Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR PESSARY REUSABLE RUB ANYTYPE

Professional

Both

$77.00

Service Code	HCPCS A4561
Min. Negotiated Rate	$28.64
Max. Negotiated Rate	$50.05
Rate for Payer: Aetna Commercial	$38.38
Rate for Payer: Aetna Medicare	$29.79
Rate for Payer: BCBS Complete	$30.80
Rate for Payer: BCBS MAPPO	$28.64
Rate for Payer: BCN Medicare Advantage	$28.64
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cofinity Commercial	$41.24
Rate for Payer: Cofinity Commercial	$38.38
Rate for Payer: Health Alliance Plan Medicare Advantage	$28.64
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$30.07
Rate for Payer: Nomi Health Commercial	$34.37
Rate for Payer: PACE SWMI	$28.64
Rate for Payer: PHP Medicare Advantage	$28.64
Rate for Payer: Priority Health Cigna Priority Health	$50.05
Rate for Payer: Priority Health Medicare	$28.93
Rate for Payer: UHC All Payor (Choice/PPO)	$28.64
Rate for Payer: UHC Dual Complete DSNP	$28.64
Rate for Payer: UHC Exchange	$28.64
Rate for Payer: UHC Medicare Advantage	$28.64

PR PHALANGECTOMY TOE EACH TOE

Professional

Both

$849.00

Service Code	HCPCS 28150
Min. Negotiated Rate	$267.77
Max. Negotiated Rate	$551.85
Rate for Payer: Aetna Commercial	$358.81
Rate for Payer: Aetna Medicare	$278.48
Rate for Payer: BCBS Complete	$339.60
Rate for Payer: BCBS MAPPO	$267.77
Rate for Payer: BCN Medicare Advantage	$267.77
Rate for Payer: Cash Price	$679.20
Rate for Payer: Cash Price	$679.20
Rate for Payer: Cofinity Commercial	$385.59
Rate for Payer: Cofinity Commercial	$358.81
Rate for Payer: Health Alliance Plan Medicare Advantage	$267.77
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$281.16
Rate for Payer: Nomi Health Commercial	$321.32
Rate for Payer: PACE SWMI	$267.77
Rate for Payer: PHP Medicare Advantage	$267.77
Rate for Payer: Priority Health Cigna Priority Health	$551.85
Rate for Payer: Priority Health Medicare	$270.45
Rate for Payer: UHC All Payor (Choice/PPO)	$267.77
Rate for Payer: UHC Dual Complete DSNP	$267.77
Rate for Payer: UHC Exchange	$267.77
Rate for Payer: UHC Medicare Advantage	$267.77

PR PHARMACOLOGIC MANAGEMENT W/PSYCHOTHERAPY

Professional

Both

$85.00

Service Code	HCPCS 90863
Min. Negotiated Rate	$34.00
Max. Negotiated Rate	$55.25
Rate for Payer: Aetna Medicare	$42.50
Rate for Payer: BCBS Complete	$34.00
Rate for Payer: Cash Price	$68.00
Rate for Payer: Priority Health Cigna Priority Health	$55.25

PR PHARYNGOPLASTY PLSTC/RCNSTV OPRATION PHARYNX

Professional

Both

$1,441.00

Service Code	HCPCS 42950
Min. Negotiated Rate	$576.40
Max. Negotiated Rate	$1,064.30
Rate for Payer: Aetna Commercial	$990.39
Rate for Payer: Aetna Medicare	$768.66
Rate for Payer: BCBS Complete	$576.40
Rate for Payer: BCBS MAPPO	$739.10
Rate for Payer: BCN Medicare Advantage	$739.10
Rate for Payer: Cash Price	$1,152.80
Rate for Payer: Cash Price	$1,152.80
Rate for Payer: Cofinity Commercial	$990.39
Rate for Payer: Cofinity Commercial	$1,064.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$739.10
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$776.05
Rate for Payer: Nomi Health Commercial	$886.92
Rate for Payer: PACE SWMI	$739.10
Rate for Payer: PHP Medicare Advantage	$739.10
Rate for Payer: Priority Health Cigna Priority Health	$936.65
Rate for Payer: Priority Health Medicare	$746.49
Rate for Payer: UHC All Payor (Choice/PPO)	$739.10
Rate for Payer: UHC Dual Complete DSNP	$739.10
Rate for Payer: UHC Exchange	$739.10
Rate for Payer: UHC Medicare Advantage	$739.10

PR PHLEBOTOMY THERAPEUTIC SEPARATE PROCEDURE

Professional

Both

$196.00

Service Code	HCPCS 99195
Min. Negotiated Rate	$78.40
Max. Negotiated Rate	$127.40
Rate for Payer: Aetna Commercial	$106.68
Rate for Payer: Aetna Medicare	$82.79
Rate for Payer: BCBS Complete	$78.40
Rate for Payer: BCBS MAPPO	$79.61
Rate for Payer: BCN Medicare Advantage	$79.61
Rate for Payer: Cash Price	$156.80
Rate for Payer: Cash Price	$156.80
Rate for Payer: Cofinity Commercial	$106.68
Rate for Payer: Cofinity Commercial	$114.64
Rate for Payer: Health Alliance Plan Medicare Advantage	$79.61
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$83.59
Rate for Payer: Nomi Health Commercial	$95.53
Rate for Payer: PACE SWMI	$79.61
Rate for Payer: PHP Medicare Advantage	$79.61
Rate for Payer: Priority Health Cigna Priority Health	$127.40
Rate for Payer: Priority Health Medicare	$80.41
Rate for Payer: UHC All Payor (Choice/PPO)	$79.61
Rate for Payer: UHC Dual Complete DSNP	$79.61
Rate for Payer: UHC Exchange	$79.61
Rate for Payer: UHC Medicare Advantage	$79.61

PR PHTFAC ARMS

Professional

Both

$255.00

Service Code	HCPCS 00079
Hospital Revenue Code	990
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$165.75
Rate for Payer: Aetna Medicare	$127.50
Rate for Payer: BCBS Complete	$102.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Priority Health Cigna Priority Health	$165.75

PR PHTFAC CHEST/SHLD

Professional

Both

$128.00

Service Code	HCPCS 00077
Hospital Revenue Code	990
Min. Negotiated Rate	$51.20
Max. Negotiated Rate	$83.20
Rate for Payer: Aetna Medicare	$64.00
Rate for Payer: BCBS Complete	$51.20
Rate for Payer: Cash Price	$102.40
Rate for Payer: Priority Health Cigna Priority Health	$83.20

PR PHTFAC FACE & NECK/ FL ARMS

Professional

Both

$255.00

Service Code	HCPCS 00076
Hospital Revenue Code	990
Min. Negotiated Rate	$102.00
Max. Negotiated Rate	$165.75
Rate for Payer: Aetna Medicare	$127.50
Rate for Payer: BCBS Complete	$102.00
Rate for Payer: Cash Price	$204.00
Rate for Payer: Priority Health Cigna Priority Health	$165.75

PR PHTFAC FL LEGS

Professional

Both

$357.00

Service Code	HCPCS 00080
Hospital Revenue Code	990
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$232.05
Rate for Payer: Aetna Medicare	$178.50
Rate for Payer: BCBS Complete	$142.80
Rate for Payer: Cash Price	$285.60
Rate for Payer: Priority Health Cigna Priority Health	$232.05

PR PHTFAC HANDS

Professional

Both

$51.00

Service Code	HCPCS 00078
Hospital Revenue Code	990
Min. Negotiated Rate	$20.40
Max. Negotiated Rate	$33.15
Rate for Payer: Aetna Medicare	$25.50
Rate for Payer: BCBS Complete	$20.40
Rate for Payer: Cash Price	$40.80
Rate for Payer: Priority Health Cigna Priority Health	$33.15

PR PHTFAC HEMANGIOMAS/WARTS

Professional

Both

$36.00

Service Code	HCPCS 00083
Hospital Revenue Code	990
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna Medicare	$18.00
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Priority Health Cigna Priority Health	$23.40

PR PHTFAC NASAL VEIN

Professional

Both

$46.00

Service Code	HCPCS 00082
Hospital Revenue Code	990
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$29.90
Rate for Payer: Aetna Medicare	$23.00
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: Cash Price	$36.80
Rate for Payer: Priority Health Cigna Priority Health	$29.90

PR PHTFAC SNGL PIGMENT

Professional

Both

$36.00

Service Code	HCPCS 00081
Hospital Revenue Code	990
Min. Negotiated Rate	$14.40
Max. Negotiated Rate	$23.40
Rate for Payer: Aetna Medicare	$18.00
Rate for Payer: BCBS Complete	$14.40
Rate for Payer: Cash Price	$28.80
Rate for Payer: Priority Health Cigna Priority Health	$23.40

PR PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN

Professional

Both

$54.00

Service Code	HCPCS 97750
Min. Negotiated Rate	$21.60
Max. Negotiated Rate	$45.69
Rate for Payer: Aetna Commercial	$42.52
Rate for Payer: Aetna Medicare	$33.00
Rate for Payer: BCBS Complete	$21.60
Rate for Payer: BCBS MAPPO	$31.73
Rate for Payer: BCN Medicare Advantage	$31.73
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cash Price	$43.20
Rate for Payer: Cofinity Commercial	$45.69
Rate for Payer: Cofinity Commercial	$42.52
Rate for Payer: Health Alliance Plan Medicare Advantage	$31.73
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$33.32
Rate for Payer: Nomi Health Commercial	$38.08
Rate for Payer: PACE SWMI	$31.73
Rate for Payer: PHP Medicare Advantage	$31.73
Rate for Payer: Priority Health Cigna Priority Health	$35.10
Rate for Payer: Priority Health Medicare	$32.05
Rate for Payer: UHC All Payor (Choice/PPO)	$31.73
Rate for Payer: UHC Dual Complete DSNP	$31.73
Rate for Payer: UHC Exchange	$31.73
Rate for Payer: UHC Medicare Advantage	$31.73

PR PHYSIOLOGIC EXERCISE STUDY & HEMODYNAMIC MEASU

Professional

Both

$183.00

Service Code	HCPCS 93464
Min. Negotiated Rate	$73.20
Max. Negotiated Rate	$282.14
Rate for Payer: Aetna Commercial	$262.55
Rate for Payer: Aetna Medicare	$203.77
Rate for Payer: BCBS Complete	$73.20
Rate for Payer: BCBS MAPPO	$195.93
Rate for Payer: BCN Medicare Advantage	$195.93
Rate for Payer: Cash Price	$146.40
Rate for Payer: Cash Price	$146.40
Rate for Payer: Cofinity Commercial	$282.14
Rate for Payer: Cofinity Commercial	$262.55
Rate for Payer: Health Alliance Plan Medicare Advantage	$195.93
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$205.73
Rate for Payer: Nomi Health Commercial	$235.12
Rate for Payer: PACE SWMI	$195.93
Rate for Payer: PHP Medicare Advantage	$195.93
Rate for Payer: Priority Health Cigna Priority Health	$118.95
Rate for Payer: Priority Health Medicare	$197.89
Rate for Payer: UHC All Payor (Choice/PPO)	$195.93
Rate for Payer: UHC Dual Complete DSNP	$195.93
Rate for Payer: UHC Exchange	$195.93
Rate for Payer: UHC Medicare Advantage	$195.93

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	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55

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

Professional

Both

$373.00

Service Code	HCPCS 99183
Min. Negotiated Rate	$101.48
Max. Negotiated Rate	$242.45
Rate for Payer: Aetna Commercial	$135.98
Rate for Payer: Aetna Medicare	$105.54
Rate for Payer: BCBS Complete	$149.20
Rate for Payer: BCBS MAPPO	$101.48
Rate for Payer: BCN Medicare Advantage	$101.48
Rate for Payer: Cash Price	$298.40
Rate for Payer: Cash Price	$298.40
Rate for Payer: Cofinity Commercial	$146.13
Rate for Payer: Cofinity Commercial	$135.98
Rate for Payer: Health Alliance Plan Medicare Advantage	$101.48
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$106.55
Rate for Payer: Nomi Health Commercial	$121.78
Rate for Payer: PACE SWMI	$101.48
Rate for Payer: PHP Medicare Advantage	$101.48
Rate for Payer: Priority Health Cigna Priority Health	$242.45
Rate for Payer: Priority Health Medicare	$102.49
Rate for Payer: UHC All Payor (Choice/PPO)	$101.48
Rate for Payer: UHC Dual Complete DSNP	$101.48
Rate for Payer: UHC Exchange	$101.48
Rate for Payer: UHC Medicare Advantage	$101.48

PR PHYS/QHP DIRECTION EMERGENCY MEDICAL SYSTEMS

Professional

Both

$250.00

Service Code	HCPCS 99288
Min. Negotiated Rate	$100.00
Max. Negotiated Rate	$162.50
Rate for Payer: Aetna Medicare	$125.00
Rate for Payer: BCBS Complete	$100.00
Rate for Payer: Cash Price	$200.00
Rate for Payer: Priority Health Cigna Priority Health	$162.50

PR PHYS/QHP EDUCATION SVCS RENDERED PTS GRP SETTING

Professional

Both

$45.00

Service Code	HCPCS 99078
Min. Negotiated Rate	$18.00
Max. Negotiated Rate	$29.25
Rate for Payer: Aetna Medicare	$22.50
Rate for Payer: BCBS Complete	$18.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Priority Health Cigna Priority Health	$29.25

PR PHYS/QHP ONLINE EVALUATION & MANAGEMENT SERVICE

Professional

Both

$50.00

Service Code	HCPCS 99444
Min. Negotiated Rate	$20.00
Max. Negotiated Rate	$32.50
Rate for Payer: Aetna Medicare	$25.00
Rate for Payer: BCBS Complete	$20.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Priority Health Cigna Priority Health	$32.50

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

Professional

Both

$33.00

Service Code	HCPCS 93797
Min. Negotiated Rate	$7.97
Max. Negotiated Rate	$21.45
Rate for Payer: Aetna Commercial	$10.68
Rate for Payer: Aetna Medicare	$8.29
Rate for Payer: BCBS Complete	$13.20
Rate for Payer: BCBS MAPPO	$7.97
Rate for Payer: BCN Medicare Advantage	$7.97
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cash Price	$26.40
Rate for Payer: Cofinity Commercial	$10.68
Rate for Payer: Cofinity Commercial	$11.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$7.97
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$8.37
Rate for Payer: Nomi Health Commercial	$9.56
Rate for Payer: PACE SWMI	$7.97
Rate for Payer: PHP Medicare Advantage	$7.97
Rate for Payer: Priority Health Cigna Priority Health	$21.45
Rate for Payer: Priority Health Medicare	$8.05
Rate for Payer: UHC All Payor (Choice/PPO)	$7.97
Rate for Payer: UHC Dual Complete DSNP	$7.97
Rate for Payer: UHC Exchange	$7.97
Rate for Payer: UHC Medicare Advantage	$7.97

PR PHYS/QHP TELEPHONE EVALUATION 11-20 MIN

Professional

Both

$149.00

Service Code	HCPCS 99442
Min. Negotiated Rate	$59.60
Max. Negotiated Rate	$96.85
Rate for Payer: Aetna Medicare	$74.50
Rate for Payer: BCBS Complete	$59.60
Rate for Payer: Cash Price	$119.20
Rate for Payer: Priority Health Cigna Priority Health	$96.85

PR PHYS/QHP TELEPHONE EVALUATION 21-30 MIN

Professional

Both

$216.00

Service Code	HCPCS 99443
Min. Negotiated Rate	$86.40
Max. Negotiated Rate	$140.40
Rate for Payer: Aetna Medicare	$108.00
Rate for Payer: BCBS Complete	$86.40
Rate for Payer: Cash Price	$172.80
Rate for Payer: Priority Health Cigna Priority Health	$140.40

PR PHYS/QHP TELEPHONE EVALUATION 5-10 MIN

Professional

Both

$90.00

Service Code	HCPCS 99441
Min. Negotiated Rate	$36.00
Max. Negotiated Rate	$58.50
Rate for Payer: Aetna Medicare	$45.00
Rate for Payer: BCBS Complete	$36.00
Rate for Payer: Cash Price	$72.00
Rate for Payer: Priority Health Cigna Priority Health	$58.50

PR PHYS STANDBY SVC PROLNG PHYS ATTN EA 30 MINUTES

Professional

Both

$261.00

Service Code	HCPCS 99360
Min. Negotiated Rate	$104.40
Max. Negotiated Rate	$169.65
Rate for Payer: Aetna Medicare	$130.50
Rate for Payer: BCBS Complete	$104.40
Rate for Payer: Cash Price	$208.80
Rate for Payer: Priority Health Cigna Priority Health	$169.65

Know your out-of-pocket cost for care.

All Charges