Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR RHO(D) IMMUNE GLOBULIN HUMAN FULL-DOSE IM

Professional

Both

$158.00

Service Code	HCPCS 90384
Min. Negotiated Rate	$78.10
Max. Negotiated Rate	$250.00
Rate for Payer: Aetna Commercial	$78.10
Rate for Payer: Aetna Medicare	$79.00
Rate for Payer: BCBS Trust/PPO	$85.31
Rate for Payer: BCN Commercial	$250.00
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.50

PR RHO D IMMUNE GLOBULIN INJ

Professional

Both

$158.00

Service Code	HCPCS J2790
Min. Negotiated Rate	$63.27
Max. Negotiated Rate	$118.50
Rate for Payer: Aetna Commercial	$83.60
Rate for Payer: Aetna Medicare	$79.00
Rate for Payer: BCBS Trust/PPO	$67.20
Rate for Payer: BCN Commercial	$63.27
Rate for Payer: Cash Price	$126.40
Rate for Payer: Cash Price	$126.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.50

PR RHYTHM ECG 1-3 LEADS INTERPRETATION & REPRT ON

Professional

Both

$29.00

Service Code	HCPCS 93042
Min. Negotiated Rate	$4.47
Max. Negotiated Rate	$21.75
Rate for Payer: Aetna Commercial	$9.24
Rate for Payer: Aetna Medicare	$14.50
Rate for Payer: BCBS Complete	$4.69
Rate for Payer: BCN Commercial	$7.85
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$23.20
Rate for Payer: Mclaren Medicaid	$4.47
Rate for Payer: Meridian Medicaid	$4.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.75
Rate for Payer: Priority Health Choice Medicaid	$4.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$9.47
Rate for Payer: Priority Health Narrow/Tiered Network	$9.47
Rate for Payer: UHC Medicaid	$4.47
Rate for Payer: UHCCP Medicaid	$4.47

PR RHYTHM ECG 1-3 LEADS TRACING ONLY W/O I&R

Professional

Both

$16.00

Service Code	HCPCS 93041
Min. Negotiated Rate	$7.33
Max. Negotiated Rate	$12.00
Rate for Payer: Aetna Commercial	$7.33
Rate for Payer: Aetna Medicare	$8.00
Rate for Payer: BCN Commercial	$9.96
Rate for Payer: Cash Price	$12.80
Rate for Payer: Cash Price	$12.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$12.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$9.47
Rate for Payer: Priority Health Narrow/Tiered Network	$9.47

PR RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT

Professional

Both

$46.00

Service Code	HCPCS 93040
Min. Negotiated Rate	$16.57
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna Commercial	$16.57
Rate for Payer: Aetna Medicare	$23.00
Rate for Payer: BCN Commercial	$19.92
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	$18.93
Rate for Payer: Priority Health Narrow/Tiered Network	$18.93

PR RHYTIDECTOMY 3 HOURS

Professional

Both

$7,210.00

Hospital Revenue Code	990
Min. Negotiated Rate	$2,884.00
Max. Negotiated Rate	$5,407.50
Rate for Payer: Aetna Medicare	$3,605.00
Rate for Payer: BCBS Complete	$2,884.00
Rate for Payer: Cash Price	$5,768.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,407.50

PR RHYTIDECTOMY SMAS FLAP

Professional

Both

$5,043.00

Service Code	HCPCS 15829
Min. Negotiated Rate	$2,521.50
Max. Negotiated Rate	$3,782.25
Rate for Payer: Aetna Commercial	$2,885.67
Rate for Payer: Aetna Medicare	$2,521.50
Rate for Payer: BCN Commercial	$3,423.01
Rate for Payer: Cash Price	$4,034.40
Rate for Payer: Cash Price	$4,034.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,782.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,663.57
Rate for Payer: Priority Health Narrow/Tiered Network	$3,663.57

PR RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT

Professional

Both

$459.00

Service Code	HCPCS 93451
Min. Negotiated Rate	$229.50
Max. Negotiated Rate	$1,220.05
Rate for Payer: Aetna Commercial	$1,160.68
Rate for Payer: Aetna Commercial	$1,160.68
Rate for Payer: Aetna Medicare	$1,133.00
Rate for Payer: Aetna Medicare	$229.50
Rate for Payer: BCN Commercial	$1,220.05
Rate for Payer: BCN Commercial	$1,220.05
Rate for Payer: Cash Price	$1,812.80
Rate for Payer: Cash Price	$1,812.80
Rate for Payer: Cash Price	$367.20
Rate for Payer: Cash Price	$367.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$344.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,699.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,159.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,159.60
Rate for Payer: Priority Health Narrow/Tiered Network	$1,159.60
Rate for Payer: Priority Health Narrow/Tiered Network	$1,159.60

PR RIMPLTJ VISC ART INFRARNL AORTIC PROSTH EA ART

Professional

Both

$338.00

Service Code	HCPCS 35697
Min. Negotiated Rate	$84.14
Max. Negotiated Rate	$253.50
Rate for Payer: Aetna Commercial	$199.90
Rate for Payer: Aetna Medicare	$169.00
Rate for Payer: BCBS Complete	$88.35
Rate for Payer: BCN Commercial	$213.13
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cash Price	$270.40
Rate for Payer: Mclaren Medicaid	$84.14
Rate for Payer: Meridian Medicaid	$88.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$253.50
Rate for Payer: Priority Health Choice Medicaid	$84.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$229.20
Rate for Payer: Priority Health Narrow/Tiered Network	$229.20
Rate for Payer: UHC Medicaid	$84.14
Rate for Payer: UHCCP Medicaid	$84.14

PR RINGERS LACTATE INFUSION

Professional

Both

$32.00

Service Code	HCPCS J7120
Min. Negotiated Rate	$0.70
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$2.67
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCBS Trust/PPO	$0.72
Rate for Payer: BCN Commercial	$0.70
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00

PR RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF

Professional

Both

$2,711.00

Service Code	HCPCS 24342
Min. Negotiated Rate	$456.67
Max. Negotiated Rate	$2,033.25
Rate for Payer: Aetna Commercial	$1,036.16
Rate for Payer: Aetna Medicare	$1,355.50
Rate for Payer: BCBS Complete	$479.50
Rate for Payer: BCN Commercial	$1,180.71
Rate for Payer: Cash Price	$2,168.80
Rate for Payer: Cash Price	$2,168.80
Rate for Payer: Mclaren Medicaid	$456.67
Rate for Payer: Meridian Medicaid	$479.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,033.25
Rate for Payer: Priority Health Choice Medicaid	$456.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,262.16
Rate for Payer: Priority Health Narrow/Tiered Network	$1,262.16
Rate for Payer: UHC Medicaid	$456.67
Rate for Payer: UHCCP Medicaid	$456.67

PR RISK ASCVD TST ONCE PR 12 MO

Professional

Both

$18.00

Service Code	HCPCS G0537
Min. Negotiated Rate	$5.11
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Medicare	$9.00
Rate for Payer: BCBS Complete	$5.37
Rate for Payer: BCN Commercial	$13.45
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Mclaren Medicaid	$5.11
Rate for Payer: Meridian Medicaid	$5.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.50
Rate for Payer: Priority Health Choice Medicaid	$5.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$12.09
Rate for Payer: Priority Health Narrow/Tiered Network	$12.09
Rate for Payer: UHC Medicaid	$5.11
Rate for Payer: UHCCP Medicaid	$5.11

PR RIV3 VACCINE PRESERVATIVE FREE FOR IM USE

Professional

Both

$114.00

Service Code	HCPCS 90673
Min. Negotiated Rate	$36.34
Max. Negotiated Rate	$86.23
Rate for Payer: Aetna Commercial	$36.34
Rate for Payer: Aetna Medicare	$57.00
Rate for Payer: BCBS Trust/PPO	$86.23
Rate for Payer: BCN Commercial	$72.06
Rate for Payer: Cash Price	$91.20
Rate for Payer: Cash Price	$91.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$85.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$42.45
Rate for Payer: Priority Health Narrow/Tiered Network	$42.45

PR RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM

Professional

Both

$96.00

Service Code	HCPCS 90682
Min. Negotiated Rate	$48.00
Max. Negotiated Rate	$73.62
Rate for Payer: Aetna Commercial	$73.40
Rate for Payer: Aetna Medicare	$48.00
Rate for Payer: BCBS Trust/PPO	$64.51
Rate for Payer: BCN Commercial	$73.62
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 R& L HRT CATH W/INJEC HRT ART/GRFT& L VENT I

Professional

Both

$2,888.00

Service Code	HCPCS 93461
Min. Negotiated Rate	$1,444.00
Max. Negotiated Rate	$2,166.00
Rate for Payer: Aetna Commercial	$1,897.18
Rate for Payer: Aetna Commercial	$1,897.18
Rate for Payer: Aetna Medicare	$1,444.00
Rate for Payer: Aetna Medicare	$1,503.50
Rate for Payer: BCN Commercial	$1,953.58
Rate for Payer: BCN Commercial	$1,953.58
Rate for Payer: Cash Price	$2,310.40
Rate for Payer: Cash Price	$2,310.40
Rate for Payer: Cash Price	$2,405.60
Rate for Payer: Cash Price	$2,405.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,166.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,255.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,856.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,856.77
Rate for Payer: Priority Health Narrow/Tiered Network	$1,856.77
Rate for Payer: Priority Health Narrow/Tiered Network	$1,856.77

PR R & L HRT CATH WINJX HRT ART& L VENTR IMG

Professional

Both

$1,266.00

Service Code	HCPCS 93460
Min. Negotiated Rate	$633.00
Max. Negotiated Rate	$1,770.82
Rate for Payer: Aetna Commercial	$1,711.27
Rate for Payer: Aetna Medicare	$633.00
Rate for Payer: BCN Commercial	$1,770.82
Rate for Payer: Cash Price	$1,012.80
Rate for Payer: Cash Price	$1,012.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$949.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,683.07
Rate for Payer: Priority Health Narrow/Tiered Network	$1,683.07

PR R & L HRT CATH W/NJX L VENTRICULOG IMG S&I

Professional

Both

$692.00

Service Code	HCPCS 93453
Min. Negotiated Rate	$346.00
Max. Negotiated Rate	$1,630.89
Rate for Payer: Aetna Commercial	$1,569.84
Rate for Payer: Aetna Medicare	$346.00
Rate for Payer: BCN Commercial	$1,630.89
Rate for Payer: Cash Price	$553.60
Rate for Payer: Cash Price	$553.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$519.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,550.08
Rate for Payer: Priority Health Narrow/Tiered Network	$1,550.08

PR RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ

Professional

Both

$1,850.00

Service Code	HCPCS 33244
Min. Negotiated Rate	$488.84
Max. Negotiated Rate	$1,387.50
Rate for Payer: Aetna Commercial	$1,162.22
Rate for Payer: Aetna Medicare	$925.00
Rate for Payer: BCBS Complete	$513.28
Rate for Payer: BCN Commercial	$1,268.85
Rate for Payer: Cash Price	$1,480.00
Rate for Payer: Cash Price	$1,480.00
Rate for Payer: Mclaren Medicaid	$488.84
Rate for Payer: Meridian Medicaid	$513.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,387.50
Rate for Payer: Priority Health Choice Medicaid	$488.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,364.50
Rate for Payer: Priority Health Narrow/Tiered Network	$1,364.50
Rate for Payer: UHC Medicaid	$488.84
Rate for Payer: UHCCP Medicaid	$488.84

PR RMVL ASCENDING-AORTA BALO DEV W/RPR ASCEND-AORTA

Professional

Both

$2,554.00

Service Code	HCPCS 33974
Min. Negotiated Rate	$555.93
Max. Negotiated Rate	$1,915.50
Rate for Payer: Aetna Commercial	$1,191.43
Rate for Payer: Aetna Medicare	$1,277.00
Rate for Payer: BCBS Complete	$583.73
Rate for Payer: BCN Commercial	$1,318.65
Rate for Payer: Cash Price	$2,043.20
Rate for Payer: Cash Price	$2,043.20
Rate for Payer: Mclaren Medicaid	$555.93
Rate for Payer: Meridian Medicaid	$583.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,915.50
Rate for Payer: Priority Health Choice Medicaid	$555.93
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,418.05
Rate for Payer: Priority Health Narrow/Tiered Network	$1,418.05
Rate for Payer: UHC Medicaid	$555.93
Rate for Payer: UHCCP Medicaid	$555.93

PR RMVL BONE FLAP/PROSTHETIC PLATE SKULL

Professional

Both

$3,472.00

Service Code	HCPCS 62142
Min. Negotiated Rate	$574.67
Max. Negotiated Rate	$2,604.00
Rate for Payer: Aetna Commercial	$1,142.27
Rate for Payer: Aetna Medicare	$1,736.00
Rate for Payer: BCBS Complete	$603.40
Rate for Payer: BCN Commercial	$1,895.37
Rate for Payer: Cash Price	$2,777.60
Rate for Payer: Cash Price	$2,777.60
Rate for Payer: Mclaren Medicaid	$574.67
Rate for Payer: Meridian Medicaid	$603.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,604.00
Rate for Payer: Priority Health Choice Medicaid	$574.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,593.49
Rate for Payer: Priority Health Narrow/Tiered Network	$1,593.49
Rate for Payer: UHC Medicaid	$574.67
Rate for Payer: UHCCP Medicaid	$574.67

PR RMVL COMPL CSF SHUNT SYSTEM W/O RPLCMT SHUNT

Professional

Both

$2,273.00

Service Code	HCPCS 62256
Min. Negotiated Rate	$408.11
Max. Negotiated Rate	$1,704.75
Rate for Payer: Aetna Commercial	$781.13
Rate for Payer: Aetna Medicare	$1,136.50
Rate for Payer: BCBS Complete	$428.52
Rate for Payer: BCN Commercial	$1,298.20
Rate for Payer: Cash Price	$1,818.40
Rate for Payer: Cash Price	$1,818.40
Rate for Payer: Mclaren Medicaid	$408.11
Rate for Payer: Meridian Medicaid	$428.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,704.75
Rate for Payer: Priority Health Choice Medicaid	$408.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,091.44
Rate for Payer: Priority Health Narrow/Tiered Network	$1,091.44
Rate for Payer: UHC Medicaid	$408.11
Rate for Payer: UHCCP Medicaid	$408.11

PR RMVL COMPLETE CSF SHUNT SYSTEM W/RPLCMT SHUNT

Professional

Both

$5,281.00

Service Code	HCPCS 62258
Min. Negotiated Rate	$704.82
Max. Negotiated Rate	$3,960.75
Rate for Payer: Aetna Commercial	$1,443.38
Rate for Payer: Aetna Medicare	$2,640.50
Rate for Payer: BCBS Complete	$740.06
Rate for Payer: BCN Commercial	$2,341.86
Rate for Payer: Cash Price	$4,224.80
Rate for Payer: Cash Price	$4,224.80
Rate for Payer: Mclaren Medicaid	$704.82
Rate for Payer: Meridian Medicaid	$740.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,960.75
Rate for Payer: Priority Health Choice Medicaid	$704.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,968.85
Rate for Payer: Priority Health Narrow/Tiered Network	$1,968.85
Rate for Payer: UHC Medicaid	$704.82
Rate for Payer: UHCCP Medicaid	$704.82

PR RMVL CORNEAL EPITHELIUM W/WO CHEMOCAUTERIZATION

Professional

Both

$152.00

Service Code	HCPCS 65435
Min. Negotiated Rate	$38.55
Max. Negotiated Rate	$120.75
Rate for Payer: Aetna Commercial	$89.02
Rate for Payer: Aetna Medicare	$76.00
Rate for Payer: BCBS Complete	$40.48
Rate for Payer: BCN Commercial	$103.08
Rate for Payer: Cash Price	$121.60
Rate for Payer: Cash Price	$121.60
Rate for Payer: Mclaren Medicaid	$38.55
Rate for Payer: Meridian Medicaid	$40.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$114.00
Rate for Payer: Priority Health Choice Medicaid	$38.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$120.75
Rate for Payer: Priority Health Narrow/Tiered Network	$120.75
Rate for Payer: UHC Medicaid	$38.55
Rate for Payer: UHCCP Medicaid	$38.55

PR RMVL DEVITAL TISS N-SLCTV DBRDMT W/O ANES 1 SESS

Professional

Both

$155.00

Service Code	HCPCS 97602
Min. Negotiated Rate	$62.00
Max. Negotiated Rate	$185.78
Rate for Payer: Aetna Commercial	$89.75
Rate for Payer: Aetna Medicare	$77.50
Rate for Payer: BCBS Complete	$62.00
Rate for Payer: BCN Commercial	$185.78
Rate for Payer: Cash Price	$124.00
Rate for Payer: Cash Price	$124.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$116.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$109.57
Rate for Payer: Priority Health Narrow/Tiered Network	$109.57

PR RMVL EMBEDDED FB VESTIBULE MOUTH COMP

Professional

Both

$726.00

Service Code	HCPCS 40805
Min. Negotiated Rate	$117.36
Max. Negotiated Rate	$544.50
Rate for Payer: Aetna Commercial	$263.54
Rate for Payer: Aetna Medicare	$363.00
Rate for Payer: BCBS Complete	$123.23
Rate for Payer: BCN Commercial	$302.28
Rate for Payer: Cash Price	$580.80
Rate for Payer: Cash Price	$580.80
Rate for Payer: Mclaren Medicaid	$117.36
Rate for Payer: Meridian Medicaid	$123.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$544.50
Rate for Payer: Priority Health Choice Medicaid	$117.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$368.30
Rate for Payer: Priority Health Narrow/Tiered Network	$368.30
Rate for Payer: UHC Medicaid	$117.36
Rate for Payer: UHCCP Medicaid	$117.36

Know your out-of-pocket cost for care.

All Charges