Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR PELVIC FIXATION OTHER THAN SACRUM

Professional

Both

$1,845.00

Service Code	HCPCS 22848
Min. Negotiated Rate	$202.56
Max. Negotiated Rate	$1,383.75
Rate for Payer: Aetna Commercial	$484.23
Rate for Payer: Aetna Medicare	$922.50
Rate for Payer: BCBS Complete	$212.69
Rate for Payer: BCN Commercial	$590.28
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Cash Price	$1,476.00
Rate for Payer: Mclaren Medicaid	$202.56
Rate for Payer: Meridian Medicaid	$212.69
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,383.75
Rate for Payer: Priority Health Choice Medicaid	$202.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$574.38
Rate for Payer: Priority Health Narrow/Tiered Network	$574.38
Rate for Payer: UHC Medicaid	$202.56
Rate for Payer: UHCCP Medicaid	$202.56

PR PELVIC RING FRACTURE UNI/BIL

Professional

Both

$3,267.00

Service Code	HCPCS G0413
Min. Negotiated Rate	$623.66
Max. Negotiated Rate	$2,450.25
Rate for Payer: Aetna Commercial	$1,062.63
Rate for Payer: Aetna Medicare	$1,633.50
Rate for Payer: BCBS Complete	$654.84
Rate for Payer: BCN Commercial	$1,611.97
Rate for Payer: Cash Price	$2,613.60
Rate for Payer: Cash Price	$2,613.60
Rate for Payer: Mclaren Medicaid	$623.66
Rate for Payer: Meridian Medicaid	$654.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,450.25
Rate for Payer: Priority Health Choice Medicaid	$623.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,723.15
Rate for Payer: Priority Health Narrow/Tiered Network	$1,723.15
Rate for Payer: UHC Medicaid	$623.66
Rate for Payer: UHCCP Medicaid	$623.66

PR PELVIC RING FX TREAT INT FIX

Professional

Both

$3,228.00

Service Code	HCPCS G0414
Min. Negotiated Rate	$589.37
Max. Negotiated Rate	$2,421.00
Rate for Payer: Aetna Commercial	$1,004.21
Rate for Payer: Aetna Medicare	$1,614.00
Rate for Payer: BCBS Complete	$618.84
Rate for Payer: BCN Commercial	$1,522.83
Rate for Payer: Cash Price	$2,582.40
Rate for Payer: Cash Price	$2,582.40
Rate for Payer: Mclaren Medicaid	$589.37
Rate for Payer: Meridian Medicaid	$618.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,421.00
Rate for Payer: Priority Health Choice Medicaid	$589.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,627.86
Rate for Payer: Priority Health Narrow/Tiered Network	$1,627.86
Rate for Payer: UHC Medicaid	$589.37
Rate for Payer: UHCCP Medicaid	$589.37

PR PENG BENZATHINE/PROCAINE INJ

Professional

Both

$6.00

Service Code	HCPCS J0558
Min. Negotiated Rate	$3.00
Max. Negotiated Rate	$19.89
Rate for Payer: Aetna Commercial	$18.11
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Trust/PPO	$19.89
Rate for Payer: BCN Commercial	$17.69
Rate for Payer: Cash Price	$4.80
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50

PR PENICILLIN G BENZATHINE INJ

Professional

Both

$10.00

Service Code	HCPCS J0561
Min. Negotiated Rate	$5.00
Max. Negotiated Rate	$33.85
Rate for Payer: Aetna Commercial	$22.38
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Trust/PPO	$33.85
Rate for Payer: BCN Commercial	$27.98
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50

PR PENILE PLETHYSMOGRAPHY

Professional

Both

$194.00

Service Code	HCPCS 54240
Min. Negotiated Rate	$97.00
Max. Negotiated Rate	$177.38
Rate for Payer: Aetna Commercial	$131.41
Rate for Payer: Aetna Medicare	$97.00
Rate for Payer: BCN Commercial	$162.84
Rate for Payer: Cash Price	$155.20
Rate for Payer: Cash Price	$155.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$145.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$177.38
Rate for Payer: Priority Health Narrow/Tiered Network	$177.38

PR PENIS CORRJ CHORDEE/1ST STAGE HYPOSPADIAS RPR

Professional

Both

$5,356.00

Service Code	HCPCS 54304
Min. Negotiated Rate	$431.11
Max. Negotiated Rate	$4,017.00
Rate for Payer: Aetna Commercial	$960.40
Rate for Payer: Aetna Medicare	$2,678.00
Rate for Payer: BCBS Complete	$452.67
Rate for Payer: BCN Commercial	$1,119.46
Rate for Payer: Cash Price	$4,284.80
Rate for Payer: Cash Price	$4,284.80
Rate for Payer: Mclaren Medicaid	$431.11
Rate for Payer: Meridian Medicaid	$452.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,017.00
Rate for Payer: Priority Health Choice Medicaid	$431.11
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,219.46
Rate for Payer: Priority Health Narrow/Tiered Network	$1,219.46
Rate for Payer: UHC Medicaid	$431.11
Rate for Payer: UHCCP Medicaid	$431.11

PR PENIS STRAIGHTENING CHORDEE

Professional

Both

$1,376.00

Service Code	HCPCS 54300
Min. Negotiated Rate	$375.31
Max. Negotiated Rate	$1,055.09
Rate for Payer: Aetna Commercial	$828.72
Rate for Payer: Aetna Medicare	$688.00
Rate for Payer: BCBS Complete	$394.08
Rate for Payer: BCN Commercial	$968.58
Rate for Payer: Cash Price	$1,100.80
Rate for Payer: Cash Price	$1,100.80
Rate for Payer: Mclaren Medicaid	$375.31
Rate for Payer: Meridian Medicaid	$394.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,032.00
Rate for Payer: Priority Health Choice Medicaid	$375.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,055.09
Rate for Payer: Priority Health Narrow/Tiered Network	$1,055.09
Rate for Payer: UHC Medicaid	$375.31
Rate for Payer: UHCCP Medicaid	$375.31

PR PENTAMIDINE AERSL INHALATION PNEUMOCYSTIS/PROPH

Professional

Both

$196.00

Service Code	HCPCS 94642
Min. Negotiated Rate	$18.04
Max. Negotiated Rate	$190.17
Rate for Payer: Aetna Commercial	$46.35
Rate for Payer: Aetna Medicare	$98.00
Rate for Payer: BCBS Complete	$18.94
Rate for Payer: BCN Commercial	$190.17
Rate for Payer: Cash Price	$156.80
Rate for Payer: Cash Price	$156.80
Rate for Payer: Mclaren Medicaid	$18.04
Rate for Payer: Meridian Medicaid	$18.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$147.00
Rate for Payer: Priority Health Choice Medicaid	$18.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$59.25
Rate for Payer: Priority Health Narrow/Tiered Network	$59.25
Rate for Payer: UHC Medicaid	$18.04
Rate for Payer: UHCCP Medicaid	$18.04

PR PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY

Professional

Both

$240.00

Service Code	HCPCS 92972
Min. Negotiated Rate	$77.96
Max. Negotiated Rate	$214.63
Rate for Payer: Aetna Commercial	$186.94
Rate for Payer: Aetna Medicare	$120.00
Rate for Payer: BCBS Complete	$81.86
Rate for Payer: BCN Commercial	$214.63
Rate for Payer: Cash Price	$192.00
Rate for Payer: Cash Price	$192.00
Rate for Payer: Mclaren Medicaid	$77.96
Rate for Payer: Meridian Medicaid	$81.86
Rate for Payer: Opus (Opus Packaging Group) HMA	$180.00
Rate for Payer: Priority Health Choice Medicaid	$77.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$203.99
Rate for Payer: Priority Health Narrow/Tiered Network	$203.99
Rate for Payer: UHC Medicaid	$77.96
Rate for Payer: UHCCP Medicaid	$77.96

PR PERCUTANEOUS TX MALAR AREA FRACTURE

Professional

Both

$943.00

Service Code	HCPCS 21355
Min. Negotiated Rate	$187.65
Max. Negotiated Rate	$707.25
Rate for Payer: Aetna Commercial	$427.46
Rate for Payer: Aetna Medicare	$471.50
Rate for Payer: BCBS Complete	$197.03
Rate for Payer: BCN Commercial	$497.49
Rate for Payer: Cash Price	$754.40
Rate for Payer: Cash Price	$754.40
Rate for Payer: Mclaren Medicaid	$187.65
Rate for Payer: Meridian Medicaid	$197.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$707.25
Rate for Payer: Priority Health Choice Medicaid	$187.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$531.79
Rate for Payer: Priority Health Narrow/Tiered Network	$531.79
Rate for Payer: UHC Medicaid	$187.65
Rate for Payer: UHCCP Medicaid	$187.65

PR PERCUTANEOUS VERTEBROPLASTY EA ADDL THRC/LMBR

Professional

Both

$741.00

Service Code	HCPCS 22522
Min. Negotiated Rate	$296.40
Max. Negotiated Rate	$555.75
Rate for Payer: Aetna Medicare	$370.50
Rate for Payer: BCBS Complete	$296.40
Rate for Payer: Cash Price	$592.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$555.75

PR PERCUTANEOUS VERTEBROPLASTY LUMBAR W/WO BNE BX

Professional

Both

$5,916.00

Service Code	HCPCS 22521
Min. Negotiated Rate	$2,366.40
Max. Negotiated Rate	$4,437.00
Rate for Payer: Aetna Medicare	$2,958.00
Rate for Payer: BCBS Complete	$2,366.40
Rate for Payer: Cash Price	$4,732.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,437.00

PR PERCUTANEOUS VERTEBROPLSTY THORACIC W/WO BONE BX

Professional

Both

$8,076.00

Service Code	HCPCS 22520
Min. Negotiated Rate	$3,230.40
Max. Negotiated Rate	$6,057.00
Rate for Payer: Aetna Medicare	$4,038.00
Rate for Payer: BCBS Complete	$3,230.40
Rate for Payer: Cash Price	$6,460.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,057.00

PR PERCUT DILATN RENAL TRACT

Professional

Both

$357.00

Service Code	HCPCS 50395
Min. Negotiated Rate	$142.80
Max. Negotiated Rate	$267.75
Rate for Payer: Aetna Medicare	$178.50
Rate for Payer: BCBS Complete	$142.80
Rate for Payer: Cash Price	$285.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$267.75

PR PERCUT INSERT KIDNEY CATH/DRAIN

Professional

Both

$376.00

Service Code	HCPCS 50392
Min. Negotiated Rate	$150.40
Max. Negotiated Rate	$282.00
Rate for Payer: Aetna Medicare	$188.00
Rate for Payer: BCBS Complete	$150.40
Rate for Payer: Cash Price	$300.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$282.00

PR PERC VERTEB AUGMENT/ KYPHOPLAST, EA ADD

Professional

Both

$520.00

Service Code	HCPCS 22525
Min. Negotiated Rate	$208.00
Max. Negotiated Rate	$390.00
Rate for Payer: Aetna Medicare	$260.00
Rate for Payer: BCBS Complete	$208.00
Rate for Payer: Cash Price	$416.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$390.00

PR PERC VERTEB AUGMENT/ KYPHOPLAST, LUMBAR

Professional

Both

$1,107.00

Service Code	HCPCS 22524
Min. Negotiated Rate	$442.80
Max. Negotiated Rate	$830.25
Rate for Payer: Aetna Medicare	$553.50
Rate for Payer: BCBS Complete	$442.80
Rate for Payer: Cash Price	$885.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$830.25

PR PERC VERTEB AUGMENT/ KYPHOPLAST, THOR

Professional

Both

$1,175.00

Service Code	HCPCS 22523
Min. Negotiated Rate	$470.00
Max. Negotiated Rate	$881.25
Rate for Payer: Aetna Medicare	$587.50
Rate for Payer: BCBS Complete	$470.00
Rate for Payer: Cash Price	$940.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$881.25

PR PEREYRA PX W/ANTERIOR COLPORRHAPHY

Professional

Both

$2,279.00

Service Code	HCPCS 57289
Min. Negotiated Rate	$446.24
Max. Negotiated Rate	$1,709.25
Rate for Payer: Aetna Commercial	$944.93
Rate for Payer: Aetna Medicare	$1,139.50
Rate for Payer: BCBS Complete	$468.55
Rate for Payer: BCN Commercial	$1,188.18
Rate for Payer: Cash Price	$1,823.20
Rate for Payer: Cash Price	$1,823.20
Rate for Payer: Mclaren Medicaid	$446.24
Rate for Payer: Meridian Medicaid	$468.55
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,709.25
Rate for Payer: Priority Health Choice Medicaid	$446.24
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,203.38
Rate for Payer: Priority Health Narrow/Tiered Network	$1,203.38
Rate for Payer: UHC Medicaid	$446.24
Rate for Payer: UHCCP Medicaid	$446.24

PR PERICARDIOCENTESIS INITIAL

Professional

Both

$465.00

Service Code	HCPCS 33010
Min. Negotiated Rate	$186.00
Max. Negotiated Rate	$348.75
Rate for Payer: Aetna Medicare	$232.50
Rate for Payer: BCBS Complete	$186.00
Rate for Payer: Cash Price	$372.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$348.75

PR PERICARDIOCENTESIS SUBSEQUENT

Professional

Both

$464.00

Service Code	HCPCS 33011
Min. Negotiated Rate	$185.60
Max. Negotiated Rate	$348.00
Rate for Payer: Aetna Medicare	$232.00
Rate for Payer: BCBS Complete	$185.60
Rate for Payer: Cash Price	$371.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$348.00

PR PERICARDIOCENTESIS W/IMG GUIDANCE WHEN PERFORMED

Professional

Both

$510.00

Service Code	HCPCS 33016
Min. Negotiated Rate	$130.14
Max. Negotiated Rate	$382.50
Rate for Payer: Aetna Commercial	$317.13
Rate for Payer: Aetna Medicare	$255.00
Rate for Payer: BCBS Complete	$136.65
Rate for Payer: BCN Commercial	$343.11
Rate for Payer: Cash Price	$408.00
Rate for Payer: Cash Price	$408.00
Rate for Payer: Mclaren Medicaid	$130.14
Rate for Payer: Meridian Medicaid	$136.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$382.50
Rate for Payer: Priority Health Choice Medicaid	$130.14
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$368.97
Rate for Payer: Priority Health Narrow/Tiered Network	$368.97
Rate for Payer: UHC Medicaid	$130.14
Rate for Payer: UHCCP Medicaid	$130.14

PR PERICARDIOTOMY REMOVAL CLOT/FOREIGN BODY PRIMARY

Professional

Both

$2,737.00

Service Code	HCPCS 33020
Min. Negotiated Rate	$499.70
Max. Negotiated Rate	$2,052.75
Rate for Payer: Aetna Commercial	$1,108.60
Rate for Payer: Aetna Medicare	$1,368.50
Rate for Payer: BCBS Complete	$524.68
Rate for Payer: BCN Commercial	$1,226.52
Rate for Payer: Cash Price	$2,189.60
Rate for Payer: Cash Price	$2,189.60
Rate for Payer: Mclaren Medicaid	$499.70
Rate for Payer: Meridian Medicaid	$524.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,052.75
Rate for Payer: Priority Health Choice Medicaid	$499.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,318.97
Rate for Payer: Priority Health Narrow/Tiered Network	$1,318.97
Rate for Payer: UHC Medicaid	$499.70
Rate for Payer: UHCCP Medicaid	$499.70

PR PERI-IMPLANT CAPSULECTOMY BREAST COMPLETE

Professional

Both

$2,217.00

Service Code	HCPCS 19371
Min. Negotiated Rate	$414.07
Max. Negotiated Rate	$1,662.75
Rate for Payer: Aetna Commercial	$770.26
Rate for Payer: Aetna Medicare	$1,108.50
Rate for Payer: BCBS Complete	$434.77
Rate for Payer: BCN Commercial	$1,080.12
Rate for Payer: Cash Price	$1,773.60
Rate for Payer: Cash Price	$1,773.60
Rate for Payer: Mclaren Medicaid	$414.07
Rate for Payer: Meridian Medicaid	$434.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,662.75
Rate for Payer: Priority Health Choice Medicaid	$414.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$988.60
Rate for Payer: Priority Health Narrow/Tiered Network	$988.60
Rate for Payer: UHC Medicaid	$414.07
Rate for Payer: UHCCP Medicaid	$414.07

Know your out-of-pocket cost for care.

All Charges