Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR ANES XTRPRTL PX LWR ABD W/UR TRACT RENAL TRANSPL

Professional

Both

$10.00

Service Code	HCPCS 00868
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 ANES XTRPRTL PX LWR ABD W/UR TRACT TOT CSTC

Professional

Both

$8.00

Service Code	HCPCS 00864
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.00

PR ANES XTRPRTL PX LWR ABD W/UR TRC CYSTOLITHOTOMY

Professional

Both

$5.00

Service Code	HCPCS 00870
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANKLE CONTROL ORTHO PRE OTS

Professional

Both

$98.00

Service Code	HCPCS L4350
Min. Negotiated Rate	$49.00
Max. Negotiated Rate	$113.84
Rate for Payer: Aetna Commercial	$58.28
Rate for Payer: Aetna Medicare	$49.00
Rate for Payer: BCN Commercial	$113.84
Rate for Payer: Cash Price	$78.40
Rate for Payer: Cash Price	$78.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$73.50

PR ANKLE DISARTICULATION

Professional

Both

$1,376.00

Service Code	HCPCS 27889
Min. Negotiated Rate	$381.06
Max. Negotiated Rate	$1,032.00
Rate for Payer: Aetna Commercial	$853.82
Rate for Payer: Aetna Medicare	$688.00
Rate for Payer: BCBS Complete	$400.11
Rate for Payer: BCN Commercial	$959.11
Rate for Payer: Cash Price	$1,100.80
Rate for Payer: Cash Price	$1,100.80
Rate for Payer: Mclaren Medicaid	$381.06
Rate for Payer: Meridian Medicaid	$400.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,032.00
Rate for Payer: Priority Health Choice Medicaid	$381.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,025.26
Rate for Payer: Priority Health Narrow/Tiered Network	$1,025.26
Rate for Payer: UHC Medicaid	$381.06
Rate for Payer: UHCCP Medicaid	$381.06

PR ANN BREAST EXAM

Professional

Both

$21.00

Service Code	HCPCS S0613
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$25.00
Rate for Payer: Aetna Commercial	$25.00
Rate for Payer: Aetna Medicare	$10.50
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: BCN Commercial	$19.15
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.75

PR ANNUAL GYNECOLOGICAL EXAMINA

Professional

Both

$83.00

Service Code	HCPCS S0612
Min. Negotiated Rate	$33.20
Max. Negotiated Rate	$65.39
Rate for Payer: Aetna Commercial	$55.00
Rate for Payer: Aetna Medicare	$41.50
Rate for Payer: BCBS Complete	$33.20
Rate for Payer: BCN Commercial	$65.39
Rate for Payer: Cash Price	$66.40
Rate for Payer: Cash Price	$66.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$62.25

PR ANOGENITAL XM MAGNIFY CHILD/SUSPECT TRAUMA W IMG

Professional

Both

$276.00

Service Code	HCPCS 99170
Min. Negotiated Rate	$45.80
Max. Negotiated Rate	$207.00
Rate for Payer: Aetna Commercial	$95.44
Rate for Payer: Aetna Medicare	$138.00
Rate for Payer: BCBS Complete	$48.09
Rate for Payer: BCN Commercial	$124.99
Rate for Payer: Cash Price	$220.80
Rate for Payer: Cash Price	$220.80
Rate for Payer: Mclaren Medicaid	$45.80
Rate for Payer: Meridian Medicaid	$48.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$207.00
Rate for Payer: Priority Health Choice Medicaid	$45.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$115.27
Rate for Payer: Priority Health Narrow/Tiered Network	$115.27
Rate for Payer: UHC Medicaid	$45.80
Rate for Payer: UHCCP Medicaid	$45.80

PR ANOPLASTY PLASTIC OPERATION STRICTURE ADULT

Professional

Both

$1,389.00

Service Code	HCPCS 46700
Min. Negotiated Rate	$407.90
Max. Negotiated Rate	$1,205.62
Rate for Payer: Aetna Commercial	$877.26
Rate for Payer: Aetna Medicare	$694.50
Rate for Payer: BCBS Complete	$428.30
Rate for Payer: BCN Commercial	$989.49
Rate for Payer: Cash Price	$1,111.20
Rate for Payer: Cash Price	$1,111.20
Rate for Payer: Mclaren Medicaid	$407.90
Rate for Payer: Meridian Medicaid	$428.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,041.75
Rate for Payer: Priority Health Choice Medicaid	$407.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,205.62
Rate for Payer: Priority Health Narrow/Tiered Network	$1,205.62
Rate for Payer: UHC Medicaid	$407.90
Rate for Payer: UHCCP Medicaid	$407.90

PR ANOPLASTY PLASTIC OPERATION STRICTURE INFANT

Professional

Both

$1,468.00

Service Code	HCPCS 46705
Min. Negotiated Rate	$367.64
Max. Negotiated Rate	$1,101.00
Rate for Payer: Aetna Commercial	$764.79
Rate for Payer: Aetna Medicare	$734.00
Rate for Payer: BCBS Complete	$386.02
Rate for Payer: BCN Commercial	$870.97
Rate for Payer: Cash Price	$1,174.40
Rate for Payer: Cash Price	$1,174.40
Rate for Payer: Mclaren Medicaid	$367.64
Rate for Payer: Meridian Medicaid	$386.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,101.00
Rate for Payer: Priority Health Choice Medicaid	$367.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,061.22
Rate for Payer: Priority Health Narrow/Tiered Network	$1,061.22
Rate for Payer: UHC Medicaid	$367.64
Rate for Payer: UHCCP Medicaid	$367.64

PR ANORECTAL MANOMETRY

Professional

Both

$405.00

Service Code	HCPCS 91122
Min. Negotiated Rate	$162.00
Max. Negotiated Rate	$406.85
Rate for Payer: Aetna Commercial	$290.91
Rate for Payer: Aetna Medicare	$202.50
Rate for Payer: BCBS Complete	$162.00
Rate for Payer: BCN Commercial	$406.85
Rate for Payer: Cash Price	$324.00
Rate for Payer: Cash Price	$324.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$303.75

PR ANORECTAL MYOMECTOMY

Professional

Both

$1,715.00

Service Code	HCPCS 45108
Min. Negotiated Rate	$237.71
Max. Negotiated Rate	$1,286.25
Rate for Payer: Aetna Commercial	$499.66
Rate for Payer: Aetna Medicare	$857.50
Rate for Payer: BCBS Complete	$249.60
Rate for Payer: BCN Commercial	$570.19
Rate for Payer: Cash Price	$1,372.00
Rate for Payer: Cash Price	$1,372.00
Rate for Payer: Mclaren Medicaid	$237.71
Rate for Payer: Meridian Medicaid	$249.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,286.25
Rate for Payer: Priority Health Choice Medicaid	$237.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$694.74
Rate for Payer: Priority Health Narrow/Tiered Network	$694.74
Rate for Payer: UHC Medicaid	$237.71
Rate for Payer: UHCCP Medicaid	$237.71

PR ANOSCOPY ABLATION LESION

Professional

Both

$690.00

Service Code	HCPCS 46615
Min. Negotiated Rate	$53.46
Max. Negotiated Rate	$517.50
Rate for Payer: Aetna Commercial	$121.05
Rate for Payer: Aetna Medicare	$345.00
Rate for Payer: BCBS Complete	$56.13
Rate for Payer: BCN Commercial	$135.45
Rate for Payer: Cash Price	$552.00
Rate for Payer: Cash Price	$552.00
Rate for Payer: Mclaren Medicaid	$53.46
Rate for Payer: Meridian Medicaid	$56.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$517.50
Rate for Payer: Priority Health Choice Medicaid	$53.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$165.03
Rate for Payer: Priority Health Narrow/Tiered Network	$165.03
Rate for Payer: UHC Medicaid	$53.46
Rate for Payer: UHCCP Medicaid	$53.46

PR ANOSCOPY CONTROL BLEEDING

Professional

Both

$658.00

Service Code	HCPCS 46614
Min. Negotiated Rate	$39.19
Max. Negotiated Rate	$493.50
Rate for Payer: Aetna Commercial	$84.49
Rate for Payer: Aetna Medicare	$329.00
Rate for Payer: BCBS Complete	$41.15
Rate for Payer: BCN Commercial	$97.11
Rate for Payer: Cash Price	$526.40
Rate for Payer: Cash Price	$526.40
Rate for Payer: Mclaren Medicaid	$39.19
Rate for Payer: Meridian Medicaid	$41.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$493.50
Rate for Payer: Priority Health Choice Medicaid	$39.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$118.33
Rate for Payer: Priority Health Narrow/Tiered Network	$118.33
Rate for Payer: UHC Medicaid	$39.19
Rate for Payer: UHCCP Medicaid	$39.19

PR ANOSCOPY DX W/COLLJ SPEC BR/WA SPX WHEN PRFRMD

Professional

Both

$252.00

Service Code	HCPCS 46600
Min. Negotiated Rate	$25.77
Max. Negotiated Rate	$189.00
Rate for Payer: Aetna Commercial	$53.23
Rate for Payer: Aetna Medicare	$126.00
Rate for Payer: BCBS Complete	$27.06
Rate for Payer: BCN Commercial	$49.09
Rate for Payer: Cash Price	$201.60
Rate for Payer: Cash Price	$201.60
Rate for Payer: Mclaren Medicaid	$25.77
Rate for Payer: Meridian Medicaid	$27.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$189.00
Rate for Payer: Priority Health Choice Medicaid	$25.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$75.84
Rate for Payer: Priority Health Narrow/Tiered Network	$75.84
Rate for Payer: UHC Medicaid	$25.77
Rate for Payer: UHCCP Medicaid	$25.77

PR ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT

Professional

Both

$280.00

Service Code	HCPCS 46601
Min. Negotiated Rate	$54.53
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$126.71
Rate for Payer: Aetna Medicare	$140.00
Rate for Payer: BCBS Complete	$57.26
Rate for Payer: BCN Commercial	$139.93
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cash Price	$224.00
Rate for Payer: Mclaren Medicaid	$54.53
Rate for Payer: Meridian Medicaid	$57.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$210.00
Rate for Payer: Priority Health Choice Medicaid	$54.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$170.49
Rate for Payer: Priority Health Narrow/Tiered Network	$170.49
Rate for Payer: UHC Medicaid	$54.53
Rate for Payer: UHCCP Medicaid	$54.53

PR ANOSCOPY DX W/HRA &CHEM AGNTS ENHANCEMENT W/BX

Professional

Both

$297.00

Service Code	HCPCS 46607
Min. Negotiated Rate	$72.21
Max. Negotiated Rate	$225.12
Rate for Payer: Aetna Commercial	$170.74
Rate for Payer: Aetna Medicare	$148.50
Rate for Payer: BCBS Complete	$75.82
Rate for Payer: BCN Commercial	$184.75
Rate for Payer: Cash Price	$237.60
Rate for Payer: Cash Price	$237.60
Rate for Payer: Mclaren Medicaid	$72.21
Rate for Payer: Meridian Medicaid	$75.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$222.75
Rate for Payer: Priority Health Choice Medicaid	$72.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$225.12
Rate for Payer: Priority Health Narrow/Tiered Network	$225.12
Rate for Payer: UHC Medicaid	$72.21
Rate for Payer: UHCCP Medicaid	$72.21

PR ANOSCOPY W/BX SINGLE/MULTIPLE

Professional

Both

$378.00

Service Code	HCPCS 46606
Min. Negotiated Rate	$45.37
Max. Negotiated Rate	$283.50
Rate for Payer: Aetna Commercial	$100.54
Rate for Payer: Aetna Medicare	$189.00
Rate for Payer: BCBS Complete	$47.64
Rate for Payer: BCN Commercial	$113.54
Rate for Payer: Cash Price	$302.40
Rate for Payer: Cash Price	$302.40
Rate for Payer: Mclaren Medicaid	$45.37
Rate for Payer: Meridian Medicaid	$47.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$283.50
Rate for Payer: Priority Health Choice Medicaid	$45.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$138.34
Rate for Payer: Priority Health Narrow/Tiered Network	$138.34
Rate for Payer: UHC Medicaid	$45.37
Rate for Payer: UHCCP Medicaid	$45.37

PR ANOSCOPY W/DILATION

Professional

Both

$1,036.00

Service Code	HCPCS 46604
Min. Negotiated Rate	$39.83
Max. Negotiated Rate	$777.00
Rate for Payer: Aetna Commercial	$86.80
Rate for Payer: Aetna Medicare	$518.00
Rate for Payer: BCBS Complete	$41.82
Rate for Payer: BCN Commercial	$98.60
Rate for Payer: Cash Price	$828.80
Rate for Payer: Cash Price	$828.80
Rate for Payer: Mclaren Medicaid	$39.83
Rate for Payer: Meridian Medicaid	$41.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$777.00
Rate for Payer: Priority Health Choice Medicaid	$39.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$120.15
Rate for Payer: Priority Health Narrow/Tiered Network	$120.15
Rate for Payer: UHC Medicaid	$39.83
Rate for Payer: UHCCP Medicaid	$39.83

PR ANOSCOPY W/RMVL FOREIGN BODY

Professional

Both

$367.00

Service Code	HCPCS 46608
Min. Negotiated Rate	$51.97
Max. Negotiated Rate	$275.25
Rate for Payer: Aetna Commercial	$112.47
Rate for Payer: Aetna Medicare	$183.50
Rate for Payer: BCBS Complete	$54.57
Rate for Payer: BCN Commercial	$127.49
Rate for Payer: Cash Price	$293.60
Rate for Payer: Cash Price	$293.60
Rate for Payer: Mclaren Medicaid	$51.97
Rate for Payer: Meridian Medicaid	$54.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$275.25
Rate for Payer: Priority Health Choice Medicaid	$51.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$155.34
Rate for Payer: Priority Health Narrow/Tiered Network	$155.34
Rate for Payer: UHC Medicaid	$51.97
Rate for Payer: UHCCP Medicaid	$51.97

PR ANOSCOPY W/RMVL LESION CAUTERY

Professional

Both

$591.00

Service Code	HCPCS 46610
Min. Negotiated Rate	$48.56
Max. Negotiated Rate	$443.25
Rate for Payer: Aetna Commercial	$106.52
Rate for Payer: Aetna Medicare	$295.50
Rate for Payer: BCBS Complete	$50.99
Rate for Payer: BCN Commercial	$120.51
Rate for Payer: Cash Price	$472.80
Rate for Payer: Cash Price	$472.80
Rate for Payer: Mclaren Medicaid	$48.56
Rate for Payer: Meridian Medicaid	$50.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$443.25
Rate for Payer: Priority Health Choice Medicaid	$48.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$146.84
Rate for Payer: Priority Health Narrow/Tiered Network	$146.84
Rate for Payer: UHC Medicaid	$48.56
Rate for Payer: UHCCP Medicaid	$48.56

PR ANOSC RMVL 1 TUM POLYP/OTH LES SNARE TQ

Professional

Both

$591.00

Service Code	HCPCS 46611
Min. Negotiated Rate	$47.71
Max. Negotiated Rate	$443.25
Rate for Payer: Aetna Commercial	$106.48
Rate for Payer: Aetna Medicare	$295.50
Rate for Payer: BCBS Complete	$50.10
Rate for Payer: BCN Commercial	$120.51
Rate for Payer: Cash Price	$472.80
Rate for Payer: Cash Price	$472.80
Rate for Payer: Mclaren Medicaid	$47.71
Rate for Payer: Meridian Medicaid	$50.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$443.25
Rate for Payer: Priority Health Choice Medicaid	$47.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$146.84
Rate for Payer: Priority Health Narrow/Tiered Network	$146.84
Rate for Payer: UHC Medicaid	$47.71
Rate for Payer: UHCCP Medicaid	$47.71

PR ANOSC RMVL MULT TUMORS CAUTERY/SNARE

Professional

Both

$690.00

Service Code	HCPCS 46612
Min. Negotiated Rate	$57.72
Max. Negotiated Rate	$517.50
Rate for Payer: Aetna Commercial	$127.63
Rate for Payer: Aetna Medicare	$345.00
Rate for Payer: BCBS Complete	$60.61
Rate for Payer: BCN Commercial	$143.92
Rate for Payer: Cash Price	$552.00
Rate for Payer: Cash Price	$552.00
Rate for Payer: Mclaren Medicaid	$57.72
Rate for Payer: Meridian Medicaid	$60.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$517.50
Rate for Payer: Priority Health Choice Medicaid	$57.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$175.35
Rate for Payer: Priority Health Narrow/Tiered Network	$175.35
Rate for Payer: UHC Medicaid	$57.72
Rate for Payer: UHCCP Medicaid	$57.72

PR ANRCT XM SURG REQ ANES GENERAL SPI/EDRL DX

Professional

Both

$332.00

Service Code	HCPCS 45990
Min. Negotiated Rate	$63.47
Max. Negotiated Rate	$249.00
Rate for Payer: Aetna Commercial	$140.68
Rate for Payer: Aetna Medicare	$166.00
Rate for Payer: BCBS Complete	$66.64
Rate for Payer: BCN Commercial	$159.35
Rate for Payer: Cash Price	$265.60
Rate for Payer: Cash Price	$265.60
Rate for Payer: Mclaren Medicaid	$63.47
Rate for Payer: Meridian Medicaid	$66.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$249.00
Rate for Payer: Priority Health Choice Medicaid	$63.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$194.16
Rate for Payer: Priority Health Narrow/Tiered Network	$194.16
Rate for Payer: UHC Medicaid	$63.47
Rate for Payer: UHCCP Medicaid	$63.47

PR ANTEPARTUM CARE ONLY 4-6 VISITS

Professional

Both

$1,191.00

Service Code	HCPCS 59425
Min. Negotiated Rate	$376.64
Max. Negotiated Rate	$893.25
Rate for Payer: Aetna Commercial	$479.68
Rate for Payer: Aetna Medicare	$595.50
Rate for Payer: BCBS Complete	$395.47
Rate for Payer: BCN Commercial	$637.82
Rate for Payer: Cash Price	$952.80
Rate for Payer: Cash Price	$952.80
Rate for Payer: Mclaren Medicaid	$376.64
Rate for Payer: Meridian Medicaid	$395.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$893.25
Rate for Payer: Priority Health Choice Medicaid	$376.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$612.06
Rate for Payer: Priority Health Narrow/Tiered Network	$612.06
Rate for Payer: UHC Medicaid	$376.64
Rate for Payer: UHCCP Medicaid	$376.64

Know your out-of-pocket cost for care.

All Charges