Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR BIOFEEDBACK PERI/URO/RECTAL

Professional

Both

$194.00

Service Code	HCPCS 90911
Min. Negotiated Rate	$77.60
Max. Negotiated Rate	$145.50
Rate for Payer: Aetna Medicare	$97.00
Rate for Payer: BCBS Complete	$77.60
Rate for Payer: Cash Price	$155.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$145.50

PR BIOFEEDBACK TRAINING ANY MODALITY

Professional

Both

$132.00

Service Code	HCPCS 90901
Min. Negotiated Rate	$28.39
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Commercial	$87.36
Rate for Payer: Aetna Medicare	$66.00
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: BCN Commercial	$28.39
Rate for Payer: Cash Price	$105.60
Rate for Payer: Cash Price	$105.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$99.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$61.18
Rate for Payer: Priority Health Narrow/Tiered Network	$61.18

PR BIOPSY BONE OPEN DEEP

Professional

Both

$1,302.00

Service Code	HCPCS 20245
Min. Negotiated Rate	$193.40
Max. Negotiated Rate	$976.50
Rate for Payer: Aetna Commercial	$465.71
Rate for Payer: Aetna Medicare	$651.00
Rate for Payer: BCBS Complete	$203.07
Rate for Payer: BCN Commercial	$511.92
Rate for Payer: Cash Price	$1,041.60
Rate for Payer: Cash Price	$1,041.60
Rate for Payer: Mclaren Medicaid	$193.40
Rate for Payer: Meridian Medicaid	$203.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$976.50
Rate for Payer: Priority Health Choice Medicaid	$193.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$547.23
Rate for Payer: Priority Health Narrow/Tiered Network	$547.23
Rate for Payer: UHC Medicaid	$193.40
Rate for Payer: UHCCP Medicaid	$193.40

PR BIOPSY BONE OPEN SUPERFICIAL

Professional

Both

$562.00

Service Code	HCPCS 20240
Min. Negotiated Rate	$80.73
Max. Negotiated Rate	$421.50
Rate for Payer: Aetna Commercial	$190.88
Rate for Payer: Aetna Medicare	$281.00
Rate for Payer: BCBS Complete	$84.77
Rate for Payer: BCN Commercial	$209.15
Rate for Payer: Cash Price	$449.60
Rate for Payer: Cash Price	$449.60
Rate for Payer: Mclaren Medicaid	$80.73
Rate for Payer: Meridian Medicaid	$84.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$421.50
Rate for Payer: Priority Health Choice Medicaid	$80.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$223.59
Rate for Payer: Priority Health Narrow/Tiered Network	$223.59
Rate for Payer: UHC Medicaid	$80.73
Rate for Payer: UHCCP Medicaid	$80.73

PR BIOPSY BONE TROCAR/NEEDLE DEEP

Professional

Both

$1,976.00

Service Code	HCPCS 20225
Min. Negotiated Rate	$72.21
Max. Negotiated Rate	$1,482.00
Rate for Payer: Aetna Commercial	$173.19
Rate for Payer: Aetna Medicare	$988.00
Rate for Payer: BCBS Complete	$75.82
Rate for Payer: BCN Commercial	$191.72
Rate for Payer: Cash Price	$1,580.80
Rate for Payer: Cash Price	$1,580.80
Rate for Payer: Mclaren Medicaid	$72.21
Rate for Payer: Meridian Medicaid	$75.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,482.00
Rate for Payer: Priority Health Choice Medicaid	$72.21
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$204.94
Rate for Payer: Priority Health Narrow/Tiered Network	$204.94
Rate for Payer: UHC Medicaid	$72.21
Rate for Payer: UHCCP Medicaid	$72.21

PR BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL

Professional

Both

$358.00

Service Code	HCPCS 20220
Min. Negotiated Rate	$48.78
Max. Negotiated Rate	$268.50
Rate for Payer: Aetna Commercial	$116.83
Rate for Payer: Aetna Medicare	$179.00
Rate for Payer: BCBS Complete	$51.22
Rate for Payer: BCN Commercial	$128.97
Rate for Payer: Cash Price	$286.40
Rate for Payer: Cash Price	$286.40
Rate for Payer: Mclaren Medicaid	$48.78
Rate for Payer: Meridian Medicaid	$51.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$268.50
Rate for Payer: Priority Health Choice Medicaid	$48.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$137.88
Rate for Payer: Priority Health Narrow/Tiered Network	$137.88
Rate for Payer: UHC Medicaid	$48.78
Rate for Payer: UHCCP Medicaid	$48.78

PR BIOPSY BREAST OPEN INCISIONAL

Professional

Both

$587.00

Service Code	HCPCS 19101
Min. Negotiated Rate	$138.02
Max. Negotiated Rate	$440.25
Rate for Payer: Aetna Commercial	$243.74
Rate for Payer: Aetna Medicare	$293.50
Rate for Payer: BCBS Complete	$144.92
Rate for Payer: BCN Commercial	$338.13
Rate for Payer: Cash Price	$469.60
Rate for Payer: Cash Price	$469.60
Rate for Payer: Mclaren Medicaid	$138.02
Rate for Payer: Meridian Medicaid	$144.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$440.25
Rate for Payer: Priority Health Choice Medicaid	$138.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$309.47
Rate for Payer: Priority Health Narrow/Tiered Network	$309.47
Rate for Payer: UHC Medicaid	$138.02
Rate for Payer: UHCCP Medicaid	$138.02

PR BIOPSY CERVIX SINGLE/MULT/EXCISION OF LESION SPX

Professional

Both

$266.00

Service Code	HCPCS 57500
Min. Negotiated Rate	$43.67
Max. Negotiated Rate	$199.50
Rate for Payer: Aetna Commercial	$88.96
Rate for Payer: Aetna Medicare	$133.00
Rate for Payer: BCBS Complete	$45.85
Rate for Payer: BCN Commercial	$89.14
Rate for Payer: Cash Price	$212.80
Rate for Payer: Cash Price	$212.80
Rate for Payer: Mclaren Medicaid	$43.67
Rate for Payer: Meridian Medicaid	$45.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$199.50
Rate for Payer: Priority Health Choice Medicaid	$43.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$114.49
Rate for Payer: Priority Health Narrow/Tiered Network	$114.49
Rate for Payer: UHC Medicaid	$43.67
Rate for Payer: UHCCP Medicaid	$43.67

PR BIOPSY, EACH ADDED LESION

Professional

Both

$70.00

Service Code	HCPCS 11101
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$52.50
Rate for Payer: Aetna Medicare	$35.00
Rate for Payer: BCBS Complete	$28.00
Rate for Payer: Cash Price	$56.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$52.50

PR BIOPSY EXTERNAL AUDITORY CANAL

Professional

Both

$246.00

Service Code	HCPCS 69105
Min. Negotiated Rate	$36.64
Max. Negotiated Rate	$184.50
Rate for Payer: Aetna Commercial	$69.92
Rate for Payer: Aetna Medicare	$123.00
Rate for Payer: BCBS Complete	$38.47
Rate for Payer: BCN Commercial	$97.60
Rate for Payer: Cash Price	$196.80
Rate for Payer: Cash Price	$196.80
Rate for Payer: Mclaren Medicaid	$36.64
Rate for Payer: Meridian Medicaid	$38.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$184.50
Rate for Payer: Priority Health Choice Medicaid	$36.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$96.44
Rate for Payer: Priority Health Narrow/Tiered Network	$96.44
Rate for Payer: UHC Medicaid	$36.64
Rate for Payer: UHCCP Medicaid	$36.64

PR BIOPSY EXTERNAL EAR

Professional

Both

$179.00

Service Code	HCPCS 69100
Min. Negotiated Rate	$23.86
Max. Negotiated Rate	$134.25
Rate for Payer: Aetna Commercial	$52.85
Rate for Payer: Aetna Medicare	$89.50
Rate for Payer: BCBS Complete	$25.05
Rate for Payer: BCN Commercial	$68.72
Rate for Payer: Cash Price	$143.20
Rate for Payer: Cash Price	$143.20
Rate for Payer: Mclaren Medicaid	$23.86
Rate for Payer: Meridian Medicaid	$25.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$134.25
Rate for Payer: Priority Health Choice Medicaid	$23.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$67.91
Rate for Payer: Priority Health Narrow/Tiered Network	$67.91
Rate for Payer: UHC Medicaid	$23.86
Rate for Payer: UHCCP Medicaid	$23.86

PR BIOPSY FLOOR MOUTH

Professional

Both

$247.00

Service Code	HCPCS 41108
Min. Negotiated Rate	$53.68
Max. Negotiated Rate	$185.25
Rate for Payer: Aetna Commercial	$119.24
Rate for Payer: Aetna Medicare	$123.50
Rate for Payer: BCBS Complete	$56.36
Rate for Payer: BCN Commercial	$138.94
Rate for Payer: Cash Price	$197.60
Rate for Payer: Cash Price	$197.60
Rate for Payer: Mclaren Medicaid	$53.68
Rate for Payer: Meridian Medicaid	$56.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$185.25
Rate for Payer: Priority Health Choice Medicaid	$53.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$169.29
Rate for Payer: Priority Health Narrow/Tiered Network	$169.29
Rate for Payer: UHC Medicaid	$53.68
Rate for Payer: UHCCP Medicaid	$53.68

PR BIOPSY HYPOPHARYNX

Professional

Both

$454.00

Service Code	HCPCS 42802
Min. Negotiated Rate	$181.60
Max. Negotiated Rate	$340.50
Rate for Payer: Aetna Medicare	$227.00
Rate for Payer: BCBS Complete	$181.60
Rate for Payer: Cash Price	$363.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$340.50

PR BIOPSY INTRANASAL

Professional

Both

$235.00

Service Code	HCPCS 30100
Min. Negotiated Rate	$38.98
Max. Negotiated Rate	$176.25
Rate for Payer: Aetna Commercial	$84.78
Rate for Payer: Aetna Medicare	$117.50
Rate for Payer: BCBS Complete	$40.93
Rate for Payer: BCN Commercial	$103.58
Rate for Payer: Cash Price	$188.00
Rate for Payer: Cash Price	$188.00
Rate for Payer: Mclaren Medicaid	$38.98
Rate for Payer: Meridian Medicaid	$40.93
Rate for Payer: Opus (Opus Packaging Group) HMA	$176.25
Rate for Payer: Priority Health Choice Medicaid	$38.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$97.54
Rate for Payer: Priority Health Narrow/Tiered Network	$97.54
Rate for Payer: UHC Medicaid	$38.98
Rate for Payer: UHCCP Medicaid	$38.98

PR BIOPSY LIVER NEEDLE PERCUTANEOUS

Professional

Both

$611.00

Service Code	HCPCS 47000
Min. Negotiated Rate	$48.78
Max. Negotiated Rate	$458.25
Rate for Payer: Aetna Commercial	$117.26
Rate for Payer: Aetna Medicare	$305.50
Rate for Payer: BCBS Complete	$51.22
Rate for Payer: BCN Commercial	$141.69
Rate for Payer: Cash Price	$488.80
Rate for Payer: Cash Price	$488.80
Rate for Payer: Mclaren Medicaid	$48.78
Rate for Payer: Meridian Medicaid	$51.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$458.25
Rate for Payer: Priority Health Choice Medicaid	$48.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$157.15
Rate for Payer: Priority Health Narrow/Tiered Network	$157.15
Rate for Payer: UHC Medicaid	$48.78
Rate for Payer: UHCCP Medicaid	$48.78

PR BIOPSY LIVER WEDGE

Professional

Both

$1,843.00

Service Code	HCPCS 47100
Min. Negotiated Rate	$519.51
Max. Negotiated Rate	$1,558.76
Rate for Payer: Aetna Commercial	$1,144.02
Rate for Payer: Aetna Medicare	$921.50
Rate for Payer: BCBS Complete	$545.49
Rate for Payer: BCN Commercial	$1,279.31
Rate for Payer: Cash Price	$1,474.40
Rate for Payer: Cash Price	$1,474.40
Rate for Payer: Mclaren Medicaid	$519.51
Rate for Payer: Meridian Medicaid	$545.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,382.25
Rate for Payer: Priority Health Choice Medicaid	$519.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,558.76
Rate for Payer: Priority Health Narrow/Tiered Network	$1,558.76
Rate for Payer: UHC Medicaid	$519.51
Rate for Payer: UHCCP Medicaid	$519.51

PR BIOPSY LUNG/MEDIASTINUM PERCUTANEOUS NEEDLE

Professional

Both

$785.00

Service Code	HCPCS 32405
Min. Negotiated Rate	$314.00
Max. Negotiated Rate	$588.75
Rate for Payer: Aetna Medicare	$392.50
Rate for Payer: BCBS Complete	$314.00
Rate for Payer: Cash Price	$628.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$588.75

PR BIOPSY MUSCLE DEEP

Professional

Both

$609.00

Service Code	HCPCS 20205
Min. Negotiated Rate	$93.72
Max. Negotiated Rate	$456.75
Rate for Payer: Aetna Commercial	$206.66
Rate for Payer: Aetna Medicare	$304.50
Rate for Payer: BCBS Complete	$98.41
Rate for Payer: BCN Commercial	$233.06
Rate for Payer: Cash Price	$487.20
Rate for Payer: Cash Price	$487.20
Rate for Payer: Mclaren Medicaid	$93.72
Rate for Payer: Meridian Medicaid	$98.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$456.75
Rate for Payer: Priority Health Choice Medicaid	$93.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$249.13
Rate for Payer: Priority Health Narrow/Tiered Network	$249.13
Rate for Payer: UHC Medicaid	$93.72
Rate for Payer: UHCCP Medicaid	$93.72

PR BIOPSY MUSCLE PERCUTANEOUS NEEDLE

Professional

Both

$426.00

Service Code	HCPCS 20206
Min. Negotiated Rate	$32.59
Max. Negotiated Rate	$319.50
Rate for Payer: Aetna Commercial	$75.67
Rate for Payer: Aetna Medicare	$213.00
Rate for Payer: BCBS Complete	$34.22
Rate for Payer: BCN Commercial	$85.15
Rate for Payer: Cash Price	$340.80
Rate for Payer: Cash Price	$340.80
Rate for Payer: Mclaren Medicaid	$32.59
Rate for Payer: Meridian Medicaid	$34.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$319.50
Rate for Payer: Priority Health Choice Medicaid	$32.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$91.02
Rate for Payer: Priority Health Narrow/Tiered Network	$91.02
Rate for Payer: UHC Medicaid	$32.59
Rate for Payer: UHCCP Medicaid	$32.59

PR BIOPSY MUSCLE SUPERFICIAL

Professional

Both

$370.00

Service Code	HCPCS 20200
Min. Negotiated Rate	$57.51
Max. Negotiated Rate	$277.50
Rate for Payer: Aetna Commercial	$125.65
Rate for Payer: Aetna Medicare	$185.00
Rate for Payer: BCBS Complete	$60.39
Rate for Payer: BCN Commercial	$144.41
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cash Price	$296.00
Rate for Payer: Mclaren Medicaid	$57.51
Rate for Payer: Meridian Medicaid	$60.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$277.50
Rate for Payer: Priority Health Choice Medicaid	$57.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$154.37
Rate for Payer: Priority Health Narrow/Tiered Network	$154.37
Rate for Payer: UHC Medicaid	$57.51
Rate for Payer: UHCCP Medicaid	$57.51

PR BIOPSY NAIL UNIT SEPARATE PROCEDURE

Professional

Both

$228.00

Service Code	HCPCS 11755
Min. Negotiated Rate	$34.72
Max. Negotiated Rate	$171.00
Rate for Payer: Aetna Commercial	$63.74
Rate for Payer: Aetna Medicare	$114.00
Rate for Payer: BCBS Complete	$36.46
Rate for Payer: BCN Commercial	$71.08
Rate for Payer: Cash Price	$182.40
Rate for Payer: Cash Price	$182.40
Rate for Payer: Mclaren Medicaid	$34.72
Rate for Payer: Meridian Medicaid	$36.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$171.00
Rate for Payer: Priority Health Choice Medicaid	$34.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$82.50
Rate for Payer: Priority Health Narrow/Tiered Network	$82.50
Rate for Payer: UHC Medicaid	$34.72
Rate for Payer: UHCCP Medicaid	$34.72

PR BIOPSY NASOPHARYNX VISIBLE LESION SIMPLE

Professional

Both

$863.00

Service Code	HCPCS 42804
Min. Negotiated Rate	$71.99
Max. Negotiated Rate	$647.25
Rate for Payer: Aetna Commercial	$153.57
Rate for Payer: Aetna Medicare	$431.50
Rate for Payer: BCBS Complete	$75.59
Rate for Payer: BCN Commercial	$185.75
Rate for Payer: Cash Price	$690.40
Rate for Payer: Cash Price	$690.40
Rate for Payer: Mclaren Medicaid	$71.99
Rate for Payer: Meridian Medicaid	$75.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$647.25
Rate for Payer: Priority Health Choice Medicaid	$71.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$226.32
Rate for Payer: Priority Health Narrow/Tiered Network	$226.32
Rate for Payer: UHC Medicaid	$71.99
Rate for Payer: UHCCP Medicaid	$71.99

PR BIOPSY NERVE

Professional

Both

$744.00

Service Code	HCPCS 64795
Min. Negotiated Rate	$118.85
Max. Negotiated Rate	$558.00
Rate for Payer: Aetna Commercial	$245.85
Rate for Payer: Aetna Medicare	$372.00
Rate for Payer: BCBS Complete	$124.79
Rate for Payer: BCN Commercial	$297.79
Rate for Payer: Cash Price	$595.20
Rate for Payer: Cash Price	$595.20
Rate for Payer: Mclaren Medicaid	$118.85
Rate for Payer: Meridian Medicaid	$124.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$558.00
Rate for Payer: Priority Health Choice Medicaid	$118.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$345.88
Rate for Payer: Priority Health Narrow/Tiered Network	$345.88
Rate for Payer: UHC Medicaid	$118.85
Rate for Payer: UHCCP Medicaid	$118.85

PR BIOPSY OF LIP

Professional

Both

$235.00

Service Code	HCPCS 40490
Min. Negotiated Rate	$35.78
Max. Negotiated Rate	$176.25
Rate for Payer: Aetna Commercial	$92.65
Rate for Payer: Aetna Medicare	$117.50
Rate for Payer: BCBS Complete	$37.57
Rate for Payer: BCN Commercial	$81.68
Rate for Payer: Cash Price	$188.00
Rate for Payer: Cash Price	$188.00
Rate for Payer: Mclaren Medicaid	$35.78
Rate for Payer: Meridian Medicaid	$37.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$176.25
Rate for Payer: Priority Health Choice Medicaid	$35.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$126.20
Rate for Payer: Priority Health Narrow/Tiered Network	$126.20
Rate for Payer: UHC Medicaid	$35.78
Rate for Payer: UHCCP Medicaid	$35.78

PR BIOPSY OF SKIN LESION

Professional

Both

$176.00

Service Code	HCPCS 11100
Min. Negotiated Rate	$70.40
Max. Negotiated Rate	$132.00
Rate for Payer: Aetna Medicare	$88.00
Rate for Payer: BCBS Complete	$70.40
Rate for Payer: Cash Price	$140.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$132.00

Know your out-of-pocket cost for care.

All Charges