Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR LYMPHANGIOTOMY/OTH OPRATIONS LYMPHATIC CHANNELS

Professional

Both

$958.00

Service Code	HCPCS 38308
Min. Negotiated Rate	$285.42
Max. Negotiated Rate	$950.18
Rate for Payer: Aetna Commercial	$570.91
Rate for Payer: Aetna Medicare	$479.00
Rate for Payer: BCBS Complete	$299.69
Rate for Payer: BCN Commercial	$714.11
Rate for Payer: Cash Price	$766.40
Rate for Payer: Cash Price	$766.40
Rate for Payer: Mclaren Medicaid	$285.42
Rate for Payer: Meridian Medicaid	$299.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$718.50
Rate for Payer: Priority Health Choice Medicaid	$285.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$950.18
Rate for Payer: Priority Health Narrow/Tiered Network	$950.18
Rate for Payer: UHC Medicaid	$285.42
Rate for Payer: UHCCP Medicaid	$285.42

PR LYSIS/EXCISION PENILE POSTCIRCUMCISION ADHESIONS

Professional

Both

$537.00

Service Code	HCPCS 54162
Min. Negotiated Rate	$117.58
Max. Negotiated Rate	$402.75
Rate for Payer: Aetna Commercial	$255.52
Rate for Payer: Aetna Medicare	$268.50
Rate for Payer: BCBS Complete	$123.46
Rate for Payer: BCN Commercial	$301.78
Rate for Payer: Cash Price	$429.60
Rate for Payer: Cash Price	$429.60
Rate for Payer: Mclaren Medicaid	$117.58
Rate for Payer: Meridian Medicaid	$123.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$402.75
Rate for Payer: Priority Health Choice Medicaid	$117.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$328.73
Rate for Payer: Priority Health Narrow/Tiered Network	$328.73
Rate for Payer: UHC Medicaid	$117.58
Rate for Payer: UHCCP Medicaid	$117.58

PR LYSIS INTRANASAL SYNECHIA

Professional

Both

$531.00

Service Code	HCPCS 30560
Min. Negotiated Rate	$89.03
Max. Negotiated Rate	$398.25
Rate for Payer: Aetna Commercial	$184.81
Rate for Payer: Aetna Medicare	$265.50
Rate for Payer: BCBS Complete	$93.48
Rate for Payer: BCN Commercial	$226.08
Rate for Payer: Cash Price	$424.80
Rate for Payer: Cash Price	$424.80
Rate for Payer: Mclaren Medicaid	$89.03
Rate for Payer: Meridian Medicaid	$93.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$398.25
Rate for Payer: Priority Health Choice Medicaid	$89.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$212.90
Rate for Payer: Priority Health Narrow/Tiered Network	$212.90
Rate for Payer: UHC Medicaid	$89.03
Rate for Payer: UHCCP Medicaid	$89.03

PR LYSIS LABIAL ADHESIONS

Professional

Both

$507.00

Service Code	HCPCS 56441
Min. Negotiated Rate	$89.67
Max. Negotiated Rate	$380.25
Rate for Payer: Aetna Commercial	$179.27
Rate for Payer: Aetna Medicare	$253.50
Rate for Payer: BCBS Complete	$94.15
Rate for Payer: BCN Commercial	$233.06
Rate for Payer: Cash Price	$405.60
Rate for Payer: Cash Price	$405.60
Rate for Payer: Mclaren Medicaid	$89.67
Rate for Payer: Meridian Medicaid	$94.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$380.25
Rate for Payer: Priority Health Choice Medicaid	$89.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$236.03
Rate for Payer: Priority Health Narrow/Tiered Network	$236.03
Rate for Payer: UHC Medicaid	$89.67
Rate for Payer: UHCCP Medicaid	$89.67

PR LYSIS OF ADHESIONS SALPINX/OVARY

Professional

Both

$2,501.00

Service Code	HCPCS 58740
Min. Negotiated Rate	$526.11
Max. Negotiated Rate	$1,875.75
Rate for Payer: Aetna Commercial	$1,075.71
Rate for Payer: Aetna Medicare	$1,250.50
Rate for Payer: BCBS Complete	$552.42
Rate for Payer: BCN Commercial	$1,359.49
Rate for Payer: Cash Price	$2,000.80
Rate for Payer: Cash Price	$2,000.80
Rate for Payer: Mclaren Medicaid	$526.11
Rate for Payer: Meridian Medicaid	$552.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,875.75
Rate for Payer: Priority Health Choice Medicaid	$526.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,376.87
Rate for Payer: Priority Health Narrow/Tiered Network	$1,376.87
Rate for Payer: UHC Medicaid	$526.11
Rate for Payer: UHCCP Medicaid	$526.11

PR MA/EC CONTRACEPTIVEINJECTION

Professional

Both

$35.00

Service Code	HCPCS J1056
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Medicare	$17.50
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.25

PR MAJOR RECONSTRUCTION CHEST WALL POSTTRAUMATIC

Professional

Both

$3,448.00

Service Code	HCPCS 32820
Min. Negotiated Rate	$837.94
Max. Negotiated Rate	$2,586.00
Rate for Payer: Aetna Commercial	$1,715.98
Rate for Payer: Aetna Medicare	$1,724.00
Rate for Payer: BCBS Complete	$879.84
Rate for Payer: BCN Commercial	$2,074.09
Rate for Payer: Cash Price	$2,758.40
Rate for Payer: Cash Price	$2,758.40
Rate for Payer: Mclaren Medicaid	$837.94
Rate for Payer: Meridian Medicaid	$879.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,586.00
Rate for Payer: Priority Health Choice Medicaid	$837.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,953.18
Rate for Payer: Priority Health Narrow/Tiered Network	$1,953.18
Rate for Payer: UHC Medicaid	$837.94
Rate for Payer: UHCCP Medicaid	$837.94

PR MAKENA, 10 MG

Professional

Both

$3.00

Service Code	HCPCS J1726
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$19.41
Rate for Payer: Aetna Commercial	$19.41
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCN Commercial	$6.80
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR MAMMAPLASTY AUGMENTATION - GEL

Professional

Both

$3,605.00

Hospital Revenue Code	990
Min. Negotiated Rate	$1,442.00
Max. Negotiated Rate	$2,703.75
Rate for Payer: Aetna Medicare	$1,802.50
Rate for Payer: BCBS Complete	$1,442.00
Rate for Payer: Cash Price	$2,884.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,703.75

PR MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD

Professional

Both

$422.00

Service Code	HCPCS 26341
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$316.50
Rate for Payer: Aetna Commercial	$102.17
Rate for Payer: Aetna Medicare	$211.00
Rate for Payer: BCBS Complete	$48.98
Rate for Payer: BCN Commercial	$119.02
Rate for Payer: Cash Price	$337.60
Rate for Payer: Cash Price	$337.60
Rate for Payer: Mclaren Medicaid	$46.65
Rate for Payer: Meridian Medicaid	$48.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$316.50
Rate for Payer: Priority Health Choice Medicaid	$46.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$127.23
Rate for Payer: Priority Health Narrow/Tiered Network	$127.23
Rate for Payer: UHC Medicaid	$46.65
Rate for Payer: UHCCP Medicaid	$46.65

PR MANIPULATION ANKLE UNDER GENERAL ANESTHESIA

Professional

Both

$649.00

Service Code	HCPCS 27860
Min. Negotiated Rate	$98.62
Max. Negotiated Rate	$486.75
Rate for Payer: Aetna Commercial	$223.16
Rate for Payer: Aetna Medicare	$324.50
Rate for Payer: BCBS Complete	$103.55
Rate for Payer: BCN Commercial	$249.49
Rate for Payer: Cash Price	$519.20
Rate for Payer: Cash Price	$519.20
Rate for Payer: Mclaren Medicaid	$98.62
Rate for Payer: Meridian Medicaid	$103.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$486.75
Rate for Payer: Priority Health Choice Medicaid	$98.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$266.70
Rate for Payer: Priority Health Narrow/Tiered Network	$266.70
Rate for Payer: UHC Medicaid	$98.62
Rate for Payer: UHCCP Medicaid	$98.62

PR MANIPULATION ELBOW UNDER ANESTHESIA

Professional

Both

$737.00

Service Code	HCPCS 24300
Min. Negotiated Rate	$284.57
Max. Negotiated Rate	$732.49
Rate for Payer: Aetna Commercial	$567.74
Rate for Payer: Aetna Medicare	$368.50
Rate for Payer: BCBS Complete	$298.80
Rate for Payer: BCN Commercial	$685.22
Rate for Payer: Cash Price	$589.60
Rate for Payer: Cash Price	$589.60
Rate for Payer: Mclaren Medicaid	$284.57
Rate for Payer: Meridian Medicaid	$298.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$552.75
Rate for Payer: Priority Health Choice Medicaid	$284.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$732.49
Rate for Payer: Priority Health Narrow/Tiered Network	$732.49
Rate for Payer: UHC Medicaid	$284.57
Rate for Payer: UHCCP Medicaid	$284.57

PR MANIPULATION FINGER JOINT UNDER ANES EACH JOINT

Professional

Both

$735.00

Service Code	HCPCS 26340
Min. Negotiated Rate	$233.02
Max. Negotiated Rate	$597.80
Rate for Payer: Aetna Commercial	$454.85
Rate for Payer: Aetna Medicare	$367.50
Rate for Payer: BCBS Complete	$244.67
Rate for Payer: BCN Commercial	$559.23
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cash Price	$588.00
Rate for Payer: Mclaren Medicaid	$233.02
Rate for Payer: Meridian Medicaid	$244.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$551.25
Rate for Payer: Priority Health Choice Medicaid	$233.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$597.80
Rate for Payer: Priority Health Narrow/Tiered Network	$597.80
Rate for Payer: UHC Medicaid	$233.02
Rate for Payer: UHCCP Medicaid	$233.02

PR MANIPULATION HIP JOINT GENERAL ANESTHESIA

Professional

Both

$1,038.00

Service Code	HCPCS 27275
Min. Negotiated Rate	$113.96
Max. Negotiated Rate	$778.50
Rate for Payer: Aetna Commercial	$244.58
Rate for Payer: Aetna Medicare	$519.00
Rate for Payer: BCBS Complete	$119.66
Rate for Payer: BCN Commercial	$282.86
Rate for Payer: Cash Price	$830.40
Rate for Payer: Cash Price	$830.40
Rate for Payer: Mclaren Medicaid	$113.96
Rate for Payer: Meridian Medicaid	$119.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$778.50
Rate for Payer: Priority Health Choice Medicaid	$113.96
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	$113.96
Rate for Payer: UHCCP Medicaid	$113.96

PR MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA

Professional

Both

$689.00

Service Code	HCPCS 27570
Min. Negotiated Rate	$95.64
Max. Negotiated Rate	$516.75
Rate for Payer: Aetna Commercial	$199.99
Rate for Payer: Aetna Medicare	$344.50
Rate for Payer: BCBS Complete	$100.42
Rate for Payer: BCN Commercial	$237.54
Rate for Payer: Cash Price	$551.20
Rate for Payer: Cash Price	$551.20
Rate for Payer: Mclaren Medicaid	$95.64
Rate for Payer: Meridian Medicaid	$100.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$516.75
Rate for Payer: Priority Health Choice Medicaid	$95.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$253.92
Rate for Payer: Priority Health Narrow/Tiered Network	$253.92
Rate for Payer: UHC Medicaid	$95.64
Rate for Payer: UHCCP Medicaid	$95.64

PR MANIPULATION SPINE REQUIRING ANESTHESIA

Professional

Both

$502.00

Service Code	HCPCS 22505
Min. Negotiated Rate	$97.98
Max. Negotiated Rate	$376.50
Rate for Payer: Aetna Commercial	$174.31
Rate for Payer: Aetna Medicare	$251.00
Rate for Payer: BCBS Complete	$102.88
Rate for Payer: BCN Commercial	$250.56
Rate for Payer: Cash Price	$401.60
Rate for Payer: Cash Price	$401.60
Rate for Payer: Mclaren Medicaid	$97.98
Rate for Payer: Meridian Medicaid	$102.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$376.50
Rate for Payer: Priority Health Choice Medicaid	$97.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$243.81
Rate for Payer: Priority Health Narrow/Tiered Network	$243.81
Rate for Payer: UHC Medicaid	$97.98
Rate for Payer: UHCCP Medicaid	$97.98

PR MANIPULATION WRIST UNDER ANESTHESIA

Professional

Both

$707.00

Service Code	HCPCS 25259
Min. Negotiated Rate	$278.82
Max. Negotiated Rate	$696.28
Rate for Payer: Aetna Commercial	$560.78
Rate for Payer: Aetna Medicare	$353.50
Rate for Payer: BCBS Complete	$292.76
Rate for Payer: BCN Commercial	$651.36
Rate for Payer: Cash Price	$565.60
Rate for Payer: Cash Price	$565.60
Rate for Payer: Mclaren Medicaid	$278.82
Rate for Payer: Meridian Medicaid	$292.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$530.25
Rate for Payer: Priority Health Choice Medicaid	$278.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$696.28
Rate for Payer: Priority Health Narrow/Tiered Network	$696.28
Rate for Payer: UHC Medicaid	$278.82
Rate for Payer: UHCCP Medicaid	$278.82

PR MANUAL PREP AND INSERTION DEEP DRUG DELIVERY DEV

Professional

Both

$175.00

Service Code	HCPCS 20700
Min. Negotiated Rate	$45.16
Max. Negotiated Rate	$133.61
Rate for Payer: Aetna Commercial	$111.83
Rate for Payer: Aetna Medicare	$87.50
Rate for Payer: BCBS Complete	$47.42
Rate for Payer: BCN Commercial	$124.99
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Mclaren Medicaid	$45.16
Rate for Payer: Meridian Medicaid	$47.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$131.25
Rate for Payer: Priority Health Choice Medicaid	$45.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$133.61
Rate for Payer: Priority Health Narrow/Tiered Network	$133.61
Rate for Payer: UHC Medicaid	$45.16
Rate for Payer: UHCCP Medicaid	$45.16

PR MANUAL PREP&INSJ INTRAMEDULLARY DRUG DLVR DEVICE

Professional

Both

$301.00

Service Code	HCPCS 20702
Min. Negotiated Rate	$78.38
Max. Negotiated Rate	$227.83
Rate for Payer: Aetna Commercial	$187.44
Rate for Payer: Aetna Medicare	$150.50
Rate for Payer: BCBS Complete	$82.30
Rate for Payer: BCN Commercial	$213.13
Rate for Payer: Cash Price	$240.80
Rate for Payer: Cash Price	$240.80
Rate for Payer: Mclaren Medicaid	$78.38
Rate for Payer: Meridian Medicaid	$82.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$225.75
Rate for Payer: Priority Health Choice Medicaid	$78.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$227.83
Rate for Payer: Priority Health Narrow/Tiered Network	$227.83
Rate for Payer: UHC Medicaid	$78.38
Rate for Payer: UHCCP Medicaid	$78.38

PR MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES

Professional

Both

$50.00

Service Code	HCPCS 97140
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$89.48
Rate for Payer: Aetna Commercial	$20.11
Rate for Payer: Aetna Medicare	$25.00
Rate for Payer: BCN Commercial	$28.04
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$37.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.48
Rate for Payer: Priority Health Narrow/Tiered Network	$89.48

PR MARSUPIALIZATION BARTHOLINS GLAND CYST

Professional

Both

$809.00

Service Code	HCPCS 56440
Min. Negotiated Rate	$104.37
Max. Negotiated Rate	$606.75
Rate for Payer: Aetna Commercial	$215.36
Rate for Payer: Aetna Medicare	$404.50
Rate for Payer: BCBS Complete	$109.59
Rate for Payer: BCN Commercial	$273.89
Rate for Payer: Cash Price	$647.20
Rate for Payer: Cash Price	$647.20
Rate for Payer: Mclaren Medicaid	$104.37
Rate for Payer: Meridian Medicaid	$109.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$606.75
Rate for Payer: Priority Health Choice Medicaid	$104.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$277.40
Rate for Payer: Priority Health Narrow/Tiered Network	$277.40
Rate for Payer: UHC Medicaid	$104.37
Rate for Payer: UHCCP Medicaid	$104.37

PR MARSUPIALIZATION CST/ABSC LVR

Professional

Both

$2,412.00

Service Code	HCPCS 47300
Min. Negotiated Rate	$684.16
Max. Negotiated Rate	$2,077.53
Rate for Payer: Aetna Commercial	$1,533.52
Rate for Payer: Aetna Medicare	$1,206.00
Rate for Payer: BCBS Complete	$718.37
Rate for Payer: BCN Commercial	$1,705.08
Rate for Payer: Cash Price	$1,929.60
Rate for Payer: Cash Price	$1,929.60
Rate for Payer: Mclaren Medicaid	$684.16
Rate for Payer: Meridian Medicaid	$718.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,809.00
Rate for Payer: Priority Health Choice Medicaid	$684.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,077.53
Rate for Payer: Priority Health Narrow/Tiered Network	$2,077.53
Rate for Payer: UHC Medicaid	$684.16
Rate for Payer: UHCCP Medicaid	$684.16

PR MARSUPIALIZATION SUBLNGL SALIVARY CST RANULA

Professional

Both

$717.00

Service Code	HCPCS 42409
Min. Negotiated Rate	$134.19
Max. Negotiated Rate	$537.75
Rate for Payer: Aetna Commercial	$297.60
Rate for Payer: Aetna Medicare	$358.50
Rate for Payer: BCBS Complete	$140.90
Rate for Payer: BCN Commercial	$354.56
Rate for Payer: Cash Price	$573.60
Rate for Payer: Cash Price	$573.60
Rate for Payer: Mclaren Medicaid	$134.19
Rate for Payer: Meridian Medicaid	$140.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$537.75
Rate for Payer: Priority Health Choice Medicaid	$134.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$432.02
Rate for Payer: Priority Health Narrow/Tiered Network	$432.02
Rate for Payer: UHC Medicaid	$134.19
Rate for Payer: UHCCP Medicaid	$134.19

PR MASTECTOMY FOR GYNECOMASTIA

Facility

$1,681.00

Service Code	CPT 19300
Hospital Charge Code	19300
Hospital Revenue Code	960
Min. Negotiated Rate	$296.36
Max. Negotiated Rate	$1,512.90
Rate for Payer: Aetna Commercial	$1,428.85
Rate for Payer: Aetna Medicare	$437.06
Rate for Payer: Allen County Amish Medical Aid Commercial	$525.31
Rate for Payer: Amish Plain Church Group Commercial	$525.31
Rate for Payer: BCBS Complete	$311.15
Rate for Payer: BCBS MAPPO	$420.25
Rate for Payer: BCBS Trust/PPO	$1,381.95
Rate for Payer: BCN Commercial	$1,381.95
Rate for Payer: BCN Medicare Advantage	$420.25
Rate for Payer: Cash Price	$1,344.80
Rate for Payer: Cofinity Commercial	$1,445.66
Rate for Payer: Encore Health Key Benefits Commercial	$1,344.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$420.25
Rate for Payer: Healthscope Commercial	$1,512.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,260.75
Rate for Payer: Mclaren Medicaid	$296.36
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$441.26
Rate for Payer: Meridian Medicaid	$311.15
Rate for Payer: MI Amish Medical Board Commercial	$483.29
Rate for Payer: Molina Medicare/Medicaid	$462.27
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,428.85
Rate for Payer: Nomi Health Commercial	$1,378.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,260.75
Rate for Payer: PACE Senior Care Partners	$399.24
Rate for Payer: PACE SWMI	$420.25
Rate for Payer: PHP Commercial	$1,428.85
Rate for Payer: PHP Medicare Advantage	$420.25
Rate for Payer: Priority Health Choice Medicaid	$296.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,462.47
Rate for Payer: Priority Health Medicare	$424.45
Rate for Payer: Priority Health Narrow/Tiered Network	$1,169.98
Rate for Payer: Railroad Medicare Medicare	$420.25
Rate for Payer: UHC Core	$1,403.63
Rate for Payer: UHC Exchange	$420.25
Rate for Payer: UHC Medicaid	$296.36
Rate for Payer: UHC Medicare Advantage	$420.25
Rate for Payer: UHCCP Medicaid	$296.36
Rate for Payer: VA VA	$420.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,260.75

PR MASTECTOMY FOR GYNECOMASTIA

Professional

Both

$1,681.00

Service Code	HCPCS 19300
Min. Negotiated Rate	$271.58
Max. Negotiated Rate	$1,260.75
Rate for Payer: Aetna Commercial	$462.52
Rate for Payer: Aetna Medicare	$840.50
Rate for Payer: BCBS Complete	$285.16
Rate for Payer: BCN Commercial	$658.33
Rate for Payer: Cash Price	$1,344.80
Rate for Payer: Cash Price	$1,344.80
Rate for Payer: Mclaren Medicaid	$271.58
Rate for Payer: Meridian Medicaid	$285.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,260.75
Rate for Payer: Priority Health Choice Medicaid	$271.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$602.54
Rate for Payer: Priority Health Narrow/Tiered Network	$602.54
Rate for Payer: UHC Medicaid	$271.58
Rate for Payer: UHCCP Medicaid	$271.58

Know your out-of-pocket cost for care.

All Charges