Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR ENTEROSCOPY > 2ND PRTN ABLTJ LESION

Professional

Both

$1,154.00

Service Code	HCPCS 44369
Min. Negotiated Rate	$137.60
Max. Negotiated Rate	$865.50
Rate for Payer: Aetna Commercial	$326.36
Rate for Payer: Aetna Medicare	$577.00
Rate for Payer: BCBS Complete	$144.48
Rate for Payer: BCN Commercial	$361.04
Rate for Payer: Cash Price	$923.20
Rate for Payer: Cash Price	$923.20
Rate for Payer: Mclaren Medicaid	$137.60
Rate for Payer: Meridian Medicaid	$144.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$865.50
Rate for Payer: Priority Health Choice Medicaid	$137.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$439.90
Rate for Payer: Priority Health Narrow/Tiered Network	$439.90
Rate for Payer: UHC Medicaid	$137.60
Rate for Payer: UHCCP Medicaid	$137.60

PR ENTEROSCOPY > 2ND PRTN CONV GSTRST TUBE

Professional

Both

$950.00

Service Code	HCPCS 44373
Min. Negotiated Rate	$108.63
Max. Negotiated Rate	$712.50
Rate for Payer: Aetna Commercial	$255.47
Rate for Payer: Aetna Medicare	$475.00
Rate for Payer: BCBS Complete	$114.06
Rate for Payer: BCN Commercial	$283.85
Rate for Payer: Cash Price	$760.00
Rate for Payer: Cash Price	$760.00
Rate for Payer: Mclaren Medicaid	$108.63
Rate for Payer: Meridian Medicaid	$114.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$712.50
Rate for Payer: Priority Health Choice Medicaid	$108.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$345.86
Rate for Payer: Priority Health Narrow/Tiered Network	$345.86
Rate for Payer: UHC Medicaid	$108.63
Rate for Payer: UHCCP Medicaid	$108.63

PR ENTEROSCOPY > 2ND PRTN ILEUM CONTROL BLEEDING

Professional

Both

$1,594.00

Service Code	HCPCS 44378
Min. Negotiated Rate	$213.64
Max. Negotiated Rate	$1,195.50
Rate for Payer: Aetna Commercial	$511.57
Rate for Payer: Aetna Medicare	$797.00
Rate for Payer: BCBS Complete	$224.32
Rate for Payer: BCN Commercial	$564.22
Rate for Payer: Cash Price	$1,275.20
Rate for Payer: Cash Price	$1,275.20
Rate for Payer: Mclaren Medicaid	$213.64
Rate for Payer: Meridian Medicaid	$224.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,195.50
Rate for Payer: Priority Health Choice Medicaid	$213.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$687.46
Rate for Payer: Priority Health Narrow/Tiered Network	$687.46
Rate for Payer: UHC Medicaid	$213.64
Rate for Payer: UHCCP Medicaid	$213.64

PR ENTEROSCOPY > 2ND PRTN TNDSC STENT PLMT

Professional

Both

$1,426.00

Service Code	HCPCS 44370
Min. Negotiated Rate	$150.17
Max. Negotiated Rate	$1,069.50
Rate for Payer: Aetna Commercial	$352.95
Rate for Payer: Aetna Medicare	$713.00
Rate for Payer: BCBS Complete	$157.68
Rate for Payer: BCN Commercial	$392.41
Rate for Payer: Cash Price	$1,140.80
Rate for Payer: Cash Price	$1,140.80
Rate for Payer: Mclaren Medicaid	$150.17
Rate for Payer: Meridian Medicaid	$157.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,069.50
Rate for Payer: Priority Health Choice Medicaid	$150.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$478.12
Rate for Payer: Priority Health Narrow/Tiered Network	$478.12
Rate for Payer: UHC Medicaid	$150.17
Rate for Payer: UHCCP Medicaid	$150.17

PR ENTEROSCOPY > 2ND PRTN W/CONTROL BLEEDING

Professional

Both

$1,358.00

Service Code	HCPCS 44366
Min. Negotiated Rate	$134.19
Max. Negotiated Rate	$1,018.50
Rate for Payer: Aetna Commercial	$318.57
Rate for Payer: Aetna Medicare	$679.00
Rate for Payer: BCBS Complete	$140.90
Rate for Payer: BCN Commercial	$352.57
Rate for Payer: Cash Price	$1,086.40
Rate for Payer: Cash Price	$1,086.40
Rate for Payer: Mclaren Medicaid	$134.19
Rate for Payer: Meridian Medicaid	$140.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,018.50
Rate for Payer: Priority Health Choice Medicaid	$134.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$429.58
Rate for Payer: Priority Health Narrow/Tiered Network	$429.58
Rate for Payer: UHC Medicaid	$134.19
Rate for Payer: UHCCP Medicaid	$134.19

PR ENTEROSCOPY > 2ND PRTN W/ILEUM W/STENT PLMT

Professional

Both

$1,578.00

Service Code	HCPCS 44379
Min. Negotiated Rate	$228.76
Max. Negotiated Rate	$1,183.50
Rate for Payer: Aetna Commercial	$543.16
Rate for Payer: Aetna Medicare	$789.00
Rate for Payer: BCBS Complete	$240.20
Rate for Payer: BCN Commercial	$600.57
Rate for Payer: Cash Price	$1,262.40
Rate for Payer: Cash Price	$1,262.40
Rate for Payer: Mclaren Medicaid	$228.76
Rate for Payer: Meridian Medicaid	$240.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,183.50
Rate for Payer: Priority Health Choice Medicaid	$228.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$731.75
Rate for Payer: Priority Health Narrow/Tiered Network	$731.75
Rate for Payer: UHC Medicaid	$228.76
Rate for Payer: UHCCP Medicaid	$228.76

PR ENTEROSCOPY > 2ND PRTN W/PLMT PRQ TUBE

Professional

Both

$968.00

Service Code	HCPCS 44372
Min. Negotiated Rate	$135.26
Max. Negotiated Rate	$726.00
Rate for Payer: Aetna Commercial	$318.37
Rate for Payer: Aetna Medicare	$484.00
Rate for Payer: BCBS Complete	$142.02
Rate for Payer: BCN Commercial	$353.57
Rate for Payer: Cash Price	$774.40
Rate for Payer: Cash Price	$774.40
Rate for Payer: Mclaren Medicaid	$135.26
Rate for Payer: Meridian Medicaid	$142.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$726.00
Rate for Payer: Priority Health Choice Medicaid	$135.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$430.80
Rate for Payer: Priority Health Narrow/Tiered Network	$430.80
Rate for Payer: UHC Medicaid	$135.26
Rate for Payer: UHCCP Medicaid	$135.26

PR ENTEROSCOPY > 2ND PRTN W/RMVL FOREIGN BODY

Professional

Both

$1,003.00

Service Code	HCPCS 44363
Min. Negotiated Rate	$108.20
Max. Negotiated Rate	$752.25
Rate for Payer: Aetna Commercial	$254.46
Rate for Payer: Aetna Medicare	$501.50
Rate for Payer: BCBS Complete	$113.61
Rate for Payer: BCN Commercial	$281.86
Rate for Payer: Cash Price	$802.40
Rate for Payer: Cash Price	$802.40
Rate for Payer: Mclaren Medicaid	$108.20
Rate for Payer: Meridian Medicaid	$113.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$752.25
Rate for Payer: Priority Health Choice Medicaid	$108.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$343.42
Rate for Payer: Priority Health Narrow/Tiered Network	$343.42
Rate for Payer: UHC Medicaid	$108.20
Rate for Payer: UHCCP Medicaid	$108.20

PR ENTEROSCOPY > 2ND PRTN W/RMVL LESION CAUTERY

Professional

Both

$1,154.00

Service Code	HCPCS 44365
Min. Negotiated Rate	$102.67
Max. Negotiated Rate	$865.50
Rate for Payer: Aetna Commercial	$241.56
Rate for Payer: Aetna Medicare	$577.00
Rate for Payer: BCBS Complete	$107.80
Rate for Payer: BCN Commercial	$268.41
Rate for Payer: Cash Price	$923.20
Rate for Payer: Cash Price	$923.20
Rate for Payer: Mclaren Medicaid	$102.67
Rate for Payer: Meridian Medicaid	$107.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$865.50
Rate for Payer: Priority Health Choice Medicaid	$102.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$327.05
Rate for Payer: Priority Health Narrow/Tiered Network	$327.05
Rate for Payer: UHC Medicaid	$102.67
Rate for Payer: UHCCP Medicaid	$102.67

PR ENTEROSCOPY > 2ND PRTN W/RMVL LESION SNARE

Professional

Both

$1,154.00

Service Code	HCPCS 44364
Min. Negotiated Rate	$115.02
Max. Negotiated Rate	$865.50
Rate for Payer: Aetna Commercial	$271.37
Rate for Payer: Aetna Medicare	$577.00
Rate for Payer: BCBS Complete	$120.77
Rate for Payer: BCN Commercial	$300.78
Rate for Payer: Cash Price	$923.20
Rate for Payer: Cash Price	$923.20
Rate for Payer: Mclaren Medicaid	$115.02
Rate for Payer: Meridian Medicaid	$120.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$865.50
Rate for Payer: Priority Health Choice Medicaid	$115.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$366.48
Rate for Payer: Priority Health Narrow/Tiered Network	$366.48
Rate for Payer: UHC Medicaid	$115.02
Rate for Payer: UHCCP Medicaid	$115.02

PR ENTEROTOMY SM INT OTH/THN DUO DCMPRN

Professional

Both

$2,847.00

Service Code	HCPCS 44021
Min. Negotiated Rate	$579.57
Max. Negotiated Rate	$2,135.25
Rate for Payer: Aetna Commercial	$1,316.39
Rate for Payer: Aetna Medicare	$1,423.50
Rate for Payer: BCBS Complete	$608.55
Rate for Payer: BCN Commercial	$1,464.57
Rate for Payer: Cash Price	$2,277.60
Rate for Payer: Cash Price	$2,277.60
Rate for Payer: Mclaren Medicaid	$579.57
Rate for Payer: Meridian Medicaid	$608.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,135.25
Rate for Payer: Priority Health Choice Medicaid	$579.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,784.47
Rate for Payer: Priority Health Narrow/Tiered Network	$1,784.47
Rate for Payer: UHC Medicaid	$579.57
Rate for Payer: UHCCP Medicaid	$579.57

PR ENTEROTOMY SM INT OTH/THN DUO EXPL BX/FB RMVL

Professional

Both

$3,034.00

Service Code	HCPCS 44020
Min. Negotiated Rate	$583.62
Max. Negotiated Rate	$2,275.50
Rate for Payer: Aetna Commercial	$1,317.49
Rate for Payer: Aetna Medicare	$1,517.00
Rate for Payer: BCBS Complete	$612.80
Rate for Payer: BCN Commercial	$1,466.05
Rate for Payer: Cash Price	$2,427.20
Rate for Payer: Cash Price	$2,427.20
Rate for Payer: Mclaren Medicaid	$583.62
Rate for Payer: Meridian Medicaid	$612.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,275.50
Rate for Payer: Priority Health Choice Medicaid	$583.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,786.29
Rate for Payer: Priority Health Narrow/Tiered Network	$1,786.29
Rate for Payer: UHC Medicaid	$583.62
Rate for Payer: UHCCP Medicaid	$583.62

PR ENTRC RESCJ ATRESIA EA RESCJ & ANASTOMOSIS

Professional

Both

$2,052.00

Service Code	HCPCS 44128
Min. Negotiated Rate	$139.30
Max. Negotiated Rate	$1,539.00
Rate for Payer: Aetna Commercial	$330.68
Rate for Payer: Aetna Medicare	$1,026.00
Rate for Payer: BCBS Complete	$146.26
Rate for Payer: BCN Commercial	$361.04
Rate for Payer: Cash Price	$1,641.60
Rate for Payer: Cash Price	$1,641.60
Rate for Payer: Mclaren Medicaid	$139.30
Rate for Payer: Meridian Medicaid	$146.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,539.00
Rate for Payer: Priority Health Choice Medicaid	$139.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$439.90
Rate for Payer: Priority Health Narrow/Tiered Network	$439.90
Rate for Payer: UHC Medicaid	$139.30
Rate for Payer: UHCCP Medicaid	$139.30

PR ENTRC RESCJ ATRESIA RESCJ & ANAST SGM W/TAPRING

Professional

Both

$5,178.00

Service Code	HCPCS 44127
Min. Negotiated Rate	$1,675.67
Max. Negotiated Rate	$5,196.26
Rate for Payer: Aetna Commercial	$3,863.33
Rate for Payer: Aetna Medicare	$2,589.00
Rate for Payer: BCBS Complete	$1,759.45
Rate for Payer: BCN Commercial	$4,264.71
Rate for Payer: Cash Price	$4,142.40
Rate for Payer: Cash Price	$4,142.40
Rate for Payer: Mclaren Medicaid	$1,675.67
Rate for Payer: Meridian Medicaid	$1,759.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,883.50
Rate for Payer: Priority Health Choice Medicaid	$1,675.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,196.26
Rate for Payer: Priority Health Narrow/Tiered Network	$5,196.26
Rate for Payer: UHC Medicaid	$1,675.67
Rate for Payer: UHCCP Medicaid	$1,675.67

PR ENTRC RESCJ ATRESIA RESCJ & ANAST W/O TAPRING

Professional

Both

$4,462.00

Service Code	HCPCS 44126
Min. Negotiated Rate	$1,457.35
Max. Negotiated Rate	$4,505.18
Rate for Payer: Aetna Commercial	$3,342.37
Rate for Payer: Aetna Medicare	$2,231.00
Rate for Payer: BCBS Complete	$1,530.22
Rate for Payer: BCN Commercial	$3,697.51
Rate for Payer: Cash Price	$3,569.60
Rate for Payer: Cash Price	$3,569.60
Rate for Payer: Mclaren Medicaid	$1,457.35
Rate for Payer: Meridian Medicaid	$1,530.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,346.50
Rate for Payer: Priority Health Choice Medicaid	$1,457.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4,505.18
Rate for Payer: Priority Health Narrow/Tiered Network	$4,505.18
Rate for Payer: UHC Medicaid	$1,457.35
Rate for Payer: UHCCP Medicaid	$1,457.35

PR ENTRC RESCJ SMALL INTESTINE 1 RESCJ & ANAST

Professional

Both

$3,415.00

Service Code	HCPCS 44120
Min. Negotiated Rate	$724.63
Max. Negotiated Rate	$2,561.25
Rate for Payer: Aetna Commercial	$1,649.65
Rate for Payer: Aetna Medicare	$1,707.50
Rate for Payer: BCBS Complete	$760.86
Rate for Payer: BCN Commercial	$1,832.57
Rate for Payer: Cash Price	$2,732.00
Rate for Payer: Cash Price	$2,732.00
Rate for Payer: Mclaren Medicaid	$724.63
Rate for Payer: Meridian Medicaid	$760.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,561.25
Rate for Payer: Priority Health Choice Medicaid	$724.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,232.87
Rate for Payer: Priority Health Narrow/Tiered Network	$2,232.87
Rate for Payer: UHC Medicaid	$724.63
Rate for Payer: UHCCP Medicaid	$724.63

PR EO W/O JOINTS CF

Professional

Both

$278.00

Service Code	HCPCS L3702
Min. Negotiated Rate	$111.20
Max. Negotiated Rate	$309.22
Rate for Payer: Aetna Commercial	$158.29
Rate for Payer: Aetna Medicare	$139.00
Rate for Payer: BCBS Complete	$111.20
Rate for Payer: BCN Commercial	$309.22
Rate for Payer: Cash Price	$222.40
Rate for Payer: Cash Price	$222.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$208.50

PR EPDRM AGRFT T/A/L EA ADD 100 SQCM/EA 1%INFT/CHLD

Professional

Both

$262.00

Service Code	HCPCS 15111
Min. Negotiated Rate	$57.72
Max. Negotiated Rate	$196.50
Rate for Payer: Aetna Commercial	$111.86
Rate for Payer: Aetna Medicare	$131.00
Rate for Payer: BCBS Complete	$60.61
Rate for Payer: BCN Commercial	$151.88
Rate for Payer: Cash Price	$209.60
Rate for Payer: Cash Price	$209.60
Rate for Payer: Mclaren Medicaid	$57.72
Rate for Payer: Meridian Medicaid	$60.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$196.50
Rate for Payer: Priority Health Choice Medicaid	$57.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$139.02
Rate for Payer: Priority Health Narrow/Tiered Network	$139.02
Rate for Payer: UHC Medicaid	$57.72
Rate for Payer: UHCCP Medicaid	$57.72

PR EP EVAL 1/2CHMB PACG CVDFB LDS TSTG OF PULSE GEN

Professional

Both

$553.00

Service Code	HCPCS 93641
Min. Negotiated Rate	$276.50
Max. Negotiated Rate	$799.41
Rate for Payer: Aetna Commercial	$765.30
Rate for Payer: Aetna Medicare	$276.50
Rate for Payer: BCN Commercial	$445.71
Rate for Payer: Cash Price	$442.40
Rate for Payer: Cash Price	$442.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$414.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$799.41
Rate for Payer: Priority Health Narrow/Tiered Network	$799.41

PR EP EVAL 1/2 CHMB TRANSVNS PAC CVDFB

Professional

Both

$1,786.00

Service Code	HCPCS 93642
Min. Negotiated Rate	$445.35
Max. Negotiated Rate	$1,339.50
Rate for Payer: Aetna Commercial	$445.35
Rate for Payer: Aetna Medicare	$893.00
Rate for Payer: BCN Commercial	$487.53
Rate for Payer: Cash Price	$1,428.80
Rate for Payer: Cash Price	$1,428.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,339.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$463.36
Rate for Payer: Priority Health Narrow/Tiered Network	$463.36

PR EPIDERMAL AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/<

Professional

Both

$1,512.00

Service Code	HCPCS 15115
Min. Negotiated Rate	$415.14
Max. Negotiated Rate	$1,134.00
Rate for Payer: Aetna Commercial	$751.44
Rate for Payer: Aetna Medicare	$756.00
Rate for Payer: BCBS Complete	$435.90
Rate for Payer: BCN Commercial	$1,054.22
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Mclaren Medicaid	$415.14
Rate for Payer: Meridian Medicaid	$435.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,134.00
Rate for Payer: Priority Health Choice Medicaid	$415.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$964.90
Rate for Payer: Priority Health Narrow/Tiered Network	$964.90
Rate for Payer: UHC Medicaid	$415.14
Rate for Payer: UHCCP Medicaid	$415.14

PR EPIDERMAL AGRFT F/S/N/H/F/G/M/DGT EA 100 SQCM

Professional

Both

$344.00

Service Code	HCPCS 15116
Min. Negotiated Rate	$78.17
Max. Negotiated Rate	$258.00
Rate for Payer: Aetna Commercial	$163.92
Rate for Payer: Aetna Medicare	$172.00
Rate for Payer: BCBS Complete	$82.08
Rate for Payer: BCN Commercial	$205.66
Rate for Payer: Cash Price	$275.20
Rate for Payer: Cash Price	$275.20
Rate for Payer: Mclaren Medicaid	$78.17
Rate for Payer: Meridian Medicaid	$82.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$258.00
Rate for Payer: Priority Health Choice Medicaid	$78.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$188.24
Rate for Payer: Priority Health Narrow/Tiered Network	$188.24
Rate for Payer: UHC Medicaid	$78.17
Rate for Payer: UHCCP Medicaid	$78.17

PR EPIDIDYMECTOMY BILATERAL

Professional

Both

$1,104.00

Service Code	HCPCS 54861
Min. Negotiated Rate	$331.64
Max. Negotiated Rate	$930.32
Rate for Payer: Aetna Commercial	$728.21
Rate for Payer: Aetna Medicare	$552.00
Rate for Payer: BCBS Complete	$348.22
Rate for Payer: BCN Commercial	$854.04
Rate for Payer: Cash Price	$883.20
Rate for Payer: Cash Price	$883.20
Rate for Payer: Mclaren Medicaid	$331.64
Rate for Payer: Meridian Medicaid	$348.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$828.00
Rate for Payer: Priority Health Choice Medicaid	$331.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$930.32
Rate for Payer: Priority Health Narrow/Tiered Network	$930.32
Rate for Payer: UHC Medicaid	$331.64
Rate for Payer: UHCCP Medicaid	$331.64

PR EPIDIDYMECTOMY UNILATERAL

Professional

Both

$779.00

Service Code	HCPCS 54860
Min. Negotiated Rate	$247.29
Max. Negotiated Rate	$688.39
Rate for Payer: Aetna Commercial	$536.30
Rate for Payer: Aetna Medicare	$389.50
Rate for Payer: BCBS Complete	$259.65
Rate for Payer: BCN Commercial	$631.94
Rate for Payer: Cash Price	$623.20
Rate for Payer: Cash Price	$623.20
Rate for Payer: Mclaren Medicaid	$247.29
Rate for Payer: Meridian Medicaid	$259.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$584.25
Rate for Payer: Priority Health Choice Medicaid	$247.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$688.39
Rate for Payer: Priority Health Narrow/Tiered Network	$688.39
Rate for Payer: UHC Medicaid	$247.29
Rate for Payer: UHCCP Medicaid	$247.29

PR EPIDIDYMOVASOSTOMY ANAST EPIDIDYMIS UNI

Professional

Both

$1,774.00

Service Code	HCPCS 54900
Min. Negotiated Rate	$462.21
Max. Negotiated Rate	$1,330.50
Rate for Payer: Aetna Commercial	$1,027.27
Rate for Payer: Aetna Medicare	$887.00
Rate for Payer: BCBS Complete	$485.32
Rate for Payer: BCN Commercial	$1,199.63
Rate for Payer: Cash Price	$1,419.20
Rate for Payer: Cash Price	$1,419.20
Rate for Payer: Mclaren Medicaid	$462.21
Rate for Payer: Meridian Medicaid	$485.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,330.50
Rate for Payer: Priority Health Choice Medicaid	$462.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,306.80
Rate for Payer: Priority Health Narrow/Tiered Network	$1,306.80
Rate for Payer: UHC Medicaid	$462.21
Rate for Payer: UHCCP Medicaid	$462.21

Know your out-of-pocket cost for care.

All Charges