Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR SYNCHRONOUS AUDIO-VIDEO VISIT EST MOD MDM 30 MIN

Professional

Both

$263.00

Service Code	HCPCS 98006
Min. Negotiated Rate	$105.20
Max. Negotiated Rate	$170.95
Rate for Payer: Priority Health Cigna Priority Health	$170.95
Rate for Payer: Aetna Medicare	$131.50
Rate for Payer: BCBS Complete	$105.20
Rate for Payer: Cash Price	$210.40

PR SYNCHRONOUS AUDIO-VIDEO VISIT EST SF MDM 10 MIN

Professional

Both

$111.00

Service Code	HCPCS 98004
Min. Negotiated Rate	$44.40
Max. Negotiated Rate	$72.15
Rate for Payer: Aetna Medicare	$55.50
Rate for Payer: BCBS Complete	$44.40
Rate for Payer: Cash Price	$88.80
Rate for Payer: Priority Health Cigna Priority Health	$72.15

PR SYNCHRONOUS AUDIO-VIDEO VISIT NEW LOW MDM 30 MIN

Professional

Both

$237.00

Service Code	HCPCS 98001
Min. Negotiated Rate	$94.80
Max. Negotiated Rate	$154.05
Rate for Payer: Aetna Medicare	$118.50
Rate for Payer: BCBS Complete	$94.80
Rate for Payer: Cash Price	$189.60
Rate for Payer: Priority Health Cigna Priority Health	$154.05

PR SYNCHRONOUS AUDIO-VIDEO VISIT NEW MOD MDM 45 MIN

Professional

Both

$355.00

Service Code	HCPCS 98002
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-VIDEO VISIT NEW SF MDM 15 MIN

Professional

Both

$127.00

Service Code	HCPCS 98000
Min. Negotiated Rate	$50.80
Max. Negotiated Rate	$82.55
Rate for Payer: Cash Price	$101.60
Rate for Payer: Aetna Medicare	$63.50
Rate for Payer: BCBS Complete	$50.80
Rate for Payer: Priority Health Cigna Priority Health	$82.55

PR SYNCHRONOUS AUDIO-VIDEO VST EST HIGH MDM 40 MIN

Professional

Both

$355.00

Service Code	HCPCS 98007
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-VIDEO VST NEW HIGH MDM 60 MIN

Professional

Both

$477.00

Service Code	HCPCS 98003
Min. Negotiated Rate	$190.80
Max. Negotiated Rate	$310.05
Rate for Payer: Aetna Medicare	$238.50
Rate for Payer: BCBS Complete	$190.80
Rate for Payer: Cash Price	$381.60
Rate for Payer: Priority Health Cigna Priority Health	$310.05

PR SYNDACTYLIZATION TOES

Professional

Both

$852.00

Service Code	HCPCS 28280
Min. Negotiated Rate	$325.92
Max. Negotiated Rate	$553.80
Rate for Payer: Aetna Commercial	$436.73
Rate for Payer: Aetna Medicare	$338.96
Rate for Payer: BCBS Complete	$340.80
Rate for Payer: BCBS MAPPO	$325.92
Rate for Payer: BCN Medicare Advantage	$325.92
Rate for Payer: Cash Price	$681.60
Rate for Payer: Cash Price	$681.60
Rate for Payer: Cofinity Commercial	$469.32
Rate for Payer: Cofinity Commercial	$436.73
Rate for Payer: Health Alliance Plan Medicare Advantage	$325.92
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$342.22
Rate for Payer: Nomi Health Commercial	$391.10
Rate for Payer: PACE SWMI	$325.92
Rate for Payer: PHP Medicare Advantage	$325.92
Rate for Payer: Priority Health Cigna Priority Health	$553.80
Rate for Payer: Priority Health Medicare	$329.18
Rate for Payer: UHC All Payor (Choice/PPO)	$325.92
Rate for Payer: UHC Dual Complete DSNP	$325.92
Rate for Payer: UHC Exchange	$325.92
Rate for Payer: UHC Medicare Advantage	$325.92

PR SYNOVECTOMY CARPOMETACARPAL JOINT

Professional

Both

$1,182.00

Service Code	HCPCS 26130
Min. Negotiated Rate	$454.89
Max. Negotiated Rate	$768.30
Rate for Payer: Aetna Commercial	$609.55
Rate for Payer: Aetna Medicare	$473.09
Rate for Payer: BCBS Complete	$472.80
Rate for Payer: BCBS MAPPO	$454.89
Rate for Payer: BCN Medicare Advantage	$454.89
Rate for Payer: Cash Price	$945.60
Rate for Payer: Cash Price	$945.60
Rate for Payer: Cofinity Commercial	$655.04
Rate for Payer: Cofinity Commercial	$609.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$454.89
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$477.63
Rate for Payer: Nomi Health Commercial	$545.87
Rate for Payer: PACE SWMI	$454.89
Rate for Payer: PHP Medicare Advantage	$454.89
Rate for Payer: Priority Health Cigna Priority Health	$768.30
Rate for Payer: Priority Health Medicare	$459.44
Rate for Payer: UHC All Payor (Choice/PPO)	$454.89
Rate for Payer: UHC Dual Complete DSNP	$454.89
Rate for Payer: UHC Exchange	$454.89
Rate for Payer: UHC Medicare Advantage	$454.89

PR SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT

Professional

Both

$1,276.00

Service Code	HCPCS 25118
Min. Negotiated Rate	$371.57
Max. Negotiated Rate	$829.40
Rate for Payer: Aetna Commercial	$497.90
Rate for Payer: Aetna Medicare	$386.43
Rate for Payer: BCBS Complete	$510.40
Rate for Payer: BCBS MAPPO	$371.57
Rate for Payer: BCN Medicare Advantage	$371.57
Rate for Payer: Cash Price	$1,020.80
Rate for Payer: Cash Price	$1,020.80
Rate for Payer: Cofinity Commercial	$535.06
Rate for Payer: Cofinity Commercial	$497.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$371.57
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$390.15
Rate for Payer: Nomi Health Commercial	$445.88
Rate for Payer: PACE SWMI	$371.57
Rate for Payer: PHP Medicare Advantage	$371.57
Rate for Payer: Priority Health Cigna Priority Health	$829.40
Rate for Payer: Priority Health Medicare	$375.29
Rate for Payer: UHC All Payor (Choice/PPO)	$371.57
Rate for Payer: UHC Dual Complete DSNP	$371.57
Rate for Payer: UHC Exchange	$371.57
Rate for Payer: UHC Medicare Advantage	$371.57

PR SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH

Professional

Both

$1,016.00

Service Code	HCPCS 28072
Min. Negotiated Rate	$311.75
Max. Negotiated Rate	$660.40
Rate for Payer: Aetna Commercial	$417.75
Rate for Payer: Aetna Medicare	$324.22
Rate for Payer: BCBS Complete	$406.40
Rate for Payer: BCBS MAPPO	$311.75
Rate for Payer: BCN Medicare Advantage	$311.75
Rate for Payer: Cash Price	$812.80
Rate for Payer: Cash Price	$812.80
Rate for Payer: Cofinity Commercial	$448.92
Rate for Payer: Cofinity Commercial	$417.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$311.75
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$327.34
Rate for Payer: Nomi Health Commercial	$374.10
Rate for Payer: PACE SWMI	$311.75
Rate for Payer: PHP Medicare Advantage	$311.75
Rate for Payer: Priority Health Cigna Priority Health	$660.40
Rate for Payer: Priority Health Medicare	$314.87
Rate for Payer: UHC All Payor (Choice/PPO)	$311.75
Rate for Payer: UHC Dual Complete DSNP	$311.75
Rate for Payer: UHC Exchange	$311.75
Rate for Payer: UHC Medicare Advantage	$311.75

PR SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD

Professional

Both

$1,726.00

Service Code	HCPCS 26135
Min. Negotiated Rate	$537.34
Max. Negotiated Rate	$1,121.90
Rate for Payer: Aetna Commercial	$720.04
Rate for Payer: Aetna Medicare	$558.83
Rate for Payer: BCBS Complete	$690.40
Rate for Payer: BCBS MAPPO	$537.34
Rate for Payer: BCN Medicare Advantage	$537.34
Rate for Payer: Cash Price	$1,380.80
Rate for Payer: Cash Price	$1,380.80
Rate for Payer: Cofinity Commercial	$773.77
Rate for Payer: Cofinity Commercial	$720.04
Rate for Payer: Health Alliance Plan Medicare Advantage	$537.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$564.21
Rate for Payer: Nomi Health Commercial	$644.81
Rate for Payer: PACE SWMI	$537.34
Rate for Payer: PHP Medicare Advantage	$537.34
Rate for Payer: Priority Health Cigna Priority Health	$1,121.90
Rate for Payer: Priority Health Medicare	$542.71
Rate for Payer: UHC All Payor (Choice/PPO)	$537.34
Rate for Payer: UHC Dual Complete DSNP	$537.34
Rate for Payer: UHC Exchange	$537.34
Rate for Payer: UHC Medicare Advantage	$537.34

PR SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT

Professional

Both

$1,476.00

Service Code	HCPCS 26140
Min. Negotiated Rate	$491.61
Max. Negotiated Rate	$959.40
Rate for Payer: Aetna Commercial	$658.76
Rate for Payer: Aetna Medicare	$511.27
Rate for Payer: BCBS Complete	$590.40
Rate for Payer: BCBS MAPPO	$491.61
Rate for Payer: BCN Medicare Advantage	$491.61
Rate for Payer: Cash Price	$1,180.80
Rate for Payer: Cash Price	$1,180.80
Rate for Payer: Cofinity Commercial	$707.92
Rate for Payer: Cofinity Commercial	$658.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$491.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$516.19
Rate for Payer: Nomi Health Commercial	$589.93
Rate for Payer: PACE SWMI	$491.61
Rate for Payer: PHP Medicare Advantage	$491.61
Rate for Payer: Priority Health Cigna Priority Health	$959.40
Rate for Payer: Priority Health Medicare	$496.53
Rate for Payer: UHC All Payor (Choice/PPO)	$491.61
Rate for Payer: UHC Dual Complete DSNP	$491.61
Rate for Payer: UHC Exchange	$491.61
Rate for Payer: UHC Medicare Advantage	$491.61

PR SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN

Professional

Both

$1,680.00

Service Code	HCPCS 26145
Min. Negotiated Rate	$500.59
Max. Negotiated Rate	$1,092.00
Rate for Payer: Aetna Commercial	$670.79
Rate for Payer: Aetna Medicare	$520.61
Rate for Payer: BCBS Complete	$672.00
Rate for Payer: BCBS MAPPO	$500.59
Rate for Payer: BCN Medicare Advantage	$500.59
Rate for Payer: Cash Price	$1,344.00
Rate for Payer: Cash Price	$1,344.00
Rate for Payer: Cofinity Commercial	$720.85
Rate for Payer: Cofinity Commercial	$670.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$500.59
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$525.62
Rate for Payer: Nomi Health Commercial	$600.71
Rate for Payer: PACE SWMI	$500.59
Rate for Payer: PHP Medicare Advantage	$500.59
Rate for Payer: Priority Health Cigna Priority Health	$1,092.00
Rate for Payer: Priority Health Medicare	$505.60
Rate for Payer: UHC All Payor (Choice/PPO)	$500.59
Rate for Payer: UHC Dual Complete DSNP	$500.59
Rate for Payer: UHC Exchange	$500.59
Rate for Payer: UHC Medicare Advantage	$500.59

PR SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA

Professional

Both

$1,796.00

Service Code	HCPCS 25119
Min. Negotiated Rate	$487.16
Max. Negotiated Rate	$1,167.40
Rate for Payer: Aetna Commercial	$652.79
Rate for Payer: Aetna Medicare	$506.65
Rate for Payer: BCBS Complete	$718.40
Rate for Payer: BCBS MAPPO	$487.16
Rate for Payer: BCN Medicare Advantage	$487.16
Rate for Payer: Cash Price	$1,436.80
Rate for Payer: Cash Price	$1,436.80
Rate for Payer: Cofinity Commercial	$701.51
Rate for Payer: Cofinity Commercial	$652.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$487.16
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$511.52
Rate for Payer: Nomi Health Commercial	$584.59
Rate for Payer: PACE SWMI	$487.16
Rate for Payer: PHP Medicare Advantage	$487.16
Rate for Payer: Priority Health Cigna Priority Health	$1,167.40
Rate for Payer: Priority Health Medicare	$492.03
Rate for Payer: UHC All Payor (Choice/PPO)	$487.16
Rate for Payer: UHC Dual Complete DSNP	$487.16
Rate for Payer: UHC Exchange	$487.16
Rate for Payer: UHC Medicare Advantage	$487.16

PR SYNVISC OR SYNVISC-ONE

Professional

Both

$51.00

Service Code	HCPCS J7325
Min. Negotiated Rate	$7.95
Max. Negotiated Rate	$33.15
Rate for Payer: Aetna Commercial	$10.65
Rate for Payer: Aetna Medicare	$8.27
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: BCBS MAPPO	$7.95
Rate for Payer: BCN Medicare Advantage	$7.95
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$11.45
Rate for Payer: Cofinity Commercial	$10.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$7.95
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8.35
Rate for Payer: Nomi Health Commercial	$9.54
Rate for Payer: PACE SWMI	$7.95
Rate for Payer: PHP Medicare Advantage	$7.95
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: Priority Health Medicare	$8.03
Rate for Payer: UHC All Payor (Choice/PPO)	$7.95
Rate for Payer: UHC Dual Complete DSNP	$7.95
Rate for Payer: UHC Exchange	$7.95
Rate for Payer: UHC Medicare Advantage	$7.95

PR TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION

Professional

Both

$105.00

Service Code	HCPCS 11103
Min. Negotiated Rate	$20.59
Max. Negotiated Rate	$68.25
Rate for Payer: Aetna Commercial	$27.59
Rate for Payer: Aetna Medicare	$21.41
Rate for Payer: BCBS Complete	$42.00
Rate for Payer: BCBS MAPPO	$20.59
Rate for Payer: BCN Medicare Advantage	$20.59
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cofinity Commercial	$29.65
Rate for Payer: Cofinity Commercial	$27.59
Rate for Payer: Health Alliance Plan Medicare Advantage	$20.59
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$21.62
Rate for Payer: Nomi Health Commercial	$24.71
Rate for Payer: PACE SWMI	$20.59
Rate for Payer: PHP Medicare Advantage	$20.59
Rate for Payer: Priority Health Cigna Priority Health	$68.25
Rate for Payer: Priority Health Medicare	$20.80
Rate for Payer: UHC All Payor (Choice/PPO)	$20.59
Rate for Payer: UHC Dual Complete DSNP	$20.59
Rate for Payer: UHC Exchange	$20.59
Rate for Payer: UHC Medicare Advantage	$20.59

PR TANGENTIAL BIOPSY SKIN SINGLE LESION

Professional

Both

$194.00

Service Code	HCPCS 11102
Min. Negotiated Rate	$35.41
Max. Negotiated Rate	$126.10
Rate for Payer: Aetna Commercial	$47.45
Rate for Payer: Aetna Medicare	$36.83
Rate for Payer: BCBS Complete	$77.60
Rate for Payer: BCBS MAPPO	$35.41
Rate for Payer: BCN Medicare Advantage	$35.41
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cofinity Commercial	$50.99
Rate for Payer: Cofinity Commercial	$47.45
Rate for Payer: Health Alliance Plan Medicare Advantage	$35.41
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$37.18
Rate for Payer: Nomi Health Commercial	$42.49
Rate for Payer: PACE SWMI	$35.41
Rate for Payer: PHP Medicare Advantage	$35.41
Rate for Payer: Priority Health Cigna Priority Health	$126.10
Rate for Payer: Priority Health Medicare	$35.76
Rate for Payer: UHC All Payor (Choice/PPO)	$35.41
Rate for Payer: UHC Dual Complete DSNP	$35.41
Rate for Payer: UHC Exchange	$35.41
Rate for Payer: UHC Medicare Advantage	$35.41

PR TAP BLOCK UNILATERAL BY INJECTION(S)

Professional

Both

$114.00

Service Code	HCPCS 64486
Min. Negotiated Rate	$45.60
Max. Negotiated Rate	$74.10
Rate for Payer: Aetna Commercial	$66.97
Rate for Payer: Aetna Medicare	$51.98
Rate for Payer: BCBS Complete	$45.60
Rate for Payer: BCBS MAPPO	$49.98
Rate for Payer: BCN Medicare Advantage	$49.98
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cofinity Commercial	$71.97
Rate for Payer: Cofinity Commercial	$66.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$49.98
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$52.48
Rate for Payer: Nomi Health Commercial	$59.98
Rate for Payer: PACE SWMI	$49.98
Rate for Payer: PHP Medicare Advantage	$49.98
Rate for Payer: Priority Health Cigna Priority Health	$74.10
Rate for Payer: Priority Health Medicare	$50.48
Rate for Payer: UHC All Payor (Choice/PPO)	$49.98
Rate for Payer: UHC Dual Complete DSNP	$49.98
Rate for Payer: UHC Exchange	$49.98
Rate for Payer: UHC Medicare Advantage	$49.98

PR TATTOOING INCL MICROPIGMENTATION 6.0 CM/<

Professional

Both

$323.00

Service Code	HCPCS 11920
Min. Negotiated Rate	$108.46
Max. Negotiated Rate	$209.95
Rate for Payer: Aetna Commercial	$145.34
Rate for Payer: Aetna Medicare	$112.80
Rate for Payer: BCBS Complete	$129.20
Rate for Payer: BCBS MAPPO	$108.46
Rate for Payer: BCN Medicare Advantage	$108.46
Rate for Payer: Cash Price	$258.40
Rate for Payer: Cash Price	$258.40
Rate for Payer: Cofinity Commercial	$156.18
Rate for Payer: Cofinity Commercial	$145.34
Rate for Payer: Health Alliance Plan Medicare Advantage	$108.46
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$113.88
Rate for Payer: Nomi Health Commercial	$130.15
Rate for Payer: PACE SWMI	$108.46
Rate for Payer: PHP Medicare Advantage	$108.46
Rate for Payer: Priority Health Cigna Priority Health	$209.95
Rate for Payer: Priority Health Medicare	$109.54
Rate for Payer: UHC All Payor (Choice/PPO)	$108.46
Rate for Payer: UHC Dual Complete DSNP	$108.46
Rate for Payer: UHC Exchange	$108.46
Rate for Payer: UHC Medicare Advantage	$108.46

PR TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM

Professional

Both

$372.00

Service Code	HCPCS 11921
Min. Negotiated Rate	$124.62
Max. Negotiated Rate	$241.80
Rate for Payer: Aetna Commercial	$166.99
Rate for Payer: Aetna Medicare	$129.60
Rate for Payer: BCBS Complete	$148.80
Rate for Payer: BCBS MAPPO	$124.62
Rate for Payer: BCN Medicare Advantage	$124.62
Rate for Payer: Cash Price	$297.60
Rate for Payer: Cash Price	$297.60
Rate for Payer: Cofinity Commercial	$179.45
Rate for Payer: Cofinity Commercial	$166.99
Rate for Payer: Health Alliance Plan Medicare Advantage	$124.62
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$130.85
Rate for Payer: Nomi Health Commercial	$149.54
Rate for Payer: PACE SWMI	$124.62
Rate for Payer: PHP Medicare Advantage	$124.62
Rate for Payer: Priority Health Cigna Priority Health	$241.80
Rate for Payer: Priority Health Medicare	$125.87
Rate for Payer: UHC All Payor (Choice/PPO)	$124.62
Rate for Payer: UHC Dual Complete DSNP	$124.62
Rate for Payer: UHC Exchange	$124.62
Rate for Payer: UHC Medicare Advantage	$124.62

PR TATTOOING INCL MICROPIGMENTATION EA 20.0 CM

Professional

Both

$121.00

Service Code	HCPCS 11922
Min. Negotiated Rate	$27.14
Max. Negotiated Rate	$78.65
Rate for Payer: Aetna Commercial	$36.37
Rate for Payer: Aetna Medicare	$28.23
Rate for Payer: BCBS Complete	$48.40
Rate for Payer: BCBS MAPPO	$27.14
Rate for Payer: BCN Medicare Advantage	$27.14
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cofinity Commercial	$39.08
Rate for Payer: Cofinity Commercial	$36.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$27.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$28.50
Rate for Payer: Nomi Health Commercial	$32.57
Rate for Payer: PACE SWMI	$27.14
Rate for Payer: PHP Medicare Advantage	$27.14
Rate for Payer: Priority Health Cigna Priority Health	$78.65
Rate for Payer: Priority Health Medicare	$27.41
Rate for Payer: UHC All Payor (Choice/PPO)	$27.14
Rate for Payer: UHC Dual Complete DSNP	$27.14
Rate for Payer: UHC Exchange	$27.14
Rate for Payer: UHC Medicare Advantage	$27.14

PR TC99M DISOFENIN

Professional

Both

$255.00

Service Code	HCPCS A9510
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$165.75
Rate for Payer: Aetna Medicare	$127.50
Rate for Payer: BCBS Complete	$102.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Priority Health Cigna Priority Health	$165.75

PR TC99M MEBROFENIN

Professional

Both

$243.00

Service Code	HCPCS A9537
Min. Negotiated Rate	$97.20
Max. Negotiated Rate	$157.95
Rate for Payer: Aetna Medicare	$121.50
Rate for Payer: BCBS Complete	$97.20
Rate for Payer: Cash Price	$194.40
Rate for Payer: Priority Health Cigna Priority Health	$157.95

PR TC99M MEDRONATE

Professional

Both

$92.00

Service Code	HCPCS A9503
Min. Negotiated Rate	$36.80
Max. Negotiated Rate	$59.80
Rate for Payer: Aetna Medicare	$46.00
Rate for Payer: BCBS Complete	$36.80
Rate for Payer: Cash Price	$73.60
Rate for Payer: Priority Health Cigna Priority Health	$59.80

Know your out-of-pocket cost for care.

All Charges