Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

CLOZAPINE 100 MG TABLET

Facility

$751.10

Service Code	NDC 0378-0860-01
Hospital Charge Code	9647
Hospital Revenue Code	637
Min. Negotiated Rate	$458.10
Max. Negotiated Rate	$675.99
Rate for Payer: Aetna Commercial	$638.44
Rate for Payer: BCBS Trust/PPO	$580.45
Rate for Payer: BCN Commercial	$580.45
Rate for Payer: Cash Price	$600.88
Rate for Payer: Cofinity Commercial	$645.95
Rate for Payer: Encore Health Key Benefits Commercial	$600.88
Rate for Payer: Healthscope Commercial	$675.99
Rate for Payer: Lakeland Regional Health Systems Commercial	$563.32
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$638.44
Rate for Payer: PHP Commercial	$638.44
Rate for Payer: Priority Health Cigna Priority Health	$525.77
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$653.46
Rate for Payer: Priority Health Narrow/Tiered Network	$458.10
Rate for Payer: UHC All Payor (Choice/PPO)	$660.97
Rate for Payer: UHC Core	$627.17
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$563.32

CLOZAPINE 100 MG TABLET

Facility

$3.16

Service Code	NDC 60687-415-11
Hospital Charge Code	9647
Hospital Revenue Code	637
Min. Negotiated Rate	$1.93
Max. Negotiated Rate	$2.84
Rate for Payer: Aetna Commercial	$2.69
Rate for Payer: BCBS Trust/PPO	$2.44
Rate for Payer: BCN Commercial	$2.44
Rate for Payer: Cash Price	$2.53
Rate for Payer: Cofinity Commercial	$2.72
Rate for Payer: Encore Health Key Benefits Commercial	$2.53
Rate for Payer: Healthscope Commercial	$2.84
Rate for Payer: Lakeland Regional Health Systems Commercial	$2.37
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.69
Rate for Payer: PHP Commercial	$2.69
Rate for Payer: Priority Health Cigna Priority Health	$2.21
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2.75
Rate for Payer: Priority Health Narrow/Tiered Network	$1.93
Rate for Payer: UHC All Payor (Choice/PPO)	$2.78
Rate for Payer: UHC Core	$2.64
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2.37

CLOZAPINE 100 MG TABLET

Facility

$794.76

Service Code	NDC 0093-7772-01
Hospital Charge Code	9647
Hospital Revenue Code	637
Min. Negotiated Rate	$484.72
Max. Negotiated Rate	$715.28
Rate for Payer: Aetna Commercial	$675.55
Rate for Payer: BCBS Trust/PPO	$614.19
Rate for Payer: BCN Commercial	$614.19
Rate for Payer: Cash Price	$635.81
Rate for Payer: Cofinity Commercial	$683.49
Rate for Payer: Encore Health Key Benefits Commercial	$635.81
Rate for Payer: Healthscope Commercial	$715.28
Rate for Payer: Lakeland Regional Health Systems Commercial	$596.07
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$675.55
Rate for Payer: PHP Commercial	$675.55
Rate for Payer: Priority Health Cigna Priority Health	$556.33
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$691.44
Rate for Payer: Priority Health Narrow/Tiered Network	$484.72
Rate for Payer: UHC All Payor (Choice/PPO)	$699.39
Rate for Payer: UHC Core	$663.62
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$596.07

CLOZAPINE 25 MG TABLET

Facility

$285.95

Service Code	NDC 60687-404-01
Hospital Charge Code	9648
Hospital Revenue Code	637
Min. Negotiated Rate	$174.40
Max. Negotiated Rate	$257.36
Rate for Payer: Aetna Commercial	$243.06
Rate for Payer: BCBS Trust/PPO	$220.98
Rate for Payer: BCN Commercial	$220.98
Rate for Payer: Cash Price	$228.76
Rate for Payer: Cofinity Commercial	$245.92
Rate for Payer: Encore Health Key Benefits Commercial	$228.76
Rate for Payer: Healthscope Commercial	$257.36
Rate for Payer: Lakeland Regional Health Systems Commercial	$214.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$243.06
Rate for Payer: PHP Commercial	$243.06
Rate for Payer: Priority Health Cigna Priority Health	$200.16
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$248.78
Rate for Payer: Priority Health Narrow/Tiered Network	$174.40
Rate for Payer: UHC All Payor (Choice/PPO)	$251.64
Rate for Payer: UHC Core	$238.77
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$214.46

CLOZAPINE 25 MG TABLET

Facility

$2.86

Service Code	NDC 60687-404-11
Hospital Charge Code	9648
Hospital Revenue Code	637
Min. Negotiated Rate	$1.74
Max. Negotiated Rate	$2.57
Rate for Payer: Aetna Commercial	$2.43
Rate for Payer: BCBS Trust/PPO	$2.21
Rate for Payer: BCN Commercial	$2.21
Rate for Payer: Cash Price	$2.29
Rate for Payer: Cofinity Commercial	$2.46
Rate for Payer: Encore Health Key Benefits Commercial	$2.29
Rate for Payer: Healthscope Commercial	$2.57
Rate for Payer: Lakeland Regional Health Systems Commercial	$2.14
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$2.43
Rate for Payer: PHP Commercial	$2.43
Rate for Payer: Priority Health Cigna Priority Health	$2.00
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2.49
Rate for Payer: Priority Health Narrow/Tiered Network	$1.74
Rate for Payer: UHC All Payor (Choice/PPO)	$2.52
Rate for Payer: UHC Core	$2.39
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$2.14

COCAINE 4 % NASAL SOLUTION

Facility

$690.54

Service Code	HCPCS C9143
Hospital Charge Code	186568
Hospital Revenue Code	636
Min. Negotiated Rate	$421.16
Max. Negotiated Rate	$621.49
Rate for Payer: Aetna Commercial	$586.96
Rate for Payer: Aetna Commercial	$545.69
Rate for Payer: BCBS Trust/PPO	$533.65
Rate for Payer: BCBS Trust/PPO	$496.13
Rate for Payer: BCN Commercial	$533.65
Rate for Payer: BCN Commercial	$496.13
Rate for Payer: Cash Price	$513.59
Rate for Payer: Cash Price	$552.43
Rate for Payer: Cofinity Commercial	$552.11
Rate for Payer: Cofinity Commercial	$593.86
Rate for Payer: Encore Health Key Benefits Commercial	$513.59
Rate for Payer: Encore Health Key Benefits Commercial	$552.43
Rate for Payer: Healthscope Commercial	$621.49
Rate for Payer: Healthscope Commercial	$577.79
Rate for Payer: Lakeland Regional Health Systems Commercial	$517.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$481.49
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$586.96
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$545.69
Rate for Payer: PHP Commercial	$545.69
Rate for Payer: PHP Commercial	$586.96
Rate for Payer: Priority Health Cigna Priority Health	$449.39
Rate for Payer: Priority Health Cigna Priority Health	$483.38
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$558.53
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$600.77
Rate for Payer: Priority Health Narrow/Tiered Network	$421.16
Rate for Payer: Priority Health Narrow/Tiered Network	$391.55
Rate for Payer: UHC All Payor (Choice/PPO)	$607.68
Rate for Payer: UHC All Payor (Choice/PPO)	$564.95
Rate for Payer: UHC Core	$536.06
Rate for Payer: UHC Core	$576.60
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$481.49
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$517.90

COLCHICINE 0.6 MG TABLET

Facility

$98.50

Service Code	NDC 70710-1351-3
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$60.08
Max. Negotiated Rate	$88.65
Rate for Payer: Aetna Commercial	$83.72
Rate for Payer: BCBS Trust/PPO	$76.12
Rate for Payer: BCN Commercial	$76.12
Rate for Payer: Cash Price	$78.80
Rate for Payer: Cofinity Commercial	$84.71
Rate for Payer: Encore Health Key Benefits Commercial	$78.80
Rate for Payer: Healthscope Commercial	$88.65
Rate for Payer: Lakeland Regional Health Systems Commercial	$73.88
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$83.72
Rate for Payer: PHP Commercial	$83.72
Rate for Payer: Priority Health Cigna Priority Health	$68.95
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$85.70
Rate for Payer: Priority Health Narrow/Tiered Network	$60.08
Rate for Payer: UHC All Payor (Choice/PPO)	$86.68
Rate for Payer: UHC Core	$82.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$73.88

COLCHICINE 0.6 MG TABLET

Facility

$742.26

Service Code	NDC 64764-119-07
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$452.70
Max. Negotiated Rate	$668.03
Rate for Payer: Aetna Commercial	$630.92
Rate for Payer: BCBS Trust/PPO	$573.62
Rate for Payer: BCN Commercial	$573.62
Rate for Payer: Cash Price	$593.81
Rate for Payer: Cofinity Commercial	$638.34
Rate for Payer: Encore Health Key Benefits Commercial	$593.81
Rate for Payer: Healthscope Commercial	$668.03
Rate for Payer: Lakeland Regional Health Systems Commercial	$556.70
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$630.92
Rate for Payer: PHP Commercial	$630.92
Rate for Payer: Priority Health Cigna Priority Health	$519.58
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$645.77
Rate for Payer: Priority Health Narrow/Tiered Network	$452.70
Rate for Payer: UHC All Payor (Choice/PPO)	$653.19
Rate for Payer: UHC Core	$619.79
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$556.70

COLCHICINE 0.6 MG TABLET

Facility

$356.20

Service Code	NDC 0904-7120-04
Hospital Charge Code	1821
Hospital Revenue Code	637
Min. Negotiated Rate	$217.25
Max. Negotiated Rate	$320.58
Rate for Payer: Aetna Commercial	$302.77
Rate for Payer: BCBS Trust/PPO	$275.27
Rate for Payer: BCN Commercial	$275.27
Rate for Payer: Cash Price	$284.96
Rate for Payer: Cofinity Commercial	$306.33
Rate for Payer: Encore Health Key Benefits Commercial	$284.96
Rate for Payer: Healthscope Commercial	$320.58
Rate for Payer: Lakeland Regional Health Systems Commercial	$267.15
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$302.77
Rate for Payer: PHP Commercial	$302.77
Rate for Payer: Priority Health Cigna Priority Health	$249.34
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$309.89
Rate for Payer: Priority Health Narrow/Tiered Network	$217.25
Rate for Payer: UHC All Payor (Choice/PPO)	$313.46
Rate for Payer: UHC Core	$297.43
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$267.15

COLESTIPOL 1 GRAM TABLET

Facility

$576.00

Service Code	NDC 59762-0450-1
Hospital Charge Code	13884
Hospital Revenue Code	637
Min. Negotiated Rate	$351.30
Max. Negotiated Rate	$518.40
Rate for Payer: Aetna Commercial	$489.60
Rate for Payer: BCBS Trust/PPO	$445.13
Rate for Payer: BCN Commercial	$445.13
Rate for Payer: Cash Price	$460.80
Rate for Payer: Cofinity Commercial	$495.36
Rate for Payer: Encore Health Key Benefits Commercial	$460.80
Rate for Payer: Healthscope Commercial	$518.40
Rate for Payer: Lakeland Regional Health Systems Commercial	$432.00
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$489.60
Rate for Payer: PHP Commercial	$489.60
Rate for Payer: Priority Health Cigna Priority Health	$403.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$501.12
Rate for Payer: Priority Health Narrow/Tiered Network	$351.30
Rate for Payer: UHC All Payor (Choice/PPO)	$506.88
Rate for Payer: UHC Core	$480.96
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$432.00

COLLAGENASE CLOSTRIDIUM HISTOLYTICUM 250 UNIT/GRAM TOPICAL OINTMENT

Facility

$875.39

Service Code	NDC 50484-010-30
Hospital Charge Code	9682
Hospital Revenue Code	637
Min. Negotiated Rate	$533.90
Max. Negotiated Rate	$787.85
Rate for Payer: Aetna Commercial	$744.08
Rate for Payer: BCBS Trust/PPO	$676.50
Rate for Payer: BCN Commercial	$676.50
Rate for Payer: Cash Price	$700.31
Rate for Payer: Cofinity Commercial	$752.84
Rate for Payer: Encore Health Key Benefits Commercial	$700.31
Rate for Payer: Healthscope Commercial	$787.85
Rate for Payer: Lakeland Regional Health Systems Commercial	$656.54
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$744.08
Rate for Payer: PHP Commercial	$744.08
Rate for Payer: Priority Health Cigna Priority Health	$612.77
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$761.59
Rate for Payer: Priority Health Narrow/Tiered Network	$533.90
Rate for Payer: UHC All Payor (Choice/PPO)	$770.34
Rate for Payer: UHC Core	$730.95
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$656.54

COLONOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$629.53

Service Code	CPT 45378
Hospital Revenue Code	360
Min. Negotiated Rate	$599.55
Max. Negotiated Rate	$629.53
Rate for Payer: BCBS Complete	$629.53
Rate for Payer: Mclaren Medicaid	$599.55
Rate for Payer: Meridian Medicaid	$629.53
Rate for Payer: Priority Health Choice Medicaid	$599.55

COLONOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)

Facility

$812.82

Service Code	CPT 45388
Hospital Revenue Code	360
Min. Negotiated Rate	$774.12
Max. Negotiated Rate	$812.82
Rate for Payer: BCBS Complete	$812.82
Rate for Payer: Mclaren Medicaid	$774.12
Rate for Payer: Meridian Medicaid	$812.82
Rate for Payer: Priority Health Choice Medicaid	$774.12

COLONOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS)

Facility

$812.82

Service Code	CPT 45398
Hospital Revenue Code	360
Min. Negotiated Rate	$774.12
Max. Negotiated Rate	$812.82
Rate for Payer: BCBS Complete	$812.82
Rate for Payer: Mclaren Medicaid	$774.12
Rate for Payer: Meridian Medicaid	$812.82
Rate for Payer: Priority Health Choice Medicaid	$774.12

COLONOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$812.82

Service Code	CPT 45380
Hospital Revenue Code	360
Min. Negotiated Rate	$774.12
Max. Negotiated Rate	$812.82
Rate for Payer: BCBS Complete	$812.82
Rate for Payer: Mclaren Medicaid	$774.12
Rate for Payer: Meridian Medicaid	$812.82
Rate for Payer: Priority Health Choice Medicaid	$774.12

COLONOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE

Facility

$812.82

Service Code	CPT 45381
Hospital Revenue Code	360
Min. Negotiated Rate	$774.12
Max. Negotiated Rate	$812.82
Rate for Payer: BCBS Complete	$812.82
Rate for Payer: Mclaren Medicaid	$774.12
Rate for Payer: Meridian Medicaid	$812.82
Rate for Payer: Priority Health Choice Medicaid	$774.12

COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS

Facility

$812.82

Service Code	CPT 45384
Hospital Revenue Code	360
Min. Negotiated Rate	$774.12
Max. Negotiated Rate	$812.82
Rate for Payer: BCBS Complete	$812.82
Rate for Payer: Mclaren Medicaid	$774.12
Rate for Payer: Meridian Medicaid	$812.82
Rate for Payer: Priority Health Choice Medicaid	$774.12

COLONOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

Facility

$812.82

Service Code	CPT 45385
Hospital Revenue Code	360
Min. Negotiated Rate	$774.12
Max. Negotiated Rate	$812.82
Rate for Payer: BCBS Complete	$812.82
Rate for Payer: Mclaren Medicaid	$774.12
Rate for Payer: Meridian Medicaid	$812.82
Rate for Payer: Priority Health Choice Medicaid	$774.12

COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)

Facility

$629.53

Service Code	CPT 44388
Hospital Revenue Code	360
Min. Negotiated Rate	$599.55
Max. Negotiated Rate	$629.53
Rate for Payer: BCBS Complete	$629.53
Rate for Payer: Mclaren Medicaid	$599.55
Rate for Payer: Meridian Medicaid	$629.53
Rate for Payer: Priority Health Choice Medicaid	$599.55

COLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE

Facility

$812.82

Service Code	CPT 44389
Hospital Revenue Code	360
Min. Negotiated Rate	$774.12
Max. Negotiated Rate	$812.82
Rate for Payer: BCBS Complete	$812.82
Rate for Payer: Mclaren Medicaid	$774.12
Rate for Payer: Meridian Medicaid	$812.82
Rate for Payer: Priority Health Choice Medicaid	$774.12

COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE

Facility

$812.82

Service Code	CPT 44394
Hospital Revenue Code	360
Min. Negotiated Rate	$774.12
Max. Negotiated Rate	$812.82
Rate for Payer: BCBS Complete	$812.82
Rate for Payer: Mclaren Medicaid	$774.12
Rate for Payer: Meridian Medicaid	$812.82
Rate for Payer: Priority Health Choice Medicaid	$774.12

COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK

Facility

$629.53

Service Code	CPT G0105
Hospital Revenue Code	360
Min. Negotiated Rate	$599.55
Max. Negotiated Rate	$629.53
Rate for Payer: BCBS Complete	$629.53
Rate for Payer: Mclaren Medicaid	$599.55
Rate for Payer: Meridian Medicaid	$629.53
Rate for Payer: Priority Health Choice Medicaid	$599.55

COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOT MEETING CRITERIA FOR HIGH RISK

Facility

$629.53

Service Code	CPT G0121
Hospital Revenue Code	360
Min. Negotiated Rate	$599.55
Max. Negotiated Rate	$629.53
Rate for Payer: BCBS Complete	$629.53
Rate for Payer: Mclaren Medicaid	$599.55
Rate for Payer: Meridian Medicaid	$629.53
Rate for Payer: Priority Health Choice Medicaid	$599.55

COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY

Facility

$629.53

Service Code	CPT G0104
Hospital Revenue Code	360
Min. Negotiated Rate	$599.55
Max. Negotiated Rate	$629.53
Rate for Payer: BCBS Complete	$629.53
Rate for Payer: Mclaren Medicaid	$599.55
Rate for Payer: Meridian Medicaid	$629.53
Rate for Payer: Priority Health Choice Medicaid	$599.55

COLPOSCOPY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA; WITH ENDOCERVICAL CURETTAGE

Facility

$220.97

Service Code	CPT 57456
Hospital Revenue Code	360
Min. Negotiated Rate	$161.36
Max. Negotiated Rate	$220.97
Rate for Payer: BCBS Complete	$220.97
Rate for Payer: BCCCP Commercial	$161.36
Rate for Payer: Mclaren Medicaid	$210.45
Rate for Payer: Meridian Medicaid	$220.97
Rate for Payer: Priority Health Choice Medicaid	$210.45

Know your out-of-pocket cost for care.

All Charges