Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR RPLCMT AORTIC VALVE ANNULUS ENLGMENT NONC SINUS

Professional

Both

$9,981.00

Service Code	HCPCS 33411
Min. Negotiated Rate	$1,988.14
Max. Negotiated Rate	$7,485.75
Rate for Payer: Aetna Commercial	$4,508.90
Rate for Payer: Aetna Medicare	$4,990.50
Rate for Payer: BCBS Complete	$2,087.55
Rate for Payer: BCN Commercial	$4,916.07
Rate for Payer: Cash Price	$7,984.80
Rate for Payer: Cash Price	$7,984.80
Rate for Payer: Mclaren Medicaid	$1,988.14
Rate for Payer: Meridian Medicaid	$2,087.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,485.75
Rate for Payer: Priority Health Choice Medicaid	$1,988.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,286.61
Rate for Payer: Priority Health Narrow/Tiered Network	$5,286.61
Rate for Payer: UHC Medicaid	$1,988.14
Rate for Payer: UHCCP Medicaid	$1,988.14

PR RPLCMT AORTIC VALVE OPN ALLOGRAFT VALVE FREEHAND

Professional

Both

$7,052.00

Service Code	HCPCS 33406
Min. Negotiated Rate	$1,708.69
Max. Negotiated Rate	$5,289.00
Rate for Payer: Aetna Commercial	$3,869.40
Rate for Payer: Aetna Medicare	$3,526.00
Rate for Payer: BCBS Complete	$1,794.12
Rate for Payer: BCN Commercial	$4,234.33
Rate for Payer: Cash Price	$5,641.60
Rate for Payer: Cash Price	$5,641.60
Rate for Payer: Mclaren Medicaid	$1,708.69
Rate for Payer: Meridian Medicaid	$1,794.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,289.00
Rate for Payer: Priority Health Choice Medicaid	$1,708.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4,553.48
Rate for Payer: Priority Health Narrow/Tiered Network	$4,553.48
Rate for Payer: UHC Medicaid	$1,708.69
Rate for Payer: UHCCP Medicaid	$1,708.69

PR RPLCMT AORTIC VALVE OPN W/STENTLESS TISSUE VALVE

Professional

Both

$8,371.00

Service Code	HCPCS 33410
Min. Negotiated Rate	$1,520.18
Max. Negotiated Rate	$6,278.25
Rate for Payer: Aetna Commercial	$3,414.07
Rate for Payer: Aetna Medicare	$4,185.50
Rate for Payer: BCBS Complete	$1,596.19
Rate for Payer: BCN Commercial	$3,739.84
Rate for Payer: Cash Price	$6,696.80
Rate for Payer: Cash Price	$6,696.80
Rate for Payer: Mclaren Medicaid	$1,520.18
Rate for Payer: Meridian Medicaid	$1,596.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,278.25
Rate for Payer: Priority Health Choice Medicaid	$1,520.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4,021.72
Rate for Payer: Priority Health Narrow/Tiered Network	$4,021.72
Rate for Payer: UHC Medicaid	$1,520.18
Rate for Payer: UHCCP Medicaid	$1,520.18

PR RPLCMT BONE FLAP/PROSTHETIC PLATE SKULL

Professional

Both

$5,184.00

Service Code	HCPCS 62143
Min. Negotiated Rate	$664.99
Max. Negotiated Rate	$3,888.00
Rate for Payer: Aetna Commercial	$1,349.48
Rate for Payer: Aetna Medicare	$2,592.00
Rate for Payer: BCBS Complete	$698.24
Rate for Payer: BCN Commercial	$2,213.21
Rate for Payer: Cash Price	$4,147.20
Rate for Payer: Cash Price	$4,147.20
Rate for Payer: Mclaren Medicaid	$664.99
Rate for Payer: Meridian Medicaid	$698.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,888.00
Rate for Payer: Priority Health Choice Medicaid	$664.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,860.70
Rate for Payer: Priority Health Narrow/Tiered Network	$1,860.70
Rate for Payer: UHC Medicaid	$664.99
Rate for Payer: UHCCP Medicaid	$664.99

PR RPLCMT CATH CTR VAD SUBQ PORT/PMP

Professional

Both

$1,055.00

Service Code	HCPCS 36578
Min. Negotiated Rate	$120.56
Max. Negotiated Rate	$791.25
Rate for Payer: Aetna Commercial	$269.73
Rate for Payer: Aetna Medicare	$527.50
Rate for Payer: BCBS Complete	$126.59
Rate for Payer: BCN Commercial	$298.29
Rate for Payer: Cash Price	$844.00
Rate for Payer: Cash Price	$844.00
Rate for Payer: Mclaren Medicaid	$120.56
Rate for Payer: Meridian Medicaid	$126.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$791.25
Rate for Payer: Priority Health Choice Medicaid	$120.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$320.78
Rate for Payer: Priority Health Narrow/Tiered Network	$320.78
Rate for Payer: UHC Medicaid	$120.56
Rate for Payer: UHCCP Medicaid	$120.56

PR RPLCMT COMPL NON-TUN CVC W/O SUBQ PORT/PMP

Professional

Both

$794.00

Service Code	HCPCS 36580
Min. Negotiated Rate	$36.64
Max. Negotiated Rate	$595.50
Rate for Payer: Aetna Commercial	$87.94
Rate for Payer: Aetna Medicare	$397.00
Rate for Payer: BCBS Complete	$38.47
Rate for Payer: BCN Commercial	$95.12
Rate for Payer: Cash Price	$635.20
Rate for Payer: Cash Price	$635.20
Rate for Payer: Mclaren Medicaid	$36.64
Rate for Payer: Meridian Medicaid	$38.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$595.50
Rate for Payer: Priority Health Choice Medicaid	$36.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$102.28
Rate for Payer: Priority Health Narrow/Tiered Network	$102.28
Rate for Payer: UHC Medicaid	$36.64
Rate for Payer: UHCCP Medicaid	$36.64

PR RPLCMT COMPL PRPH CTR VAD W/SUBQ PORT

Professional

Both

$2,206.00

Service Code	HCPCS 36585
Min. Negotiated Rate	$187.44
Max. Negotiated Rate	$1,654.50
Rate for Payer: Aetna Commercial	$362.93
Rate for Payer: Aetna Medicare	$1,103.00
Rate for Payer: BCBS Complete	$196.81
Rate for Payer: BCN Commercial	$456.64
Rate for Payer: Cash Price	$1,764.80
Rate for Payer: Cash Price	$1,764.80
Rate for Payer: Mclaren Medicaid	$187.44
Rate for Payer: Meridian Medicaid	$196.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,654.50
Rate for Payer: Priority Health Choice Medicaid	$187.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$491.07
Rate for Payer: Priority Health Narrow/Tiered Network	$491.07
Rate for Payer: UHC Medicaid	$187.44
Rate for Payer: UHCCP Medicaid	$187.44

PR RPLCMT COMPL TUN CTR VAD W/SUBQ PMP

Professional

Both

$2,003.00

Service Code	HCPCS 36583
Min. Negotiated Rate	$201.07
Max. Negotiated Rate	$1,502.25
Rate for Payer: Aetna Commercial	$440.96
Rate for Payer: Aetna Medicare	$1,001.50
Rate for Payer: BCBS Complete	$211.12
Rate for Payer: BCN Commercial	$494.00
Rate for Payer: Cash Price	$1,602.40
Rate for Payer: Cash Price	$1,602.40
Rate for Payer: Mclaren Medicaid	$201.07
Rate for Payer: Meridian Medicaid	$211.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,502.25
Rate for Payer: Priority Health Choice Medicaid	$201.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$531.24
Rate for Payer: Priority Health Narrow/Tiered Network	$531.24
Rate for Payer: UHC Medicaid	$201.07
Rate for Payer: UHCCP Medicaid	$201.07

PR RPLCMT COMPL TUN CTR VAD W/SUBQ PORT

Professional

Both

$581.00

Service Code	HCPCS 36582
Min. Negotiated Rate	$165.29
Max. Negotiated Rate	$456.26
Rate for Payer: Aetna Commercial	$384.84
Rate for Payer: Aetna Medicare	$290.50
Rate for Payer: BCBS Complete	$173.55
Rate for Payer: BCN Commercial	$424.28
Rate for Payer: Cash Price	$464.80
Rate for Payer: Cash Price	$464.80
Rate for Payer: Mclaren Medicaid	$165.29
Rate for Payer: Meridian Medicaid	$173.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$435.75
Rate for Payer: Priority Health Choice Medicaid	$165.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$456.26
Rate for Payer: Priority Health Narrow/Tiered Network	$456.26
Rate for Payer: UHC Medicaid	$165.29
Rate for Payer: UHCCP Medicaid	$165.29

PR RPLCMT COMPL TUN CVC W/O SUBQ PORT/PMP

Professional

Both

$1,617.00

Service Code	HCPCS 36581
Min. Negotiated Rate	$105.01
Max. Negotiated Rate	$1,212.75
Rate for Payer: Aetna Commercial	$243.95
Rate for Payer: Aetna Medicare	$808.50
Rate for Payer: BCBS Complete	$110.26
Rate for Payer: BCN Commercial	$269.91
Rate for Payer: Cash Price	$1,293.60
Rate for Payer: Cash Price	$1,293.60
Rate for Payer: Mclaren Medicaid	$105.01
Rate for Payer: Meridian Medicaid	$110.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,212.75
Rate for Payer: Priority Health Choice Medicaid	$105.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$290.25
Rate for Payer: Priority Health Narrow/Tiered Network	$290.25
Rate for Payer: UHC Medicaid	$105.01
Rate for Payer: UHCCP Medicaid	$105.01

PR RPLCMT/IRRG SUBARACHNOID/SUBDURAL CATHETER

Professional

Both

$1,930.00

Service Code	HCPCS 62194
Min. Negotiated Rate	$335.90
Max. Negotiated Rate	$1,447.50
Rate for Payer: Aetna Commercial	$632.44
Rate for Payer: Aetna Medicare	$965.00
Rate for Payer: BCBS Complete	$352.69
Rate for Payer: BCN Commercial	$762.90
Rate for Payer: Cash Price	$1,544.00
Rate for Payer: Cash Price	$1,544.00
Rate for Payer: Mclaren Medicaid	$335.90
Rate for Payer: Meridian Medicaid	$352.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,447.50
Rate for Payer: Priority Health Choice Medicaid	$335.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$886.10
Rate for Payer: Priority Health Narrow/Tiered Network	$886.10
Rate for Payer: UHC Medicaid	$335.90
Rate for Payer: UHCCP Medicaid	$335.90

PR RPLCMT IRRIGATION/REVJ LUMBOSARACH SHUNT

Professional

Both

$2,334.00

Service Code	HCPCS 63744
Min. Negotiated Rate	$469.45
Max. Negotiated Rate	$1,750.50
Rate for Payer: Aetna Commercial	$885.80
Rate for Payer: Aetna Medicare	$1,167.00
Rate for Payer: BCBS Complete	$492.92
Rate for Payer: BCN Commercial	$1,203.55
Rate for Payer: Cash Price	$1,867.20
Rate for Payer: Cash Price	$1,867.20
Rate for Payer: Mclaren Medicaid	$469.45
Rate for Payer: Meridian Medicaid	$492.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,750.50
Rate for Payer: Priority Health Choice Medicaid	$469.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,272.46
Rate for Payer: Priority Health Narrow/Tiered Network	$1,272.46
Rate for Payer: UHC Medicaid	$469.45
Rate for Payer: UHCCP Medicaid	$469.45

PR RPLCMT/IRRIGATION VENTRICULAR CATHETER

Professional

Both

$2,807.00

Service Code	HCPCS 62225
Min. Negotiated Rate	$364.87
Max. Negotiated Rate	$2,105.25
Rate for Payer: Aetna Commercial	$682.40
Rate for Payer: Aetna Medicare	$1,403.50
Rate for Payer: BCBS Complete	$383.11
Rate for Payer: BCN Commercial	$1,146.16
Rate for Payer: Cash Price	$2,245.60
Rate for Payer: Cash Price	$2,245.60
Rate for Payer: Mclaren Medicaid	$364.87
Rate for Payer: Meridian Medicaid	$383.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,105.25
Rate for Payer: Priority Health Choice Medicaid	$364.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$963.60
Rate for Payer: Priority Health Narrow/Tiered Network	$963.60
Rate for Payer: UHC Medicaid	$364.87
Rate for Payer: UHCCP Medicaid	$364.87

PR RPLCMT OI IMPLT SKULL PERQ ATTACHMENT ESP

Professional

Both

$2,329.00

Service Code	HCPCS 69717
Min. Negotiated Rate	$314.18
Max. Negotiated Rate	$1,746.75
Rate for Payer: Aetna Commercial	$1,259.55
Rate for Payer: Aetna Medicare	$1,164.50
Rate for Payer: BCBS Complete	$329.89
Rate for Payer: BCN Commercial	$841.58
Rate for Payer: Cash Price	$1,863.20
Rate for Payer: Cash Price	$1,863.20
Rate for Payer: Mclaren Medicaid	$314.18
Rate for Payer: Meridian Medicaid	$329.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,746.75
Rate for Payer: Priority Health Choice Medicaid	$314.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$831.58
Rate for Payer: Priority Health Narrow/Tiered Network	$831.58
Rate for Payer: UHC Medicaid	$314.18
Rate for Payer: UHCCP Medicaid	$314.18

PR RPLCMT PROST AORTIC VALVE OPEN XCP HOMOGRF/STENT

Professional

Both

$4,896.00

Service Code	HCPCS 33405
Min. Negotiated Rate	$1,355.75
Max. Negotiated Rate	$3,672.00
Rate for Payer: Aetna Commercial	$3,049.41
Rate for Payer: Aetna Medicare	$2,448.00
Rate for Payer: BCBS Complete	$1,423.54
Rate for Payer: BCN Commercial	$3,335.47
Rate for Payer: Cash Price	$3,916.80
Rate for Payer: Cash Price	$3,916.80
Rate for Payer: Mclaren Medicaid	$1,355.75
Rate for Payer: Meridian Medicaid	$1,423.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,672.00
Rate for Payer: Priority Health Choice Medicaid	$1,355.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,586.89
Rate for Payer: Priority Health Narrow/Tiered Network	$3,586.89
Rate for Payer: UHC Medicaid	$1,355.75
Rate for Payer: UHCCP Medicaid	$1,355.75

PR RPLCMT/REVJ CSF SHUNT VALVE/CATH SHUNT SYS

Professional

Both

$3,662.00

Service Code	HCPCS 62230
Min. Negotiated Rate	$535.27
Max. Negotiated Rate	$2,746.50
Rate for Payer: Aetna Commercial	$1,086.68
Rate for Payer: Aetna Medicare	$1,831.00
Rate for Payer: BCBS Complete	$562.03
Rate for Payer: BCN Commercial	$1,775.66
Rate for Payer: Cash Price	$2,929.60
Rate for Payer: Cash Price	$2,929.60
Rate for Payer: Mclaren Medicaid	$535.27
Rate for Payer: Meridian Medicaid	$562.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,746.50
Rate for Payer: Priority Health Choice Medicaid	$535.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,492.83
Rate for Payer: Priority Health Narrow/Tiered Network	$1,492.83
Rate for Payer: UHC Medicaid	$535.27
Rate for Payer: UHCCP Medicaid	$535.27

PR RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP

Professional

Both

$4,042.00

Service Code	HCPCS 20822
Min. Negotiated Rate	$1,021.97
Max. Negotiated Rate	$3,031.50
Rate for Payer: Aetna Commercial	$2,367.56
Rate for Payer: Aetna Medicare	$2,021.00
Rate for Payer: BCBS Complete	$1,073.07
Rate for Payer: BCN Commercial	$2,670.17
Rate for Payer: Cash Price	$3,233.60
Rate for Payer: Cash Price	$3,233.60
Rate for Payer: Mclaren Medicaid	$1,021.97
Rate for Payer: Meridian Medicaid	$1,073.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,031.50
Rate for Payer: Priority Health Choice Medicaid	$1,021.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,854.34
Rate for Payer: Priority Health Narrow/Tiered Network	$2,854.34
Rate for Payer: UHC Medicaid	$1,021.97
Rate for Payer: UHCCP Medicaid	$1,021.97

PR RPM TX MGMT 1 R-T IA COMUNICAJ CAL MO 1ST 20 MIN

Professional

Both

$103.00

Service Code	HCPCS 99457
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$77.25
Rate for Payer: Aetna Commercial	$31.23
Rate for Payer: Aetna Medicare	$51.50
Rate for Payer: BCBS Complete	$17.67
Rate for Payer: BCN Commercial	$44.32
Rate for Payer: Cash Price	$82.40
Rate for Payer: Cash Price	$82.40
Rate for Payer: Mclaren Medicaid	$16.83
Rate for Payer: Meridian Medicaid	$17.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$77.25
Rate for Payer: Priority Health Choice Medicaid	$16.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$39.87
Rate for Payer: Priority Health Narrow/Tiered Network	$39.87
Rate for Payer: UHC Medicaid	$16.83
Rate for Payer: UHCCP Medicaid	$16.83

PR RPM TX MGMT 1 R-T IA COMUNICAJ CAL MO EA ADDL 20

Professional

Both

$84.00

Service Code	HCPCS 99458
Min. Negotiated Rate	$16.83
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$31.23
Rate for Payer: Aetna Medicare	$42.00
Rate for Payer: BCBS Complete	$17.67
Rate for Payer: BCN Commercial	$44.32
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cash Price	$67.20
Rate for Payer: Mclaren Medicaid	$16.83
Rate for Payer: Meridian Medicaid	$17.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.00
Rate for Payer: Priority Health Choice Medicaid	$16.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$39.87
Rate for Payer: Priority Health Narrow/Tiered Network	$39.87
Rate for Payer: UHC Medicaid	$16.83
Rate for Payer: UHCCP Medicaid	$16.83

PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED

Professional

Both

$1,163.00

Service Code	HCPCS 49553
Min. Negotiated Rate	$388.30
Max. Negotiated Rate	$1,167.41
Rate for Payer: Aetna Commercial	$852.48
Rate for Payer: Aetna Medicare	$581.50
Rate for Payer: BCBS Complete	$407.71
Rate for Payer: BCN Commercial	$958.11
Rate for Payer: Cash Price	$930.40
Rate for Payer: Cash Price	$930.40
Rate for Payer: Mclaren Medicaid	$388.30
Rate for Payer: Meridian Medicaid	$407.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$872.25
Rate for Payer: Priority Health Choice Medicaid	$388.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,167.41
Rate for Payer: Priority Health Narrow/Tiered Network	$1,167.41
Rate for Payer: UHC Medicaid	$388.30
Rate for Payer: UHCCP Medicaid	$388.30

PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED

Facility

$1,163.00

Service Code	CPT 49553
Hospital Charge Code	49553
Hospital Revenue Code	960
Min. Negotiated Rate	$205.04
Max. Negotiated Rate	$1,046.70
Rate for Payer: Aetna Commercial	$988.55
Rate for Payer: Aetna Medicare	$302.38
Rate for Payer: Allen County Amish Medical Aid Commercial	$363.44
Rate for Payer: Amish Plain Church Group Commercial	$363.44
Rate for Payer: BCBS Complete	$215.27
Rate for Payer: BCBS MAPPO	$290.75
Rate for Payer: BCBS Trust/PPO	$956.10
Rate for Payer: BCN Commercial	$956.10
Rate for Payer: BCN Medicare Advantage	$290.75
Rate for Payer: Cash Price	$930.40
Rate for Payer: Cofinity Commercial	$1,000.18
Rate for Payer: Encore Health Key Benefits Commercial	$930.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$290.75
Rate for Payer: Healthscope Commercial	$1,046.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$872.25
Rate for Payer: Mclaren Medicaid	$205.04
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$305.29
Rate for Payer: Meridian Medicaid	$215.27
Rate for Payer: MI Amish Medical Board Commercial	$334.36
Rate for Payer: Molina Medicare/Medicaid	$319.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$988.55
Rate for Payer: Nomi Health Commercial	$953.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$872.25
Rate for Payer: PACE Senior Care Partners	$276.21
Rate for Payer: PACE SWMI	$290.75
Rate for Payer: PHP Commercial	$988.55
Rate for Payer: PHP Medicare Advantage	$290.75
Rate for Payer: Priority Health Choice Medicaid	$205.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,011.81
Rate for Payer: Priority Health Medicare	$293.66
Rate for Payer: Priority Health Narrow/Tiered Network	$809.45
Rate for Payer: Railroad Medicare Medicare	$290.75
Rate for Payer: UHC Core	$971.11
Rate for Payer: UHC Exchange	$290.75
Rate for Payer: UHC Medicaid	$205.04
Rate for Payer: UHC Medicare Advantage	$290.75
Rate for Payer: UHCCP Medicaid	$205.04
Rate for Payer: VA VA	$290.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$872.25

PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED

Facility

$1,163.00

Service Code	CPT 49553
Hospital Charge Code	49553
Hospital Revenue Code	960
Min. Negotiated Rate	$809.45
Max. Negotiated Rate	$1,046.70
Rate for Payer: Aetna Commercial	$988.55
Rate for Payer: BCBS Trust/PPO	$960.52
Rate for Payer: BCN Commercial	$960.52
Rate for Payer: Cash Price	$930.40
Rate for Payer: Cofinity Commercial	$1,000.18
Rate for Payer: Encore Health Key Benefits Commercial	$930.40
Rate for Payer: Healthscope Commercial	$1,046.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$872.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$988.55
Rate for Payer: Nomi Health Commercial	$953.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$872.25
Rate for Payer: PHP Commercial	$988.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,011.81
Rate for Payer: Priority Health Narrow/Tiered Network	$809.45
Rate for Payer: UHC Core	$971.11
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$872.25

PR RPR 1ST FEM HERNIA ANY AGE INCARCERATED

Professional

Both

$1,163.00

Service Code	HCPCS 49553
Hospital Charge Code	49553
Min. Negotiated Rate	$388.30
Max. Negotiated Rate	$1,167.41
Rate for Payer: Aetna Commercial	$852.48
Rate for Payer: Aetna Medicare	$581.50
Rate for Payer: BCBS Complete	$407.71
Rate for Payer: BCN Commercial	$958.11
Rate for Payer: Cash Price	$930.40
Rate for Payer: Cash Price	$930.40
Rate for Payer: Mclaren Medicaid	$388.30
Rate for Payer: Meridian Medicaid	$407.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$872.25
Rate for Payer: Priority Health Choice Medicaid	$388.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,167.41
Rate for Payer: Priority Health Narrow/Tiered Network	$1,167.41
Rate for Payer: UHC Medicaid	$388.30
Rate for Payer: UHCCP Medicaid	$388.30

PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE

Facility

$890.00

Service Code	CPT 49550
Hospital Charge Code	49550
Hospital Revenue Code	960
Min. Negotiated Rate	$156.91
Max. Negotiated Rate	$801.00
Rate for Payer: Aetna Commercial	$756.50
Rate for Payer: Aetna Medicare	$231.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$278.12
Rate for Payer: Amish Plain Church Group Commercial	$278.12
Rate for Payer: BCBS Complete	$164.74
Rate for Payer: BCBS MAPPO	$222.50
Rate for Payer: BCBS Trust/PPO	$731.67
Rate for Payer: BCN Commercial	$731.67
Rate for Payer: BCN Medicare Advantage	$222.50
Rate for Payer: Cash Price	$712.00
Rate for Payer: Cofinity Commercial	$765.40
Rate for Payer: Encore Health Key Benefits Commercial	$712.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$222.50
Rate for Payer: Healthscope Commercial	$801.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$667.50
Rate for Payer: Mclaren Medicaid	$156.91
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$233.62
Rate for Payer: Meridian Medicaid	$164.74
Rate for Payer: MI Amish Medical Board Commercial	$255.88
Rate for Payer: Molina Medicare/Medicaid	$244.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$756.50
Rate for Payer: Nomi Health Commercial	$729.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$667.50
Rate for Payer: PACE Senior Care Partners	$211.38
Rate for Payer: PACE SWMI	$222.50
Rate for Payer: PHP Commercial	$756.50
Rate for Payer: PHP Medicare Advantage	$222.50
Rate for Payer: Priority Health Choice Medicaid	$156.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$774.30
Rate for Payer: Priority Health Medicare	$224.72
Rate for Payer: Priority Health Narrow/Tiered Network	$619.44
Rate for Payer: Railroad Medicare Medicare	$222.50
Rate for Payer: UHC Core	$743.15
Rate for Payer: UHC Exchange	$222.50
Rate for Payer: UHC Medicaid	$156.91
Rate for Payer: UHC Medicare Advantage	$222.50
Rate for Payer: UHCCP Medicaid	$156.91
Rate for Payer: VA VA	$222.50
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$667.50

PR RPR 1ST FEM HRNA ANY AGE REDUCIBLE

Professional

Both

$890.00

Service Code	HCPCS 49550
Hospital Charge Code	49550
Min. Negotiated Rate	$356.14
Max. Negotiated Rate	$1,069.12
Rate for Payer: Aetna Commercial	$777.96
Rate for Payer: Aetna Medicare	$445.00
Rate for Payer: BCBS Complete	$373.95
Rate for Payer: BCN Commercial	$877.44
Rate for Payer: Cash Price	$712.00
Rate for Payer: Cash Price	$712.00
Rate for Payer: Mclaren Medicaid	$356.14
Rate for Payer: Meridian Medicaid	$373.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$667.50
Rate for Payer: Priority Health Choice Medicaid	$356.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,069.12
Rate for Payer: Priority Health Narrow/Tiered Network	$1,069.12
Rate for Payer: UHC Medicaid	$356.14
Rate for Payer: UHCCP Medicaid	$356.14

Know your out-of-pocket cost for care.

All Charges