Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS

Professional

Both

$311.00

Service Code	HCPCS 95926
Min. Negotiated Rate	$35.93
Max. Negotiated Rate	$873.81
Rate for Payer: Aetna Commercial	$153.65
Rate for Payer: BCBS Complete	$124.40
Rate for Payer: BCBS Trust/PPO	$873.81
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cash Price	$248.80
Rate for Payer: Priority Health Cigna Priority Health	$217.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.93
Rate for Payer: Priority Health Narrow Network	$35.93
Rate for Payer: Priority Health SBD	$208.41

PR SHORT-LATENCY SOMATOSENS EP STD TRNK/HEAD

Professional

Both

$282.00

Service Code	HCPCS 95927
Min. Negotiated Rate	$35.48
Max. Negotiated Rate	$222.77
Rate for Payer: Aetna Commercial	$150.85
Rate for Payer: Aetna Commercial	$150.85
Rate for Payer: BCBS Complete	$112.80
Rate for Payer: BCBS Complete	$78.80
Rate for Payer: BCBS Trust/PPO	$99.85
Rate for Payer: BCBS Trust/PPO	$99.85
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cash Price	$225.60
Rate for Payer: Cash Price	$225.60
Rate for Payer: Priority Health Cigna Priority Health	$137.90
Rate for Payer: Priority Health Cigna Priority Health	$197.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.48
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$35.48
Rate for Payer: Priority Health Narrow Network	$35.48
Rate for Payer: Priority Health Narrow Network	$35.48
Rate for Payer: Priority Health SBD	$222.77
Rate for Payer: Priority Health SBD	$222.77

PR SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS

Professional

Both

$321.00

Service Code	HCPCS 95925
Min. Negotiated Rate	$37.28
Max. Negotiated Rate	$1,239.39
Rate for Payer: Aetna Commercial	$166.52
Rate for Payer: BCBS Complete	$128.40
Rate for Payer: BCBS Trust/PPO	$1,239.39
Rate for Payer: Cash Price	$256.80
Rate for Payer: Cash Price	$256.80
Rate for Payer: Priority Health Cigna Priority Health	$224.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$37.28
Rate for Payer: Priority Health Narrow Network	$37.28
Rate for Payer: Priority Health SBD	$238.94

PR SHORT-LATENCY SOMATOSENS EP STD UPR & LOW LIMB

Professional

Both

$120.00

Service Code	HCPCS 95938
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$556.30
Rate for Payer: Aetna Commercial	$379.87
Rate for Payer: BCBS Complete	$48.00
Rate for Payer: BCBS Trust/PPO	$556.30
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Priority Health Cigna Priority Health	$84.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$59.29
Rate for Payer: Priority Health Narrow Network	$59.29
Rate for Payer: Priority Health SBD	$488.66

PR SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM

Professional

Both

$181.00

Service Code	HCPCS 11311
Min. Negotiated Rate	$39.62
Max. Negotiated Rate	$338.18
Rate for Payer: Aetna Commercial	$68.44
Rate for Payer: BCBS Complete	$41.60
Rate for Payer: BCBS Trust/PPO	$338.18
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Mclaren Medicaid	$39.62
Rate for Payer: Meridian Medicaid	$41.60
Rate for Payer: Priority Health Choice Medicaid	$39.62
Rate for Payer: Priority Health Cigna Priority Health	$126.70
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 SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM

Professional

Both

$261.00

Service Code	HCPCS 11312
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$182.70
Rate for Payer: Aetna Commercial	$80.68
Rate for Payer: BCBS Complete	$49.20
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: Cash Price	$208.80
Rate for Payer: Cash Price	$208.80
Rate for Payer: Mclaren Medicaid	$46.86
Rate for Payer: Meridian Medicaid	$49.20
Rate for Payer: Priority Health Choice Medicaid	$46.86
Rate for Payer: Priority Health Cigna Priority Health	$182.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$91.66
Rate for Payer: Priority Health Narrow Network	$91.66
Rate for Payer: Priority Health SBD	$91.66

PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM

Professional

Both

$194.00

Service Code	HCPCS 11301
Hospital Charge Code	11301
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$507.28
Rate for Payer: Aetna Commercial	$55.41
Rate for Payer: BCBS Complete	$34.00
Rate for Payer: BCBS Trust/PPO	$507.28
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cash Price	$155.20
Rate for Payer: Mclaren Medicaid	$32.38
Rate for Payer: Meridian Medicaid	$34.00
Rate for Payer: Priority Health Choice Medicaid	$32.38
Rate for Payer: Priority Health Cigna Priority Health	$135.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$62.48
Rate for Payer: Priority Health Narrow Network	$62.48
Rate for Payer: Priority Health SBD	$62.48

PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM

Facility

$194.00

Service Code	CPT 11301
Hospital Charge Code	11301
Hospital Revenue Code	521
Min. Negotiated Rate	$122.22
Max. Negotiated Rate	$174.60
Rate for Payer: Aetna Commercial	$164.90
Rate for Payer: Aetna New Business (MI Preferred)	$126.10
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cofinity Commercial	$166.84
Rate for Payer: Cofinity Commercial	$135.80
Rate for Payer: Healthscope Commercial	$174.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$164.90
Rate for Payer: PHP Commercial	$164.90
Rate for Payer: Priority Health Cigna Priority Health	$135.80
Rate for Payer: Priority Health SBD	$122.22

PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM

Facility

$194.00

Service Code	CPT 11301
Hospital Charge Code	11301
Hospital Revenue Code	521
Min. Negotiated Rate	$49.77
Max. Negotiated Rate	$541.49
Rate for Payer: Aetna Commercial	$164.90
Rate for Payer: Aetna Medicare	$185.27
Rate for Payer: Aetna New Business (MI Preferred)	$126.10
Rate for Payer: Allen County Amish Medical Aid Commercial	$222.68
Rate for Payer: Amish Plain Church Group Commercial	$222.68
Rate for Payer: BCBS Complete	$102.32
Rate for Payer: BCBS MAPPO	$178.14
Rate for Payer: BCBS Trust/PPO	$76.84
Rate for Payer: BCN Medicare Advantage	$178.14
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cofinity Commercial	$135.80
Rate for Payer: Cofinity Commercial	$166.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$178.14
Rate for Payer: Healthscope Commercial	$174.60
Rate for Payer: Mclaren Medicaid	$97.44
Rate for Payer: Mclaren Medicare	$178.14
Rate for Payer: Meridian Medicaid	$102.32
Rate for Payer: Meridian Wellcare - Medicare Advantage	$187.05
Rate for Payer: MI Amish Medical Board Commercial	$204.86
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$164.90
Rate for Payer: PACE Medicare	$169.23
Rate for Payer: PACE SWMI	$178.14
Rate for Payer: PHP Commercial	$164.90
Rate for Payer: PHP Medicare Advantage	$178.14
Rate for Payer: Priority Health Choice Medicaid	$97.44
Rate for Payer: Priority Health Cigna Priority Health	$135.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$541.49
Rate for Payer: Priority Health Medicare	$178.14
Rate for Payer: Priority Health Narrow Network	$433.19
Rate for Payer: Priority Health SBD	$122.22
Rate for Payer: Railroad Medicare Medicare	$178.14
Rate for Payer: UHC All Payor (Choice/PPO)	$54.75
Rate for Payer: UHC Dual Complete DSNP	$178.14
Rate for Payer: UHC Exchange	$49.77
Rate for Payer: UHC Medicare Advantage	$183.48
Rate for Payer: VA VA	$178.14

PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM

Professional

Both

$194.00

Service Code	HCPCS 11301
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$507.28
Rate for Payer: Aetna Commercial	$55.41
Rate for Payer: BCBS Complete	$34.00
Rate for Payer: BCBS Trust/PPO	$507.28
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cash Price	$155.20
Rate for Payer: Mclaren Medicaid	$32.38
Rate for Payer: Meridian Medicaid	$34.00
Rate for Payer: Priority Health Choice Medicaid	$32.38
Rate for Payer: Priority Health Cigna Priority Health	$135.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$62.48
Rate for Payer: Priority Health Narrow Network	$62.48
Rate for Payer: Priority Health SBD	$62.48

PR SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM

Professional

Both

$252.00

Service Code	HCPCS 11303
Min. Negotiated Rate	$44.94
Max. Negotiated Rate	$2,827.44
Rate for Payer: Aetna Commercial	$76.99
Rate for Payer: BCBS Complete	$47.19
Rate for Payer: BCBS Trust/PPO	$2,827.44
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cash Price	$201.60
Rate for Payer: Mclaren Medicaid	$44.94
Rate for Payer: Meridian Medicaid	$47.19
Rate for Payer: Priority Health Choice Medicaid	$44.94
Rate for Payer: Priority Health Cigna Priority Health	$176.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$86.31
Rate for Payer: Priority Health Narrow Network	$86.31
Rate for Payer: Priority Health SBD	$86.31

PR SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM

Professional

Both

$229.00

Service Code	HCPCS 11302
Min. Negotiated Rate	$28.95
Max. Negotiated Rate	$160.30
Rate for Payer: Aetna Commercial	$65.07
Rate for Payer: BCBS Complete	$39.58
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: Cash Price	$183.20
Rate for Payer: Cash Price	$183.20
Rate for Payer: Mclaren Medicaid	$37.70
Rate for Payer: Meridian Medicaid	$39.58
Rate for Payer: Priority Health Choice Medicaid	$37.70
Rate for Payer: Priority Health Cigna Priority Health	$160.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$72.75
Rate for Payer: Priority Health Narrow Network	$72.75
Rate for Payer: Priority Health SBD	$72.75

PR SIALOLITHOTOMY PRTD XTRORAL/COMP INTRAORAL

Professional

Both

$767.00

Service Code	HCPCS 42340
Min. Negotiated Rate	$223.01
Max. Negotiated Rate	$782.41
Rate for Payer: Aetna Commercial	$447.54
Rate for Payer: BCBS Complete	$234.16
Rate for Payer: BCBS Trust/PPO	$782.41
Rate for Payer: Cash Price	$613.60
Rate for Payer: Cash Price	$613.60
Rate for Payer: Mclaren Medicaid	$223.01
Rate for Payer: Meridian Medicaid	$234.16
Rate for Payer: Priority Health Choice Medicaid	$223.01
Rate for Payer: Priority Health Cigna Priority Health	$536.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$609.73
Rate for Payer: Priority Health Narrow Network	$609.73
Rate for Payer: Priority Health SBD	$609.73

PR SIALOLITHOTOMY SUBMNDBLR SUBMAX COMP INTRAORAL

Professional

Both

$1,001.00

Service Code	HCPCS 42335
Min. Negotiated Rate	$170.19
Max. Negotiated Rate	$700.70
Rate for Payer: Aetna Commercial	$339.73
Rate for Payer: BCBS Complete	$178.70
Rate for Payer: BCBS Trust/PPO	$395.70
Rate for Payer: Cash Price	$800.80
Rate for Payer: Cash Price	$800.80
Rate for Payer: Mclaren Medicaid	$170.19
Rate for Payer: Meridian Medicaid	$178.70
Rate for Payer: Priority Health Choice Medicaid	$170.19
Rate for Payer: Priority Health Cigna Priority Health	$700.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$463.91
Rate for Payer: Priority Health Narrow Network	$463.91
Rate for Payer: Priority Health SBD	$463.91

PR SIALOT SUBMNDBLR SUBLNGL/PRTD UNCOMP INTRAORAL

Professional

Both

$411.00

Service Code	HCPCS 42330
Min. Negotiated Rate	$106.71
Max. Negotiated Rate	$292.22
Rate for Payer: Aetna Commercial	$215.99
Rate for Payer: BCBS Complete	$112.05
Rate for Payer: BCBS Trust/PPO	$237.74
Rate for Payer: Cash Price	$328.80
Rate for Payer: Cash Price	$328.80
Rate for Payer: Mclaren Medicaid	$106.71
Rate for Payer: Meridian Medicaid	$112.05
Rate for Payer: Priority Health Choice Medicaid	$106.71
Rate for Payer: Priority Health Cigna Priority Health	$287.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$292.22
Rate for Payer: Priority Health Narrow Network	$292.22
Rate for Payer: Priority Health SBD	$292.22

PR SIGMOIDOSCOPY,ABLATE LESN

Professional

Both

$736.00

Service Code	HCPCS 45339
Min. Negotiated Rate	$294.40
Max. Negotiated Rate	$515.20
Rate for Payer: BCBS Complete	$294.40
Rate for Payer: Cash Price	$588.80
Rate for Payer: Priority Health Cigna Priority Health	$515.20

PR SIGMOIDOSCOPY FLX ABLATION TUMOR POLYP/OTH LES

Professional

Both

$741.00

Service Code	HCPCS 45346
Min. Negotiated Rate	$100.96
Max. Negotiated Rate	$518.70
Rate for Payer: Aetna Commercial	$213.21
Rate for Payer: BCBS Complete	$106.01
Rate for Payer: BCBS Trust/PPO	$333.36
Rate for Payer: Cash Price	$592.80
Rate for Payer: Cash Price	$592.80
Rate for Payer: Mclaren Medicaid	$100.96
Rate for Payer: Meridian Medicaid	$106.01
Rate for Payer: Priority Health Choice Medicaid	$100.96
Rate for Payer: Priority Health Cigna Priority Health	$518.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$277.53
Rate for Payer: Priority Health Narrow Network	$277.53
Rate for Payer: Priority Health SBD	$277.53

PR SIGMOIDOSCOPY FLX CONTROL BLEEDING

Professional

Both

$654.00

Service Code	HCPCS 45334
Min. Negotiated Rate	$74.12
Max. Negotiated Rate	$457.80
Rate for Payer: Aetna Commercial	$155.42
Rate for Payer: BCBS Complete	$77.83
Rate for Payer: BCBS Trust/PPO	$286.87
Rate for Payer: Cash Price	$523.20
Rate for Payer: Cash Price	$523.20
Rate for Payer: Mclaren Medicaid	$74.12
Rate for Payer: Meridian Medicaid	$77.83
Rate for Payer: Priority Health Choice Medicaid	$74.12
Rate for Payer: Priority Health Cigna Priority Health	$457.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$203.44
Rate for Payer: Priority Health Narrow Network	$203.44
Rate for Payer: Priority Health SBD	$203.44

PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD

Facility

$244.00

Service Code	CPT 45330
Hospital Charge Code	45330
Hospital Revenue Code	960
Min. Negotiated Rate	$55.34
Max. Negotiated Rate	$2,470.91
Rate for Payer: Aetna Commercial	$207.40
Rate for Payer: Aetna Medicare	$845.76
Rate for Payer: Aetna New Business (MI Preferred)	$158.60
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	$519.48
Rate for Payer: BCN Medicare Advantage	$813.23
Rate for Payer: Cash Price	$195.20
Rate for Payer: Cash Price	$195.20
Rate for Payer: Cofinity Commercial	$170.80
Rate for Payer: Cofinity Commercial	$209.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$813.23
Rate for Payer: Healthscope Commercial	$219.60
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	$207.40
Rate for Payer: PACE Medicare	$772.57
Rate for Payer: PACE SWMI	$813.23
Rate for Payer: PHP Commercial	$207.40
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	$170.80
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	$153.72
Rate for Payer: Railroad Medicare Medicare	$813.23
Rate for Payer: UHC All Payor (Choice/PPO)	$60.87
Rate for Payer: UHC Dual Complete DSNP	$813.23
Rate for Payer: UHC Exchange	$55.34
Rate for Payer: UHC Medicare Advantage	$837.63
Rate for Payer: VA VA	$813.23

PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD

Professional

Both

$244.00

Service Code	HCPCS 45330
Hospital Charge Code	45330
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$239.85
Rate for Payer: Aetna Commercial	$73.39
Rate for Payer: BCBS Complete	$37.80
Rate for Payer: BCBS Trust/PPO	$239.85
Rate for Payer: Cash Price	$195.20
Rate for Payer: Cash Price	$195.20
Rate for Payer: Mclaren Medicaid	$36.00
Rate for Payer: Meridian Medicaid	$37.80
Rate for Payer: Priority Health Choice Medicaid	$36.00
Rate for Payer: Priority Health Cigna Priority Health	$170.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$97.60
Rate for Payer: Priority Health Narrow Network	$97.60
Rate for Payer: Priority Health SBD	$97.60

PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD

Facility

$244.00

Service Code	CPT 45330
Hospital Charge Code	45330
Hospital Revenue Code	960
Min. Negotiated Rate	$153.72
Max. Negotiated Rate	$219.60
Rate for Payer: Aetna Commercial	$207.40
Rate for Payer: Aetna New Business (MI Preferred)	$158.60
Rate for Payer: Cash Price	$195.20
Rate for Payer: Cofinity Commercial	$170.80
Rate for Payer: Cofinity Commercial	$209.84
Rate for Payer: Healthscope Commercial	$219.60
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$207.40
Rate for Payer: PHP Commercial	$207.40
Rate for Payer: Priority Health Cigna Priority Health	$170.80
Rate for Payer: Priority Health SBD	$153.72

PR SIGMOIDOSCOPY FLX DX W/COLLJ SPEC BR/WA IF PFRMD

Professional

Both

$244.00

Service Code	HCPCS 45330
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$239.85
Rate for Payer: Aetna Commercial	$73.39
Rate for Payer: BCBS Complete	$37.80
Rate for Payer: BCBS Trust/PPO	$239.85
Rate for Payer: Cash Price	$195.20
Rate for Payer: Cash Price	$195.20
Rate for Payer: Mclaren Medicaid	$36.00
Rate for Payer: Meridian Medicaid	$37.80
Rate for Payer: Priority Health Choice Medicaid	$36.00
Rate for Payer: Priority Health Cigna Priority Health	$170.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$97.60
Rate for Payer: Priority Health Narrow Network	$97.60
Rate for Payer: Priority Health SBD	$97.60

PR SIGMOIDOSCOPY FLX NDSC US XM

Professional

Both

$291.00

Service Code	HCPCS 45341
Min. Negotiated Rate	$78.17
Max. Negotiated Rate	$291.09
Rate for Payer: Aetna Commercial	$164.11
Rate for Payer: BCBS Complete	$82.08
Rate for Payer: BCBS Trust/PPO	$291.09
Rate for Payer: Cash Price	$232.80
Rate for Payer: Cash Price	$232.80
Rate for Payer: Mclaren Medicaid	$78.17
Rate for Payer: Meridian Medicaid	$82.08
Rate for Payer: Priority Health Choice Medicaid	$78.17
Rate for Payer: Priority Health Cigna Priority Health	$203.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$213.43
Rate for Payer: Priority Health Narrow Network	$213.43
Rate for Payer: Priority Health SBD	$213.43

PR SIGMOIDOSCOPY FLX PLACEMENT OF ENDOSCOPIC STENT

Professional

Both

$364.00

Service Code	HCPCS 45347
Min. Negotiated Rate	$96.92
Max. Negotiated Rate	$265.17
Rate for Payer: Aetna Commercial	$205.04
Rate for Payer: BCBS Complete	$101.77
Rate for Payer: BCBS Trust/PPO	$118.87
Rate for Payer: Cash Price	$291.20
Rate for Payer: Cash Price	$291.20
Rate for Payer: Mclaren Medicaid	$96.92
Rate for Payer: Meridian Medicaid	$101.77
Rate for Payer: Priority Health Choice Medicaid	$96.92
Rate for Payer: Priority Health Cigna Priority Health	$254.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$265.17
Rate for Payer: Priority Health Narrow Network	$265.17
Rate for Payer: Priority Health SBD	$265.17

PR SIGMOIDOSCOPY FLX TNDSC BALO DILAT

Professional

Both

$316.00

Service Code	HCPCS 45340
Min. Negotiated Rate	$49.63
Max. Negotiated Rate	$221.20
Rate for Payer: Aetna Commercial	$102.74
Rate for Payer: BCBS Complete	$52.11
Rate for Payer: BCBS Trust/PPO	$96.68
Rate for Payer: Cash Price	$252.80
Rate for Payer: Cash Price	$252.80
Rate for Payer: Mclaren Medicaid	$49.63
Rate for Payer: Meridian Medicaid	$52.11
Rate for Payer: Priority Health Choice Medicaid	$49.63
Rate for Payer: Priority Health Cigna Priority Health	$221.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$135.82
Rate for Payer: Priority Health Narrow Network	$135.82
Rate for Payer: Priority Health SBD	$135.82

Know your out-of-pocket cost for care.

All Charges