Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR SYNCHRONOUS AUDIO-ONLY VISIT NEW MOD MDM 45 MIN

Professional

Both

$342.00

Service Code	HCPCS 98010
Min. Negotiated Rate	$136.80
Max. Negotiated Rate	$256.50
Rate for Payer: Aetna Medicare	$171.00
Rate for Payer: BCBS Complete	$136.80
Rate for Payer: BCN Commercial	$142.52
Rate for Payer: Cash Price	$273.60
Rate for Payer: Cash Price	$273.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$256.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$158.12
Rate for Payer: Priority Health Narrow/Tiered Network	$158.12

PR SYNCHRONOUS AUDIO-ONLY VISIT NEW SF MDM 15 MIN

Professional

Both

$125.00

Service Code	HCPCS 98008
Min. Negotiated Rate	$50.00
Max. Negotiated Rate	$93.75
Rate for Payer: Aetna Medicare	$62.50
Rate for Payer: BCBS Complete	$50.00
Rate for Payer: BCN Commercial	$65.87
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$93.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$57.79
Rate for Payer: Priority Health Narrow/Tiered Network	$57.79

PR SYNCHRONOUS AUDIO-VIDEO VISIT EST LOW MDM 20 MIN

Professional

Both

$200.00

Service Code	HCPCS 98005
Min. Negotiated Rate	$68.21
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Medicare	$100.00
Rate for Payer: BCBS Complete	$80.00
Rate for Payer: BCN Commercial	$68.21
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$150.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$84.21
Rate for Payer: Priority Health Narrow/Tiered Network	$84.21

PR SYNCHRONOUS AUDIO-VIDEO VISIT EST MOD MDM 30 MIN

Professional

Both

$271.00

Service Code	HCPCS 98006
Min. Negotiated Rate	$98.90
Max. Negotiated Rate	$203.25
Rate for Payer: Aetna Medicare	$135.50
Rate for Payer: BCBS Complete	$108.40
Rate for Payer: BCN Commercial	$98.90
Rate for Payer: Cash Price	$216.80
Rate for Payer: Cash Price	$216.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$203.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$125.42
Rate for Payer: Priority Health Narrow/Tiered Network	$125.42

PR SYNCHRONOUS AUDIO-VIDEO VISIT EST SF MDM 10 MIN

Professional

Both

$114.00

Service Code	HCPCS 98004
Min. Negotiated Rate	$43.40
Max. Negotiated Rate	$85.50
Rate for Payer: Aetna Medicare	$57.00
Rate for Payer: BCBS Complete	$45.60
Rate for Payer: BCN Commercial	$43.40
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	$45.24
Rate for Payer: Priority Health Narrow/Tiered Network	$45.24

PR SYNCHRONOUS AUDIO-VIDEO VISIT NEW LOW MDM 30 MIN

Professional

Both

$244.00

Service Code	HCPCS 98001
Min. Negotiated Rate	$93.27
Max. Negotiated Rate	$183.00
Rate for Payer: Aetna Medicare	$122.00
Rate for Payer: BCBS Complete	$97.60
Rate for Payer: BCN Commercial	$93.27
Rate for Payer: Cash Price	$195.20
Rate for Payer: Cash Price	$195.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$183.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$104.37
Rate for Payer: Priority Health Narrow/Tiered Network	$104.37

PR SYNCHRONOUS AUDIO-VIDEO VISIT NEW MOD MDM 45 MIN

Professional

Both

$366.00

Service Code	HCPCS 98002
Min. Negotiated Rate	$142.52
Max. Negotiated Rate	$274.50
Rate for Payer: Aetna Medicare	$183.00
Rate for Payer: BCBS Complete	$146.40
Rate for Payer: BCN Commercial	$142.52
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-VIDEO VISIT NEW SF MDM 15 MIN

Professional

Both

$131.00

Service Code	HCPCS 98000
Min. Negotiated Rate	$52.40
Max. Negotiated Rate	$98.25
Rate for Payer: Aetna Medicare	$65.50
Rate for Payer: BCBS Complete	$52.40
Rate for Payer: BCN Commercial	$65.87
Rate for Payer: Cash Price	$104.80
Rate for Payer: Cash Price	$104.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$98.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$60.47
Rate for Payer: Priority Health Narrow/Tiered Network	$60.47

PR SYNCHRONOUS AUDIO-VIDEO VST EST HIGH MDM 40 MIN

Professional

Both

$366.00

Service Code	HCPCS 98007
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-VIDEO VST NEW HIGH MDM 60 MIN

Professional

Both

$491.00

Service Code	HCPCS 98003
Min. Negotiated Rate	$180.08
Max. Negotiated Rate	$368.25
Rate for Payer: Aetna Medicare	$245.50
Rate for Payer: BCBS Complete	$196.40
Rate for Payer: BCN Commercial	$180.08
Rate for Payer: Cash Price	$392.80
Rate for Payer: Cash Price	$392.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$368.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$227.55
Rate for Payer: Priority Health Narrow/Tiered Network	$227.55

PR SYNDACTYLIZATION TOES

Professional

Both

$878.00

Service Code	HCPCS 28280
Min. Negotiated Rate	$205.33
Max. Negotiated Rate	$658.50
Rate for Payer: Aetna Commercial	$457.50
Rate for Payer: Aetna Medicare	$439.00
Rate for Payer: BCBS Complete	$215.60
Rate for Payer: BCN Commercial	$517.40
Rate for Payer: Cash Price	$702.40
Rate for Payer: Cash Price	$702.40
Rate for Payer: Mclaren Medicaid	$205.33
Rate for Payer: Meridian Medicaid	$215.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$658.50
Rate for Payer: Priority Health Choice Medicaid	$205.33
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$553.09
Rate for Payer: Priority Health Narrow/Tiered Network	$553.09
Rate for Payer: UHC Medicaid	$205.33
Rate for Payer: UHCCP Medicaid	$205.33

PR SYNOVECTOMY CARPOMETACARPAL JOINT

Professional

Both

$1,217.00

Service Code	HCPCS 26130
Min. Negotiated Rate	$292.45
Max. Negotiated Rate	$912.75
Rate for Payer: Aetna Commercial	$623.09
Rate for Payer: Aetna Medicare	$608.50
Rate for Payer: BCBS Complete	$307.07
Rate for Payer: BCN Commercial	$725.06
Rate for Payer: Cash Price	$973.60
Rate for Payer: Cash Price	$973.60
Rate for Payer: Mclaren Medicaid	$292.45
Rate for Payer: Meridian Medicaid	$307.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$912.75
Rate for Payer: Priority Health Choice Medicaid	$292.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$775.08
Rate for Payer: Priority Health Narrow/Tiered Network	$775.08
Rate for Payer: UHC Medicaid	$292.45
Rate for Payer: UHCCP Medicaid	$292.45

PR SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT

Professional

Both

$1,314.00

Service Code	HCPCS 25118
Min. Negotiated Rate	$235.79
Max. Negotiated Rate	$985.50
Rate for Payer: Aetna Commercial	$506.36
Rate for Payer: Aetna Medicare	$657.00
Rate for Payer: BCBS Complete	$247.58
Rate for Payer: BCN Commercial	$594.09
Rate for Payer: Cash Price	$1,051.20
Rate for Payer: Cash Price	$1,051.20
Rate for Payer: Mclaren Medicaid	$235.79
Rate for Payer: Meridian Medicaid	$247.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$985.50
Rate for Payer: Priority Health Choice Medicaid	$235.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$635.06
Rate for Payer: Priority Health Narrow/Tiered Network	$635.06
Rate for Payer: UHC Medicaid	$235.79
Rate for Payer: UHCCP Medicaid	$235.79

PR SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH

Professional

Both

$1,046.00

Service Code	HCPCS 28072
Min. Negotiated Rate	$199.16
Max. Negotiated Rate	$784.50
Rate for Payer: Aetna Commercial	$423.46
Rate for Payer: Aetna Medicare	$523.00
Rate for Payer: BCBS Complete	$209.12
Rate for Payer: BCN Commercial	$495.99
Rate for Payer: Cash Price	$836.80
Rate for Payer: Cash Price	$836.80
Rate for Payer: Mclaren Medicaid	$199.16
Rate for Payer: Meridian Medicaid	$209.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$784.50
Rate for Payer: Priority Health Choice Medicaid	$199.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$530.20
Rate for Payer: Priority Health Narrow/Tiered Network	$530.20
Rate for Payer: UHC Medicaid	$199.16
Rate for Payer: UHCCP Medicaid	$199.16

PR SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD

Professional

Both

$1,778.00

Service Code	HCPCS 26135
Min. Negotiated Rate	$331.22
Max. Negotiated Rate	$1,333.50
Rate for Payer: Aetna Commercial	$736.91
Rate for Payer: Aetna Medicare	$889.00
Rate for Payer: BCBS Complete	$347.78
Rate for Payer: BCN Commercial	$854.04
Rate for Payer: Cash Price	$1,422.40
Rate for Payer: Cash Price	$1,422.40
Rate for Payer: Mclaren Medicaid	$331.22
Rate for Payer: Meridian Medicaid	$347.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,333.50
Rate for Payer: Priority Health Choice Medicaid	$331.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$912.94
Rate for Payer: Priority Health Narrow/Tiered Network	$912.94
Rate for Payer: UHC Medicaid	$331.22
Rate for Payer: UHCCP Medicaid	$331.22

PR SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT

Professional

Both

$1,520.00

Service Code	HCPCS 26140
Min. Negotiated Rate	$306.51
Max. Negotiated Rate	$1,140.00
Rate for Payer: Aetna Commercial	$674.76
Rate for Payer: Aetna Medicare	$760.00
Rate for Payer: BCBS Complete	$321.84
Rate for Payer: BCN Commercial	$783.32
Rate for Payer: Cash Price	$1,216.00
Rate for Payer: Cash Price	$1,216.00
Rate for Payer: Mclaren Medicaid	$306.51
Rate for Payer: Meridian Medicaid	$321.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,140.00
Rate for Payer: Priority Health Choice Medicaid	$306.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$837.35
Rate for Payer: Priority Health Narrow/Tiered Network	$837.35
Rate for Payer: UHC Medicaid	$306.51
Rate for Payer: UHCCP Medicaid	$306.51

PR SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN

Professional

Both

$1,730.00

Service Code	HCPCS 26145
Min. Negotiated Rate	$310.55
Max. Negotiated Rate	$1,297.50
Rate for Payer: Aetna Commercial	$684.95
Rate for Payer: Aetna Medicare	$865.00
Rate for Payer: BCBS Complete	$326.08
Rate for Payer: BCN Commercial	$796.77
Rate for Payer: Cash Price	$1,384.00
Rate for Payer: Cash Price	$1,384.00
Rate for Payer: Mclaren Medicaid	$310.55
Rate for Payer: Meridian Medicaid	$326.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,297.50
Rate for Payer: Priority Health Choice Medicaid	$310.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$851.72
Rate for Payer: Priority Health Narrow/Tiered Network	$851.72
Rate for Payer: UHC Medicaid	$310.55
Rate for Payer: UHCCP Medicaid	$310.55

PR SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA

Professional

Both

$1,850.00

Service Code	HCPCS 25119
Min. Negotiated Rate	$310.34
Max. Negotiated Rate	$1,387.50
Rate for Payer: Aetna Commercial	$663.09
Rate for Payer: Aetna Medicare	$925.00
Rate for Payer: BCBS Complete	$325.86
Rate for Payer: BCN Commercial	$774.86
Rate for Payer: Cash Price	$1,480.00
Rate for Payer: Cash Price	$1,480.00
Rate for Payer: Mclaren Medicaid	$310.34
Rate for Payer: Meridian Medicaid	$325.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,387.50
Rate for Payer: Priority Health Choice Medicaid	$310.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$828.30
Rate for Payer: Priority Health Narrow/Tiered Network	$828.30
Rate for Payer: UHC Medicaid	$310.34
Rate for Payer: UHCCP Medicaid	$310.34

PR SYNVISC OR SYNVISC-ONE

Professional

Both

$53.00

Service Code	HCPCS J7325
Min. Negotiated Rate	$7.70
Max. Negotiated Rate	$39.75
Rate for Payer: Aetna Commercial	$9.40
Rate for Payer: Aetna Medicare	$26.50
Rate for Payer: BCBS Trust/PPO	$7.70
Rate for Payer: BCN Commercial	$10.87
Rate for Payer: Cash Price	$42.40
Rate for Payer: Cash Price	$42.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$39.75

PR TANGENTIAL BIOPSY SKIN EA SEP/ADDITIONAL LESION

Professional

Both

$108.00

Service Code	HCPCS 11103
Min. Negotiated Rate	$11.29
Max. Negotiated Rate	$81.00
Rate for Payer: Aetna Commercial	$23.78
Rate for Payer: Aetna Medicare	$54.00
Rate for Payer: BCBS Complete	$11.85
Rate for Payer: BCN Commercial	$25.53
Rate for Payer: Cash Price	$86.40
Rate for Payer: Cash Price	$86.40
Rate for Payer: Mclaren Medicaid	$11.29
Rate for Payer: Meridian Medicaid	$11.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$81.00
Rate for Payer: Priority Health Choice Medicaid	$11.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$29.63
Rate for Payer: Priority Health Narrow/Tiered Network	$29.63
Rate for Payer: UHC Medicaid	$11.29
Rate for Payer: UHCCP Medicaid	$11.29

PR TANGENTIAL BIOPSY SKIN SINGLE LESION

Professional

Both

$200.00

Service Code	HCPCS 11102
Min. Negotiated Rate	$19.17
Max. Negotiated Rate	$150.00
Rate for Payer: Aetna Commercial	$40.50
Rate for Payer: Aetna Medicare	$100.00
Rate for Payer: BCBS Complete	$20.13
Rate for Payer: BCN Commercial	$43.98
Rate for Payer: Cash Price	$160.00
Rate for Payer: Cash Price	$160.00
Rate for Payer: Mclaren Medicaid	$19.17
Rate for Payer: Meridian Medicaid	$20.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$150.00
Rate for Payer: Priority Health Choice Medicaid	$19.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$51.05
Rate for Payer: Priority Health Narrow/Tiered Network	$51.05
Rate for Payer: UHC Medicaid	$19.17
Rate for Payer: UHCCP Medicaid	$19.17

PR TAP BLOCK UNILATERAL BY INJECTION(S)

Professional

Both

$117.00

Service Code	HCPCS 64486
Min. Negotiated Rate	$30.89
Max. Negotiated Rate	$89.66
Rate for Payer: Aetna Commercial	$72.82
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: BCBS Complete	$32.43
Rate for Payer: BCN Commercial	$77.18
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Mclaren Medicaid	$30.89
Rate for Payer: Meridian Medicaid	$32.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$87.75
Rate for Payer: Priority Health Choice Medicaid	$30.89
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.66
Rate for Payer: Priority Health Narrow/Tiered Network	$89.66
Rate for Payer: UHC Medicaid	$30.89
Rate for Payer: UHCCP Medicaid	$30.89

PR TATTOOING INCL MICROPIGMENTATION 6.0 CM/<

Professional

Both

$333.00

Service Code	HCPCS 11920
Min. Negotiated Rate	$65.39
Max. Negotiated Rate	$249.75
Rate for Payer: Aetna Commercial	$118.80
Rate for Payer: Aetna Medicare	$166.50
Rate for Payer: BCBS Complete	$68.66
Rate for Payer: BCN Commercial	$171.30
Rate for Payer: Cash Price	$266.40
Rate for Payer: Cash Price	$266.40
Rate for Payer: Mclaren Medicaid	$65.39
Rate for Payer: Meridian Medicaid	$68.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$249.75
Rate for Payer: Priority Health Choice Medicaid	$65.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$156.79
Rate for Payer: Priority Health Narrow/Tiered Network	$156.79
Rate for Payer: UHC Medicaid	$65.39
Rate for Payer: UHCCP Medicaid	$65.39

PR TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM

Professional

Both

$383.00

Service Code	HCPCS 11921
Min. Negotiated Rate	$73.91
Max. Negotiated Rate	$287.25
Rate for Payer: Aetna Commercial	$140.70
Rate for Payer: Aetna Medicare	$191.50
Rate for Payer: BCBS Complete	$77.61
Rate for Payer: BCN Commercial	$196.20
Rate for Payer: Cash Price	$306.40
Rate for Payer: Cash Price	$306.40
Rate for Payer: Mclaren Medicaid	$73.91
Rate for Payer: Meridian Medicaid	$77.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$287.25
Rate for Payer: Priority Health Choice Medicaid	$73.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$179.58
Rate for Payer: Priority Health Narrow/Tiered Network	$179.58
Rate for Payer: UHC Medicaid	$73.91
Rate for Payer: UHCCP Medicaid	$73.91

PR TATTOOING INCL MICROPIGMENTATION EA 20.0 CM

Professional

Both

$125.00

Service Code	HCPCS 11922
Min. Negotiated Rate	$15.55
Max. Negotiated Rate	$93.75
Rate for Payer: Aetna Commercial	$31.98
Rate for Payer: Aetna Medicare	$62.50
Rate for Payer: BCBS Complete	$16.33
Rate for Payer: BCN Commercial	$42.33
Rate for Payer: Cash Price	$100.00
Rate for Payer: Cash Price	$100.00
Rate for Payer: Mclaren Medicaid	$15.55
Rate for Payer: Meridian Medicaid	$16.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$93.75
Rate for Payer: Priority Health Choice Medicaid	$15.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$38.74
Rate for Payer: Priority Health Narrow/Tiered Network	$38.74
Rate for Payer: UHC Medicaid	$15.55
Rate for Payer: UHCCP Medicaid	$15.55

Know your out-of-pocket cost for care.

All Charges