Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON

Professional

Both

$233.00

Service Code	HCPCS 15850
Min. Negotiated Rate	$93.20
Max. Negotiated Rate	$174.75
Rate for Payer: Aetna Medicare	$116.50
Rate for Payer: BCBS Complete	$93.20
Rate for Payer: Cash Price	$186.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$174.75

PR REMOVAL TISSUE EXPANDER W/O INSERTION IMPLANT

Professional

Both

$958.00

Service Code	HCPCS 11971
Min. Negotiated Rate	$328.87
Max. Negotiated Rate	$839.59
Rate for Payer: Aetna Commercial	$589.15
Rate for Payer: Aetna Medicare	$479.00
Rate for Payer: BCBS Complete	$345.31
Rate for Payer: BCN Commercial	$839.59
Rate for Payer: Cash Price	$766.40
Rate for Payer: Cash Price	$766.40
Rate for Payer: Mclaren Medicaid	$328.87
Rate for Payer: Meridian Medicaid	$345.31
Rate for Payer: Opus (Opus Packaging Group) HMA	$718.50
Rate for Payer: Priority Health Choice Medicaid	$328.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$768.44
Rate for Payer: Priority Health Narrow/Tiered Network	$768.44
Rate for Payer: UHC Medicaid	$328.87
Rate for Payer: UHCCP Medicaid	$328.87

PR REMOVAL TUNNELED INTRAPERITONEAL CATHETER

Professional

Both

$1,010.00

Service Code	HCPCS 49422
Min. Negotiated Rate	$128.65
Max. Negotiated Rate	$757.50
Rate for Payer: Aetna Commercial	$299.91
Rate for Payer: Aetna Medicare	$505.00
Rate for Payer: BCBS Complete	$135.08
Rate for Payer: BCN Commercial	$328.17
Rate for Payer: Cash Price	$808.00
Rate for Payer: Cash Price	$808.00
Rate for Payer: Mclaren Medicaid	$128.65
Rate for Payer: Meridian Medicaid	$135.08
Rate for Payer: Opus (Opus Packaging Group) HMA	$757.50
Rate for Payer: Priority Health Choice Medicaid	$128.65
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$399.85
Rate for Payer: Priority Health Narrow/Tiered Network	$399.85
Rate for Payer: UHC Medicaid	$128.65
Rate for Payer: UHCCP Medicaid	$128.65

PR REMOVAL VENTR ASSIST DEVICE XTRCORP 1 VENTRICLE

Professional

Both

$3,481.00

Service Code	HCPCS 33977
Min. Negotiated Rate	$660.30
Max. Negotiated Rate	$2,610.75
Rate for Payer: Aetna Commercial	$1,503.29
Rate for Payer: Aetna Medicare	$1,740.50
Rate for Payer: BCBS Complete	$693.32
Rate for Payer: BCN Commercial	$1,648.32
Rate for Payer: Cash Price	$2,784.80
Rate for Payer: Cash Price	$2,784.80
Rate for Payer: Mclaren Medicaid	$660.30
Rate for Payer: Meridian Medicaid	$693.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,610.75
Rate for Payer: Priority Health Choice Medicaid	$660.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,772.56
Rate for Payer: Priority Health Narrow/Tiered Network	$1,772.56
Rate for Payer: UHC Medicaid	$660.30
Rate for Payer: UHCCP Medicaid	$660.30

PR REMOVAL WRIST PROSTH COMPLICATED W/TOTAL WRIST

Professional

Both

$1,393.00

Service Code	HCPCS 25251
Min. Negotiated Rate	$432.18
Max. Negotiated Rate	$1,176.45
Rate for Payer: Aetna Commercial	$960.15
Rate for Payer: Aetna Medicare	$696.50
Rate for Payer: BCBS Complete	$453.79
Rate for Payer: BCN Commercial	$1,100.54
Rate for Payer: Cash Price	$1,114.40
Rate for Payer: Cash Price	$1,114.40
Rate for Payer: Mclaren Medicaid	$432.18
Rate for Payer: Meridian Medicaid	$453.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,044.75
Rate for Payer: Priority Health Choice Medicaid	$432.18
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,176.45
Rate for Payer: Priority Health Narrow/Tiered Network	$1,176.45
Rate for Payer: UHC Medicaid	$432.18
Rate for Payer: UHCCP Medicaid	$432.18

PR REMOVE BILE DUCT STONE, PERCUT

Professional

Both

$931.00

Service Code	HCPCS 47630
Min. Negotiated Rate	$372.40
Max. Negotiated Rate	$698.25
Rate for Payer: Aetna Medicare	$465.50
Rate for Payer: BCBS Complete	$372.40
Rate for Payer: Cash Price	$744.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$698.25

PR REMOVE DEEP SHOULDER FOREIGN BODY

Professional

Both

$1,070.00

Service Code	HCPCS 23331
Min. Negotiated Rate	$428.00
Max. Negotiated Rate	$802.50
Rate for Payer: Aetna Medicare	$535.00
Rate for Payer: BCBS Complete	$428.00
Rate for Payer: Cash Price	$856.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$802.50

PR REMOVE INT DWELL URETERAL STENT TRANSURETHRAL

Professional

Both

$1,629.00

Service Code	HCPCS 50386
Min. Negotiated Rate	$91.80
Max. Negotiated Rate	$1,221.75
Rate for Payer: Aetna Commercial	$206.76
Rate for Payer: Aetna Medicare	$814.50
Rate for Payer: BCBS Complete	$96.39
Rate for Payer: BCN Commercial	$241.02
Rate for Payer: Cash Price	$1,303.20
Rate for Payer: Cash Price	$1,303.20
Rate for Payer: Mclaren Medicaid	$91.80
Rate for Payer: Meridian Medicaid	$96.39
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,221.75
Rate for Payer: Priority Health Choice Medicaid	$91.80
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$262.56
Rate for Payer: Priority Health Narrow/Tiered Network	$262.56
Rate for Payer: UHC Medicaid	$91.80
Rate for Payer: UHCCP Medicaid	$91.80

PR REMOVE NAIL BED/FINGER TIP

Professional

Both

$546.00

Service Code	HCPCS 11752
Min. Negotiated Rate	$218.40
Max. Negotiated Rate	$409.50
Rate for Payer: Aetna Medicare	$273.00
Rate for Payer: BCBS Complete	$218.40
Rate for Payer: Cash Price	$436.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$409.50

PR REMOVE & REPLACE INDWELL URETERAL STENT TRURTHRL

Professional

Both

$2,156.00

Service Code	HCPCS 50385
Min. Negotiated Rate	$120.77
Max. Negotiated Rate	$1,617.00
Rate for Payer: Aetna Commercial	$279.88
Rate for Payer: Aetna Medicare	$1,078.00
Rate for Payer: BCBS Complete	$126.81
Rate for Payer: BCN Commercial	$318.21
Rate for Payer: Cash Price	$1,724.80
Rate for Payer: Cash Price	$1,724.80
Rate for Payer: Mclaren Medicaid	$120.77
Rate for Payer: Meridian Medicaid	$126.81
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,617.00
Rate for Payer: Priority Health Choice Medicaid	$120.77
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$346.63
Rate for Payer: Priority Health Narrow/Tiered Network	$346.63
Rate for Payer: UHC Medicaid	$120.77
Rate for Payer: UHCCP Medicaid	$120.77

PR REMVL INFLATABLE URETHRAL/BLADDER NECK SPHINCTER

Professional

Both

$1,982.00

Service Code	HCPCS 53446
Min. Negotiated Rate	$374.45
Max. Negotiated Rate	$1,486.50
Rate for Payer: Aetna Commercial	$823.67
Rate for Payer: Aetna Medicare	$991.00
Rate for Payer: BCBS Complete	$393.17
Rate for Payer: BCN Commercial	$965.58
Rate for Payer: Cash Price	$1,585.60
Rate for Payer: Cash Price	$1,585.60
Rate for Payer: Mclaren Medicaid	$374.45
Rate for Payer: Meridian Medicaid	$393.17
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,486.50
Rate for Payer: Priority Health Choice Medicaid	$374.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,051.84
Rate for Payer: Priority Health Narrow/Tiered Network	$1,051.84
Rate for Payer: UHC Medicaid	$374.45
Rate for Payer: UHCCP Medicaid	$374.45

PR REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD

Professional

Both

$723.00

Service Code	HCPCS 33227
Min. Negotiated Rate	$192.55
Max. Negotiated Rate	$542.25
Rate for Payer: Aetna Commercial	$454.03
Rate for Payer: Aetna Medicare	$361.50
Rate for Payer: BCBS Complete	$202.18
Rate for Payer: BCN Commercial	$500.47
Rate for Payer: Cash Price	$578.40
Rate for Payer: Cash Price	$578.40
Rate for Payer: Mclaren Medicaid	$192.55
Rate for Payer: Meridian Medicaid	$202.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$542.25
Rate for Payer: Priority Health Choice Medicaid	$192.55
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$538.19
Rate for Payer: Priority Health Narrow/Tiered Network	$538.19
Rate for Payer: UHC Medicaid	$192.55
Rate for Payer: UHCCP Medicaid	$192.55

PR REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS

Professional

Both

$749.00

Service Code	HCPCS 33228
Min. Negotiated Rate	$201.07
Max. Negotiated Rate	$563.37
Rate for Payer: Aetna Commercial	$475.59
Rate for Payer: Aetna Medicare	$374.50
Rate for Payer: BCBS Complete	$211.12
Rate for Payer: BCN Commercial	$523.88
Rate for Payer: Cash Price	$599.20
Rate for Payer: Cash Price	$599.20
Rate for Payer: Mclaren Medicaid	$201.07
Rate for Payer: Meridian Medicaid	$211.12
Rate for Payer: Opus (Opus Packaging Group) HMA	$561.75
Rate for Payer: Priority Health Choice Medicaid	$201.07
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$563.37
Rate for Payer: Priority Health Narrow/Tiered Network	$563.37
Rate for Payer: UHC Medicaid	$201.07
Rate for Payer: UHCCP Medicaid	$201.07

PR REMVL PERM PM PLS GEN W/REPL PLSE GEN MULT LEAD

Professional

Both

$595.00

Service Code	HCPCS 33229
Min. Negotiated Rate	$210.23
Max. Negotiated Rate	$590.67
Rate for Payer: Aetna Commercial	$502.63
Rate for Payer: Aetna Medicare	$297.50
Rate for Payer: BCBS Complete	$220.74
Rate for Payer: BCN Commercial	$549.28
Rate for Payer: Cash Price	$476.00
Rate for Payer: Cash Price	$476.00
Rate for Payer: Mclaren Medicaid	$210.23
Rate for Payer: Meridian Medicaid	$220.74
Rate for Payer: Opus (Opus Packaging Group) HMA	$446.25
Rate for Payer: Priority Health Choice Medicaid	$210.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$590.67
Rate for Payer: Priority Health Narrow/Tiered Network	$590.67
Rate for Payer: UHC Medicaid	$210.23
Rate for Payer: UHCCP Medicaid	$210.23

PR REMV TISSUE FOR GRAFT OTHR

Professional

Both

$844.00

Service Code	HCPCS 20926
Min. Negotiated Rate	$337.60
Max. Negotiated Rate	$633.00
Rate for Payer: Aetna Medicare	$422.00
Rate for Payer: BCBS Complete	$337.60
Rate for Payer: Cash Price	$675.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$633.00

PR RENAL ANGIO, CARDIAC CATH

Professional

Both

$37.00

Service Code	HCPCS G0275
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 RENAL BIOPSY PRQ TROCAR/NEEDLE

Professional

Both

$1,085.00

Service Code	HCPCS 50200
Min. Negotiated Rate	$70.29
Max. Negotiated Rate	$813.75
Rate for Payer: Aetna Commercial	$162.74
Rate for Payer: Aetna Medicare	$542.50
Rate for Payer: BCBS Complete	$73.80
Rate for Payer: BCN Commercial	$186.24
Rate for Payer: Cash Price	$868.00
Rate for Payer: Cash Price	$868.00
Rate for Payer: Mclaren Medicaid	$70.29
Rate for Payer: Meridian Medicaid	$73.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$813.75
Rate for Payer: Priority Health Choice Medicaid	$70.29
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$202.89
Rate for Payer: Priority Health Narrow/Tiered Network	$202.89
Rate for Payer: UHC Medicaid	$70.29
Rate for Payer: UHCCP Medicaid	$70.29

PR RENAL BIOPSY SURG EXPOSURE KIDNEY

Professional

Both

$1,750.00

Service Code	HCPCS 50205
Min. Negotiated Rate	$454.76
Max. Negotiated Rate	$1,312.50
Rate for Payer: Aetna Commercial	$974.57
Rate for Payer: Aetna Medicare	$875.00
Rate for Payer: BCBS Complete	$477.50
Rate for Payer: BCN Commercial	$1,137.89
Rate for Payer: Cash Price	$1,400.00
Rate for Payer: Cash Price	$1,400.00
Rate for Payer: Mclaren Medicaid	$454.76
Rate for Payer: Meridian Medicaid	$477.50
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,312.50
Rate for Payer: Priority Health Choice Medicaid	$454.76
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,239.53
Rate for Payer: Priority Health Narrow/Tiered Network	$1,239.53
Rate for Payer: UHC Medicaid	$454.76
Rate for Payer: UHCCP Medicaid	$454.76

PR RENAL ENDOSCOPY NEPHROSTOMY W/WO IRRIGATION

Professional

Both

$748.00

Service Code	HCPCS 50551
Min. Negotiated Rate	$165.50
Max. Negotiated Rate	$561.00
Rate for Payer: Aetna Commercial	$376.62
Rate for Payer: Aetna Medicare	$374.00
Rate for Payer: BCBS Complete	$173.78
Rate for Payer: BCN Commercial	$434.24
Rate for Payer: Cash Price	$598.40
Rate for Payer: Cash Price	$598.40
Rate for Payer: Mclaren Medicaid	$165.50
Rate for Payer: Meridian Medicaid	$173.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$561.00
Rate for Payer: Priority Health Choice Medicaid	$165.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$473.03
Rate for Payer: Priority Health Narrow/Tiered Network	$473.03
Rate for Payer: UHC Medicaid	$165.50
Rate for Payer: UHCCP Medicaid	$165.50

PR RENAL EXPLORATION NOT NECESSITATING OTH SPEC PX

Professional

Both

$2,589.00

Service Code	HCPCS 50010
Min. Negotiated Rate	$408.96
Max. Negotiated Rate	$1,941.75
Rate for Payer: Aetna Commercial	$951.04
Rate for Payer: Aetna Medicare	$1,294.50
Rate for Payer: BCBS Complete	$429.41
Rate for Payer: BCN Commercial	$1,057.21
Rate for Payer: Cash Price	$2,071.20
Rate for Payer: Cash Price	$2,071.20
Rate for Payer: Mclaren Medicaid	$408.96
Rate for Payer: Meridian Medicaid	$429.41
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,941.75
Rate for Payer: Priority Health Choice Medicaid	$408.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,151.66
Rate for Payer: Priority Health Narrow/Tiered Network	$1,151.66
Rate for Payer: UHC Medicaid	$408.96
Rate for Payer: UHCCP Medicaid	$408.96

PR RENAL NDSC NEPHROS/PYELOSTOMY BIOPSY

Professional

Both

$808.00

Service Code	HCPCS 50555
Min. Negotiated Rate	$191.27
Max. Negotiated Rate	$606.00
Rate for Payer: Aetna Commercial	$436.06
Rate for Payer: Aetna Medicare	$404.00
Rate for Payer: BCBS Complete	$200.83
Rate for Payer: BCN Commercial	$504.45
Rate for Payer: Cash Price	$646.40
Rate for Payer: Cash Price	$646.40
Rate for Payer: Mclaren Medicaid	$191.27
Rate for Payer: Meridian Medicaid	$200.83
Rate for Payer: Opus (Opus Packaging Group) HMA	$606.00
Rate for Payer: Priority Health Choice Medicaid	$191.27
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$549.52
Rate for Payer: Priority Health Narrow/Tiered Network	$549.52
Rate for Payer: UHC Medicaid	$191.27
Rate for Payer: UHCCP Medicaid	$191.27

PR RENAL NDSC NEPHROS/PYELOSTOMY FULG&/INC W/WO BI

Professional

Both

$856.00

Service Code	HCPCS 50557
Min. Negotiated Rate	$193.62
Max. Negotiated Rate	$642.00
Rate for Payer: Aetna Commercial	$442.24
Rate for Payer: Aetna Medicare	$428.00
Rate for Payer: BCBS Complete	$203.30
Rate for Payer: BCN Commercial	$510.44
Rate for Payer: Cash Price	$684.80
Rate for Payer: Cash Price	$684.80
Rate for Payer: Mclaren Medicaid	$193.62
Rate for Payer: Meridian Medicaid	$203.30
Rate for Payer: Opus (Opus Packaging Group) HMA	$642.00
Rate for Payer: Priority Health Choice Medicaid	$193.62
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$556.02
Rate for Payer: Priority Health Narrow/Tiered Network	$556.02
Rate for Payer: UHC Medicaid	$193.62
Rate for Payer: UHCCP Medicaid	$193.62

PR RENAL NDSC NEPHROS/PYELOSTOMY RMVL FB/CALCULUS

Professional

Both

$935.00

Service Code	HCPCS 50561
Min. Negotiated Rate	$220.88
Max. Negotiated Rate	$701.25
Rate for Payer: Aetna Commercial	$505.20
Rate for Payer: Aetna Medicare	$467.50
Rate for Payer: BCBS Complete	$231.92
Rate for Payer: BCN Commercial	$581.64
Rate for Payer: Cash Price	$748.00
Rate for Payer: Cash Price	$748.00
Rate for Payer: Mclaren Medicaid	$220.88
Rate for Payer: Meridian Medicaid	$231.92
Rate for Payer: Opus (Opus Packaging Group) HMA	$701.25
Rate for Payer: Priority Health Choice Medicaid	$220.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$633.60
Rate for Payer: Priority Health Narrow/Tiered Network	$633.60
Rate for Payer: UHC Medicaid	$220.88
Rate for Payer: UHCCP Medicaid	$220.88

PR RENAL NDSC NEPHROST W/URETERAL CATH W/WO DILA

Professional

Both

$748.00

Service Code	HCPCS 50553
Min. Negotiated Rate	$176.36
Max. Negotiated Rate	$561.00
Rate for Payer: Aetna Commercial	$402.76
Rate for Payer: Aetna Medicare	$374.00
Rate for Payer: BCBS Complete	$185.18
Rate for Payer: BCN Commercial	$463.62
Rate for Payer: Cash Price	$598.40
Rate for Payer: Cash Price	$598.40
Rate for Payer: Mclaren Medicaid	$176.36
Rate for Payer: Meridian Medicaid	$185.18
Rate for Payer: Opus (Opus Packaging Group) HMA	$561.00
Rate for Payer: Priority Health Choice Medicaid	$176.36
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$505.04
Rate for Payer: Priority Health Narrow/Tiered Network	$505.04
Rate for Payer: UHC Medicaid	$176.36
Rate for Payer: UHCCP Medicaid	$176.36

PR RENAL NDSC NEPHROTOMY W/WO IRRIGATION

Professional

Both

$983.00

Service Code	HCPCS 50570
Min. Negotiated Rate	$274.34
Max. Negotiated Rate	$788.74
Rate for Payer: Aetna Commercial	$629.91
Rate for Payer: Aetna Medicare	$491.50
Rate for Payer: BCBS Complete	$288.06
Rate for Payer: BCN Commercial	$724.06
Rate for Payer: Cash Price	$786.40
Rate for Payer: Cash Price	$786.40
Rate for Payer: Mclaren Medicaid	$274.34
Rate for Payer: Meridian Medicaid	$288.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$737.25
Rate for Payer: Priority Health Choice Medicaid	$274.34
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$788.74
Rate for Payer: Priority Health Narrow/Tiered Network	$788.74
Rate for Payer: UHC Medicaid	$274.34
Rate for Payer: UHCCP Medicaid	$274.34

Know your out-of-pocket cost for care.

All Charges