Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR PLASTIC REPAIR URETHROCELE

Professional

Both

$833.00

Service Code	HCPCS 57230
Min. Negotiated Rate	$237.71
Max. Negotiated Rate	$635.98
Rate for Payer: Aetna Commercial	$495.89
Rate for Payer: Aetna Medicare	$416.50
Rate for Payer: BCBS Complete	$249.60
Rate for Payer: BCN Commercial	$627.96
Rate for Payer: Cash Price	$666.40
Rate for Payer: Cash Price	$666.40
Rate for Payer: Mclaren Medicaid	$237.71
Rate for Payer: Meridian Medicaid	$249.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$624.75
Rate for Payer: Priority Health Choice Medicaid	$237.71
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$635.98
Rate for Payer: Priority Health Narrow/Tiered Network	$635.98
Rate for Payer: UHC Medicaid	$237.71
Rate for Payer: UHCCP Medicaid	$237.71

PR PLASTIC RPR PENIS CORRECT ANGULATION

Professional

Both

$3,915.00

Service Code	HCPCS 54360
Min. Negotiated Rate	$416.42
Max. Negotiated Rate	$2,936.25
Rate for Payer: Aetna Commercial	$925.58
Rate for Payer: Aetna Medicare	$1,957.50
Rate for Payer: BCBS Complete	$437.24
Rate for Payer: BCN Commercial	$1,080.62
Rate for Payer: Cash Price	$3,132.00
Rate for Payer: Cash Price	$3,132.00
Rate for Payer: Mclaren Medicaid	$416.42
Rate for Payer: Meridian Medicaid	$437.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,936.25
Rate for Payer: Priority Health Choice Medicaid	$416.42
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,177.15
Rate for Payer: Priority Health Narrow/Tiered Network	$1,177.15
Rate for Payer: UHC Medicaid	$416.42
Rate for Payer: UHCCP Medicaid	$416.42

PR PLASTICS COSMETIC CONSULT OFFICE VISIT

Professional

Both

$77.00

Hospital Revenue Code	990
Min. Negotiated Rate	$30.80
Max. Negotiated Rate	$57.75
Rate for Payer: Aetna Medicare	$38.50
Rate for Payer: BCBS Complete	$30.80
Rate for Payer: Cash Price	$61.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$57.75

PR PLASTICS COSMETIC FAT GRAFTING

Professional

Both

$2,575.00

Hospital Revenue Code	990
Min. Negotiated Rate	$1,030.00
Max. Negotiated Rate	$1,931.25
Rate for Payer: Aetna Medicare	$1,287.50
Rate for Payer: BCBS Complete	$1,030.00
Rate for Payer: Cash Price	$2,060.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,931.25

PR PLASTIC URETHRAL SPHINCTER VAGINAL APPROACH

Professional

Both

$1,130.00

Service Code	HCPCS 57220
Min. Negotiated Rate	$198.73
Max. Negotiated Rate	$847.50
Rate for Payer: Aetna Commercial	$406.21
Rate for Payer: Aetna Medicare	$565.00
Rate for Payer: BCBS Complete	$208.67
Rate for Payer: BCN Commercial	$521.88
Rate for Payer: Cash Price	$904.00
Rate for Payer: Cash Price	$904.00
Rate for Payer: Mclaren Medicaid	$198.73
Rate for Payer: Meridian Medicaid	$208.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$847.50
Rate for Payer: Priority Health Choice Medicaid	$198.73
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$528.55
Rate for Payer: Priority Health Narrow/Tiered Network	$528.55
Rate for Payer: UHC Medicaid	$198.73
Rate for Payer: UHCCP Medicaid	$198.73

PR PLETHYSMOGRAPHY LUNG VOLUMES & AIRWAY RESISTANCE

Professional

Both

$105.00

Service Code	HCPCS 94726
Min. Negotiated Rate	$52.50
Max. Negotiated Rate	$84.65
Rate for Payer: Aetna Commercial	$57.59
Rate for Payer: Aetna Commercial	$57.59
Rate for Payer: Aetna Medicare	$52.50
Rate for Payer: Aetna Medicare	$14.50
Rate for Payer: BCN Commercial	$84.65
Rate for Payer: BCN Commercial	$84.65
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$84.00
Rate for Payer: Cash Price	$23.20
Rate for Payer: Cash Price	$23.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$21.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$78.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$78.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$78.07
Rate for Payer: Priority Health Narrow/Tiered Network	$78.07
Rate for Payer: Priority Health Narrow/Tiered Network	$78.07

PR PLEURAL SCARIFICATION REPEAT PNEUMOTHORAX

Professional

Both

$2,242.00

Service Code	HCPCS 32215
Min. Negotiated Rate	$499.70
Max. Negotiated Rate	$1,681.50
Rate for Payer: Aetna Commercial	$1,032.67
Rate for Payer: Aetna Medicare	$1,121.00
Rate for Payer: BCBS Complete	$524.68
Rate for Payer: BCN Commercial	$1,195.65
Rate for Payer: Cash Price	$1,793.60
Rate for Payer: Cash Price	$1,793.60
Rate for Payer: Mclaren Medicaid	$499.70
Rate for Payer: Meridian Medicaid	$524.68
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,681.50
Rate for Payer: Priority Health Choice Medicaid	$499.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,125.95
Rate for Payer: Priority Health Narrow/Tiered Network	$1,125.95
Rate for Payer: UHC Medicaid	$499.70
Rate for Payer: UHCCP Medicaid	$499.70

PR PLEURECTOMY PARIETAL SEPARATE PROCEDURE

Professional

Both

$3,037.00

Service Code	HCPCS 32310
Min. Negotiated Rate	$567.22
Max. Negotiated Rate	$2,277.75
Rate for Payer: Aetna Commercial	$1,182.92
Rate for Payer: Aetna Medicare	$1,518.50
Rate for Payer: BCBS Complete	$595.58
Rate for Payer: BCN Commercial	$1,365.96
Rate for Payer: Cash Price	$2,429.60
Rate for Payer: Cash Price	$2,429.60
Rate for Payer: Mclaren Medicaid	$567.22
Rate for Payer: Meridian Medicaid	$595.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,277.75
Rate for Payer: Priority Health Choice Medicaid	$567.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,286.32
Rate for Payer: Priority Health Narrow/Tiered Network	$1,286.32
Rate for Payer: UHC Medicaid	$567.22
Rate for Payer: UHCCP Medicaid	$567.22

PR PL GLYCOLIC 35/70

Professional

Both

$63.00

Hospital Revenue Code	990
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 PL ILLUMINIZE

Professional

Both

$84.00

Hospital Revenue Code	990
Min. Negotiated Rate	$33.60
Max. Negotiated Rate	$63.00
Rate for Payer: Aetna Medicare	$42.00
Rate for Payer: BCBS Complete	$33.60
Rate for Payer: Cash Price	$67.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$63.00

PR PL JESSNERS

Professional

Both

$63.00

Hospital Revenue Code	990
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 PLMT ACCESS THRU BILIARY TREE INTO SMALL BWL NEW

Professional

Both

$2,206.00

Service Code	HCPCS 47541
Min. Negotiated Rate	$187.23
Max. Negotiated Rate	$1,654.50
Rate for Payer: Aetna Commercial	$442.75
Rate for Payer: Aetna Medicare	$1,103.00
Rate for Payer: BCBS Complete	$196.59
Rate for Payer: BCN Commercial	$489.01
Rate for Payer: Cash Price	$1,764.80
Rate for Payer: Cash Price	$1,764.80
Rate for Payer: Mclaren Medicaid	$187.23
Rate for Payer: Meridian Medicaid	$196.59
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,654.50
Rate for Payer: Priority Health Choice Medicaid	$187.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$595.83
Rate for Payer: Priority Health Narrow/Tiered Network	$595.83
Rate for Payer: UHC Medicaid	$187.23
Rate for Payer: UHCCP Medicaid	$187.23

PR PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST

Professional

Both

$10,492.00

Service Code	HCPCS 19296
Min. Negotiated Rate	$123.54
Max. Negotiated Rate	$7,869.00
Rate for Payer: Aetna Commercial	$230.34
Rate for Payer: Aetna Medicare	$5,246.00
Rate for Payer: BCBS Complete	$129.72
Rate for Payer: BCN Commercial	$314.72
Rate for Payer: Cash Price	$8,393.60
Rate for Payer: Cash Price	$8,393.60
Rate for Payer: Mclaren Medicaid	$123.54
Rate for Payer: Meridian Medicaid	$129.72
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,869.00
Rate for Payer: Priority Health Choice Medicaid	$123.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$288.05
Rate for Payer: Priority Health Narrow/Tiered Network	$288.05
Rate for Payer: UHC Medicaid	$123.54
Rate for Payer: UHCCP Medicaid	$123.54

PR PLMT FEM-FEM PROSTC GRF EVASC AORTIC ARYSM RPR

Professional

Both

$1,256.00

Service Code	HCPCS 34813
Min. Negotiated Rate	$135.04
Max. Negotiated Rate	$942.00
Rate for Payer: Aetna Commercial	$319.87
Rate for Payer: Aetna Medicare	$628.00
Rate for Payer: BCBS Complete	$141.79
Rate for Payer: BCN Commercial	$341.12
Rate for Payer: Cash Price	$1,004.80
Rate for Payer: Cash Price	$1,004.80
Rate for Payer: Mclaren Medicaid	$135.04
Rate for Payer: Meridian Medicaid	$141.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$942.00
Rate for Payer: Priority Health Choice Medicaid	$135.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$366.82
Rate for Payer: Priority Health Narrow/Tiered Network	$366.82
Rate for Payer: UHC Medicaid	$135.04
Rate for Payer: UHCCP Medicaid	$135.04

PR PLMT INTERSTITIAL DEV RADIAT TX PROSTATE 1/MULT

Professional

Both

$285.00

Service Code	HCPCS 55876
Min. Negotiated Rate	$57.94
Max. Negotiated Rate	$213.75
Rate for Payer: Aetna Commercial	$128.17
Rate for Payer: Aetna Medicare	$142.50
Rate for Payer: BCBS Complete	$60.84
Rate for Payer: BCN Commercial	$152.88
Rate for Payer: Cash Price	$228.00
Rate for Payer: Cash Price	$228.00
Rate for Payer: Mclaren Medicaid	$57.94
Rate for Payer: Meridian Medicaid	$60.84
Rate for Payer: Opus (Opus Packaging Group) HMA	$213.75
Rate for Payer: Priority Health Choice Medicaid	$57.94
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$166.53
Rate for Payer: Priority Health Narrow/Tiered Network	$166.53
Rate for Payer: UHC Medicaid	$57.94
Rate for Payer: UHCCP Medicaid	$57.94

PR PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I

Professional

Both

$1,664.00

Service Code	HCPCS 50432
Min. Negotiated Rate	$113.32
Max. Negotiated Rate	$1,248.00
Rate for Payer: Aetna Commercial	$261.42
Rate for Payer: Aetna Medicare	$832.00
Rate for Payer: BCBS Complete	$118.99
Rate for Payer: BCN Commercial	$299.28
Rate for Payer: Cash Price	$1,331.20
Rate for Payer: Cash Price	$1,331.20
Rate for Payer: Mclaren Medicaid	$113.32
Rate for Payer: Meridian Medicaid	$118.99
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,248.00
Rate for Payer: Priority Health Choice Medicaid	$113.32
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$326.02
Rate for Payer: Priority Health Narrow/Tiered Network	$326.02
Rate for Payer: UHC Medicaid	$113.32
Rate for Payer: UHCCP Medicaid	$113.32

PR PLMT PROX XTN PROSTH EVASC RPR DTA EA PROX XTN

Professional

Both

$903.00

Service Code	HCPCS 33884
Min. Negotiated Rate	$361.20
Max. Negotiated Rate	$677.25
Rate for Payer: Aetna Commercial	$532.47
Rate for Payer: Aetna Medicare	$451.50
Rate for Payer: BCBS Complete	$361.20
Rate for Payer: BCN Commercial	$574.67
Rate for Payer: Cash Price	$722.40
Rate for Payer: Cash Price	$722.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$677.25

PR PLMT SFT TISS LOCLZJ DEV PERQ 1ST LESION

Professional

Both

$244.00

Service Code	HCPCS 10035
Min. Negotiated Rate	$45.37
Max. Negotiated Rate	$183.00
Rate for Payer: Aetna Commercial	$92.22
Rate for Payer: Aetna Medicare	$122.00
Rate for Payer: BCBS Complete	$47.64
Rate for Payer: BCN Commercial	$123.49
Rate for Payer: Cash Price	$195.20
Rate for Payer: Cash Price	$195.20
Rate for Payer: Mclaren Medicaid	$45.37
Rate for Payer: Meridian Medicaid	$47.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$183.00
Rate for Payer: Priority Health Choice Medicaid	$45.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$113.03
Rate for Payer: Priority Health Narrow/Tiered Network	$113.03
Rate for Payer: UHC Medicaid	$45.37
Rate for Payer: UHCCP Medicaid	$45.37

PR PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT

Professional

Both

$580.00

Service Code	HCPCS 50693
Min. Negotiated Rate	$112.46
Max. Negotiated Rate	$435.00
Rate for Payer: Aetna Commercial	$260.02
Rate for Payer: Aetna Medicare	$290.00
Rate for Payer: BCBS Complete	$118.08
Rate for Payer: BCN Commercial	$297.79
Rate for Payer: Cash Price	$464.00
Rate for Payer: Cash Price	$464.00
Rate for Payer: Mclaren Medicaid	$112.46
Rate for Payer: Meridian Medicaid	$118.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$435.00
Rate for Payer: Priority Health Choice Medicaid	$112.46
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$324.39
Rate for Payer: Priority Health Narrow/Tiered Network	$324.39
Rate for Payer: UHC Medicaid	$112.46
Rate for Payer: UHCCP Medicaid	$112.46

PR PLMT VEIN PATCH/CUFF DSTL ANAST BYP CONDUIT

Professional

Both

$456.00

Service Code	HCPCS 35685
Min. Negotiated Rate	$113.96
Max. Negotiated Rate	$342.00
Rate for Payer: Aetna Commercial	$268.12
Rate for Payer: Aetna Medicare	$228.00
Rate for Payer: BCBS Complete	$119.66
Rate for Payer: BCN Commercial	$288.34
Rate for Payer: Cash Price	$364.80
Rate for Payer: Cash Price	$364.80
Rate for Payer: Mclaren Medicaid	$113.96
Rate for Payer: Meridian Medicaid	$119.66
Rate for Payer: Opus (Opus Packaging Group) HMA	$342.00
Rate for Payer: Priority Health Choice Medicaid	$113.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$310.07
Rate for Payer: Priority Health Narrow/Tiered Network	$310.07
Rate for Payer: UHC Medicaid	$113.96
Rate for Payer: UHCCP Medicaid	$113.96

PR PLNNING PT SPEC FENEST VISCERAL AORTIC GRAFT

Professional

Both

$210.00

Service Code	HCPCS 34839
Min. Negotiated Rate	$84.00
Max. Negotiated Rate	$240.00
Rate for Payer: Aetna Commercial	$240.00
Rate for Payer: Aetna Medicare	$105.00
Rate for Payer: BCBS Complete	$84.00
Rate for Payer: BCN Commercial	$146.64
Rate for Payer: Cash Price	$168.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$157.50

PR PL REJUV/PERFECT

Professional

Both

$126.00

Hospital Revenue Code	990
Min. Negotiated Rate	$50.40
Max. Negotiated Rate	$94.50
Rate for Payer: Aetna Medicare	$63.00
Rate for Payer: BCBS Complete	$50.40
Rate for Payer: Cash Price	$100.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$94.50

PR PLSTC RPR CL LIP/NSL DFRM SEC RECRTJ DFCT & RECL

Professional

Both

$1,939.00

Service Code	HCPCS 40720
Min. Negotiated Rate	$588.31
Max. Negotiated Rate	$1,887.02
Rate for Payer: Aetna Commercial	$1,363.02
Rate for Payer: Aetna Medicare	$969.50
Rate for Payer: BCBS Complete	$617.73
Rate for Payer: BCN Commercial	$1,548.72
Rate for Payer: Cash Price	$1,551.20
Rate for Payer: Cash Price	$1,551.20
Rate for Payer: Mclaren Medicaid	$588.31
Rate for Payer: Meridian Medicaid	$617.73
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,454.25
Rate for Payer: Priority Health Choice Medicaid	$588.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,887.02
Rate for Payer: Priority Health Narrow/Tiered Network	$1,887.02
Rate for Payer: UHC Medicaid	$588.31
Rate for Payer: UHCCP Medicaid	$588.31

PR PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY PRIM

Professional

Both

$898.00

Service Code	HCPCS 42500
Min. Negotiated Rate	$199.79
Max. Negotiated Rate	$673.50
Rate for Payer: Aetna Commercial	$454.70
Rate for Payer: Aetna Medicare	$449.00
Rate for Payer: BCBS Complete	$209.78
Rate for Payer: BCN Commercial	$523.38
Rate for Payer: Cash Price	$718.40
Rate for Payer: Cash Price	$718.40
Rate for Payer: Mclaren Medicaid	$199.79
Rate for Payer: Meridian Medicaid	$209.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$673.50
Rate for Payer: Priority Health Choice Medicaid	$199.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$637.70
Rate for Payer: Priority Health Narrow/Tiered Network	$637.70
Rate for Payer: UHC Medicaid	$199.79
Rate for Payer: UHCCP Medicaid	$199.79

PR PLSTC RPR SALIVARY DUX SIALODOCHOPLASTY SEC/COMP

Professional

Both

$1,145.00

Service Code	HCPCS 42505
Min. Negotiated Rate	$261.56
Max. Negotiated Rate	$858.75
Rate for Payer: Aetna Commercial	$603.00
Rate for Payer: Aetna Medicare	$572.50
Rate for Payer: BCBS Complete	$274.64
Rate for Payer: BCN Commercial	$692.19
Rate for Payer: Cash Price	$916.00
Rate for Payer: Cash Price	$916.00
Rate for Payer: Mclaren Medicaid	$261.56
Rate for Payer: Meridian Medicaid	$274.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$858.75
Rate for Payer: Priority Health Choice Medicaid	$261.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$843.40
Rate for Payer: Priority Health Narrow/Tiered Network	$843.40
Rate for Payer: UHC Medicaid	$261.56
Rate for Payer: UHCCP Medicaid	$261.56

Know your out-of-pocket cost for care.

All Charges