Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT

Professional

Both

$1,210.00

Service Code	HCPCS 47542
Min. Negotiated Rate	$74.76
Max. Negotiated Rate	$907.50
Rate for Payer: Aetna Commercial	$180.97
Rate for Payer: Aetna Medicare	$605.00
Rate for Payer: BCBS Complete	$78.50
Rate for Payer: BCN Commercial	$197.20
Rate for Payer: Cash Price	$968.00
Rate for Payer: Cash Price	$968.00
Rate for Payer: Mclaren Medicaid	$74.76
Rate for Payer: Meridian Medicaid	$78.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$907.50
Rate for Payer: Priority Health Choice Medicaid	$74.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$240.27
Rate for Payer: Priority Health Narrow/Tiered Network	$240.27
Rate for Payer: UHC Medicaid	$74.76
Rate for Payer: UHCCP Medicaid	$74.76

PR BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL

Professional

Both

$1,016.00

Service Code	HCPCS 61640
Min. Negotiated Rate	$406.40
Max. Negotiated Rate	$810.32
Rate for Payer: Aetna Commercial	$633.90
Rate for Payer: Aetna Medicare	$508.00
Rate for Payer: BCBS Complete	$406.40
Rate for Payer: BCN Commercial	$697.67
Rate for Payer: Cash Price	$812.80
Rate for Payer: Cash Price	$812.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$762.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$810.32
Rate for Payer: Priority Health Narrow/Tiered Network	$810.32

PR BALLOON DILAT URETERAL STRICTURE W/IMG GID RS&I

Professional

Both

$1,979.00

Service Code	HCPCS 50706
Min. Negotiated Rate	$99.05
Max. Negotiated Rate	$1,484.25
Rate for Payer: Aetna Commercial	$233.34
Rate for Payer: Aetna Medicare	$989.50
Rate for Payer: BCBS Complete	$104.00
Rate for Payer: BCN Commercial	$263.44
Rate for Payer: Cash Price	$1,583.20
Rate for Payer: Cash Price	$1,583.20
Rate for Payer: Mclaren Medicaid	$99.05
Rate for Payer: Meridian Medicaid	$104.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,484.25
Rate for Payer: Priority Health Choice Medicaid	$99.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$286.96
Rate for Payer: Priority Health Narrow/Tiered Network	$286.96
Rate for Payer: UHC Medicaid	$99.05
Rate for Payer: UHCCP Medicaid	$99.05

PR BCG LIVE INTRAVESICAL 1MG

Professional

Both

$6.00

Service Code	HCPCS J9030
Min. Negotiated Rate	$2.98
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$2.98
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Trust/PPO	$3.34
Rate for Payer: BCN Commercial	$3.19
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50

PR BCG LIVE INTRAVESICAL VAC

Professional

Both

$185.00

Service Code	HCPCS J9031
Min. Negotiated Rate	$74.00
Max. Negotiated Rate	$138.75
Rate for Payer: Aetna Medicare	$92.50
Rate for Payer: BCBS Complete	$74.00
Rate for Payer: Cash Price	$148.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$138.75

PR BCN APNEALINK PLUS

Professional

Both

$776.00

Hospital Revenue Code	960
Min. Negotiated Rate	$310.40
Max. Negotiated Rate	$582.00
Rate for Payer: Aetna Medicare	$388.00
Rate for Payer: BCBS Complete	$310.40
Rate for Payer: Cash Price	$620.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$582.00

PR BCN WATCHPAT

Professional

Both

$576.00

Hospital Revenue Code	960
Min. Negotiated Rate	$230.40
Max. Negotiated Rate	$432.00
Rate for Payer: Aetna Medicare	$288.00
Rate for Payer: BCBS Complete	$230.40
Rate for Payer: Cash Price	$460.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$432.00

PR BEDSIDE DRAINAGE BAG

Professional

Both

$15.00

Service Code	HCPCS A4357
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$13.25
Rate for Payer: Aetna Commercial	$9.04
Rate for Payer: Aetna Medicare	$7.50
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: BCN Commercial	$13.25
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.25

PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT

Professional

Both

$11.00

Service Code	HCPCS 96127
Min. Negotiated Rate	$5.01
Max. Negotiated Rate	$8.89
Rate for Payer: Aetna Commercial	$5.01
Rate for Payer: Aetna Medicare	$5.50
Rate for Payer: BCN Commercial	$6.98
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$8.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$8.89
Rate for Payer: Priority Health Narrow/Tiered Network	$8.89

PR BEHAV HLTH DAY TREAT, PER HR

Professional

Both

$567.00

Service Code	HCPCS H2012
Min. Negotiated Rate	$39.28
Max. Negotiated Rate	$425.25
Rate for Payer: Aetna Commercial	$39.28
Rate for Payer: Aetna Medicare	$283.50
Rate for Payer: BCBS Complete	$226.80
Rate for Payer: Cash Price	$453.60
Rate for Payer: Cash Price	$453.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$425.25

PR BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE

Professional

Both

$185.00

Service Code	HCPCS 92524
Min. Negotiated Rate	$92.50
Max. Negotiated Rate	$164.34
Rate for Payer: Aetna Commercial	$100.64
Rate for Payer: Aetna Medicare	$92.50
Rate for Payer: BCN Commercial	$164.34
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cash Price	$148.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$138.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$151.55
Rate for Payer: Priority Health Narrow/Tiered Network	$151.55

PR BEHAVIORAL VERIFICATION OF AMPLIFICATION

Professional

Both

$32.00

Service Code	HCPCS 92638
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00

PR BEHAVIOR COUNSEL OBESITY 15M

Professional

Both

$46.00

Service Code	HCPCS G0447
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$44.81
Rate for Payer: Aetna Commercial	$23.66
Rate for Payer: Aetna Medicare	$23.00
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: BCN Commercial	$44.81
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cash Price	$36.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$27.23
Rate for Payer: Priority Health Narrow/Tiered Network	$27.23

PR BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN

Professional

Both

$64.00

Service Code	HCPCS 97151
Min. Negotiated Rate	$20.79
Max. Negotiated Rate	$67.51
Rate for Payer: Aetna Commercial	$20.79
Rate for Payer: Aetna Medicare	$32.00
Rate for Payer: BCBS Complete	$25.60
Rate for Payer: BCN Commercial	$42.82
Rate for Payer: Cash Price	$51.20
Rate for Payer: Cash Price	$51.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$48.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$67.51
Rate for Payer: Priority Health Narrow/Tiered Network	$67.51

PR BETAMETHASONE ACET&SOD PHOSP

Professional

Both

$10.00

Service Code	HCPCS J0702
Min. Negotiated Rate	$1.61
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$7.02
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Trust/PPO	$1.61
Rate for Payer: BCN Commercial	$4.80
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50

PR BFB TRAING W/EMG &/MANOMETRY 1ST 15 MIN CNTCT

Professional

Both

$173.00

Service Code	HCPCS 90912
Min. Negotiated Rate	$48.12
Max. Negotiated Rate	$129.75
Rate for Payer: Aetna Commercial	$48.12
Rate for Payer: Aetna Medicare	$86.50
Rate for Payer: BCBS Complete	$69.20
Rate for Payer: BCN Commercial	$62.75
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cash Price	$138.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$129.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$65.04
Rate for Payer: Priority Health Narrow/Tiered Network	$65.04

PR BIA WHOLE BODY COMPOSITION ASSESSMENT W/I&R

Professional

Both

$33.00

Service Code	HCPCS 0358T
Min. Negotiated Rate	$13.20
Max. Negotiated Rate	$29.66
Rate for Payer: Aetna Commercial	$29.66
Rate for Payer: Aetna Medicare	$16.50
Rate for Payer: BCBS Complete	$13.20
Rate for Payer: BCN Commercial	$22.90
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.75

PR BILATERAL GYNECOMASTIA

Professional

Both

$4,506.00

Hospital Revenue Code	990
Min. Negotiated Rate	$1,802.40
Max. Negotiated Rate	$3,379.50
Rate for Payer: Aetna Medicare	$2,253.00
Rate for Payer: BCBS Complete	$1,802.40
Rate for Payer: Cash Price	$3,604.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,379.50

PR BILATERAL MASTOPEXY

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 BILATERAL OTOPLASTY

Professional

Both

$4,506.00

Hospital Revenue Code	990
Min. Negotiated Rate	$1,802.40
Max. Negotiated Rate	$3,379.50
Rate for Payer: Aetna Medicare	$2,253.00
Rate for Payer: BCBS Complete	$1,802.40
Rate for Payer: Cash Price	$3,604.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,379.50

PR BILATERAL REDUCTION MAMMOPLASTY

Professional

Both

$3,992.00

Hospital Revenue Code	990
Min. Negotiated Rate	$1,596.80
Max. Negotiated Rate	$2,994.00
Rate for Payer: Aetna Medicare	$1,996.00
Rate for Payer: BCBS Complete	$1,596.80
Rate for Payer: Cash Price	$3,193.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,994.00

PR BILATERAL THORACIC ROLL EXCISION

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 BILIARY ENDOSCOPY PRQ VIA T-TUBE W/RMVL CALCULUS

Professional

Both

$943.00

Service Code	HCPCS 47554
Min. Negotiated Rate	$252.83
Max. Negotiated Rate	$803.95
Rate for Payer: Aetna Commercial	$696.48
Rate for Payer: Aetna Medicare	$471.50
Rate for Payer: BCBS Complete	$265.47
Rate for Payer: BCN Commercial	$659.83
Rate for Payer: Cash Price	$754.40
Rate for Payer: Cash Price	$754.40
Rate for Payer: Mclaren Medicaid	$252.83
Rate for Payer: Meridian Medicaid	$265.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$707.25
Rate for Payer: Priority Health Choice Medicaid	$252.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$803.95
Rate for Payer: Priority Health Narrow/Tiered Network	$803.95
Rate for Payer: UHC Medicaid	$252.83
Rate for Payer: UHCCP Medicaid	$252.83

PR BILIARY NDSC INTRAOPERATIVE

Professional

Both

$546.00

Service Code	HCPCS 47550
Min. Negotiated Rate	$92.44
Max. Negotiated Rate	$409.50
Rate for Payer: Aetna Commercial	$223.49
Rate for Payer: Aetna Medicare	$273.00
Rate for Payer: BCBS Complete	$97.06
Rate for Payer: BCN Commercial	$241.52
Rate for Payer: Cash Price	$436.80
Rate for Payer: Cash Price	$436.80
Rate for Payer: Mclaren Medicaid	$92.44
Rate for Payer: Meridian Medicaid	$97.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$409.50
Rate for Payer: Priority Health Choice Medicaid	$92.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$294.28
Rate for Payer: Priority Health Narrow/Tiered Network	$294.28
Rate for Payer: UHC Medicaid	$92.44
Rate for Payer: UHCCP Medicaid	$92.44

PR BINOCULAR MICROSCOPY SEPARATE DX PROCEDURE

Professional

Both

$105.00

Service Code	HCPCS 92504
Min. Negotiated Rate	$10.27
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna Commercial	$10.27
Rate for Payer: Aetna Medicare	$52.50
Rate for Payer: BCBS Complete	$42.00
Rate for Payer: BCN Commercial	$11.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$12.86
Rate for Payer: Priority Health Narrow/Tiered Network	$12.86

Know your out-of-pocket cost for care.

All Charges