Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR TENOTOMY HIP FLEXOR OPEN SEPARATE PROCEDURE

Professional

Both

$1,453.00

Service Code	HCPCS 27005
Min. Negotiated Rate	$429.83
Max. Negotiated Rate	$1,178.57
Rate for Payer: Aetna Commercial	$959.38
Rate for Payer: Aetna Medicare	$726.50
Rate for Payer: BCBS Complete	$451.32
Rate for Payer: BCN Commercial	$1,102.53
Rate for Payer: Cash Price	$1,162.40
Rate for Payer: Cash Price	$1,162.40
Rate for Payer: Mclaren Medicaid	$429.83
Rate for Payer: Meridian Medicaid	$451.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,089.75
Rate for Payer: Priority Health Choice Medicaid	$429.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,178.57
Rate for Payer: Priority Health Narrow/Tiered Network	$1,178.57
Rate for Payer: UHC Medicaid	$429.83
Rate for Payer: UHCCP Medicaid	$429.83

PR TENOTOMY OPEN ELBOW TO SHOULDER EACH TENDON

Professional

Both

$933.00

Service Code	HCPCS 24310
Min. Negotiated Rate	$282.01
Max. Negotiated Rate	$774.01
Rate for Payer: Aetna Commercial	$632.34
Rate for Payer: Aetna Medicare	$466.50
Rate for Payer: BCBS Complete	$296.11
Rate for Payer: BCN Commercial	$724.06
Rate for Payer: Cash Price	$746.40
Rate for Payer: Cash Price	$746.40
Rate for Payer: Mclaren Medicaid	$282.01
Rate for Payer: Meridian Medicaid	$296.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$699.75
Rate for Payer: Priority Health Choice Medicaid	$282.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$774.01
Rate for Payer: Priority Health Narrow/Tiered Network	$774.01
Rate for Payer: UHC Medicaid	$282.01
Rate for Payer: UHCCP Medicaid	$282.01

PR TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON

Professional

Both

$684.00

Service Code	HCPCS 28234
Min. Negotiated Rate	$166.35
Max. Negotiated Rate	$513.00
Rate for Payer: Aetna Commercial	$349.37
Rate for Payer: Aetna Medicare	$342.00
Rate for Payer: BCBS Complete	$174.67
Rate for Payer: BCN Commercial	$413.33
Rate for Payer: Cash Price	$547.20
Rate for Payer: Cash Price	$547.20
Rate for Payer: Mclaren Medicaid	$166.35
Rate for Payer: Meridian Medicaid	$174.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$513.00
Rate for Payer: Priority Health Choice Medicaid	$166.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$441.84
Rate for Payer: Priority Health Narrow/Tiered Network	$441.84
Rate for Payer: UHC Medicaid	$166.35
Rate for Payer: UHCCP Medicaid	$166.35

PR TENOTOMY OPN HAMSTRING KNEE HIP MULTIPLE 1 LEG

Professional

Both

$1,188.00

Service Code	HCPCS 27391
Min. Negotiated Rate	$351.88
Max. Negotiated Rate	$951.27
Rate for Payer: Aetna Commercial	$733.56
Rate for Payer: Aetna Medicare	$594.00
Rate for Payer: BCBS Complete	$369.47
Rate for Payer: BCN Commercial	$889.90
Rate for Payer: Cash Price	$950.40
Rate for Payer: Cash Price	$950.40
Rate for Payer: Mclaren Medicaid	$351.88
Rate for Payer: Meridian Medicaid	$369.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$891.00
Rate for Payer: Priority Health Choice Medicaid	$351.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$951.27
Rate for Payer: Priority Health Narrow/Tiered Network	$951.27
Rate for Payer: UHC Medicaid	$351.88
Rate for Payer: UHCCP Medicaid	$351.88

PR TENOTOMY PERCUTANEOUS TOE SINGLE TENDON

Professional

Both

$406.00

Service Code	HCPCS 28010
Min. Negotiated Rate	$126.31
Max. Negotiated Rate	$340.15
Rate for Payer: Aetna Commercial	$272.02
Rate for Payer: Aetna Medicare	$203.00
Rate for Payer: BCBS Complete	$132.63
Rate for Payer: BCN Commercial	$318.21
Rate for Payer: Cash Price	$324.80
Rate for Payer: Cash Price	$324.80
Rate for Payer: Mclaren Medicaid	$126.31
Rate for Payer: Meridian Medicaid	$132.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$304.50
Rate for Payer: Priority Health Choice Medicaid	$126.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$340.15
Rate for Payer: Priority Health Narrow/Tiered Network	$340.15
Rate for Payer: UHC Medicaid	$126.31
Rate for Payer: UHCCP Medicaid	$126.31

PR TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES

Professional

Both

$893.00

Service Code	HCPCS 27606
Min. Negotiated Rate	$162.52
Max. Negotiated Rate	$669.75
Rate for Payer: Aetna Commercial	$365.88
Rate for Payer: Aetna Medicare	$446.50
Rate for Payer: BCBS Complete	$170.65
Rate for Payer: BCN Commercial	$411.33
Rate for Payer: Cash Price	$714.40
Rate for Payer: Cash Price	$714.40
Rate for Payer: Mclaren Medicaid	$162.52
Rate for Payer: Meridian Medicaid	$170.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$669.75
Rate for Payer: Priority Health Choice Medicaid	$162.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$439.70
Rate for Payer: Priority Health Narrow/Tiered Network	$439.70
Rate for Payer: UHC Medicaid	$162.52
Rate for Payer: UHCCP Medicaid	$162.52

PR TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES

Professional

Both

$785.00

Service Code	HCPCS 27605
Min. Negotiated Rate	$110.55
Max. Negotiated Rate	$588.75
Rate for Payer: Aetna Commercial	$244.41
Rate for Payer: Aetna Medicare	$392.50
Rate for Payer: BCBS Complete	$116.08
Rate for Payer: BCN Commercial	$277.38
Rate for Payer: Cash Price	$628.00
Rate for Payer: Cash Price	$628.00
Rate for Payer: Mclaren Medicaid	$110.55
Rate for Payer: Meridian Medicaid	$116.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$588.75
Rate for Payer: Priority Health Choice Medicaid	$110.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$296.51
Rate for Payer: Priority Health Narrow/Tiered Network	$296.51
Rate for Payer: UHC Medicaid	$110.55
Rate for Payer: UHCCP Medicaid	$110.55

PR TENOTOMY PRQ ADDUCTOR/HAMSTRING 1 TENDON SPX

Professional

Both

$1,216.00

Service Code	HCPCS 27306
Min. Negotiated Rate	$207.25
Max. Negotiated Rate	$912.00
Rate for Payer: Aetna Commercial	$444.87
Rate for Payer: Aetna Medicare	$608.00
Rate for Payer: BCBS Complete	$217.61
Rate for Payer: BCN Commercial	$526.86
Rate for Payer: Cash Price	$972.80
Rate for Payer: Cash Price	$972.80
Rate for Payer: Mclaren Medicaid	$207.25
Rate for Payer: Meridian Medicaid	$217.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$912.00
Rate for Payer: Priority Health Choice Medicaid	$207.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$563.21
Rate for Payer: Priority Health Narrow/Tiered Network	$563.21
Rate for Payer: UHC Medicaid	$207.25
Rate for Payer: UHCCP Medicaid	$207.25

PR TENOTOMY PRQ ADDUCTOR/HAMSTRING MULTIPLE TENDON

Professional

Both

$870.00

Service Code	HCPCS 27307
Min. Negotiated Rate	$239.84
Max. Negotiated Rate	$671.79
Rate for Payer: Aetna Commercial	$639.94
Rate for Payer: Aetna Medicare	$435.00
Rate for Payer: BCBS Complete	$251.83
Rate for Payer: BCN Commercial	$628.45
Rate for Payer: Cash Price	$696.00
Rate for Payer: Cash Price	$696.00
Rate for Payer: Mclaren Medicaid	$239.84
Rate for Payer: Meridian Medicaid	$251.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$652.50
Rate for Payer: Priority Health Choice Medicaid	$239.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$671.79
Rate for Payer: Priority Health Narrow/Tiered Network	$671.79
Rate for Payer: UHC Medicaid	$239.84
Rate for Payer: UHCCP Medicaid	$239.84

PR TENOTOMY SHOULDER AREA 1 TENDON

Professional

Both

$1,784.00

Service Code	HCPCS 23405
Min. Negotiated Rate	$366.36
Max. Negotiated Rate	$1,338.00
Rate for Payer: Aetna Commercial	$826.45
Rate for Payer: Aetna Medicare	$892.00
Rate for Payer: BCBS Complete	$384.68
Rate for Payer: BCN Commercial	$936.70
Rate for Payer: Cash Price	$1,427.20
Rate for Payer: Cash Price	$1,427.20
Rate for Payer: Mclaren Medicaid	$366.36
Rate for Payer: Meridian Medicaid	$384.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,338.00
Rate for Payer: Priority Health Choice Medicaid	$366.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,001.31
Rate for Payer: Priority Health Narrow/Tiered Network	$1,001.31
Rate for Payer: UHC Medicaid	$366.36
Rate for Payer: UHCCP Medicaid	$366.36

PR TERBUTALINE SULFATE INJ

Professional

Both

$40.00

Service Code	HCPCS J3105
Min. Negotiated Rate	$0.19
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$8.03
Rate for Payer: Aetna Medicare	$20.00
Rate for Payer: BCBS Trust/PPO	$0.28
Rate for Payer: BCN Commercial	$0.19
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.00

PR TESTING AUTONOMIC NERVOUS SYSTEM FUNCTION

Professional

Both

$452.00

Service Code	HCPCS 95923
Min. Negotiated Rate	$139.62
Max. Negotiated Rate	$339.00
Rate for Payer: Aetna Commercial	$139.62
Rate for Payer: Aetna Medicare	$226.00
Rate for Payer: BCN Commercial	$175.79
Rate for Payer: Cash Price	$361.60
Rate for Payer: Cash Price	$361.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$339.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$162.11
Rate for Payer: Priority Health Narrow/Tiered Network	$162.11

PR TESTOSTERONE CYPIONAT 100 MG

Professional

Both

$10.00

Service Code	HCPCS J1070
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50

PR TESTOSTERONE CYPIONAT 200 MG

Professional

Both

$34.00

Service Code	HCPCS J1080
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Medicare	$17.00
Rate for Payer: BCBS Complete	$13.60
Rate for Payer: Cash Price	$27.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$25.50

PR TESTOSTERONE CYPIONATE 1 ML

Professional

Both

$6.00

Service Code	HCPCS J1060
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50

PR TESTOSTERONE ENANTHATE INJ

Professional

Both

$34.00

Service Code	HCPCS J3130
Min. Negotiated Rate	$13.60
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Medicare	$17.00
Rate for Payer: BCBS Complete	$13.60
Rate for Payer: Cash Price	$27.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$25.50

PR TESTOSTERONE PELLET 75 MG

Professional

Both

$126.00

Service Code	HCPCS S0189
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$106.79
Rate for Payer: Aetna Commercial	$100.93
Rate for Payer: Aetna Medicare	$63.00
Rate for Payer: BCBS Complete	$50.40
Rate for Payer: BCN Commercial	$106.79
Rate for Payer: Cash Price	$100.80
Rate for Payer: Cash Price	$100.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$94.50

PR TESTOSTERONE UNDECANOATE 1MG

Professional

Both

$5.00

Service Code	HCPCS J3145
Min. Negotiated Rate	$1.89
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Commercial	$1.89
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Trust/PPO	$2.10
Rate for Payer: BCN Commercial	$2.06
Rate for Payer: Cash Price	$4.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR TETANUS IMMUNIZATION, IM

Professional

Both

$46.00

Service Code	HCPCS 90703
Min. Negotiated Rate	$18.40
Max. Negotiated Rate	$34.50
Rate for Payer: Aetna Medicare	$23.00
Rate for Payer: BCBS Complete	$18.40
Rate for Payer: Cash Price	$36.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$34.50

PR THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN

Professional

Both

$58.00

Service Code	HCPCS 97530
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$89.48
Rate for Payer: Aetna Commercial	$28.00
Rate for Payer: Aetna Medicare	$29.00
Rate for Payer: BCN Commercial	$35.72
Rate for Payer: Cash Price	$46.40
Rate for Payer: Cash Price	$46.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$43.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.48
Rate for Payer: Priority Health Narrow/Tiered Network	$89.48

PR THERAPEUTIC APHERESIS PLASMA PHERESIS

Professional

Both

$895.00

Service Code	HCPCS 36514
Min. Negotiated Rate	$49.84
Max. Negotiated Rate	$671.25
Rate for Payer: Aetna Commercial	$126.08
Rate for Payer: Aetna Medicare	$447.50
Rate for Payer: BCBS Complete	$52.33
Rate for Payer: BCN Commercial	$137.94
Rate for Payer: Cash Price	$716.00
Rate for Payer: Cash Price	$716.00
Rate for Payer: Mclaren Medicaid	$49.84
Rate for Payer: Meridian Medicaid	$52.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$671.25
Rate for Payer: Priority Health Choice Medicaid	$49.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$148.34
Rate for Payer: Priority Health Narrow/Tiered Network	$148.34
Rate for Payer: UHC Medicaid	$49.84
Rate for Payer: UHCCP Medicaid	$49.84

PR THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS

Professional

Both

$35.00

Service Code	HCPCS 97150
Min. Negotiated Rate	$13.09
Max. Negotiated Rate	$89.48
Rate for Payer: Aetna Commercial	$13.09
Rate for Payer: Aetna Medicare	$17.50
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: BCN Commercial	$18.03
Rate for Payer: Cash Price	$28.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.48
Rate for Payer: Priority Health Narrow/Tiered Network	$89.48

PR THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM

Professional

Both

$45.00

Service Code	HCPCS 96372
Min. Negotiated Rate	$14.35
Max. Negotiated Rate	$33.75
Rate for Payer: Aetna Commercial	$15.21
Rate for Payer: Aetna Medicare	$22.50
Rate for Payer: BCN Commercial	$14.35
Rate for Payer: Cash Price	$36.00
Rate for Payer: Cash Price	$36.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$33.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$19.75
Rate for Payer: Priority Health Narrow/Tiered Network	$19.75

PR THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES

Professional

Both

$55.00

Service Code	HCPCS 97110
Min. Negotiated Rate	$21.83
Max. Negotiated Rate	$89.48
Rate for Payer: Aetna Commercial	$21.83
Rate for Payer: Aetna Medicare	$27.50
Rate for Payer: BCN Commercial	$29.70
Rate for Payer: Cash Price	$44.00
Rate for Payer: Cash Price	$44.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$41.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.48
Rate for Payer: Priority Health Narrow/Tiered Network	$89.48

PR THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT

Professional

Both

$235.00

Service Code	HCPCS 62329
Min. Negotiated Rate	$59.21
Max. Negotiated Rate	$179.89
Rate for Payer: Aetna Commercial	$145.51
Rate for Payer: Aetna Medicare	$117.50
Rate for Payer: BCBS Complete	$62.17
Rate for Payer: BCN Commercial	$154.87
Rate for Payer: Cash Price	$188.00
Rate for Payer: Cash Price	$188.00
Rate for Payer: Mclaren Medicaid	$59.21
Rate for Payer: Meridian Medicaid	$62.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$176.25
Rate for Payer: Priority Health Choice Medicaid	$59.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$179.89
Rate for Payer: Priority Health Narrow/Tiered Network	$179.89
Rate for Payer: UHC Medicaid	$59.21
Rate for Payer: UHCCP Medicaid	$59.21

Know your out-of-pocket cost for care.

All Charges