Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT

Professional

Both

$204.00

Service Code	HCPCS 96156
Min. Negotiated Rate	$55.38
Max. Negotiated Rate	$153.00
Rate for Payer: Aetna Commercial	$95.48
Rate for Payer: Aetna Medicare	$102.00
Rate for Payer: BCBS Complete	$58.15
Rate for Payer: BCN Commercial	$133.46
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cash Price	$163.20
Rate for Payer: Mclaren Medicaid	$55.38
Rate for Payer: Meridian Medicaid	$58.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.00
Rate for Payer: Priority Health Choice Medicaid	$55.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$123.08
Rate for Payer: Priority Health Narrow/Tiered Network	$123.08
Rate for Payer: UHC Medicaid	$55.38
Rate for Payer: UHCCP Medicaid	$55.38

PR HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F 1ST 30 MIN

Professional

Both

$132.00

Service Code	HCPCS 96170
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$108.06
Rate for Payer: Aetna Commercial	$84.24
Rate for Payer: Aetna Medicare	$66.00
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: BCN Commercial	$108.06
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cash Price	$105.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$99.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$99.65
Rate for Payer: Priority Health Narrow/Tiered Network	$99.65

PR HEALTH BEHAVIOR IVNTJ FAM W/O PT F2F EA ADDL 15

Professional

Both

$59.00

Service Code	HCPCS 96171
Min. Negotiated Rate	$23.60
Max. Negotiated Rate	$44.25
Rate for Payer: Aetna Commercial	$30.11
Rate for Payer: Aetna Medicare	$29.50
Rate for Payer: BCBS Complete	$23.60
Rate for Payer: BCN Commercial	$38.84
Rate for Payer: Cash Price	$47.20
Rate for Payer: Cash Price	$47.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$44.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$35.82
Rate for Payer: Priority Health Narrow/Tiered Network	$35.82

PR HEALTH BEHAVIOR IVNTJ FAM W/PT F2F 1ST 30 MIN

Professional

Both

$149.00

Service Code	HCPCS 96167
Min. Negotiated Rate	$40.26
Max. Negotiated Rate	$111.75
Rate for Payer: Aetna Commercial	$69.61
Rate for Payer: Aetna Medicare	$74.50
Rate for Payer: BCBS Complete	$42.27
Rate for Payer: BCN Commercial	$97.11
Rate for Payer: Cash Price	$119.20
Rate for Payer: Cash Price	$119.20
Rate for Payer: Mclaren Medicaid	$40.26
Rate for Payer: Meridian Medicaid	$42.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.75
Rate for Payer: Priority Health Choice Medicaid	$40.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.56
Rate for Payer: Priority Health Narrow/Tiered Network	$89.56
Rate for Payer: UHC Medicaid	$40.26
Rate for Payer: UHCCP Medicaid	$40.26

PR HEALTH BEHAVIOR IVNTJ FAM W/PT F2F EA ADD 15 MIN

Professional

Both

$53.00

Service Code	HCPCS 96168
Min. Negotiated Rate	$14.48
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna Commercial	$24.75
Rate for Payer: Aetna Medicare	$26.50
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: BCN Commercial	$34.86
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Mclaren Medicaid	$14.48
Rate for Payer: Meridian Medicaid	$15.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.75
Rate for Payer: Priority Health Choice Medicaid	$14.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$32.14
Rate for Payer: Priority Health Narrow/Tiered Network	$32.14
Rate for Payer: UHC Medicaid	$14.48
Rate for Payer: UHCCP Medicaid	$14.48

PR HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN

Professional

Both

$140.00

Service Code	HCPCS 96158
Min. Negotiated Rate	$38.13
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$65.34
Rate for Payer: Aetna Medicare	$70.00
Rate for Payer: BCBS Complete	$40.04
Rate for Payer: BCN Commercial	$91.63
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cash Price	$112.00
Rate for Payer: Mclaren Medicaid	$38.13
Rate for Payer: Meridian Medicaid	$40.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$105.00
Rate for Payer: Priority Health Choice Medicaid	$38.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$84.50
Rate for Payer: Priority Health Narrow/Tiered Network	$84.50
Rate for Payer: UHC Medicaid	$38.13
Rate for Payer: UHCCP Medicaid	$38.13

PR HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN

Professional

Both

$48.00

Service Code	HCPCS 96159
Min. Negotiated Rate	$12.99
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$22.80
Rate for Payer: Aetna Medicare	$24.00
Rate for Payer: BCBS Complete	$13.64
Rate for Payer: BCN Commercial	$31.37
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Mclaren Medicaid	$12.99
Rate for Payer: Meridian Medicaid	$13.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.00
Rate for Payer: Priority Health Choice Medicaid	$12.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$28.93
Rate for Payer: Priority Health Narrow/Tiered Network	$28.93
Rate for Payer: UHC Medicaid	$12.99
Rate for Payer: UHCCP Medicaid	$12.99

PR HEALTH RISK ASSESSMENT TEST

Professional

Both

$53.00

Service Code	HCPCS 99420
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 HEARING AID CHECK BINAURAL

Professional

Both

$63.00

Service Code	HCPCS 92593
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$48.51
Rate for Payer: Aetna Commercial	$39.35
Rate for Payer: Aetna Medicare	$31.50
Rate for Payer: BCBS Complete	$25.20
Rate for Payer: BCN Commercial	$48.51
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.25

PR HEARING AID CHECK MONAURAL

Professional

Both

$56.00

Service Code	HCPCS 92592
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$48.51
Rate for Payer: Aetna Commercial	$23.53
Rate for Payer: Aetna Medicare	$28.00
Rate for Payer: BCBS Complete	$22.40
Rate for Payer: BCN Commercial	$48.51
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cash Price	$44.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$42.00

PR HEARING AID EXAMINATION & SELECTION BINAURAL

Professional

Both

$147.00

Service Code	HCPCS 92591
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$110.25
Rate for Payer: Aetna Commercial	$76.88
Rate for Payer: Aetna Medicare	$73.50
Rate for Payer: BCBS Complete	$58.80
Rate for Payer: BCN Commercial	$99.92
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cash Price	$117.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$110.25

PR HEARING AID EXAMINATION & SELECTION MONAURAL

Professional

Both

$147.00

Service Code	HCPCS 92590
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$110.25
Rate for Payer: Aetna Commercial	$59.96
Rate for Payer: Aetna Medicare	$73.50
Rate for Payer: BCBS Complete	$58.80
Rate for Payer: BCN Commercial	$99.92
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cash Price	$117.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$110.25

PR HEARING AID FITTING SERVICES 1ST 60 MINUTES

Professional

Both

$63.00

Service Code	HCPCS 92634
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$47.25
Rate for Payer: Aetna Medicare	$31.50
Rate for Payer: BCBS Complete	$25.20
Rate for Payer: Cash Price	$50.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.25

PR HEARING AID FITTING SERVICES EA ADDL 15 MINUTES

Professional

Both

$32.00

Service Code	HCPCS 92635
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 HEARING AID MEAS VERIF W/PROBE MICROPHONE

Professional

Both

$32.00

Service Code	HCPCS 92639
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 HEARING AID POST-FITTING F-UP SVC 1ST 30 MINUTES

Professional

Both

$63.00

Service Code	HCPCS 92636
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$47.25
Rate for Payer: Aetna Medicare	$31.50
Rate for Payer: BCBS Complete	$25.20
Rate for Payer: Cash Price	$50.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.25

PR HEARING AID POST-FITTING F-UP SVC EA ADDL 15 MIN

Professional

Both

$32.00

Service Code	HCPCS 92637
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 HEARING AID, PROG, BIN, BTE

Professional

Both

$5,681.00

Service Code	HCPCS V5253
Min. Negotiated Rate	$1,350.00
Max. Negotiated Rate	$4,260.75
Rate for Payer: Aetna Commercial	$1,350.00
Rate for Payer: Aetna Medicare	$2,840.50
Rate for Payer: BCBS Complete	$2,272.40
Rate for Payer: Cash Price	$4,544.80
Rate for Payer: Cash Price	$4,544.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,260.75

PR HEARING AID REPAIR/MODIFYING

Professional

Both

$447.00

Service Code	HCPCS V5014
Min. Negotiated Rate	$88.69
Max. Negotiated Rate	$335.25
Rate for Payer: Aetna Commercial	$88.69
Rate for Payer: Aetna Commercial	$88.69
Rate for Payer: Aetna Commercial	$88.69
Rate for Payer: Aetna Medicare	$157.50
Rate for Payer: Aetna Medicare	$223.50
Rate for Payer: Aetna Medicare	$52.50
Rate for Payer: BCBS Complete	$178.80
Rate for Payer: BCBS Complete	$42.00
Rate for Payer: BCBS Complete	$126.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$357.60
Rate for Payer: Cash Price	$357.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$335.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$236.25

PR HEARING AID SELECTION SERVICES 1ST 30 MINUTES

Professional

Both

$49.00

Service Code	HCPCS 92631
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$36.75
Rate for Payer: Aetna Medicare	$24.50
Rate for Payer: BCBS Complete	$19.60
Rate for Payer: Cash Price	$39.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.75

PR HEARING AID SELECTION SERVICES EA ADDL 15 MIN

Professional

Both

$49.00

Service Code	HCPCS 92632
Min. Negotiated Rate	$19.60
Max. Negotiated Rate	$36.75
Rate for Payer: Aetna Medicare	$24.50
Rate for Payer: BCBS Complete	$19.60
Rate for Payer: Cash Price	$39.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.75

PR HEARING ASSISTIVE DEVICE SUPPL TECH FITTING SVC

Professional

Both

$81.00

Service Code	HCPCS 92642
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$60.75
Rate for Payer: Aetna Medicare	$40.50
Rate for Payer: BCBS Complete	$32.40
Rate for Payer: Cash Price	$64.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.75

PR HEARING DEVICE VERIFICATION ELECTROACOUSTIC ALYS

Professional

Both

$81.00

Service Code	HCPCS 92641
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$60.75
Rate for Payer: Aetna Medicare	$40.50
Rate for Payer: BCBS Complete	$32.40
Rate for Payer: Cash Price	$64.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.75

PR HEMIARTHROPLASTY HIP PARTIAL

Professional

Both

$2,403.00

Service Code	HCPCS 27125
Min. Negotiated Rate	$660.51
Max. Negotiated Rate	$1,831.73
Rate for Payer: Aetna Commercial	$1,512.35
Rate for Payer: Aetna Medicare	$1,201.50
Rate for Payer: BCBS Complete	$693.54
Rate for Payer: BCN Commercial	$1,713.56
Rate for Payer: Cash Price	$1,922.40
Rate for Payer: Cash Price	$1,922.40
Rate for Payer: Mclaren Medicaid	$660.51
Rate for Payer: Meridian Medicaid	$693.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,802.25
Rate for Payer: Priority Health Choice Medicaid	$660.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,831.73
Rate for Payer: Priority Health Narrow/Tiered Network	$1,831.73
Rate for Payer: UHC Medicaid	$660.51
Rate for Payer: UHCCP Medicaid	$660.51

PR HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXC TOE

Professional

Both

$718.00

Service Code	HCPCS 28160
Min. Negotiated Rate	$162.95
Max. Negotiated Rate	$538.50
Rate for Payer: Aetna Commercial	$351.28
Rate for Payer: Aetna Medicare	$359.00
Rate for Payer: BCBS Complete	$171.10
Rate for Payer: BCN Commercial	$407.35
Rate for Payer: Cash Price	$574.40
Rate for Payer: Cash Price	$574.40
Rate for Payer: Mclaren Medicaid	$162.95
Rate for Payer: Meridian Medicaid	$171.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$538.50
Rate for Payer: Priority Health Choice Medicaid	$162.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$435.44
Rate for Payer: Priority Health Narrow/Tiered Network	$435.44
Rate for Payer: UHC Medicaid	$162.95
Rate for Payer: UHCCP Medicaid	$162.95

Know your out-of-pocket cost for care.

All Charges