Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES

Professional

Both

$246.00

Service Code	HCPCS 99343
Min. Negotiated Rate	$98.40
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna Medicare	$123.00
Rate for Payer: BCBS Complete	$98.40
Rate for Payer: Cash Price	$196.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$184.50

PR HOPD MNTL HLT, 15-29 MIN

Professional

Both

$53.00

Service Code	HCPCS C7900
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 HOPD MNTL HLT, 30-60 MIN

Professional

Both

$53.00

Service Code	HCPCS C7901
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 HOPD MNTL HLT, EA ADDL

Professional

Both

$53.00

Service Code	HCPCS C7902
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 HOSPICE CARE SUPERVISION

Professional

Both

$197.00

Service Code	HCPCS G0182
Min. Negotiated Rate	$78.80
Max. Negotiated Rate	$155.37
Rate for Payer: Aetna Commercial	$104.90
Rate for Payer: Aetna Medicare	$98.50
Rate for Payer: BCBS Complete	$78.80
Rate for Payer: BCN Commercial	$155.37
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cash Price	$157.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$147.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$143.28
Rate for Payer: Priority Health Narrow/Tiered Network	$143.28

PR HOSPITAL IP/OBS CARE SAME DATE HIGH MDM 85 MIN

Professional

Both

$404.00

Service Code	HCPCS 99236
Min. Negotiated Rate	$120.98
Max. Negotiated Rate	$307.25
Rate for Payer: Aetna Commercial	$211.34
Rate for Payer: Aetna Medicare	$202.00
Rate for Payer: BCBS Complete	$127.03
Rate for Payer: BCN Commercial	$307.25
Rate for Payer: Cash Price	$323.20
Rate for Payer: Cash Price	$323.20
Rate for Payer: Mclaren Medicaid	$120.98
Rate for Payer: Meridian Medicaid	$127.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$303.00
Rate for Payer: Priority Health Choice Medicaid	$120.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$276.38
Rate for Payer: Priority Health Narrow/Tiered Network	$276.38
Rate for Payer: UHC Medicaid	$120.98
Rate for Payer: UHCCP Medicaid	$120.98

PR HOSPITAL IP/OBS CARE SAME DATE MOD MDM 70 MIN

Professional

Both

$325.00

Service Code	HCPCS 99235
Min. Negotiated Rate	$91.16
Max. Negotiated Rate	$243.75
Rate for Payer: Aetna Commercial	$164.50
Rate for Payer: Aetna Medicare	$162.50
Rate for Payer: BCBS Complete	$95.72
Rate for Payer: BCN Commercial	$235.05
Rate for Payer: Cash Price	$260.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Mclaren Medicaid	$91.16
Rate for Payer: Meridian Medicaid	$95.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$243.75
Rate for Payer: Priority Health Choice Medicaid	$91.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$211.43
Rate for Payer: Priority Health Narrow/Tiered Network	$211.43
Rate for Payer: UHC Medicaid	$91.16
Rate for Payer: UHCCP Medicaid	$91.16

PR HOSPITAL IP/OBS CARE SAME DATE SF/LOW MDM 45 MIN

Professional

Both

$248.00

Service Code	HCPCS 99234
Min. Negotiated Rate	$56.23
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Commercial	$129.57
Rate for Payer: Aetna Medicare	$124.00
Rate for Payer: BCBS Complete	$59.04
Rate for Payer: BCN Commercial	$144.41
Rate for Payer: Cash Price	$198.40
Rate for Payer: Cash Price	$198.40
Rate for Payer: Mclaren Medicaid	$56.23
Rate for Payer: Meridian Medicaid	$59.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$186.00
Rate for Payer: Priority Health Choice Medicaid	$56.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$129.90
Rate for Payer: Priority Health Narrow/Tiered Network	$129.90
Rate for Payer: UHC Medicaid	$56.23
Rate for Payer: UHCCP Medicaid	$56.23

PR HOSPITAL IP/OBS DISCHARGE DAY MGMT > 30 MIN

Professional

Both

$263.00

Service Code	HCPCS 99239
Min. Negotiated Rate	$67.95
Max. Negotiated Rate	$197.25
Rate for Payer: Aetna Commercial	$104.19
Rate for Payer: Aetna Medicare	$131.50
Rate for Payer: BCBS Complete	$71.35
Rate for Payer: BCN Commercial	$170.31
Rate for Payer: Cash Price	$210.40
Rate for Payer: Cash Price	$210.40
Rate for Payer: Mclaren Medicaid	$67.95
Rate for Payer: Meridian Medicaid	$71.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$197.25
Rate for Payer: Priority Health Choice Medicaid	$67.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$153.21
Rate for Payer: Priority Health Narrow/Tiered Network	$153.21
Rate for Payer: UHC Medicaid	$67.95
Rate for Payer: UHCCP Medicaid	$67.95

PR HOSPITAL IP/OBS DISCHARGE DAY MGMT 30 MIN/<

Professional

Both

$142.00

Service Code	HCPCS 99238
Min. Negotiated Rate	$47.71
Max. Negotiated Rate	$120.51
Rate for Payer: Aetna Commercial	$70.69
Rate for Payer: Aetna Medicare	$71.00
Rate for Payer: BCBS Complete	$50.10
Rate for Payer: BCN Commercial	$120.51
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Mclaren Medicaid	$47.71
Rate for Payer: Meridian Medicaid	$50.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$106.50
Rate for Payer: Priority Health Choice Medicaid	$47.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$108.40
Rate for Payer: Priority Health Narrow/Tiered Network	$108.40
Rate for Payer: UHC Medicaid	$47.71
Rate for Payer: UHCCP Medicaid	$47.71

PR HO W/O JOINTS CF

Professional

Both

$261.00

Service Code	HCPCS L3919
Min. Negotiated Rate	$104.40
Max. Negotiated Rate	$290.00
Rate for Payer: Aetna Commercial	$148.45
Rate for Payer: Aetna Medicare	$130.50
Rate for Payer: BCBS Complete	$104.40
Rate for Payer: BCN Commercial	$290.00
Rate for Payer: Cash Price	$208.80
Rate for Payer: Cash Price	$208.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$195.75

PR HRHC 1 COL/GRP W/FSTULECTMY INCL FSSRECTOMY

Professional

Both

$1,217.00

Service Code	HCPCS 46258
Min. Negotiated Rate	$306.72
Max. Negotiated Rate	$912.75
Rate for Payer: Aetna Commercial	$640.84
Rate for Payer: Aetna Medicare	$608.50
Rate for Payer: BCBS Complete	$322.06
Rate for Payer: BCN Commercial	$734.02
Rate for Payer: Cash Price	$973.60
Rate for Payer: Cash Price	$973.60
Rate for Payer: Mclaren Medicaid	$306.72
Rate for Payer: Meridian Medicaid	$322.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$912.75
Rate for Payer: Priority Health Choice Medicaid	$306.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$894.37
Rate for Payer: Priority Health Narrow/Tiered Network	$894.37
Rate for Payer: UHC Medicaid	$306.72
Rate for Payer: UHCCP Medicaid	$306.72

PR HRHC 2/> COL/GRP W/FSTULECTMY INCL FSSRECTMY

Professional

Both

$1,828.00

Service Code	HCPCS 46262
Min. Negotiated Rate	$374.88
Max. Negotiated Rate	$1,371.00
Rate for Payer: Aetna Commercial	$748.16
Rate for Payer: Aetna Medicare	$914.00
Rate for Payer: BCBS Complete	$393.62
Rate for Payer: BCN Commercial	$892.38
Rate for Payer: Cash Price	$1,462.40
Rate for Payer: Cash Price	$1,462.40
Rate for Payer: Mclaren Medicaid	$374.88
Rate for Payer: Meridian Medicaid	$393.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,371.00
Rate for Payer: Priority Health Choice Medicaid	$374.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,087.31
Rate for Payer: Priority Health Narrow/Tiered Network	$1,087.31
Rate for Payer: UHC Medicaid	$374.88
Rate for Payer: UHCCP Medicaid	$374.88

PR HRHC NTRNL & XTRNL 2/> COLUMN/GROUP W/FISSU

Professional

Both

$1,784.00

Service Code	HCPCS 46261
Min. Negotiated Rate	$328.66
Max. Negotiated Rate	$1,338.00
Rate for Payer: Aetna Commercial	$701.89
Rate for Payer: Aetna Medicare	$892.00
Rate for Payer: BCBS Complete	$345.09
Rate for Payer: BCN Commercial	$806.73
Rate for Payer: Cash Price	$1,427.20
Rate for Payer: Cash Price	$1,427.20
Rate for Payer: Mclaren Medicaid	$328.66
Rate for Payer: Meridian Medicaid	$345.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,338.00
Rate for Payer: Priority Health Choice Medicaid	$328.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$982.94
Rate for Payer: Priority Health Narrow/Tiered Network	$982.94
Rate for Payer: UHC Medicaid	$328.66
Rate for Payer: UHCCP Medicaid	$328.66

PR HRV SKIN FOR SKIN CELL SSP AGRFT 1ST 25 SQ CM/<

Professional

Both

$2,449.00

Service Code	HCPCS 15011
Min. Negotiated Rate	$66.70
Max. Negotiated Rate	$2,744.01
Rate for Payer: Aetna Medicare	$1,224.50
Rate for Payer: BCBS Complete	$70.03
Rate for Payer: BCN Commercial	$1,710.33
Rate for Payer: Cash Price	$1,959.20
Rate for Payer: Cash Price	$1,959.20
Rate for Payer: Mclaren Medicaid	$66.70
Rate for Payer: Meridian Medicaid	$70.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,836.75
Rate for Payer: Priority Health Choice Medicaid	$66.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,744.01
Rate for Payer: Priority Health Narrow/Tiered Network	$2,744.01
Rate for Payer: UHC Medicaid	$66.70
Rate for Payer: UHCCP Medicaid	$66.70

PR HRV SKIN FOR SKIN CELL SSP AGRFT EA ADDL 25 SQCM

Professional

Both

$2,449.00

Service Code	HCPCS 15012
Min. Negotiated Rate	$66.70
Max. Negotiated Rate	$1,836.75
Rate for Payer: Aetna Medicare	$1,224.50
Rate for Payer: BCBS Complete	$70.03
Rate for Payer: Cash Price	$1,959.20
Rate for Payer: Cash Price	$1,959.20
Rate for Payer: Mclaren Medicaid	$66.70
Rate for Payer: Meridian Medicaid	$70.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,836.75
Rate for Payer: Priority Health Choice Medicaid	$66.70
Rate for Payer: UHC Medicaid	$66.70
Rate for Payer: UHCCP Medicaid	$66.70

PR HYALGAN SUPARTZ VISCO-3 DOSE

Professional

Both

$312.00

Service Code	HCPCS J7321
Min. Negotiated Rate	$64.00
Max. Negotiated Rate	$234.00
Rate for Payer: Aetna Commercial	$75.29
Rate for Payer: Aetna Medicare	$156.00
Rate for Payer: BCBS Trust/PPO	$64.00
Rate for Payer: BCN Commercial	$76.58
Rate for Payer: Cash Price	$249.60
Rate for Payer: Cash Price	$249.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$234.00

PR HYDROCORTISONE SODIUM SUCC I

Professional

Both

$10.00

Service Code	HCPCS J1720
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$18.38
Rate for Payer: Aetna Commercial	$18.38
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Trust/PPO	$18.00
Rate for Payer: BCN Commercial	$17.66
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50

PR HYDROMORPHONE INJECTION

Professional

Both

$5.00

Service Code	HCPCS J1170
Min. Negotiated Rate	$0.21
Max. Negotiated Rate	$4.73
Rate for Payer: Aetna Commercial	$4.73
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: BCN Commercial	$0.21
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR HYDROXYPROGESTERONE CAPROATE

Professional

Both

$3.00

Service Code	HCPCS J1725
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR HYDROXYZINE HCL INJECTION

Professional

Both

$15.00

Service Code	HCPCS J3410
Min. Negotiated Rate	$7.50
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$10.21
Rate for Payer: Aetna Medicare	$7.50
Rate for Payer: BCBS Trust/PPO	$8.65
Rate for Payer: BCN Commercial	$10.67
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.25

PR HYMENOTOMY SIMPLE INCISION

Professional

Both

$161.00

Service Code	HCPCS 56442
Min. Negotiated Rate	$27.90
Max. Negotiated Rate	$120.75
Rate for Payer: Aetna Commercial	$55.11
Rate for Payer: Aetna Medicare	$80.50
Rate for Payer: BCBS Complete	$29.30
Rate for Payer: BCN Commercial	$72.21
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cash Price	$128.80
Rate for Payer: Mclaren Medicaid	$27.90
Rate for Payer: Meridian Medicaid	$29.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$120.75
Rate for Payer: Priority Health Choice Medicaid	$27.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$73.13
Rate for Payer: Priority Health Narrow/Tiered Network	$73.13
Rate for Payer: UHC Medicaid	$27.90
Rate for Payer: UHCCP Medicaid	$27.90

PR HYPOPHYSEC/EXC PITUITARY TUM TRANSNASAL/SEPTAL

Professional

Both

$8,744.00

Service Code	HCPCS 61548
Min. Negotiated Rate	$948.28
Max. Negotiated Rate	$6,558.00
Rate for Payer: Aetna Commercial	$2,027.19
Rate for Payer: Aetna Medicare	$4,372.00
Rate for Payer: BCBS Complete	$995.69
Rate for Payer: BCN Commercial	$3,287.82
Rate for Payer: Cash Price	$6,995.20
Rate for Payer: Cash Price	$6,995.20
Rate for Payer: Mclaren Medicaid	$948.28
Rate for Payer: Meridian Medicaid	$995.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,558.00
Rate for Payer: Priority Health Choice Medicaid	$948.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,764.15
Rate for Payer: Priority Health Narrow/Tiered Network	$2,764.15
Rate for Payer: UHC Medicaid	$948.28
Rate for Payer: UHCCP Medicaid	$948.28

PR HYSTERORRHAPHY RUPTURED UTERUS

Professional

Both

$1,351.00

Service Code	HCPCS 59350
Min. Negotiated Rate	$156.98
Max. Negotiated Rate	$1,013.25
Rate for Payer: Aetna Commercial	$307.58
Rate for Payer: Aetna Medicare	$675.50
Rate for Payer: BCBS Complete	$164.83
Rate for Payer: BCN Commercial	$415.32
Rate for Payer: Cash Price	$1,080.80
Rate for Payer: Cash Price	$1,080.80
Rate for Payer: Mclaren Medicaid	$156.98
Rate for Payer: Meridian Medicaid	$164.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,013.25
Rate for Payer: Priority Health Choice Medicaid	$156.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$392.06
Rate for Payer: Priority Health Narrow/Tiered Network	$392.06
Rate for Payer: UHC Medicaid	$156.98
Rate for Payer: UHCCP Medicaid	$156.98

PR HYSTEROSCOPY BI TUBE OCCLUSION W/PERM IMPLNTS

Professional

Both

$3,467.00

Service Code	HCPCS 58565
Min. Negotiated Rate	$542.07
Max. Negotiated Rate	$2,600.25
Rate for Payer: Aetna Commercial	$542.07
Rate for Payer: Aetna Medicare	$1,733.50
Rate for Payer: BCBS Complete	$1,386.80
Rate for Payer: BCN Commercial	$685.72
Rate for Payer: Cash Price	$2,773.60
Rate for Payer: Cash Price	$2,773.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,600.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$694.48
Rate for Payer: Priority Health Narrow/Tiered Network	$694.48

Know your out-of-pocket cost for care.

All Charges