Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB IDRL

Professional

Both

$10,973.00

Service Code	HCPCS 61608
Min. Negotiated Rate	$2,016.05
Max. Negotiated Rate	$8,229.75
Rate for Payer: Aetna Commercial	$4,229.44
Rate for Payer: Aetna Medicare	$5,486.50
Rate for Payer: BCBS Complete	$2,116.85
Rate for Payer: BCN Commercial	$6,830.19
Rate for Payer: Cash Price	$8,778.40
Rate for Payer: Cash Price	$8,778.40
Rate for Payer: Mclaren Medicaid	$2,016.05
Rate for Payer: Meridian Medicaid	$2,116.85
Rate for Payer: Opus (Opus Packaging Group) HMA	$8,229.75
Rate for Payer: Priority Health Choice Medicaid	$2,016.05
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,742.31
Rate for Payer: Priority Health Narrow/Tiered Network	$5,742.31
Rate for Payer: UHC Medicaid	$2,016.05
Rate for Payer: UHCCP Medicaid	$2,016.05

PR RESCJ/EXC LES PARASELLAR SINUS CLIVUS/MSB XDRL

Professional

Both

$6,202.00

Service Code	HCPCS 61607
Min. Negotiated Rate	$1,589.83
Max. Negotiated Rate	$5,329.34
Rate for Payer: Aetna Commercial	$3,949.87
Rate for Payer: Aetna Medicare	$3,101.00
Rate for Payer: BCBS Complete	$1,669.32
Rate for Payer: BCN Commercial	$4,588.40
Rate for Payer: Cash Price	$4,961.60
Rate for Payer: Cash Price	$4,961.60
Rate for Payer: Mclaren Medicaid	$1,589.83
Rate for Payer: Meridian Medicaid	$1,669.32
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,651.50
Rate for Payer: Priority Health Choice Medicaid	$1,589.83
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,329.34
Rate for Payer: Priority Health Narrow/Tiered Network	$5,329.34
Rate for Payer: UHC Medicaid	$1,589.83
Rate for Payer: UHCCP Medicaid	$1,589.83

PR RESCJ PALATE/EXTENSIVE RESCJ LESION

Professional

Both

$2,114.00

Service Code	HCPCS 42120
Min. Negotiated Rate	$581.70
Max. Negotiated Rate	$1,829.38
Rate for Payer: Aetna Commercial	$1,336.73
Rate for Payer: Aetna Medicare	$1,057.00
Rate for Payer: BCBS Complete	$610.78
Rate for Payer: BCN Commercial	$1,501.41
Rate for Payer: Cash Price	$1,691.20
Rate for Payer: Cash Price	$1,691.20
Rate for Payer: Mclaren Medicaid	$581.70
Rate for Payer: Meridian Medicaid	$610.78
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,585.50
Rate for Payer: Priority Health Choice Medicaid	$581.70
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,829.38
Rate for Payer: Priority Health Narrow/Tiered Network	$1,829.38
Rate for Payer: UHC Medicaid	$581.70
Rate for Payer: UHCCP Medicaid	$581.70

PR RESCJ PRIM PRTL MAL W/BSO & OMNTC RAD DEBULKING

Professional

Both

$3,572.00

Service Code	HCPCS 58952
Min. Negotiated Rate	$969.15
Max. Negotiated Rate	$2,679.00
Rate for Payer: Aetna Commercial	$1,952.00
Rate for Payer: Aetna Medicare	$1,786.00
Rate for Payer: BCBS Complete	$1,017.61
Rate for Payer: BCN Commercial	$2,470.49
Rate for Payer: Cash Price	$2,857.60
Rate for Payer: Cash Price	$2,857.60
Rate for Payer: Mclaren Medicaid	$969.15
Rate for Payer: Meridian Medicaid	$1,017.61
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,679.00
Rate for Payer: Priority Health Choice Medicaid	$969.15
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,502.06
Rate for Payer: Priority Health Narrow/Tiered Network	$2,502.06
Rate for Payer: UHC Medicaid	$969.15
Rate for Payer: UHCCP Medicaid	$969.15

PR RESCJ PRIM PRTL MAL W/BSO & OMNTC TAH & LMPHAD

Professional

Both

$5,084.00

Service Code	HCPCS 58951
Min. Negotiated Rate	$848.59
Max. Negotiated Rate	$3,813.00
Rate for Payer: Aetna Commercial	$1,713.00
Rate for Payer: Aetna Medicare	$2,542.00
Rate for Payer: BCBS Complete	$891.02
Rate for Payer: BCN Commercial	$2,166.71
Rate for Payer: Cash Price	$4,067.20
Rate for Payer: Cash Price	$4,067.20
Rate for Payer: Mclaren Medicaid	$848.59
Rate for Payer: Meridian Medicaid	$891.02
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,813.00
Rate for Payer: Priority Health Choice Medicaid	$848.59
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,194.42
Rate for Payer: Priority Health Narrow/Tiered Network	$2,194.42
Rate for Payer: UHC Medicaid	$848.59
Rate for Payer: UHCCP Medicaid	$848.59

PR RESECJ/DBRDMT PANCREAS NECROTIZING PANCREATITIS

Professional

Both

$6,835.00

Service Code	HCPCS 48105
Min. Negotiated Rate	$1,629.88
Max. Negotiated Rate	$5,142.88
Rate for Payer: Aetna Commercial	$3,842.31
Rate for Payer: Aetna Medicare	$3,417.50
Rate for Payer: BCBS Complete	$1,711.37
Rate for Payer: BCN Commercial	$4,220.89
Rate for Payer: Cash Price	$5,468.00
Rate for Payer: Cash Price	$5,468.00
Rate for Payer: Mclaren Medicaid	$1,629.88
Rate for Payer: Meridian Medicaid	$1,711.37
Rate for Payer: Opus (Opus Packaging Group) HMA	$5,126.25
Rate for Payer: Priority Health Choice Medicaid	$1,629.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,142.88
Rate for Payer: Priority Health Narrow/Tiered Network	$5,142.88
Rate for Payer: UHC Medicaid	$1,629.88
Rate for Payer: UHCCP Medicaid	$1,629.88

PR RESECJ RECUR OVARIAN/TUBAL/PERITONEAL MALIGNANCY

Professional

Both

$3,425.00

Service Code	HCPCS 58957
Min. Negotiated Rate	$1,370.00
Max. Negotiated Rate	$2,568.75
Rate for Payer: Aetna Commercial	$1,889.07
Rate for Payer: Aetna Medicare	$1,712.50
Rate for Payer: BCBS Complete	$1,370.00
Rate for Payer: BCN Commercial	$2,362.28
Rate for Payer: Cash Price	$2,740.00
Rate for Payer: Cash Price	$2,740.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,568.75

PR RESEC RECURRENT LARYNX NERVE

Professional

Both

$1,418.00

Service Code	HCPCS 31595
Min. Negotiated Rate	$567.20
Max. Negotiated Rate	$1,063.50
Rate for Payer: Aetna Medicare	$709.00
Rate for Payer: BCBS Complete	$567.20
Rate for Payer: Cash Price	$1,134.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,063.50

PR RESECTION CONDYLE DISTAL END PHALANX EACH TOE

Professional

Both

$674.00

Service Code	HCPCS 28153
Min. Negotiated Rate	$159.96
Max. Negotiated Rate	$505.50
Rate for Payer: Aetna Commercial	$347.52
Rate for Payer: Aetna Medicare	$337.00
Rate for Payer: BCBS Complete	$167.96
Rate for Payer: BCN Commercial	$400.87
Rate for Payer: Cash Price	$539.20
Rate for Payer: Cash Price	$539.20
Rate for Payer: Mclaren Medicaid	$159.96
Rate for Payer: Meridian Medicaid	$167.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$505.50
Rate for Payer: Priority Health Choice Medicaid	$159.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$428.52
Rate for Payer: Priority Health Narrow/Tiered Network	$428.52
Rate for Payer: UHC Medicaid	$159.96
Rate for Payer: UHCCP Medicaid	$159.96

PR RESECTION EXTERNAL CARDIAC TUMOR

Professional

Both

$4,783.00

Service Code	HCPCS 33130
Min. Negotiated Rate	$835.39
Max. Negotiated Rate	$3,587.25
Rate for Payer: Aetna Commercial	$1,832.84
Rate for Payer: Aetna Medicare	$2,391.50
Rate for Payer: BCBS Complete	$877.16
Rate for Payer: BCN Commercial	$2,011.84
Rate for Payer: Cash Price	$3,826.40
Rate for Payer: Cash Price	$3,826.40
Rate for Payer: Mclaren Medicaid	$835.39
Rate for Payer: Meridian Medicaid	$877.16
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,587.25
Rate for Payer: Priority Health Choice Medicaid	$835.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,163.48
Rate for Payer: Priority Health Narrow/Tiered Network	$2,163.48
Rate for Payer: UHC Medicaid	$835.39
Rate for Payer: UHCCP Medicaid	$835.39

PR RESECTION HUMERAL HEAD

Professional

Both

$1,694.00

Service Code	HCPCS 23195
Min. Negotiated Rate	$452.63
Max. Negotiated Rate	$1,270.50
Rate for Payer: Aetna Commercial	$996.87
Rate for Payer: Aetna Medicare	$847.00
Rate for Payer: BCBS Complete	$475.26
Rate for Payer: BCN Commercial	$1,143.36
Rate for Payer: Cash Price	$1,355.20
Rate for Payer: Cash Price	$1,355.20
Rate for Payer: Mclaren Medicaid	$452.63
Rate for Payer: Meridian Medicaid	$475.26
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,270.50
Rate for Payer: Priority Health Choice Medicaid	$452.63
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,222.23
Rate for Payer: Priority Health Narrow/Tiered Network	$1,222.23
Rate for Payer: UHC Medicaid	$452.63
Rate for Payer: UHCCP Medicaid	$452.63

PR RESECTION/INCISION SUBVALVULAR TISSUE

Professional

Both

$6,407.00

Service Code	HCPCS 33415
Min. Negotiated Rate	$1,214.31
Max. Negotiated Rate	$4,805.25
Rate for Payer: Aetna Commercial	$2,718.53
Rate for Payer: Aetna Medicare	$3,203.50
Rate for Payer: BCBS Complete	$1,275.03
Rate for Payer: BCN Commercial	$2,979.92
Rate for Payer: Cash Price	$5,125.60
Rate for Payer: Cash Price	$5,125.60
Rate for Payer: Mclaren Medicaid	$1,214.31
Rate for Payer: Meridian Medicaid	$1,275.03
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,805.25
Rate for Payer: Priority Health Choice Medicaid	$1,214.31
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$3,204.52
Rate for Payer: Priority Health Narrow/Tiered Network	$3,204.52
Rate for Payer: UHC Medicaid	$1,214.31
Rate for Payer: UHCCP Medicaid	$1,214.31

PR RESECTION MEDIASTINAL TUMOR

Professional

Both

$5,955.00

Service Code	HCPCS 39220
Min. Negotiated Rate	$680.96
Max. Negotiated Rate	$4,466.25
Rate for Payer: Aetna Commercial	$1,157.21
Rate for Payer: Aetna Medicare	$2,977.50
Rate for Payer: BCBS Complete	$715.01
Rate for Payer: BCN Commercial	$1,690.65
Rate for Payer: Cash Price	$4,764.00
Rate for Payer: Cash Price	$4,764.00
Rate for Payer: Mclaren Medicaid	$680.96
Rate for Payer: Meridian Medicaid	$715.01
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,466.25
Rate for Payer: Priority Health Choice Medicaid	$680.96
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,818.07
Rate for Payer: Priority Health Narrow/Tiered Network	$1,818.07
Rate for Payer: UHC Medicaid	$680.96
Rate for Payer: UHCCP Medicaid	$680.96

PR RESECTION OF MEDIASTINAL CYST

Professional

Both

$5,192.00

Service Code	HCPCS 39200
Min. Negotiated Rate	$530.37
Max. Negotiated Rate	$3,894.00
Rate for Payer: Aetna Commercial	$891.30
Rate for Payer: Aetna Medicare	$2,596.00
Rate for Payer: BCBS Complete	$556.89
Rate for Payer: BCN Commercial	$1,289.77
Rate for Payer: Cash Price	$4,153.60
Rate for Payer: Cash Price	$4,153.60
Rate for Payer: Mclaren Medicaid	$530.37
Rate for Payer: Meridian Medicaid	$556.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,894.00
Rate for Payer: Priority Health Choice Medicaid	$530.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,386.98
Rate for Payer: Priority Health Narrow/Tiered Network	$1,386.98
Rate for Payer: UHC Medicaid	$530.37
Rate for Payer: UHCCP Medicaid	$530.37

PR RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH

Professional

Both

$714.00

Service Code	HCPCS 28126
Min. Negotiated Rate	$151.87
Max. Negotiated Rate	$535.50
Rate for Payer: Aetna Commercial	$324.47
Rate for Payer: Aetna Medicare	$357.00
Rate for Payer: BCBS Complete	$159.46
Rate for Payer: BCN Commercial	$379.96
Rate for Payer: Cash Price	$571.20
Rate for Payer: Cash Price	$571.20
Rate for Payer: Mclaren Medicaid	$151.87
Rate for Payer: Meridian Medicaid	$159.46
Rate for Payer: Opus (Opus Packaging Group) HMA	$535.50
Rate for Payer: Priority Health Choice Medicaid	$151.87
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$406.16
Rate for Payer: Priority Health Narrow/Tiered Network	$406.16
Rate for Payer: UHC Medicaid	$151.87
Rate for Payer: UHCCP Medicaid	$151.87

PR RESECTION PERICARDIAL CYST/TUMOR

Professional

Both

$2,955.00

Service Code	HCPCS 33050
Min. Negotiated Rate	$618.13
Max. Negotiated Rate	$2,216.25
Rate for Payer: Aetna Commercial	$1,346.58
Rate for Payer: Aetna Medicare	$1,477.50
Rate for Payer: BCBS Complete	$649.04
Rate for Payer: BCN Commercial	$1,493.94
Rate for Payer: Cash Price	$2,364.00
Rate for Payer: Cash Price	$2,364.00
Rate for Payer: Mclaren Medicaid	$618.13
Rate for Payer: Meridian Medicaid	$649.04
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,216.25
Rate for Payer: Priority Health Choice Medicaid	$618.13
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,606.55
Rate for Payer: Priority Health Narrow/Tiered Network	$1,606.55
Rate for Payer: UHC Medicaid	$618.13
Rate for Payer: UHCCP Medicaid	$618.13

PR RESECTION RIBS EXTRAPLEURAL ALL STAGES

Professional

Both

$3,238.00

Service Code	HCPCS 32900
Min. Negotiated Rate	$823.88
Max. Negotiated Rate	$2,428.50
Rate for Payer: Aetna Commercial	$1,838.39
Rate for Payer: Aetna Medicare	$1,619.00
Rate for Payer: BCBS Complete	$865.07
Rate for Payer: BCN Commercial	$2,174.18
Rate for Payer: Cash Price	$2,590.40
Rate for Payer: Cash Price	$2,590.40
Rate for Payer: Mclaren Medicaid	$823.88
Rate for Payer: Meridian Medicaid	$865.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,428.50
Rate for Payer: Priority Health Choice Medicaid	$823.88
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,047.44
Rate for Payer: Priority Health Narrow/Tiered Network	$2,047.44
Rate for Payer: UHC Medicaid	$823.88
Rate for Payer: UHCCP Medicaid	$823.88

PR RESECTION SCROTUM

Professional

Both

$1,634.00

Service Code	HCPCS 55150
Min. Negotiated Rate	$290.53
Max. Negotiated Rate	$1,225.50
Rate for Payer: Aetna Commercial	$631.01
Rate for Payer: Aetna Medicare	$817.00
Rate for Payer: BCBS Complete	$305.06
Rate for Payer: BCN Commercial	$743.98
Rate for Payer: Cash Price	$1,307.20
Rate for Payer: Cash Price	$1,307.20
Rate for Payer: Mclaren Medicaid	$290.53
Rate for Payer: Meridian Medicaid	$305.06
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,225.50
Rate for Payer: Priority Health Choice Medicaid	$290.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$810.45
Rate for Payer: Priority Health Narrow/Tiered Network	$810.45
Rate for Payer: UHC Medicaid	$290.53
Rate for Payer: UHCCP Medicaid	$290.53

PR RESECTION/TRANSPLANTATION LONG TENDON BICEPS

Professional

Both

$1,394.00

Service Code	HCPCS 23440
Min. Negotiated Rate	$447.30
Max. Negotiated Rate	$1,232.34
Rate for Payer: Aetna Commercial	$1,010.45
Rate for Payer: Aetna Medicare	$697.00
Rate for Payer: BCBS Complete	$469.67
Rate for Payer: BCN Commercial	$1,152.83
Rate for Payer: Cash Price	$1,115.20
Rate for Payer: Cash Price	$1,115.20
Rate for Payer: Mclaren Medicaid	$447.30
Rate for Payer: Meridian Medicaid	$469.67
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,045.50
Rate for Payer: Priority Health Choice Medicaid	$447.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,232.34
Rate for Payer: Priority Health Narrow/Tiered Network	$1,232.34
Rate for Payer: UHC Medicaid	$447.30
Rate for Payer: UHCCP Medicaid	$447.30

PR RESPIRATORY FLOW VOLUME LOOP

Professional

Both

$115.00

Service Code	HCPCS 94375
Min. Negotiated Rate	$41.36
Max. Negotiated Rate	$86.25
Rate for Payer: Aetna Commercial	$41.36
Rate for Payer: Aetna Medicare	$57.50
Rate for Payer: BCN Commercial	$58.26
Rate for Payer: Cash Price	$92.00
Rate for Payer: Cash Price	$92.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$86.25
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$53.74
Rate for Payer: Priority Health Narrow/Tiered Network	$53.74

PR RESPIRATORY SYNCYTIAL VIRUS IG IM 50 MG E

Professional

Both

$3,801.00

Service Code	HCPCS 90378
Min. Negotiated Rate	$1,791.52
Max. Negotiated Rate	$2,850.75
Rate for Payer: Aetna Commercial	$1,857.07
Rate for Payer: Aetna Medicare	$1,900.50
Rate for Payer: BCBS Trust/PPO	$1,820.66
Rate for Payer: BCN Commercial	$1,791.52
Rate for Payer: Cash Price	$3,040.80
Rate for Payer: Cash Price	$3,040.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,850.75

PR REVASCULARIZATION ILIAC ART ANGIOP EA IPSI VSL

Professional

Both

$614.00

Service Code	HCPCS 37222
Min. Negotiated Rate	$245.60
Max. Negotiated Rate	$460.50
Rate for Payer: Aetna Commercial	$249.11
Rate for Payer: Aetna Medicare	$307.00
Rate for Payer: BCBS Complete	$245.60
Rate for Payer: BCN Commercial	$269.91
Rate for Payer: Cash Price	$491.20
Rate for Payer: Cash Price	$491.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$460.50

PR REVASCULARIZATION ILIAC ARTERY ANGIOP 1ST VSL

Professional

Both

$998.00

Service Code	HCPCS 37220
Min. Negotiated Rate	$399.20
Max. Negotiated Rate	$748.50
Rate for Payer: Aetna Commercial	$538.63
Rate for Payer: Aetna Medicare	$499.00
Rate for Payer: BCBS Complete	$399.20
Rate for Payer: BCN Commercial	$581.14
Rate for Payer: Cash Price	$798.40
Rate for Payer: Cash Price	$798.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$748.50

PR REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT

Professional

Both

$5,149.00

Service Code	HCPCS 24371
Min. Negotiated Rate	$1,002.17
Max. Negotiated Rate	$3,861.75
Rate for Payer: Aetna Commercial	$2,368.46
Rate for Payer: Aetna Medicare	$2,574.50
Rate for Payer: BCBS Complete	$1,052.28
Rate for Payer: BCN Commercial	$2,660.22
Rate for Payer: Cash Price	$4,119.20
Rate for Payer: Cash Price	$4,119.20
Rate for Payer: Mclaren Medicaid	$1,002.17
Rate for Payer: Meridian Medicaid	$1,052.28
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,861.75
Rate for Payer: Priority Health Choice Medicaid	$1,002.17
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,843.69
Rate for Payer: Priority Health Narrow/Tiered Network	$2,843.69
Rate for Payer: UHC Medicaid	$1,002.17
Rate for Payer: UHCCP Medicaid	$1,002.17

PR REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT

Professional

Both

$3,893.00

Service Code	HCPCS 24370
Min. Negotiated Rate	$877.99
Max. Negotiated Rate	$2,919.75
Rate for Payer: Aetna Commercial	$2,055.18
Rate for Payer: Aetna Medicare	$1,946.50
Rate for Payer: BCBS Complete	$921.89
Rate for Payer: BCN Commercial	$2,320.60
Rate for Payer: Cash Price	$3,114.40
Rate for Payer: Cash Price	$3,114.40
Rate for Payer: Mclaren Medicaid	$877.99
Rate for Payer: Meridian Medicaid	$921.89
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,919.75
Rate for Payer: Priority Health Choice Medicaid	$877.99
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$2,480.65
Rate for Payer: Priority Health Narrow/Tiered Network	$2,480.65
Rate for Payer: UHC Medicaid	$877.99
Rate for Payer: UHCCP Medicaid	$877.99

Know your out-of-pocket cost for care.

All Charges