Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR ANES OPEN SYMPHYSIS PUBIS/SACROILIAC JOINT

Professional

Both

$8.00

Service Code	HCPCS 01170
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 OPN RPR DISRPJ PELVIS/COLUMN FX ACETABULUM

Professional

Both

$12.00

Service Code	HCPCS 01173
Min. Negotiated Rate	$4.80
Max. Negotiated Rate	$7.80
Rate for Payer: Aetna Medicare	$6.00
Rate for Payer: BCBS Complete	$4.80
Rate for Payer: Cash Price	$9.60
Rate for Payer: Priority Health Cigna Priority Health	$7.80

PR ANES ORCHIOPEXY UNI/BI INCL OPEN URETHRAL PX

Professional

Both

$4.00

Service Code	HCPCS 00930
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 PERMANENT TRANSVENOUS PACEMAKER INSERTION

Professional

Both

$4.00

Service Code	HCPCS 00530
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 PERQ IMG NJX DRG/ASPIR PX SPI/SP CRV/THRC

Professional

Both

$345.00

Service Code	HCPCS 01937
Min. Negotiated Rate	$138.00
Max. Negotiated Rate	$224.25
Rate for Payer: Aetna Medicare	$172.50
Rate for Payer: BCBS Complete	$138.00
Rate for Payer: Cash Price	$276.00
Rate for Payer: Priority Health Cigna Priority Health	$224.25

PR ANES RAD AMP PENIS W/BI INGUINAL LYMPH NODE RMVL

Professional

Both

$6.00

Service Code	HCPCS 00934
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 RAD AMP PENIS W/BI INGUNL&ILIAC LYMPH RMOVL

Professional

Both

$8.00

Service Code	HCPCS 00936
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 RADICAL/MODIFIED RADICAL BREAST W/NODES

Professional

Both

$13.00

Service Code	HCPCS 00406
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 RADICAL RESECJ INCL BELOW KNEE AMPUTATION

Professional

Both

$4.00

Service Code	HCPCS 01482
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 RADICAL TUMOR PELVIS XCP HINDQUARTER AMP

Professional

Both

$10.00

Service Code	HCPCS 01150
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 RADIUS ULNA WRIST/HAND BONES CLOSED PX

Professional

Both

$3.00

Service Code	HCPCS 01820
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 RAD ORCHIECTOMY ABDOMINAL INCL OPN URTL

Professional

Both

$6.00

Service Code	HCPCS 00928
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 RAD ORCHIECTOMY INGUN INCL OPEN URTL PX

Professional

Both

$4.00

Service Code	HCPCS 00926
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 RPR RUPTURED ACHILLES TENDON W/WO GRAFT

Professional

Both

$5.00

Service Code	HCPCS 01472
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 SEMINAL VESICLES INCL OPEN URETHRAL PX

Professional

Both

$6.00

Service Code	HCPCS 00922
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 SHOULDER CAST APPL REMOVAL/REPAIR NOS

Professional

Both

$3.00

Service Code	HCPCS 01680
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 ANESTH,ABORTION PROC

Professional

Both

$4.00

Service Code	HCPCS 01964
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 ANESTH DIAGNOSTIC ARTHROSCOPIC PROC KNEE JOINT

Professional

Both

$3.00

Service Code	HCPCS 01382
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 ANESTHESIA ACCESS CENTRAL VENOUS CIRCULATION

Professional

Both

$4.00

Service Code	HCPCS 00532
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 ANESTHESIA ALL PX MAJOR ABDOMINAL BLOOD VESSELS

Professional

Both

$15.00

Service Code	HCPCS 00770
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 ANESTHESIA ANORECTAL PROCEDURE

Professional

Both

$5.00

Service Code	HCPCS 00902
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 ANESTHESIA ARTERIES FOREARM WRIST & HAND NOS

Professional

Both

$6.00

Service Code	HCPCS 01840
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 ANESTHESIA ARTERIES LOWER LEG W/BYPASS GRAFT NOS

Professional

Both

$8.00

Service Code	HCPCS 01500
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 ANESTHESIA ARTERIES SHOULDER & AXILLA NOS

Professional

Both

$6.00

Service Code	HCPCS 01650
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 ANESTHESIA ARTERIES UPPER ARM&ELBOW EMBOLECTOM

Professional

Both

$6.00

Service Code	HCPCS 01772
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

Know your out-of-pocket cost for care.

All Charges