Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR ORBITOTOMY BONE FLAP/WINDOW LAT RMVL BONE DCMPRN

Professional

Both

$3,696.00

Service Code	HCPCS 67445
Min. Negotiated Rate	$836.45
Max. Negotiated Rate	$2,772.00
Rate for Payer: Aetna Commercial	$1,975.12
Rate for Payer: Aetna Medicare	$1,848.00
Rate for Payer: BCBS Complete	$878.27
Rate for Payer: BCN Commercial	$2,240.91
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Cash Price	$2,956.80
Rate for Payer: Mclaren Medicaid	$836.45
Rate for Payer: Meridian Medicaid	$878.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,772.00
Rate for Payer: Priority Health Choice Medicaid	$836.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,624.87
Rate for Payer: Priority Health Narrow/Tiered Network	$2,624.87
Rate for Payer: UHC Medicaid	$836.45
Rate for Payer: UHCCP Medicaid	$836.45

PR ORBITOTOMY W/O BONE FLAP EXPL W/WO BIOPSY

Professional

Both

$1,712.00

Service Code	HCPCS 67400
Min. Negotiated Rate	$581.06
Max. Negotiated Rate	$1,780.84
Rate for Payer: Aetna Commercial	$1,329.81
Rate for Payer: Aetna Medicare	$856.00
Rate for Payer: BCBS Complete	$610.11
Rate for Payer: BCN Commercial	$1,520.34
Rate for Payer: Cash Price	$1,369.60
Rate for Payer: Cash Price	$1,369.60
Rate for Payer: Mclaren Medicaid	$581.06
Rate for Payer: Meridian Medicaid	$610.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,284.00
Rate for Payer: Priority Health Choice Medicaid	$581.06
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,780.84
Rate for Payer: Priority Health Narrow/Tiered Network	$1,780.84
Rate for Payer: UHC Medicaid	$581.06
Rate for Payer: UHCCP Medicaid	$581.06

PR ORBITOTOMY W/O BONE FLAP W/RMVL FOREIGN BODY

Professional

Both

$2,732.00

Service Code	HCPCS 67413
Min. Negotiated Rate	$540.17
Max. Negotiated Rate	$2,049.00
Rate for Payer: Aetna Commercial	$1,231.62
Rate for Payer: Aetna Medicare	$1,366.00
Rate for Payer: BCBS Complete	$567.18
Rate for Payer: BCN Commercial	$1,412.27
Rate for Payer: Cash Price	$2,185.60
Rate for Payer: Cash Price	$2,185.60
Rate for Payer: Mclaren Medicaid	$540.17
Rate for Payer: Meridian Medicaid	$567.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,049.00
Rate for Payer: Priority Health Choice Medicaid	$540.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,654.26
Rate for Payer: Priority Health Narrow/Tiered Network	$1,654.26
Rate for Payer: UHC Medicaid	$540.17
Rate for Payer: UHCCP Medicaid	$540.17

PR ORCHIECTOMY PARTIAL

Professional

Both

$1,136.00

Service Code	HCPCS 54522
Min. Negotiated Rate	$341.23
Max. Negotiated Rate	$961.24
Rate for Payer: Aetna Commercial	$755.38
Rate for Payer: Aetna Medicare	$568.00
Rate for Payer: BCBS Complete	$358.29
Rate for Payer: BCN Commercial	$882.42
Rate for Payer: Cash Price	$908.80
Rate for Payer: Cash Price	$908.80
Rate for Payer: Mclaren Medicaid	$341.23
Rate for Payer: Meridian Medicaid	$358.29
Rate for Payer: Opus (Opus Packaging Group) HMA	$852.00
Rate for Payer: Priority Health Choice Medicaid	$341.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$961.24
Rate for Payer: Priority Health Narrow/Tiered Network	$961.24
Rate for Payer: UHC Medicaid	$341.23
Rate for Payer: UHCCP Medicaid	$341.23

PR ORCHIECTOMY RADICAL TUMOR INGUINAL APPROACH

Professional

Both

$998.00

Service Code	HCPCS 54530
Min. Negotiated Rate	$299.27
Max. Negotiated Rate	$835.94
Rate for Payer: Aetna Commercial	$650.96
Rate for Payer: Aetna Medicare	$499.00
Rate for Payer: BCBS Complete	$314.23
Rate for Payer: BCN Commercial	$767.39
Rate for Payer: Cash Price	$798.40
Rate for Payer: Cash Price	$798.40
Rate for Payer: Mclaren Medicaid	$299.27
Rate for Payer: Meridian Medicaid	$314.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$748.50
Rate for Payer: Priority Health Choice Medicaid	$299.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$835.94
Rate for Payer: Priority Health Narrow/Tiered Network	$835.94
Rate for Payer: UHC Medicaid	$299.27
Rate for Payer: UHCCP Medicaid	$299.27

PR ORCHIECTOMY RADICAL TUMOR W/ABDOMINAL EXPL

Professional

Both

$1,443.00

Service Code	HCPCS 54535
Min. Negotiated Rate	$429.62
Max. Negotiated Rate	$1,214.58
Rate for Payer: Aetna Commercial	$955.05
Rate for Payer: Aetna Medicare	$721.50
Rate for Payer: BCBS Complete	$451.10
Rate for Payer: BCN Commercial	$1,114.98
Rate for Payer: Cash Price	$1,154.40
Rate for Payer: Cash Price	$1,154.40
Rate for Payer: Mclaren Medicaid	$429.62
Rate for Payer: Meridian Medicaid	$451.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,082.25
Rate for Payer: Priority Health Choice Medicaid	$429.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,214.58
Rate for Payer: Priority Health Narrow/Tiered Network	$1,214.58
Rate for Payer: UHC Medicaid	$429.62
Rate for Payer: UHCCP Medicaid	$429.62

PR ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH

Professional

Both

$633.00

Service Code	HCPCS 54520
Min. Negotiated Rate	$194.90
Max. Negotiated Rate	$539.75
Rate for Payer: Aetna Commercial	$419.79
Rate for Payer: Aetna Medicare	$316.50
Rate for Payer: BCBS Complete	$204.65
Rate for Payer: BCN Commercial	$495.49
Rate for Payer: Cash Price	$506.40
Rate for Payer: Cash Price	$506.40
Rate for Payer: Mclaren Medicaid	$194.90
Rate for Payer: Meridian Medicaid	$204.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$474.75
Rate for Payer: Priority Health Choice Medicaid	$194.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$539.75
Rate for Payer: Priority Health Narrow/Tiered Network	$539.75
Rate for Payer: UHC Medicaid	$194.90
Rate for Payer: UHCCP Medicaid	$194.90

PR ORCHIOPEXY ABDL APPROACH INTRA-ABDOMINAL TESTIS

Professional

Both

$1,544.00

Service Code	HCPCS 54650
Min. Negotiated Rate	$413.22
Max. Negotiated Rate	$1,164.67
Rate for Payer: Aetna Commercial	$913.59
Rate for Payer: Aetna Medicare	$772.00
Rate for Payer: BCBS Complete	$433.88
Rate for Payer: BCN Commercial	$1,069.16
Rate for Payer: Cash Price	$1,235.20
Rate for Payer: Cash Price	$1,235.20
Rate for Payer: Mclaren Medicaid	$413.22
Rate for Payer: Meridian Medicaid	$433.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,158.00
Rate for Payer: Priority Health Choice Medicaid	$413.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,164.67
Rate for Payer: Priority Health Narrow/Tiered Network	$1,164.67
Rate for Payer: UHC Medicaid	$413.22
Rate for Payer: UHCCP Medicaid	$413.22

PR ORCHIOPEXY INGUINAL OR SCROTAL APPROACH

Professional

Both

$1,809.00

Service Code	HCPCS 54640
Min. Negotiated Rate	$251.13
Max. Negotiated Rate	$1,356.75
Rate for Payer: Aetna Commercial	$557.83
Rate for Payer: Aetna Medicare	$904.50
Rate for Payer: BCBS Complete	$263.69
Rate for Payer: BCN Commercial	$650.37
Rate for Payer: Cash Price	$1,447.20
Rate for Payer: Cash Price	$1,447.20
Rate for Payer: Mclaren Medicaid	$251.13
Rate for Payer: Meridian Medicaid	$263.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,356.75
Rate for Payer: Priority Health Choice Medicaid	$251.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$708.46
Rate for Payer: Priority Health Narrow/Tiered Network	$708.46
Rate for Payer: UHC Medicaid	$251.13
Rate for Payer: UHCCP Medicaid	$251.13

PR ORPHENADRINE INJECTION

Professional

Both

$31.00

Service Code	HCPCS J2360
Min. Negotiated Rate	$5.31
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna Commercial	$10.00
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCBS Trust/PPO	$5.31
Rate for Payer: BCN Commercial	$10.25
Rate for Payer: Cash Price	$24.80
Rate for Payer: Cash Price	$24.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$23.25

PR ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS

Professional

Both

$74.00

Service Code	HCPCS 97760
Min. Negotiated Rate	$35.53
Max. Negotiated Rate	$89.48
Rate for Payer: Aetna Commercial	$35.53
Rate for Payer: Aetna Medicare	$37.00
Rate for Payer: BCN Commercial	$70.71
Rate for Payer: Cash Price	$59.20
Rate for Payer: Cash Price	$59.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$55.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.48
Rate for Payer: Priority Health Narrow/Tiered Network	$89.48

PR ORTHOTICS/PROSTH MGMT &/TRAING SBSQ ENCTR 15 MIN

Professional

Both

$109.00

Service Code	HCPCS 97763
Min. Negotiated Rate	$54.50
Max. Negotiated Rate	$89.48
Rate for Payer: Aetna Commercial	$57.97
Rate for Payer: Aetna Medicare	$54.50
Rate for Payer: BCN Commercial	$77.18
Rate for Payer: Cash Price	$87.20
Rate for Payer: Cash Price	$87.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$81.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$89.48
Rate for Payer: Priority Health Narrow/Tiered Network	$89.48

PR ORTHOVISC INJ PER DOSE

Professional

Both

$195.00

Service Code	HCPCS J7324
Min. Negotiated Rate	$97.50
Max. Negotiated Rate	$146.25
Rate for Payer: Aetna Commercial	$134.56
Rate for Payer: Aetna Medicare	$97.50
Rate for Payer: BCBS Trust/PPO	$113.35
Rate for Payer: BCN Commercial	$130.97
Rate for Payer: Cash Price	$156.00
Rate for Payer: Cash Price	$156.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$146.25

PROSTATECTOMY PROCEDURES

Facility

$17,165.52

Service Code	APR-DRG 4854
Min. Negotiated Rate	$16,348.12
Max. Negotiated Rate	$17,165.52
Rate for Payer: BCBS Complete	$17,165.52
Rate for Payer: Mclaren Medicaid	$16,348.12
Rate for Payer: Meridian Medicaid	$17,165.52
Rate for Payer: Priority Health Choice Medicaid	$16,348.12
Rate for Payer: UHC Medicaid	$16,348.12
Rate for Payer: UHCCP Medicaid	$16,348.12

PROSTATECTOMY PROCEDURES

Facility

$7,673.58

Service Code	APR-DRG 4852
Min. Negotiated Rate	$7,308.17
Max. Negotiated Rate	$7,673.58
Rate for Payer: BCBS Complete	$7,673.58
Rate for Payer: Mclaren Medicaid	$7,308.17
Rate for Payer: Meridian Medicaid	$7,673.58
Rate for Payer: Priority Health Choice Medicaid	$7,308.17
Rate for Payer: UHC Medicaid	$7,308.17
Rate for Payer: UHCCP Medicaid	$7,308.17

PROSTATECTOMY PROCEDURES

Facility

$12,190.55

Service Code	APR-DRG 4853
Min. Negotiated Rate	$11,610.05
Max. Negotiated Rate	$12,190.55
Rate for Payer: BCBS Complete	$12,190.55
Rate for Payer: Mclaren Medicaid	$11,610.05
Rate for Payer: Meridian Medicaid	$12,190.55
Rate for Payer: Priority Health Choice Medicaid	$11,610.05
Rate for Payer: UHC Medicaid	$11,610.05
Rate for Payer: UHCCP Medicaid	$11,610.05

PROSTATECTOMY PROCEDURES

Facility

$6,560.91

Service Code	APR-DRG 4851
Min. Negotiated Rate	$6,248.48
Max. Negotiated Rate	$6,560.91
Rate for Payer: BCBS Complete	$6,560.91
Rate for Payer: Mclaren Medicaid	$6,248.48
Rate for Payer: Meridian Medicaid	$6,560.91
Rate for Payer: Priority Health Choice Medicaid	$6,248.48
Rate for Payer: UHC Medicaid	$6,248.48
Rate for Payer: UHCCP Medicaid	$6,248.48

PR OSTC COMPL ALL METAR HEADS W/PRTL PROX PHALANGC

Professional

Both

$1,996.00

Service Code	HCPCS 28114
Min. Negotiated Rate	$508.64
Max. Negotiated Rate	$1,497.00
Rate for Payer: Aetna Commercial	$1,103.34
Rate for Payer: Aetna Medicare	$998.00
Rate for Payer: BCBS Complete	$534.07
Rate for Payer: BCN Commercial	$1,274.84
Rate for Payer: Cash Price	$1,596.80
Rate for Payer: Cash Price	$1,596.80
Rate for Payer: Mclaren Medicaid	$508.64
Rate for Payer: Meridian Medicaid	$534.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,497.00
Rate for Payer: Priority Health Choice Medicaid	$508.64
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,362.76
Rate for Payer: Priority Health Narrow/Tiered Network	$1,362.76
Rate for Payer: UHC Medicaid	$508.64
Rate for Payer: UHCCP Medicaid	$508.64

PR OSTC PRTL EXOSTC/CONDYLC METAR HEAD

Professional

Both

$1,018.00

Service Code	HCPCS 28288
Min. Negotiated Rate	$265.61
Max. Negotiated Rate	$763.50
Rate for Payer: Aetna Commercial	$571.03
Rate for Payer: Aetna Medicare	$509.00
Rate for Payer: BCBS Complete	$278.89
Rate for Payer: BCN Commercial	$661.82
Rate for Payer: Cash Price	$814.40
Rate for Payer: Cash Price	$814.40
Rate for Payer: Mclaren Medicaid	$265.61
Rate for Payer: Meridian Medicaid	$278.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$763.50
Rate for Payer: Priority Health Choice Medicaid	$265.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$707.46
Rate for Payer: Priority Health Narrow/Tiered Network	$707.46
Rate for Payer: UHC Medicaid	$265.61
Rate for Payer: UHCCP Medicaid	$265.61

PR OSTECTOMY CALCANEUS

Professional

Both

$1,060.00

Service Code	HCPCS 28118
Min. Negotiated Rate	$258.80
Max. Negotiated Rate	$795.00
Rate for Payer: Aetna Commercial	$555.17
Rate for Payer: Aetna Medicare	$530.00
Rate for Payer: BCBS Complete	$271.74
Rate for Payer: BCN Commercial	$646.37
Rate for Payer: Cash Price	$848.00
Rate for Payer: Cash Price	$848.00
Rate for Payer: Mclaren Medicaid	$258.80
Rate for Payer: Meridian Medicaid	$271.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$795.00
Rate for Payer: Priority Health Choice Medicaid	$258.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$690.97
Rate for Payer: Priority Health Narrow/Tiered Network	$690.97
Rate for Payer: UHC Medicaid	$258.80
Rate for Payer: UHCCP Medicaid	$258.80

PR OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS

Professional

Both

$1,259.00

Service Code	HCPCS 28119
Min. Negotiated Rate	$220.67
Max. Negotiated Rate	$944.25
Rate for Payer: Aetna Commercial	$477.77
Rate for Payer: Aetna Medicare	$629.50
Rate for Payer: BCBS Complete	$231.70
Rate for Payer: BCN Commercial	$554.25
Rate for Payer: Cash Price	$1,007.20
Rate for Payer: Cash Price	$1,007.20
Rate for Payer: Mclaren Medicaid	$220.67
Rate for Payer: Meridian Medicaid	$231.70
Rate for Payer: Opus (Opus Packaging Group) HMA	$944.25
Rate for Payer: Priority Health Choice Medicaid	$220.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$592.49
Rate for Payer: Priority Health Narrow/Tiered Network	$592.49
Rate for Payer: UHC Medicaid	$220.67
Rate for Payer: UHCCP Medicaid	$220.67

PR OSTECTOMY COMPLETE 1ST METATARSAL HEAD

Professional

Both

$856.00

Service Code	HCPCS 28111
Min. Negotiated Rate	$192.77
Max. Negotiated Rate	$642.00
Rate for Payer: Aetna Commercial	$427.63
Rate for Payer: Aetna Medicare	$428.00
Rate for Payer: BCBS Complete	$202.41
Rate for Payer: BCN Commercial	$483.54
Rate for Payer: Cash Price	$684.80
Rate for Payer: Cash Price	$684.80
Rate for Payer: Mclaren Medicaid	$192.77
Rate for Payer: Meridian Medicaid	$202.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$642.00
Rate for Payer: Priority Health Choice Medicaid	$192.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$516.88
Rate for Payer: Priority Health Narrow/Tiered Network	$516.88
Rate for Payer: UHC Medicaid	$192.77
Rate for Payer: UHCCP Medicaid	$192.77

PR OSTECTOMY COMPLETE 5TH METATARSAL HEAD

Professional

Both

$1,065.00

Service Code	HCPCS 28113
Min. Negotiated Rate	$259.22
Max. Negotiated Rate	$798.75
Rate for Payer: Aetna Commercial	$559.27
Rate for Payer: Aetna Medicare	$532.50
Rate for Payer: BCBS Complete	$272.18
Rate for Payer: BCN Commercial	$651.85
Rate for Payer: Cash Price	$852.00
Rate for Payer: Cash Price	$852.00
Rate for Payer: Mclaren Medicaid	$259.22
Rate for Payer: Meridian Medicaid	$272.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$798.75
Rate for Payer: Priority Health Choice Medicaid	$259.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$696.82
Rate for Payer: Priority Health Narrow/Tiered Network	$696.82
Rate for Payer: UHC Medicaid	$259.22
Rate for Payer: UHCCP Medicaid	$259.22

PR OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4

Professional

Both

$1,000.00

Service Code	HCPCS 28112
Min. Negotiated Rate	$189.36
Max. Negotiated Rate	$750.00
Rate for Payer: Aetna Commercial	$411.03
Rate for Payer: Aetna Medicare	$500.00
Rate for Payer: BCBS Complete	$198.83
Rate for Payer: BCN Commercial	$477.56
Rate for Payer: Cash Price	$800.00
Rate for Payer: Cash Price	$800.00
Rate for Payer: Mclaren Medicaid	$189.36
Rate for Payer: Meridian Medicaid	$198.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$750.00
Rate for Payer: Priority Health Choice Medicaid	$189.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$510.50
Rate for Payer: Priority Health Narrow/Tiered Network	$510.50
Rate for Payer: UHC Medicaid	$189.36
Rate for Payer: UHCCP Medicaid	$189.36

PR OSTECTOMY PRTL 5TH METAR HEAD SPX

Professional

Both

$941.00

Service Code	HCPCS 28110
Min. Negotiated Rate	$179.99
Max. Negotiated Rate	$705.75
Rate for Payer: Aetna Commercial	$382.12
Rate for Payer: Aetna Medicare	$470.50
Rate for Payer: BCBS Complete	$188.99
Rate for Payer: BCN Commercial	$450.17
Rate for Payer: Cash Price	$752.80
Rate for Payer: Cash Price	$752.80
Rate for Payer: Mclaren Medicaid	$179.99
Rate for Payer: Meridian Medicaid	$188.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$705.75
Rate for Payer: Priority Health Choice Medicaid	$179.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$481.22
Rate for Payer: Priority Health Narrow/Tiered Network	$481.22
Rate for Payer: UHC Medicaid	$179.99
Rate for Payer: UHCCP Medicaid	$179.99

Know your out-of-pocket cost for care.

All Charges