Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR ANES ALL PX NRV MUSC TND FSCA&BRS SHOULDER&AX

Professional

Both

$5.00

Service Code	HCPCS 01610
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANES ALL PX VEINS UPR LEG INCLUDING EXPLORATION

Professional

Both

$3.00

Service Code	HCPCS 01260
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25
Rate for Payer: UMR Bronson Commercial	$1.38

PR ANES ARTHRS/NDSC DSTL RADIUS ULNA/WRIST/HAND NOS

Professional

Both

$3.00

Service Code	HCPCS 01830
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25
Rate for Payer: UMR Bronson Commercial	$1.38

PR ANES BONE MARROW ASPIR&/BX ANT/PST ILIAC CREST

Professional

Both

$5.00

Service Code	HCPCS 01112
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANES C-CATHJ W/C ANGIOGRAPHY & VENTRICULOGRAPHY

Professional

Both

$7.00

Service Code	HCPCS 01920
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25
Rate for Payer: UMR Bronson Commercial	$3.22

PR ANES C DLVR FLWG NEURAXIAL LABOR ANALG/ANES

Professional

Both

$2.00

Service Code	HCPCS 01968
Min. Negotiated Rate	$0.80
Max. Negotiated Rate	$1.50
Rate for Payer: Aetna Medicare	$1.00
Rate for Payer: BCBS Complete	$0.80
Rate for Payer: Cash Price	$1.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$1.50
Rate for Payer: UMR Bronson Commercial	$0.92

PR ANES CESARN HYST FLWG NEURAXIAL LABOR ANALG/ANES

Professional

Both

$5.00

Service Code	HCPCS 01969
Min. Negotiated Rate	$2.00
Max. Negotiated Rate	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANES CLOSED PX SYMPHYSIS PUBIS/SACROILIAC JOINT

Professional

Both

$4.00

Service Code	HCPCS 01160
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANES CLSD CH PX MEDIASTSC&THRSC W/1 LUNG VNTJ

Professional

Both

$11.00

Service Code	HCPCS 00529
Min. Negotiated Rate	$4.40
Max. Negotiated Rate	$8.25
Rate for Payer: Aetna Medicare	$5.50
Rate for Payer: BCBS Complete	$4.40
Rate for Payer: Cash Price	$8.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$8.25
Rate for Payer: UMR Bronson Commercial	$5.06

PR ANES CLSD CH PX MEDIASTSC&THRSC W/O 1 LUNG VNTJ

Professional

Both

$8.00

Service Code	HCPCS 00528
Min. Negotiated Rate	$3.20
Max. Negotiated Rate	$6.00
Rate for Payer: Aetna Medicare	$4.00
Rate for Payer: BCBS Complete	$3.20
Rate for Payer: Cash Price	$6.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.00
Rate for Payer: UMR Bronson Commercial	$3.68

PR ANES CLSD PX HUMRL H&N STRNCLAV ACROMCLAV&SHO JT

Professional

Both

$4.00

Service Code	HCPCS 01620
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANES DIAGNOSTIC/THERAPEUTIC LUMBAR PUNCTURE

Professional

Both

$4.00

Service Code	HCPCS 00635
Min. Negotiated Rate	$1.60
Max. Negotiated Rate	$3.00
Rate for Payer: Aetna Medicare	$2.00
Rate for Payer: BCBS Complete	$1.60
Rate for Payer: Cash Price	$3.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.00
Rate for Payer: UMR Bronson Commercial	$1.84

PR ANES DIRECT CABG W/O PUMP OXYGENATOR

Professional

Both

$26.00

Service Code	HCPCS 00566
Min. Negotiated Rate	$10.40
Max. Negotiated Rate	$19.50
Rate for Payer: Aetna Medicare	$13.00
Rate for Payer: BCBS Complete	$10.40
Rate for Payer: Cash Price	$20.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$19.50
Rate for Payer: UMR Bronson Commercial	$11.96

PR ANES DIRECT CABG W/PUMP OXYGENATOR

Professional

Both

$18.00

Service Code	HCPCS 00567
Min. Negotiated Rate	$7.20
Max. Negotiated Rate	$13.50
Rate for Payer: Aetna Medicare	$9.00
Rate for Payer: BCBS Complete	$7.20
Rate for Payer: Cash Price	$14.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$13.50
Rate for Payer: UMR Bronson Commercial	$8.28

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	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

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	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25
Rate for Payer: UMR Bronson Commercial	$1.38

PR ANES ESOPH THYR LARX TRCH&LYMPH NCK NDL BX THYR

Professional

Both

$3.00

Service Code	HCPCS 00322
Min. Negotiated Rate	$1.20
Max. Negotiated Rate	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25
Rate for Payer: UMR Bronson Commercial	$1.38

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	$4.50
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50
Rate for Payer: UMR Bronson Commercial	$2.76

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	$2.25
Rate for Payer: Aetna Medicare	$1.50
Rate for Payer: BCBS Complete	$1.20
Rate for Payer: Cash Price	$2.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$2.25
Rate for Payer: UMR Bronson Commercial	$1.38

PR ANES HEART TRANSPLANT/HEART/LUNG TRANSPLANT

Professional

Both

$20.00

Service Code	HCPCS 00580
Min. Negotiated Rate	$8.00
Max. Negotiated Rate	$15.00
Rate for Payer: Aetna Medicare	$10.00
Rate for Payer: BCBS Complete	$8.00
Rate for Payer: Cash Price	$16.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$15.00
Rate for Payer: UMR Bronson Commercial	$9.20

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	$3.75
Rate for Payer: Aetna Medicare	$2.50
Rate for Payer: BCBS Complete	$2.00
Rate for Payer: Cash Price	$4.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$3.75
Rate for Payer: UMR Bronson Commercial	$2.30

PR ANES HERNIA REPAIR LWR ABD VENTRAL&INCISIONAL

Professional

Both

$6.00

Service Code	HCPCS 00832
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50
Rate for Payer: UMR Bronson Commercial	$2.76

PR ANES HERNIA REPAIR UPPER ABDOMEN OMPHALOCELE

Professional

Both

$7.00

Service Code	HCPCS 00754
Min. Negotiated Rate	$2.80
Max. Negotiated Rate	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25
Rate for Payer: UMR Bronson Commercial	$3.22

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	$5.25
Rate for Payer: Aetna Medicare	$3.50
Rate for Payer: BCBS Complete	$2.80
Rate for Payer: Cash Price	$5.60
Rate for Payer: Opus (Opus Packaging Group) HMA	$5.25
Rate for Payer: UMR Bronson Commercial	$3.22

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

Professional

Both

$6.00

Service Code	HCPCS 00836
Min. Negotiated Rate	$2.40
Max. Negotiated Rate	$4.50
Rate for Payer: Aetna Medicare	$3.00
Rate for Payer: BCBS Complete	$2.40
Rate for Payer: Cash Price	$4.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$4.50
Rate for Payer: UMR Bronson Commercial	$2.76

Know your out-of-pocket cost for care.

All Charges