Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR ANES PX MALE GENITALIA VASECTOMY UNI/BI

Professional

Both

$3.00

Service Code	HCPCS 00921
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 MALE GENTIALIA RAD ORCHIECTOMY INGUN

Professional

Both

$4.00

Service Code	HCPCS 00926
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 NRV MUSC TDN FSCA&BRS UPR A&E TNOT OPEN

Professional

Both

$5.00

Service Code	HCPCS 01712
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 NRV/MUSC/TND/FASC LWR LEG ANKLE&FOOT NOS

Professional

Both

$3.00

Service Code	HCPCS 01470
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 ON EXTERNAL MIDDLE & INNER EAR W/BX NOS

Professional

Both

$5.00

Service Code	HCPCS 00120
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 ON NOSE&ACCESSORY SINUSES BX SOFT TISSUE

Professional

Both

$4.00

Service Code	HCPCS 00164
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 ON NOSE&ACCESSORY SINUSES RADICAL SURG

Professional

Both

$7.00

Service Code	HCPCS 00162
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 UPR ANT ABDL WALL PERCUTANEOUS LIVER BX

Professional

Both

$4.00

Service Code	HCPCS 00702
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 VEINS FOREARM WRIST&HAND PHLEBORRHAPHY

Professional

Both

$4.00

Service Code	HCPCS 01852
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 VEINS LOWER LEG VENOUS THRMBC DIR/W/CATH

Professional

Both

$5.00

Service Code	HCPCS 01522
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 VN KNE&POPLITEAL AREA ARTERIOVENOUS FSTL

Professional

Both

$6.00

Service Code	HCPCS 01432
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 RAD AMP PENIS W/BI INGUN&ILIAC LYMPHADEC

Professional

Both

$8.00

Service Code	HCPCS 00936
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 RADICAL PX TUMOR PELVIS XCP HINDQUARTER AMP

Professional

Both

$10.00

Service Code	HCPCS 01150
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 REPAIR RUPTURED ACHILLES TENDON W/WO GRAFT

Professional

Both

$5.00

Service Code	HCPCS 01472
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 SHOULDER CAST APPL REMOVAL/REPAIR NOS

Professional

Both

$3.00

Service Code	HCPCS 01680
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 ANESTH,ABORTION PROC

Professional

Both

$4.00

Service Code	HCPCS 01964
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 THER IVNTL RAD PX ARTERIAL ICR ICAR/AORTIC

Professional

Both

$8.00

Service Code	HCPCS 01926
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 THER IVNTL RAD PX ARTL CAROTID/CORONARY

Professional

Both

$7.00

Service Code	HCPCS 01925
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 THER IVNTL RAD VEN/LYMPHTC NTRHPTC/PRTL CRC

Professional

Both

$7.00

Service Code	HCPCS 01931
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 THER IVTNL PX VENOUS/LYMPHATIC SYS NOS

Professional

Both

$5.00

Service Code	HCPCS 01930
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 ANESTHESIA ACCESS CENTRAL VENOUS CIRCULATION

Professional

Both

$4.00

Service Code	HCPCS 00532
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 ANESTHESIA ALL CLOSED PROCEDURES KNEE JOINT

Professional

Both

$3.00

Service Code	HCPCS 01380
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 ANESTHESIA ALL CLOSED PROCEDURES LOWER 1/3 FEMUR

Professional

Both

$4.00

Service Code	HCPCS 01340
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 ANESTHESIA ALL CLOSED PX LOWER LEG ANKLE & FOOT

Professional

Both

$3.00

Service Code	HCPCS 01462
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 ANESTHESIA ALL OPEN PROCEDURES LOWER 1/3 FEMUR

Professional

Both

$5.00

Service Code	HCPCS 01360
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

Know your out-of-pocket cost for care.

All Charges