Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR INGUINOFEM LMPHADEC SUPFC W/CLOQUETS NODE SPX

Professional

Both

$2,708.00

Service Code	HCPCS 38760
Min. Negotiated Rate	$497.78
Max. Negotiated Rate	$2,031.00
Rate for Payer: Aetna Commercial	$1,041.85
Rate for Payer: Aetna Medicare	$1,354.00
Rate for Payer: BCBS Complete	$522.67
Rate for Payer: BCN Commercial	$1,260.39
Rate for Payer: Cash Price	$2,166.40
Rate for Payer: Cash Price	$2,166.40
Rate for Payer: Mclaren Medicaid	$497.78
Rate for Payer: Meridian Medicaid	$522.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,031.00
Rate for Payer: Priority Health Choice Medicaid	$497.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,677.05
Rate for Payer: Priority Health Narrow/Tiered Network	$1,677.05
Rate for Payer: UHC Medicaid	$497.78
Rate for Payer: UHCCP Medicaid	$497.78

PR INGUINOFEM LMPHADEC SUPFC W/PEL LMPHADEC

Professional

Both

$2,788.00

Service Code	HCPCS 38765
Min. Negotiated Rate	$781.50
Max. Negotiated Rate	$2,620.59
Rate for Payer: Aetna Commercial	$1,622.20
Rate for Payer: Aetna Medicare	$1,394.00
Rate for Payer: BCBS Complete	$820.58
Rate for Payer: BCN Commercial	$1,969.51
Rate for Payer: Cash Price	$2,230.40
Rate for Payer: Cash Price	$2,230.40
Rate for Payer: Mclaren Medicaid	$781.50
Rate for Payer: Meridian Medicaid	$820.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,091.00
Rate for Payer: Priority Health Choice Medicaid	$781.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,620.59
Rate for Payer: Priority Health Narrow/Tiered Network	$2,620.59
Rate for Payer: UHC Medicaid	$781.50
Rate for Payer: UHCCP Medicaid	$781.50

PR INHLJ BRNCL CHALLENGE TSTG W/HISTAMINE/METHACHOL

Professional

Both

$256.00

Service Code	HCPCS 95070
Min. Negotiated Rate	$34.09
Max. Negotiated Rate	$192.00
Rate for Payer: Aetna Commercial	$34.09
Rate for Payer: Aetna Medicare	$128.00
Rate for Payer: BCN Commercial	$52.79
Rate for Payer: Cash Price	$204.80
Rate for Payer: Cash Price	$204.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$192.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$49.69
Rate for Payer: Priority Health Narrow/Tiered Network	$49.69

PR INITIAL FOOT EXAM PT LOPS

Professional

Both

$101.00

Service Code	HCPCS G0245
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$75.75
Rate for Payer: Aetna Commercial	$41.41
Rate for Payer: Aetna Medicare	$50.50
Rate for Payer: BCBS Complete	$40.40
Rate for Payer: BCN Commercial	$58.26
Rate for Payer: Cash Price	$80.80
Rate for Payer: Cash Price	$80.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$75.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$44.36
Rate for Payer: Priority Health Narrow/Tiered Network	$44.36

PR INITIAL HOSP NEONATE 28 D/< NOT CRITICALLY ILL

Professional

Both

$1,097.00

Service Code	HCPCS 99477
Min. Negotiated Rate	$293.02
Max. Negotiated Rate	$822.75
Rate for Payer: Aetna Commercial	$342.16
Rate for Payer: Aetna Medicare	$548.50
Rate for Payer: BCBS Complete	$307.67
Rate for Payer: BCN Commercial	$498.48
Rate for Payer: Cash Price	$877.60
Rate for Payer: Cash Price	$877.60
Rate for Payer: Mclaren Medicaid	$293.02
Rate for Payer: Meridian Medicaid	$307.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$822.75
Rate for Payer: Priority Health Choice Medicaid	$293.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$448.38
Rate for Payer: Priority Health Narrow/Tiered Network	$448.38
Rate for Payer: UHC Medicaid	$293.02
Rate for Payer: UHCCP Medicaid	$293.02

PR INITIAL INPATIENT CONSULT NEW/ESTAB PT 20 MIN

Professional

Both

$138.00

Service Code	HCPCS 99251
Min. Negotiated Rate	$55.20
Max. Negotiated Rate	$103.50
Rate for Payer: Aetna Medicare	$69.00
Rate for Payer: BCBS Complete	$55.20
Rate for Payer: Cash Price	$110.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$103.50

PR INITIAL NURSING FACILITY CARE HI MDM 50 MINUTES

Professional

Both

$259.00

Service Code	HCPCS 99306
Min. Negotiated Rate	$129.50
Max. Negotiated Rate	$269.91
Rate for Payer: Aetna Commercial	$163.22
Rate for Payer: Aetna Medicare	$129.50
Rate for Payer: BCBS Complete	$150.92
Rate for Payer: BCN Commercial	$269.91
Rate for Payer: Cash Price	$207.20
Rate for Payer: Cash Price	$207.20
Rate for Payer: Mclaren Medicaid	$143.73
Rate for Payer: Meridian Medicaid	$150.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$194.25
Rate for Payer: Priority Health Choice Medicaid	$143.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$242.78
Rate for Payer: Priority Health Narrow/Tiered Network	$242.78
Rate for Payer: UHC Medicaid	$143.73
Rate for Payer: UHCCP Medicaid	$143.73

PR INITIAL NURSING FACILITY CARE MOD MDM 35 MINUTES

Professional

Both

$203.00

Service Code	HCPCS 99305
Min. Negotiated Rate	$101.50
Max. Negotiated Rate	$197.70
Rate for Payer: Aetna Commercial	$126.84
Rate for Payer: Aetna Medicare	$101.50
Rate for Payer: BCBS Complete	$110.80
Rate for Payer: BCN Commercial	$197.70
Rate for Payer: Cash Price	$162.40
Rate for Payer: Cash Price	$162.40
Rate for Payer: Mclaren Medicaid	$105.52
Rate for Payer: Meridian Medicaid	$110.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$152.25
Rate for Payer: Priority Health Choice Medicaid	$105.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$177.84
Rate for Payer: Priority Health Narrow/Tiered Network	$177.84
Rate for Payer: UHC Medicaid	$105.52
Rate for Payer: UHCCP Medicaid	$105.52

PR INITIAL NURSING FACILITY CARE SF/LOW MDM 25 MIN

Professional

Both

$142.00

Service Code	HCPCS 99304
Min. Negotiated Rate	$62.60
Max. Negotiated Rate	$119.51
Rate for Payer: Aetna Commercial	$87.92
Rate for Payer: Aetna Medicare	$71.00
Rate for Payer: BCBS Complete	$65.73
Rate for Payer: BCN Commercial	$119.51
Rate for Payer: Cash Price	$113.60
Rate for Payer: Cash Price	$113.60
Rate for Payer: Mclaren Medicaid	$62.60
Rate for Payer: Meridian Medicaid	$65.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$106.50
Rate for Payer: Priority Health Choice Medicaid	$62.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$107.50
Rate for Payer: Priority Health Narrow/Tiered Network	$107.50
Rate for Payer: UHC Medicaid	$62.60
Rate for Payer: UHCCP Medicaid	$62.60

PR INITIAL OBSERVATION CARE/DAY 30 MINUTES

Professional

Both

$156.00

Service Code	HCPCS 99218
Min. Negotiated Rate	$62.40
Max. Negotiated Rate	$117.00
Rate for Payer: Aetna Medicare	$78.00
Rate for Payer: BCBS Complete	$62.40
Rate for Payer: Cash Price	$124.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.00

PR INITIAL OBSERVATION CARE/DAY 50 MINUTES

Professional

Both

$211.00

Service Code	HCPCS 99219
Min. Negotiated Rate	$84.40
Max. Negotiated Rate	$158.25
Rate for Payer: Aetna Medicare	$105.50
Rate for Payer: BCBS Complete	$84.40
Rate for Payer: Cash Price	$168.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$158.25

PR INITIAL OBSERVATION CARE/DAY 70 MINUTES

Professional

Both

$289.00

Service Code	HCPCS 99220
Min. Negotiated Rate	$115.60
Max. Negotiated Rate	$216.75
Rate for Payer: Aetna Medicare	$144.50
Rate for Payer: BCBS Complete	$115.60
Rate for Payer: Cash Price	$231.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$216.75

PR INITIAL PED CRITICAL CARE 29 DAYS THRU 24 MONTHS

Professional

Both

$1,511.00

Service Code	HCPCS 99471
Min. Negotiated Rate	$668.97
Max. Negotiated Rate	$1,136.89
Rate for Payer: Aetna Commercial	$781.38
Rate for Payer: Aetna Medicare	$755.50
Rate for Payer: BCBS Complete	$702.42
Rate for Payer: BCN Commercial	$1,136.89
Rate for Payer: Cash Price	$1,208.80
Rate for Payer: Cash Price	$1,208.80
Rate for Payer: Mclaren Medicaid	$668.97
Rate for Payer: Meridian Medicaid	$702.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,133.25
Rate for Payer: Priority Health Choice Medicaid	$668.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,022.64
Rate for Payer: Priority Health Narrow/Tiered Network	$1,022.64
Rate for Payer: UHC Medicaid	$668.97
Rate for Payer: UHCCP Medicaid	$668.97

PR INITIAL PED CRITICAL CARE 2 THRU 5 YEARS

Professional

Both

$1,280.00

Service Code	HCPCS 99475
Min. Negotiated Rate	$470.32
Max. Negotiated Rate	$960.00
Rate for Payer: Aetna Commercial	$564.10
Rate for Payer: Aetna Medicare	$640.00
Rate for Payer: BCBS Complete	$493.84
Rate for Payer: BCN Commercial	$826.15
Rate for Payer: Cash Price	$1,024.00
Rate for Payer: Cash Price	$1,024.00
Rate for Payer: Mclaren Medicaid	$470.32
Rate for Payer: Meridian Medicaid	$493.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$960.00
Rate for Payer: Priority Health Choice Medicaid	$470.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$743.13
Rate for Payer: Priority Health Narrow/Tiered Network	$743.13
Rate for Payer: UHC Medicaid	$470.32
Rate for Payer: UHCCP Medicaid	$470.32

PR INITIAL PREVENTIVE EXAM

Professional

Both

$271.00

Service Code	HCPCS G0402
Min. Negotiated Rate	$108.40
Max. Negotiated Rate	$203.25
Rate for Payer: Aetna Commercial	$133.40
Rate for Payer: Aetna Medicare	$135.50
Rate for Payer: BCBS Complete	$108.40
Rate for Payer: BCN Commercial	$193.71
Rate for Payer: Cash Price	$216.80
Rate for Payer: Cash Price	$216.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$203.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$169.42
Rate for Payer: Priority Health Narrow/Tiered Network	$169.42

PR INITIAL PREVENTIVE MEDICINE NEW PATIENT <1YEAR

Professional

Both

$176.00

Service Code	HCPCS 99381
Min. Negotiated Rate	$66.69
Max. Negotiated Rate	$163.34
Rate for Payer: Aetna Commercial	$78.23
Rate for Payer: Aetna Medicare	$88.00
Rate for Payer: BCBS Complete	$70.02
Rate for Payer: BCN Commercial	$163.34
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cash Price	$140.80
Rate for Payer: Mclaren Medicaid	$66.69
Rate for Payer: Meridian Medicaid	$70.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$132.00
Rate for Payer: Priority Health Choice Medicaid	$66.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$162.94
Rate for Payer: Priority Health Narrow/Tiered Network	$162.94
Rate for Payer: UHC Medicaid	$66.69
Rate for Payer: UHCCP Medicaid	$66.69

PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 40-64YRS

Professional

Both

$228.00

Service Code	HCPCS 99386
Min. Negotiated Rate	$104.46
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna Commercial	$121.06
Rate for Payer: Aetna Medicare	$114.00
Rate for Payer: BCBS Complete	$109.68
Rate for Payer: BCN Commercial	$163.10
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cash Price	$182.40
Rate for Payer: Mclaren Medicaid	$104.46
Rate for Payer: Meridian Medicaid	$109.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$171.00
Rate for Payer: Priority Health Choice Medicaid	$104.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$147.64
Rate for Payer: Priority Health Narrow/Tiered Network	$147.64
Rate for Payer: UHC Medicaid	$104.46
Rate for Payer: UHCCP Medicaid	$104.46

PR INITIAL PREVENTIVE MEDICINE NEW PATIENT 65YRS&>

Professional

Both

$247.00

Service Code	HCPCS 99387
Min. Negotiated Rate	$112.07
Max. Negotiated Rate	$185.25
Rate for Payer: Aetna Commercial	$130.25
Rate for Payer: Aetna Medicare	$123.50
Rate for Payer: BCBS Complete	$117.67
Rate for Payer: BCN Commercial	$177.27
Rate for Payer: Cash Price	$197.60
Rate for Payer: Cash Price	$197.60
Rate for Payer: Mclaren Medicaid	$112.07
Rate for Payer: Meridian Medicaid	$117.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$185.25
Rate for Payer: Priority Health Choice Medicaid	$112.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$158.53
Rate for Payer: Priority Health Narrow/Tiered Network	$158.53
Rate for Payer: UHC Medicaid	$112.07
Rate for Payer: UHCCP Medicaid	$112.07

PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 12-17 YR

Professional

Both

$202.00

Service Code	HCPCS 99384
Min. Negotiated Rate	$89.84
Max. Negotiated Rate	$151.50
Rate for Payer: Aetna Commercial	$103.72
Rate for Payer: Aetna Medicare	$101.00
Rate for Payer: BCBS Complete	$94.33
Rate for Payer: BCN Commercial	$145.66
Rate for Payer: Cash Price	$161.60
Rate for Payer: Cash Price	$161.60
Rate for Payer: Mclaren Medicaid	$89.84
Rate for Payer: Meridian Medicaid	$94.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$151.50
Rate for Payer: Priority Health Choice Medicaid	$89.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$127.18
Rate for Payer: Priority Health Narrow/Tiered Network	$127.18
Rate for Payer: UHC Medicaid	$89.84
Rate for Payer: UHCCP Medicaid	$89.84

PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 1-4 YRS

Professional

Both

$184.00

Service Code	HCPCS 99382
Min. Negotiated Rate	$71.26
Max. Negotiated Rate	$171.30
Rate for Payer: Aetna Commercial	$83.18
Rate for Payer: Aetna Medicare	$92.00
Rate for Payer: BCBS Complete	$74.82
Rate for Payer: BCN Commercial	$171.30
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cash Price	$147.20
Rate for Payer: Mclaren Medicaid	$71.26
Rate for Payer: Meridian Medicaid	$74.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$138.00
Rate for Payer: Priority Health Choice Medicaid	$71.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$170.75
Rate for Payer: Priority Health Narrow/Tiered Network	$170.75
Rate for Payer: UHC Medicaid	$71.26
Rate for Payer: UHCCP Medicaid	$71.26

PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 18-39YRS

Professional

Both

$197.00

Service Code	HCPCS 99385
Min. Negotiated Rate	$86.18
Max. Negotiated Rate	$147.75
Rate for Payer: Aetna Commercial	$99.47
Rate for Payer: Aetna Medicare	$98.50
Rate for Payer: BCBS Complete	$90.49
Rate for Payer: BCN Commercial	$141.67
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cash Price	$157.60
Rate for Payer: Mclaren Medicaid	$86.18
Rate for Payer: Meridian Medicaid	$90.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$147.75
Rate for Payer: Priority Health Choice Medicaid	$86.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$121.95
Rate for Payer: Priority Health Narrow/Tiered Network	$121.95
Rate for Payer: UHC Medicaid	$86.18
Rate for Payer: UHCCP Medicaid	$86.18

PR INITIAL PREVENTIVE MEDICINE NEW PT AGE 5-11 YRS

Professional

Both

$178.00

Service Code	HCPCS 99383
Min. Negotiated Rate	$75.52
Max. Negotiated Rate	$133.50
Rate for Payer: Aetna Commercial	$88.48
Rate for Payer: Aetna Medicare	$89.00
Rate for Payer: BCBS Complete	$79.30
Rate for Payer: BCN Commercial	$129.68
Rate for Payer: Cash Price	$142.40
Rate for Payer: Cash Price	$142.40
Rate for Payer: Mclaren Medicaid	$75.52
Rate for Payer: Meridian Medicaid	$79.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$133.50
Rate for Payer: Priority Health Choice Medicaid	$75.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$107.58
Rate for Payer: Priority Health Narrow/Tiered Network	$107.58
Rate for Payer: UHC Medicaid	$75.52
Rate for Payer: UHCCP Medicaid	$75.52

PR INITIAL TX 1ST DEGREE BURN LOCAL TX

Professional

Both

$117.00

Service Code	HCPCS 16000
Min. Negotiated Rate	$26.84
Max. Negotiated Rate	$87.75
Rate for Payer: Aetna Commercial	$49.54
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: BCBS Complete	$28.18
Rate for Payer: BCN Commercial	$53.80
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Mclaren Medicaid	$26.84
Rate for Payer: Meridian Medicaid	$28.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$87.75
Rate for Payer: Priority Health Choice Medicaid	$26.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$62.44
Rate for Payer: Priority Health Narrow/Tiered Network	$62.44
Rate for Payer: UHC Medicaid	$26.84
Rate for Payer: UHCCP Medicaid	$26.84

PR INIT/SUB PSYCH CARE M 1ST 30

Professional

Both

$97.00

Service Code	HCPCS G2214
Min. Negotiated Rate	$21.51
Max. Negotiated Rate	$76.86
Rate for Payer: Aetna Commercial	$38.17
Rate for Payer: Aetna Medicare	$48.50
Rate for Payer: BCBS Complete	$22.59
Rate for Payer: BCN Commercial	$48.68
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cash Price	$77.60
Rate for Payer: Mclaren Medicaid	$21.51
Rate for Payer: Meridian Medicaid	$22.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$72.75
Rate for Payer: Priority Health Choice Medicaid	$21.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$76.86
Rate for Payer: Priority Health Narrow/Tiered Network	$76.86
Rate for Payer: UHC Medicaid	$21.51
Rate for Payer: UHCCP Medicaid	$21.51

PR INJ, DENOSUMAB-BMWO, 1 MG

Professional

Both

$24.17

Service Code	HCPCS Q5157
Min. Negotiated Rate	$12.09
Max. Negotiated Rate	$26.16
Rate for Payer: Aetna Medicare	$12.09
Rate for Payer: BCBS Trust/PPO	$26.16
Rate for Payer: Cash Price	$19.34
Rate for Payer: Cash Price	$19.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$18.13

Know your out-of-pocket cost for care.

All Charges