Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM

Professional

Both

$259.00

Service Code	HCPCS 16025
Min. Negotiated Rate	$64.97
Max. Negotiated Rate	$194.25
Rate for Payer: Aetna Commercial	$119.21
Rate for Payer: Aetna Medicare	$129.50
Rate for Payer: BCBS Complete	$68.22
Rate for Payer: BCN Commercial	$166.33
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cash Price	$207.20
Rate for Payer: Mclaren Medicaid	$64.97
Rate for Payer: Meridian Medicaid	$68.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$194.25
Rate for Payer: Priority Health Choice Medicaid	$64.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$152.23
Rate for Payer: Priority Health Narrow/Tiered Network	$152.23
Rate for Payer: UHC Medicaid	$64.97
Rate for Payer: UHCCP Medicaid	$64.97

PR DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL

Professional

Both

$142.00

Service Code	HCPCS 16020
Min. Negotiated Rate	$34.72
Max. Negotiated Rate	$106.50
Rate for Payer: Aetna Commercial	$59.06
Rate for Payer: Aetna Medicare	$71.00
Rate for Payer: BCBS Complete	$36.46
Rate for Payer: BCN Commercial	$84.16
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Mclaren Medicaid	$34.72
Rate for Payer: Meridian Medicaid	$36.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$106.50
Rate for Payer: Priority Health Choice Medicaid	$34.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$77.03
Rate for Payer: Priority Health Narrow/Tiered Network	$77.03
Rate for Payer: UHC Medicaid	$34.72
Rate for Payer: UHCCP Medicaid	$34.72

PR DRUG-ELUTING STENTS, SINGLE

Professional

Both

$2,601.00

Service Code	HCPCS G0290
Min. Negotiated Rate	$1,040.40
Max. Negotiated Rate	$1,950.75
Rate for Payer: Aetna Medicare	$1,300.50
Rate for Payer: BCBS Complete	$1,040.40
Rate for Payer: Cash Price	$2,080.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,950.75

PR DRUG SCREEN MULTI DRUG CLASS

Professional

Both

$40.00

Service Code	HCPCS G0434
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Medicare	$20.00
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.00

PR DRUG SCREEN MULTIP CLASS

Professional

Both

$64.00

Service Code	HCPCS G0431
Min. Negotiated Rate	$25.60
Max. Negotiated Rate	$48.00
Rate for Payer: Aetna Medicare	$32.00
Rate for Payer: BCBS Complete	$25.60
Rate for Payer: Cash Price	$51.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$48.00

PR DRUG SCREEN PANEL 10 WITH BATH SALTS

Professional

Both

$79.00

Hospital Revenue Code	960
Min. Negotiated Rate	$31.60
Max. Negotiated Rate	$59.25
Rate for Payer: Aetna Medicare	$39.50
Rate for Payer: BCBS Complete	$31.60
Rate for Payer: Cash Price	$63.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$59.25

PR DSTL REVSC&INTERVAL LIG UXTR HEMO ACCESS

Professional

Both

$2,507.00

Service Code	HCPCS 36838
Min. Negotiated Rate	$657.11
Max. Negotiated Rate	$1,880.25
Rate for Payer: Aetna Commercial	$1,535.31
Rate for Payer: Aetna Medicare	$1,253.50
Rate for Payer: BCBS Complete	$689.97
Rate for Payer: BCN Commercial	$1,668.24
Rate for Payer: Cash Price	$2,005.60
Rate for Payer: Cash Price	$2,005.60
Rate for Payer: Mclaren Medicaid	$657.11
Rate for Payer: Meridian Medicaid	$689.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,880.25
Rate for Payer: Priority Health Choice Medicaid	$657.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,793.98
Rate for Payer: Priority Health Narrow/Tiered Network	$1,793.98
Rate for Payer: UHC Medicaid	$657.11
Rate for Payer: UHCCP Medicaid	$657.11

PR DSTRJ CUTANEOUS VASCULAR PRLF LES 10.0-50.0SQCM

Professional

Both

$843.00

Service Code	HCPCS 17107
Min. Negotiated Rate	$197.03
Max. Negotiated Rate	$632.25
Rate for Payer: Aetna Commercial	$379.73
Rate for Payer: Aetna Medicare	$421.50
Rate for Payer: BCBS Complete	$206.88
Rate for Payer: BCN Commercial	$429.61
Rate for Payer: Cash Price	$674.40
Rate for Payer: Cash Price	$674.40
Rate for Payer: Mclaren Medicaid	$197.03
Rate for Payer: Meridian Medicaid	$206.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$632.25
Rate for Payer: Priority Health Choice Medicaid	$197.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$498.62
Rate for Payer: Priority Health Narrow/Tiered Network	$498.62
Rate for Payer: UHC Medicaid	$197.03
Rate for Payer: UHCCP Medicaid	$197.03

PR DSTRJ CUTANEOUS VASCULAR PRLF LESIONS>50.0 SQ CM

Professional

Both

$1,205.00

Service Code	HCPCS 17108
Min. Negotiated Rate	$289.25
Max. Negotiated Rate	$903.75
Rate for Payer: Aetna Commercial	$559.13
Rate for Payer: Aetna Medicare	$602.50
Rate for Payer: BCBS Complete	$303.71
Rate for Payer: BCN Commercial	$627.93
Rate for Payer: Cash Price	$964.00
Rate for Payer: Cash Price	$964.00
Rate for Payer: Mclaren Medicaid	$289.25
Rate for Payer: Meridian Medicaid	$303.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$903.75
Rate for Payer: Priority Health Choice Medicaid	$289.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$728.79
Rate for Payer: Priority Health Narrow/Tiered Network	$728.79
Rate for Payer: UHC Medicaid	$289.25
Rate for Payer: UHCCP Medicaid	$289.25

PR DSTRJ LESION ANUS EXTENSIVE

Professional

Both

$891.00

Service Code	HCPCS 46924
Hospital Charge Code	46924
Min. Negotiated Rate	$109.70
Max. Negotiated Rate	$668.25
Rate for Payer: Aetna Commercial	$239.74
Rate for Payer: Aetna Medicare	$445.50
Rate for Payer: BCBS Complete	$115.19
Rate for Payer: BCN Commercial	$275.88
Rate for Payer: Cash Price	$712.80
Rate for Payer: Cash Price	$712.80
Rate for Payer: Mclaren Medicaid	$109.70
Rate for Payer: Meridian Medicaid	$115.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$668.25
Rate for Payer: Priority Health Choice Medicaid	$109.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$336.14
Rate for Payer: Priority Health Narrow/Tiered Network	$336.14
Rate for Payer: UHC Medicaid	$109.70
Rate for Payer: UHCCP Medicaid	$109.70

PR DSTRJ LESION ANUS EXTENSIVE

Professional

Both

$891.00

Service Code	HCPCS 46924
Min. Negotiated Rate	$109.70
Max. Negotiated Rate	$668.25
Rate for Payer: Aetna Commercial	$239.74
Rate for Payer: Aetna Medicare	$445.50
Rate for Payer: BCBS Complete	$115.19
Rate for Payer: BCN Commercial	$275.88
Rate for Payer: Cash Price	$712.80
Rate for Payer: Cash Price	$712.80
Rate for Payer: Mclaren Medicaid	$109.70
Rate for Payer: Meridian Medicaid	$115.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$668.25
Rate for Payer: Priority Health Choice Medicaid	$109.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$336.14
Rate for Payer: Priority Health Narrow/Tiered Network	$336.14
Rate for Payer: UHC Medicaid	$109.70
Rate for Payer: UHCCP Medicaid	$109.70

PR DSTRJ LESION ANUS EXTENSIVE

Facility

$891.00

Service Code	CPT 46924
Hospital Charge Code	46924
Hospital Revenue Code	960
Min. Negotiated Rate	$620.14
Max. Negotiated Rate	$801.90
Rate for Payer: Aetna Commercial	$757.35
Rate for Payer: BCBS Trust/PPO	$735.88
Rate for Payer: BCN Commercial	$735.88
Rate for Payer: Cash Price	$712.80
Rate for Payer: Cofinity Commercial	$766.26
Rate for Payer: Encore Health Key Benefits Commercial	$712.80
Rate for Payer: Healthscope Commercial	$801.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$668.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$757.35
Rate for Payer: Nomi Health Commercial	$730.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$668.25
Rate for Payer: PHP Commercial	$757.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$775.17
Rate for Payer: Priority Health Narrow/Tiered Network	$620.14
Rate for Payer: UHC Core	$743.99
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$668.25

PR DSTRJ LESION ANUS EXTENSIVE

Facility

$891.00

Service Code	CPT 46924
Hospital Charge Code	46924
Hospital Revenue Code	960
Min. Negotiated Rate	$157.08
Max. Negotiated Rate	$801.90
Rate for Payer: Aetna Commercial	$757.35
Rate for Payer: Aetna Medicare	$231.66
Rate for Payer: Allen County Amish Medical Aid Commercial	$278.44
Rate for Payer: Amish Plain Church Group Commercial	$278.44
Rate for Payer: BCBS Complete	$164.92
Rate for Payer: BCBS MAPPO	$222.75
Rate for Payer: BCBS Trust/PPO	$732.49
Rate for Payer: BCN Commercial	$732.49
Rate for Payer: BCN Medicare Advantage	$222.75
Rate for Payer: Cash Price	$712.80
Rate for Payer: Cofinity Commercial	$766.26
Rate for Payer: Encore Health Key Benefits Commercial	$712.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$222.75
Rate for Payer: Healthscope Commercial	$801.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$668.25
Rate for Payer: Mclaren Medicaid	$157.08
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$233.89
Rate for Payer: Meridian Medicaid	$164.92
Rate for Payer: MI Amish Medical Board Commercial	$256.16
Rate for Payer: Molina Medicare/Medicaid	$245.03
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$757.35
Rate for Payer: Nomi Health Commercial	$730.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$668.25
Rate for Payer: PACE Senior Care Partners	$211.61
Rate for Payer: PACE SWMI	$222.75
Rate for Payer: PHP Commercial	$757.35
Rate for Payer: PHP Medicare Advantage	$222.75
Rate for Payer: Priority Health Choice Medicaid	$157.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$775.17
Rate for Payer: Priority Health Medicare	$224.98
Rate for Payer: Priority Health Narrow/Tiered Network	$620.14
Rate for Payer: Railroad Medicare Medicare	$222.75
Rate for Payer: UHC Core	$743.99
Rate for Payer: UHC Exchange	$222.75
Rate for Payer: UHC Medicaid	$157.08
Rate for Payer: UHC Medicare Advantage	$222.75
Rate for Payer: UHCCP Medicaid	$157.08
Rate for Payer: VA VA	$222.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$668.25

PR DSTRJ LESION ANUS SIMPLE CHEMICAL

Professional

Both

$394.00

Service Code	HCPCS 46900
Min. Negotiated Rate	$84.35
Max. Negotiated Rate	$295.50
Rate for Payer: Aetna Commercial	$179.17
Rate for Payer: Aetna Medicare	$197.00
Rate for Payer: BCBS Complete	$88.57
Rate for Payer: BCN Commercial	$209.15
Rate for Payer: Cash Price	$315.20
Rate for Payer: Cash Price	$315.20
Rate for Payer: Mclaren Medicaid	$84.35
Rate for Payer: Meridian Medicaid	$88.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$295.50
Rate for Payer: Priority Health Choice Medicaid	$84.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$254.85
Rate for Payer: Priority Health Narrow/Tiered Network	$254.85
Rate for Payer: UHC Medicaid	$84.35
Rate for Payer: UHCCP Medicaid	$84.35

PR DSTRJ LESION ANUS SIMPLE CRYOSURGERY

Professional

Both

$424.00

Service Code	HCPCS 46916
Min. Negotiated Rate	$77.96
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$184.99
Rate for Payer: Aetna Medicare	$212.00
Rate for Payer: BCBS Complete	$81.86
Rate for Payer: BCN Commercial	$214.13
Rate for Payer: Cash Price	$339.20
Rate for Payer: Cash Price	$339.20
Rate for Payer: Mclaren Medicaid	$77.96
Rate for Payer: Meridian Medicaid	$81.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$318.00
Rate for Payer: Priority Health Choice Medicaid	$77.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$260.91
Rate for Payer: Priority Health Narrow/Tiered Network	$260.91
Rate for Payer: UHC Medicaid	$77.96
Rate for Payer: UHCCP Medicaid	$77.96

PR DSTRJ LESION ANUS SIMPLE LASER SURG

Professional

Both

$735.00

Service Code	HCPCS 46917
Min. Negotiated Rate	$77.11
Max. Negotiated Rate	$551.25
Rate for Payer: Aetna Commercial	$169.46
Rate for Payer: Aetna Medicare	$367.50
Rate for Payer: BCBS Complete	$80.97
Rate for Payer: BCN Commercial	$195.21
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cash Price	$588.00
Rate for Payer: Mclaren Medicaid	$77.11
Rate for Payer: Meridian Medicaid	$80.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$551.25
Rate for Payer: Priority Health Choice Medicaid	$77.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$237.85
Rate for Payer: Priority Health Narrow/Tiered Network	$237.85
Rate for Payer: UHC Medicaid	$77.11
Rate for Payer: UHCCP Medicaid	$77.11

PR DSTRJ LESION ANUS SIMPLE SURG EXCISION

Professional

Both

$533.00

Service Code	HCPCS 46922
Min. Negotiated Rate	$85.63
Max. Negotiated Rate	$399.75
Rate for Payer: Aetna Commercial	$181.18
Rate for Payer: Aetna Medicare	$266.50
Rate for Payer: BCBS Complete	$89.91
Rate for Payer: BCN Commercial	$209.15
Rate for Payer: Cash Price	$426.40
Rate for Payer: Cash Price	$426.40
Rate for Payer: Mclaren Medicaid	$85.63
Rate for Payer: Meridian Medicaid	$89.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$399.75
Rate for Payer: Priority Health Choice Medicaid	$85.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$254.85
Rate for Payer: Priority Health Narrow/Tiered Network	$254.85
Rate for Payer: UHC Medicaid	$85.63
Rate for Payer: UHCCP Medicaid	$85.63

PR DSTRJ LESION ANUS SIMPLE SURG EXCISION

Facility

$533.00

Service Code	CPT 46922
Hospital Charge Code	46922
Hospital Revenue Code	960
Min. Negotiated Rate	$93.97
Max. Negotiated Rate	$479.70
Rate for Payer: Aetna Commercial	$453.05
Rate for Payer: Aetna Medicare	$138.58
Rate for Payer: Allen County Amish Medical Aid Commercial	$166.56
Rate for Payer: Amish Plain Church Group Commercial	$166.56
Rate for Payer: BCBS Complete	$98.66
Rate for Payer: BCBS MAPPO	$133.25
Rate for Payer: BCBS Trust/PPO	$438.18
Rate for Payer: BCN Commercial	$438.18
Rate for Payer: BCN Medicare Advantage	$133.25
Rate for Payer: Cash Price	$426.40
Rate for Payer: Cofinity Commercial	$458.38
Rate for Payer: Encore Health Key Benefits Commercial	$426.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$133.25
Rate for Payer: Healthscope Commercial	$479.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$399.75
Rate for Payer: Mclaren Medicaid	$93.97
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$139.91
Rate for Payer: Meridian Medicaid	$98.66
Rate for Payer: MI Amish Medical Board Commercial	$153.24
Rate for Payer: Molina Medicare/Medicaid	$146.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$453.05
Rate for Payer: Nomi Health Commercial	$437.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$399.75
Rate for Payer: PACE Senior Care Partners	$126.59
Rate for Payer: PACE SWMI	$133.25
Rate for Payer: PHP Commercial	$453.05
Rate for Payer: PHP Medicare Advantage	$133.25
Rate for Payer: Priority Health Choice Medicaid	$93.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$463.71
Rate for Payer: Priority Health Medicare	$134.58
Rate for Payer: Priority Health Narrow/Tiered Network	$370.97
Rate for Payer: Railroad Medicare Medicare	$133.25
Rate for Payer: UHC Core	$445.06
Rate for Payer: UHC Exchange	$133.25
Rate for Payer: UHC Medicaid	$93.97
Rate for Payer: UHC Medicare Advantage	$133.25
Rate for Payer: UHCCP Medicaid	$93.97
Rate for Payer: VA VA	$133.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$399.75

PR DSTRJ LESION ANUS SIMPLE SURG EXCISION

Facility

$533.00

Service Code	CPT 46922
Hospital Charge Code	46922
Hospital Revenue Code	960
Min. Negotiated Rate	$370.97
Max. Negotiated Rate	$479.70
Rate for Payer: Aetna Commercial	$453.05
Rate for Payer: BCBS Trust/PPO	$440.20
Rate for Payer: BCN Commercial	$440.20
Rate for Payer: Cash Price	$426.40
Rate for Payer: Cofinity Commercial	$458.38
Rate for Payer: Encore Health Key Benefits Commercial	$426.40
Rate for Payer: Healthscope Commercial	$479.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$399.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$453.05
Rate for Payer: Nomi Health Commercial	$437.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$399.75
Rate for Payer: PHP Commercial	$453.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$463.71
Rate for Payer: Priority Health Narrow/Tiered Network	$370.97
Rate for Payer: UHC Core	$445.06
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$399.75

PR DSTRJ LESION ANUS SIMPLE SURG EXCISION

Professional

Both

$533.00

Service Code	HCPCS 46922
Hospital Charge Code	46922
Min. Negotiated Rate	$85.63
Max. Negotiated Rate	$399.75
Rate for Payer: Aetna Commercial	$181.18
Rate for Payer: Aetna Medicare	$266.50
Rate for Payer: BCBS Complete	$89.91
Rate for Payer: BCN Commercial	$209.15
Rate for Payer: Cash Price	$426.40
Rate for Payer: Cash Price	$426.40
Rate for Payer: Mclaren Medicaid	$85.63
Rate for Payer: Meridian Medicaid	$89.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$399.75
Rate for Payer: Priority Health Choice Medicaid	$85.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$254.85
Rate for Payer: Priority Health Narrow/Tiered Network	$254.85
Rate for Payer: UHC Medicaid	$85.63
Rate for Payer: UHCCP Medicaid	$85.63

PR DSTRJ LESION ANUS SMPL ELTRDSICCATION

Professional

Both

$427.00

Service Code	HCPCS 46910
Min. Negotiated Rate	$82.86
Max. Negotiated Rate	$320.25
Rate for Payer: Aetna Commercial	$178.48
Rate for Payer: Aetna Medicare	$213.50
Rate for Payer: BCBS Complete	$87.00
Rate for Payer: BCN Commercial	$203.67
Rate for Payer: Cash Price	$341.60
Rate for Payer: Cash Price	$341.60
Rate for Payer: Mclaren Medicaid	$82.86
Rate for Payer: Meridian Medicaid	$87.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$320.25
Rate for Payer: Priority Health Choice Medicaid	$82.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$248.17
Rate for Payer: Priority Health Narrow/Tiered Network	$248.17
Rate for Payer: UHC Medicaid	$82.86
Rate for Payer: UHCCP Medicaid	$82.86

PR DSTRJ LESION PALATE/UVULA THERMAL CRYO/CHEM

Professional

Both

$443.00

Service Code	HCPCS 42160
Min. Negotiated Rate	$82.22
Max. Negotiated Rate	$332.25
Rate for Payer: Aetna Commercial	$189.22
Rate for Payer: Aetna Medicare	$221.50
Rate for Payer: BCBS Complete	$86.33
Rate for Payer: BCN Commercial	$211.14
Rate for Payer: Cash Price	$354.40
Rate for Payer: Cash Price	$354.40
Rate for Payer: Mclaren Medicaid	$82.22
Rate for Payer: Meridian Medicaid	$86.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$332.25
Rate for Payer: Priority Health Choice Medicaid	$82.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$257.27
Rate for Payer: Priority Health Narrow/Tiered Network	$257.27
Rate for Payer: UHC Medicaid	$82.22
Rate for Payer: UHCCP Medicaid	$82.22

PR DSTRJ LESION PENIS EXTENSIVE

Professional

Both

$479.00

Service Code	HCPCS 54065
Min. Negotiated Rate	$96.06
Max. Negotiated Rate	$359.25
Rate for Payer: Aetna Commercial	$215.30
Rate for Payer: Aetna Medicare	$239.50
Rate for Payer: BCBS Complete	$100.86
Rate for Payer: BCN Commercial	$262.44
Rate for Payer: Cash Price	$383.20
Rate for Payer: Cash Price	$383.20
Rate for Payer: Mclaren Medicaid	$96.06
Rate for Payer: Meridian Medicaid	$100.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$359.25
Rate for Payer: Priority Health Choice Medicaid	$96.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$285.88
Rate for Payer: Priority Health Narrow/Tiered Network	$285.88
Rate for Payer: UHC Medicaid	$96.06
Rate for Payer: UHCCP Medicaid	$96.06

PR DSTRJ LESION PENIS SIMPLE CHEMICAL

Professional

Both

$231.00

Service Code	HCPCS 54050
Min. Negotiated Rate	$61.77
Max. Negotiated Rate	$177.38
Rate for Payer: Aetna Commercial	$132.50
Rate for Payer: Aetna Medicare	$115.50
Rate for Payer: BCBS Complete	$64.86
Rate for Payer: BCN Commercial	$162.84
Rate for Payer: Cash Price	$184.80
Rate for Payer: Cash Price	$184.80
Rate for Payer: Mclaren Medicaid	$61.77
Rate for Payer: Meridian Medicaid	$64.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$173.25
Rate for Payer: Priority Health Choice Medicaid	$61.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$177.38
Rate for Payer: Priority Health Narrow/Tiered Network	$177.38
Rate for Payer: UHC Medicaid	$61.77
Rate for Payer: UHCCP Medicaid	$61.77

PR DSTRJ LESION PENIS SIMPLE CRYOSURGERY

Professional

Both

$278.00

Service Code	HCPCS 54056
Min. Negotiated Rate	$63.26
Max. Negotiated Rate	$208.50
Rate for Payer: Aetna Commercial	$137.02
Rate for Payer: Aetna Medicare	$139.00
Rate for Payer: BCBS Complete	$66.42
Rate for Payer: BCN Commercial	$135.09
Rate for Payer: Cash Price	$222.40
Rate for Payer: Cash Price	$222.40
Rate for Payer: Mclaren Medicaid	$63.26
Rate for Payer: Meridian Medicaid	$66.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$208.50
Rate for Payer: Priority Health Choice Medicaid	$63.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$186.60
Rate for Payer: Priority Health Narrow/Tiered Network	$186.60
Rate for Payer: UHC Medicaid	$63.26
Rate for Payer: UHCCP Medicaid	$63.26

Know your out-of-pocket cost for care.

All Charges