Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH CRV APPR

Professional

Both

$2,510.00

Service Code	HCPCS 43130
Min. Negotiated Rate	$455.61
Max. Negotiated Rate	$1,882.50
Rate for Payer: Aetna Commercial	$1,052.07
Rate for Payer: Aetna Medicare	$1,255.00
Rate for Payer: BCBS Complete	$478.39
Rate for Payer: BCN Commercial	$1,192.67
Rate for Payer: Cash Price	$2,008.00
Rate for Payer: Cash Price	$2,008.00
Rate for Payer: Mclaren Medicaid	$455.61
Rate for Payer: Meridian Medicaid	$478.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,882.50
Rate for Payer: Priority Health Choice Medicaid	$455.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,453.19
Rate for Payer: Priority Health Narrow/Tiered Network	$1,453.19
Rate for Payer: UHC Medicaid	$455.61
Rate for Payer: UHCCP Medicaid	$455.61

PR DIVERTICULECTOMY HYPOPHARYNX/ESOPH THRC APPR

Professional

Both

$3,262.00

Service Code	HCPCS 43135
Min. Negotiated Rate	$885.44
Max. Negotiated Rate	$2,647.89
Rate for Payer: Aetna Commercial	$1,977.64
Rate for Payer: Aetna Medicare	$1,631.00
Rate for Payer: BCBS Complete	$929.71
Rate for Payer: BCN Commercial	$2,173.19
Rate for Payer: Cash Price	$2,609.60
Rate for Payer: Cash Price	$2,609.60
Rate for Payer: Mclaren Medicaid	$885.44
Rate for Payer: Meridian Medicaid	$929.71
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,446.50
Rate for Payer: Priority Health Choice Medicaid	$885.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,647.89
Rate for Payer: Priority Health Narrow/Tiered Network	$2,647.89
Rate for Payer: UHC Medicaid	$885.44
Rate for Payer: UHCCP Medicaid	$885.44

PR DIVISION ABERRANT VESSEL VASCULAR RING

Professional

Both

$4,360.00

Service Code	HCPCS 33802
Min. Negotiated Rate	$666.69
Max. Negotiated Rate	$3,270.00
Rate for Payer: Aetna Commercial	$1,453.89
Rate for Payer: Aetna Medicare	$2,180.00
Rate for Payer: BCBS Complete	$700.02
Rate for Payer: BCN Commercial	$1,612.46
Rate for Payer: Cash Price	$3,488.00
Rate for Payer: Cash Price	$3,488.00
Rate for Payer: Mclaren Medicaid	$666.69
Rate for Payer: Meridian Medicaid	$700.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,270.00
Rate for Payer: Priority Health Choice Medicaid	$666.69
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,734.00
Rate for Payer: Priority Health Narrow/Tiered Network	$1,734.00
Rate for Payer: UHC Medicaid	$666.69
Rate for Payer: UHCCP Medicaid	$666.69

PR DIVISION PLANTAR FASCIA & MUSCLE SPX

Professional

Both

$1,350.00

Service Code	HCPCS 28250
Min. Negotiated Rate	$246.65
Max. Negotiated Rate	$1,012.50
Rate for Payer: Aetna Commercial	$533.29
Rate for Payer: Aetna Medicare	$675.00
Rate for Payer: BCBS Complete	$258.98
Rate for Payer: BCN Commercial	$629.95
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Cash Price	$1,080.00
Rate for Payer: Mclaren Medicaid	$246.65
Rate for Payer: Meridian Medicaid	$258.98
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,012.50
Rate for Payer: Priority Health Choice Medicaid	$246.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$673.39
Rate for Payer: Priority Health Narrow/Tiered Network	$673.39
Rate for Payer: UHC Medicaid	$246.65
Rate for Payer: UHCCP Medicaid	$246.65

PR DIVISION SCALENUS ANTICUS RESECTION CERVICAL RIB

Professional

Both

$1,153.00

Service Code	HCPCS 21705
Min. Negotiated Rate	$315.24
Max. Negotiated Rate	$864.75
Rate for Payer: Aetna Commercial	$719.58
Rate for Payer: Aetna Medicare	$576.50
Rate for Payer: BCBS Complete	$331.00
Rate for Payer: BCN Commercial	$792.29
Rate for Payer: Cash Price	$922.40
Rate for Payer: Cash Price	$922.40
Rate for Payer: Mclaren Medicaid	$315.24
Rate for Payer: Meridian Medicaid	$331.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$864.75
Rate for Payer: Priority Health Choice Medicaid	$315.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$846.93
Rate for Payer: Priority Health Narrow/Tiered Network	$846.93
Rate for Payer: UHC Medicaid	$315.24
Rate for Payer: UHCCP Medicaid	$315.24

PR DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB

Professional

Both

$1,595.00

Service Code	HCPCS 21700
Min. Negotiated Rate	$211.94
Max. Negotiated Rate	$1,196.25
Rate for Payer: Aetna Commercial	$478.91
Rate for Payer: Aetna Medicare	$797.50
Rate for Payer: BCBS Complete	$222.54
Rate for Payer: BCN Commercial	$531.34
Rate for Payer: Cash Price	$1,276.00
Rate for Payer: Cash Price	$1,276.00
Rate for Payer: Mclaren Medicaid	$211.94
Rate for Payer: Meridian Medicaid	$222.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,196.25
Rate for Payer: Priority Health Choice Medicaid	$211.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$568.00
Rate for Payer: Priority Health Narrow/Tiered Network	$568.00
Rate for Payer: UHC Medicaid	$211.94
Rate for Payer: UHCCP Medicaid	$211.94

PR DIVISION STRICTURE RECTUM

Professional

Both

$1,421.00

Service Code	HCPCS 45150
Min. Negotiated Rate	$266.68
Max. Negotiated Rate	$1,065.75
Rate for Payer: Aetna Commercial	$565.98
Rate for Payer: Aetna Medicare	$710.50
Rate for Payer: BCBS Complete	$280.01
Rate for Payer: BCN Commercial	$644.38
Rate for Payer: Cash Price	$1,136.80
Rate for Payer: Cash Price	$1,136.80
Rate for Payer: Mclaren Medicaid	$266.68
Rate for Payer: Meridian Medicaid	$280.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,065.75
Rate for Payer: Priority Health Choice Medicaid	$266.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$785.14
Rate for Payer: Priority Health Narrow/Tiered Network	$785.14
Rate for Payer: UHC Medicaid	$266.68
Rate for Payer: UHCCP Medicaid	$266.68

PR DLYD PLACEMENT XTN PROSTH FOR EVASC RPR 1ST VSL

Professional

Both

$1,731.00

Service Code	HCPCS 34710
Min. Negotiated Rate	$460.72
Max. Negotiated Rate	$1,298.25
Rate for Payer: Aetna Commercial	$1,070.75
Rate for Payer: Aetna Medicare	$865.50
Rate for Payer: BCBS Complete	$483.76
Rate for Payer: BCN Commercial	$1,162.29
Rate for Payer: Cash Price	$1,384.80
Rate for Payer: Cash Price	$1,384.80
Rate for Payer: Mclaren Medicaid	$460.72
Rate for Payer: Meridian Medicaid	$483.76
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,298.25
Rate for Payer: Priority Health Choice Medicaid	$460.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,249.90
Rate for Payer: Priority Health Narrow/Tiered Network	$1,249.90
Rate for Payer: UHC Medicaid	$460.72
Rate for Payer: UHCCP Medicaid	$460.72

PR DLYD PLACEMENT XTN PROSTH FOR EVASC RPR EA ADDL

Professional

Both

$648.00

Service Code	HCPCS 34711
Min. Negotiated Rate	$168.48
Max. Negotiated Rate	$486.00
Rate for Payer: Aetna Commercial	$402.19
Rate for Payer: Aetna Medicare	$324.00
Rate for Payer: BCBS Complete	$176.90
Rate for Payer: BCN Commercial	$428.76
Rate for Payer: Cash Price	$518.40
Rate for Payer: Cash Price	$518.40
Rate for Payer: Mclaren Medicaid	$168.48
Rate for Payer: Meridian Medicaid	$176.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$486.00
Rate for Payer: Priority Health Choice Medicaid	$168.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$461.07
Rate for Payer: Priority Health Narrow/Tiered Network	$461.07
Rate for Payer: UHC Medicaid	$168.48
Rate for Payer: UHCCP Medicaid	$168.48

PR DLYD PLMT PROX XTN PROSTH NOT COV LSA ORIGIN

Professional

Both

$2,346.00

Service Code	HCPCS 33883
Min. Negotiated Rate	$613.23
Max. Negotiated Rate	$1,759.50
Rate for Payer: Aetna Commercial	$1,495.47
Rate for Payer: Aetna Medicare	$1,173.00
Rate for Payer: BCBS Complete	$643.89
Rate for Payer: BCN Commercial	$1,619.44
Rate for Payer: Cash Price	$1,876.80
Rate for Payer: Cash Price	$1,876.80
Rate for Payer: Mclaren Medicaid	$613.23
Rate for Payer: Meridian Medicaid	$643.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,759.50
Rate for Payer: Priority Health Choice Medicaid	$613.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,741.50
Rate for Payer: Priority Health Narrow/Tiered Network	$1,741.50
Rate for Payer: UHC Medicaid	$613.23
Rate for Payer: UHCCP Medicaid	$613.23

PR DOG EAR REVISION

Professional

Both

$2,704.00

Hospital Revenue Code	990
Min. Negotiated Rate	$1,081.60
Max. Negotiated Rate	$2,028.00
Rate for Payer: Aetna Medicare	$1,352.00
Rate for Payer: BCBS Complete	$1,081.60
Rate for Payer: Cash Price	$2,163.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,028.00

PR DOMICIL/REST HOME NEW PT VISIT LOW SEVER 20 MIN

Professional

Both

$95.00

Service Code	HCPCS 99324
Min. Negotiated Rate	$38.00
Max. Negotiated Rate	$71.25
Rate for Payer: Aetna Medicare	$47.50
Rate for Payer: BCBS Complete	$38.00
Rate for Payer: Cash Price	$76.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$71.25

PR DOM/R-HOME E/M EST PT LW MOD SEVERITY 25 MINUTES

Professional

Both

$147.00

Service Code	HCPCS 99335
Min. Negotiated Rate	$58.80
Max. Negotiated Rate	$110.25
Rate for Payer: Aetna Medicare	$73.50
Rate for Payer: BCBS Complete	$58.80
Rate for Payer: Cash Price	$117.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$110.25

PR DOM/R-HOME E/M EST PT MOD HI SEVERITY 40 MINUTES

Professional

Both

$208.00

Service Code	HCPCS 99336
Min. Negotiated Rate	$83.20
Max. Negotiated Rate	$156.00
Rate for Payer: Aetna Medicare	$104.00
Rate for Payer: BCBS Complete	$83.20
Rate for Payer: Cash Price	$166.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$156.00

PR DOM/R-HOME E/M EST PT SELF-LMTD/MINOR 15 MINUTES

Professional

Both

$94.00

Service Code	HCPCS 99334
Min. Negotiated Rate	$37.60
Max. Negotiated Rate	$70.50
Rate for Payer: Aetna Medicare	$47.00
Rate for Payer: BCBS Complete	$37.60
Rate for Payer: Cash Price	$75.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$70.50

PR DOM/R-HOME E/M EST PT SIGNIF NEW PROB 60 MINUTES

Professional

Both

$298.00

Service Code	HCPCS 99337
Min. Negotiated Rate	$119.20
Max. Negotiated Rate	$223.50
Rate for Payer: Aetna Medicare	$149.00
Rate for Payer: BCBS Complete	$119.20
Rate for Payer: Cash Price	$238.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$223.50

PR DOPPLER ECHO COLOR FLOW VELOCITY MAPPING

Professional

Both

$207.00

Service Code	HCPCS 93325
Min. Negotiated Rate	$31.62
Max. Negotiated Rate	$155.25
Rate for Payer: Aetna Commercial	$31.62
Rate for Payer: Aetna Commercial	$31.62
Rate for Payer: Aetna Medicare	$103.50
Rate for Payer: Aetna Medicare	$170.00
Rate for Payer: BCN Commercial	$33.87
Rate for Payer: BCN Commercial	$33.87
Rate for Payer: Cash Price	$272.00
Rate for Payer: Cash Price	$165.60
Rate for Payer: Cash Price	$272.00
Rate for Payer: Cash Price	$165.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$255.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$155.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$32.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$32.19
Rate for Payer: Priority Health Narrow/Tiered Network	$32.19
Rate for Payer: Priority Health Narrow/Tiered Network	$32.19

PR DOPPLER ECHO PULSE WAVE W/SPECTRAL DISPLAY COMPL

Professional

Both

$181.00

Service Code	HCPCS 93320
Min. Negotiated Rate	$68.60
Max. Negotiated Rate	$135.75
Rate for Payer: Aetna Commercial	$68.60
Rate for Payer: Aetna Commercial	$68.60
Rate for Payer: Aetna Medicare	$90.50
Rate for Payer: Aetna Medicare	$133.50
Rate for Payer: BCN Commercial	$74.70
Rate for Payer: BCN Commercial	$74.70
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$144.80
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$144.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$135.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$200.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$71.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$71.00
Rate for Payer: Priority Health Narrow/Tiered Network	$71.00
Rate for Payer: Priority Health Narrow/Tiered Network	$71.00

PR DOPPLER ECHO PULSE WAVE W/SPECTRAL F-UP/LMTD STD

Professional

Both

$56.00

Service Code	HCPCS 93321
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$34.13
Rate for Payer: Aetna Medicare	$28.00
Rate for Payer: BCN Commercial	$36.85
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cash Price	$44.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$42.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$35.03
Rate for Payer: Priority Health Narrow/Tiered Network	$35.03

PR DRAIN ABD ABSCESS PERCUTANEOUS

Professional

Both

$638.00

Service Code	HCPCS 49021
Min. Negotiated Rate	$255.20
Max. Negotiated Rate	$478.50
Rate for Payer: Aetna Medicare	$319.00
Rate for Payer: BCBS Complete	$255.20
Rate for Payer: Cash Price	$510.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$478.50

PR DRAINAGE ABSCESS/HEMATOMA NASAL INT APPROACH

Professional

Both

$385.00

Service Code	HCPCS 30000
Min. Negotiated Rate	$70.50
Max. Negotiated Rate	$288.75
Rate for Payer: Aetna Commercial	$150.43
Rate for Payer: Aetna Medicare	$192.50
Rate for Payer: BCBS Complete	$74.03
Rate for Payer: BCN Commercial	$184.75
Rate for Payer: Cash Price	$308.00
Rate for Payer: Cash Price	$308.00
Rate for Payer: Mclaren Medicaid	$70.50
Rate for Payer: Meridian Medicaid	$74.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$288.75
Rate for Payer: Priority Health Choice Medicaid	$70.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$173.99
Rate for Payer: Priority Health Narrow/Tiered Network	$173.99
Rate for Payer: UHC Medicaid	$70.50
Rate for Payer: UHCCP Medicaid	$70.50

PR DRAINAGE ABSCESS/HEMATOMA NASAL SEPTUM

Professional

Both

$313.00

Service Code	HCPCS 30020
Min. Negotiated Rate	$71.14
Max. Negotiated Rate	$234.75
Rate for Payer: Aetna Commercial	$151.26
Rate for Payer: Aetna Medicare	$156.50
Rate for Payer: BCBS Complete	$74.70
Rate for Payer: BCN Commercial	$185.25
Rate for Payer: Cash Price	$250.40
Rate for Payer: Cash Price	$250.40
Rate for Payer: Mclaren Medicaid	$71.14
Rate for Payer: Meridian Medicaid	$74.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$234.75
Rate for Payer: Priority Health Choice Medicaid	$71.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$174.45
Rate for Payer: Priority Health Narrow/Tiered Network	$174.45
Rate for Payer: UHC Medicaid	$71.14
Rate for Payer: UHCCP Medicaid	$71.14

PR DRAINAGE ABSCESS PALATE UVULA

Professional

Both

$346.00

Service Code	HCPCS 42000
Min. Negotiated Rate	$63.26
Max. Negotiated Rate	$259.50
Rate for Payer: Aetna Commercial	$138.08
Rate for Payer: Aetna Medicare	$173.00
Rate for Payer: BCBS Complete	$66.42
Rate for Payer: BCN Commercial	$165.33
Rate for Payer: Cash Price	$276.80
Rate for Payer: Cash Price	$276.80
Rate for Payer: Mclaren Medicaid	$63.26
Rate for Payer: Meridian Medicaid	$66.42
Rate for Payer: Opus (Opus Packaging Group) HMA	$259.50
Rate for Payer: Priority Health Choice Medicaid	$63.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$201.44
Rate for Payer: Priority Health Narrow/Tiered Network	$201.44
Rate for Payer: UHC Medicaid	$63.26
Rate for Payer: UHCCP Medicaid	$63.26

PR DRAINAGE ABSCESS PAROTID COMPLICATED

Professional

Both

$806.00

Service Code	HCPCS 42305
Min. Negotiated Rate	$245.38
Max. Negotiated Rate	$798.49
Rate for Payer: Aetna Commercial	$561.76
Rate for Payer: Aetna Medicare	$403.00
Rate for Payer: BCBS Complete	$257.65
Rate for Payer: BCN Commercial	$655.34
Rate for Payer: Cash Price	$644.80
Rate for Payer: Cash Price	$644.80
Rate for Payer: Mclaren Medicaid	$245.38
Rate for Payer: Meridian Medicaid	$257.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$604.50
Rate for Payer: Priority Health Choice Medicaid	$245.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$798.49
Rate for Payer: Priority Health Narrow/Tiered Network	$798.49
Rate for Payer: UHC Medicaid	$245.38
Rate for Payer: UHCCP Medicaid	$245.38

PR DRAINAGE ABSCESS PAROTID SIMPLE

Professional

Both

$359.00

Service Code	HCPCS 42300
Min. Negotiated Rate	$90.31
Max. Negotiated Rate	$288.22
Rate for Payer: Aetna Commercial	$202.70
Rate for Payer: Aetna Medicare	$179.50
Rate for Payer: BCBS Complete	$94.83
Rate for Payer: BCN Commercial	$236.55
Rate for Payer: Cash Price	$287.20
Rate for Payer: Cash Price	$287.20
Rate for Payer: Mclaren Medicaid	$90.31
Rate for Payer: Meridian Medicaid	$94.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$269.25
Rate for Payer: Priority Health Choice Medicaid	$90.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$288.22
Rate for Payer: Priority Health Narrow/Tiered Network	$288.22
Rate for Payer: UHC Medicaid	$90.31
Rate for Payer: UHCCP Medicaid	$90.31

Know your out-of-pocket cost for care.

All Charges