Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR EKG TRACING FOR INITIAL PREV

Professional

Both

$22.00

Service Code	HCPCS G0404
Min. Negotiated Rate	$8.19
Max. Negotiated Rate	$16.50
Rate for Payer: Aetna Commercial	$8.19
Rate for Payer: Aetna Medicare	$11.00
Rate for Payer: BCBS Complete	$8.80
Rate for Payer: BCN Commercial	$9.46
Rate for Payer: Cash Price	$17.60
Rate for Payer: Cash Price	$17.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$16.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$9.00
Rate for Payer: Priority Health Narrow/Tiered Network	$9.00

PR ELASTIC GARMENT/COVERING

Professional

Both

$18.00

Service Code	HCPCS A4466
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Medicare	$9.00
Rate for Payer: BCBS Complete	$7.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.50

PR ELEC ALYS IMPLT BRN NPGT PRGRMG 1ST 15 MIN

Professional

Both

$108.00

Service Code	HCPCS 95983
Min. Negotiated Rate	$26.84
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna Commercial	$55.41
Rate for Payer: Aetna Medicare	$54.00
Rate for Payer: BCBS Complete	$28.18
Rate for Payer: BCN Commercial	$72.21
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cash Price	$86.40
Rate for Payer: Mclaren Medicaid	$26.84
Rate for Payer: Meridian Medicaid	$28.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$81.00
Rate for Payer: Priority Health Choice Medicaid	$26.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$66.59
Rate for Payer: Priority Health Narrow/Tiered Network	$66.59
Rate for Payer: UHC Medicaid	$26.84
Rate for Payer: UHCCP Medicaid	$26.84

PR ELEC ALYS IMPLT BRN NPGT PRGRMG EA ADDL 15 MIN

Professional

Both

$94.00

Service Code	HCPCS 95984
Min. Negotiated Rate	$23.64
Max. Negotiated Rate	$70.50
Rate for Payer: Aetna Commercial	$48.95
Rate for Payer: Aetna Medicare	$47.00
Rate for Payer: BCBS Complete	$24.82
Rate for Payer: BCN Commercial	$63.74
Rate for Payer: Cash Price	$75.20
Rate for Payer: Cash Price	$75.20
Rate for Payer: Mclaren Medicaid	$23.64
Rate for Payer: Meridian Medicaid	$24.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.50
Rate for Payer: Priority Health Choice Medicaid	$23.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$58.78
Rate for Payer: Priority Health Narrow/Tiered Network	$58.78
Rate for Payer: UHC Medicaid	$23.64
Rate for Payer: UHCCP Medicaid	$23.64

PR ELEC ALYS IMPLT CPLX CN NPGT PRGRMG

Professional

Both

$113.00

Service Code	HCPCS 95977
Min. Negotiated Rate	$27.05
Max. Negotiated Rate	$84.75
Rate for Payer: Aetna Commercial	$58.47
Rate for Payer: Aetna Medicare	$56.50
Rate for Payer: BCBS Complete	$28.40
Rate for Payer: BCN Commercial	$74.20
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cash Price	$90.40
Rate for Payer: Mclaren Medicaid	$27.05
Rate for Payer: Meridian Medicaid	$28.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$84.75
Rate for Payer: Priority Health Choice Medicaid	$27.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$68.43
Rate for Payer: Priority Health Narrow/Tiered Network	$68.43
Rate for Payer: UHC Medicaid	$27.05
Rate for Payer: UHCCP Medicaid	$27.05

PR ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG

Professional

Both

$173.00

Service Code	HCPCS 95972
Min. Negotiated Rate	$22.37
Max. Negotiated Rate	$129.75
Rate for Payer: Aetna Commercial	$45.74
Rate for Payer: Aetna Commercial	$45.74
Rate for Payer: Aetna Medicare	$86.50
Rate for Payer: Aetna Medicare	$246.50
Rate for Payer: BCBS Complete	$23.49
Rate for Payer: BCBS Complete	$23.49
Rate for Payer: BCN Commercial	$58.76
Rate for Payer: BCN Commercial	$58.76
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cash Price	$394.40
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cash Price	$394.40
Rate for Payer: Mclaren Medicaid	$22.37
Rate for Payer: Mclaren Medicaid	$22.37
Rate for Payer: Meridian Medicaid	$23.49
Rate for Payer: Meridian Medicaid	$23.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$129.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$369.75
Rate for Payer: Priority Health Choice Medicaid	$22.37
Rate for Payer: Priority Health Choice Medicaid	$22.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$54.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$54.19
Rate for Payer: Priority Health Narrow/Tiered Network	$54.19
Rate for Payer: Priority Health Narrow/Tiered Network	$54.19
Rate for Payer: UHC Medicaid	$22.37
Rate for Payer: UHC Medicaid	$22.37
Rate for Payer: UHCCP Medicaid	$22.37
Rate for Payer: UHCCP Medicaid	$22.37

PR ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING

Professional

Both

$158.00

Service Code	HCPCS 95970
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$118.50
Rate for Payer: Aetna Commercial	$20.90
Rate for Payer: Aetna Medicare	$79.00
Rate for Payer: BCBS Complete	$10.73
Rate for Payer: BCN Commercial	$27.39
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Mclaren Medicaid	$10.22
Rate for Payer: Meridian Medicaid	$10.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.50
Rate for Payer: Priority Health Choice Medicaid	$10.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$25.26
Rate for Payer: Priority Health Narrow/Tiered Network	$25.26
Rate for Payer: UHC Medicaid	$10.22
Rate for Payer: UHCCP Medicaid	$10.22

PR ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG

Professional

Both

$173.00

Service Code	HCPCS 95971
Min. Negotiated Rate	$21.94
Max. Negotiated Rate	$129.75
Rate for Payer: Aetna Commercial	$44.17
Rate for Payer: Aetna Medicare	$86.50
Rate for Payer: BCBS Complete	$23.04
Rate for Payer: BCN Commercial	$57.27
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cash Price	$138.40
Rate for Payer: Mclaren Medicaid	$21.94
Rate for Payer: Meridian Medicaid	$23.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$129.75
Rate for Payer: Priority Health Choice Medicaid	$21.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$52.82
Rate for Payer: Priority Health Narrow/Tiered Network	$52.82
Rate for Payer: UHC Medicaid	$21.94
Rate for Payer: UHCCP Medicaid	$21.94

PR ELEC ALYS IMPLT SMPL CN NPGT PRGRMG

Professional

Both

$87.00

Service Code	HCPCS 95976
Min. Negotiated Rate	$20.24
Max. Negotiated Rate	$65.25
Rate for Payer: Aetna Commercial	$43.64
Rate for Payer: Aetna Medicare	$43.50
Rate for Payer: BCBS Complete	$21.25
Rate for Payer: BCN Commercial	$55.28
Rate for Payer: Cash Price	$69.60
Rate for Payer: Cash Price	$69.60
Rate for Payer: Mclaren Medicaid	$20.24
Rate for Payer: Meridian Medicaid	$21.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$65.25
Rate for Payer: Priority Health Choice Medicaid	$20.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$50.97
Rate for Payer: Priority Health Narrow/Tiered Network	$50.97
Rate for Payer: UHC Medicaid	$20.24
Rate for Payer: UHCCP Medicaid	$20.24

PR ELEC ALYS NSTIM PLS GEN CPLX CRNL NRV 1ST HR

Professional

Both

$988.00

Service Code	HCPCS 95974
Min. Negotiated Rate	$395.20
Max. Negotiated Rate	$741.00
Rate for Payer: Aetna Medicare	$494.00
Rate for Payer: BCBS Complete	$395.20
Rate for Payer: Cash Price	$790.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$741.00

PR ELEC ALYS NSTIM PLS GEN CPLX SC/PERPH EA 30 MIN

Professional

Both

$173.00

Service Code	HCPCS 95973
Min. Negotiated Rate	$69.20
Max. Negotiated Rate	$129.75
Rate for Payer: Aetna Medicare	$86.50
Rate for Payer: BCBS Complete	$69.20
Rate for Payer: Cash Price	$138.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$129.75

PR ELEC STIM OTHER THAN WOUND

Professional

Both

$27.00

Service Code	HCPCS G0283
Min. Negotiated Rate	$9.50
Max. Negotiated Rate	$20.25
Rate for Payer: Aetna Commercial	$9.50
Rate for Payer: Aetna Medicare	$13.50
Rate for Payer: BCBS Complete	$10.80
Rate for Payer: BCN Commercial	$12.69
Rate for Payer: Cash Price	$21.60
Rate for Payer: Cash Price	$21.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$20.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$11.99
Rate for Payer: Priority Health Narrow/Tiered Network	$11.99

PR ELECT ANALYS IMPLT ITHCL/EDRL PUMP W/REPRGRMG

Professional

Both

$216.00

Service Code	HCPCS 62368
Min. Negotiated Rate	$18.74
Max. Negotiated Rate	$162.00
Rate for Payer: Aetna Commercial	$45.55
Rate for Payer: Aetna Medicare	$108.00
Rate for Payer: BCBS Complete	$19.68
Rate for Payer: BCN Commercial	$50.80
Rate for Payer: Cash Price	$172.80
Rate for Payer: Cash Price	$172.80
Rate for Payer: Mclaren Medicaid	$18.74
Rate for Payer: Meridian Medicaid	$19.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$162.00
Rate for Payer: Priority Health Choice Medicaid	$18.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$58.99
Rate for Payer: Priority Health Narrow/Tiered Network	$58.99
Rate for Payer: UHC Medicaid	$18.74
Rate for Payer: UHCCP Medicaid	$18.74

PR ELECT ANLYS IMPLT ITHCL/EDRL PMP W/O REPRG/REFIL

Professional

Both

$394.00

Service Code	HCPCS 62367
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$295.50
Rate for Payer: Aetna Commercial	$31.85
Rate for Payer: Aetna Medicare	$197.00
Rate for Payer: BCBS Complete	$14.31
Rate for Payer: BCN Commercial	$36.35
Rate for Payer: Cash Price	$315.20
Rate for Payer: Cash Price	$315.20
Rate for Payer: Mclaren Medicaid	$13.63
Rate for Payer: Meridian Medicaid	$14.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$295.50
Rate for Payer: Priority Health Choice Medicaid	$13.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$42.22
Rate for Payer: Priority Health Narrow/Tiered Network	$42.22
Rate for Payer: UHC Medicaid	$13.63
Rate for Payer: UHCCP Medicaid	$13.63

PR ELECTROACOUS EVAL HEARING AID BINAURAL

Professional

Both

$81.00

Service Code	HCPCS 92595
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$49.30
Rate for Payer: Aetna Medicare	$40.50
Rate for Payer: BCBS Complete	$32.40
Rate for Payer: BCN Commercial	$65.00
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$64.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.75

PR ELECTROACOUS EVAL HEARING AID MONAURAL

Professional

Both

$28.00

Service Code	HCPCS 92594
Min. Negotiated Rate	$11.20
Max. Negotiated Rate	$65.00
Rate for Payer: Aetna Commercial	$22.43
Rate for Payer: Aetna Medicare	$14.00
Rate for Payer: BCBS Complete	$11.20
Rate for Payer: BCN Commercial	$65.00
Rate for Payer: Cash Price	$22.40
Rate for Payer: Cash Price	$22.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.00

PR ELECTROENCEPHALOGRAM CERE DEATH EVAL ONLY

Professional

Both

$207.00

Service Code	HCPCS 95824
Min. Negotiated Rate	$56.28
Max. Negotiated Rate	$155.25
Rate for Payer: Aetna Commercial	$106.88
Rate for Payer: Aetna Medicare	$103.50
Rate for Payer: BCN Commercial	$56.28
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cash Price	$165.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$155.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$133.17
Rate for Payer: Priority Health Narrow/Tiered Network	$133.17

PR ELECTROENCEPHALOGRAM EXTEND MONITORING 41-60 MIN

Professional

Both

$776.00

Service Code	HCPCS 95812
Min. Negotiated Rate	$364.65
Max. Negotiated Rate	$582.00
Rate for Payer: Aetna Commercial	$364.65
Rate for Payer: Aetna Medicare	$388.00
Rate for Payer: BCN Commercial	$518.90
Rate for Payer: Cash Price	$620.80
Rate for Payer: Cash Price	$620.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$582.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$478.53
Rate for Payer: Priority Health Narrow/Tiered Network	$478.53

PR ELECTROENCEPHALOGRAM REC COMA/SLEEP ONLY

Professional

Both

$378.00

Service Code	HCPCS 95822
Min. Negotiated Rate	$189.00
Max. Negotiated Rate	$622.97
Rate for Payer: Aetna Commercial	$435.49
Rate for Payer: Aetna Medicare	$189.00
Rate for Payer: BCN Commercial	$622.97
Rate for Payer: Cash Price	$302.40
Rate for Payer: Cash Price	$302.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$283.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$574.51
Rate for Payer: Priority Health Narrow/Tiered Network	$574.51

PR ELECTROENCEPHALOGRAM W/REC AWAKE&ASLEEP

Professional

Both

$212.00

Service Code	HCPCS 95819
Min. Negotiated Rate	$106.00
Max. Negotiated Rate	$673.77
Rate for Payer: Aetna Commercial	$477.15
Rate for Payer: Aetna Commercial	$477.15
Rate for Payer: Aetna Medicare	$106.00
Rate for Payer: Aetna Medicare	$409.00
Rate for Payer: BCN Commercial	$673.77
Rate for Payer: BCN Commercial	$673.77
Rate for Payer: Cash Price	$654.40
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$654.40
Rate for Payer: Cash Price	$169.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$613.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$621.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$621.36
Rate for Payer: Priority Health Narrow/Tiered Network	$621.36
Rate for Payer: Priority Health Narrow/Tiered Network	$621.36

PR ELECTROENCEPHALOGRAM W/REC AWAKE&DROWSY

Professional

Both

$290.00

Service Code	HCPCS 95816
Min. Negotiated Rate	$145.00
Max. Negotiated Rate	$578.65
Rate for Payer: Aetna Commercial	$398.47
Rate for Payer: Aetna Commercial	$398.47
Rate for Payer: Aetna Medicare	$145.00
Rate for Payer: Aetna Medicare	$356.50
Rate for Payer: BCN Commercial	$578.65
Rate for Payer: BCN Commercial	$578.65
Rate for Payer: Cash Price	$570.40
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cash Price	$570.40
Rate for Payer: Cash Price	$232.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$217.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$534.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$533.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$533.65
Rate for Payer: Priority Health Narrow/Tiered Network	$533.65
Rate for Payer: Priority Health Narrow/Tiered Network	$533.65

PR ELECTROGASTROGRAPHY DX TRANSCUTANEOUS

Professional

Both

$290.00

Service Code	HCPCS 91132
Min. Negotiated Rate	$116.00
Max. Negotiated Rate	$622.97
Rate for Payer: Aetna Commercial	$438.73
Rate for Payer: Aetna Medicare	$145.00
Rate for Payer: BCBS Complete	$116.00
Rate for Payer: BCN Commercial	$622.97
Rate for Payer: Cash Price	$232.00
Rate for Payer: Cash Price	$232.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$217.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$574.51
Rate for Payer: Priority Health Narrow/Tiered Network	$574.51

PR ELECTRONIC ALYS ANTITACHYCARDIA PACEMAKER SYS

Professional

Both

$588.00

Service Code	HCPCS 93724
Min. Negotiated Rate	$294.00
Max. Negotiated Rate	$441.00
Rate for Payer: Aetna Commercial	$311.50
Rate for Payer: Aetna Medicare	$294.00
Rate for Payer: BCN Commercial	$413.82
Rate for Payer: Cash Price	$470.40
Rate for Payer: Cash Price	$470.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$441.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$393.32
Rate for Payer: Priority Health Narrow/Tiered Network	$393.32

PR ELEVATION DEPRESSED SKULL FX SIMPLE EXTRADURAL

Professional

Both

$4,268.00

Service Code	HCPCS 62000
Min. Negotiated Rate	$663.71
Max. Negotiated Rate	$3,201.00
Rate for Payer: Aetna Commercial	$1,335.49
Rate for Payer: Aetna Medicare	$2,134.00
Rate for Payer: BCBS Complete	$696.90
Rate for Payer: BCN Commercial	$1,587.56
Rate for Payer: Cash Price	$3,414.40
Rate for Payer: Cash Price	$3,414.40
Rate for Payer: Mclaren Medicaid	$663.71
Rate for Payer: Meridian Medicaid	$696.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,201.00
Rate for Payer: Priority Health Choice Medicaid	$663.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,843.93
Rate for Payer: Priority Health Narrow/Tiered Network	$1,843.93
Rate for Payer: UHC Medicaid	$663.71
Rate for Payer: UHCCP Medicaid	$663.71

PR ELVTN DEPRS SKL FX COMPOUND/COMMIND XDRL

Professional

Both

$5,396.00

Service Code	HCPCS 62005
Min. Negotiated Rate	$805.78
Max. Negotiated Rate	$4,047.00
Rate for Payer: Aetna Commercial	$1,642.59
Rate for Payer: Aetna Medicare	$2,698.00
Rate for Payer: BCBS Complete	$846.07
Rate for Payer: BCN Commercial	$2,690.66
Rate for Payer: Cash Price	$4,316.80
Rate for Payer: Cash Price	$4,316.80
Rate for Payer: Mclaren Medicaid	$805.78
Rate for Payer: Meridian Medicaid	$846.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,047.00
Rate for Payer: Priority Health Choice Medicaid	$805.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,262.10
Rate for Payer: Priority Health Narrow/Tiered Network	$2,262.10
Rate for Payer: UHC Medicaid	$805.78
Rate for Payer: UHCCP Medicaid	$805.78

Know your out-of-pocket cost for care.

All Charges