Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR EPIDRM AGRFT T/A/L 1ST 100 SQCM/</1% INFT/CHLD

Professional

Both

$1,656.00

Service Code	HCPCS 15110
Min. Negotiated Rate	$428.13
Max. Negotiated Rate	$1,242.00
Rate for Payer: Aetna Commercial	$761.36
Rate for Payer: Aetna Medicare	$828.00
Rate for Payer: BCBS Complete	$449.54
Rate for Payer: BCN Commercial	$1,074.64
Rate for Payer: Cash Price	$1,324.80
Rate for Payer: Cash Price	$1,324.80
Rate for Payer: Mclaren Medicaid	$428.13
Rate for Payer: Meridian Medicaid	$449.54
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,242.00
Rate for Payer: Priority Health Choice Medicaid	$428.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$983.58
Rate for Payer: Priority Health Narrow/Tiered Network	$983.58
Rate for Payer: UHC Medicaid	$428.13
Rate for Payer: UHCCP Medicaid	$428.13

PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/ULNA

Professional

Both

$1,298.00

Service Code	HCPCS 25450
Min. Negotiated Rate	$376.37
Max. Negotiated Rate	$1,015.15
Rate for Payer: Aetna Commercial	$824.26
Rate for Payer: Aetna Medicare	$649.00
Rate for Payer: BCBS Complete	$395.19
Rate for Payer: BCN Commercial	$949.65
Rate for Payer: Cash Price	$1,038.40
Rate for Payer: Cash Price	$1,038.40
Rate for Payer: Mclaren Medicaid	$376.37
Rate for Payer: Meridian Medicaid	$395.19
Rate for Payer: Opus (Opus Packaging Group) HMA	$973.50
Rate for Payer: Priority Health Choice Medicaid	$376.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,015.15
Rate for Payer: Priority Health Narrow/Tiered Network	$1,015.15
Rate for Payer: UHC Medicaid	$376.37
Rate for Payer: UHCCP Medicaid	$376.37

PR EPIPHYSL ARRST EPIPHYSIOD/STAPLING TRCHNTR FEMUR

Professional

Both

$1,210.00

Service Code	HCPCS 27185
Min. Negotiated Rate	$431.75
Max. Negotiated Rate	$1,174.31
Rate for Payer: Aetna Commercial	$958.27
Rate for Payer: Aetna Medicare	$605.00
Rate for Payer: BCBS Complete	$453.34
Rate for Payer: BCN Commercial	$1,098.55
Rate for Payer: Cash Price	$968.00
Rate for Payer: Cash Price	$968.00
Rate for Payer: Mclaren Medicaid	$431.75
Rate for Payer: Meridian Medicaid	$453.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$907.50
Rate for Payer: Priority Health Choice Medicaid	$431.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,174.31
Rate for Payer: Priority Health Narrow/Tiered Network	$1,174.31
Rate for Payer: UHC Medicaid	$431.75
Rate for Payer: UHCCP Medicaid	$431.75

PR EPISIOTOMY/VAG RPR OTH/THN ATTENDING

Professional

Both

$392.00

Service Code	HCPCS 59300
Min. Negotiated Rate	$85.20
Max. Negotiated Rate	$294.00
Rate for Payer: Aetna Commercial	$160.66
Rate for Payer: Aetna Medicare	$196.00
Rate for Payer: BCBS Complete	$89.46
Rate for Payer: BCN Commercial	$221.10
Rate for Payer: Cash Price	$313.60
Rate for Payer: Cash Price	$313.60
Rate for Payer: Mclaren Medicaid	$85.20
Rate for Payer: Meridian Medicaid	$89.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$294.00
Rate for Payer: Priority Health Choice Medicaid	$85.20
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$208.72
Rate for Payer: Priority Health Narrow/Tiered Network	$208.72
Rate for Payer: UHC Medicaid	$85.20
Rate for Payer: UHCCP Medicaid	$85.20

PR EPOETIN ALFA, NON-ESRD

Professional

Both

$40.00

Service Code	HCPCS J0885
Min. Negotiated Rate	$5.38
Max. Negotiated Rate	$30.00
Rate for Payer: Aetna Commercial	$9.15
Rate for Payer: Aetna Medicare	$20.00
Rate for Payer: BCBS Trust/PPO	$5.88
Rate for Payer: BCN Commercial	$5.38
Rate for Payer: Cash Price	$32.00
Rate for Payer: Cash Price	$32.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$30.00

PR ERCP,ABLATION TUMOR

Professional

Both

$1,705.00

Service Code	HCPCS 43272
Min. Negotiated Rate	$682.00
Max. Negotiated Rate	$1,278.75
Rate for Payer: Aetna Medicare	$852.50
Rate for Payer: BCBS Complete	$682.00
Rate for Payer: Cash Price	$1,364.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,278.75

PR ERCP BALLOON DILATE BILIARY/PANC DUCT/AMPULLA EA

Professional

Both

$1,221.00

Service Code	HCPCS 43277
Min. Negotiated Rate	$210.44
Max. Negotiated Rate	$915.75
Rate for Payer: Aetna Commercial	$503.77
Rate for Payer: Aetna Medicare	$610.50
Rate for Payer: BCBS Complete	$220.96
Rate for Payer: BCN Commercial	$555.25
Rate for Payer: Cash Price	$976.80
Rate for Payer: Cash Price	$976.80
Rate for Payer: Mclaren Medicaid	$210.44
Rate for Payer: Meridian Medicaid	$220.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$915.75
Rate for Payer: Priority Health Choice Medicaid	$210.44
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$676.53
Rate for Payer: Priority Health Narrow/Tiered Network	$676.53
Rate for Payer: UHC Medicaid	$210.44
Rate for Payer: UHCCP Medicaid	$210.44

PR ERCP,BALLOON DIL DUCTS

Professional

Both

$1,722.00

Service Code	HCPCS 43271
Min. Negotiated Rate	$688.80
Max. Negotiated Rate	$1,291.50
Rate for Payer: Aetna Medicare	$861.00
Rate for Payer: BCBS Complete	$688.80
Rate for Payer: Cash Price	$1,377.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,291.50

PR ERCP BILIARY/PANC DUCT STENT EXCHANGE W/DIL&WIRE

Professional

Both

$1,532.00

Service Code	HCPCS 43276
Min. Negotiated Rate	$267.32
Max. Negotiated Rate	$1,149.00
Rate for Payer: Aetna Commercial	$641.72
Rate for Payer: Aetna Medicare	$766.00
Rate for Payer: BCBS Complete	$280.69
Rate for Payer: BCN Commercial	$705.64
Rate for Payer: Cash Price	$1,225.60
Rate for Payer: Cash Price	$1,225.60
Rate for Payer: Mclaren Medicaid	$267.32
Rate for Payer: Meridian Medicaid	$280.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,149.00
Rate for Payer: Priority Health Choice Medicaid	$267.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$859.78
Rate for Payer: Priority Health Narrow/Tiered Network	$859.78
Rate for Payer: UHC Medicaid	$267.32
Rate for Payer: UHCCP Medicaid	$267.32

PR ERCP DESTRUCTION/LITHOTRIPSY CALCULI ANY METHOD

Professional

Both

$1,962.00

Service Code	HCPCS 43265
Min. Negotiated Rate	$240.26
Max. Negotiated Rate	$1,471.50
Rate for Payer: Aetna Commercial	$577.10
Rate for Payer: Aetna Medicare	$981.00
Rate for Payer: BCBS Complete	$252.27
Rate for Payer: BCN Commercial	$633.93
Rate for Payer: Cash Price	$1,569.60
Rate for Payer: Cash Price	$1,569.60
Rate for Payer: Mclaren Medicaid	$240.26
Rate for Payer: Meridian Medicaid	$252.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,471.50
Rate for Payer: Priority Health Choice Medicaid	$240.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$772.40
Rate for Payer: Priority Health Narrow/Tiered Network	$772.40
Rate for Payer: UHC Medicaid	$240.26
Rate for Payer: UHCCP Medicaid	$240.26

PR ERCP DX COLLECTION SPECIMEN BRUSHING/WASHING

Professional

Both

$1,137.00

Service Code	HCPCS 43260
Min. Negotiated Rate	$179.13
Max. Negotiated Rate	$852.75
Rate for Payer: Aetna Commercial	$429.07
Rate for Payer: Aetna Medicare	$568.50
Rate for Payer: BCBS Complete	$188.09
Rate for Payer: BCN Commercial	$473.58
Rate for Payer: Cash Price	$909.60
Rate for Payer: Cash Price	$909.60
Rate for Payer: Mclaren Medicaid	$179.13
Rate for Payer: Meridian Medicaid	$188.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$852.75
Rate for Payer: Priority Health Choice Medicaid	$179.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$577.04
Rate for Payer: Priority Health Narrow/Tiered Network	$577.04
Rate for Payer: UHC Medicaid	$179.13
Rate for Payer: UHCCP Medicaid	$179.13

PR ERCP,INSERT STENT,BILIARY/PANC

Professional

Both

$1,756.00

Service Code	HCPCS 43268
Min. Negotiated Rate	$702.40
Max. Negotiated Rate	$1,317.00
Rate for Payer: Aetna Medicare	$878.00
Rate for Payer: BCBS Complete	$702.40
Rate for Payer: Cash Price	$1,404.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,317.00

PR ERCP,NASOBILIARY DRAIN TUBE

Professional

Both

$1,698.00

Service Code	HCPCS 43267
Min. Negotiated Rate	$679.20
Max. Negotiated Rate	$1,273.50
Rate for Payer: Aetna Medicare	$849.00
Rate for Payer: BCBS Complete	$679.20
Rate for Payer: Cash Price	$1,358.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,273.50

PR ERCP REMOVE CALCULI/DEBRIS BILIARY/PANCREAS DUCT

Professional

Both

$1,894.00

Service Code	HCPCS 43264
Min. Negotiated Rate	$202.35
Max. Negotiated Rate	$1,420.50
Rate for Payer: Aetna Commercial	$484.52
Rate for Payer: Aetna Medicare	$947.00
Rate for Payer: BCBS Complete	$212.47
Rate for Payer: BCN Commercial	$534.83
Rate for Payer: Cash Price	$1,515.20
Rate for Payer: Cash Price	$1,515.20
Rate for Payer: Mclaren Medicaid	$202.35
Rate for Payer: Meridian Medicaid	$212.47
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,420.50
Rate for Payer: Priority Health Choice Medicaid	$202.35
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$651.65
Rate for Payer: Priority Health Narrow/Tiered Network	$651.65
Rate for Payer: UHC Medicaid	$202.35
Rate for Payer: UHCCP Medicaid	$202.35

PR ERCP REMOVE FOREIGN BODY/STENT BILIARY/PANC DUCT

Professional

Both

$843.00

Service Code	HCPCS 43275
Min. Negotiated Rate	$209.38
Max. Negotiated Rate	$672.89
Rate for Payer: Aetna Commercial	$501.03
Rate for Payer: Aetna Medicare	$421.50
Rate for Payer: BCBS Complete	$219.85
Rate for Payer: BCN Commercial	$552.26
Rate for Payer: Cash Price	$674.40
Rate for Payer: Cash Price	$674.40
Rate for Payer: Mclaren Medicaid	$209.38
Rate for Payer: Meridian Medicaid	$219.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$632.25
Rate for Payer: Priority Health Choice Medicaid	$209.38
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$672.89
Rate for Payer: Priority Health Narrow/Tiered Network	$672.89
Rate for Payer: UHC Medicaid	$209.38
Rate for Payer: UHCCP Medicaid	$209.38

PR ERCP,RMV F.B./CHANGE STENT

Professional

Both

$1,744.00

Service Code	HCPCS 43269
Min. Negotiated Rate	$697.60
Max. Negotiated Rate	$1,308.00
Rate for Payer: Aetna Medicare	$872.00
Rate for Payer: BCBS Complete	$697.60
Rate for Payer: Cash Price	$1,395.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,308.00

PR ERCP STENT PLACEMENT BILIARY/PANCREATIC DUCT

Professional

Both

$1,472.00

Service Code	HCPCS 43274
Min. Negotiated Rate	$256.45
Max. Negotiated Rate	$1,104.00
Rate for Payer: Aetna Commercial	$616.54
Rate for Payer: Aetna Medicare	$736.00
Rate for Payer: BCBS Complete	$269.27
Rate for Payer: BCN Commercial	$678.25
Rate for Payer: Cash Price	$1,177.60
Rate for Payer: Cash Price	$1,177.60
Rate for Payer: Mclaren Medicaid	$256.45
Rate for Payer: Meridian Medicaid	$269.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,104.00
Rate for Payer: Priority Health Choice Medicaid	$256.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$826.40
Rate for Payer: Priority Health Narrow/Tiered Network	$826.40
Rate for Payer: UHC Medicaid	$256.45
Rate for Payer: UHCCP Medicaid	$256.45

PR ERCP TUMOR/POLYP/LESION ABLATION W/DILATION&WIRE

Professional

Both

$1,388.00

Service Code	HCPCS 43278
Min. Negotiated Rate	$240.05
Max. Negotiated Rate	$1,041.00
Rate for Payer: Aetna Commercial	$575.78
Rate for Payer: Aetna Medicare	$694.00
Rate for Payer: BCBS Complete	$252.05
Rate for Payer: BCN Commercial	$634.93
Rate for Payer: Cash Price	$1,110.40
Rate for Payer: Cash Price	$1,110.40
Rate for Payer: Mclaren Medicaid	$240.05
Rate for Payer: Meridian Medicaid	$252.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,041.00
Rate for Payer: Priority Health Choice Medicaid	$240.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$773.62
Rate for Payer: Priority Health Narrow/Tiered Network	$773.62
Rate for Payer: UHC Medicaid	$240.05
Rate for Payer: UHCCP Medicaid	$240.05

PR ERCP W/BIOPSY SINGLE/MULTIPLE

Professional

Both

$1,205.00

Service Code	HCPCS 43261
Min. Negotiated Rate	$188.51
Max. Negotiated Rate	$903.75
Rate for Payer: Aetna Commercial	$450.13
Rate for Payer: Aetna Medicare	$602.50
Rate for Payer: BCBS Complete	$197.94
Rate for Payer: BCN Commercial	$496.49
Rate for Payer: Cash Price	$964.00
Rate for Payer: Cash Price	$964.00
Rate for Payer: Mclaren Medicaid	$188.51
Rate for Payer: Meridian Medicaid	$197.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$903.75
Rate for Payer: Priority Health Choice Medicaid	$188.51
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$604.93
Rate for Payer: Priority Health Narrow/Tiered Network	$604.93
Rate for Payer: UHC Medicaid	$188.51
Rate for Payer: UHCCP Medicaid	$188.51

PR ERCP W/PRESSURE MEASUREMENT SPHINCTER OF ODDI

Professional

Both

$1,671.00

Service Code	HCPCS 43263
Min. Negotiated Rate	$198.94
Max. Negotiated Rate	$1,253.25
Rate for Payer: Aetna Commercial	$475.49
Rate for Payer: Aetna Medicare	$835.50
Rate for Payer: BCBS Complete	$208.89
Rate for Payer: BCN Commercial	$524.87
Rate for Payer: Cash Price	$1,336.80
Rate for Payer: Cash Price	$1,336.80
Rate for Payer: Mclaren Medicaid	$198.94
Rate for Payer: Meridian Medicaid	$208.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,253.25
Rate for Payer: Priority Health Choice Medicaid	$198.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$639.52
Rate for Payer: Priority Health Narrow/Tiered Network	$639.52
Rate for Payer: UHC Medicaid	$198.94
Rate for Payer: UHCCP Medicaid	$198.94

PR ERCP W/SPHINCTEROTOMY/PAPILLOTOMY

Professional

Both

$1,739.00

Service Code	HCPCS 43262
Min. Negotiated Rate	$198.52
Max. Negotiated Rate	$1,304.25
Rate for Payer: Aetna Commercial	$475.36
Rate for Payer: Aetna Medicare	$869.50
Rate for Payer: BCBS Complete	$208.45
Rate for Payer: BCN Commercial	$523.88
Rate for Payer: Cash Price	$1,391.20
Rate for Payer: Cash Price	$1,391.20
Rate for Payer: Mclaren Medicaid	$198.52
Rate for Payer: Meridian Medicaid	$208.45
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,304.25
Rate for Payer: Priority Health Choice Medicaid	$198.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$638.32
Rate for Payer: Priority Health Narrow/Tiered Network	$638.32
Rate for Payer: UHC Medicaid	$198.52
Rate for Payer: UHCCP Medicaid	$198.52

PR ESCHAROTOMY EACH ADDITIONAL INCISION

Professional

Both

$447.00

Service Code	HCPCS 16036
Min. Negotiated Rate	$46.86
Max. Negotiated Rate	$335.25
Rate for Payer: Aetna Commercial	$86.23
Rate for Payer: Aetna Medicare	$223.50
Rate for Payer: BCBS Complete	$49.20
Rate for Payer: BCN Commercial	$123.00
Rate for Payer: Cash Price	$357.60
Rate for Payer: Cash Price	$357.60
Rate for Payer: Mclaren Medicaid	$46.86
Rate for Payer: Meridian Medicaid	$49.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$335.25
Rate for Payer: Priority Health Choice Medicaid	$46.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$112.58
Rate for Payer: Priority Health Narrow/Tiered Network	$112.58
Rate for Payer: UHC Medicaid	$46.86
Rate for Payer: UHCCP Medicaid	$46.86

PR ESCHAROTOMY INITIAL INCISION

Professional

Both

$886.00

Service Code	HCPCS 16035
Min. Negotiated Rate	$113.96
Max. Negotiated Rate	$664.50
Rate for Payer: Aetna Commercial	$212.15
Rate for Payer: Aetna Medicare	$443.00
Rate for Payer: BCBS Complete	$119.66
Rate for Payer: BCN Commercial	$291.32
Rate for Payer: Cash Price	$708.80
Rate for Payer: Cash Price	$708.80
Rate for Payer: Mclaren Medicaid	$113.96
Rate for Payer: Meridian Medicaid	$119.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$664.50
Rate for Payer: Priority Health Choice Medicaid	$113.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$266.64
Rate for Payer: Priority Health Narrow/Tiered Network	$266.64
Rate for Payer: UHC Medicaid	$113.96
Rate for Payer: UHCCP Medicaid	$113.96

PR ESOPG/GSTR FUNDOPLASTY W/FUNDIC PATCH

Professional

Both

$3,570.00

Service Code	HCPCS 43325
Min. Negotiated Rate	$811.74
Max. Negotiated Rate	$2,677.50
Rate for Payer: Aetna Commercial	$1,838.43
Rate for Payer: Aetna Medicare	$1,785.00
Rate for Payer: BCBS Complete	$852.33
Rate for Payer: BCN Commercial	$2,041.72
Rate for Payer: Cash Price	$2,856.00
Rate for Payer: Cash Price	$2,856.00
Rate for Payer: Mclaren Medicaid	$811.74
Rate for Payer: Meridian Medicaid	$852.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,677.50
Rate for Payer: Priority Health Choice Medicaid	$811.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,487.71
Rate for Payer: Priority Health Narrow/Tiered Network	$2,487.71
Rate for Payer: UHC Medicaid	$811.74
Rate for Payer: UHCCP Medicaid	$811.74

PR ESOPG/GSTR FUNDOPLASTY W/LAPAROTOMY

Professional

Both

$2,159.00

Service Code	HCPCS 43327
Min. Negotiated Rate	$504.60
Max. Negotiated Rate	$1,619.25
Rate for Payer: Aetna Commercial	$1,105.09
Rate for Payer: Aetna Medicare	$1,079.50
Rate for Payer: BCBS Complete	$529.83
Rate for Payer: BCN Commercial	$1,255.91
Rate for Payer: Cash Price	$1,727.20
Rate for Payer: Cash Price	$1,727.20
Rate for Payer: Mclaren Medicaid	$504.60
Rate for Payer: Meridian Medicaid	$529.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,619.25
Rate for Payer: Priority Health Choice Medicaid	$504.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,530.24
Rate for Payer: Priority Health Narrow/Tiered Network	$1,530.24
Rate for Payer: UHC Medicaid	$504.60
Rate for Payer: UHCCP Medicaid	$504.60

Know your out-of-pocket cost for care.

All Charges