Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR EXCISION EXTERNAL EAR COMPLETE AMPUTATION

Professional

Both

$746.00

Service Code	HCPCS 69120
Min. Negotiated Rate	$230.04
Max. Negotiated Rate	$580.64
Rate for Payer: Aetna Commercial	$447.02
Rate for Payer: Aetna Medicare	$373.00
Rate for Payer: BCBS Complete	$241.54
Rate for Payer: BCN Commercial	$580.64
Rate for Payer: Cash Price	$596.80
Rate for Payer: Cash Price	$596.80
Rate for Payer: Mclaren Medicaid	$230.04
Rate for Payer: Meridian Medicaid	$241.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$559.50
Rate for Payer: Priority Health Choice Medicaid	$230.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$573.74
Rate for Payer: Priority Health Narrow/Tiered Network	$573.74
Rate for Payer: UHC Medicaid	$230.04
Rate for Payer: UHCCP Medicaid	$230.04

PR EXCISION EXTERNAL EAR PARTIAL SIMPLE REPAIR

Professional

Both

$643.00

Service Code	HCPCS 69110
Min. Negotiated Rate	$191.70
Max. Negotiated Rate	$492.50
Rate for Payer: Aetna Commercial	$365.22
Rate for Payer: Aetna Medicare	$321.50
Rate for Payer: BCBS Complete	$201.28
Rate for Payer: BCN Commercial	$492.50
Rate for Payer: Cash Price	$514.40
Rate for Payer: Cash Price	$514.40
Rate for Payer: Mclaren Medicaid	$191.70
Rate for Payer: Meridian Medicaid	$201.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$482.25
Rate for Payer: Priority Health Choice Medicaid	$191.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$486.65
Rate for Payer: Priority Health Narrow/Tiered Network	$486.65
Rate for Payer: UHC Medicaid	$191.70
Rate for Payer: UHCCP Medicaid	$191.70

PR EXCISION FACIAL BONE

Professional

Both

$1,028.00

Service Code	HCPCS 21026
Min. Negotiated Rate	$263.69
Max. Negotiated Rate	$771.00
Rate for Payer: Aetna Commercial	$570.63
Rate for Payer: Aetna Medicare	$514.00
Rate for Payer: BCBS Complete	$276.87
Rate for Payer: BCN Commercial	$662.81
Rate for Payer: Cash Price	$822.40
Rate for Payer: Cash Price	$822.40
Rate for Payer: Mclaren Medicaid	$263.69
Rate for Payer: Meridian Medicaid	$276.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$771.00
Rate for Payer: Priority Health Choice Medicaid	$263.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$708.53
Rate for Payer: Priority Health Narrow/Tiered Network	$708.53
Rate for Payer: UHC Medicaid	$263.69
Rate for Payer: UHCCP Medicaid	$263.69

PR EXCISION/FULGURATION URETHRAL PROLAPSE

Professional

Both

$890.00

Service Code	HCPCS 53275
Min. Negotiated Rate	$152.08
Max. Negotiated Rate	$667.50
Rate for Payer: Aetna Commercial	$337.13
Rate for Payer: Aetna Medicare	$445.00
Rate for Payer: BCBS Complete	$159.68
Rate for Payer: BCN Commercial	$393.40
Rate for Payer: Cash Price	$712.00
Rate for Payer: Cash Price	$712.00
Rate for Payer: Mclaren Medicaid	$152.08
Rate for Payer: Meridian Medicaid	$159.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$667.50
Rate for Payer: Priority Health Choice Medicaid	$152.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$428.55
Rate for Payer: Priority Health Narrow/Tiered Network	$428.55
Rate for Payer: UHC Medicaid	$152.08
Rate for Payer: UHCCP Medicaid	$152.08

PR EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY

Professional

Both

$1,139.00

Service Code	HCPCS 25111
Min. Negotiated Rate	$204.69
Max. Negotiated Rate	$854.25
Rate for Payer: Aetna Commercial	$427.99
Rate for Payer: Aetna Medicare	$569.50
Rate for Payer: BCBS Complete	$214.92
Rate for Payer: BCN Commercial	$505.95
Rate for Payer: Cash Price	$911.20
Rate for Payer: Cash Price	$911.20
Rate for Payer: Mclaren Medicaid	$204.69
Rate for Payer: Meridian Medicaid	$214.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$854.25
Rate for Payer: Priority Health Choice Medicaid	$204.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$540.84
Rate for Payer: Priority Health Narrow/Tiered Network	$540.84
Rate for Payer: UHC Medicaid	$204.69
Rate for Payer: UHCCP Medicaid	$204.69

PR EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT

Professional

Both

$1,185.00

Service Code	HCPCS 25112
Min. Negotiated Rate	$240.48
Max. Negotiated Rate	$888.75
Rate for Payer: Aetna Commercial	$516.27
Rate for Payer: Aetna Medicare	$592.50
Rate for Payer: BCBS Complete	$252.50
Rate for Payer: BCN Commercial	$606.04
Rate for Payer: Cash Price	$948.00
Rate for Payer: Cash Price	$948.00
Rate for Payer: Mclaren Medicaid	$240.48
Rate for Payer: Meridian Medicaid	$252.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$888.75
Rate for Payer: Priority Health Choice Medicaid	$240.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$647.85
Rate for Payer: Priority Health Narrow/Tiered Network	$647.85
Rate for Payer: UHC Medicaid	$240.48
Rate for Payer: UHCCP Medicaid	$240.48

PR EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR

Professional

Both

$862.00

Service Code	HCPCS 11451
Min. Negotiated Rate	$204.05
Max. Negotiated Rate	$646.50
Rate for Payer: Aetna Commercial	$355.34
Rate for Payer: Aetna Medicare	$431.00
Rate for Payer: BCBS Complete	$214.25
Rate for Payer: BCN Commercial	$504.96
Rate for Payer: Cash Price	$689.60
Rate for Payer: Cash Price	$689.60
Rate for Payer: Mclaren Medicaid	$204.05
Rate for Payer: Meridian Medicaid	$214.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$646.50
Rate for Payer: Priority Health Choice Medicaid	$204.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$462.16
Rate for Payer: Priority Health Narrow/Tiered Network	$462.16
Rate for Payer: UHC Medicaid	$204.05
Rate for Payer: UHCCP Medicaid	$204.05

PR EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR

Professional

Both

$755.00

Service Code	HCPCS 11450
Min. Negotiated Rate	$162.52
Max. Negotiated Rate	$566.25
Rate for Payer: Aetna Commercial	$278.60
Rate for Payer: Aetna Medicare	$377.50
Rate for Payer: BCBS Complete	$170.65
Rate for Payer: BCN Commercial	$399.39
Rate for Payer: Cash Price	$604.00
Rate for Payer: Cash Price	$604.00
Rate for Payer: Mclaren Medicaid	$162.52
Rate for Payer: Meridian Medicaid	$170.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$566.25
Rate for Payer: Priority Health Choice Medicaid	$162.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$365.54
Rate for Payer: Priority Health Narrow/Tiered Network	$365.54
Rate for Payer: UHC Medicaid	$162.52
Rate for Payer: UHCCP Medicaid	$162.52

PR EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR

Professional

Both

$654.00

Service Code	HCPCS 11463
Min. Negotiated Rate	$201.29
Max. Negotiated Rate	$501.96
Rate for Payer: Aetna Commercial	$356.68
Rate for Payer: Aetna Medicare	$327.00
Rate for Payer: BCBS Complete	$211.35
Rate for Payer: BCN Commercial	$501.96
Rate for Payer: Cash Price	$523.20
Rate for Payer: Cash Price	$523.20
Rate for Payer: Mclaren Medicaid	$201.29
Rate for Payer: Meridian Medicaid	$211.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$490.50
Rate for Payer: Priority Health Choice Medicaid	$201.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$459.42
Rate for Payer: Priority Health Narrow/Tiered Network	$459.42
Rate for Payer: UHC Medicaid	$201.29
Rate for Payer: UHCCP Medicaid	$201.29

PR EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR

Professional

Both

$487.00

Service Code	HCPCS 11462
Min. Negotiated Rate	$154.85
Max. Negotiated Rate	$382.95
Rate for Payer: Aetna Commercial	$264.03
Rate for Payer: Aetna Medicare	$243.50
Rate for Payer: BCBS Complete	$162.59
Rate for Payer: BCN Commercial	$382.95
Rate for Payer: Cash Price	$389.60
Rate for Payer: Cash Price	$389.60
Rate for Payer: Mclaren Medicaid	$154.85
Rate for Payer: Meridian Medicaid	$162.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$365.25
Rate for Payer: Priority Health Choice Medicaid	$154.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$350.49
Rate for Payer: Priority Health Narrow/Tiered Network	$350.49
Rate for Payer: UHC Medicaid	$154.85
Rate for Payer: UHCCP Medicaid	$154.85

PR EXCISION H/P/P/U COMPLEX REPAIR

Professional

Both

$1,016.00

Service Code	HCPCS 11471
Min. Negotiated Rate	$211.51
Max. Negotiated Rate	$762.00
Rate for Payer: Aetna Commercial	$377.56
Rate for Payer: Aetna Medicare	$508.00
Rate for Payer: BCBS Complete	$222.09
Rate for Payer: BCN Commercial	$532.34
Rate for Payer: Cash Price	$812.80
Rate for Payer: Cash Price	$812.80
Rate for Payer: Mclaren Medicaid	$211.51
Rate for Payer: Meridian Medicaid	$222.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$762.00
Rate for Payer: Priority Health Choice Medicaid	$211.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$487.22
Rate for Payer: Priority Health Narrow/Tiered Network	$487.22
Rate for Payer: UHC Medicaid	$211.51
Rate for Payer: UHCCP Medicaid	$211.51

PR EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR

Professional

Both

$937.00

Service Code	HCPCS 11470
Min. Negotiated Rate	$179.13
Max. Negotiated Rate	$702.75
Rate for Payer: Aetna Commercial	$305.63
Rate for Payer: Aetna Medicare	$468.50
Rate for Payer: BCBS Complete	$188.09
Rate for Payer: BCN Commercial	$436.23
Rate for Payer: Cash Price	$749.60
Rate for Payer: Cash Price	$749.60
Rate for Payer: Mclaren Medicaid	$179.13
Rate for Payer: Meridian Medicaid	$188.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$702.75
Rate for Payer: Priority Health Choice Medicaid	$179.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$399.27
Rate for Payer: Priority Health Narrow/Tiered Network	$399.27
Rate for Payer: UHC Medicaid	$179.13
Rate for Payer: UHCCP Medicaid	$179.13

PR EXCISION HYDROCELE BILATERAL

Professional

Both

$1,898.00

Service Code	HCPCS 55041
Min. Negotiated Rate	$300.33
Max. Negotiated Rate	$1,423.50
Rate for Payer: Aetna Commercial	$655.83
Rate for Payer: Aetna Medicare	$949.00
Rate for Payer: BCBS Complete	$315.35
Rate for Payer: BCN Commercial	$769.88
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Cash Price	$1,518.40
Rate for Payer: Mclaren Medicaid	$300.33
Rate for Payer: Meridian Medicaid	$315.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,423.50
Rate for Payer: Priority Health Choice Medicaid	$300.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$838.65
Rate for Payer: Priority Health Narrow/Tiered Network	$838.65
Rate for Payer: UHC Medicaid	$300.33
Rate for Payer: UHCCP Medicaid	$300.33

PR EXCISION HYDROCELE UNILATERAL

Facility

$1,294.00

Service Code	CPT 55040
Hospital Charge Code	55040
Hospital Revenue Code	960
Min. Negotiated Rate	$900.62
Max. Negotiated Rate	$1,164.60
Rate for Payer: Aetna Commercial	$1,099.90
Rate for Payer: BCBS Trust/PPO	$1,068.71
Rate for Payer: BCN Commercial	$1,068.71
Rate for Payer: Cash Price	$1,035.20
Rate for Payer: Cofinity Commercial	$1,112.84
Rate for Payer: Encore Health Key Benefits Commercial	$1,035.20
Rate for Payer: Healthscope Commercial	$1,164.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$970.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,099.90
Rate for Payer: Nomi Health Commercial	$1,061.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$970.50
Rate for Payer: PHP Commercial	$1,099.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,125.78
Rate for Payer: Priority Health Narrow/Tiered Network	$900.62
Rate for Payer: UHC Core	$1,080.49
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$970.50

PR EXCISION HYDROCELE UNILATERAL

Professional

Both

$1,294.00

Service Code	HCPCS 55040
Hospital Charge Code	55040
Min. Negotiated Rate	$200.86
Max. Negotiated Rate	$970.50
Rate for Payer: Aetna Commercial	$433.14
Rate for Payer: Aetna Medicare	$647.00
Rate for Payer: BCBS Complete	$210.90
Rate for Payer: BCN Commercial	$511.43
Rate for Payer: Cash Price	$1,035.20
Rate for Payer: Cash Price	$1,035.20
Rate for Payer: Mclaren Medicaid	$200.86
Rate for Payer: Meridian Medicaid	$210.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$970.50
Rate for Payer: Priority Health Choice Medicaid	$200.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$557.11
Rate for Payer: Priority Health Narrow/Tiered Network	$557.11
Rate for Payer: UHC Medicaid	$200.86
Rate for Payer: UHCCP Medicaid	$200.86

PR EXCISION HYDROCELE UNILATERAL

Facility

$1,294.00

Service Code	CPT 55040
Hospital Charge Code	55040
Hospital Revenue Code	960
Min. Negotiated Rate	$228.13
Max. Negotiated Rate	$1,164.60
Rate for Payer: Aetna Commercial	$1,099.90
Rate for Payer: Aetna Medicare	$336.44
Rate for Payer: Allen County Amish Medical Aid Commercial	$404.38
Rate for Payer: Amish Plain Church Group Commercial	$404.38
Rate for Payer: BCBS Complete	$239.52
Rate for Payer: BCBS MAPPO	$323.50
Rate for Payer: BCBS Trust/PPO	$1,063.80
Rate for Payer: BCN Commercial	$1,063.80
Rate for Payer: BCN Medicare Advantage	$323.50
Rate for Payer: Cash Price	$1,035.20
Rate for Payer: Cofinity Commercial	$1,112.84
Rate for Payer: Encore Health Key Benefits Commercial	$1,035.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$323.50
Rate for Payer: Healthscope Commercial	$1,164.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$970.50
Rate for Payer: Mclaren Medicaid	$228.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$339.68
Rate for Payer: Meridian Medicaid	$239.52
Rate for Payer: MI Amish Medical Board Commercial	$372.02
Rate for Payer: Molina Medicare/Medicaid	$355.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,099.90
Rate for Payer: Nomi Health Commercial	$1,061.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$970.50
Rate for Payer: PACE Senior Care Partners	$307.32
Rate for Payer: PACE SWMI	$323.50
Rate for Payer: PHP Commercial	$1,099.90
Rate for Payer: PHP Medicare Advantage	$323.50
Rate for Payer: Priority Health Choice Medicaid	$228.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,125.78
Rate for Payer: Priority Health Medicare	$326.74
Rate for Payer: Priority Health Narrow/Tiered Network	$900.62
Rate for Payer: Railroad Medicare Medicare	$323.50
Rate for Payer: UHC Core	$1,080.49
Rate for Payer: UHC Exchange	$323.50
Rate for Payer: UHC Medicaid	$228.13
Rate for Payer: UHC Medicare Advantage	$323.50
Rate for Payer: UHCCP Medicaid	$228.13
Rate for Payer: VA VA	$323.50
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$970.50

PR EXCISION HYDROCELE UNILATERAL

Professional

Both

$1,294.00

Service Code	HCPCS 55040
Min. Negotiated Rate	$200.86
Max. Negotiated Rate	$970.50
Rate for Payer: Aetna Commercial	$433.14
Rate for Payer: Aetna Medicare	$647.00
Rate for Payer: BCBS Complete	$210.90
Rate for Payer: BCN Commercial	$511.43
Rate for Payer: Cash Price	$1,035.20
Rate for Payer: Cash Price	$1,035.20
Rate for Payer: Mclaren Medicaid	$200.86
Rate for Payer: Meridian Medicaid	$210.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$970.50
Rate for Payer: Priority Health Choice Medicaid	$200.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$557.11
Rate for Payer: Priority Health Narrow/Tiered Network	$557.11
Rate for Payer: UHC Medicaid	$200.86
Rate for Payer: UHCCP Medicaid	$200.86

PR EXCISION INFECTED GRAFT ABDOMEN

Professional

Both

$4,164.00

Service Code	HCPCS 35907
Min. Negotiated Rate	$1,098.87
Max. Negotiated Rate	$3,123.00
Rate for Payer: Aetna Commercial	$2,561.49
Rate for Payer: Aetna Medicare	$2,082.00
Rate for Payer: BCBS Complete	$1,153.81
Rate for Payer: BCN Commercial	$2,791.69
Rate for Payer: Cash Price	$3,331.20
Rate for Payer: Cash Price	$3,331.20
Rate for Payer: Mclaren Medicaid	$1,098.87
Rate for Payer: Meridian Medicaid	$1,153.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,123.00
Rate for Payer: Priority Health Choice Medicaid	$1,098.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,002.09
Rate for Payer: Priority Health Narrow/Tiered Network	$3,002.09
Rate for Payer: UHC Medicaid	$1,098.87
Rate for Payer: UHCCP Medicaid	$1,098.87

PR EXCISION INFECTED GRAFT EXTREMITY

Professional

Both

$2,065.00

Service Code	HCPCS 35903
Min. Negotiated Rate	$330.36
Max. Negotiated Rate	$1,548.75
Rate for Payer: Aetna Commercial	$757.47
Rate for Payer: Aetna Medicare	$1,032.50
Rate for Payer: BCBS Complete	$346.88
Rate for Payer: BCN Commercial	$826.65
Rate for Payer: Cash Price	$1,652.00
Rate for Payer: Cash Price	$1,652.00
Rate for Payer: Mclaren Medicaid	$330.36
Rate for Payer: Meridian Medicaid	$346.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,548.75
Rate for Payer: Priority Health Choice Medicaid	$330.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$888.95
Rate for Payer: Priority Health Narrow/Tiered Network	$888.95
Rate for Payer: UHC Medicaid	$330.36
Rate for Payer: UHCCP Medicaid	$330.36

PR EXCISION INFERIOR TURBINATE PARTIAL/COMPLETE

Professional

Both

$829.00

Service Code	HCPCS 30130
Min. Negotiated Rate	$250.70
Max. Negotiated Rate	$623.48
Rate for Payer: Aetna Commercial	$522.89
Rate for Payer: Aetna Medicare	$414.50
Rate for Payer: BCBS Complete	$263.24
Rate for Payer: BCN Commercial	$623.48
Rate for Payer: Cash Price	$663.20
Rate for Payer: Cash Price	$663.20
Rate for Payer: Mclaren Medicaid	$250.70
Rate for Payer: Meridian Medicaid	$263.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$621.75
Rate for Payer: Priority Health Choice Medicaid	$250.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$587.13
Rate for Payer: Priority Health Narrow/Tiered Network	$587.13
Rate for Payer: UHC Medicaid	$250.70
Rate for Payer: UHCCP Medicaid	$250.70

PR EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH

Professional

Both

$913.00

Service Code	HCPCS 28080
Min. Negotiated Rate	$235.79
Max. Negotiated Rate	$684.75
Rate for Payer: Aetna Commercial	$488.84
Rate for Payer: Aetna Medicare	$456.50
Rate for Payer: BCBS Complete	$247.58
Rate for Payer: BCN Commercial	$640.07
Rate for Payer: Cash Price	$730.40
Rate for Payer: Cash Price	$730.40
Rate for Payer: Mclaren Medicaid	$235.79
Rate for Payer: Meridian Medicaid	$247.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$684.75
Rate for Payer: Priority Health Choice Medicaid	$235.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$622.82
Rate for Payer: Priority Health Narrow/Tiered Network	$622.82
Rate for Payer: UHC Medicaid	$235.79
Rate for Payer: UHCCP Medicaid	$235.79

PR EXCISION LACTIFEROUS DUCT FISTULA

Professional

Both

$818.00

Service Code	HCPCS 19112
Min. Negotiated Rate	$211.08
Max. Negotiated Rate	$613.50
Rate for Payer: Aetna Commercial	$346.57
Rate for Payer: Aetna Medicare	$409.00
Rate for Payer: BCBS Complete	$221.63
Rate for Payer: BCN Commercial	$494.00
Rate for Payer: Cash Price	$654.40
Rate for Payer: Cash Price	$654.40
Rate for Payer: Mclaren Medicaid	$211.08
Rate for Payer: Meridian Medicaid	$221.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$613.50
Rate for Payer: Priority Health Choice Medicaid	$211.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$452.14
Rate for Payer: Priority Health Narrow/Tiered Network	$452.14
Rate for Payer: UHC Medicaid	$211.08
Rate for Payer: UHCCP Medicaid	$211.08

PR EXCISION LESION FLOOR MOUTH

Professional

Both

$606.00

Service Code	HCPCS 41116
Min. Negotiated Rate	$128.44
Max. Negotiated Rate	$454.50
Rate for Payer: Aetna Commercial	$281.48
Rate for Payer: Aetna Medicare	$303.00
Rate for Payer: BCBS Complete	$134.86
Rate for Payer: BCN Commercial	$327.67
Rate for Payer: Cash Price	$484.80
Rate for Payer: Cash Price	$484.80
Rate for Payer: Mclaren Medicaid	$128.44
Rate for Payer: Meridian Medicaid	$134.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$454.50
Rate for Payer: Priority Health Choice Medicaid	$128.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$399.25
Rate for Payer: Priority Health Narrow/Tiered Network	$399.25
Rate for Payer: UHC Medicaid	$128.44
Rate for Payer: UHCCP Medicaid	$128.44

PR EXCISION LESION MENISCUS/CAPSULE KNEE

Professional

Both

$2,410.00

Service Code	HCPCS 27347
Min. Negotiated Rate	$323.97
Max. Negotiated Rate	$1,807.50
Rate for Payer: Aetna Commercial	$702.81
Rate for Payer: Aetna Medicare	$1,205.00
Rate for Payer: BCBS Complete	$340.17
Rate for Payer: BCN Commercial	$811.71
Rate for Payer: Cash Price	$1,928.00
Rate for Payer: Cash Price	$1,928.00
Rate for Payer: Mclaren Medicaid	$323.97
Rate for Payer: Meridian Medicaid	$340.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,807.50
Rate for Payer: Priority Health Choice Medicaid	$323.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$867.70
Rate for Payer: Priority Health Narrow/Tiered Network	$867.70
Rate for Payer: UHC Medicaid	$323.97
Rate for Payer: UHCCP Medicaid	$323.97

PR EXCISION LESION MESENTERY SEPARATE PROCEDURE

Professional

Both

$1,553.00

Service Code	HCPCS 44820
Min. Negotiated Rate	$515.46
Max. Negotiated Rate	$1,564.83
Rate for Payer: Aetna Commercial	$1,133.59
Rate for Payer: Aetna Medicare	$776.50
Rate for Payer: BCBS Complete	$541.23
Rate for Payer: BCN Commercial	$1,284.30
Rate for Payer: Cash Price	$1,242.40
Rate for Payer: Cash Price	$1,242.40
Rate for Payer: Mclaren Medicaid	$515.46
Rate for Payer: Meridian Medicaid	$541.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,164.75
Rate for Payer: Priority Health Choice Medicaid	$515.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,564.83
Rate for Payer: Priority Health Narrow/Tiered Network	$1,564.83
Rate for Payer: UHC Medicaid	$515.46
Rate for Payer: UHCCP Medicaid	$515.46

Know your out-of-pocket cost for care.

All Charges