Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS

Professional

Both

$400.00

Service Code	HCPCS 38222
Min. Negotiated Rate	$39.83
Max. Negotiated Rate	$300.00
Rate for Payer: Aetna Commercial	$94.92
Rate for Payer: Aetna Medicare	$200.00
Rate for Payer: BCBS Complete	$41.82
Rate for Payer: BCN Commercial	$110.55
Rate for Payer: Cash Price	$320.00
Rate for Payer: Cash Price	$320.00
Rate for Payer: Mclaren Medicaid	$39.83
Rate for Payer: Meridian Medicaid	$41.82
Rate for Payer: Opus (Opus Packaging Group) HMA	$300.00
Rate for Payer: Priority Health Choice Medicaid	$39.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$147.10
Rate for Payer: Priority Health Narrow/Tiered Network	$147.10
Rate for Payer: UHC Medicaid	$39.83
Rate for Payer: UHCCP Medicaid	$39.83

PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE

Professional

Both

$583.00

Service Code	HCPCS 62270
Min. Negotiated Rate	$37.49
Max. Negotiated Rate	$437.25
Rate for Payer: Aetna Commercial	$79.39
Rate for Payer: Aetna Medicare	$291.50
Rate for Payer: BCBS Complete	$39.36
Rate for Payer: BCN Commercial	$96.11
Rate for Payer: Cash Price	$466.40
Rate for Payer: Cash Price	$466.40
Rate for Payer: Mclaren Medicaid	$37.49
Rate for Payer: Meridian Medicaid	$39.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$437.25
Rate for Payer: Priority Health Choice Medicaid	$37.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$111.63
Rate for Payer: Priority Health Narrow/Tiered Network	$111.63
Rate for Payer: UHC Medicaid	$37.49
Rate for Payer: UHCCP Medicaid	$37.49

PR DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT

Professional

Both

$182.00

Service Code	HCPCS 62328
Min. Negotiated Rate	$46.86
Max. Negotiated Rate	$146.34
Rate for Payer: Aetna Commercial	$114.31
Rate for Payer: Aetna Medicare	$91.00
Rate for Payer: BCBS Complete	$49.20
Rate for Payer: BCN Commercial	$125.99
Rate for Payer: Cash Price	$145.60
Rate for Payer: Cash Price	$145.60
Rate for Payer: Mclaren Medicaid	$46.86
Rate for Payer: Meridian Medicaid	$49.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$136.50
Rate for Payer: Priority Health Choice Medicaid	$46.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$146.34
Rate for Payer: Priority Health Narrow/Tiered Network	$146.34
Rate for Payer: UHC Medicaid	$46.86
Rate for Payer: UHCCP Medicaid	$46.86

PR DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I

Professional

Both

$1,588.00

Service Code	HCPCS 36909
Min. Negotiated Rate	$112.04
Max. Negotiated Rate	$1,191.00
Rate for Payer: Aetna Commercial	$270.76
Rate for Payer: Aetna Medicare	$794.00
Rate for Payer: BCBS Complete	$117.64
Rate for Payer: BCN Commercial	$291.81
Rate for Payer: Cash Price	$1,270.40
Rate for Payer: Cash Price	$1,270.40
Rate for Payer: Mclaren Medicaid	$112.04
Rate for Payer: Meridian Medicaid	$117.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,191.00
Rate for Payer: Priority Health Choice Medicaid	$112.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$313.81
Rate for Payer: Priority Health Narrow/Tiered Network	$313.81
Rate for Payer: UHC Medicaid	$112.04
Rate for Payer: UHCCP Medicaid	$112.04

PR DIALYSIS OTHER/THAN HEMODIALYSIS 1 PHYS/QHP EVAL

Professional

Both

$215.00

Service Code	HCPCS 90945
Min. Negotiated Rate	$49.20
Max. Negotiated Rate	$161.25
Rate for Payer: Aetna Commercial	$94.34
Rate for Payer: Aetna Medicare	$107.50
Rate for Payer: BCBS Complete	$51.66
Rate for Payer: BCN Commercial	$127.98
Rate for Payer: Cash Price	$172.00
Rate for Payer: Cash Price	$172.00
Rate for Payer: Mclaren Medicaid	$49.20
Rate for Payer: Meridian Medicaid	$51.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$161.25
Rate for Payer: Priority Health Choice Medicaid	$49.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$118.03
Rate for Payer: Priority Health Narrow/Tiered Network	$118.03
Rate for Payer: UHC Medicaid	$49.20
Rate for Payer: UHCCP Medicaid	$49.20

PR DIALYSIS OTH/THN HEMODIALY REPEAT PHYS/QHP EVALS

Professional

Both

$342.00

Service Code	HCPCS 90947
Min. Negotiated Rate	$67.73
Max. Negotiated Rate	$256.50
Rate for Payer: Aetna Commercial	$136.62
Rate for Payer: Aetna Medicare	$171.00
Rate for Payer: BCBS Complete	$71.12
Rate for Payer: BCN Commercial	$180.76
Rate for Payer: Cash Price	$273.60
Rate for Payer: Cash Price	$273.60
Rate for Payer: Mclaren Medicaid	$67.73
Rate for Payer: Meridian Medicaid	$71.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$256.50
Rate for Payer: Priority Health Choice Medicaid	$67.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$166.71
Rate for Payer: Priority Health Narrow/Tiered Network	$166.71
Rate for Payer: UHC Medicaid	$67.73
Rate for Payer: UHCCP Medicaid	$67.73

PR DIAPHRAGM

Professional

Both

$73.00

Service Code	HCPCS A4266
Min. Negotiated Rate	$29.20
Max. Negotiated Rate	$80.00
Rate for Payer: Aetna Commercial	$32.28
Rate for Payer: Aetna Medicare	$36.50
Rate for Payer: BCBS Complete	$29.20
Rate for Payer: BCN Commercial	$80.00
Rate for Payer: Cash Price	$58.40
Rate for Payer: Cash Price	$58.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$54.75

PR DIAPHRAGM/CERVICAL CAP FITTING W/INSTRUCTIONS

Professional

Both

$234.00

Service Code	HCPCS 57170
Min. Negotiated Rate	$26.41
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna Commercial	$57.60
Rate for Payer: Aetna Medicare	$117.00
Rate for Payer: BCBS Complete	$27.73
Rate for Payer: BCN Commercial	$70.71
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$187.20
Rate for Payer: Mclaren Medicaid	$26.41
Rate for Payer: Meridian Medicaid	$27.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$175.50
Rate for Payer: Priority Health Choice Medicaid	$26.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$71.61
Rate for Payer: Priority Health Narrow/Tiered Network	$71.61
Rate for Payer: UHC Medicaid	$26.41
Rate for Payer: UHCCP Medicaid	$26.41

PR DIFFUSING CAPACITY

Professional

Both

$161.00

Service Code	HCPCS 94729
Min. Negotiated Rate	$62.31
Max. Negotiated Rate	$120.75
Rate for Payer: Aetna Commercial	$62.31
Rate for Payer: Aetna Commercial	$62.31
Rate for Payer: Aetna Medicare	$80.50
Rate for Payer: Aetna Medicare	$9.00
Rate for Payer: BCN Commercial	$83.66
Rate for Payer: BCN Commercial	$83.66
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cash Price	$128.80
Rate for Payer: Cash Price	$14.40
Rate for Payer: Cash Price	$14.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$120.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$77.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$77.15
Rate for Payer: Priority Health Narrow/Tiered Network	$77.15
Rate for Payer: Priority Health Narrow/Tiered Network	$77.15

PR DIGITAL ANALYSIS ELECTROENCEPHALOGRAM

Professional

Both

$801.00

Service Code	HCPCS 95957
Min. Negotiated Rate	$270.69
Max. Negotiated Rate	$600.75
Rate for Payer: Aetna Commercial	$270.69
Rate for Payer: Aetna Medicare	$400.50
Rate for Payer: BCN Commercial	$433.74
Rate for Payer: Cash Price	$640.80
Rate for Payer: Cash Price	$640.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$600.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$400.00
Rate for Payer: Priority Health Narrow/Tiered Network	$400.00

PR DILAT ANAL SPHNCTR SPX UNDER ANES OTH/THN LOCAL

Professional

Both

$370.00

Service Code	HCPCS 45905
Min. Negotiated Rate	$107.78
Max. Negotiated Rate	$314.29
Rate for Payer: Aetna Commercial	$224.91
Rate for Payer: Aetna Medicare	$185.00
Rate for Payer: BCBS Complete	$113.17
Rate for Payer: BCN Commercial	$257.96
Rate for Payer: Cash Price	$296.00
Rate for Payer: Cash Price	$296.00
Rate for Payer: Mclaren Medicaid	$107.78
Rate for Payer: Meridian Medicaid	$113.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$277.50
Rate for Payer: Priority Health Choice Medicaid	$107.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$314.29
Rate for Payer: Priority Health Narrow/Tiered Network	$314.29
Rate for Payer: UHC Medicaid	$107.78
Rate for Payer: UHCCP Medicaid	$107.78

PR DILAT&CATHJ SALIVARY DUCT W/WO INJECTION

Professional

Both

$234.00

Service Code	HCPCS 42660
Min. Negotiated Rate	$44.73
Max. Negotiated Rate	$175.50
Rate for Payer: Aetna Commercial	$114.17
Rate for Payer: Aetna Medicare	$117.00
Rate for Payer: BCBS Complete	$46.97
Rate for Payer: BCN Commercial	$119.02
Rate for Payer: Cash Price	$187.20
Rate for Payer: Cash Price	$187.20
Rate for Payer: Mclaren Medicaid	$44.73
Rate for Payer: Meridian Medicaid	$46.97
Rate for Payer: Opus (Opus Packaging Group) HMA	$175.50
Rate for Payer: Priority Health Choice Medicaid	$44.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$145.02
Rate for Payer: Priority Health Narrow/Tiered Network	$145.02
Rate for Payer: UHC Medicaid	$44.73
Rate for Payer: UHCCP Medicaid	$44.73

PR DILATE ESOPHAGUS,BALLOON RETROGRADE

Professional

Both

$853.00

Service Code	HCPCS 43456
Min. Negotiated Rate	$341.20
Max. Negotiated Rate	$639.75
Rate for Payer: Aetna Medicare	$426.50
Rate for Payer: BCBS Complete	$341.20
Rate for Payer: Cash Price	$682.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$639.75

PR DILATE ESOPH,BALLN,>30MM ACHALASIA

Professional

Both

$1,060.00

Service Code	HCPCS 43458
Min. Negotiated Rate	$424.00
Max. Negotiated Rate	$795.00
Rate for Payer: Aetna Medicare	$530.00
Rate for Payer: BCBS Complete	$424.00
Rate for Payer: Cash Price	$848.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$795.00

PR DILAT FEMALE URETHRA GENERAL/CNDJ SPINAL ANES

Professional

Both

$84.00

Service Code	HCPCS 53665
Min. Negotiated Rate	$21.09
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Commercial	$49.66
Rate for Payer: Aetna Medicare	$42.00
Rate for Payer: BCBS Complete	$22.14
Rate for Payer: BCN Commercial	$55.28
Rate for Payer: Cash Price	$67.20
Rate for Payer: Cash Price	$67.20
Rate for Payer: Mclaren Medicaid	$21.09
Rate for Payer: Meridian Medicaid	$22.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.00
Rate for Payer: Priority Health Choice Medicaid	$21.09
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$60.21
Rate for Payer: Priority Health Narrow/Tiered Network	$60.21
Rate for Payer: UHC Medicaid	$21.09
Rate for Payer: UHCCP Medicaid	$21.09

PR DILAT FEMALE URETHRA W/SUPPOSITORY&/INSTLJ INI

Professional

Both

$148.00

Service Code	HCPCS 53660
Min. Negotiated Rate	$23.86
Max. Negotiated Rate	$111.00
Rate for Payer: Aetna Commercial	$53.15
Rate for Payer: Aetna Medicare	$74.00
Rate for Payer: BCBS Complete	$25.05
Rate for Payer: BCN Commercial	$61.75
Rate for Payer: Cash Price	$118.40
Rate for Payer: Cash Price	$118.40
Rate for Payer: Mclaren Medicaid	$23.86
Rate for Payer: Meridian Medicaid	$25.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.00
Rate for Payer: Priority Health Choice Medicaid	$23.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$67.27
Rate for Payer: Priority Health Narrow/Tiered Network	$67.27
Rate for Payer: UHC Medicaid	$23.86
Rate for Payer: UHCCP Medicaid	$23.86

PR DILAT FEMALE URT W/SUPPOSITORY&/INSTLJ SBSQ

Professional

Both

$149.00

Service Code	HCPCS 53661
Min. Negotiated Rate	$23.00
Max. Negotiated Rate	$111.75
Rate for Payer: Aetna Commercial	$51.53
Rate for Payer: Aetna Medicare	$74.50
Rate for Payer: BCBS Complete	$24.15
Rate for Payer: BCN Commercial	$59.76
Rate for Payer: Cash Price	$119.20
Rate for Payer: Cash Price	$119.20
Rate for Payer: Mclaren Medicaid	$23.00
Rate for Payer: Meridian Medicaid	$24.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$111.75
Rate for Payer: Priority Health Choice Medicaid	$23.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$65.10
Rate for Payer: Priority Health Narrow/Tiered Network	$65.10
Rate for Payer: UHC Medicaid	$23.00
Rate for Payer: UHCCP Medicaid	$23.00

PR DILATION CERVICAL CANAL INSTRUMENTAL SPX

Professional

Both

$211.00

Service Code	HCPCS 57800
Min. Negotiated Rate	$27.69
Max. Negotiated Rate	$158.25
Rate for Payer: Aetna Commercial	$57.02
Rate for Payer: Aetna Medicare	$105.50
Rate for Payer: BCBS Complete	$29.07
Rate for Payer: BCN Commercial	$72.21
Rate for Payer: Cash Price	$168.80
Rate for Payer: Cash Price	$168.80
Rate for Payer: Mclaren Medicaid	$27.69
Rate for Payer: Meridian Medicaid	$29.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$158.25
Rate for Payer: Priority Health Choice Medicaid	$27.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$73.13
Rate for Payer: Priority Health Narrow/Tiered Network	$73.13
Rate for Payer: UHC Medicaid	$27.69
Rate for Payer: UHCCP Medicaid	$27.69

PR DILATION & CURETTAGE CERVICAL STUMP

Professional

Both

$280.00

Service Code	HCPCS 57558
Min. Negotiated Rate	$72.63
Max. Negotiated Rate	$210.00
Rate for Payer: Aetna Commercial	$149.43
Rate for Payer: Aetna Medicare	$140.00
Rate for Payer: BCBS Complete	$76.26
Rate for Payer: BCN Commercial	$192.72
Rate for Payer: Cash Price	$224.00
Rate for Payer: Cash Price	$224.00
Rate for Payer: Mclaren Medicaid	$72.63
Rate for Payer: Meridian Medicaid	$76.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$210.00
Rate for Payer: Priority Health Choice Medicaid	$72.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$195.18
Rate for Payer: Priority Health Narrow/Tiered Network	$195.18
Rate for Payer: UHC Medicaid	$72.63
Rate for Payer: UHCCP Medicaid	$72.63

PR DILATION & CURETTAGE DX&/THER NONOBSTETRIC

Professional

Both

$888.00

Service Code	HCPCS 58120
Min. Negotiated Rate	$133.76
Max. Negotiated Rate	$666.00
Rate for Payer: Aetna Commercial	$275.18
Rate for Payer: Aetna Medicare	$444.00
Rate for Payer: BCBS Complete	$140.45
Rate for Payer: BCN Commercial	$351.07
Rate for Payer: Cash Price	$710.40
Rate for Payer: Cash Price	$710.40
Rate for Payer: Mclaren Medicaid	$133.76
Rate for Payer: Meridian Medicaid	$140.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$666.00
Rate for Payer: Priority Health Choice Medicaid	$133.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$355.56
Rate for Payer: Priority Health Narrow/Tiered Network	$355.56
Rate for Payer: UHC Medicaid	$133.76
Rate for Payer: UHCCP Medicaid	$133.76

PR DILATION ESOPHAGUS GUIDE WIRE

Professional

Both

$533.00

Service Code	HCPCS 43453
Min. Negotiated Rate	$49.42
Max. Negotiated Rate	$399.75
Rate for Payer: Aetna Commercial	$113.71
Rate for Payer: Aetna Medicare	$266.50
Rate for Payer: BCBS Complete	$51.89
Rate for Payer: BCN Commercial	$128.97
Rate for Payer: Cash Price	$426.40
Rate for Payer: Cash Price	$426.40
Rate for Payer: Mclaren Medicaid	$49.42
Rate for Payer: Meridian Medicaid	$51.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$399.75
Rate for Payer: Priority Health Choice Medicaid	$49.42
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	$49.42
Rate for Payer: UHCCP Medicaid	$49.42

PR DILATION ESOPH UNGUIDED SOUND/BOUGIE 1/MULT PASS

Professional

Both

$338.00

Service Code	HCPCS 43450
Min. Negotiated Rate	$46.65
Max. Negotiated Rate	$253.50
Rate for Payer: Aetna Commercial	$104.98
Rate for Payer: Aetna Medicare	$169.00
Rate for Payer: BCBS Complete	$48.98
Rate for Payer: BCN Commercial	$118.52
Rate for Payer: Cash Price	$270.40
Rate for Payer: Cash Price	$270.40
Rate for Payer: Mclaren Medicaid	$46.65
Rate for Payer: Meridian Medicaid	$48.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$253.50
Rate for Payer: Priority Health Choice Medicaid	$46.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$144.40
Rate for Payer: Priority Health Narrow/Tiered Network	$144.40
Rate for Payer: UHC Medicaid	$46.65
Rate for Payer: UHCCP Medicaid	$46.65

PR DILATION LACRIMAL PUNCTUM W/WO IRRGATION

Professional

Both

$222.00

Service Code	HCPCS 68801
Min. Negotiated Rate	$45.80
Max. Negotiated Rate	$166.50
Rate for Payer: Aetna Commercial	$100.58
Rate for Payer: Aetna Medicare	$111.00
Rate for Payer: BCBS Complete	$48.09
Rate for Payer: BCN Commercial	$93.07
Rate for Payer: Cash Price	$177.60
Rate for Payer: Cash Price	$177.60
Rate for Payer: Mclaren Medicaid	$45.80
Rate for Payer: Meridian Medicaid	$48.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$166.50
Rate for Payer: Priority Health Choice Medicaid	$45.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$138.24
Rate for Payer: Priority Health Narrow/Tiered Network	$138.24
Rate for Payer: UHC Medicaid	$45.80
Rate for Payer: UHCCP Medicaid	$45.80

PR DILATION SALIVARY DUCT

Professional

Both

$129.00

Service Code	HCPCS 42650
Min. Negotiated Rate	$34.08
Max. Negotiated Rate	$109.83
Rate for Payer: Aetna Commercial	$75.67
Rate for Payer: Aetna Medicare	$64.50
Rate for Payer: BCBS Complete	$35.78
Rate for Payer: BCN Commercial	$90.13
Rate for Payer: Cash Price	$103.20
Rate for Payer: Cash Price	$103.20
Rate for Payer: Mclaren Medicaid	$34.08
Rate for Payer: Meridian Medicaid	$35.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$96.75
Rate for Payer: Priority Health Choice Medicaid	$34.08
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$109.83
Rate for Payer: Priority Health Narrow/Tiered Network	$109.83
Rate for Payer: UHC Medicaid	$34.08
Rate for Payer: UHCCP Medicaid	$34.08

PR DILATION VAGINA W/ANESTHESIA OTHER THAN LOCAL

Professional

Both

$381.00

Service Code	HCPCS 57400
Min. Negotiated Rate	$73.70
Max. Negotiated Rate	$285.75
Rate for Payer: Aetna Commercial	$156.29
Rate for Payer: Aetna Medicare	$190.50
Rate for Payer: BCBS Complete	$77.39
Rate for Payer: BCN Commercial	$195.21
Rate for Payer: Cash Price	$304.80
Rate for Payer: Cash Price	$304.80
Rate for Payer: Mclaren Medicaid	$73.70
Rate for Payer: Meridian Medicaid	$77.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$285.75
Rate for Payer: Priority Health Choice Medicaid	$73.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$197.71
Rate for Payer: Priority Health Narrow/Tiered Network	$197.71
Rate for Payer: UHC Medicaid	$73.70
Rate for Payer: UHCCP Medicaid	$73.70

Know your out-of-pocket cost for care.

All Charges