Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR LARYNGOSCOPY W/WO TRACHEOSCOPY W/DILATION IN

Professional

Both

$792.00

Service Code	HCPCS 31528
Min. Negotiated Rate	$137.68
Max. Negotiated Rate	$514.80
Rate for Payer: Aetna Commercial	$184.49
Rate for Payer: Aetna Medicare	$143.19
Rate for Payer: BCBS Complete	$316.80
Rate for Payer: BCBS MAPPO	$137.68
Rate for Payer: BCN Medicare Advantage	$137.68
Rate for Payer: Cash Price	$633.60
Rate for Payer: Cash Price	$633.60
Rate for Payer: Cofinity Commercial	$198.26
Rate for Payer: Cofinity Commercial	$184.49
Rate for Payer: Health Alliance Plan Medicare Advantage	$137.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$144.56
Rate for Payer: Nomi Health Commercial	$165.22
Rate for Payer: PACE SWMI	$137.68
Rate for Payer: PHP Medicare Advantage	$137.68
Rate for Payer: Priority Health Cigna Priority Health	$514.80
Rate for Payer: Priority Health Medicare	$139.06
Rate for Payer: UHC All Payor (Choice/PPO)	$137.68
Rate for Payer: UHC Dual Complete DSNP	$137.68
Rate for Payer: UHC Exchange	$137.68
Rate for Payer: UHC Medicare Advantage	$137.68

PR LARYNGOSCOPY W/WO TRACHEOSCOPY W/MICRO/TELESCOPE

Professional

Both

$322.00

Service Code	HCPCS 31526
Min. Negotiated Rate	$128.80
Max. Negotiated Rate	$216.13
Rate for Payer: Aetna Commercial	$201.12
Rate for Payer: Aetna Medicare	$156.09
Rate for Payer: BCBS Complete	$128.80
Rate for Payer: BCBS MAPPO	$150.09
Rate for Payer: BCN Medicare Advantage	$150.09
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cash Price	$257.60
Rate for Payer: Cofinity Commercial	$216.13
Rate for Payer: Cofinity Commercial	$201.12
Rate for Payer: Health Alliance Plan Medicare Advantage	$150.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$157.59
Rate for Payer: Nomi Health Commercial	$180.11
Rate for Payer: PACE SWMI	$150.09
Rate for Payer: PHP Medicare Advantage	$150.09
Rate for Payer: Priority Health Cigna Priority Health	$209.30
Rate for Payer: Priority Health Medicare	$151.59
Rate for Payer: UHC All Payor (Choice/PPO)	$150.09
Rate for Payer: UHC Dual Complete DSNP	$150.09
Rate for Payer: UHC Exchange	$150.09
Rate for Payer: UHC Medicare Advantage	$150.09

PR LARYNGOTOMY W/RMVL TUMOR/LARYNGOCELE CORDECTOMY

Professional

Both

$2,271.00

Service Code	HCPCS 31300
Min. Negotiated Rate	$908.40
Max. Negotiated Rate	$1,688.37
Rate for Payer: Aetna Commercial	$1,571.12
Rate for Payer: Aetna Medicare	$1,219.38
Rate for Payer: BCBS Complete	$908.40
Rate for Payer: BCBS MAPPO	$1,172.48
Rate for Payer: BCN Medicare Advantage	$1,172.48
Rate for Payer: Cash Price	$1,816.80
Rate for Payer: Cash Price	$1,816.80
Rate for Payer: Cofinity Commercial	$1,571.12
Rate for Payer: Cofinity Commercial	$1,688.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,172.48
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,231.10
Rate for Payer: Nomi Health Commercial	$1,406.98
Rate for Payer: PACE SWMI	$1,172.48
Rate for Payer: PHP Medicare Advantage	$1,172.48
Rate for Payer: Priority Health Cigna Priority Health	$1,476.15
Rate for Payer: Priority Health Medicare	$1,184.20
Rate for Payer: UHC All Payor (Choice/PPO)	$1,172.48
Rate for Payer: UHC Dual Complete DSNP	$1,172.48
Rate for Payer: UHC Exchange	$1,172.48
Rate for Payer: UHC Medicare Advantage	$1,172.48

PR LASER CO2 - FULL FACE

Professional

Both

$2,805.00

Service Code	HCPCS 00263
Hospital Revenue Code	990
Min. Negotiated Rate	$1,122.00
Max. Negotiated Rate	$1,823.25
Rate for Payer: Aetna Medicare	$1,402.50
Rate for Payer: BCBS Complete	$1,122.00
Rate for Payer: Cash Price	$2,244.00
Rate for Payer: Priority Health Cigna Priority Health	$1,823.25

PR LASER CO2 - ONE AREA

Professional

Both

$1,785.00

Service Code	HCPCS 00181
Hospital Revenue Code	990
Min. Negotiated Rate	$714.00
Max. Negotiated Rate	$1,160.25
Rate for Payer: Aetna Medicare	$892.50
Rate for Payer: BCBS Complete	$714.00
Rate for Payer: Cash Price	$1,428.00
Rate for Payer: Priority Health Cigna Priority Health	$1,160.25

PR LASER CO2 - TWO AREAS

Professional

Both

$2,295.00

Service Code	HCPCS 00182
Hospital Revenue Code	990
Min. Negotiated Rate	$918.00
Max. Negotiated Rate	$1,491.75
Rate for Payer: Aetna Medicare	$1,147.50
Rate for Payer: BCBS Complete	$918.00
Rate for Payer: Cash Price	$1,836.00
Rate for Payer: Priority Health Cigna Priority Health	$1,491.75

PR LASER ENUCLEATION PROSTATE W/MORCELLATION

Professional

Both

$1,709.00

Service Code	HCPCS 52649
Min. Negotiated Rate	$683.60
Max. Negotiated Rate	$1,133.88
Rate for Payer: Aetna Commercial	$1,055.14
Rate for Payer: Aetna Medicare	$818.92
Rate for Payer: BCBS Complete	$683.60
Rate for Payer: BCBS MAPPO	$787.42
Rate for Payer: BCN Medicare Advantage	$787.42
Rate for Payer: Cash Price	$1,367.20
Rate for Payer: Cash Price	$1,367.20
Rate for Payer: Cofinity Commercial	$1,133.88
Rate for Payer: Cofinity Commercial	$1,055.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$787.42
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$826.79
Rate for Payer: Nomi Health Commercial	$944.90
Rate for Payer: PACE SWMI	$787.42
Rate for Payer: PHP Medicare Advantage	$787.42
Rate for Payer: Priority Health Cigna Priority Health	$1,110.85
Rate for Payer: Priority Health Medicare	$795.29
Rate for Payer: UHC All Payor (Choice/PPO)	$787.42
Rate for Payer: UHC Dual Complete DSNP	$787.42
Rate for Payer: UHC Exchange	$787.42
Rate for Payer: UHC Medicare Advantage	$787.42

PR LASER VAPORIZATION OF PROSTATE FOR URINE FLOW

Professional

Both

$3,308.00

Service Code	HCPCS 52648
Min. Negotiated Rate	$662.13
Max. Negotiated Rate	$2,150.20
Rate for Payer: Aetna Commercial	$887.25
Rate for Payer: Aetna Medicare	$688.62
Rate for Payer: BCBS Complete	$1,323.20
Rate for Payer: BCBS MAPPO	$662.13
Rate for Payer: BCN Medicare Advantage	$662.13
Rate for Payer: Cash Price	$2,646.40
Rate for Payer: Cash Price	$2,646.40
Rate for Payer: Cofinity Commercial	$953.47
Rate for Payer: Cofinity Commercial	$887.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$662.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$695.24
Rate for Payer: Nomi Health Commercial	$794.56
Rate for Payer: PACE SWMI	$662.13
Rate for Payer: PHP Medicare Advantage	$662.13
Rate for Payer: Priority Health Cigna Priority Health	$2,150.20
Rate for Payer: Priority Health Medicare	$668.75
Rate for Payer: UHC All Payor (Choice/PPO)	$662.13
Rate for Payer: UHC Dual Complete DSNP	$662.13
Rate for Payer: UHC Exchange	$662.13
Rate for Payer: UHC Medicare Advantage	$662.13

PR LATERAL RETINACULAR RELEASE OPEN

Professional

Both

$1,697.00

Service Code	HCPCS 27425
Hospital Charge Code	27425
Min. Negotiated Rate	$440.04
Max. Negotiated Rate	$1,103.05
Rate for Payer: Aetna Commercial	$589.65
Rate for Payer: Aetna Medicare	$457.64
Rate for Payer: BCBS Complete	$678.80
Rate for Payer: BCBS MAPPO	$440.04
Rate for Payer: BCN Medicare Advantage	$440.04
Rate for Payer: Cash Price	$1,357.60
Rate for Payer: Cash Price	$1,357.60
Rate for Payer: Cofinity Commercial	$633.66
Rate for Payer: Cofinity Commercial	$589.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$440.04
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$462.04
Rate for Payer: Nomi Health Commercial	$528.05
Rate for Payer: PACE SWMI	$440.04
Rate for Payer: PHP Medicare Advantage	$440.04
Rate for Payer: Priority Health Cigna Priority Health	$1,103.05
Rate for Payer: Priority Health Medicare	$444.44
Rate for Payer: UHC All Payor (Choice/PPO)	$440.04
Rate for Payer: UHC Dual Complete DSNP	$440.04
Rate for Payer: UHC Exchange	$440.04
Rate for Payer: UHC Medicare Advantage	$440.04

PR LATERAL RETINACULAR RELEASE OPEN

Professional

Both

$1,697.00

Service Code	HCPCS 27425
Min. Negotiated Rate	$440.04
Max. Negotiated Rate	$1,103.05
Rate for Payer: Aetna Commercial	$589.65
Rate for Payer: Aetna Medicare	$457.64
Rate for Payer: BCBS Complete	$678.80
Rate for Payer: BCBS MAPPO	$440.04
Rate for Payer: BCN Medicare Advantage	$440.04
Rate for Payer: Cash Price	$1,357.60
Rate for Payer: Cash Price	$1,357.60
Rate for Payer: Cofinity Commercial	$633.66
Rate for Payer: Cofinity Commercial	$589.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$440.04
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$462.04
Rate for Payer: Nomi Health Commercial	$528.05
Rate for Payer: PACE SWMI	$440.04
Rate for Payer: PHP Medicare Advantage	$440.04
Rate for Payer: Priority Health Cigna Priority Health	$1,103.05
Rate for Payer: Priority Health Medicare	$444.44
Rate for Payer: UHC All Payor (Choice/PPO)	$440.04
Rate for Payer: UHC Dual Complete DSNP	$440.04
Rate for Payer: UHC Exchange	$440.04
Rate for Payer: UHC Medicare Advantage	$440.04

PR LATERAL RETINACULAR RELEASE OPEN

Facility

$1,697.00

Service Code	CPT 27425
Hospital Charge Code	27425
Min. Negotiated Rate	$1,103.05
Max. Negotiated Rate	$1,527.30
Rate for Payer: Aetna Commercial	$1,442.45
Rate for Payer: BCBS Trust/PPO	$1,385.26
Rate for Payer: BCN Commercial	$1,311.44
Rate for Payer: Cash Price	$1,357.60
Rate for Payer: Cofinity Commercial	$1,459.42
Rate for Payer: Encore Health Key Benefits Commercial	$1,357.60
Rate for Payer: Healthscope Commercial	$1,527.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,272.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,442.45
Rate for Payer: Nomi Health Commercial	$1,391.54
Rate for Payer: PHP Commercial	$1,442.45
Rate for Payer: Priority Health Cigna Priority Health	$1,103.05
Rate for Payer: Priority Health HMO/PPO	$1,476.39
Rate for Payer: Priority Health Narrow/Tiered Network	$1,136.99
Rate for Payer: UHC All Payor (Choice/PPO)	$1,493.36
Rate for Payer: UHC Core	$1,416.99
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,272.75

PR LATERAL RETINACULAR RELEASE OPEN

Facility

$1,697.00

Service Code	CPT 27425
Hospital Charge Code	27425
Min. Negotiated Rate	$403.04
Max. Negotiated Rate	$2,463.31
Rate for Payer: Aetna Commercial	$1,442.45
Rate for Payer: Aetna Medicare	$441.22
Rate for Payer: Allen County Amish Medical Aid Commercial	$530.31
Rate for Payer: Amish Plain Church Group Commercial	$530.31
Rate for Payer: BCBS Complete	$2,463.31
Rate for Payer: BCBS MAPPO	$424.25
Rate for Payer: BCBS Trust/PPO	$1,395.10
Rate for Payer: BCN Commercial	$1,319.42
Rate for Payer: BCN Medicare Advantage	$424.25
Rate for Payer: Cash Price	$1,357.60
Rate for Payer: Cash Price	$1,357.60
Rate for Payer: Cofinity Commercial	$1,459.42
Rate for Payer: Encore Health Key Benefits Commercial	$1,357.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$424.25
Rate for Payer: Healthscope Commercial	$1,527.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,272.75
Rate for Payer: Mclaren Medicaid	$2,345.85
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$445.46
Rate for Payer: Meridian Medicaid	$2,463.31
Rate for Payer: MI Amish Medical Board Commercial	$487.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,442.45
Rate for Payer: Nomi Health Commercial	$1,391.54
Rate for Payer: PACE Senior Care Partners	$403.04
Rate for Payer: PACE SWMI	$424.25
Rate for Payer: PHP Commercial	$1,442.45
Rate for Payer: PHP Medicare Advantage	$424.25
Rate for Payer: Priority Health Choice Medicaid	$2,345.85
Rate for Payer: Priority Health Cigna Priority Health	$1,103.05
Rate for Payer: Priority Health HMO/PPO	$1,476.39
Rate for Payer: Priority Health Medicare	$428.49
Rate for Payer: Priority Health Narrow/Tiered Network	$1,136.99
Rate for Payer: Railroad Medicare Medicare	$424.25
Rate for Payer: UHC All Payor (Choice/PPO)	$1,493.36
Rate for Payer: UHC Core	$1,416.99
Rate for Payer: UHC Dual Complete DSNP	$424.25
Rate for Payer: UHC Exchange	$424.25
Rate for Payer: UHC Medicare Advantage	$424.25
Rate for Payer: UHCCP Medicaid	$2,345.85
Rate for Payer: VA VA	$424.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,272.75

PR LATISSE

Professional

Both

$183.00

Service Code	HCPCS 00267
Hospital Revenue Code	990
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$118.95
Rate for Payer: Aetna Medicare	$91.50
Rate for Payer: BCBS Complete	$73.20
Rate for Payer: Cash Price	$146.40
Rate for Payer: Priority Health Cigna Priority Health	$118.95

PR LAVAGE CANNULATION MAXILLARY SINUS

Professional

Both

$292.00

Service Code	HCPCS 31000
Min. Negotiated Rate	$103.82
Max. Negotiated Rate	$189.80
Rate for Payer: Aetna Commercial	$139.12
Rate for Payer: Aetna Medicare	$107.97
Rate for Payer: BCBS Complete	$116.80
Rate for Payer: BCBS MAPPO	$103.82
Rate for Payer: BCN Medicare Advantage	$103.82
Rate for Payer: Cash Price	$233.60
Rate for Payer: Cash Price	$233.60
Rate for Payer: Cofinity Commercial	$149.50
Rate for Payer: Cofinity Commercial	$139.12
Rate for Payer: Health Alliance Plan Medicare Advantage	$103.82
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$109.01
Rate for Payer: Nomi Health Commercial	$124.58
Rate for Payer: PACE SWMI	$103.82
Rate for Payer: PHP Medicare Advantage	$103.82
Rate for Payer: Priority Health Cigna Priority Health	$189.80
Rate for Payer: Priority Health Medicare	$104.86
Rate for Payer: UHC All Payor (Choice/PPO)	$103.82
Rate for Payer: UHC Dual Complete DSNP	$103.82
Rate for Payer: UHC Exchange	$103.82
Rate for Payer: UHC Medicare Advantage	$103.82

PR LAVAGE CANNULATION SPHENOID SINUS

Professional

Both

$337.00

Service Code	HCPCS 31002
Min. Negotiated Rate	$134.80
Max. Negotiated Rate	$248.62
Rate for Payer: Aetna Commercial	$231.35
Rate for Payer: Aetna Medicare	$179.56
Rate for Payer: BCBS Complete	$134.80
Rate for Payer: BCBS MAPPO	$172.65
Rate for Payer: BCN Medicare Advantage	$172.65
Rate for Payer: Cash Price	$269.60
Rate for Payer: Cash Price	$269.60
Rate for Payer: Cofinity Commercial	$248.62
Rate for Payer: Cofinity Commercial	$231.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$172.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$181.28
Rate for Payer: Nomi Health Commercial	$207.18
Rate for Payer: PACE SWMI	$172.65
Rate for Payer: PHP Medicare Advantage	$172.65
Rate for Payer: Priority Health Cigna Priority Health	$219.05
Rate for Payer: Priority Health Medicare	$174.38
Rate for Payer: UHC All Payor (Choice/PPO)	$172.65
Rate for Payer: UHC Dual Complete DSNP	$172.65
Rate for Payer: UHC Exchange	$172.65
Rate for Payer: UHC Medicare Advantage	$172.65

PR LEFT HEART CATH BY TRANSEPTAL PUNCTURE

Professional

Both

$442.00

Service Code	HCPCS 93462
Min. Negotiated Rate	$176.80
Max. Negotiated Rate	$287.30
Rate for Payer: Aetna Commercial	$263.11
Rate for Payer: Aetna Medicare	$204.20
Rate for Payer: BCBS Complete	$176.80
Rate for Payer: BCBS MAPPO	$196.35
Rate for Payer: BCN Medicare Advantage	$196.35
Rate for Payer: Cash Price	$353.60
Rate for Payer: Cash Price	$353.60
Rate for Payer: Cofinity Commercial	$282.74
Rate for Payer: Cofinity Commercial	$263.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$196.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$206.17
Rate for Payer: Nomi Health Commercial	$235.62
Rate for Payer: PACE SWMI	$196.35
Rate for Payer: PHP Medicare Advantage	$196.35
Rate for Payer: Priority Health Cigna Priority Health	$287.30
Rate for Payer: Priority Health Medicare	$198.31
Rate for Payer: UHC All Payor (Choice/PPO)	$196.35
Rate for Payer: UHC Dual Complete DSNP	$196.35
Rate for Payer: UHC Exchange	$196.35
Rate for Payer: UHC Medicare Advantage	$196.35

PR LENGTHENING TENDON EXTENSOR HAND/FINGER EACH

Professional

Both

$1,348.00

Service Code	HCPCS 26476
Min. Negotiated Rate	$539.20
Max. Negotiated Rate	$876.20
Rate for Payer: Aetna Commercial	$802.73
Rate for Payer: Aetna Medicare	$623.01
Rate for Payer: BCBS Complete	$539.20
Rate for Payer: BCBS MAPPO	$599.05
Rate for Payer: BCN Medicare Advantage	$599.05
Rate for Payer: Cash Price	$1,078.40
Rate for Payer: Cash Price	$1,078.40
Rate for Payer: Cofinity Commercial	$862.63
Rate for Payer: Cofinity Commercial	$802.73
Rate for Payer: Health Alliance Plan Medicare Advantage	$599.05
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$629.00
Rate for Payer: Nomi Health Commercial	$718.86
Rate for Payer: PACE SWMI	$599.05
Rate for Payer: PHP Medicare Advantage	$599.05
Rate for Payer: Priority Health Cigna Priority Health	$876.20
Rate for Payer: Priority Health Medicare	$605.04
Rate for Payer: UHC All Payor (Choice/PPO)	$599.05
Rate for Payer: UHC Dual Complete DSNP	$599.05
Rate for Payer: UHC Exchange	$599.05
Rate for Payer: UHC Medicare Advantage	$599.05

PR LENGTHENING TENDON FLEXOR HAND/FINGER EACH

Professional

Both

$2,040.00

Service Code	HCPCS 26478
Min. Negotiated Rate	$615.57
Max. Negotiated Rate	$1,326.00
Rate for Payer: Aetna Commercial	$824.86
Rate for Payer: Aetna Medicare	$640.19
Rate for Payer: BCBS Complete	$816.00
Rate for Payer: BCBS MAPPO	$615.57
Rate for Payer: BCN Medicare Advantage	$615.57
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Cofinity Commercial	$886.42
Rate for Payer: Cofinity Commercial	$824.86
Rate for Payer: Health Alliance Plan Medicare Advantage	$615.57
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$646.35
Rate for Payer: Nomi Health Commercial	$738.68
Rate for Payer: PACE SWMI	$615.57
Rate for Payer: PHP Medicare Advantage	$615.57
Rate for Payer: Priority Health Cigna Priority Health	$1,326.00
Rate for Payer: Priority Health Medicare	$621.73
Rate for Payer: UHC All Payor (Choice/PPO)	$615.57
Rate for Payer: UHC Dual Complete DSNP	$615.57
Rate for Payer: UHC Exchange	$615.57
Rate for Payer: UHC Medicare Advantage	$615.57

PR LESION <15

Professional

Both

$128.00

Service Code	HCPCS 00074
Hospital Revenue Code	990
Min. Negotiated Rate	$51.20
Max. Negotiated Rate	$83.20
Rate for Payer: Aetna Medicare	$64.00
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: Cash Price	$102.40
Rate for Payer: Priority Health Cigna Priority Health	$83.20

PR LESION FL FACE/NECK

Professional

Both

$255.00

Service Code	HCPCS 00075
Hospital Revenue Code	990
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$165.75
Rate for Payer: Aetna Medicare	$127.50
Rate for Payer: BCBS Complete	$102.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Priority Health Cigna Priority Health	$165.75

PR LESION REMOVAL COLONOSCOPY

Professional

Both

$1,584.00

Service Code	HCPCS G6024
Min. Negotiated Rate	$633.60
Max. Negotiated Rate	$1,029.60
Rate for Payer: Aetna Medicare	$792.00
Rate for Payer: BCBS Complete	$633.60
Rate for Payer: Cash Price	$1,267.20
Rate for Payer: Priority Health Cigna Priority Health	$1,029.60

PR LESION SINGLE

Professional

Both

$36.00

Service Code	HCPCS 00073
Hospital Revenue Code	990
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna Medicare	$18.00
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Priority Health Cigna Priority Health	$23.40

PR LEUPROLIDE ACETATE /3.75 MG

Professional

Both

$1,103.00

Service Code	HCPCS J1950
Min. Negotiated Rate	$441.20
Max. Negotiated Rate	$2,491.66
Rate for Payer: Aetna Commercial	$2,318.63
Rate for Payer: Aetna Medicare	$1,799.53
Rate for Payer: BCBS Complete	$441.20
Rate for Payer: BCBS MAPPO	$1,730.32
Rate for Payer: BCN Medicare Advantage	$1,730.32
Rate for Payer: Cash Price	$882.40
Rate for Payer: Cash Price	$882.40
Rate for Payer: Cofinity Commercial	$2,318.63
Rate for Payer: Cofinity Commercial	$2,491.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,730.32
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,816.84
Rate for Payer: Nomi Health Commercial	$2,076.38
Rate for Payer: PACE SWMI	$1,730.32
Rate for Payer: PHP Medicare Advantage	$1,730.32
Rate for Payer: Priority Health Cigna Priority Health	$716.95
Rate for Payer: Priority Health Medicare	$1,747.62
Rate for Payer: UHC All Payor (Choice/PPO)	$1,730.32
Rate for Payer: UHC Dual Complete DSNP	$1,730.32
Rate for Payer: UHC Exchange	$1,730.32
Rate for Payer: UHC Medicare Advantage	$1,730.32

PR LEUPROLIDE ACETATE INJECITON

Professional

Both

$38.00

Service Code	HCPCS J9218
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$24.70
Rate for Payer: Aetna Medicare	$19.00
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$24.70

PR LEUPROLIDE ACETATE SUSPNSION

Professional

Both

$461.00

Service Code	HCPCS J9217
Min. Negotiated Rate	$176.45
Max. Negotiated Rate	$299.65
Rate for Payer: Aetna Commercial	$236.44
Rate for Payer: Aetna Medicare	$183.51
Rate for Payer: BCBS Complete	$184.40
Rate for Payer: BCBS MAPPO	$176.45
Rate for Payer: BCN Medicare Advantage	$176.45
Rate for Payer: Cash Price	$368.80
Rate for Payer: Cash Price	$368.80
Rate for Payer: Cofinity Commercial	$254.09
Rate for Payer: Cofinity Commercial	$236.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$176.45
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$185.27
Rate for Payer: Nomi Health Commercial	$211.74
Rate for Payer: PACE SWMI	$176.45
Rate for Payer: PHP Medicare Advantage	$176.45
Rate for Payer: Priority Health Cigna Priority Health	$299.65
Rate for Payer: Priority Health Medicare	$178.21
Rate for Payer: UHC All Payor (Choice/PPO)	$176.45
Rate for Payer: UHC Dual Complete DSNP	$176.45
Rate for Payer: UHC Exchange	$176.45
Rate for Payer: UHC Medicare Advantage	$176.45

Know your out-of-pocket cost for care.

All Charges