Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR PRQ IMPLTJ NEUROSTIM ELTRD SACRAL NRVE W/IMAGING

Professional

Both

$2,049.00

Service Code	HCPCS 64561
Min. Negotiated Rate	$172.96
Max. Negotiated Rate	$1,536.75
Rate for Payer: Aetna Commercial	$390.63
Rate for Payer: Aetna Medicare	$1,024.50
Rate for Payer: BCBS Complete	$181.61
Rate for Payer: BCN Commercial	$452.66
Rate for Payer: Cash Price	$1,639.20
Rate for Payer: Cash Price	$1,639.20
Rate for Payer: Mclaren Medicaid	$172.96
Rate for Payer: Meridian Medicaid	$181.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,536.75
Rate for Payer: Priority Health Choice Medicaid	$172.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$525.76
Rate for Payer: Priority Health Narrow/Tiered Network	$525.76
Rate for Payer: UHC Medicaid	$172.96
Rate for Payer: UHCCP Medicaid	$172.96

PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD CRANIAL NERVE

Professional

Both

$468.00

Service Code	HCPCS 64553
Min. Negotiated Rate	$187.20
Max. Negotiated Rate	$797.61
Rate for Payer: Aetna Commercial	$465.57
Rate for Payer: Aetna Medicare	$234.00
Rate for Payer: BCBS Complete	$187.20
Rate for Payer: BCN Commercial	$686.72
Rate for Payer: Cash Price	$374.40
Rate for Payer: Cash Price	$374.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$351.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$797.61
Rate for Payer: Priority Health Narrow/Tiered Network	$797.61

PR PRQ IMPLTJ NEUROSTIMULATOR ELTRD PERIPHERAL NRV

Professional

Both

$513.00

Service Code	HCPCS 64555
Min. Negotiated Rate	$187.44
Max. Negotiated Rate	$567.41
Rate for Payer: Aetna Commercial	$436.80
Rate for Payer: Aetna Medicare	$256.50
Rate for Payer: BCBS Complete	$196.81
Rate for Payer: BCN Commercial	$488.52
Rate for Payer: Cash Price	$410.40
Rate for Payer: Cash Price	$410.40
Rate for Payer: Mclaren Medicaid	$187.44
Rate for Payer: Meridian Medicaid	$196.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$384.75
Rate for Payer: Priority Health Choice Medicaid	$187.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$567.41
Rate for Payer: Priority Health Narrow/Tiered Network	$567.41
Rate for Payer: UHC Medicaid	$187.44
Rate for Payer: UHCCP Medicaid	$187.44

PR PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL

Professional

Both

$5,506.00

Service Code	HCPCS 63650
Min. Negotiated Rate	$239.41
Max. Negotiated Rate	$4,129.50
Rate for Payer: Aetna Commercial	$533.30
Rate for Payer: Aetna Medicare	$2,753.00
Rate for Payer: BCBS Complete	$251.38
Rate for Payer: BCN Commercial	$621.48
Rate for Payer: Cash Price	$4,404.80
Rate for Payer: Cash Price	$4,404.80
Rate for Payer: Mclaren Medicaid	$239.41
Rate for Payer: Meridian Medicaid	$251.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,129.50
Rate for Payer: Priority Health Choice Medicaid	$239.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$721.83
Rate for Payer: Priority Health Narrow/Tiered Network	$721.83
Rate for Payer: UHC Medicaid	$239.41
Rate for Payer: UHCCP Medicaid	$239.41

PR PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL

Professional

Both

$2,544.00

Service Code	HCPCS 47533
Min. Negotiated Rate	$144.63
Max. Negotiated Rate	$1,908.00
Rate for Payer: Aetna Commercial	$352.38
Rate for Payer: Aetna Medicare	$1,272.00
Rate for Payer: BCBS Complete	$151.86
Rate for Payer: BCN Commercial	$383.94
Rate for Payer: Cash Price	$2,035.20
Rate for Payer: Cash Price	$2,035.20
Rate for Payer: Mclaren Medicaid	$144.63
Rate for Payer: Meridian Medicaid	$151.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,908.00
Rate for Payer: Priority Health Choice Medicaid	$144.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$467.81
Rate for Payer: Priority Health Narrow/Tiered Network	$467.81
Rate for Payer: UHC Medicaid	$144.63
Rate for Payer: UHCCP Medicaid	$144.63

PR PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE

Professional

Both

$1,709.00

Service Code	HCPCS 27756
Min. Negotiated Rate	$359.97
Max. Negotiated Rate	$1,281.75
Rate for Payer: Aetna Commercial	$767.95
Rate for Payer: Aetna Medicare	$854.50
Rate for Payer: BCBS Complete	$377.97
Rate for Payer: BCN Commercial	$903.84
Rate for Payer: Cash Price	$1,367.20
Rate for Payer: Cash Price	$1,367.20
Rate for Payer: Mclaren Medicaid	$359.97
Rate for Payer: Meridian Medicaid	$377.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,281.75
Rate for Payer: Priority Health Choice Medicaid	$359.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$966.18
Rate for Payer: Priority Health Narrow/Tiered Network	$966.18
Rate for Payer: UHC Medicaid	$359.97
Rate for Payer: UHCCP Medicaid	$359.97

PR PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB

Professional

Both

$1,586.00

Service Code	HCPCS 26650
Min. Negotiated Rate	$300.12
Max. Negotiated Rate	$1,189.50
Rate for Payer: Aetna Commercial	$639.26
Rate for Payer: Aetna Medicare	$793.00
Rate for Payer: BCBS Complete	$315.13
Rate for Payer: BCN Commercial	$747.47
Rate for Payer: Cash Price	$1,268.80
Rate for Payer: Cash Price	$1,268.80
Rate for Payer: Mclaren Medicaid	$300.12
Rate for Payer: Meridian Medicaid	$315.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,189.50
Rate for Payer: Priority Health Choice Medicaid	$300.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$799.02
Rate for Payer: Priority Health Narrow/Tiered Network	$799.02
Rate for Payer: UHC Medicaid	$300.12
Rate for Payer: UHCCP Medicaid	$300.12

PR PRQ SKELETAL FIXJ FEMORAL FX DISTAL END

Professional

Both

$2,303.00

Service Code	HCPCS 27509
Min. Negotiated Rate	$416.20
Max. Negotiated Rate	$1,727.25
Rate for Payer: Aetna Commercial	$894.48
Rate for Payer: Aetna Medicare	$1,151.50
Rate for Payer: BCBS Complete	$437.01
Rate for Payer: BCN Commercial	$1,031.31
Rate for Payer: Cash Price	$1,842.40
Rate for Payer: Cash Price	$1,842.40
Rate for Payer: Mclaren Medicaid	$416.20
Rate for Payer: Meridian Medicaid	$437.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,727.25
Rate for Payer: Priority Health Choice Medicaid	$416.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,102.46
Rate for Payer: Priority Health Narrow/Tiered Network	$1,102.46
Rate for Payer: UHC Medicaid	$416.20
Rate for Payer: UHCCP Medicaid	$416.20

PR PRQ SKELETAL FIXJ METACARPAL FX EACH BONE

Professional

Both

$1,586.00

Service Code	HCPCS 26608
Min. Negotiated Rate	$296.07
Max. Negotiated Rate	$1,189.50
Rate for Payer: Aetna Commercial	$640.23
Rate for Payer: Aetna Medicare	$793.00
Rate for Payer: BCBS Complete	$310.87
Rate for Payer: BCN Commercial	$743.98
Rate for Payer: Cash Price	$1,268.80
Rate for Payer: Cash Price	$1,268.80
Rate for Payer: Mclaren Medicaid	$296.07
Rate for Payer: Meridian Medicaid	$310.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,189.50
Rate for Payer: Priority Health Choice Medicaid	$296.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$795.30
Rate for Payer: Priority Health Narrow/Tiered Network	$795.30
Rate for Payer: UHC Medicaid	$296.07
Rate for Payer: UHCCP Medicaid	$296.07

PR PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT

Professional

Both

$1,700.00

Service Code	HCPCS 26676
Min. Negotiated Rate	$311.83
Max. Negotiated Rate	$1,275.00
Rate for Payer: Aetna Commercial	$675.35
Rate for Payer: Aetna Medicare	$850.00
Rate for Payer: BCBS Complete	$327.42
Rate for Payer: BCN Commercial	$789.79
Rate for Payer: Cash Price	$1,360.00
Rate for Payer: Cash Price	$1,360.00
Rate for Payer: Mclaren Medicaid	$311.83
Rate for Payer: Meridian Medicaid	$327.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,275.00
Rate for Payer: Priority Health Choice Medicaid	$311.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$844.28
Rate for Payer: Priority Health Narrow/Tiered Network	$844.28
Rate for Payer: UHC Medicaid	$311.83
Rate for Payer: UHCCP Medicaid	$311.83

PR PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA

Professional

Both

$1,133.00

Service Code	HCPCS 26756
Min. Negotiated Rate	$264.55
Max. Negotiated Rate	$849.75
Rate for Payer: Aetna Commercial	$560.82
Rate for Payer: Aetna Medicare	$566.50
Rate for Payer: BCBS Complete	$277.78
Rate for Payer: BCN Commercial	$656.84
Rate for Payer: Cash Price	$906.40
Rate for Payer: Cash Price	$906.40
Rate for Payer: Mclaren Medicaid	$264.55
Rate for Payer: Meridian Medicaid	$277.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$849.75
Rate for Payer: Priority Health Choice Medicaid	$264.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$702.14
Rate for Payer: Priority Health Narrow/Tiered Network	$702.14
Rate for Payer: UHC Medicaid	$264.55
Rate for Payer: UHCCP Medicaid	$264.55

PR PRQ SKEL FIXJ FEMORAL FX PROX END NECK

Professional

Both

$3,460.00

Service Code	HCPCS 27235
Min. Negotiated Rate	$533.35
Max. Negotiated Rate	$2,595.00
Rate for Payer: Aetna Commercial	$1,211.46
Rate for Payer: Aetna Medicare	$1,730.00
Rate for Payer: BCBS Complete	$560.02
Rate for Payer: BCN Commercial	$1,512.64
Rate for Payer: Cash Price	$2,768.00
Rate for Payer: Cash Price	$2,768.00
Rate for Payer: Mclaren Medicaid	$533.35
Rate for Payer: Meridian Medicaid	$560.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,595.00
Rate for Payer: Priority Health Choice Medicaid	$533.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,471.89
Rate for Payer: Priority Health Narrow/Tiered Network	$1,471.89
Rate for Payer: UHC Medicaid	$533.35
Rate for Payer: UHCCP Medicaid	$533.35

PR PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ

Professional

Both

$1,156.00

Service Code	HCPCS 28496
Min. Negotiated Rate	$179.13
Max. Negotiated Rate	$867.00
Rate for Payer: Aetna Commercial	$319.73
Rate for Payer: Aetna Medicare	$578.00
Rate for Payer: BCBS Complete	$188.09
Rate for Payer: BCN Commercial	$425.28
Rate for Payer: Cash Price	$924.80
Rate for Payer: Cash Price	$924.80
Rate for Payer: Mclaren Medicaid	$179.13
Rate for Payer: Meridian Medicaid	$188.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$867.00
Rate for Payer: Priority Health Choice Medicaid	$179.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$454.61
Rate for Payer: Priority Health Narrow/Tiered Network	$454.61
Rate for Payer: UHC Medicaid	$179.13
Rate for Payer: UHCCP Medicaid	$179.13

PR PRQ SKEL FIXJ INTERPHALANGEAL JOINT DISLC W/MANJ

Professional

Both

$609.00

Service Code	HCPCS 28666
Min. Negotiated Rate	$104.58
Max. Negotiated Rate	$456.75
Rate for Payer: Aetna Commercial	$229.82
Rate for Payer: Aetna Medicare	$304.50
Rate for Payer: BCBS Complete	$109.81
Rate for Payer: BCN Commercial	$262.93
Rate for Payer: Cash Price	$487.20
Rate for Payer: Cash Price	$487.20
Rate for Payer: Mclaren Medicaid	$104.58
Rate for Payer: Meridian Medicaid	$109.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$456.75
Rate for Payer: Priority Health Choice Medicaid	$104.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$281.07
Rate for Payer: Priority Health Narrow/Tiered Network	$281.07
Rate for Payer: UHC Medicaid	$104.58
Rate for Payer: UHCCP Medicaid	$104.58

PR PRQ SKEL FIXJ IPHAL JT DISLC W/MANJ

Professional

Both

$1,431.00

Service Code	HCPCS 26776
Min. Negotiated Rate	$277.33
Max. Negotiated Rate	$1,073.25
Rate for Payer: Aetna Commercial	$596.33
Rate for Payer: Aetna Medicare	$715.50
Rate for Payer: BCBS Complete	$291.20
Rate for Payer: BCN Commercial	$697.17
Rate for Payer: Cash Price	$1,144.80
Rate for Payer: Cash Price	$1,144.80
Rate for Payer: Mclaren Medicaid	$277.33
Rate for Payer: Meridian Medicaid	$291.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,073.25
Rate for Payer: Priority Health Choice Medicaid	$277.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$745.26
Rate for Payer: Priority Health Narrow/Tiered Network	$745.26
Rate for Payer: UHC Medicaid	$277.33
Rate for Payer: UHCCP Medicaid	$277.33

PR PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ

Professional

Both

$1,416.00

Service Code	HCPCS 26706
Min. Negotiated Rate	$266.68
Max. Negotiated Rate	$1,062.00
Rate for Payer: Aetna Commercial	$592.71
Rate for Payer: Aetna Medicare	$708.00
Rate for Payer: BCBS Complete	$280.01
Rate for Payer: BCN Commercial	$694.18
Rate for Payer: Cash Price	$1,132.80
Rate for Payer: Cash Price	$1,132.80
Rate for Payer: Mclaren Medicaid	$266.68
Rate for Payer: Meridian Medicaid	$280.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,062.00
Rate for Payer: Priority Health Choice Medicaid	$266.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$742.06
Rate for Payer: Priority Health Narrow/Tiered Network	$742.06
Rate for Payer: UHC Medicaid	$266.68
Rate for Payer: UHCCP Medicaid	$266.68

PR PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ

Professional

Both

$677.00

Service Code	HCPCS 28636
Min. Negotiated Rate	$138.66
Max. Negotiated Rate	$507.75
Rate for Payer: Aetna Commercial	$263.14
Rate for Payer: Aetna Medicare	$338.50
Rate for Payer: BCBS Complete	$145.59
Rate for Payer: BCN Commercial	$343.11
Rate for Payer: Cash Price	$541.60
Rate for Payer: Cash Price	$541.60
Rate for Payer: Mclaren Medicaid	$138.66
Rate for Payer: Meridian Medicaid	$145.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$507.75
Rate for Payer: Priority Health Choice Medicaid	$138.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$366.78
Rate for Payer: Priority Health Narrow/Tiered Network	$366.78
Rate for Payer: UHC Medicaid	$138.66
Rate for Payer: UHCCP Medicaid	$138.66

PR PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T

Professional

Both

$1,586.00

Service Code	HCPCS 26727
Min. Negotiated Rate	$291.38
Max. Negotiated Rate	$1,189.50
Rate for Payer: Aetna Commercial	$629.68
Rate for Payer: Aetna Medicare	$793.00
Rate for Payer: BCBS Complete	$305.95
Rate for Payer: BCN Commercial	$734.53
Rate for Payer: Cash Price	$1,268.80
Rate for Payer: Cash Price	$1,268.80
Rate for Payer: Mclaren Medicaid	$291.38
Rate for Payer: Meridian Medicaid	$305.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,189.50
Rate for Payer: Priority Health Choice Medicaid	$291.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$785.18
Rate for Payer: Priority Health Narrow/Tiered Network	$785.18
Rate for Payer: UHC Medicaid	$291.38
Rate for Payer: UHCCP Medicaid	$291.38

PR PRQ SKEL FIXJ TALOTARSAL JT DISLC W/MANJ

Professional

Both

$1,007.00

Service Code	HCPCS 28576
Min. Negotiated Rate	$246.44
Max. Negotiated Rate	$755.25
Rate for Payer: Aetna Commercial	$511.48
Rate for Payer: Aetna Medicare	$503.50
Rate for Payer: BCBS Complete	$258.76
Rate for Payer: BCN Commercial	$605.05
Rate for Payer: Cash Price	$805.60
Rate for Payer: Cash Price	$805.60
Rate for Payer: Mclaren Medicaid	$246.44
Rate for Payer: Meridian Medicaid	$258.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$755.25
Rate for Payer: Priority Health Choice Medicaid	$246.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$646.78
Rate for Payer: Priority Health Narrow/Tiered Network	$646.78
Rate for Payer: UHC Medicaid	$246.44
Rate for Payer: UHCCP Medicaid	$246.44

PR PRQ SKEL FIXJ TARS JT DISLC W/MANJ

Professional

Both

$1,386.00

Service Code	HCPCS 28606
Min. Negotiated Rate	$246.87
Max. Negotiated Rate	$1,039.50
Rate for Payer: Aetna Commercial	$504.07
Rate for Payer: Aetna Medicare	$693.00
Rate for Payer: BCBS Complete	$259.21
Rate for Payer: BCN Commercial	$612.52
Rate for Payer: Cash Price	$1,108.80
Rate for Payer: Cash Price	$1,108.80
Rate for Payer: Mclaren Medicaid	$246.87
Rate for Payer: Meridian Medicaid	$259.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,039.50
Rate for Payer: Priority Health Choice Medicaid	$246.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$654.76
Rate for Payer: Priority Health Narrow/Tiered Network	$654.76
Rate for Payer: UHC Medicaid	$246.87
Rate for Payer: UHCCP Medicaid	$246.87

PR PRQ SKEL FIXJ TARSL DISLC XCP TALOTARSAL W/MANJ

Professional

Both

$822.00

Service Code	HCPCS 28546
Min. Negotiated Rate	$228.12
Max. Negotiated Rate	$616.50
Rate for Payer: Aetna Commercial	$459.30
Rate for Payer: Aetna Medicare	$411.00
Rate for Payer: BCBS Complete	$239.53
Rate for Payer: BCN Commercial	$547.78
Rate for Payer: Cash Price	$657.60
Rate for Payer: Cash Price	$657.60
Rate for Payer: Mclaren Medicaid	$228.12
Rate for Payer: Meridian Medicaid	$239.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$616.50
Rate for Payer: Priority Health Choice Medicaid	$228.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$585.56
Rate for Payer: Priority Health Narrow/Tiered Network	$585.56
Rate for Payer: UHC Medicaid	$228.12
Rate for Payer: UHCCP Medicaid	$228.12

PR PRQ SKEL FIXJ TARSL FX XCP TALUS&CALCN W/MNPJ EA

Professional

Both

$478.00

Service Code	HCPCS 28456
Min. Negotiated Rate	$239.00
Max. Negotiated Rate	$609.52
Rate for Payer: Aetna Commercial	$473.02
Rate for Payer: Aetna Medicare	$239.00
Rate for Payer: BCBS Complete	$256.75
Rate for Payer: BCN Commercial	$570.19
Rate for Payer: Cash Price	$382.40
Rate for Payer: Cash Price	$382.40
Rate for Payer: Mclaren Medicaid	$244.52
Rate for Payer: Meridian Medicaid	$256.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$358.50
Rate for Payer: Priority Health Choice Medicaid	$244.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$609.52
Rate for Payer: Priority Health Narrow/Tiered Network	$609.52
Rate for Payer: UHC Medicaid	$244.52
Rate for Payer: UHCCP Medicaid	$244.52

PR PRQ TCAT CLSR CGEN INTRATRL COMUNICAJ W/IMPLT

Professional

Both

$2,115.00

Service Code	HCPCS 93580
Min. Negotiated Rate	$538.25
Max. Negotiated Rate	$1,586.25
Rate for Payer: Aetna Commercial	$1,305.02
Rate for Payer: Aetna Medicare	$1,057.50
Rate for Payer: BCBS Complete	$565.16
Rate for Payer: BCN Commercial	$1,421.73
Rate for Payer: Cash Price	$1,692.00
Rate for Payer: Cash Price	$1,692.00
Rate for Payer: Mclaren Medicaid	$538.25
Rate for Payer: Meridian Medicaid	$565.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,586.25
Rate for Payer: Priority Health Choice Medicaid	$538.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,351.28
Rate for Payer: Priority Health Narrow/Tiered Network	$1,351.28
Rate for Payer: UHC Medicaid	$538.25
Rate for Payer: UHCCP Medicaid	$538.25

PR PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING

Professional

Both

$528.00

Service Code	HCPCS 37197
Min. Negotiated Rate	$168.70
Max. Negotiated Rate	$471.25
Rate for Payer: Aetna Commercial	$402.50
Rate for Payer: Aetna Medicare	$264.00
Rate for Payer: BCBS Complete	$177.13
Rate for Payer: BCN Commercial	$438.23
Rate for Payer: Cash Price	$422.40
Rate for Payer: Cash Price	$422.40
Rate for Payer: Mclaren Medicaid	$168.70
Rate for Payer: Meridian Medicaid	$177.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$396.00
Rate for Payer: Priority Health Choice Medicaid	$168.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$471.25
Rate for Payer: Priority Health Narrow/Tiered Network	$471.25
Rate for Payer: UHC Medicaid	$168.70
Rate for Payer: UHCCP Medicaid	$168.70

PR PRQ TRANSLUMINAL MECHANICAL THROMBECTOMY VEIN

Professional

Both

$1,896.00

Service Code	HCPCS 37187
Min. Negotiated Rate	$220.46
Max. Negotiated Rate	$1,422.00
Rate for Payer: Aetna Commercial	$525.11
Rate for Payer: Aetna Medicare	$948.00
Rate for Payer: BCBS Complete	$231.48
Rate for Payer: BCN Commercial	$574.17
Rate for Payer: Cash Price	$1,516.80
Rate for Payer: Cash Price	$1,516.80
Rate for Payer: Mclaren Medicaid	$220.46
Rate for Payer: Meridian Medicaid	$231.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,422.00
Rate for Payer: Priority Health Choice Medicaid	$220.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$617.46
Rate for Payer: Priority Health Narrow/Tiered Network	$617.46
Rate for Payer: UHC Medicaid	$220.46
Rate for Payer: UHCCP Medicaid	$220.46

Know your out-of-pocket cost for care.

All Charges