Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR SUTURE PHARYNX WOUND/INJURY

Professional

Both

$623.00

Service Code	HCPCS 42900
Min. Negotiated Rate	$249.20
Max. Negotiated Rate	$456.94
Rate for Payer: Aetna Commercial	$425.21
Rate for Payer: Aetna Medicare	$330.01
Rate for Payer: BCBS Complete	$249.20
Rate for Payer: BCBS MAPPO	$317.32
Rate for Payer: BCN Medicare Advantage	$317.32
Rate for Payer: Cash Price	$498.40
Rate for Payer: Cash Price	$498.40
Rate for Payer: Cofinity Commercial	$456.94
Rate for Payer: Cofinity Commercial	$425.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$317.32
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$333.19
Rate for Payer: Nomi Health Commercial	$380.78
Rate for Payer: PACE SWMI	$317.32
Rate for Payer: PHP Medicare Advantage	$317.32
Rate for Payer: Priority Health Cigna Priority Health	$404.95
Rate for Payer: Priority Health Medicare	$320.49
Rate for Payer: UHC All Payor (Choice/PPO)	$317.32
Rate for Payer: UHC Dual Complete DSNP	$317.32
Rate for Payer: UHC Exchange	$317.32
Rate for Payer: UHC Medicare Advantage	$317.32

PR SUTURE POSTERIOR TIBIAL NERVE

Professional

Both

$1,979.00

Service Code	HCPCS 64840
Min. Negotiated Rate	$791.60
Max. Negotiated Rate	$1,336.45
Rate for Payer: Aetna Commercial	$1,243.64
Rate for Payer: Aetna Medicare	$965.21
Rate for Payer: BCBS Complete	$791.60
Rate for Payer: BCBS MAPPO	$928.09
Rate for Payer: BCN Medicare Advantage	$928.09
Rate for Payer: Cash Price	$1,583.20
Rate for Payer: Cash Price	$1,583.20
Rate for Payer: Cofinity Commercial	$1,336.45
Rate for Payer: Cofinity Commercial	$1,243.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$928.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$974.49
Rate for Payer: Nomi Health Commercial	$1,113.71
Rate for Payer: PACE SWMI	$928.09
Rate for Payer: PHP Medicare Advantage	$928.09
Rate for Payer: Priority Health Cigna Priority Health	$1,286.35
Rate for Payer: Priority Health Medicare	$937.37
Rate for Payer: UHC All Payor (Choice/PPO)	$928.09
Rate for Payer: UHC Dual Complete DSNP	$928.09
Rate for Payer: UHC Exchange	$928.09
Rate for Payer: UHC Medicare Advantage	$928.09

PR SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY

Professional

Both

$1,903.00

Service Code	HCPCS 27385
Hospital Charge Code	27385
Min. Negotiated Rate	$579.36
Max. Negotiated Rate	$1,236.95
Rate for Payer: Aetna Commercial	$776.34
Rate for Payer: Aetna Medicare	$602.53
Rate for Payer: BCBS Complete	$761.20
Rate for Payer: BCBS MAPPO	$579.36
Rate for Payer: BCN Medicare Advantage	$579.36
Rate for Payer: Cash Price	$1,522.40
Rate for Payer: Cash Price	$1,522.40
Rate for Payer: Cofinity Commercial	$834.28
Rate for Payer: Cofinity Commercial	$776.34
Rate for Payer: Health Alliance Plan Medicare Advantage	$579.36
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$608.33
Rate for Payer: Nomi Health Commercial	$695.23
Rate for Payer: PACE SWMI	$579.36
Rate for Payer: PHP Medicare Advantage	$579.36
Rate for Payer: Priority Health Cigna Priority Health	$1,236.95
Rate for Payer: Priority Health Medicare	$585.15
Rate for Payer: UHC All Payor (Choice/PPO)	$579.36
Rate for Payer: UHC Dual Complete DSNP	$579.36
Rate for Payer: UHC Exchange	$579.36
Rate for Payer: UHC Medicare Advantage	$579.36

PR SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY

Professional

Both

$1,903.00

Service Code	HCPCS 27385
Min. Negotiated Rate	$579.36
Max. Negotiated Rate	$1,236.95
Rate for Payer: Aetna Commercial	$776.34
Rate for Payer: Aetna Medicare	$602.53
Rate for Payer: BCBS Complete	$761.20
Rate for Payer: BCBS MAPPO	$579.36
Rate for Payer: BCN Medicare Advantage	$579.36
Rate for Payer: Cash Price	$1,522.40
Rate for Payer: Cash Price	$1,522.40
Rate for Payer: Cofinity Commercial	$834.28
Rate for Payer: Cofinity Commercial	$776.34
Rate for Payer: Health Alliance Plan Medicare Advantage	$579.36
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$608.33
Rate for Payer: Nomi Health Commercial	$695.23
Rate for Payer: PACE SWMI	$579.36
Rate for Payer: PHP Medicare Advantage	$579.36
Rate for Payer: Priority Health Cigna Priority Health	$1,236.95
Rate for Payer: Priority Health Medicare	$585.15
Rate for Payer: UHC All Payor (Choice/PPO)	$579.36
Rate for Payer: UHC Dual Complete DSNP	$579.36
Rate for Payer: UHC Exchange	$579.36
Rate for Payer: UHC Medicare Advantage	$579.36

PR SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY

Facility

$1,903.00

Service Code	CPT 27385
Hospital Charge Code	27385
Min. Negotiated Rate	$1,236.95
Max. Negotiated Rate	$1,712.70
Rate for Payer: Aetna Commercial	$1,617.55
Rate for Payer: BCBS Trust/PPO	$1,553.42
Rate for Payer: BCN Commercial	$1,470.64
Rate for Payer: Cash Price	$1,522.40
Rate for Payer: Cofinity Commercial	$1,636.58
Rate for Payer: Encore Health Key Benefits Commercial	$1,522.40
Rate for Payer: Healthscope Commercial	$1,712.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,427.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,617.55
Rate for Payer: Nomi Health Commercial	$1,560.46
Rate for Payer: PHP Commercial	$1,617.55
Rate for Payer: Priority Health Cigna Priority Health	$1,236.95
Rate for Payer: Priority Health HMO/PPO	$1,655.61
Rate for Payer: Priority Health Narrow/Tiered Network	$1,275.01
Rate for Payer: UHC All Payor (Choice/PPO)	$1,674.64
Rate for Payer: UHC Core	$1,589.01
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,427.25

PR SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY

Facility

$1,903.00

Service Code	CPT 27385
Hospital Charge Code	27385
Min. Negotiated Rate	$451.96
Max. Negotiated Rate	$5,423.52
Rate for Payer: Aetna Commercial	$1,617.55
Rate for Payer: Aetna Medicare	$494.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$594.69
Rate for Payer: Amish Plain Church Group Commercial	$594.69
Rate for Payer: BCBS Complete	$5,423.52
Rate for Payer: BCBS MAPPO	$475.75
Rate for Payer: BCBS Trust/PPO	$1,564.46
Rate for Payer: BCN Commercial	$1,479.58
Rate for Payer: BCN Medicare Advantage	$475.75
Rate for Payer: Cash Price	$1,522.40
Rate for Payer: Cash Price	$1,522.40
Rate for Payer: Cofinity Commercial	$1,636.58
Rate for Payer: Encore Health Key Benefits Commercial	$1,522.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$475.75
Rate for Payer: Healthscope Commercial	$1,712.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,427.25
Rate for Payer: Mclaren Medicaid	$5,164.92
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$499.54
Rate for Payer: Meridian Medicaid	$5,423.52
Rate for Payer: MI Amish Medical Board Commercial	$547.11
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,617.55
Rate for Payer: Nomi Health Commercial	$1,560.46
Rate for Payer: PACE Senior Care Partners	$451.96
Rate for Payer: PACE SWMI	$475.75
Rate for Payer: PHP Commercial	$1,617.55
Rate for Payer: PHP Medicare Advantage	$475.75
Rate for Payer: Priority Health Choice Medicaid	$5,164.92
Rate for Payer: Priority Health Cigna Priority Health	$1,236.95
Rate for Payer: Priority Health HMO/PPO	$1,655.61
Rate for Payer: Priority Health Medicare	$480.51
Rate for Payer: Priority Health Narrow/Tiered Network	$1,275.01
Rate for Payer: Railroad Medicare Medicare	$475.75
Rate for Payer: UHC All Payor (Choice/PPO)	$1,674.64
Rate for Payer: UHC Core	$1,589.01
Rate for Payer: UHC Dual Complete DSNP	$475.75
Rate for Payer: UHC Exchange	$475.75
Rate for Payer: UHC Medicare Advantage	$475.75
Rate for Payer: UHCCP Medicaid	$5,164.92
Rate for Payer: VA VA	$475.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,427.25

PR SUTURE REPAIR AORTA/GREAT VESSEL W/BYPASS

Professional

Both

$5,688.00

Service Code	HCPCS 33322
Min. Negotiated Rate	$1,330.91
Max. Negotiated Rate	$3,697.20
Rate for Payer: Aetna Commercial	$1,783.42
Rate for Payer: Aetna Medicare	$1,384.15
Rate for Payer: BCBS Complete	$2,275.20
Rate for Payer: BCBS MAPPO	$1,330.91
Rate for Payer: BCN Medicare Advantage	$1,330.91
Rate for Payer: Cash Price	$4,550.40
Rate for Payer: Cash Price	$4,550.40
Rate for Payer: Cofinity Commercial	$1,916.51
Rate for Payer: Cofinity Commercial	$1,783.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,330.91
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,397.46
Rate for Payer: Nomi Health Commercial	$1,597.09
Rate for Payer: PACE SWMI	$1,330.91
Rate for Payer: PHP Medicare Advantage	$1,330.91
Rate for Payer: Priority Health Cigna Priority Health	$3,697.20
Rate for Payer: Priority Health Medicare	$1,344.22
Rate for Payer: UHC All Payor (Choice/PPO)	$1,330.91
Rate for Payer: UHC Dual Complete DSNP	$1,330.91
Rate for Payer: UHC Exchange	$1,330.91
Rate for Payer: UHC Medicare Advantage	$1,330.91

PR SUTURE/REPAIR TESTICULAR INJURY

Professional

Both

$1,256.00

Service Code	HCPCS 54670
Min. Negotiated Rate	$391.41
Max. Negotiated Rate	$816.40
Rate for Payer: Aetna Commercial	$524.49
Rate for Payer: Aetna Medicare	$407.07
Rate for Payer: BCBS Complete	$502.40
Rate for Payer: BCBS MAPPO	$391.41
Rate for Payer: BCN Medicare Advantage	$391.41
Rate for Payer: Cash Price	$1,004.80
Rate for Payer: Cash Price	$1,004.80
Rate for Payer: Cofinity Commercial	$563.63
Rate for Payer: Cofinity Commercial	$524.49
Rate for Payer: Health Alliance Plan Medicare Advantage	$391.41
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$410.98
Rate for Payer: Nomi Health Commercial	$469.69
Rate for Payer: PACE SWMI	$391.41
Rate for Payer: PHP Medicare Advantage	$391.41
Rate for Payer: Priority Health Cigna Priority Health	$816.40
Rate for Payer: Priority Health Medicare	$395.32
Rate for Payer: UHC All Payor (Choice/PPO)	$391.41
Rate for Payer: UHC Dual Complete DSNP	$391.41
Rate for Payer: UHC Exchange	$391.41
Rate for Payer: UHC Medicare Advantage	$391.41

PR SUTURE SCIATIC NERVE

Professional

Both

$2,500.00

Service Code	HCPCS 64858
Min. Negotiated Rate	$1,000.00
Max. Negotiated Rate	$1,629.04
Rate for Payer: Aetna Commercial	$1,515.92
Rate for Payer: Aetna Medicare	$1,176.53
Rate for Payer: BCBS Complete	$1,000.00
Rate for Payer: BCBS MAPPO	$1,131.28
Rate for Payer: BCN Medicare Advantage	$1,131.28
Rate for Payer: Cash Price	$2,000.00
Rate for Payer: Cash Price	$2,000.00
Rate for Payer: Cofinity Commercial	$1,629.04
Rate for Payer: Cofinity Commercial	$1,515.92
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,131.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,187.84
Rate for Payer: Nomi Health Commercial	$1,357.54
Rate for Payer: PACE SWMI	$1,131.28
Rate for Payer: PHP Medicare Advantage	$1,131.28
Rate for Payer: Priority Health Cigna Priority Health	$1,625.00
Rate for Payer: Priority Health Medicare	$1,142.59
Rate for Payer: UHC All Payor (Choice/PPO)	$1,131.28
Rate for Payer: UHC Dual Complete DSNP	$1,131.28
Rate for Payer: UHC Exchange	$1,131.28
Rate for Payer: UHC Medicare Advantage	$1,131.28

PR SUTURE TRACHEAL WOUND/INJURY CERVICAL

Professional

Both

$1,589.00

Service Code	HCPCS 31800
Min. Negotiated Rate	$635.60
Max. Negotiated Rate	$1,032.85
Rate for Payer: Aetna Commercial	$881.96
Rate for Payer: Aetna Medicare	$684.51
Rate for Payer: BCBS Complete	$635.60
Rate for Payer: BCBS MAPPO	$658.18
Rate for Payer: BCN Medicare Advantage	$658.18
Rate for Payer: Cash Price	$1,271.20
Rate for Payer: Cash Price	$1,271.20
Rate for Payer: Cofinity Commercial	$947.78
Rate for Payer: Cofinity Commercial	$881.96
Rate for Payer: Health Alliance Plan Medicare Advantage	$658.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$691.09
Rate for Payer: Nomi Health Commercial	$789.82
Rate for Payer: PACE SWMI	$658.18
Rate for Payer: PHP Medicare Advantage	$658.18
Rate for Payer: Priority Health Cigna Priority Health	$1,032.85
Rate for Payer: Priority Health Medicare	$664.76
Rate for Payer: UHC All Payor (Choice/PPO)	$658.18
Rate for Payer: UHC Dual Complete DSNP	$658.18
Rate for Payer: UHC Exchange	$658.18
Rate for Payer: UHC Medicare Advantage	$658.18

PR SUTURE TRACHEAL WOUND/INJURY INTRATHORACIC

Professional

Both

$1,671.00

Service Code	HCPCS 31805
Min. Negotiated Rate	$668.40
Max. Negotiated Rate	$1,133.16
Rate for Payer: Aetna Commercial	$1,054.47
Rate for Payer: Aetna Medicare	$818.40
Rate for Payer: BCBS Complete	$668.40
Rate for Payer: BCBS MAPPO	$786.92
Rate for Payer: BCN Medicare Advantage	$786.92
Rate for Payer: Cash Price	$1,336.80
Rate for Payer: Cash Price	$1,336.80
Rate for Payer: Cofinity Commercial	$1,133.16
Rate for Payer: Cofinity Commercial	$1,054.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$786.92
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$826.27
Rate for Payer: Nomi Health Commercial	$944.30
Rate for Payer: PACE SWMI	$786.92
Rate for Payer: PHP Medicare Advantage	$786.92
Rate for Payer: Priority Health Cigna Priority Health	$1,086.15
Rate for Payer: Priority Health Medicare	$794.79
Rate for Payer: UHC All Payor (Choice/PPO)	$786.92
Rate for Payer: UHC Dual Complete DSNP	$786.92
Rate for Payer: UHC Exchange	$786.92
Rate for Payer: UHC Medicare Advantage	$786.92

PR SVC PRV EMER BASIS IN OFFICE DISRUPTING SVCS

Professional

Both

$57.00

Service Code	HCPCS 99058
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$37.05
Rate for Payer: Aetna Medicare	$28.50
Rate for Payer: BCBS Complete	$22.80
Rate for Payer: Cash Price	$45.60
Rate for Payer: Priority Health Cigna Priority Health	$37.05

PR SVC PRV OFFICE REG SCHEDD EVN WKEND/HOLIDAY HRS

Professional

Both

$60.00

Service Code	HCPCS 99051
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna Medicare	$30.00
Rate for Payer: BCBS Complete	$24.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Priority Health Cigna Priority Health	$39.00

PR SYMPATHECTOMY CERVICAL

Professional

Both

$1,729.00

Service Code	HCPCS 64802
Min. Negotiated Rate	$691.60
Max. Negotiated Rate	$1,205.15
Rate for Payer: Aetna Commercial	$1,121.46
Rate for Payer: Aetna Medicare	$870.39
Rate for Payer: BCBS Complete	$691.60
Rate for Payer: BCBS MAPPO	$836.91
Rate for Payer: BCN Medicare Advantage	$836.91
Rate for Payer: Cash Price	$1,383.20
Rate for Payer: Cash Price	$1,383.20
Rate for Payer: Cofinity Commercial	$1,121.46
Rate for Payer: Cofinity Commercial	$1,205.15
Rate for Payer: Health Alliance Plan Medicare Advantage	$836.91
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$878.76
Rate for Payer: Nomi Health Commercial	$1,004.29
Rate for Payer: PACE SWMI	$836.91
Rate for Payer: PHP Medicare Advantage	$836.91
Rate for Payer: Priority Health Cigna Priority Health	$1,123.85
Rate for Payer: Priority Health Medicare	$845.28
Rate for Payer: UHC All Payor (Choice/PPO)	$836.91
Rate for Payer: UHC Dual Complete DSNP	$836.91
Rate for Payer: UHC Exchange	$836.91
Rate for Payer: UHC Medicare Advantage	$836.91

PR SYMPATHECTOMY LUMBAR

Professional

Both

$319.00

Service Code	HCPCS 64818
Min. Negotiated Rate	$127.60
Max. Negotiated Rate	$1,081.73
Rate for Payer: Aetna Commercial	$1,006.61
Rate for Payer: Aetna Medicare	$781.25
Rate for Payer: BCBS Complete	$127.60
Rate for Payer: BCBS MAPPO	$751.20
Rate for Payer: BCN Medicare Advantage	$751.20
Rate for Payer: Cash Price	$255.20
Rate for Payer: Cash Price	$255.20
Rate for Payer: Cofinity Commercial	$1,081.73
Rate for Payer: Cofinity Commercial	$1,006.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$751.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$788.76
Rate for Payer: Nomi Health Commercial	$901.44
Rate for Payer: PACE SWMI	$751.20
Rate for Payer: PHP Medicare Advantage	$751.20
Rate for Payer: Priority Health Cigna Priority Health	$207.35
Rate for Payer: Priority Health Medicare	$758.71
Rate for Payer: UHC All Payor (Choice/PPO)	$751.20
Rate for Payer: UHC Dual Complete DSNP	$751.20
Rate for Payer: UHC Exchange	$751.20
Rate for Payer: UHC Medicare Advantage	$751.20

PR SYMPHYSIOTOMY HORSESHOE KDN W/WO PLOP UNI/BI

Professional

Both

$2,168.00

Service Code	HCPCS 50540
Min. Negotiated Rate	$867.20
Max. Negotiated Rate	$1,574.48
Rate for Payer: Aetna Commercial	$1,465.14
Rate for Payer: Aetna Medicare	$1,137.13
Rate for Payer: BCBS Complete	$867.20
Rate for Payer: BCBS MAPPO	$1,093.39
Rate for Payer: BCN Medicare Advantage	$1,093.39
Rate for Payer: Cash Price	$1,734.40
Rate for Payer: Cash Price	$1,734.40
Rate for Payer: Cofinity Commercial	$1,465.14
Rate for Payer: Cofinity Commercial	$1,574.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,093.39
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,148.06
Rate for Payer: Nomi Health Commercial	$1,312.07
Rate for Payer: PACE SWMI	$1,093.39
Rate for Payer: PHP Medicare Advantage	$1,093.39
Rate for Payer: Priority Health Cigna Priority Health	$1,409.20
Rate for Payer: Priority Health Medicare	$1,104.32
Rate for Payer: UHC All Payor (Choice/PPO)	$1,093.39
Rate for Payer: UHC Dual Complete DSNP	$1,093.39
Rate for Payer: UHC Exchange	$1,093.39
Rate for Payer: UHC Medicare Advantage	$1,093.39

PR SYNCHRONOUS AUDIO-ONLY VISIT EST HIGH MDM 40 MIN

Professional

Both

$355.00

Service Code	HCPCS 98015
Min. Negotiated Rate	$142.00
Max. Negotiated Rate	$230.75
Rate for Payer: Aetna Medicare	$177.50
Rate for Payer: BCBS Complete	$142.00
Rate for Payer: Cash Price	$284.00
Rate for Payer: Priority Health Cigna Priority Health	$230.75

PR SYNCHRONOUS AUDIO-ONLY VISIT EST LOW MDM 20 MIN

Professional

Both

$162.00

Service Code	HCPCS 98013
Min. Negotiated Rate	$64.80
Max. Negotiated Rate	$105.30
Rate for Payer: Aetna Medicare	$81.00
Rate for Payer: BCBS Complete	$64.80
Rate for Payer: Cash Price	$129.60
Rate for Payer: Priority Health Cigna Priority Health	$105.30

PR SYNCHRONOUS AUDIO-ONLY VISIT EST MOD MDM 30 MIN

Professional

Both

$241.00

Service Code	HCPCS 98014
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$156.65
Rate for Payer: Aetna Medicare	$120.50
Rate for Payer: BCBS Complete	$96.40
Rate for Payer: Cash Price	$192.80
Rate for Payer: Priority Health Cigna Priority Health	$156.65

PR SYNCHRONOUS AUDIO-ONLY VISIT EST SF MDM 10 MIN

Professional

Both

$89.00

Service Code	HCPCS 98012
Min. Negotiated Rate	$35.60
Max. Negotiated Rate	$57.85
Rate for Payer: Aetna Medicare	$44.50
Rate for Payer: BCBS Complete	$35.60
Rate for Payer: Cash Price	$71.20
Rate for Payer: Priority Health Cigna Priority Health	$57.85

PR SYNCHRONOUS AUDIO-ONLY VISIT NEW HIGH MDM 60 MIN

Professional

Both

$435.00

Service Code	HCPCS 98011
Min. Negotiated Rate	$174.00
Max. Negotiated Rate	$282.75
Rate for Payer: Aetna Medicare	$217.50
Rate for Payer: BCBS Complete	$174.00
Rate for Payer: Cash Price	$348.00
Rate for Payer: Priority Health Cigna Priority Health	$282.75

PR SYNCHRONOUS AUDIO-ONLY VISIT NEW LOW MDM 30 MIN

Professional

Both

$207.00

Service Code	HCPCS 98009
Min. Negotiated Rate	$82.80
Max. Negotiated Rate	$134.55
Rate for Payer: Aetna Medicare	$103.50
Rate for Payer: BCBS Complete	$82.80
Rate for Payer: Cash Price	$165.60
Rate for Payer: Priority Health Cigna Priority Health	$134.55

PR SYNCHRONOUS AUDIO-ONLY VISIT NEW MOD MDM 45 MIN

Professional

Both

$332.00

Service Code	HCPCS 98010
Min. Negotiated Rate	$132.80
Max. Negotiated Rate	$215.80
Rate for Payer: Aetna Medicare	$166.00
Rate for Payer: BCBS Complete	$132.80
Rate for Payer: Cash Price	$265.60
Rate for Payer: Priority Health Cigna Priority Health	$215.80

PR SYNCHRONOUS AUDIO-ONLY VISIT NEW SF MDM 15 MIN

Professional

Both

$121.00

Service Code	HCPCS 98008
Min. Negotiated Rate	$48.40
Max. Negotiated Rate	$78.65
Rate for Payer: Aetna Medicare	$60.50
Rate for Payer: BCBS Complete	$48.40
Rate for Payer: Cash Price	$96.80
Rate for Payer: Priority Health Cigna Priority Health	$78.65

PR SYNCHRONOUS AUDIO-VIDEO VISIT EST LOW MDM 20 MIN

Professional

Both

$194.00

Service Code	HCPCS 98005
Min. Negotiated Rate	$77.60
Max. Negotiated Rate	$126.10
Rate for Payer: Aetna Medicare	$97.00
Rate for Payer: BCBS Complete	$77.60
Rate for Payer: Cash Price	$155.20
Rate for Payer: Priority Health Cigna Priority Health	$126.10

Know your out-of-pocket cost for care.

All Charges