Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

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	$47.85
Rate for Payer: Aetna Commercial	$44.53
Rate for Payer: Aetna Medicare	$34.56
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: BCBS MAPPO	$33.23
Rate for Payer: BCN Medicare Advantage	$33.23
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$47.85
Rate for Payer: Cofinity Commercial	$44.53
Rate for Payer: Health Alliance Plan Medicare Advantage	$33.23
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$34.89
Rate for Payer: Nomi Health Commercial	$39.88
Rate for Payer: PACE SWMI	$33.23
Rate for Payer: PHP Medicare Advantage	$33.23
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: Priority Health Medicare	$33.56
Rate for Payer: UHC All Payor (Choice/PPO)	$33.23
Rate for Payer: UHC Dual Complete DSNP	$33.23
Rate for Payer: UHC Exchange	$33.23
Rate for Payer: UHC Medicare Advantage	$33.23

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	$10.40
Rate for Payer: Aetna Medicare	$8.00
Rate for Payer: BCBS Complete	$6.40
Rate for Payer: Cash Price	$12.80
Rate for Payer: Priority Health Cigna Priority Health	$10.40

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	$329.15
Max. Negotiated Rate	$742.30
Rate for Payer: Aetna Commercial	$441.06
Rate for Payer: Aetna Medicare	$342.32
Rate for Payer: BCBS Complete	$456.80
Rate for Payer: BCBS MAPPO	$329.15
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	$441.06
Rate for Payer: Cofinity Commercial	$473.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$329.15
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$345.61
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 Cigna Priority Health	$742.30
Rate for Payer: Priority Health Medicare	$332.44
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

PR HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/<

Professional

Both

$555.00

Service Code	HCPCS 15040
Min. Negotiated Rate	$120.96
Max. Negotiated Rate	$360.75
Rate for Payer: Aetna Commercial	$162.09
Rate for Payer: Aetna Medicare	$125.80
Rate for Payer: BCBS Complete	$222.00
Rate for Payer: BCBS MAPPO	$120.96
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$127.01
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 Cigna Priority Health	$360.75
Rate for Payer: Priority Health Medicare	$122.17
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

PR HARVEST UXTR VEIN 1 SGM LOWER EXTREMITY/CABG PX

Professional

Both

$1,127.00

Service Code	HCPCS 35500
Min. Negotiated Rate	$305.60
Max. Negotiated Rate	$732.55
Rate for Payer: Aetna Commercial	$409.50
Rate for Payer: Aetna Medicare	$317.82
Rate for Payer: BCBS Complete	$450.80
Rate for Payer: BCBS MAPPO	$305.60
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: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$320.88
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 Cigna Priority Health	$732.55
Rate for Payer: Priority Health Medicare	$308.66
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

PR HBOT, FULL BODY CHAMBER, 30M

Professional

Both

$161.00

Service Code	HCPCS G0277
Min. Negotiated Rate	$64.40
Max. Negotiated Rate	$223.69
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: 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 Medicare	$156.89
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	$79.20
Max. Negotiated Rate	$128.70
Rate for Payer: Aetna Commercial	$115.37
Rate for Payer: Aetna Medicare	$89.54
Rate for Payer: BCBS Complete	$79.20
Rate for Payer: BCBS MAPPO	$86.10
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	$123.98
Rate for Payer: Cofinity Commercial	$115.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$86.10
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$90.41
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 Cigna Priority Health	$128.70
Rate for Payer: Priority Health Medicare	$86.96
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

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

Professional

Both

$128.00

Service Code	HCPCS 96170
Min. Negotiated Rate	$51.20
Max. Negotiated Rate	$83.20
Rate for Payer: Aetna Medicare	$64.00
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: Cash Price	$102.40
Rate for Payer: Priority Health Cigna Priority Health	$83.20

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

Professional

Both

$57.00

Service Code	HCPCS 96171
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$37.05
Rate for Payer: Aetna Medicare	$28.50
Rate for Payer: BCBS Complete	$22.80
Rate for Payer: Cash Price	$45.60
Rate for Payer: Priority Health Cigna Priority Health	$37.05

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

Professional

Both

$145.00

Service Code	HCPCS 96167
Min. Negotiated Rate	$58.00
Max. Negotiated Rate	$94.25
Rate for Payer: Aetna Commercial	$84.00
Rate for Payer: Aetna Medicare	$65.20
Rate for Payer: BCBS Complete	$58.00
Rate for Payer: BCBS MAPPO	$62.69
Rate for Payer: BCN Medicare Advantage	$62.69
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cash Price	$116.00
Rate for Payer: Cofinity Commercial	$84.00
Rate for Payer: Cofinity Commercial	$90.27
Rate for Payer: Health Alliance Plan Medicare Advantage	$62.69
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$65.82
Rate for Payer: Nomi Health Commercial	$75.23
Rate for Payer: PACE SWMI	$62.69
Rate for Payer: PHP Medicare Advantage	$62.69
Rate for Payer: Priority Health Cigna Priority Health	$94.25
Rate for Payer: Priority Health Medicare	$63.32
Rate for Payer: UHC All Payor (Choice/PPO)	$62.69
Rate for Payer: UHC Dual Complete DSNP	$62.69
Rate for Payer: UHC Exchange	$62.69
Rate for Payer: UHC Medicare Advantage	$62.69

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

Professional

Both

$51.00

Service Code	HCPCS 96168
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$33.15
Rate for Payer: Aetna Commercial	$30.18
Rate for Payer: Aetna Medicare	$23.42
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: BCBS MAPPO	$22.52
Rate for Payer: BCN Medicare Advantage	$22.52
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cash Price	$40.80
Rate for Payer: Cofinity Commercial	$32.43
Rate for Payer: Cofinity Commercial	$30.18
Rate for Payer: Health Alliance Plan Medicare Advantage	$22.52
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$23.65
Rate for Payer: Nomi Health Commercial	$27.02
Rate for Payer: PACE SWMI	$22.52
Rate for Payer: PHP Medicare Advantage	$22.52
Rate for Payer: Priority Health Cigna Priority Health	$33.15
Rate for Payer: Priority Health Medicare	$22.75
Rate for Payer: UHC All Payor (Choice/PPO)	$22.52
Rate for Payer: UHC Dual Complete DSNP	$22.52
Rate for Payer: UHC Exchange	$22.52
Rate for Payer: UHC Medicare Advantage	$22.52

PR HEALTH BEHAVIOR IVNTJ INDIV F2F 1ST 30 MIN

Professional

Both

$136.00

Service Code	HCPCS 96158
Min. Negotiated Rate	$54.40
Max. Negotiated Rate	$88.40
Rate for Payer: Aetna Commercial	$79.25
Rate for Payer: Aetna Medicare	$61.51
Rate for Payer: BCBS Complete	$54.40
Rate for Payer: BCBS MAPPO	$59.14
Rate for Payer: BCN Medicare Advantage	$59.14
Rate for Payer: Cash Price	$108.80
Rate for Payer: Cash Price	$108.80
Rate for Payer: Cofinity Commercial	$85.16
Rate for Payer: Cofinity Commercial	$79.25
Rate for Payer: Health Alliance Plan Medicare Advantage	$59.14
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$62.10
Rate for Payer: Nomi Health Commercial	$70.97
Rate for Payer: PACE SWMI	$59.14
Rate for Payer: PHP Medicare Advantage	$59.14
Rate for Payer: Priority Health Cigna Priority Health	$88.40
Rate for Payer: Priority Health Medicare	$59.73
Rate for Payer: UHC All Payor (Choice/PPO)	$59.14
Rate for Payer: UHC Dual Complete DSNP	$59.14
Rate for Payer: UHC Exchange	$59.14
Rate for Payer: UHC Medicare Advantage	$59.14

PR HEALTH BEHAVIOR IVNTJ INDIV F2F EA ADDL 15 MIN

Professional

Both

$47.00

Service Code	HCPCS 96159
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$30.55
Rate for Payer: Aetna Commercial	$27.11
Rate for Payer: Aetna Medicare	$21.04
Rate for Payer: BCBS Complete	$18.80
Rate for Payer: BCBS MAPPO	$20.23
Rate for Payer: BCN Medicare Advantage	$20.23
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cash Price	$37.60
Rate for Payer: Cofinity Commercial	$29.13
Rate for Payer: Cofinity Commercial	$27.11
Rate for Payer: Health Alliance Plan Medicare Advantage	$20.23
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$21.24
Rate for Payer: Nomi Health Commercial	$24.28
Rate for Payer: PACE SWMI	$20.23
Rate for Payer: PHP Medicare Advantage	$20.23
Rate for Payer: Priority Health Cigna Priority Health	$30.55
Rate for Payer: Priority Health Medicare	$20.43
Rate for Payer: UHC All Payor (Choice/PPO)	$20.23
Rate for Payer: UHC Dual Complete DSNP	$20.23
Rate for Payer: UHC Exchange	$20.23
Rate for Payer: UHC Medicare Advantage	$20.23

PR HEALTH RISK ASSESSMENT TEST

Professional

Both

$51.00

Service Code	HCPCS 99420
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 HEARING AID CHECK BINAURAL

Professional

Both

$61.00

Service Code	HCPCS 92593
Min. Negotiated Rate	$24.40
Max. Negotiated Rate	$39.65
Rate for Payer: Aetna Medicare	$30.50
Rate for Payer: BCBS Complete	$24.40
Rate for Payer: Cash Price	$48.80
Rate for Payer: Priority Health Cigna Priority Health	$39.65

PR HEARING AID CHECK MONAURAL

Professional

Both

$54.00

Service Code	HCPCS 92592
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$35.10
Rate for Payer: Aetna Medicare	$27.00
Rate for Payer: BCBS Complete	$21.60
Rate for Payer: Cash Price	$43.20
Rate for Payer: Priority Health Cigna Priority Health	$35.10

Know your out-of-pocket cost for care.

All Charges