Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR PSYCHOLOGIC TESTING ADMIN BY COMPUTER

Professional

Both

$57.00

Service Code	HCPCS 96103
Min. Negotiated Rate	$22.80
Max. Negotiated Rate	$42.75
Rate for Payer: Aetna Medicare	$28.50
Rate for Payer: BCBS Complete	$22.80
Rate for Payer: Cash Price	$45.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$42.75

PR PSYCHOLOGIC TESTING BY PSYCH/PHYS

Professional

Both

$153.00

Service Code	HCPCS 96101
Min. Negotiated Rate	$61.20
Max. Negotiated Rate	$114.75
Rate for Payer: Aetna Medicare	$76.50
Rate for Payer: BCBS Complete	$61.20
Rate for Payer: Cash Price	$122.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$114.75

PR PSYCHOTHERAPY COMPLEX INTERACTIVE

Professional

Both

$148.00

Service Code	HCPCS 90785
Min. Negotiated Rate	$7.46
Max. Negotiated Rate	$111.00
Rate for Payer: Aetna Commercial	$15.85
Rate for Payer: Aetna Medicare	$74.00
Rate for Payer: BCBS Complete	$7.83
Rate for Payer: BCN Commercial	$14.92
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cash Price	$118.40
Rate for Payer: Mclaren Medicaid	$7.46
Rate for Payer: Meridian Medicaid	$7.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.00
Rate for Payer: Priority Health Choice Medicaid	$7.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$18.55
Rate for Payer: Priority Health Narrow/Tiered Network	$18.55
Rate for Payer: UHC Medicaid	$7.46
Rate for Payer: UHCCP Medicaid	$7.46

PR PSYCHOTHERAPY FOR CRISIS EACH ADDL 30 MINUTES

Professional

Both

$122.00

Service Code	HCPCS 90840
Min. Negotiated Rate	$42.09
Max. Negotiated Rate	$91.50
Rate for Payer: Aetna Commercial	$74.88
Rate for Payer: Aetna Medicare	$61.00
Rate for Payer: BCBS Complete	$44.19
Rate for Payer: BCN Commercial	$78.54
Rate for Payer: Cash Price	$97.60
Rate for Payer: Cash Price	$97.60
Rate for Payer: Mclaren Medicaid	$42.09
Rate for Payer: Meridian Medicaid	$44.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$91.50
Rate for Payer: Priority Health Choice Medicaid	$42.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$88.63
Rate for Payer: Priority Health Narrow/Tiered Network	$88.63
Rate for Payer: UHC Medicaid	$42.09
Rate for Payer: UHCCP Medicaid	$42.09

PR PSYCHOTHERAPY FOR CRISIS INITIAL 60 MINUTES

Professional

Both

$237.00

Service Code	HCPCS 90839
Min. Negotiated Rate	$87.33
Max. Negotiated Rate	$177.75
Rate for Payer: Aetna Commercial	$150.80
Rate for Payer: Aetna Medicare	$118.50
Rate for Payer: BCBS Complete	$91.70
Rate for Payer: BCN Commercial	$158.26
Rate for Payer: Cash Price	$189.60
Rate for Payer: Cash Price	$189.60
Rate for Payer: Mclaren Medicaid	$87.33
Rate for Payer: Meridian Medicaid	$91.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$177.75
Rate for Payer: Priority Health Choice Medicaid	$87.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$172.63
Rate for Payer: Priority Health Narrow/Tiered Network	$172.63
Rate for Payer: UHC Medicaid	$87.33
Rate for Payer: UHCCP Medicaid	$87.33

PR PSYCHOTHERAPY W/PATIENT 30 MINUTES

Professional

Both

$114.00

Service Code	HCPCS 90832
Min. Negotiated Rate	$46.83
Max. Negotiated Rate	$89.05
Rate for Payer: Aetna Commercial	$72.80
Rate for Payer: Aetna Medicare	$57.00
Rate for Payer: BCBS Complete	$49.17
Rate for Payer: BCN Commercial	$83.65
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Mclaren Medicaid	$46.83
Rate for Payer: Meridian Medicaid	$49.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$85.50
Rate for Payer: Priority Health Choice Medicaid	$46.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.05
Rate for Payer: Priority Health Narrow/Tiered Network	$89.05
Rate for Payer: UHC Medicaid	$46.83
Rate for Payer: UHCCP Medicaid	$46.83

PR PSYCHOTHERAPY W/PATIENT 45 MINUTES

Professional

Both

$175.00

Service Code	HCPCS 90834
Min. Negotiated Rate	$61.93
Max. Negotiated Rate	$131.25
Rate for Payer: Aetna Commercial	$114.40
Rate for Payer: Aetna Medicare	$87.50
Rate for Payer: BCBS Complete	$65.03
Rate for Payer: BCN Commercial	$110.35
Rate for Payer: Cash Price	$140.00
Rate for Payer: Cash Price	$140.00
Rate for Payer: Mclaren Medicaid	$61.93
Rate for Payer: Meridian Medicaid	$65.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$131.25
Rate for Payer: Priority Health Choice Medicaid	$61.93
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$117.40
Rate for Payer: Priority Health Narrow/Tiered Network	$117.40
Rate for Payer: UHC Medicaid	$61.93
Rate for Payer: UHCCP Medicaid	$61.93

PR PSYCHOTHERAPY W/PATIENT 60 MINUTES

Professional

Both

$245.00

Service Code	HCPCS 90837
Min. Negotiated Rate	$91.18
Max. Negotiated Rate	$183.75
Rate for Payer: Aetna Commercial	$168.48
Rate for Payer: Aetna Medicare	$122.50
Rate for Payer: BCBS Complete	$95.74
Rate for Payer: BCN Commercial	$163.36
Rate for Payer: Cash Price	$196.00
Rate for Payer: Cash Price	$196.00
Rate for Payer: Mclaren Medicaid	$91.18
Rate for Payer: Meridian Medicaid	$95.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$183.75
Rate for Payer: Priority Health Choice Medicaid	$91.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$173.99
Rate for Payer: Priority Health Narrow/Tiered Network	$173.99
Rate for Payer: UHC Medicaid	$91.18
Rate for Payer: UHCCP Medicaid	$91.18

PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 30 MIN

Professional

Both

$147.00

Service Code	HCPCS 90833
Min. Negotiated Rate	$36.15
Max. Negotiated Rate	$110.25
Rate for Payer: Aetna Commercial	$78.00
Rate for Payer: Aetna Medicare	$73.50
Rate for Payer: BCBS Complete	$46.62
Rate for Payer: BCN Commercial	$36.15
Rate for Payer: Cash Price	$117.60
Rate for Payer: Cash Price	$117.60
Rate for Payer: Mclaren Medicaid	$44.40
Rate for Payer: Meridian Medicaid	$46.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$110.25
Rate for Payer: Priority Health Choice Medicaid	$44.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$83.82
Rate for Payer: Priority Health Narrow/Tiered Network	$83.82
Rate for Payer: UHC Medicaid	$44.40
Rate for Payer: UHCCP Medicaid	$44.40

PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 45 MIN

Professional

Both

$177.00

Service Code	HCPCS 90836
Min. Negotiated Rate	$45.96
Max. Negotiated Rate	$132.75
Rate for Payer: Aetna Commercial	$126.88
Rate for Payer: Aetna Medicare	$88.50
Rate for Payer: BCBS Complete	$58.89
Rate for Payer: BCN Commercial	$45.96
Rate for Payer: Cash Price	$141.60
Rate for Payer: Cash Price	$141.60
Rate for Payer: Mclaren Medicaid	$56.09
Rate for Payer: Meridian Medicaid	$58.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$132.75
Rate for Payer: Priority Health Choice Medicaid	$56.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$106.67
Rate for Payer: Priority Health Narrow/Tiered Network	$106.67
Rate for Payer: UHC Medicaid	$56.09
Rate for Payer: UHCCP Medicaid	$56.09

PR PSYCHOTHERAPY W/PATIENT W/E&M SRVCS 60 MIN

Professional

Both

$244.00

Service Code	HCPCS 90838
Min. Negotiated Rate	$61.39
Max. Negotiated Rate	$183.04
Rate for Payer: Aetna Commercial	$183.04
Rate for Payer: Aetna Medicare	$122.00
Rate for Payer: BCBS Complete	$78.09
Rate for Payer: BCN Commercial	$61.39
Rate for Payer: Cash Price	$195.20
Rate for Payer: Cash Price	$195.20
Rate for Payer: Mclaren Medicaid	$74.37
Rate for Payer: Meridian Medicaid	$78.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$183.00
Rate for Payer: Priority Health Choice Medicaid	$74.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$147.89
Rate for Payer: Priority Health Narrow/Tiered Network	$147.89
Rate for Payer: UHC Medicaid	$74.37
Rate for Payer: UHCCP Medicaid	$74.37

PR PSYCL/NRPSYCL TST ELEC PLATFORM AUTO RESULT

Professional

Both

$4.00

Service Code	HCPCS 96146
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.49
Rate for Payer: Aetna Commercial	$2.16
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCN Commercial	$3.49
Rate for Payer: Cash Price	$3.20
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3.21
Rate for Payer: Priority Health Narrow/Tiered Network	$3.21

PR PSYCL/NRPSYCL TST PHYS/QHP 2+ TST EA ADDL 30 MIN

Professional

Both

$89.00

Service Code	HCPCS 96137
Min. Negotiated Rate	$10.44
Max. Negotiated Rate	$66.75
Rate for Payer: Aetna Commercial	$20.88
Rate for Payer: Aetna Medicare	$44.50
Rate for Payer: BCBS Complete	$10.96
Rate for Payer: BCN Commercial	$55.28
Rate for Payer: Cash Price	$71.20
Rate for Payer: Cash Price	$71.20
Rate for Payer: Mclaren Medicaid	$10.44
Rate for Payer: Meridian Medicaid	$10.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$66.75
Rate for Payer: Priority Health Choice Medicaid	$10.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$24.33
Rate for Payer: Priority Health Narrow/Tiered Network	$24.33
Rate for Payer: UHC Medicaid	$10.44
Rate for Payer: UHCCP Medicaid	$10.44

PR PSYCL/NRPSYCL TST TECH 2+ TST 1ST 30 MIN

Professional

Both

$75.00

Service Code	HCPCS 96138
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$56.25
Rate for Payer: Aetna Commercial	$38.12
Rate for Payer: Aetna Medicare	$37.50
Rate for Payer: BCN Commercial	$51.79
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$56.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$47.76
Rate for Payer: Priority Health Narrow/Tiered Network	$47.76

PR PSYCL/NRPSYCL TST TECH 2+ TST EA ADDL 30 MIN

Professional

Both

$75.00

Service Code	HCPCS 96139
Min. Negotiated Rate	$37.50
Max. Negotiated Rate	$56.25
Rate for Payer: Aetna Commercial	$38.12
Rate for Payer: Aetna Medicare	$37.50
Rate for Payer: BCN Commercial	$51.79
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$56.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$47.76
Rate for Payer: Priority Health Narrow/Tiered Network	$47.76

PR PSYL/NRPSYCL TST PHYS/QHP 2+ TST 1ST 30 MIN

Professional

Both

$97.00

Service Code	HCPCS 96136
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$72.75
Rate for Payer: Aetna Commercial	$26.94
Rate for Payer: Aetna Medicare	$48.50
Rate for Payer: BCBS Complete	$14.31
Rate for Payer: BCN Commercial	$62.75
Rate for Payer: Cash Price	$77.60
Rate for Payer: Cash Price	$77.60
Rate for Payer: Mclaren Medicaid	$13.63
Rate for Payer: Meridian Medicaid	$14.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$72.75
Rate for Payer: Priority Health Choice Medicaid	$13.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$32.14
Rate for Payer: Priority Health Narrow/Tiered Network	$32.14
Rate for Payer: UHC Medicaid	$13.63
Rate for Payer: UHCCP Medicaid	$13.63

PR PTERYGOMAXILLARY FOSSA SURGERY ANY APPROACH

Professional

Both

$2,286.00

Service Code	HCPCS 31040
Min. Negotiated Rate	$460.29
Max. Negotiated Rate	$1,714.50
Rate for Payer: Aetna Commercial	$1,025.23
Rate for Payer: Aetna Medicare	$1,143.00
Rate for Payer: BCBS Complete	$483.30
Rate for Payer: BCN Commercial	$1,203.12
Rate for Payer: Cash Price	$1,828.80
Rate for Payer: Cash Price	$1,828.80
Rate for Payer: Mclaren Medicaid	$460.29
Rate for Payer: Meridian Medicaid	$483.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,714.50
Rate for Payer: Priority Health Choice Medicaid	$460.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,132.98
Rate for Payer: Priority Health Narrow/Tiered Network	$1,132.98
Rate for Payer: UHC Medicaid	$460.29
Rate for Payer: UHCCP Medicaid	$460.29

PR PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM

Professional

Both

$53.00

Service Code	HCPCS 96160
Min. Negotiated Rate	$2.85
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna Commercial	$2.85
Rate for Payer: Aetna Medicare	$26.50
Rate for Payer: BCN Commercial	$4.48
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5.43
Rate for Payer: Priority Health Narrow/Tiered Network	$5.43

PR PULMONARY ARTERY EMBOLECTOMY W/CARD BYPASS

Professional

Both

$5,741.00

Service Code	HCPCS 33910
Min. Negotiated Rate	$1,565.34
Max. Negotiated Rate	$4,305.75
Rate for Payer: Aetna Commercial	$3,520.01
Rate for Payer: Aetna Medicare	$2,870.50
Rate for Payer: BCBS Complete	$1,643.61
Rate for Payer: BCN Commercial	$3,826.49
Rate for Payer: Cash Price	$4,592.80
Rate for Payer: Cash Price	$4,592.80
Rate for Payer: Mclaren Medicaid	$1,565.34
Rate for Payer: Meridian Medicaid	$1,643.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,305.75
Rate for Payer: Priority Health Choice Medicaid	$1,565.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4,114.91
Rate for Payer: Priority Health Narrow/Tiered Network	$4,114.91
Rate for Payer: UHC Medicaid	$1,565.34
Rate for Payer: UHCCP Medicaid	$1,565.34

PR PULMONARY COMPLIANCE STUDY

Professional

Both

$177.00

Service Code	HCPCS 94750
Min. Negotiated Rate	$70.80
Max. Negotiated Rate	$132.75
Rate for Payer: Aetna Medicare	$88.50
Rate for Payer: BCBS Complete	$70.80
Rate for Payer: Cash Price	$141.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$132.75

PR PULMONARY STRESS TESTING

Professional

Both

$48.00

Service Code	HCPCS 94618
Min. Negotiated Rate	$24.00
Max. Negotiated Rate	$51.29
Rate for Payer: Aetna Commercial	$36.28
Rate for Payer: Aetna Medicare	$24.00
Rate for Payer: BCN Commercial	$51.29
Rate for Payer: Cash Price	$38.40
Rate for Payer: Cash Price	$38.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$36.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$47.31
Rate for Payer: Priority Health Narrow/Tiered Network	$47.31

PR PULMONARY STRESS TESTING,SIMPLE

Professional

Both

$369.00

Service Code	HCPCS 94620
Min. Negotiated Rate	$147.60
Max. Negotiated Rate	$276.75
Rate for Payer: Aetna Medicare	$184.50
Rate for Payer: BCBS Complete	$147.60
Rate for Payer: Cash Price	$295.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$276.75

PR PUNCH BIOPSY SKIN EA SEP/ADDITIONAL LESION

Professional

Both

$187.00

Service Code	HCPCS 11105
Min. Negotiated Rate	$13.63
Max. Negotiated Rate	$140.25
Rate for Payer: Aetna Commercial	$27.89
Rate for Payer: Aetna Medicare	$93.50
Rate for Payer: BCBS Complete	$14.31
Rate for Payer: BCN Commercial	$29.85
Rate for Payer: Cash Price	$149.60
Rate for Payer: Cash Price	$149.60
Rate for Payer: Mclaren Medicaid	$13.63
Rate for Payer: Meridian Medicaid	$14.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$140.25
Rate for Payer: Priority Health Choice Medicaid	$13.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$34.63
Rate for Payer: Priority Health Narrow/Tiered Network	$34.63
Rate for Payer: UHC Medicaid	$13.63
Rate for Payer: UHCCP Medicaid	$13.63

PR PUNCH BIOPSY SKIN SINGLE LESION

Professional

Both

$251.00

Service Code	HCPCS 11104
Min. Negotiated Rate	$24.28
Max. Negotiated Rate	$188.25
Rate for Payer: Aetna Commercial	$51.32
Rate for Payer: Aetna Medicare	$125.50
Rate for Payer: BCBS Complete	$25.49
Rate for Payer: BCN Commercial	$54.98
Rate for Payer: Cash Price	$200.80
Rate for Payer: Cash Price	$200.80
Rate for Payer: Mclaren Medicaid	$24.28
Rate for Payer: Meridian Medicaid	$25.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$188.25
Rate for Payer: Priority Health Choice Medicaid	$24.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$63.82
Rate for Payer: Priority Health Narrow/Tiered Network	$63.82
Rate for Payer: UHC Medicaid	$24.28
Rate for Payer: UHCCP Medicaid	$24.28

PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST

Facility

$221.00

Service Code	CPT 10160
Hospital Charge Code	10160
Hospital Revenue Code	521
Min. Negotiated Rate	$38.96
Max. Negotiated Rate	$198.90
Rate for Payer: Aetna Commercial	$187.85
Rate for Payer: Aetna Medicare	$57.46
Rate for Payer: Allen County Amish Medical Aid Commercial	$69.06
Rate for Payer: Amish Plain Church Group Commercial	$69.06
Rate for Payer: BCBS Complete	$40.91
Rate for Payer: BCBS MAPPO	$55.25
Rate for Payer: BCBS Trust/PPO	$181.68
Rate for Payer: BCN Commercial	$181.68
Rate for Payer: BCN Medicare Advantage	$55.25
Rate for Payer: Cash Price	$176.80
Rate for Payer: Cofinity Commercial	$190.06
Rate for Payer: Encore Health Key Benefits Commercial	$176.80
Rate for Payer: Health Alliance Plan Medicare Advantage	$55.25
Rate for Payer: Healthscope Commercial	$198.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$165.75
Rate for Payer: Mclaren Medicaid	$38.96
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$58.01
Rate for Payer: Meridian Medicaid	$40.91
Rate for Payer: MI Amish Medical Board Commercial	$63.54
Rate for Payer: Molina Medicare/Medicaid	$60.77
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$187.85
Rate for Payer: Nomi Health Commercial	$181.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$165.75
Rate for Payer: PACE Senior Care Partners	$52.49
Rate for Payer: PACE SWMI	$55.25
Rate for Payer: PHP Commercial	$187.85
Rate for Payer: PHP Medicare Advantage	$55.25
Rate for Payer: Priority Health Choice Medicaid	$38.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$192.27
Rate for Payer: Priority Health Medicare	$55.80
Rate for Payer: Priority Health Narrow/Tiered Network	$153.82
Rate for Payer: Railroad Medicare Medicare	$55.25
Rate for Payer: UHC Core	$184.53
Rate for Payer: UHC Exchange	$55.25
Rate for Payer: UHC Medicaid	$38.96
Rate for Payer: UHC Medicare Advantage	$55.25
Rate for Payer: UHCCP Medicaid	$38.96
Rate for Payer: VA VA	$55.25
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$165.75

Know your out-of-pocket cost for care.

All Charges