Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR DEBRIDEMENT MASTOIDECTOMY CAVITY CMPLX

Professional

Both

$381.00

Service Code	HCPCS 69222
Min. Negotiated Rate	$80.30
Max. Negotiated Rate	$285.75
Rate for Payer: Aetna Commercial	$150.51
Rate for Payer: Aetna Medicare	$190.50
Rate for Payer: BCBS Complete	$84.31
Rate for Payer: BCN Commercial	$205.66
Rate for Payer: Cash Price	$304.80
Rate for Payer: Cash Price	$304.80
Rate for Payer: Mclaren Medicaid	$80.30
Rate for Payer: Meridian Medicaid	$84.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$285.75
Rate for Payer: Priority Health Choice Medicaid	$80.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$203.22
Rate for Payer: Priority Health Narrow/Tiered Network	$203.22
Rate for Payer: UHC Medicaid	$80.30
Rate for Payer: UHCCP Medicaid	$80.30

PR DEBRIDEMENT MASTOIDECTOMY CAVITY SIMPLE

Professional

Both

$231.00

Service Code	HCPCS 69220
Min. Negotiated Rate	$28.33
Max. Negotiated Rate	$173.25
Rate for Payer: Aetna Commercial	$57.79
Rate for Payer: Aetna Medicare	$115.50
Rate for Payer: BCBS Complete	$29.75
Rate for Payer: BCN Commercial	$77.69
Rate for Payer: Cash Price	$184.80
Rate for Payer: Cash Price	$184.80
Rate for Payer: Mclaren Medicaid	$28.33
Rate for Payer: Meridian Medicaid	$29.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$173.25
Rate for Payer: Priority Health Choice Medicaid	$28.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$76.76
Rate for Payer: Priority Health Narrow/Tiered Network	$76.76
Rate for Payer: UHC Medicaid	$28.33
Rate for Payer: UHCCP Medicaid	$28.33

PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<

Professional

Both

$493.00

Service Code	HCPCS 11043
Min. Negotiated Rate	$88.18
Max. Negotiated Rate	$369.75
Rate for Payer: Aetna Commercial	$168.37
Rate for Payer: Aetna Medicare	$246.50
Rate for Payer: BCBS Complete	$92.59
Rate for Payer: BCN Commercial	$230.07
Rate for Payer: Cash Price	$394.40
Rate for Payer: Cash Price	$394.40
Rate for Payer: Mclaren Medicaid	$88.18
Rate for Payer: Meridian Medicaid	$92.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$369.75
Rate for Payer: Priority Health Choice Medicaid	$88.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$210.57
Rate for Payer: Priority Health Narrow/Tiered Network	$210.57
Rate for Payer: UHC Medicaid	$88.18
Rate for Payer: UHCCP Medicaid	$88.18

PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<

Facility

$493.00

Service Code	CPT 11043
Hospital Charge Code	11043
Hospital Revenue Code	960
Min. Negotiated Rate	$343.13
Max. Negotiated Rate	$443.70
Rate for Payer: Aetna Commercial	$419.05
Rate for Payer: BCBS Trust/PPO	$407.17
Rate for Payer: BCN Commercial	$407.17
Rate for Payer: Cash Price	$394.40
Rate for Payer: Cofinity Commercial	$423.98
Rate for Payer: Encore Health Key Benefits Commercial	$394.40
Rate for Payer: Healthscope Commercial	$443.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$369.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$419.05
Rate for Payer: Nomi Health Commercial	$404.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$369.75
Rate for Payer: PHP Commercial	$419.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$428.91
Rate for Payer: Priority Health Narrow/Tiered Network	$343.13
Rate for Payer: UHC Core	$411.65
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$369.75

PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<

Professional

Both

$493.00

Service Code	HCPCS 11043
Hospital Charge Code	11043
Min. Negotiated Rate	$88.18
Max. Negotiated Rate	$369.75
Rate for Payer: Aetna Commercial	$168.37
Rate for Payer: Aetna Medicare	$246.50
Rate for Payer: BCBS Complete	$92.59
Rate for Payer: BCN Commercial	$230.07
Rate for Payer: Cash Price	$394.40
Rate for Payer: Cash Price	$394.40
Rate for Payer: Mclaren Medicaid	$88.18
Rate for Payer: Meridian Medicaid	$92.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$369.75
Rate for Payer: Priority Health Choice Medicaid	$88.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$210.57
Rate for Payer: Priority Health Narrow/Tiered Network	$210.57
Rate for Payer: UHC Medicaid	$88.18
Rate for Payer: UHCCP Medicaid	$88.18

PR DEBRIDEMENT MUSCLE &/FASCIA 1ST 20 SQ CM/<

Facility

$493.00

Service Code	CPT 11043
Hospital Charge Code	11043
Hospital Revenue Code	960
Min. Negotiated Rate	$86.92
Max. Negotiated Rate	$443.70
Rate for Payer: Aetna Commercial	$419.05
Rate for Payer: Aetna Medicare	$128.18
Rate for Payer: Allen County Amish Medical Aid Commercial	$154.06
Rate for Payer: Amish Plain Church Group Commercial	$154.06
Rate for Payer: BCBS Complete	$91.25
Rate for Payer: BCBS MAPPO	$123.25
Rate for Payer: BCBS Trust/PPO	$405.30
Rate for Payer: BCN Commercial	$405.30
Rate for Payer: BCN Medicare Advantage	$123.25
Rate for Payer: Cash Price	$394.40
Rate for Payer: Cofinity Commercial	$423.98
Rate for Payer: Encore Health Key Benefits Commercial	$394.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$123.25
Rate for Payer: Healthscope Commercial	$443.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$369.75
Rate for Payer: Mclaren Medicaid	$86.92
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$129.41
Rate for Payer: Meridian Medicaid	$91.25
Rate for Payer: MI Amish Medical Board Commercial	$141.74
Rate for Payer: Molina Medicare/Medicaid	$135.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$419.05
Rate for Payer: Nomi Health Commercial	$404.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$369.75
Rate for Payer: PACE Senior Care Partners	$117.09
Rate for Payer: PACE SWMI	$123.25
Rate for Payer: PHP Commercial	$419.05
Rate for Payer: PHP Medicare Advantage	$123.25
Rate for Payer: Priority Health Choice Medicaid	$86.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$428.91
Rate for Payer: Priority Health Medicare	$124.48
Rate for Payer: Priority Health Narrow/Tiered Network	$343.13
Rate for Payer: Railroad Medicare Medicare	$123.25
Rate for Payer: UHC Core	$411.65
Rate for Payer: UHC Exchange	$123.25
Rate for Payer: UHC Medicaid	$86.92
Rate for Payer: UHC Medicare Advantage	$123.25
Rate for Payer: UHCCP Medicaid	$86.92
Rate for Payer: VA VA	$123.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$369.75

PR DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM

Professional

Both

$104.00

Service Code	HCPCS 11046
Min. Negotiated Rate	$30.46
Max. Negotiated Rate	$80.67
Rate for Payer: Aetna Commercial	$61.04
Rate for Payer: Aetna Medicare	$52.00
Rate for Payer: BCBS Complete	$31.98
Rate for Payer: BCN Commercial	$80.67
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cash Price	$83.20
Rate for Payer: Mclaren Medicaid	$30.46
Rate for Payer: Meridian Medicaid	$31.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.00
Rate for Payer: Priority Health Choice Medicaid	$30.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$73.83
Rate for Payer: Priority Health Narrow/Tiered Network	$73.83
Rate for Payer: UHC Medicaid	$30.46
Rate for Payer: UHCCP Medicaid	$30.46

PR DEBRIDEMENT NAIL ANY METHOD 1-5

Professional

Both

$57.00

Service Code	HCPCS 11720
Min. Negotiated Rate	$8.09
Max. Negotiated Rate	$42.75
Rate for Payer: Aetna Commercial	$15.50
Rate for Payer: Aetna Medicare	$28.50
Rate for Payer: BCBS Complete	$8.49
Rate for Payer: BCN Commercial	$16.89
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$45.60
Rate for Payer: Mclaren Medicaid	$8.09
Rate for Payer: Meridian Medicaid	$8.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$42.75
Rate for Payer: Priority Health Choice Medicaid	$8.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$19.60
Rate for Payer: Priority Health Narrow/Tiered Network	$19.60
Rate for Payer: UHC Medicaid	$8.09
Rate for Payer: UHCCP Medicaid	$8.09

PR DEBRIDEMENT NAIL ANY METHOD 6/>

Professional

Both

$80.00

Service Code	HCPCS 11721
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Commercial	$25.22
Rate for Payer: Aetna Medicare	$40.00
Rate for Payer: BCBS Complete	$14.31
Rate for Payer: BCN Commercial	$27.88
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Mclaren Medicaid	$13.63
Rate for Payer: Meridian Medicaid	$14.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.00
Rate for Payer: Priority Health Choice Medicaid	$13.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$32.37
Rate for Payer: Priority Health Narrow/Tiered Network	$32.37
Rate for Payer: UHC Medicaid	$13.63
Rate for Payer: UHCCP Medicaid	$13.63

PR DEBRIDEMENT OPEN WOUND FIRST 20 SQ CM/<

Professional

Both

$124.00

Service Code	HCPCS 97597
Min. Negotiated Rate	$19.81
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$39.84
Rate for Payer: Aetna Medicare	$62.00
Rate for Payer: BCBS Complete	$20.80
Rate for Payer: BCN Commercial	$52.29
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$99.20
Rate for Payer: Mclaren Medicaid	$19.81
Rate for Payer: Meridian Medicaid	$20.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$93.00
Rate for Payer: Priority Health Choice Medicaid	$19.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$48.95
Rate for Payer: Priority Health Narrow/Tiered Network	$48.95
Rate for Payer: UHC Medicaid	$19.81
Rate for Payer: UHCCP Medicaid	$19.81

PR DEBRIDEMENT OPN WND EA ADDL 20 SQ CM/PRT THEREOF

Professional

Both

$143.00

Service Code	HCPCS 97598
Min. Negotiated Rate	$13.85
Max. Negotiated Rate	$107.25
Rate for Payer: Aetna Commercial	$27.86
Rate for Payer: Aetna Medicare	$71.50
Rate for Payer: BCBS Complete	$14.54
Rate for Payer: BCN Commercial	$35.86
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cash Price	$114.40
Rate for Payer: Mclaren Medicaid	$13.85
Rate for Payer: Meridian Medicaid	$14.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$107.25
Rate for Payer: Priority Health Choice Medicaid	$13.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$34.51
Rate for Payer: Priority Health Narrow/Tiered Network	$34.51
Rate for Payer: UHC Medicaid	$13.85
Rate for Payer: UHCCP Medicaid	$13.85

PR DEBRIDEMENT, SKIN, PARTIAL THICKNESS

Professional

Both

$80.00

Service Code	HCPCS 11040
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$60.00
Rate for Payer: Aetna Medicare	$40.00
Rate for Payer: BCBS Complete	$32.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.00

PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<

Professional

Both

$347.00

Service Code	HCPCS 11042
Hospital Charge Code	11042
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$260.25
Rate for Payer: Aetna Commercial	$65.33
Rate for Payer: Aetna Medicare	$173.50
Rate for Payer: BCBS Complete	$37.35
Rate for Payer: BCN Commercial	$90.63
Rate for Payer: Cash Price	$277.60
Rate for Payer: Cash Price	$277.60
Rate for Payer: Mclaren Medicaid	$35.57
Rate for Payer: Meridian Medicaid	$37.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$260.25
Rate for Payer: Priority Health Choice Medicaid	$35.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$82.95
Rate for Payer: Priority Health Narrow/Tiered Network	$82.95
Rate for Payer: UHC Medicaid	$35.57
Rate for Payer: UHCCP Medicaid	$35.57

PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<

Facility

$347.00

Service Code	CPT 11042
Hospital Charge Code	11042
Hospital Revenue Code	521
Min. Negotiated Rate	$241.51
Max. Negotiated Rate	$312.30
Rate for Payer: Aetna Commercial	$294.95
Rate for Payer: BCBS Trust/PPO	$286.59
Rate for Payer: BCN Commercial	$286.59
Rate for Payer: Cash Price	$277.60
Rate for Payer: Cofinity Commercial	$298.42
Rate for Payer: Encore Health Key Benefits Commercial	$277.60
Rate for Payer: Healthscope Commercial	$312.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$260.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$294.95
Rate for Payer: Nomi Health Commercial	$284.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$260.25
Rate for Payer: PHP Commercial	$294.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$301.89
Rate for Payer: Priority Health Narrow/Tiered Network	$241.51
Rate for Payer: UHC Core	$289.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$260.25

PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<

Professional

Both

$347.00

Service Code	HCPCS 11042
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$260.25
Rate for Payer: Aetna Commercial	$65.33
Rate for Payer: Aetna Medicare	$173.50
Rate for Payer: BCBS Complete	$37.35
Rate for Payer: BCN Commercial	$90.63
Rate for Payer: Cash Price	$277.60
Rate for Payer: Cash Price	$277.60
Rate for Payer: Mclaren Medicaid	$35.57
Rate for Payer: Meridian Medicaid	$37.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$260.25
Rate for Payer: Priority Health Choice Medicaid	$35.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$82.95
Rate for Payer: Priority Health Narrow/Tiered Network	$82.95
Rate for Payer: UHC Medicaid	$35.57
Rate for Payer: UHCCP Medicaid	$35.57

PR DEBRIDEMENT SUBCUTANEOUS TISSUE 1ST 20 SQ CM/<

Facility

$347.00

Service Code	CPT 11042
Hospital Charge Code	11042
Hospital Revenue Code	521
Min. Negotiated Rate	$61.18
Max. Negotiated Rate	$312.30
Rate for Payer: Aetna Commercial	$294.95
Rate for Payer: Aetna Medicare	$90.22
Rate for Payer: Allen County Amish Medical Aid Commercial	$108.44
Rate for Payer: Amish Plain Church Group Commercial	$108.44
Rate for Payer: BCBS Complete	$64.23
Rate for Payer: BCBS MAPPO	$86.75
Rate for Payer: BCBS Trust/PPO	$285.27
Rate for Payer: BCN Commercial	$285.27
Rate for Payer: BCN Medicare Advantage	$86.75
Rate for Payer: Cash Price	$277.60
Rate for Payer: Cofinity Commercial	$298.42
Rate for Payer: Encore Health Key Benefits Commercial	$277.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$86.75
Rate for Payer: Healthscope Commercial	$312.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$260.25
Rate for Payer: Mclaren Medicaid	$61.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$91.09
Rate for Payer: Meridian Medicaid	$64.23
Rate for Payer: MI Amish Medical Board Commercial	$99.76
Rate for Payer: Molina Medicare/Medicaid	$95.42
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$294.95
Rate for Payer: Nomi Health Commercial	$284.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$260.25
Rate for Payer: PACE Senior Care Partners	$82.41
Rate for Payer: PACE SWMI	$86.75
Rate for Payer: PHP Commercial	$294.95
Rate for Payer: PHP Medicare Advantage	$86.75
Rate for Payer: Priority Health Choice Medicaid	$61.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$301.89
Rate for Payer: Priority Health Medicare	$87.62
Rate for Payer: Priority Health Narrow/Tiered Network	$241.51
Rate for Payer: Railroad Medicare Medicare	$86.75
Rate for Payer: UHC Core	$289.75
Rate for Payer: UHC Exchange	$86.75
Rate for Payer: UHC Medicaid	$61.18
Rate for Payer: UHC Medicare Advantage	$86.75
Rate for Payer: UHCCP Medicaid	$61.18
Rate for Payer: VA VA	$86.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$260.25

PR DEBRIDEMENT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM

Professional

Both

$72.00

Service Code	HCPCS 11045
Min. Negotiated Rate	$14.06
Max. Negotiated Rate	$54.00
Rate for Payer: Aetna Commercial	$28.87
Rate for Payer: Aetna Medicare	$36.00
Rate for Payer: BCBS Complete	$14.76
Rate for Payer: BCN Commercial	$36.85
Rate for Payer: Cash Price	$57.60
Rate for Payer: Cash Price	$57.60
Rate for Payer: Mclaren Medicaid	$14.06
Rate for Payer: Meridian Medicaid	$14.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.00
Rate for Payer: Priority Health Choice Medicaid	$14.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$33.73
Rate for Payer: Priority Health Narrow/Tiered Network	$33.73
Rate for Payer: UHC Medicaid	$14.06
Rate for Payer: UHCCP Medicaid	$14.06

PR DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH

Professional

Both

$62.00

Service Code	HCPCS 36593
Min. Negotiated Rate	$31.00
Max. Negotiated Rate	$55.69
Rate for Payer: Aetna Commercial	$41.26
Rate for Payer: Aetna Medicare	$31.00
Rate for Payer: BCN Commercial	$51.79
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$46.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$55.69
Rate for Payer: Priority Health Narrow/Tiered Network	$55.69

PR DECOMPRESSION FASCIOTOMY PELVIC COMPARTMENT UNI

Professional

Both

$1,889.00

Service Code	HCPCS 27027
Min. Negotiated Rate	$516.31
Max. Negotiated Rate	$1,433.03
Rate for Payer: Aetna Commercial	$1,179.09
Rate for Payer: Aetna Medicare	$944.50
Rate for Payer: BCBS Complete	$542.13
Rate for Payer: BCN Commercial	$1,340.57
Rate for Payer: Cash Price	$1,511.20
Rate for Payer: Cash Price	$1,511.20
Rate for Payer: Mclaren Medicaid	$516.31
Rate for Payer: Meridian Medicaid	$542.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,416.75
Rate for Payer: Priority Health Choice Medicaid	$516.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,433.03
Rate for Payer: Priority Health Narrow/Tiered Network	$1,433.03
Rate for Payer: UHC Medicaid	$516.31
Rate for Payer: UHCCP Medicaid	$516.31

PR DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT

Professional

Both

$976.00

Service Code	HCPCS 27496
Min. Negotiated Rate	$338.67
Max. Negotiated Rate	$904.43
Rate for Payer: Aetna Commercial	$728.83
Rate for Payer: Aetna Medicare	$488.00
Rate for Payer: BCBS Complete	$355.60
Rate for Payer: BCN Commercial	$846.07
Rate for Payer: Cash Price	$780.80
Rate for Payer: Cash Price	$780.80
Rate for Payer: Mclaren Medicaid	$338.67
Rate for Payer: Meridian Medicaid	$355.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$732.00
Rate for Payer: Priority Health Choice Medicaid	$338.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$904.43
Rate for Payer: Priority Health Narrow/Tiered Network	$904.43
Rate for Payer: UHC Medicaid	$338.67
Rate for Payer: UHCCP Medicaid	$338.67

PR DECOMPRESSION FASCT FOREARM W/BRACH ARTERY EXPL

Professional

Both

$1,743.00

Service Code	HCPCS 24495
Min. Negotiated Rate	$578.08
Max. Negotiated Rate	$1,474.55
Rate for Payer: Aetna Commercial	$1,009.58
Rate for Payer: Aetna Medicare	$871.50
Rate for Payer: BCBS Complete	$606.98
Rate for Payer: BCN Commercial	$1,379.41
Rate for Payer: Cash Price	$1,394.40
Rate for Payer: Cash Price	$1,394.40
Rate for Payer: Mclaren Medicaid	$578.08
Rate for Payer: Meridian Medicaid	$606.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,307.25
Rate for Payer: Priority Health Choice Medicaid	$578.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,474.55
Rate for Payer: Priority Health Narrow/Tiered Network	$1,474.55
Rate for Payer: UHC Medicaid	$578.08
Rate for Payer: UHCCP Medicaid	$578.08

PR DECOMPRESSION FINGERS&/HAND INJECTION INJURY

Professional

Both

$2,252.00

Service Code	HCPCS 26035
Min. Negotiated Rate	$519.93
Max. Negotiated Rate	$1,689.00
Rate for Payer: Aetna Commercial	$1,146.22
Rate for Payer: Aetna Medicare	$1,126.00
Rate for Payer: BCBS Complete	$545.93
Rate for Payer: BCN Commercial	$1,316.16
Rate for Payer: Cash Price	$1,801.60
Rate for Payer: Cash Price	$1,801.60
Rate for Payer: Mclaren Medicaid	$519.93
Rate for Payer: Meridian Medicaid	$545.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,689.00
Rate for Payer: Priority Health Choice Medicaid	$519.93
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,406.95
Rate for Payer: Priority Health Narrow/Tiered Network	$1,406.95
Rate for Payer: UHC Medicaid	$519.93
Rate for Payer: UHCCP Medicaid	$519.93

PR DECOMPRESSION ORBIT ONLY TRANSCRANIAL APPROACH

Professional

Both

$5,918.00

Service Code	HCPCS 61330
Min. Negotiated Rate	$1,124.64
Max. Negotiated Rate	$4,438.50
Rate for Payer: Aetna Commercial	$2,316.66
Rate for Payer: Aetna Medicare	$2,959.00
Rate for Payer: BCBS Complete	$1,180.87
Rate for Payer: BCN Commercial	$2,736.90
Rate for Payer: Cash Price	$4,734.40
Rate for Payer: Cash Price	$4,734.40
Rate for Payer: Mclaren Medicaid	$1,124.64
Rate for Payer: Meridian Medicaid	$1,180.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,438.50
Rate for Payer: Priority Health Choice Medicaid	$1,124.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,178.86
Rate for Payer: Priority Health Narrow/Tiered Network	$3,178.86
Rate for Payer: UHC Medicaid	$1,124.64
Rate for Payer: UHCCP Medicaid	$1,124.64

PR DECOMPRESSION PLANTAR DIGITAL NERVE

Professional

Both

$1,620.00

Service Code	HCPCS 64726
Min. Negotiated Rate	$164.65
Max. Negotiated Rate	$1,215.00
Rate for Payer: Aetna Commercial	$341.98
Rate for Payer: Aetna Medicare	$810.00
Rate for Payer: BCBS Complete	$172.88
Rate for Payer: BCN Commercial	$410.84
Rate for Payer: Cash Price	$1,296.00
Rate for Payer: Cash Price	$1,296.00
Rate for Payer: Mclaren Medicaid	$164.65
Rate for Payer: Meridian Medicaid	$172.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,215.00
Rate for Payer: Priority Health Choice Medicaid	$164.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$477.18
Rate for Payer: Priority Health Narrow/Tiered Network	$477.18
Rate for Payer: UHC Medicaid	$164.65
Rate for Payer: UHCCP Medicaid	$164.65

PR DECOMPRESSION UNSPECIFIED NERVE

Professional

Both

$1,836.00

Service Code	HCPCS 64722
Min. Negotiated Rate	$237.92
Max. Negotiated Rate	$1,377.00
Rate for Payer: Aetna Commercial	$455.08
Rate for Payer: Aetna Medicare	$918.00
Rate for Payer: BCBS Complete	$249.82
Rate for Payer: BCN Commercial	$567.69
Rate for Payer: Cash Price	$1,468.80
Rate for Payer: Cash Price	$1,468.80
Rate for Payer: Mclaren Medicaid	$237.92
Rate for Payer: Meridian Medicaid	$249.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,377.00
Rate for Payer: Priority Health Choice Medicaid	$237.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$659.37
Rate for Payer: Priority Health Narrow/Tiered Network	$659.37
Rate for Payer: UHC Medicaid	$237.92
Rate for Payer: UHCCP Medicaid	$237.92

Know your out-of-pocket cost for care.

All Charges