Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR CLTX PROX HUMRL FX W/MNPJ W/WO SKELETAL TRACJ

Professional

Both

$1,467.00

Service Code	HCPCS 23605
Min. Negotiated Rate	$281.16
Max. Negotiated Rate	$1,100.25
Rate for Payer: Aetna Commercial	$569.91
Rate for Payer: Aetna Medicare	$733.50
Rate for Payer: BCBS Complete	$295.22
Rate for Payer: BCN Commercial	$664.80
Rate for Payer: Cash Price	$1,173.60
Rate for Payer: Cash Price	$1,173.60
Rate for Payer: Mclaren Medicaid	$281.16
Rate for Payer: Meridian Medicaid	$295.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,100.25
Rate for Payer: Priority Health Choice Medicaid	$281.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$710.66
Rate for Payer: Priority Health Narrow/Tiered Network	$710.66
Rate for Payer: UHC Medicaid	$281.16
Rate for Payer: UHCCP Medicaid	$281.16

PR CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION

Professional

Both

$809.00

Service Code	HCPCS 23600
Min. Negotiated Rate	$211.72
Max. Negotiated Rate	$606.75
Rate for Payer: Aetna Commercial	$415.71
Rate for Payer: Aetna Medicare	$404.50
Rate for Payer: BCBS Complete	$222.31
Rate for Payer: BCN Commercial	$394.27
Rate for Payer: Cash Price	$647.20
Rate for Payer: Cash Price	$647.20
Rate for Payer: Mclaren Medicaid	$211.72
Rate for Payer: Meridian Medicaid	$222.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$606.75
Rate for Payer: Priority Health Choice Medicaid	$211.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$534.46
Rate for Payer: Priority Health Narrow/Tiered Network	$534.46
Rate for Payer: UHC Medicaid	$211.72
Rate for Payer: UHCCP Medicaid	$211.72

PR CLTX PROX TIBFIB JT DISLC REQ ANES

Professional

Both

$783.00

Service Code	HCPCS 27831
Min. Negotiated Rate	$256.88
Max. Negotiated Rate	$681.39
Rate for Payer: Aetna Commercial	$541.69
Rate for Payer: Aetna Medicare	$391.50
Rate for Payer: BCBS Complete	$269.72
Rate for Payer: BCN Commercial	$637.42
Rate for Payer: Cash Price	$626.40
Rate for Payer: Cash Price	$626.40
Rate for Payer: Mclaren Medicaid	$256.88
Rate for Payer: Meridian Medicaid	$269.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$587.25
Rate for Payer: Priority Health Choice Medicaid	$256.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$681.39
Rate for Payer: Priority Health Narrow/Tiered Network	$681.39
Rate for Payer: UHC Medicaid	$256.88
Rate for Payer: UHCCP Medicaid	$256.88

PR CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MNPJ

Professional

Both

$740.00

Service Code	HCPCS 25660
Min. Negotiated Rate	$284.36
Max. Negotiated Rate	$749.52
Rate for Payer: Aetna Commercial	$593.54
Rate for Payer: Aetna Medicare	$370.00
Rate for Payer: BCBS Complete	$298.58
Rate for Payer: BCN Commercial	$701.16
Rate for Payer: Cash Price	$592.00
Rate for Payer: Cash Price	$592.00
Rate for Payer: Mclaren Medicaid	$284.36
Rate for Payer: Meridian Medicaid	$298.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$555.00
Rate for Payer: Priority Health Choice Medicaid	$284.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$749.52
Rate for Payer: Priority Health Narrow/Tiered Network	$749.52
Rate for Payer: UHC Medicaid	$284.36
Rate for Payer: UHCCP Medicaid	$284.36

PR CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MNPJ

Professional

Both

$251.00

Service Code	HCPCS 24640
Min. Negotiated Rate	$45.58
Max. Negotiated Rate	$188.25
Rate for Payer: Aetna Commercial	$105.52
Rate for Payer: Aetna Medicare	$125.50
Rate for Payer: BCBS Complete	$47.86
Rate for Payer: BCN Commercial	$119.02
Rate for Payer: Cash Price	$200.80
Rate for Payer: Cash Price	$200.80
Rate for Payer: Mclaren Medicaid	$45.58
Rate for Payer: Meridian Medicaid	$47.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$188.25
Rate for Payer: Priority Health Choice Medicaid	$45.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$127.23
Rate for Payer: Priority Health Narrow/Tiered Network	$127.23
Rate for Payer: UHC Medicaid	$45.58
Rate for Payer: UHCCP Medicaid	$45.58

PR CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT

Professional

Both

$1,548.00

Service Code	HCPCS 25520
Min. Negotiated Rate	$339.31
Max. Negotiated Rate	$1,161.00
Rate for Payer: Aetna Commercial	$724.04
Rate for Payer: Aetna Medicare	$774.00
Rate for Payer: BCBS Complete	$356.28
Rate for Payer: BCN Commercial	$847.57
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Cash Price	$1,238.40
Rate for Payer: Mclaren Medicaid	$339.31
Rate for Payer: Meridian Medicaid	$356.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,161.00
Rate for Payer: Priority Health Choice Medicaid	$339.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$906.03
Rate for Payer: Priority Health Narrow/Tiered Network	$906.03
Rate for Payer: UHC Medicaid	$339.31
Rate for Payer: UHCCP Medicaid	$339.31

PR CLTX SCAPULAR FX W/MNPJ W/WO SKELETAL TRACTION

Professional

Both

$1,062.00

Service Code	HCPCS 23575
Min. Negotiated Rate	$241.76
Max. Negotiated Rate	$796.50
Rate for Payer: Aetna Commercial	$502.77
Rate for Payer: Aetna Medicare	$531.00
Rate for Payer: BCBS Complete	$253.85
Rate for Payer: BCN Commercial	$595.09
Rate for Payer: Cash Price	$849.60
Rate for Payer: Cash Price	$849.60
Rate for Payer: Mclaren Medicaid	$241.76
Rate for Payer: Meridian Medicaid	$253.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$796.50
Rate for Payer: Priority Health Choice Medicaid	$241.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$636.13
Rate for Payer: Priority Health Narrow/Tiered Network	$636.13
Rate for Payer: UHC Medicaid	$241.76
Rate for Payer: UHCCP Medicaid	$241.76

PR CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MNPJ

Professional

Both

$1,414.00

Service Code	HCPCS 23665
Min. Negotiated Rate	$265.61
Max. Negotiated Rate	$1,060.50
Rate for Payer: Aetna Commercial	$529.72
Rate for Payer: Aetna Medicare	$707.00
Rate for Payer: BCBS Complete	$278.89
Rate for Payer: BCN Commercial	$625.47
Rate for Payer: Cash Price	$1,131.20
Rate for Payer: Cash Price	$1,131.20
Rate for Payer: Mclaren Medicaid	$265.61
Rate for Payer: Meridian Medicaid	$278.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,060.50
Rate for Payer: Priority Health Choice Medicaid	$265.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$668.60
Rate for Payer: Priority Health Narrow/Tiered Network	$668.60
Rate for Payer: UHC Medicaid	$265.61
Rate for Payer: UHCCP Medicaid	$265.61

PR CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MNPJ

Professional

Both

$1,689.00

Service Code	HCPCS 24535
Min. Negotiated Rate	$360.18
Max. Negotiated Rate	$1,266.75
Rate for Payer: Aetna Commercial	$761.70
Rate for Payer: Aetna Medicare	$844.50
Rate for Payer: BCBS Complete	$378.19
Rate for Payer: BCN Commercial	$887.90
Rate for Payer: Cash Price	$1,351.20
Rate for Payer: Cash Price	$1,351.20
Rate for Payer: Mclaren Medicaid	$360.18
Rate for Payer: Meridian Medicaid	$378.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,266.75
Rate for Payer: Priority Health Choice Medicaid	$360.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$949.14
Rate for Payer: Priority Health Narrow/Tiered Network	$949.14
Rate for Payer: UHC Medicaid	$360.18
Rate for Payer: UHCCP Medicaid	$360.18

PR CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/O MNPJ

Professional

Both

$869.00

Service Code	HCPCS 24530
Min. Negotiated Rate	$229.19
Max. Negotiated Rate	$651.75
Rate for Payer: Aetna Commercial	$463.61
Rate for Payer: Aetna Medicare	$434.50
Rate for Payer: BCBS Complete	$240.65
Rate for Payer: BCN Commercial	$551.76
Rate for Payer: Cash Price	$695.20
Rate for Payer: Cash Price	$695.20
Rate for Payer: Mclaren Medicaid	$229.19
Rate for Payer: Meridian Medicaid	$240.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$651.75
Rate for Payer: Priority Health Choice Medicaid	$229.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$589.82
Rate for Payer: Priority Health Narrow/Tiered Network	$589.82
Rate for Payer: UHC Medicaid	$229.19
Rate for Payer: UHCCP Medicaid	$229.19

PR CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ

Professional

Both

$2,265.00

Service Code	HCPCS 27503
Min. Negotiated Rate	$478.61
Max. Negotiated Rate	$1,698.75
Rate for Payer: Aetna Commercial	$1,072.39
Rate for Payer: Aetna Medicare	$1,132.50
Rate for Payer: BCBS Complete	$502.54
Rate for Payer: BCN Commercial	$1,220.05
Rate for Payer: Cash Price	$1,812.00
Rate for Payer: Cash Price	$1,812.00
Rate for Payer: Mclaren Medicaid	$478.61
Rate for Payer: Meridian Medicaid	$502.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,698.75
Rate for Payer: Priority Health Choice Medicaid	$478.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,304.20
Rate for Payer: Priority Health Narrow/Tiered Network	$1,304.20
Rate for Payer: UHC Medicaid	$478.61
Rate for Payer: UHCCP Medicaid	$478.61

PR CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ

Professional

Both

$1,623.00

Service Code	HCPCS 27501
Min. Negotiated Rate	$305.87
Max. Negotiated Rate	$1,217.25
Rate for Payer: Aetna Commercial	$663.19
Rate for Payer: Aetna Medicare	$811.50
Rate for Payer: BCBS Complete	$321.16
Rate for Payer: BCN Commercial	$766.39
Rate for Payer: Cash Price	$1,298.40
Rate for Payer: Cash Price	$1,298.40
Rate for Payer: Mclaren Medicaid	$305.87
Rate for Payer: Meridian Medicaid	$321.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,217.25
Rate for Payer: Priority Health Choice Medicaid	$305.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$819.25
Rate for Payer: Priority Health Narrow/Tiered Network	$819.25
Rate for Payer: UHC Medicaid	$305.87
Rate for Payer: UHCCP Medicaid	$305.87

PR CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES

Professional

Both

$731.00

Service Code	HCPCS 28545
Min. Negotiated Rate	$176.79
Max. Negotiated Rate	$548.25
Rate for Payer: Aetna Commercial	$354.16
Rate for Payer: Aetna Medicare	$365.50
Rate for Payer: BCBS Complete	$185.63
Rate for Payer: BCN Commercial	$425.77
Rate for Payer: Cash Price	$584.80
Rate for Payer: Cash Price	$584.80
Rate for Payer: Mclaren Medicaid	$176.79
Rate for Payer: Meridian Medicaid	$185.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$548.25
Rate for Payer: Priority Health Choice Medicaid	$176.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$455.14
Rate for Payer: Priority Health Narrow/Tiered Network	$455.14
Rate for Payer: UHC Medicaid	$176.79
Rate for Payer: UHCCP Medicaid	$176.79

PR CLTX TIBIAL FX PROXIMAL W/O MANIPULATION

Professional

Both

$868.00

Service Code	HCPCS 27530
Min. Negotiated Rate	$191.91
Max. Negotiated Rate	$651.00
Rate for Payer: Aetna Commercial	$379.22
Rate for Payer: Aetna Medicare	$434.00
Rate for Payer: BCBS Complete	$201.51
Rate for Payer: BCN Commercial	$456.15
Rate for Payer: Cash Price	$694.40
Rate for Payer: Cash Price	$694.40
Rate for Payer: Mclaren Medicaid	$191.91
Rate for Payer: Meridian Medicaid	$201.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$651.00
Rate for Payer: Priority Health Choice Medicaid	$191.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$487.61
Rate for Payer: Priority Health Narrow/Tiered Network	$487.61
Rate for Payer: UHC Medicaid	$191.91
Rate for Payer: UHCCP Medicaid	$191.91

PR CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ

Professional

Both

$1,170.00

Service Code	HCPCS 27532
Min. Negotiated Rate	$354.43
Max. Negotiated Rate	$955.53
Rate for Payer: Aetna Commercial	$769.38
Rate for Payer: Aetna Medicare	$585.00
Rate for Payer: BCBS Complete	$372.15
Rate for Payer: BCN Commercial	$893.88
Rate for Payer: Cash Price	$936.00
Rate for Payer: Cash Price	$936.00
Rate for Payer: Mclaren Medicaid	$354.43
Rate for Payer: Meridian Medicaid	$372.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$877.50
Rate for Payer: Priority Health Choice Medicaid	$354.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$955.53
Rate for Payer: Priority Health Narrow/Tiered Network	$955.53
Rate for Payer: UHC Medicaid	$354.43
Rate for Payer: UHCCP Medicaid	$354.43

PR CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ

Professional

Both

$1,847.00

Service Code	HCPCS 27752
Min. Negotiated Rate	$319.29
Max. Negotiated Rate	$1,385.25
Rate for Payer: Aetna Commercial	$655.97
Rate for Payer: Aetna Medicare	$923.50
Rate for Payer: BCBS Complete	$335.25
Rate for Payer: BCN Commercial	$756.93
Rate for Payer: Cash Price	$1,477.60
Rate for Payer: Cash Price	$1,477.60
Rate for Payer: Mclaren Medicaid	$319.29
Rate for Payer: Meridian Medicaid	$335.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,385.25
Rate for Payer: Priority Health Choice Medicaid	$319.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$809.14
Rate for Payer: Priority Health Narrow/Tiered Network	$809.14
Rate for Payer: UHC Medicaid	$319.29
Rate for Payer: UHCCP Medicaid	$319.29

PR CLTX TIBIAL SHAFT FX W/O MANIPULATION

Professional

Both

$949.00

Service Code	HCPCS 27750
Min. Negotiated Rate	$212.79
Max. Negotiated Rate	$711.75
Rate for Payer: Aetna Commercial	$426.43
Rate for Payer: Aetna Medicare	$474.50
Rate for Payer: BCBS Complete	$223.43
Rate for Payer: BCN Commercial	$506.95
Rate for Payer: Cash Price	$759.20
Rate for Payer: Cash Price	$759.20
Rate for Payer: Mclaren Medicaid	$212.79
Rate for Payer: Meridian Medicaid	$223.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$711.75
Rate for Payer: Priority Health Choice Medicaid	$212.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$541.91
Rate for Payer: Priority Health Narrow/Tiered Network	$541.91
Rate for Payer: UHC Medicaid	$212.79
Rate for Payer: UHCCP Medicaid	$212.79

PR CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MNPJ

Professional

Both

$921.00

Service Code	HCPCS 25680
Min. Negotiated Rate	$331.00
Max. Negotiated Rate	$880.99
Rate for Payer: Aetna Commercial	$702.57
Rate for Payer: Aetna Medicare	$460.50
Rate for Payer: BCBS Complete	$347.55
Rate for Payer: BCN Commercial	$824.16
Rate for Payer: Cash Price	$736.80
Rate for Payer: Cash Price	$736.80
Rate for Payer: Mclaren Medicaid	$331.00
Rate for Payer: Meridian Medicaid	$347.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$690.75
Rate for Payer: Priority Health Choice Medicaid	$331.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$880.99
Rate for Payer: Priority Health Narrow/Tiered Network	$880.99
Rate for Payer: UHC Medicaid	$331.00
Rate for Payer: UHCCP Medicaid	$331.00

PR CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION

Professional

Both

$1,747.00

Service Code	HCPCS 27818
Min. Negotiated Rate	$303.74
Max. Negotiated Rate	$1,310.25
Rate for Payer: Aetna Commercial	$582.68
Rate for Payer: Aetna Medicare	$873.50
Rate for Payer: BCBS Complete	$318.93
Rate for Payer: BCN Commercial	$684.22
Rate for Payer: Cash Price	$1,397.60
Rate for Payer: Cash Price	$1,397.60
Rate for Payer: Mclaren Medicaid	$303.74
Rate for Payer: Meridian Medicaid	$318.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,310.25
Rate for Payer: Priority Health Choice Medicaid	$303.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$731.42
Rate for Payer: Priority Health Narrow/Tiered Network	$731.42
Rate for Payer: UHC Medicaid	$303.74
Rate for Payer: UHCCP Medicaid	$303.74

PR CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION

Professional

Both

$602.00

Service Code	HCPCS 27816
Min. Negotiated Rate	$200.01
Max. Negotiated Rate	$495.06
Rate for Payer: Aetna Commercial	$388.50
Rate for Payer: Aetna Medicare	$301.00
Rate for Payer: BCBS Complete	$210.01
Rate for Payer: BCN Commercial	$463.12
Rate for Payer: Cash Price	$481.60
Rate for Payer: Cash Price	$481.60
Rate for Payer: Mclaren Medicaid	$200.01
Rate for Payer: Meridian Medicaid	$210.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$451.50
Rate for Payer: Priority Health Choice Medicaid	$200.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$495.06
Rate for Payer: Priority Health Narrow/Tiered Network	$495.06
Rate for Payer: UHC Medicaid	$200.01
Rate for Payer: UHCCP Medicaid	$200.01

PR CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING

Professional

Both

$922.00

Service Code	HCPCS 22310
Min. Negotiated Rate	$185.95
Max. Negotiated Rate	$691.50
Rate for Payer: Aetna Commercial	$391.04
Rate for Payer: Aetna Medicare	$461.00
Rate for Payer: BCBS Complete	$195.25
Rate for Payer: BCN Commercial	$457.15
Rate for Payer: Cash Price	$737.60
Rate for Payer: Cash Price	$737.60
Rate for Payer: Mclaren Medicaid	$185.95
Rate for Payer: Meridian Medicaid	$195.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$691.50
Rate for Payer: Priority Health Choice Medicaid	$185.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$488.68
Rate for Payer: Priority Health Narrow/Tiered Network	$488.68
Rate for Payer: UHC Medicaid	$185.95
Rate for Payer: UHCCP Medicaid	$185.95

PR CLTX VRT FX&/DISLC CSTING/BRACING MANJ/TRCJ

Professional

Both

$1,341.00

Service Code	HCPCS 22315
Min. Negotiated Rate	$482.02
Max. Negotiated Rate	$1,278.65
Rate for Payer: Aetna Commercial	$1,027.22
Rate for Payer: Aetna Medicare	$670.50
Rate for Payer: BCBS Complete	$506.12
Rate for Payer: BCN Commercial	$1,196.15
Rate for Payer: Cash Price	$1,072.80
Rate for Payer: Cash Price	$1,072.80
Rate for Payer: Mclaren Medicaid	$482.02
Rate for Payer: Meridian Medicaid	$506.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,005.75
Rate for Payer: Priority Health Choice Medicaid	$482.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,278.65
Rate for Payer: Priority Health Narrow/Tiered Network	$1,278.65
Rate for Payer: UHC Medicaid	$482.02
Rate for Payer: UHCCP Medicaid	$482.02

PR CMBND ANTERPOST COLPORRAPHY W/CYSTO

Professional

Both

$2,090.00

Service Code	HCPCS 57260
Min. Negotiated Rate	$438.35
Max. Negotiated Rate	$1,567.50
Rate for Payer: Aetna Commercial	$929.36
Rate for Payer: Aetna Medicare	$1,045.00
Rate for Payer: BCBS Complete	$460.27
Rate for Payer: BCN Commercial	$1,167.26
Rate for Payer: Cash Price	$1,672.00
Rate for Payer: Cash Price	$1,672.00
Rate for Payer: Mclaren Medicaid	$438.35
Rate for Payer: Meridian Medicaid	$460.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,567.50
Rate for Payer: Priority Health Choice Medicaid	$438.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,182.19
Rate for Payer: Priority Health Narrow/Tiered Network	$1,182.19
Rate for Payer: UHC Medicaid	$438.35
Rate for Payer: UHCCP Medicaid	$438.35

PR CMBND ANTERPOST COLPORRAPHY W/CYSTO W/NTRCL RPR

Professional

Both

$2,690.00

Service Code	HCPCS 57265
Min. Negotiated Rate	$489.90
Max. Negotiated Rate	$2,017.50
Rate for Payer: Aetna Commercial	$1,042.83
Rate for Payer: Aetna Medicare	$1,345.00
Rate for Payer: BCBS Complete	$514.39
Rate for Payer: BCN Commercial	$1,305.20
Rate for Payer: Cash Price	$2,152.00
Rate for Payer: Cash Price	$2,152.00
Rate for Payer: Mclaren Medicaid	$489.90
Rate for Payer: Meridian Medicaid	$514.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,017.50
Rate for Payer: Priority Health Choice Medicaid	$489.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,321.89
Rate for Payer: Priority Health Narrow/Tiered Network	$1,321.89
Rate for Payer: UHC Medicaid	$489.90
Rate for Payer: UHCCP Medicaid	$489.90

PR CNTRST NJX RAD EVAL CTR VAD FLUOR IMG&REPRT

Professional

Both

$407.00

Service Code	HCPCS 36598
Min. Negotiated Rate	$19.38
Max. Negotiated Rate	$305.25
Rate for Payer: Aetna Commercial	$47.92
Rate for Payer: Aetna Medicare	$203.50
Rate for Payer: BCBS Complete	$20.35
Rate for Payer: BCN Commercial	$51.79
Rate for Payer: Cash Price	$325.60
Rate for Payer: Cash Price	$325.60
Rate for Payer: Mclaren Medicaid	$19.38
Rate for Payer: Meridian Medicaid	$20.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$305.25
Rate for Payer: Priority Health Choice Medicaid	$19.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$55.69
Rate for Payer: Priority Health Narrow/Tiered Network	$55.69
Rate for Payer: UHC Medicaid	$19.38
Rate for Payer: UHCCP Medicaid	$19.38

Know your out-of-pocket cost for care.

All Charges