Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR CAST SUP LNG LEG CYLINDER FB

Professional

Both

$100.00

Service Code	HCPCS Q4034
Min. Negotiated Rate	$40.00
Max. Negotiated Rate	$65.98
Rate for Payer: BCBS Complete	$40.00
Rate for Payer: BCN Commercial	$65.98
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Priority Health Cigna Priority Health	$65.00

PR CAST SUP LNGLEG CYLNDR PED F

Professional

Both

$51.00

Service Code	HCPCS Q4036
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$33.15
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: BCN Commercial	$33.01
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Priority Health Cigna Priority Health	$33.15

PR CAST SUP LNG LEG PED FBRGLS

Professional

Both

$53.00

Service Code	HCPCS Q4032
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$37.44
Rate for Payer: BCBS Complete	$21.20
Rate for Payer: BCN Commercial	$37.44
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Priority Health Cigna Priority Health	$34.45

PR CAST SUP LNG LEG SPLNT FBRGL

Professional

Both

$77.00

Service Code	HCPCS Q4042
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$50.05
Rate for Payer: BCBS Complete	$30.80
Rate for Payer: BCN Commercial	$33.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Priority Health Cigna Priority Health	$50.05

PR CAST SUP LNG LEG SPLNT PED F

Professional

Both

$39.00

Service Code	HCPCS Q4044
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$25.35
Rate for Payer: BCBS Complete	$15.60
Rate for Payer: BCN Commercial	$16.82
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Priority Health Cigna Priority Health	$25.35

PR CAST SUP LONG ARM ADULT FBRG

Professional

Both

$56.00

Service Code	HCPCS Q4006
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$36.40
Rate for Payer: BCBS Complete	$22.40
Rate for Payer: BCN Commercial	$28.75
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cash Price	$44.80
Rate for Payer: Priority Health Cigna Priority Health	$36.40

PR CAST SUP LONG ARM PED FBRGLS

Professional

Both

$26.00

Service Code	HCPCS Q4008
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$16.90
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCN Commercial	$14.36
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$16.90

PR CAST SUP LONG LEG FIBERGLASS

Professional

Both

$116.00

Service Code	HCPCS Q4030
Min. Negotiated Rate	$46.40
Max. Negotiated Rate	$75.40
Rate for Payer: BCBS Complete	$46.40
Rate for Payer: BCN Commercial	$74.88
Rate for Payer: Cash Price	$92.80
Rate for Payer: Cash Price	$92.80
Rate for Payer: Priority Health Cigna Priority Health	$75.40

PR CAST SUPPLIES UNLISTED

Professional

Both

$102.00

Service Code	HCPCS Q4050
Min. Negotiated Rate	$25.00
Max. Negotiated Rate	$66.30
Rate for Payer: Aetna Medicare	$51.00
Rate for Payer: BCBS Complete	$40.80
Rate for Payer: BCN Commercial	$25.00
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cash Price	$81.60
Rate for Payer: Priority Health Cigna Priority Health	$66.30

PR CAST SUP SHOULDER CAST FBRGL

Professional

Both

$154.00

Service Code	HCPCS Q4004
Min. Negotiated Rate	$61.60
Max. Negotiated Rate	$119.78
Rate for Payer: BCBS Complete	$61.60
Rate for Payer: BCN Commercial	$119.78
Rate for Payer: Cash Price	$123.20
Rate for Payer: Cash Price	$123.20
Rate for Payer: Priority Health Cigna Priority Health	$100.10

PR CAST SUP SHRT LEG FIBERGLASS

Professional

Both

$61.00

Service Code	HCPCS Q4038
Min. Negotiated Rate	$24.40
Max. Negotiated Rate	$40.55
Rate for Payer: BCBS Complete	$24.40
Rate for Payer: BCN Commercial	$40.55
Rate for Payer: Cash Price	$48.80
Rate for Payer: Cash Price	$48.80
Rate for Payer: Priority Health Cigna Priority Health	$39.65

PR CAST SUP SHRT LEG PED FBRGLS

Professional

Both

$21.00

Service Code	HCPCS Q4040
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$20.27
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: BCN Commercial	$20.27
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Priority Health Cigna Priority Health	$13.65

PR CAST SUP SHT ARM ADULT FBRGL

Professional

Both

$43.00

Service Code	HCPCS Q4010
Min. Negotiated Rate	$17.20
Max. Negotiated Rate	$27.95
Rate for Payer: BCBS Complete	$17.20
Rate for Payer: BCN Commercial	$19.16
Rate for Payer: Cash Price	$34.40
Rate for Payer: Cash Price	$34.40
Rate for Payer: Priority Health Cigna Priority Health	$27.95

PR CAST SUP SHT ARM PED FBRGLAS

Professional

Both

$20.00

Service Code	HCPCS Q4012
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$13.00
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: BCN Commercial	$9.60
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$13.00

PR CAST SUP SHT ARM SPLINT FBRG

Professional

Both

$26.00

Service Code	HCPCS Q4022
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$16.90
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCN Commercial	$11.97
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$16.90

PR CAST SUP SHT ARM SPLNT PED F

Professional

Both

$28.00

Service Code	HCPCS Q4024
Min. Negotiated Rate	$5.99
Max. Negotiated Rate	$18.20
Rate for Payer: BCBS Complete	$11.20
Rate for Payer: BCN Commercial	$5.99
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$22.40
Rate for Payer: Priority Health Cigna Priority Health	$18.20

PR CAST SUP SHT LEG SPLNT FBRGL

Professional

Both

$31.00

Service Code	HCPCS Q4046
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$20.15
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: BCN Commercial	$18.37
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$20.15

PR CAST SUP SHT LEG SPLNT PED F

Professional

Both

$26.00

Service Code	HCPCS Q4048
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$16.90
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: BCN Commercial	$9.20
Rate for Payer: Cash Price	$20.80
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$16.90

PR CAST SUP SHT LEG SPLNT PED P

Professional

Both

$20.00

Service Code	HCPCS Q4047
Min. Negotiated Rate	$5.69
Max. Negotiated Rate	$13.00
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: BCN Commercial	$5.69
Rate for Payer: Cash Price	$16.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$13.00

PR CATHETERIZATION UMBILICAL NEWBORN ART DX/THERAPY

Professional

Both

$141.00

Service Code	HCPCS 36660
Min. Negotiated Rate	$42.81
Max. Negotiated Rate	$738.56
Rate for Payer: Aetna Commercial	$85.91
Rate for Payer: Aetna Medicare	$66.67
Rate for Payer: BCBS Complete	$44.95
Rate for Payer: BCBS MAPPO	$64.11
Rate for Payer: BCBS Trust/PPO	$738.56
Rate for Payer: BCN Commercial	$98.23
Rate for Payer: BCN Medicare Advantage	$64.11
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cofinity Commercial	$92.32
Rate for Payer: Cofinity Commercial	$85.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$64.11
Rate for Payer: Mclaren Medicaid	$42.81
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$67.32
Rate for Payer: Meridian Medicaid	$44.95
Rate for Payer: Nomi Health Commercial	$76.93
Rate for Payer: PACE SWMI	$64.11
Rate for Payer: PHP Medicare Advantage	$64.11
Rate for Payer: Priority Health Choice Medicaid	$42.81
Rate for Payer: Priority Health Cigna Priority Health	$91.65
Rate for Payer: Priority Health HMO/PPO	$106.90
Rate for Payer: Priority Health Medicare	$64.75
Rate for Payer: Priority Health Narrow/Tiered Network	$106.90
Rate for Payer: UHC All Payor (Choice/PPO)	$64.11
Rate for Payer: UHC Dual Complete DSNP	$64.11
Rate for Payer: UHC Exchange	$64.11
Rate for Payer: UHC Medicare Advantage	$64.11
Rate for Payer: UHCCP Medicaid	$42.81

PR CATHETERIZATION W/BRONCHIAL BRUSH BIOPSY

Professional

Both

$530.00

Service Code	HCPCS 31717
Min. Negotiated Rate	$66.24
Max. Negotiated Rate	$1,013.81
Rate for Payer: Aetna Commercial	$132.79
Rate for Payer: Aetna Medicare	$103.06
Rate for Payer: BCBS Complete	$69.55
Rate for Payer: BCBS MAPPO	$99.10
Rate for Payer: BCBS Trust/PPO	$1,013.81
Rate for Payer: BCN Commercial	$420.26
Rate for Payer: BCN Medicare Advantage	$99.10
Rate for Payer: Cash Price	$424.00
Rate for Payer: Cash Price	$424.00
Rate for Payer: Cofinity Commercial	$142.70
Rate for Payer: Cofinity Commercial	$132.79
Rate for Payer: Health Alliance Plan Medicare Advantage	$99.10
Rate for Payer: Mclaren Medicaid	$66.24
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$104.06
Rate for Payer: Meridian Medicaid	$69.55
Rate for Payer: Nomi Health Commercial	$118.92
Rate for Payer: PACE SWMI	$99.10
Rate for Payer: PHP Medicare Advantage	$99.10
Rate for Payer: Priority Health Choice Medicaid	$66.24
Rate for Payer: Priority Health Cigna Priority Health	$344.50
Rate for Payer: Priority Health HMO/PPO	$144.61
Rate for Payer: Priority Health Medicare	$100.09
Rate for Payer: Priority Health Narrow/Tiered Network	$144.61
Rate for Payer: UHC All Payor (Choice/PPO)	$99.10
Rate for Payer: UHC Dual Complete DSNP	$99.10
Rate for Payer: UHC Exchange	$99.10
Rate for Payer: UHC Medicare Advantage	$99.10
Rate for Payer: UHCCP Medicaid	$66.24

PR CATHETERIZE FOR URINE SPEC

Professional

Both

$30.00

Service Code	HCPCS P9612
Min. Negotiated Rate	$5.95
Max. Negotiated Rate	$1,574.33
Rate for Payer: Aetna Commercial	$12.18
Rate for Payer: Aetna Medicare	$9.45
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCBS MAPPO	$9.09
Rate for Payer: BCBS Trust/PPO	$1,574.33
Rate for Payer: BCN Commercial	$5.95
Rate for Payer: BCN Medicare Advantage	$9.09
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cofinity Commercial	$13.09
Rate for Payer: Cofinity Commercial	$12.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$9.09
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$9.54
Rate for Payer: Nomi Health Commercial	$10.91
Rate for Payer: PACE SWMI	$9.09
Rate for Payer: PHP Medicare Advantage	$9.09
Rate for Payer: Priority Health Cigna Priority Health	$19.50
Rate for Payer: Priority Health Medicare	$9.18
Rate for Payer: UHC All Payor (Choice/PPO)	$9.09
Rate for Payer: UHC Dual Complete DSNP	$9.09
Rate for Payer: UHC Exchange	$9.09
Rate for Payer: UHC Medicare Advantage	$9.09

PR CATHJ UMBILICAL VEIN DX/THER NB

Professional

Both

$289.00

Service Code	HCPCS 36510
Min. Negotiated Rate	$33.02
Max. Negotiated Rate	$947.77
Rate for Payer: Aetna Commercial	$66.21
Rate for Payer: Aetna Medicare	$51.39
Rate for Payer: BCBS Complete	$34.67
Rate for Payer: BCBS MAPPO	$49.41
Rate for Payer: BCBS Trust/PPO	$947.77
Rate for Payer: BCN Commercial	$124.62
Rate for Payer: BCN Medicare Advantage	$49.41
Rate for Payer: Cash Price	$231.20
Rate for Payer: Cash Price	$231.20
Rate for Payer: Cofinity Commercial	$71.15
Rate for Payer: Cofinity Commercial	$66.21
Rate for Payer: Health Alliance Plan Medicare Advantage	$49.41
Rate for Payer: Mclaren Medicaid	$33.02
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$51.88
Rate for Payer: Meridian Medicaid	$34.67
Rate for Payer: Nomi Health Commercial	$59.29
Rate for Payer: PACE SWMI	$49.41
Rate for Payer: PHP Medicare Advantage	$49.41
Rate for Payer: Priority Health Choice Medicaid	$33.02
Rate for Payer: Priority Health Cigna Priority Health	$187.85
Rate for Payer: Priority Health HMO/PPO	$83.49
Rate for Payer: Priority Health Medicare	$49.90
Rate for Payer: Priority Health Narrow/Tiered Network	$83.49
Rate for Payer: UHC All Payor (Choice/PPO)	$49.41
Rate for Payer: UHC Dual Complete DSNP	$49.41
Rate for Payer: UHC Exchange	$49.41
Rate for Payer: UHC Medicare Advantage	$49.41
Rate for Payer: UHCCP Medicaid	$33.02

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

Professional

Both

$782.00

Service Code	HCPCS 93454
Min. Negotiated Rate	$148.25
Max. Negotiated Rate	$2,147.01
Rate for Payer: Aetna Commercial	$1,047.84
Rate for Payer: Aetna Commercial	$1,047.84
Rate for Payer: Aetna Medicare	$813.25
Rate for Payer: Aetna Medicare	$813.25
Rate for Payer: BCBS Complete	$155.66
Rate for Payer: BCBS Complete	$155.66
Rate for Payer: BCBS MAPPO	$781.97
Rate for Payer: BCBS MAPPO	$781.97
Rate for Payer: BCBS Trust/PPO	$2,147.01
Rate for Payer: BCBS Trust/PPO	$2,147.01
Rate for Payer: BCN Commercial	$1,324.80
Rate for Payer: BCN Commercial	$1,324.80
Rate for Payer: BCN Medicare Advantage	$781.97
Rate for Payer: BCN Medicare Advantage	$781.97
Rate for Payer: Cash Price	$1,370.40
Rate for Payer: Cash Price	$625.60
Rate for Payer: Cash Price	$1,370.40
Rate for Payer: Cash Price	$625.60
Rate for Payer: Cofinity Commercial	$1,126.04
Rate for Payer: Cofinity Commercial	$1,047.84
Rate for Payer: Cofinity Commercial	$1,126.04
Rate for Payer: Cofinity Commercial	$1,047.84
Rate for Payer: Health Alliance Plan Medicare Advantage	$781.97
Rate for Payer: Health Alliance Plan Medicare Advantage	$781.97
Rate for Payer: Mclaren Medicaid	$148.25
Rate for Payer: Mclaren Medicaid	$148.25
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$821.07
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$821.07
Rate for Payer: Meridian Medicaid	$155.66
Rate for Payer: Meridian Medicaid	$155.66
Rate for Payer: Nomi Health Commercial	$938.36
Rate for Payer: Nomi Health Commercial	$938.36
Rate for Payer: PACE SWMI	$781.97
Rate for Payer: PACE SWMI	$781.97
Rate for Payer: PHP Medicare Advantage	$781.97
Rate for Payer: PHP Medicare Advantage	$781.97
Rate for Payer: Priority Health Choice Medicaid	$148.25
Rate for Payer: Priority Health Choice Medicaid	$148.25
Rate for Payer: Priority Health Cigna Priority Health	$508.30
Rate for Payer: Priority Health Cigna Priority Health	$1,113.45
Rate for Payer: Priority Health HMO/PPO	$327.70
Rate for Payer: Priority Health HMO/PPO	$327.70
Rate for Payer: Priority Health Medicare	$789.79
Rate for Payer: Priority Health Medicare	$789.79
Rate for Payer: Priority Health Narrow/Tiered Network	$327.70
Rate for Payer: Priority Health Narrow/Tiered Network	$327.70
Rate for Payer: UHC All Payor (Choice/PPO)	$781.97
Rate for Payer: UHC All Payor (Choice/PPO)	$781.97
Rate for Payer: UHC Dual Complete DSNP	$781.97
Rate for Payer: UHC Dual Complete DSNP	$781.97
Rate for Payer: UHC Exchange	$781.97
Rate for Payer: UHC Exchange	$781.97
Rate for Payer: UHC Medicare Advantage	$781.97
Rate for Payer: UHC Medicare Advantage	$781.97
Rate for Payer: UHCCP Medicaid	$148.25
Rate for Payer: UHCCP Medicaid	$148.25

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

Professional

Both

$2,200.00

Service Code	HCPCS 93459
Min. Negotiated Rate	$207.25
Max. Negotiated Rate	$1,637.56
Rate for Payer: Aetna Commercial	$1,304.01
Rate for Payer: Aetna Commercial	$1,304.01
Rate for Payer: Aetna Medicare	$1,012.07
Rate for Payer: Aetna Medicare	$1,012.07
Rate for Payer: BCBS Complete	$217.61
Rate for Payer: BCBS Complete	$217.61
Rate for Payer: BCBS MAPPO	$973.14
Rate for Payer: BCBS MAPPO	$973.14
Rate for Payer: BCBS Trust/PPO	$570.56
Rate for Payer: BCBS Trust/PPO	$570.56
Rate for Payer: BCN Commercial	$1,637.56
Rate for Payer: BCN Commercial	$1,637.56
Rate for Payer: BCN Medicare Advantage	$973.14
Rate for Payer: BCN Medicare Advantage	$973.14
Rate for Payer: Cash Price	$888.80
Rate for Payer: Cash Price	$888.80
Rate for Payer: Cash Price	$1,760.00
Rate for Payer: Cash Price	$1,760.00
Rate for Payer: Cofinity Commercial	$1,304.01
Rate for Payer: Cofinity Commercial	$1,401.32
Rate for Payer: Cofinity Commercial	$1,304.01
Rate for Payer: Cofinity Commercial	$1,401.32
Rate for Payer: Health Alliance Plan Medicare Advantage	$973.14
Rate for Payer: Health Alliance Plan Medicare Advantage	$973.14
Rate for Payer: Mclaren Medicaid	$207.25
Rate for Payer: Mclaren Medicaid	$207.25
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,021.80
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,021.80
Rate for Payer: Meridian Medicaid	$217.61
Rate for Payer: Meridian Medicaid	$217.61
Rate for Payer: Nomi Health Commercial	$1,167.77
Rate for Payer: Nomi Health Commercial	$1,167.77
Rate for Payer: PACE SWMI	$973.14
Rate for Payer: PACE SWMI	$973.14
Rate for Payer: PHP Medicare Advantage	$973.14
Rate for Payer: PHP Medicare Advantage	$973.14
Rate for Payer: Priority Health Choice Medicaid	$207.25
Rate for Payer: Priority Health Choice Medicaid	$207.25
Rate for Payer: Priority Health Cigna Priority Health	$722.15
Rate for Payer: Priority Health Cigna Priority Health	$1,430.00
Rate for Payer: Priority Health HMO/PPO	$458.13
Rate for Payer: Priority Health HMO/PPO	$458.13
Rate for Payer: Priority Health Medicare	$982.87
Rate for Payer: Priority Health Medicare	$982.87
Rate for Payer: Priority Health Narrow/Tiered Network	$458.13
Rate for Payer: Priority Health Narrow/Tiered Network	$458.13
Rate for Payer: UHC All Payor (Choice/PPO)	$973.14
Rate for Payer: UHC All Payor (Choice/PPO)	$973.14
Rate for Payer: UHC Dual Complete DSNP	$973.14
Rate for Payer: UHC Dual Complete DSNP	$973.14
Rate for Payer: UHC Exchange	$973.14
Rate for Payer: UHC Exchange	$973.14
Rate for Payer: UHC Medicare Advantage	$973.14
Rate for Payer: UHC Medicare Advantage	$973.14
Rate for Payer: UHCCP Medicaid	$207.25
Rate for Payer: UHCCP Medicaid	$207.25

Know your out-of-pocket cost for care.

All Charges