Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR RMVL LUNG XCP TOT PNEUMONECTOMY SLEEVE LOBECTOMY

Professional

Both

$4,569.00

Service Code	HCPCS 32486
Min. Negotiated Rate	$1,387.70
Max. Negotiated Rate	$3,440.55
Rate for Payer: Aetna Commercial	$3,031.83
Rate for Payer: Aetna Medicare	$2,284.50
Rate for Payer: BCBS Complete	$1,457.09
Rate for Payer: BCN Commercial	$3,440.55
Rate for Payer: Cash Price	$3,655.20
Rate for Payer: Cash Price	$3,655.20
Rate for Payer: Mclaren Medicaid	$1,387.70
Rate for Payer: Meridian Medicaid	$1,457.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,426.75
Rate for Payer: Priority Health Choice Medicaid	$1,387.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,239.98
Rate for Payer: Priority Health Narrow/Tiered Network	$3,239.98
Rate for Payer: UHC Medicaid	$1,387.70
Rate for Payer: UHCCP Medicaid	$1,387.70

PR RMVL NDWELLG TUNNELED PLEURAL CATHETER W/CUFF

Professional

Both

$356.00

Service Code	HCPCS 32552
Min. Negotiated Rate	$94.15
Max. Negotiated Rate	$267.00
Rate for Payer: Aetna Commercial	$202.65
Rate for Payer: Aetna Medicare	$178.00
Rate for Payer: BCBS Complete	$98.86
Rate for Payer: BCN Commercial	$232.55
Rate for Payer: Cash Price	$284.80
Rate for Payer: Cash Price	$284.80
Rate for Payer: Mclaren Medicaid	$94.15
Rate for Payer: Meridian Medicaid	$98.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$267.00
Rate for Payer: Priority Health Choice Medicaid	$94.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$219.00
Rate for Payer: Priority Health Narrow/Tiered Network	$219.00
Rate for Payer: UHC Medicaid	$94.15
Rate for Payer: UHCCP Medicaid	$94.15

PR RMVL NFROS TUBE REQ FLUORO GUIDANCE

Professional

Both

$311.00

Service Code	HCPCS 50389
Min. Negotiated Rate	$29.18
Max. Negotiated Rate	$233.25
Rate for Payer: Aetna Commercial	$68.80
Rate for Payer: Aetna Medicare	$155.50
Rate for Payer: BCBS Complete	$30.64
Rate for Payer: BCN Commercial	$78.68
Rate for Payer: Cash Price	$248.80
Rate for Payer: Cash Price	$248.80
Rate for Payer: Mclaren Medicaid	$29.18
Rate for Payer: Meridian Medicaid	$30.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$233.25
Rate for Payer: Priority Health Choice Medicaid	$29.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$85.71
Rate for Payer: Priority Health Narrow/Tiered Network	$85.71
Rate for Payer: UHC Medicaid	$29.18
Rate for Payer: UHCCP Medicaid	$29.18

PR RMVL NONINFCT MESH/PROSTH AA/PARASTOMAL HRNA RPR

Professional

Both

$414.00

Service Code	HCPCS 49623
Min. Negotiated Rate	$117.36
Max. Negotiated Rate	$368.91
Rate for Payer: Aetna Commercial	$266.29
Rate for Payer: Aetna Medicare	$207.00
Rate for Payer: BCBS Complete	$123.23
Rate for Payer: BCN Commercial	$302.77
Rate for Payer: Cash Price	$331.20
Rate for Payer: Cash Price	$331.20
Rate for Payer: Mclaren Medicaid	$117.36
Rate for Payer: Meridian Medicaid	$123.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$310.50
Rate for Payer: Priority Health Choice Medicaid	$117.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$368.91
Rate for Payer: Priority Health Narrow/Tiered Network	$368.91
Rate for Payer: UHC Medicaid	$117.36
Rate for Payer: UHCCP Medicaid	$117.36

PR RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT

Professional

Both

$1,117.00

Service Code	HCPCS 54415
Min. Negotiated Rate	$312.26
Max. Negotiated Rate	$872.28
Rate for Payer: Aetna Commercial	$679.13
Rate for Payer: Aetna Medicare	$558.50
Rate for Payer: BCBS Complete	$327.87
Rate for Payer: BCN Commercial	$800.75
Rate for Payer: Cash Price	$893.60
Rate for Payer: Cash Price	$893.60
Rate for Payer: Mclaren Medicaid	$312.26
Rate for Payer: Meridian Medicaid	$327.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$837.75
Rate for Payer: Priority Health Choice Medicaid	$312.26
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	$312.26
Rate for Payer: UHCCP Medicaid	$312.26

PR RMVL OF SUBQ IMPLANTABLE DEFIBRILLATOR ELECTRODE

Professional

Both

$742.00

Service Code	HCPCS 33272
Min. Negotiated Rate	$197.88
Max. Negotiated Rate	$556.50
Rate for Payer: Aetna Commercial	$464.31
Rate for Payer: Aetna Medicare	$371.00
Rate for Payer: BCBS Complete	$207.77
Rate for Payer: BCN Commercial	$514.91
Rate for Payer: Cash Price	$593.60
Rate for Payer: Cash Price	$593.60
Rate for Payer: Mclaren Medicaid	$197.88
Rate for Payer: Meridian Medicaid	$207.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$556.50
Rate for Payer: Priority Health Choice Medicaid	$197.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$553.72
Rate for Payer: Priority Health Narrow/Tiered Network	$553.72
Rate for Payer: UHC Medicaid	$197.88
Rate for Payer: UHCCP Medicaid	$197.88

PR RMVL PERITONEAL-VENOUS SHUNT

Professional

Both

$1,647.00

Service Code	HCPCS 49429
Min. Negotiated Rate	$277.11
Max. Negotiated Rate	$1,235.25
Rate for Payer: Aetna Commercial	$619.78
Rate for Payer: Aetna Medicare	$823.50
Rate for Payer: BCBS Complete	$290.97
Rate for Payer: BCN Commercial	$689.70
Rate for Payer: Cash Price	$1,317.60
Rate for Payer: Cash Price	$1,317.60
Rate for Payer: Mclaren Medicaid	$277.11
Rate for Payer: Meridian Medicaid	$290.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,235.25
Rate for Payer: Priority Health Choice Medicaid	$277.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$840.36
Rate for Payer: Priority Health Narrow/Tiered Network	$840.36
Rate for Payer: UHC Medicaid	$277.11
Rate for Payer: UHCCP Medicaid	$277.11

PR RMVL PREVIOUSLY IMPLTED ITHCL/EDRL CATH

Professional

Both

$2,365.00

Service Code	HCPCS 62355
Min. Negotiated Rate	$179.13
Max. Negotiated Rate	$1,773.75
Rate for Payer: Aetna Commercial	$348.09
Rate for Payer: Aetna Medicare	$1,182.50
Rate for Payer: BCBS Complete	$188.09
Rate for Payer: BCN Commercial	$426.28
Rate for Payer: Cash Price	$1,892.00
Rate for Payer: Cash Price	$1,892.00
Rate for Payer: Mclaren Medicaid	$179.13
Rate for Payer: Meridian Medicaid	$188.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,773.75
Rate for Payer: Priority Health Choice Medicaid	$179.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$495.11
Rate for Payer: Priority Health Narrow/Tiered Network	$495.11
Rate for Payer: UHC Medicaid	$179.13
Rate for Payer: UHCCP Medicaid	$179.13

PR RMVL PRM EPICAR PM&ELTRDS THORCOM DUAL LEAD SY

Professional

Both

$2,719.00

Service Code	HCPCS 33237
Min. Negotiated Rate	$529.52
Max. Negotiated Rate	$2,039.25
Rate for Payer: Aetna Commercial	$1,121.51
Rate for Payer: Aetna Medicare	$1,359.50
Rate for Payer: BCBS Complete	$556.00
Rate for Payer: BCN Commercial	$1,246.94
Rate for Payer: Cash Price	$2,175.20
Rate for Payer: Cash Price	$2,175.20
Rate for Payer: Mclaren Medicaid	$529.52
Rate for Payer: Meridian Medicaid	$556.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,039.25
Rate for Payer: Priority Health Choice Medicaid	$529.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,340.94
Rate for Payer: Priority Health Narrow/Tiered Network	$1,340.94
Rate for Payer: UHC Medicaid	$529.52
Rate for Payer: UHCCP Medicaid	$529.52

PR RMVL PROSTC MATRL/MESH ABDL WALL FOR INFECTION

Professional

Both

$850.00

Service Code	HCPCS 11008
Min. Negotiated Rate	$155.92
Max. Negotiated Rate	$637.50
Rate for Payer: Aetna Commercial	$300.89
Rate for Payer: Aetna Medicare	$425.00
Rate for Payer: BCBS Complete	$163.72
Rate for Payer: BCN Commercial	$403.86
Rate for Payer: Cash Price	$680.00
Rate for Payer: Cash Price	$680.00
Rate for Payer: Mclaren Medicaid	$155.92
Rate for Payer: Meridian Medicaid	$163.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$637.50
Rate for Payer: Priority Health Choice Medicaid	$155.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$369.64
Rate for Payer: Priority Health Narrow/Tiered Network	$369.64
Rate for Payer: UHC Medicaid	$155.92
Rate for Payer: UHCCP Medicaid	$155.92

PR RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER

Professional

Both

$3,468.00

Service Code	HCPCS 27488
Min. Negotiated Rate	$701.41
Max. Negotiated Rate	$2,601.00
Rate for Payer: Aetna Commercial	$1,603.73
Rate for Payer: Aetna Medicare	$1,734.00
Rate for Payer: BCBS Complete	$736.48
Rate for Payer: BCN Commercial	$1,817.63
Rate for Payer: Cash Price	$2,774.40
Rate for Payer: Cash Price	$2,774.40
Rate for Payer: Mclaren Medicaid	$701.41
Rate for Payer: Meridian Medicaid	$736.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,601.00
Rate for Payer: Priority Health Choice Medicaid	$701.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,943.00
Rate for Payer: Priority Health Narrow/Tiered Network	$1,943.00
Rate for Payer: UHC Medicaid	$701.41
Rate for Payer: UHCCP Medicaid	$701.41

PR RMVL/REVJ SLING MALE URINARY INCONTINENCE

Professional

Both

$1,635.00

Service Code	HCPCS 53442
Min. Negotiated Rate	$456.89
Max. Negotiated Rate	$1,286.19
Rate for Payer: Aetna Commercial	$1,005.18
Rate for Payer: Aetna Medicare	$817.50
Rate for Payer: BCBS Complete	$479.73
Rate for Payer: BCN Commercial	$1,180.71
Rate for Payer: Cash Price	$1,308.00
Rate for Payer: Cash Price	$1,308.00
Rate for Payer: Mclaren Medicaid	$456.89
Rate for Payer: Meridian Medicaid	$479.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,226.25
Rate for Payer: Priority Health Choice Medicaid	$456.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,286.19
Rate for Payer: Priority Health Narrow/Tiered Network	$1,286.19
Rate for Payer: UHC Medicaid	$456.89
Rate for Payer: UHCCP Medicaid	$456.89

PR RMVL/REVJ SLING STRESS INCONTINENCE

Professional

Both

$1,271.00

Service Code	HCPCS 57287
Min. Negotiated Rate	$420.89
Max. Negotiated Rate	$1,536.93
Rate for Payer: Aetna Commercial	$871.45
Rate for Payer: Aetna Medicare	$635.50
Rate for Payer: BCBS Complete	$441.93
Rate for Payer: BCN Commercial	$1,536.93
Rate for Payer: Cash Price	$1,016.80
Rate for Payer: Cash Price	$1,016.80
Rate for Payer: Mclaren Medicaid	$420.89
Rate for Payer: Meridian Medicaid	$441.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$953.25
Rate for Payer: Priority Health Choice Medicaid	$420.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,126.71
Rate for Payer: Priority Health Narrow/Tiered Network	$1,126.71
Rate for Payer: UHC Medicaid	$420.89
Rate for Payer: UHCCP Medicaid	$420.89

PR RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS

Professional

Both

$1,723.00

Service Code	HCPCS 54410
Min. Negotiated Rate	$498.85
Max. Negotiated Rate	$1,409.32
Rate for Payer: Aetna Commercial	$1,106.42
Rate for Payer: Aetna Medicare	$861.50
Rate for Payer: BCBS Complete	$523.79
Rate for Payer: BCN Commercial	$1,293.75
Rate for Payer: Cash Price	$1,378.40
Rate for Payer: Cash Price	$1,378.40
Rate for Payer: Mclaren Medicaid	$498.85
Rate for Payer: Meridian Medicaid	$523.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,292.25
Rate for Payer: Priority Health Choice Medicaid	$498.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,409.32
Rate for Payer: Priority Health Narrow/Tiered Network	$1,409.32
Rate for Payer: UHC Medicaid	$498.85
Rate for Payer: UHCCP Medicaid	$498.85

PR RMVL & RPLCMT INTLY DWELLING URETERAL STENT PRQ

Professional

Both

$2,215.00

Service Code	HCPCS 50382
Min. Negotiated Rate	$138.24
Max. Negotiated Rate	$1,661.25
Rate for Payer: Aetna Commercial	$326.82
Rate for Payer: Aetna Medicare	$1,107.50
Rate for Payer: BCBS Complete	$145.15
Rate for Payer: BCN Commercial	$367.51
Rate for Payer: Cash Price	$1,772.00
Rate for Payer: Cash Price	$1,772.00
Rate for Payer: Mclaren Medicaid	$138.24
Rate for Payer: Meridian Medicaid	$145.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,661.25
Rate for Payer: Priority Health Choice Medicaid	$138.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$400.34
Rate for Payer: Priority Health Narrow/Tiered Network	$400.34
Rate for Payer: UHC Medicaid	$138.24
Rate for Payer: UHCCP Medicaid	$138.24

PR RMVL & RPLCMT NFLTBL NCK SPHNCTR THRU INFCT FLD

Professional

Both

$2,732.00

Service Code	HCPCS 53448
Min. Negotiated Rate	$728.89
Max. Negotiated Rate	$2,070.59
Rate for Payer: Aetna Commercial	$1,639.79
Rate for Payer: Aetna Medicare	$1,366.00
Rate for Payer: BCBS Complete	$765.33
Rate for Payer: BCN Commercial	$1,900.79
Rate for Payer: Cash Price	$2,185.60
Rate for Payer: Cash Price	$2,185.60
Rate for Payer: Mclaren Medicaid	$728.89
Rate for Payer: Meridian Medicaid	$765.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,049.00
Rate for Payer: Priority Health Choice Medicaid	$728.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,070.59
Rate for Payer: Priority Health Narrow/Tiered Network	$2,070.59
Rate for Payer: UHC Medicaid	$728.89
Rate for Payer: UHCCP Medicaid	$728.89

PR RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL

Professional

Both

$2,195.00

Service Code	HCPCS 54411
Min. Negotiated Rate	$592.14
Max. Negotiated Rate	$1,676.75
Rate for Payer: Aetna Commercial	$1,326.02
Rate for Payer: Aetna Medicare	$1,097.50
Rate for Payer: BCBS Complete	$621.75
Rate for Payer: BCN Commercial	$1,539.26
Rate for Payer: Cash Price	$1,756.00
Rate for Payer: Cash Price	$1,756.00
Rate for Payer: Mclaren Medicaid	$592.14
Rate for Payer: Meridian Medicaid	$621.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,646.25
Rate for Payer: Priority Health Choice Medicaid	$592.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,676.75
Rate for Payer: Priority Health Narrow/Tiered Network	$1,676.75
Rate for Payer: UHC Medicaid	$592.14
Rate for Payer: UHCCP Medicaid	$592.14

PR RMVL & RPLCMT NFLTL URETHRAL/BLADDER NECK SPHINC

Professional

Both

$2,590.00

Service Code	HCPCS 53447
Min. Negotiated Rate	$466.04
Max. Negotiated Rate	$1,942.50
Rate for Payer: Aetna Commercial	$1,035.47
Rate for Payer: Aetna Medicare	$1,295.00
Rate for Payer: BCBS Complete	$489.34
Rate for Payer: BCN Commercial	$1,206.61
Rate for Payer: Cash Price	$2,072.00
Rate for Payer: Cash Price	$2,072.00
Rate for Payer: Mclaren Medicaid	$466.04
Rate for Payer: Meridian Medicaid	$489.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,942.50
Rate for Payer: Priority Health Choice Medicaid	$466.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,314.40
Rate for Payer: Priority Health Narrow/Tiered Network	$1,314.40
Rate for Payer: UHC Medicaid	$466.04
Rate for Payer: UHCCP Medicaid	$466.04

PR RMVL & RPLCMT PENILE PROSTHESIS INFECTED FIELD

Professional

Both

$2,359.00

Service Code	HCPCS 54417
Min. Negotiated Rate	$517.59
Max. Negotiated Rate	$1,769.25
Rate for Payer: Aetna Commercial	$1,152.98
Rate for Payer: Aetna Medicare	$1,179.50
Rate for Payer: BCBS Complete	$543.47
Rate for Payer: BCN Commercial	$1,346.04
Rate for Payer: Cash Price	$1,887.20
Rate for Payer: Cash Price	$1,887.20
Rate for Payer: Mclaren Medicaid	$517.59
Rate for Payer: Meridian Medicaid	$543.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,769.25
Rate for Payer: Priority Health Choice Medicaid	$517.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,466.28
Rate for Payer: Priority Health Narrow/Tiered Network	$1,466.28
Rate for Payer: UHC Medicaid	$517.59
Rate for Payer: UHCCP Medicaid	$517.59

PR RMVL & RPLCMT XTRNL ACCESSIBLE NEPHROURTRL CATH

Professional

Both

$1,235.00

Service Code	HCPCS 50387
Min. Negotiated Rate	$45.80
Max. Negotiated Rate	$926.25
Rate for Payer: Aetna Commercial	$107.12
Rate for Payer: Aetna Medicare	$617.50
Rate for Payer: BCBS Complete	$48.09
Rate for Payer: BCN Commercial	$121.50
Rate for Payer: Cash Price	$988.00
Rate for Payer: Cash Price	$988.00
Rate for Payer: Mclaren Medicaid	$45.80
Rate for Payer: Meridian Medicaid	$48.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$926.25
Rate for Payer: Priority Health Choice Medicaid	$45.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$132.37
Rate for Payer: Priority Health Narrow/Tiered Network	$132.37
Rate for Payer: UHC Medicaid	$45.80
Rate for Payer: UHCCP Medicaid	$45.80

PR RMVL/RPR EMGNT BONE CNDJ DEV TEMPORAL BONE

Professional

Both

$1,749.00

Service Code	HCPCS 69711
Min. Negotiated Rate	$478.19
Max. Negotiated Rate	$1,311.75
Rate for Payer: Aetna Commercial	$960.92
Rate for Payer: Aetna Medicare	$874.50
Rate for Payer: BCBS Complete	$502.10
Rate for Payer: BCN Commercial	$1,251.93
Rate for Payer: Cash Price	$1,399.20
Rate for Payer: Cash Price	$1,399.20
Rate for Payer: Mclaren Medicaid	$478.19
Rate for Payer: Meridian Medicaid	$502.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,311.75
Rate for Payer: Priority Health Choice Medicaid	$478.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,237.02
Rate for Payer: Priority Health Narrow/Tiered Network	$1,237.02
Rate for Payer: UHC Medicaid	$478.19
Rate for Payer: UHCCP Medicaid	$478.19

PR RMVL RUPTURED BREAST IMPLANT W/IMPLANT CONTENTS

Professional

Both

$1,179.00

Service Code	HCPCS 19330
Min. Negotiated Rate	$377.86
Max. Negotiated Rate	$978.53
Rate for Payer: Aetna Commercial	$698.31
Rate for Payer: Aetna Medicare	$589.50
Rate for Payer: BCBS Complete	$396.75
Rate for Payer: BCN Commercial	$978.53
Rate for Payer: Cash Price	$943.20
Rate for Payer: Cash Price	$943.20
Rate for Payer: Mclaren Medicaid	$377.86
Rate for Payer: Meridian Medicaid	$396.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$884.25
Rate for Payer: Priority Health Choice Medicaid	$377.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$895.61
Rate for Payer: Priority Health Narrow/Tiered Network	$895.61
Rate for Payer: UHC Medicaid	$377.86
Rate for Payer: UHCCP Medicaid	$377.86

PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY EA ADDL 10

Professional

Both

$46.00

Service Code	HCPCS 11201
Min. Negotiated Rate	$8.31
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna Commercial	$17.88
Rate for Payer: Aetna Medicare	$23.00
Rate for Payer: BCBS Complete	$8.73
Rate for Payer: BCN Commercial	$18.85
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cash Price	$36.80
Rate for Payer: Mclaren Medicaid	$8.31
Rate for Payer: Meridian Medicaid	$8.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.50
Rate for Payer: Priority Health Choice Medicaid	$8.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$21.88
Rate for Payer: Priority Health Narrow/Tiered Network	$21.88
Rate for Payer: UHC Medicaid	$8.31
Rate for Payer: UHCCP Medicaid	$8.31

PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15

Facility

$180.00

Service Code	CPT 11200
Hospital Charge Code	11200
Hospital Revenue Code	521
Min. Negotiated Rate	$125.28
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$153.00
Rate for Payer: BCBS Trust/PPO	$148.66
Rate for Payer: BCN Commercial	$148.66
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cofinity Commercial	$154.80
Rate for Payer: Encore Health Key Benefits Commercial	$144.00
Rate for Payer: Healthscope Commercial	$162.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$135.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$153.00
Rate for Payer: Nomi Health Commercial	$147.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$135.00
Rate for Payer: PHP Commercial	$153.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$156.60
Rate for Payer: Priority Health Narrow/Tiered Network	$125.28
Rate for Payer: UHC Core	$150.30
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$135.00

PR RMVL SKIN TAGS MLT FIBRQ TAGS ANY UP TO&INC 15

Professional

Both

$180.00

Service Code	HCPCS 11200
Hospital Charge Code	11200
Min. Negotiated Rate	$44.09
Max. Negotiated Rate	$135.00
Rate for Payer: Aetna Commercial	$79.26
Rate for Payer: Aetna Medicare	$90.00
Rate for Payer: BCBS Complete	$46.29
Rate for Payer: BCN Commercial	$91.50
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Mclaren Medicaid	$44.09
Rate for Payer: Meridian Medicaid	$46.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$135.00
Rate for Payer: Priority Health Choice Medicaid	$44.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$106.20
Rate for Payer: Priority Health Narrow/Tiered Network	$106.20
Rate for Payer: UHC Medicaid	$44.09
Rate for Payer: UHCCP Medicaid	$44.09

Know your out-of-pocket cost for care.

All Charges