Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM

Professional

Both

$390.00

Service Code	HCPCS 12004
Min. Negotiated Rate	$46.01
Max. Negotiated Rate	$292.50
Rate for Payer: Aetna Commercial	$80.43
Rate for Payer: Aetna Medicare	$195.00
Rate for Payer: BCBS Complete	$48.31
Rate for Payer: BCN Commercial	$109.06
Rate for Payer: Cash Price	$312.00
Rate for Payer: Cash Price	$312.00
Rate for Payer: Mclaren Medicaid	$46.01
Rate for Payer: Meridian Medicaid	$48.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$292.50
Rate for Payer: Priority Health Choice Medicaid	$46.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$99.82
Rate for Payer: Priority Health Narrow/Tiered Network	$99.82
Rate for Payer: UHC Medicaid	$46.01
Rate for Payer: UHCCP Medicaid	$46.01

PR SIMPLE UROFLOMETRY

Professional

Both

$93.00

Service Code	HCPCS 51736
Min. Negotiated Rate	$16.86
Max. Negotiated Rate	$69.75
Rate for Payer: Aetna Commercial	$16.86
Rate for Payer: Aetna Medicare	$46.50
Rate for Payer: BCN Commercial	$20.42
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cash Price	$74.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$69.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$22.24
Rate for Payer: Priority Health Narrow/Tiered Network	$22.24

PR SINUSOT FRNT NONOBLIT W/OSTPL FLAP CORONAL INC

Professional

Both

$2,207.00

Service Code	HCPCS 31087
Min. Negotiated Rate	$638.15
Max. Negotiated Rate	$1,677.20
Rate for Payer: Aetna Commercial	$1,421.59
Rate for Payer: Aetna Medicare	$1,103.50
Rate for Payer: BCBS Complete	$670.06
Rate for Payer: BCN Commercial	$1,677.20
Rate for Payer: Cash Price	$1,765.60
Rate for Payer: Cash Price	$1,765.60
Rate for Payer: Mclaren Medicaid	$638.15
Rate for Payer: Meridian Medicaid	$670.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,655.25
Rate for Payer: Priority Health Choice Medicaid	$638.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,579.42
Rate for Payer: Priority Health Narrow/Tiered Network	$1,579.42
Rate for Payer: UHC Medicaid	$638.15
Rate for Payer: UHCCP Medicaid	$638.15

PR SINUSOT FRNT OBLIT W/O OSTPL FLAP CORONAL INC

Professional

Both

$2,148.00

Service Code	HCPCS 31081
Min. Negotiated Rate	$668.82
Max. Negotiated Rate	$1,743.93
Rate for Payer: Aetna Commercial	$1,479.82
Rate for Payer: Aetna Medicare	$1,074.00
Rate for Payer: BCBS Complete	$702.26
Rate for Payer: BCN Commercial	$1,743.93
Rate for Payer: Cash Price	$1,718.40
Rate for Payer: Cash Price	$1,718.40
Rate for Payer: Mclaren Medicaid	$668.82
Rate for Payer: Meridian Medicaid	$702.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,611.00
Rate for Payer: Priority Health Choice Medicaid	$668.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,642.26
Rate for Payer: Priority Health Narrow/Tiered Network	$1,642.26
Rate for Payer: UHC Medicaid	$668.82
Rate for Payer: UHCCP Medicaid	$668.82

PR SINUSOT FRNT OBLIT W/OSTPL FLAP CORONAL INC

Professional

Both

$2,747.00

Service Code	HCPCS 31085
Min. Negotiated Rate	$710.36
Max. Negotiated Rate	$2,060.25
Rate for Payer: Aetna Commercial	$1,581.37
Rate for Payer: Aetna Medicare	$1,373.50
Rate for Payer: BCBS Complete	$745.88
Rate for Payer: BCN Commercial	$1,859.96
Rate for Payer: Cash Price	$2,197.60
Rate for Payer: Cash Price	$2,197.60
Rate for Payer: Mclaren Medicaid	$710.36
Rate for Payer: Meridian Medicaid	$745.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,060.25
Rate for Payer: Priority Health Choice Medicaid	$710.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,751.53
Rate for Payer: Priority Health Narrow/Tiered Network	$1,751.53
Rate for Payer: UHC Medicaid	$710.36
Rate for Payer: UHCCP Medicaid	$710.36

PR SINUSOT MAX ANTRT RAD W/RMVL ANTROCH POLYPS

Professional

Both

$1,158.00

Service Code	HCPCS 31032
Min. Negotiated Rate	$351.88
Max. Negotiated Rate	$893.88
Rate for Payer: Aetna Commercial	$753.09
Rate for Payer: Aetna Medicare	$579.00
Rate for Payer: BCBS Complete	$369.47
Rate for Payer: BCN Commercial	$893.88
Rate for Payer: Cash Price	$926.40
Rate for Payer: Cash Price	$926.40
Rate for Payer: Mclaren Medicaid	$351.88
Rate for Payer: Meridian Medicaid	$369.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$868.50
Rate for Payer: Priority Health Choice Medicaid	$351.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$841.77
Rate for Payer: Priority Health Narrow/Tiered Network	$841.77
Rate for Payer: UHC Medicaid	$351.88
Rate for Payer: UHCCP Medicaid	$351.88

PR SINUSOTOMY FRNT OBLITERATIVE W/O FLAP BROW INC

Professional

Both

$2,332.00

Service Code	HCPCS 31080
Min. Negotiated Rate	$626.65
Max. Negotiated Rate	$1,749.00
Rate for Payer: Aetna Commercial	$1,380.05
Rate for Payer: Aetna Medicare	$1,166.00
Rate for Payer: BCBS Complete	$657.98
Rate for Payer: BCN Commercial	$1,626.90
Rate for Payer: Cash Price	$1,865.60
Rate for Payer: Cash Price	$1,865.60
Rate for Payer: Mclaren Medicaid	$626.65
Rate for Payer: Meridian Medicaid	$657.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,749.00
Rate for Payer: Priority Health Choice Medicaid	$626.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,532.06
Rate for Payer: Priority Health Narrow/Tiered Network	$1,532.06
Rate for Payer: UHC Medicaid	$626.65
Rate for Payer: UHCCP Medicaid	$626.65

PR SINUSOTOMY FRONTAL EXTERNAL SIMPLE

Professional

Both

$913.00

Service Code	HCPCS 31070
Min. Negotiated Rate	$282.44
Max. Negotiated Rate	$712.11
Rate for Payer: Aetna Commercial	$597.38
Rate for Payer: Aetna Medicare	$456.50
Rate for Payer: BCBS Complete	$296.56
Rate for Payer: BCN Commercial	$712.11
Rate for Payer: Cash Price	$730.40
Rate for Payer: Cash Price	$730.40
Rate for Payer: Mclaren Medicaid	$282.44
Rate for Payer: Meridian Medicaid	$296.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$684.75
Rate for Payer: Priority Health Choice Medicaid	$282.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$670.59
Rate for Payer: Priority Health Narrow/Tiered Network	$670.59
Rate for Payer: UHC Medicaid	$282.44
Rate for Payer: UHCCP Medicaid	$282.44

PR SINUSOTOMY MAXILLARY ANTROTOMY INTRANASAL

Professional

Both

$735.00

Service Code	HCPCS 31020
Min. Negotiated Rate	$208.53
Max. Negotiated Rate	$551.25
Rate for Payer: Aetna Commercial	$488.09
Rate for Payer: Aetna Medicare	$367.50
Rate for Payer: BCBS Complete	$218.96
Rate for Payer: BCN Commercial	$516.91
Rate for Payer: Cash Price	$588.00
Rate for Payer: Cash Price	$588.00
Rate for Payer: Mclaren Medicaid	$208.53
Rate for Payer: Meridian Medicaid	$218.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$551.25
Rate for Payer: Priority Health Choice Medicaid	$208.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$486.78
Rate for Payer: Priority Health Narrow/Tiered Network	$486.78
Rate for Payer: UHC Medicaid	$208.53
Rate for Payer: UHCCP Medicaid	$208.53

PR SINUSOTOMY MAXILLARY RAD W/O RMVL ANTROCH POLYPS

Professional

Both

$1,191.00

Service Code	HCPCS 31030
Min. Negotiated Rate	$302.46
Max. Negotiated Rate	$893.25
Rate for Payer: Aetna Commercial	$651.88
Rate for Payer: Aetna Medicare	$595.50
Rate for Payer: BCBS Complete	$317.58
Rate for Payer: BCN Commercial	$774.86
Rate for Payer: Cash Price	$952.80
Rate for Payer: Cash Price	$952.80
Rate for Payer: Mclaren Medicaid	$302.46
Rate for Payer: Meridian Medicaid	$317.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$893.25
Rate for Payer: Priority Health Choice Medicaid	$302.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$729.68
Rate for Payer: Priority Health Narrow/Tiered Network	$729.68
Rate for Payer: UHC Medicaid	$302.46
Rate for Payer: UHCCP Medicaid	$302.46

PR SINUSOT SPHENOID W/MUCOSAL STRIPPING/RMVL POLYP

Professional

Both

$1,923.00

Service Code	HCPCS 31051
Min. Negotiated Rate	$405.13
Max. Negotiated Rate	$1,442.25
Rate for Payer: Aetna Commercial	$876.60
Rate for Payer: Aetna Medicare	$961.50
Rate for Payer: BCBS Complete	$425.39
Rate for Payer: BCN Commercial	$1,034.80
Rate for Payer: Cash Price	$1,538.40
Rate for Payer: Cash Price	$1,538.40
Rate for Payer: Mclaren Medicaid	$405.13
Rate for Payer: Meridian Medicaid	$425.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,442.25
Rate for Payer: Priority Health Choice Medicaid	$405.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$974.48
Rate for Payer: Priority Health Narrow/Tiered Network	$974.48
Rate for Payer: UHC Medicaid	$405.13
Rate for Payer: UHCCP Medicaid	$405.13

PR SKIN LESION SHAVE/EXCISION (15 MIN)

Professional

Both

$450.00

Hospital Revenue Code	990
Min. Negotiated Rate	$180.00
Max. Negotiated Rate	$337.50
Rate for Payer: Aetna Medicare	$225.00
Rate for Payer: BCBS Complete	$180.00
Rate for Payer: Cash Price	$360.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$337.50

PR SKIN LESION SHAVE/EXCISION (30 MIN)

Professional

Both

$525.00

Hospital Revenue Code	990
Min. Negotiated Rate	$210.00
Max. Negotiated Rate	$393.75
Rate for Payer: Aetna Medicare	$262.50
Rate for Payer: BCBS Complete	$210.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$393.75

PR SKYLA, 13.5 MG

Professional

Both

$1,506.00

Service Code	HCPCS J7301
Min. Negotiated Rate	$753.00
Max. Negotiated Rate	$1,129.50
Rate for Payer: Aetna Commercial	$917.35
Rate for Payer: Aetna Medicare	$753.00
Rate for Payer: BCBS Complete	$1,125.66
Rate for Payer: BCBS Trust/PPO	$1,019.71
Rate for Payer: BCN Commercial	$1,020.68
Rate for Payer: Cash Price	$1,204.80
Rate for Payer: Cash Price	$1,204.80
Rate for Payer: Mclaren Medicaid	$1,072.06
Rate for Payer: Meridian Medicaid	$1,125.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,129.50
Rate for Payer: Priority Health Choice Medicaid	$1,072.06
Rate for Payer: UHC Medicaid	$1,072.06
Rate for Payer: UHCCP Medicaid	$1,072.06

PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UN

Professional

Both

$529.00

Service Code	HCPCS 36251
Min. Negotiated Rate	$143.14
Max. Negotiated Rate	$399.49
Rate for Payer: Aetna Commercial	$344.70
Rate for Payer: Aetna Medicare	$264.50
Rate for Payer: BCBS Complete	$150.30
Rate for Payer: BCN Commercial	$371.49
Rate for Payer: Cash Price	$423.20
Rate for Payer: Cash Price	$423.20
Rate for Payer: Mclaren Medicaid	$143.14
Rate for Payer: Meridian Medicaid	$150.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$396.75
Rate for Payer: Priority Health Choice Medicaid	$143.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$399.49
Rate for Payer: Priority Health Narrow/Tiered Network	$399.49
Rate for Payer: UHC Medicaid	$143.14
Rate for Payer: UHCCP Medicaid	$143.14

PR SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BIL

Professional

Both

$689.00

Service Code	HCPCS 36252
Min. Negotiated Rate	$197.45
Max. Negotiated Rate	$559.61
Rate for Payer: Aetna Commercial	$481.35
Rate for Payer: Aetna Medicare	$344.50
Rate for Payer: BCBS Complete	$207.32
Rate for Payer: BCN Commercial	$520.39
Rate for Payer: Cash Price	$551.20
Rate for Payer: Cash Price	$551.20
Rate for Payer: Mclaren Medicaid	$197.45
Rate for Payer: Meridian Medicaid	$207.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$516.75
Rate for Payer: Priority Health Choice Medicaid	$197.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$559.61
Rate for Payer: Priority Health Narrow/Tiered Network	$559.61
Rate for Payer: UHC Medicaid	$197.45
Rate for Payer: UHCCP Medicaid	$197.45

PR SLCTV CATH CAROTID/INNOM ART ANGIO INTRCRANL ART

Professional

Both

$1,855.00

Service Code	HCPCS 36223
Min. Negotiated Rate	$189.57
Max. Negotiated Rate	$1,391.25
Rate for Payer: Aetna Commercial	$429.37
Rate for Payer: Aetna Medicare	$927.50
Rate for Payer: BCBS Complete	$199.05
Rate for Payer: BCN Commercial	$489.52
Rate for Payer: Cash Price	$1,484.00
Rate for Payer: Cash Price	$1,484.00
Rate for Payer: Mclaren Medicaid	$189.57
Rate for Payer: Meridian Medicaid	$199.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,391.25
Rate for Payer: Priority Health Choice Medicaid	$189.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$526.42
Rate for Payer: Priority Health Narrow/Tiered Network	$526.42
Rate for Payer: UHC Medicaid	$189.57
Rate for Payer: UHCCP Medicaid	$189.57

PR SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART

Professional

Both

$1,705.00

Service Code	HCPCS 36222
Min. Negotiated Rate	$161.03
Max. Negotiated Rate	$1,278.75
Rate for Payer: Aetna Commercial	$380.48
Rate for Payer: Aetna Medicare	$852.50
Rate for Payer: BCBS Complete	$169.08
Rate for Payer: BCN Commercial	$420.80
Rate for Payer: Cash Price	$1,364.00
Rate for Payer: Cash Price	$1,364.00
Rate for Payer: Mclaren Medicaid	$161.03
Rate for Payer: Meridian Medicaid	$169.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,278.75
Rate for Payer: Priority Health Choice Medicaid	$161.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$452.51
Rate for Payer: Priority Health Narrow/Tiered Network	$452.51
Rate for Payer: UHC Medicaid	$161.03
Rate for Payer: UHCCP Medicaid	$161.03

PR SLCTV CATHETER PLMT LEFT/RIGHT PULMONARY ARTERY

Professional

Both

$1,039.00

Service Code	HCPCS 36014
Min. Negotiated Rate	$83.28
Max. Negotiated Rate	$779.25
Rate for Payer: Aetna Commercial	$203.35
Rate for Payer: Aetna Medicare	$519.50
Rate for Payer: BCBS Complete	$87.44
Rate for Payer: BCN Commercial	$222.10
Rate for Payer: Cash Price	$831.20
Rate for Payer: Cash Price	$831.20
Rate for Payer: Mclaren Medicaid	$83.28
Rate for Payer: Meridian Medicaid	$87.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$779.25
Rate for Payer: Priority Health Choice Medicaid	$83.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$238.85
Rate for Payer: Priority Health Narrow/Tiered Network	$238.85
Rate for Payer: UHC Medicaid	$83.28
Rate for Payer: UHCCP Medicaid	$83.28

PR SLCTV CATH INTRCRNL BRNCH ANGIO INTRL CAROT/VERT

Professional

Both

$1,401.00

Service Code	HCPCS 36228
Min. Negotiated Rate	$143.35
Max. Negotiated Rate	$1,050.75
Rate for Payer: Aetna Commercial	$325.23
Rate for Payer: Aetna Medicare	$700.50
Rate for Payer: BCBS Complete	$150.52
Rate for Payer: BCN Commercial	$372.49
Rate for Payer: Cash Price	$1,120.80
Rate for Payer: Cash Price	$1,120.80
Rate for Payer: Mclaren Medicaid	$143.35
Rate for Payer: Meridian Medicaid	$150.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,050.75
Rate for Payer: Priority Health Choice Medicaid	$143.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$400.56
Rate for Payer: Priority Health Narrow/Tiered Network	$400.56
Rate for Payer: UHC Medicaid	$143.35
Rate for Payer: UHCCP Medicaid	$143.35

PR SLCTV CATH INTRNL CAROTID ART ANGIO INTRCRNL ART

Professional

Both

$1,296.00

Service Code	HCPCS 36224
Min. Negotiated Rate	$211.72
Max. Negotiated Rate	$972.00
Rate for Payer: Aetna Commercial	$484.13
Rate for Payer: Aetna Medicare	$648.00
Rate for Payer: BCBS Complete	$222.31
Rate for Payer: BCN Commercial	$549.77
Rate for Payer: Cash Price	$1,036.80
Rate for Payer: Cash Price	$1,036.80
Rate for Payer: Mclaren Medicaid	$211.72
Rate for Payer: Meridian Medicaid	$222.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$972.00
Rate for Payer: Priority Health Choice Medicaid	$211.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$591.22
Rate for Payer: Priority Health Narrow/Tiered Network	$591.22
Rate for Payer: UHC Medicaid	$211.72
Rate for Payer: UHCCP Medicaid	$211.72

PR SLCTV CATHJ 1ST 2ND ORD THRC/BRCH/CPHLC BRNCH

Professional

Both

$2,414.00

Service Code	HCPCS 36216
Min. Negotiated Rate	$155.28
Max. Negotiated Rate	$1,810.50
Rate for Payer: Aetna Commercial	$363.29
Rate for Payer: Aetna Medicare	$1,207.00
Rate for Payer: BCBS Complete	$163.04
Rate for Payer: BCN Commercial	$399.39
Rate for Payer: Cash Price	$1,931.20
Rate for Payer: Cash Price	$1,931.20
Rate for Payer: Mclaren Medicaid	$155.28
Rate for Payer: Meridian Medicaid	$163.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,810.50
Rate for Payer: Priority Health Choice Medicaid	$155.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$429.49
Rate for Payer: Priority Health Narrow/Tiered Network	$429.49
Rate for Payer: UHC Medicaid	$155.28
Rate for Payer: UHCCP Medicaid	$155.28

PR SLCTV CATHJ 2ND ORDER ABDL PEL/LXTR ART BRNCH

Professional

Both

$1,073.00

Service Code	HCPCS 36246
Min. Negotiated Rate	$141.22
Max. Negotiated Rate	$804.75
Rate for Payer: Aetna Commercial	$340.06
Rate for Payer: Aetna Medicare	$536.50
Rate for Payer: BCBS Complete	$148.28
Rate for Payer: BCN Commercial	$367.51
Rate for Payer: Cash Price	$858.40
Rate for Payer: Cash Price	$858.40
Rate for Payer: Mclaren Medicaid	$141.22
Rate for Payer: Meridian Medicaid	$148.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$804.75
Rate for Payer: Priority Health Choice Medicaid	$141.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$395.22
Rate for Payer: Priority Health Narrow/Tiered Network	$395.22
Rate for Payer: UHC Medicaid	$141.22
Rate for Payer: UHCCP Medicaid	$141.22

PR SLCTV CATHJ 3RD+ ORD SLCTV ABDL PEL/LXTR BRNCH

Professional

Both

$1,343.00

Service Code	HCPCS 36247
Min. Negotiated Rate	$165.08
Max. Negotiated Rate	$1,007.25
Rate for Payer: Aetna Commercial	$402.83
Rate for Payer: Aetna Medicare	$671.50
Rate for Payer: BCBS Complete	$173.33
Rate for Payer: BCN Commercial	$433.74
Rate for Payer: Cash Price	$1,074.40
Rate for Payer: Cash Price	$1,074.40
Rate for Payer: Mclaren Medicaid	$165.08
Rate for Payer: Meridian Medicaid	$173.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,007.25
Rate for Payer: Priority Health Choice Medicaid	$165.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$466.44
Rate for Payer: Priority Health Narrow/Tiered Network	$466.44
Rate for Payer: UHC Medicaid	$165.08
Rate for Payer: UHCCP Medicaid	$165.08

PR SLCTV CATHJ 3RD+ ORD SLCTV THRC/BRCH/CPHLC BRNCH

Professional

Both

$1,418.00

Service Code	HCPCS 36217
Min. Negotiated Rate	$192.34
Max. Negotiated Rate	$1,063.50
Rate for Payer: Aetna Commercial	$438.91
Rate for Payer: Aetna Medicare	$709.00
Rate for Payer: BCBS Complete	$201.96
Rate for Payer: BCN Commercial	$496.49
Rate for Payer: Cash Price	$1,134.40
Rate for Payer: Cash Price	$1,134.40
Rate for Payer: Mclaren Medicaid	$192.34
Rate for Payer: Meridian Medicaid	$201.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,063.50
Rate for Payer: Priority Health Choice Medicaid	$192.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$533.90
Rate for Payer: Priority Health Narrow/Tiered Network	$533.90
Rate for Payer: UHC Medicaid	$192.34
Rate for Payer: UHCCP Medicaid	$192.34

Know your out-of-pocket cost for care.

All Charges