Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C

Facility

$1,412.00

Service Code	CPT 58558
Hospital Charge Code	58558
Hospital Revenue Code	960
Min. Negotiated Rate	$248.94
Max. Negotiated Rate	$1,270.80
Rate for Payer: Aetna Commercial	$1,200.20
Rate for Payer: Aetna Medicare	$367.12
Rate for Payer: Allen County Amish Medical Aid Commercial	$441.25
Rate for Payer: Amish Plain Church Group Commercial	$441.25
Rate for Payer: BCBS Complete	$261.36
Rate for Payer: BCBS MAPPO	$353.00
Rate for Payer: BCBS Trust/PPO	$1,160.81
Rate for Payer: BCN Commercial	$1,160.81
Rate for Payer: BCN Medicare Advantage	$353.00
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Cofinity Commercial	$1,214.32
Rate for Payer: Encore Health Key Benefits Commercial	$1,129.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$353.00
Rate for Payer: Healthscope Commercial	$1,270.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,059.00
Rate for Payer: Mclaren Medicaid	$248.94
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$370.65
Rate for Payer: Meridian Medicaid	$261.36
Rate for Payer: MI Amish Medical Board Commercial	$405.95
Rate for Payer: Molina Medicare/Medicaid	$388.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,200.20
Rate for Payer: Nomi Health Commercial	$1,157.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,059.00
Rate for Payer: PACE Senior Care Partners	$335.35
Rate for Payer: PACE SWMI	$353.00
Rate for Payer: PHP Commercial	$1,200.20
Rate for Payer: PHP Medicare Advantage	$353.00
Rate for Payer: Priority Health Choice Medicaid	$248.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,228.44
Rate for Payer: Priority Health Medicare	$356.53
Rate for Payer: Priority Health Narrow/Tiered Network	$982.75
Rate for Payer: Railroad Medicare Medicare	$353.00
Rate for Payer: UHC Core	$1,179.02
Rate for Payer: UHC Exchange	$353.00
Rate for Payer: UHC Medicaid	$248.94
Rate for Payer: UHC Medicare Advantage	$353.00
Rate for Payer: UHCCP Medicaid	$248.94
Rate for Payer: VA VA	$353.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,059.00

PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C

Professional

Both

$1,412.00

Service Code	HCPCS 58558
Hospital Charge Code	58558
Min. Negotiated Rate	$130.36
Max. Negotiated Rate	$1,059.00
Rate for Payer: Aetna Commercial	$276.01
Rate for Payer: Aetna Medicare	$706.00
Rate for Payer: BCBS Complete	$136.88
Rate for Payer: BCN Commercial	$345.59
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Mclaren Medicaid	$130.36
Rate for Payer: Meridian Medicaid	$136.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,059.00
Rate for Payer: Priority Health Choice Medicaid	$130.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$350.01
Rate for Payer: Priority Health Narrow/Tiered Network	$350.01
Rate for Payer: UHC Medicaid	$130.36
Rate for Payer: UHCCP Medicaid	$130.36

PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C

Facility

$1,412.00

Service Code	CPT 58558
Hospital Charge Code	58558
Hospital Revenue Code	960
Min. Negotiated Rate	$982.75
Max. Negotiated Rate	$1,270.80
Rate for Payer: Aetna Commercial	$1,200.20
Rate for Payer: BCBS Trust/PPO	$1,166.17
Rate for Payer: BCN Commercial	$1,166.17
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Cofinity Commercial	$1,214.32
Rate for Payer: Encore Health Key Benefits Commercial	$1,129.60
Rate for Payer: Healthscope Commercial	$1,270.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,059.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,200.20
Rate for Payer: Nomi Health Commercial	$1,157.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,059.00
Rate for Payer: PHP Commercial	$1,200.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,228.44
Rate for Payer: Priority Health Narrow/Tiered Network	$982.75
Rate for Payer: UHC Core	$1,179.02
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,059.00

PR HYSTEROSCOPY BX ENDOMETRIUM&/POLYPC W/WO D&C

Professional

Both

$1,412.00

Service Code	HCPCS 58558
Min. Negotiated Rate	$130.36
Max. Negotiated Rate	$1,059.00
Rate for Payer: Aetna Commercial	$276.01
Rate for Payer: Aetna Medicare	$706.00
Rate for Payer: BCBS Complete	$136.88
Rate for Payer: BCN Commercial	$345.59
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Mclaren Medicaid	$130.36
Rate for Payer: Meridian Medicaid	$136.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,059.00
Rate for Payer: Priority Health Choice Medicaid	$130.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$350.01
Rate for Payer: Priority Health Narrow/Tiered Network	$350.01
Rate for Payer: UHC Medicaid	$130.36
Rate for Payer: UHCCP Medicaid	$130.36

PR HYSTEROSCOPY DIAGNOSTIC SEPARATE PROCEDURE

Professional

Both

$837.00

Service Code	HCPCS 58555
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$627.75
Rate for Payer: Aetna Commercial	$181.23
Rate for Payer: Aetna Medicare	$418.50
Rate for Payer: BCBS Complete	$90.13
Rate for Payer: BCN Commercial	$227.58
Rate for Payer: Cash Price	$669.60
Rate for Payer: Cash Price	$669.60
Rate for Payer: Mclaren Medicaid	$85.84
Rate for Payer: Meridian Medicaid	$90.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$627.75
Rate for Payer: Priority Health Choice Medicaid	$85.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$230.48
Rate for Payer: Priority Health Narrow/Tiered Network	$230.48
Rate for Payer: UHC Medicaid	$85.84
Rate for Payer: UHCCP Medicaid	$85.84

PR HYSTEROSCOPY DIV/RESCJ INTRAUTERINE SEPTUM

Professional

Both

$1,723.00

Service Code	HCPCS 58560
Min. Negotiated Rate	$175.30
Max. Negotiated Rate	$1,292.25
Rate for Payer: Aetna Commercial	$375.75
Rate for Payer: Aetna Medicare	$861.50
Rate for Payer: BCBS Complete	$184.06
Rate for Payer: BCN Commercial	$465.61
Rate for Payer: Cash Price	$1,378.40
Rate for Payer: Cash Price	$1,378.40
Rate for Payer: Mclaren Medicaid	$175.30
Rate for Payer: Meridian Medicaid	$184.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,292.25
Rate for Payer: Priority Health Choice Medicaid	$175.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$471.56
Rate for Payer: Priority Health Narrow/Tiered Network	$471.56
Rate for Payer: UHC Medicaid	$175.30
Rate for Payer: UHCCP Medicaid	$175.30

PR HYSTEROSCOPY ENDOMETRIAL ABLATION

Professional

Both

$1,611.00

Service Code	HCPCS 58563
Min. Negotiated Rate	$138.45
Max. Negotiated Rate	$1,208.25
Rate for Payer: Aetna Commercial	$294.85
Rate for Payer: Aetna Medicare	$805.50
Rate for Payer: BCBS Complete	$145.37
Rate for Payer: BCN Commercial	$366.51
Rate for Payer: Cash Price	$1,288.80
Rate for Payer: Cash Price	$1,288.80
Rate for Payer: Mclaren Medicaid	$138.45
Rate for Payer: Meridian Medicaid	$145.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,208.25
Rate for Payer: Priority Health Choice Medicaid	$138.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$371.20
Rate for Payer: Priority Health Narrow/Tiered Network	$371.20
Rate for Payer: UHC Medicaid	$138.45
Rate for Payer: UHCCP Medicaid	$138.45

PR HYSTEROSCOPY LYSIS INTRAUTERINE ADHESIONS

Professional

Both

$1,560.00

Service Code	HCPCS 58559
Min. Negotiated Rate	$158.90
Max. Negotiated Rate	$1,170.00
Rate for Payer: Aetna Commercial	$340.58
Rate for Payer: Aetna Medicare	$780.00
Rate for Payer: BCBS Complete	$166.84
Rate for Payer: BCN Commercial	$422.79
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Mclaren Medicaid	$158.90
Rate for Payer: Meridian Medicaid	$166.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,170.00
Rate for Payer: Priority Health Choice Medicaid	$158.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$428.19
Rate for Payer: Priority Health Narrow/Tiered Network	$428.19
Rate for Payer: UHC Medicaid	$158.90
Rate for Payer: UHCCP Medicaid	$158.90

PR HYSTEROSCOPY REMOVAL IMPACTED FOREIGN BODY

Professional

Both

$1,212.00

Service Code	HCPCS 58562
Min. Negotiated Rate	$124.39
Max. Negotiated Rate	$909.00
Rate for Payer: Aetna Commercial	$265.43
Rate for Payer: Aetna Medicare	$606.00
Rate for Payer: BCBS Complete	$130.61
Rate for Payer: BCN Commercial	$330.16
Rate for Payer: Cash Price	$969.60
Rate for Payer: Cash Price	$969.60
Rate for Payer: Mclaren Medicaid	$124.39
Rate for Payer: Meridian Medicaid	$130.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$909.00
Rate for Payer: Priority Health Choice Medicaid	$124.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$334.39
Rate for Payer: Priority Health Narrow/Tiered Network	$334.39
Rate for Payer: UHC Medicaid	$124.39
Rate for Payer: UHCCP Medicaid	$124.39

PR HYSTEROSCOPY REMOVAL LEIOMYOMATA

Professional

Both

$969.00

Service Code	HCPCS 58561
Min. Negotiated Rate	$200.22
Max. Negotiated Rate	$726.75
Rate for Payer: Aetna Commercial	$428.81
Rate for Payer: Aetna Medicare	$484.50
Rate for Payer: BCBS Complete	$210.23
Rate for Payer: BCN Commercial	$532.84
Rate for Payer: Cash Price	$775.20
Rate for Payer: Cash Price	$775.20
Rate for Payer: Mclaren Medicaid	$200.22
Rate for Payer: Meridian Medicaid	$210.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$726.75
Rate for Payer: Priority Health Choice Medicaid	$200.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$539.65
Rate for Payer: Priority Health Narrow/Tiered Network	$539.65
Rate for Payer: UHC Medicaid	$200.22
Rate for Payer: UHCCP Medicaid	$200.22

PR HYSTEROTOMY ABDOMINAL

Professional

Both

$1,576.00

Service Code	HCPCS 59100
Min. Negotiated Rate	$491.39
Max. Negotiated Rate	$1,288.78
Rate for Payer: Aetna Commercial	$936.56
Rate for Payer: Aetna Medicare	$788.00
Rate for Payer: BCBS Complete	$515.96
Rate for Payer: BCN Commercial	$1,288.78
Rate for Payer: Cash Price	$1,260.80
Rate for Payer: Cash Price	$1,260.80
Rate for Payer: Mclaren Medicaid	$491.39
Rate for Payer: Meridian Medicaid	$515.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,182.00
Rate for Payer: Priority Health Choice Medicaid	$491.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,216.61
Rate for Payer: Priority Health Narrow/Tiered Network	$1,216.61
Rate for Payer: UHC Medicaid	$491.39
Rate for Payer: UHCCP Medicaid	$491.39

PR HZV ZOSTER VACC RECOMBINANT ADJUVANTED IM USE

Professional

Both

$176.00

Service Code	HCPCS 90750
Min. Negotiated Rate	$88.00
Max. Negotiated Rate	$215.51
Rate for Payer: Aetna Commercial	$187.08
Rate for Payer: Aetna Medicare	$88.00
Rate for Payer: BCBS Trust/PPO	$215.51
Rate for Payer: BCN Commercial	$212.06
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cash Price	$140.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$132.00

PR I131 IODIDE CAP, RX

Professional

Both

$33.00

Service Code	HCPCS A9517
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$40.43
Rate for Payer: Aetna Commercial	$40.43
Rate for Payer: Aetna Medicare	$16.50
Rate for Payer: BCBS Complete	$13.20
Rate for Payer: BCN Commercial	$23.13
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.75

PR ICAR CATH ABLATION DISCRETE MECHANISM ARRHYTHMIA

Professional

Both

$1,537.00

Service Code	HCPCS 93655
Min. Negotiated Rate	$166.35
Max. Negotiated Rate	$1,152.75
Rate for Payer: Aetna Commercial	$570.63
Rate for Payer: Aetna Medicare	$768.50
Rate for Payer: BCBS Complete	$174.67
Rate for Payer: BCN Commercial	$447.18
Rate for Payer: Cash Price	$1,229.60
Rate for Payer: Cash Price	$1,229.60
Rate for Payer: Mclaren Medicaid	$166.35
Rate for Payer: Meridian Medicaid	$174.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,152.75
Rate for Payer: Priority Health Choice Medicaid	$166.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$425.03
Rate for Payer: Priority Health Narrow/Tiered Network	$425.03
Rate for Payer: UHC Medicaid	$166.35
Rate for Payer: UHCCP Medicaid	$166.35

PR ICAR CATHETER ABLATION ATRIOVENTR NODE FUNCTION

Professional

Both

$1,895.00

Service Code	HCPCS 93650
Min. Negotiated Rate	$316.94
Max. Negotiated Rate	$1,421.25
Rate for Payer: Aetna Commercial	$791.77
Rate for Payer: Aetna Medicare	$947.50
Rate for Payer: BCBS Complete	$332.79
Rate for Payer: BCN Commercial	$849.05
Rate for Payer: Cash Price	$1,516.00
Rate for Payer: Cash Price	$1,516.00
Rate for Payer: Mclaren Medicaid	$316.94
Rate for Payer: Meridian Medicaid	$332.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,421.25
Rate for Payer: Priority Health Choice Medicaid	$316.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$806.99
Rate for Payer: Priority Health Narrow/Tiered Network	$806.99
Rate for Payer: UHC Medicaid	$316.94
Rate for Payer: UHCCP Medicaid	$316.94

PR I&D ABSCESS PERITONSILLAR

Professional

Both

$317.00

Service Code	HCPCS 42700
Min. Negotiated Rate	$81.79
Max. Negotiated Rate	$251.81
Rate for Payer: Aetna Commercial	$176.88
Rate for Payer: Aetna Medicare	$158.50
Rate for Payer: BCBS Complete	$85.88
Rate for Payer: BCN Commercial	$206.66
Rate for Payer: Cash Price	$253.60
Rate for Payer: Cash Price	$253.60
Rate for Payer: Mclaren Medicaid	$81.79
Rate for Payer: Meridian Medicaid	$85.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$237.75
Rate for Payer: Priority Health Choice Medicaid	$81.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$251.81
Rate for Payer: Priority Health Narrow/Tiered Network	$251.81
Rate for Payer: UHC Medicaid	$81.79
Rate for Payer: UHCCP Medicaid	$81.79

PR I&D ABSC RTRPHRNGL/PARAPHARYNGEAL INTRAORAL APPR

Professional

Both

$852.00

Service Code	HCPCS 42720
Min. Negotiated Rate	$213.00
Max. Negotiated Rate	$706.88
Rate for Payer: Aetna Commercial	$511.86
Rate for Payer: Aetna Medicare	$426.00
Rate for Payer: BCBS Complete	$223.65
Rate for Payer: BCN Commercial	$580.15
Rate for Payer: Cash Price	$681.60
Rate for Payer: Cash Price	$681.60
Rate for Payer: Mclaren Medicaid	$213.00
Rate for Payer: Meridian Medicaid	$223.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$639.00
Rate for Payer: Priority Health Choice Medicaid	$213.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$706.88
Rate for Payer: Priority Health Narrow/Tiered Network	$706.88
Rate for Payer: UHC Medicaid	$213.00
Rate for Payer: UHCCP Medicaid	$213.00

PR I&D ABSC RTRPHRNGL/PARAPHARYNGEAL XTRNL APPR

Professional

Both

$1,522.00

Service Code	HCPCS 42725
Min. Negotiated Rate	$451.56
Max. Negotiated Rate	$1,468.36
Rate for Payer: Aetna Commercial	$1,060.45
Rate for Payer: Aetna Medicare	$761.00
Rate for Payer: BCBS Complete	$474.14
Rate for Payer: BCN Commercial	$1,205.11
Rate for Payer: Cash Price	$1,217.60
Rate for Payer: Cash Price	$1,217.60
Rate for Payer: Mclaren Medicaid	$451.56
Rate for Payer: Meridian Medicaid	$474.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,141.50
Rate for Payer: Priority Health Choice Medicaid	$451.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,468.36
Rate for Payer: Priority Health Narrow/Tiered Network	$1,468.36
Rate for Payer: UHC Medicaid	$451.56
Rate for Payer: UHCCP Medicaid	$451.56

PR I&D BELOW FASCIA FOOT 1 BURSAL SPACE

Professional

Both

$894.00

Service Code	HCPCS 28002
Min. Negotiated Rate	$81.15
Max. Negotiated Rate	$670.50
Rate for Payer: Aetna Commercial	$419.78
Rate for Payer: Aetna Medicare	$447.00
Rate for Payer: BCBS Complete	$85.21
Rate for Payer: BCN Commercial	$209.65
Rate for Payer: Cash Price	$715.20
Rate for Payer: Cash Price	$715.20
Rate for Payer: Mclaren Medicaid	$81.15
Rate for Payer: Meridian Medicaid	$85.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$670.50
Rate for Payer: Priority Health Choice Medicaid	$81.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$224.11
Rate for Payer: Priority Health Narrow/Tiered Network	$224.11
Rate for Payer: UHC Medicaid	$81.15
Rate for Payer: UHCCP Medicaid	$81.15

PR I&D BELOW FASCIA FOOT MULTIPLE AREAS

Professional

Both

$1,280.00

Service Code	HCPCS 28003
Min. Negotiated Rate	$147.18
Max. Negotiated Rate	$960.00
Rate for Payer: Aetna Commercial	$745.46
Rate for Payer: Aetna Medicare	$640.00
Rate for Payer: BCBS Complete	$154.54
Rate for Payer: BCN Commercial	$383.94
Rate for Payer: Cash Price	$1,024.00
Rate for Payer: Cash Price	$1,024.00
Rate for Payer: Mclaren Medicaid	$147.18
Rate for Payer: Meridian Medicaid	$154.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$960.00
Rate for Payer: Priority Health Choice Medicaid	$147.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$410.42
Rate for Payer: Priority Health Narrow/Tiered Network	$410.42
Rate for Payer: UHC Medicaid	$147.18
Rate for Payer: UHCCP Medicaid	$147.18

PR I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION

Professional

Both

$1,715.00

Service Code	HCPCS 27301
Min. Negotiated Rate	$309.28
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$675.38
Rate for Payer: Aetna Medicare	$857.50
Rate for Payer: BCBS Complete	$324.74
Rate for Payer: BCN Commercial	$777.85
Rate for Payer: Cash Price	$1,372.00
Rate for Payer: Cash Price	$1,372.00
Rate for Payer: Mclaren Medicaid	$309.28
Rate for Payer: Meridian Medicaid	$324.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,286.25
Rate for Payer: Priority Health Choice Medicaid	$309.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$831.49
Rate for Payer: Priority Health Narrow/Tiered Network	$831.49
Rate for Payer: UHC Medicaid	$309.28
Rate for Payer: UHCCP Medicaid	$309.28

PR I&D DEEP ABSCESS PST SPINE CRV THRC/CERVICOTHR

Professional

Both

$2,534.00

Service Code	HCPCS 22010
Min. Negotiated Rate	$606.41
Max. Negotiated Rate	$1,900.50
Rate for Payer: Aetna Commercial	$1,291.27
Rate for Payer: Aetna Medicare	$1,267.00
Rate for Payer: BCBS Complete	$636.73
Rate for Payer: BCN Commercial	$1,486.47
Rate for Payer: Cash Price	$2,027.20
Rate for Payer: Cash Price	$2,027.20
Rate for Payer: Mclaren Medicaid	$606.41
Rate for Payer: Meridian Medicaid	$636.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,900.50
Rate for Payer: Priority Health Choice Medicaid	$606.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,588.99
Rate for Payer: Priority Health Narrow/Tiered Network	$1,588.99
Rate for Payer: UHC Medicaid	$606.41
Rate for Payer: UHCCP Medicaid	$606.41

PR I&D DEEP ABSCESS PST SPINE LUMBAR SAC/LUMBOSAC

Professional

Both

$1,777.00

Service Code	HCPCS 22015
Min. Negotiated Rate	$587.88
Max. Negotiated Rate	$1,548.02
Rate for Payer: Aetna Commercial	$1,265.29
Rate for Payer: Aetna Medicare	$888.50
Rate for Payer: BCBS Complete	$617.27
Rate for Payer: BCN Commercial	$1,448.13
Rate for Payer: Cash Price	$1,421.60
Rate for Payer: Cash Price	$1,421.60
Rate for Payer: Mclaren Medicaid	$587.88
Rate for Payer: Meridian Medicaid	$617.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,332.75
Rate for Payer: Priority Health Choice Medicaid	$587.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,548.02
Rate for Payer: Priority Health Narrow/Tiered Network	$1,548.02
Rate for Payer: UHC Medicaid	$587.88
Rate for Payer: UHCCP Medicaid	$587.88

PR I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX

Professional

Both

$1,203.00

Service Code	HCPCS 21501
Min. Negotiated Rate	$208.95
Max. Negotiated Rate	$902.25
Rate for Payer: Aetna Commercial	$434.09
Rate for Payer: Aetna Medicare	$601.50
Rate for Payer: BCBS Complete	$219.40
Rate for Payer: BCN Commercial	$515.90
Rate for Payer: Cash Price	$962.40
Rate for Payer: Cash Price	$962.40
Rate for Payer: Mclaren Medicaid	$208.95
Rate for Payer: Meridian Medicaid	$219.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$902.25
Rate for Payer: Priority Health Choice Medicaid	$208.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$551.49
Rate for Payer: Priority Health Narrow/Tiered Network	$551.49
Rate for Payer: UHC Medicaid	$208.95
Rate for Payer: UHCCP Medicaid	$208.95

PR I&D DP ABSC/HMTMA SFT TIS NCK/THRX PRTL RIB OSTC

Professional

Both

$986.00

Service Code	HCPCS 21502
Min. Negotiated Rate	$326.32
Max. Negotiated Rate	$820.32
Rate for Payer: Aetna Commercial	$681.32
Rate for Payer: Aetna Medicare	$493.00
Rate for Payer: BCBS Complete	$342.64
Rate for Payer: BCN Commercial	$767.39
Rate for Payer: Cash Price	$788.80
Rate for Payer: Cash Price	$788.80
Rate for Payer: Mclaren Medicaid	$326.32
Rate for Payer: Meridian Medicaid	$342.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$739.50
Rate for Payer: Priority Health Choice Medicaid	$326.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$820.32
Rate for Payer: Priority Health Narrow/Tiered Network	$820.32
Rate for Payer: UHC Medicaid	$326.32
Rate for Payer: UHCCP Medicaid	$326.32

Know your out-of-pocket cost for care.

All Charges