Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR MICRONEEDLING PIN NECK

Professional

Both

$158.00

Hospital Revenue Code	990
Min. Negotiated Rate	$63.20
Max. Negotiated Rate	$118.50
Rate for Payer: Aetna Medicare	$79.00
Rate for Payer: BCBS Complete	$63.20
Rate for Payer: Cash Price	$126.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.50

PR MICRONEEDLING PIN UPPER OR LOWER FACE

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 MICRONEEDLING SCARS - UP TO 4 INCHES

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 MICRONEEDLING TAT RMVL 4-6 SQ INCHES

Professional

Both

$473.00

Hospital Revenue Code	990
Min. Negotiated Rate	$189.20
Max. Negotiated Rate	$354.75
Rate for Payer: Aetna Medicare	$236.50
Rate for Payer: BCBS Complete	$189.20
Rate for Payer: Cash Price	$378.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$354.75

PR MICRONEEDLING TAT RMVL 6-9 SQ INCHES

Professional

Both

$315.00

Hospital Revenue Code	990
Min. Negotiated Rate	$126.00
Max. Negotiated Rate	$236.25
Rate for Payer: Aetna Medicare	$157.50
Rate for Payer: BCBS Complete	$126.00
Rate for Payer: Cash Price	$252.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$236.25

PR MICRONEEDLING TAT RMVL 9-12 SQ INCHES

Professional

Both

$210.00

Hospital Revenue Code	990
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Medicare	$105.00
Rate for Payer: BCBS Complete	$84.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$157.50

PR MICRONEEDLING TAT RMVL UP TO 2 SQ INCH

Professional

Both

$158.00

Hospital Revenue Code	990
Min. Negotiated Rate	$63.20
Max. Negotiated Rate	$118.50
Rate for Payer: Aetna Medicare	$79.00
Rate for Payer: BCBS Complete	$63.20
Rate for Payer: Cash Price	$126.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.50

PR MICROSURG TQS REQ USE OPERATING MICROSCOPE

Professional

Both

$516.00

Service Code	HCPCS 69990
Min. Negotiated Rate	$126.31
Max. Negotiated Rate	$387.00
Rate for Payer: Aetna Commercial	$223.01
Rate for Payer: Aetna Medicare	$258.00
Rate for Payer: BCBS Complete	$132.63
Rate for Payer: BCN Commercial	$358.33
Rate for Payer: Cash Price	$412.80
Rate for Payer: Cash Price	$412.80
Rate for Payer: Mclaren Medicaid	$126.31
Rate for Payer: Meridian Medicaid	$132.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$387.00
Rate for Payer: Priority Health Choice Medicaid	$126.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$322.30
Rate for Payer: Priority Health Narrow/Tiered Network	$322.30
Rate for Payer: UHC Medicaid	$126.31
Rate for Payer: UHCCP Medicaid	$126.31

PR MIDDLE EAR EXPL THRU POSTAUR/EAR CANAL INC

Professional

Both

$1,755.00

Service Code	HCPCS 69440
Min. Negotiated Rate	$398.10
Max. Negotiated Rate	$1,316.25
Rate for Payer: Aetna Commercial	$785.70
Rate for Payer: Aetna Medicare	$877.50
Rate for Payer: BCBS Complete	$418.00
Rate for Payer: BCN Commercial	$1,031.31
Rate for Payer: Cash Price	$1,404.00
Rate for Payer: Cash Price	$1,404.00
Rate for Payer: Mclaren Medicaid	$398.10
Rate for Payer: Meridian Medicaid	$418.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,316.25
Rate for Payer: Priority Health Choice Medicaid	$398.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,019.05
Rate for Payer: Priority Health Narrow/Tiered Network	$1,019.05
Rate for Payer: UHC Medicaid	$398.10
Rate for Payer: UHCCP Medicaid	$398.10

PR MIDFACE FLAP W/PRESERVATION OF VASCULAR PEDICLES

Professional

Both

$3,061.00

Service Code	HCPCS 15730
Min. Negotiated Rate	$498.85
Max. Negotiated Rate	$2,295.75
Rate for Payer: Aetna Commercial	$982.33
Rate for Payer: Aetna Medicare	$1,530.50
Rate for Payer: BCBS Complete	$523.79
Rate for Payer: BCN Commercial	$1,366.96
Rate for Payer: Cash Price	$2,448.80
Rate for Payer: Cash Price	$2,448.80
Rate for Payer: Mclaren Medicaid	$498.85
Rate for Payer: Meridian Medicaid	$523.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,295.75
Rate for Payer: Priority Health Choice Medicaid	$498.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,251.12
Rate for Payer: Priority Health Narrow/Tiered Network	$1,251.12
Rate for Payer: UHC Medicaid	$498.85
Rate for Payer: UHCCP Medicaid	$498.85

PR MIRENA, 52 MG

Professional

Both

$1,516.00

Service Code	HCPCS J7298
Min. Negotiated Rate	$758.00
Max. Negotiated Rate	$1,351.89
Rate for Payer: Aetna Commercial	$1,101.70
Rate for Payer: Aetna Medicare	$758.00
Rate for Payer: BCBS Complete	$1,351.89
Rate for Payer: BCBS Trust/PPO	$1,219.54
Rate for Payer: BCN Commercial	$1,220.70
Rate for Payer: Cash Price	$1,212.80
Rate for Payer: Cash Price	$1,212.80
Rate for Payer: Mclaren Medicaid	$1,287.51
Rate for Payer: Meridian Medicaid	$1,351.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,137.00
Rate for Payer: Priority Health Choice Medicaid	$1,287.51
Rate for Payer: UHC Medicaid	$1,287.51
Rate for Payer: UHCCP Medicaid	$1,287.51

PR MISC VISION ITEM OR SERVICE

Professional

Both

$5.00

Service Code	HCPCS V2799
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR MISOPROSTOL, ORAL, 200 MCG

Professional

Both

$4.00

Service Code	HCPCS S0191
Min. Negotiated Rate	$0.50
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Commercial	$0.96
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Trust/PPO	$0.50
Rate for Payer: BCN Commercial	$0.50
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 MITOMYCIN INJECTION

Professional

Both

$158.00

Service Code	HCPCS J9280
Min. Negotiated Rate	$4.79
Max. Negotiated Rate	$118.50
Rate for Payer: Aetna Commercial	$65.25
Rate for Payer: Aetna Medicare	$79.00
Rate for Payer: BCBS Trust/PPO	$4.82
Rate for Payer: BCN Commercial	$4.79
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.50

PR MLT SLEEP LATENCY/MAINT OF WAKEFULNESS TSTG

Professional

Both

$1,025.00

Service Code	HCPCS 95805
Min. Negotiated Rate	$434.52
Max. Negotiated Rate	$768.75
Rate for Payer: Aetna Commercial	$434.52
Rate for Payer: Aetna Commercial	$434.52
Rate for Payer: Aetna Medicare	$126.00
Rate for Payer: Aetna Medicare	$512.50
Rate for Payer: BCN Commercial	$655.34
Rate for Payer: BCN Commercial	$655.34
Rate for Payer: Cash Price	$820.00
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cash Price	$820.00
Rate for Payer: Cash Price	$201.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$189.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$768.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$604.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$604.37
Rate for Payer: Priority Health Narrow/Tiered Network	$604.37
Rate for Payer: Priority Health Narrow/Tiered Network	$604.37

PR MNPJ W/ANES SHOULDER JT APPL FIXATION APPARATUS

Professional

Both

$949.00

Service Code	HCPCS 23700
Min. Negotiated Rate	$117.79
Max. Negotiated Rate	$711.75
Rate for Payer: Aetna Commercial	$259.49
Rate for Payer: Aetna Medicare	$474.50
Rate for Payer: BCBS Complete	$123.68
Rate for Payer: BCN Commercial	$299.79
Rate for Payer: Cash Price	$759.20
Rate for Payer: Cash Price	$759.20
Rate for Payer: Mclaren Medicaid	$117.79
Rate for Payer: Meridian Medicaid	$123.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$711.75
Rate for Payer: Priority Health Choice Medicaid	$117.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$320.47
Rate for Payer: Priority Health Narrow/Tiered Network	$320.47
Rate for Payer: UHC Medicaid	$117.79
Rate for Payer: UHCCP Medicaid	$117.79

PR MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME

Professional

Both

$500.00

Service Code	HCPCS 20950
Min. Negotiated Rate	$116.27
Max. Negotiated Rate	$375.00
Rate for Payer: Aetna Commercial	$116.27
Rate for Payer: Aetna Medicare	$250.00
Rate for Payer: BCBS Complete	$200.00
Rate for Payer: BCN Commercial	$133.96
Rate for Payer: Cash Price	$400.00
Rate for Payer: Cash Price	$400.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$375.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$143.19
Rate for Payer: Priority Health Narrow/Tiered Network	$143.19

PR MOBLJ SPLENIC FLXR PFRMD CONJUNCT W/PRTL COLCT

Professional

Both

$424.00

Service Code	HCPCS 44139
Min. Negotiated Rate	$68.16
Max. Negotiated Rate	$318.00
Rate for Payer: Aetna Commercial	$162.80
Rate for Payer: Aetna Medicare	$212.00
Rate for Payer: BCBS Complete	$71.57
Rate for Payer: BCN Commercial	$178.28
Rate for Payer: Cash Price	$339.20
Rate for Payer: Cash Price	$339.20
Rate for Payer: Mclaren Medicaid	$68.16
Rate for Payer: Meridian Medicaid	$71.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$318.00
Rate for Payer: Priority Health Choice Medicaid	$68.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$217.22
Rate for Payer: Priority Health Narrow/Tiered Network	$217.22
Rate for Payer: UHC Medicaid	$68.16
Rate for Payer: UHCCP Medicaid	$68.16

PR MODERATE SEDATJ DIFF PHYS/QHP 5/>YRS INIT 30 MIN

Professional

Both

$138.00

Service Code	HCPCS 99149
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 MODERATE SEDATJ DIFF PHYS/QHP EA ADDL 15 MIN

Professional

Both

$37.00

Service Code	HCPCS 99150
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 MODERATE SEDATJ SAME PHYS/QHP <5 YRS INIT 30 MIN

Professional

Both

$192.00

Service Code	HCPCS 99143
Min. Negotiated Rate	$76.80
Max. Negotiated Rate	$144.00
Rate for Payer: Aetna Medicare	$96.00
Rate for Payer: BCBS Complete	$76.80
Rate for Payer: Cash Price	$153.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$144.00

PR MODERATE SEDATJ SAME PHYS/QHP 5/>YRS INIT 30 MIN

Professional

Both

$142.00

Service Code	HCPCS 99144
Min. Negotiated Rate	$56.80
Max. Negotiated Rate	$106.50
Rate for Payer: Aetna Medicare	$71.00
Rate for Payer: BCBS Complete	$56.80
Rate for Payer: Cash Price	$113.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$106.50

PR MODERATE SEDATJ SAME PHYS/QHP EACH ADDL 15 MIN

Professional

Both

$57.00

Service Code	HCPCS 99145
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$42.75
Rate for Payer: Aetna Medicare	$28.50
Rate for Payer: BCBS Complete	$22.80
Rate for Payer: Cash Price	$45.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$42.75

PR MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS

Professional

Both

$121.00

Service Code	HCPCS 99157
Min. Negotiated Rate	$34.51
Max. Negotiated Rate	$162.49
Rate for Payer: Aetna Commercial	$69.79
Rate for Payer: Aetna Medicare	$60.50
Rate for Payer: BCBS Complete	$36.24
Rate for Payer: BCN Commercial	$93.55
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$96.80
Rate for Payer: Mclaren Medicaid	$34.51
Rate for Payer: Meridian Medicaid	$36.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$90.75
Rate for Payer: Priority Health Choice Medicaid	$34.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$162.49
Rate for Payer: Priority Health Narrow/Tiered Network	$162.49
Rate for Payer: UHC Medicaid	$34.51
Rate for Payer: UHCCP Medicaid	$34.51

PR MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS

Professional

Both

$195.00

Service Code	HCPCS 99155
Min. Negotiated Rate	$51.97
Max. Negotiated Rate	$233.76
Rate for Payer: Aetna Commercial	$93.68
Rate for Payer: Aetna Medicare	$97.50
Rate for Payer: BCBS Complete	$54.57
Rate for Payer: BCN Commercial	$134.57
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Mclaren Medicaid	$51.97
Rate for Payer: Meridian Medicaid	$54.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$146.25
Rate for Payer: Priority Health Choice Medicaid	$51.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$233.76
Rate for Payer: Priority Health Narrow/Tiered Network	$233.76
Rate for Payer: UHC Medicaid	$51.97
Rate for Payer: UHCCP Medicaid	$51.97

Know your out-of-pocket cost for care.

All Charges