Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR MAXILLECTOMY W/O ORBITAL EXENTERATION

Professional

Both

$3,403.00

Service Code	HCPCS 31225
Min. Negotiated Rate	$1,006.00
Max. Negotiated Rate	$2,692.58
Rate for Payer: Aetna Commercial	$2,328.96
Rate for Payer: Aetna Medicare	$1,701.50
Rate for Payer: BCBS Complete	$1,056.30
Rate for Payer: BCN Commercial	$2,692.58
Rate for Payer: Cash Price	$2,722.40
Rate for Payer: Cash Price	$2,722.40
Rate for Payer: Mclaren Medicaid	$1,006.00
Rate for Payer: Meridian Medicaid	$1,056.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,552.25
Rate for Payer: Priority Health Choice Medicaid	$1,006.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,535.62
Rate for Payer: Priority Health Narrow/Tiered Network	$2,535.62
Rate for Payer: UHC Medicaid	$1,006.00
Rate for Payer: UHCCP Medicaid	$1,006.00

PR MCCD, INITIAL RATE

Professional

Both

$168.00

Service Code	HCPCS G9001
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$154.19
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$84.00
Rate for Payer: BCBS Complete	$67.20
Rate for Payer: BCN Commercial	$137.71
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$134.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$126.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$154.19
Rate for Payer: Priority Health Narrow/Tiered Network	$154.19

PR MCCD,MAINTENANCE RATE

Professional

Both

$84.00

Service Code	HCPCS G9002
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$76.88
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$42.00
Rate for Payer: BCBS Complete	$33.60
Rate for Payer: BCN Commercial	$68.86
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cash Price	$67.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$76.88
Rate for Payer: Priority Health Narrow/Tiered Network	$76.88

PR MCCD,PHYS COOR-CARE OVRSGHT

Professional

Both

$90.00

Service Code	HCPCS G9008
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$67.50
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$45.00
Rate for Payer: BCBS Complete	$36.00
Rate for Payer: BCN Commercial	$50.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$67.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$65.22
Rate for Payer: Priority Health Narrow/Tiered Network	$65.22

PR MCCD, SCH TEAM CONF

Professional

Both

$42.00

Service Code	HCPCS G9007
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$39.13
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$21.00
Rate for Payer: BCBS Complete	$16.80
Rate for Payer: BCN Commercial	$29.13
Rate for Payer: Cash Price	$33.60
Rate for Payer: Cash Price	$33.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$31.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$39.13
Rate for Payer: Priority Health Narrow/Tiered Network	$39.13

PR MCHNL RMVL INTRAL OBSTR CV DEV THRU DEV LUMEN

Professional

Both

$243.00

Service Code	HCPCS 36596
Min. Negotiated Rate	$26.20
Max. Negotiated Rate	$182.25
Rate for Payer: Aetna Commercial	$57.96
Rate for Payer: Aetna Medicare	$121.50
Rate for Payer: BCBS Complete	$27.51
Rate for Payer: BCN Commercial	$67.72
Rate for Payer: Cash Price	$194.40
Rate for Payer: Cash Price	$194.40
Rate for Payer: Mclaren Medicaid	$26.20
Rate for Payer: Meridian Medicaid	$27.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$182.25
Rate for Payer: Priority Health Choice Medicaid	$26.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$72.83
Rate for Payer: Priority Health Narrow/Tiered Network	$72.83
Rate for Payer: UHC Medicaid	$26.20
Rate for Payer: UHCCP Medicaid	$26.20

PR MCHNL RMVL PRICATH OBSTR CV DEV VIA VEN ACCESS

Professional

Both

$1,176.00

Service Code	HCPCS 36595
Min. Negotiated Rate	$100.54
Max. Negotiated Rate	$882.00
Rate for Payer: Aetna Commercial	$243.74
Rate for Payer: Aetna Medicare	$588.00
Rate for Payer: BCBS Complete	$105.57
Rate for Payer: BCN Commercial	$264.92
Rate for Payer: Cash Price	$940.80
Rate for Payer: Cash Price	$940.80
Rate for Payer: Mclaren Medicaid	$100.54
Rate for Payer: Meridian Medicaid	$105.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$882.00
Rate for Payer: Priority Health Choice Medicaid	$100.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$284.89
Rate for Payer: Priority Health Narrow/Tiered Network	$284.89
Rate for Payer: UHC Medicaid	$100.54
Rate for Payer: UHCCP Medicaid	$100.54

PR MD CERTIFICATION HHA PATIENT

Professional

Both

$107.00

Service Code	HCPCS G0180
Min. Negotiated Rate	$42.80
Max. Negotiated Rate	$80.25
Rate for Payer: Aetna Commercial	$51.34
Rate for Payer: Aetna Medicare	$53.50
Rate for Payer: BCBS Complete	$42.80
Rate for Payer: BCN Commercial	$80.18
Rate for Payer: Cash Price	$85.60
Rate for Payer: Cash Price	$85.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$80.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$73.94
Rate for Payer: Priority Health Narrow/Tiered Network	$73.94

PR MD INR TEST REVIE INTER MGMT

Professional

Both

$32.00

Service Code	HCPCS G0250
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$7.97
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: BCN Commercial	$12.95
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$11.64
Rate for Payer: Priority Health Narrow/Tiered Network	$11.64

PR MD RECERTIFICATION HHA PT

Professional

Both

$81.00

Service Code	HCPCS G0179
Min. Negotiated Rate	$32.40
Max. Negotiated Rate	$63.24
Rate for Payer: Aetna Commercial	$39.71
Rate for Payer: Aetna Medicare	$40.50
Rate for Payer: BCBS Complete	$32.40
Rate for Payer: BCN Commercial	$63.24
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	$58.32
Rate for Payer: Priority Health Narrow/Tiered Network	$58.32

PR MD SERVICE REQUIRED FOR PMD

Professional

Both

$30.00

Service Code	HCPCS G0372
Min. Negotiated Rate	$8.90
Max. Negotiated Rate	$22.50
Rate for Payer: Aetna Commercial	$8.90
Rate for Payer: Aetna Medicare	$15.00
Rate for Payer: BCBS Complete	$12.00
Rate for Payer: BCN Commercial	$12.95
Rate for Payer: Cash Price	$24.00
Rate for Payer: Cash Price	$24.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$22.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$11.94
Rate for Payer: Priority Health Narrow/Tiered Network	$11.94

PR MEASLES MUMPS RUBELLA VARICELLA VACC LIVE SUBQ

Professional

Both

$315.00

Service Code	HCPCS 90710
Min. Negotiated Rate	$157.50
Max. Negotiated Rate	$289.17
Rate for Payer: Aetna Commercial	$275.04
Rate for Payer: Aetna Medicare	$157.50
Rate for Payer: BCBS Trust/PPO	$289.17
Rate for Payer: BCN Commercial	$273.21
Rate for Payer: Cash Price	$252.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$236.25

PR MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ

Professional

Both

$110.00

Service Code	HCPCS 90707
Min. Negotiated Rate	$55.00
Max. Negotiated Rate	$95.20
Rate for Payer: Aetna Commercial	$94.50
Rate for Payer: Aetna Medicare	$55.00
Rate for Payer: BCBS Trust/PPO	$95.20
Rate for Payer: BCN Commercial	$93.30
Rate for Payer: Cash Price	$88.00
Rate for Payer: Cash Price	$88.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$82.50

PR MEAS POST-VOIDING RESIDUAL URINE&/BLADDER CAP

Professional

Both

$35.00

Service Code	HCPCS 51798
Min. Negotiated Rate	$12.43
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Commercial	$12.43
Rate for Payer: Aetna Medicare	$17.50
Rate for Payer: BCN Commercial	$17.43
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$18.98
Rate for Payer: Priority Health Narrow/Tiered Network	$18.98

PR MEATOTOMY CUTTING MEATUS SPX EXCEPT INFANT

Professional

Both

$352.00

Service Code	HCPCS 53020
Min. Negotiated Rate	$54.95
Max. Negotiated Rate	$264.00
Rate for Payer: Aetna Commercial	$123.91
Rate for Payer: Aetna Medicare	$176.00
Rate for Payer: BCBS Complete	$57.70
Rate for Payer: BCN Commercial	$143.92
Rate for Payer: Cash Price	$281.60
Rate for Payer: Cash Price	$281.60
Rate for Payer: Mclaren Medicaid	$54.95
Rate for Payer: Meridian Medicaid	$57.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$264.00
Rate for Payer: Priority Health Choice Medicaid	$54.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$156.77
Rate for Payer: Priority Health Narrow/Tiered Network	$156.77
Rate for Payer: UHC Medicaid	$54.95
Rate for Payer: UHCCP Medicaid	$54.95

PR MEATOTOMY CUTTING MEATUS SPX INFANT

Professional

Both

$368.00

Service Code	HCPCS 53025
Min. Negotiated Rate	$40.04
Max. Negotiated Rate	$276.00
Rate for Payer: Aetna Commercial	$86.37
Rate for Payer: Aetna Medicare	$184.00
Rate for Payer: BCBS Complete	$42.04
Rate for Payer: BCN Commercial	$103.58
Rate for Payer: Cash Price	$294.40
Rate for Payer: Cash Price	$294.40
Rate for Payer: Mclaren Medicaid	$40.04
Rate for Payer: Meridian Medicaid	$42.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$276.00
Rate for Payer: Priority Health Choice Medicaid	$40.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$112.83
Rate for Payer: Priority Health Narrow/Tiered Network	$112.83
Rate for Payer: UHC Medicaid	$40.04
Rate for Payer: UHCCP Medicaid	$40.04

PR MEDIASTINOSCOPY INCL BIOPSIES WHEN PERFORMED

Professional

Both

$2,310.00

Service Code	HCPCS 39400
Min. Negotiated Rate	$924.00
Max. Negotiated Rate	$1,732.50
Rate for Payer: Aetna Medicare	$1,155.00
Rate for Payer: BCBS Complete	$924.00
Rate for Payer: Cash Price	$1,848.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,732.50

PR MEDIASTINOSCOPY INCLUDES MEDIASTINAL MASS BIOPSY

Professional

Both

$999.00

Service Code	HCPCS 39401
Min. Negotiated Rate	$186.59
Max. Negotiated Rate	$749.25
Rate for Payer: Aetna Commercial	$314.80
Rate for Payer: Aetna Medicare	$499.50
Rate for Payer: BCBS Complete	$195.92
Rate for Payer: BCN Commercial	$457.15
Rate for Payer: Cash Price	$799.20
Rate for Payer: Cash Price	$799.20
Rate for Payer: Mclaren Medicaid	$186.59
Rate for Payer: Meridian Medicaid	$195.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$749.25
Rate for Payer: Priority Health Choice Medicaid	$186.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$491.60
Rate for Payer: Priority Health Narrow/Tiered Network	$491.60
Rate for Payer: UHC Medicaid	$186.59
Rate for Payer: UHCCP Medicaid	$186.59

PR MEDIASTINOSCOPY WITH LYMPH NODE BIOPSY/IES

Professional

Both

$870.00

Service Code	HCPCS 39402
Min. Negotiated Rate	$240.90
Max. Negotiated Rate	$652.50
Rate for Payer: Aetna Commercial	$412.59
Rate for Payer: Aetna Medicare	$435.00
Rate for Payer: BCBS Complete	$252.94
Rate for Payer: BCN Commercial	$596.08
Rate for Payer: Cash Price	$696.00
Rate for Payer: Cash Price	$696.00
Rate for Payer: Mclaren Medicaid	$240.90
Rate for Payer: Meridian Medicaid	$252.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$652.50
Rate for Payer: Priority Health Choice Medicaid	$240.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$641.02
Rate for Payer: Priority Health Narrow/Tiered Network	$641.02
Rate for Payer: UHC Medicaid	$240.90
Rate for Payer: UHCCP Medicaid	$240.90

PR MEDIAST W/EXPL DRG RMVL FB/BX CRV APPR

Professional

Both

$2,625.00

Service Code	HCPCS 39000
Min. Negotiated Rate	$313.75
Max. Negotiated Rate	$1,968.75
Rate for Payer: Aetna Commercial	$505.24
Rate for Payer: Aetna Medicare	$1,312.50
Rate for Payer: BCBS Complete	$329.44
Rate for Payer: BCN Commercial	$757.42
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Cash Price	$2,100.00
Rate for Payer: Mclaren Medicaid	$313.75
Rate for Payer: Meridian Medicaid	$329.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,968.75
Rate for Payer: Priority Health Choice Medicaid	$313.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$814.52
Rate for Payer: Priority Health Narrow/Tiered Network	$814.52
Rate for Payer: UHC Medicaid	$313.75
Rate for Payer: UHCCP Medicaid	$313.75

PR MEDIAST W/EXPL DRG RMVL FB/BX TTHRC APPR

Professional

Both

$5,404.00

Service Code	HCPCS 39010
Min. Negotiated Rate	$486.07
Max. Negotiated Rate	$4,053.00
Rate for Payer: Aetna Commercial	$804.81
Rate for Payer: Aetna Medicare	$2,702.00
Rate for Payer: BCBS Complete	$510.37
Rate for Payer: BCN Commercial	$1,175.24
Rate for Payer: Cash Price	$4,323.20
Rate for Payer: Cash Price	$4,323.20
Rate for Payer: Mclaren Medicaid	$486.07
Rate for Payer: Meridian Medicaid	$510.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,053.00
Rate for Payer: Priority Health Choice Medicaid	$486.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,263.82
Rate for Payer: Priority Health Narrow/Tiered Network	$1,263.82
Rate for Payer: UHC Medicaid	$486.07
Rate for Payer: UHCCP Medicaid	$486.07

PR MEDICAL NUTRITION ASSMT&IVNTJ INDIV EACH 15 MI

Professional

Both

$63.00

Service Code	HCPCS 97802
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$48.30
Rate for Payer: Aetna Commercial	$47.63
Rate for Payer: Aetna Medicare	$31.50
Rate for Payer: BCBS Complete	$25.20
Rate for Payer: BCN Commercial	$48.30
Rate for Payer: Cash Price	$50.40
Rate for Payer: Cash Price	$50.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$40.91
Rate for Payer: Priority Health Narrow/Tiered Network	$40.91

PR MEDICAL NUTRITION RE-ASSMT&IVNTJ INDIV EA 15 M

Professional

Both

$52.00

Service Code	HCPCS 97803
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$40.83
Rate for Payer: Aetna Commercial	$40.61
Rate for Payer: Aetna Medicare	$26.00
Rate for Payer: BCBS Complete	$20.80
Rate for Payer: BCN Commercial	$40.83
Rate for Payer: Cash Price	$41.60
Rate for Payer: Cash Price	$41.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$34.63
Rate for Payer: Priority Health Narrow/Tiered Network	$34.63

PR MEDICAL NUTRITION THERAPY GRP2/ INDIV EA 30 MI

Professional

Both

$29.00

Service Code	HCPCS 97804
Min. Negotiated Rate	$11.60
Max. Negotiated Rate	$22.91
Rate for Payer: Aetna Commercial	$22.56
Rate for Payer: Aetna Medicare	$14.50
Rate for Payer: BCBS Complete	$11.60
Rate for Payer: BCN Commercial	$22.91
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$23.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$19.57
Rate for Payer: Priority Health Narrow/Tiered Network	$19.57

PR MEDICATION ADMIN & HEMODYNAMIC MEASURMENT

Professional

Both

$338.00

Service Code	HCPCS 93463
Min. Negotiated Rate	$52.82
Max. Negotiated Rate	$253.50
Rate for Payer: Aetna Commercial	$131.17
Rate for Payer: Aetna Medicare	$169.00
Rate for Payer: BCBS Complete	$55.46
Rate for Payer: BCN Commercial	$142.92
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cash Price	$270.40
Rate for Payer: Mclaren Medicaid	$52.82
Rate for Payer: Meridian Medicaid	$55.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$253.50
Rate for Payer: Priority Health Choice Medicaid	$52.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$135.83
Rate for Payer: Priority Health Narrow/Tiered Network	$135.83
Rate for Payer: UHC Medicaid	$52.82
Rate for Payer: UHCCP Medicaid	$52.82

Know your out-of-pocket cost for care.

All Charges