Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR EXPL PO HEMRRG THROMBOSIS/INFCTJ NCK

Professional

Both

$1,558.00

Service Code	HCPCS 35800
Min. Negotiated Rate	$421.74
Max. Negotiated Rate	$1,179.74
Rate for Payer: Aetna Commercial	$965.79
Rate for Payer: Aetna Medicare	$779.00
Rate for Payer: BCBS Complete	$442.83
Rate for Payer: BCN Commercial	$1,097.05
Rate for Payer: Cash Price	$1,246.40
Rate for Payer: Cash Price	$1,246.40
Rate for Payer: Mclaren Medicaid	$421.74
Rate for Payer: Meridian Medicaid	$442.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,168.50
Rate for Payer: Priority Health Choice Medicaid	$421.74
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,179.74
Rate for Payer: Priority Health Narrow/Tiered Network	$1,179.74
Rate for Payer: UHC Medicaid	$421.74
Rate for Payer: UHCCP Medicaid	$421.74

PR EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR

Professional

Both

$1,570.00

Service Code	HCPCS 35860
Min. Negotiated Rate	$494.59
Max. Negotiated Rate	$1,336.12
Rate for Payer: Aetna Commercial	$1,122.58
Rate for Payer: Aetna Medicare	$785.00
Rate for Payer: BCBS Complete	$519.32
Rate for Payer: BCN Commercial	$1,242.47
Rate for Payer: Cash Price	$1,256.00
Rate for Payer: Cash Price	$1,256.00
Rate for Payer: Mclaren Medicaid	$494.59
Rate for Payer: Meridian Medicaid	$519.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,177.50
Rate for Payer: Priority Health Choice Medicaid	$494.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,336.12
Rate for Payer: Priority Health Narrow/Tiered Network	$1,336.12
Rate for Payer: UHC Medicaid	$494.59
Rate for Payer: UHCCP Medicaid	$494.59

PR EXPL RETROPERITONEUM W/WO BX SPX

Professional

Both

$2,093.00

Service Code	HCPCS 49010
Min. Negotiated Rate	$551.24
Max. Negotiated Rate	$1,690.42
Rate for Payer: Aetna Commercial	$1,245.48
Rate for Payer: Aetna Medicare	$1,046.50
Rate for Payer: BCBS Complete	$578.80
Rate for Payer: BCN Commercial	$1,387.37
Rate for Payer: Cash Price	$1,674.40
Rate for Payer: Cash Price	$1,674.40
Rate for Payer: Mclaren Medicaid	$551.24
Rate for Payer: Meridian Medicaid	$578.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,569.75
Rate for Payer: Priority Health Choice Medicaid	$551.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,690.42
Rate for Payer: Priority Health Narrow/Tiered Network	$1,690.42
Rate for Payer: UHC Medicaid	$551.24
Rate for Payer: UHCCP Medicaid	$551.24

PR EXPL RPR & PRESACRAL DRG RECTAL INJURY

Professional

Both

$3,170.00

Service Code	HCPCS 45562
Min. Negotiated Rate	$716.32
Max. Negotiated Rate	$2,377.50
Rate for Payer: Aetna Commercial	$1,516.85
Rate for Payer: Aetna Medicare	$1,585.00
Rate for Payer: BCBS Complete	$752.14
Rate for Payer: BCN Commercial	$1,761.86
Rate for Payer: Cash Price	$2,536.00
Rate for Payer: Cash Price	$2,536.00
Rate for Payer: Mclaren Medicaid	$716.32
Rate for Payer: Meridian Medicaid	$752.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,377.50
Rate for Payer: Priority Health Choice Medicaid	$716.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,146.71
Rate for Payer: Priority Health Narrow/Tiered Network	$2,146.71
Rate for Payer: UHC Medicaid	$716.32
Rate for Payer: UHCCP Medicaid	$716.32

PR EXPL UNDESCENDED TESTIS W/ABDOMINAL EXPL

Professional

Both

$1,338.00

Service Code	HCPCS 54560
Min. Negotiated Rate	$397.46
Max. Negotiated Rate	$1,122.89
Rate for Payer: Aetna Commercial	$882.98
Rate for Payer: Aetna Medicare	$669.00
Rate for Payer: BCBS Complete	$417.33
Rate for Payer: BCN Commercial	$1,030.82
Rate for Payer: Cash Price	$1,070.40
Rate for Payer: Cash Price	$1,070.40
Rate for Payer: Mclaren Medicaid	$397.46
Rate for Payer: Meridian Medicaid	$417.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,003.50
Rate for Payer: Priority Health Choice Medicaid	$397.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,122.89
Rate for Payer: Priority Health Narrow/Tiered Network	$1,122.89
Rate for Payer: UHC Medicaid	$397.46
Rate for Payer: UHCCP Medicaid	$397.46

PR EXPL UNDESCENDED TSTIS INGUN/SCROTAL AREA

Professional

Both

$956.00

Service Code	HCPCS 54550
Min. Negotiated Rate	$287.98
Max. Negotiated Rate	$806.10
Rate for Payer: Aetna Commercial	$630.77
Rate for Payer: Aetna Medicare	$478.00
Rate for Payer: BCBS Complete	$302.38
Rate for Payer: BCN Commercial	$740.00
Rate for Payer: Cash Price	$764.80
Rate for Payer: Cash Price	$764.80
Rate for Payer: Mclaren Medicaid	$287.98
Rate for Payer: Meridian Medicaid	$302.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$717.00
Rate for Payer: Priority Health Choice Medicaid	$287.98
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$806.10
Rate for Payer: Priority Health Narrow/Tiered Network	$806.10
Rate for Payer: UHC Medicaid	$287.98
Rate for Payer: UHCCP Medicaid	$287.98

PR EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST

Professional

Both

$845.00

Service Code	HCPCS 25248
Min. Negotiated Rate	$260.29
Max. Negotiated Rate	$686.70
Rate for Payer: Aetna Commercial	$558.31
Rate for Payer: Aetna Medicare	$422.50
Rate for Payer: BCBS Complete	$273.30
Rate for Payer: BCN Commercial	$642.39
Rate for Payer: Cash Price	$676.00
Rate for Payer: Cash Price	$676.00
Rate for Payer: Mclaren Medicaid	$260.29
Rate for Payer: Meridian Medicaid	$273.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$633.75
Rate for Payer: Priority Health Choice Medicaid	$260.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$686.70
Rate for Payer: Priority Health Narrow/Tiered Network	$686.70
Rate for Payer: UHC Medicaid	$260.29
Rate for Payer: UHCCP Medicaid	$260.29

PR EXPOS PROSTATE ANY APPROACH INSJ RADIOACT SUBST

Professional

Both

$1,723.00

Service Code	HCPCS 55860
Min. Negotiated Rate	$501.19
Max. Negotiated Rate	$1,423.42
Rate for Payer: Aetna Commercial	$1,124.18
Rate for Payer: Aetna Medicare	$861.50
Rate for Payer: BCBS Complete	$526.25
Rate for Payer: BCN Commercial	$1,306.70
Rate for Payer: Cash Price	$1,378.40
Rate for Payer: Cash Price	$1,378.40
Rate for Payer: Mclaren Medicaid	$501.19
Rate for Payer: Meridian Medicaid	$526.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,292.25
Rate for Payer: Priority Health Choice Medicaid	$501.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,423.42
Rate for Payer: Priority Health Narrow/Tiered Network	$1,423.42
Rate for Payer: UHC Medicaid	$501.19
Rate for Payer: UHCCP Medicaid	$501.19

PR EXPRESS FACIAL REFINEMENT OR RELAXATION

Professional

Both

$158.00

Hospital Revenue Code	990
Min. Negotiated Rate	$63.20
Max. Negotiated Rate	$118.50
Rate for Payer: Aetna Medicare	$79.00
Rate for Payer: BCBS Complete	$63.20
Rate for Payer: Cash Price	$126.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$118.50

PR EXT ECG > 48HR TO 21 DAY RCRD W/CONECT INTL RCRD

Professional

Both

$195.00

Service Code	HCPCS 0296T
Min. Negotiated Rate	$78.00
Max. Negotiated Rate	$146.25
Rate for Payer: Aetna Medicare	$97.50
Rate for Payer: BCBS Complete	$78.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$146.25

PR EXT ECG > 48HR TO 21 DAY REVIEW AND INTERPRETATN

Professional

Both

$63.00

Service Code	HCPCS 0298T
Min. Negotiated Rate	$25.20
Max. Negotiated Rate	$47.25
Rate for Payer: Aetna Medicare	$31.50
Rate for Payer: BCBS Complete	$25.20
Rate for Payer: Cash Price	$50.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$47.25

PR EXTENDED ABDOMINOPLASTY

Professional

Both

$7,210.00

Hospital Revenue Code	990
Min. Negotiated Rate	$2,884.00
Max. Negotiated Rate	$5,407.50
Rate for Payer: Aetna Medicare	$3,605.00
Rate for Payer: BCBS Complete	$2,884.00
Rate for Payer: Cash Price	$5,768.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,407.50

PR EXTENDED VISUAL FIELD XM UNI/BI I&R

Professional

Both

$121.00

Service Code	HCPCS 92083
Min. Negotiated Rate	$60.50
Max. Negotiated Rate	$94.12
Rate for Payer: Aetna Commercial	$66.10
Rate for Payer: Aetna Medicare	$60.50
Rate for Payer: BCN Commercial	$94.12
Rate for Payer: Cash Price	$96.80
Rate for Payer: Cash Price	$96.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$90.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$91.34
Rate for Payer: Priority Health Narrow/Tiered Network	$91.34

PR EXTERNAL CEPHALIC VERSION W/WO TOCOLYSIS

Professional

Both

$299.00

Service Code	HCPCS 59412
Min. Negotiated Rate	$90.12
Max. Negotiated Rate	$224.25
Rate for Payer: Aetna Commercial	$112.32
Rate for Payer: Aetna Medicare	$149.50
Rate for Payer: BCBS Complete	$94.63
Rate for Payer: BCN Commercial	$153.87
Rate for Payer: Cash Price	$239.20
Rate for Payer: Cash Price	$239.20
Rate for Payer: Mclaren Medicaid	$90.12
Rate for Payer: Meridian Medicaid	$94.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$224.25
Rate for Payer: Priority Health Choice Medicaid	$90.12
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$145.26
Rate for Payer: Priority Health Narrow/Tiered Network	$145.26
Rate for Payer: UHC Medicaid	$90.12
Rate for Payer: UHCCP Medicaid	$90.12

PR EXTERNAL DRAINAGE PSEUDOCYST OF PANCREAS OPEN

Professional

Both

$3,173.00

Service Code	HCPCS 48510
Min. Negotiated Rate	$665.63
Max. Negotiated Rate	$2,379.75
Rate for Payer: Aetna Commercial	$1,486.24
Rate for Payer: Aetna Medicare	$1,586.50
Rate for Payer: BCBS Complete	$698.91
Rate for Payer: BCN Commercial	$1,650.81
Rate for Payer: Cash Price	$2,538.40
Rate for Payer: Cash Price	$2,538.40
Rate for Payer: Mclaren Medicaid	$665.63
Rate for Payer: Meridian Medicaid	$698.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,379.75
Rate for Payer: Priority Health Choice Medicaid	$665.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,011.41
Rate for Payer: Priority Health Narrow/Tiered Network	$2,011.41
Rate for Payer: UHC Medicaid	$665.63
Rate for Payer: UHCCP Medicaid	$665.63

PR EXTERNAL ECG REC>48HR<7D RECORDING

Professional

Both

$32.00

Service Code	HCPCS 93242
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.91
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCN Commercial	$13.74
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$16.56
Rate for Payer: Priority Health Narrow/Tiered Network	$16.56

PR EXTERNAL ECG REC>48HR<7D REVIEW & INTERPRETATION

Professional

Both

$50.00

Service Code	HCPCS 93244
Min. Negotiated Rate	$14.48
Max. Negotiated Rate	$37.50
Rate for Payer: Aetna Commercial	$32.63
Rate for Payer: Aetna Medicare	$25.00
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: BCN Commercial	$26.70
Rate for Payer: Cash Price	$40.00
Rate for Payer: Cash Price	$40.00
Rate for Payer: Mclaren Medicaid	$14.48
Rate for Payer: Meridian Medicaid	$15.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$37.50
Rate for Payer: Priority Health Choice Medicaid	$14.48
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: UHC Medicaid	$14.48
Rate for Payer: UHCCP Medicaid	$14.48

PR EXTERNAL ECG REC>7D<15D RECORDING

Professional

Both

$32.00

Service Code	HCPCS 93246
Min. Negotiated Rate	$13.74
Max. Negotiated Rate	$24.00
Rate for Payer: Aetna Commercial	$18.91
Rate for Payer: Aetna Medicare	$16.00
Rate for Payer: BCN Commercial	$13.74
Rate for Payer: Cash Price	$25.60
Rate for Payer: Cash Price	$25.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$24.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$16.56
Rate for Payer: Priority Health Narrow/Tiered Network	$16.56

PR EXTERNAL ECG REC>7D<15D REVIEW & INTERPRETATION

Professional

Both

$56.00

Service Code	HCPCS 93248
Min. Negotiated Rate	$15.76
Max. Negotiated Rate	$42.00
Rate for Payer: Aetna Commercial	$35.84
Rate for Payer: Aetna Medicare	$28.00
Rate for Payer: BCBS Complete	$16.55
Rate for Payer: BCN Commercial	$29.45
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cash Price	$44.80
Rate for Payer: Mclaren Medicaid	$15.76
Rate for Payer: Meridian Medicaid	$16.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$42.00
Rate for Payer: Priority Health Choice Medicaid	$15.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$35.50
Rate for Payer: Priority Health Narrow/Tiered Network	$35.50
Rate for Payer: UHC Medicaid	$15.76
Rate for Payer: UHCCP Medicaid	$15.76

PR EXTRACTION

Professional

Both

$186.00

Service Code	HCPCS 10040
Min. Negotiated Rate	$27.05
Max. Negotiated Rate	$139.50
Rate for Payer: Aetna Commercial	$56.49
Rate for Payer: Aetna Medicare	$93.00
Rate for Payer: BCBS Complete	$28.40
Rate for Payer: BCN Commercial	$61.26
Rate for Payer: Cash Price	$148.80
Rate for Payer: Cash Price	$148.80
Rate for Payer: Mclaren Medicaid	$27.05
Rate for Payer: Meridian Medicaid	$28.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$139.50
Rate for Payer: Priority Health Choice Medicaid	$27.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$71.10
Rate for Payer: Priority Health Narrow/Tiered Network	$71.10
Rate for Payer: UHC Medicaid	$27.05
Rate for Payer: UHCCP Medicaid	$27.05

PR EXTRAPLEURAL ENUCLEATION EMPYEMA EMPYEMECTOMY

Professional

Both

$3,312.00

Service Code	HCPCS 32540
Min. Negotiated Rate	$1,041.78
Max. Negotiated Rate	$2,550.16
Rate for Payer: Aetna Commercial	$2,228.79
Rate for Payer: Aetna Medicare	$1,656.00
Rate for Payer: BCBS Complete	$1,093.87
Rate for Payer: BCN Commercial	$2,550.16
Rate for Payer: Cash Price	$2,649.60
Rate for Payer: Cash Price	$2,649.60
Rate for Payer: Mclaren Medicaid	$1,041.78
Rate for Payer: Meridian Medicaid	$1,093.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,484.00
Rate for Payer: Priority Health Choice Medicaid	$1,041.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,401.49
Rate for Payer: Priority Health Narrow/Tiered Network	$2,401.49
Rate for Payer: UHC Medicaid	$1,041.78
Rate for Payer: UHCCP Medicaid	$1,041.78

PR EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>

Professional

Both

$1,240.00

Service Code	HCPCS 26111
Min. Negotiated Rate	$250.70
Max. Negotiated Rate	$930.00
Rate for Payer: Aetna Commercial	$552.97
Rate for Payer: Aetna Medicare	$620.00
Rate for Payer: BCBS Complete	$263.24
Rate for Payer: BCN Commercial	$639.90
Rate for Payer: Cash Price	$992.00
Rate for Payer: Cash Price	$992.00
Rate for Payer: Mclaren Medicaid	$250.70
Rate for Payer: Meridian Medicaid	$263.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$930.00
Rate for Payer: Priority Health Choice Medicaid	$250.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$684.04
Rate for Payer: Priority Health Narrow/Tiered Network	$684.04
Rate for Payer: UHC Medicaid	$250.70
Rate for Payer: UHCCP Medicaid	$250.70

PR EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>

Professional

Both

$1,894.00

Service Code	HCPCS 26113
Min. Negotiated Rate	$326.53
Max. Negotiated Rate	$1,420.50
Rate for Payer: Aetna Commercial	$726.61
Rate for Payer: Aetna Medicare	$947.00
Rate for Payer: BCBS Complete	$342.86
Rate for Payer: BCN Commercial	$842.09
Rate for Payer: Cash Price	$1,515.20
Rate for Payer: Cash Price	$1,515.20
Rate for Payer: Mclaren Medicaid	$326.53
Rate for Payer: Meridian Medicaid	$342.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,420.50
Rate for Payer: Priority Health Choice Medicaid	$326.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$900.17
Rate for Payer: Priority Health Narrow/Tiered Network	$900.17
Rate for Payer: UHC Medicaid	$326.53
Rate for Payer: UHCCP Medicaid	$326.53

PR FAA PHYSICAL

Professional

Both

$137.00

Hospital Revenue Code	983
Min. Negotiated Rate	$54.80
Max. Negotiated Rate	$102.75
Rate for Payer: Aetna Medicare	$68.50
Rate for Payer: BCBS Complete	$54.80
Rate for Payer: Cash Price	$109.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$102.75

PR FACIAL NERVE FUNCTION STUDIES

Professional

Both

$132.00

Service Code	HCPCS 92516
Min. Negotiated Rate	$25.46
Max. Negotiated Rate	$99.00
Rate for Payer: Aetna Commercial	$25.46
Rate for Payer: Aetna Medicare	$66.00
Rate for Payer: BCBS Complete	$52.80
Rate for Payer: BCN Commercial	$33.36
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	$30.77
Rate for Payer: Priority Health Narrow/Tiered Network	$30.77

Know your out-of-pocket cost for care.

All Charges