Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR LIGATION OF SPERM DUCT

Professional

Both

$638.00

Service Code	HCPCS 55450
Min. Negotiated Rate	$255.20
Max. Negotiated Rate	$446.60
Rate for Payer: BCBS Complete	$255.20
Rate for Payer: Cash Price	$510.40
Rate for Payer: Priority Health Cigna Priority Health	$446.60

PR LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA

Professional

Both

$1,076.00

Service Code	HCPCS 37607
Min. Negotiated Rate	$235.79
Max. Negotiated Rate	$929.28
Rate for Payer: Aetna Commercial	$500.75
Rate for Payer: BCBS Complete	$247.58
Rate for Payer: BCBS Trust/PPO	$929.28
Rate for Payer: Cash Price	$860.80
Rate for Payer: Cash Price	$860.80
Rate for Payer: Mclaren Medicaid	$235.79
Rate for Payer: Meridian Medicaid	$247.58
Rate for Payer: Priority Health Choice Medicaid	$235.79
Rate for Payer: Priority Health Cigna Priority Health	$753.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$585.69
Rate for Payer: Priority Health Narrow Network	$585.69
Rate for Payer: Priority Health SBD	$585.69

PR LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ

Professional

Both

$465.00

Service Code	HCPCS 37700
Min. Negotiated Rate	$150.57
Max. Negotiated Rate	$385.13
Rate for Payer: Aetna Commercial	$327.02
Rate for Payer: BCBS Complete	$162.37
Rate for Payer: BCBS Trust/PPO	$150.57
Rate for Payer: Cash Price	$372.00
Rate for Payer: Cash Price	$372.00
Rate for Payer: Mclaren Medicaid	$154.64
Rate for Payer: Meridian Medicaid	$162.37
Rate for Payer: Priority Health Choice Medicaid	$154.64
Rate for Payer: Priority Health Cigna Priority Health	$325.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$385.13
Rate for Payer: Priority Health Narrow Network	$385.13
Rate for Payer: Priority Health SBD	$385.13

PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG

Facility

$950.00

Service Code	CPT 37785
Hospital Charge Code	37785
Min. Negotiated Rate	$598.50
Max. Negotiated Rate	$855.00
Rate for Payer: Aetna Commercial	$807.50
Rate for Payer: Aetna New Business (MI Preferred)	$617.50
Rate for Payer: Cash Price	$760.00
Rate for Payer: Cofinity Commercial	$665.00
Rate for Payer: Cofinity Commercial	$817.00
Rate for Payer: Healthscope Commercial	$855.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$807.50
Rate for Payer: PHP Commercial	$807.50
Rate for Payer: Priority Health Cigna Priority Health	$665.00
Rate for Payer: Priority Health SBD	$598.50

PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG

Professional

Both

$950.00

Service Code	HCPCS 37785
Min. Negotiated Rate	$161.45
Max. Negotiated Rate	$665.00
Rate for Payer: Aetna Commercial	$342.53
Rate for Payer: BCBS Complete	$169.52
Rate for Payer: BCBS Trust/PPO	$583.24
Rate for Payer: Cash Price	$760.00
Rate for Payer: Cash Price	$760.00
Rate for Payer: Mclaren Medicaid	$161.45
Rate for Payer: Meridian Medicaid	$169.52
Rate for Payer: Priority Health Choice Medicaid	$161.45
Rate for Payer: Priority Health Cigna Priority Health	$665.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$400.03
Rate for Payer: Priority Health Narrow Network	$400.03
Rate for Payer: Priority Health SBD	$400.03

PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG

Professional

Both

$950.00

Service Code	HCPCS 37785
Hospital Charge Code	37785
Min. Negotiated Rate	$161.45
Max. Negotiated Rate	$665.00
Rate for Payer: Aetna Commercial	$342.53
Rate for Payer: BCBS Complete	$169.52
Rate for Payer: BCBS Trust/PPO	$583.24
Rate for Payer: Cash Price	$760.00
Rate for Payer: Cash Price	$760.00
Rate for Payer: Mclaren Medicaid	$161.45
Rate for Payer: Meridian Medicaid	$169.52
Rate for Payer: Priority Health Choice Medicaid	$161.45
Rate for Payer: Priority Health Cigna Priority Health	$665.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$400.03
Rate for Payer: Priority Health Narrow Network	$400.03
Rate for Payer: Priority Health SBD	$400.03

PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG

Facility

$950.00

Service Code	CPT 37785
Hospital Charge Code	37785
Min. Negotiated Rate	$248.20
Max. Negotiated Rate	$8,913.25
Rate for Payer: Aetna Commercial	$807.50
Rate for Payer: Aetna Medicare	$2,949.65
Rate for Payer: Aetna New Business (MI Preferred)	$617.50
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,545.25
Rate for Payer: Amish Plain Church Group Commercial	$3,545.25
Rate for Payer: BCBS Complete	$1,629.11
Rate for Payer: BCBS MAPPO	$2,836.20
Rate for Payer: BCBS Trust/PPO	$1,107.31
Rate for Payer: BCN Medicare Advantage	$2,836.20
Rate for Payer: Cash Price	$760.00
Rate for Payer: Cash Price	$760.00
Rate for Payer: Cofinity Commercial	$665.00
Rate for Payer: Cofinity Commercial	$817.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,836.20
Rate for Payer: Healthscope Commercial	$855.00
Rate for Payer: Mclaren Medicaid	$1,551.40
Rate for Payer: Mclaren Medicare	$2,836.20
Rate for Payer: Meridian Medicaid	$1,629.11
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,978.01
Rate for Payer: MI Amish Medical Board Commercial	$3,261.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$807.50
Rate for Payer: PACE Medicare	$2,694.39
Rate for Payer: PACE SWMI	$2,836.20
Rate for Payer: PHP Commercial	$807.50
Rate for Payer: PHP Medicare Advantage	$2,836.20
Rate for Payer: Priority Health Choice Medicaid	$1,551.40
Rate for Payer: Priority Health Cigna Priority Health	$665.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,913.25
Rate for Payer: Priority Health Medicare	$2,836.20
Rate for Payer: Priority Health Narrow Network	$7,130.60
Rate for Payer: Priority Health SBD	$598.50
Rate for Payer: Railroad Medicare Medicare	$2,836.20
Rate for Payer: UHC All Payor (Choice/PPO)	$273.02
Rate for Payer: UHC Dual Complete DSNP	$2,836.20
Rate for Payer: UHC Exchange	$248.20
Rate for Payer: UHC Medicare Advantage	$2,921.29
Rate for Payer: VA VA	$2,836.20

PR LIGJ & DIVJ RADICAL STRIP LONG/SHORT SAPHENOUS

Facility

$839.00

Service Code	CPT 37735
Hospital Charge Code	37735
Min. Negotiated Rate	$528.57
Max. Negotiated Rate	$755.10
Rate for Payer: Aetna Commercial	$713.15
Rate for Payer: Aetna New Business (MI Preferred)	$545.35
Rate for Payer: Cash Price	$671.20
Rate for Payer: Cofinity Commercial	$587.30
Rate for Payer: Cofinity Commercial	$721.54
Rate for Payer: Healthscope Commercial	$755.10
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$713.15
Rate for Payer: PHP Commercial	$713.15
Rate for Payer: Priority Health Cigna Priority Health	$587.30
Rate for Payer: Priority Health SBD	$528.57

PR LIGJ & DIVJ RADICAL STRIP LONG/SHORT SAPHENOUS

Facility

$839.00

Service Code	CPT 37735
Hospital Charge Code	37735
Min. Negotiated Rate	$528.57
Max. Negotiated Rate	$8,913.25
Rate for Payer: Aetna Commercial	$713.15
Rate for Payer: Aetna Medicare	$2,949.65
Rate for Payer: Aetna New Business (MI Preferred)	$545.35
Rate for Payer: Allen County Amish Medical Aid Commercial	$3,545.25
Rate for Payer: Amish Plain Church Group Commercial	$3,545.25
Rate for Payer: BCBS Complete	$1,629.11
Rate for Payer: BCBS MAPPO	$2,836.20
Rate for Payer: BCBS Trust/PPO	$1,291.86
Rate for Payer: BCN Medicare Advantage	$2,836.20
Rate for Payer: Cash Price	$671.20
Rate for Payer: Cash Price	$671.20
Rate for Payer: Cofinity Commercial	$721.54
Rate for Payer: Cofinity Commercial	$587.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,836.20
Rate for Payer: Healthscope Commercial	$755.10
Rate for Payer: Mclaren Medicaid	$1,551.40
Rate for Payer: Mclaren Medicare	$2,836.20
Rate for Payer: Meridian Medicaid	$1,629.11
Rate for Payer: Meridian Wellcare - Medicare Advantage	$2,978.01
Rate for Payer: MI Amish Medical Board Commercial	$3,261.63
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$713.15
Rate for Payer: PACE Medicare	$2,694.39
Rate for Payer: PACE SWMI	$2,836.20
Rate for Payer: PHP Commercial	$713.15
Rate for Payer: PHP Medicare Advantage	$2,836.20
Rate for Payer: Priority Health Choice Medicaid	$1,551.40
Rate for Payer: Priority Health Cigna Priority Health	$587.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8,913.25
Rate for Payer: Priority Health Medicare	$2,836.20
Rate for Payer: Priority Health Narrow Network	$7,130.60
Rate for Payer: Priority Health SBD	$528.57
Rate for Payer: Railroad Medicare Medicare	$2,836.20
Rate for Payer: UHC All Payor (Choice/PPO)	$618.44
Rate for Payer: UHC Dual Complete DSNP	$2,836.20
Rate for Payer: UHC Exchange	$562.22
Rate for Payer: UHC Medicare Advantage	$2,921.29
Rate for Payer: VA VA	$2,836.20

PR LIGJ DIVJ&STRIP LONG SAPH SAPHFEM JUNCT KNE/BELW

Professional

Both

$929.00

Service Code	HCPCS 37722
Min. Negotiated Rate	$290.32
Max. Negotiated Rate	$728.26
Rate for Payer: Aetna Commercial	$630.45
Rate for Payer: BCBS Complete	$304.84
Rate for Payer: BCBS Trust/PPO	$407.85
Rate for Payer: Cash Price	$743.20
Rate for Payer: Cash Price	$743.20
Rate for Payer: Mclaren Medicaid	$290.32
Rate for Payer: Meridian Medicaid	$304.84
Rate for Payer: Priority Health Choice Medicaid	$290.32
Rate for Payer: Priority Health Cigna Priority Health	$650.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$728.26
Rate for Payer: Priority Health Narrow Network	$728.26
Rate for Payer: Priority Health SBD	$728.26

PR LIGJ DIVJ & STRIPPING SHORT SAPHENOUS VEIN

Professional

Both

$806.00

Service Code	HCPCS 37718
Min. Negotiated Rate	$219.24
Max. Negotiated Rate	$614.42
Rate for Payer: Aetna Commercial	$567.92
Rate for Payer: BCBS Complete	$259.65
Rate for Payer: BCBS Trust/PPO	$219.24
Rate for Payer: Cash Price	$644.80
Rate for Payer: Cash Price	$644.80
Rate for Payer: Mclaren Medicaid	$247.29
Rate for Payer: Meridian Medicaid	$259.65
Rate for Payer: Priority Health Choice Medicaid	$247.29
Rate for Payer: Priority Health Cigna Priority Health	$564.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$614.42
Rate for Payer: Priority Health Narrow Network	$614.42
Rate for Payer: Priority Health SBD	$614.42

PR LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX

Professional

Both

$474.00

Service Code	HCPCS 37780
Min. Negotiated Rate	$149.31
Max. Negotiated Rate	$438.49
Rate for Payer: Aetna Commercial	$313.05
Rate for Payer: BCBS Complete	$156.78
Rate for Payer: BCBS Trust/PPO	$438.49
Rate for Payer: Cash Price	$379.20
Rate for Payer: Cash Price	$379.20
Rate for Payer: Mclaren Medicaid	$149.31
Rate for Payer: Meridian Medicaid	$156.78
Rate for Payer: Priority Health Choice Medicaid	$149.31
Rate for Payer: Priority Health Cigna Priority Health	$331.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$369.18
Rate for Payer: Priority Health Narrow Network	$369.18
Rate for Payer: Priority Health SBD	$369.18

PR LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR

Professional

Both

$2,190.00

Service Code	HCPCS 27429
Min. Negotiated Rate	$812.38
Max. Negotiated Rate	$2,210.41
Rate for Payer: Aetna Commercial	$1,675.57
Rate for Payer: BCBS Complete	$853.00
Rate for Payer: BCBS Trust/PPO	$2,210.41
Rate for Payer: Cash Price	$1,752.00
Rate for Payer: Cash Price	$1,752.00
Rate for Payer: Mclaren Medicaid	$812.38
Rate for Payer: Meridian Medicaid	$853.00
Rate for Payer: Priority Health Choice Medicaid	$812.38
Rate for Payer: Priority Health Cigna Priority Health	$1,533.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,929.75
Rate for Payer: Priority Health Narrow Network	$1,929.75
Rate for Payer: Priority Health SBD	$1,929.75

PR LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG

Professional

Both

$1,104.00

Service Code	HCPCS 37761
Min. Negotiated Rate	$338.67
Max. Negotiated Rate	$898.64
Rate for Payer: Aetna Commercial	$717.95
Rate for Payer: BCBS Complete	$355.60
Rate for Payer: BCBS Trust/PPO	$898.64
Rate for Payer: Cash Price	$883.20
Rate for Payer: Cash Price	$883.20
Rate for Payer: Mclaren Medicaid	$338.67
Rate for Payer: Meridian Medicaid	$355.60
Rate for Payer: Priority Health Choice Medicaid	$338.67
Rate for Payer: Priority Health Cigna Priority Health	$772.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$847.40
Rate for Payer: Priority Health Narrow Network	$847.40
Rate for Payer: Priority Health SBD	$847.40

PR LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG

Professional

Both

$330.00

Service Code	HCPCS 58611
Min. Negotiated Rate	$47.93
Max. Negotiated Rate	$231.00
Rate for Payer: Aetna Commercial	$91.50
Rate for Payer: BCBS Complete	$50.33
Rate for Payer: BCBS Trust/PPO	$194.94
Rate for Payer: Cash Price	$264.00
Rate for Payer: Cash Price	$264.00
Rate for Payer: Mclaren Medicaid	$47.93
Rate for Payer: Meridian Medicaid	$50.33
Rate for Payer: Priority Health Choice Medicaid	$47.93
Rate for Payer: Priority Health Cigna Priority Health	$231.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$107.00
Rate for Payer: Priority Health Narrow Network	$107.00
Rate for Payer: Priority Health SBD	$107.00

PR LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI

Professional

Both

$1,260.00

Service Code	HCPCS 58600
Min. Negotiated Rate	$78.19
Max. Negotiated Rate	$882.00
Rate for Payer: Aetna Commercial	$442.01
Rate for Payer: BCBS Complete	$251.16
Rate for Payer: BCBS Trust/PPO	$78.19
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Cash Price	$1,008.00
Rate for Payer: Mclaren Medicaid	$239.20
Rate for Payer: Meridian Medicaid	$251.16
Rate for Payer: Priority Health Choice Medicaid	$239.20
Rate for Payer: Priority Health Cigna Priority Health	$882.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$528.34
Rate for Payer: Priority Health Narrow Network	$528.34
Rate for Payer: Priority Health SBD	$528.34

PR LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX

Professional

Both

$848.00

Service Code	HCPCS 58605
Min. Negotiated Rate	$217.47
Max. Negotiated Rate	$593.60
Rate for Payer: Aetna Commercial	$400.03
Rate for Payer: BCBS Complete	$228.34
Rate for Payer: BCBS Trust/PPO	$264.15
Rate for Payer: Cash Price	$678.40
Rate for Payer: Cash Price	$678.40
Rate for Payer: Mclaren Medicaid	$217.47
Rate for Payer: Meridian Medicaid	$228.34
Rate for Payer: Priority Health Choice Medicaid	$217.47
Rate for Payer: Priority Health Cigna Priority Health	$593.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$480.53
Rate for Payer: Priority Health Narrow Network	$480.53
Rate for Payer: Priority Health SBD	$480.53

PR LILETTA, 52 MG

Professional

Both

$863.00

Service Code	HCPCS J7297
Min. Negotiated Rate	$604.10
Max. Negotiated Rate	$887.36
Rate for Payer: Aetna Commercial	$845.10
Rate for Payer: BCBS Complete	$887.36
Rate for Payer: BCBS Trust/PPO	$856.93
Rate for Payer: Cash Price	$690.40
Rate for Payer: Cash Price	$690.40
Rate for Payer: Mclaren Medicaid	$845.10
Rate for Payer: Meridian Medicaid	$887.36
Rate for Payer: Priority Health Choice Medicaid	$845.10
Rate for Payer: Priority Health Cigna Priority Health	$604.10

PR LINCOMYCIN INJECTION

Professional

Both

$20.00

Service Code	HCPCS J2010
Min. Negotiated Rate	$7.48
Max. Negotiated Rate	$14.00
Rate for Payer: Aetna Commercial	$10.14
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: BCBS Trust/PPO	$7.48
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$14.00

PR LITHOLAPAXY COMP/LG > 2.5 CM

Professional

Both

$918.00

Service Code	HCPCS 52318
Min. Negotiated Rate	$296.92
Max. Negotiated Rate	$1,353.50
Rate for Payer: Aetna Commercial	$607.33
Rate for Payer: BCBS Complete	$311.77
Rate for Payer: BCBS Trust/PPO	$1,353.50
Rate for Payer: Cash Price	$734.40
Rate for Payer: Cash Price	$734.40
Rate for Payer: Mclaren Medicaid	$296.92
Rate for Payer: Meridian Medicaid	$311.77
Rate for Payer: Priority Health Choice Medicaid	$296.92
Rate for Payer: Priority Health Cigna Priority Health	$642.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$745.69
Rate for Payer: Priority Health Narrow Network	$745.69
Rate for Payer: Priority Health SBD	$745.69

PR LITHOLAPAXY SMPL/SM <2.5 CM

Professional

Both

$1,625.00

Service Code	HCPCS 52317
Min. Negotiated Rate	$217.26
Max. Negotiated Rate	$1,148.52
Rate for Payer: Aetna Commercial	$444.33
Rate for Payer: BCBS Complete	$228.12
Rate for Payer: BCBS Trust/PPO	$1,148.52
Rate for Payer: Cash Price	$1,300.00
Rate for Payer: Cash Price	$1,300.00
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	$1,137.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$546.30
Rate for Payer: Priority Health Narrow Network	$546.30
Rate for Payer: Priority Health SBD	$546.30

PR LITHOTRIPSY XTRCORP SHOCK WAVE

Professional

Both

$1,517.00

Service Code	HCPCS 50590
Min. Negotiated Rate	$365.30
Max. Negotiated Rate	$1,061.90
Rate for Payer: Aetna Commercial	$730.18
Rate for Payer: BCBS Complete	$383.56
Rate for Payer: BCBS Trust/PPO	$1,004.83
Rate for Payer: Cash Price	$1,213.60
Rate for Payer: Cash Price	$1,213.60
Rate for Payer: Mclaren Medicaid	$365.30
Rate for Payer: Meridian Medicaid	$383.56
Rate for Payer: Priority Health Choice Medicaid	$365.30
Rate for Payer: Priority Health Cigna Priority Health	$1,061.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$911.59
Rate for Payer: Priority Health Narrow Network	$911.59
Rate for Payer: Priority Health SBD	$911.59

PR LMTD LMPHADEC STAGING SPX PEL&PARA-AORTIC

Professional

Both

$3,865.00

Service Code	HCPCS 38562
Min. Negotiated Rate	$453.26
Max. Negotiated Rate	$2,705.50
Rate for Payer: Aetna Commercial	$873.15
Rate for Payer: BCBS Complete	$475.92
Rate for Payer: BCBS Trust/PPO	$667.24
Rate for Payer: Cash Price	$3,092.00
Rate for Payer: Cash Price	$3,092.00
Rate for Payer: Mclaren Medicaid	$453.26
Rate for Payer: Meridian Medicaid	$475.92
Rate for Payer: Priority Health Choice Medicaid	$453.26
Rate for Payer: Priority Health Cigna Priority Health	$2,705.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,525.45
Rate for Payer: Priority Health Narrow Network	$1,525.45
Rate for Payer: Priority Health SBD	$1,525.45

PR LMTD LMPHADEC STAGING SPX RPR AORTIC&/SPLENIC

Professional

Both

$2,775.00

Service Code	HCPCS 38564
Min. Negotiated Rate	$448.58
Max. Negotiated Rate	$1,942.50
Rate for Payer: Aetna Commercial	$878.57
Rate for Payer: BCBS Complete	$471.01
Rate for Payer: BCBS Trust/PPO	$543.62
Rate for Payer: Cash Price	$2,220.00
Rate for Payer: Cash Price	$2,220.00
Rate for Payer: Mclaren Medicaid	$448.58
Rate for Payer: Meridian Medicaid	$471.01
Rate for Payer: Priority Health Choice Medicaid	$448.58
Rate for Payer: Priority Health Cigna Priority Health	$1,942.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,518.23
Rate for Payer: Priority Health Narrow Network	$1,518.23
Rate for Payer: Priority Health SBD	$1,518.23

PR LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN

Professional

Both

$1,588.00

Service Code	HCPCS 25280
Min. Negotiated Rate	$368.92
Max. Negotiated Rate	$1,111.60
Rate for Payer: Aetna Commercial	$754.53
Rate for Payer: BCBS Complete	$387.37
Rate for Payer: BCBS Trust/PPO	$760.22
Rate for Payer: Cash Price	$1,270.40
Rate for Payer: Cash Price	$1,270.40
Rate for Payer: Mclaren Medicaid	$368.92
Rate for Payer: Meridian Medicaid	$387.37
Rate for Payer: Priority Health Choice Medicaid	$368.92
Rate for Payer: Priority Health Cigna Priority Health	$1,111.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$874.75
Rate for Payer: Priority Health Narrow Network	$874.75
Rate for Payer: Priority Health SBD	$874.75

Know your out-of-pocket cost for care.

All Charges