Bronson Lakeview Hospital

All Charges

Charge

Type

Setting

Price

PR ANESTHESIA OPEN HIP JOINT PROCEDURE NOS

Professional

Both

$6.00

Service Code	HCPCS 01210
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 OPEN PROCEDURES LOWER 1/3 FEMUR

Professional

Both

$5.00

Service Code	HCPCS 01360
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 OPEN PROCEDURES UPPER 2/3 FEMUR NOS

Professional

Both

$6.00

Service Code	HCPCS 01230
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 OPEN REVISION TOTAL HIP ARTHROPLASTY

Professional

Both

$10.00

Service Code	HCPCS 01215
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 ANESTHESIA OPEN/SURG ARTHRS OSTEOTOMY HUMERUS

Professional

Both

$5.00

Service Code	HCPCS 01742
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 OPEN/SURG ARTHRS RADICAL PROC ELBOW

Professional

Both

$6.00

Service Code	HCPCS 01756
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 OPEN TENOTOMY ELBOW TO SHOULDER

Professional

Both

$5.00

Service Code	HCPCS 01712
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 OPEN TOTAL ANKLE REPLACEMENT

Professional

Both

$7.00

Service Code	HCPCS 01486
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 ANESTHESIA OPEN TOTAL HIP ARTHROPLASTY

Professional

Both

$8.00

Service Code	HCPCS 01214
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 PARTIAL RIB RESECTION NOS

Professional

Both

$6.00

Service Code	HCPCS 00470
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 PARTIAL RIB RESECTION RADICAL

Professional

Both

$13.00

Service Code	HCPCS 00474
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 ANESTHESIA PARTIAL RIB RESECTION THORACOPLASTY

Professional

Both

$10.00

Service Code	HCPCS 00472
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 ANESTHESIA PERINEAL PROSTATECTOMY

Professional

Both

$6.00

Service Code	HCPCS 00908
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 RADICAL/MODIFIED RADICAL BREAST

Professional

Both

$5.00

Service Code	HCPCS 00404
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 RADICAL PERINEAL PROCEDURE

Professional

Both

$7.00

Service Code	HCPCS 00904
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 ANESTHESIA RECONSTRUCTION BREAST

Professional

Both

$5.00

Service Code	HCPCS 00402
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 SALIVARY GLANDS WITH BIOPSY

Professional

Both

$5.00

Service Code	HCPCS 00100
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 TENOPLASTY ELBOW TO SHOULDER

Professional

Both

$5.00

Service Code	HCPCS 01714
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 THER IVNTL RADIOLOGICAL ARTERIAL

Professional

Both

$5.00

Service Code	HCPCS 01924
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 THORACIC SPINE & CORD NOS

Professional

Both

$10.00

Service Code	HCPCS 00620
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 ANESTHESIA TRACHEOBRONCHIAL RECONSTRUCTION

Professional

Both

$18.00

Service Code	HCPCS 00539
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 ANESTHESIA TRANSURETHRAL RESECTION OF PROSTATE

Professional

Both

$5.00

Service Code	HCPCS 00914
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 UPPER 2/3 FEMUR AMPUTATION

Professional

Both

$5.00

Service Code	HCPCS 01232
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 UPPER ANTERIOR ABDOMINAL WALL NOS

Professional

Both

$4.00

Service Code	HCPCS 00700
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 UPPER GI ENDOSCOPIC PX NOS

Professional

Both

$1.00

Service Code	HCPCS 00731
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.65
Rate for Payer: Aetna Medicare	$0.50
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: Cash Price	$0.80
Rate for Payer: Priority Health Cigna Priority Health	$0.65

Know your out-of-pocket cost for care.

All Charges