Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG

Professional

Both

$3,832.00

Service Code	HCPCS 22842
Min. Negotiated Rate	$433.67
Max. Negotiated Rate	$2,874.00
Rate for Payer: Aetna Commercial	$1,025.97
Rate for Payer: Aetna Medicare	$1,916.00
Rate for Payer: BCBS Complete	$455.35
Rate for Payer: BCN Commercial	$1,253.88
Rate for Payer: Cash Price	$3,065.60
Rate for Payer: Cash Price	$3,065.60
Rate for Payer: Mclaren Medicaid	$433.67
Rate for Payer: Meridian Medicaid	$455.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,874.00
Rate for Payer: Priority Health Choice Medicaid	$433.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,220.09
Rate for Payer: Priority Health Narrow/Tiered Network	$1,220.09
Rate for Payer: UHC Medicaid	$433.67
Rate for Payer: UHCCP Medicaid	$433.67

PR POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG

Professional

Both

$4,214.00

Service Code	HCPCS 22843
Min. Negotiated Rate	$464.55
Max. Negotiated Rate	$3,160.50
Rate for Payer: Aetna Commercial	$1,097.80
Rate for Payer: Aetna Medicare	$2,107.00
Rate for Payer: BCBS Complete	$487.78
Rate for Payer: BCN Commercial	$1,343.60
Rate for Payer: Cash Price	$3,371.20
Rate for Payer: Cash Price	$3,371.20
Rate for Payer: Mclaren Medicaid	$464.55
Rate for Payer: Meridian Medicaid	$487.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,160.50
Rate for Payer: Priority Health Choice Medicaid	$464.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,307.40
Rate for Payer: Priority Health Narrow/Tiered Network	$1,307.40
Rate for Payer: UHC Medicaid	$464.55
Rate for Payer: UHCCP Medicaid	$464.55

PR POSTPARTUM CARE ONLY SEPARATE PROCEDURE

Professional

Both

$462.00

Service Code	HCPCS 59430
Min. Negotiated Rate	$155.05
Max. Negotiated Rate	$346.50
Rate for Payer: Aetna Commercial	$198.09
Rate for Payer: Aetna Medicare	$231.00
Rate for Payer: BCBS Complete	$162.80
Rate for Payer: BCN Commercial	$253.10
Rate for Payer: Cash Price	$369.60
Rate for Payer: Cash Price	$369.60
Rate for Payer: Mclaren Medicaid	$155.05
Rate for Payer: Meridian Medicaid	$162.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$346.50
Rate for Payer: Priority Health Choice Medicaid	$155.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$251.98
Rate for Payer: Priority Health Narrow/Tiered Network	$251.98
Rate for Payer: UHC Medicaid	$155.05
Rate for Payer: UHCCP Medicaid	$155.05

PR POST TIB NEUROSTIMULATION PRQ NEEDLE ELECTRODE

Professional

Both

$238.00

Service Code	HCPCS 64566
Min. Negotiated Rate	$16.61
Max. Negotiated Rate	$178.50
Rate for Payer: Aetna Commercial	$39.89
Rate for Payer: Aetna Medicare	$119.00
Rate for Payer: BCBS Complete	$17.44
Rate for Payer: BCN Commercial	$44.32
Rate for Payer: Cash Price	$190.40
Rate for Payer: Cash Price	$190.40
Rate for Payer: Mclaren Medicaid	$16.61
Rate for Payer: Meridian Medicaid	$17.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$178.50
Rate for Payer: Priority Health Choice Medicaid	$16.61
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$51.48
Rate for Payer: Priority Health Narrow/Tiered Network	$51.48
Rate for Payer: UHC Medicaid	$16.61
Rate for Payer: UHCCP Medicaid	$16.61

PR POTASSIUM HYDROXIDE PREPS

Professional

Both

$23.00

Service Code	HCPCS Q0112
Min. Negotiated Rate	$4.37
Max. Negotiated Rate	$17.25
Rate for Payer: Aetna Commercial	$5.54
Rate for Payer: Aetna Medicare	$11.50
Rate for Payer: BCN Commercial	$4.37
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$17.25

PR PPPS, INITIAL VISIT

Professional

Both

$267.00

Service Code	HCPCS G0438
Min. Negotiated Rate	$106.80
Max. Negotiated Rate	$247.00
Rate for Payer: Aetna Commercial	$164.23
Rate for Payer: Aetna Medicare	$133.50
Rate for Payer: BCBS Complete	$106.80
Rate for Payer: BCN Commercial	$247.00
Rate for Payer: Cash Price	$213.60
Rate for Payer: Cash Price	$213.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$200.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$216.03
Rate for Payer: Priority Health Narrow/Tiered Network	$216.03

PR PPPS, SUBSEQ VISIT

Professional

Both

$180.00

Service Code	HCPCS G0439
Min. Negotiated Rate	$72.00
Max. Negotiated Rate	$194.71
Rate for Payer: Aetna Commercial	$129.30
Rate for Payer: Aetna Medicare	$90.00
Rate for Payer: BCBS Complete	$72.00
Rate for Payer: BCN Commercial	$194.71
Rate for Payer: Cash Price	$144.00
Rate for Payer: Cash Price	$144.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$135.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$170.29
Rate for Payer: Priority Health Narrow/Tiered Network	$170.29

PR PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE

Professional

Both

$150.00

Service Code	HCPCS 90732
Min. Negotiated Rate	$75.00
Max. Negotiated Rate	$230.41
Rate for Payer: Aetna Commercial	$133.47
Rate for Payer: Aetna Medicare	$75.00
Rate for Payer: BCBS Trust/PPO	$117.08
Rate for Payer: BCN Commercial	$230.41
Rate for Payer: Cash Price	$120.00
Rate for Payer: Cash Price	$120.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$112.50

PR PRCTECT CMBN ABDOMINOPRNL PULL-THRU PX

Professional

Both

$4,792.00

Service Code	HCPCS 45112
Min. Negotiated Rate	$1,046.26
Max. Negotiated Rate	$3,594.00
Rate for Payer: Aetna Commercial	$2,494.03
Rate for Payer: Aetna Medicare	$2,396.00
Rate for Payer: BCBS Complete	$1,098.57
Rate for Payer: BCN Commercial	$2,691.58
Rate for Payer: Cash Price	$3,833.60
Rate for Payer: Cash Price	$3,833.60
Rate for Payer: Mclaren Medicaid	$1,046.26
Rate for Payer: Meridian Medicaid	$1,098.57
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,594.00
Rate for Payer: Priority Health Choice Medicaid	$1,046.26
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,279.53
Rate for Payer: Priority Health Narrow/Tiered Network	$3,279.53
Rate for Payer: UHC Medicaid	$1,046.26
Rate for Payer: UHCCP Medicaid	$1,046.26

PR PRCTECT COMPL CMBN ABDOMINOPRNL W/CLST

Professional

Both

$4,867.00

Service Code	HCPCS 45110
Min. Negotiated Rate	$1,066.49
Max. Negotiated Rate	$3,650.25
Rate for Payer: Aetna Commercial	$2,449.99
Rate for Payer: Aetna Medicare	$2,433.50
Rate for Payer: BCBS Complete	$1,119.81
Rate for Payer: BCN Commercial	$2,698.56
Rate for Payer: Cash Price	$3,893.60
Rate for Payer: Cash Price	$3,893.60
Rate for Payer: Mclaren Medicaid	$1,066.49
Rate for Payer: Meridian Medicaid	$1,119.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,650.25
Rate for Payer: Priority Health Choice Medicaid	$1,066.49
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,288.02
Rate for Payer: Priority Health Narrow/Tiered Network	$3,288.02
Rate for Payer: UHC Medicaid	$1,066.49
Rate for Payer: UHCCP Medicaid	$1,066.49

PR PRCTECT COMPL W/PULL-THRU PX & ANASTOMOSIS

Professional

Both

$5,143.00

Service Code	HCPCS 45120
Min. Negotiated Rate	$955.31
Max. Negotiated Rate	$3,857.25
Rate for Payer: Aetna Commercial	$2,162.46
Rate for Payer: Aetna Medicare	$2,571.50
Rate for Payer: BCBS Complete	$1,003.08
Rate for Payer: BCN Commercial	$2,403.75
Rate for Payer: Cash Price	$4,114.40
Rate for Payer: Cash Price	$4,114.40
Rate for Payer: Mclaren Medicaid	$955.31
Rate for Payer: Meridian Medicaid	$1,003.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,857.25
Rate for Payer: Priority Health Choice Medicaid	$955.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,928.83
Rate for Payer: Priority Health Narrow/Tiered Network	$2,928.83
Rate for Payer: UHC Medicaid	$955.31
Rate for Payer: UHCCP Medicaid	$955.31

PR PRCTECT COMPL W/STOT/TOT COLCT W/MLT BXS

Professional

Both

$5,047.00

Service Code	HCPCS 45121
Min. Negotiated Rate	$1,039.65
Max. Negotiated Rate	$3,785.25
Rate for Payer: Aetna Commercial	$2,361.59
Rate for Payer: Aetna Medicare	$2,523.50
Rate for Payer: BCBS Complete	$1,091.63
Rate for Payer: BCN Commercial	$2,620.37
Rate for Payer: Cash Price	$4,037.60
Rate for Payer: Cash Price	$4,037.60
Rate for Payer: Mclaren Medicaid	$1,039.65
Rate for Payer: Meridian Medicaid	$1,091.63
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,785.25
Rate for Payer: Priority Health Choice Medicaid	$1,039.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,192.75
Rate for Payer: Priority Health Narrow/Tiered Network	$3,192.75
Rate for Payer: UHC Medicaid	$1,039.65
Rate for Payer: UHCCP Medicaid	$1,039.65

PR PRCTECT PRTL RESCJ RECTUM TABDL APPR

Professional

Both

$2,032.00

Service Code	HCPCS 45111
Min. Negotiated Rate	$644.54
Max. Negotiated Rate	$1,977.42
Rate for Payer: Aetna Commercial	$1,458.02
Rate for Payer: Aetna Medicare	$1,016.00
Rate for Payer: BCBS Complete	$676.77
Rate for Payer: BCN Commercial	$1,622.92
Rate for Payer: Cash Price	$1,625.60
Rate for Payer: Cash Price	$1,625.60
Rate for Payer: Mclaren Medicaid	$644.54
Rate for Payer: Meridian Medicaid	$676.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,524.00
Rate for Payer: Priority Health Choice Medicaid	$644.54
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,977.42
Rate for Payer: Priority Health Narrow/Tiered Network	$1,977.42
Rate for Payer: UHC Medicaid	$644.54
Rate for Payer: UHCCP Medicaid	$644.54

PR PRCTECT PRTL W/ANAST ABDL & TRANSSAC APPROACH

Professional

Both

$3,357.00

Service Code	HCPCS 45114
Min. Negotiated Rate	$1,076.72
Max. Negotiated Rate	$3,318.36
Rate for Payer: Aetna Commercial	$2,460.29
Rate for Payer: Aetna Medicare	$1,678.50
Rate for Payer: BCBS Complete	$1,130.56
Rate for Payer: BCN Commercial	$2,723.46
Rate for Payer: Cash Price	$2,685.60
Rate for Payer: Cash Price	$2,685.60
Rate for Payer: Mclaren Medicaid	$1,076.72
Rate for Payer: Meridian Medicaid	$1,130.56
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,517.75
Rate for Payer: Priority Health Choice Medicaid	$1,076.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,318.36
Rate for Payer: Priority Health Narrow/Tiered Network	$3,318.36
Rate for Payer: UHC Medicaid	$1,076.72
Rate for Payer: UHCCP Medicaid	$1,076.72

PR PRCTECT PRTL W/ANAST TRANSSAC APPR ONLY

Professional

Both

$3,925.00

Service Code	HCPCS 45116
Min. Negotiated Rate	$897.16
Max. Negotiated Rate	$2,943.75
Rate for Payer: Aetna Commercial	$2,057.79
Rate for Payer: Aetna Medicare	$1,962.50
Rate for Payer: BCBS Complete	$942.02
Rate for Payer: BCN Commercial	$2,295.70
Rate for Payer: Cash Price	$3,140.00
Rate for Payer: Cash Price	$3,140.00
Rate for Payer: Mclaren Medicaid	$897.16
Rate for Payer: Meridian Medicaid	$942.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,943.75
Rate for Payer: Priority Health Choice Medicaid	$897.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,797.14
Rate for Payer: Priority Health Narrow/Tiered Network	$2,797.14
Rate for Payer: UHC Medicaid	$897.16
Rate for Payer: UHCCP Medicaid	$897.16

PR PRCTECT PRTL W/MUCOSEC ILEOANAL ANAST RSVR

Professional

Both

$5,619.00

Service Code	HCPCS 45113
Min. Negotiated Rate	$1,081.19
Max. Negotiated Rate	$4,214.25
Rate for Payer: Aetna Commercial	$2,493.80
Rate for Payer: Aetna Medicare	$2,809.50
Rate for Payer: BCBS Complete	$1,135.25
Rate for Payer: BCN Commercial	$2,763.79
Rate for Payer: Cash Price	$4,495.20
Rate for Payer: Cash Price	$4,495.20
Rate for Payer: Mclaren Medicaid	$1,081.19
Rate for Payer: Meridian Medicaid	$1,135.25
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,214.25
Rate for Payer: Priority Health Choice Medicaid	$1,081.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,367.50
Rate for Payer: Priority Health Narrow/Tiered Network	$3,367.50
Rate for Payer: UHC Medicaid	$1,081.19
Rate for Payer: UHCCP Medicaid	$1,081.19

PR PRCTECT PRTL W/O ANAST PRNL APPR

Professional

Both

$3,138.00

Service Code	HCPCS 45123
Min. Negotiated Rate	$658.60
Max. Negotiated Rate	$2,353.50
Rate for Payer: Aetna Commercial	$1,489.82
Rate for Payer: Aetna Medicare	$1,569.00
Rate for Payer: BCBS Complete	$691.53
Rate for Payer: BCN Commercial	$1,661.77
Rate for Payer: Cash Price	$2,510.40
Rate for Payer: Cash Price	$2,510.40
Rate for Payer: Mclaren Medicaid	$658.60
Rate for Payer: Meridian Medicaid	$691.53
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,353.50
Rate for Payer: Priority Health Choice Medicaid	$658.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,024.74
Rate for Payer: Priority Health Narrow/Tiered Network	$2,024.74
Rate for Payer: UHC Medicaid	$658.60
Rate for Payer: UHCCP Medicaid	$658.60

PR PREDNISONE IR OR DR ORAL 1MG

Professional

Both

$1.00

Service Code	HCPCS J7512
Min. Negotiated Rate	$0.01
Max. Negotiated Rate	$0.75
Rate for Payer: Aetna Commercial	$0.01
Rate for Payer: Aetna Medicare	$0.50
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: BCBS Trust/PPO	$0.01
Rate for Payer: BCN Commercial	$0.01
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cash Price	$0.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.75

PR PREDNISONE ORAL

Professional

Both

$1.00

Service Code	HCPCS J7506
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.75
Rate for Payer: Aetna Medicare	$0.50
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: Cash Price	$0.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.75

PR PREPARATION SKIN CELL SSP AGRFT 1ST 25 SQ CM/<

Professional

Both

$9,709.00

Service Code	HCPCS 15013
Min. Negotiated Rate	$41.99
Max. Negotiated Rate	$9,376.33
Rate for Payer: Aetna Medicare	$4,854.50
Rate for Payer: BCBS Complete	$44.09
Rate for Payer: BCN Commercial	$6,779.22
Rate for Payer: Cash Price	$7,767.20
Rate for Payer: Cash Price	$7,767.20
Rate for Payer: Mclaren Medicaid	$41.99
Rate for Payer: Meridian Medicaid	$44.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,281.75
Rate for Payer: Priority Health Choice Medicaid	$41.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$9,376.33
Rate for Payer: Priority Health Narrow/Tiered Network	$9,376.33
Rate for Payer: UHC Medicaid	$41.99
Rate for Payer: UHCCP Medicaid	$41.99

PR PREPARATION SKIN CELL SSP AGRFT EA ADDL 25 SQ CM

Professional

Both

$9,709.00

Service Code	HCPCS 15014
Min. Negotiated Rate	$41.99
Max. Negotiated Rate	$7,281.75
Rate for Payer: Aetna Medicare	$4,854.50
Rate for Payer: BCBS Complete	$44.09
Rate for Payer: Cash Price	$7,767.20
Rate for Payer: Cash Price	$7,767.20
Rate for Payer: Mclaren Medicaid	$41.99
Rate for Payer: Meridian Medicaid	$44.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,281.75
Rate for Payer: Priority Health Choice Medicaid	$41.99
Rate for Payer: UHC Medicaid	$41.99
Rate for Payer: UHCCP Medicaid	$41.99

PR PREPARE FECAL MICROBIOTA FOR INSTILLATION

Professional

Both

$210.00

Service Code	HCPCS 44705
Min. Negotiated Rate	$39.19
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Commercial	$96.49
Rate for Payer: Aetna Medicare	$105.00
Rate for Payer: BCBS Complete	$41.15
Rate for Payer: BCN Commercial	$106.57
Rate for Payer: Cash Price	$168.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Mclaren Medicaid	$39.19
Rate for Payer: Meridian Medicaid	$41.15
Rate for Payer: Opus (Opus Packaging Group) HMA	$157.50
Rate for Payer: Priority Health Choice Medicaid	$39.19
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$129.84
Rate for Payer: Priority Health Narrow/Tiered Network	$129.84
Rate for Payer: UHC Medicaid	$39.19
Rate for Payer: UHCCP Medicaid	$39.19

PR PREPERITONEAL PEL PACK F/HEMRRG ASSOC PEL TRMA

Professional

Both

$970.00

Service Code	HCPCS 49013
Min. Negotiated Rate	$261.56
Max. Negotiated Rate	$826.40
Rate for Payer: Aetna Commercial	$585.87
Rate for Payer: Aetna Medicare	$485.00
Rate for Payer: BCBS Complete	$274.64
Rate for Payer: BCN Commercial	$678.25
Rate for Payer: Cash Price	$776.00
Rate for Payer: Cash Price	$776.00
Rate for Payer: Mclaren Medicaid	$261.56
Rate for Payer: Meridian Medicaid	$274.64
Rate for Payer: Opus (Opus Packaging Group) HMA	$727.50
Rate for Payer: Priority Health Choice Medicaid	$261.56
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$826.40
Rate for Payer: Priority Health Narrow/Tiered Network	$826.40
Rate for Payer: UHC Medicaid	$261.56
Rate for Payer: UHCCP Medicaid	$261.56

PR PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT

Professional

Both

$690.00

Service Code	HCPCS 15004
Min. Negotiated Rate	$145.91
Max. Negotiated Rate	$517.50
Rate for Payer: Aetna Commercial	$285.16
Rate for Payer: Aetna Medicare	$345.00
Rate for Payer: BCBS Complete	$153.21
Rate for Payer: BCN Commercial	$388.92
Rate for Payer: Cash Price	$552.00
Rate for Payer: Cash Price	$552.00
Rate for Payer: Mclaren Medicaid	$145.91
Rate for Payer: Meridian Medicaid	$153.21
Rate for Payer: Opus (Opus Packaging Group) HMA	$517.50
Rate for Payer: Priority Health Choice Medicaid	$145.91
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$355.97
Rate for Payer: Priority Health Narrow/Tiered Network	$355.97
Rate for Payer: UHC Medicaid	$145.91
Rate for Payer: UHCCP Medicaid	$145.91

PR PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT

Professional

Both

$210.00

Service Code	HCPCS 15005
Min. Negotiated Rate	$49.84
Max. Negotiated Rate	$157.50
Rate for Payer: Aetna Commercial	$99.66
Rate for Payer: Aetna Medicare	$105.00
Rate for Payer: BCBS Complete	$52.33
Rate for Payer: BCN Commercial	$133.46
Rate for Payer: Cash Price	$168.00
Rate for Payer: Cash Price	$168.00
Rate for Payer: Mclaren Medicaid	$49.84
Rate for Payer: Meridian Medicaid	$52.33
Rate for Payer: Opus (Opus Packaging Group) HMA	$157.50
Rate for Payer: Priority Health Choice Medicaid	$49.84
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$122.15
Rate for Payer: Priority Health Narrow/Tiered Network	$122.15
Rate for Payer: UHC Medicaid	$49.84
Rate for Payer: UHCCP Medicaid	$49.84

Know your out-of-pocket cost for care.

All Charges