Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD

Professional

Both

$402.00

Service Code	HCPCS 26341
Min. Negotiated Rate	$50.69
Max. Negotiated Rate	$354.49
Rate for Payer: Aetna Commercial	$102.17
Rate for Payer: BCBS Complete	$53.22
Rate for Payer: BCBS Trust/PPO	$354.49
Rate for Payer: Cash Price	$321.60
Rate for Payer: Cash Price	$321.60
Rate for Payer: Mclaren Medicaid	$50.69
Rate for Payer: Meridian Medicaid	$53.22
Rate for Payer: Priority Health Choice Medicaid	$50.69
Rate for Payer: Priority Health Cigna Priority Health	$281.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$120.51
Rate for Payer: Priority Health Narrow Network	$120.51
Rate for Payer: Priority Health SBD	$120.51

PR MANIPULATION ANKLE UNDER GENERAL ANESTHESIA

Professional

Both

$618.00

Service Code	HCPCS 27860
Min. Negotiated Rate	$105.44
Max. Negotiated Rate	$1,252.07
Rate for Payer: Aetna Commercial	$223.16
Rate for Payer: BCBS Complete	$110.71
Rate for Payer: BCBS Trust/PPO	$1,252.07
Rate for Payer: Cash Price	$494.40
Rate for Payer: Cash Price	$494.40
Rate for Payer: Mclaren Medicaid	$105.44
Rate for Payer: Meridian Medicaid	$110.71
Rate for Payer: Priority Health Choice Medicaid	$105.44
Rate for Payer: Priority Health Cigna Priority Health	$432.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$251.74
Rate for Payer: Priority Health Narrow Network	$251.74
Rate for Payer: Priority Health SBD	$251.74

PR MANIPULATION ELBOW UNDER ANESTHESIA

Professional

Both

$702.00

Service Code	HCPCS 24300
Min. Negotiated Rate	$92.45
Max. Negotiated Rate	$678.14
Rate for Payer: Aetna Commercial	$567.74
Rate for Payer: BCBS Complete	$303.94
Rate for Payer: BCBS Trust/PPO	$92.45
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cash Price	$561.60
Rate for Payer: Mclaren Medicaid	$289.47
Rate for Payer: Meridian Medicaid	$303.94
Rate for Payer: Priority Health Choice Medicaid	$289.47
Rate for Payer: Priority Health Cigna Priority Health	$491.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$678.14
Rate for Payer: Priority Health Narrow Network	$678.14
Rate for Payer: Priority Health SBD	$678.14

PR MANIPULATION FINGER JOINT UNDER ANES EACH JOINT

Professional

Both

$700.00

Service Code	HCPCS 26340
Min. Negotiated Rate	$108.30
Max. Negotiated Rate	$552.01
Rate for Payer: Aetna Commercial	$454.85
Rate for Payer: BCBS Complete	$247.14
Rate for Payer: BCBS Trust/PPO	$108.30
Rate for Payer: Cash Price	$560.00
Rate for Payer: Cash Price	$560.00
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	$490.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$552.01
Rate for Payer: Priority Health Narrow Network	$552.01
Rate for Payer: Priority Health SBD	$552.01

PR MANIPULATION HIP JOINT GENERAL ANESTHESIA

Professional

Both

$988.00

Service Code	HCPCS 27275
Min. Negotiated Rate	$119.49
Max. Negotiated Rate	$4,431.91
Rate for Payer: Aetna Commercial	$244.58
Rate for Payer: BCBS Complete	$125.46
Rate for Payer: BCBS Trust/PPO	$4,431.91
Rate for Payer: Cash Price	$790.40
Rate for Payer: Cash Price	$790.40
Rate for Payer: Mclaren Medicaid	$119.49
Rate for Payer: Meridian Medicaid	$125.46
Rate for Payer: Priority Health Choice Medicaid	$119.49
Rate for Payer: Priority Health Cigna Priority Health	$691.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$282.91
Rate for Payer: Priority Health Narrow Network	$282.91
Rate for Payer: Priority Health SBD	$282.91

PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA

Facility

$656.00

Service Code	CPT 27570
Hospital Charge Code	27570
Min. Negotiated Rate	$153.90
Max. Negotiated Rate	$4,301.45
Rate for Payer: Aetna Commercial	$557.60
Rate for Payer: Aetna Medicare	$1,487.28
Rate for Payer: Aetna New Business (MI Preferred)	$426.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,787.60
Rate for Payer: Amish Plain Church Group Commercial	$1,787.60
Rate for Payer: BCBS Complete	$821.44
Rate for Payer: BCBS MAPPO	$1,430.08
Rate for Payer: BCBS Trust/PPO	$996.18
Rate for Payer: BCN Medicare Advantage	$1,430.08
Rate for Payer: Cash Price	$524.80
Rate for Payer: Cash Price	$524.80
Rate for Payer: Cofinity Commercial	$564.16
Rate for Payer: Cofinity Commercial	$459.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,430.08
Rate for Payer: Healthscope Commercial	$590.40
Rate for Payer: Mclaren Medicaid	$782.25
Rate for Payer: Mclaren Medicare	$1,430.08
Rate for Payer: Meridian Medicaid	$821.44
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,501.58
Rate for Payer: MI Amish Medical Board Commercial	$1,644.59
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$557.60
Rate for Payer: PACE Medicare	$1,358.58
Rate for Payer: PACE SWMI	$1,430.08
Rate for Payer: PHP Commercial	$557.60
Rate for Payer: PHP Medicare Advantage	$1,430.08
Rate for Payer: Priority Health Choice Medicaid	$782.25
Rate for Payer: Priority Health Cigna Priority Health	$459.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,301.45
Rate for Payer: Priority Health Medicare	$1,430.08
Rate for Payer: Priority Health Narrow Network	$3,441.16
Rate for Payer: Priority Health SBD	$413.28
Rate for Payer: Railroad Medicare Medicare	$1,430.08
Rate for Payer: UHC All Payor (Choice/PPO)	$169.29
Rate for Payer: UHC Dual Complete DSNP	$1,430.08
Rate for Payer: UHC Exchange	$153.90
Rate for Payer: UHC Medicare Advantage	$1,472.98
Rate for Payer: VA VA	$1,430.08

PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA

Professional

Both

$656.00

Service Code	HCPCS 27570
Min. Negotiated Rate	$100.11
Max. Negotiated Rate	$1,799.92
Rate for Payer: Aetna Commercial	$199.99
Rate for Payer: BCBS Complete	$105.12
Rate for Payer: BCBS Trust/PPO	$1,799.92
Rate for Payer: Cash Price	$524.80
Rate for Payer: Cash Price	$524.80
Rate for Payer: Mclaren Medicaid	$100.11
Rate for Payer: Meridian Medicaid	$105.12
Rate for Payer: Priority Health Choice Medicaid	$100.11
Rate for Payer: Priority Health Cigna Priority Health	$459.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$236.43
Rate for Payer: Priority Health Narrow Network	$236.43
Rate for Payer: Priority Health SBD	$236.43

PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA

Facility

$656.00

Service Code	CPT 27570
Hospital Charge Code	27570
Min. Negotiated Rate	$413.28
Max. Negotiated Rate	$590.40
Rate for Payer: Aetna Commercial	$557.60
Rate for Payer: Aetna New Business (MI Preferred)	$426.40
Rate for Payer: Cash Price	$524.80
Rate for Payer: Cofinity Commercial	$459.20
Rate for Payer: Cofinity Commercial	$564.16
Rate for Payer: Healthscope Commercial	$590.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$557.60
Rate for Payer: PHP Commercial	$557.60
Rate for Payer: Priority Health Cigna Priority Health	$459.20
Rate for Payer: Priority Health SBD	$413.28

PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA

Professional

Both

$656.00

Service Code	HCPCS 27570
Hospital Charge Code	27570
Min. Negotiated Rate	$100.11
Max. Negotiated Rate	$1,799.92
Rate for Payer: Aetna Commercial	$199.99
Rate for Payer: BCBS Complete	$105.12
Rate for Payer: BCBS Trust/PPO	$1,799.92
Rate for Payer: Cash Price	$524.80
Rate for Payer: Cash Price	$524.80
Rate for Payer: Mclaren Medicaid	$100.11
Rate for Payer: Meridian Medicaid	$105.12
Rate for Payer: Priority Health Choice Medicaid	$100.11
Rate for Payer: Priority Health Cigna Priority Health	$459.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$236.43
Rate for Payer: Priority Health Narrow Network	$236.43
Rate for Payer: Priority Health SBD	$236.43

PR MANIPULATION SPINE REQUIRING ANESTHESIA

Professional

Both

$477.00

Service Code	HCPCS 22505
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$333.90
Rate for Payer: Aetna Commercial	$174.31
Rate for Payer: BCBS Complete	$87.90
Rate for Payer: BCBS Trust/PPO	$35.00
Rate for Payer: Cash Price	$381.60
Rate for Payer: Cash Price	$381.60
Rate for Payer: Mclaren Medicaid	$83.71
Rate for Payer: Meridian Medicaid	$87.90
Rate for Payer: Priority Health Choice Medicaid	$83.71
Rate for Payer: Priority Health Cigna Priority Health	$333.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$198.64
Rate for Payer: Priority Health Narrow Network	$198.64
Rate for Payer: Priority Health SBD	$198.64

PR MANIPULATION WRIST UNDER ANESTHESIA

Professional

Both

$673.00

Service Code	HCPCS 25259
Min. Negotiated Rate	$284.57
Max. Negotiated Rate	$1,324.45
Rate for Payer: Aetna Commercial	$560.78
Rate for Payer: BCBS Complete	$298.80
Rate for Payer: BCBS Trust/PPO	$1,324.45
Rate for Payer: Cash Price	$538.40
Rate for Payer: Cash Price	$538.40
Rate for Payer: Mclaren Medicaid	$284.57
Rate for Payer: Meridian Medicaid	$298.80
Rate for Payer: Priority Health Choice Medicaid	$284.57
Rate for Payer: Priority Health Cigna Priority Health	$471.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$672.02
Rate for Payer: Priority Health Narrow Network	$672.02
Rate for Payer: Priority Health SBD	$672.02

PR MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV

Professional

Both

$167.00

Service Code	HCPCS 20700
Min. Negotiated Rate	$53.68
Max. Negotiated Rate	$1,725.86
Rate for Payer: Aetna Commercial	$111.83
Rate for Payer: BCBS Complete	$56.36
Rate for Payer: BCBS Trust/PPO	$1,725.86
Rate for Payer: Cash Price	$133.60
Rate for Payer: Cash Price	$133.60
Rate for Payer: Mclaren Medicaid	$53.68
Rate for Payer: Meridian Medicaid	$56.36
Rate for Payer: Priority Health Choice Medicaid	$53.68
Rate for Payer: Priority Health Cigna Priority Health	$116.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$128.18
Rate for Payer: Priority Health Narrow Network	$128.18
Rate for Payer: Priority Health SBD	$128.18

PR MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE

Professional

Both

$286.00

Service Code	HCPCS 20702
Min. Negotiated Rate	$35.00
Max. Negotiated Rate	$216.00
Rate for Payer: Aetna Commercial	$187.44
Rate for Payer: BCBS Complete	$94.83
Rate for Payer: BCBS Trust/PPO	$35.00
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cash Price	$228.80
Rate for Payer: Mclaren Medicaid	$90.31
Rate for Payer: Meridian Medicaid	$94.83
Rate for Payer: Priority Health Choice Medicaid	$90.31
Rate for Payer: Priority Health Cigna Priority Health	$200.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$216.00
Rate for Payer: Priority Health Narrow Network	$216.00
Rate for Payer: Priority Health SBD	$216.00

PR MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES

Professional

Both

$48.00

Service Code	HCPCS 97140
Min. Negotiated Rate	$19.20
Max. Negotiated Rate	$1,604.98
Rate for Payer: Aetna Commercial	$20.11
Rate for Payer: BCBS Complete	$19.20
Rate for Payer: BCBS Trust/PPO	$1,604.98
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Priority Health Cigna Priority Health	$33.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$75.00
Rate for Payer: Priority Health Narrow Network	$75.00
Rate for Payer: Priority Health SBD	$75.00

PR MARSUPIALIZATION BARTHOLINS GLAND CYST

Professional

Both

$770.00

Service Code	HCPCS 56440
Min. Negotiated Rate	$116.94
Max. Negotiated Rate	$539.00
Rate for Payer: Aetna Commercial	$215.36
Rate for Payer: BCBS Complete	$122.79
Rate for Payer: BCBS Trust/PPO	$226.64
Rate for Payer: Cash Price	$616.00
Rate for Payer: Cash Price	$616.00
Rate for Payer: Mclaren Medicaid	$116.94
Rate for Payer: Meridian Medicaid	$122.79
Rate for Payer: Priority Health Choice Medicaid	$116.94
Rate for Payer: Priority Health Cigna Priority Health	$539.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$257.07
Rate for Payer: Priority Health Narrow Network	$257.07
Rate for Payer: Priority Health SBD	$257.07

PR MARSUPIALIZATION CST/ABSC LVR

Professional

Both

$2,296.00

Service Code	HCPCS 47300
Min. Negotiated Rate	$727.40
Max. Negotiated Rate	$2,350.41
Rate for Payer: Aetna Commercial	$1,533.52
Rate for Payer: BCBS Complete	$763.77
Rate for Payer: BCBS Trust/PPO	$2,350.41
Rate for Payer: Cash Price	$1,836.80
Rate for Payer: Cash Price	$1,836.80
Rate for Payer: Mclaren Medicaid	$727.40
Rate for Payer: Meridian Medicaid	$763.77
Rate for Payer: Priority Health Choice Medicaid	$727.40
Rate for Payer: Priority Health Cigna Priority Health	$1,607.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,998.53
Rate for Payer: Priority Health Narrow Network	$1,998.53
Rate for Payer: Priority Health SBD	$1,998.53

PR MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA

Professional

Both

$682.00

Service Code	HCPCS 42409
Min. Negotiated Rate	$150.38
Max. Negotiated Rate	$641.36
Rate for Payer: Aetna Commercial	$297.60
Rate for Payer: BCBS Complete	$157.90
Rate for Payer: BCBS Trust/PPO	$641.36
Rate for Payer: Cash Price	$545.60
Rate for Payer: Cash Price	$545.60
Rate for Payer: Mclaren Medicaid	$150.38
Rate for Payer: Meridian Medicaid	$157.90
Rate for Payer: Priority Health Choice Medicaid	$150.38
Rate for Payer: Priority Health Cigna Priority Health	$477.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$410.40
Rate for Payer: Priority Health Narrow Network	$410.40
Rate for Payer: Priority Health SBD	$410.40

PR MASTECTOMY GYNECOMASTIA

Facility

$1,600.00

Service Code	CPT 19300
Hospital Charge Code	19300
Hospital Revenue Code	960
Min. Negotiated Rate	$1,008.00
Max. Negotiated Rate	$1,440.00
Rate for Payer: Aetna Commercial	$1,360.00
Rate for Payer: Aetna New Business (MI Preferred)	$1,040.00
Rate for Payer: Cash Price	$1,280.00
Rate for Payer: Cofinity Commercial	$1,120.00
Rate for Payer: Cofinity Commercial	$1,376.00
Rate for Payer: Healthscope Commercial	$1,440.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,360.00
Rate for Payer: PHP Commercial	$1,360.00
Rate for Payer: Priority Health Cigna Priority Health	$1,120.00
Rate for Payer: Priority Health SBD	$1,008.00

PR MASTECTOMY GYNECOMASTIA

Facility

$1,600.00

Service Code	CPT 19300
Hospital Charge Code	19300
Hospital Revenue Code	960
Min. Negotiated Rate	$427.97
Max. Negotiated Rate	$10,308.37
Rate for Payer: Aetna Commercial	$1,360.00
Rate for Payer: Aetna Medicare	$3,527.33
Rate for Payer: Aetna New Business (MI Preferred)	$1,040.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,239.58
Rate for Payer: Amish Plain Church Group Commercial	$4,239.58
Rate for Payer: BCBS Complete	$1,948.17
Rate for Payer: BCBS MAPPO	$3,391.66
Rate for Payer: BCBS Trust/PPO	$2,998.80
Rate for Payer: BCN Medicare Advantage	$3,391.66
Rate for Payer: Cash Price	$1,280.00
Rate for Payer: Cash Price	$1,280.00
Rate for Payer: Cofinity Commercial	$1,376.00
Rate for Payer: Cofinity Commercial	$1,120.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,391.66
Rate for Payer: Healthscope Commercial	$1,440.00
Rate for Payer: Mclaren Medicaid	$1,855.24
Rate for Payer: Mclaren Medicare	$3,391.66
Rate for Payer: Meridian Medicaid	$1,948.17
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,561.24
Rate for Payer: MI Amish Medical Board Commercial	$3,900.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,360.00
Rate for Payer: PACE Medicare	$3,222.08
Rate for Payer: PACE SWMI	$3,391.66
Rate for Payer: PHP Commercial	$1,360.00
Rate for Payer: PHP Medicare Advantage	$3,391.66
Rate for Payer: Priority Health Choice Medicaid	$1,855.24
Rate for Payer: Priority Health Cigna Priority Health	$1,120.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10,308.37
Rate for Payer: Priority Health Medicare	$3,391.66
Rate for Payer: Priority Health Narrow Network	$8,246.70
Rate for Payer: Priority Health SBD	$1,008.00
Rate for Payer: Railroad Medicare Medicare	$3,391.66
Rate for Payer: UHC All Payor (Choice/PPO)	$470.77
Rate for Payer: UHC Dual Complete DSNP	$3,391.66
Rate for Payer: UHC Exchange	$427.97
Rate for Payer: UHC Medicare Advantage	$3,493.41
Rate for Payer: VA VA	$3,391.66

PR MASTECTOMY GYNECOMASTIA

Professional

Both

$1,600.00

Service Code	HCPCS 19300
Min. Negotiated Rate	$278.39
Max. Negotiated Rate	$1,120.00
Rate for Payer: Aetna Commercial	$462.52
Rate for Payer: BCBS Complete	$292.31
Rate for Payer: BCBS Trust/PPO	$570.00
Rate for Payer: Cash Price	$1,280.00
Rate for Payer: Cash Price	$1,280.00
Rate for Payer: Mclaren Medicaid	$278.39
Rate for Payer: Meridian Medicaid	$292.31
Rate for Payer: Priority Health Choice Medicaid	$278.39
Rate for Payer: Priority Health Cigna Priority Health	$1,120.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$536.00
Rate for Payer: Priority Health Narrow Network	$536.00
Rate for Payer: Priority Health SBD	$536.00

PR MASTECTOMY GYNECOMASTIA

Professional

Both

$1,600.00

Service Code	HCPCS 19300
Hospital Charge Code	19300
Min. Negotiated Rate	$278.39
Max. Negotiated Rate	$1,120.00
Rate for Payer: Aetna Commercial	$462.52
Rate for Payer: BCBS Complete	$292.31
Rate for Payer: BCBS Trust/PPO	$570.00
Rate for Payer: Cash Price	$1,280.00
Rate for Payer: Cash Price	$1,280.00
Rate for Payer: Mclaren Medicaid	$278.39
Rate for Payer: Meridian Medicaid	$292.31
Rate for Payer: Priority Health Choice Medicaid	$278.39
Rate for Payer: Priority Health Cigna Priority Health	$1,120.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$536.00
Rate for Payer: Priority Health Narrow Network	$536.00
Rate for Payer: Priority Health SBD	$536.00

PR MASTECTOMY PARTIAL

Facility

$1,087.00

Service Code	CPT 19301
Hospital Charge Code	19301
Hospital Revenue Code	960
Min. Negotiated Rate	$684.81
Max. Negotiated Rate	$978.30
Rate for Payer: Aetna Commercial	$923.95
Rate for Payer: Aetna New Business (MI Preferred)	$706.55
Rate for Payer: Cash Price	$869.60
Rate for Payer: Cofinity Commercial	$760.90
Rate for Payer: Cofinity Commercial	$934.82
Rate for Payer: Healthscope Commercial	$978.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$923.95
Rate for Payer: PHP Commercial	$923.95
Rate for Payer: Priority Health Cigna Priority Health	$760.90
Rate for Payer: Priority Health SBD	$684.81

PR MASTECTOMY PARTIAL

Professional

Both

$1,087.00

Service Code	HCPCS 19301
Min. Negotiated Rate	$424.51
Max. Negotiated Rate	$813.45
Rate for Payer: Aetna Commercial	$722.42
Rate for Payer: BCBS Complete	$445.74
Rate for Payer: BCBS Trust/PPO	$570.00
Rate for Payer: Cash Price	$869.60
Rate for Payer: Cash Price	$869.60
Rate for Payer: Mclaren Medicaid	$424.51
Rate for Payer: Meridian Medicaid	$445.74
Rate for Payer: Priority Health Choice Medicaid	$424.51
Rate for Payer: Priority Health Cigna Priority Health	$760.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$813.45
Rate for Payer: Priority Health Narrow Network	$813.45
Rate for Payer: Priority Health SBD	$813.45

PR MASTECTOMY PARTIAL

Facility

$1,087.00

Service Code	CPT 19301
Hospital Charge Code	19301
Hospital Revenue Code	960
Min. Negotiated Rate	$652.59
Max. Negotiated Rate	$10,308.37
Rate for Payer: Aetna Commercial	$923.95
Rate for Payer: Aetna Medicare	$3,527.33
Rate for Payer: Aetna New Business (MI Preferred)	$706.55
Rate for Payer: Allen County Amish Medical Aid Commercial	$4,239.58
Rate for Payer: Amish Plain Church Group Commercial	$4,239.58
Rate for Payer: BCBS Complete	$1,948.17
Rate for Payer: BCBS MAPPO	$3,391.66
Rate for Payer: BCBS Trust/PPO	$2,210.04
Rate for Payer: BCN Medicare Advantage	$3,391.66
Rate for Payer: Cash Price	$869.60
Rate for Payer: Cash Price	$869.60
Rate for Payer: Cofinity Commercial	$934.82
Rate for Payer: Cofinity Commercial	$760.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,391.66
Rate for Payer: Healthscope Commercial	$978.30
Rate for Payer: Mclaren Medicaid	$1,855.24
Rate for Payer: Mclaren Medicare	$3,391.66
Rate for Payer: Meridian Medicaid	$1,948.17
Rate for Payer: Meridian Wellcare - Medicare Advantage	$3,561.24
Rate for Payer: MI Amish Medical Board Commercial	$3,900.41
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$923.95
Rate for Payer: PACE Medicare	$3,222.08
Rate for Payer: PACE SWMI	$3,391.66
Rate for Payer: PHP Commercial	$923.95
Rate for Payer: PHP Medicare Advantage	$3,391.66
Rate for Payer: Priority Health Choice Medicaid	$1,855.24
Rate for Payer: Priority Health Cigna Priority Health	$760.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$10,308.37
Rate for Payer: Priority Health Medicare	$3,391.66
Rate for Payer: Priority Health Narrow Network	$8,246.70
Rate for Payer: Priority Health SBD	$684.81
Rate for Payer: Railroad Medicare Medicare	$3,391.66
Rate for Payer: UHC All Payor (Choice/PPO)	$717.85
Rate for Payer: UHC Dual Complete DSNP	$3,391.66
Rate for Payer: UHC Exchange	$652.59
Rate for Payer: UHC Medicare Advantage	$3,493.41
Rate for Payer: VA VA	$3,391.66

PR MASTECTOMY PARTIAL

Professional

Both

$1,087.00

Service Code	HCPCS 19301
Hospital Charge Code	19301
Min. Negotiated Rate	$424.51
Max. Negotiated Rate	$813.45
Rate for Payer: Aetna Commercial	$722.42
Rate for Payer: BCBS Complete	$445.74
Rate for Payer: BCBS Trust/PPO	$570.00
Rate for Payer: Cash Price	$869.60
Rate for Payer: Cash Price	$869.60
Rate for Payer: Mclaren Medicaid	$424.51
Rate for Payer: Meridian Medicaid	$445.74
Rate for Payer: Priority Health Choice Medicaid	$424.51
Rate for Payer: Priority Health Cigna Priority Health	$760.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$813.45
Rate for Payer: Priority Health Narrow Network	$813.45
Rate for Payer: Priority Health SBD	$813.45

Know your out-of-pocket cost for care.

All Charges