Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR WESTONE MUSICIAN EAR PLUGS

Professional

Both

$296.00

Service Code	HCPCS 00591
Hospital Revenue Code	990
Min. Negotiated Rate	$118.40
Max. Negotiated Rate	$192.40
Rate for Payer: Aetna Medicare	$148.00
Rate for Payer: BCBS Complete	$118.40
Rate for Payer: Cash Price	$236.80
Rate for Payer: Priority Health Cigna Priority Health	$192.40

PR WET MOUNTS/ W PREPARATIONS

Professional

Both

$12.00

Service Code	HCPCS Q0111
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$26.19
Rate for Payer: Aetna Commercial	$24.37
Rate for Payer: Aetna Medicare	$18.92
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: BCBS MAPPO	$18.19
Rate for Payer: BCN Medicare Advantage	$18.19
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cofinity Commercial	$26.19
Rate for Payer: Cofinity Commercial	$24.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$18.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$19.10
Rate for Payer: Nomi Health Commercial	$21.83
Rate for Payer: PACE SWMI	$18.19
Rate for Payer: PHP Medicare Advantage	$18.19
Rate for Payer: Priority Health Cigna Priority Health	$7.80
Rate for Payer: Priority Health Medicare	$18.37
Rate for Payer: UHC All Payor (Choice/PPO)	$18.19
Rate for Payer: UHC Dual Complete DSNP	$18.19
Rate for Payer: UHC Exchange	$18.19
Rate for Payer: UHC Medicare Advantage	$18.19

PR WHFO, RIGID W/O JOINTS

Professional

Both

$333.00

Service Code	HCPCS L3808
Min. Negotiated Rate	$133.20
Max. Negotiated Rate	$562.49
Rate for Payer: Aetna Commercial	$523.43
Rate for Payer: Aetna Medicare	$406.24
Rate for Payer: BCBS Complete	$133.20
Rate for Payer: BCBS MAPPO	$390.62
Rate for Payer: BCN Medicare Advantage	$390.62
Rate for Payer: Cash Price	$266.40
Rate for Payer: Cash Price	$266.40
Rate for Payer: Cofinity Commercial	$523.43
Rate for Payer: Cofinity Commercial	$562.49
Rate for Payer: Health Alliance Plan Medicare Advantage	$390.62
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$410.15
Rate for Payer: Nomi Health Commercial	$468.74
Rate for Payer: PACE SWMI	$390.62
Rate for Payer: PHP Medicare Advantage	$390.62
Rate for Payer: Priority Health Cigna Priority Health	$216.45
Rate for Payer: Priority Health Medicare	$394.53
Rate for Payer: UHC All Payor (Choice/PPO)	$390.62
Rate for Payer: UHC Dual Complete DSNP	$390.62
Rate for Payer: UHC Exchange	$390.62
Rate for Payer: UHC Medicare Advantage	$390.62

PR WHFO W/O JOINTS PRE CST

Professional

Both

$234.00

Service Code	HCPCS L3807
Min. Negotiated Rate	$93.60
Max. Negotiated Rate	$394.83
Rate for Payer: Aetna Commercial	$367.41
Rate for Payer: Aetna Medicare	$285.16
Rate for Payer: BCBS Complete	$93.60
Rate for Payer: BCBS MAPPO	$274.19
Rate for Payer: BCN Medicare Advantage	$274.19
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cofinity Commercial	$394.83
Rate for Payer: Cofinity Commercial	$367.41
Rate for Payer: Health Alliance Plan Medicare Advantage	$274.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$287.90
Rate for Payer: Nomi Health Commercial	$329.03
Rate for Payer: PACE SWMI	$274.19
Rate for Payer: PHP Medicare Advantage	$274.19
Rate for Payer: Priority Health Cigna Priority Health	$152.10
Rate for Payer: Priority Health Medicare	$276.93
Rate for Payer: UHC All Payor (Choice/PPO)	$274.19
Rate for Payer: UHC Dual Complete DSNP	$274.19
Rate for Payer: UHC Exchange	$274.19
Rate for Payer: UHC Medicare Advantage	$274.19

PR WHO COCK-UP NONMOLDE PRE OTS

Professional

Both

$69.00

Service Code	HCPCS L3908
Min. Negotiated Rate	$27.60
Max. Negotiated Rate	$115.76
Rate for Payer: Aetna Commercial	$107.72
Rate for Payer: Aetna Medicare	$83.61
Rate for Payer: BCBS Complete	$27.60
Rate for Payer: BCBS MAPPO	$80.39
Rate for Payer: BCN Medicare Advantage	$80.39
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cofinity Commercial	$115.76
Rate for Payer: Cofinity Commercial	$107.72
Rate for Payer: Health Alliance Plan Medicare Advantage	$80.39
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$84.41
Rate for Payer: Nomi Health Commercial	$96.47
Rate for Payer: PACE SWMI	$80.39
Rate for Payer: PHP Medicare Advantage	$80.39
Rate for Payer: Priority Health Cigna Priority Health	$44.85
Rate for Payer: Priority Health Medicare	$81.19
Rate for Payer: UHC All Payor (Choice/PPO)	$80.39
Rate for Payer: UHC Dual Complete DSNP	$80.39
Rate for Payer: UHC Exchange	$80.39
Rate for Payer: UHC Medicare Advantage	$80.39

PR WHO W/NONTORSION JNT(S) CF

Professional

Both

$926.00

Service Code	HCPCS L3905
Min. Negotiated Rate	$370.40
Max. Negotiated Rate	$1,565.87
Rate for Payer: Aetna Commercial	$1,457.13
Rate for Payer: Aetna Medicare	$1,130.91
Rate for Payer: BCBS Complete	$370.40
Rate for Payer: BCBS MAPPO	$1,087.41
Rate for Payer: BCN Medicare Advantage	$1,087.41
Rate for Payer: Cash Price	$740.80
Rate for Payer: Cash Price	$740.80
Rate for Payer: Cofinity Commercial	$1,565.87
Rate for Payer: Cofinity Commercial	$1,457.13
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,087.41
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,141.78
Rate for Payer: Nomi Health Commercial	$1,304.89
Rate for Payer: PACE SWMI	$1,087.41
Rate for Payer: PHP Medicare Advantage	$1,087.41
Rate for Payer: Priority Health Cigna Priority Health	$601.90
Rate for Payer: Priority Health Medicare	$1,098.28
Rate for Payer: UHC All Payor (Choice/PPO)	$1,087.41
Rate for Payer: UHC Dual Complete DSNP	$1,087.41
Rate for Payer: UHC Exchange	$1,087.41
Rate for Payer: UHC Medicare Advantage	$1,087.41

PR WHO W/O JOINTS CF

Professional

Both

$473.00

Service Code	HCPCS L3906
Min. Negotiated Rate	$189.20
Max. Negotiated Rate	$800.18
Rate for Payer: Aetna Commercial	$744.61
Rate for Payer: Aetna Medicare	$577.91
Rate for Payer: BCBS Complete	$189.20
Rate for Payer: BCBS MAPPO	$555.68
Rate for Payer: BCN Medicare Advantage	$555.68
Rate for Payer: Cash Price	$378.40
Rate for Payer: Cash Price	$378.40
Rate for Payer: Cofinity Commercial	$800.18
Rate for Payer: Cofinity Commercial	$744.61
Rate for Payer: Health Alliance Plan Medicare Advantage	$555.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$583.46
Rate for Payer: Nomi Health Commercial	$666.82
Rate for Payer: PACE SWMI	$555.68
Rate for Payer: PHP Medicare Advantage	$555.68
Rate for Payer: Priority Health Cigna Priority Health	$307.45
Rate for Payer: Priority Health Medicare	$561.24
Rate for Payer: UHC All Payor (Choice/PPO)	$555.68
Rate for Payer: UHC Dual Complete DSNP	$555.68
Rate for Payer: UHC Exchange	$555.68
Rate for Payer: UHC Medicare Advantage	$555.68

PR WINDOWING CAST

Professional

Both

$114.00

Service Code	HCPCS 29730
Min. Negotiated Rate	$42.75
Max. Negotiated Rate	$74.10
Rate for Payer: Aetna Commercial	$57.28
Rate for Payer: Aetna Medicare	$44.46
Rate for Payer: BCBS Complete	$45.60
Rate for Payer: BCBS MAPPO	$42.75
Rate for Payer: BCN Medicare Advantage	$42.75
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cofinity Commercial	$57.28
Rate for Payer: Cofinity Commercial	$61.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$42.75
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$44.89
Rate for Payer: Nomi Health Commercial	$51.30
Rate for Payer: PACE SWMI	$42.75
Rate for Payer: PHP Medicare Advantage	$42.75
Rate for Payer: Priority Health Cigna Priority Health	$74.10
Rate for Payer: Priority Health Medicare	$43.18
Rate for Payer: UHC All Payor (Choice/PPO)	$42.75
Rate for Payer: UHC Dual Complete DSNP	$42.75
Rate for Payer: UHC Exchange	$42.75
Rate for Payer: UHC Medicare Advantage	$42.75

PR WORK HARDENING/CONDITIONING 1ST 2 HR

Professional

Both

$198.00

Service Code	HCPCS 97545
Min. Negotiated Rate	$79.20
Max. Negotiated Rate	$128.70
Rate for Payer: Aetna Medicare	$99.00
Rate for Payer: BCBS Complete	$79.20
Rate for Payer: Cash Price	$158.40
Rate for Payer: Priority Health Cigna Priority Health	$128.70

PR WORK HARDENING/CONDITIONING EACH HOUR

Professional

Both

$99.00

Service Code	HCPCS 97546
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$64.35
Rate for Payer: Aetna Medicare	$49.50
Rate for Payer: BCBS Complete	$39.60
Rate for Payer: Cash Price	$79.20
Rate for Payer: Priority Health Cigna Priority Health	$64.35

PR WORK RELATED/MED DBLT XM TREATING PHYS

Professional

Both

$112.00

Service Code	HCPCS 99455
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$72.80
Rate for Payer: Aetna Medicare	$56.00
Rate for Payer: BCBS Complete	$44.80
Rate for Payer: Cash Price	$89.60
Rate for Payer: Priority Health Cigna Priority Health	$72.80

PR WOUND CLOSURE BY ADHESIVE

Professional

Both

$202.00

Service Code	HCPCS G0168
Min. Negotiated Rate	$13.99
Max. Negotiated Rate	$131.30
Rate for Payer: Aetna Commercial	$18.75
Rate for Payer: Aetna Medicare	$14.55
Rate for Payer: BCBS Complete	$80.80
Rate for Payer: BCBS MAPPO	$13.99
Rate for Payer: BCN Medicare Advantage	$13.99
Rate for Payer: Cash Price	$161.60
Rate for Payer: Cash Price	$161.60
Rate for Payer: Cofinity Commercial	$20.15
Rate for Payer: Cofinity Commercial	$18.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$13.99
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14.69
Rate for Payer: Nomi Health Commercial	$16.79
Rate for Payer: PACE SWMI	$13.99
Rate for Payer: PHP Medicare Advantage	$13.99
Rate for Payer: Priority Health Cigna Priority Health	$131.30
Rate for Payer: Priority Health Medicare	$14.13
Rate for Payer: UHC All Payor (Choice/PPO)	$13.99
Rate for Payer: UHC Dual Complete DSNP	$13.99
Rate for Payer: UHC Exchange	$13.99
Rate for Payer: UHC Medicare Advantage	$13.99

PR XEOMIN

Professional

Both

$10.00

Service Code	HCPCS 00085
Hospital Revenue Code	990
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$6.50

PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG

Professional

Both

$80.00

Service Code	HCPCS 94617
Min. Negotiated Rate	$32.00
Max. Negotiated Rate	$117.12
Rate for Payer: Aetna Commercial	$108.98
Rate for Payer: Aetna Medicare	$84.58
Rate for Payer: BCBS Complete	$32.00
Rate for Payer: BCBS MAPPO	$81.33
Rate for Payer: BCN Medicare Advantage	$81.33
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cash Price	$64.00
Rate for Payer: Cofinity Commercial	$117.12
Rate for Payer: Cofinity Commercial	$108.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$81.33
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$85.40
Rate for Payer: Nomi Health Commercial	$97.60
Rate for Payer: PACE SWMI	$81.33
Rate for Payer: PHP Medicare Advantage	$81.33
Rate for Payer: Priority Health Cigna Priority Health	$52.00
Rate for Payer: Priority Health Medicare	$82.14
Rate for Payer: UHC All Payor (Choice/PPO)	$81.33
Rate for Payer: UHC Dual Complete DSNP	$81.33
Rate for Payer: UHC Exchange	$81.33
Rate for Payer: UHC Medicare Advantage	$81.33

PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG

Professional

Both

$160.00

Service Code	HCPCS 94619
Min. Negotiated Rate	$59.42
Max. Negotiated Rate	$104.00
Rate for Payer: Aetna Commercial	$79.62
Rate for Payer: Aetna Medicare	$61.80
Rate for Payer: BCBS Complete	$64.00
Rate for Payer: BCBS MAPPO	$59.42
Rate for Payer: BCN Medicare Advantage	$59.42
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cash Price	$128.00
Rate for Payer: Cofinity Commercial	$85.56
Rate for Payer: Cofinity Commercial	$79.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$59.42
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$62.39
Rate for Payer: Nomi Health Commercial	$71.30
Rate for Payer: PACE SWMI	$59.42
Rate for Payer: PHP Medicare Advantage	$59.42
Rate for Payer: Priority Health Cigna Priority Health	$104.00
Rate for Payer: Priority Health Medicare	$60.01
Rate for Payer: UHC All Payor (Choice/PPO)	$59.42
Rate for Payer: UHC Dual Complete DSNP	$59.42
Rate for Payer: UHC Exchange	$59.42
Rate for Payer: UHC Medicare Advantage	$59.42

PR XTRNL ECG REC>48HR<7D RECORDING SCAN A/R R&I

Professional

Both

$312.00

Service Code	HCPCS 93241
Min. Negotiated Rate	$124.80
Max. Negotiated Rate	$343.30
Rate for Payer: Aetna Commercial	$319.46
Rate for Payer: Aetna Medicare	$247.94
Rate for Payer: BCBS Complete	$124.80
Rate for Payer: BCBS MAPPO	$238.40
Rate for Payer: BCN Medicare Advantage	$238.40
Rate for Payer: Cash Price	$249.60
Rate for Payer: Cash Price	$249.60
Rate for Payer: Cofinity Commercial	$343.30
Rate for Payer: Cofinity Commercial	$319.46
Rate for Payer: Health Alliance Plan Medicare Advantage	$238.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$250.32
Rate for Payer: Nomi Health Commercial	$286.08
Rate for Payer: PACE SWMI	$238.40
Rate for Payer: PHP Medicare Advantage	$238.40
Rate for Payer: Priority Health Cigna Priority Health	$202.80
Rate for Payer: Priority Health Medicare	$240.78
Rate for Payer: UHC All Payor (Choice/PPO)	$238.40
Rate for Payer: UHC Dual Complete DSNP	$238.40
Rate for Payer: UHC Exchange	$238.40
Rate for Payer: UHC Medicare Advantage	$238.40

PR XTRNL ECG REC<48 HRS RECORDING

Professional

Both

$120.00

Service Code	HCPCS 93225
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$78.00
Rate for Payer: Aetna Commercial	$21.44
Rate for Payer: Aetna Medicare	$16.64
Rate for Payer: BCBS Complete	$48.00
Rate for Payer: BCBS MAPPO	$16.00
Rate for Payer: BCN Medicare Advantage	$16.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cash Price	$96.00
Rate for Payer: Cofinity Commercial	$23.04
Rate for Payer: Cofinity Commercial	$21.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$16.00
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$16.80
Rate for Payer: Nomi Health Commercial	$19.20
Rate for Payer: PACE SWMI	$16.00
Rate for Payer: PHP Medicare Advantage	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$78.00
Rate for Payer: Priority Health Medicare	$16.16
Rate for Payer: UHC All Payor (Choice/PPO)	$16.00
Rate for Payer: UHC Dual Complete DSNP	$16.00
Rate for Payer: UHC Exchange	$16.00
Rate for Payer: UHC Medicare Advantage	$16.00

PR XTRNL ECG REC<48 HRS RECORDING SCAN A/R R&I

Professional

Both

$235.00

Service Code	HCPCS 93224
Min. Negotiated Rate	$63.55
Max. Negotiated Rate	$152.75
Rate for Payer: Aetna Commercial	$85.16
Rate for Payer: Aetna Medicare	$66.09
Rate for Payer: BCBS Complete	$94.00
Rate for Payer: BCBS MAPPO	$63.55
Rate for Payer: BCN Medicare Advantage	$63.55
Rate for Payer: Cash Price	$188.00
Rate for Payer: Cash Price	$188.00
Rate for Payer: Cofinity Commercial	$91.51
Rate for Payer: Cofinity Commercial	$85.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$63.55
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$66.73
Rate for Payer: Nomi Health Commercial	$76.26
Rate for Payer: PACE SWMI	$63.55
Rate for Payer: PHP Medicare Advantage	$63.55
Rate for Payer: Priority Health Cigna Priority Health	$152.75
Rate for Payer: Priority Health Medicare	$64.19
Rate for Payer: UHC All Payor (Choice/PPO)	$63.55
Rate for Payer: UHC Dual Complete DSNP	$63.55
Rate for Payer: UHC Exchange	$63.55
Rate for Payer: UHC Medicare Advantage	$63.55

PR XTRNL ECG REC<48 HRS RVW&INTERPJ PHYS/QHP

Professional

Both

$200.00

Service Code	HCPCS 93227
Min. Negotiated Rate	$17.12
Max. Negotiated Rate	$130.00
Rate for Payer: Aetna Commercial	$22.94
Rate for Payer: Aetna Medicare	$17.80
Rate for Payer: BCBS Complete	$80.00
Rate for Payer: BCBS MAPPO	$17.12
Rate for Payer: BCN Medicare Advantage	$17.12
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cofinity Commercial	$24.65
Rate for Payer: Cofinity Commercial	$22.94
Rate for Payer: Health Alliance Plan Medicare Advantage	$17.12
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$17.98
Rate for Payer: Nomi Health Commercial	$20.54
Rate for Payer: PACE SWMI	$17.12
Rate for Payer: PHP Medicare Advantage	$17.12
Rate for Payer: Priority Health Cigna Priority Health	$130.00
Rate for Payer: Priority Health Medicare	$17.29
Rate for Payer: UHC All Payor (Choice/PPO)	$17.12
Rate for Payer: UHC Dual Complete DSNP	$17.12
Rate for Payer: UHC Exchange	$17.12
Rate for Payer: UHC Medicare Advantage	$17.12

PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS

Professional

Both

$58.00

Service Code	HCPCS 93228
Min. Negotiated Rate	$23.20
Max. Negotiated Rate	$37.70
Rate for Payer: Aetna Commercial	$31.81
Rate for Payer: Aetna Medicare	$24.69
Rate for Payer: BCBS Complete	$23.20
Rate for Payer: BCBS MAPPO	$23.74
Rate for Payer: BCN Medicare Advantage	$23.74
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cofinity Commercial	$34.19
Rate for Payer: Cofinity Commercial	$31.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$23.74
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$24.93
Rate for Payer: Nomi Health Commercial	$28.49
Rate for Payer: PACE SWMI	$23.74
Rate for Payer: PHP Medicare Advantage	$23.74
Rate for Payer: Priority Health Cigna Priority Health	$37.70
Rate for Payer: Priority Health Medicare	$23.98
Rate for Payer: UHC All Payor (Choice/PPO)	$23.74
Rate for Payer: UHC Dual Complete DSNP	$23.74
Rate for Payer: UHC Exchange	$23.74
Rate for Payer: UHC Medicare Advantage	$23.74

PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS

Professional

Both

$654.00

Service Code	HCPCS 93271
Min. Negotiated Rate	$120.90
Max. Negotiated Rate	$425.10
Rate for Payer: Aetna Commercial	$162.01
Rate for Payer: Aetna Medicare	$125.74
Rate for Payer: BCBS Complete	$261.60
Rate for Payer: BCBS MAPPO	$120.90
Rate for Payer: BCN Medicare Advantage	$120.90
Rate for Payer: Cash Price	$523.20
Rate for Payer: Cash Price	$523.20
Rate for Payer: Cofinity Commercial	$174.10
Rate for Payer: Cofinity Commercial	$162.01
Rate for Payer: Health Alliance Plan Medicare Advantage	$120.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$126.94
Rate for Payer: Nomi Health Commercial	$145.08
Rate for Payer: PACE SWMI	$120.90
Rate for Payer: PHP Medicare Advantage	$120.90
Rate for Payer: Priority Health Cigna Priority Health	$425.10
Rate for Payer: Priority Health Medicare	$122.11
Rate for Payer: UHC All Payor (Choice/PPO)	$120.90
Rate for Payer: UHC Dual Complete DSNP	$120.90
Rate for Payer: UHC Exchange	$120.90
Rate for Payer: UHC Medicare Advantage	$120.90

PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS

Professional

Both

$123.00

Service Code	HCPCS 93270
Min. Negotiated Rate	$7.16
Max. Negotiated Rate	$79.95
Rate for Payer: Aetna Commercial	$9.59
Rate for Payer: Aetna Medicare	$7.45
Rate for Payer: BCBS Complete	$49.20
Rate for Payer: BCBS MAPPO	$7.16
Rate for Payer: BCN Medicare Advantage	$7.16
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cofinity Commercial	$9.59
Rate for Payer: Cofinity Commercial	$10.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$7.16
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7.52
Rate for Payer: Nomi Health Commercial	$8.59
Rate for Payer: PACE SWMI	$7.16
Rate for Payer: PHP Medicare Advantage	$7.16
Rate for Payer: Priority Health Cigna Priority Health	$79.95
Rate for Payer: Priority Health Medicare	$7.23
Rate for Payer: UHC All Payor (Choice/PPO)	$7.16
Rate for Payer: UHC Dual Complete DSNP	$7.16
Rate for Payer: UHC Exchange	$7.16
Rate for Payer: UHC Medicare Advantage	$7.16

PR XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS

Professional

Both

$871.00

Service Code	HCPCS 93268
Min. Negotiated Rate	$150.65
Max. Negotiated Rate	$566.15
Rate for Payer: Aetna Commercial	$201.87
Rate for Payer: Aetna Medicare	$156.68
Rate for Payer: BCBS Complete	$348.40
Rate for Payer: BCBS MAPPO	$150.65
Rate for Payer: BCN Medicare Advantage	$150.65
Rate for Payer: Cash Price	$696.80
Rate for Payer: Cash Price	$696.80
Rate for Payer: Cofinity Commercial	$216.94
Rate for Payer: Cofinity Commercial	$201.87
Rate for Payer: Health Alliance Plan Medicare Advantage	$150.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$158.18
Rate for Payer: Nomi Health Commercial	$180.78
Rate for Payer: PACE SWMI	$150.65
Rate for Payer: PHP Medicare Advantage	$150.65
Rate for Payer: Priority Health Cigna Priority Health	$566.15
Rate for Payer: Priority Health Medicare	$152.16
Rate for Payer: UHC All Payor (Choice/PPO)	$150.65
Rate for Payer: UHC Dual Complete DSNP	$150.65
Rate for Payer: UHC Exchange	$150.65
Rate for Payer: UHC Medicare Advantage	$150.65

PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS

Professional

Both

$174.00

Service Code	HCPCS 93272
Min. Negotiated Rate	$22.59
Max. Negotiated Rate	$113.10
Rate for Payer: Aetna Commercial	$30.27
Rate for Payer: Aetna Medicare	$23.49
Rate for Payer: BCBS Complete	$69.60
Rate for Payer: BCBS MAPPO	$22.59
Rate for Payer: BCN Medicare Advantage	$22.59
Rate for Payer: Cash Price	$139.20
Rate for Payer: Cash Price	$139.20
Rate for Payer: Cofinity Commercial	$32.53
Rate for Payer: Cofinity Commercial	$30.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$22.59
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$23.72
Rate for Payer: Nomi Health Commercial	$27.11
Rate for Payer: PACE SWMI	$22.59
Rate for Payer: PHP Medicare Advantage	$22.59
Rate for Payer: Priority Health Cigna Priority Health	$113.10
Rate for Payer: Priority Health Medicare	$22.82
Rate for Payer: UHC All Payor (Choice/PPO)	$22.59
Rate for Payer: UHC Dual Complete DSNP	$22.59
Rate for Payer: UHC Exchange	$22.59
Rate for Payer: UHC Medicare Advantage	$22.59

PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL

Professional

Both

$608.00

Service Code	HCPCS 41015
Min. Negotiated Rate	$243.20
Max. Negotiated Rate	$409.94
Rate for Payer: Aetna Commercial	$381.47
Rate for Payer: Aetna Medicare	$296.07
Rate for Payer: BCBS Complete	$243.20
Rate for Payer: BCBS MAPPO	$284.68
Rate for Payer: BCN Medicare Advantage	$284.68
Rate for Payer: Cash Price	$486.40
Rate for Payer: Cash Price	$486.40
Rate for Payer: Cofinity Commercial	$409.94
Rate for Payer: Cofinity Commercial	$381.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$284.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$298.91
Rate for Payer: Nomi Health Commercial	$341.62
Rate for Payer: PACE SWMI	$284.68
Rate for Payer: PHP Medicare Advantage	$284.68
Rate for Payer: Priority Health Cigna Priority Health	$395.20
Rate for Payer: Priority Health Medicare	$287.53
Rate for Payer: UHC All Payor (Choice/PPO)	$284.68
Rate for Payer: UHC Dual Complete DSNP	$284.68
Rate for Payer: UHC Exchange	$284.68
Rate for Payer: UHC Medicare Advantage	$284.68

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