Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR INTRO CATHETER RIGHT HEART/MAIN PULMONARY ARTERY

Professional

Both

$769.00

Service Code	HCPCS 36013
Min. Negotiated Rate	$71.57
Max. Negotiated Rate	$576.75
Rate for Payer: Aetna Commercial	$165.19
Rate for Payer: Aetna Medicare	$384.50
Rate for Payer: BCBS Complete	$75.15
Rate for Payer: BCN Commercial	$184.25
Rate for Payer: Cash Price	$615.20
Rate for Payer: Cash Price	$615.20
Rate for Payer: Mclaren Medicaid	$71.57
Rate for Payer: Meridian Medicaid	$75.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$576.75
Rate for Payer: Priority Health Choice Medicaid	$71.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$198.14
Rate for Payer: Priority Health Narrow/Tiered Network	$198.14
Rate for Payer: UHC Medicaid	$71.57
Rate for Payer: UHCCP Medicaid	$71.57

PR INTRO CATHETER SUPERIOR/INFERIOR VENA CAVA

Professional

Both

$1,003.00

Service Code	HCPCS 36010
Min. Negotiated Rate	$60.71
Max. Negotiated Rate	$752.25
Rate for Payer: Aetna Commercial	$147.28
Rate for Payer: Aetna Medicare	$501.50
Rate for Payer: BCBS Complete	$63.75
Rate for Payer: BCN Commercial	$157.36
Rate for Payer: Cash Price	$802.40
Rate for Payer: Cash Price	$802.40
Rate for Payer: Mclaren Medicaid	$60.71
Rate for Payer: Meridian Medicaid	$63.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$752.25
Rate for Payer: Priority Health Choice Medicaid	$60.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$169.21
Rate for Payer: Priority Health Narrow/Tiered Network	$169.21
Rate for Payer: UHC Medicaid	$60.71
Rate for Payer: UHCCP Medicaid	$60.71

PR INTRODUCTION CATHETER AORTA

Professional

Both

$593.00

Service Code	HCPCS 36200
Min. Negotiated Rate	$78.38
Max. Negotiated Rate	$444.75
Rate for Payer: Aetna Commercial	$187.30
Rate for Payer: Aetna Medicare	$296.50
Rate for Payer: BCBS Complete	$82.30
Rate for Payer: BCN Commercial	$204.18
Rate for Payer: Cash Price	$474.40
Rate for Payer: Cash Price	$474.40
Rate for Payer: Mclaren Medicaid	$78.38
Rate for Payer: Meridian Medicaid	$82.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$444.75
Rate for Payer: Priority Health Choice Medicaid	$78.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$219.56
Rate for Payer: Priority Health Narrow/Tiered Network	$219.56
Rate for Payer: UHC Medicaid	$78.38
Rate for Payer: UHCCP Medicaid	$78.38

PR INTRODUCTION LONG GI TUBE SEPARATE PROCEDURE

Professional

Both

$143.00

Service Code	HCPCS 44500
Min. Negotiated Rate	$10.44
Max. Negotiated Rate	$107.25
Rate for Payer: Aetna Commercial	$26.22
Rate for Payer: Aetna Medicare	$71.50
Rate for Payer: BCBS Complete	$10.96
Rate for Payer: BCN Commercial	$28.39
Rate for Payer: Cash Price	$114.40
Rate for Payer: Cash Price	$114.40
Rate for Payer: Mclaren Medicaid	$10.44
Rate for Payer: Meridian Medicaid	$10.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$107.25
Rate for Payer: Priority Health Choice Medicaid	$10.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$34.59
Rate for Payer: Priority Health Narrow/Tiered Network	$34.59
Rate for Payer: UHC Medicaid	$10.44
Rate for Payer: UHCCP Medicaid	$10.44

PR INTRODUCTION NEEDLE/INTRACATHETER VEIN

Professional

Both

$185.00

Service Code	HCPCS 36000
Min. Negotiated Rate	$10.60
Max. Negotiated Rate	$138.75
Rate for Payer: Aetna Commercial	$11.94
Rate for Payer: Aetna Medicare	$92.50
Rate for Payer: BCBS Complete	$74.00
Rate for Payer: BCN Commercial	$10.60
Rate for Payer: Cash Price	$148.00
Rate for Payer: Cash Price	$148.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$138.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$14.45
Rate for Payer: Priority Health Narrow/Tiered Network	$14.45

PR INTRO NEEDLE/INTRACATH CAROTID/VERTEBRAL ARTERY

Professional

Both

$757.00

Service Code	HCPCS 36100
Min. Negotiated Rate	$85.41
Max. Negotiated Rate	$567.75
Rate for Payer: Aetna Commercial	$211.05
Rate for Payer: Aetna Medicare	$378.50
Rate for Payer: BCBS Complete	$89.68
Rate for Payer: BCN Commercial	$223.09
Rate for Payer: Cash Price	$605.60
Rate for Payer: Cash Price	$605.60
Rate for Payer: Mclaren Medicaid	$85.41
Rate for Payer: Meridian Medicaid	$89.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$567.75
Rate for Payer: Priority Health Choice Medicaid	$85.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$239.91
Rate for Payer: Priority Health Narrow/Tiered Network	$239.91
Rate for Payer: UHC Medicaid	$85.41
Rate for Payer: UHCCP Medicaid	$85.41

PR INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY

Professional

Both

$970.00

Service Code	HCPCS 36140
Min. Negotiated Rate	$50.27
Max. Negotiated Rate	$727.50
Rate for Payer: Aetna Commercial	$120.54
Rate for Payer: Aetna Medicare	$485.00
Rate for Payer: BCBS Complete	$52.78
Rate for Payer: BCN Commercial	$129.48
Rate for Payer: Cash Price	$776.00
Rate for Payer: Cash Price	$776.00
Rate for Payer: Mclaren Medicaid	$50.27
Rate for Payer: Meridian Medicaid	$52.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$727.50
Rate for Payer: Priority Health Choice Medicaid	$50.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$139.23
Rate for Payer: Priority Health Narrow/Tiered Network	$139.23
Rate for Payer: UHC Medicaid	$50.27
Rate for Payer: UHCCP Medicaid	$50.27

PR INTSTINAL STRICTUROPLASTY W/WO DILAT OBSTRCJ

Professional

Both

$3,056.00

Service Code	HCPCS 44615
Min. Negotiated Rate	$634.53
Max. Negotiated Rate	$2,292.00
Rate for Payer: Aetna Commercial	$1,443.69
Rate for Payer: Aetna Medicare	$1,528.00
Rate for Payer: BCBS Complete	$666.26
Rate for Payer: BCN Commercial	$1,605.49
Rate for Payer: Cash Price	$2,444.80
Rate for Payer: Cash Price	$2,444.80
Rate for Payer: Mclaren Medicaid	$634.53
Rate for Payer: Meridian Medicaid	$666.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,292.00
Rate for Payer: Priority Health Choice Medicaid	$634.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,956.18
Rate for Payer: Priority Health Narrow/Tiered Network	$1,956.18
Rate for Payer: UHC Medicaid	$634.53
Rate for Payer: UHCCP Medicaid	$634.53

PR INTUBATION ENDOTRACHEAL EMERGENCY PROCEDURE

Professional

Both

$375.00

Service Code	HCPCS 31500
Min. Negotiated Rate	$84.77
Max. Negotiated Rate	$281.25
Rate for Payer: Aetna Commercial	$184.93
Rate for Payer: Aetna Medicare	$187.50
Rate for Payer: BCBS Complete	$89.01
Rate for Payer: BCN Commercial	$210.65
Rate for Payer: Cash Price	$300.00
Rate for Payer: Cash Price	$300.00
Rate for Payer: Mclaren Medicaid	$84.77
Rate for Payer: Meridian Medicaid	$89.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$281.25
Rate for Payer: Priority Health Choice Medicaid	$84.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$198.37
Rate for Payer: Priority Health Narrow/Tiered Network	$198.37
Rate for Payer: UHC Medicaid	$84.77
Rate for Payer: UHCCP Medicaid	$84.77

PR IONM 1 ON 1 IN OR W/ATTENDANCE EACH 15 MINUTES

Professional

Both

$58.00

Service Code	HCPCS 95940
Min. Negotiated Rate	$17.04
Max. Negotiated Rate	$47.81
Rate for Payer: Aetna Commercial	$36.02
Rate for Payer: Aetna Medicare	$29.00
Rate for Payer: BCBS Complete	$17.89
Rate for Payer: BCN Commercial	$47.81
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Mclaren Medicaid	$17.04
Rate for Payer: Meridian Medicaid	$17.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$43.50
Rate for Payer: Priority Health Choice Medicaid	$17.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$44.08
Rate for Payer: Priority Health Narrow/Tiered Network	$44.08
Rate for Payer: UHC Medicaid	$17.04
Rate for Payer: UHCCP Medicaid	$17.04

PR IONM REMOTE/NEARBY/>1 PATIENT IN OR PER HOUR

Professional

Both

$132.00

Service Code	HCPCS 95941
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$299.74
Rate for Payer: Aetna Commercial	$299.74
Rate for Payer: Aetna Medicare	$66.00
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: BCN Commercial	$105.89
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cash Price	$105.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$99.00

PR IP/OBS CONSLTJ NEW/EST PT HIGH MDM 80 MINUTES

Professional

Both

$358.00

Service Code	HCPCS 99255
Min. Negotiated Rate	$117.79
Max. Negotiated Rate	$274.89
Rate for Payer: Aetna Commercial	$208.05
Rate for Payer: Aetna Medicare	$179.00
Rate for Payer: BCBS Complete	$123.68
Rate for Payer: BCN Commercial	$274.89
Rate for Payer: Cash Price	$286.40
Rate for Payer: Cash Price	$286.40
Rate for Payer: Mclaren Medicaid	$117.79
Rate for Payer: Meridian Medicaid	$123.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$268.50
Rate for Payer: Priority Health Choice Medicaid	$117.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$247.25
Rate for Payer: Priority Health Narrow/Tiered Network	$247.25
Rate for Payer: UHC Medicaid	$117.79
Rate for Payer: UHCCP Medicaid	$117.79

PR IP/OBS CONSLTJ NEW/EST PT LOW MDM 45 MINUTES

Professional

Both

$215.00

Service Code	HCPCS 99253
Min. Negotiated Rate	$63.05
Max. Negotiated Rate	$161.25
Rate for Payer: Aetna Commercial	$119.14
Rate for Payer: Aetna Medicare	$107.50
Rate for Payer: BCBS Complete	$66.20
Rate for Payer: BCN Commercial	$147.90
Rate for Payer: Cash Price	$172.00
Rate for Payer: Cash Price	$172.00
Rate for Payer: Mclaren Medicaid	$63.05
Rate for Payer: Meridian Medicaid	$66.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$161.25
Rate for Payer: Priority Health Choice Medicaid	$63.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$133.04
Rate for Payer: Priority Health Narrow/Tiered Network	$133.04
Rate for Payer: UHC Medicaid	$63.05
Rate for Payer: UHCCP Medicaid	$63.05

PR IP/OBS CONSLTJ NEW/EST PT MOD MDM 60 MINUTES

Professional

Both

$274.00

Service Code	HCPCS 99254
Min. Negotiated Rate	$87.76
Max. Negotiated Rate	$205.50
Rate for Payer: Aetna Commercial	$172.55
Rate for Payer: Aetna Medicare	$137.00
Rate for Payer: BCBS Complete	$92.15
Rate for Payer: BCN Commercial	$204.67
Rate for Payer: Cash Price	$219.20
Rate for Payer: Cash Price	$219.20
Rate for Payer: Mclaren Medicaid	$87.76
Rate for Payer: Meridian Medicaid	$92.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$205.50
Rate for Payer: Priority Health Choice Medicaid	$87.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$184.10
Rate for Payer: Priority Health Narrow/Tiered Network	$184.10
Rate for Payer: UHC Medicaid	$87.76
Rate for Payer: UHCCP Medicaid	$87.76

PR IP/OBS CONSLTJ NEW/EST PT SF MDM 35 MINUTES

Professional

Both

$173.00

Service Code	HCPCS 99252
Min. Negotiated Rate	$44.73
Max. Negotiated Rate	$129.75
Rate for Payer: Aetna Commercial	$77.71
Rate for Payer: Aetna Medicare	$86.50
Rate for Payer: BCBS Complete	$46.97
Rate for Payer: BCN Commercial	$104.58
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cash Price	$138.40
Rate for Payer: Mclaren Medicaid	$44.73
Rate for Payer: Meridian Medicaid	$46.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$129.75
Rate for Payer: Priority Health Choice Medicaid	$44.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$94.07
Rate for Payer: Priority Health Narrow/Tiered Network	$94.07
Rate for Payer: UHC Medicaid	$44.73
Rate for Payer: UHCCP Medicaid	$44.73

PR IPRATROPIUM BROMIDE NON-COMP

Professional

Both

$4.00

Service Code	HCPCS J7644
Min. Negotiated Rate	$0.09
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$0.33
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: BCN Commercial	$0.09
Rate for Payer: Cash Price	$3.20
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR IR DEEP HEAT PAIN RELIEF 15MIN

Professional

Both

$53.00

Hospital Revenue Code	990
Min. Negotiated Rate	$21.20
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna Medicare	$26.50
Rate for Payer: BCBS Complete	$21.20
Rate for Payer: Cash Price	$42.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.75

PR IRRIGAJ IMPLNTD VENOUS ACCESS DRUG DELIVERY SYST

Professional

Both

$48.00

Service Code	HCPCS 96523
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$36.00
Rate for Payer: Aetna Commercial	$33.19
Rate for Payer: Aetna Medicare	$24.00
Rate for Payer: BCN Commercial	$35.86
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$33.07
Rate for Payer: Priority Health Narrow/Tiered Network	$33.07

PR IRRIGATION CORPORA CAVERNOSA PRIAPISM

Professional

Both

$461.00

Service Code	HCPCS 54220
Min. Negotiated Rate	$82.64
Max. Negotiated Rate	$345.75
Rate for Payer: Aetna Commercial	$171.63
Rate for Payer: Aetna Medicare	$230.50
Rate for Payer: BCBS Complete	$86.77
Rate for Payer: BCN Commercial	$200.69
Rate for Payer: Cash Price	$368.80
Rate for Payer: Cash Price	$368.80
Rate for Payer: Mclaren Medicaid	$82.64
Rate for Payer: Meridian Medicaid	$86.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$345.75
Rate for Payer: Priority Health Choice Medicaid	$82.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$218.62
Rate for Payer: Priority Health Narrow/Tiered Network	$218.62
Rate for Payer: UHC Medicaid	$82.64
Rate for Payer: UHCCP Medicaid	$82.64

PR IRRIGATION TRAY

Professional

Both

$10.00

Service Code	HCPCS A4320
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$4.58
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: BCN Commercial	$6.71
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50

PR IRRIGATION VAGINA&/APPL MEDICAMENT TX DISEASE

Professional

Both

$124.00

Service Code	HCPCS 57150
Min. Negotiated Rate	$31.87
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$31.87
Rate for Payer: Aetna Medicare	$62.00
Rate for Payer: BCBS Complete	$49.60
Rate for Payer: BCN Commercial	$37.85
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$99.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$93.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$38.33
Rate for Payer: Priority Health Narrow/Tiered Network	$38.33

PR IV DOP VEL&/PRESS C/FLO RSRV MEAS 1ST VESSEL

Professional

Both

$206.00

Service Code	HCPCS 93571
Min. Negotiated Rate	$103.00
Max. Negotiated Rate	$285.40
Rate for Payer: Aetna Commercial	$267.31
Rate for Payer: Aetna Commercial	$267.31
Rate for Payer: Aetna Medicare	$184.00
Rate for Payer: Aetna Medicare	$103.00
Rate for Payer: BCN Commercial	$105.08
Rate for Payer: BCN Commercial	$105.08
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cash Price	$294.40
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cash Price	$294.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$154.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$276.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$285.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$285.40
Rate for Payer: Priority Health Narrow/Tiered Network	$285.40
Rate for Payer: Priority Health Narrow/Tiered Network	$285.40

PR IV DOP VEL&/PRESS C/FLO RSRV MEAS EA ADDL VSL

Professional

Both

$289.00

Service Code	HCPCS 93572
Min. Negotiated Rate	$76.20
Max. Negotiated Rate	$216.75
Rate for Payer: Aetna Commercial	$145.84
Rate for Payer: Aetna Medicare	$144.50
Rate for Payer: BCN Commercial	$76.20
Rate for Payer: Cash Price	$231.20
Rate for Payer: Cash Price	$231.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$216.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$154.30
Rate for Payer: Priority Health Narrow/Tiered Network	$154.30

PR IV INFUSION HYDRATION EACH ADDITIONAL HOUR

Professional

Both

$31.00

Service Code	HCPCS 96361
Min. Negotiated Rate	$14.58
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna Commercial	$14.58
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCN Commercial	$17.92
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$23.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$16.53
Rate for Payer: Priority Health Narrow/Tiered Network	$16.53

PR IV INFUSION HYDRATION INITIAL 31 MIN-1 HOUR

Professional

Both

$112.00

Service Code	HCPCS 96360
Min. Negotiated Rate	$37.67
Max. Negotiated Rate	$84.00
Rate for Payer: Aetna Commercial	$37.67
Rate for Payer: Aetna Medicare	$56.00
Rate for Payer: BCN Commercial	$46.31
Rate for Payer: Cash Price	$89.60
Rate for Payer: Cash Price	$89.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$84.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$42.71
Rate for Payer: Priority Health Narrow/Tiered Network	$42.71

Know your out-of-pocket cost for care.

All Charges