Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

ARIPIPRAZOLE 5 MG TABLET

Facility

$225.72

Service Code	NDC 65162-897-09
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$137.67
Max. Negotiated Rate	$203.15
Rate for Payer: Aetna Commercial	$191.86
Rate for Payer: BCBS Trust/PPO	$174.44
Rate for Payer: BCN Commercial	$174.44
Rate for Payer: Cash Price	$180.58
Rate for Payer: Cofinity Commercial	$194.12
Rate for Payer: Encore Health Key Benefits Commercial	$180.58
Rate for Payer: Healthscope Commercial	$203.15
Rate for Payer: Lakeland Regional Health Systems Commercial	$169.29
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$191.86
Rate for Payer: PHP Commercial	$191.86
Rate for Payer: Priority Health Cigna Priority Health	$158.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$196.38
Rate for Payer: Priority Health Narrow/Tiered Network	$137.67
Rate for Payer: UHC All Payor (Choice/PPO)	$198.63
Rate for Payer: UHC Core	$188.48
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$169.29

ARIPIPRAZOLE 5 MG TABLET

Facility

$1,773.41

Service Code	NDC 0904-6510-61
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$1,081.60
Max. Negotiated Rate	$1,596.07
Rate for Payer: Aetna Commercial	$1,507.40
Rate for Payer: BCBS Trust/PPO	$1,370.49
Rate for Payer: BCN Commercial	$1,370.49
Rate for Payer: Cash Price	$1,418.73
Rate for Payer: Cofinity Commercial	$1,525.13
Rate for Payer: Encore Health Key Benefits Commercial	$1,418.73
Rate for Payer: Healthscope Commercial	$1,596.07
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,330.06
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,507.40
Rate for Payer: PHP Commercial	$1,507.40
Rate for Payer: Priority Health Cigna Priority Health	$1,241.39
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,542.87
Rate for Payer: Priority Health Narrow/Tiered Network	$1,081.60
Rate for Payer: UHC All Payor (Choice/PPO)	$1,560.60
Rate for Payer: UHC Core	$1,480.80
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,330.06

ARIPIPRAZOLE 5 MG TABLET

Facility

$81.23

Service Code	NDC 65162-897-03
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$49.54
Max. Negotiated Rate	$73.11
Rate for Payer: Aetna Commercial	$69.05
Rate for Payer: BCBS Trust/PPO	$62.77
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 Multiplan/Beech St/PHCS	$69.05
Rate for Payer: PHP Commercial	$69.05
Rate for Payer: Priority Health Cigna Priority Health	$56.86
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$70.67
Rate for Payer: Priority Health Narrow/Tiered Network	$49.54
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

$93.75

Service Code	NDC 27241-052-03
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$57.18
Max. Negotiated Rate	$84.38
Rate for Payer: Aetna Commercial	$79.69
Rate for Payer: BCBS Trust/PPO	$72.45
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 Multiplan/Beech St/PHCS	$79.69
Rate for Payer: PHP Commercial	$79.69
Rate for Payer: Priority Health Cigna Priority Health	$65.62
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$81.56
Rate for Payer: Priority Health Narrow/Tiered Network	$57.18
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

ARIPIPRAZOLE 5 MG TABLET

Facility

$199.16

Service Code	NDC 60505-2673-3
Hospital Charge Code	36438
Hospital Revenue Code	637
Min. Negotiated Rate	$121.47
Max. Negotiated Rate	$179.24
Rate for Payer: Aetna Commercial	$169.29
Rate for Payer: BCBS Trust/PPO	$153.91
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 Multiplan/Beech St/PHCS	$169.29
Rate for Payer: PHP Commercial	$169.29
Rate for Payer: Priority Health Cigna Priority Health	$139.41
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$173.27
Rate for Payer: Priority Health Narrow/Tiered Network	$121.47
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

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

Facility

$204.01

Service Code	CPT 20605
Hospital Revenue Code	360
Min. Negotiated Rate	$194.29
Max. Negotiated Rate	$204.01
Rate for Payer: BCBS Complete	$204.01
Rate for Payer: Mclaren Medicaid	$194.29
Rate for Payer: Meridian Medicaid	$204.01
Rate for Payer: Priority Health Choice Medicaid	$194.29

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

Facility

$204.01

Service Code	CPT 20610
Hospital Revenue Code	360
Min. Negotiated Rate	$194.29
Max. Negotiated Rate	$204.01
Rate for Payer: BCBS Complete	$204.01
Rate for Payer: Mclaren Medicaid	$194.29
Rate for Payer: Meridian Medicaid	$204.01
Rate for Payer: Priority Health Choice Medicaid	$194.29

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

Facility

$204.01

Service Code	CPT 20610
Hospital Revenue Code	361
Min. Negotiated Rate	$194.29
Max. Negotiated Rate	$204.01
Rate for Payer: BCBS Complete	$204.01
Rate for Payer: Mclaren Medicaid	$194.29
Rate for Payer: Meridian Medicaid	$204.01
Rate for Payer: Priority Health Choice Medicaid	$194.29

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

Facility

$9,065.28

Service Code	CPT 27130
Hospital Revenue Code	360
Min. Negotiated Rate	$8,633.60
Max. Negotiated Rate	$9,065.28
Rate for Payer: BCBS Complete	$9,065.28
Rate for Payer: Mclaren Medicaid	$8,633.60
Rate for Payer: Meridian Medicaid	$9,065.28
Rate for Payer: Priority Health Choice Medicaid	$8,633.60

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

Facility

$12,836.37

Service Code	CPT 23472
Hospital Revenue Code	360
Min. Negotiated Rate	$12,225.11
Max. Negotiated Rate	$12,836.37
Rate for Payer: BCBS Complete	$12,836.37
Rate for Payer: Mclaren Medicaid	$12,225.11
Rate for Payer: Meridian Medicaid	$12,836.37
Rate for Payer: Priority Health Choice Medicaid	$12,225.11

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

Facility

$9,065.28

Service Code	CPT 27447
Hospital Revenue Code	360
Min. Negotiated Rate	$8,633.60
Max. Negotiated Rate	$9,065.28
Rate for Payer: BCBS Complete	$9,065.28
Rate for Payer: Mclaren Medicaid	$8,633.60
Rate for Payer: Meridian Medicaid	$9,065.28
Rate for Payer: Priority Health Choice Medicaid	$8,633.60

ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTION

Facility

$4,927.66

Service Code	CPT 29888
Hospital Revenue Code	360
Min. Negotiated Rate	$4,693.01
Max. Negotiated Rate	$4,927.66
Rate for Payer: BCBS Complete	$4,927.66
Rate for Payer: Mclaren Medicaid	$4,693.01
Rate for Payer: Meridian Medicaid	$4,927.66
Rate for Payer: Priority Health Choice Medicaid	$4,693.01

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

Facility

$2,229.50

Service Code	CPT 29875
Hospital Revenue Code	360
Min. Negotiated Rate	$2,123.34
Max. Negotiated Rate	$2,229.50
Rate for Payer: BCBS Complete	$2,229.50
Rate for Payer: Mclaren Medicaid	$2,123.34
Rate for Payer: Meridian Medicaid	$2,229.50
Rate for Payer: Priority Health Choice Medicaid	$2,123.34

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

Facility

$2,229.50

Service Code	CPT 29876
Hospital Revenue Code	360
Min. Negotiated Rate	$2,123.34
Max. Negotiated Rate	$2,229.50
Rate for Payer: BCBS Complete	$2,229.50
Rate for Payer: Mclaren Medicaid	$2,123.34
Rate for Payer: Meridian Medicaid	$2,229.50
Rate for Payer: Priority Health Choice Medicaid	$2,123.34

ARTHROSCOPY, KNEE, SURGICAL; WITH LATERAL RELEASE

Facility

$2,229.50

Service Code	CPT 29873
Hospital Revenue Code	360
Min. Negotiated Rate	$2,123.34
Max. Negotiated Rate	$2,229.50
Rate for Payer: BCBS Complete	$2,229.50
Rate for Payer: Mclaren Medicaid	$2,123.34
Rate for Payer: Meridian Medicaid	$2,229.50
Rate for Payer: Priority Health Choice Medicaid	$2,123.34

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

$2,229.50

Service Code	CPT 29880
Hospital Revenue Code	360
Min. Negotiated Rate	$2,123.34
Max. Negotiated Rate	$2,229.50
Rate for Payer: BCBS Complete	$2,229.50
Rate for Payer: Mclaren Medicaid	$2,123.34
Rate for Payer: Meridian Medicaid	$2,229.50
Rate for Payer: Priority Health Choice Medicaid	$2,123.34

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

$2,229.50

Service Code	CPT 29881
Hospital Revenue Code	360
Min. Negotiated Rate	$2,123.34
Max. Negotiated Rate	$2,229.50
Rate for Payer: BCBS Complete	$2,229.50
Rate for Payer: Mclaren Medicaid	$2,123.34
Rate for Payer: Meridian Medicaid	$2,229.50
Rate for Payer: Priority Health Choice Medicaid	$2,123.34

ARTHROSCOPY, SHOULDER, SURGICAL; BICEPS TENODESIS

Facility

$4,927.66

Service Code	CPT 29828
Hospital Revenue Code	360
Min. Negotiated Rate	$4,693.01
Max. Negotiated Rate	$4,927.66
Rate for Payer: BCBS Complete	$4,927.66
Rate for Payer: Mclaren Medicaid	$4,693.01
Rate for Payer: Meridian Medicaid	$4,927.66
Rate for Payer: Priority Health Choice Medicaid	$4,693.01

ARTHROSCOPY, SHOULDER, SURGICAL; CAPSULORRHAPHY

Facility

$4,927.66

Service Code	CPT 29806
Hospital Revenue Code	360
Min. Negotiated Rate	$4,693.01
Max. Negotiated Rate	$4,927.66
Rate for Payer: BCBS Complete	$4,927.66
Rate for Payer: Mclaren Medicaid	$4,693.01
Rate for Payer: Meridian Medicaid	$4,927.66
Rate for Payer: Priority Health Choice Medicaid	$4,693.01

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

$2,229.50

Service Code	CPT 29823
Hospital Revenue Code	360
Min. Negotiated Rate	$2,123.34
Max. Negotiated Rate	$2,229.50
Rate for Payer: BCBS Complete	$2,229.50
Rate for Payer: Mclaren Medicaid	$2,123.34
Rate for Payer: Meridian Medicaid	$2,229.50
Rate for Payer: Priority Health Choice Medicaid	$2,123.34

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

$2,229.50

Service Code	CPT 29822
Hospital Revenue Code	360
Min. Negotiated Rate	$2,123.34
Max. Negotiated Rate	$2,229.50
Rate for Payer: BCBS Complete	$2,229.50
Rate for Payer: Mclaren Medicaid	$2,123.34
Rate for Payer: Meridian Medicaid	$2,229.50
Rate for Payer: Priority Health Choice Medicaid	$2,123.34

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

Facility

$2,229.50

Service Code	CPT 29824
Hospital Revenue Code	360
Min. Negotiated Rate	$2,123.34
Max. Negotiated Rate	$2,229.50
Rate for Payer: BCBS Complete	$2,229.50
Rate for Payer: Mclaren Medicaid	$2,123.34
Rate for Payer: Meridian Medicaid	$2,229.50
Rate for Payer: Priority Health Choice Medicaid	$2,123.34

ARTHROSCOPY, SHOULDER, SURGICAL; REPAIR OF SLAP LESION

Facility

$4,927.66

Service Code	CPT 29807
Hospital Revenue Code	360
Min. Negotiated Rate	$4,693.01
Max. Negotiated Rate	$4,927.66
Rate for Payer: BCBS Complete	$4,927.66
Rate for Payer: Mclaren Medicaid	$4,693.01
Rate for Payer: Meridian Medicaid	$4,927.66
Rate for Payer: Priority Health Choice Medicaid	$4,693.01

ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, PARTIAL

Facility

$4,927.66

Service Code	CPT 29820
Hospital Revenue Code	360
Min. Negotiated Rate	$4,693.01
Max. Negotiated Rate	$4,927.66
Rate for Payer: BCBS Complete	$4,927.66
Rate for Payer: Mclaren Medicaid	$4,693.01
Rate for Payer: Meridian Medicaid	$4,927.66
Rate for Payer: Priority Health Choice Medicaid	$4,693.01

ARTHROSCOPY, SHOULDER, SURGICAL; WITH ROTATOR CUFF REPAIR

Facility

$4,927.66

Service Code	CPT 29827
Hospital Revenue Code	360
Min. Negotiated Rate	$4,693.01
Max. Negotiated Rate	$4,927.66
Rate for Payer: BCBS Complete	$4,927.66
Rate for Payer: Mclaren Medicaid	$4,693.01
Rate for Payer: Meridian Medicaid	$4,927.66
Rate for Payer: Priority Health Choice Medicaid	$4,693.01

Know your out-of-pocket cost for care.

All Charges