Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES

Facility

$236.00

Service Code	CPT 11976
Hospital Charge Code	11976
Hospital Revenue Code	521
Min. Negotiated Rate	$90.70
Max. Negotiated Rate	$1,937.58
Rate for Payer: Aetna Commercial	$200.60
Rate for Payer: Aetna Medicare	$651.08
Rate for Payer: Aetna New Business (MI Preferred)	$153.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$782.55
Rate for Payer: Amish Plain Church Group Commercial	$782.55
Rate for Payer: BCBS Complete	$359.60
Rate for Payer: BCBS MAPPO	$626.04
Rate for Payer: BCBS Trust/PPO	$405.67
Rate for Payer: BCN Medicare Advantage	$626.04
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cofinity Commercial	$165.20
Rate for Payer: Cofinity Commercial	$202.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$626.04
Rate for Payer: Healthscope Commercial	$212.40
Rate for Payer: Mclaren Medicaid	$342.44
Rate for Payer: Mclaren Medicare	$626.04
Rate for Payer: Meridian Medicaid	$359.60
Rate for Payer: Meridian Wellcare - Medicare Advantage	$657.34
Rate for Payer: MI Amish Medical Board Commercial	$719.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$200.60
Rate for Payer: PACE Medicare	$594.74
Rate for Payer: PACE SWMI	$626.04
Rate for Payer: PHP Commercial	$200.60
Rate for Payer: PHP Medicare Advantage	$626.04
Rate for Payer: Priority Health Choice Medicaid	$342.44
Rate for Payer: Priority Health Cigna Priority Health	$165.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,937.58
Rate for Payer: Priority Health Medicare	$626.04
Rate for Payer: Priority Health Narrow Network	$1,550.06
Rate for Payer: Priority Health SBD	$148.68
Rate for Payer: Railroad Medicare Medicare	$626.04
Rate for Payer: UHC All Payor (Choice/PPO)	$99.77
Rate for Payer: UHC Dual Complete DSNP	$626.04
Rate for Payer: UHC Exchange	$90.70
Rate for Payer: UHC Medicare Advantage	$644.82
Rate for Payer: VA VA	$626.04

PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES

Professional

Both

$236.00

Service Code	HCPCS 11976
Min. Negotiated Rate	$59.00
Max. Negotiated Rate	$268.22
Rate for Payer: Aetna Commercial	$102.24
Rate for Payer: BCBS Complete	$61.95
Rate for Payer: BCBS Trust/PPO	$268.22
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cash Price	$188.80
Rate for Payer: Mclaren Medicaid	$59.00
Rate for Payer: Meridian Medicaid	$61.95
Rate for Payer: Priority Health Choice Medicaid	$59.00
Rate for Payer: Priority Health Cigna Priority Health	$165.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$113.45
Rate for Payer: Priority Health Narrow Network	$113.45
Rate for Payer: Priority Health SBD	$113.45

PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES

Facility

$236.00

Service Code	CPT 11976
Hospital Charge Code	11976
Hospital Revenue Code	521
Min. Negotiated Rate	$148.68
Max. Negotiated Rate	$212.40
Rate for Payer: Aetna Commercial	$200.60
Rate for Payer: Aetna New Business (MI Preferred)	$153.40
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cofinity Commercial	$165.20
Rate for Payer: Cofinity Commercial	$202.96
Rate for Payer: Healthscope Commercial	$212.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$200.60
Rate for Payer: PHP Commercial	$200.60
Rate for Payer: Priority Health Cigna Priority Health	$165.20
Rate for Payer: Priority Health SBD	$148.68

PR REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES

Professional

Both

$236.00

Service Code	HCPCS 11976
Hospital Charge Code	11976
Min. Negotiated Rate	$59.00
Max. Negotiated Rate	$268.22
Rate for Payer: Aetna Commercial	$102.24
Rate for Payer: BCBS Complete	$61.95
Rate for Payer: BCBS Trust/PPO	$268.22
Rate for Payer: Cash Price	$188.80
Rate for Payer: Cash Price	$188.80
Rate for Payer: Mclaren Medicaid	$59.00
Rate for Payer: Meridian Medicaid	$61.95
Rate for Payer: Priority Health Choice Medicaid	$59.00
Rate for Payer: Priority Health Cigna Priority Health	$165.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$113.45
Rate for Payer: Priority Health Narrow Network	$113.45
Rate for Payer: Priority Health SBD	$113.45

PR REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY

Professional

Both

$429.00

Service Code	HCPCS 33241
Min. Negotiated Rate	$135.68
Max. Negotiated Rate	$1,338.18
Rate for Payer: Aetna Commercial	$287.03
Rate for Payer: BCBS Complete	$142.46
Rate for Payer: BCBS Trust/PPO	$1,338.18
Rate for Payer: Cash Price	$343.20
Rate for Payer: Cash Price	$343.20
Rate for Payer: Mclaren Medicaid	$135.68
Rate for Payer: Meridian Medicaid	$142.46
Rate for Payer: Priority Health Choice Medicaid	$135.68
Rate for Payer: Priority Health Cigna Priority Health	$300.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$338.85
Rate for Payer: Priority Health Narrow Network	$338.85
Rate for Payer: Priority Health SBD	$338.85

PR REMOVAL IMPLANT DEEP

Facility

$1,064.00

Service Code	CPT 20680
Hospital Charge Code	20680
Min. Negotiated Rate	$416.18
Max. Negotiated Rate	$7,382.58
Rate for Payer: Aetna Commercial	$904.40
Rate for Payer: Aetna Medicare	$2,629.47
Rate for Payer: Aetna New Business (MI Preferred)	$691.60
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	$2,023.77
Rate for Payer: BCN Medicare Advantage	$2,528.34
Rate for Payer: Cash Price	$851.20
Rate for Payer: Cash Price	$851.20
Rate for Payer: Cofinity Commercial	$915.04
Rate for Payer: Cofinity Commercial	$744.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,528.34
Rate for Payer: Healthscope Commercial	$957.60
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	$904.40
Rate for Payer: PACE Medicare	$2,401.92
Rate for Payer: PACE SWMI	$2,528.34
Rate for Payer: PHP Commercial	$904.40
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	$744.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$7,382.58
Rate for Payer: Priority Health Medicare	$2,528.34
Rate for Payer: Priority Health Narrow Network	$5,906.06
Rate for Payer: Priority Health SBD	$670.32
Rate for Payer: Railroad Medicare Medicare	$2,528.34
Rate for Payer: UHC All Payor (Choice/PPO)	$457.80
Rate for Payer: UHC Dual Complete DSNP	$2,528.34
Rate for Payer: UHC Exchange	$416.18
Rate for Payer: UHC Medicare Advantage	$2,604.19
Rate for Payer: VA VA	$2,528.34

PR REMOVAL IMPLANT DEEP

Facility

$1,064.00

Service Code	CPT 20680
Hospital Charge Code	20680
Min. Negotiated Rate	$670.32
Max. Negotiated Rate	$957.60
Rate for Payer: Aetna Commercial	$904.40
Rate for Payer: Aetna New Business (MI Preferred)	$691.60
Rate for Payer: Cash Price	$851.20
Rate for Payer: Cofinity Commercial	$744.80
Rate for Payer: Cofinity Commercial	$915.04
Rate for Payer: Healthscope Commercial	$957.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$904.40
Rate for Payer: PHP Commercial	$904.40
Rate for Payer: Priority Health Cigna Priority Health	$744.80
Rate for Payer: Priority Health SBD	$670.32

PR REMOVAL IMPLANT DEEP

Professional

Both

$1,064.00

Service Code	HCPCS 20680
Hospital Charge Code	20680
Min. Negotiated Rate	$270.72
Max. Negotiated Rate	$8,162.77
Rate for Payer: Aetna Commercial	$557.80
Rate for Payer: BCBS Complete	$284.26
Rate for Payer: BCBS Trust/PPO	$8,162.77
Rate for Payer: Cash Price	$851.20
Rate for Payer: Cash Price	$851.20
Rate for Payer: Mclaren Medicaid	$270.72
Rate for Payer: Meridian Medicaid	$284.26
Rate for Payer: Priority Health Choice Medicaid	$270.72
Rate for Payer: Priority Health Cigna Priority Health	$744.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$641.37
Rate for Payer: Priority Health Narrow Network	$641.37
Rate for Payer: Priority Health SBD	$641.37

PR REMOVAL IMPLANT DEEP

Professional

Both

$1,064.00

Service Code	HCPCS 20680
Min. Negotiated Rate	$270.72
Max. Negotiated Rate	$8,162.77
Rate for Payer: Aetna Commercial	$557.80
Rate for Payer: BCBS Complete	$284.26
Rate for Payer: BCBS Trust/PPO	$8,162.77
Rate for Payer: Cash Price	$851.20
Rate for Payer: Cash Price	$851.20
Rate for Payer: Mclaren Medicaid	$270.72
Rate for Payer: Meridian Medicaid	$284.26
Rate for Payer: Priority Health Choice Medicaid	$270.72
Rate for Payer: Priority Health Cigna Priority Health	$744.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$641.37
Rate for Payer: Priority Health Narrow Network	$641.37
Rate for Payer: Priority Health SBD	$641.37

PR REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP

Professional

Both

$817.00

Service Code	HCPCS 36262
Min. Negotiated Rate	$203.20
Max. Negotiated Rate	$571.90
Rate for Payer: Aetna Commercial	$417.45
Rate for Payer: BCBS Complete	$213.36
Rate for Payer: BCBS Trust/PPO	$244.60
Rate for Payer: Cash Price	$653.60
Rate for Payer: Cash Price	$653.60
Rate for Payer: Mclaren Medicaid	$203.20
Rate for Payer: Meridian Medicaid	$213.36
Rate for Payer: Priority Health Choice Medicaid	$203.20
Rate for Payer: Priority Health Cigna Priority Health	$571.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$501.64
Rate for Payer: Priority Health Narrow Network	$501.64
Rate for Payer: Priority Health SBD	$501.64

PR REMOVAL IMPLANT FROM FINGER/HAND

Professional

Both

$1,024.00

Service Code	HCPCS 26320
Min. Negotiated Rate	$140.00
Max. Negotiated Rate	$716.80
Rate for Payer: Aetna Commercial	$463.71
Rate for Payer: BCBS Complete	$240.20
Rate for Payer: BCBS Trust/PPO	$140.00
Rate for Payer: Cash Price	$819.20
Rate for Payer: Cash Price	$819.20
Rate for Payer: Mclaren Medicaid	$228.76
Rate for Payer: Meridian Medicaid	$240.20
Rate for Payer: Priority Health Choice Medicaid	$228.76
Rate for Payer: Priority Health Cigna Priority Health	$716.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$542.82
Rate for Payer: Priority Health Narrow Network	$542.82
Rate for Payer: Priority Health SBD	$542.82

PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE

Facility

$901.00

Service Code	CPT 20670
Hospital Charge Code	20670
Min. Negotiated Rate	$567.63
Max. Negotiated Rate	$810.90
Rate for Payer: Aetna Commercial	$765.85
Rate for Payer: Aetna New Business (MI Preferred)	$585.65
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cofinity Commercial	$774.86
Rate for Payer: Cofinity Commercial	$630.70
Rate for Payer: Healthscope Commercial	$810.90
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$765.85
Rate for Payer: PHP Commercial	$765.85
Rate for Payer: Priority Health Cigna Priority Health	$630.70
Rate for Payer: Priority Health SBD	$567.63

PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE

Professional

Both

$901.00

Service Code	HCPCS 20670
Hospital Charge Code	20670
Min. Negotiated Rate	$93.29
Max. Negotiated Rate	$22,818.32
Rate for Payer: Aetna Commercial	$190.75
Rate for Payer: BCBS Complete	$97.95
Rate for Payer: BCBS Trust/PPO	$22,818.32
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cash Price	$720.80
Rate for Payer: Mclaren Medicaid	$93.29
Rate for Payer: Meridian Medicaid	$97.95
Rate for Payer: Priority Health Choice Medicaid	$93.29
Rate for Payer: Priority Health Cigna Priority Health	$630.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$221.11
Rate for Payer: Priority Health Narrow Network	$221.11
Rate for Payer: Priority Health SBD	$221.11

PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE

Professional

Both

$901.00

Service Code	HCPCS 20670
Min. Negotiated Rate	$93.29
Max. Negotiated Rate	$22,818.32
Rate for Payer: Aetna Commercial	$190.75
Rate for Payer: BCBS Complete	$97.95
Rate for Payer: BCBS Trust/PPO	$22,818.32
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cash Price	$720.80
Rate for Payer: Mclaren Medicaid	$93.29
Rate for Payer: Meridian Medicaid	$97.95
Rate for Payer: Priority Health Choice Medicaid	$93.29
Rate for Payer: Priority Health Cigna Priority Health	$630.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$221.11
Rate for Payer: Priority Health Narrow Network	$221.11
Rate for Payer: Priority Health SBD	$221.11

PR REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE

Facility

$901.00

Service Code	CPT 20670
Hospital Charge Code	20670
Min. Negotiated Rate	$143.42
Max. Negotiated Rate	$4,380.96
Rate for Payer: Aetna Commercial	$765.85
Rate for Payer: Aetna Medicare	$1,500.31
Rate for Payer: Aetna New Business (MI Preferred)	$585.65
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	$901.14
Rate for Payer: BCN Medicare Advantage	$1,442.61
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cash Price	$720.80
Rate for Payer: Cofinity Commercial	$630.70
Rate for Payer: Cofinity Commercial	$774.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,442.61
Rate for Payer: Healthscope Commercial	$810.90
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	$765.85
Rate for Payer: PACE Medicare	$1,370.48
Rate for Payer: PACE SWMI	$1,442.61
Rate for Payer: PHP Commercial	$765.85
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	$630.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,380.96
Rate for Payer: Priority Health Medicare	$1,442.61
Rate for Payer: Priority Health Narrow Network	$3,504.77
Rate for Payer: Priority Health SBD	$567.63
Rate for Payer: Railroad Medicare Medicare	$1,442.61
Rate for Payer: UHC All Payor (Choice/PPO)	$157.76
Rate for Payer: UHC Dual Complete DSNP	$1,442.61
Rate for Payer: UHC Exchange	$143.42
Rate for Payer: UHC Medicare Advantage	$1,485.89
Rate for Payer: VA VA	$1,442.61

PR REMOVAL INDWELLING URETERAL STENT PRQ

Professional

Both

$1,662.00

Service Code	HCPCS 50384
Min. Negotiated Rate	$140.79
Max. Negotiated Rate	$3,794.78
Rate for Payer: Aetna Commercial	$294.10
Rate for Payer: BCBS Complete	$147.83
Rate for Payer: BCBS Trust/PPO	$3,794.78
Rate for Payer: Cash Price	$1,329.60
Rate for Payer: Cash Price	$1,329.60
Rate for Payer: Mclaren Medicaid	$140.79
Rate for Payer: Meridian Medicaid	$147.83
Rate for Payer: Priority Health Choice Medicaid	$140.79
Rate for Payer: Priority Health Cigna Priority Health	$1,163.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$358.80
Rate for Payer: Priority Health Narrow Network	$358.80
Rate for Payer: Priority Health SBD	$358.80

PR REMOVAL INTACT BREAST IMPLANT

Professional

Both

$1,500.00

Service Code	HCPCS 19328
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$1,050.00
Rate for Payer: Aetna Commercial	$597.87
Rate for Payer: BCBS Complete	$373.72
Rate for Payer: BCBS Trust/PPO	$14.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Mclaren Medicaid	$355.92
Rate for Payer: Meridian Medicaid	$373.72
Rate for Payer: Priority Health Choice Medicaid	$355.92
Rate for Payer: Priority Health Cigna Priority Health	$1,050.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$683.15
Rate for Payer: Priority Health Narrow Network	$683.15
Rate for Payer: Priority Health SBD	$683.15

PR REMOVAL INTRA-AORTIC BALLOON ASSIST DEVICE PRQ

Professional

Both

$94.00

Service Code	HCPCS 33968
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$267.85
Rate for Payer: Aetna Commercial	$45.62
Rate for Payer: BCBS Complete	$22.14
Rate for Payer: BCBS Trust/PPO	$267.85
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cash Price	$75.20
Rate for Payer: Mclaren Medicaid	$21.09
Rate for Payer: Meridian Medicaid	$22.14
Rate for Payer: Priority Health Choice Medicaid	$21.09
Rate for Payer: Priority Health Cigna Priority Health	$65.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$52.67
Rate for Payer: Priority Health Narrow Network	$52.67
Rate for Payer: Priority Health SBD	$52.67

PR REMOVAL INTRAUTERINE DEVICE IUD

Professional

Both

$200.00

Service Code	HCPCS 58301
Min. Negotiated Rate	$42.17
Max. Negotiated Rate	$510.34
Rate for Payer: Aetna Commercial	$80.07
Rate for Payer: BCBS Complete	$44.28
Rate for Payer: BCBS Trust/PPO	$510.34
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Mclaren Medicaid	$42.17
Rate for Payer: Meridian Medicaid	$44.28
Rate for Payer: Priority Health Choice Medicaid	$42.17
Rate for Payer: Priority Health Cigna Priority Health	$140.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$93.27
Rate for Payer: Priority Health Narrow Network	$93.27
Rate for Payer: Priority Health SBD	$93.27

PR REMOVAL LUNG PNEUMONECTOMY RESXN SGMNT TRACHEA

Professional

Both

$5,982.00

Service Code	HCPCS 32442
Min. Negotiated Rate	$640.30
Max. Negotiated Rate	$4,187.40
Rate for Payer: Aetna Commercial	$3,956.55
Rate for Payer: BCBS Complete	$2,009.05
Rate for Payer: BCBS Trust/PPO	$640.30
Rate for Payer: Cash Price	$4,785.60
Rate for Payer: Cash Price	$4,785.60
Rate for Payer: Mclaren Medicaid	$1,913.38
Rate for Payer: Meridian Medicaid	$2,009.05
Rate for Payer: Priority Health Choice Medicaid	$1,913.38
Rate for Payer: Priority Health Cigna Priority Health	$4,187.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$4,146.10
Rate for Payer: Priority Health Narrow Network	$4,146.10
Rate for Payer: Priority Health SBD	$4,146.10

PR REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT

Professional

Both

$249.00

Service Code	HCPCS 11982
Min. Negotiated Rate	$46.43
Max. Negotiated Rate	$438.68
Rate for Payer: Aetna Commercial	$82.16
Rate for Payer: BCBS Complete	$48.75
Rate for Payer: BCBS Trust/PPO	$438.68
Rate for Payer: Cash Price	$199.20
Rate for Payer: Cash Price	$199.20
Rate for Payer: Mclaren Medicaid	$46.43
Rate for Payer: Meridian Medicaid	$48.75
Rate for Payer: Priority Health Choice Medicaid	$46.43
Rate for Payer: Priority Health Cigna Priority Health	$174.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$90.43
Rate for Payer: Priority Health Narrow Network	$90.43
Rate for Payer: Priority Health SBD	$90.43

PR REMOVAL OF LUNG PNEUMONECTOMY

Professional

Both

$5,395.00

Service Code	HCPCS 32440
Min. Negotiated Rate	$544.68
Max. Negotiated Rate	$3,776.50
Rate for Payer: Aetna Commercial	$2,027.10
Rate for Payer: BCBS Complete	$1,037.74
Rate for Payer: BCBS Trust/PPO	$544.68
Rate for Payer: Cash Price	$4,316.00
Rate for Payer: Cash Price	$4,316.00
Rate for Payer: Mclaren Medicaid	$988.32
Rate for Payer: Meridian Medicaid	$1,037.74
Rate for Payer: Priority Health Choice Medicaid	$988.32
Rate for Payer: Priority Health Cigna Priority Health	$3,776.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,136.50
Rate for Payer: Priority Health Narrow Network	$2,136.50
Rate for Payer: Priority Health SBD	$2,136.50

PR REMOVAL OF SUTURES

Professional

Both

$40.00

Service Code	HCPCS S0630
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$66.04
Rate for Payer: Aetna Commercial	$27.32
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: BCBS Trust/PPO	$66.04
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Priority Health Cigna Priority Health	$28.00

PR REMOVAL PERITONEAL FOREIGN BODY FROM CAVITY

Professional

Both

$2,213.00

Service Code	HCPCS 49402
Min. Negotiated Rate	$546.98
Max. Negotiated Rate	$2,108.97
Rate for Payer: Aetna Commercial	$1,153.44
Rate for Payer: BCBS Complete	$574.33
Rate for Payer: BCBS Trust/PPO	$2,108.97
Rate for Payer: Cash Price	$1,770.40
Rate for Payer: Cash Price	$1,770.40
Rate for Payer: Mclaren Medicaid	$546.98
Rate for Payer: Meridian Medicaid	$574.33
Rate for Payer: Priority Health Choice Medicaid	$546.98
Rate for Payer: Priority Health Cigna Priority Health	$1,549.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,500.50
Rate for Payer: Priority Health Narrow Network	$1,500.50
Rate for Payer: Priority Health SBD	$1,500.50

PR REMOVAL PERMANENT PACEMAKER PULSE GENERATOR ONLY

Professional

Both

$623.00

Service Code	HCPCS 33233
Min. Negotiated Rate	$147.40
Max. Negotiated Rate	$702.64
Rate for Payer: Aetna Commercial	$309.82
Rate for Payer: BCBS Complete	$154.77
Rate for Payer: BCBS Trust/PPO	$702.64
Rate for Payer: Cash Price	$498.40
Rate for Payer: Cash Price	$498.40
Rate for Payer: Mclaren Medicaid	$147.40
Rate for Payer: Meridian Medicaid	$154.77
Rate for Payer: Priority Health Choice Medicaid	$147.40
Rate for Payer: Priority Health Cigna Priority Health	$436.10
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

Know your out-of-pocket cost for care.

All Charges