Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR SIGMOIDOSCOPY FLX TNDSC BALO DILAT

Professional

Both

$332.00

Service Code	HCPCS 45340
Min. Negotiated Rate	$46.22
Max. Negotiated Rate	$249.00
Rate for Payer: Aetna Commercial	$102.74
Rate for Payer: Aetna Medicare	$166.00
Rate for Payer: BCBS Complete	$48.53
Rate for Payer: BCN Commercial	$115.53
Rate for Payer: Cash Price	$265.60
Rate for Payer: Cash Price	$265.60
Rate for Payer: Mclaren Medicaid	$46.22
Rate for Payer: Meridian Medicaid	$48.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$249.00
Rate for Payer: Priority Health Choice Medicaid	$46.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$140.76
Rate for Payer: Priority Health Narrow/Tiered Network	$140.76
Rate for Payer: UHC Medicaid	$46.22
Rate for Payer: UHCCP Medicaid	$46.22

PR SIGMOIDOSCOPY FLX TNDSC US GID NDL ASPIR/BX

Professional

Both

$831.00

Service Code	HCPCS 45342
Min. Negotiated Rate	$96.70
Max. Negotiated Rate	$623.25
Rate for Payer: Aetna Commercial	$225.51
Rate for Payer: Aetna Medicare	$415.50
Rate for Payer: BCBS Complete	$101.53
Rate for Payer: BCN Commercial	$250.98
Rate for Payer: Cash Price	$664.80
Rate for Payer: Cash Price	$664.80
Rate for Payer: Mclaren Medicaid	$96.70
Rate for Payer: Meridian Medicaid	$101.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$623.25
Rate for Payer: Priority Health Choice Medicaid	$96.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$305.81
Rate for Payer: Priority Health Narrow/Tiered Network	$305.81
Rate for Payer: UHC Medicaid	$96.70
Rate for Payer: UHCCP Medicaid	$96.70

PR SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE

Professional

Both

$353.00

Service Code	HCPCS 45331
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$264.75
Rate for Payer: Aetna Commercial	$94.92
Rate for Payer: Aetna Medicare	$176.50
Rate for Payer: BCBS Complete	$44.73
Rate for Payer: BCN Commercial	$108.06
Rate for Payer: Cash Price	$282.40
Rate for Payer: Cash Price	$282.40
Rate for Payer: Mclaren Medicaid	$42.60
Rate for Payer: Meridian Medicaid	$44.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$264.75
Rate for Payer: Priority Health Choice Medicaid	$42.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$131.66
Rate for Payer: Priority Health Narrow/Tiered Network	$131.66
Rate for Payer: UHC Medicaid	$42.60
Rate for Payer: UHCCP Medicaid	$42.60

PR SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE

Facility

$353.00

Service Code	CPT 45331
Hospital Charge Code	45331
Hospital Revenue Code	960
Min. Negotiated Rate	$245.69
Max. Negotiated Rate	$317.70
Rate for Payer: Aetna Commercial	$300.05
Rate for Payer: BCBS Trust/PPO	$291.54
Rate for Payer: BCN Commercial	$291.54
Rate for Payer: Cash Price	$282.40
Rate for Payer: Cofinity Commercial	$303.58
Rate for Payer: Encore Health Key Benefits Commercial	$282.40
Rate for Payer: Healthscope Commercial	$317.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$264.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$300.05
Rate for Payer: Nomi Health Commercial	$289.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$264.75
Rate for Payer: PHP Commercial	$300.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$307.11
Rate for Payer: Priority Health Narrow/Tiered Network	$245.69
Rate for Payer: UHC Core	$294.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$264.75

PR SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE

Professional

Both

$353.00

Service Code	HCPCS 45331
Hospital Charge Code	45331
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$264.75
Rate for Payer: Aetna Commercial	$94.92
Rate for Payer: Aetna Medicare	$176.50
Rate for Payer: BCBS Complete	$44.73
Rate for Payer: BCN Commercial	$108.06
Rate for Payer: Cash Price	$282.40
Rate for Payer: Cash Price	$282.40
Rate for Payer: Mclaren Medicaid	$42.60
Rate for Payer: Meridian Medicaid	$44.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$264.75
Rate for Payer: Priority Health Choice Medicaid	$42.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$131.66
Rate for Payer: Priority Health Narrow/Tiered Network	$131.66
Rate for Payer: UHC Medicaid	$42.60
Rate for Payer: UHCCP Medicaid	$42.60

PR SIGMOIDOSCOPY FLX W/BIOPSY SINGLE/MULTIPLE

Facility

$353.00

Service Code	CPT 45331
Hospital Charge Code	45331
Hospital Revenue Code	960
Min. Negotiated Rate	$62.23
Max. Negotiated Rate	$317.70
Rate for Payer: Aetna Commercial	$300.05
Rate for Payer: Aetna Medicare	$91.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$110.31
Rate for Payer: Amish Plain Church Group Commercial	$110.31
Rate for Payer: BCBS Complete	$65.34
Rate for Payer: BCBS MAPPO	$88.25
Rate for Payer: BCBS Trust/PPO	$290.20
Rate for Payer: BCN Commercial	$290.20
Rate for Payer: BCN Medicare Advantage	$88.25
Rate for Payer: Cash Price	$282.40
Rate for Payer: Cofinity Commercial	$303.58
Rate for Payer: Encore Health Key Benefits Commercial	$282.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$88.25
Rate for Payer: Healthscope Commercial	$317.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$264.75
Rate for Payer: Mclaren Medicaid	$62.23
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$92.66
Rate for Payer: Meridian Medicaid	$65.34
Rate for Payer: MI Amish Medical Board Commercial	$101.49
Rate for Payer: Molina Medicare/Medicaid	$97.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$300.05
Rate for Payer: Nomi Health Commercial	$289.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$264.75
Rate for Payer: PACE Senior Care Partners	$83.84
Rate for Payer: PACE SWMI	$88.25
Rate for Payer: PHP Commercial	$300.05
Rate for Payer: PHP Medicare Advantage	$88.25
Rate for Payer: Priority Health Choice Medicaid	$62.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$307.11
Rate for Payer: Priority Health Medicare	$89.13
Rate for Payer: Priority Health Narrow/Tiered Network	$245.69
Rate for Payer: Railroad Medicare Medicare	$88.25
Rate for Payer: UHC Core	$294.75
Rate for Payer: UHC Exchange	$88.25
Rate for Payer: UHC Medicaid	$62.23
Rate for Payer: UHC Medicare Advantage	$88.25
Rate for Payer: UHCCP Medicaid	$62.23
Rate for Payer: VA VA	$88.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$264.75

PR SIGMOIDOSCOPY FLX WITH WITH BAND LIGATION(S)

Professional

Both

$457.00

Service Code	HCPCS 45350
Min. Negotiated Rate	$58.58
Max. Negotiated Rate	$342.75
Rate for Payer: Aetna Commercial	$133.45
Rate for Payer: Aetna Medicare	$228.50
Rate for Payer: BCBS Complete	$61.51
Rate for Payer: BCN Commercial	$149.39
Rate for Payer: Cash Price	$365.60
Rate for Payer: Cash Price	$365.60
Rate for Payer: Mclaren Medicaid	$58.58
Rate for Payer: Meridian Medicaid	$61.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$342.75
Rate for Payer: Priority Health Choice Medicaid	$58.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$182.03
Rate for Payer: Priority Health Narrow/Tiered Network	$182.03
Rate for Payer: UHC Medicaid	$58.58
Rate for Payer: UHCCP Medicaid	$58.58

PR SIGMOIDOSCOPY FLX W/RMVL FOREIGN BODY

Professional

Both

$536.00

Service Code	HCPCS 45332
Min. Negotiated Rate	$61.13
Max. Negotiated Rate	$402.00
Rate for Payer: Aetna Commercial	$138.97
Rate for Payer: Aetna Medicare	$268.00
Rate for Payer: BCBS Complete	$64.19
Rate for Payer: BCN Commercial	$155.86
Rate for Payer: Cash Price	$428.80
Rate for Payer: Cash Price	$428.80
Rate for Payer: Mclaren Medicaid	$61.13
Rate for Payer: Meridian Medicaid	$64.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$402.00
Rate for Payer: Priority Health Choice Medicaid	$61.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$189.91
Rate for Payer: Priority Health Narrow/Tiered Network	$189.91
Rate for Payer: UHC Medicaid	$61.13
Rate for Payer: UHCCP Medicaid	$61.13

PR SIGMOIDOSCOPY FLX W/RMVL TUMOR BY HOT BX FORCEPS

Professional

Both

$774.00

Service Code	HCPCS 45333
Min. Negotiated Rate	$55.17
Max. Negotiated Rate	$580.50
Rate for Payer: Aetna Commercial	$124.32
Rate for Payer: Aetna Medicare	$387.00
Rate for Payer: BCBS Complete	$57.93
Rate for Payer: BCN Commercial	$139.93
Rate for Payer: Cash Price	$619.20
Rate for Payer: Cash Price	$619.20
Rate for Payer: Mclaren Medicaid	$55.17
Rate for Payer: Meridian Medicaid	$57.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$580.50
Rate for Payer: Priority Health Choice Medicaid	$55.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$170.49
Rate for Payer: Priority Health Narrow/Tiered Network	$170.49
Rate for Payer: UHC Medicaid	$55.17
Rate for Payer: UHCCP Medicaid	$55.17

PR SIGMOIDOSCOPY,TRANSENDOSCOPIC STENT

Professional

Both

$340.00

Service Code	HCPCS 45345
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$255.00
Rate for Payer: Aetna Medicare	$170.00
Rate for Payer: BCBS Complete	$136.00
Rate for Payer: Cash Price	$272.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$255.00

PR SIGMOIDOSCOPY W/STENT

Professional

Both

$340.00

Service Code	HCPCS G6023
Min. Negotiated Rate	$136.00
Max. Negotiated Rate	$255.00
Rate for Payer: Aetna Medicare	$170.00
Rate for Payer: BCBS Complete	$136.00
Rate for Payer: Cash Price	$272.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$255.00

PR SIGNAL AVERAGED ELECTROCARDIOGRAPHY W/WO ECG

Professional

Both

$41.00

Service Code	HCPCS 93278
Min. Negotiated Rate	$20.50
Max. Negotiated Rate	$47.31
Rate for Payer: Aetna Commercial	$38.45
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCN Commercial	$47.31
Rate for Payer: Cash Price	$32.80
Rate for Payer: Cash Price	$32.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$44.97
Rate for Payer: Priority Health Narrow/Tiered Network	$44.97

PR SIMPLE CYSTOMETROGRAM

Professional

Both

$553.00

Service Code	HCPCS 51725
Min. Negotiated Rate	$276.50
Max. Negotiated Rate	$414.75
Rate for Payer: Aetna Commercial	$283.90
Rate for Payer: Aetna Medicare	$276.50
Rate for Payer: BCN Commercial	$309.24
Rate for Payer: Cash Price	$442.40
Rate for Payer: Cash Price	$442.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$414.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$336.87
Rate for Payer: Priority Health Narrow/Tiered Network	$336.87

PR SIMPLE IMPLANT REMOVAL, BILATERAL

Professional

Both

$1,803.00

Hospital Revenue Code	990
Min. Negotiated Rate	$721.20
Max. Negotiated Rate	$1,352.25
Rate for Payer: Aetna Medicare	$901.50
Rate for Payer: BCBS Complete	$721.20
Rate for Payer: Cash Price	$1,442.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,352.25

PR SIMPLE INTRACRANIAL ARYSM CAROTID CIRCULATION

Professional

Both

$10,021.00

Service Code	HCPCS 61700
Min. Negotiated Rate	$2,047.57
Max. Negotiated Rate	$7,515.75
Rate for Payer: Aetna Commercial	$4,404.66
Rate for Payer: Aetna Medicare	$5,010.50
Rate for Payer: BCBS Complete	$2,149.95
Rate for Payer: BCN Commercial	$7,136.34
Rate for Payer: Cash Price	$8,016.80
Rate for Payer: Cash Price	$8,016.80
Rate for Payer: Mclaren Medicaid	$2,047.57
Rate for Payer: Meridian Medicaid	$2,149.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,515.75
Rate for Payer: Priority Health Choice Medicaid	$2,047.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,999.69
Rate for Payer: Priority Health Narrow/Tiered Network	$5,999.69
Rate for Payer: UHC Medicaid	$2,047.57
Rate for Payer: UHCCP Medicaid	$2,047.57

PR SIMPLE INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ

Professional

Both

$8,929.00

Service Code	HCPCS 61702
Min. Negotiated Rate	$2,435.02
Max. Negotiated Rate	$8,407.03
Rate for Payer: Aetna Commercial	$5,197.31
Rate for Payer: Aetna Medicare	$4,464.50
Rate for Payer: BCBS Complete	$2,556.77
Rate for Payer: BCN Commercial	$8,407.03
Rate for Payer: Cash Price	$7,143.20
Rate for Payer: Cash Price	$7,143.20
Rate for Payer: Mclaren Medicaid	$2,435.02
Rate for Payer: Meridian Medicaid	$2,556.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,696.75
Rate for Payer: Priority Health Choice Medicaid	$2,435.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$7,067.99
Rate for Payer: Priority Health Narrow/Tiered Network	$7,067.99
Rate for Payer: UHC Medicaid	$2,435.02
Rate for Payer: UHCCP Medicaid	$2,435.02

PR SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM

Professional

Both

$684.00

Service Code	HCPCS 12016
Min. Negotiated Rate	$77.96
Max. Negotiated Rate	$513.00
Rate for Payer: Aetna Commercial	$142.66
Rate for Payer: Aetna Medicare	$342.00
Rate for Payer: BCBS Complete	$81.86
Rate for Payer: BCN Commercial	$189.73
Rate for Payer: Cash Price	$547.20
Rate for Payer: Cash Price	$547.20
Rate for Payer: Mclaren Medicaid	$77.96
Rate for Payer: Meridian Medicaid	$81.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$513.00
Rate for Payer: Priority Health Choice Medicaid	$77.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$173.65
Rate for Payer: Priority Health Narrow/Tiered Network	$173.65
Rate for Payer: UHC Medicaid	$77.96
Rate for Payer: UHCCP Medicaid	$77.96

PR SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM

Professional

Both

$335.00

Service Code	HCPCS 12017
Min. Negotiated Rate	$98.41
Max. Negotiated Rate	$251.25
Rate for Payer: Aetna Commercial	$169.53
Rate for Payer: Aetna Medicare	$167.50
Rate for Payer: BCBS Complete	$103.33
Rate for Payer: BCN Commercial	$229.08
Rate for Payer: Cash Price	$268.00
Rate for Payer: Cash Price	$268.00
Rate for Payer: Mclaren Medicaid	$98.41
Rate for Payer: Meridian Medicaid	$103.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$251.25
Rate for Payer: Priority Health Choice Medicaid	$98.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$209.65
Rate for Payer: Priority Health Narrow/Tiered Network	$209.65
Rate for Payer: UHC Medicaid	$98.41
Rate for Payer: UHCCP Medicaid	$98.41

PR SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<

Professional

Both

$315.00

Service Code	HCPCS 12011
Min. Negotiated Rate	$34.72
Max. Negotiated Rate	$236.25
Rate for Payer: Aetna Commercial	$61.20
Rate for Payer: Aetna Medicare	$157.50
Rate for Payer: BCBS Complete	$36.46
Rate for Payer: BCN Commercial	$83.16
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Mclaren Medicaid	$34.72
Rate for Payer: Meridian Medicaid	$36.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$236.25
Rate for Payer: Priority Health Choice Medicaid	$34.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$76.12
Rate for Payer: Priority Health Narrow/Tiered Network	$76.12
Rate for Payer: UHC Medicaid	$34.72
Rate for Payer: UHCCP Medicaid	$34.72

PR SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM

Professional

Both

$369.00

Service Code	HCPCS 12013
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$276.75
Rate for Payer: Aetna Commercial	$64.56
Rate for Payer: Aetna Medicare	$184.50
Rate for Payer: BCBS Complete	$37.35
Rate for Payer: BCN Commercial	$86.15
Rate for Payer: Cash Price	$295.20
Rate for Payer: Cash Price	$295.20
Rate for Payer: Mclaren Medicaid	$35.57
Rate for Payer: Meridian Medicaid	$37.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$276.75
Rate for Payer: Priority Health Choice Medicaid	$35.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$78.85
Rate for Payer: Priority Health Narrow/Tiered Network	$78.85
Rate for Payer: UHC Medicaid	$35.57
Rate for Payer: UHCCP Medicaid	$35.57

PR SIMPLE REPAIR F/E/E/N/L/M >30.0 CM

Professional

Both

$1,401.00

Service Code	HCPCS 12018
Min. Negotiated Rate	$110.97
Max. Negotiated Rate	$1,050.75
Rate for Payer: Aetna Commercial	$192.24
Rate for Payer: Aetna Medicare	$700.50
Rate for Payer: BCBS Complete	$116.52
Rate for Payer: BCN Commercial	$259.44
Rate for Payer: Cash Price	$1,120.80
Rate for Payer: Cash Price	$1,120.80
Rate for Payer: Mclaren Medicaid	$110.97
Rate for Payer: Meridian Medicaid	$116.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,050.75
Rate for Payer: Priority Health Choice Medicaid	$110.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$237.47
Rate for Payer: Priority Health Narrow/Tiered Network	$237.47
Rate for Payer: UHC Medicaid	$110.97
Rate for Payer: UHCCP Medicaid	$110.97

PR SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM

Professional

Both

$506.00

Service Code	HCPCS 12014
Min. Negotiated Rate	$46.01
Max. Negotiated Rate	$379.50
Rate for Payer: Aetna Commercial	$83.07
Rate for Payer: Aetna Medicare	$253.00
Rate for Payer: BCBS Complete	$48.31
Rate for Payer: BCN Commercial	$110.55
Rate for Payer: Cash Price	$404.80
Rate for Payer: Cash Price	$404.80
Rate for Payer: Mclaren Medicaid	$46.01
Rate for Payer: Meridian Medicaid	$48.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$379.50
Rate for Payer: Priority Health Choice Medicaid	$46.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$101.18
Rate for Payer: Priority Health Narrow/Tiered Network	$101.18
Rate for Payer: UHC Medicaid	$46.01
Rate for Payer: UHCCP Medicaid	$46.01

PR SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM

Professional

Both

$653.00

Service Code	HCPCS 12015
Min. Negotiated Rate	$57.51
Max. Negotiated Rate	$489.75
Rate for Payer: Aetna Commercial	$104.96
Rate for Payer: Aetna Medicare	$326.50
Rate for Payer: BCBS Complete	$60.39
Rate for Payer: BCN Commercial	$139.93
Rate for Payer: Cash Price	$522.40
Rate for Payer: Cash Price	$522.40
Rate for Payer: Mclaren Medicaid	$57.51
Rate for Payer: Meridian Medicaid	$60.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$489.75
Rate for Payer: Priority Health Choice Medicaid	$57.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$128.07
Rate for Payer: Priority Health Narrow/Tiered Network	$128.07
Rate for Payer: UHC Medicaid	$57.51
Rate for Payer: UHCCP Medicaid	$57.51

PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<

Professional

Both

$262.00

Service Code	HCPCS 12001
Min. Negotiated Rate	$28.12
Max. Negotiated Rate	$196.50
Rate for Payer: Aetna Commercial	$48.72
Rate for Payer: Aetna Medicare	$131.00
Rate for Payer: BCBS Complete	$29.53
Rate for Payer: BCN Commercial	$66.73
Rate for Payer: Cash Price	$209.60
Rate for Payer: Cash Price	$209.60
Rate for Payer: Mclaren Medicaid	$28.12
Rate for Payer: Meridian Medicaid	$29.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$196.50
Rate for Payer: Priority Health Choice Medicaid	$28.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$61.07
Rate for Payer: Priority Health Narrow/Tiered Network	$61.07
Rate for Payer: UHC Medicaid	$28.12
Rate for Payer: UHCCP Medicaid	$28.12

PR SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM

Professional

Both

$568.00

Service Code	HCPCS 12007
Min. Negotiated Rate	$85.41
Max. Negotiated Rate	$426.00
Rate for Payer: Aetna Commercial	$161.43
Rate for Payer: Aetna Medicare	$284.00
Rate for Payer: BCBS Complete	$89.68
Rate for Payer: BCN Commercial	$215.63
Rate for Payer: Cash Price	$454.40
Rate for Payer: Cash Price	$454.40
Rate for Payer: Mclaren Medicaid	$85.41
Rate for Payer: Meridian Medicaid	$89.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$426.00
Rate for Payer: Priority Health Choice Medicaid	$85.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$197.35
Rate for Payer: Priority Health Narrow/Tiered Network	$197.35
Rate for Payer: UHC Medicaid	$85.41
Rate for Payer: UHCCP Medicaid	$85.41

Know your out-of-pocket cost for care.

All Charges