Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR TRACHEOSTOMA REVJ SMPL W/O FLAP ROTATION

Professional

Both

$939.00

Service Code	HCPCS 31613
Min. Negotiated Rate	$252.62
Max. Negotiated Rate	$704.25
Rate for Payer: Aetna Commercial	$554.79
Rate for Payer: Aetna Medicare	$469.50
Rate for Payer: BCBS Complete	$265.25
Rate for Payer: BCN Commercial	$632.43
Rate for Payer: Cash Price	$751.20
Rate for Payer: Cash Price	$751.20
Rate for Payer: Mclaren Medicaid	$252.62
Rate for Payer: Meridian Medicaid	$265.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$704.25
Rate for Payer: Priority Health Choice Medicaid	$252.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$595.57
Rate for Payer: Priority Health Narrow/Tiered Network	$595.57
Rate for Payer: UHC Medicaid	$252.62
Rate for Payer: UHCCP Medicaid	$252.62

PR TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE

Professional

Both

$833.00

Service Code	HCPCS 31605
Min. Negotiated Rate	$192.98
Max. Negotiated Rate	$624.75
Rate for Payer: Aetna Commercial	$432.01
Rate for Payer: Aetna Medicare	$416.50
Rate for Payer: BCBS Complete	$202.63
Rate for Payer: BCN Commercial	$491.51
Rate for Payer: Cash Price	$666.40
Rate for Payer: Cash Price	$666.40
Rate for Payer: Mclaren Medicaid	$192.98
Rate for Payer: Meridian Medicaid	$202.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$624.75
Rate for Payer: Priority Health Choice Medicaid	$192.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$462.85
Rate for Payer: Priority Health Narrow/Tiered Network	$462.85
Rate for Payer: UHC Medicaid	$192.98
Rate for Payer: UHCCP Medicaid	$192.98

PR TRACHEOSTOMY EMERGENCY PROCEDURE TRANSTRACHEAL

Professional

Both

$1,225.00

Service Code	HCPCS 31603
Min. Negotiated Rate	$177.64
Max. Negotiated Rate	$918.75
Rate for Payer: Aetna Commercial	$414.60
Rate for Payer: Aetna Medicare	$612.50
Rate for Payer: BCBS Complete	$186.52
Rate for Payer: BCN Commercial	$473.58
Rate for Payer: Cash Price	$980.00
Rate for Payer: Cash Price	$980.00
Rate for Payer: Mclaren Medicaid	$177.64
Rate for Payer: Meridian Medicaid	$186.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$918.75
Rate for Payer: Priority Health Choice Medicaid	$177.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$445.98
Rate for Payer: Priority Health Narrow/Tiered Network	$445.98
Rate for Payer: UHC Medicaid	$177.64
Rate for Payer: UHCCP Medicaid	$177.64

PR TRACHEOSTOMY FENESTRATION W/SKIN FLAPS

Professional

Both

$1,595.00

Service Code	HCPCS 31610
Min. Negotiated Rate	$548.90
Max. Negotiated Rate	$1,428.21
Rate for Payer: Aetna Commercial	$1,228.30
Rate for Payer: Aetna Medicare	$797.50
Rate for Payer: BCBS Complete	$576.35
Rate for Payer: BCN Commercial	$1,428.21
Rate for Payer: Cash Price	$1,276.00
Rate for Payer: Cash Price	$1,276.00
Rate for Payer: Mclaren Medicaid	$548.90
Rate for Payer: Meridian Medicaid	$576.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,196.25
Rate for Payer: Priority Health Choice Medicaid	$548.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,344.95
Rate for Payer: Priority Health Narrow/Tiered Network	$1,344.95
Rate for Payer: UHC Medicaid	$548.90
Rate for Payer: UHCCP Medicaid	$548.90

PR TRACHEOSTOMY PLANNED SEPARATE PROCEDURE

Professional

Both

$1,082.00

Service Code	HCPCS 31600
Min. Negotiated Rate	$174.23
Max. Negotiated Rate	$811.50
Rate for Payer: Aetna Commercial	$396.30
Rate for Payer: Aetna Medicare	$541.00
Rate for Payer: BCBS Complete	$182.94
Rate for Payer: BCN Commercial	$452.17
Rate for Payer: Cash Price	$865.60
Rate for Payer: Cash Price	$865.60
Rate for Payer: Mclaren Medicaid	$174.23
Rate for Payer: Meridian Medicaid	$182.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$811.50
Rate for Payer: Priority Health Choice Medicaid	$174.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$425.81
Rate for Payer: Priority Health Narrow/Tiered Network	$425.81
Rate for Payer: UHC Medicaid	$174.23
Rate for Payer: UHCCP Medicaid	$174.23

PR TRACHEOSTOMY PLANNED UNDER 2 YEARS SPX

Professional

Both

$1,069.00

Service Code	HCPCS 31601
Min. Negotiated Rate	$241.97
Max. Negotiated Rate	$801.75
Rate for Payer: Aetna Commercial	$574.14
Rate for Payer: Aetna Medicare	$534.50
Rate for Payer: BCBS Complete	$254.07
Rate for Payer: BCN Commercial	$669.28
Rate for Payer: Cash Price	$855.20
Rate for Payer: Cash Price	$855.20
Rate for Payer: Mclaren Medicaid	$241.97
Rate for Payer: Meridian Medicaid	$254.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$801.75
Rate for Payer: Priority Health Choice Medicaid	$241.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$630.27
Rate for Payer: Priority Health Narrow/Tiered Network	$630.27
Rate for Payer: UHC Medicaid	$241.97
Rate for Payer: UHCCP Medicaid	$241.97

PR TRACHEOTOMY TUBE CHANGE PRIOR TO FISTULA TRACT

Professional

Both

$75.00

Service Code	HCPCS 31502
Min. Negotiated Rate	$19.38
Max. Negotiated Rate	$56.25
Rate for Payer: Aetna Commercial	$45.05
Rate for Payer: Aetna Medicare	$37.50
Rate for Payer: BCBS Complete	$20.35
Rate for Payer: BCN Commercial	$51.29
Rate for Payer: Cash Price	$60.00
Rate for Payer: Cash Price	$60.00
Rate for Payer: Mclaren Medicaid	$19.38
Rate for Payer: Meridian Medicaid	$20.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$56.25
Rate for Payer: Priority Health Choice Medicaid	$19.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$48.31
Rate for Payer: Priority Health Narrow/Tiered Network	$48.31
Rate for Payer: UHC Medicaid	$19.38
Rate for Payer: UHCCP Medicaid	$19.38

PR TRANSCATHETER DLVR ENHNCD FIXATION DEVICES RS&I

Professional

Both

$1,427.00

Service Code	HCPCS 34712
Min. Negotiated Rate	$378.71
Max. Negotiated Rate	$1,070.25
Rate for Payer: Aetna Commercial	$882.07
Rate for Payer: Aetna Medicare	$713.50
Rate for Payer: BCBS Complete	$397.65
Rate for Payer: BCN Commercial	$957.62
Rate for Payer: Cash Price	$1,141.60
Rate for Payer: Cash Price	$1,141.60
Rate for Payer: Mclaren Medicaid	$378.71
Rate for Payer: Meridian Medicaid	$397.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,070.25
Rate for Payer: Priority Health Choice Medicaid	$378.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,029.79
Rate for Payer: Priority Health Narrow/Tiered Network	$1,029.79
Rate for Payer: UHC Medicaid	$378.71
Rate for Payer: UHCCP Medicaid	$378.71

PR TRANSCATHETER TRANSAPICAL REPLACEMT AORTIC VALVE

Professional

Both

$5,835.00

Service Code	HCPCS 33366
Min. Negotiated Rate	$893.11
Max. Negotiated Rate	$4,376.25
Rate for Payer: Aetna Commercial	$2,113.97
Rate for Payer: Aetna Medicare	$2,917.50
Rate for Payer: BCBS Complete	$937.77
Rate for Payer: BCN Commercial	$2,296.19
Rate for Payer: Cash Price	$4,668.00
Rate for Payer: Cash Price	$4,668.00
Rate for Payer: Mclaren Medicaid	$893.11
Rate for Payer: Meridian Medicaid	$937.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,376.25
Rate for Payer: Priority Health Choice Medicaid	$893.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,469.27
Rate for Payer: Priority Health Narrow/Tiered Network	$2,469.27
Rate for Payer: UHC Medicaid	$893.11
Rate for Payer: UHCCP Medicaid	$893.11

PR TRANSCATH INSERT OR REPLACE LEADLESS PM VENTR

Professional

Both

$1,679.00

Service Code	HCPCS 0387T
Min. Negotiated Rate	$671.60
Max. Negotiated Rate	$1,259.25
Rate for Payer: Aetna Medicare	$839.50
Rate for Payer: BCBS Complete	$671.60
Rate for Payer: Cash Price	$1,343.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,259.25

PR TRANSCATH INTRO, STENT, EXCL COR, CAROT, VERT

Professional

Both

$123.00

Service Code	HCPCS 75960
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$92.25
Rate for Payer: Aetna Medicare	$61.50
Rate for Payer: BCBS Complete	$49.20
Rate for Payer: Cash Price	$98.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$92.25

PR TRANSCATH OCCLUSION,PERCUT

Professional

Both

$1,912.00

Service Code	HCPCS 37204
Min. Negotiated Rate	$764.80
Max. Negotiated Rate	$1,434.00
Rate for Payer: Aetna Medicare	$956.00
Rate for Payer: BCBS Complete	$764.80
Rate for Payer: Cash Price	$1,529.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,434.00

PR TRANSCATH RX INFUSE OTHER

Professional

Both

$1,688.00

Service Code	HCPCS 37202
Min. Negotiated Rate	$675.20
Max. Negotiated Rate	$1,266.00
Rate for Payer: Aetna Medicare	$844.00
Rate for Payer: BCBS Complete	$675.20
Rate for Payer: Cash Price	$1,350.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,266.00

PR TRANSCATH STENT EACH ADDN VESSL,PERC

Professional

Both

$956.00

Service Code	HCPCS 37206
Min. Negotiated Rate	$382.40
Max. Negotiated Rate	$717.00
Rate for Payer: Aetna Medicare	$478.00
Rate for Payer: BCBS Complete	$382.40
Rate for Payer: Cash Price	$764.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$717.00

PR TRANSCATH STENT INIT VESSEL,PERCUT

Professional

Both

$1,771.00

Service Code	HCPCS 37205
Min. Negotiated Rate	$708.40
Max. Negotiated Rate	$1,328.25
Rate for Payer: Aetna Medicare	$885.50
Rate for Payer: BCBS Complete	$708.40
Rate for Payer: Cash Price	$1,416.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,328.25

PR TRANSCOCHLR POST CRNL FOSSA W/WO MOBIL NRV/ART

Professional

Both

$4,655.00

Service Code	HCPCS 61596
Min. Negotiated Rate	$1,332.53
Max. Negotiated Rate	$4,219.97
Rate for Payer: Aetna Commercial	$3,130.65
Rate for Payer: Aetna Medicare	$2,327.50
Rate for Payer: BCBS Complete	$1,399.16
Rate for Payer: BCN Commercial	$3,633.27
Rate for Payer: Cash Price	$3,724.00
Rate for Payer: Cash Price	$3,724.00
Rate for Payer: Mclaren Medicaid	$1,332.53
Rate for Payer: Meridian Medicaid	$1,399.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,491.25
Rate for Payer: Priority Health Choice Medicaid	$1,332.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$4,219.97
Rate for Payer: Priority Health Narrow/Tiered Network	$4,219.97
Rate for Payer: UHC Medicaid	$1,332.53
Rate for Payer: UHCCP Medicaid	$1,332.53

PR TRANSCRANIAL DOPPLER INTRACRAN ART EMBOLI DETECT

Professional

Both

$127.00

Service Code	HCPCS 93892
Min. Negotiated Rate	$63.50
Max. Negotiated Rate	$436.73
Rate for Payer: Aetna Commercial	$176.14
Rate for Payer: Aetna Medicare	$63.50
Rate for Payer: BCN Commercial	$436.73
Rate for Payer: Cash Price	$101.60
Rate for Payer: Cash Price	$101.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$95.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$402.76
Rate for Payer: Priority Health Narrow/Tiered Network	$402.76

PR TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART COMPL

Professional

Both

$121.00

Service Code	HCPCS 93886
Min. Negotiated Rate	$60.50
Max. Negotiated Rate	$382.45
Rate for Payer: Aetna Commercial	$293.15
Rate for Payer: Aetna Commercial	$293.15
Rate for Payer: Aetna Medicare	$60.50
Rate for Payer: Aetna Medicare	$325.50
Rate for Payer: BCN Commercial	$382.45
Rate for Payer: BCN Commercial	$382.45
Rate for Payer: Cash Price	$520.80
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$520.80
Rate for Payer: Cash Price	$96.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$488.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$90.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$352.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$352.70
Rate for Payer: Priority Health Narrow/Tiered Network	$352.70
Rate for Payer: Priority Health Narrow/Tiered Network	$352.70

PR TRANSCRANIAL DOPPLER STDY INTRACRANIAL ART LMTD

Professional

Both

$379.00

Service Code	HCPCS 93888
Min. Negotiated Rate	$139.30
Max. Negotiated Rate	$284.25
Rate for Payer: Aetna Commercial	$139.30
Rate for Payer: Aetna Medicare	$189.50
Rate for Payer: BCN Commercial	$240.53
Rate for Payer: Cash Price	$303.20
Rate for Payer: Cash Price	$303.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$284.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$221.81
Rate for Payer: Priority Health Narrow/Tiered Network	$221.81

PR TRANSECTION/AVULSION GREATER OCCIPITAL NERVE

Professional

Both

$893.00

Service Code	HCPCS 64744
Min. Negotiated Rate	$345.70
Max. Negotiated Rate	$906.35
Rate for Payer: Aetna Commercial	$643.70
Rate for Payer: Aetna Medicare	$446.50
Rate for Payer: BCBS Complete	$362.99
Rate for Payer: BCN Commercial	$857.25
Rate for Payer: Cash Price	$714.40
Rate for Payer: Cash Price	$714.40
Rate for Payer: Mclaren Medicaid	$345.70
Rate for Payer: Meridian Medicaid	$362.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$669.75
Rate for Payer: Priority Health Choice Medicaid	$345.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$906.35
Rate for Payer: Priority Health Narrow/Tiered Network	$906.35
Rate for Payer: UHC Medicaid	$345.70
Rate for Payer: UHCCP Medicaid	$345.70

PR TRANSECTION/AVULSION OTH SPINAL NRV XDRL

Professional

Both

$1,346.00

Service Code	HCPCS 64772
Min. Negotiated Rate	$329.30
Max. Negotiated Rate	$1,009.50
Rate for Payer: Aetna Commercial	$720.45
Rate for Payer: Aetna Medicare	$673.00
Rate for Payer: BCBS Complete	$345.76
Rate for Payer: BCN Commercial	$930.57
Rate for Payer: Cash Price	$1,076.80
Rate for Payer: Cash Price	$1,076.80
Rate for Payer: Mclaren Medicaid	$329.30
Rate for Payer: Meridian Medicaid	$345.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,009.50
Rate for Payer: Priority Health Choice Medicaid	$329.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$983.84
Rate for Payer: Priority Health Narrow/Tiered Network	$983.84
Rate for Payer: UHC Medicaid	$329.30
Rate for Payer: UHCCP Medicaid	$329.30

PR TRANSECTION/AVULSION VAGUS NERVE ABDOMINAL

Professional

Both

$1,093.00

Service Code	HCPCS 64760
Min. Negotiated Rate	$325.68
Max. Negotiated Rate	$918.49
Rate for Payer: Aetna Commercial	$671.50
Rate for Payer: Aetna Medicare	$546.50
Rate for Payer: BCBS Complete	$341.96
Rate for Payer: BCN Commercial	$790.79
Rate for Payer: Cash Price	$874.40
Rate for Payer: Cash Price	$874.40
Rate for Payer: Mclaren Medicaid	$325.68
Rate for Payer: Meridian Medicaid	$341.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$819.75
Rate for Payer: Priority Health Choice Medicaid	$325.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$918.49
Rate for Payer: Priority Health Narrow/Tiered Network	$918.49
Rate for Payer: UHC Medicaid	$325.68
Rate for Payer: UHCCP Medicaid	$325.68

PR TRANSFER ADDUCTOR ISCHIUM

Professional

Both

$2,737.00

Service Code	HCPCS 27098
Min. Negotiated Rate	$419.61
Max. Negotiated Rate	$2,052.75
Rate for Payer: Aetna Commercial	$926.87
Rate for Payer: Aetna Medicare	$1,368.50
Rate for Payer: BCBS Complete	$440.59
Rate for Payer: BCN Commercial	$1,065.18
Rate for Payer: Cash Price	$2,189.60
Rate for Payer: Cash Price	$2,189.60
Rate for Payer: Mclaren Medicaid	$419.61
Rate for Payer: Meridian Medicaid	$440.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,052.75
Rate for Payer: Priority Health Choice Medicaid	$419.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,138.65
Rate for Payer: Priority Health Narrow/Tiered Network	$1,138.65
Rate for Payer: UHC Medicaid	$419.61
Rate for Payer: UHCCP Medicaid	$419.61

PR TRANSFER ANY PEDICLE FLAP ANY LOCATION

Professional

Both

$759.00

Service Code	HCPCS 15650
Min. Negotiated Rate	$244.10
Max. Negotiated Rate	$613.51
Rate for Payer: Aetna Commercial	$403.21
Rate for Payer: Aetna Medicare	$379.50
Rate for Payer: BCBS Complete	$256.31
Rate for Payer: BCN Commercial	$613.51
Rate for Payer: Cash Price	$607.20
Rate for Payer: Cash Price	$607.20
Rate for Payer: Mclaren Medicaid	$244.10
Rate for Payer: Meridian Medicaid	$256.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$569.25
Rate for Payer: Priority Health Choice Medicaid	$244.10
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$561.52
Rate for Payer: Priority Health Narrow/Tiered Network	$561.52
Rate for Payer: UHC Medicaid	$244.10
Rate for Payer: UHCCP Medicaid	$244.10

PR TRANSFER ILIOPSOAS GREATER TROCHANTER FEMUR

Professional

Both

$7,157.00

Service Code	HCPCS 27110
Min. Negotiated Rate	$573.40
Max. Negotiated Rate	$5,367.75
Rate for Payer: Aetna Commercial	$1,296.83
Rate for Payer: Aetna Medicare	$3,578.50
Rate for Payer: BCBS Complete	$602.07
Rate for Payer: BCN Commercial	$1,475.02
Rate for Payer: Cash Price	$5,725.60
Rate for Payer: Cash Price	$5,725.60
Rate for Payer: Mclaren Medicaid	$573.40
Rate for Payer: Meridian Medicaid	$602.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,367.75
Rate for Payer: Priority Health Choice Medicaid	$573.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,576.75
Rate for Payer: Priority Health Narrow/Tiered Network	$1,576.75
Rate for Payer: UHC Medicaid	$573.40
Rate for Payer: UHCCP Medicaid	$573.40

Know your out-of-pocket cost for care.

All Charges