Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR INSTLJ VIA CHEST TUBE/CATH AGENT FOR PLEURODESIS

Professional

Both

$469.00

Service Code	HCPCS 32560
Min. Negotiated Rate	$43.67
Max. Negotiated Rate	$351.75
Rate for Payer: Aetna Commercial	$99.91
Rate for Payer: Aetna Medicare	$234.50
Rate for Payer: BCBS Complete	$45.85
Rate for Payer: BCN Commercial	$111.55
Rate for Payer: Cash Price	$375.20
Rate for Payer: Cash Price	$375.20
Rate for Payer: Mclaren Medicaid	$43.67
Rate for Payer: Meridian Medicaid	$45.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$351.75
Rate for Payer: Priority Health Choice Medicaid	$43.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$105.05
Rate for Payer: Priority Health Narrow/Tiered Network	$105.05
Rate for Payer: UHC Medicaid	$43.67
Rate for Payer: UHCCP Medicaid	$43.67

PR INSTLJ VIA CH TUBE/CATH AGENT FBRNLYSIS 1ST DAY

Professional

Both

$237.00

Service Code	HCPCS 32561
Min. Negotiated Rate	$38.34
Max. Negotiated Rate	$177.75
Rate for Payer: Aetna Commercial	$87.90
Rate for Payer: Aetna Medicare	$118.50
Rate for Payer: BCBS Complete	$40.26
Rate for Payer: BCN Commercial	$99.10
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cash Price	$189.60
Rate for Payer: Mclaren Medicaid	$38.34
Rate for Payer: Meridian Medicaid	$40.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$177.75
Rate for Payer: Priority Health Choice Medicaid	$38.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$93.32
Rate for Payer: Priority Health Narrow/Tiered Network	$93.32
Rate for Payer: UHC Medicaid	$38.34
Rate for Payer: UHCCP Medicaid	$38.34

PR INSTRUMENT BASED OCULAR SCR BI W/ONSITE ANALYSIS

Professional

Both

$11.00

Service Code	HCPCS 99177
Min. Negotiated Rate	$4.57
Max. Negotiated Rate	$8.25
Rate for Payer: Aetna Commercial	$4.57
Rate for Payer: Aetna Medicare	$5.50
Rate for Payer: BCN Commercial	$7.47
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$8.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$6.89
Rate for Payer: Priority Health Narrow/Tiered Network	$6.89

PR INSTRUMENT BASED OCULAR SCR BI W/RMT ANAL & RPT

Professional

Both

$53.00

Service Code	HCPCS 99174
Min. Negotiated Rate	$5.72
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna Commercial	$5.72
Rate for Payer: Aetna Medicare	$26.50
Rate for Payer: BCN Commercial	$9.46
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$8.73
Rate for Payer: Priority Health Narrow/Tiered Network	$8.73

PR INSULIN INJECTION

Professional

Both

$32.00

Service Code	HCPCS J1815
Min. Negotiated Rate	$0.04
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$0.30
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCBS Trust/PPO	$0.04
Rate for Payer: BCN Commercial	$0.04
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00

PR INT ANAST PANCREATIC CYST GI TRACT DIRECT

Professional

Both

$2,025.00

Service Code	HCPCS 48520
Min. Negotiated Rate	$659.66
Max. Negotiated Rate	$2,013.83
Rate for Payer: Aetna Commercial	$1,491.40
Rate for Payer: Aetna Medicare	$1,012.50
Rate for Payer: BCBS Complete	$692.64
Rate for Payer: BCN Commercial	$1,652.80
Rate for Payer: Cash Price	$1,620.00
Rate for Payer: Cash Price	$1,620.00
Rate for Payer: Mclaren Medicaid	$659.66
Rate for Payer: Meridian Medicaid	$692.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,518.75
Rate for Payer: Priority Health Choice Medicaid	$659.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,013.83
Rate for Payer: Priority Health Narrow/Tiered Network	$2,013.83
Rate for Payer: UHC Medicaid	$659.66
Rate for Payer: UHCCP Medicaid	$659.66

PR INT ANAST PANCREATIC CYST GI TRACT ROUX-EN-Y

Professional

Both

$2,974.00

Service Code	HCPCS 48540
Min. Negotiated Rate	$778.30
Max. Negotiated Rate	$2,391.24
Rate for Payer: Aetna Commercial	$1,774.25
Rate for Payer: Aetna Medicare	$1,487.00
Rate for Payer: BCBS Complete	$817.22
Rate for Payer: BCN Commercial	$1,962.55
Rate for Payer: Cash Price	$2,379.20
Rate for Payer: Cash Price	$2,379.20
Rate for Payer: Mclaren Medicaid	$778.30
Rate for Payer: Meridian Medicaid	$817.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,230.50
Rate for Payer: Priority Health Choice Medicaid	$778.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,391.24
Rate for Payer: Priority Health Narrow/Tiered Network	$2,391.24
Rate for Payer: UHC Medicaid	$778.30
Rate for Payer: UHCCP Medicaid	$778.30

PR INTENSIVE OUTPATIENT PSYCHIA

Professional

Both

$134.00

Service Code	HCPCS S9480
Min. Negotiated Rate	$53.60
Max. Negotiated Rate	$312.06
Rate for Payer: Aetna Commercial	$63.28
Rate for Payer: Aetna Medicare	$67.00
Rate for Payer: BCBS Complete	$53.60
Rate for Payer: BCN Commercial	$312.06
Rate for Payer: Cash Price	$107.20
Rate for Payer: Cash Price	$107.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$100.50

PR INTER DEVC REMOTE 30D

Professional

Both

$43.00

Service Code	HCPCS G2066
Min. Negotiated Rate	$17.20
Max. Negotiated Rate	$32.25
Rate for Payer: Aetna Medicare	$21.50
Rate for Payer: BCBS Complete	$17.20
Rate for Payer: Cash Price	$34.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$32.25

PR INTERMITTENT URINARY CATH

Professional

Both

$11.00

Service Code	HCPCS A4353
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$9.56
Rate for Payer: Aetna Commercial	$6.52
Rate for Payer: Aetna Medicare	$5.50
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: BCN Commercial	$9.56
Rate for Payer: Cash Price	$8.80
Rate for Payer: Cash Price	$8.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$8.25

PR INTERNAL NEUROLYSIS REQ OPERATING MICROSCOPE

Professional

Both

$773.00

Service Code	HCPCS 64727
Min. Negotiated Rate	$92.44
Max. Negotiated Rate	$579.75
Rate for Payer: Aetna Commercial	$232.94
Rate for Payer: Aetna Medicare	$386.50
Rate for Payer: BCBS Complete	$97.06
Rate for Payer: BCN Commercial	$265.43
Rate for Payer: Cash Price	$618.40
Rate for Payer: Cash Price	$618.40
Rate for Payer: Mclaren Medicaid	$92.44
Rate for Payer: Meridian Medicaid	$97.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$579.75
Rate for Payer: Priority Health Choice Medicaid	$92.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$308.29
Rate for Payer: Priority Health Narrow/Tiered Network	$308.29
Rate for Payer: UHC Medicaid	$92.44
Rate for Payer: UHCCP Medicaid	$92.44

PR INTERNAL SPINAL FIXATION WIRING SPINOUS PROCESS

Professional

Both

$1,255.00

Service Code	HCPCS 22841
Min. Negotiated Rate	$124.50
Max. Negotiated Rate	$941.25
Rate for Payer: Aetna Commercial	$519.10
Rate for Payer: Aetna Medicare	$627.50
Rate for Payer: BCBS Complete	$502.00
Rate for Payer: BCN Commercial	$124.50
Rate for Payer: Cash Price	$1,004.00
Rate for Payer: Cash Price	$1,004.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$941.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$628.68
Rate for Payer: Priority Health Narrow/Tiered Network	$628.68

PR INTERPELVIABDOMINAL AMPUTATION

Professional

Both

$5,490.00

Service Code	HCPCS 27290
Min. Negotiated Rate	$935.28
Max. Negotiated Rate	$4,117.50
Rate for Payer: Aetna Commercial	$2,173.74
Rate for Payer: Aetna Medicare	$2,745.00
Rate for Payer: BCBS Complete	$982.04
Rate for Payer: BCN Commercial	$2,449.57
Rate for Payer: Cash Price	$4,392.00
Rate for Payer: Cash Price	$4,392.00
Rate for Payer: Mclaren Medicaid	$935.28
Rate for Payer: Meridian Medicaid	$982.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,117.50
Rate for Payer: Priority Health Choice Medicaid	$935.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,618.51
Rate for Payer: Priority Health Narrow/Tiered Network	$2,618.51
Rate for Payer: UHC Medicaid	$935.28
Rate for Payer: UHCCP Medicaid	$935.28

PR INTERPJ/EXPLNAJ RSLTS PSYC/OTH XM&PX/DATA FAMILY

Professional

Both

$157.00

Service Code	HCPCS 90887
Min. Negotiated Rate	$56.09
Max. Negotiated Rate	$117.75
Rate for Payer: Aetna Commercial	$83.11
Rate for Payer: Aetna Medicare	$78.50
Rate for Payer: BCBS Complete	$58.89
Rate for Payer: BCN Commercial	$84.04
Rate for Payer: Cash Price	$125.60
Rate for Payer: Cash Price	$125.60
Rate for Payer: Mclaren Medicaid	$56.09
Rate for Payer: Meridian Medicaid	$58.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$117.75
Rate for Payer: Priority Health Choice Medicaid	$56.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$96.85
Rate for Payer: Priority Health Narrow/Tiered Network	$96.85
Rate for Payer: UHC Medicaid	$56.09
Rate for Payer: UHCCP Medicaid	$56.09

PR INTERROGATION EVAL F2F IMPLANT SUBQ LEAD DEFIB

Professional

Both

$140.00

Service Code	HCPCS 93261
Min. Negotiated Rate	$70.00
Max. Negotiated Rate	$105.00
Rate for Payer: Aetna Commercial	$89.88
Rate for Payer: Aetna Medicare	$70.00
Rate for Payer: BCN Commercial	$103.58
Rate for Payer: Cash Price	$112.00
Rate for Payer: Cash Price	$112.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$105.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$98.45
Rate for Payer: Priority Health Narrow/Tiered Network	$98.45

PR INTERROGATION EVAL IN PERSON WR DEFIBRILLATOR

Professional

Both

$66.00

Service Code	HCPCS 93292
Min. Negotiated Rate	$33.00
Max. Negotiated Rate	$75.19
Rate for Payer: Aetna Commercial	$63.69
Rate for Payer: Aetna Medicare	$33.00
Rate for Payer: BCN Commercial	$75.19
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$52.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$49.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$71.46
Rate for Payer: Priority Health Narrow/Tiered Network	$71.46

PR INTERROGATION EVAL REMOTE </90 D 1/2/MLT LD DFB

Professional

Both

$207.00

Service Code	HCPCS 93295
Min. Negotiated Rate	$23.00
Max. Negotiated Rate	$155.25
Rate for Payer: Aetna Commercial	$50.04
Rate for Payer: Aetna Medicare	$103.50
Rate for Payer: BCBS Complete	$24.15
Rate for Payer: BCN Commercial	$53.29
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cash Price	$165.60
Rate for Payer: Mclaren Medicaid	$23.00
Rate for Payer: Meridian Medicaid	$24.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$155.25
Rate for Payer: Priority Health Choice Medicaid	$23.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$50.64
Rate for Payer: Priority Health Narrow/Tiered Network	$50.64
Rate for Payer: UHC Medicaid	$23.00
Rate for Payer: UHCCP Medicaid	$23.00

PR INTERROG DEV EVAL ICPMS PHYS/QHP IN PERSON

Professional

Both

$83.00

Service Code	HCPCS 93290
Min. Negotiated Rate	$41.50
Max. Negotiated Rate	$77.69
Rate for Payer: Aetna Commercial	$67.56
Rate for Payer: Aetna Medicare	$41.50
Rate for Payer: BCN Commercial	$77.69
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$66.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$73.83
Rate for Payer: Priority Health Narrow/Tiered Network	$73.83

PR INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON

Professional

Both

$44.00

Service Code	HCPCS 93288
Min. Negotiated Rate	$22.00
Max. Negotiated Rate	$82.66
Rate for Payer: Aetna Commercial	$70.53
Rate for Payer: Aetna Commercial	$70.53
Rate for Payer: Aetna Medicare	$22.00
Rate for Payer: Aetna Medicare	$88.00
Rate for Payer: BCN Commercial	$82.66
Rate for Payer: BCN Commercial	$82.66
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cash Price	$140.80
Rate for Payer: Cash Price	$35.20
Rate for Payer: Cash Price	$35.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$132.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$33.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$78.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$78.58
Rate for Payer: Priority Health Narrow/Tiered Network	$78.58
Rate for Payer: Priority Health Narrow/Tiered Network	$78.58

PR INTERROG DEV EVAL SCRMS PHYS/QHP IN PERSON

Professional

Both

$81.00

Service Code	HCPCS 93291
Min. Negotiated Rate	$40.50
Max. Negotiated Rate	$71.71
Rate for Payer: Aetna Commercial	$62.12
Rate for Payer: Aetna Medicare	$40.50
Rate for Payer: BCN Commercial	$71.71
Rate for Payer: Cash Price	$64.80
Rate for Payer: Cash Price	$64.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$60.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$68.16
Rate for Payer: Priority Health Narrow/Tiered Network	$68.16

PR INTERROG EVAL F2F 1/DUAL/MLT LEADS IMPLTBL DFB

Professional

Both

$212.00

Service Code	HCPCS 93289
Min. Negotiated Rate	$92.99
Max. Negotiated Rate	$159.00
Rate for Payer: Aetna Commercial	$92.99
Rate for Payer: Aetna Medicare	$106.00
Rate for Payer: BCN Commercial	$105.57
Rate for Payer: Cash Price	$169.60
Rate for Payer: Cash Price	$169.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$100.33
Rate for Payer: Priority Health Narrow/Tiered Network	$100.33

PR INTERTHORACOSCAPULAR AMPUTATION

Professional

Both

$6,169.00

Service Code	HCPCS 23900
Min. Negotiated Rate	$801.52
Max. Negotiated Rate	$4,626.75
Rate for Payer: Aetna Commercial	$1,852.71
Rate for Payer: Aetna Medicare	$3,084.50
Rate for Payer: BCBS Complete	$841.60
Rate for Payer: BCN Commercial	$2,092.52
Rate for Payer: Cash Price	$4,935.20
Rate for Payer: Cash Price	$4,935.20
Rate for Payer: Mclaren Medicaid	$801.52
Rate for Payer: Meridian Medicaid	$841.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,626.75
Rate for Payer: Priority Health Choice Medicaid	$801.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,236.84
Rate for Payer: Priority Health Narrow/Tiered Network	$2,236.84
Rate for Payer: UHC Medicaid	$801.52
Rate for Payer: UHCCP Medicaid	$801.52

PR INTESTINAL PLICATION SEPARATE PROCEDURE

Professional

Both

$3,056.00

Service Code	HCPCS 44680
Min. Negotiated Rate	$643.69
Max. Negotiated Rate	$2,292.00
Rate for Payer: Aetna Commercial	$1,457.86
Rate for Payer: Aetna Medicare	$1,528.00
Rate for Payer: BCBS Complete	$675.87
Rate for Payer: BCN Commercial	$1,618.93
Rate for Payer: Cash Price	$2,444.80
Rate for Payer: Cash Price	$2,444.80
Rate for Payer: Mclaren Medicaid	$643.69
Rate for Payer: Meridian Medicaid	$675.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,292.00
Rate for Payer: Priority Health Choice Medicaid	$643.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,972.56
Rate for Payer: Priority Health Narrow/Tiered Network	$1,972.56
Rate for Payer: UHC Medicaid	$643.69
Rate for Payer: UHCCP Medicaid	$643.69

PR INT HRHC BY LIGATION 2+ HROID W/O IMG GDN

Professional

Both

$505.00

Service Code	HCPCS 46946
Min. Negotiated Rate	$244.74
Max. Negotiated Rate	$702.02
Rate for Payer: Aetna Commercial	$507.35
Rate for Payer: Aetna Medicare	$252.50
Rate for Payer: BCBS Complete	$256.98
Rate for Payer: BCN Commercial	$576.17
Rate for Payer: Cash Price	$404.00
Rate for Payer: Cash Price	$404.00
Rate for Payer: Mclaren Medicaid	$244.74
Rate for Payer: Meridian Medicaid	$256.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$378.75
Rate for Payer: Priority Health Choice Medicaid	$244.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$702.02
Rate for Payer: Priority Health Narrow/Tiered Network	$702.02
Rate for Payer: UHC Medicaid	$244.74
Rate for Payer: UHCCP Medicaid	$244.74

PR INT HRHC BY LIGATION SINGLE HROID W/O IMG GDN

Professional

Both

$475.00

Service Code	HCPCS 46945
Min. Negotiated Rate	$223.44
Max. Negotiated Rate	$631.02
Rate for Payer: Aetna Commercial	$449.56
Rate for Payer: Aetna Medicare	$237.50
Rate for Payer: BCBS Complete	$234.61
Rate for Payer: BCN Commercial	$517.90
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Mclaren Medicaid	$223.44
Rate for Payer: Meridian Medicaid	$234.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$356.25
Rate for Payer: Priority Health Choice Medicaid	$223.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$631.02
Rate for Payer: Priority Health Narrow/Tiered Network	$631.02
Rate for Payer: UHC Medicaid	$223.44
Rate for Payer: UHCCP Medicaid	$223.44

Know your out-of-pocket cost for care.

All Charges