Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR VALVULOPLASTY TRICUSPID VALVE W/RING INSERTION

Professional

Both

$5,269.00

Service Code	HCPCS 33464
Min. Negotiated Rate	$1,449.25
Max. Negotiated Rate	$3,951.75
Rate for Payer: Aetna Commercial	$3,273.60
Rate for Payer: Aetna Medicare	$2,634.50
Rate for Payer: BCBS Complete	$1,521.71
Rate for Payer: BCN Commercial	$3,578.49
Rate for Payer: Cash Price	$4,215.20
Rate for Payer: Cash Price	$4,215.20
Rate for Payer: Mclaren Medicaid	$1,449.25
Rate for Payer: Meridian Medicaid	$1,521.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,951.75
Rate for Payer: Priority Health Choice Medicaid	$1,449.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,848.22
Rate for Payer: Priority Health Narrow/Tiered Network	$3,848.22
Rate for Payer: UHC Medicaid	$1,449.25
Rate for Payer: UHCCP Medicaid	$1,449.25

PR VANTAS IMPLANT

Professional

Both

$3,503.00

Service Code	HCPCS J9225
Min. Negotiated Rate	$1,751.50
Max. Negotiated Rate	$5,264.35
Rate for Payer: Aetna Commercial	$4,678.90
Rate for Payer: Aetna Medicare	$1,751.50
Rate for Payer: BCBS Trust/PPO	$5,264.35
Rate for Payer: BCN Commercial	$5,264.35
Rate for Payer: Cash Price	$2,802.40
Rate for Payer: Cash Price	$2,802.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,627.25

PR VAR VACCINE LIVE FOR SUBCUTANEOUS USE

Professional

Both

$222.00

Service Code	HCPCS 90716
Min. Negotiated Rate	$111.00
Max. Negotiated Rate	$192.12
Rate for Payer: Aetna Commercial	$177.68
Rate for Payer: Aetna Medicare	$111.00
Rate for Payer: BCBS Trust/PPO	$192.12
Rate for Payer: BCN Commercial	$179.94
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cash Price	$177.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$166.50

PR VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX

Professional

Both

$1,375.00

Service Code	HCPCS 37500
Min. Negotiated Rate	$550.00
Max. Negotiated Rate	$1,031.25
Rate for Payer: Aetna Commercial	$846.67
Rate for Payer: Aetna Medicare	$687.50
Rate for Payer: BCBS Complete	$550.00
Rate for Payer: BCN Commercial	$927.74
Rate for Payer: Cash Price	$1,100.00
Rate for Payer: Cash Price	$1,100.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,031.25

PR VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I

Professional

Both

$1,560.00

Service Code	HCPCS 37242
Min. Negotiated Rate	$263.69
Max. Negotiated Rate	$1,170.00
Rate for Payer: Aetna Commercial	$637.38
Rate for Payer: Aetna Medicare	$780.00
Rate for Payer: BCBS Complete	$276.87
Rate for Payer: BCN Commercial	$691.69
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Cash Price	$1,248.00
Rate for Payer: Mclaren Medicaid	$263.69
Rate for Payer: Meridian Medicaid	$276.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,170.00
Rate for Payer: Priority Health Choice Medicaid	$263.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$743.83
Rate for Payer: Priority Health Narrow/Tiered Network	$743.83
Rate for Payer: UHC Medicaid	$263.69
Rate for Payer: UHCCP Medicaid	$263.69

PR VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE

Professional

Both

$9,993.00

Service Code	HCPCS 37244
Min. Negotiated Rate	$361.04
Max. Negotiated Rate	$7,494.75
Rate for Payer: Aetna Commercial	$883.47
Rate for Payer: Aetna Medicare	$4,996.50
Rate for Payer: BCBS Complete	$379.09
Rate for Payer: BCN Commercial	$960.61
Rate for Payer: Cash Price	$7,994.40
Rate for Payer: Cash Price	$7,994.40
Rate for Payer: Mclaren Medicaid	$361.04
Rate for Payer: Meridian Medicaid	$379.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,494.75
Rate for Payer: Priority Health Choice Medicaid	$361.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,033.00
Rate for Payer: Priority Health Narrow/Tiered Network	$1,033.00
Rate for Payer: UHC Medicaid	$361.04
Rate for Payer: UHCCP Medicaid	$361.04

PR VASCULAR EMBOLIZATION OR OCCLUSION VENOUS RS&I

Professional

Both

$712.00

Service Code	HCPCS 37241
Min. Negotiated Rate	$236.64
Max. Negotiated Rate	$668.32
Rate for Payer: Aetna Commercial	$579.41
Rate for Payer: Aetna Medicare	$356.00
Rate for Payer: BCBS Complete	$248.47
Rate for Payer: BCN Commercial	$621.48
Rate for Payer: Cash Price	$569.60
Rate for Payer: Cash Price	$569.60
Rate for Payer: Mclaren Medicaid	$236.64
Rate for Payer: Meridian Medicaid	$248.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$534.00
Rate for Payer: Priority Health Choice Medicaid	$236.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$668.32
Rate for Payer: Priority Health Narrow/Tiered Network	$668.32
Rate for Payer: UHC Medicaid	$236.64
Rate for Payer: UHCCP Medicaid	$236.64

PR VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT

Professional

Both

$1,254.00

Service Code	HCPCS 37243
Min. Negotiated Rate	$307.57
Max. Negotiated Rate	$940.50
Rate for Payer: Aetna Commercial	$745.17
Rate for Payer: Aetna Medicare	$627.00
Rate for Payer: BCBS Complete	$322.95
Rate for Payer: BCN Commercial	$816.69
Rate for Payer: Cash Price	$1,003.20
Rate for Payer: Cash Price	$1,003.20
Rate for Payer: Mclaren Medicaid	$307.57
Rate for Payer: Meridian Medicaid	$322.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$940.50
Rate for Payer: Priority Health Choice Medicaid	$307.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$878.24
Rate for Payer: Priority Health Narrow/Tiered Network	$878.24
Rate for Payer: UHC Medicaid	$307.57
Rate for Payer: UHCCP Medicaid	$307.57

PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS

Facility

$920.00

Service Code	CPT 55250
Hospital Charge Code	55250
Hospital Revenue Code	960
Min. Negotiated Rate	$162.20
Max. Negotiated Rate	$828.00
Rate for Payer: Aetna Commercial	$782.00
Rate for Payer: Aetna Medicare	$239.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$287.50
Rate for Payer: Amish Plain Church Group Commercial	$287.50
Rate for Payer: BCBS Complete	$170.29
Rate for Payer: BCBS MAPPO	$230.00
Rate for Payer: BCBS Trust/PPO	$756.33
Rate for Payer: BCN Commercial	$756.33
Rate for Payer: BCN Medicare Advantage	$230.00
Rate for Payer: Cash Price	$736.00
Rate for Payer: Cofinity Commercial	$791.20
Rate for Payer: Encore Health Key Benefits Commercial	$736.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$230.00
Rate for Payer: Healthscope Commercial	$828.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$690.00
Rate for Payer: Mclaren Medicaid	$162.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$241.50
Rate for Payer: Meridian Medicaid	$170.29
Rate for Payer: MI Amish Medical Board Commercial	$264.50
Rate for Payer: Molina Medicare/Medicaid	$253.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$782.00
Rate for Payer: Nomi Health Commercial	$754.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$690.00
Rate for Payer: PACE Senior Care Partners	$218.50
Rate for Payer: PACE SWMI	$230.00
Rate for Payer: PHP Commercial	$782.00
Rate for Payer: PHP Medicare Advantage	$230.00
Rate for Payer: Priority Health Choice Medicaid	$162.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$800.40
Rate for Payer: Priority Health Medicare	$232.30
Rate for Payer: Priority Health Narrow/Tiered Network	$640.32
Rate for Payer: Railroad Medicare Medicare	$230.00
Rate for Payer: UHC Core	$768.20
Rate for Payer: UHC Exchange	$230.00
Rate for Payer: UHC Medicaid	$162.20
Rate for Payer: UHC Medicare Advantage	$230.00
Rate for Payer: UHCCP Medicaid	$162.20
Rate for Payer: VA VA	$230.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$690.00

PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS

Professional

Both

$920.00

Service Code	HCPCS 55250
Min. Negotiated Rate	$139.09
Max. Negotiated Rate	$690.00
Rate for Payer: Aetna Commercial	$290.03
Rate for Payer: Aetna Medicare	$460.00
Rate for Payer: BCBS Complete	$146.04
Rate for Payer: BCN Commercial	$274.50
Rate for Payer: Cash Price	$736.00
Rate for Payer: Cash Price	$736.00
Rate for Payer: Mclaren Medicaid	$139.09
Rate for Payer: Meridian Medicaid	$146.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$690.00
Rate for Payer: Priority Health Choice Medicaid	$139.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$379.18
Rate for Payer: Priority Health Narrow/Tiered Network	$379.18
Rate for Payer: UHC Medicaid	$139.09
Rate for Payer: UHCCP Medicaid	$139.09

PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS

Professional

Both

$920.00

Service Code	HCPCS 55250
Hospital Charge Code	55250
Min. Negotiated Rate	$139.09
Max. Negotiated Rate	$690.00
Rate for Payer: Aetna Commercial	$290.03
Rate for Payer: Aetna Medicare	$460.00
Rate for Payer: BCBS Complete	$146.04
Rate for Payer: BCN Commercial	$274.50
Rate for Payer: Cash Price	$736.00
Rate for Payer: Cash Price	$736.00
Rate for Payer: Mclaren Medicaid	$139.09
Rate for Payer: Meridian Medicaid	$146.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$690.00
Rate for Payer: Priority Health Choice Medicaid	$139.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$379.18
Rate for Payer: Priority Health Narrow/Tiered Network	$379.18
Rate for Payer: UHC Medicaid	$139.09
Rate for Payer: UHCCP Medicaid	$139.09

PR VASECTOMY UNI/BI SPX W/POSTOP SEMEN EXAMS

Facility

$920.00

Service Code	CPT 55250
Hospital Charge Code	55250
Hospital Revenue Code	960
Min. Negotiated Rate	$640.32
Max. Negotiated Rate	$828.00
Rate for Payer: Aetna Commercial	$782.00
Rate for Payer: BCBS Trust/PPO	$759.83
Rate for Payer: BCN Commercial	$759.83
Rate for Payer: Cash Price	$736.00
Rate for Payer: Cofinity Commercial	$791.20
Rate for Payer: Encore Health Key Benefits Commercial	$736.00
Rate for Payer: Healthscope Commercial	$828.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$690.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$782.00
Rate for Payer: Nomi Health Commercial	$754.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$690.00
Rate for Payer: PHP Commercial	$782.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$800.40
Rate for Payer: Priority Health Narrow/Tiered Network	$640.32
Rate for Payer: UHC Core	$768.20
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$690.00

PR VASOVASOSTOMY VASOVASORRHAPHY

Professional

Both

$981.00

Service Code	HCPCS 55400
Min. Negotiated Rate	$392.40
Max. Negotiated Rate	$818.58
Rate for Payer: Aetna Commercial	$641.17
Rate for Payer: Aetna Medicare	$490.50
Rate for Payer: BCBS Complete	$392.40
Rate for Payer: BCN Commercial	$751.45
Rate for Payer: Cash Price	$784.80
Rate for Payer: Cash Price	$784.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$735.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$818.58
Rate for Payer: Priority Health Narrow/Tiered Network	$818.58

PR VCRPEC LAT XTRCAVITARY DCMPRN THRC/LMBR EA SEG

Professional

Both

$2,853.00

Service Code	HCPCS 63103
Min. Negotiated Rate	$167.63
Max. Negotiated Rate	$2,139.75
Rate for Payer: Aetna Commercial	$381.03
Rate for Payer: Aetna Medicare	$1,426.50
Rate for Payer: BCBS Complete	$176.01
Rate for Payer: BCN Commercial	$438.23
Rate for Payer: Cash Price	$2,282.40
Rate for Payer: Cash Price	$2,282.40
Rate for Payer: Mclaren Medicaid	$167.63
Rate for Payer: Meridian Medicaid	$176.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,139.75
Rate for Payer: Priority Health Choice Medicaid	$167.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$508.99
Rate for Payer: Priority Health Narrow/Tiered Network	$508.99
Rate for Payer: UHC Medicaid	$167.63
Rate for Payer: UHCCP Medicaid	$167.63

PR VCRPEC LES 1 SGM XDRL CERVICAL

Professional

Both

$4,846.00

Service Code	HCPCS 63300
Min. Negotiated Rate	$1,110.37
Max. Negotiated Rate	$3,634.50
Rate for Payer: Aetna Commercial	$2,360.58
Rate for Payer: Aetna Medicare	$2,423.00
Rate for Payer: BCBS Complete	$1,165.89
Rate for Payer: BCN Commercial	$3,036.78
Rate for Payer: Cash Price	$3,876.80
Rate for Payer: Cash Price	$3,876.80
Rate for Payer: Mclaren Medicaid	$1,110.37
Rate for Payer: Meridian Medicaid	$1,165.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,634.50
Rate for Payer: Priority Health Choice Medicaid	$1,110.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,210.67
Rate for Payer: Priority Health Narrow/Tiered Network	$3,210.67
Rate for Payer: UHC Medicaid	$1,110.37
Rate for Payer: UHCCP Medicaid	$1,110.37

PR VCRPEC LES 1 SGM XDRL THORACIC TTHRC

Professional

Both

$4,795.00

Service Code	HCPCS 63301
Min. Negotiated Rate	$1,370.87
Max. Negotiated Rate	$3,743.96
Rate for Payer: Aetna Commercial	$2,850.87
Rate for Payer: Aetna Medicare	$2,397.50
Rate for Payer: BCBS Complete	$1,439.41
Rate for Payer: BCN Commercial	$3,541.17
Rate for Payer: Cash Price	$3,836.00
Rate for Payer: Cash Price	$3,836.00
Rate for Payer: Mclaren Medicaid	$1,370.87
Rate for Payer: Meridian Medicaid	$1,439.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,596.25
Rate for Payer: Priority Health Choice Medicaid	$1,370.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,743.96
Rate for Payer: Priority Health Narrow/Tiered Network	$3,743.96
Rate for Payer: UHC Medicaid	$1,370.87
Rate for Payer: UHCCP Medicaid	$1,370.87

PR VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR 1 SEG

Professional

Both

$9,500.00

Service Code	HCPCS 63087
Min. Negotiated Rate	$1,443.93
Max. Negotiated Rate	$7,125.00
Rate for Payer: Aetna Commercial	$3,114.02
Rate for Payer: Aetna Medicare	$4,750.00
Rate for Payer: BCBS Complete	$1,516.13
Rate for Payer: BCN Commercial	$4,027.52
Rate for Payer: Cash Price	$7,600.00
Rate for Payer: Cash Price	$7,600.00
Rate for Payer: Mclaren Medicaid	$1,443.93
Rate for Payer: Meridian Medicaid	$1,516.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,125.00
Rate for Payer: Priority Health Choice Medicaid	$1,443.93
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4,258.15
Rate for Payer: Priority Health Narrow/Tiered Network	$4,258.15
Rate for Payer: UHC Medicaid	$1,443.93
Rate for Payer: UHCCP Medicaid	$1,443.93

PR VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR EA SEG

Professional

Both

$3,257.00

Service Code	HCPCS 63088
Min. Negotiated Rate	$149.53
Max. Negotiated Rate	$2,442.75
Rate for Payer: Aetna Commercial	$335.33
Rate for Payer: Aetna Medicare	$1,628.50
Rate for Payer: BCBS Complete	$157.01
Rate for Payer: BCN Commercial	$386.44
Rate for Payer: Cash Price	$2,605.60
Rate for Payer: Cash Price	$2,605.60
Rate for Payer: Mclaren Medicaid	$149.53
Rate for Payer: Meridian Medicaid	$157.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,442.75
Rate for Payer: Priority Health Choice Medicaid	$149.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$448.84
Rate for Payer: Priority Health Narrow/Tiered Network	$448.84
Rate for Payer: UHC Medicaid	$149.53
Rate for Payer: UHCCP Medicaid	$149.53

PR VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC 1 SEG

Professional

Both

$7,492.00

Service Code	HCPCS 63090
Min. Negotiated Rate	$1,161.92
Max. Negotiated Rate	$5,619.00
Rate for Payer: Aetna Commercial	$2,534.05
Rate for Payer: Aetna Medicare	$3,746.00
Rate for Payer: BCBS Complete	$1,220.02
Rate for Payer: BCN Commercial	$3,218.95
Rate for Payer: Cash Price	$5,993.60
Rate for Payer: Cash Price	$5,993.60
Rate for Payer: Mclaren Medicaid	$1,161.92
Rate for Payer: Meridian Medicaid	$1,220.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,619.00
Rate for Payer: Priority Health Choice Medicaid	$1,161.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,403.28
Rate for Payer: Priority Health Narrow/Tiered Network	$3,403.28
Rate for Payer: UHC Medicaid	$1,161.92
Rate for Payer: UHCCP Medicaid	$1,161.92

PR VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC EA SEG

Professional

Both

$2,552.00

Service Code	HCPCS 63091
Min. Negotiated Rate	$100.75
Max. Negotiated Rate	$1,914.00
Rate for Payer: Aetna Commercial	$230.26
Rate for Payer: Aetna Medicare	$1,276.00
Rate for Payer: BCBS Complete	$105.79
Rate for Payer: BCN Commercial	$286.66
Rate for Payer: Cash Price	$2,041.60
Rate for Payer: Cash Price	$2,041.60
Rate for Payer: Mclaren Medicaid	$100.75
Rate for Payer: Meridian Medicaid	$105.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,914.00
Rate for Payer: Priority Health Choice Medicaid	$100.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$303.09
Rate for Payer: Priority Health Narrow/Tiered Network	$303.09
Rate for Payer: UHC Medicaid	$100.75
Rate for Payer: UHCCP Medicaid	$100.75

PR VEIN SCREEN

Professional

Both

$21.00

Hospital Revenue Code	990
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$15.75
Rate for Payer: Aetna Medicare	$10.50
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: Cash Price	$16.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.75

PR VEN CATHJ SLCTV ORGAN BLD SAMPLING

Professional

Both

$359.00

Service Code	HCPCS 36500
Min. Negotiated Rate	$102.24
Max. Negotiated Rate	$288.10
Rate for Payer: Aetna Commercial	$244.57
Rate for Payer: Aetna Medicare	$179.50
Rate for Payer: BCBS Complete	$107.35
Rate for Payer: BCN Commercial	$267.91
Rate for Payer: Cash Price	$287.20
Rate for Payer: Cash Price	$287.20
Rate for Payer: Mclaren Medicaid	$102.24
Rate for Payer: Meridian Medicaid	$107.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$269.25
Rate for Payer: Priority Health Choice Medicaid	$102.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$288.10
Rate for Payer: Priority Health Narrow/Tiered Network	$288.10
Rate for Payer: UHC Medicaid	$102.24
Rate for Payer: UHCCP Medicaid	$102.24

PR VENOUS ANASTOMOSIS OPEN SPLENORENAL PROXIMAL

Professional

Both

$4,498.00

Service Code	HCPCS 37180
Min. Negotiated Rate	$1,250.74
Max. Negotiated Rate	$3,415.52
Rate for Payer: Aetna Commercial	$2,874.90
Rate for Payer: Aetna Medicare	$2,249.00
Rate for Payer: BCBS Complete	$1,313.28
Rate for Payer: BCN Commercial	$3,176.12
Rate for Payer: Cash Price	$3,598.40
Rate for Payer: Cash Price	$3,598.40
Rate for Payer: Mclaren Medicaid	$1,250.74
Rate for Payer: Meridian Medicaid	$1,313.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,373.50
Rate for Payer: Priority Health Choice Medicaid	$1,250.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,415.52
Rate for Payer: Priority Health Narrow/Tiered Network	$3,415.52
Rate for Payer: UHC Medicaid	$1,250.74
Rate for Payer: UHCCP Medicaid	$1,250.74

PR VENTILATING TUBE RMVL REQUIRING GENERAL ANES

Professional

Both

$631.00

Service Code	HCPCS 69424
Min. Negotiated Rate	$35.36
Max. Negotiated Rate	$473.25
Rate for Payer: Aetna Commercial	$67.67
Rate for Payer: Aetna Medicare	$315.50
Rate for Payer: BCBS Complete	$37.13
Rate for Payer: BCN Commercial	$92.13
Rate for Payer: Cash Price	$504.80
Rate for Payer: Cash Price	$504.80
Rate for Payer: Mclaren Medicaid	$35.36
Rate for Payer: Meridian Medicaid	$37.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$473.25
Rate for Payer: Priority Health Choice Medicaid	$35.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$91.03
Rate for Payer: Priority Health Narrow/Tiered Network	$91.03
Rate for Payer: UHC Medicaid	$35.36
Rate for Payer: UHCCP Medicaid	$35.36

PR VENTILATION ASSIST & MGMT INPATIENT 1ST DAY

Professional

Both

$177.00

Service Code	HCPCS 94002
Min. Negotiated Rate	$54.74
Max. Negotiated Rate	$135.45
Rate for Payer: Aetna Commercial	$102.02
Rate for Payer: Aetna Medicare	$88.50
Rate for Payer: BCBS Complete	$57.48
Rate for Payer: BCN Commercial	$135.45
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Mclaren Medicaid	$54.74
Rate for Payer: Meridian Medicaid	$57.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$132.75
Rate for Payer: Priority Health Choice Medicaid	$54.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$124.91
Rate for Payer: Priority Health Narrow/Tiered Network	$124.91
Rate for Payer: UHC Medicaid	$54.74
Rate for Payer: UHCCP Medicaid	$54.74

Know your out-of-pocket cost for care.

All Charges