Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR AMPUTATION FOREARM THROUGH RADIUS & ULNA

Professional

Both

$2,334.00

Service Code	HCPCS 25900
Min. Negotiated Rate	$87.17
Max. Negotiated Rate	$1,633.80
Rate for Payer: Aetna Commercial	$954.79
Rate for Payer: BCBS Complete	$488.23
Rate for Payer: BCBS Trust/PPO	$87.17
Rate for Payer: Cash Price	$1,867.20
Rate for Payer: Cash Price	$1,867.20
Rate for Payer: Mclaren Medicaid	$464.98
Rate for Payer: Meridian Medicaid	$488.23
Rate for Payer: Priority Health Choice Medicaid	$464.98
Rate for Payer: Priority Health Cigna Priority Health	$1,633.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,103.51
Rate for Payer: Priority Health Narrow Network	$1,103.51
Rate for Payer: Priority Health SBD	$1,103.51

PR AMPUTATION LEG THROUGH TIBIA&FIBULA

Professional

Both

$2,657.00

Service Code	HCPCS 27880
Min. Negotiated Rate	$571.69
Max. Negotiated Rate	$1,859.90
Rate for Payer: Aetna Commercial	$1,215.09
Rate for Payer: BCBS Complete	$600.27
Rate for Payer: BCBS Trust/PPO	$1,170.71
Rate for Payer: Cash Price	$2,125.60
Rate for Payer: Cash Price	$2,125.60
Rate for Payer: Mclaren Medicaid	$571.69
Rate for Payer: Meridian Medicaid	$600.27
Rate for Payer: Priority Health Choice Medicaid	$571.69
Rate for Payer: Priority Health Cigna Priority Health	$1,859.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,365.98
Rate for Payer: Priority Health Narrow Network	$1,365.98
Rate for Payer: Priority Health SBD	$1,365.98

PR AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR

Professional

Both

$2,098.00

Service Code	HCPCS 27882
Min. Negotiated Rate	$376.80
Max. Negotiated Rate	$1,468.60
Rate for Payer: Aetna Commercial	$795.07
Rate for Payer: BCBS Complete	$395.64
Rate for Payer: BCBS Trust/PPO	$1,126.86
Rate for Payer: Cash Price	$1,678.40
Rate for Payer: Cash Price	$1,678.40
Rate for Payer: Mclaren Medicaid	$376.80
Rate for Payer: Meridian Medicaid	$395.64
Rate for Payer: Priority Health Choice Medicaid	$376.80
Rate for Payer: Priority Health Cigna Priority Health	$1,468.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$898.24
Rate for Payer: Priority Health Narrow Network	$898.24
Rate for Payer: Priority Health SBD	$898.24

PR AMPUTATION METATARSAL W/TOE SINGLE

Professional

Both

$1,408.00

Service Code	HCPCS 28810
Min. Negotiated Rate	$271.36
Max. Negotiated Rate	$1,367.24
Rate for Payer: Aetna Commercial	$565.84
Rate for Payer: BCBS Complete	$284.93
Rate for Payer: BCBS Trust/PPO	$1,367.24
Rate for Payer: Cash Price	$1,126.40
Rate for Payer: Cash Price	$1,126.40
Rate for Payer: Mclaren Medicaid	$271.36
Rate for Payer: Meridian Medicaid	$284.93
Rate for Payer: Priority Health Choice Medicaid	$271.36
Rate for Payer: Priority Health Cigna Priority Health	$985.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$642.91
Rate for Payer: Priority Health Narrow Network	$642.91
Rate for Payer: Priority Health SBD	$642.91

PR AMPUTATION METATARSAL W/TOE SINGLE

Facility

$1,408.00

Service Code	CPT 28810
Hospital Charge Code	28810
Min. Negotiated Rate	$887.04
Max. Negotiated Rate	$1,267.20
Rate for Payer: Aetna Commercial	$1,196.80
Rate for Payer: Aetna New Business (MI Preferred)	$915.20
Rate for Payer: Cash Price	$1,126.40
Rate for Payer: Cofinity Commercial	$1,210.88
Rate for Payer: Cofinity Commercial	$985.60
Rate for Payer: Healthscope Commercial	$1,267.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,196.80
Rate for Payer: PHP Commercial	$1,196.80
Rate for Payer: Priority Health Cigna Priority Health	$985.60
Rate for Payer: Priority Health SBD	$887.04

PR AMPUTATION METATARSAL W/TOE SINGLE

Professional

Both

$1,408.00

Service Code	HCPCS 28810
Hospital Charge Code	28810
Min. Negotiated Rate	$271.36
Max. Negotiated Rate	$1,367.24
Rate for Payer: Aetna Commercial	$565.84
Rate for Payer: BCBS Complete	$284.93
Rate for Payer: BCBS Trust/PPO	$1,367.24
Rate for Payer: Cash Price	$1,126.40
Rate for Payer: Cash Price	$1,126.40
Rate for Payer: Mclaren Medicaid	$271.36
Rate for Payer: Meridian Medicaid	$284.93
Rate for Payer: Priority Health Choice Medicaid	$271.36
Rate for Payer: Priority Health Cigna Priority Health	$985.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$642.91
Rate for Payer: Priority Health Narrow Network	$642.91
Rate for Payer: Priority Health SBD	$642.91

PR AMPUTATION METATARSAL W/TOE SINGLE

Facility

$1,408.00

Service Code	CPT 28810
Hospital Charge Code	28810
Min. Negotiated Rate	$417.16
Max. Negotiated Rate	$3,600.14
Rate for Payer: Aetna Commercial	$1,196.80
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Aetna New Business (MI Preferred)	$915.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$1,058.03
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Cash Price	$1,126.40
Rate for Payer: Cash Price	$1,126.40
Rate for Payer: Cofinity Commercial	$985.60
Rate for Payer: Cofinity Commercial	$1,210.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Healthscope Commercial	$1,267.20
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,196.80
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Commercial	$1,196.80
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health Cigna Priority Health	$985.60
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Priority Health SBD	$887.04
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$458.88
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$417.16
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

PR AMPUTATION PENIS COMPLETE

Professional

Both

$1,522.00

Service Code	HCPCS 54125
Min. Negotiated Rate	$523.55
Max. Negotiated Rate	$2,350.94
Rate for Payer: Aetna Commercial	$1,048.07
Rate for Payer: BCBS Complete	$549.73
Rate for Payer: BCBS Trust/PPO	$2,350.94
Rate for Payer: Cash Price	$1,217.60
Rate for Payer: Cash Price	$1,217.60
Rate for Payer: Mclaren Medicaid	$523.55
Rate for Payer: Meridian Medicaid	$549.73
Rate for Payer: Priority Health Choice Medicaid	$523.55
Rate for Payer: Priority Health Cigna Priority Health	$1,065.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,316.31
Rate for Payer: Priority Health Narrow Network	$1,316.31
Rate for Payer: Priority Health SBD	$1,316.31

PR AMPUTATION PENIS PARTIAL

Professional

Both

$1,178.00

Service Code	HCPCS 54120
Min. Negotiated Rate	$403.85
Max. Negotiated Rate	$3,526.40
Rate for Payer: Aetna Commercial	$809.58
Rate for Payer: BCBS Complete	$424.04
Rate for Payer: BCBS Trust/PPO	$3,526.40
Rate for Payer: Cash Price	$942.40
Rate for Payer: Cash Price	$942.40
Rate for Payer: Mclaren Medicaid	$403.85
Rate for Payer: Meridian Medicaid	$424.04
Rate for Payer: Priority Health Choice Medicaid	$403.85
Rate for Payer: Priority Health Cigna Priority Health	$824.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,009.38
Rate for Payer: Priority Health Narrow Network	$1,009.38
Rate for Payer: Priority Health SBD	$1,009.38

PR AMPUTATION PENIS RADW/BI INGUINOFEMORAL LMPHADE

Professional

Both

$2,433.00

Service Code	HCPCS 54130
Min. Negotiated Rate	$756.58
Max. Negotiated Rate	$3,502.63
Rate for Payer: Aetna Commercial	$1,532.39
Rate for Payer: BCBS Complete	$794.41
Rate for Payer: BCBS Trust/PPO	$3,502.63
Rate for Payer: Cash Price	$1,946.40
Rate for Payer: Cash Price	$1,946.40
Rate for Payer: Mclaren Medicaid	$756.58
Rate for Payer: Meridian Medicaid	$794.41
Rate for Payer: Priority Health Choice Medicaid	$756.58
Rate for Payer: Priority Health Cigna Priority Health	$1,703.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,897.20
Rate for Payer: Priority Health Narrow Network	$1,897.20
Rate for Payer: Priority Health SBD	$1,897.20

PR AMPUTATION THIGH THROUGH FEMUR ANY LEVEL

Professional

Both

$2,531.00

Service Code	HCPCS 27590
Min. Negotiated Rate	$499.27
Max. Negotiated Rate	$2,644.67
Rate for Payer: Aetna Commercial	$1,060.77
Rate for Payer: BCBS Complete	$524.23
Rate for Payer: BCBS Trust/PPO	$2,644.67
Rate for Payer: Cash Price	$2,024.80
Rate for Payer: Cash Price	$2,024.80
Rate for Payer: Mclaren Medicaid	$499.27
Rate for Payer: Meridian Medicaid	$524.23
Rate for Payer: Priority Health Choice Medicaid	$499.27
Rate for Payer: Priority Health Cigna Priority Health	$1,771.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,190.84
Rate for Payer: Priority Health Narrow Network	$1,190.84
Rate for Payer: Priority Health SBD	$1,190.84

PR AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION

Professional

Both

$2,380.00

Service Code	HCPCS 27596
Min. Negotiated Rate	$454.33
Max. Negotiated Rate	$1,666.00
Rate for Payer: Aetna Commercial	$958.03
Rate for Payer: BCBS Complete	$477.05
Rate for Payer: BCBS Trust/PPO	$1,116.83
Rate for Payer: Cash Price	$1,904.00
Rate for Payer: Cash Price	$1,904.00
Rate for Payer: Mclaren Medicaid	$454.33
Rate for Payer: Meridian Medicaid	$477.05
Rate for Payer: Priority Health Choice Medicaid	$454.33
Rate for Payer: Priority Health Cigna Priority Health	$1,666.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,087.18
Rate for Payer: Priority Health Narrow Network	$1,087.18
Rate for Payer: Priority Health SBD	$1,087.18

PR AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR

Professional

Both

$3,036.00

Service Code	HCPCS 27592
Min. Negotiated Rate	$427.49
Max. Negotiated Rate	$2,125.20
Rate for Payer: Aetna Commercial	$901.24
Rate for Payer: BCBS Complete	$448.86
Rate for Payer: BCBS Trust/PPO	$1,803.62
Rate for Payer: Cash Price	$2,428.80
Rate for Payer: Cash Price	$2,428.80
Rate for Payer: Mclaren Medicaid	$427.49
Rate for Payer: Meridian Medicaid	$448.86
Rate for Payer: Priority Health Choice Medicaid	$427.49
Rate for Payer: Priority Health Cigna Priority Health	$2,125.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,019.77
Rate for Payer: Priority Health Narrow Network	$1,019.77
Rate for Payer: Priority Health SBD	$1,019.77

PR AMPUTATION TOE INTERPHALANGEAL JOINT

Professional

Both

$1,320.00

Service Code	HCPCS 28825
Min. Negotiated Rate	$110.12
Max. Negotiated Rate	$995.32
Rate for Payer: Aetna Commercial	$235.79
Rate for Payer: BCBS Complete	$115.63
Rate for Payer: BCBS Trust/PPO	$995.32
Rate for Payer: Cash Price	$1,056.00
Rate for Payer: Cash Price	$1,056.00
Rate for Payer: Mclaren Medicaid	$110.12
Rate for Payer: Meridian Medicaid	$115.63
Rate for Payer: Priority Health Choice Medicaid	$110.12
Rate for Payer: Priority Health Cigna Priority Health	$924.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$260.94
Rate for Payer: Priority Health Narrow Network	$260.94
Rate for Payer: Priority Health SBD	$260.94

PR AMPUTATION TOE METATARSOPHALANGEAL JOINT

Facility

$1,526.00

Service Code	CPT 28820
Hospital Charge Code	28820
Hospital Revenue Code	960
Min. Negotiated Rate	$173.54
Max. Negotiated Rate	$3,600.14
Rate for Payer: Aetna Commercial	$1,297.10
Rate for Payer: Aetna Medicare	$2,995.31
Rate for Payer: Aetna New Business (MI Preferred)	$991.90
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,600.14
Rate for Payer: Amish Plain Church Group Commercial	$3,600.14
Rate for Payer: BCBS Complete	$1,654.34
Rate for Payer: BCBS MAPPO	$2,880.11
Rate for Payer: BCBS Trust/PPO	$1,420.02
Rate for Payer: BCN Medicare Advantage	$2,880.11
Rate for Payer: Cash Price	$1,220.80
Rate for Payer: Cash Price	$1,220.80
Rate for Payer: Cofinity Commercial	$1,068.20
Rate for Payer: Cofinity Commercial	$1,312.36
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,880.11
Rate for Payer: Healthscope Commercial	$1,373.40
Rate for Payer: Mclaren Medicaid	$1,575.42
Rate for Payer: Mclaren Medicare	$2,880.11
Rate for Payer: Meridian Medicaid	$1,654.34
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,024.12
Rate for Payer: MI Amish Medical Board Commercial	$3,312.13
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,297.10
Rate for Payer: PACE Medicare	$2,736.10
Rate for Payer: PACE SWMI	$2,880.11
Rate for Payer: PHP Commercial	$1,297.10
Rate for Payer: PHP Medicare Advantage	$2,880.11
Rate for Payer: Priority Health Choice Medicaid	$1,575.42
Rate for Payer: Priority Health Cigna Priority Health	$1,068.20
Rate for Payer: Priority Health Medicare	$2,880.11
Rate for Payer: Priority Health SBD	$961.38
Rate for Payer: Railroad Medicare Medicare	$2,880.11
Rate for Payer: UHC All Payor (Choice/PPO)	$190.89
Rate for Payer: UHC Dual Complete DSNP	$2,880.11
Rate for Payer: UHC Exchange	$173.54
Rate for Payer: UHC Medicare Advantage	$2,966.51
Rate for Payer: VA VA	$2,880.11

PR AMPUTATION TOE METATARSOPHALANGEAL JOINT

Professional

Both

$1,526.00

Service Code	HCPCS 28820
Hospital Charge Code	28820
Min. Negotiated Rate	$112.89
Max. Negotiated Rate	$1,068.20
Rate for Payer: Aetna Commercial	$243.14
Rate for Payer: BCBS Complete	$118.53
Rate for Payer: BCBS Trust/PPO	$852.68
Rate for Payer: Cash Price	$1,220.80
Rate for Payer: Cash Price	$1,220.80
Rate for Payer: Mclaren Medicaid	$112.89
Rate for Payer: Meridian Medicaid	$118.53
Rate for Payer: Priority Health Choice Medicaid	$112.89
Rate for Payer: Priority Health Cigna Priority Health	$1,068.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$269.62
Rate for Payer: Priority Health Narrow Network	$269.62
Rate for Payer: Priority Health SBD	$269.62

PR AMPUTATION TOE METATARSOPHALANGEAL JOINT

Professional

Both

$1,526.00

Service Code	HCPCS 28820
Min. Negotiated Rate	$112.89
Max. Negotiated Rate	$1,068.20
Rate for Payer: Aetna Commercial	$243.14
Rate for Payer: BCBS Complete	$118.53
Rate for Payer: BCBS Trust/PPO	$852.68
Rate for Payer: Cash Price	$1,220.80
Rate for Payer: Cash Price	$1,220.80
Rate for Payer: Mclaren Medicaid	$112.89
Rate for Payer: Meridian Medicaid	$118.53
Rate for Payer: Priority Health Choice Medicaid	$112.89
Rate for Payer: Priority Health Cigna Priority Health	$1,068.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$269.62
Rate for Payer: Priority Health Narrow Network	$269.62
Rate for Payer: Priority Health SBD	$269.62

PR AMPUTATION TOE METATARSOPHALANGEAL JOINT

Facility

$1,526.00

Service Code	CPT 28820
Hospital Charge Code	28820
Hospital Revenue Code	960
Min. Negotiated Rate	$961.38
Max. Negotiated Rate	$1,373.40
Rate for Payer: Aetna Commercial	$1,297.10
Rate for Payer: Aetna New Business (MI Preferred)	$991.90
Rate for Payer: Cash Price	$1,220.80
Rate for Payer: Cofinity Commercial	$1,068.20
Rate for Payer: Cofinity Commercial	$1,312.36
Rate for Payer: Healthscope Commercial	$1,373.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,297.10
Rate for Payer: PHP Commercial	$1,297.10
Rate for Payer: Priority Health Cigna Priority Health	$1,068.20
Rate for Payer: Priority Health SBD	$961.38

PR ANALYZE NEUROSTIM BRAIN, FIRST 1H

Professional

Both

$497.00

Service Code	HCPCS 95978
Min. Negotiated Rate	$198.80
Max. Negotiated Rate	$347.90
Rate for Payer: BCBS Complete	$198.80
Rate for Payer: Cash Price	$397.60
Rate for Payer: Priority Health Cigna Priority Health	$347.90

PR ANALYZ NEUROSTIM BRAIN, EACH ADD 30 MIN

Professional

Both

$214.00

Service Code	HCPCS 95979
Min. Negotiated Rate	$85.60
Max. Negotiated Rate	$149.80
Rate for Payer: BCBS Complete	$85.60
Rate for Payer: Cash Price	$171.20
Rate for Payer: Priority Health Cigna Priority Health	$149.80

PR ANAST ARTL EXTRACRANIAL-INTRACRANIAL ARTERIES

Professional

Both

$7,712.00

Service Code	HCPCS 61711
Min. Negotiated Rate	$134.19
Max. Negotiated Rate	$5,398.40
Rate for Payer: Aetna Commercial	$3,326.27
Rate for Payer: BCBS Complete	$1,771.31
Rate for Payer: BCBS Trust/PPO	$134.19
Rate for Payer: Cash Price	$6,169.60
Rate for Payer: Cash Price	$6,169.60
Rate for Payer: Mclaren Medicaid	$1,686.96
Rate for Payer: Meridian Medicaid	$1,771.31
Rate for Payer: Priority Health Choice Medicaid	$1,686.96
Rate for Payer: Priority Health Cigna Priority Health	$5,398.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,382.00
Rate for Payer: Priority Health Narrow Network	$4,382.00
Rate for Payer: Priority Health SBD	$4,382.00

PR ANASTOMOSIS FACIAL HYPOGLOSSAL

Professional

Both

$1,822.00

Service Code	HCPCS 64868
Min. Negotiated Rate	$190.19
Max. Negotiated Rate	$1,691.31
Rate for Payer: Aetna Commercial	$1,278.09
Rate for Payer: BCBS Complete	$668.71
Rate for Payer: BCBS Trust/PPO	$190.19
Rate for Payer: Cash Price	$1,457.60
Rate for Payer: Cash Price	$1,457.60
Rate for Payer: Mclaren Medicaid	$636.87
Rate for Payer: Meridian Medicaid	$668.71
Rate for Payer: Priority Health Choice Medicaid	$636.87
Rate for Payer: Priority Health Cigna Priority Health	$1,275.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,691.31
Rate for Payer: Priority Health Narrow Network	$1,691.31
Rate for Payer: Priority Health SBD	$1,691.31

PR ANAST ROUX-EN-Y XTRHEPATC BILIARY DUCTS & GI

Professional

Both

$4,618.00

Service Code	HCPCS 47780
Min. Negotiated Rate	$1,284.83
Max. Negotiated Rate	$4,331.60
Rate for Payer: Aetna Commercial	$3,347.72
Rate for Payer: BCBS Complete	$1,656.57
Rate for Payer: BCBS Trust/PPO	$1,284.83
Rate for Payer: Cash Price	$3,694.40
Rate for Payer: Cash Price	$3,694.40
Rate for Payer: Mclaren Medicaid	$1,577.69
Rate for Payer: Meridian Medicaid	$1,656.57
Rate for Payer: Priority Health Choice Medicaid	$1,577.69
Rate for Payer: Priority Health Cigna Priority Health	$3,232.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,331.60
Rate for Payer: Priority Health Narrow Network	$4,331.60
Rate for Payer: Priority Health SBD	$4,331.60

PR ANAST XTRHEPATC BILIARY DUCTS & GI TRACT

Professional

Both

$4,184.00

Service Code	HCPCS 47760
Min. Negotiated Rate	$328.07
Max. Negotiated Rate	$3,944.71
Rate for Payer: Aetna Commercial	$3,045.85
Rate for Payer: BCBS Complete	$1,507.62
Rate for Payer: BCBS Trust/PPO	$328.07
Rate for Payer: Cash Price	$3,347.20
Rate for Payer: Cash Price	$3,347.20
Rate for Payer: Mclaren Medicaid	$1,435.83
Rate for Payer: Meridian Medicaid	$1,507.62
Rate for Payer: Priority Health Choice Medicaid	$1,435.83
Rate for Payer: Priority Health Cigna Priority Health	$2,928.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,944.71
Rate for Payer: Priority Health Narrow Network	$3,944.71
Rate for Payer: Priority Health SBD	$3,944.71

PR ANES 2/3 DGR BRN EXC/DBRDMT W/WO GRF EA 9% TBS

Professional

Both

$1.00

Service Code	HCPCS 01953
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$44.50
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cash Price	$0.80
Rate for Payer: Priority Health Cigna Priority Health	$0.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$44.50
Rate for Payer: Priority Health Narrow Network	$44.50
Rate for Payer: Priority Health SBD	$44.50

Know your out-of-pocket cost for care.

All Charges