Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR NASO/ORO-GASTRIC TUBE PLMT REQ PHYS&FLUOR GDNCE

Professional

Both

$123.00

Service Code	HCPCS 43752
Min. Negotiated Rate	$21.94
Max. Negotiated Rate	$92.25
Rate for Payer: Aetna Commercial	$54.32
Rate for Payer: Aetna Medicare	$61.50
Rate for Payer: BCBS Complete	$23.04
Rate for Payer: BCN Commercial	$59.26
Rate for Payer: Cash Price	$98.40
Rate for Payer: Cash Price	$98.40
Rate for Payer: Mclaren Medicaid	$21.94
Rate for Payer: Meridian Medicaid	$23.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$92.25
Rate for Payer: Priority Health Choice Medicaid	$21.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$72.20
Rate for Payer: Priority Health Narrow/Tiered Network	$72.20
Rate for Payer: UHC Medicaid	$21.94
Rate for Payer: UHCCP Medicaid	$21.94

PR NASOPHARYNGOSCOPY W/ENDOSCOPE SPX

Professional

Both

$238.00

Service Code	HCPCS 92511
Min. Negotiated Rate	$20.87
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Commercial	$40.68
Rate for Payer: Aetna Medicare	$119.00
Rate for Payer: BCBS Complete	$21.91
Rate for Payer: BCN Commercial	$44.77
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cash Price	$190.40
Rate for Payer: Mclaren Medicaid	$20.87
Rate for Payer: Meridian Medicaid	$21.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$178.50
Rate for Payer: Priority Health Choice Medicaid	$20.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$52.36
Rate for Payer: Priority Health Narrow/Tiered Network	$52.36
Rate for Payer: UHC Medicaid	$20.87
Rate for Payer: UHCCP Medicaid	$20.87

PR NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS

Professional

Both

$221.00

Service Code	HCPCS 95860
Min. Negotiated Rate	$110.50
Max. Negotiated Rate	$165.75
Rate for Payer: Aetna Commercial	$127.72
Rate for Payer: Aetna Medicare	$110.50
Rate for Payer: BCN Commercial	$164.83
Rate for Payer: Cash Price	$176.80
Rate for Payer: Cash Price	$176.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$165.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$152.01
Rate for Payer: Priority Health Narrow/Tiered Network	$152.01

PR NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS

Professional

Both

$305.00

Service Code	HCPCS 95861
Min. Negotiated Rate	$152.50
Max. Negotiated Rate	$230.07
Rate for Payer: Aetna Commercial	$184.98
Rate for Payer: Aetna Medicare	$152.50
Rate for Payer: BCN Commercial	$230.07
Rate for Payer: Cash Price	$244.00
Rate for Payer: Cash Price	$244.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$228.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$212.17
Rate for Payer: Priority Health Narrow/Tiered Network	$212.17

PR NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS

Professional

Both

$372.00

Service Code	HCPCS 95863
Min. Negotiated Rate	$186.00
Max. Negotiated Rate	$312.73
Rate for Payer: Aetna Commercial	$240.60
Rate for Payer: Aetna Medicare	$186.00
Rate for Payer: BCN Commercial	$312.73
Rate for Payer: Cash Price	$297.60
Rate for Payer: Cash Price	$297.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$279.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$288.41
Rate for Payer: Priority Health Narrow/Tiered Network	$288.41

PR NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS

Professional

Both

$425.00

Service Code	HCPCS 95864
Min. Negotiated Rate	$212.50
Max. Negotiated Rate	$330.66
Rate for Payer: Aetna Commercial	$268.89
Rate for Payer: Aetna Medicare	$212.50
Rate for Payer: BCN Commercial	$330.66
Rate for Payer: Cash Price	$340.00
Rate for Payer: Cash Price	$340.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$318.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$304.94
Rate for Payer: Priority Health Narrow/Tiered Network	$304.94

PR NDL OCULOELECTROMYOGRAPHY 1+EO MUSC 1/BOTH EYE

Professional

Both

$76.00

Service Code	HCPCS 92265
Min. Negotiated Rate	$38.00
Max. Negotiated Rate	$129.97
Rate for Payer: Aetna Commercial	$91.63
Rate for Payer: Aetna Medicare	$38.00
Rate for Payer: BCN Commercial	$129.97
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cash Price	$60.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$57.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$111.21
Rate for Payer: Priority Health Narrow/Tiered Network	$111.21

PR NDSC EVAL INTSTINAL POUCH DX W/COLLJ SPEC SPX

Professional

Both

$899.00

Service Code	HCPCS 44385
Min. Negotiated Rate	$43.03
Max. Negotiated Rate	$674.25
Rate for Payer: Aetna Commercial	$95.20
Rate for Payer: Aetna Medicare	$449.50
Rate for Payer: BCBS Complete	$45.18
Rate for Payer: BCN Commercial	$108.06
Rate for Payer: Cash Price	$719.20
Rate for Payer: Cash Price	$719.20
Rate for Payer: Mclaren Medicaid	$43.03
Rate for Payer: Meridian Medicaid	$45.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$674.25
Rate for Payer: Priority Health Choice Medicaid	$43.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$131.66
Rate for Payer: Priority Health Narrow/Tiered Network	$131.66
Rate for Payer: UHC Medicaid	$43.03
Rate for Payer: UHCCP Medicaid	$43.03

PR NDSC EVAL INTSTINAL POUCH W/BX SINGLE/MULTIPLE

Professional

Both

$1,069.00

Service Code	HCPCS 44386
Min. Negotiated Rate	$51.76
Max. Negotiated Rate	$801.75
Rate for Payer: Aetna Commercial	$117.55
Rate for Payer: Aetna Medicare	$534.50
Rate for Payer: BCBS Complete	$54.35
Rate for Payer: BCN Commercial	$131.97
Rate for Payer: Cash Price	$855.20
Rate for Payer: Cash Price	$855.20
Rate for Payer: Mclaren Medicaid	$51.76
Rate for Payer: Meridian Medicaid	$54.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$801.75
Rate for Payer: Priority Health Choice Medicaid	$51.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$160.79
Rate for Payer: Priority Health Narrow/Tiered Network	$160.79
Rate for Payer: UHC Medicaid	$51.76
Rate for Payer: UHCCP Medicaid	$51.76

PR NDSC NJX IMPLT MATRL URT&/BLDR NCK

Professional

Both

$1,801.00

Service Code	HCPCS 51715
Min. Negotiated Rate	$112.46
Max. Negotiated Rate	$1,350.75
Rate for Payer: Aetna Commercial	$257.04
Rate for Payer: Aetna Medicare	$900.50
Rate for Payer: BCBS Complete	$118.08
Rate for Payer: BCN Commercial	$296.30
Rate for Payer: Cash Price	$1,440.80
Rate for Payer: Cash Price	$1,440.80
Rate for Payer: Mclaren Medicaid	$112.46
Rate for Payer: Meridian Medicaid	$118.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,350.75
Rate for Payer: Priority Health Choice Medicaid	$112.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$322.76
Rate for Payer: Priority Health Narrow/Tiered Network	$322.76
Rate for Payer: UHC Medicaid	$112.46
Rate for Payer: UHCCP Medicaid	$112.46

PR NDSC SURG W/VIDEO-ASSISTED HARVEST VEIN CABG

Professional

Both

$352.00

Service Code	HCPCS 33508
Min. Negotiated Rate	$9.16
Max. Negotiated Rate	$264.00
Rate for Payer: Aetna Commercial	$21.23
Rate for Payer: Aetna Medicare	$176.00
Rate for Payer: BCBS Complete	$9.62
Rate for Payer: BCN Commercial	$23.40
Rate for Payer: Cash Price	$281.60
Rate for Payer: Cash Price	$281.60
Rate for Payer: Mclaren Medicaid	$9.16
Rate for Payer: Meridian Medicaid	$9.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$264.00
Rate for Payer: Priority Health Choice Medicaid	$9.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$25.16
Rate for Payer: Priority Health Narrow/Tiered Network	$25.16
Rate for Payer: UHC Medicaid	$9.16
Rate for Payer: UHCCP Medicaid	$9.16

PR NDSC URETEROTOMY RMVL FB/CALCULUS

Professional

Both

$712.00

Service Code	HCPCS 50980
Min. Negotiated Rate	$199.16
Max. Negotiated Rate	$571.75
Rate for Payer: Aetna Commercial	$455.66
Rate for Payer: Aetna Medicare	$356.00
Rate for Payer: BCBS Complete	$209.12
Rate for Payer: BCN Commercial	$524.87
Rate for Payer: Cash Price	$569.60
Rate for Payer: Cash Price	$569.60
Rate for Payer: Mclaren Medicaid	$199.16
Rate for Payer: Meridian Medicaid	$209.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$534.00
Rate for Payer: Priority Health Choice Medicaid	$199.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$571.75
Rate for Payer: Priority Health Narrow/Tiered Network	$571.75
Rate for Payer: UHC Medicaid	$199.16
Rate for Payer: UHCCP Medicaid	$199.16

PR NDSC URETEROTOMY URTRL CATHJ W/WO DILAT URETER

Professional

Both

$714.00

Service Code	HCPCS 50972
Min. Negotiated Rate	$200.43
Max. Negotiated Rate	$575.56
Rate for Payer: Aetna Commercial	$457.88
Rate for Payer: Aetna Medicare	$357.00
Rate for Payer: BCBS Complete	$210.45
Rate for Payer: BCN Commercial	$528.36
Rate for Payer: Cash Price	$571.20
Rate for Payer: Cash Price	$571.20
Rate for Payer: Mclaren Medicaid	$200.43
Rate for Payer: Meridian Medicaid	$210.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$535.50
Rate for Payer: Priority Health Choice Medicaid	$200.43
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$575.56
Rate for Payer: Priority Health Narrow/Tiered Network	$575.56
Rate for Payer: UHC Medicaid	$200.43
Rate for Payer: UHCCP Medicaid	$200.43

PR NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM

Professional

Both

$1,933.00

Service Code	HCPCS 29848
Min. Negotiated Rate	$309.70
Max. Negotiated Rate	$1,449.75
Rate for Payer: Aetna Commercial	$677.64
Rate for Payer: Aetna Medicare	$966.50
Rate for Payer: BCBS Complete	$325.19
Rate for Payer: BCN Commercial	$789.30
Rate for Payer: Cash Price	$1,546.40
Rate for Payer: Cash Price	$1,546.40
Rate for Payer: Mclaren Medicaid	$309.70
Rate for Payer: Meridian Medicaid	$325.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,449.75
Rate for Payer: Priority Health Choice Medicaid	$309.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$843.74
Rate for Payer: Priority Health Narrow/Tiered Network	$843.74
Rate for Payer: UHC Medicaid	$309.70
Rate for Payer: UHCCP Medicaid	$309.70

PR NECK LIFT

Professional

Both

$3,605.00

Hospital Revenue Code	990
Min. Negotiated Rate	$1,442.00
Max. Negotiated Rate	$2,703.75
Rate for Payer: Aetna Medicare	$1,802.50
Rate for Payer: BCBS Complete	$1,442.00
Rate for Payer: Cash Price	$2,884.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,703.75

PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI

Professional

Both

$277.00

Service Code	HCPCS 95868
Min. Negotiated Rate	$138.50
Max. Negotiated Rate	$207.75
Rate for Payer: Aetna Commercial	$157.00
Rate for Payer: Aetna Medicare	$138.50
Rate for Payer: BCN Commercial	$186.75
Rate for Payer: Cash Price	$221.60
Rate for Payer: Cash Price	$221.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$207.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$172.22
Rate for Payer: Priority Health Narrow/Tiered Network	$172.22

PR NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI

Professional

Both

$201.00

Service Code	HCPCS 95867
Min. Negotiated Rate	$100.50
Max. Negotiated Rate	$154.87
Rate for Payer: Aetna Commercial	$120.01
Rate for Payer: Aetna Medicare	$100.50
Rate for Payer: BCN Commercial	$154.87
Rate for Payer: Cash Price	$160.80
Rate for Payer: Cash Price	$160.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$150.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$142.83
Rate for Payer: Priority Health Narrow/Tiered Network	$142.83

PR NEEDLE ELECTROMYOGRAPHY HEMIDIAPHRAGM

Professional

Both

$244.00

Service Code	HCPCS 95866
Min. Negotiated Rate	$122.00
Max. Negotiated Rate	$193.71
Rate for Payer: Aetna Commercial	$146.53
Rate for Payer: Aetna Medicare	$122.00
Rate for Payer: BCN Commercial	$193.71
Rate for Payer: Cash Price	$195.20
Rate for Payer: Cash Price	$195.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$183.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$178.65
Rate for Payer: Priority Health Narrow/Tiered Network	$178.65

PR NEEDLE ELECTROMYOGRAPHY LARYNX

Professional

Both

$383.00

Service Code	HCPCS 95865
Min. Negotiated Rate	$168.68
Max. Negotiated Rate	$287.25
Rate for Payer: Aetna Commercial	$168.68
Rate for Payer: Aetna Medicare	$191.50
Rate for Payer: BCN Commercial	$217.12
Rate for Payer: Cash Price	$306.40
Rate for Payer: Cash Price	$306.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$287.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$200.23
Rate for Payer: Priority Health Narrow/Tiered Network	$200.23

PR NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED

Professional

Both

$159.00

Service Code	HCPCS 95885
Min. Negotiated Rate	$70.67
Max. Negotiated Rate	$119.25
Rate for Payer: Aetna Commercial	$70.67
Rate for Payer: Aetna Commercial	$70.67
Rate for Payer: Aetna Medicare	$79.50
Rate for Payer: Aetna Medicare	$33.00
Rate for Payer: BCN Commercial	$89.14
Rate for Payer: BCN Commercial	$89.14
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$127.20
Rate for Payer: Cash Price	$52.80
Rate for Payer: Cash Price	$127.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$119.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$49.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$82.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$82.20
Rate for Payer: Priority Health Narrow/Tiered Network	$82.20
Rate for Payer: Priority Health Narrow/Tiered Network	$82.20

PR NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE

Professional

Both

$175.00

Service Code	HCPCS 95886
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$141.11
Rate for Payer: Aetna Commercial	$109.55
Rate for Payer: Aetna Commercial	$109.55
Rate for Payer: Aetna Medicare	$87.50
Rate for Payer: Aetna Medicare	$124.50
Rate for Payer: BCN Commercial	$139.44
Rate for Payer: BCN Commercial	$139.44
Rate for Payer: Cash Price	$199.20
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$199.20
Rate for Payer: Cash Price	$140.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$131.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$186.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$141.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$141.11
Rate for Payer: Priority Health Narrow/Tiered Network	$141.11
Rate for Payer: Priority Health Narrow/Tiered Network	$141.11

PR NEEDLE EMG GUID W/CHEMODENERVATION

Professional

Both

$130.00

Service Code	HCPCS 95874
Min. Negotiated Rate	$65.00
Max. Negotiated Rate	$109.55
Rate for Payer: Aetna Commercial	$87.83
Rate for Payer: Aetna Medicare	$65.00
Rate for Payer: BCN Commercial	$109.55
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$97.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$101.03
Rate for Payer: Priority Health Narrow/Tiered Network	$101.03

PR NEEDLE EMG LMTD STD MUSC 1 XTR/NON-LIMB UNI/BI

Professional

Both

$158.00

Service Code	HCPCS 95870
Min. Negotiated Rate	$79.00
Max. Negotiated Rate	$119.51
Rate for Payer: Aetna Commercial	$96.78
Rate for Payer: Aetna Medicare	$79.00
Rate for Payer: BCN Commercial	$119.51
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$110.22
Rate for Payer: Priority Health Narrow/Tiered Network	$110.22

PR NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION

Professional

Both

$138.00

Service Code	HCPCS 95887
Min. Negotiated Rate	$69.00
Max. Negotiated Rate	$121.50
Rate for Payer: Aetna Commercial	$94.79
Rate for Payer: Aetna Commercial	$94.79
Rate for Payer: Aetna Medicare	$69.00
Rate for Payer: Aetna Medicare	$140.00
Rate for Payer: BCN Commercial	$121.50
Rate for Payer: BCN Commercial	$121.50
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cash Price	$110.40
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cash Price	$110.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$103.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$210.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$112.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$112.06
Rate for Payer: Priority Health Narrow/Tiered Network	$112.06
Rate for Payer: Priority Health Narrow/Tiered Network	$112.06

PR NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12

Professional

Both

$150.00

Service Code	HCPCS 95869
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$135.45
Rate for Payer: Aetna Commercial	$108.17
Rate for Payer: Aetna Medicare	$75.00
Rate for Payer: BCN Commercial	$135.45
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$112.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$124.91
Rate for Payer: Priority Health Narrow/Tiered Network	$124.91

Know your out-of-pocket cost for care.

All Charges