Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR APPLICATION FINGER SPLINT DYNAMIC

Professional

Both

$108.00

Service Code	HCPCS 29131
Min. Negotiated Rate	$19.81
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna Commercial	$45.51
Rate for Payer: Aetna Medicare	$54.00
Rate for Payer: BCBS Complete	$20.80
Rate for Payer: BCN Commercial	$52.29
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cash Price	$86.40
Rate for Payer: Mclaren Medicaid	$19.81
Rate for Payer: Meridian Medicaid	$20.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$81.00
Rate for Payer: Priority Health Choice Medicaid	$19.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$55.89
Rate for Payer: Priority Health Narrow/Tiered Network	$55.89
Rate for Payer: UHC Medicaid	$19.81
Rate for Payer: UHCCP Medicaid	$19.81

PR APPLICATION FINGER SPLINT STATIC

Professional

Both

$97.00

Service Code	HCPCS 29130
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$72.75
Rate for Payer: Aetna Commercial	$38.86
Rate for Payer: Aetna Medicare	$48.50
Rate for Payer: BCBS Complete	$17.22
Rate for Payer: BCN Commercial	$43.33
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cash Price	$77.60
Rate for Payer: Mclaren Medicaid	$16.40
Rate for Payer: Meridian Medicaid	$17.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$72.75
Rate for Payer: Priority Health Choice Medicaid	$16.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$46.31
Rate for Payer: Priority Health Narrow/Tiered Network	$46.31
Rate for Payer: UHC Medicaid	$16.40
Rate for Payer: UHCCP Medicaid	$16.40

PR APPLICATION HALO CRANIAL INCLUDING REMOVAL

Professional

Both

$1,132.00

Service Code	HCPCS 20661
Min. Negotiated Rate	$352.94
Max. Negotiated Rate	$870.93
Rate for Payer: Aetna Commercial	$671.47
Rate for Payer: Aetna Medicare	$566.00
Rate for Payer: BCBS Complete	$370.59
Rate for Payer: BCN Commercial	$870.93
Rate for Payer: Cash Price	$905.60
Rate for Payer: Cash Price	$905.60
Rate for Payer: Mclaren Medicaid	$352.94
Rate for Payer: Meridian Medicaid	$370.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$849.00
Rate for Payer: Priority Health Choice Medicaid	$352.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$847.47
Rate for Payer: Priority Health Narrow/Tiered Network	$847.47
Rate for Payer: UHC Medicaid	$352.94
Rate for Payer: UHCCP Medicaid	$352.94

PR APPLICATION HIP SPICA CAST 1 LEG

Professional

Both

$505.00

Service Code	HCPCS 29305
Min. Negotiated Rate	$96.70
Max. Negotiated Rate	$378.75
Rate for Payer: Aetna Commercial	$208.12
Rate for Payer: Aetna Medicare	$252.50
Rate for Payer: BCBS Complete	$101.53
Rate for Payer: BCN Commercial	$242.02
Rate for Payer: Cash Price	$404.00
Rate for Payer: Cash Price	$404.00
Rate for Payer: Mclaren Medicaid	$96.70
Rate for Payer: Meridian Medicaid	$101.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$378.75
Rate for Payer: Priority Health Choice Medicaid	$96.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$258.70
Rate for Payer: Priority Health Narrow/Tiered Network	$258.70
Rate for Payer: UHC Medicaid	$96.70
Rate for Payer: UHCCP Medicaid	$96.70

PR APPLICATION INTERVERTEBRAL BIOMECHANICAL DEVICE

Professional

Both

$2,145.00

Service Code	HCPCS 22851
Min. Negotiated Rate	$858.00
Max. Negotiated Rate	$1,608.75
Rate for Payer: Aetna Medicare	$1,072.50
Rate for Payer: BCBS Complete	$858.00
Rate for Payer: Cash Price	$1,716.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,608.75

PR APPLICATION LONG ARM SPLINT SHOULDER TO HAND

Professional

Both

$170.00

Service Code	HCPCS 29105
Min. Negotiated Rate	$24.07
Max. Negotiated Rate	$127.50
Rate for Payer: Aetna Commercial	$57.05
Rate for Payer: Aetna Medicare	$85.00
Rate for Payer: BCBS Complete	$25.27
Rate for Payer: BCN Commercial	$62.25
Rate for Payer: Cash Price	$136.00
Rate for Payer: Cash Price	$136.00
Rate for Payer: Mclaren Medicaid	$24.07
Rate for Payer: Meridian Medicaid	$25.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$127.50
Rate for Payer: Priority Health Choice Medicaid	$24.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$66.54
Rate for Payer: Priority Health Narrow/Tiered Network	$66.54
Rate for Payer: UHC Medicaid	$24.07
Rate for Payer: UHCCP Medicaid	$24.07

PR APPLICATION LONG LEG CAST BRACE

Professional

Both

$285.00

Service Code	HCPCS 29358
Min. Negotiated Rate	$61.13
Max. Negotiated Rate	$213.75
Rate for Payer: Aetna Commercial	$136.06
Rate for Payer: Aetna Medicare	$142.50
Rate for Payer: BCBS Complete	$64.19
Rate for Payer: BCN Commercial	$156.37
Rate for Payer: Cash Price	$228.00
Rate for Payer: Cash Price	$228.00
Rate for Payer: Mclaren Medicaid	$61.13
Rate for Payer: Meridian Medicaid	$64.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$213.75
Rate for Payer: Priority Health Choice Medicaid	$61.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$167.15
Rate for Payer: Priority Health Narrow/Tiered Network	$167.15
Rate for Payer: UHC Medicaid	$61.13
Rate for Payer: UHCCP Medicaid	$61.13

PR APPLICATION LONG LEG CAST THIGH-TOE

Professional

Both

$290.00

Service Code	HCPCS 29345
Min. Negotiated Rate	$58.36
Max. Negotiated Rate	$217.50
Rate for Payer: Aetna Commercial	$131.58
Rate for Payer: Aetna Medicare	$145.00
Rate for Payer: BCBS Complete	$61.28
Rate for Payer: BCN Commercial	$150.39
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cash Price	$232.00
Rate for Payer: Mclaren Medicaid	$58.36
Rate for Payer: Meridian Medicaid	$61.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$217.50
Rate for Payer: Priority Health Choice Medicaid	$58.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$160.77
Rate for Payer: Priority Health Narrow/Tiered Network	$160.77
Rate for Payer: UHC Medicaid	$58.36
Rate for Payer: UHCCP Medicaid	$58.36

PR APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE

Professional

Both

$260.00

Service Code	HCPCS 29355
Min. Negotiated Rate	$61.77
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$142.12
Rate for Payer: Aetna Medicare	$130.00
Rate for Payer: BCBS Complete	$64.86
Rate for Payer: BCN Commercial	$159.85
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Mclaren Medicaid	$61.77
Rate for Payer: Meridian Medicaid	$64.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$195.00
Rate for Payer: Priority Health Choice Medicaid	$61.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$170.87
Rate for Payer: Priority Health Narrow/Tiered Network	$170.87
Rate for Payer: UHC Medicaid	$61.77
Rate for Payer: UHCCP Medicaid	$61.77

PR APPLICATION LONG LEG SPLINT THIGH TO ANKLE/TOES

Professional

Both

$141.00

Service Code	HCPCS 29505
Min. Negotiated Rate	$34.93
Max. Negotiated Rate	$105.75
Rate for Payer: Aetna Commercial	$68.11
Rate for Payer: Aetna Medicare	$70.50
Rate for Payer: BCBS Complete	$36.68
Rate for Payer: BCN Commercial	$80.18
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cash Price	$112.80
Rate for Payer: Mclaren Medicaid	$34.93
Rate for Payer: Meridian Medicaid	$36.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$105.75
Rate for Payer: Priority Health Choice Medicaid	$34.93
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$85.71
Rate for Payer: Priority Health Narrow/Tiered Network	$85.71
Rate for Payer: UHC Medicaid	$34.93
Rate for Payer: UHCCP Medicaid	$34.93

PR APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS

Professional

Both

$8.00

Service Code	HCPCS 97010
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$89.48
Rate for Payer: Aetna Commercial	$4.45
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: BCN Commercial	$6.68
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.48
Rate for Payer: Priority Health Narrow/Tiered Network	$89.48

PR APPLICATION MODALITY 1/> AREAS WHIRLPOOL

Professional

Both

$35.00

Service Code	HCPCS 97022
Min. Negotiated Rate	$12.81
Max. Negotiated Rate	$89.48
Rate for Payer: Aetna Commercial	$12.81
Rate for Payer: Aetna Medicare	$17.50
Rate for Payer: BCN Commercial	$16.03
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.48
Rate for Payer: Priority Health Narrow/Tiered Network	$89.48

PR APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM

Professional

Both

$1,983.00

Service Code	HCPCS 20692
Min. Negotiated Rate	$667.76
Max. Negotiated Rate	$1,833.87
Rate for Payer: Aetna Commercial	$1,488.90
Rate for Payer: Aetna Medicare	$991.50
Rate for Payer: BCBS Complete	$701.15
Rate for Payer: BCN Commercial	$1,715.55
Rate for Payer: Cash Price	$1,586.40
Rate for Payer: Cash Price	$1,586.40
Rate for Payer: Mclaren Medicaid	$667.76
Rate for Payer: Meridian Medicaid	$701.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,487.25
Rate for Payer: Priority Health Choice Medicaid	$667.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,833.87
Rate for Payer: Priority Health Narrow/Tiered Network	$1,833.87
Rate for Payer: UHC Medicaid	$667.76
Rate for Payer: UHCCP Medicaid	$667.76

PR APPLICATION OF SURFACE NEUROSTIMULATOR

Professional

Both

$34.00

Service Code	HCPCS 64550
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Medicare	$17.00
Rate for Payer: BCBS Complete	$13.60
Rate for Payer: Cash Price	$27.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$25.50

PR APPLICATION PATELLAR TENDON BEARING CAST

Professional

Both

$359.00

Service Code	HCPCS 29435
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$269.25
Rate for Payer: Aetna Commercial	$107.32
Rate for Payer: Aetna Medicare	$179.50
Rate for Payer: BCBS Complete	$54.35
Rate for Payer: BCN Commercial	$131.47
Rate for Payer: Cash Price	$287.20
Rate for Payer: Cash Price	$287.20
Rate for Payer: Mclaren Medicaid	$51.76
Rate for Payer: Meridian Medicaid	$54.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$269.25
Rate for Payer: Priority Health Choice Medicaid	$51.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$140.53
Rate for Payer: Priority Health Narrow/Tiered Network	$140.53
Rate for Payer: UHC Medicaid	$51.76
Rate for Payer: UHCCP Medicaid	$51.76

PR APPLICATION RIGHT & LEFT PULMONARY ARTERY BAND

Professional

Both

$3,462.00

Service Code	HCPCS 33620
Min. Negotiated Rate	$980.44
Max. Negotiated Rate	$2,606.35
Rate for Payer: Aetna Commercial	$2,214.91
Rate for Payer: Aetna Medicare	$1,731.00
Rate for Payer: BCBS Complete	$1,029.46
Rate for Payer: BCN Commercial	$2,423.67
Rate for Payer: Cash Price	$2,769.60
Rate for Payer: Cash Price	$2,769.60
Rate for Payer: Mclaren Medicaid	$980.44
Rate for Payer: Meridian Medicaid	$1,029.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,596.50
Rate for Payer: Priority Health Choice Medicaid	$980.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,606.35
Rate for Payer: Priority Health Narrow/Tiered Network	$2,606.35
Rate for Payer: UHC Medicaid	$980.44
Rate for Payer: UHCCP Medicaid	$980.44

PR APPLICATION RIGID TOTAL CONTACT LEG CAST

Professional

Both

$388.00

Service Code	HCPCS 29445
Min. Negotiated Rate	$57.72
Max. Negotiated Rate	$291.00
Rate for Payer: Aetna Commercial	$133.87
Rate for Payer: Aetna Medicare	$194.00
Rate for Payer: BCBS Complete	$60.61
Rate for Payer: BCN Commercial	$115.85
Rate for Payer: Cash Price	$310.40
Rate for Payer: Cash Price	$310.40
Rate for Payer: Mclaren Medicaid	$57.72
Rate for Payer: Meridian Medicaid	$60.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$291.00
Rate for Payer: Priority Health Choice Medicaid	$57.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$157.03
Rate for Payer: Priority Health Narrow/Tiered Network	$157.03
Rate for Payer: UHC Medicaid	$57.72
Rate for Payer: UHCCP Medicaid	$57.72

PR APPLICATION SHORT ARM SPLINT DYNAMIC

Professional

Both

$198.00

Service Code	HCPCS 29126
Min. Negotiated Rate	$28.97
Max. Negotiated Rate	$148.50
Rate for Payer: Aetna Commercial	$63.68
Rate for Payer: Aetna Medicare	$99.00
Rate for Payer: BCBS Complete	$30.42
Rate for Payer: BCN Commercial	$75.19
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cash Price	$158.40
Rate for Payer: Mclaren Medicaid	$28.97
Rate for Payer: Meridian Medicaid	$30.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$148.50
Rate for Payer: Priority Health Choice Medicaid	$28.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$80.38
Rate for Payer: Priority Health Narrow/Tiered Network	$80.38
Rate for Payer: UHC Medicaid	$28.97
Rate for Payer: UHCCP Medicaid	$28.97

PR APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC

Professional

Both

$146.00

Service Code	HCPCS 29125
Min. Negotiated Rate	$26.20
Max. Negotiated Rate	$109.50
Rate for Payer: Aetna Commercial	$52.16
Rate for Payer: Aetna Medicare	$73.00
Rate for Payer: BCBS Complete	$27.51
Rate for Payer: BCN Commercial	$61.25
Rate for Payer: Cash Price	$116.80
Rate for Payer: Cash Price	$116.80
Rate for Payer: Mclaren Medicaid	$26.20
Rate for Payer: Meridian Medicaid	$27.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$109.50
Rate for Payer: Priority Health Choice Medicaid	$26.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$65.48
Rate for Payer: Priority Health Narrow/Tiered Network	$65.48
Rate for Payer: UHC Medicaid	$26.20
Rate for Payer: UHCCP Medicaid	$26.20

PR APPLICATION SHORT LEG CAST BELOW KNEE-TOE

Professional

Both

$240.00

Service Code	HCPCS 29405
Min. Negotiated Rate	$35.57
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$77.15
Rate for Payer: Aetna Medicare	$120.00
Rate for Payer: BCBS Complete	$37.35
Rate for Payer: BCN Commercial	$70.29
Rate for Payer: Cash Price	$192.00
Rate for Payer: Cash Price	$192.00
Rate for Payer: Mclaren Medicaid	$35.57
Rate for Payer: Meridian Medicaid	$37.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$180.00
Rate for Payer: Priority Health Choice Medicaid	$35.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$95.29
Rate for Payer: Priority Health Narrow/Tiered Network	$95.29
Rate for Payer: UHC Medicaid	$35.57
Rate for Payer: UHCCP Medicaid	$35.57

PR APPLICATION SHORT LEG CAST WALKING/AMBULATORY

Professional

Both

$279.00

Service Code	HCPCS 29425
Min. Negotiated Rate	$32.59
Max. Negotiated Rate	$209.25
Rate for Payer: Aetna Commercial	$71.91
Rate for Payer: Aetna Medicare	$139.50
Rate for Payer: BCBS Complete	$34.22
Rate for Payer: BCN Commercial	$64.80
Rate for Payer: Cash Price	$223.20
Rate for Payer: Cash Price	$223.20
Rate for Payer: Mclaren Medicaid	$32.59
Rate for Payer: Meridian Medicaid	$34.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$209.25
Rate for Payer: Priority Health Choice Medicaid	$32.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$87.83
Rate for Payer: Priority Health Narrow/Tiered Network	$87.83
Rate for Payer: UHC Medicaid	$32.59
Rate for Payer: UHCCP Medicaid	$32.59

PR APPLICATION SHORT LEG SPLINT CALF TO FOOT

Professional

Both

$130.00

Service Code	HCPCS 29515
Min. Negotiated Rate	$31.74
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$64.78
Rate for Payer: Aetna Medicare	$65.00
Rate for Payer: BCBS Complete	$33.33
Rate for Payer: BCN Commercial	$75.70
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Mclaren Medicaid	$31.74
Rate for Payer: Meridian Medicaid	$33.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$97.50
Rate for Payer: Priority Health Choice Medicaid	$31.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$80.92
Rate for Payer: Priority Health Narrow/Tiered Network	$80.92
Rate for Payer: UHC Medicaid	$31.74
Rate for Payer: UHCCP Medicaid	$31.74

PR APPLICATION TOPICAL FLUORIDE VARNISH BY PHS/QHP

Professional

Both

$36.00

Service Code	HCPCS 99188
Min. Negotiated Rate	$5.33
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$11.43
Rate for Payer: Aetna Medicare	$18.00
Rate for Payer: BCBS Complete	$5.60
Rate for Payer: BCN Commercial	$14.45
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Mclaren Medicaid	$5.33
Rate for Payer: Meridian Medicaid	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.00
Rate for Payer: Priority Health Choice Medicaid	$5.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$13.32
Rate for Payer: Priority Health Narrow/Tiered Network	$13.32
Rate for Payer: UHC Medicaid	$5.33
Rate for Payer: UHCCP Medicaid	$5.33

PR APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM

Professional

Both

$1,056.00

Service Code	HCPCS 20690
Min. Negotiated Rate	$348.04
Max. Negotiated Rate	$969.37
Rate for Payer: Aetna Commercial	$796.08
Rate for Payer: Aetna Medicare	$528.00
Rate for Payer: BCBS Complete	$365.44
Rate for Payer: BCN Commercial	$906.82
Rate for Payer: Cash Price	$844.80
Rate for Payer: Cash Price	$844.80
Rate for Payer: Mclaren Medicaid	$348.04
Rate for Payer: Meridian Medicaid	$365.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$792.00
Rate for Payer: Priority Health Choice Medicaid	$348.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$969.37
Rate for Payer: Priority Health Narrow/Tiered Network	$969.37
Rate for Payer: UHC Medicaid	$348.04
Rate for Payer: UHCCP Medicaid	$348.04

PR APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC

Professional

Both

$1,857.00

Service Code	HCPCS 21110
Min. Negotiated Rate	$742.80
Max. Negotiated Rate	$1,392.75
Rate for Payer: Aetna Commercial	$941.72
Rate for Payer: Aetna Medicare	$928.50
Rate for Payer: BCBS Complete	$742.80
Rate for Payer: BCN Commercial	$1,055.72
Rate for Payer: Cash Price	$1,485.60
Rate for Payer: Cash Price	$1,485.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,392.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,128.54
Rate for Payer: Priority Health Narrow/Tiered Network	$1,128.54

Know your out-of-pocket cost for care.

All Charges