Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR METHYLPREDNISOLONE INJECTION

Professional

Both

$10.00

Service Code	HCPCS J2920
Min. Negotiated Rate	$3.17
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Commercial	$4.31
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS Trust/PPO	$3.17
Rate for Payer: BCN Commercial	$3.53
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$6.50

PR MGMT LVR HEMRRG CPLX SUTR WND/INJ

Professional

Both

$3,454.00

Service Code	HCPCS 47360
Min. Negotiated Rate	$331.24
Max. Negotiated Rate	$3,346.89
Rate for Payer: Aetna Commercial	$2,436.71
Rate for Payer: Aetna Medicare	$1,891.18
Rate for Payer: BCBS Complete	$1,260.27
Rate for Payer: BCBS MAPPO	$1,818.44
Rate for Payer: BCBS Trust/PPO	$331.24
Rate for Payer: BCN Commercial	$2,732.20
Rate for Payer: BCN Medicare Advantage	$1,818.44
Rate for Payer: Cash Price	$2,763.20
Rate for Payer: Cash Price	$2,763.20
Rate for Payer: Cofinity Commercial	$2,436.71
Rate for Payer: Cofinity Commercial	$2,618.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,818.44
Rate for Payer: Mclaren Medicaid	$1,200.26
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,909.36
Rate for Payer: Meridian Medicaid	$1,260.27
Rate for Payer: Nomi Health Commercial	$2,182.13
Rate for Payer: PACE SWMI	$1,818.44
Rate for Payer: PHP Medicare Advantage	$1,818.44
Rate for Payer: Priority Health Choice Medicaid	$1,200.26
Rate for Payer: Priority Health Cigna Priority Health	$2,245.10
Rate for Payer: Priority Health HMO/PPO	$3,346.89
Rate for Payer: Priority Health Medicare	$1,836.62
Rate for Payer: Priority Health Narrow/Tiered Network	$3,346.89
Rate for Payer: UHC All Payor (Choice/PPO)	$1,818.44
Rate for Payer: UHC Dual Complete DSNP	$1,818.44
Rate for Payer: UHC Exchange	$1,818.44
Rate for Payer: UHC Medicare Advantage	$1,818.44
Rate for Payer: UHCCP Medicaid	$1,200.26

PR MGMT LVR HEMRRG EXPL WND DBRDMT COAGJ/SUTR

Professional

Both

$6,375.00

Service Code	HCPCS 47361
Min. Negotiated Rate	$1,921.90
Max. Negotiated Rate	$5,352.04
Rate for Payer: Aetna Commercial	$3,908.66
Rate for Payer: Aetna Medicare	$3,033.59
Rate for Payer: BCBS Complete	$2,018.00
Rate for Payer: BCBS MAPPO	$2,916.91
Rate for Payer: BCN Commercial	$4,387.35
Rate for Payer: BCN Medicare Advantage	$2,916.91
Rate for Payer: Cash Price	$5,100.00
Rate for Payer: Cash Price	$5,100.00
Rate for Payer: Cofinity Commercial	$4,200.35
Rate for Payer: Cofinity Commercial	$3,908.66
Rate for Payer: Health Alliance Plan Medicare Advantage	$2,916.91
Rate for Payer: Mclaren Medicaid	$1,921.90
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3,062.76
Rate for Payer: Meridian Medicaid	$2,018.00
Rate for Payer: Nomi Health Commercial	$3,500.29
Rate for Payer: PACE SWMI	$2,916.91
Rate for Payer: PHP Medicare Advantage	$2,916.91
Rate for Payer: Priority Health Choice Medicaid	$1,921.90
Rate for Payer: Priority Health Cigna Priority Health	$4,143.75
Rate for Payer: Priority Health HMO/PPO	$5,352.04
Rate for Payer: Priority Health Medicare	$2,946.08
Rate for Payer: Priority Health Narrow/Tiered Network	$5,352.04
Rate for Payer: UHC All Payor (Choice/PPO)	$2,916.91
Rate for Payer: UHC Dual Complete DSNP	$2,916.91
Rate for Payer: UHC Exchange	$2,916.91
Rate for Payer: UHC Medicare Advantage	$2,916.91
Rate for Payer: UHCCP Medicaid	$1,921.90

PR MGMT LVR HEMRRG RE-EXPL WND RMVL PACKING

Professional

Both

$2,999.00

Service Code	HCPCS 47362
Min. Negotiated Rate	$910.36
Max. Negotiated Rate	$2,594.58
Rate for Payer: Aetna Commercial	$1,839.79
Rate for Payer: Aetna Medicare	$1,427.90
Rate for Payer: BCBS Complete	$955.88
Rate for Payer: BCBS MAPPO	$1,372.98
Rate for Payer: BCN Commercial	$2,091.06
Rate for Payer: BCN Medicare Advantage	$1,372.98
Rate for Payer: Cash Price	$2,399.20
Rate for Payer: Cash Price	$2,399.20
Rate for Payer: Cofinity Commercial	$1,839.79
Rate for Payer: Cofinity Commercial	$1,977.09
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,372.98
Rate for Payer: Mclaren Medicaid	$910.36
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,441.63
Rate for Payer: Meridian Medicaid	$955.88
Rate for Payer: Nomi Health Commercial	$1,647.58
Rate for Payer: PACE SWMI	$1,372.98
Rate for Payer: PHP Medicare Advantage	$1,372.98
Rate for Payer: Priority Health Choice Medicaid	$910.36
Rate for Payer: Priority Health Cigna Priority Health	$1,949.35
Rate for Payer: Priority Health HMO/PPO	$2,594.58
Rate for Payer: Priority Health Medicare	$1,386.71
Rate for Payer: Priority Health Narrow/Tiered Network	$2,594.58
Rate for Payer: UHC All Payor (Choice/PPO)	$1,372.98
Rate for Payer: UHC Dual Complete DSNP	$1,372.98
Rate for Payer: UHC Exchange	$1,372.98
Rate for Payer: UHC Medicare Advantage	$1,372.98
Rate for Payer: UHCCP Medicaid	$910.36

PR MGMT LVR HEMRRG SMPL SUTR LVR WND/INJ

Professional

Both

$2,903.00

Service Code	HCPCS 47350
Min. Negotiated Rate	$873.51
Max. Negotiated Rate	$2,437.69
Rate for Payer: Aetna Commercial	$1,765.73
Rate for Payer: Aetna Medicare	$1,370.42
Rate for Payer: BCBS Complete	$917.19
Rate for Payer: BCBS MAPPO	$1,317.71
Rate for Payer: BCBS Trust/PPO	$1,888.67
Rate for Payer: BCN Commercial	$1,994.78
Rate for Payer: BCN Medicare Advantage	$1,317.71
Rate for Payer: Cash Price	$2,322.40
Rate for Payer: Cash Price	$2,322.40
Rate for Payer: Cofinity Commercial	$1,897.50
Rate for Payer: Cofinity Commercial	$1,765.73
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,317.71
Rate for Payer: Mclaren Medicaid	$873.51
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,383.60
Rate for Payer: Meridian Medicaid	$917.19
Rate for Payer: Nomi Health Commercial	$1,581.25
Rate for Payer: PACE SWMI	$1,317.71
Rate for Payer: PHP Medicare Advantage	$1,317.71
Rate for Payer: Priority Health Choice Medicaid	$873.51
Rate for Payer: Priority Health Cigna Priority Health	$1,886.95
Rate for Payer: Priority Health HMO/PPO	$2,437.69
Rate for Payer: Priority Health Medicare	$1,330.89
Rate for Payer: Priority Health Narrow/Tiered Network	$2,437.69
Rate for Payer: UHC All Payor (Choice/PPO)	$1,317.71
Rate for Payer: UHC Dual Complete DSNP	$1,317.71
Rate for Payer: UHC Exchange	$1,317.71
Rate for Payer: UHC Medicare Advantage	$1,317.71
Rate for Payer: UHCCP Medicaid	$873.51

PR MH PARTIAL HOSP TX UNDER 24H

Professional

Both

$259.00

Service Code	HCPCS H0035
Min. Negotiated Rate	$103.60
Max. Negotiated Rate	$268.86
Rate for Payer: Aetna Commercial	$268.86
Rate for Payer: Aetna Medicare	$129.50
Rate for Payer: BCBS Complete	$103.60
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cash Price	$207.20
Rate for Payer: Priority Health Cigna Priority Health	$168.35

PR MICRONEEDLING PIN ADB/THIGHS/BACK

Professional

Both

$459.00

Service Code	HCPCS 00108
Hospital Revenue Code	990
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$298.35
Rate for Payer: Aetna Medicare	$229.50
Rate for Payer: BCBS Complete	$183.60
Rate for Payer: Cash Price	$367.20
Rate for Payer: Priority Health Cigna Priority Health	$298.35

PR MICRONEEDLING PIN FULL FACE

Professional

Both

$408.00

Service Code	HCPCS 00105
Hospital Revenue Code	990
Min. Negotiated Rate	$163.20
Max. Negotiated Rate	$265.20
Rate for Payer: Aetna Medicare	$204.00
Rate for Payer: BCBS Complete	$163.20
Rate for Payer: Cash Price	$326.40
Rate for Payer: Priority Health Cigna Priority Health	$265.20

PR MICRONEEDLING PIN NECK

Professional

Both

$153.00

Service Code	HCPCS 00107
Hospital Revenue Code	990
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 MICRONEEDLING PIN UPPER OR LOWER FACE

Professional

Both

$255.00

Service Code	HCPCS 00106
Hospital Revenue Code	990
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$165.75
Rate for Payer: Aetna Medicare	$127.50
Rate for Payer: BCBS Complete	$102.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Priority Health Cigna Priority Health	$165.75

PR MICRONEEDLING SCARS - UP TO 4 INCHES

Professional

Both

$51.00

Service Code	HCPCS 00109
Hospital Revenue Code	990
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 MICRONEEDLING TAT RMVL 4-6 SQ INCHES

Professional

Both

$459.00

Service Code	HCPCS 00122
Hospital Revenue Code	990
Min. Negotiated Rate	$183.60
Max. Negotiated Rate	$298.35
Rate for Payer: Aetna Medicare	$229.50
Rate for Payer: BCBS Complete	$183.60
Rate for Payer: Cash Price	$367.20
Rate for Payer: Priority Health Cigna Priority Health	$298.35

PR MICRONEEDLING TAT RMVL 6-9 SQ INCHES

Professional

Both

$306.00

Service Code	HCPCS 00123
Hospital Revenue Code	990
Min. Negotiated Rate	$122.40
Max. Negotiated Rate	$198.90
Rate for Payer: Aetna Medicare	$153.00
Rate for Payer: BCBS Complete	$122.40
Rate for Payer: Cash Price	$244.80
Rate for Payer: Priority Health Cigna Priority Health	$198.90

PR MICRONEEDLING TAT RMVL 9-12 SQ INCHES

Professional

Both

$204.00

Service Code	HCPCS 00124
Hospital Revenue Code	990
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$132.60
Rate for Payer: Aetna Medicare	$102.00
Rate for Payer: BCBS Complete	$81.60
Rate for Payer: Cash Price	$163.20
Rate for Payer: Priority Health Cigna Priority Health	$132.60

PR MICRONEEDLING TAT RMVL UP TO 2 SQ INCH

Professional

Both

$153.00

Service Code	HCPCS 00110
Hospital Revenue Code	990
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 MICROSURG TQS REQ USE OPERATING MICROSCOPE

Professional

Both

$501.00

Service Code	HCPCS 69990
Min. Negotiated Rate	$139.52
Max. Negotiated Rate	$11,952.59
Rate for Payer: Aetna Commercial	$287.76
Rate for Payer: Aetna Medicare	$223.34
Rate for Payer: BCBS Complete	$146.50
Rate for Payer: BCBS MAPPO	$214.75
Rate for Payer: BCBS Trust/PPO	$11,952.59
Rate for Payer: BCN Commercial	$349.21
Rate for Payer: BCN Medicare Advantage	$214.75
Rate for Payer: Cash Price	$400.80
Rate for Payer: Cash Price	$400.80
Rate for Payer: Cofinity Commercial	$309.24
Rate for Payer: Cofinity Commercial	$287.76
Rate for Payer: Health Alliance Plan Medicare Advantage	$214.75
Rate for Payer: Mclaren Medicaid	$139.52
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$225.49
Rate for Payer: Meridian Medicaid	$146.50
Rate for Payer: Nomi Health Commercial	$257.70
Rate for Payer: PACE SWMI	$214.75
Rate for Payer: PHP Medicare Advantage	$214.75
Rate for Payer: Priority Health Choice Medicaid	$139.52
Rate for Payer: Priority Health Cigna Priority Health	$325.65
Rate for Payer: Priority Health HMO/PPO	$317.11
Rate for Payer: Priority Health Medicare	$216.90
Rate for Payer: Priority Health Narrow/Tiered Network	$317.11
Rate for Payer: UHC All Payor (Choice/PPO)	$214.75
Rate for Payer: UHC Dual Complete DSNP	$214.75
Rate for Payer: UHC Exchange	$214.75
Rate for Payer: UHC Medicare Advantage	$214.75
Rate for Payer: UHCCP Medicaid	$139.52

PR MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC

Professional

Both

$1,704.00

Service Code	HCPCS 69440
Min. Negotiated Rate	$441.12
Max. Negotiated Rate	$1,668.90
Rate for Payer: Aetna Commercial	$860.23
Rate for Payer: Aetna Medicare	$667.64
Rate for Payer: BCBS Complete	$463.18
Rate for Payer: BCBS MAPPO	$641.96
Rate for Payer: BCBS Trust/PPO	$1,668.90
Rate for Payer: BCN Commercial	$1,024.27
Rate for Payer: BCN Medicare Advantage	$641.96
Rate for Payer: Cash Price	$1,363.20
Rate for Payer: Cash Price	$1,363.20
Rate for Payer: Cofinity Commercial	$924.42
Rate for Payer: Cofinity Commercial	$860.23
Rate for Payer: Health Alliance Plan Medicare Advantage	$641.96
Rate for Payer: Mclaren Medicaid	$441.12
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$674.06
Rate for Payer: Meridian Medicaid	$463.18
Rate for Payer: Nomi Health Commercial	$770.35
Rate for Payer: PACE SWMI	$641.96
Rate for Payer: PHP Medicare Advantage	$641.96
Rate for Payer: Priority Health Choice Medicaid	$441.12
Rate for Payer: Priority Health Cigna Priority Health	$1,107.60
Rate for Payer: Priority Health HMO/PPO	$1,018.47
Rate for Payer: Priority Health Medicare	$648.38
Rate for Payer: Priority Health Narrow/Tiered Network	$1,018.47
Rate for Payer: UHC All Payor (Choice/PPO)	$641.96
Rate for Payer: UHC Dual Complete DSNP	$641.96
Rate for Payer: UHC Exchange	$641.96
Rate for Payer: UHC Medicare Advantage	$641.96
Rate for Payer: UHCCP Medicaid	$441.12

PR MIDFACE FLAP W/PRESERVATION OF VASCULAR PEDICLES

Professional

Both

$2,972.00

Service Code	HCPCS 15730
Min. Negotiated Rate	$584.69
Max. Negotiated Rate	$2,089.09
Rate for Payer: Aetna Commercial	$1,153.36
Rate for Payer: Aetna Medicare	$895.15
Rate for Payer: BCBS Complete	$613.92
Rate for Payer: BCBS MAPPO	$860.72
Rate for Payer: BCBS Trust/PPO	$1,930.99
Rate for Payer: BCN Commercial	$2,089.09
Rate for Payer: BCN Medicare Advantage	$860.72
Rate for Payer: Cash Price	$2,377.60
Rate for Payer: Cash Price	$2,377.60
Rate for Payer: Cofinity Commercial	$1,239.44
Rate for Payer: Cofinity Commercial	$1,153.36
Rate for Payer: Health Alliance Plan Medicare Advantage	$860.72
Rate for Payer: Mclaren Medicaid	$584.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$903.76
Rate for Payer: Meridian Medicaid	$613.92
Rate for Payer: Nomi Health Commercial	$1,032.86
Rate for Payer: PACE SWMI	$860.72
Rate for Payer: PHP Medicare Advantage	$860.72
Rate for Payer: Priority Health Choice Medicaid	$584.69
Rate for Payer: Priority Health Cigna Priority Health	$1,931.80
Rate for Payer: Priority Health HMO/PPO	$1,236.70
Rate for Payer: Priority Health Medicare	$869.33
Rate for Payer: Priority Health Narrow/Tiered Network	$1,236.70
Rate for Payer: UHC All Payor (Choice/PPO)	$860.72
Rate for Payer: UHC Dual Complete DSNP	$860.72
Rate for Payer: UHC Exchange	$860.72
Rate for Payer: UHC Medicare Advantage	$860.72
Rate for Payer: UHCCP Medicaid	$584.69

PR MIRENA, 52 MG

Professional

Both

$1,472.00

Service Code	HCPCS J7298
Min. Negotiated Rate	$736.00
Max. Negotiated Rate	$1,351.89
Rate for Payer: Aetna Commercial	$1,101.70
Rate for Payer: Aetna Medicare	$736.00
Rate for Payer: BCBS Complete	$1,351.89
Rate for Payer: BCBS Trust/PPO	$1,103.90
Rate for Payer: BCN Commercial	$1,107.20
Rate for Payer: Cash Price	$1,177.60
Rate for Payer: Cash Price	$1,177.60
Rate for Payer: Mclaren Medicaid	$1,287.51
Rate for Payer: Meridian Medicaid	$1,351.89
Rate for Payer: Priority Health Choice Medicaid	$1,287.51
Rate for Payer: Priority Health Cigna Priority Health	$956.80
Rate for Payer: UHCCP Medicaid	$1,287.51

PR MISC VISION ITEM OR SERVICE

Professional

Both

$5.00

Service Code	HCPCS V2799
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.25

PR MISOPROSTOL, ORAL, 200 MCG

Professional

Both

$4.00

Service Code	HCPCS S0191
Min. Negotiated Rate	$0.64
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: BCBS Trust/PPO	$0.64
Rate for Payer: BCN Commercial	$0.64
Rate for Payer: Cash Price	$3.20
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60

PR MITOMYCIN INJECTION

Professional

Both

$153.00

Service Code	HCPCS J9280
Min. Negotiated Rate	$3.72
Max. Negotiated Rate	$99.45
Rate for Payer: Aetna Commercial	$37.88
Rate for Payer: Aetna Medicare	$29.40
Rate for Payer: BCBS Complete	$61.20
Rate for Payer: BCBS MAPPO	$28.27
Rate for Payer: BCBS Trust/PPO	$10.36
Rate for Payer: BCN Commercial	$3.72
Rate for Payer: BCN Medicare Advantage	$28.27
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cofinity Commercial	$40.71
Rate for Payer: Cofinity Commercial	$37.88
Rate for Payer: Health Alliance Plan Medicare Advantage	$28.27
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$29.69
Rate for Payer: Nomi Health Commercial	$33.93
Rate for Payer: PACE SWMI	$28.27
Rate for Payer: PHP Medicare Advantage	$28.27
Rate for Payer: Priority Health Cigna Priority Health	$99.45
Rate for Payer: Priority Health Medicare	$28.55
Rate for Payer: UHC All Payor (Choice/PPO)	$28.27
Rate for Payer: UHC Dual Complete DSNP	$28.27
Rate for Payer: UHC Exchange	$28.27
Rate for Payer: UHC Medicare Advantage	$28.27

PR MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG

Professional

Both

$995.00

Service Code	HCPCS 95805
Min. Negotiated Rate	$35.78
Max. Negotiated Rate	$646.75
Rate for Payer: Aetna Commercial	$526.20
Rate for Payer: Aetna Commercial	$526.20
Rate for Payer: Aetna Medicare	$408.40
Rate for Payer: Aetna Medicare	$408.40
Rate for Payer: BCBS Complete	$37.57
Rate for Payer: BCBS Complete	$37.57
Rate for Payer: BCBS MAPPO	$392.69
Rate for Payer: BCBS MAPPO	$392.69
Rate for Payer: BCBS Trust/PPO	$639.77
Rate for Payer: BCBS Trust/PPO	$639.77
Rate for Payer: BCN Commercial	$610.36
Rate for Payer: BCN Commercial	$610.36
Rate for Payer: BCN Medicare Advantage	$392.69
Rate for Payer: BCN Medicare Advantage	$392.69
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cash Price	$796.00
Rate for Payer: Cash Price	$796.00
Rate for Payer: Cofinity Commercial	$526.20
Rate for Payer: Cofinity Commercial	$565.47
Rate for Payer: Cofinity Commercial	$526.20
Rate for Payer: Cofinity Commercial	$565.47
Rate for Payer: Health Alliance Plan Medicare Advantage	$392.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$392.69
Rate for Payer: Mclaren Medicaid	$35.78
Rate for Payer: Mclaren Medicaid	$35.78
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$412.32
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$412.32
Rate for Payer: Meridian Medicaid	$37.57
Rate for Payer: Meridian Medicaid	$37.57
Rate for Payer: Nomi Health Commercial	$471.23
Rate for Payer: Nomi Health Commercial	$471.23
Rate for Payer: PACE SWMI	$392.69
Rate for Payer: PACE SWMI	$392.69
Rate for Payer: PHP Medicare Advantage	$392.69
Rate for Payer: PHP Medicare Advantage	$392.69
Rate for Payer: Priority Health Choice Medicaid	$35.78
Rate for Payer: Priority Health Choice Medicaid	$35.78
Rate for Payer: Priority Health Cigna Priority Health	$159.25
Rate for Payer: Priority Health Cigna Priority Health	$646.75
Rate for Payer: Priority Health HMO/PPO	$75.98
Rate for Payer: Priority Health HMO/PPO	$75.98
Rate for Payer: Priority Health Medicare	$396.62
Rate for Payer: Priority Health Medicare	$396.62
Rate for Payer: Priority Health Narrow/Tiered Network	$75.98
Rate for Payer: Priority Health Narrow/Tiered Network	$75.98
Rate for Payer: UHC All Payor (Choice/PPO)	$392.69
Rate for Payer: UHC All Payor (Choice/PPO)	$392.69
Rate for Payer: UHC Dual Complete DSNP	$392.69
Rate for Payer: UHC Dual Complete DSNP	$392.69
Rate for Payer: UHC Exchange	$392.69
Rate for Payer: UHC Exchange	$392.69
Rate for Payer: UHC Medicare Advantage	$392.69
Rate for Payer: UHC Medicare Advantage	$392.69
Rate for Payer: UHCCP Medicaid	$35.78
Rate for Payer: UHCCP Medicaid	$35.78

PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS

Facility

$921.00

Service Code	CPT 23700
Hospital Charge Code	23700
Min. Negotiated Rate	$598.65
Max. Negotiated Rate	$828.90
Rate for Payer: Aetna Commercial	$782.85
Rate for Payer: BCBS Trust/PPO	$751.81
Rate for Payer: BCN Commercial	$711.75
Rate for Payer: Cash Price	$736.80
Rate for Payer: Cofinity Commercial	$792.06
Rate for Payer: Encore Health Key Benefits Commercial	$736.80
Rate for Payer: Healthscope Commercial	$828.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$690.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$782.85
Rate for Payer: Nomi Health Commercial	$755.22
Rate for Payer: PHP Commercial	$782.85
Rate for Payer: Priority Health Cigna Priority Health	$598.65
Rate for Payer: Priority Health HMO/PPO	$801.27
Rate for Payer: Priority Health Narrow/Tiered Network	$617.07
Rate for Payer: UHC All Payor (Choice/PPO)	$810.48
Rate for Payer: UHC Core	$769.04
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$690.75

PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS

Facility

$921.00

Service Code	CPT 23700
Hospital Charge Code	23700
Min. Negotiated Rate	$218.74
Max. Negotiated Rate	$1,190.46
Rate for Payer: Aetna Commercial	$782.85
Rate for Payer: Aetna Medicare	$239.46
Rate for Payer: Allen County Amish Medical Aid Commercial	$287.81
Rate for Payer: Amish Plain Church Group Commercial	$287.81
Rate for Payer: BCBS Complete	$1,190.46
Rate for Payer: BCBS MAPPO	$230.25
Rate for Payer: BCBS Trust/PPO	$757.15
Rate for Payer: BCN Commercial	$716.08
Rate for Payer: BCN Medicare Advantage	$230.25
Rate for Payer: Cash Price	$736.80
Rate for Payer: Cash Price	$736.80
Rate for Payer: Cofinity Commercial	$792.06
Rate for Payer: Encore Health Key Benefits Commercial	$736.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$230.25
Rate for Payer: Healthscope Commercial	$828.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$690.75
Rate for Payer: Mclaren Medicaid	$1,133.70
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$241.76
Rate for Payer: Meridian Medicaid	$1,190.46
Rate for Payer: MI Amish Medical Board Commercial	$264.79
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$782.85
Rate for Payer: Nomi Health Commercial	$755.22
Rate for Payer: PACE Senior Care Partners	$218.74
Rate for Payer: PACE SWMI	$230.25
Rate for Payer: PHP Commercial	$782.85
Rate for Payer: PHP Medicare Advantage	$230.25
Rate for Payer: Priority Health Choice Medicaid	$1,133.70
Rate for Payer: Priority Health Cigna Priority Health	$598.65
Rate for Payer: Priority Health HMO/PPO	$801.27
Rate for Payer: Priority Health Medicare	$232.55
Rate for Payer: Priority Health Narrow/Tiered Network	$617.07
Rate for Payer: Railroad Medicare Medicare	$230.25
Rate for Payer: UHC All Payor (Choice/PPO)	$810.48
Rate for Payer: UHC Core	$769.04
Rate for Payer: UHC Dual Complete DSNP	$230.25
Rate for Payer: UHC Exchange	$230.25
Rate for Payer: UHC Medicare Advantage	$230.25
Rate for Payer: UHCCP Medicaid	$1,133.70
Rate for Payer: VA VA	$230.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$690.75

Know your out-of-pocket cost for care.

All Charges