Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR TRANSURETHRAL RESECTION BLADDER NECK

Professional

Both

$1,738.00

Service Code	HCPCS 52500
Min. Negotiated Rate	$224.72
Max. Negotiated Rate	$1,303.50
Rate for Payer: Aetna Commercial	$627.52
Rate for Payer: Aetna Medicare	$869.00
Rate for Payer: BCBS Complete	$235.96
Rate for Payer: BCN Commercial	$743.48
Rate for Payer: Cash Price	$1,390.40
Rate for Payer: Cash Price	$1,390.40
Rate for Payer: Mclaren Medicaid	$224.72
Rate for Payer: Meridian Medicaid	$235.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,303.50
Rate for Payer: Priority Health Choice Medicaid	$224.72
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$809.89
Rate for Payer: Priority Health Narrow/Tiered Network	$809.89
Rate for Payer: UHC Medicaid	$224.72
Rate for Payer: UHCCP Medicaid	$224.72

PR TRANSV AORTIC ARCH GRAFT W BYPASS

Professional

Both

$10,594.00

Service Code	HCPCS 33870
Min. Negotiated Rate	$4,237.60
Max. Negotiated Rate	$7,945.50
Rate for Payer: Aetna Medicare	$5,297.00
Rate for Payer: BCBS Complete	$4,237.60
Rate for Payer: Cash Price	$8,475.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,945.50

PR TRANSVRS A-ARCH GRF W/CARD BYP PRFD HYPOTHERMIA

Professional

Both

$5,798.00

Service Code	HCPCS 33871
Min. Negotiated Rate	$1,915.30
Max. Negotiated Rate	$5,121.67
Rate for Payer: Aetna Commercial	$4,382.46
Rate for Payer: Aetna Medicare	$2,899.00
Rate for Payer: BCBS Complete	$2,011.07
Rate for Payer: BCN Commercial	$4,762.69
Rate for Payer: Cash Price	$4,638.40
Rate for Payer: Cash Price	$4,638.40
Rate for Payer: Mclaren Medicaid	$1,915.30
Rate for Payer: Meridian Medicaid	$2,011.07
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,348.50
Rate for Payer: Priority Health Choice Medicaid	$1,915.30
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,121.67
Rate for Payer: Priority Health Narrow/Tiered Network	$5,121.67
Rate for Payer: UHC Medicaid	$1,915.30
Rate for Payer: UHCCP Medicaid	$1,915.30

PR TRAY FEE

Professional

Both

$35.00

Hospital Revenue Code	990
Min. Negotiated Rate	$14.00
Max. Negotiated Rate	$26.25
Rate for Payer: Aetna Medicare	$17.50
Rate for Payer: BCBS Complete	$14.00
Rate for Payer: Cash Price	$28.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$26.25

PR TREATMENT CLOSED ELBOW DISLOCATION REQ ANES

Professional

Both

$1,351.00

Service Code	HCPCS 24605
Min. Negotiated Rate	$305.66
Max. Negotiated Rate	$1,013.25
Rate for Payer: Aetna Commercial	$635.25
Rate for Payer: Aetna Medicare	$675.50
Rate for Payer: BCBS Complete	$320.94
Rate for Payer: BCN Commercial	$737.51
Rate for Payer: Cash Price	$1,080.80
Rate for Payer: Cash Price	$1,080.80
Rate for Payer: Mclaren Medicaid	$305.66
Rate for Payer: Meridian Medicaid	$320.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,013.25
Rate for Payer: Priority Health Choice Medicaid	$305.66
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$788.37
Rate for Payer: Priority Health Narrow/Tiered Network	$788.37
Rate for Payer: UHC Medicaid	$305.66
Rate for Payer: UHCCP Medicaid	$305.66

PR TREATMENT CLOSED ELBOW DISLOCATION W/O ANES

Professional

Both

$773.00

Service Code	HCPCS 24600
Min. Negotiated Rate	$256.45
Max. Negotiated Rate	$579.75
Rate for Payer: Aetna Commercial	$450.64
Rate for Payer: Aetna Medicare	$386.50
Rate for Payer: BCBS Complete	$269.27
Rate for Payer: BCN Commercial	$536.82
Rate for Payer: Cash Price	$618.40
Rate for Payer: Cash Price	$618.40
Rate for Payer: Mclaren Medicaid	$256.45
Rate for Payer: Meridian Medicaid	$269.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$579.75
Rate for Payer: Priority Health Choice Medicaid	$256.45
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$573.86
Rate for Payer: Priority Health Narrow/Tiered Network	$573.86
Rate for Payer: UHC Medicaid	$256.45
Rate for Payer: UHCCP Medicaid	$256.45

PR TRIAMCINOLONE ACET INJ NOS

Professional

Both

$10.00

Service Code	HCPCS J3301
Min. Negotiated Rate	$0.35
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Commercial	$0.97
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Trust/PPO	$0.35
Rate for Payer: BCN Commercial	$0.46
Rate for Payer: Cash Price	$8.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50

PR TRIMETHOBENZAMIDE HCL INJ

Professional

Both

$25.00

Service Code	HCPCS J3250
Min. Negotiated Rate	$12.50
Max. Negotiated Rate	$58.68
Rate for Payer: Aetna Commercial	$49.27
Rate for Payer: Aetna Medicare	$12.50
Rate for Payer: BCBS Trust/PPO	$58.68
Rate for Payer: BCN Commercial	$50.98
Rate for Payer: Cash Price	$20.00
Rate for Payer: Cash Price	$20.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$18.75

PR TRIMMING NONDYSTROPHIC NAILS ANY NUMBER

Professional

Both

$34.00

Service Code	HCPCS 11719
Min. Negotiated Rate	$7.92
Max. Negotiated Rate	$25.50
Rate for Payer: Aetna Commercial	$7.92
Rate for Payer: Aetna Medicare	$17.00
Rate for Payer: BCBS Complete	$13.60
Rate for Payer: BCN Commercial	$8.64
Rate for Payer: Cash Price	$27.20
Rate for Payer: Cash Price	$27.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$25.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$10.03
Rate for Payer: Priority Health Narrow/Tiered Network	$10.03

PR TRIM NAIL(S)

Professional

Both

$38.00

Service Code	HCPCS G0127
Min. Negotiated Rate	$7.62
Max. Negotiated Rate	$28.50
Rate for Payer: Aetna Commercial	$7.62
Rate for Payer: Aetna Medicare	$19.00
Rate for Payer: BCBS Complete	$15.20
Rate for Payer: BCN Commercial	$10.96
Rate for Payer: Cash Price	$30.40
Rate for Payer: Cash Price	$30.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$28.50
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$10.03
Rate for Payer: Priority Health Narrow/Tiered Network	$10.03

PR TRLML BALO ANGIOP OPEN/PERQ IMG S&I 1ST ART

Professional

Both

$1,131.00

Service Code	HCPCS 37246
Min. Negotiated Rate	$196.60
Max. Negotiated Rate	$848.25
Rate for Payer: Aetna Commercial	$465.79
Rate for Payer: Aetna Medicare	$565.50
Rate for Payer: BCBS Complete	$206.43
Rate for Payer: BCN Commercial	$507.94
Rate for Payer: Cash Price	$904.80
Rate for Payer: Cash Price	$904.80
Rate for Payer: Mclaren Medicaid	$196.60
Rate for Payer: Meridian Medicaid	$206.43
Rate for Payer: Opus (Opus Packaging Group) HMA	$848.25
Rate for Payer: Priority Health Choice Medicaid	$196.60
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$546.22
Rate for Payer: Priority Health Narrow/Tiered Network	$546.22
Rate for Payer: UHC Medicaid	$196.60
Rate for Payer: UHCCP Medicaid	$196.60

PR TRLML BALO ANGIOP OPEN/PERQ IMG S&I EA ADDL ART

Professional

Both

$861.00

Service Code	HCPCS 37247
Min. Negotiated Rate	$96.92
Max. Negotiated Rate	$645.75
Rate for Payer: Aetna Commercial	$228.48
Rate for Payer: Aetna Medicare	$430.50
Rate for Payer: BCBS Complete	$101.77
Rate for Payer: BCN Commercial	$253.47
Rate for Payer: Cash Price	$688.80
Rate for Payer: Cash Price	$688.80
Rate for Payer: Mclaren Medicaid	$96.92
Rate for Payer: Meridian Medicaid	$101.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$645.75
Rate for Payer: Priority Health Choice Medicaid	$96.92
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$272.57
Rate for Payer: Priority Health Narrow/Tiered Network	$272.57
Rate for Payer: UHC Medicaid	$96.92
Rate for Payer: UHCCP Medicaid	$96.92

PR TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN

Professional

Both

$972.00

Service Code	HCPCS 37248
Min. Negotiated Rate	$165.93
Max. Negotiated Rate	$729.00
Rate for Payer: Aetna Commercial	$397.26
Rate for Payer: Aetna Medicare	$486.00
Rate for Payer: BCBS Complete	$174.23
Rate for Payer: BCN Commercial	$432.25
Rate for Payer: Cash Price	$777.60
Rate for Payer: Cash Price	$777.60
Rate for Payer: Mclaren Medicaid	$165.93
Rate for Payer: Meridian Medicaid	$174.23
Rate for Payer: Opus (Opus Packaging Group) HMA	$729.00
Rate for Payer: Priority Health Choice Medicaid	$165.93
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$464.83
Rate for Payer: Priority Health Narrow/Tiered Network	$464.83
Rate for Payer: UHC Medicaid	$165.93
Rate for Payer: UHCCP Medicaid	$165.93

PR TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I ADDL VEIN

Professional

Both

$477.00

Service Code	HCPCS 37249
Min. Negotiated Rate	$81.79
Max. Negotiated Rate	$357.75
Rate for Payer: Aetna Commercial	$194.65
Rate for Payer: Aetna Medicare	$238.50
Rate for Payer: BCBS Complete	$85.88
Rate for Payer: BCN Commercial	$213.64
Rate for Payer: Cash Price	$381.60
Rate for Payer: Cash Price	$381.60
Rate for Payer: Mclaren Medicaid	$81.79
Rate for Payer: Meridian Medicaid	$85.88
Rate for Payer: Opus (Opus Packaging Group) HMA	$357.75
Rate for Payer: Priority Health Choice Medicaid	$81.79
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$229.74
Rate for Payer: Priority Health Narrow/Tiered Network	$229.74
Rate for Payer: UHC Medicaid	$81.79
Rate for Payer: UHCCP Medicaid	$81.79

PR TRLUML BALO ANGIOP CTR DIALYSIS SEG W/IMG S&I

Professional

Both

$334.00

Service Code	HCPCS 36907
Min. Negotiated Rate	$81.37
Max. Negotiated Rate	$250.50
Rate for Payer: Aetna Commercial	$196.77
Rate for Payer: Aetna Medicare	$167.00
Rate for Payer: BCBS Complete	$85.44
Rate for Payer: BCN Commercial	$214.13
Rate for Payer: Cash Price	$267.20
Rate for Payer: Cash Price	$267.20
Rate for Payer: Mclaren Medicaid	$81.37
Rate for Payer: Meridian Medicaid	$85.44
Rate for Payer: Opus (Opus Packaging Group) HMA	$250.50
Rate for Payer: Priority Health Choice Medicaid	$81.37
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$230.27
Rate for Payer: Priority Health Narrow/Tiered Network	$230.27
Rate for Payer: UHC Medicaid	$81.37
Rate for Payer: UHCCP Medicaid	$81.37

PR TRLUML PERIPH ATHRC W/RS&I BRCHIOCPHL EA VSL

Professional

Both

$10,116.00

Service Code	HCPCS 0237T
Min. Negotiated Rate	$248.53
Max. Negotiated Rate	$10,603.43
Rate for Payer: Aetna Commercial	$4,395.81
Rate for Payer: Aetna Medicare	$5,058.00
Rate for Payer: BCBS Complete	$260.96
Rate for Payer: BCN Commercial	$10,603.43
Rate for Payer: Cash Price	$8,092.80
Rate for Payer: Cash Price	$8,092.80
Rate for Payer: Mclaren Medicaid	$248.53
Rate for Payer: Meridian Medicaid	$260.96
Rate for Payer: Opus (Opus Packaging Group) HMA	$7,587.00
Rate for Payer: Priority Health Choice Medicaid	$248.53
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,548.58
Rate for Payer: Priority Health Narrow/Tiered Network	$1,548.58
Rate for Payer: UHC Medicaid	$248.53
Rate for Payer: UHCCP Medicaid	$248.53

PR TRNSCONDLR POST CRNL FOSSA DCOMPR ART W/WO MOBIL

Professional

Both

$9,019.00

Service Code	HCPCS 61597
Min. Negotiated Rate	$1,891.23
Max. Negotiated Rate	$6,764.25
Rate for Payer: Aetna Commercial	$3,837.78
Rate for Payer: Aetna Medicare	$4,509.50
Rate for Payer: BCBS Complete	$1,985.79
Rate for Payer: BCN Commercial	$6,096.82
Rate for Payer: Cash Price	$7,215.20
Rate for Payer: Cash Price	$7,215.20
Rate for Payer: Mclaren Medicaid	$1,891.23
Rate for Payer: Meridian Medicaid	$1,985.79
Rate for Payer: Opus (Opus Packaging Group) HMA	$6,764.25
Rate for Payer: Priority Health Choice Medicaid	$1,891.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,125.75
Rate for Payer: Priority Health Narrow/Tiered Network	$5,125.75
Rate for Payer: UHC Medicaid	$1,891.23
Rate for Payer: UHCCP Medicaid	$1,891.23

PR TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR

Professional

Both

$473.00

Service Code	HCPCS 38207
Min. Negotiated Rate	$24.28
Max. Negotiated Rate	$354.75
Rate for Payer: Aetna Commercial	$54.89
Rate for Payer: Aetna Medicare	$236.50
Rate for Payer: BCBS Complete	$25.49
Rate for Payer: BCN Commercial	$65.73
Rate for Payer: Cash Price	$378.40
Rate for Payer: Cash Price	$378.40
Rate for Payer: Mclaren Medicaid	$24.28
Rate for Payer: Meridian Medicaid	$25.49
Rate for Payer: Opus (Opus Packaging Group) HMA	$354.75
Rate for Payer: Priority Health Choice Medicaid	$24.28
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$87.47
Rate for Payer: Priority Health Narrow/Tiered Network	$87.47
Rate for Payer: UHC Medicaid	$24.28
Rate for Payer: UHCCP Medicaid	$24.28

PR TR PARASPI MUSC HIP FASC/TDN XTN GRF

Professional

Both

$6,507.00

Service Code	HCPCS 27105
Min. Negotiated Rate	$518.23
Max. Negotiated Rate	$4,880.25
Rate for Payer: Aetna Commercial	$1,161.46
Rate for Payer: Aetna Medicare	$3,253.50
Rate for Payer: BCBS Complete	$544.14
Rate for Payer: BCN Commercial	$1,326.12
Rate for Payer: Cash Price	$5,205.60
Rate for Payer: Cash Price	$5,205.60
Rate for Payer: Mclaren Medicaid	$518.23
Rate for Payer: Meridian Medicaid	$544.14
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,880.25
Rate for Payer: Priority Health Choice Medicaid	$518.23
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,417.59
Rate for Payer: Priority Health Narrow/Tiered Network	$1,417.59
Rate for Payer: UHC Medicaid	$518.23
Rate for Payer: UHCCP Medicaid	$518.23

PR TRPOS&/RIMPLTJ CAROTID SUBCLAVIAN ART

Professional

Both

$2,138.00

Service Code	HCPCS 35695
Min. Negotiated Rate	$595.97
Max. Negotiated Rate	$1,615.64
Rate for Payer: Aetna Commercial	$1,378.42
Rate for Payer: Aetna Medicare	$1,069.00
Rate for Payer: BCBS Complete	$625.77
Rate for Payer: BCN Commercial	$1,502.40
Rate for Payer: Cash Price	$1,710.40
Rate for Payer: Cash Price	$1,710.40
Rate for Payer: Mclaren Medicaid	$595.97
Rate for Payer: Meridian Medicaid	$625.77
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,603.50
Rate for Payer: Priority Health Choice Medicaid	$595.97
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,615.64
Rate for Payer: Priority Health Narrow/Tiered Network	$1,615.64
Rate for Payer: UHC Medicaid	$595.97
Rate for Payer: UHCCP Medicaid	$595.97

PR TRPOS&/RIMPLTJ SUBCLAVIAN CAROTID ART

Professional

Both

$2,206.00

Service Code	HCPCS 35694
Min. Negotiated Rate	$574.67
Max. Negotiated Rate	$1,654.50
Rate for Payer: Aetna Commercial	$1,327.34
Rate for Payer: Aetna Medicare	$1,103.00
Rate for Payer: BCBS Complete	$603.40
Rate for Payer: BCN Commercial	$1,448.13
Rate for Payer: Cash Price	$1,764.80
Rate for Payer: Cash Price	$1,764.80
Rate for Payer: Mclaren Medicaid	$574.67
Rate for Payer: Meridian Medicaid	$603.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,654.50
Rate for Payer: Priority Health Choice Medicaid	$574.67
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,557.29
Rate for Payer: Priority Health Narrow/Tiered Network	$1,557.29
Rate for Payer: UHC Medicaid	$574.67
Rate for Payer: UHCCP Medicaid	$574.67

PR TRPOS&/RIMPLTJ VERTEBRAL CAROTID ART

Professional

Both

$4,703.00

Service Code	HCPCS 35691
Min. Negotiated Rate	$550.39
Max. Negotiated Rate	$3,527.25
Rate for Payer: Aetna Commercial	$1,271.09
Rate for Payer: Aetna Medicare	$2,351.50
Rate for Payer: BCBS Complete	$577.91
Rate for Payer: BCN Commercial	$1,385.89
Rate for Payer: Cash Price	$3,762.40
Rate for Payer: Cash Price	$3,762.40
Rate for Payer: Mclaren Medicaid	$550.39
Rate for Payer: Meridian Medicaid	$577.91
Rate for Payer: Opus (Opus Packaging Group) HMA	$3,527.25
Rate for Payer: Priority Health Choice Medicaid	$550.39
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,490.33
Rate for Payer: Priority Health Narrow/Tiered Network	$1,490.33
Rate for Payer: UHC Medicaid	$550.39
Rate for Payer: UHCCP Medicaid	$550.39

PR TRPOS&/RIMPLTJ VERTEBRAL SUBCLAVIAN ART

Professional

Both

$1,809.00

Service Code	HCPCS 35693
Min. Negotiated Rate	$489.47
Max. Negotiated Rate	$1,356.75
Rate for Payer: Aetna Commercial	$1,118.77
Rate for Payer: Aetna Medicare	$904.50
Rate for Payer: BCBS Complete	$513.94
Rate for Payer: BCN Commercial	$1,230.01
Rate for Payer: Cash Price	$1,447.20
Rate for Payer: Cash Price	$1,447.20
Rate for Payer: Mclaren Medicaid	$489.47
Rate for Payer: Meridian Medicaid	$513.94
Rate for Payer: Opus (Opus Packaging Group) HMA	$1,356.75
Rate for Payer: Priority Health Choice Medicaid	$489.47
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,322.73
Rate for Payer: Priority Health Narrow/Tiered Network	$1,322.73
Rate for Payer: UHC Medicaid	$489.47
Rate for Payer: UHCCP Medicaid	$489.47

PR TR TDN RESTORE INTRNSC FUNCJ RING&SM FNGR

Professional

Both

$2,858.00

Service Code	HCPCS 26497
Min. Negotiated Rate	$561.04
Max. Negotiated Rate	$2,143.50
Rate for Payer: Aetna Commercial	$1,202.33
Rate for Payer: Aetna Medicare	$1,429.00
Rate for Payer: BCBS Complete	$589.09
Rate for Payer: BCN Commercial	$1,365.96
Rate for Payer: Cash Price	$2,286.40
Rate for Payer: Cash Price	$2,286.40
Rate for Payer: Mclaren Medicaid	$561.04
Rate for Payer: Meridian Medicaid	$589.09
Rate for Payer: Opus (Opus Packaging Group) HMA	$2,143.50
Rate for Payer: Priority Health Choice Medicaid	$561.04
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$1,460.17
Rate for Payer: Priority Health Narrow/Tiered Network	$1,460.17
Rate for Payer: UHC Medicaid	$561.04
Rate for Payer: UHCCP Medicaid	$561.04

PR TR TOE-TO-HAND W/MVASC ANAST GRT TOE WRP/ARND

Professional

Both

$5,783.00

Service Code	HCPCS 26551
Min. Negotiated Rate	$1,897.40
Max. Negotiated Rate	$5,277.49
Rate for Payer: Aetna Commercial	$4,427.34
Rate for Payer: Aetna Medicare	$2,891.50
Rate for Payer: BCBS Complete	$1,992.27
Rate for Payer: BCN Commercial	$4,936.99
Rate for Payer: Cash Price	$4,626.40
Rate for Payer: Cash Price	$4,626.40
Rate for Payer: Mclaren Medicaid	$1,897.40
Rate for Payer: Meridian Medicaid	$1,992.27
Rate for Payer: Opus (Opus Packaging Group) HMA	$4,337.25
Rate for Payer: Priority Health Choice Medicaid	$1,897.40
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$5,277.49
Rate for Payer: Priority Health Narrow/Tiered Network	$5,277.49
Rate for Payer: UHC Medicaid	$1,897.40
Rate for Payer: UHCCP Medicaid	$1,897.40

Know your out-of-pocket cost for care.

All Charges