Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR 1ST PSYCHIATRIC COLLAB CARE MGMT 1ST 70 MINS

Professional

Both

$324.00

Service Code	HCPCS 99492
Min. Negotiated Rate	$52.40
Max. Negotiated Rate	$243.00
Rate for Payer: Aetna Commercial	$92.57
Rate for Payer: Aetna Medicare	$162.00
Rate for Payer: BCBS Complete	$55.02
Rate for Payer: BCN Commercial	$109.08
Rate for Payer: Cash Price	$259.20
Rate for Payer: Cash Price	$259.20
Rate for Payer: Mclaren Medicaid	$52.40
Rate for Payer: Meridian Medicaid	$55.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$243.00
Rate for Payer: Priority Health Choice Medicaid	$52.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$172.40
Rate for Payer: Priority Health Narrow/Tiered Network	$172.40
Rate for Payer: UHC Medicaid	$52.40
Rate for Payer: UHCCP Medicaid	$52.40

PR 1ST/SBSQ PSYCH COLLAB CARE MGMT EA ADDL 30 MINS

Professional

Both

$133.00

Service Code	HCPCS 99494
Min. Negotiated Rate	$23.00
Max. Negotiated Rate	$99.75
Rate for Payer: Aetna Commercial	$40.26
Rate for Payer: Aetna Medicare	$66.50
Rate for Payer: BCBS Complete	$24.15
Rate for Payer: BCN Commercial	$53.02
Rate for Payer: Cash Price	$106.40
Rate for Payer: Cash Price	$106.40
Rate for Payer: Mclaren Medicaid	$23.00
Rate for Payer: Meridian Medicaid	$24.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$99.75
Rate for Payer: Priority Health Choice Medicaid	$23.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$82.71
Rate for Payer: Priority Health Narrow/Tiered Network	$82.71
Rate for Payer: UHC Medicaid	$23.00
Rate for Payer: UHCCP Medicaid	$23.00

PR 2VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE

Professional

Both

$287.00

Service Code	HCPCS 90650
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$215.25
Rate for Payer: Aetna Commercial	$141.25
Rate for Payer: Aetna Medicare	$143.50
Rate for Payer: BCBS Complete	$114.80
Rate for Payer: BCBS Trust/PPO	$133.16
Rate for Payer: BCN Commercial	$0.01
Rate for Payer: Cash Price	$229.60
Rate for Payer: Cash Price	$229.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$215.25

PR 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE

Professional

Both

$271.00

Service Code	HCPCS 90649
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$203.25
Rate for Payer: Aetna Commercial	$163.24
Rate for Payer: Aetna Medicare	$135.50
Rate for Payer: BCBS Complete	$108.40
Rate for Payer: BCBS Trust/PPO	$160.17
Rate for Payer: BCN Commercial	$0.01
Rate for Payer: Cash Price	$216.80
Rate for Payer: Cash Price	$216.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$203.25

PR 5% DEXTROSE IN LAC RINGERS

Professional

Both

$32.00

Service Code	HCPCS J7121
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$7.42
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCBS Trust/PPO	$1.84
Rate for Payer: BCN Commercial	$1.85
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00

PR 9VHPV VACC 2/3 DOSE SCHED IM USE

Professional

Both

$305.00

Service Code	HCPCS 90651
Min. Negotiated Rate	$152.50
Max. Negotiated Rate	$329.09
Rate for Payer: Aetna Commercial	$293.16
Rate for Payer: Aetna Medicare	$152.50
Rate for Payer: BCBS Trust/PPO	$329.09
Rate for Payer: BCN Commercial	$310.00
Rate for Payer: Cash Price	$244.00
Rate for Payer: Cash Price	$244.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$228.75

PR AAA REPAIR,AORTO-AORTIC TUBE PROSTH

Professional

Both

$4,055.00

Service Code	HCPCS 34800
Min. Negotiated Rate	$1,622.00
Max. Negotiated Rate	$3,041.25
Rate for Payer: Aetna Medicare	$2,027.50
Rate for Payer: BCBS Complete	$1,622.00
Rate for Payer: Cash Price	$3,244.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,041.25

PR AAA REPAIR,MODULR BIFURCATED PROSTH

Professional

Both

$2,632.00

Service Code	HCPCS 34802
Min. Negotiated Rate	$1,052.80
Max. Negotiated Rate	$1,974.00
Rate for Payer: Aetna Medicare	$1,316.00
Rate for Payer: BCBS Complete	$1,052.80
Rate for Payer: Cash Price	$2,105.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,974.00

PR AAA REPAIR,MODULR BIFUR PROSTH,2-DOCK

Professional

Both

$2,701.00

Service Code	HCPCS 34803
Min. Negotiated Rate	$1,080.40
Max. Negotiated Rate	$2,025.75
Rate for Payer: Aetna Medicare	$1,350.50
Rate for Payer: BCBS Complete	$1,080.40
Rate for Payer: Cash Price	$2,160.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,025.75

PR AAA REPAIR,UNIBODY BIFURCATED PROSTH

Professional

Both

$5,677.00

Service Code	HCPCS 34804
Min. Negotiated Rate	$2,270.80
Max. Negotiated Rate	$4,257.75
Rate for Payer: Aetna Medicare	$2,838.50
Rate for Payer: BCBS Complete	$2,270.80
Rate for Payer: Cash Price	$4,541.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,257.75

PR AAA REPR,1ST VESSEL,EXTENSION PROSTH

Professional

Both

$2,779.00

Service Code	HCPCS 34825
Min. Negotiated Rate	$1,111.60
Max. Negotiated Rate	$2,084.25
Rate for Payer: Aetna Medicare	$1,389.50
Rate for Payer: BCBS Complete	$1,111.60
Rate for Payer: Cash Price	$2,223.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,084.25

PR AAA REPR,ADD VESSEL,EXTENSION PROSTH

Professional

Both

$449.00

Service Code	HCPCS 34826
Min. Negotiated Rate	$179.60
Max. Negotiated Rate	$336.75
Rate for Payer: Aetna Medicare	$224.50
Rate for Payer: BCBS Complete	$179.60
Rate for Payer: Cash Price	$359.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$336.75

PR ABATACEPT INJECTION

Professional

Both

$42.00

Service Code	HCPCS J0129
Min. Negotiated Rate	$21.00
Max. Negotiated Rate	$58.53
Rate for Payer: Aetna Commercial	$44.46
Rate for Payer: Aetna Medicare	$21.00
Rate for Payer: BCBS Trust/PPO	$58.53
Rate for Payer: BCN Commercial	$57.21
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.50

PR ABDL LMPHADEC REG CELIAC GSTR PORTAL PRIPNCRTC

Professional

Both

$497.00

Service Code	HCPCS 38747
Min. Negotiated Rate	$152.72
Max. Negotiated Rate	$525.45
Rate for Payer: Aetna Commercial	$333.84
Rate for Payer: Aetna Medicare	$248.50
Rate for Payer: BCBS Complete	$160.36
Rate for Payer: BCN Commercial	$394.90
Rate for Payer: Cash Price	$397.60
Rate for Payer: Cash Price	$397.60
Rate for Payer: Mclaren Medicaid	$152.72
Rate for Payer: Meridian Medicaid	$160.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$372.75
Rate for Payer: Priority Health Choice Medicaid	$152.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$525.45
Rate for Payer: Priority Health Narrow/Tiered Network	$525.45
Rate for Payer: UHC Medicaid	$152.72
Rate for Payer: UHCCP Medicaid	$152.72

PR ABDOMINOPLASTY (2HRS)

Professional

Both

$3,605.00

Hospital Revenue Code	990
Min. Negotiated Rate	$1,442.00
Max. Negotiated Rate	$2,703.75
Rate for Payer: Aetna Medicare	$1,802.50
Rate for Payer: BCBS Complete	$1,442.00
Rate for Payer: Cash Price	$2,884.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,703.75

PR ABDOMINOPLASTY (3HRS)

Professional

Both

$5,408.00

Hospital Revenue Code	990
Min. Negotiated Rate	$2,163.20
Max. Negotiated Rate	$4,056.00
Rate for Payer: Aetna Medicare	$2,704.00
Rate for Payer: BCBS Complete	$2,163.20
Rate for Payer: Cash Price	$4,326.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,056.00

PR ABDOMINOPLASTY W/ BREAST AUGMENT

Professional

Both

$7,669.00

Hospital Revenue Code	990
Min. Negotiated Rate	$3,067.60
Max. Negotiated Rate	$5,751.75
Rate for Payer: Aetna Medicare	$3,834.50
Rate for Payer: BCBS Complete	$3,067.60
Rate for Payer: Cash Price	$6,135.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,751.75

PR ABDOMINO-VAG VESICAL NCK SSP W/WO NDSC CTRL

Professional

Both

$2,707.00

Service Code	HCPCS 51845
Min. Negotiated Rate	$338.24
Max. Negotiated Rate	$2,030.25
Rate for Payer: Aetna Commercial	$747.51
Rate for Payer: Aetna Medicare	$1,353.50
Rate for Payer: BCBS Complete	$355.15
Rate for Payer: BCN Commercial	$875.45
Rate for Payer: Cash Price	$2,165.60
Rate for Payer: Cash Price	$2,165.60
Rate for Payer: Mclaren Medicaid	$338.24
Rate for Payer: Meridian Medicaid	$355.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,030.25
Rate for Payer: Priority Health Choice Medicaid	$338.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$953.65
Rate for Payer: Priority Health Narrow/Tiered Network	$953.65
Rate for Payer: UHC Medicaid	$338.24
Rate for Payer: UHCCP Medicaid	$338.24

PR ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE

Professional

Both

$489.00

Service Code	HCPCS 49083
Min. Negotiated Rate	$59.21
Max. Negotiated Rate	$366.75
Rate for Payer: Aetna Commercial	$141.10
Rate for Payer: Aetna Medicare	$244.50
Rate for Payer: BCBS Complete	$62.17
Rate for Payer: BCN Commercial	$156.86
Rate for Payer: Cash Price	$391.20
Rate for Payer: Cash Price	$391.20
Rate for Payer: Mclaren Medicaid	$59.21
Rate for Payer: Meridian Medicaid	$62.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$366.75
Rate for Payer: Priority Health Choice Medicaid	$59.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$191.13
Rate for Payer: Priority Health Narrow/Tiered Network	$191.13
Rate for Payer: UHC Medicaid	$59.21
Rate for Payer: UHCCP Medicaid	$59.21

PR ABDOM PARACENTESIS DX/THER W/O IMAGING GUIDANCE

Professional

Both

$268.00

Service Code	HCPCS 49082
Min. Negotiated Rate	$45.37
Max. Negotiated Rate	$201.00
Rate for Payer: Aetna Commercial	$97.15
Rate for Payer: Aetna Medicare	$134.00
Rate for Payer: BCBS Complete	$47.64
Rate for Payer: BCN Commercial	$108.56
Rate for Payer: Cash Price	$214.40
Rate for Payer: Cash Price	$214.40
Rate for Payer: Mclaren Medicaid	$45.37
Rate for Payer: Meridian Medicaid	$47.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$201.00
Rate for Payer: Priority Health Choice Medicaid	$45.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$132.28
Rate for Payer: Priority Health Narrow/Tiered Network	$132.28
Rate for Payer: UHC Medicaid	$45.37
Rate for Payer: UHCCP Medicaid	$45.37

PR ABLATE L/R ATRIAL FIBRIL W/ISOLATED PULM VEIN

Professional

Both

$902.00

Service Code	HCPCS 93657
Min. Negotiated Rate	$166.35
Max. Negotiated Rate	$676.50
Rate for Payer: Aetna Commercial	$570.20
Rate for Payer: Aetna Medicare	$451.00
Rate for Payer: BCBS Complete	$174.67
Rate for Payer: BCN Commercial	$447.69
Rate for Payer: Cash Price	$721.60
Rate for Payer: Cash Price	$721.60
Rate for Payer: Mclaren Medicaid	$166.35
Rate for Payer: Meridian Medicaid	$174.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$676.50
Rate for Payer: Priority Health Choice Medicaid	$166.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$425.51
Rate for Payer: Priority Health Narrow/Tiered Network	$425.51
Rate for Payer: UHC Medicaid	$166.35
Rate for Payer: UHCCP Medicaid	$166.35

PR ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE

Professional

Both

$7,486.00

Service Code	HCPCS 20982
Min. Negotiated Rate	$205.12
Max. Negotiated Rate	$5,614.50
Rate for Payer: Aetna Commercial	$489.87
Rate for Payer: Aetna Medicare	$3,743.00
Rate for Payer: BCBS Complete	$215.38
Rate for Payer: BCN Commercial	$543.80
Rate for Payer: Cash Price	$5,988.80
Rate for Payer: Cash Price	$5,988.80
Rate for Payer: Mclaren Medicaid	$205.12
Rate for Payer: Meridian Medicaid	$215.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,614.50
Rate for Payer: Priority Health Choice Medicaid	$205.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$581.30
Rate for Payer: Priority Health Narrow/Tiered Network	$581.30
Rate for Payer: UHC Medicaid	$205.12
Rate for Payer: UHCCP Medicaid	$205.12

PR ABLATION & RCNSTJ ATRIA EXTNSV W/BYPASS

Professional

Both

$3,879.00

Service Code	HCPCS 33256
Min. Negotiated Rate	$1,165.11
Max. Negotiated Rate	$3,041.73
Rate for Payer: Aetna Commercial	$2,606.31
Rate for Payer: Aetna Medicare	$1,939.50
Rate for Payer: BCBS Complete	$1,223.37
Rate for Payer: BCN Commercial	$2,828.53
Rate for Payer: Cash Price	$3,103.20
Rate for Payer: Cash Price	$3,103.20
Rate for Payer: Mclaren Medicaid	$1,165.11
Rate for Payer: Meridian Medicaid	$1,223.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,909.25
Rate for Payer: Priority Health Choice Medicaid	$1,165.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,041.73
Rate for Payer: Priority Health Narrow/Tiered Network	$3,041.73
Rate for Payer: UHC Medicaid	$1,165.11
Rate for Payer: UHCCP Medicaid	$1,165.11

PR ABLATION & RECONSTRUCTION ATRIA LIMITED

Professional

Both

$3,460.00

Service Code	HCPCS 33254
Min. Negotiated Rate	$824.74
Max. Negotiated Rate	$2,595.00
Rate for Payer: Aetna Commercial	$1,818.24
Rate for Payer: Aetna Medicare	$1,730.00
Rate for Payer: BCBS Complete	$865.98
Rate for Payer: BCN Commercial	$2,006.37
Rate for Payer: Cash Price	$2,768.00
Rate for Payer: Cash Price	$2,768.00
Rate for Payer: Mclaren Medicaid	$824.74
Rate for Payer: Meridian Medicaid	$865.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,595.00
Rate for Payer: Priority Health Choice Medicaid	$824.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,157.59
Rate for Payer: Priority Health Narrow/Tiered Network	$2,157.59
Rate for Payer: UHC Medicaid	$824.74
Rate for Payer: UHCCP Medicaid	$824.74

PR ABLTJ SOF TISS INF TURBS UNI/BI SUPFC INTRAMURAL

Professional

Both

$574.00

Service Code	HCPCS 30802
Min. Negotiated Rate	$116.94
Max. Negotiated Rate	$430.50
Rate for Payer: Aetna Commercial	$255.96
Rate for Payer: Aetna Medicare	$287.00
Rate for Payer: BCBS Complete	$122.79
Rate for Payer: BCN Commercial	$300.78
Rate for Payer: Cash Price	$459.20
Rate for Payer: Cash Price	$459.20
Rate for Payer: Mclaren Medicaid	$116.94
Rate for Payer: Meridian Medicaid	$122.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$430.50
Rate for Payer: Priority Health Choice Medicaid	$116.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$283.24
Rate for Payer: Priority Health Narrow/Tiered Network	$283.24
Rate for Payer: UHC Medicaid	$116.94
Rate for Payer: UHCCP Medicaid	$116.94

Know your out-of-pocket cost for care.

All Charges