Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR WHO W/NONTORSION JNT(S) CF

Professional

Both

$954.00

Service Code	HCPCS L3905
Min. Negotiated Rate	$381.60
Max. Negotiated Rate	$1,061.92
Rate for Payer: Aetna Commercial	$543.58
Rate for Payer: Aetna Medicare	$477.00
Rate for Payer: BCBS Complete	$381.60
Rate for Payer: BCN Commercial	$1,061.92
Rate for Payer: Cash Price	$763.20
Rate for Payer: Cash Price	$763.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$715.50

PR WHO W/O JOINTS CF

Professional

Both

$487.00

Service Code	HCPCS L3906
Min. Negotiated Rate	$194.80
Max. Negotiated Rate	$542.66
Rate for Payer: Aetna Commercial	$277.78
Rate for Payer: Aetna Medicare	$243.50
Rate for Payer: BCBS Complete	$194.80
Rate for Payer: BCN Commercial	$542.66
Rate for Payer: Cash Price	$389.60
Rate for Payer: Cash Price	$389.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$365.25

PR WINDOWING CAST

Professional

Both

$117.00

Service Code	HCPCS 29730
Min. Negotiated Rate	$24.71
Max. Negotiated Rate	$87.75
Rate for Payer: Aetna Commercial	$58.92
Rate for Payer: Aetna Medicare	$58.50
Rate for Payer: BCBS Complete	$25.95
Rate for Payer: BCN Commercial	$66.73
Rate for Payer: Cash Price	$93.60
Rate for Payer: Cash Price	$93.60
Rate for Payer: Mclaren Medicaid	$24.71
Rate for Payer: Meridian Medicaid	$25.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$87.75
Rate for Payer: Priority Health Choice Medicaid	$24.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$71.32
Rate for Payer: Priority Health Narrow/Tiered Network	$71.32
Rate for Payer: UHC Medicaid	$24.71
Rate for Payer: UHCCP Medicaid	$24.71

PR WORK HARDENING/CONDITIONING 1ST 2 HR

Professional

Both

$204.00

Service Code	HCPCS 97545
Min. Negotiated Rate	$81.60
Max. Negotiated Rate	$189.41
Rate for Payer: Aetna Commercial	$119.94
Rate for Payer: Aetna Medicare	$102.00
Rate for Payer: BCBS Complete	$81.60
Rate for Payer: BCN Commercial	$189.41
Rate for Payer: Cash Price	$163.20
Rate for Payer: Cash Price	$163.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$153.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.48
Rate for Payer: Priority Health Narrow/Tiered Network	$89.48

PR WORK HARDENING/CONDITIONING EACH HOUR

Professional

Both

$102.00

Service Code	HCPCS 97546
Min. Negotiated Rate	$40.80
Max. Negotiated Rate	$94.44
Rate for Payer: Aetna Commercial	$47.77
Rate for Payer: Aetna Medicare	$51.00
Rate for Payer: BCBS Complete	$40.80
Rate for Payer: BCN Commercial	$94.44
Rate for Payer: Cash Price	$81.60
Rate for Payer: Cash Price	$81.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$76.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.48
Rate for Payer: Priority Health Narrow/Tiered Network	$89.48

PR WORK RELATED/MED DBLT XM TREATING PHYS

Professional

Both

$115.00

Service Code	HCPCS 99455
Min. Negotiated Rate	$46.00
Max. Negotiated Rate	$86.25
Rate for Payer: Aetna Commercial	$84.95
Rate for Payer: Aetna Medicare	$57.50
Rate for Payer: BCBS Complete	$46.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$86.25

PR WOUND CLOSURE BY ADHESIVE

Professional

Both

$208.00

Service Code	HCPCS G0168
Min. Negotiated Rate	$8.95
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Commercial	$15.22
Rate for Payer: Aetna Medicare	$104.00
Rate for Payer: BCBS Complete	$9.40
Rate for Payer: BCN Commercial	$21.41
Rate for Payer: Cash Price	$166.40
Rate for Payer: Cash Price	$166.40
Rate for Payer: Mclaren Medicaid	$8.95
Rate for Payer: Meridian Medicaid	$9.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$156.00
Rate for Payer: Priority Health Choice Medicaid	$8.95
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$19.60
Rate for Payer: Priority Health Narrow/Tiered Network	$19.60
Rate for Payer: UHC Medicaid	$8.95
Rate for Payer: UHCCP Medicaid	$8.95

PR XCAPSL CTRC RMVL INSJ IO LENS PROSTH W/O ECP

Professional

Both

$1,265.00

Service Code	HCPCS 66984
Min. Negotiated Rate	$295.01
Max. Negotiated Rate	$948.75
Rate for Payer: Aetna Commercial	$706.68
Rate for Payer: Aetna Medicare	$632.50
Rate for Payer: BCBS Complete	$309.76
Rate for Payer: BCN Commercial	$803.24
Rate for Payer: Cash Price	$1,012.00
Rate for Payer: Cash Price	$1,012.00
Rate for Payer: Mclaren Medicaid	$295.01
Rate for Payer: Meridian Medicaid	$309.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$948.75
Rate for Payer: Priority Health Choice Medicaid	$295.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$940.87
Rate for Payer: Priority Health Narrow/Tiered Network	$940.87
Rate for Payer: UHC Medicaid	$295.01
Rate for Payer: UHCCP Medicaid	$295.01

PR XEOMIN

Professional

Both

$10.00

Hospital Revenue Code	990
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 XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX W/ECG

Professional

Both

$209.00

Service Code	HCPCS 94617
Min. Negotiated Rate	$100.14
Max. Negotiated Rate	$156.75
Rate for Payer: Aetna Commercial	$100.14
Rate for Payer: Aetna Commercial	$100.14
Rate for Payer: Aetna Medicare	$104.50
Rate for Payer: Aetna Medicare	$41.00
Rate for Payer: BCN Commercial	$133.46
Rate for Payer: BCN Commercial	$133.46
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$167.20
Rate for Payer: Cash Price	$65.60
Rate for Payer: Cash Price	$167.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$156.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$61.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$123.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$123.08
Rate for Payer: Priority Health Narrow/Tiered Network	$123.08
Rate for Payer: Priority Health Narrow/Tiered Network	$123.08

PR XERS TST BRNCSPSM PRE&POST SPMTRY&PLS OX WO /ECG

Professional

Both

$165.00

Service Code	HCPCS 94619
Min. Negotiated Rate	$77.64
Max. Negotiated Rate	$123.75
Rate for Payer: Aetna Commercial	$77.64
Rate for Payer: Aetna Medicare	$82.50
Rate for Payer: BCN Commercial	$97.60
Rate for Payer: Cash Price	$132.00
Rate for Payer: Cash Price	$132.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$123.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$90.01
Rate for Payer: Priority Health Narrow/Tiered Network	$90.01

PR XTRNL ECG REC>48HR<7D RECORDING SCAN A/R R&I

Professional

Both

$321.00

Service Code	HCPCS 93241
Min. Negotiated Rate	$142.76
Max. Negotiated Rate	$380.06
Rate for Payer: Aetna Commercial	$142.76
Rate for Payer: Aetna Medicare	$160.50
Rate for Payer: BCN Commercial	$315.34
Rate for Payer: Cash Price	$256.80
Rate for Payer: Cash Price	$256.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$240.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$380.06
Rate for Payer: Priority Health Narrow/Tiered Network	$380.06

PR XTRNL ECG REC<48 HRS RECORDING

Professional

Both

$124.00

Service Code	HCPCS 93225
Min. Negotiated Rate	$24.92
Max. Negotiated Rate	$93.00
Rate for Payer: Aetna Commercial	$24.92
Rate for Payer: Aetna Medicare	$62.00
Rate for Payer: BCN Commercial	$26.89
Rate for Payer: Cash Price	$99.20
Rate for Payer: Cash Price	$99.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$93.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$25.56
Rate for Payer: Priority Health Narrow/Tiered Network	$25.56

PR XTRNL ECG REC<48 HRS RECORDING SCAN A/R R&I

Professional

Both

$242.00

Service Code	HCPCS 93224
Min. Negotiated Rate	$99.87
Max. Negotiated Rate	$181.50
Rate for Payer: Aetna Commercial	$100.86
Rate for Payer: Aetna Medicare	$121.00
Rate for Payer: BCN Commercial	$105.08
Rate for Payer: Cash Price	$193.60
Rate for Payer: Cash Price	$193.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$181.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$99.87
Rate for Payer: Priority Health Narrow/Tiered Network	$99.87

PR XTRNL ECG REC<48 HRS RVW&INTERPJ PHYS/QHP

Professional

Both

$206.00

Service Code	HCPCS 93227
Min. Negotiated Rate	$11.29
Max. Negotiated Rate	$154.50
Rate for Payer: Aetna Commercial	$24.84
Rate for Payer: Aetna Medicare	$103.00
Rate for Payer: BCBS Complete	$11.85
Rate for Payer: BCN Commercial	$26.89
Rate for Payer: Cash Price	$164.80
Rate for Payer: Cash Price	$164.80
Rate for Payer: Mclaren Medicaid	$11.29
Rate for Payer: Meridian Medicaid	$11.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$154.50
Rate for Payer: Priority Health Choice Medicaid	$11.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$25.56
Rate for Payer: Priority Health Narrow/Tiered Network	$25.56
Rate for Payer: UHC Medicaid	$11.29
Rate for Payer: UHCCP Medicaid	$11.29

PR XTRNL ECG REC<48 HRS SCANNING A/R

Professional

Both

$74.00

Service Code	HCPCS 93226
Min. Negotiated Rate	$37.00
Max. Negotiated Rate	$55.50
Rate for Payer: Aetna Commercial	$51.10
Rate for Payer: Aetna Medicare	$37.00
Rate for Payer: BCN Commercial	$51.29
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cash Price	$59.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$55.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$48.76
Rate for Payer: Priority Health Narrow/Tiered Network	$48.76

PR XTRNL MOBILE CV TELEMETRY W/I&REPORT 30 DAYS

Professional

Both

$60.00

Service Code	HCPCS 93228
Min. Negotiated Rate	$15.98
Max. Negotiated Rate	$45.00
Rate for Payer: Aetna Commercial	$34.49
Rate for Payer: Aetna Medicare	$30.00
Rate for Payer: BCBS Complete	$16.78
Rate for Payer: BCN Commercial	$37.35
Rate for Payer: Cash Price	$48.00
Rate for Payer: Cash Price	$48.00
Rate for Payer: Mclaren Medicaid	$15.98
Rate for Payer: Meridian Medicaid	$16.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$45.00
Rate for Payer: Priority Health Choice Medicaid	$15.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$35.50
Rate for Payer: Priority Health Narrow/Tiered Network	$35.50
Rate for Payer: UHC Medicaid	$15.98
Rate for Payer: UHCCP Medicaid	$15.98

PR XTRNL PT ACTIVATED ECG REC DWNLD 30 DAYS

Professional

Both

$674.00

Service Code	HCPCS 93271
Min. Negotiated Rate	$194.05
Max. Negotiated Rate	$505.50
Rate for Payer: Aetna Commercial	$206.02
Rate for Payer: Aetna Medicare	$337.00
Rate for Payer: BCN Commercial	$204.18
Rate for Payer: Cash Price	$539.20
Rate for Payer: Cash Price	$539.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$505.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$194.05
Rate for Payer: Priority Health Narrow/Tiered Network	$194.05

PR XTRNL PT ACTIVATED ECG RECORD MONITOR 30 DAYS

Professional

Both

$127.00

Service Code	HCPCS 93270
Min. Negotiated Rate	$11.19
Max. Negotiated Rate	$95.25
Rate for Payer: Aetna Commercial	$11.19
Rate for Payer: Aetna Medicare	$63.50
Rate for Payer: BCN Commercial	$11.95
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	$11.35
Rate for Payer: Priority Health Narrow/Tiered Network	$11.35

PR XTRNL PT ACTIV ECG TRANSMIS W/R&I </30 DAYS

Professional

Both

$897.00

Service Code	HCPCS 93268
Min. Negotiated Rate	$239.02
Max. Negotiated Rate	$672.75
Rate for Payer: Aetna Commercial	$250.35
Rate for Payer: Aetna Medicare	$448.50
Rate for Payer: BCN Commercial	$251.48
Rate for Payer: Cash Price	$717.60
Rate for Payer: Cash Price	$717.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$672.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$239.02
Rate for Payer: Priority Health Narrow/Tiered Network	$239.02

PR XTRNL PT ACTIVTD ECG DWNLD W/R&I </30 DAYS

Professional

Both

$179.00

Service Code	HCPCS 93272
Min. Negotiated Rate	$15.12
Max. Negotiated Rate	$134.25
Rate for Payer: Aetna Commercial	$33.14
Rate for Payer: Aetna Medicare	$89.50
Rate for Payer: BCBS Complete	$15.88
Rate for Payer: BCN Commercial	$35.35
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cash Price	$143.20
Rate for Payer: Mclaren Medicaid	$15.12
Rate for Payer: Meridian Medicaid	$15.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$134.25
Rate for Payer: Priority Health Choice Medicaid	$15.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$33.61
Rate for Payer: Priority Health Narrow/Tiered Network	$33.61
Rate for Payer: UHC Medicaid	$15.12
Rate for Payer: UHCCP Medicaid	$15.12

PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBLNGL

Professional

Both

$626.00

Service Code	HCPCS 41015
Min. Negotiated Rate	$178.49
Max. Negotiated Rate	$555.18
Rate for Payer: Aetna Commercial	$398.41
Rate for Payer: Aetna Medicare	$313.00
Rate for Payer: BCBS Complete	$187.41
Rate for Payer: BCN Commercial	$455.65
Rate for Payer: Cash Price	$500.80
Rate for Payer: Cash Price	$500.80
Rate for Payer: Mclaren Medicaid	$178.49
Rate for Payer: Meridian Medicaid	$187.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$469.50
Rate for Payer: Priority Health Choice Medicaid	$178.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$555.18
Rate for Payer: Priority Health Narrow/Tiered Network	$555.18
Rate for Payer: UHC Medicaid	$178.49
Rate for Payer: UHCCP Medicaid	$178.49

PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMENT

Professional

Both

$747.00

Service Code	HCPCS 41016
Min. Negotiated Rate	$207.46
Max. Negotiated Rate	$635.28
Rate for Payer: Aetna Commercial	$458.87
Rate for Payer: Aetna Medicare	$373.50
Rate for Payer: BCBS Complete	$217.83
Rate for Payer: BCN Commercial	$521.38
Rate for Payer: Cash Price	$597.60
Rate for Payer: Cash Price	$597.60
Rate for Payer: Mclaren Medicaid	$207.46
Rate for Payer: Meridian Medicaid	$217.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$560.25
Rate for Payer: Priority Health Choice Medicaid	$207.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$635.28
Rate for Payer: Priority Health Narrow/Tiered Network	$635.28
Rate for Payer: UHC Medicaid	$207.46
Rate for Payer: UHCCP Medicaid	$207.46

PR XTRORAL I&D ABSC CST/HMTMA FLOOR MOUTH SUBMNDB

Professional

Both

$929.00

Service Code	HCPCS 41017
Min. Negotiated Rate	$204.91
Max. Negotiated Rate	$696.75
Rate for Payer: Aetna Commercial	$454.51
Rate for Payer: Aetna Medicare	$464.50
Rate for Payer: BCBS Complete	$215.16
Rate for Payer: BCN Commercial	$517.40
Rate for Payer: Cash Price	$743.20
Rate for Payer: Cash Price	$743.20
Rate for Payer: Mclaren Medicaid	$204.91
Rate for Payer: Meridian Medicaid	$215.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$696.75
Rate for Payer: Priority Health Choice Medicaid	$204.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$630.42
Rate for Payer: Priority Health Narrow/Tiered Network	$630.42
Rate for Payer: UHC Medicaid	$204.91
Rate for Payer: UHCCP Medicaid	$204.91

PR ZINC PASTE BAND W >=3""<5""/YD

Professional

Both

$19.00

Service Code	HCPCS A6456
Min. Negotiated Rate	$1.18
Max. Negotiated Rate	$14.25
Rate for Payer: Aetna Commercial	$1.18
Rate for Payer: Aetna Medicare	$9.50
Rate for Payer: BCBS Complete	$7.60
Rate for Payer: BCN Commercial	$1.71
Rate for Payer: Cash Price	$15.20
Rate for Payer: Cash Price	$15.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$14.25

Know your out-of-pocket cost for care.

All Charges