Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT

Professional

Both

$579.00

Service Code	HCPCS 15002
Min. Negotiated Rate	$125.67
Max. Negotiated Rate	$434.25
Rate for Payer: Aetna Commercial	$240.02
Rate for Payer: Aetna Medicare	$289.50
Rate for Payer: BCBS Complete	$131.95
Rate for Payer: BCN Commercial	$328.67
Rate for Payer: Cash Price	$463.20
Rate for Payer: Cash Price	$463.20
Rate for Payer: Mclaren Medicaid	$125.67
Rate for Payer: Meridian Medicaid	$131.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$434.25
Rate for Payer: Priority Health Choice Medicaid	$125.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$300.82
Rate for Payer: Priority Health Narrow/Tiered Network	$300.82
Rate for Payer: UHC Medicaid	$125.67
Rate for Payer: UHCCP Medicaid	$125.67

PR PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT

Professional

Both

$132.00

Service Code	HCPCS 15003
Min. Negotiated Rate	$25.35
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Commercial	$49.66
Rate for Payer: Aetna Medicare	$66.00
Rate for Payer: BCBS Complete	$26.62
Rate for Payer: BCN Commercial	$66.24
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cash Price	$105.60
Rate for Payer: Mclaren Medicaid	$25.35
Rate for Payer: Meridian Medicaid	$26.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$99.00
Rate for Payer: Priority Health Choice Medicaid	$25.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$60.62
Rate for Payer: Priority Health Narrow/Tiered Network	$60.62
Rate for Payer: UHC Medicaid	$25.35
Rate for Payer: UHCCP Medicaid	$25.35

PR PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT

Professional

Both

$39.00

Service Code	HCPCS 94640
Min. Negotiated Rate	$11.02
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna Commercial	$14.62
Rate for Payer: Aetna Medicare	$19.50
Rate for Payer: BCN Commercial	$11.95
Rate for Payer: Cash Price	$31.20
Rate for Payer: Cash Price	$31.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$29.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$11.02
Rate for Payer: Priority Health Narrow/Tiered Network	$11.02

PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 15 MIN

Professional

Both

$68.00

Service Code	HCPCS 99401
Min. Negotiated Rate	$13.21
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$25.12
Rate for Payer: Aetna Medicare	$34.00
Rate for Payer: BCBS Complete	$13.87
Rate for Payer: BCN Commercial	$34.86
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cash Price	$54.40
Rate for Payer: Mclaren Medicaid	$13.21
Rate for Payer: Meridian Medicaid	$13.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$51.00
Rate for Payer: Priority Health Choice Medicaid	$13.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$31.35
Rate for Payer: Priority Health Narrow/Tiered Network	$31.35
Rate for Payer: UHC Medicaid	$13.21
Rate for Payer: UHCCP Medicaid	$13.21

PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 30 MIN

Professional

Both

$117.00

Service Code	HCPCS 99402
Min. Negotiated Rate	$26.84
Max. Negotiated Rate	$87.75
Rate for Payer: Aetna Commercial	$51.32
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: BCBS Complete	$28.18
Rate for Payer: BCN Commercial	$70.22
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Mclaren Medicaid	$26.84
Rate for Payer: Meridian Medicaid	$28.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$87.75
Rate for Payer: Priority Health Choice Medicaid	$26.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$63.16
Rate for Payer: Priority Health Narrow/Tiered Network	$63.16
Rate for Payer: UHC Medicaid	$26.84
Rate for Payer: UHCCP Medicaid	$26.84

PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 45 MIN

Professional

Both

$151.00

Service Code	HCPCS 99403
Min. Negotiated Rate	$39.62
Max. Negotiated Rate	$113.25
Rate for Payer: Aetna Commercial	$76.44
Rate for Payer: Aetna Medicare	$75.50
Rate for Payer: BCBS Complete	$41.60
Rate for Payer: BCN Commercial	$105.08
Rate for Payer: Cash Price	$120.80
Rate for Payer: Cash Price	$120.80
Rate for Payer: Mclaren Medicaid	$39.62
Rate for Payer: Meridian Medicaid	$41.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$113.25
Rate for Payer: Priority Health Choice Medicaid	$39.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$94.51
Rate for Payer: Priority Health Narrow/Tiered Network	$94.51
Rate for Payer: UHC Medicaid	$39.62
Rate for Payer: UHCCP Medicaid	$39.62

PR PREV MED CNSL&/RSK FCTR RDCTJ INDV APPROX 60 MIN

Professional

Both

$194.00

Service Code	HCPCS 99404
Min. Negotiated Rate	$53.04
Max. Negotiated Rate	$145.50
Rate for Payer: Aetna Commercial	$101.22
Rate for Payer: Aetna Medicare	$97.00
Rate for Payer: BCBS Complete	$55.69
Rate for Payer: BCN Commercial	$141.92
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cash Price	$155.20
Rate for Payer: Mclaren Medicaid	$53.04
Rate for Payer: Meridian Medicaid	$55.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$145.50
Rate for Payer: Priority Health Choice Medicaid	$53.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$127.67
Rate for Payer: Priority Health Narrow/Tiered Network	$127.67
Rate for Payer: UHC Medicaid	$53.04
Rate for Payer: UHCCP Medicaid	$53.04

PR PREV MED COUNSEL & RISK FACTOR REDJ GRP SPX 60 M

Professional

Both

$34.00

Service Code	HCPCS 99412
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$13.09
Rate for Payer: Aetna Medicare	$17.00
Rate for Payer: BCBS Complete	$13.60
Rate for Payer: BCN Commercial	$18.43
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$27.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$25.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$16.58
Rate for Payer: Priority Health Narrow/Tiered Network	$16.58

PR PRGRMG DEV EVAL 1 LEAD PM/LDLS PM 1 CAR CHMBR IP

Professional

Both

$173.00

Service Code	HCPCS 93279
Min. Negotiated Rate	$85.64
Max. Negotiated Rate	$129.75
Rate for Payer: Aetna Commercial	$85.64
Rate for Payer: Aetna Medicare	$86.50
Rate for Payer: BCN Commercial	$99.10
Rate for Payer: Cash Price	$138.40
Rate for Payer: Cash Price	$138.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$129.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$94.19
Rate for Payer: Priority Health Narrow/Tiered Network	$94.19

PR PRGRMG DEV EVAL LDLS PM SINGLE CAR CHAMBER IP

Professional

Both

$96.00

Service Code	HCPCS 0826T
Min. Negotiated Rate	$34.87
Max. Negotiated Rate	$72.00
Rate for Payer: Aetna Medicare	$48.00
Rate for Payer: BCBS Complete	$38.40
Rate for Payer: BCN Commercial	$34.87
Rate for Payer: Cash Price	$76.80
Rate for Payer: Cash Price	$76.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$72.00

PR PRGRMG DEV EVAL LDLS PM SYS 2CHMBR IN PERSON

Professional

Both

$168.00

Service Code	HCPCS 0804T
Min. Negotiated Rate	$67.20
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna Medicare	$84.00
Rate for Payer: BCBS Complete	$67.20
Rate for Payer: BCN Commercial	$115.53
Rate for Payer: Cash Price	$134.40
Rate for Payer: Cash Price	$134.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$126.00

PR PRGRMG DEV EVAL SCRMS PHYS/QHP IN PERSON

Professional

Both

$126.00

Service Code	HCPCS 93285
Min. Negotiated Rate	$63.00
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna Commercial	$76.52
Rate for Payer: Aetna Commercial	$76.52
Rate for Payer: Aetna Medicare	$45.00
Rate for Payer: Aetna Medicare	$63.00
Rate for Payer: BCN Commercial	$87.65
Rate for Payer: BCN Commercial	$87.65
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$72.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$67.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$94.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$83.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$83.30
Rate for Payer: Priority Health Narrow/Tiered Network	$83.30
Rate for Payer: Priority Health Narrow/Tiered Network	$83.30

PR PRGRMG EVAL IMPLANTABLE IN PERSON MULTI LEAD DFB

Professional

Both

$175.00

Service Code	HCPCS 93284
Min. Negotiated Rate	$87.50
Max. Negotiated Rate	$155.37
Rate for Payer: Aetna Commercial	$137.14
Rate for Payer: Aetna Medicare	$87.50
Rate for Payer: BCN Commercial	$155.37
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$131.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$147.67
Rate for Payer: Priority Health Narrow/Tiered Network	$147.67

PR PRGRMG EVAL IMPLANTABLE IN PRSN DUAL LEAD DFB

Professional

Both

$163.00

Service Code	HCPCS 93283
Min. Negotiated Rate	$81.50
Max. Negotiated Rate	$143.92
Rate for Payer: Aetna Commercial	$126.86
Rate for Payer: Aetna Medicare	$81.50
Rate for Payer: BCN Commercial	$143.92
Rate for Payer: Cash Price	$130.40
Rate for Payer: Cash Price	$130.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$122.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$136.78
Rate for Payer: Priority Health Narrow/Tiered Network	$136.78

PR PRGRMNG DEV EVAL IMPLANTABLE IN PERSN 1 LD DFB

Professional

Both

$128.00

Service Code	HCPCS 93282
Min. Negotiated Rate	$64.00
Max. Negotiated Rate	$117.02
Rate for Payer: Aetna Commercial	$103.28
Rate for Payer: Aetna Medicare	$64.00
Rate for Payer: BCN Commercial	$117.02
Rate for Payer: Cash Price	$102.40
Rate for Payer: Cash Price	$102.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$96.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$111.22
Rate for Payer: Priority Health Narrow/Tiered Network	$111.22

PR PRICARDIECTOMY STOT/COMPL W/CARDPULM BYPASS

Professional

Both

$5,898.00

Service Code	HCPCS 33031
Min. Negotiated Rate	$1,474.17
Max. Negotiated Rate	$4,423.50
Rate for Payer: Aetna Commercial	$3,326.92
Rate for Payer: Aetna Medicare	$2,949.00
Rate for Payer: BCBS Complete	$1,547.88
Rate for Payer: BCN Commercial	$3,634.26
Rate for Payer: Cash Price	$4,718.40
Rate for Payer: Cash Price	$4,718.40
Rate for Payer: Mclaren Medicaid	$1,474.17
Rate for Payer: Meridian Medicaid	$1,547.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,423.50
Rate for Payer: Priority Health Choice Medicaid	$1,474.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,908.20
Rate for Payer: Priority Health Narrow/Tiered Network	$3,908.20
Rate for Payer: UHC Medicaid	$1,474.17
Rate for Payer: UHCCP Medicaid	$1,474.17

PR PRICARDIECTOMY STOT/COMPL W/O CARDPULM BYPASS

Professional

Both

$3,522.00

Service Code	HCPCS 33030
Min. Negotiated Rate	$1,197.49
Max. Negotiated Rate	$3,167.58
Rate for Payer: Aetna Commercial	$2,685.08
Rate for Payer: Aetna Medicare	$1,761.00
Rate for Payer: BCBS Complete	$1,257.36
Rate for Payer: BCN Commercial	$2,945.56
Rate for Payer: Cash Price	$2,817.60
Rate for Payer: Cash Price	$2,817.60
Rate for Payer: Mclaren Medicaid	$1,197.49
Rate for Payer: Meridian Medicaid	$1,257.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,641.50
Rate for Payer: Priority Health Choice Medicaid	$1,197.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,167.58
Rate for Payer: Priority Health Narrow/Tiered Network	$3,167.58
Rate for Payer: UHC Medicaid	$1,197.49
Rate for Payer: UHCCP Medicaid	$1,197.49

PR PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST

Professional

Both

$4,257.00

Service Code	HCPCS 37184
Min. Negotiated Rate	$240.05
Max. Negotiated Rate	$3,192.75
Rate for Payer: Aetna Commercial	$578.15
Rate for Payer: Aetna Medicare	$2,128.50
Rate for Payer: BCBS Complete	$252.05
Rate for Payer: BCN Commercial	$628.45
Rate for Payer: Cash Price	$3,405.60
Rate for Payer: Cash Price	$3,405.60
Rate for Payer: Mclaren Medicaid	$240.05
Rate for Payer: Meridian Medicaid	$252.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,192.75
Rate for Payer: Priority Health Choice Medicaid	$240.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$675.82
Rate for Payer: Priority Health Narrow/Tiered Network	$675.82
Rate for Payer: UHC Medicaid	$240.05
Rate for Payer: UHCCP Medicaid	$240.05

PR PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ

Professional

Both

$3,543.00

Service Code	HCPCS 37185
Min. Negotiated Rate	$90.10
Max. Negotiated Rate	$2,657.25
Rate for Payer: Aetna Commercial	$219.24
Rate for Payer: Aetna Medicare	$1,771.50
Rate for Payer: BCBS Complete	$94.61
Rate for Payer: BCN Commercial	$237.04
Rate for Payer: Cash Price	$2,834.40
Rate for Payer: Cash Price	$2,834.40
Rate for Payer: Mclaren Medicaid	$90.10
Rate for Payer: Meridian Medicaid	$94.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,657.25
Rate for Payer: Priority Health Choice Medicaid	$90.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$254.91
Rate for Payer: Priority Health Narrow/Tiered Network	$254.91
Rate for Payer: UHC Medicaid	$90.10
Rate for Payer: UHCCP Medicaid	$90.10

PR PRINCIPAL CARE MGMT SVC 1ST 30 PHYS/QHP CAL MO

Professional

Both

$171.00

Service Code	HCPCS 99424
Min. Negotiated Rate	$41.32
Max. Negotiated Rate	$128.25
Rate for Payer: Aetna Commercial	$74.16
Rate for Payer: Aetna Medicare	$85.50
Rate for Payer: BCBS Complete	$43.39
Rate for Payer: BCN Commercial	$111.05
Rate for Payer: Cash Price	$136.80
Rate for Payer: Cash Price	$136.80
Rate for Payer: Mclaren Medicaid	$41.32
Rate for Payer: Meridian Medicaid	$43.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$128.25
Rate for Payer: Priority Health Choice Medicaid	$41.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$84.54
Rate for Payer: Priority Health Narrow/Tiered Network	$84.54
Rate for Payer: UHC Medicaid	$41.32
Rate for Payer: UHCCP Medicaid	$41.32

PR PRINCIPAL CARE MGMT SVC 1ST 30 STAFF CAL MO

Professional

Both

$130.00

Service Code	HCPCS 99426
Min. Negotiated Rate	$28.12
Max. Negotiated Rate	$97.50
Rate for Payer: Aetna Commercial	$49.79
Rate for Payer: Aetna Medicare	$65.00
Rate for Payer: BCBS Complete	$29.53
Rate for Payer: BCN Commercial	$73.20
Rate for Payer: Cash Price	$104.00
Rate for Payer: Cash Price	$104.00
Rate for Payer: Mclaren Medicaid	$28.12
Rate for Payer: Meridian Medicaid	$29.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$97.50
Rate for Payer: Priority Health Choice Medicaid	$28.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$55.72
Rate for Payer: Priority Health Narrow/Tiered Network	$55.72
Rate for Payer: UHC Medicaid	$28.12
Rate for Payer: UHCCP Medicaid	$28.12

PR PRINCIPAL CARE MGMT SVC EA ADDL 30 STAFF CAL MO

Professional

Both

$100.00

Service Code	HCPCS 99427
Min. Negotiated Rate	$20.02
Max. Negotiated Rate	$75.00
Rate for Payer: Aetna Commercial	$35.13
Rate for Payer: Aetna Medicare	$50.00
Rate for Payer: BCBS Complete	$21.02
Rate for Payer: BCN Commercial	$52.79
Rate for Payer: Cash Price	$80.00
Rate for Payer: Cash Price	$80.00
Rate for Payer: Mclaren Medicaid	$20.02
Rate for Payer: Meridian Medicaid	$21.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$75.00
Rate for Payer: Priority Health Choice Medicaid	$20.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$40.18
Rate for Payer: Priority Health Narrow/Tiered Network	$40.18
Rate for Payer: UHC Medicaid	$20.02
Rate for Payer: UHCCP Medicaid	$20.02

PR PRINCIPAL CARE MGMT SVC EA ADL 30 PHY/QHP CAL MO

Professional

Both

$124.00

Service Code	HCPCS 99425
Min. Negotiated Rate	$28.12
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$51.70
Rate for Payer: Aetna Medicare	$62.00
Rate for Payer: BCBS Complete	$29.53
Rate for Payer: BCN Commercial	$75.70
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$99.20
Rate for Payer: Mclaren Medicaid	$28.12
Rate for Payer: Meridian Medicaid	$29.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$93.00
Rate for Payer: Priority Health Choice Medicaid	$28.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$57.62
Rate for Payer: Priority Health Narrow/Tiered Network	$57.62
Rate for Payer: UHC Medicaid	$28.12
Rate for Payer: UHCCP Medicaid	$28.12

PR PROBE NASOLACRIMAL DUCT W/WO IRRIGATION

Professional

Both

$293.00

Service Code	HCPCS 68810
Min. Negotiated Rate	$71.57
Max. Negotiated Rate	$223.41
Rate for Payer: Aetna Commercial	$165.22
Rate for Payer: Aetna Medicare	$146.50
Rate for Payer: BCBS Complete	$75.15
Rate for Payer: BCN Commercial	$150.40
Rate for Payer: Cash Price	$234.40
Rate for Payer: Cash Price	$234.40
Rate for Payer: Mclaren Medicaid	$71.57
Rate for Payer: Meridian Medicaid	$75.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$219.75
Rate for Payer: Priority Health Choice Medicaid	$71.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$223.41
Rate for Payer: Priority Health Narrow/Tiered Network	$223.41
Rate for Payer: UHC Medicaid	$71.57
Rate for Payer: UHCCP Medicaid	$71.57

PR PROCHLORPERAZINE INJECTION

Professional

Both

$21.00

Service Code	HCPCS J0780
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$15.75
Rate for Payer: Aetna Commercial	$3.53
Rate for Payer: Aetna Medicare	$10.50
Rate for Payer: BCBS Trust/PPO	$1.60
Rate for Payer: BCN Commercial	$1.77
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.75

Know your out-of-pocket cost for care.

All Charges