Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE

Facility

$1,558.00

Service Code	CPT 49615
Hospital Charge Code	49615
Min. Negotiated Rate	$685.52
Max. Negotiated Rate	$1,402.20
Rate for Payer: Aetna American Axle	$1,012.70
Rate for Payer: Aetna Commercial	$1,324.30
Rate for Payer: Aetna New Business (MI Preferred)	$1,012.70
Rate for Payer: Cash Price	$1,246.40
Rate for Payer: Cofinity Commercial	$1,090.60
Rate for Payer: Cofinity Commercial	$1,339.88
Rate for Payer: Encore Health Key Benefits Commercial	$1,246.40
Rate for Payer: Healthscope Commercial	$1,402.20
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,090.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,168.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,324.30
Rate for Payer: PHP Commercial	$1,324.30
Rate for Payer: Priority Health Cigna Priority Health	$1,090.60
Rate for Payer: Priority Health SBD	$981.54
Rate for Payer: UMR Bronson Commercial	$685.52
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,168.50

PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE

Facility

$1,558.00

Service Code	CPT 49615
Hospital Charge Code	49615
Min. Negotiated Rate	$576.46
Max. Negotiated Rate	$9,680.93
Rate for Payer: Aetna American Axle	$1,012.70
Rate for Payer: Aetna Commercial	$1,324.30
Rate for Payer: Aetna Medicare	$3,198.23
Rate for Payer: Aetna New Business (MI Preferred)	$1,012.70
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,844.02
Rate for Payer: Amish Plain Church Group Commercial	$3,844.02
Rate for Payer: BCBS Complete	$1,766.41
Rate for Payer: BCBS MAPPO	$3,075.22
Rate for Payer: BCBS Trust/PPO	$2,494.26
Rate for Payer: BCN Medicare Advantage	$3,075.22
Rate for Payer: Cash Price	$1,246.40
Rate for Payer: Cash Price	$1,246.40
Rate for Payer: Cofinity Commercial	$1,090.60
Rate for Payer: Cofinity Commercial	$1,339.88
Rate for Payer: Encore Health Key Benefits Commercial	$1,246.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,075.22
Rate for Payer: Healthscope Commercial	$1,402.20
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,090.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,168.50
Rate for Payer: Mclaren Medicaid	$1,682.15
Rate for Payer: Mclaren Medicare	$3,075.22
Rate for Payer: Meridian Medicaid	$1,766.41
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,228.98
Rate for Payer: MI Amish Medical Board Commercial	$3,536.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,324.30
Rate for Payer: PACE Medicare	$2,921.46
Rate for Payer: PACE SWMI	$3,075.22
Rate for Payer: PHP Commercial	$1,324.30
Rate for Payer: PHP Medicare Advantage	$3,075.22
Rate for Payer: Priority Health Choice Medicaid	$1,682.15
Rate for Payer: Priority Health Cigna Priority Health	$1,090.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$9,680.93
Rate for Payer: Priority Health Medicare	$3,075.22
Rate for Payer: Priority Health Narrow Network	$7,744.74
Rate for Payer: Priority Health SBD	$981.54
Rate for Payer: Railroad Medicare Medicare	$3,075.22
Rate for Payer: UHC All Payor (Choice/PPO)	$688.68
Rate for Payer: UHC Dual Complete DSNP	$3,075.22
Rate for Payer: UHC Exchange	$626.07
Rate for Payer: UHC Medicare Advantage	$3,167.48
Rate for Payer: UMR Bronson Commercial	$576.46
Rate for Payer: VA VA	$3,075.22
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,168.50

PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE

Professional

Both

$1,558.00

Service Code	HCPCS 49615
Min. Negotiated Rate	$407.26
Max. Negotiated Rate	$1,121.27
Rate for Payer: Aetna Commercial	$862.33
Rate for Payer: BCBS Complete	$427.62
Rate for Payer: BCBS Trust/PPO	$941.43
Rate for Payer: Cash Price	$1,246.40
Rate for Payer: Cash Price	$1,246.40
Rate for Payer: Meridian Medicaid	$427.62
Rate for Payer: Priority Health Choice Medicaid	$407.26
Rate for Payer: Priority Health Cigna Priority Health	$1,090.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,121.27
Rate for Payer: Priority Health Narrow Network	$1,121.27
Rate for Payer: Priority Health SBD	$1,121.27
Rate for Payer: UMR Bronson Commercial	$716.68

PR RPR AA HERNIA RECR 3-10 CM REDUCIBLE

Professional

Both

$1,558.00

Service Code	HCPCS 49615
Hospital Charge Code	49615
Min. Negotiated Rate	$407.26
Max. Negotiated Rate	$1,121.27
Rate for Payer: Aetna Commercial	$862.33
Rate for Payer: BCBS Complete	$427.62
Rate for Payer: BCBS Trust/PPO	$941.43
Rate for Payer: Cash Price	$1,246.40
Rate for Payer: Cash Price	$1,246.40
Rate for Payer: Meridian Medicaid	$427.62
Rate for Payer: Priority Health Choice Medicaid	$407.26
Rate for Payer: Priority Health Cigna Priority Health	$1,090.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,121.27
Rate for Payer: Priority Health Narrow Network	$1,121.27
Rate for Payer: Priority Health SBD	$1,121.27
Rate for Payer: UMR Bronson Commercial	$716.68

PR RPR AA HERNIA RECR < 3 CM NCRC8/STRANGULATED

Professional

Both

$1,142.00

Service Code	HCPCS 49614
Min. Negotiated Rate	$364.23
Max. Negotiated Rate	$2,425.95
Rate for Payer: Aetna Commercial	$771.03
Rate for Payer: BCBS Complete	$382.44
Rate for Payer: BCBS Trust/PPO	$2,425.95
Rate for Payer: Cash Price	$913.60
Rate for Payer: Cash Price	$913.60
Rate for Payer: Meridian Medicaid	$382.44
Rate for Payer: Priority Health Choice Medicaid	$364.23
Rate for Payer: Priority Health Cigna Priority Health	$799.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,002.50
Rate for Payer: Priority Health Narrow Network	$1,002.50
Rate for Payer: Priority Health SBD	$1,002.50
Rate for Payer: UMR Bronson Commercial	$525.32

PR RPR AA HERNIA RECR < 3 CM REDUCIBLE

Professional

Both

$840.00

Service Code	HCPCS 49613
Min. Negotiated Rate	$269.02
Max. Negotiated Rate	$2,199.84
Rate for Payer: Aetna Commercial	$567.44
Rate for Payer: BCBS Complete	$282.47
Rate for Payer: BCBS Trust/PPO	$2,199.84
Rate for Payer: Cash Price	$672.00
Rate for Payer: Cash Price	$672.00
Rate for Payer: Meridian Medicaid	$282.47
Rate for Payer: Priority Health Choice Medicaid	$269.02
Rate for Payer: Priority Health Cigna Priority Health	$588.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$739.08
Rate for Payer: Priority Health Narrow Network	$739.08
Rate for Payer: Priority Health SBD	$739.08
Rate for Payer: UMR Bronson Commercial	$386.40

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

Professional

Both

$1,944.00

Service Code	HCPCS 26350
Min. Negotiated Rate	$329.13
Max. Negotiated Rate	$1,360.80
Rate for Payer: Aetna Commercial	$986.19
Rate for Payer: BCBS Complete	$508.14
Rate for Payer: BCBS Trust/PPO	$329.13
Rate for Payer: Cash Price	$1,555.20
Rate for Payer: Cash Price	$1,555.20
Rate for Payer: Meridian Medicaid	$508.14
Rate for Payer: Priority Health Choice Medicaid	$483.94
Rate for Payer: Priority Health Cigna Priority Health	$1,360.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,161.21
Rate for Payer: Priority Health Narrow Network	$1,161.21
Rate for Payer: Priority Health SBD	$1,161.21
Rate for Payer: UMR Bronson Commercial	$894.24

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

Professional

Both

$2,656.00

Service Code	HCPCS 26358
Min. Negotiated Rate	$637.08
Max. Negotiated Rate	$1,859.20
Rate for Payer: Aetna Commercial	$1,314.43
Rate for Payer: BCBS Complete	$668.93
Rate for Payer: BCBS Trust/PPO	$662.49
Rate for Payer: Cash Price	$2,124.80
Rate for Payer: Cash Price	$2,124.80
Rate for Payer: Meridian Medicaid	$668.93
Rate for Payer: Priority Health Choice Medicaid	$637.08
Rate for Payer: Priority Health Cigna Priority Health	$1,859.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,514.58
Rate for Payer: Priority Health Narrow Network	$1,514.58
Rate for Payer: Priority Health SBD	$1,514.58
Rate for Payer: UMR Bronson Commercial	$1,221.76

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

Professional

Both

$2,605.00

Service Code	HCPCS 26356
Min. Negotiated Rate	$516.53
Max. Negotiated Rate	$1,823.50
Rate for Payer: Aetna Commercial	$1,057.09
Rate for Payer: BCBS Complete	$542.36
Rate for Payer: BCBS Trust/PPO	$559.47
Rate for Payer: Cash Price	$2,084.00
Rate for Payer: Cash Price	$2,084.00
Rate for Payer: Meridian Medicaid	$542.36
Rate for Payer: Priority Health Choice Medicaid	$516.53
Rate for Payer: Priority Health Cigna Priority Health	$1,823.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,229.13
Rate for Payer: Priority Health Narrow Network	$1,229.13
Rate for Payer: Priority Health SBD	$1,229.13
Rate for Payer: UMR Bronson Commercial	$1,198.30

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

Professional

Both

$2,721.00

Service Code	HCPCS 26357
Min. Negotiated Rate	$511.92
Max. Negotiated Rate	$1,904.70
Rate for Payer: Aetna Commercial	$1,188.68
Rate for Payer: BCBS Complete	$607.22
Rate for Payer: BCBS Trust/PPO	$511.92
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Cash Price	$2,176.80
Rate for Payer: Meridian Medicaid	$607.22
Rate for Payer: Priority Health Choice Medicaid	$578.30
Rate for Payer: Priority Health Cigna Priority Health	$1,904.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,375.69
Rate for Payer: Priority Health Narrow Network	$1,375.69
Rate for Payer: Priority Health SBD	$1,375.69
Rate for Payer: UMR Bronson Commercial	$1,251.66

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

Professional

Both

$2,294.00

Service Code	HCPCS 26370
Min. Negotiated Rate	$506.73
Max. Negotiated Rate	$1,605.80
Rate for Payer: Aetna Commercial	$1,045.85
Rate for Payer: BCBS Complete	$532.07
Rate for Payer: BCBS Trust/PPO	$732.75
Rate for Payer: Cash Price	$1,835.20
Rate for Payer: Cash Price	$1,835.20
Rate for Payer: Meridian Medicaid	$532.07
Rate for Payer: Priority Health Choice Medicaid	$506.73
Rate for Payer: Priority Health Cigna Priority Health	$1,605.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,219.44
Rate for Payer: Priority Health Narrow Network	$1,219.44
Rate for Payer: Priority Health SBD	$1,219.44
Rate for Payer: UMR Bronson Commercial	$1,055.24

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

Professional

Both

$2,798.00

Service Code	HCPCS 26373
Min. Negotiated Rate	$250.94
Max. Negotiated Rate	$1,958.60
Rate for Payer: Aetna Commercial	$1,174.81
Rate for Payer: BCBS Complete	$597.82
Rate for Payer: BCBS Trust/PPO	$250.94
Rate for Payer: Cash Price	$2,238.40
Rate for Payer: Cash Price	$2,238.40
Rate for Payer: Meridian Medicaid	$597.82
Rate for Payer: Priority Health Choice Medicaid	$569.35
Rate for Payer: Priority Health Cigna Priority Health	$1,958.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,368.55
Rate for Payer: Priority Health Narrow Network	$1,368.55
Rate for Payer: Priority Health SBD	$1,368.55
Rate for Payer: UMR Bronson Commercial	$1,287.08

PR RPR ANOM AORTIC ORIGIN CORONARY ART UNROOF/TLCJ

Professional

Both

$3,531.00

Service Code	HCPCS 33507
Min. Negotiated Rate	$724.30
Max. Negotiated Rate	$2,685.33
Rate for Payer: Aetna Commercial	$2,313.67
Rate for Payer: BCBS Complete	$1,133.01
Rate for Payer: BCBS Trust/PPO	$724.30
Rate for Payer: Cash Price	$2,824.80
Rate for Payer: Cash Price	$2,824.80
Rate for Payer: Meridian Medicaid	$1,133.01
Rate for Payer: Priority Health Choice Medicaid	$1,079.06
Rate for Payer: Priority Health Cigna Priority Health	$2,471.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,685.33
Rate for Payer: Priority Health Narrow Network	$2,685.33
Rate for Payer: Priority Health SBD	$2,685.33
Rate for Payer: UMR Bronson Commercial	$1,624.26

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

Professional

Both

$4,942.00

Service Code	HCPCS 33504
Min. Negotiated Rate	$576.38
Max. Negotiated Rate	$3,459.40
Rate for Payer: Aetna Commercial	$1,966.00
Rate for Payer: BCBS Complete	$971.09
Rate for Payer: BCBS Trust/PPO	$576.38
Rate for Payer: Cash Price	$3,953.60
Rate for Payer: Cash Price	$3,953.60
Rate for Payer: Meridian Medicaid	$971.09
Rate for Payer: Priority Health Choice Medicaid	$924.85
Rate for Payer: Priority Health Cigna Priority Health	$3,459.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,296.46
Rate for Payer: Priority Health Narrow Network	$2,296.46
Rate for Payer: Priority Health SBD	$2,296.46
Rate for Payer: UMR Bronson Commercial	$2,273.32

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

Professional

Both

$4,972.00

Service Code	HCPCS 33641
Min. Negotiated Rate	$957.28
Max. Negotiated Rate	$3,480.40
Rate for Payer: Aetna Commercial	$2,200.88
Rate for Payer: BCBS Complete	$1,080.23
Rate for Payer: BCBS Trust/PPO	$957.28
Rate for Payer: Cash Price	$3,977.60
Rate for Payer: Cash Price	$3,977.60
Rate for Payer: Meridian Medicaid	$1,080.23
Rate for Payer: Priority Health Choice Medicaid	$1,028.79
Rate for Payer: Priority Health Cigna Priority Health	$3,480.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,557.12
Rate for Payer: Priority Health Narrow Network	$2,557.12
Rate for Payer: Priority Health SBD	$2,557.12
Rate for Payer: UMR Bronson Commercial	$2,287.12

PR RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT INTERNAL

Professional

Both

$1,117.00

Service Code	HCPCS 67903
Min. Negotiated Rate	$303.74
Max. Negotiated Rate	$826.03
Rate for Payer: Aetna Commercial	$624.13
Rate for Payer: BCBS Complete	$318.93
Rate for Payer: BCBS Trust/PPO	$714.79
Rate for Payer: Cash Price	$893.60
Rate for Payer: Cash Price	$893.60
Rate for Payer: Meridian Medicaid	$318.93
Rate for Payer: Priority Health Choice Medicaid	$303.74
Rate for Payer: Priority Health Cigna Priority Health	$781.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$826.03
Rate for Payer: Priority Health Narrow Network	$826.03
Rate for Payer: Priority Health SBD	$826.03
Rate for Payer: UMR Bronson Commercial	$513.82

PR RPR BLEPHAROPTOSIS LEVATOR RESCJ/ADVMNT XTRNL

Professional

Both

$950.00

Service Code	HCPCS 67904
Min. Negotiated Rate	$376.80
Max. Negotiated Rate	$1,024.49
Rate for Payer: Aetna Commercial	$772.71
Rate for Payer: BCBS Complete	$395.64
Rate for Payer: BCBS Trust/PPO	$581.13
Rate for Payer: Cash Price	$760.00
Rate for Payer: Cash Price	$760.00
Rate for Payer: Meridian Medicaid	$395.64
Rate for Payer: Priority Health Choice Medicaid	$376.80
Rate for Payer: Priority Health Cigna Priority Health	$665.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,024.49
Rate for Payer: Priority Health Narrow Network	$1,024.49
Rate for Payer: Priority Health SBD	$1,024.49
Rate for Payer: UMR Bronson Commercial	$437.00

PR RPR BLOOD VESSEL DIRECT INTRA-ABDOMINAL

Professional

Both

$4,953.00

Service Code	HCPCS 35221
Min. Negotiated Rate	$926.76
Max. Negotiated Rate	$3,467.10
Rate for Payer: Aetna Commercial	$1,976.34
Rate for Payer: BCBS Complete	$973.10
Rate for Payer: BCBS Trust/PPO	$1,367.77
Rate for Payer: Cash Price	$3,962.40
Rate for Payer: Cash Price	$3,962.40
Rate for Payer: Meridian Medicaid	$973.10
Rate for Payer: Priority Health Choice Medicaid	$926.76
Rate for Payer: Priority Health Cigna Priority Health	$3,467.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,307.64
Rate for Payer: Priority Health Narrow Network	$2,307.64
Rate for Payer: Priority Health SBD	$2,307.64
Rate for Payer: UMR Bronson Commercial	$2,278.38

PR RPR BLOOD VESSEL DIRECT INTRATHORACIC W/BYPASS

Professional

Both

$2,836.00

Service Code	HCPCS 35211
Min. Negotiated Rate	$875.22
Max. Negotiated Rate	$2,168.79
Rate for Payer: Aetna Commercial	$1,871.61
Rate for Payer: BCBS Complete	$918.98
Rate for Payer: BCBS Trust/PPO	$1,289.05
Rate for Payer: Cash Price	$2,268.80
Rate for Payer: Cash Price	$2,268.80
Rate for Payer: Meridian Medicaid	$918.98
Rate for Payer: Priority Health Choice Medicaid	$875.22
Rate for Payer: Priority Health Cigna Priority Health	$1,985.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,168.79
Rate for Payer: Priority Health Narrow Network	$2,168.79
Rate for Payer: Priority Health SBD	$2,168.79
Rate for Payer: UMR Bronson Commercial	$1,304.56

PR RPR BLOOD VESSEL DIRECT INTRATHORACIC W/O BYPASS

Professional

Both

$5,222.00

Service Code	HCPCS 35216
Min. Negotiated Rate	$1,323.80
Max. Negotiated Rate	$3,655.40
Rate for Payer: Aetna Commercial	$2,794.95
Rate for Payer: BCBS Complete	$1,389.99
Rate for Payer: BCBS Trust/PPO	$2,159.69
Rate for Payer: Cash Price	$4,177.60
Rate for Payer: Cash Price	$4,177.60
Rate for Payer: Meridian Medicaid	$1,389.99
Rate for Payer: Priority Health Choice Medicaid	$1,323.80
Rate for Payer: Priority Health Cigna Priority Health	$3,655.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,289.10
Rate for Payer: Priority Health Narrow Network	$3,289.10
Rate for Payer: Priority Health SBD	$3,289.10
Rate for Payer: UMR Bronson Commercial	$2,402.12

PR RPR BLOOD VESSEL DIRECT LOWER EXTREMITY

Professional

Both

$2,608.00

Service Code	HCPCS 35226
Min. Negotiated Rate	$518.66
Max. Negotiated Rate	$2,526.86
Rate for Payer: Aetna Commercial	$1,116.75
Rate for Payer: BCBS Complete	$544.59
Rate for Payer: BCBS Trust/PPO	$2,526.86
Rate for Payer: Cash Price	$2,086.40
Rate for Payer: Cash Price	$2,086.40
Rate for Payer: Meridian Medicaid	$544.59
Rate for Payer: Priority Health Choice Medicaid	$518.66
Rate for Payer: Priority Health Cigna Priority Health	$1,825.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,296.38
Rate for Payer: Priority Health Narrow Network	$1,296.38
Rate for Payer: Priority Health SBD	$1,296.38
Rate for Payer: UMR Bronson Commercial	$1,199.68

PR RPR BLOOD VESSEL VEIN GRAFT INTRATHORACIC W/BYP

Professional

Both

$6,391.00

Service Code	HCPCS 35241
Min. Negotiated Rate	$898.65
Max. Negotiated Rate	$4,473.70
Rate for Payer: Aetna Commercial	$1,926.86
Rate for Payer: BCBS Complete	$943.58
Rate for Payer: BCBS Trust/PPO	$1,986.94
Rate for Payer: Cash Price	$5,112.80
Rate for Payer: Cash Price	$5,112.80
Rate for Payer: Meridian Medicaid	$943.58
Rate for Payer: Priority Health Choice Medicaid	$898.65
Rate for Payer: Priority Health Cigna Priority Health	$4,473.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,240.07
Rate for Payer: Priority Health Narrow Network	$2,240.07
Rate for Payer: Priority Health SBD	$2,240.07
Rate for Payer: UMR Bronson Commercial	$2,939.86

PR RPR BLOOD VSL GRF OTH/THN VEIN INTRATHRC W/BYP

Professional

Both

$6,612.00

Service Code	HCPCS 35271
Min. Negotiated Rate	$650.87
Max. Negotiated Rate	$4,628.40
Rate for Payer: Aetna Commercial	$1,857.88
Rate for Payer: BCBS Complete	$914.06
Rate for Payer: BCBS Trust/PPO	$650.87
Rate for Payer: Cash Price	$5,289.60
Rate for Payer: Cash Price	$5,289.60
Rate for Payer: Meridian Medicaid	$914.06
Rate for Payer: Priority Health Choice Medicaid	$870.53
Rate for Payer: Priority Health Cigna Priority Health	$4,628.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,164.00
Rate for Payer: Priority Health Narrow Network	$2,164.00
Rate for Payer: Priority Health SBD	$2,164.00
Rate for Payer: UMR Bronson Commercial	$3,041.52

PR RPR BLOOD VSL GRF OTH/THN VEIN UPPER EXTREMITY

Professional

Both

$1,758.00

Service Code	HCPCS 35266
Min. Negotiated Rate	$534.11
Max. Negotiated Rate	$1,341.60
Rate for Payer: Aetna Commercial	$1,163.16
Rate for Payer: BCBS Complete	$569.42
Rate for Payer: BCBS Trust/PPO	$534.11
Rate for Payer: Cash Price	$1,406.40
Rate for Payer: Cash Price	$1,406.40
Rate for Payer: Meridian Medicaid	$569.42
Rate for Payer: Priority Health Choice Medicaid	$542.30
Rate for Payer: Priority Health Cigna Priority Health	$1,230.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,341.60
Rate for Payer: Priority Health Narrow Network	$1,341.60
Rate for Payer: Priority Health SBD	$1,341.60
Rate for Payer: UMR Bronson Commercial	$808.68

PR RPR BLVSL W/GRF OTHER/THAN VEIN LOWER EXTREMITY

Professional

Both

$3,718.00

Service Code	HCPCS 35286
Min. Negotiated Rate	$579.36
Max. Negotiated Rate	$2,602.60
Rate for Payer: Aetna Commercial	$1,253.73
Rate for Payer: BCBS Complete	$608.33
Rate for Payer: BCBS Trust/PPO	$1,167.01
Rate for Payer: Cash Price	$2,974.40
Rate for Payer: Cash Price	$2,974.40
Rate for Payer: Meridian Medicaid	$608.33
Rate for Payer: Priority Health Choice Medicaid	$579.36
Rate for Payer: Priority Health Cigna Priority Health	$2,602.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,446.92
Rate for Payer: Priority Health Narrow Network	$1,446.92
Rate for Payer: Priority Health SBD	$1,446.92
Rate for Payer: UMR Bronson Commercial	$1,710.28

Know your out-of-pocket cost for care.

All Charges