Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PEPTAMEN AF INTERMITTENT FEED

Facility

$14.80

Service Code	NDC 98716066360
Hospital Charge Code	200078
Hospital Revenue Code	637
Min. Negotiated Rate	$2.61
Max. Negotiated Rate	$13.32
Rate for Payer: Aetna Commercial	$12.58
Rate for Payer: Aetna Medicare	$3.85
Rate for Payer: Allen County Amish Medical Aid Commercial	$4.62
Rate for Payer: Amish Plain Church Group Commercial	$4.62
Rate for Payer: BCBS Complete	$2.74
Rate for Payer: BCBS MAPPO	$3.70
Rate for Payer: BCBS Trust/PPO	$12.17
Rate for Payer: BCN Commercial	$12.17
Rate for Payer: BCN Medicare Advantage	$3.70
Rate for Payer: Cash Price	$11.84
Rate for Payer: Cofinity Commercial	$12.73
Rate for Payer: Encore Health Key Benefits Commercial	$11.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$3.70
Rate for Payer: Healthscope Commercial	$13.32
Rate for Payer: Lakeland Regional Health Systems Commercial	$11.10
Rate for Payer: Mclaren Medicaid	$2.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$3.88
Rate for Payer: Meridian Medicaid	$2.74
Rate for Payer: MI Amish Medical Board Commercial	$4.25
Rate for Payer: Molina Medicare/Medicaid	$4.07
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.58
Rate for Payer: Nomi Health Commercial	$12.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.10
Rate for Payer: PACE Senior Care Partners	$3.52
Rate for Payer: PACE SWMI	$3.70
Rate for Payer: PHP Commercial	$12.58
Rate for Payer: PHP Medicare Advantage	$3.70
Rate for Payer: Priority Health Choice Medicaid	$2.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$12.88
Rate for Payer: Priority Health Medicare	$3.74
Rate for Payer: Priority Health Narrow/Tiered Network	$10.30
Rate for Payer: Railroad Medicare Medicare	$3.70
Rate for Payer: UHC All Payor (Choice/PPO)	$13.02
Rate for Payer: UHC Core	$12.36
Rate for Payer: UHC Exchange	$3.70
Rate for Payer: UHC Medicaid	$2.61
Rate for Payer: UHC Medicare Advantage	$3.70
Rate for Payer: UHCCP Medicaid	$2.61
Rate for Payer: VA VA	$3.70
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$11.10

PEPTAMEN AF INTERMITTENT FEED

Facility

$14.80

Service Code	NDC 98716066360
Hospital Charge Code	200078
Hospital Revenue Code	637
Min. Negotiated Rate	$10.30
Max. Negotiated Rate	$13.32
Rate for Payer: Aetna Commercial	$12.58
Rate for Payer: BCBS Trust/PPO	$12.22
Rate for Payer: BCN Commercial	$12.22
Rate for Payer: Cash Price	$11.84
Rate for Payer: Cofinity Commercial	$12.73
Rate for Payer: Encore Health Key Benefits Commercial	$11.84
Rate for Payer: Healthscope Commercial	$13.32
Rate for Payer: Lakeland Regional Health Systems Commercial	$11.10
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$12.58
Rate for Payer: Nomi Health Commercial	$12.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.10
Rate for Payer: PHP Commercial	$12.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$12.88
Rate for Payer: Priority Health Narrow/Tiered Network	$10.30
Rate for Payer: UHC All Payor (Choice/PPO)	$13.02
Rate for Payer: UHC Core	$12.36
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$11.10

PEPTIC ULCER AND GASTRITIS

Facility

$13,239.07

Service Code	APR-DRG 2414
Min. Negotiated Rate	$12,608.64
Max. Negotiated Rate	$13,239.07
Rate for Payer: BCBS Complete	$13,239.07
Rate for Payer: Mclaren Medicaid	$12,608.64
Rate for Payer: Meridian Medicaid	$13,239.07
Rate for Payer: Priority Health Choice Medicaid	$12,608.64
Rate for Payer: UHC Medicaid	$12,608.64
Rate for Payer: UHCCP Medicaid	$12,608.64

PEPTIC ULCER AND GASTRITIS

Facility

$4,905.56

Service Code	APR-DRG 2412
Min. Negotiated Rate	$4,671.96
Max. Negotiated Rate	$4,905.56
Rate for Payer: BCBS Complete	$4,905.56
Rate for Payer: Mclaren Medicaid	$4,671.96
Rate for Payer: Meridian Medicaid	$4,905.56
Rate for Payer: Priority Health Choice Medicaid	$4,671.96
Rate for Payer: UHC Medicaid	$4,671.96
Rate for Payer: UHCCP Medicaid	$4,671.96

PEPTIC ULCER AND GASTRITIS

Facility

$3,900.68

Service Code	APR-DRG 2411
Min. Negotiated Rate	$3,714.93
Max. Negotiated Rate	$3,900.68
Rate for Payer: BCBS Complete	$3,900.68
Rate for Payer: Mclaren Medicaid	$3,714.93
Rate for Payer: Meridian Medicaid	$3,900.68
Rate for Payer: Priority Health Choice Medicaid	$3,714.93
Rate for Payer: UHC Medicaid	$3,714.93
Rate for Payer: UHCCP Medicaid	$3,714.93

PEPTIC ULCER AND GASTRITIS

Facility

$7,129.34

Service Code	APR-DRG 2413
Min. Negotiated Rate	$6,789.85
Max. Negotiated Rate	$7,129.34
Rate for Payer: BCBS Complete	$7,129.34
Rate for Payer: Mclaren Medicaid	$6,789.85
Rate for Payer: Meridian Medicaid	$7,129.34
Rate for Payer: Priority Health Choice Medicaid	$6,789.85
Rate for Payer: UHC Medicaid	$6,789.85
Rate for Payer: UHCCP Medicaid	$6,789.85

PERCUTANEOUS CARDIAC INTERVENTION WITH AMI

Facility

$20,519.33

Service Code	APR-DRG 1744
Min. Negotiated Rate	$19,542.22
Max. Negotiated Rate	$20,519.33
Rate for Payer: BCBS Complete	$20,519.33
Rate for Payer: Mclaren Medicaid	$19,542.22
Rate for Payer: Meridian Medicaid	$20,519.33
Rate for Payer: Priority Health Choice Medicaid	$19,542.22
Rate for Payer: UHC Medicaid	$19,542.22
Rate for Payer: UHCCP Medicaid	$19,542.22

PERCUTANEOUS CARDIAC INTERVENTION WITH AMI

Facility

$10,075.09

Service Code	APR-DRG 1741
Min. Negotiated Rate	$9,595.33
Max. Negotiated Rate	$10,075.09
Rate for Payer: BCBS Complete	$10,075.09
Rate for Payer: Mclaren Medicaid	$9,595.33
Rate for Payer: Meridian Medicaid	$10,075.09
Rate for Payer: Priority Health Choice Medicaid	$9,595.33
Rate for Payer: UHC Medicaid	$9,595.33
Rate for Payer: UHCCP Medicaid	$9,595.33

PERCUTANEOUS CARDIAC INTERVENTION WITH AMI

Facility

$12,624.37

Service Code	APR-DRG 1742
Min. Negotiated Rate	$12,023.21
Max. Negotiated Rate	$12,624.37
Rate for Payer: BCBS Complete	$12,624.37
Rate for Payer: Mclaren Medicaid	$12,023.21
Rate for Payer: Meridian Medicaid	$12,624.37
Rate for Payer: Priority Health Choice Medicaid	$12,023.21
Rate for Payer: UHC Medicaid	$12,023.21
Rate for Payer: UHCCP Medicaid	$12,023.21

PERCUTANEOUS CARDIAC INTERVENTION WITH AMI

Facility

$14,196.63

Service Code	APR-DRG 1743
Min. Negotiated Rate	$13,520.60
Max. Negotiated Rate	$14,196.63
Rate for Payer: BCBS Complete	$14,196.63
Rate for Payer: Mclaren Medicaid	$13,520.60
Rate for Payer: Meridian Medicaid	$14,196.63
Rate for Payer: Priority Health Choice Medicaid	$13,520.60
Rate for Payer: UHC Medicaid	$13,520.60
Rate for Payer: UHCCP Medicaid	$13,520.60

PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI

Facility

$8,293.55

Service Code	APR-DRG 1751
Min. Negotiated Rate	$7,898.62
Max. Negotiated Rate	$8,293.55
Rate for Payer: BCBS Complete	$8,293.55
Rate for Payer: Mclaren Medicaid	$7,898.62
Rate for Payer: Meridian Medicaid	$8,293.55
Rate for Payer: Priority Health Choice Medicaid	$7,898.62
Rate for Payer: UHC Medicaid	$7,898.62
Rate for Payer: UHCCP Medicaid	$7,898.62

PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI

Facility

$23,030.21

Service Code	APR-DRG 1754
Min. Negotiated Rate	$21,933.54
Max. Negotiated Rate	$23,030.21
Rate for Payer: BCBS Complete	$23,030.21
Rate for Payer: Mclaren Medicaid	$21,933.54
Rate for Payer: Meridian Medicaid	$23,030.21
Rate for Payer: Priority Health Choice Medicaid	$21,933.54
Rate for Payer: UHC Medicaid	$21,933.54
Rate for Payer: UHCCP Medicaid	$21,933.54

PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI

Facility

$11,024.76

Service Code	APR-DRG 1752
Min. Negotiated Rate	$10,499.77
Max. Negotiated Rate	$11,024.76
Rate for Payer: BCBS Complete	$11,024.76
Rate for Payer: Mclaren Medicaid	$10,499.77
Rate for Payer: Meridian Medicaid	$11,024.76
Rate for Payer: Priority Health Choice Medicaid	$10,499.77
Rate for Payer: UHC Medicaid	$10,499.77
Rate for Payer: UHCCP Medicaid	$10,499.77

PERCUTANEOUS CARDIAC INTERVENTION WITHOUT AMI

Facility

$14,217.66

Service Code	APR-DRG 1753
Min. Negotiated Rate	$13,540.63
Max. Negotiated Rate	$14,217.66
Rate for Payer: BCBS Complete	$14,217.66
Rate for Payer: Mclaren Medicaid	$13,540.63
Rate for Payer: Meridian Medicaid	$14,217.66
Rate for Payer: Priority Health Choice Medicaid	$13,540.63
Rate for Payer: UHC Medicaid	$13,540.63
Rate for Payer: UHCCP Medicaid	$13,540.63

PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$7,308.65

Service Code	APR-DRG 0301
Min. Negotiated Rate	$6,960.62
Max. Negotiated Rate	$7,308.65
Rate for Payer: BCBS Complete	$7,308.65
Rate for Payer: Mclaren Medicaid	$6,960.62
Rate for Payer: Meridian Medicaid	$7,308.65
Rate for Payer: Priority Health Choice Medicaid	$6,960.62
Rate for Payer: UHC Medicaid	$6,960.62
Rate for Payer: UHCCP Medicaid	$6,960.62

PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$16,024.45

Service Code	APR-DRG 0303
Min. Negotiated Rate	$15,261.38
Max. Negotiated Rate	$16,024.45
Rate for Payer: BCBS Complete	$16,024.45
Rate for Payer: Mclaren Medicaid	$15,261.38
Rate for Payer: Meridian Medicaid	$16,024.45
Rate for Payer: Priority Health Choice Medicaid	$15,261.38
Rate for Payer: UHC Medicaid	$15,261.38
Rate for Payer: UHCCP Medicaid	$15,261.38

PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$21,660.40

Service Code	APR-DRG 0304
Min. Negotiated Rate	$20,628.95
Max. Negotiated Rate	$21,660.40
Rate for Payer: BCBS Complete	$21,660.40
Rate for Payer: Mclaren Medicaid	$20,628.95
Rate for Payer: Meridian Medicaid	$21,660.40
Rate for Payer: Priority Health Choice Medicaid	$20,628.95
Rate for Payer: UHC Medicaid	$20,628.95
Rate for Payer: UHCCP Medicaid	$20,628.95

PERCUTANEOUS INTRACRANIAL AND EXTRACRANIAL VASCULAR PROCEDURES

Facility

$12,467.14

Service Code	APR-DRG 0302
Min. Negotiated Rate	$11,873.47
Max. Negotiated Rate	$12,467.14
Rate for Payer: BCBS Complete	$12,467.14
Rate for Payer: Mclaren Medicaid	$11,873.47
Rate for Payer: Meridian Medicaid	$12,467.14
Rate for Payer: Priority Health Choice Medicaid	$11,873.47
Rate for Payer: UHC Medicaid	$11,873.47
Rate for Payer: UHCCP Medicaid	$11,873.47

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$22,761.51

Service Code	APR-DRG 1833
Min. Negotiated Rate	$21,677.63
Max. Negotiated Rate	$22,761.51
Rate for Payer: BCBS Complete	$22,761.51
Rate for Payer: Mclaren Medicaid	$21,677.63
Rate for Payer: Meridian Medicaid	$22,761.51
Rate for Payer: Priority Health Choice Medicaid	$21,677.63
Rate for Payer: UHC Medicaid	$21,677.63
Rate for Payer: UHCCP Medicaid	$21,677.63

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$16,502.96

Service Code	APR-DRG 1831
Min. Negotiated Rate	$15,717.11
Max. Negotiated Rate	$16,502.96
Rate for Payer: BCBS Complete	$16,502.96
Rate for Payer: Mclaren Medicaid	$15,717.11
Rate for Payer: Meridian Medicaid	$16,502.96
Rate for Payer: Priority Health Choice Medicaid	$15,717.11
Rate for Payer: UHC Medicaid	$15,717.11
Rate for Payer: UHCCP Medicaid	$15,717.11

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$32,018.92

Service Code	APR-DRG 1834
Min. Negotiated Rate	$30,494.21
Max. Negotiated Rate	$32,018.92
Rate for Payer: BCBS Complete	$32,018.92
Rate for Payer: Mclaren Medicaid	$30,494.21
Rate for Payer: Meridian Medicaid	$32,018.92
Rate for Payer: Priority Health Choice Medicaid	$30,494.21
Rate for Payer: UHC Medicaid	$30,494.21
Rate for Payer: UHCCP Medicaid	$30,494.21

PERCUTANEOUS STRUCTURAL CARDIAC PROCEDURES

Facility

$18,035.26

Service Code	APR-DRG 1832
Min. Negotiated Rate	$17,176.44
Max. Negotiated Rate	$18,035.26
Rate for Payer: BCBS Complete	$18,035.26
Rate for Payer: Mclaren Medicaid	$17,176.44
Rate for Payer: Meridian Medicaid	$18,035.26
Rate for Payer: Priority Health Choice Medicaid	$17,176.44
Rate for Payer: UHC Medicaid	$17,176.44
Rate for Payer: UHCCP Medicaid	$17,176.44

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$7,199.80

Service Code	APR-DRG 1973
Min. Negotiated Rate	$6,856.95
Max. Negotiated Rate	$7,199.80
Rate for Payer: BCBS Complete	$7,199.80
Rate for Payer: Mclaren Medicaid	$6,856.95
Rate for Payer: Meridian Medicaid	$7,199.80
Rate for Payer: Priority Health Choice Medicaid	$6,856.95
Rate for Payer: UHC Medicaid	$6,856.95
Rate for Payer: UHCCP Medicaid	$6,856.95

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$3,480.01

Service Code	APR-DRG 1971
Min. Negotiated Rate	$3,314.29
Max. Negotiated Rate	$3,480.01
Rate for Payer: BCBS Complete	$3,480.01
Rate for Payer: Mclaren Medicaid	$3,314.29
Rate for Payer: Meridian Medicaid	$3,480.01
Rate for Payer: Priority Health Choice Medicaid	$3,314.29
Rate for Payer: UHC Medicaid	$3,314.29
Rate for Payer: UHCCP Medicaid	$3,314.29

PERIPHERAL AND OTHER VASCULAR DISORDERS

Facility

$10,500.50

Service Code	APR-DRG 1974
Min. Negotiated Rate	$10,000.48
Max. Negotiated Rate	$10,500.50
Rate for Payer: BCBS Complete	$10,500.50
Rate for Payer: Mclaren Medicaid	$10,000.48
Rate for Payer: Meridian Medicaid	$10,500.50
Rate for Payer: Priority Health Choice Medicaid	$10,000.48
Rate for Payer: UHC Medicaid	$10,000.48
Rate for Payer: UHCCP Medicaid	$10,000.48

Know your out-of-pocket cost for care.

All Charges