Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR INJECTION AIR/CONTRAST PERITONEAL CAVITY SPX

Professional

Both

$316.00

Service Code	HCPCS 49400
Min. Negotiated Rate	$50.06
Max. Negotiated Rate	$237.00
Rate for Payer: Aetna Commercial	$122.24
Rate for Payer: Aetna Medicare	$158.00
Rate for Payer: BCBS Complete	$52.56
Rate for Payer: BCN Commercial	$132.96
Rate for Payer: Cash Price	$252.80
Rate for Payer: Cash Price	$252.80
Rate for Payer: Mclaren Medicaid	$50.06
Rate for Payer: Meridian Medicaid	$52.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$237.00
Rate for Payer: Priority Health Choice Medicaid	$50.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$162.01
Rate for Payer: Priority Health Narrow/Tiered Network	$162.01
Rate for Payer: UHC Medicaid	$50.06
Rate for Payer: UHCCP Medicaid	$50.06

PR INJECTION ANES AGENT SPHENOPALATINE GANGLION

Professional

Both

$184.00

Service Code	HCPCS 64505
Min. Negotiated Rate	$62.20
Max. Negotiated Rate	$185.66
Rate for Payer: Aetna Commercial	$128.32
Rate for Payer: Aetna Medicare	$92.00
Rate for Payer: BCBS Complete	$65.31
Rate for Payer: BCN Commercial	$159.85
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cash Price	$147.20
Rate for Payer: Mclaren Medicaid	$62.20
Rate for Payer: Meridian Medicaid	$65.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$138.00
Rate for Payer: Priority Health Choice Medicaid	$62.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$185.66
Rate for Payer: Priority Health Narrow/Tiered Network	$185.66
Rate for Payer: UHC Medicaid	$62.20
Rate for Payer: UHCCP Medicaid	$62.20

PR INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC

Professional

Both

$212.00

Service Code	HCPCS 64520
Min. Negotiated Rate	$48.99
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$107.54
Rate for Payer: Aetna Commercial	$107.54
Rate for Payer: Aetna Medicare	$106.00
Rate for Payer: Aetna Medicare	$184.00
Rate for Payer: BCBS Complete	$51.44
Rate for Payer: BCBS Complete	$51.44
Rate for Payer: BCN Commercial	$126.98
Rate for Payer: BCN Commercial	$126.98
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$294.40
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$294.40
Rate for Payer: Mclaren Medicaid	$48.99
Rate for Payer: Mclaren Medicaid	$48.99
Rate for Payer: Meridian Medicaid	$51.44
Rate for Payer: Meridian Medicaid	$51.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$276.00
Rate for Payer: Priority Health Choice Medicaid	$48.99
Rate for Payer: Priority Health Choice Medicaid	$48.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$147.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$147.48
Rate for Payer: Priority Health Narrow/Tiered Network	$147.48
Rate for Payer: Priority Health Narrow/Tiered Network	$147.48
Rate for Payer: UHC Medicaid	$48.99
Rate for Payer: UHC Medicaid	$48.99
Rate for Payer: UHCCP Medicaid	$48.99
Rate for Payer: UHCCP Medicaid	$48.99

PR INJECTION, BUPIVICAINE HYDRO

Professional

Both

$10.00

Service Code	HCPCS S0020
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50

PR INJECTION CORPORA CAVERNOSA PHARMACOLOGIC AGENT

Professional

Both

$180.00

Service Code	HCPCS 54235
Min. Negotiated Rate	$43.45
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$92.84
Rate for Payer: Aetna Medicare	$90.00
Rate for Payer: BCBS Complete	$45.62
Rate for Payer: BCN Commercial	$111.55
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Mclaren Medicaid	$43.45
Rate for Payer: Meridian Medicaid	$45.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$135.00
Rate for Payer: Priority Health Choice Medicaid	$43.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$121.52
Rate for Payer: Priority Health Narrow/Tiered Network	$121.52
Rate for Payer: UHC Medicaid	$43.45
Rate for Payer: UHCCP Medicaid	$43.45

PR INJECTION ENZYME PALMAR FASCIAL CORD

Professional

Both

$171.00

Service Code	HCPCS 20527
Min. Negotiated Rate	$37.28
Max. Negotiated Rate	$128.25
Rate for Payer: Aetna Commercial	$86.70
Rate for Payer: Aetna Medicare	$85.50
Rate for Payer: BCBS Complete	$39.14
Rate for Payer: BCN Commercial	$99.10
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Mclaren Medicaid	$37.28
Rate for Payer: Meridian Medicaid	$39.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$128.25
Rate for Payer: Priority Health Choice Medicaid	$37.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$105.93
Rate for Payer: Priority Health Narrow/Tiered Network	$105.93
Rate for Payer: UHC Medicaid	$37.28
Rate for Payer: UHCCP Medicaid	$37.28

PR INJECTION EPIDURAL BLOOD/CLOT PATCH

Professional

Both

$485.00

Service Code	HCPCS 62273
Min. Negotiated Rate	$65.18
Max. Negotiated Rate	$363.75
Rate for Payer: Aetna Commercial	$145.25
Rate for Payer: Aetna Medicare	$242.50
Rate for Payer: BCBS Complete	$68.44
Rate for Payer: BCN Commercial	$185.46
Rate for Payer: Cash Price	$388.00
Rate for Payer: Cash Price	$388.00
Rate for Payer: Mclaren Medicaid	$65.18
Rate for Payer: Meridian Medicaid	$68.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$363.75
Rate for Payer: Priority Health Choice Medicaid	$65.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$196.07
Rate for Payer: Priority Health Narrow/Tiered Network	$196.07
Rate for Payer: UHC Medicaid	$65.18
Rate for Payer: UHCCP Medicaid	$65.18

PR INJECTION INTRALESIONAL >7 LESIONS

Professional

Both

$126.00

Service Code	HCPCS 11901
Min. Negotiated Rate	$23.22
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna Commercial	$50.17
Rate for Payer: Aetna Medicare	$63.00
Rate for Payer: BCBS Complete	$24.38
Rate for Payer: BCN Commercial	$53.01
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Mclaren Medicaid	$23.22
Rate for Payer: Meridian Medicaid	$24.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$94.50
Rate for Payer: Priority Health Choice Medicaid	$23.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$61.53
Rate for Payer: Priority Health Narrow/Tiered Network	$61.53
Rate for Payer: UHC Medicaid	$23.22
Rate for Payer: UHCCP Medicaid	$23.22

PR INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS

Professional

Both

$95.00

Service Code	HCPCS 11900
Min. Negotiated Rate	$15.34
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Commercial	$32.33
Rate for Payer: Aetna Medicare	$47.50
Rate for Payer: BCBS Complete	$16.11
Rate for Payer: BCN Commercial	$34.56
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cash Price	$76.00
Rate for Payer: Mclaren Medicaid	$15.34
Rate for Payer: Meridian Medicaid	$16.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$71.25
Rate for Payer: Priority Health Choice Medicaid	$15.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$40.10
Rate for Payer: Priority Health Narrow/Tiered Network	$40.10
Rate for Payer: UHC Medicaid	$15.34
Rate for Payer: UHCCP Medicaid	$15.34

PR INJECTION KNEE ARTHROGRAPHY

Professional

Both

$295.00

Service Code	HCPCS 27370
Min. Negotiated Rate	$118.00
Max. Negotiated Rate	$221.25
Rate for Payer: Aetna Medicare	$147.50
Rate for Payer: BCBS Complete	$118.00
Rate for Payer: Cash Price	$236.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$221.25

PR INJECTION,ONABOTULINUMTOXINA

Professional

Both

$8.00

Service Code	HCPCS J0585
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$6.52
Rate for Payer: Aetna Commercial	$6.52
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Trust/PPO	$6.52
Rate for Payer: BCN Commercial	$6.38
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.00

PR INJECTION, PLATELET RICH PLASMA, ANY SITE INCLUDING IMAGE GUIDANCE, HARVESTING AND PREPARATION WHEN PERFORMED

Professional

Both

$630.00

Hospital Revenue Code	990
Min. Negotiated Rate	$252.00
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna Medicare	$315.00
Rate for Payer: BCBS Complete	$252.00
Rate for Payer: Cash Price	$504.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$472.50

PR INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY

Professional

Both

$296.00

Service Code	HCPCS 24220
Min. Negotiated Rate	$35.78
Max. Negotiated Rate	$222.00
Rate for Payer: Aetna Commercial	$90.48
Rate for Payer: Aetna Medicare	$148.00
Rate for Payer: BCBS Complete	$37.57
Rate for Payer: BCN Commercial	$98.10
Rate for Payer: Cash Price	$236.80
Rate for Payer: Cash Price	$236.80
Rate for Payer: Mclaren Medicaid	$35.78
Rate for Payer: Meridian Medicaid	$37.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$222.00
Rate for Payer: Priority Health Choice Medicaid	$35.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$104.86
Rate for Payer: Priority Health Narrow/Tiered Network	$104.86
Rate for Payer: UHC Medicaid	$35.78
Rate for Payer: UHCCP Medicaid	$35.78

PR INJECTION PROCEDURE FOR PEYRONIE DISEASE

Professional

Both

$228.00

Service Code	HCPCS 54200
Min. Negotiated Rate	$53.25
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna Commercial	$107.78
Rate for Payer: Aetna Medicare	$114.00
Rate for Payer: BCBS Complete	$55.91
Rate for Payer: BCN Commercial	$133.46
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cash Price	$182.40
Rate for Payer: Mclaren Medicaid	$53.25
Rate for Payer: Meridian Medicaid	$55.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$171.00
Rate for Payer: Priority Health Choice Medicaid	$53.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$145.38
Rate for Payer: Priority Health Narrow/Tiered Network	$145.38
Rate for Payer: UHC Medicaid	$53.25
Rate for Payer: UHCCP Medicaid	$53.25

PR INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR

Professional

Both

$620.00

Service Code	HCPCS 62284
Min. Negotiated Rate	$45.80
Max. Negotiated Rate	$465.00
Rate for Payer: Aetna Commercial	$109.22
Rate for Payer: Aetna Medicare	$310.00
Rate for Payer: BCBS Complete	$48.09
Rate for Payer: BCN Commercial	$135.13
Rate for Payer: Cash Price	$496.00
Rate for Payer: Cash Price	$496.00
Rate for Payer: Mclaren Medicaid	$45.80
Rate for Payer: Meridian Medicaid	$48.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$465.00
Rate for Payer: Priority Health Choice Medicaid	$45.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$142.87
Rate for Payer: Priority Health Narrow/Tiered Network	$142.87
Rate for Payer: UHC Medicaid	$45.80
Rate for Payer: UHCCP Medicaid	$45.80

PR INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR

Professional

Both

$1,483.00

Service Code	HCPCS 62290
Min. Negotiated Rate	$90.95
Max. Negotiated Rate	$1,112.25
Rate for Payer: Aetna Commercial	$210.47
Rate for Payer: Aetna Medicare	$741.50
Rate for Payer: BCBS Complete	$95.50
Rate for Payer: BCN Commercial	$256.03
Rate for Payer: Cash Price	$1,186.40
Rate for Payer: Cash Price	$1,186.40
Rate for Payer: Mclaren Medicaid	$90.95
Rate for Payer: Meridian Medicaid	$95.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,112.25
Rate for Payer: Priority Health Choice Medicaid	$90.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$270.69
Rate for Payer: Priority Health Narrow/Tiered Network	$270.69
Rate for Payer: UHC Medicaid	$90.95
Rate for Payer: UHCCP Medicaid	$90.95

PR INJECTION PX ONLY MAMMARY DUCTOGRAM/GALACTOGRAM

Professional

Both

$340.00

Service Code	HCPCS 19030
Min. Negotiated Rate	$40.90
Max. Negotiated Rate	$255.00
Rate for Payer: Aetna Commercial	$82.84
Rate for Payer: Aetna Medicare	$170.00
Rate for Payer: BCBS Complete	$42.95
Rate for Payer: BCN Commercial	$111.55
Rate for Payer: Cash Price	$272.00
Rate for Payer: Cash Price	$272.00
Rate for Payer: Mclaren Medicaid	$40.90
Rate for Payer: Meridian Medicaid	$42.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$255.00
Rate for Payer: Priority Health Choice Medicaid	$40.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$102.10
Rate for Payer: Priority Health Narrow/Tiered Network	$102.10
Rate for Payer: UHC Medicaid	$40.90
Rate for Payer: UHCCP Medicaid	$40.90

PR INJECTION PX PEYRONIE DS W/SURG EXPOSURE PLAQUE

Professional

Both

$1,124.00

Service Code	HCPCS 54205
Min. Negotiated Rate	$311.41
Max. Negotiated Rate	$872.28
Rate for Payer: Aetna Commercial	$681.56
Rate for Payer: Aetna Medicare	$562.00
Rate for Payer: BCBS Complete	$326.98
Rate for Payer: BCN Commercial	$800.75
Rate for Payer: Cash Price	$899.20
Rate for Payer: Cash Price	$899.20
Rate for Payer: Mclaren Medicaid	$311.41
Rate for Payer: Meridian Medicaid	$326.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$843.00
Rate for Payer: Priority Health Choice Medicaid	$311.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$872.28
Rate for Payer: Priority Health Narrow/Tiered Network	$872.28
Rate for Payer: UHC Medicaid	$311.41
Rate for Payer: UHCCP Medicaid	$311.41

PR INJECTION PX PRQ TX EXTREMITY PSEUDOANEURYSM

Professional

Both

$470.00

Service Code	HCPCS 36002
Min. Negotiated Rate	$58.58
Max. Negotiated Rate	$352.50
Rate for Payer: Aetna Commercial	$138.71
Rate for Payer: Aetna Medicare	$235.00
Rate for Payer: BCBS Complete	$61.51
Rate for Payer: BCN Commercial	$152.88
Rate for Payer: Cash Price	$376.00
Rate for Payer: Cash Price	$376.00
Rate for Payer: Mclaren Medicaid	$58.58
Rate for Payer: Meridian Medicaid	$61.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$352.50
Rate for Payer: Priority Health Choice Medicaid	$58.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$164.40
Rate for Payer: Priority Health Narrow/Tiered Network	$164.40
Rate for Payer: UHC Medicaid	$58.58
Rate for Payer: UHCCP Medicaid	$58.58

PR INJECTION SCLEROSANT MULTIPLE INCMPTNT VEINS

Professional

Both

$348.00

Service Code	HCPCS 36471
Min. Negotiated Rate	$42.60
Max. Negotiated Rate	$261.00
Rate for Payer: Aetna Commercial	$101.56
Rate for Payer: Aetna Medicare	$174.00
Rate for Payer: BCBS Complete	$44.73
Rate for Payer: BCN Commercial	$87.57
Rate for Payer: Cash Price	$278.40
Rate for Payer: Cash Price	$278.40
Rate for Payer: Mclaren Medicaid	$42.60
Rate for Payer: Meridian Medicaid	$44.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$261.00
Rate for Payer: Priority Health Choice Medicaid	$42.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$119.42
Rate for Payer: Priority Health Narrow/Tiered Network	$119.42
Rate for Payer: UHC Medicaid	$42.60
Rate for Payer: UHCCP Medicaid	$42.60

PR INJECTION SCLEROSANT SINGLE INCMPTNT VEIN

Professional

Both

$278.00

Service Code	HCPCS 36470
Min. Negotiated Rate	$21.51
Max. Negotiated Rate	$208.50
Rate for Payer: Aetna Commercial	$51.69
Rate for Payer: Aetna Medicare	$139.00
Rate for Payer: BCBS Complete	$22.59
Rate for Payer: BCN Commercial	$44.77
Rate for Payer: Cash Price	$222.40
Rate for Payer: Cash Price	$222.40
Rate for Payer: Mclaren Medicaid	$21.51
Rate for Payer: Meridian Medicaid	$22.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$208.50
Rate for Payer: Priority Health Choice Medicaid	$21.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$61.06
Rate for Payer: Priority Health Narrow/Tiered Network	$61.06
Rate for Payer: UHC Medicaid	$21.51
Rate for Payer: UHCCP Medicaid	$21.51

PR INJECTION SCLEROSING SOLUTION HEMORRHOIDS

Professional

Both

$359.00

Service Code	HCPCS 46500
Min. Negotiated Rate	$123.97
Max. Negotiated Rate	$339.18
Rate for Payer: Aetna Commercial	$245.44
Rate for Payer: Aetna Medicare	$179.50
Rate for Payer: BCBS Complete	$130.17
Rate for Payer: BCN Commercial	$278.37
Rate for Payer: Cash Price	$287.20
Rate for Payer: Cash Price	$287.20
Rate for Payer: Mclaren Medicaid	$123.97
Rate for Payer: Meridian Medicaid	$130.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$269.25
Rate for Payer: Priority Health Choice Medicaid	$123.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$339.18
Rate for Payer: Priority Health Narrow/Tiered Network	$339.18
Rate for Payer: UHC Medicaid	$123.97
Rate for Payer: UHCCP Medicaid	$123.97

PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES

Professional

Both

$124.00

Service Code	HCPCS 20552
Min. Negotiated Rate	$22.79
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$50.69
Rate for Payer: Aetna Medicare	$62.00
Rate for Payer: BCBS Complete	$23.93
Rate for Payer: BCN Commercial	$54.28
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$99.20
Rate for Payer: Mclaren Medicaid	$22.79
Rate for Payer: Meridian Medicaid	$23.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$93.00
Rate for Payer: Priority Health Choice Medicaid	$22.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$58.03
Rate for Payer: Priority Health Narrow/Tiered Network	$58.03
Rate for Payer: UHC Medicaid	$22.79
Rate for Payer: UHCCP Medicaid	$22.79

PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES

Facility

$124.00

Service Code	CPT 20552
Hospital Charge Code	20552
Hospital Revenue Code	521
Min. Negotiated Rate	$86.30
Max. Negotiated Rate	$111.60
Rate for Payer: Aetna Commercial	$105.40
Rate for Payer: BCBS Trust/PPO	$102.41
Rate for Payer: BCN Commercial	$102.41
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cofinity Commercial	$106.64
Rate for Payer: Encore Health Key Benefits Commercial	$99.20
Rate for Payer: Healthscope Commercial	$111.60
Rate for Payer: Lakeland Regional Health Systems Commercial	$93.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$105.40
Rate for Payer: Nomi Health Commercial	$101.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$93.00
Rate for Payer: PHP Commercial	$105.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$107.88
Rate for Payer: Priority Health Narrow/Tiered Network	$86.30
Rate for Payer: UHC Core	$103.54
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$93.00

PR INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES

Professional

Both

$124.00

Service Code	HCPCS 20552
Hospital Charge Code	20552
Min. Negotiated Rate	$22.79
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$50.69
Rate for Payer: Aetna Medicare	$62.00
Rate for Payer: BCBS Complete	$23.93
Rate for Payer: BCN Commercial	$54.28
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$99.20
Rate for Payer: Mclaren Medicaid	$22.79
Rate for Payer: Meridian Medicaid	$23.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$93.00
Rate for Payer: Priority Health Choice Medicaid	$22.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$58.03
Rate for Payer: Priority Health Narrow/Tiered Network	$58.03
Rate for Payer: UHC Medicaid	$22.79
Rate for Payer: UHCCP Medicaid	$22.79

Know your out-of-pocket cost for care.

All Charges