Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM

Professional

Both

$1,730.00

Service Code	HCPCS 26116
Min. Negotiated Rate	$315.03
Max. Negotiated Rate	$1,297.50
Rate for Payer: Aetna Commercial	$697.72
Rate for Payer: Aetna Medicare	$865.00
Rate for Payer: BCBS Complete	$330.78
Rate for Payer: BCN Commercial	$809.22
Rate for Payer: Cash Price	$1,384.00
Rate for Payer: Cash Price	$1,384.00
Rate for Payer: Mclaren Medicaid	$315.03
Rate for Payer: Meridian Medicaid	$330.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,297.50
Rate for Payer: Priority Health Choice Medicaid	$315.03
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$865.03
Rate for Payer: Priority Health Narrow/Tiered Network	$865.03
Rate for Payer: UHC Medicaid	$315.03
Rate for Payer: UHCCP Medicaid	$315.03

PR EXC URACHAL CYST/SINUS W/WO UMBILICAL HERNIA RPR

Professional

Both

$5,703.00

Service Code	HCPCS 51500
Min. Negotiated Rate	$369.98
Max. Negotiated Rate	$4,277.25
Rate for Payer: Aetna Commercial	$817.18
Rate for Payer: Aetna Medicare	$2,851.50
Rate for Payer: BCBS Complete	$388.48
Rate for Payer: BCN Commercial	$958.11
Rate for Payer: Cash Price	$4,562.40
Rate for Payer: Cash Price	$4,562.40
Rate for Payer: Mclaren Medicaid	$369.98
Rate for Payer: Meridian Medicaid	$388.48
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,277.25
Rate for Payer: Priority Health Choice Medicaid	$369.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,043.70
Rate for Payer: Priority Health Narrow/Tiered Network	$1,043.70
Rate for Payer: UHC Medicaid	$369.98
Rate for Payer: UHCCP Medicaid	$369.98

PR EXC URETHRAL DIVERTICULUM SPX FEMALE

Professional

Both

$1,183.00

Service Code	HCPCS 53230
Min. Negotiated Rate	$353.37
Max. Negotiated Rate	$998.14
Rate for Payer: Aetna Commercial	$782.17
Rate for Payer: Aetna Medicare	$591.50
Rate for Payer: BCBS Complete	$371.04
Rate for Payer: BCN Commercial	$916.28
Rate for Payer: Cash Price	$946.40
Rate for Payer: Cash Price	$946.40
Rate for Payer: Mclaren Medicaid	$353.37
Rate for Payer: Meridian Medicaid	$371.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$887.25
Rate for Payer: Priority Health Choice Medicaid	$353.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$998.14
Rate for Payer: Priority Health Narrow/Tiered Network	$998.14
Rate for Payer: UHC Medicaid	$353.37
Rate for Payer: UHCCP Medicaid	$353.37

PR EXC VARICOCELE/LIGATION SPERMATIC VEINS ABDL

Professional

Both

$2,207.00

Service Code	HCPCS 55535
Min. Negotiated Rate	$253.68
Max. Negotiated Rate	$1,655.25
Rate for Payer: Aetna Commercial	$551.00
Rate for Payer: Aetna Medicare	$1,103.50
Rate for Payer: BCBS Complete	$266.36
Rate for Payer: BCN Commercial	$648.87
Rate for Payer: Cash Price	$1,765.60
Rate for Payer: Cash Price	$1,765.60
Rate for Payer: Mclaren Medicaid	$253.68
Rate for Payer: Meridian Medicaid	$266.36
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,655.25
Rate for Payer: Priority Health Choice Medicaid	$253.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$706.82
Rate for Payer: Priority Health Narrow/Tiered Network	$706.82
Rate for Payer: UHC Medicaid	$253.68
Rate for Payer: UHCCP Medicaid	$253.68

PR EXC VARICOCELE/LIGATION SPERMATIC VEINS SPX

Professional

Both

$675.00

Service Code	HCPCS 55530
Min. Negotiated Rate	$208.31
Max. Negotiated Rate	$579.35
Rate for Payer: Aetna Commercial	$450.95
Rate for Payer: Aetna Medicare	$337.50
Rate for Payer: BCBS Complete	$218.73
Rate for Payer: BCN Commercial	$531.85
Rate for Payer: Cash Price	$540.00
Rate for Payer: Cash Price	$540.00
Rate for Payer: Mclaren Medicaid	$208.31
Rate for Payer: Meridian Medicaid	$218.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$506.25
Rate for Payer: Priority Health Choice Medicaid	$208.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$579.35
Rate for Payer: Priority Health Narrow/Tiered Network	$579.35
Rate for Payer: UHC Medicaid	$208.31
Rate for Payer: UHCCP Medicaid	$208.31

PR EXC VARICOCELE/LIGATION VEINS W/HERNIA RPR

Professional

Both

$816.00

Service Code	HCPCS 55540
Min. Negotiated Rate	$344.42
Max. Negotiated Rate	$917.84
Rate for Payer: Aetna Commercial	$718.72
Rate for Payer: Aetna Medicare	$408.00
Rate for Payer: BCBS Complete	$361.64
Rate for Payer: BCN Commercial	$842.58
Rate for Payer: Cash Price	$652.80
Rate for Payer: Cash Price	$652.80
Rate for Payer: Mclaren Medicaid	$344.42
Rate for Payer: Meridian Medicaid	$361.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$612.00
Rate for Payer: Priority Health Choice Medicaid	$344.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$917.84
Rate for Payer: Priority Health Narrow/Tiered Network	$917.84
Rate for Payer: UHC Medicaid	$344.42
Rate for Payer: UHCCP Medicaid	$344.42

PR EXC XTRPARENCHYMAL LESION TESTIS

Professional

Both

$1,145.00

Service Code	HCPCS 54512
Min. Negotiated Rate	$312.68
Max. Negotiated Rate	$882.59
Rate for Payer: Aetna Commercial	$692.89
Rate for Payer: Aetna Medicare	$572.50
Rate for Payer: BCBS Complete	$328.31
Rate for Payer: BCN Commercial	$810.21
Rate for Payer: Cash Price	$916.00
Rate for Payer: Cash Price	$916.00
Rate for Payer: Mclaren Medicaid	$312.68
Rate for Payer: Meridian Medicaid	$328.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$858.75
Rate for Payer: Priority Health Choice Medicaid	$312.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$882.59
Rate for Payer: Priority Health Narrow/Tiered Network	$882.59
Rate for Payer: UHC Medicaid	$312.68
Rate for Payer: UHCCP Medicaid	$312.68

PR EXERCISE EQUIPMENT

Professional

Both

$5.00

Service Code	HCPCS A9300
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR EXISION OF SUBLINGUAL GLAND

Professional

Both

$790.00

Service Code	HCPCS 42450
Min. Negotiated Rate	$210.02
Max. Negotiated Rate	$673.51
Rate for Payer: Aetna Commercial	$478.95
Rate for Payer: Aetna Medicare	$395.00
Rate for Payer: BCBS Complete	$220.52
Rate for Payer: BCN Commercial	$552.76
Rate for Payer: Cash Price	$632.00
Rate for Payer: Cash Price	$632.00
Rate for Payer: Mclaren Medicaid	$210.02
Rate for Payer: Meridian Medicaid	$220.52
Rate for Payer: Opus (Opus Packaging Group) HMA	$592.50
Rate for Payer: Priority Health Choice Medicaid	$210.02
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$673.51
Rate for Payer: Priority Health Narrow/Tiered Network	$673.51
Rate for Payer: UHC Medicaid	$210.02
Rate for Payer: UHCCP Medicaid	$210.02

PR EXPL CONGENITAL ATRESIA BILE DUCTS

Professional

Both

$2,989.00

Service Code	HCPCS 47700
Min. Negotiated Rate	$643.05
Max. Negotiated Rate	$2,241.75
Rate for Payer: Aetna Commercial	$1,432.99
Rate for Payer: Aetna Medicare	$1,494.50
Rate for Payer: BCBS Complete	$675.20
Rate for Payer: BCN Commercial	$1,594.03
Rate for Payer: Cash Price	$2,391.20
Rate for Payer: Cash Price	$2,391.20
Rate for Payer: Mclaren Medicaid	$643.05
Rate for Payer: Meridian Medicaid	$675.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,241.75
Rate for Payer: Priority Health Choice Medicaid	$643.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,942.23
Rate for Payer: Priority Health Narrow/Tiered Network	$1,942.23
Rate for Payer: UHC Medicaid	$643.05
Rate for Payer: UHCCP Medicaid	$643.05

PR EXPLORATION EPIDIDYMIS W/WO BIOPSY

Professional

Both

$693.00

Service Code	HCPCS 54865
Min. Negotiated Rate	$214.28
Max. Negotiated Rate	$593.99
Rate for Payer: Aetna Commercial	$459.23
Rate for Payer: Aetna Medicare	$346.50
Rate for Payer: BCBS Complete	$224.99
Rate for Payer: BCN Commercial	$545.29
Rate for Payer: Cash Price	$554.40
Rate for Payer: Cash Price	$554.40
Rate for Payer: Mclaren Medicaid	$214.28
Rate for Payer: Meridian Medicaid	$224.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$519.75
Rate for Payer: Priority Health Choice Medicaid	$214.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$593.99
Rate for Payer: Priority Health Narrow/Tiered Network	$593.99
Rate for Payer: UHC Medicaid	$214.28
Rate for Payer: UHCCP Medicaid	$214.28

PR EXPLORATION, FEMORAL ARTERY

Professional

Both

$1,610.00

Service Code	HCPCS 35721
Min. Negotiated Rate	$644.00
Max. Negotiated Rate	$1,207.50
Rate for Payer: Aetna Medicare	$805.00
Rate for Payer: BCBS Complete	$644.00
Rate for Payer: Cash Price	$1,288.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,207.50

PR EXPLORATION N/FLWD SURG LOWER EXTREMITY ARTERY

Professional

Both

$897.00

Service Code	HCPCS 35703
Min. Negotiated Rate	$242.18
Max. Negotiated Rate	$672.75
Rate for Payer: Aetna Commercial	$562.28
Rate for Payer: Aetna Medicare	$448.50
Rate for Payer: BCBS Complete	$254.29
Rate for Payer: BCN Commercial	$615.50
Rate for Payer: Cash Price	$717.60
Rate for Payer: Cash Price	$717.60
Rate for Payer: Mclaren Medicaid	$242.18
Rate for Payer: Meridian Medicaid	$254.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$672.75
Rate for Payer: Priority Health Choice Medicaid	$242.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$661.89
Rate for Payer: Priority Health Narrow/Tiered Network	$661.89
Rate for Payer: UHC Medicaid	$242.18
Rate for Payer: UHCCP Medicaid	$242.18

PR EXPLORATION N/FLWD SURG NECK ARTERY

Professional

Both

$935.00

Service Code	HCPCS 35701
Min. Negotiated Rate	$244.52
Max. Negotiated Rate	$702.06
Rate for Payer: Aetna Commercial	$586.02
Rate for Payer: Aetna Medicare	$467.50
Rate for Payer: BCBS Complete	$256.75
Rate for Payer: BCN Commercial	$652.85
Rate for Payer: Cash Price	$748.00
Rate for Payer: Cash Price	$748.00
Rate for Payer: Mclaren Medicaid	$244.52
Rate for Payer: Meridian Medicaid	$256.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$701.25
Rate for Payer: Priority Health Choice Medicaid	$244.52
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$702.06
Rate for Payer: Priority Health Narrow/Tiered Network	$702.06
Rate for Payer: UHC Medicaid	$244.52
Rate for Payer: UHCCP Medicaid	$244.52

PR EXPLORATION N/FLWD SURG UPPER EXTREMITY ARTERY

Professional

Both

$932.00

Service Code	HCPCS 35702
Min. Negotiated Rate	$237.28
Max. Negotiated Rate	$699.00
Rate for Payer: Aetna Commercial	$551.92
Rate for Payer: Aetna Medicare	$466.00
Rate for Payer: BCBS Complete	$249.14
Rate for Payer: BCN Commercial	$606.54
Rate for Payer: Cash Price	$745.60
Rate for Payer: Cash Price	$745.60
Rate for Payer: Mclaren Medicaid	$237.28
Rate for Payer: Meridian Medicaid	$249.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$699.00
Rate for Payer: Priority Health Choice Medicaid	$237.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$652.26
Rate for Payer: Priority Health Narrow/Tiered Network	$652.26
Rate for Payer: UHC Medicaid	$237.28
Rate for Payer: UHCCP Medicaid	$237.28

PR EXPLORATION OF ARTERY/VEIN

Professional

Both

$1,347.00

Service Code	HCPCS 35761
Min. Negotiated Rate	$538.80
Max. Negotiated Rate	$1,010.25
Rate for Payer: Aetna Medicare	$673.50
Rate for Payer: BCBS Complete	$538.80
Rate for Payer: Cash Price	$1,077.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,010.25

PR EXPLORATION PENETRATING WOUND SPX CHEST

Professional

Both

$1,182.00

Service Code	HCPCS 20101
Min. Negotiated Rate	$128.65
Max. Negotiated Rate	$886.50
Rate for Payer: Aetna Commercial	$282.53
Rate for Payer: Aetna Medicare	$591.00
Rate for Payer: BCBS Complete	$135.08
Rate for Payer: BCN Commercial	$315.23
Rate for Payer: Cash Price	$945.60
Rate for Payer: Cash Price	$945.60
Rate for Payer: Mclaren Medicaid	$128.65
Rate for Payer: Meridian Medicaid	$135.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$886.50
Rate for Payer: Priority Health Choice Medicaid	$128.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$336.96
Rate for Payer: Priority Health Narrow/Tiered Network	$336.96
Rate for Payer: UHC Medicaid	$128.65
Rate for Payer: UHCCP Medicaid	$128.65

PR EXPLORATION PENETRATING WOUND SPX EXTREMITY

Professional

Both

$1,872.00

Service Code	HCPCS 20103
Min. Negotiated Rate	$201.92
Max. Negotiated Rate	$1,404.00
Rate for Payer: Aetna Commercial	$461.03
Rate for Payer: Aetna Medicare	$936.00
Rate for Payer: BCBS Complete	$212.02
Rate for Payer: BCN Commercial	$518.90
Rate for Payer: Cash Price	$1,497.60
Rate for Payer: Cash Price	$1,497.60
Rate for Payer: Mclaren Medicaid	$201.92
Rate for Payer: Meridian Medicaid	$212.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,404.00
Rate for Payer: Priority Health Choice Medicaid	$201.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$554.68
Rate for Payer: Priority Health Narrow/Tiered Network	$554.68
Rate for Payer: UHC Medicaid	$201.92
Rate for Payer: UHCCP Medicaid	$201.92

PR EXPLORATION PENETRATING WOUND SPX NECK

Professional

Both

$1,997.00

Service Code	HCPCS 20100
Min. Negotiated Rate	$348.04
Max. Negotiated Rate	$1,497.75
Rate for Payer: Aetna Commercial	$810.47
Rate for Payer: Aetna Medicare	$998.50
Rate for Payer: BCBS Complete	$365.44
Rate for Payer: BCN Commercial	$899.85
Rate for Payer: Cash Price	$1,597.60
Rate for Payer: Cash Price	$1,597.60
Rate for Payer: Mclaren Medicaid	$348.04
Rate for Payer: Meridian Medicaid	$365.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,497.75
Rate for Payer: Priority Health Choice Medicaid	$348.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$961.91
Rate for Payer: Priority Health Narrow/Tiered Network	$961.91
Rate for Payer: UHC Medicaid	$348.04
Rate for Payer: UHCCP Medicaid	$348.04

PR EXPLORATION POPLITEAL ARTERY

Professional

Both

$1,111.00

Service Code	HCPCS 35741
Min. Negotiated Rate	$444.40
Max. Negotiated Rate	$833.25
Rate for Payer: Aetna Medicare	$555.50
Rate for Payer: BCBS Complete	$444.40
Rate for Payer: Cash Price	$888.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$833.25

PR EXPLORATION SPINAL FUSION

Professional

Both

$5,330.00

Service Code	HCPCS 22830
Min. Negotiated Rate	$504.81
Max. Negotiated Rate	$3,997.50
Rate for Payer: Aetna Commercial	$1,097.19
Rate for Payer: Aetna Medicare	$2,665.00
Rate for Payer: BCBS Complete	$530.05
Rate for Payer: BCN Commercial	$1,255.41
Rate for Payer: Cash Price	$4,264.00
Rate for Payer: Cash Price	$4,264.00
Rate for Payer: Mclaren Medicaid	$504.81
Rate for Payer: Meridian Medicaid	$530.05
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,997.50
Rate for Payer: Priority Health Choice Medicaid	$504.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,342.01
Rate for Payer: Priority Health Narrow/Tiered Network	$1,342.01
Rate for Payer: UHC Medicaid	$504.81
Rate for Payer: UHCCP Medicaid	$504.81

PR EXPLORATORY LAPAROTOMY CELIOTOMY W/WO BIOPSY SPX

Professional

Both

$2,424.00

Service Code	HCPCS 49000
Min. Negotiated Rate	$464.77
Max. Negotiated Rate	$1,818.00
Rate for Payer: Aetna Commercial	$1,035.31
Rate for Payer: Aetna Medicare	$1,212.00
Rate for Payer: BCBS Complete	$488.01
Rate for Payer: BCN Commercial	$1,158.31
Rate for Payer: Cash Price	$1,939.20
Rate for Payer: Cash Price	$1,939.20
Rate for Payer: Mclaren Medicaid	$464.77
Rate for Payer: Meridian Medicaid	$488.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,818.00
Rate for Payer: Priority Health Choice Medicaid	$464.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,411.32
Rate for Payer: Priority Health Narrow/Tiered Network	$1,411.32
Rate for Payer: UHC Medicaid	$464.77
Rate for Payer: UHCCP Medicaid	$464.77

PR EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK

Professional

Both

$2,095.00

Service Code	HCPCS 20102
Min. Negotiated Rate	$156.34
Max. Negotiated Rate	$1,571.25
Rate for Payer: Aetna Commercial	$342.28
Rate for Payer: Aetna Medicare	$1,047.50
Rate for Payer: BCBS Complete	$164.16
Rate for Payer: BCN Commercial	$385.44
Rate for Payer: Cash Price	$1,676.00
Rate for Payer: Cash Price	$1,676.00
Rate for Payer: Mclaren Medicaid	$156.34
Rate for Payer: Meridian Medicaid	$164.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,571.25
Rate for Payer: Priority Health Choice Medicaid	$156.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$412.02
Rate for Payer: Priority Health Narrow/Tiered Network	$412.02
Rate for Payer: UHC Medicaid	$156.34
Rate for Payer: UHCCP Medicaid	$156.34

PR EXPL PO HEMRRG THROMBOSIS/INFCTJ ABD

Professional

Both

$2,424.00

Service Code	HCPCS 35840
Min. Negotiated Rate	$716.32
Max. Negotiated Rate	$1,954.64
Rate for Payer: Aetna Commercial	$1,617.90
Rate for Payer: Aetna Medicare	$1,212.00
Rate for Payer: BCBS Complete	$752.14
Rate for Payer: BCN Commercial	$1,817.63
Rate for Payer: Cash Price	$1,939.20
Rate for Payer: Cash Price	$1,939.20
Rate for Payer: Mclaren Medicaid	$716.32
Rate for Payer: Meridian Medicaid	$752.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,818.00
Rate for Payer: Priority Health Choice Medicaid	$716.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,954.64
Rate for Payer: Priority Health Narrow/Tiered Network	$1,954.64
Rate for Payer: UHC Medicaid	$716.32
Rate for Payer: UHCCP Medicaid	$716.32

PR EXPL PO HEMRRG THROMBOSIS/INFCTJ CH

Professional

Both

$5,759.00

Service Code	HCPCS 35820
Min. Negotiated Rate	$1,193.01
Max. Negotiated Rate	$4,319.25
Rate for Payer: Aetna Commercial	$2,700.88
Rate for Payer: Aetna Medicare	$2,879.50
Rate for Payer: BCBS Complete	$1,252.66
Rate for Payer: BCN Commercial	$2,962.49
Rate for Payer: Cash Price	$4,607.20
Rate for Payer: Cash Price	$4,607.20
Rate for Payer: Mclaren Medicaid	$1,193.01
Rate for Payer: Meridian Medicaid	$1,252.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,319.25
Rate for Payer: Priority Health Choice Medicaid	$1,193.01
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,185.78
Rate for Payer: Priority Health Narrow/Tiered Network	$3,185.78
Rate for Payer: UHC Medicaid	$1,193.01
Rate for Payer: UHCCP Medicaid	$1,193.01

Know your out-of-pocket cost for care.

All Charges