Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG 4-9% TBSA

Professional

Both

$5.00

Service Code	HCPCS 01952
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG <4% TBSA

Professional

Both

$3.00

Service Code	HCPCS 01951
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES 2&3 DGR BURN EXC/DBRDMT W/WO GRFG EA 9%TBSA

Professional

Both

$1.00

Service Code	HCPCS 01953
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$44.50
Rate for Payer: Aetna Medicare	$0.50
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: Cash Price	$0.80
Rate for Payer: Cash Price	$0.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO	$44.50
Rate for Payer: Priority Health Narrow/Tiered Network	$44.50

PR ANES ALL CAST APPLICATION RMVL/REPAIR KNEE JOINT

Professional

Both

$3.00

Service Code	HCPCS 01420
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES ALL CLOSED PX UPR END TIBIA FIBULA&/PATELLA

Professional

Both

$3.00

Service Code	HCPCS 01390
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES ALL CLSD PX RADIUS ULNA WRIST/HAND BONES

Professional

Both

$3.00

Service Code	HCPCS 01820
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES ALL OPEN PX UPR ENDS TIBIA FIBULA&/PATELLA

Professional

Both

$4.00

Service Code	HCPCS 01392
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR ANES ALL PX INTEG MUSC&NRV HEAD NCK&PST TRNK NOS

Professional

Both

$5.00

Service Code	HCPCS 00300
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANES ALL PX NRV MUSC TDN FASCIA&BURSAE KNEE&/POP

Professional

Both

$4.00

Service Code	HCPCS 01320
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR ANES ALL PX NRV MUSC TDN FASCIA&BURSAE UPPER LEG

Professional

Both

$4.00

Service Code	HCPCS 01250
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR ANES ALL PX NRV MUSC TDN FSCA&BRS F/ARM WRST&HND

Professional

Both

$3.00

Service Code	HCPCS 01810
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES ALL PX NRV MUSC TND FSCA&BRS SHOULDER&AX

Professional

Both

$5.00

Service Code	HCPCS 01610
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANES ALL PX VEINS UPR LEG INCLUDING EXPLORATION

Professional

Both

$3.00

Service Code	HCPCS 01260
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES ARTHRS/NDSC DSTL RADIUS ULNA/WRIST/HAND NOS

Professional

Both

$3.00

Service Code	HCPCS 01830
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25

PR ANES BONE MARROW ASPIR&/BX ANT/PST ILIAC CREST

Professional

Both

$5.00

Service Code	HCPCS 01112
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANES C-CATHJ W/C ANGIOGRAPHY & VENTRICULOGRAPHY

Professional

Both

$7.00

Service Code	HCPCS 01920
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25

PR ANES C DLVR FLWG NEURAXIAL LABOR ANALG/ANES

Professional

Both

$2.00

Service Code	HCPCS 01968
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Medicare	$1.00
Rate for Payer: BCBS Complete	$0.80
Rate for Payer: Cash Price	$1.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.50

PR ANES CESARN HYST FLWG NEURAXIAL LABOR ANALG/ANES

Professional

Both

$5.00

Service Code	HCPCS 01969
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75

PR ANES CLOSED PX SYMPHYSIS PUBIS/SACROILIAC JOINT

Professional

Both

$4.00

Service Code	HCPCS 01160
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR ANES CLSD CH PX MEDIASTSC&THRSC W/1 LUNG VNTJ

Professional

Both

$11.00

Service Code	HCPCS 00529
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$8.25
Rate for Payer: Aetna Medicare	$5.50
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: Cash Price	$8.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$8.25

PR ANES CLSD CH PX MEDIASTSC&THRSC W/O 1 LUNG VNTJ

Professional

Both

$8.00

Service Code	HCPCS 00528
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.00

PR ANES CLSD PX HUMRL H&N STRNCLAV ACROMCLAV&SHO JT

Professional

Both

$4.00

Service Code	HCPCS 01620
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR ANES DIAGNOSTIC/THERAPEUTIC LUMBAR PUNCTURE

Professional

Both

$4.00

Service Code	HCPCS 00635
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00

PR ANES DIRECT CABG W/O PUMP OXYGENATOR

Professional

Both

$26.00

Service Code	HCPCS 00566
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna Medicare	$13.00
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$19.50

PR ANES DIRECT CABG W/PUMP OXYGENATOR

Professional

Both

$18.00

Service Code	HCPCS 00567
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Medicare	$9.00
Rate for Payer: BCBS Complete	$7.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.50

Know your out-of-pocket cost for care.

All Charges