Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM

Professional

Both

$1,272.00

Service Code	HCPCS 24075
Min. Negotiated Rate	$116.31
Max. Negotiated Rate	$890.40
Rate for Payer: Aetna Commercial	$437.22
Rate for Payer: BCBS Complete	$224.77
Rate for Payer: BCBS Trust/PPO	$116.31
Rate for Payer: Cash Price	$1,017.60
Rate for Payer: Cash Price	$1,017.60
Rate for Payer: Mclaren Medicaid	$214.07
Rate for Payer: Meridian Medicaid	$224.77
Rate for Payer: Priority Health Choice Medicaid	$214.07
Rate for Payer: Priority Health Cigna Priority Health	$890.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$508.61
Rate for Payer: Priority Health Narrow Network	$508.61
Rate for Payer: Priority Health SBD	$508.61

PR EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM

Facility

$1,272.00

Service Code	CPT 24075
Hospital Charge Code	24075
Hospital Revenue Code	360
Min. Negotiated Rate	$329.08
Max. Negotiated Rate	$4,536.73
Rate for Payer: Aetna Commercial	$1,081.20
Rate for Payer: Aetna Medicare	$1,500.31
Rate for Payer: Aetna New Business (MI Preferred)	$826.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,803.26
Rate for Payer: Amish Plain Church Group Commercial	$1,803.26
Rate for Payer: BCBS Complete	$828.64
Rate for Payer: BCBS MAPPO	$1,442.61
Rate for Payer: BCBS Trust/PPO	$746.15
Rate for Payer: BCN Medicare Advantage	$1,442.61
Rate for Payer: Cash Price	$1,017.60
Rate for Payer: Cash Price	$1,017.60
Rate for Payer: Cofinity Commercial	$1,093.92
Rate for Payer: Cofinity Commercial	$890.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,442.61
Rate for Payer: Healthscope Commercial	$1,144.80
Rate for Payer: Mclaren Medicaid	$789.11
Rate for Payer: Mclaren Medicare	$1,442.61
Rate for Payer: Meridian Medicaid	$828.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,514.74
Rate for Payer: MI Amish Medical Board Commercial	$1,659.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,081.20
Rate for Payer: PACE Medicare	$1,370.48
Rate for Payer: PACE SWMI	$1,442.61
Rate for Payer: PHP Commercial	$1,081.20
Rate for Payer: PHP Medicare Advantage	$1,442.61
Rate for Payer: Priority Health Choice Medicaid	$789.11
Rate for Payer: Priority Health Cigna Priority Health	$890.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,536.73
Rate for Payer: Priority Health Medicare	$1,442.61
Rate for Payer: Priority Health Narrow Network	$3,629.38
Rate for Payer: Priority Health SBD	$801.36
Rate for Payer: Railroad Medicare Medicare	$1,442.61
Rate for Payer: UHC All Payor (Choice/PPO)	$361.99
Rate for Payer: UHC Core	$3,138.00
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$329.08
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

PR EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM

Facility

$1,272.00

Service Code	CPT 24075
Hospital Charge Code	24075
Hospital Revenue Code	360
Min. Negotiated Rate	$801.36
Max. Negotiated Rate	$1,144.80
Rate for Payer: Aetna Commercial	$1,081.20
Rate for Payer: Aetna New Business (MI Preferred)	$826.80
Rate for Payer: Cash Price	$1,017.60
Rate for Payer: Cofinity Commercial	$1,093.92
Rate for Payer: Cofinity Commercial	$890.40
Rate for Payer: Healthscope Commercial	$1,144.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,081.20
Rate for Payer: PHP Commercial	$1,081.20
Rate for Payer: Priority Health Cigna Priority Health	$890.40
Rate for Payer: Priority Health SBD	$801.36

PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>

Facility

$1,660.00

Service Code	CPT 24073
Hospital Charge Code	24073
Hospital Revenue Code	960
Min. Negotiated Rate	$1,045.80
Max. Negotiated Rate	$1,494.00
Rate for Payer: Aetna Commercial	$1,411.00
Rate for Payer: Aetna New Business (MI Preferred)	$1,079.00
Rate for Payer: Cash Price	$1,328.00
Rate for Payer: Cofinity Commercial	$1,162.00
Rate for Payer: Cofinity Commercial	$1,427.60
Rate for Payer: Healthscope Commercial	$1,494.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,411.00
Rate for Payer: PHP Commercial	$1,411.00
Rate for Payer: Priority Health Cigna Priority Health	$1,162.00
Rate for Payer: Priority Health SBD	$1,045.80

PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>

Professional

Both

$1,660.00

Service Code	HCPCS 24073
Hospital Charge Code	24073
Min. Negotiated Rate	$293.21
Max. Negotiated Rate	$1,162.00
Rate for Payer: Aetna Commercial	$928.71
Rate for Payer: BCBS Complete	$469.21
Rate for Payer: BCBS Trust/PPO	$293.21
Rate for Payer: Cash Price	$1,328.00
Rate for Payer: Cash Price	$1,328.00
Rate for Payer: Mclaren Medicaid	$446.87
Rate for Payer: Meridian Medicaid	$469.21
Rate for Payer: Priority Health Choice Medicaid	$446.87
Rate for Payer: Priority Health Cigna Priority Health	$1,162.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,063.17
Rate for Payer: Priority Health Narrow Network	$1,063.17
Rate for Payer: Priority Health SBD	$1,063.17

PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>

Professional

Both

$1,660.00

Service Code	HCPCS 24073
Min. Negotiated Rate	$293.21
Max. Negotiated Rate	$1,162.00
Rate for Payer: Aetna Commercial	$928.71
Rate for Payer: BCBS Complete	$469.21
Rate for Payer: BCBS Trust/PPO	$293.21
Rate for Payer: Cash Price	$1,328.00
Rate for Payer: Cash Price	$1,328.00
Rate for Payer: Mclaren Medicaid	$446.87
Rate for Payer: Meridian Medicaid	$469.21
Rate for Payer: Priority Health Choice Medicaid	$446.87
Rate for Payer: Priority Health Cigna Priority Health	$1,162.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,063.17
Rate for Payer: Priority Health Narrow Network	$1,063.17
Rate for Payer: Priority Health SBD	$1,063.17

PR EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>

Facility

$1,660.00

Service Code	CPT 24073
Hospital Charge Code	24073
Hospital Revenue Code	960
Min. Negotiated Rate	$686.97
Max. Negotiated Rate	$3,160.42
Rate for Payer: Aetna Commercial	$1,411.00
Rate for Payer: Aetna Medicare	$2,629.47
Rate for Payer: Aetna New Business (MI Preferred)	$1,079.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,160.42
Rate for Payer: Amish Plain Church Group Commercial	$3,160.42
Rate for Payer: BCBS Complete	$1,452.28
Rate for Payer: BCBS MAPPO	$2,528.34
Rate for Payer: BCBS Trust/PPO	$1,044.57
Rate for Payer: BCN Medicare Advantage	$2,528.34
Rate for Payer: Cash Price	$1,328.00
Rate for Payer: Cash Price	$1,328.00
Rate for Payer: Cofinity Commercial	$1,162.00
Rate for Payer: Cofinity Commercial	$1,427.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,528.34
Rate for Payer: Healthscope Commercial	$1,494.00
Rate for Payer: Mclaren Medicaid	$1,383.00
Rate for Payer: Mclaren Medicare	$2,528.34
Rate for Payer: Meridian Medicaid	$1,452.28
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,654.76
Rate for Payer: MI Amish Medical Board Commercial	$2,907.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,411.00
Rate for Payer: PACE Medicare	$2,401.92
Rate for Payer: PACE SWMI	$2,528.34
Rate for Payer: PHP Commercial	$1,411.00
Rate for Payer: PHP Medicare Advantage	$2,528.34
Rate for Payer: Priority Health Choice Medicaid	$1,383.00
Rate for Payer: Priority Health Cigna Priority Health	$1,162.00
Rate for Payer: Priority Health Medicare	$2,528.34
Rate for Payer: Priority Health SBD	$1,045.80
Rate for Payer: Railroad Medicare Medicare	$2,528.34
Rate for Payer: UHC All Payor (Choice/PPO)	$755.67
Rate for Payer: UHC Dual Complete DSNP	$2,528.34
Rate for Payer: UHC Exchange	$686.97
Rate for Payer: UHC Medicare Advantage	$2,604.19
Rate for Payer: VA VA	$2,528.34

PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM

Professional

Both

$1,132.00

Service Code	HCPCS 24076
Min. Negotiated Rate	$293.21
Max. Negotiated Rate	$843.09
Rate for Payer: Aetna Commercial	$725.09
Rate for Payer: BCBS Complete	$372.15
Rate for Payer: BCBS Trust/PPO	$293.21
Rate for Payer: Cash Price	$905.60
Rate for Payer: Cash Price	$905.60
Rate for Payer: Mclaren Medicaid	$354.43
Rate for Payer: Meridian Medicaid	$372.15
Rate for Payer: Priority Health Choice Medicaid	$354.43
Rate for Payer: Priority Health Cigna Priority Health	$792.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$843.09
Rate for Payer: Priority Health Narrow Network	$843.09
Rate for Payer: Priority Health SBD	$843.09

PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM

Professional

Both

$1,132.00

Service Code	HCPCS 24076
Hospital Charge Code	24076
Min. Negotiated Rate	$293.21
Max. Negotiated Rate	$843.09
Rate for Payer: Aetna Commercial	$725.09
Rate for Payer: BCBS Complete	$372.15
Rate for Payer: BCBS Trust/PPO	$293.21
Rate for Payer: Cash Price	$905.60
Rate for Payer: Cash Price	$905.60
Rate for Payer: Mclaren Medicaid	$354.43
Rate for Payer: Meridian Medicaid	$372.15
Rate for Payer: Priority Health Choice Medicaid	$354.43
Rate for Payer: Priority Health Cigna Priority Health	$792.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$843.09
Rate for Payer: Priority Health Narrow Network	$843.09
Rate for Payer: Priority Health SBD	$843.09

PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM

Facility

$1,132.00

Service Code	CPT 24076
Hospital Charge Code	24076
Hospital Revenue Code	960
Min. Negotiated Rate	$544.86
Max. Negotiated Rate	$3,160.42
Rate for Payer: Aetna Commercial	$962.20
Rate for Payer: Aetna Medicare	$2,629.47
Rate for Payer: Aetna New Business (MI Preferred)	$735.80
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,160.42
Rate for Payer: Amish Plain Church Group Commercial	$3,160.42
Rate for Payer: BCBS Complete	$1,452.28
Rate for Payer: BCBS MAPPO	$2,528.34
Rate for Payer: BCBS Trust/PPO	$895.36
Rate for Payer: BCN Medicare Advantage	$2,528.34
Rate for Payer: Cash Price	$905.60
Rate for Payer: Cash Price	$905.60
Rate for Payer: Cofinity Commercial	$973.52
Rate for Payer: Cofinity Commercial	$792.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,528.34
Rate for Payer: Healthscope Commercial	$1,018.80
Rate for Payer: Mclaren Medicaid	$1,383.00
Rate for Payer: Mclaren Medicare	$2,528.34
Rate for Payer: Meridian Medicaid	$1,452.28
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,654.76
Rate for Payer: MI Amish Medical Board Commercial	$2,907.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$962.20
Rate for Payer: PACE Medicare	$2,401.92
Rate for Payer: PACE SWMI	$2,528.34
Rate for Payer: PHP Commercial	$962.20
Rate for Payer: PHP Medicare Advantage	$2,528.34
Rate for Payer: Priority Health Choice Medicaid	$1,383.00
Rate for Payer: Priority Health Cigna Priority Health	$792.40
Rate for Payer: Priority Health Medicare	$2,528.34
Rate for Payer: Priority Health SBD	$713.16
Rate for Payer: Railroad Medicare Medicare	$2,528.34
Rate for Payer: UHC All Payor (Choice/PPO)	$599.35
Rate for Payer: UHC Dual Complete DSNP	$2,528.34
Rate for Payer: UHC Exchange	$544.86
Rate for Payer: UHC Medicare Advantage	$2,604.19
Rate for Payer: VA VA	$2,528.34

PR EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM

Facility

$1,132.00

Service Code	CPT 24076
Hospital Charge Code	24076
Hospital Revenue Code	960
Min. Negotiated Rate	$713.16
Max. Negotiated Rate	$1,018.80
Rate for Payer: Aetna Commercial	$962.20
Rate for Payer: Aetna New Business (MI Preferred)	$735.80
Rate for Payer: Cash Price	$905.60
Rate for Payer: Cofinity Commercial	$792.40
Rate for Payer: Cofinity Commercial	$973.52
Rate for Payer: Healthscope Commercial	$1,018.80
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$962.20
Rate for Payer: PHP Commercial	$962.20
Rate for Payer: Priority Health Cigna Priority Health	$792.40
Rate for Payer: Priority Health SBD	$713.16

PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM

Facility

$1,068.00

Service Code	CPT 26115
Hospital Charge Code	26115
Hospital Revenue Code	960
Min. Negotiated Rate	$672.84
Max. Negotiated Rate	$961.20
Rate for Payer: Aetna Commercial	$907.80
Rate for Payer: Aetna New Business (MI Preferred)	$694.20
Rate for Payer: Cash Price	$854.40
Rate for Payer: Cofinity Commercial	$747.60
Rate for Payer: Cofinity Commercial	$918.48
Rate for Payer: Healthscope Commercial	$961.20
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$907.80
Rate for Payer: PHP Commercial	$907.80
Rate for Payer: Priority Health Cigna Priority Health	$747.60
Rate for Payer: Priority Health SBD	$672.84

PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM

Professional

Both

$1,068.00

Service Code	HCPCS 26115
Hospital Charge Code	26115
Min. Negotiated Rate	$108.67
Max. Negotiated Rate	$747.60
Rate for Payer: Aetna Commercial	$438.57
Rate for Payer: BCBS Complete	$228.12
Rate for Payer: BCBS Trust/PPO	$108.67
Rate for Payer: Cash Price	$854.40
Rate for Payer: Cash Price	$854.40
Rate for Payer: Mclaren Medicaid	$217.26
Rate for Payer: Meridian Medicaid	$228.12
Rate for Payer: Priority Health Choice Medicaid	$217.26
Rate for Payer: Priority Health Cigna Priority Health	$747.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$513.72
Rate for Payer: Priority Health Narrow Network	$513.72
Rate for Payer: Priority Health SBD	$513.72

PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM

Professional

Both

$1,068.00

Service Code	HCPCS 26115
Min. Negotiated Rate	$108.67
Max. Negotiated Rate	$747.60
Rate for Payer: Aetna Commercial	$438.57
Rate for Payer: BCBS Complete	$228.12
Rate for Payer: BCBS Trust/PPO	$108.67
Rate for Payer: Cash Price	$854.40
Rate for Payer: Cash Price	$854.40
Rate for Payer: Mclaren Medicaid	$217.26
Rate for Payer: Meridian Medicaid	$228.12
Rate for Payer: Priority Health Choice Medicaid	$217.26
Rate for Payer: Priority Health Cigna Priority Health	$747.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$513.72
Rate for Payer: Priority Health Narrow Network	$513.72
Rate for Payer: Priority Health SBD	$513.72

PR EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM

Facility

$1,068.00

Service Code	CPT 26115
Hospital Charge Code	26115
Hospital Revenue Code	960
Min. Negotiated Rate	$333.99
Max. Negotiated Rate	$1,803.26
Rate for Payer: Aetna Commercial	$907.80
Rate for Payer: Aetna Medicare	$1,500.31
Rate for Payer: Aetna New Business (MI Preferred)	$694.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,803.26
Rate for Payer: Amish Plain Church Group Commercial	$1,803.26
Rate for Payer: BCBS Complete	$828.64
Rate for Payer: BCBS MAPPO	$1,442.61
Rate for Payer: BCBS Trust/PPO	$849.05
Rate for Payer: BCN Medicare Advantage	$1,442.61
Rate for Payer: Cash Price	$854.40
Rate for Payer: Cash Price	$854.40
Rate for Payer: Cofinity Commercial	$918.48
Rate for Payer: Cofinity Commercial	$747.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,442.61
Rate for Payer: Healthscope Commercial	$961.20
Rate for Payer: Mclaren Medicaid	$789.11
Rate for Payer: Mclaren Medicare	$1,442.61
Rate for Payer: Meridian Medicaid	$828.64
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,514.74
Rate for Payer: MI Amish Medical Board Commercial	$1,659.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$907.80
Rate for Payer: PACE Medicare	$1,370.48
Rate for Payer: PACE SWMI	$1,442.61
Rate for Payer: PHP Commercial	$907.80
Rate for Payer: PHP Medicare Advantage	$1,442.61
Rate for Payer: Priority Health Choice Medicaid	$789.11
Rate for Payer: Priority Health Cigna Priority Health	$747.60
Rate for Payer: Priority Health Medicare	$1,442.61
Rate for Payer: Priority Health SBD	$672.84
Rate for Payer: Railroad Medicare Medicare	$1,442.61
Rate for Payer: UHC All Payor (Choice/PPO)	$367.39
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$333.99
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

PR EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM

Professional

Both

$1,647.00

Service Code	HCPCS 26116
Min. Negotiated Rate	$149.00
Max. Negotiated Rate	$1,152.90
Rate for Payer: Aetna Commercial	$697.72
Rate for Payer: BCBS Complete	$358.96
Rate for Payer: BCBS Trust/PPO	$149.00
Rate for Payer: Cash Price	$1,317.60
Rate for Payer: Cash Price	$1,317.60
Rate for Payer: Mclaren Medicaid	$341.87
Rate for Payer: Meridian Medicaid	$358.96
Rate for Payer: Priority Health Choice Medicaid	$341.87
Rate for Payer: Priority Health Cigna Priority Health	$1,152.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$811.43
Rate for Payer: Priority Health Narrow Network	$811.43
Rate for Payer: Priority Health SBD	$811.43

PR EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR

Professional

Both

$5,428.00

Service Code	HCPCS 51500
Min. Negotiated Rate	$406.62
Max. Negotiated Rate	$3,799.60
Rate for Payer: Aetna Commercial	$817.18
Rate for Payer: BCBS Complete	$426.95
Rate for Payer: BCBS Trust/PPO	$3,025.57
Rate for Payer: Cash Price	$4,342.40
Rate for Payer: Cash Price	$4,342.40
Rate for Payer: Mclaren Medicaid	$406.62
Rate for Payer: Meridian Medicaid	$426.95
Rate for Payer: Priority Health Choice Medicaid	$406.62
Rate for Payer: Priority Health Cigna Priority Health	$3,799.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,018.03
Rate for Payer: Priority Health Narrow Network	$1,018.03
Rate for Payer: Priority Health SBD	$1,018.03

PR EXC URETHRAL DIVERTICULUM SPX FEMALE

Professional

Both

$1,126.00

Service Code	HCPCS 53230
Min. Negotiated Rate	$52.30
Max. Negotiated Rate	$975.34
Rate for Payer: Aetna Commercial	$782.17
Rate for Payer: BCBS Complete	$409.28
Rate for Payer: BCBS Trust/PPO	$52.30
Rate for Payer: Cash Price	$900.80
Rate for Payer: Cash Price	$900.80
Rate for Payer: Mclaren Medicaid	$389.79
Rate for Payer: Meridian Medicaid	$409.28
Rate for Payer: Priority Health Choice Medicaid	$389.79
Rate for Payer: Priority Health Cigna Priority Health	$788.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$975.34
Rate for Payer: Priority Health Narrow Network	$975.34
Rate for Payer: Priority Health SBD	$975.34

PR EXC VARICOCELE/LIGATION SPERMATIC VEINS ABDL

Professional

Both

$2,101.00

Service Code	HCPCS 55535
Min. Negotiated Rate	$275.84
Max. Negotiated Rate	$1,511.99
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: BCBS Complete	$289.63
Rate for Payer: BCBS Trust/PPO	$1,511.99
Rate for Payer: Cash Price	$1,680.80
Rate for Payer: Cash Price	$1,680.80
Rate for Payer: Mclaren Medicaid	$275.84
Rate for Payer: Meridian Medicaid	$289.63
Rate for Payer: Priority Health Choice Medicaid	$275.84
Rate for Payer: Priority Health Cigna Priority Health	$1,470.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$689.50
Rate for Payer: Priority Health Narrow Network	$689.50
Rate for Payer: Priority Health SBD	$689.50

PR EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX

Professional

Both

$642.00

Service Code	HCPCS 55530
Min. Negotiated Rate	$225.99
Max. Negotiated Rate	$1,577.50
Rate for Payer: Aetna Commercial	$450.95
Rate for Payer: BCBS Complete	$237.29
Rate for Payer: BCBS Trust/PPO	$1,577.50
Rate for Payer: Cash Price	$513.60
Rate for Payer: Cash Price	$513.60
Rate for Payer: Mclaren Medicaid	$225.99
Rate for Payer: Meridian Medicaid	$237.29
Rate for Payer: Priority Health Choice Medicaid	$225.99
Rate for Payer: Priority Health Cigna Priority Health	$449.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$564.67
Rate for Payer: Priority Health Narrow Network	$564.67
Rate for Payer: Priority Health SBD	$564.67

PR EXC VARICOCELE/LIGATION VEINS W/HERNIA RPR

Professional

Both

$776.00

Service Code	HCPCS 55540
Min. Negotiated Rate	$357.63
Max. Negotiated Rate	$1,332.37
Rate for Payer: Aetna Commercial	$718.72
Rate for Payer: BCBS Complete	$375.51
Rate for Payer: BCBS Trust/PPO	$1,332.37
Rate for Payer: Cash Price	$620.80
Rate for Payer: Cash Price	$620.80
Rate for Payer: Mclaren Medicaid	$357.63
Rate for Payer: Meridian Medicaid	$375.51
Rate for Payer: Priority Health Choice Medicaid	$357.63
Rate for Payer: Priority Health Cigna Priority Health	$543.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$900.24
Rate for Payer: Priority Health Narrow Network	$900.24
Rate for Payer: Priority Health SBD	$900.24

PR EXC XTRPARENCHYMAL LESION TESTIS

Professional

Both

$1,090.00

Service Code	HCPCS 54512
Min. Negotiated Rate	$343.57
Max. Negotiated Rate	$1,954.18
Rate for Payer: Aetna Commercial	$692.89
Rate for Payer: BCBS Complete	$360.75
Rate for Payer: BCBS Trust/PPO	$1,954.18
Rate for Payer: Cash Price	$872.00
Rate for Payer: Cash Price	$872.00
Rate for Payer: Mclaren Medicaid	$343.57
Rate for Payer: Meridian Medicaid	$360.75
Rate for Payer: Priority Health Choice Medicaid	$343.57
Rate for Payer: Priority Health Cigna Priority Health	$763.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$858.63
Rate for Payer: Priority Health Narrow Network	$858.63
Rate for Payer: Priority Health SBD	$858.63

PR EXERCISE EQUIPMENT

Professional

Both

$5.00

Service Code	HCPCS A9300
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.50

PR EXISION OF SUBLINGUAL GLAND

Professional

Both

$752.00

Service Code	HCPCS 42450
Min. Negotiated Rate	$235.37
Max. Negotiated Rate	$646.18
Rate for Payer: Aetna Commercial	$478.95
Rate for Payer: BCBS Complete	$247.14
Rate for Payer: BCBS Trust/PPO	$563.70
Rate for Payer: Cash Price	$601.60
Rate for Payer: Cash Price	$601.60
Rate for Payer: Mclaren Medicaid	$235.37
Rate for Payer: Meridian Medicaid	$247.14
Rate for Payer: Priority Health Choice Medicaid	$235.37
Rate for Payer: Priority Health Cigna Priority Health	$526.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$646.18
Rate for Payer: Priority Health Narrow Network	$646.18
Rate for Payer: Priority Health SBD	$646.18

PR EXPL CONGENITAL ATRESIA BILE DUCTS

Professional

Both

$2,845.00

Service Code	HCPCS 47700
Min. Negotiated Rate	$678.34
Max. Negotiated Rate	$1,991.50
Rate for Payer: Aetna Commercial	$1,432.99
Rate for Payer: BCBS Complete	$712.99
Rate for Payer: BCBS Trust/PPO	$678.34
Rate for Payer: Cash Price	$2,276.00
Rate for Payer: Cash Price	$2,276.00
Rate for Payer: Mclaren Medicaid	$679.04
Rate for Payer: Meridian Medicaid	$712.99
Rate for Payer: Priority Health Choice Medicaid	$679.04
Rate for Payer: Priority Health Cigna Priority Health	$1,991.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,865.64
Rate for Payer: Priority Health Narrow Network	$1,865.64
Rate for Payer: Priority Health SBD	$1,865.64

Know your out-of-pocket cost for care.

All Charges