Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR APPL MLTLAYR CMPRN SYS LEG BELW KNE W/ANKLE&FOOT

Professional

Both

$201.00

Service Code	HCPCS 29581
Min. Negotiated Rate	$14.70
Max. Negotiated Rate	$150.75
Rate for Payer: Aetna Commercial	$36.91
Rate for Payer: Aetna Medicare	$100.50
Rate for Payer: BCBS Complete	$15.44
Rate for Payer: BCN Commercial	$39.34
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cash Price	$160.80
Rate for Payer: Mclaren Medicaid	$14.70
Rate for Payer: Meridian Medicaid	$15.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$150.75
Rate for Payer: Priority Health Choice Medicaid	$14.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$42.05
Rate for Payer: Priority Health Narrow/Tiered Network	$42.05
Rate for Payer: UHC Medicaid	$14.70
Rate for Payer: UHCCP Medicaid	$14.70

PR APPL MLTLAYR COMPRES SYSTEM UPPER & LOWER ARM

Professional

Both

$85.00

Service Code	HCPCS 29583
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$63.75
Rate for Payer: Aetna Medicare	$42.50
Rate for Payer: BCBS Complete	$34.00
Rate for Payer: Cash Price	$68.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.75

PR APPL MLTLAYR COMPRES THGH LEG ANKLE FT WHEN DONE

Professional

Both

$136.00

Service Code	HCPCS 29582
Min. Negotiated Rate	$54.40
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Medicare	$68.00
Rate for Payer: BCBS Complete	$54.40
Rate for Payer: Cash Price	$108.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$102.00

PR APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED

Professional

Both

$27.00

Service Code	HCPCS 97014
Min. Negotiated Rate	$9.73
Max. Negotiated Rate	$89.48
Rate for Payer: Aetna Commercial	$9.73
Rate for Payer: Aetna Medicare	$13.50
Rate for Payer: BCN Commercial	$12.69
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.48
Rate for Payer: Priority Health Narrow/Tiered Network	$89.48

PR APPL MODALITY 1+ AREAS ESTIM EA 15 MIN

Professional

Both

$32.00

Service Code	HCPCS 97032
Min. Negotiated Rate	$10.85
Max. Negotiated Rate	$89.48
Rate for Payer: Aetna Commercial	$10.85
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCN Commercial	$14.69
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.48
Rate for Payer: Priority Health Narrow/Tiered Network	$89.48

PR APPL MODALITY 1+ AREAS IONTOPHORESIS EA 15 MIN

Professional

Both

$48.00

Service Code	HCPCS 97033
Min. Negotiated Rate	$14.69
Max. Negotiated Rate	$89.48
Rate for Payer: Aetna Commercial	$14.69
Rate for Payer: Aetna Medicare	$24.00
Rate for Payer: BCN Commercial	$19.36
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.48
Rate for Payer: Priority Health Narrow/Tiered Network	$89.48

PR APPL MODALITY 1+ AREAS ULTRASOUND EA 15 MIN

Professional

Both

$23.00

Service Code	HCPCS 97035
Min. Negotiated Rate	$10.52
Max. Negotiated Rate	$89.48
Rate for Payer: Aetna Commercial	$10.52
Rate for Payer: Aetna Medicare	$11.50
Rate for Payer: BCN Commercial	$14.35
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$17.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.48
Rate for Payer: Priority Health Narrow/Tiered Network	$89.48

PR APPL MULTILAYR CMPRN SYS UPR ARM F/ARM HAND&FNGR

Professional

Both

$136.00

Service Code	HCPCS 29584
Min. Negotiated Rate	$8.52
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$21.24
Rate for Payer: Aetna Medicare	$68.00
Rate for Payer: BCBS Complete	$8.95
Rate for Payer: BCN Commercial	$23.40
Rate for Payer: Cash Price	$108.80
Rate for Payer: Cash Price	$108.80
Rate for Payer: Mclaren Medicaid	$8.52
Rate for Payer: Meridian Medicaid	$8.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$102.00
Rate for Payer: Priority Health Choice Medicaid	$8.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$25.01
Rate for Payer: Priority Health Narrow/Tiered Network	$25.01
Rate for Payer: UHC Medicaid	$8.52
Rate for Payer: UHCCP Medicaid	$8.52

PR APPL SKIN CELL SSP AGRFT T/A/L 1ST 480 SQ CM/<

Professional

Both

$2,449.00

Service Code	HCPCS 15015
Min. Negotiated Rate	$360.51
Max. Negotiated Rate	$2,744.01
Rate for Payer: Aetna Medicare	$1,224.50
Rate for Payer: BCBS Complete	$378.54
Rate for Payer: BCN Commercial	$1,710.33
Rate for Payer: Cash Price	$1,959.20
Rate for Payer: Cash Price	$1,959.20
Rate for Payer: Mclaren Medicaid	$360.51
Rate for Payer: Meridian Medicaid	$378.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,836.75
Rate for Payer: Priority Health Choice Medicaid	$360.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,744.01
Rate for Payer: Priority Health Narrow/Tiered Network	$2,744.01
Rate for Payer: UHC Medicaid	$360.51
Rate for Payer: UHCCP Medicaid	$360.51

PR APPL SKIN CELL SSP AGRFT T/A/L EA ADDL 480 SQ CM

Professional

Both

$2,449.00

Service Code	HCPCS 15016
Min. Negotiated Rate	$58.34
Max. Negotiated Rate	$1,836.75
Rate for Payer: Aetna Medicare	$1,224.50
Rate for Payer: BCBS Complete	$61.26
Rate for Payer: Cash Price	$1,959.20
Rate for Payer: Cash Price	$1,959.20
Rate for Payer: Mclaren Medicaid	$58.34
Rate for Payer: Meridian Medicaid	$61.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,836.75
Rate for Payer: Priority Health Choice Medicaid	$58.34
Rate for Payer: UHC Medicaid	$58.34
Rate for Payer: UHCCP Medicaid	$58.34

PR APPL SKN CLL SSP AGRFT F/S/N/H/F/G/M/DGT 1ST 480

Professional

Both

$2,449.00

Service Code	HCPCS 15017
Min. Negotiated Rate	$380.83
Max. Negotiated Rate	$2,744.01
Rate for Payer: Aetna Medicare	$1,224.50
Rate for Payer: BCBS Complete	$399.87
Rate for Payer: BCN Commercial	$1,710.33
Rate for Payer: Cash Price	$1,959.20
Rate for Payer: Cash Price	$1,959.20
Rate for Payer: Mclaren Medicaid	$380.83
Rate for Payer: Meridian Medicaid	$399.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,836.75
Rate for Payer: Priority Health Choice Medicaid	$380.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,744.01
Rate for Payer: Priority Health Narrow/Tiered Network	$2,744.01
Rate for Payer: UHC Medicaid	$380.83
Rate for Payer: UHCCP Medicaid	$380.83

PR APPL SKN CLL SSP AGRFT F/S/N/H/F/G/M/DGT EA ADDL

Professional

Both

$2,449.00

Service Code	HCPCS 15018
Min. Negotiated Rate	$80.77
Max. Negotiated Rate	$1,836.75
Rate for Payer: Aetna Medicare	$1,224.50
Rate for Payer: BCBS Complete	$84.81
Rate for Payer: Cash Price	$1,959.20
Rate for Payer: Cash Price	$1,959.20
Rate for Payer: Mclaren Medicaid	$80.77
Rate for Payer: Meridian Medicaid	$84.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,836.75
Rate for Payer: Priority Health Choice Medicaid	$80.77
Rate for Payer: UHC Medicaid	$80.77
Rate for Payer: UHCCP Medicaid	$80.77

PR APP MLTPLN UNI XTRNL FIX STRTCTC ADJMT EXCHANGE

Professional

Both

$4,012.00

Service Code	HCPCS 20697
Min. Negotiated Rate	$2,006.00
Max. Negotiated Rate	$3,009.00
Rate for Payer: Aetna Commercial	$2,627.28
Rate for Payer: Aetna Medicare	$2,006.00
Rate for Payer: BCN Commercial	$2,527.75
Rate for Payer: Cash Price	$3,209.60
Rate for Payer: Cash Price	$3,209.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,009.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,702.10
Rate for Payer: Priority Health Narrow/Tiered Network	$2,702.10

PR APP SKN SUB GRFT T/A/L AREA>=100SCM ADL 100SQCM

Professional

Both

$145.00

Service Code	HCPCS 15274
Min. Negotiated Rate	$24.92
Max. Negotiated Rate	$108.75
Rate for Payer: Aetna Commercial	$49.31
Rate for Payer: Aetna Medicare	$72.50
Rate for Payer: BCBS Complete	$26.17
Rate for Payer: BCN Commercial	$65.23
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cash Price	$116.00
Rate for Payer: Mclaren Medicaid	$24.92
Rate for Payer: Meridian Medicaid	$26.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$108.75
Rate for Payer: Priority Health Choice Medicaid	$24.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$59.70
Rate for Payer: Priority Health Narrow/Tiered Network	$59.70
Rate for Payer: UHC Medicaid	$24.92
Rate for Payer: UHCCP Medicaid	$24.92

PR APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM

Professional

Both

$634.00

Service Code	HCPCS 15273
Min. Negotiated Rate	$109.48
Max. Negotiated Rate	$475.50
Rate for Payer: Aetna Commercial	$216.78
Rate for Payer: Aetna Medicare	$317.00
Rate for Payer: BCBS Complete	$114.95
Rate for Payer: BCN Commercial	$288.34
Rate for Payer: Cash Price	$507.20
Rate for Payer: Cash Price	$507.20
Rate for Payer: Mclaren Medicaid	$109.48
Rate for Payer: Meridian Medicaid	$114.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$475.50
Rate for Payer: Priority Health Choice Medicaid	$109.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$263.90
Rate for Payer: Priority Health Narrow/Tiered Network	$263.90
Rate for Payer: UHC Medicaid	$109.48
Rate for Payer: UHCCP Medicaid	$109.48

PR APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25

Professional

Both

$286.00

Service Code	HCPCS 15271
Min. Negotiated Rate	$47.93
Max. Negotiated Rate	$214.50
Rate for Payer: Aetna Commercial	$91.37
Rate for Payer: Aetna Medicare	$143.00
Rate for Payer: BCBS Complete	$50.33
Rate for Payer: BCN Commercial	$125.50
Rate for Payer: Cash Price	$228.80
Rate for Payer: Cash Price	$228.80
Rate for Payer: Mclaren Medicaid	$47.93
Rate for Payer: Meridian Medicaid	$50.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$214.50
Rate for Payer: Priority Health Choice Medicaid	$47.93
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$114.85
Rate for Payer: Priority Health Narrow/Tiered Network	$114.85
Rate for Payer: UHC Medicaid	$47.93
Rate for Payer: UHCCP Medicaid	$47.93

PR APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC

Professional

Both

$50.00

Service Code	HCPCS 15272
Min. Negotiated Rate	$9.37
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$18.74
Rate for Payer: Aetna Medicare	$25.00
Rate for Payer: BCBS Complete	$9.84
Rate for Payer: BCN Commercial	$24.90
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Mclaren Medicaid	$9.37
Rate for Payer: Meridian Medicaid	$9.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$37.50
Rate for Payer: Priority Health Choice Medicaid	$9.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$22.78
Rate for Payer: Priority Health Narrow/Tiered Network	$22.78
Rate for Payer: UHC Medicaid	$9.37
Rate for Payer: UHCCP Medicaid	$9.37

PR ARREST EPIPHYSEAL DISTAL FEMUR

Professional

Both

$1,749.00

Service Code	HCPCS 27475
Min. Negotiated Rate	$400.01
Max. Negotiated Rate	$1,311.75
Rate for Payer: Aetna Commercial	$885.07
Rate for Payer: Aetna Medicare	$874.50
Rate for Payer: BCBS Complete	$420.01
Rate for Payer: BCN Commercial	$1,015.38
Rate for Payer: Cash Price	$1,399.20
Rate for Payer: Cash Price	$1,399.20
Rate for Payer: Mclaren Medicaid	$400.01
Rate for Payer: Meridian Medicaid	$420.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,311.75
Rate for Payer: Priority Health Choice Medicaid	$400.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,085.42
Rate for Payer: Priority Health Narrow/Tiered Network	$1,085.42
Rate for Payer: UHC Medicaid	$400.01
Rate for Payer: UHCCP Medicaid	$400.01

PR ARREST EPIPHYSEAL OPEN DISTAL FIBULA

Professional

Both

$1,568.00

Service Code	HCPCS 27732
Min. Negotiated Rate	$281.80
Max. Negotiated Rate	$1,176.00
Rate for Payer: Aetna Commercial	$602.74
Rate for Payer: Aetna Medicare	$784.00
Rate for Payer: BCBS Complete	$295.89
Rate for Payer: BCN Commercial	$700.66
Rate for Payer: Cash Price	$1,254.40
Rate for Payer: Cash Price	$1,254.40
Rate for Payer: Mclaren Medicaid	$281.80
Rate for Payer: Meridian Medicaid	$295.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,176.00
Rate for Payer: Priority Health Choice Medicaid	$281.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$748.99
Rate for Payer: Priority Health Narrow/Tiered Network	$748.99
Rate for Payer: UHC Medicaid	$281.80
Rate for Payer: UHCCP Medicaid	$281.80

PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA

Professional

Both

$1,473.00

Service Code	HCPCS 27730
Min. Negotiated Rate	$357.84
Max. Negotiated Rate	$1,104.75
Rate for Payer: Aetna Commercial	$784.73
Rate for Payer: Aetna Medicare	$736.50
Rate for Payer: BCBS Complete	$375.73
Rate for Payer: BCN Commercial	$902.84
Rate for Payer: Cash Price	$1,178.40
Rate for Payer: Cash Price	$1,178.40
Rate for Payer: Mclaren Medicaid	$357.84
Rate for Payer: Meridian Medicaid	$375.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,104.75
Rate for Payer: Priority Health Choice Medicaid	$357.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$965.11
Rate for Payer: Priority Health Narrow/Tiered Network	$965.11
Rate for Payer: UHC Medicaid	$357.84
Rate for Payer: UHCCP Medicaid	$357.84

PR ARREST EPIPHYSEAL OPEN DISTAL TIBIA&FIBULA

Professional

Both

$3,046.00

Service Code	HCPCS 27734
Min. Negotiated Rate	$396.82
Max. Negotiated Rate	$2,284.50
Rate for Payer: Aetna Commercial	$878.18
Rate for Payer: Aetna Medicare	$1,523.00
Rate for Payer: BCBS Complete	$416.66
Rate for Payer: BCN Commercial	$1,007.91
Rate for Payer: Cash Price	$2,436.80
Rate for Payer: Cash Price	$2,436.80
Rate for Payer: Mclaren Medicaid	$396.82
Rate for Payer: Meridian Medicaid	$416.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,284.50
Rate for Payer: Priority Health Choice Medicaid	$396.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,077.43
Rate for Payer: Priority Health Narrow/Tiered Network	$1,077.43
Rate for Payer: UHC Medicaid	$396.82
Rate for Payer: UHCCP Medicaid	$396.82

PR ARRST EPIPHYSL ANY METH TIBFIB&DSTL FEMUR

Professional

Both

$1,394.00

Service Code	HCPCS 27742
Min. Negotiated Rate	$465.83
Max. Negotiated Rate	$1,269.07
Rate for Payer: Aetna Commercial	$1,037.50
Rate for Payer: Aetna Medicare	$697.00
Rate for Payer: BCBS Complete	$489.12
Rate for Payer: BCN Commercial	$1,187.19
Rate for Payer: Cash Price	$1,115.20
Rate for Payer: Cash Price	$1,115.20
Rate for Payer: Mclaren Medicaid	$465.83
Rate for Payer: Meridian Medicaid	$489.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,045.50
Rate for Payer: Priority Health Choice Medicaid	$465.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,269.07
Rate for Payer: Priority Health Narrow/Tiered Network	$1,269.07
Rate for Payer: UHC Medicaid	$465.83
Rate for Payer: UHCCP Medicaid	$465.83

PR ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB

Professional

Both

$3,192.00

Service Code	HCPCS 27479
Min. Negotiated Rate	$541.66
Max. Negotiated Rate	$2,394.00
Rate for Payer: Aetna Commercial	$1,228.23
Rate for Payer: Aetna Medicare	$1,596.00
Rate for Payer: BCBS Complete	$568.74
Rate for Payer: BCN Commercial	$1,396.34
Rate for Payer: Cash Price	$2,553.60
Rate for Payer: Cash Price	$2,553.60
Rate for Payer: Mclaren Medicaid	$541.66
Rate for Payer: Meridian Medicaid	$568.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,394.00
Rate for Payer: Priority Health Choice Medicaid	$541.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,492.65
Rate for Payer: Priority Health Narrow/Tiered Network	$1,492.65
Rate for Payer: UHC Medicaid	$541.66
Rate for Payer: UHCCP Medicaid	$541.66

PR ARTERIAL PUNCTURE WITHDRAWAL BLOOD DX

Professional

Both

$144.00

Service Code	HCPCS 36600
Min. Negotiated Rate	$8.31
Max. Negotiated Rate	$108.00
Rate for Payer: Aetna Commercial	$21.21
Rate for Payer: Aetna Medicare	$72.00
Rate for Payer: BCBS Complete	$8.73
Rate for Payer: BCN Commercial	$21.91
Rate for Payer: Cash Price	$115.20
Rate for Payer: Cash Price	$115.20
Rate for Payer: Mclaren Medicaid	$8.31
Rate for Payer: Meridian Medicaid	$8.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$108.00
Rate for Payer: Priority Health Choice Medicaid	$8.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$23.56
Rate for Payer: Priority Health Narrow/Tiered Network	$23.56
Rate for Payer: UHC Medicaid	$8.31
Rate for Payer: UHCCP Medicaid	$8.31

PR ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT

Professional

Both

$2,305.00

Service Code	HCPCS 36821
Min. Negotiated Rate	$383.19
Max. Negotiated Rate	$1,728.75
Rate for Payer: Aetna Commercial	$889.36
Rate for Payer: Aetna Medicare	$1,152.50
Rate for Payer: BCBS Complete	$402.35
Rate for Payer: BCN Commercial	$966.58
Rate for Payer: Cash Price	$1,844.00
Rate for Payer: Cash Price	$1,844.00
Rate for Payer: Mclaren Medicaid	$383.19
Rate for Payer: Meridian Medicaid	$402.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,728.75
Rate for Payer: Priority Health Choice Medicaid	$383.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,039.44
Rate for Payer: Priority Health Narrow/Tiered Network	$1,039.44
Rate for Payer: UHC Medicaid	$383.19
Rate for Payer: UHCCP Medicaid	$383.19

Know your out-of-pocket cost for care.

All Charges