Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

ARIPIPRAZOLE 5 MG TABLET

Facility

$1,831.87

Service Code	NDC 00904651061
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$1,190.72
Max. Negotiated Rate	$1,648.68
Rate for Payer: Aetna Commercial	$1,557.09
Rate for Payer: BCBS Trust/PPO	$1,495.36
Rate for Payer: BCN Commercial	$1,415.67
Rate for Payer: Cash Price	$1,465.50
Rate for Payer: Cofinity Commercial	$1,575.41
Rate for Payer: Encore Health Key Benefits Commercial	$1,465.50
Rate for Payer: Healthscope Commercial	$1,648.68
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,373.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,557.09
Rate for Payer: Nomi Health Commercial	$1,502.13
Rate for Payer: PHP Commercial	$1,557.09
Rate for Payer: Priority Health Cigna Priority Health	$1,190.72
Rate for Payer: Priority Health HMO/PPO	$1,593.73
Rate for Payer: Priority Health Narrow/Tiered Network	$1,227.35
Rate for Payer: UHC All Payor (Choice/PPO)	$1,612.05
Rate for Payer: UHC Core	$1,529.61
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,373.90

ARIPIPRAZOLE 5 MG TABLET

Facility

$242.82

Service Code	NDC 65162089709
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$157.83
Max. Negotiated Rate	$218.54
Rate for Payer: Aetna Commercial	$206.40
Rate for Payer: BCBS Trust/PPO	$198.21
Rate for Payer: BCN Commercial	$187.65
Rate for Payer: Cash Price	$194.26
Rate for Payer: Cofinity Commercial	$208.83
Rate for Payer: Encore Health Key Benefits Commercial	$194.26
Rate for Payer: Healthscope Commercial	$218.54
Rate for Payer: Lakeland Regional Health Systems Commercial	$182.12
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$206.40
Rate for Payer: Nomi Health Commercial	$199.11
Rate for Payer: PHP Commercial	$206.40
Rate for Payer: Priority Health Cigna Priority Health	$157.83
Rate for Payer: Priority Health HMO/PPO	$211.25
Rate for Payer: Priority Health Narrow/Tiered Network	$162.69
Rate for Payer: UHC All Payor (Choice/PPO)	$213.68
Rate for Payer: UHC Core	$202.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$182.12

ARIPIPRAZOLE 5 MG TABLET

Facility

$199.16

Service Code	NDC 60505267303
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$129.45
Max. Negotiated Rate	$179.24
Rate for Payer: Aetna Commercial	$169.29
Rate for Payer: BCBS Trust/PPO	$162.57
Rate for Payer: BCN Commercial	$153.91
Rate for Payer: Cash Price	$159.33
Rate for Payer: Cofinity Commercial	$171.28
Rate for Payer: Encore Health Key Benefits Commercial	$159.33
Rate for Payer: Healthscope Commercial	$179.24
Rate for Payer: Lakeland Regional Health Systems Commercial	$149.37
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.29
Rate for Payer: Nomi Health Commercial	$163.31
Rate for Payer: PHP Commercial	$169.29
Rate for Payer: Priority Health Cigna Priority Health	$129.45
Rate for Payer: Priority Health HMO/PPO	$173.27
Rate for Payer: Priority Health Narrow/Tiered Network	$133.44
Rate for Payer: UHC All Payor (Choice/PPO)	$175.26
Rate for Payer: UHC Core	$166.30
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$149.37

ARIPIPRAZOLE 5 MG TABLET

Facility

$81.23

Service Code	NDC 65162089703
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$73.11
Rate for Payer: Aetna Commercial	$69.05
Rate for Payer: BCBS Trust/PPO	$66.31
Rate for Payer: BCN Commercial	$62.77
Rate for Payer: Cash Price	$64.98
Rate for Payer: Cofinity Commercial	$69.86
Rate for Payer: Encore Health Key Benefits Commercial	$64.98
Rate for Payer: Healthscope Commercial	$73.11
Rate for Payer: Lakeland Regional Health Systems Commercial	$60.92
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$69.05
Rate for Payer: Nomi Health Commercial	$66.61
Rate for Payer: PHP Commercial	$69.05
Rate for Payer: Priority Health Cigna Priority Health	$52.80
Rate for Payer: Priority Health HMO/PPO	$70.67
Rate for Payer: Priority Health Narrow/Tiered Network	$54.42
Rate for Payer: UHC All Payor (Choice/PPO)	$71.48
Rate for Payer: UHC Core	$67.83
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$60.92

ARIPIPRAZOLE 5 MG TABLET

Facility

$1,831.87

Service Code	NDC 00904651061
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$435.07
Max. Negotiated Rate	$1,648.68
Rate for Payer: Aetna Commercial	$1,557.09
Rate for Payer: Aetna Medicare	$476.29
Rate for Payer: Allen County Amish Medical Aid Commercial	$572.46
Rate for Payer: Amish Plain Church Group Commercial	$572.46
Rate for Payer: BCBS Complete	$732.75
Rate for Payer: BCBS MAPPO	$457.97
Rate for Payer: BCBS Trust/PPO	$1,505.98
Rate for Payer: BCN Commercial	$1,424.28
Rate for Payer: BCN Medicare Advantage	$457.97
Rate for Payer: Cash Price	$1,465.50
Rate for Payer: Cofinity Commercial	$1,575.41
Rate for Payer: Encore Health Key Benefits Commercial	$1,465.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$457.97
Rate for Payer: Healthscope Commercial	$1,648.68
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,373.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$480.87
Rate for Payer: MI Amish Medical Board Commercial	$526.66
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,557.09
Rate for Payer: Nomi Health Commercial	$1,502.13
Rate for Payer: PACE Senior Care Partners	$435.07
Rate for Payer: PACE SWMI	$457.97
Rate for Payer: PHP Commercial	$1,557.09
Rate for Payer: PHP Medicare Advantage	$457.97
Rate for Payer: Priority Health Cigna Priority Health	$1,190.72
Rate for Payer: Priority Health HMO/PPO	$1,593.73
Rate for Payer: Priority Health Medicare	$462.55
Rate for Payer: Priority Health Narrow/Tiered Network	$1,227.35
Rate for Payer: Railroad Medicare Medicare	$457.97
Rate for Payer: UHC All Payor (Choice/PPO)	$1,612.05
Rate for Payer: UHC Core	$1,529.61
Rate for Payer: UHC Dual Complete DSNP	$457.97
Rate for Payer: UHC Exchange	$457.97
Rate for Payer: UHC Medicare Advantage	$457.97
Rate for Payer: VA VA	$457.97
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,373.90

ARIPIPRAZOLE 5 MG TABLET

Facility

$199.16

Service Code	NDC 60505267303
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$47.30
Max. Negotiated Rate	$179.24
Rate for Payer: Aetna Commercial	$169.29
Rate for Payer: Aetna Medicare	$51.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$62.24
Rate for Payer: Amish Plain Church Group Commercial	$62.24
Rate for Payer: BCBS Complete	$79.66
Rate for Payer: BCBS MAPPO	$49.79
Rate for Payer: BCBS Trust/PPO	$163.73
Rate for Payer: BCN Commercial	$154.85
Rate for Payer: BCN Medicare Advantage	$49.79
Rate for Payer: Cash Price	$159.33
Rate for Payer: Cofinity Commercial	$171.28
Rate for Payer: Encore Health Key Benefits Commercial	$159.33
Rate for Payer: Health Alliance Plan Medicare Advantage	$49.79
Rate for Payer: Healthscope Commercial	$179.24
Rate for Payer: Lakeland Regional Health Systems Commercial	$149.37
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$52.28
Rate for Payer: MI Amish Medical Board Commercial	$57.26
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$169.29
Rate for Payer: Nomi Health Commercial	$163.31
Rate for Payer: PACE Senior Care Partners	$47.30
Rate for Payer: PACE SWMI	$49.79
Rate for Payer: PHP Commercial	$169.29
Rate for Payer: PHP Medicare Advantage	$49.79
Rate for Payer: Priority Health Cigna Priority Health	$129.45
Rate for Payer: Priority Health HMO/PPO	$173.27
Rate for Payer: Priority Health Medicare	$50.29
Rate for Payer: Priority Health Narrow/Tiered Network	$133.44
Rate for Payer: Railroad Medicare Medicare	$49.79
Rate for Payer: UHC All Payor (Choice/PPO)	$175.26
Rate for Payer: UHC Core	$166.30
Rate for Payer: UHC Dual Complete DSNP	$49.79
Rate for Payer: UHC Exchange	$49.79
Rate for Payer: UHC Medicare Advantage	$49.79
Rate for Payer: VA VA	$49.79
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$149.37

ARIPIPRAZOLE 5 MG TABLET

Facility

$93.75

Service Code	NDC 27241005203
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$60.94
Max. Negotiated Rate	$84.38
Rate for Payer: Aetna Commercial	$79.69
Rate for Payer: BCBS Trust/PPO	$76.53
Rate for Payer: BCN Commercial	$72.45
Rate for Payer: Cash Price	$75.00
Rate for Payer: Cofinity Commercial	$80.62
Rate for Payer: Encore Health Key Benefits Commercial	$75.00
Rate for Payer: Healthscope Commercial	$84.38
Rate for Payer: Lakeland Regional Health Systems Commercial	$70.31
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$79.69
Rate for Payer: Nomi Health Commercial	$76.88
Rate for Payer: PHP Commercial	$79.69
Rate for Payer: Priority Health Cigna Priority Health	$60.94
Rate for Payer: Priority Health HMO/PPO	$81.56
Rate for Payer: Priority Health Narrow/Tiered Network	$62.81
Rate for Payer: UHC All Payor (Choice/PPO)	$82.50
Rate for Payer: UHC Core	$78.28
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$70.31

ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA (EG, TEMPOROMANDIBULAR, ACROMIOCLAVICULAR, WRIST, ELBOW OR ANKLE, OLECRANON BURSA); WITHOUT ULTRASOUND GUIDANCE

Facility

$219.58

Service Code	CPT 20605
Hospital Revenue Code	360
Min. Negotiated Rate	$209.11
Max. Negotiated Rate	$219.58
Rate for Payer: BCBS Complete	$219.58
Rate for Payer: Mclaren Medicaid	$209.11
Rate for Payer: Meridian Medicaid	$219.58
Rate for Payer: Priority Health Choice Medicaid	$209.11
Rate for Payer: UHCCP Medicaid	$209.11

ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE

Facility

$219.58

Service Code	CPT 20610
Hospital Revenue Code	361
Min. Negotiated Rate	$209.11
Max. Negotiated Rate	$219.58
Rate for Payer: BCBS Complete	$219.58
Rate for Payer: Mclaren Medicaid	$209.11
Rate for Payer: Meridian Medicaid	$219.58
Rate for Payer: Priority Health Choice Medicaid	$209.11
Rate for Payer: UHCCP Medicaid	$209.11

ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITHOUT ULTRASOUND GUIDANCE

Facility

$219.58

Service Code	CPT 20610
Hospital Revenue Code	360
Min. Negotiated Rate	$209.11
Max. Negotiated Rate	$219.58
Rate for Payer: BCBS Complete	$219.58
Rate for Payer: Mclaren Medicaid	$209.11
Rate for Payer: Meridian Medicaid	$219.58
Rate for Payer: Priority Health Choice Medicaid	$209.11
Rate for Payer: UHCCP Medicaid	$209.11

ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHROPLASTY), WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT

Facility

$9,570.97

Service Code	CPT 27130
Hospital Revenue Code	360
Min. Negotiated Rate	$9,114.61
Max. Negotiated Rate	$9,570.97
Rate for Payer: BCBS Complete	$9,570.97
Rate for Payer: Mclaren Medicaid	$9,114.61
Rate for Payer: Meridian Medicaid	$9,570.97
Rate for Payer: Priority Health Choice Medicaid	$9,114.61
Rate for Payer: UHCCP Medicaid	$9,114.61

ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL REPLACEMENT (EG, TOTAL SHOULDER))

Facility

$13,679.42

Service Code	CPT 23472
Hospital Revenue Code	360
Min. Negotiated Rate	$13,027.16
Max. Negotiated Rate	$13,679.42
Rate for Payer: BCBS Complete	$13,679.42
Rate for Payer: Mclaren Medicaid	$13,027.16
Rate for Payer: Meridian Medicaid	$13,679.42
Rate for Payer: Priority Health Choice Medicaid	$13,027.16
Rate for Payer: UHCCP Medicaid	$13,027.16

ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATELLA RESURFACING (TOTAL KNEE ARTHROPLASTY)

Facility

$9,570.97

Service Code	CPT 27447
Hospital Revenue Code	360
Min. Negotiated Rate	$9,114.61
Max. Negotiated Rate	$9,570.97
Rate for Payer: BCBS Complete	$9,570.97
Rate for Payer: Mclaren Medicaid	$9,114.61
Rate for Payer: Meridian Medicaid	$9,570.97
Rate for Payer: Priority Health Choice Medicaid	$9,114.61
Rate for Payer: UHCCP Medicaid	$9,114.61

ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG, PLICA OR SHELF RESECTION) (SEPARATE PROCEDURE)

Facility

$2,413.50

Service Code	CPT 29875
Hospital Revenue Code	360
Min. Negotiated Rate	$2,298.42
Max. Negotiated Rate	$2,413.50
Rate for Payer: BCBS Complete	$2,413.50
Rate for Payer: Mclaren Medicaid	$2,298.42
Rate for Payer: Meridian Medicaid	$2,413.50
Rate for Payer: Priority Health Choice Medicaid	$2,298.42
Rate for Payer: UHCCP Medicaid	$2,298.42

ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, MAJOR, 2 OR MORE COMPARTMENTS (EG, MEDIAL OR LATERAL)

Facility

$2,413.50

Service Code	CPT 29876
Hospital Revenue Code	360
Min. Negotiated Rate	$2,298.42
Max. Negotiated Rate	$2,413.50
Rate for Payer: BCBS Complete	$2,413.50
Rate for Payer: Mclaren Medicaid	$2,298.42
Rate for Payer: Meridian Medicaid	$2,413.50
Rate for Payer: Priority Health Choice Medicaid	$2,298.42
Rate for Payer: UHCCP Medicaid	$2,298.42

ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND LATERAL, INCLUDING ANY MENISCAL SHAVING) INCLUDING DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY), SAME OR SEPARATE COMPARTMENT(S), WHEN PERFORMED

Facility

$2,413.50

Service Code	CPT 29880
Hospital Revenue Code	360
Min. Negotiated Rate	$2,298.42
Max. Negotiated Rate	$2,413.50
Rate for Payer: BCBS Complete	$2,413.50
Rate for Payer: Mclaren Medicaid	$2,298.42
Rate for Payer: Meridian Medicaid	$2,413.50
Rate for Payer: Priority Health Choice Medicaid	$2,298.42
Rate for Payer: UHCCP Medicaid	$2,298.42

ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LATERAL, INCLUDING ANY MENISCAL SHAVING) INCLUDING DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY), SAME OR SEPARATE COMPARTMENT(S), WHEN PERFORMED

Facility

$2,413.50

Service Code	CPT 29881
Hospital Revenue Code	360
Min. Negotiated Rate	$2,298.42
Max. Negotiated Rate	$2,413.50
Rate for Payer: BCBS Complete	$2,413.50
Rate for Payer: Mclaren Medicaid	$2,298.42
Rate for Payer: Meridian Medicaid	$2,413.50
Rate for Payer: Priority Health Choice Medicaid	$2,298.42
Rate for Payer: UHCCP Medicaid	$2,298.42

ARTHROSCOPY, SHOULDER, SURGICAL; BICEPS TENODESIS

Facility

$5,313.85

Service Code	CPT 29828
Hospital Revenue Code	360
Min. Negotiated Rate	$5,060.48
Max. Negotiated Rate	$5,313.85
Rate for Payer: BCBS Complete	$5,313.85
Rate for Payer: Mclaren Medicaid	$5,060.48
Rate for Payer: Meridian Medicaid	$5,313.85
Rate for Payer: Priority Health Choice Medicaid	$5,060.48
Rate for Payer: UHCCP Medicaid	$5,060.48

ARTHROSCOPY, SHOULDER, SURGICAL; CAPSULORRHAPHY

Facility

$5,313.85

Service Code	CPT 29806
Hospital Revenue Code	360
Min. Negotiated Rate	$5,060.48
Max. Negotiated Rate	$5,313.85
Rate for Payer: BCBS Complete	$5,313.85
Rate for Payer: Mclaren Medicaid	$5,060.48
Rate for Payer: Meridian Medicaid	$5,313.85
Rate for Payer: Priority Health Choice Medicaid	$5,060.48
Rate for Payer: UHCCP Medicaid	$5,060.48

ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE, 3 OR MORE DISCRETE STRUCTURES (EG, HUMERAL BONE, HUMERAL ARTICULAR CARTILAGE, GLENOID BONE, GLENOID ARTICULAR CARTILAGE, BICEPS TENDON, BICEPS ANCHOR COMPLEX, LABRUM, ARTICULAR CAPSULE, ARTICULAR SIDE OF THE ROTATOR CUFF, BURSAL SIDE OF THE ROTATOR CUFF, SUBACROMIAL BURSA, FOREIGN BODY[IES])

Facility

$2,413.50

Service Code	CPT 29823
Hospital Revenue Code	360
Min. Negotiated Rate	$2,298.42
Max. Negotiated Rate	$2,413.50
Rate for Payer: BCBS Complete	$2,413.50
Rate for Payer: Mclaren Medicaid	$2,298.42
Rate for Payer: Meridian Medicaid	$2,413.50
Rate for Payer: Priority Health Choice Medicaid	$2,298.42
Rate for Payer: UHCCP Medicaid	$2,298.42

ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, LIMITED, 1 OR 2 DISCRETE STRUCTURES (EG, HUMERAL BONE, HUMERAL ARTICULAR CARTILAGE, GLENOID BONE, GLENOID ARTICULAR CARTILAGE, BICEPS TENDON, BICEPS ANCHOR COMPLEX, LABRUM, ARTICULAR CAPSULE, ARTICULAR SIDE OF THE ROTATOR CUFF, BURSAL SIDE OF THE ROTATOR CUFF, SUBACROMIAL BURSA, FOREIGN BODY[IES])

Facility

$2,413.50

Service Code	CPT 29822
Hospital Revenue Code	360
Min. Negotiated Rate	$2,298.42
Max. Negotiated Rate	$2,413.50
Rate for Payer: BCBS Complete	$2,413.50
Rate for Payer: Mclaren Medicaid	$2,298.42
Rate for Payer: Meridian Medicaid	$2,413.50
Rate for Payer: Priority Health Choice Medicaid	$2,298.42
Rate for Payer: UHCCP Medicaid	$2,298.42

ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY INCLUDING DISTAL ARTICULAR SURFACE (MUMFORD PROCEDURE)

Facility

$2,413.50

Service Code	CPT 29824
Hospital Revenue Code	360
Min. Negotiated Rate	$2,298.42
Max. Negotiated Rate	$2,413.50
Rate for Payer: BCBS Complete	$2,413.50
Rate for Payer: Mclaren Medicaid	$2,298.42
Rate for Payer: Meridian Medicaid	$2,413.50
Rate for Payer: Priority Health Choice Medicaid	$2,298.42
Rate for Payer: UHCCP Medicaid	$2,298.42

ARTHROSCOPY, SHOULDER, SURGICAL; REPAIR OF SLAP LESION

Facility

$5,313.85

Service Code	CPT 29807
Hospital Revenue Code	360
Min. Negotiated Rate	$5,060.48
Max. Negotiated Rate	$5,313.85
Rate for Payer: BCBS Complete	$5,313.85
Rate for Payer: Mclaren Medicaid	$5,060.48
Rate for Payer: Meridian Medicaid	$5,313.85
Rate for Payer: Priority Health Choice Medicaid	$5,060.48
Rate for Payer: UHCCP Medicaid	$5,060.48

ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, PARTIAL

Facility

$5,313.85

Service Code	CPT 29820
Hospital Revenue Code	360
Min. Negotiated Rate	$5,060.48
Max. Negotiated Rate	$5,313.85
Rate for Payer: BCBS Complete	$5,313.85
Rate for Payer: Mclaren Medicaid	$5,060.48
Rate for Payer: Meridian Medicaid	$5,313.85
Rate for Payer: Priority Health Choice Medicaid	$5,060.48
Rate for Payer: UHCCP Medicaid	$5,060.48

ARTHROSCOPY, SHOULDER, SURGICAL; WITH ROTATOR CUFF REPAIR

Facility

$5,313.85

Service Code	CPT 29827
Hospital Revenue Code	360
Min. Negotiated Rate	$5,060.48
Max. Negotiated Rate	$5,313.85
Rate for Payer: BCBS Complete	$5,313.85
Rate for Payer: Mclaren Medicaid	$5,060.48
Rate for Payer: Meridian Medicaid	$5,313.85
Rate for Payer: Priority Health Choice Medicaid	$5,060.48
Rate for Payer: UHCCP Medicaid	$5,060.48

Know your out-of-pocket cost for care.

All Charges