Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR

Professional

Both

$1,526.00

Service Code	HCPCS 28238
Min. Negotiated Rate	$292.88
Max. Negotiated Rate	$1,144.50
Rate for Payer: Aetna Commercial	$642.89
Rate for Payer: Aetna Medicare	$763.00
Rate for Payer: BCBS Complete	$307.52
Rate for Payer: BCN Commercial	$734.53
Rate for Payer: Cash Price	$1,220.80
Rate for Payer: Cash Price	$1,220.80
Rate for Payer: Mclaren Medicaid	$292.88
Rate for Payer: Meridian Medicaid	$307.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,144.50
Rate for Payer: Priority Health Choice Medicaid	$292.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$785.18
Rate for Payer: Priority Health Narrow/Tiered Network	$785.18
Rate for Payer: UHC Medicaid	$292.88
Rate for Payer: UHCCP Medicaid	$292.88

PR RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ

Professional

Both

$3,547.00

Service Code	HCPCS 25337
Min. Negotiated Rate	$528.24
Max. Negotiated Rate	$2,660.25
Rate for Payer: Aetna Commercial	$1,179.01
Rate for Payer: Aetna Medicare	$1,773.50
Rate for Payer: BCBS Complete	$554.65
Rate for Payer: BCN Commercial	$1,360.99
Rate for Payer: Cash Price	$2,837.60
Rate for Payer: Cash Price	$2,837.60
Rate for Payer: Mclaren Medicaid	$528.24
Rate for Payer: Meridian Medicaid	$554.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,660.25
Rate for Payer: Priority Health Choice Medicaid	$528.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,454.85
Rate for Payer: Priority Health Narrow/Tiered Network	$1,454.85
Rate for Payer: UHC Medicaid	$528.24
Rate for Payer: UHCCP Medicaid	$528.24

PR RCNSTJ SUPERIOR-LATERAL ORBITAL RIM & LOWER FHD

Professional

Both

$4,612.00

Service Code	HCPCS 21172
Min. Negotiated Rate	$1,332.32
Max. Negotiated Rate	$3,459.00
Rate for Payer: Aetna Commercial	$2,826.55
Rate for Payer: Aetna Medicare	$2,306.00
Rate for Payer: BCBS Complete	$1,398.94
Rate for Payer: BCN Commercial	$3,204.51
Rate for Payer: Cash Price	$3,689.60
Rate for Payer: Cash Price	$3,689.60
Rate for Payer: Mclaren Medicaid	$1,332.32
Rate for Payer: Meridian Medicaid	$1,398.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,459.00
Rate for Payer: Priority Health Choice Medicaid	$1,332.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,425.53
Rate for Payer: Priority Health Narrow/Tiered Network	$3,425.53
Rate for Payer: UHC Medicaid	$1,332.32
Rate for Payer: UHCCP Medicaid	$1,332.32

PR RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX

Professional

Both

$1,477.00

Service Code	HCPCS 26502
Min. Negotiated Rate	$475.20
Max. Negotiated Rate	$1,218.50
Rate for Payer: Aetna Commercial	$1,000.01
Rate for Payer: Aetna Medicare	$738.50
Rate for Payer: BCBS Complete	$498.96
Rate for Payer: BCN Commercial	$1,139.88
Rate for Payer: Cash Price	$1,181.60
Rate for Payer: Cash Price	$1,181.60
Rate for Payer: Mclaren Medicaid	$475.20
Rate for Payer: Meridian Medicaid	$498.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,107.75
Rate for Payer: Priority Health Choice Medicaid	$475.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,218.50
Rate for Payer: Priority Health Narrow/Tiered Network	$1,218.50
Rate for Payer: UHC Medicaid	$475.20
Rate for Payer: UHCCP Medicaid	$475.20

PR RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX

Professional

Both

$1,430.00

Service Code	HCPCS 26500
Min. Negotiated Rate	$438.14
Max. Negotiated Rate	$1,109.90
Rate for Payer: Aetna Commercial	$873.76
Rate for Payer: Aetna Medicare	$715.00
Rate for Payer: BCBS Complete	$460.05
Rate for Payer: BCN Commercial	$1,038.29
Rate for Payer: Cash Price	$1,144.00
Rate for Payer: Cash Price	$1,144.00
Rate for Payer: Mclaren Medicaid	$438.14
Rate for Payer: Meridian Medicaid	$460.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,072.50
Rate for Payer: Priority Health Choice Medicaid	$438.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,109.90
Rate for Payer: Priority Health Narrow/Tiered Network	$1,109.90
Rate for Payer: UHC Medicaid	$438.14
Rate for Payer: UHCCP Medicaid	$438.14

PR RDCTJ PROCIDENTIA UNDER ANES SEPARATE PROCEDURE

Professional

Both

$399.00

Service Code	HCPCS 45900
Min. Negotiated Rate	$134.83
Max. Negotiated Rate	$392.57
Rate for Payer: Aetna Commercial	$285.26
Rate for Payer: Aetna Medicare	$199.50
Rate for Payer: BCBS Complete	$141.57
Rate for Payer: BCN Commercial	$322.19
Rate for Payer: Cash Price	$319.20
Rate for Payer: Cash Price	$319.20
Rate for Payer: Mclaren Medicaid	$134.83
Rate for Payer: Meridian Medicaid	$141.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$299.25
Rate for Payer: Priority Health Choice Medicaid	$134.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$392.57
Rate for Payer: Priority Health Narrow/Tiered Network	$392.57
Rate for Payer: UHC Medicaid	$134.83
Rate for Payer: UHCCP Medicaid	$134.83

PR RDCTJ TORSION TSTIS W/WO FIXJ CLAT TESTIS

Professional

Both

$842.00

Service Code	HCPCS 54600
Min. Negotiated Rate	$266.04
Max. Negotiated Rate	$743.18
Rate for Payer: Aetna Commercial	$579.83
Rate for Payer: Aetna Medicare	$421.00
Rate for Payer: BCBS Complete	$279.34
Rate for Payer: BCN Commercial	$682.23
Rate for Payer: Cash Price	$673.60
Rate for Payer: Cash Price	$673.60
Rate for Payer: Mclaren Medicaid	$266.04
Rate for Payer: Meridian Medicaid	$279.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$631.50
Rate for Payer: Priority Health Choice Medicaid	$266.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$743.18
Rate for Payer: Priority Health Narrow/Tiered Network	$743.18
Rate for Payer: UHC Medicaid	$266.04
Rate for Payer: UHCCP Medicaid	$266.04

PR RDCTJ VOLVULUS INTUSSUSCEPTION INT HRNA LAPT

Professional

Both

$2,447.00

Service Code	HCPCS 44050
Min. Negotiated Rate	$562.11
Max. Negotiated Rate	$1,835.25
Rate for Payer: Aetna Commercial	$1,263.25
Rate for Payer: Aetna Medicare	$1,223.50
Rate for Payer: BCBS Complete	$590.22
Rate for Payer: BCN Commercial	$1,408.29
Rate for Payer: Cash Price	$1,957.60
Rate for Payer: Cash Price	$1,957.60
Rate for Payer: Mclaren Medicaid	$562.11
Rate for Payer: Meridian Medicaid	$590.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,835.25
Rate for Payer: Priority Health Choice Medicaid	$562.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,715.91
Rate for Payer: Priority Health Narrow/Tiered Network	$1,715.91
Rate for Payer: UHC Medicaid	$562.11
Rate for Payer: UHCCP Medicaid	$562.11

PR REALIGNMENT EXTENSOR TENDON HAND EACH TENDON

Professional

Both

$1,634.00

Service Code	HCPCS 26437
Min. Negotiated Rate	$414.29
Max. Negotiated Rate	$1,225.50
Rate for Payer: Aetna Commercial	$878.32
Rate for Payer: Aetna Medicare	$817.00
Rate for Payer: BCBS Complete	$435.00
Rate for Payer: BCN Commercial	$1,007.42
Rate for Payer: Cash Price	$1,307.20
Rate for Payer: Cash Price	$1,307.20
Rate for Payer: Mclaren Medicaid	$414.29
Rate for Payer: Meridian Medicaid	$435.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,225.50
Rate for Payer: Priority Health Choice Medicaid	$414.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,076.90
Rate for Payer: Priority Health Narrow/Tiered Network	$1,076.90
Rate for Payer: UHC Medicaid	$414.29
Rate for Payer: UHCCP Medicaid	$414.29

PR REAORT VALV W CP BYPASS

Professional

Both

$8,285.00

Service Code	HCPCS 33400
Min. Negotiated Rate	$3,314.00
Max. Negotiated Rate	$6,213.75
Rate for Payer: Aetna Medicare	$4,142.50
Rate for Payer: BCBS Complete	$3,314.00
Rate for Payer: Cash Price	$6,628.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,213.75

PR RECMPL WND LID,NOS,EAR <1 CM

Professional

Both

$621.00

Service Code	HCPCS 13150
Min. Negotiated Rate	$248.40
Max. Negotiated Rate	$465.75
Rate for Payer: Aetna Medicare	$310.50
Rate for Payer: BCBS Complete	$248.40
Rate for Payer: Cash Price	$496.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$465.75

PR RECONSTRUCTION EXTERNAL AUDITORY CANAL SPX

Professional

Both

$3,569.00

Service Code	HCPCS 69310
Min. Negotiated Rate	$661.37
Max. Negotiated Rate	$2,676.75
Rate for Payer: Aetna Commercial	$1,261.16
Rate for Payer: Aetna Medicare	$1,784.50
Rate for Payer: BCBS Complete	$694.44
Rate for Payer: BCN Commercial	$1,669.73
Rate for Payer: Cash Price	$2,855.20
Rate for Payer: Cash Price	$2,855.20
Rate for Payer: Mclaren Medicaid	$661.37
Rate for Payer: Meridian Medicaid	$694.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,676.75
Rate for Payer: Priority Health Choice Medicaid	$661.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,649.86
Rate for Payer: Priority Health Narrow/Tiered Network	$1,649.86
Rate for Payer: UHC Medicaid	$661.37
Rate for Payer: UHCCP Medicaid	$661.37

PR RECONSTRUCTION NAIL BED W/GRAFT

Professional

Both

$460.00

Service Code	HCPCS 11762
Min. Negotiated Rate	$111.61
Max. Negotiated Rate	$345.00
Rate for Payer: Aetna Commercial	$195.65
Rate for Payer: Aetna Medicare	$230.00
Rate for Payer: BCBS Complete	$117.19
Rate for Payer: BCN Commercial	$283.35
Rate for Payer: Cash Price	$368.00
Rate for Payer: Cash Price	$368.00
Rate for Payer: Mclaren Medicaid	$111.61
Rate for Payer: Meridian Medicaid	$117.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$345.00
Rate for Payer: Priority Health Choice Medicaid	$111.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$259.34
Rate for Payer: Priority Health Narrow/Tiered Network	$259.34
Rate for Payer: UHC Medicaid	$111.61
Rate for Payer: UHCCP Medicaid	$111.61

PR RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC

Professional

Both

$4,106.00

Service Code	HCPCS 23420
Min. Negotiated Rate	$578.08
Max. Negotiated Rate	$3,079.50
Rate for Payer: Aetna Commercial	$1,298.68
Rate for Payer: Aetna Medicare	$2,053.00
Rate for Payer: BCBS Complete	$606.98
Rate for Payer: BCN Commercial	$1,630.81
Rate for Payer: Cash Price	$3,284.80
Rate for Payer: Cash Price	$3,284.80
Rate for Payer: Mclaren Medicaid	$578.08
Rate for Payer: Meridian Medicaid	$606.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,079.50
Rate for Payer: Priority Health Choice Medicaid	$578.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,586.87
Rate for Payer: Priority Health Narrow/Tiered Network	$1,586.87
Rate for Payer: UHC Medicaid	$578.08
Rate for Payer: UHCCP Medicaid	$578.08

PR RECONSTRUCTION TOE POLYDACTYLY

Professional

Both

$850.00

Service Code	HCPCS 28344
Min. Negotiated Rate	$168.27
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$367.99
Rate for Payer: Aetna Medicare	$425.00
Rate for Payer: BCBS Complete	$176.68
Rate for Payer: BCN Commercial	$424.78
Rate for Payer: Cash Price	$680.00
Rate for Payer: Cash Price	$680.00
Rate for Payer: Mclaren Medicaid	$168.27
Rate for Payer: Meridian Medicaid	$176.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$637.50
Rate for Payer: Priority Health Choice Medicaid	$168.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$454.08
Rate for Payer: Priority Health Narrow/Tiered Network	$454.08
Rate for Payer: UHC Medicaid	$168.27
Rate for Payer: UHCCP Medicaid	$168.27

PR RECONSTRUCTION VENA CAVA ANY METHOD

Professional

Both

$2,471.00

Service Code	HCPCS 34502
Min. Negotiated Rate	$903.33
Max. Negotiated Rate	$2,445.69
Rate for Payer: Aetna Commercial	$2,077.33
Rate for Payer: Aetna Medicare	$1,235.50
Rate for Payer: BCBS Complete	$948.50
Rate for Payer: BCN Commercial	$2,274.28
Rate for Payer: Cash Price	$1,976.80
Rate for Payer: Cash Price	$1,976.80
Rate for Payer: Mclaren Medicaid	$903.33
Rate for Payer: Meridian Medicaid	$948.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,853.25
Rate for Payer: Priority Health Choice Medicaid	$903.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,445.69
Rate for Payer: Priority Health Narrow/Tiered Network	$2,445.69
Rate for Payer: UHC Medicaid	$903.33
Rate for Payer: UHCCP Medicaid	$903.33

PR RECTAL SESATION TONE & COMPLIANCE TEST

Professional

Both

$731.00

Service Code	HCPCS 91120
Min. Negotiated Rate	$292.40
Max. Negotiated Rate	$713.11
Rate for Payer: Aetna Commercial	$562.84
Rate for Payer: Aetna Commercial	$562.84
Rate for Payer: Aetna Medicare	$47.50
Rate for Payer: Aetna Medicare	$365.50
Rate for Payer: BCBS Complete	$292.40
Rate for Payer: BCBS Complete	$38.00
Rate for Payer: BCN Commercial	$713.11
Rate for Payer: BCN Commercial	$713.11
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cash Price	$584.80
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cash Price	$584.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$548.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$71.25

PR RECTAL TUMOR EXCISION TRANSANAL ENDOSCOPIC

Professional

Both

$1,847.00

Service Code	HCPCS 0184T
Min. Negotiated Rate	$738.80
Max. Negotiated Rate	$5,565.88
Rate for Payer: Aetna Commercial	$771.30
Rate for Payer: Aetna Medicare	$923.50
Rate for Payer: BCBS Complete	$738.80
Rate for Payer: BCN Commercial	$5,565.88
Rate for Payer: Cash Price	$1,477.60
Rate for Payer: Cash Price	$1,477.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,385.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,238.26
Rate for Payer: Priority Health Narrow/Tiered Network	$1,238.26

PR REGION IV LOCAL ANESTH,UPPER/LOWER EXT

Professional

Both

$5.00

Service Code	HCPCS 01995
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR REIMPLANTATION ANOMALOUS PULMONARY ARTERY

Professional

Both

$6,904.00

Service Code	HCPCS 33788
Min. Negotiated Rate	$917.18
Max. Negotiated Rate	$5,178.00
Rate for Payer: Aetna Commercial	$2,061.08
Rate for Payer: Aetna Medicare	$3,452.00
Rate for Payer: BCBS Complete	$963.04
Rate for Payer: BCN Commercial	$2,258.34
Rate for Payer: Cash Price	$5,523.20
Rate for Payer: Cash Price	$5,523.20
Rate for Payer: Mclaren Medicaid	$917.18
Rate for Payer: Meridian Medicaid	$963.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,178.00
Rate for Payer: Priority Health Choice Medicaid	$917.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,428.56
Rate for Payer: Priority Health Narrow/Tiered Network	$2,428.56
Rate for Payer: UHC Medicaid	$917.18
Rate for Payer: UHCCP Medicaid	$917.18

PR REINSERTION SPINAL FIXATION DEVICE

Professional

Both

$5,150.00

Service Code	HCPCS 22849
Min. Negotiated Rate	$782.35
Max. Negotiated Rate	$3,862.50
Rate for Payer: Aetna Commercial	$1,754.05
Rate for Payer: Aetna Medicare	$2,575.00
Rate for Payer: BCBS Complete	$821.47
Rate for Payer: BCN Commercial	$2,176.24
Rate for Payer: Cash Price	$4,120.00
Rate for Payer: Cash Price	$4,120.00
Rate for Payer: Mclaren Medicaid	$782.35
Rate for Payer: Meridian Medicaid	$821.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,862.50
Rate for Payer: Priority Health Choice Medicaid	$782.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,117.59
Rate for Payer: Priority Health Narrow/Tiered Network	$2,117.59
Rate for Payer: UHC Medicaid	$782.35
Rate for Payer: UHCCP Medicaid	$782.35

PR RELEASE INTRINSIC MUSCLES HAND EACH MUSCLE

Professional

Both

$1,074.00

Service Code	HCPCS 26593
Min. Negotiated Rate	$405.34
Max. Negotiated Rate	$1,040.69
Rate for Payer: Aetna Commercial	$849.31
Rate for Payer: Aetna Medicare	$537.00
Rate for Payer: BCBS Complete	$425.61
Rate for Payer: BCN Commercial	$973.55
Rate for Payer: Cash Price	$859.20
Rate for Payer: Cash Price	$859.20
Rate for Payer: Mclaren Medicaid	$405.34
Rate for Payer: Meridian Medicaid	$425.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$805.50
Rate for Payer: Priority Health Choice Medicaid	$405.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,040.69
Rate for Payer: Priority Health Narrow/Tiered Network	$1,040.69
Rate for Payer: UHC Medicaid	$405.34
Rate for Payer: UHCCP Medicaid	$405.34

PR RELEASE/RECESSION HAMSTRING PROXIMAL

Professional

Both

$2,396.00

Service Code	HCPCS 27097
Min. Negotiated Rate	$410.66
Max. Negotiated Rate	$1,797.00
Rate for Payer: Aetna Commercial	$911.61
Rate for Payer: Aetna Medicare	$1,198.00
Rate for Payer: BCBS Complete	$431.19
Rate for Payer: BCN Commercial	$1,045.76
Rate for Payer: Cash Price	$1,916.80
Rate for Payer: Cash Price	$1,916.80
Rate for Payer: Mclaren Medicaid	$410.66
Rate for Payer: Meridian Medicaid	$431.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,797.00
Rate for Payer: Priority Health Choice Medicaid	$410.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,117.89
Rate for Payer: Priority Health Narrow/Tiered Network	$1,117.89
Rate for Payer: UHC Medicaid	$410.66
Rate for Payer: UHCCP Medicaid	$410.66

PR RELEASE TARSAL TUNNEL

Professional

Both

$1,426.00

Service Code	HCPCS 28035
Min. Negotiated Rate	$219.18
Max. Negotiated Rate	$1,069.50
Rate for Payer: Aetna Commercial	$471.96
Rate for Payer: Aetna Medicare	$713.00
Rate for Payer: BCBS Complete	$230.14
Rate for Payer: BCN Commercial	$551.76
Rate for Payer: Cash Price	$1,140.80
Rate for Payer: Cash Price	$1,140.80
Rate for Payer: Mclaren Medicaid	$219.18
Rate for Payer: Meridian Medicaid	$230.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,069.50
Rate for Payer: Priority Health Choice Medicaid	$219.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$589.82
Rate for Payer: Priority Health Narrow/Tiered Network	$589.82
Rate for Payer: UHC Medicaid	$219.18
Rate for Payer: UHCCP Medicaid	$219.18

PR RELEASE THENAR MUSCLE

Professional

Both

$1,634.00

Service Code	HCPCS 26508
Min. Negotiated Rate	$408.96
Max. Negotiated Rate	$1,225.50
Rate for Payer: Aetna Commercial	$890.70
Rate for Payer: Aetna Medicare	$817.00
Rate for Payer: BCBS Complete	$429.41
Rate for Payer: BCN Commercial	$1,018.87
Rate for Payer: Cash Price	$1,307.20
Rate for Payer: Cash Price	$1,307.20
Rate for Payer: Mclaren Medicaid	$408.96
Rate for Payer: Meridian Medicaid	$429.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,225.50
Rate for Payer: Priority Health Choice Medicaid	$408.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,089.14
Rate for Payer: Priority Health Narrow/Tiered Network	$1,089.14
Rate for Payer: UHC Medicaid	$408.96
Rate for Payer: UHCCP Medicaid	$408.96

Know your out-of-pocket cost for care.

All Charges