Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR BOTOX UNIT

Professional

Both

$13.00

Hospital Revenue Code	990
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna Medicare	$6.50
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.75

PR BPG OTH/THN VEIN AORTOBIFEMORAL

Professional

Both

$5,955.00

Service Code	HCPCS 35646
Min. Negotiated Rate	$984.06
Max. Negotiated Rate	$4,466.25
Rate for Payer: Aetna Commercial	$2,302.34
Rate for Payer: Aetna Medicare	$2,977.50
Rate for Payer: BCBS Complete	$1,033.26
Rate for Payer: BCN Commercial	$2,482.43
Rate for Payer: Cash Price	$4,764.00
Rate for Payer: Cash Price	$4,764.00
Rate for Payer: Mclaren Medicaid	$984.06
Rate for Payer: Meridian Medicaid	$1,033.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,466.25
Rate for Payer: Priority Health Choice Medicaid	$984.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,669.54
Rate for Payer: Priority Health Narrow/Tiered Network	$2,669.54
Rate for Payer: UHC Medicaid	$984.06
Rate for Payer: UHCCP Medicaid	$984.06

PR BPG OTH/THN VEIN AORTOBI-ILIAC

Professional

Both

$5,091.00

Service Code	HCPCS 35638
Min. Negotiated Rate	$1,008.34
Max. Negotiated Rate	$3,818.25
Rate for Payer: Aetna Commercial	$2,341.64
Rate for Payer: Aetna Medicare	$2,545.50
Rate for Payer: BCBS Complete	$1,058.76
Rate for Payer: BCN Commercial	$2,549.17
Rate for Payer: Cash Price	$4,072.80
Rate for Payer: Cash Price	$4,072.80
Rate for Payer: Mclaren Medicaid	$1,008.34
Rate for Payer: Meridian Medicaid	$1,058.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,818.25
Rate for Payer: Priority Health Choice Medicaid	$1,008.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,741.31
Rate for Payer: Priority Health Narrow/Tiered Network	$2,741.31
Rate for Payer: UHC Medicaid	$1,008.34
Rate for Payer: UHCCP Medicaid	$1,008.34

PR BPG OTH/THN VEIN AORTOCELIAC AORTOMSN AORTORNL

Professional

Both

$5,218.00

Service Code	HCPCS 35631
Min. Negotiated Rate	$1,067.56
Max. Negotiated Rate	$3,913.50
Rate for Payer: Aetna Commercial	$2,492.94
Rate for Payer: Aetna Medicare	$2,609.00
Rate for Payer: BCBS Complete	$1,120.94
Rate for Payer: BCN Commercial	$2,694.08
Rate for Payer: Cash Price	$4,174.40
Rate for Payer: Cash Price	$4,174.40
Rate for Payer: Mclaren Medicaid	$1,067.56
Rate for Payer: Meridian Medicaid	$1,120.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,913.50
Rate for Payer: Priority Health Choice Medicaid	$1,067.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,897.15
Rate for Payer: Priority Health Narrow/Tiered Network	$2,897.15
Rate for Payer: UHC Medicaid	$1,067.56
Rate for Payer: UHCCP Medicaid	$1,067.56

PR BPG OTH/THN VEIN AORTOFEMORAL

Professional

Both

$3,159.00

Service Code	HCPCS 35647
Min. Negotiated Rate	$866.70
Max. Negotiated Rate	$2,409.29
Rate for Payer: Aetna Commercial	$2,084.62
Rate for Payer: Aetna Medicare	$1,579.50
Rate for Payer: BCBS Complete	$910.03
Rate for Payer: BCN Commercial	$2,240.42
Rate for Payer: Cash Price	$2,527.20
Rate for Payer: Cash Price	$2,527.20
Rate for Payer: Mclaren Medicaid	$866.70
Rate for Payer: Meridian Medicaid	$910.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,369.25
Rate for Payer: Priority Health Choice Medicaid	$866.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,409.29
Rate for Payer: Priority Health Narrow/Tiered Network	$2,409.29
Rate for Payer: UHC Medicaid	$866.70
Rate for Payer: UHCCP Medicaid	$866.70

PR BPG OTH/THN VEIN AORTOILIAC

Professional

Both

$3,744.00

Service Code	HCPCS 35637
Min. Negotiated Rate	$961.48
Max. Negotiated Rate	$2,808.00
Rate for Payer: Aetna Commercial	$2,231.68
Rate for Payer: Aetna Medicare	$1,872.00
Rate for Payer: BCBS Complete	$1,009.55
Rate for Payer: BCN Commercial	$2,423.67
Rate for Payer: Cash Price	$2,995.20
Rate for Payer: Cash Price	$2,995.20
Rate for Payer: Mclaren Medicaid	$961.48
Rate for Payer: Meridian Medicaid	$1,009.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,808.00
Rate for Payer: Priority Health Choice Medicaid	$961.48
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	$961.48
Rate for Payer: UHCCP Medicaid	$961.48

PR BPG OTH/THN VEIN AORTOSUBCLA/INNOMINATE/CAROTID

Professional

Both

$4,903.00

Service Code	HCPCS 35626
Min. Negotiated Rate	$944.66
Max. Negotiated Rate	$3,677.25
Rate for Payer: Aetna Commercial	$2,142.20
Rate for Payer: Aetna Medicare	$2,451.50
Rate for Payer: BCBS Complete	$991.89
Rate for Payer: BCN Commercial	$2,338.52
Rate for Payer: Cash Price	$3,922.40
Rate for Payer: Cash Price	$3,922.40
Rate for Payer: Mclaren Medicaid	$944.66
Rate for Payer: Meridian Medicaid	$991.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,677.25
Rate for Payer: Priority Health Choice Medicaid	$944.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,514.78
Rate for Payer: Priority Health Narrow/Tiered Network	$2,514.78
Rate for Payer: UHC Medicaid	$944.66
Rate for Payer: UHCCP Medicaid	$944.66

PR BPG OTH/THN VEIN AXILLARY-AXILLARY

Professional

Both

$2,281.00

Service Code	HCPCS 35650
Min. Negotiated Rate	$593.84
Max. Negotiated Rate	$1,710.75
Rate for Payer: Aetna Commercial	$1,374.21
Rate for Payer: Aetna Medicare	$1,140.50
Rate for Payer: BCBS Complete	$623.53
Rate for Payer: BCN Commercial	$1,494.94
Rate for Payer: Cash Price	$1,824.80
Rate for Payer: Cash Price	$1,824.80
Rate for Payer: Mclaren Medicaid	$593.84
Rate for Payer: Meridian Medicaid	$623.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,710.75
Rate for Payer: Priority Health Choice Medicaid	$593.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,607.61
Rate for Payer: Priority Health Narrow/Tiered Network	$1,607.61
Rate for Payer: UHC Medicaid	$593.84
Rate for Payer: UHCCP Medicaid	$593.84

PR BPG OTH/THN VEIN AXILLARY-FEMORAL

Professional

Both

$4,316.00

Service Code	HCPCS 35621
Min. Negotiated Rate	$631.55
Max. Negotiated Rate	$3,237.00
Rate for Payer: Aetna Commercial	$1,473.74
Rate for Payer: Aetna Medicare	$2,158.00
Rate for Payer: BCBS Complete	$663.13
Rate for Payer: BCN Commercial	$1,598.52
Rate for Payer: Cash Price	$3,452.80
Rate for Payer: Cash Price	$3,452.80
Rate for Payer: Mclaren Medicaid	$631.55
Rate for Payer: Meridian Medicaid	$663.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,237.00
Rate for Payer: Priority Health Choice Medicaid	$631.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,719.00
Rate for Payer: Priority Health Narrow/Tiered Network	$1,719.00
Rate for Payer: UHC Medicaid	$631.55
Rate for Payer: UHCCP Medicaid	$631.55

PR BPG OTH/THN VEIN AXILLARY-FEMORAL-FEMORAL

Professional

Both

$5,070.00

Service Code	HCPCS 35654
Min. Negotiated Rate	$788.53
Max. Negotiated Rate	$3,802.50
Rate for Payer: Aetna Commercial	$1,837.45
Rate for Payer: Aetna Medicare	$2,535.00
Rate for Payer: BCBS Complete	$827.96
Rate for Payer: BCN Commercial	$1,994.41
Rate for Payer: Cash Price	$4,056.00
Rate for Payer: Cash Price	$4,056.00
Rate for Payer: Mclaren Medicaid	$788.53
Rate for Payer: Meridian Medicaid	$827.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,802.50
Rate for Payer: Priority Health Choice Medicaid	$788.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,144.74
Rate for Payer: Priority Health Narrow/Tiered Network	$2,144.74
Rate for Payer: UHC Medicaid	$788.53
Rate for Payer: UHCCP Medicaid	$788.53

PR BPG OTH/THN VEIN CAROTID-SUBCLAVIAN

Professional

Both

$2,394.00

Service Code	HCPCS 35606
Min. Negotiated Rate	$679.04
Max. Negotiated Rate	$1,844.31
Rate for Payer: Aetna Commercial	$1,574.58
Rate for Payer: Aetna Medicare	$1,197.00
Rate for Payer: BCBS Complete	$712.99
Rate for Payer: BCN Commercial	$1,715.04
Rate for Payer: Cash Price	$1,915.20
Rate for Payer: Cash Price	$1,915.20
Rate for Payer: Mclaren Medicaid	$679.04
Rate for Payer: Meridian Medicaid	$712.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,795.50
Rate for Payer: Priority Health Choice Medicaid	$679.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,844.31
Rate for Payer: Priority Health Narrow/Tiered Network	$1,844.31
Rate for Payer: UHC Medicaid	$679.04
Rate for Payer: UHCCP Medicaid	$679.04

PR BPG OTH/THN VEIN COM CRTD-IPSILATERAL INT CRTD

Professional

Both

$3,030.00

Service Code	HCPCS 35601
Min. Negotiated Rate	$809.40
Max. Negotiated Rate	$2,272.50
Rate for Payer: Aetna Commercial	$1,879.18
Rate for Payer: Aetna Medicare	$1,515.00
Rate for Payer: BCBS Complete	$849.87
Rate for Payer: BCN Commercial	$2,055.17
Rate for Payer: Cash Price	$2,424.00
Rate for Payer: Cash Price	$2,424.00
Rate for Payer: Mclaren Medicaid	$809.40
Rate for Payer: Meridian Medicaid	$849.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,272.50
Rate for Payer: Priority Health Choice Medicaid	$809.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,210.07
Rate for Payer: Priority Health Narrow/Tiered Network	$2,210.07
Rate for Payer: UHC Medicaid	$809.40
Rate for Payer: UHCCP Medicaid	$809.40

PR BPG OTH/THN VEIN FEM-ANT TIBL PST TIBL/PRNL ART

Professional

Both

$4,334.00

Service Code	HCPCS 35666
Min. Negotiated Rate	$744.65
Max. Negotiated Rate	$3,250.50
Rate for Payer: Aetna Commercial	$1,724.92
Rate for Payer: Aetna Medicare	$2,167.00
Rate for Payer: BCBS Complete	$781.88
Rate for Payer: BCN Commercial	$1,875.39
Rate for Payer: Cash Price	$3,467.20
Rate for Payer: Cash Price	$3,467.20
Rate for Payer: Mclaren Medicaid	$744.65
Rate for Payer: Meridian Medicaid	$781.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,250.50
Rate for Payer: Priority Health Choice Medicaid	$744.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,016.75
Rate for Payer: Priority Health Narrow/Tiered Network	$2,016.75
Rate for Payer: UHC Medicaid	$744.65
Rate for Payer: UHCCP Medicaid	$744.65

PR BPG OTH/THN VEIN FEMORAL-FEMORAL

Professional

Both

$2,321.00

Service Code	HCPCS 35661
Min. Negotiated Rate	$626.43
Max. Negotiated Rate	$1,740.75
Rate for Payer: Aetna Commercial	$1,456.02
Rate for Payer: Aetna Medicare	$1,160.50
Rate for Payer: BCBS Complete	$657.75
Rate for Payer: BCN Commercial	$1,581.59
Rate for Payer: Cash Price	$1,856.80
Rate for Payer: Cash Price	$1,856.80
Rate for Payer: Mclaren Medicaid	$626.43
Rate for Payer: Meridian Medicaid	$657.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,740.75
Rate for Payer: Priority Health Choice Medicaid	$626.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,700.79
Rate for Payer: Priority Health Narrow/Tiered Network	$1,700.79
Rate for Payer: UHC Medicaid	$626.43
Rate for Payer: UHCCP Medicaid	$626.43

PR BPG OTH/THN VEIN FEMORAL-POPLITEAL

Professional

Both

$2,346.00

Service Code	HCPCS 35656
Min. Negotiated Rate	$619.83
Max. Negotiated Rate	$1,759.50
Rate for Payer: Aetna Commercial	$1,449.39
Rate for Payer: Aetna Medicare	$1,173.00
Rate for Payer: BCBS Complete	$650.82
Rate for Payer: BCN Commercial	$1,563.66
Rate for Payer: Cash Price	$1,876.80
Rate for Payer: Cash Price	$1,876.80
Rate for Payer: Mclaren Medicaid	$619.83
Rate for Payer: Meridian Medicaid	$650.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,759.50
Rate for Payer: Priority Health Choice Medicaid	$619.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,681.52
Rate for Payer: Priority Health Narrow/Tiered Network	$1,681.52
Rate for Payer: UHC Medicaid	$619.83
Rate for Payer: UHCCP Medicaid	$619.83

PR BPG OTH/THN VEIN ILIOFEMORAL

Professional

Both

$4,719.00

Service Code	HCPCS 35665
Min. Negotiated Rate	$679.90
Max. Negotiated Rate	$3,539.25
Rate for Payer: Aetna Commercial	$1,576.23
Rate for Payer: Aetna Medicare	$2,359.50
Rate for Payer: BCBS Complete	$713.89
Rate for Payer: BCN Commercial	$1,711.56
Rate for Payer: Cash Price	$3,775.20
Rate for Payer: Cash Price	$3,775.20
Rate for Payer: Mclaren Medicaid	$679.90
Rate for Payer: Meridian Medicaid	$713.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,539.25
Rate for Payer: Priority Health Choice Medicaid	$679.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,840.57
Rate for Payer: Priority Health Narrow/Tiered Network	$1,840.57
Rate for Payer: UHC Medicaid	$679.90
Rate for Payer: UHCCP Medicaid	$679.90

PR BPG OTH/THN VEIN POPLITEAL-TIBIAL/-PERONEAL ART

Professional

Both

$2,269.00

Service Code	HCPCS 35671
Min. Negotiated Rate	$656.04
Max. Negotiated Rate	$1,769.35
Rate for Payer: Aetna Commercial	$1,517.78
Rate for Payer: Aetna Medicare	$1,134.50
Rate for Payer: BCBS Complete	$688.84
Rate for Payer: BCN Commercial	$1,645.33
Rate for Payer: Cash Price	$1,815.20
Rate for Payer: Cash Price	$1,815.20
Rate for Payer: Mclaren Medicaid	$656.04
Rate for Payer: Meridian Medicaid	$688.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,701.75
Rate for Payer: Priority Health Choice Medicaid	$656.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,769.35
Rate for Payer: Priority Health Narrow/Tiered Network	$1,769.35
Rate for Payer: UHC Medicaid	$656.04
Rate for Payer: UHCCP Medicaid	$656.04

PR BPG OTH/THN VEIN SUBCLAVIAN-SUBCLAVIAN

Professional

Both

$2,311.00

Service Code	HCPCS 35612
Min. Negotiated Rate	$607.90
Max. Negotiated Rate	$1,733.25
Rate for Payer: Aetna Commercial	$1,403.00
Rate for Payer: Aetna Medicare	$1,155.50
Rate for Payer: BCBS Complete	$638.29
Rate for Payer: BCN Commercial	$1,531.79
Rate for Payer: Cash Price	$1,848.80
Rate for Payer: Cash Price	$1,848.80
Rate for Payer: Mclaren Medicaid	$607.90
Rate for Payer: Meridian Medicaid	$638.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,733.25
Rate for Payer: Priority Health Choice Medicaid	$607.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,647.25
Rate for Payer: Priority Health Narrow/Tiered Network	$1,647.25
Rate for Payer: UHC Medicaid	$607.90
Rate for Payer: UHCCP Medicaid	$607.90

PR BRACHIOPLASTY

Professional

Both

$6,309.00

Hospital Revenue Code	990
Min. Negotiated Rate	$2,523.60
Max. Negotiated Rate	$4,731.75
Rate for Payer: Aetna Medicare	$3,154.50
Rate for Payer: BCBS Complete	$2,523.60
Rate for Payer: Cash Price	$5,047.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,731.75

PR BREAST AUGMENTATION WITH IMPLANT

Professional

Both

$2,101.00

Service Code	HCPCS 19325
Min. Negotiated Rate	$361.04
Max. Negotiated Rate	$1,575.75
Rate for Payer: Aetna Commercial	$661.62
Rate for Payer: Aetna Medicare	$1,050.50
Rate for Payer: BCBS Complete	$379.09
Rate for Payer: BCN Commercial	$933.72
Rate for Payer: Cash Price	$1,680.80
Rate for Payer: Cash Price	$1,680.80
Rate for Payer: Mclaren Medicaid	$361.04
Rate for Payer: Meridian Medicaid	$379.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,575.75
Rate for Payer: Priority Health Choice Medicaid	$361.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$854.59
Rate for Payer: Priority Health Narrow/Tiered Network	$854.59
Rate for Payer: UHC Medicaid	$361.04
Rate for Payer: UHCCP Medicaid	$361.04

PR BREAST AUGMENT W MASTOPEXY-GEL 2.5

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 BREAST AUGMENT W MASTOPEXY-GEL 3.5

Professional

Both

$6,309.00

Hospital Revenue Code	990
Min. Negotiated Rate	$2,523.60
Max. Negotiated Rate	$4,731.75
Rate for Payer: Aetna Medicare	$3,154.50
Rate for Payer: BCBS Complete	$2,523.60
Rate for Payer: Cash Price	$5,047.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,731.75

PR BREAST AUGMENT W MASTOPEXY-SALINE 3.5

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 BREAST RECONSTRUCTION 1PEDICLED TRAM FLAP ANAST

Professional

Both

$4,953.00

Service Code	HCPCS 19368
Min. Negotiated Rate	$1,203.02
Max. Negotiated Rate	$3,714.75
Rate for Payer: Aetna Commercial	$2,367.91
Rate for Payer: Aetna Medicare	$2,476.50
Rate for Payer: BCBS Complete	$1,263.17
Rate for Payer: BCN Commercial	$3,253.81
Rate for Payer: Cash Price	$3,962.40
Rate for Payer: Cash Price	$3,962.40
Rate for Payer: Mclaren Medicaid	$1,203.02
Rate for Payer: Meridian Medicaid	$1,263.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,714.75
Rate for Payer: Priority Health Choice Medicaid	$1,203.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,978.08
Rate for Payer: Priority Health Narrow/Tiered Network	$2,978.08
Rate for Payer: UHC Medicaid	$1,203.02
Rate for Payer: UHCCP Medicaid	$1,203.02

PR BREAST RECONSTRUCTION BIPEDICLED TRAM FLAP

Professional

Both

$4,339.00

Service Code	HCPCS 19369
Min. Negotiated Rate	$1,119.74
Max. Negotiated Rate	$3,254.25
Rate for Payer: Aetna Commercial	$2,199.14
Rate for Payer: Aetna Medicare	$2,169.50
Rate for Payer: BCBS Complete	$1,175.73
Rate for Payer: BCN Commercial	$3,023.74
Rate for Payer: Cash Price	$3,471.20
Rate for Payer: Cash Price	$3,471.20
Rate for Payer: Mclaren Medicaid	$1,119.74
Rate for Payer: Meridian Medicaid	$1,175.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,254.25
Rate for Payer: Priority Health Choice Medicaid	$1,119.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,767.51
Rate for Payer: Priority Health Narrow/Tiered Network	$2,767.51
Rate for Payer: UHC Medicaid	$1,119.74
Rate for Payer: UHCCP Medicaid	$1,119.74

Know your out-of-pocket cost for care.

All Charges