Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR CATHETER ASPIRATION NASOTRACHEAL SPX

Professional

Both

$114.00

Service Code	HCPCS 31720
Min. Negotiated Rate	$28.97
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna Commercial	$70.26
Rate for Payer: Aetna Medicare	$57.00
Rate for Payer: BCBS Complete	$30.42
Rate for Payer: BCN Commercial	$79.18
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Mclaren Medicaid	$28.97
Rate for Payer: Meridian Medicaid	$30.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$85.50
Rate for Payer: Priority Health Choice Medicaid	$28.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$74.56
Rate for Payer: Priority Health Narrow/Tiered Network	$74.56
Rate for Payer: UHC Medicaid	$28.97
Rate for Payer: UHCCP Medicaid	$28.97

PR CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY

Professional

Both

$145.00

Service Code	HCPCS 36660
Min. Negotiated Rate	$36.64
Max. Negotiated Rate	$108.75
Rate for Payer: Aetna Commercial	$91.56
Rate for Payer: Aetna Medicare	$72.50
Rate for Payer: BCBS Complete	$38.47
Rate for Payer: BCN Commercial	$100.09
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cash Price	$116.00
Rate for Payer: Mclaren Medicaid	$36.64
Rate for Payer: Meridian Medicaid	$38.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$108.75
Rate for Payer: Priority Health Choice Medicaid	$36.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$107.64
Rate for Payer: Priority Health Narrow/Tiered Network	$107.64
Rate for Payer: UHC Medicaid	$36.64
Rate for Payer: UHCCP Medicaid	$36.64

PR CATHETERIZATION W/BRONCHIAL BRUSH BIOPSY

Professional

Both

$546.00

Service Code	HCPCS 31717
Min. Negotiated Rate	$61.56
Max. Negotiated Rate	$409.50
Rate for Payer: Aetna Commercial	$136.71
Rate for Payer: Aetna Medicare	$273.00
Rate for Payer: BCBS Complete	$64.64
Rate for Payer: BCN Commercial	$154.87
Rate for Payer: Cash Price	$436.80
Rate for Payer: Cash Price	$436.80
Rate for Payer: Mclaren Medicaid	$61.56
Rate for Payer: Meridian Medicaid	$64.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$409.50
Rate for Payer: Priority Health Choice Medicaid	$61.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$145.85
Rate for Payer: Priority Health Narrow/Tiered Network	$145.85
Rate for Payer: UHC Medicaid	$61.56
Rate for Payer: UHCCP Medicaid	$61.56

PR CATHETERIZE FOR URINE SPEC

Professional

Both

$31.00

Service Code	HCPCS P9612
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: BCN Commercial	$6.38
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$23.25

PR CATHJ UMBILICAL VEIN DX/THER NB

Professional

Both

$298.00

Service Code	HCPCS 36510
Min. Negotiated Rate	$28.76
Max. Negotiated Rate	$223.50
Rate for Payer: Aetna Commercial	$70.85
Rate for Payer: Aetna Medicare	$149.00
Rate for Payer: BCBS Complete	$30.20
Rate for Payer: BCN Commercial	$77.18
Rate for Payer: Cash Price	$238.40
Rate for Payer: Cash Price	$238.40
Rate for Payer: Mclaren Medicaid	$28.76
Rate for Payer: Meridian Medicaid	$30.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$223.50
Rate for Payer: Priority Health Choice Medicaid	$28.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$83.01
Rate for Payer: Priority Health Narrow/Tiered Network	$83.01
Rate for Payer: UHC Medicaid	$28.76
Rate for Payer: UHCCP Medicaid	$28.76

PR CATH PLACEMENT & NJX CORONARY ART ANGIO IMG S&I

Professional

Both

$1,764.00

Service Code	HCPCS 93454
Min. Negotiated Rate	$882.00
Max. Negotiated Rate	$1,323.00
Rate for Payer: Aetna Commercial	$1,231.58
Rate for Payer: Aetna Commercial	$1,231.58
Rate for Payer: Aetna Medicare	$882.00
Rate for Payer: Aetna Medicare	$402.50
Rate for Payer: BCN Commercial	$1,286.78
Rate for Payer: BCN Commercial	$1,286.78
Rate for Payer: Cash Price	$644.00
Rate for Payer: Cash Price	$1,411.20
Rate for Payer: Cash Price	$644.00
Rate for Payer: Cash Price	$1,411.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,323.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$603.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,223.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,223.02
Rate for Payer: Priority Health Narrow/Tiered Network	$1,223.02
Rate for Payer: Priority Health Narrow/Tiered Network	$1,223.02

PR CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I

Professional

Both

$1,144.00

Service Code	HCPCS 93459
Min. Negotiated Rate	$572.00
Max. Negotiated Rate	$1,596.03
Rate for Payer: Aetna Commercial	$1,542.00
Rate for Payer: Aetna Commercial	$1,542.00
Rate for Payer: Aetna Medicare	$572.00
Rate for Payer: Aetna Medicare	$1,133.00
Rate for Payer: BCN Commercial	$1,596.03
Rate for Payer: BCN Commercial	$1,596.03
Rate for Payer: Cash Price	$1,812.80
Rate for Payer: Cash Price	$915.20
Rate for Payer: Cash Price	$1,812.80
Rate for Payer: Cash Price	$915.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$858.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,699.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,516.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,516.95
Rate for Payer: Priority Health Narrow/Tiered Network	$1,516.95
Rate for Payer: Priority Health Narrow/Tiered Network	$1,516.95

PR CATH PLMT L HRT & ARTS W/NJX & ANGIO IMG S&I

Professional

Both

$2,044.00

Service Code	HCPCS 93458
Min. Negotiated Rate	$1,022.00
Max. Negotiated Rate	$1,533.00
Rate for Payer: Aetna Commercial	$1,424.59
Rate for Payer: Aetna Commercial	$1,424.59
Rate for Payer: Aetna Medicare	$1,022.00
Rate for Payer: Aetna Medicare	$499.50
Rate for Payer: BCN Commercial	$1,482.49
Rate for Payer: BCN Commercial	$1,482.49
Rate for Payer: Cash Price	$799.20
Rate for Payer: Cash Price	$1,635.20
Rate for Payer: Cash Price	$799.20
Rate for Payer: Cash Price	$1,635.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,533.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$749.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,409.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,409.04
Rate for Payer: Priority Health Narrow/Tiered Network	$1,409.04
Rate for Payer: Priority Health Narrow/Tiered Network	$1,409.04

PR CATH PLMT & NJX CORONARY ART/GRFT ANGIO IMG S&I

Professional

Both

$599.00

Service Code	HCPCS 93455
Min. Negotiated Rate	$299.50
Max. Negotiated Rate	$1,436.67
Rate for Payer: Aetna Commercial	$1,384.11
Rate for Payer: Aetna Medicare	$299.50
Rate for Payer: BCN Commercial	$1,436.67
Rate for Payer: Cash Price	$479.20
Rate for Payer: Cash Price	$479.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$449.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,365.49
Rate for Payer: Priority Health Narrow/Tiered Network	$1,365.49

PR CATH PLMT R HRT/ARTS/GRFTS W/NJX& ANGIO IMG S&I

Professional

Both

$2,500.00

Service Code	HCPCS 93457
Min. Negotiated Rate	$1,250.00
Max. Negotiated Rate	$1,875.00
Rate for Payer: Aetna Commercial	$1,695.32
Rate for Payer: Aetna Medicare	$1,250.00
Rate for Payer: BCN Commercial	$1,748.41
Rate for Payer: Cash Price	$2,000.00
Rate for Payer: Cash Price	$2,000.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,875.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,661.78
Rate for Payer: Priority Health Narrow/Tiered Network	$1,661.78

PR CATH PLMT R HRT & ARTS W/NJX & ANGIO IMG S&I

Professional

Both

$2,236.00

Service Code	HCPCS 93456
Min. Negotiated Rate	$1,118.00
Max. Negotiated Rate	$1,677.00
Rate for Payer: Aetna Commercial	$1,544.51
Rate for Payer: Aetna Medicare	$1,118.00
Rate for Payer: BCN Commercial	$1,602.00
Rate for Payer: Cash Price	$1,788.80
Rate for Payer: Cash Price	$1,788.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,677.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,522.63
Rate for Payer: Priority Health Narrow/Tiered Network	$1,522.63

PR CATH & SALINE/CONTRAST SONOHYSTER/HYSTEROSALPI

Professional

Both

$663.00

Service Code	HCPCS 58340
Min. Negotiated Rate	$33.23
Max. Negotiated Rate	$497.25
Rate for Payer: Aetna Commercial	$67.35
Rate for Payer: Aetna Medicare	$331.50
Rate for Payer: BCBS Complete	$34.89
Rate for Payer: BCN Commercial	$87.15
Rate for Payer: Cash Price	$530.40
Rate for Payer: Cash Price	$530.40
Rate for Payer: Mclaren Medicaid	$33.23
Rate for Payer: Meridian Medicaid	$34.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$497.25
Rate for Payer: Priority Health Choice Medicaid	$33.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$88.27
Rate for Payer: Priority Health Narrow/Tiered Network	$88.27
Rate for Payer: UHC Medicaid	$33.23
Rate for Payer: UHCCP Medicaid	$33.23

PR CAUTERY CERVIX CRYOCAUTERY INITIAL/REPEAT

Professional

Both

$474.00

Service Code	HCPCS 57511
Min. Negotiated Rate	$83.92
Max. Negotiated Rate	$355.50
Rate for Payer: Aetna Commercial	$171.03
Rate for Payer: Aetna Medicare	$237.00
Rate for Payer: BCBS Complete	$88.12
Rate for Payer: BCN Commercial	$174.75
Rate for Payer: Cash Price	$379.20
Rate for Payer: Cash Price	$379.20
Rate for Payer: Mclaren Medicaid	$83.92
Rate for Payer: Meridian Medicaid	$88.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$355.50
Rate for Payer: Priority Health Choice Medicaid	$83.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$224.43
Rate for Payer: Priority Health Narrow/Tiered Network	$224.43
Rate for Payer: UHC Medicaid	$83.92
Rate for Payer: UHCCP Medicaid	$83.92

PR CAUTERY CERVIX ELECTRO/THERMAL

Professional

Both

$494.00

Service Code	HCPCS 57510
Min. Negotiated Rate	$65.18
Max. Negotiated Rate	$370.50
Rate for Payer: Aetna Commercial	$134.58
Rate for Payer: Aetna Medicare	$247.00
Rate for Payer: BCBS Complete	$68.44
Rate for Payer: BCN Commercial	$169.31
Rate for Payer: Cash Price	$395.20
Rate for Payer: Cash Price	$395.20
Rate for Payer: Mclaren Medicaid	$65.18
Rate for Payer: Meridian Medicaid	$68.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$370.50
Rate for Payer: Priority Health Choice Medicaid	$65.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$171.48
Rate for Payer: Priority Health Narrow/Tiered Network	$171.48
Rate for Payer: UHC Medicaid	$65.18
Rate for Payer: UHCCP Medicaid	$65.18

PR CAUTERY CERVIX LASER ABLATION

Professional

Both

$571.00

Service Code	HCPCS 57513
Min. Negotiated Rate	$83.50
Max. Negotiated Rate	$428.25
Rate for Payer: Aetna Commercial	$170.65
Rate for Payer: Aetna Medicare	$285.50
Rate for Payer: BCBS Complete	$87.67
Rate for Payer: BCN Commercial	$220.60
Rate for Payer: Cash Price	$456.80
Rate for Payer: Cash Price	$456.80
Rate for Payer: Mclaren Medicaid	$83.50
Rate for Payer: Meridian Medicaid	$87.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$428.25
Rate for Payer: Priority Health Choice Medicaid	$83.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$223.42
Rate for Payer: Priority Health Narrow/Tiered Network	$223.42
Rate for Payer: UHC Medicaid	$83.50
Rate for Payer: UHCCP Medicaid	$83.50

PR CBHC CONSULT FEE $150

Professional

Both

$158.00

Hospital Revenue Code	990
Min. Negotiated Rate	$63.20
Max. Negotiated Rate	$118.50
Rate for Payer: Aetna Medicare	$79.00
Rate for Payer: BCBS Complete	$63.20
Rate for Payer: Cash Price	$126.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.50

PR CBHC CONSULT FEE $300

Professional

Both

$315.00

Hospital Revenue Code	990
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$236.25
Rate for Payer: Aetna Medicare	$157.50
Rate for Payer: BCBS Complete	$126.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$236.25

PR CBHC IN HOUSE REPAIR

Professional

Both

$37.00

Hospital Revenue Code	990
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$27.75
Rate for Payer: Aetna Medicare	$18.50
Rate for Payer: BCBS Complete	$14.80
Rate for Payer: Cash Price	$29.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.75

PR CBHC IN-HOUSE REPAIR

Professional

Both

$28.00

Hospital Revenue Code	990
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$21.00
Rate for Payer: Aetna Medicare	$14.00
Rate for Payer: BCBS Complete	$11.20
Rate for Payer: Cash Price	$22.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.00

PR CBHC LOSS AND DAMAGE FEE

Professional

Both

$289.00

Hospital Revenue Code	990
Min. Negotiated Rate	$115.60
Max. Negotiated Rate	$216.75
Rate for Payer: Aetna Medicare	$144.50
Rate for Payer: BCBS Complete	$115.60
Rate for Payer: Cash Price	$231.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$216.75

PR CBHC MAILING CHARGE

Professional

Both

$47.00

Hospital Revenue Code	990
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$35.25
Rate for Payer: Aetna Medicare	$23.50
Rate for Payer: BCBS Complete	$18.80
Rate for Payer: Cash Price	$37.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.25

PR CBHC RECASE BTE

Professional

Both

$63.00

Hospital Revenue Code	990
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$47.25
Rate for Payer: Aetna Medicare	$31.50
Rate for Payer: BCBS Complete	$25.20
Rate for Payer: Cash Price	$50.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.25

PR CBHC RECASE ITE

Professional

Both

$184.00

Hospital Revenue Code	990
Min. Negotiated Rate	$73.60
Max. Negotiated Rate	$138.00
Rate for Payer: Aetna Medicare	$92.00
Rate for Payer: BCBS Complete	$73.60
Rate for Payer: Cash Price	$147.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$138.00

PR CBHC REPAIR 5 YRS AND OLDER

Professional

Both

$447.00

Hospital Revenue Code	990
Min. Negotiated Rate	$178.80
Max. Negotiated Rate	$335.25
Rate for Payer: Aetna Medicare	$223.50
Rate for Payer: BCBS Complete	$178.80
Rate for Payer: Cash Price	$357.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$335.25

PR CBHC REPAIR DIGITAL/CIC

Professional

Both

$315.00

Hospital Revenue Code	990
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$236.25
Rate for Payer: Aetna Medicare	$157.50
Rate for Payer: BCBS Complete	$126.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$236.25

Know your out-of-pocket cost for care.

All Charges