Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR PHTFAC SNGL PIGMENT

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 PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN

Professional

Both

$56.00

Service Code	HCPCS 97750
Min. Negotiated Rate	$22.40
Max. Negotiated Rate	$89.48
Rate for Payer: Aetna Commercial	$24.69
Rate for Payer: Aetna Medicare	$28.00
Rate for Payer: BCBS Complete	$22.40
Rate for Payer: BCN Commercial	$34.38
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cash Price	$44.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$42.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.48
Rate for Payer: Priority Health Narrow/Tiered Network	$89.48

PR PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU

Professional

Both

$188.00

Service Code	HCPCS 93464
Min. Negotiated Rate	$94.00
Max. Negotiated Rate	$320.20
Rate for Payer: Aetna Commercial	$307.40
Rate for Payer: Aetna Medicare	$94.00
Rate for Payer: BCN Commercial	$320.20
Rate for Payer: Cash Price	$150.40
Rate for Payer: Cash Price	$150.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$141.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$304.34
Rate for Payer: Priority Health Narrow/Tiered Network	$304.34

PR PHYSIOL SUPPORT HARVEST ORGAN FROM BRAIN-DEAD PT

Professional

Both

$7.00

Service Code	HCPCS 01990
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR PHYS/QHP ATTN&SUPVJ HYPRBARIC OXYGEN TX/SESSION

Professional

Both

$384.00

Service Code	HCPCS 99183
Min. Negotiated Rate	$69.86
Max. Negotiated Rate	$288.00
Rate for Payer: Aetna Commercial	$120.18
Rate for Payer: Aetna Medicare	$192.00
Rate for Payer: BCBS Complete	$73.35
Rate for Payer: BCN Commercial	$157.36
Rate for Payer: Cash Price	$307.20
Rate for Payer: Cash Price	$307.20
Rate for Payer: Mclaren Medicaid	$69.86
Rate for Payer: Meridian Medicaid	$73.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$288.00
Rate for Payer: Priority Health Choice Medicaid	$69.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$145.11
Rate for Payer: Priority Health Narrow/Tiered Network	$145.11
Rate for Payer: UHC Medicaid	$69.86
Rate for Payer: UHCCP Medicaid	$69.86

PR PHYS/QHP DIRECTION EMERGENCY MEDICAL SYSTEMS

Professional

Both

$258.00

Service Code	HCPCS 99288
Min. Negotiated Rate	$48.26
Max. Negotiated Rate	$193.50
Rate for Payer: Aetna Commercial	$48.75
Rate for Payer: Aetna Medicare	$129.00
Rate for Payer: BCBS Complete	$103.20
Rate for Payer: BCN Commercial	$48.26
Rate for Payer: Cash Price	$206.40
Rate for Payer: Cash Price	$206.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$193.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$72.00
Rate for Payer: Priority Health Narrow/Tiered Network	$72.00

PR PHYS/QHP EDUCATION SVCS RENDERED PTS GRP SETTING

Professional

Both

$46.00

Service Code	HCPCS 99078
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna Commercial	$25.00
Rate for Payer: Aetna Medicare	$23.00
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: BCN Commercial	$20.00
Rate for Payer: Cash Price	$36.80
Rate for Payer: Cash Price	$36.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$31.89
Rate for Payer: Priority Health Narrow/Tiered Network	$31.89

PR PHYS/QHP ONLINE EVALUATION & MANAGEMENT SERVICE

Professional

Both

$52.00

Service Code	HCPCS 99444
Min. Negotiated Rate	$20.80
Max. Negotiated Rate	$39.00
Rate for Payer: Aetna Medicare	$26.00
Rate for Payer: BCBS Complete	$20.80
Rate for Payer: Cash Price	$41.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.00

PR PHYS/QHP O/P CARDIAC RHAB W/O CONT ECG MONITOR

Professional

Both

$34.00

Service Code	HCPCS 93797
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$10.29
Rate for Payer: Aetna Medicare	$17.00
Rate for Payer: BCBS Complete	$5.14
Rate for Payer: BCN Commercial	$12.45
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$27.20
Rate for Payer: Mclaren Medicaid	$4.90
Rate for Payer: Meridian Medicaid	$5.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$25.50
Rate for Payer: Priority Health Choice Medicaid	$4.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$11.84
Rate for Payer: Priority Health Narrow/Tiered Network	$11.84
Rate for Payer: UHC Medicaid	$4.90
Rate for Payer: UHCCP Medicaid	$4.90

PR PHYS/QHP TELEPHONE EVALUATION 11-20 MIN

Professional

Both

$153.00

Service Code	HCPCS 99442
Min. Negotiated Rate	$37.41
Max. Negotiated Rate	$114.75
Rate for Payer: Aetna Commercial	$67.27
Rate for Payer: Aetna Medicare	$76.50
Rate for Payer: BCBS Complete	$61.20
Rate for Payer: BCN Commercial	$37.41
Rate for Payer: Cash Price	$122.40
Rate for Payer: Cash Price	$122.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$114.75

PR PHYS/QHP TELEPHONE EVALUATION 21-30 MIN

Professional

Both

$222.00

Service Code	HCPCS 99443
Min. Negotiated Rate	$55.60
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna Commercial	$99.17
Rate for Payer: Aetna Medicare	$111.00
Rate for Payer: BCBS Complete	$88.80
Rate for Payer: BCN Commercial	$55.60
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cash Price	$177.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$166.50

PR PHYS/QHP TELEPHONE EVALUATION 5-10 MIN

Professional

Both

$93.00

Service Code	HCPCS 99441
Min. Negotiated Rate	$18.69
Max. Negotiated Rate	$69.75
Rate for Payer: Aetna Commercial	$35.71
Rate for Payer: Aetna Medicare	$46.50
Rate for Payer: BCBS Complete	$37.20
Rate for Payer: BCN Commercial	$18.69
Rate for Payer: Cash Price	$74.40
Rate for Payer: Cash Price	$74.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$69.75

PR PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MINUTES

Professional

Both

$269.00

Service Code	HCPCS 99360
Min. Negotiated Rate	$60.51
Max. Negotiated Rate	$201.75
Rate for Payer: Aetna Commercial	$60.51
Rate for Payer: Aetna Medicare	$134.50
Rate for Payer: BCBS Complete	$107.60
Rate for Payer: BCN Commercial	$86.15
Rate for Payer: Cash Price	$215.20
Rate for Payer: Cash Price	$215.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$201.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$77.49
Rate for Payer: Priority Health Narrow/Tiered Network	$77.49

PR PINCH GRAFT 1/MLT SM ULCER TIP/OTH AR UP TO 2 CM

Professional

Both

$945.00

Service Code	HCPCS 15050
Min. Negotiated Rate	$273.28
Max. Negotiated Rate	$708.75
Rate for Payer: Aetna Commercial	$494.38
Rate for Payer: Aetna Medicare	$472.50
Rate for Payer: BCBS Complete	$286.94
Rate for Payer: BCN Commercial	$694.69
Rate for Payer: Cash Price	$756.00
Rate for Payer: Cash Price	$756.00
Rate for Payer: Mclaren Medicaid	$273.28
Rate for Payer: Meridian Medicaid	$286.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$708.75
Rate for Payer: Priority Health Choice Medicaid	$273.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$635.81
Rate for Payer: Priority Health Narrow/Tiered Network	$635.81
Rate for Payer: UHC Medicaid	$273.28
Rate for Payer: UHCCP Medicaid	$273.28

PR PLACE CATH BRACHIAL ART

Professional

Both

$784.00

Service Code	HCPCS 36120
Min. Negotiated Rate	$313.60
Max. Negotiated Rate	$588.00
Rate for Payer: Aetna Medicare	$392.00
Rate for Payer: BCBS Complete	$313.60
Rate for Payer: Cash Price	$627.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$588.00

PR PLACE DRAIN PERIPANCREATIC ACUTE PANCREATITIS

Professional

Both

$3,381.00

Service Code	HCPCS 48000
Min. Negotiated Rate	$1,113.99
Max. Negotiated Rate	$3,435.46
Rate for Payer: Aetna Commercial	$2,551.38
Rate for Payer: Aetna Medicare	$1,690.50
Rate for Payer: BCBS Complete	$1,169.69
Rate for Payer: BCN Commercial	$2,819.57
Rate for Payer: Cash Price	$2,704.80
Rate for Payer: Cash Price	$2,704.80
Rate for Payer: Mclaren Medicaid	$1,113.99
Rate for Payer: Meridian Medicaid	$1,169.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,535.75
Rate for Payer: Priority Health Choice Medicaid	$1,113.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,435.46
Rate for Payer: Priority Health Narrow/Tiered Network	$3,435.46
Rate for Payer: UHC Medicaid	$1,113.99
Rate for Payer: UHCCP Medicaid	$1,113.99

PR PLACEMENT CHOLEDOCHAL STENT

Professional

Both

$2,623.00

Service Code	HCPCS 47801
Min. Negotiated Rate	$661.79
Max. Negotiated Rate	$2,027.78
Rate for Payer: Aetna Commercial	$1,511.06
Rate for Payer: Aetna Medicare	$1,311.50
Rate for Payer: BCBS Complete	$694.88
Rate for Payer: BCN Commercial	$1,664.25
Rate for Payer: Cash Price	$2,098.40
Rate for Payer: Cash Price	$2,098.40
Rate for Payer: Mclaren Medicaid	$661.79
Rate for Payer: Meridian Medicaid	$694.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,967.25
Rate for Payer: Priority Health Choice Medicaid	$661.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,027.78
Rate for Payer: Priority Health Narrow/Tiered Network	$2,027.78
Rate for Payer: UHC Medicaid	$661.79
Rate for Payer: UHCCP Medicaid	$661.79

PR PLACEMENT ENTEROSTOMY/CECOSTOMY TUBE OPEN

Professional

Both

$2,030.00

Service Code	HCPCS 44300
Min. Negotiated Rate	$507.79
Max. Negotiated Rate	$1,542.38
Rate for Payer: Aetna Commercial	$1,135.71
Rate for Payer: Aetna Medicare	$1,015.00
Rate for Payer: BCBS Complete	$533.18
Rate for Payer: BCN Commercial	$1,265.87
Rate for Payer: Cash Price	$1,624.00
Rate for Payer: Cash Price	$1,624.00
Rate for Payer: Mclaren Medicaid	$507.79
Rate for Payer: Meridian Medicaid	$533.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,522.50
Rate for Payer: Priority Health Choice Medicaid	$507.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,542.38
Rate for Payer: Priority Health Narrow/Tiered Network	$1,542.38
Rate for Payer: UHC Medicaid	$507.79
Rate for Payer: UHCCP Medicaid	$507.79

PR PLACEMENT NEEDLE INTRAOSSEOUS INFUSION

Professional

Both

$582.00

Service Code	HCPCS 36680
Min. Negotiated Rate	$36.85
Max. Negotiated Rate	$436.50
Rate for Payer: Aetna Commercial	$79.98
Rate for Payer: Aetna Medicare	$291.00
Rate for Payer: BCBS Complete	$38.69
Rate for Payer: BCN Commercial	$88.64
Rate for Payer: Cash Price	$465.60
Rate for Payer: Cash Price	$465.60
Rate for Payer: Mclaren Medicaid	$36.85
Rate for Payer: Meridian Medicaid	$38.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$436.50
Rate for Payer: Priority Health Choice Medicaid	$36.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$95.33
Rate for Payer: Priority Health Narrow/Tiered Network	$95.33
Rate for Payer: UHC Medicaid	$36.85
Rate for Payer: UHCCP Medicaid	$36.85

PR PLACEMENT SETON

Professional

Both

$402.00

Service Code	HCPCS 46020
Min. Negotiated Rate	$70.72
Max. Negotiated Rate	$315.96
Rate for Payer: Aetna Commercial	$315.96
Rate for Payer: Aetna Medicare	$201.00
Rate for Payer: BCBS Complete	$74.26
Rate for Payer: BCN Commercial	$175.79
Rate for Payer: Cash Price	$321.60
Rate for Payer: Cash Price	$321.60
Rate for Payer: Mclaren Medicaid	$70.72
Rate for Payer: Meridian Medicaid	$74.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$301.50
Rate for Payer: Priority Health Choice Medicaid	$70.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$214.18
Rate for Payer: Priority Health Narrow/Tiered Network	$214.18
Rate for Payer: UHC Medicaid	$70.72
Rate for Payer: UHCCP Medicaid	$70.72

PR PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR

Professional

Both

$701.00

Service Code	HCPCS 34709
Min. Negotiated Rate	$184.03
Max. Negotiated Rate	$525.75
Rate for Payer: Aetna Commercial	$435.90
Rate for Payer: Aetna Medicare	$350.50
Rate for Payer: BCBS Complete	$193.23
Rate for Payer: BCN Commercial	$468.10
Rate for Payer: Cash Price	$560.80
Rate for Payer: Cash Price	$560.80
Rate for Payer: Mclaren Medicaid	$184.03
Rate for Payer: Meridian Medicaid	$193.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$525.75
Rate for Payer: Priority Health Choice Medicaid	$184.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$503.39
Rate for Payer: Priority Health Narrow/Tiered Network	$503.39
Rate for Payer: UHC Medicaid	$184.03
Rate for Payer: UHCCP Medicaid	$184.03

PR PLACE NEEDLE/CATH A-V DIALYSIS SHUNT,1ST ACCESS W/ RAD EVAL

Professional

Both

$1,555.00

Service Code	HCPCS 36147
Min. Negotiated Rate	$622.00
Max. Negotiated Rate	$1,166.25
Rate for Payer: Aetna Medicare	$777.50
Rate for Payer: BCBS Complete	$622.00
Rate for Payer: Cash Price	$1,244.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,166.25

PR PLACE NEEDLE/CATH A-V DIALYSIS SHUNT,ADDL ACCESS FOR THERAPY

Professional

Both

$693.00

Service Code	HCPCS 36148
Min. Negotiated Rate	$277.20
Max. Negotiated Rate	$519.75
Rate for Payer: Aetna Medicare	$346.50
Rate for Payer: BCBS Complete	$277.20
Rate for Payer: Cash Price	$554.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$519.75

PR PLASTIC OPERATION PENIS INJURY

Professional

Both

$2,042.00

Service Code	HCPCS 54440
Min. Negotiated Rate	$711.74
Max. Negotiated Rate	$3,224.79
Rate for Payer: Aetna Commercial	$711.74
Rate for Payer: Aetna Medicare	$1,021.00
Rate for Payer: BCBS Complete	$777.06
Rate for Payer: BCN Commercial	$3,224.79
Rate for Payer: Cash Price	$1,633.60
Rate for Payer: Cash Price	$1,633.60
Rate for Payer: Mclaren Medicaid	$740.06
Rate for Payer: Meridian Medicaid	$777.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,531.50
Rate for Payer: Priority Health Choice Medicaid	$740.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$915.14
Rate for Payer: Priority Health Narrow/Tiered Network	$915.14
Rate for Payer: UHC Medicaid	$740.06
Rate for Payer: UHCCP Medicaid	$740.06

PR PLASTIC REPAIR INTROITUS

Professional

Both

$926.00

Service Code	HCPCS 56800
Min. Negotiated Rate	$144.84
Max. Negotiated Rate	$694.50
Rate for Payer: Aetna Commercial	$298.27
Rate for Payer: Aetna Medicare	$463.00
Rate for Payer: BCBS Complete	$152.08
Rate for Payer: BCN Commercial	$381.45
Rate for Payer: Cash Price	$740.80
Rate for Payer: Cash Price	$740.80
Rate for Payer: Mclaren Medicaid	$144.84
Rate for Payer: Meridian Medicaid	$152.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$694.50
Rate for Payer: Priority Health Choice Medicaid	$144.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$386.32
Rate for Payer: Priority Health Narrow/Tiered Network	$386.32
Rate for Payer: UHC Medicaid	$144.84
Rate for Payer: UHCCP Medicaid	$144.84

Know your out-of-pocket cost for care.

All Charges