Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR I&D DP SUPRALEVATOR PELVIRCT/RETRORCT ABSC

Professional

Both

$1,686.00

Service Code	HCPCS 45020
Min. Negotiated Rate	$351.88
Max. Negotiated Rate	$1,264.50
Rate for Payer: Aetna Commercial	$768.90
Rate for Payer: Aetna Medicare	$843.00
Rate for Payer: BCBS Complete	$369.47
Rate for Payer: BCN Commercial	$867.98
Rate for Payer: Cash Price	$1,348.80
Rate for Payer: Cash Price	$1,348.80
Rate for Payer: Mclaren Medicaid	$351.88
Rate for Payer: Meridian Medicaid	$369.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,264.50
Rate for Payer: Priority Health Choice Medicaid	$351.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,057.58
Rate for Payer: Priority Health Narrow/Tiered Network	$1,057.58
Rate for Payer: UHC Medicaid	$351.88
Rate for Payer: UHCCP Medicaid	$351.88

PR I&D EPIDIDYMIS TESTIS&/SCROTAL SPACE

Professional

Both

$417.00

Service Code	HCPCS 54700
Min. Negotiated Rate	$127.59
Max. Negotiated Rate	$351.52
Rate for Payer: Aetna Commercial	$273.26
Rate for Payer: Aetna Medicare	$208.50
Rate for Payer: BCBS Complete	$133.97
Rate for Payer: BCN Commercial	$322.69
Rate for Payer: Cash Price	$333.60
Rate for Payer: Cash Price	$333.60
Rate for Payer: Mclaren Medicaid	$127.59
Rate for Payer: Meridian Medicaid	$133.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$312.75
Rate for Payer: Priority Health Choice Medicaid	$127.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$351.52
Rate for Payer: Priority Health Narrow/Tiered Network	$351.52
Rate for Payer: UHC Medicaid	$127.59
Rate for Payer: UHCCP Medicaid	$127.59

PR I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA

Professional

Both

$959.00

Service Code	HCPCS 25028
Min. Negotiated Rate	$438.78
Max. Negotiated Rate	$1,106.18
Rate for Payer: Aetna Commercial	$870.43
Rate for Payer: Aetna Medicare	$479.50
Rate for Payer: BCBS Complete	$460.72
Rate for Payer: BCN Commercial	$1,034.80
Rate for Payer: Cash Price	$767.20
Rate for Payer: Cash Price	$767.20
Rate for Payer: Mclaren Medicaid	$438.78
Rate for Payer: Meridian Medicaid	$460.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$719.25
Rate for Payer: Priority Health Choice Medicaid	$438.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,106.18
Rate for Payer: Priority Health Narrow/Tiered Network	$1,106.18
Rate for Payer: UHC Medicaid	$438.78
Rate for Payer: UHCCP Medicaid	$438.78

PR I&D HEMATOMA SEROMA/FLUID COLLECTION

Facility

$277.00

Service Code	CPT 10140
Hospital Charge Code	10140
Hospital Revenue Code	521
Min. Negotiated Rate	$192.79
Max. Negotiated Rate	$249.30
Rate for Payer: Aetna Commercial	$235.45
Rate for Payer: BCBS Trust/PPO	$228.77
Rate for Payer: BCN Commercial	$228.77
Rate for Payer: Cash Price	$221.60
Rate for Payer: Cofinity Commercial	$238.22
Rate for Payer: Encore Health Key Benefits Commercial	$221.60
Rate for Payer: Healthscope Commercial	$249.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$207.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.45
Rate for Payer: Nomi Health Commercial	$227.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$207.75
Rate for Payer: PHP Commercial	$235.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$240.99
Rate for Payer: Priority Health Narrow/Tiered Network	$192.79
Rate for Payer: UHC Core	$231.29
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$207.75

PR I&D HEMATOMA SEROMA/FLUID COLLECTION

Facility

$277.00

Service Code	CPT 10140
Hospital Charge Code	10140
Hospital Revenue Code	521
Min. Negotiated Rate	$48.84
Max. Negotiated Rate	$249.30
Rate for Payer: Aetna Commercial	$235.45
Rate for Payer: Aetna Medicare	$72.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$86.56
Rate for Payer: Amish Plain Church Group Commercial	$86.56
Rate for Payer: BCBS Complete	$51.27
Rate for Payer: BCBS MAPPO	$69.25
Rate for Payer: BCBS Trust/PPO	$227.72
Rate for Payer: BCN Commercial	$227.72
Rate for Payer: BCN Medicare Advantage	$69.25
Rate for Payer: Cash Price	$221.60
Rate for Payer: Cofinity Commercial	$238.22
Rate for Payer: Encore Health Key Benefits Commercial	$221.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$69.25
Rate for Payer: Healthscope Commercial	$249.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$207.75
Rate for Payer: Mclaren Medicaid	$48.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$72.71
Rate for Payer: Meridian Medicaid	$51.27
Rate for Payer: MI Amish Medical Board Commercial	$79.64
Rate for Payer: Molina Medicare/Medicaid	$76.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$235.45
Rate for Payer: Nomi Health Commercial	$227.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$207.75
Rate for Payer: PACE Senior Care Partners	$65.79
Rate for Payer: PACE SWMI	$69.25
Rate for Payer: PHP Commercial	$235.45
Rate for Payer: PHP Medicare Advantage	$69.25
Rate for Payer: Priority Health Choice Medicaid	$48.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$240.99
Rate for Payer: Priority Health Medicare	$69.94
Rate for Payer: Priority Health Narrow/Tiered Network	$192.79
Rate for Payer: Railroad Medicare Medicare	$69.25
Rate for Payer: UHC Core	$231.29
Rate for Payer: UHC Exchange	$69.25
Rate for Payer: UHC Medicaid	$48.84
Rate for Payer: UHC Medicare Advantage	$69.25
Rate for Payer: UHCCP Medicaid	$48.84
Rate for Payer: VA VA	$69.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$207.75

PR I&D HEMATOMA SEROMA/FLUID COLLECTION

Professional

Both

$277.00

Service Code	HCPCS 10140
Hospital Charge Code	10140
Min. Negotiated Rate	$73.70
Max. Negotiated Rate	$207.75
Rate for Payer: Aetna Commercial	$126.93
Rate for Payer: Aetna Medicare	$138.50
Rate for Payer: BCBS Complete	$77.39
Rate for Payer: BCN Commercial	$141.37
Rate for Payer: Cash Price	$221.60
Rate for Payer: Cash Price	$221.60
Rate for Payer: Mclaren Medicaid	$73.70
Rate for Payer: Meridian Medicaid	$77.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$207.75
Rate for Payer: Priority Health Choice Medicaid	$73.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$164.08
Rate for Payer: Priority Health Narrow/Tiered Network	$164.08
Rate for Payer: UHC Medicaid	$73.70
Rate for Payer: UHCCP Medicaid	$73.70

PR I&D HEMATOMA SEROMA/FLUID COLLECTION

Professional

Both

$277.00

Service Code	HCPCS 10140
Min. Negotiated Rate	$73.70
Max. Negotiated Rate	$207.75
Rate for Payer: Aetna Commercial	$126.93
Rate for Payer: Aetna Medicare	$138.50
Rate for Payer: BCBS Complete	$77.39
Rate for Payer: BCN Commercial	$141.37
Rate for Payer: Cash Price	$221.60
Rate for Payer: Cash Price	$221.60
Rate for Payer: Mclaren Medicaid	$73.70
Rate for Payer: Meridian Medicaid	$77.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$207.75
Rate for Payer: Priority Health Choice Medicaid	$73.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$164.08
Rate for Payer: Priority Health Narrow/Tiered Network	$164.08
Rate for Payer: UHC Medicaid	$73.70
Rate for Payer: UHCCP Medicaid	$73.70

PR I&D INTRAMURAL IM/SUBMUCOSAL ABSC TRANSANAL ANES

Professional

Both

$758.00

Service Code	HCPCS 46045
Min. Negotiated Rate	$285.42
Max. Negotiated Rate	$813.05
Rate for Payer: Aetna Commercial	$588.31
Rate for Payer: Aetna Medicare	$379.00
Rate for Payer: BCBS Complete	$299.69
Rate for Payer: BCN Commercial	$667.29
Rate for Payer: Cash Price	$606.40
Rate for Payer: Cash Price	$606.40
Rate for Payer: Mclaren Medicaid	$285.42
Rate for Payer: Meridian Medicaid	$299.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$568.50
Rate for Payer: Priority Health Choice Medicaid	$285.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$813.05
Rate for Payer: Priority Health Narrow/Tiered Network	$813.05
Rate for Payer: UHC Medicaid	$285.42
Rate for Payer: UHCCP Medicaid	$285.42

PR I&D ISCHIORECTAL/INTRAMURAL ABSC W/WO SETON

Professional

Both

$2,191.00

Service Code	HCPCS 46060
Min. Negotiated Rate	$313.54
Max. Negotiated Rate	$1,643.25
Rate for Payer: Aetna Commercial	$645.77
Rate for Payer: Aetna Medicare	$1,095.50
Rate for Payer: BCBS Complete	$329.22
Rate for Payer: BCN Commercial	$740.50
Rate for Payer: Cash Price	$1,752.80
Rate for Payer: Cash Price	$1,752.80
Rate for Payer: Mclaren Medicaid	$313.54
Rate for Payer: Meridian Medicaid	$329.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,643.25
Rate for Payer: Priority Health Choice Medicaid	$313.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$902.24
Rate for Payer: Priority Health Narrow/Tiered Network	$902.24
Rate for Payer: UHC Medicaid	$313.54
Rate for Payer: UHCCP Medicaid	$313.54

PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX

Facility

$952.00

Service Code	CPT 46040
Hospital Charge Code	46040
Hospital Revenue Code	960
Min. Negotiated Rate	$167.84
Max. Negotiated Rate	$856.80
Rate for Payer: Aetna Commercial	$809.20
Rate for Payer: Aetna Medicare	$247.52
Rate for Payer: Allen County Amish Medical Aid Commercial	$297.50
Rate for Payer: Amish Plain Church Group Commercial	$297.50
Rate for Payer: BCBS Complete	$176.22
Rate for Payer: BCBS MAPPO	$238.00
Rate for Payer: BCBS Trust/PPO	$782.64
Rate for Payer: BCN Commercial	$782.64
Rate for Payer: BCN Medicare Advantage	$238.00
Rate for Payer: Cash Price	$761.60
Rate for Payer: Cofinity Commercial	$818.72
Rate for Payer: Encore Health Key Benefits Commercial	$761.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$238.00
Rate for Payer: Healthscope Commercial	$856.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$714.00
Rate for Payer: Mclaren Medicaid	$167.84
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$249.90
Rate for Payer: Meridian Medicaid	$176.22
Rate for Payer: MI Amish Medical Board Commercial	$273.70
Rate for Payer: Molina Medicare/Medicaid	$261.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$809.20
Rate for Payer: Nomi Health Commercial	$780.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$714.00
Rate for Payer: PACE Senior Care Partners	$226.10
Rate for Payer: PACE SWMI	$238.00
Rate for Payer: PHP Commercial	$809.20
Rate for Payer: PHP Medicare Advantage	$238.00
Rate for Payer: Priority Health Choice Medicaid	$167.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$828.24
Rate for Payer: Priority Health Medicare	$240.38
Rate for Payer: Priority Health Narrow/Tiered Network	$662.59
Rate for Payer: Railroad Medicare Medicare	$238.00
Rate for Payer: UHC Core	$794.92
Rate for Payer: UHC Exchange	$238.00
Rate for Payer: UHC Medicaid	$167.84
Rate for Payer: UHC Medicare Advantage	$238.00
Rate for Payer: UHCCP Medicaid	$167.84
Rate for Payer: VA VA	$238.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$714.00

PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX

Facility

$952.00

Service Code	CPT 46040
Hospital Charge Code	46040
Hospital Revenue Code	960
Min. Negotiated Rate	$662.59
Max. Negotiated Rate	$856.80
Rate for Payer: Aetna Commercial	$809.20
Rate for Payer: BCBS Trust/PPO	$786.26
Rate for Payer: BCN Commercial	$786.26
Rate for Payer: Cash Price	$761.60
Rate for Payer: Cofinity Commercial	$818.72
Rate for Payer: Encore Health Key Benefits Commercial	$761.60
Rate for Payer: Healthscope Commercial	$856.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$714.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$809.20
Rate for Payer: Nomi Health Commercial	$780.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$714.00
Rate for Payer: PHP Commercial	$809.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$828.24
Rate for Payer: Priority Health Narrow/Tiered Network	$662.59
Rate for Payer: UHC Core	$794.92
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$714.00

PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX

Professional

Both

$952.00

Service Code	HCPCS 46040
Hospital Charge Code	46040
Min. Negotiated Rate	$277.33
Max. Negotiated Rate	$792.43
Rate for Payer: Aetna Commercial	$564.66
Rate for Payer: Aetna Medicare	$476.00
Rate for Payer: BCBS Complete	$291.20
Rate for Payer: BCN Commercial	$650.37
Rate for Payer: Cash Price	$761.60
Rate for Payer: Cash Price	$761.60
Rate for Payer: Mclaren Medicaid	$277.33
Rate for Payer: Meridian Medicaid	$291.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$714.00
Rate for Payer: Priority Health Choice Medicaid	$277.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$792.43
Rate for Payer: Priority Health Narrow/Tiered Network	$792.43
Rate for Payer: UHC Medicaid	$277.33
Rate for Payer: UHCCP Medicaid	$277.33

PR I&D ISCHIORECTAL&/PERIRECTAL ABSCESS SPX

Professional

Both

$952.00

Service Code	HCPCS 46040
Min. Negotiated Rate	$277.33
Max. Negotiated Rate	$792.43
Rate for Payer: Aetna Commercial	$564.66
Rate for Payer: Aetna Medicare	$476.00
Rate for Payer: BCBS Complete	$291.20
Rate for Payer: BCN Commercial	$650.37
Rate for Payer: Cash Price	$761.60
Rate for Payer: Cash Price	$761.60
Rate for Payer: Mclaren Medicaid	$277.33
Rate for Payer: Meridian Medicaid	$291.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$714.00
Rate for Payer: Priority Health Choice Medicaid	$277.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$792.43
Rate for Payer: Priority Health Narrow/Tiered Network	$792.43
Rate for Payer: UHC Medicaid	$277.33
Rate for Payer: UHCCP Medicaid	$277.33

PR I&D OF BARTHOLINS GLAND ABSCESS

Professional

Both

$398.00

Service Code	HCPCS 56420
Min. Negotiated Rate	$63.90
Max. Negotiated Rate	$298.50
Rate for Payer: Aetna Commercial	$128.52
Rate for Payer: Aetna Medicare	$199.00
Rate for Payer: BCBS Complete	$67.09
Rate for Payer: BCN Commercial	$165.33
Rate for Payer: Cash Price	$318.40
Rate for Payer: Cash Price	$318.40
Rate for Payer: Mclaren Medicaid	$63.90
Rate for Payer: Meridian Medicaid	$67.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$298.50
Rate for Payer: Priority Health Choice Medicaid	$63.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$167.44
Rate for Payer: Priority Health Narrow/Tiered Network	$167.44
Rate for Payer: UHC Medicaid	$63.90
Rate for Payer: UHCCP Medicaid	$63.90

PR I&D PELVIS/HIP JOINT AREA INFECTED BURSA

Professional

Both

$1,281.00

Service Code	HCPCS 26991
Min. Negotiated Rate	$313.54
Max. Negotiated Rate	$960.75
Rate for Payer: Aetna Commercial	$701.42
Rate for Payer: Aetna Medicare	$640.50
Rate for Payer: BCBS Complete	$329.22
Rate for Payer: BCN Commercial	$799.26
Rate for Payer: Cash Price	$1,024.80
Rate for Payer: Cash Price	$1,024.80
Rate for Payer: Mclaren Medicaid	$313.54
Rate for Payer: Meridian Medicaid	$329.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$960.75
Rate for Payer: Priority Health Choice Medicaid	$313.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$854.38
Rate for Payer: Priority Health Narrow/Tiered Network	$854.38
Rate for Payer: UHC Medicaid	$313.54
Rate for Payer: UHCCP Medicaid	$313.54

PR I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA

Professional

Both

$1,558.00

Service Code	HCPCS 26990
Min. Negotiated Rate	$421.31
Max. Negotiated Rate	$1,168.50
Rate for Payer: Aetna Commercial	$895.50
Rate for Payer: Aetna Medicare	$779.00
Rate for Payer: BCBS Complete	$442.38
Rate for Payer: BCN Commercial	$1,031.31
Rate for Payer: Cash Price	$1,246.40
Rate for Payer: Cash Price	$1,246.40
Rate for Payer: Mclaren Medicaid	$421.31
Rate for Payer: Meridian Medicaid	$442.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,168.50
Rate for Payer: Priority Health Choice Medicaid	$421.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,102.46
Rate for Payer: Priority Health Narrow/Tiered Network	$1,102.46
Rate for Payer: UHC Medicaid	$421.31
Rate for Payer: UHCCP Medicaid	$421.31

PR I&D PENIS DEEP

Professional

Both

$789.00

Service Code	HCPCS 54015
Min. Negotiated Rate	$176.79
Max. Negotiated Rate	$591.75
Rate for Payer: Aetna Commercial	$391.78
Rate for Payer: Aetna Medicare	$394.50
Rate for Payer: BCBS Complete	$185.63
Rate for Payer: BCN Commercial	$456.15
Rate for Payer: Cash Price	$631.20
Rate for Payer: Cash Price	$631.20
Rate for Payer: Mclaren Medicaid	$176.79
Rate for Payer: Meridian Medicaid	$185.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$591.75
Rate for Payer: Priority Health Choice Medicaid	$176.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$496.89
Rate for Payer: Priority Health Narrow/Tiered Network	$496.89
Rate for Payer: UHC Medicaid	$176.79
Rate for Payer: UHCCP Medicaid	$176.79

PR I&D PERIANAL ABSCESS SUPERFICIAL

Professional

Both

$464.00

Service Code	HCPCS 46050
Min. Negotiated Rate	$66.03
Max. Negotiated Rate	$348.00
Rate for Payer: Aetna Commercial	$132.59
Rate for Payer: Aetna Medicare	$232.00
Rate for Payer: BCBS Complete	$69.33
Rate for Payer: BCN Commercial	$154.38
Rate for Payer: Cash Price	$371.20
Rate for Payer: Cash Price	$371.20
Rate for Payer: Mclaren Medicaid	$66.03
Rate for Payer: Meridian Medicaid	$69.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$348.00
Rate for Payer: Priority Health Choice Medicaid	$66.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$188.09
Rate for Payer: Priority Health Narrow/Tiered Network	$188.09
Rate for Payer: UHC Medicaid	$66.03
Rate for Payer: UHCCP Medicaid	$66.03

PR I&D SHOULDER DEEP ABSCESS/HEMATOMA

Professional

Both

$737.00

Service Code	HCPCS 23030
Min. Negotiated Rate	$155.49
Max. Negotiated Rate	$552.75
Rate for Payer: Aetna Commercial	$338.61
Rate for Payer: Aetna Medicare	$368.50
Rate for Payer: BCBS Complete	$163.26
Rate for Payer: BCN Commercial	$388.43
Rate for Payer: Cash Price	$589.60
Rate for Payer: Cash Price	$589.60
Rate for Payer: Mclaren Medicaid	$155.49
Rate for Payer: Meridian Medicaid	$163.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$552.75
Rate for Payer: Priority Health Choice Medicaid	$155.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$415.21
Rate for Payer: Priority Health Narrow/Tiered Network	$415.21
Rate for Payer: UHC Medicaid	$155.49
Rate for Payer: UHCCP Medicaid	$155.49

PR I&D SHOULDER INFECTED BURSA

Professional

Both

$742.00

Service Code	HCPCS 23031
Min. Negotiated Rate	$137.60
Max. Negotiated Rate	$556.50
Rate for Payer: Aetna Commercial	$287.48
Rate for Payer: Aetna Medicare	$371.00
Rate for Payer: BCBS Complete	$144.48
Rate for Payer: BCN Commercial	$341.12
Rate for Payer: Cash Price	$593.60
Rate for Payer: Cash Price	$593.60
Rate for Payer: Mclaren Medicaid	$137.60
Rate for Payer: Meridian Medicaid	$144.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$556.50
Rate for Payer: Priority Health Choice Medicaid	$137.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$364.64
Rate for Payer: Priority Health Narrow/Tiered Network	$364.64
Rate for Payer: UHC Medicaid	$137.60
Rate for Payer: UHCCP Medicaid	$137.60

PR I&D SOFT TISSUE ABSCESS SUBFASCIAL

Professional

Both

$530.00

Service Code	HCPCS 20005
Min. Negotiated Rate	$212.00
Max. Negotiated Rate	$397.50
Rate for Payer: Aetna Medicare	$265.00
Rate for Payer: BCBS Complete	$212.00
Rate for Payer: Cash Price	$424.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$397.50

PR I&D SUBMUCOSAL ABSCESS RECTUM

Professional

Both

$543.00

Service Code	HCPCS 45005
Min. Negotiated Rate	$110.76
Max. Negotiated Rate	$407.25
Rate for Payer: Aetna Commercial	$217.12
Rate for Payer: Aetna Medicare	$271.50
Rate for Payer: BCBS Complete	$116.30
Rate for Payer: BCN Commercial	$254.97
Rate for Payer: Cash Price	$434.40
Rate for Payer: Cash Price	$434.40
Rate for Payer: Mclaren Medicaid	$110.76
Rate for Payer: Meridian Medicaid	$116.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$407.25
Rate for Payer: Priority Health Choice Medicaid	$110.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$310.65
Rate for Payer: Priority Health Narrow/Tiered Network	$310.65
Rate for Payer: UHC Medicaid	$110.76
Rate for Payer: UHCCP Medicaid	$110.76

PR I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA

Professional

Both

$639.00

Service Code	HCPCS 23930
Min. Negotiated Rate	$130.78
Max. Negotiated Rate	$479.25
Rate for Payer: Aetna Commercial	$288.31
Rate for Payer: Aetna Medicare	$319.50
Rate for Payer: BCBS Complete	$137.32
Rate for Payer: BCN Commercial	$329.17
Rate for Payer: Cash Price	$511.20
Rate for Payer: Cash Price	$511.20
Rate for Payer: Mclaren Medicaid	$130.78
Rate for Payer: Meridian Medicaid	$137.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$479.25
Rate for Payer: Priority Health Choice Medicaid	$130.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$351.87
Rate for Payer: Priority Health Narrow/Tiered Network	$351.87
Rate for Payer: UHC Medicaid	$130.78
Rate for Payer: UHCCP Medicaid	$130.78

PR I&D VAGINAL HEMATOMA NON-OBSTETRICAL

Professional

Both

$542.00

Service Code	HCPCS 57023
Min. Negotiated Rate	$180.62
Max. Negotiated Rate	$486.19
Rate for Payer: Aetna Commercial	$380.17
Rate for Payer: Aetna Medicare	$271.00
Rate for Payer: BCBS Complete	$189.65
Rate for Payer: BCN Commercial	$480.06
Rate for Payer: Cash Price	$433.60
Rate for Payer: Cash Price	$433.60
Rate for Payer: Mclaren Medicaid	$180.62
Rate for Payer: Meridian Medicaid	$189.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$406.50
Rate for Payer: Priority Health Choice Medicaid	$180.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$486.19
Rate for Payer: Priority Health Narrow/Tiered Network	$486.19
Rate for Payer: UHC Medicaid	$180.62
Rate for Payer: UHCCP Medicaid	$180.62

PR I&D VAGINAL HEMATOMA OBSTETRICAL/POSTPARTUM

Professional

Both

$472.00

Service Code	HCPCS 57022
Min. Negotiated Rate	$101.81
Max. Negotiated Rate	$354.00
Rate for Payer: Aetna Commercial	$214.36
Rate for Payer: Aetna Medicare	$236.00
Rate for Payer: BCBS Complete	$106.90
Rate for Payer: BCN Commercial	$272.89
Rate for Payer: Cash Price	$377.60
Rate for Payer: Cash Price	$377.60
Rate for Payer: Mclaren Medicaid	$101.81
Rate for Payer: Meridian Medicaid	$106.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$354.00
Rate for Payer: Priority Health Choice Medicaid	$101.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$276.38
Rate for Payer: Priority Health Narrow/Tiered Network	$276.38
Rate for Payer: UHC Medicaid	$101.81
Rate for Payer: UHCCP Medicaid	$101.81

Know your out-of-pocket cost for care.

All Charges