Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN

Professional

Both

$918.00

Service Code	HCPCS 15823
Min. Negotiated Rate	$367.20
Max. Negotiated Rate	$734.86
Rate for Payer: Aetna Commercial	$683.83
Rate for Payer: Aetna Medicare	$530.73
Rate for Payer: BCBS Complete	$367.20
Rate for Payer: BCBS MAPPO	$510.32
Rate for Payer: BCN Medicare Advantage	$510.32
Rate for Payer: Cash Price	$734.40
Rate for Payer: Cash Price	$734.40
Rate for Payer: Cofinity Commercial	$734.86
Rate for Payer: Cofinity Commercial	$683.83
Rate for Payer: Health Alliance Plan Medicare Advantage	$510.32
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$535.84
Rate for Payer: Nomi Health Commercial	$612.38
Rate for Payer: PACE SWMI	$510.32
Rate for Payer: PHP Medicare Advantage	$510.32
Rate for Payer: Priority Health Cigna Priority Health	$596.70
Rate for Payer: Priority Health Medicare	$515.42
Rate for Payer: UHC All Payor (Choice/PPO)	$510.32
Rate for Payer: UHC Dual Complete DSNP	$510.32
Rate for Payer: UHC Exchange	$510.32
Rate for Payer: UHC Medicare Advantage	$510.32

PR BLEPHAROTOMY DRAINAGE ABSCESS EYELID

Professional

Both

$443.00

Service Code	HCPCS 67700
Min. Negotiated Rate	$107.89
Max. Negotiated Rate	$287.95
Rate for Payer: Aetna Commercial	$144.57
Rate for Payer: Aetna Medicare	$112.21
Rate for Payer: BCBS Complete	$177.20
Rate for Payer: BCBS MAPPO	$107.89
Rate for Payer: BCN Medicare Advantage	$107.89
Rate for Payer: Cash Price	$354.40
Rate for Payer: Cash Price	$354.40
Rate for Payer: Cofinity Commercial	$155.36
Rate for Payer: Cofinity Commercial	$144.57
Rate for Payer: Health Alliance Plan Medicare Advantage	$107.89
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$113.28
Rate for Payer: Nomi Health Commercial	$129.47
Rate for Payer: PACE SWMI	$107.89
Rate for Payer: PHP Medicare Advantage	$107.89
Rate for Payer: Priority Health Cigna Priority Health	$287.95
Rate for Payer: Priority Health Medicare	$108.97
Rate for Payer: UHC All Payor (Choice/PPO)	$107.89
Rate for Payer: UHC Dual Complete DSNP	$107.89
Rate for Payer: UHC Exchange	$107.89
Rate for Payer: UHC Medicare Advantage	$107.89

PR BLUE TIDAL

Professional

Both

$61.00

Service Code	HCPCS 00072
Hospital Revenue Code	990
Min. Negotiated Rate	$24.40
Max. Negotiated Rate	$39.65
Rate for Payer: Aetna Medicare	$30.50
Rate for Payer: BCBS Complete	$24.40
Rate for Payer: Cash Price	$48.80
Rate for Payer: Priority Health Cigna Priority Health	$39.65

PR BONE GRAFT ANY DONOR AREA MAJOR/LARGE

Professional

Both

$1,253.00

Service Code	HCPCS 20902
Min. Negotiated Rate	$262.65
Max. Negotiated Rate	$814.45
Rate for Payer: Aetna Commercial	$351.95
Rate for Payer: Aetna Medicare	$273.16
Rate for Payer: BCBS Complete	$501.20
Rate for Payer: BCBS MAPPO	$262.65
Rate for Payer: BCN Medicare Advantage	$262.65
Rate for Payer: Cash Price	$1,002.40
Rate for Payer: Cash Price	$1,002.40
Rate for Payer: Cofinity Commercial	$378.22
Rate for Payer: Cofinity Commercial	$351.95
Rate for Payer: Health Alliance Plan Medicare Advantage	$262.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$275.78
Rate for Payer: Nomi Health Commercial	$315.18
Rate for Payer: PACE SWMI	$262.65
Rate for Payer: PHP Medicare Advantage	$262.65
Rate for Payer: Priority Health Cigna Priority Health	$814.45
Rate for Payer: Priority Health Medicare	$265.28
Rate for Payer: UHC All Payor (Choice/PPO)	$262.65
Rate for Payer: UHC Dual Complete DSNP	$262.65
Rate for Payer: UHC Exchange	$262.65
Rate for Payer: UHC Medicare Advantage	$262.65

PR BONE GRAFT ANY DONOR AREA MINOR/SMALL

Professional

Both

$909.00

Service Code	HCPCS 20900
Min. Negotiated Rate	$172.59
Max. Negotiated Rate	$590.85
Rate for Payer: Aetna Commercial	$231.27
Rate for Payer: Aetna Medicare	$179.49
Rate for Payer: BCBS Complete	$363.60
Rate for Payer: BCBS MAPPO	$172.59
Rate for Payer: BCN Medicare Advantage	$172.59
Rate for Payer: Cash Price	$727.20
Rate for Payer: Cash Price	$727.20
Rate for Payer: Cofinity Commercial	$248.53
Rate for Payer: Cofinity Commercial	$231.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$172.59
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$181.22
Rate for Payer: Nomi Health Commercial	$207.11
Rate for Payer: PACE SWMI	$172.59
Rate for Payer: PHP Medicare Advantage	$172.59
Rate for Payer: Priority Health Cigna Priority Health	$590.85
Rate for Payer: Priority Health Medicare	$174.32
Rate for Payer: UHC All Payor (Choice/PPO)	$172.59
Rate for Payer: UHC Dual Complete DSNP	$172.59
Rate for Payer: UHC Exchange	$172.59
Rate for Payer: UHC Medicare Advantage	$172.59

PR BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR

Professional

Both

$4,588.00

Service Code	HCPCS 20962
Min. Negotiated Rate	$1,835.20
Max. Negotiated Rate	$3,689.47
Rate for Payer: Aetna Commercial	$3,433.25
Rate for Payer: Aetna Medicare	$2,664.62
Rate for Payer: BCBS Complete	$1,835.20
Rate for Payer: BCBS MAPPO	$2,562.13
Rate for Payer: BCN Medicare Advantage	$2,562.13
Rate for Payer: Cash Price	$3,670.40
Rate for Payer: Cash Price	$3,670.40
Rate for Payer: Cofinity Commercial	$3,689.47
Rate for Payer: Cofinity Commercial	$3,433.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,562.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,690.24
Rate for Payer: Nomi Health Commercial	$3,074.56
Rate for Payer: PACE SWMI	$2,562.13
Rate for Payer: PHP Medicare Advantage	$2,562.13
Rate for Payer: Priority Health Cigna Priority Health	$2,982.20
Rate for Payer: Priority Health Medicare	$2,587.75
Rate for Payer: UHC All Payor (Choice/PPO)	$2,562.13
Rate for Payer: UHC Dual Complete DSNP	$2,562.13
Rate for Payer: UHC Exchange	$2,562.13
Rate for Payer: UHC Medicare Advantage	$2,562.13

PR BOTOX UNIT

Professional

Both

$13.00

Service Code	HCPCS 00084
Hospital Revenue Code	990
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$8.45
Rate for Payer: Aetna Medicare	$6.50
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$8.45

PR BRACHIOPLASTY

Professional

Both

$4,590.00

Service Code	HCPCS 00537
Hospital Revenue Code	990
Min. Negotiated Rate	$1,836.00
Max. Negotiated Rate	$2,983.50
Rate for Payer: Aetna Medicare	$2,295.00
Rate for Payer: BCBS Complete	$1,836.00
Rate for Payer: Cash Price	$3,672.00
Rate for Payer: Priority Health Cigna Priority Health	$2,983.50

PR BREAST AUGMENTATION WITH IMPLANT

Professional

Both

$2,040.00

Service Code	HCPCS 19325
Min. Negotiated Rate	$588.61
Max. Negotiated Rate	$1,326.00
Rate for Payer: Aetna Commercial	$788.74
Rate for Payer: Aetna Medicare	$612.15
Rate for Payer: BCBS Complete	$816.00
Rate for Payer: BCBS MAPPO	$588.61
Rate for Payer: BCN Medicare Advantage	$588.61
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Cofinity Commercial	$847.60
Rate for Payer: Cofinity Commercial	$788.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$588.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$618.04
Rate for Payer: Nomi Health Commercial	$706.33
Rate for Payer: PACE SWMI	$588.61
Rate for Payer: PHP Medicare Advantage	$588.61
Rate for Payer: Priority Health Cigna Priority Health	$1,326.00
Rate for Payer: Priority Health Medicare	$594.50
Rate for Payer: UHC All Payor (Choice/PPO)	$588.61
Rate for Payer: UHC Dual Complete DSNP	$588.61
Rate for Payer: UHC Exchange	$588.61
Rate for Payer: UHC Medicare Advantage	$588.61

PR BREAST AUGMENT W MASTOPEXY-GEL 2.5

Professional

Both

$6,671.00

Service Code	HCPCS 00258
Hospital Revenue Code	990
Min. Negotiated Rate	$2,668.40
Max. Negotiated Rate	$4,336.15
Rate for Payer: Aetna Medicare	$3,335.50
Rate for Payer: BCBS Complete	$2,668.40
Rate for Payer: Cash Price	$5,336.80
Rate for Payer: Priority Health Cigna Priority Health	$4,336.15

PR BREAST AUGMENT W MASTOPEXY-GEL 3.5

Professional

Both

$7,589.00

Service Code	HCPCS 00260
Hospital Revenue Code	990
Min. Negotiated Rate	$3,035.60
Max. Negotiated Rate	$4,932.85
Rate for Payer: Aetna Medicare	$3,794.50
Rate for Payer: BCBS Complete	$3,035.60
Rate for Payer: Cash Price	$6,071.20
Rate for Payer: Priority Health Cigna Priority Health	$4,932.85

PR BREAST AUGMENT W MASTOPEXY-SALINE 2.5

Professional

Both

$5,610.00

Service Code	HCPCS 00257
Hospital Revenue Code	990
Min. Negotiated Rate	$2,244.00
Max. Negotiated Rate	$3,646.50
Rate for Payer: Aetna Medicare	$2,805.00
Rate for Payer: BCBS Complete	$2,244.00
Rate for Payer: Cash Price	$4,488.00
Rate for Payer: Priority Health Cigna Priority Health	$3,646.50

PR BREAST AUGMENT W MASTOPEXY-SALINE 3.5

Professional

Both

$6,528.00

Service Code	HCPCS 00259
Hospital Revenue Code	990
Min. Negotiated Rate	$2,611.20
Max. Negotiated Rate	$4,243.20
Rate for Payer: Aetna Medicare	$3,264.00
Rate for Payer: BCBS Complete	$2,611.20
Rate for Payer: Cash Price	$5,222.40
Rate for Payer: Priority Health Cigna Priority Health	$4,243.20

PR BREAST IMPLANT WARRANTY

Professional

Both

$357.00

Service Code	HCPCS 00523
Hospital Revenue Code	990
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$232.05
Rate for Payer: Aetna Medicare	$178.50
Rate for Payer: BCBS Complete	$142.80
Rate for Payer: Cash Price	$285.60
Rate for Payer: Priority Health Cigna Priority Health	$232.05

PR BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST

Professional

Both

$4,809.00

Service Code	HCPCS 19368
Min. Negotiated Rate	$1,923.60
Max. Negotiated Rate	$3,125.85
Rate for Payer: Aetna Commercial	$2,781.24
Rate for Payer: Aetna Medicare	$2,158.57
Rate for Payer: BCBS Complete	$1,923.60
Rate for Payer: BCBS MAPPO	$2,075.55
Rate for Payer: BCN Medicare Advantage	$2,075.55
Rate for Payer: Cash Price	$3,847.20
Rate for Payer: Cash Price	$3,847.20
Rate for Payer: Cofinity Commercial	$2,781.24
Rate for Payer: Cofinity Commercial	$2,988.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,075.55
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,179.33
Rate for Payer: Nomi Health Commercial	$2,490.66
Rate for Payer: PACE SWMI	$2,075.55
Rate for Payer: PHP Medicare Advantage	$2,075.55
Rate for Payer: Priority Health Cigna Priority Health	$3,125.85
Rate for Payer: Priority Health Medicare	$2,096.31
Rate for Payer: UHC All Payor (Choice/PPO)	$2,075.55
Rate for Payer: UHC Dual Complete DSNP	$2,075.55
Rate for Payer: UHC Exchange	$2,075.55
Rate for Payer: UHC Medicare Advantage	$2,075.55

PR BREAST RECONSTRUCTION BIPEDICLED TRAM FLAP

Professional

Both

$4,213.00

Service Code	HCPCS 19369
Min. Negotiated Rate	$1,685.20
Max. Negotiated Rate	$2,776.28
Rate for Payer: Aetna Commercial	$2,583.48
Rate for Payer: Aetna Medicare	$2,005.09
Rate for Payer: BCBS Complete	$1,685.20
Rate for Payer: BCBS MAPPO	$1,927.97
Rate for Payer: BCN Medicare Advantage	$1,927.97
Rate for Payer: Cash Price	$3,370.40
Rate for Payer: Cash Price	$3,370.40
Rate for Payer: Cofinity Commercial	$2,776.28
Rate for Payer: Cofinity Commercial	$2,583.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,927.97
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,024.37
Rate for Payer: Nomi Health Commercial	$2,313.56
Rate for Payer: PACE SWMI	$1,927.97
Rate for Payer: PHP Medicare Advantage	$1,927.97
Rate for Payer: Priority Health Cigna Priority Health	$2,738.45
Rate for Payer: Priority Health Medicare	$1,947.25
Rate for Payer: UHC All Payor (Choice/PPO)	$1,927.97
Rate for Payer: UHC Dual Complete DSNP	$1,927.97
Rate for Payer: UHC Exchange	$1,927.97
Rate for Payer: UHC Medicare Advantage	$1,927.97

PR BREAST RECONSTRUCTION SINGLE PEDICLED TRAM FLAP

Professional

Both

$3,032.00

Service Code	HCPCS 19367
Min. Negotiated Rate	$1,212.80
Max. Negotiated Rate	$2,440.35
Rate for Payer: Aetna Commercial	$2,270.88
Rate for Payer: Aetna Medicare	$1,762.48
Rate for Payer: BCBS Complete	$1,212.80
Rate for Payer: BCBS MAPPO	$1,694.69
Rate for Payer: BCN Medicare Advantage	$1,694.69
Rate for Payer: Cash Price	$2,425.60
Rate for Payer: Cash Price	$2,425.60
Rate for Payer: Cofinity Commercial	$2,440.35
Rate for Payer: Cofinity Commercial	$2,270.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,694.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,779.42
Rate for Payer: Nomi Health Commercial	$2,033.63
Rate for Payer: PACE SWMI	$1,694.69
Rate for Payer: PHP Medicare Advantage	$1,694.69
Rate for Payer: Priority Health Cigna Priority Health	$1,970.80
Rate for Payer: Priority Health Medicare	$1,711.64
Rate for Payer: UHC All Payor (Choice/PPO)	$1,694.69
Rate for Payer: UHC Dual Complete DSNP	$1,694.69
Rate for Payer: UHC Exchange	$1,694.69
Rate for Payer: UHC Medicare Advantage	$1,694.69

PR BREAST RECONSTRUCTION W/LATISSIMUS DORSI FLAP

Professional

Both

$2,920.00

Service Code	HCPCS 19361
Min. Negotiated Rate	$1,168.00
Max. Negotiated Rate	$2,148.97
Rate for Payer: Aetna Commercial	$1,999.74
Rate for Payer: Aetna Medicare	$1,552.03
Rate for Payer: BCBS Complete	$1,168.00
Rate for Payer: BCBS MAPPO	$1,492.34
Rate for Payer: BCN Medicare Advantage	$1,492.34
Rate for Payer: Cash Price	$2,336.00
Rate for Payer: Cash Price	$2,336.00
Rate for Payer: Cofinity Commercial	$2,148.97
Rate for Payer: Cofinity Commercial	$1,999.74
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,492.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,566.96
Rate for Payer: Nomi Health Commercial	$1,790.81
Rate for Payer: PACE SWMI	$1,492.34
Rate for Payer: PHP Medicare Advantage	$1,492.34
Rate for Payer: Priority Health Cigna Priority Health	$1,898.00
Rate for Payer: Priority Health Medicare	$1,507.26
Rate for Payer: UHC All Payor (Choice/PPO)	$1,492.34
Rate for Payer: UHC Dual Complete DSNP	$1,492.34
Rate for Payer: UHC Exchange	$1,492.34
Rate for Payer: UHC Medicare Advantage	$1,492.34

PR BREAST RECONSTRUC W OTHR TECHNIQ

Professional

Both

$2,903.00

Service Code	HCPCS 19366
Min. Negotiated Rate	$1,161.20
Max. Negotiated Rate	$1,886.95
Rate for Payer: Aetna Medicare	$1,451.50
Rate for Payer: BCBS Complete	$1,161.20
Rate for Payer: Cash Price	$2,322.40
Rate for Payer: Priority Health Cigna Priority Health	$1,886.95

PR BREAST REDUCTION

Facility

$1,938.00

Service Code	CPT 19318
Hospital Charge Code	19318
Min. Negotiated Rate	$460.27
Max. Negotiated Rate	$4,951.09
Rate for Payer: Aetna Commercial	$1,647.30
Rate for Payer: Aetna Medicare	$503.88
Rate for Payer: Allen County Amish Medical Aid Commercial	$605.62
Rate for Payer: Amish Plain Church Group Commercial	$605.62
Rate for Payer: BCBS Complete	$4,951.09
Rate for Payer: BCBS MAPPO	$484.50
Rate for Payer: BCBS Trust/PPO	$1,593.23
Rate for Payer: BCN Commercial	$1,506.80
Rate for Payer: BCN Medicare Advantage	$484.50
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cofinity Commercial	$1,666.68
Rate for Payer: Encore Health Key Benefits Commercial	$1,550.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$484.50
Rate for Payer: Healthscope Commercial	$1,744.20
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,453.50
Rate for Payer: Mclaren Medicaid	$4,715.02
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$508.73
Rate for Payer: Meridian Medicaid	$4,951.09
Rate for Payer: MI Amish Medical Board Commercial	$557.17
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,647.30
Rate for Payer: Nomi Health Commercial	$1,589.16
Rate for Payer: PACE Senior Care Partners	$460.27
Rate for Payer: PACE SWMI	$484.50
Rate for Payer: PHP Commercial	$1,647.30
Rate for Payer: PHP Medicare Advantage	$484.50
Rate for Payer: Priority Health Choice Medicaid	$4,715.02
Rate for Payer: Priority Health Cigna Priority Health	$1,259.70
Rate for Payer: Priority Health HMO/PPO	$1,686.06
Rate for Payer: Priority Health Medicare	$489.35
Rate for Payer: Priority Health Narrow/Tiered Network	$1,298.46
Rate for Payer: Railroad Medicare Medicare	$484.50
Rate for Payer: UHC All Payor (Choice/PPO)	$1,705.44
Rate for Payer: UHC Core	$1,618.23
Rate for Payer: UHC Dual Complete DSNP	$484.50
Rate for Payer: UHC Exchange	$484.50
Rate for Payer: UHC Medicare Advantage	$484.50
Rate for Payer: UHCCP Medicaid	$4,715.02
Rate for Payer: VA VA	$484.50
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,453.50

PR BREAST REDUCTION

Professional

Both

$1,938.00

Service Code	HCPCS 19318
Hospital Charge Code	19318
Min. Negotiated Rate	$775.20
Max. Negotiated Rate	$1,509.61
Rate for Payer: Aetna Commercial	$1,404.78
Rate for Payer: Aetna Medicare	$1,090.27
Rate for Payer: BCBS Complete	$775.20
Rate for Payer: BCBS MAPPO	$1,048.34
Rate for Payer: BCN Medicare Advantage	$1,048.34
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cofinity Commercial	$1,509.61
Rate for Payer: Cofinity Commercial	$1,404.78
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,048.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,100.76
Rate for Payer: Nomi Health Commercial	$1,258.01
Rate for Payer: PACE SWMI	$1,048.34
Rate for Payer: PHP Medicare Advantage	$1,048.34
Rate for Payer: Priority Health Cigna Priority Health	$1,259.70
Rate for Payer: Priority Health Medicare	$1,058.82
Rate for Payer: UHC All Payor (Choice/PPO)	$1,048.34
Rate for Payer: UHC Dual Complete DSNP	$1,048.34
Rate for Payer: UHC Exchange	$1,048.34
Rate for Payer: UHC Medicare Advantage	$1,048.34

PR BREAST REDUCTION

Facility

$1,938.00

Service Code	CPT 19318
Hospital Charge Code	19318
Min. Negotiated Rate	$1,259.70
Max. Negotiated Rate	$1,744.20
Rate for Payer: Aetna Commercial	$1,647.30
Rate for Payer: BCBS Trust/PPO	$1,581.99
Rate for Payer: BCN Commercial	$1,497.69
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cofinity Commercial	$1,666.68
Rate for Payer: Encore Health Key Benefits Commercial	$1,550.40
Rate for Payer: Healthscope Commercial	$1,744.20
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,453.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,647.30
Rate for Payer: Nomi Health Commercial	$1,589.16
Rate for Payer: PHP Commercial	$1,647.30
Rate for Payer: Priority Health Cigna Priority Health	$1,259.70
Rate for Payer: Priority Health HMO/PPO	$1,686.06
Rate for Payer: Priority Health Narrow/Tiered Network	$1,298.46
Rate for Payer: UHC All Payor (Choice/PPO)	$1,705.44
Rate for Payer: UHC Core	$1,618.23
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,453.50

PR BREAST REDUCTION

Professional

Both

$1,938.00

Service Code	HCPCS 19318
Min. Negotiated Rate	$775.20
Max. Negotiated Rate	$1,509.61
Rate for Payer: Aetna Commercial	$1,404.78
Rate for Payer: Aetna Medicare	$1,090.27
Rate for Payer: BCBS Complete	$775.20
Rate for Payer: BCBS MAPPO	$1,048.34
Rate for Payer: BCN Medicare Advantage	$1,048.34
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cash Price	$1,550.40
Rate for Payer: Cofinity Commercial	$1,509.61
Rate for Payer: Cofinity Commercial	$1,404.78
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,048.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,100.76
Rate for Payer: Nomi Health Commercial	$1,258.01
Rate for Payer: PACE SWMI	$1,048.34
Rate for Payer: PHP Medicare Advantage	$1,048.34
Rate for Payer: Priority Health Cigna Priority Health	$1,259.70
Rate for Payer: Priority Health Medicare	$1,058.82
Rate for Payer: UHC All Payor (Choice/PPO)	$1,048.34
Rate for Payer: UHC Dual Complete DSNP	$1,048.34
Rate for Payer: UHC Exchange	$1,048.34
Rate for Payer: UHC Medicare Advantage	$1,048.34

PR BREATH HYDROGEN/METHANE TEST

Professional

Both

$167.00

Service Code	HCPCS 91065
Min. Negotiated Rate	$58.50
Max. Negotiated Rate	$108.55
Rate for Payer: Aetna Commercial	$78.39
Rate for Payer: Aetna Medicare	$60.84
Rate for Payer: BCBS Complete	$66.80
Rate for Payer: BCBS MAPPO	$58.50
Rate for Payer: BCN Medicare Advantage	$58.50
Rate for Payer: Cash Price	$133.60
Rate for Payer: Cash Price	$133.60
Rate for Payer: Cofinity Commercial	$84.24
Rate for Payer: Cofinity Commercial	$78.39
Rate for Payer: Health Alliance Plan Medicare Advantage	$58.50
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$61.42
Rate for Payer: Nomi Health Commercial	$70.20
Rate for Payer: PACE SWMI	$58.50
Rate for Payer: PHP Medicare Advantage	$58.50
Rate for Payer: Priority Health Cigna Priority Health	$108.55
Rate for Payer: Priority Health Medicare	$59.09
Rate for Payer: UHC All Payor (Choice/PPO)	$58.50
Rate for Payer: UHC Dual Complete DSNP	$58.50
Rate for Payer: UHC Exchange	$58.50
Rate for Payer: UHC Medicare Advantage	$58.50

PR BREATHING RESPONSE TO HYPOXIA

Professional

Both

$180.00

Service Code	HCPCS 94450
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Commercial	$105.85
Rate for Payer: Aetna Medicare	$82.15
Rate for Payer: BCBS Complete	$72.00
Rate for Payer: BCBS MAPPO	$78.99
Rate for Payer: BCN Medicare Advantage	$78.99
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cofinity Commercial	$113.75
Rate for Payer: Cofinity Commercial	$105.85
Rate for Payer: Health Alliance Plan Medicare Advantage	$78.99
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$82.94
Rate for Payer: Nomi Health Commercial	$94.79
Rate for Payer: PACE SWMI	$78.99
Rate for Payer: PHP Medicare Advantage	$78.99
Rate for Payer: Priority Health Cigna Priority Health	$117.00
Rate for Payer: Priority Health Medicare	$79.78
Rate for Payer: UHC All Payor (Choice/PPO)	$78.99
Rate for Payer: UHC Dual Complete DSNP	$78.99
Rate for Payer: UHC Exchange	$78.99
Rate for Payer: UHC Medicare Advantage	$78.99

Know your out-of-pocket cost for care.

All Charges