Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST

Professional

Both

$221.00

Service Code	HCPCS 10160
Hospital Charge Code	10160
Min. Negotiated Rate	$58.36
Max. Negotiated Rate	$165.75
Rate for Payer: Aetna Commercial	$101.52
Rate for Payer: Aetna Medicare	$110.50
Rate for Payer: BCBS Complete	$61.28
Rate for Payer: BCN Commercial	$115.06
Rate for Payer: Cash Price	$176.80
Rate for Payer: Cash Price	$176.80
Rate for Payer: Mclaren Medicaid	$58.36
Rate for Payer: Meridian Medicaid	$61.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$165.75
Rate for Payer: Priority Health Choice Medicaid	$58.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$133.55
Rate for Payer: Priority Health Narrow/Tiered Network	$133.55
Rate for Payer: UHC Medicaid	$58.36
Rate for Payer: UHCCP Medicaid	$58.36

PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST

Facility

$221.00

Service Code	CPT 10160
Hospital Charge Code	10160
Hospital Revenue Code	521
Min. Negotiated Rate	$153.82
Max. Negotiated Rate	$198.90
Rate for Payer: Aetna Commercial	$187.85
Rate for Payer: BCBS Trust/PPO	$182.52
Rate for Payer: BCN Commercial	$182.52
Rate for Payer: Cash Price	$176.80
Rate for Payer: Cofinity Commercial	$190.06
Rate for Payer: Encore Health Key Benefits Commercial	$176.80
Rate for Payer: Healthscope Commercial	$198.90
Rate for Payer: Lakeland Regional Health Systems Commercial	$165.75
Rate for Payer: Multiplan/Beech St/PHCS Commercial	$187.85
Rate for Payer: Nomi Health Commercial	$181.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$165.75
Rate for Payer: PHP Commercial	$187.85
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$192.27
Rate for Payer: Priority Health Narrow/Tiered Network	$153.82
Rate for Payer: UHC Core	$184.53
Rate for Payer: Van Buren County Sheriff Dept. Commercial	$165.75

PR PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST

Professional

Both

$221.00

Service Code	HCPCS 10160
Min. Negotiated Rate	$58.36
Max. Negotiated Rate	$165.75
Rate for Payer: Aetna Commercial	$101.52
Rate for Payer: Aetna Medicare	$110.50
Rate for Payer: BCBS Complete	$61.28
Rate for Payer: BCN Commercial	$115.06
Rate for Payer: Cash Price	$176.80
Rate for Payer: Cash Price	$176.80
Rate for Payer: Mclaren Medicaid	$58.36
Rate for Payer: Meridian Medicaid	$61.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$165.75
Rate for Payer: Priority Health Choice Medicaid	$58.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$133.55
Rate for Payer: Priority Health Narrow/Tiered Network	$133.55
Rate for Payer: UHC Medicaid	$58.36
Rate for Payer: UHCCP Medicaid	$58.36

PR PUNCTURE ASPIRATION CYST BREAST EACH ADDL CYST

Professional

Both

$77.00

Service Code	HCPCS 19001
Min. Negotiated Rate	$11.50
Max. Negotiated Rate	$57.75
Rate for Payer: Aetna Commercial	$23.24
Rate for Payer: Aetna Medicare	$38.50
Rate for Payer: BCBS Complete	$12.07
Rate for Payer: BCN Commercial	$30.38
Rate for Payer: Cash Price	$61.60
Rate for Payer: Cash Price	$61.60
Rate for Payer: Mclaren Medicaid	$11.50
Rate for Payer: Meridian Medicaid	$12.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$57.75
Rate for Payer: Priority Health Choice Medicaid	$11.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$27.80
Rate for Payer: Priority Health Narrow/Tiered Network	$27.80
Rate for Payer: UHC Medicaid	$11.50
Rate for Payer: UHCCP Medicaid	$11.50

PR PUNCTURE ASPIRATION CYST OF BREAST

Professional

Both

$197.00

Service Code	HCPCS 19000
Min. Negotiated Rate	$23.22
Max. Negotiated Rate	$147.75
Rate for Payer: Aetna Commercial	$47.21
Rate for Payer: Aetna Medicare	$98.50
Rate for Payer: BCBS Complete	$24.38
Rate for Payer: BCN Commercial	$63.24
Rate for Payer: Cash Price	$157.60
Rate for Payer: Cash Price	$157.60
Rate for Payer: Mclaren Medicaid	$23.22
Rate for Payer: Meridian Medicaid	$24.38
Rate for Payer: Opus (Opus Packaging Group) HMA	$147.75
Rate for Payer: Priority Health Choice Medicaid	$23.22
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$57.88
Rate for Payer: Priority Health Narrow/Tiered Network	$57.88
Rate for Payer: UHC Medicaid	$23.22
Rate for Payer: UHCCP Medicaid	$23.22

PR PUNCTURE SHUNT TUBE/RESERVOIR ASPIRATION/INJ PX

Professional

Both

$413.00

Service Code	HCPCS 61070
Min. Negotiated Rate	$32.80
Max. Negotiated Rate	$309.75
Rate for Payer: Aetna Commercial	$71.83
Rate for Payer: Aetna Medicare	$206.50
Rate for Payer: BCBS Complete	$34.44
Rate for Payer: BCN Commercial	$116.27
Rate for Payer: Cash Price	$330.40
Rate for Payer: Cash Price	$330.40
Rate for Payer: Mclaren Medicaid	$32.80
Rate for Payer: Meridian Medicaid	$34.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$309.75
Rate for Payer: Priority Health Choice Medicaid	$32.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$97.76
Rate for Payer: Priority Health Narrow/Tiered Network	$97.76
Rate for Payer: UHC Medicaid	$32.80
Rate for Payer: UHCCP Medicaid	$32.80

PR PURE TONE AUDIOMETRY AIR & BONE

Professional

Both

$67.00

Service Code	HCPCS 92553
Min. Negotiated Rate	$33.50
Max. Negotiated Rate	$72.21
Rate for Payer: Aetna Commercial	$40.97
Rate for Payer: Aetna Medicare	$33.50
Rate for Payer: BCN Commercial	$72.21
Rate for Payer: Cash Price	$53.60
Rate for Payer: Cash Price	$53.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$50.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$66.59
Rate for Payer: Priority Health Narrow/Tiered Network	$66.59

PR PURE TONE AUDIOMETRY AIR ONLY

Professional

Both

$56.00

Service Code	HCPCS 92552
Min. Negotiated Rate	$28.00
Max. Negotiated Rate	$59.76
Rate for Payer: Aetna Commercial	$33.49
Rate for Payer: Aetna Medicare	$28.00
Rate for Payer: BCN Commercial	$59.76
Rate for Payer: Cash Price	$44.80
Rate for Payer: Cash Price	$44.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$42.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$55.12
Rate for Payer: Priority Health Narrow/Tiered Network	$55.12

PR PVB THORACIC CONT CATHETER INFUSION W/IMG GID

Professional

Both

$327.00

Service Code	HCPCS 64463
Min. Negotiated Rate	$48.78
Max. Negotiated Rate	$245.25
Rate for Payer: Aetna Commercial	$107.31
Rate for Payer: Aetna Medicare	$163.50
Rate for Payer: BCBS Complete	$51.22
Rate for Payer: BCN Commercial	$120.51
Rate for Payer: Cash Price	$261.60
Rate for Payer: Cash Price	$261.60
Rate for Payer: Mclaren Medicaid	$48.78
Rate for Payer: Meridian Medicaid	$51.22
Rate for Payer: Opus (Opus Packaging Group) HMA	$245.25
Rate for Payer: Priority Health Choice Medicaid	$48.78
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$139.97
Rate for Payer: Priority Health Narrow/Tiered Network	$139.97
Rate for Payer: UHC Medicaid	$48.78
Rate for Payer: UHCCP Medicaid	$48.78

PR PYELOPLASTY COMPLICATED

Professional

Both

$2,748.00

Service Code	HCPCS 50405
Min. Negotiated Rate	$793.00
Max. Negotiated Rate	$2,261.54
Rate for Payer: Aetna Commercial	$1,790.90
Rate for Payer: Aetna Medicare	$1,374.00
Rate for Payer: BCBS Complete	$832.65
Rate for Payer: BCN Commercial	$2,076.08
Rate for Payer: Cash Price	$2,198.40
Rate for Payer: Cash Price	$2,198.40
Rate for Payer: Mclaren Medicaid	$793.00
Rate for Payer: Meridian Medicaid	$832.65
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,061.00
Rate for Payer: Priority Health Choice Medicaid	$793.00
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,261.54
Rate for Payer: Priority Health Narrow/Tiered Network	$2,261.54
Rate for Payer: UHC Medicaid	$793.00
Rate for Payer: UHCCP Medicaid	$793.00

PR PYELOPLASTY SIMPLE

Professional

Both

$1,849.00

Service Code	HCPCS 50400
Min. Negotiated Rate	$658.81
Max. Negotiated Rate	$1,874.76
Rate for Payer: Aetna Commercial	$1,482.71
Rate for Payer: Aetna Medicare	$924.50
Rate for Payer: BCBS Complete	$691.75
Rate for Payer: BCN Commercial	$1,721.03
Rate for Payer: Cash Price	$1,479.20
Rate for Payer: Cash Price	$1,479.20
Rate for Payer: Mclaren Medicaid	$658.81
Rate for Payer: Meridian Medicaid	$691.75
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,386.75
Rate for Payer: Priority Health Choice Medicaid	$658.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,874.76
Rate for Payer: Priority Health Narrow/Tiered Network	$1,874.76
Rate for Payer: UHC Medicaid	$658.81
Rate for Payer: UHCCP Medicaid	$658.81

PR PYLOROMYOTOMY CUTTING PYLORIC MUSC

Professional

Both

$2,324.00

Service Code	HCPCS 43520
Min. Negotiated Rate	$434.31
Max. Negotiated Rate	$1,743.00
Rate for Payer: Aetna Commercial	$925.56
Rate for Payer: Aetna Medicare	$1,162.00
Rate for Payer: BCBS Complete	$456.03
Rate for Payer: BCN Commercial	$1,077.13
Rate for Payer: Cash Price	$1,859.20
Rate for Payer: Cash Price	$1,859.20
Rate for Payer: Mclaren Medicaid	$434.31
Rate for Payer: Meridian Medicaid	$456.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,743.00
Rate for Payer: Priority Health Choice Medicaid	$434.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,312.41
Rate for Payer: Priority Health Narrow/Tiered Network	$1,312.41
Rate for Payer: UHC Medicaid	$434.31
Rate for Payer: UHCCP Medicaid	$434.31

PR PYLOROPLASTY

Professional

Both

$2,634.00

Service Code	HCPCS 43800
Min. Negotiated Rate	$555.50
Max. Negotiated Rate	$1,975.50
Rate for Payer: Aetna Commercial	$1,258.80
Rate for Payer: Aetna Medicare	$1,317.00
Rate for Payer: BCBS Complete	$583.27
Rate for Payer: BCN Commercial	$1,398.83
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Cash Price	$2,107.20
Rate for Payer: Mclaren Medicaid	$555.50
Rate for Payer: Meridian Medicaid	$583.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,975.50
Rate for Payer: Priority Health Choice Medicaid	$555.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,704.38
Rate for Payer: Priority Health Narrow/Tiered Network	$1,704.38
Rate for Payer: UHC Medicaid	$555.50
Rate for Payer: UHCCP Medicaid	$555.50

PR QUADRICEPSPLASTY

Professional

Both

$2,110.00

Service Code	HCPCS 27430
Min. Negotiated Rate	$445.81
Max. Negotiated Rate	$1,582.50
Rate for Payer: Aetna Commercial	$990.95
Rate for Payer: Aetna Medicare	$1,055.00
Rate for Payer: BCBS Complete	$468.10
Rate for Payer: BCN Commercial	$1,132.41
Rate for Payer: Cash Price	$1,688.00
Rate for Payer: Cash Price	$1,688.00
Rate for Payer: Mclaren Medicaid	$445.81
Rate for Payer: Meridian Medicaid	$468.10
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,582.50
Rate for Payer: Priority Health Choice Medicaid	$445.81
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,210.51
Rate for Payer: Priority Health Narrow/Tiered Network	$1,210.51
Rate for Payer: UHC Medicaid	$445.81
Rate for Payer: UHCCP Medicaid	$445.81

PR QUAL NONMD EST PT 11-20M

Professional

Both

$37.00

Service Code	HCPCS G2062
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$27.75
Rate for Payer: Aetna Medicare	$18.50
Rate for Payer: BCBS Complete	$14.80
Rate for Payer: Cash Price	$29.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.75

PR QUAL NONMD EST PT 21>MIN

Professional

Both

$37.00

Service Code	HCPCS G2063
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$27.75
Rate for Payer: Aetna Medicare	$18.50
Rate for Payer: BCBS Complete	$14.80
Rate for Payer: Cash Price	$29.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.75

PR QUAL NONMD EST PT 5-10M

Professional

Both

$37.00

Service Code	HCPCS G2061
Min. Negotiated Rate	$14.80
Max. Negotiated Rate	$27.75
Rate for Payer: Aetna Medicare	$18.50
Rate for Payer: BCBS Complete	$14.80
Rate for Payer: Cash Price	$29.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$27.75

PR RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ

Professional

Both

$227.00

Service Code	HCPCS 90375
Min. Negotiated Rate	$113.50
Max. Negotiated Rate	$347.06
Rate for Payer: Aetna Commercial	$289.98
Rate for Payer: Aetna Medicare	$113.50
Rate for Payer: BCBS Trust/PPO	$347.06
Rate for Payer: BCN Commercial	$334.80
Rate for Payer: Cash Price	$181.60
Rate for Payer: Cash Price	$181.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$170.25

PR RABIES VACCINE INTRAMUSCULAR

Professional

Both

$214.00

Service Code	HCPCS 90675
Min. Negotiated Rate	$107.00
Max. Negotiated Rate	$443.93
Rate for Payer: Aetna Commercial	$324.74
Rate for Payer: Aetna Medicare	$107.00
Rate for Payer: BCBS Trust/PPO	$434.61
Rate for Payer: BCN Commercial	$443.93
Rate for Payer: Cash Price	$171.20
Rate for Payer: Cash Price	$171.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$160.50

PR RAD ABDL HYSTERECTOMY W/BI PELVIC LMPHADENECTOMY

Professional

Both

$6,209.00

Service Code	HCPCS 58210
Min. Negotiated Rate	$1,069.90
Max. Negotiated Rate	$4,656.75
Rate for Payer: Aetna Commercial	$2,168.52
Rate for Payer: Aetna Medicare	$3,104.50
Rate for Payer: BCBS Complete	$1,123.39
Rate for Payer: BCN Commercial	$2,732.92
Rate for Payer: Cash Price	$4,967.20
Rate for Payer: Cash Price	$4,967.20
Rate for Payer: Mclaren Medicaid	$1,069.90
Rate for Payer: Meridian Medicaid	$1,123.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,656.75
Rate for Payer: Priority Health Choice Medicaid	$1,069.90
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,767.86
Rate for Payer: Priority Health Narrow/Tiered Network	$2,767.86
Rate for Payer: UHC Medicaid	$1,069.90
Rate for Payer: UHCCP Medicaid	$1,069.90

PR RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS

Professional

Both

$2,801.00

Service Code	HCPCS 25115
Min. Negotiated Rate	$448.58
Max. Negotiated Rate	$2,100.75
Rate for Payer: Aetna Commercial	$1,005.89
Rate for Payer: Aetna Medicare	$1,400.50
Rate for Payer: BCBS Complete	$471.01
Rate for Payer: BCN Commercial	$1,162.29
Rate for Payer: Cash Price	$2,240.80
Rate for Payer: Cash Price	$2,240.80
Rate for Payer: Mclaren Medicaid	$448.58
Rate for Payer: Meridian Medicaid	$471.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,100.75
Rate for Payer: Priority Health Choice Medicaid	$448.58
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,242.46
Rate for Payer: Priority Health Narrow/Tiered Network	$1,242.46
Rate for Payer: UHC Medicaid	$448.58
Rate for Payer: UHCCP Medicaid	$448.58

PR RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS

Professional

Both

$2,400.00

Service Code	HCPCS 25116
Min. Negotiated Rate	$364.23
Max. Negotiated Rate	$1,800.00
Rate for Payer: Aetna Commercial	$800.80
Rate for Payer: Aetna Medicare	$1,200.00
Rate for Payer: BCBS Complete	$382.44
Rate for Payer: BCN Commercial	$931.72
Rate for Payer: Cash Price	$1,920.00
Rate for Payer: Cash Price	$1,920.00
Rate for Payer: Mclaren Medicaid	$364.23
Rate for Payer: Meridian Medicaid	$382.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,800.00
Rate for Payer: Priority Health Choice Medicaid	$364.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$995.98
Rate for Payer: Priority Health Narrow/Tiered Network	$995.98
Rate for Payer: UHC Medicaid	$364.23
Rate for Payer: UHCCP Medicaid	$364.23

PR RAD EXC XTRNL AUDITORY CANAL LES W/O NCK DSJ

Professional

Both

$1,959.00

Service Code	HCPCS 69150
Min. Negotiated Rate	$574.04
Max. Negotiated Rate	$1,501.91
Rate for Payer: Aetna Commercial	$1,163.90
Rate for Payer: Aetna Medicare	$979.50
Rate for Payer: BCBS Complete	$602.74
Rate for Payer: BCN Commercial	$1,501.91
Rate for Payer: Cash Price	$1,567.20
Rate for Payer: Cash Price	$1,567.20
Rate for Payer: Mclaren Medicaid	$574.04
Rate for Payer: Meridian Medicaid	$602.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,469.25
Rate for Payer: Priority Health Choice Medicaid	$574.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,484.04
Rate for Payer: Priority Health Narrow/Tiered Network	$1,484.04
Rate for Payer: UHC Medicaid	$574.04
Rate for Payer: UHCCP Medicaid	$574.04

PR RADICAL RESCJ TONSIL CLOSURE W/LOCAL FLAP

Professional

Both

$3,131.00

Service Code	HCPCS 42844
Min. Negotiated Rate	$783.41
Max. Negotiated Rate	$2,501.67
Rate for Payer: Aetna Commercial	$1,833.58
Rate for Payer: Aetna Medicare	$1,565.50
Rate for Payer: BCBS Complete	$822.58
Rate for Payer: BCN Commercial	$2,053.18
Rate for Payer: Cash Price	$2,504.80
Rate for Payer: Cash Price	$2,504.80
Rate for Payer: Mclaren Medicaid	$783.41
Rate for Payer: Meridian Medicaid	$822.58
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,348.25
Rate for Payer: Priority Health Choice Medicaid	$783.41
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,501.67
Rate for Payer: Priority Health Narrow/Tiered Network	$2,501.67
Rate for Payer: UHC Medicaid	$783.41
Rate for Payer: UHCCP Medicaid	$783.41

PR RADICAL RESECTION STERNUM

Professional

Both

$2,754.00

Service Code	HCPCS 21630
Min. Negotiated Rate	$746.57
Max. Negotiated Rate	$2,117.59
Rate for Payer: Aetna Commercial	$1,601.13
Rate for Payer: Aetna Medicare	$1,377.00
Rate for Payer: BCBS Complete	$783.90
Rate for Payer: BCN Commercial	$1,980.97
Rate for Payer: Cash Price	$2,203.20
Rate for Payer: Cash Price	$2,203.20
Rate for Payer: Mclaren Medicaid	$746.57
Rate for Payer: Meridian Medicaid	$783.90
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,065.50
Rate for Payer: Priority Health Choice Medicaid	$746.57
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,117.59
Rate for Payer: Priority Health Narrow/Tiered Network	$2,117.59
Rate for Payer: UHC Medicaid	$746.57
Rate for Payer: UHCCP Medicaid	$746.57

Know your out-of-pocket cost for care.

All Charges