Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR IMMUNIZE COUNS < 21YR 6-30 M

Professional

Both

$47.00

Service Code	HCPCS G0313
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$35.25
Rate for Payer: Aetna Medicare	$23.50
Rate for Payer: BCBS Complete	$18.80
Rate for Payer: Cash Price	$37.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.25

PR IMMUNIZE COUNSEL 16-30 MINS

Professional

Both

$47.00

Service Code	HCPCS G0311
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$35.25
Rate for Payer: Aetna Medicare	$23.50
Rate for Payer: BCBS Complete	$18.80
Rate for Payer: Cash Price	$37.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.25

PR IMMUNIZE COUNSEL 5-15 MIN

Professional

Both

$32.00

Service Code	HCPCS G0310
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 IMPL ABSRB MESH/PRSTH DLYD CLSR DFCT INFCTJ/TRMA

Professional

Both

$826.00

Service Code	HCPCS 15778
Min. Negotiated Rate	$225.35
Max. Negotiated Rate	$619.50
Rate for Payer: Aetna Commercial	$421.47
Rate for Payer: Aetna Medicare	$413.00
Rate for Payer: BCBS Complete	$236.62
Rate for Payer: BCN Commercial	$585.63
Rate for Payer: Cash Price	$660.80
Rate for Payer: Cash Price	$660.80
Rate for Payer: Mclaren Medicaid	$225.35
Rate for Payer: Meridian Medicaid	$236.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$619.50
Rate for Payer: Priority Health Choice Medicaid	$225.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$535.99
Rate for Payer: Priority Health Narrow/Tiered Network	$535.99
Rate for Payer: UHC Medicaid	$225.35
Rate for Payer: UHCCP Medicaid	$225.35

PR IMPLANTABLE TISSUE MARKER

Professional

Both

$1,261.00

Service Code	HCPCS A4648
Min. Negotiated Rate	$102.14
Max. Negotiated Rate	$945.75
Rate for Payer: Aetna Commercial	$102.14
Rate for Payer: Aetna Medicare	$630.50
Rate for Payer: BCBS Complete	$504.40
Rate for Payer: BCN Commercial	$136.96
Rate for Payer: Cash Price	$1,008.80
Rate for Payer: Cash Price	$1,008.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$945.75

PR IMPLANTATION NERVE END BONE/MUSCLE

Professional

Both

$1,909.00

Service Code	HCPCS 64787
Min. Negotiated Rate	$129.93
Max. Negotiated Rate	$1,431.75
Rate for Payer: Aetna Commercial	$310.40
Rate for Payer: Aetna Medicare	$954.50
Rate for Payer: BCBS Complete	$136.43
Rate for Payer: BCN Commercial	$350.08
Rate for Payer: Cash Price	$1,527.20
Rate for Payer: Cash Price	$1,527.20
Rate for Payer: Mclaren Medicaid	$129.93
Rate for Payer: Meridian Medicaid	$136.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,431.75
Rate for Payer: Priority Health Choice Medicaid	$129.93
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$406.62
Rate for Payer: Priority Health Narrow/Tiered Network	$406.62
Rate for Payer: UHC Medicaid	$129.93
Rate for Payer: UHCCP Medicaid	$129.93

PR IMPLANTATION PT-ACTIVATED CARDIAC EVENT RECORDER

Professional

Both

$649.00

Service Code	HCPCS 33282
Min. Negotiated Rate	$259.60
Max. Negotiated Rate	$486.75
Rate for Payer: Aetna Medicare	$324.50
Rate for Payer: BCBS Complete	$259.60
Rate for Payer: Cash Price	$519.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$486.75

PR IMPLANT MESH OPN HERNIA RPR/DEBRIDEMENT CLOSURE

Professional

Both

$1,040.00

Service Code	HCPCS 49568
Min. Negotiated Rate	$416.00
Max. Negotiated Rate	$780.00
Rate for Payer: Aetna Medicare	$520.00
Rate for Payer: BCBS Complete	$416.00
Rate for Payer: Cash Price	$832.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$780.00

PR IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT

Professional

Both

$461.00

Service Code	HCPCS 15777
Min. Negotiated Rate	$116.30
Max. Negotiated Rate	$345.75
Rate for Payer: Aetna Commercial	$234.53
Rate for Payer: Aetna Medicare	$230.50
Rate for Payer: BCBS Complete	$122.11
Rate for Payer: BCN Commercial	$319.70
Rate for Payer: Cash Price	$368.80
Rate for Payer: Cash Price	$368.80
Rate for Payer: Mclaren Medicaid	$116.30
Rate for Payer: Meridian Medicaid	$122.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$345.75
Rate for Payer: Priority Health Choice Medicaid	$116.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$292.61
Rate for Payer: Priority Health Narrow/Tiered Network	$292.61
Rate for Payer: UHC Medicaid	$116.30
Rate for Payer: UHCCP Medicaid	$116.30

PR IMPL OI IMPLT SKULL MAG TC ATTACHMENT ESP<100

Professional

Both

$1,383.00

Service Code	HCPCS 69716
Min. Negotiated Rate	$347.19
Max. Negotiated Rate	$1,037.25
Rate for Payer: Aetna Commercial	$688.61
Rate for Payer: Aetna Medicare	$691.50
Rate for Payer: BCBS Complete	$364.55
Rate for Payer: BCN Commercial	$930.73
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Cash Price	$1,106.40
Rate for Payer: Mclaren Medicaid	$347.19
Rate for Payer: Meridian Medicaid	$364.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,037.25
Rate for Payer: Priority Health Choice Medicaid	$347.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$919.66
Rate for Payer: Priority Health Narrow/Tiered Network	$919.66
Rate for Payer: UHC Medicaid	$347.19
Rate for Payer: UHCCP Medicaid	$347.19

PR IMPL OI IMPLT SKULL PERQ ATTACHMENT ESP

Professional

Both

$2,012.00

Service Code	HCPCS 69714
Min. Negotiated Rate	$279.03
Max. Negotiated Rate	$1,509.00
Rate for Payer: Aetna Commercial	$1,199.38
Rate for Payer: Aetna Medicare	$1,006.00
Rate for Payer: BCBS Complete	$292.98
Rate for Payer: BCN Commercial	$743.48
Rate for Payer: Cash Price	$1,609.60
Rate for Payer: Cash Price	$1,609.60
Rate for Payer: Mclaren Medicaid	$279.03
Rate for Payer: Meridian Medicaid	$292.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,509.00
Rate for Payer: Priority Health Choice Medicaid	$279.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$734.63
Rate for Payer: Priority Health Narrow/Tiered Network	$734.63
Rate for Payer: UHC Medicaid	$279.03
Rate for Payer: UHCCP Medicaid	$279.03

PR IMPLTJ BRAIN INTRACAVITARY CHEMOTHERAPY AGENT

Professional

Both

$432.00

Service Code	HCPCS 61517
Min. Negotiated Rate	$50.69
Max. Negotiated Rate	$324.00
Rate for Payer: Aetna Commercial	$112.93
Rate for Payer: Aetna Medicare	$216.00
Rate for Payer: BCBS Complete	$53.22
Rate for Payer: BCN Commercial	$131.47
Rate for Payer: Cash Price	$345.60
Rate for Payer: Cash Price	$345.60
Rate for Payer: Mclaren Medicaid	$50.69
Rate for Payer: Meridian Medicaid	$53.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$324.00
Rate for Payer: Priority Health Choice Medicaid	$50.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$152.69
Rate for Payer: Priority Health Narrow/Tiered Network	$152.69
Rate for Payer: UHC Medicaid	$50.69
Rate for Payer: UHCCP Medicaid	$50.69

PR IMPLTJ NONBIOL/SYNTH IMPLT FASC RNFCMT ABDL WALL

Professional

Both

$505.00

Service Code	HCPCS 0437T
Min. Negotiated Rate	$202.00
Max. Negotiated Rate	$378.75
Rate for Payer: Aetna Commercial	$294.80
Rate for Payer: Aetna Medicare	$252.50
Rate for Payer: BCBS Complete	$202.00
Rate for Payer: Cash Price	$404.00
Rate for Payer: Cash Price	$404.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$378.75

PR IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM

Professional

Both

$846.00

Service Code	HCPCS 62350
Min. Negotiated Rate	$240.90
Max. Negotiated Rate	$702.18
Rate for Payer: Aetna Commercial	$512.70
Rate for Payer: Aetna Medicare	$423.00
Rate for Payer: BCBS Complete	$252.94
Rate for Payer: BCN Commercial	$604.55
Rate for Payer: Cash Price	$676.80
Rate for Payer: Cash Price	$676.80
Rate for Payer: Mclaren Medicaid	$240.90
Rate for Payer: Meridian Medicaid	$252.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$634.50
Rate for Payer: Priority Health Choice Medicaid	$240.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$702.18
Rate for Payer: Priority Health Narrow/Tiered Network	$702.18
Rate for Payer: UHC Medicaid	$240.90
Rate for Payer: UHCCP Medicaid	$240.90

PR IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP

Professional

Both

$2,602.00

Service Code	HCPCS 62362
Min. Negotiated Rate	$237.07
Max. Negotiated Rate	$1,951.50
Rate for Payer: Aetna Commercial	$496.29
Rate for Payer: Aetna Medicare	$1,301.00
Rate for Payer: BCBS Complete	$248.92
Rate for Payer: BCN Commercial	$584.63
Rate for Payer: Cash Price	$2,081.60
Rate for Payer: Cash Price	$2,081.60
Rate for Payer: Mclaren Medicaid	$237.07
Rate for Payer: Meridian Medicaid	$248.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,951.50
Rate for Payer: Priority Health Choice Medicaid	$237.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$679.04
Rate for Payer: Priority Health Narrow/Tiered Network	$679.04
Rate for Payer: UHC Medicaid	$237.07
Rate for Payer: UHCCP Medicaid	$237.07

PR IMPREG GAUZE NO H20/SAL/YARD

Professional

Both

$7.00

Service Code	HCPCS A6266
Min. Negotiated Rate	$1.78
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Commercial	$1.78
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: BCN Commercial	$2.61
Rate for Payer: Cash Price	$5.60
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW

Professional

Both

$1,542.00

Service Code	HCPCS 23935
Min. Negotiated Rate	$315.88
Max. Negotiated Rate	$1,156.50
Rate for Payer: Aetna Commercial	$680.86
Rate for Payer: Aetna Medicare	$771.00
Rate for Payer: BCBS Complete	$331.67
Rate for Payer: BCN Commercial	$790.30
Rate for Payer: Cash Price	$1,233.60
Rate for Payer: Cash Price	$1,233.60
Rate for Payer: Mclaren Medicaid	$315.88
Rate for Payer: Meridian Medicaid	$331.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,156.50
Rate for Payer: Priority Health Choice Medicaid	$315.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$844.81
Rate for Payer: Priority Health Narrow/Tiered Network	$844.81
Rate for Payer: UHC Medicaid	$315.88
Rate for Payer: UHCCP Medicaid	$315.88

PR INC DEEP W/OPNG BONE CORTEX FEMUR/KNEE

Professional

Both

$1,617.00

Service Code	HCPCS 27303
Min. Negotiated Rate	$385.10
Max. Negotiated Rate	$1,212.75
Rate for Payer: Aetna Commercial	$859.62
Rate for Payer: Aetna Medicare	$808.50
Rate for Payer: BCBS Complete	$404.36
Rate for Payer: BCN Commercial	$981.52
Rate for Payer: Cash Price	$1,293.60
Rate for Payer: Cash Price	$1,293.60
Rate for Payer: Mclaren Medicaid	$385.10
Rate for Payer: Meridian Medicaid	$404.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,212.75
Rate for Payer: Priority Health Choice Medicaid	$385.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,049.22
Rate for Payer: Priority Health Narrow/Tiered Network	$1,049.22
Rate for Payer: UHC Medicaid	$385.10
Rate for Payer: UHCCP Medicaid	$385.10

PR INCISE&RETRIEVAL SUBQ CRANIOPLASTY BONE GRAFT

Professional

Both

$606.00

Service Code	HCPCS 62148
Min. Negotiated Rate	$73.49
Max. Negotiated Rate	$454.50
Rate for Payer: Aetna Commercial	$163.26
Rate for Payer: Aetna Medicare	$303.00
Rate for Payer: BCBS Complete	$77.16
Rate for Payer: BCN Commercial	$261.43
Rate for Payer: Cash Price	$484.80
Rate for Payer: Cash Price	$484.80
Rate for Payer: Mclaren Medicaid	$73.49
Rate for Payer: Meridian Medicaid	$77.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$454.50
Rate for Payer: Priority Health Choice Medicaid	$73.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$219.80
Rate for Payer: Priority Health Narrow/Tiered Network	$219.80
Rate for Payer: UHC Medicaid	$73.49
Rate for Payer: UHCCP Medicaid	$73.49

PR INCIS HEART SAC TUBE

Professional

Both

$1,733.00

Service Code	HCPCS 33015
Min. Negotiated Rate	$693.20
Max. Negotiated Rate	$1,299.75
Rate for Payer: Aetna Medicare	$866.50
Rate for Payer: BCBS Complete	$693.20
Rate for Payer: Cash Price	$1,386.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,299.75

PR INCISIONAL BIOPSY EYELID SKIN W/LID MARGIN

Professional

Both

$376.00

Service Code	HCPCS 67810
Min. Negotiated Rate	$35.15
Max. Negotiated Rate	$282.00
Rate for Payer: Aetna Commercial	$90.70
Rate for Payer: Aetna Medicare	$188.00
Rate for Payer: BCBS Complete	$36.91
Rate for Payer: BCN Commercial	$101.59
Rate for Payer: Cash Price	$300.80
Rate for Payer: Cash Price	$300.80
Rate for Payer: Mclaren Medicaid	$35.15
Rate for Payer: Meridian Medicaid	$36.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$282.00
Rate for Payer: Priority Health Choice Medicaid	$35.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$119.00
Rate for Payer: Priority Health Narrow/Tiered Network	$119.00
Rate for Payer: UHC Medicaid	$35.15
Rate for Payer: UHCCP Medicaid	$35.15

PR INCISIONAL BIOPSY SKIN EA SEP/ADDITIONAL LESION

Professional

Both

$146.00

Service Code	HCPCS 11107
Min. Negotiated Rate	$15.98
Max. Negotiated Rate	$109.50
Rate for Payer: Aetna Commercial	$33.44
Rate for Payer: Aetna Medicare	$73.00
Rate for Payer: BCBS Complete	$16.78
Rate for Payer: BCN Commercial	$35.74
Rate for Payer: Cash Price	$116.80
Rate for Payer: Cash Price	$116.80
Rate for Payer: Mclaren Medicaid	$15.98
Rate for Payer: Meridian Medicaid	$16.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$109.50
Rate for Payer: Priority Health Choice Medicaid	$15.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$41.48
Rate for Payer: Priority Health Narrow/Tiered Network	$41.48
Rate for Payer: UHC Medicaid	$15.98
Rate for Payer: UHCCP Medicaid	$15.98

PR INCISIONAL BIOPSY SKIN SINGLE LESION

Professional

Both

$304.00

Service Code	HCPCS 11106
Min. Negotiated Rate	$29.61
Max. Negotiated Rate	$228.00
Rate for Payer: Aetna Commercial	$62.48
Rate for Payer: Aetna Medicare	$152.00
Rate for Payer: BCBS Complete	$31.09
Rate for Payer: BCN Commercial	$66.37
Rate for Payer: Cash Price	$243.20
Rate for Payer: Cash Price	$243.20
Rate for Payer: Mclaren Medicaid	$29.61
Rate for Payer: Meridian Medicaid	$31.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$228.00
Rate for Payer: Priority Health Choice Medicaid	$29.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$77.03
Rate for Payer: Priority Health Narrow/Tiered Network	$77.03
Rate for Payer: UHC Medicaid	$29.61
Rate for Payer: UHCCP Medicaid	$29.61

PR INCISION AND DRAINAGE APPENDICEAL ABSCESS OPEN

Professional

Both

$1,428.00

Service Code	HCPCS 44900
Min. Negotiated Rate	$474.35
Max. Negotiated Rate	$1,440.45
Rate for Payer: Aetna Commercial	$1,060.30
Rate for Payer: Aetna Medicare	$714.00
Rate for Payer: BCBS Complete	$498.07
Rate for Payer: BCN Commercial	$1,182.20
Rate for Payer: Cash Price	$1,142.40
Rate for Payer: Cash Price	$1,142.40
Rate for Payer: Mclaren Medicaid	$474.35
Rate for Payer: Meridian Medicaid	$498.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,071.00
Rate for Payer: Priority Health Choice Medicaid	$474.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,440.45
Rate for Payer: Priority Health Narrow/Tiered Network	$1,440.45
Rate for Payer: UHC Medicaid	$474.35
Rate for Payer: UHCCP Medicaid	$474.35

PR INCISION BONE CORTEX FOOT

Professional

Both

$1,187.00

Service Code	HCPCS 28005
Min. Negotiated Rate	$341.01
Max. Negotiated Rate	$924.13
Rate for Payer: Aetna Commercial	$762.45
Rate for Payer: Aetna Medicare	$593.50
Rate for Payer: BCBS Complete	$358.06
Rate for Payer: BCN Commercial	$864.49
Rate for Payer: Cash Price	$949.60
Rate for Payer: Cash Price	$949.60
Rate for Payer: Mclaren Medicaid	$341.01
Rate for Payer: Meridian Medicaid	$358.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$890.25
Rate for Payer: Priority Health Choice Medicaid	$341.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$924.13
Rate for Payer: Priority Health Narrow/Tiered Network	$924.13
Rate for Payer: UHC Medicaid	$341.01
Rate for Payer: UHCCP Medicaid	$341.01

Know your out-of-pocket cost for care.

All Charges