Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR COLSC FLEXIBLE W/TRANSENDOSCOPIC BALLOON DILAT

Professional

Both

$1,360.00

Service Code	HCPCS 45386
Min. Negotiated Rate	$119.49
Max. Negotiated Rate	$1,020.00
Rate for Payer: Aetna Commercial	$281.59
Rate for Payer: Aetna Medicare	$680.00
Rate for Payer: BCBS Complete	$125.46
Rate for Payer: BCN Commercial	$313.23
Rate for Payer: Cash Price	$1,088.00
Rate for Payer: Cash Price	$1,088.00
Rate for Payer: Mclaren Medicaid	$119.49
Rate for Payer: Meridian Medicaid	$125.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,020.00
Rate for Payer: Priority Health Choice Medicaid	$119.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$381.65
Rate for Payer: Priority Health Narrow/Tiered Network	$381.65
Rate for Payer: UHC Medicaid	$119.49
Rate for Payer: UHCCP Medicaid	$119.49

PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST

Professional

Both

$1,448.00

Service Code	HCPCS 45381
Hospital Charge Code	45381
Min. Negotiated Rate	$113.32
Max. Negotiated Rate	$1,086.00
Rate for Payer: Aetna Commercial	$267.31
Rate for Payer: Aetna Medicare	$724.00
Rate for Payer: BCBS Complete	$118.99
Rate for Payer: BCN Commercial	$296.80
Rate for Payer: Cash Price	$1,158.40
Rate for Payer: Cash Price	$1,158.40
Rate for Payer: Mclaren Medicaid	$113.32
Rate for Payer: Meridian Medicaid	$118.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,086.00
Rate for Payer: Priority Health Choice Medicaid	$113.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$361.64
Rate for Payer: Priority Health Narrow/Tiered Network	$361.64
Rate for Payer: UHC Medicaid	$113.32
Rate for Payer: UHCCP Medicaid	$113.32

PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST

Facility

$1,448.00

Service Code	CPT 45381
Hospital Charge Code	45381
Hospital Revenue Code	960
Min. Negotiated Rate	$1,007.81
Max. Negotiated Rate	$1,303.20
Rate for Payer: Aetna Commercial	$1,230.80
Rate for Payer: BCBS Trust/PPO	$1,195.90
Rate for Payer: BCN Commercial	$1,195.90
Rate for Payer: Cash Price	$1,158.40
Rate for Payer: Cofinity Commercial	$1,245.28
Rate for Payer: Encore Health Key Benefits Commercial	$1,158.40
Rate for Payer: Healthscope Commercial	$1,303.20
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,086.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,230.80
Rate for Payer: Nomi Health Commercial	$1,187.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,086.00
Rate for Payer: PHP Commercial	$1,230.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,259.76
Rate for Payer: Priority Health Narrow/Tiered Network	$1,007.81
Rate for Payer: UHC Core	$1,209.08
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,086.00

PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST

Professional

Both

$1,448.00

Service Code	HCPCS 45381
Min. Negotiated Rate	$113.32
Max. Negotiated Rate	$1,086.00
Rate for Payer: Aetna Commercial	$267.31
Rate for Payer: Aetna Medicare	$724.00
Rate for Payer: BCBS Complete	$118.99
Rate for Payer: BCN Commercial	$296.80
Rate for Payer: Cash Price	$1,158.40
Rate for Payer: Cash Price	$1,158.40
Rate for Payer: Mclaren Medicaid	$113.32
Rate for Payer: Meridian Medicaid	$118.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,086.00
Rate for Payer: Priority Health Choice Medicaid	$113.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$361.64
Rate for Payer: Priority Health Narrow/Tiered Network	$361.64
Rate for Payer: UHC Medicaid	$113.32
Rate for Payer: UHCCP Medicaid	$113.32

PR COLSC FLX WITH DIRECTED SUBMUCOSAL NJX ANY SBST

Facility

$1,448.00

Service Code	CPT 45381
Hospital Charge Code	45381
Hospital Revenue Code	960
Min. Negotiated Rate	$255.28
Max. Negotiated Rate	$1,303.20
Rate for Payer: Aetna Commercial	$1,230.80
Rate for Payer: Aetna Medicare	$376.48
Rate for Payer: Allen County Amish Medical Aid Commercial	$452.50
Rate for Payer: Amish Plain Church Group Commercial	$452.50
Rate for Payer: BCBS Complete	$268.02
Rate for Payer: BCBS MAPPO	$362.00
Rate for Payer: BCBS Trust/PPO	$1,190.40
Rate for Payer: BCN Commercial	$1,190.40
Rate for Payer: BCN Medicare Advantage	$362.00
Rate for Payer: Cash Price	$1,158.40
Rate for Payer: Cofinity Commercial	$1,245.28
Rate for Payer: Encore Health Key Benefits Commercial	$1,158.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$362.00
Rate for Payer: Healthscope Commercial	$1,303.20
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,086.00
Rate for Payer: Mclaren Medicaid	$255.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$380.10
Rate for Payer: Meridian Medicaid	$268.02
Rate for Payer: MI Amish Medical Board Commercial	$416.30
Rate for Payer: Molina Medicare/Medicaid	$398.20
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,230.80
Rate for Payer: Nomi Health Commercial	$1,187.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,086.00
Rate for Payer: PACE Senior Care Partners	$343.90
Rate for Payer: PACE SWMI	$362.00
Rate for Payer: PHP Commercial	$1,230.80
Rate for Payer: PHP Medicare Advantage	$362.00
Rate for Payer: Priority Health Choice Medicaid	$255.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,259.76
Rate for Payer: Priority Health Medicare	$365.62
Rate for Payer: Priority Health Narrow/Tiered Network	$1,007.81
Rate for Payer: Railroad Medicare Medicare	$362.00
Rate for Payer: UHC Core	$1,209.08
Rate for Payer: UHC Exchange	$362.00
Rate for Payer: UHC Medicaid	$255.28
Rate for Payer: UHC Medicare Advantage	$362.00
Rate for Payer: UHCCP Medicaid	$255.28
Rate for Payer: VA VA	$362.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,086.00

PR COLSC FLX W/NDSC US XM RCTM ET AL LMTD&ADJ STRUX

Professional

Both

$560.00

Service Code	HCPCS 45391
Min. Negotiated Rate	$144.20
Max. Negotiated Rate	$461.75
Rate for Payer: Aetna Commercial	$341.98
Rate for Payer: Aetna Medicare	$280.00
Rate for Payer: BCBS Complete	$151.41
Rate for Payer: BCN Commercial	$378.96
Rate for Payer: Cash Price	$448.00
Rate for Payer: Cash Price	$448.00
Rate for Payer: Mclaren Medicaid	$144.20
Rate for Payer: Meridian Medicaid	$151.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$420.00
Rate for Payer: Priority Health Choice Medicaid	$144.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$461.75
Rate for Payer: Priority Health Narrow/Tiered Network	$461.75
Rate for Payer: UHC Medicaid	$144.20
Rate for Payer: UHCCP Medicaid	$144.20

PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS

Professional

Both

$1,491.00

Service Code	HCPCS 45384
Min. Negotiated Rate	$129.72
Max. Negotiated Rate	$1,118.25
Rate for Payer: Aetna Commercial	$303.80
Rate for Payer: Aetna Medicare	$745.50
Rate for Payer: BCBS Complete	$136.21
Rate for Payer: BCN Commercial	$337.13
Rate for Payer: Cash Price	$1,192.80
Rate for Payer: Cash Price	$1,192.80
Rate for Payer: Mclaren Medicaid	$129.72
Rate for Payer: Meridian Medicaid	$136.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,118.25
Rate for Payer: Priority Health Choice Medicaid	$129.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$410.78
Rate for Payer: Priority Health Narrow/Tiered Network	$410.78
Rate for Payer: UHC Medicaid	$129.72
Rate for Payer: UHCCP Medicaid	$129.72

PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS

Professional

Both

$1,491.00

Service Code	HCPCS 45384
Hospital Charge Code	45384
Min. Negotiated Rate	$129.72
Max. Negotiated Rate	$1,118.25
Rate for Payer: Aetna Commercial	$303.80
Rate for Payer: Aetna Medicare	$745.50
Rate for Payer: BCBS Complete	$136.21
Rate for Payer: BCN Commercial	$337.13
Rate for Payer: Cash Price	$1,192.80
Rate for Payer: Cash Price	$1,192.80
Rate for Payer: Mclaren Medicaid	$129.72
Rate for Payer: Meridian Medicaid	$136.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,118.25
Rate for Payer: Priority Health Choice Medicaid	$129.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$410.78
Rate for Payer: Priority Health Narrow/Tiered Network	$410.78
Rate for Payer: UHC Medicaid	$129.72
Rate for Payer: UHCCP Medicaid	$129.72

PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS

Facility

$1,491.00

Service Code	CPT 45384
Hospital Charge Code	45384
Hospital Revenue Code	960
Min. Negotiated Rate	$1,037.74
Max. Negotiated Rate	$1,341.90
Rate for Payer: Aetna Commercial	$1,267.35
Rate for Payer: BCBS Trust/PPO	$1,231.42
Rate for Payer: BCN Commercial	$1,231.42
Rate for Payer: Cash Price	$1,192.80
Rate for Payer: Cofinity Commercial	$1,282.26
Rate for Payer: Encore Health Key Benefits Commercial	$1,192.80
Rate for Payer: Healthscope Commercial	$1,341.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,118.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,267.35
Rate for Payer: Nomi Health Commercial	$1,222.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,118.25
Rate for Payer: PHP Commercial	$1,267.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,297.17
Rate for Payer: Priority Health Narrow/Tiered Network	$1,037.74
Rate for Payer: UHC Core	$1,244.98
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,118.25

PR COLSC FLX W/REMOVAL LESION BY HOT BX FORCEPS

Facility

$1,491.00

Service Code	CPT 45384
Hospital Charge Code	45384
Hospital Revenue Code	960
Min. Negotiated Rate	$262.86
Max. Negotiated Rate	$1,341.90
Rate for Payer: Aetna Commercial	$1,267.35
Rate for Payer: Aetna Medicare	$387.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$465.94
Rate for Payer: Amish Plain Church Group Commercial	$465.94
Rate for Payer: BCBS Complete	$275.98
Rate for Payer: BCBS MAPPO	$372.75
Rate for Payer: BCBS Trust/PPO	$1,225.75
Rate for Payer: BCN Commercial	$1,225.75
Rate for Payer: BCN Medicare Advantage	$372.75
Rate for Payer: Cash Price	$1,192.80
Rate for Payer: Cofinity Commercial	$1,282.26
Rate for Payer: Encore Health Key Benefits Commercial	$1,192.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$372.75
Rate for Payer: Healthscope Commercial	$1,341.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,118.25
Rate for Payer: Mclaren Medicaid	$262.86
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$391.39
Rate for Payer: Meridian Medicaid	$275.98
Rate for Payer: MI Amish Medical Board Commercial	$428.66
Rate for Payer: Molina Medicare/Medicaid	$410.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,267.35
Rate for Payer: Nomi Health Commercial	$1,222.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,118.25
Rate for Payer: PACE Senior Care Partners	$354.11
Rate for Payer: PACE SWMI	$372.75
Rate for Payer: PHP Commercial	$1,267.35
Rate for Payer: PHP Medicare Advantage	$372.75
Rate for Payer: Priority Health Choice Medicaid	$262.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,297.17
Rate for Payer: Priority Health Medicare	$376.48
Rate for Payer: Priority Health Narrow/Tiered Network	$1,037.74
Rate for Payer: Railroad Medicare Medicare	$372.75
Rate for Payer: UHC Core	$1,244.98
Rate for Payer: UHC Exchange	$372.75
Rate for Payer: UHC Medicaid	$262.86
Rate for Payer: UHC Medicare Advantage	$372.75
Rate for Payer: UHCCP Medicaid	$262.86
Rate for Payer: VA VA	$372.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,118.25

PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ

Facility

$1,491.00

Service Code	CPT 45385
Hospital Charge Code	45385
Hospital Revenue Code	960
Min. Negotiated Rate	$1,037.74
Max. Negotiated Rate	$1,341.90
Rate for Payer: Aetna Commercial	$1,267.35
Rate for Payer: BCBS Trust/PPO	$1,231.42
Rate for Payer: BCN Commercial	$1,231.42
Rate for Payer: Cash Price	$1,192.80
Rate for Payer: Cofinity Commercial	$1,282.26
Rate for Payer: Encore Health Key Benefits Commercial	$1,192.80
Rate for Payer: Healthscope Commercial	$1,341.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,118.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,267.35
Rate for Payer: Nomi Health Commercial	$1,222.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,118.25
Rate for Payer: PHP Commercial	$1,267.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,297.17
Rate for Payer: Priority Health Narrow/Tiered Network	$1,037.74
Rate for Payer: UHC Core	$1,244.98
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,118.25

PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ

Facility

$1,491.00

Service Code	CPT 45385
Hospital Charge Code	45385
Hospital Revenue Code	960
Min. Negotiated Rate	$262.86
Max. Negotiated Rate	$1,341.90
Rate for Payer: Aetna Commercial	$1,267.35
Rate for Payer: Aetna Medicare	$387.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$465.94
Rate for Payer: Amish Plain Church Group Commercial	$465.94
Rate for Payer: BCBS Complete	$275.98
Rate for Payer: BCBS MAPPO	$372.75
Rate for Payer: BCBS Trust/PPO	$1,225.75
Rate for Payer: BCN Commercial	$1,225.75
Rate for Payer: BCN Medicare Advantage	$372.75
Rate for Payer: Cash Price	$1,192.80
Rate for Payer: Cofinity Commercial	$1,282.26
Rate for Payer: Encore Health Key Benefits Commercial	$1,192.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$372.75
Rate for Payer: Healthscope Commercial	$1,341.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,118.25
Rate for Payer: Mclaren Medicaid	$262.86
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$391.39
Rate for Payer: Meridian Medicaid	$275.98
Rate for Payer: MI Amish Medical Board Commercial	$428.66
Rate for Payer: Molina Medicare/Medicaid	$410.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,267.35
Rate for Payer: Nomi Health Commercial	$1,222.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,118.25
Rate for Payer: PACE Senior Care Partners	$354.11
Rate for Payer: PACE SWMI	$372.75
Rate for Payer: PHP Commercial	$1,267.35
Rate for Payer: PHP Medicare Advantage	$372.75
Rate for Payer: Priority Health Choice Medicaid	$262.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,297.17
Rate for Payer: Priority Health Medicare	$376.48
Rate for Payer: Priority Health Narrow/Tiered Network	$1,037.74
Rate for Payer: Railroad Medicare Medicare	$372.75
Rate for Payer: UHC Core	$1,244.98
Rate for Payer: UHC Exchange	$372.75
Rate for Payer: UHC Medicaid	$262.86
Rate for Payer: UHC Medicare Advantage	$372.75
Rate for Payer: UHCCP Medicaid	$262.86
Rate for Payer: VA VA	$372.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,118.25

PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ

Professional

Both

$1,491.00

Service Code	HCPCS 45385
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$1,118.25
Rate for Payer: Aetna Commercial	$337.92
Rate for Payer: Aetna Medicare	$745.50
Rate for Payer: BCBS Complete	$149.62
Rate for Payer: BCN Commercial	$373.98
Rate for Payer: Cash Price	$1,192.80
Rate for Payer: Cash Price	$1,192.80
Rate for Payer: Mclaren Medicaid	$142.50
Rate for Payer: Meridian Medicaid	$149.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,118.25
Rate for Payer: Priority Health Choice Medicaid	$142.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$455.67
Rate for Payer: Priority Health Narrow/Tiered Network	$455.67
Rate for Payer: UHC Medicaid	$142.50
Rate for Payer: UHCCP Medicaid	$142.50

PR COLSC FLX W/RMVL OF TUMOR POLYP LESION SNARE TQ

Professional

Both

$1,491.00

Service Code	HCPCS 45385
Hospital Charge Code	45385
Min. Negotiated Rate	$142.50
Max. Negotiated Rate	$1,118.25
Rate for Payer: Aetna Commercial	$337.92
Rate for Payer: Aetna Medicare	$745.50
Rate for Payer: BCBS Complete	$149.62
Rate for Payer: BCN Commercial	$373.98
Rate for Payer: Cash Price	$1,192.80
Rate for Payer: Cash Price	$1,192.80
Rate for Payer: Mclaren Medicaid	$142.50
Rate for Payer: Meridian Medicaid	$149.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,118.25
Rate for Payer: Priority Health Choice Medicaid	$142.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$455.67
Rate for Payer: Priority Health Narrow/Tiered Network	$455.67
Rate for Payer: UHC Medicaid	$142.50
Rate for Payer: UHCCP Medicaid	$142.50

PR COLSC FLX W/US GUID NDL ASPIR/BX W/US RCTM ET AL

Professional

Both

$1,025.00

Service Code	HCPCS 45392
Min. Negotiated Rate	$169.55
Max. Negotiated Rate	$768.75
Rate for Payer: Aetna Commercial	$405.72
Rate for Payer: Aetna Medicare	$512.50
Rate for Payer: BCBS Complete	$178.03
Rate for Payer: BCN Commercial	$446.69
Rate for Payer: Cash Price	$820.00
Rate for Payer: Cash Price	$820.00
Rate for Payer: Mclaren Medicaid	$169.55
Rate for Payer: Meridian Medicaid	$178.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$768.75
Rate for Payer: Priority Health Choice Medicaid	$169.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$544.26
Rate for Payer: Priority Health Narrow/Tiered Network	$544.26
Rate for Payer: UHC Medicaid	$169.55
Rate for Payer: UHCCP Medicaid	$169.55

PR COMM SVCS BY RHC/FQHC 5 MIN

Professional

Both

$50.00

Service Code	HCPCS G0071
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$23.13
Rate for Payer: Aetna Medicare	$25.00
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: BCN Commercial	$21.41
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$37.50

PR COMPLETE REPLACEMENT PICC RS&I

Professional

Both

$414.00

Service Code	HCPCS 36584
Min. Negotiated Rate	$32.38
Max. Negotiated Rate	$310.50
Rate for Payer: Aetna Commercial	$80.12
Rate for Payer: Aetna Medicare	$207.00
Rate for Payer: BCBS Complete	$34.00
Rate for Payer: BCN Commercial	$86.65
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
Rate for Payer: Mclaren Medicaid	$32.38
Rate for Payer: Meridian Medicaid	$34.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$310.50
Rate for Payer: Priority Health Choice Medicaid	$32.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$93.17
Rate for Payer: Priority Health Narrow/Tiered Network	$93.17
Rate for Payer: UHC Medicaid	$32.38
Rate for Payer: UHCCP Medicaid	$32.38

PR COMPLETE TTHRC ECHO CONGENITAL CARDIAC ANOMALY

Professional

Both

$374.00

Service Code	HCPCS 93303
Min. Negotiated Rate	$187.00
Max. Negotiated Rate	$321.20
Rate for Payer: Aetna Commercial	$298.31
Rate for Payer: Aetna Medicare	$187.00
Rate for Payer: BCN Commercial	$321.20
Rate for Payer: Cash Price	$299.20
Rate for Payer: Cash Price	$299.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$280.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$305.28
Rate for Payer: Priority Health Narrow/Tiered Network	$305.28

PR COMPLEX CHRONIC CARE MGMT SVC 1ST 60 MIN CAL MO

Professional

Both

$113.00

Service Code	HCPCS 99487
Min. Negotiated Rate	$50.45
Max. Negotiated Rate	$147.84
Rate for Payer: Aetna Commercial	$50.45
Rate for Payer: Aetna Medicare	$56.50
Rate for Payer: BCBS Complete	$53.00
Rate for Payer: BCN Commercial	$147.84
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cash Price	$90.40
Rate for Payer: Mclaren Medicaid	$50.48
Rate for Payer: Meridian Medicaid	$53.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$84.75
Rate for Payer: Priority Health Choice Medicaid	$50.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$120.49
Rate for Payer: Priority Health Narrow/Tiered Network	$120.49
Rate for Payer: UHC Medicaid	$50.48
Rate for Payer: UHCCP Medicaid	$50.48

PR COMPLEX CYSTOMETROGRAM URETHRAL PRESS PROFILE

Professional

Both

$706.00

Service Code	HCPCS 51727
Min. Negotiated Rate	$353.00
Max. Negotiated Rate	$553.86
Rate for Payer: Aetna Commercial	$457.56
Rate for Payer: Aetna Medicare	$353.00
Rate for Payer: BCN Commercial	$508.43
Rate for Payer: Cash Price	$564.80
Rate for Payer: Cash Price	$564.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$529.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$553.86
Rate for Payer: Priority Health Narrow/Tiered Network	$553.86

PR COMPLEX CYSTOMETROGRAM VOIDING PRESSURE STUDIES

Professional

Both

$680.00

Service Code	HCPCS 51728
Min. Negotiated Rate	$340.00
Max. Negotiated Rate	$551.14
Rate for Payer: Aetna Commercial	$461.60
Rate for Payer: Aetna Medicare	$340.00
Rate for Payer: BCN Commercial	$505.95
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$510.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$551.14
Rate for Payer: Priority Health Narrow/Tiered Network	$551.14

PR COMPLEX E/M VISIT ADD ON

Professional

Both

$49.00

Service Code	HCPCS G2211
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$36.75
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$24.50
Rate for Payer: BCBS Complete	$19.60
Rate for Payer: BCN Commercial	$15.00
Rate for Payer: Cash Price	$39.20
Rate for Payer: Cash Price	$39.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$18.20
Rate for Payer: Priority Health Narrow/Tiered Network	$18.20

PR COMPLEX IMPLANT REMOVAL, BILATERAL

Professional

Both

$3,605.00

Hospital Revenue Code	990
Min. Negotiated Rate	$1,442.00
Max. Negotiated Rate	$2,703.75
Rate for Payer: Aetna Medicare	$1,802.50
Rate for Payer: BCBS Complete	$1,442.00
Rate for Payer: Cash Price	$2,884.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,703.75

PR COMPLEX UROFLOMETRY

Professional

Both

$175.00

Service Code	HCPCS 51741
Min. Negotiated Rate	$17.72
Max. Negotiated Rate	$131.25
Rate for Payer: Aetna Commercial	$17.72
Rate for Payer: Aetna Medicare	$87.50
Rate for Payer: BCN Commercial	$21.41
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$131.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$23.33
Rate for Payer: Priority Health Narrow/Tiered Network	$23.33

PR COMPL OPH XM&EVAL GENERAL ANES W/WO MNPJ GLOBE

Professional

Both

$220.00

Service Code	HCPCS 92018
Min. Negotiated Rate	$72.21
Max. Negotiated Rate	$178.11
Rate for Payer: Aetna Commercial	$150.76
Rate for Payer: Aetna Medicare	$110.00
Rate for Payer: BCBS Complete	$75.82
Rate for Payer: BCN Commercial	$151.83
Rate for Payer: Cash Price	$176.00
Rate for Payer: Cash Price	$176.00
Rate for Payer: Mclaren Medicaid	$72.21
Rate for Payer: Meridian Medicaid	$75.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$165.00
Rate for Payer: Priority Health Choice Medicaid	$72.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$178.11
Rate for Payer: Priority Health Narrow/Tiered Network	$178.11
Rate for Payer: UHC Medicaid	$72.21
Rate for Payer: UHCCP Medicaid	$72.21

Know your out-of-pocket cost for care.

All Charges