Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR RPR VENTR O/F TRC OBSTRCJ PATCH ENLGMENT O/F TRC

Professional

Both

$8,282.00

Service Code	HCPCS 33414
Min. Negotiated Rate	$1,273.31
Max. Negotiated Rate	$6,211.50
Rate for Payer: Aetna Commercial	$2,886.79
Rate for Payer: Aetna Medicare	$4,141.00
Rate for Payer: BCBS Complete	$1,336.98
Rate for Payer: BCN Commercial	$3,154.71
Rate for Payer: Cash Price	$6,625.60
Rate for Payer: Cash Price	$6,625.60
Rate for Payer: Mclaren Medicaid	$1,273.31
Rate for Payer: Meridian Medicaid	$1,336.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,211.50
Rate for Payer: Priority Health Choice Medicaid	$1,273.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,392.49
Rate for Payer: Priority Health Narrow/Tiered Network	$3,392.49
Rate for Payer: UHC Medicaid	$1,273.31
Rate for Payer: UHCCP Medicaid	$1,273.31

PR RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER

Professional

Both

$2,908.00

Service Code	HCPCS 26428
Min. Negotiated Rate	$503.32
Max. Negotiated Rate	$2,181.00
Rate for Payer: Aetna Commercial	$1,057.07
Rate for Payer: Aetna Medicare	$1,454.00
Rate for Payer: BCBS Complete	$528.49
Rate for Payer: BCN Commercial	$1,200.63
Rate for Payer: Cash Price	$2,326.40
Rate for Payer: Cash Price	$2,326.40
Rate for Payer: Mclaren Medicaid	$503.32
Rate for Payer: Meridian Medicaid	$528.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,181.00
Rate for Payer: Priority Health Choice Medicaid	$503.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,283.44
Rate for Payer: Priority Health Narrow/Tiered Network	$1,283.44
Rate for Payer: UHC Medicaid	$503.32
Rate for Payer: UHCCP Medicaid	$503.32

PR RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR

Professional

Both

$2,042.00

Service Code	HCPCS 26426
Min. Negotiated Rate	$303.53
Max. Negotiated Rate	$1,531.50
Rate for Payer: Aetna Commercial	$669.62
Rate for Payer: Aetna Medicare	$1,021.00
Rate for Payer: BCBS Complete	$318.71
Rate for Payer: BCN Commercial	$777.35
Rate for Payer: Cash Price	$1,633.60
Rate for Payer: Cash Price	$1,633.60
Rate for Payer: Mclaren Medicaid	$303.53
Rate for Payer: Meridian Medicaid	$318.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,531.50
Rate for Payer: Priority Health Choice Medicaid	$303.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$830.97
Rate for Payer: Priority Health Narrow/Tiered Network	$830.97
Rate for Payer: UHC Medicaid	$303.53
Rate for Payer: UHCCP Medicaid	$303.53

PR RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD

Professional

Both

$1,336.00

Service Code	HCPCS 33226
Min. Negotiated Rate	$269.87
Max. Negotiated Rate	$1,002.00
Rate for Payer: Aetna Commercial	$663.10
Rate for Payer: Aetna Medicare	$668.00
Rate for Payer: BCBS Complete	$283.36
Rate for Payer: BCN Commercial	$717.09
Rate for Payer: Cash Price	$1,068.80
Rate for Payer: Cash Price	$1,068.80
Rate for Payer: Mclaren Medicaid	$269.87
Rate for Payer: Meridian Medicaid	$283.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,002.00
Rate for Payer: Priority Health Choice Medicaid	$269.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$771.14
Rate for Payer: Priority Health Narrow/Tiered Network	$771.14
Rate for Payer: UHC Medicaid	$269.87
Rate for Payer: UHCCP Medicaid	$269.87

PR RPSG PREV IMPLTED PM/DFB R ATR/R VENTR ELECTRODE

Professional

Both

$1,060.00

Service Code	HCPCS 33215
Min. Negotiated Rate	$175.51
Max. Negotiated Rate	$795.00
Rate for Payer: Aetna Commercial	$415.09
Rate for Payer: Aetna Medicare	$530.00
Rate for Payer: BCBS Complete	$184.29
Rate for Payer: BCN Commercial	$458.64
Rate for Payer: Cash Price	$848.00
Rate for Payer: Cash Price	$848.00
Rate for Payer: Mclaren Medicaid	$175.51
Rate for Payer: Meridian Medicaid	$184.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$795.00
Rate for Payer: Priority Health Choice Medicaid	$175.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$493.21
Rate for Payer: Priority Health Narrow/Tiered Network	$493.21
Rate for Payer: UHC Medicaid	$175.51
Rate for Payer: UHCCP Medicaid	$175.51

PR RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE

Professional

Both

$325.00

Service Code	HCPCS 36597
Min. Negotiated Rate	$33.23
Max. Negotiated Rate	$243.75
Rate for Payer: Aetna Commercial	$81.05
Rate for Payer: Aetna Medicare	$162.50
Rate for Payer: BCBS Complete	$34.89
Rate for Payer: BCN Commercial	$88.64
Rate for Payer: Cash Price	$260.00
Rate for Payer: Cash Price	$260.00
Rate for Payer: Mclaren Medicaid	$33.23
Rate for Payer: Meridian Medicaid	$34.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$243.75
Rate for Payer: Priority Health Choice Medicaid	$33.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$95.33
Rate for Payer: Priority Health Narrow/Tiered Network	$95.33
Rate for Payer: UHC Medicaid	$33.23
Rate for Payer: UHCCP Medicaid	$33.23

PR RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE

Professional

Both

$1,342.00

Service Code	HCPCS 90380
Min. Negotiated Rate	$504.90
Max. Negotiated Rate	$1,006.50
Rate for Payer: Aetna Commercial	$504.90
Rate for Payer: Aetna Medicare	$671.00
Rate for Payer: BCBS Trust/PPO	$595.06
Rate for Payer: BCN Commercial	$547.23
Rate for Payer: Cash Price	$1,073.60
Rate for Payer: Cash Price	$1,073.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,006.50

PR RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE

Professional

Both

$1,342.00

Service Code	HCPCS 90381
Min. Negotiated Rate	$504.90
Max. Negotiated Rate	$1,006.50
Rate for Payer: Aetna Commercial	$504.90
Rate for Payer: Aetna Medicare	$671.00
Rate for Payer: BCBS Trust/PPO	$595.06
Rate for Payer: BCN Commercial	$547.23
Rate for Payer: Cash Price	$1,073.60
Rate for Payer: Cash Price	$1,073.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,006.50

PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE

Professional

Both

$865.00

Service Code	HCPCS 90678
Min. Negotiated Rate	$300.90
Max. Negotiated Rate	$648.75
Rate for Payer: Aetna Commercial	$300.90
Rate for Payer: Aetna Medicare	$432.50
Rate for Payer: BCBS Trust/PPO	$319.07
Rate for Payer: BCN Commercial	$325.00
Rate for Payer: Cash Price	$692.00
Rate for Payer: Cash Price	$692.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$648.75

PR RSV VACC PREF RECOMBINANT ADJUVANTED FOR IM USE

Professional

Both

$821.00

Service Code	HCPCS 90679
Min. Negotiated Rate	$285.60
Max. Negotiated Rate	$615.75
Rate for Payer: Aetna Commercial	$285.60
Rate for Payer: Aetna Medicare	$410.50
Rate for Payer: BCBS Trust/PPO	$306.35
Rate for Payer: BCN Commercial	$289.29
Rate for Payer: Cash Price	$656.80
Rate for Payer: Cash Price	$656.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$615.75

PR RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I

Professional

Both

$3,034.00

Service Code	HCPCS 37193
Min. Negotiated Rate	$192.55
Max. Negotiated Rate	$2,275.50
Rate for Payer: Aetna Commercial	$464.98
Rate for Payer: Aetna Medicare	$1,517.00
Rate for Payer: BCBS Complete	$202.18
Rate for Payer: BCN Commercial	$504.96
Rate for Payer: Cash Price	$2,427.20
Rate for Payer: Cash Price	$2,427.20
Rate for Payer: Mclaren Medicaid	$192.55
Rate for Payer: Meridian Medicaid	$202.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,275.50
Rate for Payer: Priority Health Choice Medicaid	$192.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$543.01
Rate for Payer: Priority Health Narrow/Tiered Network	$543.01
Rate for Payer: UHC Medicaid	$192.55
Rate for Payer: UHCCP Medicaid	$192.55

PR RUBELLA IMMUNIZATION, SUBCUT

Professional

Both

$32.00

Service Code	HCPCS 90706
Min. Negotiated Rate	$12.80
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCBS Complete	$12.80
Rate for Payer: Cash Price	$25.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00

PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE

Professional

Both

$164.00

Service Code	HCPCS 90681
Min. Negotiated Rate	$82.00
Max. Negotiated Rate	$147.02
Rate for Payer: Aetna Commercial	$137.29
Rate for Payer: Aetna Medicare	$82.00
Rate for Payer: BCBS Trust/PPO	$147.02
Rate for Payer: BCN Commercial	$144.54
Rate for Payer: Cash Price	$131.20
Rate for Payer: Cash Price	$131.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$123.00

PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE

Professional

Both

$99.00

Service Code	HCPCS 90680
Min. Negotiated Rate	$49.50
Max. Negotiated Rate	$102.74
Rate for Payer: Aetna Commercial	$97.75
Rate for Payer: Aetna Medicare	$49.50
Rate for Payer: BCBS Trust/PPO	$102.74
Rate for Payer: BCN Commercial	$97.11
Rate for Payer: Cash Price	$79.20
Rate for Payer: Cash Price	$79.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$74.25

PR R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY

Professional

Both

$3,236.00

Service Code	HCPCS 33476
Min. Negotiated Rate	$923.78
Max. Negotiated Rate	$2,427.00
Rate for Payer: Aetna Commercial	$2,042.75
Rate for Payer: Aetna Medicare	$1,618.00
Rate for Payer: BCBS Complete	$969.97
Rate for Payer: BCN Commercial	$2,253.86
Rate for Payer: Cash Price	$2,588.80
Rate for Payer: Cash Price	$2,588.80
Rate for Payer: Mclaren Medicaid	$923.78
Rate for Payer: Meridian Medicaid	$969.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,427.00
Rate for Payer: Priority Health Choice Medicaid	$923.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,423.74
Rate for Payer: Priority Health Narrow/Tiered Network	$2,423.74
Rate for Payer: UHC Medicaid	$923.78
Rate for Payer: UHCCP Medicaid	$923.78

PR RX&FITG C-LENS SUPVJ CRNL LENS OU XCPT APHK

Professional

Both

$170.00

Service Code	HCPCS 92310
Min. Negotiated Rate	$31.10
Max. Negotiated Rate	$127.50
Rate for Payer: Aetna Commercial	$64.40
Rate for Payer: Aetna Medicare	$85.00
Rate for Payer: BCBS Complete	$32.66
Rate for Payer: BCN Commercial	$84.16
Rate for Payer: Cash Price	$136.00
Rate for Payer: Cash Price	$136.00
Rate for Payer: Mclaren Medicaid	$31.10
Rate for Payer: Meridian Medicaid	$32.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$127.50
Rate for Payer: Priority Health Choice Medicaid	$31.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$72.02
Rate for Payer: Priority Health Narrow/Tiered Network	$72.02
Rate for Payer: UHC Medicaid	$31.10
Rate for Payer: UHCCP Medicaid	$31.10

PR RX&FITG C-LENS TECH CRNL LENS OU XCPT APHAKIA

Professional

Both

$141.00

Service Code	HCPCS 92314
Min. Negotiated Rate	$37.80
Max. Negotiated Rate	$105.75
Rate for Payer: Aetna Commercial	$37.80
Rate for Payer: Aetna Medicare	$70.50
Rate for Payer: BCBS Complete	$56.40
Rate for Payer: BCN Commercial	$49.80
Rate for Payer: Cash Price	$112.80
Rate for Payer: Cash Price	$112.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$105.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$42.61
Rate for Payer: Priority Health Narrow/Tiered Network	$42.61

PR RX RIB FRACTURE W EXTERN FIXATN

Professional

Both

$1,357.00

Service Code	HCPCS 21810
Min. Negotiated Rate	$542.80
Max. Negotiated Rate	$1,017.75
Rate for Payer: Aetna Medicare	$678.50
Rate for Payer: BCBS Complete	$542.80
Rate for Payer: Cash Price	$1,085.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,017.75

PR SACRAL NERVE STIM TEST LEAD

Professional

Both

$168.00

Service Code	HCPCS A4290
Min. Negotiated Rate	$22.50
Max. Negotiated Rate	$126.00
Rate for Payer: Aetna Commercial	$57.67
Rate for Payer: Aetna Medicare	$84.00
Rate for Payer: BCBS Complete	$67.20
Rate for Payer: BCN Commercial	$22.50
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 SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX

Professional

Both

$1,801.00

Service Code	HCPCS 58700
Min. Negotiated Rate	$465.83
Max. Negotiated Rate	$1,350.75
Rate for Payer: Aetna Commercial	$948.70
Rate for Payer: Aetna Medicare	$900.50
Rate for Payer: BCBS Complete	$489.12
Rate for Payer: BCN Commercial	$1,205.61
Rate for Payer: Cash Price	$1,440.80
Rate for Payer: Cash Price	$1,440.80
Rate for Payer: Mclaren Medicaid	$465.83
Rate for Payer: Meridian Medicaid	$489.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,350.75
Rate for Payer: Priority Health Choice Medicaid	$465.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,221.03
Rate for Payer: Priority Health Narrow/Tiered Network	$1,221.03
Rate for Payer: UHC Medicaid	$465.83
Rate for Payer: UHCCP Medicaid	$465.83

PR SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX

Professional

Both

$2,102.00

Service Code	HCPCS 58720
Min. Negotiated Rate	$445.38
Max. Negotiated Rate	$1,576.50
Rate for Payer: Aetna Commercial	$897.45
Rate for Payer: Aetna Medicare	$1,051.00
Rate for Payer: BCBS Complete	$467.65
Rate for Payer: BCN Commercial	$1,143.36
Rate for Payer: Cash Price	$1,681.60
Rate for Payer: Cash Price	$1,681.60
Rate for Payer: Mclaren Medicaid	$445.38
Rate for Payer: Meridian Medicaid	$467.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,576.50
Rate for Payer: Priority Health Choice Medicaid	$445.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,157.99
Rate for Payer: Priority Health Narrow/Tiered Network	$1,157.99
Rate for Payer: UHC Medicaid	$445.38
Rate for Payer: UHCCP Medicaid	$445.38

PR SALPINGOSTOMY

Professional

Both

$2,809.00

Service Code	HCPCS 58770
Min. Negotiated Rate	$484.79
Max. Negotiated Rate	$2,106.75
Rate for Payer: Aetna Commercial	$1,032.82
Rate for Payer: Aetna Medicare	$1,404.50
Rate for Payer: BCBS Complete	$509.03
Rate for Payer: BCN Commercial	$1,290.27
Rate for Payer: Cash Price	$2,247.20
Rate for Payer: Cash Price	$2,247.20
Rate for Payer: Mclaren Medicaid	$484.79
Rate for Payer: Meridian Medicaid	$509.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,106.75
Rate for Payer: Priority Health Choice Medicaid	$484.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,306.77
Rate for Payer: Priority Health Narrow/Tiered Network	$1,306.77
Rate for Payer: UHC Medicaid	$484.79
Rate for Payer: UHCCP Medicaid	$484.79

PR SARSCOV2 VACC 10MCG/0.3ML TRIS-SUCROSE IM USE

Professional

Both

$226.00

Service Code	HCPCS 91319
Min. Negotiated Rate	$75.76
Max. Negotiated Rate	$169.50
Rate for Payer: Aetna Commercial	$87.78
Rate for Payer: Aetna Medicare	$113.00
Rate for Payer: BCBS Trust/PPO	$83.16
Rate for Payer: BCN Commercial	$75.76
Rate for Payer: Cash Price	$180.80
Rate for Payer: Cash Price	$180.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$169.50

PR SARSCOV2 VACC 30MCG/0.3ML TRIS-SUCROSE IM USE

Professional

Both

$337.00

Service Code	HCPCS 91320
Min. Negotiated Rate	$131.10
Max. Negotiated Rate	$252.75
Rate for Payer: Aetna Commercial	$131.10
Rate for Payer: Aetna Medicare	$168.50
Rate for Payer: BCBS Trust/PPO	$168.94
Rate for Payer: BCN Commercial	$134.56
Rate for Payer: Cash Price	$269.60
Rate for Payer: Cash Price	$269.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$252.75

PR SARSCOV2 VACC 3MCG/0.3ML TRIS-SUCROSE IM USE

Professional

Both

$169.00

Service Code	HCPCS 91318
Min. Negotiated Rate	$56.58
Max. Negotiated Rate	$126.75
Rate for Payer: Aetna Commercial	$65.36
Rate for Payer: Aetna Medicare	$84.50
Rate for Payer: BCBS Trust/PPO	$57.50
Rate for Payer: BCN Commercial	$56.58
Rate for Payer: Cash Price	$135.20
Rate for Payer: Cash Price	$135.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$126.75

Know your out-of-pocket cost for care.

All Charges