Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR GRAFT DERMA-FAT-FASCIA

Professional

Both

$1,513.00

Service Code	HCPCS 15770
Min. Negotiated Rate	$386.60
Max. Negotiated Rate	$1,134.75
Rate for Payer: Aetna Commercial	$716.30
Rate for Payer: Aetna Medicare	$756.50
Rate for Payer: BCBS Complete	$405.93
Rate for Payer: BCN Commercial	$1,018.87
Rate for Payer: Cash Price	$1,210.40
Rate for Payer: Cash Price	$1,210.40
Rate for Payer: Mclaren Medicaid	$386.60
Rate for Payer: Meridian Medicaid	$405.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,134.75
Rate for Payer: Priority Health Choice Medicaid	$386.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$932.53
Rate for Payer: Priority Health Narrow/Tiered Network	$932.53
Rate for Payer: UHC Medicaid	$386.60
Rate for Payer: UHCCP Medicaid	$386.60

PR GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR

Professional

Both

$1,262.00

Service Code	HCPCS 21235
Min. Negotiated Rate	$322.70
Max. Negotiated Rate	$946.50
Rate for Payer: Aetna Commercial	$741.79
Rate for Payer: Aetna Medicare	$631.00
Rate for Payer: BCBS Complete	$338.83
Rate for Payer: BCN Commercial	$862.50
Rate for Payer: Cash Price	$1,009.60
Rate for Payer: Cash Price	$1,009.60
Rate for Payer: Mclaren Medicaid	$322.70
Rate for Payer: Meridian Medicaid	$338.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$946.50
Rate for Payer: Priority Health Choice Medicaid	$322.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$921.99
Rate for Payer: Priority Health Narrow/Tiered Network	$921.99
Rate for Payer: UHC Medicaid	$322.70
Rate for Payer: UHCCP Medicaid	$322.70

PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 25 CC OR LESS

Professional

Both

$1,203.00

Service Code	HCPCS 15773
Min. Negotiated Rate	$289.68
Max. Negotiated Rate	$902.25
Rate for Payer: Aetna Commercial	$519.36
Rate for Payer: Aetna Medicare	$601.50
Rate for Payer: BCBS Complete	$304.16
Rate for Payer: BCN Commercial	$760.42
Rate for Payer: Cash Price	$962.40
Rate for Payer: Cash Price	$962.40
Rate for Payer: Mclaren Medicaid	$289.68
Rate for Payer: Meridian Medicaid	$304.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$902.25
Rate for Payer: Priority Health Choice Medicaid	$289.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$695.98
Rate for Payer: Priority Health Narrow/Tiered Network	$695.98
Rate for Payer: UHC Medicaid	$289.68
Rate for Payer: UHCCP Medicaid	$289.68

PR GRAFTING OF AUTOLOGOUS FAT BY LIPO 50 CC OR LESS

Professional

Both

$1,192.00

Service Code	HCPCS 15771
Min. Negotiated Rate	$302.03
Max. Negotiated Rate	$894.00
Rate for Payer: Aetna Commercial	$514.12
Rate for Payer: Aetna Medicare	$596.00
Rate for Payer: BCBS Complete	$317.13
Rate for Payer: BCN Commercial	$777.35
Rate for Payer: Cash Price	$953.60
Rate for Payer: Cash Price	$953.60
Rate for Payer: Mclaren Medicaid	$302.03
Rate for Payer: Meridian Medicaid	$317.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$894.00
Rate for Payer: Priority Health Choice Medicaid	$302.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$711.48
Rate for Payer: Priority Health Narrow/Tiered Network	$711.48
Rate for Payer: UHC Medicaid	$302.03
Rate for Payer: UHCCP Medicaid	$302.03

PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 25 CC

Professional

Both

$367.00

Service Code	HCPCS 15774
Min. Negotiated Rate	$77.53
Max. Negotiated Rate	$275.25
Rate for Payer: Aetna Commercial	$146.72
Rate for Payer: Aetna Medicare	$183.50
Rate for Payer: BCBS Complete	$81.41
Rate for Payer: BCN Commercial	$215.63
Rate for Payer: Cash Price	$293.60
Rate for Payer: Cash Price	$293.60
Rate for Payer: Mclaren Medicaid	$77.53
Rate for Payer: Meridian Medicaid	$81.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$275.25
Rate for Payer: Priority Health Choice Medicaid	$77.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$197.35
Rate for Payer: Priority Health Narrow/Tiered Network	$197.35
Rate for Payer: UHC Medicaid	$77.53
Rate for Payer: UHCCP Medicaid	$77.53

PR GRAFTING OF AUTOLOGOUS FAT BY LIPO EA ADDL 50 CC

Professional

Both

$378.00

Service Code	HCPCS 15772
Min. Negotiated Rate	$80.51
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna Commercial	$152.33
Rate for Payer: Aetna Medicare	$189.00
Rate for Payer: BCBS Complete	$84.54
Rate for Payer: BCN Commercial	$222.60
Rate for Payer: Cash Price	$302.40
Rate for Payer: Cash Price	$302.40
Rate for Payer: Mclaren Medicaid	$80.51
Rate for Payer: Meridian Medicaid	$84.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$283.50
Rate for Payer: Priority Health Choice Medicaid	$80.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$203.74
Rate for Payer: Priority Health Narrow/Tiered Network	$203.74
Rate for Payer: UHC Medicaid	$80.51
Rate for Payer: UHCCP Medicaid	$80.51

PR GRAFTING OF AUTOLOGOUS SOFT TISS BY DIRECT EXC

Professional

Both

$1,004.00

Service Code	HCPCS 15769
Min. Negotiated Rate	$289.89
Max. Negotiated Rate	$753.00
Rate for Payer: Aetna Commercial	$517.80
Rate for Payer: Aetna Medicare	$502.00
Rate for Payer: BCBS Complete	$304.38
Rate for Payer: BCN Commercial	$726.55
Rate for Payer: Cash Price	$803.20
Rate for Payer: Cash Price	$803.20
Rate for Payer: Mclaren Medicaid	$289.89
Rate for Payer: Meridian Medicaid	$304.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$753.00
Rate for Payer: Priority Health Choice Medicaid	$289.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$664.99
Rate for Payer: Priority Health Narrow/Tiered Network	$664.99
Rate for Payer: UHC Medicaid	$289.89
Rate for Payer: UHCCP Medicaid	$289.89

PR GRAFT THIERSCH RCT INCONTINENCE &/PROLAPSE

Professional

Both

$1,236.00

Service Code	HCPCS 46753
Min. Negotiated Rate	$391.92
Max. Negotiated Rate	$1,145.55
Rate for Payer: Aetna Commercial	$835.54
Rate for Payer: Aetna Medicare	$618.00
Rate for Payer: BCBS Complete	$411.52
Rate for Payer: BCN Commercial	$940.19
Rate for Payer: Cash Price	$988.80
Rate for Payer: Cash Price	$988.80
Rate for Payer: Mclaren Medicaid	$391.92
Rate for Payer: Meridian Medicaid	$411.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$927.00
Rate for Payer: Priority Health Choice Medicaid	$391.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,145.55
Rate for Payer: Priority Health Narrow/Tiered Network	$1,145.55
Rate for Payer: UHC Medicaid	$391.92
Rate for Payer: UHCCP Medicaid	$391.92

PR GROUP BEHAVE COUNS 2-10

Professional

Both

$32.00

Service Code	HCPCS G0473
Min. Negotiated Rate	$10.97
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$10.97
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: BCN Commercial	$16.93
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$15.10
Rate for Payer: Priority Health Narrow/Tiered Network	$15.10

PR GROUP PSYCHOTHERAPY

Professional

Both

$57.00

Service Code	HCPCS 90853
Min. Negotiated Rate	$16.44
Max. Negotiated Rate	$46.80
Rate for Payer: Aetna Commercial	$46.80
Rate for Payer: Aetna Medicare	$28.50
Rate for Payer: BCBS Complete	$17.26
Rate for Payer: BCN Commercial	$29.45
Rate for Payer: Cash Price	$45.60
Rate for Payer: Cash Price	$45.60
Rate for Payer: Mclaren Medicaid	$16.44
Rate for Payer: Meridian Medicaid	$17.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$42.75
Rate for Payer: Priority Health Choice Medicaid	$16.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$33.48
Rate for Payer: Priority Health Narrow/Tiered Network	$33.48
Rate for Payer: UHC Medicaid	$16.44
Rate for Payer: UHCCP Medicaid	$16.44

PR GSTRCT PRTL DSTL W/GASTRODUODENOSTOMY

Professional

Both

$2,686.00

Service Code	HCPCS 43631
Min. Negotiated Rate	$864.57
Max. Negotiated Rate	$2,655.78
Rate for Payer: Aetna Commercial	$1,960.99
Rate for Payer: Aetna Medicare	$1,343.00
Rate for Payer: BCBS Complete	$907.80
Rate for Payer: BCN Commercial	$2,179.66
Rate for Payer: Cash Price	$2,148.80
Rate for Payer: Cash Price	$2,148.80
Rate for Payer: Mclaren Medicaid	$864.57
Rate for Payer: Meridian Medicaid	$907.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,014.50
Rate for Payer: Priority Health Choice Medicaid	$864.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,655.78
Rate for Payer: Priority Health Narrow/Tiered Network	$2,655.78
Rate for Payer: UHC Medicaid	$864.57
Rate for Payer: UHCCP Medicaid	$864.57

PR GSTRCT PRTL DSTL W/GASTROJEJUNOSTOMY

Professional

Both

$3,874.00

Service Code	HCPCS 43632
Min. Negotiated Rate	$1,196.00
Max. Negotiated Rate	$3,715.78
Rate for Payer: Aetna Commercial	$2,747.05
Rate for Payer: Aetna Medicare	$1,937.00
Rate for Payer: BCBS Complete	$1,255.80
Rate for Payer: BCN Commercial	$3,049.63
Rate for Payer: Cash Price	$3,099.20
Rate for Payer: Cash Price	$3,099.20
Rate for Payer: Mclaren Medicaid	$1,196.00
Rate for Payer: Meridian Medicaid	$1,255.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,905.50
Rate for Payer: Priority Health Choice Medicaid	$1,196.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,715.78
Rate for Payer: Priority Health Narrow/Tiered Network	$3,715.78
Rate for Payer: UHC Medicaid	$1,196.00
Rate for Payer: UHCCP Medicaid	$1,196.00

PR GSTRCT PRTL DSTL W/ROUX-EN-Y RCNSTJ

Professional

Both

$3,549.00

Service Code	HCPCS 43633
Min. Negotiated Rate	$1,132.52
Max. Negotiated Rate	$3,514.34
Rate for Payer: Aetna Commercial	$2,599.01
Rate for Payer: Aetna Medicare	$1,774.50
Rate for Payer: BCBS Complete	$1,189.15
Rate for Payer: BCN Commercial	$2,884.31
Rate for Payer: Cash Price	$2,839.20
Rate for Payer: Cash Price	$2,839.20
Rate for Payer: Mclaren Medicaid	$1,132.52
Rate for Payer: Meridian Medicaid	$1,189.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,661.75
Rate for Payer: Priority Health Choice Medicaid	$1,132.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,514.34
Rate for Payer: Priority Health Narrow/Tiered Network	$3,514.34
Rate for Payer: UHC Medicaid	$1,132.52
Rate for Payer: UHCCP Medicaid	$1,132.52

PR GSTRCT TOT W/ESOPHAGOENTEROSTOMY

Professional

Both

$6,814.00

Service Code	HCPCS 43620
Min. Negotiated Rate	$1,169.80
Max. Negotiated Rate	$5,110.50
Rate for Payer: Aetna Commercial	$2,685.76
Rate for Payer: Aetna Medicare	$3,407.00
Rate for Payer: BCBS Complete	$1,228.29
Rate for Payer: BCN Commercial	$2,968.96
Rate for Payer: Cash Price	$5,451.20
Rate for Payer: Cash Price	$5,451.20
Rate for Payer: Mclaren Medicaid	$1,169.80
Rate for Payer: Meridian Medicaid	$1,228.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,110.50
Rate for Payer: Priority Health Choice Medicaid	$1,169.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,617.49
Rate for Payer: Priority Health Narrow/Tiered Network	$3,617.49
Rate for Payer: UHC Medicaid	$1,169.80
Rate for Payer: UHCCP Medicaid	$1,169.80

PR HAIR REDUC 1/2 LEGS

Professional

Both

$210.00

Hospital Revenue Code	990
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Medicare	$105.00
Rate for Payer: BCBS Complete	$84.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$157.50

PR HAIR REDUC ABD TRAIL

Professional

Both

$53.00

Hospital Revenue Code	990
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna Medicare	$26.50
Rate for Payer: BCBS Complete	$21.20
Rate for Payer: Cash Price	$42.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.75

PR HAIR REDUC BACK

Professional

Both

$315.00

Hospital Revenue Code	990
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$236.25
Rate for Payer: Aetna Medicare	$157.50
Rate for Payer: BCBS Complete	$126.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$236.25

PR HAIR REDUC BIKINI LN

Professional

Both

$53.00

Hospital Revenue Code	990
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna Medicare	$26.50
Rate for Payer: BCBS Complete	$21.20
Rate for Payer: Cash Price	$42.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.75

PR HAIR REDUC BRAZ

Professional

Both

$132.00

Hospital Revenue Code	990
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Medicare	$66.00
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: Cash Price	$105.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$99.00

PR HAIR REDUC BROW/NOSE/EARS/TOE/HND

Professional

Both

$37.00

Hospital Revenue Code	990
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$27.75
Rate for Payer: Aetna Medicare	$18.50
Rate for Payer: BCBS Complete	$14.80
Rate for Payer: Cash Price	$29.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.75

PR HAIR REDUC CHIN/NECK

Professional

Both

$53.00

Hospital Revenue Code	990
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna Medicare	$26.50
Rate for Payer: BCBS Complete	$21.20
Rate for Payer: Cash Price	$42.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.75

PR HAIR REDUC FL FACE/SCALP/FL ABD

Professional

Both

$95.00

Hospital Revenue Code	990
Min. Negotiated Rate	$38.00
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Medicare	$47.50
Rate for Payer: BCBS Complete	$38.00
Rate for Payer: Cash Price	$76.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$71.25

PR HAIR REDUC FL LEGS

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 HAIR REDUC HLF ARMS/CHEST/ABD/SHLDR

Professional

Both

$105.00

Hospital Revenue Code	990
Min. Negotiated Rate	$42.00
Max. Negotiated Rate	$78.75
Rate for Payer: Aetna Medicare	$52.50
Rate for Payer: BCBS Complete	$42.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.75

PR HAIR REDUC LIP

Professional

Both

$37.00

Hospital Revenue Code	990
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$27.75
Rate for Payer: Aetna Medicare	$18.50
Rate for Payer: BCBS Complete	$14.80
Rate for Payer: Cash Price	$29.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.75

Know your out-of-pocket cost for care.

All Charges