Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR SUTURE FACIAL NERVE EXTRACRANIAL

Professional

Both

$2,502.00

Service Code	HCPCS 64864
Min. Negotiated Rate	$481.59
Max. Negotiated Rate	$1,876.50
Rate for Payer: Aetna Commercial	$1,100.43
Rate for Payer: Aetna Medicare	$1,251.00
Rate for Payer: BCBS Complete	$505.67
Rate for Payer: BCN Commercial	$1,294.26
Rate for Payer: Cash Price	$2,001.60
Rate for Payer: Cash Price	$2,001.60
Rate for Payer: Mclaren Medicaid	$481.59
Rate for Payer: Meridian Medicaid	$505.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,876.50
Rate for Payer: Priority Health Choice Medicaid	$481.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,503.26
Rate for Payer: Priority Health Narrow/Tiered Network	$1,503.26
Rate for Payer: UHC Medicaid	$481.59
Rate for Payer: UHCCP Medicaid	$481.59

PR SUTURE FACIAL NERVE INFRATEMPORAL W/WO GRAFT

Professional

Both

$3,128.00

Service Code	HCPCS 64865
Min. Negotiated Rate	$604.49
Max. Negotiated Rate	$2,346.00
Rate for Payer: Aetna Commercial	$1,394.17
Rate for Payer: Aetna Medicare	$1,564.00
Rate for Payer: BCBS Complete	$634.71
Rate for Payer: BCN Commercial	$1,618.44
Rate for Payer: Cash Price	$2,502.40
Rate for Payer: Cash Price	$2,502.40
Rate for Payer: Mclaren Medicaid	$604.49
Rate for Payer: Meridian Medicaid	$634.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,346.00
Rate for Payer: Priority Health Choice Medicaid	$604.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,879.78
Rate for Payer: Priority Health Narrow/Tiered Network	$1,879.78
Rate for Payer: UHC Medicaid	$604.49
Rate for Payer: UHCCP Medicaid	$604.49

PR SUTURE INFRAPATELLAR TENDON PRIMARY

Professional

Both

$1,598.00

Service Code	HCPCS 27380
Min. Negotiated Rate	$381.27
Max. Negotiated Rate	$1,198.50
Rate for Payer: Aetna Commercial	$824.66
Rate for Payer: Aetna Medicare	$799.00
Rate for Payer: BCBS Complete	$400.33
Rate for Payer: BCN Commercial	$948.65
Rate for Payer: Cash Price	$1,278.40
Rate for Payer: Cash Price	$1,278.40
Rate for Payer: Mclaren Medicaid	$381.27
Rate for Payer: Meridian Medicaid	$400.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,198.50
Rate for Payer: Priority Health Choice Medicaid	$381.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,014.08
Rate for Payer: Priority Health Narrow/Tiered Network	$1,014.08
Rate for Payer: UHC Medicaid	$381.27
Rate for Payer: UHCCP Medicaid	$381.27

PR SUTURE MESENTERY SEPARATE PROCEDURE

Professional

Both

$2,038.00

Service Code	HCPCS 44850
Min. Negotiated Rate	$452.41
Max. Negotiated Rate	$1,528.50
Rate for Payer: Aetna Commercial	$1,006.64
Rate for Payer: Aetna Medicare	$1,019.00
Rate for Payer: BCBS Complete	$475.03
Rate for Payer: BCN Commercial	$1,127.93
Rate for Payer: Cash Price	$1,630.40
Rate for Payer: Cash Price	$1,630.40
Rate for Payer: Mclaren Medicaid	$452.41
Rate for Payer: Meridian Medicaid	$475.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,528.50
Rate for Payer: Priority Health Choice Medicaid	$452.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,374.31
Rate for Payer: Priority Health Narrow/Tiered Network	$1,374.31
Rate for Payer: UHC Medicaid	$452.41
Rate for Payer: UHCCP Medicaid	$452.41

PR SUTURE NERVE REQ SECONDARY/DELAYED SUTURE

Professional

Both

$208.00

Service Code	HCPCS 64872
Min. Negotiated Rate	$63.47
Max. Negotiated Rate	$199.55
Rate for Payer: Aetna Commercial	$150.63
Rate for Payer: Aetna Medicare	$104.00
Rate for Payer: BCBS Complete	$66.64
Rate for Payer: BCN Commercial	$171.81
Rate for Payer: Cash Price	$166.40
Rate for Payer: Cash Price	$166.40
Rate for Payer: Mclaren Medicaid	$63.47
Rate for Payer: Meridian Medicaid	$66.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$156.00
Rate for Payer: Priority Health Choice Medicaid	$63.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$199.55
Rate for Payer: Priority Health Narrow/Tiered Network	$199.55
Rate for Payer: UHC Medicaid	$63.47
Rate for Payer: UHCCP Medicaid	$63.47

PR SUTURE NERVE REQ XTNSV MOBIL/TRPOS NERVE

Professional

Both

$319.00

Service Code	HCPCS 64874
Min. Negotiated Rate	$94.79
Max. Negotiated Rate	$298.46
Rate for Payer: Aetna Commercial	$225.49
Rate for Payer: Aetna Medicare	$159.50
Rate for Payer: BCBS Complete	$99.53
Rate for Payer: BCN Commercial	$256.96
Rate for Payer: Cash Price	$255.20
Rate for Payer: Cash Price	$255.20
Rate for Payer: Mclaren Medicaid	$94.79
Rate for Payer: Meridian Medicaid	$99.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$239.25
Rate for Payer: Priority Health Choice Medicaid	$94.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$298.46
Rate for Payer: Priority Health Narrow/Tiered Network	$298.46
Rate for Payer: UHC Medicaid	$94.79
Rate for Payer: UHCCP Medicaid	$94.79

PR SUTURE PHARYNX WOUND/INJURY

Professional

Both

$642.00

Service Code	HCPCS 42900
Min. Negotiated Rate	$184.25
Max. Negotiated Rate	$608.59
Rate for Payer: Aetna Commercial	$440.38
Rate for Payer: Aetna Medicare	$321.00
Rate for Payer: BCBS Complete	$193.46
Rate for Payer: BCN Commercial	$499.48
Rate for Payer: Cash Price	$513.60
Rate for Payer: Cash Price	$513.60
Rate for Payer: Mclaren Medicaid	$184.25
Rate for Payer: Meridian Medicaid	$193.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$481.50
Rate for Payer: Priority Health Choice Medicaid	$184.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$608.59
Rate for Payer: Priority Health Narrow/Tiered Network	$608.59
Rate for Payer: UHC Medicaid	$184.25
Rate for Payer: UHCCP Medicaid	$184.25

PR SUTURE POSTERIOR TIBIAL NERVE

Professional

Both

$2,038.00

Service Code	HCPCS 64840
Min. Negotiated Rate	$564.24
Max. Negotiated Rate	$1,694.69
Rate for Payer: Aetna Commercial	$1,237.15
Rate for Payer: Aetna Medicare	$1,019.00
Rate for Payer: BCBS Complete	$592.45
Rate for Payer: BCN Commercial	$1,459.09
Rate for Payer: Cash Price	$1,630.40
Rate for Payer: Cash Price	$1,630.40
Rate for Payer: Mclaren Medicaid	$564.24
Rate for Payer: Meridian Medicaid	$592.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,528.50
Rate for Payer: Priority Health Choice Medicaid	$564.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,694.69
Rate for Payer: Priority Health Narrow/Tiered Network	$1,694.69
Rate for Payer: UHC Medicaid	$564.24
Rate for Payer: UHCCP Medicaid	$564.24

PR SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY

Professional

Both

$1,960.00

Service Code	HCPCS 27385
Min. Negotiated Rate	$375.31
Max. Negotiated Rate	$1,470.00
Rate for Payer: Aetna Commercial	$800.67
Rate for Payer: Aetna Medicare	$980.00
Rate for Payer: BCBS Complete	$394.08
Rate for Payer: BCN Commercial	$925.74
Rate for Payer: Cash Price	$1,568.00
Rate for Payer: Cash Price	$1,568.00
Rate for Payer: Mclaren Medicaid	$375.31
Rate for Payer: Meridian Medicaid	$394.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,470.00
Rate for Payer: Priority Health Choice Medicaid	$375.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$989.59
Rate for Payer: Priority Health Narrow/Tiered Network	$989.59
Rate for Payer: UHC Medicaid	$375.31
Rate for Payer: UHCCP Medicaid	$375.31

PR SUTURE REPAIR AORTA/GREAT VESSEL W/BYPASS

Professional

Both

$5,859.00

Service Code	HCPCS 33322
Min. Negotiated Rate	$847.10
Max. Negotiated Rate	$4,394.25
Rate for Payer: Aetna Commercial	$1,863.91
Rate for Payer: Aetna Medicare	$2,929.50
Rate for Payer: BCBS Complete	$889.46
Rate for Payer: BCN Commercial	$2,046.71
Rate for Payer: Cash Price	$4,687.20
Rate for Payer: Cash Price	$4,687.20
Rate for Payer: Mclaren Medicaid	$847.10
Rate for Payer: Meridian Medicaid	$889.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,394.25
Rate for Payer: Priority Health Choice Medicaid	$847.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,200.97
Rate for Payer: Priority Health Narrow/Tiered Network	$2,200.97
Rate for Payer: UHC Medicaid	$847.10
Rate for Payer: UHCCP Medicaid	$847.10

PR SUTURE/REPAIR TESTICULAR INJURY

Professional

Both

$1,294.00

Service Code	HCPCS 54670
Min. Negotiated Rate	$241.54
Max. Negotiated Rate	$970.50
Rate for Payer: Aetna Commercial	$521.74
Rate for Payer: Aetna Medicare	$647.00
Rate for Payer: BCBS Complete	$253.62
Rate for Payer: BCN Commercial	$617.49
Rate for Payer: Cash Price	$1,035.20
Rate for Payer: Cash Price	$1,035.20
Rate for Payer: Mclaren Medicaid	$241.54
Rate for Payer: Meridian Medicaid	$253.62
Rate for Payer: Opus (Opus Packaging Group) HMA	$970.50
Rate for Payer: Priority Health Choice Medicaid	$241.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$672.66
Rate for Payer: Priority Health Narrow/Tiered Network	$672.66
Rate for Payer: UHC Medicaid	$241.54
Rate for Payer: UHCCP Medicaid	$241.54

PR SUTURE SCIATIC NERVE

Professional

Both

$2,575.00

Service Code	HCPCS 64858
Min. Negotiated Rate	$678.41
Max. Negotiated Rate	$2,059.10
Rate for Payer: Aetna Commercial	$1,514.83
Rate for Payer: Aetna Medicare	$1,287.50
Rate for Payer: BCBS Complete	$712.33
Rate for Payer: BCN Commercial	$1,772.82
Rate for Payer: Cash Price	$2,060.00
Rate for Payer: Cash Price	$2,060.00
Rate for Payer: Mclaren Medicaid	$678.41
Rate for Payer: Meridian Medicaid	$712.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,931.25
Rate for Payer: Priority Health Choice Medicaid	$678.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,059.10
Rate for Payer: Priority Health Narrow/Tiered Network	$2,059.10
Rate for Payer: UHC Medicaid	$678.41
Rate for Payer: UHCCP Medicaid	$678.41

PR SUTURE TRACHEAL WOUND/INJURY CERVICAL

Professional

Both

$1,637.00

Service Code	HCPCS 31800
Min. Negotiated Rate	$411.09
Max. Negotiated Rate	$1,227.75
Rate for Payer: Aetna Commercial	$913.40
Rate for Payer: Aetna Medicare	$818.50
Rate for Payer: BCBS Complete	$431.64
Rate for Payer: BCN Commercial	$1,055.72
Rate for Payer: Cash Price	$1,309.60
Rate for Payer: Cash Price	$1,309.60
Rate for Payer: Mclaren Medicaid	$411.09
Rate for Payer: Meridian Medicaid	$431.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,227.75
Rate for Payer: Priority Health Choice Medicaid	$411.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$994.18
Rate for Payer: Priority Health Narrow/Tiered Network	$994.18
Rate for Payer: UHC Medicaid	$411.09
Rate for Payer: UHCCP Medicaid	$411.09

PR SUTURE TRACHEAL WOUND/INJURY INTRATHORACIC

Professional

Both

$1,721.00

Service Code	HCPCS 31805
Min. Negotiated Rate	$506.94
Max. Negotiated Rate	$1,290.75
Rate for Payer: Aetna Commercial	$1,053.39
Rate for Payer: Aetna Medicare	$860.50
Rate for Payer: BCBS Complete	$532.29
Rate for Payer: BCN Commercial	$1,217.57
Rate for Payer: Cash Price	$1,376.80
Rate for Payer: Cash Price	$1,376.80
Rate for Payer: Mclaren Medicaid	$506.94
Rate for Payer: Meridian Medicaid	$532.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,290.75
Rate for Payer: Priority Health Choice Medicaid	$506.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,146.58
Rate for Payer: Priority Health Narrow/Tiered Network	$1,146.58
Rate for Payer: UHC Medicaid	$506.94
Rate for Payer: UHCCP Medicaid	$506.94

PR SVC PRV EMER BASIS IN OFFICE DISRUPTING SVCS

Professional

Both

$59.00

Service Code	HCPCS 99058
Min. Negotiated Rate	$23.60
Max. Negotiated Rate	$44.25
Rate for Payer: Aetna Commercial	$28.30
Rate for Payer: Aetna Medicare	$29.50
Rate for Payer: BCBS Complete	$23.60
Rate for Payer: BCN Commercial	$42.65
Rate for Payer: Cash Price	$47.20
Rate for Payer: Cash Price	$47.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$44.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$28.93
Rate for Payer: Priority Health Narrow/Tiered Network	$28.93

PR SVC PRV OFFICE REG SCHEDD EVN WKEND/HOLIDAY HRS

Professional

Both

$62.00

Service Code	HCPCS 99051
Min. Negotiated Rate	$20.02
Max. Negotiated Rate	$46.50
Rate for Payer: Aetna Commercial	$20.02
Rate for Payer: Aetna Medicare	$31.00
Rate for Payer: BCBS Complete	$24.80
Rate for Payer: BCN Commercial	$20.37
Rate for Payer: Cash Price	$49.60
Rate for Payer: Cash Price	$49.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$46.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$24.80
Rate for Payer: Priority Health Narrow/Tiered Network	$24.80

PR SYMPATHECTOMY CERVICAL

Professional

Both

$1,781.00

Service Code	HCPCS 64802
Min. Negotiated Rate	$560.62
Max. Negotiated Rate	$1,513.07
Rate for Payer: Aetna Commercial	$1,082.29
Rate for Payer: Aetna Medicare	$890.50
Rate for Payer: BCBS Complete	$588.65
Rate for Payer: BCN Commercial	$1,302.72
Rate for Payer: Cash Price	$1,424.80
Rate for Payer: Cash Price	$1,424.80
Rate for Payer: Mclaren Medicaid	$560.62
Rate for Payer: Meridian Medicaid	$588.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,335.75
Rate for Payer: Priority Health Choice Medicaid	$560.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,513.07
Rate for Payer: Priority Health Narrow/Tiered Network	$1,513.07
Rate for Payer: UHC Medicaid	$560.62
Rate for Payer: UHCCP Medicaid	$560.62

PR SYMPATHECTOMY LUMBAR

Professional

Both

$329.00

Service Code	HCPCS 64818
Min. Negotiated Rate	$164.50
Max. Negotiated Rate	$1,371.96
Rate for Payer: Aetna Commercial	$1,002.38
Rate for Payer: Aetna Medicare	$164.50
Rate for Payer: BCBS Complete	$481.52
Rate for Payer: BCN Commercial	$1,181.21
Rate for Payer: Cash Price	$263.20
Rate for Payer: Cash Price	$263.20
Rate for Payer: Mclaren Medicaid	$458.59
Rate for Payer: Meridian Medicaid	$481.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$246.75
Rate for Payer: Priority Health Choice Medicaid	$458.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,371.96
Rate for Payer: Priority Health Narrow/Tiered Network	$1,371.96
Rate for Payer: UHC Medicaid	$458.59
Rate for Payer: UHCCP Medicaid	$458.59

PR SYMPHYSIOTOMY HORSESHOE KDN W/WO PLOP UNI/BI

Professional

Both

$2,233.00

Service Code	HCPCS 50540
Min. Negotiated Rate	$653.91
Max. Negotiated Rate	$1,861.19
Rate for Payer: Aetna Commercial	$1,471.63
Rate for Payer: Aetna Medicare	$1,116.50
Rate for Payer: BCBS Complete	$686.61
Rate for Payer: BCN Commercial	$1,708.57
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Cash Price	$1,786.40
Rate for Payer: Mclaren Medicaid	$653.91
Rate for Payer: Meridian Medicaid	$686.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,674.75
Rate for Payer: Priority Health Choice Medicaid	$653.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,861.19
Rate for Payer: Priority Health Narrow/Tiered Network	$1,861.19
Rate for Payer: UHC Medicaid	$653.91
Rate for Payer: UHCCP Medicaid	$653.91

PR SYNCHRONOUS AUDIO-ONLY VISIT EST HIGH MDM 40 MIN

Professional

Both

$366.00

Service Code	HCPCS 98015
Min. Negotiated Rate	$134.08
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna Medicare	$183.00
Rate for Payer: BCBS Complete	$146.40
Rate for Payer: BCN Commercial	$134.08
Rate for Payer: Cash Price	$292.80
Rate for Payer: Cash Price	$292.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$274.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$169.32
Rate for Payer: Priority Health Narrow/Tiered Network	$169.32

PR SYNCHRONOUS AUDIO-ONLY VISIT EST LOW MDM 20 MIN

Professional

Both

$167.00

Service Code	HCPCS 98013
Min. Negotiated Rate	$66.80
Max. Negotiated Rate	$125.25
Rate for Payer: Aetna Medicare	$83.50
Rate for Payer: BCBS Complete	$66.80
Rate for Payer: BCN Commercial	$68.21
Rate for Payer: Cash Price	$133.60
Rate for Payer: Cash Price	$133.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$125.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$77.49
Rate for Payer: Priority Health Narrow/Tiered Network	$77.49

PR SYNCHRONOUS AUDIO-ONLY VISIT EST MOD MDM 30 MIN

Professional

Both

$248.00

Service Code	HCPCS 98014
Min. Negotiated Rate	$98.90
Max. Negotiated Rate	$186.00
Rate for Payer: Aetna Medicare	$124.00
Rate for Payer: BCBS Complete	$99.20
Rate for Payer: BCN Commercial	$98.90
Rate for Payer: Cash Price	$198.40
Rate for Payer: Cash Price	$198.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$186.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$114.67
Rate for Payer: Priority Health Narrow/Tiered Network	$114.67

PR SYNCHRONOUS AUDIO-ONLY VISIT EST SF MDM 10 MIN

Professional

Both

$92.00

Service Code	HCPCS 98012
Min. Negotiated Rate	$36.80
Max. Negotiated Rate	$69.00
Rate for Payer: Aetna Medicare	$46.00
Rate for Payer: BCBS Complete	$36.80
Rate for Payer: BCN Commercial	$43.40
Rate for Payer: Cash Price	$73.60
Rate for Payer: Cash Price	$73.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$69.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$42.56
Rate for Payer: Priority Health Narrow/Tiered Network	$42.56

PR SYNCHRONOUS AUDIO-ONLY VISIT NEW HIGH MDM 60 MIN

Professional

Both

$448.00

Service Code	HCPCS 98011
Min. Negotiated Rate	$179.20
Max. Negotiated Rate	$336.00
Rate for Payer: Aetna Medicare	$224.00
Rate for Payer: BCBS Complete	$179.20
Rate for Payer: BCN Commercial	$180.08
Rate for Payer: Cash Price	$358.40
Rate for Payer: Cash Price	$358.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$336.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$207.85
Rate for Payer: Priority Health Narrow/Tiered Network	$207.85

PR SYNCHRONOUS AUDIO-ONLY VISIT NEW LOW MDM 30 MIN

Professional

Both

$213.00

Service Code	HCPCS 98009
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$159.75
Rate for Payer: Aetna Medicare	$106.50
Rate for Payer: BCBS Complete	$85.20
Rate for Payer: BCN Commercial	$93.27
Rate for Payer: Cash Price	$170.40
Rate for Payer: Cash Price	$170.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$100.34
Rate for Payer: Priority Health Narrow/Tiered Network	$100.34

Know your out-of-pocket cost for care.

All Charges