Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR ANTEPARTUM CARE ONLY 7/> VISITS

Professional

Both

$1,637.00

Service Code	HCPCS 59426
Min. Negotiated Rate	$690.73
Max. Negotiated Rate	$1,227.75
Rate for Payer: Aetna Commercial	$878.78
Rate for Payer: Aetna Medicare	$818.50
Rate for Payer: BCBS Complete	$725.27
Rate for Payer: BCN Commercial	$1,138.94
Rate for Payer: Cash Price	$1,309.60
Rate for Payer: Cash Price	$1,309.60
Rate for Payer: Mclaren Medicaid	$690.73
Rate for Payer: Meridian Medicaid	$725.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,227.75
Rate for Payer: Priority Health Choice Medicaid	$690.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,123.99
Rate for Payer: Priority Health Narrow/Tiered Network	$1,123.99
Rate for Payer: UHC Medicaid	$690.73
Rate for Payer: UHCCP Medicaid	$690.73

PR ANTERIOR COLPORRAPHY RPR CYSTOCELE W/CYSTO

Professional

Both

$1,600.00

Service Code	HCPCS 57240
Min. Negotiated Rate	$347.62
Max. Negotiated Rate	$1,200.00
Rate for Payer: Aetna Commercial	$727.57
Rate for Payer: Aetna Medicare	$800.00
Rate for Payer: BCBS Complete	$365.00
Rate for Payer: BCN Commercial	$921.26
Rate for Payer: Cash Price	$1,280.00
Rate for Payer: Cash Price	$1,280.00
Rate for Payer: Mclaren Medicaid	$347.62
Rate for Payer: Meridian Medicaid	$365.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,200.00
Rate for Payer: Priority Health Choice Medicaid	$347.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$933.04
Rate for Payer: Priority Health Narrow/Tiered Network	$933.04
Rate for Payer: UHC Medicaid	$347.62
Rate for Payer: UHCCP Medicaid	$347.62

PR ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS

Professional

Both

$3,997.00

Service Code	HCPCS 22845
Min. Negotiated Rate	$413.01
Max. Negotiated Rate	$2,997.75
Rate for Payer: Aetna Commercial	$979.87
Rate for Payer: Aetna Medicare	$1,998.50
Rate for Payer: BCBS Complete	$433.66
Rate for Payer: BCN Commercial	$1,192.61
Rate for Payer: Cash Price	$3,197.60
Rate for Payer: Cash Price	$3,197.60
Rate for Payer: Mclaren Medicaid	$413.01
Rate for Payer: Meridian Medicaid	$433.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,997.75
Rate for Payer: Priority Health Choice Medicaid	$413.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,160.47
Rate for Payer: Priority Health Narrow/Tiered Network	$1,160.47
Rate for Payer: UHC Medicaid	$413.01
Rate for Payer: UHCCP Medicaid	$413.01

PR ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS

Professional

Both

$4,398.00

Service Code	HCPCS 22846
Min. Negotiated Rate	$429.41
Max. Negotiated Rate	$3,298.50
Rate for Payer: Aetna Commercial	$1,018.33
Rate for Payer: Aetna Medicare	$2,199.00
Rate for Payer: BCBS Complete	$450.88
Rate for Payer: BCN Commercial	$1,242.39
Rate for Payer: Cash Price	$3,518.40
Rate for Payer: Cash Price	$3,518.40
Rate for Payer: Mclaren Medicaid	$429.41
Rate for Payer: Meridian Medicaid	$450.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,298.50
Rate for Payer: Priority Health Choice Medicaid	$429.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,208.92
Rate for Payer: Priority Health Narrow/Tiered Network	$1,208.92
Rate for Payer: UHC Medicaid	$429.41
Rate for Payer: UHCCP Medicaid	$429.41

PR ANTERIOR INSTRUMENTATION 8/> VERTEBRAL SEGMENTS

Professional

Both

$3,892.00

Service Code	HCPCS 22847
Min. Negotiated Rate	$438.35
Max. Negotiated Rate	$2,919.00
Rate for Payer: Aetna Commercial	$1,078.87
Rate for Payer: Aetna Medicare	$1,946.00
Rate for Payer: BCBS Complete	$460.27
Rate for Payer: BCN Commercial	$1,188.68
Rate for Payer: Cash Price	$3,113.60
Rate for Payer: Cash Price	$3,113.60
Rate for Payer: Mclaren Medicaid	$438.35
Rate for Payer: Meridian Medicaid	$460.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,919.00
Rate for Payer: Priority Health Choice Medicaid	$438.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,270.66
Rate for Payer: Priority Health Narrow/Tiered Network	$1,270.66
Rate for Payer: UHC Medicaid	$438.35
Rate for Payer: UHCCP Medicaid	$438.35

PR ANTERIOR TIBIAL TUBERCLEPLASTY

Professional

Both

$2,654.00

Service Code	HCPCS 27418
Min. Negotiated Rate	$486.71
Max. Negotiated Rate	$1,990.50
Rate for Payer: Aetna Commercial	$1,109.69
Rate for Payer: Aetna Medicare	$1,327.00
Rate for Payer: BCBS Complete	$511.05
Rate for Payer: BCN Commercial	$1,366.58
Rate for Payer: Cash Price	$2,123.20
Rate for Payer: Cash Price	$2,123.20
Rate for Payer: Mclaren Medicaid	$486.71
Rate for Payer: Meridian Medicaid	$511.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,990.50
Rate for Payer: Priority Health Choice Medicaid	$486.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,329.76
Rate for Payer: Priority Health Narrow/Tiered Network	$1,329.76
Rate for Payer: UHC Medicaid	$486.71
Rate for Payer: UHCCP Medicaid	$486.71

PR ANTICOAG MGMT, EACH SUBSEQ 90 DAYS

Professional

Both

$97.00

Service Code	HCPCS 99364
Min. Negotiated Rate	$38.80
Max. Negotiated Rate	$72.75
Rate for Payer: Aetna Medicare	$48.50
Rate for Payer: BCBS Complete	$38.80
Rate for Payer: Cash Price	$77.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$72.75

PR ANTICOAG MGMT, INITIAL 90 DAYS

Professional

Both

$213.00

Service Code	HCPCS 99363
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$159.75
Rate for Payer: Aetna Medicare	$106.50
Rate for Payer: BCBS Complete	$85.20
Rate for Payer: Cash Price	$170.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$159.75

PR ANTICOAGULANT MGMT FOR PT TAKING WARFARIN

Professional

Both

$25.00

Service Code	HCPCS 93793
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$18.75
Rate for Payer: Aetna Commercial	$12.40
Rate for Payer: Aetna Medicare	$12.50
Rate for Payer: BCN Commercial	$16.93
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$18.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$16.10
Rate for Payer: Priority Health Narrow/Tiered Network	$16.10

PR ANT VESICOURETHROPEXY/URETHROPEXY SMPL

Professional

Both

$2,533.00

Service Code	HCPCS 51840
Min. Negotiated Rate	$396.82
Max. Negotiated Rate	$1,899.75
Rate for Payer: Aetna Commercial	$888.00
Rate for Payer: Aetna Medicare	$1,266.50
Rate for Payer: BCBS Complete	$416.66
Rate for Payer: BCN Commercial	$1,040.78
Rate for Payer: Cash Price	$2,026.40
Rate for Payer: Cash Price	$2,026.40
Rate for Payer: Mclaren Medicaid	$396.82
Rate for Payer: Meridian Medicaid	$416.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,899.75
Rate for Payer: Priority Health Choice Medicaid	$396.82
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,133.75
Rate for Payer: Priority Health Narrow/Tiered Network	$1,133.75
Rate for Payer: UHC Medicaid	$396.82
Rate for Payer: UHCCP Medicaid	$396.82

PR AORTIC HEMIARCH GRAFT W/ISOL & CTRL ARCH VESSELS

Professional

Both

$1,998.00

Service Code	HCPCS 33866
Min. Negotiated Rate	$533.57
Max. Negotiated Rate	$1,498.50
Rate for Payer: Aetna Commercial	$1,243.44
Rate for Payer: Aetna Medicare	$999.00
Rate for Payer: BCBS Complete	$560.25
Rate for Payer: BCN Commercial	$1,343.55
Rate for Payer: Cash Price	$1,598.40
Rate for Payer: Cash Price	$1,598.40
Rate for Payer: Mclaren Medicaid	$533.57
Rate for Payer: Meridian Medicaid	$560.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,498.50
Rate for Payer: Priority Health Choice Medicaid	$533.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,444.82
Rate for Payer: Priority Health Narrow/Tiered Network	$1,444.82
Rate for Payer: UHC Medicaid	$533.57
Rate for Payer: UHCCP Medicaid	$533.57

PR AORTIC SUSPENSION TRACHEAL DECOMPRESSION SPX

Professional

Both

$1,920.00

Service Code	HCPCS 33800
Min. Negotiated Rate	$597.04
Max. Negotiated Rate	$1,568.00
Rate for Payer: Aetna Commercial	$1,324.10
Rate for Payer: Aetna Medicare	$960.00
Rate for Payer: BCBS Complete	$626.89
Rate for Payer: BCN Commercial	$1,458.09
Rate for Payer: Cash Price	$1,536.00
Rate for Payer: Cash Price	$1,536.00
Rate for Payer: Mclaren Medicaid	$597.04
Rate for Payer: Meridian Medicaid	$626.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,440.00
Rate for Payer: Priority Health Choice Medicaid	$597.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,568.00
Rate for Payer: Priority Health Narrow/Tiered Network	$1,568.00
Rate for Payer: UHC Medicaid	$597.04
Rate for Payer: UHCCP Medicaid	$597.04

PR AORTOPLASTY SUPRAVALVULAR STENOSIS

Professional

Both

$9,659.00

Service Code	HCPCS 33417
Min. Negotiated Rate	$1,007.70
Max. Negotiated Rate	$7,244.25
Rate for Payer: Aetna Commercial	$2,236.97
Rate for Payer: Aetna Medicare	$4,829.50
Rate for Payer: BCBS Complete	$1,058.09
Rate for Payer: BCN Commercial	$2,464.01
Rate for Payer: Cash Price	$7,727.20
Rate for Payer: Cash Price	$7,727.20
Rate for Payer: Mclaren Medicaid	$1,007.70
Rate for Payer: Meridian Medicaid	$1,058.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,244.25
Rate for Payer: Priority Health Choice Medicaid	$1,007.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,649.72
Rate for Payer: Priority Health Narrow/Tiered Network	$2,649.72
Rate for Payer: UHC Medicaid	$1,007.70
Rate for Payer: UHCCP Medicaid	$1,007.70

PR APNEALINK

Professional

Both

$10.00

Hospital Revenue Code	920
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 APPENDEC INDICATED PURPOSE OTH MAJOR PX NOT SPX

Professional

Both

$891.00

Service Code	HCPCS 44955
Min. Negotiated Rate	$47.71
Max. Negotiated Rate	$668.25
Rate for Payer: Aetna Commercial	$112.58
Rate for Payer: Aetna Medicare	$445.50
Rate for Payer: BCBS Complete	$50.10
Rate for Payer: BCN Commercial	$124.00
Rate for Payer: Cash Price	$712.80
Rate for Payer: Cash Price	$712.80
Rate for Payer: Mclaren Medicaid	$47.71
Rate for Payer: Meridian Medicaid	$50.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$668.25
Rate for Payer: Priority Health Choice Medicaid	$47.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$151.08
Rate for Payer: Priority Health Narrow/Tiered Network	$151.08
Rate for Payer: UHC Medicaid	$47.71
Rate for Payer: UHCCP Medicaid	$47.71

PR APPENDEC RPTD APPENDIX ABSC/PRITONITIS

Professional

Both

$2,201.00

Service Code	HCPCS 44960
Min. Negotiated Rate	$526.11
Max. Negotiated Rate	$1,650.75
Rate for Payer: Aetna Commercial	$1,185.47
Rate for Payer: Aetna Medicare	$1,100.50
Rate for Payer: BCBS Complete	$552.42
Rate for Payer: BCN Commercial	$1,319.65
Rate for Payer: Cash Price	$1,760.80
Rate for Payer: Cash Price	$1,760.80
Rate for Payer: Mclaren Medicaid	$526.11
Rate for Payer: Meridian Medicaid	$552.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,650.75
Rate for Payer: Priority Health Choice Medicaid	$526.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,607.90
Rate for Payer: Priority Health Narrow/Tiered Network	$1,607.90
Rate for Payer: UHC Medicaid	$526.11
Rate for Payer: UHCCP Medicaid	$526.11

PR APPENDECTOMY

Professional

Both

$1,790.00

Service Code	HCPCS 44950
Min. Negotiated Rate	$386.17
Max. Negotiated Rate	$1,342.50
Rate for Payer: Aetna Commercial	$868.66
Rate for Payer: Aetna Medicare	$895.00
Rate for Payer: BCBS Complete	$405.48
Rate for Payer: BCN Commercial	$967.08
Rate for Payer: Cash Price	$1,432.00
Rate for Payer: Cash Price	$1,432.00
Rate for Payer: Mclaren Medicaid	$386.17
Rate for Payer: Meridian Medicaid	$405.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,342.50
Rate for Payer: Priority Health Choice Medicaid	$386.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,178.32
Rate for Payer: Priority Health Narrow/Tiered Network	$1,178.32
Rate for Payer: UHC Medicaid	$386.17
Rate for Payer: UHCCP Medicaid	$386.17

PR APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX

Professional

Both

$890.00

Service Code	HCPCS 20660
Min. Negotiated Rate	$136.96
Max. Negotiated Rate	$667.50
Rate for Payer: Aetna Commercial	$326.16
Rate for Payer: Aetna Medicare	$445.00
Rate for Payer: BCBS Complete	$143.81
Rate for Payer: BCN Commercial	$362.03
Rate for Payer: Cash Price	$712.00
Rate for Payer: Cash Price	$712.00
Rate for Payer: Mclaren Medicaid	$136.96
Rate for Payer: Meridian Medicaid	$143.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$667.50
Rate for Payer: Priority Health Choice Medicaid	$136.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$387.00
Rate for Payer: Priority Health Narrow/Tiered Network	$387.00
Rate for Payer: UHC Medicaid	$136.96
Rate for Payer: UHCCP Medicaid	$136.96

PR APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS

Professional

Both

$680.00

Service Code	HCPCS 29325
Min. Negotiated Rate	$107.35
Max. Negotiated Rate	$510.00
Rate for Payer: Aetna Commercial	$232.63
Rate for Payer: Aetna Medicare	$340.00
Rate for Payer: BCBS Complete	$112.72
Rate for Payer: BCN Commercial	$271.40
Rate for Payer: Cash Price	$544.00
Rate for Payer: Cash Price	$544.00
Rate for Payer: Mclaren Medicaid	$107.35
Rate for Payer: Meridian Medicaid	$112.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$510.00
Rate for Payer: Priority Health Choice Medicaid	$107.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$290.12
Rate for Payer: Priority Health Narrow/Tiered Network	$290.12
Rate for Payer: UHC Medicaid	$107.35
Rate for Payer: UHCCP Medicaid	$107.35

PR APPLICATION CAST ELBOW TO FINGER SHORT ARM

Professional

Both

$207.00

Service Code	HCPCS 29075
Min. Negotiated Rate	$37.49
Max. Negotiated Rate	$155.25
Rate for Payer: Aetna Commercial	$81.81
Rate for Payer: Aetna Medicare	$103.50
Rate for Payer: BCBS Complete	$39.36
Rate for Payer: BCN Commercial	$75.79
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cash Price	$165.60
Rate for Payer: Mclaren Medicaid	$37.49
Rate for Payer: Meridian Medicaid	$39.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$155.25
Rate for Payer: Priority Health Choice Medicaid	$37.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$102.74
Rate for Payer: Priority Health Narrow/Tiered Network	$102.74
Rate for Payer: UHC Medicaid	$37.49
Rate for Payer: UHCCP Medicaid	$37.49

PR APPLICATION CAST FIGURE-OF-EIGHT

Professional

Both

$246.00

Service Code	HCPCS 29049
Min. Negotiated Rate	$42.81
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna Commercial	$90.96
Rate for Payer: Aetna Medicare	$123.00
Rate for Payer: BCBS Complete	$44.95
Rate for Payer: BCN Commercial	$106.57
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cash Price	$196.80
Rate for Payer: Mclaren Medicaid	$42.81
Rate for Payer: Meridian Medicaid	$44.95
Rate for Payer: Opus (Opus Packaging Group) HMA	$184.50
Rate for Payer: Priority Health Choice Medicaid	$42.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$113.92
Rate for Payer: Priority Health Narrow/Tiered Network	$113.92
Rate for Payer: UHC Medicaid	$42.81
Rate for Payer: UHCCP Medicaid	$42.81

PR APPLICATION CAST FINGER

Professional

Both

$135.00

Service Code	HCPCS 29086
Min. Negotiated Rate	$29.39
Max. Negotiated Rate	$101.25
Rate for Payer: Aetna Commercial	$62.87
Rate for Payer: Aetna Medicare	$67.50
Rate for Payer: BCBS Complete	$30.86
Rate for Payer: BCN Commercial	$74.70
Rate for Payer: Cash Price	$108.00
Rate for Payer: Cash Price	$108.00
Rate for Payer: Mclaren Medicaid	$29.39
Rate for Payer: Meridian Medicaid	$30.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$101.25
Rate for Payer: Priority Health Choice Medicaid	$29.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$79.85
Rate for Payer: Priority Health Narrow/Tiered Network	$79.85
Rate for Payer: UHC Medicaid	$29.39
Rate for Payer: UHCCP Medicaid	$29.39

PR APPLICATION CAST HAND & LOWER FOREARM GAUNTLET

Professional

Both

$195.00

Service Code	HCPCS 29085
Min. Negotiated Rate	$40.47
Max. Negotiated Rate	$146.25
Rate for Payer: Aetna Commercial	$87.81
Rate for Payer: Aetna Medicare	$97.50
Rate for Payer: BCBS Complete	$42.49
Rate for Payer: BCN Commercial	$81.29
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Mclaren Medicaid	$40.47
Rate for Payer: Meridian Medicaid	$42.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$146.25
Rate for Payer: Priority Health Choice Medicaid	$40.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$110.20
Rate for Payer: Priority Health Narrow/Tiered Network	$110.20
Rate for Payer: UHC Medicaid	$40.47
Rate for Payer: UHCCP Medicaid	$40.47

PR APPLICATION CAST SHOULDER TO HAND LONG ARM

Professional

Both

$267.00

Service Code	HCPCS 29065
Min. Negotiated Rate	$41.11
Max. Negotiated Rate	$200.25
Rate for Payer: Aetna Commercial	$89.13
Rate for Payer: Aetna Medicare	$133.50
Rate for Payer: BCBS Complete	$43.17
Rate for Payer: BCN Commercial	$81.68
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Mclaren Medicaid	$41.11
Rate for Payer: Meridian Medicaid	$43.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$200.25
Rate for Payer: Priority Health Choice Medicaid	$41.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$110.72
Rate for Payer: Priority Health Narrow/Tiered Network	$110.72
Rate for Payer: UHC Medicaid	$41.11
Rate for Payer: UHCCP Medicaid	$41.11

PR APPLICATION CYLINDER CAST THIGH TO ANKLE

Professional

Both

$260.00

Service Code	HCPCS 29365
Min. Negotiated Rate	$52.40
Max. Negotiated Rate	$195.00
Rate for Payer: Aetna Commercial	$114.22
Rate for Payer: Aetna Medicare	$130.00
Rate for Payer: BCBS Complete	$55.02
Rate for Payer: BCN Commercial	$132.46
Rate for Payer: Cash Price	$208.00
Rate for Payer: Cash Price	$208.00
Rate for Payer: Mclaren Medicaid	$52.40
Rate for Payer: Meridian Medicaid	$55.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$195.00
Rate for Payer: Priority Health Choice Medicaid	$52.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$141.60
Rate for Payer: Priority Health Narrow/Tiered Network	$141.60
Rate for Payer: UHC Medicaid	$52.40
Rate for Payer: UHCCP Medicaid	$52.40

Know your out-of-pocket cost for care.

All Charges