Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR VISION EXAM

Facility

$53.00

Service Code	CPT 99173
Hospital Charge Code	51000008
Hospital Revenue Code	510
Min. Negotiated Rate	$36.89
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna Commercial	$45.05
Rate for Payer: BCBS Trust/PPO	$43.77
Rate for Payer: BCN Commercial	$43.77
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cofinity Commercial	$45.58
Rate for Payer: Encore Health Key Benefits Commercial	$42.40
Rate for Payer: Healthscope Commercial	$47.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$39.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.05
Rate for Payer: Nomi Health Commercial	$43.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.75
Rate for Payer: PHP Commercial	$45.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$46.11
Rate for Payer: Priority Health Narrow/Tiered Network	$36.89
Rate for Payer: UHC All Payor (Choice/PPO)	$46.64
Rate for Payer: UHC Core	$44.26
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$39.75

PR VISION EXAM

Facility

$53.00

Service Code	CPT 99173
Hospital Charge Code	51000008
Hospital Revenue Code	510
Min. Negotiated Rate	$9.34
Max. Negotiated Rate	$47.70
Rate for Payer: Aetna Commercial	$45.05
Rate for Payer: Aetna Medicare	$13.78
Rate for Payer: Allen County Amish Medical Aid Commercial	$16.56
Rate for Payer: Amish Plain Church Group Commercial	$16.56
Rate for Payer: BCBS Complete	$9.81
Rate for Payer: BCBS MAPPO	$13.25
Rate for Payer: BCBS Trust/PPO	$43.57
Rate for Payer: BCN Commercial	$43.57
Rate for Payer: BCN Medicare Advantage	$13.25
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cofinity Commercial	$45.58
Rate for Payer: Encore Health Key Benefits Commercial	$42.40
Rate for Payer: Health Alliance Plan Medicare Advantage	$13.25
Rate for Payer: Healthscope Commercial	$47.70
Rate for Payer: Lakeland Regional Health Systems Commercial	$39.75
Rate for Payer: Mclaren Medicaid	$9.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$13.91
Rate for Payer: Meridian Medicaid	$9.81
Rate for Payer: MI Amish Medical Board Commercial	$15.24
Rate for Payer: Molina Medicare/Medicaid	$14.57
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$45.05
Rate for Payer: Nomi Health Commercial	$43.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.75
Rate for Payer: PACE Senior Care Partners	$12.59
Rate for Payer: PACE SWMI	$13.25
Rate for Payer: PHP Commercial	$45.05
Rate for Payer: PHP Medicare Advantage	$13.25
Rate for Payer: Priority Health Choice Medicaid	$9.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$46.11
Rate for Payer: Priority Health Medicare	$13.38
Rate for Payer: Priority Health Narrow/Tiered Network	$36.89
Rate for Payer: Railroad Medicare Medicare	$13.25
Rate for Payer: UHC All Payor (Choice/PPO)	$46.64
Rate for Payer: UHC Core	$44.26
Rate for Payer: UHC Exchange	$13.25
Rate for Payer: UHC Medicaid	$9.34
Rate for Payer: UHC Medicare Advantage	$13.25
Rate for Payer: UHCCP Medicaid	$9.34
Rate for Payer: VA VA	$13.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$39.75

PR VISIT TO DETERM LDCT ELIG

Professional

Both

$56.00

Service Code	HCPCS G0296
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$26.13
Rate for Payer: Aetna Medicare	$28.00
Rate for Payer: BCBS Complete	$22.40
Rate for Payer: BCN Commercial	$37.35
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cash Price	$44.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$42.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$34.44
Rate for Payer: Priority Health Narrow/Tiered Network	$34.44

PR VISUAL EP TESTING CNS EXCEPT GLAUCOMA W/I&R

Professional

Both

$281.00

Service Code	HCPCS 95930
Min. Negotiated Rate	$71.41
Max. Negotiated Rate	$210.75
Rate for Payer: Aetna Commercial	$71.41
Rate for Payer: Aetna Medicare	$140.50
Rate for Payer: BCN Commercial	$98.60
Rate for Payer: Cash Price	$224.80
Rate for Payer: Cash Price	$224.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$210.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$90.94
Rate for Payer: Priority Health Narrow/Tiered Network	$90.94

PR VISUAL REINFORCEMENT AUDIOMETRY

Professional

Both

$79.00

Service Code	HCPCS 92579
Min. Negotiated Rate	$31.60
Max. Negotiated Rate	$59.25
Rate for Payer: Aetna Commercial	$42.06
Rate for Payer: Aetna Medicare	$39.50
Rate for Payer: BCBS Complete	$31.60
Rate for Payer: BCN Commercial	$54.78
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cash Price	$63.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$59.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$50.52
Rate for Payer: Priority Health Narrow/Tiered Network	$50.52

PR VITAL CAPACITY TOTAL SEPARATE PROCEDURE

Professional

Both

$45.00

Service Code	HCPCS 94150
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$37.85
Rate for Payer: Aetna Commercial	$26.29
Rate for Payer: Aetna Medicare	$22.50
Rate for Payer: BCN Commercial	$37.85
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$33.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$34.90
Rate for Payer: Priority Health Narrow/Tiered Network	$34.90

PR VITAMIN B12 INJECTION

Professional

Both

$5.00

Service Code	HCPCS J3420
Min. Negotiated Rate	$0.05
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$1.49
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Trust/PPO	$0.06
Rate for Payer: BCN Commercial	$0.05
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR VITAMIN K PHYTONADIONE INJ

Professional

Both

$5.00

Service Code	HCPCS J3430
Min. Negotiated Rate	$1.48
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$2.99
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Trust/PPO	$1.48
Rate for Payer: BCN Commercial	$2.24
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR VLVP MITRAL VALVE W/BYPASS RAD RCNSTJ W/WO RING

Professional

Both

$5,278.00

Service Code	HCPCS 33427
Min. Negotiated Rate	$1,449.68
Max. Negotiated Rate	$3,958.50
Rate for Payer: Aetna Commercial	$3,275.80
Rate for Payer: Aetna Medicare	$2,639.00
Rate for Payer: BCBS Complete	$1,522.16
Rate for Payer: BCN Commercial	$3,579.98
Rate for Payer: Cash Price	$4,222.40
Rate for Payer: Cash Price	$4,222.40
Rate for Payer: Mclaren Medicaid	$1,449.68
Rate for Payer: Meridian Medicaid	$1,522.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,958.50
Rate for Payer: Priority Health Choice Medicaid	$1,449.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,849.82
Rate for Payer: Priority Health Narrow/Tiered Network	$3,849.82
Rate for Payer: UHC Medicaid	$1,449.68
Rate for Payer: UHCCP Medicaid	$1,449.68

PR VLVP MITRAL VALVE W/CARD BYP W/PROSTC RING

Professional

Both

$9,170.00

Service Code	HCPCS 33426
Min. Negotiated Rate	$1,423.27
Max. Negotiated Rate	$6,877.50
Rate for Payer: Aetna Commercial	$3,196.20
Rate for Payer: Aetna Medicare	$4,585.00
Rate for Payer: BCBS Complete	$1,494.43
Rate for Payer: BCN Commercial	$3,502.80
Rate for Payer: Cash Price	$7,336.00
Rate for Payer: Cash Price	$7,336.00
Rate for Payer: Mclaren Medicaid	$1,423.27
Rate for Payer: Meridian Medicaid	$1,494.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,877.50
Rate for Payer: Priority Health Choice Medicaid	$1,423.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,766.81
Rate for Payer: Priority Health Narrow/Tiered Network	$3,766.81
Rate for Payer: UHC Medicaid	$1,423.27
Rate for Payer: UHCCP Medicaid	$1,423.27

PR VNPNXR <3 YEARS PHY/QHP SKILL FEMORAL/JUGULAR VN

Professional

Both

$85.00

Service Code	HCPCS 36400
Min. Negotiated Rate	$10.01
Max. Negotiated Rate	$63.75
Rate for Payer: Aetna Commercial	$25.75
Rate for Payer: Aetna Medicare	$42.50
Rate for Payer: BCBS Complete	$10.51
Rate for Payer: BCN Commercial	$27.39
Rate for Payer: Cash Price	$68.00
Rate for Payer: Cash Price	$68.00
Rate for Payer: Mclaren Medicaid	$10.01
Rate for Payer: Meridian Medicaid	$10.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.75
Rate for Payer: Priority Health Choice Medicaid	$10.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$29.45
Rate for Payer: Priority Health Narrow/Tiered Network	$29.45
Rate for Payer: UHC Medicaid	$10.01
Rate for Payer: UHCCP Medicaid	$10.01

PR VNPNXR 3 YEARS/> PHYS/QHP SKILL DX/THER PURPOSES

Professional

Both

$36.00

Service Code	HCPCS 36410
Min. Negotiated Rate	$12.41
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$12.41
Rate for Payer: Aetna Medicare	$18.00
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: BCN Commercial	$13.45
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$14.45
Rate for Payer: Priority Health Narrow/Tiered Network	$14.45

PR VNPNXR <3 YEARS PHYS/QHP SKILL OTHER VEIN

Professional

Both

$38.00

Service Code	HCPCS 36406
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna Commercial	$11.51
Rate for Payer: Aetna Medicare	$19.00
Rate for Payer: BCBS Complete	$5.14
Rate for Payer: BCN Commercial	$12.95
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cash Price	$30.40
Rate for Payer: Mclaren Medicaid	$4.90
Rate for Payer: Meridian Medicaid	$5.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$28.50
Rate for Payer: Priority Health Choice Medicaid	$4.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$13.92
Rate for Payer: Priority Health Narrow/Tiered Network	$13.92
Rate for Payer: UHC Medicaid	$4.90
Rate for Payer: UHCCP Medicaid	$4.90

PR VOID PRESSURE STUDIES INTRAABDOMINAL

Professional

Both

$534.00

Service Code	HCPCS 51797
Min. Negotiated Rate	$231.52
Max. Negotiated Rate	$400.50
Rate for Payer: Aetna Commercial	$231.52
Rate for Payer: Aetna Medicare	$267.00
Rate for Payer: BCN Commercial	$247.99
Rate for Payer: Cash Price	$427.20
Rate for Payer: Cash Price	$427.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$400.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$270.15
Rate for Payer: Priority Health Narrow/Tiered Network	$270.15

PR VSTBLR FUNCJ NYSTAG FOVL&PERPH STIMJ OSCIL TRK

Professional

Both

$144.00

Service Code	HCPCS 92540
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$156.37
Rate for Payer: Aetna Commercial	$119.63
Rate for Payer: Aetna Medicare	$72.00
Rate for Payer: BCN Commercial	$156.37
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cash Price	$115.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$108.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$144.21
Rate for Payer: Priority Health Narrow/Tiered Network	$144.21

PR VULVECTOMY RADICAL PARTIAL

Professional

Both

$1,672.00

Service Code	HCPCS 56630
Min. Negotiated Rate	$572.54
Max. Negotiated Rate	$1,462.61
Rate for Payer: Aetna Commercial	$1,132.58
Rate for Payer: Aetna Medicare	$836.00
Rate for Payer: BCBS Complete	$601.17
Rate for Payer: BCN Commercial	$1,444.14
Rate for Payer: Cash Price	$1,337.60
Rate for Payer: Cash Price	$1,337.60
Rate for Payer: Mclaren Medicaid	$572.54
Rate for Payer: Meridian Medicaid	$601.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,254.00
Rate for Payer: Priority Health Choice Medicaid	$572.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,462.61
Rate for Payer: Priority Health Narrow/Tiered Network	$1,462.61
Rate for Payer: UHC Medicaid	$572.54
Rate for Payer: UHCCP Medicaid	$572.54

PR VULVECTOMY SIMPLE PARTIAL

Professional

Both

$1,618.00

Service Code	HCPCS 56620
Min. Negotiated Rate	$348.68
Max. Negotiated Rate	$1,213.50
Rate for Payer: Aetna Commercial	$677.28
Rate for Payer: Aetna Medicare	$809.00
Rate for Payer: BCBS Complete	$366.11
Rate for Payer: BCN Commercial	$883.42
Rate for Payer: Cash Price	$1,294.40
Rate for Payer: Cash Price	$1,294.40
Rate for Payer: Mclaren Medicaid	$348.68
Rate for Payer: Meridian Medicaid	$366.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,213.50
Rate for Payer: Priority Health Choice Medicaid	$348.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$894.72
Rate for Payer: Priority Health Narrow/Tiered Network	$894.72
Rate for Payer: UHC Medicaid	$348.68
Rate for Payer: UHCCP Medicaid	$348.68

PR WEDGE EXCISION SKIN NAIL FOLD

Professional

Both

$280.00

Service Code	HCPCS 11765
Min. Negotiated Rate	$56.87
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$94.01
Rate for Payer: Aetna Medicare	$140.00
Rate for Payer: BCBS Complete	$59.71
Rate for Payer: BCN Commercial	$110.74
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cash Price	$224.00
Rate for Payer: Mclaren Medicaid	$56.87
Rate for Payer: Meridian Medicaid	$59.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$210.00
Rate for Payer: Priority Health Choice Medicaid	$56.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$128.53
Rate for Payer: Priority Health Narrow/Tiered Network	$128.53
Rate for Payer: UHC Medicaid	$56.87
Rate for Payer: UHCCP Medicaid	$56.87

PR WEDGE RESCJ/BISCTJ OVARY UNI/BI

Professional

Both

$1,987.00

Service Code	HCPCS 58920
Min. Negotiated Rate	$402.57
Max. Negotiated Rate	$1,490.25
Rate for Payer: Aetna Commercial	$854.80
Rate for Payer: Aetna Medicare	$993.50
Rate for Payer: BCBS Complete	$422.70
Rate for Payer: BCN Commercial	$1,070.66
Rate for Payer: Cash Price	$1,589.60
Rate for Payer: Cash Price	$1,589.60
Rate for Payer: Mclaren Medicaid	$402.57
Rate for Payer: Meridian Medicaid	$422.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,490.25
Rate for Payer: Priority Health Choice Medicaid	$402.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,084.35
Rate for Payer: Priority Health Narrow/Tiered Network	$1,084.35
Rate for Payer: UHC Medicaid	$402.57
Rate for Payer: UHCCP Medicaid	$402.57

PR WEDGING CAST EXCEPT CLUBFOOT CASTS

Professional

Both

$117.00

Service Code	HCPCS 29740
Min. Negotiated Rate	$38.55
Max. Negotiated Rate	$110.20
Rate for Payer: Aetna Commercial	$92.51
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: BCBS Complete	$40.48
Rate for Payer: BCN Commercial	$103.08
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Mclaren Medicaid	$38.55
Rate for Payer: Meridian Medicaid	$40.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$87.75
Rate for Payer: Priority Health Choice Medicaid	$38.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$110.20
Rate for Payer: Priority Health Narrow/Tiered Network	$110.20
Rate for Payer: UHC Medicaid	$38.55
Rate for Payer: UHCCP Medicaid	$38.55

PR WESTONE MUSICIAN EAR PLUGS

Professional

Both

$305.00

Hospital Revenue Code	990
Min. Negotiated Rate	$122.00
Max. Negotiated Rate	$228.75
Rate for Payer: Aetna Medicare	$152.50
Rate for Payer: BCBS Complete	$122.00
Rate for Payer: Cash Price	$244.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$228.75

PR WET MOUNTS/ W PREPARATIONS

Professional

Both

$12.00

Service Code	HCPCS Q0111
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$14.39
Rate for Payer: Aetna Commercial	$14.39
Rate for Payer: Aetna Medicare	$6.00
Rate for Payer: BCN Commercial	$12.75
Rate for Payer: Cash Price	$9.60
Rate for Payer: Cash Price	$9.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.00

PR WHFO, RIGID W/O JOINTS

Professional

Both

$343.00

Service Code	HCPCS L3808
Min. Negotiated Rate	$137.20
Max. Negotiated Rate	$381.46
Rate for Payer: Aetna Commercial	$195.26
Rate for Payer: Aetna Medicare	$171.50
Rate for Payer: BCBS Complete	$137.20
Rate for Payer: BCN Commercial	$381.46
Rate for Payer: Cash Price	$274.40
Rate for Payer: Cash Price	$274.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$257.25

PR WHFO W/O JOINTS PRE CST

Professional

Both

$241.00

Service Code	HCPCS L3807
Min. Negotiated Rate	$96.40
Max. Negotiated Rate	$267.76
Rate for Payer: Aetna Commercial	$137.06
Rate for Payer: Aetna Medicare	$120.50
Rate for Payer: BCBS Complete	$96.40
Rate for Payer: BCN Commercial	$267.76
Rate for Payer: Cash Price	$192.80
Rate for Payer: Cash Price	$192.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$180.75

PR WHO COCK-UP NONMOLDE PRE OTS

Professional

Both

$71.00

Service Code	HCPCS L3908
Min. Negotiated Rate	$28.40
Max. Negotiated Rate	$78.51
Rate for Payer: Aetna Commercial	$40.19
Rate for Payer: Aetna Medicare	$35.50
Rate for Payer: BCBS Complete	$28.40
Rate for Payer: BCN Commercial	$78.51
Rate for Payer: Cash Price	$56.80
Rate for Payer: Cash Price	$56.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$53.25

Know your out-of-pocket cost for care.

All Charges