Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR HEMODIALYSIS PROCEDURE W/ PHYS/QHP EVALUATION

Professional

Both

$129.00

Service Code	HCPCS 90935
Min. Negotiated Rate	$39.19
Max. Negotiated Rate	$104.58
Rate for Payer: Aetna Commercial	$80.15
Rate for Payer: Aetna Medicare	$64.50
Rate for Payer: BCBS Complete	$41.15
Rate for Payer: BCN Commercial	$104.58
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cash Price	$103.20
Rate for Payer: Mclaren Medicaid	$39.19
Rate for Payer: Meridian Medicaid	$41.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$96.75
Rate for Payer: Priority Health Choice Medicaid	$39.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$96.44
Rate for Payer: Priority Health Narrow/Tiered Network	$96.44
Rate for Payer: UHC Medicaid	$39.19
Rate for Payer: UHCCP Medicaid	$39.19

PR HEMODIALYSIS PX REPEAT EVAL W/WO REVJ DIALYS RX

Professional

Both

$614.00

Service Code	HCPCS 90937
Min. Negotiated Rate	$56.45
Max. Negotiated Rate	$460.50
Rate for Payer: Aetna Commercial	$115.20
Rate for Payer: Aetna Medicare	$307.00
Rate for Payer: BCBS Complete	$59.27
Rate for Payer: BCN Commercial	$151.39
Rate for Payer: Cash Price	$491.20
Rate for Payer: Cash Price	$491.20
Rate for Payer: Mclaren Medicaid	$56.45
Rate for Payer: Meridian Medicaid	$59.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$460.50
Rate for Payer: Priority Health Choice Medicaid	$56.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$139.61
Rate for Payer: Priority Health Narrow/Tiered Network	$139.61
Rate for Payer: UHC Medicaid	$56.45
Rate for Payer: UHCCP Medicaid	$56.45

PR HEMORRHOIDECTOMY INTERNAL RUBBER BAND LIGATIONS

Professional

Both

$427.00

Service Code	HCPCS 46221
Min. Negotiated Rate	$125.67
Max. Negotiated Rate	$357.38
Rate for Payer: Aetna Commercial	$256.42
Rate for Payer: Aetna Medicare	$213.50
Rate for Payer: BCBS Complete	$131.95
Rate for Payer: BCN Commercial	$231.30
Rate for Payer: Cash Price	$341.60
Rate for Payer: Cash Price	$341.60
Rate for Payer: Mclaren Medicaid	$125.67
Rate for Payer: Meridian Medicaid	$131.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$320.25
Rate for Payer: Priority Health Choice Medicaid	$125.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$357.38
Rate for Payer: Priority Health Narrow/Tiered Network	$357.38
Rate for Payer: UHC Medicaid	$125.67
Rate for Payer: UHCCP Medicaid	$125.67

PR HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO

Professional

Both

$1,662.00

Service Code	HCPCS 46260
Hospital Charge Code	46260
Min. Negotiated Rate	$305.87
Max. Negotiated Rate	$1,246.50
Rate for Payer: Aetna Commercial	$644.26
Rate for Payer: Aetna Medicare	$831.00
Rate for Payer: BCBS Complete	$321.16
Rate for Payer: BCN Commercial	$731.04
Rate for Payer: Cash Price	$1,329.60
Rate for Payer: Cash Price	$1,329.60
Rate for Payer: Mclaren Medicaid	$305.87
Rate for Payer: Meridian Medicaid	$321.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,246.50
Rate for Payer: Priority Health Choice Medicaid	$305.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$890.73
Rate for Payer: Priority Health Narrow/Tiered Network	$890.73
Rate for Payer: UHC Medicaid	$305.87
Rate for Payer: UHCCP Medicaid	$305.87

PR HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO

Facility

$1,662.00

Service Code	CPT 46260
Hospital Charge Code	46260
Hospital Revenue Code	960
Min. Negotiated Rate	$293.01
Max. Negotiated Rate	$1,495.80
Rate for Payer: Aetna Commercial	$1,412.70
Rate for Payer: Aetna Medicare	$432.12
Rate for Payer: Allen County Amish Medical Aid Commercial	$519.38
Rate for Payer: Amish Plain Church Group Commercial	$519.38
Rate for Payer: BCBS Complete	$307.64
Rate for Payer: BCBS MAPPO	$415.50
Rate for Payer: BCBS Trust/PPO	$1,366.33
Rate for Payer: BCN Commercial	$1,366.33
Rate for Payer: BCN Medicare Advantage	$415.50
Rate for Payer: Cash Price	$1,329.60
Rate for Payer: Cofinity Commercial	$1,429.32
Rate for Payer: Encore Health Key Benefits Commercial	$1,329.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$415.50
Rate for Payer: Healthscope Commercial	$1,495.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,246.50
Rate for Payer: Mclaren Medicaid	$293.01
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$436.27
Rate for Payer: Meridian Medicaid	$307.64
Rate for Payer: MI Amish Medical Board Commercial	$477.82
Rate for Payer: Molina Medicare/Medicaid	$457.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,412.70
Rate for Payer: Nomi Health Commercial	$1,362.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,246.50
Rate for Payer: PACE Senior Care Partners	$394.73
Rate for Payer: PACE SWMI	$415.50
Rate for Payer: PHP Commercial	$1,412.70
Rate for Payer: PHP Medicare Advantage	$415.50
Rate for Payer: Priority Health Choice Medicaid	$293.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,445.94
Rate for Payer: Priority Health Medicare	$419.65
Rate for Payer: Priority Health Narrow/Tiered Network	$1,156.75
Rate for Payer: Railroad Medicare Medicare	$415.50
Rate for Payer: UHC Core	$1,387.77
Rate for Payer: UHC Exchange	$415.50
Rate for Payer: UHC Medicaid	$293.01
Rate for Payer: UHC Medicare Advantage	$415.50
Rate for Payer: UHCCP Medicaid	$293.01
Rate for Payer: VA VA	$415.50
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,246.50

PR HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO

Professional

Both

$1,662.00

Service Code	HCPCS 46260
Min. Negotiated Rate	$305.87
Max. Negotiated Rate	$1,246.50
Rate for Payer: Aetna Commercial	$644.26
Rate for Payer: Aetna Medicare	$831.00
Rate for Payer: BCBS Complete	$321.16
Rate for Payer: BCN Commercial	$731.04
Rate for Payer: Cash Price	$1,329.60
Rate for Payer: Cash Price	$1,329.60
Rate for Payer: Mclaren Medicaid	$305.87
Rate for Payer: Meridian Medicaid	$321.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,246.50
Rate for Payer: Priority Health Choice Medicaid	$305.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$890.73
Rate for Payer: Priority Health Narrow/Tiered Network	$890.73
Rate for Payer: UHC Medicaid	$305.87
Rate for Payer: UHCCP Medicaid	$305.87

PR HEMORRHOIDECTOMY INT & XTRNL 2/> COLUMN/GRO

Facility

$1,662.00

Service Code	CPT 46260
Hospital Charge Code	46260
Hospital Revenue Code	960
Min. Negotiated Rate	$1,156.75
Max. Negotiated Rate	$1,495.80
Rate for Payer: Aetna Commercial	$1,412.70
Rate for Payer: BCBS Trust/PPO	$1,372.65
Rate for Payer: BCN Commercial	$1,372.65
Rate for Payer: Cash Price	$1,329.60
Rate for Payer: Cofinity Commercial	$1,429.32
Rate for Payer: Encore Health Key Benefits Commercial	$1,329.60
Rate for Payer: Healthscope Commercial	$1,495.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,246.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,412.70
Rate for Payer: Nomi Health Commercial	$1,362.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,246.50
Rate for Payer: PHP Commercial	$1,412.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,445.94
Rate for Payer: Priority Health Narrow/Tiered Network	$1,156.75
Rate for Payer: UHC Core	$1,387.77
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,246.50

PR HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP

Facility

$1,131.00

Service Code	CPT 46255
Hospital Charge Code	46255
Hospital Revenue Code	960
Min. Negotiated Rate	$787.18
Max. Negotiated Rate	$1,017.90
Rate for Payer: Aetna Commercial	$961.35
Rate for Payer: BCBS Trust/PPO	$934.09
Rate for Payer: BCN Commercial	$934.09
Rate for Payer: Cash Price	$904.80
Rate for Payer: Cofinity Commercial	$972.66
Rate for Payer: Encore Health Key Benefits Commercial	$904.80
Rate for Payer: Healthscope Commercial	$1,017.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$848.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$961.35
Rate for Payer: Nomi Health Commercial	$927.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$848.25
Rate for Payer: PHP Commercial	$961.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$983.97
Rate for Payer: Priority Health Narrow/Tiered Network	$787.18
Rate for Payer: UHC Core	$944.38
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$848.25

PR HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP

Professional

Both

$1,131.00

Service Code	HCPCS 46255
Hospital Charge Code	46255
Min. Negotiated Rate	$223.65
Max. Negotiated Rate	$848.25
Rate for Payer: Aetna Commercial	$477.30
Rate for Payer: Aetna Medicare	$565.50
Rate for Payer: BCBS Complete	$234.83
Rate for Payer: BCN Commercial	$537.33
Rate for Payer: Cash Price	$904.80
Rate for Payer: Cash Price	$904.80
Rate for Payer: Mclaren Medicaid	$223.65
Rate for Payer: Meridian Medicaid	$234.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$848.25
Rate for Payer: Priority Health Choice Medicaid	$223.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$654.69
Rate for Payer: Priority Health Narrow/Tiered Network	$654.69
Rate for Payer: UHC Medicaid	$223.65
Rate for Payer: UHCCP Medicaid	$223.65

PR HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP

Professional

Both

$1,131.00

Service Code	HCPCS 46255
Min. Negotiated Rate	$223.65
Max. Negotiated Rate	$848.25
Rate for Payer: Aetna Commercial	$477.30
Rate for Payer: Aetna Medicare	$565.50
Rate for Payer: BCBS Complete	$234.83
Rate for Payer: BCN Commercial	$537.33
Rate for Payer: Cash Price	$904.80
Rate for Payer: Cash Price	$904.80
Rate for Payer: Mclaren Medicaid	$223.65
Rate for Payer: Meridian Medicaid	$234.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$848.25
Rate for Payer: Priority Health Choice Medicaid	$223.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$654.69
Rate for Payer: Priority Health Narrow/Tiered Network	$654.69
Rate for Payer: UHC Medicaid	$223.65
Rate for Payer: UHCCP Medicaid	$223.65

PR HEMORRHOIDECTOMY NTRNL & XTRNL 1 COLUMN/GROUP

Facility

$1,131.00

Service Code	CPT 46255
Hospital Charge Code	46255
Hospital Revenue Code	960
Min. Negotiated Rate	$199.40
Max. Negotiated Rate	$1,017.90
Rate for Payer: Aetna Commercial	$961.35
Rate for Payer: Aetna Medicare	$294.06
Rate for Payer: Allen County Amish Medical Aid Commercial	$353.44
Rate for Payer: Amish Plain Church Group Commercial	$353.44
Rate for Payer: BCBS Complete	$209.35
Rate for Payer: BCBS MAPPO	$282.75
Rate for Payer: BCBS Trust/PPO	$929.80
Rate for Payer: BCN Commercial	$929.80
Rate for Payer: BCN Medicare Advantage	$282.75
Rate for Payer: Cash Price	$904.80
Rate for Payer: Cofinity Commercial	$972.66
Rate for Payer: Encore Health Key Benefits Commercial	$904.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$282.75
Rate for Payer: Healthscope Commercial	$1,017.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$848.25
Rate for Payer: Mclaren Medicaid	$199.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$296.89
Rate for Payer: Meridian Medicaid	$209.35
Rate for Payer: MI Amish Medical Board Commercial	$325.16
Rate for Payer: Molina Medicare/Medicaid	$311.02
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$961.35
Rate for Payer: Nomi Health Commercial	$927.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$848.25
Rate for Payer: PACE Senior Care Partners	$268.61
Rate for Payer: PACE SWMI	$282.75
Rate for Payer: PHP Commercial	$961.35
Rate for Payer: PHP Medicare Advantage	$282.75
Rate for Payer: Priority Health Choice Medicaid	$199.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$983.97
Rate for Payer: Priority Health Medicare	$285.58
Rate for Payer: Priority Health Narrow/Tiered Network	$787.18
Rate for Payer: Railroad Medicare Medicare	$282.75
Rate for Payer: UHC Core	$944.38
Rate for Payer: UHC Exchange	$282.75
Rate for Payer: UHC Medicaid	$199.40
Rate for Payer: UHC Medicare Advantage	$282.75
Rate for Payer: UHCCP Medicaid	$199.40
Rate for Payer: VA VA	$282.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$848.25

PR HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP

Facility

$1,163.00

Service Code	CPT 46250
Hospital Charge Code	46250
Hospital Revenue Code	960
Min. Negotiated Rate	$809.45
Max. Negotiated Rate	$1,046.70
Rate for Payer: Aetna Commercial	$988.55
Rate for Payer: BCBS Trust/PPO	$960.52
Rate for Payer: BCN Commercial	$960.52
Rate for Payer: Cash Price	$930.40
Rate for Payer: Cofinity Commercial	$1,000.18
Rate for Payer: Encore Health Key Benefits Commercial	$930.40
Rate for Payer: Healthscope Commercial	$1,046.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$872.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$988.55
Rate for Payer: Nomi Health Commercial	$953.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$872.25
Rate for Payer: PHP Commercial	$988.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,011.81
Rate for Payer: Priority Health Narrow/Tiered Network	$809.45
Rate for Payer: UHC Core	$971.11
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$872.25

PR HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP

Facility

$1,163.00

Service Code	CPT 46250
Hospital Charge Code	46250
Hospital Revenue Code	960
Min. Negotiated Rate	$205.04
Max. Negotiated Rate	$1,046.70
Rate for Payer: Aetna Commercial	$988.55
Rate for Payer: Aetna Medicare	$302.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$363.44
Rate for Payer: Amish Plain Church Group Commercial	$363.44
Rate for Payer: BCBS Complete	$215.27
Rate for Payer: BCBS MAPPO	$290.75
Rate for Payer: BCBS Trust/PPO	$956.10
Rate for Payer: BCN Commercial	$956.10
Rate for Payer: BCN Medicare Advantage	$290.75
Rate for Payer: Cash Price	$930.40
Rate for Payer: Cofinity Commercial	$1,000.18
Rate for Payer: Encore Health Key Benefits Commercial	$930.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$290.75
Rate for Payer: Healthscope Commercial	$1,046.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$872.25
Rate for Payer: Mclaren Medicaid	$205.04
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$305.29
Rate for Payer: Meridian Medicaid	$215.27
Rate for Payer: MI Amish Medical Board Commercial	$334.36
Rate for Payer: Molina Medicare/Medicaid	$319.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$988.55
Rate for Payer: Nomi Health Commercial	$953.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$872.25
Rate for Payer: PACE Senior Care Partners	$276.21
Rate for Payer: PACE SWMI	$290.75
Rate for Payer: PHP Commercial	$988.55
Rate for Payer: PHP Medicare Advantage	$290.75
Rate for Payer: Priority Health Choice Medicaid	$205.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,011.81
Rate for Payer: Priority Health Medicare	$293.66
Rate for Payer: Priority Health Narrow/Tiered Network	$809.45
Rate for Payer: Railroad Medicare Medicare	$290.75
Rate for Payer: UHC Core	$971.11
Rate for Payer: UHC Exchange	$290.75
Rate for Payer: UHC Medicaid	$205.04
Rate for Payer: UHC Medicare Advantage	$290.75
Rate for Payer: UHCCP Medicaid	$205.04
Rate for Payer: VA VA	$290.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$872.25

PR HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP

Professional

Both

$1,163.00

Service Code	HCPCS 46250
Min. Negotiated Rate	$203.20
Max. Negotiated Rate	$872.25
Rate for Payer: Aetna Commercial	$425.75
Rate for Payer: Aetna Medicare	$581.50
Rate for Payer: BCBS Complete	$213.36
Rate for Payer: BCN Commercial	$486.03
Rate for Payer: Cash Price	$930.40
Rate for Payer: Cash Price	$930.40
Rate for Payer: Mclaren Medicaid	$203.20
Rate for Payer: Meridian Medicaid	$213.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$872.25
Rate for Payer: Priority Health Choice Medicaid	$203.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$592.19
Rate for Payer: Priority Health Narrow/Tiered Network	$592.19
Rate for Payer: UHC Medicaid	$203.20
Rate for Payer: UHCCP Medicaid	$203.20

PR HEMORRHOIDECTOMY XTRNL 2/> COLUMN/GROUP

Professional

Both

$1,163.00

Service Code	HCPCS 46250
Hospital Charge Code	46250
Min. Negotiated Rate	$203.20
Max. Negotiated Rate	$872.25
Rate for Payer: Aetna Commercial	$425.75
Rate for Payer: Aetna Medicare	$581.50
Rate for Payer: BCBS Complete	$213.36
Rate for Payer: BCN Commercial	$486.03
Rate for Payer: Cash Price	$930.40
Rate for Payer: Cash Price	$930.40
Rate for Payer: Mclaren Medicaid	$203.20
Rate for Payer: Meridian Medicaid	$213.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$872.25
Rate for Payer: Priority Health Choice Medicaid	$203.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$592.19
Rate for Payer: Priority Health Narrow/Tiered Network	$592.19
Rate for Payer: UHC Medicaid	$203.20
Rate for Payer: UHCCP Medicaid	$203.20

PR HEMORRHOID NTRNL & XTRNL 1 COLUMN W/FISSURECTO

Professional

Both

$765.00

Service Code	HCPCS 46257
Min. Negotiated Rate	$265.19
Max. Negotiated Rate	$770.58
Rate for Payer: Aetna Commercial	$570.73
Rate for Payer: Aetna Medicare	$382.50
Rate for Payer: BCBS Complete	$278.45
Rate for Payer: BCN Commercial	$632.43
Rate for Payer: Cash Price	$612.00
Rate for Payer: Cash Price	$612.00
Rate for Payer: Mclaren Medicaid	$265.19
Rate for Payer: Meridian Medicaid	$278.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$573.75
Rate for Payer: Priority Health Choice Medicaid	$265.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$770.58
Rate for Payer: Priority Health Narrow/Tiered Network	$770.58
Rate for Payer: UHC Medicaid	$265.19
Rate for Payer: UHCCP Medicaid	$265.19

PR HEMORRHOIDOPEXY STAPLING

Professional

Both

$665.00

Service Code	HCPCS 46947
Min. Negotiated Rate	$241.97
Max. Negotiated Rate	$717.20
Rate for Payer: Aetna Commercial	$517.14
Rate for Payer: Aetna Medicare	$332.50
Rate for Payer: BCBS Complete	$254.07
Rate for Payer: BCN Commercial	$588.61
Rate for Payer: Cash Price	$532.00
Rate for Payer: Cash Price	$532.00
Rate for Payer: Mclaren Medicaid	$241.97
Rate for Payer: Meridian Medicaid	$254.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$498.75
Rate for Payer: Priority Health Choice Medicaid	$241.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$717.20
Rate for Payer: Priority Health Narrow/Tiered Network	$717.20
Rate for Payer: UHC Medicaid	$241.97
Rate for Payer: UHCCP Medicaid	$241.97

PR HEPATECTOMY RESCJ PARTIAL LOBECTOMY

Professional

Both

$4,772.00

Service Code	HCPCS 47120
Min. Negotiated Rate	$1,381.73
Max. Negotiated Rate	$4,259.43
Rate for Payer: Aetna Commercial	$3,154.10
Rate for Payer: Aetna Medicare	$2,386.00
Rate for Payer: BCBS Complete	$1,450.82
Rate for Payer: BCN Commercial	$3,495.82
Rate for Payer: Cash Price	$3,817.60
Rate for Payer: Cash Price	$3,817.60
Rate for Payer: Mclaren Medicaid	$1,381.73
Rate for Payer: Meridian Medicaid	$1,450.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,579.00
Rate for Payer: Priority Health Choice Medicaid	$1,381.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4,259.43
Rate for Payer: Priority Health Narrow/Tiered Network	$4,259.43
Rate for Payer: UHC Medicaid	$1,381.73
Rate for Payer: UHCCP Medicaid	$1,381.73

PR HEPATECTOMY RESCJ TOTAL RIGHT LOBECTOMY

Professional

Both

$6,344.00

Service Code	HCPCS 47130
Min. Negotiated Rate	$1,927.86
Max. Negotiated Rate	$6,008.11
Rate for Payer: Aetna Commercial	$4,470.87
Rate for Payer: Aetna Medicare	$3,172.00
Rate for Payer: BCBS Complete	$2,024.25
Rate for Payer: BCN Commercial	$4,931.01
Rate for Payer: Cash Price	$5,075.20
Rate for Payer: Cash Price	$5,075.20
Rate for Payer: Mclaren Medicaid	$1,927.86
Rate for Payer: Meridian Medicaid	$2,024.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,758.00
Rate for Payer: Priority Health Choice Medicaid	$1,927.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$6,008.11
Rate for Payer: Priority Health Narrow/Tiered Network	$6,008.11
Rate for Payer: UHC Medicaid	$1,927.86
Rate for Payer: UHCCP Medicaid	$1,927.86

PR HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM

Professional

Both

$158.00

Service Code	HCPCS 90636
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$132.43
Rate for Payer: Aetna Commercial	$123.57
Rate for Payer: Aetna Medicare	$79.00
Rate for Payer: BCBS Trust/PPO	$132.43
Rate for Payer: BCN Commercial	$130.06
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.50

PR HEPATITIS B IMMUNE GLOBULIN HBIG HUMAN IM

Professional

Both

$187.00

Service Code	HCPCS 90371
Min. Negotiated Rate	$93.50
Max. Negotiated Rate	$174.06
Rate for Payer: Aetna Commercial	$137.89
Rate for Payer: Aetna Medicare	$93.50
Rate for Payer: BCBS Trust/PPO	$158.07
Rate for Payer: BCN Commercial	$174.06
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cash Price	$149.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$140.25

PR HEPATOTOMY OPEN DRAINAGE ABSCESS/CYST 1/2 STAGES

Professional

Both

$2,310.00

Service Code	HCPCS 47010
Min. Negotiated Rate	$728.89
Max. Negotiated Rate	$2,223.17
Rate for Payer: Aetna Commercial	$1,637.45
Rate for Payer: Aetna Medicare	$1,155.00
Rate for Payer: BCBS Complete	$765.33
Rate for Payer: BCN Commercial	$1,824.61
Rate for Payer: Cash Price	$1,848.00
Rate for Payer: Cash Price	$1,848.00
Rate for Payer: Mclaren Medicaid	$728.89
Rate for Payer: Meridian Medicaid	$765.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,732.50
Rate for Payer: Priority Health Choice Medicaid	$728.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,223.17
Rate for Payer: Priority Health Narrow/Tiered Network	$2,223.17
Rate for Payer: UHC Medicaid	$728.89
Rate for Payer: UHCCP Medicaid	$728.89

PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE

Professional

Both

$53.00

Service Code	HCPCS 90633
Min. Negotiated Rate	$26.50
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna Commercial	$38.42
Rate for Payer: Aetna Medicare	$26.50
Rate for Payer: BCBS Trust/PPO	$39.13
Rate for Payer: BCN Commercial	$38.37
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.75

PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE

Professional

Both

$93.00

Service Code	HCPCS 90632
Min. Negotiated Rate	$46.50
Max. Negotiated Rate	$84.64
Rate for Payer: Aetna Commercial	$70.26
Rate for Payer: Aetna Medicare	$46.50
Rate for Payer: BCBS Trust/PPO	$83.73
Rate for Payer: BCN Commercial	$84.64
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cash Price	$74.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$69.75

PR HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM

Professional

Both

$106.00

Service Code	HCPCS 90743
Min. Negotiated Rate	$53.00
Max. Negotiated Rate	$79.50
Rate for Payer: Aetna Commercial	$75.15
Rate for Payer: Aetna Medicare	$53.00
Rate for Payer: BCBS Trust/PPO	$72.21
Rate for Payer: BCN Commercial	$67.58
Rate for Payer: Cash Price	$84.80
Rate for Payer: Cash Price	$84.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$79.50

Know your out-of-pocket cost for care.

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