Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR REVSC EVASC IVT ST PLMT UNI CPLX LES 1ST VSL

Professional

Both

$1,470.00

Service Code	HCPCS 37260
Min. Negotiated Rate	$369.77
Max. Negotiated Rate	$1,102.50
Rate for Payer: Aetna Medicare	$735.00
Rate for Payer: BCBS Complete	$388.26
Rate for Payer: Cash Price	$1,176.00
Rate for Payer: Cash Price	$1,176.00
Rate for Payer: Mclaren Medicaid	$369.77
Rate for Payer: Meridian Medicaid	$388.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,102.50
Rate for Payer: Priority Health Choice Medicaid	$369.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$854.95
Rate for Payer: Priority Health Narrow/Tiered Network	$854.95
Rate for Payer: UHC Medicaid	$369.77
Rate for Payer: UHCCP Medicaid	$369.77

PR REVSC EVASC IVT ST PLMT UNI SF LES 1ST VSL

Professional

Both

$1,016.00

Service Code	HCPCS 37258
Min. Negotiated Rate	$255.81
Max. Negotiated Rate	$762.00
Rate for Payer: Aetna Medicare	$508.00
Rate for Payer: BCBS Complete	$268.60
Rate for Payer: Cash Price	$812.80
Rate for Payer: Cash Price	$812.80
Rate for Payer: Mclaren Medicaid	$255.81
Rate for Payer: Meridian Medicaid	$268.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$762.00
Rate for Payer: Priority Health Choice Medicaid	$255.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$591.47
Rate for Payer: Priority Health Narrow/Tiered Network	$591.47
Rate for Payer: UHC Medicaid	$255.81
Rate for Payer: UHCCP Medicaid	$255.81

PR REVSC EVASC IVT ST PLMT UNI SF LES EA ADDL VSL

Professional

Both

$342.00

Service Code	HCPCS 37259
Min. Negotiated Rate	$115.66
Max. Negotiated Rate	$267.42
Rate for Payer: Aetna Medicare	$171.00
Rate for Payer: BCBS Complete	$121.44
Rate for Payer: Cash Price	$273.60
Rate for Payer: Cash Price	$273.60
Rate for Payer: Mclaren Medicaid	$115.66
Rate for Payer: Meridian Medicaid	$121.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$256.50
Rate for Payer: Priority Health Choice Medicaid	$115.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$267.42
Rate for Payer: Priority Health Narrow/Tiered Network	$267.42
Rate for Payer: UHC Medicaid	$115.66
Rate for Payer: UHCCP Medicaid	$115.66

PR REVSC EVASC TPVT ANGIOP UNI CPLX LES 1ST VSL

Professional

Both

$1,058.00

Service Code	HCPCS 37282
Min. Negotiated Rate	$358.05
Max. Negotiated Rate	$826.88
Rate for Payer: Aetna Medicare	$529.00
Rate for Payer: BCBS Complete	$375.95
Rate for Payer: Cash Price	$846.40
Rate for Payer: Cash Price	$846.40
Rate for Payer: Mclaren Medicaid	$358.05
Rate for Payer: Meridian Medicaid	$375.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$793.50
Rate for Payer: Priority Health Choice Medicaid	$358.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$826.88
Rate for Payer: Priority Health Narrow/Tiered Network	$826.88
Rate for Payer: UHC Medicaid	$358.05
Rate for Payer: UHCCP Medicaid	$358.05

PR REVSC EVASC TPVT ANGIOP UNI CPLX LES EA ADDL VSL

Professional

Both

$361.00

Service Code	HCPCS 37283
Min. Negotiated Rate	$122.26
Max. Negotiated Rate	$282.19
Rate for Payer: Aetna Medicare	$180.50
Rate for Payer: BCBS Complete	$128.37
Rate for Payer: Cash Price	$288.80
Rate for Payer: Cash Price	$288.80
Rate for Payer: Mclaren Medicaid	$122.26
Rate for Payer: Meridian Medicaid	$128.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$270.75
Rate for Payer: Priority Health Choice Medicaid	$122.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$282.19
Rate for Payer: Priority Health Narrow/Tiered Network	$282.19
Rate for Payer: UHC Medicaid	$122.26
Rate for Payer: UHCCP Medicaid	$122.26

PR REVSC EVASC TPVT ANGIOP UNI SF LES 1ST VSL

Professional

Both

$1,134.00

Service Code	HCPCS 37280
Min. Negotiated Rate	$285.42
Max. Negotiated Rate	$850.50
Rate for Payer: Aetna Medicare	$567.00
Rate for Payer: BCBS Complete	$299.69
Rate for Payer: Cash Price	$907.20
Rate for Payer: Cash Price	$907.20
Rate for Payer: Mclaren Medicaid	$285.42
Rate for Payer: Meridian Medicaid	$299.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$850.50
Rate for Payer: Priority Health Choice Medicaid	$285.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$659.93
Rate for Payer: Priority Health Narrow/Tiered Network	$659.93
Rate for Payer: UHC Medicaid	$285.42
Rate for Payer: UHCCP Medicaid	$285.42

PR REVSC EVASC TPVT ANGIOP UNI SF LES EA ADDL VSL

Professional

Both

$341.00

Service Code	HCPCS 37281
Min. Negotiated Rate	$85.84
Max. Negotiated Rate	$255.75
Rate for Payer: Aetna Medicare	$170.50
Rate for Payer: BCBS Complete	$90.13
Rate for Payer: Cash Price	$272.80
Rate for Payer: Cash Price	$272.80
Rate for Payer: Mclaren Medicaid	$85.84
Rate for Payer: Meridian Medicaid	$90.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$255.75
Rate for Payer: Priority Health Choice Medicaid	$85.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$198.47
Rate for Payer: Priority Health Narrow/Tiered Network	$198.47
Rate for Payer: UHC Medicaid	$85.84
Rate for Payer: UHCCP Medicaid	$85.84

PR REVSC OPN/PRG FEM/POP W/ANGIOPLASTY UNI

Professional

Both

$1,098.00

Service Code	HCPCS 37224
Min. Negotiated Rate	$439.20
Max. Negotiated Rate	$823.50
Rate for Payer: Aetna Commercial	$598.07
Rate for Payer: Aetna Medicare	$549.00
Rate for Payer: BCBS Complete	$439.20
Rate for Payer: BCN Commercial	$645.38
Rate for Payer: Cash Price	$878.40
Rate for Payer: Cash Price	$878.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$823.50

PR REVSC OPN/PRQ FEM/POP W/ATHRC/ANGIOP SM VSL

Professional

Both

$2,387.00

Service Code	HCPCS 37225
Min. Negotiated Rate	$809.21
Max. Negotiated Rate	$1,790.25
Rate for Payer: Aetna Commercial	$809.21
Rate for Payer: Aetna Medicare	$1,193.50
Rate for Payer: BCBS Complete	$954.80
Rate for Payer: BCN Commercial	$865.99
Rate for Payer: Cash Price	$1,909.60
Rate for Payer: Cash Price	$1,909.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,790.25

PR REVSC OPN/PRQ FEM/POP W/STNT/ANGIOP SM VSL

Professional

Both

$1,190.00

Service Code	HCPCS 37226
Min. Negotiated Rate	$476.00
Max. Negotiated Rate	$892.50
Rate for Payer: Aetna Commercial	$699.45
Rate for Payer: Aetna Medicare	$595.00
Rate for Payer: BCBS Complete	$476.00
Rate for Payer: BCN Commercial	$753.44
Rate for Payer: Cash Price	$952.00
Rate for Payer: Cash Price	$952.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$892.50

PR REVSC OPN/PRQ FEM/POP W/STNT/ATHRC/ANGIOP SM VSL

Professional

Both

$2,026.00

Service Code	HCPCS 37227
Min. Negotiated Rate	$810.40
Max. Negotiated Rate	$1,519.50
Rate for Payer: Aetna Commercial	$970.23
Rate for Payer: Aetna Medicare	$1,013.00
Rate for Payer: BCBS Complete	$810.40
Rate for Payer: BCN Commercial	$1,038.79
Rate for Payer: Cash Price	$1,620.80
Rate for Payer: Cash Price	$1,620.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,519.50

PR REVSC OPN/PRQ ILIAC ART W/STNT & ANGIOP IPSILATL

Professional

Both

$514.00

Service Code	HCPCS 37223
Min. Negotiated Rate	$205.60
Max. Negotiated Rate	$385.50
Rate for Payer: Aetna Commercial	$286.46
Rate for Payer: Aetna Medicare	$257.00
Rate for Payer: BCBS Complete	$205.60
Rate for Payer: BCN Commercial	$307.76
Rate for Payer: Cash Price	$411.20
Rate for Payer: Cash Price	$411.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$385.50

PR REVSC OPN/PRQ ILIAC ART W/STNT PLMT & ANGIOPLSTY

Professional

Both

$2,083.00

Service Code	HCPCS 37221
Min. Negotiated Rate	$664.33
Max. Negotiated Rate	$1,562.25
Rate for Payer: Aetna Commercial	$664.33
Rate for Payer: Aetna Medicare	$1,041.50
Rate for Payer: BCBS Complete	$833.20
Rate for Payer: BCN Commercial	$715.60
Rate for Payer: Cash Price	$1,666.40
Rate for Payer: Cash Price	$1,666.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,562.25

PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI

Professional

Both

$1,344.00

Service Code	HCPCS 37228
Min. Negotiated Rate	$537.60
Max. Negotiated Rate	$1,008.00
Rate for Payer: Aetna Commercial	$728.29
Rate for Payer: Aetna Medicare	$672.00
Rate for Payer: BCBS Complete	$537.60
Rate for Payer: BCN Commercial	$785.81
Rate for Payer: Cash Price	$1,075.20
Rate for Payer: Cash Price	$1,075.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,008.00

PR REVSC OPN/PRQ TIB/PERO W/ANGIOPLASTY UNI EA VSL

Professional

Both

$4,482.00

Service Code	HCPCS 37232
Min. Negotiated Rate	$268.20
Max. Negotiated Rate	$3,361.50
Rate for Payer: Aetna Commercial	$268.20
Rate for Payer: Aetna Medicare	$2,241.00
Rate for Payer: BCBS Complete	$1,792.80
Rate for Payer: BCN Commercial	$288.83
Rate for Payer: Cash Price	$3,585.60
Rate for Payer: Cash Price	$3,585.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,361.50

PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP SM VSL

Professional

Both

$2,815.00

Service Code	HCPCS 37229
Min. Negotiated Rate	$937.57
Max. Negotiated Rate	$2,111.25
Rate for Payer: Aetna Commercial	$937.57
Rate for Payer: Aetna Medicare	$1,407.50
Rate for Payer: BCBS Complete	$1,126.00
Rate for Payer: BCN Commercial	$1,005.42
Rate for Payer: Cash Price	$2,252.00
Rate for Payer: Cash Price	$2,252.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,111.25

PR REVSC OPN/PRQ TIB/PERO W/ATHRC/ANGIOP UNI EA VSL

Professional

Both

$1,175.00

Service Code	HCPCS 37233
Min. Negotiated Rate	$437.50
Max. Negotiated Rate	$881.25
Rate for Payer: Aetna Commercial	$437.50
Rate for Payer: Aetna Medicare	$587.50
Rate for Payer: BCBS Complete	$470.00
Rate for Payer: BCN Commercial	$467.60
Rate for Payer: Cash Price	$940.00
Rate for Payer: Cash Price	$940.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$881.25

PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP SM VSL

Professional

Both

$2,821.00

Service Code	HCPCS 37230
Min. Negotiated Rate	$935.98
Max. Negotiated Rate	$2,115.75
Rate for Payer: Aetna Commercial	$935.98
Rate for Payer: Aetna Medicare	$1,410.50
Rate for Payer: BCBS Complete	$1,128.40
Rate for Payer: BCN Commercial	$1,009.41
Rate for Payer: Cash Price	$2,256.80
Rate for Payer: Cash Price	$2,256.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,115.75

PR REVSC OPN/PRQ TIB/PERO W/STNT/ANGIOP UNI EA VSL

Professional

Both

$536.00

Service Code	HCPCS 37234
Min. Negotiated Rate	$214.40
Max. Negotiated Rate	$408.84
Rate for Payer: Aetna Commercial	$383.02
Rate for Payer: Aetna Medicare	$268.00
Rate for Payer: BCBS Complete	$214.40
Rate for Payer: BCN Commercial	$408.84
Rate for Payer: Cash Price	$428.80
Rate for Payer: Cash Price	$428.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$402.00

PR RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR

Professional

Both

$2,538.00

Service Code	HCPCS 30420
Min. Negotiated Rate	$836.88
Max. Negotiated Rate	$2,154.27
Rate for Payer: Aetna Commercial	$1,845.15
Rate for Payer: Aetna Medicare	$1,269.00
Rate for Payer: BCBS Complete	$878.72
Rate for Payer: BCN Commercial	$2,154.27
Rate for Payer: Cash Price	$2,030.40
Rate for Payer: Cash Price	$2,030.40
Rate for Payer: Mclaren Medicaid	$836.88
Rate for Payer: Meridian Medicaid	$878.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,903.50
Rate for Payer: Priority Health Choice Medicaid	$836.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,028.68
Rate for Payer: Priority Health Narrow/Tiered Network	$2,028.68
Rate for Payer: UHC Medicaid	$836.88
Rate for Payer: UHCCP Medicaid	$836.88

PR RHINOPLASTY SECONDARY INTERMEDIATE REVISION

Professional

Both

$2,091.00

Service Code	HCPCS 30435
Min. Negotiated Rate	$823.03
Max. Negotiated Rate	$1,999.89
Rate for Payer: Aetna Commercial	$1,717.52
Rate for Payer: Aetna Medicare	$1,045.50
Rate for Payer: BCBS Complete	$864.18
Rate for Payer: BCN Commercial	$1,999.89
Rate for Payer: Cash Price	$1,672.80
Rate for Payer: Cash Price	$1,672.80
Rate for Payer: Mclaren Medicaid	$823.03
Rate for Payer: Meridian Medicaid	$864.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,568.25
Rate for Payer: Priority Health Choice Medicaid	$823.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,883.31
Rate for Payer: Priority Health Narrow/Tiered Network	$1,883.31
Rate for Payer: UHC Medicaid	$823.03
Rate for Payer: UHCCP Medicaid	$823.03

PR RHINOPLASTY SECONDARY MAJOR REVISION

Professional

Both

$3,605.00

Service Code	HCPCS 30450
Min. Negotiated Rate	$1,046.26
Max. Negotiated Rate	$2,703.75
Rate for Payer: Aetna Commercial	$2,252.58
Rate for Payer: Aetna Medicare	$1,802.50
Rate for Payer: BCBS Complete	$1,098.57
Rate for Payer: BCN Commercial	$2,616.89
Rate for Payer: Cash Price	$2,884.00
Rate for Payer: Cash Price	$2,884.00
Rate for Payer: Mclaren Medicaid	$1,046.26
Rate for Payer: Meridian Medicaid	$1,098.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,703.75
Rate for Payer: Priority Health Choice Medicaid	$1,046.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,464.34
Rate for Payer: Priority Health Narrow/Tiered Network	$2,464.34
Rate for Payer: UHC Medicaid	$1,046.26
Rate for Payer: UHCCP Medicaid	$1,046.26

PR RHINP DFRM W/COLUM LNGTH TIP ONLY

Professional

Both

$1,411.00

Service Code	HCPCS 30460
Min. Negotiated Rate	$489.47
Max. Negotiated Rate	$1,245.45
Rate for Payer: Aetna Commercial	$1,069.66
Rate for Payer: Aetna Medicare	$705.50
Rate for Payer: BCBS Complete	$513.94
Rate for Payer: BCN Commercial	$1,245.45
Rate for Payer: Cash Price	$1,128.80
Rate for Payer: Cash Price	$1,128.80
Rate for Payer: Mclaren Medicaid	$489.47
Rate for Payer: Meridian Medicaid	$513.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,058.25
Rate for Payer: Priority Health Choice Medicaid	$489.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,172.85
Rate for Payer: Priority Health Narrow/Tiered Network	$1,172.85
Rate for Payer: UHC Medicaid	$489.47
Rate for Payer: UHCCP Medicaid	$489.47

PR RHINP PRIM COMPLETE XTRNL PARTS

Professional

Both

$3,152.00

Service Code	HCPCS 30410
Min. Negotiated Rate	$863.72
Max. Negotiated Rate	$2,364.00
Rate for Payer: Aetna Commercial	$1,815.03
Rate for Payer: Aetna Commercial	$1,815.03
Rate for Payer: Aetna Medicare	$1,588.50
Rate for Payer: Aetna Medicare	$1,576.00
Rate for Payer: BCBS Complete	$906.91
Rate for Payer: BCBS Complete	$906.91
Rate for Payer: BCN Commercial	$2,112.93
Rate for Payer: BCN Commercial	$2,112.93
Rate for Payer: Cash Price	$2,521.60
Rate for Payer: Cash Price	$2,541.60
Rate for Payer: Cash Price	$2,541.60
Rate for Payer: Cash Price	$2,521.60
Rate for Payer: Mclaren Medicaid	$863.72
Rate for Payer: Mclaren Medicaid	$863.72
Rate for Payer: Meridian Medicaid	$906.91
Rate for Payer: Meridian Medicaid	$906.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,382.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,364.00
Rate for Payer: Priority Health Choice Medicaid	$863.72
Rate for Payer: Priority Health Choice Medicaid	$863.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,989.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,989.75
Rate for Payer: Priority Health Narrow/Tiered Network	$1,989.75
Rate for Payer: Priority Health Narrow/Tiered Network	$1,989.75
Rate for Payer: UHC Medicaid	$863.72
Rate for Payer: UHC Medicaid	$863.72
Rate for Payer: UHCCP Medicaid	$863.72
Rate for Payer: UHCCP Medicaid	$863.72

PR RHINP PRIM LAT&ALAR CRTLGS&/ELVTN NASAL TI

Professional

Both

$1,576.00

Service Code	HCPCS 30400
Min. Negotiated Rate	$762.75
Max. Negotiated Rate	$1,833.56
Rate for Payer: Aetna Commercial	$1,572.55
Rate for Payer: Aetna Medicare	$788.00
Rate for Payer: BCBS Complete	$800.89
Rate for Payer: BCN Commercial	$1,833.56
Rate for Payer: Cash Price	$1,260.80
Rate for Payer: Cash Price	$1,260.80
Rate for Payer: Mclaren Medicaid	$762.75
Rate for Payer: Meridian Medicaid	$800.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,182.00
Rate for Payer: Priority Health Choice Medicaid	$762.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,726.68
Rate for Payer: Priority Health Narrow/Tiered Network	$1,726.68
Rate for Payer: UHC Medicaid	$762.75
Rate for Payer: UHCCP Medicaid	$762.75

Know your out-of-pocket cost for care.

All Charges