Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR BIOPSY OROPHARYNX

Professional

Both

$266.00

Service Code	HCPCS 42800
Min. Negotiated Rate	$67.73
Max. Negotiated Rate	$217.22
Rate for Payer: Aetna Commercial	$149.58
Rate for Payer: Aetna Medicare	$133.00
Rate for Payer: BCBS Complete	$71.12
Rate for Payer: BCN Commercial	$178.28
Rate for Payer: Cash Price	$212.80
Rate for Payer: Cash Price	$212.80
Rate for Payer: Mclaren Medicaid	$67.73
Rate for Payer: Meridian Medicaid	$71.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$199.50
Rate for Payer: Priority Health Choice Medicaid	$67.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$217.22
Rate for Payer: Priority Health Narrow/Tiered Network	$217.22
Rate for Payer: UHC Medicaid	$67.73
Rate for Payer: UHCCP Medicaid	$67.73

PR BIOPSY OVARY UNI/BI SEPARATE PROCEDURE

Professional

Both

$1,666.00

Service Code	HCPCS 58900
Min. Negotiated Rate	$248.15
Max. Negotiated Rate	$1,249.50
Rate for Payer: Aetna Commercial	$516.89
Rate for Payer: Aetna Medicare	$833.00
Rate for Payer: BCBS Complete	$260.56
Rate for Payer: BCN Commercial	$656.34
Rate for Payer: Cash Price	$1,332.80
Rate for Payer: Cash Price	$1,332.80
Rate for Payer: Mclaren Medicaid	$248.15
Rate for Payer: Meridian Medicaid	$260.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,249.50
Rate for Payer: Priority Health Choice Medicaid	$248.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$664.73
Rate for Payer: Priority Health Narrow/Tiered Network	$664.73
Rate for Payer: UHC Medicaid	$248.15
Rate for Payer: UHCCP Medicaid	$248.15

PR BIOPSY PALATE UVULA

Professional

Both

$276.00

Service Code	HCPCS 42100
Min. Negotiated Rate	$64.75
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$141.39
Rate for Payer: Aetna Medicare	$138.00
Rate for Payer: BCBS Complete	$67.99
Rate for Payer: BCN Commercial	$166.82
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cash Price	$220.80
Rate for Payer: Mclaren Medicaid	$64.75
Rate for Payer: Meridian Medicaid	$67.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$207.00
Rate for Payer: Priority Health Choice Medicaid	$64.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$203.26
Rate for Payer: Priority Health Narrow/Tiered Network	$203.26
Rate for Payer: UHC Medicaid	$64.75
Rate for Payer: UHCCP Medicaid	$64.75

PR BIOPSY PANCREAS OPEN

Professional

Both

$1,636.00

Service Code	HCPCS 48100
Min. Negotiated Rate	$538.25
Max. Negotiated Rate	$1,628.54
Rate for Payer: Aetna Commercial	$1,190.74
Rate for Payer: Aetna Medicare	$818.00
Rate for Payer: BCBS Complete	$565.16
Rate for Payer: BCN Commercial	$1,336.58
Rate for Payer: Cash Price	$1,308.80
Rate for Payer: Cash Price	$1,308.80
Rate for Payer: Mclaren Medicaid	$538.25
Rate for Payer: Meridian Medicaid	$565.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,227.00
Rate for Payer: Priority Health Choice Medicaid	$538.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,628.54
Rate for Payer: Priority Health Narrow/Tiered Network	$1,628.54
Rate for Payer: UHC Medicaid	$538.25
Rate for Payer: UHCCP Medicaid	$538.25

PR BIOPSY PENIS DEEP STRUCTURES

Professional

Both

$580.00

Service Code	HCPCS 54105
Min. Negotiated Rate	$124.61
Max. Negotiated Rate	$435.00
Rate for Payer: Aetna Commercial	$272.65
Rate for Payer: Aetna Medicare	$290.00
Rate for Payer: BCBS Complete	$130.84
Rate for Payer: BCN Commercial	$320.20
Rate for Payer: Cash Price	$464.00
Rate for Payer: Cash Price	$464.00
Rate for Payer: Mclaren Medicaid	$124.61
Rate for Payer: Meridian Medicaid	$130.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$435.00
Rate for Payer: Priority Health Choice Medicaid	$124.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$348.81
Rate for Payer: Priority Health Narrow/Tiered Network	$348.81
Rate for Payer: UHC Medicaid	$124.61
Rate for Payer: UHCCP Medicaid	$124.61

PR BIOPSY PENIS SEPARATE PROCEDURE

Professional

Both

$316.00

Service Code	HCPCS 54100
Min. Negotiated Rate	$66.24
Max. Negotiated Rate	$237.00
Rate for Payer: Aetna Commercial	$153.72
Rate for Payer: Aetna Medicare	$158.00
Rate for Payer: BCBS Complete	$69.55
Rate for Payer: BCN Commercial	$182.76
Rate for Payer: Cash Price	$252.80
Rate for Payer: Cash Price	$252.80
Rate for Payer: Mclaren Medicaid	$66.24
Rate for Payer: Meridian Medicaid	$69.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$237.00
Rate for Payer: Priority Health Choice Medicaid	$66.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$199.08
Rate for Payer: Priority Health Narrow/Tiered Network	$199.08
Rate for Payer: UHC Medicaid	$66.24
Rate for Payer: UHCCP Medicaid	$66.24

PR BIOPSY PROSTATE ANY APPROACH NONIMAGING-GUIDED

Professional

Both

$491.00

Service Code	HCPCS 55705
Min. Negotiated Rate	$63.69
Max. Negotiated Rate	$432.89
Rate for Payer: Aetna Commercial	$340.09
Rate for Payer: Aetna Medicare	$245.50
Rate for Payer: BCBS Complete	$66.87
Rate for Payer: BCN Commercial	$397.38
Rate for Payer: Cash Price	$392.80
Rate for Payer: Cash Price	$392.80
Rate for Payer: Mclaren Medicaid	$63.69
Rate for Payer: Meridian Medicaid	$66.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$368.25
Rate for Payer: Priority Health Choice Medicaid	$63.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$432.89
Rate for Payer: Priority Health Narrow/Tiered Network	$432.89
Rate for Payer: UHC Medicaid	$63.69
Rate for Payer: UHCCP Medicaid	$63.69

PR BIOPSY PROSTATE TRANSRECTAL ULTRASOUND-GUIDED

Professional

Both

$326.00

Service Code	HCPCS 55707
Min. Negotiated Rate	$86.90
Max. Negotiated Rate	$244.50
Rate for Payer: Aetna Medicare	$163.00
Rate for Payer: BCBS Complete	$91.25
Rate for Payer: Cash Price	$260.80
Rate for Payer: Cash Price	$260.80
Rate for Payer: Mclaren Medicaid	$86.90
Rate for Payer: Meridian Medicaid	$91.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$244.50
Rate for Payer: Priority Health Choice Medicaid	$86.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$200.93
Rate for Payer: Priority Health Narrow/Tiered Network	$200.93
Rate for Payer: UHC Medicaid	$86.90
Rate for Payer: UHCCP Medicaid	$86.90

PR BIOPSY SALIVARY GLAND INCISIONAL

Professional

Both

$549.00

Service Code	HCPCS 42405
Min. Negotiated Rate	$128.87
Max. Negotiated Rate	$418.06
Rate for Payer: Aetna Commercial	$298.24
Rate for Payer: Aetna Medicare	$274.50
Rate for Payer: BCBS Complete	$135.31
Rate for Payer: BCN Commercial	$343.11
Rate for Payer: Cash Price	$439.20
Rate for Payer: Cash Price	$439.20
Rate for Payer: Mclaren Medicaid	$128.87
Rate for Payer: Meridian Medicaid	$135.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$411.75
Rate for Payer: Priority Health Choice Medicaid	$128.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$418.06
Rate for Payer: Priority Health Narrow/Tiered Network	$418.06
Rate for Payer: UHC Medicaid	$128.87
Rate for Payer: UHCCP Medicaid	$128.87

PR BIOPSY SOFT TISSUE BACK/FLANK DEEP

Professional

Both

$948.00

Service Code	HCPCS 21925
Min. Negotiated Rate	$237.71
Max. Negotiated Rate	$711.00
Rate for Payer: Aetna Commercial	$488.62
Rate for Payer: Aetna Medicare	$474.00
Rate for Payer: BCBS Complete	$249.60
Rate for Payer: BCN Commercial	$578.16
Rate for Payer: Cash Price	$758.40
Rate for Payer: Cash Price	$758.40
Rate for Payer: Mclaren Medicaid	$237.71
Rate for Payer: Meridian Medicaid	$249.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$711.00
Rate for Payer: Priority Health Choice Medicaid	$237.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$618.03
Rate for Payer: Priority Health Narrow/Tiered Network	$618.03
Rate for Payer: UHC Medicaid	$237.71
Rate for Payer: UHCCP Medicaid	$237.71

PR BIOPSY SOFT TISSUE BACK/FLANK SUPERFICIAL

Professional

Both

$523.00

Service Code	HCPCS 21920
Min. Negotiated Rate	$90.74
Max. Negotiated Rate	$392.25
Rate for Payer: Aetna Commercial	$205.43
Rate for Payer: Aetna Medicare	$261.50
Rate for Payer: BCBS Complete	$95.28
Rate for Payer: BCN Commercial	$234.05
Rate for Payer: Cash Price	$418.40
Rate for Payer: Cash Price	$418.40
Rate for Payer: Mclaren Medicaid	$90.74
Rate for Payer: Meridian Medicaid	$95.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$392.25
Rate for Payer: Priority Health Choice Medicaid	$90.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$250.20
Rate for Payer: Priority Health Narrow/Tiered Network	$250.20
Rate for Payer: UHC Medicaid	$90.74
Rate for Payer: UHCCP Medicaid	$90.74

PR BIOPSY SOFT TISSUE FOREARM&/WRIST DEEP

Professional

Both

$863.00

Service Code	HCPCS 25066
Min. Negotiated Rate	$228.55
Max. Negotiated Rate	$647.25
Rate for Payer: Aetna Commercial	$479.14
Rate for Payer: Aetna Medicare	$431.50
Rate for Payer: BCBS Complete	$239.98
Rate for Payer: BCN Commercial	$573.68
Rate for Payer: Cash Price	$690.40
Rate for Payer: Cash Price	$690.40
Rate for Payer: Mclaren Medicaid	$228.55
Rate for Payer: Meridian Medicaid	$239.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$647.25
Rate for Payer: Priority Health Choice Medicaid	$228.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$613.24
Rate for Payer: Priority Health Narrow/Tiered Network	$613.24
Rate for Payer: UHC Medicaid	$228.55
Rate for Payer: UHCCP Medicaid	$228.55

PR BIOPSY SOFT TISSUE FOREARM&/WRIST SUPERFICIAL

Professional

Both

$502.00

Service Code	HCPCS 25065
Min. Negotiated Rate	$93.08
Max. Negotiated Rate	$376.50
Rate for Payer: Aetna Commercial	$208.50
Rate for Payer: Aetna Medicare	$251.00
Rate for Payer: BCBS Complete	$97.73
Rate for Payer: BCN Commercial	$238.54
Rate for Payer: Cash Price	$401.60
Rate for Payer: Cash Price	$401.60
Rate for Payer: Mclaren Medicaid	$93.08
Rate for Payer: Meridian Medicaid	$97.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$376.50
Rate for Payer: Priority Health Choice Medicaid	$93.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$254.99
Rate for Payer: Priority Health Narrow/Tiered Network	$254.99
Rate for Payer: UHC Medicaid	$93.08
Rate for Payer: UHCCP Medicaid	$93.08

PR BIOPSY SOFT TISSUE LEG/ANKLE AREA DEEP

Professional

Both

$972.00

Service Code	HCPCS 27614
Min. Negotiated Rate	$249.85
Max. Negotiated Rate	$729.00
Rate for Payer: Aetna Commercial	$544.43
Rate for Payer: Aetna Medicare	$486.00
Rate for Payer: BCBS Complete	$262.34
Rate for Payer: BCN Commercial	$627.96
Rate for Payer: Cash Price	$777.60
Rate for Payer: Cash Price	$777.60
Rate for Payer: Mclaren Medicaid	$249.85
Rate for Payer: Meridian Medicaid	$262.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$729.00
Rate for Payer: Priority Health Choice Medicaid	$249.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$671.27
Rate for Payer: Priority Health Narrow/Tiered Network	$671.27
Rate for Payer: UHC Medicaid	$249.85
Rate for Payer: UHCCP Medicaid	$249.85

PR BIOPSY SOFT TISSUE LEG/ANKLE AREA SUPERFICIAL

Professional

Both

$459.00

Service Code	HCPCS 27613
Min. Negotiated Rate	$96.28
Max. Negotiated Rate	$344.25
Rate for Payer: Aetna Commercial	$210.61
Rate for Payer: Aetna Medicare	$229.50
Rate for Payer: BCBS Complete	$101.09
Rate for Payer: BCN Commercial	$245.01
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cash Price	$367.20
Rate for Payer: Mclaren Medicaid	$96.28
Rate for Payer: Meridian Medicaid	$101.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$344.25
Rate for Payer: Priority Health Choice Medicaid	$96.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$261.90
Rate for Payer: Priority Health Narrow/Tiered Network	$261.90
Rate for Payer: UHC Medicaid	$96.28
Rate for Payer: UHCCP Medicaid	$96.28

PR BIOPSY SOFT TISSUE NECK/THORAX

Professional

Both

$471.00

Service Code	HCPCS 21550
Min. Negotiated Rate	$91.59
Max. Negotiated Rate	$353.25
Rate for Payer: Aetna Commercial	$204.97
Rate for Payer: Aetna Medicare	$235.50
Rate for Payer: BCBS Complete	$96.17
Rate for Payer: BCN Commercial	$234.54
Rate for Payer: Cash Price	$376.80
Rate for Payer: Cash Price	$376.80
Rate for Payer: Mclaren Medicaid	$91.59
Rate for Payer: Meridian Medicaid	$96.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$353.25
Rate for Payer: Priority Health Choice Medicaid	$91.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$250.72
Rate for Payer: Priority Health Narrow/Tiered Network	$250.72
Rate for Payer: UHC Medicaid	$91.59
Rate for Payer: UHCCP Medicaid	$91.59

PR BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL

Professional

Both

$615.00

Service Code	HCPCS 27040
Min. Negotiated Rate	$116.51
Max. Negotiated Rate	$461.25
Rate for Payer: Aetna Commercial	$264.26
Rate for Payer: Aetna Medicare	$307.50
Rate for Payer: BCBS Complete	$122.34
Rate for Payer: BCN Commercial	$301.78
Rate for Payer: Cash Price	$492.00
Rate for Payer: Cash Price	$492.00
Rate for Payer: Mclaren Medicaid	$116.51
Rate for Payer: Meridian Medicaid	$122.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$461.25
Rate for Payer: Priority Health Choice Medicaid	$116.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$322.59
Rate for Payer: Priority Health Narrow/Tiered Network	$322.59
Rate for Payer: UHC Medicaid	$116.51
Rate for Payer: UHCCP Medicaid	$116.51

PR BIOPSY SOFT TISSUE PELVIS&HIP DEEP/SUBFSCAL/IM

Professional

Both

$1,467.00

Service Code	HCPCS 27041
Min. Negotiated Rate	$417.69
Max. Negotiated Rate	$1,148.77
Rate for Payer: Aetna Commercial	$939.71
Rate for Payer: Aetna Medicare	$733.50
Rate for Payer: BCBS Complete	$438.57
Rate for Payer: BCN Commercial	$1,074.64
Rate for Payer: Cash Price	$1,173.60
Rate for Payer: Cash Price	$1,173.60
Rate for Payer: Mclaren Medicaid	$417.69
Rate for Payer: Meridian Medicaid	$438.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,100.25
Rate for Payer: Priority Health Choice Medicaid	$417.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,148.77
Rate for Payer: Priority Health Narrow/Tiered Network	$1,148.77
Rate for Payer: UHC Medicaid	$417.69
Rate for Payer: UHCCP Medicaid	$417.69

PR BIOPSY SOFT TISSUE SHOULDER DEEP

Professional

Both

$873.00

Service Code	HCPCS 23066
Min. Negotiated Rate	$233.66
Max. Negotiated Rate	$654.75
Rate for Payer: Aetna Commercial	$485.10
Rate for Payer: Aetna Medicare	$436.50
Rate for Payer: BCBS Complete	$245.34
Rate for Payer: BCN Commercial	$570.69
Rate for Payer: Cash Price	$698.40
Rate for Payer: Cash Price	$698.40
Rate for Payer: Mclaren Medicaid	$233.66
Rate for Payer: Meridian Medicaid	$245.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$654.75
Rate for Payer: Priority Health Choice Medicaid	$233.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$610.05
Rate for Payer: Priority Health Narrow/Tiered Network	$610.05
Rate for Payer: UHC Medicaid	$233.66
Rate for Payer: UHCCP Medicaid	$233.66

PR BIOPSY SOFT TISSUE THIGH/KNEE AREA DEEP

Professional

Both

$717.00

Service Code	HCPCS 27324
Min. Negotiated Rate	$256.67
Max. Negotiated Rate	$674.46
Rate for Payer: Aetna Commercial	$541.89
Rate for Payer: Aetna Medicare	$358.50
Rate for Payer: BCBS Complete	$269.50
Rate for Payer: BCN Commercial	$630.94
Rate for Payer: Cash Price	$573.60
Rate for Payer: Cash Price	$573.60
Rate for Payer: Mclaren Medicaid	$256.67
Rate for Payer: Meridian Medicaid	$269.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$537.75
Rate for Payer: Priority Health Choice Medicaid	$256.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$674.46
Rate for Payer: Priority Health Narrow/Tiered Network	$674.46
Rate for Payer: UHC Medicaid	$256.67
Rate for Payer: UHCCP Medicaid	$256.67

PR BIOPSY SOFT TISSUE THIGH/KNEE AREA SUPERFICIAL

Professional

Both

$495.00

Service Code	HCPCS 27323
Min. Negotiated Rate	$100.54
Max. Negotiated Rate	$371.25
Rate for Payer: Aetna Commercial	$230.57
Rate for Payer: Aetna Medicare	$247.50
Rate for Payer: BCBS Complete	$105.57
Rate for Payer: BCN Commercial	$265.92
Rate for Payer: Cash Price	$396.00
Rate for Payer: Cash Price	$396.00
Rate for Payer: Mclaren Medicaid	$100.54
Rate for Payer: Meridian Medicaid	$105.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$371.25
Rate for Payer: Priority Health Choice Medicaid	$100.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$284.26
Rate for Payer: Priority Health Narrow/Tiered Network	$284.26
Rate for Payer: UHC Medicaid	$100.54
Rate for Payer: UHCCP Medicaid	$100.54

PR BIOPSY SOFT TISSUE UPPER ARM/ELBOW AREA DEEP

Professional

Both

$1,105.00

Service Code	HCPCS 24066
Min. Negotiated Rate	$265.19
Max. Negotiated Rate	$828.75
Rate for Payer: Aetna Commercial	$557.74
Rate for Payer: Aetna Medicare	$552.50
Rate for Payer: BCBS Complete	$278.45
Rate for Payer: BCN Commercial	$652.36
Rate for Payer: Cash Price	$884.00
Rate for Payer: Cash Price	$884.00
Rate for Payer: Mclaren Medicaid	$265.19
Rate for Payer: Meridian Medicaid	$278.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$828.75
Rate for Payer: Priority Health Choice Medicaid	$265.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$697.35
Rate for Payer: Priority Health Narrow/Tiered Network	$697.35
Rate for Payer: UHC Medicaid	$265.19
Rate for Payer: UHCCP Medicaid	$265.19

PR BIOPSY SOFT TISSUE UPPER ARM/ELBOW SUPERFICIAL

Professional

Both

$481.00

Service Code	HCPCS 24065
Min. Negotiated Rate	$94.79
Max. Negotiated Rate	$360.75
Rate for Payer: Aetna Commercial	$215.45
Rate for Payer: Aetna Medicare	$240.50
Rate for Payer: BCBS Complete	$99.53
Rate for Payer: BCN Commercial	$246.00
Rate for Payer: Cash Price	$384.80
Rate for Payer: Cash Price	$384.80
Rate for Payer: Mclaren Medicaid	$94.79
Rate for Payer: Meridian Medicaid	$99.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$360.75
Rate for Payer: Priority Health Choice Medicaid	$94.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$262.97
Rate for Payer: Priority Health Narrow/Tiered Network	$262.97
Rate for Payer: UHC Medicaid	$94.79
Rate for Payer: UHCCP Medicaid	$94.79

PR BIOPSY SPINAL CORD PERCUTANEOUS NEEDLE

Professional

Both

$2,621.00

Service Code	HCPCS 62269
Min. Negotiated Rate	$141.65
Max. Negotiated Rate	$1,965.75
Rate for Payer: Aetna Commercial	$336.41
Rate for Payer: Aetna Medicare	$1,310.50
Rate for Payer: BCBS Complete	$148.73
Rate for Payer: BCN Commercial	$385.94
Rate for Payer: Cash Price	$2,096.80
Rate for Payer: Cash Price	$2,096.80
Rate for Payer: Mclaren Medicaid	$141.65
Rate for Payer: Meridian Medicaid	$148.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,965.75
Rate for Payer: Priority Health Choice Medicaid	$141.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$448.26
Rate for Payer: Priority Health Narrow/Tiered Network	$448.26
Rate for Payer: UHC Medicaid	$141.65
Rate for Payer: UHCCP Medicaid	$141.65

PR BIOPSY TESTIS INCISIONAL SEPARATE PROCEDURE

Professional

Both

$701.00

Service Code	HCPCS 54505
Min. Negotiated Rate	$123.11
Max. Negotiated Rate	$525.75
Rate for Payer: Aetna Commercial	$269.15
Rate for Payer: Aetna Medicare	$350.50
Rate for Payer: BCBS Complete	$129.27
Rate for Payer: BCN Commercial	$315.72
Rate for Payer: Cash Price	$560.80
Rate for Payer: Cash Price	$560.80
Rate for Payer: Mclaren Medicaid	$123.11
Rate for Payer: Meridian Medicaid	$129.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$525.75
Rate for Payer: Priority Health Choice Medicaid	$123.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$343.93
Rate for Payer: Priority Health Narrow/Tiered Network	$343.93
Rate for Payer: UHC Medicaid	$123.11
Rate for Payer: UHCCP Medicaid	$123.11

Know your out-of-pocket cost for care.

All Charges