Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR VENTILATION ASSIST & MGMT INPATIENT EA SBSQ DA

Professional

Both

$130.00

Service Code	HCPCS 94003
Min. Negotiated Rate	$37.70
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$72.70
Rate for Payer: Aetna Medicare	$65.00
Rate for Payer: BCBS Complete	$39.59
Rate for Payer: BCN Commercial	$95.12
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Mclaren Medicaid	$37.70
Rate for Payer: Meridian Medicaid	$39.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$97.50
Rate for Payer: Priority Health Choice Medicaid	$37.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$87.71
Rate for Payer: Priority Health Narrow/Tiered Network	$87.71
Rate for Payer: UHC Medicaid	$37.70
Rate for Payer: UHCCP Medicaid	$37.70

PR VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/INJ

Professional

Both

$580.00

Service Code	HCPCS 61026
Min. Negotiated Rate	$66.88
Max. Negotiated Rate	$435.00
Rate for Payer: Aetna Commercial	$135.98
Rate for Payer: Aetna Medicare	$290.00
Rate for Payer: BCBS Complete	$70.22
Rate for Payer: BCN Commercial	$170.31
Rate for Payer: Cash Price	$464.00
Rate for Payer: Cash Price	$464.00
Rate for Payer: Mclaren Medicaid	$66.88
Rate for Payer: Meridian Medicaid	$70.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$435.00
Rate for Payer: Priority Health Choice Medicaid	$66.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$197.82
Rate for Payer: Priority Health Narrow/Tiered Network	$197.82
Rate for Payer: UHC Medicaid	$66.88
Rate for Payer: UHCCP Medicaid	$66.88

PR VENTRICULAR PUNCTURE PREVIOUS BURR HOLE W/O NJX

Professional

Both

$472.00

Service Code	HCPCS 61020
Min. Negotiated Rate	$62.84
Max. Negotiated Rate	$354.00
Rate for Payer: Aetna Commercial	$134.44
Rate for Payer: Aetna Medicare	$236.00
Rate for Payer: BCBS Complete	$65.98
Rate for Payer: BCN Commercial	$160.35
Rate for Payer: Cash Price	$377.60
Rate for Payer: Cash Price	$377.60
Rate for Payer: Mclaren Medicaid	$62.84
Rate for Payer: Meridian Medicaid	$65.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$354.00
Rate for Payer: Priority Health Choice Medicaid	$62.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$186.25
Rate for Payer: Priority Health Narrow/Tiered Network	$186.25
Rate for Payer: UHC Medicaid	$62.84
Rate for Payer: UHCCP Medicaid	$62.84

PR VENTRICULOCISTERNOSTOMY

Professional

Both

$4,896.00

Service Code	HCPCS 62180
Min. Negotiated Rate	$1,003.02
Max. Negotiated Rate	$3,672.00
Rate for Payer: Aetna Commercial	$2,066.64
Rate for Payer: Aetna Medicare	$2,448.00
Rate for Payer: BCBS Complete	$1,053.17
Rate for Payer: BCN Commercial	$3,375.19
Rate for Payer: Cash Price	$3,916.80
Rate for Payer: Cash Price	$3,916.80
Rate for Payer: Mclaren Medicaid	$1,003.02
Rate for Payer: Meridian Medicaid	$1,053.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,672.00
Rate for Payer: Priority Health Choice Medicaid	$1,003.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,837.61
Rate for Payer: Priority Health Narrow/Tiered Network	$2,837.61
Rate for Payer: UHC Medicaid	$1,003.02
Rate for Payer: UHCCP Medicaid	$1,003.02

PR VENTRICULOCISTERNOSTOMY 3RD VENTRICLE

Professional

Both

$6,744.00

Service Code	HCPCS 62200
Min. Negotiated Rate	$866.91
Max. Negotiated Rate	$5,058.00
Rate for Payer: Aetna Commercial	$1,779.36
Rate for Payer: Aetna Medicare	$3,372.00
Rate for Payer: BCBS Complete	$910.26
Rate for Payer: BCN Commercial	$2,907.37
Rate for Payer: Cash Price	$5,395.20
Rate for Payer: Cash Price	$5,395.20
Rate for Payer: Mclaren Medicaid	$866.91
Rate for Payer: Meridian Medicaid	$910.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,058.00
Rate for Payer: Priority Health Choice Medicaid	$866.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,444.29
Rate for Payer: Priority Health Narrow/Tiered Network	$2,444.29
Rate for Payer: UHC Medicaid	$866.91
Rate for Payer: UHCCP Medicaid	$866.91

PR VENTRICULOCISTERNOSTOMY 3RD VNTRC NEURONDSC

Professional

Both

$6,129.00

Service Code	HCPCS 62201
Min. Negotiated Rate	$782.14
Max. Negotiated Rate	$4,596.75
Rate for Payer: Aetna Commercial	$1,562.86
Rate for Payer: Aetna Medicare	$3,064.50
Rate for Payer: BCBS Complete	$821.25
Rate for Payer: BCN Commercial	$2,572.33
Rate for Payer: Cash Price	$4,903.20
Rate for Payer: Cash Price	$4,903.20
Rate for Payer: Mclaren Medicaid	$782.14
Rate for Payer: Meridian Medicaid	$821.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,596.75
Rate for Payer: Priority Health Choice Medicaid	$782.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,162.63
Rate for Payer: Priority Health Narrow/Tiered Network	$2,162.63
Rate for Payer: UHC Medicaid	$782.14
Rate for Payer: UHCCP Medicaid	$782.14

PR VENTRICULOMYOTOMY-MYECTOMY

Professional

Both

$9,371.00

Service Code	HCPCS 33416
Min. Negotiated Rate	$1,213.04
Max. Negotiated Rate	$7,028.25
Rate for Payer: Aetna Commercial	$2,713.83
Rate for Payer: Aetna Medicare	$4,685.50
Rate for Payer: BCBS Complete	$1,273.69
Rate for Payer: BCN Commercial	$2,975.94
Rate for Payer: Cash Price	$7,496.80
Rate for Payer: Cash Price	$7,496.80
Rate for Payer: Mclaren Medicaid	$1,213.04
Rate for Payer: Meridian Medicaid	$1,273.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,028.25
Rate for Payer: Priority Health Choice Medicaid	$1,213.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,200.25
Rate for Payer: Priority Health Narrow/Tiered Network	$3,200.25
Rate for Payer: UHC Medicaid	$1,213.04
Rate for Payer: UHCCP Medicaid	$1,213.04

PR VERMILIONECTOMY LIP SHV W/MUCOSAL ADVMNT

Professional

Both

$771.00

Service Code	HCPCS 40500
Min. Negotiated Rate	$212.36
Max. Negotiated Rate	$683.82
Rate for Payer: Aetna Commercial	$478.94
Rate for Payer: Aetna Medicare	$385.50
Rate for Payer: BCBS Complete	$222.98
Rate for Payer: BCN Commercial	$561.22
Rate for Payer: Cash Price	$616.80
Rate for Payer: Cash Price	$616.80
Rate for Payer: Mclaren Medicaid	$212.36
Rate for Payer: Meridian Medicaid	$222.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$578.25
Rate for Payer: Priority Health Choice Medicaid	$212.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$683.82
Rate for Payer: Priority Health Narrow/Tiered Network	$683.82
Rate for Payer: UHC Medicaid	$212.36
Rate for Payer: UHCCP Medicaid	$212.36

PR VERTEB CORPECT LAT XTRCAVITARY DCMPRN LMBR 1 SEG

Professional

Both

$8,831.00

Service Code	HCPCS 63102
Min. Negotiated Rate	$1,386.42
Max. Negotiated Rate	$6,623.25
Rate for Payer: Aetna Commercial	$2,933.25
Rate for Payer: Aetna Medicare	$4,415.50
Rate for Payer: BCBS Complete	$1,455.74
Rate for Payer: BCN Commercial	$3,479.89
Rate for Payer: Cash Price	$7,064.80
Rate for Payer: Cash Price	$7,064.80
Rate for Payer: Mclaren Medicaid	$1,386.42
Rate for Payer: Meridian Medicaid	$1,455.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,623.25
Rate for Payer: Priority Health Choice Medicaid	$1,386.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4,041.82
Rate for Payer: Priority Health Narrow/Tiered Network	$4,041.82
Rate for Payer: UHC Medicaid	$1,386.42
Rate for Payer: UHCCP Medicaid	$1,386.42

PR VERTEB CORPECT LAT XTRCAVITARY DCMPRN THRC 1 SEG

Professional

Both

$5,017.00

Service Code	HCPCS 63101
Min. Negotiated Rate	$1,414.11
Max. Negotiated Rate	$4,085.20
Rate for Payer: Aetna Commercial	$3,005.13
Rate for Payer: Aetna Medicare	$2,508.50
Rate for Payer: BCBS Complete	$1,484.82
Rate for Payer: BCN Commercial	$3,517.24
Rate for Payer: Cash Price	$4,013.60
Rate for Payer: Cash Price	$4,013.60
Rate for Payer: Mclaren Medicaid	$1,414.11
Rate for Payer: Meridian Medicaid	$1,484.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,762.75
Rate for Payer: Priority Health Choice Medicaid	$1,414.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4,085.20
Rate for Payer: Priority Health Narrow/Tiered Network	$4,085.20
Rate for Payer: UHC Medicaid	$1,414.11
Rate for Payer: UHCCP Medicaid	$1,414.11

PR VERTEBRAL CORPECTOMY ANT DCMPRN CERVICAL 1 SEG

Professional

Both

$6,630.00

Service Code	HCPCS 63081
Min. Negotiated Rate	$1,058.61
Max. Negotiated Rate	$4,972.50
Rate for Payer: Aetna Commercial	$2,269.94
Rate for Payer: Aetna Medicare	$3,315.00
Rate for Payer: BCBS Complete	$1,111.54
Rate for Payer: BCN Commercial	$2,936.12
Rate for Payer: Cash Price	$5,304.00
Rate for Payer: Cash Price	$5,304.00
Rate for Payer: Mclaren Medicaid	$1,058.61
Rate for Payer: Meridian Medicaid	$1,111.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,972.50
Rate for Payer: Priority Health Choice Medicaid	$1,058.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,104.25
Rate for Payer: Priority Health Narrow/Tiered Network	$3,104.25
Rate for Payer: UHC Medicaid	$1,058.61
Rate for Payer: UHCCP Medicaid	$1,058.61

PR VERTEBRAL CORPECTOMY DCMPRN CERVICAL EA SEG

Professional

Both

$2,210.00

Service Code	HCPCS 63082
Min. Negotiated Rate	$151.44
Max. Negotiated Rate	$1,657.50
Rate for Payer: Aetna Commercial	$343.91
Rate for Payer: Aetna Medicare	$1,105.00
Rate for Payer: BCBS Complete	$159.01
Rate for Payer: BCN Commercial	$437.10
Rate for Payer: Cash Price	$1,768.00
Rate for Payer: Cash Price	$1,768.00
Rate for Payer: Mclaren Medicaid	$151.44
Rate for Payer: Meridian Medicaid	$159.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,657.50
Rate for Payer: Priority Health Choice Medicaid	$151.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$462.14
Rate for Payer: Priority Health Narrow/Tiered Network	$462.14
Rate for Payer: UHC Medicaid	$151.44
Rate for Payer: UHCCP Medicaid	$151.44

PR VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC 1 SEG

Professional

Both

$7,305.00

Service Code	HCPCS 63085
Min. Negotiated Rate	$1,160.64
Max. Negotiated Rate	$5,478.75
Rate for Payer: Aetna Commercial	$2,486.89
Rate for Payer: Aetna Medicare	$3,652.50
Rate for Payer: BCBS Complete	$1,218.67
Rate for Payer: BCN Commercial	$3,206.37
Rate for Payer: Cash Price	$5,844.00
Rate for Payer: Cash Price	$5,844.00
Rate for Payer: Mclaren Medicaid	$1,160.64
Rate for Payer: Meridian Medicaid	$1,218.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,478.75
Rate for Payer: Priority Health Choice Medicaid	$1,160.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,389.98
Rate for Payer: Priority Health Narrow/Tiered Network	$3,389.98
Rate for Payer: UHC Medicaid	$1,160.64
Rate for Payer: UHCCP Medicaid	$1,160.64

PR VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC EA SEG

Professional

Both

$2,435.00

Service Code	HCPCS 63086
Min. Negotiated Rate	$109.06
Max. Negotiated Rate	$1,826.25
Rate for Payer: Aetna Commercial	$245.29
Rate for Payer: Aetna Medicare	$1,217.50
Rate for Payer: BCBS Complete	$114.51
Rate for Payer: BCN Commercial	$313.47
Rate for Payer: Cash Price	$1,948.00
Rate for Payer: Cash Price	$1,948.00
Rate for Payer: Mclaren Medicaid	$109.06
Rate for Payer: Meridian Medicaid	$114.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,826.25
Rate for Payer: Priority Health Choice Medicaid	$109.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$331.43
Rate for Payer: Priority Health Narrow/Tiered Network	$331.43
Rate for Payer: UHC Medicaid	$109.06
Rate for Payer: UHCCP Medicaid	$109.06

PR VERTEBRAL CORPECTOMY EXC INDRL LES EACH SEG

Professional

Both

$1,611.00

Service Code	HCPCS 63308
Min. Negotiated Rate	$184.25
Max. Negotiated Rate	$1,208.25
Rate for Payer: Aetna Commercial	$416.97
Rate for Payer: Aetna Medicare	$805.50
Rate for Payer: BCBS Complete	$193.46
Rate for Payer: BCN Commercial	$525.19
Rate for Payer: Cash Price	$1,288.80
Rate for Payer: Cash Price	$1,288.80
Rate for Payer: Mclaren Medicaid	$184.25
Rate for Payer: Meridian Medicaid	$193.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,208.25
Rate for Payer: Priority Health Choice Medicaid	$184.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$555.27
Rate for Payer: Priority Health Narrow/Tiered Network	$555.27
Rate for Payer: UHC Medicaid	$184.25
Rate for Payer: UHCCP Medicaid	$184.25

PR VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL

Professional

Both

$1,810.00

Service Code	HCPCS 22512
Min. Negotiated Rate	$115.66
Max. Negotiated Rate	$1,357.50
Rate for Payer: Aetna Commercial	$277.49
Rate for Payer: Aetna Medicare	$905.00
Rate for Payer: BCBS Complete	$121.44
Rate for Payer: BCN Commercial	$306.75
Rate for Payer: Cash Price	$1,448.00
Rate for Payer: Cash Price	$1,448.00
Rate for Payer: Mclaren Medicaid	$115.66
Rate for Payer: Meridian Medicaid	$121.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,357.50
Rate for Payer: Priority Health Choice Medicaid	$115.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$327.91
Rate for Payer: Priority Health Narrow/Tiered Network	$327.91
Rate for Payer: UHC Medicaid	$115.66
Rate for Payer: UHCCP Medicaid	$115.66

PR VESICULOTOMY COMPLICATED

Professional

Both

$855.00

Service Code	HCPCS 55605
Min. Negotiated Rate	$307.36
Max. Negotiated Rate	$859.26
Rate for Payer: Aetna Commercial	$670.35
Rate for Payer: Aetna Medicare	$427.50
Rate for Payer: BCBS Complete	$322.73
Rate for Payer: BCN Commercial	$788.80
Rate for Payer: Cash Price	$684.00
Rate for Payer: Cash Price	$684.00
Rate for Payer: Mclaren Medicaid	$307.36
Rate for Payer: Meridian Medicaid	$322.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$641.25
Rate for Payer: Priority Health Choice Medicaid	$307.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$859.26
Rate for Payer: Priority Health Narrow/Tiered Network	$859.26
Rate for Payer: UHC Medicaid	$307.36
Rate for Payer: UHCCP Medicaid	$307.36

PR VESSEL MAPPING HEMO ACCESS

Professional

Both

$377.00

Service Code	HCPCS G0365
Min. Negotiated Rate	$150.80
Max. Negotiated Rate	$282.75
Rate for Payer: Aetna Medicare	$188.50
Rate for Payer: BCBS Complete	$150.80
Rate for Payer: Cash Price	$301.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$282.75

PR VGTMY W/PYLORPLSTY W/WO GASTROST TRUNCAL/SLCTV

Professional

Both

$3,738.00

Service Code	HCPCS 43640
Min. Negotiated Rate	$715.25
Max. Negotiated Rate	$2,803.50
Rate for Payer: Aetna Commercial	$1,594.37
Rate for Payer: Aetna Medicare	$1,869.00
Rate for Payer: BCBS Complete	$751.01
Rate for Payer: BCN Commercial	$1,794.23
Rate for Payer: Cash Price	$2,990.40
Rate for Payer: Cash Price	$2,990.40
Rate for Payer: Mclaren Medicaid	$715.25
Rate for Payer: Meridian Medicaid	$751.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,803.50
Rate for Payer: Priority Health Choice Medicaid	$715.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,186.14
Rate for Payer: Priority Health Narrow/Tiered Network	$2,186.14
Rate for Payer: UHC Medicaid	$715.25
Rate for Payer: UHCCP Medicaid	$715.25

PR VISCER AND INFRARENAL ABDOM AORTA 1 PROSTHESIS

Professional

Both

$897.00

Service Code	HCPCS 34845
Min. Negotiated Rate	$448.50
Max. Negotiated Rate	$2,923.92
Rate for Payer: Aetna Commercial	$2,344.71
Rate for Payer: Aetna Medicare	$448.50
Rate for Payer: BCBS Complete	$1,424.60
Rate for Payer: BCN Commercial	$1,831.76
Rate for Payer: Cash Price	$717.60
Rate for Payer: Cash Price	$717.60
Rate for Payer: Mclaren Medicaid	$1,356.76
Rate for Payer: Meridian Medicaid	$1,424.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$672.75
Rate for Payer: Priority Health Choice Medicaid	$1,356.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,923.92
Rate for Payer: Priority Health Narrow/Tiered Network	$2,923.92
Rate for Payer: UHC Medicaid	$1,356.76
Rate for Payer: UHCCP Medicaid	$1,356.76

PR VISCER AND INFRARENAL ABDOM AORTA 2 PROSTHESIS

Professional

Both

$3,152.00

Service Code	HCPCS 34846
Min. Negotiated Rate	$1,492.43
Max. Negotiated Rate	$3,161.14
Rate for Payer: Aetna Commercial	$2,496.07
Rate for Payer: Aetna Medicare	$1,576.00
Rate for Payer: BCBS Complete	$1,567.05
Rate for Payer: BCN Commercial	$2,035.28
Rate for Payer: Cash Price	$2,521.60
Rate for Payer: Cash Price	$2,521.60
Rate for Payer: Mclaren Medicaid	$1,492.43
Rate for Payer: Meridian Medicaid	$1,567.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,364.00
Rate for Payer: Priority Health Choice Medicaid	$1,492.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,161.14
Rate for Payer: Priority Health Narrow/Tiered Network	$3,161.14
Rate for Payer: UHC Medicaid	$1,492.43
Rate for Payer: UHCCP Medicaid	$1,492.43

PR VISCER AND INFRARENAL ABDOM AORTA 3 PROSTHESIS

Professional

Both

$5,253.00

Service Code	HCPCS 34847
Min. Negotiated Rate	$1,628.11
Max. Negotiated Rate	$3,939.75
Rate for Payer: Aetna Commercial	$2,642.90
Rate for Payer: Aetna Medicare	$2,626.50
Rate for Payer: BCBS Complete	$1,709.52
Rate for Payer: BCN Commercial	$2,442.34
Rate for Payer: Cash Price	$4,202.40
Rate for Payer: Cash Price	$4,202.40
Rate for Payer: Mclaren Medicaid	$1,628.11
Rate for Payer: Meridian Medicaid	$1,709.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,939.75
Rate for Payer: Priority Health Choice Medicaid	$1,628.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,343.77
Rate for Payer: Priority Health Narrow/Tiered Network	$3,343.77
Rate for Payer: UHC Medicaid	$1,628.11
Rate for Payer: UHCCP Medicaid	$1,628.11

PR VISCO GEL SPACER - LARGE

Professional

Both

$7.00

Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR VISCO GEL SPACER - MEDIUM

Professional

Both

$7.00

Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR VISCO GEL SPACER - SMALL

Professional

Both

$7.00

Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

Know your out-of-pocket cost for care.

All Charges