Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR ABLTJ SOFT TIS INFERIOR TURBINATES UNI/BI SUPFC

Professional

Both

$383.00

Service Code	HCPCS 30801
Min. Negotiated Rate	$89.46
Max. Negotiated Rate	$287.25
Rate for Payer: Aetna Commercial	$190.20
Rate for Payer: Aetna Medicare	$191.50
Rate for Payer: BCBS Complete	$93.93
Rate for Payer: BCN Commercial	$224.59
Rate for Payer: Cash Price	$306.40
Rate for Payer: Cash Price	$306.40
Rate for Payer: Mclaren Medicaid	$89.46
Rate for Payer: Meridian Medicaid	$93.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$287.25
Rate for Payer: Priority Health Choice Medicaid	$89.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$211.49
Rate for Payer: Priority Health Narrow/Tiered Network	$211.49
Rate for Payer: UHC Medicaid	$89.46
Rate for Payer: UHCCP Medicaid	$89.46

PR ABRASION 1 LESION

Professional

Both

$455.00

Service Code	HCPCS 15786
Min. Negotiated Rate	$75.83
Max. Negotiated Rate	$341.25
Rate for Payer: Aetna Commercial	$142.60
Rate for Payer: Aetna Medicare	$227.50
Rate for Payer: BCBS Complete	$79.62
Rate for Payer: BCN Commercial	$203.18
Rate for Payer: Cash Price	$364.00
Rate for Payer: Cash Price	$364.00
Rate for Payer: Mclaren Medicaid	$75.83
Rate for Payer: Meridian Medicaid	$79.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$341.25
Rate for Payer: Priority Health Choice Medicaid	$75.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$185.95
Rate for Payer: Priority Health Narrow/Tiered Network	$185.95
Rate for Payer: UHC Medicaid	$75.83
Rate for Payer: UHCCP Medicaid	$75.83

PR ACETABULOPLASTY RESECTION FEMORAL HEAD

Professional

Both

$2,035.00

Service Code	HCPCS 27122
Min. Negotiated Rate	$644.54
Max. Negotiated Rate	$1,785.42
Rate for Payer: Aetna Commercial	$1,473.67
Rate for Payer: Aetna Medicare	$1,017.50
Rate for Payer: BCBS Complete	$676.77
Rate for Payer: BCN Commercial	$1,670.23
Rate for Payer: Cash Price	$1,628.00
Rate for Payer: Cash Price	$1,628.00
Rate for Payer: Mclaren Medicaid	$644.54
Rate for Payer: Meridian Medicaid	$676.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,526.25
Rate for Payer: Priority Health Choice Medicaid	$644.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,785.42
Rate for Payer: Priority Health Narrow/Tiered Network	$1,785.42
Rate for Payer: UHC Medicaid	$644.54
Rate for Payer: UHCCP Medicaid	$644.54

PR ACOUSTIC IMMIT TEST TYMPANOM/ACOUST REFLX/DECAY

Professional

Both

$60.00

Service Code	HCPCS 92570
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$32.99
Rate for Payer: Aetna Medicare	$30.00
Rate for Payer: BCBS Complete	$15.88
Rate for Payer: BCN Commercial	$42.82
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Mclaren Medicaid	$15.12
Rate for Payer: Meridian Medicaid	$15.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$45.00
Rate for Payer: Priority Health Choice Medicaid	$15.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$39.50
Rate for Payer: Priority Health Narrow/Tiered Network	$39.50
Rate for Payer: UHC Medicaid	$15.12
Rate for Payer: UHCCP Medicaid	$15.12

PR ACROMIOPLASTY/ACROMIONECTOMY PRTL +-LIGAMENT RLS

Professional

Both

$1,177.00

Service Code	HCPCS 23130
Min. Negotiated Rate	$376.80
Max. Negotiated Rate	$1,014.61
Rate for Payer: Aetna Commercial	$821.57
Rate for Payer: Aetna Medicare	$588.50
Rate for Payer: BCBS Complete	$395.64
Rate for Payer: BCN Commercial	$949.16
Rate for Payer: Cash Price	$941.60
Rate for Payer: Cash Price	$941.60
Rate for Payer: Mclaren Medicaid	$376.80
Rate for Payer: Meridian Medicaid	$395.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$882.75
Rate for Payer: Priority Health Choice Medicaid	$376.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,014.61
Rate for Payer: Priority Health Narrow/Tiered Network	$1,014.61
Rate for Payer: UHC Medicaid	$376.80
Rate for Payer: UHCCP Medicaid	$376.80

PR ACTIGRAPHY TESTING RECORDING ANALYSIS I&R

Professional

Both

$622.00

Service Code	HCPCS 95803
Min. Negotiated Rate	$160.55
Max. Negotiated Rate	$466.50
Rate for Payer: Aetna Commercial	$160.55
Rate for Payer: Aetna Commercial	$160.55
Rate for Payer: Aetna Medicare	$311.00
Rate for Payer: Aetna Medicare	$47.00
Rate for Payer: BCN Commercial	$194.71
Rate for Payer: BCN Commercial	$194.71
Rate for Payer: Cash Price	$497.60
Rate for Payer: Cash Price	$497.60
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cash Price	$75.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$466.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$179.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$179.56
Rate for Payer: Priority Health Narrow/Tiered Network	$179.56
Rate for Payer: Priority Health Narrow/Tiered Network	$179.56

PR ADAPT BHV TX PRTCL MODIFICAJ PHYS/QHP EA 15 MIN

Professional

Both

$55.00

Service Code	HCPCS 97155
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$45.93
Rate for Payer: Aetna Commercial	$20.80
Rate for Payer: Aetna Medicare	$27.50
Rate for Payer: BCBS Complete	$22.00
Rate for Payer: BCN Commercial	$25.38
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$41.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$45.93
Rate for Payer: Priority Health Narrow/Tiered Network	$45.93

PR ADDITIONAL KIT 2-4 CC, INJECTION, PLATELET RICH PLASMA

Professional

Both

$210.00

Hospital Revenue Code	990
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Medicare	$105.00
Rate for Payer: BCBS Complete	$84.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$157.50

PR ADDITIONAL KIT 4-10 CC, INJECTION, PLATELET RICH PLASMA

Professional

Both

$315.00

Hospital Revenue Code	990
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$236.25
Rate for Payer: Aetna Medicare	$157.50
Rate for Payer: BCBS Complete	$126.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$236.25

PR ADENOIDECTOMY PRIMARY <AGE 12

Professional

Both

$390.00

Service Code	HCPCS 42830
Min. Negotiated Rate	$124.61
Max. Negotiated Rate	$396.21
Rate for Payer: Aetna Commercial	$274.50
Rate for Payer: Aetna Medicare	$195.00
Rate for Payer: BCBS Complete	$130.84
Rate for Payer: BCN Commercial	$325.18
Rate for Payer: Cash Price	$312.00
Rate for Payer: Cash Price	$312.00
Rate for Payer: Mclaren Medicaid	$124.61
Rate for Payer: Meridian Medicaid	$130.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$292.50
Rate for Payer: Priority Health Choice Medicaid	$124.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$396.21
Rate for Payer: Priority Health Narrow/Tiered Network	$396.21
Rate for Payer: UHC Medicaid	$124.61
Rate for Payer: UHCCP Medicaid	$124.61

PR ADENOIDECTOMY PRIMARY AGE 12/>

Professional

Both

$665.00

Service Code	HCPCS 42831
Min. Negotiated Rate	$135.68
Max. Negotiated Rate	$498.75
Rate for Payer: Aetna Commercial	$297.97
Rate for Payer: Aetna Medicare	$332.50
Rate for Payer: BCBS Complete	$142.46
Rate for Payer: BCN Commercial	$353.07
Rate for Payer: Cash Price	$532.00
Rate for Payer: Cash Price	$532.00
Rate for Payer: Mclaren Medicaid	$135.68
Rate for Payer: Meridian Medicaid	$142.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$498.75
Rate for Payer: Priority Health Choice Medicaid	$135.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$430.20
Rate for Payer: Priority Health Narrow/Tiered Network	$430.20
Rate for Payer: UHC Medicaid	$135.68
Rate for Payer: UHCCP Medicaid	$135.68

PR ADENOIDECTOMY SECONDARY AGE 12/>

Professional

Both

$625.00

Service Code	HCPCS 42836
Min. Negotiated Rate	$142.07
Max. Negotiated Rate	$468.75
Rate for Payer: Aetna Commercial	$318.51
Rate for Payer: Aetna Medicare	$312.50
Rate for Payer: BCBS Complete	$149.17
Rate for Payer: BCN Commercial	$374.98
Rate for Payer: Cash Price	$500.00
Rate for Payer: Cash Price	$500.00
Rate for Payer: Mclaren Medicaid	$142.07
Rate for Payer: Meridian Medicaid	$149.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$468.75
Rate for Payer: Priority Health Choice Medicaid	$142.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$456.89
Rate for Payer: Priority Health Narrow/Tiered Network	$456.89
Rate for Payer: UHC Medicaid	$142.07
Rate for Payer: UHCCP Medicaid	$142.07

PR ADENOIDECTOMY SECONDARY<AGE 12

Professional

Both

$528.00

Service Code	HCPCS 42835
Min. Negotiated Rate	$116.94
Max. Negotiated Rate	$396.00
Rate for Payer: Aetna Commercial	$254.78
Rate for Payer: Aetna Medicare	$264.00
Rate for Payer: BCBS Complete	$122.79
Rate for Payer: BCN Commercial	$303.27
Rate for Payer: Cash Price	$422.40
Rate for Payer: Cash Price	$422.40
Rate for Payer: Mclaren Medicaid	$116.94
Rate for Payer: Meridian Medicaid	$122.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$396.00
Rate for Payer: Priority Health Choice Medicaid	$116.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$369.51
Rate for Payer: Priority Health Narrow/Tiered Network	$369.51
Rate for Payer: UHC Medicaid	$116.94
Rate for Payer: UHCCP Medicaid	$116.94

PR ADENOSINE INJ 1MG

Professional

Both

$1.00

Service Code	HCPCS J0153
Min. Negotiated Rate	$0.18
Max. Negotiated Rate	$0.75
Rate for Payer: Aetna Commercial	$0.62
Rate for Payer: Aetna Medicare	$0.50
Rate for Payer: BCBS Trust/PPO	$0.25
Rate for Payer: BCN Commercial	$0.18
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cash Price	$0.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.75

PR ADENOSINE INJECTION

Professional

Both

$123.00

Service Code	HCPCS J0152
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$92.25
Rate for Payer: Aetna Medicare	$61.50
Rate for Payer: BCBS Complete	$49.20
Rate for Payer: Cash Price	$98.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$92.25

PR ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<

Professional

Both

$1,071.00

Service Code	HCPCS 14000
Min. Negotiated Rate	$296.71
Max. Negotiated Rate	$803.25
Rate for Payer: Aetna Commercial	$533.56
Rate for Payer: Aetna Medicare	$535.50
Rate for Payer: BCBS Complete	$311.55
Rate for Payer: BCN Commercial	$764.90
Rate for Payer: Cash Price	$856.80
Rate for Payer: Cash Price	$856.80
Rate for Payer: Mclaren Medicaid	$296.71
Rate for Payer: Meridian Medicaid	$311.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$803.25
Rate for Payer: Priority Health Choice Medicaid	$296.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$700.08
Rate for Payer: Priority Health Narrow/Tiered Network	$700.08
Rate for Payer: UHC Medicaid	$296.71
Rate for Payer: UHCCP Medicaid	$296.71

PR ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM

Professional

Both

$1,395.00

Service Code	HCPCS 14001
Min. Negotiated Rate	$383.83
Max. Negotiated Rate	$1,046.25
Rate for Payer: Aetna Commercial	$696.49
Rate for Payer: Aetna Medicare	$697.50
Rate for Payer: BCBS Complete	$403.02
Rate for Payer: BCN Commercial	$987.00
Rate for Payer: Cash Price	$1,116.00
Rate for Payer: Cash Price	$1,116.00
Rate for Payer: Mclaren Medicaid	$383.83
Rate for Payer: Meridian Medicaid	$403.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,046.25
Rate for Payer: Priority Health Choice Medicaid	$383.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$903.36
Rate for Payer: Priority Health Narrow/Tiered Network	$903.36
Rate for Payer: UHC Medicaid	$383.83
Rate for Payer: UHCCP Medicaid	$383.83

PR ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM

Professional

Both

$1,779.00

Service Code	HCPCS 14301
Min. Negotiated Rate	$489.90
Max. Negotiated Rate	$1,334.25
Rate for Payer: Aetna Commercial	$932.47
Rate for Payer: Aetna Medicare	$889.50
Rate for Payer: BCBS Complete	$514.39
Rate for Payer: BCN Commercial	$1,307.20
Rate for Payer: Cash Price	$1,423.20
Rate for Payer: Cash Price	$1,423.20
Rate for Payer: Mclaren Medicaid	$489.90
Rate for Payer: Meridian Medicaid	$514.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,334.25
Rate for Payer: Priority Health Choice Medicaid	$489.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,196.43
Rate for Payer: Priority Health Narrow/Tiered Network	$1,196.43
Rate for Payer: UHC Medicaid	$489.90
Rate for Payer: UHCCP Medicaid	$489.90

PR ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM

Professional

Both

$1,663.00

Service Code	HCPCS 14041
Min. Negotiated Rate	$416.20
Max. Negotiated Rate	$1,247.25
Rate for Payer: Aetna Commercial	$811.62
Rate for Payer: Aetna Medicare	$831.50
Rate for Payer: BCBS Complete	$437.01
Rate for Payer: BCN Commercial	$1,148.35
Rate for Payer: Cash Price	$1,330.40
Rate for Payer: Cash Price	$1,330.40
Rate for Payer: Mclaren Medicaid	$416.20
Rate for Payer: Meridian Medicaid	$437.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,247.25
Rate for Payer: Priority Health Choice Medicaid	$416.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,051.03
Rate for Payer: Priority Health Narrow/Tiered Network	$1,051.03
Rate for Payer: UHC Medicaid	$416.20
Rate for Payer: UHCCP Medicaid	$416.20

PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM

Professional

Both

$1,523.00

Service Code	HCPCS 14021
Min. Negotiated Rate	$395.54
Max. Negotiated Rate	$1,142.25
Rate for Payer: Aetna Commercial	$753.63
Rate for Payer: Aetna Medicare	$761.50
Rate for Payer: BCBS Complete	$415.32
Rate for Payer: BCN Commercial	$1,069.66
Rate for Payer: Cash Price	$1,218.40
Rate for Payer: Cash Price	$1,218.40
Rate for Payer: Mclaren Medicaid	$395.54
Rate for Payer: Meridian Medicaid	$415.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,142.25
Rate for Payer: Priority Health Choice Medicaid	$395.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$979.01
Rate for Payer: Priority Health Narrow/Tiered Network	$979.01
Rate for Payer: UHC Medicaid	$395.54
Rate for Payer: UHCCP Medicaid	$395.54

PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM

Facility

$1,523.00

Service Code	CPT 14021
Hospital Charge Code	14021
Hospital Revenue Code	960
Min. Negotiated Rate	$1,060.01
Max. Negotiated Rate	$1,370.70
Rate for Payer: Aetna Commercial	$1,294.55
Rate for Payer: BCBS Trust/PPO	$1,257.85
Rate for Payer: BCN Commercial	$1,257.85
Rate for Payer: Cash Price	$1,218.40
Rate for Payer: Cofinity Commercial	$1,309.78
Rate for Payer: Encore Health Key Benefits Commercial	$1,218.40
Rate for Payer: Healthscope Commercial	$1,370.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,142.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,294.55
Rate for Payer: Nomi Health Commercial	$1,248.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,142.25
Rate for Payer: PHP Commercial	$1,294.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,325.01
Rate for Payer: Priority Health Narrow/Tiered Network	$1,060.01
Rate for Payer: UHC Core	$1,271.70
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,142.25

PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM

Professional

Both

$1,523.00

Service Code	HCPCS 14021
Hospital Charge Code	14021
Min. Negotiated Rate	$395.54
Max. Negotiated Rate	$1,142.25
Rate for Payer: Aetna Commercial	$753.63
Rate for Payer: Aetna Medicare	$761.50
Rate for Payer: BCBS Complete	$415.32
Rate for Payer: BCN Commercial	$1,069.66
Rate for Payer: Cash Price	$1,218.40
Rate for Payer: Cash Price	$1,218.40
Rate for Payer: Mclaren Medicaid	$395.54
Rate for Payer: Meridian Medicaid	$415.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,142.25
Rate for Payer: Priority Health Choice Medicaid	$395.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$979.01
Rate for Payer: Priority Health Narrow/Tiered Network	$979.01
Rate for Payer: UHC Medicaid	$395.54
Rate for Payer: UHCCP Medicaid	$395.54

PR ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM

Facility

$1,523.00

Service Code	CPT 14021
Hospital Charge Code	14021
Hospital Revenue Code	960
Min. Negotiated Rate	$268.50
Max. Negotiated Rate	$1,370.70
Rate for Payer: Aetna Commercial	$1,294.55
Rate for Payer: Aetna Medicare	$395.98
Rate for Payer: Allen County Amish Medical Aid Commercial	$475.94
Rate for Payer: Amish Plain Church Group Commercial	$475.94
Rate for Payer: BCBS Complete	$281.91
Rate for Payer: BCBS MAPPO	$380.75
Rate for Payer: BCBS Trust/PPO	$1,252.06
Rate for Payer: BCN Commercial	$1,252.06
Rate for Payer: BCN Medicare Advantage	$380.75
Rate for Payer: Cash Price	$1,218.40
Rate for Payer: Cofinity Commercial	$1,309.78
Rate for Payer: Encore Health Key Benefits Commercial	$1,218.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$380.75
Rate for Payer: Healthscope Commercial	$1,370.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,142.25
Rate for Payer: Mclaren Medicaid	$268.50
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$399.79
Rate for Payer: Meridian Medicaid	$281.91
Rate for Payer: MI Amish Medical Board Commercial	$437.86
Rate for Payer: Molina Medicare/Medicaid	$418.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,294.55
Rate for Payer: Nomi Health Commercial	$1,248.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,142.25
Rate for Payer: PACE Senior Care Partners	$361.71
Rate for Payer: PACE SWMI	$380.75
Rate for Payer: PHP Commercial	$1,294.55
Rate for Payer: PHP Medicare Advantage	$380.75
Rate for Payer: Priority Health Choice Medicaid	$268.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,325.01
Rate for Payer: Priority Health Medicare	$384.56
Rate for Payer: Priority Health Narrow/Tiered Network	$1,060.01
Rate for Payer: Railroad Medicare Medicare	$380.75
Rate for Payer: UHC Core	$1,271.70
Rate for Payer: UHC Exchange	$380.75
Rate for Payer: UHC Medicaid	$268.50
Rate for Payer: UHC Medicare Advantage	$380.75
Rate for Payer: UHCCP Medicaid	$268.50
Rate for Payer: VA VA	$380.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,142.25

PR ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM

Professional

Both

$2,302.00

Service Code	HCPCS 14061
Min. Negotiated Rate	$445.60
Max. Negotiated Rate	$1,726.50
Rate for Payer: Aetna Commercial	$870.72
Rate for Payer: Aetna Medicare	$1,151.00
Rate for Payer: BCBS Complete	$467.88
Rate for Payer: BCN Commercial	$1,231.01
Rate for Payer: Cash Price	$1,841.60
Rate for Payer: Cash Price	$1,841.60
Rate for Payer: Mclaren Medicaid	$445.60
Rate for Payer: Meridian Medicaid	$467.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,726.50
Rate for Payer: Priority Health Choice Medicaid	$445.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,126.70
Rate for Payer: Priority Health Narrow/Tiered Network	$1,126.70
Rate for Payer: UHC Medicaid	$445.60
Rate for Payer: UHCCP Medicaid	$445.60

PR ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM

Professional

Both

$466.00

Service Code	HCPCS 14302
Min. Negotiated Rate	$116.51
Max. Negotiated Rate	$349.50
Rate for Payer: Aetna Commercial	$235.75
Rate for Payer: Aetna Medicare	$233.00
Rate for Payer: BCBS Complete	$122.34
Rate for Payer: BCN Commercial	$320.20
Rate for Payer: Cash Price	$372.80
Rate for Payer: Cash Price	$372.80
Rate for Payer: Mclaren Medicaid	$116.51
Rate for Payer: Meridian Medicaid	$122.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$349.50
Rate for Payer: Priority Health Choice Medicaid	$116.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$293.07
Rate for Payer: Priority Health Narrow/Tiered Network	$293.07
Rate for Payer: UHC Medicaid	$116.51
Rate for Payer: UHCCP Medicaid	$116.51

Know your out-of-pocket cost for care.

All Charges