Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR

Professional

Both

$4,189.00

Service Code	HCPCS 22326
Min. Negotiated Rate	$939.76
Max. Negotiated Rate	$3,141.75
Rate for Payer: Aetna Commercial	$2,012.34
Rate for Payer: Aetna Medicare	$2,094.50
Rate for Payer: BCBS Complete	$986.75
Rate for Payer: BCN Commercial	$2,529.10
Rate for Payer: Cash Price	$3,351.20
Rate for Payer: Cash Price	$3,351.20
Rate for Payer: Mclaren Medicaid	$939.76
Rate for Payer: Meridian Medicaid	$986.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,141.75
Rate for Payer: Priority Health Choice Medicaid	$939.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,460.95
Rate for Payer: Priority Health Narrow/Tiered Network	$2,460.95
Rate for Payer: UHC Medicaid	$939.76
Rate for Payer: UHCCP Medicaid	$939.76

PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA

Professional

Both

$1,206.00

Service Code	HCPCS 22328
Min. Negotiated Rate	$161.03
Max. Negotiated Rate	$904.50
Rate for Payer: Aetna Commercial	$380.05
Rate for Payer: Aetna Medicare	$603.00
Rate for Payer: BCBS Complete	$169.08
Rate for Payer: BCN Commercial	$464.46
Rate for Payer: Cash Price	$964.80
Rate for Payer: Cash Price	$964.80
Rate for Payer: Mclaren Medicaid	$161.03
Rate for Payer: Meridian Medicaid	$169.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$904.50
Rate for Payer: Priority Health Choice Medicaid	$161.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$451.94
Rate for Payer: Priority Health Narrow/Tiered Network	$451.94
Rate for Payer: UHC Medicaid	$161.03
Rate for Payer: UHCCP Medicaid	$161.03

PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM

Professional

Both

$3,853.00

Service Code	HCPCS 22325
Min. Negotiated Rate	$921.01
Max. Negotiated Rate	$2,889.75
Rate for Payer: Aetna Commercial	$1,958.38
Rate for Payer: Aetna Medicare	$1,926.50
Rate for Payer: BCBS Complete	$967.06
Rate for Payer: BCN Commercial	$2,259.34
Rate for Payer: Cash Price	$3,082.40
Rate for Payer: Cash Price	$3,082.40
Rate for Payer: Mclaren Medicaid	$921.01
Rate for Payer: Meridian Medicaid	$967.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,889.75
Rate for Payer: Priority Health Choice Medicaid	$921.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,415.17
Rate for Payer: Priority Health Narrow/Tiered Network	$2,415.17
Rate for Payer: UHC Medicaid	$921.01
Rate for Payer: UHCCP Medicaid	$921.01

PR OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH

Professional

Both

$4,022.00

Service Code	HCPCS 22327
Min. Negotiated Rate	$958.71
Max. Negotiated Rate	$3,016.50
Rate for Payer: Aetna Commercial	$2,041.44
Rate for Payer: Aetna Medicare	$2,011.00
Rate for Payer: BCBS Complete	$1,006.65
Rate for Payer: BCN Commercial	$2,346.49
Rate for Payer: Cash Price	$3,217.60
Rate for Payer: Cash Price	$3,217.60
Rate for Payer: Mclaren Medicaid	$958.71
Rate for Payer: Meridian Medicaid	$1,006.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,016.50
Rate for Payer: Priority Health Choice Medicaid	$958.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,508.33
Rate for Payer: Priority Health Narrow/Tiered Network	$2,508.33
Rate for Payer: UHC Medicaid	$958.71
Rate for Payer: UHCCP Medicaid	$958.71

PR OPTX RDL SHAFT FX&CLTX DSTL RAD/ULN JT DISLC

Professional

Both

$2,656.00

Service Code	HCPCS 25525
Min. Negotiated Rate	$469.88
Max. Negotiated Rate	$1,992.00
Rate for Payer: Aetna Commercial	$1,049.63
Rate for Payer: Aetna Medicare	$1,328.00
Rate for Payer: BCBS Complete	$493.37
Rate for Payer: BCN Commercial	$1,210.10
Rate for Payer: Cash Price	$2,124.80
Rate for Payer: Cash Price	$2,124.80
Rate for Payer: Mclaren Medicaid	$469.88
Rate for Payer: Meridian Medicaid	$493.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,992.00
Rate for Payer: Priority Health Choice Medicaid	$469.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,293.56
Rate for Payer: Priority Health Narrow/Tiered Network	$1,293.56
Rate for Payer: UHC Medicaid	$469.88
Rate for Payer: UHCCP Medicaid	$469.88

PR OPTX RDL SHAFT FX&OPTX DSTL RAD/ULN JT DISLC

Professional

Both

$3,064.00

Service Code	HCPCS 25526
Min. Negotiated Rate	$570.84
Max. Negotiated Rate	$2,298.00
Rate for Payer: Aetna Commercial	$1,274.50
Rate for Payer: Aetna Medicare	$1,532.00
Rate for Payer: BCBS Complete	$599.38
Rate for Payer: BCN Commercial	$1,458.59
Rate for Payer: Cash Price	$2,451.20
Rate for Payer: Cash Price	$2,451.20
Rate for Payer: Mclaren Medicaid	$570.84
Rate for Payer: Meridian Medicaid	$599.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,298.00
Rate for Payer: Priority Health Choice Medicaid	$570.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,559.19
Rate for Payer: Priority Health Narrow/Tiered Network	$1,559.19
Rate for Payer: UHC Medicaid	$570.84
Rate for Payer: UHCCP Medicaid	$570.84

PR OPTX SHO DISLC W/FX GR HUMERAL TUBRST INT FIXJ

Professional

Both

$3,027.00

Service Code	HCPCS 23670
Min. Negotiated Rate	$521.42
Max. Negotiated Rate	$2,270.25
Rate for Payer: Aetna Commercial	$1,162.77
Rate for Payer: Aetna Medicare	$1,513.50
Rate for Payer: BCBS Complete	$547.49
Rate for Payer: BCN Commercial	$1,330.61
Rate for Payer: Cash Price	$2,421.60
Rate for Payer: Cash Price	$2,421.60
Rate for Payer: Mclaren Medicaid	$521.42
Rate for Payer: Meridian Medicaid	$547.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,270.25
Rate for Payer: Priority Health Choice Medicaid	$521.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,422.38
Rate for Payer: Priority Health Narrow/Tiered Network	$1,422.38
Rate for Payer: UHC Medicaid	$521.42
Rate for Payer: UHCCP Medicaid	$521.42

PR OPTX SHO DISLC W/SURG/ANTMCL NECK FX INT FIXJ

Professional

Both

$1,705.00

Service Code	HCPCS 23680
Min. Negotiated Rate	$551.67
Max. Negotiated Rate	$1,514.48
Rate for Payer: Aetna Commercial	$1,237.80
Rate for Payer: Aetna Medicare	$852.50
Rate for Payer: BCBS Complete	$579.25
Rate for Payer: BCN Commercial	$1,416.76
Rate for Payer: Cash Price	$1,364.00
Rate for Payer: Cash Price	$1,364.00
Rate for Payer: Mclaren Medicaid	$551.67
Rate for Payer: Meridian Medicaid	$579.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,278.75
Rate for Payer: Priority Health Choice Medicaid	$551.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,514.48
Rate for Payer: Priority Health Narrow/Tiered Network	$1,514.48
Rate for Payer: UHC Medicaid	$551.67
Rate for Payer: UHCCP Medicaid	$551.67

PR OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN

Professional

Both

$1,696.00

Service Code	HCPCS 27178
Min. Negotiated Rate	$546.35
Max. Negotiated Rate	$1,500.09
Rate for Payer: Aetna Commercial	$1,230.99
Rate for Payer: Aetna Medicare	$848.00
Rate for Payer: BCBS Complete	$573.67
Rate for Payer: BCN Commercial	$1,403.31
Rate for Payer: Cash Price	$1,356.80
Rate for Payer: Cash Price	$1,356.80
Rate for Payer: Mclaren Medicaid	$546.35
Rate for Payer: Meridian Medicaid	$573.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,272.00
Rate for Payer: Priority Health Choice Medicaid	$546.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,500.09
Rate for Payer: Priority Health Narrow/Tiered Network	$1,500.09
Rate for Payer: UHC Medicaid	$546.35
Rate for Payer: UHCCP Medicaid	$546.35

PR OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ

Professional

Both

$2,422.00

Service Code	HCPCS 27181
Min. Negotiated Rate	$658.38
Max. Negotiated Rate	$1,816.50
Rate for Payer: Aetna Commercial	$1,496.07
Rate for Payer: Aetna Medicare	$1,211.00
Rate for Payer: BCBS Complete	$691.30
Rate for Payer: BCN Commercial	$1,699.11
Rate for Payer: Cash Price	$1,937.60
Rate for Payer: Cash Price	$1,937.60
Rate for Payer: Mclaren Medicaid	$658.38
Rate for Payer: Meridian Medicaid	$691.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,816.50
Rate for Payer: Priority Health Choice Medicaid	$658.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,816.30
Rate for Payer: Priority Health Narrow/Tiered Network	$1,816.30
Rate for Payer: UHC Medicaid	$658.38
Rate for Payer: UHCCP Medicaid	$658.38

PR OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT

Professional

Both

$2,051.00

Service Code	HCPCS 27177
Min. Negotiated Rate	$654.55
Max. Negotiated Rate	$1,808.84
Rate for Payer: Aetna Commercial	$1,490.05
Rate for Payer: Aetna Medicare	$1,025.50
Rate for Payer: BCBS Complete	$687.28
Rate for Payer: BCN Commercial	$1,692.13
Rate for Payer: Cash Price	$1,640.80
Rate for Payer: Cash Price	$1,640.80
Rate for Payer: Mclaren Medicaid	$654.55
Rate for Payer: Meridian Medicaid	$687.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,538.25
Rate for Payer: Priority Health Choice Medicaid	$654.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,808.84
Rate for Payer: Priority Health Narrow/Tiered Network	$1,808.84
Rate for Payer: UHC Medicaid	$654.55
Rate for Payer: UHCCP Medicaid	$654.55

PR OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM

Professional

Both

$2,046.00

Service Code	HCPCS 27258
Min. Negotiated Rate	$649.86
Max. Negotiated Rate	$1,800.33
Rate for Payer: Aetna Commercial	$1,486.20
Rate for Payer: Aetna Medicare	$1,023.00
Rate for Payer: BCBS Complete	$682.35
Rate for Payer: BCN Commercial	$1,684.17
Rate for Payer: Cash Price	$1,636.80
Rate for Payer: Cash Price	$1,636.80
Rate for Payer: Mclaren Medicaid	$649.86
Rate for Payer: Meridian Medicaid	$682.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,534.50
Rate for Payer: Priority Health Choice Medicaid	$649.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,800.33
Rate for Payer: Priority Health Narrow/Tiered Network	$1,800.33
Rate for Payer: UHC Medicaid	$649.86
Rate for Payer: UHCCP Medicaid	$649.86

PR OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF

Professional

Both

$2,202.00

Service Code	HCPCS 23532
Min. Negotiated Rate	$380.84
Max. Negotiated Rate	$1,651.50
Rate for Payer: Aetna Commercial	$835.21
Rate for Payer: Aetna Medicare	$1,101.00
Rate for Payer: BCBS Complete	$399.88
Rate for Payer: BCN Commercial	$962.60
Rate for Payer: Cash Price	$1,761.60
Rate for Payer: Cash Price	$1,761.60
Rate for Payer: Mclaren Medicaid	$380.84
Rate for Payer: Meridian Medicaid	$399.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,651.50
Rate for Payer: Priority Health Choice Medicaid	$380.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,028.99
Rate for Payer: Priority Health Narrow/Tiered Network	$1,028.99
Rate for Payer: UHC Medicaid	$380.84
Rate for Payer: UHCCP Medicaid	$380.84

PR OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ

Professional

Both

$3,190.00

Service Code	HCPCS 27536
Min. Negotiated Rate	$695.66
Max. Negotiated Rate	$2,392.50
Rate for Payer: Aetna Commercial	$1,583.28
Rate for Payer: Aetna Medicare	$1,595.00
Rate for Payer: BCBS Complete	$730.44
Rate for Payer: BCN Commercial	$1,799.20
Rate for Payer: Cash Price	$2,552.00
Rate for Payer: Cash Price	$2,552.00
Rate for Payer: Mclaren Medicaid	$695.66
Rate for Payer: Meridian Medicaid	$730.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,392.50
Rate for Payer: Priority Health Choice Medicaid	$695.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,923.30
Rate for Payer: Priority Health Narrow/Tiered Network	$1,923.30
Rate for Payer: UHC Medicaid	$695.66
Rate for Payer: UHCCP Medicaid	$695.66

PR OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE

Professional

Both

$3,694.00

Service Code	HCPCS 27758
Min. Negotiated Rate	$531.44
Max. Negotiated Rate	$2,770.50
Rate for Payer: Aetna Commercial	$1,195.54
Rate for Payer: Aetna Medicare	$1,847.00
Rate for Payer: BCBS Complete	$558.01
Rate for Payer: BCN Commercial	$1,363.47
Rate for Payer: Cash Price	$2,955.20
Rate for Payer: Cash Price	$2,955.20
Rate for Payer: Mclaren Medicaid	$531.44
Rate for Payer: Meridian Medicaid	$558.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,770.50
Rate for Payer: Priority Health Choice Medicaid	$531.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,457.52
Rate for Payer: Priority Health Narrow/Tiered Network	$1,457.52
Rate for Payer: UHC Medicaid	$531.44
Rate for Payer: UHCCP Medicaid	$531.44

PROPYLENE GLYCOL 0.6 % EYE DROPS

Facility

$36.93

Service Code	NDC 00650048111
Hospital Charge Code	106794
Hospital Revenue Code	637
Min. Negotiated Rate	$6.51
Max. Negotiated Rate	$33.24
Rate for Payer: Aetna Commercial	$31.39
Rate for Payer: Aetna Medicare	$9.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$11.54
Rate for Payer: Amish Plain Church Group Commercial	$11.54
Rate for Payer: BCBS Complete	$6.84
Rate for Payer: BCBS MAPPO	$9.23
Rate for Payer: BCBS Trust/PPO	$30.36
Rate for Payer: BCN Commercial	$30.36
Rate for Payer: BCN Medicare Advantage	$9.23
Rate for Payer: Cash Price	$29.54
Rate for Payer: Cofinity Commercial	$31.76
Rate for Payer: Encore Health Key Benefits Commercial	$29.54
Rate for Payer: Health Alliance Plan Medicare Advantage	$9.23
Rate for Payer: Healthscope Commercial	$33.24
Rate for Payer: Lakeland Regional Health Systems Commercial	$27.70
Rate for Payer: Mclaren Medicaid	$6.51
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9.69
Rate for Payer: Meridian Medicaid	$6.84
Rate for Payer: MI Amish Medical Board Commercial	$10.62
Rate for Payer: Molina Medicare/Medicaid	$10.16
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.39
Rate for Payer: Nomi Health Commercial	$30.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.70
Rate for Payer: PACE Senior Care Partners	$8.77
Rate for Payer: PACE SWMI	$9.23
Rate for Payer: PHP Commercial	$31.39
Rate for Payer: PHP Medicare Advantage	$9.23
Rate for Payer: Priority Health Choice Medicaid	$6.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$32.13
Rate for Payer: Priority Health Medicare	$9.32
Rate for Payer: Priority Health Narrow/Tiered Network	$25.70
Rate for Payer: Railroad Medicare Medicare	$9.23
Rate for Payer: UHC All Payor (Choice/PPO)	$32.50
Rate for Payer: UHC Core	$30.84
Rate for Payer: UHC Exchange	$9.23
Rate for Payer: UHC Medicaid	$6.51
Rate for Payer: UHC Medicare Advantage	$9.23
Rate for Payer: UHCCP Medicaid	$6.51
Rate for Payer: VA VA	$9.23
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$27.70

PROPYLENE GLYCOL 0.6 % EYE DROPS

Facility

$39.45

Service Code	NDC 00065048111
Hospital Charge Code	106794
Hospital Revenue Code	637
Min. Negotiated Rate	$6.96
Max. Negotiated Rate	$35.51
Rate for Payer: Aetna Commercial	$33.53
Rate for Payer: Aetna Medicare	$10.26
Rate for Payer: Allen County Amish Medical Aid Commercial	$12.33
Rate for Payer: Amish Plain Church Group Commercial	$12.33
Rate for Payer: BCBS Complete	$7.30
Rate for Payer: BCBS MAPPO	$9.86
Rate for Payer: BCBS Trust/PPO	$32.43
Rate for Payer: BCN Commercial	$32.43
Rate for Payer: BCN Medicare Advantage	$9.86
Rate for Payer: Cash Price	$31.56
Rate for Payer: Cofinity Commercial	$33.93
Rate for Payer: Encore Health Key Benefits Commercial	$31.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$9.86
Rate for Payer: Healthscope Commercial	$35.51
Rate for Payer: Lakeland Regional Health Systems Commercial	$29.59
Rate for Payer: Mclaren Medicaid	$6.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$10.36
Rate for Payer: Meridian Medicaid	$7.30
Rate for Payer: MI Amish Medical Board Commercial	$11.34
Rate for Payer: Molina Medicare/Medicaid	$10.85
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.53
Rate for Payer: Nomi Health Commercial	$32.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$29.59
Rate for Payer: PACE Senior Care Partners	$9.37
Rate for Payer: PACE SWMI	$9.86
Rate for Payer: PHP Commercial	$33.53
Rate for Payer: PHP Medicare Advantage	$9.86
Rate for Payer: Priority Health Choice Medicaid	$6.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$34.32
Rate for Payer: Priority Health Medicare	$9.96
Rate for Payer: Priority Health Narrow/Tiered Network	$27.46
Rate for Payer: Railroad Medicare Medicare	$9.86
Rate for Payer: UHC All Payor (Choice/PPO)	$34.72
Rate for Payer: UHC Core	$32.94
Rate for Payer: UHC Exchange	$9.86
Rate for Payer: UHC Medicaid	$6.96
Rate for Payer: UHC Medicare Advantage	$9.86
Rate for Payer: UHCCP Medicaid	$6.96
Rate for Payer: VA VA	$9.86
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$29.59

PROPYLENE GLYCOL 0.6 % EYE DROPS

Facility

$36.93

Service Code	NDC 00650048111
Hospital Charge Code	106794
Hospital Revenue Code	637
Min. Negotiated Rate	$25.70
Max. Negotiated Rate	$33.24
Rate for Payer: Aetna Commercial	$31.39
Rate for Payer: BCBS Trust/PPO	$30.50
Rate for Payer: BCN Commercial	$30.50
Rate for Payer: Cash Price	$29.54
Rate for Payer: Cofinity Commercial	$31.76
Rate for Payer: Encore Health Key Benefits Commercial	$29.54
Rate for Payer: Healthscope Commercial	$33.24
Rate for Payer: Lakeland Regional Health Systems Commercial	$27.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$31.39
Rate for Payer: Nomi Health Commercial	$30.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.70
Rate for Payer: PHP Commercial	$31.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$32.13
Rate for Payer: Priority Health Narrow/Tiered Network	$25.70
Rate for Payer: UHC All Payor (Choice/PPO)	$32.50
Rate for Payer: UHC Core	$30.84
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$27.70

PROPYLENE GLYCOL 0.6 % EYE DROPS

Facility

$39.45

Service Code	NDC 00065048111
Hospital Charge Code	106794
Hospital Revenue Code	637
Min. Negotiated Rate	$27.46
Max. Negotiated Rate	$35.51
Rate for Payer: Aetna Commercial	$33.53
Rate for Payer: BCBS Trust/PPO	$32.58
Rate for Payer: BCN Commercial	$32.58
Rate for Payer: Cash Price	$31.56
Rate for Payer: Cofinity Commercial	$33.93
Rate for Payer: Encore Health Key Benefits Commercial	$31.56
Rate for Payer: Healthscope Commercial	$35.51
Rate for Payer: Lakeland Regional Health Systems Commercial	$29.59
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$33.53
Rate for Payer: Nomi Health Commercial	$32.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$29.59
Rate for Payer: PHP Commercial	$33.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$34.32
Rate for Payer: Priority Health Narrow/Tiered Network	$27.46
Rate for Payer: UHC All Payor (Choice/PPO)	$34.72
Rate for Payer: UHC Core	$32.94
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$29.59

PR ORAL DEXAMETHASONE

Professional

Both

$1.00

Service Code	HCPCS J8540
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.75
Rate for Payer: Aetna Commercial	$0.09
Rate for Payer: Aetna Medicare	$0.50
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: BCBS Trust/PPO	$0.01
Rate for Payer: BCN Commercial	$0.01
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cash Price	$0.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.75

PR ORAL POLIOVIRUS IMMUNIZATN,LIVE,OPC

Professional

Both

$29.00

Service Code	HCPCS 90712
Min. Negotiated Rate	$11.60
Max. Negotiated Rate	$21.75
Rate for Payer: Aetna Medicare	$14.50
Rate for Payer: BCBS Complete	$11.60
Rate for Payer: Cash Price	$23.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.75

PR ORAL PRESCRIP DRUG NON CHEMO

Professional

Both

$4.00

Service Code	HCPCS J8499
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR ORBICULARIS OCULI REFLX ELECTRODIAGNOSTIC TEST

Professional

Both

$173.00

Service Code	HCPCS 95933
Min. Negotiated Rate	$86.50
Max. Negotiated Rate	$129.75
Rate for Payer: Aetna Commercial	$92.26
Rate for Payer: Aetna Medicare	$86.50
Rate for Payer: BCN Commercial	$119.51
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cash Price	$138.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$129.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$110.22
Rate for Payer: Priority Health Narrow/Tiered Network	$110.22

PR ORBITOCRANIAL ANT CRANIAL FOSSA W/O ORBIT EXNTJ

Professional

Both

$8,195.00

Service Code	HCPCS 61584
Min. Negotiated Rate	$1,805.60
Max. Negotiated Rate	$6,146.25
Rate for Payer: Aetna Commercial	$3,731.75
Rate for Payer: Aetna Medicare	$4,097.50
Rate for Payer: BCBS Complete	$1,895.88
Rate for Payer: BCN Commercial	$6,003.94
Rate for Payer: Cash Price	$6,556.00
Rate for Payer: Cash Price	$6,556.00
Rate for Payer: Mclaren Medicaid	$1,805.60
Rate for Payer: Meridian Medicaid	$1,895.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,146.25
Rate for Payer: Priority Health Choice Medicaid	$1,805.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,047.66
Rate for Payer: Priority Health Narrow/Tiered Network	$5,047.66
Rate for Payer: UHC Medicaid	$1,805.60
Rate for Payer: UHCCP Medicaid	$1,805.60

PR ORBITOCRNL APPR MID CRANIAL FOSSA TEMPORAL LOBE

Professional

Both

$5,932.00

Service Code	HCPCS 61592
Min. Negotiated Rate	$1,934.47
Max. Negotiated Rate	$6,587.35
Rate for Payer: Aetna Commercial	$4,118.86
Rate for Payer: Aetna Medicare	$2,966.00
Rate for Payer: BCBS Complete	$2,031.19
Rate for Payer: BCN Commercial	$6,587.35
Rate for Payer: Cash Price	$4,745.60
Rate for Payer: Cash Price	$4,745.60
Rate for Payer: Mclaren Medicaid	$1,934.47
Rate for Payer: Meridian Medicaid	$2,031.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,449.00
Rate for Payer: Priority Health Choice Medicaid	$1,934.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,538.14
Rate for Payer: Priority Health Narrow/Tiered Network	$5,538.14
Rate for Payer: UHC Medicaid	$1,934.47
Rate for Payer: UHCCP Medicaid	$1,934.47

Know your out-of-pocket cost for care.

All Charges