Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR HAIR REDUC UDR ARMS OR BUTTOCKS

Professional

Both

$51.00

Service Code	HCPCS 00064
Hospital Revenue Code	990
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$33.15
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: Cash Price	$40.80
Rate for Payer: Priority Health Cigna Priority Health	$33.15

PR HAIR REDUC UP/LOW LEGS

Professional

Both

$204.00

Service Code	HCPCS 00065
Hospital Revenue Code	990
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$132.60
Rate for Payer: Aetna Medicare	$102.00
Rate for Payer: BCBS Complete	$81.60
Rate for Payer: Cash Price	$163.20
Rate for Payer: Priority Health Cigna Priority Health	$132.60

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

Professional

Both

$1,470.00

Service Code	HCPCS 28291
Min. Negotiated Rate	$309.06
Max. Negotiated Rate	$1,803.62
Rate for Payer: Aetna Commercial	$611.91
Rate for Payer: Aetna Medicare	$474.92
Rate for Payer: BCBS Complete	$324.51
Rate for Payer: BCBS MAPPO	$456.65
Rate for Payer: BCBS Trust/PPO	$1,803.62
Rate for Payer: BCN Commercial	$1,013.03
Rate for Payer: BCN Medicare Advantage	$456.65
Rate for Payer: Cash Price	$1,176.00
Rate for Payer: Cash Price	$1,176.00
Rate for Payer: Cofinity Commercial	$657.58
Rate for Payer: Cofinity Commercial	$611.91
Rate for Payer: Health Alliance Plan Medicare Advantage	$456.65
Rate for Payer: Mclaren Medicaid	$309.06
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$479.48
Rate for Payer: Meridian Medicaid	$324.51
Rate for Payer: Nomi Health Commercial	$547.98
Rate for Payer: PACE SWMI	$456.65
Rate for Payer: PHP Medicare Advantage	$456.65
Rate for Payer: Priority Health Choice Medicaid	$309.06
Rate for Payer: Priority Health Cigna Priority Health	$955.50
Rate for Payer: Priority Health HMO/PPO	$738.86
Rate for Payer: Priority Health Medicare	$461.22
Rate for Payer: Priority Health Narrow/Tiered Network	$738.86
Rate for Payer: UHC All Payor (Choice/PPO)	$456.65
Rate for Payer: UHC Dual Complete DSNP	$456.65
Rate for Payer: UHC Exchange	$456.65
Rate for Payer: UHC Medicare Advantage	$456.65
Rate for Payer: UHCCP Medicaid	$309.06

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

Professional

Both

$1,236.00

Service Code	HCPCS 28289
Min. Negotiated Rate	$300.76
Max. Negotiated Rate	$2,027.62
Rate for Payer: Aetna Commercial	$593.37
Rate for Payer: Aetna Medicare	$460.52
Rate for Payer: BCBS Complete	$315.80
Rate for Payer: BCBS MAPPO	$442.81
Rate for Payer: BCBS Trust/PPO	$2,027.62
Rate for Payer: BCN Commercial	$1,002.27
Rate for Payer: BCN Medicare Advantage	$442.81
Rate for Payer: Cash Price	$988.80
Rate for Payer: Cash Price	$988.80
Rate for Payer: Cofinity Commercial	$637.65
Rate for Payer: Cofinity Commercial	$593.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$442.81
Rate for Payer: Mclaren Medicaid	$300.76
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$464.95
Rate for Payer: Meridian Medicaid	$315.80
Rate for Payer: Nomi Health Commercial	$531.37
Rate for Payer: PACE SWMI	$442.81
Rate for Payer: PHP Medicare Advantage	$442.81
Rate for Payer: Priority Health Choice Medicaid	$300.76
Rate for Payer: Priority Health Cigna Priority Health	$803.40
Rate for Payer: Priority Health HMO/PPO	$711.39
Rate for Payer: Priority Health Medicare	$447.24
Rate for Payer: Priority Health Narrow/Tiered Network	$711.39
Rate for Payer: UHC All Payor (Choice/PPO)	$442.81
Rate for Payer: UHC Dual Complete DSNP	$442.81
Rate for Payer: UHC Exchange	$442.81
Rate for Payer: UHC Medicare Advantage	$442.81
Rate for Payer: UHCCP Medicaid	$300.76

PR HAMMER TOE CREST FELT - LARGE LT

Professional

Both

$7.00

Service Code	HCPCS 00044
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55

PR HAMMER TOE CREST FELT - LARGE RT

Professional

Both

$7.00

Service Code	HCPCS 00045
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55

PR HAMMER TOE CREST FELT - MEDIUM LT

Professional

Both

$7.00

Service Code	HCPCS 00042
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55

PR HAMMER TOE CREST FELT - MEDIUM RT

Professional

Both

$7.00

Service Code	HCPCS 00043
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55

PR HAMMER TOE CREST FELT - SMALL LT

Professional

Both

$7.00

Service Code	HCPCS 00040
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55

PR HAMMER TOE CREST FELT - SMALL RT

Professional

Both

$7.00

Service Code	HCPCS 00041
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55

PR HAMMER TOE CREST FELT - XLARGE LT

Professional

Both

$7.00

Service Code	HCPCS 00046
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55

PR HAMMER TOE CREST FELT - XLARGE RT

Professional

Both

$7.00

Service Code	HCPCS 00047
Hospital Revenue Code	990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55

PR HAND-HELD PEFR METER

Professional

Both

$51.00

Service Code	HCPCS A4614
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$33.15
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: BCN Commercial	$26.19
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Priority Health Cigna Priority Health	$33.15

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	$595.92
Rate for Payer: Aetna Commercial	$7.00
Rate for Payer: Aetna Medicare	$8.00
Rate for Payer: BCBS Complete	$6.40
Rate for Payer: BCBS Trust/PPO	$595.92
Rate for Payer: BCN Commercial	$10.15
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cash Price	$12.80
Rate for Payer: Priority Health Cigna Priority Health	$10.40
Rate for Payer: Priority Health HMO/PPO	$7.24
Rate for Payer: Priority Health Narrow/Tiered Network	$7.24

PR HAND MUSCLE TEST,MANUAL

Professional

Both

$86.00

Service Code	HCPCS 95832
Min. Negotiated Rate	$34.40
Max. Negotiated Rate	$55.90
Rate for Payer: Aetna Medicare	$43.00
Rate for Payer: BCBS Complete	$34.40
Rate for Payer: Cash Price	$68.80
Rate for Payer: Priority Health Cigna Priority Health	$55.90

PR HARVEST FEMPOP VEIN 1 SGM VASC RCNSTJ PX

Professional

Both

$1,142.00

Service Code	HCPCS 35572
Min. Negotiated Rate	$213.64
Max. Negotiated Rate	$987.92
Rate for Payer: Aetna Commercial	$441.06
Rate for Payer: Aetna Medicare	$342.32
Rate for Payer: BCBS Complete	$224.32
Rate for Payer: BCBS MAPPO	$329.15
Rate for Payer: BCBS Trust/PPO	$987.92
Rate for Payer: BCN Commercial	$488.19
Rate for Payer: BCN Medicare Advantage	$329.15
Rate for Payer: Cash Price	$913.60
Rate for Payer: Cash Price	$913.60
Rate for Payer: Cofinity Commercial	$473.98
Rate for Payer: Cofinity Commercial	$441.06
Rate for Payer: Health Alliance Plan Medicare Advantage	$329.15
Rate for Payer: Mclaren Medicaid	$213.64
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$345.61
Rate for Payer: Meridian Medicaid	$224.32
Rate for Payer: Nomi Health Commercial	$394.98
Rate for Payer: PACE SWMI	$329.15
Rate for Payer: PHP Medicare Advantage	$329.15
Rate for Payer: Priority Health Choice Medicaid	$213.64
Rate for Payer: Priority Health Cigna Priority Health	$742.30
Rate for Payer: Priority Health HMO/PPO	$532.36
Rate for Payer: Priority Health Medicare	$332.44
Rate for Payer: Priority Health Narrow/Tiered Network	$532.36
Rate for Payer: UHC All Payor (Choice/PPO)	$329.15
Rate for Payer: UHC Dual Complete DSNP	$329.15
Rate for Payer: UHC Exchange	$329.15
Rate for Payer: UHC Medicare Advantage	$329.15
Rate for Payer: UHCCP Medicaid	$213.64

PR HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<

Professional

Both

$555.00

Service Code	HCPCS 15040
Min. Negotiated Rate	$80.94
Max. Negotiated Rate	$386.55
Rate for Payer: Aetna Commercial	$162.09
Rate for Payer: Aetna Medicare	$125.80
Rate for Payer: BCBS Complete	$84.99
Rate for Payer: BCBS MAPPO	$120.96
Rate for Payer: BCBS Trust/PPO	$206.12
Rate for Payer: BCN Commercial	$386.55
Rate for Payer: BCN Medicare Advantage	$120.96
Rate for Payer: Cash Price	$444.00
Rate for Payer: Cash Price	$444.00
Rate for Payer: Cofinity Commercial	$174.18
Rate for Payer: Cofinity Commercial	$162.09
Rate for Payer: Health Alliance Plan Medicare Advantage	$120.96
Rate for Payer: Mclaren Medicaid	$80.94
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$127.01
Rate for Payer: Meridian Medicaid	$84.99
Rate for Payer: Nomi Health Commercial	$145.15
Rate for Payer: PACE SWMI	$120.96
Rate for Payer: PHP Medicare Advantage	$120.96
Rate for Payer: Priority Health Choice Medicaid	$80.94
Rate for Payer: Priority Health Cigna Priority Health	$360.75
Rate for Payer: Priority Health HMO/PPO	$168.87
Rate for Payer: Priority Health Medicare	$122.17
Rate for Payer: Priority Health Narrow/Tiered Network	$168.87
Rate for Payer: UHC All Payor (Choice/PPO)	$120.96
Rate for Payer: UHC Dual Complete DSNP	$120.96
Rate for Payer: UHC Exchange	$120.96
Rate for Payer: UHC Medicare Advantage	$120.96
Rate for Payer: UHCCP Medicaid	$80.94

PR HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX

Professional

Both

$1,127.00

Service Code	HCPCS 35500
Min. Negotiated Rate	$197.88
Max. Negotiated Rate	$777.66
Rate for Payer: Aetna Commercial	$409.50
Rate for Payer: Aetna Medicare	$317.82
Rate for Payer: BCBS Complete	$207.77
Rate for Payer: BCBS MAPPO	$305.60
Rate for Payer: BCBS Trust/PPO	$777.66
Rate for Payer: BCN Commercial	$451.54
Rate for Payer: BCN Medicare Advantage	$305.60
Rate for Payer: Cash Price	$901.60
Rate for Payer: Cash Price	$901.60
Rate for Payer: Cofinity Commercial	$440.06
Rate for Payer: Cofinity Commercial	$409.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$305.60
Rate for Payer: Mclaren Medicaid	$197.88
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$320.88
Rate for Payer: Meridian Medicaid	$207.77
Rate for Payer: Nomi Health Commercial	$366.72
Rate for Payer: PACE SWMI	$305.60
Rate for Payer: PHP Medicare Advantage	$305.60
Rate for Payer: Priority Health Choice Medicaid	$197.88
Rate for Payer: Priority Health Cigna Priority Health	$732.55
Rate for Payer: Priority Health HMO/PPO	$493.54
Rate for Payer: Priority Health Medicare	$308.66
Rate for Payer: Priority Health Narrow/Tiered Network	$493.54
Rate for Payer: UHC All Payor (Choice/PPO)	$305.60
Rate for Payer: UHC Dual Complete DSNP	$305.60
Rate for Payer: UHC Exchange	$305.60
Rate for Payer: UHC Medicare Advantage	$305.60
Rate for Payer: UHCCP Medicaid	$197.88

PR HBOT, FULL BODY CHAMBER, 30M

Professional

Both

$161.00

Service Code	HCPCS G0277
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$784.00
Rate for Payer: Aetna Commercial	$208.16
Rate for Payer: Aetna Medicare	$161.55
Rate for Payer: BCBS Complete	$64.40
Rate for Payer: BCBS MAPPO	$155.34
Rate for Payer: BCBS Trust/PPO	$784.00
Rate for Payer: BCN Commercial	$248.25
Rate for Payer: BCN Medicare Advantage	$155.34
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cofinity Commercial	$223.69
Rate for Payer: Cofinity Commercial	$208.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$155.34
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$163.11
Rate for Payer: Nomi Health Commercial	$186.41
Rate for Payer: PACE SWMI	$155.34
Rate for Payer: PHP Medicare Advantage	$155.34
Rate for Payer: Priority Health Cigna Priority Health	$104.65
Rate for Payer: Priority Health HMO/PPO	$247.41
Rate for Payer: Priority Health Medicare	$156.89
Rate for Payer: Priority Health Narrow/Tiered Network	$247.41
Rate for Payer: UHC All Payor (Choice/PPO)	$155.34
Rate for Payer: UHC Dual Complete DSNP	$155.34
Rate for Payer: UHC Exchange	$155.34
Rate for Payer: UHC Medicare Advantage	$155.34

PR HEAL & BEHAV ASSESS,EA 15 MIN,INIT

Professional

Both

$42.00

Service Code	HCPCS 96150
Min. Negotiated Rate	$16.80
Max. Negotiated Rate	$27.30
Rate for Payer: Aetna Medicare	$21.00
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: Cash Price	$33.60
Rate for Payer: Priority Health Cigna Priority Health	$27.30

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

Professional

Both

$41.00

Service Code	HCPCS 96151
Min. Negotiated Rate	$16.40
Max. Negotiated Rate	$26.65
Rate for Payer: Aetna Medicare	$20.50
Rate for Payer: BCBS Complete	$16.40
Rate for Payer: Cash Price	$32.80
Rate for Payer: Priority Health Cigna Priority Health	$26.65

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

Professional

Both

$39.00

Service Code	HCPCS 96155
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$25.35
Rate for Payer: Aetna Medicare	$19.50
Rate for Payer: BCBS Complete	$15.60
Rate for Payer: Cash Price	$31.20
Rate for Payer: Priority Health Cigna Priority Health	$25.35

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

Professional

Both

$38.00

Service Code	HCPCS 96154
Min. Negotiated Rate	$15.20
Max. Negotiated Rate	$24.70
Rate for Payer: Aetna Medicare	$19.00
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: Cash Price	$30.40
Rate for Payer: Priority Health Cigna Priority Health	$24.70

PR HEAL & BEHAV INTERVENT,EA 15 MIN,INDIV

Professional

Both

$39.00

Service Code	HCPCS 96152
Min. Negotiated Rate	$15.60
Max. Negotiated Rate	$25.35
Rate for Payer: Aetna Medicare	$19.50
Rate for Payer: BCBS Complete	$15.60
Rate for Payer: Cash Price	$31.20
Rate for Payer: Priority Health Cigna Priority Health	$25.35

PR HEALTH BEHAVIOR ASSESSMENT/RE-ASSESSMENT

Professional

Both

$198.00

Service Code	HCPCS 96156
Min. Negotiated Rate	$57.08
Max. Negotiated Rate	$137.32
Rate for Payer: Aetna Commercial	$115.37
Rate for Payer: Aetna Medicare	$89.54
Rate for Payer: BCBS Complete	$59.93
Rate for Payer: BCBS MAPPO	$86.10
Rate for Payer: BCBS Trust/PPO	$135.77
Rate for Payer: BCN Commercial	$137.32
Rate for Payer: BCN Medicare Advantage	$86.10
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cash Price	$158.40
Rate for Payer: Cofinity Commercial	$115.37
Rate for Payer: Cofinity Commercial	$123.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$86.10
Rate for Payer: Mclaren Medicaid	$57.08
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$90.40
Rate for Payer: Meridian Medicaid	$59.93
Rate for Payer: Nomi Health Commercial	$103.32
Rate for Payer: PACE SWMI	$86.10
Rate for Payer: PHP Medicare Advantage	$86.10
Rate for Payer: Priority Health Choice Medicaid	$57.08
Rate for Payer: Priority Health Cigna Priority Health	$128.70
Rate for Payer: Priority Health HMO/PPO	$118.96
Rate for Payer: Priority Health Medicare	$86.96
Rate for Payer: Priority Health Narrow/Tiered Network	$118.96
Rate for Payer: UHC All Payor (Choice/PPO)	$86.10
Rate for Payer: UHC Dual Complete DSNP	$86.10
Rate for Payer: UHC Exchange	$86.10
Rate for Payer: UHC Medicare Advantage	$86.10
Rate for Payer: UHCCP Medicaid	$57.08

Know your out-of-pocket cost for care.

All Charges