Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR LATERAL RETINACULAR RELEASE OPEN

Professional

Both

$1,748.00

Service Code	HCPCS 27425
Min. Negotiated Rate	$282.44
Max. Negotiated Rate	$1,311.00
Rate for Payer: Aetna Commercial	$601.92
Rate for Payer: Aetna Medicare	$874.00
Rate for Payer: BCBS Complete	$296.56
Rate for Payer: BCN Commercial	$770.82
Rate for Payer: Cash Price	$1,398.40
Rate for Payer: Cash Price	$1,398.40
Rate for Payer: Mclaren Medicaid	$282.44
Rate for Payer: Meridian Medicaid	$296.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,311.00
Rate for Payer: Priority Health Choice Medicaid	$282.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$750.05
Rate for Payer: Priority Health Narrow/Tiered Network	$750.05
Rate for Payer: UHC Medicaid	$282.44
Rate for Payer: UHCCP Medicaid	$282.44

PR LATISSE

Professional

Both

$188.00

Hospital Revenue Code	990
Min. Negotiated Rate	$75.20
Max. Negotiated Rate	$141.00
Rate for Payer: Aetna Medicare	$94.00
Rate for Payer: BCBS Complete	$75.20
Rate for Payer: Cash Price	$150.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$141.00

PR LAVAGE CANNULATION MAXILLARY SINUS

Professional

Both

$301.00

Service Code	HCPCS 31000
Min. Negotiated Rate	$65.18
Max. Negotiated Rate	$225.75
Rate for Payer: Aetna Commercial	$134.27
Rate for Payer: Aetna Medicare	$150.50
Rate for Payer: BCBS Complete	$68.44
Rate for Payer: BCN Commercial	$167.32
Rate for Payer: Cash Price	$240.80
Rate for Payer: Cash Price	$240.80
Rate for Payer: Mclaren Medicaid	$65.18
Rate for Payer: Meridian Medicaid	$68.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$225.75
Rate for Payer: Priority Health Choice Medicaid	$65.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$157.56
Rate for Payer: Priority Health Narrow/Tiered Network	$157.56
Rate for Payer: UHC Medicaid	$65.18
Rate for Payer: UHCCP Medicaid	$65.18

PR LAVAGE CANNULATION SPHENOID SINUS

Professional

Both

$347.00

Service Code	HCPCS 31002
Min. Negotiated Rate	$106.71
Max. Negotiated Rate	$279.37
Rate for Payer: Aetna Commercial	$246.23
Rate for Payer: Aetna Medicare	$173.50
Rate for Payer: BCBS Complete	$112.05
Rate for Payer: BCN Commercial	$279.37
Rate for Payer: Cash Price	$277.60
Rate for Payer: Cash Price	$277.60
Rate for Payer: Mclaren Medicaid	$106.71
Rate for Payer: Meridian Medicaid	$112.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$260.25
Rate for Payer: Priority Health Choice Medicaid	$106.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$263.08
Rate for Payer: Priority Health Narrow/Tiered Network	$263.08
Rate for Payer: UHC Medicaid	$106.71
Rate for Payer: UHCCP Medicaid	$106.71

PR LEFT HEART CATH BY TRANSEPTAL PUNCTURE

Professional

Both

$455.00

Service Code	HCPCS 93462
Min. Negotiated Rate	$112.89
Max. Negotiated Rate	$341.25
Rate for Payer: Aetna Commercial	$282.18
Rate for Payer: Aetna Medicare	$227.50
Rate for Payer: BCBS Complete	$118.53
Rate for Payer: BCN Commercial	$301.78
Rate for Payer: Cash Price	$364.00
Rate for Payer: Cash Price	$364.00
Rate for Payer: Mclaren Medicaid	$112.89
Rate for Payer: Meridian Medicaid	$118.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$341.25
Rate for Payer: Priority Health Choice Medicaid	$112.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$286.82
Rate for Payer: Priority Health Narrow/Tiered Network	$286.82
Rate for Payer: UHC Medicaid	$112.89
Rate for Payer: UHCCP Medicaid	$112.89

PR LENGTHENING TENDON EXTENSOR HAND/FINGER EACH

Professional

Both

$1,388.00

Service Code	HCPCS 26476
Min. Negotiated Rate	$413.43
Max. Negotiated Rate	$1,041.00
Rate for Payer: Aetna Commercial	$846.36
Rate for Payer: Aetna Medicare	$694.00
Rate for Payer: BCBS Complete	$434.10
Rate for Payer: BCN Commercial	$970.57
Rate for Payer: Cash Price	$1,110.40
Rate for Payer: Cash Price	$1,110.40
Rate for Payer: Mclaren Medicaid	$413.43
Rate for Payer: Meridian Medicaid	$434.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,041.00
Rate for Payer: Priority Health Choice Medicaid	$413.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,037.50
Rate for Payer: Priority Health Narrow/Tiered Network	$1,037.50
Rate for Payer: UHC Medicaid	$413.43
Rate for Payer: UHCCP Medicaid	$413.43

PR LENGTHENING TENDON FLEXOR HAND/FINGER EACH

Professional

Both

$2,101.00

Service Code	HCPCS 26478
Min. Negotiated Rate	$415.14
Max. Negotiated Rate	$1,575.75
Rate for Payer: Aetna Commercial	$874.34
Rate for Payer: Aetna Medicare	$1,050.50
Rate for Payer: BCBS Complete	$435.90
Rate for Payer: BCN Commercial	$995.47
Rate for Payer: Cash Price	$1,680.80
Rate for Payer: Cash Price	$1,680.80
Rate for Payer: Mclaren Medicaid	$415.14
Rate for Payer: Meridian Medicaid	$435.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,575.75
Rate for Payer: Priority Health Choice Medicaid	$415.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,064.13
Rate for Payer: Priority Health Narrow/Tiered Network	$1,064.13
Rate for Payer: UHC Medicaid	$415.14
Rate for Payer: UHCCP Medicaid	$415.14

PR LESION <15

Professional

Both

$132.00

Hospital Revenue Code	990
Min. Negotiated Rate	$52.80
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Medicare	$66.00
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: Cash Price	$105.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$99.00

PR LESION FL FACE/NECK

Professional

Both

$263.00

Hospital Revenue Code	990
Min. Negotiated Rate	$105.20
Max. Negotiated Rate	$197.25
Rate for Payer: Aetna Medicare	$131.50
Rate for Payer: BCBS Complete	$105.20
Rate for Payer: Cash Price	$210.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$197.25

PR LESION REMOVAL COLONOSCOPY

Professional

Both

$1,632.00

Service Code	HCPCS G6024
Min. Negotiated Rate	$652.80
Max. Negotiated Rate	$1,224.00
Rate for Payer: Aetna Medicare	$816.00
Rate for Payer: BCBS Complete	$652.80
Rate for Payer: Cash Price	$1,305.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,224.00

PR LESION SINGLE

Professional

Both

$37.00

Hospital Revenue Code	990
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$27.75
Rate for Payer: Aetna Medicare	$18.50
Rate for Payer: BCBS Complete	$14.80
Rate for Payer: Cash Price	$29.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.75

PR LEUPROLIDE ACETATE /3.75 MG

Professional

Both

$1,136.00

Service Code	HCPCS J1950
Min. Negotiated Rate	$568.00
Max. Negotiated Rate	$1,611.54
Rate for Payer: Aetna Commercial	$1,611.54
Rate for Payer: Aetna Medicare	$568.00
Rate for Payer: BCBS Trust/PPO	$1,253.42
Rate for Payer: BCN Commercial	$1,186.93
Rate for Payer: Cash Price	$908.80
Rate for Payer: Cash Price	$908.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$852.00

PR LEUPROLIDE ACETATE INJECITON

Professional

Both

$39.00

Service Code	HCPCS J9218
Min. Negotiated Rate	$6.23
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna Commercial	$14.16
Rate for Payer: Aetna Medicare	$19.50
Rate for Payer: BCBS Complete	$15.60
Rate for Payer: BCBS Trust/PPO	$6.23
Rate for Payer: BCN Commercial	$23.39
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$29.25

PR LEUPROLIDE ACETATE SUSPNSION

Professional

Both

$475.00

Service Code	HCPCS J9217
Min. Negotiated Rate	$180.44
Max. Negotiated Rate	$356.25
Rate for Payer: Aetna Commercial	$186.74
Rate for Payer: Aetna Medicare	$237.50
Rate for Payer: BCBS Trust/PPO	$180.44
Rate for Payer: BCN Commercial	$182.04
Rate for Payer: Cash Price	$380.00
Rate for Payer: Cash Price	$380.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$356.25

PR LEVALBUTEROL NON-COMP UNIT

Professional

Both

$5.00

Service Code	HCPCS J7614
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$0.05
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: BCN Commercial	$0.01
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR LEVONORGESTREL IMPLANT SYS

Professional

Both

$578.00

Service Code	HCPCS J7306
Min. Negotiated Rate	$231.20
Max. Negotiated Rate	$433.50
Rate for Payer: Aetna Commercial	$406.00
Rate for Payer: Aetna Medicare	$289.00
Rate for Payer: BCBS Complete	$231.20
Rate for Payer: Cash Price	$462.40
Rate for Payer: Cash Price	$462.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$433.50

PR LEVONORGESTREL IU CONTRACEPT

Professional

Both

$864.00

Service Code	HCPCS J7302
Min. Negotiated Rate	$345.60
Max. Negotiated Rate	$648.00
Rate for Payer: Aetna Medicare	$432.00
Rate for Payer: BCBS Complete	$345.60
Rate for Payer: Cash Price	$691.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$648.00

PR L HRT CATH W/NJX L VENTRICULOGRAPHY IMG S&I

Professional

Both

$510.00

Service Code	HCPCS 93452
Min. Negotiated Rate	$255.00
Max. Negotiated Rate	$1,277.82
Rate for Payer: Aetna Commercial	$1,229.14
Rate for Payer: Aetna Medicare	$255.00
Rate for Payer: BCN Commercial	$1,277.82
Rate for Payer: Cash Price	$408.00
Rate for Payer: Cash Price	$408.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$382.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,214.50
Rate for Payer: Priority Health Narrow/Tiered Network	$1,214.50

PR LIDOCAINE INJECTION

Professional

Both

$3.00

Service Code	HCPCS J2001
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Commercial	$0.03
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: BCN Commercial	$0.01
Rate for Payer: Cash Price	$2.40
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR

Professional

Both

$2,564.00

Service Code	HCPCS 27427
Min. Negotiated Rate	$422.59
Max. Negotiated Rate	$1,923.00
Rate for Payer: Aetna Commercial	$951.25
Rate for Payer: Aetna Medicare	$1,282.00
Rate for Payer: BCBS Complete	$443.72
Rate for Payer: BCN Commercial	$1,081.11
Rate for Payer: Cash Price	$2,051.20
Rate for Payer: Cash Price	$2,051.20
Rate for Payer: Mclaren Medicaid	$422.59
Rate for Payer: Meridian Medicaid	$443.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,923.00
Rate for Payer: Priority Health Choice Medicaid	$422.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,155.68
Rate for Payer: Priority Health Narrow/Tiered Network	$1,155.68
Rate for Payer: UHC Medicaid	$422.59
Rate for Payer: UHCCP Medicaid	$422.59

PR LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR

Professional

Both

$3,344.00

Service Code	HCPCS 27428
Min. Negotiated Rate	$663.50
Max. Negotiated Rate	$2,508.00
Rate for Payer: Aetna Commercial	$1,488.41
Rate for Payer: Aetna Medicare	$1,672.00
Rate for Payer: BCBS Complete	$696.67
Rate for Payer: BCN Commercial	$1,700.11
Rate for Payer: Cash Price	$2,675.20
Rate for Payer: Cash Price	$2,675.20
Rate for Payer: Mclaren Medicaid	$663.50
Rate for Payer: Meridian Medicaid	$696.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,508.00
Rate for Payer: Priority Health Choice Medicaid	$663.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,817.37
Rate for Payer: Priority Health Narrow/Tiered Network	$1,817.37
Rate for Payer: UHC Medicaid	$663.50
Rate for Payer: UHCCP Medicaid	$663.50

PR LIGATION ARTERIES ETHMOIDAL

Professional

Both

$1,069.00

Service Code	HCPCS 30915
Min. Negotiated Rate	$344.85
Max. Negotiated Rate	$901.84
Rate for Payer: Aetna Commercial	$764.23
Rate for Payer: Aetna Medicare	$534.50
Rate for Payer: BCBS Complete	$362.09
Rate for Payer: BCN Commercial	$901.84
Rate for Payer: Cash Price	$855.20
Rate for Payer: Cash Price	$855.20
Rate for Payer: Mclaren Medicaid	$344.85
Rate for Payer: Meridian Medicaid	$362.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$801.75
Rate for Payer: Priority Health Choice Medicaid	$344.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$849.28
Rate for Payer: Priority Health Narrow/Tiered Network	$849.28
Rate for Payer: UHC Medicaid	$344.85
Rate for Payer: UHCCP Medicaid	$344.85

PR LIGATION ARTERIES INT MAXILLARY TRANSANTRAL

Professional

Both

$1,546.00

Service Code	HCPCS 30920
Min. Negotiated Rate	$494.80
Max. Negotiated Rate	$1,301.73
Rate for Payer: Aetna Commercial	$1,110.06
Rate for Payer: Aetna Medicare	$773.00
Rate for Payer: BCBS Complete	$519.54
Rate for Payer: BCN Commercial	$1,301.73
Rate for Payer: Cash Price	$1,236.80
Rate for Payer: Cash Price	$1,236.80
Rate for Payer: Mclaren Medicaid	$494.80
Rate for Payer: Meridian Medicaid	$519.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,159.50
Rate for Payer: Priority Health Choice Medicaid	$494.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,225.84
Rate for Payer: Priority Health Narrow/Tiered Network	$1,225.84
Rate for Payer: UHC Medicaid	$494.80
Rate for Payer: UHCCP Medicaid	$494.80

PR LIGATION/BIOPSY TEMPORAL ARTERY

Professional

Both

$927.00

Service Code	HCPCS 37609
Min. Negotiated Rate	$119.92
Max. Negotiated Rate	$695.25
Rate for Payer: Aetna Commercial	$272.71
Rate for Payer: Aetna Medicare	$463.50
Rate for Payer: BCBS Complete	$125.92
Rate for Payer: BCN Commercial	$303.77
Rate for Payer: Cash Price	$741.60
Rate for Payer: Cash Price	$741.60
Rate for Payer: Mclaren Medicaid	$119.92
Rate for Payer: Meridian Medicaid	$125.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$695.25
Rate for Payer: Priority Health Choice Medicaid	$119.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$326.66
Rate for Payer: Priority Health Narrow/Tiered Network	$326.66
Rate for Payer: UHC Medicaid	$119.92
Rate for Payer: UHCCP Medicaid	$119.92

PR LIGATION/BIOPSY TEMPORAL ARTERY

Facility

$927.00

Service Code	CPT 37609
Hospital Charge Code	37609
Hospital Revenue Code	960
Min. Negotiated Rate	$163.43
Max. Negotiated Rate	$834.30
Rate for Payer: Aetna Commercial	$787.95
Rate for Payer: Aetna Medicare	$241.02
Rate for Payer: Allen County Amish Medical Aid Commercial	$289.69
Rate for Payer: Amish Plain Church Group Commercial	$289.69
Rate for Payer: BCBS Complete	$171.59
Rate for Payer: BCBS MAPPO	$231.75
Rate for Payer: BCBS Trust/PPO	$762.09
Rate for Payer: BCN Commercial	$762.09
Rate for Payer: BCN Medicare Advantage	$231.75
Rate for Payer: Cash Price	$741.60
Rate for Payer: Cofinity Commercial	$797.22
Rate for Payer: Encore Health Key Benefits Commercial	$741.60
Rate for Payer: Health Alliance Plan Medicare Advantage	$231.75
Rate for Payer: Healthscope Commercial	$834.30
Rate for Payer: Lakeland Regional Health Systems Commercial	$695.25
Rate for Payer: Mclaren Medicaid	$163.43
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$243.34
Rate for Payer: Meridian Medicaid	$171.59
Rate for Payer: MI Amish Medical Board Commercial	$266.51
Rate for Payer: Molina Medicare/Medicaid	$254.93
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$787.95
Rate for Payer: Nomi Health Commercial	$760.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$695.25
Rate for Payer: PACE Senior Care Partners	$220.16
Rate for Payer: PACE SWMI	$231.75
Rate for Payer: PHP Commercial	$787.95
Rate for Payer: PHP Medicare Advantage	$231.75
Rate for Payer: Priority Health Choice Medicaid	$163.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$806.49
Rate for Payer: Priority Health Medicare	$234.07
Rate for Payer: Priority Health Narrow/Tiered Network	$645.19
Rate for Payer: Railroad Medicare Medicare	$231.75
Rate for Payer: UHC Core	$774.04
Rate for Payer: UHC Exchange	$231.75
Rate for Payer: UHC Medicaid	$163.43
Rate for Payer: UHC Medicare Advantage	$231.75
Rate for Payer: UHCCP Medicaid	$163.43
Rate for Payer: VA VA	$231.75
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$695.25

Know your out-of-pocket cost for care.

All Charges