Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR MYRINGOTOMY ASPIR&/EUSTACHIAN TUBE NFLTJ ANES

Professional

Both

$486.00

Service Code	HCPCS 69421
Min. Negotiated Rate	$87.97
Max. Negotiated Rate	$364.50
Rate for Payer: Aetna Commercial	$167.15
Rate for Payer: Aetna Medicare	$243.00
Rate for Payer: BCBS Complete	$92.37
Rate for Payer: BCN Commercial	$228.57
Rate for Payer: Cash Price	$388.80
Rate for Payer: Cash Price	$388.80
Rate for Payer: Mclaren Medicaid	$87.97
Rate for Payer: Meridian Medicaid	$92.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$364.50
Rate for Payer: Priority Health Choice Medicaid	$87.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$225.85
Rate for Payer: Priority Health Narrow/Tiered Network	$225.85
Rate for Payer: UHC Medicaid	$87.97
Rate for Payer: UHCCP Medicaid	$87.97

PR NASAL ENDOSCOPY DIAGNOSTIC UNI/BI SPX

Professional

Both

$323.00

Service Code	HCPCS 31231
Min. Negotiated Rate	$34.93
Max. Negotiated Rate	$242.25
Rate for Payer: Aetna Commercial	$81.77
Rate for Payer: Aetna Medicare	$161.50
Rate for Payer: BCBS Complete	$36.68
Rate for Payer: BCN Commercial	$75.79
Rate for Payer: Cash Price	$258.40
Rate for Payer: Cash Price	$258.40
Rate for Payer: Mclaren Medicaid	$34.93
Rate for Payer: Meridian Medicaid	$36.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$242.25
Rate for Payer: Priority Health Choice Medicaid	$34.93
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$86.12
Rate for Payer: Priority Health Narrow/Tiered Network	$86.12
Rate for Payer: UHC Medicaid	$34.93
Rate for Payer: UHCCP Medicaid	$34.93

PR NASAL/SINUS ENDOSCOPY DX MAXILLARY SINUSOSCOPY

Professional

Both

$533.00

Service Code	HCPCS 31233
Min. Negotiated Rate	$74.76
Max. Negotiated Rate	$399.75
Rate for Payer: Aetna Commercial	$170.89
Rate for Payer: Aetna Medicare	$266.50
Rate for Payer: BCBS Complete	$78.50
Rate for Payer: BCN Commercial	$202.18
Rate for Payer: Cash Price	$426.40
Rate for Payer: Cash Price	$426.40
Rate for Payer: Mclaren Medicaid	$74.76
Rate for Payer: Meridian Medicaid	$78.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$399.75
Rate for Payer: Priority Health Choice Medicaid	$74.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$190.40
Rate for Payer: Priority Health Narrow/Tiered Network	$190.40
Rate for Payer: UHC Medicaid	$74.76
Rate for Payer: UHCCP Medicaid	$74.76

PR NASAL/SINUS ENDOSCOPY DX SPHENOID SINUSOSCOPY

Professional

Both

$522.00

Service Code	HCPCS 31235
Min. Negotiated Rate	$87.97
Max. Negotiated Rate	$391.50
Rate for Payer: Aetna Commercial	$199.96
Rate for Payer: Aetna Medicare	$261.00
Rate for Payer: BCBS Complete	$92.37
Rate for Payer: BCN Commercial	$240.53
Rate for Payer: Cash Price	$417.60
Rate for Payer: Cash Price	$417.60
Rate for Payer: Mclaren Medicaid	$87.97
Rate for Payer: Meridian Medicaid	$92.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$391.50
Rate for Payer: Priority Health Choice Medicaid	$87.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$226.50
Rate for Payer: Priority Health Narrow/Tiered Network	$226.50
Rate for Payer: UHC Medicaid	$87.97
Rate for Payer: UHCCP Medicaid	$87.97

PR NASAL/SINUS ENDOSCOPY W/MAXILLARY ANTROSTOMY

Professional

Both

$557.00

Service Code	HCPCS 31256
Min. Negotiated Rate	$97.34
Max. Negotiated Rate	$417.75
Rate for Payer: Aetna Commercial	$229.59
Rate for Payer: Aetna Medicare	$278.50
Rate for Payer: BCBS Complete	$102.21
Rate for Payer: BCN Commercial	$270.40
Rate for Payer: Cash Price	$445.60
Rate for Payer: Cash Price	$445.60
Rate for Payer: Mclaren Medicaid	$97.34
Rate for Payer: Meridian Medicaid	$102.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$417.75
Rate for Payer: Priority Health Choice Medicaid	$97.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$254.64
Rate for Payer: Priority Health Narrow/Tiered Network	$254.64
Rate for Payer: UHC Medicaid	$97.34
Rate for Payer: UHCCP Medicaid	$97.34

PR NASAL/SINUS ENDOSCOPY W/SPHENOIDOTOMY

Professional

Both

$916.00

Service Code	HCPCS 31287
Min. Negotiated Rate	$108.63
Max. Negotiated Rate	$687.00
Rate for Payer: Aetna Commercial	$256.12
Rate for Payer: Aetna Medicare	$458.00
Rate for Payer: BCBS Complete	$114.06
Rate for Payer: BCN Commercial	$300.28
Rate for Payer: Cash Price	$732.80
Rate for Payer: Cash Price	$732.80
Rate for Payer: Mclaren Medicaid	$108.63
Rate for Payer: Meridian Medicaid	$114.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$687.00
Rate for Payer: Priority Health Choice Medicaid	$108.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$282.78
Rate for Payer: Priority Health Narrow/Tiered Network	$282.78
Rate for Payer: UHC Medicaid	$108.63
Rate for Payer: UHCCP Medicaid	$108.63

PR NASAL/SINUS NDSC DSTRJ CRYOABLATION PST NSL NRV

Professional

Both

$4,591.00

Service Code	HCPCS 31243
Min. Negotiated Rate	$86.05
Max. Negotiated Rate	$3,443.25
Rate for Payer: Aetna Commercial	$197.73
Rate for Payer: Aetna Medicare	$2,295.50
Rate for Payer: BCBS Complete	$90.35
Rate for Payer: BCN Commercial	$235.55
Rate for Payer: Cash Price	$3,672.80
Rate for Payer: Cash Price	$3,672.80
Rate for Payer: Mclaren Medicaid	$86.05
Rate for Payer: Meridian Medicaid	$90.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,443.25
Rate for Payer: Priority Health Choice Medicaid	$86.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$221.82
Rate for Payer: Priority Health Narrow/Tiered Network	$221.82
Rate for Payer: UHC Medicaid	$86.05
Rate for Payer: UHCCP Medicaid	$86.05

PR NASAL/SINUS NDSC RPR CEREBRSP FLUID LEAK ETHMOID

Professional

Both

$2,173.00

Service Code	HCPCS 31290
Min. Negotiated Rate	$632.82
Max. Negotiated Rate	$1,715.55
Rate for Payer: Aetna Commercial	$1,463.14
Rate for Payer: Aetna Medicare	$1,086.50
Rate for Payer: BCBS Complete	$664.46
Rate for Payer: BCN Commercial	$1,715.55
Rate for Payer: Cash Price	$1,738.40
Rate for Payer: Cash Price	$1,738.40
Rate for Payer: Mclaren Medicaid	$632.82
Rate for Payer: Meridian Medicaid	$664.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,629.75
Rate for Payer: Priority Health Choice Medicaid	$632.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,615.54
Rate for Payer: Priority Health Narrow/Tiered Network	$1,615.54
Rate for Payer: UHC Medicaid	$632.82
Rate for Payer: UHCCP Medicaid	$632.82

PR NASAL/SINUS NDSC RPR CEREBSP FLUID LEAK SPHENOID

Professional

Both

$2,388.00

Service Code	HCPCS 31291
Min. Negotiated Rate	$686.71
Max. Negotiated Rate	$1,836.56
Rate for Payer: Aetna Commercial	$1,549.71
Rate for Payer: Aetna Medicare	$1,194.00
Rate for Payer: BCBS Complete	$721.05
Rate for Payer: BCN Commercial	$1,836.56
Rate for Payer: Cash Price	$1,910.40
Rate for Payer: Cash Price	$1,910.40
Rate for Payer: Mclaren Medicaid	$686.71
Rate for Payer: Meridian Medicaid	$721.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,791.00
Rate for Payer: Priority Health Choice Medicaid	$686.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,729.49
Rate for Payer: Priority Health Narrow/Tiered Network	$1,729.49
Rate for Payer: UHC Medicaid	$686.71
Rate for Payer: UHCCP Medicaid	$686.71

PR NASAL/SINUS NDSC SURG MEDIAL/INF ORB WALL DCMPRN

Professional

Both

$2,117.00

Service Code	HCPCS 31292
Min. Negotiated Rate	$544.85
Max. Negotiated Rate	$1,587.75
Rate for Payer: Aetna Commercial	$1,268.54
Rate for Payer: Aetna Medicare	$1,058.50
Rate for Payer: BCBS Complete	$572.09
Rate for Payer: BCN Commercial	$1,480.50
Rate for Payer: Cash Price	$1,693.60
Rate for Payer: Cash Price	$1,693.60
Rate for Payer: Mclaren Medicaid	$544.85
Rate for Payer: Meridian Medicaid	$572.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,587.75
Rate for Payer: Priority Health Choice Medicaid	$544.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,394.19
Rate for Payer: Priority Health Narrow/Tiered Network	$1,394.19
Rate for Payer: UHC Medicaid	$544.85
Rate for Payer: UHCCP Medicaid	$544.85

PR NASAL/SINUS NDSC SURG W/BX POLYPC/DBRDMT SPX

Professional

Both

$609.00

Service Code	HCPCS 31237
Min. Negotiated Rate	$88.18
Max. Negotiated Rate	$456.75
Rate for Payer: Aetna Commercial	$202.11
Rate for Payer: Aetna Medicare	$304.50
Rate for Payer: BCBS Complete	$92.59
Rate for Payer: BCN Commercial	$189.67
Rate for Payer: Cash Price	$487.20
Rate for Payer: Cash Price	$487.20
Rate for Payer: Mclaren Medicaid	$88.18
Rate for Payer: Meridian Medicaid	$92.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$456.75
Rate for Payer: Priority Health Choice Medicaid	$88.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$226.50
Rate for Payer: Priority Health Narrow/Tiered Network	$226.50
Rate for Payer: UHC Medicaid	$88.18
Rate for Payer: UHCCP Medicaid	$88.18

PR NASAL/SINUS NDSC SURG W/CONCHA BULLOSA RESECTION

Professional

Both

$533.00

Service Code	HCPCS 31240
Min. Negotiated Rate	$87.12
Max. Negotiated Rate	$399.75
Rate for Payer: Aetna Commercial	$201.32
Rate for Payer: Aetna Medicare	$266.50
Rate for Payer: BCBS Complete	$91.48
Rate for Payer: BCN Commercial	$238.54
Rate for Payer: Cash Price	$426.40
Rate for Payer: Cash Price	$426.40
Rate for Payer: Mclaren Medicaid	$87.12
Rate for Payer: Meridian Medicaid	$91.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$399.75
Rate for Payer: Priority Health Choice Medicaid	$87.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$224.63
Rate for Payer: Priority Health Narrow/Tiered Network	$224.63
Rate for Payer: UHC Medicaid	$87.12
Rate for Payer: UHCCP Medicaid	$87.12

PR NASAL/SINUS NDSC SURG W/CONTROL NASAL HEMORRHAGE

Professional

Both

$667.00

Service Code	HCPCS 31238
Min. Negotiated Rate	$92.02
Max. Negotiated Rate	$500.25
Rate for Payer: Aetna Commercial	$211.83
Rate for Payer: Aetna Medicare	$333.50
Rate for Payer: BCBS Complete	$96.62
Rate for Payer: BCN Commercial	$250.49
Rate for Payer: Cash Price	$533.60
Rate for Payer: Cash Price	$533.60
Rate for Payer: Mclaren Medicaid	$92.02
Rate for Payer: Meridian Medicaid	$96.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$500.25
Rate for Payer: Priority Health Choice Medicaid	$92.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$235.88
Rate for Payer: Priority Health Narrow/Tiered Network	$235.88
Rate for Payer: UHC Medicaid	$92.02
Rate for Payer: UHCCP Medicaid	$92.02

PR NASAL/SINUS NDSC SURG W/DACRYOCYSTORHINOSTOMY

Professional

Both

$1,372.00

Service Code	HCPCS 31239
Min. Negotiated Rate	$334.62
Max. Negotiated Rate	$1,029.00
Rate for Payer: Aetna Commercial	$773.69
Rate for Payer: Aetna Medicare	$686.00
Rate for Payer: BCBS Complete	$351.35
Rate for Payer: BCN Commercial	$910.31
Rate for Payer: Cash Price	$1,097.60
Rate for Payer: Cash Price	$1,097.60
Rate for Payer: Mclaren Medicaid	$334.62
Rate for Payer: Meridian Medicaid	$351.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,029.00
Rate for Payer: Priority Health Choice Medicaid	$334.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$857.24
Rate for Payer: Priority Health Narrow/Tiered Network	$857.24
Rate for Payer: UHC Medicaid	$334.62
Rate for Payer: UHCCP Medicaid	$334.62

PR NASAL/SINUS NDSC SURG W/DILATION FRONTAL SINUS

Professional

Both

$588.00

Service Code	HCPCS 31296
Min. Negotiated Rate	$97.13
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna Commercial	$228.73
Rate for Payer: Aetna Medicare	$294.00
Rate for Payer: BCBS Complete	$101.99
Rate for Payer: BCN Commercial	$269.41
Rate for Payer: Cash Price	$470.40
Rate for Payer: Cash Price	$470.40
Rate for Payer: Mclaren Medicaid	$97.13
Rate for Payer: Meridian Medicaid	$101.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$441.00
Rate for Payer: Priority Health Choice Medicaid	$97.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$253.70
Rate for Payer: Priority Health Narrow/Tiered Network	$253.70
Rate for Payer: UHC Medicaid	$97.13
Rate for Payer: UHCCP Medicaid	$97.13

PR NASAL/SINUS NDSC SURG W/DILATION MAXILLARY SINUS

Professional

Both

$4,113.00

Service Code	HCPCS 31295
Min. Negotiated Rate	$86.05
Max. Negotiated Rate	$3,084.75
Rate for Payer: Aetna Commercial	$200.89
Rate for Payer: Aetna Medicare	$2,056.50
Rate for Payer: BCBS Complete	$90.35
Rate for Payer: BCN Commercial	$236.04
Rate for Payer: Cash Price	$3,290.40
Rate for Payer: Cash Price	$3,290.40
Rate for Payer: Mclaren Medicaid	$86.05
Rate for Payer: Meridian Medicaid	$90.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,084.75
Rate for Payer: Priority Health Choice Medicaid	$86.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$222.28
Rate for Payer: Priority Health Narrow/Tiered Network	$222.28
Rate for Payer: UHC Medicaid	$86.05
Rate for Payer: UHCCP Medicaid	$86.05

PR NASAL/SINUS NDSC SURG W/DILATION SPHENOID SINUS

Professional

Both

$3,370.00

Service Code	HCPCS 31297
Min. Negotiated Rate	$78.81
Max. Negotiated Rate	$2,527.50
Rate for Payer: Aetna Commercial	$182.81
Rate for Payer: Aetna Medicare	$1,685.00
Rate for Payer: BCBS Complete	$82.75
Rate for Payer: BCN Commercial	$215.12
Rate for Payer: Cash Price	$2,696.00
Rate for Payer: Cash Price	$2,696.00
Rate for Payer: Mclaren Medicaid	$78.81
Rate for Payer: Meridian Medicaid	$82.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,527.50
Rate for Payer: Priority Health Choice Medicaid	$78.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$202.59
Rate for Payer: Priority Health Narrow/Tiered Network	$202.59
Rate for Payer: UHC Medicaid	$78.81
Rate for Payer: UHCCP Medicaid	$78.81

PR NASAL/SINUS NDSC SURG W/LIG SPHENOPALATINE ART

Professional

Both

$952.00

Service Code	HCPCS 31241
Min. Negotiated Rate	$237.92
Max. Negotiated Rate	$714.00
Rate for Payer: Aetna Commercial	$567.94
Rate for Payer: Aetna Medicare	$476.00
Rate for Payer: BCBS Complete	$249.82
Rate for Payer: BCN Commercial	$660.33
Rate for Payer: Cash Price	$761.60
Rate for Payer: Cash Price	$761.60
Rate for Payer: Mclaren Medicaid	$237.92
Rate for Payer: Meridian Medicaid	$249.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$714.00
Rate for Payer: Priority Health Choice Medicaid	$237.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$621.82
Rate for Payer: Priority Health Narrow/Tiered Network	$621.82
Rate for Payer: UHC Medicaid	$237.92
Rate for Payer: UHCCP Medicaid	$237.92

PR NASAL/SINUS NDSC SURG W/OPTIC NERVE DCMPRN

Professional

Both

$2,669.00

Service Code	HCPCS 31294
Min. Negotiated Rate	$670.95
Max. Negotiated Rate	$2,001.75
Rate for Payer: Aetna Commercial	$1,571.24
Rate for Payer: Aetna Medicare	$1,334.50
Rate for Payer: BCBS Complete	$704.50
Rate for Payer: BCN Commercial	$1,831.08
Rate for Payer: Cash Price	$2,135.20
Rate for Payer: Cash Price	$2,135.20
Rate for Payer: Mclaren Medicaid	$670.95
Rate for Payer: Meridian Medicaid	$704.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,001.75
Rate for Payer: Priority Health Choice Medicaid	$670.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,724.33
Rate for Payer: Priority Health Narrow/Tiered Network	$1,724.33
Rate for Payer: UHC Medicaid	$670.95
Rate for Payer: UHCCP Medicaid	$670.95

PR NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY

Professional

Both

$948.00

Service Code	HCPCS 31257
Min. Negotiated Rate	$239.20
Max. Negotiated Rate	$711.00
Rate for Payer: Aetna Commercial	$570.01
Rate for Payer: Aetna Medicare	$474.00
Rate for Payer: BCBS Complete	$251.16
Rate for Payer: BCN Commercial	$662.81
Rate for Payer: Cash Price	$758.40
Rate for Payer: Cash Price	$758.40
Rate for Payer: Mclaren Medicaid	$239.20
Rate for Payer: Meridian Medicaid	$251.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$711.00
Rate for Payer: Priority Health Choice Medicaid	$239.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$624.17
Rate for Payer: Priority Health Narrow/Tiered Network	$624.17
Rate for Payer: UHC Medicaid	$239.20
Rate for Payer: UHCCP Medicaid	$239.20

PR NASAL/SINUS NDSC TOT W/FRNT SINS EXPL TISS RMVL

Professional

Both

$1,050.00

Service Code	HCPCS 31253
Min. Negotiated Rate	$267.95
Max. Negotiated Rate	$787.50
Rate for Payer: Aetna Commercial	$639.80
Rate for Payer: Aetna Medicare	$525.00
Rate for Payer: BCBS Complete	$281.35
Rate for Payer: BCN Commercial	$742.99
Rate for Payer: Cash Price	$840.00
Rate for Payer: Cash Price	$840.00
Rate for Payer: Mclaren Medicaid	$267.95
Rate for Payer: Meridian Medicaid	$281.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$787.50
Rate for Payer: Priority Health Choice Medicaid	$267.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$699.67
Rate for Payer: Priority Health Narrow/Tiered Network	$699.67
Rate for Payer: UHC Medicaid	$267.95
Rate for Payer: UHCCP Medicaid	$267.95

PR NASAL/SINUS NDSC TOT W/SPHENDT W/SPHEN TISS RMVL

Professional

Both

$1,004.00

Service Code	HCPCS 31259
Min. Negotiated Rate	$253.26
Max. Negotiated Rate	$753.00
Rate for Payer: Aetna Commercial	$603.57
Rate for Payer: Aetna Medicare	$502.00
Rate for Payer: BCBS Complete	$265.92
Rate for Payer: BCN Commercial	$701.65
Rate for Payer: Cash Price	$803.20
Rate for Payer: Cash Price	$803.20
Rate for Payer: Mclaren Medicaid	$253.26
Rate for Payer: Meridian Medicaid	$265.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$753.00
Rate for Payer: Priority Health Choice Medicaid	$253.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$660.75
Rate for Payer: Priority Health Narrow/Tiered Network	$660.75
Rate for Payer: UHC Medicaid	$253.26
Rate for Payer: UHCCP Medicaid	$253.26

PR NASAL/SINUS NDSC W/PARTIAL ETHMOIDECTOMY

Professional

Both

$765.00

Service Code	HCPCS 31254
Min. Negotiated Rate	$131.21
Max. Negotiated Rate	$573.75
Rate for Payer: Aetna Commercial	$310.39
Rate for Payer: Aetna Medicare	$382.50
Rate for Payer: BCBS Complete	$137.77
Rate for Payer: BCN Commercial	$362.53
Rate for Payer: Cash Price	$612.00
Rate for Payer: Cash Price	$612.00
Rate for Payer: Mclaren Medicaid	$131.21
Rate for Payer: Meridian Medicaid	$137.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$573.75
Rate for Payer: Priority Health Choice Medicaid	$131.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$341.39
Rate for Payer: Priority Health Narrow/Tiered Network	$341.39
Rate for Payer: UHC Medicaid	$131.21
Rate for Payer: UHCCP Medicaid	$131.21

PR NASAL/SINUS NDSC W/RMVL TISS FROM FRONTAL SINUS

Professional

Both

$1,401.00

Service Code	HCPCS 31276
Min. Negotiated Rate	$202.78
Max. Negotiated Rate	$1,050.75
Rate for Payer: Aetna Commercial	$482.62
Rate for Payer: Aetna Medicare	$700.50
Rate for Payer: BCBS Complete	$212.92
Rate for Payer: BCN Commercial	$562.72
Rate for Payer: Cash Price	$1,120.80
Rate for Payer: Cash Price	$1,120.80
Rate for Payer: Mclaren Medicaid	$202.78
Rate for Payer: Meridian Medicaid	$212.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,050.75
Rate for Payer: Priority Health Choice Medicaid	$202.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$529.92
Rate for Payer: Priority Health Narrow/Tiered Network	$529.92
Rate for Payer: UHC Medicaid	$202.78
Rate for Payer: UHCCP Medicaid	$202.78

PR NASAL/SINUS NDSC W/TOTAL ETHOIDECTOMY

Professional

Both

$973.00

Service Code	HCPCS 31255
Min. Negotiated Rate	$174.23
Max. Negotiated Rate	$729.75
Rate for Payer: Aetna Commercial	$412.82
Rate for Payer: Aetna Medicare	$486.50
Rate for Payer: BCBS Complete	$182.94
Rate for Payer: BCN Commercial	$481.05
Rate for Payer: Cash Price	$778.40
Rate for Payer: Cash Price	$778.40
Rate for Payer: Mclaren Medicaid	$174.23
Rate for Payer: Meridian Medicaid	$182.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$729.75
Rate for Payer: Priority Health Choice Medicaid	$174.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$453.01
Rate for Payer: Priority Health Narrow/Tiered Network	$453.01
Rate for Payer: UHC Medicaid	$174.23
Rate for Payer: UHCCP Medicaid	$174.23

Know your out-of-pocket cost for care.

All Charges