Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR CABG W/ARTERIAL GRAFT SINGLE ARTERIAL GRAFT

Professional

Both

$4,028.00

Service Code	HCPCS 33533
Min. Negotiated Rate	$1,121.02
Max. Negotiated Rate	$3,021.00
Rate for Payer: Aetna Commercial	$2,513.12
Rate for Payer: Aetna Medicare	$2,014.00
Rate for Payer: BCBS Complete	$1,177.07
Rate for Payer: BCN Commercial	$2,754.33
Rate for Payer: Cash Price	$3,222.40
Rate for Payer: Cash Price	$3,222.40
Rate for Payer: Mclaren Medicaid	$1,121.02
Rate for Payer: Meridian Medicaid	$1,177.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,021.00
Rate for Payer: Priority Health Choice Medicaid	$1,121.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,961.93
Rate for Payer: Priority Health Narrow/Tiered Network	$2,961.93
Rate for Payer: UHC Medicaid	$1,121.02
Rate for Payer: UHCCP Medicaid	$1,121.02

PR CABG W/ARTERIAL GRAFT THREE ARTERIAL GRAFTS

Professional

Both

$5,290.00

Service Code	HCPCS 33535
Min. Negotiated Rate	$1,457.56
Max. Negotiated Rate	$3,967.50
Rate for Payer: Aetna Commercial	$3,289.41
Rate for Payer: Aetna Medicare	$2,645.00
Rate for Payer: BCBS Complete	$1,530.44
Rate for Payer: BCN Commercial	$3,593.92
Rate for Payer: Cash Price	$4,232.00
Rate for Payer: Cash Price	$4,232.00
Rate for Payer: Mclaren Medicaid	$1,457.56
Rate for Payer: Meridian Medicaid	$1,530.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,967.50
Rate for Payer: Priority Health Choice Medicaid	$1,457.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,864.82
Rate for Payer: Priority Health Narrow/Tiered Network	$3,864.82
Rate for Payer: UHC Medicaid	$1,457.56
Rate for Payer: UHCCP Medicaid	$1,457.56

PR CABG W/ARTERIAL GRAFT TWO ARTERIAL GRAFTS

Professional

Both

$4,740.00

Service Code	HCPCS 33534
Min. Negotiated Rate	$1,314.42
Max. Negotiated Rate	$3,555.00
Rate for Payer: Aetna Commercial	$2,950.85
Rate for Payer: Aetna Medicare	$2,370.00
Rate for Payer: BCBS Complete	$1,380.14
Rate for Payer: BCN Commercial	$3,235.38
Rate for Payer: Cash Price	$3,792.00
Rate for Payer: Cash Price	$3,792.00
Rate for Payer: Mclaren Medicaid	$1,314.42
Rate for Payer: Meridian Medicaid	$1,380.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,555.00
Rate for Payer: Priority Health Choice Medicaid	$1,314.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,479.24
Rate for Payer: Priority Health Narrow/Tiered Network	$3,479.24
Rate for Payer: UHC Medicaid	$1,314.42
Rate for Payer: UHCCP Medicaid	$1,314.42

PR CALIBRATED MICROCAP TUBE

Professional

Both

$79.00

Service Code	HCPCS A4651
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$59.25
Rate for Payer: Aetna Commercial	$0.03
Rate for Payer: Aetna Medicare	$39.50
Rate for Payer: BCBS Complete	$31.60
Rate for Payer: BCN Commercial	$1.86
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cash Price	$63.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$59.25

PR CALORIC VESTIBULAR TEST, EACH IRRIGATION, WITH RECORDING

Professional

Both

$20.00

Service Code	HCPCS 92543
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Medicare	$10.00
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.00

PR CANALITH REPOSITIONING PROCEDURE

Professional

Both

$135.00

Service Code	HCPCS 95992
Min. Negotiated Rate	$40.81
Max. Negotiated Rate	$101.25
Rate for Payer: Aetna Commercial	$40.81
Rate for Payer: Aetna Medicare	$67.50
Rate for Payer: BCBS Complete	$54.00
Rate for Payer: BCN Commercial	$52.79
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$101.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$48.68
Rate for Payer: Priority Health Narrow/Tiered Network	$48.68

PR CANTHOPLASTY

Professional

Both

$1,180.00

Service Code	HCPCS 67950
Min. Negotiated Rate	$253.47
Max. Negotiated Rate	$885.00
Rate for Payer: Aetna Commercial	$599.67
Rate for Payer: Aetna Medicare	$590.00
Rate for Payer: BCBS Complete	$266.14
Rate for Payer: BCN Commercial	$685.22
Rate for Payer: Cash Price	$944.00
Rate for Payer: Cash Price	$944.00
Rate for Payer: Mclaren Medicaid	$253.47
Rate for Payer: Meridian Medicaid	$266.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$885.00
Rate for Payer: Priority Health Choice Medicaid	$253.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$802.63
Rate for Payer: Priority Health Narrow/Tiered Network	$802.63
Rate for Payer: UHC Medicaid	$253.47
Rate for Payer: UHCCP Medicaid	$253.47

PR CANTHOTOMY SEPARATE PROCEDURE

Professional

Both

$385.00

Service Code	HCPCS 67715
Min. Negotiated Rate	$65.18
Max. Negotiated Rate	$288.75
Rate for Payer: Aetna Commercial	$139.69
Rate for Payer: Aetna Medicare	$192.50
Rate for Payer: BCBS Complete	$68.44
Rate for Payer: BCN Commercial	$161.34
Rate for Payer: Cash Price	$308.00
Rate for Payer: Cash Price	$308.00
Rate for Payer: Mclaren Medicaid	$65.18
Rate for Payer: Meridian Medicaid	$68.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$288.75
Rate for Payer: Priority Health Choice Medicaid	$65.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$188.99
Rate for Payer: Priority Health Narrow/Tiered Network	$188.99
Rate for Payer: UHC Medicaid	$65.18
Rate for Payer: UHCCP Medicaid	$65.18

PR CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS

Professional

Both

$1,808.00

Service Code	HCPCS 25320
Min. Negotiated Rate	$591.50
Max. Negotiated Rate	$1,621.46
Rate for Payer: Aetna Commercial	$1,305.27
Rate for Payer: Aetna Medicare	$904.00
Rate for Payer: BCBS Complete	$621.08
Rate for Payer: BCN Commercial	$1,516.85
Rate for Payer: Cash Price	$1,446.40
Rate for Payer: Cash Price	$1,446.40
Rate for Payer: Mclaren Medicaid	$591.50
Rate for Payer: Meridian Medicaid	$621.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,356.00
Rate for Payer: Priority Health Choice Medicaid	$591.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,621.46
Rate for Payer: Priority Health Narrow/Tiered Network	$1,621.46
Rate for Payer: UHC Medicaid	$591.50
Rate for Payer: UHCCP Medicaid	$591.50

PR CAPSULAR CONTRACTURE RELEASE

Professional

Both

$2,070.00

Service Code	HCPCS 23020
Min. Negotiated Rate	$414.92
Max. Negotiated Rate	$1,552.50
Rate for Payer: Aetna Commercial	$919.64
Rate for Payer: Aetna Medicare	$1,035.00
Rate for Payer: BCBS Complete	$435.67
Rate for Payer: BCN Commercial	$1,056.72
Rate for Payer: Cash Price	$1,656.00
Rate for Payer: Cash Price	$1,656.00
Rate for Payer: Mclaren Medicaid	$414.92
Rate for Payer: Meridian Medicaid	$435.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,552.50
Rate for Payer: Priority Health Choice Medicaid	$414.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,129.59
Rate for Payer: Priority Health Narrow/Tiered Network	$1,129.59
Rate for Payer: UHC Medicaid	$414.92
Rate for Payer: UHCCP Medicaid	$414.92

PR CAPSULECTOMY/CAPSULOTOMY HIP W/RLS HIP FLXR MUSC

Professional

Both

$4,943.00

Service Code	HCPCS 27036
Min. Negotiated Rate	$601.30
Max. Negotiated Rate	$3,707.25
Rate for Payer: Aetna Commercial	$1,355.49
Rate for Payer: Aetna Medicare	$2,471.50
Rate for Payer: BCBS Complete	$631.37
Rate for Payer: BCN Commercial	$1,547.23
Rate for Payer: Cash Price	$3,954.40
Rate for Payer: Cash Price	$3,954.40
Rate for Payer: Mclaren Medicaid	$601.30
Rate for Payer: Meridian Medicaid	$631.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,707.25
Rate for Payer: Priority Health Choice Medicaid	$601.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,653.95
Rate for Payer: Priority Health Narrow/Tiered Network	$1,653.95
Rate for Payer: UHC Medicaid	$601.30
Rate for Payer: UHCCP Medicaid	$601.30

PR CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH

Professional

Both

$1,634.00

Service Code	HCPCS 26525
Min. Negotiated Rate	$431.75
Max. Negotiated Rate	$1,225.50
Rate for Payer: Aetna Commercial	$907.21
Rate for Payer: Aetna Medicare	$817.00
Rate for Payer: BCBS Complete	$453.34
Rate for Payer: BCN Commercial	$1,030.32
Rate for Payer: Cash Price	$1,307.20
Rate for Payer: Cash Price	$1,307.20
Rate for Payer: Mclaren Medicaid	$431.75
Rate for Payer: Meridian Medicaid	$453.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,225.50
Rate for Payer: Priority Health Choice Medicaid	$431.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,101.39
Rate for Payer: Priority Health Narrow/Tiered Network	$1,101.39
Rate for Payer: UHC Medicaid	$431.75
Rate for Payer: UHCCP Medicaid	$431.75

PR CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH

Professional

Both

$1,634.00

Service Code	HCPCS 26520
Min. Negotiated Rate	$427.70
Max. Negotiated Rate	$1,225.50
Rate for Payer: Aetna Commercial	$904.90
Rate for Payer: Aetna Medicare	$817.00
Rate for Payer: BCBS Complete	$449.08
Rate for Payer: BCN Commercial	$1,022.85
Rate for Payer: Cash Price	$1,307.20
Rate for Payer: Cash Price	$1,307.20
Rate for Payer: Mclaren Medicaid	$427.70
Rate for Payer: Meridian Medicaid	$449.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,225.50
Rate for Payer: Priority Health Choice Medicaid	$427.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,093.41
Rate for Payer: Priority Health Narrow/Tiered Network	$1,093.41
Rate for Payer: UHC Medicaid	$427.70
Rate for Payer: UHCCP Medicaid	$427.70

PR CAPSUL MTTARPHLNGL JT W/WO TENORRHAPHY EA JT SPX

Professional

Both

$826.00

Service Code	HCPCS 28270
Min. Negotiated Rate	$202.78
Max. Negotiated Rate	$619.50
Rate for Payer: Aetna Commercial	$440.61
Rate for Payer: Aetna Medicare	$413.00
Rate for Payer: BCBS Complete	$212.92
Rate for Payer: BCN Commercial	$509.93
Rate for Payer: Cash Price	$660.80
Rate for Payer: Cash Price	$660.80
Rate for Payer: Mclaren Medicaid	$202.78
Rate for Payer: Meridian Medicaid	$212.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$619.50
Rate for Payer: Priority Health Choice Medicaid	$202.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$545.11
Rate for Payer: Priority Health Narrow/Tiered Network	$545.11
Rate for Payer: UHC Medicaid	$202.78
Rate for Payer: UHCCP Medicaid	$202.78

PR CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT

Professional

Both

$2,063.00

Service Code	HCPCS 26516
Min. Negotiated Rate	$457.52
Max. Negotiated Rate	$1,547.25
Rate for Payer: Aetna Commercial	$983.79
Rate for Payer: Aetna Medicare	$1,031.50
Rate for Payer: BCBS Complete	$480.40
Rate for Payer: BCN Commercial	$1,124.44
Rate for Payer: Cash Price	$1,650.40
Rate for Payer: Cash Price	$1,650.40
Rate for Payer: Mclaren Medicaid	$457.52
Rate for Payer: Meridian Medicaid	$480.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,547.25
Rate for Payer: Priority Health Choice Medicaid	$457.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,201.99
Rate for Payer: Priority Health Narrow/Tiered Network	$1,201.99
Rate for Payer: UHC Medicaid	$457.52
Rate for Payer: UHCCP Medicaid	$457.52

PR CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON

Professional

Both

$2,953.00

Service Code	HCPCS 23450
Min. Negotiated Rate	$555.93
Max. Negotiated Rate	$2,214.75
Rate for Payer: Aetna Commercial	$1,266.50
Rate for Payer: Aetna Medicare	$1,476.50
Rate for Payer: BCBS Complete	$583.73
Rate for Payer: BCN Commercial	$1,436.18
Rate for Payer: Cash Price	$2,362.40
Rate for Payer: Cash Price	$2,362.40
Rate for Payer: Mclaren Medicaid	$555.93
Rate for Payer: Meridian Medicaid	$583.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,214.75
Rate for Payer: Priority Health Choice Medicaid	$555.93
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,535.23
Rate for Payer: Priority Health Narrow/Tiered Network	$1,535.23
Rate for Payer: UHC Medicaid	$555.93
Rate for Payer: UHCCP Medicaid	$555.93

PR CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR

Professional

Both

$3,516.00

Service Code	HCPCS 23462
Min. Negotiated Rate	$623.24
Max. Negotiated Rate	$2,637.00
Rate for Payer: Aetna Commercial	$1,427.63
Rate for Payer: Aetna Medicare	$1,758.00
Rate for Payer: BCBS Complete	$654.40
Rate for Payer: BCN Commercial	$1,617.44
Rate for Payer: Cash Price	$2,812.80
Rate for Payer: Cash Price	$2,812.80
Rate for Payer: Mclaren Medicaid	$623.24
Rate for Payer: Meridian Medicaid	$654.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,637.00
Rate for Payer: Priority Health Choice Medicaid	$623.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,728.99
Rate for Payer: Priority Health Narrow/Tiered Network	$1,728.99
Rate for Payer: UHC Medicaid	$623.24
Rate for Payer: UHCCP Medicaid	$623.24

PR CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK

Professional

Both

$2,877.00

Service Code	HCPCS 23460
Min. Negotiated Rate	$638.15
Max. Negotiated Rate	$2,157.75
Rate for Payer: Aetna Commercial	$1,456.90
Rate for Payer: Aetna Medicare	$1,438.50
Rate for Payer: BCBS Complete	$670.06
Rate for Payer: BCN Commercial	$1,653.30
Rate for Payer: Cash Price	$2,301.60
Rate for Payer: Cash Price	$2,301.60
Rate for Payer: Mclaren Medicaid	$638.15
Rate for Payer: Meridian Medicaid	$670.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,157.75
Rate for Payer: Priority Health Choice Medicaid	$638.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,767.32
Rate for Payer: Priority Health Narrow/Tiered Network	$1,767.32
Rate for Payer: UHC Medicaid	$638.15
Rate for Payer: UHCCP Medicaid	$638.15

PR CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR

Professional

Both

$3,299.00

Service Code	HCPCS 23455
Min. Negotiated Rate	$561.47
Max. Negotiated Rate	$2,474.25
Rate for Payer: Aetna Commercial	$1,328.69
Rate for Payer: Aetna Medicare	$1,649.50
Rate for Payer: BCBS Complete	$589.54
Rate for Payer: BCN Commercial	$1,473.03
Rate for Payer: Cash Price	$2,639.20
Rate for Payer: Cash Price	$2,639.20
Rate for Payer: Mclaren Medicaid	$561.47
Rate for Payer: Meridian Medicaid	$589.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,474.25
Rate for Payer: Priority Health Choice Medicaid	$561.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,574.63
Rate for Payer: Priority Health Narrow/Tiered Network	$1,574.63
Rate for Payer: UHC Medicaid	$561.47
Rate for Payer: UHCCP Medicaid	$561.47

PR CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK

Professional

Both

$3,605.00

Service Code	HCPCS 23465
Min. Negotiated Rate	$653.48
Max. Negotiated Rate	$2,703.75
Rate for Payer: Aetna Commercial	$1,495.78
Rate for Payer: Aetna Medicare	$1,802.50
Rate for Payer: BCBS Complete	$686.15
Rate for Payer: BCN Commercial	$1,694.63
Rate for Payer: Cash Price	$2,884.00
Rate for Payer: Cash Price	$2,884.00
Rate for Payer: Mclaren Medicaid	$653.48
Rate for Payer: Meridian Medicaid	$686.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,703.75
Rate for Payer: Priority Health Choice Medicaid	$653.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,811.51
Rate for Payer: Priority Health Narrow/Tiered Network	$1,811.51
Rate for Payer: UHC Medicaid	$653.48
Rate for Payer: UHCCP Medicaid	$653.48

PR CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS

Professional

Both

$2,068.00

Service Code	HCPCS 23466
Min. Negotiated Rate	$659.87
Max. Negotiated Rate	$1,815.77
Rate for Payer: Aetna Commercial	$1,490.07
Rate for Payer: Aetna Medicare	$1,034.00
Rate for Payer: BCBS Complete	$692.86
Rate for Payer: BCN Commercial	$1,698.61
Rate for Payer: Cash Price	$1,654.40
Rate for Payer: Cash Price	$1,654.40
Rate for Payer: Mclaren Medicaid	$659.87
Rate for Payer: Meridian Medicaid	$692.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,551.00
Rate for Payer: Priority Health Choice Medicaid	$659.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,815.77
Rate for Payer: Priority Health Narrow/Tiered Network	$1,815.77
Rate for Payer: UHC Medicaid	$659.87
Rate for Payer: UHCCP Medicaid	$659.87

PR CAPSULOTOMY MIDFOOT MEDIAL RELEASE ONLY SPX

Professional

Both

$1,603.00

Service Code	HCPCS 28260
Min. Negotiated Rate	$324.61
Max. Negotiated Rate	$1,202.25
Rate for Payer: Aetna Commercial	$691.20
Rate for Payer: Aetna Medicare	$801.50
Rate for Payer: BCBS Complete	$340.84
Rate for Payer: BCN Commercial	$815.20
Rate for Payer: Cash Price	$1,282.40
Rate for Payer: Cash Price	$1,282.40
Rate for Payer: Mclaren Medicaid	$324.61
Rate for Payer: Meridian Medicaid	$340.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,202.25
Rate for Payer: Priority Health Choice Medicaid	$324.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$871.42
Rate for Payer: Priority Health Narrow/Tiered Network	$871.42
Rate for Payer: UHC Medicaid	$324.61
Rate for Payer: UHCCP Medicaid	$324.61

PR CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE

Professional

Both

$2,796.00

Service Code	HCPCS 27435
Min. Negotiated Rate	$485.00
Max. Negotiated Rate	$2,097.00
Rate for Payer: Aetna Commercial	$1,080.31
Rate for Payer: Aetna Medicare	$1,398.00
Rate for Payer: BCBS Complete	$509.25
Rate for Payer: BCN Commercial	$1,232.51
Rate for Payer: Cash Price	$2,236.80
Rate for Payer: Cash Price	$2,236.80
Rate for Payer: Mclaren Medicaid	$485.00
Rate for Payer: Meridian Medicaid	$509.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,097.00
Rate for Payer: Priority Health Choice Medicaid	$485.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,317.52
Rate for Payer: Priority Health Narrow/Tiered Network	$1,317.52
Rate for Payer: UHC Medicaid	$485.00
Rate for Payer: UHCCP Medicaid	$485.00

PR CAPSULOTOMY WRIST

Professional

Both

$1,689.00

Service Code	HCPCS 25085
Min. Negotiated Rate	$271.79
Max. Negotiated Rate	$1,266.75
Rate for Payer: Aetna Commercial	$597.69
Rate for Payer: Aetna Medicare	$844.50
Rate for Payer: BCBS Complete	$285.38
Rate for Payer: BCN Commercial	$692.69
Rate for Payer: Cash Price	$1,351.20
Rate for Payer: Cash Price	$1,351.20
Rate for Payer: Mclaren Medicaid	$271.79
Rate for Payer: Meridian Medicaid	$285.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,266.75
Rate for Payer: Priority Health Choice Medicaid	$271.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$740.47
Rate for Payer: Priority Health Narrow/Tiered Network	$740.47
Rate for Payer: UHC Medicaid	$271.79
Rate for Payer: UHCCP Medicaid	$271.79

PR CARDIOPULMONARY EXERCISE TESTING

Professional

Both

$291.00

Service Code	HCPCS 94621
Min. Negotiated Rate	$145.50
Max. Negotiated Rate	$232.06
Rate for Payer: Aetna Commercial	$168.62
Rate for Payer: Aetna Medicare	$145.50
Rate for Payer: BCN Commercial	$232.06
Rate for Payer: Cash Price	$232.80
Rate for Payer: Cash Price	$232.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$218.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$214.00
Rate for Payer: Priority Health Narrow/Tiered Network	$214.00

Know your out-of-pocket cost for care.

All Charges