Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$1,205.21

Service Code	CPT 21931
Hospital Revenue Code	360
Min. Negotiated Rate	$1,147.75
Max. Negotiated Rate	$1,205.21
Rate for Payer: BCBS Complete	$1,205.21
Rate for Payer: Mclaren Medicaid	$1,147.75
Rate for Payer: Meridian Medicaid	$1,205.21
Rate for Payer: Priority Health Choice Medicaid	$1,147.75
Rate for Payer: UHCCP Medicaid	$1,147.75

EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$1,205.21

Service Code	CPT 21930
Hospital Revenue Code	360
Min. Negotiated Rate	$1,147.75
Max. Negotiated Rate	$1,205.21
Rate for Payer: BCBS Complete	$1,205.21
Rate for Payer: Mclaren Medicaid	$1,147.75
Rate for Payer: Meridian Medicaid	$1,205.21
Rate for Payer: Priority Health Choice Medicaid	$1,147.75
Rate for Payer: UHCCP Medicaid	$1,147.75

EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

Facility

$2,128.93

Service Code	CPT 21933
Hospital Revenue Code	360
Min. Negotiated Rate	$2,027.42
Max. Negotiated Rate	$2,128.93
Rate for Payer: BCBS Complete	$2,128.93
Rate for Payer: Mclaren Medicaid	$2,027.42
Rate for Payer: Meridian Medicaid	$2,128.93
Rate for Payer: Priority Health Choice Medicaid	$2,027.42
Rate for Payer: UHCCP Medicaid	$2,027.42

EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; 2 CM OR GREATER

Facility

$1,205.21

Service Code	CPT 21012
Hospital Revenue Code	360
Min. Negotiated Rate	$1,147.75
Max. Negotiated Rate	$1,205.21
Rate for Payer: BCBS Complete	$1,205.21
Rate for Payer: Mclaren Medicaid	$1,147.75
Rate for Payer: Meridian Medicaid	$1,205.21
Rate for Payer: Priority Health Choice Medicaid	$1,147.75
Rate for Payer: UHCCP Medicaid	$1,147.75

EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBCUTANEOUS; LESS THAN 1.5 CM

Facility

$1,205.21

Service Code	CPT 28043
Hospital Revenue Code	360
Min. Negotiated Rate	$1,147.75
Max. Negotiated Rate	$1,205.21
Rate for Payer: BCBS Complete	$1,205.21
Rate for Payer: Mclaren Medicaid	$1,147.75
Rate for Payer: Meridian Medicaid	$1,205.21
Rate for Payer: Priority Health Choice Medicaid	$1,147.75
Rate for Payer: UHCCP Medicaid	$1,147.75

EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$1,205.21

Service Code	CPT 25075
Hospital Revenue Code	360
Min. Negotiated Rate	$1,147.75
Max. Negotiated Rate	$1,205.21
Rate for Payer: BCBS Complete	$1,205.21
Rate for Payer: Mclaren Medicaid	$1,147.75
Rate for Payer: Meridian Medicaid	$1,205.21
Rate for Payer: Priority Health Choice Medicaid	$1,147.75
Rate for Payer: UHCCP Medicaid	$1,147.75

EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$2,128.93

Service Code	CPT 27632
Hospital Revenue Code	360
Min. Negotiated Rate	$2,027.42
Max. Negotiated Rate	$2,128.93
Rate for Payer: BCBS Complete	$2,128.93
Rate for Payer: Mclaren Medicaid	$2,027.42
Rate for Payer: Meridian Medicaid	$2,128.93
Rate for Payer: Priority Health Choice Medicaid	$2,027.42
Rate for Payer: UHCCP Medicaid	$2,027.42

EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$2,128.93

Service Code	CPT 21552
Hospital Revenue Code	360
Min. Negotiated Rate	$2,027.42
Max. Negotiated Rate	$2,128.93
Rate for Payer: BCBS Complete	$2,128.93
Rate for Payer: Mclaren Medicaid	$2,027.42
Rate for Payer: Meridian Medicaid	$2,128.93
Rate for Payer: Priority Health Choice Medicaid	$2,027.42
Rate for Payer: UHCCP Medicaid	$2,027.42

EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; LESS THAN 3 CM

Facility

$1,205.21

Service Code	CPT 21555
Hospital Revenue Code	360
Min. Negotiated Rate	$1,147.75
Max. Negotiated Rate	$1,205.21
Rate for Payer: BCBS Complete	$1,205.21
Rate for Payer: Mclaren Medicaid	$1,147.75
Rate for Payer: Meridian Medicaid	$1,205.21
Rate for Payer: Priority Health Choice Medicaid	$1,147.75
Rate for Payer: UHCCP Medicaid	$1,147.75

EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER

Facility

$2,128.93

Service Code	CPT 21554
Hospital Revenue Code	360
Min. Negotiated Rate	$2,027.42
Max. Negotiated Rate	$2,128.93
Rate for Payer: BCBS Complete	$2,128.93
Rate for Payer: Mclaren Medicaid	$2,027.42
Rate for Payer: Meridian Medicaid	$2,128.93
Rate for Payer: Priority Health Choice Medicaid	$2,027.42
Rate for Payer: UHCCP Medicaid	$2,027.42

EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM

Facility

$2,128.93

Service Code	CPT 21556
Hospital Revenue Code	360
Min. Negotiated Rate	$2,027.42
Max. Negotiated Rate	$2,128.93
Rate for Payer: BCBS Complete	$2,128.93
Rate for Payer: Mclaren Medicaid	$2,027.42
Rate for Payer: Meridian Medicaid	$2,128.93
Rate for Payer: Priority Health Choice Medicaid	$2,027.42
Rate for Payer: UHCCP Medicaid	$2,027.42

EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$2,128.93

Service Code	CPT 27043
Hospital Revenue Code	360
Min. Negotiated Rate	$2,027.42
Max. Negotiated Rate	$2,128.93
Rate for Payer: BCBS Complete	$2,128.93
Rate for Payer: Mclaren Medicaid	$2,027.42
Rate for Payer: Meridian Medicaid	$2,128.93
Rate for Payer: Priority Health Choice Medicaid	$2,027.42
Rate for Payer: UHCCP Medicaid	$2,027.42

EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$1,205.21

Service Code	CPT 23071
Hospital Revenue Code	360
Min. Negotiated Rate	$1,147.75
Max. Negotiated Rate	$1,205.21
Rate for Payer: BCBS Complete	$1,205.21
Rate for Payer: Mclaren Medicaid	$1,147.75
Rate for Payer: Meridian Medicaid	$1,205.21
Rate for Payer: Priority Health Choice Medicaid	$1,147.75
Rate for Payer: UHCCP Medicaid	$1,147.75

EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$2,128.93

Service Code	CPT 27337
Hospital Revenue Code	360
Min. Negotiated Rate	$2,027.42
Max. Negotiated Rate	$2,128.93
Rate for Payer: BCBS Complete	$2,128.93
Rate for Payer: Mclaren Medicaid	$2,027.42
Rate for Payer: Meridian Medicaid	$2,128.93
Rate for Payer: Priority Health Choice Medicaid	$2,027.42
Rate for Payer: UHCCP Medicaid	$2,027.42

EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBCUTANEOUS; 3 CM OR GREATER

Facility

$2,128.93

Service Code	CPT 24071
Hospital Revenue Code	360
Min. Negotiated Rate	$2,027.42
Max. Negotiated Rate	$2,128.93
Rate for Payer: BCBS Complete	$2,128.93
Rate for Payer: Mclaren Medicaid	$2,027.42
Rate for Payer: Meridian Medicaid	$2,128.93
Rate for Payer: Priority Health Choice Medicaid	$2,027.42
Rate for Payer: UHCCP Medicaid	$2,027.42

EYELASH TINTING

Professional

Both

$31.00

Service Code	HCPCS 00176
Hospital Revenue Code	960
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$20.15
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$20.15

EZETIMIBE 10 MG TABLET

Facility

$1,190.92

Service Code	NDC 66582041431
Hospital Charge Code	34153
Hospital Revenue Code	637
Min. Negotiated Rate	$282.84
Max. Negotiated Rate	$1,071.83
Rate for Payer: Aetna Commercial	$1,012.28
Rate for Payer: Aetna Medicare	$309.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$372.16
Rate for Payer: Amish Plain Church Group Commercial	$372.16
Rate for Payer: BCBS Complete	$476.37
Rate for Payer: BCBS MAPPO	$297.73
Rate for Payer: BCBS Trust/PPO	$979.06
Rate for Payer: BCN Commercial	$925.94
Rate for Payer: BCN Medicare Advantage	$297.73
Rate for Payer: Cash Price	$952.74
Rate for Payer: Cofinity Commercial	$1,024.19
Rate for Payer: Encore Health Key Benefits Commercial	$952.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$297.73
Rate for Payer: Healthscope Commercial	$1,071.83
Rate for Payer: Lakeland Regional Health Systems Commercial	$893.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$312.62
Rate for Payer: MI Amish Medical Board Commercial	$342.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,012.28
Rate for Payer: Nomi Health Commercial	$976.55
Rate for Payer: PACE Senior Care Partners	$282.84
Rate for Payer: PACE SWMI	$297.73
Rate for Payer: PHP Commercial	$1,012.28
Rate for Payer: PHP Medicare Advantage	$297.73
Rate for Payer: Priority Health Cigna Priority Health	$774.10
Rate for Payer: Priority Health HMO/PPO	$1,036.10
Rate for Payer: Priority Health Medicare	$300.71
Rate for Payer: Priority Health Narrow/Tiered Network	$797.92
Rate for Payer: Railroad Medicare Medicare	$297.73
Rate for Payer: UHC All Payor (Choice/PPO)	$1,048.01
Rate for Payer: UHC Core	$994.42
Rate for Payer: UHC Dual Complete DSNP	$297.73
Rate for Payer: UHC Exchange	$297.73
Rate for Payer: UHC Medicare Advantage	$297.73
Rate for Payer: VA VA	$297.73
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$893.19

EZETIMIBE 10 MG TABLET

Facility

$76.95

Service Code	NDC 00781569031
Hospital Charge Code	34153
Hospital Revenue Code	637
Min. Negotiated Rate	$18.28
Max. Negotiated Rate	$69.26
Rate for Payer: Aetna Commercial	$65.41
Rate for Payer: Aetna Medicare	$20.01
Rate for Payer: Allen County Amish Medical Aid Commercial	$24.05
Rate for Payer: Amish Plain Church Group Commercial	$24.05
Rate for Payer: BCBS Complete	$30.78
Rate for Payer: BCBS MAPPO	$19.24
Rate for Payer: BCBS Trust/PPO	$63.26
Rate for Payer: BCN Commercial	$59.83
Rate for Payer: BCN Medicare Advantage	$19.24
Rate for Payer: Cash Price	$61.56
Rate for Payer: Cofinity Commercial	$66.18
Rate for Payer: Encore Health Key Benefits Commercial	$61.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$19.24
Rate for Payer: Healthscope Commercial	$69.26
Rate for Payer: Lakeland Regional Health Systems Commercial	$57.71
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$20.20
Rate for Payer: MI Amish Medical Board Commercial	$22.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.41
Rate for Payer: Nomi Health Commercial	$63.10
Rate for Payer: PACE Senior Care Partners	$18.28
Rate for Payer: PACE SWMI	$19.24
Rate for Payer: PHP Commercial	$65.41
Rate for Payer: PHP Medicare Advantage	$19.24
Rate for Payer: Priority Health Cigna Priority Health	$50.02
Rate for Payer: Priority Health HMO/PPO	$66.95
Rate for Payer: Priority Health Medicare	$19.43
Rate for Payer: Priority Health Narrow/Tiered Network	$51.56
Rate for Payer: Railroad Medicare Medicare	$19.24
Rate for Payer: UHC All Payor (Choice/PPO)	$67.72
Rate for Payer: UHC Core	$64.25
Rate for Payer: UHC Dual Complete DSNP	$19.24
Rate for Payer: UHC Exchange	$19.24
Rate for Payer: UHC Medicare Advantage	$19.24
Rate for Payer: VA VA	$19.24
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$57.71

EZETIMIBE 10 MG TABLET

Facility

$1,190.92

Service Code	NDC 66582041431
Hospital Charge Code	34153
Hospital Revenue Code	637
Min. Negotiated Rate	$774.10
Max. Negotiated Rate	$1,071.83
Rate for Payer: Aetna Commercial	$1,012.28
Rate for Payer: BCBS Trust/PPO	$972.15
Rate for Payer: BCN Commercial	$920.34
Rate for Payer: Cash Price	$952.74
Rate for Payer: Cofinity Commercial	$1,024.19
Rate for Payer: Encore Health Key Benefits Commercial	$952.74
Rate for Payer: Healthscope Commercial	$1,071.83
Rate for Payer: Lakeland Regional Health Systems Commercial	$893.19
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,012.28
Rate for Payer: Nomi Health Commercial	$976.55
Rate for Payer: PHP Commercial	$1,012.28
Rate for Payer: Priority Health Cigna Priority Health	$774.10
Rate for Payer: Priority Health HMO/PPO	$1,036.10
Rate for Payer: Priority Health Narrow/Tiered Network	$797.92
Rate for Payer: UHC All Payor (Choice/PPO)	$1,048.01
Rate for Payer: UHC Core	$994.42
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$893.19

EZETIMIBE 10 MG TABLET

Facility

$81.80

Service Code	NDC 67877049030
Hospital Charge Code	34153
Hospital Revenue Code	637
Min. Negotiated Rate	$19.43
Max. Negotiated Rate	$73.62
Rate for Payer: Aetna Commercial	$69.53
Rate for Payer: Aetna Medicare	$21.27
Rate for Payer: Allen County Amish Medical Aid Commercial	$25.56
Rate for Payer: Amish Plain Church Group Commercial	$25.56
Rate for Payer: BCBS Complete	$32.72
Rate for Payer: BCBS MAPPO	$20.45
Rate for Payer: BCBS Trust/PPO	$67.25
Rate for Payer: BCN Commercial	$63.60
Rate for Payer: BCN Medicare Advantage	$20.45
Rate for Payer: Cash Price	$65.44
Rate for Payer: Cofinity Commercial	$70.35
Rate for Payer: Encore Health Key Benefits Commercial	$65.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$20.45
Rate for Payer: Healthscope Commercial	$73.62
Rate for Payer: Lakeland Regional Health Systems Commercial	$61.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$21.47
Rate for Payer: MI Amish Medical Board Commercial	$23.52
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.53
Rate for Payer: Nomi Health Commercial	$67.08
Rate for Payer: PACE Senior Care Partners	$19.43
Rate for Payer: PACE SWMI	$20.45
Rate for Payer: PHP Commercial	$69.53
Rate for Payer: PHP Medicare Advantage	$20.45
Rate for Payer: Priority Health Cigna Priority Health	$53.17
Rate for Payer: Priority Health HMO/PPO	$71.17
Rate for Payer: Priority Health Medicare	$20.65
Rate for Payer: Priority Health Narrow/Tiered Network	$54.81
Rate for Payer: Railroad Medicare Medicare	$20.45
Rate for Payer: UHC All Payor (Choice/PPO)	$71.98
Rate for Payer: UHC Core	$68.30
Rate for Payer: UHC Dual Complete DSNP	$20.45
Rate for Payer: UHC Exchange	$20.45
Rate for Payer: UHC Medicare Advantage	$20.45
Rate for Payer: VA VA	$20.45
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$61.35

EZETIMIBE 10 MG TABLET

Facility

$81.80

Service Code	NDC 67877049030
Hospital Charge Code	34153
Hospital Revenue Code	637
Min. Negotiated Rate	$53.17
Max. Negotiated Rate	$73.62
Rate for Payer: Aetna Commercial	$69.53
Rate for Payer: BCBS Trust/PPO	$66.77
Rate for Payer: BCN Commercial	$63.22
Rate for Payer: Cash Price	$65.44
Rate for Payer: Cofinity Commercial	$70.35
Rate for Payer: Encore Health Key Benefits Commercial	$65.44
Rate for Payer: Healthscope Commercial	$73.62
Rate for Payer: Lakeland Regional Health Systems Commercial	$61.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.53
Rate for Payer: Nomi Health Commercial	$67.08
Rate for Payer: PHP Commercial	$69.53
Rate for Payer: Priority Health Cigna Priority Health	$53.17
Rate for Payer: Priority Health HMO/PPO	$71.17
Rate for Payer: Priority Health Narrow/Tiered Network	$54.81
Rate for Payer: UHC All Payor (Choice/PPO)	$71.98
Rate for Payer: UHC Core	$68.30
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$61.35

EZETIMIBE 10 MG TABLET

Facility

$488.96

Service Code	NDC 00904710304
Hospital Charge Code	34153
Hospital Revenue Code	637
Min. Negotiated Rate	$317.82
Max. Negotiated Rate	$440.06
Rate for Payer: Aetna Commercial	$415.62
Rate for Payer: BCBS Trust/PPO	$399.14
Rate for Payer: BCN Commercial	$377.87
Rate for Payer: Cash Price	$391.17
Rate for Payer: Cofinity Commercial	$420.51
Rate for Payer: Encore Health Key Benefits Commercial	$391.17
Rate for Payer: Healthscope Commercial	$440.06
Rate for Payer: Lakeland Regional Health Systems Commercial	$366.72
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$415.62
Rate for Payer: Nomi Health Commercial	$400.95
Rate for Payer: PHP Commercial	$415.62
Rate for Payer: Priority Health Cigna Priority Health	$317.82
Rate for Payer: Priority Health HMO/PPO	$425.40
Rate for Payer: Priority Health Narrow/Tiered Network	$327.60
Rate for Payer: UHC All Payor (Choice/PPO)	$430.28
Rate for Payer: UHC Core	$408.28
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$366.72

EZETIMIBE 10 MG TABLET

Facility

$488.96

Service Code	NDC 00904710304
Hospital Charge Code	34153
Hospital Revenue Code	637
Min. Negotiated Rate	$116.13
Max. Negotiated Rate	$440.06
Rate for Payer: Aetna Commercial	$415.62
Rate for Payer: Aetna Medicare	$127.13
Rate for Payer: Allen County Amish Medical Aid Commercial	$152.80
Rate for Payer: Amish Plain Church Group Commercial	$152.80
Rate for Payer: BCBS Complete	$195.58
Rate for Payer: BCBS MAPPO	$122.24
Rate for Payer: BCBS Trust/PPO	$401.97
Rate for Payer: BCN Commercial	$380.17
Rate for Payer: BCN Medicare Advantage	$122.24
Rate for Payer: Cash Price	$391.17
Rate for Payer: Cofinity Commercial	$420.51
Rate for Payer: Encore Health Key Benefits Commercial	$391.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$122.24
Rate for Payer: Healthscope Commercial	$440.06
Rate for Payer: Lakeland Regional Health Systems Commercial	$366.72
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$128.35
Rate for Payer: MI Amish Medical Board Commercial	$140.58
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$415.62
Rate for Payer: Nomi Health Commercial	$400.95
Rate for Payer: PACE Senior Care Partners	$116.13
Rate for Payer: PACE SWMI	$122.24
Rate for Payer: PHP Commercial	$415.62
Rate for Payer: PHP Medicare Advantage	$122.24
Rate for Payer: Priority Health Cigna Priority Health	$317.82
Rate for Payer: Priority Health HMO/PPO	$425.40
Rate for Payer: Priority Health Medicare	$123.46
Rate for Payer: Priority Health Narrow/Tiered Network	$327.60
Rate for Payer: Railroad Medicare Medicare	$122.24
Rate for Payer: UHC All Payor (Choice/PPO)	$430.28
Rate for Payer: UHC Core	$408.28
Rate for Payer: UHC Dual Complete DSNP	$122.24
Rate for Payer: UHC Exchange	$122.24
Rate for Payer: UHC Medicare Advantage	$122.24
Rate for Payer: VA VA	$122.24
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$366.72

EZETIMIBE 10 MG TABLET

Facility

$76.95

Service Code	NDC 00781569031
Hospital Charge Code	34153
Hospital Revenue Code	637
Min. Negotiated Rate	$50.02
Max. Negotiated Rate	$69.26
Rate for Payer: Aetna Commercial	$65.41
Rate for Payer: BCBS Trust/PPO	$62.81
Rate for Payer: BCN Commercial	$59.47
Rate for Payer: Cash Price	$61.56
Rate for Payer: Cofinity Commercial	$66.18
Rate for Payer: Encore Health Key Benefits Commercial	$61.56
Rate for Payer: Healthscope Commercial	$69.26
Rate for Payer: Lakeland Regional Health Systems Commercial	$57.71
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$65.41
Rate for Payer: Nomi Health Commercial	$63.10
Rate for Payer: PHP Commercial	$65.41
Rate for Payer: Priority Health Cigna Priority Health	$50.02
Rate for Payer: Priority Health HMO/PPO	$66.95
Rate for Payer: Priority Health Narrow/Tiered Network	$51.56
Rate for Payer: UHC All Payor (Choice/PPO)	$67.72
Rate for Payer: UHC Core	$64.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$57.71

FACIAL

Professional

Both

$66.00

Service Code	HCPCS 00174
Hospital Revenue Code	960
Min. Negotiated Rate	$26.40
Max. Negotiated Rate	$42.90
Rate for Payer: Aetna Medicare	$33.00
Rate for Payer: BCBS Complete	$26.40
Rate for Payer: Cash Price	$52.80
Rate for Payer: Priority Health Cigna Priority Health	$42.90

Know your out-of-pocket cost for care.

All Charges