Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX

Facility

$221.00

Service Code	CPT 58100
Hospital Charge Code	58100
Hospital Revenue Code	521
Min. Negotiated Rate	$38.96
Max. Negotiated Rate	$198.90
Rate for Payer: Aetna Commercial	$187.85
Rate for Payer: Aetna Medicare	$57.46
Rate for Payer: Allen County Amish Medical Aid Commercial	$69.06
Rate for Payer: Amish Plain Church Group Commercial	$69.06
Rate for Payer: BCBS Complete	$40.91
Rate for Payer: BCBS MAPPO	$55.25
Rate for Payer: BCBS Trust/PPO	$181.68
Rate for Payer: BCCCP Commercial	$97.15
Rate for Payer: BCN Commercial	$181.68
Rate for Payer: BCN Medicare Advantage	$55.25
Rate for Payer: Cash Price	$176.80
Rate for Payer: Cash Price	$176.80
Rate for Payer: Cofinity Commercial	$190.06
Rate for Payer: Encore Health Key Benefits Commercial	$176.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$55.25
Rate for Payer: Healthscope Commercial	$198.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$165.75
Rate for Payer: Mclaren Medicaid	$38.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$58.01
Rate for Payer: Meridian Medicaid	$40.91
Rate for Payer: MI Amish Medical Board Commercial	$63.54
Rate for Payer: Molina Medicare/Medicaid	$60.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$187.85
Rate for Payer: Nomi Health Commercial	$181.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$165.75
Rate for Payer: PACE Senior Care Partners	$52.49
Rate for Payer: PACE SWMI	$55.25
Rate for Payer: PHP Commercial	$187.85
Rate for Payer: PHP Medicare Advantage	$55.25
Rate for Payer: Priority Health Choice Medicaid	$38.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$192.27
Rate for Payer: Priority Health Medicare	$55.80
Rate for Payer: Priority Health Narrow/Tiered Network	$153.82
Rate for Payer: Railroad Medicare Medicare	$55.25
Rate for Payer: UHC Core	$184.53
Rate for Payer: UHC Exchange	$55.25
Rate for Payer: UHC Medicaid	$38.96
Rate for Payer: UHC Medicare Advantage	$55.25
Rate for Payer: UHCCP Medicaid	$38.96
Rate for Payer: VA VA	$55.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$165.75

PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX

Professional

Both

$221.00

Service Code	HCPCS 58100
Hospital Charge Code	58100
Min. Negotiated Rate	$35.15
Max. Negotiated Rate	$165.75
Rate for Payer: Aetna Commercial	$76.79
Rate for Payer: Aetna Medicare	$110.50
Rate for Payer: BCBS Complete	$36.91
Rate for Payer: BCN Commercial	$74.22
Rate for Payer: Cash Price	$176.80
Rate for Payer: Cash Price	$176.80
Rate for Payer: Mclaren Medicaid	$35.15
Rate for Payer: Meridian Medicaid	$36.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$165.75
Rate for Payer: Priority Health Choice Medicaid	$35.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$95.31
Rate for Payer: Priority Health Narrow/Tiered Network	$95.31
Rate for Payer: UHC Medicaid	$35.15
Rate for Payer: UHCCP Medicaid	$35.15

PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX

Professional

Both

$221.00

Service Code	HCPCS 58100
Min. Negotiated Rate	$35.15
Max. Negotiated Rate	$165.75
Rate for Payer: Aetna Commercial	$76.79
Rate for Payer: Aetna Medicare	$110.50
Rate for Payer: BCBS Complete	$36.91
Rate for Payer: BCN Commercial	$74.22
Rate for Payer: Cash Price	$176.80
Rate for Payer: Cash Price	$176.80
Rate for Payer: Mclaren Medicaid	$35.15
Rate for Payer: Meridian Medicaid	$36.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$165.75
Rate for Payer: Priority Health Choice Medicaid	$35.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$95.31
Rate for Payer: Priority Health Narrow/Tiered Network	$95.31
Rate for Payer: UHC Medicaid	$35.15
Rate for Payer: UHCCP Medicaid	$35.15

PR ENDOMETRIAL BX W/WO ENDOCERVIX BX W/O DILAT SPX

Facility

$221.00

Service Code	CPT 58100
Hospital Charge Code	58100
Hospital Revenue Code	521
Min. Negotiated Rate	$153.82
Max. Negotiated Rate	$198.90
Rate for Payer: Aetna Commercial	$187.85
Rate for Payer: BCBS Trust/PPO	$182.52
Rate for Payer: BCN Commercial	$182.52
Rate for Payer: Cash Price	$176.80
Rate for Payer: Cofinity Commercial	$190.06
Rate for Payer: Encore Health Key Benefits Commercial	$176.80
Rate for Payer: Healthscope Commercial	$198.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$165.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$187.85
Rate for Payer: Nomi Health Commercial	$181.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$165.75
Rate for Payer: PHP Commercial	$187.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$192.27
Rate for Payer: Priority Health Narrow/Tiered Network	$153.82
Rate for Payer: UHC Core	$184.53
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$165.75

PR ENDOMETRIAL CRYOABLATION W/US & ENDOMETRIAL CR

Professional

Both

$2,897.00

Service Code	HCPCS 58356
Min. Negotiated Rate	$194.90
Max. Negotiated Rate	$2,172.75
Rate for Payer: Aetna Commercial	$426.17
Rate for Payer: Aetna Medicare	$1,448.50
Rate for Payer: BCBS Complete	$204.65
Rate for Payer: BCN Commercial	$526.37
Rate for Payer: Cash Price	$2,317.60
Rate for Payer: Cash Price	$2,317.60
Rate for Payer: Mclaren Medicaid	$194.90
Rate for Payer: Meridian Medicaid	$204.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,172.75
Rate for Payer: Priority Health Choice Medicaid	$194.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$533.09
Rate for Payer: Priority Health Narrow/Tiered Network	$533.09
Rate for Payer: UHC Medicaid	$194.90
Rate for Payer: UHCCP Medicaid	$194.90

PR ENDOSCOPIC PAPILLA CANNULATION BILE/PANCREATIC

Professional

Both

$482.00

Service Code	HCPCS 43273
Min. Negotiated Rate	$64.97
Max. Negotiated Rate	$361.50
Rate for Payer: Aetna Commercial	$159.96
Rate for Payer: Aetna Medicare	$241.00
Rate for Payer: BCBS Complete	$68.22
Rate for Payer: BCN Commercial	$174.79
Rate for Payer: Cash Price	$385.60
Rate for Payer: Cash Price	$385.60
Rate for Payer: Mclaren Medicaid	$64.97
Rate for Payer: Meridian Medicaid	$68.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$361.50
Rate for Payer: Priority Health Choice Medicaid	$64.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$212.98
Rate for Payer: Priority Health Narrow/Tiered Network	$212.98
Rate for Payer: UHC Medicaid	$64.97
Rate for Payer: UHCCP Medicaid	$64.97

PR ENDOSCOPY UPPER SMALL INTESTINE

Professional

Both

$963.00

Service Code	HCPCS 44360
Min. Negotiated Rate	$81.37
Max. Negotiated Rate	$722.25
Rate for Payer: Aetna Commercial	$190.22
Rate for Payer: Aetna Medicare	$481.50
Rate for Payer: BCBS Complete	$85.44
Rate for Payer: BCN Commercial	$211.65
Rate for Payer: Cash Price	$770.40
Rate for Payer: Cash Price	$770.40
Rate for Payer: Mclaren Medicaid	$81.37
Rate for Payer: Meridian Medicaid	$85.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$722.25
Rate for Payer: Priority Health Choice Medicaid	$81.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$257.87
Rate for Payer: Priority Health Narrow/Tiered Network	$257.87
Rate for Payer: UHC Medicaid	$81.37
Rate for Payer: UHCCP Medicaid	$81.37

PR ENDOSCOPY UPPER SMALL INTESTINE W/BIOPSY

Professional

Both

$1,018.00

Service Code	HCPCS 44361
Min. Negotiated Rate	$89.67
Max. Negotiated Rate	$763.50
Rate for Payer: Aetna Commercial	$210.83
Rate for Payer: Aetna Medicare	$509.00
Rate for Payer: BCBS Complete	$94.15
Rate for Payer: BCN Commercial	$234.05
Rate for Payer: Cash Price	$814.40
Rate for Payer: Cash Price	$814.40
Rate for Payer: Mclaren Medicaid	$89.67
Rate for Payer: Meridian Medicaid	$94.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$763.50
Rate for Payer: Priority Health Choice Medicaid	$89.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$285.18
Rate for Payer: Priority Health Narrow/Tiered Network	$285.18
Rate for Payer: UHC Medicaid	$89.67
Rate for Payer: UHCCP Medicaid	$89.67

PR ENDOVASC ABDO REPAIR W/PROS

Professional

Both

$5,493.00

Service Code	HCPCS 34805
Min. Negotiated Rate	$2,197.20
Max. Negotiated Rate	$4,119.75
Rate for Payer: Aetna Medicare	$2,746.50
Rate for Payer: BCBS Complete	$2,197.20
Rate for Payer: Cash Price	$4,394.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,119.75

PR ENDOVASCULAR REPAIR ILIAC ARTERY W ILIO-ILIAC PROSTHESIS

Professional

Both

$1,819.00

Service Code	HCPCS 34900
Min. Negotiated Rate	$727.60
Max. Negotiated Rate	$1,364.25
Rate for Payer: Aetna Medicare	$909.50
Rate for Payer: BCBS Complete	$727.60
Rate for Payer: Cash Price	$1,455.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,364.25

PR ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN

Professional

Both

$2,823.00

Service Code	HCPCS 36478
Min. Negotiated Rate	$157.41
Max. Negotiated Rate	$2,117.25
Rate for Payer: Aetna Commercial	$372.23
Rate for Payer: Aetna Medicare	$1,411.50
Rate for Payer: BCBS Complete	$165.28
Rate for Payer: BCN Commercial	$407.35
Rate for Payer: Cash Price	$2,258.40
Rate for Payer: Cash Price	$2,258.40
Rate for Payer: Mclaren Medicaid	$157.41
Rate for Payer: Meridian Medicaid	$165.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,117.25
Rate for Payer: Priority Health Choice Medicaid	$157.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$438.04
Rate for Payer: Priority Health Narrow/Tiered Network	$438.04
Rate for Payer: UHC Medicaid	$157.41
Rate for Payer: UHCCP Medicaid	$157.41

PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN

Professional

Both

$3,243.00

Service Code	HCPCS 36475
Min. Negotiated Rate	$157.19
Max. Negotiated Rate	$2,432.25
Rate for Payer: Aetna Commercial	$374.63
Rate for Payer: Aetna Medicare	$1,621.50
Rate for Payer: BCBS Complete	$165.05
Rate for Payer: BCN Commercial	$406.35
Rate for Payer: Cash Price	$2,594.40
Rate for Payer: Cash Price	$2,594.40
Rate for Payer: Mclaren Medicaid	$157.19
Rate for Payer: Meridian Medicaid	$165.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,432.25
Rate for Payer: Priority Health Choice Medicaid	$157.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$436.98
Rate for Payer: Priority Health Narrow/Tiered Network	$436.98
Rate for Payer: UHC Medicaid	$157.19
Rate for Payer: UHCCP Medicaid	$157.19

PR ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS

Professional

Both

$336.00

Service Code	HCPCS 36476
Min. Negotiated Rate	$74.98
Max. Negotiated Rate	$252.00
Rate for Payer: Aetna Commercial	$180.63
Rate for Payer: Aetna Medicare	$168.00
Rate for Payer: BCBS Complete	$78.73
Rate for Payer: BCN Commercial	$195.70
Rate for Payer: Cash Price	$268.80
Rate for Payer: Cash Price	$268.80
Rate for Payer: Mclaren Medicaid	$74.98
Rate for Payer: Meridian Medicaid	$78.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$252.00
Rate for Payer: Priority Health Choice Medicaid	$74.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$210.45
Rate for Payer: Priority Health Narrow/Tiered Network	$210.45
Rate for Payer: UHC Medicaid	$74.98
Rate for Payer: UHCCP Medicaid	$74.98

PR ENTERECTOMY RESCJ SMALL INTESTINE EA RESCJ & ANA

Professional

Both

$1,709.00

Service Code	HCPCS 44121
Min. Negotiated Rate	$138.02
Max. Negotiated Rate	$1,281.75
Rate for Payer: Aetna Commercial	$326.50
Rate for Payer: Aetna Medicare	$854.50
Rate for Payer: BCBS Complete	$144.92
Rate for Payer: BCN Commercial	$357.05
Rate for Payer: Cash Price	$1,367.20
Rate for Payer: Cash Price	$1,367.20
Rate for Payer: Mclaren Medicaid	$138.02
Rate for Payer: Meridian Medicaid	$144.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,281.75
Rate for Payer: Priority Health Choice Medicaid	$138.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$435.04
Rate for Payer: Priority Health Narrow/Tiered Network	$435.04
Rate for Payer: UHC Medicaid	$138.02
Rate for Payer: UHCCP Medicaid	$138.02

PR ENTERECTOMY RESCJ SMALL INTESTINE W/ENTEROSTOMY

Professional

Both

$3,602.00

Service Code	HCPCS 44125
Min. Negotiated Rate	$699.92
Max. Negotiated Rate	$2,701.50
Rate for Payer: Aetna Commercial	$1,588.54
Rate for Payer: Aetna Medicare	$1,801.00
Rate for Payer: BCBS Complete	$734.92
Rate for Payer: BCN Commercial	$1,762.85
Rate for Payer: Cash Price	$2,881.60
Rate for Payer: Cash Price	$2,881.60
Rate for Payer: Mclaren Medicaid	$699.92
Rate for Payer: Meridian Medicaid	$734.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,701.50
Rate for Payer: Priority Health Choice Medicaid	$699.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,147.93
Rate for Payer: Priority Health Narrow/Tiered Network	$2,147.93
Rate for Payer: UHC Medicaid	$699.92
Rate for Payer: UHCCP Medicaid	$699.92

PR ENTEROCYSTOPLASTY W/INTESTINAL ANASTOMOSIS

Professional

Both

$2,963.00

Service Code	HCPCS 51960
Min. Negotiated Rate	$788.74
Max. Negotiated Rate	$2,245.25
Rate for Payer: Aetna Commercial	$1,776.46
Rate for Payer: Aetna Medicare	$1,481.50
Rate for Payer: BCBS Complete	$828.18
Rate for Payer: BCN Commercial	$2,061.14
Rate for Payer: Cash Price	$2,370.40
Rate for Payer: Cash Price	$2,370.40
Rate for Payer: Mclaren Medicaid	$788.74
Rate for Payer: Meridian Medicaid	$828.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,222.25
Rate for Payer: Priority Health Choice Medicaid	$788.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,245.25
Rate for Payer: Priority Health Narrow/Tiered Network	$2,245.25
Rate for Payer: UHC Medicaid	$788.74
Rate for Payer: UHCCP Medicaid	$788.74

PR ENTEROENTEROST ANAST INT W/WO CUTAN NTRSTM SPX

Professional

Both

$3,267.00

Service Code	HCPCS 44130
Min. Negotiated Rate	$784.91
Max. Negotiated Rate	$2,450.25
Rate for Payer: Aetna Commercial	$1,773.78
Rate for Payer: Aetna Medicare	$1,633.50
Rate for Payer: BCBS Complete	$824.16
Rate for Payer: BCN Commercial	$1,975.99
Rate for Payer: Cash Price	$2,613.60
Rate for Payer: Cash Price	$2,613.60
Rate for Payer: Mclaren Medicaid	$784.91
Rate for Payer: Meridian Medicaid	$824.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,450.25
Rate for Payer: Priority Health Choice Medicaid	$784.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,407.62
Rate for Payer: Priority Health Narrow/Tiered Network	$2,407.62
Rate for Payer: UHC Medicaid	$784.91
Rate for Payer: UHCCP Medicaid	$784.91

PR ENTEROLSS FRING INTSTINAL ADHESION SPX

Professional

Both

$2,900.00

Service Code	HCPCS 44005
Hospital Charge Code	44005
Min. Negotiated Rate	$650.72
Max. Negotiated Rate	$2,175.00
Rate for Payer: Aetna Commercial	$1,475.02
Rate for Payer: Aetna Medicare	$1,450.00
Rate for Payer: BCBS Complete	$683.26
Rate for Payer: BCN Commercial	$1,637.86
Rate for Payer: Cash Price	$2,320.00
Rate for Payer: Cash Price	$2,320.00
Rate for Payer: Mclaren Medicaid	$650.72
Rate for Payer: Meridian Medicaid	$683.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,175.00
Rate for Payer: Priority Health Choice Medicaid	$650.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,995.63
Rate for Payer: Priority Health Narrow/Tiered Network	$1,995.63
Rate for Payer: UHC Medicaid	$650.72
Rate for Payer: UHCCP Medicaid	$650.72

PR ENTEROLSS FRING INTSTINAL ADHESION SPX

Professional

Both

$2,900.00

Service Code	HCPCS 44005
Min. Negotiated Rate	$650.72
Max. Negotiated Rate	$2,175.00
Rate for Payer: Aetna Commercial	$1,475.02
Rate for Payer: Aetna Medicare	$1,450.00
Rate for Payer: BCBS Complete	$683.26
Rate for Payer: BCN Commercial	$1,637.86
Rate for Payer: Cash Price	$2,320.00
Rate for Payer: Cash Price	$2,320.00
Rate for Payer: Mclaren Medicaid	$650.72
Rate for Payer: Meridian Medicaid	$683.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,175.00
Rate for Payer: Priority Health Choice Medicaid	$650.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,995.63
Rate for Payer: Priority Health Narrow/Tiered Network	$1,995.63
Rate for Payer: UHC Medicaid	$650.72
Rate for Payer: UHCCP Medicaid	$650.72

PR ENTEROLSS FRING INTSTINAL ADHESION SPX

Facility

$2,900.00

Service Code	CPT 44005
Hospital Charge Code	44005
Hospital Revenue Code	960
Min. Negotiated Rate	$511.27
Max. Negotiated Rate	$2,610.00
Rate for Payer: Aetna Commercial	$2,465.00
Rate for Payer: Aetna Medicare	$754.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$906.25
Rate for Payer: Amish Plain Church Group Commercial	$906.25
Rate for Payer: BCBS Complete	$536.79
Rate for Payer: BCBS MAPPO	$725.00
Rate for Payer: BCBS Trust/PPO	$2,384.09
Rate for Payer: BCN Commercial	$2,384.09
Rate for Payer: BCN Medicare Advantage	$725.00
Rate for Payer: Cash Price	$2,320.00
Rate for Payer: Cofinity Commercial	$2,494.00
Rate for Payer: Encore Health Key Benefits Commercial	$2,320.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$725.00
Rate for Payer: Healthscope Commercial	$2,610.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$2,175.00
Rate for Payer: Mclaren Medicaid	$511.27
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$761.25
Rate for Payer: Meridian Medicaid	$536.79
Rate for Payer: MI Amish Medical Board Commercial	$833.75
Rate for Payer: Molina Medicare/Medicaid	$797.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,465.00
Rate for Payer: Nomi Health Commercial	$2,378.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,175.00
Rate for Payer: PACE Senior Care Partners	$688.75
Rate for Payer: PACE SWMI	$725.00
Rate for Payer: PHP Commercial	$2,465.00
Rate for Payer: PHP Medicare Advantage	$725.00
Rate for Payer: Priority Health Choice Medicaid	$511.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,523.00
Rate for Payer: Priority Health Medicare	$732.25
Rate for Payer: Priority Health Narrow/Tiered Network	$2,018.40
Rate for Payer: Railroad Medicare Medicare	$725.00
Rate for Payer: UHC Core	$2,421.50
Rate for Payer: UHC Exchange	$725.00
Rate for Payer: UHC Medicaid	$511.27
Rate for Payer: UHC Medicare Advantage	$725.00
Rate for Payer: UHCCP Medicaid	$511.27
Rate for Payer: VA VA	$725.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2,175.00

PR ENTEROLSS FRING INTSTINAL ADHESION SPX

Facility

$2,900.00

Service Code	CPT 44005
Hospital Charge Code	44005
Hospital Revenue Code	960
Min. Negotiated Rate	$2,018.40
Max. Negotiated Rate	$2,610.00
Rate for Payer: Aetna Commercial	$2,465.00
Rate for Payer: BCBS Trust/PPO	$2,395.11
Rate for Payer: BCN Commercial	$2,395.11
Rate for Payer: Cash Price	$2,320.00
Rate for Payer: Cofinity Commercial	$2,494.00
Rate for Payer: Encore Health Key Benefits Commercial	$2,320.00
Rate for Payer: Healthscope Commercial	$2,610.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$2,175.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,465.00
Rate for Payer: Nomi Health Commercial	$2,378.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,175.00
Rate for Payer: PHP Commercial	$2,465.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,523.00
Rate for Payer: Priority Health Narrow/Tiered Network	$2,018.40
Rate for Payer: UHC Core	$2,421.50
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2,175.00

PR ENTERORRHAPHY MULTIPLE PERFORATIONS

Professional

Both

$3,173.00

Service Code	HCPCS 44603
Min. Negotiated Rate	$946.57
Max. Negotiated Rate	$2,943.98
Rate for Payer: Aetna Commercial	$2,183.13
Rate for Payer: Aetna Medicare	$1,586.50
Rate for Payer: BCBS Complete	$993.90
Rate for Payer: BCN Commercial	$2,416.21
Rate for Payer: Cash Price	$2,538.40
Rate for Payer: Cash Price	$2,538.40
Rate for Payer: Mclaren Medicaid	$946.57
Rate for Payer: Meridian Medicaid	$993.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,379.75
Rate for Payer: Priority Health Choice Medicaid	$946.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,943.98
Rate for Payer: Priority Health Narrow/Tiered Network	$2,943.98
Rate for Payer: UHC Medicaid	$946.57
Rate for Payer: UHCCP Medicaid	$946.57

PR ENTERORRHAPHY SINGLE PERFORATION

Professional

Both

$2,498.00

Service Code	HCPCS 44602
Min. Negotiated Rate	$822.82
Max. Negotiated Rate	$2,558.09
Rate for Payer: Aetna Commercial	$1,903.43
Rate for Payer: Aetna Medicare	$1,249.00
Rate for Payer: BCBS Complete	$863.96
Rate for Payer: BCN Commercial	$2,099.49
Rate for Payer: Cash Price	$1,998.40
Rate for Payer: Cash Price	$1,998.40
Rate for Payer: Mclaren Medicaid	$822.82
Rate for Payer: Meridian Medicaid	$863.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,873.50
Rate for Payer: Priority Health Choice Medicaid	$822.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,558.09
Rate for Payer: Priority Health Narrow/Tiered Network	$2,558.09
Rate for Payer: UHC Medicaid	$822.82
Rate for Payer: UHCCP Medicaid	$822.82

PR ENTEROSC >2ND PRTN W/ILEUM W/BX SINGLE/MULTIPLE

Professional

Both

$1,170.00

Service Code	HCPCS 44377
Min. Negotiated Rate	$166.35
Max. Negotiated Rate	$877.50
Rate for Payer: Aetna Commercial	$397.53
Rate for Payer: Aetna Medicare	$585.00
Rate for Payer: BCBS Complete	$174.67
Rate for Payer: BCN Commercial	$438.23
Rate for Payer: Cash Price	$936.00
Rate for Payer: Cash Price	$936.00
Rate for Payer: Mclaren Medicaid	$166.35
Rate for Payer: Meridian Medicaid	$174.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$877.50
Rate for Payer: Priority Health Choice Medicaid	$166.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$533.95
Rate for Payer: Priority Health Narrow/Tiered Network	$533.95
Rate for Payer: UHC Medicaid	$166.35
Rate for Payer: UHCCP Medicaid	$166.35

PR ENTEROSC >2ND PRTN W/ILEUM W/WO COLLJ SPEC SPX

Professional

Both

$1,067.00

Service Code	HCPCS 44376
Min. Negotiated Rate	$158.47
Max. Negotiated Rate	$800.25
Rate for Payer: Aetna Commercial	$377.32
Rate for Payer: Aetna Medicare	$533.50
Rate for Payer: BCBS Complete	$166.39
Rate for Payer: BCN Commercial	$417.80
Rate for Payer: Cash Price	$853.60
Rate for Payer: Cash Price	$853.60
Rate for Payer: Mclaren Medicaid	$158.47
Rate for Payer: Meridian Medicaid	$166.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$800.25
Rate for Payer: Priority Health Choice Medicaid	$158.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$509.07
Rate for Payer: Priority Health Narrow/Tiered Network	$509.07
Rate for Payer: UHC Medicaid	$158.47
Rate for Payer: UHCCP Medicaid	$158.47

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