Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR ANES KNEE & POPLITEAL ARTERY VEIN FISTULA NOS

Professional

Both

$6.00

Service Code	HCPCS 01432
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 LITHOTRP XTRCORP SHOCK WAVE W/O WATER BATH

Professional

Both

$5.00

Service Code	HCPCS 00873
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 LITHOTRP XTRCORP SHOCK WAVE W/WATER BATH

Professional

Both

$7.00

Service Code	HCPCS 00872
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 LOWER ANT ABDOMINAL WALL PANNICULECTOMY

Professional

Both

$5.00

Service Code	HCPCS 00802
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 LOWER LEG CAST APPLICATION REMOVAL/REPAIR

Professional

Both

$3.00

Service Code	HCPCS 01490
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 LWR ABD VENTRAL & INCISIONAL HERNIA REPAIR

Professional

Both

$6.00

Service Code	HCPCS 00832
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 MAJOR LOWER ABDOMINAL VESSELS IVC LIGATION

Professional

Both

$10.00

Service Code	HCPCS 00882
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 MANIPULATE SPINE/CLSD CRV THORC/LUMBR SPINE

Professional

Both

$3.00

Service Code	HCPCS 00640
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 MEDIASTINOSCOPY&THORACOSCOPY W/1 LUNG VNT

Professional

Both

$11.00

Service Code	HCPCS 00529
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 MEDIASTINOSCOPY&THORACSCOPY W/O 1 LUNG VNTJ

Professional

Both

$8.00

Service Code	HCPCS 00528
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 NERVE MUSCLE TDN FASCIA&BURSA FOREARM WRIST

Professional

Both

$3.00

Service Code	HCPCS 01810
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 NERVE MUSC TENDON FASCIA & BURSAE UPPER LEG

Professional

Both

$4.00

Service Code	HCPCS 01250
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 NERVE MUSC TENDON FASCIA&BURSA KNEE&/POPLT

Professional

Both

$4.00

Service Code	HCPCS 01320
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 NON-INVASIVE IMAGING/RADIATION THERAPY

Professional

Both

$7.00

Service Code	HCPCS 01922
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 NOSE & ACCESSORY SINUSES BIOPSY SOFT TISSUE

Professional

Both

$4.00

Service Code	HCPCS 00164
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 NOSE & ACCESSORY SINUSES RADICAL SURGERY

Professional

Both

$7.00

Service Code	HCPCS 00162
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 NRV MUSC TDN FSCA&BRS UPR ARM/ELBOW NOS

Professional

Both

$3.00

Service Code	HCPCS 01710
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 NRV MUSC TNDN FSCIA BURSA SHOULDER & AXILLA

Professional

Both

$5.00

Service Code	HCPCS 01610
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 NRV/MUS/TND/FASC LOWER LEG/ANKLE/FOOT NOS

Professional

Both

$3.00

Service Code	HCPCS 01470
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 OPEN OSTEOTOMY/OSTEOPLASTY TIBIA&/FIBULA

Professional

Both

$4.00

Service Code	HCPCS 01484
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 OPEN PROC BONES LOWER LEG/ANKLE/FOOT NOS

Professional

Both

$3.00

Service Code	HCPCS 01480
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 OPEN PROC UPPER ENDS TIBIA FIBULA&/PATELLA

Professional

Both

$4.00

Service Code	HCPCS 01392
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 OPEN/SURG ARTHROSCOPIC ELBOW PROC NOS

Professional

Both

$4.00

Service Code	HCPCS 01740
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 OPEN/SURG ARTHROSCOPIC PROC KNEE JOINT NOS

Professional

Both

$4.00

Service Code	HCPCS 01400
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 OPEN/SURG ARTHRS REPRS NON/MALUNION HUMERUS

Professional

Both

$5.00

Service Code	HCPCS 01744
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

Know your out-of-pocket cost for care.

All Charges