Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR CHOLECSTC EXPL DUX SPHNCTROTOMY/SPHNCTROP

Professional

Both

$2,184.00

Service Code	HCPCS 47620
Min. Negotiated Rate	$818.13
Max. Negotiated Rate	$2,512.59
Rate for Payer: Aetna Commercial	$1,866.04
Rate for Payer: Aetna Medicare	$1,092.00
Rate for Payer: BCBS Complete	$859.04
Rate for Payer: BCN Commercial	$2,062.14
Rate for Payer: Cash Price	$1,747.20
Rate for Payer: Cash Price	$1,747.20
Rate for Payer: Mclaren Medicaid	$818.13
Rate for Payer: Meridian Medicaid	$859.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,638.00
Rate for Payer: Priority Health Choice Medicaid	$818.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,512.59
Rate for Payer: Priority Health Narrow/Tiered Network	$2,512.59
Rate for Payer: UHC Medicaid	$818.13
Rate for Payer: UHCCP Medicaid	$818.13

PR CHOLECSTONTRSTM ROUX-EN-Y W/GASTRONTRSTM

Professional

Both

$2,723.00

Service Code	HCPCS 47741
Min. Negotiated Rate	$883.10
Max. Negotiated Rate	$2,698.85
Rate for Payer: Aetna Commercial	$2,001.81
Rate for Payer: Aetna Medicare	$1,361.50
Rate for Payer: BCBS Complete	$927.25
Rate for Payer: BCN Commercial	$2,215.02
Rate for Payer: Cash Price	$2,178.40
Rate for Payer: Cash Price	$2,178.40
Rate for Payer: Mclaren Medicaid	$883.10
Rate for Payer: Meridian Medicaid	$927.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,042.25
Rate for Payer: Priority Health Choice Medicaid	$883.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,698.85
Rate for Payer: Priority Health Narrow/Tiered Network	$2,698.85
Rate for Payer: UHC Medicaid	$883.10
Rate for Payer: UHCCP Medicaid	$883.10

PR CHOLECSTOT/CHOLECSTOST W/EXPL DRG/RMVL ST1 SPX

Professional

Both

$2,702.00

Service Code	HCPCS 47480
Min. Negotiated Rate	$534.20
Max. Negotiated Rate	$2,026.50
Rate for Payer: Aetna Commercial	$1,185.52
Rate for Payer: Aetna Medicare	$1,351.00
Rate for Payer: BCBS Complete	$560.91
Rate for Payer: BCN Commercial	$1,325.13
Rate for Payer: Cash Price	$2,161.60
Rate for Payer: Cash Price	$2,161.60
Rate for Payer: Mclaren Medicaid	$534.20
Rate for Payer: Meridian Medicaid	$560.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,026.50
Rate for Payer: Priority Health Choice Medicaid	$534.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,614.58
Rate for Payer: Priority Health Narrow/Tiered Network	$1,614.58
Rate for Payer: UHC Medicaid	$534.20
Rate for Payer: UHCCP Medicaid	$534.20

PR CHOLECYSTECTOMY

Professional

Both

$2,696.00

Service Code	HCPCS 47600
Min. Negotiated Rate	$644.33
Max. Negotiated Rate	$2,022.00
Rate for Payer: Aetna Commercial	$1,444.32
Rate for Payer: Aetna Medicare	$1,348.00
Rate for Payer: BCBS Complete	$676.55
Rate for Payer: BCN Commercial	$1,613.45
Rate for Payer: Cash Price	$2,156.80
Rate for Payer: Cash Price	$2,156.80
Rate for Payer: Mclaren Medicaid	$644.33
Rate for Payer: Meridian Medicaid	$676.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,022.00
Rate for Payer: Priority Health Choice Medicaid	$644.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,965.90
Rate for Payer: Priority Health Narrow/Tiered Network	$1,965.90
Rate for Payer: UHC Medicaid	$644.33
Rate for Payer: UHCCP Medicaid	$644.33

PR CHOLECYSTECTOMY EXPL DUCT CHOLEDOCHOENTEROSTOMY

Professional

Both

$4,851.00

Service Code	HCPCS 47612
Min. Negotiated Rate	$759.77
Max. Negotiated Rate	$3,638.25
Rate for Payer: Aetna Commercial	$1,727.64
Rate for Payer: Aetna Medicare	$2,425.50
Rate for Payer: BCBS Complete	$797.76
Rate for Payer: BCN Commercial	$1,910.76
Rate for Payer: Cash Price	$3,880.80
Rate for Payer: Cash Price	$3,880.80
Rate for Payer: Mclaren Medicaid	$759.77
Rate for Payer: Meridian Medicaid	$797.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,638.25
Rate for Payer: Priority Health Choice Medicaid	$759.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,328.14
Rate for Payer: Priority Health Narrow/Tiered Network	$2,328.14
Rate for Payer: UHC Medicaid	$759.77
Rate for Payer: UHCCP Medicaid	$759.77

PR CHOLECYSTECTOMY W/CHOLANGIOGRAPHY

Professional

Both

$3,099.00

Service Code	HCPCS 47605
Min. Negotiated Rate	$676.91
Max. Negotiated Rate	$2,324.25
Rate for Payer: Aetna Commercial	$1,522.79
Rate for Payer: Aetna Medicare	$1,549.50
Rate for Payer: BCBS Complete	$710.76
Rate for Payer: BCN Commercial	$1,696.62
Rate for Payer: Cash Price	$2,479.20
Rate for Payer: Cash Price	$2,479.20
Rate for Payer: Mclaren Medicaid	$676.91
Rate for Payer: Meridian Medicaid	$710.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,324.25
Rate for Payer: Priority Health Choice Medicaid	$676.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,067.23
Rate for Payer: Priority Health Narrow/Tiered Network	$2,067.23
Rate for Payer: UHC Medicaid	$676.91
Rate for Payer: UHCCP Medicaid	$676.91

PR CHOLECYSTECTOMY W/EXPLORATION COMMON DUCT

Professional

Both

$3,409.00

Service Code	HCPCS 47610
Min. Negotiated Rate	$748.48
Max. Negotiated Rate	$2,556.75
Rate for Payer: Aetna Commercial	$1,695.84
Rate for Payer: Aetna Medicare	$1,704.50
Rate for Payer: BCBS Complete	$785.90
Rate for Payer: BCN Commercial	$1,885.35
Rate for Payer: Cash Price	$2,727.20
Rate for Payer: Cash Price	$2,727.20
Rate for Payer: Mclaren Medicaid	$748.48
Rate for Payer: Meridian Medicaid	$785.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,556.75
Rate for Payer: Priority Health Choice Medicaid	$748.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,297.19
Rate for Payer: Priority Health Narrow/Tiered Network	$2,297.19
Rate for Payer: UHC Medicaid	$748.48
Rate for Payer: UHCCP Medicaid	$748.48

PR CHOLECYSTOSTOMY PRQ W/IMAGING & CATHETER PLMT

Professional

Both

$697.00

Service Code	HCPCS 47490
Min. Negotiated Rate	$190.21
Max. Negotiated Rate	$598.87
Rate for Payer: Aetna Commercial	$438.85
Rate for Payer: Aetna Medicare	$348.50
Rate for Payer: BCBS Complete	$199.72
Rate for Payer: BCN Commercial	$491.51
Rate for Payer: Cash Price	$557.60
Rate for Payer: Cash Price	$557.60
Rate for Payer: Mclaren Medicaid	$190.21
Rate for Payer: Meridian Medicaid	$199.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$522.75
Rate for Payer: Priority Health Choice Medicaid	$190.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$598.87
Rate for Payer: Priority Health Narrow/Tiered Network	$598.87
Rate for Payer: UHC Medicaid	$190.21
Rate for Payer: UHCCP Medicaid	$190.21

PR CHOLEDOCHOT/OST W/O SPHNCTROTOMY/SPHNCTROP

Professional

Both

$2,477.00

Service Code	HCPCS 47420
Min. Negotiated Rate	$790.02
Max. Negotiated Rate	$2,440.39
Rate for Payer: Aetna Commercial	$1,804.45
Rate for Payer: Aetna Medicare	$1,238.50
Rate for Payer: BCBS Complete	$829.52
Rate for Payer: BCN Commercial	$2,002.88
Rate for Payer: Cash Price	$1,981.60
Rate for Payer: Cash Price	$1,981.60
Rate for Payer: Mclaren Medicaid	$790.02
Rate for Payer: Meridian Medicaid	$829.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,857.75
Rate for Payer: Priority Health Choice Medicaid	$790.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,440.39
Rate for Payer: Priority Health Narrow/Tiered Network	$2,440.39
Rate for Payer: UHC Medicaid	$790.02
Rate for Payer: UHCCP Medicaid	$790.02

PR CHOLERA IMMUNIZATION,INJECTABLE

Professional

Both

$12.00

Service Code	HCPCS 90725
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$9.00
Rate for Payer: Aetna Medicare	$6.00
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.00

PR CHOLINESTERASE INHIBITOR CHALLENGE TEST

Professional

Both

$166.00

Service Code	HCPCS 95857
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$124.50
Rate for Payer: Aetna Commercial	$32.57
Rate for Payer: Aetna Medicare	$83.00
Rate for Payer: BCBS Complete	$15.88
Rate for Payer: BCN Commercial	$41.83
Rate for Payer: Cash Price	$132.80
Rate for Payer: Cash Price	$132.80
Rate for Payer: Mclaren Medicaid	$15.12
Rate for Payer: Meridian Medicaid	$15.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$124.50
Rate for Payer: Priority Health Choice Medicaid	$15.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$38.58
Rate for Payer: Priority Health Narrow/Tiered Network	$38.58
Rate for Payer: UHC Medicaid	$15.12
Rate for Payer: UHCCP Medicaid	$15.12

PR CHORIONIC VILLUS SAMPLING

Professional

Both

$410.00

Service Code	HCPCS 59015
Min. Negotiated Rate	$74.98
Max. Negotiated Rate	$307.50
Rate for Payer: Aetna Commercial	$144.10
Rate for Payer: Aetna Medicare	$205.00
Rate for Payer: BCBS Complete	$78.73
Rate for Payer: BCN Commercial	$196.20
Rate for Payer: Cash Price	$328.00
Rate for Payer: Cash Price	$328.00
Rate for Payer: Mclaren Medicaid	$74.98
Rate for Payer: Meridian Medicaid	$78.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$307.50
Rate for Payer: Priority Health Choice Medicaid	$74.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$185.22
Rate for Payer: Priority Health Narrow/Tiered Network	$185.22
Rate for Payer: UHC Medicaid	$74.98
Rate for Payer: UHCCP Medicaid	$74.98

PR CHROMOTUBATION OVIDUCT W/MATERIALS

Professional

Both

$210.00

Service Code	HCPCS 58350
Min. Negotiated Rate	$53.46
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Commercial	$108.54
Rate for Payer: Aetna Medicare	$105.00
Rate for Payer: BCBS Complete	$56.13
Rate for Payer: BCN Commercial	$141.92
Rate for Payer: Cash Price	$168.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Mclaren Medicaid	$53.46
Rate for Payer: Meridian Medicaid	$56.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$157.50
Rate for Payer: Priority Health Choice Medicaid	$53.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$143.74
Rate for Payer: Priority Health Narrow/Tiered Network	$143.74
Rate for Payer: UHC Medicaid	$53.46
Rate for Payer: UHCCP Medicaid	$53.46

PR CHRONIC CARE MGMT SVCS STAFF 1ST 20 MIN CAL MO

Professional

Both

$139.00

Service Code	HCPCS 99490
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$104.25
Rate for Payer: Aetna Commercial	$31.23
Rate for Payer: Aetna Medicare	$69.50
Rate for Payer: BCBS Complete	$29.30
Rate for Payer: BCN Commercial	$73.70
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Mclaren Medicaid	$27.90
Rate for Payer: Meridian Medicaid	$29.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.25
Rate for Payer: Priority Health Choice Medicaid	$27.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$66.29
Rate for Payer: Priority Health Narrow/Tiered Network	$66.29
Rate for Payer: UHC Medicaid	$27.90
Rate for Payer: UHCCP Medicaid	$27.90

PR CINEPLASTY UPPER EXTREMITY COMPLETE PROCEDURE

Professional

Both

$3,641.00

Service Code	HCPCS 24940
Min. Negotiated Rate	$602.42
Max. Negotiated Rate	$11,802.16
Rate for Payer: Aetna Commercial	$1,439.82
Rate for Payer: Aetna Medicare	$1,820.50
Rate for Payer: BCBS Complete	$632.54
Rate for Payer: BCN Commercial	$11,802.16
Rate for Payer: Cash Price	$2,912.80
Rate for Payer: Cash Price	$2,912.80
Rate for Payer: Mclaren Medicaid	$602.42
Rate for Payer: Meridian Medicaid	$632.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,730.75
Rate for Payer: Priority Health Choice Medicaid	$602.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,773.72
Rate for Payer: Priority Health Narrow/Tiered Network	$1,773.72
Rate for Payer: UHC Medicaid	$602.42
Rate for Payer: UHCCP Medicaid	$602.42

PR CIRCADIAN RESPIRATORY PATTERN REC 12-24 HR INFT

Professional

Both

$665.00

Service Code	HCPCS 94772
Min. Negotiated Rate	$98.71
Max. Negotiated Rate	$498.75
Rate for Payer: Aetna Commercial	$318.52
Rate for Payer: Aetna Medicare	$332.50
Rate for Payer: BCN Commercial	$98.71
Rate for Payer: Cash Price	$532.00
Rate for Payer: Cash Price	$532.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$498.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$436.28
Rate for Payer: Priority Health Narrow/Tiered Network	$436.28

PR CIRCUMCISION AGE >28 DAYS

Professional

Both

$1,589.00

Service Code	HCPCS 54161
Hospital Charge Code	54161
Min. Negotiated Rate	$115.45
Max. Negotiated Rate	$1,191.75
Rate for Payer: Aetna Commercial	$252.22
Rate for Payer: Aetna Medicare	$794.50
Rate for Payer: BCBS Complete	$121.22
Rate for Payer: BCN Commercial	$297.29
Rate for Payer: Cash Price	$1,271.20
Rate for Payer: Cash Price	$1,271.20
Rate for Payer: Mclaren Medicaid	$115.45
Rate for Payer: Meridian Medicaid	$121.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,191.75
Rate for Payer: Priority Health Choice Medicaid	$115.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$323.85
Rate for Payer: Priority Health Narrow/Tiered Network	$323.85
Rate for Payer: UHC Medicaid	$115.45
Rate for Payer: UHCCP Medicaid	$115.45

PR CIRCUMCISION AGE >28 DAYS

Facility

$1,589.00

Service Code	CPT 54161
Hospital Charge Code	54161
Hospital Revenue Code	960
Min. Negotiated Rate	$280.14
Max. Negotiated Rate	$1,430.10
Rate for Payer: Aetna Commercial	$1,350.65
Rate for Payer: Aetna Medicare	$413.14
Rate for Payer: Allen County Amish Medical Aid Commercial	$496.56
Rate for Payer: Amish Plain Church Group Commercial	$496.56
Rate for Payer: BCBS Complete	$294.12
Rate for Payer: BCBS MAPPO	$397.25
Rate for Payer: BCBS Trust/PPO	$1,306.32
Rate for Payer: BCN Commercial	$1,306.32
Rate for Payer: BCN Medicare Advantage	$397.25
Rate for Payer: Cash Price	$1,271.20
Rate for Payer: Cofinity Commercial	$1,366.54
Rate for Payer: Encore Health Key Benefits Commercial	$1,271.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$397.25
Rate for Payer: Healthscope Commercial	$1,430.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,191.75
Rate for Payer: Mclaren Medicaid	$280.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$417.11
Rate for Payer: Meridian Medicaid	$294.12
Rate for Payer: MI Amish Medical Board Commercial	$456.84
Rate for Payer: Molina Medicare/Medicaid	$436.98
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,350.65
Rate for Payer: Nomi Health Commercial	$1,302.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,191.75
Rate for Payer: PACE Senior Care Partners	$377.39
Rate for Payer: PACE SWMI	$397.25
Rate for Payer: PHP Commercial	$1,350.65
Rate for Payer: PHP Medicare Advantage	$397.25
Rate for Payer: Priority Health Choice Medicaid	$280.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,382.43
Rate for Payer: Priority Health Medicare	$401.22
Rate for Payer: Priority Health Narrow/Tiered Network	$1,105.94
Rate for Payer: Railroad Medicare Medicare	$397.25
Rate for Payer: UHC Core	$1,326.82
Rate for Payer: UHC Exchange	$397.25
Rate for Payer: UHC Medicaid	$280.14
Rate for Payer: UHC Medicare Advantage	$397.25
Rate for Payer: UHCCP Medicaid	$280.14
Rate for Payer: VA VA	$397.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,191.75

PR CIRCUMCISION AGE >28 DAYS

Facility

$1,589.00

Service Code	CPT 54161
Hospital Charge Code	54161
Hospital Revenue Code	960
Min. Negotiated Rate	$1,105.94
Max. Negotiated Rate	$1,430.10
Rate for Payer: Aetna Commercial	$1,350.65
Rate for Payer: BCBS Trust/PPO	$1,312.36
Rate for Payer: BCN Commercial	$1,312.36
Rate for Payer: Cash Price	$1,271.20
Rate for Payer: Cofinity Commercial	$1,366.54
Rate for Payer: Encore Health Key Benefits Commercial	$1,271.20
Rate for Payer: Healthscope Commercial	$1,430.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,191.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,350.65
Rate for Payer: Nomi Health Commercial	$1,302.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,191.75
Rate for Payer: PHP Commercial	$1,350.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,382.43
Rate for Payer: Priority Health Narrow/Tiered Network	$1,105.94
Rate for Payer: UHC Core	$1,326.82
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,191.75

PR CIRCUMCISION AGE >28 DAYS

Professional

Both

$1,589.00

Service Code	HCPCS 54161
Min. Negotiated Rate	$115.45
Max. Negotiated Rate	$1,191.75
Rate for Payer: Aetna Commercial	$252.22
Rate for Payer: Aetna Medicare	$794.50
Rate for Payer: BCBS Complete	$121.22
Rate for Payer: BCN Commercial	$297.29
Rate for Payer: Cash Price	$1,271.20
Rate for Payer: Cash Price	$1,271.20
Rate for Payer: Mclaren Medicaid	$115.45
Rate for Payer: Meridian Medicaid	$121.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,191.75
Rate for Payer: Priority Health Choice Medicaid	$115.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$323.85
Rate for Payer: Priority Health Narrow/Tiered Network	$323.85
Rate for Payer: UHC Medicaid	$115.45
Rate for Payer: UHCCP Medicaid	$115.45

PR CIRCUMCISION NEONATE

Professional

Both

$624.00

Service Code	HCPCS 54160
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$468.00
Rate for Payer: Aetna Commercial	$185.88
Rate for Payer: Aetna Medicare	$312.00
Rate for Payer: BCBS Complete	$88.57
Rate for Payer: BCN Commercial	$217.62
Rate for Payer: Cash Price	$499.20
Rate for Payer: Cash Price	$499.20
Rate for Payer: Mclaren Medicaid	$84.35
Rate for Payer: Meridian Medicaid	$88.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$468.00
Rate for Payer: Priority Health Choice Medicaid	$84.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$237.05
Rate for Payer: Priority Health Narrow/Tiered Network	$237.05
Rate for Payer: UHC Medicaid	$84.35
Rate for Payer: UHCCP Medicaid	$84.35

PR CIRCUMCISION W/CLAMP/OTH DEV W/BLOCK

Professional

Both

$537.00

Service Code	HCPCS 54150
Min. Negotiated Rate	$53.68
Max. Negotiated Rate	$402.75
Rate for Payer: Aetna Commercial	$125.80
Rate for Payer: Aetna Medicare	$268.50
Rate for Payer: BCBS Complete	$56.36
Rate for Payer: BCN Commercial	$142.92
Rate for Payer: Cash Price	$429.60
Rate for Payer: Cash Price	$429.60
Rate for Payer: Mclaren Medicaid	$53.68
Rate for Payer: Meridian Medicaid	$56.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$402.75
Rate for Payer: Priority Health Choice Medicaid	$53.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$155.68
Rate for Payer: Priority Health Narrow/Tiered Network	$155.68
Rate for Payer: UHC Medicaid	$53.68
Rate for Payer: UHCCP Medicaid	$53.68

PR CISTERNAL/LATERAL C1-C2 PUNCTURE W/O INJ SPX

Professional

Both

$493.00

Service Code	HCPCS 61050
Min. Negotiated Rate	$44.09
Max. Negotiated Rate	$369.75
Rate for Payer: Aetna Commercial	$105.74
Rate for Payer: Aetna Medicare	$246.50
Rate for Payer: BCBS Complete	$46.29
Rate for Payer: BCN Commercial	$120.02
Rate for Payer: Cash Price	$394.40
Rate for Payer: Cash Price	$394.40
Rate for Payer: Mclaren Medicaid	$44.09
Rate for Payer: Meridian Medicaid	$46.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$369.75
Rate for Payer: Priority Health Choice Medicaid	$44.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$139.40
Rate for Payer: Priority Health Narrow/Tiered Network	$139.40
Rate for Payer: UHC Medicaid	$44.09
Rate for Payer: UHCCP Medicaid	$44.09

PR CLAVICULECTOMY PARTIAL

Professional

Both

$1,125.00

Service Code	HCPCS 23120
Min. Negotiated Rate	$360.18
Max. Negotiated Rate	$991.29
Rate for Payer: Aetna Commercial	$781.06
Rate for Payer: Aetna Medicare	$562.50
Rate for Payer: BCBS Complete	$378.19
Rate for Payer: BCN Commercial	$991.29
Rate for Payer: Cash Price	$900.00
Rate for Payer: Cash Price	$900.00
Rate for Payer: Mclaren Medicaid	$360.18
Rate for Payer: Meridian Medicaid	$378.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$843.75
Rate for Payer: Priority Health Choice Medicaid	$360.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$964.58
Rate for Payer: Priority Health Narrow/Tiered Network	$964.58
Rate for Payer: UHC Medicaid	$360.18
Rate for Payer: UHCCP Medicaid	$360.18

PR CLAVICULECTOMY TOTAL

Professional

Both

$1,647.00

Service Code	HCPCS 23125
Min. Negotiated Rate	$426.64
Max. Negotiated Rate	$1,235.25
Rate for Payer: Aetna Commercial	$947.74
Rate for Payer: Aetna Medicare	$823.50
Rate for Payer: BCBS Complete	$447.97
Rate for Payer: BCN Commercial	$1,086.10
Rate for Payer: Cash Price	$1,317.60
Rate for Payer: Cash Price	$1,317.60
Rate for Payer: Mclaren Medicaid	$426.64
Rate for Payer: Meridian Medicaid	$447.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,235.25
Rate for Payer: Priority Health Choice Medicaid	$426.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,161.01
Rate for Payer: Priority Health Narrow/Tiered Network	$1,161.01
Rate for Payer: UHC Medicaid	$426.64
Rate for Payer: UHCCP Medicaid	$426.64

Know your out-of-pocket cost for care.

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