Bronson Battle Creek

All Charges

Charge

Type

Setting

Price

SEVELAMER CARBONATE 800 MG TABLET

Facility

$5.17

Service Code	NDC 50268072011
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$3.26
Max. Negotiated Rate	$4.65
Rate for Payer: Aetna Commercial	$4.39
Rate for Payer: Aetna New Business (MI Preferred)	$3.36
Rate for Payer: Cash Price	$4.14
Rate for Payer: Cofinity Advantage	$3.62
Rate for Payer: Cofinity Commercial	$4.45
Rate for Payer: Encore Health Key Benefits Commercial	$4.14
Rate for Payer: Healthscope Commercial	$4.65
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.88
Rate for Payer: PHP Commercial	$4.39
Rate for Payer: Priority Health SBD	$3.26

SEVELAMER CARBONATE 800 MG TABLET

Facility

$928.53

Service Code	NDC 65162005827
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$584.97
Max. Negotiated Rate	$835.68
Rate for Payer: Aetna Commercial	$789.25
Rate for Payer: Aetna New Business (MI Preferred)	$603.54
Rate for Payer: Cash Price	$742.82
Rate for Payer: Cofinity Advantage	$649.97
Rate for Payer: Cofinity Commercial	$798.54
Rate for Payer: Encore Health Key Benefits Commercial	$742.82
Rate for Payer: Healthscope Commercial	$835.68
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$789.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$696.40
Rate for Payer: PHP Commercial	$789.25
Rate for Payer: Priority Health SBD	$584.97

SEVELAMER CARBONATE 800 MG TABLET

Facility

$5,499.50

Service Code	NDC 58468013001
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$3,464.68
Max. Negotiated Rate	$4,949.55
Rate for Payer: Aetna Commercial	$4,674.57
Rate for Payer: Aetna New Business (MI Preferred)	$3,574.68
Rate for Payer: Cash Price	$4,399.60
Rate for Payer: Cofinity Advantage	$3,849.65
Rate for Payer: Cofinity Commercial	$4,729.57
Rate for Payer: Encore Health Key Benefits Commercial	$4,399.60
Rate for Payer: Healthscope Commercial	$4,949.55
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$4,674.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,124.62
Rate for Payer: PHP Commercial	$4,674.57
Rate for Payer: Priority Health SBD	$3,464.68

SEVELAMER CARBONATE 800 MG TABLET

Facility

$7.49

Service Code	NDC 68094003459
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$2.94
Max. Negotiated Rate	$6.74
Rate for Payer: Aetna Commercial	$6.37
Rate for Payer: Aetna Medicare	$3.75
Rate for Payer: Aetna New Business (MI Preferred)	$4.87
Rate for Payer: BCBS Complete	$3.00
Rate for Payer: Cash Price	$5.99
Rate for Payer: Cofinity Advantage	$5.24
Rate for Payer: Cofinity Commercial	$6.44
Rate for Payer: Encore Health Key Benefits Commercial	$5.99
Rate for Payer: Healthscope Commercial	$6.74
Rate for Payer: MI Amish Medical Board Commercial	$5.99
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$6.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.62
Rate for Payer: PHP Commercial	$6.37
Rate for Payer: Priority Health SBD	$4.72
Rate for Payer: UHC All Payor (Choice/PPO)	$4.87
Rate for Payer: UHC Core	$3.90
Rate for Payer: UHC Exchange	$2.94

SEVELAMER CARBONATE 800 MG TABLET

Facility

$9.88

Service Code	NDC 60687032811
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$6.22
Max. Negotiated Rate	$8.89
Rate for Payer: Aetna Commercial	$8.40
Rate for Payer: Aetna New Business (MI Preferred)	$6.42
Rate for Payer: Cash Price	$7.90
Rate for Payer: Cofinity Advantage	$6.92
Rate for Payer: Cofinity Commercial	$8.50
Rate for Payer: Encore Health Key Benefits Commercial	$7.90
Rate for Payer: Healthscope Commercial	$8.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$8.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.41
Rate for Payer: PHP Commercial	$8.40
Rate for Payer: Priority Health SBD	$6.22

SEVELAMER CARBONATE 800 MG TABLET

Facility

$673.66

Service Code	NDC 68094003464
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$264.75
Max. Negotiated Rate	$606.29
Rate for Payer: Aetna Commercial	$572.61
Rate for Payer: Aetna Medicare	$336.83
Rate for Payer: Aetna New Business (MI Preferred)	$437.88
Rate for Payer: BCBS Complete	$269.46
Rate for Payer: Cash Price	$538.93
Rate for Payer: Cofinity Advantage	$471.56
Rate for Payer: Cofinity Commercial	$579.35
Rate for Payer: Encore Health Key Benefits Commercial	$538.93
Rate for Payer: Healthscope Commercial	$606.29
Rate for Payer: MI Amish Medical Board Commercial	$538.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$572.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$505.25
Rate for Payer: PHP Commercial	$572.61
Rate for Payer: Priority Health SBD	$424.41
Rate for Payer: UHC All Payor (Choice/PPO)	$437.88
Rate for Payer: UHC Core	$350.98
Rate for Payer: UHC Exchange	$264.75

SEVELAMER CARBONATE 800 MG TABLET

Facility

$928.53

Service Code	NDC 65162005827
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$364.91
Max. Negotiated Rate	$835.68
Rate for Payer: Aetna Commercial	$789.25
Rate for Payer: Aetna Medicare	$464.26
Rate for Payer: Aetna New Business (MI Preferred)	$603.54
Rate for Payer: BCBS Complete	$371.41
Rate for Payer: Cash Price	$742.82
Rate for Payer: Cofinity Advantage	$649.97
Rate for Payer: Cofinity Commercial	$798.54
Rate for Payer: Encore Health Key Benefits Commercial	$742.82
Rate for Payer: Healthscope Commercial	$835.68
Rate for Payer: MI Amish Medical Board Commercial	$742.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$789.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$696.40
Rate for Payer: PHP Commercial	$789.25
Rate for Payer: Priority Health SBD	$584.97
Rate for Payer: UHC All Payor (Choice/PPO)	$603.54
Rate for Payer: UHC Core	$483.76
Rate for Payer: UHC Exchange	$364.91

SEVELAMER CARBONATE 800 MG TABLET

Facility

$493.58

Service Code	NDC 60687032865
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$193.98
Max. Negotiated Rate	$444.22
Rate for Payer: Aetna Commercial	$419.54
Rate for Payer: Aetna Medicare	$246.79
Rate for Payer: Aetna New Business (MI Preferred)	$320.83
Rate for Payer: BCBS Complete	$197.43
Rate for Payer: Cash Price	$394.86
Rate for Payer: Cofinity Advantage	$345.51
Rate for Payer: Cofinity Commercial	$424.48
Rate for Payer: Encore Health Key Benefits Commercial	$394.86
Rate for Payer: Healthscope Commercial	$444.22
Rate for Payer: MI Amish Medical Board Commercial	$394.86
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$419.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$370.19
Rate for Payer: PHP Commercial	$419.54
Rate for Payer: Priority Health SBD	$310.96
Rate for Payer: UHC All Payor (Choice/PPO)	$320.83
Rate for Payer: UHC Core	$257.16
Rate for Payer: UHC Exchange	$193.98

SEVELAMER CARBONATE 800 MG TABLET

Facility

$951.75

Service Code	NDC 69097096793
Hospital Charge Code	89201
Hospital Revenue Code	637
Min. Negotiated Rate	$374.04
Max. Negotiated Rate	$856.58
Rate for Payer: Aetna Commercial	$808.99
Rate for Payer: Aetna Medicare	$475.88
Rate for Payer: Aetna New Business (MI Preferred)	$618.64
Rate for Payer: BCBS Complete	$380.70
Rate for Payer: Cash Price	$761.40
Rate for Payer: Cofinity Advantage	$666.23
Rate for Payer: Cofinity Commercial	$818.50
Rate for Payer: Encore Health Key Benefits Commercial	$761.40
Rate for Payer: Healthscope Commercial	$856.58
Rate for Payer: MI Amish Medical Board Commercial	$761.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$808.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$713.81
Rate for Payer: PHP Commercial	$808.99
Rate for Payer: Priority Health SBD	$599.60
Rate for Payer: UHC All Payor (Choice/PPO)	$618.64
Rate for Payer: UHC Core	$495.86
Rate for Payer: UHC Exchange	$374.04

SEVELAMER HCL 800 MG TABLET

Facility

$4,583.42

Service Code	NDC 58468002101
Hospital Charge Code	28715
Hospital Revenue Code	637
Min. Negotiated Rate	$1,801.28
Max. Negotiated Rate	$4,125.08
Rate for Payer: Aetna Commercial	$3,895.91
Rate for Payer: Aetna Medicare	$2,291.71
Rate for Payer: Aetna New Business (MI Preferred)	$2,979.22
Rate for Payer: BCBS Complete	$1,833.37
Rate for Payer: Cash Price	$3,666.74
Rate for Payer: Cofinity Advantage	$3,208.39
Rate for Payer: Cofinity Commercial	$3,941.74
Rate for Payer: Encore Health Key Benefits Commercial	$3,666.74
Rate for Payer: Healthscope Commercial	$4,125.08
Rate for Payer: MI Amish Medical Board Commercial	$3,666.74
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,895.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,437.57
Rate for Payer: PHP Commercial	$3,895.91
Rate for Payer: Priority Health SBD	$2,887.55
Rate for Payer: UHC All Payor (Choice/PPO)	$2,979.22
Rate for Payer: UHC Core	$2,387.96
Rate for Payer: UHC Exchange	$1,801.28

SEVELAMER HCL 800 MG TABLET

Facility

$4,583.42

Service Code	NDC 58468002101
Hospital Charge Code	28715
Hospital Revenue Code	637
Min. Negotiated Rate	$2,887.55
Max. Negotiated Rate	$4,125.08
Rate for Payer: Aetna Commercial	$3,895.91
Rate for Payer: Aetna New Business (MI Preferred)	$2,979.22
Rate for Payer: Cash Price	$3,666.74
Rate for Payer: Cofinity Advantage	$3,208.39
Rate for Payer: Cofinity Commercial	$3,941.74
Rate for Payer: Encore Health Key Benefits Commercial	$3,666.74
Rate for Payer: Healthscope Commercial	$4,125.08
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$3,895.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,437.57
Rate for Payer: PHP Commercial	$3,895.91
Rate for Payer: Priority Health SBD	$2,887.55

SEVOFLURANE 99.97 % INHALATION LIQUID

Facility

$214.38

Service Code	NDC 00074445604
Hospital Charge Code	15119
Hospital Revenue Code	637
Min. Negotiated Rate	$84.25
Max. Negotiated Rate	$192.94
Rate for Payer: Aetna Commercial	$182.22
Rate for Payer: Aetna Medicare	$107.19
Rate for Payer: Aetna New Business (MI Preferred)	$139.35
Rate for Payer: BCBS Complete	$85.75
Rate for Payer: Cash Price	$171.50
Rate for Payer: Cofinity Advantage	$150.07
Rate for Payer: Cofinity Commercial	$184.37
Rate for Payer: Encore Health Key Benefits Commercial	$171.50
Rate for Payer: Healthscope Commercial	$192.94
Rate for Payer: MI Amish Medical Board Commercial	$171.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$182.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$160.78
Rate for Payer: PHP Commercial	$182.22
Rate for Payer: Priority Health SBD	$135.06
Rate for Payer: UHC All Payor (Choice/PPO)	$139.35
Rate for Payer: UHC Core	$111.69
Rate for Payer: UHC Exchange	$84.25

SEVOFLURANE 99.97 % INHALATION LIQUID

Facility

$223.13

Service Code	NDC 10019065164
Hospital Charge Code	15119
Hospital Revenue Code	637
Min. Negotiated Rate	$87.69
Max. Negotiated Rate	$200.82
Rate for Payer: Aetna Commercial	$189.66
Rate for Payer: Aetna Medicare	$111.56
Rate for Payer: Aetna New Business (MI Preferred)	$145.03
Rate for Payer: BCBS Complete	$89.25
Rate for Payer: Cash Price	$178.50
Rate for Payer: Cofinity Advantage	$156.19
Rate for Payer: Cofinity Commercial	$191.89
Rate for Payer: Encore Health Key Benefits Commercial	$178.50
Rate for Payer: Healthscope Commercial	$200.82
Rate for Payer: MI Amish Medical Board Commercial	$178.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$189.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$167.35
Rate for Payer: PHP Commercial	$189.66
Rate for Payer: Priority Health SBD	$140.57
Rate for Payer: UHC All Payor (Choice/PPO)	$145.03
Rate for Payer: UHC Core	$116.25
Rate for Payer: UHC Exchange	$87.69

SEVOFLURANE 99.97 % INHALATION LIQUID

Facility

$211.75

Service Code	NDC 66794002225
Hospital Charge Code	15119
Hospital Revenue Code	637
Min. Negotiated Rate	$133.40
Max. Negotiated Rate	$190.57
Rate for Payer: Aetna Commercial	$179.99
Rate for Payer: Aetna New Business (MI Preferred)	$137.64
Rate for Payer: Cash Price	$169.40
Rate for Payer: Cofinity Advantage	$148.22
Rate for Payer: Cofinity Commercial	$182.10
Rate for Payer: Encore Health Key Benefits Commercial	$169.40
Rate for Payer: Healthscope Commercial	$190.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$179.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$158.81
Rate for Payer: PHP Commercial	$179.99
Rate for Payer: Priority Health SBD	$133.40

SEVOFLURANE 99.97 % INHALATION LIQUID

Facility

$211.75

Service Code	NDC 66794002225
Hospital Charge Code	15119
Hospital Revenue Code	637
Min. Negotiated Rate	$83.22
Max. Negotiated Rate	$190.57
Rate for Payer: Aetna Commercial	$179.99
Rate for Payer: Aetna Medicare	$105.88
Rate for Payer: Aetna New Business (MI Preferred)	$137.64
Rate for Payer: BCBS Complete	$84.70
Rate for Payer: Cash Price	$169.40
Rate for Payer: Cofinity Advantage	$148.22
Rate for Payer: Cofinity Commercial	$182.10
Rate for Payer: Encore Health Key Benefits Commercial	$169.40
Rate for Payer: Healthscope Commercial	$190.57
Rate for Payer: MI Amish Medical Board Commercial	$169.40
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$179.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$158.81
Rate for Payer: PHP Commercial	$179.99
Rate for Payer: Priority Health SBD	$133.40
Rate for Payer: UHC All Payor (Choice/PPO)	$137.64
Rate for Payer: UHC Core	$110.32
Rate for Payer: UHC Exchange	$83.22

SEVOFLURANE 99.97 % INHALATION LIQUID

Facility

$223.13

Service Code	NDC 10019065164
Hospital Charge Code	15119
Hospital Revenue Code	637
Min. Negotiated Rate	$140.57
Max. Negotiated Rate	$200.82
Rate for Payer: Aetna Commercial	$189.66
Rate for Payer: Aetna New Business (MI Preferred)	$145.03
Rate for Payer: Cash Price	$178.50
Rate for Payer: Cofinity Advantage	$156.19
Rate for Payer: Cofinity Commercial	$191.89
Rate for Payer: Encore Health Key Benefits Commercial	$178.50
Rate for Payer: Healthscope Commercial	$200.82
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$189.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$167.35
Rate for Payer: PHP Commercial	$189.66
Rate for Payer: Priority Health SBD	$140.57

SEVOFLURANE 99.97 % INHALATION LIQUID

Facility

$214.38

Service Code	NDC 00074445604
Hospital Charge Code	15119
Hospital Revenue Code	637
Min. Negotiated Rate	$135.06
Max. Negotiated Rate	$192.94
Rate for Payer: Aetna Commercial	$182.22
Rate for Payer: Aetna New Business (MI Preferred)	$139.35
Rate for Payer: Cash Price	$171.50
Rate for Payer: Cofinity Advantage	$150.07
Rate for Payer: Cofinity Commercial	$184.37
Rate for Payer: Encore Health Key Benefits Commercial	$171.50
Rate for Payer: Healthscope Commercial	$192.94
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$182.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$160.78
Rate for Payer: PHP Commercial	$182.22
Rate for Payer: Priority Health SBD	$135.06

SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$16,611.94

Service Code	APR-DRG 3223
Min. Negotiated Rate	$15,820.90
Max. Negotiated Rate	$16,611.94
Rate for Payer: BCBS Complete	$16,611.94
Rate for Payer: Mclaren Medicaid	$15,820.90
Rate for Payer: Meridian Medicaid	$16,611.94
Rate for Payer: Priority Health Choice Medicaid	$15,820.90
Rate for Payer: UHC Medicaid	$15,820.90
Rate for Payer: UHCCP Medicaid	$15,820.90

SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$10,152.00

Service Code	APR-DRG 3221
Min. Negotiated Rate	$9,668.57
Max. Negotiated Rate	$10,152.00
Rate for Payer: BCBS Complete	$10,152.00
Rate for Payer: Mclaren Medicaid	$9,668.57
Rate for Payer: Meridian Medicaid	$10,152.00
Rate for Payer: Priority Health Choice Medicaid	$9,668.57
Rate for Payer: UHC Medicaid	$9,668.57
Rate for Payer: UHCCP Medicaid	$9,668.57

SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$12,566.74

Service Code	APR-DRG 3222
Min. Negotiated Rate	$11,968.32
Max. Negotiated Rate	$12,566.74
Rate for Payer: BCBS Complete	$12,566.74
Rate for Payer: Mclaren Medicaid	$11,968.32
Rate for Payer: Meridian Medicaid	$12,566.74
Rate for Payer: Priority Health Choice Medicaid	$11,968.32
Rate for Payer: UHC Medicaid	$11,968.32
Rate for Payer: UHCCP Medicaid	$11,968.32

SHOULDER AND ELBOW JOINT REPLACEMENT

Facility

$23,722.58

Service Code	APR-DRG 3224
Min. Negotiated Rate	$22,592.93
Max. Negotiated Rate	$23,722.58
Rate for Payer: BCBS Complete	$23,722.58
Rate for Payer: Mclaren Medicaid	$22,592.93
Rate for Payer: Meridian Medicaid	$23,722.58
Rate for Payer: Priority Health Choice Medicaid	$22,592.93
Rate for Payer: UHC Medicaid	$22,592.93
Rate for Payer: UHCCP Medicaid	$22,592.93

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC

Facility

$40,081.52

Service Code	MSDRG 511
Min. Negotiated Rate	$15,816.62
Max. Negotiated Rate	$40,081.52
Rate for Payer: Aetna Medicare	$17,315.03
Rate for Payer: Allen County Amish Medical Aid Commercial	$20,811.34
Rate for Payer: Amish Plain Church Group Commercial	$20,811.34
Rate for Payer: BCBS MAPPO	$16,649.07
Rate for Payer: BCBS Trust/PPO	$40,081.52
Rate for Payer: BCN Commercial	$40,081.52
Rate for Payer: BCN Medicare Advantage	$16,649.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$16,649.07
Rate for Payer: Mclaren Medicare	$16,649.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$17,481.52
Rate for Payer: MI Amish Medical Board Commercial	$19,146.43
Rate for Payer: Molina Medicare/Medicaid	$18,313.98
Rate for Payer: Nomi Health Commercial	$26,824.26
Rate for Payer: PACE Medicare	$15,816.62
Rate for Payer: PACE SWMI	$16,649.07
Rate for Payer: PHP Medicare Advantage	$16,649.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$33,524.38
Rate for Payer: Priority Health Medicare	$16,649.07
Rate for Payer: Priority Health Tiered Network	$26,819.50
Rate for Payer: Railroad Medicare Medicare	$16,649.07
Rate for Payer: UHC All Payor (Choice/PPO)	$33,894.22
Rate for Payer: UHC Core	$28,356.78
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$16,649.07
Rate for Payer: UHC Exchange	$23,158.28
Rate for Payer: VA VA	$16,649.07

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC

Facility

$49,234.15

Service Code	MSDRG 510
Min. Negotiated Rate	$22,726.00
Max. Negotiated Rate	$49,234.15
Rate for Payer: Aetna Medicare	$24,878.99
Rate for Payer: Allen County Amish Medical Aid Commercial	$29,902.64
Rate for Payer: Amish Plain Church Group Commercial	$29,902.64
Rate for Payer: BCBS MAPPO	$23,922.11
Rate for Payer: BCBS Trust/PPO	$41,301.08
Rate for Payer: BCN Commercial	$41,301.08
Rate for Payer: BCN Medicare Advantage	$23,922.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$23,922.11
Rate for Payer: Mclaren Medicare	$23,922.11
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$25,118.22
Rate for Payer: MI Amish Medical Board Commercial	$27,510.43
Rate for Payer: Molina Medicare/Medicaid	$26,314.32
Rate for Payer: Nomi Health Commercial	$38,964.45
Rate for Payer: PACE Medicare	$22,726.00
Rate for Payer: PACE SWMI	$23,922.11
Rate for Payer: PHP Medicare Advantage	$23,922.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$48,696.92
Rate for Payer: Priority Health Medicare	$23,922.11
Rate for Payer: Priority Health Tiered Network	$38,957.53
Rate for Payer: Railroad Medicare Medicare	$23,922.11
Rate for Payer: UHC All Payor (Choice/PPO)	$49,234.15
Rate for Payer: UHC Core	$41,190.56
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$23,922.11
Rate for Payer: UHC Exchange	$33,639.31
Rate for Payer: VA VA	$23,922.11

SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC

Facility

$34,121.84

Service Code	MSDRG 512
Min. Negotiated Rate	$12,703.69
Max. Negotiated Rate	$34,121.84
Rate for Payer: Aetna Medicare	$13,907.20
Rate for Payer: Allen County Amish Medical Aid Commercial	$16,715.39
Rate for Payer: Amish Plain Church Group Commercial	$16,715.39
Rate for Payer: BCBS MAPPO	$13,372.31
Rate for Payer: BCBS Trust/PPO	$34,121.84
Rate for Payer: BCN Commercial	$34,121.84
Rate for Payer: BCN Medicare Advantage	$13,372.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$13,372.31
Rate for Payer: Mclaren Medicare	$13,372.31
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14,040.93
Rate for Payer: MI Amish Medical Board Commercial	$15,378.16
Rate for Payer: Molina Medicare/Medicaid	$14,709.54
Rate for Payer: Nomi Health Commercial	$21,354.66
Rate for Payer: PACE Medicare	$12,703.69
Rate for Payer: PACE SWMI	$13,372.31
Rate for Payer: PHP Medicare Advantage	$13,372.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$26,688.59
Rate for Payer: Priority Health Medicare	$13,372.31
Rate for Payer: Priority Health Tiered Network	$21,350.87
Rate for Payer: Railroad Medicare Medicare	$13,372.31
Rate for Payer: UHC All Payor (Choice/PPO)	$26,983.02
Rate for Payer: UHC Core	$22,574.69
Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage	$13,372.31
Rate for Payer: UHC Exchange	$18,436.19
Rate for Payer: VA VA	$13,372.31

SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT

Facility

$7,815.23

Service Code	APR-DRG 3151
Min. Negotiated Rate	$7,443.07
Max. Negotiated Rate	$7,815.23
Rate for Payer: BCBS Complete	$7,815.23
Rate for Payer: Mclaren Medicaid	$7,443.07
Rate for Payer: Meridian Medicaid	$7,815.23
Rate for Payer: Priority Health Choice Medicaid	$7,443.07
Rate for Payer: UHC Medicaid	$7,443.07
Rate for Payer: UHCCP Medicaid	$7,443.07

Know your out-of-pocket cost for care.

All Charges