Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR COLONOSCOPY STOMA ABLATION LESION

Professional

Both

$1,254.00

Service Code	HCPCS 44401
Min. Negotiated Rate	$135.89
Max. Negotiated Rate	$940.50
Rate for Payer: Aetna Commercial	$321.78
Rate for Payer: Aetna Medicare	$627.00
Rate for Payer: BCBS Complete	$142.68
Rate for Payer: BCN Commercial	$356.06
Rate for Payer: Cash Price	$1,003.20
Rate for Payer: Cash Price	$1,003.20
Rate for Payer: Mclaren Medicaid	$135.89
Rate for Payer: Meridian Medicaid	$142.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$940.50
Rate for Payer: Priority Health Choice Medicaid	$135.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$433.84
Rate for Payer: Priority Health Narrow/Tiered Network	$433.84
Rate for Payer: UHC Medicaid	$135.89
Rate for Payer: UHCCP Medicaid	$135.89

PR COLONOSCOPY STOMA CONTROL BLEEDING

Professional

Both

$1,652.00

Service Code	HCPCS 44391
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$1,239.00
Rate for Payer: Aetna Commercial	$306.27
Rate for Payer: Aetna Medicare	$826.00
Rate for Payer: BCBS Complete	$135.97
Rate for Payer: BCN Commercial	$338.63
Rate for Payer: Cash Price	$1,321.60
Rate for Payer: Cash Price	$1,321.60
Rate for Payer: Mclaren Medicaid	$129.50
Rate for Payer: Meridian Medicaid	$135.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,239.00
Rate for Payer: Priority Health Choice Medicaid	$129.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$412.60
Rate for Payer: Priority Health Narrow/Tiered Network	$412.60
Rate for Payer: UHC Medicaid	$129.50
Rate for Payer: UHCCP Medicaid	$129.50

PR COLONOSCOPY STOMA DX INCLUDING COLLJ SPEC SPX

Professional

Both

$1,039.00

Service Code	HCPCS 44388
Min. Negotiated Rate	$89.89
Max. Negotiated Rate	$779.25
Rate for Payer: Aetna Commercial	$208.34
Rate for Payer: Aetna Medicare	$519.50
Rate for Payer: BCBS Complete	$94.38
Rate for Payer: BCN Commercial	$231.56
Rate for Payer: Cash Price	$831.20
Rate for Payer: Cash Price	$831.20
Rate for Payer: Mclaren Medicaid	$89.89
Rate for Payer: Meridian Medicaid	$94.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$779.25
Rate for Payer: Priority Health Choice Medicaid	$89.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$282.14
Rate for Payer: Priority Health Narrow/Tiered Network	$282.14
Rate for Payer: UHC Medicaid	$89.89
Rate for Payer: UHCCP Medicaid	$89.89

PR COLONOSCOPY STOMA RMVL LES BY HOT BIOPSY FORCEPS

Professional

Both

$1,412.00

Service Code	HCPCS 44392
Min. Negotiated Rate	$114.59
Max. Negotiated Rate	$1,059.00
Rate for Payer: Aetna Commercial	$264.41
Rate for Payer: Aetna Medicare	$706.00
Rate for Payer: BCBS Complete	$120.32
Rate for Payer: BCN Commercial	$295.80
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Mclaren Medicaid	$114.59
Rate for Payer: Meridian Medicaid	$120.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,059.00
Rate for Payer: Priority Health Choice Medicaid	$114.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$360.42
Rate for Payer: Priority Health Narrow/Tiered Network	$360.42
Rate for Payer: UHC Medicaid	$114.59
Rate for Payer: UHCCP Medicaid	$114.59

PR COLONOSCOPY STOMA W/BALLOON DILATION

Professional

Both

$1,083.00

Service Code	HCPCS 44405
Min. Negotiated Rate	$103.73
Max. Negotiated Rate	$812.25
Rate for Payer: Aetna Commercial	$242.93
Rate for Payer: Aetna Medicare	$541.50
Rate for Payer: BCBS Complete	$108.92
Rate for Payer: BCN Commercial	$270.40
Rate for Payer: Cash Price	$866.40
Rate for Payer: Cash Price	$866.40
Rate for Payer: Mclaren Medicaid	$103.73
Rate for Payer: Meridian Medicaid	$108.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$812.25
Rate for Payer: Priority Health Choice Medicaid	$103.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$329.47
Rate for Payer: Priority Health Narrow/Tiered Network	$329.47
Rate for Payer: UHC Medicaid	$103.73
Rate for Payer: UHCCP Medicaid	$103.73

PR COLONOSCOPY STOMA W/BIOPSY SINGLE/MULTIPLE

Professional

Both

$1,205.00

Service Code	HCPCS 44389
Min. Negotiated Rate	$97.98
Max. Negotiated Rate	$903.75
Rate for Payer: Aetna Commercial	$228.87
Rate for Payer: Aetna Medicare	$602.50
Rate for Payer: BCBS Complete	$102.88
Rate for Payer: BCN Commercial	$253.97
Rate for Payer: Cash Price	$964.00
Rate for Payer: Cash Price	$964.00
Rate for Payer: Mclaren Medicaid	$97.98
Rate for Payer: Meridian Medicaid	$102.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$903.75
Rate for Payer: Priority Health Choice Medicaid	$97.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$309.45
Rate for Payer: Priority Health Narrow/Tiered Network	$309.45
Rate for Payer: UHC Medicaid	$97.98
Rate for Payer: UHCCP Medicaid	$97.98

PR COLONOSCOPY STOMA W/ENDOSCOPIC MUCOSAL RESCJ

Professional

Both

$1,082.00

Service Code	HCPCS 44403
Min. Negotiated Rate	$169.55
Max. Negotiated Rate	$811.50
Rate for Payer: Aetna Commercial	$404.30
Rate for Payer: Aetna Medicare	$541.00
Rate for Payer: BCBS Complete	$178.03
Rate for Payer: BCN Commercial	$446.19
Rate for Payer: Cash Price	$865.60
Rate for Payer: Cash Price	$865.60
Rate for Payer: Mclaren Medicaid	$169.55
Rate for Payer: Meridian Medicaid	$178.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$811.50
Rate for Payer: Priority Health Choice Medicaid	$169.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$543.65
Rate for Payer: Priority Health Narrow/Tiered Network	$543.65
Rate for Payer: UHC Medicaid	$169.55
Rate for Payer: UHCCP Medicaid	$169.55

PR COLONOSCOPY STOMA W/ENDOSCOPIC STENT PLCMT

Professional

Both

$569.00

Service Code	HCPCS 44402
Min. Negotiated Rate	$146.12
Max. Negotiated Rate	$467.81
Rate for Payer: Aetna Commercial	$346.99
Rate for Payer: Aetna Medicare	$284.50
Rate for Payer: BCBS Complete	$153.43
Rate for Payer: BCN Commercial	$383.94
Rate for Payer: Cash Price	$455.20
Rate for Payer: Cash Price	$455.20
Rate for Payer: Mclaren Medicaid	$146.12
Rate for Payer: Meridian Medicaid	$153.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$426.75
Rate for Payer: Priority Health Choice Medicaid	$146.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$467.81
Rate for Payer: Priority Health Narrow/Tiered Network	$467.81
Rate for Payer: UHC Medicaid	$146.12
Rate for Payer: UHCCP Medicaid	$146.12

PR COLONOSCOPY STOMA W/RMVL FOREIGN BODY

Professional

Both

$1,205.00

Service Code	HCPCS 44390
Min. Negotiated Rate	$118.43
Max. Negotiated Rate	$903.75
Rate for Payer: Aetna Commercial	$279.62
Rate for Payer: Aetna Medicare	$602.50
Rate for Payer: BCBS Complete	$124.35
Rate for Payer: BCN Commercial	$310.74
Rate for Payer: Cash Price	$964.00
Rate for Payer: Cash Price	$964.00
Rate for Payer: Mclaren Medicaid	$118.43
Rate for Payer: Meridian Medicaid	$124.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$903.75
Rate for Payer: Priority Health Choice Medicaid	$118.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$378.61
Rate for Payer: Priority Health Narrow/Tiered Network	$378.61
Rate for Payer: UHC Medicaid	$118.43
Rate for Payer: UHCCP Medicaid	$118.43

PR COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE

Facility

$1,412.00

Service Code	CPT 44394
Hospital Charge Code	44394
Hospital Revenue Code	960
Min. Negotiated Rate	$982.75
Max. Negotiated Rate	$1,270.80
Rate for Payer: Aetna Commercial	$1,200.20
Rate for Payer: BCBS Trust/PPO	$1,166.17
Rate for Payer: BCN Commercial	$1,166.17
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Cofinity Commercial	$1,214.32
Rate for Payer: Encore Health Key Benefits Commercial	$1,129.60
Rate for Payer: Healthscope Commercial	$1,270.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,059.00
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,200.20
Rate for Payer: Nomi Health Commercial	$1,157.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,059.00
Rate for Payer: PHP Commercial	$1,200.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,228.44
Rate for Payer: Priority Health Narrow/Tiered Network	$982.75
Rate for Payer: UHC Core	$1,179.02
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,059.00

PR COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE

Professional

Both

$1,412.00

Service Code	HCPCS 44394
Hospital Charge Code	44394
Min. Negotiated Rate	$127.37
Max. Negotiated Rate	$1,059.00
Rate for Payer: Aetna Commercial	$299.55
Rate for Payer: Aetna Medicare	$706.00
Rate for Payer: BCBS Complete	$133.74
Rate for Payer: BCN Commercial	$332.15
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Mclaren Medicaid	$127.37
Rate for Payer: Meridian Medicaid	$133.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,059.00
Rate for Payer: Priority Health Choice Medicaid	$127.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$404.71
Rate for Payer: Priority Health Narrow/Tiered Network	$404.71
Rate for Payer: UHC Medicaid	$127.37
Rate for Payer: UHCCP Medicaid	$127.37

PR COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE

Facility

$1,412.00

Service Code	CPT 44394
Hospital Charge Code	44394
Hospital Revenue Code	960
Min. Negotiated Rate	$248.94
Max. Negotiated Rate	$1,270.80
Rate for Payer: Aetna Commercial	$1,200.20
Rate for Payer: Aetna Medicare	$367.12
Rate for Payer: Allen County Amish Medical Aid Commercial	$441.25
Rate for Payer: Amish Plain Church Group Commercial	$441.25
Rate for Payer: BCBS Complete	$261.36
Rate for Payer: BCBS MAPPO	$353.00
Rate for Payer: BCBS Trust/PPO	$1,160.81
Rate for Payer: BCN Commercial	$1,160.81
Rate for Payer: BCN Medicare Advantage	$353.00
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Cofinity Commercial	$1,214.32
Rate for Payer: Encore Health Key Benefits Commercial	$1,129.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$353.00
Rate for Payer: Healthscope Commercial	$1,270.80
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,059.00
Rate for Payer: Mclaren Medicaid	$248.94
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$370.65
Rate for Payer: Meridian Medicaid	$261.36
Rate for Payer: MI Amish Medical Board Commercial	$405.95
Rate for Payer: Molina Medicare/Medicaid	$388.30
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$1,200.20
Rate for Payer: Nomi Health Commercial	$1,157.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,059.00
Rate for Payer: PACE Senior Care Partners	$335.35
Rate for Payer: PACE SWMI	$353.00
Rate for Payer: PHP Commercial	$1,200.20
Rate for Payer: PHP Medicare Advantage	$353.00
Rate for Payer: Priority Health Choice Medicaid	$248.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,228.44
Rate for Payer: Priority Health Medicare	$356.53
Rate for Payer: Priority Health Narrow/Tiered Network	$982.75
Rate for Payer: Railroad Medicare Medicare	$353.00
Rate for Payer: UHC Core	$1,179.02
Rate for Payer: UHC Exchange	$353.00
Rate for Payer: UHC Medicaid	$248.94
Rate for Payer: UHC Medicare Advantage	$353.00
Rate for Payer: UHCCP Medicaid	$248.94
Rate for Payer: VA VA	$353.00
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,059.00

PR COLONOSCOPY STOMA W/RMVL TUM POLYP/OTH LES SNARE

Professional

Both

$1,412.00

Service Code	HCPCS 44394
Min. Negotiated Rate	$127.37
Max. Negotiated Rate	$1,059.00
Rate for Payer: Aetna Commercial	$299.55
Rate for Payer: Aetna Medicare	$706.00
Rate for Payer: BCBS Complete	$133.74
Rate for Payer: BCN Commercial	$332.15
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Mclaren Medicaid	$127.37
Rate for Payer: Meridian Medicaid	$133.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,059.00
Rate for Payer: Priority Health Choice Medicaid	$127.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$404.71
Rate for Payer: Priority Health Narrow/Tiered Network	$404.71
Rate for Payer: UHC Medicaid	$127.37
Rate for Payer: UHCCP Medicaid	$127.37

PR COLONOSCOPY THRU STOMA,LESION REMOVAL

Professional

Both

$1,412.00

Service Code	HCPCS 44393
Min. Negotiated Rate	$564.80
Max. Negotiated Rate	$1,059.00
Rate for Payer: Aetna Medicare	$706.00
Rate for Payer: BCBS Complete	$564.80
Rate for Payer: Cash Price	$1,129.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,059.00

PR COLONOSCOPY,TRANSENDOSCOPIC STENT

Professional

Both

$1,650.00

Service Code	HCPCS 45387
Min. Negotiated Rate	$660.00
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Medicare	$825.00
Rate for Payer: BCBS Complete	$660.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,237.50

PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE

Professional

Both

$1,159.00

Service Code	HCPCS 45380
Min. Negotiated Rate	$113.32
Max. Negotiated Rate	$869.25
Rate for Payer: Aetna Commercial	$267.31
Rate for Payer: Aetna Medicare	$579.50
Rate for Payer: BCBS Complete	$118.99
Rate for Payer: BCN Commercial	$296.80
Rate for Payer: Cash Price	$927.20
Rate for Payer: Cash Price	$927.20
Rate for Payer: Mclaren Medicaid	$113.32
Rate for Payer: Meridian Medicaid	$118.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$869.25
Rate for Payer: Priority Health Choice Medicaid	$113.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$361.64
Rate for Payer: Priority Health Narrow/Tiered Network	$361.64
Rate for Payer: UHC Medicaid	$113.32
Rate for Payer: UHCCP Medicaid	$113.32

PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE

Facility

$1,159.00

Service Code	CPT 45380
Hospital Charge Code	45380
Hospital Revenue Code	960
Min. Negotiated Rate	$806.66
Max. Negotiated Rate	$1,043.10
Rate for Payer: Aetna Commercial	$985.15
Rate for Payer: BCBS Trust/PPO	$957.22
Rate for Payer: BCN Commercial	$957.22
Rate for Payer: Cash Price	$927.20
Rate for Payer: Cofinity Commercial	$996.74
Rate for Payer: Encore Health Key Benefits Commercial	$927.20
Rate for Payer: Healthscope Commercial	$1,043.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$869.25
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$985.15
Rate for Payer: Nomi Health Commercial	$950.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$869.25
Rate for Payer: PHP Commercial	$985.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,008.33
Rate for Payer: Priority Health Narrow/Tiered Network	$806.66
Rate for Payer: UHC Core	$967.76
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$869.25

PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE

Facility

$1,159.00

Service Code	CPT 45380
Hospital Charge Code	45380
Hospital Revenue Code	960
Min. Negotiated Rate	$204.33
Max. Negotiated Rate	$1,043.10
Rate for Payer: Aetna Commercial	$985.15
Rate for Payer: Aetna Medicare	$301.34
Rate for Payer: Allen County Amish Medical Aid Commercial	$362.19
Rate for Payer: Amish Plain Church Group Commercial	$362.19
Rate for Payer: BCBS Complete	$214.53
Rate for Payer: BCBS MAPPO	$289.75
Rate for Payer: BCBS Trust/PPO	$952.81
Rate for Payer: BCN Commercial	$952.81
Rate for Payer: BCN Medicare Advantage	$289.75
Rate for Payer: Cash Price	$927.20
Rate for Payer: Cofinity Commercial	$996.74
Rate for Payer: Encore Health Key Benefits Commercial	$927.20
Rate for Payer: Health Alliance Plan Medicare Advantage	$289.75
Rate for Payer: Healthscope Commercial	$1,043.10
Rate for Payer: Lakeland Regional Health Systems Commercial	$869.25
Rate for Payer: Mclaren Medicaid	$204.33
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$304.24
Rate for Payer: Meridian Medicaid	$214.53
Rate for Payer: MI Amish Medical Board Commercial	$333.21
Rate for Payer: Molina Medicare/Medicaid	$318.73
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$985.15
Rate for Payer: Nomi Health Commercial	$950.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$869.25
Rate for Payer: PACE Senior Care Partners	$275.26
Rate for Payer: PACE SWMI	$289.75
Rate for Payer: PHP Commercial	$985.15
Rate for Payer: PHP Medicare Advantage	$289.75
Rate for Payer: Priority Health Choice Medicaid	$204.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,008.33
Rate for Payer: Priority Health Medicare	$292.65
Rate for Payer: Priority Health Narrow/Tiered Network	$806.66
Rate for Payer: Railroad Medicare Medicare	$289.75
Rate for Payer: UHC Core	$967.76
Rate for Payer: UHC Exchange	$289.75
Rate for Payer: UHC Medicaid	$204.33
Rate for Payer: UHC Medicare Advantage	$289.75
Rate for Payer: UHCCP Medicaid	$204.33
Rate for Payer: VA VA	$289.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$869.25

PR COLONOSCOPY W/BIOPSY SINGLE/MULTIPLE

Professional

Both

$1,159.00

Service Code	HCPCS 45380
Hospital Charge Code	45380
Min. Negotiated Rate	$113.32
Max. Negotiated Rate	$869.25
Rate for Payer: Aetna Commercial	$267.31
Rate for Payer: Aetna Medicare	$579.50
Rate for Payer: BCBS Complete	$118.99
Rate for Payer: BCN Commercial	$296.80
Rate for Payer: Cash Price	$927.20
Rate for Payer: Cash Price	$927.20
Rate for Payer: Mclaren Medicaid	$113.32
Rate for Payer: Meridian Medicaid	$118.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$869.25
Rate for Payer: Priority Health Choice Medicaid	$113.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$361.64
Rate for Payer: Priority Health Narrow/Tiered Network	$361.64
Rate for Payer: UHC Medicaid	$113.32
Rate for Payer: UHCCP Medicaid	$113.32

PR COLONOSCOPY W/STENT

Professional

Both

$1,650.00

Service Code	HCPCS G6025
Min. Negotiated Rate	$660.00
Max. Negotiated Rate	$1,237.50
Rate for Payer: Aetna Medicare	$825.00
Rate for Payer: BCBS Complete	$660.00
Rate for Payer: Cash Price	$1,320.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,237.50

PR COLORECTAL SCRN; HI RISK IND

Professional

Both

$1,221.00

Service Code	HCPCS G0105
Min. Negotiated Rate	$105.01
Max. Negotiated Rate	$915.75
Rate for Payer: Aetna Commercial	$184.58
Rate for Payer: Aetna Medicare	$610.50
Rate for Payer: BCBS Complete	$110.26
Rate for Payer: BCN Commercial	$272.89
Rate for Payer: Cash Price	$976.80
Rate for Payer: Cash Price	$976.80
Rate for Payer: Mclaren Medicaid	$105.01
Rate for Payer: Meridian Medicaid	$110.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$915.75
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 COLORECTAL SCRN; HI RISK IND

Facility

$1,221.00

Service Code	HCPCS G0105
Hospital Charge Code	G0105
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 COLORECTAL SCRN; HI RISK IND

Professional

Both

$1,221.00

Service Code	HCPCS G0105
Hospital Charge Code	G0105
Min. Negotiated Rate	$105.01
Max. Negotiated Rate	$915.75
Rate for Payer: Aetna Commercial	$184.58
Rate for Payer: Aetna Medicare	$610.50
Rate for Payer: BCBS Complete	$110.26
Rate for Payer: BCN Commercial	$272.89
Rate for Payer: Cash Price	$976.80
Rate for Payer: Cash Price	$976.80
Rate for Payer: Mclaren Medicaid	$105.01
Rate for Payer: Meridian Medicaid	$110.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$915.75
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 COLORECTAL SCRN; HI RISK IND

Facility

$1,221.00

Service Code	HCPCS G0105
Hospital Charge Code	G0105
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 COLOR VISION XM EXTENDED ANOMALOSCOPE/EQUIV

Professional

Both

$99.00

Service Code	HCPCS 92283
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$81.17
Rate for Payer: Aetna Commercial	$56.23
Rate for Payer: Aetna Medicare	$49.50
Rate for Payer: BCN Commercial	$81.17
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cash Price	$79.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$74.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$69.45
Rate for Payer: Priority Health Narrow/Tiered Network	$69.45

Know your out-of-pocket cost for care.

All Charges