Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR DRAINAGE DEEP PERIURETHRAL ABSCESS

Professional

Both

$839.00

Service Code	HCPCS 53040
Min. Negotiated Rate	$231.11
Max. Negotiated Rate	$644.99
Rate for Payer: Aetna Commercial	$501.88
Rate for Payer: Aetna Medicare	$419.50
Rate for Payer: BCBS Complete	$242.67
Rate for Payer: BCN Commercial	$592.10
Rate for Payer: Cash Price	$671.20
Rate for Payer: Cash Price	$671.20
Rate for Payer: Mclaren Medicaid	$231.11
Rate for Payer: Meridian Medicaid	$242.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$629.25
Rate for Payer: Priority Health Choice Medicaid	$231.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$644.99
Rate for Payer: Priority Health Narrow/Tiered Network	$644.99
Rate for Payer: UHC Medicaid	$231.11
Rate for Payer: UHCCP Medicaid	$231.11

PR DRAINAGE EXTERNAL AUDITORY CANAL ABSCESS

Professional

Both

$391.00

Service Code	HCPCS 69020
Min. Negotiated Rate	$84.77
Max. Negotiated Rate	$293.25
Rate for Payer: Aetna Commercial	$158.84
Rate for Payer: Aetna Medicare	$195.50
Rate for Payer: BCBS Complete	$89.01
Rate for Payer: BCN Commercial	$216.62
Rate for Payer: Cash Price	$312.80
Rate for Payer: Cash Price	$312.80
Rate for Payer: Mclaren Medicaid	$84.77
Rate for Payer: Meridian Medicaid	$89.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$293.25
Rate for Payer: Priority Health Choice Medicaid	$84.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$214.05
Rate for Payer: Priority Health Narrow/Tiered Network	$214.05
Rate for Payer: UHC Medicaid	$84.77
Rate for Payer: UHCCP Medicaid	$84.77

PR DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA COMP

Professional

Both

$397.00

Service Code	HCPCS 69005
Min. Negotiated Rate	$93.29
Max. Negotiated Rate	$297.75
Rate for Payer: Aetna Commercial	$177.45
Rate for Payer: Aetna Medicare	$198.50
Rate for Payer: BCBS Complete	$97.95
Rate for Payer: BCN Commercial	$244.01
Rate for Payer: Cash Price	$317.60
Rate for Payer: Cash Price	$317.60
Rate for Payer: Mclaren Medicaid	$93.29
Rate for Payer: Meridian Medicaid	$97.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$297.75
Rate for Payer: Priority Health Choice Medicaid	$93.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$241.11
Rate for Payer: Priority Health Narrow/Tiered Network	$241.11
Rate for Payer: UHC Medicaid	$93.29
Rate for Payer: UHCCP Medicaid	$93.29

PR DRAINAGE EXTERNAL EAR ABSCESS/HEMATOMA SIMPLE

Professional

Both

$327.00

Service Code	HCPCS 69000
Min. Negotiated Rate	$74.98
Max. Negotiated Rate	$245.25
Rate for Payer: Aetna Commercial	$136.46
Rate for Payer: Aetna Medicare	$163.50
Rate for Payer: BCBS Complete	$78.73
Rate for Payer: BCN Commercial	$189.23
Rate for Payer: Cash Price	$261.60
Rate for Payer: Cash Price	$261.60
Rate for Payer: Mclaren Medicaid	$74.98
Rate for Payer: Meridian Medicaid	$78.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$245.25
Rate for Payer: Priority Health Choice Medicaid	$74.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$186.99
Rate for Payer: Priority Health Narrow/Tiered Network	$186.99
Rate for Payer: UHC Medicaid	$74.98
Rate for Payer: UHCCP Medicaid	$74.98

PR DRAINAGE FINGER ABSCESS COMPLICATED

Professional

Both

$835.00

Service Code	HCPCS 26011
Min. Negotiated Rate	$116.30
Max. Negotiated Rate	$626.25
Rate for Payer: Aetna Commercial	$245.87
Rate for Payer: Aetna Medicare	$417.50
Rate for Payer: BCBS Complete	$122.11
Rate for Payer: BCN Commercial	$282.86
Rate for Payer: Cash Price	$668.00
Rate for Payer: Cash Price	$668.00
Rate for Payer: Mclaren Medicaid	$116.30
Rate for Payer: Meridian Medicaid	$122.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$626.25
Rate for Payer: Priority Health Choice Medicaid	$116.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$302.37
Rate for Payer: Priority Health Narrow/Tiered Network	$302.37
Rate for Payer: UHC Medicaid	$116.30
Rate for Payer: UHCCP Medicaid	$116.30

PR DRAINAGE FINGER ABSCESS SIMPLE

Professional

Both

$593.00

Service Code	HCPCS 26010
Min. Negotiated Rate	$92.44
Max. Negotiated Rate	$444.75
Rate for Payer: Aetna Commercial	$184.30
Rate for Payer: Aetna Medicare	$296.50
Rate for Payer: BCBS Complete	$97.06
Rate for Payer: BCN Commercial	$214.63
Rate for Payer: Cash Price	$474.40
Rate for Payer: Cash Price	$474.40
Rate for Payer: Mclaren Medicaid	$92.44
Rate for Payer: Meridian Medicaid	$97.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$444.75
Rate for Payer: Priority Health Choice Medicaid	$92.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$229.43
Rate for Payer: Priority Health Narrow/Tiered Network	$229.43
Rate for Payer: UHC Medicaid	$92.44
Rate for Payer: UHCCP Medicaid	$92.44

PR DRAINAGE OF PALMAR BURSA MULTIPLE BURSA

Professional

Both

$3,273.00

Service Code	HCPCS 26030
Min. Negotiated Rate	$297.14
Max. Negotiated Rate	$2,454.75
Rate for Payer: Aetna Commercial	$651.70
Rate for Payer: Aetna Medicare	$1,636.50
Rate for Payer: BCBS Complete	$312.00
Rate for Payer: BCN Commercial	$756.93
Rate for Payer: Cash Price	$2,618.40
Rate for Payer: Cash Price	$2,618.40
Rate for Payer: Mclaren Medicaid	$297.14
Rate for Payer: Meridian Medicaid	$312.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,454.75
Rate for Payer: Priority Health Choice Medicaid	$297.14
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	$297.14
Rate for Payer: UHCCP Medicaid	$297.14

PR DRAINAGE OF PALMAR BURSA SINGLE BURSA

Professional

Both

$1,404.00

Service Code	HCPCS 26025
Min. Negotiated Rate	$257.94
Max. Negotiated Rate	$1,053.00
Rate for Payer: Aetna Commercial	$560.79
Rate for Payer: Aetna Medicare	$702.00
Rate for Payer: BCBS Complete	$270.84
Rate for Payer: BCN Commercial	$643.89
Rate for Payer: Cash Price	$1,123.20
Rate for Payer: Cash Price	$1,123.20
Rate for Payer: Mclaren Medicaid	$257.94
Rate for Payer: Meridian Medicaid	$270.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,053.00
Rate for Payer: Priority Health Choice Medicaid	$257.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$688.30
Rate for Payer: Priority Health Narrow/Tiered Network	$688.30
Rate for Payer: UHC Medicaid	$257.94
Rate for Payer: UHCCP Medicaid	$257.94

PR DRAINAGE OF RETROPERITONEAL ABSCESS OPEN

Professional

Both

$2,316.00

Service Code	HCPCS 49060
Min. Negotiated Rate	$654.34
Max. Negotiated Rate	$2,020.51
Rate for Payer: Aetna Commercial	$1,480.16
Rate for Payer: Aetna Medicare	$1,158.00
Rate for Payer: BCBS Complete	$687.06
Rate for Payer: BCN Commercial	$1,658.28
Rate for Payer: Cash Price	$1,852.80
Rate for Payer: Cash Price	$1,852.80
Rate for Payer: Mclaren Medicaid	$654.34
Rate for Payer: Meridian Medicaid	$687.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,737.00
Rate for Payer: Priority Health Choice Medicaid	$654.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,020.51
Rate for Payer: Priority Health Narrow/Tiered Network	$2,020.51
Rate for Payer: UHC Medicaid	$654.34
Rate for Payer: UHCCP Medicaid	$654.34

PR DRAINAGE OVARIAN ABSCESS ABDOMINAL APPROACH

Professional

Both

$1,777.00

Service Code	HCPCS 58822
Min. Negotiated Rate	$403.42
Max. Negotiated Rate	$1,332.75
Rate for Payer: Aetna Commercial	$854.23
Rate for Payer: Aetna Medicare	$888.50
Rate for Payer: BCBS Complete	$423.59
Rate for Payer: BCN Commercial	$1,071.66
Rate for Payer: Cash Price	$1,421.60
Rate for Payer: Cash Price	$1,421.60
Rate for Payer: Mclaren Medicaid	$403.42
Rate for Payer: Meridian Medicaid	$423.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,332.75
Rate for Payer: Priority Health Choice Medicaid	$403.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,085.36
Rate for Payer: Priority Health Narrow/Tiered Network	$1,085.36
Rate for Payer: UHC Medicaid	$403.42
Rate for Payer: UHCCP Medicaid	$403.42

PR DRAINAGE OVARIAN ABSCESS VAGINAL APPR OPEN

Professional

Both

$924.00

Service Code	HCPCS 58820
Min. Negotiated Rate	$193.62
Max. Negotiated Rate	$693.00
Rate for Payer: Aetna Commercial	$398.40
Rate for Payer: Aetna Medicare	$462.00
Rate for Payer: BCBS Complete	$203.30
Rate for Payer: BCN Commercial	$510.44
Rate for Payer: Cash Price	$739.20
Rate for Payer: Cash Price	$739.20
Rate for Payer: Mclaren Medicaid	$193.62
Rate for Payer: Meridian Medicaid	$203.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$693.00
Rate for Payer: Priority Health Choice Medicaid	$193.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$516.95
Rate for Payer: Priority Health Narrow/Tiered Network	$516.95
Rate for Payer: UHC Medicaid	$193.62
Rate for Payer: UHCCP Medicaid	$193.62

PR DRAINAGE OVARIAN CYST UNI/BI SPX ABDOMINAL

Professional

Both

$1,660.00

Service Code	HCPCS 58805
Min. Negotiated Rate	$243.03
Max. Negotiated Rate	$1,245.00
Rate for Payer: Aetna Commercial	$506.69
Rate for Payer: Aetna Medicare	$830.00
Rate for Payer: BCBS Complete	$255.18
Rate for Payer: BCN Commercial	$642.39
Rate for Payer: Cash Price	$1,328.00
Rate for Payer: Cash Price	$1,328.00
Rate for Payer: Mclaren Medicaid	$243.03
Rate for Payer: Meridian Medicaid	$255.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,245.00
Rate for Payer: Priority Health Choice Medicaid	$243.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$650.61
Rate for Payer: Priority Health Narrow/Tiered Network	$650.61
Rate for Payer: UHC Medicaid	$243.03
Rate for Payer: UHCCP Medicaid	$243.03

PR DRAINAGE OVARIAN CYST UNI/BI SPX VAGINAL APPR

Professional

Both

$1,023.00

Service Code	HCPCS 58800
Min. Negotiated Rate	$179.56
Max. Negotiated Rate	$767.25
Rate for Payer: Aetna Commercial	$373.31
Rate for Payer: Aetna Medicare	$511.50
Rate for Payer: BCBS Complete	$188.54
Rate for Payer: BCN Commercial	$476.07
Rate for Payer: Cash Price	$818.40
Rate for Payer: Cash Price	$818.40
Rate for Payer: Mclaren Medicaid	$179.56
Rate for Payer: Meridian Medicaid	$188.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$767.25
Rate for Payer: Priority Health Choice Medicaid	$179.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$482.15
Rate for Payer: Priority Health Narrow/Tiered Network	$482.15
Rate for Payer: UHC Medicaid	$179.56
Rate for Payer: UHCCP Medicaid	$179.56

PR DRAINAGE PERITON ABSCESS/LOCAL PERITONITIS OPEN

Professional

Both

$2,913.00

Service Code	HCPCS 49020
Min. Negotiated Rate	$948.92
Max. Negotiated Rate	$2,913.05
Rate for Payer: Aetna Commercial	$2,149.64
Rate for Payer: Aetna Medicare	$1,456.50
Rate for Payer: BCBS Complete	$996.37
Rate for Payer: BCN Commercial	$2,390.80
Rate for Payer: Cash Price	$2,330.40
Rate for Payer: Cash Price	$2,330.40
Rate for Payer: Mclaren Medicaid	$948.92
Rate for Payer: Meridian Medicaid	$996.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,184.75
Rate for Payer: Priority Health Choice Medicaid	$948.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,913.05
Rate for Payer: Priority Health Narrow/Tiered Network	$2,913.05
Rate for Payer: UHC Medicaid	$948.92
Rate for Payer: UHCCP Medicaid	$948.92

PR DRAINAGE SCROTAL WALL ABSCESS

Professional

Both

$411.00

Service Code	HCPCS 55100
Min. Negotiated Rate	$104.58
Max. Negotiated Rate	$308.25
Rate for Payer: Aetna Commercial	$212.60
Rate for Payer: Aetna Medicare	$205.50
Rate for Payer: BCBS Complete	$109.81
Rate for Payer: BCN Commercial	$254.47
Rate for Payer: Cash Price	$328.80
Rate for Payer: Cash Price	$328.80
Rate for Payer: Mclaren Medicaid	$104.58
Rate for Payer: Meridian Medicaid	$109.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$308.25
Rate for Payer: Priority Health Choice Medicaid	$104.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$277.20
Rate for Payer: Priority Health Narrow/Tiered Network	$277.20
Rate for Payer: UHC Medicaid	$104.58
Rate for Payer: UHCCP Medicaid	$104.58

PR DRAINAGE SUBDIAPHRAGMATIC/SUBPHREN ABSCESS OPEN

Professional

Both

$2,291.00

Service Code	HCPCS 49040
Min. Negotiated Rate	$611.52
Max. Negotiated Rate	$1,842.72
Rate for Payer: Aetna Commercial	$1,356.51
Rate for Payer: Aetna Medicare	$1,145.50
Rate for Payer: BCBS Complete	$642.10
Rate for Payer: BCN Commercial	$1,512.37
Rate for Payer: Cash Price	$1,832.80
Rate for Payer: Cash Price	$1,832.80
Rate for Payer: Mclaren Medicaid	$611.52
Rate for Payer: Meridian Medicaid	$642.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,718.25
Rate for Payer: Priority Health Choice Medicaid	$611.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,842.72
Rate for Payer: Priority Health Narrow/Tiered Network	$1,842.72
Rate for Payer: UHC Medicaid	$611.52
Rate for Payer: UHCCP Medicaid	$611.52

PR DRAINAGE TENDON SHEATH DIGIT&/PALM EACH

Professional

Both

$788.00

Service Code	HCPCS 26020
Min. Negotiated Rate	$339.31
Max. Negotiated Rate	$915.08
Rate for Payer: Aetna Commercial	$737.75
Rate for Payer: Aetna Medicare	$394.00
Rate for Payer: BCBS Complete	$356.28
Rate for Payer: BCN Commercial	$856.03
Rate for Payer: Cash Price	$630.40
Rate for Payer: Cash Price	$630.40
Rate for Payer: Mclaren Medicaid	$339.31
Rate for Payer: Meridian Medicaid	$356.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$591.00
Rate for Payer: Priority Health Choice Medicaid	$339.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$915.08
Rate for Payer: Priority Health Narrow/Tiered Network	$915.08
Rate for Payer: UHC Medicaid	$339.31
Rate for Payer: UHCCP Medicaid	$339.31

PR DRESSING CHANGE UNDER ANESTHESIA

Professional

Both

$175.00

Service Code	HCPCS 15852
Min. Negotiated Rate	$24.71
Max. Negotiated Rate	$131.25
Rate for Payer: Aetna Commercial	$50.88
Rate for Payer: Aetna Medicare	$87.50
Rate for Payer: BCBS Complete	$25.95
Rate for Payer: BCN Commercial	$66.24
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Mclaren Medicaid	$24.71
Rate for Payer: Meridian Medicaid	$25.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$131.25
Rate for Payer: Priority Health Choice Medicaid	$24.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$60.62
Rate for Payer: Priority Health Narrow/Tiered Network	$60.62
Rate for Payer: UHC Medicaid	$24.71
Rate for Payer: UHCCP Medicaid	$24.71

PR DRG ABSC CST HMTMA FROM DENTOALVEOLAR STRUXS

Professional

Both

$575.00

Service Code	HCPCS 41800
Min. Negotiated Rate	$120.56
Max. Negotiated Rate	$431.25
Rate for Payer: Aetna Commercial	$204.22
Rate for Payer: Aetna Medicare	$287.50
Rate for Payer: BCBS Complete	$126.59
Rate for Payer: BCN Commercial	$239.53
Rate for Payer: Cash Price	$460.00
Rate for Payer: Cash Price	$460.00
Rate for Payer: Mclaren Medicaid	$120.56
Rate for Payer: Meridian Medicaid	$126.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$431.25
Rate for Payer: Priority Health Choice Medicaid	$120.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$291.86
Rate for Payer: Priority Health Narrow/Tiered Network	$291.86
Rate for Payer: UHC Medicaid	$120.56
Rate for Payer: UHCCP Medicaid	$120.56

PR DRG ABSC CST HMTMA VESTIBULE MOUTH COMP

Professional

Both

$651.00

Service Code	HCPCS 40801
Min. Negotiated Rate	$120.77
Max. Negotiated Rate	$488.25
Rate for Payer: Aetna Commercial	$262.87
Rate for Payer: Aetna Medicare	$325.50
Rate for Payer: BCBS Complete	$126.81
Rate for Payer: BCN Commercial	$304.76
Rate for Payer: Cash Price	$520.80
Rate for Payer: Cash Price	$520.80
Rate for Payer: Mclaren Medicaid	$120.77
Rate for Payer: Meridian Medicaid	$126.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$488.25
Rate for Payer: Priority Health Choice Medicaid	$120.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$371.33
Rate for Payer: Priority Health Narrow/Tiered Network	$371.33
Rate for Payer: UHC Medicaid	$120.77
Rate for Payer: UHCCP Medicaid	$120.77

PR DRG ABSC CST HMTMA VESTIBULE MOUTH SMPL

Professional

Both

$490.00

Service Code	HCPCS 40800
Min. Negotiated Rate	$73.91
Max. Negotiated Rate	$367.50
Rate for Payer: Aetna Commercial	$157.92
Rate for Payer: Aetna Medicare	$245.00
Rate for Payer: BCBS Complete	$77.61
Rate for Payer: BCN Commercial	$181.76
Rate for Payer: Cash Price	$392.00
Rate for Payer: Cash Price	$392.00
Rate for Payer: Mclaren Medicaid	$73.91
Rate for Payer: Meridian Medicaid	$77.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$367.50
Rate for Payer: Priority Health Choice Medicaid	$73.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$221.46
Rate for Payer: Priority Health Narrow/Tiered Network	$221.46
Rate for Payer: UHC Medicaid	$73.91
Rate for Payer: UHCCP Medicaid	$73.91

PR DRG LYMPH NODE ABSC/LYMPHADENITIS EXTNSV

Professional

Both

$1,090.00

Service Code	HCPCS 38305
Min. Negotiated Rate	$313.32
Max. Negotiated Rate	$1,001.86
Rate for Payer: Aetna Commercial	$608.51
Rate for Payer: Aetna Medicare	$545.00
Rate for Payer: BCBS Complete	$328.99
Rate for Payer: BCN Commercial	$752.95
Rate for Payer: Cash Price	$872.00
Rate for Payer: Cash Price	$872.00
Rate for Payer: Mclaren Medicaid	$313.32
Rate for Payer: Meridian Medicaid	$328.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$817.50
Rate for Payer: Priority Health Choice Medicaid	$313.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,001.86
Rate for Payer: Priority Health Narrow/Tiered Network	$1,001.86
Rate for Payer: UHC Medicaid	$313.32
Rate for Payer: UHCCP Medicaid	$313.32

PR DRG LYMPH NODE ABSC/LYMPHADENITIS SMPL

Professional

Both

$469.00

Service Code	HCPCS 38300
Min. Negotiated Rate	$137.81
Max. Negotiated Rate	$425.38
Rate for Payer: Aetna Commercial	$255.68
Rate for Payer: Aetna Medicare	$234.50
Rate for Payer: BCBS Complete	$144.70
Rate for Payer: BCN Commercial	$319.70
Rate for Payer: Cash Price	$375.20
Rate for Payer: Cash Price	$375.20
Rate for Payer: Mclaren Medicaid	$137.81
Rate for Payer: Meridian Medicaid	$144.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$351.75
Rate for Payer: Priority Health Choice Medicaid	$137.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$425.38
Rate for Payer: Priority Health Narrow/Tiered Network	$425.38
Rate for Payer: UHC Medicaid	$137.81
Rate for Payer: UHCCP Medicaid	$137.81

PR DRG OF SKENE'S GLAND ABSCESS OR CYST

Professional

Both

$633.00

Service Code	HCPCS 53060
Min. Negotiated Rate	$95.00
Max. Negotiated Rate	$474.75
Rate for Payer: Aetna Commercial	$213.39
Rate for Payer: Aetna Medicare	$316.50
Rate for Payer: BCBS Complete	$99.75
Rate for Payer: BCN Commercial	$250.98
Rate for Payer: Cash Price	$506.40
Rate for Payer: Cash Price	$506.40
Rate for Payer: Mclaren Medicaid	$95.00
Rate for Payer: Meridian Medicaid	$99.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$474.75
Rate for Payer: Priority Health Choice Medicaid	$95.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$273.41
Rate for Payer: Priority Health Narrow/Tiered Network	$273.41
Rate for Payer: UHC Medicaid	$95.00
Rate for Payer: UHCCP Medicaid	$95.00

PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE

Professional

Both

$318.00

Service Code	HCPCS 16030
Min. Negotiated Rate	$78.38
Max. Negotiated Rate	$238.50
Rate for Payer: Aetna Commercial	$141.99
Rate for Payer: Aetna Medicare	$159.00
Rate for Payer: BCBS Complete	$82.30
Rate for Payer: BCN Commercial	$199.19
Rate for Payer: Cash Price	$254.40
Rate for Payer: Cash Price	$254.40
Rate for Payer: Mclaren Medicaid	$78.38
Rate for Payer: Meridian Medicaid	$82.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$238.50
Rate for Payer: Priority Health Choice Medicaid	$78.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$182.32
Rate for Payer: Priority Health Narrow/Tiered Network	$182.32
Rate for Payer: UHC Medicaid	$78.38
Rate for Payer: UHCCP Medicaid	$78.38

Know your out-of-pocket cost for care.

All Charges