Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR CORRECTION INVERTED NIPPLES

Professional

Both

$1,705.00

Service Code	HCPCS 19355
Min. Negotiated Rate	$358.48
Max. Negotiated Rate	$1,278.75
Rate for Payer: Aetna Commercial	$666.64
Rate for Payer: Aetna Medicare	$852.50
Rate for Payer: BCBS Complete	$376.40
Rate for Payer: BCN Commercial	$935.21
Rate for Payer: Cash Price	$1,364.00
Rate for Payer: Cash Price	$1,364.00
Rate for Payer: Mclaren Medicaid	$358.48
Rate for Payer: Meridian Medicaid	$376.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,278.75
Rate for Payer: Priority Health Choice Medicaid	$358.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$855.96
Rate for Payer: Priority Health Narrow/Tiered Network	$855.96
Rate for Payer: UHC Medicaid	$358.48
Rate for Payer: UHCCP Medicaid	$358.48

PR CORRECTION TRICHIASIS EPILATION FORCEPS ONLY

Professional

Both

$148.00

Service Code	HCPCS 67820
Min. Negotiated Rate	$12.14
Max. Negotiated Rate	$111.00
Rate for Payer: Aetna Commercial	$29.30
Rate for Payer: Aetna Medicare	$74.00
Rate for Payer: BCBS Complete	$12.75
Rate for Payer: BCN Commercial	$25.92
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cash Price	$118.40
Rate for Payer: Mclaren Medicaid	$12.14
Rate for Payer: Meridian Medicaid	$12.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.00
Rate for Payer: Priority Health Choice Medicaid	$12.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$38.50
Rate for Payer: Priority Health Narrow/Tiered Network	$38.50
Rate for Payer: UHC Medicaid	$12.14
Rate for Payer: UHCCP Medicaid	$12.14

PR CORRJ HLX VLGS BNCTY SESMDC DSTL METAR OSTEOT

Professional

Both

$2,308.00

Service Code	HCPCS 28296
Min. Negotiated Rate	$308.85
Max. Negotiated Rate	$1,731.00
Rate for Payer: Aetna Commercial	$677.65
Rate for Payer: Aetna Medicare	$1,154.00
Rate for Payer: BCBS Complete	$324.29
Rate for Payer: BCN Commercial	$782.32
Rate for Payer: Cash Price	$1,846.40
Rate for Payer: Cash Price	$1,846.40
Rate for Payer: Mclaren Medicaid	$308.85
Rate for Payer: Meridian Medicaid	$324.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,731.00
Rate for Payer: Priority Health Choice Medicaid	$308.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$836.28
Rate for Payer: Priority Health Narrow/Tiered Network	$836.28
Rate for Payer: UHC Medicaid	$308.85
Rate for Payer: UHCCP Medicaid	$308.85

PR CORRJ HLX VLGS BNCTY SESMDC JOINT ARTHRODESIS

Professional

Both

$2,037.00

Service Code	HCPCS 28297
Min. Negotiated Rate	$358.27
Max. Negotiated Rate	$1,527.75
Rate for Payer: Aetna Commercial	$799.03
Rate for Payer: Aetna Medicare	$1,018.50
Rate for Payer: BCBS Complete	$376.18
Rate for Payer: BCN Commercial	$907.82
Rate for Payer: Cash Price	$1,629.60
Rate for Payer: Cash Price	$1,629.60
Rate for Payer: Mclaren Medicaid	$358.27
Rate for Payer: Meridian Medicaid	$376.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,527.75
Rate for Payer: Priority Health Choice Medicaid	$358.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$970.44
Rate for Payer: Priority Health Narrow/Tiered Network	$970.44
Rate for Payer: UHC Medicaid	$358.27
Rate for Payer: UHCCP Medicaid	$358.27

PR CORRJ HLX VLGS BNCTY SESMDC PROX METAR OSTEOT

Professional

Both

$1,693.00

Service Code	HCPCS 28295
Min. Negotiated Rate	$358.91
Max. Negotiated Rate	$1,269.75
Rate for Payer: Aetna Commercial	$819.40
Rate for Payer: Aetna Medicare	$846.50
Rate for Payer: BCBS Complete	$376.86
Rate for Payer: BCN Commercial	$908.82
Rate for Payer: Cash Price	$1,354.40
Rate for Payer: Cash Price	$1,354.40
Rate for Payer: Mclaren Medicaid	$358.91
Rate for Payer: Meridian Medicaid	$376.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,269.75
Rate for Payer: Priority Health Choice Medicaid	$358.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$971.49
Rate for Payer: Priority Health Narrow/Tiered Network	$971.49
Rate for Payer: UHC Medicaid	$358.91
Rate for Payer: UHCCP Medicaid	$358.91

PR CORRJ HLX VLGS BNCTY SESMDC PROX PHLX OSTEOT

Professional

Both

$1,968.00

Service Code	HCPCS 28298
Min. Negotiated Rate	$308.21
Max. Negotiated Rate	$1,476.00
Rate for Payer: Aetna Commercial	$662.21
Rate for Payer: Aetna Medicare	$984.00
Rate for Payer: BCBS Complete	$323.62
Rate for Payer: BCN Commercial	$769.38
Rate for Payer: Cash Price	$1,574.40
Rate for Payer: Cash Price	$1,574.40
Rate for Payer: Mclaren Medicaid	$308.21
Rate for Payer: Meridian Medicaid	$323.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,476.00
Rate for Payer: Priority Health Choice Medicaid	$308.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$822.44
Rate for Payer: Priority Health Narrow/Tiered Network	$822.44
Rate for Payer: UHC Medicaid	$308.21
Rate for Payer: UHCCP Medicaid	$308.21

PR CORRJ HLX VLGS BNCTY SESMDC RESCJ PROX PHLX BASE

Professional

Both

$1,833.00

Service Code	HCPCS 28292
Min. Negotiated Rate	$293.30
Max. Negotiated Rate	$1,374.75
Rate for Payer: Aetna Commercial	$635.54
Rate for Payer: Aetna Medicare	$916.50
Rate for Payer: BCBS Complete	$307.96
Rate for Payer: BCN Commercial	$740.00
Rate for Payer: Cash Price	$1,466.40
Rate for Payer: Cash Price	$1,466.40
Rate for Payer: Mclaren Medicaid	$293.30
Rate for Payer: Meridian Medicaid	$307.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,374.75
Rate for Payer: Priority Health Choice Medicaid	$293.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$791.04
Rate for Payer: Priority Health Narrow/Tiered Network	$791.04
Rate for Payer: UHC Medicaid	$293.30
Rate for Payer: UHCCP Medicaid	$293.30

PR CORRJ HLX VLGS BNCTY SESMDC W/DOUBLE OSTEOTOMY

Professional

Both

$2,478.00

Service Code	HCPCS 28299
Min. Negotiated Rate	$359.33
Max. Negotiated Rate	$1,858.50
Rate for Payer: Aetna Commercial	$775.94
Rate for Payer: Aetna Medicare	$1,239.00
Rate for Payer: BCBS Complete	$377.30
Rate for Payer: BCN Commercial	$904.83
Rate for Payer: Cash Price	$1,982.40
Rate for Payer: Cash Price	$1,982.40
Rate for Payer: Mclaren Medicaid	$359.33
Rate for Payer: Meridian Medicaid	$377.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,858.50
Rate for Payer: Priority Health Choice Medicaid	$359.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$967.25
Rate for Payer: Priority Health Narrow/Tiered Network	$967.25
Rate for Payer: UHC Medicaid	$359.33
Rate for Payer: UHCCP Medicaid	$359.33

PR CORRJ LAGOPHTHALMOS IMPLTJ UPR EYELID LID LOAD

Professional

Both

$3,087.00

Service Code	HCPCS 67912
Min. Negotiated Rate	$270.30
Max. Negotiated Rate	$2,315.25
Rate for Payer: Aetna Commercial	$631.22
Rate for Payer: Aetna Medicare	$1,543.50
Rate for Payer: BCBS Complete	$283.81
Rate for Payer: BCN Commercial	$719.59
Rate for Payer: Cash Price	$2,469.60
Rate for Payer: Cash Price	$2,469.60
Rate for Payer: Mclaren Medicaid	$270.30
Rate for Payer: Meridian Medicaid	$283.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,315.25
Rate for Payer: Priority Health Choice Medicaid	$270.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$842.88
Rate for Payer: Priority Health Narrow/Tiered Network	$842.88
Rate for Payer: UHC Medicaid	$270.30
Rate for Payer: UHCCP Medicaid	$270.30

PR CORRJ MALROTATION BANDS&/RDCTJ VOLVULUS

Professional

Both

$3,267.00

Service Code	HCPCS 44055
Min. Negotiated Rate	$878.63
Max. Negotiated Rate	$2,727.38
Rate for Payer: Aetna Commercial	$2,013.07
Rate for Payer: Aetna Medicare	$1,633.50
Rate for Payer: BCBS Complete	$922.56
Rate for Payer: BCN Commercial	$2,238.43
Rate for Payer: Cash Price	$2,613.60
Rate for Payer: Cash Price	$2,613.60
Rate for Payer: Mclaren Medicaid	$878.63
Rate for Payer: Meridian Medicaid	$922.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,450.25
Rate for Payer: Priority Health Choice Medicaid	$878.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,727.38
Rate for Payer: Priority Health Narrow/Tiered Network	$2,727.38
Rate for Payer: UHC Medicaid	$878.63
Rate for Payer: UHCCP Medicaid	$878.63

PR COSMETIC CORRECTION OF INVERTED NIPPLES

Professional

Both

$1,803.00

Hospital Revenue Code	990
Min. Negotiated Rate	$721.20
Max. Negotiated Rate	$1,352.25
Rate for Payer: Aetna Medicare	$901.50
Rate for Payer: BCBS Complete	$721.20
Rate for Payer: Cash Price	$1,442.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,352.25

PR COSMETIC SCLEROTHERAPY

Professional

Both

$300.00

Hospital Revenue Code	960
Min. Negotiated Rate	$120.00
Max. Negotiated Rate	$225.00
Rate for Payer: Aetna Medicare	$150.00
Rate for Payer: BCBS Complete	$120.00
Rate for Payer: Cash Price	$240.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$225.00

PR COSMETIC SCLEROTHERAPY/LASER

Professional

Both

$263.00

Hospital Revenue Code	960
Min. Negotiated Rate	$105.20
Max. Negotiated Rate	$197.25
Rate for Payer: Aetna Medicare	$131.50
Rate for Payer: BCBS Complete	$105.20
Rate for Payer: Cash Price	$210.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$197.25

PR COSMETIC SCLEROTHERAPY/LASER/F/U TREATMENT

Professional

Both

$79.00

Hospital Revenue Code	960
Min. Negotiated Rate	$31.60
Max. Negotiated Rate	$59.25
Rate for Payer: Aetna Medicare	$39.50
Rate for Payer: BCBS Complete	$31.60
Rate for Payer: Cash Price	$63.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$59.25

PR COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG

Professional

Both

$6,444.00

Service Code	HCPCS 63064
Min. Negotiated Rate	$1,075.01
Max. Negotiated Rate	$4,833.00
Rate for Payer: Aetna Commercial	$2,309.28
Rate for Payer: Aetna Medicare	$3,222.00
Rate for Payer: BCBS Complete	$1,128.76
Rate for Payer: BCN Commercial	$2,939.95
Rate for Payer: Cash Price	$5,155.20
Rate for Payer: Cash Price	$5,155.20
Rate for Payer: Mclaren Medicaid	$1,075.01
Rate for Payer: Meridian Medicaid	$1,128.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,833.00
Rate for Payer: Priority Health Choice Medicaid	$1,075.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,108.30
Rate for Payer: Priority Health Narrow/Tiered Network	$3,108.30
Rate for Payer: UHC Medicaid	$1,075.01
Rate for Payer: UHCCP Medicaid	$1,075.01

PR COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG

Professional

Both

$2,209.00

Service Code	HCPCS 63066
Min. Negotiated Rate	$119.71
Max. Negotiated Rate	$1,656.75
Rate for Payer: Aetna Commercial	$266.49
Rate for Payer: Aetna Medicare	$1,104.50
Rate for Payer: BCBS Complete	$125.70
Rate for Payer: BCN Commercial	$339.18
Rate for Payer: Cash Price	$1,767.20
Rate for Payer: Cash Price	$1,767.20
Rate for Payer: Mclaren Medicaid	$119.71
Rate for Payer: Meridian Medicaid	$125.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,656.75
Rate for Payer: Priority Health Choice Medicaid	$119.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$358.61
Rate for Payer: Priority Health Narrow/Tiered Network	$358.61
Rate for Payer: UHC Medicaid	$119.71
Rate for Payer: UHCCP Medicaid	$119.71

PR COUDE TIP URINARY CATHETER

Professional

Both

$8.00

Service Code	HCPCS A4352
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$7.45
Rate for Payer: Aetna Commercial	$5.09
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: BCN Commercial	$7.45
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.00

PR COUNSEL IMMUNE <21 16-30 M

Professional

Both

$47.00

Service Code	HCPCS G0314
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 COUNSEL IMMUNE <21 5-15 M

Professional

Both

$32.00

Service Code	HCPCS G0315
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00

PR CPAP VENTILATION CPAP INITIATION&MGMT

Professional

Both

$240.00

Service Code	HCPCS 94660
Min. Negotiated Rate	$20.66
Max. Negotiated Rate	$180.00
Rate for Payer: Aetna Commercial	$41.58
Rate for Payer: Aetna Medicare	$120.00
Rate for Payer: BCBS Complete	$21.69
Rate for Payer: BCN Commercial	$54.28
Rate for Payer: Cash Price	$192.00
Rate for Payer: Cash Price	$192.00
Rate for Payer: Mclaren Medicaid	$20.66
Rate for Payer: Meridian Medicaid	$21.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$180.00
Rate for Payer: Priority Health Choice Medicaid	$20.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$50.06
Rate for Payer: Priority Health Narrow/Tiered Network	$50.06
Rate for Payer: UHC Medicaid	$20.66
Rate for Payer: UHCCP Medicaid	$20.66

PR CPLX CHRONIC CARE MGMT SVC EA ADDL 30 MIN CAL MO

Professional

Both

$59.00

Service Code	HCPCS 99489
Min. Negotiated Rate	$25.42
Max. Negotiated Rate	$79.19
Rate for Payer: Aetna Commercial	$25.42
Rate for Payer: Aetna Medicare	$29.50
Rate for Payer: BCBS Complete	$29.30
Rate for Payer: BCN Commercial	$79.19
Rate for Payer: Cash Price	$47.20
Rate for Payer: Cash Price	$47.20
Rate for Payer: Mclaren Medicaid	$27.90
Rate for Payer: Meridian Medicaid	$29.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$44.25
Rate for Payer: Priority Health Choice Medicaid	$27.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$65.40
Rate for Payer: Priority Health Narrow/Tiered Network	$65.40
Rate for Payer: UHC Medicaid	$27.90
Rate for Payer: UHCCP Medicaid	$27.90

PR CPLX INTRACRANIAL ARYSM VERTEBROBASILAR CRCJ

Professional

Both

$10,611.00

Service Code	HCPCS 61698
Min. Negotiated Rate	$2,787.96
Max. Negotiated Rate	$9,661.21
Rate for Payer: Aetna Commercial	$5,979.62
Rate for Payer: Aetna Medicare	$5,305.50
Rate for Payer: BCBS Complete	$2,927.36
Rate for Payer: BCN Commercial	$9,661.21
Rate for Payer: Cash Price	$8,488.80
Rate for Payer: Cash Price	$8,488.80
Rate for Payer: Mclaren Medicaid	$2,787.96
Rate for Payer: Meridian Medicaid	$2,927.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,958.25
Rate for Payer: Priority Health Choice Medicaid	$2,787.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$8,122.41
Rate for Payer: Priority Health Narrow/Tiered Network	$8,122.41
Rate for Payer: UHC Medicaid	$2,787.96
Rate for Payer: UHCCP Medicaid	$2,787.96

PR CPTR-ASST MUSCSKEL NAVIGJ ORTHO CT/MRI

Professional

Both

$525.00

Service Code	HCPCS 0055T
Min. Negotiated Rate	$146.69
Max. Negotiated Rate	$393.75
Rate for Payer: Aetna Commercial	$210.14
Rate for Payer: Aetna Medicare	$262.50
Rate for Payer: BCBS Complete	$154.02
Rate for Payer: Cash Price	$420.00
Rate for Payer: Cash Price	$420.00
Rate for Payer: Mclaren Medicaid	$146.69
Rate for Payer: Meridian Medicaid	$154.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$393.75
Rate for Payer: Priority Health Choice Medicaid	$146.69
Rate for Payer: UHC Medicaid	$146.69
Rate for Payer: UHCCP Medicaid	$146.69

PR CPTR-ASST MUSCSKEL NAVIGJ ORTHO FLUOR IMAGES

Professional

Both

$275.00

Service Code	HCPCS 0054T
Min. Negotiated Rate	$91.75
Max. Negotiated Rate	$206.25
Rate for Payer: Aetna Commercial	$179.20
Rate for Payer: Aetna Medicare	$137.50
Rate for Payer: BCBS Complete	$96.34
Rate for Payer: Cash Price	$220.00
Rate for Payer: Cash Price	$220.00
Rate for Payer: Mclaren Medicaid	$91.75
Rate for Payer: Meridian Medicaid	$96.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$206.25
Rate for Payer: Priority Health Choice Medicaid	$91.75
Rate for Payer: UHC Medicaid	$91.75
Rate for Payer: UHCCP Medicaid	$91.75

PR CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS

Professional

Both

$291.00

Service Code	HCPCS 20985
Min. Negotiated Rate	$79.02
Max. Negotiated Rate	$230.50
Rate for Payer: Aetna Commercial	$194.83
Rate for Payer: Aetna Medicare	$145.50
Rate for Payer: BCBS Complete	$82.97
Rate for Payer: BCN Commercial	$215.63
Rate for Payer: Cash Price	$232.80
Rate for Payer: Cash Price	$232.80
Rate for Payer: Mclaren Medicaid	$79.02
Rate for Payer: Meridian Medicaid	$82.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$218.25
Rate for Payer: Priority Health Choice Medicaid	$79.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$230.50
Rate for Payer: Priority Health Narrow/Tiered Network	$230.50
Rate for Payer: UHC Medicaid	$79.02
Rate for Payer: UHCCP Medicaid	$79.02

Know your out-of-pocket cost for care.

All Charges