Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR LIGATION/BIOPSY TEMPORAL ARTERY

Facility

$927.00

Service Code	CPT 37609
Hospital Charge Code	37609
Hospital Revenue Code	960
Min. Negotiated Rate	$645.19
Max. Negotiated Rate	$834.30
Rate for Payer: Aetna Commercial	$787.95
Rate for Payer: BCBS Trust/PPO	$765.61
Rate for Payer: BCN Commercial	$765.61
Rate for Payer: Cash Price	$741.60
Rate for Payer: Cofinity Commercial	$797.22
Rate for Payer: Encore Health Key Benefits Commercial	$741.60
Rate for Payer: Healthscope Commercial	$834.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$695.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$787.95
Rate for Payer: Nomi Health Commercial	$760.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$695.25
Rate for Payer: PHP Commercial	$787.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$806.49
Rate for Payer: Priority Health Narrow/Tiered Network	$645.19
Rate for Payer: UHC Core	$774.04
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$695.25

PR LIGATION/BIOPSY TEMPORAL ARTERY

Professional

Both

$927.00

Service Code	HCPCS 37609
Hospital Charge Code	37609
Min. Negotiated Rate	$119.92
Max. Negotiated Rate	$695.25
Rate for Payer: Aetna Commercial	$272.71
Rate for Payer: Aetna Medicare	$463.50
Rate for Payer: BCBS Complete	$125.92
Rate for Payer: BCN Commercial	$303.77
Rate for Payer: Cash Price	$741.60
Rate for Payer: Cash Price	$741.60
Rate for Payer: Mclaren Medicaid	$119.92
Rate for Payer: Meridian Medicaid	$125.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$695.25
Rate for Payer: Priority Health Choice Medicaid	$119.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$326.66
Rate for Payer: Priority Health Narrow/Tiered Network	$326.66
Rate for Payer: UHC Medicaid	$119.92
Rate for Payer: UHCCP Medicaid	$119.92

PR LIGATION DIRECT ESOPHAGEAL VARICES

Professional

Both

$3,228.00

Service Code	HCPCS 43400
Min. Negotiated Rate	$905.68
Max. Negotiated Rate	$2,784.41
Rate for Payer: Aetna Commercial	$2,061.51
Rate for Payer: Aetna Medicare	$1,614.00
Rate for Payer: BCBS Complete	$950.96
Rate for Payer: BCN Commercial	$2,285.23
Rate for Payer: Cash Price	$2,582.40
Rate for Payer: Cash Price	$2,582.40
Rate for Payer: Mclaren Medicaid	$905.68
Rate for Payer: Meridian Medicaid	$950.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,421.00
Rate for Payer: Priority Health Choice Medicaid	$905.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,784.41
Rate for Payer: Priority Health Narrow/Tiered Network	$2,784.41
Rate for Payer: UHC Medicaid	$905.68
Rate for Payer: UHCCP Medicaid	$905.68

PR LIGATION HEMORRHOID BUNDLE W/US

Professional

Both

$2,154.00

Service Code	HCPCS 0249T
Min. Negotiated Rate	$861.60
Max. Negotiated Rate	$1,615.50
Rate for Payer: Aetna Medicare	$1,077.00
Rate for Payer: BCBS Complete	$861.60
Rate for Payer: Cash Price	$1,723.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,615.50

PR LIGATION INTERNAL/COMMON CAROTID ARTERY

Professional

Both

$2,056.00

Service Code	HCPCS 37605
Min. Negotiated Rate	$430.69
Max. Negotiated Rate	$1,542.00
Rate for Payer: Aetna Commercial	$991.38
Rate for Payer: Aetna Medicare	$1,028.00
Rate for Payer: BCBS Complete	$452.22
Rate for Payer: BCN Commercial	$1,083.61
Rate for Payer: Cash Price	$1,644.80
Rate for Payer: Cash Price	$1,644.80
Rate for Payer: Mclaren Medicaid	$430.69
Rate for Payer: Meridian Medicaid	$452.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,542.00
Rate for Payer: Priority Health Choice Medicaid	$430.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,165.28
Rate for Payer: Priority Health Narrow/Tiered Network	$1,165.28
Rate for Payer: UHC Medicaid	$430.69
Rate for Payer: UHCCP Medicaid	$430.69

PR LIGATION INTERNAL JUGULAR VEIN

Professional

Both

$1,561.00

Service Code	HCPCS 37565
Min. Negotiated Rate	$415.35
Max. Negotiated Rate	$1,170.75
Rate for Payer: Aetna Commercial	$977.47
Rate for Payer: Aetna Medicare	$780.50
Rate for Payer: BCBS Complete	$436.12
Rate for Payer: BCN Commercial	$1,083.11
Rate for Payer: Cash Price	$1,248.80
Rate for Payer: Cash Price	$1,248.80
Rate for Payer: Mclaren Medicaid	$415.35
Rate for Payer: Meridian Medicaid	$436.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,170.75
Rate for Payer: Priority Health Choice Medicaid	$415.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,164.75
Rate for Payer: Priority Health Narrow/Tiered Network	$1,164.75
Rate for Payer: UHC Medicaid	$415.35
Rate for Payer: UHCCP Medicaid	$415.35

PR LIGATION MAJOR ARTERY ABDOMEN

Professional

Both

$3,369.00

Service Code	HCPCS 37617
Min. Negotiated Rate	$768.08
Max. Negotiated Rate	$2,526.75
Rate for Payer: Aetna Commercial	$1,785.58
Rate for Payer: Aetna Medicare	$1,684.50
Rate for Payer: BCBS Complete	$806.48
Rate for Payer: BCN Commercial	$1,961.55
Rate for Payer: Cash Price	$2,695.20
Rate for Payer: Cash Price	$2,695.20
Rate for Payer: Mclaren Medicaid	$768.08
Rate for Payer: Meridian Medicaid	$806.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,526.75
Rate for Payer: Priority Health Choice Medicaid	$768.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,109.40
Rate for Payer: Priority Health Narrow/Tiered Network	$2,109.40
Rate for Payer: UHC Medicaid	$768.08
Rate for Payer: UHCCP Medicaid	$768.08

PR LIGATION MAJOR ARTERY CHEST

Professional

Both

$3,489.00

Service Code	HCPCS 37616
Min. Negotiated Rate	$682.88
Max. Negotiated Rate	$2,616.75
Rate for Payer: Aetna Commercial	$1,477.32
Rate for Payer: Aetna Medicare	$1,744.50
Rate for Payer: BCBS Complete	$717.02
Rate for Payer: BCN Commercial	$1,700.61
Rate for Payer: Cash Price	$2,791.20
Rate for Payer: Cash Price	$2,791.20
Rate for Payer: Mclaren Medicaid	$682.88
Rate for Payer: Meridian Medicaid	$717.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,616.75
Rate for Payer: Priority Health Choice Medicaid	$682.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,828.78
Rate for Payer: Priority Health Narrow/Tiered Network	$1,828.78
Rate for Payer: UHC Medicaid	$682.88
Rate for Payer: UHCCP Medicaid	$682.88

PR LIGATION MAJOR ARTERY EXTREMITY

Professional

Both

$1,108.00

Service Code	HCPCS 37618
Min. Negotiated Rate	$235.58
Max. Negotiated Rate	$831.00
Rate for Payer: Aetna Commercial	$521.95
Rate for Payer: Aetna Medicare	$554.00
Rate for Payer: BCBS Complete	$247.36
Rate for Payer: BCN Commercial	$583.64
Rate for Payer: Cash Price	$886.40
Rate for Payer: Cash Price	$886.40
Rate for Payer: Mclaren Medicaid	$235.58
Rate for Payer: Meridian Medicaid	$247.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$831.00
Rate for Payer: Priority Health Choice Medicaid	$235.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$627.62
Rate for Payer: Priority Health Narrow/Tiered Network	$627.62
Rate for Payer: UHC Medicaid	$235.58
Rate for Payer: UHCCP Medicaid	$235.58

PR LIGATION MAJOR ARTERY NECK

Professional

Both

$1,249.00

Service Code	HCPCS 37615
Min. Negotiated Rate	$295.01
Max. Negotiated Rate	$936.75
Rate for Payer: Aetna Commercial	$713.42
Rate for Payer: Aetna Medicare	$624.50
Rate for Payer: BCBS Complete	$309.76
Rate for Payer: BCN Commercial	$773.86
Rate for Payer: Cash Price	$999.20
Rate for Payer: Cash Price	$999.20
Rate for Payer: Mclaren Medicaid	$295.01
Rate for Payer: Meridian Medicaid	$309.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$936.75
Rate for Payer: Priority Health Choice Medicaid	$295.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$832.18
Rate for Payer: Priority Health Narrow/Tiered Network	$832.18
Rate for Payer: UHC Medicaid	$295.01
Rate for Payer: UHCCP Medicaid	$295.01

PR LIGATION OF FEMORAL VEIN

Professional

Both

$1,729.00

Service Code	HCPCS 37650
Min. Negotiated Rate	$270.08
Max. Negotiated Rate	$1,296.75
Rate for Payer: Aetna Commercial	$615.48
Rate for Payer: Aetna Medicare	$864.50
Rate for Payer: BCBS Complete	$283.58
Rate for Payer: BCN Commercial	$678.74
Rate for Payer: Cash Price	$1,383.20
Rate for Payer: Cash Price	$1,383.20
Rate for Payer: Mclaren Medicaid	$270.08
Rate for Payer: Meridian Medicaid	$283.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,296.75
Rate for Payer: Priority Health Choice Medicaid	$270.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$729.90
Rate for Payer: Priority Health Narrow/Tiered Network	$729.90
Rate for Payer: UHC Medicaid	$270.08
Rate for Payer: UHCCP Medicaid	$270.08

PR LIGATION OF INFERIOR VENA CAVA

Professional

Both

$3,544.00

Service Code	HCPCS 37619
Min. Negotiated Rate	$1,009.41
Max. Negotiated Rate	$2,771.82
Rate for Payer: Aetna Commercial	$2,337.83
Rate for Payer: Aetna Medicare	$1,772.00
Rate for Payer: BCBS Complete	$1,059.88
Rate for Payer: BCN Commercial	$2,577.55
Rate for Payer: Cash Price	$2,835.20
Rate for Payer: Cash Price	$2,835.20
Rate for Payer: Mclaren Medicaid	$1,009.41
Rate for Payer: Meridian Medicaid	$1,059.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,658.00
Rate for Payer: Priority Health Choice Medicaid	$1,009.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,771.82
Rate for Payer: Priority Health Narrow/Tiered Network	$2,771.82
Rate for Payer: UHC Medicaid	$1,009.41
Rate for Payer: UHCCP Medicaid	$1,009.41

PR LIGATION OF SPERM DUCT

Professional

Both

$671.00

Service Code	HCPCS 55450
Min. Negotiated Rate	$268.40
Max. Negotiated Rate	$503.25
Rate for Payer: Aetna Medicare	$335.50
Rate for Payer: BCBS Complete	$268.40
Rate for Payer: Cash Price	$536.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$503.25

PR LIG/BANDING ANGIOACCESS ARTERIOVENOUS FISTULA

Professional

Both

$1,131.00

Service Code	HCPCS 37607
Min. Negotiated Rate	$220.67
Max. Negotiated Rate	$848.25
Rate for Payer: Aetna Commercial	$500.75
Rate for Payer: Aetna Medicare	$565.50
Rate for Payer: BCBS Complete	$231.70
Rate for Payer: BCN Commercial	$552.76
Rate for Payer: Cash Price	$904.80
Rate for Payer: Cash Price	$904.80
Rate for Payer: Mclaren Medicaid	$220.67
Rate for Payer: Meridian Medicaid	$231.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$848.25
Rate for Payer: Priority Health Choice Medicaid	$220.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$594.43
Rate for Payer: Priority Health Narrow/Tiered Network	$594.43
Rate for Payer: UHC Medicaid	$220.67
Rate for Payer: UHCCP Medicaid	$220.67

PR LIG&DIV&COMPL STRPG LONG/SHRT SAPHENOUS VN W/EXC

Professional

Both

$881.00

Service Code	HCPCS 37735
Min. Negotiated Rate	$341.01
Max. Negotiated Rate	$921.62
Rate for Payer: Aetna Commercial	$780.18
Rate for Payer: Aetna Medicare	$440.50
Rate for Payer: BCBS Complete	$358.06
Rate for Payer: BCN Commercial	$857.02
Rate for Payer: Cash Price	$704.80
Rate for Payer: Cash Price	$704.80
Rate for Payer: Mclaren Medicaid	$341.01
Rate for Payer: Meridian Medicaid	$358.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$660.75
Rate for Payer: Priority Health Choice Medicaid	$341.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$921.62
Rate for Payer: Priority Health Narrow/Tiered Network	$921.62
Rate for Payer: UHC Medicaid	$341.01
Rate for Payer: UHCCP Medicaid	$341.01

PR LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ

Professional

Both

$488.00

Service Code	HCPCS 37700
Min. Negotiated Rate	$145.27
Max. Negotiated Rate	$390.93
Rate for Payer: Aetna Commercial	$327.02
Rate for Payer: Aetna Medicare	$244.00
Rate for Payer: BCBS Complete	$152.53
Rate for Payer: BCN Commercial	$363.53
Rate for Payer: Cash Price	$390.40
Rate for Payer: Cash Price	$390.40
Rate for Payer: Mclaren Medicaid	$145.27
Rate for Payer: Meridian Medicaid	$152.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$366.00
Rate for Payer: Priority Health Choice Medicaid	$145.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$390.93
Rate for Payer: Priority Health Narrow/Tiered Network	$390.93
Rate for Payer: UHC Medicaid	$145.27
Rate for Payer: UHCCP Medicaid	$145.27

PR LIG DIV & STRIPPING SHORT SAPHENOUS VEIN

Professional

Both

$847.00

Service Code	HCPCS 37718
Min. Negotiated Rate	$231.32
Max. Negotiated Rate	$635.25
Rate for Payer: Aetna Commercial	$567.92
Rate for Payer: Aetna Medicare	$423.50
Rate for Payer: BCBS Complete	$242.89
Rate for Payer: BCN Commercial	$581.64
Rate for Payer: Cash Price	$677.60
Rate for Payer: Cash Price	$677.60
Rate for Payer: Mclaren Medicaid	$231.32
Rate for Payer: Meridian Medicaid	$242.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$635.25
Rate for Payer: Priority Health Choice Medicaid	$231.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$625.49
Rate for Payer: Priority Health Narrow/Tiered Network	$625.49
Rate for Payer: UHC Medicaid	$231.32
Rate for Payer: UHCCP Medicaid	$231.32

PR LIG DIV&STRPG LONG SAPH SAPHFEM JUNCT KNE/BELW

Professional

Both

$976.00

Service Code	HCPCS 37722
Min. Negotiated Rate	$270.51
Max. Negotiated Rate	$732.00
Rate for Payer: Aetna Commercial	$630.45
Rate for Payer: Aetna Medicare	$488.00
Rate for Payer: BCBS Complete	$284.04
Rate for Payer: BCN Commercial	$676.26
Rate for Payer: Cash Price	$780.80
Rate for Payer: Cash Price	$780.80
Rate for Payer: Mclaren Medicaid	$270.51
Rate for Payer: Meridian Medicaid	$284.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$732.00
Rate for Payer: Priority Health Choice Medicaid	$270.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$727.24
Rate for Payer: Priority Health Narrow/Tiered Network	$727.24
Rate for Payer: UHC Medicaid	$270.51
Rate for Payer: UHCCP Medicaid	$270.51

PR LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG

Professional

Both

$998.00

Service Code	HCPCS 37785
Min. Negotiated Rate	$149.31
Max. Negotiated Rate	$748.50
Rate for Payer: Aetna Commercial	$342.53
Rate for Payer: Aetna Medicare	$499.00
Rate for Payer: BCBS Complete	$156.78
Rate for Payer: BCN Commercial	$373.49
Rate for Payer: Cash Price	$798.40
Rate for Payer: Cash Price	$798.40
Rate for Payer: Mclaren Medicaid	$149.31
Rate for Payer: Meridian Medicaid	$156.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$748.50
Rate for Payer: Priority Health Choice Medicaid	$149.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$401.64
Rate for Payer: Priority Health Narrow/Tiered Network	$401.64
Rate for Payer: UHC Medicaid	$149.31
Rate for Payer: UHCCP Medicaid	$149.31

PR LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX

Professional

Both

$497.00

Service Code	HCPCS 37780
Min. Negotiated Rate	$140.79
Max. Negotiated Rate	$377.00
Rate for Payer: Aetna Commercial	$313.05
Rate for Payer: Aetna Medicare	$248.50
Rate for Payer: BCBS Complete	$147.83
Rate for Payer: BCN Commercial	$350.58
Rate for Payer: Cash Price	$397.60
Rate for Payer: Cash Price	$397.60
Rate for Payer: Mclaren Medicaid	$140.79
Rate for Payer: Meridian Medicaid	$147.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$372.75
Rate for Payer: Priority Health Choice Medicaid	$140.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$377.00
Rate for Payer: Priority Health Narrow/Tiered Network	$377.00
Rate for Payer: UHC Medicaid	$140.79
Rate for Payer: UHCCP Medicaid	$140.79

PR LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR

Professional

Both

$2,301.00

Service Code	HCPCS 27429
Min. Negotiated Rate	$747.42
Max. Negotiated Rate	$2,048.93
Rate for Payer: Aetna Commercial	$1,675.57
Rate for Payer: Aetna Medicare	$1,150.50
Rate for Payer: BCBS Complete	$784.79
Rate for Payer: BCN Commercial	$1,916.73
Rate for Payer: Cash Price	$1,840.80
Rate for Payer: Cash Price	$1,840.80
Rate for Payer: Mclaren Medicaid	$747.42
Rate for Payer: Meridian Medicaid	$784.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,725.75
Rate for Payer: Priority Health Choice Medicaid	$747.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,048.93
Rate for Payer: Priority Health Narrow/Tiered Network	$2,048.93
Rate for Payer: UHC Medicaid	$747.42
Rate for Payer: UHCCP Medicaid	$747.42

PR LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG

Professional

Both

$1,160.00

Service Code	HCPCS 37761
Min. Negotiated Rate	$310.98
Max. Negotiated Rate	$870.00
Rate for Payer: Aetna Commercial	$717.95
Rate for Payer: Aetna Medicare	$580.00
Rate for Payer: BCBS Complete	$326.53
Rate for Payer: BCN Commercial	$785.81
Rate for Payer: Cash Price	$928.00
Rate for Payer: Cash Price	$928.00
Rate for Payer: Mclaren Medicaid	$310.98
Rate for Payer: Meridian Medicaid	$326.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$870.00
Rate for Payer: Priority Health Choice Medicaid	$310.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$845.05
Rate for Payer: Priority Health Narrow/Tiered Network	$845.05
Rate for Payer: UHC Medicaid	$310.98
Rate for Payer: UHCCP Medicaid	$310.98

PR LIG/TRNSXJ FALOPIAN TUBE CESAREAN DEL/ABDML SURG

Professional

Both

$347.00

Service Code	HCPCS 58611
Min. Negotiated Rate	$41.54
Max. Negotiated Rate	$260.25
Rate for Payer: Aetna Commercial	$91.50
Rate for Payer: Aetna Medicare	$173.50
Rate for Payer: BCBS Complete	$43.62
Rate for Payer: BCN Commercial	$112.05
Rate for Payer: Cash Price	$277.60
Rate for Payer: Cash Price	$277.60
Rate for Payer: Mclaren Medicaid	$41.54
Rate for Payer: Meridian Medicaid	$43.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$260.25
Rate for Payer: Priority Health Choice Medicaid	$41.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$113.48
Rate for Payer: Priority Health Narrow/Tiered Network	$113.48
Rate for Payer: UHC Medicaid	$41.54
Rate for Payer: UHCCP Medicaid	$41.54

PR LIG/TRNSXJ FLP TUBE ABDL/VAG APPR UNI/BI

Professional

Both

$1,324.00

Service Code	HCPCS 58600
Min. Negotiated Rate	$211.94
Max. Negotiated Rate	$993.00
Rate for Payer: Aetna Commercial	$442.01
Rate for Payer: Aetna Medicare	$662.00
Rate for Payer: BCBS Complete	$222.54
Rate for Payer: BCN Commercial	$557.74
Rate for Payer: Cash Price	$1,059.20
Rate for Payer: Cash Price	$1,059.20
Rate for Payer: Mclaren Medicaid	$211.94
Rate for Payer: Meridian Medicaid	$222.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$993.00
Rate for Payer: Priority Health Choice Medicaid	$211.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$564.87
Rate for Payer: Priority Health Narrow/Tiered Network	$564.87
Rate for Payer: UHC Medicaid	$211.94
Rate for Payer: UHCCP Medicaid	$211.94

PR LIG/TRNSXJ FLP TUBE ABDL/VAG POSTPARTUM SPX

Professional

Both

$891.00

Service Code	HCPCS 58605
Min. Negotiated Rate	$192.77
Max. Negotiated Rate	$668.25
Rate for Payer: Aetna Commercial	$400.03
Rate for Payer: Aetna Medicare	$445.50
Rate for Payer: BCBS Complete	$202.41
Rate for Payer: BCN Commercial	$506.44
Rate for Payer: Cash Price	$712.80
Rate for Payer: Cash Price	$712.80
Rate for Payer: Mclaren Medicaid	$192.77
Rate for Payer: Meridian Medicaid	$202.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$668.25
Rate for Payer: Priority Health Choice Medicaid	$192.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$512.91
Rate for Payer: Priority Health Narrow/Tiered Network	$512.91
Rate for Payer: UHC Medicaid	$192.77
Rate for Payer: UHCCP Medicaid	$192.77

Know your out-of-pocket cost for care.

All Charges