Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR AEP HEARING STATUS DETER BROADBAND STIMULI I&R

Professional

Both

$161.00

Service Code	HCPCS 92651
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$3,831.23
Rate for Payer: Aetna Commercial	$97.90
Rate for Payer: Aetna Medicare	$75.98
Rate for Payer: BCBS Complete	$64.40
Rate for Payer: BCBS MAPPO	$73.06
Rate for Payer: BCBS Trust/PPO	$3,831.23
Rate for Payer: BCN Commercial	$123.64
Rate for Payer: BCN Medicare Advantage	$73.06
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cofinity Commercial	$97.90
Rate for Payer: Cofinity Commercial	$105.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$73.06
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$76.71
Rate for Payer: Nomi Health Commercial	$87.67
Rate for Payer: PACE SWMI	$73.06
Rate for Payer: PHP Medicare Advantage	$73.06
Rate for Payer: Priority Health Cigna Priority Health	$104.65
Rate for Payer: Priority Health HMO/PPO	$112.17
Rate for Payer: Priority Health Medicare	$73.79
Rate for Payer: Priority Health Narrow/Tiered Network	$112.17
Rate for Payer: UHC All Payor (Choice/PPO)	$73.06
Rate for Payer: UHC Dual Complete DSNP	$73.06
Rate for Payer: UHC Exchange	$73.06
Rate for Payer: UHC Medicare Advantage	$73.06

PR AEP NEURODIAGNOSTIC INTERPRETATION AND REPORT

Professional

Both

$169.00

Service Code	HCPCS 92653
Min. Negotiated Rate	$67.60
Max. Negotiated Rate	$1,917.20
Rate for Payer: Aetna Commercial	$100.57
Rate for Payer: Aetna Medicare	$78.05
Rate for Payer: BCBS Complete	$67.60
Rate for Payer: BCBS MAPPO	$75.05
Rate for Payer: BCBS Trust/PPO	$1,917.20
Rate for Payer: BCN Commercial	$123.15
Rate for Payer: BCN Medicare Advantage	$75.05
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cofinity Commercial	$108.07
Rate for Payer: Cofinity Commercial	$100.57
Rate for Payer: Health Alliance Plan Medicare Advantage	$75.05
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$78.80
Rate for Payer: Nomi Health Commercial	$90.06
Rate for Payer: PACE SWMI	$75.05
Rate for Payer: PHP Medicare Advantage	$75.05
Rate for Payer: Priority Health Cigna Priority Health	$109.85
Rate for Payer: Priority Health HMO/PPO	$112.63
Rate for Payer: Priority Health Medicare	$75.80
Rate for Payer: Priority Health Narrow/Tiered Network	$112.63
Rate for Payer: UHC All Payor (Choice/PPO)	$75.05
Rate for Payer: UHC Dual Complete DSNP	$75.05
Rate for Payer: UHC Exchange	$75.05
Rate for Payer: UHC Medicare Advantage	$75.05

PR AEP SCR AUDITORY POTENTIAL W/STIMULI AUTO ALYS

Professional

Both

$55.00

Service Code	HCPCS 92650
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$1,517.28
Rate for Payer: Aetna Commercial	$30.47
Rate for Payer: Aetna Medicare	$27.50
Rate for Payer: BCBS Complete	$22.00
Rate for Payer: BCBS Trust/PPO	$1,517.28
Rate for Payer: BCN Commercial	$40.56
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Priority Health Cigna Priority Health	$35.75
Rate for Payer: Priority Health HMO/PPO	$36.63
Rate for Payer: Priority Health Narrow/Tiered Network	$36.63

PR AEP THRESHOLD ESTIMATION MLT FREQUENCIES I&R

Professional

Both

$233.00

Service Code	HCPCS 92652
Min. Negotiated Rate	$93.20
Max. Negotiated Rate	$4,564.51
Rate for Payer: Aetna Commercial	$134.91
Rate for Payer: Aetna Medicare	$104.71
Rate for Payer: BCBS Complete	$93.20
Rate for Payer: BCBS MAPPO	$100.68
Rate for Payer: BCBS Trust/PPO	$4,564.51
Rate for Payer: BCN Commercial	$165.18
Rate for Payer: BCN Medicare Advantage	$100.68
Rate for Payer: Cash Price	$186.40
Rate for Payer: Cash Price	$186.40
Rate for Payer: Cofinity Commercial	$134.91
Rate for Payer: Cofinity Commercial	$144.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$100.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$105.71
Rate for Payer: Nomi Health Commercial	$120.82
Rate for Payer: PACE SWMI	$100.68
Rate for Payer: PHP Medicare Advantage	$100.68
Rate for Payer: Priority Health Cigna Priority Health	$151.45
Rate for Payer: Priority Health HMO/PPO	$151.98
Rate for Payer: Priority Health Medicare	$101.69
Rate for Payer: Priority Health Narrow/Tiered Network	$151.98
Rate for Payer: UHC All Payor (Choice/PPO)	$100.68
Rate for Payer: UHC Dual Complete DSNP	$100.68
Rate for Payer: UHC Exchange	$100.68
Rate for Payer: UHC Medicare Advantage	$100.68

PR AFO ANKLE GAUNTLET PRE OTS

Professional

Both

$73.00

Service Code	HCPCS L1902
Min. Negotiated Rate	$29.20
Max. Negotiated Rate	$70.88
Rate for Payer: BCBS Complete	$29.20
Rate for Payer: BCN Commercial	$70.88
Rate for Payer: Cash Price	$58.40
Rate for Payer: Cash Price	$58.40
Rate for Payer: Priority Health Cigna Priority Health	$47.45

PR AFO MULTILIG ANK SUP PRE OTS

Professional

Both

$110.00

Service Code	HCPCS L1906
Min. Negotiated Rate	$44.00
Max. Negotiated Rate	$106.78
Rate for Payer: BCBS Complete	$44.00
Rate for Payer: BCN Commercial	$106.78
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Priority Health Cigna Priority Health	$71.50

PR AIIV4 VACC INACTIVATED PRSRV FR 0.5ML DOS IM USE

Professional

Both

$182.00

Service Code	HCPCS 90694
Min. Negotiated Rate	$71.68
Max. Negotiated Rate	$118.30
Rate for Payer: Aetna Commercial	$77.36
Rate for Payer: Aetna Medicare	$91.00
Rate for Payer: BCBS Complete	$72.80
Rate for Payer: BCBS Trust/PPO	$77.36
Rate for Payer: BCN Commercial	$71.68
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cash Price	$145.60
Rate for Payer: Priority Health Cigna Priority Health	$118.30

PR AK SLEEVE SUSP NEOPRENE/EQUA

Professional

Both

$159.00

Service Code	HCPCS L5695
Min. Negotiated Rate	$63.60
Max. Negotiated Rate	$171.39
Rate for Payer: BCBS Complete	$63.60
Rate for Payer: BCN Commercial	$171.39
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cash Price	$127.20
Rate for Payer: Priority Health Cigna Priority Health	$103.35

PR ALBUTEROL IPRATROP NON-COMP

Professional

Both

$2.00

Service Code	HCPCS J7620
Min. Negotiated Rate	$0.02
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna Commercial	$0.27
Rate for Payer: Aetna Medicare	$0.21
Rate for Payer: BCBS Complete	$0.80
Rate for Payer: BCBS MAPPO	$0.20
Rate for Payer: BCN Commercial	$0.02
Rate for Payer: BCN Medicare Advantage	$0.20
Rate for Payer: Cash Price	$1.60
Rate for Payer: Cash Price	$1.60
Rate for Payer: Cofinity Commercial	$0.29
Rate for Payer: Cofinity Commercial	$0.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.21
Rate for Payer: Nomi Health Commercial	$0.24
Rate for Payer: PACE SWMI	$0.20
Rate for Payer: PHP Medicare Advantage	$0.20
Rate for Payer: Priority Health Cigna Priority Health	$1.30
Rate for Payer: Priority Health Medicare	$0.20
Rate for Payer: UHC All Payor (Choice/PPO)	$0.20
Rate for Payer: UHC Dual Complete DSNP	$0.20
Rate for Payer: UHC Exchange	$0.20
Rate for Payer: UHC Medicare Advantage	$0.20

PR ALBUTEROL NON-COMP CON

Professional

Both

$2.00

Service Code	HCPCS J7611
Min. Negotiated Rate	$0.06
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna Commercial	$0.22
Rate for Payer: Aetna Medicare	$0.17
Rate for Payer: BCBS Complete	$0.80
Rate for Payer: BCBS MAPPO	$0.16
Rate for Payer: BCN Commercial	$0.06
Rate for Payer: BCN Medicare Advantage	$0.16
Rate for Payer: Cash Price	$1.60
Rate for Payer: Cash Price	$1.60
Rate for Payer: Cofinity Commercial	$0.23
Rate for Payer: Cofinity Commercial	$0.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.16
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.17
Rate for Payer: Nomi Health Commercial	$0.19
Rate for Payer: PACE SWMI	$0.16
Rate for Payer: PHP Medicare Advantage	$0.16
Rate for Payer: Priority Health Cigna Priority Health	$1.30
Rate for Payer: Priority Health Medicare	$0.16
Rate for Payer: UHC All Payor (Choice/PPO)	$0.16
Rate for Payer: UHC Dual Complete DSNP	$0.16
Rate for Payer: UHC Exchange	$0.16
Rate for Payer: UHC Medicare Advantage	$0.16

PR ALBUTEROL NON-COMP UNIT

Professional

Both

$2.00

Service Code	HCPCS J7613
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna Commercial	$0.10
Rate for Payer: Aetna Medicare	$0.08
Rate for Payer: BCBS Complete	$0.80
Rate for Payer: BCBS MAPPO	$0.08
Rate for Payer: BCN Commercial	$0.01
Rate for Payer: BCN Medicare Advantage	$0.08
Rate for Payer: Cash Price	$1.60
Rate for Payer: Cash Price	$1.60
Rate for Payer: Cofinity Commercial	$0.11
Rate for Payer: Cofinity Commercial	$0.10
Rate for Payer: Health Alliance Plan Medicare Advantage	$0.08
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$0.08
Rate for Payer: Nomi Health Commercial	$0.09
Rate for Payer: PACE SWMI	$0.08
Rate for Payer: PHP Medicare Advantage	$0.08
Rate for Payer: Priority Health Cigna Priority Health	$1.30
Rate for Payer: Priority Health Medicare	$0.08
Rate for Payer: UHC All Payor (Choice/PPO)	$0.08
Rate for Payer: UHC Dual Complete DSNP	$0.08
Rate for Payer: UHC Exchange	$0.08
Rate for Payer: UHC Medicare Advantage	$0.08

PR ALCOHOL AND/OR DRUG SERVICES

Professional

Both

$247.00

Service Code	HCPCS H0015
Min. Negotiated Rate	$98.80
Max. Negotiated Rate	$160.55
Rate for Payer: Aetna Commercial	$134.33
Rate for Payer: Aetna Medicare	$123.50
Rate for Payer: BCBS Complete	$98.80
Rate for Payer: Cash Price	$197.60
Rate for Payer: Cash Price	$197.60
Rate for Payer: Priority Health Cigna Priority Health	$160.55

PR ALCOHOL/SUBSTANCE SCREEN & INTERVEN 15-30 MIN

Professional

Both

$54.00

Service Code	HCPCS 99408
Min. Negotiated Rate	$20.24
Max. Negotiated Rate	$1,099.92
Rate for Payer: Aetna Commercial	$33.63
Rate for Payer: Aetna Medicare	$27.00
Rate for Payer: BCBS Complete	$21.25
Rate for Payer: BCBS Trust/PPO	$1,099.92
Rate for Payer: BCN Commercial	$50.33
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Mclaren Medicaid	$20.24
Rate for Payer: Meridian Medicaid	$21.25
Rate for Payer: Priority Health Choice Medicaid	$20.24
Rate for Payer: Priority Health Cigna Priority Health	$35.10
Rate for Payer: Priority Health HMO/PPO	$42.18
Rate for Payer: Priority Health Narrow/Tiered Network	$42.18
Rate for Payer: UHCCP Medicaid	$20.24

PR ALCOHOL/SUBSTANCE SCREEN & INTERVENTION >30 MIN

Professional

Both

$104.00

Service Code	HCPCS 99409
Min. Negotiated Rate	$40.04
Max. Negotiated Rate	$1,109.43
Rate for Payer: Aetna Commercial	$67.61
Rate for Payer: Aetna Medicare	$52.00
Rate for Payer: BCBS Complete	$42.04
Rate for Payer: BCBS Trust/PPO	$1,109.43
Rate for Payer: BCN Commercial	$96.27
Rate for Payer: Cash Price	$83.20
Rate for Payer: Cash Price	$83.20
Rate for Payer: Mclaren Medicaid	$40.04
Rate for Payer: Meridian Medicaid	$42.04
Rate for Payer: Priority Health Choice Medicaid	$40.04
Rate for Payer: Priority Health Cigna Priority Health	$67.60
Rate for Payer: Priority Health HMO/PPO	$84.36
Rate for Payer: Priority Health Narrow/Tiered Network	$84.36
Rate for Payer: UHCCP Medicaid	$40.04

PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION

Facility

$286.25

Service Code	HCPCS J2730
Hospital Charge Code	6462
Hospital Revenue Code	636
Min. Negotiated Rate	$186.06
Max. Negotiated Rate	$257.62
Rate for Payer: Aetna Commercial	$243.31
Rate for Payer: BCBS Trust/PPO	$233.67
Rate for Payer: BCN Commercial	$221.21
Rate for Payer: Cash Price	$229.00
Rate for Payer: Cofinity Commercial	$246.18
Rate for Payer: Encore Health Key Benefits Commercial	$229.00
Rate for Payer: Healthscope Commercial	$257.62
Rate for Payer: Lakeland Regional Health Systems Commercial	$214.69
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.31
Rate for Payer: Nomi Health Commercial	$234.72
Rate for Payer: PHP Commercial	$243.31
Rate for Payer: Priority Health Cigna Priority Health	$186.06
Rate for Payer: Priority Health HMO/PPO	$249.04
Rate for Payer: Priority Health Narrow/Tiered Network	$191.79
Rate for Payer: UHC All Payor (Choice/PPO)	$251.90
Rate for Payer: UHC Core	$239.02
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$214.69

PRALIDOXIME 1 GRAM SOLUTION FOR INJECTION

Facility

$286.25

Service Code	HCPCS J2730
Hospital Charge Code	6462
Hospital Revenue Code	636
Min. Negotiated Rate	$67.98
Max. Negotiated Rate	$257.62
Rate for Payer: Aetna Commercial	$243.31
Rate for Payer: Aetna Medicare	$74.42
Rate for Payer: Allen County Amish Medical Aid Commercial	$89.45
Rate for Payer: Amish Plain Church Group Commercial	$89.45
Rate for Payer: BCBS Complete	$114.50
Rate for Payer: BCBS MAPPO	$71.56
Rate for Payer: BCBS Trust/PPO	$235.33
Rate for Payer: BCN Commercial	$222.56
Rate for Payer: BCN Medicare Advantage	$71.56
Rate for Payer: Cash Price	$229.00
Rate for Payer: Cofinity Commercial	$246.18
Rate for Payer: Encore Health Key Benefits Commercial	$229.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$71.56
Rate for Payer: Healthscope Commercial	$257.62
Rate for Payer: Lakeland Regional Health Systems Commercial	$214.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$75.14
Rate for Payer: MI Amish Medical Board Commercial	$82.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$243.31
Rate for Payer: Nomi Health Commercial	$234.72
Rate for Payer: PACE Senior Care Partners	$67.98
Rate for Payer: PACE SWMI	$71.56
Rate for Payer: PHP Commercial	$243.31
Rate for Payer: PHP Medicare Advantage	$71.56
Rate for Payer: Priority Health Cigna Priority Health	$186.06
Rate for Payer: Priority Health HMO/PPO	$249.04
Rate for Payer: Priority Health Medicare	$72.28
Rate for Payer: Priority Health Narrow/Tiered Network	$191.79
Rate for Payer: Railroad Medicare Medicare	$71.56
Rate for Payer: UHC All Payor (Choice/PPO)	$251.90
Rate for Payer: UHC Core	$239.02
Rate for Payer: UHC Dual Complete DSNP	$71.56
Rate for Payer: UHC Exchange	$71.56
Rate for Payer: UHC Medicare Advantage	$71.56
Rate for Payer: VA VA	$71.56
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$214.69

PR ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED

Professional

Both

$489.00

Service Code	HCPCS 20930
Min. Negotiated Rate	$135.79
Max. Negotiated Rate	$11,952.59
Rate for Payer: Aetna Commercial	$155.86
Rate for Payer: Aetna Medicare	$244.50
Rate for Payer: BCBS Complete	$195.60
Rate for Payer: BCBS Trust/PPO	$11,952.59
Rate for Payer: BCN Commercial	$135.79
Rate for Payer: Cash Price	$391.20
Rate for Payer: Cash Price	$391.20
Rate for Payer: Priority Health Cigna Priority Health	$317.85
Rate for Payer: Priority Health HMO/PPO	$178.11
Rate for Payer: Priority Health Narrow/Tiered Network	$178.11

PR ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL

Professional

Both

$446.00

Service Code	HCPCS 20931
Min. Negotiated Rate	$70.93
Max. Negotiated Rate	$29,358.48
Rate for Payer: Aetna Commercial	$145.28
Rate for Payer: Aetna Medicare	$112.76
Rate for Payer: BCBS Complete	$74.48
Rate for Payer: BCBS MAPPO	$108.42
Rate for Payer: BCBS Trust/PPO	$29,358.48
Rate for Payer: BCN Commercial	$177.03
Rate for Payer: BCN Medicare Advantage	$108.42
Rate for Payer: Cash Price	$356.80
Rate for Payer: Cash Price	$356.80
Rate for Payer: Cofinity Commercial	$156.12
Rate for Payer: Cofinity Commercial	$145.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$108.42
Rate for Payer: Mclaren Medicaid	$70.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$113.84
Rate for Payer: Meridian Medicaid	$74.48
Rate for Payer: Nomi Health Commercial	$130.10
Rate for Payer: PACE SWMI	$108.42
Rate for Payer: PHP Medicare Advantage	$108.42
Rate for Payer: Priority Health Choice Medicaid	$70.93
Rate for Payer: Priority Health Cigna Priority Health	$289.90
Rate for Payer: Priority Health HMO/PPO	$167.93
Rate for Payer: Priority Health Medicare	$109.50
Rate for Payer: Priority Health Narrow/Tiered Network	$167.93
Rate for Payer: UHC All Payor (Choice/PPO)	$108.42
Rate for Payer: UHC Dual Complete DSNP	$108.42
Rate for Payer: UHC Exchange	$108.42
Rate for Payer: UHC Medicare Advantage	$108.42
Rate for Payer: UHCCP Medicaid	$70.93

PR ALTEPLASE RECOMBINANT

Professional

Both

$91.00

Service Code	HCPCS J2997
Min. Negotiated Rate	$36.40
Max. Negotiated Rate	$135.58
Rate for Payer: Aetna Commercial	$126.16
Rate for Payer: Aetna Medicare	$97.92
Rate for Payer: BCBS Complete	$36.40
Rate for Payer: BCBS MAPPO	$94.15
Rate for Payer: BCBS Trust/PPO	$88.53
Rate for Payer: BCN Commercial	$87.12
Rate for Payer: BCN Medicare Advantage	$94.15
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cash Price	$72.80
Rate for Payer: Cofinity Commercial	$135.58
Rate for Payer: Cofinity Commercial	$126.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$94.15
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$98.86
Rate for Payer: Nomi Health Commercial	$112.98
Rate for Payer: PACE SWMI	$94.15
Rate for Payer: PHP Medicare Advantage	$94.15
Rate for Payer: Priority Health Cigna Priority Health	$59.15
Rate for Payer: Priority Health Medicare	$95.09
Rate for Payer: UHC All Payor (Choice/PPO)	$94.15
Rate for Payer: UHC Dual Complete DSNP	$94.15
Rate for Payer: UHC Exchange	$94.15
Rate for Payer: UHC Medicare Advantage	$94.15

PR AMBULATORY BP MNTR W/SW 24 HR+ REC SCAN ALYS I&R

Professional

Both

$257.00

Service Code	HCPCS 93784
Min. Negotiated Rate	$37.78
Max. Negotiated Rate	$167.05
Rate for Payer: Aetna Commercial	$56.29
Rate for Payer: Aetna Medicare	$43.69
Rate for Payer: BCBS Complete	$102.80
Rate for Payer: BCBS MAPPO	$42.01
Rate for Payer: BCBS Trust/PPO	$37.78
Rate for Payer: BCN Commercial	$66.46
Rate for Payer: BCN Medicare Advantage	$42.01
Rate for Payer: Cash Price	$205.60
Rate for Payer: Cash Price	$205.60
Rate for Payer: Cofinity Commercial	$60.49
Rate for Payer: Cofinity Commercial	$56.29
Rate for Payer: Health Alliance Plan Medicare Advantage	$42.01
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$44.11
Rate for Payer: Nomi Health Commercial	$50.41
Rate for Payer: PACE SWMI	$42.01
Rate for Payer: PHP Medicare Advantage	$42.01
Rate for Payer: Priority Health Cigna Priority Health	$167.05
Rate for Payer: Priority Health HMO/PPO	$64.98
Rate for Payer: Priority Health Medicare	$42.43
Rate for Payer: Priority Health Narrow/Tiered Network	$64.98
Rate for Payer: UHC All Payor (Choice/PPO)	$42.01
Rate for Payer: UHC Dual Complete DSNP	$42.01
Rate for Payer: UHC Exchange	$42.01
Rate for Payer: UHC Medicare Advantage	$42.01

PR AMBULATORY BP MNTR W/SW 24 HR+ REVIEW W/I&R

Professional

Both

$36.00

Service Code	HCPCS 93790
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$31.84
Rate for Payer: Aetna Commercial	$22.51
Rate for Payer: Aetna Medicare	$17.47
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: BCBS MAPPO	$16.80
Rate for Payer: BCBS Trust/PPO	$31.84
Rate for Payer: BCN Commercial	$25.90
Rate for Payer: BCN Medicare Advantage	$16.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cofinity Commercial	$24.19
Rate for Payer: Cofinity Commercial	$22.51
Rate for Payer: Health Alliance Plan Medicare Advantage	$16.80
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$17.64
Rate for Payer: Nomi Health Commercial	$20.16
Rate for Payer: PACE SWMI	$16.80
Rate for Payer: PHP Medicare Advantage	$16.80
Rate for Payer: Priority Health Cigna Priority Health	$23.40
Rate for Payer: Priority Health HMO/PPO	$24.95
Rate for Payer: Priority Health Medicare	$16.97
Rate for Payer: Priority Health Narrow/Tiered Network	$24.95
Rate for Payer: UHC All Payor (Choice/PPO)	$16.80
Rate for Payer: UHC Dual Complete DSNP	$16.80
Rate for Payer: UHC Exchange	$16.80
Rate for Payer: UHC Medicare Advantage	$16.80

PR AMBULATORY EEG MONITORING

Professional

Both

$584.00

Service Code	HCPCS 95950
Min. Negotiated Rate	$233.60
Max. Negotiated Rate	$379.60
Rate for Payer: Aetna Medicare	$292.00
Rate for Payer: BCBS Complete	$233.60
Rate for Payer: Cash Price	$467.20
Rate for Payer: Priority Health Cigna Priority Health	$379.60

PR AMINOLEVULINIC ACID HCL TOP

Professional

Both

$177.00

Service Code	HCPCS J7308
Min. Negotiated Rate	$70.80
Max. Negotiated Rate	$567.18
Rate for Payer: Aetna Commercial	$527.79
Rate for Payer: Aetna Medicare	$409.63
Rate for Payer: BCBS Complete	$70.80
Rate for Payer: BCBS MAPPO	$393.87
Rate for Payer: BCBS Trust/PPO	$399.72
Rate for Payer: BCN Commercial	$388.57
Rate for Payer: BCN Medicare Advantage	$393.87
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cofinity Commercial	$527.79
Rate for Payer: Cofinity Commercial	$567.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$393.87
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$413.57
Rate for Payer: Nomi Health Commercial	$472.65
Rate for Payer: PACE SWMI	$393.87
Rate for Payer: PHP Medicare Advantage	$393.87
Rate for Payer: Priority Health Cigna Priority Health	$115.05
Rate for Payer: Priority Health Medicare	$397.81
Rate for Payer: UHC All Payor (Choice/PPO)	$393.87
Rate for Payer: UHC Dual Complete DSNP	$393.87
Rate for Payer: UHC Exchange	$393.87
Rate for Payer: UHC Medicare Advantage	$393.87

PRAMIPEXOLE 0.125 MG TABLET

Facility

$217.85

Service Code	NDC 68462033090
Hospital Charge Code	21287
Hospital Revenue Code	637
Min. Negotiated Rate	$51.74
Max. Negotiated Rate	$196.06
Rate for Payer: Aetna Commercial	$185.17
Rate for Payer: Aetna Medicare	$56.64
Rate for Payer: Allen County Amish Medical Aid Commercial	$68.08
Rate for Payer: Amish Plain Church Group Commercial	$68.08
Rate for Payer: BCBS Complete	$87.14
Rate for Payer: BCBS MAPPO	$54.46
Rate for Payer: BCBS Trust/PPO	$179.09
Rate for Payer: BCN Commercial	$169.38
Rate for Payer: BCN Medicare Advantage	$54.46
Rate for Payer: Cash Price	$174.28
Rate for Payer: Cofinity Commercial	$187.35
Rate for Payer: Encore Health Key Benefits Commercial	$174.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$54.46
Rate for Payer: Healthscope Commercial	$196.06
Rate for Payer: Lakeland Regional Health Systems Commercial	$163.39
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$57.19
Rate for Payer: MI Amish Medical Board Commercial	$62.63
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.17
Rate for Payer: Nomi Health Commercial	$178.64
Rate for Payer: PACE Senior Care Partners	$51.74
Rate for Payer: PACE SWMI	$54.46
Rate for Payer: PHP Commercial	$185.17
Rate for Payer: PHP Medicare Advantage	$54.46
Rate for Payer: Priority Health Cigna Priority Health	$141.60
Rate for Payer: Priority Health HMO/PPO	$189.53
Rate for Payer: Priority Health Medicare	$55.01
Rate for Payer: Priority Health Narrow/Tiered Network	$145.96
Rate for Payer: Railroad Medicare Medicare	$54.46
Rate for Payer: UHC All Payor (Choice/PPO)	$191.71
Rate for Payer: UHC Core	$181.90
Rate for Payer: UHC Dual Complete DSNP	$54.46
Rate for Payer: UHC Exchange	$54.46
Rate for Payer: UHC Medicare Advantage	$54.46
Rate for Payer: VA VA	$54.46
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$163.39

PRAMIPEXOLE 0.125 MG TABLET

Facility

$217.85

Service Code	NDC 68462033090
Hospital Charge Code	21287
Hospital Revenue Code	637
Min. Negotiated Rate	$141.60
Max. Negotiated Rate	$196.06
Rate for Payer: Aetna Commercial	$185.17
Rate for Payer: BCBS Trust/PPO	$177.83
Rate for Payer: BCN Commercial	$168.35
Rate for Payer: Cash Price	$174.28
Rate for Payer: Cofinity Commercial	$187.35
Rate for Payer: Encore Health Key Benefits Commercial	$174.28
Rate for Payer: Healthscope Commercial	$196.06
Rate for Payer: Lakeland Regional Health Systems Commercial	$163.39
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$185.17
Rate for Payer: Nomi Health Commercial	$178.64
Rate for Payer: PHP Commercial	$185.17
Rate for Payer: Priority Health Cigna Priority Health	$141.60
Rate for Payer: Priority Health HMO/PPO	$189.53
Rate for Payer: Priority Health Narrow/Tiered Network	$145.96
Rate for Payer: UHC All Payor (Choice/PPO)	$191.71
Rate for Payer: UHC Core	$181.90
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$163.39

Know your out-of-pocket cost for care.

All Charges