Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR NORMAL SALINE SOLUTION INFUS

Professional

Both

$5.00

Service Code	HCPCS J7050
Min. Negotiated Rate	$0.38
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$0.69
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Trust/PPO	$0.41
Rate for Payer: BCN Commercial	$0.38
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 NORMAL SALINE SOLUTION INFUS

Professional

Both

$8.00

Service Code	HCPCS J7040
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Commercial	$1.39
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Trust/PPO	$0.62
Rate for Payer: BCN Commercial	$0.35
Rate for Payer: Cash Price	$6.40
Rate for Payer: Cash Price	$6.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.00

PR NQHP OL DIGITAL ASSMT&MGMT EST PT <7 D 11-20 MIN

Professional

Both

$69.00

Service Code	HCPCS 98971
Min. Negotiated Rate	$22.59
Max. Negotiated Rate	$51.75
Rate for Payer: Aetna Commercial	$22.59
Rate for Payer: Aetna Medicare	$34.50
Rate for Payer: BCBS Complete	$27.60
Rate for Payer: BCN Commercial	$32.87
Rate for Payer: Cash Price	$55.20
Rate for Payer: Cash Price	$55.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$51.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$30.31
Rate for Payer: Priority Health Narrow/Tiered Network	$30.31

PR NQHP OL DIGITAL ASSMT&MGMT EST PT <7 D 21+ MIN

Professional

Both

$96.00

Service Code	HCPCS 98972
Min. Negotiated Rate	$35.97
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna Commercial	$35.97
Rate for Payer: Aetna Medicare	$48.00
Rate for Payer: BCBS Complete	$38.40
Rate for Payer: BCN Commercial	$49.30
Rate for Payer: Cash Price	$76.80
Rate for Payer: Cash Price	$76.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$72.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$45.46
Rate for Payer: Priority Health Narrow/Tiered Network	$45.46

PR NQHP OL DIGITAL ASSMT&MGMT EST PT <7 D 5-10 MIN

Professional

Both

$36.00

Service Code	HCPCS 98970
Min. Negotiated Rate	$12.64
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$12.64
Rate for Payer: Aetna Medicare	$18.00
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: BCN Commercial	$17.43
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$16.07
Rate for Payer: Priority Health Narrow/Tiered Network	$16.07

PR NSL/SINUS NDSC MAX ANTROST W/RMVL TISS MAX SINUS

Professional

Both

$833.00

Service Code	HCPCS 31267
Min. Negotiated Rate	$142.92
Max. Negotiated Rate	$624.75
Rate for Payer: Aetna Commercial	$338.24
Rate for Payer: Aetna Medicare	$416.50
Rate for Payer: BCBS Complete	$150.07
Rate for Payer: BCN Commercial	$394.90
Rate for Payer: Cash Price	$666.40
Rate for Payer: Cash Price	$666.40
Rate for Payer: Mclaren Medicaid	$142.92
Rate for Payer: Meridian Medicaid	$150.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$624.75
Rate for Payer: Priority Health Choice Medicaid	$142.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$371.88
Rate for Payer: Priority Health Narrow/Tiered Network	$371.88
Rate for Payer: UHC Medicaid	$142.92
Rate for Payer: UHCCP Medicaid	$142.92

PR NSL/SINUS NDSC SPHENDT RMVL TISS SPHENOID SINUS

Professional

Both

$792.00

Service Code	HCPCS 31288
Min. Negotiated Rate	$126.31
Max. Negotiated Rate	$594.00
Rate for Payer: Aetna Commercial	$298.93
Rate for Payer: Aetna Medicare	$396.00
Rate for Payer: BCBS Complete	$132.63
Rate for Payer: BCN Commercial	$349.08
Rate for Payer: Cash Price	$633.60
Rate for Payer: Cash Price	$633.60
Rate for Payer: Mclaren Medicaid	$126.31
Rate for Payer: Meridian Medicaid	$132.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$594.00
Rate for Payer: Priority Health Choice Medicaid	$126.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$328.74
Rate for Payer: Priority Health Narrow/Tiered Network	$328.74
Rate for Payer: UHC Medicaid	$126.31
Rate for Payer: UHCCP Medicaid	$126.31

PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 11-20 MIN

Professional

Both

$76.00

Service Code	HCPCS 99447
Min. Negotiated Rate	$20.45
Max. Negotiated Rate	$57.00
Rate for Payer: Aetna Commercial	$35.14
Rate for Payer: Aetna Medicare	$38.00
Rate for Payer: BCBS Complete	$21.47
Rate for Payer: BCN Commercial	$53.29
Rate for Payer: Cash Price	$60.80
Rate for Payer: Cash Price	$60.80
Rate for Payer: Mclaren Medicaid	$20.45
Rate for Payer: Meridian Medicaid	$21.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$57.00
Rate for Payer: Priority Health Choice Medicaid	$20.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$40.56
Rate for Payer: Priority Health Narrow/Tiered Network	$40.56
Rate for Payer: UHC Medicaid	$20.45
Rate for Payer: UHCCP Medicaid	$20.45

PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 21-30 MIN

Professional

Both

$95.00

Service Code	HCPCS 99448
Min. Negotiated Rate	$30.46
Max. Negotiated Rate	$79.18
Rate for Payer: Aetna Commercial	$55.57
Rate for Payer: Aetna Medicare	$47.50
Rate for Payer: BCBS Complete	$31.98
Rate for Payer: BCN Commercial	$79.18
Rate for Payer: Cash Price	$76.00
Rate for Payer: Cash Price	$76.00
Rate for Payer: Mclaren Medicaid	$30.46
Rate for Payer: Meridian Medicaid	$31.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$71.25
Rate for Payer: Priority Health Choice Medicaid	$30.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$60.27
Rate for Payer: Priority Health Narrow/Tiered Network	$60.27
Rate for Payer: UHC Medicaid	$30.46
Rate for Payer: UHCCP Medicaid	$30.46

PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 31/> MIN

Professional

Both

$152.00

Service Code	HCPCS 99449
Min. Negotiated Rate	$40.47
Max. Negotiated Rate	$114.00
Rate for Payer: Aetna Commercial	$75.64
Rate for Payer: Aetna Medicare	$76.00
Rate for Payer: BCBS Complete	$42.49
Rate for Payer: BCN Commercial	$107.07
Rate for Payer: Cash Price	$121.60
Rate for Payer: Cash Price	$121.60
Rate for Payer: Mclaren Medicaid	$40.47
Rate for Payer: Meridian Medicaid	$42.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$114.00
Rate for Payer: Priority Health Choice Medicaid	$40.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$81.50
Rate for Payer: Priority Health Narrow/Tiered Network	$81.50
Rate for Payer: UHC Medicaid	$40.47
Rate for Payer: UHCCP Medicaid	$40.47

PR NTRPROF PHONE/NTRNET/EHR ASSMT&MGMT 5-10 MIN

Professional

Both

$38.00

Service Code	HCPCS 99446
Min. Negotiated Rate	$10.22
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna Commercial	$19.45
Rate for Payer: Aetna Medicare	$19.00
Rate for Payer: BCBS Complete	$10.73
Rate for Payer: BCN Commercial	$26.40
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cash Price	$30.40
Rate for Payer: Mclaren Medicaid	$10.22
Rate for Payer: Meridian Medicaid	$10.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$28.50
Rate for Payer: Priority Health Choice Medicaid	$10.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$20.09
Rate for Payer: Priority Health Narrow/Tiered Network	$20.09
Rate for Payer: UHC Medicaid	$10.22
Rate for Payer: UHCCP Medicaid	$10.22

PR NUNDSC ICRA DSJ ADS FENESTRATION SEPTUM CSTS

Professional

Both

$7,322.00

Service Code	HCPCS 62161
Min. Negotiated Rate	$958.29
Max. Negotiated Rate	$5,491.50
Rate for Payer: Aetna Commercial	$1,957.24
Rate for Payer: Aetna Medicare	$3,661.00
Rate for Payer: BCBS Complete	$1,006.20
Rate for Payer: BCN Commercial	$3,215.59
Rate for Payer: Cash Price	$5,857.60
Rate for Payer: Cash Price	$5,857.60
Rate for Payer: Mclaren Medicaid	$958.29
Rate for Payer: Meridian Medicaid	$1,006.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,491.50
Rate for Payer: Priority Health Choice Medicaid	$958.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,703.43
Rate for Payer: Priority Health Narrow/Tiered Network	$2,703.43
Rate for Payer: UHC Medicaid	$958.29
Rate for Payer: UHCCP Medicaid	$958.29

PR NUNDSC ICRA EXC PITUITRY TUM TRNSNSL/SPHENOID

Professional

Both

$2,909.00

Service Code	HCPCS 62165
Min. Negotiated Rate	$893.11
Max. Negotiated Rate	$2,665.25
Rate for Payer: Aetna Commercial	$1,955.95
Rate for Payer: Aetna Medicare	$1,454.50
Rate for Payer: BCBS Complete	$937.77
Rate for Payer: BCN Commercial	$2,294.70
Rate for Payer: Cash Price	$2,327.20
Rate for Payer: Cash Price	$2,327.20
Rate for Payer: Mclaren Medicaid	$893.11
Rate for Payer: Meridian Medicaid	$937.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,181.75
Rate for Payer: Priority Health Choice Medicaid	$893.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,665.25
Rate for Payer: Priority Health Narrow/Tiered Network	$2,665.25
Rate for Payer: UHC Medicaid	$893.11
Rate for Payer: UHCCP Medicaid	$893.11

PR NUNDSC ICRA FENESTEXC CYST W/VENTRIC CATH DRG

Professional

Both

$8,069.00

Service Code	HCPCS 62162
Min. Negotiated Rate	$1,181.94
Max. Negotiated Rate	$6,051.75
Rate for Payer: Aetna Commercial	$2,441.45
Rate for Payer: Aetna Medicare	$4,034.50
Rate for Payer: BCBS Complete	$1,241.04
Rate for Payer: BCN Commercial	$2,881.82
Rate for Payer: Cash Price	$6,455.20
Rate for Payer: Cash Price	$6,455.20
Rate for Payer: Mclaren Medicaid	$1,181.94
Rate for Payer: Meridian Medicaid	$1,241.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,051.75
Rate for Payer: Priority Health Choice Medicaid	$1,181.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,347.17
Rate for Payer: Priority Health Narrow/Tiered Network	$3,347.17
Rate for Payer: UHC Medicaid	$1,181.94
Rate for Payer: UHCCP Medicaid	$1,181.94

PR NUNDSC ICRA PLMT/RPLCMT VENTR CATH SHUNT SYS

Professional

Both

$840.00

Service Code	HCPCS 62160
Min. Negotiated Rate	$109.91
Max. Negotiated Rate	$630.00
Rate for Payer: Aetna Commercial	$245.74
Rate for Payer: Aetna Medicare	$420.00
Rate for Payer: BCBS Complete	$115.41
Rate for Payer: BCN Commercial	$390.76
Rate for Payer: Cash Price	$672.00
Rate for Payer: Cash Price	$672.00
Rate for Payer: Mclaren Medicaid	$109.91
Rate for Payer: Meridian Medicaid	$115.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$630.00
Rate for Payer: Priority Health Choice Medicaid	$109.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$328.53
Rate for Payer: Priority Health Narrow/Tiered Network	$328.53
Rate for Payer: UHC Medicaid	$109.91
Rate for Payer: UHCCP Medicaid	$109.91

PR NURSING FACILITY DSCHRG MGMT 30 MIN+ TOT TIME

Professional

Both

$163.00

Service Code	HCPCS 99316
Min. Negotiated Rate	$81.50
Max. Negotiated Rate	$193.71
Rate for Payer: Aetna Commercial	$102.91
Rate for Payer: Aetna Medicare	$81.50
Rate for Payer: BCBS Complete	$108.63
Rate for Payer: BCN Commercial	$193.71
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cash Price	$130.40
Rate for Payer: Mclaren Medicaid	$103.46
Rate for Payer: Meridian Medicaid	$108.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$122.25
Rate for Payer: Priority Health Choice Medicaid	$103.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$174.25
Rate for Payer: Priority Health Narrow/Tiered Network	$174.25
Rate for Payer: UHC Medicaid	$103.46
Rate for Payer: UHCCP Medicaid	$103.46

PR NURSING FACILITY DSCHRG MGMT 30 MIN/< TOT TIME

Professional

Both

$113.00

Service Code	HCPCS 99315
Min. Negotiated Rate	$56.50
Max. Negotiated Rate	$121.01
Rate for Payer: Aetna Commercial	$71.33
Rate for Payer: Aetna Medicare	$56.50
Rate for Payer: BCBS Complete	$67.59
Rate for Payer: BCN Commercial	$121.01
Rate for Payer: Cash Price	$90.40
Rate for Payer: Cash Price	$90.40
Rate for Payer: Mclaren Medicaid	$64.37
Rate for Payer: Meridian Medicaid	$67.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$84.75
Rate for Payer: Priority Health Choice Medicaid	$64.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$108.84
Rate for Payer: Priority Health Narrow/Tiered Network	$108.84
Rate for Payer: UHC Medicaid	$64.37
Rate for Payer: UHCCP Medicaid	$64.37

PR O2 UPTAKE EXP GAS ANALYSIS REST INDIRECT SPX

Professional

Both

$134.00

Service Code	HCPCS 94690
Min. Negotiated Rate	$45.87
Max. Negotiated Rate	$100.50
Rate for Payer: Aetna Commercial	$45.87
Rate for Payer: Aetna Medicare	$67.00
Rate for Payer: BCN Commercial	$72.21
Rate for Payer: Cash Price	$107.20
Rate for Payer: Cash Price	$107.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$100.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$66.59
Rate for Payer: Priority Health Narrow/Tiered Network	$66.59

PR O2 UPTK EXP GAS ANALYSIS REST&XERS DIRECT SIMPLE

Professional

Both

$117.00

Service Code	HCPCS 94680
Min. Negotiated Rate	$56.14
Max. Negotiated Rate	$87.75
Rate for Payer: Aetna Commercial	$56.14
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: BCN Commercial	$78.68
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$87.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$72.56
Rate for Payer: Priority Health Narrow/Tiered Network	$72.56

PR OB ANTEPARTUM CARE CESAREAN DLVR & POSTPARTUM

Professional

Both

$4,376.00

Service Code	HCPCS 59510
Min. Negotiated Rate	$2,150.00
Max. Negotiated Rate	$3,802.61
Rate for Payer: Aetna Commercial	$2,150.00
Rate for Payer: Aetna Medicare	$2,188.00
Rate for Payer: BCBS Complete	$2,465.36
Rate for Payer: BCN Commercial	$3,276.87
Rate for Payer: Cash Price	$3,500.80
Rate for Payer: Cash Price	$3,500.80
Rate for Payer: Mclaren Medicaid	$2,347.96
Rate for Payer: Meridian Medicaid	$2,465.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,282.00
Rate for Payer: Priority Health Choice Medicaid	$2,347.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,802.61
Rate for Payer: Priority Health Narrow/Tiered Network	$3,802.61
Rate for Payer: UHC Medicaid	$2,347.96
Rate for Payer: UHCCP Medicaid	$2,347.96

PR OB CARE ANTEPARTUM VAG DLVR & POSTPARTUM

Professional

Both

$3,945.00

Service Code	HCPCS 59400
Min. Negotiated Rate	$1,972.50
Max. Negotiated Rate	$3,423.23
Rate for Payer: Aetna Commercial	$2,150.00
Rate for Payer: Aetna Medicare	$1,972.50
Rate for Payer: BCBS Complete	$2,199.49
Rate for Payer: BCN Commercial	$3,276.87
Rate for Payer: Cash Price	$3,156.00
Rate for Payer: Cash Price	$3,156.00
Rate for Payer: Mclaren Medicaid	$2,094.75
Rate for Payer: Meridian Medicaid	$2,199.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,958.75
Rate for Payer: Priority Health Choice Medicaid	$2,094.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,423.23
Rate for Payer: Priority Health Narrow/Tiered Network	$3,423.23
Rate for Payer: UHC Medicaid	$2,094.75
Rate for Payer: UHCCP Medicaid	$2,094.75

PR OBLTRJ AORTOPULMONARY SEPTAL DEFECT W/O BYPASS

Professional

Both

$2,478.00

Service Code	HCPCS 33813
Min. Negotiated Rate	$991.20
Max. Negotiated Rate	$1,858.50
Rate for Payer: Aetna Commercial	$1,663.43
Rate for Payer: Aetna Medicare	$1,239.00
Rate for Payer: BCBS Complete	$991.20
Rate for Payer: BCN Commercial	$1,811.49
Rate for Payer: Cash Price	$1,982.40
Rate for Payer: Cash Price	$1,982.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,858.50

PR OBLTRJ AORTOPULMONARY SEPTAL DFCT W/CARD BYPASS

Professional

Both

$3,184.00

Service Code	HCPCS 33814
Min. Negotiated Rate	$924.42
Max. Negotiated Rate	$2,425.34
Rate for Payer: Aetna Commercial	$2,044.47
Rate for Payer: Aetna Medicare	$1,592.00
Rate for Payer: BCBS Complete	$970.64
Rate for Payer: BCN Commercial	$2,255.36
Rate for Payer: Cash Price	$2,547.20
Rate for Payer: Cash Price	$2,547.20
Rate for Payer: Mclaren Medicaid	$924.42
Rate for Payer: Meridian Medicaid	$970.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,388.00
Rate for Payer: Priority Health Choice Medicaid	$924.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,425.34
Rate for Payer: Priority Health Narrow/Tiered Network	$2,425.34
Rate for Payer: UHC Medicaid	$924.42
Rate for Payer: UHCCP Medicaid	$924.42

PR OBSERVATION CARE DISCHARGE MANAGEMENT

Professional

Both

$129.00

Service Code	HCPCS 99217
Min. Negotiated Rate	$51.60
Max. Negotiated Rate	$96.75
Rate for Payer: Aetna Medicare	$64.50
Rate for Payer: BCBS Complete	$51.60
Rate for Payer: Cash Price	$103.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$96.75

PR OBTAINING SCREEN PAP SMEAR

Professional

Both

$75.00

Service Code	HCPCS Q0091
Min. Negotiated Rate	$10.01
Max. Negotiated Rate	$56.25
Rate for Payer: Aetna Commercial	$18.73
Rate for Payer: Aetna Medicare	$37.50
Rate for Payer: BCBS Complete	$10.51
Rate for Payer: BCN Commercial	$18.70
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Mclaren Medicaid	$10.01
Rate for Payer: Meridian Medicaid	$10.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$56.25
Rate for Payer: Priority Health Choice Medicaid	$10.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$23.38
Rate for Payer: Priority Health Narrow/Tiered Network	$23.38
Rate for Payer: UHC Medicaid	$10.01
Rate for Payer: UHCCP Medicaid	$10.01

Know your out-of-pocket cost for care.

All Charges