Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

PR SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX

Professional

Both

$791.00

Service Code	HCPCS 45342
Min. Negotiated Rate	$107.35
Max. Negotiated Rate	$553.70
Rate for Payer: Aetna Commercial	$225.51
Rate for Payer: BCBS Complete	$112.72
Rate for Payer: BCBS Trust/PPO	$269.43
Rate for Payer: Cash Price	$632.80
Rate for Payer: Cash Price	$632.80
Rate for Payer: Mclaren Medicaid	$107.35
Rate for Payer: Meridian Medicaid	$112.72
Rate for Payer: Priority Health Choice Medicaid	$107.35
Rate for Payer: Priority Health Cigna Priority Health	$553.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$295.16
Rate for Payer: Priority Health Narrow Network	$295.16
Rate for Payer: Priority Health SBD	$295.16

PR SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE

Facility

$336.00

Service Code	CPT 45331
Hospital Charge Code	45331
Hospital Revenue Code	960
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$2,470.91
Rate for Payer: Aetna Commercial	$285.60
Rate for Payer: Aetna Medicare	$845.76
Rate for Payer: Aetna New Business (MI Preferred)	$218.40
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	$648.77
Rate for Payer: BCN Medicare Advantage	$813.23
Rate for Payer: Cash Price	$268.80
Rate for Payer: Cash Price	$268.80
Rate for Payer: Cofinity Commercial	$288.96
Rate for Payer: Cofinity Commercial	$235.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$813.23
Rate for Payer: Healthscope Commercial	$302.40
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	$285.60
Rate for Payer: PACE Medicare	$772.57
Rate for Payer: PACE SWMI	$813.23
Rate for Payer: PHP Commercial	$285.60
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	$235.20
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	$211.68
Rate for Payer: Railroad Medicare Medicare	$813.23
Rate for Payer: UHC All Payor (Choice/PPO)	$77.44
Rate for Payer: UHC Dual Complete DSNP	$813.23
Rate for Payer: UHC Exchange	$70.40
Rate for Payer: UHC Medicare Advantage	$837.63
Rate for Payer: VA VA	$813.23

PR SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE

Professional

Both

$336.00

Service Code	HCPCS 45331
Min. Negotiated Rate	$45.80
Max. Negotiated Rate	$302.72
Rate for Payer: Aetna Commercial	$94.92
Rate for Payer: BCBS Complete	$48.09
Rate for Payer: BCBS Trust/PPO	$302.72
Rate for Payer: Cash Price	$268.80
Rate for Payer: Cash Price	$268.80
Rate for Payer: Mclaren Medicaid	$45.80
Rate for Payer: Meridian Medicaid	$48.09
Rate for Payer: Priority Health Choice Medicaid	$45.80
Rate for Payer: Priority Health Cigna Priority Health	$235.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$124.65
Rate for Payer: Priority Health Narrow Network	$124.65
Rate for Payer: Priority Health SBD	$124.65

PR SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE

Professional

Both

$336.00

Service Code	HCPCS 45331
Hospital Charge Code	45331
Min. Negotiated Rate	$45.80
Max. Negotiated Rate	$302.72
Rate for Payer: Aetna Commercial	$94.92
Rate for Payer: BCBS Complete	$48.09
Rate for Payer: BCBS Trust/PPO	$302.72
Rate for Payer: Cash Price	$268.80
Rate for Payer: Cash Price	$268.80
Rate for Payer: Mclaren Medicaid	$45.80
Rate for Payer: Meridian Medicaid	$48.09
Rate for Payer: Priority Health Choice Medicaid	$45.80
Rate for Payer: Priority Health Cigna Priority Health	$235.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$124.65
Rate for Payer: Priority Health Narrow Network	$124.65
Rate for Payer: Priority Health SBD	$124.65

PR SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE

Facility

$336.00

Service Code	CPT 45331
Hospital Charge Code	45331
Hospital Revenue Code	960
Min. Negotiated Rate	$211.68
Max. Negotiated Rate	$302.40
Rate for Payer: Aetna Commercial	$285.60
Rate for Payer: Aetna New Business (MI Preferred)	$218.40
Rate for Payer: Cash Price	$268.80
Rate for Payer: Cofinity Commercial	$235.20
Rate for Payer: Cofinity Commercial	$288.96
Rate for Payer: Healthscope Commercial	$302.40
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$285.60
Rate for Payer: PHP Commercial	$285.60
Rate for Payer: Priority Health Cigna Priority Health	$235.20
Rate for Payer: Priority Health SBD	$211.68

PR SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)

Professional

Both

$435.00

Service Code	HCPCS 45350
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$383.02
Rate for Payer: Aetna Commercial	$133.45
Rate for Payer: BCBS Complete	$67.10
Rate for Payer: BCBS Trust/PPO	$383.02
Rate for Payer: Cash Price	$348.00
Rate for Payer: Cash Price	$348.00
Rate for Payer: Mclaren Medicaid	$63.90
Rate for Payer: Meridian Medicaid	$67.10
Rate for Payer: Priority Health Choice Medicaid	$63.90
Rate for Payer: Priority Health Cigna Priority Health	$304.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$174.05
Rate for Payer: Priority Health Narrow Network	$174.05
Rate for Payer: Priority Health SBD	$174.05

PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY

Facility

$510.00

Service Code	CPT 45332
Hospital Charge Code	45332
Min. Negotiated Rate	$321.30
Max. Negotiated Rate	$459.00
Rate for Payer: Aetna Commercial	$433.50
Rate for Payer: Aetna New Business (MI Preferred)	$331.50
Rate for Payer: Cash Price	$408.00
Rate for Payer: Cofinity Commercial	$357.00
Rate for Payer: Cofinity Commercial	$438.60
Rate for Payer: Healthscope Commercial	$459.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$433.50
Rate for Payer: PHP Commercial	$433.50
Rate for Payer: Priority Health Cigna Priority Health	$357.00
Rate for Payer: Priority Health SBD	$321.30

PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY

Facility

$510.00

Service Code	CPT 45332
Hospital Charge Code	45332
Min. Negotiated Rate	$102.49
Max. Negotiated Rate	$3,228.76
Rate for Payer: Aetna Commercial	$433.50
Rate for Payer: Aetna Medicare	$1,092.02
Rate for Payer: Aetna New Business (MI Preferred)	$331.50
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	$411.67
Rate for Payer: BCN Medicare Advantage	$1,050.02
Rate for Payer: Cash Price	$408.00
Rate for Payer: Cash Price	$408.00
Rate for Payer: Cofinity Commercial	$357.00
Rate for Payer: Cofinity Commercial	$438.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,050.02
Rate for Payer: Healthscope Commercial	$459.00
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	$433.50
Rate for Payer: PACE Medicare	$997.52
Rate for Payer: PACE SWMI	$1,050.02
Rate for Payer: PHP Commercial	$433.50
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	$357.00
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	$321.30
Rate for Payer: Railroad Medicare Medicare	$1,050.02
Rate for Payer: UHC All Payor (Choice/PPO)	$112.74
Rate for Payer: UHC Dual Complete DSNP	$1,050.02
Rate for Payer: UHC Exchange	$102.49
Rate for Payer: UHC Medicare Advantage	$1,081.52
Rate for Payer: VA VA	$1,050.02

PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY

Professional

Both

$510.00

Service Code	HCPCS 45332
Hospital Charge Code	45332
Min. Negotiated Rate	$66.67
Max. Negotiated Rate	$357.00
Rate for Payer: Aetna Commercial	$138.97
Rate for Payer: BCBS Complete	$70.00
Rate for Payer: BCBS Trust/PPO	$147.92
Rate for Payer: Cash Price	$408.00
Rate for Payer: Cash Price	$408.00
Rate for Payer: Mclaren Medicaid	$66.67
Rate for Payer: Meridian Medicaid	$70.00
Rate for Payer: Priority Health Choice Medicaid	$66.67
Rate for Payer: Priority Health Cigna Priority Health	$357.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$181.09
Rate for Payer: Priority Health Narrow Network	$181.09
Rate for Payer: Priority Health SBD	$181.09

PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY

Professional

Both

$510.00

Service Code	HCPCS 45332
Min. Negotiated Rate	$66.67
Max. Negotiated Rate	$357.00
Rate for Payer: Aetna Commercial	$138.97
Rate for Payer: BCBS Complete	$70.00
Rate for Payer: BCBS Trust/PPO	$147.92
Rate for Payer: Cash Price	$408.00
Rate for Payer: Cash Price	$408.00
Rate for Payer: Mclaren Medicaid	$66.67
Rate for Payer: Meridian Medicaid	$70.00
Rate for Payer: Priority Health Choice Medicaid	$66.67
Rate for Payer: Priority Health Cigna Priority Health	$357.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$181.09
Rate for Payer: Priority Health Narrow Network	$181.09
Rate for Payer: Priority Health SBD	$181.09

PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS

Facility

$736.00

Service Code	CPT 45333
Hospital Charge Code	45333
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 SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS

Professional

Both

$736.00

Service Code	HCPCS 45333
Hospital Charge Code	45333
Min. Negotiated Rate	$59.64
Max. Negotiated Rate	$515.20
Rate for Payer: Aetna Commercial	$124.32
Rate for Payer: BCBS Complete	$62.62
Rate for Payer: BCBS Trust/PPO	$297.83
Rate for Payer: Cash Price	$588.80
Rate for Payer: Cash Price	$588.80
Rate for Payer: Mclaren Medicaid	$59.64
Rate for Payer: Meridian Medicaid	$62.62
Rate for Payer: Priority Health Choice Medicaid	$59.64
Rate for Payer: Priority Health Cigna Priority Health	$515.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$162.28
Rate for Payer: Priority Health Narrow Network	$162.28
Rate for Payer: Priority Health SBD	$162.28

PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS

Professional

Both

$736.00

Service Code	HCPCS 45333
Min. Negotiated Rate	$59.64
Max. Negotiated Rate	$515.20
Rate for Payer: Aetna Commercial	$124.32
Rate for Payer: BCBS Complete	$62.62
Rate for Payer: BCBS Trust/PPO	$297.83
Rate for Payer: Cash Price	$588.80
Rate for Payer: Cash Price	$588.80
Rate for Payer: Mclaren Medicaid	$59.64
Rate for Payer: Meridian Medicaid	$62.62
Rate for Payer: Priority Health Choice Medicaid	$59.64
Rate for Payer: Priority Health Cigna Priority Health	$515.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$162.28
Rate for Payer: Priority Health Narrow Network	$162.28
Rate for Payer: Priority Health SBD	$162.28

PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS

Facility

$736.00

Service Code	CPT 45333
Hospital Charge Code	45333
Min. Negotiated Rate	$91.68
Max. Negotiated Rate	$2,470.91
Rate for Payer: Aetna Commercial	$625.60
Rate for Payer: Aetna Medicare	$845.76
Rate for Payer: Aetna New Business (MI Preferred)	$478.40
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	$588.80
Rate for Payer: Cash Price	$588.80
Rate for Payer: Cofinity Commercial	$632.96
Rate for Payer: Cofinity Commercial	$515.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$813.23
Rate for Payer: Healthscope Commercial	$662.40
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	$625.60
Rate for Payer: PACE Medicare	$772.57
Rate for Payer: PACE SWMI	$813.23
Rate for Payer: PHP Commercial	$625.60
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	$515.20
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	$463.68
Rate for Payer: Railroad Medicare Medicare	$813.23
Rate for Payer: UHC All Payor (Choice/PPO)	$100.85
Rate for Payer: UHC Dual Complete DSNP	$813.23
Rate for Payer: UHC Exchange	$91.68
Rate for Payer: UHC Medicare Advantage	$837.63
Rate for Payer: VA VA	$813.23

PR SIGMOIDOSCOPY,TRANSENDOSCOPIC STENT

Professional

Both

$324.00

Service Code	HCPCS 45345
Min. Negotiated Rate	$129.60
Max. Negotiated Rate	$226.80
Rate for Payer: BCBS Complete	$129.60
Rate for Payer: Cash Price	$259.20
Rate for Payer: Priority Health Cigna Priority Health	$226.80

PR SIGMOIDOSCOPY W/STENT

Professional

Both

$324.00

Service Code	HCPCS G6023
Min. Negotiated Rate	$129.60
Max. Negotiated Rate	$226.80
Rate for Payer: BCBS Complete	$129.60
Rate for Payer: Cash Price	$259.20
Rate for Payer: Priority Health Cigna Priority Health	$226.80

PR SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG

Professional

Both

$39.00

Service Code	HCPCS 93278
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$981.33
Rate for Payer: Aetna Commercial	$38.45
Rate for Payer: BCBS Complete	$15.60
Rate for Payer: BCBS Trust/PPO	$981.33
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Priority Health Cigna Priority Health	$27.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$17.02
Rate for Payer: Priority Health Narrow Network	$17.02
Rate for Payer: Priority Health SBD	$40.66

PR SIMPLE CYSTOMETROGRAM

Professional

Both

$526.00

Service Code	HCPCS 51725
Min. Negotiated Rate	$121.04
Max. Negotiated Rate	$642.41
Rate for Payer: Aetna Commercial	$283.90
Rate for Payer: BCBS Complete	$210.40
Rate for Payer: BCBS Trust/PPO	$642.41
Rate for Payer: Cash Price	$420.80
Rate for Payer: Cash Price	$420.80
Rate for Payer: Priority Health Cigna Priority Health	$368.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$121.04
Rate for Payer: Priority Health Narrow Network	$121.04
Rate for Payer: Priority Health SBD	$370.69

PR SIMPLE IMPLANT REMOVAL, BILATERAL

Professional

Both

$1,500.00

Service Code	HCPCS 00522
Hospital Revenue Code	990
Min. Negotiated Rate	$600.00
Max. Negotiated Rate	$1,050.00
Rate for Payer: BCBS Complete	$600.00
Rate for Payer: Cash Price	$1,200.00
Rate for Payer: Priority Health Cigna Priority Health	$1,050.00

PR SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION

Professional

Both

$9,538.00

Service Code	HCPCS 61700
Min. Negotiated Rate	$1,257.35
Max. Negotiated Rate	$6,676.60
Rate for Payer: Aetna Commercial	$4,404.66
Rate for Payer: BCBS Complete	$2,313.43
Rate for Payer: BCBS Trust/PPO	$1,257.35
Rate for Payer: Cash Price	$7,630.40
Rate for Payer: Cash Price	$7,630.40
Rate for Payer: Mclaren Medicaid	$2,203.27
Rate for Payer: Meridian Medicaid	$2,313.43
Rate for Payer: Priority Health Choice Medicaid	$2,203.27
Rate for Payer: Priority Health Cigna Priority Health	$6,676.60
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$5,773.78
Rate for Payer: Priority Health Narrow Network	$5,773.78
Rate for Payer: Priority Health SBD	$5,773.78

PR SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ

Professional

Both

$8,499.00

Service Code	HCPCS 61702
Min. Negotiated Rate	$1,072.45
Max. Negotiated Rate	$6,842.81
Rate for Payer: Aetna Commercial	$5,197.31
Rate for Payer: BCBS Complete	$2,722.04
Rate for Payer: BCBS Trust/PPO	$1,072.45
Rate for Payer: Cash Price	$6,799.20
Rate for Payer: Cash Price	$6,799.20
Rate for Payer: Mclaren Medicaid	$2,592.42
Rate for Payer: Meridian Medicaid	$2,722.04
Rate for Payer: Priority Health Choice Medicaid	$2,592.42
Rate for Payer: Priority Health Cigna Priority Health	$5,949.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$6,842.81
Rate for Payer: Priority Health Narrow Network	$6,842.81
Rate for Payer: Priority Health SBD	$6,842.81

PR SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM

Professional

Both

$651.00

Service Code	HCPCS 12016
Min. Negotiated Rate	$81.15
Max. Negotiated Rate	$455.70
Rate for Payer: Aetna Commercial	$142.66
Rate for Payer: BCBS Complete	$85.21
Rate for Payer: BCBS Trust/PPO	$117.56
Rate for Payer: Cash Price	$520.80
Rate for Payer: Cash Price	$520.80
Rate for Payer: Mclaren Medicaid	$81.15
Rate for Payer: Meridian Medicaid	$85.21
Rate for Payer: Priority Health Choice Medicaid	$81.15
Rate for Payer: Priority Health Cigna Priority Health	$455.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$156.19
Rate for Payer: Priority Health Narrow Network	$156.19
Rate for Payer: Priority Health SBD	$156.19

PR SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM

Professional

Both

$319.00

Service Code	HCPCS 12017
Min. Negotiated Rate	$85.82
Max. Negotiated Rate	$223.30
Rate for Payer: Aetna Commercial	$169.53
Rate for Payer: BCBS Complete	$102.88
Rate for Payer: BCBS Trust/PPO	$85.82
Rate for Payer: Cash Price	$255.20
Rate for Payer: Cash Price	$255.20
Rate for Payer: Mclaren Medicaid	$97.98
Rate for Payer: Meridian Medicaid	$102.88
Rate for Payer: Priority Health Choice Medicaid	$97.98
Rate for Payer: Priority Health Cigna Priority Health	$223.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$187.84
Rate for Payer: Priority Health Narrow Network	$187.84
Rate for Payer: Priority Health SBD	$187.84

PR SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<

Professional

Both

$300.00

Service Code	HCPCS 12011
Min. Negotiated Rate	$35.36
Max. Negotiated Rate	$212.16
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: BCBS Complete	$37.13
Rate for Payer: BCBS Trust/PPO	$212.16
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Mclaren Medicaid	$35.36
Rate for Payer: Meridian Medicaid	$37.13
Rate for Payer: Priority Health Choice Medicaid	$35.36
Rate for Payer: Priority Health Cigna Priority Health	$210.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$67.42
Rate for Payer: Priority Health Narrow Network	$67.42
Rate for Payer: Priority Health SBD	$67.42

PR SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM

Professional

Both

$351.00

Service Code	HCPCS 12013
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$351.25
Rate for Payer: Aetna Commercial	$64.56
Rate for Payer: BCBS Complete	$38.69
Rate for Payer: BCBS Trust/PPO	$351.25
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Mclaren Medicaid	$36.85
Rate for Payer: Meridian Medicaid	$38.69
Rate for Payer: Priority Health Choice Medicaid	$36.85
Rate for Payer: Priority Health Cigna Priority Health	$245.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$71.52
Rate for Payer: Priority Health Narrow Network	$71.52
Rate for Payer: Priority Health SBD	$71.52

Know your out-of-pocket cost for care.

All Charges