Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR RPR AA HERNIA 1ST 3-10 CM REDUCIBLE

Professional

Both

$1,466.00

Service Code	HCPCS 49593
Min. Negotiated Rate	$334.84
Max. Negotiated Rate	$1,099.50
Rate for Payer: Aetna Commercial	$772.74
Rate for Payer: Aetna Medicare	$733.00
Rate for Payer: BCBS Complete	$351.58
Rate for Payer: BCN Commercial	$859.02
Rate for Payer: Cash Price	$1,172.80
Rate for Payer: Cash Price	$1,172.80
Rate for Payer: Mclaren Medicaid	$334.84
Rate for Payer: Meridian Medicaid	$351.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,099.50
Rate for Payer: Priority Health Choice Medicaid	$334.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,046.66
Rate for Payer: Priority Health Narrow/Tiered Network	$1,046.66
Rate for Payer: UHC Medicaid	$334.84
Rate for Payer: UHCCP Medicaid	$334.84

PR RPR AA HERNIA 1ST < 3 CM NCRC8/STRANGULATED

Professional

Both

$1,217.00

Service Code	HCPCS 49592
Min. Negotiated Rate	$278.60
Max. Negotiated Rate	$912.75
Rate for Payer: Aetna Commercial	$641.53
Rate for Payer: Aetna Medicare	$608.50
Rate for Payer: BCBS Complete	$292.53
Rate for Payer: BCN Commercial	$714.11
Rate for Payer: Cash Price	$973.60
Rate for Payer: Cash Price	$973.60
Rate for Payer: Mclaren Medicaid	$278.60
Rate for Payer: Meridian Medicaid	$292.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$912.75
Rate for Payer: Priority Health Choice Medicaid	$278.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$870.09
Rate for Payer: Priority Health Narrow/Tiered Network	$870.09
Rate for Payer: UHC Medicaid	$278.60
Rate for Payer: UHCCP Medicaid	$278.60

PR RPR AA HERNIA 1ST < 3 CM REDUCIBLE

Professional

Both

$895.00

Service Code	HCPCS 49591
Min. Negotiated Rate	$201.29
Max. Negotiated Rate	$671.25
Rate for Payer: Aetna Commercial	$460.31
Rate for Payer: Aetna Medicare	$447.50
Rate for Payer: BCBS Complete	$211.35
Rate for Payer: BCN Commercial	$513.42
Rate for Payer: Cash Price	$716.00
Rate for Payer: Cash Price	$716.00
Rate for Payer: Mclaren Medicaid	$201.29
Rate for Payer: Meridian Medicaid	$211.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$671.25
Rate for Payer: Priority Health Choice Medicaid	$201.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$625.56
Rate for Payer: Priority Health Narrow/Tiered Network	$625.56
Rate for Payer: UHC Medicaid	$201.29
Rate for Payer: UHCCP Medicaid	$201.29

PR RPR AA HERNIA RECR > 10 CM NCRC8/STRANGULATED

Professional

Both

$3,256.00

Service Code	HCPCS 49618
Min. Negotiated Rate	$721.64
Max. Negotiated Rate	$2,442.00
Rate for Payer: Aetna Commercial	$1,673.34
Rate for Payer: Aetna Medicare	$1,628.00
Rate for Payer: BCBS Complete	$757.72
Rate for Payer: BCN Commercial	$1,863.94
Rate for Payer: Cash Price	$2,604.80
Rate for Payer: Cash Price	$2,604.80
Rate for Payer: Mclaren Medicaid	$721.64
Rate for Payer: Meridian Medicaid	$757.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,442.00
Rate for Payer: Priority Health Choice Medicaid	$721.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,271.09
Rate for Payer: Priority Health Narrow/Tiered Network	$2,271.09
Rate for Payer: UHC Medicaid	$721.64
Rate for Payer: UHCCP Medicaid	$721.64

PR RPR AA HERNIA RECR > 10 CM REDUCIBLE

Professional

Both

$1,903.00

Service Code	HCPCS 49617
Min. Negotiated Rate	$515.46
Max. Negotiated Rate	$1,621.26
Rate for Payer: Aetna Commercial	$1,193.22
Rate for Payer: Aetna Medicare	$951.50
Rate for Payer: BCBS Complete	$541.23
Rate for Payer: BCN Commercial	$1,330.61
Rate for Payer: Cash Price	$1,522.40
Rate for Payer: Cash Price	$1,522.40
Rate for Payer: Mclaren Medicaid	$515.46
Rate for Payer: Meridian Medicaid	$541.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,427.25
Rate for Payer: Priority Health Choice Medicaid	$515.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,621.26
Rate for Payer: Priority Health Narrow/Tiered Network	$1,621.26
Rate for Payer: UHC Medicaid	$515.46
Rate for Payer: UHCCP Medicaid	$515.46

PR RPR AA HERNIA RECR 3-10 CM NCRC8/STRANGULATED

Professional

Both

$1,804.00

Service Code	HCPCS 49616
Min. Negotiated Rate	$499.49
Max. Negotiated Rate	$1,566.65
Rate for Payer: Aetna Commercial	$1,159.17
Rate for Payer: Aetna Medicare	$902.00
Rate for Payer: BCBS Complete	$524.46
Rate for Payer: BCN Commercial	$1,285.78
Rate for Payer: Cash Price	$1,443.20
Rate for Payer: Cash Price	$1,443.20
Rate for Payer: Mclaren Medicaid	$499.49
Rate for Payer: Meridian Medicaid	$524.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,353.00
Rate for Payer: Priority Health Choice Medicaid	$499.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,566.65
Rate for Payer: Priority Health Narrow/Tiered Network	$1,566.65
Rate for Payer: UHC Medicaid	$499.49
Rate for Payer: UHCCP Medicaid	$499.49

PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE

Professional

Both

$1,637.00

Service Code	HCPCS 49615
Min. Negotiated Rate	$372.32
Max. Negotiated Rate	$1,227.75
Rate for Payer: Aetna Commercial	$862.33
Rate for Payer: Aetna Medicare	$818.50
Rate for Payer: BCBS Complete	$390.94
Rate for Payer: BCN Commercial	$957.62
Rate for Payer: Cash Price	$1,309.60
Rate for Payer: Cash Price	$1,309.60
Rate for Payer: Mclaren Medicaid	$372.32
Rate for Payer: Meridian Medicaid	$390.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,227.75
Rate for Payer: Priority Health Choice Medicaid	$372.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,166.79
Rate for Payer: Priority Health Narrow/Tiered Network	$1,166.79
Rate for Payer: UHC Medicaid	$372.32
Rate for Payer: UHCCP Medicaid	$372.32

PR RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED

Professional

Both

$1,200.00

Service Code	HCPCS 49614
Min. Negotiated Rate	$334.20
Max. Negotiated Rate	$1,043.62
Rate for Payer: Aetna Commercial	$771.03
Rate for Payer: Aetna Medicare	$600.00
Rate for Payer: BCBS Complete	$350.91
Rate for Payer: BCN Commercial	$856.53
Rate for Payer: Cash Price	$960.00
Rate for Payer: Cash Price	$960.00
Rate for Payer: Mclaren Medicaid	$334.20
Rate for Payer: Meridian Medicaid	$350.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$900.00
Rate for Payer: Priority Health Choice Medicaid	$334.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,043.62
Rate for Payer: Priority Health Narrow/Tiered Network	$1,043.62
Rate for Payer: UHC Medicaid	$334.20
Rate for Payer: UHCCP Medicaid	$334.20

PR RPR AA HERNIA RECR < 3 CM REDUCIBLE

Professional

Both

$883.00

Service Code	HCPCS 49613
Min. Negotiated Rate	$246.87
Max. Negotiated Rate	$769.36
Rate for Payer: Aetna Commercial	$567.44
Rate for Payer: Aetna Medicare	$441.50
Rate for Payer: BCBS Complete	$259.21
Rate for Payer: BCN Commercial	$631.44
Rate for Payer: Cash Price	$706.40
Rate for Payer: Cash Price	$706.40
Rate for Payer: Mclaren Medicaid	$246.87
Rate for Payer: Meridian Medicaid	$259.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$662.25
Rate for Payer: Priority Health Choice Medicaid	$246.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$769.36
Rate for Payer: Priority Health Narrow/Tiered Network	$769.36
Rate for Payer: UHC Medicaid	$246.87
Rate for Payer: UHCCP Medicaid	$246.87

PR RPR ACQUIRED/TRAUMATIC AV FISTULA EXTREMITIES

Professional

Both

$1,587.00

Service Code	HCPCS 35190
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$1,192.05
Rate for Payer: Aetna Commercial	$1,022.68
Rate for Payer: Aetna Medicare	$793.50
Rate for Payer: BCBS Complete	$459.38
Rate for Payer: BCN Commercial	$1,108.51
Rate for Payer: Cash Price	$1,269.60
Rate for Payer: Cash Price	$1,269.60
Rate for Payer: Mclaren Medicaid	$437.50
Rate for Payer: Meridian Medicaid	$459.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,190.25
Rate for Payer: Priority Health Choice Medicaid	$437.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,192.05
Rate for Payer: Priority Health Narrow/Tiered Network	$1,192.05
Rate for Payer: UHC Medicaid	$437.50
Rate for Payer: UHCCP Medicaid	$437.50

PR RPR ACQUIRED/TRAUMATIC AV FISTULA HEAD & NECK

Professional

Both

$4,367.00

Service Code	HCPCS 35188
Min. Negotiated Rate	$805.57
Max. Negotiated Rate	$3,275.25
Rate for Payer: Aetna Commercial	$1,718.98
Rate for Payer: Aetna Medicare	$2,183.50
Rate for Payer: BCBS Complete	$845.85
Rate for Payer: BCN Commercial	$1,956.57
Rate for Payer: Cash Price	$3,493.60
Rate for Payer: Cash Price	$3,493.60
Rate for Payer: Mclaren Medicaid	$805.57
Rate for Payer: Meridian Medicaid	$845.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,275.25
Rate for Payer: Priority Health Choice Medicaid	$805.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,104.03
Rate for Payer: Priority Health Narrow/Tiered Network	$2,104.03
Rate for Payer: UHC Medicaid	$805.57
Rate for Payer: UHCCP Medicaid	$805.57

PR RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDON

Professional

Both

$2,042.00

Service Code	HCPCS 26350
Min. Negotiated Rate	$471.16
Max. Negotiated Rate	$1,531.50
Rate for Payer: Aetna Commercial	$986.19
Rate for Payer: Aetna Medicare	$1,021.00
Rate for Payer: BCBS Complete	$494.72
Rate for Payer: BCN Commercial	$1,124.94
Rate for Payer: Cash Price	$1,633.60
Rate for Payer: Cash Price	$1,633.60
Rate for Payer: Mclaren Medicaid	$471.16
Rate for Payer: Meridian Medicaid	$494.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,531.50
Rate for Payer: Priority Health Choice Medicaid	$471.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,202.53
Rate for Payer: Priority Health Narrow/Tiered Network	$1,202.53
Rate for Payer: UHC Medicaid	$471.16
Rate for Payer: UHCCP Medicaid	$471.16

PR RPR/ADVMNT FLXR TDN ZONE 2 W/FR GRAFT EA TENDON

Professional

Both

$2,790.00

Service Code	HCPCS 26358
Min. Negotiated Rate	$595.12
Max. Negotiated Rate	$2,092.50
Rate for Payer: Aetna Commercial	$1,314.43
Rate for Payer: Aetna Medicare	$1,395.00
Rate for Payer: BCBS Complete	$624.88
Rate for Payer: BCN Commercial	$1,499.42
Rate for Payer: Cash Price	$2,232.00
Rate for Payer: Cash Price	$2,232.00
Rate for Payer: Mclaren Medicaid	$595.12
Rate for Payer: Meridian Medicaid	$624.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,092.50
Rate for Payer: Priority Health Choice Medicaid	$595.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,602.83
Rate for Payer: Priority Health Narrow/Tiered Network	$1,602.83
Rate for Payer: UHC Medicaid	$595.12
Rate for Payer: UHCCP Medicaid	$595.12

PR RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON

Professional

Both

$2,858.00

Service Code	HCPCS 26357
Min. Negotiated Rate	$544.22
Max. Negotiated Rate	$2,143.50
Rate for Payer: Aetna Commercial	$1,188.68
Rate for Payer: Aetna Medicare	$1,429.00
Rate for Payer: BCBS Complete	$571.43
Rate for Payer: BCN Commercial	$1,360.99
Rate for Payer: Cash Price	$2,286.40
Rate for Payer: Cash Price	$2,286.40
Rate for Payer: Mclaren Medicaid	$544.22
Rate for Payer: Meridian Medicaid	$571.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,143.50
Rate for Payer: Priority Health Choice Medicaid	$544.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,454.85
Rate for Payer: Priority Health Narrow/Tiered Network	$1,454.85
Rate for Payer: UHC Medicaid	$544.22
Rate for Payer: UHCCP Medicaid	$544.22

PR RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON

Professional

Both

$2,737.00

Service Code	HCPCS 26356
Min. Negotiated Rate	$480.53
Max. Negotiated Rate	$2,052.75
Rate for Payer: Aetna Commercial	$1,057.09
Rate for Payer: Aetna Medicare	$1,368.50
Rate for Payer: BCBS Complete	$504.56
Rate for Payer: BCN Commercial	$1,218.56
Rate for Payer: Cash Price	$2,189.60
Rate for Payer: Cash Price	$2,189.60
Rate for Payer: Mclaren Medicaid	$480.53
Rate for Payer: Meridian Medicaid	$504.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,052.75
Rate for Payer: Priority Health Choice Medicaid	$480.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,302.61
Rate for Payer: Priority Health Narrow/Tiered Network	$1,302.61
Rate for Payer: UHC Medicaid	$480.53
Rate for Payer: UHCCP Medicaid	$480.53

PR RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN

Professional

Both

$2,410.00

Service Code	HCPCS 26370
Min. Negotiated Rate	$484.58
Max. Negotiated Rate	$1,807.50
Rate for Payer: Aetna Commercial	$1,045.85
Rate for Payer: Aetna Medicare	$1,205.00
Rate for Payer: BCBS Complete	$508.81
Rate for Payer: BCN Commercial	$1,181.21
Rate for Payer: Cash Price	$1,928.00
Rate for Payer: Cash Price	$1,928.00
Rate for Payer: Mclaren Medicaid	$484.58
Rate for Payer: Meridian Medicaid	$508.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,807.50
Rate for Payer: Priority Health Choice Medicaid	$484.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,262.68
Rate for Payer: Priority Health Narrow/Tiered Network	$1,262.68
Rate for Payer: UHC Medicaid	$484.58
Rate for Payer: UHCCP Medicaid	$484.58

PR RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/FREE GRAFT EA

Professional

Both

$3,199.00

Service Code	HCPCS 26372
Min. Negotiated Rate	$572.54
Max. Negotiated Rate	$2,399.25
Rate for Payer: Aetna Commercial	$1,222.37
Rate for Payer: Aetna Medicare	$1,599.50
Rate for Payer: BCBS Complete	$601.17
Rate for Payer: BCN Commercial	$1,376.42
Rate for Payer: Cash Price	$2,559.20
Rate for Payer: Cash Price	$2,559.20
Rate for Payer: Mclaren Medicaid	$572.54
Rate for Payer: Meridian Medicaid	$601.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,399.25
Rate for Payer: Priority Health Choice Medicaid	$572.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,471.36
Rate for Payer: Priority Health Narrow/Tiered Network	$1,471.36
Rate for Payer: UHC Medicaid	$572.54
Rate for Payer: UHCCP Medicaid	$572.54

PR RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/O FREE GRF EA

Professional

Both

$2,940.00

Service Code	HCPCS 26373
Min. Negotiated Rate	$553.80
Max. Negotiated Rate	$2,205.00
Rate for Payer: Aetna Commercial	$1,174.81
Rate for Payer: Aetna Medicare	$1,470.00
Rate for Payer: BCBS Complete	$581.49
Rate for Payer: BCN Commercial	$1,324.63
Rate for Payer: Cash Price	$2,352.00
Rate for Payer: Cash Price	$2,352.00
Rate for Payer: Mclaren Medicaid	$553.80
Rate for Payer: Meridian Medicaid	$581.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,205.00
Rate for Payer: Priority Health Choice Medicaid	$553.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,416.00
Rate for Payer: Priority Health Narrow/Tiered Network	$1,416.00
Rate for Payer: UHC Medicaid	$553.80
Rate for Payer: UHCCP Medicaid	$553.80

PR RPR ANOM AORTIC ORIGIN CORONARY ART UNROOF/TLCJ

Professional

Both

$3,710.00

Service Code	HCPCS 33507
Min. Negotiated Rate	$1,022.61
Max. Negotiated Rate	$2,782.50
Rate for Payer: Aetna Commercial	$2,313.67
Rate for Payer: Aetna Medicare	$1,855.00
Rate for Payer: BCBS Complete	$1,073.74
Rate for Payer: BCN Commercial	$2,530.24
Rate for Payer: Cash Price	$2,968.00
Rate for Payer: Cash Price	$2,968.00
Rate for Payer: Mclaren Medicaid	$1,022.61
Rate for Payer: Meridian Medicaid	$1,073.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,782.50
Rate for Payer: Priority Health Choice Medicaid	$1,022.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,720.96
Rate for Payer: Priority Health Narrow/Tiered Network	$2,720.96
Rate for Payer: UHC Medicaid	$1,022.61
Rate for Payer: UHCCP Medicaid	$1,022.61

PR RPR ANOM CORONARY ART PULM ART ORIGIN GRF W/BYP

Professional

Both

$5,192.00

Service Code	HCPCS 33504
Min. Negotiated Rate	$890.77
Max. Negotiated Rate	$3,894.00
Rate for Payer: Aetna Commercial	$1,966.00
Rate for Payer: Aetna Medicare	$2,596.00
Rate for Payer: BCBS Complete	$935.31
Rate for Payer: BCN Commercial	$2,171.70
Rate for Payer: Cash Price	$4,153.60
Rate for Payer: Cash Price	$4,153.60
Rate for Payer: Mclaren Medicaid	$890.77
Rate for Payer: Meridian Medicaid	$935.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,894.00
Rate for Payer: Priority Health Choice Medicaid	$890.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,335.38
Rate for Payer: Priority Health Narrow/Tiered Network	$2,335.38
Rate for Payer: UHC Medicaid	$890.77
Rate for Payer: UHCCP Medicaid	$890.77

PR RPR ATRIAL SEPTAL DFCT SECUNDUM W/BYP W/WO PATCH

Professional

Both

$5,223.00

Service Code	HCPCS 33641
Min. Negotiated Rate	$978.31
Max. Negotiated Rate	$3,917.25
Rate for Payer: Aetna Commercial	$2,200.88
Rate for Payer: Aetna Medicare	$2,611.50
Rate for Payer: BCBS Complete	$1,027.23
Rate for Payer: BCN Commercial	$2,412.22
Rate for Payer: Cash Price	$4,178.40
Rate for Payer: Cash Price	$4,178.40
Rate for Payer: Mclaren Medicaid	$978.31
Rate for Payer: Meridian Medicaid	$1,027.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,917.25
Rate for Payer: Priority Health Choice Medicaid	$978.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,594.03
Rate for Payer: Priority Health Narrow/Tiered Network	$2,594.03
Rate for Payer: UHC Medicaid	$978.31
Rate for Payer: UHCCP Medicaid	$978.31

PR RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL

Professional

Both

$1,173.00

Service Code	HCPCS 67903
Min. Negotiated Rate	$260.50
Max. Negotiated Rate	$879.75
Rate for Payer: Aetna Commercial	$624.13
Rate for Payer: Aetna Medicare	$586.50
Rate for Payer: BCBS Complete	$273.52
Rate for Payer: BCN Commercial	$711.62
Rate for Payer: Cash Price	$938.40
Rate for Payer: Cash Price	$938.40
Rate for Payer: Mclaren Medicaid	$260.50
Rate for Payer: Meridian Medicaid	$273.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$879.75
Rate for Payer: Priority Health Choice Medicaid	$260.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$833.54
Rate for Payer: Priority Health Narrow/Tiered Network	$833.54
Rate for Payer: UHC Medicaid	$260.50
Rate for Payer: UHCCP Medicaid	$260.50

PR RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL

Professional

Both

$998.00

Service Code	HCPCS 67904
Min. Negotiated Rate	$323.97
Max. Negotiated Rate	$1,032.45
Rate for Payer: Aetna Commercial	$772.71
Rate for Payer: Aetna Medicare	$499.00
Rate for Payer: BCBS Complete	$340.17
Rate for Payer: BCN Commercial	$881.42
Rate for Payer: Cash Price	$798.40
Rate for Payer: Cash Price	$798.40
Rate for Payer: Mclaren Medicaid	$323.97
Rate for Payer: Meridian Medicaid	$340.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$748.50
Rate for Payer: Priority Health Choice Medicaid	$323.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,032.45
Rate for Payer: Priority Health Narrow/Tiered Network	$1,032.45
Rate for Payer: UHC Medicaid	$323.97
Rate for Payer: UHCCP Medicaid	$323.97

PR RPR BLOOD VESSEL DIRECT INTRATHORACIC W/BYPASS

Professional

Both

$2,980.00

Service Code	HCPCS 35211
Min. Negotiated Rate	$841.99
Max. Negotiated Rate	$2,235.00
Rate for Payer: Aetna Commercial	$1,871.61
Rate for Payer: Aetna Medicare	$1,490.00
Rate for Payer: BCBS Complete	$884.09
Rate for Payer: BCN Commercial	$2,051.18
Rate for Payer: Cash Price	$2,384.00
Rate for Payer: Cash Price	$2,384.00
Rate for Payer: Mclaren Medicaid	$841.99
Rate for Payer: Meridian Medicaid	$884.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,235.00
Rate for Payer: Priority Health Choice Medicaid	$841.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,205.78
Rate for Payer: Priority Health Narrow/Tiered Network	$2,205.78
Rate for Payer: UHC Medicaid	$841.99
Rate for Payer: UHCCP Medicaid	$841.99

PR RPR BLOOD VESSEL DIRECT INTRATHORACIC W/O BYPASS

Professional

Both

$5,486.00

Service Code	HCPCS 35216
Min. Negotiated Rate	$1,216.44
Max. Negotiated Rate	$4,114.50
Rate for Payer: Aetna Commercial	$2,794.95
Rate for Payer: Aetna Medicare	$2,743.00
Rate for Payer: BCBS Complete	$1,277.26
Rate for Payer: BCN Commercial	$3,069.56
Rate for Payer: Cash Price	$4,388.80
Rate for Payer: Cash Price	$4,388.80
Rate for Payer: Mclaren Medicaid	$1,216.44
Rate for Payer: Meridian Medicaid	$1,277.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,114.50
Rate for Payer: Priority Health Choice Medicaid	$1,216.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,300.92
Rate for Payer: Priority Health Narrow/Tiered Network	$3,300.92
Rate for Payer: UHC Medicaid	$1,216.44
Rate for Payer: UHCCP Medicaid	$1,216.44

Know your out-of-pocket cost for care.

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