Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR ANES HYSTEROSCOPY&/HYSTEROSALPINGOGRAPHY W/BX

Professional

Both

$4.00

Service Code	HCPCS 00952
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 ICRA ICAR/AORTIC THER IVNTL RAD ARTL

Professional

Both

$8.00

Service Code	HCPCS 01926
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.20

PR ANES INSJ PENILE PROSTH PRNL INCL OPEN URTL

Professional

Both

$4.00

Service Code	HCPCS 00938
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 INTEG EXTREMITIES ANT TRUNK & PERINEUM NOS

Professional

Both

$3.00

Service Code	HCPCS 00400
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 INTEG MUSC & NRV HEAD NECK&POSTERIOR TRUNK

Professional

Both

$5.00

Service Code	HCPCS 00300
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 INTEG SYS ELEC CONVERSION ARRHYTHMIAS

Professional

Both

$4.00

Service Code	HCPCS 00410
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 INTRACRANIAL BURR HOLES W/VENTRICULOGRAPHY

Professional

Both

$9.00

Service Code	HCPCS 00214
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$5.85
Rate for Payer: Aetna Medicare	$4.50
Rate for Payer: BCBS Complete	$3.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Priority Health Cigna Priority Health	$5.85

PR ANES INTRACRANIAL CEREBROSPINAL FLUID SHUNTING

Professional

Both

$10.00

Service Code	HCPCS 00220
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$6.50

PR ANES INTRACRANIAL CRANIOTOMY/CRANIECTOMY HMTMA

Professional

Both

$10.00

Service Code	HCPCS 00211
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$6.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Priority Health Cigna Priority Health	$6.50

PR ANES INTRACRANIAL ELECTROCOAGULATION ICRA NERVE

Professional

Both

$6.00

Service Code	HCPCS 00222
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 INTRACRANIAL/ELEVATION DEPRSD SKULL FX XDRL

Professional

Both

$9.00

Service Code	HCPCS 00215
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$5.85
Rate for Payer: Aetna Medicare	$4.50
Rate for Payer: BCBS Complete	$3.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Priority Health Cigna Priority Health	$5.85

PR ANES INTRACRANIAL PROCEDURE IN SITTING POSITION

Professional

Both

$13.00

Service Code	HCPCS 00218
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$8.45
Rate for Payer: Aetna Medicare	$6.50
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$8.45

PR ANES INTRACRANIAL THER IVNTL RAD VENS/LYMPHTC

Professional

Both

$7.00

Service Code	HCPCS 01933
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 INTRAORAL W/BIOPSY REPAIR CLEFT PALATE

Professional

Both

$6.00

Service Code	HCPCS 00172
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 INTRAORAL W/BX EXC RETROPHARYNGEAL TUMOR

Professional

Both

$6.00

Service Code	HCPCS 00174
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 INTRAPERITONEAL UPPER ABDOMEN W/LAPS NOS

Professional

Both

$7.00

Service Code	HCPCS 00790
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 IPER LOWER ABDOMEN W/LAPS AMNIOCENTESIS

Professional

Both

$4.00

Service Code	HCPCS 00842
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 IPER LOWER ABD W/LAPS ABDOMINOPRNL RESCJ

Professional

Both

$7.00

Service Code	HCPCS 00844
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 IPER LOWER ABD W/LAPS PELVIC EXENTERATION

Professional

Both

$8.00

Service Code	HCPCS 00848
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.20

PR ANES IPER LOWER ABD W/LAPS RAD HYSTERECTOMY

Professional

Both

$8.00

Service Code	HCPCS 00846
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.20

PR ANES IPER LWR ABD W/LAPS TUBAL LIGATION/TRANSECT

Professional

Both

$6.00

Service Code	HCPCS 00851
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 IPER UPR ABD GASTRIC RSTCV PX MO

Professional

Both

$11.00

Service Code	HCPCS 00797
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$7.15
Rate for Payer: Aetna Medicare	$5.50
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: Cash Price	$8.80
Rate for Payer: Priority Health Cigna Priority Health	$7.15

PR ANES IPER UPR ABD LIVER TRANSPLANT

Professional

Both

$31.00

Service Code	HCPCS 00796
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$20.15
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: Cash Price	$24.80
Rate for Payer: Priority Health Cigna Priority Health	$20.15

PR ANES IPER UPR ABD PARTIAL/TOTAL PANCREATECTOMY

Professional

Both

$8.00

Service Code	HCPCS 00794
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$5.20
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Priority Health Cigna Priority Health	$5.20

PR ANES IPER UPR ABD PRTL HPTC MGMT LIVER HEMRRG

Professional

Both

$13.00

Service Code	HCPCS 00792
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$8.45
Rate for Payer: Aetna Medicare	$6.50
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Priority Health Cigna Priority Health	$8.45

Know your out-of-pocket cost for care.

All Charges