Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR ANES PX ART KNEE&POP EXC&GRF/RPR OCCLS/ANEURYSM

Professional

Both

$8.00

Service Code	HCPCS 01444
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 PX ART KNEE&POPLITEAL TEAEC W/WO PATCH GRF

Professional

Both

$8.00

Service Code	HCPCS 01442
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 PX ART LWR LEG W/BYP GRAFT EMBLC DIR/W/CATH

Professional

Both

$6.00

Service Code	HCPCS 01502
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 PX ART SHO&AX AXILLARY-BRACHIAL ANEURYSM

Professional

Both

$10.00

Service Code	HCPCS 01652
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 PX ART SHO&AX AXILLARY-FEMORAL BYPASS GRAFT

Professional

Both

$10.00

Service Code	HCPCS 01656
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 PX ART UPPER LEG W/BYPASS GRAFT FEM ART LIG

Professional

Both

$4.00

Service Code	HCPCS 01272
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 PX ART UPR LEG BYPASS GRAFT FEM ART EMBLC

Professional

Both

$6.00

Service Code	HCPCS 01274
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 PX CERVICAL SPINE & CORD W/PATIENT SITTING

Professional

Both

$13.00

Service Code	HCPCS 00604
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 PX ESOPH THYR LARX TRCH&LYMPH NCK NOS 1YR/>

Professional

Both

$6.00

Service Code	HCPCS 00320
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 PX EXTERNAL MIDDLE&INNER EAR W/BX OTOSCOPY

Professional

Both

$4.00

Service Code	HCPCS 00124
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 PX EXTERNAL MID&INNER EAR W/BX TYMPANOTOMY

Professional

Both

$4.00

Service Code	HCPCS 00126
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 PX FACIAL BONES/SKL RAD SURG W/PROGNATHISM

Professional

Both

$7.00

Service Code	HCPCS 00192
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 PX HRT PRCRD SAC&GREAT VSLS W/O PUMP OXTJ

Professional

Both

$15.00

Service Code	HCPCS 00560
Min. Negotiated Rate	$6.00
Max. Negotiated Rate	$11.25
Rate for Payer: Aetna Medicare	$7.50
Rate for Payer: BCBS Complete	$6.00
Rate for Payer: Cash Price	$12.00
Rate for Payer: Opus (Opus Packaging Group) HMA	$11.25
Rate for Payer: UMR Bronson Commercial	$6.90

PR ANES PX HRT PRCRD SAC&GREAT VSLS W/PUMP OXTJ<1YR

Professional

Both

$26.00

Service Code	HCPCS 00561
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 PX HRT PRCRD SAC&GRT VSL PMP OXT CRC ARREST

Professional

Both

$26.00

Service Code	HCPCS 00563
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 PX HRT PRCRD SAC&GRT VSL W/PMP OXT AGE 1YR+

Professional

Both

$20.00

Service Code	HCPCS 00562
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 PX INTEG SYS ELEC CONVERSION ARRHYTHMIAS

Professional

Both

$4.00

Service Code	HCPCS 00410
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 PX INTEG SYS XTR ANT TRUNK & PERINEUM NOS

Professional

Both

$3.00

Service Code	HCPCS 00400
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 PX LOWER ANT ABDOMINAL WALL PANNICULECTOMY

Professional

Both

$5.00

Service Code	HCPCS 00802
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 PX MAJ LOWER ABDOMINAL VESSELS IVC LIGATION

Professional

Both

$10.00

Service Code	HCPCS 00882
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 PX MALE GENITALIA COMPL AMPUTATION PENIS

Professional

Both

$4.00

Service Code	HCPCS 00932
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 PX MALE GENITALIA INSJ PENILE PROSTHESIS

Professional

Both

$4.00

Service Code	HCPCS 00938
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 PX MALE GENITALIA ORCHIOPEXY UNI/BI

Professional

Both

$4.00

Service Code	HCPCS 00930
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 PX MALE GENITALIA RAD ORCHIECTOMY ABDOMINAL

Professional

Both

$6.00

Service Code	HCPCS 00928
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 PX MALE GENITALIA UNDSCND TESTIS UNI/BI

Professional

Both

$4.00

Service Code	HCPCS 00924
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

Know your out-of-pocket cost for care.

All Charges