Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL

Professional

Both

$1,065.00

Service Code	HCPCS 99477
Min. Negotiated Rate	$319.28
Max. Negotiated Rate	$692.25
Rate for Payer: Aetna Commercial	$427.84
Rate for Payer: Aetna Medicare	$332.05
Rate for Payer: BCBS Complete	$426.00
Rate for Payer: BCBS MAPPO	$319.28
Rate for Payer: BCN Medicare Advantage	$319.28
Rate for Payer: Cash Price	$852.00
Rate for Payer: Cash Price	$852.00
Rate for Payer: Cofinity Commercial	$459.76
Rate for Payer: Cofinity Commercial	$427.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$319.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$335.24
Rate for Payer: Nomi Health Commercial	$383.14
Rate for Payer: PACE SWMI	$319.28
Rate for Payer: PHP Medicare Advantage	$319.28
Rate for Payer: Priority Health Cigna Priority Health	$692.25
Rate for Payer: Priority Health Medicare	$322.47
Rate for Payer: UHC All Payor (Choice/PPO)	$319.28
Rate for Payer: UHC Dual Complete DSNP	$319.28
Rate for Payer: UHC Exchange	$319.28
Rate for Payer: UHC Medicare Advantage	$319.28

PR INITIAL INPATIENT CONSULT NEW/ESTAB PT 20 MIN

Professional

Both

$134.00

Service Code	HCPCS 99251
Min. Negotiated Rate	$53.60
Max. Negotiated Rate	$87.10
Rate for Payer: Aetna Medicare	$67.00
Rate for Payer: BCBS Complete	$53.60
Rate for Payer: Cash Price	$107.20
Rate for Payer: Priority Health Cigna Priority Health	$87.10

PR INITIAL NURSING FACILITY CARE HI MDM 50 MINUTES

Professional

Both

$251.00

Service Code	HCPCS 99306
Min. Negotiated Rate	$100.40
Max. Negotiated Rate	$247.19
Rate for Payer: Aetna Commercial	$230.02
Rate for Payer: Aetna Medicare	$178.53
Rate for Payer: BCBS Complete	$100.40
Rate for Payer: BCBS MAPPO	$171.66
Rate for Payer: BCN Medicare Advantage	$171.66
Rate for Payer: Cash Price	$200.80
Rate for Payer: Cash Price	$200.80
Rate for Payer: Cofinity Commercial	$247.19
Rate for Payer: Cofinity Commercial	$230.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$171.66
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$180.24
Rate for Payer: Nomi Health Commercial	$205.99
Rate for Payer: PACE SWMI	$171.66
Rate for Payer: PHP Medicare Advantage	$171.66
Rate for Payer: Priority Health Cigna Priority Health	$163.15
Rate for Payer: Priority Health Medicare	$173.38
Rate for Payer: UHC All Payor (Choice/PPO)	$171.66
Rate for Payer: UHC Dual Complete DSNP	$171.66
Rate for Payer: UHC Exchange	$171.66
Rate for Payer: UHC Medicare Advantage	$171.66

PR INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES

Professional

Both

$197.00

Service Code	HCPCS 99305
Min. Negotiated Rate	$78.80
Max. Negotiated Rate	$180.78
Rate for Payer: Aetna Commercial	$168.22
Rate for Payer: Aetna Medicare	$130.56
Rate for Payer: BCBS Complete	$78.80
Rate for Payer: BCBS MAPPO	$125.54
Rate for Payer: BCN Medicare Advantage	$125.54
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cofinity Commercial	$168.22
Rate for Payer: Cofinity Commercial	$180.78
Rate for Payer: Health Alliance Plan Medicare Advantage	$125.54
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$131.82
Rate for Payer: Nomi Health Commercial	$150.65
Rate for Payer: PACE SWMI	$125.54
Rate for Payer: PHP Medicare Advantage	$125.54
Rate for Payer: Priority Health Cigna Priority Health	$128.05
Rate for Payer: Priority Health Medicare	$126.80
Rate for Payer: UHC All Payor (Choice/PPO)	$125.54
Rate for Payer: UHC Dual Complete DSNP	$125.54
Rate for Payer: UHC Exchange	$125.54
Rate for Payer: UHC Medicare Advantage	$125.54

PR INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN

Professional

Both

$138.00

Service Code	HCPCS 99304
Min. Negotiated Rate	$55.20
Max. Negotiated Rate	$109.53
Rate for Payer: Aetna Commercial	$101.92
Rate for Payer: Aetna Medicare	$79.10
Rate for Payer: BCBS Complete	$55.20
Rate for Payer: BCBS MAPPO	$76.06
Rate for Payer: BCN Medicare Advantage	$76.06
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cofinity Commercial	$101.92
Rate for Payer: Cofinity Commercial	$109.53
Rate for Payer: Health Alliance Plan Medicare Advantage	$76.06
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$79.86
Rate for Payer: Nomi Health Commercial	$91.27
Rate for Payer: PACE SWMI	$76.06
Rate for Payer: PHP Medicare Advantage	$76.06
Rate for Payer: Priority Health Cigna Priority Health	$89.70
Rate for Payer: Priority Health Medicare	$76.82
Rate for Payer: UHC All Payor (Choice/PPO)	$76.06
Rate for Payer: UHC Dual Complete DSNP	$76.06
Rate for Payer: UHC Exchange	$76.06
Rate for Payer: UHC Medicare Advantage	$76.06

PR INITIAL OBSERVATION CARE/DAY 30 MINUTES

Professional

Both

$151.00

Service Code	HCPCS 99218
Min. Negotiated Rate	$60.40
Max. Negotiated Rate	$98.15
Rate for Payer: Aetna Medicare	$75.50
Rate for Payer: BCBS Complete	$60.40
Rate for Payer: Cash Price	$120.80
Rate for Payer: Priority Health Cigna Priority Health	$98.15

PR INITIAL OBSERVATION CARE/DAY 50 MINUTES

Professional

Both

$205.00

Service Code	HCPCS 99219
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$133.25
Rate for Payer: Aetna Medicare	$102.50
Rate for Payer: BCBS Complete	$82.00
Rate for Payer: Cash Price	$164.00
Rate for Payer: Priority Health Cigna Priority Health	$133.25

PR INITIAL OBSERVATION CARE/DAY 70 MINUTES

Professional

Both

$281.00

Service Code	HCPCS 99220
Min. Negotiated Rate	$112.40
Max. Negotiated Rate	$182.65
Rate for Payer: Aetna Medicare	$140.50
Rate for Payer: BCBS Complete	$112.40
Rate for Payer: Cash Price	$224.80
Rate for Payer: Priority Health Cigna Priority Health	$182.65

PR INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS

Professional

Both

$1,467.00

Service Code	HCPCS 99471
Min. Negotiated Rate	$586.80
Max. Negotiated Rate	$1,048.42
Rate for Payer: Aetna Commercial	$975.61
Rate for Payer: Aetna Medicare	$757.19
Rate for Payer: BCBS Complete	$586.80
Rate for Payer: BCBS MAPPO	$728.07
Rate for Payer: BCN Medicare Advantage	$728.07
Rate for Payer: Cash Price	$1,173.60
Rate for Payer: Cash Price	$1,173.60
Rate for Payer: Cofinity Commercial	$975.61
Rate for Payer: Cofinity Commercial	$1,048.42
Rate for Payer: Health Alliance Plan Medicare Advantage	$728.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$764.47
Rate for Payer: Nomi Health Commercial	$873.68
Rate for Payer: PACE SWMI	$728.07
Rate for Payer: PHP Medicare Advantage	$728.07
Rate for Payer: Priority Health Cigna Priority Health	$953.55
Rate for Payer: Priority Health Medicare	$735.35
Rate for Payer: UHC All Payor (Choice/PPO)	$728.07
Rate for Payer: UHC Dual Complete DSNP	$728.07
Rate for Payer: UHC Exchange	$728.07
Rate for Payer: UHC Medicare Advantage	$728.07

PR INITIAL PED CRITICAL CARE 2 THRU 5 YEARS

Professional

Both

$1,243.00

Service Code	HCPCS 99475
Min. Negotiated Rate	$497.20
Max. Negotiated Rate	$807.95
Rate for Payer: Aetna Commercial	$708.82
Rate for Payer: Aetna Medicare	$550.13
Rate for Payer: BCBS Complete	$497.20
Rate for Payer: BCBS MAPPO	$528.97
Rate for Payer: BCN Medicare Advantage	$528.97
Rate for Payer: Cash Price	$994.40
Rate for Payer: Cash Price	$994.40
Rate for Payer: Cofinity Commercial	$761.72
Rate for Payer: Cofinity Commercial	$708.82
Rate for Payer: Health Alliance Plan Medicare Advantage	$528.97
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$555.42
Rate for Payer: Nomi Health Commercial	$634.76
Rate for Payer: PACE SWMI	$528.97
Rate for Payer: PHP Medicare Advantage	$528.97
Rate for Payer: Priority Health Cigna Priority Health	$807.95
Rate for Payer: Priority Health Medicare	$534.26
Rate for Payer: UHC All Payor (Choice/PPO)	$528.97
Rate for Payer: UHC Dual Complete DSNP	$528.97
Rate for Payer: UHC Exchange	$528.97
Rate for Payer: UHC Medicare Advantage	$528.97

PR INITIAL PREVENTIVE EXAM

Professional

Both

$263.00

Service Code	HCPCS G0402
Min. Negotiated Rate	$105.20
Max. Negotiated Rate	$177.80
Rate for Payer: Aetna Commercial	$165.45
Rate for Payer: Aetna Medicare	$128.41
Rate for Payer: BCBS Complete	$105.20
Rate for Payer: BCBS MAPPO	$123.47
Rate for Payer: BCN Medicare Advantage	$123.47
Rate for Payer: Cash Price	$210.40
Rate for Payer: Cash Price	$210.40
Rate for Payer: Cofinity Commercial	$165.45
Rate for Payer: Cofinity Commercial	$177.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$123.47
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$129.64
Rate for Payer: Nomi Health Commercial	$148.16
Rate for Payer: PACE SWMI	$123.47
Rate for Payer: PHP Medicare Advantage	$123.47
Rate for Payer: Priority Health Cigna Priority Health	$170.95
Rate for Payer: Priority Health Medicare	$124.70
Rate for Payer: UHC All Payor (Choice/PPO)	$123.47
Rate for Payer: UHC Dual Complete DSNP	$123.47
Rate for Payer: UHC Exchange	$123.47
Rate for Payer: UHC Medicare Advantage	$123.47

PR INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR

Professional

Both

$171.00

Service Code	HCPCS 99381
Min. Negotiated Rate	$68.40
Max. Negotiated Rate	$111.15
Rate for Payer: Aetna Medicare	$85.50
Rate for Payer: BCBS Complete	$68.40
Rate for Payer: Cash Price	$136.80
Rate for Payer: Priority Health Cigna Priority Health	$111.15

PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS

Professional

Both

$221.00

Service Code	HCPCS 99386
Min. Negotiated Rate	$88.40
Max. Negotiated Rate	$143.65
Rate for Payer: Aetna Medicare	$110.50
Rate for Payer: BCBS Complete	$88.40
Rate for Payer: Cash Price	$176.80
Rate for Payer: Priority Health Cigna Priority Health	$143.65

PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>

Professional

Both

$240.00

Service Code	HCPCS 99387
Min. Negotiated Rate	$96.00
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Medicare	$120.00
Rate for Payer: BCBS Complete	$96.00
Rate for Payer: Cash Price	$192.00
Rate for Payer: Priority Health Cigna Priority Health	$156.00

PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR

Professional

Both

$196.00

Service Code	HCPCS 99384
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$127.40
Rate for Payer: Aetna Medicare	$98.00
Rate for Payer: BCBS Complete	$78.40
Rate for Payer: Cash Price	$156.80
Rate for Payer: Priority Health Cigna Priority Health	$127.40

PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS

Professional

Both

$179.00

Service Code	HCPCS 99382
Min. Negotiated Rate	$71.60
Max. Negotiated Rate	$116.35
Rate for Payer: Aetna Medicare	$89.50
Rate for Payer: BCBS Complete	$71.60
Rate for Payer: Cash Price	$143.20
Rate for Payer: Priority Health Cigna Priority Health	$116.35

PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS

Professional

Both

$191.00

Service Code	HCPCS 99385
Min. Negotiated Rate	$76.40
Max. Negotiated Rate	$124.15
Rate for Payer: Aetna Medicare	$95.50
Rate for Payer: BCBS Complete	$76.40
Rate for Payer: Cash Price	$152.80
Rate for Payer: Priority Health Cigna Priority Health	$124.15

PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS

Professional

Both

$173.00

Service Code	HCPCS 99383
Min. Negotiated Rate	$69.20
Max. Negotiated Rate	$112.45
Rate for Payer: Aetna Medicare	$86.50
Rate for Payer: BCBS Complete	$69.20
Rate for Payer: Cash Price	$138.40
Rate for Payer: Priority Health Cigna Priority Health	$112.45

PR INITIAL TX 1ST DEGREE BURN LOCAL TX

Professional

Both

$114.00

Service Code	HCPCS 16000
Min. Negotiated Rate	$44.20
Max. Negotiated Rate	$74.10
Rate for Payer: Aetna Commercial	$59.23
Rate for Payer: Aetna Medicare	$45.97
Rate for Payer: BCBS Complete	$45.60
Rate for Payer: BCBS MAPPO	$44.20
Rate for Payer: BCN Medicare Advantage	$44.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cofinity Commercial	$59.23
Rate for Payer: Cofinity Commercial	$63.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$44.20
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$46.41
Rate for Payer: Nomi Health Commercial	$53.04
Rate for Payer: PACE SWMI	$44.20
Rate for Payer: PHP Medicare Advantage	$44.20
Rate for Payer: Priority Health Cigna Priority Health	$74.10
Rate for Payer: Priority Health Medicare	$44.64
Rate for Payer: UHC All Payor (Choice/PPO)	$44.20
Rate for Payer: UHC Dual Complete DSNP	$44.20
Rate for Payer: UHC Exchange	$44.20
Rate for Payer: UHC Medicare Advantage	$44.20

PR INIT/SUB PSYCH CARE M 1ST 30

Professional

Both

$94.00

Service Code	HCPCS G2214
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$61.10
Rate for Payer: Aetna Commercial	$48.44
Rate for Payer: Aetna Medicare	$37.60
Rate for Payer: BCBS Complete	$37.60
Rate for Payer: BCBS MAPPO	$36.15
Rate for Payer: BCN Medicare Advantage	$36.15
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cofinity Commercial	$52.06
Rate for Payer: Cofinity Commercial	$48.44
Rate for Payer: Health Alliance Plan Medicare Advantage	$36.15
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$37.96
Rate for Payer: Nomi Health Commercial	$43.38
Rate for Payer: PACE SWMI	$36.15
Rate for Payer: PHP Medicare Advantage	$36.15
Rate for Payer: Priority Health Cigna Priority Health	$61.10
Rate for Payer: Priority Health Medicare	$36.51
Rate for Payer: UHC All Payor (Choice/PPO)	$36.15
Rate for Payer: UHC Dual Complete DSNP	$36.15
Rate for Payer: UHC Exchange	$36.15
Rate for Payer: UHC Medicare Advantage	$36.15

PR INJ DEXAMETHASONE ACETATE

Professional

Both

$2.00

Service Code	HCPCS J1094
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.30
Rate for Payer: Aetna Medicare	$1.00
Rate for Payer: BCBS Complete	$0.80
Rate for Payer: Cash Price	$1.60
Rate for Payer: Priority Health Cigna Priority Health	$1.30

PR INJ, DUROLANE 1 MG

Professional

Both

$21.00

Service Code	HCPCS J7318
Min. Negotiated Rate	$6.77
Max. Negotiated Rate	$13.65
Rate for Payer: Aetna Commercial	$9.07
Rate for Payer: Aetna Medicare	$7.04
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: BCBS MAPPO	$6.77
Rate for Payer: BCN Medicare Advantage	$6.77
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cofinity Commercial	$9.75
Rate for Payer: Cofinity Commercial	$9.07
Rate for Payer: Health Alliance Plan Medicare Advantage	$6.77
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7.11
Rate for Payer: Nomi Health Commercial	$8.12
Rate for Payer: PACE SWMI	$6.77
Rate for Payer: PHP Medicare Advantage	$6.77
Rate for Payer: Priority Health Cigna Priority Health	$13.65
Rate for Payer: Priority Health Medicare	$6.84
Rate for Payer: UHC All Payor (Choice/PPO)	$6.77
Rate for Payer: UHC Dual Complete DSNP	$6.77
Rate for Payer: UHC Exchange	$6.77
Rate for Payer: UHC Medicare Advantage	$6.77

PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS

Professional

Both

$145.00

Service Code	HCPCS 20550
Min. Negotiated Rate	$37.48
Max. Negotiated Rate	$94.25
Rate for Payer: Aetna Commercial	$50.22
Rate for Payer: Aetna Medicare	$38.98
Rate for Payer: BCBS Complete	$58.00
Rate for Payer: BCBS MAPPO	$37.48
Rate for Payer: BCN Medicare Advantage	$37.48
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cofinity Commercial	$53.97
Rate for Payer: Cofinity Commercial	$50.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$37.48
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$39.35
Rate for Payer: Nomi Health Commercial	$44.98
Rate for Payer: PACE SWMI	$37.48
Rate for Payer: PHP Medicare Advantage	$37.48
Rate for Payer: Priority Health Cigna Priority Health	$94.25
Rate for Payer: Priority Health Medicare	$37.85
Rate for Payer: UHC All Payor (Choice/PPO)	$37.48
Rate for Payer: UHC Dual Complete DSNP	$37.48
Rate for Payer: UHC Exchange	$37.48
Rate for Payer: UHC Medicare Advantage	$37.48

PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS

Professional

Both

$145.00

Service Code	HCPCS 20550
Hospital Charge Code	20550
Min. Negotiated Rate	$37.48
Max. Negotiated Rate	$94.25
Rate for Payer: Aetna Commercial	$50.22
Rate for Payer: Aetna Medicare	$38.98
Rate for Payer: BCBS Complete	$58.00
Rate for Payer: BCBS MAPPO	$37.48
Rate for Payer: BCN Medicare Advantage	$37.48
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cofinity Commercial	$53.97
Rate for Payer: Cofinity Commercial	$50.22
Rate for Payer: Health Alliance Plan Medicare Advantage	$37.48
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$39.35
Rate for Payer: Nomi Health Commercial	$44.98
Rate for Payer: PACE SWMI	$37.48
Rate for Payer: PHP Medicare Advantage	$37.48
Rate for Payer: Priority Health Cigna Priority Health	$94.25
Rate for Payer: Priority Health Medicare	$37.85
Rate for Payer: UHC All Payor (Choice/PPO)	$37.48
Rate for Payer: UHC Dual Complete DSNP	$37.48
Rate for Payer: UHC Exchange	$37.48
Rate for Payer: UHC Medicare Advantage	$37.48

PR INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS

Facility

$145.00

Service Code	CPT 20550
Hospital Charge Code	20550
Hospital Revenue Code	521
Min. Negotiated Rate	$94.25
Max. Negotiated Rate	$130.50
Rate for Payer: Aetna Commercial	$123.25
Rate for Payer: BCBS Trust/PPO	$118.36
Rate for Payer: BCN Commercial	$112.06
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cofinity Commercial	$124.70
Rate for Payer: Encore Health Key Benefits Commercial	$116.00
Rate for Payer: Healthscope Commercial	$130.50
Rate for Payer: Lakeland Regional Health Systems Commercial	$108.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$123.25
Rate for Payer: Nomi Health Commercial	$118.90
Rate for Payer: PHP Commercial	$123.25
Rate for Payer: Priority Health Cigna Priority Health	$94.25
Rate for Payer: Priority Health HMO/PPO	$126.15
Rate for Payer: Priority Health Narrow/Tiered Network	$97.15
Rate for Payer: UHC All Payor (Choice/PPO)	$127.60
Rate for Payer: UHC Core	$121.08
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$108.75

Know your out-of-pocket cost for care.

All Charges