPO	$981.53
Rate for Payer: BCN Medicare Advantage	$981.53
Rate for Payer: Cash Price	$3,839.20
Rate for Payer: Cash Price	$3,839.20
Rate for Payer: Cofinity Commercial	$1,413.40
Rate for Payer: Cofinity Commercial	$1,315.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$981.53
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,030.61
Rate for Payer: Nomi Health Commercial	$1,177.84
Rate for Payer: PACE SWMI	$981.53
Rate for Payer: PHP Medicare Advantage	$981.53
Rate for Payer: Priority Health Cigna Priority Health	$3,119.35
Rate for Payer: Priority Health Medicare	$991.35
Rate for Payer: UHC All Payor (Choice/PPO)	$981.53
Rate for Payer: UHC Dual Complete DSNP	$981.53
Rate for Payer: UHC Exchange	$981.53
Rate for Payer: UHC Medicare Advantage	$981.53

PR CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS

Professional

Both

$1,755.00

Service Code	HCPCS 25320
Min. Negotiated Rate	$702.00
Max. Negotiated Rate	$1,374.54
Rate for Payer: Aetna Commercial	$1,279.08
Rate for Payer: Aetna Medicare	$992.72
Rate for Payer: BCBS Complete	$702.00
Rate for Payer: BCBS MAPPO	$954.54
Rate for Payer: BCN Medicare Advantage	$954.54
Rate for Payer: Cash Price	$1,404.00
Rate for Payer: Cash Price	$1,404.00
Rate for Payer: Cofinity Commercial	$1,374.54
Rate for Payer: Cofinity Commercial	$1,279.08
Rate for Payer: Health Alliance Plan Medicare Advantage	$954.54
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,002.27
Rate for Payer: Nomi Health Commercial	$1,145.45
Rate for Payer: PACE SWMI	$954.54
Rate for Payer: PHP Medicare Advantage	$954.54
Rate for Payer: Priority Health Cigna Priority Health	$1,140.75
Rate for Payer: Priority Health Medicare	$964.09
Rate for Payer: UHC All Payor (Choice/PPO)	$954.54
Rate for Payer: UHC Dual Complete DSNP	$954.54
Rate for Payer: UHC Exchange	$954.54
Rate for Payer: UHC Medicare Advantage	$954.54

PR CAPSULAR CONTRACTURE RELEASE

Professional

Both

$2,010.00

Service Code	HCPCS 23020
Min. Negotiated Rate	$668.27
Max. Negotiated Rate	$1,306.50
Rate for Payer: Aetna Commercial	$895.48
Rate for Payer: Aetna Medicare	$695.00
Rate for Payer: BCBS Complete	$804.00
Rate for Payer: BCBS MAPPO	$668.27
Rate for Payer: BCN Medicare Advantage	$668.27
Rate for Payer: Cash Price	$1,608.00
Rate for Payer: Cash Price	$1,608.00
Rate for Payer: Cofinity Commercial	$962.31
Rate for Payer: Cofinity Commercial	$895.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$668.27
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$701.68
Rate for Payer: Nomi Health Commercial	$801.92
Rate for Payer: PACE SWMI	$668.27
Rate for Payer: PHP Medicare Advantage	$668.27
Rate for Payer: Priority Health Cigna Priority Health	$1,306.50
Rate for Payer: Priority Health Medicare	$674.95
Rate for Payer: UHC All Payor (Choice/PPO)	$668.27
Rate for Payer: UHC Dual Complete DSNP	$668.27
Rate for Payer: UHC Exchange	$668.27
Rate for Payer: UHC Medicare Advantage	$668.27

Know your out-of-pocket cost for care.

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