Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR ARTERY EXPOS/GRAFT ARTERY PERFUSION ECMO/ECLS

Professional

Both

$455.00

Service Code	HCPCS 33987
Min. Negotiated Rate	$121.41
Max. Negotiated Rate	$341.25
Rate for Payer: Aetna Commercial	$281.69
Rate for Payer: Aetna Medicare	$227.50
Rate for Payer: BCBS Complete	$127.48
Rate for Payer: BCN Commercial	$301.78
Rate for Payer: Cash Price	$364.00
Rate for Payer: Cash Price	$364.00
Rate for Payer: Mclaren Medicaid	$121.41
Rate for Payer: Meridian Medicaid	$127.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$341.25
Rate for Payer: Priority Health Choice Medicaid	$121.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$324.52
Rate for Payer: Priority Health Narrow/Tiered Network	$324.52
Rate for Payer: UHC Medicaid	$121.41
Rate for Payer: UHCCP Medicaid	$121.41

PR ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2

Professional

Both

$4,548.00

Service Code	HCPCS 22551
Min. Negotiated Rate	$1,023.47
Max. Negotiated Rate	$3,411.00
Rate for Payer: Aetna Commercial	$2,284.82
Rate for Payer: Aetna Medicare	$2,274.00
Rate for Payer: BCBS Complete	$1,074.64
Rate for Payer: BCN Commercial	$2,576.55
Rate for Payer: Cash Price	$3,638.40
Rate for Payer: Cash Price	$3,638.40
Rate for Payer: Mclaren Medicaid	$1,023.47
Rate for Payer: Meridian Medicaid	$1,074.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,411.00
Rate for Payer: Priority Health Choice Medicaid	$1,023.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,754.27
Rate for Payer: Priority Health Narrow/Tiered Network	$2,754.27
Rate for Payer: UHC Medicaid	$1,023.47
Rate for Payer: UHCCP Medicaid	$1,023.47

PR ARTHRD ANT INTERBODY MIN DSC CRV BELOW C2

Professional

Both

$5,063.00

Service Code	HCPCS 22554
Min. Negotiated Rate	$775.32
Max. Negotiated Rate	$3,797.25
Rate for Payer: Aetna Commercial	$1,684.41
Rate for Payer: Aetna Medicare	$2,531.50
Rate for Payer: BCBS Complete	$814.09
Rate for Payer: BCN Commercial	$2,109.50
Rate for Payer: Cash Price	$4,050.40
Rate for Payer: Cash Price	$4,050.40
Rate for Payer: Mclaren Medicaid	$775.32
Rate for Payer: Meridian Medicaid	$814.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,797.25
Rate for Payer: Priority Health Choice Medicaid	$775.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,052.65
Rate for Payer: Priority Health Narrow/Tiered Network	$2,052.65
Rate for Payer: UHC Medicaid	$775.32
Rate for Payer: UHCCP Medicaid	$775.32

PR ARTHRD ANT INTERBODY MIN DSC LUMBAR

Professional

Both

$3,286.00

Service Code	HCPCS 22558
Min. Negotiated Rate	$908.02
Max. Negotiated Rate	$2,532.92
Rate for Payer: Aetna Commercial	$2,054.27
Rate for Payer: Aetna Medicare	$1,643.00
Rate for Payer: BCBS Complete	$953.42
Rate for Payer: BCN Commercial	$2,532.92
Rate for Payer: Cash Price	$2,628.80
Rate for Payer: Cash Price	$2,628.80
Rate for Payer: Mclaren Medicaid	$908.02
Rate for Payer: Meridian Medicaid	$953.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,464.50
Rate for Payer: Priority Health Choice Medicaid	$908.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,464.67
Rate for Payer: Priority Health Narrow/Tiered Network	$2,464.67
Rate for Payer: UHC Medicaid	$908.02
Rate for Payer: UHCCP Medicaid	$908.02

PR ARTHRD ANT INTERBODY MIN DSC THORACIC

Professional

Both

$6,162.00

Service Code	HCPCS 22556
Min. Negotiated Rate	$1,019.63
Max. Negotiated Rate	$4,621.50
Rate for Payer: Aetna Commercial	$2,232.24
Rate for Payer: Aetna Medicare	$3,081.00
Rate for Payer: BCBS Complete	$1,070.61
Rate for Payer: BCN Commercial	$2,807.01
Rate for Payer: Cash Price	$4,929.60
Rate for Payer: Cash Price	$4,929.60
Rate for Payer: Mclaren Medicaid	$1,019.63
Rate for Payer: Meridian Medicaid	$1,070.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,621.50
Rate for Payer: Priority Health Choice Medicaid	$1,019.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,731.38
Rate for Payer: Priority Health Narrow/Tiered Network	$2,731.38
Rate for Payer: UHC Medicaid	$1,019.63
Rate for Payer: UHCCP Medicaid	$1,019.63

PR ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC

Professional

Both

$1,062.00

Service Code	HCPCS 22552
Min. Negotiated Rate	$225.14
Max. Negotiated Rate	$796.50
Rate for Payer: Aetna Commercial	$532.98
Rate for Payer: Aetna Medicare	$531.00
Rate for Payer: BCBS Complete	$236.40
Rate for Payer: BCN Commercial	$593.10
Rate for Payer: Cash Price	$849.60
Rate for Payer: Cash Price	$849.60
Rate for Payer: Mclaren Medicaid	$225.14
Rate for Payer: Meridian Medicaid	$236.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$796.50
Rate for Payer: Priority Health Choice Medicaid	$225.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$634.01
Rate for Payer: Priority Health Narrow/Tiered Network	$634.01
Rate for Payer: UHC Medicaid	$225.14
Rate for Payer: UHCCP Medicaid	$225.14

PR ARTHRD ANT NTRBD MIN DSC EA ADDL INTERSPACE

Professional

Both

$1,717.00

Service Code	HCPCS 22585
Min. Negotiated Rate	$183.39
Max. Negotiated Rate	$1,287.75
Rate for Payer: Aetna Commercial	$439.49
Rate for Payer: Aetna Medicare	$858.50
Rate for Payer: BCBS Complete	$192.56
Rate for Payer: BCN Commercial	$531.75
Rate for Payer: Cash Price	$1,373.60
Rate for Payer: Cash Price	$1,373.60
Rate for Payer: Mclaren Medicaid	$183.39
Rate for Payer: Meridian Medicaid	$192.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,287.75
Rate for Payer: Priority Health Choice Medicaid	$183.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$517.43
Rate for Payer: Priority Health Narrow/Tiered Network	$517.43
Rate for Payer: UHC Medicaid	$183.39
Rate for Payer: UHCCP Medicaid	$183.39

PR ARTHRD CARP/MTCRPL JT DGT OTHER THAN THUMB EACH

Professional

Both

$3,204.00

Service Code	HCPCS 26843
Min. Negotiated Rate	$490.75
Max. Negotiated Rate	$2,403.00
Rate for Payer: Aetna Commercial	$1,037.06
Rate for Payer: Aetna Medicare	$1,602.00
Rate for Payer: BCBS Complete	$515.29
Rate for Payer: BCN Commercial	$1,180.21
Rate for Payer: Cash Price	$2,563.20
Rate for Payer: Cash Price	$2,563.20
Rate for Payer: Mclaren Medicaid	$490.75
Rate for Payer: Meridian Medicaid	$515.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,403.00
Rate for Payer: Priority Health Choice Medicaid	$490.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,261.61
Rate for Payer: Priority Health Narrow/Tiered Network	$1,261.61
Rate for Payer: UHC Medicaid	$490.75
Rate for Payer: UHCCP Medicaid	$490.75

PR ARTHRD CARP/MTCRPL JT DGT OTH/THN THMB W/AGRFT

Professional

Both

$3,448.00

Service Code	HCPCS 26844
Min. Negotiated Rate	$536.12
Max. Negotiated Rate	$2,586.00
Rate for Payer: Aetna Commercial	$1,141.96
Rate for Payer: Aetna Medicare	$1,724.00
Rate for Payer: BCBS Complete	$562.93
Rate for Payer: BCN Commercial	$1,299.73
Rate for Payer: Cash Price	$2,758.40
Rate for Payer: Cash Price	$2,758.40
Rate for Payer: Mclaren Medicaid	$536.12
Rate for Payer: Meridian Medicaid	$562.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,586.00
Rate for Payer: Priority Health Choice Medicaid	$536.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,389.37
Rate for Payer: Priority Health Narrow/Tiered Network	$1,389.37
Rate for Payer: UHC Medicaid	$536.12
Rate for Payer: UHCCP Medicaid	$536.12

PR ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ

Professional

Both

$3,204.00

Service Code	HCPCS 26841
Min. Negotiated Rate	$479.04
Max. Negotiated Rate	$2,403.00
Rate for Payer: Aetna Commercial	$1,018.84
Rate for Payer: Aetna Medicare	$1,602.00
Rate for Payer: BCBS Complete	$502.99
Rate for Payer: BCN Commercial	$1,167.26
Rate for Payer: Cash Price	$2,563.20
Rate for Payer: Cash Price	$2,563.20
Rate for Payer: Mclaren Medicaid	$479.04
Rate for Payer: Meridian Medicaid	$502.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,403.00
Rate for Payer: Priority Health Choice Medicaid	$479.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,247.77
Rate for Payer: Priority Health Narrow/Tiered Network	$1,247.77
Rate for Payer: UHC Medicaid	$479.04
Rate for Payer: UHCCP Medicaid	$479.04

PR ARTHRD CRP/MTACRPL JT THMB W/WO INT FIXJ W/AGRFT

Professional

Both

$3,399.00

Service Code	HCPCS 26842
Min. Negotiated Rate	$520.36
Max. Negotiated Rate	$2,549.25
Rate for Payer: Aetna Commercial	$1,103.54
Rate for Payer: Aetna Medicare	$1,699.50
Rate for Payer: BCBS Complete	$546.38
Rate for Payer: BCN Commercial	$1,257.41
Rate for Payer: Cash Price	$2,719.20
Rate for Payer: Cash Price	$2,719.20
Rate for Payer: Mclaren Medicaid	$520.36
Rate for Payer: Meridian Medicaid	$546.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,549.25
Rate for Payer: Priority Health Choice Medicaid	$520.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,344.13
Rate for Payer: Priority Health Narrow/Tiered Network	$1,344.13
Rate for Payer: UHC Medicaid	$520.36
Rate for Payer: UHCCP Medicaid	$520.36

PR ARTHRD DSTL RAD/ULN JT SGMTL RSCJ ULNA W/WO BONE

Professional

Both

$1,737.00

Service Code	HCPCS 25830
Min. Negotiated Rate	$618.98
Max. Negotiated Rate	$1,659.26
Rate for Payer: Aetna Commercial	$1,340.21
Rate for Payer: Aetna Medicare	$868.50
Rate for Payer: BCBS Complete	$649.93
Rate for Payer: BCN Commercial	$1,552.20
Rate for Payer: Cash Price	$1,389.60
Rate for Payer: Cash Price	$1,389.60
Rate for Payer: Mclaren Medicaid	$618.98
Rate for Payer: Meridian Medicaid	$649.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,302.75
Rate for Payer: Priority Health Choice Medicaid	$618.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,659.26
Rate for Payer: Priority Health Narrow/Tiered Network	$1,659.26
Rate for Payer: UHC Medicaid	$618.98
Rate for Payer: UHCCP Medicaid	$618.98

PR ARTHRD MIDTARSL/TARS MLT/TRANSVRS W/OSTEOT

Professional

Both

$2,958.00

Service Code	HCPCS 28735
Min. Negotiated Rate	$464.55
Max. Negotiated Rate	$2,218.50
Rate for Payer: Aetna Commercial	$1,039.96
Rate for Payer: Aetna Medicare	$1,479.00
Rate for Payer: BCBS Complete	$487.78
Rate for Payer: BCN Commercial	$1,181.21
Rate for Payer: Cash Price	$2,366.40
Rate for Payer: Cash Price	$2,366.40
Rate for Payer: Mclaren Medicaid	$464.55
Rate for Payer: Meridian Medicaid	$487.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,218.50
Rate for Payer: Priority Health Choice Medicaid	$464.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,262.68
Rate for Payer: Priority Health Narrow/Tiered Network	$1,262.68
Rate for Payer: UHC Medicaid	$464.55
Rate for Payer: UHCCP Medicaid	$464.55

PR ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS

Professional

Both

$2,866.00

Service Code	HCPCS 28730
Min. Negotiated Rate	$432.60
Max. Negotiated Rate	$2,149.50
Rate for Payer: Aetna Commercial	$976.15
Rate for Payer: Aetna Medicare	$1,433.00
Rate for Payer: BCBS Complete	$454.23
Rate for Payer: BCN Commercial	$1,099.54
Rate for Payer: Cash Price	$2,292.80
Rate for Payer: Cash Price	$2,292.80
Rate for Payer: Mclaren Medicaid	$432.60
Rate for Payer: Meridian Medicaid	$454.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,149.50
Rate for Payer: Priority Health Choice Medicaid	$432.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,175.38
Rate for Payer: Priority Health Narrow/Tiered Network	$1,175.38
Rate for Payer: UHC Medicaid	$432.60
Rate for Payer: UHCCP Medicaid	$432.60

PR ARTHRD PST/PSTLAT TQ 1NTRSPC CRV BELW C2 SEGMENT

Professional

Both

$4,498.00

Service Code	HCPCS 22600
Min. Negotiated Rate	$818.13
Max. Negotiated Rate	$3,373.50
Rate for Payer: Aetna Commercial	$1,732.46
Rate for Payer: Aetna Medicare	$2,249.00
Rate for Payer: BCBS Complete	$859.04
Rate for Payer: BCN Commercial	$2,186.63
Rate for Payer: Cash Price	$3,598.40
Rate for Payer: Cash Price	$3,598.40
Rate for Payer: Mclaren Medicaid	$818.13
Rate for Payer: Meridian Medicaid	$859.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,373.50
Rate for Payer: Priority Health Choice Medicaid	$818.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,127.71
Rate for Payer: Priority Health Narrow/Tiered Network	$2,127.71
Rate for Payer: UHC Medicaid	$818.13
Rate for Payer: UHCCP Medicaid	$818.13

PR ARTHRD SI JT PLMT TRANSARTICULAR&/I-ARTIC DEVICE

Professional

Both

$1,355.00

Service Code	HCPCS 27279
Min. Negotiated Rate	$483.72
Max. Negotiated Rate	$1,300.47
Rate for Payer: Aetna Commercial	$1,152.73
Rate for Payer: Aetna Medicare	$677.50
Rate for Payer: BCBS Complete	$507.91
Rate for Payer: BCN Commercial	$1,216.57
Rate for Payer: Cash Price	$1,084.00
Rate for Payer: Cash Price	$1,084.00
Rate for Payer: Mclaren Medicaid	$483.72
Rate for Payer: Meridian Medicaid	$507.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,016.25
Rate for Payer: Priority Health Choice Medicaid	$483.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,300.47
Rate for Payer: Priority Health Narrow/Tiered Network	$1,300.47
Rate for Payer: UHC Medicaid	$483.72
Rate for Payer: UHCCP Medicaid	$483.72

PR ARTHRD W/TDN LNGTH&ADVMNT TARSL NVCLR-CUNEIFOR

Professional

Both

$1,261.00

Service Code	HCPCS 28737
Min. Negotiated Rate	$403.00
Max. Negotiated Rate	$1,110.97
Rate for Payer: Aetna Commercial	$910.09
Rate for Payer: Aetna Medicare	$630.50
Rate for Payer: BCBS Complete	$423.15
Rate for Payer: BCN Commercial	$1,039.29
Rate for Payer: Cash Price	$1,008.80
Rate for Payer: Cash Price	$1,008.80
Rate for Payer: Mclaren Medicaid	$403.00
Rate for Payer: Meridian Medicaid	$423.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$945.75
Rate for Payer: Priority Health Choice Medicaid	$403.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,110.97
Rate for Payer: Priority Health Narrow/Tiered Network	$1,110.97
Rate for Payer: UHC Medicaid	$403.00
Rate for Payer: UHCCP Medicaid	$403.00

PR ARTHRD W/XTNSR HALLUCIS LONGUS TR 1ST METAR NCK

Professional

Both

$1,516.00

Service Code	HCPCS 28760
Min. Negotiated Rate	$342.29
Max. Negotiated Rate	$1,137.00
Rate for Payer: Aetna Commercial	$754.22
Rate for Payer: Aetna Medicare	$758.00
Rate for Payer: BCBS Complete	$359.40
Rate for Payer: BCN Commercial	$864.49
Rate for Payer: Cash Price	$1,212.80
Rate for Payer: Cash Price	$1,212.80
Rate for Payer: Mclaren Medicaid	$342.29
Rate for Payer: Meridian Medicaid	$359.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,137.00
Rate for Payer: Priority Health Choice Medicaid	$342.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$924.13
Rate for Payer: Priority Health Narrow/Tiered Network	$924.13
Rate for Payer: UHC Medicaid	$342.29
Rate for Payer: UHCCP Medicaid	$342.29

PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US

Professional

Both

$128.00

Service Code	HCPCS 20605
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$96.00
Rate for Payer: Aetna Commercial	$49.91
Rate for Payer: Aetna Medicare	$64.00
Rate for Payer: BCBS Complete	$21.47
Rate for Payer: BCN Commercial	$43.20
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cash Price	$102.40
Rate for Payer: Mclaren Medicaid	$20.45
Rate for Payer: Meridian Medicaid	$21.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$96.00
Rate for Payer: Priority Health Choice Medicaid	$20.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$58.55
Rate for Payer: Priority Health Narrow/Tiered Network	$58.55
Rate for Payer: UHC Medicaid	$20.45
Rate for Payer: UHCCP Medicaid	$20.45

PR ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US

Professional

Both

$151.00

Service Code	HCPCS 20606
Min. Negotiated Rate	$28.54
Max. Negotiated Rate	$113.25
Rate for Payer: Aetna Commercial	$71.12
Rate for Payer: Aetna Medicare	$75.50
Rate for Payer: BCBS Complete	$29.97
Rate for Payer: BCN Commercial	$61.26
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cash Price	$120.80
Rate for Payer: Mclaren Medicaid	$28.54
Rate for Payer: Meridian Medicaid	$29.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$113.25
Rate for Payer: Priority Health Choice Medicaid	$28.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$83.04
Rate for Payer: Priority Health Narrow/Tiered Network	$83.04
Rate for Payer: UHC Medicaid	$28.54
Rate for Payer: UHCCP Medicaid	$28.54

PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US

Facility

$190.00

Service Code	CPT 20610
Hospital Charge Code	20610
Hospital Revenue Code	521
Min. Negotiated Rate	$33.50
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: Aetna Medicare	$49.40
Rate for Payer: Allen County Amish Medical Aid Commercial	$59.38
Rate for Payer: Amish Plain Church Group Commercial	$59.38
Rate for Payer: BCBS Complete	$35.17
Rate for Payer: BCBS MAPPO	$47.50
Rate for Payer: BCBS Trust/PPO	$156.20
Rate for Payer: BCN Commercial	$156.20
Rate for Payer: BCN Medicare Advantage	$47.50
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cofinity Commercial	$163.40
Rate for Payer: Encore Health Key Benefits Commercial	$152.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$47.50
Rate for Payer: Healthscope Commercial	$171.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$142.50
Rate for Payer: Mclaren Medicaid	$33.50
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$49.88
Rate for Payer: Meridian Medicaid	$35.17
Rate for Payer: MI Amish Medical Board Commercial	$54.62
Rate for Payer: Molina Medicare/Medicaid	$52.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$161.50
Rate for Payer: Nomi Health Commercial	$155.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$142.50
Rate for Payer: PACE Senior Care Partners	$45.12
Rate for Payer: PACE SWMI	$47.50
Rate for Payer: PHP Commercial	$161.50
Rate for Payer: PHP Medicare Advantage	$47.50
Rate for Payer: Priority Health Choice Medicaid	$33.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$165.30
Rate for Payer: Priority Health Medicare	$47.98
Rate for Payer: Priority Health Narrow/Tiered Network	$132.24
Rate for Payer: Railroad Medicare Medicare	$47.50
Rate for Payer: UHC Core	$158.65
Rate for Payer: UHC Exchange	$47.50
Rate for Payer: UHC Medicaid	$33.50
Rate for Payer: UHC Medicare Advantage	$47.50
Rate for Payer: UHCCP Medicaid	$33.50
Rate for Payer: VA VA	$47.50
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$142.50

PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US

Facility

$190.00

Service Code	CPT 20610
Hospital Charge Code	20610
Hospital Revenue Code	521
Min. Negotiated Rate	$132.24
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna Commercial	$161.50
Rate for Payer: BCBS Trust/PPO	$156.92
Rate for Payer: BCN Commercial	$156.92
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cofinity Commercial	$163.40
Rate for Payer: Encore Health Key Benefits Commercial	$152.00
Rate for Payer: Healthscope Commercial	$171.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$142.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$161.50
Rate for Payer: Nomi Health Commercial	$155.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$142.50
Rate for Payer: PHP Commercial	$161.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$165.30
Rate for Payer: Priority Health Narrow/Tiered Network	$132.24
Rate for Payer: UHC Core	$158.65
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$142.50

PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US

Professional

Both

$190.00

Service Code	HCPCS 20610
Hospital Charge Code	20610
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$142.50
Rate for Payer: Aetna Commercial	$61.23
Rate for Payer: Aetna Medicare	$95.00
Rate for Payer: BCBS Complete	$26.62
Rate for Payer: BCN Commercial	$53.41
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Mclaren Medicaid	$25.35
Rate for Payer: Meridian Medicaid	$26.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$142.50
Rate for Payer: Priority Health Choice Medicaid	$25.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$72.39
Rate for Payer: Priority Health Narrow/Tiered Network	$72.39
Rate for Payer: UHC Medicaid	$25.35
Rate for Payer: UHCCP Medicaid	$25.35

PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US

Professional

Both

$190.00

Service Code	HCPCS 20610
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$142.50
Rate for Payer: Aetna Commercial	$61.23
Rate for Payer: Aetna Medicare	$95.00
Rate for Payer: BCBS Complete	$26.62
Rate for Payer: BCN Commercial	$53.41
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Mclaren Medicaid	$25.35
Rate for Payer: Meridian Medicaid	$26.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$142.50
Rate for Payer: Priority Health Choice Medicaid	$25.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$72.39
Rate for Payer: Priority Health Narrow/Tiered Network	$72.39
Rate for Payer: UHC Medicaid	$25.35
Rate for Payer: UHCCP Medicaid	$25.35

PR ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US

Facility

$200.00

Service Code	CPT 20611
Hospital Charge Code	20611
Hospital Revenue Code	521
Min. Negotiated Rate	$35.26
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$170.00
Rate for Payer: Aetna Medicare	$52.00
Rate for Payer: Allen County Amish Medical Aid Commercial	$62.50
Rate for Payer: Amish Plain Church Group Commercial	$62.50
Rate for Payer: BCBS Complete	$37.02
Rate for Payer: BCBS MAPPO	$50.00
Rate for Payer: BCBS Trust/PPO	$164.42
Rate for Payer: BCN Commercial	$164.42
Rate for Payer: BCN Medicare Advantage	$50.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cofinity Commercial	$172.00
Rate for Payer: Encore Health Key Benefits Commercial	$160.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$50.00
Rate for Payer: Healthscope Commercial	$180.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$150.00
Rate for Payer: Mclaren Medicaid	$35.26
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$52.50
Rate for Payer: Meridian Medicaid	$37.02
Rate for Payer: MI Amish Medical Board Commercial	$57.50
Rate for Payer: Molina Medicare/Medicaid	$55.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$170.00
Rate for Payer: Nomi Health Commercial	$164.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$150.00
Rate for Payer: PACE Senior Care Partners	$47.50
Rate for Payer: PACE SWMI	$50.00
Rate for Payer: PHP Commercial	$170.00
Rate for Payer: PHP Medicare Advantage	$50.00
Rate for Payer: Priority Health Choice Medicaid	$35.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$174.00
Rate for Payer: Priority Health Medicare	$50.50
Rate for Payer: Priority Health Narrow/Tiered Network	$139.20
Rate for Payer: Railroad Medicare Medicare	$50.00
Rate for Payer: UHC Core	$167.00
Rate for Payer: UHC Exchange	$50.00
Rate for Payer: UHC Medicaid	$35.26
Rate for Payer: UHC Medicare Advantage	$50.00
Rate for Payer: UHCCP Medicaid	$35.26
Rate for Payer: VA VA	$50.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$150.00

Know your out-of-pocket cost for care.

All Charges