Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF

Professional

Both

$3,100.00

Service Code	HCPCS 30520
Min. Negotiated Rate	$435.16
Max. Negotiated Rate	$2,170.00
Rate for Payer: Aetna Commercial	$848.68
Rate for Payer: Aetna Commercial	$848.68
Rate for Payer: BCBS Complete	$456.92
Rate for Payer: BCBS Complete	$456.92
Rate for Payer: BCBS Trust/PPO	$1,206.64
Rate for Payer: BCBS Trust/PPO	$1,206.64
Rate for Payer: Cash Price	$1,427.20
Rate for Payer: Cash Price	$1,427.20
Rate for Payer: Cash Price	$2,480.00
Rate for Payer: Cash Price	$2,480.00
Rate for Payer: Mclaren Medicaid	$435.16
Rate for Payer: Mclaren Medicaid	$435.16
Rate for Payer: Meridian Medicaid	$456.92
Rate for Payer: Meridian Medicaid	$456.92
Rate for Payer: Priority Health Choice Medicaid	$435.16
Rate for Payer: Priority Health Choice Medicaid	$435.16
Rate for Payer: Priority Health Cigna Priority Health	$1,248.80
Rate for Payer: Priority Health Cigna Priority Health	$2,170.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$947.39
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$947.39
Rate for Payer: Priority Health Narrow Network	$947.39
Rate for Payer: Priority Health Narrow Network	$947.39
Rate for Payer: Priority Health SBD	$947.39
Rate for Payer: Priority Health SBD	$947.39

PR SEQUESTRECTOMY FOREARM &/WRIST

Professional

Both

$2,213.00

Service Code	HCPCS 25145
Min. Negotiated Rate	$334.94
Max. Negotiated Rate	$1,549.10
Rate for Payer: Aetna Commercial	$694.20
Rate for Payer: BCBS Complete	$357.62
Rate for Payer: BCBS Trust/PPO	$334.94
Rate for Payer: Cash Price	$1,770.40
Rate for Payer: Cash Price	$1,770.40
Rate for Payer: Mclaren Medicaid	$340.59
Rate for Payer: Meridian Medicaid	$357.62
Rate for Payer: Priority Health Choice Medicaid	$340.59
Rate for Payer: Priority Health Cigna Priority Health	$1,549.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$807.34
Rate for Payer: Priority Health Narrow Network	$807.34
Rate for Payer: Priority Health SBD	$807.34

PR SEQUESTRECTOMY SHAFT/DISTAL HUMERUS

Professional

Both

$2,176.00

Service Code	HCPCS 24134
Min. Negotiated Rate	$175.92
Max. Negotiated Rate	$1,523.20
Rate for Payer: Aetna Commercial	$998.19
Rate for Payer: BCBS Complete	$508.81
Rate for Payer: BCBS Trust/PPO	$175.92
Rate for Payer: Cash Price	$1,740.80
Rate for Payer: Cash Price	$1,740.80
Rate for Payer: Mclaren Medicaid	$484.58
Rate for Payer: Meridian Medicaid	$508.81
Rate for Payer: Priority Health Choice Medicaid	$484.58
Rate for Payer: Priority Health Cigna Priority Health	$1,523.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,151.52
Rate for Payer: Priority Health Narrow Network	$1,151.52
Rate for Payer: Priority Health SBD	$1,151.52

PR SERVICES PROVIDED OFFICE OTH/THN REG SCHED HOURS

Professional

Both

$38.00

Service Code	HCPCS 99050
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$608.60
Rate for Payer: Aetna Commercial	$23.50
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: BCBS Trust/PPO	$608.60
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$26.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$24.25
Rate for Payer: Priority Health Narrow Network	$24.25
Rate for Payer: Priority Health SBD	$24.25

PR SESAMOIDECTOMY FIRST TOE SPX

Professional

Both

$872.00

Service Code	HCPCS 28315
Min. Negotiated Rate	$210.23
Max. Negotiated Rate	$1,893.96
Rate for Payer: Aetna Commercial	$432.42
Rate for Payer: BCBS Complete	$220.74
Rate for Payer: BCBS Trust/PPO	$1,893.96
Rate for Payer: Cash Price	$697.60
Rate for Payer: Cash Price	$697.60
Rate for Payer: Mclaren Medicaid	$210.23
Rate for Payer: Meridian Medicaid	$220.74
Rate for Payer: Priority Health Choice Medicaid	$210.23
Rate for Payer: Priority Health Cigna Priority Health	$610.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$497.88
Rate for Payer: Priority Health Narrow Network	$497.88
Rate for Payer: Priority Health SBD	$497.88

PR SESAMOIDECTOMY THUMB/FINGER SEPARATE PROCEDURE

Professional

Both

$1,647.00

Service Code	HCPCS 26185
Min. Negotiated Rate	$364.87
Max. Negotiated Rate	$1,152.90
Rate for Payer: Aetna Commercial	$737.45
Rate for Payer: BCBS Complete	$383.11
Rate for Payer: BCBS Trust/PPO	$580.95
Rate for Payer: Cash Price	$1,317.60
Rate for Payer: Cash Price	$1,317.60
Rate for Payer: Mclaren Medicaid	$364.87
Rate for Payer: Meridian Medicaid	$383.11
Rate for Payer: Priority Health Choice Medicaid	$364.87
Rate for Payer: Priority Health Cigna Priority Health	$1,152.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$862.99
Rate for Payer: Priority Health Narrow Network	$862.99
Rate for Payer: Priority Health SBD	$862.99

PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST

Professional

Both

$637.00

Service Code	HCPCS 45335
Min. Negotiated Rate	$42.39
Max. Negotiated Rate	$445.90
Rate for Payer: Aetna Commercial	$88.06
Rate for Payer: BCBS Complete	$44.51
Rate for Payer: BCBS Trust/PPO	$306.41
Rate for Payer: Cash Price	$509.60
Rate for Payer: Cash Price	$509.60
Rate for Payer: Mclaren Medicaid	$42.39
Rate for Payer: Meridian Medicaid	$44.51
Rate for Payer: Priority Health Choice Medicaid	$42.39
Rate for Payer: Priority Health Cigna Priority Health	$445.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$115.83
Rate for Payer: Priority Health Narrow Network	$115.83
Rate for Payer: Priority Health SBD	$115.83

PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST

Facility

$637.00

Service Code	CPT 45335
Hospital Charge Code	45335
Min. Negotiated Rate	$401.31
Max. Negotiated Rate	$573.30
Rate for Payer: Aetna Commercial	$541.45
Rate for Payer: Aetna New Business (MI Preferred)	$414.05
Rate for Payer: Cash Price	$509.60
Rate for Payer: Cofinity Commercial	$445.90
Rate for Payer: Cofinity Commercial	$547.82
Rate for Payer: Healthscope Commercial	$573.30
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$541.45
Rate for Payer: PHP Commercial	$541.45
Rate for Payer: Priority Health Cigna Priority Health	$445.90
Rate for Payer: Priority Health SBD	$401.31

PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST

Facility

$637.00

Service Code	CPT 45335
Hospital Charge Code	45335
Min. Negotiated Rate	$65.16
Max. Negotiated Rate	$2,470.91
Rate for Payer: Aetna Commercial	$541.45
Rate for Payer: Aetna Medicare	$845.76
Rate for Payer: Aetna New Business (MI Preferred)	$414.05
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,016.54
Rate for Payer: Amish Plain Church Group Commercial	$1,016.54
Rate for Payer: BCBS Complete	$467.12
Rate for Payer: BCBS MAPPO	$813.23
Rate for Payer: BCBS Trust/PPO	$313.19
Rate for Payer: BCN Medicare Advantage	$813.23
Rate for Payer: Cash Price	$509.60
Rate for Payer: Cash Price	$509.60
Rate for Payer: Cofinity Commercial	$547.82
Rate for Payer: Cofinity Commercial	$445.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$813.23
Rate for Payer: Healthscope Commercial	$573.30
Rate for Payer: Mclaren Medicaid	$444.84
Rate for Payer: Mclaren Medicare	$813.23
Rate for Payer: Meridian Medicaid	$467.12
Rate for Payer: Meridian Wellcare - Medicare Advantage	$853.89
Rate for Payer: MI Amish Medical Board Commercial	$935.21
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$541.45
Rate for Payer: PACE Medicare	$772.57
Rate for Payer: PACE SWMI	$813.23
Rate for Payer: PHP Commercial	$541.45
Rate for Payer: PHP Medicare Advantage	$813.23
Rate for Payer: Priority Health Choice Medicaid	$444.84
Rate for Payer: Priority Health Cigna Priority Health	$445.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,470.91
Rate for Payer: Priority Health Medicare	$813.23
Rate for Payer: Priority Health Narrow Network	$1,976.73
Rate for Payer: Priority Health SBD	$401.31
Rate for Payer: Railroad Medicare Medicare	$813.23
Rate for Payer: UHC All Payor (Choice/PPO)	$71.68
Rate for Payer: UHC Dual Complete DSNP	$813.23
Rate for Payer: UHC Exchange	$65.16
Rate for Payer: UHC Medicare Advantage	$837.63
Rate for Payer: VA VA	$813.23

PR SGMDSC FLX DIRED SBMCSL NJX ANY SBST

Professional

Both

$637.00

Service Code	HCPCS 45335
Hospital Charge Code	45335
Min. Negotiated Rate	$42.39
Max. Negotiated Rate	$445.90
Rate for Payer: Aetna Commercial	$88.06
Rate for Payer: BCBS Complete	$44.51
Rate for Payer: BCBS Trust/PPO	$306.41
Rate for Payer: Cash Price	$509.60
Rate for Payer: Cash Price	$509.60
Rate for Payer: Mclaren Medicaid	$42.39
Rate for Payer: Meridian Medicaid	$44.51
Rate for Payer: Priority Health Choice Medicaid	$42.39
Rate for Payer: Priority Health Cigna Priority Health	$445.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$115.83
Rate for Payer: Priority Health Narrow Network	$115.83
Rate for Payer: Priority Health SBD	$115.83

PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ

Facility

$736.00

Service Code	CPT 45338
Hospital Charge Code	45338
Min. Negotiated Rate	$463.68
Max. Negotiated Rate	$662.40
Rate for Payer: Aetna Commercial	$625.60
Rate for Payer: Aetna New Business (MI Preferred)	$478.40
Rate for Payer: Cash Price	$588.80
Rate for Payer: Cofinity Commercial	$515.20
Rate for Payer: Cofinity Commercial	$632.96
Rate for Payer: Healthscope Commercial	$662.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$625.60
Rate for Payer: PHP Commercial	$625.60
Rate for Payer: Priority Health Cigna Priority Health	$515.20
Rate for Payer: Priority Health SBD	$463.68

PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ

Professional

Both

$736.00

Service Code	HCPCS 45338
Min. Negotiated Rate	$75.83
Max. Negotiated Rate	$515.20
Rate for Payer: Aetna Commercial	$159.59
Rate for Payer: BCBS Complete	$79.62
Rate for Payer: BCBS Trust/PPO	$76.08
Rate for Payer: Cash Price	$588.80
Rate for Payer: Cash Price	$588.80
Rate for Payer: Mclaren Medicaid	$75.83
Rate for Payer: Meridian Medicaid	$79.62
Rate for Payer: Priority Health Choice Medicaid	$75.83
Rate for Payer: Priority Health Cigna Priority Health	$515.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$207.55
Rate for Payer: Priority Health Narrow Network	$207.55
Rate for Payer: Priority Health SBD	$207.55

PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ

Facility

$736.00

Service Code	CPT 45338
Hospital Charge Code	45338
Min. Negotiated Rate	$116.57
Max. Negotiated Rate	$3,228.76
Rate for Payer: Aetna Commercial	$625.60
Rate for Payer: Aetna Medicare	$1,092.02
Rate for Payer: Aetna New Business (MI Preferred)	$478.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,312.52
Rate for Payer: Amish Plain Church Group Commercial	$1,312.52
Rate for Payer: BCBS Complete	$603.13
Rate for Payer: BCBS MAPPO	$1,050.02
Rate for Payer: BCBS Trust/PPO	$826.85
Rate for Payer: BCN Medicare Advantage	$1,050.02
Rate for Payer: Cash Price	$588.80
Rate for Payer: Cash Price	$588.80
Rate for Payer: Cofinity Commercial	$515.20
Rate for Payer: Cofinity Commercial	$632.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,050.02
Rate for Payer: Healthscope Commercial	$662.40
Rate for Payer: Mclaren Medicaid	$574.36
Rate for Payer: Mclaren Medicare	$1,050.02
Rate for Payer: Meridian Medicaid	$603.13
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,102.52
Rate for Payer: MI Amish Medical Board Commercial	$1,207.52
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$625.60
Rate for Payer: PACE Medicare	$997.52
Rate for Payer: PACE SWMI	$1,050.02
Rate for Payer: PHP Commercial	$625.60
Rate for Payer: PHP Medicare Advantage	$1,050.02
Rate for Payer: Priority Health Choice Medicaid	$574.36
Rate for Payer: Priority Health Cigna Priority Health	$515.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$3,228.76
Rate for Payer: Priority Health Medicare	$1,050.02
Rate for Payer: Priority Health Narrow Network	$2,583.01
Rate for Payer: Priority Health SBD	$463.68
Rate for Payer: Railroad Medicare Medicare	$1,050.02
Rate for Payer: UHC All Payor (Choice/PPO)	$128.23
Rate for Payer: UHC Dual Complete DSNP	$1,050.02
Rate for Payer: UHC Exchange	$116.57
Rate for Payer: UHC Medicare Advantage	$1,081.52
Rate for Payer: VA VA	$1,050.02

PR SGMDSC FLX RMVL TUM POLYP/OTH LES SNARE TQ

Professional

Both

$736.00

Service Code	HCPCS 45338
Hospital Charge Code	45338
Min. Negotiated Rate	$75.83
Max. Negotiated Rate	$515.20
Rate for Payer: Aetna Commercial	$159.59
Rate for Payer: BCBS Complete	$79.62
Rate for Payer: BCBS Trust/PPO	$76.08
Rate for Payer: Cash Price	$588.80
Rate for Payer: Cash Price	$588.80
Rate for Payer: Mclaren Medicaid	$75.83
Rate for Payer: Meridian Medicaid	$79.62
Rate for Payer: Priority Health Choice Medicaid	$75.83
Rate for Payer: Priority Health Cigna Priority Health	$515.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$207.55
Rate for Payer: Priority Health Narrow Network	$207.55
Rate for Payer: Priority Health SBD	$207.55

PR SGMDSC FLX W/DCMPRN W/PLMT DCMPRN TUBE

Professional

Both

$594.00

Service Code	HCPCS 45337
Min. Negotiated Rate	$71.99
Max. Negotiated Rate	$415.80
Rate for Payer: Aetna Commercial	$153.40
Rate for Payer: BCBS Complete	$75.59
Rate for Payer: BCBS Trust/PPO	$349.73
Rate for Payer: Cash Price	$475.20
Rate for Payer: Cash Price	$475.20
Rate for Payer: Mclaren Medicaid	$71.99
Rate for Payer: Meridian Medicaid	$75.59
Rate for Payer: Priority Health Choice Medicaid	$71.99
Rate for Payer: Priority Health Cigna Priority Health	$415.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$197.56
Rate for Payer: Priority Health Narrow Network	$197.56
Rate for Payer: Priority Health SBD	$197.56

PR SGMDSC FLX WITH ENDOSCOPIC MUCOSAL RESECTION

Professional

Both

$358.00

Service Code	HCPCS 45349
Min. Negotiated Rate	$124.39
Max. Negotiated Rate	$380.90
Rate for Payer: Aetna Commercial	$263.62
Rate for Payer: BCBS Complete	$130.61
Rate for Payer: BCBS Trust/PPO	$380.90
Rate for Payer: Cash Price	$286.40
Rate for Payer: Cash Price	$286.40
Rate for Payer: Mclaren Medicaid	$124.39
Rate for Payer: Meridian Medicaid	$130.61
Rate for Payer: Priority Health Choice Medicaid	$124.39
Rate for Payer: Priority Health Cigna Priority Health	$250.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$342.19
Rate for Payer: Priority Health Narrow Network	$342.19
Rate for Payer: Priority Health SBD	$342.19

PR SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<

Professional

Both

$184.00

Service Code	HCPCS 11310
Min. Negotiated Rate	$28.76
Max. Negotiated Rate	$128.80
Rate for Payer: Aetna Commercial	$49.47
Rate for Payer: BCBS Complete	$30.20
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cash Price	$147.20
Rate for Payer: Mclaren Medicaid	$28.76
Rate for Payer: Meridian Medicaid	$30.20
Rate for Payer: Priority Health Choice Medicaid	$28.76
Rate for Payer: Priority Health Cigna Priority Health	$128.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$55.91
Rate for Payer: Priority Health Narrow Network	$55.91
Rate for Payer: Priority Health SBD	$55.91

PR SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM

Professional

Both

$301.00

Service Code	HCPCS 11313
Min. Negotiated Rate	$60.71
Max. Negotiated Rate	$338.18
Rate for Payer: Aetna Commercial	$103.74
Rate for Payer: BCBS Complete	$63.75
Rate for Payer: BCBS Trust/PPO	$338.18
Rate for Payer: Cash Price	$240.80
Rate for Payer: Cash Price	$240.80
Rate for Payer: Mclaren Medicaid	$60.71
Rate for Payer: Meridian Medicaid	$63.75
Rate for Payer: Priority Health Choice Medicaid	$60.71
Rate for Payer: Priority Health Cigna Priority Health	$210.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$116.32
Rate for Payer: Priority Health Narrow Network	$116.32
Rate for Payer: Priority Health SBD	$116.32

PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<

Professional

Both

$158.00

Service Code	HCPCS 11305
Min. Negotiated Rate	$23.64
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$41.35
Rate for Payer: BCBS Complete	$24.82
Rate for Payer: BCBS Trust/PPO	$450.00
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Mclaren Medicaid	$23.64
Rate for Payer: Meridian Medicaid	$24.82
Rate for Payer: Priority Health Choice Medicaid	$23.64
Rate for Payer: Priority Health Cigna Priority Health	$110.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$45.62
Rate for Payer: Priority Health Narrow Network	$45.62
Rate for Payer: Priority Health SBD	$45.62

PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM

Professional

Both

$196.00

Service Code	HCPCS 11306
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$137.20
Rate for Payer: Aetna Commercial	$53.87
Rate for Payer: BCBS Complete	$32.43
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: Cash Price	$156.80
Rate for Payer: Cash Price	$156.80
Rate for Payer: Mclaren Medicaid	$30.89
Rate for Payer: Meridian Medicaid	$32.43
Rate for Payer: Priority Health Choice Medicaid	$30.89
Rate for Payer: Priority Health Cigna Priority Health	$137.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$60.02
Rate for Payer: Priority Health Narrow Network	$60.02
Rate for Payer: Priority Health SBD	$60.02

PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM

Professional

Both

$232.00

Service Code	HCPCS 11307
Min. Negotiated Rate	$39.41
Max. Negotiated Rate	$2,827.44
Rate for Payer: Aetna Commercial	$69.07
Rate for Payer: BCBS Complete	$41.38
Rate for Payer: BCBS Trust/PPO	$2,827.44
Rate for Payer: Cash Price	$185.60
Rate for Payer: Cash Price	$185.60
Rate for Payer: Mclaren Medicaid	$39.41
Rate for Payer: Meridian Medicaid	$41.38
Rate for Payer: Priority Health Choice Medicaid	$39.41
Rate for Payer: Priority Health Cigna Priority Health	$162.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$76.45
Rate for Payer: Priority Health Narrow Network	$76.45
Rate for Payer: Priority Health SBD	$76.45

PR SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM

Professional

Both

$246.00

Service Code	HCPCS 11308
Min. Negotiated Rate	$44.09
Max. Negotiated Rate	$338.18
Rate for Payer: Aetna Commercial	$78.76
Rate for Payer: BCBS Complete	$46.29
Rate for Payer: BCBS Trust/PPO	$338.18
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cash Price	$196.80
Rate for Payer: Mclaren Medicaid	$44.09
Rate for Payer: Meridian Medicaid	$46.29
Rate for Payer: Priority Health Choice Medicaid	$44.09
Rate for Payer: Priority Health Cigna Priority Health	$172.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$85.09
Rate for Payer: Priority Health Narrow Network	$85.09
Rate for Payer: Priority Health SBD	$85.09

PR SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/<

Professional

Both

$158.00

Service Code	HCPCS 11300
Min. Negotiated Rate	$21.51
Max. Negotiated Rate	$285.00
Rate for Payer: Aetna Commercial	$36.45
Rate for Payer: BCBS Complete	$22.59
Rate for Payer: BCBS Trust/PPO	$285.00
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Mclaren Medicaid	$21.51
Rate for Payer: Meridian Medicaid	$22.59
Rate for Payer: Priority Health Choice Medicaid	$21.51
Rate for Payer: Priority Health Cigna Priority Health	$110.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$41.52
Rate for Payer: Priority Health Narrow Network	$41.52
Rate for Payer: Priority Health SBD	$41.52

PR SHOE LIFTS ELEVATION HEEL /I

Professional

Both

$64.00

Service Code	HCPCS L3334
Min. Negotiated Rate	$22.97
Max. Negotiated Rate	$44.80
Rate for Payer: Aetna Commercial	$22.97
Rate for Payer: BCBS Complete	$25.60
Rate for Payer: Cash Price	$51.20
Rate for Payer: Cash Price	$51.20
Rate for Payer: Priority Health Cigna Priority Health	$44.80

PR SHORTENING TENDON EXTENSOR HAND/FINGER EACH

Professional

Both

$1,184.00

Service Code	HCPCS 26477
Min. Negotiated Rate	$408.32
Max. Negotiated Rate	$974.84
Rate for Payer: Aetna Commercial	$822.68
Rate for Payer: BCBS Complete	$428.74
Rate for Payer: BCBS Trust/PPO	$974.19
Rate for Payer: Cash Price	$947.20
Rate for Payer: Cash Price	$947.20
Rate for Payer: Mclaren Medicaid	$408.32
Rate for Payer: Meridian Medicaid	$428.74
Rate for Payer: Priority Health Choice Medicaid	$408.32
Rate for Payer: Priority Health Cigna Priority Health	$828.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$974.84
Rate for Payer: Priority Health Narrow Network	$974.84
Rate for Payer: Priority Health SBD	$974.84

Know your out-of-pocket cost for care.

All Charges