Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR CBHC REPAIR RECEIVER

Professional

Both

$132.00

Hospital Revenue Code	990
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Medicare	$66.00
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: Cash Price	$105.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$99.00

PR CCIIV3 VACCINE ABX FREE 0.5 ML FOR IM USE

Professional

Both

$44.00

Service Code	HCPCS 90661
Min. Negotiated Rate	$19.94
Max. Negotiated Rate	$43.54
Rate for Payer: Aetna Commercial	$19.94
Rate for Payer: Aetna Medicare	$22.00
Rate for Payer: BCBS Trust/PPO	$43.54
Rate for Payer: BCN Commercial	$31.80
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$33.00

PR CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE

Professional

Both

$70.00

Service Code	HCPCS 90756
Min. Negotiated Rate	$28.52
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Commercial	$32.37
Rate for Payer: Aetna Medicare	$35.00
Rate for Payer: BCBS Trust/PPO	$28.52
Rate for Payer: BCN Commercial	$33.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.50

PR CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE

Professional

Both

$75.00

Service Code	HCPCS 90674
Min. Negotiated Rate	$29.49
Max. Negotiated Rate	$56.25
Rate for Payer: Aetna Commercial	$34.17
Rate for Payer: Aetna Medicare	$37.50
Rate for Payer: BCBS Trust/PPO	$30.10
Rate for Payer: BCN Commercial	$29.49
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$56.25

PR CCM/BHI BY RHC/FQHC 20MIN MO

Professional

Both

$259.00

Service Code	HCPCS G0511
Min. Negotiated Rate	$48.30
Max. Negotiated Rate	$194.25
Rate for Payer: Aetna Commercial	$63.19
Rate for Payer: Aetna Medicare	$129.50
Rate for Payer: BCBS Complete	$103.60
Rate for Payer: BCN Commercial	$48.30
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cash Price	$207.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$194.25

PR CDP-SOT 6 CONDITIONS W/I&R W/MCT & ADT

Professional

Both

$139.00

Service Code	HCPCS 92549
Min. Negotiated Rate	$69.38
Max. Negotiated Rate	$104.25
Rate for Payer: Aetna Commercial	$69.38
Rate for Payer: Aetna Medicare	$69.50
Rate for Payer: BCN Commercial	$96.60
Rate for Payer: Cash Price	$111.20
Rate for Payer: Cash Price	$111.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$104.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.09
Rate for Payer: Priority Health Narrow/Tiered Network	$89.09

PR CEFTRIAXONE SODIUM INJECTION

Professional

Both

$21.00

Service Code	HCPCS J0696
Min. Negotiated Rate	$0.03
Max. Negotiated Rate	$15.75
Rate for Payer: Aetna Commercial	$0.51
Rate for Payer: Aetna Medicare	$10.50
Rate for Payer: BCBS Trust/PPO	$0.03
Rate for Payer: BCN Commercial	$0.03
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.75

PR CERCLAGE CERVIX PREGNANCY VAGINAL

Professional

Both

$756.00

Service Code	HCPCS 59320
Min. Negotiated Rate	$87.54
Max. Negotiated Rate	$567.00
Rate for Payer: Aetna Commercial	$165.15
Rate for Payer: Aetna Medicare	$378.00
Rate for Payer: BCBS Complete	$91.92
Rate for Payer: BCN Commercial	$228.07
Rate for Payer: Cash Price	$604.80
Rate for Payer: Cash Price	$604.80
Rate for Payer: Mclaren Medicaid	$87.54
Rate for Payer: Meridian Medicaid	$91.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$567.00
Rate for Payer: Priority Health Choice Medicaid	$87.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$215.31
Rate for Payer: Priority Health Narrow/Tiered Network	$215.31
Rate for Payer: UHC Medicaid	$87.54
Rate for Payer: UHCCP Medicaid	$87.54

PR CERCLAGE UTERINE CERVIX NONOBSTETRICAL

Professional

Both

$852.00

Service Code	HCPCS 57700
Min. Negotiated Rate	$203.20
Max. Negotiated Rate	$639.00
Rate for Payer: Aetna Commercial	$412.98
Rate for Payer: Aetna Medicare	$426.00
Rate for Payer: BCBS Complete	$213.36
Rate for Payer: BCN Commercial	$534.33
Rate for Payer: Cash Price	$681.60
Rate for Payer: Cash Price	$681.60
Rate for Payer: Mclaren Medicaid	$203.20
Rate for Payer: Meridian Medicaid	$213.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$639.00
Rate for Payer: Priority Health Choice Medicaid	$203.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$541.17
Rate for Payer: Priority Health Narrow/Tiered Network	$541.17
Rate for Payer: UHC Medicaid	$203.20
Rate for Payer: UHCCP Medicaid	$203.20

PR CERTOLIZUMAB PEGOL INJ 1MG

Professional

Both

$10.00

Service Code	HCPCS J0717
Min. Negotiated Rate	$3.93
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.96
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Trust/PPO	$3.93
Rate for Payer: BCN Commercial	$4.05
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50

PR CERV FLEX N/ADJ FOAM PRE OTS

Professional

Both

$28.00

Service Code	HCPCS L0120
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$31.12
Rate for Payer: Aetna Commercial	$15.93
Rate for Payer: Aetna Medicare	$14.00
Rate for Payer: BCBS Complete	$11.20
Rate for Payer: BCN Commercial	$31.12
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$22.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.00

PR CERVICAL CAP CONTRACEPTIVE

Professional

Both

$105.00

Service Code	HCPCS A4261
Min. Negotiated Rate	$26.50
Max. Negotiated Rate	$78.84
Rate for Payer: Aetna Commercial	$26.50
Rate for Payer: Aetna Medicare	$52.50
Rate for Payer: BCBS Complete	$42.00
Rate for Payer: BCN Commercial	$78.84
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.75

PR CERVICAL LYMPHADEC MODIFIED RADICAL NECK DSJ

Professional

Both

$4,115.00

Service Code	HCPCS 38724
Min. Negotiated Rate	$805.14
Max. Negotiated Rate	$3,086.25
Rate for Payer: Aetna Commercial	$1,778.47
Rate for Payer: Aetna Medicare	$2,057.50
Rate for Payer: BCBS Complete	$845.40
Rate for Payer: BCN Commercial	$2,178.67
Rate for Payer: Cash Price	$3,292.00
Rate for Payer: Cash Price	$3,292.00
Rate for Payer: Mclaren Medicaid	$805.14
Rate for Payer: Meridian Medicaid	$845.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,086.25
Rate for Payer: Priority Health Choice Medicaid	$805.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,898.89
Rate for Payer: Priority Health Narrow/Tiered Network	$2,898.89
Rate for Payer: UHC Medicaid	$805.14
Rate for Payer: UHCCP Medicaid	$805.14

PR CERVICAL LYMPHADENECTOMY

Professional

Both

$2,517.00

Service Code	HCPCS 38720
Min. Negotiated Rate	$762.11
Max. Negotiated Rate	$2,688.19
Rate for Payer: Aetna Commercial	$1,646.91
Rate for Payer: Aetna Medicare	$1,258.50
Rate for Payer: BCBS Complete	$800.22
Rate for Payer: BCN Commercial	$2,020.31
Rate for Payer: Cash Price	$2,013.60
Rate for Payer: Cash Price	$2,013.60
Rate for Payer: Mclaren Medicaid	$762.11
Rate for Payer: Meridian Medicaid	$800.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,887.75
Rate for Payer: Priority Health Choice Medicaid	$762.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,688.19
Rate for Payer: Priority Health Narrow/Tiered Network	$2,688.19
Rate for Payer: UHC Medicaid	$762.11
Rate for Payer: UHCCP Medicaid	$762.11

PR CESAREAN DELIVERY ATTEMPTED VBAC

Professional

Both

$2,574.00

Service Code	HCPCS 59620
Min. Negotiated Rate	$821.48
Max. Negotiated Rate	$1,930.50
Rate for Payer: Aetna Commercial	$1,034.69
Rate for Payer: Aetna Medicare	$1,287.00
Rate for Payer: BCBS Complete	$862.55
Rate for Payer: BCN Commercial	$1,674.98
Rate for Payer: Cash Price	$2,059.20
Rate for Payer: Cash Price	$2,059.20
Rate for Payer: Mclaren Medicaid	$821.48
Rate for Payer: Meridian Medicaid	$862.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,930.50
Rate for Payer: Priority Health Choice Medicaid	$821.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,323.31
Rate for Payer: Priority Health Narrow/Tiered Network	$1,323.31
Rate for Payer: UHC Medicaid	$821.48
Rate for Payer: UHCCP Medicaid	$821.48

PR CESAREAN DELIVERY ONLY

Professional

Both

$2,391.00

Service Code	HCPCS 59514
Min. Negotiated Rate	$792.56
Max. Negotiated Rate	$1,793.25
Rate for Payer: Aetna Commercial	$1,001.86
Rate for Payer: Aetna Medicare	$1,195.50
Rate for Payer: BCBS Complete	$832.19
Rate for Payer: BCN Commercial	$1,595.20
Rate for Payer: Cash Price	$1,912.80
Rate for Payer: Cash Price	$1,912.80
Rate for Payer: Mclaren Medicaid	$792.56
Rate for Payer: Meridian Medicaid	$832.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,793.25
Rate for Payer: Priority Health Choice Medicaid	$792.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,279.13
Rate for Payer: Priority Health Narrow/Tiered Network	$1,279.13
Rate for Payer: UHC Medicaid	$792.56
Rate for Payer: UHCCP Medicaid	$792.56

PR CESAREAN DELIVERY ONLY W/POSTPARTUM CARE

Professional

Both

$2,671.00

Service Code	HCPCS 59515
Min. Negotiated Rate	$1,175.02
Max. Negotiated Rate	$2,003.25
Rate for Payer: Aetna Commercial	$1,434.55
Rate for Payer: Aetna Medicare	$1,335.50
Rate for Payer: BCBS Complete	$1,233.77
Rate for Payer: BCN Commercial	$1,851.61
Rate for Payer: Cash Price	$2,136.80
Rate for Payer: Cash Price	$2,136.80
Rate for Payer: Mclaren Medicaid	$1,175.02
Rate for Payer: Meridian Medicaid	$1,233.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,003.25
Rate for Payer: Priority Health Choice Medicaid	$1,175.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,894.48
Rate for Payer: Priority Health Narrow/Tiered Network	$1,894.48
Rate for Payer: UHC Medicaid	$1,175.02
Rate for Payer: UHCCP Medicaid	$1,175.02

PR CESAREAN DLVRY & POSTPARTUM CARE ATTEMPTED VBA

Professional

Both

$2,854.00

Service Code	HCPCS 59622
Min. Negotiated Rate	$1,211.94
Max. Negotiated Rate	$2,140.50
Rate for Payer: Aetna Commercial	$1,484.84
Rate for Payer: Aetna Medicare	$1,427.00
Rate for Payer: BCBS Complete	$1,272.54
Rate for Payer: BCN Commercial	$1,944.19
Rate for Payer: Cash Price	$2,283.20
Rate for Payer: Cash Price	$2,283.20
Rate for Payer: Mclaren Medicaid	$1,211.94
Rate for Payer: Meridian Medicaid	$1,272.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,140.50
Rate for Payer: Priority Health Choice Medicaid	$1,211.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,960.30
Rate for Payer: Priority Health Narrow/Tiered Network	$1,960.30
Rate for Payer: UHC Medicaid	$1,211.94
Rate for Payer: UHCCP Medicaid	$1,211.94

PR CESSATION THROMBOLYTIC THER W/CATHETER REMOVAL

Professional

Both

$254.00

Service Code	HCPCS 37214
Min. Negotiated Rate	$68.37
Max. Negotiated Rate	$192.24
Rate for Payer: Aetna Commercial	$164.52
Rate for Payer: Aetna Medicare	$127.00
Rate for Payer: BCBS Complete	$71.79
Rate for Payer: BCN Commercial	$178.77
Rate for Payer: Cash Price	$203.20
Rate for Payer: Cash Price	$203.20
Rate for Payer: Mclaren Medicaid	$68.37
Rate for Payer: Meridian Medicaid	$71.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$190.50
Rate for Payer: Priority Health Choice Medicaid	$68.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$192.24
Rate for Payer: Priority Health Narrow/Tiered Network	$192.24
Rate for Payer: UHC Medicaid	$68.37
Rate for Payer: UHCCP Medicaid	$68.37

PR CHANGE CYSTOSTOMY TUBE COMPLICATED

Professional

Both

$351.00

Service Code	HCPCS 51710
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$263.25
Rate for Payer: Aetna Commercial	$100.96
Rate for Payer: Aetna Medicare	$175.50
Rate for Payer: BCBS Complete	$48.98
Rate for Payer: BCN Commercial	$119.51
Rate for Payer: Cash Price	$280.80
Rate for Payer: Cash Price	$280.80
Rate for Payer: Mclaren Medicaid	$46.65
Rate for Payer: Meridian Medicaid	$48.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$263.25
Rate for Payer: Priority Health Choice Medicaid	$46.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$130.19
Rate for Payer: Priority Health Narrow/Tiered Network	$130.19
Rate for Payer: UHC Medicaid	$46.65
Rate for Payer: UHCCP Medicaid	$46.65

PR CHANGE CYSTOSTOMY TUBE SIMPLE

Professional

Both

$204.00

Service Code	HCPCS 51705
Min. Negotiated Rate	$30.03
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna Commercial	$65.96
Rate for Payer: Aetna Medicare	$102.00
Rate for Payer: BCBS Complete	$31.53
Rate for Payer: BCN Commercial	$78.18
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cash Price	$163.20
Rate for Payer: Mclaren Medicaid	$30.03
Rate for Payer: Meridian Medicaid	$31.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.00
Rate for Payer: Priority Health Choice Medicaid	$30.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$85.16
Rate for Payer: Priority Health Narrow/Tiered Network	$85.16
Rate for Payer: UHC Medicaid	$30.03
Rate for Payer: UHCCP Medicaid	$30.03

PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE

Facility

$860.00

Service Code	CPT 43760
Hospital Charge Code	43760
Hospital Revenue Code	960
Min. Negotiated Rate	$598.56
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$731.00
Rate for Payer: BCBS Trust/PPO	$710.27
Rate for Payer: BCN Commercial	$710.27
Rate for Payer: Cash Price	$688.00
Rate for Payer: Cofinity Commercial	$739.60
Rate for Payer: Encore Health Key Benefits Commercial	$688.00
Rate for Payer: Healthscope Commercial	$774.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$645.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$731.00
Rate for Payer: Nomi Health Commercial	$705.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$645.00
Rate for Payer: PHP Commercial	$731.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$748.20
Rate for Payer: Priority Health Narrow/Tiered Network	$598.56
Rate for Payer: UHC Core	$718.10
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$645.00

PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE

Facility

$860.00

Service Code	CPT 43760
Hospital Charge Code	43760
Hospital Revenue Code	960
Min. Negotiated Rate	$151.62
Max. Negotiated Rate	$774.00
Rate for Payer: Aetna Commercial	$731.00
Rate for Payer: Aetna Medicare	$223.60
Rate for Payer: Allen County Amish Medical Aid Commercial	$268.75
Rate for Payer: Amish Plain Church Group Commercial	$268.75
Rate for Payer: BCBS Complete	$159.19
Rate for Payer: BCBS MAPPO	$215.00
Rate for Payer: BCBS Trust/PPO	$707.01
Rate for Payer: BCN Commercial	$707.01
Rate for Payer: BCN Medicare Advantage	$215.00
Rate for Payer: Cash Price	$688.00
Rate for Payer: Cofinity Commercial	$739.60
Rate for Payer: Encore Health Key Benefits Commercial	$688.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$215.00
Rate for Payer: Healthscope Commercial	$774.00
Rate for Payer: Lakeland Regional Health Systems Commercial	$645.00
Rate for Payer: Mclaren Medicaid	$151.62
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$225.75
Rate for Payer: Meridian Medicaid	$159.19
Rate for Payer: MI Amish Medical Board Commercial	$247.25
Rate for Payer: Molina Medicare/Medicaid	$236.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$731.00
Rate for Payer: Nomi Health Commercial	$705.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$645.00
Rate for Payer: PACE Senior Care Partners	$204.25
Rate for Payer: PACE SWMI	$215.00
Rate for Payer: PHP Commercial	$731.00
Rate for Payer: PHP Medicare Advantage	$215.00
Rate for Payer: Priority Health Choice Medicaid	$151.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$748.20
Rate for Payer: Priority Health Medicare	$217.15
Rate for Payer: Priority Health Narrow/Tiered Network	$598.56
Rate for Payer: Railroad Medicare Medicare	$215.00
Rate for Payer: UHC Core	$718.10
Rate for Payer: UHC Exchange	$215.00
Rate for Payer: UHC Medicaid	$151.62
Rate for Payer: UHC Medicare Advantage	$215.00
Rate for Payer: UHCCP Medicaid	$151.62
Rate for Payer: VA VA	$215.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$645.00

PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE

Professional

Both

$860.00

Service Code	HCPCS 43760
Min. Negotiated Rate	$344.00
Max. Negotiated Rate	$645.00
Rate for Payer: Aetna Medicare	$430.00
Rate for Payer: BCBS Complete	$344.00
Rate for Payer: Cash Price	$688.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$645.00

PR CHANGE GASTROSTOMY TUBE PERCUTANEOUS W/O GUIDE

Professional

Both

$860.00

Service Code	HCPCS 43760
Hospital Charge Code	43760
Min. Negotiated Rate	$344.00
Max. Negotiated Rate	$645.00
Rate for Payer: Aetna Medicare	$430.00
Rate for Payer: BCBS Complete	$344.00
Rate for Payer: Cash Price	$688.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$645.00

Know your out-of-pocket cost for care.

All Charges