Bronson Lakeview Hospital

All Charges

Charge

Type

Price

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR

Facility IP

$154.47

Service Code	NDC 70756-703-60
Hospital Charge Code	70434
Hospital Revenue Code	637
Min. Negotiated Rate	$94.21
Max. Negotiated Rate	$139.02
Rate for Payer: Aetna Commercial	$131.30
Rate for Payer: BCBS Trust/PPO	$119.37
Rate for Payer: BCN Commercial	$119.37
Rate for Payer: Cash Price	$123.58
Rate for Payer: Cofinity Commercial	$132.84
Rate for Payer: Encore Health Key Benefits Commercial	$123.58
Rate for Payer: Healthscope Commercial	$139.02
Rate for Payer: Lakeland Regional Health Systems Commercial	$115.85
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$131.30
Rate for Payer: PHP Commercial	$131.30
Rate for Payer: Priority Health Cigna Priority Health	$108.13
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$134.39
Rate for Payer: Priority Health Narrow/Tiered Network	$94.21
Rate for Payer: UHC All Payor (Choice/PPO)	$135.93
Rate for Payer: UHC Core	$128.98
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$115.85

RANOLAZINE ER 500 MG TABLET,EXTENDED RELEASE,12 HR

Facility IP

$1,414.81

Service Code	NDC 61958-1003-1
Hospital Charge Code	70434
Hospital Revenue Code	637
Min. Negotiated Rate	$862.89
Max. Negotiated Rate	$1,273.33
Rate for Payer: Aetna Commercial	$1,202.59
Rate for Payer: BCBS Trust/PPO	$1,093.37
Rate for Payer: BCN Commercial	$1,093.37
Rate for Payer: Cash Price	$1,131.85
Rate for Payer: Cofinity Commercial	$1,216.74
Rate for Payer: Encore Health Key Benefits Commercial	$1,131.85
Rate for Payer: Healthscope Commercial	$1,273.33
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,061.11
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,202.59
Rate for Payer: PHP Commercial	$1,202.59
Rate for Payer: Priority Health Cigna Priority Health	$990.37
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,230.88
Rate for Payer: Priority Health Narrow/Tiered Network	$862.89
Rate for Payer: UHC All Payor (Choice/PPO)	$1,245.03
Rate for Payer: UHC Core	$1,181.37
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,061.11

RECONSTRUCTION OF DISLOCATING PATELLA; WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCEMENT OR RELEASE (EG, CAMPBELL, GOLDWAITE TYPE PROCEDURE)

Facility OP

$4,927.66

Service Code	CPT 27422
Hospital Revenue Code	360
Min. Negotiated Rate	$4,693.01
Max. Negotiated Rate	$4,927.66
Rate for Payer: BCBS Complete	$4,927.66
Rate for Payer: Mclaren Medicaid	$4,693.01
Rate for Payer: Meridian Medicaid	$4,927.66
Rate for Payer: Priority Health Choice Medicaid	$4,693.01

REGADENOSON 0.4 MG/5 ML INTRAVENOUS SYRINGE

Facility IP

$476.59

Service Code	HCPCS J2785
Hospital Charge Code	91408
Hospital Revenue Code	636
Min. Negotiated Rate	$290.67
Max. Negotiated Rate	$428.93
Rate for Payer: Aetna Commercial	$405.10
Rate for Payer: BCBS Trust/PPO	$368.31
Rate for Payer: BCN Commercial	$368.31
Rate for Payer: Cash Price	$381.27
Rate for Payer: Cofinity Commercial	$409.87
Rate for Payer: Encore Health Key Benefits Commercial	$381.27
Rate for Payer: Healthscope Commercial	$428.93
Rate for Payer: Lakeland Regional Health Systems Commercial	$357.44
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$405.10
Rate for Payer: PHP Commercial	$405.10
Rate for Payer: Priority Health Cigna Priority Health	$333.61
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$414.63
Rate for Payer: Priority Health Narrow/Tiered Network	$290.67
Rate for Payer: UHC All Payor (Choice/PPO)	$419.40
Rate for Payer: UHC Core	$397.95
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$357.44

REMDESIVIR 100 MG INTRAVENOUS POWDER FOR SOLUTION

Facility IP

$1,918.34

Service Code	HCPCS J0248
Hospital Charge Code	300469
Hospital Revenue Code	636
Min. Negotiated Rate	$1,170.00
Max. Negotiated Rate	$1,726.51
Rate for Payer: Aetna Commercial	$1,630.59
Rate for Payer: BCBS Trust/PPO	$1,482.49
Rate for Payer: BCN Commercial	$1,482.49
Rate for Payer: Cash Price	$1,534.67
Rate for Payer: Cofinity Commercial	$1,649.77
Rate for Payer: Encore Health Key Benefits Commercial	$1,534.67
Rate for Payer: Healthscope Commercial	$1,726.51
Rate for Payer: Lakeland Regional Health Systems Commercial	$1,438.76
Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS	$1,630.59
Rate for Payer: PHP Commercial	$1,630.59
Rate for Payer: Priority Health Cigna Priority Health	$1,342.84
Rate for Payer: Priority Health HMO/PPO/Tiered Network	$1,668.96
Rate for Payer: Priority Health Narrow/Tiered Network	$1,170.00
Rate for Payer: UHC All Payor (Choice/PPO)	$1,688.14
Rate for Payer: UHC Core	$1,601.81
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$1,438.76

REMOVAL OF EMBEDDED FOREIGN BODY, EYELID

Facility OP

$200.65

Service Code	CPT 67938
Hospital Revenue Code	360
Min. Negotiated Rate	$191.10
Max. Negotiated Rate	$200.65
Rate for Payer: BCBS Complete	$200.65
Rate for Payer: Mclaren Medicaid	$191.10
Rate for Payer: Meridian Medicaid	$200.65
Rate for Payer: Priority Health Choice Medicaid	$191.10

REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; SUBCUTANEOUS

Facility OP

$1,116.73

Service Code	CPT 24200
Hospital Revenue Code	360
Min. Negotiated Rate	$1,063.55
Max. Negotiated Rate	$1,116.73
Rate for Payer: BCBS Complete	$1,116.73
Rate for Payer: Mclaren Medicaid	$1,063.55
Rate for Payer: Meridian Medicaid	$1,116.73
Rate for Payer: Priority Health Choice Medicaid	$1,063.55

REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL BAND, NAIL, ROD OR PLATE)

Facility OP

$1,957.20

Service Code	CPT 20680
Hospital Revenue Code	360
Min. Negotiated Rate	$1,864.00
Max. Negotiated Rate	$1,957.20
Rate for Payer: BCBS Complete	$1,957.20
Rate for Payer: Mclaren Medicaid	$1,864.00
Rate for Payer: Meridian Medicaid	$1,957.20
Rate for Payer: Priority Health Choice Medicaid	$1,864.00

REMOVAL OF INTRAUTERINE DEVICE (IUD)

Facility OP

$220.97

Service Code	CPT 58301
Hospital Revenue Code	360
Min. Negotiated Rate	$210.45
Max. Negotiated Rate	$220.97
Rate for Payer: BCBS Complete	$220.97
Rate for Payer: Mclaren Medicaid	$210.45
Rate for Payer: Meridian Medicaid	$220.97
Rate for Payer: Priority Health Choice Medicaid	$210.45

REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS

Facility OP

$137.89

Service Code	CPT 11200
Hospital Revenue Code	360
Min. Negotiated Rate	$131.33
Max. Negotiated Rate	$137.89
Rate for Payer: BCBS Complete	$137.89
Rate for Payer: Mclaren Medicaid	$131.33
Rate for Payer: Meridian Medicaid	$137.89
Rate for Payer: Priority Health Choice Medicaid	$131.33

REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5 CM

Facility OP

$432.60

Service Code	CPT 13121
Hospital Revenue Code	360
Min. Negotiated Rate	$412.00
Max. Negotiated Rate	$432.60
Rate for Payer: BCBS Complete	$432.60
Rate for Payer: Mclaren Medicaid	$412.00
Rate for Payer: Meridian Medicaid	$432.60
Rate for Payer: Priority Health Choice Medicaid	$412.00

REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM

Facility OP

$432.60

Service Code	CPT 13101
Hospital Revenue Code	360
Min. Negotiated Rate	$412.00
Max. Negotiated Rate	$432.60
Rate for Payer: BCBS Complete	$432.60
Rate for Payer: Mclaren Medicaid	$412.00
Rate for Payer: Meridian Medicaid	$432.60
Rate for Payer: Priority Health Choice Medicaid	$412.00

REPAIR INGUINAL HERNIA, SLIDING, ANY AGE

Facility OP

$2,382.99

Service Code	CPT 49525
Hospital Revenue Code	360
Min. Negotiated Rate	$2,269.51
Max. Negotiated Rate	$2,382.99
Rate for Payer: BCBS Complete	$2,382.99
Rate for Payer: Mclaren Medicaid	$2,269.51
Rate for Payer: Meridian Medicaid	$2,382.99
Rate for Payer: Priority Health Choice Medicaid	$2,269.51

REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; INCARCERATED OR STRANGULATED

Facility OP

$2,382.99

Service Code	CPT 49507
Hospital Revenue Code	360
Min. Negotiated Rate	$2,269.51
Max. Negotiated Rate	$2,382.99
Rate for Payer: BCBS Complete	$2,382.99
Rate for Payer: Mclaren Medicaid	$2,269.51
Rate for Payer: Meridian Medicaid	$2,382.99
Rate for Payer: Priority Health Choice Medicaid	$2,269.51

REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OLDER; REDUCIBLE

Facility OP

$2,382.99

Service Code	CPT 49505
Hospital Revenue Code	360
Min. Negotiated Rate	$2,269.51
Max. Negotiated Rate	$2,382.99
Rate for Payer: BCBS Complete	$2,382.99
Rate for Payer: Mclaren Medicaid	$2,269.51
Rate for Payer: Meridian Medicaid	$2,382.99
Rate for Payer: Priority Health Choice Medicaid	$2,269.51

REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.6 CM TO 5.0 CM

Facility OP

$274.65

Service Code	CPT 12052
Hospital Revenue Code	360
Min. Negotiated Rate	$261.57
Max. Negotiated Rate	$274.65
Rate for Payer: BCBS Complete	$274.65
Rate for Payer: Mclaren Medicaid	$261.57
Rate for Payer: Meridian Medicaid	$274.65
Rate for Payer: Priority Health Choice Medicaid	$261.57

REPAIR, INTERMEDIATE, WOUNDS OF FACE, EARS, EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 5.1 CM TO 7.5 CM

Facility OP

$274.65

Service Code	CPT 12053
Hospital Revenue Code	360
Min. Negotiated Rate	$261.57
Max. Negotiated Rate	$274.65
Rate for Payer: BCBS Complete	$274.65
Rate for Payer: Mclaren Medicaid	$261.57
Rate for Payer: Meridian Medicaid	$274.65
Rate for Payer: Priority Health Choice Medicaid	$261.57

REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.5 CM OR LESS

Facility OP

$274.65

Service Code	CPT 12041
Hospital Revenue Code	360
Min. Negotiated Rate	$261.57
Max. Negotiated Rate	$274.65
Rate for Payer: BCBS Complete	$274.65
Rate for Payer: Mclaren Medicaid	$261.57
Rate for Payer: Meridian Medicaid	$274.65
Rate for Payer: Priority Health Choice Medicaid	$261.57

REPAIR, INTERMEDIATE, WOUNDS OF NECK, HANDS, FEET AND/OR EXTERNAL GENITALIA; 2.6 CM TO 7.5 CM

Facility OP

$274.65

Service Code	CPT 12042
Hospital Revenue Code	360
Min. Negotiated Rate	$261.57
Max. Negotiated Rate	$274.65
Rate for Payer: BCBS Complete	$274.65
Rate for Payer: Mclaren Medicaid	$261.57
Rate for Payer: Meridian Medicaid	$274.65
Rate for Payer: Priority Health Choice Medicaid	$261.57

REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 12.6 CM TO 20.0 CM

Facility OP

$274.65

Service Code	CPT 12035
Hospital Revenue Code	360
Min. Negotiated Rate	$261.57
Max. Negotiated Rate	$274.65
Rate for Payer: BCBS Complete	$274.65
Rate for Payer: Mclaren Medicaid	$261.57
Rate for Payer: Meridian Medicaid	$274.65
Rate for Payer: Priority Health Choice Medicaid	$261.57

REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.5 CM OR LESS

Facility OP

$274.65

Service Code	CPT 12031
Hospital Revenue Code	360
Min. Negotiated Rate	$261.57
Max. Negotiated Rate	$274.65
Rate for Payer: BCBS Complete	$274.65
Rate for Payer: Mclaren Medicaid	$261.57
Rate for Payer: Meridian Medicaid	$274.65
Rate for Payer: Priority Health Choice Medicaid	$261.57

REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM

Facility OP

$274.65

Service Code	CPT 12032
Hospital Revenue Code	360
Min. Negotiated Rate	$261.57
Max. Negotiated Rate	$274.65
Rate for Payer: BCBS Complete	$274.65
Rate for Payer: Mclaren Medicaid	$261.57
Rate for Payer: Meridian Medicaid	$274.65
Rate for Payer: Priority Health Choice Medicaid	$261.57

REPAIR, INTERMEDIATE, WOUNDS OF SCALP, AXILLAE, TRUNK AND/OR EXTREMITIES (EXCLUDING HANDS AND FEET); 7.6 CM TO 12.5 CM

Facility OP

$274.65

Service Code	CPT 12034
Hospital Revenue Code	360
Min. Negotiated Rate	$261.57
Max. Negotiated Rate	$274.65
Rate for Payer: BCBS Complete	$274.65
Rate for Payer: Mclaren Medicaid	$261.57
Rate for Payer: Meridian Medicaid	$274.65
Rate for Payer: Priority Health Choice Medicaid	$261.57

REPAIR OF ANTERIOR ABDOMINAL HERNIA(S) (IE, EPIGASTRIC, INCISIONAL, VENTRAL, UMBILICAL, SPIGELIAN), ANY APPROACH (IE, OPEN, LAPAROSCOPIC, ROBOTIC), INITIAL, INCLUDING IMPLANTATION OF MESH OR OTHER PROSTHESIS WHEN PERFORMED, TOTAL LENGTH OF DEFECT(S); 3 CM TO 10 CM, INCARCERATED OR STRANGULATED

Facility OP

$3,974.31

Service Code	CPT 49594
Hospital Revenue Code	360
Min. Negotiated Rate	$3,785.06
Max. Negotiated Rate	$3,974.31
Rate for Payer: BCBS Complete	$3,974.31
Rate for Payer: Mclaren Medicaid	$3,785.06
Rate for Payer: Meridian Medicaid	$3,974.31
Rate for Payer: Priority Health Choice Medicaid	$3,785.06

Facility OP

$2,382.99

Service Code	CPT 49593
Hospital Revenue Code	360
Min. Negotiated Rate	$2,269.51
Max. Negotiated Rate	$2,382.99
Rate for Payer: BCBS Complete	$2,382.99
Rate for Payer: Mclaren Medicaid	$2,269.51
Rate for Payer: Meridian Medicaid	$2,382.99
Rate for Payer: Priority Health Choice Medicaid	$2,269.51

Price Transparency.

All Charges