Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR HAIR REDUC LIP & CHIN

Professional

Both

$84.00

Hospital Revenue Code	990
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Medicare	$42.00
Rate for Payer: BCBS Complete	$33.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.00

PR HAIR REDUC UDR ARMS OR BUTTOCKS

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 UP/LOW 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 HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/IMPLT

Professional

Both

$1,514.00

Service Code	HCPCS 28291
Min. Negotiated Rate	$282.44
Max. Negotiated Rate	$1,135.50
Rate for Payer: Aetna Commercial	$653.60
Rate for Payer: Aetna Medicare	$757.00
Rate for Payer: BCBS Complete	$296.56
Rate for Payer: BCN Commercial	$722.57
Rate for Payer: Cash Price	$1,211.20
Rate for Payer: Cash Price	$1,211.20
Rate for Payer: Mclaren Medicaid	$282.44
Rate for Payer: Meridian Medicaid	$296.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,135.50
Rate for Payer: Priority Health Choice Medicaid	$282.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$772.41
Rate for Payer: Priority Health Narrow/Tiered Network	$772.41
Rate for Payer: UHC Medicaid	$282.44
Rate for Payer: UHCCP Medicaid	$282.44

PR HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT

Professional

Both

$1,273.00

Service Code	HCPCS 28289
Min. Negotiated Rate	$279.88
Max. Negotiated Rate	$954.75
Rate for Payer: Aetna Commercial	$605.08
Rate for Payer: Aetna Medicare	$636.50
Rate for Payer: BCBS Complete	$293.87
Rate for Payer: BCN Commercial	$703.15
Rate for Payer: Cash Price	$1,018.40
Rate for Payer: Cash Price	$1,018.40
Rate for Payer: Mclaren Medicaid	$279.88
Rate for Payer: Meridian Medicaid	$293.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$954.75
Rate for Payer: Priority Health Choice Medicaid	$279.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$751.64
Rate for Payer: Priority Health Narrow/Tiered Network	$751.64
Rate for Payer: UHC Medicaid	$279.88
Rate for Payer: UHCCP Medicaid	$279.88

PR HAMMER TOE CREST FELT - LARGE LT

Professional

Both

$7.00

Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR HAMMER TOE CREST FELT - LARGE RT

Professional

Both

$7.00

Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR HAMMER TOE CREST FELT - MEDIUM LT

Professional

Both

$7.00

Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR HAMMER TOE CREST FELT - MEDIUM RT

Professional

Both

$7.00

Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR HAMMER TOE CREST FELT - SMALL LT

Professional

Both

$7.00

Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR HAMMER TOE CREST FELT - SMALL RT

Professional

Both

$7.00

Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR HAMMER TOE CREST FELT - XLARGE LT

Professional

Both

$7.00

Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR HAMMER TOE CREST FELT - XLARGE RT

Professional

Both

$7.00

Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR HAND-HELD PEFR METER

Professional

Both

$53.00

Service Code	HCPCS A4614
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna Commercial	$22.15
Rate for Payer: Aetna Medicare	$26.50
Rate for Payer: BCBS Complete	$21.20
Rate for Payer: BCN Commercial	$32.45
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 HANDLG&/OR CONVEY OF SPEC FOR TR OFFICE TO LAB

Professional

Both

$16.00

Service Code	HCPCS 99000
Min. Negotiated Rate	$6.40
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$7.00
Rate for Payer: Aetna Medicare	$8.00
Rate for Payer: BCBS Complete	$6.40
Rate for Payer: BCN Commercial	$10.15
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cash Price	$12.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$12.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$7.35
Rate for Payer: Priority Health Narrow/Tiered Network	$7.35

PR HAND MUSCLE TEST,MANUAL

Professional

Both

$89.00

Service Code	HCPCS 95832
Min. Negotiated Rate	$35.60
Max. Negotiated Rate	$66.75
Rate for Payer: Aetna Medicare	$44.50
Rate for Payer: BCBS Complete	$35.60
Rate for Payer: Cash Price	$71.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.75

PR HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX

Professional

Both

$1,176.00

Service Code	HCPCS 35572
Min. Negotiated Rate	$195.75
Max. Negotiated Rate	$882.00
Rate for Payer: Aetna Commercial	$465.42
Rate for Payer: Aetna Medicare	$588.00
Rate for Payer: BCBS Complete	$205.54
Rate for Payer: BCN Commercial	$499.48
Rate for Payer: Cash Price	$940.80
Rate for Payer: Cash Price	$940.80
Rate for Payer: Mclaren Medicaid	$195.75
Rate for Payer: Meridian Medicaid	$205.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$882.00
Rate for Payer: Priority Health Choice Medicaid	$195.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$537.13
Rate for Payer: Priority Health Narrow/Tiered Network	$537.13
Rate for Payer: UHC Medicaid	$195.75
Rate for Payer: UHCCP Medicaid	$195.75

PR HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<

Professional

Both

$572.00

Service Code	HCPCS 15040
Min. Negotiated Rate	$72.63
Max. Negotiated Rate	$429.00
Rate for Payer: Aetna Commercial	$135.10
Rate for Payer: Aetna Medicare	$286.00
Rate for Payer: BCBS Complete	$76.26
Rate for Payer: BCN Commercial	$189.23
Rate for Payer: Cash Price	$457.60
Rate for Payer: Cash Price	$457.60
Rate for Payer: Mclaren Medicaid	$72.63
Rate for Payer: Meridian Medicaid	$76.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$429.00
Rate for Payer: Priority Health Choice Medicaid	$72.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$173.20
Rate for Payer: Priority Health Narrow/Tiered Network	$173.20
Rate for Payer: UHC Medicaid	$72.63
Rate for Payer: UHCCP Medicaid	$72.63

PR HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX

Professional

Both

$1,161.00

Service Code	HCPCS 35500
Min. Negotiated Rate	$182.97
Max. Negotiated Rate	$870.75
Rate for Payer: Aetna Commercial	$429.28
Rate for Payer: Aetna Medicare	$580.50
Rate for Payer: BCBS Complete	$192.12
Rate for Payer: BCN Commercial	$462.63
Rate for Payer: Cash Price	$928.80
Rate for Payer: Cash Price	$928.80
Rate for Payer: Mclaren Medicaid	$182.97
Rate for Payer: Meridian Medicaid	$192.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$870.75
Rate for Payer: Priority Health Choice Medicaid	$182.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$497.50
Rate for Payer: Priority Health Narrow/Tiered Network	$497.50
Rate for Payer: UHC Medicaid	$182.97
Rate for Payer: UHCCP Medicaid	$182.97

PR HBOT, FULL BODY CHAMBER, 30M

Professional

Both

$166.00

Service Code	HCPCS G0277
Min. Negotiated Rate	$83.00
Max. Negotiated Rate	$261.94
Rate for Payer: Aetna Commercial	$153.19
Rate for Payer: Aetna Medicare	$83.00
Rate for Payer: BCN Commercial	$261.94
Rate for Payer: Cash Price	$132.80
Rate for Payer: Cash Price	$132.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$124.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$241.56
Rate for Payer: Priority Health Narrow/Tiered Network	$241.56

PR HEAL & BEHAV ASSESS,EA 15 MIN,INIT

Professional

Both

$43.00

Service Code	HCPCS 96150
Min. Negotiated Rate	$17.20
Max. Negotiated Rate	$32.25
Rate for Payer: Aetna Medicare	$21.50
Rate for Payer: BCBS Complete	$17.20
Rate for Payer: Cash Price	$34.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$32.25

PR HEAL & BEHAV ASSESS,EA 15 MIN,RE-ASSESS

Professional

Both

$42.00

Service Code	HCPCS 96151
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$31.50
Rate for Payer: Aetna Medicare	$21.00
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: Cash Price	$33.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.50

PR HEAL & BEHAV INTERV,EA 15 MIN,FAM W/O PT

Professional

Both

$40.00

Service Code	HCPCS 96155
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Medicare	$20.00
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.00

PR HEAL & BEHAV INTERV,EA 15 MIN,FAM W/PT

Professional

Both

$39.00

Service Code	HCPCS 96154
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna Medicare	$19.50
Rate for Payer: BCBS Complete	$15.60
Rate for Payer: Cash Price	$31.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$29.25

PR HEAL & BEHAV INTERVENT,EA 15 MIN,INDIV

Professional

Both

$40.00

Service Code	HCPCS 96152
Min. Negotiated Rate	$16.00
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Medicare	$20.00
Rate for Payer: BCBS Complete	$16.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.00

Know your out-of-pocket cost for care.

All Charges