Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR PROLONG OUTPT/OFFICE VIS

Professional

Both

$68.00

Service Code	HCPCS G2212
Min. Negotiated Rate	$17.47
Max. Negotiated Rate	$51.00
Rate for Payer: Aetna Commercial	$31.89
Rate for Payer: Aetna Medicare	$34.00
Rate for Payer: BCBS Complete	$18.34
Rate for Payer: BCN Commercial	$37.27
Rate for Payer: Cash Price	$54.40
Rate for Payer: Cash Price	$54.40
Rate for Payer: Mclaren Medicaid	$17.47
Rate for Payer: Meridian Medicaid	$18.34
Rate for Payer: Opus (Opus Packaging Group) HMA	$51.00
Rate for Payer: Priority Health Choice Medicaid	$17.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$34.88
Rate for Payer: Priority Health Narrow/Tiered Network	$34.88
Rate for Payer: UHC Medicaid	$17.47
Rate for Payer: UHCCP Medicaid	$17.47

PR PROMETHAZINE HCL INJECTION

Professional

Both

$15.00

Service Code	HCPCS J2550
Min. Negotiated Rate	$0.27
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Commercial	$3.70
Rate for Payer: Aetna Medicare	$7.50
Rate for Payer: BCBS Trust/PPO	$0.33
Rate for Payer: BCN Commercial	$0.27
Rate for Payer: Cash Price	$12.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.25

PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR

Professional

Both

$2,865.00

Service Code	HCPCS 27495
Min. Negotiated Rate	$1,146.00
Max. Negotiated Rate	$2,148.75
Rate for Payer: Aetna Commercial	$1,510.18
Rate for Payer: Aetna Medicare	$1,432.50
Rate for Payer: BCBS Complete	$1,146.00
Rate for Payer: BCN Commercial	$1,711.56
Rate for Payer: Cash Price	$2,292.00
Rate for Payer: Cash Price	$2,292.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,148.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,829.61
Rate for Payer: Priority Health Narrow/Tiered Network	$1,829.61

PR PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA

Professional

Both

$2,212.00

Service Code	HCPCS 27745
Min. Negotiated Rate	$884.80
Max. Negotiated Rate	$1,659.00
Rate for Payer: Aetna Commercial	$1,016.22
Rate for Payer: Aetna Medicare	$1,106.00
Rate for Payer: BCBS Complete	$884.80
Rate for Payer: BCN Commercial	$1,116.47
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Cash Price	$1,769.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,659.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,193.48
Rate for Payer: Priority Health Narrow/Tiered Network	$1,193.48

PR PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR

Professional

Both

$2,102.00

Service Code	HCPCS 27187
Min. Negotiated Rate	$840.80
Max. Negotiated Rate	$1,617.22
Rate for Payer: Aetna Commercial	$1,329.48
Rate for Payer: Aetna Medicare	$1,051.00
Rate for Payer: BCBS Complete	$840.80
Rate for Payer: BCN Commercial	$1,512.87
Rate for Payer: Cash Price	$1,681.60
Rate for Payer: Cash Price	$1,681.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,576.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,617.22
Rate for Payer: Priority Health Narrow/Tiered Network	$1,617.22

PR PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT

Professional

Both

$2,659.00

Service Code	HCPCS 24498
Min. Negotiated Rate	$1,063.60
Max. Negotiated Rate	$1,994.25
Rate for Payer: Aetna Commercial	$1,157.39
Rate for Payer: Aetna Medicare	$1,329.50
Rate for Payer: BCBS Complete	$1,063.60
Rate for Payer: BCN Commercial	$1,314.17
Rate for Payer: Cash Price	$2,127.20
Rate for Payer: Cash Price	$2,127.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,994.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,404.81
Rate for Payer: Priority Health Narrow/Tiered Network	$1,404.81

PR PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS

Professional

Both

$2,153.00

Service Code	HCPCS 23491
Min. Negotiated Rate	$861.20
Max. Negotiated Rate	$1,649.69
Rate for Payer: Aetna Commercial	$1,357.22
Rate for Payer: Aetna Medicare	$1,076.50
Rate for Payer: BCBS Complete	$861.20
Rate for Payer: BCN Commercial	$1,543.25
Rate for Payer: Cash Price	$1,722.40
Rate for Payer: Cash Price	$1,722.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,614.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,649.69
Rate for Payer: Priority Health Narrow/Tiered Network	$1,649.69

PR PROPH TX W/WO METHYLMETHACRYLATE RADIUS

Professional

Both

$2,319.00

Service Code	HCPCS 25490
Min. Negotiated Rate	$927.60
Max. Negotiated Rate	$1,739.25
Rate for Payer: Aetna Commercial	$959.31
Rate for Payer: Aetna Medicare	$1,159.50
Rate for Payer: BCBS Complete	$927.60
Rate for Payer: BCN Commercial	$1,100.04
Rate for Payer: Cash Price	$1,855.20
Rate for Payer: Cash Price	$1,855.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,739.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,175.91
Rate for Payer: Priority Health Narrow/Tiered Network	$1,175.91

PR PROSTATE CA SCREENING; DRE

Professional

Both

$36.00

Service Code	HCPCS G0102
Min. Negotiated Rate	$4.90
Max. Negotiated Rate	$27.00
Rate for Payer: Aetna Commercial	$8.94
Rate for Payer: Aetna Medicare	$18.00
Rate for Payer: BCBS Complete	$5.14
Rate for Payer: BCN Commercial	$12.95
Rate for Payer: Cash Price	$28.80
Rate for Payer: Cash Price	$28.80
Rate for Payer: Mclaren Medicaid	$4.90
Rate for Payer: Meridian Medicaid	$5.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.00
Rate for Payer: Priority Health Choice Medicaid	$4.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$11.64
Rate for Payer: Priority Health Narrow/Tiered Network	$11.64
Rate for Payer: UHC Medicaid	$4.90
Rate for Payer: UHCCP Medicaid	$4.90

PR PROSTATECTOMY PERINEAL RAD W/BI PELVIC LYMPH EXC

Professional

Both

$3,767.00

Service Code	HCPCS 55815
Min. Negotiated Rate	$997.27
Max. Negotiated Rate	$2,850.65
Rate for Payer: Aetna Commercial	$2,262.59
Rate for Payer: Aetna Medicare	$1,883.50
Rate for Payer: BCBS Complete	$1,047.13
Rate for Payer: BCN Commercial	$2,616.89
Rate for Payer: Cash Price	$3,013.60
Rate for Payer: Cash Price	$3,013.60
Rate for Payer: Mclaren Medicaid	$997.27
Rate for Payer: Meridian Medicaid	$1,047.13
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,825.25
Rate for Payer: Priority Health Choice Medicaid	$997.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,850.65
Rate for Payer: Priority Health Narrow/Tiered Network	$2,850.65
Rate for Payer: UHC Medicaid	$997.27
Rate for Payer: UHCCP Medicaid	$997.27

PR PROSTATECTOMY RETROPUBIC SUBTOTAL

Professional

Both

$3,441.00

Service Code	HCPCS 55831
Min. Negotiated Rate	$494.16
Max. Negotiated Rate	$2,580.75
Rate for Payer: Aetna Commercial	$1,213.98
Rate for Payer: Aetna Medicare	$1,720.50
Rate for Payer: BCBS Complete	$518.87
Rate for Payer: BCN Commercial	$1,285.29
Rate for Payer: Cash Price	$2,752.80
Rate for Payer: Cash Price	$2,752.80
Rate for Payer: Mclaren Medicaid	$494.16
Rate for Payer: Meridian Medicaid	$518.87
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,580.75
Rate for Payer: Priority Health Choice Medicaid	$494.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,400.09
Rate for Payer: Priority Health Narrow/Tiered Network	$1,400.09
Rate for Payer: UHC Medicaid	$494.16
Rate for Payer: UHCCP Medicaid	$494.16

PR PROSTATECTOMY RETROPUBIC W/WO NERVE SPARING

Professional

Both

$2,640.00

Service Code	HCPCS 55840
Min. Negotiated Rate	$666.48
Max. Negotiated Rate	$1,980.00
Rate for Payer: Aetna Commercial	$1,501.37
Rate for Payer: Aetna Medicare	$1,320.00
Rate for Payer: BCBS Complete	$699.80
Rate for Payer: BCN Commercial	$1,745.93
Rate for Payer: Cash Price	$2,112.00
Rate for Payer: Cash Price	$2,112.00
Rate for Payer: Mclaren Medicaid	$666.48
Rate for Payer: Meridian Medicaid	$699.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,980.00
Rate for Payer: Priority Health Choice Medicaid	$666.48
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,901.88
Rate for Payer: Priority Health Narrow/Tiered Network	$1,901.88
Rate for Payer: UHC Medicaid	$666.48
Rate for Payer: UHCCP Medicaid	$666.48

PR PROSTATECTOMY SUPRAPUBIC SUBTOTAL 1/2 STAGES

Professional

Both

$3,367.00

Service Code	HCPCS 55821
Min. Negotiated Rate	$481.59
Max. Negotiated Rate	$2,525.25
Rate for Payer: Aetna Commercial	$1,121.76
Rate for Payer: Aetna Medicare	$1,683.50
Rate for Payer: BCBS Complete	$505.67
Rate for Payer: BCN Commercial	$1,253.41
Rate for Payer: Cash Price	$2,693.60
Rate for Payer: Cash Price	$2,693.60
Rate for Payer: Mclaren Medicaid	$481.59
Rate for Payer: Meridian Medicaid	$505.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,525.25
Rate for Payer: Priority Health Choice Medicaid	$481.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,365.38
Rate for Payer: Priority Health Narrow/Tiered Network	$1,365.38
Rate for Payer: UHC Medicaid	$481.59
Rate for Payer: UHCCP Medicaid	$481.59

PR PROSTATE NEEDLE BIOPSY ANY APPROACH

Professional

Both

$519.00

Service Code	HCPCS 55700
Min. Negotiated Rate	$167.16
Max. Negotiated Rate	$389.25
Rate for Payer: Aetna Commercial	$167.16
Rate for Payer: Aetna Medicare	$259.50
Rate for Payer: BCBS Complete	$207.60
Rate for Payer: BCN Commercial	$192.22
Rate for Payer: Cash Price	$415.20
Rate for Payer: Cash Price	$415.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$389.25

PR PROSTATOTOMY EXTERNAL DRG ABSCESS COMPLICATED

Professional

Both

$1,102.00

Service Code	HCPCS 55725
Min. Negotiated Rate	$348.68
Max. Negotiated Rate	$977.51
Rate for Payer: Aetna Commercial	$761.53
Rate for Payer: Aetna Medicare	$551.00
Rate for Payer: BCBS Complete	$366.11
Rate for Payer: BCN Commercial	$897.37
Rate for Payer: Cash Price	$881.60
Rate for Payer: Cash Price	$881.60
Rate for Payer: Mclaren Medicaid	$348.68
Rate for Payer: Meridian Medicaid	$366.11
Rate for Payer: Opus (Opus Packaging Group) HMA	$826.50
Rate for Payer: Priority Health Choice Medicaid	$348.68
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$977.51
Rate for Payer: Priority Health Narrow/Tiered Network	$977.51
Rate for Payer: UHC Medicaid	$348.68
Rate for Payer: UHCCP Medicaid	$348.68

PR PROSTECT RETROPUBIC RAD W/WO NRV SPAR W/LYMPH BX

Professional

Both

$4,339.00

Service Code	HCPCS 55842
Min. Negotiated Rate	$664.99
Max. Negotiated Rate	$3,254.25
Rate for Payer: Aetna Commercial	$1,503.98
Rate for Payer: Aetna Medicare	$2,169.50
Rate for Payer: BCBS Complete	$698.24
Rate for Payer: BCN Commercial	$1,741.93
Rate for Payer: Cash Price	$3,471.20
Rate for Payer: Cash Price	$3,471.20
Rate for Payer: Mclaren Medicaid	$664.99
Rate for Payer: Meridian Medicaid	$698.24
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,254.25
Rate for Payer: Priority Health Choice Medicaid	$664.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,897.54
Rate for Payer: Priority Health Narrow/Tiered Network	$1,897.54
Rate for Payer: UHC Medicaid	$664.99
Rate for Payer: UHCCP Medicaid	$664.99

PR PROSTECT RETROPUB RAD W/WO NRV SPAR & BI PLV LYM

Professional

Both

$2,923.00

Service Code	HCPCS 55845
Min. Negotiated Rate	$771.27
Max. Negotiated Rate	$2,208.37
Rate for Payer: Aetna Commercial	$1,747.88
Rate for Payer: Aetna Medicare	$1,461.50
Rate for Payer: BCBS Complete	$809.83
Rate for Payer: BCN Commercial	$2,027.28
Rate for Payer: Cash Price	$2,338.40
Rate for Payer: Cash Price	$2,338.40
Rate for Payer: Mclaren Medicaid	$771.27
Rate for Payer: Meridian Medicaid	$809.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,192.25
Rate for Payer: Priority Health Choice Medicaid	$771.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,208.37
Rate for Payer: Priority Health Narrow/Tiered Network	$2,208.37
Rate for Payer: UHC Medicaid	$771.27
Rate for Payer: UHCCP Medicaid	$771.27

PR PROSTHESIS REMOVAL HUMERAL AND GLENOID COMPONENT

Professional

Both

$2,026.00

Service Code	HCPCS 23335
Min. Negotiated Rate	$732.29
Max. Negotiated Rate	$2,045.20
Rate for Payer: Aetna Commercial	$1,694.09
Rate for Payer: Aetna Medicare	$1,013.00
Rate for Payer: BCBS Complete	$768.90
Rate for Payer: BCN Commercial	$1,913.24
Rate for Payer: Cash Price	$1,620.80
Rate for Payer: Cash Price	$1,620.80
Rate for Payer: Mclaren Medicaid	$732.29
Rate for Payer: Meridian Medicaid	$768.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,519.50
Rate for Payer: Priority Health Choice Medicaid	$732.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,045.20
Rate for Payer: Priority Health Narrow/Tiered Network	$2,045.20
Rate for Payer: UHC Medicaid	$732.29
Rate for Payer: UHCCP Medicaid	$732.29

PR PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS

Professional

Both

$2,114.00

Service Code	HCPCS 24160
Min. Negotiated Rate	$732.29
Max. Negotiated Rate	$2,032.95
Rate for Payer: Aetna Commercial	$1,679.78
Rate for Payer: Aetna Medicare	$1,057.00
Rate for Payer: BCBS Complete	$768.90
Rate for Payer: BCN Commercial	$1,901.79
Rate for Payer: Cash Price	$1,691.20
Rate for Payer: Cash Price	$1,691.20
Rate for Payer: Mclaren Medicaid	$732.29
Rate for Payer: Meridian Medicaid	$768.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,585.50
Rate for Payer: Priority Health Choice Medicaid	$732.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,032.95
Rate for Payer: Priority Health Narrow/Tiered Network	$2,032.95
Rate for Payer: UHC Medicaid	$732.29
Rate for Payer: UHCCP Medicaid	$732.29

PR PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT

Professional

Both

$2,609.00

Service Code	HCPCS 23334
Min. Negotiated Rate	$622.39
Max. Negotiated Rate	$1,956.75
Rate for Payer: Aetna Commercial	$1,422.34
Rate for Payer: Aetna Medicare	$1,304.50
Rate for Payer: BCBS Complete	$653.51
Rate for Payer: BCN Commercial	$1,611.46
Rate for Payer: Cash Price	$2,087.20
Rate for Payer: Cash Price	$2,087.20
Rate for Payer: Mclaren Medicaid	$622.39
Rate for Payer: Meridian Medicaid	$653.51
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,956.75
Rate for Payer: Priority Health Choice Medicaid	$622.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,722.61
Rate for Payer: Priority Health Narrow/Tiered Network	$1,722.61
Rate for Payer: UHC Medicaid	$622.39
Rate for Payer: UHCCP Medicaid	$622.39

PR PROSTHESIS REMOVAL RADIAL HEAD

Professional

Both

$2,356.00

Service Code	HCPCS 24164
Min. Negotiated Rate	$435.16
Max. Negotiated Rate	$1,767.00
Rate for Payer: Aetna Commercial	$961.44
Rate for Payer: Aetna Medicare	$1,178.00
Rate for Payer: BCBS Complete	$456.92
Rate for Payer: BCN Commercial	$1,108.51
Rate for Payer: Cash Price	$1,884.80
Rate for Payer: Cash Price	$1,884.80
Rate for Payer: Mclaren Medicaid	$435.16
Rate for Payer: Meridian Medicaid	$456.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,767.00
Rate for Payer: Priority Health Choice Medicaid	$435.16
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,184.96
Rate for Payer: Priority Health Narrow/Tiered Network	$1,184.96
Rate for Payer: UHC Medicaid	$435.16
Rate for Payer: UHCCP Medicaid	$435.16

PR PROSTHESIS SERVICE APHAKIA TEMPORARY

Professional

Both

$23.00

Service Code	HCPCS 92358
Min. Negotiated Rate	$9.20
Max. Negotiated Rate	$17.43
Rate for Payer: Aetna Commercial	$11.22
Rate for Payer: Aetna Medicare	$11.50
Rate for Payer: BCBS Complete	$9.20
Rate for Payer: BCN Commercial	$17.43
Rate for Payer: Cash Price	$18.40
Rate for Payer: Cash Price	$18.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$17.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$14.91
Rate for Payer: Priority Health Narrow/Tiered Network	$14.91

PR PROTECTOR HEEL OR ELBOW

Professional

Both

$21.00

Service Code	HCPCS E0191
Min. Negotiated Rate	$8.40
Max. Negotiated Rate	$15.75
Rate for Payer: Aetna Commercial	$10.47
Rate for Payer: Aetna Medicare	$10.50
Rate for Payer: BCBS Complete	$8.40
Rate for Payer: BCN Commercial	$13.63
Rate for Payer: Cash Price	$16.80
Rate for Payer: Cash Price	$16.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.75

PR PRQ ASPIR PULPOSUS/INTERVERTEBRAL DISC/PVRT TISS

Professional

Both

$1,440.00

Service Code	HCPCS 62267
Min. Negotiated Rate	$86.05
Max. Negotiated Rate	$1,080.00
Rate for Payer: Aetna Commercial	$199.28
Rate for Payer: Aetna Medicare	$720.00
Rate for Payer: BCBS Complete	$90.35
Rate for Payer: BCN Commercial	$228.07
Rate for Payer: Cash Price	$1,152.00
Rate for Payer: Cash Price	$1,152.00
Rate for Payer: Mclaren Medicaid	$86.05
Rate for Payer: Meridian Medicaid	$90.35
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,080.00
Rate for Payer: Priority Health Choice Medicaid	$86.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$264.91
Rate for Payer: Priority Health Narrow/Tiered Network	$264.91
Rate for Payer: UHC Medicaid	$86.05
Rate for Payer: UHCCP Medicaid	$86.05

PR PRQ BALLOON VALVULOPLASTY AORTIC VALVE

Professional

Both

$2,760.00

Service Code	HCPCS 92986
Min. Negotiated Rate	$744.86
Max. Negotiated Rate	$2,070.00
Rate for Payer: Aetna Commercial	$1,761.54
Rate for Payer: Aetna Medicare	$1,380.00
Rate for Payer: BCBS Complete	$782.10
Rate for Payer: BCN Commercial	$1,946.60
Rate for Payer: Cash Price	$2,208.00
Rate for Payer: Cash Price	$2,208.00
Rate for Payer: Mclaren Medicaid	$744.86
Rate for Payer: Meridian Medicaid	$782.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,070.00
Rate for Payer: Priority Health Choice Medicaid	$744.86
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,850.15
Rate for Payer: Priority Health Narrow/Tiered Network	$1,850.15
Rate for Payer: UHC Medicaid	$744.86
Rate for Payer: UHCCP Medicaid	$744.86

Know your out-of-pocket cost for care.

All Charges