Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PRAZOSIN 5 MG CAPSULE

Facility

$201.95

Service Code	NDC 60687-572-32
Hospital Charge Code	6470
Hospital Revenue Code	637
Min. Negotiated Rate	$123.17
Max. Negotiated Rate	$181.76
Rate for Payer: Aetna Commercial	$171.66
Rate for Payer: BCBS Trust/PPO	$156.07
Rate for Payer: BCN Commercial	$156.07
Rate for Payer: Cash Price	$161.56
Rate for Payer: Cofinity Commercial	$173.68
Rate for Payer: Encore Health Key Benefits Commercial	$161.56
Rate for Payer: Healthscope Commercial	$181.76
Rate for Payer: Lakeland Regional Health Systems Commercial	$151.46
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$171.66
Rate for Payer: PHP Commercial	$171.66
Rate for Payer: Priority Health Cigna Priority Health	$141.36
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$175.70
Rate for Payer: Priority Health Narrow/Tiered Network	$123.17
Rate for Payer: UHC All Payor (Choice/PPO)	$177.72
Rate for Payer: UHC Core	$168.63
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$151.46

PR B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA

Professional

Both

$2,131.00

Service Code	HCPCS 27170
Min. Negotiated Rate	$750.40
Max. Negotiated Rate	$1,814.18
Rate for Payer: Aetna Commercial	$1,548.75
Rate for Payer: Aetna Medicare	$1,202.01
Rate for Payer: BCBS Complete	$787.92
Rate for Payer: BCBS MAPPO	$1,155.78
Rate for Payer: BCBS Trust/PPO	$1,814.18
Rate for Payer: BCN Commercial	$1,713.79
Rate for Payer: BCN Medicare Advantage	$1,155.78
Rate for Payer: Cash Price	$1,704.80
Rate for Payer: Cash Price	$1,704.80
Rate for Payer: Cofinity Commercial	$1,664.32
Rate for Payer: Cofinity Commercial	$1,548.75
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,155.78
Rate for Payer: Mclaren Medicaid	$750.40
Rate for Payer: Meridian Medicaid	$787.92
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,213.57
Rate for Payer: PACE SWMI	$1,155.78
Rate for Payer: PHP Medicare Advantage	$1,155.78
Rate for Payer: Priority Health Choice Medicaid	$750.40
Rate for Payer: Priority Health Cigna Priority Health	$1,491.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,790.84
Rate for Payer: Priority Health Medicare	$1,155.78
Rate for Payer: Priority Health Narrow/Tiered Network	$1,790.84
Rate for Payer: UHC All Payor (Choice/PPO)	$1,155.78
Rate for Payer: UHC Dual Complete DSNP	$1,155.78
Rate for Payer: UHC Medicare Advantage	$1,190.45

PR BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL

Professional

Both

$268.00

Service Code	HCPCS 90586
Min. Negotiated Rate	$107.20
Max. Negotiated Rate	$208.39
Rate for Payer: Aetna Commercial	$193.92
Rate for Payer: Aetna Medicare	$150.50
Rate for Payer: BCBS Complete	$107.20
Rate for Payer: BCBS MAPPO	$144.71
Rate for Payer: BCBS Trust/PPO	$147.22
Rate for Payer: BCN Commercial	$146.43
Rate for Payer: BCN Medicare Advantage	$144.71
Rate for Payer: Cash Price	$214.40
Rate for Payer: Cash Price	$214.40
Rate for Payer: Cofinity Commercial	$208.39
Rate for Payer: Cofinity Commercial	$193.92
Rate for Payer: Health Alliance Plan Medicare Advantage	$144.71
Rate for Payer: Meridian Wellcare - Medicare Advantage	$151.95
Rate for Payer: PACE SWMI	$144.71
Rate for Payer: PHP Medicare Advantage	$144.71
Rate for Payer: Priority Health Cigna Priority Health	$187.60
Rate for Payer: Priority Health Medicare	$144.71
Rate for Payer: UHC All Payor (Choice/PPO)	$144.71
Rate for Payer: UHC Dual Complete DSNP	$144.71
Rate for Payer: UHC Medicare Advantage	$149.06

PR BALLN ANGIOPLASTY OPEN,BRACHCEPH

Professional

Both

$939.00

Service Code	HCPCS 35458
Min. Negotiated Rate	$375.60
Max. Negotiated Rate	$657.30
Rate for Payer: BCBS Complete	$375.60
Rate for Payer: Cash Price	$751.20
Rate for Payer: Priority Health Cigna Priority Health	$657.30

PR BALLN ANGIOPLASTY PERC,AORTIC

Professional

Both

$675.00

Service Code	HCPCS 35472
Min. Negotiated Rate	$270.00
Max. Negotiated Rate	$472.50
Rate for Payer: BCBS Complete	$270.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Priority Health Cigna Priority Health	$472.50

PR BALLN ANGIOPLASTY PERC,BRACHIOCEPH

Professional

Both

$1,999.00

Service Code	HCPCS 35475
Min. Negotiated Rate	$799.60
Max. Negotiated Rate	$1,399.30
Rate for Payer: BCBS Complete	$799.60
Rate for Payer: Cash Price	$1,599.20
Rate for Payer: Priority Health Cigna Priority Health	$1,399.30

PR BALLN ANGIOPLASTY,PERC VENOUS

Professional

Both

$3,374.00

Service Code	HCPCS 35476
Min. Negotiated Rate	$1,349.60
Max. Negotiated Rate	$2,361.80
Rate for Payer: BCBS Complete	$1,349.60
Rate for Payer: Cash Price	$2,699.20
Rate for Payer: Priority Health Cigna Priority Health	$2,361.80

PR BALLN ANGIOPLASTY PERC,VISCERAL

Professional

Both

$2,801.00

Service Code	HCPCS 35471
Min. Negotiated Rate	$1,120.40
Max. Negotiated Rate	$1,960.70
Rate for Payer: BCBS Complete	$1,120.40
Rate for Payer: Cash Price	$2,240.80
Rate for Payer: Priority Health Cigna Priority Health	$1,960.70

PR BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS

Professional

Both

$4,825.00

Service Code	HCPCS 61630
Min. Negotiated Rate	$18.49
Max. Negotiated Rate	$3,377.50
Rate for Payer: Aetna Commercial	$1,827.41
Rate for Payer: Aetna Medicare	$1,418.29
Rate for Payer: BCBS Complete	$1,930.00
Rate for Payer: BCBS MAPPO	$1,363.74
Rate for Payer: BCBS Trust/PPO	$18.49
Rate for Payer: BCN Commercial	$1,995.76
Rate for Payer: BCN Medicare Advantage	$1,363.74
Rate for Payer: Cash Price	$3,860.00
Rate for Payer: Cash Price	$3,860.00
Rate for Payer: Cofinity Commercial	$1,963.79
Rate for Payer: Cofinity Commercial	$1,827.41
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,363.74
Rate for Payer: Meridian Wellcare - Medicare Advantage	$1,431.93
Rate for Payer: PACE SWMI	$1,363.74
Rate for Payer: PHP Medicare Advantage	$1,363.74
Rate for Payer: Priority Health Cigna Priority Health	$3,377.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$2,312.45
Rate for Payer: Priority Health Medicare	$1,363.74
Rate for Payer: Priority Health Narrow/Tiered Network	$2,312.45
Rate for Payer: UHC All Payor (Choice/PPO)	$1,363.74
Rate for Payer: UHC Dual Complete DSNP	$1,363.74
Rate for Payer: UHC Medicare Advantage	$1,404.65

PR BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL

Professional

Both

$967.00

Service Code	HCPCS 61640
Min. Negotiated Rate	$73.96
Max. Negotiated Rate	$793.28
Rate for Payer: Aetna Commercial	$633.90
Rate for Payer: BCBS Complete	$386.80
Rate for Payer: BCBS Trust/PPO	$73.96
Rate for Payer: BCN Commercial	$684.64
Rate for Payer: Cash Price	$773.60
Rate for Payer: Cash Price	$773.60
Rate for Payer: Priority Health Cigna Priority Health	$676.90
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$793.28
Rate for Payer: Priority Health Narrow/Tiered Network	$793.28

PR BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I

Professional

Both

$1,883.00

Service Code	HCPCS 50706
Min. Negotiated Rate	$111.83
Max. Negotiated Rate	$4,073.19
Rate for Payer: Aetna Commercial	$235.80
Rate for Payer: Aetna Medicare	$183.01
Rate for Payer: BCBS Complete	$117.42
Rate for Payer: BCBS MAPPO	$175.97
Rate for Payer: BCBS Trust/PPO	$4,073.19
Rate for Payer: BCN Commercial	$1,238.31
Rate for Payer: BCN Medicare Advantage	$175.97
Rate for Payer: Cash Price	$1,506.40
Rate for Payer: Cash Price	$1,506.40
Rate for Payer: Cofinity Commercial	$253.40
Rate for Payer: Cofinity Commercial	$235.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$175.97
Rate for Payer: Mclaren Medicaid	$111.83
Rate for Payer: Meridian Medicaid	$117.42
Rate for Payer: Meridian Wellcare - Medicare Advantage	$184.77
Rate for Payer: PACE SWMI	$175.97
Rate for Payer: PHP Medicare Advantage	$175.97
Rate for Payer: Priority Health Choice Medicaid	$111.83
Rate for Payer: Priority Health Cigna Priority Health	$1,318.10
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$284.23
Rate for Payer: Priority Health Medicare	$175.97
Rate for Payer: Priority Health Narrow/Tiered Network	$284.23
Rate for Payer: UHC All Payor (Choice/PPO)	$175.97
Rate for Payer: UHC Dual Complete DSNP	$175.97
Rate for Payer: UHC Medicare Advantage	$181.25

PR BCG LIVE INTRAVESICAL VAC

Professional

Both

$176.00

Service Code	HCPCS J9031
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$123.20
Rate for Payer: BCBS Complete	$70.40
Rate for Payer: Cash Price	$140.80
Rate for Payer: Priority Health Cigna Priority Health	$123.20

PR BCN APNEALINK PLUS

Professional

Both

$738.65

Service Code	HCPCS 00119
Hospital Revenue Code	960
Min. Negotiated Rate	$295.46
Max. Negotiated Rate	$517.06
Rate for Payer: BCBS Complete	$295.46
Rate for Payer: Cash Price	$590.92
Rate for Payer: Priority Health Cigna Priority Health	$517.06

PR BCN WATCHPAT

Professional

Both

$547.64

Service Code	HCPCS 00120
Hospital Revenue Code	960
Min. Negotiated Rate	$219.06
Max. Negotiated Rate	$383.35
Rate for Payer: BCBS Complete	$219.06
Rate for Payer: Cash Price	$438.11
Rate for Payer: Priority Health Cigna Priority Health	$383.35

PR BEDSIDE DRAINAGE BAG

Professional

Both

$15.00

Service Code	HCPCS A4357
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$10.69
Rate for Payer: Aetna Commercial	$9.04
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: BCN Commercial	$10.69
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$10.50

PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT

Professional

Both

$11.00

Service Code	HCPCS 96127
Min. Negotiated Rate	$4.38
Max. Negotiated Rate	$986.86
Rate for Payer: Aetna Commercial	$5.87
Rate for Payer: Aetna Medicare	$4.56
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: BCBS MAPPO	$4.38
Rate for Payer: BCBS Trust/PPO	$986.86
Rate for Payer: BCN Commercial	$6.85
Rate for Payer: BCN Medicare Advantage	$4.38
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cofinity Commercial	$5.87
Rate for Payer: Cofinity Commercial	$6.31
Rate for Payer: Health Alliance Plan Medicare Advantage	$4.38
Rate for Payer: Meridian Wellcare - Medicare Advantage	$4.60
Rate for Payer: PACE SWMI	$4.38
Rate for Payer: PHP Medicare Advantage	$4.38
Rate for Payer: Priority Health Cigna Priority Health	$7.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$8.89
Rate for Payer: Priority Health Medicare	$4.38
Rate for Payer: Priority Health Narrow/Tiered Network	$8.89
Rate for Payer: UHC All Payor (Choice/PPO)	$4.38
Rate for Payer: UHC Dual Complete DSNP	$4.38
Rate for Payer: UHC Medicare Advantage	$4.51

PR BEHAV HLTH DAY TREAT, PER HR

Professional

Both

$539.00

Service Code	HCPCS H2012
Min. Negotiated Rate	$39.28
Max. Negotiated Rate	$377.30
Rate for Payer: Aetna Commercial	$39.28
Rate for Payer: BCBS Complete	$215.60
Rate for Payer: Cash Price	$431.20
Rate for Payer: Cash Price	$431.20
Rate for Payer: Priority Health Cigna Priority Health	$377.30

PR BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE

Professional

Both

$176.00

Service Code	HCPCS 92524
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$1,450.71
Rate for Payer: Aetna Commercial	$143.55
Rate for Payer: Aetna Medicare	$111.42
Rate for Payer: BCBS Complete	$70.40
Rate for Payer: BCBS MAPPO	$107.13
Rate for Payer: BCBS Trust/PPO	$1,450.71
Rate for Payer: BCN Commercial	$159.79
Rate for Payer: BCN Medicare Advantage	$107.13
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cofinity Commercial	$143.55
Rate for Payer: Cofinity Commercial	$154.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$107.13
Rate for Payer: Meridian Wellcare - Medicare Advantage	$112.49
Rate for Payer: PACE SWMI	$107.13
Rate for Payer: PHP Medicare Advantage	$107.13
Rate for Payer: Priority Health Cigna Priority Health	$123.20
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$146.87
Rate for Payer: Priority Health Medicare	$107.13
Rate for Payer: Priority Health Narrow/Tiered Network	$146.87
Rate for Payer: UHC All Payor (Choice/PPO)	$107.13
Rate for Payer: UHC Dual Complete DSNP	$107.13
Rate for Payer: UHC Medicare Advantage	$110.34

PR BEHAVIOR COUNSEL OBESITY 15M

Professional

Both

$44.00

Service Code	HCPCS G0447
Min. Negotiated Rate	$17.60
Max. Negotiated Rate	$1,436.98
Rate for Payer: Aetna Commercial	$30.24
Rate for Payer: Aetna Medicare	$23.47
Rate for Payer: BCBS Complete	$17.60
Rate for Payer: BCBS MAPPO	$22.57
Rate for Payer: BCBS Trust/PPO	$1,436.98
Rate for Payer: BCN Commercial	$37.14
Rate for Payer: BCN Medicare Advantage	$22.57
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cofinity Commercial	$30.24
Rate for Payer: Cofinity Commercial	$32.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$22.57
Rate for Payer: Meridian Wellcare - Medicare Advantage	$23.70
Rate for Payer: PACE SWMI	$22.57
Rate for Payer: PHP Medicare Advantage	$22.57
Rate for Payer: Priority Health Cigna Priority Health	$30.80
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$27.23
Rate for Payer: Priority Health Medicare	$22.57
Rate for Payer: Priority Health Narrow/Tiered Network	$27.23
Rate for Payer: UHC All Payor (Choice/PPO)	$22.57
Rate for Payer: UHC Dual Complete DSNP	$22.57
Rate for Payer: UHC Medicare Advantage	$23.25

PR BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN

Professional

Both

$61.00

Service Code	HCPCS 97151
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$1,118.41
Rate for Payer: Aetna Commercial	$20.79
Rate for Payer: BCBS Complete	$24.40
Rate for Payer: BCBS Trust/PPO	$1,118.41
Rate for Payer: BCN Commercial	$42.82
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Priority Health Cigna Priority Health	$42.70
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$37.41
Rate for Payer: Priority Health Narrow/Tiered Network	$37.41

PR BETAMETHASONE ACET&SOD PHOSP

Professional

Both

$10.00

Service Code	HCPCS J0702
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$10.02
Rate for Payer: Aetna Commercial	$9.32
Rate for Payer: Aetna Medicare	$7.23
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS MAPPO	$6.96
Rate for Payer: BCBS Trust/PPO	$3.84
Rate for Payer: BCN Commercial	$4.80
Rate for Payer: BCN Medicare Advantage	$6.96
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cofinity Commercial	$10.02
Rate for Payer: Cofinity Commercial	$9.32
Rate for Payer: Health Alliance Plan Medicare Advantage	$6.96
Rate for Payer: Meridian Wellcare - Medicare Advantage	$7.30
Rate for Payer: PACE SWMI	$6.96
Rate for Payer: PHP Medicare Advantage	$6.96
Rate for Payer: Priority Health Cigna Priority Health	$7.00
Rate for Payer: Priority Health Medicare	$6.96
Rate for Payer: UHC All Payor (Choice/PPO)	$6.96
Rate for Payer: UHC Dual Complete DSNP	$6.96
Rate for Payer: UHC Medicare Advantage	$7.16

PR BFB TRAING W/EMG &/MANOMETRY 1ST 15 MIN CNTCT

Professional

Both

$165.00

Service Code	HCPCS 90912
Min. Negotiated Rate	$41.84
Max. Negotiated Rate	$184.91
Rate for Payer: Aetna Commercial	$56.07
Rate for Payer: Aetna Medicare	$43.51
Rate for Payer: BCBS Complete	$66.00
Rate for Payer: BCBS MAPPO	$41.84
Rate for Payer: BCBS Trust/PPO	$184.91
Rate for Payer: BCN Commercial	$117.28
Rate for Payer: BCN Medicare Advantage	$41.84
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cofinity Commercial	$60.25
Rate for Payer: Cofinity Commercial	$56.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$41.84
Rate for Payer: Meridian Wellcare - Medicare Advantage	$43.93
Rate for Payer: PACE SWMI	$41.84
Rate for Payer: PHP Medicare Advantage	$41.84
Rate for Payer: Priority Health Cigna Priority Health	$115.50
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$65.04
Rate for Payer: Priority Health Medicare	$41.84
Rate for Payer: Priority Health Narrow/Tiered Network	$65.04
Rate for Payer: UHC All Payor (Choice/PPO)	$41.84
Rate for Payer: UHC Dual Complete DSNP	$41.84
Rate for Payer: UHC Medicare Advantage	$43.10

PR BIA WHOLE BODY COMPOSITION ASSESSMENT W/I&R

Professional

Both

$31.00

Service Code	HCPCS 0358T
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$29.66
Rate for Payer: Aetna Commercial	$29.66
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: BCBS Trust/PPO	$28.95
Rate for Payer: BCN Commercial	$23.09
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$21.70

PR BILATERAL GYNECOMASTIA

Professional

Both

$3,200.00

Service Code	HCPCS 00524
Hospital Revenue Code	990
Min. Negotiated Rate	$1,280.00
Max. Negotiated Rate	$2,240.00
Rate for Payer: BCBS Complete	$1,280.00
Rate for Payer: Cash Price	$2,560.00
Rate for Payer: Priority Health Cigna Priority Health	$2,240.00

PR BILATERAL MASTOPEXY

Professional

Both

$3,800.00

Service Code	HCPCS 00525
Hospital Revenue Code	990
Min. Negotiated Rate	$1,520.00
Max. Negotiated Rate	$2,660.00
Rate for Payer: BCBS Complete	$1,520.00
Rate for Payer: Cash Price	$3,040.00
Rate for Payer: Priority Health Cigna Priority Health	$2,660.00

Know your out-of-pocket cost for care.

All Charges