Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR BALLN ANGIOPLASTY PERC,BRACHIOCEPH

Professional

Both

$2,039.00

Service Code	HCPCS 35475
Min. Negotiated Rate	$815.60
Max. Negotiated Rate	$1,325.35
Rate for Payer: Aetna Medicare	$1,019.50
Rate for Payer: BCBS Complete	$815.60
Rate for Payer: Cash Price	$1,631.20
Rate for Payer: Priority Health Cigna Priority Health	$1,325.35

PR BALLN ANGIOPLASTY,PERC VENOUS

Professional

Both

$3,441.00

Service Code	HCPCS 35476
Min. Negotiated Rate	$1,376.40
Max. Negotiated Rate	$2,236.65
Rate for Payer: Aetna Medicare	$1,720.50
Rate for Payer: BCBS Complete	$1,376.40
Rate for Payer: Cash Price	$2,752.80
Rate for Payer: Priority Health Cigna Priority Health	$2,236.65

PR BALLN ANGIOPLASTY PERC,VISCERAL

Professional

Both

$2,857.00

Service Code	HCPCS 35471
Min. Negotiated Rate	$1,142.80
Max. Negotiated Rate	$1,857.05
Rate for Payer: Aetna Medicare	$1,428.50
Rate for Payer: BCBS Complete	$1,142.80
Rate for Payer: Cash Price	$2,285.60
Rate for Payer: Priority Health Cigna Priority Health	$1,857.05

PR BALLOON ANGIOPLASTY INTRACRANIAL PERCUTANEOUS

Professional

Both

$4,922.00

Service Code	HCPCS 61630
Min. Negotiated Rate	$1,331.64
Max. Negotiated Rate	$3,199.30
Rate for Payer: Aetna Commercial	$1,784.40
Rate for Payer: Aetna Medicare	$1,384.91
Rate for Payer: BCBS Complete	$1,968.80
Rate for Payer: BCBS MAPPO	$1,331.64
Rate for Payer: BCN Medicare Advantage	$1,331.64
Rate for Payer: Cash Price	$3,937.60
Rate for Payer: Cash Price	$3,937.60
Rate for Payer: Cofinity Commercial	$1,784.40
Rate for Payer: Cofinity Commercial	$1,917.56
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,331.64
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,398.22
Rate for Payer: Nomi Health Commercial	$1,597.97
Rate for Payer: PACE SWMI	$1,331.64
Rate for Payer: PHP Medicare Advantage	$1,331.64
Rate for Payer: Priority Health Cigna Priority Health	$3,199.30
Rate for Payer: Priority Health Medicare	$1,344.96
Rate for Payer: UHC All Payor (Choice/PPO)	$1,331.64
Rate for Payer: UHC Dual Complete DSNP	$1,331.64
Rate for Payer: UHC Exchange	$1,331.64
Rate for Payer: UHC Medicare Advantage	$1,331.64

PR BALLOON DILAT BILIARY DUCT/AMPULLA PRQ EACH DUCT

Professional

Both

$1,175.00

Service Code	HCPCS 47542
Min. Negotiated Rate	$127.35
Max. Negotiated Rate	$763.75
Rate for Payer: Aetna Commercial	$170.65
Rate for Payer: Aetna Medicare	$132.44
Rate for Payer: BCBS Complete	$470.00
Rate for Payer: BCBS MAPPO	$127.35
Rate for Payer: BCN Medicare Advantage	$127.35
Rate for Payer: Cash Price	$940.00
Rate for Payer: Cash Price	$940.00
Rate for Payer: Cofinity Commercial	$183.38
Rate for Payer: Cofinity Commercial	$170.65
Rate for Payer: Health Alliance Plan Medicare Advantage	$127.35
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$133.72
Rate for Payer: Nomi Health Commercial	$152.82
Rate for Payer: PACE SWMI	$127.35
Rate for Payer: PHP Medicare Advantage	$127.35
Rate for Payer: Priority Health Cigna Priority Health	$763.75
Rate for Payer: Priority Health Medicare	$128.62
Rate for Payer: UHC All Payor (Choice/PPO)	$127.35
Rate for Payer: UHC Dual Complete DSNP	$127.35
Rate for Payer: UHC Exchange	$127.35
Rate for Payer: UHC Medicare Advantage	$127.35

PR BALLOON DILAT INTRACRANIAL VASOSPASM PRQ INITIAL

Professional

Both

$986.00

Service Code	HCPCS 61640
Min. Negotiated Rate	$394.40
Max. Negotiated Rate	$640.90
Rate for Payer: Aetna Medicare	$493.00
Rate for Payer: BCBS Complete	$394.40
Rate for Payer: Cash Price	$788.80
Rate for Payer: Priority Health Cigna Priority Health	$640.90

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

Professional

Both

$1,921.00

Service Code	HCPCS 50706
Min. Negotiated Rate	$170.13
Max. Negotiated Rate	$1,248.65
Rate for Payer: Aetna Commercial	$227.97
Rate for Payer: Aetna Medicare	$176.94
Rate for Payer: BCBS Complete	$768.40
Rate for Payer: BCBS MAPPO	$170.13
Rate for Payer: BCN Medicare Advantage	$170.13
Rate for Payer: Cash Price	$1,536.80
Rate for Payer: Cash Price	$1,536.80
Rate for Payer: Cofinity Commercial	$244.99
Rate for Payer: Cofinity Commercial	$227.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$170.13
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$178.64
Rate for Payer: Nomi Health Commercial	$204.16
Rate for Payer: PACE SWMI	$170.13
Rate for Payer: PHP Medicare Advantage	$170.13
Rate for Payer: Priority Health Cigna Priority Health	$1,248.65
Rate for Payer: Priority Health Medicare	$171.83
Rate for Payer: UHC All Payor (Choice/PPO)	$170.13
Rate for Payer: UHC Dual Complete DSNP	$170.13
Rate for Payer: UHC Exchange	$170.13
Rate for Payer: UHC Medicare Advantage	$170.13

PR BCG LIVE INTRAVESICAL VAC

Professional

Both

$180.00

Service Code	HCPCS J9031
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Medicare	$90.00
Rate for Payer: BCBS Complete	$72.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Priority Health Cigna Priority Health	$117.00

PR BCN APNEALINK PLUS

Professional

Both

$753.00

Service Code	HCPCS 00119
Hospital Revenue Code	960
Min. Negotiated Rate	$301.20
Max. Negotiated Rate	$489.45
Rate for Payer: Aetna Medicare	$376.50
Rate for Payer: BCBS Complete	$301.20
Rate for Payer: Cash Price	$602.40
Rate for Payer: Priority Health Cigna Priority Health	$489.45

PR BCN WATCHPAT

Professional

Both

$559.00

Service Code	HCPCS 00120
Hospital Revenue Code	960
Min. Negotiated Rate	$223.60
Max. Negotiated Rate	$363.35
Rate for Payer: Aetna Medicare	$279.50
Rate for Payer: BCBS Complete	$223.60
Rate for Payer: Cash Price	$447.20
Rate for Payer: Priority Health Cigna Priority Health	$363.35

PR BEDSIDE DRAINAGE BAG

Professional

Both

$15.00

Service Code	HCPCS A4357
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$19.54
Rate for Payer: Aetna Commercial	$18.18
Rate for Payer: Aetna Medicare	$14.11
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: BCBS MAPPO	$13.57
Rate for Payer: BCN Medicare Advantage	$13.57
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cofinity Commercial	$19.54
Rate for Payer: Cofinity Commercial	$18.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$13.57
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$14.25
Rate for Payer: Nomi Health Commercial	$16.28
Rate for Payer: PACE SWMI	$13.57
Rate for Payer: PHP Medicare Advantage	$13.57
Rate for Payer: Priority Health Cigna Priority Health	$9.75
Rate for Payer: Priority Health Medicare	$13.71
Rate for Payer: UHC All Payor (Choice/PPO)	$13.57
Rate for Payer: UHC Dual Complete DSNP	$13.57
Rate for Payer: UHC Exchange	$13.57
Rate for Payer: UHC Medicare Advantage	$13.57

PR BEHAV ASSMT W/SCORE & DOCD/STAND INSTRUMENT

Professional

Both

$11.00

Service Code	HCPCS 96127
Min. Negotiated Rate	$4.21
Max. Negotiated Rate	$7.15
Rate for Payer: Aetna Commercial	$5.64
Rate for Payer: Aetna Medicare	$4.38
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: BCBS MAPPO	$4.21
Rate for Payer: BCN Medicare Advantage	$4.21
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cofinity Commercial	$5.64
Rate for Payer: Cofinity Commercial	$6.06
Rate for Payer: Health Alliance Plan Medicare Advantage	$4.21
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$4.42
Rate for Payer: Nomi Health Commercial	$5.05
Rate for Payer: PACE SWMI	$4.21
Rate for Payer: PHP Medicare Advantage	$4.21
Rate for Payer: Priority Health Cigna Priority Health	$7.15
Rate for Payer: Priority Health Medicare	$4.25
Rate for Payer: UHC All Payor (Choice/PPO)	$4.21
Rate for Payer: UHC Dual Complete DSNP	$4.21
Rate for Payer: UHC Exchange	$4.21
Rate for Payer: UHC Medicare Advantage	$4.21

PR BEHAV HLTH DAY TREAT, PER HR

Professional

Both

$550.00

Service Code	HCPCS H2012
Min. Negotiated Rate	$220.00
Max. Negotiated Rate	$357.50
Rate for Payer: Aetna Medicare	$275.00
Rate for Payer: BCBS Complete	$220.00
Rate for Payer: Cash Price	$440.00
Rate for Payer: Priority Health Cigna Priority Health	$357.50

PR BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE

Professional

Both

$180.00

Service Code	HCPCS 92524
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$148.59
Rate for Payer: Aetna Commercial	$138.27
Rate for Payer: Aetna Medicare	$107.32
Rate for Payer: BCBS Complete	$72.00
Rate for Payer: BCBS MAPPO	$103.19
Rate for Payer: BCN Medicare Advantage	$103.19
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cofinity Commercial	$148.59
Rate for Payer: Cofinity Commercial	$138.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$103.19
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$108.35
Rate for Payer: Nomi Health Commercial	$123.83
Rate for Payer: PACE SWMI	$103.19
Rate for Payer: PHP Medicare Advantage	$103.19
Rate for Payer: Priority Health Cigna Priority Health	$117.00
Rate for Payer: Priority Health Medicare	$104.22
Rate for Payer: UHC All Payor (Choice/PPO)	$103.19
Rate for Payer: UHC Dual Complete DSNP	$103.19
Rate for Payer: UHC Exchange	$103.19
Rate for Payer: UHC Medicare Advantage	$103.19

PR BEHAVIOR COUNSEL OBESITY 15M

Professional

Both

$45.00

Service Code	HCPCS G0447
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$41.17
Rate for Payer: Aetna Commercial	$38.31
Rate for Payer: Aetna Medicare	$29.73
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: BCBS MAPPO	$28.59
Rate for Payer: BCN Medicare Advantage	$28.59
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cofinity Commercial	$38.31
Rate for Payer: Cofinity Commercial	$41.17
Rate for Payer: Health Alliance Plan Medicare Advantage	$28.59
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$30.02
Rate for Payer: Nomi Health Commercial	$34.31
Rate for Payer: PACE SWMI	$28.59
Rate for Payer: PHP Medicare Advantage	$28.59
Rate for Payer: Priority Health Cigna Priority Health	$29.25
Rate for Payer: Priority Health Medicare	$28.88
Rate for Payer: UHC All Payor (Choice/PPO)	$28.59
Rate for Payer: UHC Dual Complete DSNP	$28.59
Rate for Payer: UHC Exchange	$28.59
Rate for Payer: UHC Medicare Advantage	$28.59

PR BEHAVIOR ID ASSESSMENT BY PHYS/QHP EA 15 MIN

Professional

Both

$62.00

Service Code	HCPCS 97151
Min. Negotiated Rate	$24.80
Max. Negotiated Rate	$40.30
Rate for Payer: Aetna Medicare	$31.00
Rate for Payer: BCBS Complete	$24.80
Rate for Payer: Cash Price	$49.60
Rate for Payer: Priority Health Cigna Priority Health	$40.30

PR BETAMETHASONE ACET&SOD PHOSP

Professional

Both

$10.00

Service Code	HCPCS J0702
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$10.02
Rate for Payer: Aetna Commercial	$9.33
Rate for Payer: Aetna Medicare	$7.24
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCBS MAPPO	$6.96
Rate for Payer: BCN Medicare Advantage	$6.96
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cofinity Commercial	$9.33
Rate for Payer: Cofinity Commercial	$10.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$6.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$7.31
Rate for Payer: Nomi Health Commercial	$8.35
Rate for Payer: PACE SWMI	$6.96
Rate for Payer: PHP Medicare Advantage	$6.96
Rate for Payer: Priority Health Cigna Priority Health	$6.50
Rate for Payer: Priority Health Medicare	$7.03
Rate for Payer: UHC All Payor (Choice/PPO)	$6.96
Rate for Payer: UHC Dual Complete DSNP	$6.96
Rate for Payer: UHC Exchange	$6.96
Rate for Payer: UHC Medicare Advantage	$6.96

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

Professional

Both

$168.00

Service Code	HCPCS 90912
Min. Negotiated Rate	$40.06
Max. Negotiated Rate	$109.20
Rate for Payer: Aetna Commercial	$53.68
Rate for Payer: Aetna Medicare	$41.66
Rate for Payer: BCBS Complete	$67.20
Rate for Payer: BCBS MAPPO	$40.06
Rate for Payer: BCN Medicare Advantage	$40.06
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cofinity Commercial	$53.68
Rate for Payer: Cofinity Commercial	$57.69
Rate for Payer: Health Alliance Plan Medicare Advantage	$40.06
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$42.06
Rate for Payer: Nomi Health Commercial	$48.07
Rate for Payer: PACE SWMI	$40.06
Rate for Payer: PHP Medicare Advantage	$40.06
Rate for Payer: Priority Health Cigna Priority Health	$109.20
Rate for Payer: Priority Health Medicare	$40.46
Rate for Payer: UHC All Payor (Choice/PPO)	$40.06
Rate for Payer: UHC Dual Complete DSNP	$40.06
Rate for Payer: UHC Exchange	$40.06
Rate for Payer: UHC Medicare Advantage	$40.06

PR BIA WHOLE BODY COMPOSITION ASSESSMENT W/I&R

Professional

Both

$32.00

Service Code	HCPCS 0358T
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$20.80
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Priority Health Cigna Priority Health	$20.80

PR BILATERAL GYNECOMASTIA

Professional

Both

$3,264.00

Service Code	HCPCS 00524
Hospital Revenue Code	990
Min. Negotiated Rate	$1,305.60
Max. Negotiated Rate	$2,121.60
Rate for Payer: Aetna Medicare	$1,632.00
Rate for Payer: BCBS Complete	$1,305.60
Rate for Payer: Cash Price	$2,611.20
Rate for Payer: Priority Health Cigna Priority Health	$2,121.60

PR BILATERAL MASTOPEXY

Professional

Both

$3,876.00

Service Code	HCPCS 00525
Hospital Revenue Code	990
Min. Negotiated Rate	$1,550.40
Max. Negotiated Rate	$2,519.40
Rate for Payer: Aetna Medicare	$1,938.00
Rate for Payer: BCBS Complete	$1,550.40
Rate for Payer: Cash Price	$3,100.80
Rate for Payer: Priority Health Cigna Priority Health	$2,519.40

PR BILATERAL OTOPLASTY

Professional

Both

$3,162.00

Service Code	HCPCS 00533
Hospital Revenue Code	990
Min. Negotiated Rate	$1,264.80
Max. Negotiated Rate	$2,055.30
Rate for Payer: Aetna Medicare	$1,581.00
Rate for Payer: BCBS Complete	$1,264.80
Rate for Payer: Cash Price	$2,529.60
Rate for Payer: Priority Health Cigna Priority Health	$2,055.30

PR BILATERAL REDUCTION MAMMOPLASTY

Professional

Both

$3,876.00

Service Code	HCPCS 00526
Hospital Revenue Code	990
Min. Negotiated Rate	$1,550.40
Max. Negotiated Rate	$2,519.40
Rate for Payer: Aetna Medicare	$1,938.00
Rate for Payer: BCBS Complete	$1,550.40
Rate for Payer: Cash Price	$3,100.80
Rate for Payer: Priority Health Cigna Priority Health	$2,519.40

PR BILATERAL THORACIC ROLL EXCISION

Professional

Both

$2,754.00

Service Code	HCPCS 00543
Hospital Revenue Code	990
Min. Negotiated Rate	$1,101.60
Max. Negotiated Rate	$1,790.10
Rate for Payer: Aetna Medicare	$1,377.00
Rate for Payer: BCBS Complete	$1,101.60
Rate for Payer: Cash Price	$2,203.20
Rate for Payer: Priority Health Cigna Priority Health	$1,790.10

PR BILIARY ENDOSCOPY PRQ VIA T-TUBE W/RMVL CALCULUS

Professional

Both

$916.00

Service Code	HCPCS 47554
Min. Negotiated Rate	$366.40
Max. Negotiated Rate	$614.89
Rate for Payer: Aetna Commercial	$572.19
Rate for Payer: Aetna Medicare	$444.09
Rate for Payer: BCBS Complete	$366.40
Rate for Payer: BCBS MAPPO	$427.01
Rate for Payer: BCN Medicare Advantage	$427.01
Rate for Payer: Cash Price	$732.80
Rate for Payer: Cash Price	$732.80
Rate for Payer: Cofinity Commercial	$614.89
Rate for Payer: Cofinity Commercial	$572.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$427.01
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$448.36
Rate for Payer: Nomi Health Commercial	$512.41
Rate for Payer: PACE SWMI	$427.01
Rate for Payer: PHP Medicare Advantage	$427.01
Rate for Payer: Priority Health Cigna Priority Health	$595.40
Rate for Payer: Priority Health Medicare	$431.28
Rate for Payer: UHC All Payor (Choice/PPO)	$427.01
Rate for Payer: UHC Dual Complete DSNP	$427.01
Rate for Payer: UHC Exchange	$427.01
Rate for Payer: UHC Medicare Advantage	$427.01

Know your out-of-pocket cost for care.

All Charges