Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR DECOMPRESSIVE FASCIOTOMY HAND

Professional

Both

$1,404.00

Service Code	HCPCS 26037
Min. Negotiated Rate	$336.11
Max. Negotiated Rate	$1,053.00
Rate for Payer: Aetna Commercial	$751.25
Rate for Payer: Aetna Medicare	$702.00
Rate for Payer: BCBS Complete	$352.92
Rate for Payer: BCN Commercial	$863.50
Rate for Payer: Cash Price	$1,123.20
Rate for Payer: Cash Price	$1,123.20
Rate for Payer: Mclaren Medicaid	$336.11
Rate for Payer: Meridian Medicaid	$352.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,053.00
Rate for Payer: Priority Health Choice Medicaid	$336.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$923.06
Rate for Payer: Priority Health Narrow/Tiered Network	$923.06
Rate for Payer: UHC Medicaid	$336.11
Rate for Payer: UHCCP Medicaid	$336.11

PR DECORTICATION & PARIETAL PLEURECTOMY

Professional

Both

$4,133.00

Service Code	HCPCS 32320
Min. Negotiated Rate	$977.46
Max. Negotiated Rate	$3,099.75
Rate for Payer: Aetna Commercial	$2,067.00
Rate for Payer: Aetna Medicare	$2,066.50
Rate for Payer: BCBS Complete	$1,026.33
Rate for Payer: BCN Commercial	$2,377.86
Rate for Payer: Cash Price	$3,306.40
Rate for Payer: Cash Price	$3,306.40
Rate for Payer: Mclaren Medicaid	$977.46
Rate for Payer: Meridian Medicaid	$1,026.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,099.75
Rate for Payer: Priority Health Choice Medicaid	$977.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,239.25
Rate for Payer: Priority Health Narrow/Tiered Network	$2,239.25
Rate for Payer: UHC Medicaid	$977.46
Rate for Payer: UHCCP Medicaid	$977.46

PR DECORTICATION PULMONARY PARTIAL SEPARATE PROC

Professional

Both

$2,124.00

Service Code	HCPCS 32225
Min. Negotiated Rate	$610.67
Max. Negotiated Rate	$1,593.00
Rate for Payer: Aetna Commercial	$1,281.01
Rate for Payer: Aetna Medicare	$1,062.00
Rate for Payer: BCBS Complete	$641.20
Rate for Payer: BCN Commercial	$1,478.01
Rate for Payer: Cash Price	$1,699.20
Rate for Payer: Cash Price	$1,699.20
Rate for Payer: Mclaren Medicaid	$610.67
Rate for Payer: Meridian Medicaid	$641.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,593.00
Rate for Payer: Priority Health Choice Medicaid	$610.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,391.84
Rate for Payer: Priority Health Narrow/Tiered Network	$1,391.84
Rate for Payer: UHC Medicaid	$610.67
Rate for Payer: UHCCP Medicaid	$610.67

PR DECORTICATION PULMONARY TOTAL SEPARATE PROCEDURE

Professional

Both

$3,052.00

Service Code	HCPCS 32220
Min. Negotiated Rate	$981.08
Max. Negotiated Rate	$2,372.38
Rate for Payer: Aetna Commercial	$2,051.72
Rate for Payer: Aetna Medicare	$1,526.00
Rate for Payer: BCBS Complete	$1,030.13
Rate for Payer: BCN Commercial	$2,372.38
Rate for Payer: Cash Price	$2,441.60
Rate for Payer: Cash Price	$2,441.60
Rate for Payer: Mclaren Medicaid	$981.08
Rate for Payer: Meridian Medicaid	$1,030.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,289.00
Rate for Payer: Priority Health Choice Medicaid	$981.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,234.08
Rate for Payer: Priority Health Narrow/Tiered Network	$2,234.08
Rate for Payer: UHC Medicaid	$981.08
Rate for Payer: UHCCP Medicaid	$981.08

PR DEGARELIX INJECTION

Professional

Both

$6.00

Service Code	HCPCS J9155
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Commercial	$4.31
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Trust/PPO	$4.44
Rate for Payer: BCN Commercial	$4.35
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50

PR DELAYED CREATION EXIT SITE EMBEDDED CATHETER

Professional

Both

$1,329.00

Service Code	HCPCS 49436
Min. Negotiated Rate	$113.32
Max. Negotiated Rate	$996.75
Rate for Payer: Aetna Commercial	$252.08
Rate for Payer: Aetna Medicare	$664.50
Rate for Payer: BCBS Complete	$118.99
Rate for Payer: BCN Commercial	$280.86
Rate for Payer: Cash Price	$1,063.20
Rate for Payer: Cash Price	$1,063.20
Rate for Payer: Mclaren Medicaid	$113.32
Rate for Payer: Meridian Medicaid	$118.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$996.75
Rate for Payer: Priority Health Choice Medicaid	$113.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$342.20
Rate for Payer: Priority Health Narrow/Tiered Network	$342.20
Rate for Payer: UHC Medicaid	$113.32
Rate for Payer: UHCCP Medicaid	$113.32

PR DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS

Professional

Both

$933.00

Service Code	HCPCS 15630
Min. Negotiated Rate	$198.52
Max. Negotiated Rate	$699.75
Rate for Payer: Aetna Commercial	$362.89
Rate for Payer: Aetna Medicare	$466.50
Rate for Payer: BCBS Complete	$208.45
Rate for Payer: BCN Commercial	$521.38
Rate for Payer: Cash Price	$746.40
Rate for Payer: Cash Price	$746.40
Rate for Payer: Mclaren Medicaid	$198.52
Rate for Payer: Meridian Medicaid	$208.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$699.75
Rate for Payer: Priority Health Choice Medicaid	$198.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$477.21
Rate for Payer: Priority Health Narrow/Tiered Network	$477.21
Rate for Payer: UHC Medicaid	$198.52
Rate for Payer: UHCCP Medicaid	$198.52

PR DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F

Professional

Both

$746.00

Service Code	HCPCS 15620
Min. Negotiated Rate	$194.26
Max. Negotiated Rate	$559.50
Rate for Payer: Aetna Commercial	$345.81
Rate for Payer: Aetna Medicare	$373.00
Rate for Payer: BCBS Complete	$203.97
Rate for Payer: BCN Commercial	$496.49
Rate for Payer: Cash Price	$596.80
Rate for Payer: Cash Price	$596.80
Rate for Payer: Mclaren Medicaid	$194.26
Rate for Payer: Meridian Medicaid	$203.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$559.50
Rate for Payer: Priority Health Choice Medicaid	$194.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$454.41
Rate for Payer: Priority Health Narrow/Tiered Network	$454.41
Rate for Payer: UHC Medicaid	$194.26
Rate for Payer: UHCCP Medicaid	$194.26

PR DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS

Professional

Both

$630.00

Service Code	HCPCS 15610
Min. Negotiated Rate	$150.17
Max. Negotiated Rate	$472.50
Rate for Payer: Aetna Commercial	$257.64
Rate for Payer: Aetna Medicare	$315.00
Rate for Payer: BCBS Complete	$157.68
Rate for Payer: BCN Commercial	$372.99
Rate for Payer: Cash Price	$504.00
Rate for Payer: Cash Price	$504.00
Rate for Payer: Mclaren Medicaid	$150.17
Rate for Payer: Meridian Medicaid	$157.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$472.50
Rate for Payer: Priority Health Choice Medicaid	$150.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$341.39
Rate for Payer: Priority Health Narrow/Tiered Network	$341.39
Rate for Payer: UHC Medicaid	$150.17
Rate for Payer: UHCCP Medicaid	$150.17

PR DELAY FLAP/SECTIONING FLAP TRUNK

Professional

Both

$545.00

Service Code	HCPCS 15600
Min. Negotiated Rate	$135.68
Max. Negotiated Rate	$408.75
Rate for Payer: Aetna Commercial	$222.85
Rate for Payer: Aetna Medicare	$272.50
Rate for Payer: BCBS Complete	$142.46
Rate for Payer: BCN Commercial	$320.70
Rate for Payer: Cash Price	$436.00
Rate for Payer: Cash Price	$436.00
Rate for Payer: Mclaren Medicaid	$135.68
Rate for Payer: Meridian Medicaid	$142.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$408.75
Rate for Payer: Priority Health Choice Medicaid	$135.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$293.52
Rate for Payer: Priority Health Narrow/Tiered Network	$293.52
Rate for Payer: UHC Medicaid	$135.68
Rate for Payer: UHCCP Medicaid	$135.68

PR DELIVERY/BIRTHING ROOM RESUSCITATION

Professional

Both

$479.00

Service Code	HCPCS 99465
Min. Negotiated Rate	$78.81
Max. Negotiated Rate	$359.25
Rate for Payer: Aetna Commercial	$143.87
Rate for Payer: Aetna Medicare	$239.50
Rate for Payer: BCBS Complete	$82.75
Rate for Payer: BCN Commercial	$208.65
Rate for Payer: Cash Price	$383.20
Rate for Payer: Cash Price	$383.20
Rate for Payer: Mclaren Medicaid	$78.81
Rate for Payer: Meridian Medicaid	$82.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$359.25
Rate for Payer: Priority Health Choice Medicaid	$78.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$187.68
Rate for Payer: Priority Health Narrow/Tiered Network	$187.68
Rate for Payer: UHC Medicaid	$78.81
Rate for Payer: UHCCP Medicaid	$78.81

PR DELIVERY PLACENTA SEPARATE PROCEDURE

Professional

Both

$267.00

Service Code	HCPCS 59414
Min. Negotiated Rate	$79.13
Max. Negotiated Rate	$200.25
Rate for Payer: Aetna Commercial	$100.38
Rate for Payer: Aetna Medicare	$133.50
Rate for Payer: BCBS Complete	$83.09
Rate for Payer: BCN Commercial	$135.95
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Mclaren Medicaid	$79.13
Rate for Payer: Meridian Medicaid	$83.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$200.25
Rate for Payer: Priority Health Choice Medicaid	$79.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$128.34
Rate for Payer: Priority Health Narrow/Tiered Network	$128.34
Rate for Payer: UHC Medicaid	$79.13
Rate for Payer: UHCCP Medicaid	$79.13

PR DEMO&/EVAL PT UTILIZ AERSL GEN NEB INHLR/IPPB

Professional

Both

$58.00

Service Code	HCPCS 94664
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$43.50
Rate for Payer: Aetna Commercial	$17.47
Rate for Payer: Aetna Medicare	$29.00
Rate for Payer: BCN Commercial	$26.89
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$43.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$24.80
Rate for Payer: Priority Health Narrow/Tiered Network	$24.80

PR DENOSUMAB INJECTION

Professional

Both

$27.00

Service Code	HCPCS J0897
Min. Negotiated Rate	$13.50
Max. Negotiated Rate	$28.75
Rate for Payer: Aetna Commercial	$25.95
Rate for Payer: Aetna Medicare	$13.50
Rate for Payer: BCBS Trust/PPO	$28.75
Rate for Payer: BCN Commercial	$26.77
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.25

PR DEPO-ESTRADIOL CYPIONATE INJ

Professional

Both

$18.00

Service Code	HCPCS J1000
Min. Negotiated Rate	$9.00
Max. Negotiated Rate	$52.79
Rate for Payer: Aetna Commercial	$36.83
Rate for Payer: Aetna Medicare	$9.00
Rate for Payer: BCBS Trust/PPO	$52.79
Rate for Payer: BCN Commercial	$43.12
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.50

PR DEPRESSION SCREEN ANNUAL

Professional

Both

$33.00

Service Code	HCPCS G0444
Min. Negotiated Rate	$9.26
Max. Negotiated Rate	$24.75
Rate for Payer: Aetna Commercial	$9.26
Rate for Payer: Aetna Medicare	$16.50
Rate for Payer: BCBS Complete	$13.20
Rate for Payer: BCN Commercial	$13.45
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$10.80
Rate for Payer: Priority Health Narrow/Tiered Network	$10.80

PR DERMABRASION SEGMENTAL FACE

Professional

Both

$1,249.00

Service Code	HCPCS 15781
Min. Negotiated Rate	$234.94
Max. Negotiated Rate	$936.75
Rate for Payer: Aetna Commercial	$457.99
Rate for Payer: Aetna Medicare	$624.50
Rate for Payer: BCBS Complete	$246.69
Rate for Payer: BCN Commercial	$632.93
Rate for Payer: Cash Price	$999.20
Rate for Payer: Cash Price	$999.20
Rate for Payer: Mclaren Medicaid	$234.94
Rate for Payer: Meridian Medicaid	$246.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$936.75
Rate for Payer: Priority Health Choice Medicaid	$234.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$579.29
Rate for Payer: Priority Health Narrow/Tiered Network	$579.29
Rate for Payer: UHC Medicaid	$234.94
Rate for Payer: UHCCP Medicaid	$234.94

PR DERMAGRAFT

Professional

Both

$53.00

Service Code	HCPCS Q4106
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$46.29
Rate for Payer: Aetna Commercial	$46.29
Rate for Payer: Aetna Medicare	$26.50
Rate for Payer: BCBS Complete	$21.20
Rate for Payer: BCN Commercial	$33.86
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.75

PR DERMAL AUTOGRAFT F/S/N/H/F/G/M/DGT 1ST 100 SQCM

Professional

Both

$1,634.00

Service Code	HCPCS 15135
Min. Negotiated Rate	$429.83
Max. Negotiated Rate	$1,225.50
Rate for Payer: Aetna Commercial	$810.88
Rate for Payer: Aetna Medicare	$817.00
Rate for Payer: BCBS Complete	$451.32
Rate for Payer: BCN Commercial	$1,139.88
Rate for Payer: Cash Price	$1,307.20
Rate for Payer: Cash Price	$1,307.20
Rate for Payer: Mclaren Medicaid	$429.83
Rate for Payer: Meridian Medicaid	$451.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,225.50
Rate for Payer: Priority Health Choice Medicaid	$429.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,043.28
Rate for Payer: Priority Health Narrow/Tiered Network	$1,043.28
Rate for Payer: UHC Medicaid	$429.83
Rate for Payer: UHCCP Medicaid	$429.83

PR DERMAL FILLER JUVEDERM ULTRA

Professional

Both

$773.00

Hospital Revenue Code	990
Min. Negotiated Rate	$309.20
Max. Negotiated Rate	$579.75
Rate for Payer: Aetna Medicare	$386.50
Rate for Payer: BCBS Complete	$309.20
Rate for Payer: Cash Price	$618.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$579.75

PR DERMAL FILLER JUVEDERM ULTRA PR PLUS

Professional

Both

$420.00

Hospital Revenue Code	990
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Medicare	$210.00
Rate for Payer: BCBS Complete	$168.00
Rate for Payer: Cash Price	$336.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$315.00

PR DERMAL FILLER JUVEDERM VOLLURE

Professional

Both

$876.00

Hospital Revenue Code	990
Min. Negotiated Rate	$350.40
Max. Negotiated Rate	$657.00
Rate for Payer: Aetna Medicare	$438.00
Rate for Payer: BCBS Complete	$350.40
Rate for Payer: Cash Price	$700.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$657.00

PR DERMAL FILLER JUVEDERM VOLUMA

Professional

Both

$927.00

Hospital Revenue Code	990
Min. Negotiated Rate	$370.80
Max. Negotiated Rate	$695.25
Rate for Payer: Aetna Medicare	$463.50
Rate for Payer: BCBS Complete	$370.80
Rate for Payer: Cash Price	$741.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$695.25

PR DERMAL FILLER RESTYLANE 1/2 UNIT

Professional

Both

$420.00

Hospital Revenue Code	990
Min. Negotiated Rate	$168.00
Max. Negotiated Rate	$315.00
Rate for Payer: Aetna Medicare	$210.00
Rate for Payer: BCBS Complete	$168.00
Rate for Payer: Cash Price	$336.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$315.00

PR DERMAL FILLER RESTYLANE 1 UNIT

Professional

Both

$773.00

Hospital Revenue Code	990
Min. Negotiated Rate	$309.20
Max. Negotiated Rate	$579.75
Rate for Payer: Aetna Medicare	$386.50
Rate for Payer: BCBS Complete	$309.20
Rate for Payer: Cash Price	$618.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$579.75

Know your out-of-pocket cost for care.

All Charges