Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR CRTJ DSTL ARVEN FSTL LXTR BYP SURG NON-HEMO

Professional

Both

$352.00

Service Code	HCPCS 35686
Min. Negotiated Rate	$92.66
Max. Negotiated Rate	$264.00
Rate for Payer: Aetna Commercial	$216.51
Rate for Payer: Aetna Medicare	$176.00
Rate for Payer: BCBS Complete	$97.29
Rate for Payer: BCN Commercial	$234.05
Rate for Payer: Cash Price	$281.60
Rate for Payer: Cash Price	$281.60
Rate for Payer: Mclaren Medicaid	$92.66
Rate for Payer: Meridian Medicaid	$97.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$264.00
Rate for Payer: Priority Health Choice Medicaid	$92.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$251.69
Rate for Payer: Priority Health Narrow/Tiered Network	$251.69
Rate for Payer: UHC Medicaid	$92.66
Rate for Payer: UHCCP Medicaid	$92.66

PR CRTJ PERICARDIAL WINDOW/PRTL RESECJ W/DRG/BX

Professional

Both

$2,627.00

Service Code	HCPCS 33025
Min. Negotiated Rate	$472.01
Max. Negotiated Rate	$1,970.25
Rate for Payer: Aetna Commercial	$1,030.99
Rate for Payer: Aetna Medicare	$1,313.50
Rate for Payer: BCBS Complete	$495.61
Rate for Payer: BCN Commercial	$1,141.87
Rate for Payer: Cash Price	$2,101.60
Rate for Payer: Cash Price	$2,101.60
Rate for Payer: Mclaren Medicaid	$472.01
Rate for Payer: Meridian Medicaid	$495.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,970.25
Rate for Payer: Priority Health Choice Medicaid	$472.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,227.94
Rate for Payer: Priority Health Narrow/Tiered Network	$1,227.94
Rate for Payer: UHC Medicaid	$472.01
Rate for Payer: UHCCP Medicaid	$472.01

PR CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL/OTH W/LAM

Professional

Both

$4,496.00

Service Code	HCPCS 63740
Min. Negotiated Rate	$643.47
Max. Negotiated Rate	$3,372.00
Rate for Payer: Aetna Commercial	$1,267.15
Rate for Payer: Aetna Medicare	$2,248.00
Rate for Payer: BCBS Complete	$675.64
Rate for Payer: BCN Commercial	$1,665.82
Rate for Payer: Cash Price	$3,596.80
Rate for Payer: Cash Price	$3,596.80
Rate for Payer: Mclaren Medicaid	$643.47
Rate for Payer: Meridian Medicaid	$675.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,372.00
Rate for Payer: Priority Health Choice Medicaid	$643.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,761.21
Rate for Payer: Priority Health Narrow/Tiered Network	$1,761.21
Rate for Payer: UHC Medicaid	$643.47
Rate for Payer: UHCCP Medicaid	$643.47

PR CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL PRQ X LAM

Professional

Both

$2,475.00

Service Code	HCPCS 63741
Min. Negotiated Rate	$454.76
Max. Negotiated Rate	$1,856.25
Rate for Payer: Aetna Commercial	$868.81
Rate for Payer: Aetna Medicare	$1,237.50
Rate for Payer: BCBS Complete	$477.50
Rate for Payer: BCN Commercial	$1,029.32
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Cash Price	$1,980.00
Rate for Payer: Mclaren Medicaid	$454.76
Rate for Payer: Meridian Medicaid	$477.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,856.25
Rate for Payer: Priority Health Choice Medicaid	$454.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,195.54
Rate for Payer: Priority Health Narrow/Tiered Network	$1,195.54
Rate for Payer: UHC Medicaid	$454.76
Rate for Payer: UHCCP Medicaid	$454.76

PR CRTJ SHUNT SARACH/SDRL-PRTL-PLEURAL OTH

Professional

Both

$6,031.00

Service Code	HCPCS 62192
Min. Negotiated Rate	$647.73
Max. Negotiated Rate	$4,523.25
Rate for Payer: Aetna Commercial	$1,267.26
Rate for Payer: Aetna Medicare	$3,015.50
Rate for Payer: BCBS Complete	$680.12
Rate for Payer: BCN Commercial	$2,100.38
Rate for Payer: Cash Price	$4,824.80
Rate for Payer: Cash Price	$4,824.80
Rate for Payer: Mclaren Medicaid	$647.73
Rate for Payer: Meridian Medicaid	$680.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,523.25
Rate for Payer: Priority Health Choice Medicaid	$647.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,765.84
Rate for Payer: Priority Health Narrow/Tiered Network	$1,765.84
Rate for Payer: UHC Medicaid	$647.73
Rate for Payer: UHCCP Medicaid	$647.73

PR CRTJ SHUNT VENTRICULO-ATR-JUG-AUR

Professional

Both

$5,217.00

Service Code	HCPCS 62220
Min. Negotiated Rate	$618.34
Max. Negotiated Rate	$3,912.75
Rate for Payer: Aetna Commercial	$1,269.68
Rate for Payer: Aetna Medicare	$2,608.50
Rate for Payer: BCBS Complete	$649.26
Rate for Payer: BCN Commercial	$2,052.22
Rate for Payer: Cash Price	$4,173.60
Rate for Payer: Cash Price	$4,173.60
Rate for Payer: Mclaren Medicaid	$618.34
Rate for Payer: Meridian Medicaid	$649.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,912.75
Rate for Payer: Priority Health Choice Medicaid	$618.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,725.36
Rate for Payer: Priority Health Narrow/Tiered Network	$1,725.36
Rate for Payer: UHC Medicaid	$618.34
Rate for Payer: UHCCP Medicaid	$618.34

PR CRTJ SHUNT VENTRICULO-PERITNEAL-PLEURAL TERMINUS

Professional

Both

$5,203.00

Service Code	HCPCS 62223
Min. Negotiated Rate	$652.63
Max. Negotiated Rate	$3,902.25
Rate for Payer: Aetna Commercial	$1,340.52
Rate for Payer: Aetna Medicare	$2,601.50
Rate for Payer: BCBS Complete	$685.26
Rate for Payer: BCN Commercial	$2,173.30
Rate for Payer: Cash Price	$4,162.40
Rate for Payer: Cash Price	$4,162.40
Rate for Payer: Mclaren Medicaid	$652.63
Rate for Payer: Meridian Medicaid	$685.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,902.25
Rate for Payer: Priority Health Choice Medicaid	$652.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,827.16
Rate for Payer: Priority Health Narrow/Tiered Network	$1,827.16
Rate for Payer: UHC Medicaid	$652.63
Rate for Payer: UHCCP Medicaid	$652.63

PR CRX RPR DURAL/CSF LEAK RHINORRHEA/OTORRHEA

Professional

Both

$7,464.00

Service Code	HCPCS 62100
Min. Negotiated Rate	$928.68
Max. Negotiated Rate	$5,598.00
Rate for Payer: Aetna Commercial	$2,017.87
Rate for Payer: Aetna Medicare	$3,732.00
Rate for Payer: BCBS Complete	$975.11
Rate for Payer: BCN Commercial	$3,294.01
Rate for Payer: Cash Price	$5,971.20
Rate for Payer: Cash Price	$5,971.20
Rate for Payer: Mclaren Medicaid	$928.68
Rate for Payer: Meridian Medicaid	$975.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,598.00
Rate for Payer: Priority Health Choice Medicaid	$928.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,769.36
Rate for Payer: Priority Health Narrow/Tiered Network	$2,769.36
Rate for Payer: UHC Medicaid	$928.68
Rate for Payer: UHCCP Medicaid	$928.68

PR CRYOSURGICAL ABLATION PROSTATE W/US & MONITORI

Professional

Both

$2,130.00

Service Code	HCPCS 55873
Min. Negotiated Rate	$438.99
Max. Negotiated Rate	$1,597.50
Rate for Payer: Aetna Commercial	$980.44
Rate for Payer: Aetna Medicare	$1,065.00
Rate for Payer: BCBS Complete	$460.94
Rate for Payer: BCN Commercial	$1,145.85
Rate for Payer: Cash Price	$1,704.00
Rate for Payer: Cash Price	$1,704.00
Rate for Payer: Mclaren Medicaid	$438.99
Rate for Payer: Meridian Medicaid	$460.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,597.50
Rate for Payer: Priority Health Choice Medicaid	$438.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,248.20
Rate for Payer: Priority Health Narrow/Tiered Network	$1,248.20
Rate for Payer: UHC Medicaid	$438.99
Rate for Payer: UHCCP Medicaid	$438.99

PR CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE

Professional

Both

$106.00

Service Code	HCPCS 17340
Min. Negotiated Rate	$26.84
Max. Negotiated Rate	$79.50
Rate for Payer: Aetna Commercial	$52.87
Rate for Payer: Aetna Medicare	$53.00
Rate for Payer: BCBS Complete	$28.18
Rate for Payer: BCN Commercial	$73.70
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cash Price	$84.80
Rate for Payer: Mclaren Medicaid	$26.84
Rate for Payer: Meridian Medicaid	$28.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$79.50
Rate for Payer: Priority Health Choice Medicaid	$26.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$67.45
Rate for Payer: Priority Health Narrow/Tiered Network	$67.45
Rate for Payer: UHC Medicaid	$26.84
Rate for Payer: UHCCP Medicaid	$26.84

PR CSTC COMPL W/CONDUIT/SIGMOID BLDR PEL LMPHADEC

Professional

Both

$4,697.00

Service Code	HCPCS 51595
Min. Negotiated Rate	$1,233.91
Max. Negotiated Rate	$3,532.51
Rate for Payer: Aetna Commercial	$2,809.09
Rate for Payer: Aetna Medicare	$2,348.50
Rate for Payer: BCBS Complete	$1,295.61
Rate for Payer: BCN Commercial	$3,242.85
Rate for Payer: Cash Price	$3,757.60
Rate for Payer: Cash Price	$3,757.60
Rate for Payer: Mclaren Medicaid	$1,233.91
Rate for Payer: Meridian Medicaid	$1,295.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,522.75
Rate for Payer: Priority Health Choice Medicaid	$1,233.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,532.51
Rate for Payer: Priority Health Narrow/Tiered Network	$3,532.51
Rate for Payer: UHC Medicaid	$1,233.91
Rate for Payer: UHCCP Medicaid	$1,233.91

PR CSTC COMPL W/CONTINENT DVRJ OPN NEOBLDR

Professional

Both

$5,053.00

Service Code	HCPCS 51596
Min. Negotiated Rate	$1,331.68
Max. Negotiated Rate	$3,816.23
Rate for Payer: Aetna Commercial	$3,025.03
Rate for Payer: Aetna Medicare	$2,526.50
Rate for Payer: BCBS Complete	$1,398.26
Rate for Payer: BCN Commercial	$3,503.30
Rate for Payer: Cash Price	$4,042.40
Rate for Payer: Cash Price	$4,042.40
Rate for Payer: Mclaren Medicaid	$1,331.68
Rate for Payer: Meridian Medicaid	$1,398.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,789.75
Rate for Payer: Priority Health Choice Medicaid	$1,331.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,816.23
Rate for Payer: Priority Health Narrow/Tiered Network	$3,816.23
Rate for Payer: UHC Medicaid	$1,331.68
Rate for Payer: UHCCP Medicaid	$1,331.68

PR CSTC COMPL W/URTROILEAL CONDUIT/BLDR W/INT ANAST

Professional

Both

$5,058.00

Service Code	HCPCS 51590
Min. Negotiated Rate	$1,091.63
Max. Negotiated Rate	$3,793.50
Rate for Payer: Aetna Commercial	$2,483.67
Rate for Payer: Aetna Medicare	$2,529.00
Rate for Payer: BCBS Complete	$1,146.21
Rate for Payer: BCN Commercial	$2,866.88
Rate for Payer: Cash Price	$4,046.40
Rate for Payer: Cash Price	$4,046.40
Rate for Payer: Mclaren Medicaid	$1,091.63
Rate for Payer: Meridian Medicaid	$1,146.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,793.50
Rate for Payer: Priority Health Choice Medicaid	$1,091.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,122.96
Rate for Payer: Priority Health Narrow/Tiered Network	$3,122.96
Rate for Payer: UHC Medicaid	$1,091.63
Rate for Payer: UHCCP Medicaid	$1,091.63

PR CSTC PRTL W/RIMPLTJ URTR IN BLDR URTRONEOCSTOST

Professional

Both

$2,732.00

Service Code	HCPCS 51565
Min. Negotiated Rate	$734.00
Max. Negotiated Rate	$2,090.65
Rate for Payer: Aetna Commercial	$1,654.05
Rate for Payer: Aetna Medicare	$1,366.00
Rate for Payer: BCBS Complete	$770.70
Rate for Payer: BCN Commercial	$1,919.22
Rate for Payer: Cash Price	$2,185.60
Rate for Payer: Cash Price	$2,185.60
Rate for Payer: Mclaren Medicaid	$734.00
Rate for Payer: Meridian Medicaid	$770.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,049.00
Rate for Payer: Priority Health Choice Medicaid	$734.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,090.65
Rate for Payer: Priority Health Narrow/Tiered Network	$2,090.65
Rate for Payer: UHC Medicaid	$734.00
Rate for Payer: UHCCP Medicaid	$734.00

PR CSTOPLASTY/CSTOURTP PLSTC ANY

Professional

Both

$1,169.00

Service Code	HCPCS 51800
Min. Negotiated Rate	$584.50
Max. Negotiated Rate	$1,687.07
Rate for Payer: Aetna Commercial	$1,338.27
Rate for Payer: Aetna Medicare	$584.50
Rate for Payer: BCBS Complete	$623.53
Rate for Payer: BCN Commercial	$1,548.72
Rate for Payer: Cash Price	$935.20
Rate for Payer: Cash Price	$935.20
Rate for Payer: Mclaren Medicaid	$593.84
Rate for Payer: Meridian Medicaid	$623.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$876.75
Rate for Payer: Priority Health Choice Medicaid	$593.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,687.07
Rate for Payer: Priority Health Narrow/Tiered Network	$1,687.07
Rate for Payer: UHC Medicaid	$593.84
Rate for Payer: UHCCP Medicaid	$593.84

PR CSTOURTP W/UNI/BI URTRONEOCSTOST

Professional

Both

$2,490.00

Service Code	HCPCS 51820
Min. Negotiated Rate	$621.75
Max. Negotiated Rate	$1,867.50
Rate for Payer: Aetna Commercial	$1,392.31
Rate for Payer: Aetna Medicare	$1,245.00
Rate for Payer: BCBS Complete	$652.84
Rate for Payer: BCN Commercial	$1,619.93
Rate for Payer: Cash Price	$1,992.00
Rate for Payer: Cash Price	$1,992.00
Rate for Payer: Mclaren Medicaid	$621.75
Rate for Payer: Meridian Medicaid	$652.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,867.50
Rate for Payer: Priority Health Choice Medicaid	$621.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,764.63
Rate for Payer: Priority Health Narrow/Tiered Network	$1,764.63
Rate for Payer: UHC Medicaid	$621.75
Rate for Payer: UHCCP Medicaid	$621.75

PR CTRL NASOPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ

Professional

Both

$965.00

Service Code	HCPCS 42972
Min. Negotiated Rate	$283.50
Max. Negotiated Rate	$931.98
Rate for Payer: Aetna Commercial	$670.67
Rate for Payer: Aetna Medicare	$482.50
Rate for Payer: BCBS Complete	$297.68
Rate for Payer: BCN Commercial	$764.90
Rate for Payer: Cash Price	$772.00
Rate for Payer: Cash Price	$772.00
Rate for Payer: Mclaren Medicaid	$283.50
Rate for Payer: Meridian Medicaid	$297.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$723.75
Rate for Payer: Priority Health Choice Medicaid	$283.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$931.98
Rate for Payer: Priority Health Narrow/Tiered Network	$931.98
Rate for Payer: UHC Medicaid	$283.50
Rate for Payer: UHCCP Medicaid	$283.50

PR CTRL NASOPHARYNGEAL HEMRRG SMPL W/PST NSL PACKS

Professional

Both

$771.00

Service Code	HCPCS 42970
Min. Negotiated Rate	$232.38
Max. Negotiated Rate	$757.23
Rate for Payer: Aetna Commercial	$542.75
Rate for Payer: Aetna Medicare	$385.50
Rate for Payer: BCBS Complete	$244.00
Rate for Payer: BCN Commercial	$621.48
Rate for Payer: Cash Price	$616.80
Rate for Payer: Cash Price	$616.80
Rate for Payer: Mclaren Medicaid	$232.38
Rate for Payer: Meridian Medicaid	$244.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$578.25
Rate for Payer: Priority Health Choice Medicaid	$232.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$757.23
Rate for Payer: Priority Health Narrow/Tiered Network	$757.23
Rate for Payer: UHC Medicaid	$232.38
Rate for Payer: UHCCP Medicaid	$232.38

PR CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY 1ST

Professional

Both

$592.00

Service Code	HCPCS 30905
Min. Negotiated Rate	$63.26
Max. Negotiated Rate	$444.00
Rate for Payer: Aetna Commercial	$136.69
Rate for Payer: Aetna Medicare	$296.00
Rate for Payer: BCBS Complete	$66.42
Rate for Payer: BCN Commercial	$158.86
Rate for Payer: Cash Price	$473.60
Rate for Payer: Cash Price	$473.60
Rate for Payer: Mclaren Medicaid	$63.26
Rate for Payer: Meridian Medicaid	$66.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$444.00
Rate for Payer: Priority Health Choice Medicaid	$63.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$149.60
Rate for Payer: Priority Health Narrow/Tiered Network	$149.60
Rate for Payer: UHC Medicaid	$63.26
Rate for Payer: UHCCP Medicaid	$63.26

PR CTRL NSL HEMRRG PST NASAL PACKS&/CAUTERY SUBSQ

Professional

Both

$617.00

Service Code	HCPCS 30906
Min. Negotiated Rate	$76.04
Max. Negotiated Rate	$462.75
Rate for Payer: Aetna Commercial	$174.23
Rate for Payer: Aetna Medicare	$308.50
Rate for Payer: BCBS Complete	$79.84
Rate for Payer: BCN Commercial	$197.20
Rate for Payer: Cash Price	$493.60
Rate for Payer: Cash Price	$493.60
Rate for Payer: Mclaren Medicaid	$76.04
Rate for Payer: Meridian Medicaid	$79.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$462.75
Rate for Payer: Priority Health Choice Medicaid	$76.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$185.70
Rate for Payer: Priority Health Narrow/Tiered Network	$185.70
Rate for Payer: UHC Medicaid	$76.04
Rate for Payer: UHCCP Medicaid	$76.04

PR CTRL OROPHARYNGEAL HEMORRHAGE COMP REQ HOSPITJ

Professional

Both

$803.00

Service Code	HCPCS 42961
Min. Negotiated Rate	$237.71
Max. Negotiated Rate	$772.40
Rate for Payer: Aetna Commercial	$551.09
Rate for Payer: Aetna Medicare	$401.50
Rate for Payer: BCBS Complete	$249.60
Rate for Payer: BCN Commercial	$633.93
Rate for Payer: Cash Price	$642.40
Rate for Payer: Cash Price	$642.40
Rate for Payer: Mclaren Medicaid	$237.71
Rate for Payer: Meridian Medicaid	$249.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$602.25
Rate for Payer: Priority Health Choice Medicaid	$237.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$772.40
Rate for Payer: Priority Health Narrow/Tiered Network	$772.40
Rate for Payer: UHC Medicaid	$237.71
Rate for Payer: UHCCP Medicaid	$237.71

PR CTRL OROPHARYNGEAL HEMORRHAGE W/SEC SURG IVNTJ

Professional

Both

$1,958.00

Service Code	HCPCS 42962
Min. Negotiated Rate	$292.02
Max. Negotiated Rate	$1,468.50
Rate for Payer: Aetna Commercial	$682.74
Rate for Payer: Aetna Medicare	$979.00
Rate for Payer: BCBS Complete	$306.62
Rate for Payer: BCN Commercial	$781.33
Rate for Payer: Cash Price	$1,566.40
Rate for Payer: Cash Price	$1,566.40
Rate for Payer: Mclaren Medicaid	$292.02
Rate for Payer: Meridian Medicaid	$306.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,468.50
Rate for Payer: Priority Health Choice Medicaid	$292.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$952.01
Rate for Payer: Priority Health Narrow/Tiered Network	$952.01
Rate for Payer: UHC Medicaid	$292.02
Rate for Payer: UHCCP Medicaid	$292.02

PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ LWR LIMBS

Professional

Both

$555.00

Service Code	HCPCS 95929
Min. Negotiated Rate	$260.29
Max. Negotiated Rate	$416.25
Rate for Payer: Aetna Commercial	$260.29
Rate for Payer: Aetna Medicare	$277.50
Rate for Payer: BCN Commercial	$353.07
Rate for Payer: Cash Price	$444.00
Rate for Payer: Cash Price	$444.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$416.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$325.61
Rate for Payer: Priority Health Narrow/Tiered Network	$325.61

PR CTR MOTOR EP STD TRANSCRNL MOTOR STIMJ UPR LIMBS

Professional

Both

$512.00

Service Code	HCPCS 95928
Min. Negotiated Rate	$253.19
Max. Negotiated Rate	$384.00
Rate for Payer: Aetna Commercial	$253.19
Rate for Payer: Aetna Commercial	$253.19
Rate for Payer: Aetna Medicare	$175.00
Rate for Payer: Aetna Medicare	$256.00
Rate for Payer: BCN Commercial	$352.57
Rate for Payer: BCN Commercial	$352.57
Rate for Payer: Cash Price	$280.00
Rate for Payer: Cash Price	$280.00
Rate for Payer: Cash Price	$409.60
Rate for Payer: Cash Price	$409.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$262.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$384.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$325.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$325.14
Rate for Payer: Priority Health Narrow/Tiered Network	$325.14
Rate for Payer: Priority Health Narrow/Tiered Network	$325.14

PR CTR MOTR EP STD TRANSCRNL MOTR STIM UPR&LOW LI

Professional

Both

$338.00

Service Code	HCPCS 95939
Min. Negotiated Rate	$169.00
Max. Negotiated Rate	$823.66
Rate for Payer: Aetna Commercial	$578.57
Rate for Payer: Aetna Medicare	$169.00
Rate for Payer: BCN Commercial	$823.66
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cash Price	$270.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$253.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$759.59
Rate for Payer: Priority Health Narrow/Tiered Network	$759.59

Know your out-of-pocket cost for care.

All Charges