Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR ANES CLOSED SYMPHYSIS PUBIS/SACROILIAC JOINT

Professional

Both

$4.00

Service Code	HCPCS 01160
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60

PR ANES COLPTMY VAGNC COLPRPHY INCL BX W/OPN URTL

Professional

Both

$4.00

Service Code	HCPCS 00942
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60

PR ANES COMPLETE AMPUTATION PENIS INCL OPEN URTL

Professional

Both

$4.00

Service Code	HCPCS 00932
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60

PR ANES DIAG ARTHROSCOPIC SHOULDER JOINT PROC NOS

Professional

Both

$4.00

Service Code	HCPCS 01622
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60

PR ANES DIAGNOSTIC/THERAPEUTIC LUMBAR PUNCTURE

Professional

Both

$4.00

Service Code	HCPCS 00635
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60

PR ANES DIRECT CABG W/O PUMP OXYGENATOR

Professional

Both

$26.00

Service Code	HCPCS 00566
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$16.90
Rate for Payer: Aetna Medicare	$13.00
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$16.90

PR ANES DIRECT CABG W/PUMP OXYGENATOR

Professional

Both

$18.00

Service Code	HCPCS 00567
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$11.70
Rate for Payer: Aetna Medicare	$9.00
Rate for Payer: BCBS Complete	$7.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Priority Health Cigna Priority Health	$11.70

PR ANES DX/THER NERVE BLOCK/INJECTION PRONE POS

Professional

Both

$5.00

Service Code	HCPCS 01992
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.25

PR ANES DX/THER NRV BLK/NJX OTH/THN PRONE POS

Professional

Both

$3.00

Service Code	HCPCS 01991
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.95

PR ANES ESOPH THYRD LARX TRACH & LYMPH NCK BX THYRD

Professional

Both

$3.00

Service Code	HCPCS 00322
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.95

PR ANES ESOPH THYRD LARYNX TRACH & LYMPH NECK 1YR

Professional

Both

$6.00

Service Code	HCPCS 00320
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$3.90
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Priority Health Cigna Priority Health	$3.90

PR ANES EXTERNAL MIDDLE & INNER EAR W/BX OTOSCOPY

Professional

Both

$4.00

Service Code	HCPCS 00124
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$2.60
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Priority Health Cigna Priority Health	$2.60

PR ANES EXTRAPERITONEAL LWR ABD W/URINARY TRACT NOS

Professional

Both

$6.00

Service Code	HCPCS 00860
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$3.90
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Priority Health Cigna Priority Health	$3.90

PR ANES FACIAL BONES/SKULL RAD SURG W/PROGNATHISM

Professional

Both

$7.00

Service Code	HCPCS 00192
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55

PR ANES FOREARM WRIST/HAND CAST APPL RMVL/REPAIR

Professional

Both

$3.00

Service Code	HCPCS 01860
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$1.95
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Priority Health Cigna Priority Health	$1.95

PR ANES HEART TRANSPLANT/HEART/LUNG TRANSPLANT

Professional

Both

$20.00

Service Code	HCPCS 00580
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Medicare	$10.00
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$13.00

PR ANES HERNIA REPAIR LOWER ABDOMEN NOS & 1YR AGE

Professional

Both

$5.00

Service Code	HCPCS 00834
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.25
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Priority Health Cigna Priority Health	$3.25

PR ANES HERNIA REPAIR UPPER ABDOMEN OMPHALOCELE

Professional

Both

$7.00

Service Code	HCPCS 00754
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55

PR ANES HRNA REPAIR UPR ABD TABDL RPR DIPHRG HRNA

Professional

Both

$7.00

Service Code	HCPCS 00756
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$4.55
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Priority Health Cigna Priority Health	$4.55

PR ANES HRNA RPR LWR ABD NOS INFTS <37WK BRTH/50WK

Professional

Both

$6.00

Service Code	HCPCS 00836
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$3.90
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Priority Health Cigna Priority Health	$3.90

PR ANES HRNA RPR UPR ABD LMBR&VNT HERNIA&/DEHSN

Professional

Both

$6.00

Service Code	HCPCS 00752
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$3.90
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Priority Health Cigna Priority Health	$3.90

PR ANES HRT PERICARDIAL SAC& GRT VESLS W/O PMP OXT

Professional

Both

$15.00

Service Code	HCPCS 00560
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna Medicare	$7.50
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Priority Health Cigna Priority Health	$9.75

PR ANES HRT PERICARD SAC&GREAT VSLS W/PMP OXTJ <1YR

Professional

Both

$26.00

Service Code	HCPCS 00561
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$16.90
Rate for Payer: Aetna Medicare	$13.00
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$16.90

PR ANES HRT PERICRD SAC&GRT VSLS W/PMP OXTJ >1MO PO

Professional

Both

$20.00

Service Code	HCPCS 00562
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$13.00
Rate for Payer: Aetna Medicare	$10.00
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Priority Health Cigna Priority Health	$13.00

PR ANES HRT PRCRD SAC & GREAT VSL W/PUMP OXTJ HYPTH

Professional

Both

$26.00

Service Code	HCPCS 00563
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$16.90
Rate for Payer: Aetna Medicare	$13.00
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Priority Health Cigna Priority Health	$16.90

Know your out-of-pocket cost for care.

All Charges