Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR HEMORRHOIDOPEXY STAPLING

Professional

Both

$646.00

Service Code	HCPCS 46947
Min. Negotiated Rate	$258.40
Max. Negotiated Rate	$538.93
Rate for Payer: Aetna Commercial	$501.51
Rate for Payer: Aetna Medicare	$389.23
Rate for Payer: BCBS Complete	$258.40
Rate for Payer: BCBS MAPPO	$374.26
Rate for Payer: BCN Medicare Advantage	$374.26
Rate for Payer: Cash Price	$516.80
Rate for Payer: Cash Price	$516.80
Rate for Payer: Cofinity Commercial	$538.93
Rate for Payer: Cofinity Commercial	$501.51
Rate for Payer: Health Alliance Plan Medicare Advantage	$374.26
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$392.97
Rate for Payer: Nomi Health Commercial	$449.11
Rate for Payer: PACE SWMI	$374.26
Rate for Payer: PHP Medicare Advantage	$374.26
Rate for Payer: Priority Health Cigna Priority Health	$419.90
Rate for Payer: Priority Health Medicare	$378.00
Rate for Payer: UHC All Payor (Choice/PPO)	$374.26
Rate for Payer: UHC Dual Complete DSNP	$374.26
Rate for Payer: UHC Exchange	$374.26
Rate for Payer: UHC Medicare Advantage	$374.26

PR HEPATECTOMY RESCJ PARTIAL LOBECTOMY

Professional

Both

$4,633.00

Service Code	HCPCS 47120
Min. Negotiated Rate	$1,853.20
Max. Negotiated Rate	$3,257.09
Rate for Payer: Aetna Commercial	$3,030.91
Rate for Payer: Aetna Medicare	$2,352.34
Rate for Payer: BCBS Complete	$1,853.20
Rate for Payer: BCBS MAPPO	$2,261.87
Rate for Payer: BCN Medicare Advantage	$2,261.87
Rate for Payer: Cash Price	$3,706.40
Rate for Payer: Cash Price	$3,706.40
Rate for Payer: Cofinity Commercial	$3,257.09
Rate for Payer: Cofinity Commercial	$3,030.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,261.87
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$2,374.96
Rate for Payer: Nomi Health Commercial	$2,714.24
Rate for Payer: PACE SWMI	$2,261.87
Rate for Payer: PHP Medicare Advantage	$2,261.87
Rate for Payer: Priority Health Cigna Priority Health	$3,011.45
Rate for Payer: Priority Health Medicare	$2,284.49
Rate for Payer: UHC All Payor (Choice/PPO)	$2,261.87
Rate for Payer: UHC Dual Complete DSNP	$2,261.87
Rate for Payer: UHC Exchange	$2,261.87
Rate for Payer: UHC Medicare Advantage	$2,261.87

PR HEPATECTOMY RESCJ TOTAL RIGHT LOBECTOMY

Professional

Both

$6,159.00

Service Code	HCPCS 47130
Min. Negotiated Rate	$2,463.60
Max. Negotiated Rate	$4,612.87
Rate for Payer: Aetna Commercial	$4,292.53
Rate for Payer: Aetna Medicare	$3,331.52
Rate for Payer: BCBS Complete	$2,463.60
Rate for Payer: BCBS MAPPO	$3,203.38
Rate for Payer: BCN Medicare Advantage	$3,203.38
Rate for Payer: Cash Price	$4,927.20
Rate for Payer: Cash Price	$4,927.20
Rate for Payer: Cofinity Commercial	$4,612.87
Rate for Payer: Cofinity Commercial	$4,292.53
Rate for Payer: Health Alliance Plan Medicare Advantage	$3,203.38
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,363.55
Rate for Payer: Nomi Health Commercial	$3,844.06
Rate for Payer: PACE SWMI	$3,203.38
Rate for Payer: PHP Medicare Advantage	$3,203.38
Rate for Payer: Priority Health Cigna Priority Health	$4,003.35
Rate for Payer: Priority Health Medicare	$3,235.41
Rate for Payer: UHC All Payor (Choice/PPO)	$3,203.38
Rate for Payer: UHC Dual Complete DSNP	$3,203.38
Rate for Payer: UHC Exchange	$3,203.38
Rate for Payer: UHC Medicare Advantage	$3,203.38

PR HEPATITIS A & B VACCINE HEPA-HEPB ADULT IM

Professional

Both

$153.00

Service Code	HCPCS 90636
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$99.45
Rate for Payer: Aetna Medicare	$76.50
Rate for Payer: BCBS Complete	$61.20
Rate for Payer: Cash Price	$122.40
Rate for Payer: Priority Health Cigna Priority Health	$99.45

PR HEPATITIS B IMMUNE GLOBULIN HBIG HUMAN IM

Professional

Both

$182.00

Service Code	HCPCS 90371
Min. Negotiated Rate	$72.80
Max. Negotiated Rate	$193.23
Rate for Payer: Aetna Commercial	$179.81
Rate for Payer: Aetna Medicare	$139.56
Rate for Payer: BCBS Complete	$72.80
Rate for Payer: BCBS MAPPO	$134.19
Rate for Payer: BCN Medicare Advantage	$134.19
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cofinity Commercial	$193.23
Rate for Payer: Cofinity Commercial	$179.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$134.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$140.90
Rate for Payer: Nomi Health Commercial	$161.03
Rate for Payer: PACE SWMI	$134.19
Rate for Payer: PHP Medicare Advantage	$134.19
Rate for Payer: Priority Health Cigna Priority Health	$118.30
Rate for Payer: Priority Health Medicare	$135.53
Rate for Payer: UHC All Payor (Choice/PPO)	$134.19
Rate for Payer: UHC Dual Complete DSNP	$134.19
Rate for Payer: UHC Exchange	$134.19
Rate for Payer: UHC Medicare Advantage	$134.19

PR HEPATOTOMY OPEN DRAINAGE ABSCESS/CYST 1/2 STAGES

Professional

Both

$2,243.00

Service Code	HCPCS 47010
Min. Negotiated Rate	$897.20
Max. Negotiated Rate	$1,694.00
Rate for Payer: Aetna Commercial	$1,576.36
Rate for Payer: Aetna Medicare	$1,223.45
Rate for Payer: BCBS Complete	$897.20
Rate for Payer: BCBS MAPPO	$1,176.39
Rate for Payer: BCN Medicare Advantage	$1,176.39
Rate for Payer: Cash Price	$1,794.40
Rate for Payer: Cash Price	$1,794.40
Rate for Payer: Cofinity Commercial	$1,576.36
Rate for Payer: Cofinity Commercial	$1,694.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,176.39
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,235.21
Rate for Payer: Nomi Health Commercial	$1,411.67
Rate for Payer: PACE SWMI	$1,176.39
Rate for Payer: PHP Medicare Advantage	$1,176.39
Rate for Payer: Priority Health Cigna Priority Health	$1,457.95
Rate for Payer: Priority Health Medicare	$1,188.15
Rate for Payer: UHC All Payor (Choice/PPO)	$1,176.39
Rate for Payer: UHC Dual Complete DSNP	$1,176.39
Rate for Payer: UHC Exchange	$1,176.39
Rate for Payer: UHC Medicare Advantage	$1,176.39

PR HEPA VACCINE 2 DOSE SCHEDULE PED/ADOLESC IM USE

Professional

Both

$51.00

Service Code	HCPCS 90633
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$33.15
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: Cash Price	$40.80
Rate for Payer: Priority Health Cigna Priority Health	$33.15

PR HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE

Professional

Both

$90.00

Service Code	HCPCS 90632
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$106.26
Rate for Payer: Aetna Commercial	$98.88
Rate for Payer: Aetna Medicare	$76.74
Rate for Payer: BCBS Complete	$36.00
Rate for Payer: BCBS MAPPO	$73.79
Rate for Payer: BCN Medicare Advantage	$73.79
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cofinity Commercial	$98.88
Rate for Payer: Cofinity Commercial	$106.26
Rate for Payer: Health Alliance Plan Medicare Advantage	$73.79
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$77.48
Rate for Payer: Nomi Health Commercial	$88.55
Rate for Payer: PACE SWMI	$73.79
Rate for Payer: PHP Medicare Advantage	$73.79
Rate for Payer: Priority Health Cigna Priority Health	$58.50
Rate for Payer: Priority Health Medicare	$74.53
Rate for Payer: UHC All Payor (Choice/PPO)	$73.79
Rate for Payer: UHC Dual Complete DSNP	$73.79
Rate for Payer: UHC Exchange	$73.79
Rate for Payer: UHC Medicare Advantage	$73.79

PR HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM

Professional

Both

$103.00

Service Code	HCPCS 90743
Min. Negotiated Rate	$41.20
Max. Negotiated Rate	$108.22
Rate for Payer: Aetna Commercial	$100.70
Rate for Payer: Aetna Medicare	$78.16
Rate for Payer: BCBS Complete	$41.20
Rate for Payer: BCBS MAPPO	$75.15
Rate for Payer: BCN Medicare Advantage	$75.15
Rate for Payer: Cash Price	$82.40
Rate for Payer: Cash Price	$82.40
Rate for Payer: Cofinity Commercial	$100.70
Rate for Payer: Cofinity Commercial	$108.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$75.15
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$78.91
Rate for Payer: Nomi Health Commercial	$90.18
Rate for Payer: PACE SWMI	$75.15
Rate for Payer: PHP Medicare Advantage	$75.15
Rate for Payer: Priority Health Cigna Priority Health	$66.95
Rate for Payer: Priority Health Medicare	$75.90
Rate for Payer: UHC All Payor (Choice/PPO)	$75.15
Rate for Payer: UHC Dual Complete DSNP	$75.15
Rate for Payer: UHC Exchange	$75.15
Rate for Payer: UHC Medicare Advantage	$75.15

PR HEPB VACCINE ADULT 2/4 DOSE SCHEDULE FOR IM USE

Professional

Both

$326.00

Service Code	HCPCS 90739
Min. Negotiated Rate	$130.40
Max. Negotiated Rate	$255.69
Rate for Payer: Aetna Commercial	$237.93
Rate for Payer: Aetna Medicare	$184.66
Rate for Payer: BCBS Complete	$130.40
Rate for Payer: BCBS MAPPO	$177.56
Rate for Payer: BCN Medicare Advantage	$177.56
Rate for Payer: Cash Price	$260.80
Rate for Payer: Cash Price	$260.80
Rate for Payer: Cofinity Commercial	$255.69
Rate for Payer: Cofinity Commercial	$237.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$177.56
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$186.44
Rate for Payer: Nomi Health Commercial	$213.07
Rate for Payer: PACE SWMI	$177.56
Rate for Payer: PHP Medicare Advantage	$177.56
Rate for Payer: Priority Health Cigna Priority Health	$211.90
Rate for Payer: Priority Health Medicare	$179.34
Rate for Payer: UHC All Payor (Choice/PPO)	$177.56
Rate for Payer: UHC Dual Complete DSNP	$177.56
Rate for Payer: UHC Exchange	$177.56
Rate for Payer: UHC Medicare Advantage	$177.56

PR HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE

Professional

Both

$83.00

Service Code	HCPCS 90746
Min. Negotiated Rate	$33.20
Max. Negotiated Rate	$101.35
Rate for Payer: Aetna Commercial	$94.31
Rate for Payer: Aetna Medicare	$73.20
Rate for Payer: BCBS Complete	$33.20
Rate for Payer: BCBS MAPPO	$70.38
Rate for Payer: BCN Medicare Advantage	$70.38
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cofinity Commercial	$94.31
Rate for Payer: Cofinity Commercial	$101.35
Rate for Payer: Health Alliance Plan Medicare Advantage	$70.38
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$73.90
Rate for Payer: Nomi Health Commercial	$84.46
Rate for Payer: PACE SWMI	$70.38
Rate for Payer: PHP Medicare Advantage	$70.38
Rate for Payer: Priority Health Cigna Priority Health	$53.95
Rate for Payer: Priority Health Medicare	$71.08
Rate for Payer: UHC All Payor (Choice/PPO)	$70.38
Rate for Payer: UHC Dual Complete DSNP	$70.38
Rate for Payer: UHC Exchange	$70.38
Rate for Payer: UHC Medicare Advantage	$70.38

PR HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM

Professional

Both

$36.00

Service Code	HCPCS 90744
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$45.60
Rate for Payer: Aetna Commercial	$42.44
Rate for Payer: Aetna Medicare	$32.94
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: BCBS MAPPO	$31.67
Rate for Payer: BCN Medicare Advantage	$31.67
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cofinity Commercial	$45.60
Rate for Payer: Cofinity Commercial	$42.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$31.67
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$33.25
Rate for Payer: Nomi Health Commercial	$38.00
Rate for Payer: PACE SWMI	$31.67
Rate for Payer: PHP Medicare Advantage	$31.67
Rate for Payer: Priority Health Cigna Priority Health	$23.40
Rate for Payer: Priority Health Medicare	$31.99
Rate for Payer: UHC All Payor (Choice/PPO)	$31.67
Rate for Payer: UHC Dual Complete DSNP	$31.67
Rate for Payer: UHC Exchange	$31.67
Rate for Payer: UHC Medicare Advantage	$31.67

PR HFO FLEXION GLOVE PRE OTS

Professional

Both

$99.00

Service Code	HCPCS L3912
Min. Negotiated Rate	$39.60
Max. Negotiated Rate	$166.36
Rate for Payer: Aetna Commercial	$154.81
Rate for Payer: Aetna Medicare	$120.15
Rate for Payer: BCBS Complete	$39.60
Rate for Payer: BCBS MAPPO	$115.53
Rate for Payer: BCN Medicare Advantage	$115.53
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cofinity Commercial	$166.36
Rate for Payer: Cofinity Commercial	$154.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$115.53
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$121.31
Rate for Payer: Nomi Health Commercial	$138.64
Rate for Payer: PACE SWMI	$115.53
Rate for Payer: PHP Medicare Advantage	$115.53
Rate for Payer: Priority Health Cigna Priority Health	$64.35
Rate for Payer: Priority Health Medicare	$116.69
Rate for Payer: UHC All Payor (Choice/PPO)	$115.53
Rate for Payer: UHC Dual Complete DSNP	$115.53
Rate for Payer: UHC Exchange	$115.53
Rate for Payer: UHC Medicare Advantage	$115.53

PR HFO NONTORSION JNTS PRE CST

Professional

Both

$86.00

Service Code	HCPCS L3929
Min. Negotiated Rate	$34.40
Max. Negotiated Rate	$144.23
Rate for Payer: Aetna Commercial	$134.21
Rate for Payer: Aetna Medicare	$104.17
Rate for Payer: BCBS Complete	$34.40
Rate for Payer: BCBS MAPPO	$100.16
Rate for Payer: BCN Medicare Advantage	$100.16
Rate for Payer: Cash Price	$68.80
Rate for Payer: Cash Price	$68.80
Rate for Payer: Cofinity Commercial	$144.23
Rate for Payer: Cofinity Commercial	$134.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$100.16
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$105.17
Rate for Payer: Nomi Health Commercial	$120.19
Rate for Payer: PACE SWMI	$100.16
Rate for Payer: PHP Medicare Advantage	$100.16
Rate for Payer: Priority Health Cigna Priority Health	$55.90
Rate for Payer: Priority Health Medicare	$101.16
Rate for Payer: UHC All Payor (Choice/PPO)	$100.16
Rate for Payer: UHC Dual Complete DSNP	$100.16
Rate for Payer: UHC Exchange	$100.16
Rate for Payer: UHC Medicare Advantage	$100.16

PR HFO W/JOINT(S) CF

Professional

Both

$300.00

Service Code	HCPCS L3921
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$507.23
Rate for Payer: Aetna Commercial	$472.00
Rate for Payer: Aetna Medicare	$366.33
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: BCBS MAPPO	$352.24
Rate for Payer: BCN Medicare Advantage	$352.24
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Cofinity Commercial	$507.23
Rate for Payer: Cofinity Commercial	$472.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$352.24
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$369.85
Rate for Payer: Nomi Health Commercial	$422.69
Rate for Payer: PACE SWMI	$352.24
Rate for Payer: PHP Medicare Advantage	$352.24
Rate for Payer: Priority Health Cigna Priority Health	$195.00
Rate for Payer: Priority Health Medicare	$355.76
Rate for Payer: UHC All Payor (Choice/PPO)	$352.24
Rate for Payer: UHC Dual Complete DSNP	$352.24
Rate for Payer: UHC Exchange	$352.24
Rate for Payer: UHC Medicare Advantage	$352.24

PR HFO W/O JOINTS CF

Professional

Both

$253.00

Service Code	HCPCS L3913
Min. Negotiated Rate	$101.20
Max. Negotiated Rate	$427.62
Rate for Payer: Aetna Commercial	$397.93
Rate for Payer: Aetna Medicare	$308.84
Rate for Payer: BCBS Complete	$101.20
Rate for Payer: BCBS MAPPO	$296.96
Rate for Payer: BCN Medicare Advantage	$296.96
Rate for Payer: Cash Price	$202.40
Rate for Payer: Cash Price	$202.40
Rate for Payer: Cofinity Commercial	$397.93
Rate for Payer: Cofinity Commercial	$427.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$296.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$311.81
Rate for Payer: Nomi Health Commercial	$356.35
Rate for Payer: PACE SWMI	$296.96
Rate for Payer: PHP Medicare Advantage	$296.96
Rate for Payer: Priority Health Cigna Priority Health	$164.45
Rate for Payer: Priority Health Medicare	$299.93
Rate for Payer: UHC All Payor (Choice/PPO)	$296.96
Rate for Payer: UHC Dual Complete DSNP	$296.96
Rate for Payer: UHC Exchange	$296.96
Rate for Payer: UHC Medicare Advantage	$296.96

PR HIB-HEPB VACCINE FOR INTRAMUSCULAR USE

Professional

Both

$265.00

Service Code	HCPCS 90748
Min. Negotiated Rate	$106.00
Max. Negotiated Rate	$172.25
Rate for Payer: Aetna Medicare	$132.50
Rate for Payer: BCBS Complete	$106.00
Rate for Payer: Cash Price	$212.00
Rate for Payer: Priority Health Cigna Priority Health	$172.25

PR HIB PRP-OMP VACCINE 3 DOSE SCHEDULE IM USE

Professional

Both

$37.00

Service Code	HCPCS 90647
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$24.05
Rate for Payer: Aetna Medicare	$18.50
Rate for Payer: BCBS Complete	$14.80
Rate for Payer: Cash Price	$29.60
Rate for Payer: Priority Health Cigna Priority Health	$24.05

PR HIB PRP-T VACCINE 4 DOSE SCHEDULE IM USE

Professional

Both

$33.00

Service Code	HCPCS 90648
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$21.45
Rate for Payer: Aetna Medicare	$16.50
Rate for Payer: BCBS Complete	$13.20
Rate for Payer: Cash Price	$26.40
Rate for Payer: Priority Health Cigna Priority Health	$21.45

PR HIB VACCINE, HBOC, IM

Professional

Both

$32.00

Service Code	HCPCS 90645
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Priority Health Cigna Priority Health	$20.80

PR HIB VACCINE, PRP-D, IM

Professional

Both

$33.00

Service Code	HCPCS 90646
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$21.45
Rate for Payer: Aetna Medicare	$16.50
Rate for Payer: BCBS Complete	$13.20
Rate for Payer: Cash Price	$26.40
Rate for Payer: Priority Health Cigna Priority Health	$21.45

PR HINGE EXTENSION/FLEX WRIST/F

Professional

Both

$1,512.00

Service Code	HCPCS L3900
Min. Negotiated Rate	$604.80
Max. Negotiated Rate	$2,557.90
Rate for Payer: Aetna Commercial	$2,380.27
Rate for Payer: Aetna Medicare	$1,847.37
Rate for Payer: BCBS Complete	$604.80
Rate for Payer: BCBS MAPPO	$1,776.32
Rate for Payer: BCN Medicare Advantage	$1,776.32
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Cash Price	$1,209.60
Rate for Payer: Cofinity Commercial	$2,380.27
Rate for Payer: Cofinity Commercial	$2,557.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,776.32
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,865.14
Rate for Payer: Nomi Health Commercial	$2,131.58
Rate for Payer: PACE SWMI	$1,776.32
Rate for Payer: PHP Medicare Advantage	$1,776.32
Rate for Payer: Priority Health Cigna Priority Health	$982.80
Rate for Payer: Priority Health Medicare	$1,794.08
Rate for Payer: UHC All Payor (Choice/PPO)	$1,776.32
Rate for Payer: UHC Dual Complete DSNP	$1,776.32
Rate for Payer: UHC Exchange	$1,776.32
Rate for Payer: UHC Medicare Advantage	$1,776.32

PR HOME HEALTH CARE SUPERVISION

Professional

Both

$184.00

Service Code	HCPCS G0181
Min. Negotiated Rate	$73.60
Max. Negotiated Rate	$142.85
Rate for Payer: Aetna Commercial	$132.93
Rate for Payer: Aetna Medicare	$103.17
Rate for Payer: BCBS Complete	$73.60
Rate for Payer: BCBS MAPPO	$99.20
Rate for Payer: BCN Medicare Advantage	$99.20
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cofinity Commercial	$142.85
Rate for Payer: Cofinity Commercial	$132.93
Rate for Payer: Health Alliance Plan Medicare Advantage	$99.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$104.16
Rate for Payer: Nomi Health Commercial	$119.04
Rate for Payer: PACE SWMI	$99.20
Rate for Payer: PHP Medicare Advantage	$99.20
Rate for Payer: Priority Health Cigna Priority Health	$119.60
Rate for Payer: Priority Health Medicare	$100.19
Rate for Payer: UHC All Payor (Choice/PPO)	$99.20
Rate for Payer: UHC Dual Complete DSNP	$99.20
Rate for Payer: UHC Exchange	$99.20
Rate for Payer: UHC Medicare Advantage	$99.20

PR HOME/RES VISIT EST PATIENT HIGH MDM 60 MINUTES

Professional

Both

$306.00

Service Code	HCPCS 99350
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$251.12
Rate for Payer: Aetna Commercial	$233.68
Rate for Payer: Aetna Medicare	$181.37
Rate for Payer: BCBS Complete	$122.40
Rate for Payer: BCBS MAPPO	$174.39
Rate for Payer: BCN Medicare Advantage	$174.39
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cash Price	$244.80
Rate for Payer: Cofinity Commercial	$251.12
Rate for Payer: Cofinity Commercial	$233.68
Rate for Payer: Health Alliance Plan Medicare Advantage	$174.39
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$183.11
Rate for Payer: Nomi Health Commercial	$209.27
Rate for Payer: PACE SWMI	$174.39
Rate for Payer: PHP Medicare Advantage	$174.39
Rate for Payer: Priority Health Cigna Priority Health	$198.90
Rate for Payer: Priority Health Medicare	$176.13
Rate for Payer: UHC All Payor (Choice/PPO)	$174.39
Rate for Payer: UHC Dual Complete DSNP	$174.39
Rate for Payer: UHC Exchange	$174.39
Rate for Payer: UHC Medicare Advantage	$174.39

PR HOME/RES VISIT EST PATIENT LOW MDM 30 MINUTES

Professional

Both

$150.00

Service Code	HCPCS 99348
Min. Negotiated Rate	$60.00
Max. Negotiated Rate	$104.37
Rate for Payer: Aetna Commercial	$97.12
Rate for Payer: Aetna Medicare	$75.38
Rate for Payer: BCBS Complete	$60.00
Rate for Payer: BCBS MAPPO	$72.48
Rate for Payer: BCN Medicare Advantage	$72.48
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cofinity Commercial	$97.12
Rate for Payer: Cofinity Commercial	$104.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$72.48
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$76.10
Rate for Payer: Nomi Health Commercial	$86.98
Rate for Payer: PACE SWMI	$72.48
Rate for Payer: PHP Medicare Advantage	$72.48
Rate for Payer: Priority Health Cigna Priority Health	$97.50
Rate for Payer: Priority Health Medicare	$73.20
Rate for Payer: UHC All Payor (Choice/PPO)	$72.48
Rate for Payer: UHC Dual Complete DSNP	$72.48
Rate for Payer: UHC Exchange	$72.48
Rate for Payer: UHC Medicare Advantage	$72.48

Know your out-of-pocket cost for care.

All Charges