Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR PERQ TRLUML C ANGIOPLASTY 1 MAJ C ART&/BRANCHES

Professional

Both

$1,153.00

Service Code	HCPCS 92920
Min. Negotiated Rate	$246.87
Max. Negotiated Rate	$864.75
Rate for Payer: Aetna Commercial	$590.08
Rate for Payer: Aetna Medicare	$576.50
Rate for Payer: BCBS Complete	$259.21
Rate for Payer: BCN Commercial	$771.38
Rate for Payer: Cash Price	$922.40
Rate for Payer: Cash Price	$922.40
Rate for Payer: Mclaren Medicaid	$246.87
Rate for Payer: Meridian Medicaid	$259.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$864.75
Rate for Payer: Priority Health Choice Medicaid	$246.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$733.15
Rate for Payer: Priority Health Narrow/Tiered Network	$733.15
Rate for Payer: UHC Medicaid	$246.87
Rate for Payer: UHCCP Medicaid	$246.87

PR PERQ TRLUML C ATHRC ANGIOP 1 MAJ C ART&/BRANCHES

Professional

Both

$2,627.00

Service Code	HCPCS 92924
Min. Negotiated Rate	$299.27
Max. Negotiated Rate	$1,970.25
Rate for Payer: Aetna Commercial	$703.51
Rate for Payer: Aetna Medicare	$1,313.50
Rate for Payer: BCBS Complete	$314.23
Rate for Payer: BCN Commercial	$918.78
Rate for Payer: Cash Price	$2,101.60
Rate for Payer: Cash Price	$2,101.60
Rate for Payer: Mclaren Medicaid	$299.27
Rate for Payer: Meridian Medicaid	$314.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,970.25
Rate for Payer: Priority Health Choice Medicaid	$299.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$873.25
Rate for Payer: Priority Health Narrow/Tiered Network	$873.25
Rate for Payer: UHC Medicaid	$299.27
Rate for Payer: UHCCP Medicaid	$299.27

PR PERQ TRLUML C ATHRC ST ANGIOP 1 MAJ C ART&/BRNCH

Professional

Both

$1,480.00

Service Code	HCPCS 92933
Min. Negotiated Rate	$352.94
Max. Negotiated Rate	$1,110.00
Rate for Payer: Aetna Commercial	$737.15
Rate for Payer: Aetna Medicare	$740.00
Rate for Payer: BCBS Complete	$370.59
Rate for Payer: BCN Commercial	$962.10
Rate for Payer: Cash Price	$1,184.00
Rate for Payer: Cash Price	$1,184.00
Rate for Payer: Mclaren Medicaid	$352.94
Rate for Payer: Meridian Medicaid	$370.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,110.00
Rate for Payer: Priority Health Choice Medicaid	$352.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$914.42
Rate for Payer: Priority Health Narrow/Tiered Network	$914.42
Rate for Payer: UHC Medicaid	$352.94
Rate for Payer: UHCCP Medicaid	$352.94

PR PERQ TRLUML CORONARY MCHNL ASPIR THROMBECTOMY

Professional

Both

$1,077.00

Service Code	HCPCS 92973
Min. Negotiated Rate	$51.97
Max. Negotiated Rate	$807.75
Rate for Payer: Aetna Commercial	$237.55
Rate for Payer: Aetna Medicare	$538.50
Rate for Payer: BCBS Complete	$54.57
Rate for Payer: BCN Commercial	$256.46
Rate for Payer: Cash Price	$861.60
Rate for Payer: Cash Price	$861.60
Rate for Payer: Mclaren Medicaid	$51.97
Rate for Payer: Meridian Medicaid	$54.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$807.75
Rate for Payer: Priority Health Choice Medicaid	$51.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$243.75
Rate for Payer: Priority Health Narrow/Tiered Network	$243.75
Rate for Payer: UHC Medicaid	$51.97
Rate for Payer: UHCCP Medicaid	$51.97

PR PERQ TRLUML REVSC CHRNC TOT OCCLS 1 C ART ANTGRD

Professional

Both

$1,434.00

Service Code	HCPCS 92943
Min. Negotiated Rate	$404.27
Max. Negotiated Rate	$1,075.50
Rate for Payer: Aetna Commercial	$738.29
Rate for Payer: Aetna Medicare	$717.00
Rate for Payer: BCBS Complete	$424.48
Rate for Payer: BCN Commercial	$963.10
Rate for Payer: Cash Price	$1,147.20
Rate for Payer: Cash Price	$1,147.20
Rate for Payer: Mclaren Medicaid	$404.27
Rate for Payer: Meridian Medicaid	$424.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,075.50
Rate for Payer: Priority Health Choice Medicaid	$404.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$915.37
Rate for Payer: Priority Health Narrow/Tiered Network	$915.37
Rate for Payer: UHC Medicaid	$404.27
Rate for Payer: UHCCP Medicaid	$404.27

PR PERQ TRLUML REVSC OF/-CAB GRF 1 MAJ C ART&/BRNCH

Professional

Both

$1,280.00

Service Code	HCPCS 92937
Min. Negotiated Rate	$333.98
Max. Negotiated Rate	$960.00
Rate for Payer: Aetna Commercial	$655.81
Rate for Payer: Aetna Medicare	$640.00
Rate for Payer: BCBS Complete	$350.68
Rate for Payer: BCN Commercial	$856.53
Rate for Payer: Cash Price	$1,024.00
Rate for Payer: Cash Price	$1,024.00
Rate for Payer: Mclaren Medicaid	$333.98
Rate for Payer: Meridian Medicaid	$350.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$960.00
Rate for Payer: Priority Health Choice Medicaid	$333.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$814.09
Rate for Payer: Priority Health Narrow/Tiered Network	$814.09
Rate for Payer: UHC Medicaid	$333.98
Rate for Payer: UHCCP Medicaid	$333.98

PR PERQ TRLUML REVSC TOT/STOT OCCLS AMI 1MAJ C ART

Professional

Both

$1,440.00

Service Code	HCPCS 92941
Min. Negotiated Rate	$375.95
Max. Negotiated Rate	$1,080.00
Rate for Payer: Aetna Commercial	$737.52
Rate for Payer: Aetna Medicare	$720.00
Rate for Payer: BCBS Complete	$394.75
Rate for Payer: BCN Commercial	$963.10
Rate for Payer: Cash Price	$1,152.00
Rate for Payer: Cash Price	$1,152.00
Rate for Payer: Mclaren Medicaid	$375.95
Rate for Payer: Meridian Medicaid	$394.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,080.00
Rate for Payer: Priority Health Choice Medicaid	$375.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$915.37
Rate for Payer: Priority Health Narrow/Tiered Network	$915.37
Rate for Payer: UHC Medicaid	$375.95
Rate for Payer: UHCCP Medicaid	$375.95

PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION

Professional

Both

$1,592.00

Service Code	HCPCS 22513
Min. Negotiated Rate	$289.25
Max. Negotiated Rate	$1,194.00
Rate for Payer: Aetna Commercial	$684.44
Rate for Payer: Aetna Medicare	$796.00
Rate for Payer: BCBS Complete	$303.71
Rate for Payer: BCN Commercial	$759.43
Rate for Payer: Cash Price	$1,273.60
Rate for Payer: Cash Price	$1,273.60
Rate for Payer: Mclaren Medicaid	$289.25
Rate for Payer: Meridian Medicaid	$303.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,194.00
Rate for Payer: Priority Health Choice Medicaid	$289.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$811.79
Rate for Payer: Priority Health Narrow/Tiered Network	$811.79
Rate for Payer: UHC Medicaid	$289.25
Rate for Payer: UHCCP Medicaid	$289.25

PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH

Professional

Both

$830.00

Service Code	HCPCS 22515
Min. Negotiated Rate	$120.56
Max. Negotiated Rate	$622.50
Rate for Payer: Aetna Commercial	$294.64
Rate for Payer: Aetna Medicare	$415.00
Rate for Payer: BCBS Complete	$126.59
Rate for Payer: BCN Commercial	$322.69
Rate for Payer: Cash Price	$664.00
Rate for Payer: Cash Price	$664.00
Rate for Payer: Mclaren Medicaid	$120.56
Rate for Payer: Meridian Medicaid	$126.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$622.50
Rate for Payer: Priority Health Choice Medicaid	$120.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$344.96
Rate for Payer: Priority Health Narrow/Tiered Network	$344.96
Rate for Payer: UHC Medicaid	$120.56
Rate for Payer: UHCCP Medicaid	$120.56

PR PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR

Professional

Both

$1,487.00

Service Code	HCPCS 22514
Min. Negotiated Rate	$270.51
Max. Negotiated Rate	$1,115.25
Rate for Payer: Aetna Commercial	$638.90
Rate for Payer: Aetna Medicare	$743.50
Rate for Payer: BCBS Complete	$284.04
Rate for Payer: BCN Commercial	$709.63
Rate for Payer: Cash Price	$1,189.60
Rate for Payer: Cash Price	$1,189.60
Rate for Payer: Mclaren Medicaid	$270.51
Rate for Payer: Meridian Medicaid	$284.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,115.25
Rate for Payer: Priority Health Choice Medicaid	$270.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$758.57
Rate for Payer: Priority Health Narrow/Tiered Network	$758.57
Rate for Payer: UHC Medicaid	$270.51
Rate for Payer: UHCCP Medicaid	$270.51

PR PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL

Professional

Both

$1,089.00

Service Code	HCPCS 22511
Min. Negotiated Rate	$230.47
Max. Negotiated Rate	$816.75
Rate for Payer: Aetna Commercial	$541.34
Rate for Payer: Aetna Medicare	$544.50
Rate for Payer: BCBS Complete	$241.99
Rate for Payer: BCN Commercial	$606.04
Rate for Payer: Cash Price	$871.20
Rate for Payer: Cash Price	$871.20
Rate for Payer: Mclaren Medicaid	$230.47
Rate for Payer: Meridian Medicaid	$241.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$816.75
Rate for Payer: Priority Health Choice Medicaid	$230.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$647.85
Rate for Payer: Priority Health Narrow/Tiered Network	$647.85
Rate for Payer: UHC Medicaid	$230.47
Rate for Payer: UHCCP Medicaid	$230.47

PR PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC

Professional

Both

$3,524.00

Service Code	HCPCS 22510
Min. Negotiated Rate	$244.31
Max. Negotiated Rate	$2,643.00
Rate for Payer: Aetna Commercial	$576.08
Rate for Payer: Aetna Medicare	$1,762.00
Rate for Payer: BCBS Complete	$256.53
Rate for Payer: BCN Commercial	$643.39
Rate for Payer: Cash Price	$2,819.20
Rate for Payer: Cash Price	$2,819.20
Rate for Payer: Mclaren Medicaid	$244.31
Rate for Payer: Meridian Medicaid	$256.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,643.00
Rate for Payer: Priority Health Choice Medicaid	$244.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$687.77
Rate for Payer: Priority Health Narrow/Tiered Network	$687.77
Rate for Payer: UHC Medicaid	$244.31
Rate for Payer: UHCCP Medicaid	$244.31

PR PESSARY REUSABLE NONRUBBER

Professional

Both

$79.00

Service Code	HCPCS A4562
Min. Negotiated Rate	$39.50
Max. Negotiated Rate	$69.48
Rate for Payer: Aetna Commercial	$47.42
Rate for Payer: Aetna Medicare	$39.50
Rate for Payer: BCN Commercial	$69.48
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cash Price	$63.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$59.25

PR PESSARY REUSABLE RUB ANYTYPE

Professional

Both

$79.00

Service Code	HCPCS A4561
Min. Negotiated Rate	$19.09
Max. Negotiated Rate	$59.25
Rate for Payer: Aetna Commercial	$19.09
Rate for Payer: Aetna Medicare	$39.50
Rate for Payer: BCN Commercial	$27.97
Rate for Payer: Cash Price	$63.20
Rate for Payer: Cash Price	$63.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$59.25

PR PHALANGECTOMY TOE EACH TOE

Professional

Both

$874.00

Service Code	HCPCS 28150
Min. Negotiated Rate	$169.34
Max. Negotiated Rate	$655.50
Rate for Payer: Aetna Commercial	$367.96
Rate for Payer: Aetna Medicare	$437.00
Rate for Payer: BCBS Complete	$177.81
Rate for Payer: BCN Commercial	$425.77
Rate for Payer: Cash Price	$699.20
Rate for Payer: Cash Price	$699.20
Rate for Payer: Mclaren Medicaid	$169.34
Rate for Payer: Meridian Medicaid	$177.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$655.50
Rate for Payer: Priority Health Choice Medicaid	$169.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$455.14
Rate for Payer: Priority Health Narrow/Tiered Network	$455.14
Rate for Payer: UHC Medicaid	$169.34
Rate for Payer: UHCCP Medicaid	$169.34

PR PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY

Professional

Both

$88.00

Service Code	HCPCS 90863
Min. Negotiated Rate	$31.40
Max. Negotiated Rate	$66.00
Rate for Payer: Aetna Commercial	$31.40
Rate for Payer: Aetna Medicare	$44.00
Rate for Payer: BCBS Complete	$35.20
Rate for Payer: BCN Commercial	$53.43
Rate for Payer: Cash Price	$70.40
Rate for Payer: Cash Price	$70.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$36.18
Rate for Payer: Priority Health Narrow/Tiered Network	$36.18

PR PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX

Professional

Both

$1,484.00

Service Code	HCPCS 42950
Min. Negotiated Rate	$467.54
Max. Negotiated Rate	$1,451.37
Rate for Payer: Aetna Commercial	$1,064.01
Rate for Payer: Aetna Medicare	$742.00
Rate for Payer: BCBS Complete	$490.92
Rate for Payer: BCN Commercial	$1,191.17
Rate for Payer: Cash Price	$1,187.20
Rate for Payer: Cash Price	$1,187.20
Rate for Payer: Mclaren Medicaid	$467.54
Rate for Payer: Meridian Medicaid	$490.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,113.00
Rate for Payer: Priority Health Choice Medicaid	$467.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,451.37
Rate for Payer: Priority Health Narrow/Tiered Network	$1,451.37
Rate for Payer: UHC Medicaid	$467.54
Rate for Payer: UHCCP Medicaid	$467.54

PR PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE

Professional

Both

$202.00

Service Code	HCPCS 99195
Min. Negotiated Rate	$101.00
Max. Negotiated Rate	$151.50
Rate for Payer: Aetna Commercial	$110.88
Rate for Payer: Aetna Medicare	$101.00
Rate for Payer: BCN Commercial	$133.96
Rate for Payer: Cash Price	$161.60
Rate for Payer: Cash Price	$161.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$151.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$123.53
Rate for Payer: Priority Health Narrow/Tiered Network	$123.53

PR PHTFAC ARMS

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 PHTFAC CHEST/SHLD

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 PHTFAC FACE & NECK/ FL ARMS

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 PHTFAC FL LEGS

Professional

Both

$368.00

Hospital Revenue Code	990
Min. Negotiated Rate	$147.20
Max. Negotiated Rate	$276.00
Rate for Payer: Aetna Medicare	$184.00
Rate for Payer: BCBS Complete	$147.20
Rate for Payer: Cash Price	$294.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$276.00

PR PHTFAC HANDS

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 PHTFAC HEMANGIOMAS/WARTS

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 PHTFAC NASAL VEIN

Professional

Both

$47.00

Hospital Revenue Code	990
Min. Negotiated Rate	$18.80
Max. Negotiated Rate	$35.25
Rate for Payer: Aetna Medicare	$23.50
Rate for Payer: BCBS Complete	$18.80
Rate for Payer: Cash Price	$37.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$35.25

Know your out-of-pocket cost for care.

All Charges