Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR CYSTOURETHROSCOPY W/URETERAL CATHETERIZATION

Professional

Both

$576.00

Service Code	HCPCS 52005
Min. Negotiated Rate	$76.25
Max. Negotiated Rate	$432.00
Rate for Payer: Aetna Commercial	$169.08
Rate for Payer: Aetna Medicare	$288.00
Rate for Payer: BCBS Complete	$80.06
Rate for Payer: BCN Commercial	$217.73
Rate for Payer: Cash Price	$460.80
Rate for Payer: Cash Price	$460.80
Rate for Payer: Mclaren Medicaid	$76.25
Rate for Payer: Meridian Medicaid	$80.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$432.00
Rate for Payer: Priority Health Choice Medicaid	$76.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$215.90
Rate for Payer: Priority Health Narrow/Tiered Network	$215.90
Rate for Payer: UHC Medicaid	$76.25
Rate for Payer: UHCCP Medicaid	$76.25

PR CYSTOURETHROSCOPY W/URETERAL MEATOTOMY UNI/BI

Professional

Both

$488.00

Service Code	HCPCS 52290
Min. Negotiated Rate	$137.39
Max. Negotiated Rate	$392.75
Rate for Payer: Aetna Commercial	$311.87
Rate for Payer: Aetna Medicare	$244.00
Rate for Payer: BCBS Complete	$144.26
Rate for Payer: BCN Commercial	$360.54
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cash Price	$390.40
Rate for Payer: Mclaren Medicaid	$137.39
Rate for Payer: Meridian Medicaid	$144.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$366.00
Rate for Payer: Priority Health Choice Medicaid	$137.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$392.75
Rate for Payer: Priority Health Narrow/Tiered Network	$392.75
Rate for Payer: UHC Medicaid	$137.39
Rate for Payer: UHCCP Medicaid	$137.39

PR CYSTO W/COMPLEX REMOVAL STONE & STENT

Professional

Both

$833.00

Service Code	HCPCS 52315
Min. Negotiated Rate	$154.64
Max. Negotiated Rate	$624.75
Rate for Payer: Aetna Commercial	$351.84
Rate for Payer: Aetna Medicare	$416.50
Rate for Payer: BCBS Complete	$162.37
Rate for Payer: BCN Commercial	$405.36
Rate for Payer: Cash Price	$666.40
Rate for Payer: Cash Price	$666.40
Rate for Payer: Mclaren Medicaid	$154.64
Rate for Payer: Meridian Medicaid	$162.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$624.75
Rate for Payer: Priority Health Choice Medicaid	$154.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$441.56
Rate for Payer: Priority Health Narrow/Tiered Network	$441.56
Rate for Payer: UHC Medicaid	$154.64
Rate for Payer: UHCCP Medicaid	$154.64

PR CYSTO W/DESTRUCTION OF LESIONS

Professional

Both

$2,910.00

Service Code	HCPCS 52214
Min. Negotiated Rate	$96.92
Max. Negotiated Rate	$2,182.50
Rate for Payer: Aetna Commercial	$227.00
Rate for Payer: Aetna Medicare	$1,455.00
Rate for Payer: BCBS Complete	$101.77
Rate for Payer: BCN Commercial	$258.95
Rate for Payer: Cash Price	$2,328.00
Rate for Payer: Cash Price	$2,328.00
Rate for Payer: Mclaren Medicaid	$96.92
Rate for Payer: Meridian Medicaid	$101.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,182.50
Rate for Payer: Priority Health Choice Medicaid	$96.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$282.08
Rate for Payer: Priority Health Narrow/Tiered Network	$282.08
Rate for Payer: UHC Medicaid	$96.92
Rate for Payer: UHCCP Medicaid	$96.92

PR CYSTO W/DILAT RX BALO CATH URTL STRIX/STEN MALE

Professional

Both

$4,172.00

Service Code	HCPCS 52284
Min. Negotiated Rate	$93.08
Max. Negotiated Rate	$3,129.00
Rate for Payer: Aetna Commercial	$204.45
Rate for Payer: Aetna Medicare	$2,086.00
Rate for Payer: BCBS Complete	$97.73
Rate for Payer: BCN Commercial	$244.51
Rate for Payer: Cash Price	$3,337.60
Rate for Payer: Cash Price	$3,337.60
Rate for Payer: Mclaren Medicaid	$93.08
Rate for Payer: Meridian Medicaid	$97.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,129.00
Rate for Payer: Priority Health Choice Medicaid	$93.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$266.35
Rate for Payer: Priority Health Narrow/Tiered Network	$266.35
Rate for Payer: UHC Medicaid	$93.08
Rate for Payer: UHCCP Medicaid	$93.08

PR CYSTO W/INSERT URETERAL STENT

Professional

Both

$893.00

Service Code	HCPCS 52332
Min. Negotiated Rate	$89.03
Max. Negotiated Rate	$669.75
Rate for Payer: Aetna Commercial	$198.36
Rate for Payer: Aetna Medicare	$446.50
Rate for Payer: BCBS Complete	$93.48
Rate for Payer: BCN Commercial	$231.07
Rate for Payer: Cash Price	$714.40
Rate for Payer: Cash Price	$714.40
Rate for Payer: Mclaren Medicaid	$89.03
Rate for Payer: Meridian Medicaid	$93.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$669.75
Rate for Payer: Priority Health Choice Medicaid	$89.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$251.71
Rate for Payer: Priority Health Narrow/Tiered Network	$251.71
Rate for Payer: UHC Medicaid	$89.03
Rate for Payer: UHCCP Medicaid	$89.03

PR CYSTO W/IRRIG & EVAC MULTPLE OBSTRUCTING CLOTS

Professional

Both

$793.00

Service Code	HCPCS 52001
Min. Negotiated Rate	$161.24
Max. Negotiated Rate	$594.75
Rate for Payer: Aetna Commercial	$367.75
Rate for Payer: Aetna Medicare	$396.50
Rate for Payer: BCBS Complete	$169.30
Rate for Payer: BCN Commercial	$423.78
Rate for Payer: Cash Price	$634.40
Rate for Payer: Cash Price	$634.40
Rate for Payer: Mclaren Medicaid	$161.24
Rate for Payer: Meridian Medicaid	$169.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$594.75
Rate for Payer: Priority Health Choice Medicaid	$161.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$461.64
Rate for Payer: Priority Health Narrow/Tiered Network	$461.64
Rate for Payer: UHC Medicaid	$161.24
Rate for Payer: UHCCP Medicaid	$161.24

PR CYSTO W/REMOVAL OF LESIONS SMALL

Professional

Both

$2,396.00

Service Code	HCPCS 52224
Min. Negotiated Rate	$112.04
Max. Negotiated Rate	$1,797.00
Rate for Payer: Aetna Commercial	$261.58
Rate for Payer: Aetna Medicare	$1,198.00
Rate for Payer: BCBS Complete	$117.64
Rate for Payer: BCN Commercial	$299.28
Rate for Payer: Cash Price	$1,916.80
Rate for Payer: Cash Price	$1,916.80
Rate for Payer: Mclaren Medicaid	$112.04
Rate for Payer: Meridian Medicaid	$117.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,797.00
Rate for Payer: Priority Health Choice Medicaid	$112.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$326.02
Rate for Payer: Priority Health Narrow/Tiered Network	$326.02
Rate for Payer: UHC Medicaid	$112.04
Rate for Payer: UHCCP Medicaid	$112.04

PR CYSTO W/REMOVAL OF TUMORS SMALL

Professional

Both

$1,109.00

Service Code	HCPCS 52234
Min. Negotiated Rate	$138.24
Max. Negotiated Rate	$831.75
Rate for Payer: Aetna Commercial	$314.10
Rate for Payer: Aetna Medicare	$554.50
Rate for Payer: BCBS Complete	$145.15
Rate for Payer: BCN Commercial	$363.53
Rate for Payer: Cash Price	$887.20
Rate for Payer: Cash Price	$887.20
Rate for Payer: Mclaren Medicaid	$138.24
Rate for Payer: Meridian Medicaid	$145.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$831.75
Rate for Payer: Priority Health Choice Medicaid	$138.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$396.00
Rate for Payer: Priority Health Narrow/Tiered Network	$396.00
Rate for Payer: UHC Medicaid	$138.24
Rate for Payer: UHCCP Medicaid	$138.24

PR CYSTO W/RESCJ/FULG ORTHOPIC URETEROCELE UNI/BI

Professional

Both

$567.00

Service Code	HCPCS 52300
Min. Negotiated Rate	$157.62
Max. Negotiated Rate	$450.25
Rate for Payer: Aetna Commercial	$358.89
Rate for Payer: Aetna Medicare	$283.50
Rate for Payer: BCBS Complete	$165.50
Rate for Payer: BCN Commercial	$413.33
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cash Price	$453.60
Rate for Payer: Mclaren Medicaid	$157.62
Rate for Payer: Meridian Medicaid	$165.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$425.25
Rate for Payer: Priority Health Choice Medicaid	$157.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$450.25
Rate for Payer: Priority Health Narrow/Tiered Network	$450.25
Rate for Payer: UHC Medicaid	$157.62
Rate for Payer: UHCCP Medicaid	$157.62

PR CYSTO W/RESECJ ECTOPIC URETEROCELE UNI/BI

Professional

Both

$600.00

Service Code	HCPCS 52301
Min. Negotiated Rate	$162.73
Max. Negotiated Rate	$466.52
Rate for Payer: Aetna Commercial	$371.30
Rate for Payer: Aetna Medicare	$300.00
Rate for Payer: BCBS Complete	$170.87
Rate for Payer: BCN Commercial	$428.27
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Mclaren Medicaid	$162.73
Rate for Payer: Meridian Medicaid	$170.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$450.00
Rate for Payer: Priority Health Choice Medicaid	$162.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$466.52
Rate for Payer: Priority Health Narrow/Tiered Network	$466.52
Rate for Payer: UHC Medicaid	$162.73
Rate for Payer: UHCCP Medicaid	$162.73

PR CYSTO W/SIMPLE REMOVAL STONE & STENT

Professional

Both

$608.00

Service Code	HCPCS 52310
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$456.00
Rate for Payer: Aetna Commercial	$193.36
Rate for Payer: Aetna Medicare	$304.00
Rate for Payer: BCBS Complete	$90.13
Rate for Payer: BCN Commercial	$225.09
Rate for Payer: Cash Price	$486.40
Rate for Payer: Cash Price	$486.40
Rate for Payer: Mclaren Medicaid	$85.84
Rate for Payer: Meridian Medicaid	$90.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$456.00
Rate for Payer: Priority Health Choice Medicaid	$85.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$245.20
Rate for Payer: Priority Health Narrow/Tiered Network	$245.20
Rate for Payer: UHC Medicaid	$85.84
Rate for Payer: UHCCP Medicaid	$85.84

PR CYSTO W/SUBURTRIC NJX IMPLT MATRL

Professional

Both

$1,352.00

Service Code	HCPCS 52327
Min. Negotiated Rate	$143.56
Max. Negotiated Rate	$1,014.00
Rate for Payer: Aetna Commercial	$338.60
Rate for Payer: Aetna Medicare	$676.00
Rate for Payer: BCBS Complete	$150.74
Rate for Payer: BCN Commercial	$381.95
Rate for Payer: Cash Price	$1,081.60
Rate for Payer: Cash Price	$1,081.60
Rate for Payer: Mclaren Medicaid	$143.56
Rate for Payer: Meridian Medicaid	$150.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,014.00
Rate for Payer: Priority Health Choice Medicaid	$143.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$416.07
Rate for Payer: Priority Health Narrow/Tiered Network	$416.07
Rate for Payer: UHC Medicaid	$143.56
Rate for Payer: UHCCP Medicaid	$143.56

PR CYSTO W/TX INTRA-RENAL STRICTURE

Professional

Both

$697.00

Service Code	HCPCS 52343
Min. Negotiated Rate	$192.98
Max. Negotiated Rate	$553.86
Rate for Payer: Aetna Commercial	$439.49
Rate for Payer: Aetna Medicare	$348.50
Rate for Payer: BCBS Complete	$202.63
Rate for Payer: BCN Commercial	$508.43
Rate for Payer: Cash Price	$557.60
Rate for Payer: Cash Price	$557.60
Rate for Payer: Mclaren Medicaid	$192.98
Rate for Payer: Meridian Medicaid	$202.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$522.75
Rate for Payer: Priority Health Choice Medicaid	$192.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$553.86
Rate for Payer: Priority Health Narrow/Tiered Network	$553.86
Rate for Payer: UHC Medicaid	$192.98
Rate for Payer: UHCCP Medicaid	$192.98

PR CYSTO W/TX URETERAL STRICTURE

Professional

Both

$1,583.00

Service Code	HCPCS 52341
Min. Negotiated Rate	$159.75
Max. Negotiated Rate	$1,187.25
Rate for Payer: Aetna Commercial	$363.22
Rate for Payer: Aetna Medicare	$791.50
Rate for Payer: BCBS Complete	$167.74
Rate for Payer: BCN Commercial	$419.30
Rate for Payer: Cash Price	$1,266.40
Rate for Payer: Cash Price	$1,266.40
Rate for Payer: Mclaren Medicaid	$159.75
Rate for Payer: Meridian Medicaid	$167.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,187.25
Rate for Payer: Priority Health Choice Medicaid	$159.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$456.76
Rate for Payer: Priority Health Narrow/Tiered Network	$456.76
Rate for Payer: UHC Medicaid	$159.75
Rate for Payer: UHCCP Medicaid	$159.75

PR CYSTO W/TX URETEROPELVIC JUNCTION STRICTURE

Professional

Both

$1,763.00

Service Code	HCPCS 52342
Min. Negotiated Rate	$173.60
Max. Negotiated Rate	$1,322.25
Rate for Payer: Aetna Commercial	$395.15
Rate for Payer: Aetna Medicare	$881.50
Rate for Payer: BCBS Complete	$182.28
Rate for Payer: BCN Commercial	$456.64
Rate for Payer: Cash Price	$1,410.40
Rate for Payer: Cash Price	$1,410.40
Rate for Payer: Mclaren Medicaid	$173.60
Rate for Payer: Meridian Medicaid	$182.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,322.25
Rate for Payer: Priority Health Choice Medicaid	$173.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$497.44
Rate for Payer: Priority Health Narrow/Tiered Network	$497.44
Rate for Payer: UHC Medicaid	$173.60
Rate for Payer: UHCCP Medicaid	$173.60

PR CYSTO W/URETEROSCOPY W/LITHOTRIPSY

Professional

Both

$849.00

Service Code	HCPCS 52353
Min. Negotiated Rate	$219.18
Max. Negotiated Rate	$636.75
Rate for Payer: Aetna Commercial	$501.54
Rate for Payer: Aetna Medicare	$424.50
Rate for Payer: BCBS Complete	$230.14
Rate for Payer: BCN Commercial	$577.66
Rate for Payer: Cash Price	$679.20
Rate for Payer: Cash Price	$679.20
Rate for Payer: Mclaren Medicaid	$219.18
Rate for Payer: Meridian Medicaid	$230.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$636.75
Rate for Payer: Priority Health Choice Medicaid	$219.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$629.26
Rate for Payer: Priority Health Narrow/Tiered Network	$629.26
Rate for Payer: UHC Medicaid	$219.18
Rate for Payer: UHCCP Medicaid	$219.18

PR CYSTO W/URETEROSCOPY W/RMVL/MANJ STONES

Professional

Both

$3,090.00

Service Code	HCPCS 52352
Min. Negotiated Rate	$198.73
Max. Negotiated Rate	$2,317.50
Rate for Payer: Aetna Commercial	$452.78
Rate for Payer: Aetna Medicare	$1,545.00
Rate for Payer: BCBS Complete	$208.67
Rate for Payer: BCN Commercial	$523.38
Rate for Payer: Cash Price	$2,472.00
Rate for Payer: Cash Price	$2,472.00
Rate for Payer: Mclaren Medicaid	$198.73
Rate for Payer: Meridian Medicaid	$208.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,317.50
Rate for Payer: Priority Health Choice Medicaid	$198.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$570.13
Rate for Payer: Priority Health Narrow/Tiered Network	$570.13
Rate for Payer: UHC Medicaid	$198.73
Rate for Payer: UHCCP Medicaid	$198.73

PR CYSTO W/URTROSCOPY&/PYELOSCOPY DX

Professional

Both

$626.00

Service Code	HCPCS 52351
Min. Negotiated Rate	$169.97
Max. Negotiated Rate	$487.68
Rate for Payer: Aetna Commercial	$386.83
Rate for Payer: Aetna Medicare	$313.00
Rate for Payer: BCBS Complete	$178.47
Rate for Payer: BCN Commercial	$447.69
Rate for Payer: Cash Price	$500.80
Rate for Payer: Cash Price	$500.80
Rate for Payer: Mclaren Medicaid	$169.97
Rate for Payer: Meridian Medicaid	$178.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$469.50
Rate for Payer: Priority Health Choice Medicaid	$169.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$487.68
Rate for Payer: Priority Health Narrow/Tiered Network	$487.68
Rate for Payer: UHC Medicaid	$169.97
Rate for Payer: UHCCP Medicaid	$169.97

PR CYSTO W/URTROSCOPY W/TX INTRA-RENAL STRICTURE

Professional

Both

$911.00

Service Code	HCPCS 52346
Min. Negotiated Rate	$249.64
Max. Negotiated Rate	$716.60
Rate for Payer: Aetna Commercial	$571.60
Rate for Payer: Aetna Medicare	$455.50
Rate for Payer: BCBS Complete	$262.12
Rate for Payer: BCN Commercial	$657.83
Rate for Payer: Cash Price	$728.80
Rate for Payer: Cash Price	$728.80
Rate for Payer: Mclaren Medicaid	$249.64
Rate for Payer: Meridian Medicaid	$262.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$683.25
Rate for Payer: Priority Health Choice Medicaid	$249.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$716.60
Rate for Payer: Priority Health Narrow/Tiered Network	$716.60
Rate for Payer: UHC Medicaid	$249.64
Rate for Payer: UHCCP Medicaid	$249.64

PR CYSTO W/URTROSCOPY W/TX URETERAL STRICTURE

Professional

Both

$823.00

Service Code	HCPCS 52344
Min. Negotiated Rate	$207.04
Max. Negotiated Rate	$617.25
Rate for Payer: Aetna Commercial	$471.86
Rate for Payer: Aetna Medicare	$411.50
Rate for Payer: BCBS Complete	$217.39
Rate for Payer: BCN Commercial	$545.29
Rate for Payer: Cash Price	$658.40
Rate for Payer: Cash Price	$658.40
Rate for Payer: Mclaren Medicaid	$207.04
Rate for Payer: Meridian Medicaid	$217.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$617.25
Rate for Payer: Priority Health Choice Medicaid	$207.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$593.99
Rate for Payer: Priority Health Narrow/Tiered Network	$593.99
Rate for Payer: UHC Medicaid	$207.04
Rate for Payer: UHCCP Medicaid	$207.04

PR CYSTO W/URTROSCOPY W/TX URTROPEL JUNCT STRIX

Professional

Both

$1,161.00

Service Code	HCPCS 52345
Min. Negotiated Rate	$220.88
Max. Negotiated Rate	$870.75
Rate for Payer: Aetna Commercial	$504.64
Rate for Payer: Aetna Medicare	$580.50
Rate for Payer: BCBS Complete	$231.92
Rate for Payer: BCN Commercial	$581.64
Rate for Payer: Cash Price	$928.80
Rate for Payer: Cash Price	$928.80
Rate for Payer: Mclaren Medicaid	$220.88
Rate for Payer: Meridian Medicaid	$231.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$870.75
Rate for Payer: Priority Health Choice Medicaid	$220.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$633.60
Rate for Payer: Priority Health Narrow/Tiered Network	$633.60
Rate for Payer: UHC Medicaid	$220.88
Rate for Payer: UHCCP Medicaid	$220.88

PR DACRYOCSTORHINOSTOMY

Professional

Both

$1,619.00

Service Code	HCPCS 68720
Min. Negotiated Rate	$448.15
Max. Negotiated Rate	$1,402.27
Rate for Payer: Aetna Commercial	$1,040.24
Rate for Payer: Aetna Medicare	$809.50
Rate for Payer: BCBS Complete	$470.56
Rate for Payer: BCN Commercial	$1,197.15
Rate for Payer: Cash Price	$1,295.20
Rate for Payer: Cash Price	$1,295.20
Rate for Payer: Mclaren Medicaid	$448.15
Rate for Payer: Meridian Medicaid	$470.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,214.25
Rate for Payer: Priority Health Choice Medicaid	$448.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,402.27
Rate for Payer: Priority Health Narrow/Tiered Network	$1,402.27
Rate for Payer: UHC Medicaid	$448.15
Rate for Payer: UHCCP Medicaid	$448.15

PR DAILY HOSP MGMT EDRL/SARACH CONT DRUG ADMN

Professional

Both

$3.00

Service Code	HCPCS 01996
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$133.50
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$133.50
Rate for Payer: Priority Health Narrow/Tiered Network	$133.50

PR DBRDMT EXTENSV ECZMT/INFCT SKIN UP 10% BDY SURF

Professional

Both

$93.00

Service Code	HCPCS 11000
Min. Negotiated Rate	$15.55
Max. Negotiated Rate	$69.75
Rate for Payer: Aetna Commercial	$30.50
Rate for Payer: Aetna Medicare	$46.50
Rate for Payer: BCBS Complete	$16.33
Rate for Payer: BCN Commercial	$31.42
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cash Price	$74.40
Rate for Payer: Mclaren Medicaid	$15.55
Rate for Payer: Meridian Medicaid	$16.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$69.75
Rate for Payer: Priority Health Choice Medicaid	$15.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$36.47
Rate for Payer: Priority Health Narrow/Tiered Network	$36.47
Rate for Payer: UHC Medicaid	$15.55
Rate for Payer: UHCCP Medicaid	$15.55

Know your out-of-pocket cost for care.

All Charges