Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY

Professional

Both

$3,100.00

Service Code	HCPCS 15879
Min. Negotiated Rate	$106.97
Max. Negotiated Rate	$2,170.00
Rate for Payer: Aetna Commercial	$656.25
Rate for Payer: BCBS Complete	$1,240.00
Rate for Payer: BCBS Trust/PPO	$106.97
Rate for Payer: Cash Price	$2,480.00
Rate for Payer: Cash Price	$2,480.00
Rate for Payer: Priority Health Cigna Priority Health	$2,170.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$217.36
Rate for Payer: Priority Health Narrow Network	$217.36
Rate for Payer: Priority Health SBD	$217.36
Rate for Payer: UMR Bronson Commercial	$1,426.00

PR SUCTION ASSISTED LIPECTOMY TRUNK

Professional

Both

$2,700.00

Service Code	HCPCS 15877
Min. Negotiated Rate	$217.36
Max. Negotiated Rate	$1,890.00
Rate for Payer: Aetna Commercial	$656.25
Rate for Payer: BCBS Complete	$1,080.00
Rate for Payer: BCBS Trust/PPO	$438.68
Rate for Payer: Cash Price	$2,160.00
Rate for Payer: Cash Price	$2,160.00
Rate for Payer: Priority Health Cigna Priority Health	$1,890.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$217.36
Rate for Payer: Priority Health Narrow Network	$217.36
Rate for Payer: Priority Health SBD	$217.36
Rate for Payer: UMR Bronson Commercial	$1,242.00

PR SUMATRIPTAN SUCCINATE / 6 MG

Professional

Both

$110.00

Service Code	HCPCS J3030
Min. Negotiated Rate	$2.09
Max. Negotiated Rate	$77.00
Rate for Payer: Aetna Commercial	$60.24
Rate for Payer: BCBS Complete	$44.00
Rate for Payer: BCBS Trust/PPO	$2.09
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Priority Health Cigna Priority Health	$77.00
Rate for Payer: UMR Bronson Commercial	$50.60

PR SUPERVISION HOSPICE PATIENT/MONTH 15-29 MIN

Professional

Both

$133.00

Service Code	HCPCS 99377
Min. Negotiated Rate	$53.20
Max. Negotiated Rate	$1,432.75
Rate for Payer: Aetna Commercial	$55.68
Rate for Payer: BCBS Complete	$53.20
Rate for Payer: BCBS Trust/PPO	$1,432.75
Rate for Payer: Cash Price	$106.40
Rate for Payer: Cash Price	$106.40
Rate for Payer: Priority Health Cigna Priority Health	$93.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$68.53
Rate for Payer: Priority Health Narrow Network	$68.53
Rate for Payer: Priority Health SBD	$68.53
Rate for Payer: UMR Bronson Commercial	$61.18

PR SUPERVISION NURS FACILITY PATIENT MO 15-29 MIN

Professional

Both

$133.00

Service Code	HCPCS 99379
Min. Negotiated Rate	$53.20
Max. Negotiated Rate	$2,731.31
Rate for Payer: Aetna Commercial	$55.68
Rate for Payer: BCBS Complete	$53.20
Rate for Payer: BCBS Trust/PPO	$2,731.31
Rate for Payer: Cash Price	$106.40
Rate for Payer: Cash Price	$106.40
Rate for Payer: Priority Health Cigna Priority Health	$93.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$68.53
Rate for Payer: Priority Health Narrow Network	$68.53
Rate for Payer: Priority Health SBD	$68.53
Rate for Payer: UMR Bronson Commercial	$61.18

PR SUPERVISION NURS FACILITY PATIENT MONTH 30 MIN/>

Professional

Both

$170.00

Service Code	HCPCS 99380
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$843.17
Rate for Payer: Aetna Commercial	$87.31
Rate for Payer: BCBS Complete	$68.00
Rate for Payer: BCBS Trust/PPO	$843.17
Rate for Payer: Cash Price	$136.00
Rate for Payer: Cash Price	$136.00
Rate for Payer: Priority Health Cigna Priority Health	$119.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$107.08
Rate for Payer: Priority Health Narrow Network	$107.08
Rate for Payer: Priority Health SBD	$107.08
Rate for Payer: UMR Bronson Commercial	$78.20

PR SUPERVISION PT HOME HEALTH AGENCY MONTH 30 MIN/>

Professional

Both

$181.00

Service Code	HCPCS 99375
Min. Negotiated Rate	$72.40
Max. Negotiated Rate	$2,731.31
Rate for Payer: Aetna Commercial	$87.31
Rate for Payer: BCBS Complete	$72.40
Rate for Payer: BCBS Trust/PPO	$2,731.31
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$144.80
Rate for Payer: Priority Health Cigna Priority Health	$126.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$107.08
Rate for Payer: Priority Health Narrow Network	$107.08
Rate for Payer: Priority Health SBD	$107.08
Rate for Payer: UMR Bronson Commercial	$83.26

PR SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY

Professional

Both

$3,176.00

Service Code	HCPCS 58180
Min. Negotiated Rate	$161.66
Max. Negotiated Rate	$2,223.20
Rate for Payer: Aetna Commercial	$1,147.30
Rate for Payer: BCBS Complete	$647.69
Rate for Payer: BCBS Trust/PPO	$161.66
Rate for Payer: Cash Price	$2,540.80
Rate for Payer: Cash Price	$2,540.80
Rate for Payer: Meridian Medicaid	$647.69
Rate for Payer: Priority Health Choice Medicaid	$616.85
Rate for Payer: Priority Health Cigna Priority Health	$2,223.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,360.15
Rate for Payer: Priority Health Narrow Network	$1,360.15
Rate for Payer: Priority Health SBD	$1,360.15
Rate for Payer: UMR Bronson Commercial	$1,460.96

PR SUPRAHYOID LYMPHADENECTOMY

Professional

Both

$1,431.00

Service Code	HCPCS 38700
Min. Negotiated Rate	$494.49
Max. Negotiated Rate	$1,752.90
Rate for Payer: Aetna Commercial	$985.34
Rate for Payer: BCBS Complete	$542.80
Rate for Payer: BCBS Trust/PPO	$494.49
Rate for Payer: Cash Price	$1,144.80
Rate for Payer: Cash Price	$1,144.80
Rate for Payer: Meridian Medicaid	$542.80
Rate for Payer: Priority Health Choice Medicaid	$516.95
Rate for Payer: Priority Health Cigna Priority Health	$1,001.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,752.90
Rate for Payer: Priority Health Narrow Network	$1,752.90
Rate for Payer: Priority Health SBD	$1,752.90
Rate for Payer: UMR Bronson Commercial	$658.26

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

Professional

Both

$702.00

Service Code	HCPCS 36253
Min. Negotiated Rate	$219.18
Max. Negotiated Rate	$1,416.90
Rate for Payer: Aetna Commercial	$473.49
Rate for Payer: BCBS Complete	$230.14
Rate for Payer: BCBS Trust/PPO	$1,416.90
Rate for Payer: Cash Price	$561.60
Rate for Payer: Cash Price	$561.60
Rate for Payer: Meridian Medicaid	$230.14
Rate for Payer: Priority Health Choice Medicaid	$219.18
Rate for Payer: Priority Health Cigna Priority Health	$491.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$547.39
Rate for Payer: Priority Health Narrow Network	$547.39
Rate for Payer: Priority Health SBD	$547.39
Rate for Payer: UMR Bronson Commercial	$322.92

PR SUPVJ PT HOME HEALTH AGENCY MO 15-29 MINUTES

Professional

Both

$133.00

Service Code	HCPCS 99374
Min. Negotiated Rate	$53.20
Max. Negotiated Rate	$2,302.33
Rate for Payer: Aetna Commercial	$55.68
Rate for Payer: BCBS Complete	$53.20
Rate for Payer: BCBS Trust/PPO	$2,302.33
Rate for Payer: Cash Price	$106.40
Rate for Payer: Cash Price	$106.40
Rate for Payer: Priority Health Cigna Priority Health	$93.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$68.53
Rate for Payer: Priority Health Narrow Network	$68.53
Rate for Payer: Priority Health SBD	$68.53
Rate for Payer: UMR Bronson Commercial	$61.18

PR SURG CLSR TRACHEOSTOMY/FISTULA W/O PLASTIC RPR

Professional

Both

$720.00

Service Code	HCPCS 31820
Min. Negotiated Rate	$214.28
Max. Negotiated Rate	$1,141.66
Rate for Payer: Aetna Commercial	$418.37
Rate for Payer: BCBS Complete	$224.99
Rate for Payer: BCBS Trust/PPO	$1,141.66
Rate for Payer: Cash Price	$576.00
Rate for Payer: Cash Price	$576.00
Rate for Payer: Meridian Medicaid	$224.99
Rate for Payer: Priority Health Choice Medicaid	$214.28
Rate for Payer: Priority Health Cigna Priority Health	$504.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$462.11
Rate for Payer: Priority Health Narrow Network	$462.11
Rate for Payer: Priority Health SBD	$462.11
Rate for Payer: UMR Bronson Commercial	$331.20

PR SURG CLSR TRACHEOSTOMY/FISTULA W/PLASTIC RPR

Professional

Both

$1,011.00

Service Code	HCPCS 31825
Min. Negotiated Rate	$313.11
Max. Negotiated Rate	$1,118.94
Rate for Payer: Aetna Commercial	$610.54
Rate for Payer: BCBS Complete	$328.77
Rate for Payer: BCBS Trust/PPO	$1,118.94
Rate for Payer: Cash Price	$808.80
Rate for Payer: Cash Price	$808.80
Rate for Payer: Meridian Medicaid	$328.77
Rate for Payer: Priority Health Choice Medicaid	$313.11
Rate for Payer: Priority Health Cigna Priority Health	$707.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$676.51
Rate for Payer: Priority Health Narrow Network	$676.51
Rate for Payer: Priority Health SBD	$676.51
Rate for Payer: UMR Bronson Commercial	$465.06

PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS

Professional

Both

$2,919.00

Service Code	HCPCS 29828
Hospital Charge Code	29828
Min. Negotiated Rate	$590.22
Max. Negotiated Rate	$2,043.30
Rate for Payer: Aetna Commercial	$1,224.94
Rate for Payer: BCBS Complete	$619.73
Rate for Payer: BCBS Trust/PPO	$1,677.88
Rate for Payer: Cash Price	$2,335.20
Rate for Payer: Cash Price	$2,335.20
Rate for Payer: Meridian Medicaid	$619.73
Rate for Payer: Priority Health Choice Medicaid	$590.22
Rate for Payer: Priority Health Cigna Priority Health	$2,043.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,403.78
Rate for Payer: Priority Health Narrow Network	$1,403.78
Rate for Payer: Priority Health SBD	$1,403.78
Rate for Payer: UMR Bronson Commercial	$1,342.74

PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS

Professional

Both

$2,919.00

Service Code	HCPCS 29828
Min. Negotiated Rate	$590.22
Max. Negotiated Rate	$2,043.30
Rate for Payer: Aetna Commercial	$1,224.94
Rate for Payer: BCBS Complete	$619.73
Rate for Payer: BCBS Trust/PPO	$1,677.88
Rate for Payer: Cash Price	$2,335.20
Rate for Payer: Cash Price	$2,335.20
Rate for Payer: Meridian Medicaid	$619.73
Rate for Payer: Priority Health Choice Medicaid	$590.22
Rate for Payer: Priority Health Cigna Priority Health	$2,043.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,403.78
Rate for Payer: Priority Health Narrow Network	$1,403.78
Rate for Payer: Priority Health SBD	$1,403.78
Rate for Payer: UMR Bronson Commercial	$1,342.74

PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS

Facility

$2,919.00

Service Code	CPT 29828
Hospital Charge Code	29828
Min. Negotiated Rate	$907.34
Max. Negotiated Rate	$20,018.71
Rate for Payer: Aetna American Axle	$1,897.35
Rate for Payer: Aetna Commercial	$2,481.15
Rate for Payer: Aetna Medicare	$6,613.45
Rate for Payer: Aetna New Business (MI Preferred)	$1,897.35
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,948.86
Rate for Payer: Amish Plain Church Group Commercial	$7,948.86
Rate for Payer: BCBS Complete	$3,652.66
Rate for Payer: BCBS MAPPO	$6,359.09
Rate for Payer: BCBS Trust/PPO	$4,931.06
Rate for Payer: BCN Medicare Advantage	$6,359.09
Rate for Payer: Cash Price	$2,335.20
Rate for Payer: Cash Price	$2,335.20
Rate for Payer: Cofinity Commercial	$2,043.30
Rate for Payer: Cofinity Commercial	$2,510.34
Rate for Payer: Encore Health Key Benefits Commercial	$2,335.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,359.09
Rate for Payer: Healthscope Commercial	$2,627.10
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$2,043.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$2,189.25
Rate for Payer: Mclaren Medicaid	$3,478.42
Rate for Payer: Mclaren Medicare	$6,359.09
Rate for Payer: Meridian Medicaid	$3,652.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,677.04
Rate for Payer: MI Amish Medical Board Commercial	$7,312.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,481.15
Rate for Payer: PACE Medicare	$6,041.14
Rate for Payer: PACE SWMI	$6,359.09
Rate for Payer: PHP Commercial	$2,481.15
Rate for Payer: PHP Medicare Advantage	$6,359.09
Rate for Payer: Priority Health Choice Medicaid	$3,478.42
Rate for Payer: Priority Health Cigna Priority Health	$2,043.30
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20,018.71
Rate for Payer: Priority Health Medicare	$6,359.09
Rate for Payer: Priority Health Narrow Network	$16,014.97
Rate for Payer: Priority Health SBD	$1,838.97
Rate for Payer: Railroad Medicare Medicare	$6,359.09
Rate for Payer: UHC All Payor (Choice/PPO)	$998.07
Rate for Payer: UHC Dual Complete DSNP	$6,359.09
Rate for Payer: UHC Exchange	$907.34
Rate for Payer: UHC Medicare Advantage	$6,549.86
Rate for Payer: UMR Bronson Commercial	$1,080.03
Rate for Payer: VA VA	$6,359.09
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2,189.25

PR SURGICAL ARTHROSCOPY SHOULDER BICEPS TENODESIS

Facility

$2,919.00

Service Code	CPT 29828
Hospital Charge Code	29828
Min. Negotiated Rate	$1,284.36
Max. Negotiated Rate	$2,627.10
Rate for Payer: Aetna American Axle	$1,897.35
Rate for Payer: Aetna Commercial	$2,481.15
Rate for Payer: Aetna New Business (MI Preferred)	$1,897.35
Rate for Payer: Cash Price	$2,335.20
Rate for Payer: Cofinity Commercial	$2,043.30
Rate for Payer: Cofinity Commercial	$2,510.34
Rate for Payer: Encore Health Key Benefits Commercial	$2,335.20
Rate for Payer: Healthscope Commercial	$2,627.10
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$2,043.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$2,189.25
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,481.15
Rate for Payer: PHP Commercial	$2,481.15
Rate for Payer: Priority Health Cigna Priority Health	$2,043.30
Rate for Payer: Priority Health SBD	$1,838.97
Rate for Payer: UMR Bronson Commercial	$1,284.36
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2,189.25

PR SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY

Professional

Both

$3,173.00

Service Code	HCPCS 29806
Hospital Charge Code	29806
Min. Negotiated Rate	$682.03
Max. Negotiated Rate	$2,221.10
Rate for Payer: Aetna Commercial	$1,411.69
Rate for Payer: BCBS Complete	$716.13
Rate for Payer: BCBS Trust/PPO	$846.86
Rate for Payer: Cash Price	$2,538.40
Rate for Payer: Cash Price	$2,538.40
Rate for Payer: Meridian Medicaid	$716.13
Rate for Payer: Priority Health Choice Medicaid	$682.03
Rate for Payer: Priority Health Cigna Priority Health	$2,221.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,620.29
Rate for Payer: Priority Health Narrow Network	$1,620.29
Rate for Payer: Priority Health SBD	$1,620.29
Rate for Payer: UMR Bronson Commercial	$1,459.58

PR SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY

Facility

$3,173.00

Service Code	CPT 29806
Hospital Charge Code	29806
Min. Negotiated Rate	$1,048.47
Max. Negotiated Rate	$20,018.71
Rate for Payer: Aetna American Axle	$2,062.45
Rate for Payer: Aetna Commercial	$2,697.05
Rate for Payer: Aetna Medicare	$6,613.45
Rate for Payer: Aetna New Business (MI Preferred)	$2,062.45
Rate for Payer: Allen County Amish Medical Aid Commercial	$7,948.86
Rate for Payer: Amish Plain Church Group Commercial	$7,948.86
Rate for Payer: BCBS Complete	$3,652.66
Rate for Payer: BCBS MAPPO	$6,359.09
Rate for Payer: BCBS Trust/PPO	$5,516.91
Rate for Payer: BCN Medicare Advantage	$6,359.09
Rate for Payer: Cash Price	$2,538.40
Rate for Payer: Cash Price	$2,538.40
Rate for Payer: Cofinity Commercial	$2,221.10
Rate for Payer: Cofinity Commercial	$2,728.78
Rate for Payer: Encore Health Key Benefits Commercial	$2,538.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$6,359.09
Rate for Payer: Healthscope Commercial	$2,855.70
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$2,221.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$2,379.75
Rate for Payer: Mclaren Medicaid	$3,478.42
Rate for Payer: Mclaren Medicare	$6,359.09
Rate for Payer: Meridian Medicaid	$3,652.66
Rate for Payer: Meridian Wellcare - Medicare Advantage	$6,677.04
Rate for Payer: MI Amish Medical Board Commercial	$7,312.95
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,697.05
Rate for Payer: PACE Medicare	$6,041.14
Rate for Payer: PACE SWMI	$6,359.09
Rate for Payer: PHP Commercial	$2,697.05
Rate for Payer: PHP Medicare Advantage	$6,359.09
Rate for Payer: Priority Health Choice Medicaid	$3,478.42
Rate for Payer: Priority Health Cigna Priority Health	$2,221.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$20,018.71
Rate for Payer: Priority Health Medicare	$6,359.09
Rate for Payer: Priority Health Narrow Network	$16,014.97
Rate for Payer: Priority Health SBD	$1,998.99
Rate for Payer: Railroad Medicare Medicare	$6,359.09
Rate for Payer: UHC All Payor (Choice/PPO)	$1,153.32
Rate for Payer: UHC Dual Complete DSNP	$6,359.09
Rate for Payer: UHC Exchange	$1,048.47
Rate for Payer: UHC Medicare Advantage	$6,549.86
Rate for Payer: UMR Bronson Commercial	$1,174.01
Rate for Payer: VA VA	$6,359.09
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2,379.75

PR SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY

Professional

Both

$3,173.00

Service Code	HCPCS 29806
Min. Negotiated Rate	$682.03
Max. Negotiated Rate	$2,221.10
Rate for Payer: Aetna Commercial	$1,411.69
Rate for Payer: BCBS Complete	$716.13
Rate for Payer: BCBS Trust/PPO	$846.86
Rate for Payer: Cash Price	$2,538.40
Rate for Payer: Cash Price	$2,538.40
Rate for Payer: Meridian Medicaid	$716.13
Rate for Payer: Priority Health Choice Medicaid	$682.03
Rate for Payer: Priority Health Cigna Priority Health	$2,221.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,620.29
Rate for Payer: Priority Health Narrow Network	$1,620.29
Rate for Payer: Priority Health SBD	$1,620.29
Rate for Payer: UMR Bronson Commercial	$1,459.58

PR SURGICAL ARTHROSCOPY SHOULDER CAPSULORRHAPHY

Facility

$3,173.00

Service Code	CPT 29806
Hospital Charge Code	29806
Min. Negotiated Rate	$1,396.12
Max. Negotiated Rate	$2,855.70
Rate for Payer: Aetna American Axle	$2,062.45
Rate for Payer: Aetna Commercial	$2,697.05
Rate for Payer: Aetna New Business (MI Preferred)	$2,062.45
Rate for Payer: Cash Price	$2,538.40
Rate for Payer: Cofinity Commercial	$2,221.10
Rate for Payer: Cofinity Commercial	$2,728.78
Rate for Payer: Encore Health Key Benefits Commercial	$2,538.40
Rate for Payer: Healthscope Commercial	$2,855.70
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$2,221.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$2,379.75
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2,697.05
Rate for Payer: PHP Commercial	$2,697.05
Rate for Payer: Priority Health Cigna Priority Health	$2,221.10
Rate for Payer: Priority Health SBD	$1,998.99
Rate for Payer: UMR Bronson Commercial	$1,396.12
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2,379.75

PR SURGICAL ARTHROSCOPY SHOULDER COMPL SYNOVECTOMY

Professional

Both

$2,223.00

Service Code	HCPCS 29821
Min. Negotiated Rate	$384.04
Max. Negotiated Rate	$1,682.64
Rate for Payer: Aetna Commercial	$793.22
Rate for Payer: BCBS Complete	$403.24
Rate for Payer: BCBS Trust/PPO	$1,682.64
Rate for Payer: Cash Price	$1,778.40
Rate for Payer: Cash Price	$1,778.40
Rate for Payer: Meridian Medicaid	$403.24
Rate for Payer: Priority Health Choice Medicaid	$384.04
Rate for Payer: Priority Health Cigna Priority Health	$1,556.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$914.57
Rate for Payer: Priority Health Narrow Network	$914.57
Rate for Payer: Priority Health SBD	$914.57
Rate for Payer: UMR Bronson Commercial	$1,022.58

PR SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC

Facility

$2,062.00

Service Code	CPT 29824
Hospital Charge Code	29824
Min. Negotiated Rate	$907.28
Max. Negotiated Rate	$1,855.80
Rate for Payer: Aetna American Axle	$1,340.30
Rate for Payer: Aetna Commercial	$1,752.70
Rate for Payer: Aetna New Business (MI Preferred)	$1,340.30
Rate for Payer: Cash Price	$1,649.60
Rate for Payer: Cofinity Commercial	$1,443.40
Rate for Payer: Cofinity Commercial	$1,773.32
Rate for Payer: Encore Health Key Benefits Commercial	$1,649.60
Rate for Payer: Healthscope Commercial	$1,855.80
Rate for Payer: Kalamazoo County Sherrif's Dept Commercial	$1,443.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,546.50
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,752.70
Rate for Payer: PHP Commercial	$1,752.70
Rate for Payer: Priority Health Cigna Priority Health	$1,443.40
Rate for Payer: Priority Health SBD	$1,299.06
Rate for Payer: UMR Bronson Commercial	$907.28
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,546.50

PR SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC

Professional

Both

$2,062.00

Service Code	HCPCS 29824
Min. Negotiated Rate	$438.57
Max. Negotiated Rate	$1,443.40
Rate for Payer: Aetna Commercial	$901.45
Rate for Payer: BCBS Complete	$460.50
Rate for Payer: BCBS Trust/PPO	$1,084.60
Rate for Payer: Cash Price	$1,649.60
Rate for Payer: Cash Price	$1,649.60
Rate for Payer: Meridian Medicaid	$460.50
Rate for Payer: Priority Health Choice Medicaid	$438.57
Rate for Payer: Priority Health Cigna Priority Health	$1,443.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,042.75
Rate for Payer: Priority Health Narrow Network	$1,042.75
Rate for Payer: Priority Health SBD	$1,042.75
Rate for Payer: UMR Bronson Commercial	$948.52

PR SURGICAL ARTHROSCOPY SHOULDER DSTL CLAVICULC

Professional

Both

$2,062.00

Service Code	HCPCS 29824
Hospital Charge Code	29824
Min. Negotiated Rate	$438.57
Max. Negotiated Rate	$1,443.40
Rate for Payer: Aetna Commercial	$901.45
Rate for Payer: BCBS Complete	$460.50
Rate for Payer: BCBS Trust/PPO	$1,084.60
Rate for Payer: Cash Price	$1,649.60
Rate for Payer: Cash Price	$1,649.60
Rate for Payer: Meridian Medicaid	$460.50
Rate for Payer: Priority Health Choice Medicaid	$438.57
Rate for Payer: Priority Health Cigna Priority Health	$1,443.40
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,042.75
Rate for Payer: Priority Health Narrow Network	$1,042.75
Rate for Payer: Priority Health SBD	$1,042.75
Rate for Payer: UMR Bronson Commercial	$948.52

Know your out-of-pocket cost for care.

All Charges