Bronson Methodist Hospital

All Charges

Charge

Type

Setting

Price

PR ANESTHESIA EXTERNAL CEPHALIC VERSION

Professional

Both

$5.00

Service Code	HCPCS 01958
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 EXTREME AGE PATIENT<1 YR&>70

Professional

Both

$101.00

Service Code	HCPCS 99100
Min. Negotiated Rate	$40.40
Max. Negotiated Rate	$75.75
Rate for Payer: Aetna Commercial	$52.00
Rate for Payer: Aetna Medicare	$50.50
Rate for Payer: Aetna New Business (MI Preferred)	$52.00
Rate for Payer: BCBS Complete	$40.40
Rate for Payer: Cash Price	$80.80
Rate for Payer: Cash Price	$80.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$75.75
Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network	$50.00
Rate for Payer: Priority Health SBD	$50.00
Rate for Payer: Priority Health Tiered Network	$50.00
Rate for Payer: UMR Bronson Commercial	$46.46

PR ANESTHESIA FOR ALL CLOSED PX INVOLVING HIP JOINT

Professional

Both

$4.00

Service Code	HCPCS 01200
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 FOR PX MAJOR VESSELS NECK NOS

Professional

Both

$10.00

Service Code	HCPCS 00350
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 ANESTHESIA FOR STERNAL DEBRIDEMENT

Professional

Both

$10.00

Service Code	HCPCS 00550
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 ANESTHESIA GASTROCNEMIUS RECESSION

Professional

Both

$5.00

Service Code	HCPCS 01474
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 HERNIA REPAIR LOWER ABDOMEN NOS

Professional

Both

$4.00

Service Code	HCPCS 00830
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 HERNIA REPAIR UPPER ABDOMEN NOS

Professional

Both

$4.00

Service Code	HCPCS 00750
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 INCOMPLETE/MISSED ABORTION PROCEDURES

Professional

Both

$4.00

Service Code	HCPCS 01965
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 INDUCED ABORTION PROCEDURES

Professional

Both

$4.00

Service Code	HCPCS 01966
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 INTERPELVIABDOMINAL AMPUTATION

Professional

Both

$15.00

Service Code	HCPCS 01140
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 ANESTHESIA INTRACRANIAL PROCEDURES NOS

Professional

Both

$11.00

Service Code	HCPCS 00210
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 ANESTHESIA INTRACRANIAL PROCEDURE SUBDURAL TAPS

Professional

Both

$5.00

Service Code	HCPCS 00212
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 INTRACRANIAL PX VASCULAR PROCEDURES

Professional

Both

$15.00

Service Code	HCPCS 00216
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 ANESTHESIA INTRAORAL PX W/BIOPSY RADICAL SURGERY

Professional

Both

$7.00

Service Code	HCPCS 00176
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 ANESTHESIA INTRAORAL PX WITH BIOPSY NOS

Professional

Both

$5.00

Service Code	HCPCS 00170
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 INTRAPERITONEAL PX LWR ABD W/LAPS NOS

Professional

Both

$6.00

Service Code	HCPCS 00840
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 ANESTHESIA LOWER INTST ENDOSCOPIC PX NOS

Professional

Both

$1.00

Service Code	HCPCS 00811
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.75
Rate for Payer: Aetna Medicare	$0.50
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: Cash Price	$0.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.75
Rate for Payer: UMR Bronson Commercial	$0.46

PR ANESTHESIA LOWER INTST ENDOSCOPIC PX SCR COLSC

Professional

Both

$1.00

Service Code	HCPCS 00812
Min. Negotiated Rate	$0.40
Max. Negotiated Rate	$0.75
Rate for Payer: Aetna Medicare	$0.50
Rate for Payer: BCBS Complete	$0.40
Rate for Payer: Cash Price	$0.80
Rate for Payer: Opus (Opus Packaging Group) HMA	$0.75
Rate for Payer: UMR Bronson Commercial	$0.46

PR ANESTHESIA MAJOR VESSELS NECK SIMPLE LIGATION

Professional

Both

$5.00

Service Code	HCPCS 00352
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 OPEN PROCEDURES HIP JOINT NOS

Professional

Both

$6.00

Service Code	HCPCS 01210
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 ANESTHESIA OPEN PROCEDURES UPPER 2/3 FEMUR NOS

Professional

Both

$6.00

Service Code	HCPCS 01230
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 ANESTHESIA OPEN PX HIP JOINT HIP DISARTICULATION

Professional

Both

$10.00

Service Code	HCPCS 01212
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 ANESTHESIA OPEN PX REVISION TOT HIP ARTHROPLASTY

Professional

Both

$10.00

Service Code	HCPCS 01215
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 ANESTHESIA OPEN PX TOTAL ANKLE REPLACEMENT

Professional

Both

$7.00

Service Code	HCPCS 01486
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

Know your out-of-pocket cost for care.

All Charges