Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR TONSILLECTOMY & ADENOIDECTOMY <AGE 12

Professional

Both

$936.00

Service Code	HCPCS 42820
Min. Negotiated Rate	$166.35
Max. Negotiated Rate	$702.00
Rate for Payer: Aetna Commercial	$381.77
Rate for Payer: Aetna Medicare	$468.00
Rate for Payer: BCBS Complete	$174.67
Rate for Payer: BCN Commercial	$442.70
Rate for Payer: Cash Price	$748.80
Rate for Payer: Cash Price	$748.80
Rate for Payer: Mclaren Medicaid	$166.35
Rate for Payer: Meridian Medicaid	$174.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$702.00
Rate for Payer: Priority Health Choice Medicaid	$166.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$539.41
Rate for Payer: Priority Health Narrow/Tiered Network	$539.41
Rate for Payer: UHC Medicaid	$166.35
Rate for Payer: UHCCP Medicaid	$166.35

PR TONSILLECTOMY & ADENOIDECTOMY AGE 12/>

Professional

Both

$596.00

Service Code	HCPCS 42821
Min. Negotiated Rate	$173.60
Max. Negotiated Rate	$562.46
Rate for Payer: Aetna Commercial	$398.73
Rate for Payer: Aetna Medicare	$298.00
Rate for Payer: BCBS Complete	$182.28
Rate for Payer: BCN Commercial	$461.63
Rate for Payer: Cash Price	$476.80
Rate for Payer: Cash Price	$476.80
Rate for Payer: Mclaren Medicaid	$173.60
Rate for Payer: Meridian Medicaid	$182.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$447.00
Rate for Payer: Priority Health Choice Medicaid	$173.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$562.46
Rate for Payer: Priority Health Narrow/Tiered Network	$562.46
Rate for Payer: UHC Medicaid	$173.60
Rate for Payer: UHCCP Medicaid	$173.60

PR TONSILLECTOMY PRIMARY/SECONDARY <AGE 12

Professional

Both

$500.00

Service Code	HCPCS 42825
Min. Negotiated Rate	$155.28
Max. Negotiated Rate	$499.36
Rate for Payer: Aetna Commercial	$347.97
Rate for Payer: Aetna Medicare	$250.00
Rate for Payer: BCBS Complete	$163.04
Rate for Payer: BCN Commercial	$409.84
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Mclaren Medicaid	$155.28
Rate for Payer: Meridian Medicaid	$163.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$375.00
Rate for Payer: Priority Health Choice Medicaid	$155.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$499.36
Rate for Payer: Priority Health Narrow/Tiered Network	$499.36
Rate for Payer: UHC Medicaid	$155.28
Rate for Payer: UHCCP Medicaid	$155.28

PR TONSILLECTOMY PRIMARY/SECONDARY AGE 12/>

Professional

Both

$487.00

Service Code	HCPCS 42826
Min. Negotiated Rate	$147.61
Max. Negotiated Rate	$474.49
Rate for Payer: Aetna Commercial	$332.24
Rate for Payer: Aetna Medicare	$243.50
Rate for Payer: BCBS Complete	$154.99
Rate for Payer: BCN Commercial	$389.42
Rate for Payer: Cash Price	$389.60
Rate for Payer: Cash Price	$389.60
Rate for Payer: Mclaren Medicaid	$147.61
Rate for Payer: Meridian Medicaid	$154.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$365.25
Rate for Payer: Priority Health Choice Medicaid	$147.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$474.49
Rate for Payer: Priority Health Narrow/Tiered Network	$474.49
Rate for Payer: UHC Medicaid	$147.61
Rate for Payer: UHCCP Medicaid	$147.61

PR TOT ABD HYST W/PARAORTIC & PELVIC LYMPH NODE SAM

Professional

Both

$2,482.00

Service Code	HCPCS 58200
Min. Negotiated Rate	$801.31
Max. Negotiated Rate	$2,054.20
Rate for Payer: Aetna Commercial	$1,612.51
Rate for Payer: Aetna Medicare	$1,241.00
Rate for Payer: BCBS Complete	$841.38
Rate for Payer: BCN Commercial	$2,028.28
Rate for Payer: Cash Price	$1,985.60
Rate for Payer: Cash Price	$1,985.60
Rate for Payer: Mclaren Medicaid	$801.31
Rate for Payer: Meridian Medicaid	$841.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,861.50
Rate for Payer: Priority Health Choice Medicaid	$801.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,054.20
Rate for Payer: Priority Health Narrow/Tiered Network	$2,054.20
Rate for Payer: UHC Medicaid	$801.31
Rate for Payer: UHCCP Medicaid	$801.31

PR TOT ABD HYST W/WO RMVL TUBE OVARY W/COLPURETHRXY

Professional

Both

$3,458.00

Service Code	HCPCS 58152
Min. Negotiated Rate	$695.23
Max. Negotiated Rate	$2,593.50
Rate for Payer: Aetna Commercial	$1,487.05
Rate for Payer: Aetna Medicare	$1,729.00
Rate for Payer: BCBS Complete	$729.99
Rate for Payer: BCN Commercial	$1,851.99
Rate for Payer: Cash Price	$2,766.40
Rate for Payer: Cash Price	$2,766.40
Rate for Payer: Mclaren Medicaid	$695.23
Rate for Payer: Meridian Medicaid	$729.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,593.50
Rate for Payer: Priority Health Choice Medicaid	$695.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,875.67
Rate for Payer: Priority Health Narrow/Tiered Network	$1,875.67
Rate for Payer: UHC Medicaid	$695.23
Rate for Payer: UHCCP Medicaid	$695.23

PR TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY

Professional

Both

$3,312.00

Service Code	HCPCS 58150
Min. Negotiated Rate	$595.12
Max. Negotiated Rate	$2,484.00
Rate for Payer: Aetna Commercial	$1,207.92
Rate for Payer: Aetna Medicare	$1,656.00
Rate for Payer: BCBS Complete	$624.88
Rate for Payer: BCN Commercial	$1,528.80
Rate for Payer: Cash Price	$2,649.60
Rate for Payer: Cash Price	$2,649.60
Rate for Payer: Mclaren Medicaid	$595.12
Rate for Payer: Meridian Medicaid	$624.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,484.00
Rate for Payer: Priority Health Choice Medicaid	$595.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,548.35
Rate for Payer: Priority Health Narrow/Tiered Network	$1,548.35
Rate for Payer: UHC Medicaid	$595.12
Rate for Payer: UHCCP Medicaid	$595.12

PR TOTAL DISC ARTHRP ANT 2ND LEVEL CERVICAL

Professional

Both

$1,108.00

Service Code	HCPCS 22858
Min. Negotiated Rate	$286.49
Max. Negotiated Rate	$831.00
Rate for Payer: Aetna Commercial	$683.01
Rate for Payer: Aetna Medicare	$554.00
Rate for Payer: BCBS Complete	$300.81
Rate for Payer: BCN Commercial	$758.43
Rate for Payer: Cash Price	$886.40
Rate for Payer: Cash Price	$886.40
Rate for Payer: Mclaren Medicaid	$286.49
Rate for Payer: Meridian Medicaid	$300.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$831.00
Rate for Payer: Priority Health Choice Medicaid	$286.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$810.74
Rate for Payer: Priority Health Narrow/Tiered Network	$810.74
Rate for Payer: UHC Medicaid	$286.49
Rate for Payer: UHCCP Medicaid	$286.49

PR TOTAL DISC ARTHRP ANT SINGLE INTERSPACE CERVICAL

Professional

Both

$3,521.00

Service Code	HCPCS 22856
Min. Negotiated Rate	$970.64
Max. Negotiated Rate	$2,640.75
Rate for Payer: Aetna Commercial	$2,188.95
Rate for Payer: Aetna Medicare	$1,760.50
Rate for Payer: BCBS Complete	$1,019.17
Rate for Payer: BCN Commercial	$2,458.54
Rate for Payer: Cash Price	$2,816.80
Rate for Payer: Cash Price	$2,816.80
Rate for Payer: Mclaren Medicaid	$970.64
Rate for Payer: Meridian Medicaid	$1,019.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,640.75
Rate for Payer: Priority Health Choice Medicaid	$970.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,628.11
Rate for Payer: Priority Health Narrow/Tiered Network	$2,628.11
Rate for Payer: UHC Medicaid	$970.64
Rate for Payer: UHCCP Medicaid	$970.64

PR TOTAL DISC ARTHRP ANT SINGLE INTERSPACE LUMBAR

Professional

Both

$7,256.00

Service Code	HCPCS 22857
Min. Negotiated Rate	$1,000.46
Max. Negotiated Rate	$5,442.00
Rate for Payer: Aetna Commercial	$2,366.42
Rate for Payer: Aetna Medicare	$3,628.00
Rate for Payer: BCBS Complete	$1,050.48
Rate for Payer: BCN Commercial	$2,631.33
Rate for Payer: Cash Price	$5,804.80
Rate for Payer: Cash Price	$5,804.80
Rate for Payer: Mclaren Medicaid	$1,000.46
Rate for Payer: Meridian Medicaid	$1,050.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,442.00
Rate for Payer: Priority Health Choice Medicaid	$1,000.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,812.82
Rate for Payer: Priority Health Narrow/Tiered Network	$2,812.82
Rate for Payer: UHC Medicaid	$1,000.46
Rate for Payer: UHCCP Medicaid	$1,000.46

PR TOTAL ESOPHAGECTOMY W/THORCOM W/WO PYLORPLASTY

Professional

Both

$6,062.00

Service Code	HCPCS 43112
Min. Negotiated Rate	$2,039.90
Max. Negotiated Rate	$6,137.95
Rate for Payer: Aetna Commercial	$4,681.60
Rate for Payer: Aetna Medicare	$3,031.00
Rate for Payer: BCBS Complete	$2,141.89
Rate for Payer: BCN Commercial	$5,037.57
Rate for Payer: Cash Price	$4,849.60
Rate for Payer: Cash Price	$4,849.60
Rate for Payer: Mclaren Medicaid	$2,039.90
Rate for Payer: Meridian Medicaid	$2,141.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,546.50
Rate for Payer: Priority Health Choice Medicaid	$2,039.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$6,137.95
Rate for Payer: Priority Health Narrow/Tiered Network	$6,137.95
Rate for Payer: UHC Medicaid	$2,039.90
Rate for Payer: UHCCP Medicaid	$2,039.90

PR TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY

Professional

Both

$2,621.00

Service Code	HCPCS 60220
Min. Negotiated Rate	$408.32
Max. Negotiated Rate	$1,965.75
Rate for Payer: Aetna Commercial	$907.32
Rate for Payer: Aetna Medicare	$1,310.50
Rate for Payer: BCBS Complete	$428.74
Rate for Payer: BCN Commercial	$1,065.68
Rate for Payer: Cash Price	$2,096.80
Rate for Payer: Cash Price	$2,096.80
Rate for Payer: Mclaren Medicaid	$408.32
Rate for Payer: Meridian Medicaid	$428.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,965.75
Rate for Payer: Priority Health Choice Medicaid	$408.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,155.57
Rate for Payer: Priority Health Narrow/Tiered Network	$1,155.57
Rate for Payer: UHC Medicaid	$408.32
Rate for Payer: UHCCP Medicaid	$408.32

PR TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY

Facility

$2,621.00

Service Code	CPT 60220
Hospital Charge Code	60220
Hospital Revenue Code	960
Min. Negotiated Rate	$1,824.22
Max. Negotiated Rate	$2,358.90
Rate for Payer: Aetna Commercial	$2,227.85
Rate for Payer: BCBS Trust/PPO	$2,164.68
Rate for Payer: BCN Commercial	$2,164.68
Rate for Payer: Cash Price	$2,096.80
Rate for Payer: Cofinity Commercial	$2,254.06
Rate for Payer: Encore Health Key Benefits Commercial	$2,096.80
Rate for Payer: Healthscope Commercial	$2,358.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,965.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,227.85
Rate for Payer: Nomi Health Commercial	$2,149.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,965.75
Rate for Payer: PHP Commercial	$2,227.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,280.27
Rate for Payer: Priority Health Narrow/Tiered Network	$1,824.22
Rate for Payer: UHC Core	$2,188.53
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,965.75

PR TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY

Facility

$2,621.00

Service Code	CPT 60220
Hospital Charge Code	60220
Hospital Revenue Code	960
Min. Negotiated Rate	$462.08
Max. Negotiated Rate	$2,358.90
Rate for Payer: Aetna Commercial	$2,227.85
Rate for Payer: Aetna Medicare	$681.46
Rate for Payer: Allen County Amish Medical Aid Commercial	$819.06
Rate for Payer: Amish Plain Church Group Commercial	$819.06
Rate for Payer: BCBS Complete	$485.15
Rate for Payer: BCBS MAPPO	$655.25
Rate for Payer: BCBS Trust/PPO	$2,154.72
Rate for Payer: BCN Commercial	$2,154.72
Rate for Payer: BCN Medicare Advantage	$655.25
Rate for Payer: Cash Price	$2,096.80
Rate for Payer: Cofinity Commercial	$2,254.06
Rate for Payer: Encore Health Key Benefits Commercial	$2,096.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$655.25
Rate for Payer: Healthscope Commercial	$2,358.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,965.75
Rate for Payer: Mclaren Medicaid	$462.08
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$688.01
Rate for Payer: Meridian Medicaid	$485.15
Rate for Payer: MI Amish Medical Board Commercial	$753.54
Rate for Payer: Molina Medicare/Medicaid	$720.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,227.85
Rate for Payer: Nomi Health Commercial	$2,149.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,965.75
Rate for Payer: PACE Senior Care Partners	$622.49
Rate for Payer: PACE SWMI	$655.25
Rate for Payer: PHP Commercial	$2,227.85
Rate for Payer: PHP Medicare Advantage	$655.25
Rate for Payer: Priority Health Choice Medicaid	$462.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,280.27
Rate for Payer: Priority Health Medicare	$661.80
Rate for Payer: Priority Health Narrow/Tiered Network	$1,824.22
Rate for Payer: Railroad Medicare Medicare	$655.25
Rate for Payer: UHC Core	$2,188.53
Rate for Payer: UHC Exchange	$655.25
Rate for Payer: UHC Medicaid	$462.08
Rate for Payer: UHC Medicare Advantage	$655.25
Rate for Payer: UHCCP Medicaid	$462.08
Rate for Payer: VA VA	$655.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,965.75

PR TOTAL THYROID LOBECTOMY UNI W/WO ISTHMUSECTOMY

Professional

Both

$2,621.00

Service Code	HCPCS 60220
Hospital Charge Code	60220
Min. Negotiated Rate	$408.32
Max. Negotiated Rate	$1,965.75
Rate for Payer: Aetna Commercial	$907.32
Rate for Payer: Aetna Medicare	$1,310.50
Rate for Payer: BCBS Complete	$428.74
Rate for Payer: BCN Commercial	$1,065.68
Rate for Payer: Cash Price	$2,096.80
Rate for Payer: Cash Price	$2,096.80
Rate for Payer: Mclaren Medicaid	$408.32
Rate for Payer: Meridian Medicaid	$428.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,965.75
Rate for Payer: Priority Health Choice Medicaid	$408.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,155.57
Rate for Payer: Priority Health Narrow/Tiered Network	$1,155.57
Rate for Payer: UHC Medicaid	$408.32
Rate for Payer: UHCCP Medicaid	$408.32

PR TOTAL THYROID LOBEC UNI W/CONTRALAT STOT LOBEC

Professional

Both

$1,480.00

Service Code	HCPCS 60225
Min. Negotiated Rate	$541.66
Max. Negotiated Rate	$1,534.08
Rate for Payer: Aetna Commercial	$1,197.71
Rate for Payer: Aetna Medicare	$740.00
Rate for Payer: BCBS Complete	$568.74
Rate for Payer: BCN Commercial	$1,414.77
Rate for Payer: Cash Price	$1,184.00
Rate for Payer: Cash Price	$1,184.00
Rate for Payer: Mclaren Medicaid	$541.66
Rate for Payer: Meridian Medicaid	$568.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,110.00
Rate for Payer: Priority Health Choice Medicaid	$541.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,534.08
Rate for Payer: Priority Health Narrow/Tiered Network	$1,534.08
Rate for Payer: UHC Medicaid	$541.66
Rate for Payer: UHCCP Medicaid	$541.66

PR TOT ESOPHAGECTOMY W/O THORCOM W/WO PYLOROPLASTY

Professional

Both

$5,741.00

Service Code	HCPCS 43107
Min. Negotiated Rate	$1,759.38
Max. Negotiated Rate	$5,358.88
Rate for Payer: Aetna Commercial	$4,000.38
Rate for Payer: Aetna Medicare	$2,870.50
Rate for Payer: BCBS Complete	$1,847.35
Rate for Payer: BCN Commercial	$4,398.17
Rate for Payer: Cash Price	$4,592.80
Rate for Payer: Cash Price	$4,592.80
Rate for Payer: Mclaren Medicaid	$1,759.38
Rate for Payer: Meridian Medicaid	$1,847.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,305.75
Rate for Payer: Priority Health Choice Medicaid	$1,759.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,358.88
Rate for Payer: Priority Health Narrow/Tiered Network	$5,358.88
Rate for Payer: UHC Medicaid	$1,759.38
Rate for Payer: UHCCP Medicaid	$1,759.38

PR TOT/PRTL ESPHG W/O RCNSTJ W/CRV ESOPHAGOSTOMY

Professional

Both

$8,204.00

Service Code	HCPCS 43124
Min. Negotiated Rate	$2,266.11
Max. Negotiated Rate	$6,830.28
Rate for Payer: Aetna Commercial	$5,120.17
Rate for Payer: Aetna Medicare	$4,102.00
Rate for Payer: BCBS Complete	$2,379.42
Rate for Payer: BCN Commercial	$5,605.77
Rate for Payer: Cash Price	$6,563.20
Rate for Payer: Cash Price	$6,563.20
Rate for Payer: Mclaren Medicaid	$2,266.11
Rate for Payer: Meridian Medicaid	$2,379.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,153.00
Rate for Payer: Priority Health Choice Medicaid	$2,266.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$6,830.28
Rate for Payer: Priority Health Narrow/Tiered Network	$6,830.28
Rate for Payer: UHC Medicaid	$2,266.11
Rate for Payer: UHCCP Medicaid	$2,266.11

PR TRABECULOPLASTY BY LASER SURGERY

Professional

Both

$1,269.00

Service Code	HCPCS 65855
Min. Negotiated Rate	$109.27
Max. Negotiated Rate	$951.75
Rate for Payer: Aetna Commercial	$267.76
Rate for Payer: Aetna Medicare	$634.50
Rate for Payer: BCBS Complete	$114.73
Rate for Payer: BCN Commercial	$239.15
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Cash Price	$1,015.20
Rate for Payer: Mclaren Medicaid	$109.27
Rate for Payer: Meridian Medicaid	$114.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$951.75
Rate for Payer: Priority Health Choice Medicaid	$109.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$355.23
Rate for Payer: Priority Health Narrow/Tiered Network	$355.23
Rate for Payer: UHC Medicaid	$109.27
Rate for Payer: UHCCP Medicaid	$109.27

PR TRACHEAL PNXR PERQ W/TRANSTRACHEAL ASPIR&/NJX

Professional

Both

$182.00

Service Code	HCPCS 31612
Min. Negotiated Rate	$26.63
Max. Negotiated Rate	$136.50
Rate for Payer: Aetna Commercial	$62.37
Rate for Payer: Aetna Medicare	$91.00
Rate for Payer: BCBS Complete	$27.96
Rate for Payer: BCN Commercial	$72.21
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cash Price	$145.60
Rate for Payer: Mclaren Medicaid	$26.63
Rate for Payer: Meridian Medicaid	$27.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$136.50
Rate for Payer: Priority Health Choice Medicaid	$26.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$67.99
Rate for Payer: Priority Health Narrow/Tiered Network	$67.99
Rate for Payer: UHC Medicaid	$26.63
Rate for Payer: UHCCP Medicaid	$26.63

PR TRACHELECTOMY CERVICECTOMY AMP CERVIX SPX

Professional

Both

$598.00

Service Code	HCPCS 57530
Min. Negotiated Rate	$216.62
Max. Negotiated Rate	$571.43
Rate for Payer: Aetna Commercial	$438.14
Rate for Payer: Aetna Medicare	$299.00
Rate for Payer: BCBS Complete	$227.45
Rate for Payer: BCN Commercial	$564.22
Rate for Payer: Cash Price	$478.40
Rate for Payer: Cash Price	$478.40
Rate for Payer: Mclaren Medicaid	$216.62
Rate for Payer: Meridian Medicaid	$227.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$448.50
Rate for Payer: Priority Health Choice Medicaid	$216.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$571.43
Rate for Payer: Priority Health Narrow/Tiered Network	$571.43
Rate for Payer: UHC Medicaid	$216.62
Rate for Payer: UHCCP Medicaid	$216.62

PR TRACHELORRHAPHY PLSTC RPR UTERINE CERVIX VAG

Professional

Both

$981.00

Service Code	HCPCS 57720
Min. Negotiated Rate	$190.85
Max. Negotiated Rate	$735.75
Rate for Payer: Aetna Commercial	$393.11
Rate for Payer: Aetna Medicare	$490.50
Rate for Payer: BCBS Complete	$200.39
Rate for Payer: BCN Commercial	$503.46
Rate for Payer: Cash Price	$784.80
Rate for Payer: Cash Price	$784.80
Rate for Payer: Mclaren Medicaid	$190.85
Rate for Payer: Meridian Medicaid	$200.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$735.75
Rate for Payer: Priority Health Choice Medicaid	$190.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$509.89
Rate for Payer: Priority Health Narrow/Tiered Network	$509.89
Rate for Payer: UHC Medicaid	$190.85
Rate for Payer: UHCCP Medicaid	$190.85

PR TRACHEOBRONCHOSCOPY THRU EST TRACHEOSTOMY INC

Professional

Both

$476.00

Service Code	HCPCS 31615
Min. Negotiated Rate	$64.97
Max. Negotiated Rate	$357.00
Rate for Payer: Aetna Commercial	$145.81
Rate for Payer: Aetna Medicare	$238.00
Rate for Payer: BCBS Complete	$68.22
Rate for Payer: BCN Commercial	$173.29
Rate for Payer: Cash Price	$380.80
Rate for Payer: Cash Price	$380.80
Rate for Payer: Mclaren Medicaid	$64.97
Rate for Payer: Meridian Medicaid	$68.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$357.00
Rate for Payer: Priority Health Choice Medicaid	$64.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$163.20
Rate for Payer: Priority Health Narrow/Tiered Network	$163.20
Rate for Payer: UHC Medicaid	$64.97
Rate for Payer: UHCCP Medicaid	$64.97

PR TRACHEOPLASTY CERVICAL

Professional

Both

$4,537.00

Service Code	HCPCS 31750
Min. Negotiated Rate	$795.34
Max. Negotiated Rate	$3,402.75
Rate for Payer: Aetna Commercial	$1,748.98
Rate for Payer: Aetna Medicare	$2,268.50
Rate for Payer: BCBS Complete	$835.11
Rate for Payer: BCN Commercial	$2,018.32
Rate for Payer: Cash Price	$3,629.60
Rate for Payer: Cash Price	$3,629.60
Rate for Payer: Mclaren Medicaid	$795.34
Rate for Payer: Meridian Medicaid	$835.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,402.75
Rate for Payer: Priority Health Choice Medicaid	$795.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,900.65
Rate for Payer: Priority Health Narrow/Tiered Network	$1,900.65
Rate for Payer: UHC Medicaid	$795.34
Rate for Payer: UHCCP Medicaid	$795.34

PR TRACHEOSTOMA REVJ CPLX W/FLAP ROTATION

Professional

Both

$1,396.00

Service Code	HCPCS 31614
Min. Negotiated Rate	$409.60
Max. Negotiated Rate	$1,065.68
Rate for Payer: Aetna Commercial	$924.68
Rate for Payer: Aetna Medicare	$698.00
Rate for Payer: BCBS Complete	$430.08
Rate for Payer: BCN Commercial	$1,065.68
Rate for Payer: Cash Price	$1,116.80
Rate for Payer: Cash Price	$1,116.80
Rate for Payer: Mclaren Medicaid	$409.60
Rate for Payer: Meridian Medicaid	$430.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,047.00
Rate for Payer: Priority Health Choice Medicaid	$409.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,003.56
Rate for Payer: Priority Health Narrow/Tiered Network	$1,003.56
Rate for Payer: UHC Medicaid	$409.60
Rate for Payer: UHCCP Medicaid	$409.60

Know your out-of-pocket cost for care.

All Charges