Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR TX ECTOPIC PREGNANCY W/O SALPING&/OOPHORECTOMY

Professional

Both

$1,511.00

Service Code	HCPCS 59121
Min. Negotiated Rate	$468.81
Max. Negotiated Rate	$1,229.52
Rate for Payer: Aetna Commercial	$893.35
Rate for Payer: Aetna Medicare	$755.50
Rate for Payer: BCBS Complete	$492.25
Rate for Payer: BCN Commercial	$1,229.52
Rate for Payer: Cash Price	$1,208.80
Rate for Payer: Cash Price	$1,208.80
Rate for Payer: Mclaren Medicaid	$468.81
Rate for Payer: Meridian Medicaid	$492.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,133.25
Rate for Payer: Priority Health Choice Medicaid	$468.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,160.67
Rate for Payer: Priority Health Narrow/Tiered Network	$1,160.67
Rate for Payer: UHC Medicaid	$468.81
Rate for Payer: UHCCP Medicaid	$468.81

PR TX HUMRL SHFT FX W/INSJ IMED IMPLT W/WO CERCLAGE

Professional

Both

$3,619.00

Service Code	HCPCS 24516
Min. Negotiated Rate	$508.64
Max. Negotiated Rate	$2,714.25
Rate for Payer: Aetna Commercial	$1,148.79
Rate for Payer: Aetna Medicare	$1,809.50
Rate for Payer: BCBS Complete	$534.07
Rate for Payer: BCN Commercial	$1,306.20
Rate for Payer: Cash Price	$2,895.20
Rate for Payer: Cash Price	$2,895.20
Rate for Payer: Mclaren Medicaid	$508.64
Rate for Payer: Meridian Medicaid	$534.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,714.25
Rate for Payer: Priority Health Choice Medicaid	$508.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,396.30
Rate for Payer: Priority Health Narrow/Tiered Network	$1,396.30
Rate for Payer: UHC Medicaid	$508.64
Rate for Payer: UHCCP Medicaid	$508.64

PR TX INCOMPLETE ABORTION ANY TRIMESTER SURGICAL

Professional

Both

$788.00

Service Code	HCPCS 59812
Min. Negotiated Rate	$178.28
Max. Negotiated Rate	$591.00
Rate for Payer: Aetna Commercial	$335.23
Rate for Payer: Aetna Medicare	$394.00
Rate for Payer: BCBS Complete	$187.19
Rate for Payer: BCN Commercial	$464.62
Rate for Payer: Cash Price	$630.40
Rate for Payer: Cash Price	$630.40
Rate for Payer: Mclaren Medicaid	$178.28
Rate for Payer: Meridian Medicaid	$187.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$591.00
Rate for Payer: Priority Health Choice Medicaid	$178.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$438.60
Rate for Payer: Priority Health Narrow/Tiered Network	$438.60
Rate for Payer: UHC Medicaid	$178.28
Rate for Payer: UHCCP Medicaid	$178.28

PR TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW

Professional

Both

$4,229.00

Service Code	HCPCS 27245
Min. Negotiated Rate	$713.12
Max. Negotiated Rate	$3,171.75
Rate for Payer: Aetna Commercial	$1,639.86
Rate for Payer: Aetna Medicare	$2,114.50
Rate for Payer: BCBS Complete	$748.78
Rate for Payer: BCN Commercial	$1,854.98
Rate for Payer: Cash Price	$3,383.20
Rate for Payer: Cash Price	$3,383.20
Rate for Payer: Mclaren Medicaid	$713.12
Rate for Payer: Meridian Medicaid	$748.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,171.75
Rate for Payer: Priority Health Choice Medicaid	$713.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,982.93
Rate for Payer: Priority Health Narrow/Tiered Network	$1,982.93
Rate for Payer: UHC Medicaid	$713.12
Rate for Payer: UHCCP Medicaid	$713.12

PR TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT

Professional

Both

$3,575.00

Service Code	HCPCS 27244
Min. Negotiated Rate	$715.04
Max. Negotiated Rate	$2,681.25
Rate for Payer: Aetna Commercial	$1,641.64
Rate for Payer: Aetna Medicare	$1,787.50
Rate for Payer: BCBS Complete	$750.79
Rate for Payer: BCN Commercial	$2,040.56
Rate for Payer: Cash Price	$2,860.00
Rate for Payer: Cash Price	$2,860.00
Rate for Payer: Mclaren Medicaid	$715.04
Rate for Payer: Meridian Medicaid	$750.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,681.25
Rate for Payer: Priority Health Choice Medicaid	$715.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,985.58
Rate for Payer: Priority Health Narrow/Tiered Network	$1,985.58
Rate for Payer: UHC Medicaid	$715.04
Rate for Payer: UHCCP Medicaid	$715.04

PR TX MISSED ABORTION FIRST TRIMESTER SURGICAL

Professional

Both

$840.00

Service Code	HCPCS 59820
Min. Negotiated Rate	$224.08
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna Commercial	$413.43
Rate for Payer: Aetna Medicare	$420.00
Rate for Payer: BCBS Complete	$235.28
Rate for Payer: BCN Commercial	$584.13
Rate for Payer: Cash Price	$672.00
Rate for Payer: Cash Price	$672.00
Rate for Payer: Mclaren Medicaid	$224.08
Rate for Payer: Meridian Medicaid	$235.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$630.00
Rate for Payer: Priority Health Choice Medicaid	$224.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$551.42
Rate for Payer: Priority Health Narrow/Tiered Network	$551.42
Rate for Payer: UHC Medicaid	$224.08
Rate for Payer: UHCCP Medicaid	$224.08

PR TX MISSED ABORTION SECOND TRIMESTER SURGICAL

Professional

Both

$840.00

Service Code	HCPCS 59821
Min. Negotiated Rate	$219.39
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna Commercial	$407.50
Rate for Payer: Aetna Medicare	$420.00
Rate for Payer: BCBS Complete	$230.36
Rate for Payer: BCN Commercial	$570.69
Rate for Payer: Cash Price	$672.00
Rate for Payer: Cash Price	$672.00
Rate for Payer: Mclaren Medicaid	$219.39
Rate for Payer: Meridian Medicaid	$230.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$630.00
Rate for Payer: Priority Health Choice Medicaid	$219.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$538.73
Rate for Payer: Priority Health Narrow/Tiered Network	$538.73
Rate for Payer: UHC Medicaid	$219.39
Rate for Payer: UHCCP Medicaid	$219.39

PR TX OPEN TENDON FLEXOR TOE 1 TENDON SPX

Professional

Both

$654.00

Service Code	HCPCS 28232
Min. Negotiated Rate	$147.40
Max. Negotiated Rate	$490.50
Rate for Payer: Aetna Commercial	$316.96
Rate for Payer: Aetna Medicare	$327.00
Rate for Payer: BCBS Complete	$154.77
Rate for Payer: BCN Commercial	$366.51
Rate for Payer: Cash Price	$523.20
Rate for Payer: Cash Price	$523.20
Rate for Payer: Mclaren Medicaid	$147.40
Rate for Payer: Meridian Medicaid	$154.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$490.50
Rate for Payer: Priority Health Choice Medicaid	$147.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$391.79
Rate for Payer: Priority Health Narrow/Tiered Network	$391.79
Rate for Payer: UHC Medicaid	$147.40
Rate for Payer: UHCCP Medicaid	$147.40

PR TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX

Professional

Both

$640.00

Service Code	HCPCS 28230
Min. Negotiated Rate	$172.10
Max. Negotiated Rate	$480.00
Rate for Payer: Aetna Commercial	$375.41
Rate for Payer: Aetna Medicare	$320.00
Rate for Payer: BCBS Complete	$180.71
Rate for Payer: BCN Commercial	$434.74
Rate for Payer: Cash Price	$512.00
Rate for Payer: Cash Price	$512.00
Rate for Payer: Mclaren Medicaid	$172.10
Rate for Payer: Meridian Medicaid	$180.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$480.00
Rate for Payer: Priority Health Choice Medicaid	$172.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$464.71
Rate for Payer: Priority Health Narrow/Tiered Network	$464.71
Rate for Payer: UHC Medicaid	$172.10
Rate for Payer: UHCCP Medicaid	$172.10

PR TX SEPTIC ABORTION SURGICAL

Professional

Both

$1,030.00

Service Code	HCPCS 59830
Min. Negotiated Rate	$267.32
Max. Negotiated Rate	$772.50
Rate for Payer: Aetna Commercial	$503.21
Rate for Payer: Aetna Medicare	$515.00
Rate for Payer: BCBS Complete	$280.69
Rate for Payer: BCN Commercial	$698.67
Rate for Payer: Cash Price	$824.00
Rate for Payer: Cash Price	$824.00
Rate for Payer: Mclaren Medicaid	$267.32
Rate for Payer: Meridian Medicaid	$280.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$772.50
Rate for Payer: Priority Health Choice Medicaid	$267.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$659.54
Rate for Payer: Priority Health Narrow/Tiered Network	$659.54
Rate for Payer: UHC Medicaid	$267.32
Rate for Payer: UHCCP Medicaid	$267.32

PR TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU

Professional

Both

$6,649.00

Service Code	HCPCS 27176
Min. Negotiated Rate	$546.35
Max. Negotiated Rate	$4,986.75
Rate for Payer: Aetna Commercial	$1,230.99
Rate for Payer: Aetna Medicare	$3,324.50
Rate for Payer: BCBS Complete	$573.67
Rate for Payer: BCN Commercial	$1,403.31
Rate for Payer: Cash Price	$5,319.20
Rate for Payer: Cash Price	$5,319.20
Rate for Payer: Mclaren Medicaid	$546.35
Rate for Payer: Meridian Medicaid	$573.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,986.75
Rate for Payer: Priority Health Choice Medicaid	$546.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,500.09
Rate for Payer: Priority Health Narrow/Tiered Network	$1,500.09
Rate for Payer: UHC Medicaid	$546.35
Rate for Payer: UHCCP Medicaid	$546.35

PR TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES

Professional

Both

$899.00

Service Code	HCPCS 27257
Min. Negotiated Rate	$210.23
Max. Negotiated Rate	$674.25
Rate for Payer: Aetna Commercial	$483.93
Rate for Payer: Aetna Medicare	$449.50
Rate for Payer: BCBS Complete	$220.74
Rate for Payer: BCN Commercial	$547.78
Rate for Payer: Cash Price	$719.20
Rate for Payer: Cash Price	$719.20
Rate for Payer: Mclaren Medicaid	$210.23
Rate for Payer: Meridian Medicaid	$220.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$674.25
Rate for Payer: Priority Health Choice Medicaid	$210.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$585.56
Rate for Payer: Priority Health Narrow/Tiered Network	$585.56
Rate for Payer: UHC Medicaid	$210.23
Rate for Payer: UHCCP Medicaid	$210.23

PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE

Professional

Both

$484.00

Service Code	HCPCS 12020
Min. Negotiated Rate	$113.96
Max. Negotiated Rate	$363.00
Rate for Payer: Aetna Commercial	$203.61
Rate for Payer: Aetna Medicare	$242.00
Rate for Payer: BCBS Complete	$119.66
Rate for Payer: BCN Commercial	$284.85
Rate for Payer: Cash Price	$387.20
Rate for Payer: Cash Price	$387.20
Rate for Payer: Mclaren Medicaid	$113.96
Rate for Payer: Meridian Medicaid	$119.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$363.00
Rate for Payer: Priority Health Choice Medicaid	$113.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$260.70
Rate for Payer: Priority Health Narrow/Tiered Network	$260.70
Rate for Payer: UHC Medicaid	$113.96
Rate for Payer: UHCCP Medicaid	$113.96

PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE

Professional

Both

$484.00

Service Code	HCPCS 12020
Hospital Charge Code	12020
Min. Negotiated Rate	$113.96
Max. Negotiated Rate	$363.00
Rate for Payer: Aetna Commercial	$203.61
Rate for Payer: Aetna Medicare	$242.00
Rate for Payer: BCBS Complete	$119.66
Rate for Payer: BCN Commercial	$284.85
Rate for Payer: Cash Price	$387.20
Rate for Payer: Cash Price	$387.20
Rate for Payer: Mclaren Medicaid	$113.96
Rate for Payer: Meridian Medicaid	$119.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$363.00
Rate for Payer: Priority Health Choice Medicaid	$113.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$260.70
Rate for Payer: Priority Health Narrow/Tiered Network	$260.70
Rate for Payer: UHC Medicaid	$113.96
Rate for Payer: UHCCP Medicaid	$113.96

PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE

Facility

$484.00

Service Code	CPT 12020
Hospital Charge Code	12020
Hospital Revenue Code	521
Min. Negotiated Rate	$85.33
Max. Negotiated Rate	$435.60
Rate for Payer: Aetna Commercial	$411.40
Rate for Payer: Aetna Medicare	$125.84
Rate for Payer: Allen County Amish Medical Aid Commercial	$151.25
Rate for Payer: Amish Plain Church Group Commercial	$151.25
Rate for Payer: BCBS Complete	$89.59
Rate for Payer: BCBS MAPPO	$121.00
Rate for Payer: BCBS Trust/PPO	$397.90
Rate for Payer: BCN Commercial	$397.90
Rate for Payer: BCN Medicare Advantage	$121.00
Rate for Payer: Cash Price	$387.20
Rate for Payer: Cofinity Commercial	$416.24
Rate for Payer: Encore Health Key Benefits Commercial	$387.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$121.00
Rate for Payer: Healthscope Commercial	$435.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$363.00
Rate for Payer: Mclaren Medicaid	$85.33
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$127.05
Rate for Payer: Meridian Medicaid	$89.59
Rate for Payer: MI Amish Medical Board Commercial	$139.15
Rate for Payer: Molina Medicare/Medicaid	$133.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$411.40
Rate for Payer: Nomi Health Commercial	$396.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$363.00
Rate for Payer: PACE Senior Care Partners	$114.95
Rate for Payer: PACE SWMI	$121.00
Rate for Payer: PHP Commercial	$411.40
Rate for Payer: PHP Medicare Advantage	$121.00
Rate for Payer: Priority Health Choice Medicaid	$85.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$421.08
Rate for Payer: Priority Health Medicare	$122.21
Rate for Payer: Priority Health Narrow/Tiered Network	$336.86
Rate for Payer: Railroad Medicare Medicare	$121.00
Rate for Payer: UHC Core	$404.14
Rate for Payer: UHC Exchange	$121.00
Rate for Payer: UHC Medicaid	$85.33
Rate for Payer: UHC Medicare Advantage	$121.00
Rate for Payer: UHCCP Medicaid	$85.33
Rate for Payer: VA VA	$121.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$363.00

PR TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE

Facility

$484.00

Service Code	CPT 12020
Hospital Charge Code	12020
Hospital Revenue Code	521
Min. Negotiated Rate	$336.86
Max. Negotiated Rate	$435.60
Rate for Payer: Aetna Commercial	$411.40
Rate for Payer: BCBS Trust/PPO	$399.74
Rate for Payer: BCN Commercial	$399.74
Rate for Payer: Cash Price	$387.20
Rate for Payer: Cofinity Commercial	$416.24
Rate for Payer: Encore Health Key Benefits Commercial	$387.20
Rate for Payer: Healthscope Commercial	$435.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$363.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$411.40
Rate for Payer: Nomi Health Commercial	$396.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$363.00
Rate for Payer: PHP Commercial	$411.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$421.08
Rate for Payer: Priority Health Narrow/Tiered Network	$336.86
Rate for Payer: UHC Core	$404.14
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$363.00

PR TX SUPERFICIAL WOUND DEHISCENCE W/PACKING

Professional

Both

$359.00

Service Code	HCPCS 12021
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$269.25
Rate for Payer: Aetna Commercial	$150.60
Rate for Payer: Aetna Medicare	$179.50
Rate for Payer: BCBS Complete	$90.13
Rate for Payer: BCN Commercial	$211.65
Rate for Payer: Cash Price	$287.20
Rate for Payer: Cash Price	$287.20
Rate for Payer: Mclaren Medicaid	$85.84
Rate for Payer: Meridian Medicaid	$90.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$269.25
Rate for Payer: Priority Health Choice Medicaid	$85.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$193.70
Rate for Payer: Priority Health Narrow/Tiered Network	$193.70
Rate for Payer: UHC Medicaid	$85.84
Rate for Payer: UHCCP Medicaid	$85.84

PR TX TARSAL BONE FX XCP TALUS&CALCNS W/O MNPJ EACH

Professional

Both

$600.00

Service Code	HCPCS 28450
Min. Negotiated Rate	$123.97
Max. Negotiated Rate	$450.00
Rate for Payer: Aetna Commercial	$250.09
Rate for Payer: Aetna Medicare	$300.00
Rate for Payer: BCBS Complete	$130.17
Rate for Payer: BCN Commercial	$298.79
Rate for Payer: Cash Price	$480.00
Rate for Payer: Cash Price	$480.00
Rate for Payer: Mclaren Medicaid	$123.97
Rate for Payer: Meridian Medicaid	$130.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$450.00
Rate for Payer: Priority Health Choice Medicaid	$123.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$319.40
Rate for Payer: Priority Health Narrow/Tiered Network	$319.40
Rate for Payer: UHC Medicaid	$123.97
Rate for Payer: UHCCP Medicaid	$123.97

PR TX TARSAL BONE FX XCP TALUS&CALCN W/MNPJ EACH

Professional

Both

$832.00

Service Code	HCPCS 28455
Min. Negotiated Rate	$141.01
Max. Negotiated Rate	$624.00
Rate for Payer: Aetna Commercial	$340.48
Rate for Payer: Aetna Medicare	$416.00
Rate for Payer: BCBS Complete	$148.06
Rate for Payer: BCN Commercial	$353.07
Rate for Payer: Cash Price	$665.60
Rate for Payer: Cash Price	$665.60
Rate for Payer: Mclaren Medicaid	$141.01
Rate for Payer: Meridian Medicaid	$148.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$624.00
Rate for Payer: Priority Health Choice Medicaid	$141.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$377.43
Rate for Payer: Priority Health Narrow/Tiered Network	$377.43
Rate for Payer: UHC Medicaid	$141.01
Rate for Payer: UHCCP Medicaid	$141.01

PR TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA

Professional

Both

$4,393.00

Service Code	HCPCS 27759
Min. Negotiated Rate	$585.54
Max. Negotiated Rate	$3,294.75
Rate for Payer: Aetna Commercial	$1,333.51
Rate for Payer: Aetna Medicare	$2,196.50
Rate for Payer: BCBS Complete	$614.82
Rate for Payer: BCN Commercial	$1,662.54
Rate for Payer: Cash Price	$3,514.40
Rate for Payer: Cash Price	$3,514.40
Rate for Payer: Mclaren Medicaid	$585.54
Rate for Payer: Meridian Medicaid	$614.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,294.75
Rate for Payer: Priority Health Choice Medicaid	$585.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,617.74
Rate for Payer: Priority Health Narrow/Tiered Network	$1,617.74
Rate for Payer: UHC Medicaid	$585.54
Rate for Payer: UHCCP Medicaid	$585.54

PR TYMPANIC MEMB RPR W/WO PREPJ PERFOR PATCH

Professional

Both

$688.00

Service Code	HCPCS 69610
Min. Negotiated Rate	$159.11
Max. Negotiated Rate	$516.00
Rate for Payer: Aetna Commercial	$323.65
Rate for Payer: Aetna Medicare	$344.00
Rate for Payer: BCBS Complete	$167.07
Rate for Payer: BCN Commercial	$431.75
Rate for Payer: Cash Price	$550.40
Rate for Payer: Cash Price	$550.40
Rate for Payer: Mclaren Medicaid	$159.11
Rate for Payer: Meridian Medicaid	$167.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$516.00
Rate for Payer: Priority Health Choice Medicaid	$159.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$426.60
Rate for Payer: Priority Health Narrow/Tiered Network	$426.60
Rate for Payer: UHC Medicaid	$159.11
Rate for Payer: UHCCP Medicaid	$159.11

PR TYMPANOMETRY

Professional

Both

$40.00

Service Code	HCPCS 92567
Min. Negotiated Rate	$5.54
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$11.76
Rate for Payer: Aetna Medicare	$20.00
Rate for Payer: BCBS Complete	$5.82
Rate for Payer: BCN Commercial	$15.93
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Mclaren Medicaid	$5.54
Rate for Payer: Meridian Medicaid	$5.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.00
Rate for Payer: Priority Health Choice Medicaid	$5.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$14.69
Rate for Payer: Priority Health Narrow/Tiered Network	$14.69
Rate for Payer: UHC Medicaid	$5.54
Rate for Payer: UHCCP Medicaid	$5.54

PR TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS

Professional

Both

$39.00

Service Code	HCPCS 92550
Min. Negotiated Rate	$19.50
Max. Negotiated Rate	$32.37
Rate for Payer: Aetna Commercial	$24.41
Rate for Payer: Aetna Medicare	$19.50
Rate for Payer: BCN Commercial	$32.37
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$29.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$29.86
Rate for Payer: Priority Health Narrow/Tiered Network	$29.86

PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/OCR

Professional

Both

$2,877.00

Service Code	HCPCS 69646
Min. Negotiated Rate	$912.71
Max. Negotiated Rate	$2,342.01
Rate for Payer: Aetna Commercial	$1,770.52
Rate for Payer: Aetna Medicare	$1,438.50
Rate for Payer: BCBS Complete	$958.35
Rate for Payer: BCN Commercial	$2,342.01
Rate for Payer: Cash Price	$2,301.60
Rate for Payer: Cash Price	$2,301.60
Rate for Payer: Mclaren Medicaid	$912.71
Rate for Payer: Meridian Medicaid	$958.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,157.75
Rate for Payer: Priority Health Choice Medicaid	$912.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,314.14
Rate for Payer: Priority Health Narrow/Tiered Network	$2,314.14
Rate for Payer: UHC Medicaid	$912.71
Rate for Payer: UHCCP Medicaid	$912.71

PR TYMPANOPLASTY MASTOIDECTOMY RAD/COMPL W/O OCR

Professional

Both

$2,732.00

Service Code	HCPCS 69645
Min. Negotiated Rate	$861.37
Max. Negotiated Rate	$2,214.02
Rate for Payer: Aetna Commercial	$1,673.47
Rate for Payer: Aetna Medicare	$1,366.00
Rate for Payer: BCBS Complete	$904.44
Rate for Payer: BCN Commercial	$2,214.02
Rate for Payer: Cash Price	$2,185.60
Rate for Payer: Cash Price	$2,185.60
Rate for Payer: Mclaren Medicaid	$861.37
Rate for Payer: Meridian Medicaid	$904.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,049.00
Rate for Payer: Priority Health Choice Medicaid	$861.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,187.68
Rate for Payer: Priority Health Narrow/Tiered Network	$2,187.68
Rate for Payer: UHC Medicaid	$861.37
Rate for Payer: UHCCP Medicaid	$861.37

Know your out-of-pocket cost for care.

All Charges