Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP

Professional

Both

$2,904.00

Service Code	HCPCS 27691
Min. Negotiated Rate	$447.94
Max. Negotiated Rate	$2,178.00
Rate for Payer: Aetna Commercial	$991.04
Rate for Payer: Aetna Medicare	$1,452.00
Rate for Payer: BCBS Complete	$470.34
Rate for Payer: BCN Commercial	$1,131.91
Rate for Payer: Cash Price	$2,323.20
Rate for Payer: Cash Price	$2,323.20
Rate for Payer: Mclaren Medicaid	$447.94
Rate for Payer: Meridian Medicaid	$470.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,178.00
Rate for Payer: Priority Health Choice Medicaid	$447.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,209.99
Rate for Payer: Priority Health Narrow/Tiered Network	$1,209.99
Rate for Payer: UHC Medicaid	$447.94
Rate for Payer: UHCCP Medicaid	$447.94

PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING EA TDN

Professional

Both

$525.00

Service Code	HCPCS 27692
Min. Negotiated Rate	$57.08
Max. Negotiated Rate	$393.75
Rate for Payer: Aetna Commercial	$138.03
Rate for Payer: Aetna Medicare	$262.50
Rate for Payer: BCBS Complete	$59.93
Rate for Payer: BCN Commercial	$152.88
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Mclaren Medicaid	$57.08
Rate for Payer: Meridian Medicaid	$59.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$393.75
Rate for Payer: Priority Health Choice Medicaid	$57.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$163.42
Rate for Payer: Priority Health Narrow/Tiered Network	$163.42
Rate for Payer: UHC Medicaid	$57.08
Rate for Payer: UHCCP Medicaid	$57.08

PR TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC

Professional

Both

$2,055.00

Service Code	HCPCS 27690
Min. Negotiated Rate	$387.87
Max. Negotiated Rate	$1,541.25
Rate for Payer: Aetna Commercial	$854.26
Rate for Payer: Aetna Medicare	$1,027.50
Rate for Payer: BCBS Complete	$407.26
Rate for Payer: BCN Commercial	$974.05
Rate for Payer: Cash Price	$1,644.00
Rate for Payer: Cash Price	$1,644.00
Rate for Payer: Mclaren Medicaid	$387.87
Rate for Payer: Meridian Medicaid	$407.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,541.25
Rate for Payer: Priority Health Choice Medicaid	$387.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,041.24
Rate for Payer: Priority Health Narrow/Tiered Network	$1,041.24
Rate for Payer: UHC Medicaid	$387.87
Rate for Payer: UHCCP Medicaid	$387.87

PR TR/TRNSPL TDN CARP/MTCRPL HAND W/O FR GRF EA TDN

Professional

Both

$2,124.00

Service Code	HCPCS 26480
Min. Negotiated Rate	$426.00
Max. Negotiated Rate	$1,593.00
Rate for Payer: Aetna Commercial	$1,042.22
Rate for Payer: Aetna Medicare	$1,062.00
Rate for Payer: BCBS Complete	$447.30
Rate for Payer: BCN Commercial	$1,094.06
Rate for Payer: Cash Price	$1,699.20
Rate for Payer: Cash Price	$1,699.20
Rate for Payer: Mclaren Medicaid	$426.00
Rate for Payer: Meridian Medicaid	$447.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,593.00
Rate for Payer: Priority Health Choice Medicaid	$426.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,169.52
Rate for Payer: Priority Health Narrow/Tiered Network	$1,169.52
Rate for Payer: UHC Medicaid	$426.00
Rate for Payer: UHCCP Medicaid	$426.00

PR TRURL DRAINAGE PROSTATIC ABSCESS

Professional

Both

$852.00

Service Code	HCPCS 52700
Min. Negotiated Rate	$258.58
Max. Negotiated Rate	$725.82
Rate for Payer: Aetna Commercial	$564.73
Rate for Payer: Aetna Medicare	$426.00
Rate for Payer: BCBS Complete	$271.51
Rate for Payer: BCN Commercial	$666.30
Rate for Payer: Cash Price	$681.60
Rate for Payer: Cash Price	$681.60
Rate for Payer: Mclaren Medicaid	$258.58
Rate for Payer: Meridian Medicaid	$271.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$639.00
Rate for Payer: Priority Health Choice Medicaid	$258.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$725.82
Rate for Payer: Priority Health Narrow/Tiered Network	$725.82
Rate for Payer: UHC Medicaid	$258.58
Rate for Payer: UHCCP Medicaid	$258.58

PR TRURL DSTRJ PRST8 TISS RF WV THERMOTHERAPY

Professional

Both

$3,657.00

Service Code	HCPCS 53854
Min. Negotiated Rate	$225.78
Max. Negotiated Rate	$2,742.75
Rate for Payer: Aetna Commercial	$482.70
Rate for Payer: Aetna Medicare	$1,828.50
Rate for Payer: BCBS Complete	$237.07
Rate for Payer: BCN Commercial	$575.67
Rate for Payer: Cash Price	$2,925.60
Rate for Payer: Cash Price	$2,925.60
Rate for Payer: Mclaren Medicaid	$225.78
Rate for Payer: Meridian Medicaid	$237.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,742.75
Rate for Payer: Priority Health Choice Medicaid	$225.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$627.09
Rate for Payer: Priority Health Narrow/Tiered Network	$627.09
Rate for Payer: UHC Medicaid	$225.78
Rate for Payer: UHCCP Medicaid	$225.78

PR TRURL DSTRJ PRSTATE TISS RF THERMOTH

Professional

Both

$3,023.00

Service Code	HCPCS 53852
Min. Negotiated Rate	$225.57
Max. Negotiated Rate	$2,267.25
Rate for Payer: Aetna Commercial	$482.28
Rate for Payer: Aetna Medicare	$1,511.50
Rate for Payer: BCBS Complete	$236.85
Rate for Payer: BCN Commercial	$575.67
Rate for Payer: Cash Price	$2,418.40
Rate for Payer: Cash Price	$2,418.40
Rate for Payer: Mclaren Medicaid	$225.57
Rate for Payer: Meridian Medicaid	$236.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,267.25
Rate for Payer: Priority Health Choice Medicaid	$225.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$627.09
Rate for Payer: Priority Health Narrow/Tiered Network	$627.09
Rate for Payer: UHC Medicaid	$225.57
Rate for Payer: UHCCP Medicaid	$225.57

PR TRURL ELECTROSURG RESCJ PROSTATE BLEED COMPLETE

Professional

Both

$1,638.00

Service Code	HCPCS 52601
Min. Negotiated Rate	$335.48
Max. Negotiated Rate	$1,228.50
Rate for Payer: Aetna Commercial	$935.09
Rate for Payer: Aetna Medicare	$819.00
Rate for Payer: BCBS Complete	$352.25
Rate for Payer: BCN Commercial	$1,088.58
Rate for Payer: Cash Price	$1,310.40
Rate for Payer: Cash Price	$1,310.40
Rate for Payer: Mclaren Medicaid	$335.48
Rate for Payer: Meridian Medicaid	$352.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,228.50
Rate for Payer: Priority Health Choice Medicaid	$335.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,185.82
Rate for Payer: Priority Health Narrow/Tiered Network	$1,185.82
Rate for Payer: UHC Medicaid	$335.48
Rate for Payer: UHCCP Medicaid	$335.48

PR TRURL RESCJ POSTOP BLADDER NECK CONTRACTURE

Professional

Both

$746.00

Service Code	HCPCS 52640
Min. Negotiated Rate	$192.77
Max. Negotiated Rate	$559.50
Rate for Payer: Aetna Commercial	$405.73
Rate for Payer: Aetna Medicare	$373.00
Rate for Payer: BCBS Complete	$202.41
Rate for Payer: BCN Commercial	$490.01
Rate for Payer: Cash Price	$596.80
Rate for Payer: Cash Price	$596.80
Rate for Payer: Mclaren Medicaid	$192.77
Rate for Payer: Meridian Medicaid	$202.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$559.50
Rate for Payer: Priority Health Choice Medicaid	$192.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$533.78
Rate for Payer: Priority Health Narrow/Tiered Network	$533.78
Rate for Payer: UHC Medicaid	$192.77
Rate for Payer: UHCCP Medicaid	$192.77

PR TRURL RESCJ RESIDUAL/REGROWTH OBSTR PRSTATE TISS

Professional

Both

$813.00

Service Code	HCPCS 52630
Min. Negotiated Rate	$239.84
Max. Negotiated Rate	$667.78
Rate for Payer: Aetna Commercial	$515.11
Rate for Payer: Aetna Medicare	$406.50
Rate for Payer: BCBS Complete	$251.83
Rate for Payer: BCN Commercial	$613.01
Rate for Payer: Cash Price	$650.40
Rate for Payer: Cash Price	$650.40
Rate for Payer: Mclaren Medicaid	$239.84
Rate for Payer: Meridian Medicaid	$251.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$609.75
Rate for Payer: Priority Health Choice Medicaid	$239.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$667.78
Rate for Payer: Priority Health Narrow/Tiered Network	$667.78
Rate for Payer: UHC Medicaid	$239.84
Rate for Payer: UHCCP Medicaid	$239.84

PR TSTG ANS FUNCJ CARDIOVAGAL INNERVAJ PARASYMP

Professional

Both

$159.00

Service Code	HCPCS 95921
Min. Negotiated Rate	$79.50
Max. Negotiated Rate	$128.97
Rate for Payer: Aetna Commercial	$96.18
Rate for Payer: Aetna Medicare	$79.50
Rate for Payer: BCN Commercial	$128.97
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cash Price	$127.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$119.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$118.95
Rate for Payer: Priority Health Narrow/Tiered Network	$118.95

PR TSTG ANS FUNCJ PARASYMP&SYMP W/5 MIN PASIVE TILT

Professional

Both

$186.00

Service Code	HCPCS 95924
Min. Negotiated Rate	$93.00
Max. Negotiated Rate	$219.61
Rate for Payer: Aetna Commercial	$163.67
Rate for Payer: Aetna Medicare	$93.00
Rate for Payer: BCN Commercial	$219.61
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cash Price	$148.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$139.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$202.53
Rate for Payer: Priority Health Narrow/Tiered Network	$202.53

PR TSTG ANS FUNCJ VASOMOTOR ADRENERGIC INNERVAJ

Professional

Both

$191.00

Service Code	HCPCS 95922
Min. Negotiated Rate	$95.50
Max. Negotiated Rate	$143.25
Rate for Payer: Aetna Commercial	$113.87
Rate for Payer: Aetna Medicare	$95.50
Rate for Payer: BCN Commercial	$132.46
Rate for Payer: Cash Price	$152.80
Rate for Payer: Cash Price	$152.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$143.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$122.16
Rate for Payer: Priority Health Narrow/Tiered Network	$122.16

PR TTRACH INTRO NDL WIRE DIL/STENT/TUBE O2 THER

Professional

Both

$314.00

Service Code	HCPCS 31730
Min. Negotiated Rate	$125.60
Max. Negotiated Rate	$235.50
Rate for Payer: Aetna Commercial	$194.23
Rate for Payer: Aetna Medicare	$157.00
Rate for Payer: BCBS Complete	$125.60
Rate for Payer: BCN Commercial	$221.60
Rate for Payer: Cash Price	$251.20
Rate for Payer: Cash Price	$251.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$235.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$208.68
Rate for Payer: Priority Health Narrow/Tiered Network	$208.68

PR TUBE/NEEDLE CATH JEJUNOSTOMY ANY METHOD

Professional

Both

$1,280.00

Service Code	HCPCS 44015
Min. Negotiated Rate	$80.73
Max. Negotiated Rate	$960.00
Rate for Payer: Aetna Commercial	$192.38
Rate for Payer: Aetna Medicare	$640.00
Rate for Payer: BCBS Complete	$84.77
Rate for Payer: BCN Commercial	$209.15
Rate for Payer: Cash Price	$1,024.00
Rate for Payer: Cash Price	$1,024.00
Rate for Payer: Mclaren Medicaid	$80.73
Rate for Payer: Meridian Medicaid	$84.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$960.00
Rate for Payer: Priority Health Choice Medicaid	$80.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$254.85
Rate for Payer: Priority Health Narrow/Tiered Network	$254.85
Rate for Payer: UHC Medicaid	$80.73
Rate for Payer: UHCCP Medicaid	$80.73

PR TUBE THORACOSTOMY INCLUDES WATER SEAL

Professional

Both

$620.00

Service Code	HCPCS 32551
Min. Negotiated Rate	$91.16
Max. Negotiated Rate	$465.00
Rate for Payer: Aetna Commercial	$202.73
Rate for Payer: Aetna Medicare	$310.00
Rate for Payer: BCBS Complete	$95.72
Rate for Payer: BCN Commercial	$229.57
Rate for Payer: Cash Price	$496.00
Rate for Payer: Cash Price	$496.00
Rate for Payer: Mclaren Medicaid	$91.16
Rate for Payer: Meridian Medicaid	$95.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$465.00
Rate for Payer: Priority Health Choice Medicaid	$91.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$216.19
Rate for Payer: Priority Health Narrow/Tiered Network	$216.19
Rate for Payer: UHC Medicaid	$91.16
Rate for Payer: UHCCP Medicaid	$91.16

PR TUBOTUBAL ANASTATOMOSIS

Professional

Both

$1,703.00

Service Code	HCPCS 58750
Min. Negotiated Rate	$681.20
Max. Negotiated Rate	$1,380.39
Rate for Payer: Aetna Commercial	$1,090.66
Rate for Payer: Aetna Medicare	$851.50
Rate for Payer: BCBS Complete	$681.20
Rate for Payer: BCN Commercial	$1,362.98
Rate for Payer: Cash Price	$1,362.40
Rate for Payer: Cash Price	$1,362.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,277.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,380.39
Rate for Payer: Priority Health Narrow/Tiered Network	$1,380.39

PR TWIST DRILL HOLE EVAC&/DRG SUBDURAL HEMATOMA

Professional

Both

$4,027.00

Service Code	HCPCS 61108
Min. Negotiated Rate	$592.35
Max. Negotiated Rate	$3,020.25
Rate for Payer: Aetna Commercial	$1,160.13
Rate for Payer: Aetna Medicare	$2,013.50
Rate for Payer: BCBS Complete	$621.97
Rate for Payer: BCN Commercial	$1,920.82
Rate for Payer: Cash Price	$3,221.60
Rate for Payer: Cash Price	$3,221.60
Rate for Payer: Mclaren Medicaid	$592.35
Rate for Payer: Meridian Medicaid	$621.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,020.25
Rate for Payer: Priority Health Choice Medicaid	$592.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,614.87
Rate for Payer: Priority Health Narrow/Tiered Network	$1,614.87
Rate for Payer: UHC Medicaid	$592.35
Rate for Payer: UHCCP Medicaid	$592.35

PR TWIST DRILL HOLE IMPLT VENTRICULAR CATH/DEVICE

Professional

Both

$2,553.00

Service Code	HCPCS 61107
Min. Negotiated Rate	$183.39
Max. Negotiated Rate	$1,914.75
Rate for Payer: Aetna Commercial	$405.53
Rate for Payer: Aetna Medicare	$1,276.50
Rate for Payer: BCBS Complete	$192.56
Rate for Payer: BCN Commercial	$649.45
Rate for Payer: Cash Price	$2,042.40
Rate for Payer: Cash Price	$2,042.40
Rate for Payer: Mclaren Medicaid	$183.39
Rate for Payer: Meridian Medicaid	$192.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,914.75
Rate for Payer: Priority Health Choice Medicaid	$183.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$546.00
Rate for Payer: Priority Health Narrow/Tiered Network	$546.00
Rate for Payer: UHC Medicaid	$183.39
Rate for Payer: UHCCP Medicaid	$183.39

PR TWIST DRILL HOLE SUBDURAL/VENTRICULAR PUNCTURE

Professional

Both

$2,213.00

Service Code	HCPCS 61105
Min. Negotiated Rate	$317.80
Max. Negotiated Rate	$1,659.75
Rate for Payer: Aetna Commercial	$593.07
Rate for Payer: Aetna Medicare	$1,106.50
Rate for Payer: BCBS Complete	$333.69
Rate for Payer: BCN Commercial	$992.05
Rate for Payer: Cash Price	$1,770.40
Rate for Payer: Cash Price	$1,770.40
Rate for Payer: Mclaren Medicaid	$317.80
Rate for Payer: Meridian Medicaid	$333.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,659.75
Rate for Payer: Priority Health Choice Medicaid	$317.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$834.05
Rate for Payer: Priority Health Narrow/Tiered Network	$834.05
Rate for Payer: UHC Medicaid	$317.80
Rate for Payer: UHCCP Medicaid	$317.80

PR TWO AREA LIPOSUCTION - 2 AREA 2.0 HR

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 TX ANAL FSTL TRANS/SUPRA/XTRASPHNCTRC INCL SETON

Professional

Both

$1,509.00

Service Code	HCPCS 46280
Min. Negotiated Rate	$307.79
Max. Negotiated Rate	$1,131.75
Rate for Payer: Aetna Commercial	$637.07
Rate for Payer: Aetna Medicare	$754.50
Rate for Payer: BCBS Complete	$323.18
Rate for Payer: BCN Commercial	$730.53
Rate for Payer: Cash Price	$1,207.20
Rate for Payer: Cash Price	$1,207.20
Rate for Payer: Mclaren Medicaid	$307.79
Rate for Payer: Meridian Medicaid	$323.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,131.75
Rate for Payer: Priority Health Choice Medicaid	$307.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$890.11
Rate for Payer: Priority Health Narrow/Tiered Network	$890.11
Rate for Payer: UHC Medicaid	$307.79
Rate for Payer: UHCCP Medicaid	$307.79

PR TX ECTOPIC PREGNANCY ABDL PREGNANCY

Professional

Both

$1,550.00

Service Code	HCPCS 59130
Min. Negotiated Rate	$543.58
Max. Negotiated Rate	$1,426.22
Rate for Payer: Aetna Commercial	$1,039.81
Rate for Payer: Aetna Medicare	$775.00
Rate for Payer: BCBS Complete	$570.76
Rate for Payer: BCN Commercial	$1,426.22
Rate for Payer: Cash Price	$1,240.00
Rate for Payer: Cash Price	$1,240.00
Rate for Payer: Mclaren Medicaid	$543.58
Rate for Payer: Meridian Medicaid	$570.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,162.50
Rate for Payer: Priority Health Choice Medicaid	$543.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,346.35
Rate for Payer: Priority Health Narrow/Tiered Network	$1,346.35
Rate for Payer: UHC Medicaid	$543.58
Rate for Payer: UHCCP Medicaid	$543.58

PR TX ECTOPIC PREGNANCY ABDOMINAL/VAGINAL APPR

Professional

Both

$1,781.00

Service Code	HCPCS 59120
Min. Negotiated Rate	$468.60
Max. Negotiated Rate	$1,335.75
Rate for Payer: Aetna Commercial	$892.36
Rate for Payer: Aetna Medicare	$890.50
Rate for Payer: BCBS Complete	$492.03
Rate for Payer: BCN Commercial	$1,229.02
Rate for Payer: Cash Price	$1,424.80
Rate for Payer: Cash Price	$1,424.80
Rate for Payer: Mclaren Medicaid	$468.60
Rate for Payer: Meridian Medicaid	$492.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,335.75
Rate for Payer: Priority Health Choice Medicaid	$468.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,160.19
Rate for Payer: Priority Health Narrow/Tiered Network	$1,160.19
Rate for Payer: UHC Medicaid	$468.60
Rate for Payer: UHCCP Medicaid	$468.60

PR TX ECTOPIC PREGNANCY NTRSTL PRTL RESCJ UTER

Professional

Both

$1,872.00

Service Code	HCPCS 59136
Min. Negotiated Rate	$515.25
Max. Negotiated Rate	$1,404.00
Rate for Payer: Aetna Commercial	$986.02
Rate for Payer: Aetna Medicare	$936.00
Rate for Payer: BCBS Complete	$541.01
Rate for Payer: BCN Commercial	$1,354.01
Rate for Payer: Cash Price	$1,497.60
Rate for Payer: Cash Price	$1,497.60
Rate for Payer: Mclaren Medicaid	$515.25
Rate for Payer: Meridian Medicaid	$541.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,404.00
Rate for Payer: Priority Health Choice Medicaid	$515.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,278.19
Rate for Payer: Priority Health Narrow/Tiered Network	$1,278.19
Rate for Payer: UHC Medicaid	$515.25
Rate for Payer: UHCCP Medicaid	$515.25

Know your out-of-pocket cost for care.

All Charges