Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR CHEMICAL CAUTERIZATION OF GRANULATION TISSUE

Professional

Both

$149.00

Service Code	HCPCS 17250
Min. Negotiated Rate	$22.58
Max. Negotiated Rate	$111.75
Rate for Payer: Aetna Commercial	$38.93
Rate for Payer: Aetna Medicare	$74.50
Rate for Payer: BCBS Complete	$23.71
Rate for Payer: BCN Commercial	$56.27
Rate for Payer: Cash Price	$119.20
Rate for Payer: Cash Price	$119.20
Rate for Payer: Mclaren Medicaid	$22.58
Rate for Payer: Meridian Medicaid	$23.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.75
Rate for Payer: Priority Health Choice Medicaid	$22.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$51.50
Rate for Payer: Priority Health Narrow/Tiered Network	$51.50
Rate for Payer: UHC Medicaid	$22.58
Rate for Payer: UHCCP Medicaid	$22.58

PR CHEMICAL PEEL FACIAL EPIDERMAL

Professional

Both

$918.00

Service Code	HCPCS 15788
Min. Negotiated Rate	$124.82
Max. Negotiated Rate	$688.50
Rate for Payer: Aetna Commercial	$232.57
Rate for Payer: Aetna Medicare	$459.00
Rate for Payer: BCBS Complete	$131.06
Rate for Payer: BCN Commercial	$258.79
Rate for Payer: Cash Price	$734.40
Rate for Payer: Cash Price	$734.40
Rate for Payer: Mclaren Medicaid	$124.82
Rate for Payer: Meridian Medicaid	$131.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$688.50
Rate for Payer: Priority Health Choice Medicaid	$124.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$300.36
Rate for Payer: Priority Health Narrow/Tiered Network	$300.36
Rate for Payer: UHC Medicaid	$124.82
Rate for Payer: UHCCP Medicaid	$124.82

PR CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES

Professional

Both

$325.00

Service Code	HCPCS 64644
Min. Negotiated Rate	$66.03
Max. Negotiated Rate	$243.75
Rate for Payer: Aetna Commercial	$150.70
Rate for Payer: Aetna Medicare	$162.50
Rate for Payer: BCBS Complete	$69.33
Rate for Payer: BCN Commercial	$174.29
Rate for Payer: Cash Price	$260.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Mclaren Medicaid	$66.03
Rate for Payer: Meridian Medicaid	$69.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$243.75
Rate for Payer: Priority Health Choice Medicaid	$66.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$202.43
Rate for Payer: Priority Health Narrow/Tiered Network	$202.43
Rate for Payer: UHC Medicaid	$66.03
Rate for Payer: UHCCP Medicaid	$66.03

PR CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE

Professional

Both

$190.00

Service Code	HCPCS 64643
Min. Negotiated Rate	$38.13
Max. Negotiated Rate	$142.50
Rate for Payer: Aetna Commercial	$91.59
Rate for Payer: Aetna Medicare	$95.00
Rate for Payer: BCBS Complete	$40.04
Rate for Payer: BCN Commercial	$103.58
Rate for Payer: Cash Price	$152.00
Rate for Payer: Cash Price	$152.00
Rate for Payer: Mclaren Medicaid	$38.13
Rate for Payer: Meridian Medicaid	$40.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$142.50
Rate for Payer: Priority Health Choice Medicaid	$38.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$120.30
Rate for Payer: Priority Health Narrow/Tiered Network	$120.30
Rate for Payer: UHC Medicaid	$38.13
Rate for Payer: UHCCP Medicaid	$38.13

PR CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES

Professional

Both

$327.00

Service Code	HCPCS 64645
Min. Negotiated Rate	$44.94
Max. Negotiated Rate	$245.25
Rate for Payer: Aetna Commercial	$106.16
Rate for Payer: Aetna Medicare	$163.50
Rate for Payer: BCBS Complete	$47.19
Rate for Payer: BCN Commercial	$121.50
Rate for Payer: Cash Price	$261.60
Rate for Payer: Cash Price	$261.60
Rate for Payer: Mclaren Medicaid	$44.94
Rate for Payer: Meridian Medicaid	$47.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$245.25
Rate for Payer: Priority Health Choice Medicaid	$44.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$141.14
Rate for Payer: Priority Health Narrow/Tiered Network	$141.14
Rate for Payer: UHC Medicaid	$44.94
Rate for Payer: UHCCP Medicaid	$44.94

PR CHEMODENERVATION EXTREMITY&/TRUNK MUSCLE

Professional

Both

$483.00

Service Code	HCPCS 64614
Min. Negotiated Rate	$193.20
Max. Negotiated Rate	$362.25
Rate for Payer: Aetna Medicare	$241.50
Rate for Payer: BCBS Complete	$193.20
Rate for Payer: Cash Price	$386.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$362.25

PR CHEMODENERVATION INTERNAL ANAL SPHINCTER

Professional

Both

$767.00

Service Code	HCPCS 46505
Min. Negotiated Rate	$157.19
Max. Negotiated Rate	$575.25
Rate for Payer: Aetna Commercial	$332.13
Rate for Payer: Aetna Medicare	$383.50
Rate for Payer: BCBS Complete	$165.05
Rate for Payer: BCN Commercial	$375.48
Rate for Payer: Cash Price	$613.60
Rate for Payer: Cash Price	$613.60
Rate for Payer: Mclaren Medicaid	$157.19
Rate for Payer: Meridian Medicaid	$165.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$575.25
Rate for Payer: Priority Health Choice Medicaid	$157.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$457.49
Rate for Payer: Priority Health Narrow/Tiered Network	$457.49
Rate for Payer: UHC Medicaid	$157.19
Rate for Payer: UHCCP Medicaid	$157.19

PR CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG

Professional

Both

$332.00

Service Code	HCPCS 64617
Min. Negotiated Rate	$58.58
Max. Negotiated Rate	$249.00
Rate for Payer: Aetna Commercial	$138.64
Rate for Payer: Aetna Medicare	$166.00
Rate for Payer: BCBS Complete	$61.51
Rate for Payer: BCN Commercial	$162.34
Rate for Payer: Cash Price	$265.60
Rate for Payer: Cash Price	$265.60
Rate for Payer: Mclaren Medicaid	$58.58
Rate for Payer: Meridian Medicaid	$61.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$249.00
Rate for Payer: Priority Health Choice Medicaid	$58.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$188.56
Rate for Payer: Priority Health Narrow/Tiered Network	$188.56
Rate for Payer: UHC Medicaid	$58.58
Rate for Payer: UHCCP Medicaid	$58.58

PR CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA

Professional

Both

$372.00

Service Code	HCPCS 64616
Min. Negotiated Rate	$63.47
Max. Negotiated Rate	$279.00
Rate for Payer: Aetna Commercial	$139.45
Rate for Payer: Aetna Medicare	$186.00
Rate for Payer: BCBS Complete	$66.64
Rate for Payer: BCN Commercial	$165.83
Rate for Payer: Cash Price	$297.60
Rate for Payer: Cash Price	$297.60
Rate for Payer: Mclaren Medicaid	$63.47
Rate for Payer: Meridian Medicaid	$66.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$279.00
Rate for Payer: Priority Health Choice Medicaid	$63.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$192.60
Rate for Payer: Priority Health Narrow/Tiered Network	$192.60
Rate for Payer: UHC Medicaid	$63.47
Rate for Payer: UHCCP Medicaid	$63.47

PR CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES

Professional

Both

$318.00

Service Code	HCPCS 64646
Min. Negotiated Rate	$66.24
Max. Negotiated Rate	$238.50
Rate for Payer: Aetna Commercial	$148.68
Rate for Payer: Aetna Medicare	$159.00
Rate for Payer: BCBS Complete	$69.55
Rate for Payer: BCN Commercial	$175.29
Rate for Payer: Cash Price	$254.40
Rate for Payer: Cash Price	$254.40
Rate for Payer: Mclaren Medicaid	$66.24
Rate for Payer: Meridian Medicaid	$69.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$238.50
Rate for Payer: Priority Health Choice Medicaid	$66.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$203.60
Rate for Payer: Priority Health Narrow/Tiered Network	$203.60
Rate for Payer: UHC Medicaid	$66.24
Rate for Payer: UHCCP Medicaid	$66.24

PR CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE

Professional

Both

$410.00

Service Code	HCPCS 64642
Min. Negotiated Rate	$61.34
Max. Negotiated Rate	$307.50
Rate for Payer: Aetna Commercial	$137.53
Rate for Payer: Aetna Medicare	$205.00
Rate for Payer: BCBS Complete	$64.41
Rate for Payer: BCN Commercial	$160.85
Rate for Payer: Cash Price	$328.00
Rate for Payer: Cash Price	$328.00
Rate for Payer: Mclaren Medicaid	$61.34
Rate for Payer: Meridian Medicaid	$64.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$307.50
Rate for Payer: Priority Health Choice Medicaid	$61.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$186.82
Rate for Payer: Priority Health Narrow/Tiered Network	$186.82
Rate for Payer: UHC Medicaid	$61.34
Rate for Payer: UHCCP Medicaid	$61.34

PR CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS

Professional

Both

$220.00

Service Code	HCPCS 64611
Min. Negotiated Rate	$69.01
Max. Negotiated Rate	$198.39
Rate for Payer: Aetna Commercial	$137.09
Rate for Payer: Aetna Medicare	$110.00
Rate for Payer: BCBS Complete	$72.46
Rate for Payer: BCN Commercial	$170.81
Rate for Payer: Cash Price	$176.00
Rate for Payer: Cash Price	$176.00
Rate for Payer: Mclaren Medicaid	$69.01
Rate for Payer: Meridian Medicaid	$72.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$165.00
Rate for Payer: Priority Health Choice Medicaid	$69.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$198.39
Rate for Payer: Priority Health Narrow/Tiered Network	$198.39
Rate for Payer: UHC Medicaid	$69.01
Rate for Payer: UHCCP Medicaid	$69.01

PR CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE

Professional

Both

$431.00

Service Code	HCPCS 64615
Min. Negotiated Rate	$69.65
Max. Negotiated Rate	$323.25
Rate for Payer: Aetna Commercial	$158.88
Rate for Payer: Aetna Medicare	$215.50
Rate for Payer: BCBS Complete	$73.13
Rate for Payer: BCN Commercial	$184.75
Rate for Payer: Cash Price	$344.80
Rate for Payer: Cash Price	$344.80
Rate for Payer: Mclaren Medicaid	$69.65
Rate for Payer: Meridian Medicaid	$73.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$323.25
Rate for Payer: Priority Health Choice Medicaid	$69.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$214.59
Rate for Payer: Priority Health Narrow/Tiered Network	$214.59
Rate for Payer: UHC Medicaid	$69.65
Rate for Payer: UHCCP Medicaid	$69.65

PR CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL

Professional

Both

$335.00

Service Code	HCPCS 64612
Min. Negotiated Rate	$69.01
Max. Negotiated Rate	$251.25
Rate for Payer: Aetna Commercial	$148.68
Rate for Payer: Aetna Medicare	$167.50
Rate for Payer: BCBS Complete	$72.46
Rate for Payer: BCN Commercial	$141.37
Rate for Payer: Cash Price	$268.00
Rate for Payer: Cash Price	$268.00
Rate for Payer: Mclaren Medicaid	$69.01
Rate for Payer: Meridian Medicaid	$72.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$251.25
Rate for Payer: Priority Health Choice Medicaid	$69.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$208.23
Rate for Payer: Priority Health Narrow/Tiered Network	$208.23
Rate for Payer: UHC Medicaid	$69.01
Rate for Payer: UHCCP Medicaid	$69.01

PR CHEMOTHERAPY ADMN IV INFUSION TQ EA HR

Professional

Both

$137.00

Service Code	HCPCS 96415
Min. Negotiated Rate	$36.27
Max. Negotiated Rate	$102.75
Rate for Payer: Aetna Commercial	$36.56
Rate for Payer: Aetna Medicare	$68.50
Rate for Payer: BCN Commercial	$39.34
Rate for Payer: Cash Price	$109.60
Rate for Payer: Cash Price	$109.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$102.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$36.27
Rate for Payer: Priority Health Narrow/Tiered Network	$36.27

PR CHEMOTX ADMN CNS REQ SPINAL PUNCTURE

Professional

Both

$755.00

Service Code	HCPCS 96450
Min. Negotiated Rate	$42.39
Max. Negotiated Rate	$566.25
Rate for Payer: Aetna Commercial	$96.12
Rate for Payer: Aetna Medicare	$377.50
Rate for Payer: BCBS Complete	$44.51
Rate for Payer: BCN Commercial	$114.04
Rate for Payer: Cash Price	$604.00
Rate for Payer: Cash Price	$604.00
Rate for Payer: Mclaren Medicaid	$42.39
Rate for Payer: Meridian Medicaid	$44.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$566.25
Rate for Payer: Priority Health Choice Medicaid	$42.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$105.16
Rate for Payer: Priority Health Narrow/Tiered Network	$105.16
Rate for Payer: UHC Medicaid	$42.39
Rate for Payer: UHCCP Medicaid	$42.39

PR CHEMOTX ADMN IV NFS TQ EA SEQL NFS TO 1 HR

Professional

Both

$136.00

Service Code	HCPCS 96417
Min. Negotiated Rate	$68.00
Max. Negotiated Rate	$102.00
Rate for Payer: Aetna Commercial	$82.79
Rate for Payer: Aetna Medicare	$68.00
Rate for Payer: BCN Commercial	$90.63
Rate for Payer: Cash Price	$108.80
Rate for Payer: Cash Price	$108.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$102.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$83.58
Rate for Payer: Priority Health Narrow/Tiered Network	$83.58

PR CHEMOTX ADMN IV NFS TQ UP 1 HR 1/1ST SBST/DRUG

Professional

Both

$255.00

Service Code	HCPCS 96413
Min. Negotiated Rate	$127.50
Max. Negotiated Rate	$191.25
Rate for Payer: Aetna Commercial	$170.23
Rate for Payer: Aetna Medicare	$127.50
Rate for Payer: BCN Commercial	$183.76
Rate for Payer: Cash Price	$204.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$191.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$169.46
Rate for Payer: Priority Health Narrow/Tiered Network	$169.46

PR CHEMOTX ADMN IV PUSH TQ 1/1ST SBST/DRUG

Professional

Both

$213.00

Service Code	HCPCS 96409
Min. Negotiated Rate	$106.50
Max. Negotiated Rate	$159.75
Rate for Payer: Aetna Commercial	$130.25
Rate for Payer: Aetna Medicare	$106.50
Rate for Payer: BCN Commercial	$142.42
Rate for Payer: Cash Price	$170.40
Rate for Payer: Cash Price	$170.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$131.34
Rate for Payer: Priority Health Narrow/Tiered Network	$131.34

PR CHEMOTX ADMN IV PUSH TQ EA SBST/DRUG

Professional

Both

$121.00

Service Code	HCPCS 96411
Min. Negotiated Rate	$60.50
Max. Negotiated Rate	$90.75
Rate for Payer: Aetna Commercial	$71.62
Rate for Payer: Aetna Medicare	$60.50
Rate for Payer: BCN Commercial	$78.18
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$96.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$90.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$72.10
Rate for Payer: Priority Health Narrow/Tiered Network	$72.10

PR CHEMOTX ADMN SUBQ/IM HORMONAL ANTI-NEO

Professional

Both

$85.00

Service Code	HCPCS 96402
Min. Negotiated Rate	$38.54
Max. Negotiated Rate	$63.75
Rate for Payer: Aetna Commercial	$38.54
Rate for Payer: Aetna Medicare	$42.50
Rate for Payer: BCN Commercial	$53.78
Rate for Payer: Cash Price	$68.00
Rate for Payer: Cash Price	$68.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$49.59
Rate for Payer: Priority Health Narrow/Tiered Network	$49.59

PR CHEMOTX ADMN SUBQ/IM NON-HORMONAL ANTI-NEO

Professional

Both

$119.00

Service Code	HCPCS 96401
Min. Negotiated Rate	$59.50
Max. Negotiated Rate	$102.08
Rate for Payer: Aetna Commercial	$94.74
Rate for Payer: Aetna Medicare	$59.50
Rate for Payer: BCN Commercial	$102.08
Rate for Payer: Cash Price	$95.20
Rate for Payer: Cash Price	$95.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$89.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$94.14
Rate for Payer: Priority Health Narrow/Tiered Network	$94.14

PR CHEMOTX NJX SUBARACHND/INTRAVENTR RSVR 1/MULT

Professional

Both

$293.00

Service Code	HCPCS 96542
Min. Negotiated Rate	$22.79
Max. Negotiated Rate	$219.75
Rate for Payer: Aetna Commercial	$51.17
Rate for Payer: Aetna Medicare	$146.50
Rate for Payer: BCBS Complete	$23.93
Rate for Payer: BCN Commercial	$61.25
Rate for Payer: Cash Price	$234.40
Rate for Payer: Cash Price	$234.40
Rate for Payer: Mclaren Medicaid	$22.79
Rate for Payer: Meridian Medicaid	$23.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$219.75
Rate for Payer: Priority Health Choice Medicaid	$22.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$56.49
Rate for Payer: Priority Health Narrow/Tiered Network	$56.49
Rate for Payer: UHC Medicaid	$22.79
Rate for Payer: UHCCP Medicaid	$22.79

PR CHIROPRACTIC MANIPULATIVE TX SPINAL 3-4 REGIONS

Professional

Both

$64.00

Service Code	HCPCS 98941
Min. Negotiated Rate	$25.60
Max. Negotiated Rate	$48.00
Rate for Payer: Aetna Commercial	$29.14
Rate for Payer: Aetna Medicare	$32.00
Rate for Payer: BCBS Complete	$25.60
Rate for Payer: BCN Commercial	$33.72
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	$46.38
Rate for Payer: Priority Health Narrow/Tiered Network	$46.38

PR CHNG URTROST TUBE/XTRNLLY ACCESSIBLE STENT ILEAL

Professional

Both

$155.00

Service Code	HCPCS 50688
Min. Negotiated Rate	$45.37
Max. Negotiated Rate	$127.47
Rate for Payer: Aetna Commercial	$97.34
Rate for Payer: Aetna Medicare	$77.50
Rate for Payer: BCBS Complete	$47.64
Rate for Payer: BCN Commercial	$117.02
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cash Price	$124.00
Rate for Payer: Mclaren Medicaid	$45.37
Rate for Payer: Meridian Medicaid	$47.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$116.25
Rate for Payer: Priority Health Choice Medicaid	$45.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$127.47
Rate for Payer: Priority Health Narrow/Tiered Network	$127.47
Rate for Payer: UHC Medicaid	$45.37
Rate for Payer: UHCCP Medicaid	$45.37

Know your out-of-pocket cost for care.

All Charges