Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR SUBTEMPORAL CRANIAL DECOMPRESSION

Professional

Both

$4,236.00

Service Code	HCPCS 61340
Min. Negotiated Rate	$1,430.75
Max. Negotiated Rate	$2,753.40
Rate for Payer: Aetna Commercial	$1,917.20
Rate for Payer: Aetna Medicare	$1,487.98
Rate for Payer: BCBS Complete	$1,694.40
Rate for Payer: BCBS MAPPO	$1,430.75
Rate for Payer: BCN Medicare Advantage	$1,430.75
Rate for Payer: Cash Price	$3,388.80
Rate for Payer: Cash Price	$3,388.80
Rate for Payer: Cofinity Commercial	$1,917.20
Rate for Payer: Cofinity Commercial	$2,060.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,430.75
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,502.29
Rate for Payer: Nomi Health Commercial	$1,716.90
Rate for Payer: PACE SWMI	$1,430.75
Rate for Payer: PHP Medicare Advantage	$1,430.75
Rate for Payer: Priority Health Cigna Priority Health	$2,753.40
Rate for Payer: Priority Health Medicare	$1,445.06
Rate for Payer: UHC All Payor (Choice/PPO)	$1,430.75
Rate for Payer: UHC Dual Complete DSNP	$1,430.75
Rate for Payer: UHC Exchange	$1,430.75
Rate for Payer: UHC Medicare Advantage	$1,430.75

PR SUCTION ASSISTED LIPECTOMY HEAD & NECK

Professional

Both

$2,040.00

Service Code	HCPCS 15876
Min. Negotiated Rate	$816.00
Max. Negotiated Rate	$1,326.00
Rate for Payer: Aetna Medicare	$1,020.00
Rate for Payer: BCBS Complete	$816.00
Rate for Payer: Cash Price	$1,632.00
Rate for Payer: Priority Health Cigna Priority Health	$1,326.00

PR SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY

Professional

Both

$3,162.00

Service Code	HCPCS 15879
Min. Negotiated Rate	$1,264.80
Max. Negotiated Rate	$2,055.30
Rate for Payer: Aetna Medicare	$1,581.00
Rate for Payer: BCBS Complete	$1,264.80
Rate for Payer: Cash Price	$2,529.60
Rate for Payer: Priority Health Cigna Priority Health	$2,055.30

PR SUCTION ASSISTED LIPECTOMY TRUNK

Professional

Both

$2,754.00

Service Code	HCPCS 15877
Min. Negotiated Rate	$1,101.60
Max. Negotiated Rate	$1,790.10
Rate for Payer: Aetna Medicare	$1,377.00
Rate for Payer: BCBS Complete	$1,101.60
Rate for Payer: Cash Price	$2,203.20
Rate for Payer: Priority Health Cigna Priority Health	$1,790.10

PR SUMATRIPTAN SUCCINATE / 6 MG

Professional

Both

$112.00

Service Code	HCPCS J3030
Min. Negotiated Rate	$44.80
Max. Negotiated Rate	$72.80
Rate for Payer: Aetna Medicare	$56.00
Rate for Payer: BCBS Complete	$44.80
Rate for Payer: Cash Price	$89.60
Rate for Payer: Priority Health Cigna Priority Health	$72.80

PR SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN

Professional

Both

$136.00

Service Code	HCPCS 99377
Min. Negotiated Rate	$54.40
Max. Negotiated Rate	$88.40
Rate for Payer: Aetna Medicare	$68.00
Rate for Payer: BCBS Complete	$54.40
Rate for Payer: Cash Price	$108.80
Rate for Payer: Priority Health Cigna Priority Health	$88.40

PR SUPERVISION INTERFACILITY TRANSPORT INIT 30 MIN

Professional

Both

$153.00

Service Code	HCPCS 99485
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 SUPERVISION NURS FACILITY PATIENT MO 15-29 MIN

Professional

Both

$136.00

Service Code	HCPCS 99379
Min. Negotiated Rate	$54.40
Max. Negotiated Rate	$88.40
Rate for Payer: Aetna Medicare	$68.00
Rate for Payer: BCBS Complete	$54.40
Rate for Payer: Cash Price	$108.80
Rate for Payer: Priority Health Cigna Priority Health	$88.40

PR SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/>

Professional

Both

$173.00

Service Code	HCPCS 99380
Min. Negotiated Rate	$69.20
Max. Negotiated Rate	$112.45
Rate for Payer: Aetna Medicare	$86.50
Rate for Payer: BCBS Complete	$69.20
Rate for Payer: Cash Price	$138.40
Rate for Payer: Priority Health Cigna Priority Health	$112.45

PR SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/>

Professional

Both

$185.00

Service Code	HCPCS 99375
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$120.25
Rate for Payer: Aetna Medicare	$92.50
Rate for Payer: BCBS Complete	$74.00
Rate for Payer: Cash Price	$148.00
Rate for Payer: Priority Health Cigna Priority Health	$120.25

PR SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY

Professional

Both

$3,240.00

Service Code	HCPCS 58180
Min. Negotiated Rate	$925.11
Max. Negotiated Rate	$2,106.00
Rate for Payer: Aetna Commercial	$1,239.65
Rate for Payer: Aetna Medicare	$962.11
Rate for Payer: BCBS Complete	$1,296.00
Rate for Payer: BCBS MAPPO	$925.11
Rate for Payer: BCN Medicare Advantage	$925.11
Rate for Payer: Cash Price	$2,592.00
Rate for Payer: Cash Price	$2,592.00
Rate for Payer: Cofinity Commercial	$1,332.16
Rate for Payer: Cofinity Commercial	$1,239.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$925.11
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$971.37
Rate for Payer: Nomi Health Commercial	$1,110.13
Rate for Payer: PACE SWMI	$925.11
Rate for Payer: PHP Medicare Advantage	$925.11
Rate for Payer: Priority Health Cigna Priority Health	$2,106.00
Rate for Payer: Priority Health Medicare	$934.36
Rate for Payer: UHC All Payor (Choice/PPO)	$925.11
Rate for Payer: UHC Dual Complete DSNP	$925.11
Rate for Payer: UHC Exchange	$925.11
Rate for Payer: UHC Medicare Advantage	$925.11

PR SUPRAHYOID LYMPHADENECTOMY

Professional

Both

$1,460.00

Service Code	HCPCS 38700
Min. Negotiated Rate	$584.00
Max. Negotiated Rate	$1,111.80
Rate for Payer: Aetna Commercial	$1,034.59
Rate for Payer: Aetna Medicare	$802.96
Rate for Payer: BCBS Complete	$584.00
Rate for Payer: BCBS MAPPO	$772.08
Rate for Payer: BCN Medicare Advantage	$772.08
Rate for Payer: Cash Price	$1,168.00
Rate for Payer: Cash Price	$1,168.00
Rate for Payer: Cofinity Commercial	$1,111.80
Rate for Payer: Cofinity Commercial	$1,034.59
Rate for Payer: Health Alliance Plan Medicare Advantage	$772.08
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$810.68
Rate for Payer: Nomi Health Commercial	$926.50
Rate for Payer: PACE SWMI	$772.08
Rate for Payer: PHP Medicare Advantage	$772.08
Rate for Payer: Priority Health Cigna Priority Health	$949.00
Rate for Payer: Priority Health Medicare	$779.80
Rate for Payer: UHC All Payor (Choice/PPO)	$772.08
Rate for Payer: UHC Dual Complete DSNP	$772.08
Rate for Payer: UHC Exchange	$772.08
Rate for Payer: UHC Medicare Advantage	$772.08

PR SUPSLCTV CATH 2ND+ORD RENAL&ACCESSORY ARTERY/S&I

Professional

Both

$716.00

Service Code	HCPCS 36253
Min. Negotiated Rate	$286.40
Max. Negotiated Rate	$479.82
Rate for Payer: Aetna Commercial	$446.50
Rate for Payer: Aetna Medicare	$346.54
Rate for Payer: BCBS Complete	$286.40
Rate for Payer: BCBS MAPPO	$333.21
Rate for Payer: BCN Medicare Advantage	$333.21
Rate for Payer: Cash Price	$572.80
Rate for Payer: Cash Price	$572.80
Rate for Payer: Cofinity Commercial	$479.82
Rate for Payer: Cofinity Commercial	$446.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$333.21
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$349.87
Rate for Payer: Nomi Health Commercial	$399.85
Rate for Payer: PACE SWMI	$333.21
Rate for Payer: PHP Medicare Advantage	$333.21
Rate for Payer: Priority Health Cigna Priority Health	$465.40
Rate for Payer: Priority Health Medicare	$336.54
Rate for Payer: UHC All Payor (Choice/PPO)	$333.21
Rate for Payer: UHC Dual Complete DSNP	$333.21
Rate for Payer: UHC Exchange	$333.21
Rate for Payer: UHC Medicare Advantage	$333.21

PR SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES

Professional

Both

$136.00

Service Code	HCPCS 99374
Min. Negotiated Rate	$54.40
Max. Negotiated Rate	$88.40
Rate for Payer: Aetna Medicare	$68.00
Rate for Payer: BCBS Complete	$54.40
Rate for Payer: Cash Price	$108.80
Rate for Payer: Priority Health Cigna Priority Health	$88.40

PR SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR

Professional

Both

$734.00

Service Code	HCPCS 31820
Min. Negotiated Rate	$293.60
Max. Negotiated Rate	$477.10
Rate for Payer: Aetna Commercial	$421.56
Rate for Payer: Aetna Medicare	$327.18
Rate for Payer: BCBS Complete	$293.60
Rate for Payer: BCBS MAPPO	$314.60
Rate for Payer: BCN Medicare Advantage	$314.60
Rate for Payer: Cash Price	$587.20
Rate for Payer: Cash Price	$587.20
Rate for Payer: Cofinity Commercial	$453.02
Rate for Payer: Cofinity Commercial	$421.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$314.60
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$330.33
Rate for Payer: Nomi Health Commercial	$377.52
Rate for Payer: PACE SWMI	$314.60
Rate for Payer: PHP Medicare Advantage	$314.60
Rate for Payer: Priority Health Cigna Priority Health	$477.10
Rate for Payer: Priority Health Medicare	$317.75
Rate for Payer: UHC All Payor (Choice/PPO)	$314.60
Rate for Payer: UHC Dual Complete DSNP	$314.60
Rate for Payer: UHC Exchange	$314.60
Rate for Payer: UHC Medicare Advantage	$314.60

PR SURG CLSR TRACHEOSTOMY/FISTULA W/PLASTIC RPR

Professional

Both

$1,031.00

Service Code	HCPCS 31825
Min. Negotiated Rate	$412.40
Max. Negotiated Rate	$670.15
Rate for Payer: Aetna Commercial	$619.66
Rate for Payer: Aetna Medicare	$480.93
Rate for Payer: BCBS Complete	$412.40
Rate for Payer: BCBS MAPPO	$462.43
Rate for Payer: BCN Medicare Advantage	$462.43
Rate for Payer: Cash Price	$824.80
Rate for Payer: Cash Price	$824.80
Rate for Payer: Cofinity Commercial	$619.66
Rate for Payer: Cofinity Commercial	$665.90
Rate for Payer: Health Alliance Plan Medicare Advantage	$462.43
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$485.55
Rate for Payer: Nomi Health Commercial	$554.92
Rate for Payer: PACE SWMI	$462.43
Rate for Payer: PHP Medicare Advantage	$462.43
Rate for Payer: Priority Health Cigna Priority Health	$670.15
Rate for Payer: Priority Health Medicare	$467.05
Rate for Payer: UHC All Payor (Choice/PPO)	$462.43
Rate for Payer: UHC Dual Complete DSNP	$462.43
Rate for Payer: UHC Exchange	$462.43
Rate for Payer: UHC Medicare Advantage	$462.43

PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS

Professional

Both

$2,977.00

Service Code	HCPCS 29828
Min. Negotiated Rate	$881.73
Max. Negotiated Rate	$1,935.05
Rate for Payer: Aetna Commercial	$1,181.52
Rate for Payer: Aetna Medicare	$917.00
Rate for Payer: BCBS Complete	$1,190.80
Rate for Payer: BCBS MAPPO	$881.73
Rate for Payer: BCN Medicare Advantage	$881.73
Rate for Payer: Cash Price	$2,381.60
Rate for Payer: Cash Price	$2,381.60
Rate for Payer: Cofinity Commercial	$1,269.69
Rate for Payer: Cofinity Commercial	$1,181.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$881.73
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$925.82
Rate for Payer: Nomi Health Commercial	$1,058.08
Rate for Payer: PACE SWMI	$881.73
Rate for Payer: PHP Medicare Advantage	$881.73
Rate for Payer: Priority Health Cigna Priority Health	$1,935.05
Rate for Payer: Priority Health Medicare	$890.55
Rate for Payer: UHC All Payor (Choice/PPO)	$881.73
Rate for Payer: UHC Dual Complete DSNP	$881.73
Rate for Payer: UHC Exchange	$881.73
Rate for Payer: UHC Medicare Advantage	$881.73

PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS

Facility

$2,977.00

Service Code	CPT 29828
Hospital Charge Code	29828
Min. Negotiated Rate	$1,935.05
Max. Negotiated Rate	$2,679.30
Rate for Payer: Aetna Commercial	$2,530.45
Rate for Payer: BCBS Trust/PPO	$2,430.13
Rate for Payer: BCN Commercial	$2,300.63
Rate for Payer: Cash Price	$2,381.60
Rate for Payer: Cofinity Commercial	$2,560.22
Rate for Payer: Encore Health Key Benefits Commercial	$2,381.60
Rate for Payer: Healthscope Commercial	$2,679.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$2,232.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,530.45
Rate for Payer: Nomi Health Commercial	$2,441.14
Rate for Payer: PHP Commercial	$2,530.45
Rate for Payer: Priority Health Cigna Priority Health	$1,935.05
Rate for Payer: Priority Health HMO/PPO	$2,589.99
Rate for Payer: Priority Health Narrow/Tiered Network	$1,994.59
Rate for Payer: UHC All Payor (Choice/PPO)	$2,619.76
Rate for Payer: UHC Core	$2,485.80
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2,232.75

PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS

Professional

Both

$2,977.00

Service Code	HCPCS 29828
Hospital Charge Code	29828
Min. Negotiated Rate	$881.73
Max. Negotiated Rate	$1,935.05
Rate for Payer: Aetna Commercial	$1,181.52
Rate for Payer: Aetna Medicare	$917.00
Rate for Payer: BCBS Complete	$1,190.80
Rate for Payer: BCBS MAPPO	$881.73
Rate for Payer: BCN Medicare Advantage	$881.73
Rate for Payer: Cash Price	$2,381.60
Rate for Payer: Cash Price	$2,381.60
Rate for Payer: Cofinity Commercial	$1,269.69
Rate for Payer: Cofinity Commercial	$1,181.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$881.73
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$925.82
Rate for Payer: Nomi Health Commercial	$1,058.08
Rate for Payer: PACE SWMI	$881.73
Rate for Payer: PHP Medicare Advantage	$881.73
Rate for Payer: Priority Health Cigna Priority Health	$1,935.05
Rate for Payer: Priority Health Medicare	$890.55
Rate for Payer: UHC All Payor (Choice/PPO)	$881.73
Rate for Payer: UHC Dual Complete DSNP	$881.73
Rate for Payer: UHC Exchange	$881.73
Rate for Payer: UHC Medicare Advantage	$881.73

PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS

Facility

$2,977.00

Service Code	CPT 29828
Hospital Charge Code	29828
Min. Negotiated Rate	$707.04
Max. Negotiated Rate	$5,423.52
Rate for Payer: Aetna Commercial	$2,530.45
Rate for Payer: Aetna Medicare	$774.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$930.31
Rate for Payer: Amish Plain Church Group Commercial	$930.31
Rate for Payer: BCBS Complete	$5,423.52
Rate for Payer: BCBS MAPPO	$744.25
Rate for Payer: BCBS Trust/PPO	$2,447.39
Rate for Payer: BCN Commercial	$2,314.62
Rate for Payer: BCN Medicare Advantage	$744.25
Rate for Payer: Cash Price	$2,381.60
Rate for Payer: Cash Price	$2,381.60
Rate for Payer: Cofinity Commercial	$2,560.22
Rate for Payer: Encore Health Key Benefits Commercial	$2,381.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$744.25
Rate for Payer: Healthscope Commercial	$2,679.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$2,232.75
Rate for Payer: Mclaren Medicaid	$5,164.92
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$781.46
Rate for Payer: Meridian Medicaid	$5,423.52
Rate for Payer: MI Amish Medical Board Commercial	$855.89
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,530.45
Rate for Payer: Nomi Health Commercial	$2,441.14
Rate for Payer: PACE Senior Care Partners	$707.04
Rate for Payer: PACE SWMI	$744.25
Rate for Payer: PHP Commercial	$2,530.45
Rate for Payer: PHP Medicare Advantage	$744.25
Rate for Payer: Priority Health Choice Medicaid	$5,164.92
Rate for Payer: Priority Health Cigna Priority Health	$1,935.05
Rate for Payer: Priority Health HMO/PPO	$2,589.99
Rate for Payer: Priority Health Medicare	$751.69
Rate for Payer: Priority Health Narrow/Tiered Network	$1,994.59
Rate for Payer: Railroad Medicare Medicare	$744.25
Rate for Payer: UHC All Payor (Choice/PPO)	$2,619.76
Rate for Payer: UHC Core	$2,485.80
Rate for Payer: UHC Dual Complete DSNP	$744.25
Rate for Payer: UHC Exchange	$744.25
Rate for Payer: UHC Medicare Advantage	$744.25
Rate for Payer: UHCCP Medicaid	$5,164.92
Rate for Payer: VA VA	$744.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2,232.75

PR SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY

Professional

Both

$3,236.00

Service Code	HCPCS 29806
Hospital Charge Code	29806
Min. Negotiated Rate	$1,018.37
Max. Negotiated Rate	$2,103.40
Rate for Payer: Aetna Commercial	$1,364.62
Rate for Payer: Aetna Medicare	$1,059.10
Rate for Payer: BCBS Complete	$1,294.40
Rate for Payer: BCBS MAPPO	$1,018.37
Rate for Payer: BCN Medicare Advantage	$1,018.37
Rate for Payer: Cash Price	$2,588.80
Rate for Payer: Cash Price	$2,588.80
Rate for Payer: Cofinity Commercial	$1,466.45
Rate for Payer: Cofinity Commercial	$1,364.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,018.37
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,069.29
Rate for Payer: Nomi Health Commercial	$1,222.04
Rate for Payer: PACE SWMI	$1,018.37
Rate for Payer: PHP Medicare Advantage	$1,018.37
Rate for Payer: Priority Health Cigna Priority Health	$2,103.40
Rate for Payer: Priority Health Medicare	$1,028.55
Rate for Payer: UHC All Payor (Choice/PPO)	$1,018.37
Rate for Payer: UHC Dual Complete DSNP	$1,018.37
Rate for Payer: UHC Exchange	$1,018.37
Rate for Payer: UHC Medicare Advantage	$1,018.37

PR SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY

Facility

$3,236.00

Service Code	CPT 29806
Hospital Charge Code	29806
Min. Negotiated Rate	$2,103.40
Max. Negotiated Rate	$2,912.40
Rate for Payer: Aetna Commercial	$2,750.60
Rate for Payer: BCBS Trust/PPO	$2,641.55
Rate for Payer: BCN Commercial	$2,500.78
Rate for Payer: Cash Price	$2,588.80
Rate for Payer: Cofinity Commercial	$2,782.96
Rate for Payer: Encore Health Key Benefits Commercial	$2,588.80
Rate for Payer: Healthscope Commercial	$2,912.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$2,427.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,750.60
Rate for Payer: Nomi Health Commercial	$2,653.52
Rate for Payer: PHP Commercial	$2,750.60
Rate for Payer: Priority Health Cigna Priority Health	$2,103.40
Rate for Payer: Priority Health HMO/PPO	$2,815.32
Rate for Payer: Priority Health Narrow/Tiered Network	$2,168.12
Rate for Payer: UHC All Payor (Choice/PPO)	$2,847.68
Rate for Payer: UHC Core	$2,702.06
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2,427.00

PR SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY

Professional

Both

$3,236.00

Service Code	HCPCS 29806
Min. Negotiated Rate	$1,018.37
Max. Negotiated Rate	$2,103.40
Rate for Payer: Aetna Commercial	$1,364.62
Rate for Payer: Aetna Medicare	$1,059.10
Rate for Payer: BCBS Complete	$1,294.40
Rate for Payer: BCBS MAPPO	$1,018.37
Rate for Payer: BCN Medicare Advantage	$1,018.37
Rate for Payer: Cash Price	$2,588.80
Rate for Payer: Cash Price	$2,588.80
Rate for Payer: Cofinity Commercial	$1,466.45
Rate for Payer: Cofinity Commercial	$1,364.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,018.37
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,069.29
Rate for Payer: Nomi Health Commercial	$1,222.04
Rate for Payer: PACE SWMI	$1,018.37
Rate for Payer: PHP Medicare Advantage	$1,018.37
Rate for Payer: Priority Health Cigna Priority Health	$2,103.40
Rate for Payer: Priority Health Medicare	$1,028.55
Rate for Payer: UHC All Payor (Choice/PPO)	$1,018.37
Rate for Payer: UHC Dual Complete DSNP	$1,018.37
Rate for Payer: UHC Exchange	$1,018.37
Rate for Payer: UHC Medicare Advantage	$1,018.37

PR SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY

Facility

$3,236.00

Service Code	CPT 29806
Hospital Charge Code	29806
Min. Negotiated Rate	$768.55
Max. Negotiated Rate	$5,423.52
Rate for Payer: Aetna Commercial	$2,750.60
Rate for Payer: Aetna Medicare	$841.36
Rate for Payer: Allen County Amish Medical Aid Commercial	$1,011.25
Rate for Payer: Amish Plain Church Group Commercial	$1,011.25
Rate for Payer: BCBS Complete	$5,423.52
Rate for Payer: BCBS MAPPO	$809.00
Rate for Payer: BCBS Trust/PPO	$2,660.32
Rate for Payer: BCN Commercial	$2,515.99
Rate for Payer: BCN Medicare Advantage	$809.00
Rate for Payer: Cash Price	$2,588.80
Rate for Payer: Cash Price	$2,588.80
Rate for Payer: Cofinity Commercial	$2,782.96
Rate for Payer: Encore Health Key Benefits Commercial	$2,588.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$809.00
Rate for Payer: Healthscope Commercial	$2,912.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$2,427.00
Rate for Payer: Mclaren Medicaid	$5,164.92
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$849.45
Rate for Payer: Meridian Medicaid	$5,423.52
Rate for Payer: MI Amish Medical Board Commercial	$930.35
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$2,750.60
Rate for Payer: Nomi Health Commercial	$2,653.52
Rate for Payer: PACE Senior Care Partners	$768.55
Rate for Payer: PACE SWMI	$809.00
Rate for Payer: PHP Commercial	$2,750.60
Rate for Payer: PHP Medicare Advantage	$809.00
Rate for Payer: Priority Health Choice Medicaid	$5,164.92
Rate for Payer: Priority Health Cigna Priority Health	$2,103.40
Rate for Payer: Priority Health HMO/PPO	$2,815.32
Rate for Payer: Priority Health Medicare	$817.09
Rate for Payer: Priority Health Narrow/Tiered Network	$2,168.12
Rate for Payer: Railroad Medicare Medicare	$809.00
Rate for Payer: UHC All Payor (Choice/PPO)	$2,847.68
Rate for Payer: UHC Core	$2,702.06
Rate for Payer: UHC Dual Complete DSNP	$809.00
Rate for Payer: UHC Exchange	$809.00
Rate for Payer: UHC Medicare Advantage	$809.00
Rate for Payer: UHCCP Medicaid	$5,164.92
Rate for Payer: VA VA	$809.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2,427.00

PR SURGICAL ARTHROSCOPY SHOULDER COMPL SYNOVECTOMY

Professional

Both

$2,267.00

Service Code	HCPCS 29821
Min. Negotiated Rate	$573.42
Max. Negotiated Rate	$1,473.55
Rate for Payer: Aetna Commercial	$768.38
Rate for Payer: Aetna Medicare	$596.36
Rate for Payer: BCBS Complete	$906.80
Rate for Payer: BCBS MAPPO	$573.42
Rate for Payer: BCN Medicare Advantage	$573.42
Rate for Payer: Cash Price	$1,813.60
Rate for Payer: Cash Price	$1,813.60
Rate for Payer: Cofinity Commercial	$825.72
Rate for Payer: Cofinity Commercial	$768.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$573.42
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$602.09
Rate for Payer: Nomi Health Commercial	$688.10
Rate for Payer: PACE SWMI	$573.42
Rate for Payer: PHP Medicare Advantage	$573.42
Rate for Payer: Priority Health Cigna Priority Health	$1,473.55
Rate for Payer: Priority Health Medicare	$579.15
Rate for Payer: UHC All Payor (Choice/PPO)	$573.42
Rate for Payer: UHC Dual Complete DSNP	$573.42
Rate for Payer: UHC Exchange	$573.42
Rate for Payer: UHC Medicare Advantage	$573.42

Know your out-of-pocket cost for care.

All Charges