Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR ANES HRNA RPR UPR ABD LMBR&VNT HERNIA&/DEHSN

Professional

Both

$6.00

Service Code	HCPCS 00752
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 ICR PX CEREBROSPINAL FLUID SHUNTING PX

Professional

Both

$10.00

Service Code	HCPCS 00220
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50
Rate for Payer: UMR Bronson Commercial	$4.60

PR ANES ICR PX CRANIOTOMY/CRANIECTOMY HMTMA

Professional

Both

$10.00

Service Code	HCPCS 00211
Min. Negotiated Rate	$4.00
Max. Negotiated Rate	$7.50
Rate for Payer: Aetna Medicare	$5.00
Rate for Payer: BCBS Complete	$4.00
Rate for Payer: Cash Price	$8.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$7.50
Rate for Payer: UMR Bronson Commercial	$4.60

PR ANES ICR PX CRNOP/ELEVATION DEPRS SKULL FX XDRL

Professional

Both

$9.00

Service Code	HCPCS 00215
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$6.75
Rate for Payer: Aetna Medicare	$4.50
Rate for Payer: BCBS Complete	$3.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.75
Rate for Payer: UMR Bronson Commercial	$4.14

PR ANES INTEG SYS RAD/MODIFIED RAD BRST W/NODE DSJ

Professional

Both

$13.00

Service Code	HCPCS 00406
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna Medicare	$6.50
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.75
Rate for Payer: UMR Bronson Commercial	$5.98

PR ANES INTRACRANIAL PROCEDURE IN SITTING POSITION

Professional

Both

$13.00

Service Code	HCPCS 00218
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna Medicare	$6.50
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.75
Rate for Payer: UMR Bronson Commercial	$5.98

PR ANES INTRACRANIAL PX BURR HOLES W/VENTRG

Professional

Both

$9.00

Service Code	HCPCS 00214
Min. Negotiated Rate	$3.60
Max. Negotiated Rate	$6.75
Rate for Payer: Aetna Medicare	$4.50
Rate for Payer: BCBS Complete	$3.60
Rate for Payer: Cash Price	$7.20
Rate for Payer: Opus (Opus Packaging Group) HMA	$6.75
Rate for Payer: UMR Bronson Commercial	$4.14

PR ANES INTRACRANIAL PX ELECTROCOAGULATION ICR NRV

Professional

Both

$6.00

Service Code	HCPCS 00222
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 INTRAORAL PX W/BIOPSY REPAIR CLEFT PALATE

Professional

Both

$6.00

Service Code	HCPCS 00172
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 INTRAORAL PX W/BX EXC RETROPHARYNGEAL TUMOR

Professional

Both

$6.00

Service Code	HCPCS 00174
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 INTRAPERITONEAL UPPER ABDOMEN W/LAPS NOS

Professional

Both

$7.00

Service Code	HCPCS 00790
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 IPER PX LOWER ABDOMEN W/LAPS AMNIOCENTESIS

Professional

Both

$4.00

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

Professional

Both

$7.00

Service Code	HCPCS 00844
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 IPER PX LOWER ABD W/LAPS RAD HYSTERECTOMY

Professional

Both

$8.00

Service Code	HCPCS 00846
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 IPER PX LWR ABD W/LAPS PELVIC EXENTERATION

Professional

Both

$8.00

Service Code	HCPCS 00848
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 IPER PX LWR ABD W/LAPS TUBAL LIG/TRNSXJ

Professional

Both

$6.00

Service Code	HCPCS 00851
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 IPER UPR ABD GASTRIC RSTCV PX MO

Professional

Both

$11.00

Service Code	HCPCS 00797
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 IPER UPR ABD LIVER TRANSPLANT

Professional

Both

$31.00

Service Code	HCPCS 00796
Min. Negotiated Rate	$12.40
Max. Negotiated Rate	$23.25
Rate for Payer: Aetna Medicare	$15.50
Rate for Payer: BCBS Complete	$12.40
Rate for Payer: Cash Price	$24.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$23.25
Rate for Payer: UMR Bronson Commercial	$14.26

PR ANES IPER UPR ABD PARTIAL/TOTAL PANCREATECTOMY

Professional

Both

$8.00

Service Code	HCPCS 00794
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 IPER UPR ABD PRTL HPTC MGMT LIVER HEMRRG

Professional

Both

$13.00

Service Code	HCPCS 00792
Min. Negotiated Rate	$5.20
Max. Negotiated Rate	$9.75
Rate for Payer: Aetna Medicare	$6.50
Rate for Payer: BCBS Complete	$5.20
Rate for Payer: Cash Price	$10.40
Rate for Payer: Opus (Opus Packaging Group) HMA	$9.75
Rate for Payer: UMR Bronson Commercial	$5.98

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	$3.75
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 LITHOTRP XTRCORP SHOCK WAVE W/WATER BATH

Professional

Both

$7.00

Service Code	HCPCS 00872
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 LOWER LEG CAST APPLICATION REMOVAL/REPAIR

Professional

Both

$3.00

Service Code	HCPCS 01490
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 MALE GENT RAD AMP PENIS BI INGUN LYMPHADEC

Professional

Both

$6.00

Service Code	HCPCS 00934
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 MNPJ SPINE/CLSD PX CRV THRC/LUMBAR SPINE

Professional

Both

$3.00

Service Code	HCPCS 00640
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

Know your out-of-pocket cost for care.

All Charges