Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR INJ, REMDESIVIR, 1 MG

Professional

Both

$18.00

Service Code	HCPCS J0248
Min. Negotiated Rate	$5.51
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Commercial	$5.51
Rate for Payer: Aetna Medicare	$9.00
Rate for Payer: BCBS Trust/PPO	$7.02
Rate for Payer: BCN Commercial	$6.47
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.50

PR INJ, RIMABOTULINUMTOXINB

Professional

Both

$14.00

Service Code	HCPCS J0587
Min. Negotiated Rate	$7.00
Max. Negotiated Rate	$13.53
Rate for Payer: Aetna Commercial	$13.42
Rate for Payer: Aetna Medicare	$7.00
Rate for Payer: BCBS Trust/PPO	$13.53
Rate for Payer: BCN Commercial	$13.24
Rate for Payer: Cash Price	$11.20
Rate for Payer: Cash Price	$11.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$10.50

PR INJ RISPERDAL CONSTA, 0.5 MG

Professional

Both

$8.00

Service Code	HCPCS J2794
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$12.52
Rate for Payer: Aetna Commercial	$12.52
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Trust/PPO	$10.97
Rate for Payer: BCN Commercial	$10.16
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.00

PR INJ. ROMOSOZUMAB-AQQG 1 MG

Professional

Both

$11.00

Service Code	HCPCS J3111
Min. Negotiated Rate	$5.50
Max. Negotiated Rate	$12.33
Rate for Payer: Aetna Commercial	$11.05
Rate for Payer: Aetna Medicare	$5.50
Rate for Payer: BCBS Trust/PPO	$12.33
Rate for Payer: BCN Commercial	$11.71
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$8.25

PR INJ TESTOSTERONE CYPIONATE

Professional

Both

$0.16

Service Code	HCPCS J1071
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.12
Rate for Payer: Aetna Commercial	$0.03
Rate for Payer: Aetna Medicare	$0.08
Rate for Payer: BCBS Trust/PPO	$0.01
Rate for Payer: BCN Commercial	$0.01
Rate for Payer: Cash Price	$0.13
Rate for Payer: Cash Price	$0.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.12

PR INJ, TRIVISC 1 MG

Professional

Both

$0.01

Service Code	HCPCS J7329
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$18.17
Rate for Payer: Aetna Commercial	$8.14
Rate for Payer: Aetna Medicare	$0.01
Rate for Payer: BCBS Trust/PPO	$3.67
Rate for Payer: BCN Commercial	$18.17
Rate for Payer: Cash Price	$0.01
Rate for Payer: Cash Price	$0.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.01

PR INPT/ED TELECONSULT30

Professional

Both

$207.00

Service Code	HCPCS G0425
Min. Negotiated Rate	$53.68
Max. Negotiated Rate	$155.25
Rate for Payer: Aetna Commercial	$99.61
Rate for Payer: Aetna Medicare	$103.50
Rate for Payer: BCBS Complete	$56.36
Rate for Payer: BCN Commercial	$136.95
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cash Price	$165.60
Rate for Payer: Mclaren Medicaid	$53.68
Rate for Payer: Meridian Medicaid	$56.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$155.25
Rate for Payer: Priority Health Choice Medicaid	$53.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$123.18
Rate for Payer: Priority Health Narrow/Tiered Network	$123.18
Rate for Payer: UHC Medicaid	$53.68
Rate for Payer: UHCCP Medicaid	$53.68

PR INPT/ED TELECONSULT50

Professional

Both

$280.00

Service Code	HCPCS G0426
Min. Negotiated Rate	$74.76
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$133.90
Rate for Payer: Aetna Medicare	$140.00
Rate for Payer: BCBS Complete	$78.50
Rate for Payer: BCN Commercial	$193.71
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cash Price	$224.00
Rate for Payer: Mclaren Medicaid	$74.76
Rate for Payer: Meridian Medicaid	$78.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$210.00
Rate for Payer: Priority Health Choice Medicaid	$74.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$174.25
Rate for Payer: Priority Health Narrow/Tiered Network	$174.25
Rate for Payer: UHC Medicaid	$74.76
Rate for Payer: UHCCP Medicaid	$74.76

PR INPT/ED TELECONSULT70

Professional

Both

$416.00

Service Code	HCPCS G0427
Min. Negotiated Rate	$107.35
Max. Negotiated Rate	$312.00
Rate for Payer: Aetna Commercial	$197.06
Rate for Payer: Aetna Medicare	$208.00
Rate for Payer: BCBS Complete	$112.72
Rate for Payer: BCN Commercial	$275.39
Rate for Payer: Cash Price	$332.80
Rate for Payer: Cash Price	$332.80
Rate for Payer: Mclaren Medicaid	$107.35
Rate for Payer: Meridian Medicaid	$112.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$312.00
Rate for Payer: Priority Health Choice Medicaid	$107.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$247.72
Rate for Payer: Priority Health Narrow/Tiered Network	$247.72
Rate for Payer: UHC Medicaid	$107.35
Rate for Payer: UHCCP Medicaid	$107.35

PR INPT/TELE FOLLOW UP 25

Professional

Both

$153.00

Service Code	HCPCS G0407
Min. Negotiated Rate	$40.68
Max. Negotiated Rate	$114.75
Rate for Payer: Aetna Commercial	$70.74
Rate for Payer: Aetna Medicare	$76.50
Rate for Payer: BCBS Complete	$42.71
Rate for Payer: BCN Commercial	$107.56
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Mclaren Medicaid	$40.68
Rate for Payer: Meridian Medicaid	$42.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$114.75
Rate for Payer: Priority Health Choice Medicaid	$40.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$99.20
Rate for Payer: Priority Health Narrow/Tiered Network	$99.20
Rate for Payer: UHC Medicaid	$40.68
Rate for Payer: UHCCP Medicaid	$40.68

PR INPT/TELE FOLLOW UP 35

Professional

Both

$190.00

Service Code	HCPCS G0408
Min. Negotiated Rate	$59.64
Max. Negotiated Rate	$155.37
Rate for Payer: Aetna Commercial	$101.64
Rate for Payer: Aetna Medicare	$95.00
Rate for Payer: BCBS Complete	$62.62
Rate for Payer: BCN Commercial	$155.37
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Mclaren Medicaid	$59.64
Rate for Payer: Meridian Medicaid	$62.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$142.50
Rate for Payer: Priority Health Choice Medicaid	$59.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$143.28
Rate for Payer: Priority Health Narrow/Tiered Network	$143.28
Rate for Payer: UHC Medicaid	$59.64
Rate for Payer: UHCCP Medicaid	$59.64

PR INSERT CANNULA PROLONG CP INSUFF

Professional

Both

$1,629.00

Service Code	HCPCS 36822
Min. Negotiated Rate	$651.60
Max. Negotiated Rate	$1,221.75
Rate for Payer: Aetna Medicare	$814.50
Rate for Payer: BCBS Complete	$651.60
Rate for Payer: Cash Price	$1,303.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,221.75

PR INSERT GASTROSTOMY TUBE PERCUTANEOUS

Professional

Both

$394.00

Service Code	HCPCS 49440
Min. Negotiated Rate	$113.74
Max. Negotiated Rate	$364.66
Rate for Payer: Aetna Commercial	$270.42
Rate for Payer: Aetna Medicare	$197.00
Rate for Payer: BCBS Complete	$119.43
Rate for Payer: BCN Commercial	$299.28
Rate for Payer: Cash Price	$315.20
Rate for Payer: Cash Price	$315.20
Rate for Payer: Mclaren Medicaid	$113.74
Rate for Payer: Meridian Medicaid	$119.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$295.50
Rate for Payer: Priority Health Choice Medicaid	$113.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$364.66
Rate for Payer: Priority Health Narrow/Tiered Network	$364.66
Rate for Payer: UHC Medicaid	$113.74
Rate for Payer: UHCCP Medicaid	$113.74

PR INSERTION BREAST IMPLANT SAME DAY OF MASTECTOMY

Professional

Both

$1,765.00

Service Code	HCPCS 19340
Min. Negotiated Rate	$447.09
Max. Negotiated Rate	$1,323.75
Rate for Payer: Aetna Commercial	$818.17
Rate for Payer: Aetna Medicare	$882.50
Rate for Payer: BCBS Complete	$469.44
Rate for Payer: BCN Commercial	$1,149.83
Rate for Payer: Cash Price	$1,412.00
Rate for Payer: Cash Price	$1,412.00
Rate for Payer: Mclaren Medicaid	$447.09
Rate for Payer: Meridian Medicaid	$469.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,323.75
Rate for Payer: Priority Health Choice Medicaid	$447.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,052.40
Rate for Payer: Priority Health Narrow/Tiered Network	$1,052.40
Rate for Payer: UHC Medicaid	$447.09
Rate for Payer: UHCCP Medicaid	$447.09

PR INSERTION CERVICAL DILATOR SEPARATE PROCEDURE

Professional

Both

$163.00

Service Code	HCPCS 59200
Min. Negotiated Rate	$49.05
Max. Negotiated Rate	$122.25
Rate for Payer: Aetna Commercial	$49.05
Rate for Payer: Aetna Medicare	$81.50
Rate for Payer: BCBS Complete	$65.20
Rate for Payer: BCN Commercial	$100.60
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cash Price	$130.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$122.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$94.96
Rate for Payer: Priority Health Narrow/Tiered Network	$94.96

PR INSERTION DRUG DELIVERY IMPLANT

Professional

Both

$234.00

Service Code	HCPCS 11981
Min. Negotiated Rate	$34.93
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna Commercial	$69.83
Rate for Payer: Aetna Medicare	$117.00
Rate for Payer: BCBS Complete	$36.68
Rate for Payer: BCN Commercial	$94.12
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$187.20
Rate for Payer: Mclaren Medicaid	$34.93
Rate for Payer: Meridian Medicaid	$36.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$175.50
Rate for Payer: Priority Health Choice Medicaid	$34.93
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$86.14
Rate for Payer: Priority Health Narrow/Tiered Network	$86.14
Rate for Payer: UHC Medicaid	$34.93
Rate for Payer: UHCCP Medicaid	$34.93

PR INSERTION EPICARDIAL ELECTRODE OPEN

Professional

Both

$2,443.00

Service Code	HCPCS 33202
Min. Negotiated Rate	$472.65
Max. Negotiated Rate	$1,832.25
Rate for Payer: Aetna Commercial	$1,033.14
Rate for Payer: Aetna Medicare	$1,221.50
Rate for Payer: BCBS Complete	$496.28
Rate for Payer: BCN Commercial	$1,139.88
Rate for Payer: Cash Price	$1,954.40
Rate for Payer: Cash Price	$1,954.40
Rate for Payer: Mclaren Medicaid	$472.65
Rate for Payer: Meridian Medicaid	$496.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,832.25
Rate for Payer: Priority Health Choice Medicaid	$472.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,225.79
Rate for Payer: Priority Health Narrow/Tiered Network	$1,225.79
Rate for Payer: UHC Medicaid	$472.65
Rate for Payer: UHCCP Medicaid	$472.65

PR INSERTION FLOW DIRECTED CATHETER FOR MONITORING

Professional

Both

$879.00

Service Code	HCPCS 93503
Min. Negotiated Rate	$51.97
Max. Negotiated Rate	$659.25
Rate for Payer: Aetna Commercial	$118.36
Rate for Payer: Aetna Medicare	$439.50
Rate for Payer: BCBS Complete	$54.57
Rate for Payer: BCN Commercial	$128.48
Rate for Payer: Cash Price	$703.20
Rate for Payer: Cash Price	$703.20
Rate for Payer: Mclaren Medicaid	$51.97
Rate for Payer: Meridian Medicaid	$54.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$659.25
Rate for Payer: Priority Health Choice Medicaid	$51.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$122.11
Rate for Payer: Priority Health Narrow/Tiered Network	$122.11
Rate for Payer: UHC Medicaid	$51.97
Rate for Payer: UHCCP Medicaid	$51.97

PR INSERTION INDWELLING TUNNELED PLEURAL CATHETER

Professional

Both

$2,009.00

Service Code	HCPCS 32550
Min. Negotiated Rate	$115.66
Max. Negotiated Rate	$1,506.75
Rate for Payer: Aetna Commercial	$264.99
Rate for Payer: Aetna Medicare	$1,004.50
Rate for Payer: BCBS Complete	$121.44
Rate for Payer: BCN Commercial	$299.79
Rate for Payer: Cash Price	$1,607.20
Rate for Payer: Cash Price	$1,607.20
Rate for Payer: Mclaren Medicaid	$115.66
Rate for Payer: Meridian Medicaid	$121.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,506.75
Rate for Payer: Priority Health Choice Medicaid	$115.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$282.31
Rate for Payer: Priority Health Narrow/Tiered Network	$282.31
Rate for Payer: UHC Medicaid	$115.66
Rate for Payer: UHCCP Medicaid	$115.66

PR INSERTION INTRA-AORTIC BALLOON ASSIST DEV PERQ

Professional

Both

$774.00

Service Code	HCPCS 33967
Min. Negotiated Rate	$143.35
Max. Negotiated Rate	$580.50
Rate for Payer: Aetna Commercial	$349.07
Rate for Payer: Aetna Medicare	$387.00
Rate for Payer: BCBS Complete	$150.52
Rate for Payer: BCN Commercial	$377.96
Rate for Payer: Cash Price	$619.20
Rate for Payer: Cash Price	$619.20
Rate for Payer: Mclaren Medicaid	$143.35
Rate for Payer: Meridian Medicaid	$150.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$580.50
Rate for Payer: Priority Health Choice Medicaid	$143.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$406.46
Rate for Payer: Priority Health Narrow/Tiered Network	$406.46
Rate for Payer: UHC Medicaid	$143.35
Rate for Payer: UHCCP Medicaid	$143.35

PR INSERTION INTRAUTERINE DEVICE IUD

Facility

$305.00

Service Code	CPT 58300
Hospital Charge Code	58300
Hospital Revenue Code	521
Min. Negotiated Rate	$53.77
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna Commercial	$259.25
Rate for Payer: Aetna Medicare	$79.30
Rate for Payer: Allen County Amish Medical Aid Commercial	$95.31
Rate for Payer: Amish Plain Church Group Commercial	$95.31
Rate for Payer: BCBS Complete	$56.46
Rate for Payer: BCBS MAPPO	$76.25
Rate for Payer: BCBS Trust/PPO	$250.74
Rate for Payer: BCN Commercial	$250.74
Rate for Payer: BCN Medicare Advantage	$76.25
Rate for Payer: Cash Price	$244.00
Rate for Payer: Cofinity Commercial	$262.30
Rate for Payer: Encore Health Key Benefits Commercial	$244.00
Rate for Payer: Health Alliance Plan Medicare Advantage	$76.25
Rate for Payer: Healthscope Commercial	$274.50
Rate for Payer: Lakeland Regional Health Systems Commercial	$228.75
Rate for Payer: Mclaren Medicaid	$53.77
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$80.06
Rate for Payer: Meridian Medicaid	$56.46
Rate for Payer: MI Amish Medical Board Commercial	$87.69
Rate for Payer: Molina Medicare/Medicaid	$83.88
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$259.25
Rate for Payer: Nomi Health Commercial	$250.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$228.75
Rate for Payer: PACE Senior Care Partners	$72.44
Rate for Payer: PACE SWMI	$76.25
Rate for Payer: PHP Commercial	$259.25
Rate for Payer: PHP Medicare Advantage	$76.25
Rate for Payer: Priority Health Choice Medicaid	$53.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$265.35
Rate for Payer: Priority Health Medicare	$77.01
Rate for Payer: Priority Health Narrow/Tiered Network	$212.28
Rate for Payer: Railroad Medicare Medicare	$76.25
Rate for Payer: UHC Core	$254.68
Rate for Payer: UHC Exchange	$76.25
Rate for Payer: UHC Medicaid	$53.77
Rate for Payer: UHC Medicare Advantage	$76.25
Rate for Payer: UHCCP Medicaid	$53.77
Rate for Payer: VA VA	$76.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$228.75

PR INSERTION INTRAUTERINE DEVICE IUD

Professional

Both

$305.00

Service Code	HCPCS 58300
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$228.75
Rate for Payer: Aetna Commercial	$60.86
Rate for Payer: Aetna Medicare	$152.50
Rate for Payer: BCBS Complete	$29.30
Rate for Payer: BCN Commercial	$59.30
Rate for Payer: Cash Price	$244.00
Rate for Payer: Cash Price	$244.00
Rate for Payer: Mclaren Medicaid	$27.90
Rate for Payer: Meridian Medicaid	$29.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$228.75
Rate for Payer: Priority Health Choice Medicaid	$27.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$76.15
Rate for Payer: Priority Health Narrow/Tiered Network	$76.15
Rate for Payer: UHC Medicaid	$27.90
Rate for Payer: UHCCP Medicaid	$27.90

PR INSERTION INTRAUTERINE DEVICE IUD

Facility

$305.00

Service Code	CPT 58300
Hospital Charge Code	58300
Hospital Revenue Code	521
Min. Negotiated Rate	$212.28
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna Commercial	$259.25
Rate for Payer: BCBS Trust/PPO	$251.90
Rate for Payer: BCN Commercial	$251.90
Rate for Payer: Cash Price	$244.00
Rate for Payer: Cofinity Commercial	$262.30
Rate for Payer: Encore Health Key Benefits Commercial	$244.00
Rate for Payer: Healthscope Commercial	$274.50
Rate for Payer: Lakeland Regional Health Systems Commercial	$228.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$259.25
Rate for Payer: Nomi Health Commercial	$250.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$228.75
Rate for Payer: PHP Commercial	$259.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$265.35
Rate for Payer: Priority Health Narrow/Tiered Network	$212.28
Rate for Payer: UHC Core	$254.68
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$228.75

PR INSERTION INTRAUTERINE DEVICE IUD

Professional

Both

$305.00

Service Code	HCPCS 58300
Hospital Charge Code	58300
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$228.75
Rate for Payer: Aetna Commercial	$60.86
Rate for Payer: Aetna Medicare	$152.50
Rate for Payer: BCBS Complete	$29.30
Rate for Payer: BCN Commercial	$59.30
Rate for Payer: Cash Price	$244.00
Rate for Payer: Cash Price	$244.00
Rate for Payer: Mclaren Medicaid	$27.90
Rate for Payer: Meridian Medicaid	$29.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$228.75
Rate for Payer: Priority Health Choice Medicaid	$27.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$76.15
Rate for Payer: Priority Health Narrow/Tiered Network	$76.15
Rate for Payer: UHC Medicaid	$27.90
Rate for Payer: UHCCP Medicaid	$27.90

PR INSERTION PICC W/O IMG GDN < 5 YR

Professional

Both

$179.00

Service Code	HCPCS 36568
Min. Negotiated Rate	$53.46
Max. Negotiated Rate	$146.73
Rate for Payer: Aetna Commercial	$123.67
Rate for Payer: Aetna Medicare	$89.50
Rate for Payer: BCBS Complete	$56.13
Rate for Payer: BCN Commercial	$136.44
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cash Price	$143.20
Rate for Payer: Mclaren Medicaid	$53.46
Rate for Payer: Meridian Medicaid	$56.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$134.25
Rate for Payer: Priority Health Choice Medicaid	$53.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$146.73
Rate for Payer: Priority Health Narrow/Tiered Network	$146.73
Rate for Payer: UHC Medicaid	$53.46
Rate for Payer: UHCCP Medicaid	$53.46

Know your out-of-pocket cost for care.

All Charges