Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR SPHINCTEROTOMY ANAL DIVISION SPHINCTER SPX

Professional

Both

$927.00

Service Code	HCPCS 46080
Min. Negotiated Rate	$95.64
Max. Negotiated Rate	$695.25
Rate for Payer: Aetna Commercial	$211.65
Rate for Payer: Aetna Medicare	$463.50
Rate for Payer: BCBS Complete	$100.42
Rate for Payer: BCN Commercial	$239.03
Rate for Payer: Cash Price	$741.60
Rate for Payer: Cash Price	$741.60
Rate for Payer: Mclaren Medicaid	$95.64
Rate for Payer: Meridian Medicaid	$100.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$695.25
Rate for Payer: Priority Health Choice Medicaid	$95.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$291.24
Rate for Payer: Priority Health Narrow/Tiered Network	$291.24
Rate for Payer: UHC Medicaid	$95.64
Rate for Payer: UHCCP Medicaid	$95.64

PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE ADULT

Professional

Both

$1,555.00

Service Code	HCPCS 46750
Min. Negotiated Rate	$438.14
Max. Negotiated Rate	$1,368.23
Rate for Payer: Aetna Commercial	$1,008.35
Rate for Payer: Aetna Medicare	$777.50
Rate for Payer: BCBS Complete	$460.05
Rate for Payer: BCN Commercial	$1,122.94
Rate for Payer: Cash Price	$1,244.00
Rate for Payer: Cash Price	$1,244.00
Rate for Payer: Mclaren Medicaid	$438.14
Rate for Payer: Meridian Medicaid	$460.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,166.25
Rate for Payer: Priority Health Choice Medicaid	$438.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,368.23
Rate for Payer: Priority Health Narrow/Tiered Network	$1,368.23
Rate for Payer: UHC Medicaid	$438.14
Rate for Payer: UHCCP Medicaid	$438.14

PR SPHNCTROP ANAL INCONTINENCE/PROLAPSE CHLD

Professional

Both

$1,340.00

Service Code	HCPCS 46751
Min. Negotiated Rate	$423.44
Max. Negotiated Rate	$1,238.39
Rate for Payer: Aetna Commercial	$898.95
Rate for Payer: Aetna Medicare	$670.00
Rate for Payer: BCBS Complete	$444.61
Rate for Payer: BCN Commercial	$1,016.38
Rate for Payer: Cash Price	$1,072.00
Rate for Payer: Cash Price	$1,072.00
Rate for Payer: Mclaren Medicaid	$423.44
Rate for Payer: Meridian Medicaid	$444.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,005.00
Rate for Payer: Priority Health Choice Medicaid	$423.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,238.39
Rate for Payer: Priority Health Narrow/Tiered Network	$1,238.39
Rate for Payer: UHC Medicaid	$423.44
Rate for Payer: UHCCP Medicaid	$423.44

PR SPHNCTROP ANAL LEVATOR MUSC IMBRCJ

Professional

Both

$1,945.00

Service Code	HCPCS 46761
Min. Negotiated Rate	$529.31
Max. Negotiated Rate	$1,664.95
Rate for Payer: Aetna Commercial	$1,233.15
Rate for Payer: Aetna Medicare	$972.50
Rate for Payer: BCBS Complete	$555.78
Rate for Payer: BCN Commercial	$1,366.46
Rate for Payer: Cash Price	$1,556.00
Rate for Payer: Cash Price	$1,556.00
Rate for Payer: Mclaren Medicaid	$529.31
Rate for Payer: Meridian Medicaid	$555.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,458.75
Rate for Payer: Priority Health Choice Medicaid	$529.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,664.95
Rate for Payer: Priority Health Narrow/Tiered Network	$1,664.95
Rate for Payer: UHC Medicaid	$529.31
Rate for Payer: UHCCP Medicaid	$529.31

PR SPLENC TOT EN BLOC EXTNSV DS CONJUNCT W/OTH PX

Professional

Both

$2,778.00

Service Code	HCPCS 38102
Min. Negotiated Rate	$150.59
Max. Negotiated Rate	$2,083.50
Rate for Payer: Aetna Commercial	$326.41
Rate for Payer: Aetna Medicare	$1,389.00
Rate for Payer: BCBS Complete	$158.12
Rate for Payer: BCN Commercial	$389.42
Rate for Payer: Cash Price	$2,222.40
Rate for Payer: Cash Price	$2,222.40
Rate for Payer: Mclaren Medicaid	$150.59
Rate for Payer: Meridian Medicaid	$158.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,083.50
Rate for Payer: Priority Health Choice Medicaid	$150.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$518.16
Rate for Payer: Priority Health Narrow/Tiered Network	$518.16
Rate for Payer: UHC Medicaid	$150.59
Rate for Payer: UHCCP Medicaid	$150.59

PR SPLENECTOMY PARTIAL SEPARATE PROCEDURE

Professional

Both

$3,087.00

Service Code	HCPCS 38101
Min. Negotiated Rate	$692.89
Max. Negotiated Rate	$2,326.41
Rate for Payer: Aetna Commercial	$1,458.52
Rate for Payer: Aetna Medicare	$1,543.50
Rate for Payer: BCBS Complete	$727.53
Rate for Payer: BCN Commercial	$1,748.41
Rate for Payer: Cash Price	$2,469.60
Rate for Payer: Cash Price	$2,469.60
Rate for Payer: Mclaren Medicaid	$692.89
Rate for Payer: Meridian Medicaid	$727.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,315.25
Rate for Payer: Priority Health Choice Medicaid	$692.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,326.41
Rate for Payer: Priority Health Narrow/Tiered Network	$2,326.41
Rate for Payer: UHC Medicaid	$692.89
Rate for Payer: UHCCP Medicaid	$692.89

PR SPLENECTOMY TOTAL SEPARATE PROCEDURE

Professional

Both

$4,874.00

Service Code	HCPCS 38100
Min. Negotiated Rate	$684.80
Max. Negotiated Rate	$3,655.50
Rate for Payer: Aetna Commercial	$1,440.33
Rate for Payer: Aetna Medicare	$2,437.00
Rate for Payer: BCBS Complete	$719.04
Rate for Payer: BCN Commercial	$1,725.01
Rate for Payer: Cash Price	$3,899.20
Rate for Payer: Cash Price	$3,899.20
Rate for Payer: Mclaren Medicaid	$684.80
Rate for Payer: Meridian Medicaid	$719.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,655.50
Rate for Payer: Priority Health Choice Medicaid	$684.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,295.25
Rate for Payer: Priority Health Narrow/Tiered Network	$2,295.25
Rate for Payer: UHC Medicaid	$684.80
Rate for Payer: UHCCP Medicaid	$684.80

PR SPLINT

Professional

Both

$32.00

Service Code	HCPCS A4570
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$8.90
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00

PR SPLINT SUPPLIES MISC

Professional

Both

$77.00

Service Code	HCPCS Q4051
Min. Negotiated Rate	$20.11
Max. Negotiated Rate	$57.75
Rate for Payer: Aetna Medicare	$38.50
Rate for Payer: BCN Commercial	$20.11
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$57.75

PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%

Professional

Both

$1,650.00

Service Code	HCPCS 15120
Hospital Charge Code	15120
Min. Negotiated Rate	$392.13
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$743.74
Rate for Payer: Aetna Medicare	$825.00
Rate for Payer: BCBS Complete	$411.74
Rate for Payer: BCN Commercial	$1,039.79
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Mclaren Medicaid	$392.13
Rate for Payer: Meridian Medicaid	$411.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,237.50
Rate for Payer: Priority Health Choice Medicaid	$392.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$951.66
Rate for Payer: Priority Health Narrow/Tiered Network	$951.66
Rate for Payer: UHC Medicaid	$392.13
Rate for Payer: UHCCP Medicaid	$392.13

PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%

Professional

Both

$1,650.00

Service Code	HCPCS 15120
Min. Negotiated Rate	$392.13
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Commercial	$743.74
Rate for Payer: Aetna Medicare	$825.00
Rate for Payer: BCBS Complete	$411.74
Rate for Payer: BCN Commercial	$1,039.79
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Mclaren Medicaid	$392.13
Rate for Payer: Meridian Medicaid	$411.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,237.50
Rate for Payer: Priority Health Choice Medicaid	$392.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$951.66
Rate for Payer: Priority Health Narrow/Tiered Network	$951.66
Rate for Payer: UHC Medicaid	$392.13
Rate for Payer: UHCCP Medicaid	$392.13

PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%

Facility

$1,650.00

Service Code	CPT 15120
Hospital Charge Code	15120
Hospital Revenue Code	960
Min. Negotiated Rate	$1,148.40
Max. Negotiated Rate	$1,485.00
Rate for Payer: Aetna Commercial	$1,402.50
Rate for Payer: BCBS Trust/PPO	$1,362.73
Rate for Payer: BCN Commercial	$1,362.73
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Cofinity Commercial	$1,419.00
Rate for Payer: Encore Health Key Benefits Commercial	$1,320.00
Rate for Payer: Healthscope Commercial	$1,485.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,237.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,402.50
Rate for Payer: Nomi Health Commercial	$1,353.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,237.50
Rate for Payer: PHP Commercial	$1,402.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,435.50
Rate for Payer: Priority Health Narrow/Tiered Network	$1,148.40
Rate for Payer: UHC Core	$1,377.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,237.50

PR SPLT AGRFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM/</1%

Facility

$1,650.00

Service Code	CPT 15120
Hospital Charge Code	15120
Hospital Revenue Code	960
Min. Negotiated Rate	$290.89
Max. Negotiated Rate	$1,485.00
Rate for Payer: Aetna Commercial	$1,402.50
Rate for Payer: Aetna Medicare	$429.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$515.62
Rate for Payer: Amish Plain Church Group Commercial	$515.62
Rate for Payer: BCBS Complete	$305.42
Rate for Payer: BCBS MAPPO	$412.50
Rate for Payer: BCBS Trust/PPO	$1,356.46
Rate for Payer: BCN Commercial	$1,356.46
Rate for Payer: BCN Medicare Advantage	$412.50
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Cofinity Commercial	$1,419.00
Rate for Payer: Encore Health Key Benefits Commercial	$1,320.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$412.50
Rate for Payer: Healthscope Commercial	$1,485.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,237.50
Rate for Payer: Mclaren Medicaid	$290.89
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$433.12
Rate for Payer: Meridian Medicaid	$305.42
Rate for Payer: MI Amish Medical Board Commercial	$474.38
Rate for Payer: Molina Medicare/Medicaid	$453.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,402.50
Rate for Payer: Nomi Health Commercial	$1,353.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,237.50
Rate for Payer: PACE Senior Care Partners	$391.88
Rate for Payer: PACE SWMI	$412.50
Rate for Payer: PHP Commercial	$1,402.50
Rate for Payer: PHP Medicare Advantage	$412.50
Rate for Payer: Priority Health Choice Medicaid	$290.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,435.50
Rate for Payer: Priority Health Medicare	$416.62
Rate for Payer: Priority Health Narrow/Tiered Network	$1,148.40
Rate for Payer: Railroad Medicare Medicare	$412.50
Rate for Payer: UHC Core	$1,377.75
Rate for Payer: UHC Exchange	$412.50
Rate for Payer: UHC Medicaid	$290.89
Rate for Payer: UHC Medicare Advantage	$412.50
Rate for Payer: UHCCP Medicaid	$290.89
Rate for Payer: VA VA	$412.50
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,237.50

PR SPLT AGRFT F/S/N/H/F/G/M/DGT EA 100 SQCM/EA 1%

Professional

Both

$515.00

Service Code	HCPCS 15121
Min. Negotiated Rate	$76.04
Max. Negotiated Rate	$386.25
Rate for Payer: Aetna Commercial	$147.37
Rate for Payer: Aetna Medicare	$257.50
Rate for Payer: BCBS Complete	$79.84
Rate for Payer: BCN Commercial	$195.70
Rate for Payer: Cash Price	$412.00
Rate for Payer: Cash Price	$412.00
Rate for Payer: Mclaren Medicaid	$76.04
Rate for Payer: Meridian Medicaid	$79.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$386.25
Rate for Payer: Priority Health Choice Medicaid	$76.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$179.12
Rate for Payer: Priority Health Narrow/Tiered Network	$179.12
Rate for Payer: UHC Medicaid	$76.04
Rate for Payer: UHCCP Medicaid	$76.04

PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD

Facility

$2,217.00

Service Code	CPT 15100
Hospital Charge Code	15100
Hospital Revenue Code	960
Min. Negotiated Rate	$390.86
Max. Negotiated Rate	$1,995.30
Rate for Payer: Aetna Commercial	$1,884.45
Rate for Payer: Aetna Medicare	$576.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$692.81
Rate for Payer: Amish Plain Church Group Commercial	$692.81
Rate for Payer: BCBS Complete	$410.37
Rate for Payer: BCBS MAPPO	$554.25
Rate for Payer: BCBS Trust/PPO	$1,822.60
Rate for Payer: BCN Commercial	$1,822.60
Rate for Payer: BCN Medicare Advantage	$554.25
Rate for Payer: Cash Price	$1,773.60
Rate for Payer: Cofinity Commercial	$1,906.62
Rate for Payer: Encore Health Key Benefits Commercial	$1,773.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$554.25
Rate for Payer: Healthscope Commercial	$1,995.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,662.75
Rate for Payer: Mclaren Medicaid	$390.86
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$581.96
Rate for Payer: Meridian Medicaid	$410.37
Rate for Payer: MI Amish Medical Board Commercial	$637.39
Rate for Payer: Molina Medicare/Medicaid	$609.67
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,884.45
Rate for Payer: Nomi Health Commercial	$1,817.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,662.75
Rate for Payer: PACE Senior Care Partners	$526.54
Rate for Payer: PACE SWMI	$554.25
Rate for Payer: PHP Commercial	$1,884.45
Rate for Payer: PHP Medicare Advantage	$554.25
Rate for Payer: Priority Health Choice Medicaid	$390.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,928.79
Rate for Payer: Priority Health Medicare	$559.79
Rate for Payer: Priority Health Narrow/Tiered Network	$1,543.03
Rate for Payer: Railroad Medicare Medicare	$554.25
Rate for Payer: UHC Core	$1,851.19
Rate for Payer: UHC Exchange	$554.25
Rate for Payer: UHC Medicaid	$390.86
Rate for Payer: UHC Medicare Advantage	$554.25
Rate for Payer: UHCCP Medicaid	$390.86
Rate for Payer: VA VA	$554.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,662.75

PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD

Facility

$2,217.00

Service Code	CPT 15100
Hospital Charge Code	15100
Hospital Revenue Code	960
Min. Negotiated Rate	$1,543.03
Max. Negotiated Rate	$1,995.30
Rate for Payer: Aetna Commercial	$1,884.45
Rate for Payer: BCBS Trust/PPO	$1,831.02
Rate for Payer: BCN Commercial	$1,831.02
Rate for Payer: Cash Price	$1,773.60
Rate for Payer: Cofinity Commercial	$1,906.62
Rate for Payer: Encore Health Key Benefits Commercial	$1,773.60
Rate for Payer: Healthscope Commercial	$1,995.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,662.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,884.45
Rate for Payer: Nomi Health Commercial	$1,817.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,662.75
Rate for Payer: PHP Commercial	$1,884.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,928.79
Rate for Payer: Priority Health Narrow/Tiered Network	$1,543.03
Rate for Payer: UHC Core	$1,851.19
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,662.75

PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD

Professional

Both

$2,217.00

Service Code	HCPCS 15100
Min. Negotiated Rate	$421.10
Max. Negotiated Rate	$1,662.75
Rate for Payer: Aetna Commercial	$770.92
Rate for Payer: Aetna Medicare	$1,108.50
Rate for Payer: BCBS Complete	$442.15
Rate for Payer: BCN Commercial	$1,079.63
Rate for Payer: Cash Price	$1,773.60
Rate for Payer: Cash Price	$1,773.60
Rate for Payer: Mclaren Medicaid	$421.10
Rate for Payer: Meridian Medicaid	$442.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,662.75
Rate for Payer: Priority Health Choice Medicaid	$421.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$988.13
Rate for Payer: Priority Health Narrow/Tiered Network	$988.13
Rate for Payer: UHC Medicaid	$421.10
Rate for Payer: UHCCP Medicaid	$421.10

PR SPLT AGRFT T/A/L 1ST 100 SQCM/</1% BDY INFT/CHLD

Professional

Both

$2,217.00

Service Code	HCPCS 15100
Hospital Charge Code	15100
Min. Negotiated Rate	$421.10
Max. Negotiated Rate	$1,662.75
Rate for Payer: Aetna Commercial	$770.92
Rate for Payer: Aetna Medicare	$1,108.50
Rate for Payer: BCBS Complete	$442.15
Rate for Payer: BCN Commercial	$1,079.63
Rate for Payer: Cash Price	$1,773.60
Rate for Payer: Cash Price	$1,773.60
Rate for Payer: Mclaren Medicaid	$421.10
Rate for Payer: Meridian Medicaid	$442.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,662.75
Rate for Payer: Priority Health Choice Medicaid	$421.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$988.13
Rate for Payer: Priority Health Narrow/Tiered Network	$988.13
Rate for Payer: UHC Medicaid	$421.10
Rate for Payer: UHCCP Medicaid	$421.10

PR SPLT AGRFT T/A/L EA ADD 100 SQCM/EA 1% INFT/CHLD

Professional

Both

$1,420.00

Service Code	HCPCS 15101
Min. Negotiated Rate	$64.11
Max. Negotiated Rate	$1,065.00
Rate for Payer: Aetna Commercial	$122.15
Rate for Payer: Aetna Medicare	$710.00
Rate for Payer: BCBS Complete	$67.32
Rate for Payer: BCN Commercial	$164.83
Rate for Payer: Cash Price	$1,136.00
Rate for Payer: Cash Price	$1,136.00
Rate for Payer: Mclaren Medicaid	$64.11
Rate for Payer: Meridian Medicaid	$67.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,065.00
Rate for Payer: Priority Health Choice Medicaid	$64.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$150.87
Rate for Payer: Priority Health Narrow/Tiered Network	$150.87
Rate for Payer: UHC Medicaid	$64.11
Rate for Payer: UHCCP Medicaid	$64.11

PR SPMTRY W/VC EXPIRATORY FLO W/WO MXML VOL VNTJ

Professional

Both

$16.00

Service Code	HCPCS 94010
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$40.83
Rate for Payer: Aetna Commercial	$31.26
Rate for Payer: Aetna Commercial	$31.26
Rate for Payer: Aetna Medicare	$8.00
Rate for Payer: Aetna Medicare	$41.00
Rate for Payer: BCN Commercial	$40.83
Rate for Payer: BCN Commercial	$40.83
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$65.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$12.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$61.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$37.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$37.65
Rate for Payer: Priority Health Narrow/Tiered Network	$37.65
Rate for Payer: Priority Health Narrow/Tiered Network	$37.65

PR SPONTANEOUS NYSTAGMUS TEST

Professional

Both

$53.00

Service Code	HCPCS 92541
Min. Negotiated Rate	$26.50
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna Commercial	$27.79
Rate for Payer: Aetna Medicare	$26.50
Rate for Payer: BCN Commercial	$37.35
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$34.44
Rate for Payer: Priority Health Narrow/Tiered Network	$34.44

PR SPORTS PHYSICAL

Professional

Both

$50.00

Hospital Revenue Code	960
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Medicare	$25.00
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$37.50

PR STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS

Professional

Both

$1,250.00

Service Code	HCPCS 37765
Min. Negotiated Rate	$156.56
Max. Negotiated Rate	$937.50
Rate for Payer: Aetna Commercial	$362.87
Rate for Payer: Aetna Medicare	$625.00
Rate for Payer: BCBS Complete	$164.39
Rate for Payer: BCN Commercial	$396.39
Rate for Payer: Cash Price	$1,000.00
Rate for Payer: Cash Price	$1,000.00
Rate for Payer: Mclaren Medicaid	$156.56
Rate for Payer: Meridian Medicaid	$164.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$937.50
Rate for Payer: Priority Health Choice Medicaid	$156.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$426.27
Rate for Payer: Priority Health Narrow/Tiered Network	$426.27
Rate for Payer: UHC Medicaid	$156.56
Rate for Payer: UHCCP Medicaid	$156.56

PR STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS

Professional

Both

$1,288.00

Service Code	HCPCS 37766
Min. Negotiated Rate	$192.34
Max. Negotiated Rate	$966.00
Rate for Payer: Aetna Commercial	$444.13
Rate for Payer: Aetna Medicare	$644.00
Rate for Payer: BCBS Complete	$201.96
Rate for Payer: BCN Commercial	$489.01
Rate for Payer: Cash Price	$1,030.40
Rate for Payer: Cash Price	$1,030.40
Rate for Payer: Mclaren Medicaid	$192.34
Rate for Payer: Meridian Medicaid	$201.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$966.00
Rate for Payer: Priority Health Choice Medicaid	$192.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$525.87
Rate for Payer: Priority Health Narrow/Tiered Network	$525.87
Rate for Payer: UHC Medicaid	$192.34
Rate for Payer: UHCCP Medicaid	$192.34

PR STAGING CELIOTOMY,HODGKIN'S DIS/LYMPHOMA

Professional

Both

$1,795.00

Service Code	HCPCS 49220
Min. Negotiated Rate	$718.00
Max. Negotiated Rate	$1,346.25
Rate for Payer: Aetna Medicare	$897.50
Rate for Payer: BCBS Complete	$718.00
Rate for Payer: Cash Price	$1,436.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,346.25

Know your out-of-pocket cost for care.

All Charges