Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR CARDIOPULMONARY RESUSCITATION

Professional

Both

$576.00

Service Code	HCPCS 92950
Min. Negotiated Rate	$108.63
Max. Negotiated Rate	$432.00
Rate for Payer: Aetna Commercial	$248.46
Rate for Payer: Aetna Medicare	$288.00
Rate for Payer: BCBS Complete	$114.06
Rate for Payer: BCN Commercial	$270.40
Rate for Payer: Cash Price	$460.80
Rate for Payer: Cash Price	$460.80
Rate for Payer: Mclaren Medicaid	$108.63
Rate for Payer: Meridian Medicaid	$114.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$432.00
Rate for Payer: Priority Health Choice Medicaid	$108.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$257.00
Rate for Payer: Priority Health Narrow/Tiered Network	$257.00
Rate for Payer: UHC Medicaid	$108.63
Rate for Payer: UHCCP Medicaid	$108.63

PR CARDIOT EXPL RMVL FB ATR/VENTR THRMB CARD BYP

Professional

Both

$7,051.00

Service Code	HCPCS 33315
Min. Negotiated Rate	$1,137.42
Max. Negotiated Rate	$5,288.25
Rate for Payer: Aetna Commercial	$2,572.47
Rate for Payer: Aetna Medicare	$3,525.50
Rate for Payer: BCBS Complete	$1,194.29
Rate for Payer: BCN Commercial	$2,807.62
Rate for Payer: Cash Price	$5,640.80
Rate for Payer: Cash Price	$5,640.80
Rate for Payer: Mclaren Medicaid	$1,137.42
Rate for Payer: Meridian Medicaid	$1,194.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,288.25
Rate for Payer: Priority Health Choice Medicaid	$1,137.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,019.24
Rate for Payer: Priority Health Narrow/Tiered Network	$3,019.24
Rate for Payer: UHC Medicaid	$1,137.42
Rate for Payer: UHCCP Medicaid	$1,137.42

PR CARDIOT EXPL W/RMVL FB ATR/VENTR THRMB W/O BYP

Professional

Both

$4,758.00

Service Code	HCPCS 33310
Min. Negotiated Rate	$720.58
Max. Negotiated Rate	$3,568.50
Rate for Payer: Aetna Commercial	$1,565.46
Rate for Payer: Aetna Medicare	$2,379.00
Rate for Payer: BCBS Complete	$756.61
Rate for Payer: BCN Commercial	$1,725.51
Rate for Payer: Cash Price	$3,806.40
Rate for Payer: Cash Price	$3,806.40
Rate for Payer: Mclaren Medicaid	$720.58
Rate for Payer: Meridian Medicaid	$756.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,568.50
Rate for Payer: Priority Health Choice Medicaid	$720.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,855.57
Rate for Payer: Priority Health Narrow/Tiered Network	$1,855.57
Rate for Payer: UHC Medicaid	$720.58
Rate for Payer: UHCCP Medicaid	$720.58

PR CARDIOVASCULAR FUNCTION EVAL W/TILT TABLE W/MNTR

Professional

Both

$590.00

Service Code	HCPCS 93660
Min. Negotiated Rate	$205.18
Max. Negotiated Rate	$442.50
Rate for Payer: Aetna Commercial	$205.18
Rate for Payer: Aetna Medicare	$295.00
Rate for Payer: BCN Commercial	$245.01
Rate for Payer: Cash Price	$472.00
Rate for Payer: Cash Price	$472.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$442.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$232.86
Rate for Payer: Priority Health Narrow/Tiered Network	$232.86

PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL

Facility

$516.00

Service Code	CPT 92960
Hospital Charge Code	92960
Hospital Revenue Code	960
Min. Negotiated Rate	$359.14
Max. Negotiated Rate	$464.40
Rate for Payer: Aetna Commercial	$438.60
Rate for Payer: BCBS Trust/PPO	$426.16
Rate for Payer: BCN Commercial	$426.16
Rate for Payer: Cash Price	$412.80
Rate for Payer: Cofinity Commercial	$443.76
Rate for Payer: Encore Health Key Benefits Commercial	$412.80
Rate for Payer: Healthscope Commercial	$464.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$387.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$438.60
Rate for Payer: Nomi Health Commercial	$423.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$387.00
Rate for Payer: PHP Commercial	$438.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$448.92
Rate for Payer: Priority Health Narrow/Tiered Network	$359.14
Rate for Payer: UHC Core	$430.86
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$387.00

PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL

Professional

Both

$516.00

Service Code	HCPCS 92960
Hospital Charge Code	92960
Min. Negotiated Rate	$60.49
Max. Negotiated Rate	$387.00
Rate for Payer: Aetna Commercial	$144.47
Rate for Payer: Aetna Medicare	$258.00
Rate for Payer: BCBS Complete	$63.51
Rate for Payer: BCN Commercial	$175.61
Rate for Payer: Cash Price	$412.80
Rate for Payer: Cash Price	$412.80
Rate for Payer: Mclaren Medicaid	$60.49
Rate for Payer: Meridian Medicaid	$63.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$387.00
Rate for Payer: Priority Health Choice Medicaid	$60.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$151.93
Rate for Payer: Priority Health Narrow/Tiered Network	$151.93
Rate for Payer: UHC Medicaid	$60.49
Rate for Payer: UHCCP Medicaid	$60.49

PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL

Facility

$516.00

Service Code	CPT 92960
Hospital Charge Code	92960
Hospital Revenue Code	960
Min. Negotiated Rate	$90.97
Max. Negotiated Rate	$464.40
Rate for Payer: Aetna Commercial	$438.60
Rate for Payer: Aetna Medicare	$134.16
Rate for Payer: Allen County Amish Medical Aid Commercial	$161.25
Rate for Payer: Amish Plain Church Group Commercial	$161.25
Rate for Payer: BCBS Complete	$95.51
Rate for Payer: BCBS MAPPO	$129.00
Rate for Payer: BCBS Trust/PPO	$424.20
Rate for Payer: BCN Commercial	$424.20
Rate for Payer: BCN Medicare Advantage	$129.00
Rate for Payer: Cash Price	$412.80
Rate for Payer: Cofinity Commercial	$443.76
Rate for Payer: Encore Health Key Benefits Commercial	$412.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$129.00
Rate for Payer: Healthscope Commercial	$464.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$387.00
Rate for Payer: Mclaren Medicaid	$90.97
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$135.45
Rate for Payer: Meridian Medicaid	$95.51
Rate for Payer: MI Amish Medical Board Commercial	$148.35
Rate for Payer: Molina Medicare/Medicaid	$141.90
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$438.60
Rate for Payer: Nomi Health Commercial	$423.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$387.00
Rate for Payer: PACE Senior Care Partners	$122.55
Rate for Payer: PACE SWMI	$129.00
Rate for Payer: PHP Commercial	$438.60
Rate for Payer: PHP Medicare Advantage	$129.00
Rate for Payer: Priority Health Choice Medicaid	$90.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$448.92
Rate for Payer: Priority Health Medicare	$130.29
Rate for Payer: Priority Health Narrow/Tiered Network	$359.14
Rate for Payer: Railroad Medicare Medicare	$129.00
Rate for Payer: UHC Core	$430.86
Rate for Payer: UHC Exchange	$129.00
Rate for Payer: UHC Medicaid	$90.97
Rate for Payer: UHC Medicare Advantage	$129.00
Rate for Payer: UHCCP Medicaid	$90.97
Rate for Payer: VA VA	$129.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$387.00

PR CARDIOVERSION ELECTIVE ARRHYTHMIA EXTERNAL

Professional

Both

$516.00

Service Code	HCPCS 92960
Min. Negotiated Rate	$60.49
Max. Negotiated Rate	$387.00
Rate for Payer: Aetna Commercial	$144.47
Rate for Payer: Aetna Medicare	$258.00
Rate for Payer: BCBS Complete	$63.51
Rate for Payer: BCN Commercial	$175.61
Rate for Payer: Cash Price	$412.80
Rate for Payer: Cash Price	$412.80
Rate for Payer: Mclaren Medicaid	$60.49
Rate for Payer: Meridian Medicaid	$63.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$387.00
Rate for Payer: Priority Health Choice Medicaid	$60.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$151.93
Rate for Payer: Priority Health Narrow/Tiered Network	$151.93
Rate for Payer: UHC Medicaid	$60.49
Rate for Payer: UHCCP Medicaid	$60.49

PR CARDIOVERSION ELECTIVE ARRHYTHMIA INTERNAL SPX

Professional

Both

$517.00

Service Code	HCPCS 92961
Min. Negotiated Rate	$137.39
Max. Negotiated Rate	$387.75
Rate for Payer: Aetna Commercial	$330.21
Rate for Payer: Aetna Medicare	$258.50
Rate for Payer: BCBS Complete	$144.26
Rate for Payer: BCN Commercial	$356.55
Rate for Payer: Cash Price	$413.60
Rate for Payer: Cash Price	$413.60
Rate for Payer: Mclaren Medicaid	$137.39
Rate for Payer: Meridian Medicaid	$144.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$387.75
Rate for Payer: Priority Health Choice Medicaid	$137.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$338.89
Rate for Payer: Priority Health Narrow/Tiered Network	$338.89
Rate for Payer: UHC Medicaid	$137.39
Rate for Payer: UHCCP Medicaid	$137.39

PR CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM

Professional

Both

$7.00

Service Code	HCPCS 96161
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$5.43
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCN Commercial	$4.48
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5.43
Rate for Payer: Priority Health Narrow/Tiered Network	$5.43

PR CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS

Professional

Both

$94.00

Service Code	HCPCS 99484
Min. Negotiated Rate	$24.71
Max. Negotiated Rate	$70.50
Rate for Payer: Aetna Commercial	$30.26
Rate for Payer: Aetna Medicare	$47.00
Rate for Payer: BCBS Complete	$25.95
Rate for Payer: BCN Commercial	$39.56
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cash Price	$75.20
Rate for Payer: Mclaren Medicaid	$24.71
Rate for Payer: Meridian Medicaid	$25.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.50
Rate for Payer: Priority Health Choice Medicaid	$24.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$57.33
Rate for Payer: Priority Health Narrow/Tiered Network	$57.33
Rate for Payer: UHC Medicaid	$24.71
Rate for Payer: UHCCP Medicaid	$24.71

PR CARPECTOMY 1 BONE

Facility

$1,752.00

Service Code	CPT 25210
Hospital Charge Code	25210
Hospital Revenue Code	490
Min. Negotiated Rate	$308.88
Max. Negotiated Rate	$1,576.80
Rate for Payer: Aetna Commercial	$1,489.20
Rate for Payer: Aetna Medicare	$455.52
Rate for Payer: Allen County Amish Medical Aid Commercial	$547.50
Rate for Payer: Amish Plain Church Group Commercial	$547.50
Rate for Payer: BCBS Complete	$324.30
Rate for Payer: BCBS MAPPO	$438.00
Rate for Payer: BCBS Trust/PPO	$1,440.32
Rate for Payer: BCN Commercial	$1,440.32
Rate for Payer: BCN Medicare Advantage	$438.00
Rate for Payer: Cash Price	$1,401.60
Rate for Payer: Cofinity Commercial	$1,506.72
Rate for Payer: Encore Health Key Benefits Commercial	$1,401.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$438.00
Rate for Payer: Healthscope Commercial	$1,576.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,314.00
Rate for Payer: Mclaren Medicaid	$308.88
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$459.90
Rate for Payer: Meridian Medicaid	$324.30
Rate for Payer: MI Amish Medical Board Commercial	$503.70
Rate for Payer: Molina Medicare/Medicaid	$481.80
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,489.20
Rate for Payer: Nomi Health Commercial	$1,436.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,314.00
Rate for Payer: PACE Senior Care Partners	$416.10
Rate for Payer: PACE SWMI	$438.00
Rate for Payer: PHP Commercial	$1,489.20
Rate for Payer: PHP Medicare Advantage	$438.00
Rate for Payer: Priority Health Choice Medicaid	$308.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,524.24
Rate for Payer: Priority Health Medicare	$442.38
Rate for Payer: Priority Health Narrow/Tiered Network	$1,219.39
Rate for Payer: Railroad Medicare Medicare	$438.00
Rate for Payer: UHC All Payor (Choice/PPO)	$1,541.76
Rate for Payer: UHC Core	$1,462.92
Rate for Payer: UHC Exchange	$438.00
Rate for Payer: UHC Medicaid	$308.88
Rate for Payer: UHC Medicare Advantage	$438.00
Rate for Payer: UHCCP Medicaid	$308.88
Rate for Payer: VA VA	$438.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,314.00

PR CARPECTOMY 1 BONE

Professional

Both

$1,752.00

Service Code	HCPCS 25210
Hospital Charge Code	25210
Min. Negotiated Rate	$297.99
Max. Negotiated Rate	$1,314.00
Rate for Payer: Aetna Commercial	$654.43
Rate for Payer: Aetna Medicare	$876.00
Rate for Payer: BCBS Complete	$312.89
Rate for Payer: BCN Commercial	$761.42
Rate for Payer: Cash Price	$1,401.60
Rate for Payer: Cash Price	$1,401.60
Rate for Payer: Mclaren Medicaid	$297.99
Rate for Payer: Meridian Medicaid	$312.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,314.00
Rate for Payer: Priority Health Choice Medicaid	$297.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$813.93
Rate for Payer: Priority Health Narrow/Tiered Network	$813.93
Rate for Payer: UHC Medicaid	$297.99
Rate for Payer: UHCCP Medicaid	$297.99

PR CARPECTOMY 1 BONE

Facility

$1,752.00

Service Code	CPT 25210
Hospital Charge Code	25210
Hospital Revenue Code	490
Min. Negotiated Rate	$1,219.39
Max. Negotiated Rate	$1,576.80
Rate for Payer: Aetna Commercial	$1,489.20
Rate for Payer: BCBS Trust/PPO	$1,446.98
Rate for Payer: BCN Commercial	$1,446.98
Rate for Payer: Cash Price	$1,401.60
Rate for Payer: Cofinity Commercial	$1,506.72
Rate for Payer: Encore Health Key Benefits Commercial	$1,401.60
Rate for Payer: Healthscope Commercial	$1,576.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,314.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,489.20
Rate for Payer: Nomi Health Commercial	$1,436.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,314.00
Rate for Payer: PHP Commercial	$1,489.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,524.24
Rate for Payer: Priority Health Narrow/Tiered Network	$1,219.39
Rate for Payer: UHC All Payor (Choice/PPO)	$1,541.76
Rate for Payer: UHC Core	$1,462.92
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,314.00

PR CARPECTOMY 1 BONE

Professional

Both

$1,752.00

Service Code	HCPCS 25210
Min. Negotiated Rate	$297.99
Max. Negotiated Rate	$1,314.00
Rate for Payer: Aetna Commercial	$654.43
Rate for Payer: Aetna Medicare	$876.00
Rate for Payer: BCBS Complete	$312.89
Rate for Payer: BCN Commercial	$761.42
Rate for Payer: Cash Price	$1,401.60
Rate for Payer: Cash Price	$1,401.60
Rate for Payer: Mclaren Medicaid	$297.99
Rate for Payer: Meridian Medicaid	$312.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,314.00
Rate for Payer: Priority Health Choice Medicaid	$297.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$813.93
Rate for Payer: Priority Health Narrow/Tiered Network	$813.93
Rate for Payer: UHC Medicaid	$297.99
Rate for Payer: UHCCP Medicaid	$297.99

PR CARPECTOMY ALL BONES PROXIMAL ROW

Professional

Both

$2,358.00

Service Code	HCPCS 25215
Min. Negotiated Rate	$368.49
Max. Negotiated Rate	$1,768.50
Rate for Payer: Aetna Commercial	$824.12
Rate for Payer: Aetna Medicare	$1,179.00
Rate for Payer: BCBS Complete	$386.91
Rate for Payer: BCN Commercial	$952.63
Rate for Payer: Cash Price	$1,886.40
Rate for Payer: Cash Price	$1,886.40
Rate for Payer: Mclaren Medicaid	$368.49
Rate for Payer: Meridian Medicaid	$386.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,768.50
Rate for Payer: Priority Health Choice Medicaid	$368.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,018.35
Rate for Payer: Priority Health Narrow/Tiered Network	$1,018.35
Rate for Payer: UHC Medicaid	$368.49
Rate for Payer: UHCCP Medicaid	$368.49

PR CARTILAGE GRAFT COSTOCHONDRAL

Professional

Both

$967.00

Service Code	HCPCS 20910
Min. Negotiated Rate	$295.86
Max. Negotiated Rate	$781.99
Rate for Payer: Aetna Commercial	$625.78
Rate for Payer: Aetna Medicare	$483.50
Rate for Payer: BCBS Complete	$310.65
Rate for Payer: BCN Commercial	$731.53
Rate for Payer: Cash Price	$773.60
Rate for Payer: Cash Price	$773.60
Rate for Payer: Mclaren Medicaid	$295.86
Rate for Payer: Meridian Medicaid	$310.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$725.25
Rate for Payer: Priority Health Choice Medicaid	$295.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$781.99
Rate for Payer: Priority Health Narrow/Tiered Network	$781.99
Rate for Payer: UHC Medicaid	$295.86
Rate for Payer: UHCCP Medicaid	$295.86

PR CARTILAGE GRAFT NASAL SEPTUM

Professional

Both

$1,088.00

Service Code	HCPCS 20912
Min. Negotiated Rate	$277.54
Max. Negotiated Rate	$816.00
Rate for Payer: Aetna Commercial	$630.42
Rate for Payer: Aetna Medicare	$544.00
Rate for Payer: BCBS Complete	$291.42
Rate for Payer: BCN Commercial	$730.04
Rate for Payer: Cash Price	$870.40
Rate for Payer: Cash Price	$870.40
Rate for Payer: Mclaren Medicaid	$277.54
Rate for Payer: Meridian Medicaid	$291.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$816.00
Rate for Payer: Priority Health Choice Medicaid	$277.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$780.39
Rate for Payer: Priority Health Narrow/Tiered Network	$780.39
Rate for Payer: UHC Medicaid	$277.54
Rate for Payer: UHCCP Medicaid	$277.54

PR CA SCREEN;FLEXI SIGMOIDSCOPE

Professional

Both

$422.00

Service Code	HCPCS G0104
Min. Negotiated Rate	$34.08
Max. Negotiated Rate	$316.50
Rate for Payer: Aetna Commercial	$54.91
Rate for Payer: Aetna Medicare	$211.00
Rate for Payer: BCBS Complete	$35.78
Rate for Payer: BCN Commercial	$84.65
Rate for Payer: Cash Price	$337.60
Rate for Payer: Cash Price	$337.60
Rate for Payer: Mclaren Medicaid	$34.08
Rate for Payer: Meridian Medicaid	$35.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$316.50
Rate for Payer: Priority Health Choice Medicaid	$34.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$103.15
Rate for Payer: Priority Health Narrow/Tiered Network	$103.15
Rate for Payer: UHC Medicaid	$34.08
Rate for Payer: UHCCP Medicaid	$34.08

PR CA SCREEN;FLEXI SIGMOIDSCOPE

Facility

$422.00

Service Code	HCPCS G0104
Hospital Charge Code	G0104
Hospital Revenue Code	730
Min. Negotiated Rate	$74.40
Max. Negotiated Rate	$379.80
Rate for Payer: Aetna Commercial	$358.70
Rate for Payer: Aetna Medicare	$109.72
Rate for Payer: Allen County Amish Medical Aid Commercial	$131.88
Rate for Payer: Amish Plain Church Group Commercial	$131.88
Rate for Payer: BCBS Complete	$78.11
Rate for Payer: BCBS MAPPO	$105.50
Rate for Payer: BCBS Trust/PPO	$346.93
Rate for Payer: BCN Commercial	$346.93
Rate for Payer: BCN Medicare Advantage	$105.50
Rate for Payer: Cash Price	$337.60
Rate for Payer: Cofinity Commercial	$362.92
Rate for Payer: Encore Health Key Benefits Commercial	$337.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$105.50
Rate for Payer: Healthscope Commercial	$379.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$316.50
Rate for Payer: Mclaren Medicaid	$74.40
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$110.78
Rate for Payer: Meridian Medicaid	$78.11
Rate for Payer: MI Amish Medical Board Commercial	$121.33
Rate for Payer: Molina Medicare/Medicaid	$116.05
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$358.70
Rate for Payer: Nomi Health Commercial	$346.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$316.50
Rate for Payer: PACE Senior Care Partners	$100.22
Rate for Payer: PACE SWMI	$105.50
Rate for Payer: PHP Commercial	$358.70
Rate for Payer: PHP Medicare Advantage	$105.50
Rate for Payer: Priority Health Choice Medicaid	$74.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$367.14
Rate for Payer: Priority Health Medicare	$106.56
Rate for Payer: Priority Health Narrow/Tiered Network	$293.71
Rate for Payer: Railroad Medicare Medicare	$105.50
Rate for Payer: UHC All Payor (Choice/PPO)	$371.36
Rate for Payer: UHC Core	$352.37
Rate for Payer: UHC Exchange	$105.50
Rate for Payer: UHC Medicaid	$74.40
Rate for Payer: UHC Medicare Advantage	$105.50
Rate for Payer: UHCCP Medicaid	$74.40
Rate for Payer: VA VA	$105.50
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$316.50

PR CA SCREEN;FLEXI SIGMOIDSCOPE

Facility

$422.00

Service Code	HCPCS G0104
Hospital Charge Code	G0104
Hospital Revenue Code	730
Min. Negotiated Rate	$293.71
Max. Negotiated Rate	$379.80
Rate for Payer: Aetna Commercial	$358.70
Rate for Payer: BCBS Trust/PPO	$348.53
Rate for Payer: BCN Commercial	$348.53
Rate for Payer: Cash Price	$337.60
Rate for Payer: Cofinity Commercial	$362.92
Rate for Payer: Encore Health Key Benefits Commercial	$337.60
Rate for Payer: Healthscope Commercial	$379.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$316.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$358.70
Rate for Payer: Nomi Health Commercial	$346.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$316.50
Rate for Payer: PHP Commercial	$358.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$367.14
Rate for Payer: Priority Health Narrow/Tiered Network	$293.71
Rate for Payer: UHC All Payor (Choice/PPO)	$371.36
Rate for Payer: UHC Core	$352.37
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$316.50

PR CA SCREEN;FLEXI SIGMOIDSCOPE

Professional

Both

$422.00

Service Code	HCPCS G0104
Hospital Charge Code	G0104
Min. Negotiated Rate	$34.08
Max. Negotiated Rate	$316.50
Rate for Payer: Aetna Commercial	$54.91
Rate for Payer: Aetna Medicare	$211.00
Rate for Payer: BCBS Complete	$35.78
Rate for Payer: BCN Commercial	$84.65
Rate for Payer: Cash Price	$337.60
Rate for Payer: Cash Price	$337.60
Rate for Payer: Mclaren Medicaid	$34.08
Rate for Payer: Meridian Medicaid	$35.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$316.50
Rate for Payer: Priority Health Choice Medicaid	$34.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$103.15
Rate for Payer: Priority Health Narrow/Tiered Network	$103.15
Rate for Payer: UHC Medicaid	$34.08
Rate for Payer: UHCCP Medicaid	$34.08

PR CA SCREEN;PELVIC/BREAST EXAM

Professional

Both

$70.00

Service Code	HCPCS G0101
Min. Negotiated Rate	$15.76
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$27.24
Rate for Payer: Aetna Medicare	$35.00
Rate for Payer: BCBS Complete	$16.55
Rate for Payer: BCN Commercial	$40.34
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Mclaren Medicaid	$15.76
Rate for Payer: Meridian Medicaid	$16.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.50
Rate for Payer: Priority Health Choice Medicaid	$15.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$36.28
Rate for Payer: Priority Health Narrow/Tiered Network	$36.28
Rate for Payer: UHC Medicaid	$15.76
Rate for Payer: UHCCP Medicaid	$15.76

PR CAST SUP GAUNTLET FIBERGLASS

Professional

Both

$58.00

Service Code	HCPCS Q4014
Min. Negotiated Rate	$22.26
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$22.26
Rate for Payer: Aetna Medicare	$29.00
Rate for Payer: BCN Commercial	$32.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$43.50

PR CAST SUP GAUNTLET PLASTER

Professional

Both

$35.00

Service Code	HCPCS Q4013
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$13.21
Rate for Payer: Aetna Medicare	$17.50
Rate for Payer: BCN Commercial	$19.22
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.25

Know your out-of-pocket cost for care.

All Charges