Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR COLLJ & INTERPJ PHYSIOL DATA MIN 30 MIN EA 30 D

Professional

Both

$121.00

Service Code	HCPCS 99091
Min. Negotiated Rate	$48.40
Max. Negotiated Rate	$90.75
Rate for Payer: Aetna Commercial	$62.02
Rate for Payer: Aetna Medicare	$60.50
Rate for Payer: BCBS Complete	$48.40
Rate for Payer: BCN Commercial	$79.68
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$96.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$90.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$73.47
Rate for Payer: Priority Health Narrow/Tiered Network	$73.47

PR COLON CA SCREEN;BARIUM ENEMA

Professional

Both

$648.00

Service Code	HCPCS G0106
Min. Negotiated Rate	$220.17
Max. Negotiated Rate	$486.00
Rate for Payer: Aetna Commercial	$220.17
Rate for Payer: Aetna Medicare	$324.00
Rate for Payer: BCBS Complete	$259.20
Rate for Payer: BCN Commercial	$255.24
Rate for Payer: Cash Price	$518.40
Rate for Payer: Cash Price	$518.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$486.00

PR COLON CA SCRN; BARIUM ENEMA

Professional

Both

$411.00

Service Code	HCPCS G0120
Min. Negotiated Rate	$164.40
Max. Negotiated Rate	$308.25
Rate for Payer: Aetna Commercial	$220.17
Rate for Payer: Aetna Medicare	$205.50
Rate for Payer: BCBS Complete	$164.40
Rate for Payer: BCN Commercial	$255.24
Rate for Payer: Cash Price	$328.80
Rate for Payer: Cash Price	$328.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$308.25

PR COLON CA SCRN NOT HI RSK IND

Facility

$1,221.00

Service Code	HCPCS G0121
Hospital Charge Code	G0121
Hospital Revenue Code	960
Min. Negotiated Rate	$215.26
Max. Negotiated Rate	$1,098.90
Rate for Payer: Aetna Commercial	$1,037.85
Rate for Payer: Aetna Medicare	$317.46
Rate for Payer: Allen County Amish Medical Aid Commercial	$381.56
Rate for Payer: Amish Plain Church Group Commercial	$381.56
Rate for Payer: BCBS Complete	$226.01
Rate for Payer: BCBS MAPPO	$305.25
Rate for Payer: BCBS Trust/PPO	$1,003.78
Rate for Payer: BCN Commercial	$1,003.78
Rate for Payer: BCN Medicare Advantage	$305.25
Rate for Payer: Cash Price	$976.80
Rate for Payer: Cofinity Commercial	$1,050.06
Rate for Payer: Encore Health Key Benefits Commercial	$976.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$305.25
Rate for Payer: Healthscope Commercial	$1,098.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$915.75
Rate for Payer: Mclaren Medicaid	$215.26
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$320.51
Rate for Payer: Meridian Medicaid	$226.01
Rate for Payer: MI Amish Medical Board Commercial	$351.04
Rate for Payer: Molina Medicare/Medicaid	$335.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,037.85
Rate for Payer: Nomi Health Commercial	$1,001.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$915.75
Rate for Payer: PACE Senior Care Partners	$289.99
Rate for Payer: PACE SWMI	$305.25
Rate for Payer: PHP Commercial	$1,037.85
Rate for Payer: PHP Medicare Advantage	$305.25
Rate for Payer: Priority Health Choice Medicaid	$215.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,062.27
Rate for Payer: Priority Health Medicare	$308.30
Rate for Payer: Priority Health Narrow/Tiered Network	$849.82
Rate for Payer: Railroad Medicare Medicare	$305.25
Rate for Payer: UHC Core	$1,019.53
Rate for Payer: UHC Exchange	$305.25
Rate for Payer: UHC Medicaid	$215.26
Rate for Payer: UHC Medicare Advantage	$305.25
Rate for Payer: UHCCP Medicaid	$215.26
Rate for Payer: VA VA	$305.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$915.75

PR COLON CA SCRN NOT HI RSK IND

Professional

Both

$1,221.00

Service Code	HCPCS G0121
Min. Negotiated Rate	$105.22
Max. Negotiated Rate	$915.75
Rate for Payer: Aetna Commercial	$184.92
Rate for Payer: Aetna Medicare	$610.50
Rate for Payer: BCBS Complete	$110.48
Rate for Payer: BCN Commercial	$273.39
Rate for Payer: Cash Price	$976.80
Rate for Payer: Cash Price	$976.80
Rate for Payer: Mclaren Medicaid	$105.22
Rate for Payer: Meridian Medicaid	$110.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$915.75
Rate for Payer: Priority Health Choice Medicaid	$105.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$333.11
Rate for Payer: Priority Health Narrow/Tiered Network	$333.11
Rate for Payer: UHC Medicaid	$105.22
Rate for Payer: UHCCP Medicaid	$105.22

PR COLON CA SCRN NOT HI RSK IND

Facility

$1,221.00

Service Code	HCPCS G0121
Hospital Charge Code	G0121
Hospital Revenue Code	960
Min. Negotiated Rate	$849.82
Max. Negotiated Rate	$1,098.90
Rate for Payer: Aetna Commercial	$1,037.85
Rate for Payer: BCBS Trust/PPO	$1,008.42
Rate for Payer: BCN Commercial	$1,008.42
Rate for Payer: Cash Price	$976.80
Rate for Payer: Cofinity Commercial	$1,050.06
Rate for Payer: Encore Health Key Benefits Commercial	$976.80
Rate for Payer: Healthscope Commercial	$1,098.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$915.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,037.85
Rate for Payer: Nomi Health Commercial	$1,001.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$915.75
Rate for Payer: PHP Commercial	$1,037.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,062.27
Rate for Payer: Priority Health Narrow/Tiered Network	$849.82
Rate for Payer: UHC Core	$1,019.53
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$915.75

PR COLON CA SCRN NOT HI RSK IND

Professional

Both

$1,221.00

Service Code	HCPCS G0121
Hospital Charge Code	G0121
Min. Negotiated Rate	$105.22
Max. Negotiated Rate	$915.75
Rate for Payer: Aetna Commercial	$184.92
Rate for Payer: Aetna Medicare	$610.50
Rate for Payer: BCBS Complete	$110.48
Rate for Payer: BCN Commercial	$273.39
Rate for Payer: Cash Price	$976.80
Rate for Payer: Cash Price	$976.80
Rate for Payer: Mclaren Medicaid	$105.22
Rate for Payer: Meridian Medicaid	$110.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$915.75
Rate for Payer: Priority Health Choice Medicaid	$105.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$333.11
Rate for Payer: Priority Health Narrow/Tiered Network	$333.11
Rate for Payer: UHC Medicaid	$105.22
Rate for Payer: UHCCP Medicaid	$105.22

PR COLON MOTILITY STDY MIN 6 HR CONT RECORD W/I&R

Professional

Both

$474.00

Service Code	HCPCS 91117
Min. Negotiated Rate	$77.75
Max. Negotiated Rate	$355.50
Rate for Payer: Aetna Commercial	$149.90
Rate for Payer: Aetna Medicare	$237.00
Rate for Payer: BCBS Complete	$81.64
Rate for Payer: BCN Commercial	$200.69
Rate for Payer: Cash Price	$379.20
Rate for Payer: Cash Price	$379.20
Rate for Payer: Mclaren Medicaid	$77.75
Rate for Payer: Meridian Medicaid	$81.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$355.50
Rate for Payer: Priority Health Choice Medicaid	$77.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$185.08
Rate for Payer: Priority Health Narrow/Tiered Network	$185.08
Rate for Payer: UHC Medicaid	$77.75
Rate for Payer: UHCCP Medicaid	$77.75

PR COLONOSCOPY,ABLATE LESION

Facility

$1,558.00

Service Code	CPT 45383
Hospital Charge Code	45383
Hospital Revenue Code	960
Min. Negotiated Rate	$1,084.37
Max. Negotiated Rate	$1,402.20
Rate for Payer: Aetna Commercial	$1,324.30
Rate for Payer: BCBS Trust/PPO	$1,286.75
Rate for Payer: BCN Commercial	$1,286.75
Rate for Payer: Cash Price	$1,246.40
Rate for Payer: Cofinity Commercial	$1,339.88
Rate for Payer: Encore Health Key Benefits Commercial	$1,246.40
Rate for Payer: Healthscope Commercial	$1,402.20
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,168.50
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,324.30
Rate for Payer: Nomi Health Commercial	$1,277.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,168.50
Rate for Payer: PHP Commercial	$1,324.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,355.46
Rate for Payer: Priority Health Narrow/Tiered Network	$1,084.37
Rate for Payer: UHC Core	$1,300.93
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,168.50

PR COLONOSCOPY,ABLATE LESION

Professional

Both

$1,558.00

Service Code	HCPCS 45383
Min. Negotiated Rate	$623.20
Max. Negotiated Rate	$1,168.50
Rate for Payer: Aetna Medicare	$779.00
Rate for Payer: BCBS Complete	$623.20
Rate for Payer: Cash Price	$1,246.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,168.50

PR COLONOSCOPY,ABLATE LESION

Professional

Both

$1,558.00

Service Code	HCPCS 45383
Hospital Charge Code	45383
Min. Negotiated Rate	$623.20
Max. Negotiated Rate	$1,168.50
Rate for Payer: Aetna Medicare	$779.00
Rate for Payer: BCBS Complete	$623.20
Rate for Payer: Cash Price	$1,246.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,168.50

PR COLONOSCOPY,ABLATE LESION

Facility

$1,558.00

Service Code	CPT 45383
Hospital Charge Code	45383
Hospital Revenue Code	960
Min. Negotiated Rate	$274.68
Max. Negotiated Rate	$1,402.20
Rate for Payer: Aetna Commercial	$1,324.30
Rate for Payer: Aetna Medicare	$405.08
Rate for Payer: Allen County Amish Medical Aid Commercial	$486.88
Rate for Payer: Amish Plain Church Group Commercial	$486.88
Rate for Payer: BCBS Complete	$288.39
Rate for Payer: BCBS MAPPO	$389.50
Rate for Payer: BCBS Trust/PPO	$1,280.83
Rate for Payer: BCN Commercial	$1,280.83
Rate for Payer: BCN Medicare Advantage	$389.50
Rate for Payer: Cash Price	$1,246.40
Rate for Payer: Cofinity Commercial	$1,339.88
Rate for Payer: Encore Health Key Benefits Commercial	$1,246.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$389.50
Rate for Payer: Healthscope Commercial	$1,402.20
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,168.50
Rate for Payer: Mclaren Medicaid	$274.68
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$408.98
Rate for Payer: Meridian Medicaid	$288.39
Rate for Payer: MI Amish Medical Board Commercial	$447.93
Rate for Payer: Molina Medicare/Medicaid	$428.45
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,324.30
Rate for Payer: Nomi Health Commercial	$1,277.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,168.50
Rate for Payer: PACE Senior Care Partners	$370.02
Rate for Payer: PACE SWMI	$389.50
Rate for Payer: PHP Commercial	$1,324.30
Rate for Payer: PHP Medicare Advantage	$389.50
Rate for Payer: Priority Health Choice Medicaid	$274.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,355.46
Rate for Payer: Priority Health Medicare	$393.39
Rate for Payer: Priority Health Narrow/Tiered Network	$1,084.37
Rate for Payer: Railroad Medicare Medicare	$389.50
Rate for Payer: UHC Core	$1,300.93
Rate for Payer: UHC Exchange	$389.50
Rate for Payer: UHC Medicaid	$274.68
Rate for Payer: UHC Medicare Advantage	$389.50
Rate for Payer: UHCCP Medicaid	$274.68
Rate for Payer: VA VA	$389.50
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,168.50

PR COLONOSCOPY FLEXIBLE WITH BAND LIGATION(S)

Professional

Both

$1,352.00

Service Code	HCPCS 45398
Min. Negotiated Rate	$133.55
Max. Negotiated Rate	$1,014.00
Rate for Payer: Aetna Commercial	$313.45
Rate for Payer: Aetna Medicare	$676.00
Rate for Payer: BCBS Complete	$140.23
Rate for Payer: BCN Commercial	$347.09
Rate for Payer: Cash Price	$1,081.60
Rate for Payer: Cash Price	$1,081.60
Rate for Payer: Mclaren Medicaid	$133.55
Rate for Payer: Meridian Medicaid	$140.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,014.00
Rate for Payer: Priority Health Choice Medicaid	$133.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$422.92
Rate for Payer: Priority Health Narrow/Tiered Network	$422.92
Rate for Payer: UHC Medicaid	$133.55
Rate for Payer: UHCCP Medicaid	$133.55

PR COLONOSCOPY FLEXIBLE WITH DECOMPRESSION

Professional

Both

$836.00

Service Code	HCPCS 45393
Min. Negotiated Rate	$139.30
Max. Negotiated Rate	$627.00
Rate for Payer: Aetna Commercial	$337.78
Rate for Payer: Aetna Medicare	$418.00
Rate for Payer: BCBS Complete	$146.26
Rate for Payer: BCN Commercial	$369.50
Rate for Payer: Cash Price	$668.80
Rate for Payer: Cash Price	$668.80
Rate for Payer: Mclaren Medicaid	$139.30
Rate for Payer: Meridian Medicaid	$146.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$627.00
Rate for Payer: Priority Health Choice Medicaid	$139.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$450.21
Rate for Payer: Priority Health Narrow/Tiered Network	$450.21
Rate for Payer: UHC Medicaid	$139.30
Rate for Payer: UHCCP Medicaid	$139.30

PR COLONOSCOPY FLX ABLATION TUMOR POLYP/OTHER LES

Professional

Both

$1,632.00

Service Code	HCPCS 45388
Min. Negotiated Rate	$152.08
Max. Negotiated Rate	$1,224.00
Rate for Payer: Aetna Commercial	$360.51
Rate for Payer: Aetna Medicare	$816.00
Rate for Payer: BCBS Complete	$159.68
Rate for Payer: BCN Commercial	$397.89
Rate for Payer: Cash Price	$1,305.60
Rate for Payer: Cash Price	$1,305.60
Rate for Payer: Mclaren Medicaid	$152.08
Rate for Payer: Meridian Medicaid	$159.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,224.00
Rate for Payer: Priority Health Choice Medicaid	$152.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$484.80
Rate for Payer: Priority Health Narrow/Tiered Network	$484.80
Rate for Payer: UHC Medicaid	$152.08
Rate for Payer: UHCCP Medicaid	$152.08

PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD

Professional

Both

$1,053.00

Service Code	HCPCS 45378
Hospital Charge Code	45378
Min. Negotiated Rate	$105.01
Max. Negotiated Rate	$789.75
Rate for Payer: Aetna Commercial	$246.71
Rate for Payer: Aetna Medicare	$526.50
Rate for Payer: BCBS Complete	$110.26
Rate for Payer: BCN Commercial	$272.89
Rate for Payer: Cash Price	$842.40
Rate for Payer: Cash Price	$842.40
Rate for Payer: Mclaren Medicaid	$105.01
Rate for Payer: Meridian Medicaid	$110.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$789.75
Rate for Payer: Priority Health Choice Medicaid	$105.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$332.51
Rate for Payer: Priority Health Narrow/Tiered Network	$332.51
Rate for Payer: UHC Medicaid	$105.01
Rate for Payer: UHCCP Medicaid	$105.01

PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD

Facility

$1,053.00

Service Code	CPT 45378
Hospital Charge Code	45378
Hospital Revenue Code	960
Min. Negotiated Rate	$732.89
Max. Negotiated Rate	$947.70
Rate for Payer: Aetna Commercial	$895.05
Rate for Payer: BCBS Trust/PPO	$869.67
Rate for Payer: BCN Commercial	$869.67
Rate for Payer: Cash Price	$842.40
Rate for Payer: Cofinity Commercial	$905.58
Rate for Payer: Encore Health Key Benefits Commercial	$842.40
Rate for Payer: Healthscope Commercial	$947.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$789.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$895.05
Rate for Payer: Nomi Health Commercial	$863.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$789.75
Rate for Payer: PHP Commercial	$895.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$916.11
Rate for Payer: Priority Health Narrow/Tiered Network	$732.89
Rate for Payer: UHC Core	$879.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$789.75

PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD

Facility

$1,053.00

Service Code	CPT 45378
Hospital Charge Code	45378
Hospital Revenue Code	960
Min. Negotiated Rate	$185.64
Max. Negotiated Rate	$947.70
Rate for Payer: Aetna Commercial	$895.05
Rate for Payer: Aetna Medicare	$273.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$329.06
Rate for Payer: Amish Plain Church Group Commercial	$329.06
Rate for Payer: BCBS Complete	$194.91
Rate for Payer: BCBS MAPPO	$263.25
Rate for Payer: BCBS Trust/PPO	$865.67
Rate for Payer: BCN Commercial	$865.67
Rate for Payer: BCN Medicare Advantage	$263.25
Rate for Payer: Cash Price	$842.40
Rate for Payer: Cofinity Commercial	$905.58
Rate for Payer: Encore Health Key Benefits Commercial	$842.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$263.25
Rate for Payer: Healthscope Commercial	$947.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$789.75
Rate for Payer: Mclaren Medicaid	$185.64
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$276.41
Rate for Payer: Meridian Medicaid	$194.91
Rate for Payer: MI Amish Medical Board Commercial	$302.74
Rate for Payer: Molina Medicare/Medicaid	$289.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$895.05
Rate for Payer: Nomi Health Commercial	$863.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$789.75
Rate for Payer: PACE Senior Care Partners	$250.09
Rate for Payer: PACE SWMI	$263.25
Rate for Payer: PHP Commercial	$895.05
Rate for Payer: PHP Medicare Advantage	$263.25
Rate for Payer: Priority Health Choice Medicaid	$185.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$916.11
Rate for Payer: Priority Health Medicare	$265.88
Rate for Payer: Priority Health Narrow/Tiered Network	$732.89
Rate for Payer: Railroad Medicare Medicare	$263.25
Rate for Payer: UHC Core	$879.25
Rate for Payer: UHC Exchange	$263.25
Rate for Payer: UHC Medicaid	$185.64
Rate for Payer: UHC Medicare Advantage	$263.25
Rate for Payer: UHCCP Medicaid	$185.64
Rate for Payer: VA VA	$263.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$789.75

PR COLONOSCOPY FLX DX W/COLLJ SPEC WHEN PFRMD

Professional

Both

$1,053.00

Service Code	HCPCS 45378
Min. Negotiated Rate	$105.01
Max. Negotiated Rate	$789.75
Rate for Payer: Aetna Commercial	$246.71
Rate for Payer: Aetna Medicare	$526.50
Rate for Payer: BCBS Complete	$110.26
Rate for Payer: BCN Commercial	$272.89
Rate for Payer: Cash Price	$842.40
Rate for Payer: Cash Price	$842.40
Rate for Payer: Mclaren Medicaid	$105.01
Rate for Payer: Meridian Medicaid	$110.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$789.75
Rate for Payer: Priority Health Choice Medicaid	$105.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$332.51
Rate for Payer: Priority Health Narrow/Tiered Network	$332.51
Rate for Payer: UHC Medicaid	$105.01
Rate for Payer: UHCCP Medicaid	$105.01

PR COLONOSCOPY FLX W/ENDOSCOPIC MUCOSAL RESECTION

Professional

Both

$1,053.00

Service Code	HCPCS 45390
Min. Negotiated Rate	$185.10
Max. Negotiated Rate	$789.75
Rate for Payer: Aetna Commercial	$441.91
Rate for Payer: Aetna Medicare	$526.50
Rate for Payer: BCBS Complete	$194.35
Rate for Payer: BCN Commercial	$488.02
Rate for Payer: Cash Price	$842.40
Rate for Payer: Cash Price	$842.40
Rate for Payer: Mclaren Medicaid	$185.10
Rate for Payer: Meridian Medicaid	$194.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$789.75
Rate for Payer: Priority Health Choice Medicaid	$185.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$594.63
Rate for Payer: Priority Health Narrow/Tiered Network	$594.63
Rate for Payer: UHC Medicaid	$185.10
Rate for Payer: UHCCP Medicaid	$185.10

PR COLONOSCOPY FLX WITH ENDOSCOPIC STENT PLACEMENT

Professional

Both

$906.00

Service Code	HCPCS 45389
Min. Negotiated Rate	$161.45
Max. Negotiated Rate	$679.50
Rate for Payer: Aetna Commercial	$385.62
Rate for Payer: Aetna Medicare	$453.00
Rate for Payer: BCBS Complete	$169.52
Rate for Payer: BCN Commercial	$425.28
Rate for Payer: Cash Price	$724.80
Rate for Payer: Cash Price	$724.80
Rate for Payer: Mclaren Medicaid	$161.45
Rate for Payer: Meridian Medicaid	$169.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$679.50
Rate for Payer: Priority Health Choice Medicaid	$161.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$518.17
Rate for Payer: Priority Health Narrow/Tiered Network	$518.17
Rate for Payer: UHC Medicaid	$161.45
Rate for Payer: UHCCP Medicaid	$161.45

PR COLONOSCOPY FLX W/REMOVAL OF FOREIGN BODY(S)

Professional

Both

$1,228.00

Service Code	HCPCS 45379
Hospital Charge Code	45379
Min. Negotiated Rate	$133.98
Max. Negotiated Rate	$921.00
Rate for Payer: Aetna Commercial	$317.33
Rate for Payer: Aetna Medicare	$614.00
Rate for Payer: BCBS Complete	$140.68
Rate for Payer: BCN Commercial	$351.07
Rate for Payer: Cash Price	$982.40
Rate for Payer: Cash Price	$982.40
Rate for Payer: Mclaren Medicaid	$133.98
Rate for Payer: Meridian Medicaid	$140.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$921.00
Rate for Payer: Priority Health Choice Medicaid	$133.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$427.76
Rate for Payer: Priority Health Narrow/Tiered Network	$427.76
Rate for Payer: UHC Medicaid	$133.98
Rate for Payer: UHCCP Medicaid	$133.98

PR COLONOSCOPY FLX W/REMOVAL OF FOREIGN BODY(S)

Facility

$1,228.00

Service Code	CPT 45379
Hospital Charge Code	45379
Hospital Revenue Code	960
Min. Negotiated Rate	$854.69
Max. Negotiated Rate	$1,105.20
Rate for Payer: Aetna Commercial	$1,043.80
Rate for Payer: BCBS Trust/PPO	$1,014.21
Rate for Payer: BCN Commercial	$1,014.21
Rate for Payer: Cash Price	$982.40
Rate for Payer: Cofinity Commercial	$1,056.08
Rate for Payer: Encore Health Key Benefits Commercial	$982.40
Rate for Payer: Healthscope Commercial	$1,105.20
Rate for Payer: Lakeland Regional Health Systems Commercial	$921.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,043.80
Rate for Payer: Nomi Health Commercial	$1,006.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$921.00
Rate for Payer: PHP Commercial	$1,043.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,068.36
Rate for Payer: Priority Health Narrow/Tiered Network	$854.69
Rate for Payer: UHC Core	$1,025.38
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$921.00

PR COLONOSCOPY FLX W/REMOVAL OF FOREIGN BODY(S)

Facility

$1,228.00

Service Code	CPT 45379
Hospital Charge Code	45379
Hospital Revenue Code	960
Min. Negotiated Rate	$216.50
Max. Negotiated Rate	$1,105.20
Rate for Payer: Aetna Commercial	$1,043.80
Rate for Payer: Aetna Medicare	$319.28
Rate for Payer: Allen County Amish Medical Aid Commercial	$383.75
Rate for Payer: Amish Plain Church Group Commercial	$383.75
Rate for Payer: BCBS Complete	$227.30
Rate for Payer: BCBS MAPPO	$307.00
Rate for Payer: BCBS Trust/PPO	$1,009.54
Rate for Payer: BCN Commercial	$1,009.54
Rate for Payer: BCN Medicare Advantage	$307.00
Rate for Payer: Cash Price	$982.40
Rate for Payer: Cofinity Commercial	$1,056.08
Rate for Payer: Encore Health Key Benefits Commercial	$982.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$307.00
Rate for Payer: Healthscope Commercial	$1,105.20
Rate for Payer: Lakeland Regional Health Systems Commercial	$921.00
Rate for Payer: Mclaren Medicaid	$216.50
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$322.35
Rate for Payer: Meridian Medicaid	$227.30
Rate for Payer: MI Amish Medical Board Commercial	$353.05
Rate for Payer: Molina Medicare/Medicaid	$337.70
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,043.80
Rate for Payer: Nomi Health Commercial	$1,006.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$921.00
Rate for Payer: PACE Senior Care Partners	$291.65
Rate for Payer: PACE SWMI	$307.00
Rate for Payer: PHP Commercial	$1,043.80
Rate for Payer: PHP Medicare Advantage	$307.00
Rate for Payer: Priority Health Choice Medicaid	$216.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,068.36
Rate for Payer: Priority Health Medicare	$310.07
Rate for Payer: Priority Health Narrow/Tiered Network	$854.69
Rate for Payer: Railroad Medicare Medicare	$307.00
Rate for Payer: UHC Core	$1,025.38
Rate for Payer: UHC Exchange	$307.00
Rate for Payer: UHC Medicaid	$216.50
Rate for Payer: UHC Medicare Advantage	$307.00
Rate for Payer: UHCCP Medicaid	$216.50
Rate for Payer: VA VA	$307.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$921.00

PR COLONOSCOPY FLX W/REMOVAL OF FOREIGN BODY(S)

Professional

Both

$1,228.00

Service Code	HCPCS 45379
Min. Negotiated Rate	$133.98
Max. Negotiated Rate	$921.00
Rate for Payer: Aetna Commercial	$317.33
Rate for Payer: Aetna Medicare	$614.00
Rate for Payer: BCBS Complete	$140.68
Rate for Payer: BCN Commercial	$351.07
Rate for Payer: Cash Price	$982.40
Rate for Payer: Cash Price	$982.40
Rate for Payer: Mclaren Medicaid	$133.98
Rate for Payer: Meridian Medicaid	$140.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$921.00
Rate for Payer: Priority Health Choice Medicaid	$133.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$427.76
Rate for Payer: Priority Health Narrow/Tiered Network	$427.76
Rate for Payer: UHC Medicaid	$133.98
Rate for Payer: UHCCP Medicaid	$133.98

Know your out-of-pocket cost for care.

All Charges