Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

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

Professional

Both

$2,823.00

Service Code	HCPCS 26428
Min. Negotiated Rate	$744.65
Max. Negotiated Rate	$1,834.95
Rate for Payer: Aetna Commercial	$997.83
Rate for Payer: Aetna Medicare	$774.44
Rate for Payer: BCBS Complete	$1,129.20
Rate for Payer: BCBS MAPPO	$744.65
Rate for Payer: BCN Medicare Advantage	$744.65
Rate for Payer: Cash Price	$2,258.40
Rate for Payer: Cash Price	$2,258.40
Rate for Payer: Cofinity Commercial	$997.83
Rate for Payer: Cofinity Commercial	$1,072.30
Rate for Payer: Health Alliance Plan Medicare Advantage	$744.65
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$781.88
Rate for Payer: Nomi Health Commercial	$893.58
Rate for Payer: PACE SWMI	$744.65
Rate for Payer: PHP Medicare Advantage	$744.65
Rate for Payer: Priority Health Cigna Priority Health	$1,834.95
Rate for Payer: Priority Health Medicare	$752.10
Rate for Payer: UHC All Payor (Choice/PPO)	$744.65
Rate for Payer: UHC Dual Complete DSNP	$744.65
Rate for Payer: UHC Exchange	$744.65
Rate for Payer: UHC Medicare Advantage	$744.65

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

Professional

Both

$1,983.00

Service Code	HCPCS 26426
Min. Negotiated Rate	$488.18
Max. Negotiated Rate	$1,288.95
Rate for Payer: Aetna Commercial	$654.16
Rate for Payer: Aetna Medicare	$507.71
Rate for Payer: BCBS Complete	$793.20
Rate for Payer: BCBS MAPPO	$488.18
Rate for Payer: BCN Medicare Advantage	$488.18
Rate for Payer: Cash Price	$1,586.40
Rate for Payer: Cash Price	$1,586.40
Rate for Payer: Cofinity Commercial	$702.98
Rate for Payer: Cofinity Commercial	$654.16
Rate for Payer: Health Alliance Plan Medicare Advantage	$488.18
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$512.59
Rate for Payer: Nomi Health Commercial	$585.82
Rate for Payer: PACE SWMI	$488.18
Rate for Payer: PHP Medicare Advantage	$488.18
Rate for Payer: Priority Health Cigna Priority Health	$1,288.95
Rate for Payer: Priority Health Medicare	$493.06
Rate for Payer: UHC All Payor (Choice/PPO)	$488.18
Rate for Payer: UHC Dual Complete DSNP	$488.18
Rate for Payer: UHC Exchange	$488.18
Rate for Payer: UHC Medicare Advantage	$488.18

PR RPSG PREV IMPLTED CAR VEN SYS L VENTR ELTRD

Professional

Both

$1,297.00

Service Code	HCPCS 33226
Min. Negotiated Rate	$466.10
Max. Negotiated Rate	$843.05
Rate for Payer: Aetna Commercial	$624.57
Rate for Payer: Aetna Medicare	$484.74
Rate for Payer: BCBS Complete	$518.80
Rate for Payer: BCBS MAPPO	$466.10
Rate for Payer: BCN Medicare Advantage	$466.10
Rate for Payer: Cash Price	$1,037.60
Rate for Payer: Cash Price	$1,037.60
Rate for Payer: Cofinity Commercial	$671.18
Rate for Payer: Cofinity Commercial	$624.57
Rate for Payer: Health Alliance Plan Medicare Advantage	$466.10
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$489.40
Rate for Payer: Nomi Health Commercial	$559.32
Rate for Payer: PACE SWMI	$466.10
Rate for Payer: PHP Medicare Advantage	$466.10
Rate for Payer: Priority Health Cigna Priority Health	$843.05
Rate for Payer: Priority Health Medicare	$470.76
Rate for Payer: UHC All Payor (Choice/PPO)	$466.10
Rate for Payer: UHC Dual Complete DSNP	$466.10
Rate for Payer: UHC Exchange	$466.10
Rate for Payer: UHC Medicare Advantage	$466.10

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

Professional

Both

$1,029.00

Service Code	HCPCS 33215
Min. Negotiated Rate	$295.05
Max. Negotiated Rate	$668.85
Rate for Payer: Aetna Commercial	$395.37
Rate for Payer: Aetna Medicare	$306.85
Rate for Payer: BCBS Complete	$411.60
Rate for Payer: BCBS MAPPO	$295.05
Rate for Payer: BCN Medicare Advantage	$295.05
Rate for Payer: Cash Price	$823.20
Rate for Payer: Cash Price	$823.20
Rate for Payer: Cofinity Commercial	$424.87
Rate for Payer: Cofinity Commercial	$395.37
Rate for Payer: Health Alliance Plan Medicare Advantage	$295.05
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$309.80
Rate for Payer: Nomi Health Commercial	$354.06
Rate for Payer: PACE SWMI	$295.05
Rate for Payer: PHP Medicare Advantage	$295.05
Rate for Payer: Priority Health Cigna Priority Health	$668.85
Rate for Payer: Priority Health Medicare	$298.00
Rate for Payer: UHC All Payor (Choice/PPO)	$295.05
Rate for Payer: UHC Dual Complete DSNP	$295.05
Rate for Payer: UHC Exchange	$295.05
Rate for Payer: UHC Medicare Advantage	$295.05

PR RPSG PREVIOUSLY PLACED CVC UNDER FLUOR GDNCE

Professional

Both

$316.00

Service Code	HCPCS 36597
Min. Negotiated Rate	$57.29
Max. Negotiated Rate	$205.40
Rate for Payer: Aetna Commercial	$76.77
Rate for Payer: Aetna Medicare	$59.58
Rate for Payer: BCBS Complete	$126.40
Rate for Payer: BCBS MAPPO	$57.29
Rate for Payer: BCN Medicare Advantage	$57.29
Rate for Payer: Cash Price	$252.80
Rate for Payer: Cash Price	$252.80
Rate for Payer: Cofinity Commercial	$76.77
Rate for Payer: Cofinity Commercial	$82.50
Rate for Payer: Health Alliance Plan Medicare Advantage	$57.29
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$60.15
Rate for Payer: Nomi Health Commercial	$68.75
Rate for Payer: PACE SWMI	$57.29
Rate for Payer: PHP Medicare Advantage	$57.29
Rate for Payer: Priority Health Cigna Priority Health	$205.40
Rate for Payer: Priority Health Medicare	$57.86
Rate for Payer: UHC All Payor (Choice/PPO)	$57.29
Rate for Payer: UHC Dual Complete DSNP	$57.29
Rate for Payer: UHC Exchange	$57.29
Rate for Payer: UHC Medicare Advantage	$57.29

PR RSV MONOCLONAL ANTB SEASONAL DOSE 0.5ML IM USE

Professional

Both

$1,303.00

Service Code	HCPCS 90380
Min. Negotiated Rate	$521.20
Max. Negotiated Rate	$846.95
Rate for Payer: Aetna Medicare	$651.50
Rate for Payer: BCBS Complete	$521.20
Rate for Payer: Cash Price	$1,042.40
Rate for Payer: Priority Health Cigna Priority Health	$846.95

PR RSV MONOCLONAL ANTB SEASONAL DOSE 1 ML IM USE

Professional

Both

$1,303.00

Service Code	HCPCS 90381
Min. Negotiated Rate	$521.20
Max. Negotiated Rate	$846.95
Rate for Payer: Aetna Medicare	$651.50
Rate for Payer: BCBS Complete	$521.20
Rate for Payer: Cash Price	$1,042.40
Rate for Payer: Priority Health Cigna Priority Health	$846.95

PR RSV VACCINE PREF SUBUNIT BIVALENT FOR IM USE

Professional

Both

$840.00

Service Code	HCPCS 90678
Min. Negotiated Rate	$336.00
Max. Negotiated Rate	$546.00
Rate for Payer: Aetna Medicare	$420.00
Rate for Payer: BCBS Complete	$336.00
Rate for Payer: Cash Price	$672.00
Rate for Payer: Priority Health Cigna Priority Health	$546.00

PR RSV VACC PREF RECOMBINANT ADJUVANTED FOR IM USE

Professional

Both

$797.00

Service Code	HCPCS 90679
Min. Negotiated Rate	$318.80
Max. Negotiated Rate	$518.05
Rate for Payer: Aetna Medicare	$398.50
Rate for Payer: BCBS Complete	$318.80
Rate for Payer: Cash Price	$637.60
Rate for Payer: Priority Health Cigna Priority Health	$518.05

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

Professional

Both

$2,946.00

Service Code	HCPCS 37193
Min. Negotiated Rate	$327.97
Max. Negotiated Rate	$1,914.90
Rate for Payer: Aetna Commercial	$439.48
Rate for Payer: Aetna Medicare	$341.09
Rate for Payer: BCBS Complete	$1,178.40
Rate for Payer: BCBS MAPPO	$327.97
Rate for Payer: BCN Medicare Advantage	$327.97
Rate for Payer: Cash Price	$2,356.80
Rate for Payer: Cash Price	$2,356.80
Rate for Payer: Cofinity Commercial	$472.28
Rate for Payer: Cofinity Commercial	$439.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$327.97
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$344.37
Rate for Payer: Nomi Health Commercial	$393.56
Rate for Payer: PACE SWMI	$327.97
Rate for Payer: PHP Medicare Advantage	$327.97
Rate for Payer: Priority Health Cigna Priority Health	$1,914.90
Rate for Payer: Priority Health Medicare	$331.25
Rate for Payer: UHC All Payor (Choice/PPO)	$327.97
Rate for Payer: UHC Dual Complete DSNP	$327.97
Rate for Payer: UHC Exchange	$327.97
Rate for Payer: UHC Medicare Advantage	$327.97

PR RUBELLA IMMUNIZATION, SUBCUT

Professional

Both

$31.00

Service Code	HCPCS 90706
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$20.15
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$20.15

PR RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE

Professional

Both

$159.00

Service Code	HCPCS 90681
Min. Negotiated Rate	$63.60
Max. Negotiated Rate	$103.35
Rate for Payer: Aetna Medicare	$79.50
Rate for Payer: BCBS Complete	$63.60
Rate for Payer: Cash Price	$127.20
Rate for Payer: Priority Health Cigna Priority Health	$103.35

PR RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE

Professional

Both

$96.00

Service Code	HCPCS 90680
Min. Negotiated Rate	$38.40
Max. Negotiated Rate	$62.40
Rate for Payer: Aetna Medicare	$48.00
Rate for Payer: BCBS Complete	$38.40
Rate for Payer: Cash Price	$76.80
Rate for Payer: Priority Health Cigna Priority Health	$62.40

PR R VENTRIC RESCJ INFUND STEN W/WO COMMISSUROTOMY

Professional

Both

$3,142.00

Service Code	HCPCS 33476
Min. Negotiated Rate	$1,256.80
Max. Negotiated Rate	$2,110.00
Rate for Payer: Aetna Commercial	$1,963.48
Rate for Payer: Aetna Medicare	$1,523.89
Rate for Payer: BCBS Complete	$1,256.80
Rate for Payer: BCBS MAPPO	$1,465.28
Rate for Payer: BCN Medicare Advantage	$1,465.28
Rate for Payer: Cash Price	$2,513.60
Rate for Payer: Cash Price	$2,513.60
Rate for Payer: Cofinity Commercial	$2,110.00
Rate for Payer: Cofinity Commercial	$1,963.48
Rate for Payer: Health Alliance Plan Medicare Advantage	$1,465.28
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$1,538.54
Rate for Payer: Nomi Health Commercial	$1,758.34
Rate for Payer: PACE SWMI	$1,465.28
Rate for Payer: PHP Medicare Advantage	$1,465.28
Rate for Payer: Priority Health Cigna Priority Health	$2,042.30
Rate for Payer: Priority Health Medicare	$1,479.93
Rate for Payer: UHC All Payor (Choice/PPO)	$1,465.28
Rate for Payer: UHC Dual Complete DSNP	$1,465.28
Rate for Payer: UHC Exchange	$1,465.28
Rate for Payer: UHC Medicare Advantage	$1,465.28

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

Professional

Both

$165.00

Service Code	HCPCS 92310
Min. Negotiated Rate	$66.00
Max. Negotiated Rate	$107.25
Rate for Payer: Aetna Medicare	$82.50
Rate for Payer: BCBS Complete	$66.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Priority Health Cigna Priority Health	$107.25

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

Professional

Both

$137.00

Service Code	HCPCS 92314
Min. Negotiated Rate	$54.80
Max. Negotiated Rate	$89.05
Rate for Payer: Aetna Medicare	$68.50
Rate for Payer: BCBS Complete	$54.80
Rate for Payer: Cash Price	$109.60
Rate for Payer: Priority Health Cigna Priority Health	$89.05

PR RX RIB FRACTURE W EXTERN FIXATN

Professional

Both

$1,317.00

Service Code	HCPCS 21810
Min. Negotiated Rate	$526.80
Max. Negotiated Rate	$856.05
Rate for Payer: Aetna Medicare	$658.50
Rate for Payer: BCBS Complete	$526.80
Rate for Payer: Cash Price	$1,053.60
Rate for Payer: Priority Health Cigna Priority Health	$856.05

PR SACRAL NERVE STIM TEST LEAD

Professional

Both

$163.00

Service Code	HCPCS A4290
Min. Negotiated Rate	$65.20
Max. Negotiated Rate	$105.95
Rate for Payer: Aetna Medicare	$81.50
Rate for Payer: BCBS Complete	$65.20
Rate for Payer: Cash Price	$130.40
Rate for Payer: Priority Health Cigna Priority Health	$105.95

PR SALPINGECTOMY COMPLETE/PARTIAL UNI/BI SPX

Professional

Both

$1,749.00

Service Code	HCPCS 58700
Min. Negotiated Rate	$699.60
Max. Negotiated Rate	$1,136.85
Rate for Payer: Aetna Commercial	$1,033.18
Rate for Payer: Aetna Medicare	$801.87
Rate for Payer: BCBS Complete	$699.60
Rate for Payer: BCBS MAPPO	$771.03
Rate for Payer: BCN Medicare Advantage	$771.03
Rate for Payer: Cash Price	$1,399.20
Rate for Payer: Cash Price	$1,399.20
Rate for Payer: Cofinity Commercial	$1,033.18
Rate for Payer: Cofinity Commercial	$1,110.28
Rate for Payer: Health Alliance Plan Medicare Advantage	$771.03
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$809.58
Rate for Payer: Nomi Health Commercial	$925.24
Rate for Payer: PACE SWMI	$771.03
Rate for Payer: PHP Medicare Advantage	$771.03
Rate for Payer: Priority Health Cigna Priority Health	$1,136.85
Rate for Payer: Priority Health Medicare	$778.74
Rate for Payer: UHC All Payor (Choice/PPO)	$771.03
Rate for Payer: UHC Dual Complete DSNP	$771.03
Rate for Payer: UHC Exchange	$771.03
Rate for Payer: UHC Medicare Advantage	$771.03

PR SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX

Professional

Both

$2,041.00

Service Code	HCPCS 58720
Min. Negotiated Rate	$729.64
Max. Negotiated Rate	$1,326.65
Rate for Payer: Aetna Commercial	$977.72
Rate for Payer: Aetna Medicare	$758.83
Rate for Payer: BCBS Complete	$816.40
Rate for Payer: BCBS MAPPO	$729.64
Rate for Payer: BCN Medicare Advantage	$729.64
Rate for Payer: Cash Price	$1,632.80
Rate for Payer: Cash Price	$1,632.80
Rate for Payer: Cofinity Commercial	$977.72
Rate for Payer: Cofinity Commercial	$1,050.68
Rate for Payer: Health Alliance Plan Medicare Advantage	$729.64
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$766.12
Rate for Payer: Nomi Health Commercial	$875.57
Rate for Payer: PACE SWMI	$729.64
Rate for Payer: PHP Medicare Advantage	$729.64
Rate for Payer: Priority Health Cigna Priority Health	$1,326.65
Rate for Payer: Priority Health Medicare	$736.94
Rate for Payer: UHC All Payor (Choice/PPO)	$729.64
Rate for Payer: UHC Dual Complete DSNP	$729.64
Rate for Payer: UHC Exchange	$729.64
Rate for Payer: UHC Medicare Advantage	$729.64

PR SALPINGOSTOMY

Professional

Both

$2,727.00

Service Code	HCPCS 58770
Min. Negotiated Rate	$826.88
Max. Negotiated Rate	$1,772.55
Rate for Payer: Aetna Commercial	$1,108.02
Rate for Payer: Aetna Medicare	$859.96
Rate for Payer: BCBS Complete	$1,090.80
Rate for Payer: BCBS MAPPO	$826.88
Rate for Payer: BCN Medicare Advantage	$826.88
Rate for Payer: Cash Price	$2,181.60
Rate for Payer: Cash Price	$2,181.60
Rate for Payer: Cofinity Commercial	$1,190.71
Rate for Payer: Cofinity Commercial	$1,108.02
Rate for Payer: Health Alliance Plan Medicare Advantage	$826.88
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$868.22
Rate for Payer: Nomi Health Commercial	$992.26
Rate for Payer: PACE SWMI	$826.88
Rate for Payer: PHP Medicare Advantage	$826.88
Rate for Payer: Priority Health Cigna Priority Health	$1,772.55
Rate for Payer: Priority Health Medicare	$835.15
Rate for Payer: UHC All Payor (Choice/PPO)	$826.88
Rate for Payer: UHC Dual Complete DSNP	$826.88
Rate for Payer: UHC Exchange	$826.88
Rate for Payer: UHC Medicare Advantage	$826.88

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

Professional

Both

$219.00

Service Code	HCPCS 91319
Min. Negotiated Rate	$87.60
Max. Negotiated Rate	$142.35
Rate for Payer: Aetna Commercial	$127.03
Rate for Payer: Aetna Medicare	$98.59
Rate for Payer: BCBS Complete	$87.60
Rate for Payer: BCBS MAPPO	$94.80
Rate for Payer: BCN Medicare Advantage	$94.80
Rate for Payer: Cash Price	$175.20
Rate for Payer: Cash Price	$175.20
Rate for Payer: Cofinity Commercial	$136.51
Rate for Payer: Cofinity Commercial	$127.03
Rate for Payer: Health Alliance Plan Medicare Advantage	$94.80
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$99.54
Rate for Payer: Nomi Health Commercial	$113.76
Rate for Payer: PACE SWMI	$94.80
Rate for Payer: PHP Medicare Advantage	$94.80
Rate for Payer: Priority Health Cigna Priority Health	$142.35
Rate for Payer: Priority Health Medicare	$95.75
Rate for Payer: UHC All Payor (Choice/PPO)	$94.80
Rate for Payer: UHC Dual Complete DSNP	$94.80
Rate for Payer: UHC Exchange	$94.80
Rate for Payer: UHC Medicare Advantage	$94.80

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

Professional

Both

$327.00

Service Code	HCPCS 91320
Min. Negotiated Rate	$130.80
Max. Negotiated Rate	$242.45
Rate for Payer: Aetna Commercial	$225.62
Rate for Payer: Aetna Medicare	$175.10
Rate for Payer: BCBS Complete	$130.80
Rate for Payer: BCBS MAPPO	$168.37
Rate for Payer: BCN Medicare Advantage	$168.37
Rate for Payer: Cash Price	$261.60
Rate for Payer: Cash Price	$261.60
Rate for Payer: Cofinity Commercial	$242.45
Rate for Payer: Cofinity Commercial	$225.62
Rate for Payer: Health Alliance Plan Medicare Advantage	$168.37
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$176.79
Rate for Payer: Nomi Health Commercial	$202.04
Rate for Payer: PACE SWMI	$168.37
Rate for Payer: PHP Medicare Advantage	$168.37
Rate for Payer: Priority Health Cigna Priority Health	$212.55
Rate for Payer: Priority Health Medicare	$170.05
Rate for Payer: UHC All Payor (Choice/PPO)	$168.37
Rate for Payer: UHC Dual Complete DSNP	$168.37
Rate for Payer: UHC Exchange	$168.37
Rate for Payer: UHC Medicare Advantage	$168.37

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

Professional

Both

$164.00

Service Code	HCPCS 91318
Min. Negotiated Rate	$65.60
Max. Negotiated Rate	$106.60
Rate for Payer: Aetna Medicare	$82.00
Rate for Payer: BCBS Complete	$65.60
Rate for Payer: Cash Price	$131.20
Rate for Payer: Priority Health Cigna Priority Health	$106.60

PR SBSQ HOSPITAL IP/OBS CARE HIGH MDM 50 MINUTES

Professional

Both

$184.00

Service Code	HCPCS 99233
Min. Negotiated Rate	$73.60
Max. Negotiated Rate	$161.40
Rate for Payer: Aetna Commercial	$150.19
Rate for Payer: Aetna Medicare	$116.56
Rate for Payer: BCBS Complete	$73.60
Rate for Payer: BCBS MAPPO	$112.08
Rate for Payer: BCN Medicare Advantage	$112.08
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cash Price	$147.20
Rate for Payer: Cofinity Commercial	$161.40
Rate for Payer: Cofinity Commercial	$150.19
Rate for Payer: Health Alliance Plan Medicare Advantage	$112.08
Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage	$117.68
Rate for Payer: Nomi Health Commercial	$134.50
Rate for Payer: PACE SWMI	$112.08
Rate for Payer: PHP Medicare Advantage	$112.08
Rate for Payer: Priority Health Cigna Priority Health	$119.60
Rate for Payer: Priority Health Medicare	$113.20
Rate for Payer: UHC All Payor (Choice/PPO)	$112.08
Rate for Payer: UHC Dual Complete DSNP	$112.08
Rate for Payer: UHC Exchange	$112.08
Rate for Payer: UHC Medicare Advantage	$112.08

Know your out-of-pocket cost for care.

All Charges